30 January 2010

Gender Dysphoria

'Dysphoria' is Greek for discomfort. Some dictionaries list 'fidget' as among its meanings. I quite like the idea of being a gender fidget - it has a nice implication of every-day subversion of imposed gender. I am certainly uncomfortable with gender as it is constructed in post-industrial societies, and probably with most pre-industrial societies. However 'gender dysphoria' as used is not this innocent. 'Transvestism' and 'transsexualism' (note the *ism*) were used by medical men to describe a pathology, the former by Hirschfeld and the latter by Cauldwell and Benjamin independently. The two terms were taken on by society at large and applied to any form of cross-dressing or sex-change respectively whether pathological or not. By the early 1970s doctors were terminologically dysphoric particularly about the word 'transsexualism' because it had lost its medical connotations, and so Norman Fisk (1973) proposed 'gender dysphoria syndrome' to remedicalize the concept. It was then intended to be an umbrella phrase for all the gender disorders, but with time has become particularly associated with the desire for a sex-change.

I do not use 'gender dysphoria syndrome' or 'gender dysphoria' as it is commonly abbreviated, because its users normally assume that transsexuality is a pathology. To use 'gender dysphoria' and not to mean a pathological state is to ask to be misunderstood.

'Dysphoria' as a general concept is psycho-babble that cries out for us to take the piss. A few sentences above I referred to 'terminological dysphoria'. Equally any circumstances leading to any kind of change could be referred to as a dysphoria. People change jobs because they have occupational dysphoria, they move to live elsewhere because they have geographical dysphoria, they channel surf because of signal dysphoria, and so on. The fact that only 'gender dysphoria' is regarded as a pathology is a political fact.


In Hirschfeld’s Die Transvestiten, 1910, the word he uses for what we might call transsexualism is ‘Geschlechtsuebergaenge’, which would literally be a sexual over-going. This word is translated as ‘transsexual’ in Michael Lombardi-Nash’s 1991 English translation of Die Transvestiten. Obviously 'sexual over-going' was not going to catch on in English.

In 1923, Hirschfeld did use the expression 'seelischer transsexualismus' (psychic transsexualism) in a journal paper, ‘Die intersexuelle konstitution’. Although, of course, one wonders whether it was his own expression, or one suggested by one of his minions.

Die Transvestiten was not translated into English until 1991, and ‘Die intersexuelle konstitution’ has never been translated. Kurt Freund, as a German-speaking Czech sexologist, probably read read both of them. Harry Benjamin, being German, could have read them, but he shows no evidence of taking the word ‘transsexual’ from Hirschfeld. There is no evidence of British or US doctors having read Hirschfeld.

The word ‘transsexual’ next appeared in Kinsey, Pomeroy, and Martin, 1948: 612, as a kind of homosexual considered as an intermediate sex.

The next year, 1949, David Cauldwell wrote a paper for Sexology about a girl who wanted to be a boy. He entitled the paper ‘Psychopathia transexualis’ (note the one S). This paper was not much noticed. Harry Benjamin later commented: "Whether I had ever read that article and the expression remained in my subconscious, frankly, I do not know". It was Louise Lawrence who introduced Benjamin to Cauldwell’s writings.

The word next turns up in Edward D. Wood, Jr’s 1953 film, Glen or Glenda. This is intriguing. Was the word in use among trans people before Benjamin started using it? Did Louise, having read Cauldwell, pass the word on to other transvestites? We do know that the word ‘homophobe’ was used in Screw magazine two years before it was officially coined in 1972. Probably by the early 1950s, the word ‘transvestite’ was sufficiently common that that different people coined ‘transsexual’ independently.

Harry Benjamin first used the word in December 1953, and went on to popularize it, particularly in his 1966 book. He spelt the word with two-SS.

By the early 1970s doctors were dissatisfied with the word 'transsexualism' because it had lost its medical connotations, and so Norman Fisk in 1973 proposed 'gender dysphoria syndrome' to remedicalize the concept.

John Money pays homage to Cauldwell by using his one-S spelling, as does The Rocky Horror (Picture) Show, 1973 on stage, 1975 film (“I'm just a Sweet Transvestite from Transexual, Transylvania“. However the two-S spelling has proved more popular.

  • Harry Benjamin. The Transsexual Phenomenon, New York: The Julian Press. 1966.
  • Harry Benjamin. “Introduction”. In Richard Green and John Money (eds.), Transsexualism and Sex Reassignment, Baltimore: The Johns Hopkins Press. 1969.
  • David O. Cauldwell. ‘Psychopathia transexualis’. Sexology, 1949. 16: 274-280.
  • Richard Ekins, Dave King. (2001) "Pioneers of Transgendering: The Popular Sexology of David O. Cauldwell". IJT 5,2,
  • Norman Fisk. "Gender Dysphoria Syndrome". In D. Laub & P. Gandy (Eds.) Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome. 1974: 7–14.
  • Magnus Hirschfeld,. Die Transvestiten; ein Untersuchung uber den erotischen Verkleidungstrieb: mit umfangreichem casuistischen und historischen Material. Berlin: Pulvermacher, vi, 562 pp1910. English translation by Michael A Lombardi-Nash. Tranvestites: The Erotic urge to Crossdress. Buffalo: Prometheus Books. 424 pp 1991.
  • Magnus Hirschfeld. ‘Die intersexuelle konstitution’. Jahrbuch fuer sexuelle Zwischenstufen, 1923. 23: 3-27.
  • Andrea James. “Magnus Hirschfeld”. Transsexual Road Map.
  • Kinsey, A.C., Pomeroy, W.B., and Martin, C.E. (1948) Sexual Behavior in the Human Male, Philadelphia: W.B. Saunders.

