Tag Archives: Transgender

What I Am Learning about Privilege

Published / by rmaddy / 4 Comments on What I Am Learning about Privilege

History flows—oozes perhaps—like lava to the sea, burning all that stands in its path.  That we are among the things in that path is something we generally prefer to forget, only to be shaken by moments that awaken us to the approaching fire.  Accidents, deaths,  national tragedies—each arouse us momentarily to the droning, one way1 march of time.  These moments anchor us in history.  “Where were you when…”

As I sat down to write this evening, news of the Parisian fire awoke me once again from my oblivious slumber.  For decades to come, every child of France will ask, “Where were you when Notre Dame burned?”  A mere Francophile, and not at all religious, I cried at the destruction of the ancient cathedral.

Already we hear the promises.  Notre Dame will be rebuilt, and so it will be.  Ashes do not smolder forever.  When they cool, they will be swept away.   France is awake.  With tears in her eyes, she prepares to work.

Events that turn our eyes to the flames do not relieve us of our daily obligations.   Paralyzed by our grief, we must nevertheless go on.  With  barely a moment to catch our breath, we find ways to take the first few steps.

  • We take control of the story.  Our loved ones are not gone; they watch over us.
  • We tell ourselves that this is for the best.  True, the car is totaled, but the next one will be so much nicer.  
  • We rescue something from the carnage.  We carve a coffee table out of the 100 year old oak uprooted like a sapling by a passing storm.  Better yet, we plant a new tree.  In time might it not also prove to be magnificent?

And yet.  And yet.

We cope and we remember,  We hurt and we continue.  We grow and we change.  We do whatever we can to forget, once again, the relentless approaching inferno. There is no shame in this.  We do these things because it is in us to do so.  “Whatever gets you to sleep at night” is as valid a moral compass as any other as I can imagine, so long as what that is prevents no one else from peaceful rest.

There is no UNDO button on history.   In whatever moment we find ourselves awake, we do well to look momentarily into the fire.  Tomorrow we must pick up our tools and get busy.  And when we complete all we intend, we will rest once again, telling ourselves that it is even better than before, as if to say, of all possible critiques, Notre Dame was nice, but maybe just a little too old.


I remember the room—the half-painted walls and the stacks of books; my therapist’s glasses and the my butt sank into cushions of the old plaid sofa.  Exactly what words were used and in what sequence is far less clear.  We were talking about the price I had recently paid for beginning transition.  I lost most of my friends, and family support was anything but at that time.  

She asked me about why I had lost my friends, and I said something like, ”I broke the man code.”  She directed me to think about what that was and why that mattered, and we spoke of the concept of privilege, an idea which at most I had seen darting across my peripheral vision.  Now I was tasked to look straight at it.  As nearly as I can recall, I said this:

“Whatever I do with my gender dysphoria, that  (i.e. male privilege) has to go.”  

I was, in that moment, startled awake.  Like many erstwhile sleepers, a light flickered on, I bolted upright in bed, and I uttered some gibberish that I didn’t remotely understand.  I had no bearings, but out of this confusion, a new waypoint emerged—one from which I would navigate in the future.


Fast forward 10 years.  

I have completed those aspects of gender transition which most deeply involve medical intervention .  Many of you now do reflexively what I asked of you five years ago—to refer to me by a new name and honor the validity of my gender identity by using coherent pronouns.  For my part, I have begun to understand and that there are nearly four billion living examples of what it means to be a woman, and that I am one of them.  I do my best to remember that being misgendered at this point says far more about the speaker than it does about me.  I take measures to see that such invalidations continue to diminish and I keep appropriate emotional distance from those who cannot or will not make those adjustments.  Transition is a path rather than a destination, but today the path is better lit.

For the past several years, I have had the annual pleasure of helping to teach first year medical students about transgender experience independent of and connected to medical systems.  First year medical students consume information with ferocious intensity.  By the time I meet them in the spring, they separate fuel from fluff with mechanical efficiency.2   This being the case, I look forward most of all to the question and answer period.  This year, the most fantastic inquiry went something like this:

“Having lived most of your life as a well-educated, well-compensated white male, and having gone through such a transition, what have you learned about privilege?”

In the moment, I related the story of the counseling session which lit the spark, to which the student immediately parried, “Do you think you’ve accomplished that?”  My answer was, “No, of course not.”   The remainder of this post concerns what I actually have learned.


I know next to nothing about privilege.

I write at some length in a sincere attempt to consider the question posed to me.  In so doing, I will certainly say things that sound rather stupid and embarrassing ten years from now.  This, I think, is about what one might expect from someone who forfeited only a small fraction of the privilege afforded to me.  I deliberately write under the title “What I Am Learning about Privilege”, because I recognize that I still don’t understand the topic well, and that understanding it better only offers the possibility, not a guarantee, that I will find ways to be less a part of the problem.  Those who wish to learn about privilege from a qualified source should look elsewhere3  I would suggest White Fragilty:  Why It Is So Hard for White People to Talk About Racism, by Robin DiAngelo, The New Jim Crow:  Mass Incarceration in the Age of Colorblindness, by Michelle Alexander,  Whipping Girl:  A Transsexual Woman on Sexism and the Scapegoating of Femininty, by Julia Serano or So You Want to Talk About Race, by Ijeola Oluo.  These are difficult reads for many of us.  Go on, be brave.

I write despite these limitations for several reasons. First, I  remain committed to sharing aspects of what it is like (for me) to be a transgender person, and what is involved in transitioning specifically.   I serve the reader poorly if I leave unchallenged the dominant cultural understanding that transition is a matter of the surgeries one has and/or the medicines one takes.  Second, I know that my readership is limited, and that the vast majority of people who take the time to read do so because they know me in some fashion.  I doubt that the undeniable gall of me writing half-wittedly about this will drown out the voices of those who know of which they speak.  Third, I do some small penance in these pages for the my historical blindness to the plight of others.  In writing these 50 lines on the chalkboard, may I become a little less so.  Finally, I wish to encourage.  If someone as oblivious as I was can start to see privilege, I’m pretty sure that anyone can.

Privilege is a fact, not an attitude.  

Like many beneficiaries of privilege, I originally saw privilege as a character flaw–a way of thinking–and believed that was something that I could unlearn to whatever extent I exhibited it.  Conversations about privilege so often derail because privileged participants feel affronted and respond by defending their honor rather than by trying to understand.  Had I not already been in therapy for an extended period of time and had I not observed that people reacted to me much differently as a transperson than as one they encountered as male, I would have tried to shut down my therapist’s question.  Hell, I probably still did.  I don’t honestly remember feeling insulted, but my initial response reflects that I saw “eliminating privilege” as a bullet point to add to my to-do list.

Privilege is a fact of social structure.  Those belonging to privileged classes—white, male, Christian4, educated, middle or upper class, heterosexual, financially comfortable or wealthy, two-parented, etc. experience easier access to the tools of prosperity—finances, education, employment, power and so on.  It matters not a bit that I never consciously took advantage of anyone else.  Advantage accrued to me, silently, persistently, unsolicited and unnoticed because society, law, culture and the economy were fashioned for centuries by self-interested people who were demographically similar to me, using such power as they had to protect their turf. 

Perhaps you are a positive person, hard-working and always willing to lend a hand to those in need.  Kudos, my friend.  Personally, I’m rather lazy and self-centered.  You are a better human than I am.  You still prosper through privilege which you did not earn.

