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Transsexual or Transgender?

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The correct terminology for referring to those who have been medically diagnosed as Transsexual seems to be in a state of confusion. This article will ensure that those who are experiencing an influx of conflicting information have a sound basis to enable them to ensure that the correct terminology is used. The word Transgender is often preferred by Transsexuals as their condition has nothing to do with sexual preference but everything to do with crossing the gender divide. It is however causing confusion as some Transvestites are claiming this definition as a blanket cover for their cross dressing preferences. In some documentation referring to Transsexual or Transgender persons the definition is implied that the terms are for male to female persons only whereas the definition includes both male to female and female to male. The FtM (Female to Male) network has twice as many members as the Gender Trust (Male to Female) which could indicate that there are equal numbers of each, if not more F t M Transsexuals. The first well documented gender reassignment was on a female to male, it was carried out in the United Kingdom. Testosterone treatment started in the 1930s with GRS in 1945.

There are two main diagnostic systems in operation for Transsexualism; they are the World Health Organisation International Classification of Disorders, Geneva: WHO. The other is the American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Washington: APA.

The diagnosis of Transsexualism is confirmed when Gender Dysphoria has been present for at least two years and has been alleviated by cross-gender identification.

Dr. Harry Benjamine introduced the syndrome to the general medical community in the early 1950s and advocated the compassionate treatment of it. Since then much research has been conducted into the potential causality of GID. Recent studies of the hypothalamus gland support the hypothesis that gender identity stems from an interaction between the developing brain and the hormones that determine gender. This happens during the second month of foetal development, thus a transsexual is born with this medical condition.

Correct definitions are;

Gender Identity Disorder: A condition in which the psychological experience of oneself as male or female is incongruent with the external sexual characteristics of one’s body.

Gender Dysphoria: The personal experience of Gender Identity Disorder.

Gender Identity: The sense of belonging to a particular sex.

Trans man: An individual who was born with a female phenotype, who is seeking to undergo or in the process of undergoing ‘transition’ from female to male.

Trans woman: An individual who was born with a male phenotype, who is seeking to undergo or is undergoing ’transition’ from male to female.

Transsexual: A person confirmed as having GID in which there is strong and ongoing cross gender identification and a desire to live and be accepted as a member of the opposite gender. There is persistent discomfort with his or her anatomical sex and a sense of inappropriateness in the gender role of that sex.

Transgender: A person who has the need to change their whole being into a single identity. This definition includes Male to Female and Female to Male Transsexuals as well as those with Intersex conditions.

Transvestite: A man who dresses as a woman but has no desire to become a woman. The main thing to remember is that Transvestism is not about gender, it is a lifestyle choice.

Gender Reassignment Surgery

          For male to female Transsexuals:

          Vaginoplasty (construction of a vagina)
          Penectomy (removal of penis)
          Orchidectomy (removal of testes)
          Clitoroplasty (construction of a clitoris)

For female to male Transsexuals:

          Hysterectomy & Oophorectomy (removal of uterus and ovaries)
          Phalloplasty (construction of a penis)
          Bilateral mastectomy (breast removal)

Other or additional treatment may be used. In all cases the treatment provided will depend on individual needs and the funding at their disposal.

The invention of the terms ‘primary’ and ‘secondary’ Transsexuals have been brought into existence by uninformed persons who seem to be trying to find a formula to differentiate between individual timescales in transitioning. If there is a need to differentiate the criteria should be aimed at those who have made their condition known before puberty and those who are post puberty. The Gender Identity Clinic within the Tavistock clinic is currently carrying out important assessment work of Gender Dysphoria in childhood and adolescence.

The current position of the medical profession in this country is that even if a child has been diagnosed at a young age they will not be treated until they are sixteen. This means that they have to go through the painful experience of puberty. It is at this time that a good many transgender persons start to self harm. It is a vain attempt to stop puberty turning their bodies into the adult that they are trying not to become. In Vienna a child of twelve was prescribed treatment which has artificially arrested male puberty before the administration of female hormones to initiate appropriate physical development. She will have Gender Reassignment Surgery when she is eighteen. Britain’s youngest Transsexual to have gender reassignment surgery was seventeen.

