A transgender person (often shortened to trans person) is someone whose gender identity differs from that typically associated with the sex they were assigned at birth.[1] Some transgender people who desire medical assistance to transition from one sex to another identify as transsexual.[2][3] Transgender is also an umbrella term; in addition to including people whose gender identity is the opposite of their assigned sex (trans men and trans women), it may also include people who are non-binary or genderqueer.[4][5][6] Other definitions of transgender also include people who belong to a third gender, or else conceptualize transgender people as a third gender.[7][8] The term may also include cross-dressers or drag kings and drag queens in some contexts.[9] The term transgender does not have a universally accepted definition, including among researchers.[10][11]

Being transgender is distinct from sexual orientation, and transgender people may identify as heterosexual (straight), homosexual (gay or lesbian), bisexual, asexual, or otherwise, or may decline to label their sexual orientation.[12] The opposite of transgender is cisgender, which describes persons whose gender identity matches their assigned sex.[13] Accurate statistics on the number of transgender people vary widely,[14] in part due to different definitions of what constitutes being transgender.[10] Some countries, such as Canada, collect census data on transgender people.[15] Generally, fewer than 1% of the worldwide population are transgender, with figures ranging from <0.1% to 0.6%.[16][17][18]

Many transgender people experience gender dysphoria, and some seek medical treatments such as hormone replacement therapy, gender-affirming surgery, or psychotherapy.[19] Not all transgender people desire these treatments, and some cannot undergo them for financial or medical reasons.[19][20]

The legal status of transgender people varies by jurisdiction. Many transgender people experience transphobia, or violence or discrimination towards transgender people, in the workplace,[21] in accessing public accommodations,[22] and in healthcare.[23] In many places, they are not legally protected from discrimination.[24] Several cultural events are held to celebrate the awareness of transgender people, including Transgender Day of Remembrance and International Transgender Day of Visibility,[25][26] and the transgender flag is a common transgender pride symbol.[27]

Transgender friends in Washington, D.C.[28][29]

Terminology

Before the mid-20th century, various terms were used within and beyond Western medical and psychological sciences to identify persons and identities labeled transsexual, and later transgender from mid-century onward.[5][30] Imported from the German and ultimately modeled after German Transsexualismus (coined in 1923),[31] the English term transsexual has enjoyed international acceptability, though transgender has been increasingly preferred over transsexual.[32] The word transgender acquired its modern umbrella term meaning in the 1990s.[33][34]

Transgender

Psychiatrist John F. Oliven of Columbia University used the term transgenderism in his 1965 reference work Sexual Hygiene and Pathology,[35][36][37] writing that the term which had previously been used, transsexualism, "is misleading; actually, 'transgenderism' is meant, because sexuality is not a major factor in primary transvestism."[38][39] The term transgender was then popularized with varying definitions by transgender, transsexual, and transvestite people, including Christine Jorgensen[40] and Virginia Prince,[2] who used transgenderal[41] in the December 1969 issue of Transvestia, a national magazine for cross-dressers she founded.[42] By the mid-1970s both trans-gender and trans people were in use as umbrella terms,[note 1] while transgenderist and transgenderal were used to refer to people who wanted to live their lives as cross-gendered individuals without gender-affirming surgery.[43] Transgenderist was sometimes abbreviated as TG in educational and community resources; this abbreviation developed by the 1980s.[44][45]

By 1984, the concept of a "transgender community" had developed, in which transgender was used as an umbrella term.[46] In 1985, Richard Elkins established the "Trans-Gender Archive" at the University of Ulster.[42] By 1992, the International Conference on Transgender Law and Employment Policy defined transgender as an expansive umbrella term including "transsexuals, transgenderists, cross dressers", and anyone transitioning.[47] Leslie Feinberg's pamphlet, "Transgender Liberation: A Movement Whose Time has Come", circulated in 1992, identified transgender as a term to unify all forms of gender nonconformity; in this way transgender has become synonymous with queer.[48] In 1994, gender theorist Susan Stryker defined transgender as encompassing "all identities or practices that cross over, cut across, move between, or otherwise queer socially constructed sex/gender boundaries", including, but not limited to, "transsexuality, heterosexual transvestism, gay drag, butch lesbianism, and such non-European identities as the Native American berdache or the Indian Hijra".[49]

Between the mid-1990s and the early 2000s, the primary terms used under the transgender umbrella were "female to male" (FtM) for men who transitioned from female to male, and "male to female" (MtF) for women who transitioned from male to female. These terms have been superseded by "trans man" and "trans woman", respectively.[50] This shift in preference from terms highlighting biological sex ("transsexual", "FtM") to terms highlighting gender identity and expression ("transgender", "trans man") reflects a broader shift in the understanding of transgender people's sense of self and the increasing recognition of those who decline medical reassignment as part of the transgender community.[50]

Transgender can also refer specifically to a person whose gender identity is opposite (rather than different from) the sex the person had or was identified as having at birth.[51][52][53][54]

Transfeminine is a term for any person, binary or non-binary, who was assigned male at birth and has a predominantly feminine gender identity or presentation.[55]

Transmasculine refers to a person assigned female at birth who has a predominantly masculine gender identity or presentation.[55]

Transgendered is a common term in older literature. Many within the transgender community deprecate it on the basis that transgender is an adjective, not a verb.[56] Organizations such as GLAAD and The Guardian also state that transgender should never be used as a noun (e.g., "Max is transgender" or "Max is a transgender man", not "Max is a transgender").[5][57] "Transgender" is also a noun for the broader topic of transgender identity and experience.[58]

Although the term "transgenderism" was once considered acceptable, it has come to be viewed as offensive, according to GLAAD.[59][60] In 2020 the International Journal of Transgenderism changed its name to the International Journal of Transgender Health "to reflect a change toward more appropriate and acceptable use of language in our field."[61]

Health-practitioner manuals, professional journalistic style guides, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender person's past.[62][63]

In contrast, people whose sense of personal identity corresponds to the sex and gender assigned to them at birth – that is, those who are neither transgender nor non-binary or genderqueer – are called cisgender.[64]

Transsexual

Inspired by Magnus Hirschfeld's 1923 term seelischer Transsexualismus, the term transsexual was introduced to English in 1949 by David Oliver Cauldwell[note 2] and popularized by Harry Benjamin in 1966, around the same time transgender was coined and began to be popularized.[2] Since the 1990s, transsexual has generally been used to refer to the subset of transgender people[2][65][66] who desire to transition permanently to the gender with which they identify and who seek medical assistance (for example, sex reassignment surgery) with this.