Seeing privilege is uncomfortable for those who have it.

I worked hard, I assure myself, to get where I am, but even those aspects of my personality that enabled me to work so hard are essentially happy accidents of genetics and social context.  I emphatically am not a self made woman.  I was given an easier path to walk and I did so without falling on my ass—nothing more.  There are uncounted millions who worked harder than I did languishing in poverty, crushing daily stress, and powerlessness.  The price of my easier path to success is the treacherousness of theirs.  

I can not “get rid of privilege” in my life.

I dislike, now that I recognize it, the skewing of society that prevents others who work as hard or harder than I did from succeeding.  Disliking the inequities of society does not negate them or the fact that I still benefit from them.  Disliking inequity does not necessarily mean that I am willing to give up a single thing to diminish it.

Transition merely enabled me to experience directly what goes missing when moving from a privileged (male) to a marginalized (transgender female) gender status.  Parenthetically, when I hear the refrain that people are claiming to be transgender because it is trendy, I worry that my head might explode.  Sure, it is a moment when transgender identity is somewhat novel and newsworthy, but being transgender affords no advantage whatsoever in terms of access to the levers of power and thriving.  

Having lost one sliver of privilege going foreword does not erase the privilege I accrued prior to coming out.  In fact, I continue to possess certain social traits that were rewarded in my male upbringing which were not similarly rewarded in those socialized as female.  I never learned, for example, to be deferential to men or to be act graciously in accepting an assignment that I perceive to be a waste of my talent.  Privilege is a fact, and the facts don’t change until the societal structures that create it are dismantled.

Privilege cannot be addressed, let alone eliminated, until or unless the structures which create it are dismantled.

Sometimes my next bullet point comes to me as I am trying to mop up the last one.  File this under things I did not know that I knew a couple of hours ago, but it turns out that I did.

Privileged people have difficulty seeing privilege because of perspective bias.

I practice medicine in the era of information.  Patient surveys reveal that physicians and patients, when asked the same question—“How long did the physician spend in the room with you?”—give widely different answers, and that the answers often have relatively little to do with the actual amount of time spent.  Perspective matters.

It seems to be a common human trait to overestimate the extent to which we “made it on our own” and to underestimate the extent to which others did so.  Anecdotal evidence fertilizes such perceptions nicely.  How many of you believed that racism had diminished to the point of political irrelevance when Barack Obama was elected President?  I certainly did, because my perspective—a white person voting for a black person—caused me to assume that 300 million other Americans felt more or less the same.  The privilege I experienced as a white person made it easier for me to ignore the fact that employment/housing discrimination, mass incarceration and historically unaddressed racist social structures did not disappear in 2008.  No–I felt good about myself for being so “colorblind”.  This did nothing to mitigate that I could, the next morning, number my black and brown friends without using my toes, and that I had no possible way to actually understand the struggle of being black in America.

This is the trap that prevents reasonable discussions about privilege.  Those who have privilege feel that mention of it diminishes them.  Not so.  Privilege elevates them at the expense of others.  What is felt is not insult, but guilt.  Privilege guilt needs to be faced, not dismissed.

Privilege is nearly impossible to see from the inside

I am a recreational astrophotographer.  I take pictures of the sky because if I do the work, I can count on the sky to be stunningly beautiful.   A few years ago, I posted a picture I took of the Andromeda Galaxy, some 3 million light-years distant from our sun.  Much to my surprise, several people asked if this was a picture of the Milky Way.  I spent years getting to know the sky and hours setting up and acquiring the photo.  Coming from this background, I could not conceive of taking a high-level external photo of the entire Milky Way because I am inside of it.  When next I take a picture of the Milky Way, my telescope will stand idly by, because I do not need to zoom in, but rather to try, as much as possible, to lean back in order to catch a glimpse of the big picture.  

Otherwise put, recall the old saw about the forest and the trees.

I have a friend—truly a friend—to whom I recently confided my angst about the difficulties I might have finding another job if my current one disappeared.  Meaning no ill will whatsoever—in fact intending the opposite—he told me that he understood how I felt.  I told him that he could not possibly understand because our circumstances were substantially different.  I botched the conversation, honestly, but my objection was valid. He felt aggrieved because he personally would have hired me.  Still, he could not possibly know how it feels to be a member of a class which faces employment discrimination and wrongful firing sanctioned by law in the majority of the United States.  He did not see the extent of the privilege that smoothes his path–virtually identical to mine pre-transition–because he never once stepped off of it.  Privilege is obvious only to those who do not have it.

This is the transition I will never finish.

I spent forty years mostly oblivious to the ways in which the structures of society continually enhanced my chances of success.  I spent the next ten, starting on my therapist’s sofa, merely beginning to grasp what is obvious to those who have to contend with structural bias on a daily basis.  If I live another forty, I will still never fully unlearn the patterns stamped into my thoughts or be able to give back the advantages that I received.

It is not enough for me to wish for a better society.  I need to work toward one.  I will probably never be in a position to rebuild social structures, but my shovel too has dug this hole, and at the very least, I must lay it down.


History flows like lava to the sea.  All will burn in the end.  If, for the moment, I find myself on high ground, it is largely because I was born there.  If I stay here, I will still burn eventually.  All around me echo the screams of those scrambling through harsh terrain, pursued by the same fire.  The ground must be leveled so that they will not be tripped up.   I am nothing but a hindrance to this effort untilI get off the higher ground so that it may be used to begin the arduous process of filling in the pits and potholes.  And when the path is leveled, all will follow it.  Then we will run together, run like hell toward the sea, reaching down to help those who stumble and spurring each other on until finally our legs fail us.

Land of the Free, Home of the Obtuse

Published / by rmaddy / Leave a Comment

I began my transition from a position of ignorance.  I was largely disconnected from the transgender community, had not read much from the increasingly rich corpus of trans memoirs and academic writings, and most of all, didn’t know where the hell I was going.  In the past decade I addressed and erased these deficiencies, and I report to you today, among other things, that all has worked out, more or less.1

We all start from a position of ignorance.  Human beings are blank checks of possibility.  We do not know, perhaps, the total balance against which we can draw, but it falls to us to continually fill in the recipients and amounts until the damn things (inevitably, I’m afraid) start bouncing.  Ignorance as a starting place, is not a problem.

Ignorance as a way of life, however…


I infer from the fact that, having read this far, you accept certain propositions.  First, you know that despite the fact that making sweeping assumptions about who people are on the basis of visible/audible characteristics that you perceive often works, it only works up to a point, rather than every time you do it. Since you make such assumptions with minimal conscious effort every day in regards to dozens of people, your assumptions will occasionally  be wrong, requiring you to adjust them on the basis of information subsequently acquired.  Second, you realize that you know almost nothing of the thought life of the people you think you know, and that pretty much everything you actually do know owes to what they say and/or what they do.

Easy-peasy so far, right?  The rest of this post depends on you synthesizing a conclusion out of what you have already accepted.  That conclusion is this:  that your perceptions of the gender of other people is reflexive, shallow, peripheral and effortless, while their perceptions of their own gender is experiential, deep, central and crucial.  Otherwise put, our half-assed, knee-jerk judgments about the gender of others are less accurate than, and trumped by, the gender that they experience internally.  

Yes, we are going to talk about pronouns and names again, but first I need to tell you a story.


