The Riddle of Gender - Deborah Rudacille [14]
Though the first scientific study of gender variance was published in Germany nearly a century ago, scientific understanding of the causes of what are today classified as “gender identity disorders” remains sketchy. Did transvestites (people who wear the clothes and sometimes adopt the lifestyle of the other sex) exist before the German sexologist Magnus Hirschfeld introduced them into the clinical literature in 1910? Undoubtedly. But prior to Hirschfeld, transvestites were believed to be a kind of homosexual—a category that itself had been only recently created. (Hirschfeld was the first to note that transvestites were usually heterosexual.) Similarly, though Hirschfeld included case studies of people born male who clearly expressed female gender identities, he didn’t identify transsexuals as a separate diagnostic category. British sexologist Havelock Ellis, who had experience with both transvestites and transsexuals, wanted to call members of both groups “eonists,” after the Chevalier d’Eon, a nomenclature that never caught on. It remained for the American physician Harry Benjamin to clarify the distinction between transvestism (today called cross-dressing) and transsexuality in his 1966 book, The Transsexual Phenomenon, and for a professional organization in Benjamin’s name to establish Standards of Care for treatment of transsexuality, in 1980.
More recently, “gender identity disorder” has been created to replace “ transsexualism” as a diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). But science is no more certain today why some people feel so acutely uncomfortable in the sex they were assigned at birth than it was in Hirschfeld’s time—nor why their number seems to be increasing.
Statistics on transsexualism and transgenderism are notoriously unreliable; in the case of transgenderism (a broad and variously defined category) they are mere guesswork. However, it is possible to track the number of people requesting sex-reassignment surgery and to make some general estimates of prevalence (the number of cases of a given condition present in a given population during a given time) based on those figures.
According to the fourth edition of the DSM (DSM-IV), about 1 in 10,000 people seek sex-reassignment surgery (SRS) in the United States every year, and approximately 1 in 30,000 men and 1 in 100,000 women will undergo SRS at some point during their lives. This is believed to be a very conservative estimate, based on SRS statistics that are decades old. Professor Lynn Conway of the University of Michigan suggests that the DSM-IV figures are off by at least two orders of magnitude and that “the prevalence of SRS in the U.S. is at least on the order of 1:2500, and may be as much as twice that value. Therefore, the intrinsic prevalence of MtF transsexualism here must be on the order of ≈ 1:500 and may be even larger than that.” A group of researchers in the Netherlands recently estimated the prevalence of transsexuality to be 1 in 11,900 males and 1 in 30,400 females; this estimate was based on the number of Dutch citizens seeking services compared with the general population.
Legal scholar Julian Weiss has pointed out that “gender identity disorders” are probably far more common than previously suspected, on the basis of four general observations. First, unrecognized gender problems are occasionally diagnosed when patients are seen with anxiety, depression, substance abuse, and other psychiatric conditions, which often serve to mask the underlying gender issue. Second, many individuals who meet the diagnostic criteria for “gender identity disorder” never present themselves for treatment (this category includes the great majority of cross-dressers, professional female impersonators, and gender-variant gay people). Third, the intensity of some people’s feelings of gender-related discomfort fluctuates throughout their lifetimes, and does not always achieve