Tag: Transsexual

Transsexualism: A Guide for Employers

Transsexualism is the most pronounced form of Gender Dysphoria, in which a person experiences such a deep conflict between their physical sex and their mental gender that they have no choice but to embark upon the process of Gender Reassignment. Persons with this condition are likely to have been under a great deal of stress for many years prior to embarking upon treatment. The treatment has a very high success rate (over 97%} in alleviating the person’s suffering and helping them to function better both in society and at work.

The process of Transition (switching into living full-time in the desired gender role) and Gender Reassignment (medical and surgical treatment to alter the body) can be stressful for the person involved, and sympathetic treatment by their employers and colleagues will contribute greatly to successful outcome.

It is common for transsexuals to be diligent and highly motivated employees. Prior to transition, many take refuge from their emotional pain in being ‘workaholics’; after transition a good employee is likely to be better: the process of changing gender role alleviates the stress and pain, but the motivation remains. Gender reassignment does not change the inner person, and there is no need for it to adversely affect workplace relationships.

The Law

This is an area that is currently in a state of change. Historically, transsexuals have had no employment rights and there have been numerous cases of transsexuals being dismissed merely because of their condition. This changed in the spring of 1996 when the European Court of Human Rights ruled, in a test case, that such dismissal constituted a breach of human rights, and thus effectively extended the scope of the Sex Discrimination Act to include discrimination against someone for changing sex within the meaning of discrimination on grounds of sex. The outgoing UK government did not actually amend statute law to reflect this ruling, however Industrial Tribunals began enforcing it (such EC rulings automatically supervene over national law). The Sex Discrimination Act has now been updated by the present government with effect from 1st May 1999, including employment protection for transsexual people — and the government has made a commitment to examining the whole issue of legal rights for transsexuals.

The Transition Process

Before being officially diagnosed, a transsexual will usually have gone through a period of profound introspection, possibly denial, and certainly much emotional torment. The medical diagnosis confirms what the patient has felt, and treatment then commences. The diagnosis is made by a Consultant Psychiatrist with special knowledge of the subject — this Psychiatrist will also oversee the entire reassignment process. This does not mean that transsexualism is a mental illness or a delusion: in fact, quite the opposite. The psychiatrist’s role is to ensure that the patient is sane and really is transsexual, and that they really will be helped by a change of gender role. Recent research has proved that the ‘female brain in a male body’ (or vice- versa for female-to-male transsexuals) is a biological reality, not a fanciful metaphor. Some transsexuals will require a period of counselling before, or in parallel with, the medical treatment – in many cases they will have experienced much emotional pain from their years trapped in the wrong gender role and the wrong physical sex.

Given a reasonably certain diagnosis by the psychiatrist, the patient will commence Hormone Replacement Therapy (HRT). This involves the administration of high doses of hormones appropriate to the target gender: female hormones for male-to-female (MtF) and male hormones for female-to-male (FtM) transsexuals. These cause the body to start changing: MtFs develop breasts, lose muscle mass and body hair and start to look feminine facially, while FtMs become muscular, hairy and masculine and the voice breaks. As well as starting the process of physical change, HRT has a diagnostic function: a person who is not truly transsexual will feel strange and unhappy under the effects of HRT, while a true transsexual will show a marked increase in emotional well-being. This confirms the diagnosis of transsexualism. Once this confirmation takes place, most MtFs commence antiandrogen drugs, which wipe out male hormonal and genital function; as an alternative, some undergo orchidectomy (castration) at this stage or later.

MtF transsexuals also require electrolysis treatment to remove facial hair as HRT does not do this. Neither HRT nor genital surgery will ‘un-break’ a male voice, so speech therapy is often required. During this period the person is likely to start living more and more in their desired gender role, as their appearance changes towards that of their true gender. Once the transsexual and their psychiatrist feel that they are ready, they will ‘transition’ – that is to say, legally change their name and official documents to match the target gender, and start to live and work full-time m that gender role. At this point the person is on ‘Real Life Test’ (RLT); this is a period of at least a year in which the person must demonstrate that they can successfully live in the target gender role before Gender Reassignment Surgery takes place.

Good Practice for Management

There is every reason to believe that a transsexual who has been a good employee before transition will continue to be a good (and usually better) employee afterwards; in many cases the Company will have made a substantial investment in an employee in the form of training and job experience, and hence it is desirable to manage the person’s transition in such a way as to preserve good working relationships all round and to continue to reap the benefits of the person’s work.

The attitudes of the person’s colleagues and management is vitally important. It has been found in many companies that it is worthwhile to convene a meeting to explain to all employees having contact with the transsexual person what is happening and why. Good, accurate information on the condition, presented carefully, can go a long way towards dispelling prejudice and possible hostility in the workplace. Many companies have benefited from calling in a professional or voluntary counsellor with special training in this area, to give a presentation and answer questions. It should be emphasised that it is a medical condition that has been properly diagnosed by a specialist doctor and that the person’s change of gender role at work is a recognised and medically necessary part of their treatment. Having informed the person’s colleagues and chain of management about the situation, it should be made clear that the Company recognises that the transsexual employee has a genuine medical condition and that the Company is fully supporting the employee in their transition. It should be made clear that harassment or discrimination against the person will not be tolerated, and colleagues are expected to treat them with the same respect and courtesy as any other employee of the Company. Once the person has officially transitioned at work, they should always be referred to by their new name and by pronouns appropriate to their new gender role; to wilfully use the old name or pronouns (occasional slips are inevitable at first of course) is very hurtful to the transsexual and should be treated as harassment.

Sympathetic treatment by management is also vital. The person will have to spend much time undergoing various treatments (especially electrolysis for MtFs, which may take hundreds of hours in total), and while an employer cannot realistically be expected to grant paid leave for all of this, a sympathetic approach (such as allowing some degree of flexible-hours working, or perhaps unpaid leave) will be beneficial. Of course for strictly medical treatments such as checkup visits and surgery, the patient should be granted sick leave and sick pay under the same rules as for any other medical condition.

The timing of the transition will be as nominated by the employee in consultation with the medical specialist(s) supervising their treatment. Provided that reasonable notice is given, the employer should not attempt to block or delay the transition, as that can be positively harmful to the transsexual. A reasonable period of notice will allow the company to change records and inform other staff of the impending change before it actually happens.

The Company should provide appropriate recognition of the legal name change, when the transition at work occurs, in the form of changing payroll records, computer logins, staff lists and so on to reflect the new name. The person should always be referred to by pronouns appropriate to the new gender (i.e. ‘she’ for an MtF).

No guide to transsexualism in the workplace would be complete without a discussion on the issue of toilets. There is absolutely no reason why a transsexual employee should not use the toilets appropriate to their new gender, once official transition has occurred – in other words, prior to surgery. To force a pre-operative MtF to use the male toilets despite living as, and looking like, a woman is cruel and discriminatory. Of course it would be wise to reassure the female employees that the person is, psychologically speaking, a woman, and that as a result of the hormone treatment could not possibly pose a hazard of sexual impropriety. The fact that she still has male genitals is not relevant as they would only be exposed inside a toilet cubicle.

It goes without saying, of course, that in return for sympathetic treatment of the transsexual employee, the employer has a right to expect the employee to continue to work to the best of their ability and to conduct themselves with appropriate professionalism and dignity, and to dress and present themselves in an appropriate manner for their job – and not to wilfully do anything that might cause unnecessary embarrassment to the Company.

It should perhaps be pointed out at this point that MtF transsexuals undergoing electrolysis for the removal of facial hair will have to grow some ‘stubble’ for one to three days prior to each treatment. If the employee is not in a public-facing role, then this should simply be recognised as a necessary part of the treatment (and not as untidiness or wilful gender-mixing). If the employee is in a public-facing role then it might be necessary for her to restrict her electrolysis to Monday mornings so that the stubble only appears at the weekend, or maybe to delay transition until the facial hair is less obvious. In such cases the situation should be discussed with the employee’s counsellor or psychiatrist: it is not acceptable for a company to attempt to delay or prevent a medically necessary gender transition, and usually an acceptable compromise can be found. In some cases, transsexual staff have been temporarily transferred to less public-facing roles (with their consent of course) until their physical presentation is more ‘passable’. Counsellors and Psychiatrists treating transsexual patients are generally very willing to provide guidance and advice to employers, as well as specific advice regarding individual situations (subject, of course, to the patient’s consent to being discussed).

The following is a suggested draft Company Policy which embodies the recommended ‘best practice’ set out in this document and may be adopted ‘as it stands’ or used as a basis for the Company’s own policy towards transsexualism in the workplace.

Company Policy on Transsexual Employees

The Company recognises that Transsexualism (a form of Gender Dysphoria) is a genuine medical condition. Staff with this condition will be afforded the same treatment and support by the Company as if they suffered from any other treatable medical condition.

Transsexual staff are entitled to be treated with respect and permitted to perform their ,jobs free from harassment and discrimination. The Company views harassment or discrimination against any employee, on any grounds, as a serious disciplinary offence.

The Company recognises the right of the transsexual employee to work, and to present themselves at work, as a member of their new gender as soon as the official transition and legal name-change occur.

Once official transition to the new gender role has taken place, the Company expects all its staff to treat the transsexual employee in a manner appropriate to their new gender and to address them, and refer to them, by their new name and appropriate pronouns.

Once official transition has taken place, the transsexual employee will be permitted to use the lavatory facilities appropriate to their new gender.

The Company will provide appropriate recognition of the legal name change, when the transition at work occurs, in the form of changing payroll records, computer logins, staff lists and so on to reflect the new name and gender.

This information sheet is based on the paper Transsexualism : Notes for Employers published by The Looking Glass Society in June 1997.

This information sheet is distributed by the Gender Trust, with thanks to The Looking Glass Society, 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.

The Gender Trust publishes a book Transsexuality in the Workplace – A Guide for Employers by Julie Denning available priced £2.50.

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.

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.

Frequently Asked Questions about Transsexuality

Most of us are perfectly comfortable with the fact that we are male or female. In fact we normally never give it a thought. But there are a very few people who feel they were born with the wrong body – men who feel they should have been born women and vice versa. These people suffer from a recognised medical condition known as gender dysphoria and are generally referred to as transsexual.

Because transsexual people are born with bodies that seem perfectly normal to other people, we may suspect that the source of these deep seated feelings about the body arises from the brain. A report from the Netherlands Institute for Brain Research confirms this theory. In examining the brains of many individuals, including homosexual men, heterosexual men and women and six male-to-female transsexuals, they found that a tiny region known as the central region of the bed nucleus of the stria terininalis (BSTc), which is believed to be responsible for gender identity, was larger in men than in women. The BSTc of the six transsexuals was as small as that of women, thus the brains of the transsexuals seem to coincide with their conviction that they are women.

The rate of occurrence of transsexuality is not accurately known. Because of the social stigma attached to being transsexual, arising from a widespread lack of awareness of the true nature of the condition, it is something that is often kept hidden. Therefore it is only possible to collect statistics on the numbers of declared transsexuals and such figures undoubtedly represent only a proportion of those affected. Not very long ago estimates of the rate of occurrence of male-to-female transsexuality might have been around 1 in 100,000 of the male population. Today, with the greater awareness and openness that exists, some estimates now put the figure at greater than 1 in 10,000. It is known that other chromosomal or intersexed conditions can have rates of occurrence of, or approaching, 1 in 1,000 of the population and it may well be that this is the true order of magnitude of transsexuality.

Rates of occurrence of known female-to-male transsexuals are significantly lower, typically being around 1/3 to 1/4 of the rate for male-to-female transsexuals. However, this rate has varied somewhat with time and between different parts of the world. This suggests that varying cultural factors might play a role in the decision to be open about the condition.

