Sexual feelings and characteristic of transgender

India’s 2011 Census was the first census in its history to incorporate the number of ‘trans’
population of the country. The report estimated that 4.8 million Indians identified as transgender.
India -490,000 (2014)

Key terms

 Cisgender. This term is used to describe an individual whose gender identity and

expression matches the stereotypical societal characteristics related to sex assigned at
birth.
 Cross-dressing. This involves dressing as the other gender for entertainment or
pleasure. Cross-dressing isn't necessarily a sign of a person's gender identity or
sexual orientation. Cross-dressing also isn't indicative of gender dysphoria.
 Gender fluidity. This is the exhibition of a variability of gender identity and
expression. Gender fluid people don't feel restricted by typical societal norms and
expectations and might identify and express themselves as masculine, feminine or
along a spectrum, and possibly with variations over time.
 Gender nonconforming. This occurs when gender expression, gender roles or both
differ from societal norms and expectations for an individual's sex assigned at birth.
 Gender role. This term refers to the societal norms and expectations associated with
a person's sex assigned at birth.
 Sexual minority stress. This is stress related to societal stigma, prejudice and
discrimination toward individuals with diverse gender identity and expression.
 Trans man and trans woman. These terms are used to describe, in a gender binary
manner, a transgender individual's gender identity or expression. For example, the
term "trans woman" is used for an individual whose sex at birth was assigned male
and whose gender identity is female. However, not all transgender individuals use
these terms to describe themselves.

Sexual behaviors
 Concerning sexual behaviors, we explored sexual intercourse as well as masturbation
behaviors. Regarding the indicators of sexual intercourse, our study showed no significant
differences between subgroups of MtF transgender persons in whether or not they ever had
sexual intercourse, whether they had sexual intercourse in the past six months, and frequency of
sex. In contrast, among FtM transgender persons, those with a fulfilled treatment desire were
more likely to have been sexually active in the past six months and had a higher frequency of sex
than FtM transgender persons who did not have any treatment and had no desire for treatment.
Concerning masturbation behavior, MtF transgender persons who had no desire for any
treatment were more likely to masturbate and masturbated more often than the other two
subgroups. In contrast, among FtM transgender persons, those who did not want any treatment
masturbated less often than the other two subgroups.

In sum, there were little differences in the sex and masturbation behaviors between trans
people with an unfulfilled and those with a fulfilled treatment desire. There were, however, some
differences in the sexual behaviors between transgender persons with no treatment desire and the
other two subgroups, which are likely due to differences in testosterone levels. In cisgender
people, males have higher testosterone levels, which relates to higher sexual desire and arousal,
than females Hormone treatment affects testosterone levels, with decreasing testosterone level in
trans women who receive cross-sex hormone treatment and increasing testosterone levels in trans
men receiving cross-sex hormone treatment. In our sample of MtF transgender persons without
treatment desire, who are not treated with hormones and thus still exposed to endogenous
testosterone levels, the frequency of masturbation was higher than in the other two groups. For
FtM transgender persons, the majority received hormone treatment (i.e., testosterone) in the UTD
and FTD groups, and their frequency of masturbation was higher than in the group without
treatment desire not receiving any testosterone. A similar pattern can be seen for frequency of
sex, especially in the sample of FtM transgender persons.

These findings are in line with previous studies showing that after gender-confirming
interventions, trans women reported low levels of sexual desire and trans men high levels of
sexual desire. Higher levels of sexual desire will result in more motivation to engage in sexual
activities like masturbation and partner sex. In our sample of FtM transgender persons with a
fulfilled treatment desire, the percentage that had been sexually active in the past six months was
significantly higher than the other two groups. Further, the frequency of sex was higher than the
other two groups, although this difference was not statistically significant. Thus, when FtM
transgender persons with a fulfilled treatment desire have no treatment wishes anymore
(regardless of whether they had genital surgery or not), they may feel “ready” to engage in
sexual activities with a partner, whereas frequency of masturbation is also higher in the group
that still desires treatment probably as a result of testosterone treatment.

