Ok... I have just finished reading this article and this is my immediate reaction. That is a fair interpretation of the condition and an answer to the question which was posed. I find it uncannily close to my own perception and feelings with regard to this subject. The facts as we see them were clearly laid out but, I am pleased to say, not without compassion. Compassion for those who do not have HBS but who, nevertheless and for whatever reason, feel compelled to deviate from accepted gender norms. I have no right or wish to sit in judgement upon them.

Permit me to extend this thought a little further. I never liked the term transsexual, simply for those three letters "SEX" and the connotation probably associated in the minds of society although, in reality, there is little wrong with its etymology. What then of the labels applied to TG? Probably one of the "nicest" was secondary transsexual but even that implies second class. Some labels are even more uncomplimentary, such as "fetishistic transvestite". Who can blame people for balking at such a term being applied to them? Perhaps if a term was found, which the TG etc. could "live with" they would not feel the need to compromise the integrity of HBS by erroniously claiming to suffer it.

Kaye

Someone actually wrote a lengthy piece on my life condition in which I can find nothing to dispute (including in the sidebar).

Nice work!

Sharon makes it seem all too easy. Overweight? Just lose the weight! Not enough money? Get a second job!

It isn't necessarily all that easy for people to lose weight, and there are people out there for whom bariatric (weight loss) surgery risk is too high for a surgeon to operate. I have sadly been losing the same 20 pounds trying to lose the 100 I would need just to overcome that one obstacle - and then there are things like a heart condition that still make for a surgical down-check. I'd sign a waiver to have SRS anyway - if any of the surgeons would accept the waiver.

I personally don't have the money issue (I already have my surgery fund saved up) - but I do believe it's somewhat cavalier to dismiss the money issue with a wave of the hand and advice to get a second job. That may be great advice to middle class white folks, particularly those who are early in transition and haven't started suffering collateral damage of transition-related job loss. There are minority folks who already have one strike for being a minority. Some have a second strike for being undocumented (and afraid of deportation to some South American country where they might get killed for being who they are) (And yes, I know that there are cases where the US has granted asylum - one in particular to a trans woman who founded a trans rights group in Argentina - but the risk of deportation is still high for many of them.) For them, getting any job at all is tough. Then there are cultural barriers - those who resort to sex work to stay alive are often pumping auto grade silicone to "transition" their bodies and shooting up with black market hormones - all using shared needles. HIV infection in this group is at 50% or more in New York City, based in part on the shared needle issue.

What works as a means t separate the "real" people with HBS from people who don;t have HBS, for middle class white people (at least those without medical complications) seeking transition, does not necessarily work in that particular milieu.

I also know of people who have put off surgery for other reasons. It isn't as if they don't want and even desperately need it, it's just that they have decided on other priorities - keeping a family together in one case, or continuing their work, in another. (The latter example I am thinking of is Denise Brennan, former Catholic priest, who was quoted as stating she had severe dysphoria from her mid-40's but struggled to keep things in check until she retired from the priesthood 20 years later - *then* she transitioned and had her surgery. One can't say that Denise did not have HBS while she was delaying her transition - or can one?)

I do believe that there is some truth in Sharon's observations - if one has HBS, the need to complete a transition to the extent humanly possible can be used as a litmus test. I know people who do not want surgery and are perfectly happy being physiologically somewhere "in between." While I wouldn't necessarily leave them in a completely separate category (Harry Benjamin himself did not), I can understand the desire on the part of some to create separations and distinctions between an "us" and a "them." Some would deny a line altogether, and that is also not a good thing (we are, after all, *not* all the same). I think Sharon unnecessarily draws the line too narrowly.

Hi Kaye! The column, of course, was an answer to a questioning comment. However, it raises a number of interrelated concerns.

One concern is the way transgenders are often discussed solely in terms of their extremes.

There exists an unknown number of transgenders, perhaps the majority, that have nothing to do with cross-dressing per se or fetishism. They simply happen to be read as either effeminate males or masculine-seeming females.

