Is transgender transition the same as gender reassignment?

Do transgender people live less than others? Why don’t even some feminists like them?

Recently, writer Joan Rowling made fun of the expression “menstruating people” on Twitter and immediately received accusations of transphobia. In the meantime, many people did not understand why the joke was offensive, and once again began to argue about how to talk about transgenderism without offending anyone.

The top 10 things to know about transgenderism

1. Transgenderism is not a mental disorder.
2. Not all transgender people change what is commonly thought of as their biological sex. Moreover, it cannot be changed completely.
3. Therefore, when talking about transgender people, try to use the word “gender” (the term refers to a person’s identity) rather than “gender” or “sex” (the same as “sex” in English).
4. “Trans people,” “transvestites,” “transgender people,” should not be said that way. Better like this: “transgender people,” “transhumans,” “transpersons.
5. A person who sometimes changes into women’s clothes but does not feel like a woman should be called a crossdresser, not a transvestite.
6. Transgender people who have undergone hormone therapy do not live less than other people and do not have terrible health problems.
7. If a transgender man did not have his uterus and ovaries removed, he will be able to have a baby (he will have to stop hormone therapy to do so).
8. Scientists do not know the cause of transgenderism.
9. Transgenderism is not related to a person’s sexual orientation.
10. Some feminists do not accept transgender women as “real women.

PART FIRST.

Correct Words.

Are transgender people those who have had a sex change?

No. Instead of the word “gender” at all, it is better to use “gender,” a concept that refers primarily to social expectations of men and women, rather than to biological traits. These expectations include appearance, behavior, role models, etc. The sex assigned to a person at birth and his or her gender identity may not match.

The common expression “gender reassignment” usually implies that a person has changed his or her biological sex characteristics. But in reality, there is no one magic operation that “changes the sex”: every transhuman (even before any interventions) can do one or more manipulations to bring the inner feeling in line with the outer data – depending on his desires and abilities. This can be hormone therapy, one or more surgeries on the body, cosmetic changes in appearance (for example, a new closet or hairstyle), a change of name, documents and gender marker in the passport – everyone chooses for himself. And instead of “gender reassignment,” we should say “transgender transition” or “transsexual transition. Or even just “transition.”

What words should we use when we talk about transgender people? Is transgender okay?

It is correct to say “transgender person,” “transgender man,” and “transgender woman” about people. You can also use the prefix “trans”: “transhuman,” “transmasculine,” “transwoman,” “transpersonal.

The word “transgender” (a calque from the English adjective transgender, which came into Russian as a noun) is also incorrect, as it reduces transgender people only to their gender identity (for the same reason it is better to say “person with a disability” rather than “disabled person”). The word “trans” is also a bad word. No one says “cisgender” – much less “cis.”

I’m sorry, but I don’t understand – when are we talking about trans men and when are we talking about trans women?

Transgender people are referred to as “male” or “female” based on which direction the transition is taking. That is, a transgender man or transmasculine person is a person with a female sex assigned at birth who is making or has already made the transition. Not the other way around.

Speaking of the direction of transition. The abbreviations MtF (male to female) and FtM (female to male) mean the direction of transition, not the person himself. You can’t say “he’s an FtM-man” – it’s correct to say “he’s in the FtM-transition”. One can also say “transfeminine” or “transmasculine” about the transition – with this, we think, everything is clear.

Are transsexuals and transgender people the same thing?

“Transsexualism” is an outdated medical diagnosis, offensive to the trans community, so we should not use this word and its derivatives at all. There’s also confusion over the word “sex”: in English, where the words came from, sex means “sex,” not just having sex.

Who are transvestites then? Or is it no longer allowed to say that either?

You shouldn’t. Transgender people should not be confused with crossdressers – they used to be called transvestites, but that term is outdated and considered incorrect today because it was once used as a diagnosis too.

Crossdressers dress in the clothes of the opposite gender, usually temporarily, but do not make the transgender transition and do not experience (or experience to a lesser degree) dissatisfaction because of their assigned sex at birth. For some people, though, crossdressing can be one step in transgender transition.

There are also hermaphrodites. Are they transgender as well?

The correct term in this case is intersex people, and they do not refer to trans people. Intersex people can have any sexual orientation and gender identity.

Intersex people are people born with genitalia that do not look typically male or female or simply do not match the chromosomal sex of the person. There are about 60 intersex variations in total. For example, a person can have a completely female body, but with a large clitoris (which can be confused with a penis) or, for example, a completely male body, but with an extra X chromosome. In short, it could be any anatomy that differs from a typically female or male body.