Sexual feelings

In both samples, there were no significant differences between subgroups on general

sexual satisfaction. However, when comparing our groups to general population percentages, it
seems that in general in our groups, the percentage of those satisfied with their sex life is lower
(27%–41% compared to 46.8% in the general population) and the percentage of those
dissatisfied is higher (27%–39% compared to 20.8% in the general population) . We did find
differences between our groups when examining three separate aspects of sexual satisfaction,
namely agency (the extent to which one has influence over what happens during sex), pleasure
(whether sex is enjoyable), and esteem (whether one feels confident during sex). MtF
transgender persons with a fulfilled treatment desire responded most positively: They scored
higher on all of these three aspects of sexual satisfaction than those with an unfulfilled treatment
desire. Further, they scored higher on sexual agency and esteem than those with no treatment
desire. These positive effects may be a result of the alleviation of gender dysphoria by getting rid
of the unwanted sex organs and/or having a body congruent with gender identity. This indicates
that for those MtF transgender adults, GCT may have a positive influence on these different
aspects of sexual satisfaction.

In the sample of FtM transgender persons, individuals with a fulfilled treatment desire
scored higher than those with an unfulfilled treatment desire on sexual esteem, but not on sexual
agency or pleasure. FtM transgender persons with a fulfilled treatment desire seem to be more
confident in their sex life than those with an unfulfilled treatment desire, although only 20% of
the FTD group had genital surgery (phalloplasty or metoidioplasty). Chest surgery may be
crucial here: In the FTD group, 91% had undergone this surgery as opposed to only 32% in the
UTD group, and in the UTD group 64% indicated a desire for chest surgery. Mastectomy has
been reported to improve body satisfaction beyond satisfaction with chest appearance only and
body satisfaction was associated with higher self-esteem in trans men. For agency and pleasure,
however, there was no significant difference between FtM transgender persons with an unfilled
and fulfilled treatment desire. These two aspects of sexual feelings may be—like sexual behavior
—very much related to the hormonal environment, with also the majority in the UTD group
receiving testosterone treatment.

Concerning transgender persons with no treatment desire, we found that this subgroup
did not score particularly high on the separate aspects of sexual satisfaction. In the sample of
MtF transgender persons, those with no treatment desire scored in between the other two
subgroups on pleasure and esteem, but scored lowest on sexual agency. In FtM transgender
persons, those with no treatment desire scored lowest on both sexual agency and pleasure. These
findings suggest that besides whether or not one undergoes or wants to undergo GCT, the
difficulties that come with the experience of being transgender itself can influence aspects of
sexual satisfaction. Further, the findings indicate that not having a treatment desire does not
necessarily indicate that an individual is satisfied with one's body. One explanation may be that
some transgender people without desire for GCT may abstain from treatment because they see a
lot of disadvantages to it or may even fear it. Also, they may feel dissatisfied with their body, but
may not expect to get something better in return by undergoing GCT. Transgender persons with
no treatment desire are often overlooked in research on sexual experiences and therefore deserve
specific attention.

How does someone know that they are transgender?

Transgender people experience their transgender identity in a variety of ways and may
become aware of their transgender identity at any age. Some can trace their transgender identities
and feelings back to their earliest memories. They may have vague feelings of “not fitting in”
with people of their assigned sex or specific wishes to be something other than their assigned
sex. Others become aware of their transgender identities or begin to explore and experience
gender-nonconforming attitudes and behaviors during adolescence or much later in life. Some
embrace their transgender feelings, while others struggle with feelings of shame or confusion.
Those who transition later in life may have struggled to fit in adequately as their assigned sex
only to later face dissatisfaction with their lives. Some transgender people, transsexuals in
particular, experience intense dissatisfaction with their sex assigned at birth, physical sex
characteristics, or the gender role associated with that sex. These individuals often seek gender-
affirming treatments.

What should parents do if their 3 child appears to be transgender or gender

nonconforming?

