Transsexuality

Transsexuality or transsexualism (from Latin trans "over, beyond", and sexus "gender [steep]") describes the subjective incomplete identification of a person with his objective, holistic gender characteristics . This sexual incongruence has often been described as "born in the wrong body". According to international studies and data from Germany, 0.33 to 0.61% of the population are transsexuals; the average age when changing gender roles is around 38 years.

The persons affected may also wish for gender reassignment measures if they want to change the gender expression of their body. According to the definition of the World Health Organization (WHO), transsexuality is “the desire to live and be recognized as a member of the opposite sex”. Accordingly, in medicine , transsexuality is understood to mean that a person also wants gender reassignment measures in order to be able to externally live their subjective personal gender identity . Harry Benjamin (1885–1986) - a pioneer in the field of transsexuality research - described in 1966 that transsexual people wanted a physical and social assimilation to the perceived inner sex as much as possible because of an internal psychological stress. Benjamin also distinguished between different degrees of transsexualism.

In comparison with the terms “ heterosexuality ” and “ homosexuality ”, transsexuality does not define the sexual orientation or the sexual behavior of those affected. Instead, the subjective gender identity, from which the objective innate body characteristics deviate, is decisive and central to understanding transsexuality. The term transidentity has existed in German-speaking countries since around 1985, but it is more broadly defined as transsexuality, and u. a. also includes various extensive forms of gender reassignment. Transsexuality is often understood as the broadest manifestation of a whole spectrum of people who do not want to adjust their bodies or only partially (for example only through hormone therapy ). What the terms transsexuality , transidentity and transgender have in common is that they are understood and handled differently in medicine, law, society and by those affected themselves. An example of this is the German Transsexual Act , which since 2011 has also offered people without surgery the option of changing their civil status.

ICD-10, the 2019 detached version of the International Classification of Diseases and Related Health Problems of the World Health Organization, is one of Transsexualism (F64.0) as gender identity disorder to personality and behavioral disorders. In the subsequent version ICD-11, which was adopted in 2019 and must be implemented by the end of 2021, this designation will be replaced by gender incongruence of adolescence or adulthood (" social gender mismatch in adolescence or adulthood"), which is classified as "circumstances in connection with sexual health ”.

Definitions

People who were assigned the female gender at birth but are male are often referred to as woman-to-man (= FzM) transsexuals in medical or psychological literature ; People who were assigned the male gender at birth but are female, correspondingly as male-to-female (= MzF) transsexuals. Most transgender people, however, reject these word creations because they represent the innate gender identity; H. Do not respect the body image, the knowledge and feeling about one's own gender as gender-determining, but only proceed from physical factors. The definitions implicitly assume that the person concerned originally was a “real woman” or a “real man” who would transform into the opposite. This does not correspond to the own perception of transsexual people who adapt their body to their inner gender, because they perceive this as unchangeable (which is also seen by most experts).

Both of the above definitions correspond to the still relatively new concepts Transmann or trans woman who depend on the respective gender identity, be rejected also by some stakeholders as ugly. Especially since transsexual people with medical or legal gender reassignment often no longer see themselves as transsexual, but either as a man with a transsexual past or as a woman with a transsexual past or simply as a man or woman.

Terms such as non-binary or non-binary are used by people who consider themselves neither clearly female nor male.

Concept history

The Austrian philosopher Otto Weininger used the term transsexuality to describe the opposite-sex parts of a person, which he saw embodied in the figure of Parsifal by Richard Wagner . For him, transsexual meant everything non-masculine, including books, politics, science and art, which would be in contrast to the sexual - for Weininger it was synonymous with the phallus . Weininger stated in his book Gender and Character that women are only attracted by the sexual, not the transsexual. However, Weininger's definitions (apart from a few errors) have next to nothing to do with the modern understanding of transsexuality.

In 1910, the German doctor and sex researcher Magnus Hirschfeld coined the term transvestite for people who occasionally, regularly or constantly dress as members of the opposite sex. Hirschfeld's original definition of “transvestite” was, however, much broader than the modern definition, despite the outward focus of clothing, it also encompassed transsexual phenomena, similar to the current term “ transgender ”, which, however, focuses on the internal gender identity. In 1923 - in the last edition of his yearbook for sexual intermediate stages - he used the term “psychological transsexualism”, a gender variation for people who did not just dress in opposite sexes, but rather belonged to one sex in mental terms, but to the opposite sex physically he saw as a preliminary stage of hermaphroditism .

At times, David O. Cauldwell , who took up the word in his 1949 article Psychopathia transexualis , was mistakenly believed to be the originator of the term. Harry Benjamin , who knew Hirschfeld, his publications and his institute for sexology , took up the term again in 1953 in his article Transvestism and Transsexualism in connection with the case of Christine Jorgensen , and established it in 1966 with his book The Transsexual Phenomenon in Sexual Medicine . In the works of Cauldwell and Benjamin, the term transsexualism was already used in its current meaning.

In the 1990s, the term transsexualism was removed from the Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV , and replaced by the term gender identity disorder . In the International Classification of Diseases of the World Health Organization, ICD-10, the terms transsexualism and gender identity disorder were used synonymously. Transsexualism can be found under class F ( mental disorders and behavior disorders ) as sub-item F64.0 in paragraph F64 (disorders of gender identity) of chapter F6 (personality and behavior disorders).

In the new draft of the ICD-11 classification, only gender incongruence is spoken of, which means that the gender characteristics of the body and / or the social role do not match the gender of the identity.

History of transsexuality

Indian hijras , ca.1865 .

Conjuring dance of a (transsexual?) Korean shaman, Maurice Courant: “Souvenir de Séoul, Corée”, 1900

Transsexual Kathoeys in Pattaya, Thailand, 2004

The phenomenon of people changing gender roles has been known since ancient times . Since the possibilities of physical gender reassignment were (presumably) relatively limited in historical times and there was also no precise definition, it cannot always be precisely decided in individual cases whether it is transsexuality or other transgender forms such as transvestism , or intersexuality or effeminate homosexuality acted. In old or conservatively oriented texts, corresponding historical persons are almost always confused with homosexuals or eunuchs by often poorly informed historians or doctors .

A corresponding delimitation of transsexual phenomena does not exist until modern times in other cultures, e.g. B. at the so-called Kathoeys in Thailand , among which there is however a high proportion of transsexuals. The fact that transsexuality was or is more visible in historical or exotic cultures than in the West, however, does not necessarily mean that the phenomenon has always met or is more widely understood in the corresponding cultures. So live z. B. Kathoeys or Indian Hijras are basically rejected by society, are viewed as second or lowest class people and often have to prostitute themselves .

Cases of transsexualism (and / or transvestism) are also common among North and East Asian shamans and the like. a. known in Siberia , Tibet and Korea , and among American Indians , and were there to some extent socially accepted until the 20th century. Transsexual children born with male physical characteristics were allowed to grow up as girls in certain Indian cultures, performed exclusively female activities and could later even become the second or third wife of a man. However, the boundaries to effeminate homosexuality cannot be clearly drawn. This phenomenon has been reported by many travelers and researchers since the 16th century, first by Cabeça de Vaca in 1555. Europeans sometimes mistook the persons concerned for “hermaphrodites” (first by Laudonnière in 1586); However, according to Hirschfeld (1910), more precise physical inspections usually resulted in the finding that these were "effeminate men". After a trip to America from 1832–1834 , Wied said that the phenomenon had been proven for “most of the nations of inner North America”. Hirschfeld (1910) names u. a. the tribes of Sioux and Illinois , Indians in Florida , Louisiana , " Yucatan " and in southern Brazil . Conversely, there were also biologically female people among the Indians who were allowed to live as men, hunters and warriors.

Antiquity

Gallus on a relief from Lanuvium, mid-2nd century, Rome, Capitoline Museums

In antiquity, gender role changes occurred particularly in a religious-priestly context. This seems to indicate that the extreme discrepancy between soul and body, and possibly also the clear shining through and supremacy of the soul through an actually opposing physical disposition in some of those affected, was associated with a mysterious , divine- numinous work.

Examples can be found in religions of Near Eastern goddesses such as B. Astarte , Inanna, and especially Cybele . Simple physical changes were also made, such as total castration in adolescence, which not only prevented masculinization, but also feminization to a certain extent in the long term (however, eunuchoid tall stature can also occur, which is not at all in the case of MTF transsexuality is desired). Those affected lived as women (clothes, hairstyle, etc.). This was / is still practiced by the Hijras in India and Bangladesh up to the present day . The religion of the Cybele with its partly transsexual priestesses ( Galloi ) spread in antiquity and late antiquity also in the Roman Empire, i.e. also in Europe. However, under Domitian it was initially made a punishable offense to castrate slaves, under Hadrian it was forbidden to castrate free or unfree people under the penalty of death, even with consent. The performing doctor and the consenting neutered person were threatened with punishment. Until late antiquity, the regulation was repeatedly confirmed by imperial edicts, threatened with the Talion under Justinian . Nevertheless, the cult and associated priesthood spread in late antiquity.

"A fraw was pabst", Pope Johannes Anglicus, in: Weltchronik des Jan Enenkel (Jans der Enikel); Passau (?), Around 1420, page: 203r. Cod. Pal. Germ. 336

middle Ages

In Europe, after antiquity, the topic of gender "changing" was an absolute taboo . Medieval dress codes attempted to regulate the length and other details of the robes themselves for each social class, and wearing clothes of the opposite sex was strictly forbidden. The legendary figure of the so-called Popess Johanna - according to Martin von Troppau actually Johannes Anglicus, who ruled either in the 9th century or around 1100 - is an example of the odor of monstrosity, even of the demonic and the demonization , which was ascribed to an attempted change of sex should. Regardless of the question of the authenticity of this figure, the few records teach us how one would have treated transsexuals in the Middle Ages if discovered. In his Chronica Universalis Mettensis (c. 1250), Jean de Mailly, a French Dominican in Metz, wrote :

“Query. Concerning a certain pope or rather female pope, who is not set down in the list of popes or bishops of Rome, because she was a woman who disguised herself as a man and became, by her character and talents, a curial secretary, then a cardinal and finally pope. One day, while mounting a horse, she gave birth to a child. Immediately, by Roman justice, she was bound by the feet to a horse's tail and dragged and stoned by the people for half a league. And where she died, there she was buried, ... "

- Jean de Mailly in Chronica Universalis Mettensis (around 1250)

"Question / doubt. Regarding a certain Pope, or more precisely female Pope, who is not on the list of Popes or Bishops of Rome because she was a woman who disguised herself as a man and, because of her character and talent, became a secretary of the Curia , then a cardinal and finally Pope. One day when she was getting on a horse, she gave birth to a child. Immediately, according to Roman law , she was tied with her feet to the horse's tail, dragged half a mile across the ground, and stoned by the people . And where she died, she was buried [...] "

- Jean de Mailly in Chronica Universalis Mettensis (around 1250)

If John really existed, the procedure of the Roman Catholic Church to remove him from the papal list would correspond to an attempt to completely erase a person's memory after death, as is already known from ancient Egypt . Significantly, theologians , historians and authors of all stripes to this day think purely physically and concentrate on the femininity of Johanna , modern feminists even see Johannes as a kind of champion of emancipation . It is overlooked that the story of Johannes Anglicus is completely implausible, especially under the harsh historical conditions of the Middle Ages, unless one assumes a real (FzM-) transsexuality or intersexuality with male gender identity as a plausible explanation - i.e. H. John probably really felt himself to be a man, a monk and a Pope, and by no means a Pope. The case was also mentioned by Harry Benjamin in The Transsexual Phenomenon in 1966 .

Modern times (approx. 1500 to 1900)

Kristina of Sweden , portrait by Sébastien Bourdon

Another possible case of transsexuality is Queen Kristina of Sweden (1626–1689), who stood out all her life for her conspicuous masculine behavior, appearance and clothing, which was perceived as inappropriate by contemporaries , and abdicated early (1654) - not least because she never wanted to marry a man. In her autobiographical notes she stated that she had "an insurmountable aversion to marriage" and "against everything that women talk about and do". Both during her lifetime and posthumously, she gave rise to numerous speculations about her true gender and sexual orientation.

Transsexuality is basically also the only really satisfactory explanation for the behavior of some historical persons (16th to 19th centuries) who were born physically female, but lived undetected as men for years or decades, and in extremely tough, masculine professions, as in the military , for example ; they were often only revealed as alleged women when they died. To this day, some (often feminist-oriented) authors regard such cases as cases of female transvestism and ultimately also represent a model for modern women.

