Trans Man, Female to Male Transgender: Sexuality

By and large, the transsexual condition is referred to, and often dealt with, as a sexual problem. Gender identity and sexuality are two separate aspects of our lives. Yet, it is amazing how many people have trouble conceptualizing the difference. Since transsexuals began approaching the medical community after W.W.II, the general view of those practitioners was one of taking a social deviant (socially embarrassing, “effeminate” men) and through chemical and surgical adjustments create a socially acceptable woman. Once it was discovered that a portion of these “new” women took female partners and identified as lesbians, the medical screening process was tightened up. Those who identified as anything other than heterosexual were forced to lie. If they mentioned any behavior that smacked of bisexuality or homosexuality, they were rejected from most gender programs. Those who felt they could not fight the system learned to lie. The medical community taught many transsexuals that their gender and sexual identity were inseparable.

One of the first people to challenge the gender programs and the medical professionals on this attitude was Louis Sullivan. He was the founder of the largest and longest-running FTM organization (to date) in the world, now known as FTM International, Inc. Lou identified not only as an FTM, but also as a gay man. He spent ten years of his life writing letters, personally visiting doctors, educating them, and persevering against the system. For ten years, he was denied hormone therapy or surgery. Finally, his persistence paid off and he was granted the right to pursue the treatment he felt he needed. He was the first FTM who openly led the way for others who identified as gay or bisexual.

Within the FTM experience, the entire gamut of the sexual spectrum is covered. A large portion of FTMs identify as heterosexual men who date and even marry women. There are those who identify as non-sexual and others who see themselves as asexual, choosing only self-stimulation. A large number of people identify as gay or queer, others identify as bisexual. There are those who identify as pansexual or simply sexual.

Of course with the exploration of sexuality comes the discovery and exploration of sex. And with sex, the specter of HIV/AIDS and STDs arises. Most of the FTMs on the street hustling for survival and money are fully aware of the risks they run. They face some of the tough problems that other male hustlers face on the streets. Most johns will pay higher dollar if they don’t have to use a condom. In San Francisco, $10 to $30 dollars will get you a blowjob. These are usually performed with condoms. To kick without a condom, the asking price is $75 to $150. Several of the young men have commanded prices of $500 or more for the john’s privilege to not use a rubber. It seems an awfully low price for their life. The chance of drug use, mostly intravenous, is high for these young men. To our knowledge, at this point in time, the number of young FTM men who work the streets is low.

The FTMs who are probably at the highest risk of transmitting or contracting STDs are those who identify as heterosexual. Many hetero FTMs feel they are immune to HIV/AIDS because it is still considered a gay disease, and not all FTMs emerge from the dyke community. Their biggest risk is their ignorance and lack of education. This is probably less so in urban areas, but the attitude is still alarmingly proliferant. Not surprisingly, those FTMs who identify as gay or bisexual are usually the most educated in regard to any STD as well as safer sex practices. This has not, however, kept FTMs from contracting HIV or other STDs. In both urban and rural areas, the number of FTMs who have sero-converted has risen in the past three years. Herpes is wide-spread if not epidemic. A large number of FTMs have spoken up about cases of gonorrhea as well. When asked why they choose not use condoms or other forms of protection, many state that they have felt pressured into not using them. Several have spoken of being told they won’t be seen as “real” men if they insist on protection. This kind of pressure has come from straight women, bisexual men and women, and gay men. Peer pressure seems to run the gamut in the sexual spectrum as well. More education is needed about safe sex that recognizes the unique conditions of FTM bodies and psyches.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

By: Shadow Morton, Yosenio Lewis, Aaron Hans–James Green, Editor

FTM Related Books

Here Is A List of Female to Male Related Books…

Bornstein, Kate. Gender Outlaw: On Men, Women, and the Rest of Us. Vintage Books, 1995.

Bornstein, Kate. My Gender Workbook: How to Become a Real Man, a Real Woman, the Real You, or Something Else Entirely. Routledge, 1998.

Brown, Mildred L. & Chloe Ann Rounsley. True Selves: Understanding Transsexualism-For Families, Friends, Coworkers, and Helping Professionals. Jossey-Bass Publishers, 1996.

Burke, Phyllis. Gender Shock: Exploding the Myths of Male and Female. Anchor Press, 1997.

Califia, Pat. Sex Changes: The Politics of Transgenderism. Cleis Press, 1997.

Cameron, Loren. Body Alchemy: Transsexual Portraits. Cleis Press, 1996.

Colapinto, John. As Nature Made Him: The Boy Who Was Raised As A Girl. Harper Collins, 2000.

Devor, Holly. FTM: Female-To-Male Transsexuals in Sciety. Indiana University Press, 1997.

Devor, Holly. Gender Blending: Confronting The Limits Of Duality. Indiana University, 1989.

Feinberg, Leslie. Trans Liberation: Beyond Pink or Blue. Beacon Press, 1998.

Feinberg, Leslie. Stone Butch Blues: A Novel. Firebrand Books, 1993.

Feinberg, Leslie. Transgender Warriors : Making History from Joan of Arc to Dennis Rodman. Beacon Press, 1997.

Halberstam, Judith. Female Masculinity. Duke University Press, 1998.

Hewitt, Paul. A Self-Made Man: The Diary Of A Man Born In A Woman’s Body. Headline, 1995.

Israel, Gianna E. Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts. Temple University Press, 1997.

Jones, Aphrodite. All She Wanted. Pocket Books, 1996.

Kirk, Sheila M.D. Masculinizing Hormonal Therapy for the Transgendered. Together Lifeworks, 1996.

Middlebrook, Diane Wood. Suits Me: The Double Life Of Billy Tipton. Houghton Mifflin, 1998.

Morpurgo, Michael. Joan Of Arc. Harcourt Brace, 1999 (Children’s Book)

Nataf, Zachary I. Lesbians Talk Transgender. Scarlet Press, 1996.

Nestle, Joan. The Persistent Desire: A Femme-Butch Reader. Alyson Publications, 1992.

Pratt, Minnie Bruce. S/he. Firebrand Books, 1995.

Queen, Carol and Lawrence Schimel. Pomosexuals: Challenging Assumptions About Gender and Sexuality. Cleis Press, 1997.

Ramsey, Gerald, Ph.D. Transsexuals: Candid Answers To Private Questions. The Crossing Press, 1996.

Rees, Mark Nicholas Alban. Dear Sir or Madam: The Autobiography of a Female-To-Male Transsexual. Cassell Academic: 1996.