How to refer to transgender people?

Call a person by the gender in which they refer to themselves. A transgender man is “he,” a transgender woman is “she.” Most transgender people change their name and do not want their previous name (“deadname”) to be used. Addressing a person by their old name is called deadnaming.

However, some non-binary people prefer to call themselves “they” or “it” because they do not identify themselves as a gender. Some trans people have a feminine name, but refer to themselves as masculine (and vice versa). Generally speaking, when it comes to gender and pronouns, it’s always best to ask the person themselves, so as not to get confused.

The same applies to talking about a person’s past. From the outside world’s perspective, the transgender man “was a woman” and spoke of himself in the feminine gender. But don’t forget that he himself was uncomfortable with it (at least for a while), even if he didn’t show it. He could wear skirts and wear makeup, he could say “I went” and so on, but if, after making the transition, he talks about himself in the male gender and associates himself with the male gender, you should believe him and accept it – even if before that the man had positioned himself as a woman.

But why is everyone so viciously against Joan Rowling? “Menstruating people” does sound strange.

Not only cisgender women can have menstruation, but also trans men and non-binary people. That said, transwomen do not have periods. The phrase “people who menstruate” is correct because it acknowledges that transgender and non-binary people also have menstrual experiences.

PART TWO.

Transgender Transition

Why don’t all transgender people have surgery? How do they feel in a body that does not conform to their self-image?

Most transgender people experience dysphoria, a term used to describe the discomfort of not conforming to the gender identity assigned at birth. Often such dysphoria generates a desire to adjust one’s inner feelings with one’s appearance and documents. It is enough for some to change their clothing style and name, some change their documents and the gender marker in their passport, some start hormonal therapy, some have one or more surgeries, and some have all or some of the above.

Trans men can have mastectomies (removal of the breasts), hysterectomies (removal of the uterus), metoidioplasty, and phalloplasty (lengthening the clitoris and shaping the penis).

Trans women can have orchiectomies (removal of testicles), vaginoplasty (vagina shaping), and breast augmentation surgery.

All of this costs money, and not everyone is willing to undergo surgery, which is why not all trans people undergo surgery. Metoidioplasty and phalloplasty are considered particularly difficult and traumatic, which is why most trans men do not have genital surgery.

How much does it cost to do all the surgeries and manipulations to make a transgender transition?

As we said, there is no one complete set of manipulations. Depending on the country and the type of surgery, prices can range from one thousand dollars (for a mastectomy in Russia) to $10,000 (for vaginoplasty in Thailand). Metoidioplasty and Falloplasty are even more expensive and are often performed in several stages. In addition to genital and breast surgeries, trans people can undergo plastic surgery on the face and other parts of the body. The number of such surgeries can be anything – accordingly, the price tag can be infinitely high.

Many trans people prefer to have surgeries in Thailand because of the price-quality ratio, and the experience of Thai doctors is quite extensive. Surgeries in Europe and the United States are predictably more expensive. In Russia, on the contrary, it’s cheaper, but there are far fewer experienced surgeons who specialize, for example, in vaginoplasty or phalloplasty.

Is it true that people who want to make the transition, first put in a mental hospital? What do they do to them there?

No. But in order to change documents and start hormone replacement therapy, in Russia you have to register with a psychiatrist – this can be done as an outpatient – and no surgery is required beforehand. Unfortunately, the diagnosis of “transsexualism” (F 64.0) in our country refers to mental illness, although in Western countries “transsexualism” has long been in fact not considered a disease. In 2019, the International Classification of Diseases Revision 11 (ICD-11) removed transgenderism from the group of mental illnesses. Everywhere in the world, including Russia, ICD-11 is scheduled to take effect in 2022.

After a diagnosis is made, a person receives a certificate of indication for hormone therapy and/or surgery and undergoes a medical commission consisting of a psychiatrist, medical psychologist and sexologist. As a rule, such commissions are paid and cost about 30 thousand rubles. The commission, if everything goes according to plan, issues certificate No. 087/ “About the sex change”, with which one may go to the registry office and change the name and gender marker in the passport.

Often registries refuse the first time – then a person goes to court, which, as a rule, wins. On the second attempt the registry office changes the documents. In Russia, this is quite a well-established practice, and transgender support groups advise those who wish to do so.

Does hormone therapy make women grow beards and men grow breasts?

