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From Transsexualism to Harry Benjamin Syndrome.
Magnus Hirschfeld introduced the term transsexualism in 1923, and first labelled the condition as
"psychic transsexuality". He delivered the first scientific lecture on transsexuality in an address to the Association for
the Advancement of Psychotherapy in 1930. Hirschfeld considered transsexuality to be a form of intersexual condition. Later,
Caldwell called it "pyschopathia transexualis" in the late 1940s. However, it was not until the 1950s that Dr Harry Benjamin
introduced the term to wider medical circles.
Dr Harry Benjamin was a pioneer into the research of this condition, and he believed that it had a biological cause. This was also the contention
of Dr Hirschfeld, the originator of the term. There was a great need to distinguish this condition from transvestism and homosexuality,
and the term transsexuality seemed adequate to the task. Unfortunately, there was a great amount of ignorance concerning
the origins of this condition, but medical professionals did at least start to talk responsibly concerning the transsexual
phenomenon.
However, there was a basic difference between Hirschfeld and Benjamin. Hirschfeld considered transsexuality
to be a form of "third sex", and connected it to his defence of the rights of homosexuals. On the other hand, Dr Harry Benjamin
considered it a physiological condition that merely needed the modification of the phenotype and endocrinology to bring accord
between the neurological gender and the anatomical genital structures.
Dr Harry Benjamin paved the way for a better understanding and recognition form the international medical
community. Without his deep compassion for more than a thousand patients, without his engagement in academic and professional
circles, and without his numerous lectures and publications, treatment for HBS might not be as available as it is today. Dr
Harry Benjamin shed light upon the topic as no previous doctor had, and his professional biography is the most prominent in
the history of the treatment of transsexuality.
In the past, doctors considered HBS to be a psychopathological condition where an individual had delusions
of being of the opposite sex. Practitioners considered the condition aberrant, and many considered it an "unexplainable" fancy.
(see Caldwell, Pyschopathia Transexualis, 1949)
However, there has been much detailed and
technical research in the last two decades devoted to the origins and treatment of HBS. Researchers have concluded that HBS is a physiological condition, and there is no link to psychopathology
whatsoever. Today, the term 'transsexualism' is outmoded in its' ability to properly describe the condition.
Research now documents the fact that neurological events undergird the existence of HBS. The old psychological construct known as transsexualism is now passé. Thus, those with HBS have the objective neurological gender identity of their sex of subjective identification.
Recent studies tell us that neurological gender identity, not anatomical genital structures, determines
the actual sexual identity of an individual. Therefore, someone born with HBS is already a member of the "opposite" sex. This overturns the term transsexualism because
there is no "change of sex". Rather, one only does corrective surgery on physical structures.
Someone with HBS is already a member of their identified sex biologically, as their neurological structures
are of the identified sex, not of the genital sex. Simply put, their neurological sex is opposed to that of their genital sex.
Therefore, we see that HBS is actually an intersexual condition, and the old idea of transsexualism becomes outdated. The idea of a neutral and physiological neurological basis for the
conundrum replaces the obsolete idea that transsexualism was a psychological disorder.
Thus, we see that HBS is not a personality aberration or a mental orientation towards a particular sexual
identity. Such a physiological condition demands early diagnosis and treatment, so that the affected individual can live a
normal and adjusted life. One cannot delay it for reasons of "psychotherapy", which is of dubious utility in any case.
Doctors once thought that schizophrenia and manic-depressive Disorder were mental illnesses. Today, we see them as physical diseases of the brain structure, which we treat with the appropriate medication
to correct the chemical imbalances that cause them. We see the same phenomenon in the current thinking regarding Parkinson’s Disease and Alzheimer’s Syndrome.
Likewise, experts now consider that HBS is not a mental disorder, but rather a biological anomaly of
human sexual formation. It is an intersexual condition where the morphological sex of the brain is in conflict with the phenotype
and genotype. We can treat it with the proper hormonal intervention and surgical modification of the anatomical genital structures.
