The “Transsexual” Delusion

The word “transsexual” implies that the person is in process of or has made a transition between the two sexes. It is impossible, however, to transition from one sex to the other. The only transition possible for a person who believes that he or she is “transsexual” is from a whole person to a person with a mutilated body.

Transsexuality is presented as the conviction that one has been born into the wrong body – that while the body is one sex, the brain is the other. It follows that this “mistake” can be corrected with surgery and hormones, so that the “transsexual” person can live as a member of the desired sex rather than his or her birth sex. Since there is no scientific evidence to back up the belief a person’s body can be one sex and their brain the other, transsexuality may be characterized as a delusion. The general criteria for a delusion are:

certainty (it is held with absolute conviction);

incorrigibility (it is not changeable by compelling counterargument or proof to the contrary);

impossibility or falsity of content (the belief is implausible, bizarre or patently untrue).

The transsexual delusion (TD) leads to sexual identity dysphoria – a profound unhappiness with the biological reality. Transsexuals insist since that they can’t change their brain, the only way to alleviate their dysphoria is to surgically alter their bodies. They become obsessed with the idea of surgery and are willing to make tremendous sacrifices in order to obtain this solution – including alienation from family, loss of career, substantial expenses, and considerable pain. Given our knowledge of neural plasticity, it is certainly possible that the brain could be altered to relieve much of the dysphoria associated with the transsexual delusion, however, persons experiencing a transsexual delusion generally resist therapy. The availability of surgery convinces them that their perception of reality is true and that all they need to do is to persevere. They become extremely anxious when their desire for surgery is delayed or frustrated. They can become angry to the point of narcissistic rage when their delusion is challenged, as illustrated by the vicious attacks by surgically altered men on J. Michael Bailey, author of The Man Who Would Be Queen.[1]

Delusions are often encapsulated, that is they affect only one part of life. The rest of the persons’ lives and their ability to think logically may not be affected, although eventually the delusion may lead them to make tremendous sacrifices to sustain their view of reality.

Is the belief that one was born in the wrong body implausible or patently untrue? Yes.

Every cell of the body of a person claiming to be “transsexual” contains DNA that is clearly marked male or female. The DNA in the brain is the same as the DNA in the rest of the body. The transsexual community has tried to associate its claim to have been born in the wrong body with the situation of persons with genetic disorders and Sexual Development Disorders, however, persons claiming to be transsexual are virtually always genetically and physical healthy, normal males or females. There is no evidence of a genetic cause for the transsexual desires. There are reported cases of identical twins where one was transsexual and the other wasn’t. The hormones that trigger the development of the sexual organs also affect the brain and create subtle but real differences between the sexes. There is no evidence for “prenatal hormones affected the brain but not the body” theory. While transsexuals insist that they have the brains of their desired sex, in fact many of their behaviors resemble their actual sex. For example, the sexual activity pattern of transsexuals with same-sex attraction (SSA) is similar to that of other men with SSA – the desire for many partners and willingness to engage in anonymous and uncommitted sexual relationships. Another type of transsexuality — autogynephilia, (a man who is in love with the image of himself as a woman) — is categorized as a paraphilia. Paraphilias are found predominantly in males. In addition, autogynephilias are predominantly attracted to women, and some insist that they are lesbians, when the more obvious explanation is that they are men who have retained their masculine attraction to women, even though they have been surgically altered to resemble women. Male transsexuals have a stereotyped and inaccurate understanding of what it means to be a woman. SSA transsexuals insist that have always felt like the other sex. While the feelings of alienation from the actual birth sex may have begun in early child, this can be explained by interactions between the child and family members. Small boys who are considered effeminate or girlish do not, in fact, resemble girls of the same age. For example, girls have expansive interests and are capable of wearing dresses or jeans, playing with dolls or in the sandbox, playing games outside or inside. In contrast to this, these “girlish” boys are uncomfortable with boyish clothing, rough-and-tumble play, and in general limited in their range of activities. In addiction, many of these boys have other psychological problems. Surgery does not change a person’s sex. Surgeons can simulate the appearance of the external sexual organs of the other sex, but they cannot make the simulated organs reproductively functional. Surgery destroys the possibility of future fertility. The willingness to surrender one’s potential fertility as though it were nothing points to the power of the transsexual delusion. The transsexual delusion is a denial of the unity of the human person. The surgical solution may be a fad, comparable to psychiatry’s embrace of frontal lobotomies or raising genetic boys with genital deformities as girls. This too may in time be recognized as unethical mutilation. There has already been a change in attitudes among “sexual minorities” even in the last decade. Many teenagers who are confused about sexual identity and attractions are choosing to be identify as “Gender Queer.” Rejecting identification as one sex or the other, they move between the sexes or present themselves as something in between. It is difficult to say what they will choose when they grow up, but it is possible that as sexual stereotypes become less pervasive, surgery may become as less popular. Partial solutions (that is, women who do undergo breast removal or hysterectomies but do not choose to have a pseudo penis and testicles, or men who have breast implants but retain their genitals) are also becoming more popular.

