Happy Independence Day!  Today, we celebrate the independence of our country from Britain, which includes, among other things, the assertion that all people are created equal!  Well, ok, the Constitution says it’s all men, which was definitely the initial intention of the Founding Fathers at the time, but thanks to suffragists, the Supreme Court, and the passage of time, women are considered (in theory, if often not in practice) to be equal as well.

But what about transgender people?  As of two days ago, Governor Deval Patrick signed a legislative act declaring that in Massachusetts, transgender people are subject to all of the same rights and protections as cisgender (the opposite of transgender) people when it comes to employment, housing, education, and lending.  It also takes transgender status into consideration when deciding whether to rule an attack as a hate crime.
In celebration of this ruling – of Massachusetts recognizing all men, women, and transgender people as being equal – I think it’s time to write about what all of this gender stuff means.

Sex v Gender

The first thing you need to know in order to understand transgender issues is that there is a difference between sex and gender.  Sex is the biological component of being male or female, and gender is the sociological component of defining oneself as male or female.  What this means is that if you are cisgender (you were born with male parts and chromosomes and you now identify readily with a male identity, or you were born with female parts and chromosomes and you now identify readily with a female identity), your sex and gender are the same.  Conversely, if you are transgender (you were born with male parts and chromosomes and you now identify with a female identity, or vice versa), your sex is different from your gender.

Because gender is sociological, it is also a construct, which means that it is cultural.  Other cultures view the notion of femininity and masculinity very differently than we do here in the United States.  Some cultures have three or four genders, rather than just two, or assign a position of prestige to people who are transgender.  For this reason, it is important to question ideas about what is “girly” or “masculine”.  All of these things are relative to the environment in which they exist.

People often use the words sex and gender interchangeably, but this is inaccurate.  Often, this happens because people are afraid to use the word “sex” since it’s a “dirty word.”  Whenever a pregnant woman tells me she is going to find out the gender of her baby, I want to ask her how technology has advanced so far as to be able to know such a thing!  The more accurate statement for her to make would be that she is going to find out the sex of her baby, and that if she fosters a positive, open, and nonjudgmental relationship with her child and maintains a healthy attachment with him or her, she may be fortunate enough to know the baby’s gender in anywhere from five to forty years.

The Definition of Transgender

Once upon a time, there were transsexual people and transvestites.  The former were people whose sex and gender did not match (male sex, female gender, or vice versa) and who therefore sought out surgeries to correct the situation.  Transvestites were people who simply enjoyed wearing the clothing of the opposite sex.

While the latter term is still used (most famously by comedian Eddie Izzard), it was decided that these terms are limited and do not adequately sum up everyone’s experience.  There are people whose sex and gender differ, but who do not have any interest in undergoing a surgical procedure to have their bodies match their gender.  Those who do choose to have corrective surgery may not completely physically transition.  For example, many female to male (FtM) people get “top surgery,” which involves a double mastectomy, but do not undergo a surgery to obtain male genitals.  Furthermore, some people are “third gender”, and do not feel their gender fits into either the male or female categories.

Transgender is an umbrella term that was coined to resolve this, and to simply mean anyone whose gender differs from their sex.

The Definition of Intersex

Transgender is often confused by laypeople as being the same thing as intersex.  Someone who is intersex is a person whose biological sex is more complicated than being simply male or female.  There are many ways in which this can occur, the most well-known of which is ambiguous genitalia, which used to be called hermaphroditism.  However, there are many other ways in which a person can be intersex.  These include over a dozen conditions, including Klinefelter Syndrome, where a person has an XXY chromosomal makeup, guevedoces, a condition common in the Dominican Republic in which a person appears to be female until puberty, at which point he develops a masculine appearance, and androgen insensitivity syndrome, in which a person’s body does not respond to testosterone, which in males creates a feminine appearance.

Often, it is not readily apparent that someone is intersex because their external genitalia appears male or female, but when a baby is born with obviously ambiguous genitals, the parents are often tasked with the decision of which gender they want their child to be and “corrective” surgery is done on the infant.  This is very controversial, and a lot of intersex people, as well as the Intersex Society of North America, are staunchly against it.

Some, but not all, intersex people identify as transgender.  As with any sexual or gender minority, it is important to ask individuals how they identify themselves, rather than relegating them into a category to which they may or may not relate.  It is equally important to understand that being intersex has to do with biological sex, whereas being transgender has to do with gender identity.

