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INTRODUCTION

Transsexuality, also termed 'Gender Dysphoria' is now reaching the point of being reasonably well understood, though many myths and general foolishness about the subject still abound. This document concerns the classic definition of transsexuality, as defined by Benjamin, Money, Green, and so forth. Intersexuality and transgenderism will not be addressed other than obliquely. The word transsexual originated in the medical and psychological communities. It was defined by Harry Benjamin in his seminal book The Transsexual Phenomenon. In particular he defined transsexuals on a scale called the "Benjamin Scale", which defines a few different levels of intensity of transsexualism.These are listed as "Transsexual (nonsurgical)", "True Transsexual (moderate intensity)", and "True Transsexual (high intensity)". Many transsexuals believe that to be a true transsexual one needs to have a desire for surgery. However, it is notable that Benjamin's moderate intensity "true transsexual" needs either estrogens or testosterone medication as a "substitute for or preliminary to operation. In other words, Transsexual is a person who has undergone a sex change operation whose inner sense of gender identity and brain patterns are completely the opposite of what physical form they are born into.Transsexuality occurs in equal numbers across born male and born female people. It been estimates that they are approximately 1 in 30,000 people are born with the condition.

Philippines and Thailand is the example of country that have a much higher percentage of transsexuals compared to places like the USA and UK. One theory on why there are more Transsexual in this two countries is because of tolerance. However, the tolerance argument is probably not the reason because, people are more tolerant because it is more common.

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The question why countries like Philippines and Thailand have much higher percentage of transsexual is one which has been discussed by many but it doesnt have a clear answer, until now. This have shown that Transsexualism is stigmatized in many parts of the world.

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DIAGNOSIS
Transsexualism appears in the two major diagnostic manuals used by mental health professionals worldwide, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM, currently in its fourth edition) and the International Statistical Classification of Diseases and Related Health Problems (ICD, currently in its tenth edition). The ICD-10 incorporatestranssexualism, dual role transvestism and gender identity disorder of

childhood into its gender identity disorder category, and defines transsexualism as "[a] desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex."[4] The DSM does not distinguish between gender identity disorder and transsexualism, and defines transvestic fetishism as a separate phenomenon which may co-occur with transsexualism. The DSM diagnosis requires four components:[5]

A desire or insistence that one is of the opposite biological sex (that is not due to a perceived advantage of being the other sex)

Evidence of persistent discomfort with, and perceived inappropriateness of the individual's biological sex

The individual is not intersex (although a diagnosis of GID Not Otherwise Specified is available, which enables intersex people who reject their sex-assignment to access transsexual treatments)

Evidence of clinically significant distress or impairment in work or social life.

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PROCESS
The current diagnosis for transsexual people who present themselves for psychological treatment is "gender identity disorder" (leaving out those who have sexual identity disorders without gender concerns). The DSM changed its terminology in 1994 away from the diagnosis of "transsexualism". According to the Standards Of Care formulated by the World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and states that the designation of gender identity disorders as mental disorders is not a license for stigmatization, or for the deprivation of gender patients' civil rights. However, some people diagnosed with gender identity disorder known astransgenders rather than transsexuals have no desire for sex reassignment therapy at all, particularly not genital reassignment surgery, and/or are not appropriate candidates for such treatment. While some feel that formal diagnosis helps to destigmatize transsexualism, others feel that it only adds stigma, essentially feeling that such a diagnosis is equivalent to saying something really is wrong with transsexual people. The diagnosis of "gender identity disorder" is seen as insulting and irrelevant to some transsexuals, and may be considered a causal factor in instances of harm occurring to, or death of, transsexual people as the result of prejudice and discrimination when deprived of their civil rights. (Brown 105) Many transsexual people have asked the American Psychiatric Association to remove Gender Identity Disorder from the DSM. Many of these people feel that at least some mental health professionals are being insensitive by labeling transsexualism as "a disease", rather than as an inborn trait.

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RELATION TO GENDER ROLES

Transsexual men and women (referred to as a trans man or trans woman respectively) desire to establish a permanent gender role as a member of the gender with which they identify, often pursuing medical interventions as part of the process. These physical alterations are collectively referred to as sex reassignment therapy and may include female-to-male or male-to-

female hormone replacement therapy, or various surgeries such as orchiectomy, facial feminization surgery, sex reassignment surgery, trachea shave and mastectomy. The entire process of switching from one physical sex and social gender presentation to the other is often referred to as transition, and usually takes several years.

