Welcome to Debbie Ballard's Transgender Information Site.

 Deborah Ballard aka Debbie Lawrence is a transgender woman with nearly 40 years of IT experience, nearly 40 years of transformational programs including 12 step programs, leadership training programs, open source support groups, transgender support groups and websites.  Debbie has written 6 books on transgender issues, so far.

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Paul McHugh is a well known right-wing opponent of all transgender treatments, including HRT and GRS.
 
He bases his conclusions on operations done by Johns Hopkins in the early 1960s. However, within the community of GRS performing surgeons, the Johns Hopkins Surgeries were known to be flawed. They sent ONE doctor to observe a few operations in Sweden, document his observations, and then bring the notes back to JHU so they could perform similar surgeries.
 
It turned out that the surgeon took poor notes, ignored several key steps, and created inaccurate drawings. As a result most of the surgeries performed left those who received them looking a bit freakish. The vagina was forward and up, there was no sensation in the clitoris, there was little sensation in the shaft. Patients hoping for a naturally looking vagina were disappointed and some went to other surgeons to have the JHU surgeries corrected.
 
Unfortunately, many others did commit suicide.
 
At about that same time, Bill Masters, of Masters and Johnson believed that he could cure "sexual deviancy" using shock therapy, aversion therapy (electrocution of genitals and breasts), and sterilizing medication.
 
Unfortunately, this treatment was so unsuccessful and so ineffective that most of the patients treated required lobotomy to keep them from killing themselves because the suicide was so high.
 
Later, psychiatrists treated gender identity disorder with medications such as extremely high doses of Haldol, which only delayed the inevitable suicides, most had to be locked up or lobotomized.
 
Meanwhile, back at the ranch, Harry Benjamin began to do more comprehensive research, distinguishing degrees of transsexuality and appropriate treatment for the various degrees.
 
Benjaman, like McHugh recognized that not all transgender people needed gender change therapy and surgery. He broke the patients into six degrees of severity. To reduce confusion, I will refer to birth assigned males who show female or feminine desires.
 
0 - Cisgender men - these are men who have no desire to transition, have no desire to dress up, and if they have dressed up, did not particularly enjoy it. They socialize primarily with men, and their interest in women is primarily sexual. Surprisingly, very few men are zero.
Often, these men struggle with issues such as violence and sexism which needs to be dealt with in conventional therapy.
1 - Infrequent mildly trans - This would include fetish dressers and men who enjoy socializing with both men and women, and prefer the company of men. This group is actually rather large.
2 - Privately trans - These are men who maintain a public male persona and may enjoy crossdressing, but don't want to transition, they struggle with informing a spouse or lover. They are also more likely to spend more time socializing with the opposite sex, enjoying the company of both men and women equally.
3 - Periodic trans - If crossdressing, enjoy occasional outings in a safe environment, such as parties for crossdressers, usually held in private locations or in hotels where special accomodations such as restrooms have been arranged. They tend to socialize with both men and women, including topics that are usually of more interest to women, such as cooking, childcare, housekeeping, and fashion.
4 - Mild Dysphoria - These are people who want to be girls, but often only on a part time basis. They take great effort to look as much like natural women as possible, yet also maintain their male lives, often keeping the two lives very separate.
5 - Severe Dysphoria - These are people who consider themselves more female than male. They often have difficulty functioning as boys and men, and often have more female friends than male, and many of their male friends may be gay. Often has very little interest in traditionally male activities such as hunting, fishing, and competitive team sports. They are often uncomfortable when other men start talking about women in sexual terms. Most of these should transition, but there is no urgency.
6 - Do or die Dysphoria - these are the most severe cases. They are often dysfunctional as males socially. They often have professions that involve extended periods of solitude such as computer programming, accounting, or scientific research. They are often severely bullied as children and as a result, tend to avoid most male companionship. They often have a history of suicidal attempts, often associated with belief in reincarnation. Often, they will attempt self-castration, and self-medication using herbal or mail-order medications to attempt to induce transition. For these subjects, transition is urgently needed. They should start real life experience as soon as possible followed by hormones on an accelerated schedule. Surgery is almost always required and is considered required therapy.
 
