A medical diagnosis can be made if a person experiences discomfort as a result of a desire to be a member of the opposite sex, or if a person experiences impaired functioning or distress as a result of that gender identification.
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Transsexualism in different cultures
Transsexualism is stigmatized in many parts of the world but has become more widely known in Western culture in the mid to late 20th century, concurrently with the sexual revolution and the development of sexual reassignment surgeries. It remains controversial, however. Discrimination and negative attitudes towards transsexualism often accompany certain religious beliefs or cultural values. There are other cultures, however, that have not only held a place for transsexuals but even sanction them. Some native American tribes accept them as Two-Spirit People.
Transsexual people experience varying degrees of acceptance in non-Western societies. Since the mid-1980s, transsexual individuals in Iran been officially recognized by the government and allowed to undergo sex reassignment surgery. Thailand is thought to have the highest prevalence of transsexualism in the world. In Thailand, kathoey (who are often, but not always, transsexual) are accepted to a greater extent than in most countries, but are not completely free of societal stigma. Feminine transsexual kathoey are much more accepted than gay male kathoey; this may be seen as an example of heteronormativity. Transsexual- (and tg-) related issues remain largely taboo in much of Africa and in developing countries around the world
Sex Reassignment Therapy
To obtain sex reassignment therapy, transsexual people are usually required to receive psychological therapy and a diagnosis of gender identity disorder in accordance with the Standards of Care (SOC) as issued by the World Professional Association for Transgender Health. After preliminary psychological screening for both men and women, medical treatment typically begins with hormone replacement therapy. Transwomen are usually required to live as members of their target sex for at least one year prior to genital surgery. Transmen must generally wait two to three years after beginning testosterone treatment in order to allow for sufficient clitoral growth. However, some transsexuals, especially among transmen, may not wish to have this surgery. There are many reasons why some transsexuals opt out of genital surgery. Among these are cost, surgical risks, and acceptance of a certain amount of physical deformity.
Causes of Transsexualism
Many psychological causes for transsexualism have been proposed, while research has also been presented to suggest that the cause of transsexualism has its roots in biology. There remains no agreement, however, as to the cause of transsexualism.
Some transsexual people and professionals feel that research into causes of transsexualism assumes at face value the legitimacy of a normative gender identity, and/or that transsexualism is contrary to normal development, and could be considered a disease, or syndrome, which transsexual people may find stigmatizing. Other transsexual individuals and professionals believe that transsexualism is, in fact, a syndrome with a physiological basis as a form of intersexuality.
Studies indicate that transsexualism is connected with a difference in the human brain called the bed nucleus of the stria terminalis. In one study, male-to-female transsexuals and cisgendered women were shown to have brains that were similar to each other in the BSTc area of the brain. Both heterosexual and homosexual men showed male brain structuring in this area.
- Two-Spirited People