After her transition, Jenner said: ‘I always felt female and that scared me.’ Jenner’s case, where a person born biologically male chooses to live their life as a woman after going through some kind of medical intervention, would be considered by today’s standards to be a more traditional transgender case. Today, as children are given the option of choosing their preferred gender, and a younger generation demands extra pronouns for their own personal gender identity, it is becoming clear that transgenderism has become a much more complicated issue.
The Oxford English Dictionary defines transgender as ‘[d]enoting or relating to a person whose sense of personal identity and gender does not correspond with their birth sex’. It is a relatively new term. According to equality-law professor and trans activist Stephen Whittle, the term ‘transvestite’ was first used in 1910 by the German sexologist Magnus Hirschfeld, who would later found the Berlin Institute where the very first sex-change operations took place. ‘Transsexual’ was not coined until 1949; ‘transgender’ not until 1971; and ‘trans’, which is a very British term, not until 1996.
The first reported sex-change operation may have taken place at Hirschfeld’s Berlin Institute in 1931, but the procedure only became widely known after American Christine (George) Jorgensen travelled to Denmark in 1952 to undergo sex-change surgery. In 1954, following Jorgensen’s transition, US endocrinologist Harry Benjamin began using the term ‘transsexualism’ to describe a unique condition of sex and gender role disorientation.
Throughout the 1960s, transsexualism, and the clinical response to it, remained a contentious issue. Medical professionals in the US were largely opposed to the idea of offering sex-change surgery. A 1965 survey showed that just three per cent of US surgeons would take seriously a request for a sex-change operation. And yet, by the early 1980s, thousands of sex-change operations had taken place.
The Hopkins Hospital, affiliated with Johns Hopkins University, became the most prominent institution to offer transsexual surgery during the 1970s. Under the guidance of psychologist John Money, psychiatrist Eugene Meyer and plastic surgeon Milton Edgerton, the Hopkins Hospital utilised the ‘single theme’ method for diagnosing transsexuals. This involved determining whether or not the patient had an intense conviction to be the other sex.
But, as the rate of referrals increased, by the late-1970s, some of the negative after-effects of sex-change surgery became apparent. These included: medical complications, demands for reverse surgery and suicide attempts. Moreover, it was discovered that, due to the self-diagnostic nature of the ‘single theme’ method for determining treatment, some patients had learned what kinds of things they needed to say in order to receive surgery.
Hopkins Hospital eventually stopped performing the operations in 1979, after Jon Meyer, the chair of the sexual behaviours unit, conducted a study comparing 29 patients who had the surgery and 21 who didn’t, and concluded that those who had the surgery were no more adjusted to society than those who did not have the surgery. As Meyer told the New York Times in 1979: ‘My personal feeling is that surgery is not proper treatment for a psychiatric disorder, and it’s clear to me that these patients have severe psychological problems that don’t go away following surgery.’
While physicians and commentators argued over whether or not medical intervention benefited the patient, for some of those who chose to undergo treatment, it was a lifeline.
Composer and electronic synthesiser pioneer Wendy Carlos, née Walter, was one of the most high-profile transgender cases of the 1970s, revealing her gender-reassignment surgery in a 1979 interview in Playboy magazine. Carlos had begun living permanently as a woman in May 1969, before undergoing hormonal treatment in the mid-1970s ahead of her sex-change operation. In the interview, Carlos objects to being called a ‘transsexual’. ‘By most definitions [a transsexual] is a person who is born with the physical characteristics of one gender but who identifies in every way with the opposite gender and may seek an operation to complete that identification. Although I was born male, from my earliest days I’ve felt female, and the conflict finally became so terrible I had to take the ultimate step – to become a female in body as well as in mind. Incidentally, I wish the word transsexual hadn’t become current. Transgender is a better description, because sexuality per se is only one factor in the spectrum of feelings and needs that led me to this step.’