To help with diagnosis, and to facilitate a safe and successful transition, Benjamin created a protocol now known as the WPATH guidelines that involve the following steps.
 
1 - Real life experience - This may include coaching on outings ranging starting with short outings such as a walk to the car, and a drive around the block to going out to various clubs. The therapist discusses the outing to help address what feelings came up, and to make sure that the assignments were actually done.
2 - Full Time (sorta) - typically this would include all time not at work or commuting. Therapists like to see someone doing 80-100 hours a week as a woman before starting therapy. Again, the therapist will discuss feelings and experiences. She make additional assignments, especially to address family, work, and social structures.
3 - Hormone therapy - This is usually the point where hormones are started - and the therapist is observing to see if there are regrets, if situations are being avoided.
4 - Consequences - At this point, the client becomes aware of the negative consequences of transition, the therapist helps address these. This is pretty much the "point of no return" since breasts, once grown, must be surgically removed to revert.
5 - Legal status and Full Time - this is usually when the client comes out at work. At this point, the client will start the process of legal name change, legal gender change on social security card, driver's license, and passport.
6 - Gender Confirmation Surgery - it is usually only at this point that the client can even consider confirmation surgery. 
 
At this point, the client has already lived for a year or more as a woman, and is able to blend with other women.  Often, by the time a trans-woman gets the surgery, she is merely confirming the live she has been living.  Due to financial requirements, fitness requirements, and the WPATH requirements, many women have  been living as Eunuchs for 3-5 years. 

Hormones reduce the size of penis and testicles to the point where even finding them is difficult.  Ejaculation is no longer possible.  Orgasms are possible, but very different, more like those of a woman.  Some trans-women find that they aren't in that much of a rush to get surgery once they are living full time on hormones.

As you can see, the treatment protocols are vastly improved from the days when Johns Hopkins would just perform surgeries on any woman who requested the procedure, paid for it up front, and met minimal screening criteria.

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Transgender is an adjective.  A transgender person has a desire to live and act like a member of the opposite sex.

A transgender woman is a male who has the desire to live and act like a woman.

A transgender man is a female who has the desire to live and act like a man.

The opposite of transgender is cisgender.  A cisgender person has NO desire to EVER live or act like a member of the opposite sex.

Transgender is a comprehensive term describing an entire spectrum of this desire to live and act like a member of the opposite sex.  This includes social behavior, activity preferences, mannerisms, speech patterns, and appearance.  A transgender person may dress and appear cisgender and yet prefers friendships with the opposite sex, prefers activities that are typically enjoyed by the opposite sex, behaves more like the opposite sex, or speaks more like the opposite sex.

Harry Benjamin studied a wide range of people and attempted to define a range, similar to Kinsey's range of sexual preferences.  The criteria for the range values has evolved over time as larger survey groups are studied.  The most recent survey group was over 700,000 respondents.

Gender is one's identity, how you see yourself, how you think, how you act, how you interact with others.

Sex is one's biological characteristics

One's sex may be clearly male, clearly female, or ambiguous.  An ambiguous male may have a very small penis, undescended testicles, or even urinary abnormalities.  These are obvious forms.  More subtle forms that are often not detected until surgery, MRI, or CT scan, include organ abnormalities including testes that are shaped more like ovaries, known as ova-testes, internal uterus, internal ovaries, even a malformed uterus that empties into the bowels.  Brain variations include a smaller hypothalamus, which results in lack of aggression, most common in women, less common in men.  Also skeletal variations including hip width and position, and even finger lengths.  There are about 50 forms of gender ambiguity, so the odds of having one or more are actually pretty high.

There are a number of different causes.  The current theory related to sexual ambiguity has been that there was a deficiency of testosterone in the male fetus, or too much testosterone in the female fetus.  Possible causes for this include high levels of stress (children born in concentration camps, prisons, and refugee centers have higher incidence), medications (DES to prevent miscarriages, birth control methods such as Norplant or oral contraceptives taken after pregnancy), and other environmental factors.  Recently, research has shown that there is a genetic pattern that causes something called Androgen Insensitivity Syndrome (AIS), which prevents the fetus from assimilating and processing testosterone during early pregnancy.  There are also a number of genetic disorders including having XXY chromosomes.

