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Knowing yourself.

Gender identity is the sense of belonging that a person feels for a particular sex, not only biologically but also psychologically as well as socially.

This is independent of a person`s biological sex which is always`s decided on the basis of the organs between the legs.

"Congratulations! It's a girl!" or "It's a boy!" Often these are the first words spoken when a baby is born. This is based on the genitals visible between the newborn babies legs.

From then onwards the infant's fate is sealed and his or her training starts in earnest. A boy is often given toys like guns, cars, tanks and construction kits. While girls are given things like dolls, kitchen sets and sewing kits. Society even decides which colour the baby will wear - blue for a boy and pink for a girl.

This gender-related difference continues throughout a child's upbringing, eventually resulting in an adult who has been trained to behave in a strictly feminine or masculine manner. Anyone who doesn't conform is often labelled a weirdo.

A child's sex may well be decided on the basis of the organs between it`s legs, however it`s gender identity (self-identification as male, female or neither) is decided by factors which have still not been fully understood by the medical profession. This is what transsexualism is.

Did you know?

Transsexualism is prevalent all over the world, the way in which Transsexualism is expressed varies depending on which culture you belong to for example.

Hijras are from the Indian subcontinent and Southern Asia they would form advanced social communities lead by a Guru. Hijras would express themselves as male and female but many would self identify as third gender and have lobbied for the recognition of being third gender (A third sex inbetween male and female).

In Oman someone who identifies as third gender are known as Xanith. They like the Hijra have come to have a place in society inbetween men and women. The Xanith usually keep their male names however they would wear clothing which is partly male and partly female they would keep their hair at a medium length. They are allowed to socialise with women and they retain the right to move around unescorted in public which women are not allowed to do unless accompanied by an escort. Often the Xanith would be hired as servants and also hired to work as prostitutes.

Another cross gender behavior can also be seen among some Native American Indian tribes. A teenage boy who displays female traits is known as a Berdache (Twin spirited.) They would take part in a ceremony getting in to a trance like state where they would receive spiritual enlightenment they would then begin to dress as a female and live there lives as females and often get married living as man and wife.

In Thailand there is a community know as Kathoey. Kathoey refers to a Transgender women or an effeminate gay male. The Kathoey usually take up work in female industrial sectors and many become show girls performing in glamorous cabaret shows many also become prostitutes to make a living.


A transsexual is a person who has a lifelong feeling of being trapped in the wrong body. The identification with the opposite sex is so strong and persistent that transsexual people feel that the only way to achieve peace of mind is to change the body to match their mind. Some transsexual people go through the process of living in their chosen gender role with the help of hormone replacement therapy (HRT), eventually leading to gender confirmation surgery. others seek help such as counselling or therapy to help them to cope with their discomfort.

Gender variance of adolescence and adulthood

This term is used to denote individuals who have passed puberty and feel a persistent or recurrent discomfort or sense of inappropriateness about their assigned gender identity. They  often cross-dress persistently but are not sexually excited by these actions or fantasies.

How prevalent is gender variance?

There are no recent epidemiological studies to provide data on the prevalence of gender variance. Referrals to gender clinics suggest that approximately 1 in 30,000 adult males and 1 in 100,000 adult females seek gender reassignment surgery. Gender variance is more common in males than in females. In childhood, boys suffering with gender variance outnumber girls by approximately five to one. This disparity between the genders may partly reflect the greater stigma that cross-gender behaviour carries for boys than for girls. In adult life, men suffering with gender variance outnumber women by between two and three to one.

What causes gender variance?

Little is known about the causes of gender variance. One theory is that changes in the brain prior to birth cause parts of the brain to develop in a pattern opposite to that of the physical gender. It has been found, for example, that significant proportions of male transsexuals have abnormally low levels of HY antigen. (HY antigen mediates the masculinising effect of the Y chromosome in men.) Another theory is that life experiences especially those in early childhood’ may affect the outward expressions of gender behaviour. Gender-appropriate behaviour is learned early in life; society places a huge emphasis on it, and deviations may result in castigation or ostracism. The problems therefore arise from societies attitudes towards people who do not conform to its stereotypes rather than being inherent in the person. Psychiatry's labelling of people who find they cannot fit in with sexual stereotypes as suffering from a disorder is a case in point.

Is suffering with gender variance the same as being a homosexual or a transvestite?

Gender identity is separate from a person's sexuality, people who suffer with gender variance can be homosexual, bisexual or heterosexual. A male to female transsexual, for example,attracted to women, may consider themselves to be a lesbian. Others may be attracted to heterosexual men and would not identify as being homosexual since their adopted gender identity is female. Some adults who suffer with gender variance, like other people, may go through a period of transvestite or homosexual behaviour while they are exploring their true natures.

A transvestite is a person who cross-dresses as a member of the opposite sex. Transvestites often derive sexual excitement from the experience of cross-dressing. Transvestitism is quite distinct from transsexualism or other forms of gender variance. A transvestite usually has no feelings of belonging to the opposite gender and doesn't experience alienation from their body or sexual organs.

Do transsexuals have abnormal chromosomes or physical characteristics?

Transsexuals have normal male (XY) or female (XX) chromosomes appropriate for their physical sex. There are no identifiable physical characteristics for gender variance, and there is no test for the condition. Inter-sexed  individual and others with ambiguous sexual characteristics at birth are not normally  transsexuals and do not necessarily experience gender variance.

What is gender reassignment?