Not only that. Because of testosterone, trans men get body and facial hair, they lose their periods, and their muscles grow. Body and facial fat is redistributed, the complexion becomes redder. Their blood pressure rises and the veins in their arms become bulging. Body odor changes. Many people lose hair on their heads. The clitoris begins to grow and may reach a length of three to five centimeters. He gets an erection.

When taking estrogen, the opposite is true for trans women. Muscle relief disappears, the body becomes more streamlined. The color of the face becomes pale, the veins in the arms cease to be bulging, the mammary glands swell.

They say that in Western countries, teenagers are allowed to make the transgender transition until they reach adulthood. Is this true? After all, they’re kids and can change their minds.

Yes, in many Western countries it is possible to start hormone therapy before adulthood – but under different conditions. For example, in the U.S., it is possible with parental consent, with surgery performed only from the age of 18. In many European countries, such as France, Greece, Hungary, it is the same. In Spain, Poland and the Netherlands the parental consent is needed only till the age of 16, and in Latvia – till 14.

Hormone therapy with parental consent can be started in the Netherlands from the age of 12, and in some countries there is no minimum age for parental consent at all.

Discussions about the age at which a child has the right to start transgender transition are still going on in the West. On the one hand, there is indeed a risk that after the end of transition age the dysphoria will pass – and with it the need for transition. On the other hand, many psychologists write that the later the transition begins, the longer the feeling of dissatisfaction lasts, which means stress, discomfort and anxiety, and this is bad for the psyche. In general, it is recommended that hormone therapy not be prescribed until puberty.

In any case, psychologists and psychiatrists work with the child before prescribing hormone replacement therapy. Many experts recommend making a social transition first – that is, calling yourself by a different name and in the desired gender, changing your clothing style and gender representation, without resorting to medical changes. In this way one can try on life in the desired gender, but without medical interventions, so that in case of need one can turn it all back on.

In Western countries, the number of transgender transitions among teenage girls is on the rise. Joan Rowling, who has been criticized for her transphobia, claimed that in the UK the number of such transitions increased by 4400%. In absolute numbers, we are talking about 40 approved transitions in 2009 – and 1,806 in 2017. Many believe the reason for the increase is due to better access to health care.

PART Third

What happens after transgender transition?

Is it true that transgender people have shorter life expectancy and lower quality of life (tendency to mood swings, unstable psyche) due to the hormones they take?

There is no such data. Taking hormonal replacement therapy does not affect longevity or mental stability – on the contrary, many transmasculine people and transmasculine men report that they become calmer and more confident under the influence of testosterone. But, of course, the life of transhumans, especially in Russia, is associated with additional stresses: transphobia, change of documents, problems with visiting doctors, rejection of relatives and friends, surgery, problems with getting a job. Often all of these lead people to anxiety disorders, depression and suicide, not to mention the violence and physical risks of surgery. There is even a Day of Remembrance for Transhumans (victims of transphobia and suicide) – it is celebrated on November 20.

How does transgenderism affect the psyche of a transgender person?

Everything is individual. But, as a rule, transition brings the desired relief from dysphoria and gaining harmony of internal feeling with external signs. However, the changes that occur to the body after the start of hormone therapy and surgery are certainly stressful for the body. Not to mention the reaction of others to the transition, problems with work and socialization. Many trans women after transition are surprised to discover all the disadvantages of female gender socialization – they face harassment, discrimination and violence from men.

If a trans man hasn’t had his uterus and ovaries removed, can he give birth? Can a transwoman?

Sometimes yes. Some transmasculine men do: if you don’t start testosterone hormone therapy or stop it for a while, fertility can be restored and you can get pregnant. But a transwoman cannot get pregnant and give birth.

So if I say “all pregnant women should be screened,” I’m not talking about all pregnant people?

Yes, that’s exactly right. That’s not very correct.

If a person has made a transference, can they go back later? Is it realistic to restore the former functions of the body?

A small number of people who have made the transition do detransition. Studies show that the number of people who are disappointed in the transition is about 2 to 8% (and of the 8%, more than half interrupted the transition only temporarily). Critics, however, rightly point out that the topic has been little researched and we do not really have accurate data.

Detransition occurs for a variety of reasons. A person may realize that dissatisfaction with themselves has not gone away after transgender transition, may experience problems in their new gender role, or something else. Often during or after transition the transgender person comes to the realization that they do not want to fit into a binary gender system – in other words, they do not consider themselves to be either male or female. Some people then stop taking hormone therapy or cut back on it in order to look androgynous. There are cases where a man makes several “back and forth” transitions. In doing so, he does not necessarily consider it a mistake – rather it is his experience and his quest.

