Learning about Transgender

Although the term “transgender” entered everyday speech even before the All My Children storyline with such movies as “Boys Don’t Cry” and “Transamerica,” few can define it.

Advocacy groups, such as the National Center for Transgender Equality (http://www.NCTEquality.org ) and GLAAD (http://www.glaad.org ) say transgender is an umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth. The term may include, but is not limited to, transsexuals, cross-dressers, and other gender-variant people. Many transgender people can identify as female-to-male (FTM) or male-to-female (MTF). The descriptive term (transgender, transsexual, cross-dresser, FTM or MTF) preferred by the transgender person is the one that should be used by others addressing the individual.

The difference between being transgender and being gay or lesbian is that the terms “lesbian,” “gay,” “bisexual,” or “heterosexual” refer to sexual orientation, while being transgender deals with one’s gender identity and/or expression (a sense of femininity, masculinity, or androgynous gender). There are heterosexual, lesbian, gay and bisexual transgender people. A glossary of transgender terminology can be found on the GLAAD website at http://www.glaad.org/media/guide/transfocus.php .

Because the U.S. Census does not include “transgender” as a person category, a statistical count of the number of transgenders is impossible. However, the NCTE estimates that between 0.25% and 2% of the U.S. population is transsexual. As transsexuals form are but one group of the larger term “transgender,” the organizations representatives believe that the entire transgender population is much larger than the data contained in studies on transsexuals suggests.

A strong misconception is that most transgender people want sexual reassignment surgery (SRS). SRS was previously commonly referred to a “sex change” operation. In fact, only a minority of transgender people desire SRS says Simon Aronoff, deputy director of the NCTE. The changes necessary for that person to feel comfortable in his or her own body may be limited. “It may involve hormones or it may just involve dressing differently or wearing a different hair style,” adds Damon Romine, a GLAAD spokesperson.

But a transgender without sexual reassignment surgery often faces insurmountable legal obstacles if the person wants to self-designate a different gender, says Aronoff.

For those interesting in pursuing SRS, there are medical specialists who perform the requisite surgeries. Some are known for FTM procedures, particularly chest reconstruction, while some work mainly in MTF vaginoplasties. Others specialize in MTF “facial feminization” surgeries and there are a few who specialize in FTM genital surgeries, although these FTM “lower surgeries” techniques are not very advanced to date.

Cost varies on the type of surgery and by surgeon. For FTM, NCTE says the range is anywhere from $5,000 to $100,000 (chest reconstruction is around $5,000 to $8,000 in the United States while the real cost is hysterectomy and genital surgeries). For MTF, it ranges from $15,000 to $30,000.

Jamison Green, a 58 year old FTM transsexual from Oakland, CA who has written a book entitled “Becoming a Visible Man” published in 2004 (Vanderbilt University Press) encourages people who are interested in transgender health issues to look at the website for the World Professional Association for Transgender Health, Inc. at http://www.hbigda.org . “A person who feels that he or she might be transgender learns about this by going to community-based organizations where there are others like them,” says Green.

Green, who lectures on transgender understanding at private corporations and has done crises intervention at Securities and Exchange Commission’s regional offices where employees were going through transsexual transition, began his SRS transition in 1988. He had two surgeries, one each the following two years and had his name and birth certificate legally changed in 1991. His operations consisted of one surgical team focusing on plastic surgery alongside an OB/GYN surgeon who performed the female hysterectomy. Conversely, a plastic surgeon and urologist did the phalloplasty. His website at http://www.jamisongreen.com chronicles his personal journey and lists a number of transgender organizations.

None of the major insurance companies or HMOs covers SRS or related health or medical needs, including hair removal for MTF. For example, in the case of FTM, it’s not just chest reconstruction that isn’t covered, but the twice-monthly testosterone injections are excluded too, and if the person still has a uterus and has gynecologic conditions like endometriosis, fibroids or cancer, an insurance carrier may deny coverage on the basis that the SRS or hormones ingested in the transition caused the illness.

“It’s one of the biggest discrimination issues that the transgender community is working on,” says Aronoff.