The old term of transsexualism urgently needs a radical revision. We must leave the old superstitions regarding
HBS in the past. Too many negative connotations surround transsexualism: stigma, superstition, media distortion, and back-alley
medical treatment. It does not describe the somatic condition adequately, and so we must discard it at the first opportunity.
We have a responsibility to bring the facts to light. We must stop the continual sensationalism in the mass media, and we must do our part to halt the spread of misinformation
concerning HBS. Only then, shall we see HBS as it is in reality: a neutral and somatic condition, no different from any other
physical condition.
The Problem of Terminology.
The question of the proper terminology we use to describe our condition is the greatest problem that must
be attended to by people with HBS.
To achieve full social assimilation into the gender role of physiological reassignment we must first
sharpen our perception of ourselves as we are in actuality. One of the main factors in this process is the proper terminology
used to define our condition.
At present, definitions that are inadequate in both medical and intellectual terms are in use. Although these
formulations had some currency when they were first proposed, they have lost all validity today. The very methodology of treatment
appears to be in a state of flux now, and people may even use several different (and often contradictory) constructions to
describe themselves.
The confusion regarding terminology is most serious in the various forms of the popular mass media. Most
of this material is not serious in tone, nor does it focus on any of the actual problems of the condition. We should keep
in mind that these media are entertainment vehicles, modern equivalents of the Roman panes et circenses.
This chaotic disorder appears to be this forum’s typical reaction to any serious medical concern, but
as far as HBS is regarded, the mass media and its’ anointed spokesmen give it only smirking and prurient treatment.
Perhaps, we should not expect much from a medium that glorifies the likes of Dr Phil and Dr Laura.
Let us look at some of terms that are currently in use, or may be adapted in the future.
Harry Benjamin Syndrome (HBS)
In Medicine the term Syndrome refers to the association of several clinically recognizable features,
signs (discovered by a physician), symptoms (reported by the patient), phenomena or characteristics which often occur together,
so that the presence of one feature alerts the physician to the presence of the others. In recent decades the term has been
used outside of medicine to refer to a combination of phenomena seen in association.
In technical medical language,
a "syndrome" refers only to the set of detectable characteristics that identifies a specific physiological or psychological
particular situation or condition. We consider positive to define Harry Benjamin Syndrome as a medical illness as
opposed to a psychiatric disorder, in order to ensure proper medical treatment and research of the condition.
The title
HBS comes from Dr Harry Benjamin, a pioneer in the serious research of this condition. More than any other single figure, Dr Harry Benjamin initiated the
systematic and regular treatment of HBS (then called transsexuality). His career is the most prominent in the history of treating
HBS to date.
The formerly know as HBIGDA (Harry Benjamin International Gender Dysphoria Association) also used his name.
It produces the Standards of Care followed by medical practitioners who treat HBS.
Of the terms in use at present, Harry Benjamin Syndrome is the most neutral, and
the freest of any pejorative connotations. Most other current terms are simply inaccurate or inadequate.
Transsexualism/Transsexual(s)
The most common and well-known term for HBS is transsexualism, which the German sexologist
Magnus Hirschfeld coined in the 1920s. There are several serious problems with this construction. Including "sex" in the name
attracts undesirable attention. This has strong implications of connections with sexual orientation, which simply do not exist.
It is much too similar to "transvestism", which is a completely unrelated phenomenon.
Men who receive a sexual frisson from wearing female clothing have nothing in common with men who were born with female
anatomy, and are therefore in inner turmoil as a result. There is enough superficial similarity between the two terms to cause
much confusion in the minds of the simple.
In any case, transsexualism is a badly defined term. To use transsexual as a noun
is dehumanising, leaches people with HBS of their personality, and makes it easy for the bigoted to think of them as being
"other", "weird", and "perverted". People with HBS have a particular medical condition, it is not the basis and ground of
their identity, and we should not see them as "laboratory specimens" or "circus freaks".
