Transsexual/Transgender
Let’s start right at the beginning of a person’s life as this is where
all things start off, it’s when everything is created and set, and we have to
live with what we receive it’s a case of the good, bad and the ugly… you don’t
get a choice in all of this it just happens.
I have spent many hours researching the information below, to be in a position to actually put out the information I believe to be correct within the current understanding of transgenderism in 2016. These are of course mine and other peoples research and all credit to the people who undertook the detailed studies and research, I'm not trying to pass all of this information as my own so please don't think that I am...
All human foetuses start off in a female configuration, and in the
absence of biochemical instructions to the contrary, will develop into baby
girls --- irrespective of their chromosomal sex. This 'female by
default' development is overridden in normal male foetuses by a complex
sequence of hormonal processes.
It starts about six weeks after conception,
when the SRY gene on the Y chromosome causes a weak male hormone precursor to
be secreted. This causes the foetal gonads to differentiate into testes instead
of ovaries. Some weeks later, the primitive testes start working, and secrete a
large dose of testosterone (the principal male hormone), which causes the
foetal brain to differentiate into the male pattern. It is at this point that
the brain structure responsible for gender identity, as well as all the other
well-known (and measurable) brain differences between men and women, is laid
down.
Transsexualism is caused by that second burst of hormones failing to
happen, or only happening very weakly (many male-to-female transsexuals do
exhibit some masculine mental tendencies, but retain the feminine gender
identity, suggesting that the masculinisation of the brain went part of the way
and then failed).
In the case of the most extreme primary transsexuals, with no
detectable brain masculinisation at all, the second hormone surge is probably
entirely absent. There are a number of possible reasons for this failure; in
some cases, the genitals do not develop normally, and therefore do not manage
to secrete testosterone on schedule to alter the brain. This is likely to
produce a certain degree of physical intersex in the infant as well as
transsexualism. Most transsexuals, however, are not obviously intersexed, so
subtler causes must be involved.
Overall, I think the condition seems to have three possible causes there could be more but I have singled out the three most common thinking by the people who know this stuff:
1. Chromosomes: by no
means the only cause, but the easiest possibility to identify. As many as 1 in
400 of the population have a karyotype other than XX (standard female) or XY
(standard male), some of the other combinations can give rise to a variety of
conditions including transsexualism and intersex. A few, but by no means all,
transsexuals have a non-standard karyotype, leading to hormonal 'confusion'
during foetal development.
2. Chemicals: some drugs
that were administered to pregnant women (most notoriously
diethylstilboestrol), or oral contraceptives unknowingly taken after
conception, frequently caused transsexual offspring by disrupting the hormone
processes. There is also increasing evidence that some pollutants can have the
same effect --- many man-made chemicals are known to mimic oestrogen and/or
disrupt androgen receptors; especially substances like polychlorobiphenyls and
dibenzodioxins, which were very widespread in the 1950's and 1960's, before
their hazardous nature was realised and they were banned. Polychlorobiphenyls
were even used as ingredients in makeup in those days --- many women were
exposed to dangerously high levels of these chemicals.
3. Random events:
sometimes, the biochemistry simply fails to work properly --- things just go
wrong for no very clear reason. Perhaps the expectant mother is anaemic or the
foetus is undernourished for some reason, or maybe maternal hormones cross the
placenta in sufficient quantity to disrupt foetal development (progesterone in
particular is very good at blocking the action of testosterone). The process by
which a fertilised ovum develops into a complete baby human is so unimaginably
complex that there is an almost unlimited number of things that could go wrong.
Some other causes have been suggested in the past, but have by and large
been discredited. In particular, all variants of the 'nurture' explanation
(which suggests that the infant was subject to a 'wrong-gender' upbringing ---
perhaps the parents really wanted a girl, not a boy) can be discounted, now it
is known that male-to-female transsexuals have physiologically female brains
--- after all, neither upbringing nor cultural influences can change the pre-natal
wiring of one's brain.
Once the relevant stage of pregnancy has passed, there is no way that
the foetus's brain-sex (and hence gender) can be altered: postnatally, hormones
can alter the body, but the brain remains forever as it was born.
This is why
it is impossible to change a transsexual's gender to match their natal sex. I did ask the specialists I saw at the NHS Gender Identity Clinic this question and their answer was of course just the same as above. "You don't get to turn the clock back" was one reply that I felt comfortable with, as its totally true isn't it.
It
may seem strange to some out there to change someone's body-sex to match their gender, but it is
the only treatment possible, as the brain cannot be altered to match the natal
physiological sex. So gender reassignment ('sex-change') is the only successful
way of treating transsexuals.
There are a number of ways in which transsexuals deal with their
condition, and many transsexuals will pass through several of these as 'stages'
on their journey to self-fulfilment.
Denial
This is not a way of dealing with being transsexual, but is something
that all transsexuals probably go through at some stage. Trying to convince
themselves that they are not really transsexual, or will grow out of it, or
'ignoring it and seeing if it goes away', all characterise the denial phase.
Denial does not usually work for too long, and there is considerable evidence
that transsexuals who fail to escape this stage frequently commit suicide.
Figures suggest that as many as forty one percent of transsexuals that are not
diagnosed and treated soon enough to prevent them from taking their own lives. This is a stage that some can spend years in being totally unhappy and confused at their feelings and actions. I know sometimes life overtakes you and you end up in a vicious circle of denial, hiding behind psychological masks that allow you to function partly day to day. Finally it all becomes too much and like a house of cards it all comes tumbling down around you and the situation has to be addressed.
