Preface (1999) Preface (1990) 1. Subjects of Sex/Gender/Desire I. 'Women' as the Subject of Feminism II. The Compulsory Order of Sex/Gender/Desire III. Gender: The Circular Ruins of Contemporary Debate IV. Theorizing the Binary, the Unitary and Beyond V. Identity, Sex and the Metaphysics of Substance VI. Language, Power and the Strategies of Displacement 2. Prohibition, Psychoanalysis, and the Production of the Heterosexual Matrix I. Structuralism's Critical Exchange II. Lacan, Riviere, and the Strategies of Masquerade III. Freud and the Melancholia of Gender IV. Gender Complexity and the Limits of Identification V. Reformulating Prohibition as Power 3. Subversive Bodily Acts I. The Body Politics of Julia Kristeva II. Foucault, Herculine, and the Politics of Sexual Discontinuity III. Monique Wittig - Bodily Disintegration and Fictive Sex IV. Bodily Inscriptions, Performative Subversions Conclusion - From Parody to Politics

Postmodern Subjects, Postmodern BodiesThinking Fragments: Psychoanalysis, Feminism, and Postmodernism in the Contemporary WestYearning: Race, Gender, and Cultural PoliticsGender Trouble: Feminism and the Subversion of Identity

Abstract Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Hormonal and surgical treatments for transgender people have a devastating effect on the possibility for these patients to reproduce. Additionally, transgender people tend to start sex reassignment treatment at a young age, when reproductive wishes are not yet clearly defined nor fulfilled. The most recent Standards of Care of the World Professional Association for Transgender Health recommend clearly informing patients regarding their future reproductive options prior to initiation of treatment. This review gives an overview of the current knowledge and state-of-the-art techniques in the field of fertility preservation for transgender people. Where genital reconstructive surgery definitely results in sterility, hormone therapy on the other hand also has an important, but partially reversible impact on fertility. The current fertility preservation options for trans men are embryo cryopreservation, oocyte cryopreservation and ovarian tissue cryopreservation. For trans women, sperm cryopreservation, surgical sperm extraction and testicular tissue cryopreservation are possible. Although certain fertility preservation techniques could be applicable in a standardized manner based on clear biological criteria, the technique that eventually will be performed should be the preferred choice of the patient after extended explanation of all possible options.

Fertility options in transgender people

This Task Force document discusses ethical issues arising with requests for medically assisted reproduction from people in what may be called 'non-standard' situations and relationships. The document stresses that categorically denying access to any of these groups cannot be reconciled with a human rights perspective. If there are concerns about the implications of assisted reproduction on the wellbeing of any of the persons involved, including the future child, a surrogate mother or the applicants themselves, these concerns have to be considered in the light of the available scientific evidence. When doing so it is important to avoid the use of double standards. More research is needed into the psychosocial implications of raising children in non-standard situations, especially with regard to single women, male homosexual couples and transsexual people.

ESHRE Task Force on Ethics and Law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people

Quand céder n'est pas consentir. IN: L'anatomie politique: catégorisations et idéologies du sexe

Objective In France, female-to-male transsexuals who have obtained a change of civil status have the right to request donor sperm insemination (DSI) for the woman with whom they live. Because this was met with some reluctance, a trial program with a follow-up study was devised with the agreement of the ethical committee. The aim was to check the quality of parenthood and the development and quality of life of the children. Patients and methods These couples were considered to be similar to any couple requesting medical assistance to procreate. There is always an interview with a specialist in psychology before gametes are given. In these cases, there was a second one with a professional who worked with transsexuals. Usually parents are left free to choose to disclose or not the gift of gametes; but in this situation, since everybody in the father's environment as a child was aware of his background history, these parents were advised to tell the truth about the DSI and the father's transsexual past. A follow-up was proposed every second year. Parents and children were not volunteers participating in a research program; they came for a consultation from which they expected some help in their particular situation. The parents had interviews with a psychiatrist and two psychologists, the children were observed in their playing and drawing, and one standard measure (the Brunet-Lezine Scale) was used. Results Forty-two children born to 32 couples were followed up from 2000 to 2012 and the program is still on-going. Though without a penis, the transmen are considered by their wives as men; the wives are not homosexual; the couples are stable (there have been only three separations); the children are very well cared for and have good relationships with their fathers, they seem normal, happy, without any major difficulty, without any gender identity variant. Fathers (with one exception) spoke easily of the DSI, but had some difficulty with their transsexualism – although willing to talk about it, they found it hard to put into appropriate words. They were helped by one father, who wrote and illustrated a booklet, telling of his childhood experience in simple words. The children coped well with this disclosure. Conclusion This trial program brought positive results. It may continue and others may be set up in spite of persistent prejudices. The “therapeutic alliance” with these couples is now good enough to allow for research beyond pure observation – with a protocol and standard measures to appreciate the mental health, gender identity and quality of life of these children as they become adolescents.