They really aren't any different from many of the people you can see in a large urban grocery store on Saturday aternoon. And most of them have nothing to do with transgender activism. Like most people, they just want to get on with their lives and do so without discrimination.

Then there are the people - again, not CDs or TVs - who are intimidated by the workplace and social scene and view themselves as gender transgressive even if they lie well within gender norms (i.e., passive male or assertive female). Many are in the ranks crowding under the TG Umbrella for emotional protection.

Yelling at the "Transgenders" seems problematic to me, given that TGs are not exclusively the cross-dressing males, but include a lot of other people. Granted, the most vocal of the activists most often are CDs and TVs, but there are a lot of other people crowding under the umbrella.

And let's add in another group, germaine to the focus of our column. We know there are some post-ops that also set forth as Transgender. I am not talking about AGs, but regular 'ol HBS/TS. It is only partly due to a confusion of sex with gender, conflating them into a gender spectrum.

It also has to do with their social connections, often forged early in transition. This is fascinating, given that the vast majority of post-ops we know are glad to leave that phase of their lives well behind them.

We also know of a surprising number who seldom if ever use the phrase classic transsexual any more. They think it is a rude put-down of the CDs, etc. (rather like HBS). Some times people use the term for clarification: "Yes, I am a transsexual, but my therapist and I knew right away I am a classic transsexual. That is, not trapped on the spectrum.

Everyone deserves respect and compassion. It would be nice, though, if we could all just be who we are without encroaching on others.

Hello, Joann. It is always good to have you here.

I think we covered most of your points in the column. There is one thing, though, that needs immediate clarification. You said:

... I can understand the desire on the part of some to create separations and distinctions between an "us" and a "them."

I do not see it as an "us" and "them" (which naturally leads to inclusion vs. exclusion). As we have said, it is simply a matter of focus. One can be a cross-dresser and have no more medical problems than other people.

We can share the same general health status with the cross-dressers but a simple fact remains. We have distinct additional medical needs they do not have.

In my view, that isn't a "line" (which I take to be social in nature). Rather, it acknowleges an urgent physical reality faced by all HBS-born.

I agree about distinct additional medical needs for those who are postoperative. For that matter, there are distinct additional/different medical needs for those who are pre-op (even if they are not surgery-tracked because of real barriers, as opposed to "non-op by choice") compared with those (including those who are "non-op by choice") who "cross dress" without HBS. Some of the differences in needs change as one progresses through surgery.

Even if we are limiting the discussion to the medical condition aspect of HBS, the "line" should still be seen as more fuzzy than the one you seem to be drawing.

Still, I'm glad of the "no us, no them" statement - I do appreciate the clarification.

It seems to me that those who find difficulty with HBS born are those who accept the transgender identity in the first place and use any and all excuses not to have surgery. I have no problem with that as long as they simply identify as being something 'other'. And let us understand that Dr Benjamin used the term 'primary transsexual' which of course excluded the 'transsexual transvestite'...(use whichever of the last two in conjunction as an adjective and the other as the noun. It makes no difference as I see it).

The need to separate from 'sex' as if a dirty word is escapism. I did correct my sex and am not one iota ashamed of having done so. I am also a heterosexual woman and not at all ashamed of that either. I almost went bankrupt; I lost my career; I lost many 'friends' and even family; I faced dread and most of the material 'rewards' I had accumulated.

But I succeeded in being what I had to be: a woman.

To use those threatened losses as an excuse for not driving forth to have corrective surgery is simply what it is: an excuse and a lame one for it covers what I see as simply a fabrication. If comfort is your choice then remain what makes you feel comfortable and don't make imposing claims of like identity upon those who did what needed to be done. Be yourself without confusing others about what and who you really are. Is that asking too much?????

NO! If one does not harbor the need to have corrective surgery from before puberty then I suggest they are any one of the 'trans' elements but they are not HBS born. If one claims a medical problem that accompanied age then NO, they are not anything but that oxymoron...non-op trans-sexual...or connected to that other one...trans-gender.