The currently accepted and effective model of treatment for the condition of transsexuality utilises hormone therapy and surgical reconstruction and may include counselling and other psychotherapeutic approaches. Speech therapy and facial surgery may be appropriate for some male to females, and most will need electrolysis to remove beard growth and other body hair. In all cases, the length and kind of treatment provided will depend on the individual needs of the patient. The male to female will take a course of female hormones (oestrogen) similar to those used in the contraceptive pill and HRT, the female to male will take the male hormone testosterone.

At this time they will also be required to carry out the Real Life Test, during which they will be required to legally change their name and all documents to show their new gender identity. All documents including passport, driving licence, medical card, etc can be changed, but at present it is not possible for UK citizens to change their birth certificate. During the Real Life Test they will also be expected to live, work and socialise full time in the new gender role, to deal with any problems which may arise for example at work or within the family, and generally become familiar with the reality of living this way. After a minimum of a year (two years if being treated via the NHS) if the Real Life Test has been successful and the psychiatrist is satisfied with the person’s progress, they can be referred for surgery. After surgery the person will continue to take hormones for the rest of their life, but probably at a reduced dosage.

Because the BSTc is so small none of the non-invasive imaging techniques currently available can measure it, it cannot be detected through scans, X-rays of blood tests. Diagnosis is carried out through lengthy and in-depth assessment by a specialist consultant psychiatrist, however it is important to understand that gender dysphoria is not a psychiatric condition, nor is it a mental disorder.

In a male to female transsexual person, the effects of feminising hormones vary greatly from patient to patient but most patients experience noticeable changes within 2-3 months, with irreversible effects after as little as 6 months.

The main effects of feminising hormones are as follows:

1) Fertility and ‘male’ sex drive drop rapidly, erections become infrequent or unobtainable and this may become permanent after a few months.

2) Breasts develop, the nipples expand and the areolae darken to some extent, but typical final breast size is usually somewhat smaller than that of close female relatives.

3) Body and facial fat is redistributed. The face becomes more typically feminine, with fuller cheeks and less angularity. In the longer term, fat tends to migrate away from the waist and be re-deposited at the hips and buttocks, giving a more feminine figure.

4) Body hair growth often reduces and body hair may lighten in both texture and colour. There is seldom any major effect on facial hair, although if the patient is undergoing electrolysis, hormone treatment does noticeably reduce the strength and amount of re-growth. Scalp hair often improves in texture and thickness, and male pattern baldness generally stops progressing.

5) Many people report sensory and emotional changes: heightened senses of touch and smell are common, along with generally feeling more ’emotional’. Mood swings are common for a while following commencement of hormone therapy or any change in the regime.

In the female to male transsexual, where biological females are prescribed androgens, changes include:

1) A permanent deepening of the voice, this usually occurs within four months and is irreversible.

2) Permanent clitoral enlargement occurs.

3) Some breast atrophy, but at this stage it is usual to bind the breasts.

4) There is cessation of menstruation within three to six months

5) Increased strength and weight gain particularly around the waist and upper body with decreased hip fat. With exercise this can take the form of muscular development. Testosterone will not alter height or bone structure.

6) Growth of facial and body hair is likely to follow the pattern of hair growth inherent in the family, for example if other male members of the patient’s family have a tendency to baldness or if they do not have a great deal of body hair this is what can be expected with hormone treatment.

7) Increased social and sexual interest and arousability may occur and there may also be heightened feelings of aggression.

The most frequent form of surgery for male to female patients is known as penile inversion. When carried out by a skilled and experienced gender surgeon the results look almost indistinguishable from the external genitals of a natal woman. The transsexual women, however, does not have ovaries and a womb, is not able to conceive and does not have monthly periods. During the operation tissue and skin from the penis and scrotum is relocated to form a vagina and clitoris. Following surgery the patient will need to keep the newly formed vagina from closing up by performing regular dilation.

In the female to male, surgery is often carried out in stages, and the first stage is usually removal of the breasts with a bilateral mastectomy during which the nipples are preserved but may need to be reduced in size. The next stage is usually hysterectomy and oophorectomy to remove uterus and ovaries. Both these stages are commonly performed operations and can be carried out by any competent surgeon who does not necessarily need experience of gender reassignment surgery. Further stages are more specialised and involve metaidoioplasty for construction of a microphallus by surgically releasing the enlarged clitoris, or possibly phalloplasty which is construction of a penis. There are various techniques in use for phalloplasty, but as yet there is no method which can produce a totally realistic and fully functioning penis. Scrotoplasty may be carried out at the same time, or separately, to create a scrotum from the labia and silicone implants.

There is no evidence of any genetic link to the condition of gender dysphoria and therefore it is not something that is known to be passed down through generations of the same family. Nobody knows exactly what causes the condition, although there are various theories that consider a possible link between hormone disturbance in the mother during the first weeks of pregnancy or other interruptions to the normal course of pregnancy while the foetus is at a critical point of development.Is this Person a Man or a Woman?

In this example let us look at the male to female transsexual person. Gender dysphoria occurs when the person believes themselves to be a woman, their brain knows them to be a woman, even though their physical body may be that of a man. The only ‘cure’ for gender dysphoria is to change the body to match the brain. Therefore after surgery both brain and body are those of a woman. This person is in all respects a woman, even her passport will show this. It is therefore extremely painful for such a person to be addressed as ‘him’ or ‘Mr’. Having gone through so much to find a sense of inner peace in their true gender role, they should rightly expect to be treated as the woman they know themselves to be.

Even after hormone treatment and surgery, a transsexual male to female, may still retain certain male physical characteristics. These may include a voice that is unusually deep for a woman, or they may be very tall, or have large, hands and feet and heavy bones, particularly in the jaw and brow area of the face. They may have a receding hairline and need to wear a wig. When you meet this person for the first time you may feel shocked, uncomfortable or uncertain how to treat them. Hopefully you will understand that this is a medical condition for which the person is receiving treatment from highly qualified doctors and consultants, that they have been carefully assessed and diagnosed, and in many cases their treatment has been carried out under the National Health Service. If you think of it in this way you will find it easier to accept that this is a genuine and serious situation. If you are willing to accept this person for who they are, you will be helping them to adjust to a very difficult life challenge, and you may find you are making a very good and loyal friend.

What is the Difference Between Transvestite and Transsexual?

The differences are very distinct between a person who cross dresses and someone whose brain is telling them they belong to the opposite gender role. The transvestite may just cross dress occasionally, or may enjoy dressing regularly either in the privacy of their own home or to socialise. Some live full time in female clothes, but they always retain their core identity of themselves as male and will not want to consider gender surgery. Generally TVs who are “out” are sociable and may attract a lot of attention, they may enjoy wearing outrageous or fetish outfits and spend a lot of time involved with their clothes and appearance. It has often been observed that TVs tend to be heterosexual males while drag queens and female impersonators are often gay men. Although transsexual people are often very concerned about their dress and appearance, this is not the driving force behind their cross dressing. For the transsexual person clothes are an expression of their core female identity and many strive to blend in by studying how women of their age and background dress and learning how to tailor their appearance and mannerisms to attract as little attention as possible.

The above is a general guideline, but this is far from being a black and white issue and most cross dressers would place themselves somewhere on a gradient between the outrageous female impersonator at one extreme and the totally integrated post operative transsexual at the other. Many people who later go on to complete full gender reassignment begin the search for their true identity within the transvestite community, perhaps this is the only obvious and safe place where they feel they can cross dress. Also there are very few social groups where transsexual people meet, so those who enjoy socialising may be attracted to transvestite clubs. Many individuals feel very confused about their true gender identity, so how can an outsider be expected to judge whether a person is TV or TS when that person themselves does not know – or cannot accept – where their true identity lies and is therefore not giving out any clear signals about themself.

Long before they begin medical treatment, in fact often long before they even realise what is happening within them, most transsexual people will already show signs of thinking and behaving in ways more usual to the sex opposite to that of their physical appearance. They will frequently recall knowing from childhood that they were in some way “different” and it is usual for a transsexual woman to remember dressing in the clothes of a mother or sister, having a dislike for traditional boys’ toys and games, and feeling more comfortable in the company of girls.

Because of social pressures, particularly on young men, many transsexual people enter a period of denial in their late teens, in which they try to suppress any thoughts or feelings to do with their gender identity. For example it is common for a male to female to take up a typically male profession such as the armed forces, police, engineering, lorry driving, and also to marry and have children. They tell themselves that this proves they cannot possibly be a woman. At this time of their life they may also absorb themselves totally in a career – often becoming very successful – or in some form of sport or hobby which occupies all their spare time. Some may continue to cross dress.

But in time the stress begins to build until the person no longer feels able to keep this thing hidden and they need to seek help and medical treatment. When the gender dysphoria has been suppressed in this way for many years, the person may have developed other problems such as severe depression or a dependence on alcohol or drugs, and this will also need to be dealt with, along with any commitments to family responsibilities. There may be a break with wife, children and siblings, a change of career, loss of home, money and security, so the road to gender transition is an extremely difficult and often painful one.

Transsexual people often reveal themselves to be extremely isolated individuals, some people never make it through transition. Those who do have to find a lot of inner strength and determination to keep going. During transition these people need the support and understanding of friends and family as well as work colleagues and society in general. After surgery it is common for many people to melt away into society, living a normal life and often nobody guesses what they have been through. However the scars created by the pain of living with gender dysphoria for many years may remain and make it difficult for them to settle into an ordinary lifestyle.

Transsexual people are just ordinary people who experience all the challenges and problems that everyone has to deal with. Some are optimistic and cheerful, some slip easily into depression, some are determined, some are fragile, some make friends easily, some find socialising difficult. They are people like everyone else – they also suffer from a condition called gender dysphoria.

Understand what is happening, and accept the person for who they truly are – this is often all a transsexual person wants from you. Try to offer encouragement and support. Imagine how you would feel if it was you – take a moment to try and imagine how you would feel if you woke up tomorrow morning to find your body had become the opposite gender.

After all it could easily have been you who was born with this medical condition, nobody knows exactly what causes it but the dysphoria is believed to occur in an unborn baby during the first three months of the mother’s pregnancy. Someone who has already been through so much does not need to be victimised and taunted, humorous remarks, clever comments and other subtle ways of intimidation can cause intense pain. Also remember it is now against the law to discriminate against someone because they are transsexual.

Gender Trust – 2003

My Facial Feminisation Surgery

Smoakie Bulle Just after midnight on New Year’s Eve 2000, six months or so ago, my friends and myself were invited into a house across the road from where I live to join a party. It was one of those only- on-New-Year’s-Eve-with-a-skinful-occasions, and when I went in I was treated as the bloke across the road in a frock. It was he and him without cease – they just saw me as male, unbelievably, and I began this year deep in yet more of those unending tears back at my flat. Will this never end, I said, is there no way out of this? After all I have done, after living well as a woman for all this time, rarely read, or so I thought, after Sex Reassignment Surgery, after thousands of little white oestrogen pills, with a skin like a baby, a girl at last and happy and well in my world? After all I’ve been through, and it means nothing?

Right, I said to my partner, gritting my teeth yet again, this is it. I’ve had enough, I won’t live with this. I’m going to have my face fixed this year no matter what. You see, I knew what it was these people were seeing, what it was in me that made them see the old maleness; it was in the structures of the bones of my face, and this is what I decided had to be changed. In for a penny, in for a pound, that’s my way. I forgot how to spell kompromize a long time ago. Why stop before the end? Why not the best?

I stumbled on the Anne Lawrence website (annelawrence.com/twr) years ago, and with its links it has led me through many a maze, and it was here that I learned of Facial Feminization Surgery (FFS). Go and look for yourself, and what you will find is a revelation. Once you see it, it’s obvious, and male and female faces are never the same again. It all comes down to hormones again, that demon testosterone and the ravages it had on our bodies and minds.