In the spring of 2017, my wife, son and I took a brief vacation to West Texas.  The destination satisfied the annual need to escape the hopelessness of lingering winter in Minnesota, and offered further opportunity for some sorely-needed political catharsis.  Specifically, I wanted to take in the beauty of our nation’s natural southern border before some asshole tried to cover it over with concrete and barbed wire.  The trip was glorious, made even more so by the chance to spend a couple of days with a long-lost friend from high school, who parenthetically had, like me, changed her first name since we last met.

As a transgender person, I know that being misnamed is at least distracting, and often painful.  I also knew that if I let my thoughts run on auto-pilot, I would almost certainly misname her.  Auto-pilot, therefore, was not an acceptable option.  50 miles away from her home, on approach, I started to say her name over and over:  “Hello, Marlys.  Hey Marlys!  Yo…Marlys.”  I did this both silently and audibly.  Of course, I had already accepted her new name when she re-introduced herself to me months earlier.  It was, after all, her name, and she had no reason to be mistaken about it.

I think the strategy worked.  The reason I think that is because, throughout our renewed friendship, I always identify her in my thoughts by her new name.  Somewhere back in the brambles of my psyche, I know that she once had another, but unless I write a piece like this, I tend to forget what it was.  She is Marlys.  She told me so herself.  Good enough for me.


I once believed that hoping to be named and/or pronouned correctly by friends, family and strangers was too big of an ask.  I adopted a strategy of never correcting my patients and their visitors.  I concluded—after years of frustration—that it was far too difficult for older people, or those who had known me longer to make adjustments and resolved to just try to take their persistent misgenderings in stride.  I remembered that I too had made misnamed and misgendered others on occasion, mentally downplaying the conscious efforts I subsequently made to rewrite my memories—in the manner exemplified in the Marlys snippet—about those I had so offended.  I could not expect people to make such an effort on behalf of transgender people in general, let alone me specifically.

Then I went to France.

When out and about at home, whether socially or at work, I generally expect to be misgendered 10-15 times per day.  Most of the time, those who misgendered me tend to do so continuously, whether or not I correct them, or if they hear the correct name and pronouns from my work associates.  In France I was misgendered once over the period of two weeks.  The woman who did so apologized, looking somewhat chagrined in the process,  and did not repeat the mistake going forward.

How did France get right what my homeland so consistently gets wrong?  The possibilities:

  1.  I heard wrong.  Maybe I was too distracted by the sights and sounds to notice what usually feels, emotionally, like being whacked with a stick.  The thing is, they spoke English to us most of the time, and when they spoke French, phrases were always punctuated, without guidance from me, with the polite “Madame’s”.
  2. Their language makes gendering easier.  After all, French, like all Latin-derived languages, is structually gendered to a far greater degree than English.  Every object is a him or a her, not an it and every adjective and verb associated with the object follows suit.  “This table—she is beautiful.”  “This wine—he is sour.” In French, even the word this would have to be either masculine or feminine, and the adjectives change spelling, sometimes dramatically.  Perhaps the language does ingrain a sense of importance toward the task of properly labeling, but this in itself would tend to point out that they consistently labeled me as female.  Incidentally, the Brits, Kiwis, Aussies, and Argentinians with whom we broke bread over the two week interval also did so, despite the fact that only the Argentinians would have a linguistic cue to do so.
  3. They culturally accept transgender identity as valid in a way that Americans simply do not.  I’m not going to lie.  I’m betting all of my chips on this one.  

Despite my frustration that misgendering is a fact of my day to day life, and that transgender people are transparently being used as pawns in the raging culture war, I do see some occasional signs of progress.  For example, I have abandoned my previous conclusions that older people cannot get gender right.2. Though still more the exception than the rule, I get correctly gendered by people of all ages and essentially 100% of the time by those employed in customer service.3. Many of you have already updated your thinking.

Nevertheless, I still have ample occasion to cringe when, even as strangers increasingly address me as feminine, some of my closest associates and family—sometimes in the same conversation—continue to refer to me as he, him, etc, almost as if it were their job to correct the person who got it right.  I don’t necessarily assume that this is an intentional thought, but the confusion on the part of the person who just met me is instantly apparent.

I’m tired of making allowances for intention.  Maybe you didn’t intend to call me “him.”  The larger, more salient fact, is that intention has nothing to do with how you speak to me or about me—intention implies both effort and ownership—and that fact in and of itself hurts like hell, especially years down the road with no apparent end in sight.  And, if you really do just accidentantally slip up in a moment of distraction, apologize, for fuck’s sake, and start acting like the problem is yours, not mine.  It is.

Perhaps you find yourself thinking, “It is hard to remember what so-and-so, wants to be called now.”  And so it is.  This is because you are quitting after the word “hard”, ignoring the words “want” and “now”, and what they imply—that you still think you know who I really am, whereas I am deluded on that point.  Read that last sentence again, and understand that I, and most trans folk, hear the message loud and clear.

I wish I could tell you what it feels like.  The closest I can get is another story:

Imagine you meet a childhood friend and have a lovely conversation, reminiscing about old times.  As they leave, they call you the name of another of your old playmates, and it dawns on you that they genuinely thought that’s who you were.  Your companion remembers a moment of shared experience, but the fact that they have forgotten who you are in the story leaves you feeling a little empty.

Multiply by 70 and repeat 10x daily.  Or, better yet, recognize the limits of your ability to make casual inferences about who people are, and listen instead to what they tell you.


The Audacity of Poop

Published / by rmaddy / 3 Comments on The Audacity of Poop

“We should be guided by what works.”  –Barack Obama, The Audacity of Hope

It’s flu season again–our annual lesson in biological humility.  A tiny capsule of protein and RNA, 1/20,000,000th our size manages to break through our admirable system of defenses and actually turn them against us, killing a half million people worldwide every year, and leaving more than a billion of us utterly miserable and worthless for 7-10 days.  Medically, our best hope to treat the disease is not to get it at all, a strategy which requires a new vaccine every year, some of which work better than others.  All of this is compounded by the fact that the majority of the population has somehow convinced itself that the flu is no big deal, certainly not worth taking 15 minutes out of one’s schedule and enduring 1 second of mild pain, to prevent.  It’s the perfect recipe for a pandemic, and nearly every year it rises to the occasion.

Today I take a break from transgender education and advocacy to talk about another deadly infection which continues to adapt its defenses, rendering  the treatments which, until 15 years ago, worked in the vast majority of cases, substantially less effective.  This disease, caused by a bacterium named Clostridium difficile–or “C diff” for short–now infects 500,000 Americans per year, causing approximately 30,000 deaths.  In the waning days of November 2017, I very nearly was one of them.  This is the story of a deadly disease which already lies quiet in your intestines and challenges the way we think about bacteria in general.  And, it’s a story where the best hope of cure lies not in medicine, but in shit.

I recently posted regarding my experience with FFS–facial feminization surgery.  I was about 5 days post op at that point, and still really swollen, but optimistic about a rapid recovery.  It turned out to be anything but rapid.  I developed infections in my cheeks which required multiple courses of antibiotics and surgical revision.  Before the dust settled, I had been on antibiotics for nearly 8 weeks.

Four days after taking my last dose of cipro1, the diarrhea started.  C diff most commonly strikes after antibiotic use, when the normal bacteria of the intestines are disrupted.  I was ready for the possibility of C diff.  I had a full bottle of metronidazole–an antibiotic used to suppress C diff2–at the ready.  I started taking it immediately, and the diarrhea lessened as long as I took it.  No tests were done, but I was pretty sure I had it.  I finished my course of metronidazole on Thanksgiving day.