The Chevalière Charlotte-Geneviève d'Éon de Beaumont, 1779, engraving by JB Bradel

As mystery the legendary applies Chevalier d'Éon (1728-1810), a French nobleman who in drag as a spy (in) Louis XV worked, apparently never had a sexual relationship, and in 1774 declared, actually being a woman, which was officially and officially confirmed after a medical assessment. After the death of the Mademoiselle d'Éon, however, an autopsy revealed that she was physically male. The Chevalière d'Éon later became the model for the term Eonism even before the terms transvestism and transsexuality existed.

Dr. James Barry (ca.1792-1865). Painting, circa 1820s.

Another well-known and impressive case is the life of Dr. James Barry (approx. 1789-1865), who lived his entire adult life from 1809 to 1865 (56 years), even studied medicine and made a career as a surgeon and military doctor. He challenged anyone who questioned his masculinity to a duel. It was only after his death that it was discovered that he was physically “not a man”. Not even his colleague and family doctor, Major DR McKinnon, had noticed, and Florence Nightingale found Barry "... the toughest creature I have ever met". In the event of his death, James Barry gave strict instructions that his body should be buried in the sheets without further examination and without being embalmed. This suggests that he wanted to be remembered as a man even after his death. Despite James Barry's clearly proven male personality and historical reality, cases like his are still interpreted by some authors as examples of the pursuit of female emancipation - a grave misunderstanding that ultimately serves neither side.

Until the early 20th century - and in some cases well beyond that - trans people in the western world were viewed at best as a subspecies of homosexuality, a desire to change the physical sex was considered outrageous, immoral, terrible, even seriously insane - and not in the end simply as not possible. Many of those affected may have died by suicide .

20th century

Lili Elbe, 1926

Gender reassignments with really satisfactory results (i.e. vaginoplasty ), initially in male-to-female transsexuals, only became possible in the 20th century. Similar attempts were made in the 1920s and 1930s at the Berlin Institute for Sexology under the direction of Magnus Hirschfeld . The first transsexual person known by name who underwent such a gender reassignment in several stages between 1922 and 1931 was a long-time patient of Hirschfeld and a domestic worker at the Berlin institute: Dorchen Richter (1891-ca. 1933?). Your operations were u. a. carried out by Ludwig Levy-Lenz and Erwin Gohrbandt (1890–1965). Even better known is the case of the Danish artist Lili Elbe , which underwent several operations in 1930/31, first in Berlin and later at the Women's Clinic in Dresden, where her from Kurt Warnekros a worldwide first transplant of ovaries was attempted; she died as a result of this operation. However, based on investigation reports from Warnekros, Lili Elbe was possibly intersexual , i.e. not transsexual in a narrower sense. The public portrayal of from man to woman - so the front pages of the newspapers and the original title of your book - suggested a transsexuality by today's standards. The surgical techniques used on her and Dorchen Richter were an exemplary pioneering achievement for the time and were only not further developed for the time being due to the political situation in Nazi Germany.

Transsexuals in the United States have been able to receive hormone therapy since the 1940s . From this time on, many transsexuals were cared for by Harry Benjamin , a pioneer in this then young field of research who, unlike most of his colleagues, did not consider transsexuals to be mentally ill, but rather believed that their physical gender was actually different from their gender identity.

Christine Jorgensen 1954

At the end of 1952 - at a time when the surgical methods were still in the experimental stage - the media reported for the first time about a transsexual American, Christine Jorgensen , who had undergone hormonal and surgical sex reassignment (man-woman) in Copenhagen. Jorgensen had several operations; a vaginoplasty was only performed on her in May 1954. The international press turned the case up into a scandal with a huge stir , and she suffered a lot of harassment, was not given a normal job, and was not allowed to appear on television for years. Later she gave many educational lectures on the subject at universities.

The Christine Jorgensen case also drew attention to the phenomenon in medicine, Harry Benjamin published an important article that finally established the term transsexuality. Many of those affected recognized their own problems through the familiarity of Jorgensen. So Dr. Christian Hamburger - one of the doctors treating Jorgensen - wrote so many letters within a few months that he published an article about them:

“These personal letters from nearly 500 deeply unhappy people leave an overwhelming impression. One tragic existence follows another; they cry out for help and understanding. It is devastating to realize how little can be done to help them. It is felt as a duty to appeal to the medical profession and the responsible legislature: do your best to facilitate the existence of these fellow human beings who are deprived of the possibilities of a harmonious and happy life - but not through their own fault. "

- Christian Hamburger : Acta Endocrinologica 14, 1953

In the 1950s, Dr. Georges Burou in Casablanca to develop a new, more perfect surgical method for vaginoplasty, which should become a model for all later surgeons to this day. He became famous in 1958 through the French woman Coccinelle , one of his first patients, who worked at the Cabaret Le Carrousel in Paris . Coccinelle became a figurehead and icon of many other transsexuals because of her beauty and she also changed her name and birth status in France . She also managed to get married in 1960 - both civil and church.

Since sex reassignment surgery was banned in large parts of Europe and the USA at that time, many sufferers had to travel abroad in the sixties (and seventies), especially to Casablanca to see Dr. Burou and to Mexico . Transsexuals continued to be viewed as psychotics , were forcibly hospitalized and treated with aversion therapy and electroshock therapy. Even compulsive therapies with hormones that corresponded to the biologically predetermined gender have been tried (see e.g. the April Ashley case ). It was not until 1966 that the Johns Hopkins Medical Center in Baltimore set up a Gender Identity Clinic, in which gender reassignment measures have also been carried out since then. From 1969 on, other specialist clinics followed, in which well-known researchers such as Stanley Biber worked.

April Ashey, February 18, 2009, Southbank Center. Ashley had to wait 45 years for her papers to be changed

For a long time, the legal situation of those affected in many countries was precarious. Even in the case of a successfully performed operation and also externally perfect adjustment, they got, for example, in Germany or England - and to this day (as of 2018) e.g. B. in Thailand - no reasonable papers issued in their (new) name, and no change of birth entry (i.e. male or female). This situation means a constant burden for those affected, as they z. B. have to go looking for a job with papers that do not correspond to their gender, which has now changed, and therefore often have no chance of a sensible job. Real social integration was / is not possible under such circumstances. This situation changed only gradually, first in Scandinavian countries such as Sweden, and in 1981 in Germany with the so-called Transsexual Act ; in England, for example, only in 2004 with the Gender Recognition Act - although the Englishwoman April Ashley had a successful alignment at Burou in 1960 and was outed as transsexual in the British press in 1961 .

In Germany, gender reassignment operations were not started again until the late 1970s at university clinics and the like. a. in Giessen by Dr. Jarrar and in Heidelberg / Mannheim by Prof. Dr. Eicher carried out. In 1984 the latter also published the most important German-language monograph Transsexualism to date , which dealt extensively with the subject.

In Germany there was a first self-help group since 1968 , the TS working group - interest group for transsexuals and transvestites in Hamburg under the direction of Gert Christian Südel. The association Transidentitas eV, founded in 1985 (until 1995) in Frankfurt am Main, was known by name and had an impact on the public. The media's interest in the topic of transsexuality has increased since around 1990, and it is now e.g. T. treated in a slightly more understanding way.

After 2000

Lynn Conway, July 2006

In the fall of the pioneer in the development of electronic circuits, Lynn Conway , who came out herself in 1999 for fear of an outing and then began to set up a detailed information website on the Internet about transsexuality, both the person concerned and the also provide easier access to information on the subject for the general public. In the meantime, Conway's website has largely been translated into other languages ​​(including German) and contains extensive information material as well as many biographies and pictures of other people affected.

There are also now known cases of those affected who made adjustments before and around 1960, were in the meantime partially submerged, and are still happy with this decision even after decades, sometimes at over 70 or 80 years of age ( Christine Jorgensen (1926– 1989: OP: 1952), Coccinelle (1931-2006; OP: 1958), Bambi (* 1935; OP: 1960), April Ashley (* 1935; OP: 1960), Lynn Conway (* 1938; OP: 1968) and others ). Some of these people have now received official honors in their country of origin because of the services they have rendered to the "transsexual cause" through their example and courage (April Ashley, Coccinelle, Bambi).

Balian Buschbaum , 2010

Through better information, longer experience and developments towards greater tolerance towards minorities in the western world, it has been possible since about the year 2000, at least in some countries, that even underage adolescent patients can legally receive hormonal measures (with the consent of their parents) which can prevent a fatal physical development in the wrong (ie biologically predetermined) direction (see e.g. Kim Petras and Jazz Jennings ). A situation that still seemed completely unthinkable in 1990.

Nevertheless, there is still a lot of incomprehension and hostility towards transsexuals ( transphobia ). For example, in 2012 alone, 238 transgender people were murdered in 60 countries (not just transsexuals) - the number of unreported cases is probably higher, however, as there are also countries that do not register such cases.

Transsexuality and the Modern Christian Churches

An example of organized transphobia is the behavior of the Catholic Church , which only issued a decree in 2003 which not only forbids church weddings for transsexual people, but also forbids those affected to join a religious order or to become a priest - at least after operational measures . A transsexual person who suppresses their emotional feelings can marry or enter a monastery before and without appropriate measures . In connection with a specific case in Cadiz , Spain , transsexuals were even denied the right and ability to become godparents .

On the other hand, in an unofficial audience in January 2015 , Pope Francis received the Spanish transsexual Diego Neria Lejárraga , who had been subjected to severe bullying in his home parish and was insulted by a member of the Church as the "daughter of the devil" - for Lejárraga a double insult and denigration, because he not only feels like a man, but now also has a physical assimilation to the man. Pope Francis had previously contacted Lejárraga by phone and told him that God loves “... all his children as they are. You are a son of God and the church loves you and accepts you as you are. "

The Pope has meanwhile publicly declared that transsexuals should not be marginalized, but rather “… rather integrated, accompanied and brought 'closer to God' by the congregations. ... That is exactly what Jesus would do nowadays. ”The Vatican has not issued an official statement on the Pope's statements.

In the Evangelical Church , many regional churches are clearly more accepting. There are now several cases of openly living transsexual pastors known. B. Christine Bergmann, Dorothea Zwölfer and Elke Spörkel. In cooperation with these pastors, transsexual Christians, the German Society for Transidentity and Intersexuality dgti e. V. with several leaderships of Protestant regional churches, the Reformation for All * project was created. As a result of this project, the brochure “Created in the Image of God - Transsexuality in the Church” of the Evangelical Church in Hesse and Nassau was created.

causes

According to experts such as the German Society for Sexual Research , which was initiated by Hans Giese in 1950 , or the International Academy for Sex Research, which was launched by Volkmar Sigusch, transsexuality is a disorder of gender identity and its causes are unknown. This view is based primarily on the assumptions of the World Professional Association for Transgender Health (formerly Harry Benjamin, International Gender Dysphoria Association), which refers to research by the German-American psychologist Harry Benjamin (1885–1986).

For example, although Harry Benjamin assumed that transsexuality is a special form of intersexuality , the theory developed in the 1970s that there are fundamentally psychological causes for transsexuality; however, no model has been developed so far which undisputedly applies to a large number of those affected.

In the meantime, several studies that indicate physical causes or predispositions support Benjamin's original assumption. This is supported by data published by Zhou and colleagues. They found indications that in the prenatal development phase the same sex hormones at different times influence on the one hand the morphology of the genitals and on the other hand the morphology and the function of the brain. At the University of São Paulo, different characteristics in the brains of transsexual women compared to cissexual examiners could be demonstrated. There are several signs of genetic predisposition.

According to another study, hormonal imbalance during embryonic development could contribute to a person being born transsexual.

Another indication that transsexuality is most likely innate is the early self-awareness of transsexual children and adolescents. According to one study, children can assign their gender identity at an average of 8.5 years of age. In the study with over 100 transsexual children and adolescents, the range of self-awareness was between 4 and 13 years of age.

diagnosis

As the consequences of surgical transformation measures are irreversible and far-reaching, careful diagnosis is essential. The diagnosis of the existence of a gender incongruity and the necessity of gender reassignment measures are clarified in the context of an individual diagnostic and accompanying process. A new guideline (S3) of the AWMF was published in October 2018. According to this, the diagnosis serves to enable access to further psychotherapeutic and medical treatments. The diagnosis is usually based on the self-description of the person seeking treatment. Everyday testing and accompanying psychotherapy are no longer provided as absolute prerequisites for gender reassignment measures.

According to ICD-10

Classification according to ICD-10
F64.0	Transsexualism
ICD-10 online (WHO version 2019)

According to the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the following criteria must be met for a diagnosis of transsexuality (F64.0) :

• a profound and lasting identification of the opposite sex
• persistent discomfort and inappropriateness of biological gender
• the desire for surgical and hormonal treatment in order to adapt one's own body to the preferred gender as much as possible
• a clinically relevant psychological stress and / or impairments in social, professional or other important areas

According to ICD-11

The eleventh version of the ICD instead contains the diagnosis "Sexual incongruence" (HA60), with the description:

"Gender incongruence is characterized by a marked and persistent incongruence between an individual's experienced gender and the assigned sex. Gender variant behavior and preferences alone are not a basis for assigning the diagnoses in this group."