In late adolescence, boys turn into young men. I’ve watched this happen to my son, who is now eighteen. The bones change, and what makes a man a man, and brings a woman like myself a life behind a mask, is the creation of, from the top down;

The brow ridge, and brow bossing. For me, the most significant of all. Like many results of the work of testosterone, my browridge formed almost a hood over my eyes. The line of the forehead in profile came down, then out just before the eyes, then right in. Oestrogen does not make this happen, and the brow in natal women remains the same as in children, where the line of the forehead comes straight down, leaving the eyes more open and unhooded. As we first look at the eyes when we meet someone, this subconscious marker of gender is highly significant.

The nose in the natal female is often smaller, narrower, less significant; the testosterone nose wider, more powerful a presence.

The prominence of the chin and the line of the jaw. This is more well-known. The female chin comes more to a point, it is rounded and is slighter in profile; it doesn’t stick out so much. The testosterone jaw is often wider, coming to strong angled points below the ears.

Of course, faces come in billions of forms, none of them the same, and masculinity and femininity shows in other ways on the face, but the main markers of maleness and femaleness are consistent. Freud said that the first point of recognition when we meet a person is that of gender; is this a male or a female? The rest of identity follows, is built on this. The subconscious indicators of gender come in the form of dress and body language, ways of moving, ways of dressing, the skin, the voice, the way we speak, the way the person feels to us; on and on. Many of these we can work at and change, but the bone structures of the face, the frame upon which the skin hangs, can only be changed by surgery, and this is what we look at first, this is what sets the tone for all that folows.

If you look on the Net, you will mostly see the work of Dr Ousterhout in San Francisco. The results of this surgery can be astonishing; craggy male faces turned into attractive women’s. For some, a life which would be unbearable becomes a joy.

No wonder so many transsexual women don’t mind what Dr Ousterhout charges; anything to get me out of this! When I contacted some of the women who had put their results up on the Internet, I was told of Ousterhout’s costs, and my heart sank. Around $28,000. Plus two trips to San Franscisco. It comes to around £20,000. A great surgeon, no doubt, but way too expensive for me.

So I looked for alternatives. This was not so easy. What I was looking for specifically was a cranio-maxillary-aesthetic surgeon with experience of transforming the transsexual face at a good price. I needed a surgeon who works with the bone structures of the face, with empathy and understanding of who and what I am, and these guys hardly come on every street corner.

Still, with determination I found one, not advertised at all, tucked off in a corner of Belgium. Dear Dr Noorman van der Dussen. I went to see him in February, loved him, and had extensive facial surgery at the Eeufeestkliniek in Antwerp on April 18th. Not bad, eh? Less than four months from New Year’s Eve and it was all done.

I had my brow ridge removed; Dr Noorman van der Dussen (all of this is his surname, let’s call him Dr NvvD) told me afterwards that he had removed about 1 centimetre of bone from over my eyes. A centimetre! Usually these things are done in millimetres. I had a lot to lose.

My nose, which was always slender, had its upturned, ski-jump end removed. My upper lip was enhanced. My chin was narrowed, taken back, the angle changed, and the jaw line altered to fit. Seven hours on the operating table; not a small thing to do.

I left the clinic the day after surgery and went to a hotel, amazingly, but it was fine. As Dr NvvD said, all you need is comfort to recover, better and cheaper in a hotel. I had two days of great discomfort, but almost no pain at all, thank God. How lovely I looked; bandages over the scalp, right round the jaw, my nose in a plastic cover taped to my face, one eye closed completely and the colour of a red fruit, the other open a crack, gorgeous colours everywhere, looking like a creature from a strange part of the universe in Star Wars.

But recovery was swift. Five days after surgery I was out in the Belgian countryside with the friend who came with me – bless you Jane, where would I be without you? – and a new transsexual friend I made in the hotel, enjoying pancakes and coffee. Avoid the tea; this is not England. I had on so much covering make-up I could hardly lift my head, and there was swelling in plenty which made me look a little odd, but I made it.

Then I was back home less than a week after surgery, feeling tired and full of anaesthetic, but not too bad. No signs of surgery at all. Incisions were made behind the hairline for the forehead, inside the mouth for the chin and jaw. It was like a miracle had happened.

It took a few weeks for the whole thing to settle in properly, but it did, and now I am fine. But the test of the pudding is in the eating, and the test of FFS is not only in the looking, but in how I feel, the most important thing of all. And what I have to tell you is that I am very happy. It’s made all the difference in the world. When my friends look at me, they still see Persia. It’s not as if I have another face; what’s happened is that my own face has been softened and opened. It has been feminized. The work is subtle and very well done, integral, looking so natural that many people have no idea anything has been done at all. You are looking well, Persia, they say, not knowing what they are seeing.

The greatest effect can be seen in profile. All the prominent angles of my face have been removed. The overhanging brow, the ski-jump nose, the angular chin, all replaced with softness. I love it. I now have none of the indicators of the male on my face. I have always felt that the transsexual transition was, for me, a restoration of my own true being, and now I have even restored my own face. It is no longer the face of a brother I never had.

And I feel completely relaxed now. I am seen as a woman now, almost completely, except for on one of those bad days when nothing goes well. I am what I am, a transsexual woman, and there will always be someone somewhere who knows. But so little, so rarely that I no longer care.

The feelings of this cannot be expressed better than in the words of anon (name witheld by request), who underwent FFS at the hands of Dr. DouglasOusterhout in San Francisco, but the same is true of Dr Noorman van der Dussen, and anon expresses my own feelings with a beauty I cannot hope to match.

” When I went out before my surgery, no amount of radiated joy and peace would have kept me from being perceived oddly by some. I’m not talking about passing here, I’m talking about how, as a human being, people saw me. I want people to see *me* clearly, not through the filter of doubt about who I might be. Even as happy and upbeat as I was prior to surgery with Doug, the lines and curves in my face that didn’t belong to me abraded my confidence, were as wrong as a lock of hair that stands away from your scalp that no amount of coaxing can keep down.

I am sure that if Doug’s work did not exist, I would have made the best of it, but I suspect that as much happiness as I would have mined out of life, the difference between who I am and who my face said I was would have eaten away at me. Who knows.

Results aside, it allows me to not simply move through the world and society — the best I could hope for beforehand — but to actively embrace it, to find a peace within myself, or the possibility for it, that others see and perceive. It is a wonderful resonant cycle as the relaxed comfort in my own skin radiates from me to others, who in turn sense my centeredness and reflect happiness back at me.

It’s how I feel too. Undergoing this surgery has let me cross the line into my own womanhood in a way I could not quite manage before, no matter how well I did, how good I looked, and even then I could go to the women only sessions at the swimming pool and feel almost at ease. Now I am completely relaxed, found myself chatting to other women in the showers while we waited for one to be free the other day without me noticing what I was doing – an amazing feat of transformation when I think back to my early days.

There is a form of trasngendered political correctness in the USA these days which states that we should be accepted as we are, no matter how we are, this being our truth, this being one form of human existence the world needs to accept as another normalcy. We should be proud of who we are, no matter how we look.

Very good, but my own truth is that I am just a simple girl from Liverpool who wants to live without problem in this world; more than that, to live here with joy. I was like Dorothy in the Wizard of Oz – but I wanted to come home even more than she did. And I’ve made it, I’m back in Kansas, back in Brighton actually, just living in the world but now with restored exquisite normalcy. I am a very happy and fulfilled person, and my life is opening like a flower. What I have done, despite having no money to speak of, you can do too. Go for it.

The cost of the surgery with Dr Noorman van der Dussen, by the way, came to around £6,500. Not cheap, but a bargain in British or U.S. surgical terms. About a third of the cost here, if you could find the surgeon, and I don’t think he or she exists. I had SRS in Belgium too, under the kind knife of Dr. Seghers, a complete coincidence, so I know about Belgian medicine. It’s very good indeed, recommended.

By Persia West June 2001

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.

 

Transsexuals’ Children

Continuing contact between transsexual parents and their children has met with significant opposition. Two areas of concern are effects on the gender identity of the children and reactions by the children’s peer group. Eighteen children, 10 boys, 8 girls of 9 transsexual parents, have been evaluated. Their ages range from 5-16 years. All live with or have regular contact with their transsexual parent. No child has gender identity disorder. No child has had extensive conflict with the peer group. All continue positive relationships with their transsexual parent.

Introduction

In 1978 I published a paper on sexually atypical and gender atypical parents and their children (Green 1978). It described 21 children being raised by lesbian mothers and 16 by transsexual parents. Since that paper 20 years ago, none other has been published describing a series of children of transsexuals. This absence explains why that report was cited as a stand alone in the case brought by a female-to-male transsexual in his recent fight for parental status before the European Court of Human Rights (Case of X, Y and Z v United Kingdom, 1997).

Opposition is strong to a transsexual continuing in a parenting role during or after gender transition. It derives in part from concerns that the children will become confused in their own gender identity during critical years of psychosexual development. Although to those concerned about this posited impact no developmental period is safe harbour, the first handful of years are seen as exceptionally vulnerable. This is during the setting of basic gender identity and resolution of the posited Oedipal conflict. Early adolescence when sexual orientation manifests strongly, perhaps reviving earlier Oedipal conflicts, is another arguably vulnerable period. The second focus of concern impacting on the best interests of these children is the reaction of their age mates, the peer group. Will the children be teased, ostracised, bullied in consequence of their parent’s transsexualism?

But, beyond these presumably empirically testable concerns, there is more. There are the feelings of betrayal, abandonment and hostility of the non-transsexual parent. Many are so enraged at the transsexual parent that they defiantly oppose any contact with the child. As custodial parent, some non-transsexual parents instil in the child a distorted, negative image of the absent (or rarely present) transsexual parent, the Parental Alienation Syndrome (Gardner 1978). In time, the child, too, opposes continuing or renewed contact. The concern to courts here is that the conflict and trauma imposed on the child of enforcing contact with one parent when the other is implacably opposed, and perhaps the child too is opposed, is greater than terminating contact.

Are the former noted issues concerning the children’s gender identity and peer group reaction to be considered as independent of the latter consideration of uncompromising parental opposition? They should not be. To the extent research demonstrates the absence of an objective basis for concern for the child’s welfare as a direct effect of the transsexual status of one parent, the other parent’s opposition becomes increasingly irrational. It should be given less legal weight on the scales of justice in judicial determinations.

During the past four years I have interviewed transsexual parents at Charing Cross Hospital in London. Many have not seen their children for years. Several abdicated their parenting role because they feared their transsexualism would be harmful to the child, others because their former spouse had been adamantly opposed to contact and the transsexual believed that a legal fight was hopeless. There have been other families, however, where the transsexual parent has continued to live with child(ren) and spouse during the gender transition of the “Rea.l Life Test” or has maintained frequent parenting contact, though living apart. An outline of these children is drawn here.

There are 18 children. They are from 9 families, with 10 children boys and 8 girls. Six transsexual parents are male-to-female, three are female-to-male. The children’s age range is 5-16 years, with 4 ages 5-7, 6 ages 8-10, 4 ages 11-13 and 4 ages 14-16. The frequency distribution is shown in Table l.

Areas of focus in interviewing these children and parents have been the two typically cited as potentially problematic for the children: their own gender identity and peer group stigma.

Gender Identity

None of the children meet the DSM IV or ICD 10 criteria for “gender identity disorder”. One boy and one girl had thoughts about changing sex briefly when informed of the transsexualism of the parent, but the curiosity did not evolve into a desire to change sex and the curiosity did not continue. No clinically significant cross-gender behaviour is reported.

Peer Group

Three children have been selective in informing peers of the transsexual status of their parent. They informed those whom they thought they could trust with the information and who would not tease or spread it indiscriminately. Three children experienced some teasing; it was transient and resolved. The remainder report no problems.

Understanding the Parent

Three children do not remember their parent in the parent’s birth sex. The others became aware of the transsexual status 1-3 years before my interview. The children have a reasonable understanding of the parent’s gender dysphoria and the treatment process. Some examples of their perceptions of their parents follow:-

Seven year old boy with male-to-female transsexual parent (father):

“Linda. wants to be a woman. Linda wants to start a fresh life. She likes living as a woman. I think that is happy for her. At first (when I was 4’/2) I didn’t quite understand. As I got older, I realized she must be happy living as a woman, so I’ll just accept that.”

