Is Transsexuality a Mental Disorder

The short answer is no, because while gender dysphoria is included in the DSM-5 (the regularly updated Diagnostic and Statistical Manual of Mental Disorders), transsexuality is not. But that explanation is hardly going to win you any debates.

To thoroughly answer this, we need to ask a few more questions. First and foremost, what constitutes a mental disorder? Once we’ve established that, then we can ask the more fun questions, like what is biological sex? what is gender? and what’s it to anyone anyway?

What Constitutes a Mental Disorder?

First off, let’s define “mental disorder”. I’m no psychologist, so I’ll just quote straight from the handy DSM-5:

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”

It’s important to note that the exact definition of mental disorder changes in every edition of the DSM. It’s gone from exceptionally vague to gradually attempting to establish something somewhat concrete. We should also note that mental disorders don’t really exist in any tangible way.

It’s all up to interpretation and largely dependent on what is and isn’t socially acceptable in society. For instance, talking to an invisible man in the sky would normally constitute a disorder – but not if it’s a part of a well-recognized religion.

Homosexuality was once considered a disorder. That was back when society was exceptionally inhospitable to gays. And when society starts locking people up and recommending electroshock therapy to any group, they tend to become depressed, anxious, and otherwise emotionally distressed. Now that society is just a little bit more hospitable to gays, suddenly they seem so much more normal. Imagine that!

In general, if it doesn’t cause “significant distress in social, occupational, or other important activities”, then it’s not considered a disorder. After all, if any condition caused no distressed in these major categories, you probably wouldn’t be going to see a therapist anyway. But this in itself means that a disorder for one person in one career or social group may be normal in another.

The point I’m trying to drive home here is that the notion of mental disorders is largely subjective and dependent entirely on personal variables. Not exactly straightforward.

What is Biological Sex?

If you think this is a more straightforward question, you’d be dead wrong. The typical argument is that XX chromosomes denote female and XY chromosomes denote male. Seriously though, if biology were ever that simple, med school would be a lot shorter and cheaper. We’d all be fucking doctors. Case closed!

It gets more complicated when we consider Klinefelter syndrome, in which a person has XXY Chromosomes, and Turner Syndrome, in which a female is either missing or partially missing an X chromosome. There’s also XYY Syndrome and XXYY syndrome.

Then there’s intersex, in which a person is born with ambiguous genitalia. This isn’t always completely obvious at birth. For instance, some are assigned female at birth because they appear to have a typical vagina. Some don’t find out until later on in life, while others are obvious from the start, often leading the parents to make a decision on whether to raise their baby as male or female (sometimes surgeries are done to make their genitals conform to the parent’s decision).

According to Anne Fausto-Sterling, professor of biology and gender studies at Brown University, intersex people account for 1.7% of the population. This may seem like an insignificant percentage, but that’s about as common as redheads, who also account for under 2% of the population. It should be noted, however, that Fausto-Sterling’s figure includes figures such as Klinefelter’s Syndrome and Turner Syndrome, which aren’t typically diagnosed as intersex. Still, it goes to show that people who fall outside of the XX/XY binary are more common than many would think.

Additionally, the Y chromosome requires the SRY gene in order to activate the male traits of the Y chromosome. In people with Swyer Syndrome, the SRY is absent, leading to typical female sex development, but with undeveloped gonads.

This leads us to an interesting topic. Gonads make up both the ovaries in females and the testes in males. But it’s the same structure in the beginning. In utero, we all got the same gonadal structures. The SRY gene in the Y chromosome tells the gonads to descend into testes. In the absence of the SRY gene, the gonads stay put and form into ovaries (I’m simplifying of course).

In this, female is sort of considered the default sex. After all, we all start out as females in the womb (hence male nipples). Because of this fact, even with typical XY chromosomes with the required SRY gene in tact, people can still be born more or less physically and/or mentally androgynous.

For instance, researchers have found a significant association between an elongated androgen receptor and male-to-female transsexuals. The extra length that androgens (male hormones) must travel in order to masculinize the fetus results in less potency. Hence, undermasculinization of the brain.

This may be the reason that trans women’s brains tend to closely resemble cis female brains, while trans men’s brains tend to resemble cis male brains. Which brings us to our next topic!

What is Gender?

I don’t even know where to start on this.

