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Transsexual people experience a gender identity that is inconsistent with their assigned sex and desire to permanently transition to the sex or gender with which they identify, usually seeking medical assistance including sex reassignment therapies , such as hormone replacement therapy and sex reassignment surgery to help them align their body with their identified sex or gender.

Transsexual is a subset of transgender , [1] [2] [3] but some transsexual people reject the label of transgender. Norman Haire reported that in [10] Dora R of Germany began a surgical transition, under the care of Magnus Hirschfeld , which ended in with a successful genital reassignment surgery.

In , Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal, that of Lili Elbe of Denmark.

In , Hirschfeld introduced the German term "Transsexualismus", [11] after which David Oliver Cauldwell introduced "transsexualism" and "transsexual" to English in and Cauldwell appears to be the first to use the term to refer to those who desired a change of physiological sex.

True transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such.

For them, their sex organs, the primary testes as well as the secondary penis and others are disgusting deformities that must be changed by the surgeon's knife.

Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation.

Beyond Benjamin's work, which focused on male-to-female transsexual people, there are cases of the female to male transsexual, for whom genital surgery may not be practical.

Benjamin gave certifying letters to his MTF transsexual patients that stated "Their anatomical sex, that is to say, the body, is male.

Their psychological sex, that is to say, the mind, is female. Around the same time as Benjamin's book, in , the term transgender was coined by John Oliven.

Historically, one reason some people preferred transsexual to transgender is that the medical community in the s through the s encouraged a distinction between the terms that would only allow the former access to medical treatment.

Another reason for objecting to the term transsexual is the concern that it implies something to do with sexuality , when it is actually about gender identity.

Like other trans people, transsexual people prefer to be referred to by the gender pronouns and terms associated with their gender identity. For example, a trans man is a person who was assigned the female sex at birth on the basis of his genitals , but despite that assignment, identifies as a man and is transitioning or has transitioned to a male gender role; in the case of a transsexual man, he furthermore has or will have a masculine body.

Individuals who have undergone and completed sex reassignment surgery are sometimes referred to as transsexed individuals; [32] however, the term transsexed is not to be confused with the term transsexual , which can also refer to individuals who have not yet undergone SRS, and whose anatomical sex still does not match their psychological sense of personal gender identity.

The terms gender dysphoria and gender identity disorder were not used until the s, [24] when Laub and Fisk published several works on transsexualism using these terms.

Male-to-female transsexualism has sometimes been called "Harry Benjamin's syndrome" after the endocrinologist who pioneered the study of dysphoria.

Since the middle of the 20th century, homosexual transsexual and related terms were used to label individuals' sexual orientation based on their birth sex.

Michael Bailey , and Martin Lalumiere , who she says "have completely failed to appreciate the implications of alternative ways of framing sexual orientation.

The terms androphilia and gynephilia to describe a person's sexual orientation without reference to their gender identity were proposed and popularized by psychologist Ron Langevin in the s.

Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their birth assigned sex.

Several terms are in common use, especially within the community itself relating to the surgical or operative status of someone who is transsexual, depending on whether they have already had sex reassignment surgery SRS , have not had SRS but still intend to, or do not intend to have SRS.

They are, post-op, pre-op, and non-op, respectively. A pre-operative transsexual person, or simply pre-op for short, is someone who intends to have SRS at some point, but has not yet had it.

A post-operative transsexual person, or post-op for short, is someone who has had SRS. A non-operative transsexual person, or non-op , is someone who has not had SRS, and does not intend to have it in the future.

There can be various reasons for this, from personal to financial. The World Professional Association for Transgender Health WPATH and many transsexual people had recommended this removal, [49] arguing that at least some mental health professionals are being insensitive by labelling transsexualism as a "disease" rather than as an inborn trait, as many transsexuals believe it to be.

The previous version, ICD, had incorporated transsexualism , dual role transvestism, and gender identity disorder of childhood into its gender identity disorder category.

It defined transsexualism as "[a] desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex.

With the DSM-5 , transsexualism was removed as a diagnosis, and a diagnosis of gender dysphoria was created in its place. The current diagnosis for transsexual people who present themselves for medical treatment is gender dysphoria leaving out those who have sexual identity disorders without gender concerns.

Twin studies suggest that there are likely genetic causes of transsexuality, although the precise genes involved are not fully understood.

Ray Blanchard created a taxonomy of male-to-female transsexualism that proposes two distinct etiologies for androphilic and gynephilic individuals that has become controversial, supported by J.

Sex reassignment therapy SRT is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersex people.