Distinctions between the terms transgender and transsexual are commonly based on distinctions between gender and sex.[67][68] Transsexuality may be said to deal more with physical aspects of one's sex, while transgender considerations deal more with one's psychological gender disposition or predisposition, as well as the related social expectations that may accompany a given gender role.[69] Many transgender people reject the term transsexual.[3][70][5] Christine Jorgensen publicly rejected transsexual in 1979 and instead identified herself in newsprint as trans-gender, saying, "gender doesn't have to do with bed partners, it has to do with identity."[71][72] Some have objected to the term transsexual on the basis that it describes a condition related to gender identity rather than sexuality.[73][better source needed][note 3][failed verification] Some transsexual people object to being included in the transgender umbrella.[74][75][76]

In his 2007 book Imagining Transgender: An Ethnography of a Category, anthropologist David Valentine asserts that transgender was coined and used by activists to include many people who do not necessarily identify with the term and states that people who do not identify with the term transgender should not be included in the transgender spectrum.[74] Leslie Feinberg likewise asserts that transgender is not a self-identifier (for some people) but a category imposed by observers to understand other people.[75] According to the Transgender Health Program (THP) at Fenway Health in Boston, there are no universally-accepted definitions, and confusion is common because terms that were popular at the turn of the 21st century may have since been deemed offensive. The THP recommends that clinicians ask clients what terminology they prefer, and avoid the term transsexual unless they are sure that a client is comfortable with it.[73][undue weight? ]

Harry Benjamin invented a classification system for transsexuals and transvestites, called the Sex Orientation Scale (SOS), in which he assigned transsexuals and transvestites to one of six categories based on their reasons for cross-dressing and the relative urgency of their need (if any) for sex reassignment surgery.[77] Contemporary views on gender identity and classification differ markedly from Harry Benjamin's original opinions.[78] Sexual orientation is no longer regarded as a criterion for diagnosis, or for distinction between transsexuality, transvestism and other forms of gender-variant behavior and expression. Benjamin's scale was designed for use with heterosexual trans women, and trans men's identities do not align with its categories.[79]

Sexual orientation

Gender, gender identity, and being transgender are distinct concepts from sexual orientation.[80] Sexual orientation is an individual's enduring pattern of attraction, or lack thereof, to others (being straight, lesbian, gay, bisexual, asexual, etc.), whereas gender identity is a person's innate knowledge of their own gender (being a man, woman, non-binary, etc.).[59] Transgender people can have any orientation, and generally use labels corresponding to their gender, rather than assigned sex at birth. For example, trans women who are exclusively attracted to other women commonly identify as lesbians, and trans men exclusively attracted to women would identify as straight.[59] Many trans people describe their sexual orientation as queer, in addition to or instead of, other terms.[81][82][83]

For much of the 20th century, transgender identity was conflated with homosexuality and transvestism.[84][85] In earlier academic literature, sexologists used the labels homosexual and heterosexual transsexual to categorize transgender individuals' sexual orientation based on their birth sex.[86] Critics consider these terms "heterosexist",[87] "archaic",[88] and demeaning.[89] Newer literature often uses terms such as attracted to men (androphilic), attracted to women (gynephilic), attracted to both (bisexual), or attracted to neither (asexual) to describe a person's sexual orientation without reference to their gender identity.[90] Therapists are coming to understand the necessity of using terms with respect to their clients' gender identities and preferences.[91]

The 2015 U.S. Transgender Survey reported that of the 27,715 transgender and non-binary respondents, 21% said queer best described their sexual orientation, 18% said pansexual, 16% said gay, lesbian, or same-gender-loving, 15% said straight, 14% said bisexual, and 10% said asexual.[82] A 2019 Canadian survey of 2,873 trans and non-binary people found that 51% described their sexual orientation as queer, 13% as asexual, 28% as bisexual, 13% as gay, 15% as lesbian, 31% as pansexual, 8% as straight or heterosexual, 4% as two-spirit, and 9% as unsure or questioning.[83] A 2009 study in Spain found that 90% of trans women patients reported being androphilic and 94% of trans men patients reported being gynephilic.[92]

Related identities and practices

Non-binary identity

Some non-binary (or genderqueer) people identify as transgender. These identities are not specifically male or female. They can be agender, androgynous, bigender, pangender, or genderfluid,[93] and exist outside of cisnormativity.[94][95] Bigender and androgynous are overlapping categories; bigender individuals may identify as moving between male and female roles (genderfluid) or as being both masculine and feminine simultaneously (androgynous), and androgynes may similarly identify as beyond gender or genderless (agender), between genders (intergender), moving across genders (genderfluid), or simultaneously exhibiting multiple genders (pangender).[96] Non-binary gender identities are independent of sexual orientation.[97][98]