Reit, Seymour. Behind Rebel Lines. Odyssey, 1988. ( Children’s Book about a girl who enlisted in the Union Army as a boy.)

Stringer, Joann Altman. The Transsexual’s Survival Guide: To Transition & Beyond. Creative Design Services, 1990.

Sullivan, Louis. From Female To Male: The Life Of Jack Bee Garland. Alyson Publications, 1990.

Thompson, C.J.S. Ladies Or Gentleman: Women Who Posed As Men, And Men Who Impersonated Women. Dorset Press, 1993

Valerio, Max Wolf. A Man: The Transsexual Journey of an Agent Provocateur. William Morrow & Company, 1998.

Volcano, Del LaGrace & Halberstam, Judith “Jack”. The Drag King Book. Serpent’s Tail, 1999.

Wilchins, Riki Anne. Read My Lips: Sexual Subversion and the End of Gender. Firebrand Books, 1997.

What is FTM?

The border between intersex (hermaphrodites) and transsexuals is very fluent. In fact it can be argued that both are two sides of the same phenomena: during the early devellopment of the fetus the body develloped in a nonstandard way, making it difficult for third persons to guess the gender of the baby after birth.

In the FTM case a child has mistakenly (if the psychological identity is used as defining standart) been labeled and assigned as female at birth.

During childhood, adolescence but usually only as an adult the FTM corrects this mistake and lives as a man.

This can be a disruptive process as parents, friends, employers are often relucutant to aceept that their perception of this person was incorrect. Usually after some time most people do adapt, also because it is easier to relate to a FTM as a man.

Hormones, surgery or a legal court order are usually nessesary to achive a complete recognition by society. Many countries, smore health organisations unfortunately still discriminate against FTMs, and intersex and transgendered people in general.

Many FTMs have started to explore ways which lead to a recognition without surgery, especially FTMs who pass as boys or young men without any medical intervention. Others have explored bi-gendered ways, bluring the border between the gay/lesbian and transgender population.

The abreviation FTM is derived from the medical term female to male (transgender, transsexual, etc.). As most FTMs have no serious medical disorders related to their condition, FTM and intersex people who match this statement should however rather seen as a part of the rich heritage of human diversity, which has produced differnt races, bodyshapes, and on a higher level ethinically diverse cultures.

Transgender Theory

To understand the history of transgender people, one must also understand how both transgendered people themselves, and non-transgendered people explained the presence of such apparent misfits in the otherwise neat binary sex/gender social fabric. One can understand how law, medicine, and society in general treated transgendered people only within the context in which the transgendered person fit into a theoretic framework. If transsexuals were a medical entity, one still needs to know if it is a psychiatrically pathological entity, or a developmentally intersexed entity. If the former, one would expect that “cures” would be attempted, if the latter, then compassionate, though not always welcome, medical treatments might be applied. The law could see the transgendered person as a civil indentity question, a criminal pervert, or as a medical entity. The law’s treatment very much depends on the explanitory world view surrounding the transgendered in society.

Judeo-Christian-Moslem culture, drawing on a single verse in one old testament book, Deuteronomy 22-5, held that cross-dressing was an “abomination in the sight of the Lord”. Some biblical scholars hold that this line refers to a prohibition of the Hebrew people from participating in religious practices of the neighboring cultures, which included the followers of Cybele whose priestesses were post-operative male to female transsexuals. This single edict, surrounded by edicts that are seldom if ever followed today, save for the Ultra-Orthodox Jews, is sometimes quoted as sanctioning the worst transphobic treatment of transgendered people. Other old testament laws detail the status of “eunuchs”, males whose genitals have been surgically removed. Primarily these laws prescribe a second class status to the eunuch, since they are no longer “men”, they do not have male privileges, including the right to “testify” in court… since they no longer have the required equipment, testicles. (This is not a pun, but literally the origin of the words… one needed testicles to testify… and the old testament really does refer to the story, or testimony, of patriarchy.) Thus, built into Judeo-Christian-Moslem is the assumption that MTF transgendered people are untrustworthy abominations. This explains why Judeo-Christian-Moslem cultures have mistreated transgendered people while other cultures have either tolerated, or sometimes, venerated transgendered people, why Joan d’Arc was burned at the stake for wearing men’s vestments as well as armor, while the hijra of India have houses that have been in existence for hundreds of years.

Early in this century, as the United States population moved to the cities, transgender people, though extremely rare, started finding each other, just as they had in other city cultures in more populated countries as China and India. These gatherings of transgendered people were noted by their neighbors. These good people, educated in Christian values, complained to the civil authorities, who duly passed ordinances outlawing transgender expression, society, and existence. It was the cities who passed the laws against transgendered people. It must be noted that these laws were passed in the same climate and time that produced laws prohibiting citizens of African descent from owning property in the city limits, or of Catholics to operate schools. It should be noted that while the cities passed ordinances against transgendered people, the States were concerned with criminalizing homosexual conduct. City police, when they wanted to harrass homosexuals, used the ordinances against the transgendered as more visible targets. Thus, the Stonewall riots of 1969, naturally began with the standard sweeping arrests of transgendered people. The ordinances began to be repealed in the 1970s. It is perhaps fitting that the first governmental bodies to atone for past discrimination by passing anti-discrimination measures in the 1990s should be the very cities that once had laws designed to expose them to criminal sanction.

Laws criminalizing homosexuality were also used to incarcerate or force medical treatment on the transgendered. In the name of eugenics, homosexual and transgendered people were sterilized against their wills. Later, when hormones became available, various medical treatments were devised. Some sought to reduce the libido by suppressing natural hormones, others sought to replace putatively low hormones. These actions were done under the theory of enlightened criminologists that many lawbreakers were rehabilitable using modern medicine. It was rarely questioned in law enforcement that the law itself was in need of rehabilitation. But there were movements to do just that, lead by social reforming physicians such as Magnus Hirschfeld in Germany.

There were times, when the transgendered person came to the attention of the courts through the medical establishment, rather than the police, when compassionate justice prevailed. Until the mid to late century, the prevailing mechanism for transgendered people to gain protective legal status was to seek a change of sex status through correction of birth certificates or registry in the same manner as was done in cases of intersex, where physicians provide for a ‘second opinion’ as to a person’s sex later in life. The law literally saw transsexuals as a form of intersex and helpfully corrected sex designations when asked. It was not until the popular press created the myth of “sex change” that the law began to see transsexuals as separate from intersexed people. Only after this change in perception was it neccessary for specific statutes needed to secure a mechanism for transsexuls to change birth certificates and indentification cards. Even then it was done as an extension of the intersex theory, a reaffirmation, to counter the “sex change” paradigm.

