Transsexual

Transsexuality or transsexualism (from Latin trans "over, beyond", and sexus "sex [steil]") is a controversial term, it refers to the incomplete identification of a person with the assignment made at birth to a social and legal sex accompanied by a varying degree of suffering from their sexual characteristics. However, the term is rejected by many affected individuals because of its linguistic proximity to sexuality and because they perceive it as discriminatory. Often this gender incongruence has been described as "born in the wrong body". According to international studies and data from Germany, 0.33 to 0.61% of the population are transsexuals, and the average age at gender role change is about 38 years.

The persons concerned may also wish to undergo gender reassignment procedures if they wish to change the gender expression of their body. According to the definition of the World Health Organization (WHO), transsexuality is "the desire to live and be recognized as a member of a different sex". Accordingly, in medicine, transsexuality is understood to mean that a person also desires gender reassignment procedures in order to be able to live outwardly their subjective personal gender identity. Harry Benjamin (1885-1986) - a pioneer in the field of transsexuality research - described in 1966 that transsexual people, because of an inner pressure of suffering, wanted a physical and social assimilation to the perceived inner gender as far as possible. Benjamin also distinguished between different strong expressions of transsexualism.

In comparison to the concepts of heterosexuality and homosexuality, transsexuality does not define the sexual orientation or the sexual behavior of the affected person. Instead, for the understanding of transsexuality the subjective gender identity is determining and central, from which the objective innate body characteristics deviate. Since 1985, the term transidentity has been used in German-speaking countries, but it is broader than transsexuality and also includes various forms of gender reassignment. Transsexuality is often understood as the most extensive expression of a whole spectrum of people who do not want to assimilate their body or only partially (for example only by hormone therapy). The used terms transsexuality, transidentity and transgender have in common that they are understood and handled differently in medicine, in law, in society and by the affected persons themselves. An example of this is the German transsexual law, which since 2011 has also offered the possibility of changing personal status for people without surgical intervention.

According to ICD-10, the version of the World Health Organization's International Classification of Diseases and Related Health Problems that was initially formally but not yet practically superseded in 2019, transsexualism (F64.0) counted as a gender identity disorder among the personality and behavioral disorders. This designation is replaced by gender incongruence of adolescence or adulthood ("social-sex nonconformity in adolescence or adulthood"), which is listed as "circumstances related to sexual health", in the subsequent version ICD-11, which was adopted in 2019 and must be implemented in national law by the end of 2021.

Definitions

People who were assigned the female gender at birth but are male are often referred to in medical or psychological literature as female-to-male (FzM) transsexuals; people who were assigned the male gender at birth but are female are correspondingly referred to as male-to-female (MzF) transsexuals. Most transsexual people, however, reject these word creations because they do not respect the innate gender identity, i.e. the body image, the knowledge and feeling about one's own gender, as gender-determining, but assume exclusively physical factors. The definitions thereby implicitly impute to those affected that they were originally a "real woman" or a "real man" who would turn into the opposite. This does not correspond to the own feeling of transsexual people, who adjust their body to their inner identity gender, because they perceive this as unchangeable (which is also seen this way by most professionals).

The two definitions above correspond to the still new terms transwoman/transman, which are based on the respective gender identity, but which are also rejected as unattractive by some affected persons. Especially since transsexual people with medical or legal gender reassignment often do not see themselves as transsexual anymore, but either as a man with a transsexual past or as a woman with a transsexual past or simply as a man or a woman.

Labels such as non-binary, genderqueer, genderfluid are used by people who define themselves as neither unambiguously female nor unambiguously male.

Term History

The Austrian philosopher Otto Weininger used the term "transsexuality" to describe the opposite-sex parts of a human being, which he saw embodied in the figure of Parsifal by Richard Wagner. Transsexual meant to him everything non-male, including books, politics, science, and art, which would be antithetical to the sexual - for Weininger synonymous with the phallus. Weininger argued in his book Gender and Character that only the sexual, not the transsexual, was attractive to women. Weininger's definitions, however, have (apart from a few errors) almost nothing to do with the modern understanding of transsexuality.

In 1910, German physician and sex researcher Magnus Hirschfeld coined the term transvestite to describe people who occasionally, regularly, or constantly dress as members of the opposite sex. Hirschfeld's original definition of "transvestite," however, was much broader than the modern definition, despite the outward focus of dress; it also included transsexual phenomena, similar to today's term "transgender," but focusing on internal gender identity. In 1923 - in the last edition of his Jahrbuch für sexuelle Zwischenstufen (Yearbook for Sexual Intermediates) - he used the term "psychic transsexualism" for people who did not simply dress in the opposite sex but belonged mentally to one sex but physically to the other, a gender variation that he regarded as a precursor to hermaphroditism.

For a time, David O. Cauldwell, who had taken up the word in his 1949 article Psychopathia transexualis, was mistakenly considered the originator of the term. Harry Benjamin, who knew Hirschfeld, his publications, and his Institute of Sexology, took up the term again in 1953 in his article Transvestism and Transsexualism in connection with the case of Christine Jorgensen, and established it in sexual medicine in 1966 with his book The Transsexual Phenomenon. In the works of Cauldwell and Benjamin, the term transsexualism was already used in its current meaning.

In the 1990s, the term transsexualism was removed from the Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV, and replaced by the term gender identity disorder. In contrast, the World Health Organization's International Classification of Diseases, ICD-10 still used the terms transsexualism and gender identity disorder interchangeably. Transsexualism is found under Class F (Mental and behavioural disorders) as subheading F64.0 in paragraph F64 (Gender identity disorders) of Chapter F6 (Personality and behavioural disorders).

In the new draft of the ICD-11 classification, only gender incongruence is mentioned, which means non-conformity of the gender characteristics of the body and/or the social role with the identity gender.