7. Cross-Gendered Persons

A. Conceptualizations

[On March 12, 1993, the “Op-Ed” page of The New York Times carried a full-page reflection on “How Many Sexes Are There?” The March/April issue of The Sciences, published by the New York Academy of Sciences, featured an article on “The Five Sexes: Why Male and Female Are Not Enough.” These articles, by biologist Anne Fausto-Sterling, are evidence of a trend in changing definitions of gender roles over the past decade that is echoed in the appearance in 1995 of Hermaphrodites with Attitudes, a newsletter published by cross-gendered persons who endorse Fausto-Sterling's call for the medical profession to recognize gender diversity and cease using surgery and gender reassignment to force true hermaphrodites (“herms”), female pseudohermaphrodites (“ferms”), and male pseudohermaphrodites (“merms”) into the dichotomous mold of male or female. (Editor)]

An Indigenous View

American society, with its cultural diversity, has long assumed that one's gender perception, role, and presentation are all a function of biological anatomy, as visually ascertained at birth. This biocentric viewpoint served as the basis for looking at sexual and gender variations for both sexologists and therapists. Until the mid-1970s, many sexual and gender options were seen and diagnosed as deviations of the male/female gender dichotomy and/or as types of sexual dysfunction. Gender options, as style modes of clothing and accouterment, gender shifts, and transsexualism were viewed as diseases [sic] of the psyche. Those who chose such options were considered “gender-conflicted” and were treated on the basis of known medical or psychological modalities (Pauly 1994).

Factors contributing to the current trend of changing gender roles include the rise and powerful articulation of feminism among both women and men; the knowledge explosion in molecular biology, specifically genetics and endocrinology, artistic diversity in both the visual arts and music with their individual styles and presentations (with cinema, television, and music increasingly dealing with gender and cross-gender issues), the emergence of an articulate, vocative, and visible gay-lesbian-cross-gender “community,” and the influence of computer technology and its application in almost all sectors of American life. The impact of these factors on the daily lives of Americans - how they think, how they feel both about themselves as well as society, and how they act and present themselves to each other - has been awesome.

In this social context, there is a powerful drive to question the biocentric notion about gender being a derivative of the biomorphic nature of Homo sapiens, i.e., two sexes implies only two gender forms. This challenge to gender rigidity, in roles and presentations, is seen in many areas of American social and economic life. Women as bus drivers and heavy-equipment operators and men as nurses and secretaries represent only one aspect of the varied paradigm shift occurring in America in the nature of gender identity and its concomitant behaviors. Instead of a two-sexes/two-genders model, one needs a model of two or more sexes and many genders. This gives rise to a sociocentric view of gender, in which one can think of gender in terms of three basic parameters: perception (Jungian constructs of anima/animus), social role (cuing, interactions, and gender-role inventories), and presentation (modes of presenting one's self, for whom, when, motivations, etc.). A person is then seen as a composite of these three parameters, with the gender composite time-dependent and always subject to some change in one or more component over the lifespan.

The shift from focusing on individual gender conflict to looking at facets of gender diversity is evident in the “gender rainbow” paradigm suggested by gender counselors Leah Schaefer and Constance Wheeler, June Reinisch's concept of “gender flavors,” and James Weinrich's model of “gender landscapes” (Francoeur 1991, 100-101). In these paradigms, the notion of conflict is broadened to include gender explorations and gender clarifications and how an individual can access these avenues in their search for personal growth in a tolerant and more nurturant society. Armed with this sociocentric model of gender, one can study CD/CG (cross-dressing/cross-gender) behaviors and conflicts with a more-sensitive approach to the issues and problems of gender expression in an ethnoculturally diverse American society.

Traditionally, the terms “transvestite” (TV) and “transsexual” (TS) have been used to label individuals, mostly males, who wear apparel usually associated with the other sex, or who want to cross a gender boundary and seek anatomical congruity with the other sex. These terms are too inclusive and stigmatize the person, who may be on a gender exploration, or who sees personal gender expression as only one piece in their total personality matrix. To deal with this limitation, the following new glossary has been proposed, with the terms serving as “mileposts” on the road to gender “happiness:”

· A “cross-dresser” (CD) is a person, male or female, who wears an item or items of apparel usually worn by the other gender; it is a descriptor of behavior and includes previously used terms like TV (transvestite), FI (female impersonator), and DQ, (drag queen).

· “Cross-gender” (CG) refers to a person, male or female, who desires to cross and explore a gender role different from typical gender roles associated with their biologic sex. It can also be used as a behavior descriptor.

· A “transsexual” (TS) is a person, male or female, who has chosen a preferred gender role and wants anatomical congruity with that gender-role preference. This is achieved with an appropriate sex-hormone-therapy program and sex-reassignment surgery (SRS).

