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Harry Benjamin's Syndrome :

Retrospective
and Terminology issues

 

 
 
 
by Charlotte Goiar

Copyright @ 2005-2007 All Rights Reserved

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Contents

From Transsexualism to Harry Benjamin's Syndrome.
 
The Problem of Terminology.

Transpeak Terminologies.

Practical and definite Terminology and its meaning.

HBS: Where did it all start?
 

Constantly updated.


F
rom Transsexualism to Harry Benjamin's Syndrome.
 

Magnus Hirschfeld introduced the term transsexualism in 1923, and first labelled the condition as "psychic transsexuality". He delivered the first scientific lecture on transsexuality in an address to the Association for the Advancement of Psychotherapy in 1930. Hirschfeld considered transsexuality to be a form of intersexual condition. Later, Caldwell called it "pyschopathia transexualis" in the late 1940s. However, it was not until the 1950s that Dr Harry Benjamin introduced the term to wider medical circles.

Dr Harry Benjamin was a pioneer into the research of this condition, and he believed that it had a biological cause. This was also the contention of Dr Hirschfeld, the originator of the term. There was a great need to distinguish this condition from transvestism and homosexuality, and the term transsexuality seemed adequate to the task. Unfortunately, there was a great amount of ignorance concerning the origins of this condition, but medical professionals did at least start to talk responsibly concerning the transsexual phenomenon.

However, there was a basic difference between Hirschfeld and Benjamin. Hirschfeld considered transsexuality to be a form of "third sex", and connected it to his defence of the rights of homosexuals. On the other hand, Dr Harry Benjamin considered it a physiological condition that merely needed the modification of the phenotype and endocrinology to bring accord between the neurological gender and the anatomical genital structures.

Dr Harry Benjamin paved the way for a better understanding and recognition form the international medical community. Without his deep compassion for more than a thousand patients, without his engagement in academic and professional circles, and without his numerous lectures and publications, treatment for HBS might not be as available as it is today. Dr Harry Benjamin shed light upon the topic as no previous doctor had, and his professional biography is the most prominent in the history of the treatment of transsexuality.

In the past, doctors considered HBS to be a psychopathological condition where an individual had delusions of being of the opposite sex. Practitioners considered the condition aberrant, and many considered it an "unexplainable" fancy. (see Caldwell, Pyschopathia Transexualis, 1949)

However, there has been much detailed and technical research in the last two decades devoted to the origins and treatment of HBS. Researchers have concluded that HBS is a physiological condition, and there is no link to psychopathology whatsoever. Today, the term 'transsexualism' is outmoded in its' ability to properly describe the condition.

Research now documents the fact that neurological events undergird the existence of HBS. The old psychological construct known as transsexualism is now passé. Thus, those with HBS have the objective neurological gender identity of their sex of subjective identification.

Recent studies tell us that neurological gender identity, not anatomical genital structures, determines the actual sexual identity of an individual. Therefore, someone born with HBS is already a member of the "opposite" sex. This overturns the term transsexualism because there is no "change of sex". Rather, one only does corrective surgery on physical structures.

Someone with HBS is already a member of their identified sex biologically, as their neurological structures are of the identified sex, not of the genital sex. Simply put, their neurological sex is opposed to that of their genital sex.

Therefore, we see that HBS is actually an intersexual condition, and the old idea of transsexualism becomes outdated. The idea of a neutral and physiological neurological basis for the conundrum replaces the obsolete idea that transsexualism was a psychological disorder.

Thus, we see that HBS is not a personality aberration or a mental orientation towards a particular sexual identity. Such a physiological condition demands early diagnosis and treatment, so that the affected individual can live a normal and adjusted life. One cannot delay it for reasons of "psychotherapy", which is of dubious utility in any case.

Doctors once thought that schizophrenia and manic-depressive Disorder were mental illnesses. Today, we see them as physical diseases of the brain structure, which we treat with the appropriate medication to correct the chemical imbalances that cause them. We see the same phenomenon in the current thinking regarding Parkinson’s Disease and Alzheimer’s Syndrome.

Likewise, experts now consider that HBS is not a mental disorder, but rather a natural and biological variation of human sexual identity. It is an intersexual condition where the morphological sex of the brain is in conflict with the phenotype and genotype. We can treat it with the proper hormonal intervention and surgical modification of the anatomical genital structures.