Three days later, my symptoms were back with a vengeance.  This time, the diarrhea came with intensely burning rectal cramps and high fever.  I was at work at the time, and ended up becoming my own next patient in the ER.  Holding off as long as I could stand it, I ended up just flopping onto the cot in Room 4 an hour before my shift ended.  My temperature was 105, my white blood cell count was 4x normal and it took three liters of IV saline to get my blood pressure back above 90.  I had sepsis and there was some concern that my colon had perforated.  This time a stool specimen was collected, and I was started on another antibiotic–vancomycin.  I felt better after IV fluids, but I was admitted to the hospital for a couple of days.  The test result confirmed that I had C diff.

Vancomycin seemed to resolve the symptoms better.  I ended up taking it for ten days–long enough to get some R and R in Hawaii.  I felt like a limp dishrag, but it is better to be sick in paradise than sick at home.  While there, I saw a T-shirt that I liked, but unfortunately not in my size:  Salt Water Cures Everything.  Unfortunately this proved not to be the case.  Two days after returning home and taking the last of the vancomycin, the diarrhea returned.

I restarted vancomycin again, and this time got permission from my insurance to go on a new medicine tailor made to treat C diff–fidaxomicin.  I was on the good stuff this time–$100 per pill of pure healing.  I still have half a bottle of it in my purse.  I was sick again within five days and switched back to vancomycin, which at least suppressed the symptoms a little better.  I resigned myself to the fact that antibiotics were not getting rid of the infection, and there was only one treatment left to try.

About six years previously, I had given a medical lecture for our hospital staff on emerging infections.  I covered the latest on Ebola and resistant Staph infections (aka MRSA), but mentioned that an old infection, C diff, was making a resurgence and seemed to be suddenly less susceptible to antibiotics.  The change seemed to happen abruptly in 2003-4.  The disease had literally evolved in front of our eyes.3  I mentioned a new therapy–stool transplantation from a healthy donor–to the audience, who mostly, like me, laughed it off at the time.

Now I found myself desperate enough to try it.  The problem was that it was now Christmas Day and nothing much was likely to happen until after the holidays.  My doctor said she would refer me to a gastroenterologist at Mayo Rochester.  It would probably take about 3-4 weeks to get an appointment.  They did have a stool transplant–aka Fecal Microbiota Transplantation–program.  If I were accepted as a patient I should be able to get the procedure done within another 2-3 weeks.  She would be happy to supply with more vancomycin in the meantime.  Quick math suggested that I was looking at early February, and meanwhile I was still sick, never able to do any better than suppress the symptoms somewhat.  Hope delayed is hope denied.  I wondered what I should do.  More to the point, I wondered what would Angus MacGuyver would do.

I gathered supplies and read up on potential complications.  Most hospital based FMT programs require you to supply your own donor, and subject that person to a lot of testing to prevent exposure to other infections.  My donor and I have shared a bathroom for nearly 30 years, and I was not concerned in the least about catching anything from her.  Hospital programs also typically use a colonoscope to deliver a mixture of stool and water carefully prepared and homogenized in their microbiology lab.  I don’t have a colonoscope or a microbiology lab.  I decided to settle for an enema bag and some kitchen tools4.  There is a surprisingly robust DIY community of fecal transplanters online.  I read all that I could from them and from the medical literature about FMT.

One day before the main event, I stopped eating.  I laid out everything in the bathroom and even rehearsed the sequence, practicing shifting from position to position in a manner which would allow my mixture to follow gravity back through the length of my colon.  I drank magnesium citrate to empty out what was left in my gut and waited for shit to happen.  Once it did, the procedure was done in an hour including clean up.  I held the mixture internally for 5 hours.  That night, everything exploded back out.  For good measure, we repeated the transplant the next morning.  This time, nothing came back.  For days.  I have not had a single episode of diarrhea since, nor have I taken a single tablet of vancomycin.

For decades, doctors have prescribed antibiotics for increasingly flimsy reasons to satisfy a patient population that has largely come to expect them.  In so doing, we have created a host of emerging diseases which are resistant to treatment.  The hope has been that even better antibiotics would come along to treat the tougher diseases.  That hope is starting to wear a little thin.  In this particular case, antibiotics gave me C diff, or more precisely, they killed off the normal bacteria that usually keep C diff in check.  I took more antibiotics to kill the C diff, but they could not eradicate the infection.  What finally cured me was not better drugs, but better bacteria, specifically those of my healthy spouse.

C diff may be unique in its ability to be cured by bacteria.  I suspect that it is not.  Regardless, in the long run, we will need to be more prudent, both as physicians and as patients.  Doctors should take the time to explain why antibiotics do not help in viral illnesses (including bronchitis, sinusitis and other upper respiratory infections).  Patients should become savvy consumers, not pushing for medication where time and rest will suffice.  We hope that diseases will become less resistant to antibiotics if we use them less frequently.  Unfortunately, that is only one possible outcome.  The other may be the emergence of a deadly post-antibiotic era, where antibiotic treatment is no longer works at all.

FFS

Published / by rmaddy / 5 Comments on FFS

Image credit David Tenant, Hamlet, 2009

 

The arc of a ball through the air can be described mathematically.  For each fraction of a second, the ball approaches you at a certain rate, drops slightly due to gravity and perhaps curves in one direction or another due to spin.  In a second, the ball moves so far.  In a half second, less.  It is possible to consider smaller and smaller increments of time.  In fact, if you consider an instant, an infinitesimally small increment of time, you may still describe the position and motion in that moment.  To do so requires a branch of mathematics known as calculus.  Odds are, you don’t understand calculus.  Nevertheless, through practice and experience you catch the ball.  Your brain gets calculus even when you don’t.


Something parallel happens regarding gender.  The senses give input to the brain which turns this information subconsciously into complex ratios and estimates of probability.  Men tend to be taller than women, but height alone does not distinguish between them.  Similarly, women tend to speak in a higher pitch, but there is sufficient overlap that pitch alone does not reliably allow for gender recognition.  At any given moment, nearly instantaneously, we measure thousands of parameters in order to classify our human companions with regards to gender.  Most of the time, we are unaware that we are doing it.  In fact, if we try to consciously measure and process data in order to make a gender determination, we suddenly get very, very bad at it.  Our brains are really good at making gender determinations that cannot easily be made if we set our attention to it.

Consider the face.  You recognize the difference between male and female faces, but if asked why you think a face is male or female, you either draw a blank or tend to mention things (shape, for example) that are not particularly potent predictors of gender.  At any given moment your eyes are picking up subtle details and your brain uses this information to calculate ratios which you have probably never considered.  There are nearly 4 billion male and 4 billion female faces on the planet.  They are so unique that even genetically identical twins can be recognized by close contacts.  Somehow, your brain recognizes them as male or female, familiar or unfamiliar and may instantly assign a biographical file to a face before you have a moment to think of it.  And, to today’s topic, you assign gender to a face almost instantaneously, despite the fact that there are four billion men’s faces that don’t look all that alike and four billion women’s faces with the same degree of variance.

Certain patterns tend to hold.  Women on average have smaller heads with smaller features.  The male hairline is a relatively higher “M” to the female’s upside down “U”.  The male forehead slants backward subtly compared to the relatively vertical female counterpart.  The female mandible is narrower, culminating in a somewhat more v-shaped chin.  The male nose to lip distance tends to be longer.  Without even considering the relatively obvious marker of facial hair, there are patterns and ratios which, taken together, help to form a gender impression.

