Be yourself; everyone else is already taken.  –Oscar Wilde

Some of you will have noticed that I have not posted for several weeks under the heading of “Transgender University,” and that this admittedly somewhat pretentious heading is now missing from the current title.   Rather abruptly I have come to the conclusion that I have passed on most of the information which I think you will find helpful to understanding transgender identity.  Of course having nothing to teach and having nothing to say are two different things altogether, and the latter will probably not occur anytime soon.  If it is within my power, the final words on my deathbed will be, “And another thing…”

I intend to continue blogging on transgender issues, but I now shift gears, conceding that most of what follows will increasingly consist more of personal experience and opinion than anything truly educational.  But who knows–you might still enjoy reading it, we both might learn something by accident and with any luck the weather will improve to the point where another astronomy post or two will creep into the mix.

Bruce, we hardly knew ye…

I confess that I have not kept up with the Kardashians.  Accordingly, I was rather chagrined to discover that the quintessential athlete of my formative years is now only known to my son as “the dad on that show.”  Worse, Christian had never even heard of Wheaties. Vey iz mir.

I hope some of you got a chance to watch the Jenner interview.  For me, it was the first opportunity to see someone about whom I had formed a masculine mental picture now presenting as feminine.  This is as close as I have come to what you have already done in having to reimagine me.  Oddly, I didn’t have nearly so much difficulty in adjusting to the gender shift as I did to the peculiarities of speech–speaking about himself¹ in the third person, punctuating statements with “okay”, etc.  I presume these are the stigmata of life in front of the camera.  Still, knowing what he faces, I don’t worry that this is a publicity stunt.  The personal cost of gender shift tends to discourage frivolous pursuit.  Jenner’s transition will almost certainly be more public than anyone’s since Renee Richards or Christine Jorgensen, but I see this as cause for pity, not suspicion.  I can’t imagine a lonelier way to transition than to do so in front of 20 million people.

Jenner’s saga reflects my experience more than many of the transgender biographies I have encountered.  To the casual observer he seemed happily male, even epitomizing masculinity for a season.²  Now, at 65, he reveals an enduring “female soul” despite appearing stumbling and unconvincingly feminine.  If I don’t know what to make of Bruce’s story, it is only because I don’t really know what to make of mine either.  Shit happens.

Flocking Together

I once marched in a transgender parade at Twin Cities Pride Festival.  It was my first Pride, so I kept a fairly low profile and just soaked it all in.³  At the head of our phalanx, some beautiful human toted a large placard saying, “I [heart] Being Trans.” This remains one of the enduring images of my journey, and I have spent considerable time pondering how one comes to carry such a sign.

The parade in question set off from a small park to which I arrived by cab.  The only way back to Loring Park was to continue to put one foot in front of another and assume that someone else knew the way.  This was a new sensation for me, and one that lingers with me throughout transition.  That I cannot yet feel the jubilation of the sign bearer is not the point.  There are others like me, and they are moving forward.

Last month I had the opportunity to meet with a transgender support group in Rochester.  In so doing, I probably doubled the number of transgender people I know.  We are rarea aves, even in these recent days of trans visibility.  When we do manage to gather, we are like ostriches, auks, bobolinks and blue footed boobies, as similar to each other as any dozen people whom you might grab randomly off the street are to you.  Nevertheless, we are united by that one thing which so sharply demarcates our existence from that of everyone else.  That’s enough for now.

Thus I welcome Bruce, and anyone else for whom the proverbial shoe does not fit.  We are so few.  We should be good to one another.

Buckle up.  This is going to be a long one.

Rewind 100 years.  Homosexuality is considered to be a mental disorder and/or crime.  The now-obsolete term transvestite ¹ has only recently been coined, and transvestites are generally presumed to be homosexual.  Any behavior seen as potentially homosexual is illegal, and public persecution is widespread and tolerated.    When the medical establishment gets involved at all, treatments range from drugged incarceration to electroconvulsive therapy to lobotomy.  A German physician named Harry Benjamin emigrates to the United States and sets up a private practice in New York

A couple of world wars come and go.  Dr. Benjamin’s practice is thriving.  He has developed expertise in the field of endocrinology, particularly using sex hormones to treat symptoms of aging.  He comes into contact with Alfred Kinsey, who refers to him a young patient born male but with an unshakable desire to become female. Up to this time (1948), tranvestism is mostly seen as a fetishistic condition of adults.  Neither Kinsey nor Benjamin think that this explains the child’s behavior.  Benjamin treats the child with estrogen and his dysphoric symptoms ease.  He sends the child to Germany where surgical techniques for transsexuality are maturing.

Similar patients follow.  Benjamin develops a reputation for treating transsexuals (a term he popularized, if not invented) with compassion and sympathy–a welcome change within the culture of the time.  He networks with psychologists and surgeons and catapults into the public eye as physician to Christine Jorgensen, the first widely-known recipient of sex reassignment surgery.  More patients, publications and research follow.

In 1979, an international group of psychologists form the Harry Benjamin International Gender Dysphoria Association to develop standards of care for the treatment of patients with gender identity disorder (since renamed gender dysphoria).  Harry, now 94, consents to the honor.  In 2007, it renames itself the World Professional Association for Transgender Health (WPATH).  Their Standards of Care (SOC) form the basis for all that follows in this post.²

With our history lesson firmly in hand, I now move on to treatments for transsexuality.  Nevertheless, I must pause momentarily to talk about what does not work:

Psychotherapy aimed at changing gender identity and/or sexual orientation.  This was the realization that drove Benjamin’s work.  He found that dealing with the mind/body tension of transsexuality by trying to change the mind was dreadfully ineffective, and reasoned that it would be far easier to change the body instead.  The success of his methods and public notoriety brought on by Christine Jorgensen fueled funding and research questions which ultimately ended up vindicating this approach.