How can I say this? I was born with a congenital heart defect and also had abdominal bleeding threats as well. Could I have claimed non-op status and be accepted for doing just that. YES, I suppose could have! But, what was most important to me was to live a life whole and not fragmented and that was in total disregard to the threat of losing my life by undergoing surgery. That now allows me to claim with honor HBS born, a now corrected condition.

To claim womanhood while keeping your male birth genitalia is a fabrication undermined by a socially constructed disordered concept of acceptance to which I will never be a part. I am not a woman with a penis...I am both a woman mentally and physically so if you claim yourself to be otherwise then I must claim that NO, you cannot be HBS born if that is your elective no matter your manufactured reasoning.

The confusion did not exist when only two terms were used: transsexual or transvestite and/or transgender. Now, since we elect to separate ourselves from those who have joined us to porn or the wannabee's who opt to extend their compulsions to include surgery, (i.e. the AG's), are we being attacked as being elitists. No, that we are not but we do claim distinction not a part of a social construct but instead to the truth from which we take our life giving cue as we now identify as an intersex birth condition.

We were born and not created by a social order and we do not make claim for a choice as an extension of our wants. We NEEDED to transition to a conclusion; we did not use excuses so that we might be able to claim allegiance to those born HBS who never used the status of lifetime pre-op or non-op as a cover.

Diane, HarryBenjaminSyndrome.org

As I would have the transgenders let me self-identify as HBS, I would let the transgenders self-identify as they wish. I would not do to them any different than I would have them do me.

I would love my neighbor as I would love myself. If we cannot love one another, what purpose is there in all of this? I would hope that we are more than clanging cymbals.

I have been contemplating the column and some of the responses. Surely, there is no question that should not be asked. The responses may well emphasise a fact or imply to an obvious answer but this can serve a useful purpose.

Let us assume that we agree about the definition of HBS. This being, in non-rigorous terms, that we have a pre-natal neurological birth defect, which renders some of our physical attributes incompatible with that neurological programming. Perhaps we can also agree that it is not possible to change the neurological programming, so correction of the respective physically incompatible aspects are the only medical solution.

The question then implies certain consequences of the above, by the words "A bridge too far" and "necessary". In terms of a resolution of our condition, transition and corrective surgery are, virtually, by definition, the only means.

As with treatment for many medical conditions there are decisions concerning whether to proceed and when. This is in spite of confidence in the diagnosis and the effectiveness of the treatment. The when may also be affected by relatively prompt privately funded treatment compared with the waiting time for publicly funded health services.

So it may reasonably be concluded that "transition and corrective surgery" is "necessary" for the treatment of HBS; one might substitute "essential" for "necessary". This would seem to eliminate the "bridge too far" concept. In this context, the expression "bridge too far" is perhaps an oxymoron. These conclusions do not solve the problem of funding. The "when" is an aspect involved with many personal circumstances and does not undermine the necessity.

A more difficult aspect, associated with the "when", is when in terms of the age of the patient. There has been much discussion about treatment of young people. There does not appear to be a totally satisfactory answer. I can only say that my only regret is never having been young. I am in no doubt that the earliest possible treatment would have transformed my life. That life would have been different due to the place of women 75 years ago, but I am convinced, it would have been just as successful. This constraint has much less significance now.

Bernadette

When I asked this question I did have an opinion about what I felt was a correct answer.

The answer I received is very much the answer I expected, and no it is not in full alignment with my believes.

Before I give the answer I had hope for and no this is not the answer I had hoped for, let me clarify who I am a little.

I am a woman in transition. I entered into therapy in February 2007, and was diagnosed with HBS/GID. In July 2007 started living full time as who I know I am. I started on HRT in October 2007 and see my transition to full a full woman taking place within the next 5 years.

On July 4th 2007 I stared a group on a dating site I am on to help others who self identify as other then the physical appearance would indicate. There are many in this group who do wish they could transition and yet feel that at this time transition is well out of their reach for various reasons. The fact that many do not or cannot transition does not preclude them from being treated as the men or women that they feel they are or choose to identify as in the group.

