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Transsexuality - transsexual orientation

Transsexuality - transsexual orientation

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Caught in the wrong body? Transsexual and transgender
Transsexuality is the desire to live and be accepted as a person with the opposite gender as the biological. Usually, those affected feel uncomfortable in their male or female bodies and wish to have a body with surgery and hormones that comes as close as possible to the preferred gender.

This definition also applied historically and today stands for a possible use of the term by people who define themselves as transsexual. Others, who take the term more broadly, mean anyone and everyone who lives socially like a member of the opposite sex, regardless of whether the person concerned has undergone or wants to undergo medical interventions.

The person affected by this sometimes appears as if they are physically fully compliant with their innate gender identity. Only in his thoughts, feelings and perceptions does he feel a powerful pressure to be misplaced.

To date, there is no conclusive theory as to why this condition arises, but current research hypotheses focus heavily on a biological basis that develops in the developing fetus before birth.

How common is transsexuality?

In 1983, an investigation in what was then the FRG revealed around 6,000 to 8,000 transident people in Germany. However, these numbers only covered those treated with surgery. They do not take into account those affected who were operated on abroad or people who found ways other than surgery.

Today's estimates assume that around 170,000 people in Germany have a transgender identity. However, since many of those affected live anonymously, the number of unreported cases is probably much higher.

Transsexual or transgender?

John Oliven coined the term transgender in 1965. In the 1990s, transsexual prevailed, but transgender is more widespread, and many who describe themselves as transgender reject the term transsexual.

But transsexual is still in use, especially when it comes to biological definition. However, people who want to change their gender with an operation often reject the term transgender, which can also refer to gender as gender.

Many who have undergone surgery also reject the term transgender because they have changed their biological gender, but their social gender has remained the same.

There are historical reasons why some of those affected prefer to call themselves transsexual rather than transgender: From the 1950s to the 1980s, the medical community discussed the difference between transsexuals who converted their sex through surgery and others who did not want these physical interventions Both groups are completely different.

This view is still controversial, with many doctors now assuming that there is no clear distinction between those who want to change their bodies medically and others who are not interested.

Many affected people reject the term transsexual because they are concerned not with sexuality but with their gender identity.

Transgender means that this person does not identify with the gender with which he was born, i.e. as a woman or a man. For example, someone who sees himself as transgender was born with a vagina, but feels like a man.

Causes of transsexuality

Many transsexuals, therapists, sexologists and others think that transsexuality is innate. Some suspect that the concept is contained in the DNA of those affected, but studies have so far been lacking. Others believe that fluctuations in the hormone level of the fetus cause the peculiarity.

The root of transsexuality has not yet been found. Comparable to other conditions, it appears to be a variety of factors that work together, making research difficult. Genetic factors probably play a role in transsexuality as well as prenatal hormones and additional environmental conditions.

There are currently many possible explanations for the phenomenon, such as brain structure, dysfunction, psychological causes and behaviors.

A post mortem study from the Netherlands identified a region in the hypothalamus that is significantly smaller in women than in men. The brains of transsexuals who transferred from men to women showed a brain development similar to that of other women. This led to the theory that this region of the brain is responsible for the gender identity that forms before birth in a way that does not necessarily go with the physical shape of the body.

This brain function cannot be recognized when the baby is born, and so the child is assigned its gender identity due to its genitals. The hypothalamus thesis is supported by the fact that many transsexuals report that they felt in the "wrong body" at a very early age, not just when looking for a sexual identity.

Rather, the feeling of living in the wrong body began in the time when toddlers become aware that they have a self that differentiates them from others. Since at this age the social imprint on social and gender roles does not yet play a role, the thesis of innate transsexuality gains weight.

Childhood transsexuality

Most adult sufferers remember that in childhood they understood themselves differently from their peers. Long before they had sexual experiences, they knew that they belonged to the "other camp". Such knowledge can be terrible if the environment demands conformity and rejects diversity.

“Gender-atypical” behavior in children is not uncommon. Girls who take on the role of boys are more likely to be tolerated than boys who take on the role of girls. Many boys who play with girls' toys grow up as heterosexual men; some become gay; and a few never consider themselves men at all, but often fear for their safety when other children label them "fagots".

Childhood conformity and group pressure are the first problems that transgender people experience on their journey to transition.