Bullough and Bullough in Crossdressing, Sex and Gender, 1993: 257, state that "Hirschfeld in 1910 called one of his patients a psychic transsexual". They give no reference. Presumably they are confusing his book and his 1923 paper.


In early common law the crime of mayhem was committed by inflicting a wound that reduced a man's ability to fight. Women were not expected to fight and so one could not commit mayhem against them. The crime was committed against the king also in that he required the use of fighting men.

The loss of an ear or nose did not count because these do not affect the ability to fight; however the loss of a penis was deemed to be mayhem (which would seem to imply that rape is part of a soldier's duty).

With time the military angle faded out and mayhem is today regarded as injury to normal bodily functioning or disfigurement. Today one can commit mayhem against a woman. Castration is definitely an act of mayhem if it is committed maliciously.

Is transsexual surgery mayhem?

Sally Barry was approved for surgery in Wisconsin in 1948, but had her operation vetoed by the state attorney general’s office as it would constitute mayhem. She was also declined surgery in California in 1949 based on advice from that state’s attorney general’s office.

For a long time surgeons in the US declined to do transsexual surgery because of fear of being charged with mayhem. Elmer Belt, the pioneering US surgeon, preserved the testicles in trans women, pushing them into the abdomen, to preserve the hormones that they produced and to avoid such charges. Some patients got around this by doing a self-castration, or having a castration done in Europe, before going to Dr Belt. However no US surgeon was actually ever charged with mayhem.

Twice in Argentina, surgeons have been charged with mayhem after sex-change surgery. In 1966 a surgeon, Ricardo San Martin, was convicted of assault. The patient's consent was considered invalid because of 'his' low mental and emotional age and 'the fact that his neurotic craving for surgery made his consent involuntary'. In 1969 another Argentinian surgeon, Francisco Sefazio, was charged with aggravated assault but was acquited on the technicality that all of the patients were actually ‘pseudohermaprodites’ and that he had clarified rather than changed their sex.


One often comes across the facile assertion that Magnus Hirschfeld coined the word ‘transvestite’ in the 1920s. Unfortunately for this assertion, transvest* and the French form travest* have been around as noun, verb and adjective for almost 500 years.

Here is a potted history of ‘transvestite’ and similar words in mainly English and French. To write this I used the Oxford English Dictionary and the Petit Robert. The Wikipedia article on En Travesti was also consulted.
  • The Italian ‘travestire’ from the Latin ‘transvestire’ is recorded in the 16th century. It is first recorded in French as ‘transvestir’ in 1569, and had become ‘travestir’ by 1580. The Italian origin probably accounts for the retained ‘s’ rather than a circumflex, as opposed to ‘vÄ›tir’ without the prefix. The original meaning is dressing up or disguise rather than gendervesting in particular. The English meaning of ‘travesty’ as ‘ridiculous’ is not used in the French.
  • The word ‘travesty’ first became well known in England in 1648 with Scarron’s satire, Le Virgile Travesty en vers burlesque. So the modern English meaning of things done badly or ridiculously was there almost from the start, but so was the meaning of dressing as another.
  • However the pseudo-French expression ‘en travesti’, using the past participle of the verb, which is not recorded in French, was used particularly in the theatre with the specific meaning of dressing as the other gender. This usage has continued from the seventeenth century until today.
  • The verb form, ‘to travesty’, is not found until after 1700, and was not needed for the sense of Gendervesting, for the verb ‘to transvest’ is recorded from 1652: “How often did she please her fancy with the imagination of transvesting herself, and by the help of Man’s disguise deceiving the eyes of those who watched her deportment”. This usage, particularly applied to female-bodied persons continued into the nineteenth century.
  • 'Travestissement' was being used in France by 1692.
  • 'Transvestisme' is recorded in French in1845. The Petit Robert lists it as an hapax (only one recorded instance) in this period, but just as Ed Wood used ‘transsexual’ before Harry Benjamin did, people on the street are using words before dictionary compilers catch up with them.
  • 'Travestiment' was being used in England by 1832, and 'Travestier' by 1883.
Thus Hirschfeld was rather a Magnus-come-lately a far as being a coiner of the term. However he and Sigmund Freud did reinvigorate the concept, although the psychoanalysts in Freud’s wake have done a lot of damage in rewriting transvestism to be a fetish and a perversion. While ‘travesty’, especially in English, always had a second meaning of ridiculous or badly done, the associated words did not, before the twentieth century, have the meaning of neurosis or perversion.

The enduring calumnification of ‘transvestism’ is probably the reason why ‘transvestity’ did not evolve, while ‘transsexuality’ did evolve alongside ‘transsexualism’.


Consider the following pairs of words:


There is an importance difference of meaning between the first and the second in each case. The first word is simply the state or condition. The second word turns it into something that is being advocated, an ideology.

There is another usage of the 'ism' ending. It is used by doctors for diseases. Both 'transvestism' and 'transsexualism' were coined by doctors to label diseases.

In English both 'transsexuality' and 'transsexualism' are used. I and others use the former by preference to diminish the medical implications of the word. Even 'transsexualism' had lost much of its medical implications by the 1970s, and the doctors came up with a new phrase: 'gender dysphoria syndrome' frequently shortened to 'gender dysphoria' to remedicalize the concept.

So, as we have both 'transsexuality' and 'transsexualism', why don't we have both 'transvestity' and 'transvestism'? A google search for 'transvestity' shows that it is used in Czech, but not much in other languages. I seem to be in a small minority in my use of it in English.

I have been using 'transvestity' since the early 1990s, and will continue to do so. I urge others to follow.