As a transgender person, I have been invited to join the CSCS Committee to try to ensure that the ‘T’ in ‘LGBT’ is not ignored and I will do my best to represent transgender people. My intention here is to share something of my story in the hope that it will help to increase understanding of gender variance and the consequences of being a transgender person.
The LGBT acronym has become well used over the past few years but although many people reading this will know a great deal about L, G and B, I suspect that few will know very much about T.
I will start by trying to define some words and phrases such as transgender, gender dysphoria, gender identity disorder and transsexuality. However, since there are no universally agreed definitions, all I can really do is give my understanding of what they mean.
The word dysphoria has Greek roots which means ‘difficult to bear’ and as such I find the term gender dysphoria very meaningful because my birth gender has been something I have found difficult to bear throughout my life.
But gender identity disorder is also very meaningful because most of my self-discovery and self-acceptance has been firmly rooted in establishing my own identity within the gender in which I feel most comfortable. And it is with identity that I have had the greatest struggles all my life. Who am I? What am I? And does it matter?
Transsexuality is perhaps the worst term since it implies that all this has a lot to do with sex or sexuality, which it does not. Yes, sexuality is a part of gender identity but it is not the overarching factor.
All this gives rise to the many adjectives associated with the world of transgender people. The term I now prefer is ‘gender variant’ simply because my externally defined gender was at variance with how I perceived my internal gender.
So if I have to apply a defining term to myself it would be a gender variant person. However, I would prefer to be just Rosie, and to be perceived and accepted by others as the woman I honestly believe I have always been despite the first diagnosis I received from the doctor when I was born – “it’s a boy!”.
What it means to be a gender variant person
Human beings have an amazing ability to recognise one another. Whether it’s a celebrity or a favourite aunt or even someone who suddenly crops up from our past; we almost instantly recognise people simply because everyone is different.
However, the problem that many people seem to have with difference is that they somehow expect it to be little more than skin deep – thereafter we are all to be the same. We are all expected to conform and be what many would define as normal, whatever normal may mean.
But a person is much more than simply their outward appearance and although beauty may only be skin deep, a person is the whole package from their outer skin right down to their very mind and soul.
For some time now L, G, B and T people have been grouped together in this apparently all-embracing term LGBT. I am sure that there are good reasons for this but despite several similarities, it seems to me that there are some significant differences between Lesbian, Gay and Bisexual people and Trans people.
So let me start with the similarities.
First I would suggest that every L, G, B and T person has experienced that feeling of not fitting in with the world in which we live. We seem to continually bump up against social constructs that we find at the very least difficult, and at worst, distressing.
Secondly I suspect that most if not all LGBT people have felt an intense loneliness as they have struggled to come to terms with not fitting in, and the feeling of being the only one in the world who feels the way we do.
Thirdly we have experienced that moment when we have to make a life changing decision to speak with someone about how we feel. Feelings that have, up to that moment, been very personal and totally secret are suddenly put in the spotlight as our secret becomes a secret no more, and our lives are irrevocably changed forever.
Many things we do in life can be undone, but what is said cannot be unsaid and that moment of ‘coming-out’ to someone else is a moment of immense vulnerability when we have no idea how the person we tell will react. One thing is sure – we, and those whom we tell, will never be the same people again.
The final similarity is somewhat less clear as it is rather dependent upon our personal circumstances, but it seems to me that all LGBT people have to make some decision about how they are going to face the future.
And it is at this point that T differs significantly from L, G and B simply because trans-people need to seek some degree of medical intervention to enable them to become the people they believe they truly are.
Once again this means becoming very vulnerable. We have to approach our GP before undergoing several years of analysis by mental health professionals, medication guidance by endocrinologists, and finally, surgical intervention to rectify what many of us would regard as an anatomical birth defect.
What is Gender Dysphoria?
Whether we realise it or not gender is immensely significant to all of us. When told that someone we know has given birth, one of the first questions we ask is “is it a boy or a girl?” When my Mum gave birth to me at home just after the Second World War, her GP was in attendance and he simply made a declaration that was intended to firmly place me in one of two groups of people for the rest of my life.
I find it interesting that such a simple declaration encompasses one of the first difficulties that gender variant people face, namely how should we be referred to. ‘It’s a boy’ or ‘it’s a girl’ signifies that moment when a newborn baby moves on from being nothing more than an ‘it’ to being a ‘something’.
And it’s really at this point that the problems with gender identity begin, for at birth we are all assigned to one of two possible genders on the basis of nothing more than the size of a protuberance between our legs.
(Note: not all are ‘assigned’ in this way. The Intersex Society of North America estimate that something like 1% of new-born babies present with some form of ambiguous genitalia, and between 0.1% and 0.2% are ambiguous enough to require specialist medical attention. See Intersex Society of North America: How common is Intersex? http://www.isna.org/faq/frequency).
However, gender variance differs significantly from intersex in that there are often no outward signs that the person is anything other than male or female as defined by their genitalia. For a gender variant person, it is a deep-rooted feeling of being female with a male anatomy or being male with a female anatomy. Another major difference is that intersex people may have difficulty in procreating whereas gender variant people may be parents in their birth assigned gender.
