Diverse-Gender Sexology

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Gender Diversity:  People who were assigned a gender, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of themselves.

Throughout this web site, Dave Wells prefers to use the term ‘Gender Diversity’ as he views the term as taking away any presumptions and embraces all people who identify and live with a gender identity outside of sis-male or sis-female.  At the same time in stating this, Dave Wells respects the person’s choice of identity, but prefers to learn about the person and their individualities, rather than conforming to an ‘identity label’ that is interpreted by a number of pre-requisite symptoms.

There are many descriptions and labels used to describe people who are gender diverse, they include;

‘Transgender’:  a person whose sense of personal identity and gender does not correspond with their sex given at birth.  

When referring to the two basic "directions" of transgender, the terms ‘transman’ for female-to-male transgender people (which may be further abbreviated to FtM), and

‘Transwoman’ for male-to-female transgender people (which may be further abbreviated to MtF).

- Transgender is sometimes also used specifically in an "in-between" sense for a person who intends on transitioning, rather than as an umbrella term.

‘Transsexual’ or ‘Tranny’:  a person who emotionally and psychologically feels that they belong to the opposite sex and seek medical assistance to align their body with their identified sex or gender.

-  Originally, the term transgender was coined in the 1970s by Virginia Prince in the USA, as a contrast with the term "transsexual," to refer to someone who does not desire surgical intervention to "change sex," and/or who considers that they fall "between" genders, not identifying strictly to one gender or the other, identifying themselves as neither fully male, nor female.  Some spell the term ‘transexual’ with one ‘s’ in order to reduce the association of their identity with psychiatry and medicine.

‘Gender Dysphoria’:  This is a medical term to describe the condition of feeling one's emotional and psychological identity to be at a variance with one's birth sex.  

- Dave Wells chooses not to use this term as he views diverse-gender as a human diversity, rather than a medical condition (with respect to a person’s own choice of identity).

‘Gender Identity Disorder’ (GID): "A strong and lasting cross-gender identification and persistent discomfort with one's biological gender (sex) role. Transsexual - A person with gender identity disorder who has an overwhelming desire to change anatomic sex; one who seeks hormonal or surgical treatment to change sex.

- Again, Dave Wells chooses not to use this term as he views diverse-gender as a human diversity, rather than a disorder (with respect to a person’s own choice of identity).  

The terms "gender dysphoria" and "gender identity disorder" are used in the medical community to explain these tendencies as a psychological condition and the reaction to its social consequences. Strictly speaking, gender dysphoria and gender identity disorder are considered to be mental illnesses, as recorded in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), the standard for mental healthcare professionals. Unfortunately, many mental healthcare providers know little about transgender life, and persons seeking help from these professionals often end up educating the professional, rather than receiving help themselves.

Among those therapists, psychologists, etc. who do know about transgender health and lifestyle issues, many believe that transitioning from one sex to another "the standard transsexual model" is the best or only solution. This usually works well for those who are ‘transsexual’, but often far less well for those cross-gender people who do not identify as plainly male or female.

Disorders of sex development (DSDs): are medical conditions involving the reproductive system. More specifically, these terms refer to “congenital conditions’ in which development of chromosomal, gonadal, or anatomical sex is atypical."  Dave Wells prefers to explore the gender-diversities of the individual as a complete person, rather than view the narrow societal ‘Cis-male’ and ‘Cis-female’ view of gender.

Intersex:  A person born with both male and female sex organs, or other sexual characteristics.

Non-binary: “not relating to, composed of, or involving just two things”.

“Denoting or relating to a gender or sexual identity that is not defined in terms of traditional binary oppositions such as male and female or homosexual and heterosexual.

Hermaphrodite:  a person born with both male and female sex organs, and other sexual characteristics.  Intersex is the correct term used replacing the old term, hermaphrodite.  This word is deemed offensive.

Gender queer: relating to a person who does not subscribe to conventional gender distinctions, but identifies with neither, both, or a combination of male and female genders.

Transvestite:  a person, typically a man, who derives pleasure from dressing in clothes primarily associated with the opposite sex.

A cross dresser: a person who largely identifies as heterosexual who on occasion enjoy presenting as female and usually does not have relationships with people who have penises.

Cis gender: identity matches the sex that they were assigned at birth.