Does Linda have a penis?

“She is going to have it taken off.”

What is your worry?

“The thing I worry about is if he gets injections that the wrong amount would be given and something would go wrong… Is there a chance he could die in the operation?”

Nine year old boy with female-to-male transsexual parent (mother):

“She will change into a man with plastic surgery.”

Why?

“My dad (biological mother) reckons that God had made a mistake when he was born.”

Seven year old girl with male-to-female transsexual parent (father):

Why does your daddy dress as a lady?

“It’s a better life.”

Sixteen year oId boy with female-to-male transsezual parent (mother):

“Jim is a bloke. The only thing missing is a dick.”

Ten year old boy with male-to-female transsexual parent (father):

How do you feel about it?

“It’s alright.”

Why is your daddy doing this?

“He does not like being a man.”

Eleven year old sister:

“My dad’s having a sex change. He is turning into a woman.

Why?

“He feels like a woman”

How do you feel about it?

“I feel OK about it.”

Fourteen year old daughter with female-to-male transsexual parent (mother):

“My Mother’s not happy in the body she is in. My mom is a lot happier since starting to live as who she wants to be. When I was 13, my mother said, ‘I want to be a man, do you care?’

I said, no, as long a you are the same person inside and still love me. I don’t care what you are on the outside… It’s like a chocolate bar, It’s got a new wrapper but it’s the same chocolate inside.”

Ten year old brother:

“Jim (mother) is my dad because he is having a sex change. It’s alright with me. If it makes Jim happy, it makes me happy.”

Conclusion

Available evidence does not support concerns that a parent’s transsexualism directly adversely impacts on the children. By contrast, there is extensive clinical experience showing the detriment to children in consequence of terminated contact with a parent after divorce.

Can anything be done to help maintain these families? Courts can be educated regarding clinical or research findings. Transsexual parents may profit from engaging with children in counselling sessions in anticipation of, or during, the gender transition process where concerns and questions can be addressed. Marital counselling early in the transition process could mitigate the hostility of the non-transsexual parent. Hopefully, the non-transsexual parent’s feelings of disappointment, loss and perhaps anger can be placed in perspective to the benefit children derive from contact with two parents. Children can also benefit from counselling, when troubled, after parent sex reassignment (Sales, 1995)

The cases described here and twenty years earlier demonstrate that transsexual parents can remain effective parents and that children can understand and empathise with their transsexual parent. The cases demonstrate that gender identity confusion does not occur and that any teasing is no more a problem than the teasing children get for a myriad of reasons.

Children’s best interests are not served by the bullying tactic of implacable parental opposition by one parent to continuing contact with both parents. Divorce may be inevitable between parent and parent, but divorce need not be inevitable between parent and child.

References

Case of X, Y and Z v United Kingdom (75/1995/581/667), European Court of Human Rights, Strasbourg, 1997.

Gardner, R (1998). The Parental Alienation Syndrome, Second Edition. Cresskill, New Jersey, Creative Therapeutics.

Green,R (1978). Sexual identity of thirty-seven children raised by homosexual or transsexual parents. American Journal of Psychiatry 135: 692-697.

Sales, J. (1995). Children of a transsexual father: a successful intervention. European Child and Adolescent Psychiatry 4:136-139.

Table 1

Transsexual Type | Number of Sons | Ages | Number of Daughters | Ages

M-F | 1 | 7 | – | –

F-M | 1 | 16 | 2 | 14, 12

M-F | – | – | 2 | 5, 7

M-F | 1 | 10 | 1 | 12

F-M | 2 | 8, 10 | – | –

F-M | 1 | 10 | 1 | 14

M-F | 2 | 9, 12 | – | –

M-F | 2 | 10, 13 | 1 | 16

M-F | – | – | 1 | 5

A Research Paper by Professor Richard Green

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.

Rich Man, Poor Man, Transsexual Woman

Summer 1955 and this child’s fate has already been determined by nature.

A child giggles whilst drinking the bath water from an egg cup. It is 1955 and not long since the national press have reported the story of a Spitfire pilot and racing driver who has “become” a woman through what we now call Gender Reassignment Treatment.

The child’s parents have registered and christened her as a boy. How is anyone to know any different? Within three years “he” will know otherwise though … and the little girl inside will have learned enough about life already not to mention her profound self knowledge to anyone.

In years to come she will learn that people who seek the treatment to release them from this silent hell are labelled as freaks and get hounded by the press. They are shunned by their families and friends. They are treated with less respect than murderers and rapists. Anything they receive from medical specialists or authority is to be regarded as a grudging and contemptuous concession which they don’t really deserve. Not surprisingly, she will seek to bury her terrifying self knowledge deep within herself.

As enlightenment gradually dawns on society, sometime in her thirties, she will wince though when she sees women like her described as having been “born a man”.

A man? Look again at the photograph. You could no more call the child a “man”, than you could label them a “Computer Consultant”, “Conservative” or “Rights Campaigner”. Yet all of these labels are a part of her development potential, just as her innate femininity means she will not rest until she finds her true self-expression within society.

So, eventually, she will come to the agonising choice which confronts all transsexual people in the end … made worse for having deferred it until mid life. She will have to decide how to deal with the partner and family she acquired whilst trying to be what everyone expected of her. She will have to put her career on the line. She will lose her home and tens of thousands of pounds through divorce. She will lose some of her friends. For a while she will wonder if she deserves to keep her own self respect. Yet the choice is between that and suicide. For a life which is a perpetual lie … a life which gets more painful with every passing day of the soul’s denial … is no life at all.

Make believe? No. Increasing research evidence indicates that everything which transsexual people have ever reported about their mysterious juxtaposition of psychological gender and physical sex is true. The more science is inclined to look, the more it finds to substantiate the discovery that children like the little “boy” in the picture above really did already have the brain of a little girl.

Nobody can be blamed for assuming this little girl was a boy. If we have to have a basis for distinguishing how we’re going to differentiate the type of upbringing we’re to give our children then the appearance of their genitals is no more and no less arbitrary than the colour of their skin or the country they were born in. What matters, however, is how we respond when the child is old enough to turn round and say that we got it wrong in their case.

It helps, of course, to be sophisticated enough to be able to accept such an assertion with the respect it deserves. If society attaches such importance to gender then it’s hardly a trivial thing when you know you’ve been dragooned into the wrong one. Transsexuals need help, not hindrance, if they are to manage a transition which affects every single way in which they relate to the world around them.

More than that, however, a compassionate and sensible society will recognise that once such a change has occurred then there is absolutely no benefit to anyone in making it anything less than a 100% change. Society only has two social genders to choose from. Man and Woman. To cripple a man with a legal status which regards him as a woman, or to say that a woman cannot marry a man because of her long-since-removed birth deformity is to erect a deliberate barrier to the otherwise successful functioning of that individual. It is, in short, like breaking a man’s leg because you don’t want to accept that he can walk.

And that is all that we in Press for Change seek from British society. The right to walk. To stand on our own two feet after being forced to crawl for almost thirty years. It’s not a lot, is it?

This information sheet is compiled from an article by Press for Change, the organisation which campaigns for rights for transsexual people. To find out more about Press For Change visit their website at pfc.org.uk or write to them at:- Press For Change, BM Network, London WC1N 3XX

By Christine Burns, April 1997

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.

To Be Transsexual

What it feels like to be a Male-To-Female Transsexual, Before, during, and after transition. How it touches the soul, and How it affected my life.

Initially, the trouble with my body being the wrong sex was just…troubling. My mother told me stories, before she died, of the difficulties toilet training me, of getting me to deal with plumbing I felt unhappy with. I remember how kindergarten gave me my first taste of the shame I would be indoctrinated with over my life, of ridicule by adults and my peers. Back then, in early childhood, I knew something was wrong, it caused me embarrassment and a little shame, but I always felt that it would work out, if I just hoped and prayed hard enough.

From the earliest I felt different, because I was not like those I was supposed to be kin to, boys. I was quiet and gentle and they were rough and loud. I liked to draw and read, to paint and play with stuffed animals making little homes for them and myself, I did not fit in with my supposed peers. I felt outcast even in kindergarten, and I had a difficult time understanding fully just why.

Girls would often not include me, which I also did not understand, so the best definition of what it felt like for me to be a transsexual child would be Outcast and Confused.

As I approached puberty, the exclusion from both boys and girls increased, as each had reasons for avoiding the shy strange child I was. To boys I was weird because I liked girlish things, and to girls I was icky because I was supposed to be a boy. When they did include me, they wanted me to play the role of ‘daddy’ or ‘boyfriend’ or other such role, and I would only be willing to play ‘mommy’ or my usual, the ‘baby’ in games of playing house. In every activity my gender dilemma affected me. If I wanted to twirl on the monkey bars I was ridiculed because only girls did that, and my stuffed animals were taken away by my vile father, fearful of my love for them.

Eventually, I had to find a way to avoid persecution, for my difference increasingly resulted in physical abuse from the boys. I was threatened and beaten, called a fag and a queer, and constantly humiliated. I found an answer in Science Fiction, and my substitute dolls were little soft rubber monsters for which I would build not houses, but elaborate spacecraft. Science was just cool enough to be barely acceptable, and sometimes I could avoid persecution under the disguise of being an expectedly odd ‘Brain’. I used my intellect carefully to make myself fit that role as best I could, but I never was able to find real safety. My home-built starships had all the amenities, such as domed gardens and bathrooms, and I imagined elaborate relationships for my little toy friends. The boys that would play with me wanted to create adventures of conflict, but my stories always had my little monsters visiting peaceful worlds filled with gentle creatures who just wanted to be friends. The girls that would play with me sometimes let me play with their dolls, but then would ridicule me for it later.

The feelings of being a prepubescent transsexual might best be summarized by Hiding, Substitution, and the pain of Physical Abuse.

By puberty, I knew shame very well indeed, and feared the names and violence applied to me. Increasingly I tried to deny my true self, and felt that my gender identity was something to be disgusted about. Puberty brought a rush of sexual tension, and with it the most awful horror…sexuality.

The awful incorrectness of my body now seemed to have a will and mind of it’s own, and I felt devoured and possessed as if by some alien bodysnatching spore. I withdrew into the back of my own mind, and for the next decade and then some, would feel as if I were in the back row of a dark empty theater, watching helplessly as my life was lived by another.

Male hormones were like a poison and a terrible drug to me, they brought madness and sickness. I felt terrible all the time, poisoned by sweating, nervous twisted lust. The hormones made sexual feelings flood my mind, I could think of little else. I masturbated like a monkey in a cage, constantly, loathing the act but tortured by the uncontrollable drive. I felt like my constant nightmares, of being trapped in the backseat of a car, rolling to doom, down a steep hill.

The feeling of being a puberty stricken transsexual was for me the feeling of being possessed by a demon, the feeling of being out of control, with the only help in withdrawal deep within my own mind. It felt like I was being raped by my own flesh, turned against me and possessed by an alien will.

The agony of this drove me to near madness. My mind did it’s best to survive, and split into two separate awareness. One awareness became a day-to-day attempt to fit in, to be what the world expected, and this version of me had little conscious acknowledgment of my gender problem. All it knew was that I was miserable, sick to die.

The other half of my consciousness became dominant only when it was safe, it waited to become me when ever the opportunity to be alone arose.
Alone, my true self leapt panting into full consciousness, desperate to seize a moment to be itself. It was inevitable that my dressing up in my mothers things would become tarnished by that dreadful sex drive that owned my body utterly, and the endless masturbation became entwined with dressing as a woman, at least for a while.

