Alex Tang
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Medical Students /Paediatric notes
Sexual Gender Disorder: Transsexuality
Dr Alex Tang
1. Definition of Terms
a. SEX refers to the biological characteristics which define humans as female or
male
b. GENDER refers to the economic, social and cultural attributes and
opportunities associated with being male or female.
c. TRANSSEXUAL is a person who undergoes surgical and/or hormonal interventions
to reassign his/her sex.
d. TRANSVESTITE is a person who has compulsion to dress and act like members of
the opposite sex, but does not have strong desire to change sex.
e. GENDER IDENTITY DISORDER a psychiatric term for transsexuality, transgender
and transvestism.
f. INTERSEX refers to rare medical conditions where people are born with
ambiguous sexual characteristics, and nearly always due to physiological causes.
g. HERMAPHRODITE refers to rare clear physiological causal medical congenital
conditions where the sex of newly born babies is ambiguous due to the presence
of gonads and genitalia of both sexes.
2. How Common is Transsexuality?
a. 1 in 30,000 males, 1 in 100,000 females (1993, 1997,USA)
b. 1 in 11,900 males, 1 in 30,400 females (1996, Netherlands)
c. In Malaysia, a survey taken in 2000 estimated that there were 50,000
transsexuals in the country (The Star, 21/1/ 2001). Muslim transsexuals formed
the majority of population.
3. Gender Identity Disorder
Transsexuality is a Gender Identity Disorder (GID) in which there is strong
cross-gender identification. There are currently two main diagnostic systems for
transsexualism.
a. The current edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV, 1994) has five criteria that must be met before a diagnosis
of Gender Identity Disorder can be given:
1. There must be evidence of strong and persistent cross-gender identification.
2. This cross-gender identification must not merely be a desire for any
perceived cultural advantages of being the other sex.
3. There must also be evidence of persistent discomfort about one's assigned sex
or a sense of inappropriateness in the gender role of that sex.
4. The individual must not have a concurrent physical intersex condition (e.g.,
androgen insensitivity syndrome or congenital adrenal hyperplasia).
5. There must be evidence of clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
b. The current edition of the International Statistical Classification of
Diseases and Related Health Problems (ICD-10, 1992) has the following criteria
for transsexualism:
1. The desire to live and be accepted as a member of the opposite sex, usually
accompanied by the wish to make his or her body as congruent as possible with
the preferred sex through surgery and hormone treatment.
2. The transsexual identity has been present persistently for at least two
years.
3. The disorder is not a symptom of another mental disorder or a chromosomal
abnormality.
4. Development
a. In males, transsexuality may begin in childhood with dissatisfaction with his
being male and desires the company of girls rather than boys.
b. This may often lead to cross-dressing.
c. This conflict with the male gender identity may then lead to the adoption of
a different gender role identity. In effect, a biological male believes that he
is somehow ‘trapped in the wrong body' and should really be a woman.
d. The development is different in females where the fetish element is less
important, if not absent.
e. In both sexes however, there is an obsessive striving to change appearance
and behavior to mimic that of the opposite sex.
5. Causes
a. The causes of transsexuality have been discussed extensively but the issues
are mainly centered on ‘nature vs. nurture.'
b. Dr Mohd Ismail Mohd Tambi, a consultant clinical andrologist, disclosed to
the media that one of the reasons for transsexuality was biological (The Star,
28/11/2005). Research has also not been able to confirm the suggestion of
differences in hormone levels nor demonstrate genetic cause.
c. According to a report by the Evangelical Alliance Policy Commission (EAPC) in
Britain, the body of evidence for transsexuals having psychological causes is
greater and more long-standing compared to evidence for biological causes.
"Published academic literature that indicates transsexual people as children
have experienced much greater psychological harm than non-transsexuals remains
largely undisputed."
d. Some examples of psychological factors are: parental rejection, absence of
father during childhood, having emotionally-distant father, peer pressure,
perfectionism, media images, self-rejection and poor self-esteem which may be
reinforced by hostile reception from society.
6. Medical treatment
a. Gender reassignment surgery (GRS)
b. Most transsexuals suffer from great psychological and emotional pain due to
the conflict between their identity and their original gender role and anatomy.
Although GRS meets many of their wishes and affords them a measure of increased
comfort, it nevertheless does not deal with root psychological causes.
c. The question to ask is whether a treatment tackles the illness or manages the
symptom. Experts in their field at the Portman Clinic in London believe that
offering GRS to transsexuals is preying on their delusional fantasies and is, in
itself, absurd. The expectation of GRS is that it will afford the transsexual
acceptance; there is no evidence to show this is true. An Australian transsexual
is suing the state of Victoria for giving him poor advice, which led to him
agreeing to GRS; he claims that it has not helped him and has actually harmed
him further psychologically.
d. EAPC believes that GRS increases the deep psychological confusion and hurt
suffered by transsexual people, and thereby "increasing the prospect of future
emotional damage."
e. Post-operative transsexual lifestyle requires regular assistance of hormone
therapy throughout its lifetime.
f. A difficulty with transsexuality is that it is largely concerned with a state
of mind.
