Let's start with a few definitions. Transgender is actually anyone who has the desire to look, act, and behave as a member of the opposite sex. This goes far deeper than dressing, or even make-up. This is the desire to BE a member of the opposite sex. For example, a person born male who very much dislikes being a boy, guy, or man, and very much prefers to be "one of the girls". Often, transgender women will socialize with other women more easily. At a party, he is the one in the kitchen exchanging recipes, helping with the prep, and helping with clean-up afterward. The biggest give-away, which only women are aware of, is that a transgender woman, while presenting as a man, almost always looks all women in the eye. He may also give a woman complements, on her wardrobe, make-up, or hair color, but almost never on her physical attributes.
Transgender women don't just decide on a summer afternoon "I'm transgender, I'll put on a dress and go to the bathroom". Quite the opposite. Transgender women struggle with their identity for years. Often, in elementary school, they are the ones who get bullied by ALL the boys in the class for being a "Sissy" - which ironically is slang for Sister much the same way buddy is slang for brother. The irony is that the term actually fits. A "Sissy" is a boy who acts more like a girl. As a boy, he is less likely to fight or push other kids, he's usually quieter and less argumentative, he enjoys gentle play, fine motor skills such as coloring, crafts, and playing house. Often, the majority of their friends will be women. They may LOOK like men, but in most ways, they are women, or if younger, girls.
There are many explanations, but one of the most common is that there are fundamental differences between the brains of men and women. Cisgender men have a larger limbic system, which makes them tend to be more aggressive, more inclined to push, to fight, to argue. This was probably necessary to be able to hunt and defend the tribe, village, or town. The most aggressive men tended to breed. In wars, all men would be sent to battle and less aggressive men would be killed off quickly, leaving the most aggressive to reproduce.
Cisgender women tend to be less aggressive, this is probably because women who were too violent, aggressive, and short-tempered would have great difficulty raising children, gathering the plants and herbs, and being able to notice small details that helped to distinguish which mushrooms were safe to eat and which would cause illness or death.
Transgender males tend to be less aggressive, more like cisgender women. Conversely, transgender females tend to be stronger, more aggressive, and more competitive. Even as young girls, transgender females, often called "Tomboys", will compete, even fight, with other boys, and often will even win.
Ironically, Freud thought that transgender women were actually relatively normal, calling the condition "penis envy" based on the assumption that wanted the power and privilege that comes with being respected as a man. On the other hand, he assumed that males who wanted to be women must be insane or delusional because no sane man would want to give up the power and privilege of manhood to become a woman, a lady, a girl.
Transgender women (males who want to be women) are not new or even that rare. In India, the Hajiri have been around for over 10,000 years. In pagan societies many "witches" and "shaman" were transgender. The native-Americans called them two-spirit people because they were believed to have the spirits of both a male and a female in one body.
As for what causes someone to be transgender, we know that for transgender women, the fetus forms as female for the first 8 weeks then begins to form male features later in pregnancy. As a result, the brain, skeletal features, and even many internal organs may be female, yet the genitalia forms as male because less testosterone is needed to produce it. Even so, transgender women are often not well endowed. It's not unusual for transgender girls to be teased in the shower by the other males, because her equipment is so small, deformed or even missing. Undescended testes are not unusual, and often are far up the unguinal canal or even in the abdominal cavity - like ovaries. Some even have deformities called ova-testes which are actually capable of producing natural estrogen as well as just enough testosterone to trigger male puberty.
Not all transgender women are intersexed, and not all intersexed people are transgender.
Many transgender kids know that they are transgender at a very young age. They may not even consider cross-dressing, but they socialize and interact like the opposite gender. Almost as soon as this manifests, transgender girls tend to become the targets of teasing, insults, and bullying. Often, as the child gets older, the abuse escalates into gang violence against the transgender girl (who the boys see as a weak boy), with a dozen or more boys punching, kicking, clubbing, and stoning the transgender girl, on a daily basis, even to the point where hospitalization is occasionally needed. The violence may start as young as first grade, and may continue into high school or college.
