According to an article by Ashby (online) Laurence Michael Dillon
was the first transgender man in the United Kingdom to undergo a phalloplasty
in 1949 (a doctor constructed a penis from scratch and grafted it onto his
body) in May 1915 he was assigned female at birth and named Laura Maud.
Dillon wrote a book describing how transgender identity is innate
and unaffected by psychotherapy. The book was called “A Study in Endocrinology
and Ethics” and considered the first book about transgender identity and gender
Michael Dillon helped Roberta Cowell obtain access to the surgery.
Roberta, born in 1918, a British fighter pilot became Britain’s first
male-to-female transgender person to undergo sexual reassignment surgery.
Dillon had long known that he was not a woman and felt more
comfortable in men’s clothing. In 1939 he sought treatment but at the time
hormone masculinizing effects were poorly understood. In 1943 Dillon met with
Dr.Gillies, a plastic surgeon who was one of the world’s very few practitioners
for plastic surgery. In his book he described how transgender was innate and should
be treated medically. He wrote “Where the mind cannot be made to fit the
body, the body should be made to fit, approximately at any rate, to the
According to Chapman (2015 online)
the CNSNews.com advised that Dr. Paul R. McHugh believes that transgenderism is
a mental disorder which merits treatment, he argues that sex change is
biologically impossible and those who promote sexual reassignment surgery are
collaborating with and promoting a mental disorder.
Pink News (2010
Online) report from 2000 to 2009 gender reassignment surgery rates have tripled.
Surgery was performed on a total of 853 trans women and 12 trans men, costing
the NHS around £10,000 on each case. The true number of transgender people is
estimated to be much higher due to many people refraining from painful and
complex surgery or are unable to access it. Batty (2004 Online) reports there
is no robust scientific evidence that gender reassignment surgery is clinically
effective. Large numbers of patients who
have undergone surgery remain traumatised to the point of suicide. However,
there is no conclusive evidence to suggest that increase in suicide rates are
the result of gender reassignment surgeries or social stigma.
Hewett (2017 online) explains in his article that for decades the
non-conformity to birth assigned roles was diagnosed as a mental illness by the
Diagnostic and Statistical Manual of Mental Disorders (DSM). In December 2012
it was announced that “Gender Identity Disorder” (GID) has been replaced with
the new term “Gender Dysphoria” which refers to the distress a person
experiences because of their sex and gender they were assigned at birth. The term
implies a temporary mental state rather than being labelled a disorder and helps
remove the stigma faced by many transgender people.
project will gather a small amount of primary data and include further
secondary data to uncover the wider population identifying as transgender. It
will also encompass both qualitative and quantitative sources of data.
Primary data will
be collected directly from the participants through interviews and will be used
to analyse qualitative data. The questions will consist of mostly open-ended
questions with a semi-structured approach, subjective to enable a true valid
picture. A snowball sampling method will be used to recruit trans-men and
trans-women within the Lancashire County based in North West of England, taking
into consideration the very small size of the transgender population and the
difficulty in finding willing participants. The sample size will be limited to
2-3 individuals from the transgender population. The duration of the interview
will be approximately 30mins and conducted in normal life settings to help build
trust and rapport encouraging participants to open-up and be at ease. No
discrimination will be made in-terms of race, religion, sex, disability or
social economic factors however, all participants involved will be over the age
of eighteen due to ethical issues surrounding consent. The strengths to using
this method is that interviews will be quick and cheap to administer. It is
suitable to gather the common, straightforward information but with the added
ability to probe and clarify matters. The limitations to this method is that
the participant may lie to suit social desirability factors and open-ended
questions make it harder to quantify data as cannot be measured in numbers. The
sample size is very small and unique therefore unable to generalise.
issues faced are finding an adult transgender individual willing to participate
in the research and finding mutual time agreement, cost of transportation and
possible purchase of a Dictaphone.
consideration will involve obtaining consent forms prior to the interview,
participants will need to be briefed and informed of their right to withdraw. A
covert attitude where no deception is involved, participants will be guaranteed
anonymity and confidentiality. Special care will be taken to ensure
participants are safeguarded from any physical or psychological harm,
interviews will need to be held in a private area, questions will be relative
to the research and not too intrusive, the informality will ensure participant
is kept comfortable and at ease.
with the interviews are based mainly upon the interpretivists approach. They
prefer the use of data with high validity, which can be achieved through
qualitative methods. By asking open ended questions a true picture of the
subject will be encouraged.
semi-structured method will allow to make generalisations about behaviour
pattern and may be able to replicate. Positivists view this method lacks
objectivity, reliability and fails to produce representative data that can be
generalised to the wider population.
will be collected through Internet sources and text books. This will include
the research of real life history by other researchers and gathering statistics
for quantitative data.