At the turn of the century, the concepts of sexual orientation and gender identity were conflated. One was either a normal man or woman, or one was an abnormal psychosexual invert. In some respects this concept is closer to the modern concept of the classic transsexual in that it was conceptualized as a person who both identified with and shared the same sexual object as a normal member of the opposite sex. Only through education by the homophile community and open minded sexologists such as Evelyn Hooker and Alfred Kinsey was the homosexual person viewed as having a congruent gender identity, merely finding one’s own sex to be the chief object of amorous affections. This left the concept of gender identity separable from sexual attraction, opening the door to conceptualizing the catagories of the lesbian identified male to female and the gay male identified female to male transsexual. Still, it took the work of FTM transman Lou Sullivan in the late ‘70s, early ‘80s, to get the medical establishment to recognize the distinction.

There are three main currents of thought on the origin of gender identity in humans, Essentialism, Social Constructionism, and PsychoSocialism. In academic circles these differing theories are hotly debated. But in the lives of ordinary people, especially transgendered people, the model that is applied by the medical, educational, legal, and even parental authorities that transgendered people interact, as individuals and as a class, deeply influence the interaction and the outcomes.

PsychoSocial Theories

Though Sigmond Freud was from Austria originally, his work influenced North American thought to a greater degree than European. His thoughts on the developing sexual identity and sexuality of infants and children profoundly influenced how transgendered people would be viewed in North America. Freud felt that gender identity was mediated by the existance or absence of a penis, directly. In the case of the owner of a penis the discovery that not all humans have one occasions deep anxiety lest that delightful organ of pleasure might be removed. This “Castration Anxiety” led to a distancing of the owner of the penis from the caretaker who did not own one… presumably because that person might want to steal it. While simultaneously, the owner of the penis wishes to emulate the other caretaker who by good fortune still owns a penis. Thus the owner of a penis learns to be a boy. Meanwhile, the infant who does not own a penis discovers that there are individuals who do own one. This occasions extreme jealousy. This “Penis Envy” leads one to court, and compete for, the affections of the caretaker who owns this marvelous appendage, while simultaneously emulating the caretaker who does not own a penis, who demonstrates ways of successfully courting the affections of the owner of a penis. Thus the one who lacks a penis learns to be a girl.

The existance of transgendered people brought the theory a serious challenge. How to explain people who end up having the exact opposite reaction to the presence or absence of a penis? The first answer of any theorist to such a challenge is denial, “transgendered people are psychotic”, likening the transsexual to a delusional man who believes himself to be Napolean. This glib answer sufficed for those who had never actually spoken at length with transgendered people. But the diagnosis of psychosis failed to hold up apon examination. The challenge remained.

For FTM transgendered people the failure to resolve “Penis Envy” was enough explaination. But MTF trangendered people were still a mystery. The psychoanalytic theorists response was to posit a family constellation involving an overly close mother, who kept her son wrapped up in her emotional world, and a distant or absent father. The son could not make the emotional and subsequent identity break with his mother. Perhaps we can call this theory “Castration Envy”? This seemed at first glance to hold up well, since such family histories were indeed present in MTF transgendered people. Except it didn’t explain all of the cases since many profoundly transsexual MTF individuals had extremely good relationships with their fathers. The theory further broke down when comparing the statistics with non transgendered people. The were many families with an absent or emotionally distant father, the vast majority of single mothers, whose sons did not show signs of being transgendered. Though it remained popular to blame mothers, especially single mothers for all sorts of society’s woes, transgenderism was not able to hold up as being caused by family dynamics when tested statistically.

Still the psychoanalytic model held for most of the 20th Century, inspite of repeated failures of psychoanalytic therapy to dissuade transgendered people to abandon their gender identity. It is probably responsible for the prevailing attitude that Gender Identity Disorder is a psychiatric illness as defined by the American Psychiatric Association’s Diagnostic and Statistic Manual.

Toward the middle of the 20th Century, as the psychoanalytic model for all mental illness began to be cast into doubt, a new model of gender identity came into vogue, “Imprinting”. One the chief proponents of the theory was John Money, Ph.D. Observing that intersex infants with the same physical features at birth who had been assigned to different sexes both seemed to adjust equally well, Money theorized that there was a critical period in the infant’s early life when the parents’ sexually dimorphic treatment imprinted apon the child a congruent gender identity. The notion of imprinting comes from observation that some animals imprint the image of a caretaker in infancy. The popular image is that of gosslings first sight of a farmer’s child, who subsequently is followed around as “mother”. This lead to the standard procedure of early genital surgery for intersexed infants to unambiguously assign a sex, any sex, to child so that an unambiguous gender identity will be imprinted by parents and family who “know” the childs sex. It lead to a medical ethic of misinforming even the parents as to the intersexed nature of the child. It also resulted in sterilization of thousands of male children, who born with a phallus too small to be comfortably described as a penis were reassigned as female.

Transgender people were explained by the imprinting theory simularly to the psychoanalytic model, blaming the mother. Again, an overly emotionally close mother, and sometimes the father as well, coset and pamper a male child in a manner that the hapless male child gets the message that it is female. Sometimes it was noted that the feminine male child was “physically beautiful”, that is, like a pretty girl child, illiciting a response from adults in a manner that reinforces the mistaken identity as a female child. Similarly, a physically adventurous female child might illicit masculinizing responces.

Money’s hypothesis and recommendations lead directly to the tragedy and “experiment of opportunity” of John Theissen, a man who’s penis was accidentally destroyed during circumcision. Mr. Thessien was later surgically reassigned as female. His parents then proceeded to raise him as their daughter, while his identical twin brother served as “control”. When the children we several years old the clinics declared that the reassigned child was accepting “her” gender as a girl. The case became known as that of John/Joan. Money published this case as proof of his hypothesis. Unfortunately, John Theissen as a teen refused to continue the program, insisting that he was a boy… he grew to be a man, obtained phalloplasty, married, and is raising three children from his wife’s prior relationships. It can be said that his is a case of surgically created transsexuality, as his personal gender identity was at odds with his sex assignment as an infant. Mr. Theissen’s story was published in Rolling Stone magazine in the mid ‘90s after a scientic paper was published by Milton Diamond, a proponent of pre- and neonatal hormonal brain sex differentiation.

Social Constructionism:

As the Second Wave of Feminism grew in strength, critism of discrimination against women led to a reaction to prescribed restrictive societal roles for the sexes. “Biology is not destiny” became a rallying cry. What started out as a critism of socially constructed roles developed into a theory of gender which denied Essentialism in every form, stating instead that society took the biological differences of procreation, and instilled in them an artificial behavioral difference. The theory, thus expanded, denies that there is any natural basis for gender identity. Thus it denies to transgender people any rational cause… while at the same time, presenting no reason why not.