Nearing my 20’s I had begun to finally have some slight control over the impulses that rode me, and once again became able to separate dressing from the need for sexual release. I could once again simply enjoy, for however brief a time, feeling somewhat close to being my true self. One fine night I simply sat in a rocking chair in my favorite nightgown and watched the rain, a blessed eternal time of utter, peaceful contentment.

Then as soon as the moment was no longer safe, as soon as discovery became imminent, my mind slammed down the steel shutters, and I literally had no memory of what I had just been doing.

This schizoid defense mechanism is the closest I ever hope to be to true madness. I comprehend that it was the way my mind found to survive an unendurable agony, but it was a frightening and disturbing guard.

No sane human wants to be utterly alone, and I still had some shed of sanity left. Of the lovers I had at that time, all were female, and I did my best to fill the role expected of me…but it was very difficult. My sex drive found release, at first, but what I most deeply wanted was an eternal, committed relationship, something few other 18 year olds of my time seemed to want. In coping with the sex I was driven to engage in, the only way I could deal with the soul-rending horror of using those accursed organs I possessed was to distance my self increasingly from the act. Eventually I was all machine inside, carefully memorizing and calculating the exact behaviors that would please my partner, with no thought of what was happening for my own lizard brain. If my partner was satisfied, perhaps they would like me and stay with me forever. It was a reasoned transaction. It became like playing a video game or pinball, as I used intellectual techniques and trained motor control to rack up a performance score measured in orgasms per hour on the fleshy console I played. Of course this kind of distancing cannot last without self destruction, and soon I was incapable of ‘performing’ -for that was indeed what it was- any more. Impotence was a relief, for it spared me from this special hell of squirming wetness and reptilian compulsion. To this day, because of this agony, sex is all but anathema to me, and I am essentially asexual. Being sexual at all brings back some of the awfulness of those days, and flashback shrieking horrors in my soul, but happily, I now possess almost no sex drive at all. This is a magnificent benefit to my comfort, but frustrating upon occasion for my spouses. I do not know if I will ever be able to feel good about sex. It hurts so much less -and feels so wonderful- to be an angel. It seems that being innocent and childlike is my safety and my salvation.

The feeling of young adulthood as a transsexual was for me best described by Schizoid Denial and Crumbling Survival.

When I finally had my catharsis, and awakened, when the cleft halves of my split mind rejoined, when the pain finally brought me to the point of facing my self or welcoming death by my own hand, I knew Purpose.

Fully, consciously aware of my lifelong torture, armed with a definition of my condition, and clear on what I must do to save my own life, I began a Holy Quest to redress the unendurable fault of my birth.

Transition was enormous pain, and required every ounce of will and strength I possessed merely to continue one day to the next. All about me was hostility, and the loss of friends and family. My sadness was oceanic. Even so, I have never felt more alive, for I was facing life and death square on, for a Holy Purpose, and driven by that Purpose I felt invincible!

As my flesh, under the gentle but powerful magic of female hormones, began to change, as my sex drive fell away and the driving demon that possessed me was exorcised, I began to feel light as air. Sylphlike, I floated on wings of hope, and knew peace in my body, my mind and my soul. Oh, the difference! Where male hormones made me feel poisoned and sick to die, driven by sweaty-dark aggression, female hormones made me feel innocent and pure, filled with light and gentle contentment. I felt cherubic and new born, and I knew in a matter of weeks that my choice was correct.

It felt so wonderful to shapeshift ! Every day held promise, for I enjoyed a second childhood of soft growing wonder. I saw my hands soften and become delicate again, a sight lost to puberty. I itched sweetly inside my growing bosom, and the sea of life within my body altered it’s flow to fit the contours of my soul. I was no longer in the back of the dark theater of my perception, I was outside that metaphoric theater altogether, living life fully, as I do to this day. I knew constant hope, and the exquisite pleasure of being resculpted by the very Nature who once betrayed me. The Mother was repairing Her mistake.

Only this boundless joy and ecstasy could have permitted me to survive the misery I endured at the hands of the cruel humans around me. The stuff of ridicule, there were many days I could not face the grocery store and went hungry, because the taunting and insults of the clerks were too much to bear.

The feeling of transition was Absolute Heaven, and Deepest Hell. It was miracle and curse, release and damnation both. But I have never before or since, felt more truly alive. It was Real Magick, the stuff of dreams made solid.

Surgery was almost anticlimactic, at the same time as being utterly terrifying and hideously painful. I knew I could die from it, and for the first time in my life, I had something to live for. But I also knew I could not endure to live with those horrid organs. I loathed them, how they looked, how the worked, what they felt like. It was like having some decaying parasitic worm hanging off of my body, or a tumor that had distended to freakshow proportions.

After my surgery, after the bloody mess had healed and the stitches removed, after the Frankenstein reconstruction had finally become Human, I marveled.

I finally felt….right. Correct. Oddest of all, I felt exactly the way that I imagined that I would feel before surgery. How could I possibly know what having a vagina, labia, clitoris, -even a ‘pseudo cervix’ would feel? Yet I had, long before these things were my body, in my dreams.

Science tells us that there is a map in the circuitry of the brain of the layout of our bodies, and children born without limbs suffer phantom limb syndrome though they have never known the missing limbs, my explanation is that my ‘body map’ was female, and the cause of my desperate need for surgery. Things felt wrong because my wiring told me clearly what I should be shaped like. Now that I am, the conflict is gone, and my suffering for missing organs is absent. I possess the contours and organs that fit my internal ‘map’, and so I feel…..all right.

So the feeling of surgical correction is…normality. Finally feeling free from internal and external conflict. It just…finally….is OK.

Now, 16 years after surgery, I live my life pretty much without much thought to gender dilemma. I am fixed, I am repaired. But I will never be utterly without this difference. Unlike most women, I suspect, I cannot help but occasionally hug my own breasts, feel the delicate flower of my labia, or the softness of my skin, and whisper a heartfelt prayer of thanks for the gift of finally being me. I can never take these things for granted, they are happy birthday presents forever, reminders that I lived a miracle.

And because I have lived such an adventure, I am forever set apart. I cannot simply be an ordinary woman, because I have not lived an ordinary woman’s life. The mindless chit-chat of either the average woman, or the average man, bores me to tears, and so in a way, I am still apart, alien on the inside. And so many life experiences I cannot join in to discuss, like menstruation, or dating, or Girl Scouts, or the myriad trials of growing up as a girl. I have known all of the discriminations and limitations of being a female…and then some, for I was treated as a freak before my attainment of womanhood…but few of the joys. I can not relate to the childhood of a boy either, for I did not have one, so I have so many things -not- to say.

This difference does haunt me, and in my years of hiding until this site on the internet, I felt the most disturbing muteness, the fear of discovery, that anyone should know my shameful past. This is why I have decided to come Out, because even if my body is at last corrected, I have been altered in my soul and mind by the journey to achieve it.

So the feeling of being a post-op transsexual is for me the comfort of happy correctness mixed with the bitterness of forever lost girlhood, and the joy of remembering that I am a miracle, a shapeshifter incarnate, and that I have lived an adventure. I am at once Normalized and Alienated, Wistful and Joyful together.

This is what it feels like, at least for me.

transsexual.org/Feels.html – 2002

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

Reasons To Cherish Being Transsexual

Because being transsexual is often so hurtful, so filled with sadness and longing, with shame and loss and difficulty, it is easy to come to the conclusion that the whole thing is utterly a curse, perhaps inflicted by arcane and evil ancient gods.

Oh, probably.

But there is an upside too.

Most human lives are utterly mundane, devoid of any real uniqueness, the average person somnambulates through an existence devoted to filling the roles expected of them.

But to be a transsexual is a magical, wondrous thing.

Consider. We are given many gifts in compensation for the terrible loss of our childhood as ourselves, and for the pain we endure. We are by some as yet unknown mechanism statistically far more intelligent, as a class, than perhaps any other kind of people. We are almost universally more creative, and we often possess incredible levels of courage and self determination, demonstrated by our very survival, and ultimate attainment of our goal. We are rare as miracles, and in our own way, as magical, or so has been the belief of all ancient cultures on the earth.

We are given awareness that others would never experience, understanding of gender, of the human condition, of society and the roles and hidden rules unquestioned within it. We are given a window into the lives of both sexes, and cannot help but be, to some degree, beyond either. From this we have a rare opportunity: to choose our own life, outside predetermined and unquestioned definition or role. We can do new things, original things, only because our experience is so unique.

We get to be true shapeshifters, and experience the sheer wonder of melty-wax flesh and a real rebirth into the world. Our brains and bodies gain benefit from having been bathed in and altered by the hormones of both sexes. We appear to retain our visible youthfulness where others wrinkle, and for years longer. We possess neural advantages from both sexes, such as the language advantages of the feminized brain, and the spatial abilities of the masculinized brain both. We are shocked into waking up, if we allow it, to a life we create for ourselves…we are not automatically doomed to sleepwalk through life.

After our transformations, after the full-moon lycanthropic miracle that the modern age affords us, we can live lives of success and love, and genuine specialness, if we choose. If we can get past our upbringing, past the programming, the bigotry, the messages of disgust from the culture around us, if we can stand as ourselves in freedom, then our special gifts grant us a heritage of wondrous power.

We have a proud and marvelous history. In ancient days we were magic incarnate. We were Nadle, Winkte, Two-Souls, Shamans and healers and magical beings to our communities. We possessed the ability to give the blessings of the gods and spirits, and were prized as companions, lovers, and teachers.

We were the prize gift of ancient tribes, entertainers, designers and dreamers. Sometimes we were the -somewhat reluctant- rulers of empires, and the consorts of emperors. We were champions and warriors too, who were feared for our unique gifts turned to inevitable victory.

Know that it is only in recent centuries, with the rise of the single minded, monolithic and monotheistic desert religions, filled with harsh single gods and twisted, narrow morals, that our kind have become reviled, the objects of scorn. Once, we were the kin of the gods.

To be transsexual is not easy, and it is not a birth that could be envied, but neither is it a damnation. It was once considered a rare wonder, if a mixed one; a faery gift that cuts as it blesses.

And in the modern age, of hormones and surgery, we are the first generations of our kind to finally know the joy of complete transformation, of truly gaining our rightful bodies. No other transsexuals in history have been so fortunate.

I say that we are unicorns, rare and wondrous, with still a touch of ancient magic and the kinship of the gods. Though it is agony, beyond the fire we have the opportunity to become alchemic gold.

We have much to add to the world, and to give to ourselves and those who love us.

We have always been, we are still the prize of the tribe, for only the world around us has changed, the desert harshness branding us vile. We are still the same.

Our compensations are real, and our lives are special; we have but to grasp the gifts born of our sufferings.

When I look around me at the mundane lives, there are times I think that maybe I am glad I was born transsexual, for I would never have been what I have become without that curse. I cannot help but be grateful for my uniqueness, so I am brought to a strange revelation:

Deep down, I cherish having been born a transsexual.

Be a unicorn with me, and cherish it too.

transsexual.org/cherish.html – 2002

About Our Transgender Children And Their Families

Q: What does it mean to be transgender?

A: Transgender people are individuals of any age or sex who manifest characteristics, behaviors or self-expression, which in their own or someone else’s perception, is typical of or commonly associated with persons of another gender.

Q: Are there different types of transgender people?

A: Yes. There is great diversity among transgender people. Various terms are used to describe segments of the transgender community. Some of these terms are transvestite, crossdresser, bi-gendered, androgyne, transsexual, drag queen and male/female impersonator. Each of these terms describes a distinct type of transgender person. A detailed glossary of transgender terminology is available on request (see below).

Q: What causes a person to be transgender?

A: No definite answer can be offered to this question. Research suggests there is a biological basis for transgender behavior but to what degree is unknown. Transgender people manifest their condition at different stages in their lives ranging from infancy to old age. This leads to the observation that biology creates a capacity while nurture and individual choice may retard or accelerate the emergence or degree of transgender behavior.

Q: How many transgender people are there in the world?

