A Discussion of Sex and Gender
The Heart of the Transgender Dilemma

Any attempt to try to explain or understand the heart of the transgender conundrum must necessarily begin by making a the distinction between Sex and Gender. 

For many people, the terms Sex and Gender are used interchangeably.  In fact, I think it's safe to say that most people consider both to be one and the same, never having a reason to consider otherwise.  For most people they ARE the same, so it's easy to see why this would seem obvious.  However, although sex and gender are certainly closely related, those of us who face a lifelong body/psyche dissonance know that they are most certainly NOT the same.  They are different, and it's this subtle difference that seems to be the source of so much confusion and debate.

What is a man?  Ask a small child this question and you'll get any number of things to describe what a man is.  In fact, ask anyone to answer that question and I think you'll be surprised by what different people define a man to be.

From a physical perspective, a man has certain attributes that make him a man.  He's muscular.  His skeletal structure is generally larger than a woman's.  And, of course, he's got a penis.  

However, when we think of a man, we think of any number of other things, too.  He dresses a certain way.  His hair is expected to be some certain length.  He's not allowed to wear makeup.  He probably has a certain role in a family, or in his workplace.  He probably does "manly" things.  Are all of these traits we used to define a "man" physical things?  No.  They are the things our culture has decided are appropriate for this person based on the fact that his physical attributes make him a "man".  The end result is that the definition of a man is ultimately a combination of physical Sex and culturally-defined Gender.

The dictionary has several definitions of the word "man", two of which I think are particularly interesting:

Main Entry: ¹man
1 a (1) : an individual human; especially : an adult male human; 
1 d (1) : one possessing in high degree the qualities considered distinctive of manhood

Sex is the physical state of being male or female.  It's chromosomal.  It's a body thing; a physical thing.  It is decided when an egg is fertilized, and from that point on the embryo will develop based on the XX, XY nature of the zygote.  For the vast majority of people, there is no question.  Boys have a penis.  Girls do not.  Period.  End of story. As with anything, there are certainly anomalies here (intersexed people, people with abnormal chromosomes, etc).  Never forget that our society is a very binary one (which is one of many problems, because in reality the world does not exist by that same standard), and it forces the doctor to make a choice: Boy=Penis, Girl=no penis.  There is no middle ground. 

Gender is a much more difficult term to define.  The dictionary defines gender as "the behavioral, cultural, or psychological traits typically associated with one sex".  That's a lot of stuff!  It's all the roles, expectations, norms, and rights that we establish for people based on their physical sex.  In our society men are allowed (and expected) to dress a certain way, to look a certain way, to have certain jobs, to have certain interests, to act in certain ways....and the same is true for women.  Gender is not being male or female - it is being masculine or feminine. 

Some believe that male-ness and female-ness is inherent, that our culture articulates gender based on things that are somehow inborn or part of some higher natural order based on physical sex.  I do not buy into this theory; in fact I think it's pretty self-centered and simplistic to really believe that.  Although I do agree that there are some significant differences in the male and the female brain which lead to some differences between men and women, to think that Western interpretation of masculinity and femininity is somehow part of some larger natural order is something that seems obviously flawed to me.  In fact, to really believe that is to ignore the fact that there's a world out there that expresses gender differently than we do.   

Gender Identity

A person's sense of their gender is known as their gender identity.  Sex is a physical thing, or a body thing.  Gender identity is a mind thing, and an expression thing.  It is a self thing.

Where does a person's gender identity come from?  Is it something we learn?  Or, is it something we're born with?  

Early theories were based on the belief that gender is learned behavior.  The general consensus was that if you took a genetic boy and raised him as a girl in our culture, he'd learn to be comfortable in that role and would adapt just fine. This approach refused to acknowledge that there might be something inherent to a person's identity that makes them feel like a boy or a girl in relation to the culture around them.  As a result, throughout the first half of the 20th century people whose sense of gender was different than their physical sex were treated as though they were mentally ill.  This "illness" was treated with any number of behavior modification treatments. Aversion therapy, shock therapy, and any number of other unpleasant (and unsuccessful) methods were used to try to teach the patient to be the proper gender (much in the same way that there was a time not-all-that-long-ago that we tried to make left-handed people to be right-handed).  It's no wonder that people experiencing any sense of gender confusion remained hidden and closeted.

Thankfully, more recent research has proven that theory to be misguided and wrong.  (For a compelling story about this, read As Nature Made Him: The Boy Who Was Raised As A Girl).  Certainly, some aspects of gender are learned.  But current thinking is that our sense of self, and specifically our sense of our gender, is largely dependent on prenatal brain development.  It is part of our overall personality, and once imprinted is immutable and cannot be changed. 

All embryos begin life as female.  In the days shortly after fertilization, the presence or absence of an X chromosome will cause the fetus to continue on that path, or to begin developing as male.  It is not until several weeks later that a series of hormone "baths" help the brain to develop its personality, including its sense of gender identity.  Since the two events are not directly related, are based on completely different things, and occur at significantly different points of embryonic development, it leaves an opportunity for something to go wrong.  What happens if the hormone "bath" doesn't occur on time, or at all?  What happens if there are other problems based on medication, life event, or other things the mother might be experiencing?  There is a possibility that a person's sense of their gender, or their gender identity, will not match their physical gender.

Some might call this a birth defect, and although I agree that it's a birth "anomaly" I have a hard time perceiving of myself as a defect.  In any event, that's the current thinking of how this happens.  Later in life these become very heated arguments: that this is somehow a choice.  Personally, I have no idea why someone would choose this.  We feel this way for our entire lives, and although we certainly didn't choose to be like this what we ultimately do about it has an element of choice to it.  