Transvestism and cross-dressing

A transvestite is a person who cross-dresses, or dresses in clothes typically associated with the gender opposite the one they were assigned at birth.[99][100] The term transvestite is used as a synonym for the term cross-dresser,[101][102] although cross-dresser is generally considered the preferred term.[102][103] The term cross-dresser is not exactly defined in the relevant literature. Michael A. Gilbert, professor at the Department of Philosophy, York University, Toronto, offers this definition: "[A cross-dresser] is a person who has an apparent gender identification with one sex, and who has and certainly has been birth-designated as belonging to [that] sex, but who wears the clothing of the opposite sex because it is that of the opposite sex."[104] This definition excludes people "who wear opposite sex clothing for other reasons", such as "those female impersonators who look upon dressing as solely connected to their livelihood, actors undertaking roles, individual males and females enjoying a masquerade, and so on. These individuals are cross dressing but are not cross dressers."[105] Cross-dressers may not identify with, want to be, or adopt the behaviors or practices of the opposite gender and generally do not want to change their bodies medically or surgically. The majority of cross-dressers identify as heterosexual.[106]

The term transvestite and the associated outdated term transvestism are conceptually different from the term transvestic fetishism, as transvestic fetishist refers to those who intermittently use clothing of the opposite gender for fetishistic purposes.[107][108] In medical terms, transvestic fetishism is differentiated from cross-dressing by use of the separate codes 302.3 in the Diagnostic and Statistical Manual of Mental Disorders (DSM)[108] and F65.1 in the ICD.[107][needs update]

Drag

A drag queen performer

Drag is clothing and makeup worn on special occasions for performing or entertaining, unlike those who are transgender or who cross-dress for other reasons.[109] Drag performance includes overall presentation and behavior in addition to clothing and makeup. Drag can be theatrical, comedic, or grotesque. Drag queens have been considered caricatures of women by second-wave feminism. Drag artists have a long tradition in LGBT culture.

Generally the term drag queen covers men doing female drag, drag king covers women doing male drag, and faux queen covers women doing female drag.[11][110] Nevertheless, there are drag artists of all genders and sexualities who perform for various reasons. Drag performers are not inherently transgender. Some drag performers, transvestites, and people in the gay community have embraced the pornographically derived term tranny for drag queens or people who engage in transvestism or cross-dressing; this term is widely considered an offensive slur if applied to transgender people.

History

A precise history of the global occurrence of transgender people is difficult to assess because the modern concept of being transgender, and of gender in general in relation to transgender identity, did not develop until the mid-1900s. Historical depictions, records and understandings are inherently filtered through modern principles, and were largely viewed through a medical and (often outsider) anthropological lens until the late 1900s.[111][112]

Some historians consider the Roman emperor Elagabalus to have been transgender. Elagabalus was reported to have dressed in a feminine manner, preferred to be called "Lady" instead of "Lord" and may have even sought a primitive form of gender-affirming surgery.[113][114][115][116][117][excessive citations]

Worldwide, a number of societies have had traditional third gender roles, some of which continue in some form into the present day.[118]The Hippocratic Corpus (interpreting the writing of Herodotus) describes the "disease of the Scythians" (regarding the Enaree), which it attributes to impotency due to riding on a horse without stirrups. This reference was well discussed by medical writings of the 1500s–1700s. Pierre Petit writing in 1596 viewed the "Scythian disease" as natural variation, but by the 1700s writers viewed it as a "melancholy", or "hysterical" psychiatric disease. By the early 1800s, being transgender separate from Hippocrates' idea of it was claimed to be widely known, but remained poorly documented. Both trans women and trans men were cited in European insane asylums of the early 1800s. One of the earliest recorded transgender people in America was Thomas(ine) Hall, a seventeenth century colonial servant.[119] The most complete account of the time came from the life of the Chevalier d'Éon (1728–1810), a French diplomat. As cross-dressing became more widespread in the late 1800s, discussion of transgender people increased greatly and writers attempted to explain the origins of being transgender. Much study came out of Germany, and was exported to other Western audiences. Cross-dressing was seen in a pragmatic light until the late 1800s; it had previously served a satirical or disguising purpose. But in the latter half of the 1800s, cross-dressing and being transgender became viewed as an increasing societal danger.[111]

William A. Hammond wrote an 1882 account of transgender Pueblo "shamans" [sic] (mujerados), comparing them to the Scythian disease. Other writers of the late 1700s and 1800s (including Hammond's associates in the American Neurological Association) had noted the widespread nature of transgender cultural practices among native peoples. Explanations varied, but authors generally did not ascribe native transgender practices to psychiatric causes, instead condemning the practices in a religious and moral sense. Native groups provided much study on the subject, and perhaps the majority of all study until after WWII.[111]

Critical studies first began to emerge in the late 1800s in Germany, with the works of Magnus Hirschfeld. Hirschfeld coined the term "transvestite" in 1910 as the scope of transgender study grew. His work would lead to the 1919 founding of the Institut für Sexualwissenschaft in Berlin. Though Hirscheld's legacy is disputed, he revolutionized the field of study. The Institut was destroyed when the Nazis seized power in 1933, and its research was infamously burned in the May 1933 Nazi book burnings.[120] Transgender issues went largely out of the public eye until after World War II. Even when they re-emerged, they reflected a forensic psychology approach, unlike the more sexological that had been employed in the lost German research.[111][121]

Healthcare

Mental healthcare

People who experience discord between their gender and the expectations of others or whose gender identity conflicts with their body may benefit by talking through their feelings in depth. While individuals may find counseling or psychotherapy helpful, it is no longer recommended as a prerequisite for further transition steps.[122] Research on gender identity with regard to psychology, and scientific understanding of the phenomenon and its related issues, is relatively new.[123][needs update?] The term gender incongruence is listed in the ICD by the WHO. In the American (DSM), the term gender dysphoria is listed under code F64.0 for adolescents and adults, and F64.2 for children.[124] (Further information: Causes of gender incongruence.)