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RELATION TO TRANSGENDERISM
Transsexualism is often included within the broader term transgender, which is generally considered an umbrella term for people who do not conform to typical accepted gender roles, for example cross-dressers, drag queens, and people who identify as genderqueer. Some transsexuals object to this inclusion. Anthropologist David Valentine contextualizes the objection to including transsexuals in his book "Transgender, an Ethnography of a Category." He writes that transgender is a term coined and used by activists to include many people who do not necessarily identify with the term. He observes that many current health clinics and services set up to serve gender variant communities employ the term, but that most of the service-seekers do not identify with the term. The rejection of this political category, first coined by self-identified activist Leslie Feinberg, illustrates the difference between a self-identifier and categories imposed by observers to understand other people. Historically the reason that transsexuals rejected associations with the transgender or broader LGBT community is largely that the medical community in the 1950s through the late 1980s encouraged (and in many ways required) this rejection of such a grouping in order to be a 'good transsexual' who would thus be allowed to access medical and surgical care. The animosity that is present today is no longer fed by this same kind of pressure from the medical community. However, where some of the beliefs of modern day transsexual people that they are not transgender, is reflective of this historical division (Denny 176), other transsexual people state that someone choosing to retain their former physical sex (no SRS) is very different from someone who needs to be of "the other sex", that the groups have different issues and concerns

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and are not doing the same things. The latter view is rather contested, with opponents pointing out that merely having or not having some medical procedures hardly can have such far-reaching consequences as to put those who have them and those who have not into such distinctive categories. Notably Harry Benjamin's original definition of transsexualism does not require that they need to have had SRS.

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UNITED STATES STATISTICS

There are no reliable statistics on the prevalence of transsexualism. The DSM-IV (1994) quotes a prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery in the USA. The most reliable estimate of prevalence is from the Amsterdam Gender Dysphoria Clinic The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexuals, gives figures of 1:10,000 assigned males and 1:30,000 assigned females. Olyslager and Conway presented a paper at the WPATH 20th International Symposium (2007) arguing that the data from their own and other studies actually imply much higher prevalence, with minimum lower bounds of 1:4,500 male-to-female transsexuals and 1:8,000 female-to-male transsexuals for a number of countries worldwide. They suggest the prevalence might be as high as 1:500 births overall. Olyslager and Conway also argued that the U.S. population of assigned males having already undergone reassignment surgery by the top three U.S. SRS surgeons alone is enough to account for the entire transsexual population implied by the 1:10,000 prevalence number. This excludes all other U.S. SRS surgeons, surgeons in countries such as Thailand, Canada, and others, and the high proportion of transsexuals who have not yet sought treatment, suggesting that a prevalance of 1:10,000 is too low. A presentation at the LGBT Health Summit in Bristol, UK, based upon figures from a number of reputable European and UK sources, shows that this population is increasing rapidly (14% per year) and that the mean age of transition is actually rising.

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MALAYSIAS STATISTICS
In Malaysia, mak nyahs are labelled as sexual deviants and are generally shunned by society. It has been estimated by IKHLAS (Pink Triangle), a non-governmental organisation in Malaysia which gives HIV/AIDS awareness information to mak nyahs, that there are about 10,000 mak nyahs in the country (Teh, 1998: 169). About 70% to 80% are Malay; the rest are made up of Chinese, Indian and other minority ethnic groups. Malays make up 50.7% of the total population; the Chinese, the Indians and other minority ethnic groups make up 27.5%, 7.8% and 14% respectively (Department of Statistics Malaysia, 1995). Islam is the religion of the Malay population and is the official religion of Malaysia. The majority of mak nyahs are Muslim.

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TRANSGENDER POPULATION

There are no concrete statistics on the number of transgender people in the United States. Estimates on the number of transsexual people, which ignore the broader transgender population, range anywhere from 0.25 to 1 percent of the U.S. population. These estimates are dated and likely undercount the transsexual population because, for example, they do not account for people who have not yet undergone, cannot (for medical, financial, safety or other reasons) or choose not to undergo sex reassignment surgeries. The most-cited estimates have been based on counts of people who have undergone sex-reassignment under the care of certain European clinics.

In 1994, the American Psychiatric Association reported that "data from small countries in Europe with access to total population statistics and referrals suggest that roughly 1 per 30,000 adult males and 1 per 100,000 adult females seek sex reassignment surgeries."

In 1986, researchers in the Netherlands, which offers transgender-related health benefits in its universal healthcare plan, calculated the prevalence of male-to-female transsexualism at 1 in 18,000 and female-to-male at 1 in 54,000. A follow-up study from 1996 cited prevalence at 1 in 11,900 males and 1 in 30,400 females.

In 2002, Lynn Conway, a professor at the University of Michigan, estimated male-to-female transsexualism in the United States to be in the range of 1 in 500 to 1 in 2,500.

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ADDITIONAL STATISTICS
90% of female-to-male transsexuals and 61% of male-to-female transsexuals are sexually satisfied. 70% of female-to-male transsexuals and 43% of male-to-female transsexuals retain close contact with their families. 57% of female-to-male transsexuals and 27% of male-to-female transsexuals form lasting romantic partnerships. 100% of female-to-male transsexuals and 60% of male-to-female transsexuals inform their partners about their transsexualism. 5% of female-to-male transsexuals and 21% of male to female transsexuals have made a suicide attempt. 100% of sexual partners of female-to-male transsexuals are female. 60% of sexual partners of male-to-female transsexuals are male.