Well, since everyone wants to be a fucking etymologist when it comes to the distinction or nondistinction of sex and gender, let’s start there. Both words have been used even in Old English and were used interchangeably. The word gender comes from the Latin genus, which means a “class”, “kind”, or “group”.

The word gender was generally used to refer to one’s biological sex, and thus their role in society, throughout English history (possibly to avoid using the dirty word “sex”). It wasn’t until 1945 when the American Journal of Psychology published a paper stating that “In the grade-school years, too, gender (which is the socialized obverse of sex) is a fixed line of demarkation, the qualifying terms being ‘feminine’ and ‘masculine.’”

This is the first time we see a real distinction between how we use the words “gender” and “sex”. The reason for the distinction at that time was that we were becoming interested in the sociological roles of gender.

Keep in mind that women officially got the right to vote in the U.S. in 1920. Prior to women’s suffrage, women were barred from such involvement for a variety of given reasons. Initially, only property-owners were allowed to vote. Women didn’t own property, so withholding their suffrage was easy enough.

But when poor white men successfully gained their right to vote, continuing to keep women from voting required newer excuses. Namely, that women and men simply had different roles in society. Men worked and contributed to society, while women stayed at home and took care of the men.

So whenever women were allowed similar privileges to men, it really called the notion of gender roles into question. Hence the 1945 American Journal of Psychology article.

Fast forward to 1965. A kid named David Reimer suffered a botched circumcision during infancy. Psychologist John Money, who had made a career of studying gender and sex, recommended that the parents opt to just have the genitals altered and to raise the baby as a girl, arguing that male and female characteristics are learned behaviors. In other words, Dr. Money was suggesting that gender was entirely a social construct.

Unfortunately, Reimer was unhappy living as a female, even from the age of 9 – and this was with them not knowing about the circumcision mishap. Reimer enjoyed male activities and disliked the feminine clothing they were made to wear. At age 15, Reimer decided to start living life as a male instead.

This story is often used to show that gender is more than a mere social construct. It’s well embedded in our brains. We know what gender roles we’re most comfortable expressing even from a young age.

Since then, feminists and trans activists have been further adapting the term “gender”. Even today, there’s a lot of disagreement. But in general, sex refers to biology, while gender refers to one’s identity.

Conclusion

Seriously, there’s so many scientific studies showing the naturality of transsexuality. And the literature on how the word “gender” came to evolve in the first place kind of makes you wonder if maybe transphobia is really just misogyny with extra steps.

At any rate, to formally answer the question of whether transsexuality is a mental disorder, you just need to remember what it even means to have a disorder. Mental disorders just indicate anything that causes severe distress in a person’s work or social life. So I guess if you’re transsexual and distressed about it, then sure, maybe you could be said to have a disorder. But if you’re embracing your transsexuality and have supportive friends, family, and co-workers, then you’re probably not quite so distressed.

The reason gender dysphoria is listed as a disorder is because the distressed caused by living in what feels like the wrong body and having to behave in manners that are socially appropriate for your sex assigned at birth is worthy of that label. Hopefully though, transitioning allows one with gender dysphoria to be their real selves, which is immensely therapeutic. In which case, one could say that transitioning is the cure to the disorder of gender dysphoria.

Some people just want anything that they don’t consider “normal” to be a disorder or “unnatural” or anything along those lines. But if ignorance is natural, then I don’t want to be natural. I just want to be me!

 

Works Consulted:
“Klinefelter Syndrome and Other Sex Chromosomal Aneuploidies.” U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1634840/
“How Common Is Intersex? A Response to Anne Fausto-Sterling.” The Journal of Sex Research. Vol. 39, No. 3 (Aug., 2002), pp. 174-178. http://www.jstor.org/stable/3813612
“Structural Connectivity Networks of Transgender People.” Cerebral Cortex. Oxford Journals. https://academic.oup.com/cercor/article-lookup/doi/10.1093/cercor/bhu194
“Androgen Receptor Repeat Length Polymorphism Associated with Male-to-Female Transsexualism.” Biological Psychiatry: A Journal of Psychiatric Neuroscience and Therapeutics. http://www.biologicalpsychiatryjournal.com/article/S0006-3223(08)01087-1/fulltext
“Sex Reassignment at Birth: A Long Term Review and Clinical Implications.” Archives of Pediatrics and Adolescent Medicine, No. 151. http://www.hawaii.edu/PCSS/biblio/articles/1961to1999/1997-sex-reassignment.html
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