France removed gender identity disorder as a diagnosis by decree in 2010,[125][126] but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed.[127] In 2017, the Danish parliament abolished the F64 Gender identity disorders. The DSM-5 refers to the topic as gender dysphoria (GD) while reinforcing the idea that being transgender is not considered a mental illness.[128]

Transgender people may meet the criteria for a diagnosis of gender dysphoria "only if [being transgender] causes distress or disability."[129] This distress may manifest as depression or inability to work and form healthy relationships with others. This diagnosis is often misinterpreted as implying that all transgender people suffer from GD, which has confused transgender people and those who seek to either criticize or affirm them. Transgender people who are comfortable with their gender and whose gender is not directly causing inner frustration or impairing their functioning do not suffer from GD. Moreover, GD is not necessarily permanent and is often resolved through therapy or transitioning. Feeling oppressed by the negative attitudes and behaviours of such others as legal entities does not indicate GD. GD does not imply an opinion of immorality; the psychological establishment holds that people with any kind of mental or emotional problem should not receive stigma. The solution for GD is whatever will alleviate suffering and restore functionality; this solution often, but not always, consists of undergoing a gender transition.[123]

Clinical training lacks relevant information needed in order to adequately help transgender clients, which results in a large number of practitioners who are not prepared to sufficiently work with this population of individuals.[130] Many mental healthcare providers know little about transgender issues. Those who seek help from these professionals often educate the professional without receiving help.[123] This solution usually is good for transsexual people but is not the solution for other transgender people, particularly non-binary people who lack an exclusively male or female identity. Instead, therapists can support their clients in whatever steps they choose to take to transition or can support their decision not to transition while also addressing their clients' sense of congruence between gender identity and appearance.[131]

Research on the specific problems faced by the transgender community in mental health has focused on diagnosis and clinicians' experiences instead of transgender clients' experiences.[132] Therapy was not always sought by transgender people due to mental health needs. Prior to the seventh version of the Standards of Care (SOC), an individual had to be diagnosed with gender identity disorder in order to proceed with hormone treatments or sexual reassignment surgery. The new version decreased the focus on diagnosis and instead emphasized the importance of flexibility in order to meet the diverse health care needs of transsexual, transgender, and all gender-nonconforming people.[133]

The reasons for seeking mental health services vary according to the individual. A transgender person seeking treatment does not necessarily mean their gender identity is problematic. The emotional strain of dealing with stigma and experiencing transphobia pushes many transgender people to seek treatment to improve their quality of life, as one trans woman reflected: "Transgendered individuals are going to come to a therapist and most of their issues have nothing to do, specifically, with being transgendered. It has to do because they've had to hide, they've had to lie, and they've felt all of this guilt and shame, unfortunately usually for years!"[132] Many transgender people also seek mental health treatment for depression and anxiety caused by the stigma attached to being transgender, and some transgender people have stressed the importance of acknowledging their gender identity with a therapist in order to discuss other quality-of-life issues.[132] Rarely, some choose to detransition.[134]

Problems still remain surrounding misinformation about transgender issues that hurt transgender people's mental health experiences. One trans man who was enrolled as a student in a psychology graduate program highlighted the main concerns with modern clinical training: "Most people probably are familiar with the term transgender, but maybe that's it. I don't think I've had any formal training just going through [clinical] programs ... I don't think most [therapists] know. Most therapists – Master's degree, PhD level – they've had ... one diversity class on GLBT issues. One class out of the huge diversity training. One class. And it was probably mostly about gay lifestyle."[132] Many health insurance policies do not cover treatment associated with gender transition, and numerous people are under- or uninsured, which raises concerns about the insufficient training most therapists receive prior to working with transgender clients, potentially increasing financial strain on clients without providing the treatment they need.[132] Many clinicians who work with transgender clients only receive mediocre training on gender identity, but introductory training on interacting with transgender people has recently been made available to health care professionals to help remove barriers and increase the level of service for the transgender population.[135] In February 2010, France became the first country in the world to remove transgender identity from the list of mental diseases.[136][137]

A 2014 study carried out by the Williams Institute (a UCLA think tank) found that 41% of transgender people had attempted suicide, with the rate being higher among people who experienced discrimination in access to housing or healthcare, harassment, physical or sexual assault, or rejection by family.[138] A 2019 follow-up study found that transgender people who wanted and received gender-affirming medical care had significantly lower rates of suicidal thoughts and attempts.[139] However, a study on the impact of parental support on trans youth found that among trans children with supportive parents, only 4% attempted suicide, a 93% decrease.[140]

Suicidal thoughts and attempts by gender affirmation milestones[139]
Intervention Category Suicidal Thoughts (Past 12 Months) Suicidal Attempts (Past 12 Months) Lifetime Suicidal Thoughts Lifetime Suicidal Attempts
Want horomones and have not had them 57.9 8.9 84.4 41.1
Want horomones and have had them 42.9 6.5 81.9 42.4
Want reassignment surgery, have not had 54.8 8.5 83.9 41.5
Want reassignment surgery, have had 38.2 5.1 79.0 39.5
Have not "de-transitioned" 44.2 6.7 81.6 41.8
Have "de-transitioned" 57.3 11.8 86.0 52.5

Autism is more common in people who are gender dysphoric. It is not known whether there is a biological basis. This may be due to the fact that people on the autism spectrum are less concerned with societal disapproval, and feel less fear or inhibition about coming out as trans than others.[141][better source needed]

Physical healthcare

Medical and surgical procedures exist for transsexual and some transgender people, though most categories of transgender people as described above are not known for seeking the following treatments. Hormone replacement therapy for trans men induces beard growth and masculinizes skin, hair, voice, and fat distribution. Hormone replacement therapy for trans women feminizes fat distribution and breasts, as well as diminishes muscle mass and strength. Laser hair removal or electrolysis removes excess hair for trans women. Surgical procedures for trans women feminize the voice, skin, face, Adam's apple, breasts, waist, buttocks, and genitals. Surgical procedures for trans men masculinize the chest and genitals and remove the womb, ovaries, and fallopian tubes. The acronyms "Gender-affirming surgery (GAS)" and "sex reassignment surgery" (SRS) refer to genital surgery. The term "sex reassignment therapy" (SRT) is used as an umbrella term for physical procedures required for transition. Use of the term "sex change" has been criticized for its emphasis on surgery, and the term "transition" is preferred.[5][142] Availability of these procedures depends on degree of gender dysphoria, presence or absence of gender identity disorder,[143] and standards of care in the relevant jurisdiction.