The strengths to
using secondary data is the ease of access being able to study from home. It is
cost effective due to not having to carry out thorough research. Books are
genuine sources of data rating high in reliability, the vast amount of
information available from the internet gives significant use for being able to
compare both past and present data. The weakness of using secondary research is
that it is time consuming and will need to ensure internet information is from
trustworthy sources. Other people’s research which may not match the aims and
objectives to be studied. Not having control over the quality of data, it could
be out of date, inaccurate or biased.
The research will
display a true insight of the journey to becoming a transgender identity by
producing valid responses however, the results will rate low in reliability as
difficult to obtain similar results each time.
Results and Findings
Due to the small numbers of the transgender
population, significant practical issues were faced in finding participants. Members
from Blackburn College LGBTQ group were unavailable due to staff sickness. Some
gender variants found were under the age of 18 and delays were experienced with
those who meet the criteria as difficulty in finding mutual time to conduct the
interviews. To repeat this research it would be advisable to allow more time next
inconclusive since the numbers of trans people are extremely small, many
researchers have lost track of former patients after transitioning, many of
them have moved to a new place to re-start their lives under their newly formed
identity or some have even committed suicide.
There are three elements to gender: Biological sex, gender
expression and gender identity. People are accustomed to recognising two
genders male and female. Usually, by the age of three a child has formed a
clear sense of their gender identity, most of the time their gender conforms to
their biological sex. Society gradually programs the mind on how one should
conform according to their birth sex.
Transgender is an umbrella term for persons whose gender identity,
gender expression or behaviour does not conform to that typically associated
with their sex at birth. Most transgender people know they are uncomfortable
with their gender from an early stage. Some people may come to realise later in
life but even then, they have had early experiences of other gender
nonconforming behaviours such as cross dressing. Donnelly (2015) reports rates
have quadrupled in five years of children being referred to the NHS with gender
confusion under the age of 10. The transgender community is incredibly diverse,
there is a spectrum of terminologies under the transgender umbrella, ranging
from those who cross-dress to transsexual people. The term also encompasses
other gender variant people, including individuals who are androgynous and
those who identify themselves as non-gendered. According to the Office of
National Statistics (2009) The estimated figures for the trans community in the
UK range from 65,000 (Johnson, 2001) to 300,000 (Gires, 2008).
People will risk so much to represent the gender that they feel
belongs to them, regardless of the social, cultural and legal expectations of
their birth sex.
Although the transgender communities have always existed
throughout time, countries and different cultures there is very little mention
of this type of population. In India trans women are recognised as “Hijra”, men
raised as females in Samoa are called Fa’afafine. Historically, transgender
identities were considered abnormal and unacceptable, this is probably the
reason why Dillon fled to different places. There is still significant stigma
and discrimination around being transgender in society, this may be the reason
why many people suppress the feeling for so long resulting in delayed treatment
and causing further distress.
Flanagan (2009) outline the view of psychologists who believe that the DSM
diagnosis of gender dysphoria is a mental illness which may arise from
childhood trauma or maladaptive upbringing. They refer to a case study of
Coates et al (1991), a boy developing gender dysphoria which was a result of a
defensive reaction to his mother’s depression following an abortion. They suggest
that the trauma which occurred at the age of three (when a child is gender
sensitive) may have led to a cross-gender fantasy as a means of resolving
anxiety. This case study explains reasons in which an individual may develop
gender dysphoria however, it ignores the role of biology, cannot be generalised
and may not be reliable.