To some authors this meant that transgender people were free to express themselves in any manner they chose since all gender expression is as valid as any other. Only societal convention stands in the way of such freedom. Such conventions can be modified by the society as is deemed desirable. To some, all such restrictions are to be avoided, in a live and let live ethos.

Other authors, Janice Ramond and Germain Greer being notable examples, saw MTF transgender people as exploitive of women, aping the forms of femininity, supporting the artificial sexist forms that oppress women. It is interesting that in this regard they exhibit a hidden Essentialism, one that focusses on the genitalia as defining classes of human beings. They decried the restrictions on one class, while dispising those of the other class when they break those very restrictions.

Still the existence of transgender people poses a challenge to the social constructionist theory. One must explain both why gender identity exists, how it is perpetuated, enforced, and why some rare individuals “chose” to express a gender identity at odds with societally prescibed gender expression norms.

Performance Theory has it that we are taught to Perform Gender, to act it out, in the same way that we learn to act out social roles like teacher, student, friendly store clerk, police officer, etc. One is said to “do gender” rather than “have a gender”. This is very similar in basics to the psychosocial theory of imprinting, save that there is no instinctual basis for having the ability to absorb a particular gender identity. We are taught a set of gender behaviors that become so ingrained as habit that we forget that we are merely acting them out.

Transgender people are explained by this as having been improperly instructed. Even among those inclined toward psychosocial models as one would expect physicians to be, one finds this theory in currency. It is the model used in justifying Behavioral Modification Therapy to treat Gender Identity Disorder in children. Under the assumption that even though gender identity is arbitrarily socially constucted and taught to children, one should not allow children to express gender behavior different than the norm. Some rationize it on the basis of wanting the children to fit in, experience less rejection and bullying, a ‘blame the victim’ mentality. Others are simply moralists that insist that God has ordained that we should all behave in a certain prescribed manner.

One Post-Modern philosophical theory, one that has a striking resemblance to the psychosocial theory that transgendered people are simply crazy, has it that transgendered people are suffering under a “false consiousness”. That they are not really experiencing a gender at all… but an alienation from their social and biological reality. This theory is perhap the most transphobic of all theories in that it denies what is called in Post-Modern cant, “agency”, the characteristic of experiencing and expressing their existence and very real psychic pain.

Oppression Theory starts from the assumption that transgendered people are very much in command of their faculties and have made a rational decision to avoid societal restrictions on desires they experience. The usual script is that an ambitious woman noting that she is unable to succeed “in a man’s world”, dons mens clothes, assumes a fictious identity as a man, in order to achieve career success. These “passing women” are the darlings of the feminist historian because they are reveared as daring pioneers for women’s liberation, or they are held as examples, proof, of how horrible conditions were in some past epoch. To the feminist historian, modern FTM transsexuals are an embarrassing disproof of the theory. Similarly, Oppression theory is used to explain modern MTF transgendered people as being examples of internalized homophobia in gay men, too ashamed to live openly, and so have to “pretend” to be women in order to express their desire for same sex relations. To such gay male chauvenists, the fact that half of transgendered people identify as lesbian or gay male after transition, are an equally ebarrassing disproof of the theory.

Social Constructionist theories fail to note that ethnobiological studies of sexually dimorphic behavior in animals is not socially constructed for non-humans. Nor does it explain the cross cultural similarity and temporal stability of core gender identity throughout history around the world.

Essentialism:

Essentialism posits that men and woman are “made that way”. It is a deceptively self-evident fact that most everyone accepts since for over 99% of the population there is a clear cut correlation between genital morphology and gender identity. It is easy to for the average person to ignore the disquieting cases of intersex that cast doubt on the simplistic assumption of binary sex assignment. The question of which sex an intersex person “really is” demonstrates the esentiallist bias through much of Western Society for the past two centuries. Historically, Essentialism divided on which of two somatic characteristics was indicative of the “real sex” of an individual, genitalia or gonads. For most people the genitalia, the presence or absence of a penis was the overriding feature. As medical science grew more sophisticated in the 19th century, the gonads came to be the indicative feature. But early in the 20th Century the newly discovered chromosomes, specifically the presence or absence of the “Y” chromosome, became the newly crowned final arbiter of “real” sex. The faith in microscopic examination to “scientifically” determine one’s sex was unquestioned.

In 1968 the International Olympic Committee instituted chromosomal karyotyping for all female athletes. Any that did not have the required 46,XX chromosome karyotype were disqualified from competition, informed that, scientifically speaking, they were not women. The demonstrable fact that they had female genitalia, had lived as female all of their lives not knowing that they did not have the officially approved karyotype for women, did not enter into the unfeeling officials minds. Reductionist Essentialism had no room for intersexed people. They were counselled to fake an injury, slink away into silence to keep their shame of being “not female” from becoming known.

In 1970, the Corbet vs Corbet decision to nullify the marriage of a MTF transsexual to a non-transsexual man used karyotyping as the “scientific” marker for sex and gender that the law was henseforth to follow in the United Kingdom, throwing the legal status of transsexual and many intersexed people into limbo, neither male nor female.

Although essentialism has often been used as a philosophy to ‘prove’ that transsexuals and transgendered people do not have a valid claim to their identity, Essentialism still has explanitory power. If the locus of gender is found, not in the genitals or chromosomes, but elsewhere, transsexuals could be rationally described as “men trapped in women’s’ bodies” or “women trapped in mens’ bodies”. There are several loci that are, or have been proposed as the Essential Seat of Gender, but they come down to two main catagories, “Brain Sex”, and “The Soul”.

Many religions have a concept of an essential self, separable from the body. In Judeo-Christian-Moslem belief systems one’s soul separates from the body after death. This soul retains the sense of self, including gender indentity. Some religious thought includes the concept of the soul entering the body at some point in becoming a living being… and therefor must become, or always have been a gendered self. For religions that included the concept of reincarnation, the notion that a being always returns to the same sex body suggested an explanation for transgendered identity. Once in a while, a soul finds itself in the wrong sexed body. This idea was openly discussed in newsletters published in the ‘60s and ‘70s by the Erickson Education Foundation, as this was the personal belief of Reed Erickson, the Foundations benefactor. The Church of Latterday Saints (Mormon) debated the issue of pre-born souls finding themselves in the wrong body with Kristi Independence Kelly in 1980 at her excommunication. The Church held that, though the pre-born souls did have a gender before birth, God did not make mistakes: “There is no such thing as a man in a woman’s body or a woman in a man’s body” was declared, ex-cathedra by the leader fo the Mormon faith. Apparently, intersexed people must have also intersexed souls?