Those who target, as ‘secondary transsexuals’, people transitioning later in their life, forget that until the Sexual Offences Act received Royal Assent on 27th July 1967 it was almost impossible for a transgender person to attain recognition. Any attempt to publicly declare the desire to change sex resulted in being diagnosed as having a mental illness. The treatment for this illness was harsh; it usually involved being incarcerated in a mental institution where treatment such as Electroconvulsive therapy was common. The attitude of the masses is still intolerant towards Transsexuals. Is it any wonder that many have remained in seclusion until they could transition without bringing ‘shame’ to their families?

It is the position of those within Chrysalis that there is no differentiation that warrants the introduction of the terms primary and secondary transsexuals. All Transsexuals deserve the same degree of compassionate treatment advocated by Dr. Harry Benjamine.

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A Guide to Gender Dysphoria.

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Gender Dysphoria or Transsexual syndrome, is a clearly defined medical condition. Medical research conducted in the 1970’s formed the opinion that it is a physical, biological condition originating in the womb. In autopsies carried out on trans-gendered people, all had the brain-sexing of the gender opposite that which was ascribed to them at birth. It is thought not to be hereditary.

Every baby of every mammal begins potentially female. During the second month of foetal development, hormones released within the foetus determine whether the baby will remain female or become male. The physical body and brain are strongly influenced at this stage, the child’s overall sexual identity is being fixed. The crucial period, when the genetic trigger is activated to determine whether the baby should remain female or change to male, is over very quickly. The process of developing into ‘male’ or ‘female’ is called sex-differentiation. These differences are programmed before birth creating a sense of ‘gender identity’, or ‘core gender identity’.

Foetal development is a finely balanced process with the potential to go wrong. In some cases this means that the baby is born with the body of one sex and the brain of the other, leaving it stranded across the sexes. It is now a recognised fact that the brain is dimorphic. This means it comes in two distinct types, in this instance, referring to the layout of the brain and the prioritising of thoughts which differ between males and females. We expect that someone who looks ‘male’ will identify as a boy and later, a man. In the same way we expect someone who looks ‘female’ will identify as a girl and later, a women. With trans-gendered people this is not the case.

This medical condition is a fact. The treatment of any medical condition has to be directed at helping the person who is suffering from it. In the unfortunate circumstances that surround the life of a transsexual person, they have been suffering the effects of the condition all their life. So far medical knowledge does not encompass the ability to change the brain or reverse dimorphic properties. It is therefore necessary to pass the responsibility to surgeons to reassign the body gender to match the brain. In this way the transsexual, or trans-gendered, person can become a whole person and lead a normal life.

Gender reassignment surgery is not automatic and is the culmination of years of effort, and in many cases, a great deal of sacrifice, before the trans-gendered person is enabled to start living as a cosmetically whole person. The reality is, of course, that it is impossible for medical science to fully reverse the gender- assigned birth defect. Unfortunately, even after gender reassignment surgery a trans-gendered person can never actually have a fully working reproductive system.

The aim of Chrysalis is to enable the Gender Dysphoric person, once sure that they are trans-sexual, to transition with as much support as they and their families need. Each of the Meeting Centress has a Gender Advisor, Counsellor & Support Workers. In addition, specialist speakers & advisors visit the Meeting Centress to offer a wide range of experience & expertise.

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This is easier if split into sections; we would suggest the following as a guide:

  • From GP to counselling – varies, hopefully within 6 weeks
  • From counselling commencement to evaluation leading to psychiatric diagnosis – 3 to 6 months
  • From the commencement of medication, with counselling, up to surgery - 2 to 2.5 years
  • The surgery itself, until out of hospital - 3 to 4 weeks if everything goes ok.
  • Recovery time, until return to work - 6 to 8 weeks
  • Supportive counselling – 1 to 2 years

The body can take up to 3 years to recover from this major surgery.