Parents may be concerned about a child who appears to be gender-nonconforming for a

variety of reasons. Some children express a great deal of distress about their assigned sex at birth
or the gender roles they are expected to follow. Some children experience difficult social
interactions with peers and adults because of their gender expression. Parents may become
concerned when what they believed to be a “phase” does not pass. Parents of gender-
nonconforming children may need to work with schools and other institutions to address their
children’s particular needs and ensure their children’s safety. It is helpful to consult with mental
health and medical professionals familiar with gender issues in children to decide how to best
address these concerns. It is not helpful to force the child to act in a more genderconforming
way. Peer support from other parents of gender-nonconforming children may also be helpful.

How do transsexuals make a gender transition?

Transitioning from one gender to another is a complex process and may involve
transition to a gender that is neither traditionally male nor female. People who transition often
start by expressing their preferred gender in situations where they feel safe. They typically work
up to living full time as members of their preferred gender by making many changes a little at a
time. While there is no “right” way to transition genders, there are some common social changes
transgender people experience that may involve one or more of the following: adopting the
appearance of the desired sex through changes in clothing and grooming, adopting a new name,
changing sex designation on identity documents (if possible), using hormone therapy treatment,
and/or undergoing medical procedures that modify their body to conform with their gender
identity. Every transgender person’s process or transition differs. Because of this, many factors
may determine how the individual wishes to live and express their gender identity. Finding a
qualified mental health professional who is experienced in providing affirmative care for
transgender people is an important first step. A qualified professional can provide guidance and
referrals to other helping professionals. Connecting with other transgender people through peer
support groups and transgender community organizations is also helpful.

What kinds of discrimination do transgender people face?

Anti-discrimination laws in most U.S. cities and states do not protect transgender people
from discrimination based on gender identity or gender expression. Consequently, transgender
people in most cities and states face discrimination in nearly every aspect of their lives. The
National Center for Transgender Equality and the National Gay and Lesbian Task Force released
a report in 2011 entitled Injustice at Every Turn, which confirmed the pervasive and severe
discrimination faced by transgender people. Out of a sample of nearly 6,500 transgender people,
the report found that transgender people experience high levels of discrimination in employment,
housing, health care, education, legal systems, and even in their families

Transgender people may also have additional identities that may affect the types of
discrimination they experience. Groups with such additional identities include transgender
people of racial, ethnic, or religious minority backgrounds; transgender people of lower
socioeconomic statuses; transgender people with disabilities; transgender youth; transgender
elderly; and others. Experiencing discrimination may cause significant psychological stress,
often leaving transgender individuals to wonder whether they were discriminated against because
of their gender identity or gender expression, another sociocultural identity, or some combination
of all of these. According to the study, while discrimination is pervasive for the majority of
transgender people, the intersection of anti-transgender bias and persistent, structural racism is
especially severe. People of color in general fare worse than White transgender people, with
African American transgender individuals faring far worse than all other transgender populations
examined. Many transgender people are the targets of hate crimes. They are also the victims of
subtle discrimination—which includes everything from glances or glares of disapproval or
discomfort to invasive questions about their body parts.
Physiology of transgender
Gender expression

Gender expression, as opposed to gender identity, is what is on the outside. It is how

people express their gender to others.

All people make daily choices about what clothes to wear; whether and how to use or not
use accessories, jewelry, and/or makeup; and how their hair is cut or styled. Most people have a
specific look or style that is personally comfortable. This may also include how individuals walk,
sit, or carry themselves.

In the United States, women and men often are expected to make appearance-related
choices from mutually exclusive sets of options. For example, although women may wear
feminine-tailored clothing, use makeup, have a feminine hairstyle, and act "femininely," these
gender expressions are very rarely considered acceptable for men. Other examples include
separate women's and men's clothing departments, jewelry and watch display cases, and hygiene-
related store shelves.

A growing number of non-transgender individuals are breaking traditional gender norms.

Male goth youth, for example, wear eyeliner and fingernail polish; business women wear
pantsuits without makeup or jewelry; metrosexual men use moisturizing products and get
manicures. Although gender expression is less rigid with each passing year, in large part
expectations to conform to the stereotypes remain in place.