Conversion (“reparative”) therapy.  This might sound like the same thing, but the motivation and methodology is so draconian that it requires separate mention.  Reparative therapy continues to be touted by religious groups as an effective and biblical approach to homosexuality and transgenderism.  I’ll leave judgments about how biblical it is up to you, but the questions of efficacy are easily addressed.  It doesn’t work.  Studies claiming to support the success of reparative therapy are plagued by high rates of participant dropout, short follow up times and false equivalences drawn between decreased homosexual arousal and actual conversion to heterosexuality.  In other words, through harsh shaming, indoctrination of the idea that God doesn’t want you to be LGBT, and in many cases, frank physical torture–aversion therapy–reparative therapy might (but probably won’t) make you asexual.  It will not make you straight.  The largest reparative therapy organization in the country, Exodus International, stopped their ministry in 2013, admitted that their program did not work and apologized to the LGBT community.  Nevertheless, other organizations are picking up the banner and soldiering on.³

I did not undergo reparative therapy, but I can personally attest that more than two decades of earnest religiously-motivated efforts to “straighten up” did nothing to shake the girl out of me.  It did, however, help make me become a miserable prick.  My own methods consisted of prayer–increasingly desperate pleading for deliverance–bible study, humiliating confession (first to Kathy, then to anonymous souls on the nascent internet, and decades later to friends), and traditional practices of spiritual discipline, particularly meditation and fasting.  Throughout this process, my gender dysphoria became worse, not better, until I eventually scared myself, waking up one morning to realize that my frequent fasting had driven my weight down to 159 pounds.  I am 6’3″.  Even this didn’t squelch my motivation.  On my first visit to a psychologist (which felt like a defection for me), I laid out how I had tried and failed to break free from transgenderism, and that I realized it wasn’t working.  I needed a new approach.  She⁴ basically said that she couldn’t offer any cure, but that I was welcome to stick around if I wanted help in dealing with being trans.

I’ll let you know if this new direction ultimately results in my sanity.  If nothing else, I can certainly attest that my life has changed dramatically, mostly for the better.  Now, without further ado, here are the treatment options for transsexuals:

1.  Mental health services.  Trained therapists can help identify gender dysphoria and possible co-existing mental illness.  Psychotherapy is offered, but is not strictly speaking required for gender transition.  Therapists work to control co-existing illness (e.g. depression, anxiety, PTSD, chemical dependence) if present, and lay out the medical options for gender change.  While the therapist can work with the patient to understand and choose options, the choice emphatically rests with the patient.

2.  Hormonal therapy.  Appropriate and interested patients are referred to an experienced physician (often, but not always an endocrinologist) to consider cross-hormone therapy.  A risk/benefit discussion takes place, and further medical testing may occur to predict risk.  The principle risks of masculinizing hormones are osteoporosis, cardiovascular disease, hypertension, slight increase risk of ovarian and endometrial cancers and psychological symptoms including manic behavior and aggressively.  FTM’s need ongoing screening including pap smears and mammography if they do not undergo hysterectomy and/or mastectomy respectively.  The principal risks of feminizing hormonal therapy include blood clots, cardiovascular disease in patients with associated risk, hypertension and loss of libido.  Feminizing hormones do not cause breast cancer in MTF’s and may alleviate prostate cancer risk, although prostate screening is still necessary even after full medical and surgical transition.

It all sounds rather scary, does it not?  Why would anyone consider this?  In a nutshell, it works.

Cross-sex hormonal therapy appears to be effective treatment for gender dysphoria.  We tend to think about this backwards in light of what I described last post as our societal genital fixation.  We suppose, “Tom (formerly Tammy) wanted to have muscles and a low voice.  Now he has them.  Tom is happy.”  Or, Tammy (formerly Tom) wanted breasts and a bigger booty.  Now she has them.  Tammy is happy.”  While I don’t deny at all that physical changes which allow a person to move more comfortably through our gender binary society can and do promote happiness, we risk missing the main benefit.  Increasingly it is becoming clear that the brain is a primary target for hormonal therapy, not merely the beneficiary of external physical changes.  Hormones change the way we think–something no parent of a teenager would ever deny–and these changes can potentially be harnessed for the benefit of those who deal with gender dysphoria.

Cross-sex hormones cause the patient to express traits that are already present in their DNA.  Their bodies come to more closely resemble that of their male (FTM) or female (MTF) relatives.  Hormonal therapy is particularly effective for FTM transsexuals.  They experience increase in muscle mass, deepening of the voice growth of body hair, male pattern hairline (baldness if they carry the genes) and often increased libido.  Testosterone will not increase their skeleton size or cause them to grow a penis, but they will experience clitoral enlargement and, unfortunately, vaginal dryness.  Fat redistributes from the chest, buttocks, arms and legs to the abdomen. They go through menopause and a second puberty, complete with acne.  There are pluses and minuses, obviously, but the final result is someone who convincingly looks and sounds like a genetic male, albeit one with shorter/small limbs, wider hips and breasts.  With chest binding or surgery, you walk right past FTM’s without noticing.