Flanagan also report an opposing study of Cole et al (1997) of 435 individuals
experiencing gender dysphoria and reported that the range of psychiatric
conditions displayed was no greater than found in a ‘normal’ population. This
suggests that gender dysphoria may not be related to trauma or pathological
(2016 online) refers to Guillamon quotes: “Trans people have brains that are
different from males and females, a unique kind of brain. It is simplistic to
say that a female-to-male transgender person is a female trapped in a male
body. It’s not because they have a male brain but a transsexual brain.” Behaviour
and experience shape brain anatomy, so it may be impossible to say if these
subtle differences are inborn. At birth an examination of the brain in
impractical and inconclusive with current medical technology to distinguish the
gender type which is a limitation.
The biological explanation suggest that most
transgender people are born with a pre-disposition to being transgender that
was formed prenatally which directly drive’s development.
According to Williams (2016 – online) there are three major factors in
development; Chemical/Hormonal, Genetic and Environmental. Men and women have
different brains according to size and proportion, these differences are small
yet specific and identifiable. The brain of a transgender consistently matches
the brain structure of their adopted gender and not the birth sex. These
changes are understood to be caused due to chemical imbalances that causes the
wrong hormones to be expressed prenatally and during the development of the
brain. Although there is a growing consistent trend in these studies, the
sample sizes are small due to the number of transgender persons brain used for
medical purposes and therefore difficult to generalise. He also conducted a study on animals to show how
the cross of the wrong hormones leads to transgender issues during the brain
development stage. The animal subsequently exhibited mating behaviours of the
opposite sex even when the genitals match their genetic sex. The biological approach is valid and based on
scientific findings, they predict behaviour according to heredity which is a
strength. The limitations are that it is a reductionist, offers a few
suggestions for the change in personality not considering thoughts and feelings.
According to the NHS (2016 online) gender dysphoria
may be the result of congenital adrenal hyperplasia (CAH) when a high level of
male hormones is produced in a female foetus which causes the genitals to
become more male in appearance and in some cases, the baby may be thought
to be biologically male when she is born.
debate continues between the medical and transgender communities about “Gender
Dysphoria” being a mental illness and whether it should remain in the DSM.
treatment methods can help manage this discontent including counselling and
other mental health services, hormonal treatments, and surgery. Psychological
interventions may help refrain from any physical treatments. Blood tests and
medical checks are an important part of safe treatment.
Treatment can begin in adolescent age with puberty blockers, these can
buy time before a surge of unwanted hormones which can prevent physical changes
such as breast development and facial hair.
Puberty blockers are completely reversible and can be stopped at any
time, but they also contain risks including effects on bone development and
height. The next step is the cross-sex hormones such as oestrogen for breast
growth and testosterone for facial hair growth. Hormone therapy helps by
changing the physical appearance into more of the adopted gender and therefore
improvs the feeling of oneself. They usually need to be taken indefinitely and
the effects are irreversible. Some risks involved are weight gain, sleep
apnoea, blood clots and can also make trans men and trans women less fertile.
Not all transgender people choose to have surgery, it can be costly and
therefore unaffordable. Some people may not see surgery to be an important way
to express their gender and some may not be discontent with their genitals.
is usually performed in adulthood. A functioning vagina or penis can be created
with an acceptable appearance allowing to pass urine and retain sexual
sensation. NHS reports 96% satisfaction rate for genital reconstructive surgery,
which suggests after surgery most trans men and trans women are happy with
their new sex and feel more comfortable with their gender identity. Surgical
interventions are irreversible and may require more than one operation to
achieve satisfactory results. Risk of post-operative complications. Despite
surgery trans men and women may still face prejudice and discrimination from
society because of their condition.
In the UK access to free medical
care has allowed more people to explore their gender options enabling the
doctors to understand the need for transgender patients. Not all transgender
people report experiencing discomfort or distress related to their assigned birth
sex, but for many the medical intervention can be a great relief. The
modification in the DSM indicates a significant development in the medical
perception for transgender people, recognising that the conflict between birth,
gender and identity does not necessarily suggest it is a mental disorder unless
it causes the individual distress. For some people just by taking hormones is
life-changing enough and don’t feel the need to do anything else. Most people
will formally change their name to match their gender through Deed Poll. Although
this is a rare condition the number of people being diagnosed with gender
dysphoria is increasing due to growing awareness.