A: No one knows what the population of transgender people is because there is no means of identifying and counting them. The evidence suggests that many transgender people hide their condition to avoid discrimination and abuse by others. However, transgender people are found in every society and culture, and in every country, from the most primitive to the most advanced. And, transgender people have been present throughout human history. Figures such as Saint Joan D’Arc, The Chevalier D’Eon, Lord Cornbury and Dr. Mary Walker are but a few of the transgender people to be found In the pages of history books.

Literary references to transgender people abound. In the latter half of the twentieth century the visible population of transgender people has increased into the millions worldwide. The evidence suggests that transgenderism is but another facet of the diverse human condition.

Q: Are transgender people considered to be disabled, sick or mentally ill?

A: Under the provisions of the Americans for Disabilities Act (ADA) transgender people are not considered to be disabled solely on the basis of their transgender status. Transgender people are not considered to be medically at risk by virtue of their status. Transgender people may be diagnosed by the psychiatric profession under the provisions of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), American Psychiatric Association, 1994. However, the vast majority of transgender people do not require psychiatric diagnosis or treatment and are not regarded as mentally ill or incompetent solely by virtue of their transgender status. The inclusion of transgender people in the DSM-IV is subject to periodic review. Just as homosexuality was removed from an earlier DSM, it is possible that transgender people will not be included in future DSM’s.

Q: Can transgender people be treated or cured?

A: There is no known cure or course of treatment which reverses the transgender person’s manifestation of the characteristics and behaviors of another gender. Transgender people have at times been subjected to electric shock therapy, aversion therapy (applying physical pain to condition response), drug therapy and other procedures. None of these “cures” have succeeded. Many such “cures” have been painful and dehumanizing for the victims.

Q: Is transgender behavior sinful and against the teachings of the Bible?

A: An isolated passage in the Book of Deuteronomy (22:5) reads: “The woman shall not wear that which pertaineth unto a man, neither shall a man put on a woman’s garment: for all that do so are abomination unto the Lord thy God.” This passage is part of what biblical scholars refer to as the Hebrew Purity Code, a system of rules for social behavior and dietary consumption intended to “purify” the body and spirit in God’s eyes. In the broader context of the Purity Code this is a minor passage which is accompanied by prohibitions against intercourse with a menstruating woman, wearing clothing made of mixed fibers, sacrificing a blemished animal and remarrying a former wife. Taken together the prohibitions of the Purity Code amount to arbitrary cultural taboos as contrasted with the more profound precepts of the Ten Commandments. Biblical scholars and theologians warn of the danger of selective interpretation of the Bible in a way which upholds some passages while ignoring others and overlooking the broader context. Other authors point out that what “pertaineth unto a man” and what garments “pertain to women” have undergone continual change throughout history. Judged strictly by Hebrew standards the entirety of modern civilization would appear to violate the Purity Code.

Q: Are transgender people homosexual, bisexual or heterosexual?

A: The sexual orientation of transgender people may be homosexual, bisexual, or heterosexual.

Q: Are transgender people subject to discrimination and denial of their human rights? Are they subjected to hate crimes and bashing incidents?

A: Transgender people face discrimination in the workplace, in housing, in healthcare, in the military service, in prison and in the society at large. Many transgender people are unemployed or under-employed by virtue of their status. With the exception of a few jurisdictions the jobs of transgender people are not protected by law. Because of their “visible” behavior and choice of attire transgender people are frequently subjected to verbal and physical abuse by other citizens, leading in some cases to the loss of life. In the U.S.A. such hate crimes are currently not reported statistically as crimes perpetrated against transgender people.

Q: How can I help support the transgender person in my family?

A: First, offer your family member your unconditional love and support. Secondly, educate yourself about transgenderism and transgender people and their concerns. Thirdly, help your loved one educate and “come out” to other family members and friends who will be supportive.

From the PFLAG-Talk/TGS-PFLAG Virtual Library
critpath.org/pflag-talk/library.html – 2002

Female to Male Breast Reconstruction

The great challenge in reconstructing a male- appearing chest from a female breast is the management of the overlying breast skin. There is always a “skin excess” when the underlying glandular and fatty breast tissue is surgically removed. One goal in gender reassignment surgery is to manage this skin excess with a minimal amount of scarring. Excess skin can easily be cut away but every incision in surgery leaves a scar — the challenge for the surgeon is to remove this excees skin and to “hide” the incisions in natural folds, previous scars, or in the pigmented skin of the nipple-areolar complex.

The most critical factor in determining the appropriate procedure for each patient is the breast size. A very large breast (C-cup or larger) always requires a more extensive incision or series of incisions. Obviously, the larger the breast size, the more overlying skin there will be left to manage after the underlying breast tissue is removed. My preference for the large breast is to place an incision in a horizontal direction with a gentle curve that follows the curve and lower border of the pectoralis muscle. This scar, although it is long, can heal very nicely and can be “hidden” in the fold that is created by the well-developed pectoralis muscle. With a long incision, there is no problem removing the skin that is in excess after the breast tissue is removed and this procedure can be performed in one stage with only a small percentage of patients requiring any surgical revisions. Chest hair growth is also very beneficial in helping to conceal the scarring. With this procedure, I often will completely remove the nipple areolar complex, decrease it to the appropriate size, and replace the nipples in their new elevated and more lateral position as skin grafts. Liposuction also is an integral part of any breast reconstruction surgery to help create a smooth contour and transition from the breast to the surrounding chest wall.

The B-cup breast size has always created controversy for the plastic surgeon. A patient could be evaluated by 10 different surgeons and receive 10 different opinions on how the procedure should be performed and where the incisions should be placed. Common incisions used are: 1) the inverted “T”, 2) a horizontal incision on either side of the nipple, 3) a vertical incision under the nipple which curves outward near the fold of the pre-existing breast, and 4) the peri-areolar incision.

My preferred incision for the B-cup breast and smaller is the periareolar incision. The average male nipple-areolar complex (NAC) size is about the size of a dime or slightly larger. The average female NAC size is about the size of a half dollar, but it will be much larger in larger breasts. An incision is always made around the entire border of the NAC to reduce the size. This incision is called a periareolar incision. Because this incision is placed at the junction where the normal skin joins the pigmented or colored skin of the NAC, this incision can “hide” nicely and can appear to be the border of the pigmented skin. The excess skin is removed in a circular fashion around the NAC. The challenge is then to close the large skin circle to the dime-sized new NAC. The discrepancy in size of the outer skin circle to the inner circle (NAC) creates a very pleated skin closure — much like a drawstring purse. With normal healing, all skin will contract and tighten. We are relying on the skin contraction properties (which are different in each patient) to tighten the skin and to reduce the appearance of the pleating. Almost every patient will require a minor surgical revision to manage persistent pleating after the first stage procedure. If bothersome pleating exists after the revision, then the patient and surgeon must decide on creating another scar and in which direction. Often this additional scar or scars will be short and well-accepted by the patient because residual pleating rarely extends for more than an inch from the border of the NAC. Obviously, if the scar can be limited to the periareolar incision, this is the most desirable situation as there would be no obvious scarring that the patient might have to “explain” to someone when the chest was exposed.

In summary, the goals of female to male breast reconstruction surgery are to remove the glandular and fatty breast tissue with a smooth transition to the surrounding chest wall, to decrease the NAC size, and to perform the surgery with acceptable and minimal scarring.

Originally published in 1998 True Spirit Conference book.

Gender Reassignment Surgery: Female to Male Breast Reconstruction

By Beverly A. Fischer, M.D, 2002, amboyz.org

Transgender Pride

A person I shall call “G.” wrote:

Dear Gender Gifted Brothers and Sisters

Last thursday I visited a friend of mine who had her surgery two months ago. It was somewhat frustrating trying to communicate with her as she appeared rather depressed, or aggressive, or whatever, I don’t know how to describe that kind of mood. I just knew her since shortly before her SRS, and obviously she was very happy in, looking forward to it. Her first reaction after the surgery was that now she was not a ts any more, now she could start living as a normal woman without having to think about all those problems. Now, two months later, she was rather angry (or how should I put it) about the fact that the neighbour’s kids (for example) still call her “Sir” (I suppose they do that because it upsets her, which they find funny). I wonder if she seriously expected strangers to notice the difference. I don’t think she’s walking around naked in the neighbourhood.

She used to have two ts friends (other than me). One got her surgery some four months ago. She had (has?) a relationship to a guy who considers himself gay and tried to convince her not to have surgery because it would be the end of their relationship. At the hospital he showed up and said it was over, but since she didn’t have anywhere else to stay she went to his place after the surgery anyway, and they continued the relationship. However, he told her that she would have to stop dress en femme etc. as he could only love her if he saw her as a man, and she apparently accepted that. So she broke up with all her ts friends (including my friend) because she had to live as a man.

I hope the story isn’t true. Not only because it’s terrible, but also because it would be bad PR for the relatively liberal Dutch SRS policy.

The other friend of hers send her a postcard last Christmas, in which he explained her that he had decided to halt HRT and live as a TV, and that he didn’t want to have any contact with any ts people anymore.

Then she asked about how things are going between me and the gender clinic, and she came with the most incredible suggestions, obviously being somewhat out of her mind. One suggestion was that I should just go to Iran (where you can have anything if you have a credit card) and have the surgery done right away instead of going through this lasting Dutch SRS permission procedure. They would just give me an enormous doze of hormones which should be good for one year so that I wouldn’t have to buy hormones on the black market.

The other suggestion was that since I don’t parse it would be better to dress as a man. This is similar to some suggestion I got from this newsgroup when I complained about the difficulty of finding a job as a not-passible pre-everything ts. It was somewhat frustrating not being able to make her understand that while this stay-in-closet approach may work for a good actress in an intolerant social environment, it is both impossible and unnecessary for me.

I think I will try to explain it to her in letter. It is sometimes difficult to talk when you are a little but pissed of with each other. And Dutch is a foreign language for both of us.

Thanks for reading this.

G.

I responded:

Hi G.,

This is a very sad story that you have told. Thank you for sharing, even if it is so painful.

It does bring up some difficult issues related to surgery. Surgery really does only two things. Obviously, it makes significant changes to one’s genitals. Second, to the degree that one’s self-image is tied to one’s body, one’s self-image will change. But that’s it. There is no magic. Surgery does not change your past. Any human being who rejects such a sigificant part of hir past is running an extreme risk of emotional difficulties. This is why I have such trouble with the idea of a “former ts”; “former male” I agree with, but our heritage of being transgendered will stay with us forever. It is not a bad heritage, but it is one that many of us have trouble accepting.

Given her rejection of her male past, I can certainly understand her difficulties and her bitterness. There is an aura of magic about surgery, and it does lead to problems. I have lost my best friend in the community to this same issue, because she does not want reminders of her past in her new life. I am one of those reminders, simply because I knew her before, and I am a part of what she no longer wants to associate with–or perhaps more to the point, what she doesn’t want associated with her.

It is also a caution to all of us to be sure that our support networks are in place, and that they are truly functioning to support us. It is one thing that she had those neighboring kids calling her “sir”; it was almost certainly a taunt, destructive and mean-spirited. It takes a lot of positive support to balance these insults. But the boyfriend who wanted her to remain male–well, I don’t think I need to explain to anyone here how destructive that could be, and apparently is.

It is one thing to know that we are one the right path, but few enough of us are strong enough to walk that path alone. We need our support within the community. We need our support in every-day life, too; our friends, our social circles, the people we work with, and our relationships, for those of us who have them. When those around us work against us, for whatever reason, we need to find ways to balance the negative influences, or change them, or eliminate them if necessary. No one needs to be hit over the head with a club when we are trying to come to terms with our identity, or to make the changes that are necessary to live our lives as we choose.