Trans men who have not had a hysterectomy and who take testosterone are at increased risk for endometrial cancer because androstenedione, which is made from testosterone in the body, can be converted into estrogen, and external estrogen is a risk factor for endometrial cancer.[144]

Detransition

Detransition refers to the cessation or reversal of a sex reassignment surgery or gender transition. Formal studies of detransition have been few in number,[145] of disputed quality,[146] and politically controversial.[147] Estimates of the rate at which detransitioning occurs vary from less than 1% to as high as 13%.[148] Those who undergo sex reassignment surgery have very low rates of detransition or regret.[134][149][150][151]

The 2015 U.S. Transgender Survey, with responses from 27,715 individuals who identified as "transgender, trans, genderqueer, [or] non-binary", found that 8% of respondents reported some kind of detransition. "Most of those who de-transitioned did so only temporarily: 62% of those who had de-transitioned reported that they were currently living full time in a gender different than the gender they were thought to be at birth."[82] Detransition was associated with assigned male sex at birth, nonbinary gender identity, and bisexual orientation, among other cohorts.[150] Only 5% of detransitioners (or 0.4% of total respondents) reported doing so because gender transition was "not for them"; 82% cited external reason(s), including pressure from others, the difficulties of transition, and discrimination. "The most common reason cited for de-transitioning was pressure from a parent (36%)."[152][153][82]

Legality

Camille Cabral, a French transgender activist at a demonstration for transgender people in Paris, October 1, 2005

Legal procedures exist in some jurisdictions which allow individuals to change their legal gender or name to reflect their gender identity. Requirements for these procedures vary from an explicit formal diagnosis of transsexualism, to a diagnosis of gender identity disorder, to a letter from a physician that attests the individual's gender transition or having established a different gender role.[154] In 1994, the DSM IV entry was changed from "Transsexual" to "Gender Identity Disorder". In 2013, the DSM V removed "Gender Identity Disorder" and published "Gender Dysphoria" in its place.[155] In many places, transgender people are not legally protected from discrimination in the workplace or in public accommodations.[24] A report released in February 2011 found that 90% of transgender people faced discrimination at work and were unemployed at double the rate of the general population,[22] and over half had been harassed or turned away when attempting to access public services.[22] Members of the transgender community also encounter high levels of discrimination in health care.[156]

Europe

A Welsh Government advisory video on transgender hate crimes

36 countries in Europe require a mental health diagnosis for legal gender recognition and 20 countries require sterilisation.[157] In April 2017, the European Court of Human Rights ruled that requiring sterilisation for legal gender recognition violates human rights.[158]

Canada

Jurisdiction over legal classification of sex in Canada is assigned to the provinces and territories. This includes legal change of gender classification. On June 19, 2017, Bill C-16, having passed the legislative process in the House of Commons of Canada and the Senate of Canada, became law upon receiving Royal Assent, which put it into immediate force.[159][160][161] The law updated the Canadian Human Rights Act and the Criminal Code to include "gender identity and gender expression" as protected grounds from discrimination, hate publications and advocating transgender genocide. The bill also added "gender identity and expression" to the list of aggravating factors in sentencing, where the accused commits a criminal offence against an individual because of those personal characteristics. Similar transgender laws also exist in all the provinces and territories.[162]

United States

In the United States, transgender people are protected from employment discrimination by Title VII of the Civil Rights Act of 1964. Exceptions apply to certain types of employers, for example, employers with fewer than 15 employees and religious organizations.[163] In 2020, the U.S. Supreme Court affirmed that Title VII prohibits discrimination against transgender people in the case R.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission.[164]

Nicole Maines, a trans girl, took a case to Maine's supreme court in June 2013. She argued that being denied access to her high school's women's restroom was a violation of Maine's Human Rights Act; one state judge has disagreed with her,[165] but Maines won her lawsuit against the Orono school district in January 2014 before the Maine Supreme Judicial Court.[166] On May 14, 2016, the United States Department of Education and Department of Justice issued guidance directing public schools to allow transgender students to use bathrooms that match their gender identities.[167]

On June 30, 2016, the United States Department of Defense removed the ban that prohibited transgender people from openly serving in the US military.[168] On July 27, 2017, President Donald Trump tweeted that transgender Americans would not be allowed to serve "in any capacity" in the United States Armed Forces.[169] Later that day, Joint Chiefs of Staff Chairman Joseph Dunford announced, "there will be no modifications to the current policy until the president's direction has been received by the Secretary of Defense and the secretary has issued implementation guidance."[170] Joe Biden later reversed Trump's policy when he became president in 2021.[171][172]

India

Jogappa is a transgender community in Karnataka and Andhra Pradesh. They are traditional folk singers and dancers.