The adjectival use is hardly better. People all too easily construe "transsexual
man" or "transsexual woman" as "false man" or "impostor woman". Many are confused because of this term as to the proper term
to call a person with HBS. They wonder whether they should address them as "man" or "woman". This is the source of such vile
constructions as "he-she".
After a childhood spent in the wrong social gender, and being in much confusion consequently,
a person with HBS is most in need of consonance in their psychophysical identity. The driving need in one’s life becomes
the achievement of congruence between neurological gender and anatomical reality. At the same time, there is a desire to leave
all sexual ambiguities behind, to have wholeness in the gestalt of body, soul, and mind.
It is diabolically cruel to affix the label of "transsexual" onto a person for the
rest of their life. They do not engage themselves in a life-long journey between the sexes; it is only a temporary stage on
the way to total personal congruency. This usage of transsexual clearly suggests and implies that the person involved is never
a true man or woman, but rather a pariah and on a perpetual pilgrimage between the sexes.
Whenever the term "transsexual man" or "transsexual woman" is used, the strong implication
is that they are not truly men or women. It matters not if the person involved is at peace because they have finally reached
congruence or if their personal appearance is well within the bounds of their sex.
This term robs the person with HBS of full completion, it steals the peace of congruence,
and it smirkily informs one that no matter how much one tries, you shall never be allowed to end the perpetual wandering of
transsexuality. The continual accusations never give you rest, and you shall never be finally safe at home, in concord and
harmony.
This is ironic, because we live in an age where we can correct the physical anomalies
completely. This is cruel because the time of transition is only a year or two at most, but as long as one is a "transsexual",
many shall never allow you to reach the far shore.
You must stay anchored out in the harbour, and only hear the laughter and joy of
others ashore in the city. You must wear a placard about your neck proclaiming your status, ring a bell loudly, and shout,
"Leper, Leper! Unclean, unclean"! as you make your way amongst the crowd.
The term transsexual comes from two Latin roots. "Trans" is a prefix that means through,
across, beyond, or to change. "Sexual" is a verb that comes from the Latin sexualis, which means anything associated
with sex or the sexes. We can see where the original derivation of the word came from. It referred to someone who was in the
process of moving between the two sexes.
It is unfair to burden people permanently with labels that are no longer appropriate
or applicable once changes are made, obstacles are overcome, surgery is finished, and they have taken their place in society
in their proper gender. If you must give a classification, let me suggest two: "man" and "woman". Full stop.
Dr Harry Benjamin wrote:
"The term transsexualism may prove to be inappropriate if it should ever be shown that an anatomically normal
male may actually be a genetic female, or at least not a genetically normal male. In such event, we would be dealing with
a transgenital desire instead of a transsexual. "
The Transsexual Phenomenon (the Etiology of Transsexualism), 1966
Harry Benjamin MD
By transgenital, Benjamin was referring to a form of intersexual condition. Recent
research has corroborated this early hypothesis of Dr Benjamin. A team headed by Vilain at the UCLA in 2003 pointed out this
very differentiation.
Moreover, the neurological-sexual differentiation as a biological marker existent in all with HBS has been confirmed
by Dutch scientists (Kruijver, 2000). This proves the physiological and intersexual nature of HBS.
If HBS is a pre-existent neurological condition, transsexuality loses all its’
validity as a definition, for in such a case no one is "changing their sex" at all. One can change physical body structures,
but one can never change one’s neurological gender. If such is so, no one is "trans-ing" anything.
If one looks in the dictionary for the definition of the term transsexual,
one finds the following:
- a person who has undergone a "sex-change" operation
- a person whose sexual identification is entirely with the opposite sex
- overwhelmingly desirous of being, or completely identifying with the opposite sex
These are all adjectival usages.