Transgender people may decide to consistently present as male or female in alignment

with societal norms. They may also deliberately choose both male and female gender expressions
and thus have mixed, gender non-conforming, or genderfluid presentation. Some are more fluid
about their gender expression, which they may change from day to day, hour to hour, or setting
to setting either because they feel they have to (e.g., an individual chooses not to transition at
work) or because they want to.

Some transgender people express gender in very traditional or overt ways to better "pass"
as the gender with which they identify. For example, a male-to-female (MTF) transgender person
may always wear skirts and stereotypically feminine blouses, paired with matching earrings and
pristine makeup. A female-to-male (FTM) individual may wear a pressed oxford shirt and tie,
dress pants and buffed shoes, and neatly trimmed short hair. In these cases, there is an intentional
effort to send very clear, gendered messages to others.

Often, as people are in the process of figuring out what feels most comfortable for
themselves, they may experiment with styles and looks. They may later relax into more
comfortable clothes, or clothes that reflect their own personal sense of style, rather than basing
their choices on rigid cultural norms.

Body image can play a role in how people express their gender. Transgender people
generally have an even more uncomfortable or negative relationship with their bodies than non-
transgender people. Some create a literal armor to hide or alter their bodies or to create a
different bodily contour:

 Some FTMs (or other people on the trans-masculine spectrum)—

o Bind their chests.
o Wear baggy or multiple layers of clothing to help flatten the appearance of their
chest.
o Wear self-made or store-bought penile prosthetics.
o Use prosthetics to allow them to urinate while standing.
o Slouch or intentionally gain weight to add mass to their midsection, altering their
feminine contour.
 Some MTFs (or other people on the trans-feminine spectrum)—
o Use breast or hip forms to create a more feminine contour.
o "Gaff" or "tuck" (i.e., pull back their genitals to create a smoother line).
o Wear wigs.
 o Dress in a highly stereotypical feminine way to create an outward appearance of
undeniable femaleness.

Safety can also be a major component of how gender is expressed. More detail about safety is
found in the Passing section of this e-pub.

Hormones

Some transgender people—but by no means all—use hormones as part of their medical

transition. According to the National Center for Transgender Equality's (NCTE) groundbreaking
study of 6,450 transgender individuals, 62 percent of respondents have had some hormone
therapy and 23 percent hope to have it in the future. Hormones are available in injectable, pill,
patch, and gel/cream formats.

Hormones help shift bodies into a more traditionally masculine or feminine form. Using
testosterone, for example, can deepen the voice, activate facial and body hair growth, redistribute
fat, cause the clitoris to enlarge, and may stimulate male pattern balding. Vaginal tissue typically
becomes more fragile and less elastic and may not lubricate easily. The vaginal opening may
become smaller and tighter, especially if the person does not use their vagina for consensual
sexual penetration. Testosterone use usually, but not always, results in the cessation of menstrual
cycles and renders the individual infertile. Using estrogen, progesterone, and anti-androgens can
cause breast growth, reduce body hair, redistribute body fat, soften the skin, cause some loss of
muscle mass, and increase the risk of blood clots, particularly following surgery and in people
who smoke. Although mood swings are a typical side effect of hormones in the first few years of
use, people who use them frequently report that hormones make them calmer and happier.

Because some of the changes from hormone use are permanent, some transgender people
stop using hormones once they have achieved specific physical goals. Others stop for health
reasons or because they become unable to afford hormones (which may not be covered by health
insurance, even for those who have insurance). Others continue lifelong use, which is generally
recommended for anyone who no longer generates their own hormones due to a hysterectomy
(removal of the ovaries and uterus) or orchiectomy (removal of the testes), or due to age (when
hormone levels naturally decline).
 People can acquire hormones from a health care provider or clinic—the safest method—
but they may also get them on the street, from friends, or online (frequently without any medical
supervision or monitoring). Non-physician prescribed hormones are relatively common due to a
lack of access to health care, an inability to afford physician visits and routine laboratory tests, a
preference not to see a physician, or a preference to avoid or an inability to afford psychotherapy,
which a physician may require prior to prescribing hormones.

