By Linda Jane

is seldom as neat as scientists would like it to be. Most of the problems arise because psychological sex, or gender, is not as tangible an entity as chromosomes, hormones, or genitals.

Gender Hangups

That gender problems exist as an area of scientific study at all is an indication of the importance our society places on sex-appropriate attitudes and behaviors. In reviewing the literature on gender problems, the social biases of this "science" become clear.

Gender theory, developed largely by John Money of Johns Hopkins, breaks gender down into two elements. Gender identity is defined as "the unified and persistent experience of oneself as male, female, or ambivalent, particularly as experienced in selfawareness." Gender role is defined as "actions, activities and behavior indicating to others or to the self the degree to which one is male, female, or ambivalent." The first element is thought to be determined by rearing and the second is believed to be influenced, but not necessarily dependent upon, prenatal hormones. (Incidentally, sexual orientation is thought to be a subcategory of gender role.)

Transsexualism is considered as falling within the realm of gender identity-the person experiences himself or herself as the opposite of his or her biological sex. Clinically, it is distinguished from transvestitism in that, in the latter case, the person may "act out" the role of a person of the opposite sex without necessarily feeling that they are a person of the opposite sex.

If the language surrounding transsexualism sounds confusing, it is. And the frightening consequences of the recognition of "gender dysphoria" as a bona fide disease is that if someone says and can prove to a doctor's satisfaction that they believe themselves to be a member of the opposite sex, they are a potential candidate for a painful and arduous "cure".

"Curing" the Transsexual

Since the majority of transsexuals are male (the ratio of males to females is approximately 4 to 1), the role of the medical establishment in treating the disease will be confined here to men.

The place where many transsexuals go, or are sent, to seek a solution to their gender identity conflicts (which, in most cases is seen as surgery) are the. gender identity clinics. The first clinic to open was at Johns Hopkins in 1965, and it is considered to be one of the most prestigious of its kind. As of 1979, there were estimated to be over 30 "reputable" clinics across the nation.

The course of treatment is similar throughout the clinics. It usually begins with a screening procedure during which the transsexual is required to live and dress like a woman for at least one and as much as two or more years. This interim is designed to give the patient the opportunity to try out the new role and find out if they can truly "pass" as a woman. (A very large, hirsute male, for instance, may have trouble passing as a woman and realize that surgery may not be a viable solution.) This period also gives the transsexual the opportunity to back out if he changes his mind. During the simulation, the surgical candidate usually receives hormone therapy and counseling. In many cases, the doctor will also sugge electrolysis, voice training, charm school, and feminist group sessions to insure that the patient feels comfortable in his chosen role.

The candidate also undergoes extensive psychological testing. The purpose of this testing appears to be twofold: first, to rule out any major mental illthe motives, and nesses; and second, to test the sincerity of the person's desire to change the sex.. One doctor estimated that at least 10 percent of

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transsexuals that come to the clinics have severe emotional disorders that contraindicate a transsexual solution. This same doctor estimates that another 30 percent can be considered homophobics who, rather than accept their homosexuality, want to change their sex.

Once a candidate has been screened for other mental illnesses, the professionals still need to determine whether the person actually qualifies as a transsexual. Various measures are used to test a candidate's qualifications. For example, the patient might be asked to rate over a period of time certain statements he made regarding his desires to become a woman. In an initial interview, for instance, one patient might say that he wishes to have female genitals. He is then asked to rate this statement in terms of its desirability over a period of several months, the assumption being that if he continues to rate having female genitals as highly desirable, he is indeed sincere. The tests might also include measures of a patient's arousal patterns. One common measurement is to show the

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patient pictures of male and female nudes to compare homosexual or heterosexual responses. Or the patient may be asked to self-monitor his sexual fantasies to determine whether he consistently acts out the role of a woman in his fantasies. Another typical technique is to observe the patient's behavior by taking daily measures of his masculine and feminine patterns of sitting, standing, and walking.

It is estimated that only about one in ten candidates pass this lengthy screening process and obtain permission for surgery. The surgery itself is a costly, multi-staged process involving a team of specialists, including a plastic surgeon, a urologist, and a gynecologist. It may take several years and cost upwards of $10,000 before it is complete. Many transsexuals request additional cosmetic procedures for such purposés as to improve the appearance of the genitals, enlarge their breasts, and reduce the size of their Adam's apples. After surgery, the transsexual usually remains on some type of estrogen maintenance program.

Other Options

The benefits of surgery, at least theoretically, are that the transsexual's anatomy is brought into line

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with his or her gender. There is a growing concern, however, both within and outside the medical establishment, that the "cure" may be more harmful than the disease.

A study published in 1979 by Jon Meyer and Donna Reter of Johns Hopkins comparing a group of operated and non-operated transsexuals suggests that "Sex reassignment surgery confers no objective advantage in terms of social rehabilitation, although it remains subjectively satisfying to those who have rigorously pursued a trial period and who have

undergone it." Another study published that year by Barlow, Abel, and Blanchard went a step further by proposing that behavior modification techniques to alter sex roles may be a fruitful alternative to surgery. Their specific techniques involved gradually changing male transsexuals' standing, sitting, walking, and social behaviors from feminine to masculine and modifying their sexual fantasizing from homosexual to heterosexual.

It seems fairly obvious that a new perspective on transsexuality is not forthcoming from the medical establishment. However, there is some indication that attitudes may be changing. Dr. James Morgan of the University of Pennsylvania Hospital contends that what he calls the "transsexual imperative" is an "echo of the societal imperative to be 'normal,' 'regular,' and 'straight,' as society defines those terms....The self-hatred which is learned by those who feel they somehow have not met a given societal standard, no matter how unreasonable that standard may be, is a potent force to be reckoned with. It is not responsible professional behavior in the highest traditions of psychiatry to look only at the patient and not ourselves, our attitudes, and our biases."

The most outspoken criticism of the medical profession's position of transsexualism comes from the feminist community. Mary Daly, Janice Raymond and others propose that transsexuality is not merely a social issue, but a male issue. Janice Raymond, in her book The Transsexual Empire, published in 1979, argues that it is no coincidence that more men are being transsexed than women. Among her reasons for this imbalance are that men have fewer options than women in our rigidly gender-defined society to "opt out of culturally prescribed roles" and that transsexual surgery is a "creation of men, initially developed for men." The female transsexual is a token, the "buffer zone who can be used to promote the universalist argument that transsexualism is a supposed 'human' problem, not uniquely restricted to men." Another, and what she considered to be the most compelling, reason is that men are socialized to fetishize and objectify: "The same socialization that enables men to objectify women in rape, pornography, and 'drag' enables them to objectify their own bodies....the penis is seen as a 'thing to be gotten rid of and female genitals 'things to be acquired.""

The position taken by Janice Raymond and other feminists has, in turn, been condemned by feminists as too harsh on the "victims" of the medical institution's attempts to remodel individuals to conform to social stereotypes. Certainly, the individual cannot be blamed for the problems that arise in a society so rigidly stratified into male and female. On the other hand, can we afford to reinforce those attitudes by

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accepting the male transsexual as a woman? There is no easy answer.

What is clear is the unbridled arrogance of the medical establishment, Transsexualism, an essentially male phenomenon, presumes to define a woman's life experience in terms of the stereotypes of posture, poise, and personality. The medical establishment's criteria for womanhood are the same male-defined, socially induced modes, of behavior that feminists recognize as the symptoms of the subjection of

women.

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April, 1980/What She Wants/Page 7