The old term of transsexualism urgently needs a radical revision. We must leave the old superstitions regarding HBS in the past. Too many negative connotations surround transsexualism: stigma, superstition, media distortion, and back-alley medical treatment. It does not describe the somatic condition adequately, and so we must discard it at the first opportunity.

We have a responsibility to bring the facts to light. We must stop the continual sensationalism in the mass media, and we must do our part to halt the spread of misinformation concerning HBS. Only then, shall we see HBS as it is in reality: a neutral and somatic condition, no different from any other physical condition.

 







T
he Problem of Terminology.
  

The question of the proper terminology we use to describe our condition is the greatest problem that must be attended to by people with HBS. What is our identity as a group? Who are we? What shall we call ourselves? What do we consider ourselves, and how do we introduce ourselves to others?

To achieve full social assimilation into the gender role of physiological reassignment we must first sharpen our perception of ourselves as we are in actuality. One of the main factors in this process is the proper terminology used to define our condition.

At present, definitions that are inadequate in both medical and intellectual terms are in use. Although these formulations had some currency when they were first proposed, they have lost all validity today. The very methodology of treatment appears to be in a state of flux now, and people may even use several different (and often contradictory) constructions to describe themselves.

The confusion regarding terminology is most serious in the various forms of the popular mass media. Most of this material is not serious in tone, nor does it focus on any of the actual problems of the condition. We should keep in mind that these media are entertainment vehicles, modern equivalents of the Roman panes et circenses.

This chaotic disorder appears to be this forum’s typical reaction to any serious medical concern, but as far as HBS is regarded, the mass media and its’ anointed spokesmen give it only smirking and prurient treatment. Perhaps, we should not expect much from a medium that glorifies the likes of Dr Phil and Dr Laura.

Let us look at some of terms that are currently in use, or may be adapted in the future.

 



Harry Benjamin’s Syndrome (HBS)

The title HBS comes from Dr Harry Benjamin, a pioneer in the serious research of this condition. More than any other single figure, Dr Harry Benjamin initiated the systematic and regular treatment of HBS (then called transsexuality). His career is the most prominent in the history of treating HBS to date.

The formerly know as HBIGDA (Harry Benjamin International Gender Dysphoria Association) also used his name. It produces the Standards of Care followed by medical practitioners who treat HBS.

Of the terms in use at present, Harry Benjamin's Syndrome is the most neutral, and the freest of any pejorative connotations. Most other current terms are simply inaccurate or inadequate.


 

Transsexualism/Transsexual(s)

The most common and well-known term for HBS is transsexualism, which the German sexologist Magnus Hirschfeld coined in the 1920s. There are several serious problems with this construction. Including "sex" in the name attracts undesirable attention. This has strong implications of connections with sexual orientation, which simply do not exist.

It is much too similar to "transvestism", which is a completely unrelated phenomenon. Men who receive a sexual frisson from wearing female clothing have nothing in common with men who were born with female anatomy, and are therefore in inner turmoil as a result. There is enough superficial similarity between the two terms to cause much confusion in the minds of the simple.

In any case, transsexualism is a badly defined term. To use transsexual as a noun is dehumanising, leaches people with HBS of their personality, and makes it easy for the bigoted to think of them as being "other", "weird", and "perverted". People with HBS have a particular medical condition, it is not the basis and ground of their identity, and we should not see them as "laboratory specimens" or "circus freaks".

The adjectival use is hardly better. People all too easily construe "transsexual man" or "transsexual woman" as "false man" or "impostor woman". Many are confused because of this term as to the proper term to call a person with HBS. They wonder whether they should address them as "man" or "woman". This is the source of such vile constructions as "he-she".

After a childhood spent in the wrong social gender, and being in much confusion consequently, a person with HBS is most in need of consonance in their psychophysical identity. The driving need in one’s life becomes the achievement of congruence between neurological gender and anatomical reality. At the same time, there is a desire to leave all sexual ambiguities behind, to have wholeness in the gestalt of body, soul, and mind.

It is diabolically cruel to affix the label of "transsexual" onto a person for the rest of their life. They do not engage themselves in a life-long journey between the sexes; it is only a temporary stage on the way to total personal congruency. This usage of transsexual clearly suggests and implies that the person involved is never a true man or woman, but rather a pariah and on a perpetual pilgrimage between the sexes.