Individuals make different choices regarding sex reassignment therapy, which may include female-to-male or male-to-female hormone replacement therapy HRT to modify secondary sex characteristics , sex reassignment surgery such as orchiectomy to alter primary sex characteristics , chest surgery such as top surgery or breast augmentation , or, in the case of trans women, a trachea shave , facial feminization surgery or permanent hair removal.

To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care SOC as published by the World Professional Association for Transgender Health.

The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations.

After an initial psychological evaluation, trans men and trans women may begin medical treatment, starting with hormone replacement therapy [55] [58] or hormone blockers.

In these cases, people who change their gender are usually required to live as members of their target gender for at least one year prior to genital surgery, gaining real-life experience , which is sometimes called the "real-life test" RLT.

Some people posit that transsexualism is a physical condition, not a psychological issue, and assert that sex reassignment therapy should be given on request.

Brown Like other trans people, transsexual people may refer to themselves as trans men or trans women. Transsexual people desire to establish a permanent gender role as a member of the gender with which they identify, and many transsexual people pursue medical interventions as part of the process of expressing their gender.

The entire process of switching from one physical sex and social gender presentation to another is often referred to as transitioning, and usually takes several years.

Transsexual people who transition usually change their social gender roles, legal names and legal sex designation.

Not all transsexual people undergo a physical transition. Some find reasons not to; for example, the expense of surgery, the risk of medical complications, or medical conditions which make the use of hormones or surgery dangerous.

Some may not identify strongly with another binary gender role. Others may find balance at a midpoint during the process, regardless of whether or not they are binary-identified.

Many transsexual people, including binary-identified transsexual people, do not undergo genital surgery, because they are comfortable with their own genitals, or because they are concerned about nerve damage and the potential loss of sexual pleasure, including orgasm.

This is especially so in the case of trans men, many of whom are dissatisfied with the current state of phalloplasty , which is typically very expensive, not covered by health insurance, and commonly does not achieve desired results.

For example, not only does phalloplasty not result in a completely natural erection, it may not allow for an erection at all, and its results commonly lack penile sexual sensitivity; in other cases, however, phalloplasty results are satisfying for trans men.

By contrast, metoidioplasty , which is more popular, is significantly less expensive and has far better sexual results.

Transsexual people can be heterosexual, gay, lesbian, or bisexual; many choose the language of how they refer to their sexual orientation based on their gender identity, not their birth assigned sex.

Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex are typically ineffective.

The widely recognized Standards of Care [55] note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.

The need for treatment of transsexual people is emphasized by the high rate of mental health problems, including depression , anxiety , and various addictions , as well as a higher suicide rate among untreated transsexual people than in the general population.

Many transgender and transsexual activists, and many caregivers, note that these problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-variant individuals.

Some transsexual people reject the counseling that is recommended by the Standards of Care [55] because they do not consider their gender identity to be a cause of psychological problems.

Because of this, some transsexual people feel coerced into affirming outdated concepts of gender to overcome simple legal and medical hurdles Brown People who undergo sex reassignment surgery can develop regret for the procedure later in life, largely due to lack of support from family or peers, with data from the s suggesting a rate of 3.

A meta-study, based on 28 previous long-term studies of transsexual men and women, found that the overall psychological functioning of transsexual people after transition was similar to that of the general population and significantly better than that of untreated transsexual people.

Prevalence is the proportion of a population found to be affected by a condition. It is usually expressed as a fraction, a percentage, or as the number of cases per 10, or , people.

Incidence is a measure of new cases arising in a population over a given period per year, etc. The difference between prevalence and incidence in this context can be summarized thus: prevalence answers "How many people are transsexual right now?

A study of Swedes estimated an incidence of transsexualism of 0. Estimates of the prevalence of transsexual people are highly dependent on the specific case definitions used in the studies, with prevalence rates varying by orders of magnitude.

Olyslager and Conway presented a paper [75] at the WPATH 20th International Symposium arguing that the data from their own and other studies actually imply much higher prevalence, with minimum lower bounds of , male-to-female transsexual people and , female-to-male transsexual people for a number of countries worldwide.

They estimate the number of post-op women in the US to be 32, and obtain a figure of male-to-female transsexual people. They further compare the annual incidences of sex reassignment surgery SRS and male birth in the U.

Olyslager and Conway also argue that the US population of assigned males having already undergone reassignment surgery by the top three US SRS surgeons alone is enough to account for the entire transsexual population implied by the , prevalence number, yet this excludes all other US SRS surgeons, surgeons in countries such as Thailand, Canada, and others, and the high proportion of transsexual people who have not yet sought treatment, suggesting that a prevalence of , is too low.