MTF patients experience somewhat less convincing physical changes.  Hair loss stops, but hair does not regrow.  Body hair thins and softens, but facial hair remains.  Muscle mass decreases and fat redistributes to the hips and chest.  Some breast development occurs.  The voice does not change.  Testicular volume decreases and libido often does as well.  Skeletal structure is unchanged including facial structure.  The skin softens, but again, a puberty-like display of acne is typical.  The visual end result is a tall, large-framed, masculine-jawed woman with small breasts and a masculine pelvis.  Some transwomen “pass as women,”⁵ but many do not.

These changes start in a couple of months and develop over a couple of years.  As I mentioned early in this series, hormonal therapy prior to onset of puberty achieves results that are cosmetically remarkable.  Recall the picture of Nicole Maines and her identical twin brother.  The Standards of Care from WPATH apply to persons of the age of majority, but there are also guidelines for minors with parental involvement/consent.

One more detour to the top of the old soap box before proceeding on to transsexual surgery, which I suppose is the juicy bit that has kept you reading thus far.  Hormonal therapy is quite common.  Cross-sex hormone therapy is quite common.  My grandfather took estrogen for decades to slow the progress of prostate cancer.  It worked.  I can think of a half dozen other people (outside the context of work) off the top of my head who are taking or have taken cross-sex hormones to thwart one disease process or another.  Beyond that, millions of Americans take sex hormones to promote well being through and beyond mid life for that which is not even a disease–aging.  We certainly knew about menopause before hormone therapy.  Now we have andropause too.  People take hormones for a variety of reasons, ranging from life-saving to wellness-promoting.  They do this to live longer and better–to make their bodies more habitable–and no one seems to get too knotted about them “screwing with nature.”  Transgender people deserve nothing less than the same respect.

3.  Transsexual surgery.  There is no such thing as “The Surgery”.  That expression derives from societal fixation on male genitalia.  Dozens of procedures that would qualify as transsexual surgeries.  Here, the results are opposite what we saw with hormonal therapy–treatment is more effective for MTF’s than FTM’s.  The transsexual catchphrase here is, “It’s easier to dig a hole than to build a pole.”

Construction of a functional penis from spare parts does is not yet within our technological grasp.  Last week’s news of a successful penis transplant may offer hope for the future, but for now options are limited.  Phalloplasty involves creation of a penis from a combination of genital skin and a muscular flap taken from the chest, abdomen or forearm.  The result may be cosmetically satisfying but cannot become erect.  Mechanical implants can be added to simulate natural erection.  Research is underway to grow erectile tissue in the lab.  Other common surgical options for women include hysterectomy, oophorectomy (removal of the ovaries), and as mentioned above, mastectomy.  MTF lingo refers to these procedures colloquially as top (breast) and bottom (genital) surgery.

A variety of surgical options exist for MTF’s as well.  Vaginoplasty consists of removing the spongy, erectile tissue out of the penis, then inverting the penis to form a cavity.  The tip of the penis is used to form a clitoris.  Multiple different techniques have been developed.  In some, the result is a dry neo-vagina that requires lubrication, but does not involve surgical entry of the abdomen.  Others choose to have a small ring of intestinal tissue rotated down and incorporated into the vagina.  The intestinal ring continues to produce mucus, which lubricates the vagina.  Unfortunately, it never stops doing so, so it’s always a bit wet and sloppy down there, which trans-activist Kate Bornstein has quipped “isn’t necessarily a bad thing.”  Whichever technique is chosen, the results can be cosmetically remarkable–“good enough to fool your gynecologist” and fully functional sexually (although who the hell knows if transfemale orgasm and female orgasm feel similar).  The point is that, once again quoting Kate, “the plumbing works, and so does the electricity.”

Other transsexual surgeries for MTF’s include breast augmentation, facial feminization, tracheal shave (to minimize the laryngeal cartilage or “Adam’s apple”), liposuction/lipocontouring, voice surgery⁶ and a variety of cosmetic procedures (e.g. buttock augmentation, I kid you not) which are not unique to transwomen.

4.  Voice therapy.  Part of the reason I chose Renae for my name is that I anticipated that there would be days when I lacked the energy to explain to an incredulous person on the other end of the phone that they were speaking to a female.  A name that allows me to opt out of that conversation is useful in that regard.  Still, I suspect that it is my voice, even more than my size that causes people to react to me as male, despite my clearly displayed preferences to the contrary.  Voice therapy offers transsexuals the most effective means of dealing with this problem.

Testosterone lowers the voice of FTM’s, but estrogen does not raise the voice of MTF’s.   I mentioned vocal surgery, but I don’t think it is particularly common.  For one, it is quite expensive.  Further, as it involves manipulating the vocal chords, there is risk to the airway.  In vocal coaching/therapy, MTF’s learn to alter pitch and timbre, as well as to adopt more stereotypically feminine patterns of speech.

5.  Hair removal.  Testosterone causes body and facial hair to grow in FTM’s, but it does not reverse male pattern hairline/baldness or remove facial hair in MTF’s.  Two techniques compete now for MTF hair removal.  The tried-and-true solution is electrolysis, which consists of inserting a needle into each hair follicle one by one and discharging an electric shock.  This must happen roughly five times per hair (there are thousands), but results in permanent removal.  The newer technique involves laser therapy at frequencies that target the growing follicle.  This allows for removal of many hairs simultaneously and with less pain.  It works best for individuals with light skin and dark hair.  The results are not reliably permanent.