It would be preferable to discuss, as far as possible, the time you will need off work for the surgery you will require. It is hoped that your employer would allow you this time as with any employee having time off for surgery.

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The Legal Position of Transgender People and Related Issues in Everyday Life.

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There is much written about this subject; you can find all sorts of information on the Internet, but most of it is written in technical terms. The aim of this piece is to try and cut the gobbledygook out and put it in plain English

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First you need to know where you stand in law. Well, regardless of what many people think, you have the same rights as everyone else in the country, the only small difference is concerning your "sex" (We shall cover this in more detail later). Most of the laws in England and Wales are the same for both sexes, i.e. asexual, for example; In the Housing Act, the Act refers to the tenant; it does not discriminate between male and female. Likewise, Consumer Law also covers you, it does not matter what sex you are if, for example, you buy a dress and it is faulty you can take it back, exchange it, or get your money back. Goods have to be fit for the purpose they were made for.

The law has recognised the inequality between the sexes for some time. That is why most of the legal terms refer to the title and not the person. Therefore, it can be argued that, in most cases, Transgender people are covered by many of our laws, even though the lawmakers did not do it intentionally.

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If you are employed and are a transgender person, your employer cannot sack you because of this. It is unlawful to treat a worker less favourably on grounds that he or she intends to undergo, is undergoing, or has undergone gender reassignment. (SDA 1975 s2A (1) and SDA Gender reassingment regulations 1999). The comparison is made by the way the employer treats, or would treat, a worker who is not a transgender/transsexual person. It would be discriminatory to treat a worker's time off for gender reassignment less favourably than a routine sickness absence (SDA 1975 s2A (3)(a) and SDA Gender reassignment regulations 1999). It may also be discrimination to treat such absence less favourably than an absence for some other cause would be treated e.g. paid or unpaid leave, but this depends on whether it is reasonable to do so.

There are, of course, a few exception but, suffice to say, most people are not in this category:

  • A person's sex is a Genuine Occupational Qualification (GOQ) for a specific job
  • The job involves the holder conducting intimate searches pursuant to statutory powers(The Police, Customs etc).
  • The job involves the holder working in a private home and reasonable objection can be shown by the employer because of the intimate contact in those circumstances.

Many employers tell the Employment Tribunal (ET) that they are not prejudice and insist that they are only doing what is in the best interests of everyone and had only the best intentions in everything they did. What actually counts is what the employer does, not what they think. This leads us on to:-

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The following is taken from the DfEE's Guide to the Sex Discirmination (Gender Reassignment) Regulations 1999

What is the Guide?

It is the culmination of many years of campaigning to have the laws put in place to protect Transgender people. It incorporates United Kingdom and European Law. It also takes into account the rulings of the European Courts.

That is all well and good, you might say, but what does it do for me in every day life? It gives you the same cover that a woman or man has who is not a transgender person.

There are exceptions to everything, in this case it only applies during the process of reassignment. Once you have gone through your reassignment, you have the same rights as the gender you have taken.

Provisions are also in place, though limited circumstances are taken into account, for an employer to dismiss on the grounds of gender. For example, Shared Accommodation where it would not be appropriate to share a room with either sex when in transition and awaiting reassignment i.e. if you had a live in position and you had to share a room with someone. If your employer can show that it is not reasonable for them to provide alternative accommodation, then they could dismiss you.

Although, if you are already working for them and start gender reassignment, your employer would have an obligation to take all reasonable steps to give you alternative accommodation. They should not try to take the easy option first and dismiss you. Likewise if you are working with vulnerable people, in the personal services sector and, in the view of your employer, these services could not be fulfilled by a person going through gender reassignment, then they may have a case. Nevertheless, this is very rare indeed, and would not normally be accepted by any employment tribunal. The employer has to show a number of things, including showing the person is indeed vulnerable and it is not reasonable for you to carry on with the duties you were carrying out.

