Why “transsexual” is an inappropriate term

Both the psycho-medical health care providers and groups of trans people themselves use “transsexual” as the only valid group within the transgender category. I argue here that this is problematic because it delegitimises the existence of others. And I consider it not wise to adopt an alien identity that comes with a whole power structure behind it, as genuine.

The idea of transsexual historically comes from doctors and psychiatrists who were confronted with trans* people who sought relief from their stress of being confronted daily with a world that denies their feelings, their wishes. From the 1950s there were increasing possibilities to use medicine to change the body more towards ones’s own perception. With the arrival of synthetic sex hormones it became feasible to feminize or masculinize the body. Robert Stoller tells in his Sex and Gender (1968) the story of Agnes who presented as intersex (hermaphrodite) but actually was a trans woman who used her mothers/sisters Stilbestrol to feminize her body. Trans as we know it thus has a strong link with the development of the biochemical industry, something that Paul B. Preciado writes about extensively in Testo Junkie.

From the 1980s something like a transition trajectory got created in the Western world through adoption of gender identity in DSM-9 and through the first Standards of Care of the Harry Benjamin International Gender Dysphoria Association (HBIGDA, now WPATH, World Professional Association for Transgender Health.) The website trans-health.com mentions that the first SOC of HBIGDA (1979) were very strict with their requirement of six months (real life test) before surgery. Later this has grown to a year and a half or a year.

Where does “transsexual” come from? What does it describe?

While the appearance of the term comes from a complex interplay and power struggle between endocrinology, pharmaceutical industry and psychiatry, it is mostly thanks to Harry Benjamin (the father of WPATH) that it got into mainstream. Benjamin’s “The Transsexual Phenomenon” became the Bible for trans* people seeking access to medical procedures. Who presents as straight and decent enough feminine often got accepted thanks to the heterosexual bias of the providers. In a setting of scarcity in access this is of course important.

This need for a psychiatric diagnosis, specifically of transsexualism, is problematic for several reasons. First of all is assumes a stable identity called transsexual with the defined criteria for that. But this becomes a circular reasoning: Transsexual is defines as A and to become transsexual one must identify as, comply with the reasons for A. One is transsexual by definition.

A complicating factor is that many legal procedures – if there are legal procedures in place – require this diagnosis (or a relevant psychiatric diagnosis) regardless of how one feels or identifies and that produces people who (for the record) identify as such. So often there is no free will in play anyway.

Only a handful of countries up to now have done away with this criterion: Argentina (2012), Ireland (21014), Malta (2015), Norway (2106), Denmark (2014 and 2017), Colombia (2014) and only Argentina and Malta are really ‘clean’. While other countries also declassified trans people from having a mental disorder – France already did that in 2009, though in a very cranky way, replacing it with placement with chronic diseases – real depathologization still is far away often. And some countries are worse than any standard: Belarus requires a six weeks stay in psychiatric ward, with tests nobody understands the usefulness of. Plus the whole (unfriendly) medical procedure, before a legal change might be possible.

The fact that gender identity disorder, with the specification transsexuality, entered classifications at the time most of homosexuality left, is an indication the providers were mostly interested in gender norm deviation. The change for ICD-11 (the only really globally authoritative classification, scientifically sound is not sure yet, nor sufficient if accepted.

That people started naming themselves transsexual is understandable, given the conditions mentioned above. However slowly, with transgender really in vogue as alternative umbrella term, it is time to liberate ourselves as much as possible from this diagnosis that ascribes us all kinds of issues.

The sexual orientation group of SOGIE has emancipated hugely after their removal from the DSM and ICD, it is time trans* people start doing he same. It is not about the need to adapt our body, but that this need comes largely from minority stress: we feel different for not being accepted and that gets us stress; when we adapt our body to sex and gender norms, we are better accepted. We gain more acceptance. But multiple groups of trans* people who do not want or cannot enter such a process, are not accepted for legal change.

Western

Another reason to stop using “transsexual” in classifications is its regional Western origin. While these classifications pretend to have a global working and tell global truths. Global truths that do not exist automatically, but instead are the product of colonial effects and history. Aniruddha Dutta and Raina Roy describe in their “Decolonizing transgender in India: some reflections” (Transgender Studies Quarterly 1:3, p.320-337) how transgender as a reference has become the term of preference when working with higher level funders or NGOs (f.i. UNDP, UNAIDS) and that an effect of this is the elision of local identities like kothi (a complex identity, that is comparable as a partial overlap between gay and trans in the Western world). South Asian discourses of gender/sexual variance may blur cis-trans or homo-trans distinction and community formations may also be built on calls/caste position rather than just the singular axis of gender identity, they say (P.321) Again: things are more complex.

Medical classifications take up issues and identities without investigating the cultural and conceptual baggage that comes from it, such as the false homo-trans or cis-trans binaries, that are definitely not global. The idea that people are either trans or homo is still pretty much alive, as incorrect as it is. Someone who starts out feeling homosexual and then moves on towards trans does not always leave their homosexuality behind, these are no discrete binaries. Nor is cis-trans a discrete binary: where to leave intersex people whose sex characteristics and identification may put them at odds with both categories. Using only one axis for identification leaves out several factors of importance.

Ways forward

With “transsexual” several elements from different disciplines are joined together under a disciplinary regime. Heteronormativity (why else get rid of reproductive organs that may still have a function for the trans person) as perfectly described under the old regime by Ines Orobio de Castro in her dissertation.

A good way out would be to first of all declassify gender identity issues out of the psychiatric classification categories and change it towards something along the lines of “medical assistance with (somatic) gender transition”. In technical terms it would end somewhere in what are now in ICD-10 the Z categories. As the campaign “Stop Trans Pathologization” suggests:

We identified Chapter XXI “Factors influencing health status and contact with health services” as the least pathologizing section for introducing a new “Trans Health Care” block in the ICD. In the process of elaborating a new trans health care block we consider it important to take into account the following aspects:

  • The inclusion of an explication at the beginning of the new block / code stating that“trans health care” comprehends a health care that recognizes and affirms the chosen gender of the persons, independently of their birth-assigned gender.
  • The inclusion of a description not based on etiological hypothesis or diagnostic criteria, but on a reference of procedures that are relevant for trans health care.
  • We definitely need a human rights approach because everything is connected with rights, that we can ‘cash in’ or not. There is a right to health that should be applicable to everyone, including trans* people. There is right to be free of unnecessary and unwanted treatment. This is why the intersex movement says: keep your hands off our bodies! Just that bodies do not conform to societal standards does not mean they are to be cut open and rearranged. As we have a right to bodily autonomy it is up to the person concerned to indicate what they need.

And as we fight for our rights to self define our feelings and identities, expressions, we should leave the definition of transsexual out. An alien definition that promotes – with the relative entitlements – hierarchies under trans* people.