“Sexual incongruence is characterized by a clear and persistent mismatch between the experienced social gender and the assigned biological gender. Gender variant behavior and preferences are not in themselves a basis for a diagnosis in this group. "

The diagnoses HA60 and HA61 "Sexual incongruence in childhood" (before puberty) are classified in category 17 "Conditions related to sexual health", which has no relation to mental disorders. This reflects a paradigm shift to the effect that a gender-incongruent person has a property that is not fundamentally pathological.

Differential diagnostics

In the area of ​​gender identity disorder, it is not always a diagnosis of transsexuality, and therefore precise differential diagnosis is required even before gender reassignment steps.

The following should be excluded:

• partial or temporary gender identity disorders (e.g. adolescence crises)
• Problems with common role expectations of the sexes in society without persistent gender identity disorder
• Transvestism with a temporary but not permanent and deep desire for physical and social assimilation to the opposite sex
• Gender identity problems based on the rejection of a homosexual orientation
• an acute psychosis or severe personality disorders
• a dissociative identity disorder

Different subtypes of transsexuality

Over the decades, different experts have observed very different forms of transsexuality. In the past, this led to various attempts at typing.

A rigid demarcation according to types and categories no longer makes sense due to the research results of the last 20 years and the changed situation with the legal recognition of gender identity. The one-sided consideration, especially with type VI of Benjamin's "SOS" scale, in which sexual orientation was included and transsexual men were not considered, has proven to be unsustainable. It is only recently that studies have also taken into account social influences that prevented an early coming-out, although the self-awareness of those affected is on average at pre-pubescent age. 53% of the adolescents had their self-knowledge before the age of 14, 70% before the age of 18.

course

In the wrong gender role

“There is hardly a person so constantly unhappy (before sex change) as the transsexual. … Gender disharmony… makes him forever a candidate for self-mutilation, suicide, or its attempt. "

"There is hardly a person who is so persistently unhappy as transgender people before the gender change. ... The perceived gender disharmony ... makes them eternal candidates for self-mutilation, suicide or their attempts."

- Harry Benjamin : The Transsexual Phenomenon, 1966

The gender assignment takes place before or at the time of birth if the midwife or doctor classifies the gender on the basis of external or chromosomal characteristics. This assignment happens once. A lifelong process that takes place over and over again is gender ascription by others, which is linked to information such as gait, voice, facial expression, posture and charisma. Primary and secondary sexual characteristics do not play a role.

There are clear individual differences in the course of a transsexual development, as the above-mentioned attempts at typifying primary and secondary transsexuality as well as the Harry Benjamin scale show.

Many transsexual people develop the feeling of being different even in preschool age, but often cannot yet assign it specifically. Others report that as early as preschool age they developed an awareness that, contrary to their physical gender, they were actually a boy or girl, or at least not a girl or boy. Occasionally, this awareness does not appear until puberty or adulthood.

Some of the children express themselves very early, completely naturally and naturally in accordance with their inner gender identity. In this case, the behavior of the environment (family, friends, later classmates, teachers, etc.) has an important influence in terms of rejection, acceptance or ambivalence.

The more widely the particular character of children is accepted by their environment, the more normal and unencumbered they can develop. In modern society, however, it has only happened more and more often since around the year 2000 that parents let their transsexual child develop completely freely and support it in assimilating from puberty onwards. However, there can still be problems with the rest of the environment (school, neighbors, other children, etc.).

In the vast majority of cases, the environment tries more or less intensively to bring up the child according to its assigned gender and to force the appropriate role on him. The affected children usually try to meet the expectations and demands of their environment as much as possible, that is, to live the gender role that corresponds to their physical gender. Since the related social pressure on male assigned transsexuals is generally greater than for female assigned affected persons (as of 2018), the typical development for transsexual men and women is generally somewhat different:

• In the case of very clear transsexuality among transsexual girls, those affected try to adapt to the male role or at least appear neutral due to the social pressure from the outside world and for fear of discrimination - but this often only succeeds to a limited extent and with great internal suffering Those affected remain conspicuous and often find themselves in an outsider role in childhood or adolescence . Bullying and other forms of discrimination from the outside world are particularly frequent in the case of transsexual girls and can also be particularly severe. Complete isolation of those affected is not infrequently the consequence. A professional, partnership-based and general perspective on life is often so obstructed due to the contrast between the (male) role required biologically and by the outside world and the typically female personality, predispositions and interests that many affected people become depressed and suicidal up to attempting suicide or attempting self-mutilation . From the point of view of those affected, they basically have no choice but to try gender reassignment.
• In cases of less clear MTF transsexuality, those affected often initially succeed relatively easily in matching the classic image of a man as closely as possible. A decidedly male career choice, which is often pursued with great success, is by no means rare. Since those affected often prefer women as partners anyway, it is by no means rare for them to get married and start a family first. These affected people have to struggle more with inner doubts about their actual gender and desires than transsexuals with early self-knowledge, and their discomfort in the male role is often expressed before a transition in an interplay between phases of cross-dressing and phases of overcompensation , in which for example they throw away all women's clothes and try to appear particularly masculine.
• Transsexual boys can often act out their discomfort in the female gender role more uninhibitedly than the reverse case, because in the modern western world, especially since the last third of the 20th century, the female role is less narrowly defined. So it happens For example, from an early age they can walk around in pants and with a short haircut without any problems. Other male behaviors can often be integrated relatively unhindered into everyday life, as this is more accepted in women than female behavior in men. Transsexual men who officially still live as women therefore often appear boyish or emancipated , and are often considered lesbian , even if they prefer men as partners (which is not so often the case). During puberty, however, large and severe internal and social problems can arise, and those affected often try to suppress physical changes, e.g. B. through excessive sport or strength training, by tying off and flattening the female breasts, etc. Transsexual men before a gender change marry somewhat less often and also have fewer children. When choosing a career, they almost always choose either gender-neutral or typically male jobs.

The pressure exerted on transgender people by society and their own body, and thus the psychological pressure they feel, increases continuously over time, especially during puberty and young adulthood. In addition to psychosomatic illnesses and various other psychological problems, depression in particular is a consequence, which, however, depends heavily on the acceptance in the environment.

Transition

Most transsexuals sooner or later find themselves forced to inform those around them about their transsexuality ( outing ) and to officially and permanently change their gender role. The corresponding decision is often the result of a particular crisis phase that is often perceived as threatening the very existence of the company.

The point in time at which the problem of transsexuality is recognized in individual cases varies greatly from person to person. It depends both on the individual personality traits of the person concerned, and u. a. with the available information and the social climate in which the person concerned lives. Overall, however, the average age at which people try to seek medical treatment has been falling for years.

Changing one's gender role can, but does not have to, lead to major social problems, at least temporarily. Discrimination and bullying by the outside world after a change of sex depend to a particular extent on how strongly one recognizes the person concerned about their former biological origin and role. In the case of very clear cases of (primary) transsexuality, a change in gender role that is sought as early as possible is ultimately usually objectively advantageous, since those affected are often less conspicuous in the perceived and desired gender role than before, and usually very happy. Nevertheless, in the past (and still today in less tolerant, e.g. strictly religious societies) it was not infrequent for young people affected that parents or the whole family rejected the child and the child somehow had to survive on its own. In the worst case, those affected can end up on the street and be forced to prostitute themselves (in the wrong body).

Friendships can also break as a result, and those affected who entered into love relationships in the original gender role or who were married must expect such partnerships to break. Children usually cope with the role change of a parent much better than expected; Exceptions are especially children in puberty and children who are strongly influenced from the outside against the affected parent. The loss of a job, which used to be so taken for granted that it was advised to quit, has also become much less common - among other things because the European Court of Justice has now declared dismissal of a person because of an intended change of gender role unconstitutional it is a matter of gender discrimination .

Regardless of this, many transsexuals seek psychological or psychotherapeutic care on the occasion of their gender role change ; because without proof of professional support, it is almost impossible to obtain the reports required for the use of medical and legal accompanying measures.

Early transition of young transsexuals

In recent years the number of parents of transsexual children who recognize their transsexuality as such has increased; Likewise, the number of parents who respond with acceptance rather than rejection is increasing. In these situations, medical measures are increasingly used to delay the onset of puberty. This is to prevent the development of sexual characteristics which would later only have to be reversed with great effort and often questionable success or which cannot be reversed. As a result, the number of transsexual people who decide to change their sex role shortly before, during or shortly after puberty is also growing. The hormonal treatment of very young patients is rejected by a minority of child and adolescent therapists, regularly with reference to the joint work of Susan J. Bradley and Kenneth Zucker. With Kenneth Zucker's termination without notice in 2016 due to outdated standards and methods, his work is under discussion. In this context, Kim Petras became known in the media a few years ago, who was given puberty-delaying hormones at the age of 12. Another world-famous case is the American Jazz Jennings , whose parents allowed her to live as she would like from an early age.

After the alignment

The gender reassignment measures usually relieve the stress of suffering that has arisen, i. H. After-effects like depression, suicidality, etc. usually go away. Immediately after the operation, those affected are usually very to extremely happy, even euphoric.

Patients who regret the operation are extremely rare, even in cases where the external alignment has not objectively been 100% successful. When asked if they would do it again, the vast majority answered “yes”. As early as 1966, Harry Benjamin found, as a result of gender reassignment, that "[...] mental changes were much clearer than physical [, ...] the great satisfaction that comes with the eventual fulfillment of a difficult and long-awaited dream goal was impressively clear". A significant improvement in the psychological well-being of trans people after hormonal and surgical treatment is also proven by many later studies.

Most of those affected - especially those who “go through” unrecognized in the desired role - often go into hiding (at the latest) after the gender reassignment operation in order to lead a life that is as normal as possible; they want nothing more to do with their past and if possible not be reminded of it. Even after the operation, the social situation of many of those affected is by no means completely unproblematic or completely “rosy” compared to the 'normal population'. In the long term, many ex-transsexuals are exposed to greater social stress than comparable persons in the 'normal population'. For example, even those affected, whose external adaptation to the experienced and desired target sex has been completely successful and are very attractive, can lead to massive problems when choosing a partner. For example, transsexual women fall in love with a man who rejects them or leaves them when their past comes out - and when some of those affected may have to experience this again and again. Harry Benjamin already stated that such a situation "... can easily cause strong feelings of insecurity, dissatisfaction and depression". Nevertheless, many of those affected find an understanding partner and have stable relationships or marry.

Even in friendships beyond any eroticism, difficulties, lack of understanding and a break can occur when a transsexual past comes to light. Even the search for an understanding, trustworthy and family doctor can be characterized by interpersonal frustrations. For fear of 'discovery', being abandoned and discrimination, many of those affected hide their difficult past; some would rather lead a secluded and lonely life than risk a 'discovery'. The very idea of ​​a possible public outing is an absolute catastrophe for most ex-transsexuals, as this could have far-reaching and more traumatic consequences than z. B. an outing of homosexuals. The difference is that when homosexuals (or most other people) come out, the truth about them comes to light, while with ex-transsexuals it is a lie. B. in a newspaper would say: "He was a woman".

Medical measures

The medical measures serve to adapt the body as much as possible to the perceived gender; the still common term gender reassignment is therefore incorrect. In addition, some sexual characteristics such as B. not convert the genome of the (outwardly invisible) chromosomes into those of the opposite sex.

The medical measures consist of hormone therapy, gender reassignment operations and, if necessary, further measures such as B. the permanent removal of the beard through epilation and surgical facial feminization surgery ( FFS).

With hormone therapy it is important to check the long-term physical and psychological tolerance of the hormonal treatment and its effects. The patient must be fully informed about their consequences and informed that hormonal treatment must be lifelong in order to avoid damage caused by hormonal deficits.

During hormone treatment, the sex hormones of the target body's sex are supplied and the formation of the body's own sex hormones is suppressed. It initiates a kind of second puberty and with it the development of the secondary sexual characteristics. In trans women, hormone treatment is often complemented by treatment with antiandrogens . In adolescent transsexuals, the onset of puberty is often delayed by puberty-delaying hormones in order to gain time for the final decision for or against further medical measures before physical changes set in.