Personally, I’ve had a hell of a lot of laser, and a single trial of electrolysis.  The laser technician warns you that the laser will feel like the snap of a rubber band against the skin.  While this is perfectly true on, say, the back of one’s calf, the sensation on the face, particularly around the mouth more closely resembles someone pushing a lit cigarette against the skin for a 1/2 second.  The zap of electrolysis is roughly equivalent, but remember that each zap of the electrologist’s needle corresponds to a single hair.  Repeat times 10,000 or so over a multi-year period.  Additionally, I found that electrolysis left my skin swollen, and pitted, the latter for more than a year after a single treatment.  For the time being, I have chosen to shave the lighter hair that remains post laser, but some regrowth is inevitable if I do nothing else.

6.  Legal changes.  Alteration of vital documents allows some transgender people to move more comfortably in society.  Legal requirements for name and gender change have been rewritten to remove hormonal therapy and/or surgery as prerequisites.  I previously blogged on this process here.

The list above is not complete or exhaustive.  WPATH recommends that these treatments be made available to qualified patients who experience persistent, significant gender dysphoria, who are competent to give informed consent to the treatment options and who do not have severe psychopathology.  Treatment is flexible.  Some people opt for none of the treatments, others for all.  Still more pick and choose among them.  Given that understanding the WPATH standards provide a roadmap for all transgender people, not just those who ultimately go on to surgery.  Indeed, the word transsexual itself is just a position on a spectrum of variance, and is already fading into obsolescence.

Whither from here?

In 1974, homosexuality was removed from the DSM, the reference text which lists and defines mental illness.  This decision stands as a critical landmark in the advancement of homosexual rights.  Will the same thing happen with gender dysphoria?

In some ways, I hope not.  What we desire is to be taken as human beings, and to be seen as valuable and whole within the human family.  On the other hand, the treatments which offer the most hope for promoting transgender wholeness are irreducibly medical and really, really damned expensive.  We can learn only so much from the experience our sisters and brothers in the homosexual community.  As Jenny Boylan remarked, gays and transgender folks have very little in common beyond the fact that we get beat up by the same people.  We walk a different path, and must do it in our own way.

Kudos.  You did it!  Thank you for putting in the effort to understand.  I have thrown an absolute mess of information at you, so I reiterate my initial offer to ask questions from the medical to the personal at this point.  Further, those who made it this far are welcome to claim a prize of either a Human Rights Campaign (= sign) or Be Who You Are sticker until my supplies run out.  Let me know.

Squares are rectangles, but not all rectangles are squares.  Basketball is a game, but not all games are basketball.  Boston Terriers are dogs but not all dogs are Boston Terriers.¹  Transsexuals are transgender, but not all transgender people are transsexual.

Transgender is the umbrella term, encompassing the entire spectrum of gender variance. (crossdresser, transvestite, genderqueer, fetishist, transsexual, butch, drag queen, to name a few).  Transsexual refers to a subset of transgender people.  Transsexuals are those trans-people who “desire to live and be accepted as a member of the opposite sex”², who feel discomfort or distress about their biologic sex, and who (often) take measures, or wish to take measures, to alter their bodies to conform to their gender identity.  Those of you reading from the beginning will remember the concept of gender dysphoria; transsexuals are loaded with it.

Transsexuals, specifically male to female (MTF) transsexuals, dominate the popular cultural perception of what it means to be transgender.  It is worth pausing to reflect on this for a moment.  First, some transgender people suffer little or no dysphoria, are completely at peace with their bodies and have no desire whatsoever to modify them.   Second, roughly half of transgender people were assigned female gender at birth (FAAB).  Nevertheless, the public eye is fully trained on Laverne Cox, Bruce Jenner, Janet Mock, Chelsea Manning, Andreja Pejic and Nicole Maines.  Not that the (mostly positive) attention is bad–the fact that more transgender people are being celebrated rather than ridiculed is in itself cause for celebration.  Today I will present two reasons why I think the public spotlight is so narrowly focused.  If you have time, spend a moment and come up with your own theories before reading on.

Reason #1:  Genital fixation

Genitals mesmerize us.³  No other body part exerts similar or simultaneous power to arouse, amuse and define and disgust.  Sure, we’d like to think that our brains matter most, believing in the freedom of thought and the nobility of reason, but such things are no match for the simple, built-in binary of the human crotch.  It is your junk, not your brain, which essentially maps out the details of your life–whom you can befriend, how much money you can make, what sort of emotions you are allowed to express, what you wear, what jobs you should consider or whether or not you are seen as fit to lead.

Transsexuals regularly hear that they are fixated on the genitals of the opposite sex from a society that is fixated on theirs.  Total strangers feel no qualms at all against asking about our plumbing and/or sex life.  Poor, frightened kids who thoroughly see themselves as female and already feel betrayed by their bodies are compelled to be submitted to risk of further personal injury and humiliation in the boys room because, well…penises.

Penises are trump in the (small) deck of genital cards.  Transsexuals supposedly want to “cut their dicks off”, even though that is not what actually happens in gender reassignment surgery.  Woman with ovaries removed?  Woman.  Man with testicles removed?  Eunuch.  Not so long ago, the internet teemed with suggestions that Osama Bin Ladin and various Taliban extremists should be made into women by having their genitals excised, as if that’s all it would take.⁴  Society has a simply enormous case of collective castration anxiety which shapes its approach to trans people.

I don’t know how typical my experience is, but I generally observe that others are far more fascinated with my genitals than I am.  Rumors and bets about if and when I would have The Surgery proliferated around town long before I gave the question any thought at all.  If I ever write a sequel to my “Bathroom Song,” it will contain this little true-life morsel:

This time in the Ladies room, I’m standing there in line

When she asked about my genitals as if to pass the time

I struggled for an answer, I stammered out some words

And I wondered, “Was I selfish for not asking about hers?”