A study of the number of New Zealand passport holders who changed the sex on their passport estimated that , birth-assigned males and , birth-assigned females were transsexual.

Though no direct studies on the prevalence of gender identity disorder GID have been done, a variety of clinical papers published in the past 20 years provide estimates ranging from , to , in assigned males and , to , in assigned females.

A systematic review and meta-analysis of "how various definitions of transgender affect prevalence estimates" in 27 studies found a meta-prevalence mP estimates per , population of 9.

A number of Native American and First Nations cultures have traditional social and ceremonial roles for individuals who do not fit into the usual roles for males and females in that culture.

These roles can vary widely between tribes, because gender roles, when they exist at all, also vary considerably among different Native cultures. Laws regarding changes to the legal status of transsexual people are different from country to country.

Some jurisdictions allow an individual to change their name , and sometimes, their legal gender, to reflect their gender identity. Within the US, some states allow amendments or complete replacement of the original birth certificates.

In many places, it is not possible to change birth records or other legal designations of sex, although changes are occurring. Medical treatment for transsexual and transgender people is available in most Western countries.

However, transsexual and transgender people challenge the "normative" gender roles of many cultures and often face considerable hatred and prejudice.

The film Boys Don't Cry chronicles the case of Brandon Teena , a transsexual man who was raped and murdered after his status was discovered. The project Remembering Our Dead , founded by Gwendolyn Ann Smith, archives numerous cases of transsexual and transgender people being murdered.

Jurisdictions allowing changes to birth records generally allow trans people to marry members of the opposite sex to their gender identity and to adopt children.

Jurisdictions which prohibit same sex marriage often require pre-transition marriages to be ended before they will issue an amended birth certificate.

Health-practitioner manuals, professional journalistic style guides , and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender or transsexual person's past.

Sometimes transsexual people have to correct their friends and family members many times before they begin to use the transsexual person's desired pronouns consistently.

According to Julia Serano , deliberate mis-gendering of transsexual people is "an arrogant attempt to belittle and humiliate trans people" [91].

Both "transsexualism" and "gender identity disorders not resulting from physical impairments" are specifically excluded from coverage under the Americans with Disabilities Act Section Openly transsexual people can have difficulty maintaining employment.

Most find it necessary to remain employed during transition in order to cover the costs of living and transition.

However, employment discrimination against trans people is rampant and many of them are fired when they come out or are involuntarily outed at work.

Other stresses that transsexual people face in the workplace are being fearful of coworkers negatively responding to their transition, and losing job experience under a previous name—even deciding which rest room to use can prove challenging.

Laws regarding name and gender changes in many countries make it difficult for transsexual people to conceal their trans status from their employers.

In many countries, laws provide protection from workplace discrimination based on gender identity or gender expression, including masculine women and feminine men.

An increasing number of companies are including "gender identity and expression" in their non-discrimination policies. California 's anti-discrimination laws protect transsexual persons in the workplace and specifically prohibit employers from terminating or refusing to hire a person based on their transsexuality.

Many transsexual men and women choose to live completely as members of their gender without disclosing details of their birth-assigned sex.

This approach is sometimes called stealth. Transsexualism was discussed in the mass media as long ago as the s.

The American magazine Time in devoted an article to what it called " hermaphrodites ", treating the subject with sensitivity and not sensationalism.

Christine Jorgensen was a transgender woman who received considerable attention in American mass media in the s.

Jorgensen was a former G. Her story appeared in publications including Time and Newsweek. Other representations of transgender women appeared in mainstream media in the s and s, such as Delisa Newton , Charlotte McLeod, Tamara Rees, and Marta Olmos Ramiro, but Jorgensen received the most attention.

Her story was sensationalized, but received positively. Before transsexual people were depicted in popular movies and television shows, Aleshia Brevard —a transsexual whose surgery took place in [] : 3 —was actively working as an actress [] : and model [] : in Hollywood and New York throughout the s and '70s.

Aleshia never portrayed a transsexual person, though she appeared in eight Hollywood-produced films, on most of the popular variety shows of the day, including The Dean Martin Show , and was a regular on The Red Skelton Show and One Life to Live before returning to university to teach drama and acting.

Thomas Harris 's Silence of the Lambs included a serial killer who considered himself a transsexual. After being turned down for sex reassignment surgery due to not meeting necessary psychological evaluations, he then harvested female bodies to make a feminine suit.

In the novel, it is noted that the character is not actually a transsexual; this distinction is made only briefly in the film.

The film Different for Girls is notable for its depiction of a transsexual woman who meets up with, and forms a romantic relationship with, her former best friend from her all-male boarding school.

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