Sistergirl & Brotherboy: Are terms used by the Aboriginal or Torres Strait Islander communities to describe being ‘transgendered’ in a way specific to Indigenous culture.

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Pleasenote:  A ‘drag queen’ is a female impersonator and a ‘drag king’ is a male impersonator and neither is a gender diversity in itself.

Transgender in non-Western cultures

Many other cultures have differences on how they define gender diversity:

·    Varied Native American communities recognized gender-diversity as, a woman-living-man, not as a man who wants to be a woman. Different Native American ethnic groups had different names for the role, such as the ‘winkte’. The husband of such a person is not viewed as being gender-different themself, but as a normal male. In some societies there is a corresponding gender for man-living-women (amazons).

·    In Thai culture, there is the 'kathoey', who is very similar to the English definition of transgender, but is sometimes broader, including effeminate gay males more so than the term "transgender" does.

·    South Asian cultures have 'hijra',usually genetic males who have been castrated and live as women.

·    Chinese cultures have a wide variety of transgender modes of existence.

“Distress arising from an incongruence between a person's felt gender and assigned sex/gender (usually at birth) is the key symptom of gender dysphoria.

'Gender Dysphoria' has been adopted as the new tern used by the DSM 5 in replace of GID (Gender Identity Disorder).

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'Gender Dysphoria' in those assigned male at birth tends to follow one of two broad trajectories: ‘early-onset’ or ‘late-onset’.

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Early-onset ‘gender dysphoria’ is behaviourally visible in childhood with symptoms including:

• preferences for opposite sex-typical toys, games, or activities.
• great dislike of their own genitalia; and
• a strong preference for playmate of opposite sex children.
• Some children may also experience social isolation from their peers, anxiety, loneliness, and depression.
• Please note that these symptoms do not necessarily mean that your child is diverse gender.

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Sometimes gender dysphoria will desist in this group, and they will identify as gay or homosexual for a period of time, followed by recurrence of gender dysphoria. This group is usually sexually attracted to members of their natal sex in adulthood.

Late-onset gender dysphoria does not include visible signs in early childhood, but some report having had wishes to be the opposite sex in childhood that they did not report to others.

Trans-women who experience late-onset gender dysphoria will usually be sexually attracted to women and may identify as lesbians. It is common for people assigned male at birth who have late-onset gender dysphoria to engage in cross-dressing with sexual excitement.

In those assigned female at birth, early-onset gender dysphoria is the most common course. This group is usually sexually attracted to women. Trans-men who experience late-onset gender dysphoria will usually be sexually attracted to men and may identify as gay.

Dave Wells views the term 'Gender Dysphoria' as offensive and stigmatising due to many defining the term as inferring that Trans people are unwell, or they have a condition that can be cured. In reality, dysphoria experienced by trans people is often caused by the reactions of others in relation to a person’s gender, as a result of living in a society that is not inclusive. Therefore, it is the judgement and discrimination placed on trans people that causes dysphoria.

Often in older writings (pre ~1990s), but rarely today, the term transgender is used to refer to "non-op transsexuals" or "non-op trans people" who live as the gender opposite to their assigned gender at birth and though sexual reassignment surgery is possible, have chosen not to undergo it.

Another label or term used is ‘Pre-op transexual’, meaning that they have not engaged in surgery to change their genitals. Many people who are trans are comfortable with their genitalia, and do not believe that their sexual anatomy defines the gender of the person. This view is also very true for people who identify as non-binary.

There are also trans people who chose to live with the genitalia that is consistent with the gender that they identify as, (e.g. male = penis, female= vagina), and will choose to have gender reassignment therapy to change their genitalia.

Sometimes, the term transgender is used as an umbrella term to encompass all gender diversities.

Dave Wells has experienced a large divide between the way western health views ‘gender’ to how he views gender. From a ‘health perspective’ gender is associated to the male and female genitals. For example:

If a heterosexual identifying male (has penis), is in a relationship with a pre-op Trans woman (has penis), many health professionals would identify them as being in a homosexual relationship, due to both having penises.

Dave Wells allows for the individuals to identify their own relationship, however at the same time, Dave Wells would assume that they are in a heterosexual relationship because the gender identity that is being presented is that of a male and female.

‍Transgender as "in between"

‍Transgender is sometimes also used specifically in an "in-between" sense, rather than as an umbrella term. A newer related term is "gender queer", which refers to the mixing of qualities traditionally associated with "male" and "female," and can also refer to the "in-between" sense sometimes associated with transgender or transgenderism.

