Are you not the same gender as your biological body? Do you have another resident who isn't?
Many Multiples deal with some transgender issues--in other words, most multiples have people in their system whom are not the same gender-identity as the physical gender is. 'Gender dysphoria' is the psychological term for the feeling that one is a different gender than their physical body (and sometimes considered degrading, although people can work at "reclaiming" terms that others find degrading). Many multiples (and singletons?!) are also dissatisfied with the traditional binary view of gender, and identify as something other than male or female-- androgynous, gender-neutral, and third gender are among terms you may hear used to describe this.
Not all member of the system may share the trangendered system members' view(s) on what should be done about the displeasing appearance or genetically-induced structure of the body. The usual questions get more complicated, due to this, as descisions regarding transgender issues can and often will affect the lives ot the other system members.
- Dissatisfaction with the present body's appearance
- If the body can't "pass" how will the transgendered system members react?
- Gender Presentation
- Are the others in-system comfortable with the body being made to look like the other gender? Are they willing to deal for the backlash that a society which doesn't look well upon this will produce?
- "Out"-ness about being transgendered
- Like multiplicity, this can carry a large and unfair stigma. Are non-transgendered members of the system willing to bear the stigma along with the transgendered ones?
- Some systems with a majority of transgendered members may choose to get hormone treatments. Traditionally, most therapists who work with transgendered patients make them follow the very stringent Benjamin standards, aka Standards of Care for Patients with Gender Identity Disorder (http://www.symposion.com/ijt/ijtc0405.htm), which require that the patient undergo psychiatric evaluation before getting even a single dose of hormones. Fortunately, these days, some doctors have begun to loosen up about giving hormones to transgendered patients, especially in receptive cities like San Francisco. Some points to consider: What effect will the hormones have on the system as a whole? Some transgendered patients (both male and female) find that hormones make them moody; others become more cheerful and outgoing. There are health risks associated with hormones. Are they aware of these risks and comfortable with them? Are the non-transgendered system members okay with it?
- Some systems with a transgendered majority decide to complete a full transition and undergo surgery, ranging from mastectomy or castration (removal of the testicles) to genital (re)constructive surgery. In any form, however, surgery is surely a life-altering step, sometimes carrying considerable health risks with it. Is everyone in the system informed of the risks, capable of giving consent, and okay with the decision? As with hormones, do plenty of research and find a doctor who is informed, understanding, and willing to answer questions.
Alternatively, one can view a system with cross-gender residents to be interesting and fun, and also provides a nice balance most of the time, without the need for cross-dressing, hormones or surgery.
Such residents may be the results of a metaphor for the system needing to adopt coping mechanisms and social skills normally relegated to the opposite gender, or absorption of traits from opposite-gendered people. Some psychologists think that opposite-gendered alters are created because "this abuse wouldn't happen to me if I were the other gender."
Conversely, some people may feel that abuse that happened to them was something that is more likely to happen to the other gender. At least one example of this can be found in the book First Person Plural by Cameron West Ph.D., and his system, where they adopted feminine personalities because of sexual abuse history.
Other systems feel that their opposite-gendered (or third-gendered, or non-gendered) members are that way because that's just who they are-- not because of any influence or requirement in the body's outside life.
In any case, cross-gender residents can have phantom limb syndrome (i.e. being in a female body but fully feeling a male appendage and it's suitable reactions to stimulus even though someone else is touching air where it ought to be) which can make for very interesting bedroom play, with a lot of what might seem to be roleplaying on the part of the persons in bed, which is EXCEPTIONALLY strange if both persons in question are fronting persons of the opposite gender, and sexual play is taking place between bodies that technically don't really exist.
This brings into play a concept called body part "mapping" -- when one maps a true-form or phantom body part to another body part that actually exists. A woman's clit becomes the mapped part for a penis (or vice-versa), a man's anus becomes a mapped part for a female vagina, or, in the case of non-sexual parts, one's arms might be mapped to a wyvern's wings. Again, this concept makes for some very strange and interesting -- and often fulfilling -- bedroom play. This is one reason why not all multiples feel any pressure at all to undergo any version of gender reassignment treatments or hormones.