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BOY MEETS GIRL Document
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Jon Lusk explores the social, personal and political issues raised by crossing gender boundaries Though it is a lighthearted game show, Boy Meets Girl brings up serious issues about gender identity for both audience and participants. Those who were involved in the programme did not wish to change their sex permanently. For some viewers though, the issue of gender identity is real and problematic, perhaps even a matter of life or death. Nature and nurture With very few exceptions, a person's physical/biological sex is either definitely male or definitely female. How they express their identity in terms of culturally received norms of masculinity and femininity (and how others perceive them) is what we call their gender. Unlike biological sex, which is recognisable everywhere in the world, gender is a social construct: it varies from one culture to another. 'Masculine' to a male inhabitant of the Australian outback is not the same as 'masculine' to an Ethiopian tribesman. One might be expected to wear make-up on certain occasions to prove his attractiveness to a female. The other would rather die. In most people, there is a straightforward relationship between sex and gender. Male children become 'masculine', and female children 'feminine'. If they follow the stereotype, male children will tend to play more actively and to use all the available space, while girls will tend to play more quietly and co-operatively. Gender is fixed at an early age, but how much such stereotypical behaviour is instilled in the children (nurture) and how much is biologically intrinsic (nature) is a subject of continuing debate. The wrong body A small number of children feel strongly that their gender is in conflict with their physical sex. The technical term for this is Gender Dysphoria or Gender Identity Disorder. As such children grow up, this difference will cause feelings of dissatisfaction, confusion or deep distress, depending on the environment or culture they find themselves in. This arises out of the conflict between the messages from within the individual and those that come from the surrounding society. Their dysphoria — feeling ill at ease — may be expressed by cross-dressing or behaving in a way that is consistent with what they perceive to be their true gender. Alternatively, they may suppress these feelings and try to conform, resulting in inner torment. Sooner, or perhaps much later, they may reach a crisis or find themselves in a situation that leads them to seek professional help. There are high rates of self-harm and suicidal behaviour among people who experience gender dysphoria. The strength of their feeling that they have been born into the wrong body, as well as increasing scientific evidence that there is at least a partial biological basis for their psychological state, has led the medical profession to recognise gender dysphoria and to make treatment available through the National Health Service. This treatment may be done in two main stages: Transition (switching into living full-time in the desired gender role); and Gender Reassignment (medical and surgical treatment to alter the body). This major and irreversible change is not something anybody would do (or be allowed to do) on a whim. The treatment The process usually starts with the patient being referred by their GP to a consultant psychiatrist. The psychiatrist assesses whether the patient is genuinely experiencing gender dysphoria before referring them to a Gender Identity Clinic. The one in London's Charing Cross Hospital is the largest such clinic in the world. If gender dysphoria is still diagnosed after the patient has had counselling, they will be given the option of entering a 'real-life experience' to test their resolve to live in their chosen gender role. They must change their name and mode of dress, and live and work in the community in that role. In Britain this period is normally two years, though the US-based Harry Benjamin International Gender Dysphoria Association only requires one year. Depending on the medical assessment, hormone therapy may commence as early as three months after the start of the real-life experience. This starts to cause physical changes that may not be reversible. Their purpose is to feminise or masculinise the body. At the end of this period, if the person feels they have successfully adapted to life in their new role and they wish to complete the process, they may opt for surgery. If the Gender Identity Clinic recommends an operation, the local health authority is required by law to fund it but they may have to wait for up to 18 months. Alternatively, there is the option of having it done privately. In men, sex reassignment surgery generally means removal of the penis (penectomy) and testicles (orchidectomy). A 'neovagina' is constructed by invaginating (pushing inwards) the remaining skin from the penis. Breast development can be achieved with use of hormones, which may be augmented with surgery. Speech therapy is needed to modify the voice, and electrolysis to achieve the desired body hair patterns such as beard removal. In some cases the nose may be reshaped (rhinoplasty). In female-to-male (FTM) transsexuals, the surgical procedures are far more complicated, which may partly account for the fact that the numbers completing sex reassignment are between a third and a quarter of those for male-to-female. First a double mastectomy (breast removal) is performed, in conjunction with a nipple reduction procedure. A second operation is required to remove the ovaries (oophorectomy) and uterus (hysterectomy). If the transition is to be completed, a third operation creates a penis (phalloplasty) and scrotum (scrotoplasty). Implants are used to approximate an erection. At present the operation to create a penis is only partially successful. One alternative to phalloplasty is to create a 'microphallus' from the existing clitoris, which will have been enlarged by hormone therapy. A further operation may be performed on the Adam's apple. Changing scene But very often a female-to-male transsexual will settle for masculinisation with hormones plus a mastectomy. It is difficult to give accurate figures about how common gender dysphoria is since this depends on transgendered people disclosing their situation. One person in 10,000 is a commonly cited estimate. However, any figures are subject to revision as changing attitudes allow more openness for people who experience a degree of gender dysphoria. There are also many people who define themselves as 'transgenderist'. They are full- time cross-dressers who experience gender dysphoria, but for various reasons do not undergo hormone therapy treatment or operations. This may be because of the age group they belong to, aversion to surgery, or health concerns. But they still choose to live in the gender role that is the opposite of their physical sex. 'When I get out of the bath I look like my dad; when I go shopping I look like my mum,' says Janett Scott, president of the Beaumont Society, the world's largest membership organisation for transvestites and transsexuals. Many such people prefer the term 'cross-dresser' because they believe the word 'transvestite' has connotations of sexual perversion. The law Like transsexuals, transgenderists can change their name and most of their identification documents to match their new gender role. However, under British law it is still not possible to change the sex recorded on a birth certificate. The Republic of Ireland, Andorra and Albania are the only other countries in Europe that share this rule. This means that transgender people cannot marry a member of the opposite gender, just as same-sex marriages are not yet permitted in Britain. Additionally, legal protection from discrimination for transsexuals is still not adequate. This touches on a commonly held misconception. A lot of the confusion surrounding transgender issues arises from people assuming that there is a straightforward correlation between gender and sexual orientation (whether one is heterosexual, homosexual or somewhere between the two). In fact the relationship between the two is much more complex. Recognising this, and because of reduced homophobia in society, workers in the field no longer push people who have been through sex realignment into heterosexuality. Take for example, a gender dysphoric man who is sexually attracted to women. To outsiders who see his sex and gender as the same thing, he is a heterosexual man. Once he has altered his body to 'feminine' gender, that person may still be attracted to women and thus be perceived by others as a lesbian. Another common mistaken belief is that 'cross-dressers' (transvestites) are the same as transsexuals. But most transvestites do not want to alter their body because they are not gender dysphoric. They may cross-dress for their own satisfaction or they may do it for a living. They may be homosexual, heterosexual or bisexual. Given the prevalence of such misconceptions, it is hardly surprising that tabloid newspapers continue to sensationalise transgender people's lives. Some broadsheets collude with this. One example was Julie Burchill's Guardian article (20 January 2001) in which she ridiculed cross-dressers, identifying them with pantomime 'ugly sisters' and comparing them with the Black and White Minstrels. More honest
discussion of transgender issues can only be welcomed, and the internet
has become a major forum for educational debate, as you can see from the
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