A congenital disorder

Congenital disorder is the proper name for a birth defect. A congenital disorder is a condition existing at or before birth. Congenital disorders include physical anomalies and malformations.

Transsexualism is a unique congenital disorder. It doesn’t show. There is, at this time, no test for it. The brain and body in themselves are perfectly healthy. There is no malformation. The only problem is that the healthy brain and healthy body don’t belong together. Not a malformation, but a mismatch.

Despite the lack of a test to confirm the presence of the congenital disorder, the perception of the one suffering from the disorder is strong and persistent. Someone made a mistake. My body is not configured correctly. Why do I have a penis and not a vagina? Why do I have a vagina and not a penis?

Repercussions
All congenital disorders have repercussions on the sufferer’s life, but none as fundamental and far-reaching as transsexualism does. There's no question that being born without legs or arms or something similar is profound, but no disorder other than transsexualism will get you sexed incorrectly. In human societies, the sex of a child is one of the most basic facts about the child. And a child is sexed according to the apparent configuration of external genitalia at birth.

Children with a penis go in one line. Children with a vagina go in a different line. However much parents might attempt to mitigate this division, it remains. Girls will eventually become capable of bearing offspring. Boys will eventually become capable of begetting offspring. Biology is uncompromising. Society is only somewhat more flexible. And even egalitarian parents and families have certain expectations of children because of their sex.

Children in whom the congenital disorder is manifested particularly strongly rebel early against the notion that anatomy is destiny. They refuse to accept the fact that their body dictates which sex they are. Other sufferers reluctantly come to terms with the body that feels wrong and knuckle under to the pressure to behave in accordance with that body. Sometimes they even come to believe that what the body is telling them must be right—for a time.

The congenital disorder does not go away, however. Compromises, coming to terms, attempting to conform all fail eventually. Tragically, the sufferer can often live with the congenital disorder for a long time. Much of society doesn’t even accept that the congenital disorder exists and puts constant pressure on the sufferer to reach the same conclusion. The distress this causes is enormous. And the longer it takes for the sufferer to understand that the congenital disorder must be corrected, the more difficult it is to correct.

Treatment
Correction of the congenital disorder is the only successful treatment. Technically, it could be considered a disorder of the brain or the body. Neither is more right than the other. But even if a “correction” to the brain were possible, which repeated studies show it is not, it would result in a drastic alteration of personality. The patient would not survive the procedure.

Thus, the only correction that works is to make the body conform to what the brain expects, bringing it as much in line as possible with what it would have been like if the person had been born without the disorder. Hormone replacement therapy alters the chemical aspects and, to an extent, the soft tissue. Surgical procedures change the genitalia and possibly other physical aspects of the person.

Once the congenital disorder is corrected, the person can live a relatively normal life. There should be little evidence of there ever having been a congenital disorder.