Transsexual Analysis: 11. Overview and summary

Transsexual Analysis

Nature vs nurture: humans are diverse  |   Diversity in society  |   Woman in a man's body?  |   Trauma can shape us  |   Emasculation trauma

Trauma as a turn-on?  |   Perversion or lifestyle choice?  |   How to treat?  |   Superficiality  |   Problems and reversion  |   In summary

11. Overview and summary


To answer the questions posed earlier:

The most likely answer to these questions needs to be made in two parts, for each of the types.

Emasculation trauma, which very likely has a large bearing on autogynephilic behavior, can affect young males who may be extremely feminine mentally and/or emotionally (as per standard human diversity).

In the case of homosexual/androphilic transsexuals, it would be fair to say that the very most feminine examples of these people make the change because it was impossible for them to find any male role in which they did not feel inadequate or ridiculous. After much rejection they essentially change over in order to gain greater social acceptance as human beings.

The main danger for such individuals is that male development can occur even up to age 20 or so, and some very small and unmasculine youths, without hormonal intervention, may eventually grow tall and bulk up. In a more tolerant social environment, these people may find more acceptance as gay males than in the past, although their choice of partners will tend to be limited by the strong emphasis in the gay community towards classic masculine physical beauty.

Hyper-feminine boys can experience problems described by both homosexual and autogynephilic transsexuals (to use Dr Blanchard's terminology). Parental denial may lead such children to deny their basic natures leading to internal pressures. In the face of both internal and external assaults such individuals may present with considerable psychopathology.

Ultimately, the existence of an autogynephilic or transvestic history should be no bar to a sex change applicant being given the go-ahead for a sex change. The bottom line must always be a decided on the basis of whether transition will improve the patient's wellbeing and functioning in society.

Some males who are quite masculine by nature can also experience emasculation trauma (with subsequent autogynephilic feelings), believing themselves unable to live up to the model of masculinity they encountered as children - due to their social environment and/or traumatic/sensitizing events.

It has been reported that up to 90% of males who ask their doctors for treatment for gender identity order (GID), at some stage change their minds and discontinue treatment. It would be safe to say that most of these would be reasonably masculine autogynephilic males who find the female role uncomfortable or difficult to fulfil.

Cognitive treatment for GID should include a focus on that sense of childhood emasculation, that is, the reasons why the patient seeks a sex change, as opposed to being a gay man or crossdresser.

The aim in treatment should not be changing the person's mind so much as raising self-awareness and helping to explore feelings.

If this exploration leads to a change of heart, then such self-knowledge may help the patient find a life path more suited to him/her. If the patient wishes to continue treatment s/he will at least have a better understanding of his/her needs and desires and perhaps be motivated to work towards less dependence on cross-gender behavior for happiness. Whatever, once people "face their demons", they are in a better position to make informed decisions.

Due to stigma, false morality, ignorance, and a failure to understand risk management principles, there is a widely-held belief that sex changes are wrong per se, and that therapists should try to talk gender reassignment applicants out of making the change. Some some therapists do, in fact, take a watered-down version of this approach, only recommending patients for surgery if they determinedly resist this subtle coercion and succeed in the 2-year real life test.

This win-or-lose "gatekeeper" approach only serves to undermine meaningful treatment of any underlying problems. It may at times raise competitive or rebellious instincts in sex change applicants, who are already oversensitized to judgmental attitudes, almost encouraging them to "prove the therapist wrong".

Many observers believe that transsexualism should be avoided at all costs and that therapy should be targeted towards either diverting androphilic types towards life as gay men and more masculine "heterosexual" autogynephilic types to recognize and embrace their masculinity. Given the issue of emasculation trauma, the only possible "cure" for transsexualism would be the complete removal of stigmas in relation to sexuality and differentiated social gender expression.

While these may be laudable goals, unfortunately they are not achievable in the short, or even the medium term, if at all. It is therefore unrealistic and cruel to expect transsexuals to offer themselves to be sacrificed on the altar of ideology. Given that transsexuals comprise of at most 0.01% of the population, their role in changing the gender consciousness of the public at large is minimal.

There is a common view that the human body is sacred and that cosmetic surgical changes to it are wrong, immoral or tragic. When emotive words like "mutilation", "false" and "fake" are used to describe surgical changes to a person's body, this indicates that the speaker/writer subscribes to this "body is sacred" viewpoint.

An alternative viewpoint would be that our psyches and social roles are more "sacred" than our bodies, which are essentially carriages with which to do the bidding of our minds and emotions. For many gender reassignment applicants, their cross-gender needs are so ingrained from such an early age that is easier to, as Dr Harry Benjamin once put it, "to change the body to fit the mind".

There is no tragedy in a person choosing to modify his or her body surgically if it relieves psychological, emotional or existential problems and allows him or her to "get on with life" and move onto more productive activities rather than wasting it agonizing over gender, or other distracting, issues.

Finally, it should be said that changing sex is such an extraordinarily difficult enterprise that those who successfully traverse its many pitfalls and hardships, and end up relatively unscathed, may well be endowed with some extraordinary personal qualities for having survived the experience. It could even be said one needs to possess some extraordinary qualities to survive the experience intact.

Chapter summaries

Chapter 1 - Nature vs nurture: humans are diverse

Chapter 2 - Diversity in society

Chapter 3 - A woman trapped within a man's body or autogynephilia?

Chapter 4 - Trauma can shape us

Chapter 5 - Emasculation trauma and autogynephilia

Chapter 6 - Trauma and sexuality

Chapter 7 - Perversion or lifestyle choice?

Chapter 8 - How to treat transsexuals?

Chapter 10 - Problems and reversion

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