Whenever the term "transsexual man" or "transsexual woman" is used, the strong implication is that they are not truly men or women. It matters not if the person involved is at peace because they have finally reached congruence or if their personal appearance is well within the bounds of their sex.

This term robs the person with HBS of full completion, it steals the peace of congruence, and it smirkily informs one that no matter how much one tries, you shall never be allowed to end the perpetual wandering of transsexuality. The continual accusations never give you rest, and you shall never be finally safe at home, in concord and harmony.

This is ironic, because we live in an age where we can correct the physical anomalies completely. This is cruel because the time of transition is only a year or two at most, but as long as one is a "transsexual", many shall never allow you to reach the far shore.

You must stay anchored out in the harbour, and only hear the laughter and joy of others ashore in the city. You must wear a placard about your neck proclaiming your status, ring a bell loudly, and shout, "Leper, Leper! Unclean, unclean"! as you make your way amongst the crowd.

The term transsexual comes from two Latin roots. "Trans" is a prefix that means through, across, beyond, or to change. "Sexual" is a verb that comes from the Latin sexualis, which means anything associated with sex or the sexes. We can see where the original derivation of the word came from. It referred to someone who was in the process of moving between the two sexes.

It is unfair to burden people permanently with labels that are no longer appropriate or applicable once changes are made, obstacles are overcome, surgery is finished, and they have taken their place in society in their proper gender. If you must give a classification, let me suggest two: "man" and "woman". Full stop.

Dr Harry Benjamin wrote:

"The term transsexualism may prove to be inappropriate if it should ever be shown that an anatomically normal male may actually be a genetic female, or at least not a genetically normal male. In such event, we would be dealing with a transgenital desire instead of a transsexual. "

The Transsexual Phenomenon (the Etiology of Transsexualism), 1966

Harry Benjamin MD


By transgenital, Benjamin was referring to a form of intersexual condition. Recent research has corroborated this early hypothesis of Dr Benjamin. A team headed by Vilain in 2003 pointed out this very differentiation.

Moreover, the neurological-sexual differentiation as a biological marker existent in all with HBS has been confirmed by Dutch scientists (Kruijver, 2000). This proves the physiological and intersexual nature of HBS.

If HBS is a pre-existent neurological condition, transsexuality loses all its’ validity as a definition, for in such a case no one is "changing their sex" at all. One can change physical body structures, but one can never change one’s neurological gender. If such is so, no one is "trans-ing" anything.

If one looks in the dictionary for the definition of the term transsexual, one finds the following:

  • a person who has undergone a "sex-change" operation

  • a person whose sexual identification is entirely with the opposite sex

  • overwhelmingly desirous of being, or completely identifying with the opposite sex

These are all adjectival usages.

None of these definitions fits people with HBS, at least in the sense of being scientifically rigorous, medically accurate, or intellectually precise. Therefore, people with HBS do not fall into these categories. This means that people with HBS are NOT transsexuals, in any sense of the word. What do we call people with HBS? Why not simply "people with HBS in their medical history"?

Today, most people living with HBS have found the term transsexual to be awkward and uncomfortable, and do not wish others to address them as such. Let us admit it, this construction is sleazy, outmoded, and inaccurate. It has no future, save in certain restricted uses in zoology.


 

Transsexuality

One of the terms with the greatest amount of pejorative meaning and stigma attached is Transsexuality. Although it sounds similar to the above construction, it is actually a distinct designation. Some call it a "lifestyle choice" or the expression of an aberrant personality. It is the term with the greatest stigma attached for the person with HBS.

The finding of physiological indicators and the consequent change in terminology have liberated people with HBS from the cruel grip of this term.

The only legitimate usage of the word "transsexuality" is in the field of zoology, where it applies to animals, not human beings. It refers to the fact that certain species of amphibians can change from male to female, or vice versa, as environmental needs demand.

People with HBS do not "change their sex", nor do they become members of the "opposite" sex. People with HBS already are members of their aspirational sex through the fact that their neurological structures are organised accordingly. Please, remember that gender is a fixed quantity, it is immutable, and we cannot change it by any method medical or psychological.


 

Gender Identity Disorder

Two other terms, Gender Identity Disorder (GID) and Gender Dysphoria, seem to be suitably clinical and objective in tone and meaning. Unfortunately, many construe their definitions in such a way as to identify HBS as a psychiatric condition. This is emphatically not so, for HBS is a physiological condition and can only be treated by using conventional medical methods.