‍Transgender in non-Western cultures

‍This page describes primarily Western modes of transgenderism. Many other cultures have or have had similar phenomena:

• The so-called berdache in many Native American groups is recognized as a separate gender, a woman-living-man, not as a man who wants to be a woman. The term "berdache" is a misnomer, however, as no Native American group actually used the term; different ethnic groups had different names for the role, such as the winkte. The husband of such a person is not viewed as being gender-different themselves, but as a normal male. In some societies there is a corresponding gender for man-living-women (amazons).
• In Thai culture, there is the kathoey, who is very similar to the English definition of transgender, but is sometimes broader, including effeminate gay males more so than "transgender" does.
• South Asian cultures have hijra, usually genetic males who have been castrated and live as women.
• Chinese cultures have a wide variety of transgender modes of existence.

It is unfortunate that people who have a diverse gender often get grouped with people who have a diverse sexual orientation, especially when there is little connection.

The two groups became paired due to phobia and discrimination. There was safety for both groups when socialising together, at a time when society was not wise to the differences, both were viewed as deviant.  This connection between "gay' and 'trans' often leads to a confusion between what a drag queen is, and what a transgendered person is, and the same goes for sexuality and gender.   The 'everyday' person (gay or straight), often view gay bars as having ‘drag queens’ (gay men dressed up as the opposite sex for entertainment purposes), and gay means same sex attraction, so people who are diverse-gendered must be either homosexual or bisexual.  This situation can result in a diverse-gendered person having to not only having to explain their diverse-gender when they come out, but also justifying their sexuality.  People who are diverse in their gender identify their sexual attraction to others as; straight, gay, bisexual and queer, no different to any other human.

The ‘coming-out process’ can be much more difficult for people who are diverse-gendered, in comparison to people who are sexually diverse.  If a diverse-gendered person, presents and lives their life in society as they identify and naturally feel, then their ‘diverse-gender’ is going to be obvious to those around them.

For many 'same sex attracted' people, they can present in society without exhibiting their diverse sexual orientation, resulting in being able to avoid standing out, and in-turn from attracting possible discrimination and violence.  This view does not ignore or underestimate the many same sex attracted people who have been discriminated and violated due to being themselves in society, however these differences between living your gender identity and living your sexual orientation can negatively affect the ability for a person to safely explore their gender, as well as the freedom to be themselves when engaging in everyday life.

Some common experiences that can affect gender diverse people when coming out, include:

·    feeling‘ different’ from other people around you.

·    phobic bullying about your gender identity, whether verbal or physical.

·    feeling pressure to define or deny your feelings regarding your gender identity.

·    feeling unsupported or worried that your gender identity will not be accepted by friends and family members, along with the possibility of being rejected or isolated.

·    feeling stressed and anxious in relation to the pressure to conform with your sex assigned at birth.

·    constant discriminatory attacks from media, church, politicians and the general public.

Feeling these pressures can be stressful, especially with all the other stresses in your life such as managing school or university, job hunting, forming relationships, and making sense of who you are and your place in the world.

It is important to add that sometimes therapy is required for others who are outside of the person who is coming out as diverse-gendered.  In many instances, the diverse-gendered person has re-played the coming out scenario a thousand times in their head and are aware of the processes that they would use, and the potential fears of things going wrong. Sometimes planning or researching for the coming out event, the person requires brief support.

Dave Wells has worked extensively with people who are diverse-gendered and is also knowledgeable and empathetic about the societal barriers and difficulties that can present, as well as the necessary psychological and medical referral pathways required if the person presents with wanting re-assignment surgery, hormone therapy, or hormone- blockers.

Many people are very comfortable and confident with being diverse-gendered and experience other difficulties outside of how they identify. Finding a professional who is ‘safe’ to talk to without judgement and basing everything around a person’s gender diversity, can be difficult to find. Dave Wells will give you this respect.

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The identity of “Drag Queens” or “Drag Kings” has only been included in the ‘Diverse-gender’ section to educate the non-educated.

A ‘drag queen’ is a male entertainer who is impersonating people who are female, and a ‘drag king’ is a female entertainer who is impersonating people who are male.