So I started life with the whole world, and especially my parents, expecting me to develop into a boy who would grow into a young man, marry, father children and have a successful masculine career. As a result there was no way my father was going to allow me to become the professional dancer I wanted to be, rather engineering was the career path I had to follow.
The problem was that despite what the doctor had said and the undoubted anatomical truth of his diagnosis at my birth, this was not how I felt. As a result, from about the age of 4, I had great difficulty in understanding why I could not dress as my younger sister did or why boys had to come to my birthday parties rather than girls.
Therapy and Treatment
Gender dysphoria is a recognised medical condition that is currently treated as a mental health condition. There is considerable debate over whether such a classification is justified but that is too complex to go into here.
The usual therapy and treatment under the NHS is for a GP referral to a local Primary Care Trust psychologist whose role is to establish whether or not there are other underlying conditions that may give rise to these feelings of gender dysphoria.
The next assessment is by a local PCT psychiatrist who may then refer to a Gender Identity Clinic (GIC) such as the one at Charing Cross Hospital. (Some 1,500 new referrals were made last year and referrals are increasing by about 20% per annum.)
Transitioning to live in the opposite gender is undertaken with the support of the clinicians at the GIC. Patients have to live in their chosen gender role 24/7 for a minimum of 2 years and provide evidence of their ability to function fully in their chosen gender. This is called the real life test or RLT (which for some has become known as a really long time!), and will also require a legal change of name.
Once transitioned, hormones can be prescribed; oestrogen and anti-androgens for a male-to-female (MTF) and testosterone for a female-to-male (FTM). The effect on FTM is almost instantaneous with a deeper voice, facial hair growth and male pattern baldness but for MTF there is only slow breast development and while there is a reduction of body hair facial hair does not reduce and has to be removed by electrolysis or laser treatment.
In addition, the male to female trans-person may need some voice therapy and those with male pattern baldness will probably also have to permanently wear a wig or hairpiece. All of these factors add to the distress and the immense feeling of vulnerability.
Finally, after several sessions of psychological and psychiatric analysis by at least two mental health professionals, the patient may be referred for genital surgery. Unfortunately this has become commonly known as a “sex change” but is more properly known as gender reassignment surgery or, as I prefer, gender confirmation surgery.
The Gender Recognition Act of 2004 enables gender variant people who can prove they have been living in their acquired gender for at least two years to apply for a gender recognition certificate. This is an official document that legally recognises the holder in their acquired gender with all the advantages and disadvantages that brings with it. For example, a male-to-female person may then legally marry a man and the state pension is payable at the same age as natal born women.
A new birth certificate may also then be obtained which will state the new name of the individual and their acquired gender.
However, married gender variant people have to be divorced or have their marriage annulled before a Gender Recognition Certificate can be granted. This is to protect the concept of marriage as only existing between a male and a female. The couple may simultaneously have a Civil Partnership which grants the same protection as marriage but is clearly different.
Gender confirmation surgery is not a pre-requisite of obtaining a Gender Recognition Certificate because some gender variant people are unable to undergo surgery due to other underlying health conditions.
Treatment of Gender Variant People in the workplace and the World
The English language is very rich indeed with some 1 million words which would appear to offer plenty of scope for describing all situations, and yet there is an amazing dearth of gender-neutral terms.
For example Mr, Sir or Lord are uniformly taken to refer to men and Ms, Miss, Mrs, Madam, or Lady are uniformly taken to refer to women. It’s only titles such as Dr, Rev or Professor that are gender-neutral and few of us aspire to such dizzy heights!
So the first rule for addressing a gender variant person is to address them either by their first name, or by a title, or some other form of address that is appropriate for their presentation. Of course even this is not always easy as some people purposely dress androgynously.
I have mentioned the term transsexual but this should only ever be used as an adjective as in ‘a transsexual person’ or ‘transsexual people’. However I hope that even this term will fall into disuse as ‘gender variant person’ becomes more favoured.
The Gender Recognition Act offers considerable protection to gender variant people so, for example, it would be illegal for anyone to identify me as having a transgender history unless I give specific permission to do so, which I would rather not. It is also illegal to ask to see a gender recognition certificate.
This is not an easy road and I personally cannot conceive of anyone following such a route simply to fulfil some sort of lifestyle choice. However, I would not have missed one moment of what has been a momentous journey of self-acceptance and self-discovery. At last, after a lifetime of wondering who I am, I now know.
Some Further Information
GIRES http://gires.org.uk/ - Gender Identity Research and Education Society – offers wide-ranging help and support and has many useful documents which may be freely downloaded
GT http://www.gendertrust.org.uk/ - Gender Trust – supporting people affected by gender identity issues
PFC http://www.pfc.org.uk/ - Press for Change – campaigning for respect and equality for all trans people
GRP http://www.grp.gov.uk/ - Gender Recognition Panel website