In trans * women, the physical fat distribution changes in a feminine direction. a. on the face, hips and buttocks. Those affected get a breast ( gynecomastia , individually very different depending on the system). The body hair can decrease somewhat; Existing body hair is usually only slightly affected by the hormone treatment and usually requires further treatment by epilation ; the same applies to beard growth . Testosterone- related hair loss is stopped and can partially recede, but existing baldness (in older patients) cannot be reversed by hormones. The testicles shrink and the production of semen stops ( testicular atrophy ). The libido is usually weaker, except in cases where the person concerned is deliberately keeping the hormone medication rather low, e.g. B. do not want an operation anyway and continue to want a functioning sex life with a female partner. In the long term, the muscles recede and physical resilience decreases.

Correspondingly, the skin of trans * men becomes larger-pored, the fat shifts from the hips to the waist, and physical performance increases as a result of further muscle building. Beard growth begins, body hair can increase (very differently depending on the individual predisposition) and the patient's voice breaks. The clitoris becomes larger, and the testosterone stops menstruation and often increases libido. In the long term, male baldness also occurs in some patients.

The effects (or damage) of the first biological puberty cannot be completely reversed, neither in trans men nor in trans women. A transformation or development of the primary sex organs is excluded. To avoid damage to health from hormone deficiency, a lifelong hormone substitution is necessary (however, the hormones can also cause side effects that make premature discontinuation necessary).

Since the body's own gonads are removed during a sex reassignment operation , this inevitably leads to infertility in both sexes .

frequency

There are a number of studies from the USA, the Netherlands and Germany on the prevalence of transsexuality. The different studies come to percentages that range from 0.0015% to 0.6% of the population. The younger the study, the higher the frequency. The value for Germany is a guaranteed minimum number due to the central statistics of the Federal Office of Justice on applications under the Transsexual Act.

The Diagnostic and Statistical Manual of Mental Disorders , in its fourth version from 1994 (DSM-IV), mentioned that in the United States about one in 30,000 men and one in 100,000 women seek gender reassignment surgery (total 0.0015%). Another estimate of the prevalence of transsexuality comes from the Amsterdam Gender Clinic: The data, which have been collected over more than four decades, speak of one in 10,000 men and one in 30,000 women (0.005%).

A June 2016 study by the Williams Institute on how many US adults identify as transgender found a population share of 0.6%.

Stephenne Rhodes u. a. speak in the presentation before the LGBT Health Summit 2008 in Bristol of a rapidly increasing prevalence (14% per year) and in 2009 at the symposium of the World Professional Association for Transgender Health in Oslo that the average age at the gender role change has been about constant since 2000 38 years ago.

Germany

The prevalence in Germany can be derived from the case numbers of the Federal Ministry of Justice and Consumer Protection (BmJV). The business burden at courts and public prosecutors for the area of ​​voluntary jurisdiction shows around 29,700 proceedings under the Transsexual Act (TSG, procedure for changing names and civil status) for the period 1981 to 2018. The number of cases has been increasing for years and is currently (2018) 2614 (2017: 2085, 2016: 1,868, 2015: 1648) per year. This does not include people who see themselves as transsexual or transident, but do not want to be classified into one of the two available genders according to the TSG and therefore do not submit an application under this law. A frequency of 1: 298 (0.336% of the total population) results if the annual number of cases is related to the annual births (2018: 778100, DeStatis.de).

As far as the frequency of FzM- in relation to MzF-transsexuality is concerned, since the decision of the Federal Constitutional Court on the Transsexual Act (TSG) 2011, which eliminates the need for a sex-reassigning operation for the purpose of changing the civil status, it has become a balanced ratio as many trans men as trans women change their civil status. Germany is one of the few countries in which, through applications under the TSG, the necessary procedures at the local courts can be statistically recorded by the Federal Office of Justice.

Classification of transsexuality as a disease

With the adoption of the ICD-11 (WHO Classification of Diseases and Relevant Medical Conditions, Version 11) in 2019, transsexuality is defined as a condition of sexual health and is therefore no longer part of the psychopathological categories (ICD-11 is until the end of 2021 to be implemented in national law). For cases of transsexuality, however, there may be a need for treatment due to a level of suffering, which in itself can have a disease value: The level of suffering can make people sick, but transsexuality itself is not generally seen as an illness. In Germany, this is also determined by a decision of the Federal Social Court, "because there are, [...], manifestations of transsexuality which, as far as the brokenness of gender-specific identity-consciousness is concerned, are an anomaly - in the indicated sense - but still after from a natural point of view can never be regarded as a disease ”(3 RK 15/86).

The gender reassignment measures usually relieve the stress of suffering that has arisen, and consequential symptoms such as depression or suicidality mostly disappear.

The frequency and severity of psychosomatic illnesses and depression are not based on transsexuality per se, but depend to a large extent on the individual environment. Mental illnesses or disorders that can lead to a false self-assessment as transsexual are rare.

In Germany, the "S3 guideline" of the Working Group of Scientific Medical Societies has been in effect since October 2018 ; it defines the medical standard in the field of diagnostics, advice and treatment in Germany.

The euro Council has called in its resolution 2048 of 22 April 2015 for the legal and social equality of trans people, the 47 member states, among other things, to cancel all classifications as mental disorders in national classifications. As early as 2011, the European Parliament asked the European Commission and the World Health Organization (WHO) to remove gender identity disorders from the list of mental and behavioral disorders and a non-pathologizing one in the negotiations on the 11th revision of the International Classification of Diseases (ICD-11) Ensure reclassification.

The ICD-11 classification text, finalized in 2018, has existed at the WHO since 2015, which contains the new category 17 Conditions related to sexual health . Category 17 is not a category of mental disorders or illnesses. A perceived gender affiliation that deviates from the assigned gender (incongruence between an individual's experienced gender and the assigned sex) is confirmed by the designation of the diagnoses HA60 (Gender incongruence of adolescence or adulthood) and HA61 (Gender incongruence of childhood) . Medical measures (for gender reassignment) may be necessary. The final text was decided in June 2018 and put into effect in May 2019 by resolution of the World Health Assembly for the entire ICD-11. There is a transition period until December 31, 2021 for adoption into national law.

The specialists Timo O. Nieder, Peer Briken and Hertha Richter-Appelt see the classification in ICD-11 as a safeguard of health care and note a paradigm shift that is leading away from the psychopathologization of transsexual people.

In his latest publications, Udo Rauchfleisch also calls for the depathologization of transsexual people and uses the term trans * people for them. Also Friedemann Pfäfflin asks that, but without recognizing gender identity from the outset.

In May 2015, doctors, therapists and human rights associations, who advocate a complete renunciation of gender interpretations during medical treatment, published alternative treatment recommendations that are directly linked to the practitioner's understanding of ethics. In the "Stuttgart Declaration", which was also signed by members of the Bundestag such as Ute Vogt ( SPD ), Ulla Jelpke ( Die Linke ), and human rights experts such as Heiner Bielefeldt , the former head of the German Institute for Human Rights, a clear move away from gender interpretive medicine formulated. The gender identity of a person is no longer declared to be the subject of treatment, as is the case with gender dysphoria , but rather recognized from the start. The medical measures that are formulated in the declaration are understood as concrete help and are no longer made dependent on gender interpretations.

Consequences under social law

Only when a position arises from a transsexuality suffering has a pathological significance within the meaning of § 27 SGB V, the cost of medical treatments by the statutory health insurance accepted.

In its judgment of August 6, 1987 - 3 RK 15/86, the Federal Social Court affirmed the assessment made there by the lower court, ascribing a disease value to a particularly profound form of transsexuality, thus requiring treatment and a reason for the right to a gender reassignment operation. Under these conditions, the lower court had determined, by not attaching a disease value to every type of transsexuality, that it depends on the individual case whether this is the case.

According to a ruling by the Stuttgart Regional Social Court in 1981, transsexuality is "an illness within the meaning of statutory health insurance which, if there is a medical indication, triggers the health insurance company's obligation to provide benefits for gender-changing agents and measures".

"However, an illness is not only present if the physical condition of an insured person deviates from the model of a physically healthy person or if his psyche does not correspond to the model of a mentally healthy person, but also if the relationship between the mental state of an insured person and the physical condition does not correspond to the relationship between the mental and physical condition of a healthy person. In this sense, transsexuality is a disease. "

By enacting the Transsexual Act , the German legislature has also confirmed that the finding of transsexuality justifies an exceptional legal assessment. According to the previous case law of the lower courts, gender reassignment operations do not have to be granted to a transsexual insured person in general, but only in the case of corresponding suffering. After all, the courts do not award a transsexual insured person any kind of gender reassignment surgical measures in the sense of the closest possible approximation to a supposed ideal, as has just been shown by the example of breast enlargement.

Whether and to what extent there is psychological strain, for the treatment of which the statutory health insurance has to pay, requires an individual consideration of the individual case.

In October 2015, the World Medical Association published a statement recognizing the right to gender self-determination and no longer pathologizing transgender people. Doctors and medical professionals are called upon to ensure the best possible and non-discriminatory health care for transgender people that is geared towards their needs. This also includes the requirement that the legal change in sex may no longer be made dependent on the applicant being permanently incapable of reproduction. In Germany, the legal change in gender has no longer been dependent on permanent inability to reproduce since 2011, as a result of a decision by the Federal Constitutional Court.

Legal regulations

Members of the group Col·lectiu de Transsexuals de Catalunya at a protest in Barcelona 2001

Most European countries, including Germany , Austria , Belgium , the Netherlands , Luxembourg , Poland , Sweden and Switzerland , as well as some non-European countries allow transgender people to adapt their first names or the gender information entered in the civil status registers to their perceived gender ( identity gender ) . The relevant regulations were mostly only established after the relevant decisions by the European courts and usually require the approval of a court. In general, prior medical assessment of applicants is also required.

In its resolution 2048 of April 22, 2015, the Council of Europe called on the member states, among other things, to simplify the procedure for changing names and civil status and to dispense with the evidence of mental health required for this purpose as well as all mandatory medical measures, e.g. B. can be equivalent to a forced sterilization , to abolish, Section 6.2.2. of the resolution:… abolish sterilization and other mandatory medical measures, including the diagnosis of mental health as a necessary legal requirement for the recognition of gender identity in laws regulating the procedure for changing names and registered sex (civil status).

Bernd Meyenburg, Karin Renter-Schmidt and Gunter Schmidt recommend, on the basis of an evaluation of 670 reports under the Transsexual Act, to replace the current legal regulation with a procedure without an assessment and with a waiting period.

Germany

→ Main article : Transsexual Act

In Germany, the Transsexual Act (TSG) since 1981 has laid down the conditions under which transsexuals can apply for a change of first name or civil status. The original legal regulation has been modified in favor of the applicant through a large number of decisions by the Federal Constitutional Court. A basic distinction is made between changing the first name (small solution) and changing the civil status (large solution). The proceedings take place before the competent local courts. Upon application for legal aid is granted.

Countries with an application process - without an assessment requirement

Sweden (2012), Denmark (2014) and Malta (2015) have introduced an application procedure without assessment for the legal recognition of gender identity (change of civil status and name). Ireland passed a corresponding law in July 2015, Norway also in June 2016, and Belgium also waived an assessment from January 1, 2018, as did Luxembourg since July 2018.

Austria

The transsexual decree of 1996, as the successor to the transsexual decree of 1983 , was repealed as unconstitutional by the Austrian Constitutional Court in July 2006 .

The transsexual decree of the Federal Ministry of the Interior (BMI) stipulated a number of requirements, if they were met, the civil status authority had to make an administrative change to the gender assignment entered in the birth register and / or a change of first name. The decree was based on Section 16 of the Austrian Civil Status Act (ÖPStG), according to which the civil status authority has to change a certification if it has become incorrect after the entry.

The reason for the constitutional repeal of the decree was that a married trans woman had had a gender reassignment carried out and now wanted her gender corrected in the birth register. However, the decree provided, unconstitutionally, that only unmarried persons could have their gender changed in the birth register. Because of this, married transsexuals after gender reassignment surgery were forced to divorce their legitimate, legally concluded marriage before their gender assignment was entered in the birth register. (The divorce took place with all the associated adverse consequences for the two spouses and their children, who were thus made children of divorce.) The supposed basis for this was Section 44 ABGB , according to which a marriage should only exist between two people of different sex. The Constitutional Court, however, rightly recognized in its decision to repeal the TS decree that an upright marriage cannot prevent a change in gender in the birth register, since only the actual gender is relevant. However, this does not depend on any legal relationships, thus also not on an existing marriage. Even if the marriage changes to a (non-permitted) homosexual marriage as a result of the gender change of one of the spouses, this would not have any influence on the applicant's sex and should therefore not be an obstacle to entry in the birth register. The Constitutional Court expressly did not want to judge whether a marriage that would continue to exist after this would be legally compliant, as this was not the subject of the proceedings.