I'd also add that, as with most things, this is not a binary situation.  It's not like this is something you have, or you don't.  There are any number of levels of discomfort as a result of this mind/body dissonance.  Sometimes, we find ways to address it internally without having to share our secret self with others.  Other times, addressing it and fixing it becomes a life-sustaining imperative.  Whether people choose to acknowledge it or not doesn't change the fact that they may be transgendered to one degree or another.  Is that an illness?  Of course not.  Is it wrong?  Only if you choose to believe that.

Gender and Sexuality: Related but Not the Same

Now that we've spent some time talking about what gender Is, I think it's also important to discuss what gender is Not.

Gender is NOT sexuality.  The same as most people tend to perceive that sex and gender are one and the same, so too do they perceive that motivations for transsexuals have to do with sexuality. This is an erroneous, and ultimately damaging, misconception.

First, I think part of the difficulty is that our culture does not have good words to explain any of this.  Sex has two very different meanings, one having to do with the physical nature of being a man or a woman (as already described). and another having to do with the act of sex.  Certainly, sexuality plays a significant role in the latter definition of the word.  However, it has very little to do with the former.

Our culture is obsessed with Sex.  Particularly men.  Since we live in a largely patriarchal culture, there's little wonder that everything comes down to sex.  I have a small sign in my cubicle at work: "When all you have is a hammer, everything looks like a nail."  That simple saying could be translated as: "When all you think about is sex, it's all about sex.".  A man's universe often revolves around his penis, and we accept that as part of being a man.  Sex has become a measure of manhood, of conquest, of success.  As a result, most motivations in many men's lives have to do with Sex.

For a man to be perceived as feminine is to be called a Sissy, or a faggot.  There are few more derogatory words that one man can say to another.  To impugn a person's manhood is to challenge him at his most basic level, and in some cases just looking at a man the wrong way will get you pummeled or killed.  The question of whether a person appears to be somewhat feminine is because of their own sense of gender identity, or their sexuality, is really never considered.  Although both may have the same outward appearance, the underlying causes/motivations/needs are absolutely and completely different.  That distinction, however, is rarely considered so in the end feminine men are perceived as gay, and gay men are perceived to be feminine.

Consider the simple logic at work here.  In the "normal" world men have sex with women, and women have sex with men. Some would say that that's just the "natural" way.  So, if a man wants to have sex with a man that must mean that he really wants to be a woman.  Is this true?  Of course not.  However, most people cannot get past this point, so the connection between sex/gender and sexuality has become a difficult link to sever.

Within the GLBT community there are those who argue that the T really doesn't belong with the GLB.  In one sense, I agree.  Gay, Lesbian, and Bisexual are all terms used to describe a person's sexuality, whereas being Transgender has other motivators.  However, the outward appearances of all are often the same.  All cross cultural barriers of traditional "male" and "female" roles, so in that sense they are related.  A masculine acting/appearing woman is immediately considered to be a lesbian.  Whether or not that's true or not won't keep her from getting beat up or attacked.  I think those in the GLBT community who refuse to acknowledge this connection need to consider their own deeper issues of transphobia or homophobia, but that's a different topic for a different day.

Generally speaking, most cross-dressers I know are heterosexual men.  Most are married, with families, and have successful careers.  The fact that they've got a distinctly feminine component to their personality in no way interferes with their overall identity as men. It usually says nothing about their sexual nature, and is in no way an indication of anything more than the fact that they're complex.  And, the fact that others have a hard time understanding how that can be really doesn't change the fact that it is what it is.

To think that being transsexual is totally sexually motivated, as some would have you believe (i.e The Man Who Would Be Queen), is to buy into the outdated belief that male-ness or our female-ness is defined by sexuality.  To believe that the deep motivators of being male and female can be pinpointed to a specific, universal cause is absolutely asinine.  However, for those who can't see beyond the tip of their penis, I suppose this sadly misguided rationale shouldn't be surprising.

What Does It All Mean?

When I was born, they looked at me and said
what a good boy, what a smart boy, what a strong boy.
And when you were born, they looked at you and said,
what a good girl, what a what a smart girl, what a pretty girl.

We've got these chains that hang around our necks,
people want to strangle us with them before we take our first breath.
Afraid of change, afraid of staying the same,
when temptation calls, we just look away.

- -  lyrics to "What a Good Boy" by The Barenaked Ladies

How often does this happen?  How often does this body/psyche dissonance occur?

As far as most are concerned, this is a rare phenomenon.  It's considered an "oddity" more than anything.  Few people are knowingly exposed to transsexuals in their day-to-day life.  However, the question at hand is whether that's because there really aren't that many of them, or whether they just don't want to be found.

Outdated estimates projected that transgenderism occurred in approximately 1 our of every 30,000 births.  However, Professor Lynn Conway did some extensive research into these numbers, using the number of Sex Reassignment surgeries that have been performed, and her results are startling. 

For the full study, please visit Dr. Conway's complete analysis:  How Often Does Transsexualism Occur?  It's fascinating.

This table, as reproduced from Dr. Conway's website, indicates that one out of  500 to 2500 genetic males born in the United States will be born with a gender dysphoria so severe they will eventually undergo SRS.  That's an amazing number, and it indicates that previous estimates of the prevalence of transsexualism where more than ten times too high.

Compare these numbers to some other conditions:

As Dr. Conway points out:

"All of these conditions are high on our society's radar screen and there is massive public empathy for those who suffer from them. There are large research funds available for studying and treating these conditions, and patients have welcome access to any existing medical treatments that might relieve such conditions.

So you see, it's not really all that rare.  It happens more than most could even begin to imagine...