Tertium non datur– either/or reactions to transsexualism amongst health care professionals: the situation past and present, and its relevance to the future

Abstract

According to the principle of the excluded third (tertium non datur) the gender binary divides our social life into two options only: male or female. Similarly, either/or reactions also seem to be applied by people dealing professionally with issues of transsexualism, transgenderism or related statuses. For instance, the history of transsexualism is characterised by attempts to classify transsexual people hierarchically and descriptively. The primary intention was to discriminate between different types of transsexualism to prescribe hormonal and surgical treatment for 'real' transsexual people and to recommend psychotherapy aiming at relieving gender dysphoria for all the others. In this regard, from the early beginnings sexologists have argued about the origins of transsexualism, because the type of origin -the professionals assumed -legitimises a specific kind of treatment, for example psychotherapy for psychological issues and somatic cross-sex treatment for biological issues. Consequently, psychoanalysts and biologically orientated professionals have debated at great lengths about state-of-the-art treatment for transsexual people. Furthermore, to pass as a 'real' transsexual, most of the people concerned presented themselves in a very schematic way.The main focus of this article is the long-standing history of either/or reactions in health care professionals dealing with issues of transsexualism and related states. In addition, it elaborates on the iatrogenic influence on the behaviour of transsexual people of the biases of health care professionals. Finally, in highlighting perspectives of recent trans theory, conclusions important for the debate of current issues are drawn and ideas for the future of care are developed.

Transgender health care in Germany: Participatory approaches and the development of a guideline

“…Secondly, the patient was suffering from the internal amalgamation of both genders, meaning that, in a sense, postsurgically he would not need an external partner. Following Boss (1950Boss ( /1951, right after the genital surgery, the patient was able to return to live as a father and breadwinner (for details of the debate in reaction to Boss's talk, see Nieder & Richter-Appelt, 2011;T ö pfer, 2012).…”

“…So far, transsexual individuals have only had the opportunity to change their gender role and their sex characteristics either from male to exclusively female or from female to exclusively male. Around the turn of the millennium, transgender health services have been used increasingly by individuals who on one hand experience their gender as incongruent with their sex assigned at birth, but on the other hand intend to perform no or only selective physical changes and wish to live fl uctuating between the established gender roles (Nieder & Richter-Appelt, 2011;Scheim & Bauer, 2014;Sigusch, 2013). Therefore, the term transgender is used to recognize different binary and non-binary as well as variable manifestations of transgender states.…”

Non-binary or genderqueer genders

“…However, it is very likely that they were not distinguished as such but were instead diagnosed as having a gender identity disorder not otherwise specified by gender teams at medical centres; and have only become increasingly visible in recent years (Hage & Karim, 2000, Nieder & Richter-Appelt, 2011). An analogy may be drawn with the number of lesbian and gay people who became able to identify their sexualities within contemporary Western societies when the possibility to do so became more available and the identities became more widely understood and accepted.…”

Sexual health service providers’ perceptions of transgender youth in England

“…As previously described, anchoring is the process of fitting a less familiar idea into one's preconceived framework of social representations. The common social representation of gender is that people are either male or female (Butler , Nieder & Richter‐Appelt , Joel et al . ), while transgender is less familiar.…”

“…As previously described, anchoring is the process of fitting a less familiar idea into one's preconceived framework of social representations. The common social representation of gender is that people are either male or female (Butler 1990, Nieder & Richter-Appelt 2011, Joel et al 2013, while transgender is less familiar. By perceiving transgender youth as simply transitioning to the 'opposite sex' service providers are fitting transgender identity into their familiar binary representation of gender.…”