A change of the first name is only possible in accordance with the general rules for changing names set out in the Name Change Act (NÄG): According to § 2 Paragraph 2 Z 3 i. V. m. § 3 Paragraph 1 Z 7 NÄG i. V. m. "Name change decree" (Erl. BMI 8.6.2988, 10.649 / 61-IV / 4/88) at least the first first name must correspond to the gender of the applicant, whereby according to the explanations neither biological nor psychological criteria play a role, but only the entry in the Birth register is decisive (see also Zeyringer in the literature section). Transsexuals (transgenders) who cannot or do not want to change the gender assignment in the birth register can therefore still not choose a first name that corresponds to their identity gender . With the NÄG 1988 and the associated name change decree including explanations, the name change to a gender-neutral first name became possible: "On § 3 Z 5 of the law [...] From the deletion of the words 'inland' in connection with the Usage as a first name can reveal the intention of the legislature to also allow first names that are only in use abroad. ”(Decree on changing names). The authorities correctly interpret and interpret this provision of § 3 Z 5 NÄG (as amended in 1995: § 3 Paragraph 1 Z 7 NÄG), which means that in practice since NÄG 1988, in addition to several hundred other first names, e.g. Carmen, Eve, Gaby, Simone or Andrea, who is considered male in Italy, must be accepted as gender-neutral.

In its decision of February 27, 2009, the Higher Administrative Court ruled that “a serious surgical procedure, such as the […] removal of the primary sex characteristics, is not a necessary prerequisite for a clear approximation of the external appearance of the opposite sex” and thus the change of civil status is. This means that gender reassignment surgery is no longer a mandatory requirement. This was also confirmed by the Constitutional Court in its decision of December 3, 2009 and cited the transsexual decree of 1983: Nothing stands in the way of changing the gender entry if at least "there is a clear approximation of the external appearance of the opposite sex and [...] It is highly likely that the feeling of belonging to the opposite sex will no longer change ”.

Since September 5, 2016, the Upper Austrian Regional Administrative Court has dealt with the request of the Linz transsexual Alex Jürgen "X", which was rejected by the Steyr registry office , to have the third gender expression entered in the birth register (and passport). On October 5, 2016, the court dismissed the applicant's request.

Switzerland

There is no special transsexual law in Switzerland either. According to case law, however, the first name and gender information in the civil status registers can be corrected upon a judicial request after a gender reassignment. According to the Federal Supreme Court, the correction may not result in a marriage being officially dissolved. The Zurich Higher Court ruled in the first quarter of 2011 that an operative intervention as a prerequisite for the adjustment of civil status and change of first name violated personal rights. In the 3rd quarter of 2012, the regional court of Bern-Mittelland decided with the decision CIV 12 1217 JAC that neither hormone therapy nor surgical intervention was necessary for changing the civil status; appropriate psychological reports are decisive.

United Kingdom

The so-called Gender Recognition Act has existed in the UK since 2004 , which enables people with transsexuality to have their birth entry corrected retrospectively without the prerequisite for surgical or other physical measures (see gender reassignment measure ). The prerequisite is, among other things, that the person concerned has lived in the desired gender for at least two years at the time of the application and, as a rule, proves via two reports that they have or had gender dysphoria. However, married transsexuals are not permitted to legally change their sex.

France

Since May 17, 2009, transsexuality in France can no longer be designated as a mental disorder and thus no longer as a gender identity disorder by decree . The classification in the ICD-10 under F64.0 is also rejected. France sees the interpretation of transsexuality as a mental disorder as a stigmatization that contributes to the discrimination of transsexual people. A new law is under discussion. The Delaunay proposal (submitted in 2013) aims to make it easier to change names and gender entries in documents.

Other countries

In Iran transsexuality is legal (see transsexuality in Iran ). Gender reassignment operations are financially supported by the state and the birth certificate can then be adjusted accordingly.

In Pakistan , the government passed a law in May 2018 that strengthens the rights of transsexuals and aims to protect them from discrimination.

Treatment by the criminal justice system

The treatment of transsexuals by the police, criminal courts and the penal system represents a special problem. In every type of detention in particular, questions of treatment, care and care arise according to the gender of the identity. An almost insoluble problem for the authorities arises from the requirement to separate women and men in custody.

The so-called deadnaming ("naming the dead name"), ie naming a person with a transhistory by their previous name and gender, is not punishable as an insult under current law in Germany .

Controversy

Conceptual criticism

Many of those affected reject the word transsexuality, as the word component “sexuality” suggests in their opinion that transsexuality is not an identity problem, but merely a sexual preference. Transsexuality, however, is a question of gender and not a variety of sexuality in the strict sense: Transsexuals are not people with certain sexual preferences, but people who were born with the wrong sex organs, so to speak. Instead of man-to-woman transsexuals or woman-to-man transsexuals, these critics prefer to be referred to simply as transwomen or transmen. An alternative term introduced in Germany in the 1980s is trans identity , but the much broader term transgender has also been gaining ground since the 1990s . On the one hand, transgender is used as a generic term for people who cannot come to terms with the gender assigned at birth, and on the other hand, the term serves as a term for people who feel themselves to be between the sexes, i.e. not 100% male or female understand. These term alternatives have been widespread in the German-speaking area since the mid-1990s; the term criticism itself came up in the 1980s.

The concept of transsexuality has been criticized for several years, especially by those who see themselves as transgender, because the criteria for its existence are based on a binary gender image (see heteronormativity and transgender ) and rely too heavily on the possibilities of medical changes in the body and relate too little to social circumstances.

Definition criticism

In many countries outside Germany, the majority now assume that transsexuality is innate (and not acquired) and that it is rather a special form of intersexuality . This is consistent with statements by Harry Benjamin (1885–1986), who was considered a pioneer in the field of transsexuality research. Benjamin said, among other things, that intersexuality occurs both physically and in the brain . Other medical professionals such as the Hawaiian professor Milton Diamond support this thesis. Building on these findings, the UK is the most progressive country to date for people affected by transsexuality. The so-called Gender Recognition Act from 2004 enables transsexual people to have their birth entry changed retrospectively, assuming that the entry was incorrect at the time of birth. This means that Great Britain is so far the only country in Europe that recognizes that transsexuality is a physical deviation from the gender determined by the brain.

However, this theoretical assumption has so far not been proven beyond doubt by empirical evidence. In Germany, transsexuality is still considered a mental disorder. However, in this country too, doctors are increasingly recognizing that prenatal imprinting is the most likely cause of transsexuality, which means a prenatal imprinting of the brain that can then no longer be changed.

The replacement term gender incongruence , which comes from the future ICD-11, leaves open whether the gender identity or the body should be the non-conforming or deviating part according to the definition and which is decisive. Some human rights organizations and interest groups therefore reject this classification. Due to the lack of clarity, the pathologization of transsexual people is still possible, depending on the perspective.

Transsexuality in film, music and literature

Movies

• List of transgender films
• Boys Don't Cry by Kimberly Peirce , USA 1999
• The Danish Girl by Tom Hooper , USA / GB 2002, based on a novel by David Ebershoff about the life story of the transsexual Lili Elbe .
• Transfamily by Sabine Bernardi , Germany 2005, documentary about two transsexual men, one today lives in a heterosexual, one in a homosexual partnership.
• Transamerica by Duncan Tucker , USA 2005
• Romeos by Sabine Bernardi , Germany 2010
• I am a woman now , original Casablanca revisited , by Michiel van Erp, Netherlands 2011, with April Ashley , Bambi ; Documentation about five ex-transsexual women who were operated on by Georges Burou in Casablanca between 1960 and the 1970s.
• Bambi by Sébastien Lifshitz , France 2013. Documentary about Marie-Pierre Pruvot , alias Bambi , a path from transsexual showgirl to school teacher for French literature , awarded the Teddy Award , Berlin International Film Festival 2013.
• The episode Daniela of the series Cold Case - No Victim Is Ever Forgotten is about a young trans woman who is with a man and who commits suicide due to her transsexuality and the subsequent lack of acceptance of her surroundings, with the exception of that of her boyfriend.
• A fantastic woman , feature film by Sebastián Lelio , Germany 2017.

music

• From Little Brother to Little Sister - Chanson by singer-songwriter Max Biundo (2011)
• Horst und Monika - Lied von Die Orsons featuring Cro (2012)

literature

• Virginia Woolf : Orlando . Novel. 1928.
• Alex Gino: George. Novel. Fischer, 2016, ISBN 978-3-7373-4032-8 .
• Jessica Walton: Teddy Tilly. Children's book. Sauerländer, 2016, ISBN 978-3-7373-5430-1 .
• Catherine Castro, Quentin Zuttion: Call me Nathan. Comic. Splitter, Bielefeld 2019, ISBN 978-3-96219-305-8 (from the French by Tanja Krämling).
• Laura Kneidl : Someone new. Novel. Lyx, Cologne 2019, ISBN 978-3-7363-0829-9 .
• Julie Anne Peters : Luna (2004, youth novel)
• Meredith Russo: If I Was Your Girl (2016, children's novel)

Selected biographies

• Man into woman: The first sex change - a portrait of Lili Elbe . Edited by Niels Hoyer. Jarrolds 1933, new edition: Blue Boat Books, London 2004 (English).
• Christine Jorgensen : A personal autobiography. San Francisco 1967 / New edition: Cleis Press, 2000. (Autobiography, English).
• Romina Cecconi - Io la Romanina - perche 'sono diventato donna. Great edizione. Vallecchi, Firenze 1976. (Italian autobiography).
• Romy Haag - One woman and more. Quadriga, Berlin, 1999. ISBN 978-3-88679-328-0 .
• Duncan Fallowell &, April Ashley : April Ashley's Odyssey. Jonathan Cape, 1982, ISBN 978-0-224-01849-4 (autobiography, English).
• Coccinelle par Coccinelle . Editions Filipacchi, Paris 1987, ISBN 978-2-85018-586-1 . (Autobiography, French).
• Marie-Pierre Pruvot : Marie parce que c'est jolie. Editions Bonobo, 2007 (autobiography, French).
• Lynn Conway : autobiography on her website (German); undated, accessed January 2018.
• Niki Trauthwein - Peter Pan in Hamburg. Gert-Christian Südel: transpioneer, activist and survivor. Lit Verlag, Berlin 2020, ISBN 978-3-643-14698-4

See also

• 

  Portal: Transgender, transsexuality and gender diversity  - Wikipedia content on the subject areas

Specialist literature

• Jannik Brauckmann: The Reality of Transsexual Men: Becoming a Man and Heterosexual Partnerships of Woman-to-Man Transsexuals (=  Contributions to Sexual Research . Volume 80 ). Psychosozial, Gießen 2002, ISBN 3-89806-135-3 ( table of contents with reading sample [PDF]).
• Mari Günther, Kirsten Teren, Gisela Wolf: Psychotherapeutic work with trans * people: Handbook for health care. Reinhardt, Munich 2019, ISBN 978-3-497-02881-8 .
• Rainer Herrn: Patterns of Gender: Transvestism and Transsexuality in Early Sexology. Psychosozial, Gießen 2005, ISBN 3-89806-463-8 ( table of contents with reading sample [PDF]).
• Stefan Hirschauer: The social construction of transsexuality: About medicine and gender change. Suhrkamp, ​​Frankfurt / M. 1993.
• Jean-Daniel Marc Lelle: Quality of life, patient satisfaction and surgical outcome after gender reassignment surgery in man-to-woman transsexualism. Medical doctoral thesis TU Munich March 2018 ( PDF: 3.5 MB, 126 pages at ub.tum.de ).
• Gesa Lindemann : The paradoxical gender: transsexuality in the field of tension between body, body and feeling. Fischer, Frankfurt / M. 1993.
• Friedemann Pfäfflin , Astrid Junge (ed.): Gender change: Treatises on transsexuality. Schattauer, Stuttgart 1992.
• Friedemann Pfäfflin: Transsexuality: Contributions to psychopathology, psychodynamics and the course. Enke, Stuttgart 1993.
• Livia Prüll: Trans * in luck: gender reassignment as an opportunity. Autobiography, medical ethics, medical history. Vandenhoeck & Ruprecht, Göttingen 2016, ISBN 978-3-525-49011-2 .
• Udo Rauchfleisch : Anne will be Tom - Klaus will Lara: Understand transidentity / transsexuality. Patmos, Ostfildern 2013, ISBN 978-3-8436-0427-7 .
• Udo Rauchfleisch: Transsexuality - Transidentity Assessment, support, therapy. Vandenhoeck & Ruprecht, Göttingen 2014, ISBN 978-3-525-46270-6 .
• Udo Rauchfleisch: Transexualism - Gender dysphoria - Gender incongruence - Transidentity: The difficult way of depathologization. , Vandenhoeck & Ruprecht, Göttingen 2019, ISBN 978-3-525-40516-1 .
• Gerhard Schreiber (Ed.): Transsexuality in Theology and Neuroscience: Results, Controversies, Perspectives. de Gruyter, Berlin 2016, ISBN 978-3-11-043439-2 .
• Mirjam Siedenbiedel: Self-determination about one's own gender: Legal aspects of the treatment request of transsexual minors. Nomos, Baden-Baden 2016, ISBN 978-3-8487-3366-8 .
• Volkmar Sigusch : Change of sex. Klein, Hamburg 1992.
• Karim El Souessi: Dissertation on the question of the delimitation of transvestism and transsexuality in men. Doctoral thesis TU Munich 1991 ( DNB 920867278 ).
• Günter K. Stalla (Ed.): Therapy Guide Transsexuality. Uni-Med, Bremen 2006.
• Niki Trauthwein: Trans * community magazines and pamphlets as a place of education. In the research journal Social Movements. Volume 29, Issue 4, 2016, ISSN  2365-9890 , pp. 124-129.
• Niki Trauthwein: Biographical Sketches of Gender Identity. In: Loccumer Pelikan. No. 1, 2017, ISSN  1435-8387 , pp. 45-47.
• Walter Zeyringer (Ed.): The new name change law with explanations, name change ordinance and guidelines. Austrian law. Manz, Vienna 1988, ISBN 3-214-03514-2 .