· “New Women/Men” refer to persons, male or female, who have transited to a preferred gender role, i.e., transgenderist, and have had sex-reassignment surgery.

· The “CD/CG/TS paraculture” refers to the community of people, males and females, whose general behavior patterns include a major component of gender-diverse activity.

The term “transgender” indicates that a person is crossing gender boundaries usually associated with traditional gender traits of one or the other sex. Transgender, transgendered, and transgenderist are also used to indicate transcending - rising above - traditional gender forms and expressions, a usage that has gained popularity both within the paraculture, as well as in the health-care and academic professions.

A Clinical View

The term “transsexualism” was coined by D. O. Cauldwell, an American sexologist, and popularized by Harry Benjamin in the 1950s and 1960s. Research on this phenomenon was facilitated in 1980 when the concepts of transsexualism and gender disorders were recognized in the American Psychiatric Association's Diagnostic and Statistical Manual III. In 1988, transsexualism was defined by the DSM-III-R as having the following diagnostic criteria:

1. persistent discomfort and sense of inappropriateness about one's assigned sex;

2. persistent preoccupation for at least two years with getting rid of one's primary and secondary sex characteristics and acquiring the sex characteristics of the other sex; and

3. having reached puberty (otherwise, the diagnosis would be childhood gender identity disorder).

DSM-IV has replaced the term “transsexual” with the generic term “gender disorder.”

Transsexualism is estimated to affect at least 1 in 50,000 individuals over the age of 15 years, with a 1:1 male-to-female ratio. The greater visibility of male-to-female transsexuals may reflect a more-negative bias toward male homosexuality or a lack of available female-to-male treatment in a society. Whatever the real incidence, this disorder carries more social significance and impact than the actual prevalence might suggest because of the questions raised for anyone who watches and listens to transsexuals (and transvestites) in their frequent appearances on television talk shows (Pauly 1994, 591).

An individual's perception of his or her own body, and the way she or he feels about these perceptions, are important in the clinical diagnosis of gender disorders. In 1975, Lindgren and Pauly introduced a Body Image Scale, a thirty-item list of body parts, for which the individual is asked to rate her or his feelings on a five-point scale ranging from (1) very satisfied to (5) very dissatisfied. This scale is useful in following the progress and evaluating the success of sex-reassignment treatment.

Evaluating the outcome of sex-reassignment surgery is complicated and difficult. The most recent evaluation leaves little question that the vast majority of post-operative transsexuals claim satisfaction and would pursue the same course if they had to do it again. Post-operative satisfaction ranged from 71.4 percent to 87.8 percent for post-operative male-to-female transsexuals, with only 8.1 percent to 10.3 percent expressing dissatisfaction. Among female-to-male transsexuals surveyed, 80.7 percent to 89.5 percent were satisfied with their outcome, compared with only 6.0 percent to 9.7 percent who are not satisfied. The difference between male-to-female and female-to-male satisfaction was not statistically significant (Pauly 1994, 597).

The publicity that followed the American, Christine Jorgenson's sex-change surgery in Denmark in 1953, led to widespread public and professional discussion, and ultimately a distinction between transsexualism and transvestism. Harry Benjamin developed a three-point scale of transvestism, with transsexuals viewed as an extreme form of transvestism; he later came to regard the two as different entities.

The variety of cross-dressers includes fetishistic males and females who cross-dress for erotic arousal and those who enjoy cross-dressing to express their female persona; it includes individuals who cross-dress and live full-time in the other gender role, and those who cross-dress only occasionally and partially, with the whole range between these two ends of the spectrum.

In the 1960s, Virginia (Charles) Prince, a Los Angeles transvestite, began publishing Transvestia, a magazine for heterosexual cross-dressers. Encouraged by the response, Prince organized a “sorority without sisters,” the Society for the Second Self or Tri-Ess (SSS), with chapters in several major cities. As a result of her worldwide travels, lectures, and television appearances, research on transvestism increased significantly because of the availability of research subjects.

As the cross-gender movement grew and became more visible, dissident and new voices appeared. At present, there are a variety of support groups for cross-dressers; some accept only heterosexual or homosexual and bisexual members, while others are not concerned with orientation. Some CD groups include transsexuals, others do not. In addition, there is a small industry, including “tall or big girl” fashion shops and mail-order catalogs, that cater to the clothing and other needs of cross-gendered persons.

B. Current Status of American CD/CG Paraculture

It is apparent that many more American males and females are openly cross-dressing than at any other time in this century. The motivations for this activity are quite varied, ranging from female- or male-impersonation (FI, MI) as “Miss Coquette” or “Mr. Baggypants” at a Halloween party, to lip-synching performances at FI and MI reviews (i.e., “La Cage aux Folles” or Mr. Elvis Presley look-alike shows), to femme expressions in daily activities such as work or socializing. While it appears less obvious, there are many more females who cross-dress with the intent of expressing some part of their masculine persona (animus).