Throughout the interview Carlos repeatedly refers to her innate sense of being a woman trapped in a man’s body. ‘I was about five or six’, she says, ‘and I remember being convinced I was a little girl… I felt that nature had made a cruel mistake… I felt myself to be a woman whenever I saw a woman of similar build or looks. It had created a psychic pain within me that stopped me from being able to think or function in any fashion for very long periods. I feel that some innermost part of me was always a woman, so that all I have really done is change my suit of bone and skin.’
For Carlos, the medical procedure was ‘inevitable’. ‘It was corrective surgery… It’s something I had to do’, she says. When the interviewer asks what would have happened if she hadn’t had the operation, she says bluntly, ‘I’d be dead’. For Carlos, the medical intervention was seen as crucial to becoming who she believed she had been all along. Remarkably, at the end of the interview, Carlos says she does not wish to ‘champion the cause’, and emphasises the fact that she believes her condition to be ‘very rare’.
Transgenderism in the UK
Yet in the UK today, that condition does not appear to be very rare at all. In evidence given to the Women and Equalities Committee transgender inquiry last year, the Gender Identity Research and Education Society (GIRES) claimed 650,000 people – one per cent of the UK population – ‘are likely to be gender incongruent to some degree’. Admittedly, of that 650,000, just 30,000 have sought medical help for gender dysphoria. But GIRES estimates that a further 100,000 are likely to pursue treatment in the future.
Supply is certainly rising to meet demand. The NHS now runs eight gender-identity clinics, which offer treatments for gender dysphoria. The NHS describes gender dysphoria as ‘a condition where a person experiences discomfort or distress because there’s a mismatch between their biological sex and gender identity. It’s sometimes known as gender-identity disorder (GID), gender incongruence or transgenderism.’ Treatments available for GID include psychotherapy, counselling, hormone therapy – taking the hormones of your preferred gender, usually resulting in physical changes – and surgery.
In recent years, there has been a sharp increase in patient referral numbers to gender-identity clinics. According to a Guardian report, referrals have risen at all of the UK’s gender-identity clinics, some by as much as several hundred per cent.
At the NHS Nottingham Centre for Gender Dysphoria, for instance, referrals have increased 28-fold, from 30 in 2008 to 850 in 2015. This year, the centre expects more than 1,000 referrals. The West London Gender Identity Clinic opened in 1966 and is the oldest clinic of its kind in the UK. The clinic received 1,299 referrals in 2011/12. By 2015/16, it had received 1,985 referrals.
The rise of transgenderism among the young is particularly striking. The Tavistock and Portman Gender Identity Development Service is the only NHS-funded gender service in the UK for young people, dealing exclusively with under-18s. Over the past year, the number of referrals has more than doubled from 697 in 2014/15 to 1,419 in 2015/16. The number of children aged 10 and under (the youngest age included in the statistics is three) referred to the clinic has followed a similar pattern, rising from 87 to 167 referrals between 2014/15 and 2015/16.
And how exactly is a child purportedly suffering from GID treated? The Tavistock clinic gives us a good idea, offering psychotherapy, as well as, in some cases, sending youngsters for hormone treatment. For under-18s, this may mean hormone blockers, which can suspend puberty (the effects are reversible); or it could mean cross-sex hormone therapy, which means taking the hormones of the patient’s preferred gender (the effects are only partially reversible). Cross-sex therapy is currently only available to over-16s.
I asked Dr Bernadette Wren, a consultant clinical psychologist, and head of psychology at the Tavistock and Portman NHS Foundation Trust, why she thinks there has been such an exponential rise in transgenderism among the young over the past few years. ‘We don’t think we can pronounce with any certainty about why it is’, she tells me. ‘We, like a lot of other services across the world, are trying to make sense of it. There is a lot of speculation and I could join in that speculation, but obviously our job here is to try and understand it a little bit more profoundly than that.