English:

• Harry Benjamin: Transvestism and Transsexualism. In: International Journal of Sexology. Volume 7, 1953, pp. 12-14.
• Harry Benjamin: The Transsexual Phenomenon. Julian Press, New York 1966 (English; PDF: 998 kB, 156 pages at mut23.de ).
• Harry Benjamin : Transvestism and Transsexualism in the Male and Female. In: The Journal of Sex Research. Volume 3, 1967, ISSN  0022-4499 , pp. 107-127.
• David O. Cauldwell : Psychopathia transexualis. In: International Journal of Sexology. Volume 16, 1949, pp. 274–280 (republished in: International Journal of Transgenderism. Volume 5, No. 2, April – June 2001; online at iiav.nl ( Memento of March 10, 2015 in the Internet Archive )).
• John Money (Ed.): Transsexualism and Sex Reassignment. Johns Hopkins Press, Baltimore 1969.
• Douglas Ousterhout: FFS - Facial Feminization Surgery. Addicult Books, 2009.

Web links

Commons : Transsexuality  - collection of images, videos and audio files

Wiktionary: Transsexuality  - explanations of meanings, word origins, synonyms, translations

Wikibooks: Gender and Identity  - Learning and Teaching Materials

Materials from the EU and the Council of Europe :

• EU Roadmap against homophobia and discrimination on grounds of sexual orientation and gender identity. Own-initiative procedure, 2013/2183 (INI) [= own-initiative report] of the European Parliament , introduced in 2013, completed in 2014. (Among other things, it contains a point against the classification of transsexuality as a mental disorder by the WHO.)
• Resolution Discrimination against transgender people in Europe. (English) Resolution RES 2048 of April 22, 2015 of the Parliamentary Assembly of the Council of Europe .

Medical associations:

• World Professional Association for Transgender Health (WPATH ) - website of the professional association; Among other things, with the international standards of care (multilingual; recommendations for action for specialists in the field of trans *).
• European Professional Association for Transgender Health (EPATH) (English) - Website of the European professional association (European branch of the WPATH).
• German Society for Sexual Research (DGfS) - official website
  • Development of guidelines on gender incongruence and gender dysphoria. Working group of the German Society for Sexual Research (DGfS) to develop a "methodologically high-quality guideline according to the specifications of the AWMF" as a replacement for the outdated German standards for the treatment and assessment of transsexuals from 1997 against the background of the 7th Standards of Care of the WPATH and Judicature of the German Federal Constitutional Court .

Supranational and national associations of transsexual people:

• Transgender Europe (TGEU) (English) - Website of the European umbrella organization with around 130 member organizations from 43 European and Central Asian countries.
• ILGA-Europe (English) - Website of the European LGBTI - lobbying organization for equality and human rights in Europe and Central Asia.
• National Center for Transgender Equality. USA (English).
• DA-CH (members of Transgender Europe):
  • German Society for Transidentity and Intersexuality V. (dgti) - Website of what is probably the oldest still existing association that is active throughout Germany.
  • Federal Association of Trans * e. V. (BVT * e.V.) - Website of the association as an association at regional, state and federal level.
  • TransX - Association for Transgender People - Website of the nationwide transgender advocacy and networking.
  • Transgender Network Switzerland (TGNS) - Website of the Swiss-wide transgender advocacy and networking.

Individual evidence

• ( B ) Harry Benjamin: The Transsexual Phenomenon. Julian Press, New York 1966 (English; PDF: 998 kB, 156 pages at mut23.de ).

1. ↑ Harry Benjamin, 1966: pp. 11 and 13/14.
2. ↑ Harry Benjamin, 1966: p. 12.
3. ↑ Harry Benjamin, 1966: p. ??.
4. ↑ Harry Benjamin, 1966: pp. 98/99.
5. ↑ Harry Benjamin, 1966: pp. 13-16 and 37-39.
6. ↑ Harry Benjamin, 1966: p. 30. Benjamin also distinguished between different degrees or types of transsexualism.
7. ↑ Harry Benjamin, 1966: p. 73, quotation: "[...] mental changes were invariably more pronounced than any physical ones [...] The great satisfaction that goes with a final accomplishment of a difficult and long-sought-for mission was strikingly evident ".
8. ↑ Harry Benjamin, 1966: p. 73, quotation: “Even an attractive girl may find it difficult to meet her Prince Charming. If she feels that time may be running out, it could easily cause much feeling of insecurity, dissatisfaction and depression [...] ".
9. ↑ Harry Benjamin, 1966: p. 74: Of 51 postoperative cases (MzF) 12 had married, 5 of them were divorced and 3 remarried; this result does not differ from general marriage statistics. There are also some famous examples of ex-transsexuals who got married after surgery such as Coccinelle , April Ashley , Lynn Conway .