If a transgender person does not remove his or her childbearing organs during the transition, once the hormone therapy is discontinued, their function may be restored.

How do transgender people (especially those who haven’t had surgery) go to the pool, fitness club, beach, and bathroom?

As much as possible, the same way cisgender people do. Trans men go to the men’s room, trans women go to the women’s room. Everyone decides for themselves where and how much to be naked in the locker rooms and on the beaches. Trans men often wear a packer, a special silicone imitation of a penis that is inserted into their underwear or swim trunks. They come in varying degrees of realism, some can even be used to pee standing up, and are used by those who want to use urinals in toilets. Of course, some trans people continue to experience dysphoria and shyness and avoid places where they have to undress in public.

PART Fourth

Other important questions

How many transgender people are there in the world right now? Can they be counted?

There is no exact answer. The UN HIV/AIDS program UNAIDS estimates that transgender people may represent 0.1-1.1% of the adult population. To better understand the scale: in 2017, 4.5 percent of Americans thought they belonged to the LGBT community, according to the research company Gallup. In 2018, 2.2 percent of people in the U.K. considered themselves lesbian, gay or bisexual, according to the Annual Population Survey.

What is the cause of transgenderism? Maybe scientists are working to learn how to prevent it?

Medicine and biology do not yet know the exact answer, although scattered studies offer possible explanations for transgenderism. On the one hand, gender formation in the womb occurs in several stages: sex hormones affect the brain and genitals at different times, and these processes can be disrupted. On the other hand, there are a number of twin studies showing that the propensity for transgenderism is higher in identical twins. But no “transgender gene” has yet been found.

Current scientists are inclined to believe that even though a person may have some biological predisposition to transgenderism, its emergence is influenced by a host of complex factors, including social factors. Neither brain research, nor the study of genes and hormones have yet given a definite answer. Therefore, no “prevention”, let alone “treatment” (as in the case of homosexuality, which is not a disease) is out of the question.

Is transgenderism somehow related to sexual orientation?

No, transgender people can have any orientation. Another thing is that after transition the very name of orientation changes. For example, if a transgender woman has always liked women, before transition she was perceived by society as a heterosexual man, but after transition she will be considered a lesbian. Often in the process and after transition, trans people begin to move away from the binary gender system and are no longer willing to call themselves by any clear definitions. Of course, sexual orientation can change, but it also happens to cisgender people.

Why do transgender people provoke such public rejection? Why are they criticized even by feminists?

The same reason why other people who are different in some way. The degree of society’s acceptance of transgender people directly depends on the degree of development and tolerance of this society as a whole.

As for “even feminists,” this has its own specifics. There is an offshoot of second-wave feminism that has the same name: trans-exclusive radical feminism (TERF). In short, its supporters believe that trans women encroach on women’s bodies and invade typically feminine spaces without the right to do so because they have no real “feminine” experience.

Meanwhile, third-wave feminism largely includes new oppressed groups – in particular, there is a separate movement of transfeminism that fights for trans women’s rights.

Is it true that in some cultures transgender people are not considered unusual or wrong? Is that why there are so many transgender women in Thailand?

Not all cultures have a strict division between men and women. In Thailand, in addition to male and female, a third gender was traditionally identified as kathoey. As Gender and Sexual Identities in Thailand researcher Peter Jackson notes, the word “kathoey” originally referred to intersex people, but over time it has also come to refer to transgender women and homosexual men (sometimes in a derogatory way). In Buddhism, unlike Christianity, there is no consensus on transgenderism and homosexuality. Although in the 1980s, Jackson writes, there were increasing voices against homosexual people because of the emerging HIV epidemic.

Also widely known were the “people with two souls” – Indians who may have looked, behaved, and had sex in a way that was not at all what European colonizers expected of men and women. Now the concept of “two souls” is popular among LGBT Native American people.

In the future, because of transgender people, will all the usual notions of gender and sex shift?

To some extent, the process is already underway-and not necessarily because of trans people. Feminism, with its postulate that gender is a social construct, is gradually changing society’s ideas of what female and male gender socialization is (simply put, how women and men should look and behave). The diversity of sexual orientations and gender identities is growing and is also contributing. There are no longer only gays, lesbians and bisexuals, but pansexuals, for example. Gender identities are also becoming more numerous: in addition to transgenderism, there are non-binary, bigenderism, and others.