Body image and transsexuality

The body image is the inner representation of the physical appearance of an individual. People with a gender identity disorder who call themselves transsexual are unable to develop a satisfactory body image because their biological gender and gender identity diverge.

Affected people have a bad body image, because being trapped in the wrong body is their basic feeling. Body image means not only how someone perceives their body, but also how that person feels with this perception. Therefore, the body image is an important part of the self-concept that a person has.

The transsexual is unable to develop a body that satisfies him - because of the dissonance between his or her anatomical gender and gender identity. The reality of the transsexual's body does not conform to the desired body image. The result is a chronic disorder in the development of a consistent self-concept.

Those affected try to reduce this dissonance by bringing their appearance closer to the desired gender concept. Male transsexuals wear women's clothing, remove facial hair or cover them with make-up, use padded bras or paint their nails to change the unsatisfactory body image.

They often confuse outsiders with homosexuals, which is not correct. The mostly negative terms "tune" and "tranny" are almost interchangeable.

They refer to clichéd homosexual men who behave in an feminine manner, dress shrillly feminine, behave exaggeratedly ladylike, for example, spread their little fingers while drinking coffee, speak with a high voice and easily frighten like young women in old films, with sounds like "Yikes ”Or“ Ui ”. Tunts weigh the hips, giggle, and use obscene terms, so the cliché.

Drag queens have developed this ingenuity into an art form. When homosexuality was suppressed, punctuality was a form of protest. For example, Rosa von Praunheim wrote in 1971: “The majority of homosexuals are like the type of unremarkable son from a good family who attaches the greatest importance to appearing male. His biggest enemy is the conspicuous fag. Tunts are not as mendacious as the bourgeois gay. Tuns exaggerate their gay qualities and make fun of them. You are questioning the norms of our society and showing what it means to be gay. ”

Exaggerated or not, the “tune” stands for a homosexual man who takes on the passive role in the relationship, the “female”. Their counterpart is the macho-like leather guy, often with a mustache, leather harness and a body shaped in the bodybuilding center that fulfills the “male” role.

However, taking on a gender role is not the same as the need for transsexuals to change gender. A gay man is a man who desires men, a transsexual man a man who feels like a woman.

Conversely, affected women wear men's clothing, e.g. cut their hair short, flatten their breasts and position their crotch so that it looks as if they have a penis. Ultimately, they are looking to change their gender, be it through medical or through surgical methods to bring the body into harmony with the preferred body image.

In laypersons, women quickly become lesbians who take on the male role in relationships. Analogous to homosexual men, the following applies here: A lesbian is a woman who desires women, a transsexual woman a woman who wants to be a man.


The situation of people feeling trapped in the wrong body leads to physical and psychological complaints. Many problems appear when coming out. The stress of hiding a truth that changes life is a factor in stress-related illnesses such as high blood pressure or migraines.

The permanent stress often manifests itself in chronic anxiety and depression. The level of mental overload can be so bad that those affected no longer work at work and school.

Depression to a certain degree is extremely common among transsexuals, especially when they have experienced rejection or loss. Some religious, cultural and ethnic groups do not accept young transgender people. Young people in these communities suffer more from stress, which ultimately leads to suicidal thoughts.

Transsexuals deal with suicidal behavior continuously. There are three phases in which transsexuals are at greatest risk of committing suicide: the first is childhood, when the young person is desperate because his peers dislike him and fails to try to adapt to gender interests.

The second phase comes when people accept their transsexuality but try to live a “normal” life. He now feels more and more like someone wearing a mask. Accepting him now takes the edge off suicidal thoughts.

The third phase with a high risk of suicide begins with sex change. People may now have a high expectation of success in their chosen gender, and some of them will be bitterly disappointed.

Most of the "changed" find their place in society, continue their careers or start again. However, some lose their jobs and are unable to find a new job where they earn enough to pay their living expenses.

Family and friends may continue to reject transsexuality until they expel those affected from the family. But the most frustrating thing is probably if the person concerned does not find a partner who loves and accepts him.

Not necessarily a reason for suicidal thoughts, but it is for depression if the feeling of life does not really get better after the conversion into the desired gender, i.e. if the person keeps the problems that he previously had as a man as a woman.

Psychological counseling should take all these hurdles into account and plan the transition process with those affected well. In particular, psychologists should address problems that can arise, then the transsexuals can better deal with them in an emergency.