Persons suffering from TD are very unhappy if their desire for a surgical solution is delayed or denied. They may become depressed or suicidal or take the matter into their own hands, obtaining hormones on the black market and even resorting to self-mutilation. The supporters of the surgical solution argue that since there is no treatment for this disorder (which may be because no one is looking for a treatment, or because persons with TD resist therapeutic assistance) the only solution is to grant their desire for surgery.

One of the problems is that as the surgical solution is publicized more, people are deciding that they are “transsexual” and requesting surgery. The transsexual delusion may in fact be “contagious.” A number of transsexuals say that they hadn’t “realized that they were trapped in the wrong body until they saw a TV program with a positive portrayal of a person who claimed to have changed sex.”

Persons with TD are very eager to “pass” as their desired sex — that is deceive others into accepting them as members of the other sex. They may insist that others participate in their delusion. They are deeply offended when people refuse to acknowledge their “change” and want laws enacted that would force people to accept them as their desired sex.

It is important to note that not all persons seeking sexual surgery suffer from a transsexual delusion. Guidelines were set up by The World Professional Association for Transgender Health to sort out “true transsexuals” from those who didn’t believe they were trapped n the wrong body. According to the guidelines “true” transsexuals had:

cross-gender identifications that were consistently expressed behaviorally in childhood, adolescence, and adulthood; minimal or no sexual arousal to cross-dressing; no heterosexual interest, relative to their anatomic sex.[2]

However, the Association has altered this criterion because according to their Standards of Care:

Belief in the true transsexual concept for males dissipated when it was realized that such patients were rarely encountered, and that some of the original true transsexuals had falsified their histories to make their stories match the earliest theories about the disorder.

Since there is no biological test for “transsexuality,” and since acceptance into a surgical program is based on what the clients tell the therapists and surgeons, clients may say what they think the therapists want to hear in order to gain acceptance into the program.

Since there is no biological test for “transsexuality,” and since acceptance into a surgical program is based on what the clients tell the therapists and surgeons, clients may say what they think the therapists want to hear in order to gain acceptance into the program. If some men seeking surgical intervention in order to appear as women don’t believe in their heart of hearts that they are women trapped in men’s bodies but only say they are because that is what they are convinced the gatekeepers to the process want to hear, then why do they seek a surgical solution.

Their reasons vary according to the category of sexual dysphoria. Anne Lawrence, a post-surgery autogynephile, described autogynephiles as “men trapped in men’s bodies.”[3] Lawrence admits that some autogynephiles “knew we were male anatomically, who were not outwardly feminine and sometimes had to work rather hard to appear feminine, yet who intensely wanted to be women.” Lawrence believes that the autogynephiles desire for surgery springs from a “romantic” desire to become what they love. They love women and therefore want to become women[4]but fear that therapists and surgeons might not give approval for surgery if they believed they were helping a man act out his “paraphilic sexual script.”[5]

The men with SSA seeking surgery have been described by Dr. Paul McHugh, psychiatrist-in-chief at Johns Hopkins, as

conflicted and guilt-ridden homosexual men who saw a sex-change as a way to resolve their conflicts over homosexuality by allowing them to behave sexually as females with males.[6]

The insistence that one is transsexual may be a push/pull. A man seeking surgery may feel pushed from masculine identification by rejection he experienced as a boy because of his fear of rough-and-tumble play and pulled toward female identification by his desire for such things as beautiful clothes, which he believes are available only to women. A woman seeking surgery may feel pushed away from attraction to men by fear of male violence or abuse. She may believe that being a woman is being vulnerable. At the same time she may be pulled by the power and privileges associated with males in our culture. While these feelings are very real, the solution is not to pretend that it is possible to “change” one’s sex through surgery.

Surgery is generally preceded by the administration of hormone. Hormones do have an affect on personality. Females taking male hormones may experience a testosterone high. Men taking female hormones may experience a lessening of compulsive sexual desire. Those seeking surgery may hope that the surgery will increase what they regard as positive changes gained from the hormone treatments.

The desire to be the other sex is a symptom of one of several mental disorders and should be treated as such, because according to Dr. Paul McHugh — who oversaw the termination of the transsexual surgical program at his hospital — notes, providing surgery is “collaborating with madness rather than trying to study, cure, and ultimately prevent it.”

[1] Alice Dreger (2008) “The controversy surrounding The Man Who Would be Queen: A case history of the politics of science, identity, and sex in the internet age,” Archives of Sexual Behavior, 37, pp. 366-421; Anne Lawrence, (2008) “Shame and Narcissistic rage in autogynephilic transsexualism,” Archives of Sexual Behavior, 37, pp. 457-461. [2] Harry Benjamin International Gender Dysphoria Association’s Standards Of Care For Gender Identity Disorders The, Sixth Version February, 2001 [3] Anne Lawrence (2008) “Men trapped in men’s bodies”: An introduction to the concept of autogynephilia,” http://home.swipnet.se/ [4] Anne Lawrence, (2007) “Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love,’ Perspective in Biology and Medicine, 50 (4): pp 506-520. [5] Op cite, Lawrence (2008) [6] Paul McHugh (2004) “Surgical Sex,” First Things, Nov. pp. 34-38.