For G.: I’ve let some distance grow between myself and this community, so forgive me for not being current with your situation. There are few enough of us who pass flawlessly; the rest of us, including me, have to adapt to being read some of the time. My experience has been that it is much easier to deal with these incidents if I expect them, and if I don’t make an issue of them. Yes, sometimes they hurt. Most of the time, though, I simply don’t worry about it. If it happens, it happens. I’m still me, I still know who I am, and I am still proud of the fact that I am living the life that I want to live and need to live. Getting read takes nothing away from who I am.

Over time, hormones and electrolysis do make a tremendous difference in passability. Some of us are impatient, though, and I certainly do understand that! When I was pre-everything, I didn’t pass well at all, and there were some who didn’t think that I ever would. But that has changed, even to the point of passing in jeans, a simple blouse or t-shirt, and no makeup.

How we feel about ourselves makes a difference in passing, too. Fully accepting ourselves as women (or men) makes a difference in how we feel about ourselves, and how we treat ourselves, and how we present ourselves to others. Other people pick up on this in subtle ways, and the most important thing that they can perceive–in terms of how they react to us–is our own self-acceptance.

It is essential to learn and to remember that we were born as women, or as men. What we have between our legs does not alter that. What other people see from the outside does not alter that. We are who we believe that we are; those feelings are too deeply rooted to be changed, ever. When the body does not match, it can set up a terrible conflict, and it is that conflict that causes us to suffer. Not our womanhood or manhood, but the conflict between mind and body. Changing our bodies is part of the resolution of that conflict. But the other part of resolving the conflict takes place in our minds, not by rejecting the gender that we feel, but simply by accepting the fact that we were given this conflict to resolve, that our experience of life will be different because of it. Not better, not worse, but different and uniquely ours.

We have every right to struggle to achieve our true identity. We have every right to be proud of what we achieve in the struggle, because we know the pain that each of us has faced, and we know that this pain has killed others. We have every reason to be proud of who we are, and that we have come to peace with this conflict, by whatever path that we need to take.

This is what transgender pride is about. It is about being true to ourselves, to both our true gender that has come to the surface after being buried and rejected for so long, and to our heritage, which includes the struggle and the pain, as well as the triumph. It is about taking our true place in the community, and not accepting when others see us as less than we are.

We have no reason to be ashamed of who we are. We are human, and we are strong. When we live as our true selves, other people will perceive this and understand this. Pride in ourselves is an important part of passing, because what I want in my interactions with others is to be respected, and that respect starts with me.

—————

In another context, I wrote:

Speaking of which, in private email with another person in swlab, I mentioned that “out and proud” is something that you don’t hear very much in the trans community.

R. responded:

Makes sense to me. I mean, I’m quite happy being lesbian. If I had a button I could press that would make me like guys, I wouldn’t press it, not for anything. But being TS is a bit different. I don’t think there’s anything to be ashamed of, but what’s to be proud of? A woman should be proud that she used to have a messed up bod that looked like a guy’s?

To which I responded:

There is a lot to be proud of. I have an unusual heritage–not unique, but unique within the experience of many people who know me. Although my experience of life is different from that of single-gendered people, I know some of what it means to live as each gender. This has been useful, both to me, and to others with whom I share my life, even when the topic has little to do with what we tend to think of as gender issues.

I have learned to deal with difficult issues, both internally and in relating to others. In itself, this is something to be proud of. This, too, is something that I can share with others, because we all experience difficulties in life, and for many of us there are common problems that we face, including depression, isolation, shame, anger, and fear. Single-gendered people can and do learn from my experience, and I am happy to be able to share in ways that will improve and enrich their lives.

But pride runs deeper than that. Although I might not have chosen this life, I can truly say that I like who I am. I don’t like everything that has happened in my life–who does?–but I like the person that I have become. That includes the part of me that is transgendered.

Being transgendered gives me a different outlook on life. It has given me a keen appreciation of ambiguity and irony that helps me understand so many things in this world. It has been, and continues to be, a rich source of humor, something which I need every day in order to survive. It is ambiguous, and sometimes even absurd, but then so is much of the rest of life. Being transgendered helps me to appreciate the richness of life, its diversity, its pain, and our triumphs over that pain.

What is there to be proud of? The same things that any person can be proud of–who we are, what we have made of ourselves, what we leave behind for the benefit of others. Being transgendered has made me a better person than I would have been otherwise, all other things being equal. Why would I not be proud of that?

firelily.com/gender/diane/tgpride.html – 2002

Transgender Employment and Job Seeking

Transgender people comprise 0.3 % of American adults, or about 700,000 people, according to a 2011 study by the Williams Institute. And their unemployment is 2X the rate of the general population, with athema also 4X more likely to live in poverty (according to the 2011 National Transgender Discrimination Survey, (n=6,450.) The challenge then is how do we get our community employed and above the poverty line?

The U.S. Equal Employment Opportunity Commission (EEOC) ruled that discrimination based on gender identity is sex discrimination, triggering Title VII of the Civil Rights Act of 1964. President Obama has also signed Executive Orders protecting federal employee and federal contractor transgender workers. Some states and localities have passed laws protecting transgender workers. Despite this, many transgender people struggle to find work.

And now, many states are are pushing back and try to remove protextions for the transgender community, just as President Trump announced his intensions to block the trans community from serving in the military.

Aside from the surface issues of presentation, (how you look) there is the issue of legal identification. Almost all job applications ask for legal name, social security number, and past references. If you haven’t changed your name yet, you face the ugly requirement of putting your legal name on your application instead of your gender conforming name. You may also have to check the dreaded M box instead of the F, or vice-versa.

Macy’s, no doubt as a result of the Macy vs. Holder decision, has adopted a very trans-friendly application that adds a space where you can put down the name you prefer to be called by, in addition to your legal name.

Companies can’t get around the legal name issue for obvious reasons. Even if you have changed your legal name, you have to deal with all of your references knowing you by your birthname. So many transgender people wonder, often with some level of desperation, how they will find gainful employment other than the local street corner. Below is some advice to help you land a decent job.

LGBT Job Fairs

Hey, if companies have tables at these, they are looking to hire you! That should give you a great confidence boost. Even if they are looking for the L or G component, at least you know your odds are better than a blind interview. Affirmations in Ferndale, MI has a LGBT career fair, and many large cities host LGBT career fairs. You may have to travel, but you hook up with some local girls and make a day out of it while you are there. Getting hired will take some effort; be prepared to put some mileage on your car and be prepared (and willing) to relocate.

LinkedIn

I have to admit that I’ve been a bit disappointed with this one, but it is obligatory that you at least have a good profile there. Most HR departments will look you up online, and LinkedIn is one of the first places they look — so you need to have some good info on your publicly accessible profile. ou can also search for jobs and networks there, and it is good for at least seeing the ebb and flow of local jobs in your area.

Networking

As transgender people enter the workforce, we have an obligation to help one another. Flat out, yes we do. In the same way that there is an good ol’ boys network, there needs to be a “former old boy’s network,” (or former girl’s network.) Affirmative actio — regardless of your political views as to the fairness of it — helped African Americans. Employee support groups, both company led and privately formed, definitely helped move more African Americans into the professional workforce. We need to help each other in the same way, and this includes those closeted individuals who aren’t ready to come out themselves, but can definitely help a sister (or brother) out.

Be That Much Better

You need to be stellar awesome in your communications, interview, and preparation. The cards will be stacked against you, not only from being one of hundreds of applicants (potentially), but realistically because of your transgender status. You need to be that much better than everyone else so as to shine so brightly that your ability transcends your gender. Proper research on the company you are interviewing with is essential. Preparation, such as practice interviews, and presentation (dressing) skills are essential. Record yourself in a practice interview and lsiten to it over and over until you’ve worked out all the flaws. Get a friend to work with you. Let them ask off the cuff questions so you can get comfortable in your responses. You can learn a lot about what the interviewer sees; then work to correct any mistakes and perfect your responses.

Human Rights Campaign Foundation’s Corporate Equality Index

This is a great resource to quickly check up on how LGBT friendly companies are. Companies are rated on a score of 0 to 100. The higher the score the more inclusive the company is. You should also check out the company website and find their diversity and non-discrimination language. If they have transgender listed, then it is an indication that at least someone in HR is aware of transgender people.

Be Confident

Confidence is a huge asset! You are an asset tho the company, you know, and need to let them see and feel it too — without coming across as arrogant or conceited. There are many out there that will patronize you, and/or be condesending. Don’t let them. You can be confident is who you are and what you’re capable of contributing, all while maintaing your composure. Be upfront about your status, don’t hide it, but don’t overly volunteer more than they want, or need, to know. You may also have to walk the fine line between being a “crusader” and getting hired. Some questions that are put to you may be illegal, so do some homework and be prepared. But remember your goal is not to be confrontational, it’s to get hired. Grace and gentle education can go a long way. Finally, always follow up. You can never close a sale if you don’t ask for it. Proper manners and etiquette are always appreciated, but show them through your eagaerness and persistance that you want this job.

Take Acton if You are Wronged

If you are definitely discriminated against you are unlikely to sue — it’s expensive, time consuming, and in some cases very public. However, you could file a complaint with the Equal Employment Opportunity Commission. You can also inform national and/or local advocacy groups, such as the afore-mentioned Human Rights Campaign, or your local LGBT organization. At the very least, it will help inform others about how companies treat transgender people.

Hope this helps.

Jenni Contrisciani, MBA

08 April 2001 @tglife.com

My Teenage Son Wants to be a Woman

Beth Thomas always knew her son Adam was different she just couldn’t put her finger on it. At times she grew despondent at his mood swings. Adam was spending more and more time alone in his bedroom and when Beth asked what was wrong he wouldn’t answer properly.

“I’d always wondered if Adam was gay,” says Beth, 49, an office manager from Southend, Essex. “Even when he was growing up he’d always choose girls’ clothes instead of boys’ and play with the girls at school. I thought it was just a matter of time before he told me.”

But a few years later, when Adam was 18, he dropped a bombshell. He wasn’t gay but he wanted to change sex.

“I knew telling Mum would be one of the hardest things I’d ever have to do,” says Adam who’s now living as Zoe. “She’d always been quite open-minded but I knew telling her I wanted a sex change was going to be difficult. It would be hard for anyone to deal with.”

Five years earlier, Adam had started to feel uncomfortable about his identity and sank into a deep depression.

“It didn’t help that I was being bullied at school,” explains Zoe, 19. “I simply didn’t want to do any of the things other boys did like play football, fight and so on. I even took ballet lessons for a while. I’d get called a poof and be pushed around. I felt suicidal”

But when puberty hit, things got worse. “I started growing facial hair and it simply didn’t feel right,” adds Zoe. “I felt disgusted by it. I developed a sex drive too and that was very confusing. I wondered if I was gay but I fancied girls, though I felt more like them than a teenage boy.”

Adam left school at 16 to take a course in computing. There he found an outlet for his frustrations and made some friends. “There were boys at college who experimented with makeup.” recalls Zoe. “So I could wear lipstick and dress in sarongs without other students thinking I was strange.”

It was six months later that Adam discovered why he was feeling the way he was.

Surfing the Internet one night in July 1999 he came across the word ‘transsexual‘.

He logged on to the website and everything began to make sense. “There were stories about women trapped in men’s bodies,” recalls Zoe. “I identified with them strongly and nearly shouted out that’s me! Suddenly I didn’t feel so alone. I was frightened about the future but the overwhelming feeling was one of relief.”

Adam discovered there were operations and hormone treatments available for transsexuals to help them cope with their feelings.

“Almost immediately I knew I was really a girl,” says Zoe. “I asked Mum what she would have called me if I’d been born a girl. She said Zoe and that’s what I decided to call my alter ego my real self.”

Adam confided in friends first of all. “My closest friend Michelle said, ‘Oh, cool! If that will make you happy,'” remembers Zoe. “My other friends, Alex and Mike, didn’t seem shocked at all. The only comment they made was at Christmas when Alex said he didn’t know what to get me as he’d never bought anything for a girl before.”

