I don't think it's a mental illness. It's just a change from societal norms. We expect men and women to dress and groom a certain way, and when they don't there must be a label attached. While it is by no means all inclusive, we have all known men who act more feminine than "normal", as well as women who act and dress more masculine than "normal". Sometimes they are homosexual, other times not. Yet they are still often stigmatized, though that happens less now than just a few years ago.

 

I do know other cultures are more understanding and accepting than ours. In parts of Asia, parents often recognize it in their children at an early age and make no effort to change their behavior. In the Philippines and Thailand transgendered women enter beauty pageants around age 18 as a rite of passage. During times of local festivals, there will be events like beauty pageants and sports events featuring transgendered women sponsored by the local governments.

 

It's not all wonderful for them, it is a complicated situation. They can be honored and celebrated, yet cannot find jobs at which they can dress as a woman, or wear their hair long, though even this is changing. In the more conservative, rural areas there will still be horror stories of fathers drowning their sons who display feminine characteristics at an early age. Thankfully this is becoming a very rare occurrence.

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