While most of the sexologists stated that transsexual subjects express their gen-der identity very differently, they disagreed over the extent to which transsexual subjects wish to undergo surgery and perceivably live according to the gender they identify with. Three different clinical observations emerged on the issue of surgical interventions. According to some sexologists, transsexual individuals’
surgery requirements range from no interventions to extensive measures. Oth-ers tentatively suggested that the type and extent of surgery correlates with a person’s sexual orientation and assigned gender. To other sexologists, surgery remained the defining feature of transsexualism.
Clement and Senf e. g. observed that some transsexual individuals do not reveal their gender identity publicly. Others wish to be accepted in public and private life as the gender they identify with without wanting to undergo
hor-mone treatment and surgery, whereas some transsexual subjects require one particular surgical measure only of a set of several possible surgical interven-tions (Clement/Senf 1996: 1).28 Similarly, Kockott observed that while several transsexual individuals require extensive sex reassignment surgery, there is a significant number of individuals that opts for other solutions (Kockott 1996:
15).29
Becker, Berner, Dannecker and Richter-Appelt suggested that the consist-ent experience of living and enjoying recognition as a member of the gender the respective individual identifies with is crucial to a transsexual person’s psy-chological stability. Hence, a successful transition does not necessarily include surgical measures (Becker et al. 2001: 261). A few years later, Becker summa-rised this observation succinctly when noting that, while surgery continues to be indicated urgently in order to alleviate distress in some transsexual individu-als, »[o]nly fundamentalists hang onto the ›real‹ (genuine, true) transsexual-ity that is by definition always linked to the desire for sex-transforming opera-tions« (Becker 2006: 157 f.).
Sigusch’s statements at the beginning of the 1990s were contradictory.
While Sigusch observed that transsexualism had changed as a psychiatric and social phenomenon,30 he reported in his concept of depathologisation31 that in the 1970s, he encountered transsexual individuals living according to their concepts of gendered selves without resorting to medical means or frequently changed their gender affiliation (Sigusch 1991: 324), suggesting that several ways existed of leading a transsexual life.
In his discussion of the issue of whether transsexual individuals were in the process of becoming a minority (ibid: 325-329), however, his
understand-28 | Clement and Senf’s observations are congruent with those by Rauchfleisch (2006:
17).
29 | As early as in 1987, Kockott and Fahrner noted in their follow-up study on transsexual individuals without surgery that a highly valued job or the development of a meaningful partnership that could only be maintained in the initial gender or with the initial physical characteristics were among the reasons for transsexuals not to undergo surgery (Kockott/
Fahrner 1987: 520).
30 | Sigusch observed that transsexualism had changed with regard to diagnostic findings (Sigusch 1991a: 322 f.), therapeutic concepts (ibid: 323) and the social and psychological situation of transsexual individuals (ibid).
31 | Sigusch reiterated several of his arguments presented in his initial article on the depathologisation of transsexuality in an interview in 1992, a monography in 1995, journal articles (1992; 1995a; 1997) and in articles in the sexological reference books he published in 1996 and revised in 2001, 2006 and 2007. Sigusch’s concept constituted the most extensive and radical published sexological perspective on the depathologisation of transsexuality throughout the 1990s and the first decade of the 21st century.
ing of transsexuality took on a totalising ring. Sigusch e. g. argued that unlike the gay movement, which he believed had developed beyond narrow issues, transsexual individuals were due to their characteristics tied to the law and in particular to medical science:
In some ways the dawn of transsexuals is reminiscent of the dawns of homosexuals 90 to 150 years ago and once more after World War II: low intellectual and political stand-ards, simple-minded smugness, narrow-mindedness, great redundancy and struggling for everything, public coming out, the founding of clubs, members, subscribers, a right to speak before jurists and physicians, etc. However while homosexuals soon looked beyond their noses, transsexuals are due to their characteristics tied to law and especially medicine. (Ibid: 326)32
According to Sigusch, other than with the »collective of homosexuals«, which is in his opinion based on mutual sexual attraction, »medical science is the bond that renders transsexuals a collective in a historical and an individual sense« (ibid: 330).33
Moreover, he argued that the transsexual community did not, unlike the protest cultures of the 1960s challenge the gender binary.34 He suggested that transvestites and transsexuals were corrupted by the system via the benefit
32 | Sigusch’s understanding of the gay and trans movements is problematic. First, Sigusch’s concept of homosexuality is ahistorical. As Hirschauer points out, social phenomena Westphal termed contrary sexuals in 1869 are not the same as present-day homosexuals (Hirschauer 1992: 250 f.). Second, Sigusch romanticises the gay movement (ibid: 251).
In the 2007 edition of his sexological reference book, Sigusch no longer maintained the ahistorical concept of homosexuality: »At any rate, in some ways the present situation of transsexuals reminds me of the people over a hundred years ago who are currently called homosexuals« (Sigusch 2007: 354).