I write today five days post facial feminization surgery,1 still a bit bruised and sore from 6 hours under anesthesia during which dozens of millimeter scale adjustments were made to my features.  When next we meet, you will still recognize me, but your brain will tend to classify me differently.  Some of the changes (higher brow, smaller nose) will already be present, whereas some (lower hairline, narrower chin) may take six months or more to settle.  Although most people have never heard of it, FFS is often the surgery most coveted by male to female (MTF) transsexuals.  It is expensive, painful, and unlike GCS, aka “The Operation,” impactful in day to day social interactions.

Unfortunately, it is also widely considered to be purely cosmetic and elective.  Insurance rarely picks up the tab, and it can run anywhere from $15,000-$50,000 depending on what is done, by whom and in what facility.  Personally, I opted for a fairly limited course, concentrating on the upper part of the face, particularly the forehead, which seems to play a crucial role in how the brain processes gender.  Most transwomen never get the opportunity.  I write this fully cognizant that I am a woman of great privilege.

I also had the procedure done in a local office, which given the length and intensity of the surgery was not the sort of caution I would have preferred, but I am not immune to the economic argument.  And, I seemed to have escaped death, for at least the period of time that I would likely have been hospitalized elsewhere.  It is not my intention to review here the care of my surgeon, but Kathy and I were drawn to him for his reassuring demeanor, his thoughtful listening, his artistic eye and ultimately, his training in complex craniofacial procedures.  I appear to have won the bet, and saved thousands over what the same care would have cost in my hospital system, which as I mentioned, wouldn’t financially support it anyway.

The bruises and swelling are still too extensive to permit much of a look, but I like what I can see.  Mostly, I see my eyes, but the way I think they were meant to look.  The pain is intense, but I was never particularly afraid of that–a few butterflies the day before at most.  My biggest fear was that I would wake up with regret, thinking that I had made some sort of a mistake.  I don’t.  Not one bit.

I hope that my surgery will help you to see me differently, but ultimately it was more about greeting the person I see in the mirror each morning.  I want, in the words once given to me by my friend Anne, to feel at home inside my skin.  Time will tell, but the deed is now done, I am convalescing, and I am feeling very grateful.  I do hope that you will not think me vain.  I am of course, but it’s still uncharitable to think that.  This fixes for me something that was existentially broken for 50 years.

Perhaps my new lines will persuade your brain to accept my femininity.  Nevertheless, I remain ever hopeful that you will accept it for the best reason of all…because I asked.

Dunsinane. Within the Castle.

Published / by rmaddy / 1 Comment on Dunsinane. Within the Castle.

His elbow caught me more or less in the center of my abdomen.  Instantly, accident scene reconstruction commenced.

Option #1.  I walked into somebody.  Sure.  I do this, particularly but not exclusively when I am lost in thought.1 Ordinarily my well-honed reflex to beg pardon would engage at this point, but paradoxically the moment of contact found me unusually dedicated to interpersonal spacing.  Specifically, I had chosen an opening at the luggage carousel where I would have the best chance of extracting my heavy ass suitcase without risk of jostling or be jostled.  The elbow did not compute.  My brain sought more information.  It came as I made eye contact with the other party and noted that rather than registering the expected surprise, he was smiling.

Option #2.  I must know this person.  Memories of past chance encounters in the airport begin to percolate towards the surface, only to be superseded by the frantic urgency of identifying the face before me.  This is not a talent for which I am recognized.  I feel a bit queasy, whether from the potential embarrassment of being recognized without recognizing or an increasing insistence by my usually passive abdominal wall that I suddenly pay attention to it.

He is short.  Slightly built.  Blond.  Roughly twenty-five.  The only friends I have in this age group are musicians and wannabes.   A patient perhaps…then why the touchy-feely familiarity?  A co-worker’s spouse?  Dammit.  No match.

The encounter approaches the ripe old age of four seconds.  He starts circling to my left, eyes locked, smile shifting ever so slightly into a display of teeth, holding a distance of 20-25 feet. I recall the elementary school playground and those TV specials about hyenas.  Option #3 begins to take shape.

I voice it first as a question:  “Oh my God…did he just hit me?”  My subconscious runs with this, and starts laying the groundwork for a shift from “What?” to “Why?”  It will have precious little time to proceed.  He is about to speak, thereby signaling the end of the internal inquisition.

Good luck with the operation.

He continued to my left, and while I considered whether to believe my ears, he repeated it, so as to register his preference that I do.  Well, thanks…I suppose…although I didn’t recall bringing it up.

That’s as far as the story goes.  If the dissection of my thoughts seems overly detailed, it is only because there is nothing else to report.  In striking me in the center of my spare tire, he chose the one target where he was least likely to do much damage, his elbow bouncing harmlessly away like a pebble on the roadway.  Parenthetically, this happened not in the ruby red state of Texas, from which I had presently returned,2 but in brilliantly purple Minnesota.

I don’t know what impression will linger in the months to come, but the early verdict is that I had no good options.  Whereas my youthful self was directly and indirectly trained to resist a bully, it now occurs to me that most often resistance really is futile.  I am aging and recently, quite achy.  My size no longer protects; it only identifies me as a target.   I have also acquired just enough wisdom to know that answering petty violence with more petty violence would put me on level with this little cretin.  There was nothing whatsoever but to wait for the end of the scene.

I offer this story with no moral attached unless it is that shit happens.  I’ll brood, and verbally process and move on.  Eventually something else like this will happen and I’ll go right back to Square Fucking One.  Repeat until you can’t.

Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

 

Unfinished Business

Published / by rmaddy / Leave a Comment

Occasionally a patient or family member will call the ER to say that they are on their way in to see us.  Similarly, radio traffic alerts us to the dispatch of ambulances in the surrounding communities.  I refer to potential patients not yet within our walls as “lurkers”.  Thus, when asked if I am busy, I might respond, “3 here, 2 lurking.”  The lurking patient has already entered into my problem-solving calculus, and perhaps not in the manner you might expect:  lurkers count double.1

Why, you might ask, should this be the case?  Is not a bird in the hand worth two in the bush?  Quite the opposite, as far as I am concerned.  There are many words that might be used to describe what I do at work:  diagnostician, comforter, risk manager, explainer, and so forth.  In order for me to be an Emergency Physician, however, something else must be in the mix.  I am someone who finishes shit.  I meet people, enter into their dilemma and, to whatever extent possible, solve the problem.  At the very least, I figure out how it is going to be solved.  Quickly.  Perhaps you have a physician who knows you like a neighbor and who will walk with you through decades of sickness and health.  That’s not me.  I’m the one who checks out at 7:30.  I do as much as I can as well as I can, then I go home.  I am a specialist of the first hour, sifting through the problems of the day and always trying to be maximally prepared and available for the next bad thing that happens.  You need me to have such an outlook–the next disaster might befall you, and you will want my full attention at that time.

A lurker is a person I cannot yet help, a problem I can not yet solve.  If the lurker would kindly arrive, then we might make some progress together.  A job begun really is half done, as far as I am concerned.2  Until then, I have unfinished business.

I dislike unfinished business.  I paid off my 30 year mortgage in 12.  Don’t ask me to pledge x number of dollars for every mile you walk.  Tell me rather how much you want and how I can complete the transaction online right now.  No, I’m not interested in a wine-of-the-month club, and hell yeah–I belong to Amazon Prime.