There is no minimum, or even a maximum, time limit an employer should allow you to have your reassignment surgery. The employer should not treat you any different that they would treat any other employee. If they allow employees to take sabbaticals, time off for illness or any other reasons, then it is reasonable for them to allow you to have the same sort of time for your treatment. There is, of course, the unexpected that might happen during, or after, your surgery that would prolong your time off work, and then you would be at the hands of your employer.

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Harassment of an individual, on any grounds, is illegal. It would, therefore, go without saying that you would be protected if you were to be harassed by either your employer or a co-worker, and would have grounds for recourse.


This, like harassment, is unlawful and you will have grounds for action against the person, or persons, responsible.

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By now, most employers should have an Equal Opportunities Policy operating, this would include discrimination on the grounds of race, creed or colour. It should also include discrimination on the grounds of sex, age, HIV status and disability. Many may not have come across gender reassignment before, but they should include this in their policies. It would be nice to think that all employers out there have already done so, but that would not be living in the real world. If you come across this problem it is worth pointing out that refusing you employment on the grounds of gender reassignment, is discrimination.

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The question will undoubtedly arise as to whether you should disclose your status as a transgender. There are a number of different views about this, we would suggest that, in the interview, unless it is mentioned, or there is a real exception that the need for disclosure is required, the information can be considered private. However, having said that, there are only limited circumstances where the employer needs disclosure. Anything else is irrelevant and questions relating to your status should not be asked or answered.

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Skillful managers would be able to discuss, with their employees, the best way forward. This is your opportunity to say how your employer can best help you in the work environment, this may include:-

  • Is the employee to stay in their present position or move to a different site location within the company?
  • The time scale from first taking medication, or changing your name (Social Gender) and transition through the surgery.
  • How to inform colleagues and customers that do not already know. Will you inform them, or would you like the company to do this?
  • Is the company geared up to make changes in records, insurance etc?
  • What will the company require as a dress code, if they have one?
  • At what point will you want to use the amenities provided for your new gender?

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R informed her company that she was a transgender person. After explaining this to the Chairman, it was decided that a plan should be drawn up, so as to make the transition for both smooth.

This was helped by R as she had enlisted our services and had a plan of action of her own, which was flexible and able to fit in with the company's plans.

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This is the sixty four thousand dollar question! When do you switch? Well, there is no easy answer; this will have to be agreed between you and your employer. It could be at any point along the path you are taking; when you are permanently dressed in your new gender or it could be when you have the appearance of your new gender. e.g. you might have facial hair, or your breasts have developed. All that we can say, on this point, is that it is not acceptable for your employer to ask you to use the disabled facilities for an extended period.

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Q. Do I have to tell colleagues?
A. No, you do not.

Q. What about any clients I may have?
A. The answer to this one is not as straight forward; if you have clients who you meet in person, then it would be good practice for your employer to inform them, unless you wanted to do this yourself. You should discuss this with your employer.

Q. What about work colleagues?
A. The ones you work closely with will see the changes taking place and it is hoped that they will be supportive of you. As for other people in your company, that would be up to you.

Q. What if my clients do not want to deal with me, is my job on the line?
A. It should not be a case of your job being on the line because clients do not want to deal with you. What should happen, once you have told your clients what you are doing, is for your employer to interview them and ask them if they are happy with you continuing as their contact, with the company. Those that do not wish to continue with you can be offered a new contact person.

Q. What if I get hassle from colleagues?
A. If you are getting any sort or hassle e.g. unwanted remarks, bad behaviour, or being blanked, you should report this to your boss, or you can contact us and we will intervene on your behalf.

Q. What should I give to the employer and/or client to help them understand what I am going through?
A. We have training material available, it is limited and there is a small cost involved, but, in general, any information you can give them would help them to understand.

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