Some non-Judeo-Christian-Moslem cultures held that transgendered people were indeed gendered souls in the wrong body. Some believed that this juxtaposition have the transgendered person a special status with the spirits of nature or the powers. In ancient times in the mediteranean culture, MTF transsexual women became priestesses, Galla, of the goddess, Cebele. The Hopi Nation held that a transgendered spirit, or katchina, sent visions to transgendered people. In India, the hijra, transgendered and intersexed people are both reviled and revered, given varying circumstances. Mystical Essentialism has played an important role in various cultures, including our own.

The early 20th Century european researchers and medical practitioners believed that gender and sexual behavior in general are the result of a sexually dimorphic brain. That is to say that the brain itself has a sex. This sex usually conforms with the chromosomal and the genital sex. However, just as there can be chromosomal and genital >intersex conditions, the brain might also exhibit intersex morphology leading to behavior and that elusive personal experience, gender identity, at odds with either somatic or chromosomal sex. Magnus Hirschfeld, a leading early researcher described the entire spectrum of what today we would call Queer expression, gay, lesbian, bisexual, transgender, transsexual, as forms of “Sexual Intermediates”, or intersex. This was not a metaphor or a rationalization. Instead it was an earnest theory, based on careful observation and scientific generalization, understanding the then current lack of neurological science. Hirschfeld and his colleague, Harry Benjamin believed that as our understanding of the brain grew we would discover just where and how the brain was organized to produce sexual orientation and gender identity. For Hirschfeld, there was no major divide between non-conforming sexual orientation and gender identity, they were simply different forms that intersex could take. Thus for Hirschfeld, the late 20th century division between the concepts of gender identity and sexual orientation, the great political divide between the gay & lesbians and the transgender community would be meaningless. To Hirschfeld, we are all transgendered, gay and transsexual alike.

In the first decades of the century, experiments with cross sex gonadal implants in animals suggested that there was a connection between hormones and gender specific behavior. This lead to horrific experiments in humans during the NAZI era and beyond as hormones became available as a common pharmaceutical. Testosterone was administered to gay men and MTF transgendered people in an attempt to ‘cure’ them. The hormone treatments had no effect on the sexuality or gender identity of the experiments. No lasting harm was done to the gay men. But the supermasculinizing effects on the transgendered victims was severely traumatizing.

In the later decades of the century, neuroscientists found significant sexual dimorphism in microstructures in the brains of animals and humans. Experiments on rats indicated that hormone levels during a period in late gestation and early post-natal development to be critical to the development of these structures and subsequent behavior. Gorby was able to create what he described as a laboratory model of transsexuality in rats. He demonstrated this in both MTF and FTM cases. When he introduced them to each other, the FTM rats mounted the receptive MTF rats.

Using human children to explore gender identity and sexual orientation would be extremely unethical in the laboratory, but science often uses “experiments of opportunity”. Simon La Vey used autopsy material from straight and gay men who had died from aids to find that a small microstructure of the brain differed in the two populations, suggestive of a sexual orientation controlling microstructure. The same technique of using autopsy was performed by Swaab to discover a different structure associated with gender identity. Shaffer, in an as yet unpublished study, used MRI data from a large pool of controls, MTF and FTM transsexuals to demonstrate that the corpus collosum showed sexually dimorphic structures that, on a statistical basis, correlated with gender identity. Both Swaab’s and Shaffer’s work ruled out effects of hormones in adulthood.

The early data is tantalizing, and agrees with laboritory findings using animals. However, it is also known that experience can shape the brain. Lack of sensory stimulus and a chance to work out problems leads to dramaticly less brain development in infantile rats. In humans there is a suggestion that early musical training affects the shape of the corpus collosum, building greater connectivity between the two hemispheres of the brain. These early experiences suggest that early gender experiences could also lead to sexual dimorphism in the human brain by a similar mechanism. This would agree with Dr. Money’s imprinting hypothesis… But would be at odds with Gorby’s work with rats, and the results of the case of “John/Joan”.

Science could very well demonstrate that the seat of sexual orientation and gender identity is located in the brain. How that arises developmentally is still open for further research.

transhistory.org/history/TH_Theory.html – 2003

The Rights of Man, Woman and Transsexual

The authors are in the employment department at Bates Wells & Braithwaite. Copyright 2001 Times Newspapers Ltd. 30th January 2001

Employers are disturbingly ignorant of sex change issues, say . With 5,000 transsexuals in Britain, issues about gender reassignment are arising within the workplace with increasing regularity. Several employers have sought advice from us in the past year about the treatment of employees undergoing gender reassignment. Although few cases about transsexuals have been reported, it is clear from the output of the Equal Opportunities Commission that many cases are being brought, and often settled. But there appears to be a disturbing ignorance among employers about the legal protection of transsexuals and good equal opportunities practice.

In 1996 the European Court of Justice held, in the case of P v S and Cornwall County Council, that the dismissal of an employee because she was starting gender reassignment was unfair and contrary to the European Equal Treatment Directive. As a result, the Sex Discrimination (Gender Reassignment) Regulations 1999 were brought into force. They amended the Sex Discrimination Act 1975 to extend protection in employment and vocational training to anyone who ‘intends to undergo, is undergoing or has undergone gender reassignment’.

Gender reassignment is defined as ‘a process undertaken under medical supervision for the purpose of reassigning a person_s sex by changing physiological or other characteristics of sex and includes any part of such a process’. There is no definition of ‘intends’ within the regulations but clearly more than cross-dressing is envisaged (although individual freedom of expression by way of dress is now to some extent protected by the Human Rights Act 1998). The category of individuals protected is wide, with no differentiation between pre and post-operative transsexuals.

Less favourable treatment of a transsexual is permissible in limited circumstances: where the job requires performance of intimate physical searches or doing work or living in a private home where objection may reasonably be taken by the individual to this degree of intimacy and contact. These genuine occupational qualifications are applicable at all stages of the gender reassignment process.

There are two further exceptional circumstances: where it is necessary for the employee to live in shared accommodation, or where personal services are being provided to vulnerable individuals ‘and in the reasonable view of the employer those services cannot be effectively provided by a person whilst that person is undergoing gender reassignment’. However, these two genuine occupational qualifications do not apply to individuals who have undergone gender reassignment.