7. Transsexuality in Malaysia
a. In Malaysia, the local term for male transsexuals is mak nyah, and pak nyah
for females.
b. In1983, the Conference of Rulers in Malaysia decided that a fatwa prohibiting
sex change operation should be imposed on all Muslims, except in the case of a
hermaphrodite.
c. Although there are no official religious rulings from other faith
communities, the groups have staunchly opposed sex-change.
d. In November 2004, a judge dismissed an application by a 33-year-old who
wanted to become legally male after a sex-change surgery, and ruled that
biological characteristics were set at birth and that biological, rather than
psychological tests, determined gender identity (BBC, 5/11/2004).
e. Currently there is no law covering gender reassignment in Malaysia.
f. Jessie Chung, who was born a male and underwent 3 major sex change operations
in the last 3 years to become a female, married at a high-profile wedding
reception at the Crowne Plaza Riverside Hotel in Kuching, Sarawak. The wedding,
the first of its kind in Malaysia, attracted attention from local and foreign
media. While the Government and many Christian leaders did not consider the
marriage valid, there was much public empathy and support for Jessie.
g. Responding to the transsexual marriage in Kuching, Home Affairs Minister
Datuk Seri Azmi Khalid said that Malaysia laws do not allow its citizens to
change their gender in their identity card despite a sex-change operation (The
Star, 15/11/2005).
h. His deputy Datuk Tan Chai Ho told Bernama that the marriage was "invalid" as
the Marriage and Divorce Reform Act 1976 does not allow marriage between two
people of the same sex, even if one of them has undergone sex change surgery
(14/11/2005).
i. Prime Minister Dato' Seri Abdullah Ahmad Badawi stressed that the government
does not condone same-sex marriages (The Sun, 23/11/2005).
8. The Christian Response
a. It is sad that with regards to transsexual, the Church may have appeared to
be strong on condemnation and weak on compassion.
b. Most Christians uses Deut 22:5 (prohibition on cross-dressing), 23:1
(prohibition on emasculation) or 1 Cor 6:9-11 (in regards to effeminate
behavior), and apply them to transsexual.
DT 22:5 A woman must not wear men's clothing, nor a man
wear women's clothing, for the LORD your God detests anyone who does this.
The context of Deut. 22:5 intends to maintain the sanctity of the
distinctiveness between the two created sexes.
DT 23:1 No one who has been emasculated by crushing or
cutting may enter the assembly of the LORD.
The context of 23:1 supports and affirms the positive value of sex and that
sexuality and spirituality are not in opposite to one another.
1CO 6:9 Do you not know that the wicked will not inherit
the kingdom of God? Do not be deceived: Neither the sexually immoral nor
idolaters nor adulterers nor male prostitutes nor homosexual offenders 10 nor
thieves nor the greedy nor drunkards nor slanderers nor swindlers will inherit
the kingdom of God. 11 And that is what some of you were. But you were washed,
you were sanctified, you were justified in the name of the Lord Jesus Christ and
by the Spirit of our God.
Regardless, all these verses cannot be read in isolation from the rest of the
Scripture. Scripture always teaches us to hate the sin but love the sinners. To
consider the issue of transsexuality, we need to view the whole Scripture in
light of creation, fall, redemption and final restoration.
c. The doctrine of creation shows that our sexual identity is given by God.
Genesis 1:27 So God created man in his own image, in the image of God he created
him; male and female he created them. It also emphasizes the basic and clear
distinction between men and women. It sets out the foundation for Christian
understanding of marriage as one of God's gracious gifts to humanity and that
relationships are (1) heterosexual, (2) monogamous and (3) open to the
possibility of procreation. This will be difficult in a couple where one or both
are gender reassigned.
d. The doctrine of fall tells us about the effects of sin on creation as a
whole. Adam and Eve's wilful disobedience had resulted in the distortion in
God's pattern for living, including biological abnormalities and psychological
disorders. Transsexuality is the result of being in a fallen world.
e. The doctrine of redemption is central to how God is involved in His creation
after the fall. Therefore those who suffer the effects of sin may find hope, a
hope that is based on the healing work of Jesus Christ. Jesus Christ offers
redemption to all, including transsexuals-both physically, emotionally and
spiritually.
f. The doctrine of final restoration warns us that our present experience of
God's healing work is often necessarily partial and incomplete. The fulfilment
of our redemption is in store in the future existence beyond the present world.
Transsexuals must realise that their problems may not be fully resolved in this
world. Like homosexuals, they must learn to live with their limitations.
g. To transsexual we must maintain a balanced approach that maintains scriptural
convictions with a compassionate response. Yet, it is important to stress that
insensitive and ill-advised treatment of transsexuals can prove devastating and
dangerous. There is no general formula for dealing with transsexuals, for each
person is an individual with a unique personality and history.
h. "The need for patience, long-term commitment and the active seeking of God
for wisdom by all concerned cannot be over emphasized" (EAPC). For Christians,
"the emphasis is on both psychological and physical wholeness in the hope that
the transsexual people will of themselves produce the desired psychosomatic
unity, more truly reflects a biblical view of holistic health" (EAPC).
Redemption and restoration begin within the church community and the challenge
demands compassion, knowledge and wisdom.
References
1. A report by the Evangelical Alliance Policy Commission. Transsexuality .
London : Evangelical Alliance , 2000.
2. Sax, Leonard. How common is intersex? A response to Anne Fausto-Sterling.
Journal of Sex Research , August 2002.
3. Transsexuality-An Evangelical Christian Response by NECF Research Commission
4. Wenham, John, Ethical Enigma 14, Nucleus: Christian Medical Fellowship,
January 2206, p 38-39
5. Whitehead, Neil. Are Transsexual Born That Way? Triple Helix : Christian
Medical Fellowship, Autumn 2000, p. 6-8
6. Whiteheas, N.E, Should transsexuality be freely endorsed by Christians?
http://www.parakaleo.co.uk/articles3.html
7. Transsexualism in the church: a pastor responds
http://www.parakaleo.co.uk/article2.html Interesting narrative about
how a church deals with a member who is a transsexual.
|posted 2 September 2006|