Reason #2:  Gender inequality

Ask the average man, “Would you ever want to be a woman?” and you are likely to hear either a) vigorous, indignant denial, or b) some incredibly inane comment about being able to play with one’s own boobs.  Ask a woman if she would ever want to be a man, and you will likely hear either a) matter of fact denial, or b) a relatively sophisticated non-sexual gain/loss analysis.  Male privilege enables some women to question whether it might be easier, more fun, or advantageous to be men.  The same male privilege leads men to see being female as a downgrade, or even, as we saw above, a potential punishment.  I should hasten to remind that transsexuality isn’t so much about who we want to be as who we think we are, and yet the thought experiment above is useful.

If a woman (female assigned at birth–FAAB) transitions to manhood (FTM), society seems to get that on at least some level.  Further, FTM transsexuals tend to escape notice due to the high efficacy of hormonal therapy in their case.  Of course FTM transsexuals face horrendous discrimination, but the flavor of their oppression tends more toward shunning, ignoring or denial of opportunity.  Theirs is the curse of invisibility.  We don’t see them peppering the checkout line supermarket news rags, and thankfully we don’t see them murdered at the same rate as MTF transsexuals, particularly transwomen of color.

Try another thought experiment.  Match a word or words from column A with a word from column B.  Do some words seem to fit better than others?

I welcome your honest feedback on this.  My suspicion is that the words mentally associated with FTM’s and MTF’s will overlap to some extent, but still vary significantly.

Getting back to castration anxiety⁵, we can begin to understand violence against transwomen.  Some men feel threatened by the mere presence of MTF transsexuals.  And God forbid that they discover that they are attracted to one!  Such arousal often precedes MTF homicides, both random and relational.

In the next posts, I plan to address the treatments for and the medicalization of transsexuality.   Stay tuned and feel free to subscribe.  All you’ll get is an email when a new post publishes.

My son pointed out that I have more posts in this series than the link bar on the right can hold, making it difficult to go back to earlier posts in the series.  I am looking for a way to correct this without messing up existing subscriptions.  Any of you wordpress-savvy folk tuning in please feel free to point me in the right direction, and perhaps this paragraph will get to go away.

_{I hope you enjoy the nifty new footnotes.  I am undecided as to whether I will bother to back-edit the old posts, but you can now click down and back without losing your spot.¹}

More than 50% of expectant parents want to know the sex of their unborn child.  Armed with this information, they choose the paint for their nursery, purchase a wardrobe and select appropriate toys.  Mothers-to-be speak to their bellies in a higher pitch for girls than they do for boys.  They begin to ascribe gender-stereotyped behaviors (strong kicks, peacefulness, etc) after the 20 week ultrasound.  A 2005 study showed that birth announcements disproportionately describe the parents of boys as “proud” and the parents of girls as “happy”.   Before babies give a literal shit, a whole lot of metaphorical shit has already been given regarding their heavily-gendered destiny.

As I conceded before, the binary gender system²  usually works.  Most kids seem quite content with their gender assignments or at least eventually grow up into adults who do.  In my business, 99% predictive power in a diagnostic test is remarkable, and the old check-between-the-legs trick appears to predict gender 99% percent of the time.  It’s a great test.

Or is it?  I don’t propose to answer the question so much as to encourage a bit of healthy skepticism.  Do the same labels that help us choose toys and clothes for a baby come at the price of unequal pay for women?  What if “girls are more empathetic” is just the flip side of “girls can’t do math”?  Should we be surprised that names and fashion trends cross from boys to girls, but not in the other direction?  People rob banks, not parks.   Where are the public service announcements intoning that a boy can do everything that a girl can do?  Children of both sexes who transgress the boundaries of gender learn early that the border is ferociously defended.   Written on every guard tower are two words:  male privilege.

Women who have spent their entire lives dealing with male privilege can be forgiven for amusement at the angst I feel from losing it³.  The gender border exists principally to subjugate them rather than to shoot deserters like me.  Considering that I continue to gain unearned advantage from my race, economic class, nationality, educational opportunity and a host of other factors, I really have no cause to bemoan that the system works against me simply because I no longer receive favoritism on account of sex.  Indeed, had I not come out, I might not have even had an inkling of what disadvantage felt like.  It’s probably good for me to at least taste bias, but I don’t like it one little bit.

Conscientious objection to gendering our children seems to be gaining traction.  Parents in England and Canada recently made waves by choosing not to disclose the sex of their children to the general public.  Swedish dictionaries have recently added a new gender-neutral pronoun for children, “hen”, reflecting a privately initiated trend in Stockholm nurseries.  The linked media coverage demonstrates the difficulty we have in even talking about such an approach to raising children.  I’ll leave it up to you to decide how radical these efforts are, but criticism offered so far depends on misunderstanding of terms (confusing sex and gender), misrepresentation of fact (reporting as if information is being withheld from the children themselves) or concern that children won’t develop gender differences that are supposedly innate.  Well, are they or aren’t they?

We all wore the dress.  Generations of clan TeBrake ⁴ were baptized in the long satin gown which my mom still preserves as a family heirloom and ships around the country as needed for any new arrival.  If you are my age or older, you have almost certainly seen photos of your grandfathers as toddlers also wearing dresses.  Less than 100 years ago, dresses were children’s clothes, not girls’ clothes.  That this is no longer the case probably owes to highly absorbent disposal diapers and abundant, relatively inexpensive clothing.⁵  As far as I know, I am the only MTF transsexual in my family, so the dress’s track record on producing gender confusion manages to eclipse even its failure in producing lifelong religious converts.