In April 2014, the Supreme Court of India declared transgender to be a 'third gender' in Indian law.[173][174][175] The transgender community in India (made up of Hijras and others) has a long history in India and in Hindu mythology.[176][177] Justice KS Radhakrishnan noted in his decision that, "Seldom, our society realizes or cares to realize the trauma, agony and pain which the members of Transgender community undergo, nor appreciates the innate feelings of the members of the Transgender community, especially of those whose mind and body disown their biological sex".[178] Hijras have faced structural discrimination including not being able to obtain driving licenses, and being prohibited from accessing various social benefits. It is also common for them to be banished from communities.[179]

Sociocultural relationships

LGBT community

Despite the distinction between sexual orientation and gender, throughout history gay, lesbian and bisexual subcultures were often the only places where gender-variant people were socially accepted in the gender role they felt they belonged to; especially during the time when legal or medical transitioning was almost impossible. This acceptance has had a complex history. Like the wider world, the gay community in Western societies did not generally distinguish between sex and gender identity until the 1970s, and the role of the transgender community in the history of LGBT rights is often overlooked.[180]

According to a study done at University of California, Los Angeles in 2011, conducted in part by Gary J. Gates, 3.5% of adults across the United States identify as either gay, lesbian, or bisexuals whereas only 0.3% of adults identify as transgender.[181] Transgender individuals have been part of various LGBT movements throughout history, with significant contributions dating back to the early days of the gay liberation movement.[182]

The LGBT community is not a monolithic group, and there are different modes of thought on who is a part of this diverse community. The changes that came with the Gay Liberation Movement and Civil Rights movement saw many gay, lesbian, and bisexual people making headway within the public sphere, and gaining support from the wider public, throughout the latter half of the twentieth century. The trans community only experienced a similar surge in activism during the start of the twenty-first century.[183][182] Due to the many different groups that make up the broader LGBT movement, there are those within the larger community who do not believe that the trans community has a place within the LGBT space.[183][184]

Religion

The Vatican’s doctrine department has issued a recent ruling that allows Catholic baptism for transgender individuals and infants born to same-sex couples. Dated October 31, 2023, these new regulations stem from questions submitted by Brazilian bishop Giuseppe Negri to the dicastery for the Doctrine of the Faith (DDF). The responses, addressing specific sacraments, were published on the Vatican’s website in Italy. Concerning transgender individuals, the document states that they can undergo baptism like any other adult, as long as there is no potential for causing scandal or disorientation among other Catholics.

If children identifying as transgender are adequately prepared and willing, they can receive baptism, according to the document. Additionally, it mentions that transgender individuals, including those who have undergone gender reassignment, can serve as godparents and witnesses in Catholic weddings under appropriate conditions. The document also allows the baptism of children from same-sex couples, provided there is a well-founded hope that they will receive Catholic religious education. The document emphasizes that individuals in same-sex relationships are regarded as committing a sin, and baptism is conditional upon repentance for such actions. Several sermons by Pope Francis are referenced in the document to support this ruling.[185]

The Church of England passed a motion at the 2017 General Synod, which would ensure Anglican churches accepted transgender people, even suggesting on their website that transgender people could be gifted a Bible with their new name inscribed to support them.[186]

Feminism

Feminist views on transgender women have changed over time, but have generally become more positive. Second-wave feminism saw numerous clashes opposed to transgender women, since they were not seen as "true" women, and as invading women-only spaces.[187][188] Though second-wave feminism argued for the sex and gender distinction, some feminists believed there was a conflict between transgender identity and the feminist cause; e.g., they believed that male-to-female transition abandoned or devalued female identity and that transgender people embraced traditional gender roles and stereotypes.[189] By the emergence of third-wave feminism (around 1990), opinions had shifted to being more inclusive of both trans and gay identities.[190][191] Fourth-wave feminism (starting around 2012) has been widely trans-inclusive, but trans-exclusive groups and ideas remain as a minority, though one that is especially prominent in the UK.[192][190][193] Feminists who do not accept that trans women are women have been labeled "trans-exclusionary radical feminists" (TERFs) or gender-critical feminists by opponents.[194][195]

Discrimination and support

Transgender individuals experience significant rates of employment discrimination. Approximately 90% of trans people have encountered some form of harassment or mistreatment in their workplace. Moreover, 47% have experienced some form of adverse employment outcome due to being transgender; of this figure, 44% were passed over for a job, 23% were denied a promotion, and 26% were terminated on the grounds that they were transgender.[196]

Studies in several cultures have found that cisgender women are more likely to be accepting of trans people than cisgender men.[197][198][199][200]

The start of the twenty-first century saw the rise in transgender activism and with it an increase in support.[182] Within the United States, groups such as the Trevor Project have been serving the wider LGBT community including people who identify with the term transgender. The group offers support in the form of educational resources including research, advocacy, and crisis services.[201] The American Civil Liberties Unions (ACLU) is another group that fights legal battles in support of many different groups including those in the trans community.[202]

Other groups within the United States specifically advocate for transgender rights. One of these groups directly related to transgender support is the National Center for Transgender Equality (NCTE), which is committed to advocating for policy changes that protect transgender people and promote equality. Through their research, education, and advocacy efforts, the NCTE works to address issues such as healthcare access, employment discrimination, and legal recognition for transgender individuals.[203] One prominent organization within Europe is Transgender Europe (TGEU), a network of organizations and individuals committed to promoting equality and human rights for transgender people within European borders. TGEU works to challenge discrimination, improve transgender healthcare access, advocate for legal recognition of gender identity, and support the well-being of transgender communities.[204]

Population figures and prevalence

Little is known about the prevalence of transgender people in the general population and reported prevalence estimates are greatly affected by variable definitions of transgender.[205] According to a recent systematic review, an estimated 9.2 out of every 100,000 people have received or requested gender affirmation surgery or transgender hormone therapy; 6.8 out of every 100,000 people have received a transgender-specific diagnoses; and 355 out of every 100,000 people self-identify as transgender.[205] These findings underscore the value of using consistent terminology related to studying the experience of transgender, as studies that explore surgical or hormonal gender affirmation therapy may or may not be connected with others that follow a diagnosis of "transsexualism", "gender identity disorder", or "gender dysphoria", none of which may relate with those that assess self-reported identity.[205] Common terminology across studies does not yet exist, so population numbers may be inconsistent, depending on how they are being counted.