None of these definitions fits people with HBS, at least in the sense of being scientifically
rigorous, medically accurate, or intellectually precise. Therefore, people with HBS do not fall into these categories. This
means that people with HBS are NOT
transsexuals, in any sense of the word. What do we call people with HBS? Why not simply "people with HBS in their medical
history"?
Today, most people living with HBS have found the term transsexual to be awkward
and uncomfortable, and do not wish others to address them as such. Let us admit it, this construction is sleazy, outmoded,
and inaccurate. It has no future, save in certain restricted uses in Zoology.
Transsexuality
One of the terms with the greatest amount of pejorative meaning and stigma attached is Transsexuality.
Although it sounds similar to the above construction, it is actually a distinct designation. Some call it a "lifestyle choice"
or the expression of an aberrant personality. It is the term with the greatest stigma attached for the person with HBS.
The finding of physiological indicators and the consequent change in terminology have liberated people with
HBS from the cruel grip of this term.
The only legitimate usage of the word "transsexuality" is in the field of zoology, where it applies to animals, not human beings. It refers to the fact that certain species of amphibians can change from
male to female, or vice versa, as environmental needs demand.
People with HBS do not "change their sex", nor do they become members of the "opposite" sex. People with
HBS already are members of their aspirational sex through the fact that their neurological structures are organised accordingly.
Please, remember that gender is a fixed quantity, it is immutable, and we cannot change it by any method medical or psychological.
Transgender
This all-inclusive term has gained currency in recent years, especially amongst those affiliated with homosexuals.
It covers everything from casual cross-dressing, female impersonation, severe transvestism, psychological transsexualism,
autogynephilia, and actual HBS sufferers.
This far too broad a characterisation to be useful and it is not precise or clinically discriminating. It
implies similarity in actions that have no relationship whatsoever. Since it is nebulous and vague in meaning, it ends by
telling you nothing about a particular individual.
My own opinion is that all others in this umbrella category are using the arguments for HBS to undergird
their arguments in favour of their specific psychopathology. In effect, they attempt to ride upon the backs of those with
HBS to gain sympathy for their cause.
In terms of numbers, people with HBS are perhaps only 1% of this group. We are silent in comparison with
the often loud and strident "transgendered activists". Therefore, one can see that much of the misconception in the public
perception of HBS comes from those who do not have the condition in the first place.
All people with HBS should distance themselves from "transgenderists" completely and totally.
Sex Affirmation Surgery (SAS)
This term is preferable to the terms Sexual Reassignment Surgery (SRS) or Gender Reassignment Surgery
(GRS). SAS is the most precise medically.
It highlights the fact that the surgeon only makes corrections to anatomical structures. This procedure is
emphatically not a reassignment of gender (for that is immutable), nor is it a reassignment of sex (for that occurred during
the process of preliminary HRT).
This surgery brings congruence between neurological gender and anatomical genitalia, so the title Sex Affirmation Surgery is not only medically precise, it describes for others
what the surgeon has done. He has not changed sex or gender, he has merely fixed a physical structure.
We must always keep our language regarding HBS precise, clinical, and objective. This is what shall gain
us support in the larger community.
There are other terms in use for HBS, but they are colloquialisms, slang, or rude usages. They merit no discussion
here.
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Transpeak Terminology
Transpeak is the language of transworld.
Transpeak Terminology refers to all words with "trans"
in their structures or definitions.
Examples of Transpeak Terminology
are:
transsexual, transsexuality, transition, pre-op, post-op, non-op,
MtF,
FtM, transwoman, transman, transgenderist, translife, transex,
trans, tranny, cross-living, new man, new woman, pass, passing,
transproud,
T-friendly, T-love, transphobia, TS, transsexual woman,
transsexual man, femme, butch, getting read, and many others...
We strongly recommend that you NEVER use Transpeak Terminology to refer to yourself or others. It only spreads the misconceptions that are already
current in society.
We have HBS, a physiological condition: nothing more.
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