By now you’ve guessed the segue, and if it sounds familiar, I think it is because I have riffed on it before:  transition is seemingly endless.  Whether it is actually endless, I cannot say.  I have met plenty of people that speak of completing transition in such and such a year, but the very fact that I have met them usually owes to their presence in transgender support groups.  Maybe they are Bodhisattvas, remaining among the transitioning to help us along our way.  Following that analogy, though, I wonder if transition, like enlightenment, is more something that you habitually do than a place you arrive.3  Use it or lose it.

But oh, how I hope it is a destination!  I even know what it would look like:  a state of happiness and coherence.  In this respect my goals are not much different than those of anybody else.  It doesn’t really matter how one gets there, so long as one gets there.  If the journey  itself is the reward, however, then I could end up nearly anywhere.  One can get in decent shape even by running after nothing, but in line with my introduction, I have always proceeded under the assumption that the point of a race is to break the tape at the end.

There you have it–a perfect recipe for my restlessness and a plausible explanation for why I intermittently flip out.  For me, there is not a reliable degree of joy in the journey, only the sense of not having arrived.  A friend of mine bears a tattoo stating, in oriental script, “Not all who wander are lost,”4 but I secretly suspect a healthy percentage actually are.  I certainly am.  This is hard…really hard, and I don’t know if I’ll ever, as the Scots say, “Get on wi’ ae.”

I believe people who say they have completed transition.  They own their stories, just as I own mine.  The sense I have gotten from speaking to several who have said so and from reading the blogs of others though is that they are referring very specifically to gender confirmation surgery (GCS), i.e. when they had their fun bits rearranged.  This is certainly understandable, since society in general thinks is what transition means.  Apparently, at least for some,  this really can be the end of the road.  The tricky part is that we are all on different roads and I don’t think we can infer too much from the experience of others.  The end of my road, you recall, is primarily defined by a mental state–happiness and coherence.  There doesn’t seem to be any guarantee that these things follow surgical transition.  The people I know post-GCS appear to fill a broad spectrum between happy and miserable.  Having major surgery because someone else said it helped them is flawed process.5

I experience transition as a mental phenomenon.  It is in my mind that I envision happiness/coherence and in my mind that I suffer its absence.  When you ask me how I feel, I think I can safely assume that you refer to my mental state, not my genitals.6  I publish my story largely to help me “think things through”–now there is a metaphor–hoping along the way to help the next transgender person do the same.  When I blew an emotional circuit breaker last month, I called my psychiatrist, not my endocrinologist.  It is in my mind where my demons lurk7, and it is there that I go to fight them.

I was raised this way, taught that my mind would “take me far.”  In some sense, it has, and yet I recognize that my religious upbringing thoroughly stigmatized “the flesh” as corrupt.  I often wish that I had recognized myself as transgender when I was younger, but I don’t see how that would have been possible.  I didn’t have the tools.  Speaking to another issue, but with great eloquence, my sister once remarked, “We were raised without bodies.”  She has since found hers back but I am still looking.

I have moved on, but I still tend to forget that the mind/body dichotomy is a metaphor.  It is often a useful metaphor, but metaphors have their limits.  We ought not to eat the menu.   Humans do not think, octopus-style, with their arms, but the brain is nevertheless thoroughly embodied.  When I deal with depression, I experience physical pain in my upper abdomen strong enough to wake me from sleep.  In my summary of a year on estrogen, I recounted what I was hoping it would do to my mind, and how surprised I was by how quickly it was messing with my body and that the things it was doing to my body were affecting my mind.  Well, duh…I need to stop being shocked by the obvious.  The term transgender would be meaningless if I had no body.

I have a body.  It’s that tall thing that glares at me from the other side of the mirror, every damned time I look.  It knows that I don’t like it and I can tell that the feeling is mutual.  Lately, just to piss me off further, it has been getting older.  Perhaps someday we will call a truce, but for now, we scowl at each other like old enemies, each demanding that the other surrender.

Unfinished business.

 

 

There are no happy endings.
Endings are the saddest part, 
So just give me a happy middle
And a very happy start.

Shel Silverstein, Every Thing on It

Footnotes

This or That?

Published / by rmaddy / Leave a Comment

My name is Renae Gage1 and I am a binary thinker.

If I was ever anything else, it was far away and long ago, lost even to memory.  Not 100% of the time of course.  It do hate peas and carrots more or less equally, and I observe that some folk really are a little bit country and a little bit rock and roll.  Nevertheless, binary thinking is my tragic flaw, the pit into which I regularly fall.  “As a dog returns to its vomit,” offers the scriptures, “so fools repeat their folly.”

Speaking of which, I blame religious indoctrination for this rut in my thinking.  I was raised on Heaven and Hell, good and evil, darkness and light, blessings and curses.  The stripe of Christianity which I was force-fed does not do nuance well.  Whether this only amplified some innate tendency within me or produced it out of whole cloth, my reflexes are honed to a razor’s edge.  Where others see similarity, I see difference.  My contrast knob 2 is dialed to the maximum.

The fact that I have rejected the crucible in which I was fired is of no consequence–the pattern is etched in my brain, and there isn’t a hell of a lot I can do about it.  In fact, the manner in which I extracted myself from religion looks just as binary–some people just file their faith on a dusty back shelf and ignore it.  I sent mine packing, barred the doors and secured a restraining order lest it ever contemplate a return.

Being a binary thinker is a serious bummer as a transgender person.  It has taken a Herculean effort for me to understand, for example, gender as a spectrum or, even more, as a social construction.  To be sure, I understand it up here, but not so much in here.   Note to self:  add head/heart to my list of artificial binaries.

It seems that the difficulty is primarily internal.  I have friends who reject gender completely and I think I am able to take their assertions at face value.  Nor would I think any less of another trans person who told me that they don’t fit neatly into the boy or the girl box.  I thoroughly accept that people are, so long as they are honest, exactly who they say they are.

For me, however, the binary tyrant lives.  I am unable to shrug at my variance.  Every day, I run into people who are ostensibly 100% male or 100% female with the singular exception of my morning encounter with the mirror.  I can opine until I am ROYGBIV3 in the face about gender as a spectrum, but waiting for me around every corner are two little boxes labeled “M” and “F”.

Nor is it just me, society.  I hear your “Good night, ladies.  Good night, Renae.”  I feel your hand-crushing handshakes and bro hugs.  I notice the angle of your lip when you stare at me in the checkout line.  Nevertheless, I recognize the steep discount I am getting.  In some places, the price is much, much higher.

I don’t believe in a world without gender.  I don’t feel genderless.  I feel feminine.  While the younger generations may be starting to chip away at the moulds, most of us were already hardened in them.  I’m told that I need to let go of the binary.  What if I can’t?  What if this also is simply something that is?

I’ve had the privilege of meeting more and more trans people.  Some are happy and others not so much.  Almost none of them are “embracing the broader gender continuum”.  To an individual, they all seem to be crawling into the “other box” and closing the lid.  The ones who fit in the box better seem to be happier.  Maybe that’s all you can do.  You can’t beat everybody.

Into the darkness

Published / by rmaddy / 6 Comments on Into the darkness

The first storm of winter is upon us.  The early indications predict that we will escape the heavy snow this time, but we have already been treated to gusting winds, steeply dropping temperatures and some sort of snow/sleet/hail thingie that didn’t do any damage, but produced an absolutely deafening roar on my windshield as I headed into work this morning.  Twas the witch of November come stealin’, as the prophet Gordon1 once intoned.

