Transsexuals Misunderstood and Misrepresented
Transsexuals are people who are assigned a gender at birth that doesn't fit their sense of self. Most transsexuals alter their bodies in some way, through either hormone treatment or sex-reassignment surgery or both, to bring their physical self into better alignment with their gender identity. Others simply live as the gender that feels right to them, without making any physical changes.
Hormone treatment-in which male-to-female transsexuals (MTFs) take estrogen and antiandrogens and female-to-male transsexuals (FTMs) take testosterone-is more common than surgery. Hormones alter secondary sex characteristics such as fat-to-muscle ratio, body hair, facial hair, and vocal pitch-all of which are among the primary cues we use in reading gender. Naturally, these hormones also affect sexual anatomy and responsiveness: MTFs taking estrogen often report that their penises can no longer become erect and that they must explore other paths to arousal and orgasm, while FTMs taking testosterone often report clitoral enlargement and an increased libido.
Genital surgery is more common for MTFs than FTMs. It's been argued that the medical establishment finds it less threatening to surgically create a vagina than a penis, and this may well be true-it's also true that constructing a vagina is less difficult. In penile- inversion surgery, the penis is turned inside out, so that the skin of the former penis shaft becomes the walls of the new vagina, and part of the corpus spongiosum is used to create a clitoris.
Some FTMs opt for upper-body surgery-a double mastectomy-but not lower-body surgery. Some choose to retain their vagina and reproductive organs, while others choose their surgical removal. Those seeking genital reconstruction can choose between phalloplasty-in which a penis is surgically constructed from skin grafts-and metoidioplasty- which involves releasing the testosterone-enlarged clitoris from its hood and creating a scrotum out of the labia majora. The resulting penis is smaller than one "built" through phalloplasty and can't necessarily be used for penetration, but it has full sensitivity, unlike a penis created through skin grafts. In phalloplasty, the clitoris is left at the base of the newly constructed penis, above the scrotum, to allow for sexual sensation.
A thorough discussion of the varieties of preoperative and surgical approaches available to transsexuals is beyond the scope of this book. At this time, sex- reassignment surgery is far from perfect. Post-op transsexuals may suffer genital nerve damage, have limited ability to reach orgasm, or have reduced sex drives. Of course, there are a rich variety of sensations available from erogenous zones other than the penis and vagina.
Some transsexuals identify exclusively as their post-transition sex and embrace traditional gender roles. Others identify as transgendered, a general term for anyone who challenges binary definitions of sex and gender. The transgendered movement includes transsexuals, cross-dressers, intersexed people (see sidebar), and all those who feel the categories male and female are inadequate to describe their experience of gender identity.
Despite increasing awareness of transgender issues, our society remains repressively phobic of any blurring of gender lines, and transgendered people face bias, hostility, and even violence simply for being who they are. A grassroots civil rights movement has taken shape, aided by the networking possibilities of the Web. Check out our resource listings for referrals to transgender organizations- ending discrimination based on gender identity will liberate every one of us.