If people acquire hormones through a health care provider, that provider should monitor
the individuals' laboratory results and physical wellness. Many providers adhere to a standard of
care to guide their treatment of transgender patients, which requires that a mental health
professional also be involved. Most standards of care require that transgender clients participate
in therapy for a time, typically 3 months to 1 year, after which the mental health care provider
will write a letter stating that the client is ready to start medical treatment. This "gatekeeping"
model can create additional challenges. For example, transgender people who visit mental health
professionals may omit certain details about their lives out of fear that they will be denied the
letter required by the standard of care. Past traumas, current mental health issues, or drug or
alcohol use are generally known to have been used as justification for withholding these letters.
A growing number of LGBT community health clinics and individual providers, however, are
moving from standards of care to informed consent models of care, giving both transgender
patients and providers more flexibility, autonomy, and control over the health care process.

The risks associated with medically supervised hormone use are in line with the risks of
many other medications. Routine monitoring, moderate dosing, a healthy lifestyle (e.g., exercise,
healthy diet, adequate rest, low-to-moderate stress), and well-managed medical conditions (e.g.,
diabetes, high blood pressure, other common or rare conditions) help to minimize the risks
associated with hormone use.

Economics, access to medical care, and access to physicians who are willing to prescribe
hormones often influence how and whether people obtain hormones as a part of their medical
transition.

Surgery
 Non-transgender people frequently believe there is one "transgender surgery," which
involves the genitals. The reality is that there is no "one" surgery and that multiple options or
combinations of surgeries can help people change their bodies to be more closely in line with
their gender identity. As with hormone use, health care providers operating under standards of
care may require their transgender clients to participate in therapy before surgery. In fact,
surgeons specializing in gender-related surgeries often require letters from two mental health
professionals rather than just one.

The following data on surgeries were taken from the National Transgender Discrimination
Survey conducted in 2011

 The most common FTM surgeries are mastectomy or chest reconstruction (41 percent)

and hysterectomy (20 percent). Few have phalloplasty (construction of a penis) (2
percent) or other genital surgery (e.g., metoidioplasty and/or construction of testes) (3
percent) because of their high cost and frequent complications, and dissatisfaction with
the results.
 MTF surgeries can involve breast augmentation (18 percent), facial feminization surgery
(e.g., creating a less prominent brow or chin, shaving the Adams apple), vaginoplasty
(creating a vagina) (20 percent), and/or removal of the testes (21 percent). Because of the
danger of attracting anti-transgender violence in public, some transgender women
consider breast augmentation and facial feminization surgeries higher priorities than
genital surgery.
 Genital surgery, as noted above, is far more common for MTFs than FTMs. The
difference in function and aesthetics may be among the reasons for this disparity, as well
as the difference in cost for vaginoplasty (cheaper) versus phalloplasty (much more
expensive).
 On rare occasions, some transgender people who have been unable to access surgeries
due to cost and/or surgeons' refusals to operate have attempted self-surgery to remove
their breasts, penis, or testicles.
 Contrary to popular belief, many transgender people do not feel the need to surgically
alter their bodies. For that reason, combined with prohibitive costs, lack of access, and
worries about functionality and aesthetics, FORGE believes that most transgender people
 do not have gender-related surgery. This underlying belief is supported by the National
Transgender Discrimination Survey's broad sample of transgender individuals and their
experiences and desires with/for surgery.

REFERENCE:

1. Sanne W. C. Nikkelen &Baudewijntje P. C. Kreukels “Sexual Experiences in

Transgender People: The Role of Desire for Gender-Confirming Interventions,
Psychological Well-Being, and Body Satisfaction
Journal of Sex & Marital Therapy . 16 Nov 2017,
2. https://www.apa.org/topics/lgbtq/transgender
3. https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/transgender_physical.html
4.