A study in 2020 found that, since 1990, of those seeking sex hormone therapy for gender dysphoria there has been a steady increase in the percentage of trans men, such that they equal the number of trans women seeking this treatment.[206]

Asia

Nong Tum, a Kathoey internationally recognized for her portrayal in the film Beautiful Boxer

In Thailand and Laos,[207] the term kathoey is used to refer to male-to-female transgender people[208] and effeminate gay men.[209] However, many transgender people in Thailand do not identify as kathoey.[210] Transgender people have also been documented in Iran,[211] Japan,[212] Nepal,[213] Indonesia,[214] Vietnam,[215] South Korea,[216] Jordan,[217] Singapore,[218] and the greater Chinese region, including Hong Kong,[219][220] Taiwan,[221] and the People's Republic of China.[222][223]

The cultures of the Indian subcontinent include a third gender, referred to as hijra in Hindi. In India, the Supreme Court on April 15, 2014, recognized a third gender that is neither male nor female, stating "Recognition of transgenders as a third gender is not a social or medical issue but a human rights issue."[224] In 1998, Shabnam Mausi became the first transgender person to be elected in India, in the central Indian state of Madhya Pradesh.[225]

Europe

According to Amnesty International, 1.5 million transgender people live in the European Union (as at 2017), making up 0.3% of the population.[226] A 2011 survey conducted by the Equality and Human Rights Commission in the UK found that of 10,026 respondents, 1.4% would be classified into a gender minority group. The survey also showed that 1% had gone through any part of a gender reassignment process (including thoughts or actions).[227] In the England and Wales section of the 2021 United Kingdom census, 0.5% of respondents aged 16 and over indicated that their gender identity was different from their sex assigned at birth.[228]

North America

The 2021 Canadian census released by Statistics Canada found that 59,460 Canadians (0.19% of the population) identified as transgender.[229] According to the Survey of Safety in Public and Private Spaces by Statistics Canada in 2018, 0.24% of the Canadian population identified as transgender men, women or non-binary individuals.[230]

The Social Security Administration has tracked the sex of United States citizens since 1936.[231] A 1968 estimate, by Ira B. Pauly, estimated that about 2,500 transsexual people were living in the United States, with four times as many trans women as trans men.[232] One effort to quantify the modern population in 2011 gave a "rough estimate" that 0.3% of adults in the US are transgender.[233][234] More recent studies released in 2016 estimate the proportion of Americans who identify as transgender at 0.5 to 0.6%. This would put the total number of transgender Americans at approximately 1.4 million adults (as of 2016).[235][236][237][238]

In the United States and Canada, some Native American and First Nations cultures traditionally recognize the existence of more than two genders,[239] such as the Zuni male-bodied lhamana,[240] the Lakota male-bodied winkte,[241] and the Mohave male-bodied alyhaa and female-bodied hwamee.[242] These traditional people, along with those from other North American Indigenous cultures, are sometimes part of the contemporary, pan-Indian two-spirit community.[241] Historically, in most cultures who have alternate gender roles, if the spouse of a third gender person is not otherwise gender variant, they have not generally been regarded as other-gendered themselves, simply for being in a same-sex relationship.[242] In Mexico, the Zapotec culture includes a third gender in the form of the Muxe.[243] Mahu is a traditional third gender in Hawai'i and Tahiti. Mahu are valued as teachers, caretakers of culture, and healers, such as Kapaemahu. Diné (Navajo) have Nádleehi.[118]

Latin America

In Latin American cultures, a travesti is an individual who has been assigned male at birth and who has a feminine, transfeminine, or "femme" gender identity. Travestis generally undergo hormonal treatment, use female gender expression including new names and pronouns from the masculine ones they were given when assigned a sex, and might use breast implants, but they are not offered or do not desire sex-reassignment surgery. Travesti might be regarded as a gender in itself (a "third gender"), a mix between man and woman ("intergender/androgynes"), or the presence of both masculine and feminine identities in a single person ("bigender"). They are framed as something entirely separate from transgender women, who possess the same gender identity of people assigned female at birth.[244]

Other transgender identities are becoming more widely known, as a result of contact with other cultures of the Western world.[245] These newer identities, sometimes known under the umbrella use of the term "genderqueer",[245] along with the older travesti term, are known as non-binary and go along with binary transgender identities (those traditionally diagnosed under the obsolete label of "transsexualism") under the single umbrella of transgender, but are distinguished from cross-dressers and drag queens and kings, that are held as nonconforming gender expressions rather than transgender gender identities when a distinction is made.[246]

Culture

Coming out

Transgender people vary greatly in choosing when, whether, and how to disclose their transgender status to family, close friends, and others. The prevalence of discrimination and violence against transgender persons can make coming out a risky decision. Fear of retaliatory behavior, such as being removed from the parental home while underage, is a cause for transgender people to not come out to their families until they have reached adulthood.[citation needed] Parental confusion and lack of acceptance of a transgender child may result in parents treating a newly revealed gender identity as a "phase" or making efforts to change their children back to "normal" by utilizing mental health services to alter the child's gender identity.[247][better source needed]

The internet can play a significant role in the coming out process for transgender people. Some come out in an online identity first, providing an opportunity to go through experiences virtually and safely before risking social sanctions in the real world.[248]

Visibility

Actress Laverne Cox, who is trans, in July 2014

In 2014, the United States reached a "transgender tipping point", according to Time.[249][250] At this time, the media visibility of transgender people reached a level higher than seen before. Since then, the number of transgender portrayals across TV platforms has stayed elevated.[251]