There is thus, evidently, potential for difficulty with, for example, a care worker who has completed the process of changing but by whom an elderly client does not wish to be cared because the client is aware of the transsexuality. A refusal to provide work would amount to discrimination. Employers and prospective employers should bear in mind that tribunals are able to draw the inference of discrimination from the very fact of less favourable treatment.

It is often practical issues that cause difficulties at work. In particular, there is the question of which lavatory a transsexual should use. The answer is straightforward: whichever he or she prefers to use. If this preference causes embarrassment among staff, the employer must attempt to inculcate a more enlightened attitude. A last resort may be to agree with the transsexual that a lavatory be designated as unisex (this should preferably not be the same as the disabled facility).

This course of action was approved by an employment tribunal in the 1999 case of Bourne v Roberts & the Post Office. Equally, employers are often concerned about when other employees should be informed about a change of gender. All that is required is agreement on a timescale and to be flexible. Again, it should be borne in mind that the legislation encompasses the whole process from the stage of intention onwards. Personnel records should be updated at an appropriate point, and any references to previous gender removed (save if required for specific and legitimate purposes, such as insurance or pension records). It is an anomaly at present that transsexuals are unable to alter their birth certificates to reflect a change in sex.

The regulations do not address the question of discrimination in areas other than employment, such as education and access to goods, facilities and services. However, it is recognised that domestic legislation is inadequate and is likely to be expanded. Last May a case brought by a transsexual, Lisa Jones, against a landlord who asked her to stay away from his pub in Honley, near Huddersfield, settled for £1,000 compensation plus a £600 contribution towards costs. We can expect more such cases in future.

By Lucy McLynn and William Garnett

Gender Trust – 2003, This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

Dating for Male-To-Female Transsexuals

1. If you date men, you are always in potentially fatal danger. Be aware.

2. Make certain, before you even consider a date, that your partner is FULLY aware of your status and is not significantly bothered by it. Never date anyone who does not know about you.

3. Be aware that in our society, men who are secure enough to accept you are rare. there are predators who attack transsexuals, confused sorts who seek to use and then punish transsexuals, and those who try to be accepting but fail, often violently.

4. Be honest, be aware, and be very, very cautious.

5. Some men may only like you because of your transsexuality, and may find you uninteresting post-operatively. Be sure of the attractions that occur.

6. It is not all dark, but you will have to search more carefully, and be more aware, than nontranssexual women. Even with all the above, know that it is possible to find caring partners and loving friends.

The reasons

Dating both pre, and even post-op, involves concerns that nontranssexual folk do not have to concern themselves with. Some of these issues are serious.
Most, if not all of the dangerous issues revolve around sexual and gender insecurities. These insecurities are not dangerous in the transsexual, they are very dangerous in nontranssexuals.

Our culture still has a lot of bigotry and mindless hatred in it, and much of this evil comes from religious origins.

Homosexuality and Gender Threat

Early Christianity, Judaism, and to a lesser degree, Islam, became dominant in the western world by virtue of being warfare based religions. The universe was spiritually divided into an Absolute Good, and and Absolute Evil, and the basic premise was that the Good and True believers in the faith had to overcome everyone and everything else. To accomplish this, two things had to be done: one, the group, tribe, and religion had to concern itself with converting by any means possible other groups, and two, it had to become as populous as possible.
This last requirement is the basic reason behind homosexuality being made into a crime and an Evil. More babies means more tribe members. More tribe members means more ability to conquer and convert. Homosexuality produces fewer babies than heterosexuality. It cannot be tolerated by a belief system bent on domination.

You may be a woman, but be you pre-op or post-op, the social stigma of ever possessing a penis is there. If you date a man, those old Judeo-Christian issues in our western society kick in, and problems can occur. Sometimes these problems can be fatal.

Transsexuals and the Foundations of Assumed Truth

Transsexuals, by their existence, threaten basic assumptions and truths about gender and religion. The ‘Evil’ of homosexuality is shown to be the violent nonsense it is when the transsexual enters into the equation. Am I, a post-op, a woman? A surgically altered man? Something outside the scope of current belief and understanding?
As for the pre-op transsexual, then all possibility of a clear answer becomes lost. Is a pre-op a woman, a man, a woman in some ways, a man in others? To the average, simple mind, the result is paradox, confusion, and the destruction of neat, tidy categories and labels. It is hard to believe in religious prohibitions when reality itself shows the limits of them. If the word of god is so limited, so meaningless, the universe itself becomes upset for some folks. They find themselves adrift, without answers, forced to think, perhaps for the very first time. They begin to question themselves and their place in the universe, they are filled with nagging doubts.

Scared, confused people can be very dangerous. They can become violent, they can kill.

Far too many transsexuals have been murdered by men that just could not handle the issues they were forced to confront, the doubt they felt, the insecurity they suffered, or the ‘Truth’ that came tumbling down.

Sometimes the conflict is so severe, that men become convinced that the only way to restore their lost faith is to destroy that which caused it to be questioned. Such men deliberately seek out transsexuals to punish, humiliate, control, or harm them.

These same issues can also lead to other reactions besides murder. Some people are attracted to the forbidden and the rejected, and find it exciting. Such folks will find you desirable only as long as you fit this category.

Other folks try very hard to accept the transsexual, but fail at the task, because the conflict between what they were raised to believe, and what they want to be accepting about, is too much. In the end, sometimes the original ‘Truth’ wins out, especially because society supports it.

In all cases, the root cause of this nastiness is fear and instilled hatred of homosexuality, and this comes from only one place, religion. It is pervasive in our culture, because our culture is steeped in Judeo-Christian values and beliefs.

The Game Of ‘What Am I ?’

If you are a Male-To-Female transsexual and you are attracted to men, then what is really going on? Are you gay or straight or what? The answer depends on how one chooses to look at the transsexual.
If what matters is identity, is the mind and the heart, then you are a heterosexual woman with very standard desires.

If all that matters is the birth shape of the skin, in the past, present ot future, then you are an altered gay man experiencing homosexual desires.

If all that matters is the current cut of the skin, then a pre-op is a gay man and a post-op is a straight woman.

If the transsexual is considered a unique creature, a ‘third sex’, then all definitions become moot…perhaps being some shade of bisexual might come closest.

The problem is that, however you may define yourself, others will create definitions of their own over which you have little or no control.

What you must do is to be conscious of this, and determine what you want, and what you are willing to do, accept and teach, to get what you want. You must also be aware of the very real dangers involved.

It is not fair that this should be so. It is not fair that transsexuals should be forced to be so cautious, so concerned with safety, so endangered. It is not fair that religious dogma should brand transsexuals and homosexuals both as evil or as misguided, or even simply as distasteful.