A new type of family: Transmen as fathers thanks to donor sperm insemination. A 12-year follow-up exploratory study of their children

L'enfant vulnérable

Resume L’identite sexuee n’est pas un donne, mais une construction, une croyance. L’enfant eprouve un vecu dans son corps propre, mais ce sont ses parents ou son entourage qui lui apprennent qu’il est un garcon ou une fille et le traitent differemment selon qu’il est un garcon ou une fille. Les composantes biologiques du sexe peuvent etre incompletes ou melangees ; une decision est a prendre sur le sexe a attribuer a l’enfant dans un nombre tres limite de cas. On a parle d’intersexuation, d’hermaphrodisme, de pseudohermaphrodisme ; on propose maintenant de parler de « troubles du developpement du sexe ». L’etude du devenir de ces enfants est a l’origine de la notion de genre psychosocial comme differente du sexe biologique, notion qui a fait fortune et est maintenant remise en question. D’autres enfants en dehors de tout signe d’atypie du developpement du sexe refusent leur sexe biologique. Quelques-uns d’entre eux deviendront des transsexuels et demanderont une transformation du sexe par les hormones et la chirurgie. Tous ceux qui ont une « variation » dans leur corps, leur identite ou leur orientation sexuelle redoutent d’etres stigmatises, et veulent surmonter le secret et la honte qui ont pese sur leur vie. Ils pensent parfois que ce ne sera possible qu’au prix de la suppression de la « binarite » des sexes/genres.

La problématique de l’identité sexuée

Resume Gender est un mot importe en anglais du francais gendre au xiv e siecle ; il a alors un sens principal grammatical : classe de noms qui regit des accords, masculin, feminin, neutre. Gender a aussi un sens mineur tombe dans l’oubli : l’etat de mâle ou de femelle. En 1955, John Money donne une vie nouvelle a ce deuxieme sens en parlant de gender comme du statut social en fonction du sexe, affiche dans le role, ressenti dans l’identite. Genre en francais avait le meme sens grammatical que gender, mais en outre une importante polysemie ; il va s’enrichir du sens identitaire/statutaire en accord ou non avec le sexe biologique natal. Ce terme est approprie pour rendre compte de la dissociation qui peut se produire chez les intersexes entre realite biologique du sexe et statut social. Le terme genre connait une inflation et perd le sens originel donne par Money pour en arriver a designer une realite psychedelique qui l’emporte sur la realite biologique. Il est etrange que personne ne cite le texte originel de Money. Peut-etre parce que Money sent le soufre… Les transsexuels, les transgenres, les neo-feministes qui se declarent queer, lesbiennes et non pas femmes formulent des demandes diverses. On ne peut pas changer le sexe biologique d’une personne humaine, mais on peut inventer des statuts ad hoc pour diminuer les souffrances. Parler un langage clair peut aider a raison garder et a parvenir a un consensus grâce a un dialogue constructif plus tolerant de part et d’autre.

Qu’est-ce que le genre ?

Le Cecos (Centre d’Etude et de Conservation des Œufs et du Sperme) de l’Hopital Cochin a ouvert en 1999 un programme pour l’insemination artificielle avec donneur (IAD) de la compagne d’un homme d’origine transsexuelle (transman). Ce projet avait suscite des reticences, discutees dans un comite d’ethique?: interrogation sur la sante mentale du transman, sa capacite a etre pere, sur la possibilite d’un developpement normal chez les enfants, en particulier sur la construction de leur identite sexuee. Un suivi des enfants fut propose aux parents pour savoir si les objections faites etaient pertinentes, auquel cas il faudrait interrompre le programme, ou non pertinentes, auquel cas on serait fonde a poursuivre le programme et en proposer la generalisation aux autres Cecos. Ce suivi a ete accepte des parents, qui ont ete revus avec leurs enfants a la fin de la premiere annee de l’enfant, puis tous les deux ans, dans le cadre d’une consultation. De 2000 a 2010, 42 enfants (28 garcons et 14 filles) sont nes de 29 couples et, a la fin de 2010, 24 enfants avaient ete suivis, les autres devant etre vus l’annee suivante. Ce suivi montre qu’il ne s’agit pas de couples homosexuels?; ces couples sont stables?; le pere se conduit en pere competent?; mais ce sont des peres sans penis qui s’identifient aux valeurs masculines et paternelles de leur culture. Quant aux enfants, ils vont bien, se developpent normalement, ont l’air d’etre heureux de vivre et se sentent des garcons ou des filles en accord avec leur sexe biologique. Il avait ete recommande aux parents de dire la verite sur l’IAD et le transsexualisme du pere. Pour l’IAD, il n’y a guere eu de problemes. Pour le transsexualisme, malgre leur desir d’en parler a l’enfant, les peres ne trouvaient pas les mots pour le dire?; un livret ecrit et dessine par l’un des peres les a aides, montrant qu’il s’agissait de parler simplement de leur enfance telle qu’ils l’avaient vecue, ce que les peres ont souvent du mal a faire spontanement. Il n’y a pas lieu de regretter d’avoir permis a des transmen d’acceder a la paternite. Il sera interessant de voir comment leurs enfants vivront leur adolescence.

Colette Chiland

Papers

A new type of family: Transmen as fathers thanks to donor sperm insemination. A 12-year follow-up exploratory study of their children

L'enfant vulnérable

La problématique de l’identité sexuée

Qu’est-ce que le genre ?

Pères d'un nouveau genre et leurs enfants