Transsexual

The word is a subset of the umbrella in the sense the reference works use, but a number of the people it describes reject the umbrella and keep this word instead. The reference works also record what sat behind the word for most of its life: transsexual people were classified as mentally ill, which is the history that produced both the clinical vocabulary and the objections to it.

Where the word transsexual was coined

Magnus Hirschfeld introduced the German Transsexualismus in 1923. David Oliver Cauldwell carried transsexualism and transsexual into English in 1949 and 1950, and appears to have been the first to use the word for people who wanted a change of physiological sex.

The surgical record runs alongside the lexical one and slightly ahead of it. Norman Haire reported that Dora Richter began a surgical transition in Germany in 1921 under Hirschfeld's care, completed in 1930; in that same year Hirschfeld supervised the operation on Lili Elbe, the second such case to be reported in detail in a peer-reviewed journal. The word therefore arrives after the thing it names, which is unusual in this vocabulary and is why the coinage dates and the surgical dates are so close together.

How Harry Benjamin popularised the term

Benjamin claimed in 1969 that he had been the first to use transsexual in public, in a lecture given in December 1953. He made the word general with The Transsexual Phenomenon in 1966, which set transsexual people on a scale of intensities, later called the Benjamin scale: nonsurgical, moderate and high. The scale is the older clinical thinking compressed into one diagram, a single axis with surgery at the far end of it, and it is the shape the later objections are aimed at.

Why transgender displaced it

Transgender was coined by John Oliven in 1965, and by the 1990s transsexual had settled into place as a subset of it. Several pressures produced that change.

Gatekeeping is the first. From the 1950s to the 1980s the medical community encouraged a distinction between the two terms under which only transsexual people were eligible for treatment, and transgender emerged partly to break what has been described as a medical monopoly on transitioning. The second pressure is the objection that the word over-medicalises the experience, or fixes attention on a diagnosis. The third is grammatical: the second element points at sexuality when the subject is gender identity. Christine Jorgensen, the first person widely known in the United States to have had gender-affirming surgery, refused transsexual on exactly that ground and described herself in newsprint as trans-gender.

GLAAD's media reference guide draws a parallel. As the gay and lesbian community rejected homosexual and replaced it with gay and lesbian, the transgender community rejected transsexual and replaced it with transgender. Both replacements swap a clinical Latinate word for an ordinary one, and both leave a minority behind who kept the older term deliberately.

Who still uses the word

Some people who have transitioned medically prefer transsexual and reject transgender. One argument for the preference is that surgery alters anatomical sex while gender stays constant, which is the reasoning behind the variant transsexed; the reference record is careful to note that transsexed and transsexual are not synonyms, because the second covers people who have not had surgery and may never. Another argument holds that people who do not seek surgery have different concerns from those who do; the reference record notes that this view is controversial, and notes the counter-argument that medical procedures do not divide people into categories that distinct.

Style guides answer procedurally. Merriam-Webster labels the adjective dated, often offensive, with a note that transgender is preferred and that the word is sometimes used in self-reference; it marks transsexualism and transsexuality dated as well. GLAAD advises never applying it to anyone unless they use it themselves, and using it as an adjective when they do: a transsexual woman, a transsexual man. The noun form was already deprecated inside the community by 2018, and the adjective is the form that survives. A variant spelling with a single s, transexual, is British in origin and was taken up by the activist group The Transexual Menace, in an attempt to strip the pathologising implication out of the word. The directional abbreviations that grew up beside it, FTM and MTF, belong to the same period and the same clinical register.

Where transsexual still appears in print

Merriam-Webster's file of example sentences is the clearest evidence that the word has not left the language, and it shows the word working in registers that do not agree with each other.

The same file catches the word in ordinary reporting: an artist described as the oldest transsexual woman in Italy, a Polish parliament that in 2011 elected an openly gay man and a transsexual woman, and legislation adding transsexual people to those protected from hate crimes. The word is dated in the dictionary and current in the newspaper.

What Blanchard's typology claimed

The theory attached to this word more than any other is Ray Blanchard's, and it is controversial within the field as well as outside it. Across the 1980s and 1990s Blanchard proposed that trans women fall into two classes: those attracted exclusively to men, whom he called "homosexual transsexuals", and those he called "autogynephilic", meaning aroused by the thought of themselves as female. He built on Kurt Freund, who had argued in 1982 for two types along similar lines, one associated with childhood femininity and attraction to men and the other with fetishism and attraction to women.

The typology inherited an older clinical division between transsexuals, who transitioned, and transvestites, who did not, in which the classical transsexual was imagined as a man with a feminised brain who would be feminine and attracted to men. Trans women's own accounts did not fit that model, and the questioning of it in the 1970s and 1980s is where the typology comes from. Blanchard's use of "homosexual" is relative to a birth assignment, not to a gender identity, and other researchers have called it archaic, confusing, pejorative, offensive and heterosexist, proposing androphilia as a neutral substitute.

J. Michael Bailey's The Man Who Would Be Queen put the typology in front of a general readership in 2003, and the public controversy dates from there. Among professionals who work with transgender patients the typology is often treated as discredited or unscientific. The recorded scientific objections are that it is unfalsifiable, because data against it is dismissed, and that it rated levels of autogynephilia against cisgender men rather than against cisgender women; where the comparison has been run properly, most women, cis or trans, report some level of the arousal at issue. The dispute is over whether such fantasies are the central motivation for one group and absent in the other; that they exist in some trans women is not generally contested. Anne Lawrence holds that autogynephilia produces a female gender identity which then produces dysphoria; Julia Serano holds the order is the reverse.

Where the manuals stopped short

The American Psychiatric Association added with autogynephilia as a specifier to transvestic disorder in the DSM-5 in 2013 and kept it in the 2022 text revision, without describing it as a paraphilia, and neither edition asserts that transgender or transsexual women fall into these categories. The World Professional Association for Transgender Health objected to the addition on the grounds that there was no scientific consensus on the concept and no empirical evidence for it. A 2011 study by Larry Nuttbrock and colleagues interviewed 571 trans women in New York City and found transvestic fetishism reported by 73.2 per cent of non-androphilic and 23.0 per cent of androphilic interviewees, concluding that the differences were statistically significant but indicated strong associations without a rigid division.

What the surveys no longer ask

No major survey now offers transsexual as a response option, so nobody can say how many people use it of themselves. That is a fact about instruments: a word dropped from the answer list cannot be selected, and the absence of a figure is then read as an absence of users.

What is visible is the direction of travel. Dictionaries mark it dated, style guides restrict it to self-description, and a minority of trans people go on claiming it. The word has also stayed in clinical use in places where the umbrella has not fully arrived, which is why a term described as historical in one register keeps turning up as current in another. The reference works add the reason the older register persists: the classification of transsexual people as mentally ill has been withdrawn in the manuals, and the barriers it produced remain in place in many parts of the world.