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RELIGIONS PERSPECTIVE TOWARDS TRANSSEXUALISM

ISLAM
In Islam, the term mukhannathun is used to describe gender-variant people, usually male-tofemale transsexuals. Neither this term nor the equivalent for "eunuch" occurs in the Qur'an, but the term does appear in the Hadith, the sayings of Muhammad, which have a secondary status to the central text. Moreover, within Islam, there is a tradition on the elaboration and refinement of extended religious doctrines through scholarship. This doctrine contains a surprisingly transpositive passage by the scholar and hadith collector An-Nawawi: A mukhannath is the one ("male") who carries in his movements, in his appearance and in his language the characteristics of a woman. There are two types; the first is the one in whom these characteristics are innate, he did not put them on by himself, and therein is no guilt, no blame and no shame, as long as he does not perform any (illicit) act or exploit it for money (prostitution etc.). The second type acts like a woman out of immoral purposes and he is the sinner and blameworthy. Muslims people are not allowed to have the sex change operation. Islam does not accept transsexualism, as stated in the Hadith. For example, the Hadith in Sahih Bukhari (Vol. 7, Bk. 72, No. 774) stated that: Narrated Ibn Abbas: The Prophet cursed effeminate men and those women who assume the manners of men, and he said, "Turn them out of your houses."

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The Hadith in Sunan Abu-Dawud, (Bk. 32, No. 4087) stated that: Narrated Abu Hurayrah: The Apostle of Allah cursed the man who dressed like a woman and the woman who dressed like a man.

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CHRISTIAN
The biblical view is that God's intent for every male is to grow into masculinity, and for every female to grow into femininity. When that doesn't happen, the culture has come up with new labels to describe something new and different: transgendered, transsexual. God isn't affected by these new labels nor does He have to honor them: He sees the people behind the labels as His precious, broken children. It's only recently that the culture has tried to suggest that "a woman in a man's body" and vice versa is a variation of what is normal and right. The reason that there are two, and only two, sexes is that God created mankind such that to be human means to be either human male or human female (Genesis 1:27). The human body is therefore a good gift of God and essential to the human person. But the transsexual sees their body as an accident, as denying their 'true self' which resides in their mind and emotions. This is opposed to the Bible, which teaches a positive view of the body: the supreme expression of this being that Jesus became flesh (John 1:14). It is an old heresy ('Manichaeanism') which detaches the person from the body. Corinthians 6:18-20 warns against 'sinning sexually against your own body'. Christians must honour God with their body. The Old Testament uses the same word to condemn homosexual practice and intentional cross-dressing. Deuteronomy 22:5 states: "A woman must not wear man's clothing, nor a man wear woman's clothing, for the LORD your God detests anyone who does this." (compare Leviticus 18:22).

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BUDDHA
According to the Buddhist commenter: "The Vinaya Pitaka, the ancient Buddhist texts that define the rules for Buddhist monks and nuns, record two incidences of sex change that a monk and a nun had gone through. A group of monks and nuns bring the two incidences to the Buddhas notice. The Buddha accepts their changed status. He allows the former male disciple who became a female to live with female disciples, and the former female disciple to live with males." In reality, how transexuals are treated in a Buddhist community is more a matter of cultural bias than any rules or doctrine. And as a side note, I seem to remember that one of the first "female to male" surgical transgenders ended up a monk in a Tibetan Buddhist temple. Mugwan Sunim, director of Traditional Vinaya Seminary of Haeinsa Temple, showed positive opinions on the transsexuals joining the Buddhist priesthood. He said, "There is a precept banning the bisexual who has both male and female genitals at the same time from receiving Monastic Full Precepts. Such a ban is to prevent from losing purity not only of the individual concerned but other practitioners as well. But with regard to transsexuals, they have already been fixed into a certain sex, so their receiving priesthood provides no problem." and added, "There is no concrete evidence of sex transformation at Buddha's times, but viewing from today's standard, our Buddhist community should also respect their rights." Buddhists see genderisation as a sign of decay. In the Buddhist version of the Genesis, Agga-asutta (also known as the Aphorism on the Knowledge of the Beginning), male and female genders were a part of the fall. Originally, the primordial ancestors of humans were self-

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luminous, mind-born and sexless. So the mind is supreme and sexless, which is consistent with the higher form of existence. The most important principle to derive from that is there is no superiority of one gender over the other. The first sin among them which perpetuated the fall was the prejudice of appearance, when those of brighter skin looked down on those with darker skin. Based on this principle, homosexual people should not be discriminated against; they are humans who deserve all the rights and dignity endowed upon them as members of human race.

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CONCLUSION
Transsexuality is not hereditary, and a person cannot not just "become" transsexual one day. As an extremely complex birth condition, the situation is simply a variable in nature and there is nothing and no one to blame. Most transsexuals are acutely aware of something feeling incorrect from a very early age but lack the ability to approach the issue. Transsexuality occurs across all races, socioeconomic classes, religions, and childhood family upbringings, and has been documented throughout history for thousands of years. Many cultures even have revered or worshipped them for having extraordinary vision and wisdom and some do not. The Transsexuals are actually very good, intelligent, family loving people who are valuable, creative and productive members of society when their given the opportunity to flourish without oppression.