Trans March "Existrans" 2017

Annual marches, protests or gatherings take place around the world for transgender issues, often taking place during the time of local Pride parades for LGBT people. These events are frequently organised by trans communities to build community, address human rights struggles, and create visibility.[252][253][254][255] International Transgender Day of Visibility is an annual holiday occurring on March 31[26][256] dedicated to celebrating transgender people and raising awareness of discrimination faced by transgender people worldwide. The holiday was founded by Michigan-based transgender activist[257] Rachel Crandall in 2009.[258]

Transgender Day of Remembrance (TDOR) is held every year on November 20 in honor of Rita Hester, who was killed on November 28, 1998. Her murder remains unsolved, but was described in 2022 as "a result of transphobia and anti-trans violence" by the Office of the Mayor of Boston, Michelle Wu.[25] TDOR memorializes victims of hate crimes and prejudice and raises awareness of hate crimes committed upon living transgender people.[259] Transgender Awareness Week is a one-week celebration leading up to TDOR, dedicated to educating about transgender and gender non-conforming people and the issues associated with their transition or identity.[260] Several trans marches occur in cities around the world, including Paris, San Francisco, and Toronto, in order to raise awareness of the transgender community.[261][262]

There are also significant portrayals of transgender people in the media. Transgender literature includes literature portraying transgender people, as well as memoirs or novels by transgender people, who often discuss elements of the transgender experience.[263] Several films and television shows feature transgender characters in the storyline, and several fictional works also have notable transgender characters.[264]

Pride symbols

A pedestrian traffic light in Trafalgar Square, London with the ⚧ symbol, installed for the 2016 Pride in London

A common symbol for the transgender community is the Transgender Pride Flag, which was designed by the American transgender woman Monica Helms in 1999, and was first shown at a pride parade in Phoenix, Arizona, in 2000. The flag consists of five horizontal stripes: light blue, pink, white, pink, and light blue[27] Other transgender symbols include the butterfly (symbolizing transformation or metamorphosis),[265] and a pink/light blue yin and yang symbol.[266] Several gender symbols have been used to represent transgender people, including ⚥ and .[267][268]

See also

Notes

  1. ^ * In April 1970, TV Guide published an article which referenced a post-operative transsexual movie character as being "transgendered."("Sunday Highlights". TV Guide. April 26, 1970. Archived from the original on 4 June 2012. Retrieved 28 May 2012. [R]aquel Welch (left), moviedom's sex queen soon to be seen as the heroine/hero of Gore Vidal's transgendered "Myra Breckinridge"...)
    • In the 1974 edition of Clinical Sexuality: A Manual for the Physician and the Professions, transgender was used as an umbrella term and the Conference Report from the 1974 "National TV.TS Conference" held in Leeds, West Yorkshire, UK used "trans-gender" and "trans.people" as umbrella terms.(Oliven, John F. (1974). Clinical sexuality: A Manual for the Physician and the Professions (3rd ed.). Lippincott. "Transgender deviance" p 110, "Transgender research" p 484, "transgender deviates" p 485, Transvestites not welcome at "Transgender Center" p 487. ISBN 9780397503292. OCLC 563898062. Archived from the original on 2015-12-05.), (2006). The Transgender Phenomenon (Elkins, Richard; King, Dave (2006). The Transgender Phenomenon. Sage. p. 13. ISBN 978-0-7619-7163-4. Archived from the original on 2015-09-26.)
    • A Practical Handbook of Psychiatry (1974) references "transgender surgery" noting, "The transvestite rarely seeks transgender surgery, since the core of his perversion is an attempt to realize the fantasy of a phallic woman."(Novello, Joseph R. (1974). A Practical Handbook of Psychiatry. Springfield, Illinois: C. C. Thomas. p. 176. ISBN 9780398028688. OCLC 643581864. Archived from the original on 2015-09-19.)
  2. ^ Magnus Hirschfeld coined the German term Transsexualismus in 1923, which Cauldwell translated into English.
  3. ^ The recurring concern that transsexual implies sexuality stems from the tendency of many informal speakers to ignore the sex and gender distinction and use gender for any male/female difference and sex for sexual activity. (Liberman, Mark. "Single-X Education". Language Log. Archived from the original on 15 April 2012. Retrieved 28 June 2012.)

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  35. ^ Thomas E. Bevan, The Psychobiology of Transsexualism and Transgenderism (2014, ISBN 1440831270, pages 42, 61: "The term transsexual was introduced by Cauldwell (1949) and popularized by Harry Benjamin (1966) [...]. The term transgender was coined by John Oliven (1965) and was popularized by various transgender people who pioneered the concept and practice of transgenderism....Oliven, J. (1965, June). Transgenderism = transsexualism. Sexual Hygiene and Pathology, 514.
  36. ^ Simon, Ray (2017). "Stirring up the origin of the 'alphabet soup'". Erie Gay News. Archived from the original on 11 November 2021. "According to scholars, the word first appeared in print in John F. Oliven's 1965 book, "Sexual Hygiene and Pathology." Oliven writes:
    Where the compulsive urge reaches beyond female vestments, and becomes an urge for gender ('sex') change, transvestism becomes 'transsexualism.' The term is misleading; actually, 'transgenderism' is what is meant, because sexuality is not a major factor in primary transvestism.
    Although Oliven's understanding of "transgender"is not the same as our understanding of it today, his use of it is still significant. As K.J. Rawson and Cristan Williams note in their book, "Transgender*: The Rhetorical Landscape of a Term," Oliven didn't use the word in the book's 1955 edition; it was added later, when the second edition was revised and published.
    Gradually, some members of this marginalized community began to apply the word "transgender"to themselves. For example, Virginia Charles Prince, publisher of the long-running periodical "Transvestia," occasionally used a variation of the word, "transgenderal.""
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Further reading