As much as I hate winter, I love a good storm.  Any storm.  I love “sheltering in place,” as they say, looking across the hills and fields out the back (southwest) windows of my home.  I don’t cower in the basement.  I grab a camera.  I step out of the front door to welcome the arrival of the new wind, to take in its measure and flavor.  In my formative years, I loved to go for a run during the height of a downpour, especially when the streetlights were knocked out.2  Like Lieutenant Dan, I climb to the top of the proverbial mast and taunt the sky:  “Is that all you’ve got?”

But not all storms are weather.

There are other kinds of storms which terrify me.  They paralyze–stunning me with a dizzying barrage of emotional lightening and pounding me with the thunder of confusion.  The very foundations of my life erode and I cascade downstream into Mare Crisium–the Sea of Crisis.3  It is there that, for the last several weeks, I have been treading water, at times with some success, but occasionally sinking beneath the waves of doubt.

Enough with the metaphor?  I suppose, but then again, you have never known me to be a particularly linear writer, and, as I have found myself saying more than once recently, I am not at my best.

I prefer to narrate the storm from the relative safety of its aftermath.  “Hey, things got bad, but look at all the nifty rainbows now!”4  I seem to be okay with vulnerability, but usual only with a certain degree of retrospect. I am not immune to shame.

I struggle to find a pathway into describing my whereabouts, but I think the storm is the best place to start.  I am prone to disruptions.  They strike without much warning and make a tangled mess of my thoughts and self-confidence.  If there are warning signs in advance, I am blind to them.  They are infrequent enough lull me into the delusion that they are done and gone.

Almost exactly three weeks ago, I was beset by crippling doubts about my identity.  True, there has always been a “female gravity” bending the trajectory of my life in the direction with which you have become familiar, but this crisis began with an overwhelming sense that, wherever I seem to be headed or feel I need to be, where I am isn’t identifiably feminine to most people, nor, during these dark hours, to me.

The disruption seems to be centered on two perceptions which still loom large in my present state of mind.  First, it is far more than the physical which separates me from other women.  I have been denied (or spared) the particular rhythms and discomforts of feminine physiology, but perhaps even more significantly, I have missed out on so many formative experiences:  I did not grow up in a world which devalued my gender.  I have not been groped or ogled by predatory men.  My size has conferred upon me a degree of protection from conflict.  I have been rewarded, not chastised, for “speaking out”.  I have made one dollar on the dollar.  I have not been asked on a date, nor spent any time worrying that this would never happen.  I have not spent a lifetime being conditioned to fret about my beauty.5  Not only did I get math (many women do, of course); I learned early that I must get math.  Though I have always made friends with women far more naturally than with men, have I ever truly convinced either them or myself that I am one of them?

I am unsurprised that this hit me so hard during the run up and run off of the election, whether or not this was actually the trigger.  Misogyny offends the hell out of me, but have I ever actually felt it?  As much as I desired the election of HRC, would it have produced any sense whatsoever of existential validation for me?  I was born into nearly every privilege imaginable.  What right do I have to see myself as a citizen of Pantsuit Nation?

The second perception was that my identity seems to be largely aspirational.  Am I female or do I simply experience intense conviction hat I ought to be?  I was trained to believe the unbelievable–is this simply the latest version?  Yes, masculinity took effort for me, but does femininity take less?  Without imaging that other women sail from moment to moment free of self-doubt, I observe that they never have to spend a moment convincing anyone else, let alone themselves, of their gender.  I do not think that this is merely to say that I don’t pass in society.  The question is whether I even pass to myself.  I fit the typical profile of a late transitioning transsexual–white, XY socialized male, melancholic, above average intelligence6.  Is there any sense in which transphobic critics, who see my identity as a sustained delusion, have a point?

Suffice it to say, the last several weeks have sucked mightily.  For the first 4-5 days, I was back to being a squirrel in the road, unsure which direction to run and consequently immobilized in front of the approaching headlights.

“Forward?  I can’t go forward!  Back?  I can’t go back!  Oh God, I definitely can’t stay here…”

My brain flip-flopped rapidly, wanting desperately to decide or better, to do something, and yet I knew there was nothing to do.  I just wanted to go back to bed so I could shut it out for a bit.

Fast forwarding a couple of weeks, the intensity has dialed down a little, but I’m still “dazed and confused”, and worse, worried that I won’t ever be able to un-think some of the thoughts of the last couple weeks.  And there is no resolution, no personal victory to report.  I still feel the wind and hear the thunder.

More ominously, this is the first time I have gone through this post-hormonal therapy.  There is certainly a lot more to the sense of calm and general well-being I have tried to convey beyond freedom from crisis, but until now, I really did have freedom from crisis.  For 18 months.  Even more, it had the feeling of resolution.  Peace was the benefit of therapy that justified the various downsides.  What now?

I don’t really know, and I don’t know when I will find out.  Sorry, there is no moral to this story.  Sometimes there isn’t.

 

 

Notes:

Out of the Woodwork

Published / by rmaddy / Leave a Comment

Minnesota…ever a blue state.

We’ve doubled, it seems.  In 2011, the William Institute (UCLA School of Law) estimated that 3 out of every 1000 Americans–a total of 700,000–identified as transgender.  Now, their most recent study suggests that the actual figure is twice as high.  1.4 million, or 0.6%, of Americans identify as transgender.  The vivid blue color of my home state, above, indicates that Minnesota has the highest proportion of transgender residents in the midwest.1

I see this as very, very good news.  At this rate, we will take over the world in less than 40 years, well ahead of schedule.  Long live the transgender agenda!  Chill the champagne and check to see if Lady Gaga is busy in the summer of 2055…

Of course, it might just be possible that the doubled estimate has nothing whatsoever to do with an increase in transgender people.  More mice crawling out of the woodwork could owe to a bumper crop of pinkies,2 but it might also mean that the cat has gone on vacation.  Translation:  it is likely that more transgender people are being identified because they are less afraid to be out.


Being transgender in a small town can be a lonely business, but not everything is as it seems.  Before I came out (somewhat before the 2011) survey, I could have never imagined that there were 20 other trans people in my little hamlet.  If this were the case, why wouldn’t I have already met some?  Such is the ironic reasoning of the closeted individual.  Invisible at the time myself, I wondered that others were not more apparent.

Eventually3 I realized that I hadn’t met other transgender people because I had never tried, and I really wasn’t paying much attention.  Further, I came to grips with the fact that I was afraid to meet others like me.  What if I didn’t like them?

I got out more.  I tried a couple of support groups.  Most of all, I stepped out into the open myself.  There is simply no better way to meet transgender people than to be openly transgender4  Fairly quickly I discovered that belonged to a largish cohort of people that I had never even noticed before.

Additionally, I found that the skill of noticing gets better with practice.  Walking through my town festival last week, I spotted several transgender people in the crowd.  There is sort of a secret nod that increasingly happens.  In my medical practice, I meet upwards of 1000 people every year.  I suppose that my social interactions add a few hundred more.  The current research suggests that about 1 out of every 170 are trans.  I do directly experience that proportion, but I no longer doubt that it is the case.  Not everyone who is trans is noticeably so.  Some are not out at all and are performing their expected gender.  Others have the privilege of passing,5.  And, if I’m honest, most of the time I’m still not paying attention.