Transgender People and Sexual Orientation

As much as being transgender is independent from being intersex, it is also independent from one’s sexual orientation.  Some transmen and transwomen are attracted to men, others to women, and others are bisexual, asexual, or pansexual.  The biggest similarity between someone who is “transgender” and someone who is “gay” is that they are part of a minority.  However, the former is part of a gender minority, and the latter is part of a sexual minority.  Many people in the GLBTQQIAA (gay, lesbian, bisexual, transgender, questioning, queer, intersex, asexual, ally) community choose to simplify the question of identity by identifying as “queer,” which is an all-encompassing term for a person in a gender or sexual minority.

“Gender Identity Disorder” in Mental Health

The Diagnostic and Statistical Manual, 4th edition Revised (DSM-IV-TR) is the current bible of the mental health world.  That means that anything a person is diagnosed with is in that book.  The third edition of the DSM eliminated the diagnosis of homosexuality as a mental disorder in 1980.  However, transgender people are still seeking recognition that their gender identity is not a “disorder.”

Currently, in the DSM-IV-TR, Gender Identity Disorder is a diagnosable mental health condition.  This name is very offensive to many people because it implies that someone who is transgender is mentally ill.  In the 5th edition of the DSM (DSM-V), which is due to come out next year, there is a proposed revision to the diagnosis, and it has been renamed “Gender Dysphoria,” which is a much less offensive term.  However, many advocates want the diagnosis removed from the manual completely so that it the stigma and the idea of “pathology” are separated from the idea of being transgender.

It should also be noted that gender identity is often considered differently in children than in adults, and is a different diagnosis (GID or Gender Dysphoria in Children).  This is because there is a much higher incidence of gender dysphoria in children than in adults, and some prepubescent children “grow out of it.”  However, although transgender children do not always grow up to be transgender adults, there is a strong correlation between childhood gender dysphoria and adult homosexuality.

Transitioning

The process of transitioning can be difficult for everyone involved.  For the friends and family of the person “coming out,” it can mirror a grief process.  If Billy tells his friends and family that he is transgender and would like people to call her Suzy, Suzy’s friends and family are grieving Billy while they are learning to understand Suzy.  At best, this is done compassionately, and at worst, the transitioning individual can lose some important people in his or her life.

Transitioning can also be difficult for the individual, whether or not he or she chooses to have surgical procedures.  Reactions to the news that a person is transgender can range from well-meaning but ignorant questions to outright cruelty, transphobia, and hatefulness.  As a person begins to live as his or her true gender, there is peacefulness to that, but society responds differently to men than to women.  My friend Tom wrote a beautiful article about how he was treated differently after transitioning.

If you know someone who is transitioning, or who has just come out as transgender, the best thing you can do is take a learning stance.  Ask the person about his or her own individual experience, and how he or she identifies.  Don’t assume you know what it means when a person tells you they are transitioning.  For some people, a transition is a social identity shift rather than a surgical procedure.  This is a very personal decision and each person approaches it differently.

Additionally, don’t “out” people.  Before discussing a transgender person’s transition with a third party, ask who they are “out” to.  Be respectful of a person’s right to go through this process at their own pace.

Talking to Transgender People

I’m now going to seemingly contradict what I just said: Think before asking questions.  Allow me to clarify.  If a question would be rude to ask someone cisgender, assume it is rude to ask someone who is transgender.  Someone who is transgender is also a human being, and deserves the same respect, consideration, and right of privacy you would give to other human beings.

When faced with a person whose lifestyle or identity is new to us, we have normal human curiosity and we want to know more… but some questions are invasive and very personal, and some are invalidating of an individual’s gender identity.  An FtM transgender friend of mine is often asked whether he has a penis, and he usually responds by asking the questioner to describe his or her own genitalia in detail.  If a question is rude to ask someone who is cisgender, it is probably also rude to ask someone who is transgender.  Another offensive question people get asked is what their “real” name is.  This is invalidating not only because it undermines their current identity, but also because it may be something they are trying to move beyond.  One person told me, “I don’t usually tell people my birth name, because then the person I’ve told tries to see me as that person.”  Honor the person’s identity by using the name and gender identity with which they have introduced themself.

Lastly, the question of pronouns can be tricky.  When unsure about a person’s gender, “it” and “he-she” are very offensive unless a person has told you that they are his or her preference.  The former objectifies the person, and the latter implies something “freakish.”  The best thing to do is ask a person what his or her preferred pronoun is and to honor this to the best of your ability.  For a primer about gender-neutral pronouns, here is a great article, put out by Transcending Boundaries, an annual gender and sexuality convention.

In Conclusion

For anyone interested in learning more about all of this, there are many great resources.  The collected works of Kate Bornstein is a great place to start.

It is also worth noting that I identify as a cisgender ally.  If you are reading this and find that you disagree with anything I’ve written, or that something is factually inaccurate, I’d love for you to leave that feedback.  You can put it in the comments, or send me an email.