Transsexuals under Islamic law using the example of Iran

In Iran, homosexuality is under the death penalty under Islamic law. Ironically, gender reassignment surgery is not only legal, it is even claimed by a society that accepts male or female, but nothing in between. Iran's sex change industry is booming.

Attracted by members of the same gender, but forced to deny their sexual identity, a young generation of men and women choose the only identity they are allowed to do - homosexuals become transsexual through surgery.

Transsexuality was first discussed by the Iranian government in the mid-1980s. Before the Islamic Revolution of 1979, the phenomenon had never been an issue for the government. In 1963 Ayatollah Khomeini wrote that there were no religious prohibitions on surgical corrections by hermaphrodites or intersexuals.

On the other hand, stigmatization due to cross-dressing is one of the main reasons for social restrictions in Iranian society. In 2008, there were more operations to change gender in Iran than in any other country in the world except Thailand. The government pays half the cost of those in need of financial assistance, and gender change is evident in the birth certificate.

Despite government support, the cost of the operation is the main problem for people who want to change their sex: a sex operation in Iran is around $ 7,000, and most of those affected do not have this money: on the one hand, there is no help from the families, and on the other hand, they have problems finding jobs.

Iranians with a transsexual tendency receive the necessary medical treatment and new passports. In order to get a cosmetic surgery permit, applicants must provide a medical certificate for a gender identity disorder.

Iran is an Islamic society in which sexual difference is not simply accepted. Families of homosexuals and transsexuals usually fear losing face and reject transsexuals in their families.

A victim, who has turned from woman to man, says: "My mother said I could do what I want - I just had to leave the country." Another victim heard: "My mother said that if you change your gender, I hope you die."

Siblings also have problems with the changed gender. A victim's 15-year-old brother says: “For 15 years I have been calling him brother. What should I call him sister now? ”

Ali Askar is a 24 year old man who is bothered by other men for dressing and behaving feminine. He doesn't want to become a woman biologically, but sees no other options for him in Iranian society. He decides to go ahead with his operation, although his father threatens to kill him.

Al say: “When my father made life at home unbearable for me, I ran away and through the city - in women's clothes. Everyone thought I was crazy. My father shouted, "Why do you want to change your birth certificate." He wanted to kill me, he tried to keep me at home so he could kill me there. That's why I ran away. ”

The day he found out I was going to have surgery, he tried to poison me with rat poison in tea.

The 20-year-old Mehran tells about his experiences when a boy was: “I had a lot of problems at the time. If I didn't go to school in the car but walked down the street, either the police, the Revolutionary Guards or the religious police arrested me. They severely humiliated me. There was no way to defend my rights.

Transsexuality as a spiritual phenomenon

Transsexuality has survived throughout history. In Rome, Canaan, Turkey, India, North Africa, "changed sex" to worship deities. The literature on this phenomenon usually reports “castration”. However, testimonies show that it was a change in sexual identity.

This ritual practice continues in India to this day. The hijras cannot be operated on themselves, but have a local guru whom they despise and respect at the same time. They treat this “eunuch” like a woman.

Greek mythology was also devoted to transsexuality: Teiresias gained supernatural power because he magically transformed from man to woman. Aphrodite, the goddess of love, the most feminine of all goddesses, rose when Kronos sacrificed his male genitals to the god of heaven and threw them into the sea.

A nobleman served Louis XV of France and spied as his nonexistent sister in Russia. When he returned, Louis ordered the nobleman to dress like a woman, and he lived in this role until his death.

Most Christians and Muslims consider transsexualism reprehensible, but some religions accept transsexuals with open arms.

Shamanism goes hand in hand with transsexuality, and most shamanic religions see a transsexual as a person with the potential to become a shaman. The initiation of a shaman involves a change of gender; a shaman is considered a wanderer between the worlds - humans and spirits, humans and animals, men and women.

When a shaman has visions, he often thinks that ghosts command him to give up his identity and adopt the opposite sex. Shamans report that this experience scares them, that they can possibly resist them. This is reminiscent of many transsexuals who feel overwhelmed by the transsexual impulse.

Almost all American Indians knew a “third gender”. The Ojibwa called it nisomanito, the branch spirit. Those affected should have two souls, one female and one male.

Boys and girls who preferred “opposite sex” behavior before puberty were considered two-spirits. The sexual attraction had nothing to do with it. A man who dressed like a woman had a special position and was often considered a healer. They then married men and took on the role of women.