Of course, there is far more to gender than what we wear.  I trust you not to oversimplify gender in your thoughts to the extent that I often must to write a column of less than 1000 words.  I aim not to persuade you to adopt gender neutral parenting, but rather to encourage you to consider whether gender stereotyping, which is almost undeniably out of hand, might be more destructive than previously recognized.  Neither do I defend a position of gender as completely constructed.  Stating the obvious, no one raised me to be female.

I begin with two apologies.

The first has been brewing for awhile.  Six posts into this series, I have said almost nothing whatsoever about female-to-male (FTM) transgender living.  This owes not to intentional slight, but rather to the fact that I have no personal experience to relate.  Nevertheless, I am quite fortunate to count several transmen as friends.  I do not wish to perpetuate the myth that transgender identity occurs more often in those born male than those born female.  Not so.¹

The second relates to a certain lack of creativity in this post.  The interwebs teem with “things not to say” lists.  I hesitate to walk on such a well-trodden path except that it is impossible for any one list to encapsulate the way all transgender people think.  Try this thought experiment:  get together with a friend and make a similar list for some demographic that applies to both of you: farm kids, Belgians, women or twenty-seven year olds.  A few common themes might arise, but are your lists identical?  Is your list better than your friend’s attempt?  Step one in relating to anyone, whether trans, Latino, socialist or cat lover is to see the individual.   Consider my list to be a friendly addition to excellent offerings by others.

Further, I think it no mistake that the first of our enumerated rights is that of unfettered speech.  The freedom to express myself that I hold so dear as a trans person is inseparably linked to your freedom to do the same.  What follows are not rigid rules, but rather examples to highlight ways in which people subconsciously tend to dehumanize trans people and reminders about polite social engagement.  With that understanding, here are things I think you probably should not say to a trans person:

1.  Nothing.  One of the hardest parts about coming out for me was that people were talking about changes in my life, but I was not invited to the conversation.    Feel free to speak with me as if I do not have a contagious disease.²  The danger in preparing a no-no list is in giving the impression that speaking with a trans person requires an entirely new complement of social graces.  I do not think this is the case.  All the usual social cues apply:  depth of relationship, who else is listening, what topics have been on the table in the past, non-verbal expressions of comfort/discomfort, urgency of information, mutual negotiation of conversation boundaries, etc.

2.  So…now?  Put almost anything between those words and I can almost guarantee that it will finish badly.  These little bookends magically convert a request for information into an expression of skepticism or dismissal.  Witness:

“Do you think you are a woman?”

“So, do you think you are a woman now?”

3.  Why would you ever want to be a woman?  Odds are, you have never said this to your daughter.  A woman is a perfectly wonderful thing to be.  Even if one could get past the sexist vibe, the question approaches gender identity as a matter of choice, and a foolish one at that.  Transgender people get barraged with messages that they are fucking with the natural order rather than simply trying to live authentically.  We recognize the code:  lifestyles instead of lives, agendas instead of dreams, choice instead of birthright.

4.  I’m sorry but I just I can’t call you _________.  Yes, you can, actually, and the sooner the better.  Claiming impossibility sidesteps the normal social courtesy of meeting people on their own terms.  Often what is meant is that associating a new name to an old face is difficult.  Trans people understand this–it took me awhile too.  Try this instead:  “I’m having a hard time training myself to use your new name.  I’m sorry if I still mess it up sometimes.”

5.  Why are you wearing that?  The color makes me happy.  I like the way the fabric feels against my skin.  I saw it on the mannequin and I just had to have it.  The cut gives me a curvier shape.  Black is always fashionable.  I have fabulous legs.  It matches my shoes.  It hides my belly.  It brings out my eyes.  Prints are all the rage.  The dress code calls for business casual.  It’s supposed to get windy later.  LTS marked it 80% off.

Self-expression is intensely personal.  I have paid an excruciatingly high social price for dressing in a way that makes me feel beautiful, confident…even, to quote a dear friend, glorious.

At least it did make me feel that way until you said that…

6.  Whoa…for a minute I thought you were a woman.  I can’t get anything past you, can I?  You saw right through my seven years of presenting as feminine, changing my name and even the “F” on my driver’s license, passport and birth certificate.  Kudos to you, sir.  You solved the puzzle.  Have a biscuit.

7.  “It’s like I’ve lost you.”   Variations abound:

“Who are you and what have you done with the person I loved?”

“I miss <old name>.”

“We are grieving.”

Transition disrupts social order.  The impact ripples outward to family, friends and beyond.  The first order of business is to openly acknowledge the validity of whatever emotions come in to play.  We feel what we feel.

What comes next may sound odd coming from someone who has made so many waves in the area of self expression:  not everything felt needs to be expressed.  Yes, it genuinely hurts to find out that someone you love doesn’t match up to the image of them you hold in your head.  Worse, the frightened souls emerging from the closet tend to careen into walls and stumble awkwardly over the furniture.  Might they not be a little more understanding of what you are going through and try not to make such a mess?  They need a little perspective.  “It feels like you’re dead.”

