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Legal procedures exist in some jurisdictions, allowing individuals to change their legal gender or name to reflect their gender identity. Requirements for these procedures vary from an explicit formal diagnosis of transsexualism to a diagnosis of gender identity disorder to a letter from a physician that attests the individual’s gender transition or having established a different gender role.[85] In 1994, the DSM IV entry was changed from “Transsexual” to “Gender Identity Disorder.” In many places, transgender people are not legally protected from discrimination in the workplace or in public accommodations.[17] A report released in February 2011 found that 90% of transgender people faced discrimination at work and were unemployed at double the rate of the general population.[15] Over half had been harassed or turned away when attempting to access public services.[15] Members of the transgender community also encounter high levels of discrimination in health care on an everyday basis.[86]

In Canada, a private members bill protecting the rights of freedom of gender expression and gender identity passed in the House of Commons on February 9, 2011. It amends the Canada Human Rights code to help protect gender-variant people from discrimination by including gender identity and expression in the list of prohibited grounds for discrimination, as well as including gender identity and expression in the description of identifiable group, so that offences deliberately against gender-variant people can be punished to a similar extent as a racial-based crime.[87] The bill may or may not be passed by the Senate.[88]

In the United States, a federal bill to protect workers from discrimination based on sexual orientation and gender identity—called the Employment Non-Discrimination Act—has stalled and failed several times over the past two decades.[89] Still, individual states and cities have begun passing their own non-discrimination ordinances. In New York, for example, Governor David Paterson passed the first legislation to include transgender protections in September 2010.[90]

Nicole Maines, a trans girl, took a case to Maine’s Supreme Court in June, 2013. She argued that being denied access to her high school’s women’s restroom was a violation of Maine’s Human Rights Act; one state judge has disagreed with her,[91] but Maines won her lawsuit against the Orono school district in January 2014 before the Maine Supreme Judicial Court.[92]

On May 14, 2016, the United States Department of Education and Department of Justice issued guidance directing public schools to allow transgender students to use bathrooms that match their gender identities.[93]

In April 2014, the Supreme Court of India declared transgender to be a ‘third gender’ in Indian law.[94][95][96] The transgender community in India (made up of Hijras and others) has a long history in Indian history and in Hindu mythology.[97][98] Justice KS Radhakrishnan noted in his decision that, “Seldom, our society realizes or cares to realize the trauma, agony and pain which the members of Transgender community undergo, nor appreciates the innate feelings of the members of the Transgender community, especially of those whose mind and body disown their biological sex”, adding:

Non-recognition of the identity of Hijras/transgender persons denies them equal protection of law, thereby leaving them extremely vulnerable to harassment, violence and sexual assault in public spaces, at home and in jail, also by the police. Sexual assault, including molestation, rape, forced anal and oral sex, gang rape and stripping is being committed with impunity and there are reliable statistics and materials to support such activities. Further, non-recognition of identity of Hijras /transgender persons results in them facing extreme discrimination in all spheres of society, especially in the field of employment, education, healthcare etc.

Hijras/transgender persons face huge discrimination in access to public spaces like restaurants, cinemas, shops, malls etc. Further, access to public toilets is also a serious problem they face quite often. Since, there are no separate toilet facilities for Hijras/transgender persons, they have to use male toilets where they are prone to sexual assault and harassment. Discrimination on the ground of sexual orientation or gender identity, therefore, impairs equality before law and equal protection of law and violates Article 14 of the Constitution of India.[99]

Transgender people are also prohibited from serving in the US military, but United States Secretary of Defense Chuck Hagel is quoted as stating that the military should “continually” review its prohibition on transgender individuals and stating: “Every qualified American who wants to serve our country should have an opportunity if they fit the qualifications and can do it.”[100]

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A study of Swedes estimated a ratio of 1.4:1 trans women to trans men for those requesting sex reassignment surgery and a ratio of 1:1 for those who proceeded.[104] The causes of transsexuality have been studied for decades.

The most studied factors are biological. Studies beginning with Zhou in 1995 have found that trans women’s brain structure (volume and density of neurons) is similar to cisgender (cis) women’s and unlike cis men’s, and trans men’s is similar to cis men’s, even when controlling for hormone use. A 2002 study by Chung suggested significant sexual dimorphism in the BSTc did not become established until adulthood, theorizing that either changes in fetal hormone levels produce changes in BSTc synaptic density and other factors which later lead to the observed differences in BSTc, or the differences are affected by the generation of a gender identity inconsistent with assigned sex. Studies in 2004 (Swaab), 2006 (Gooran) and 2008 (Garcia-Falgueras) confirmed earlier research finding that gender identity is influenced by brain structure. (Brain structure differences have also been noted between gay and heterosexual men, and lesbian and heterosexual women.) Studies have also found that both androphilic and gynephilic trans women’s brain function and responses are like cis women’s and unlike cis men’s, or are intermediate between the two. Likewise, studies have found that gynephilic trans men have male-like white matter patterns (even before using hormones).

With regard to genetic factors, a study by Hare reported that trans women have a longer androgen receptor gene than cis men, which is less effective at binding testosterone, potentially preventing complete masculinization of the brain. (Prenatal androgen exposure or sensitivity, or lack thereof, is often cited mechanisms to explain observed brain-structure differences.) A study by Bentz found that trans men have a CYP17 allele distribution like cis men and unlike cis women.[105] A twin study found that 33% of pairs of identical twins were both trans, compared to only 2.6% of non-identical twins who were raised in the same family at the same time, but were not genetically identical.[106]

Psychological factors have also been proposed. The failure of an attempt to raise David Reimer from infancy through adolescence as a girl after his genitals were accidentally mutilated is cited as disproving the theory that gender identity is determined by parenting. Ray Blanchard developed a taxonomy of male-to-female transsexuality that assumes transsexuals are either homosexual or autogynephilic, but it is controversial; J. Michael Bailey, Anne Lawrence, James Cantor and others support it, but Charles Allen Moser, Larry Nuttbrock, Julia Serano, the World Professional Association for Transgender Health and others argue it is poorly representative, non-instructive, and lacks empirical evidence, because the experiments behind it are poorly controlled and/or contradicted by other data.

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