• Further evidence

1. ↑ ^{a b} bundesjustizamt.de (PDF)
2. ^ ^{A b} Presentation on prevalence of transsexual people in the UK. ( Memento from October 19, 2014 in the Internet Archive )
3. ↑ Flores, Herman, Gates, NT Brown: How many Adults identify as Transgender in the United States. (PDF) 2016, accessed December 20, 2017 . 
4. ↑ F64.0 Transsexualism. In: ICD-10 Version: 2016. World Health Organization, 2016, accessed October 8, 2019 . 
5. ↑ Timo O. Nieder, Peer Briken: Transgender, transsexuality and gender dysphoria. In: Ulrich Voderholzer, Fritz Hohagen (Hrsg.): Therapy of mental illnesses. 11th edition. Urban & Fischer, Munich 2016, ISBN 978-3-437-24907-5 , p. 343.
6. ↑ Jannik Franzen, Arn Sauer: Discrimination against trans * people, especially in working life. Federal Anti-Discrimination Agency, Berlin 2010, p. 9 ( PDF: 899 kB, 118 pages on antidiskriminierungsstelle.de ).
7. ↑ ^{a b} ICD-11 adopted by the WHA. Retrieved November 29, 2019 . 
8. ↑ ^{a b c d} World Health Organization (WHO): ICD-11 for Mortality and Morbidity Statistics: Gender incongruence. In: WHO.int. April 2019, accessed December 8, 2019.
9. ↑ 72. World Health Assembly: Eleventh revision of the International Classification of Diseases . Resolution WHA72.15. Ed .: World Health Organization. Geneva May 28, 2019 (English, who.int [PDF]).
10. ↑ Verena Klein, Franziska Brunner a. a .: Diagnostic guidelines for sexual disorders in the International Classification of Diseases and Related Health Problems (ICD) -11: Documentation of the revision process. In: Journal for Sexual Research. Volume 28, 2015, pp. 363-373 ( doi: 10.1055 / s-0041-109281 ).
11. ↑ Message: After WHO announcement: Opposition calls for the abolition of the Transsexual Act. In: Queer.de. June 19, 2018, accessed September 28, 2019.
12. ^ Tilmann Warnecke: New ICD classification: WHO wants to delete transsexuality as a mental illness. In: Tagesspiegel.de. June 19, 2018, accessed September 28, 2019.
13. ↑ Message: Sexual minorities: WHO removes transsexuality as a mental disorder. In: Morgenpost.de. June 19, 2018, accessed September 28, 2019.
14. ↑ For example in: Wolf Eicher: Transsexualism: Possibilities and limits of gender reassignment. Fischer, Stuttgart a. a. 1984.
15. ↑ Otto Weininger About the Last Things (PDF) at: naturalthinker.net
16. ↑ dalank.de (PDF)
17. ↑ Magnus Hirschfeld: Die Transvestiten: An investigation into the erotic disguise instinct, with extensive casuistic and historical material. Alfred Pulvermacher, Berlin 1910 ( online at digitaltransgenderarchive.net).
18. ↑ Gisela Bleibtreu-Ehrenberg : The woman man. Cultic gender change in shamanism. A study on transvestment and transsexuality among indigenous peoples. Fischer, Frankfurt a. M. 1984.
19. ↑ Sabine Lang: Men as Women - Women as Men. Change of gender roles among the Indians of North America. Hamburg, Wayasabah 1990.
20. ↑ Sabine Lang: Men as Women - Women as Men. Change of gender roles among the Indians of North America. Hamburg, Wayasabah 1990.
21. ↑ Magnus Hirschfeld: Die Transvestiten: An investigation into the erotic disguise instinct, with extensive casuistic and historical material. Alfred Pulvermacher, Berlin 1910, pp. 318–329, here: p. 321
22. ↑ Magnus Hirschfeld: Die Transvestiten: An investigation into the erotic disguise instinct, with extensive casuistic and historical material. Alfred Pulvermacher, Berlin 1910, pp. 318–321, here: 319-320.
23. ↑ Magnus Hirschfeld: Die Transvestiten: An investigation into the erotic disguise instinct, with extensive casuistic and historical material. Alfred Pulvermacher, Berlin 1910, pp. 318–329, here: p. 322.
24. ↑ Magnus Hirschfeld: Die Transvestiten: An investigation into the erotic disguise instinct, with extensive casuistic and historical material. Alfred Pulvermacher, Berlin 1910, pp. 318–329, here: p. 321
25. ↑ Irma Della Giovampola: La provenenzia del rilievo di Gallus ai Musei Capitolini e le testimonianze del culto della Magna Mater nell ' ager Lanuvinus. In: Horti Hesperidum. Volume 2, 2012, pp. 503-531.
26. ↑ Transsexuality in Ancient Priestesses and Indian Hijras on Lynn Conway's website , accessed January 19, 2018.
27. ↑ Transsexuality in Ancient Priestesses and Indian Hijras on Lynn Conway's website , accessed January 19, 2018.
28. ^ Hermann Ferdinand Hitzig : Castratio . In: Paulys Realencyclopadie der classischen Antiquity Science (RE). Volume III, 2, Stuttgart 1899, Col. 1772 f.
29. ↑ Gabriel Sanders: Cybele and Attis. In: Maarten Jozef Vermaseren (ed.): The oriental religions in the Roman Empire. Brill, Leiden 1981, pp. 264-291, in the Roman Empire: pp. 275-289.
30. ↑ Original in Heidelberg University , accessed on January 18, 2018.
31. ↑ According to Martin von Troppau he became Pope around 855, according to Jean de Mailly in Chronica Universalis Mettensis (approx. 1250) only around 1099. Rosemary and Darroll Pardoe: The Female Pope: The mystery of Pope Joan , ( “Chapter 1: The first appearances of Pope Poan "(English) , accessed on January 18, 2018)
32. ↑ Rosemary and Darroll Pardoe: The Female Pope: The mystery of Pope Joan, Crucible (Thorsons) 1988, "Chapter 1: The first appearances of Pope Poan" , accessed January 18, 2018.
33. ↑ Rosemary and Darroll Pardoe: The Female Pope: The mystery of Pope Joan , Crucible (Thorsons) 1988, “Chapter 1: The first appearances of Pope Poan” , accessed January 2018
34. ↑ This concerns e.g. For example, the Amarna dynasty ( Akhenaten , Tutankhamun, etc.), which is particularly famous today , whose memory was obliterated by the Haremhab and which was therefore completely forgotten by the 19th century. See: Joshua J. Mark, “Horemheb,” April 22, 2014, in: Ancient History Encyclopedia. On the web: "Horemheb", in: Ancient History Encyclopedia , accessed January 19, 2018
35. ↑ see e.g. B. Otto Beneke: "Queen Christina of Sweden", in: Hamburg stories and legends , Hamburg 1854, pp. 312-314. Text on Wikisource , accessed January 18, 2018
36. ↑ See also the description of Christine by the Grande Mademoiselle , in: Memoirs of Mademoiselle de Montpensier. H. Colburn, 1848, p. 48.
37. ↑ "an insurmountable distaste for marriage" and "for all the things that females talked about and did."
38. ^ Sylvie Steinberg: La confusion des sexes - le travestissement de la Renaissance à la Revolution. Fayard 2001 (French; table of contents ).
39. ↑ “Qui était le chevalier d'Éon?” (French) , accessed on January 18, 2018
40. ↑ Unsung LGBT heroes ... James Barry. In: We Are Family Magazine , issue 6, summer 2014, accessed on January 18, 2018.
41. ^ AK Kubba, M. Young: The Life, Work and Gender of Dr James Barry MD. In: Proceedings of the Royal College of Physicians of Edinburgh , 2001, 31 (4), pp. 352-356. PMID 11833588 , rcpe.ac.uk (PDF) accessed January 27, 2018.
42. ↑ "After" he "was dead, I was told that (Barry) was a woman... I should say that (Barry) was the most hardened creature I ever met." Florence Nightingale in a letter to Parthenope, Lady Verney, after the death of James Barry, in: Wellcome Library, Wellcome Institute for the History of Medicine, undated, (English) , accessed January 18, 2018.
43. ↑ Michael du Preez, Jeremy Dronfield: Dr James Barry: A Woman Ahead of Her Time. Oneworld Publications, London, ISBN 978-1-78074-831-3 , pp. 251-252. The authors refer to: Edward Bradford: The Reputed Female Army Surgeon. In: The Medical Times and Gazette. Volume 2, 1865, p. 293 (English).
44. ↑ Irvine Loudon: Scanty Particulars: The Strange Life and Astonishing Secret of Victorian Adventurer and Pioneer Surgeon James Barry. In: British Medical Journal (BJM). Volume 324 (7349), June 1, 2002, p. 1341 (English).
45. ↑ "In short, his wish was to die and be remembered as a man." "Unsung LGBT heroes ... James Barry" , in: "We Are Family Magazine", issue 6, summer 2014 (English), accessed on 18 January 2018.
46. ↑ James Barry appears e.g. B. in: Christoph Fuhr: Women who conquered the world of medicine. In: Ärzte Zeitung , October 13, 2010, online . Barry also appears in the book: Annette Kerckhoff: Heilende Frauen. Elisabeth Sandmann, Munich 2010, ISBN 978-3-938045-47-3 , pp. 22-23.
47. ^ Sylvie Steinberg: La confusion des sexes - le travestissement de la Renaissance à la Revolution. Fayard 2001 ( table of contents (French) accessed on January 18, 2018)
48. ↑ Harald Rimmele: Biography of Dorchen Richter. hirschfeld.in-berlin.de; accessed on February 15, 2018
49. ↑ A Trans Timeline - Trans Media Watch . In: Trans Media Watch . Retrieved February 3, 2016. 
50. ↑ Man into woman: The first sex change - a portrait of Lili Elbe. Edited by Niels Hoyer, originally: Jarrolds 1933, new edition: Blue Boat Books, London 2004.
51. ↑ In 1931 Lili Elbe was apparently only reported in German and Danish newspapers. See: Man into woman: The first sex change - a portrait of Lili Elbe. Edited by Niels Hoyer, originally: Jarrolds 1933, new edition: Blue Boat Books, London 2004, pp. 13-14.
52. ↑ Christine Jorgensen: A personal autobiography. San Francisco 1967 / new edition: Cleis Press, 2000, p. 235.
53. ↑ TV interview with Christine Jorgensen with Gary Collins in Hour Magazine in the 1980s (English) accessed January 2018.
54. ↑ Christine Jorgensen: A personal autobiography. San Francisco 1967 / reprint: Cleis Press, 2000.
55. ^ "These personal letters from almost 500 deeply unhappy persons leave an overwhelming impression. One tragic existence is unfolded after another; they cry for help and understanding. It is depressing to realize how little can be done to come to their aid. One feels it a duty to appeal to the medical profession and to the responsible legislative: do your utmost to ease the existence of these fellow-men who are deprived of the possibilities of a harmonious and happy life - through no fault of their own. " Christian Hamburger: "The Desire for change of sex as shown by Personal letters from 465 Men and Women", in: Acta Endocrinologica 14, 1953, pp. 361-375 (here quoted from: Harry Benjamin: The Transsexual Phenomenon. Julian Press, New York 1966, p. 41 (English; PDF: 998 kB, 156 pages at mut23.de ).
56. ^ Coccinelle par Coccinelle (autobiography, French). Editions Filipacchi, Paris, 1987. ISBN 978-2-85018-586-1
57. ^ History of Vaginoplasty on Lynn Conway's website , accessed January 19, 2018
58. ↑ Wolf Eicher: Transsexualism: Possibilities and limits of gender reassignment. Fischer, Stuttgart a. a. 1984.
59. ↑ Niki Trauthwein: ways out of isolation - emancipatory aspirations and structural organization in 1945 to 1980 . In: Senate Department for Justice, Consumer Protection and Anti-Discrimination Berlin, State Office for Equal Treatment - Against Discrimination (Ed.): Off to Casablanca? Realities of life of transgender people between 1945 and 1980 . tape 37 . Berlin, S. 53-68 .
60. ↑ Lynn Conway website accessed January 2018.
61. ↑ I'm a woman now, by Michiel van Erp, Netherlands 2011. Documentation about five transsexual women who were born by Dr. Georges Burou in Casablanca.
62. ↑ Film: Bambi, by Sébastien Lifshitz, France 2013. The story of Marie-Pierre Pruvot, a journey from transsexual showgirl to school teacher, awarded the Teddy Award, International Berlin Film Festival 2013.
63. ↑ “There were 238 known murders of Trans people last year - however only 60 countries collate information on Trans Hate Crime and it is believed the real figure could be much higher.” Louise Muddle: Transday of Remembrance - Remembering victims of Hate. “April Ashley - Portrait of a Lady”, Museum of Liverpool, November 21, 2013 (English); accessed on January 21, 2018.
64. ^ Neither priesthood nor marriage for transsexuals. Kath.net, February 1, 2003; accessed in January 2018.
65. ↑ Vatican: Objectively, transsexuals cannot be godparents. In: Katholisches - Magazine for Church and Culture , September 2, 2015; accessed in January 2018.
66. ↑ Pope receives transsexuals for an audience. n-tv.de, January 27, 2015; accessed on January 18, 2018.
67. ^ Estar con el Papa ha sido maravilloso. (“It was wonderful to be with the Pope”), report in the Spanish newspaper Hoy , January 27, 2015 (Spanish); January 2018.
68. ↑ Thomas C. Fox: Pope Francis meets with, hugs transgender man. In: National Catholic Reporter , Jan. 30, 2015; accessed on January 21, 2018.
69. ↑ Giuseppe Nardi: Pope receives transsexuals including a "girlfriend" - is the papal approach to mainstream? In: Katholisches - Magazin für Kirche und Kultur , January 26, 2015. Accessed on September 28, 2019. Note: This article is massively transphobic, the formerly transsexual man is consistently referred to as "she"!
70. ↑ According to Hoy, Francis told Lejarraga in an initial phone call that God loves all his children "as they are." He went on: "You are a son of God and the Church loves you and accepts you as you are." : Thomas C. Fox: Pope Francis meets with, hugs transgender man. In: National Catholic Reporter , Jan. 30, 2015; accessed on January 21, 2018.
71. ↑ Pope: Do not exclude homosexuals and transsexuals. Katholisch.de, October 3, 2016; accessed January 18, 2018.
72. ↑ Michael Hollenbach: Transsexuality and the Protestant Church - How clear is the creation. Deutschlandfunk Kultur , July 7, 2016; accessed in January 2018.
73. ^ Reformation for All *: Transidentity / Transsexuality and Church. accessed in February 2018.
74. ↑ Made in the image of God. our.ekhn.de
75. ↑ J.-N. Zhou, MA Hofman, DF Swaab: A sex difference in the human brain and its relation to transsexuality. In: Letters to Nature. Volume 378, November 2, 1995, pp. 68-70 (English; PDF: 212 kB, 8 pages on sindromebenjamin.tripod.com ).
    Translation: A gender difference in the human brain and its relationship to transsexuality. In: Transgender.at.
76. ↑ Frank PM Kruijver, Jiang-Ning Zhou u. a .: Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus. In: The Journal of Clinical Endocrinology & Metabolism . Vol. 85, No. 5, 2000, pp. 2034-2041 (English).
77. ↑ Giancarlo Spizzirri, Fábio Luis Souza Duran u. a .: Gray and white matter volumes either in treatment-naïve or hormone-treated transgender women: a voxel-based morphometry study. In: Scientific Reports. Volume 8, article number 736, 2018 (English; online at nature.com ).