This sets up what I call the "Pressure Cooker Effect". The transgender girl knows that she has to try and pretend to be more like a boy in order to survive, or at least avoid the violent beatings. At this point he begins living in "Stealth Mode", trying to dress, act, and present more like a boy. It often doesn't go well, and he his perceived as homosexual, but male.
Many transgender girls begin avoiding people entirely. They spend their spare time reading books and learning hobbies to avoid having to be involved in sports and competitions. They may learn a lot about technology, engineering, medicine, religion, psychology, and philosophy. They may also develop an interest in the arts, music, theater, or dance. As a result, transgender children often have extremely high IQs and because they question and seek to understand everything, they become quite inventive, creative, and productive. They may hold many patents and/or copyrights, or may be the source of many patents and copyrights filed by others.
The pressure cooker builds pressure as the transgender girl gets older. As puberty starts to set in, a transgender girl may find herself wishing she were getting breasts like her girl friends, and may see the growth of hair all over the body as something gross and disgusting. Some transgender girls will even try to castrate themselves in creative ways. Strangulation, boiling water, even a hammer and a two-by-four. I've even heard of younger children who tried to cut it off with a pair of scissors.
Some young transgender girls as well as many transgender boys get so upset over their transition that they will actually end up killing themselves - often hoping to be reincarnated in the right body, which makes suicide even more likely, because they don't see it as ending their lives, but rather as ending a really horrible life so they can move on to the next one where things make sense. I started down that tunnel until I found out about Karma and realized that suicide in this life might mean being a girl in Africa or a country where women are little more than property.
As it is, at least 40% of all transgender men and women have attempted suicide, using methods they believed would be fatal, at least once, before they celebrated their 25th birthday.
Often, as puberty sets in, the situation gets more and more confusing. They hate becoming men, but they can't stop it. They start to experience testosterone induced sexual desires, and they start to experience feelings of romantic love toward one sex or the other. Either sex is a bear-trap. If you are attracted to men, you relate to men as these cruel and nasty beasts, but then you find yourself attracted, but you have no idea how to relate to a man romantically. If you are attracted to women, you keep ending up in the "friend zone", because they see you as "one of the girls". And if/when you finally do find a romantic partner, they try to seduce you as a man, which is NOT what you want. Many of us find such treatment painful, even repulsive. I told one girl, "It's not taffy and pulling it won't make it any bigger".
Attraction to women can be very confusing, because you don't know whether you want to kiss her, or BE her. I used to see a girl in a dress I really liked, imagine myself in a similar outfit, and imagine her taking the aggressor role, and sweeping me off my feet. And then I'd fall in love with the fantasy. That would last until the next day when she'd be wearing jeans and a T-shirt.
Sometimes the pressure cooker explodes when they are outed, or out themselves. Often, a romantic interest either baits them into coming out and then rejects them, or finds out their secret and tells all his/her friends. Often, this is followed by more bullying and daily torments. The risk of suicide at this point is extremely high. In addition, parents who find out that their son is really their daughter get so upset that they will literally put a 12 year old kid out of the house, to live on the street, with no support whatsoever. These girls are often exploited. They are forced into prostitution just to survive, they turn to drugs, alcohol, and sex-for-pay or sex-for-favors just to keep from freezing to death. In some cases, they just deliberately attempt overdoses or commit suicide by falling asleep in a park in freezing weather.
The suicide attempt rates for transgender women who are rejected by family, lovers, and/or friends because they are transgender, is estimated to be as 80% One out of three of all those who actualize multiple suicide attempts, will eventually succeed.
If a girl manages to maintain her cover long enough, and finishes school and goes to college, she will often become successful in "his" career, and might even get married. Some cling to the hope that once they are married, with kids, and secure, they won't hate being men so badly and can just be happy. Of course, this ultimately leads to regression, hiding, and trying to find very private and personal ways to express the woman, like cross-dressing, fantasy role-play on video games, even going to a hotel and getting fully dressed as a woman, and maybe going out for a few minutes at a time. Many men keep the girl hidden from their wives, children, employers, coworkers, and friends, for years, even decades.