There are similar issues with girls.  Girls may be sensitized to testosterone produced by the mother's kidneys, testosterone introduced into the mother's bloodstream by a partner, or possibly even a genetic sensitivity that makes a girl exhibit more masculine traits, including an enlarged clitoris, closed or partially closed labia, and internal organ differences.

Gender Identity - how one perceives themselves, may be influenced by various forms of gender ambiguity.  For example, a boy with a lack of aggression may find that it is too dangerous to play with other boys because he cannot fight back.  A girl with a strong aggressive nature might be frustrated or bored with the passive and fine motor activities enjoyed by cisgender females.

Transgender females were so common that Freud called it "Penis Envy".  This may be because aggressive and competitive girls are encouraged and supported as "Tom-Boys" and are often able to compete with boys even into early puberty. 

On the other hand, boys who exhibit feminine behaviors are often ridiculed, derided, abused, even assaulted, terms such as "Sissy", "Pussy", "Wimp", "Girlie", and "Mama's Boy" are frequently used.  During puberty, homosexuality based terms such as "Fairy", "Queen", "Queer", and "Faggot" are often misapplied.  As a result, it is more common for boys who are transgender to go into "Stealth Mode", doing their best to hide or minimize feminine behaviors and desires from public view.  In many cases, they hide by isolating themselves, becoming "book-worms", "Nerds", "Egg-heads" and similar terms.

Transgender males and females are often very intelligent, because they have to be smart to survive.  They are acutely aware and observant of things that most people take for granted.  They are acutely aware of the activities of their desired gender as well as those of their forced gender (the gender they are forced to exhibit based on birth traits).  Their isolation often involves intellectual pursuits, solitary hobbies, as well as a wide variety of interests.  In some cases, they may enjoy activities of both their desired gender and their forced gender.  For example, they may love cooking, housework, and crafts, but they also enjoy science, technology, and philosophy.  Many also have strong spiritual beliefs.

Here are some characteristics of the various levels.

  1. Cisgender - This is someone who is quite happy in their gender role, often very invested in that gender role.  For example, an Alpha Male, or a "Girly Girl".  These people take great pride in their gender, which matches their sex.
  2. Secretive and Periodic - These people are mostly happy with their birth gender, but enjoy certain aspects of the opposite sex.  They might enjoy cooking or fashion, and may even enjoy cross-dressing - but usually any overt feminine behavior such as cross-dressing, are kept very secret.
  3. Secretive and Frequent - This is someone who struggles with their gender role, but enjoys aspects of their birth gender.  They have exhibited a number of "acceptable" behaviors that are traditionally those of the opposite gender, such as cooking, sewing, babysitting, and have many female friends.  They also enjoy cisgender activities and non-gender activities such as hobbies, dancing, or reading several books a week..  They may secretly engage in overt feminine activities like cross-dressing, often on a frequent basis.  They may elude discovery for years, even decades, because they are very good at avoiding discovery.  There are some level three cross-dressers who even hid their "stash" in secret compartments in the walls or ceilings.  An important warning sign is if they are frequently bullied and avoid socialization with others of the same gender.  This is often an indicative of someone who is more severely transgender and living in terror of discovery.
  4. Public and Periodic - These are people who openly exhibit transgender behavior, and enjoy living and acting like a member of the opposite sex, but only for brief periods.  One transgender woman called it the "Vampire" stage, because it was usually only at night on the week-ends.  Some engage in theatrical activities such as drag shows, however not all drag queens are transgender and most transgender girls are not drag queens.  Drag queens are often more cisgender, but enjoy dressing up and doing shows where they can earn tips and other money.  Periodic public transgender women often look for "safe" environments where they won't get attacked if they are read.  This may include gay bars, lesbian bars, or activities at LGBT community centers.  For many, these are the first steps toward transition itself.
  5. Public and Frequent - These are people who like to fully interact as the opposite sex on a regular basis.  They may be out most evenings and most week-ends.  Often they lead a double life, maintaining a cisgender identity at work, church, family, and socially, but they get great happiness being out in social environments as transgender.  Most of these people have little trouble "passing" but may be a bit too beautiful to "blend" when they first start regular outings.  This is often because they are only going to clubs and recreational events, so they dress to party.  Again, for many, these are early steps toward transition itself.
  6. Severe and constant - These are the most severe type.  These are sometimes called "Do or Die" Transsexuals.  They can barely stand to look in the mirror when in forced gender mode, and willing to consider extreme measures to be able to be their "True Selves".  Many have tried to castrate or emasculate themselves as early as 2-3 years old.  Sometimes they injure themselves pretty seriously.  Puberty is an especially terrible time for them as they see their bodies changing into the forced gender.  Many have strong faith and study multiple religions, including Christianity, Hindu, and Buddhism.  They often begin to consider reincarnation as the only way to be rid of the body they so hate, with the hope of either heaven as a girl, or reincarnation as a girl.  They are often seriously contemplating suicide, and likely to attempt suicide multiple times.  Suicide triggers include rejection by family, lover, and/or friends, often in combination with being "Outed" or Kicked out of their childhood home.