We should note that the psychological problems that many with HBS suffer are not central and essential to the condition. The pressures of outside society or the conundrum of the dissonance existing between the neurological gender and the anatomical genital structures causes them. Therefore, we see these personality conflicts for what they are, incidental and peripheral to the question of HBS.

To put it another way, to argue that HBS is primarily psychological in origin is ontologically unsound, and not in accordance with scientific method. This syllogism is specious, and all that advance it have no objective evidence to document it.

Do we treat influenza by sending sufferers for psychotherapy? Of course, we do not. The same applies here, for HBS is, at root, a physiological condition.

There is a minor role for psychologists in the process of diagnosis of HBS, and we can use them to weed out unstable candidates for GRS. Otherwise, their role is purely peripheral and minor.

All attempts to change a person’s gender identity through psychotherapy have proved spectacular failures, for how can mere talk affect neurological structures? That would be as if we tried to treat a blocked artery in the heart by sending the person involved to see a psychotherapist for a year before one could schedule surgery. That is absurd.

Finally, these terms imply that people with HBS are mentally ill, deranged, demented, or suffer from delusional fantasies. This is why we must abandon this term completely and immediately.


 

Transgender

This all-inclusive term has gained currency in recent years, especially amongst those affiliated with homosexuals. It covers everything from casual cross-dressing, female impersonation, severe transvestism, psychological transsexualism, autogynephilia, and actual HBS sufferers.

This far too broad a characterisation to be useful and it is not precise or clinically discriminating. It implies similarity in actions that have no relationship whatsoever. Since it is nebulous and vague in meaning, it ends by telling you nothing about a particular individual.

My own opinion is that all others in this umbrella category are using the arguments for HBS to undergird their arguments in favour of their specific psychopathology. In effect, they attempt to ride upon the backs of those with HBS to gain sympathy for their cause.

In terms of numbers, people with HBS are perhaps only 1% of this group. We are silent in comparison with the often loud and strident "transgendered activists". Therefore, one can see that much of the misconception in the public perception of HBS comes from those who do not have the condition in the first place.

All people with HBS should distance themselves from "transgenderists" completely and totally.


 

Sex Affirmation Surgery (SAS)

This term is preferable to the terms Sexual Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS). SAS is the most precise medically.

It highlights the fact that the surgeon only makes corrections to anatomical structures. This procedure is emphatically not a reassignment of gender (for that is immutable), nor is it a reassignment of sex (for that occurred during the process of preliminary HRT).

This surgery brings congruence between neurological gender and anatomical genitalia, so the title Sex Affirmation Surgery is not only medically precise, it describes for others what the surgeon has done. He has not changed sex or gender, he has merely fixed a physical structure.

We must always keep our language regarding HBS precise, clinical, and objective. This is what shall gain us support in the larger community.

There are other terms in use for HBS, but they are colloquialisms, slang, or rude usages. They merit no discussion here.


 


Transpeak Terminology


Transpeak
is the language of transworld.

Transpeak Terminology refers to all words with "trans" in their structures or definitions.

Examples of Transpeak Terminology are:

transsexual, transsexuality, transition, pre-op, post-op, non-op,
MtF, FtM, transwoman, transman, transgenderist, translife, transex,
trans, tranny, cross-living, new man, new woman, pass, passing,
transproud, T-friendly, T-love, transphobia, TS, transsexual woman,
transsexual man, femme, butch, getting read, and many others...
 

We strongly recommend that you NEVER use Transpeak Terminology to refer to yourself or others. It only spreads the misconceptions that are already current in society.

We have HBS, a physiological condition: nothing more.

 







Practical and definite Terminology and its meaning.

 


Harry Benjamin’s Syndrome (HBS)
is an intersex condition that develops before birth involving the process of differentiation between male and female. HBS occurs when the brain develops in the manner of one sex and the rest of the body develops with the characteristics of the opposite sex. The sex indicated by the phenotype and the genotype opposes the morphologic sex of the brain.


Persons with HBS
are people who have Harry Benjamin’s Syndrome (HBS), a purely physiological condition. They are simply men or women. Such people are born with the characteristics of both male and female. In common with others who exhibit atypical sexual development, they desire to modify their phenotype and endocrinal system to correct it to their dominant sexual identity, an identity that is determined by the structure of the brain. The person with HBS does not change sex, as gender identity is fixed at birth, and the medical treatment involved is only physical correction.