33 | Sigusch’s evaluation of trans subcultures is flawed. First, he inappropriately distances homosexuality from transsexuality. As Hirschauer points out, the differentiation of homosexuality from sodomy did not occur without reliance on and resistance to, medical science (Hirschauer 1992: 251). Moreover, with a similarly distancing gesture Sigusch suggests that transsexuality is a historical construction, while he features homosexuality as a pre-social, essentialist phenomenon (Lindemann 1992: 262). Furthermore, Augstein and Hirschauer suggest that rather than the awkward juxtaposition of medical science and desire, social discrimination (Augstein 1992: 257; Hirschauer 1992: 251) as well as the creation of spaces for developing gay and trans lifestyles (Hirschauer 1992: 251) constitute unifying elements in both minoritised populations.
34 | According to Hirschauer, Sigusch overestimated the challenge protest movements of the 1960s posed to the gender binary (Hirschauer 1992: 250).
of a law and of health insurances, tv and treatment programmes (ibid: 328).35 Hence, transvestites and transsexuals are unable to articulate the growing un-ease with gender publicly in this culture. Instead, they succumb to the tyranny of the gender binary, »because they are addicted to normality and unable to ascend from gender dysphoria to gender relaxation« (ibid: 328 f.):36
If they owned up to their transgression as a transgression, i. e., to their femininity with a male body and their masculinity with a female body, they would transition from the
›dignity of a psychiatric-surgical entity of disease‹ to the ›dignity of a social minority‹.
This would be contranomic, the height of a provocation in a society that does not grant an institutional space for a change of gender and gender crossings beyond clinics and chambers, in a society that despite all weakening of gender roles ranging from the social division of labour to the legal system leaves no doubt about which gender is the sexus sequior. (Ibid)37
In his sexological reference book referred to earlier on, Sigusch did not repeat his depreciative and homogenising statements on trans individuals and the trans movement. Instead, he noted that transsexual individuals manifest a wide range of very different identities, roles and lifestyles (Sigusch 2007: 347).
He also implicitly repealed his former equation of transsexuality with surgical measures in his critique of the German Standards (ibid).
Beier, Bosinski and Loewit tentatively suggested that the need for surgery correlates with the assigned sex/gender and sexual orientation. While they cautioned that their typology did not apply to every single case, their attempt to systematise transsexual individuals led to more homogenous clinical pic-tures compared to those of the aforementioned sexologists. Beier, Bosinski and
35 | As Augstein pointed out, Sigusch conflated transsexualism with transvestism.
Especially in the context of the Transsexual Act and medicine, it is misleading not to differentiate between transvestites and transsexual individuals, since there are neither legal nor medical provisions that transvestites might benefit from (Augstein 1992: 256).
36 | Sigusch’s assumptions on transsexual subjects who undergo surgery and on social change are problematic for several reasons. With regard to the former, Sigusch defamed all trans individuals who opt for surgical measures (Augstein 1992: 257; Lindemann 1992: 265). This devaluation is also inappropriate considering that in particular sexology, the media and the law produced the image that genital surgery stands for the social treatment as a man or woman (Hirschauer 1992: 248). Sigusch’s concept of social change is debatable, since he adhered to an emancipatory policy model, which places the onus for social change on trans individuals (Lindemann 1992: 268).
37 | It remains unclear why Sigusch mentioned transvestites in this context, since they ›own up‹ to their femininity in a male body and their masculinity in a female body (Augstein 1992: 256).
Loewit e. g. claimed that biological women with a gender identity disorder pro-foundly reject their secondary sex characteristics (Beier/Bosinski/Loewit 2005:
369 f.). They prioritise mastectomies over the construction of phalloplasties (ibid: 370 f.). According to their observations, gynophilic biological men with a gender identity disorder most urgently wish to have large breasts and tend to be ambivalent with regard to their genitalia (ibid: 376), while androphilic biological men with a gender identity disorder preferably opt for a neovagina (ibid: 374).
The German Standards mirror the most homogenising clinical picture of transsexual individuals with regard to gendered self-concepts and attitudes towards surgery. According to the Standards, transsexual individuals wish to resemble the physical appearance of the gender they identify with as much as possible through hormonal and surgical measures and to live socially and legally recognised in the desired gender role (Becker et al. 1997: 147).
Most sexologists agreed that transsexual developments vary. While some sexologists pointed out to individual variations in general (e. g. Sigusch 2007;
Clement/Senf 1996; Rauchfleisch 2006), others believed it was possible to sys-tematise them (e. g. Bosinski 2003; Beier/Bosinski/Loewit 2005).
Clement, Senf and Rauchfleisch observed that while some transsexual de-velopments begin at such an early age with the effect that the respective trans individuals feel they have always been transsexual, other developments mani-fest as late as from the thirties onward (Clement/Senf 1996: 1; Rauchfleisch 2006: 16). Clement and Senf suggested that transsexual individuals frequently experience uneasiness with their morphology in childhood. The difficulties in-crease in puberty when physical features associated with a particular gender emerge or become more prominent (Clement/Senf 1996: 1 f.).
Clement, Senf and Rauchfleisch agreed that the terms ›primary‹ and ›sec-ondary‹ transsexuality simply attest to the time of manifestation (ibid; Rauch-fleisch 2006: 16). They do not require different treatment and cannot be dis-tinguished aetiologically (Sigusch 2007: 354). Similarly, the authors of the German Standards suggested that a persistent transsexual desire »is the result of sequential factors that have an impact in various episodes of the psycho-sexual development and possibly become effective cumulatively. Accordingly,
»different developmental paths can lead to the development of a transsexual desire« (Becker et al. 1997: 147).