The difficult part is that the behavior may not be an indication of the actual severity.  Experience treating many more transgender people and more comprehensive surveys have shown that there are many people who may have only exhibited as cross dressers, maybe even in private, yet they were type six transsexuals with a history of suicide and castration attempts.  WPATH attributes this to the social pressures and constraints one experiences.  If a child lives in a home with intolerant parents, they are less likely to exhibit transgender behaviors publicly, but they are more likely to commit suicide.  See the "Pressure Cooker" notes below.

How many transgender people are there?

This is very hard to determine.  We know that there are about 700,000 transgender men and women who have sought out Hormone Replacement Therapy (HRT) and Gender Correction Surgery (GCS).  But we know that this is only the tip of the iceberg.  Estimates today suggest that there may be more than 3 million transgender people in the United States.  Part of the problem is that so many in the transgender community are so secretive, living in stealth.  Many live in stealth before their transition, and again after transition.  Other than their early transition period, they are not really visible as transgender.  The image of a guy in "Camp Drag" is extremely rare.  By the time a transgender woman comes out in public, she has practiced walking, talking, dressing, make-up, and behavior.  In many cases, it took great effort to exhibit forced gender behavior, so acting more like their "True Gender" is actually quite natural.

Gender Dysphoria is often misdiagnosed as depression, bipolar, autism, or PTSD.  Gender Dysphoria has many of those elements.  There may be depression do to the conflict of being forced to accept birth gender, PTSD may actually be present due to the frequent, violent, and severe bullying, especially when authorities made no attempt to intervene.  Many transgender children isolate.  Unable to play with girls and unwilling to play with boys, they may become avid readers, spend hours on their computers, or other solitary activities deemed "acceptable" by parents or peers.

Another difficulty with knowing how many is that many repress it so deeply and so hard.  Often, without a "push" from someone, a sister, a cousin, a girlfriend, or someone else they trust, they will not only avoid talking about being transgender, they will become very upset if someone threatens to expose their secret.  A woman calling a man a Sissy may seem like a cute phrase, but to a young man who has faced years of violence for being "Sissy" or "Girly", the word can trigger flashbacks of extreme violence.

The other problem is the "Pressure Cooker" syndrome.  Both transgender men and women are often literally forced to conform to their birth gender.  A transgender girl is sent to play with the boys, where she is physically attacked, often by large groups of a dozen or more boys her own size and age, who take out anger at older sisters, stronger girls, and any other girl they aren't allowed to hit, by hitting, kicking, and even clubbing and stoning, the "Sissy".

As a result, many of those who might even be a 4, 5, or even a 6, may not show up on anybody's radar until they are full grown, and even then, may not want to risk losing spouse, children, job, career, social standing, status, even their home, because they "come out".  Some transgender women don't transition until they are old enough to retire.  Others will transition only after a divorce.

According to some surveys done back in the 1970s, before transition was a viable option in the United States, 1 in 3 men admitted that they had dressed up as women, and enjoyed it.   In an average classroom of 30 boys and girls in roughly equal proportions, there will be at least one "tom-boy" and at least one "sissy", but there will also be 4 to 6 "book-worms".  It's entirely possible that as many as 1 in 5 people are in the 3-6 spectrum of the transgender scale, but many may still limit or try to control overt behavior such as cross-dressing to avoid discovery and the fear of the persecution they experienced or saw as children.