I still feel like a zebra among horses, but there really is a degree of strength in numbers.  Besides, one could do far worse than to be a zebra.

Vote Trans 2016

Published / by rmaddy / 1 Comment on Vote Trans 2016

What a difference a year makes.  At this point last fall, I predicted that anti-transgender bills would continue to proliferate (as they did in 2015) and that transgender rights would remain a contentious issue in state and national politics.  Instead, 2016 has become a referendum on economic and racial grievance as well as an increasingly nauseating contest of personalities.  Yippee!  We’re off of the hot seat, at least for the time being.

I’m sure that your political views, like mine are a conglomeration of a variety of opinions to which you give degrees of weight as you approach election day.  Trans issues, as you might expect, are weighted rather strongly in my calculus.  That you are reading this at all leads me to expect that you assign some importance to transgender politics, but what, if anything, does that mean in a practical sense as one enters the voting booth?  In other words, what might it look like to “vote trans” in November if nothing else mattered to you?

Presidential

Four candidates remain for the Presidency.  Reading “from left to right”, their positions on transgender issues are as follows:

Jill Stein–thoroughly on record in favor of LGBT rights, she also states explicitly that transgender rights fall under the heading of existing protections against discrimination based on sexual identity (similar to the declaration in the Minnesota Human Rights Act of 1993, which defines transgender identity as a sexual orientation).  Some trans advocates chafe at this designation.1  Nevertheless, this approach works has resulted in durable human rights protection for trans people wherever it has been enacted.  In other words, there is a semantic quibble, but no broad concern on policy direction.

Hillary Clinton–consistently supportive of transgender rights and inclusive of trans people within her circle of advisors.  As Secretary of State she changed changed the internal policies to prevent anti-trans discrimination and re-wrote the procedures for issuance of a passport such that trans people do not need to prove a history of genital surgery prior to changing their gender marker.

Donald Trump–apparently personally disinterested in LGBT rights as a political issue.  There is no evidence that he discriminates against LGBT employees in his business.  His only public comment on trans rights during the current campaign indicated a belief that transgender people should be allowed to use the bathroom facilities with which they felt comfortable.  Due to a reaction from his party, he subsequently walked this back, saying that he would “leave it up to the states.”

Despite managing to insult nearly everyone during this campaign, he has not made any truly inflammatory remarks against trans people.  He somewhat famously said that if Caitlyn Jenner came to his hotel, she could use the women’s room.  During primary season, his relatively easy-going attitude about the LGBT community stood in stark contrast to the nearly daily anti-trans pronouncements of his closest Republican rival, Ted Cruz.

That said, trans people have some cause to be wary of Trump’s candidacy, if not his personal opinions.  First, trans people aren’t generally comfortable with dealing with transgender rights at the state level.  During a recent business trip, my stopover was changed from Phoenix to Dallas/Ft Worth.  On landing, I could not recollect whether using the women’s room was illegal, and I believed (with some cause) that the local culture in which I found myself was substantially more hostile than the Land of 10,000 Lakes.  When, in the past, we have left civil rights up to the states, the end result has tended to look like a historical re-enactment of the Confederate succession.

Second, Trump nominated Mike Pence to serve as VP.  Pence was the pioneer of so-called “religious freedom laws” at the state level (as governor of Indiana) which were written in such a way as to open the door for sanctioned discrimination against LGBT people.  True, he ended up walking back this stance after threats of a national boycott, but he established the template that North Carolina, Mississippi  and others would subsequently follow.  The media have tended to interpret the appointment of Pence steadiness to counterbalance Trump’s erratic nature.  LGBT people see Pence as a dog whistle to culture warriors.

Third, Trump’s publish list of potential judicial appointments (which was lifted wholesale from a pre-existing RNC list), includes a number of justices who have already voiced opposition to gay and transgender rights.  Whatever Trump’s personal tolerance toward LGBT people, he shows no reluctance whatsoever to throw us under the bus to appease his base.

Gary Johnson–supports LGBT rights in general, stating a libertarian desire to “keep government out of the bedroom.”  Although he has not said much about transgender rights, he was early, at least among conservatives, to support marriage equality.

In summary, a voter prioritizing candidate stances on transgender rights above all else would have most cause to trust Clinton, but might comfortably end up backing Johnson or Klein as well.  Trump the man doesn’t seem to harbor any personal animus against trans people,2 but Trump the candidate has taken on associates and policies far more hostile to the advancement of LGBT rights in calculated moves on the pathway toward his election.

In the grand scheme of things, however, the trans-conscious voter probably would not sweat the Presidential election too much, if at all.  The reason for this you have already guessed:  the battle lines in the battle for transequality are drawn not so much in Washington DC as in the state houses, city councils and school boards.

As I mentioned, the wave of specifically anti-trans legislation (mainly bathroom bills) we saw last year seems to be losing a bit of energy.  There are a few reasons for this.  First and foremost, the corporate response to such legislation was swift and unambiguous.  Companies will halt expansion or worse in states that pass bigoted laws.  Transphobia, like homophobia is bad for business.

Second, in anything beyond the reddest of states, voter backlash is a real problem for those facing election.  I have previously written about the 2012 Republican implosion in Minnesota after their bigoted crusade of 2010.  More recently, Governor McCrory, the architect of North Carolina’s anti-trans bathroom law is poised to lose his re-election campaign, and there is concern within that state’s GOP that the backlash against McCrory might spill over into the Presidential election, essentially blocking Trump from any chance of victory.  If McCrory loses, which seems increasingly likely, his political career is over.

Finally, state and federal courts are ruling against such laws.  There is a growing sense that the issue of transgender equality will be resolved much in the same way that marriage equality was in 2015.  Both pro- and anti-equality advocates suspect that a game-changing ruling is coming, making expenditure of political capital on what will likely prove to be temporary legislation does not make sense.  Instead, each side is nationalizing the fight, hoping for a more favorable court.  Meanwhile, trans-conscious voters can become more savvy voters by carefully listening for the dog whistles within the broader campaigns.

The most shrill is that religious freedom is under attack.3  Of what does this attack consist?  If the “corrective” legislation is any indication, the threat is that it is becoming more difficult to discriminate against others with impunity.  In addition to anti-trans proposals, there are growing movements to favor “European”4 and Christian immigration despite the fact that the most severely oppressed refugees are brown and Muslim.  Churches still pay no taxes, enjoy broad protections to discriminate in their hiring/firing practices even when it violates federal law, and polls regularly demonstrate that Republicans would sooner vote for Democrats and vice versa far more readily than either would vote for an atheist.

Lately, an even louder chorus is booming: we must protect our children.  Not from poverty, inadequate education, measles, air pollution, racism or school shootings.  No–our children are threatened by transgender kids, who are willing to subject themselves to anxiety, social ostracism and daily abuse in hopes of seeing your kid partially naked before gym class.  Be afraid.  Be very afraid.


At the beginning of this post, I enjoined you into a thought experiment in which you would vote based on transgender issues alone.  Let us put that thinking aside once again.  I do not advocate one-issue voting.  Nevertheless, if someone you know is transgender, or if trans people simply matter to you in general, elections are a time of great angst and greater opportunity.  I would ask you simply to factor our concerns into your electoral calculus.  Whatever your political assumptions, please do not leave your voting decisions until the afternoon of November 8.  Read.  Ask.  Contact.  Consider.

Vote.