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Acupuncture Today – May, 2003, Vol. 04, Issue 05

The Dance of Yin and Yang: Transgender Health, Part One

By Elizabeth Sommers, PhD, MPH, LAc and Kristen E. Porter, PhD, MS, MAc, LAc

"Please bear in mind, however, that the concept of yin and yang is relative and that it defines no clear-cut antithesis understood to be absolutely active and positive or absolutely passive and negative.

Yin can exist within yang, and yang within yin. The active and passive principles are not merely an arbitrary division of energy, but they are the actual interplay between the elements. All, let it be remembered, is relative."

- Mme. Dr. M. Hashimoto1

In our work with Asian medicine, we develop a professional understanding and respect for the ancient concepts of yin and yang. Originally used to describe the relation of light and shadow, as in the sun's course through the heavens in the daily cycle, yin often represents shade, the moon and the feminine principle; yang is frequently interpreted as bright, the sun and the masculine principle.

Just as the light of the sun shifts throughout the course of the day, yin and yang are continually changing and transforming into each other. The morning's sunny slope becomes the shaded area of the afternoon; there is a perpetual polarity of metamorphosis, a dialectic of contradictions and solutions that results in the unification of opposites. At the point of most extreme night (viz. midnight), morning begins. At the moment the tide is at its lowest ebb, the swell of resurgence commences.

These concepts are rooted in the forces of nature, which are ever-changing. Human beings, as part of the natural world, also reflect the unending cycle of antithesis and synthesis. Charlotte Furth2 writes about the "multi-valence" of yin and yang, which provides a view of nature suffused with gendered attributes that do not depend on the body for their point of reference.

In this context, we are privileged to work with clients who reflect the rainbow of gender identity. One of the primary principles of public health is providing accessible care to all people regardless of age, ethnicity or gender. On a daily basis, gender is often associated with a binary male or female system, such as bathroom delineations; driver's license categories; and male or female check-off boxes on survey forms. However, many gender identities and presentations do not conform to this limited categorization. Activists and advocates have challenged this binary social construct of sex. The resulting response has become a progressive social and political movement. As this article is completed for print, even the national publication People magazine highlights its first mainstream article about transgenderism.

"Transgender" is an umbrella term to describe a person who cannot or chooses not to conform to societal gender norms associated with their physical sex.3 Transgender persons live their lives to varying degrees as their chosen gender and may self-identify as female; male; trans-women or trans-men; nonoperative transsexuals; preoperative transsexuals; transsexuals who have completed surgical sex reassignment; transvestites or cross-dressers; and drag queens or kings, among others. A person's sexual identity is not relevant to this issue.

Intersexuality (formerly called hermaphroditism) involves a set of medical conditions that feature congenital variations of the reproductive and sexual systems. Intersex people are born with "sex chromosomes," external genitalia, or internal reproductive systems not considered "standard" for either male or female. The mere biological existence of intersexuals has challenged the social construct the binary gender system has traditionally reinforced.

A transsexual is a person with an apparently normal somatic sexual differentiation who has the conviction he or she is actually a member of the opposite sex.4 The ICD-10 (International Code of Diagnoses) cites three criteria for this diagnosis: the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment. This identity has been present persistently for at least two years, and is not a symptom of a mental disorder or a chromosomal abnormality.

A transvestite is defined by the ICD-10 as an individual who wears clothing of the opposite sex to experience temporary membership in the opposite sex. There is no sexual motivation for the cross-dressing, and the individual has no desire for a permanent change to the opposite sex.

The second part of this series will be published in the July 2003 issue.

A concluding announcement: We hope readers will join us in Boston November 15-16 for the 10th annual meeting of the Society for Acupuncture Research (SAR). Acupuncture professionals from around the country will provide presentations on clinical and physiological research and evaluation, as well for discussions on emerging trends in our profession. Abstracts are due June 30, 2003. Please check SAR's Web site ( for further details.


  1. Mme. Dr. M. Hashimoto (ed.) Japanese Acupuncture. Dr. P.M. Chancellor. New York: Liveright Press, 1966.
  2. Furth C. A Flourishing Yin: Gender in China's Medical History 960-1665. Berkeley: University of California Press, 1999.
  3. Gender Education and Advocacy. Gender Variance: A Primer. 2001.
  4. Gooren L. An appraisal of endocrine theories of homosexuality and gender dysphoria. In: Sitsen JMA (ed.) Handbook of Sexology, vol 6. Amsterdam: Elsevier Science Publishers, 1988, pp 410-424.

Click here for previous articles by Elizabeth Sommers, PhD, MPH, LAc.

Click here for more information about Kristen E. Porter, PhD, MS, MAc, LAc.

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