Transsexualism (TS), Gender Identity Disorder (GID), or Gender Dysphoria is a mental condition that consists of the desire to live and to receive acceptance as a member of the opposite sex. Do not confuse this with HBS, as it is not medical. Feelings of malaise or discord with one’s anatomical sex and desires to obtain surgical or hormonal treatment to modify the body to agree with the desired sex usually accompany it (ICD-10 F64.0/ DSM-IV-TR).


Persons with Transsexualism, GID, or Gender Dysphoria (also called transsexual or gender dysphoric) are people who have Transsexualism (GID), a very serious mental condition (ICD-10/ DSM-IV-TR). Such people do not have HBS, as they lack the physical markers of the condition. In addition, we apply this term to people when they "change sex" or alter their sexual characteristics, or when they change their public sexual identity. On the other hand, as the word indicates (trans-sexual), it designates people who move from one sex to another or it indicates the process of such movement. Given the great variety of people with diverse psychological-sexual problems that self-define themselves as "transsexuals" today, the term "transsexual" has lost its (confused) original meaning, and has now acquired a new meaning that is interchangeable with the term "transgender" (for more on this term, see below).

 

Transsexuality is a phenomenon that occurs in the animal kingdom (e.g. certain amphibious, oysters) that consists of a change of natural sex in the species. Popularly, we apply it also to humans when speaking of people who "change their sex".  "Transsexuality" is a generic term that applies to all kinds of species and variations, while "Transsexualism" is a much more precise medical term, which we should use exclusively for people with the condition of Transsexualism (now, better defined as Harry Benjamin’s Syndrome).



Transgender Persons (or transgenderist)
are people whose gender experimentation or expression of gender differs from the accepted social conventions. A transgender person can be a transvestite, a transsexual, or anyone who manifests certain qualities that do not correspond with the characteristics traditionally associated to the sex of the person.

 






      
  
HBS: Where did it all start?
   
 
 

After groundbreaking studies in the Netherlands in the 1990s, many physicians are now considering HBS an intersexual condition with physiological origins.

At the same time, the so-called "transgendered" movement became ever larger and diffuse as more disparate and contradictory groups joined it. Moreover, people began to employ many new terms instead of the designation "transsexual".

Some of these new usages were Gender Dysphoria Syndrome, Benjamin Syndrome, and Transsexual Dysphoria. This has led to a serious lack of uniformity and scientific precision in the definition of HBS.

As the transgendered category became ever broader, people with medical transsexuality became merely a sub-set of this group, and this jumbled together individuals with genuine medical conditions with those who merely wished to exhibit "gender-variant" behaviour.

Another cause for anxiety was that the transgenderist movement tended to confuse the legitimate medical concerns of those with HBS with the political agenda of the homosexual lobby.

People with the classical form of medical transsexuality felt misplaced in the new transgenderist movement and alternatives to it began to arise. In the 1990s in Paris, a group began to call the condition "Benjamin’s Syndrome" (BS).

Unfortunately, they developed a model with a psychiatric definition, and this group ultimately rejoined the transgenderists. In Europe particularly, the initials "BS" have become attached to all sorts of homosexual and transgenderist organisations.

In time, activists attached this term to a plethora of possible causes for HBS, but they rarely, if ever, acknowledged that it was an intersexual condition with a neurological origin. The often attributed the cause of HBS to hormonal considerations, or to some yet-undiscovered "X-factor".

Aware of the confusion surrounding the condition, and tired of the resulting chaotic discussions in transsexual circles, in the summer of 2005 Charlotte Guren in Spain decided to attempt to popularise the term "Harry Benjamin’s Syndrome" (HBS).

Her concern was to keep the definition focused upon the intersexual and physiological nature of the condition, and try to keep the concerns of those with HBS distinct and discrete from those of the homosexual and transgenderist lobbies. This was a new and unprecedented development in the understanding of HBS.

This term became more widespread in use in Europe, North and South America, and Australia. This definition has garnered bitter opposition from homosexual and transgenderist groups, and those allied to them. People such as Alejandra Victoria in Argentina picked up this idea only months after it started for this definition finally separated people with HBS from those whose agendas were inimical to a proper medical understanding of the condition.

HBS as a term is still a "work in progress", but it remains the most objective and unpejorative term available today.

 

 

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Charlotte Goiar Copyright @ 2005-2007  http://shb-info.org  All Rights Reserved