Beier, Bosinski and Loewit suggested that transsexual developments can be typified along the lines of gender and sexual orientation. Beier, Bosinski and Loewit e. g. claimed that biological women with a gender identity disorder usu-ally present in the physician’s office in the twenties to the mid-thirties (Beier/
Bosinski/Loewit 2005: 369). They have a childhood history of tomboy behav-iour, experienced their puberties as traumatic and profoundly reject their
sec-ondary sex characteristics (ibid: 369 f.). They appear as masculine as possible with regard to clothing and hairstyle (ibid: 370).
According to their observations, androphilic biological men with a gender identity disorder are usually in the mid-twenties as opposed to gynophilic biologi-cal men with a gender identity disorder who tend to be ten to fifteen years older when they first present in a physician’s office (ibid: 372). Unlike the latter, so-called androphilic biological men with a gender identity disorder cross-dress and engage in activities conventionally associated with female children (ibid: 373 f.).
While gynophilic biological men with a gender identity disorder develop trans-vestic fetishism during their puberties (ibid: 374), androphilic biological men with a gender identity disorder envision themselves as heterosexual women who desire cismen and cross-dress as a means to express their femininity (ibid: 373).
Sexologists observed that unlike clinical and theoretical descriptions in the late 1970s and early 1980s, transsexual developments appeared to be more di-verse. Sigusch and Langer observed that transsexual individuals seeking sex reassignment surgery in the 1990s were on average clearly younger than a few decades ago. Moreover, the sex ratio of feto-male transsexuals and male-to-female transsexuals had become more even (Sigusch 1991a: 321; Langer 1995:
265). Furthermore, the choice of sex partners was no longer consistently hetero-sexual (Sigusch 1991a: 323; Langer 1995: 265) and female-to-male transhetero-sexuals appeared less aggressive and more driven by sexual desires (Sigusch 1991a: 322).
However, the abovementioned sexologists explained these changes differ-ently. Sigusch did not rule out that so-called experts were maybe only now able to observe things that existed before or that transsexual individuals were only at this point able to disclose more information to medical professionals, be-cause the latter no longer reacted as rigidly as they did earlier on. However, he attributed the changes foremost to changed gender relations (Sigusch 1991a:
320). Langer however suggested that gender identity disorders were sympto-matic variants of contemporary »frequent structural deficits of personality« for which a »sex change is a propagated solution« (Langer 1995: 263).
Since the beginning of the 1990s, most sexologists considered transsexual individuals sexual beings. Sigusch stated that unlike in earlier clinical descrip-tions, sexologists no longer ruled out that transsexual individuals could be sexual (Sigusch 2007: 353 f.; Sigusch 1991a: 322).38 The German Standards e. g.
38 | Sigusch argued that transsexual individuals’ gender identities are no longer as fragmentary as they used to be. He suggested that a structured sexuality is impossible without a gender identity. Morever, collective notions of genders changed to the effect that women are nowadays constructed as sexual beings (Sigusch 2007: 353 f.).
However, his argumentation is not convincing. His, Meyenburg and Reiche’s argumentation in the late 1970s was premised on psychoanalytic assumptions that suggest that transsexual individuals are not likely to develop much of a sexuality due to very early
implicitly affirmed that transsexual individuals could relate to sexuality, since the psychosexual development, including the sexual orientation constituted part of the diagnostics (Becker et al. 1997: 149).
This notion was reinforced by Bosinski (2003: 713 f.) and Beier, Bosinski and Loewit (2005: 372-375) who systematised transsexual individuals according to their respective sexual orientations. While Sigusch did not elaborate on trans-sexual individuals’ trans-sexual involvement, Beier, Bosinski and Loewit assumed that pre-operative transsexual individuals’ erotic lives were usually dissatisfy-ing. With regard to biological women with a transsexual gender identity disor-der, they e. g. suggested that, »[o]ccasional attempts to act out this gynophilic orientation in a lesbian setting remain dissatisfying, since the patients (unlike lesbian women) cannot pleasurably bring in their physicality in such relation-ships« (Beier/Bosinski/Loewit 2005: 371).
While sexologists more or less considered transsexual individuals to be het-erosexual in the 1970s and 1980s, clinical pictures from the 1990s onward with few exceptions39 suggested that transsexual individuals’ sexual orientations are more diverse. Sigusch stated in his concept of depathologisation that gender roles and sexual preferences vary in transsexual individuals as they do in cis subjects (Sigusch 1991a: 322).
Bosinski distinguished between biological women with a transsexual gender identity disorder, which he believed were predominantly heterosexual (Bosinski 2003: 713) and biological men with a transsexual gender identity dis-order who feature as either androphilic or gynophilic (ibid: 713 f.). While Beier, Bosinski and Loewit adopted Bosinski’s model, they added autogynophilic sub-jects to the group mentioned last (Beier/Bosinski/Loewit 2005: 376).