But it is real, and you have to deal with that, or possibly die.

On the positive side, however, real, decent relationships are not impossible. They can and do occur, because there are men out there who can sort themselves out, and get past this inculcated bigotry or fear.
I know of such relationships personally, and am even involved in one: in my polyamory, or group marriage, one of my spouses is male. But it does take a little more effort and searching than the nontranssexual woman must face.

Selectively Out

All of this does not mean that the transsexual must wear their transsexual status as a badge, or be out to everyone, everywhere.
The key is to be selectively ‘Out’, to carefully choose who to tell and when and why. This is something the individual transsexual must be in control of, if at all possible.

Each circumstance must be evaluated on it’s own merits, but there is a general rule of thumb to follow:

Tell men up front, as early as possible

Why? because 93.7 percent of all violent crime, on the planet earth, is committed by men. Women just do not commit violent crimes even faintly as often. Women do not rape, murder, kill for hate, fag bash, mutilate, dismember, shoot, eviscerate, disembowel or torture unto death nearly as often as men do.

I will not bother with a discussion of the possible reasons for this, suffice to say that in the debate all sides are correct: the reasons are cultural, biological, genetic, and social all at the same time. Why this is true is not important.

What is important is that it is true, across the globe, in every society, everywhere. Even if violence is all but nonexistent, what violence there is will follow this statistic. Learn the one thing all women must:

Be afraid of men.

Nontranssexual women learn this from an early age. 3 out of 4 women learn it the hard way, in America, at some point in their lives. When you live as a woman, love as a woman, exist as a woman, you automatically are the heir to the perils of being a woman. To think yourself immune or to fail to be aware of this, is suicide.
Even more extreme, the status of being transsexual, even post-op, put one at a greater risk than that of nontranssexual woman.

Save your own life. Be up front, be ‘Out’ to any prospective male date.

Different For Women

This article is concerned with MTF transsexual woman who wish to date men, primarily because this is the group in serious statistical peril. Why not an article about the issues of dating as a lesbian?

Perhaps in time, but in general, the issues there are more about rejection and social bigotry, rather than physical violence and death or dismemberment. Your author identifies as being primarily lesbian, or if you prefer, a ‘polarized bisexual’: dedicated to reducing reflected glare off of sexual surfaces.

Although this may be a terribly politically incorrect thing to say, because of the vastly smaller risk of getting dead or mutilated, it is reasonably safe to date with women without outing ones self, until the relationship reaches the point of sexual involvement.

Because one is less likely to be killed, one can hope to become close friends first, before revealing the Big Secret, if one is living in secrecy of any degree.

The value of doing this is simple: it increases slightly the odds of being considered a human being, and therefore also increases the possibility of not being immediately dismissed out of bigotry, political dogma, ignorance, or blind, mindless hatred.

Because women are less likely to disembowel you for being a transsexual, you have a chance to escape having to suffer outing yourself immediately.

You have a chance to be seen, for a while at least, as something other than a politically unacceptable Frankenstein monster.

This may be enough time to cut through the bigotry and be truly seen.

Conclusions

The content of this article sounds quite frightening, and this is not without some rationality. However, there is also a danger in becoming paralyzed by fear or concern. That danger is loneliness.
What I suggest that you do is to be aware of the dangers and issues, but also realize that they are indicative of probabilities. It is very possible for you to find joy and and love, it is just my intent that you live long enough to find them.

Be smarter than those who would harm you, and you have the edge. Be aware of the very real dangers, and select carefully, mindful of your own precious safety.

The concerns for the MTF transsexual woman are a bit more severe than for the nontranssexual woman, but not insurmountable.

Keep your wits sharp and be careful out there.

transsexual.org/dating1.html – 2002

Female to Male: Sex Reassignment Surgery

This is one of the more controversial aspects of the transgender (TG) experience. There are many transgender folk who choose not to have any surgery, some who pick and choose which surgeries they want, and some who feel they have no choice but to go through all of them. There are also the moral pressures to consider from internal and external sources. Average cost ranges are as follows:

Chest…………………..$2100 – $7500

Hysterectomy………….$10,500 – $18,000

Metoidioplasty…………$8,000v- $15,000

Phalloplasty……………$15,000 – 150,000

Please keep in mind that these costs vary from doctor-to-doctor as well as from country-to country.

Most of the surgeries listed above can only be acquired by paying the surgeon cash up front. The cost is one of the weightiest factors as to whether a person decides to have the surgery or not. Many FTMs are under-employed, if not unemployed. Those who do seek surgical alteration often work 2 and 3 jobs to save the money needed. Some of the younger FTMs work the streets just for survival money, although a few have used this as a means to supplement other earnings for surgeries. A few FTMs have been able to acquire some or all of their surgeries through insurance. This is very rare since most insurance companies explicitly exclude transsexual treatments from their covered procedures.

When to have any of the surgeries is also an issue for many FTMs. The Harry Benjamin Standards of Care (SOC) clearly delineates when a transsexual can do certain things pertinent to their transition. Many transsexuals who only choose to do one or two of the surgeries circumvent the SOC. However, this can mean seeking doctors through the black market. The other concern for many FTMs is the condition of the body before and after taking hormones. There have been several FTMs who have sought and received different surgeries before taking hormones. Reasons for this will be disclosed in the following paragraphs.

The double mastectomy and/or mastopexy is the procedure most commonly sought by FTMs. The biggest reasons for this are image/presentation and comfort. Transsexuals are asked to dress and live in the world as a person of the gender they are trying to achieve for a set amount of time&emdash;usually six months to one year before they are allowed to pursue hormone therapy or any of the surgeries. The biggest obstacle for an female to male is usually hiding the breasts. However, this is absolutely necessary. Far too many FTMs have been humiliated, harassed, and even beaten up for walking into the men’s room because their chests gave them away. This harassment is not exclusive to the bathroom situation. Mainstream society is notorious for its violence toward anyone presenting a conflicting image, period. Many FTMs choose to have this surgery before they pursue hormones for several reasons. With testosterone comes body hair. The chest hair that grows in around the sutures and incisions can, at the very least, be incredibly annoying, and in the extreme can become ingrown and even cause infection. Many FTMs also look to the advantage of estrogen keeping the skin more pliant as a bonus. Several individuals have gone through the mastopexy, waited 6 to 9 months to heal, and then begun testosterone therapy. It seems that most of these individuals have less visible scarring or less extensive scarring. The muscle growth into the chest with the testosterone seems to them more natural as well.

