The Body Project
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Transsexuality & Body Image

In American society, there is strong social pressure to conform to gender norms. Everyone is expected to be either clearly masculine/male or clearly feminine/female; and people can become uncomfortable, or even angry, if they are unable to readily determine someone’s gender (Fausto-Sterling, 2000; Lorber, 1994). There is also a firm expectation that one’s gender will match one’s biological sex: that is, that people with XX chromosomes and female genitalia will be feminine women, and people with XY chromosomes and male genitalia will be masculine men. But this is not always the case.

What is transsexuality?

Some people feel that the way they think about themselves does not match their sexual anatomy. One may feel like a woman “trapped in a man’s body,” a man “trapped in a woman’s body,” or somewhere in between the two sexes—neither fully a man nor fully a woman. Some individuals take steps to bring their bodies and their self-concept into closer alignment. They may dress and live as the “opposite” sex, they may take sex hormones to make their bodies more masculine or more feminine, and they may undergo sex reassignment surgery to give them sexual anatomy that matches the brain’s perceived sex.

The terms transgender or gender variant are generally used to refer to anyone whose gender (eg. their femininity or masculinity) does not align with their biological sex (their female or male anatomy). Transvestism (or “cross-dressing”) is one kind of transgender practice. And transexuality (making the physical transition from one sex to another through practices such as surgery and hormone use) is another. In some cultures, people in gender variant categories are well-integrated into the social structure, as is the case with Hijras in India (Reddy 2005). In the United States, however, transgender, transsexual and transvestite people still suffer considerable stigma and discrimination.

The Prevalence and Origins of Transsexuality

There are several common transsexual categories. Those who were born biologically female but come to live as men are often called transmen or FTMs (female-to-male). Those who were born biologically male but come to live as women are known as transwomen or MTFs (male-to-female). Those who identify as having a gender somewhere between male and female are sometimes called intergendered, cross-gendered, genderqueer, androgyne, or bigendered; and they may, or may not, identify as transsexual (Feinberg, 1996).

Coming up with the estimated proportion of transsexuals in the general population has proved daunting. The US census only offers the choices of “male” and “female;” medical professionals only have a very rough estimate because hormones can be purchased online; surgery can be done overseas; and many people who live as the “opposite” sex cannot afford to undergo sex-reassignment surgery (Kailey, 2005). Estimates range from 1 in 21,000 people (from a 1993 Dutch study, Meyerowitz 2002) to as many as 1 in 500 people (estimated by American transgender activist Lynn Conway, 2002). However, no official statistics exist.

The origins of transsexuality are also in dispute.

  • Some researchers suggest that transsexuality is biologically based. Most theories have concentrated on fetus exposure to hormones during gestation. (See discussions in Brown & Rounsley, 1996; Girshick, 2008; and Heath, 2006).
  • Others contend that transsexuality results from a combination of nature and nurture. Bullough (2000) theorizes that LGBT (lesbian, gay, bisexual, and transgender) people are born with a predisposition (originating either genetically or hormonally) that is then reinforced by socialization.
  • Others consider the perceived conflict between one’s physical sex and one’s brain sex to be symptomatic of a mental disorder categorized as Gender Identity Disorder in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association.

Barriers to Transition

Those who choose to transition from one sex category to another face a number of barriers. In 1980, the Benjamin Standards of Care were established for the treatment of those diagnosed with Gender Identity Disorder (Barres, 2005). These standards require those wishing to take hormones or undergo surgery to pass tests before being allowed to change their body (Heath, 2006). In order to start transitioning, a transsexual must first receive at least three months of counseling. During these three months, hormone use is frequently encouraged since the side effects are not permanent within that window of time. Before surgery, two independent professionals must certify that the surgery candidate has spent at least one year living as the “opposite” sex. Evidence also needs to be given that the candidate’s mental health has shown improvement over the course of that year (HBIGDA, 2001).

For many candidates, the costs of transition are prohibitive. Not only are the surgical procedures very expensive (and insurance seldom fully covers these costs), but candidates are required to pay for multiple counselors as well. Not surprisingly, many transsexuals resent the implication that they have a “gender problem” or “pathology” and are incapable of making informed choices on their own. They assert that it is society that needs to correct its views of sex and gender (Stryker, 2005).

Transsexuality and Body Image

Negative body image is a fundamental issue associated with transsexuality (and transgenderism more broadly). Early researchers with transgender individuals consistently found negative attitudes toward their own sex characteristics, particularly their genitalia (Benjamin, 1966; Steiner 1985). Many adult transsexuals report that as children they felt like there was something wrong with their bodies, feelings they often addressed by cross-dressing (Brown & Rounsley, 1996; Mason-Schrock, 1996).

Such feelings appear to be grounded in society’s strict adherence to sex and gender binaries, and to the assumed correspondence between sex and gender. In other words, the strong social pressure to be either a masculine biological-male or a feminine biological-female, not only makes many people feel like social outcastes, but makes them feel like their bodies are enemies—foreign entities that need to be controlled and overcome.

After Transition

Many transsexuals are able to be very successful in life after transition. In one well publicized case, Deirdre McCloskey, a male-to-female transsexual, continued a prominent career as a distinguished economist and historian without skipping a beat (Wilson, 1996). The Social Science History Association passed a resolution in support of McCloskey’s transition and elected her president of the Economic History Association after transitioning (Wilson, 1996; McCloskey, 1999).

After transitioning, many transsexuals experience a greater sense of satisfaction with their bodies. As two transsexuals told Girshick (2008, 175):

  • “I am more pleased with my body than I’ve ever been.” (FTM Kerwin)
  • “I am at home in my body for the first time in my life.” (MTF Raven)

This body acceptance also appears to influence overall mental health (Girshick, 2008, 174):

  • “My self-esteem has shot way up. I’m so much more confident. I do a lot of things by myself now which I could never do before.” (MTF Bonnie)

In fact, some transsexuals see their ability to experience both of society’s sex categories as a very positive thing:

  • “I believe that all of my life is worthwhile and that none of it was wrong; there was no mistake. The fact that I went through this transition is not a problem, it’s a privilege” (Cram, 1996).

Ask Yourself

  • Why is our society so uncomfortable with people who do not fit neatly into the standard sex/gender categories?
  • We think of gender as an either-or category (either masculine/male or feminine/female). But, in fact, gender is a continuum with some people being more masculine, some more feminine, and many somewhere in-between. Where are you on the gender continuum? What factors have shaped the way you think about gender?