In the last decade, there has been a dramatic increase in the number of social contact groups, both for males who cross-dress and want social contact with others of similar persuasion in a secure setting, and for females who want to explore more fully the dimensions of their masculinity. Both female and male adolescents are cross-dressing to reflect feelings of their favorite musical stars, e.g., k.d. lang, RuPaul, Boy George, Melissa Etheridge, Michael Jackson, or the Erasure or Indigo Girls rock groups. (It should be noted that several of these performers are also known to be gay or lesbian, perhaps creating some public confusion about the association between cross-dressing and sexual orientation.) There are also young people who show some affinity for atypical gender-role expression. These may be early phases of mixing aspects of traditional gender norms with explorations of the limits of gender duality, that may benefit from appropriate professional help.

One segment of this paraculture is definitely exploring gender options with the aim of resolving gender conflict. Such conflicts may not be limited to the intrapsychic, but extend into resolving tensions between the rights of individual expression and the norms of conventional gender roles and presentations. When the desire to shift gender is experienced, there is a need for professional help in understanding the motivation for the gender shift and to develop a program that will clarify some of the important questions that individual may have to address in pursuing such a choice. Such a program of gender exploration or gender shift may involve the use of hormones and also the decision to have sex-reassignment surgery. Some of these people label themselves transgenderists, in the sense noted above, and can fully develop and express an alternate gender role and lifestyle. Some may be satisfied with this shift and not want to pursue sex-reassignment surgery. For others, after living full-time for one-and-a-half to two years in the preferred gender role, the decision is to complete the shift with surgery; in which case, the label “transsexual” is appropriate.

Currently, more and more people are challenging the binary gender forms and want to explore other gender options. If surgery is not the ultimate objective, these individuals may choose to blend traits and become more androgynous or gynandrous, expressing a feminine-masculine or masculine-feminine gender. This segment of the paraculture is also receiving some attention.

As for legal issues involving CD/CG behaviors, most states do not have statutes that specifically prohibit the practice of CD/CG presentation in public. However, there may be some local ordinances that restrict this behavior in their jurisdiction. If tested in the judicial system, such laws would probably be ruled unconstitutional. Obtaining a legal change of name is not a problem in most areas of the country, and should be accompanied by some form of public notice for creditors, usually in the classified section of a local newspaper. Change of birth certificate may pose some problems; again each state has its own guidelines.

With regard to sex-reassignment surgery, a medical group created a pamphlet of guidelines for the preoperative transsexual about 1980. Standards of Care details guidelines for the client, health-care counselor/therapist, and the surgeon for handling the process of gender shift prior to surgery. This document is available from any of the organizations listed at the end of this section. Few, if any medical-insurance plans pay for this surgery, which for a male-to-female runs about $8,000 to $10,000. In recent years, several reputable gender clinics have discontinued providing this surgery.

For health-care professionals, sex educators, counselors, therapists, physicians, nurses, and sexologists, there are two major programs available to update one's knowledge about gender or to facilitate change in attitudes about gender issues. Segments in die standard Sexual Attitudes Reassessment (SAR) Workshop focus on CD/CG behaviors and lifestyles. In the Gender Attitude Reassessment Program (GARP), the focus is on all aspects of gender and its diversity; ten to fifteen units deal with specific topics in the phenomenon of gender. Both of these programs are given at national professional meetings and in continuing education programs at major universities and mental health centers in the U.S.A.

Within the paraculture structures, there are several programs for CD/TG/TS/AN Americans. Two of the oldest and “personal-growth-oriented” are Fantasia Fair and Be All. Fantasia Fair, founded twenty years ago, provides a living/learning experience for adult male cross-dressers who want to explore the many dimensions of their femme persona in a tolerant open community. Fantasia events, often held at Provincetown on Cape Cod, Massachusetts, emphasize personal growth in all aspects of their programming. Be All, an offshoot of Fantasia Fair, focuses on the practical and social aspects of femme persona development. It is usually held in a motel/inn near a major city and is sponsored by a regional group of social contact organizations.

Organizations providing information on gender issues include:

American Education and General Information Service, P. O. Box 33724, Decatur, Georgia 33033.

Harry Benjamin International Gender Dysphoria Association, P. O. Box 1718, Sonoma, California 95476.

I.C.T.L.E.P., Inc., 5707 Firenza St., Houston, Texas 77035-5515.

Outreach Institute of Gender Studies (OIGS), 126 Western Ave., Suite 246, Augusta, Maine 04330.

The Society for the Second Self (Tri-Ess) (for heterosexual cross-dressers only), P. O. Box 194, Tulare, California 93275. (Publishes a quarterly magazine, Femme Mirror, and other support material.)