‘The difficulty is that gender-identity development is a process over time, over many years, and yet the demand is for physical treatment for quite young people. So we’re trying to hold a balance between the young patient not really understanding all that is implied by physical intervention at a young age, but equally not feeling we can put a complete hold on intervention until we know what is going on.’
Wren explains that the clinic deals with a wide range of gender-identity issues, from children who are confused about being a boy or a girl, to others who feel an absolute certainty their gender identity is not the same as their birth-assigned gender.
‘There’s not one thing that gender dysphoria is’, explains Wren. ‘How people experience their gender identity and their relationship to their own body is enormously varied. We’re trying to see how they experience themselves, the level of distress, the level of adaptability, the tenacity with which they have these feelings, the extent to which it’s related more to their experience in their body or their social role, and then try to work out with them how they’re going to manage this and what steps they can take – only one of which is medical intervention. Supposing someone is distressed in their social role and the expectations of it, well, one of the conversations is about the many different ways in which you can be a boy or a girl.’
At the Tavistock clinic, the number of onward patient referrals for hormone treatment is relatively low compared with the total number of referrals to the clinic. In 2015/16, of the total 1,419 referrals, 488 patients – about one third – were referred to the Paediatric Endocrine Liaison Team for possible hormone treatment.
From medical intervention to legal recognition
While medical referrals to gender-identity clinics are increasing, a transgender person today does not have to undergo any physical medical intervention to legally change their gender. Under the 2004 Gender Recognition Act (GRA), a transgender person can apply for a gender-recognition certificate (GRC) to become, in the eyes of the law, their chosen gender. This includes the right to retire and receive a pension at the age appropriate to the acquired gender. People who obtain a GRC can also apply for a new birth certificate to state their acquired, rather than birth, gender.
A panel decides whether or not to issue the GRC based on certain criteria. According to the government’s GRA guidelines: ‘The Standard Application track for a Gender Recognition Certificate requires applicants to demonstrate that: they have, or have had, gender dysphoria; they have lived fully for the past two years in their acquired gender and continue to do so; they intend to live permanently in their acquired gender until death.’
While proof of a diagnosis of gender dysphoria is required, the applicant does not have to have undergone any physical medical treatment, such as surgery or hormone medication.
This is a crucial development in the rise of transgenderism: gender recognition is increasingly separate from the need for medical intervention. According to research carried out by Sally Hines and Zowie Davy, who were exploring the impact of the UK Gender Recognition Act, of the 25 transgender people they interviewed, ‘around half… believed that medical psychiatric professionals should not be involved in the process of gender recognition’. One participant stated: ‘I think it’s a very dangerous way of legitimising any piece of legislation that you have to have this array of medical support.’
Moreover, report Hines and Davy, ‘the majority of participants felt that the Gender Recognition Act excluded people whose gender identities fell outside of the categories of male or female’. It is a sentiment which is gaining traction, with many insisting that a third gender identity, neither male nor female, ought to be recognised. Last year, Sweden added the gender-neutral pronoun ‘hen’ to its dictionary. In 2015, the Oxford English Dictionary added the title ‘Mx’ as a gender-neutral title. However, the overriding drive here does not stop at three genders. We are now encouraged to think of gender as a spectrum – rather than a binary – and to see transgender people as one or more points on that spectrum. Consequently, the term ‘non-binary’ is used to mean a person who identifies as being at some point on the gender spectrum.
Confusingly, definitions of the gender spectrum and how it relates to transgenderism vary. According to LGBT Youth, transgender is ‘an umbrella term for those whose gender identity or expression differs in some way from the gender assigned to them at birth and conflicts with the “norms” expected by the society they live in. Included in the overall transgender umbrella are transsexual people, non-binary gender identities and cross-dressing people.’ So here non-binary people are also transgender, as they appear under the ‘transgender umbrella’. However, according to Nonbinary.org, ‘the transgender umbrella does include people with non-binary gender identities, but not all non-binary people refer to themselves as transgender.’ Transgender is a concept so fluid as to be almost meaningless.