No Action
A few transsexuals come to a realisation of what they are, but
consciously choose to live with the discomfort of an inappropriate body and
gender role, perhaps because of religious beliefs or perhaps for the sake of
wife or children. In a few cases, transsexuals may live in a way more
reminiscent of transvestites, only expressing their true gender on agreed
occasions. This type of adaptation is nearly always found to be unsatisfactory
for the true transsexual, and similar problems to those of the Denial phase
then occur. Leaving family to wonder why they didn’t discuss it with them more,
in 2016 most people are in fact able to understand a close family member
informing them they are transsexual, it tends to be fear of being rejected and
ridiculed for telling everybody who they really are that holds people back from coming out.
Social Reassignment
For many transsexuals, the most pressing need is the need to alter their
gender role and to live in accordance with their gender identity. This means,
for a male-to-female transsexual, living completely as a woman. This is
usually, but not always, done as a step in a journey leading to hormonal and
surgical gender reassignment, but some people choose to stop here (and usually
label themselves as 'transgenderists'), or maybe even to live a 'mixed-gender'
lifestyle --- a few people with Gender Dysphoria feel that they are neither
truly male nor truly female.
For male-to-female transsexuals, permanent removal of facial hair by
electrolysis is usually a necessary step, and is usually done before, or just
after, social reassignment. It is time-consuming, expensive and painful: two
years of treatment at two or three hours per week is often required, at a cost
that can often exceed £25-£30 per hour. Many people find the pain barely tolerable,
even with a local anaesthetic. It is normally impossible to obtain electrolysis
from the NHS, so the transsexual must pay for private treatment.
Hormonal Reassignment via GIC
Most transsexuals undertake hormone treatment to bring their body shape
and appearance into closer accord with their gender identity. Hormone treatment
may start before or after social reassignment: a few transsexuals can 'pass' in
their new social role without hormone treatment, many may require some months
of treatment before undertaking social reassignment. In Britain, hormones can
only be prescribed by a consultant psychiatrist as part of a gender
reassignment programme, this normally takes place in a Gender Identity Clinic
(GIC) the specialists at the current seven UK clinics are known as the services
GateKeepers
Gate keeps safety check
The initial hormone treatment is largely reversible if stopped early,
and this is often used as a gate keeper safety check to prevent people who are
not truly transsexual (such as confused transvestites who convince themselves
that they are transsexual) from taking a disastrous course of action. Since
transvestites have male brain structure and core identity, and their behaviour
is mediated by male sex hormones, their cross-dressing behaviour stops when
female hormones are administered.
This effect is used to 'weed out' people who
are not true transsexuals: a true transsexual will feel natural and happy under
the effects of female hormones, anyone else will feel wrong and will stop their
apparent cross-gender behavior as male hormone function ceases. The reasons of
being given cross sex hormones is there for a double edged sword.
Large doses of hormones are used to overcome the body's own sex
hormones, which carry some risk of side effects that need to be monitored every
3 months while being prescribed hormones After genital surgery, the dosage is
greatly reduced as the body no longer produces hormones in opposition to the
prescribed ones, but a post-operative transsexual will need to take a
maintenance dose of hormones for life.
Some transsexuals continue in a pre-operative state for long periods,
taking hormones and living in their preferred gender role, but perhaps never
having surgery. There is evidence that continuing the high hormone dosages
required for pre-op transsexuals for long periods may be harmful.
Male-to-female hormone treatment causes development of breasts, usually
rather small, as well as redistribution of body fat and a general feminisation
of the figure, hair and skin. Body hair is often reduced but not removed, and
hormones seldom have any large effect on facial hair. Hormones will not alter a
male voice (nor will genital surgery), so male-to-female transsexuals must
usually undertake some kind of speech training, learning to raise and soften
the voice as well as using more feminine inflection and vocabulary.
Surgical Reassignment
This is seen by some as the entire purpose of the long process of gender
reassignment, while others feel that it is more of a final step to achieve
congruity of body and mind after the really hard work of establishing a life in
the proper gender role has been done.
The process, for male-to-female transsexuals, involves removal of the
male genitals and the construction of a set of female genitals (excluding
uterus and ovaries, of course) using material from the male genitals. Present
state-of-the-art surgical technique produces a very good approximation to
natural female genitals (even gynaecologists have been known not to realise
that a patient is a post-op transsexual), with fairly good nervous sensation,
although of course it is dependent on the skill of the surgeon.
The operation is a major surgical procedure (requiring about ten days in
hospital, and four hours or more under anesthetic), is quite painful and
invariably expensive. Many transsexuals in Britain opt for private treatment as
it has become very difficult, and impossible in many areas, to obtain NHS
treatment and the waiting lists are very long.
No reputable surgeon will perform surgical reassignment without
recommendations from two psychiatrists.
Under the NHS England clinical guidance it is normally impossible to
obtain permission for surgery without performing what is known as the 'Real
Life Test' where a person has to be living and working as a woman for at least
one year but most specialist’s insist on a minimum of two years real life test
before surgery is considered. However, to undergo NHS surgery you have to meet
some very stringent conditions laid down pre surgery, this alone is enough to
inhibit the surgery from happening as planned. Failure to meet these conditions
has meant some males who attend their pre surgery appointment have been turned
down and sent to the back of the waiting list as they didn’t meet all of the
criteria at the time of the pre-op, this alone is enough to make most think of
surgery overseas.
But ensuring you meet the required targets laid down by the
gate keepers and the surgeons you are guaranteed quality NHS care, overseas
this might not be the case and all care has to be paid for by the patient
including complications etc.