Unfortunately, at some point, the girl is discovered, and there are denials, and rejections. Some transgender women live in platonic relationships for years because their wives refuse to have sex with them, sometimes even finding other lovers who are "real men", while at the same time refusing to allow space for the girl to find her place. In fact, the girl is often used as leverage, as blackmail. Meanwhile, they do remain friends, as two girls would be friends, and the girl expresses herself solely through social interactions. Transgender women often enjoy housework, child-care, and don't have much interest in sports, hunting, fishing, or NASCAR racing. At the same time, they watch Disney movies with the kids, watch romance movies with their wives. So when they go to a social event, such as a cocktail party, the wife may be hanging out with the boys talking football, while the husband is back in the kitchen talking about recipes, kids, movies, how to get out a particular type of stain, or even helping with the next charity event.
Often, by the time a transgender woman actually starts making public appearances as a woman, she is fully committed to living full time as a woman. Because this is real for them, it's not as simple as getting a thrift-shop dress, a costume wig, and some lipstick and going out to the local restaurant. Transgender often struggle to come out. Typically, before their first outings, they will have waxed their legs, arms, and any other body hair, they will have done some laser and/or electrolysis, they will have practiced for HOURS walking in heels, often under a cisgender woman who will coach them on their walk, mannerisms, and voice.
They will then BEGIN the "Real Life Experience", which means spending as much time as possible living and acting like a girl. They will start out by being a girl full time at home, often from the time they get home from work, until they have to get dressed for work the next morning. They will go out in public, starting with low risk excursions such as a 10 minute drive, a trip to a convenience store to by a fountain drink, then a trip to a Walgreens or CVS to pick up some make-up, then a 30 minute walk through a shopping mall. They do everything they can to avoid even the thought of going to the women's restroom until they can walk through a mall for an hour or more without being noticed, because they look like every other woman in the mall. She can also make cash purchases and interact with the store clerks without being noticed as anything other than just another nice lady.
By the time a transgender woman is ready to use the restroom, she can walk through a crowded space such as a busy shopping mall, a train station, or even a theater, without being noticed. And when she DOES use the restroom, she does her best to minimize her interactions with others. She will wait 5-10 seconds after a woman goes in to make sure that the woman has time to get settled, when she does go in, she finds an empty stall as quickly as possible, locks the door, and SITS DOWN! She wouldn't even think of going standing up, and has probably been sitting to pee for a year or more already. When she finishes her business, she will stand up, wipe down the seat, flush, and go to wash her hands.
While washing her hands, there is a greater exposure to interaction with other women. At first, she probably will minimize that time as much as possible. She will already know better than to be looking at a woman's chest. She will speak when spoken to, but will generally not initiate conversations. She will be sensibly dressed, and won't attract attention. She'll be pretty like a girl who dresses to impress, but not so pretty that she draws excessive attention. We call it "Blending", dressing appropriate to age, weight, size, and situation. So she won't be wearing club-wear to the shopping mall or the Denny's, but she might be wearing a knee-length skirt, blouse, and jacket to a nicer restaurant.
The last thing a transgender woman wants to do is draw a lot of attention to themselves. Ironically, this has created a problem. The visible "males in dresses" are most often "Drag Queens" or "Female Impersonators", men who dress up as women, being overly feminine, overly sexy, and doing everything they can to attract a LOT of attention, to build up their clientele who will pay them tips as they perform such acts as lip syncing popular songs by female vocalist icons such as Cher, Madonna, Marilyn Monroe, and so on. Some of these people are actually transgender, but even the transgender girls, when the show is over, take off the sequin dress, the fantasy big hair wig, and the 6 inch platform heels, and switch into jeans, a peasant blouse, and some low heel wedges or even track shoes.
As for the question of psychosis, this has been considered. Bill Masters, of Masters and Johnson fame, believed that he could "cure" homosexuals and transsexuals (the most severe form of transgender) using a combination of shock therapy and aversion therapy. The shock therapy used at the time was an electric shock that caused severe convulsions and cramping that was acutely painful for 90 seconds that seemed like 90 hours. It was normally done without anesthesia and the subject was often gagged with a ball on a string or a stick covered with gauze. The patient would wake up an hour or two later, disoriented, in a state of panic, often unable to remember days of their lives, and unable to even remember where they were or why they were there. A terrifying experience to say the least.