I had it all, as they say–a beautiful wife and family, postcard views of every sunset and a job that more than compensated me for my efforts.  Rumor has it I was even kind of cute.  The only hitch was that someday I would die and nobody would ever have known who I really was.  When I could bear it no longer, I told the world my secret.  It was unwelcome news, and there has been no shortage whatsoever of people telling me I am metaphorically dead.  Please don’t add to that vile roster.  It won’t actually make you feel any better.

Transgender people sometimes surprise me too.  There really aren’t that many of us–mere millions, if the statistics can be trusted.  Sometimes we get so rattled by the unexpected that we start to babble the most ridiculous gibberish.  We’ve all been there.  The best we can do is to expand our comfort zones and stretch our horizons.  Meanwhile, I hope my list helps you avoid stepping the occasional pile of poo.  If nothing else, remember one golden rule:

Do unto transgender people as you would do unto anyone else.

_{¹  You might encounter the abbreviations FAAB (female-assigned at birth) or MAAB (male-assigned at birth).  These terms point to the fact that gender is routinely assumed from sex even though it does not always follow in this manner.}

_{²  As far as you know.  Hug?}

Fast forward…

In the year 2315, an archeologist explores the remnants of a hilltop home 50 kilometers southwest of the spaceport of Minneapolis.  To her delight, she spies an undamaged safe buried within the mound of rotten wood, broken glass and plastic water bottles.    Her sonic screwdriver makes short work of the rudimentary lock, and within seconds she holds a fading document.  It is a birth certificate, which declares that Renae Gage, female, was born in San Diego County at 10:45 PM on the 12th of January, nearly 350 years ago.  30 meters away, she discovers a shallow grave marked with the same name.  A bit of digging uncovers skeletal remains.  A wave of curiosity crosses her face.  She examines the pelvis.  No doubt about it–male.

How might our archeologist make sense of seemingly contradictory information?  She knows that bones don’t lie¹, but then again, neither do birth certificates.  Do gravestones?  Perhaps she has found the wrong body.  Or, maybe someone altered the vital records.  In either case, the story is starting to get really interesting…

We face the same question in 2015.  “Who is this person in front of me?”  Those who would advise the archeologist to trust the bones see little mystery.  Gender, in their view, is identical to sex and fixed at birth.  Oddly enough, those who would advise the archeologist to trust the birth certificate  are starting to sing the same refrain–they claim that I was born this way.

I am not sure about that.  I wasn’t present at my birth, where “I” equals my conscious self.  I vaguely recall once either thinking or saying “I am three” while descending into the basement of the house where I lived at the time.  If memory serves at all, the stairs were oriented such that the back yard would have been to my left as I went down.²  That’s as far as I go back.

I personally find it difficult to think of myself as being born as one gender or the other.  What does it mean to speak about my core identity three years before a time when I may or may not remember which way it was to the back yard?  At some point I developed awareness that I was a boy because my parents told me I was, dressed me like one and sent me outside to play with others.  And, to be clear, this almost always works out just fine.  I don’t recall questioning it, but if I did, the answers given almost certainly had something to do with how I peed.

I plead ignorance about how my trans identity came to be.  I spent many years denying that it existed.  By the time I had to admit to myself that it did, I was already pretty far removed from the facts of the matter.  Before I gathered the courage to express my identity, I was further removed still.  I don’t know if I was born this way, and I am even less sure how much it matters.

Personally, I think it is a metaphor.  By this I don’t mean to say that those who use it are either wrong or dishonest.  Again, I claim expertise only on my own story.  Others may have more vivid memories of the early years that are nothing more than a blur to me.  However, I just don’t think about either gender or infancy in that way.  What was my identity when I could do no more than eat, poop and smile?

Language is thoroughly metaphorical.  You feel “up” today, but Sally feels “down”.   We have no difficulty at all grasping how Katrina feels when she is “walking on sunshine”.  Those of us in midlife nod empathetically  when Bruce Cockburn “paces the cage“.  These words are true without being factual.    It may or may not be that our gender is fixed at birth–I genuinely don’t know–but the words are true enough for the person who speaks them.  Here are some reasons why I think those particular words might be so common in the personal narratives of trans persons:

Sometimes gender variance really does show up in the nursery.  Nicole Maines, who recently won a civil rights law suit against her school district because she was denied use of the girl’s restroom, clearly expressed female identity at age two.  Her story is particularly interesting because she has an identical twin brother who is not transgender.  Their joint experience undercuts the notion that gender is genetically determined–their DNA is also identical.  Further, photos of the siblings together demonstrate how effective hormonal therapy can be if initiated before the onset of puberty.

People like Nicole prove to my satisfaction that transgender identity is real.  Given the shame and doubt that transpeople regularly experience, she is a welcome source of inspiration.  Still, I wonder how much her experience helps to explain what I see more commonly–people coming out in early, middle and even late adulthood.  Are Nicole and I the same sort of creature?  If not, how much can I really apply from the apparent success of her transition?

People more readily accept trans identity in children.  Few people seriously doubt Nicole’s story.  On the other hand, when I read about Chelsea Manning transitioning in the midst of legal trouble, or Bruce Jenner coming out after years as a professional media hound, part of me wants to ask , “What the hell are they up to now?”³  Adults who transition get routinely cast as nut cases or perverts.  Indeed, many of us shame ourselves in this way as we try to figure out who we are.  There might be a social and psychological incentive to the “born this way” narrative.  It asserts that our identities were forged in an age of innocence.

Gender feels inevitable.  I can recall what I now recognize as transgender feelings as early as 9 or 10 despite the fact that memories of that era have grown vague and sparse.  These feelings multiplied through adolescence and still more so throughout adulthood.  Even if I can’t see all the way back to the cradle, the general impression that something set itself in motion from the beginning seems plausible.