They are not representative of people who identify as gender diverse.  However, there are individuals who will utilise this role as an entertainer to gradually come to terms and experiment with their own gender identity.  In a majority of cases, a ‘drag queen’ or ‘drag king’ is a role played in an environment where fancy dress is the theme.

Although fancy dress is an activity enjoyed by many people regardless of their sexual orientation, the roles of drag have become commonly known as a form of entertainment provided by the gay community.

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Definition of Intersex:

In humans and other animals, is a variation in sex characteristics including chromosomes, gonads, or genitals that do not allow an individual to be distinctly identified as male or female.

Intersex is a group of conditions where there is a discrepancy between the external genitals and the internal genitals (the testes and ovaries).

The older term for this condition, hermaphroditism, came from joining the names of a Greek god and goddess, Hermes and Aphrodite. Hermes was a god of male sexuality (among other things) and Aphrodite a goddess of female sexuality, love, and beauty.

Although the older terms are still included in this article for reference, they have been replaced by most experts (and patients and families) because they are misleading, confusing, and insensitive. Increasingly this group of conditions is being called disorders of sex development (DSDs).

Dave Wells prefers not to use labels and will identify a person by their chosen identity.  Although DSDs maybe the new term used by some, it still identifies the gender diversity as a ‘Disorder’.  It has been labelled as a disorder due to the causes which include a number of conditions such as; ‘Congenital adrenal hyperplasia’, ‘ovarian tumours’, among others.  Dave Wells, view people who are ‘intersex’ as having a variation or diversity of their gender, rather than a condition which can also be related to an illness, which he sees as insulting.

Causes

In humans, each cell normally contains 23 pairs of chromosomes, for a total of 46. Twenty-two of these pairs, called autosomes, look the same in both males and females.

The 23rd pair, the sex chromosomes, differ between males and females. Females have two copies of the X chromosome (XX), while males have one X and one Y chromosome (XY).Intersex can be divided into four categories:

• 46, XX Intersex

• 46, XY Intersex

• True Gonadal Intersex

• Complex or Undetermined Intersex

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46, XX Intersex.

The person has the chromosomes of a woman, the ovaries of a woman, but external (outside) genitals that appear male. This usually is the result of a female foetus having been exposed to excess male hormones before birth. The labia ("lips" or folds of skin of the external female genitals) fuse, and the clitoris enlarges to appear like a penis. Usually this person has a normal uterus and Fallopian tubes. This condition is also called 46, XX with virilisation. It used to be called female pseudo-hermaphroditism.

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46, XX Intersex

has several possible causes:

• Congenital adrenal hyperplasia (the most common cause).

• Male hormones (such as testosterone) taken or encountered by the mother during pregnancy.

• Male hormone-producing tumours in the mother. These are most often ‘ovarian tumors’. Mothers who have children with 46, XX intersex should be checked unless there is another clear cause.

• Aromatase deficiency. This one may not be noticeable until puberty. Aromatase is an enzyme that normally converts male hormones to female hormones. Too much aromatase activity can lead to excess estrogen (female hormone); too little to 46, XX intersex. At puberty, these XX children, who had been raised as girls, may begin to take on male characteristics.

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46, XY Intersex.

The person has the chromosomes of a man, but the external genitals are incompletely formed, ambiguous, or clearly female.

Internally, testes may be normal, malformed, or absent. This condition is also called 46, XY with under-virilization. It used to be called male pseudo-hermaphroditism. Formation of normal male external genitals depends on the appropriate balance between male and female hormones; therefore, it requires the adequate production and function of male hormones.

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46, XY intersex

Has many possible causes:

• Problems with the testes:

The testes normally produce male hormones. If the testes do not form properly, it will lead to under virilization. There are a number of possible causes for this, including XY pure gonadal dysgenesis.

• Problems with testosterone formation:

‍Testosterone is formed through a series of steps, where each requires a different enzyme. Deficiencies in any of these enzymes can result in inadequate testosterone and produce a different syndrome of 46, XY intersex. Different types of congenital adrenal hyperplasia can fall in this category.

• Problems with using testosterone:

Some people have normal testes and make adequate amounts of testosterone, but still have 46, XY intersex.

• 5-alpha-reductase deficiency:  

People with 5-alpha-reductase deficiency lack the enzyme needed to convert testosterone to dihydrotestosterone (DHT). There are at least five different types of 5-alpha-reductase deficiency. Some of the babies have normal male genitalia, some have normal female genitalia, and many have something in between. Most change to external male genitalia around the time of puberty.