78. ^ V. Harley, Prince Henry's Institute of Medical Research, Melbourne: abc.net.au Transsexual study reveals genetic link abc.net.au, on October 27, 2008
79. ↑ Madeleine Foreman, Lauren Hare et al. a .: Genetic Link Between Gender Dysphoria and Sex Hormone Signaling? In: The Journal of Clinical Endocrinology & Metabolism. Volume 104, February 2, 2019, pages 390-396 (English; doi: 10.1210 / jc.2018-01105 ).
80. ↑ Transsexuality - hormonal disorder in the womb. In: Focus-Online. October 7, 2007, (Last accessed December 30, 2007.)
81. ^ ^{A b} Johanna Olson, Sheree M. Schrager, Marvin Belzer, Lisa K. Simons, Leslie F. Clark: Baseline Physiologic and Psychosocial Characteristics of Transgender Youth Seeking Care for Gender Dysphoria. In: Journal of Adolescent Health. 2015, doi: 10.1016 / j.jadohealth.2015.04.027 .
82. ↑ S3 guidelines - gender incongruence, gender dysphoria and trans health: diagnostics, counseling, treatment
83. ^ TO Nieder, P. Briken, H. Richter-Appelt: Transgender. Transsexuality and gender dysphoria: Current developments in diagnostics and therapy. In: PPmP-Psychotheraphie-Psychosomatik-Medical Psychology. 64 (06), 2014, pp. 232–245.
84. ↑ German Institute for Medical Documentation and Information (DIMDI): 024 ICD code F64.0 - transsexualism - add the term transidentity: proposed amendment to ICD-10-GM 2020. March 14, 2019 ( PDF: 206 kB, 7 pages on dimdi.de ).
85. ↑ S. Becker u. a .: Standards of treatment and assessment of transsexuals. In: Sexology. 4, Stuttgart 1997, pp. 130-138.
86. ^ David Rowland, Luca Incrocci: Handbook of sexual and gender identity disorders . John Wiley & Sons, Hoboken, NJ 2008, ISBN 978-0-471-76738-1 , pp. 441 ( google.de [accessed September 1, 2019]).
87. ^ Margo Rivera: Informed and Supportive Treatment for Lesbian, Gay, Bisexual and Transgendered Trauma Survivors . In: Journal of Trauma & Dissociation . tape 3 , no. 4 , September 2002, ISSN  1529-9732 , p. 33–58 , doi : 10.1300 / J229v03n04_03 ( tandfonline.com [accessed September 1, 2019]).
88. ↑ Harry Benjamin: Trans * types on the TransX website. Retrieved February 21, 2018.
89. ↑ Olson, Journal of Adolescent Health jahonline.org
90. ↑ https://www.dji.de/fileadmin/user_upload/bibs2015/DJI_Broschuere_ComingOut.pdf Kerstin Oldemeier, Coming-out and then?, 2015, p. 12
91. ↑ Annette Treibel: Introduction to Sociological Theories of the Present. 5th edition. Leske + Budrich, Opladen 2000, ISBN 3-8100-2756-1 , p. 145.
92. ↑ See the section: "Travestis (" Shemales ") and Similar Gender Identifications" on: Information about different types of transgender on Lynn Conway's website; accessed in January 2018.
93. ^ Reform of the transsexual law. In: Journal of Sex Education. Edition 1, 3/2016.
94. ↑ GIS in childhood and adolescence. In: Deutsches Ärzteblatt. 2008, accessed March 24, 2017 . 
95. ^ Supporting Boys or Girls When the Line Isn't Clear. Retrieved March 24, 2017 . 
96. ↑ Outcry prompts CAMH to review its controversial treatment of trans youth. Retrieved March 24, 2017 . 
97. ^ Children With Gender Nonconformity. Retrieved April 17, 2017 . 
98. ↑ Gender identity debate swirls over CAMH psychologist, transgender program. Retrieved March 24, 2017 . 
99. ^ How the Fight Over Transgender Kids Got a Leading Sex Researcher Fired. Retrieved March 24, 2017 . 
100. ↑ Beate Lakotte: Errors in the sky factory . In: Der Spiegel . No. 4 , 2007 ( online ).
101. ↑ Wolf Eicher: Results and satisfaction with the interventions. In: Transsexualism: Possibilities and Limits of Gender Reassignment. , Chap. X. Fischer, Stuttgart a. a. 1984.
102. ^ For example Wolf Eicher: Results and satisfaction with the interventions. In: Transsexualism: Possibilities and Limits of Gender Reassignment. Fischer, Stuttgart a. a. 1984, chapter 10.
103. ↑ The yes answers mean that those affected would (if you turned back the clock) have an operation again.
104. ↑ Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, Anna LV Johansson, Niklas Långström, Mikael Landén: Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. February 22, 2011, PMID 21364939 , “Swedish Long-Term Study of Postoperative Transsexuals 1973-2003”.
105. ↑ YL Smith, SH van Goozen, PT Cohen-Kettenis: Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study. In: Journal of the American Academy of Child & Adolescent Psychiatry , 2001, 40, pp. 472-481.
106. ^ YL Smith, SH Van Goozen, AJ Kuiper, PT Cohen-Kettenis: Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. In: Psychol Med. , 2005, 35, pp. 89-99.
107. ^ F. Leavitt, JC Berger, JA Hoeppner, G. Northrop: Presurgical adjustment in male transsexuals with and without hormonal treatment. In: The Journal of Nervous and Mental Disease , 1980, 168, pp. 693-697.
108. ^ PT Cohen Kettenis, SH van Goozen: Sex reassignment of adolescent transsexuals: a follow-up study. In: Journal of the American Academy of Child & Adolescent Psychiatry , 1997, 36, pp. 263-271.
109. ^ E. Newfield, S. Hart, S. Dibble, L. Kohler: Female-to-male transgender quality of life. In: Qual Life Res. , 2006, 15, pp. 1447-1457.
110. ↑ Paul J. M van Kesteren, Henk Asscheman, Jos A. J Megens, Louis J. G Gooren: Mortality and morbidity in transsexual subjects treated with cross-sex hormones . In: J. Clin. Endocrinol. tape 47 , no. 3 . Blackwell, Oxford, UK 1997, pp. 337-343 , doi : 10.1046 / j.1365-2265.1997.2601068.x .
111. ↑ Flores, Herman, Gates, NT Brown: How many Adults identify as Transgender in the United States. (PDF) 2016, accessed December 20, 2017 . 
112. ↑ bundesjustizamt.de (PDF)
113. ↑ Prevalence: “How many transsexuals are there in Germany?” Www.dgti.org www.trans-ident.de
114. ↑ Bernd Meyenburg, Karin Renter-Schmidt, Gunter Schmidt: Assessment according to the transsexual law. In: Journal of Sex Education. 28/2015, ISSN  0932-8114 , pp. 107-120.
115. ↑ Bernd Meyenburg, Karin Renter-Schmidt, Gunter Schmidt: Assessment according to the transsexual law. In: Journal of Sex Education. 28/2015, ISSN  0932-8114 , pp. 107-120.
116. ↑ BSGE 62, 83 = SozR 2200 § 182 No. 106.
117. ↑ Jochen Hess, Roberto Rossi Neto a. a .: Satisfaction with male to female gender reassignment surgery. In: Deutsches Ärzteblatt. No. 47, 2014 (full text: doi: 10.3238 / arztebl.2014.0795 ).
118. ↑ Yves Steinmetz: Gender reassignment operations in woman-to-man transsexuals with phalloplasty: comparison of different surgical techniques and assessment of the surgical results. Medical doctoral thesis University of Hamburg 2010, p. ?? ( Download page ).
119. ↑ Udo Rauchfleisch: Transsexuality - Transidentity Assessment, accompaniment, therapy. 4th edition. Vandenhoeck & Ruprecht, Göttingen 2014, ISBN 978-3-525-46270-6 , p. ??.
120. ↑ German Society for Sexual Research (DGfS): Gender incongruence, gender dysphoria and trans health: S3 guideline for diagnostics, advice and treatment. AWMF register no. 138 | 001. Version of February 27, 2019, p. ?? ( PDF: 3.6 MB, 127 pages on awmf.org ).
121. ↑ Resolution 2048 (2015): Discrimination against transgender people in Europe PDF. Retrieved May 2, 2015.
122. ↑ Christina Laußmann: Historical resolution for the rights of trans * people passed. German Aids Aid, April 23, 2015.
123. ↑ Resolution of the European Parliament of December 12, 2012 on the situation of fundamental rights in the European Union (2010-2011) (2011/2069 (INI)), Sexual orientation and gender identity, Recommendation No. 98 .
124. ↑ icd.who.int WHO ICD-11 Beta Draft (Joint Linearization for Mortality and Morbidity Statistics)
125. ↑ World Health Organization (WHO): International Classification of Diseases, 11th Revision (ICD-11). In: WHO.int. October 11, 2019, accessed December 8, 2019; Quote: "Member States will start reporting using ICD-11 on January 1, 2022.".
126. ↑ Timo O. Nieder, Peer Briken, Hertha Richter-Appelt: Transgender, transsexuality and gender dysphoria. Current developments in diagnostics and therapy. (PDF) In: PSYCH up2date. 7/2013, p. 375.
127. ^ The Stuttgart Declaration
128. ↑ BSGE 62, 83 = SozR 2200 § 182 No. 106
129. ↑ ^{a b} Landessozialgericht Stuttgart, judgment of November 27, 1981 - Az .: L 4 Kr 483/80.
130. ↑ LSG Baden-Württemberg Breith 1982, 175; LSG Lower Saxony Breith 1987, 1; Bavarian LSG Breith 1987, 531
131. ↑ Saxon LSG of February 3, 1999 - L 1 KR 31/98 - in JURIS; Bavarian LSG of October 30, 2003 - L 4 KR 203/01 - on a special penis plastic for the purpose of urinating while standing in woman-to-man transsexuals; BSG judgment of October 19, 2004 - B 1 KR 3/03
132. ^ LSVD: World Medical Association: Transgender is not a disease
133. ↑ Queer.de: Weltärztebund: Transgender is not a disease
134. ↑ European Court of Justice, judgment of April 30, 1996 - Az .: C-13/94: “Prohibition of discrimination on grounds of gender in employment and dismissal of a transsexual person”.
     European Court of Human Rights, judgment of July 11, 2002 - Ref .: 28957/95: “Legal recognition of a gender reassignment and right to marriage for a transsexual”.
     European Court of Human Rights, judgment of July 11, 2002 - Ref .: 28957/95: “Legal recognition of a gender reassignment and right to marriage for a transsexual”.
     European Court of Human Rights, judgment of June 12, 2003 - Ref .: 35968/97: “Reimbursement of the costs of gender reassignment measures for privately insured male-to-female transsexuals”.
     European Court of Human Rights, judgment of June 12, 2003 - Ref .: 35968/97: “Reimbursement of the costs of gender reassignment measures for privately insured male-to-female transsexuals”.
     European Court of Justice, judgment of 7 January 2004 - Ref .: C-117/01: “Exclusion of a transsexual partner from the entitlement to a survivor's pension”.
135. ↑ Resolution 2048 (2015): Discrimination against transgender people in Europe PDF. Retrieved May 2, 2015.
136. ↑ Bernd Meyenburg, Karin Renter-Schmidt, Gunter Schmidt: Assessment according to the transsexual law. In: Journal of Sex Education. 28/2015, ISSN  0932-8114 , pp. 107-120.
137. ↑ Decision of March 16, 1982 - Ref .: 1 BvR 938/81: “No rigid age limit for changing the marital status of a transsexual”.
     Decision of January 26, 1993 - 1 BvL 38/92, 1 BvL 40/92, 1 BvL 43/92: “Age limit for changing first names for transsexuals”.
     Decision of August 15, 1996 - 2 BvR 1833/95: “Addressing transsexual persons after changing their name”.
     Decision of December 6, 2005 - 1 BvL 3/03: "On the loss of the change of first name when getting married".
     Decision of July 18, 2006 - Ref .: 1 BvL 1/04 and 1 BvL 12/04: “Application of the Transsexual Act to Foreigners”.
     Decision of May 27, 2008 - Ref .: 1 BvL 10/05: “Refusal to change the civil status of married transsexuals”.
     Decision of January 11, 2011 - Ref .: 1 BvR 3295/07: "Registered civil partnership even without changing operative intervention"
138. ↑ queeramnesty.de
139. ↑ tgeu.org
140. ↑ teni.ie
141. ↑ ggg.at
142. ↑ Adapt first name and gender registration / Belgium. Retrieved January 5, 2018 . 
143. ↑ [1]
144. ↑ Austria: Transsexual Decree of 1996 ( Memento of July 18, 2006 in the Internet Archive ) (PDF file; 14 kB) of the Federal Ministry of the Interior .
145. ^ Austria: Name Change Act (NÄG) as amended
146. ↑ Austria: “Name Changes Decree” - “Guideline for the Execution of the NÄG and the NÄV”, referred to in Walter Zeyringer, Vienna: “The New Name Changes Act ”, p. 2. (PDF; 44 kB), printed in ÖJZ 1988, 737
147. ↑ Austria: BMI: Statement on Petition No. 67 regarding "Free choice of first name", October 24, 2005 (last accessed on August 16, 2009)
148. ↑ Austria: VwGH Zl. 2008/17 / 0054-8 of February 27, 2009, full text (PDF; 242 kB).
149. ↑ Austria: VfGH B 1973 / 08-13 of December 3, 2009 ( full text, in particular point 5.2. (PDF)).
150. ↑ “Third gender” before LVwG orf.at, September 5, 2016, accessed on September 5, 2016.
151. ↑ LVwG Upper Austria, LVwG-750369/5 / MZ / MR
152. ^ Decision of the Higher Court of the Canton of Zurich of February 1, 2011, NC090012 (PDF). Thomas Hasler: When is a man ... a woman? In: Tages-Anzeiger . March 8, 2011. (online)
153. ↑ Decision of the regional court of the canton of Bern-Mittelland of September 12, 2012 (PDF). Wolf Röcken: Even without an operation, Claudia Meier is a woman before the law. In: Berner Zeitung . September 17, 2012 ( bernerzeitung.ch ).
154. ↑ Gender Recognition Act 2004 Section 2 legislation.gov.uk
155. ^ Gender Recognition Act 2004 Section 3 legislation.gov.uk
156. ↑ gires.org.uk ( Memento of the original from September 28, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
157. ↑ Transsexuality in France is no longer a mental illness. ( Memento from June 23, 2013 in the Internet Archive ) AFP report. May 16, 2009.
158. ↑ Vanessa Barford: Iran's “diagnosed transsexuals”. In: News.BBC.co.uk . February 25, 2008, accessed November 16, 2019.
159. ^ Announcement (cw): Progress in Islamabad - Pakistan: Historical Trans Law passed. In: Queer.de. May 10, 2018, accessed November 16, 2019.
160. ^ Hauke ​​Rath: Transsexuals (from PrisonPortal). ( Memento from October 26, 2008 in the Internet Archive ) In: prisonportal.informatik.uni-bremen.de. October 2, 2008, accessed August 7, 2020.
161. ↑ Mitsuo Iwamoto: Deadnaming of Trans People: No Offense? In: taz.de . August 6, 2020, accessed August 7, 2020.
162. ↑ “Intersexes exist, in body as well as in mind”, The Transsexual Phenomenon (PDF) 1966.
163. ↑ Sex Reassignment at Birth - A Long Term Review and Clinical Implications , 1997.
164. ↑ cf. The Gender Identity Research & Education Society , UK
165. ↑ Yves Steinmetz: Gender reassignment operations in woman-to-man transsexuals with phalloplasty: comparison of different surgical techniques and assessment of the surgical results. Medical doctoral thesis University of Hamburg 2010, p. 15 ( download page ).
166. ↑ Interministerial Working Group on Intersexuality / Transsexuality. In: atme-ev.de. Retrieved June 14, 2015 . 
167. ^ I am a woman now in the Internet Movie Database (English) by M. van Erp.
168. ↑ Video by Max Biundo: From Little Brother to Little Sister on YouTube, December 27, 2011, accessed on April 28, 2020 (3:45 minutes; 357 views).
169. ↑ Video from Chimperator Channel: The Orsons feat. Cro - Horst und Monika on YouTube, August 26, 2012, accessed on April 28, 2020 (4:15 minutes; 4,075,324 views).