Duration imparts credibility.  A 300 year old building often impresses us more than a brand new one, even if the latter is more functional.  The first objection a transperson encounters is, “You were never like this before.”  This is untrue.  None of us would go through the disruption of gender transition unless we were tapping into something real and long-lasting.  Coming out is not for wimps.  On the other hand, given the tendency of society to doubt the validity of our identity, might it not be tempting to overemphasize  early awareness when we tell our stories?

There is no morality where there is no choice.  The dominant paradigm throughout human history held that LGBT people are morally deficient, having opted against normal, healthy and righteous behavior.  This alleged deviancy has been used to justify horrible discrimination and violence against our community.  Seeing transgender identity as fixed at birth is one way of diffusing this prejudice.

I don’t think it is the only way.  It might well prove true that we have no choice whatsoever in our gender identity.  But what if this is not the case?  I am open to the idea that factors operating later than birth, including choices on my part, might have played a role in my identity formation.  However, I also recognize that whatever input I had into the process occurred at such a tender age as to make moral condemnation meaningless.  Further, I understand that any lack of understanding I might have about how I came to be transgender pales in comparison to the demonstrated historical ignorance of those who insist that the root cause is sin.

_{¹  Actually, bones lie almost as well as sleeping dogs if you let them.}

_{²    I would be interested in finding out if this is correct, because that would prove…well, nothing actually.}

_{³  In the end though, I choose to believe in what they are doing until or unless it is utterly unbelievable.  It’s a hard road to walk even for the best of reasons, and I am very much living in a metaphorical glass house on this one.}

Dysphoria is such an ugly word.  It sounds like something that you catch from an uncovered sneeze or a dirty toilet seat.  You don’t need to have a solid grasp on the definition to sense viscerally that you don’t want it.  Nothing good is about to happen when a word starts with D-Y-S-P-H.¹  Dysphoria opposes and negates of all those words we associate with peace and wellbeing.   It is dissatisfaction, discomfort, disorientation, and perhaps even dis-ease.

People may be dysphoric for all sorts of reasons, or for no apparent reason at all.  Gender dysphoria is specifically the discontentment or anguish felt by the transgender individuals arising from tension between their biological sex and their gender identity.

Not all transgender people experience significant gender dysphoria. Corporal Klinger didn’t.  Your average tomboy probably doesn’t.  The occasional crossdresser who tarts up for thrills or stress relief might or might not.  In other words, regardless of how people see themselves or express themselves, they are not gender dysphoric unless they suffer distress over it.

In an earlier post, I compared my own gender dysphoria to the hiss of an old time radio.  I can still hear the music  (life), but the underlying static is always with me, sometimes nearly drowning out the music itself.  Indeed, the delay to publication in this post owes largely to the fact that the noise has been all but deafening lately.

The emerging cultural narrative about transgender people doesn’t totally ignore gender dysphoria, but it does tend to cast it as a temporary nuisance rather than the lingering existential crisis with which I am more familiar.  The trans person, so the story goes, isn’t really conflicted at all.  They were merely born in the wrong body.²  They always knew who they were, and suffered only because society didn’t see it too.  Once everyone was on the same page, the situation was quickly set aright.  Hormones.  Surgery.  Happily ever after.

Transitions like this certainly happen, and I think they are cause for raucous celebration.  A life liberated from the ponderousness of gender dysphoria is a very, very beautiful thing.  Unfortunately, my own limited experience with the transgender community leads me to question how often this is the case.

I recently started watching Transparent.  I don’t know if I will get through it.  At first I thought it was the obvious comparison–watching aging, frumpy protagonist Maura Pfefferman stumbling awkwardly through transition hits me fairly close to home.  The more I’ve watched, however, the more it seems that Maura is the one stable character in a cast of crazies.  She is long-suffering, self-sacrificing, patient and wise.  She is transgender Jesus–healing the sick all around her.

Well, I’m not Jesus.  I have moods and I make messes.  I give my best to those I love, but I often screw up and have to rebuild.  I see myself not as a beacon of stability, but rather as the fortunate recipient of love and support from people better attuned to the rhythms of life than I am.  I haven’t always known who I am and I don’t know where I am going.  I don’t know if or how I will ever get beyond gender dysphoria.   One day I think that I need to make further efforts toward establishing my feminine identity, and the next I wonder if whether I might be happier back in the closet.  I wake up anxious and restless in the wee hours. I crave distraction–anything to dial down the soundtrack of doubt in my head and lessen the increasingly familiar tightness in my chest.

And, I write.  Though I certainly hope you enjoy and benefit from this latest creative endeavor, I am fully aware it is my own lifeboat that I inflate.  Five short years ago, I wrote Gawker Slowdown.  

I’m not trying to make a statement

I don’t want to draw a crowd

But being true to who I am is not a sin

I just want to feel at home inside my skin

That is still the promised land toward which I journey.  One day, I hope to see its beauty with my own eyes and taste its fruit with my own mouth.  For now, I still wander in the wilderness.

_{¹  There are two other words that start with the same five letters.  Neither of them are any good either.}

_{²    We sometimes forget this is a metaphor.   I take its meaning as:   a) the person experiences disconnection  between mind (gender) and body (sex); and b) doing nothing to fix that would be too painful to bear.  For me, the concept of being born in the wrong body seems less an answer than it is a clichéd restatement of  the problem of dysphoria.}