• Androgen insensitivity syndrome (AIS):  

This is the most common cause of 46, XY intersex. It has also been called testicular feminization. Here the hormones are all normal, but the receptors to male hormones don't function properly. There are over 150 different defects that have been identified so far, and each causes a different type of AIS.

True Gonadal Intersex:  

Here the person must have both ovarian and testicular tissue. This may be in the same gonad (an ovotestis), or the person might have one ovary and one testis. The person may have XX chromosomes, XY chromosomes, or both. The external genitals may be ambiguous or may appear to be female or male. This condition used to be called true hermaphroditism. In most people with true gonadal intersex, the underlying cause is unknown, although in some animal studies it has been linked to exposure to common agricultural pesticides.

Complex or Undetermined Intersex Disorders of Sexual Development Diversities). Many chromosome configurations other than simple 46, XX or 46, XY can result in disorders (diversities/variations) of sex development (DSDs).These include:

• 45, XO (only one X chromosome), and

• 47, XXY, 47, XXX -- both cases have an extra sex chromosome, either an X or a Y.

These different formations of chromosomal make-up do not result in an outcome where there is discrepancy between internal and external genitalia. However, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes.

Note: In many kids the cause of intersex may remain undetermined, even with modern diagnostic techniques.

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Symptoms:

The symptoms associated with intersex will depend on the underlying cause, but may include:

• Ambiguous genitalia at birth

• Micro-penis

• Clitoromegaly (an enlarged clitoris)

• Partial labial fusion

• Apparently undescended testes (which may turn out to be ovaries) in boys.

• Labial or inguinal (groin) masses -- which may turn out to be testes -- in girls.

• Hypospadias

• Otherwise, unusual-appearing genitalia at birth

• Electrolyte abnormalities

• Delayed or absent puberty

• Unexpected changes at puberty

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Different Examinations and Tests used to determine:

• Chromosome analysis

• Hormone levels (for example, testosterone level)

• Hormone stimulation tests

• Electrolyte tests

• Specific molecular testing

• Endoscopic examination (to verify the absence or presence of a vagina or cervix)

• Ultrasound or MRI to evaluate whether internal sex organs are present (for example, a uterus).

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Treatment:

Ideally, a Sexologist will collaborate with a team of health care professionals with expertise in intersex who should work together to understand and treat the child with intersex -- and to understand, counsel, and support the entire family.

Parents should understand controversies and changes in treating intersex in recent years.  In the past, the prevailing opinion was that it was generally best to assign a gender as quickly as possible, often based on the external genitals rather than the chromosomal gender, and to instruct the parents to have no ambiguity in their minds as to the gender of the child. Prompt surgery was often recommended. Ovarian or testicular tissue from the other gender would be removed. In general, it was considered easier to reconstruct female genitalia than functioning male genitalia, so if the "correct" choice was not clear, the child was often assigned to be a girl.

More recently, the opinion of many experts has shifted. Greater respect for the complexities of female sexual functioning has led them to conclude that suboptimal female genitalia may not be inherently better than suboptimal male genitalia, even if the reconstruction is "easier." In addition, other factors may be more important in gender satisfaction than functioning external genitals. Chromosomal, neural, hormonal, psychological, and behavioural (gender brain) factors can all influence gender identity. Many experts now urge delaying definitive surgery for as long as healthy, and ideally involving the child in the gender decision.

Clearly, intersex is a complex issue, and its treatment has short- and long-term consequences. The best answer will depend on many factors, including the specific cause of the intersex. It is best to take the time to understand the issues before rushing into a decision. An intersex support group may help acquaint families with the latest research, and may provide a community of other families, children, and adult individuals who have faced the same issues.

Support groups are very important for families dealing with intersex as they enable other people with chromosomal diversities to share experiences.  Different support groups may differ in their thoughts regarding this very sensitive topic. Look for one that supports your thoughts and feelings on the topic.

Dave Wells has a broad experience in working with people with different variations of gender and can support you to put your gender into context in your life (if required), as well as navigate through any barriers that arise.

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Information adapted from:

https://www.nlm.nih.gov/medlineplus/ency/article/001669.htm

Porterbrook Gender Clinic Resources – Sheffield, England