Gender reassignment is a lengthy process that involves long term hormone treatment and surgery to alter the physical appearance of a  transsexual person. A person's chromosomes cannot be changed; hormone treatment and gender reassignment surgery aims to achieve the physical appearance and sexual functions of the opposite gender. Post-surgical transsexuals cannot bear or father children, as fertility is lost in the gender reassignment process.

How is the need for gender reassignment assessed?

Individuals requesting gender reassignment are generally referred to a recognised gender identity clinic by a psychiatrist, doctor or social worker. A detailed history of gender development from childhood through puberty and thereafter is central to the evaluation. Medical and personal history is considered along with current life circumstances and general stability. Additional psychological assessments may be arranged to clarify unanswered questions.

Gender reassignment is not the solution for everyone, it needs very careful consideration. If any alternatives to gender reassignment are considered possible, the clinic will actively pursue these options. A number of people who initially attend clinics requesting gender reassignment are encouraged to pursue less drastic possibilities, for example, to pursue their chosen lifestyle without surgical intervention, or to access other forms of support such as counselling or support groups.

What does male to female gender reassignment involve?

For an individual assigned male at birth wishing to affirm themselves as a female, treatment with female hormones is required for at least one year before any irreversible surgical steps are taken. This produces changes in the secondary sexual characteristics, such as body hair reduction, breast development, and a general feminisation of body shape and skin texture.

Patients are required to live full-time as the gender that they wish to affirm themselves in for a minimum of one year before any surgery can be authorised. During this period some transsexuals may choose to have their facial hair removed by electrolysis or IPL (intense pulsed light),  others may choose to undergo cosmetic surgery to help feminise facial features, while others learn to raise the pitch of their voice to a more feminine level. When a patient feels ready, they may apply for medical approval of reassignment surgery. The clinical team will review the patient's progress and adaptation to their new role. Surgery may then be approved based on this and other evaluations.

Gender reassignment is a major surgical procedure. Under general anaesthetic  the testes and erectile tissue of the penis are removed. A vagina is then created and lined with the skin of the penis, the nerves and blood vessels of which remain largely intact. Scrotal tissue is then used to create the labia, and the urethra is shortened and positioned in the correct female location.

What does female to male gender reassignment involve?

For a person wishing to affirm themselves as a male, undergo treatment with testosterone, the male hormone, produces largely irreversible effects of beard growth and masculine muscle development. A mastectomy may be authorised as early as six months into the hormone program. As it is of significant benefit in helping the person to affirm their male identity in public. After at least a year of hormone treatment the ovaries and uterus are removed. For many individual wishing to affirm themselves as male this is as far as they will go with surgery, as additional procedures are more complex, costly and difficult to obtain. For those who do continue, phalloplasty (penis construction) and artificial testes implants are available, as are procedures to create a male urethra and relocation of the clitoris to the head of the penis.

What about one's name, birth records and legal status?

In the U.K. it is possible to legally change your name and to have this name inserted on official documentation such as a passport and driving license. It is also now possible to change the gender on your birth certificate. Under current laws this means, for example, that an individual who has a male identity can legally marry a person with a female identity. The British passport agency has stated that on receipt of reasonable proof that a person's affirmation of gender is thought to be permanent, they will issue a full ten-year passport in the newly affirmed gender, even if the person is of a pre-operative status.

How is gender variance displayed?


In boys, cross-gender identification is generally displayed by a marked interest in traditionally feminine activities. They may have a preference for dressing in girls' or women's clothes. A boy who wants to be a girl and who admits this to others is likely to be corrected, ridiculed or reprimanded in a severe manner. They are expected to grow out of it quickly. A girl who wants to be a boy and expresses this is less likely to receive retribution for it. Girls who display boyish behaviour are often labelled as tomboys' - but they too are expected to grow out of it. In most cases only a small number of children will continue to have these feelings in later adolescence and adulthood. Families vary in the extent of their acceptance of their offspring. Some children living openly in their chosen gender role endure the taunts of their peer group as well as pressure from their parents 7 families. Others cope by hiding their feelings and learning to play the gender role assigned to them, meanwhile going deeper into a private world of cross-gender fantasy and desire.


At this stage in life coping with gender variance becomes far more complex and different pressures begin to apply to the different genders. With the onset of puberty hormones are produced which trigger the growth of secondary sexual characteristics. Boys must contend with higher levels of testosterone leading to a deepening of the voice, beard and bodily hair growth. Girls must contend with the growth of their breasts and menstruation. These physical effects can be very distressing and confusing to young people who suffer with gender variance.

Boys often secretly crossdress to relieve their anxieties. Boys can also often employ overtly stereotypical masculine behaviour in an attempt to hide their secret desires to be female. Girls may adopt loose or baggy gender-neutral clothing in an attempt to hide their female bodies.

Early adulthood

Most people who have grown up with being gender variant display less overt cross-gender behaviour with time, parental intervention, or peer pressure. It has been found that by early adulthood, about three quarters of boys who had a childhood history of gender variance may identify as being homosexual or bisexual, but they no longer have feelings of belonging to the wrong gender.

However, many young adults continue to experience gender variance, they may make various attempts to rid themselves of their ever-increasing gender anxiety. They may get married and have children, in the hope that this will help, or simply hide their feelings from others. Some seek professional help, typically requesting gender affirming surgeries.

Later adulthood

Later adulthood can be a very difficult time for people suffering with gender variance. Years of trying to overcome a deep-rooted desire and coping with anxiety can lead to depression. For some the pressure is so great that they attempt or complete suicide. Many reassess their feelings when they come to later life, some will seek professional help, others may try to relieve their stress and anxieties by more frequent cross-dressing, usually in private.