A couple of advantages to testosterone are that the healing rate (from surgery) appears to be quicker, and with the advanced muscle development, there is less chance of severed or damaged muscle.

Some of the older FTMs have had the advantage of having an hysterectomy before they’ve sought hormone therapy. Many FTMs feel there is an advantage to this as there will be less of a strain on the liver once testosterone therapy is initiated. Some symptoms of chemical/hormonal imbalance (such as migraines) often disappear after the FTM has his hysterectomy. One advantage of hysterectomy is the possibility of either reducing the dosage of testosterone or extending the time period between injections, thus possibly reducing the strain on the liver. Those who do undergo this surgery are sometimes advised to then take small doses of estrogen. Many refuse because of the implications of femaleness. Many people do not understand that estrogen is present in the male body as well. Testosterone is also used to alleviate osteoporosis, though, and estrogen may not be necessary. People should also be aware that excess testosterone in the system is naturally converted into estrogen.

There are many who choose not to undergo an hysterectomy and suffer no ill-effects, although there does seem to be a greater degree of difficulty dealing with the last few days before the next injection, known as the trough. In the 3 to 4 days before the next injection, many FTMs (with female reproductive organs still functioning) report irritability, shortness of attention span, headaches, fatigue, lack of sex drive, and sometimes cramping similar to menstrual cramping. Some FTMs who experience extremes of these symptoms then pursue hysterectomy, or opt for an oophorectomy.

In recent years, more and more FTMs are choosing the metaoidioplasty (also inaccurately referred to as genitoplasty, and often contracted to metoidioplasty). One reason is money. It is less expensive, and therefore easier to set one’s sights on as an attainable goal. Metaoidioplasty is the freeing of the enlarged clitoris (micro penis) and construction of a scrotal sack with testicular implants. The patient can opt for several choices. A urethral extension can be constructed so that the FTM can pee from his freed penis. This choice carries the risk of infections, fistulas, and corrective surgeries for complications. A hysterectomy and / or vaginectomy can be performed simultaneously. If the vaginal canal is left intact, this gives the FTM better options if he chooses to pursue a phalloplasty in the future.

The phalloplasty is usually a series of surgeries, not just one. The surgeries are still brutal and leave extensive scars on several places of the body&emdash;usually the inside of one forearm, the lower side of the torso, and the side of one thigh. Although these surgeries have been improved upon in the past ten years, there are still major drawbacks that deter many FTMs. The amount of time spent in recovery from the surgeries is extensive. Some FTMs have spent nearly one year in recovery stages from the surgeries, dealing with infections, getting corrective surgeries, and sometimes having to deal with their body’s out-and-out rejection of the graft. The emotional toll of this surgery can be incredibly high. The surgically constructed penis is also non-functional sexually. It does not get erect or flaccid on its own. Most constructions utilize Teflon inserts to achieve erections. A few surgeons use pumps similar to those used for penile reconstruction in genetic males suffering from cancer or erectile dysfunction. There is a chance of rejection with this option. The constructed penis frequently does not look like a penis. In recent years, some doctors have been fine-tuning their surgical techniques and have also teamed up with tattoo artists for better aesthetic results.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

By: Shadow Morton, Yosenio Lewis, Aaron Hans–James Green, Editor

Female to Male Transgender: General Health Care

There are many reasons why FTMs will be reluctant to seek out medical attention or even preventative health care. Many older FTMs have assimilated even without hormones or surgery. Their greatest fear is discovery. Sometimes even their own partners and families don’t have a clue about their situation, and if they do, they are just as frightened of discovery. Mainstream society has not been very kind to anyone who is perceived as different. An even greater deterrent for many FTMs is the very treatment they receive once in a doctor’s office or in hospital. Far too many of us have stories of being treated like the latest circus attraction, or of being outed to the entire waiting room. Perhaps the greatest fear for many of us is being involved in an accident and being “discovered” on the scene or in the emergency room. The person fears being unconscious or so severely injured that he cannot defend himself while outrageous remarks are tossed about, jokes are cracked, epithets are shouted, treatment is interrupted or stopped. All of these things have happened and continue to happen to transsexuals every day. If it hasn’t already happened to us, it has happened to a friend, and we know that it could happen to us.

Since most insurance companies have explicitly written us out of their policies, most of us find it difficult to seek health care through those avenues, even if they are available to us. There have been many transsexuals who have been denied even simple health care because doctors and insurers can claim that the condition would not exist if we were not pursuing transition. Unless we can find sympathetic health care workers, we are often at the mercy of the big money machine insurance companies.

For the FTM specifically, dealing with the female reproductive organs can be a nightmare. Most of us do not have regular pap smears. The procedure is invasive. And again, finding a gynecologist who is sympathetic is difficult. Most FTMs will not seek out a gynecologist unless they are already experiencing symptoms of a problem. Most gynecologists, when it comes to female reproductive organs, have one goal–that of the continuation of the human race. When a male person with female reproductive organs comes into the office, most gynecologists see the organs and their possibilities, not the person. There are FTMs who have been dealing with severe symptoms of endometriosis or other health problems, and their gynecologists will not remove the organs at the patients request because the gynecologist sees the possibility of saving the organs. The FTM could be in severe, constant pain, not want the organs in the first place, have no intention of ever having children, even be past childbearing years, and the physician will override the patient’s wishes just to save the reproductive organs. Never mind the physical, mental, and psychological strain this puts on the patient. Never mind that it is the patient’s body.

Although many FTMs perform their own breast exams, most do not. They will rarely go to a physician if they find anything unless they already have a doctor who is aware of their situation. If surgery is recommended, many will not follow through because of probable exposure in the operating room. This is often true of hysterectomies as well. FTMs who choose to have one of the lower surgeries can get the hysterectomy at that time. If the FTM has opted to not undergo alteration surgery, chances are he is not getting any kind of medical attention for any health concerns.

Diet is an on-going concern. Many of the FTMs who are seeking some or all of the surgeries are working several jobs just to earn the needed money. There is little time for proper eating and sleeping. Those on the streets have an even greater difficulty meeting even the minimum dietary needs. Usually their main focus is on taking the steps they deem necessary for their transition. It is very important to point out to them that their health is one of the steps of their transition. If they do not have their basic health, they will not be able to maintain the work schedule they’ve set for themselves, they will not heal well from surgery or may even compromise their health to the point that they won’t be able to have surgery, and that they may achieve the goals they’ve set for themselves and then not have the health to enjoy their new life to the fullest.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

By: Shadow Morton, Yosenio Lewis, Aaron Hans–James Green, Editor