As for my own personal belief of whether or not someone is HBS/TS is that they and they alone know the answer. Do all who are HBS/TS need to transition to bring who they are into congruence. No I do not believe that is necessary. We have been around for to long for me to believe that it is the only answer. Ever culture makes mention of us throughout their histories, and most held us in high esteem. So my personal belief is that yes transitioning does make our live easier for us to accept who we are, but it is not necessary for all who are HBS/TS. I believe that it is also possible that some may be fully HBS/TS and at the same time find that they need not transition, this does not make them any less man/woman on the inside it just makes them different then those of us who do feel that transition is what we needed to make the best of our lives

Thank you for returning to review the answer Lisa Thompson and I gave to your question.

We chose to write an extended answer to your question because, as we said at the begining of the column, We received a thoughtful response to a Global Warning column by Lisa Thompson ... A visitor posed a well constructed question. We still feel that way. Moreover, the question is an important one, and of general interest to our readers.

There is a lot of information and supporting discussion in the column, but let me hone in on a couple of your comments and reemphasize our position.

Do all who are HBS/TS need to transition to bring who they are into congruence. No I do not believe that is necessary.

We wouldn't have any comment on that statement except for the invocation of HBS. The descriptive phrase, Harry Benjamin Syndrome (HBS) was developed to deal specifically with those of us who drive toward full correction of the mialignment of our innate neurobiological wiring and external genitalia.

As we said in the opinion column, there are a number of valid reason why correction might be deferred, but the work toward achieving surgery and beyond does not stop. We fully recognize that some may run out of time and not make it in the end.

The term transsexual has been expanded and adopted by a lot of people who will not strive for correction. That is why some folks use true transsexual. We respect the intentions of those who use true transsexual and understand what they are trying to say. We have friends and associates who prefer the term, but we do disagree on pragmatic grounds: we don't think it works in practice.

... yes transitioning does make our live easier for us to accept who we are, but it is not necessary for all who are HBS/TS.

We who are HBS-born do not transition because it is easy. We do it because it is necessary. Optimally, our "acceptance" precedes our transition. For me, it was in childhood. HBS, by definition, is an either/or situation. Either one is HBS or not. The definition of HBS was established to specifically address the reality of our birth condition and is not interchangeable with"transsexual".

I believe that it is also possible that some may be fully HBS/TS and at the same time find that they need not transition, this does not make them any less man/woman on the inside it just makes them different then those of us who do feel that transition is what we needed to make the best of our lives.

It is very important for those of us who are HBS-born that transition not be an incomplete path toward making the best of our lives. For us, living life as the females (or males) we were meant to be is of signal importance. It is a question of being the females and women we were meant to be.

TS-Si exists to work for those who are on a path toward full correction. We appreciate that there are others whose needs are different and wish them well on their journey.

Finally, you started your comment by saying:

When I asked this question I did have an opinion about what I felt was a correct answer.

The answer I received is very much the answer I expected, and no it is not in full alignment with my believes.

We are entirely open to alternative views. We provide the articles at TS-Si.org with a comment facility to enable a respectful and civil exchange of views. If you have an opinion not in alignment with our views, we can accept that - just step up and say what you have to say.

Jayne...
"they would love to transition but cannot because of xyz"
The old meaning of transsexual was someone driven to congruence of body and soul....period.
The wiggle room in that was limited to the arrival of the day of GID crisis as it used to be known, on that day you no longer have any choice other than if you are going to live or die. There is NO choice. Transgenders have been doing the "I'm just like you except for..." for ages but without that GID crisis day, if you haven't done something before it arrives, you are not anything at all the same. HBS became necessary as a concept precisely because transgenders erased the meaning of transsexual, what you are saying appears to be an attempt to erase the meaning of HBS.