If that was bad, Aversion Therapy was even worse. The patient would often be given a drink containing ipecac, give an IV drip that could be loaded with large quantities of adrenalin or epinephrine, the patient would be strapped to a chair at wrists, elbows, shoulders, knees, and ankles, with head strapped to a headrest. The eyes would be taped open and moistened with saline. Then electrodes would be wired to the genitals, anus, nipples, and scrotum. Then movies containing erotic material to be discouraged would be shown, often in an otherwise pitch black room. As the subject began to get aroused, they would receive an electric shock. Over time, even the slightest arousal could be addressed with a massive jolt that had the intensity of someone hammering a testicle with a carpenter's hammer. The shocks would be given at choice moments during the film, and often with such intensity that the subject would beg for mercy. Meanwhile, the IV would be loaded with the Eppy to induce intense feelings of fear, terror, and extreme fright. The subject, unable to move or look away, would then begin vomiting, convulsing, screaming in pain, until the movie was over, at which point, they usually passed out from shock.
An even more dramatic description of Aversion Therapy was documented in horrible detail in the book "A Clockwork Orange", which is far more grotesque than depicted in the movie.
Typically each "series" was done every day for 90 days, with no days off.
Unfortunately, the treatment was horribly ineffective, and often, faced with the prospect another series of Shock/Aversion, the subject would become suicidal. Many of these patients ended up killing themselves, the survivors usually had to be lobotomized.
Later, faced with no ability to facilitate a cure, and the remarkably high suicide rates, psychiatrists gave up on conversion and just gave transgender patients massive doses of Haldol, essentially a chemical straight-jacket that effectively turned patients into zombies, unable to even communicate.basic needs. Many had to be fed because they couldn't focus enough to feed themselves.
It was about this time that Harry Benjamin proposed a radical new concept. Rather than try and stop the transsexual, they could try a controlled and carefully monitored transition. A few hospitals, including Johns Hopkins, had attempted to perform sex change operations on transsexual women, but the shock of suddenly going from male to female was often too much, and the suicide rate was still very high. It is these findings that are often quoted when a certain "trannny basher" cites the John's Hopkins study that said just "cutting it off" did more harm than good.
Dr Benjamin came up with a radical new solution. Rather than just perform a quick surgery (which Johns Hopkins was doing incorrectly due to lack of proper documentation), Benjamin established a process for evaluating the initial requests to transition, evaluating the transition prior to the use of any medications, evaluating transition during the process of inducing female puberty with hormone replacement therapy (HRT), and then only if the patient remained stable and happy for at least 1 year of living full time as a woman with breasts, would they consider the surgical procedures.
It turned out that many transgender women were perfectly happy once they had breasts. The hormones took away their ability to have erections and made their male genitalia shrink to as small as a quarter of their original size, but for a transgender woman, this was a good thing. Others were content with just the Orchiectomy, removal of the testicles, because the penis had already shriveled up an disappeared.
For those who still wanted the final surgery, there were still formidable obstacles. The surgery was expensive, costing almost as much as a house in those early days. Insurance didn't cover the procedure, so the money had to be raised, a process that could take years. The early surgeries were primitive, the cliteris was cosmetic only, with no sensation. After surgery, patients were unable to achieve orgasm.through the cliteral stimulation.
What they did discover, and has been confirmed by numerous subsequent studies, is that transgender women who did transition, whether only with breasts or with surgery, were happier, healthier, and more successful than they had been prior to transition. They were much less likely to commit suicide, and they often made substantially more money in their chosen profession.
They found that post-transition transsexuals also had better relationships, especially with friends, coworkers, and customers, because they weren't putting so much effort into being something they weren't.
If your son or daughter had a disease and had a 20% chance of survival, and could be cured with a 90% chance of being happy, healthy, and normal, simply by taking some pills every day, changing their wardrobe, and maybe even getting a safe and simple surgery, would you tell the doctor NOT to treat your child?