However, they were mostly not homosexuals. In contrast to body changes through operations such as transsexuals, they did not change their sex biologically. Two-spirits in a man's body who had sex with a man were not considered gay. They were a third gender.

Transsexuality in Cultures

Thailand is considered the country with the most gender reassignments. Kathoey here refers to biological men who have properties of women. This ranges from cross-dressing to identification of being a “woman of the second kind”.

Homosexuals can be Kathoeys as well as people who change sex with hormones or surgery.

However, many Kathoeys see no contradiction between their gender identity and their body, and some even deliberately call themselves shemales or ladyboys.

Japan has a rich tradition of gender crossing in myths and literature. Gods, the Dosojon were as male as female, and people should be able to change their gender in the phases of the moon. Such sex changers were called crescent.

Japanese clothing made no clear distinction between men and women, making gender crossing easier than in European cultures.

In the Middle Ages, men dressed as women danced at the imperial court to amuse the monarch.

There is the Chanidh in Oman. They are biologically men, but take on the role of women. They are traditionally treated like women, but are not considered women.

They wear men's and women's clothing, but the women's clothing has unusual colors. These transgender people do not cover their heads and have long hair, unlike women and men.

They behave like drag queens, use strong perfume, speak in an exaggeratedly high voice and go overly feminine.

The Omanis do not see these transgenders as a third sex, but rather as castrated men. If the voice of those affected deepens, they can be accepted as men.

Hormone therapy

Sex hormones are responsible for the changes in human bodies that produce male and female properties, namely the male hormone testosterone and the female hormone estrogen.

For some transsexuals, hormone therapy is an important part of their transition. Male transsexuals use estrogen to feminize the body, while hormone blockers push male hormones back. In female transsexuals, testosterone brings many of the secondary male sexual characteristics.

Changing body shape is a serious decision and requires a lot of preparation. Most doctors recommend 3 months to 2 years of life experience in the chosen gender before those affected should change their body biologically.

As with any medication that lasts a lifetime, a healthy lifestyle, physical training and a balanced diet is important, those affected should neither drink alcohol excessively nor take drugs or smoke. Serious doctors will not start hormone therapy if they are in poor physical shape.

Testosterone can be administered by injection or gel, among other things. When the therapy strikes, physical changes are the result: the voice becomes deeper, the clitoris grows, the facial and body hair grows.

The hormones for male transsexuals cause female puberty, but without menstruation, the hormones reduce hair growth but do not stop it. The following changes can be expected with therapy with female hormones: the breast grows, the erection of the penis subsides, the testicles shrink, and the proportion of body fat increases compared to the muscle mass.

Transsexual operations have been possible since the 1930s. However, hormonal and surgical techniques have only been discussed since the 1950s. Thanks to institutions like the Erickson Educational Foundation, transsexual treatments and operations have become a recognized medical field.


Transvestites wear clothes of the opposite sex, heterosexuals as well as homosexuals.

Magnus Hirschfeld coined the term 1910. He wrote about “all people who, for whatever reason, voluntarily wear clothes that are not usually worn by the gender to which they are physically assigned; both men and women. "

Transvestivism and the transsexual need to belong to the opposite sex are not the same. But there are smooth transitions.

Transvestites include women's underwear, i.e. men who wear women's underwear under their visible clothing. Women's garments are often fetishists.

Drag queens and drag kings, on the other hand, represent the opposite sex in an exaggerated manner. Male drag queens, for example, put on make-up extremely, wear clothes that go far abroad, and female drag queens put on top hats and ties.

Finally, travesty describes an art form in which actors play the role of people of the opposite sex.

Transvestite fetishism is considered a mental disorder, but only if those affected suffer to a great extent.

Most transvestites do not suffer from their tendency at all and are therefore not a case for the psychiatrist.
(Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


  • Christiane Ant: Transsexuality and Human Identity: Challenge of Sexual Ethical Conceptions, Lit Verlag, 2000
  • George Fink: Stress Consequences: Mental, Neuropsychological and Socioeconomic, Academic Press, 2009
  • Department of Health (ed.): Www.mermaidsuk.org.uk (accessed on August 20, 2019), A guide for young trans people in the UK
  • Vern L. Bullough; Bonnie Bullough: Human Sexuality: An Encyclopedia, Routledge, 2014
  • American Psychological Association (ed.): "Report of the Task Force on Gender Identity and Gender Variance", 2005, Report of the Task Force on Gender Identity and Gender Variance

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