Some of those women you mention may very well be HBS and when their day of crisis arrives they will know it.......or die. That's the only wiggle room in this.

that this is a life or death matter for us when she said

on that day you no longer have any choice other than if you are going to live or die. There is NO choice.

I had a great many obstacles to overcome (multiple shock-trauma episodes, cancer, money, responsibilities, and such. The doctors, in particular, held firm opinions that correction would kill me. My story differs not a lot from that of other HBS-born.

My response was simple and heartfelt: "I would rather die on the operating table than go on like this. I will die anyway, so get on with it." Whew!

I think part of this problem stems from the wide dissemination of views by people struggling to maintain a holding pattern, figuring they can avoid the endgame. If they can, then they aren't HBS. They extrapolate from their particulars to the general and deny the reality of others who have a different situation.

Worse, we once again face male encroachment on female space, in an attempt to dumb-down HBS (or even the good faith insistence on the more traditional true transsexual formulation). For years, every venue I had ever been in experienced an influx of people who claimed "they would love to transition but cannot because of xyz" and/or "surgery isn't necessary" and/or "they" (meaning us) are "the extreme case" and/or "you couldn't possibly known at such a young age".

Fortunately, there is now resistance with more and more of us saying no to the encroachment and insisting on the integrity of our orgins and existence as females and women.

This organization, TS-Si, and the website service, TS-Si.org, will not yield. It is my fondest hope that others stand with us and hold the line this time.

Sharon

I am finding this to be very enlightening. I do know the wall you are talking about. I do know the high cost of transitioning and I do know the even higher cost of not transitioning. I have had to pay a cost thus far I would not wish on anyone and yet know that I am not alone in paying that cost.

In the group I mentioned we do what we can to stay away from terms such as HBS or even transsexual for the reason that the group is an open format in which all are given the same status as those who are transitioning. If the terms I use seem wrong it is because of that that I find it hard to use the terms it seems everyone here uses. I thank you for your pateients with me on this.

The point I was trying to make is that yes I do agree that those born GID do indeed need to transition but the speed of transition can and does very so widely that many never make a full transition and many who are GID will do all they can to not transition at all if they can. I don't think that makes them any less HBS/GID/TS or whatever. I asked this question knowing or at least expecting the answer I got, but also knowing or hoping that there would be a lot of information given to help clarify as well and that hope has been proven right. I have learned a great deal in the exchange that has taken place. I do feel that I have grown from the articles I have read here, and no I do not agree with them all but I do agree with a lot of what I have read and I have grown even from that I have not agreed with.

I do love an open dialog such as taken place here I think we all grow from them and may find that our views are not as different as they sometimes seem.

To everyone here at TS-SI thank you for the work you do. Perhaps one day soon we will have back the rights stripped when we came open about who we are.

The thing is, the "speed of transition" doesn't matter as log as they are working and putting all their effort into transitioning and not sitting back saying "I'll never make it". That circumstaces may prevent them from reaching the goal of transitioning is understandable. However, for the

many who are GID will do all they can to not transition at all if they can.

then they don't fit the definition of HBS as those that ARE HBS are driven to transition and work to do so, NOT drag their feet as if it were a fate worse than death. So by definition, they are NOT HBS, may not be GID and at most maybe TG or transvestites if you go by some definitions. HBS don't fight transitioning but rather welcome it as a relief and confirmation of who they are and have been since they were old enough to determine their gender.

Pamela

many who are GID will do all they can to not transition at all if they can.

then they don't fit the definition of HBS as those that ARE HBS are driven to transition and work to do so, NOT drag their feet as if it were a fate worse than death.

As you say they are driven to transition. I do agree with that, but many do all they can to deny they need to transition for many years.

I for an example took 50 years in coming to accept that the truth I knew in my heart was the truth that I had to have in my outwardly life if I were ever to find peace with my self. For some self acceptance is not an easy thing and thus causes a conflict in transitioning.

What I am saying or trying to say is that for many they do all they can because of religious up bringing or other causes to deny that they have no hope of finding peace within themselves with out accepting who they are and then working to correct the problem by transitioning.