A climate of confusion
Nowhere has transgenderism had a greater impact than on university campuses. Freshers are even invited to wear pronoun badges, an opportunity for those who identify as non-binary to declare their ‘preferred pronouns’. Some wish to be referred to using plural pronouns, ‘they’ and ‘them’, while others request entirely invented words, such as ‘ze, hir, hirs’, which are used to replace, respectively, ‘he, him, his’.
At the University of Toronto, professor of psychology Jordan Peterson came under fire both for his criticism of what he called ‘PC indoctrination’ on university campuses, and his rejection of the idea that professors should have to use students’ preferred pronouns. He also argued against proposed laws against transphobic speech in Canada.
Significantly, Peterson rejects the idea that biological sex and gender identity are independent of each other. ‘The vast majority of people’, he tells me, ‘who either have male or female as a biological sex, have male or female as a gender identity and male or female as a gender expression, and furthermore they are also traditionally heterosexual. So 98 per cent of the population line up on all four of those dimensions in the traditional manner. Therefore they do not vary independently. That doesn’t mean there aren’t exceptions. There are exceptions to every rule.
‘Not only that, the transgender community itself makes the case very frequently that gender identity does not vary independently of biology – that is, they make the case that you can be a man born in a woman’s body, and that implies biological determination of gender identity, because how else could you be a man born in a woman’s body?’
Peterson is equally critical of the concept of a gender-identity spectrum. ‘Gender identity is not a spectrum, it’s the wrong word’, he says. ‘At most, it’s a slightly modified bimodal distribution. There are two poles, male and female, and virtually everyone winds up on one or the other. There are feminine men and masculine women, they are in a minority. And maybe there are a few people in the middle who aren’t sure which one they are, but they are a tiny, tiny, tiny minority.’
What does he think lies behind the rise of transgenderism, and the accompanying demand to have an expanded range of pronouns?
‘It’s a quick route to identity, and to privilege, and to specialness’, he says. ‘Look, there is one person who gets to choose her pronoun: that’s the Queen. The Queen is “we”. Well, okay, the Queen gets to pick a pronoun, I’m okay with that. But you don’t get to be Queen just because you asked for it. It’s an unearned, special distinction.’
Peterson says the current trend will have far-reaching consequences for society. ‘For every person that you might hypothetically calm, by allowing for, or encouraging, gender confusion, there are 50 people you’re going to confuse so badly you won’t be able to believe it. We are going to see an epidemic of gender-identity transformation errors.
‘There are many, many people who are confused – deeply confused. And deeply confused people search for reasons why they are deeply confused, and anytime someone offers them a reason why they might be deeply confused, they jump on it as a potential solution. So maybe that’s five per cent of the population. These are people who no one has ever paid any attention to. They don’t really have an identity, they have no sense of themselves. They have no articulated self, they have no place in the community, and they are searching for reasons and a solution. And they are so desperate for that, that they will take any solution. That might include radical biological transformation, even. That doesn’t mean I’m saying every transgender person is confused. But I am saying that a huge number of confused people are now going to think they are transgender. And we’re going to pay for that, and so are they.’
Transgenderism has certainly been pushed to the forefront of the public consciousness, and has probably been done so with the best of intentions. But we all know where good intentions pave the way to. Yes, for many transgender people, receiving treatment has enabled them to live happy lives. But some of the newest developments are worrying. As we have seen, referral rates to gender-identity clinics are skyrocketing, parents are facing questions over allowing their children to undergo body-altering treatment, and invented pronouns are being legally enforced (businesses in New York City, for instance, face fines for not using transgender pronouns). All this ought to raise questions over the implications and consequences of the championing of transgenderism. Are we not, under the misguided belief that we are aiding the vulnerable, sowing more confusion and angst in society’s midst?
Naomi Firsht is staff writer at spiked and co-author of The Parisians’ Guide to Cafés, Bars and Restaurants.
Picture by: Getty Images.
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