Adam, an only child who’s had no contact with his father since his parents split up five years ago, was still petrified about telling his mum. It wasn’t until Christmas Eve 1999 that the truth came out.

“I came home and found him wearing one of my Chinese dresses,” recalls Beth. “I was stunned and asked him what he was doing. He burst into tears, sat down and hid his face. He told me he wanted a sex change. I told him he was messed up. I didn’t think he could be serious. The only transsexual I knew was Hayley in Coronation Street. He was far too young to be making decisions like this. Looking back I feel awful about the way I reacted.”

Over the next six months, Adam and Beth often rowed about his identity crisis.

“She kept saying it was stupid.” says Zoe, who works for an Internet company. “I tried to explain that I was really Zoe but she wouldn’t listen.”

Beth tried desperately to come to terms with her son’s feelings. She began surfing the Net for more information and also phoning helplines.

“I spoke to other transsexuals and realised they were ordinary, nice people,” she says. “I discovered it was a medical condition, diagnosed from psychiatric assessment, not a lifestyle choice or perversion.

“I suddenly understood why Adam had been behaving the way he had and that having a sex change might finally make him happy.

“I spoke to my GP and he said it was a good thing that Adam had made the decision so young, as it would save him years of anguish having to live as a man.

“I’ve found the fact that I’ll never have grandchildren very hard to deal with. But I’ve learnt to accept it. If things had carried on the way they were, then my son may have committed suicide and I’d have lost him altogether.”

One day last summer, Beth came home with a surprise. She held out her hand and gave Adam a keyring with the name ‘Zoe’ on it.

“I hugged him and told him I’d support him,” she says. “I knew he was determined to go through with it. I told him I wanted to meet Zoe, to see my son dressed as a girl.”

A few days later Beth took Zoe on a shopping spree to buy skirts and tops. “When he put on the clothes I was a bit shocked,” says Beth. “But the striking thing was how his personality changed. He was like a kid in a sweet shop. I could see he was so much happier being Zoe.”

Zoe discovered help on the Internet and visited a psychologist in London. He was diagnosed as transsexual and on his very first visit in August last year he was prescribed a course of female hormones.

“It can help to have the operation earlier rather than later,” says Dr Russell Reid, consultant psychiatrist specialising in gender identity, who’s treating Zoe.

“One in every 10 coming to see me is now under 20. For many young people with a crisis about their gender identity it can lead to confusion and hold them back. Having the operation can help them get on with the rest of their life.”

“Since I’ve been taking the hormones my skin is softer and people tell me my figure is much more feminine,” says Zoe. “I’ve even started to develop breasts. I’m a lot calmer but I find myself getting much more emotional, especially at the end of soppy films!

“When it comes to relationships I think of myself as a bisexual female and most people I mix with are transsexuals or very open-minded, so I don’t think I’ll have many problems.”

Adam began living as Zoe 24 hours a day.

“When I told my boss, my stomach was churning,” says Zoe. “But he was really understanding. I wore I women’s clothes to work and sent an e-mail to everyone asking if they’d call me Zoe. I’m sure there was gossip but everyone has been great.”

Beth knew she’d have to tell her friends. “Not one of them batted an eyelid:” says Beth. “They were just intrigued.”

Zoe is now saving for the private £9,000 operation which she plans to have next year. The surgery, which takes four hours, involves cutting the penis and inverting it to construct a vagina. Before then Zoe has to live as a woman for 12 months.

“Mum has gone from one extreme to the other,” says Zoe. “She wants me to be really girlie. But I just like to be natural and wear denim skirts, a blouse and not much make-up.”

Beth has surprised herself at her change of attitude.

“I genuinely think it’s for the best,” she says. “Zoe is a much happier person than Adam ever was. Adam had difficulties growing up and was a very difficult child. Zoe is much more happy-go-lucky. There was a period when I felt like I was in mourning for the son I’d lost. A little bit of my heart still misses him. But now I think of it as losing a son but gaining a daughter. And Zoe is a lovely daughter too!”

by Chris Morris
From Woman
19 February 2001, mermaids.freeuk.com/woman2.html

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

Female to Male Transgender: Mental Health

Mental health is tightly intertwined with general health. Most FTMs tend to isolate. Not only do they deny themselves contact with society at large, they tend to isolate from each other. Even though this has slowly been changing in urban areas within the past five years, it tends to be the rule of thumb. Many FTMs who meet at meetings are happy to share the physical changes they experience. They are very private about emotional and psychological changes. The struggle against gender stereotypes is more pronounced for FTMs; or the majority of FTMs are simply more aware of gender stereotypes. This often creates a barrier between FTMs and MTFs, creating an even greater sense of isolation&emdash;an isolation from those who might be best equipped to understand or help us.

It is quite often difficult for any transsexual to feel confident about themselves or even feel good about who they are when so many people in their lives (and society as a whole) have regarded them as deceivers, evil, worthless, liars, mentally ill, psychologically unfit, ad nauseum. We are required to seek psychological treatment just for verification of our circumstances. We are told how we are to act, whom we are allowed to love what our sexuality may or may not be, what clothes to wear. Many of us have been taught to lie about who we truly are by the very people who are supposed to be helping us learn to accept who we are. It has only been within the last ten years that some therapists and psychologists have become guides to our process and let us come up with the answers to who we are. Needless to say, the trust level transsexuals have for therapy and mental health professionals is very low. Most sympathetic counselors understand that they will have to do a great deal of coaxing and laying down of a foundation for trust with most transgender folk just to draw them out.

The constant threat of being “outed,” harassed, beaten/ and most profoundly, the threat of being killed is an everyday concern that wears on transgender people. People in the mainstream feel that Brandon Teena “got what he deserved, because he deceived” the people in the town where he was murdered. Sean O’Neil received the same general response from his neighbors: people felt he deserved to face the charges brought against him for deceiving those around him. Some of those charges were valid. However, the majority of them were not. (Ask us for more information about these people’s cases, if you are interested.)

If the person is “out” about their transition, or has even transitioned on the job or in a small town, the risks are even greater. The emotional and psychological toll of these threats is tremendous. There is the added threat in many areas of being locked up and committed to any number of treatments, including shock treatment. These kind of mental pressures make every transgender person susceptible to mental illness of one form or another at any given point in their lives. This does not mean that we are mentally ill or incapable all of our lives. Because this is usually the perception that we encounter, our frustration level is only compounded. The suicide rate for transgender folk is very high. Substance abuse, eating and sleeping disorders, abuse as children, and domestic violence have only recently been being viewed as symptoms of the social pressures that transgender people are under as opposed to being a part of our so-called illness. Not only do we need more help around these issues, we need more education and compassion.

As more and more transgendered people come together and share their experiences with each other as well as the rest of the world, the primary emotion that arises is anger. It is usually the first barrier that must be dealt with by mental health professionals. Because of that anger, transsexuals can be marked as socially unfit. Western medicine’s approach to classifying the symptom and not dealing with the root problem(s) is constantly used as a weapon against transgender folk. Until transgendered people are given space to feel safe, that will continue to be true. It is not just the transgendered folk who need help or have a problem; it is society as a whole.

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: Hormones

Any person on hormones is a chemistry experiment. It is very important to listen to the FTM (or MTF) as they tell you what is occurring for them physically and emotionally. FTMs have learned to watch and monitor the changes they experience over time. On this note, it is very important that if you have a pre-op transsexual come to you for help, you educate that person to listen to their body and know how to monitor changes. It will be up to them to guide you through their changes so that you can help them navigate their future health as safely as possible. This is also true for the individuals who choose not to do hormones or surgery. Transsexuals are often dissociated from their bodies due to the schisms they experience between the way they feel and the way their bodies are (sometimes) perceived by others, or the way they know their bodies are. Many transsexuals have extremely high thresholds for pain, or cannot differentiate pain from other experiences.

It is important for every FTM to get a complete blood work-up before even beginning hormone therapy. Those who decide to go through the black market to obtain hormones are at risk for a variety of health problems. Even if someone comes to you who is not receiving injections through a program or doctor following the Harry Benjamin Standards of Care, it is important to listen closely to what they tell you. They will often times be able to tell you what it is that they need from you. (We do not wish to imply that we are telling you to throw out your knowledge or ideas. We simply ask that you not throw out the information and knowledge being given to you by the FTM in your office.)

Once hormone therapy has begun, it is a good idea to do blood work-ups every three months for the first year. If there are no indicators of complications, this can be changed to every six months in the second year. After the third year, unless complications arise, once a year is not unusual practice for blood work-ups. The blood work-ups should not only monitor bilirubin levels for the liver, but should also monitor the cholesterol level. An occasional check of the serum testosterone level is a good idea, to be certain that the level is within the normal range for a male of the patient’s age.

In the United States, the most common approach to hormone therapy for the FTM is intramuscular injection. This is usually prescribed at 200 ml/cc, lcc every two weeks. This can vary between individuals, and it will take time to determine the proper dosage and frequency of injections. Testosterone Cypionate, a cottonseed oil suspension, and Testosterone Enanthate, a sesame seed oil suspension, are the two most common forms prescribed. There are doctors who insist on administering the shots. However, most doctors will do so only for the first few injections, and will then teach the FTM how to inject himself so the FTM can take care of this at home. Most doctors who insist on injecting the hormones themselves are also charging higher rates for the injections as well as the office visits. This usually occurs in rural areas or isolated areas where the FTM has little choice but to comply. Oral Testosterone is still sometimes prescribed, but is strongly discouraged. The high doses of testosterone administered through this method are harmful to the liver. This method has also caused high blood pressure in many FTMs.

A growing number of FTMs who have been on hormones for 4 to 5 years who have not had hysterectomies, have developed intrauterine complications. These range from endometriosis to fibroid cysts, to fibrous scar tissue forming around the reproductive organs, to absorption of the organs into the abdominal muscles or even, in a couple of cases, into the intestines. The rising number of FTMs who have been experiencing these complications has pushed many of us to ask for an hysterectomy earlier in our transition. Many FTMs, however, do not experience these problems, and for them hysterectomy may be an unnecessary surgery. Some FTMs require hysterectomy/oophorectomy for psychological reasons.

Some FTMs may experience migraines in the first few months of hormone therapy. This can sometimes be alleviated by adjusting the dosage or the frequency of injections. Whether the dosage should be raised or lowered varies from person to person. This is a totally experimental stage, and also a very important time for the doctor to be listening to the instincts of the patient. Many FTMs choose to weather the headaches. They usually dissipate after 3 – 6 months. Others may experience cold-like symptoms in the first few months; others may be at a higher risk for yeast infections for the first few months.

Diet is very important. Lowering fat intake will reduce the risks of high blood pressure and heart disease. Taking supplements of milk thistle can assist the liver in processing any toxicity. Smoking and drinking should be discouraged. If the FTM intends to pursue any kind of surgery, he should be educated on the damage smoking does to the vascular system. Most surgeons performing any of the alterations sought by transsexuals insist that the patient quit smoking 6 to 9 months before surgery.

Hormone therapy begins at different times in life for different people. Those who start at a very early age will probably notice a variety of changes at several stages of their lives. Even people who do not walk this path experience hormonal fluctuations throughout their lives. Those who begin hormone therapy later on in life will probably have fewer fluctuations, but will need to pay closer attention to the changes that do occur. Anybody is at risk of arthritis and heart disease, but with the added factor of hormone therapy, the usual course of events may not apply. It is also important to note that all of this information will vary from person-to-person depending on age, ethnicity, diet, and current health.

Listed below are some of the differences between the cypionate and enanthate suspensions.

Testosterone cypionate&emdash;This form brings on the secondary male characteristics sooner than enanthate. However, since this is a cottonseed oil suspension, more guys have a variety of allergy reactions to it. These reactions can manifest in the form of mild rashes or itching at the site of injection. Acne is usually more prevalent and harder to control. Muscle and bone density increase is fairly rapid. However, ligaments and tendons are at risk of damage or injury because they take longer to “beef up” in correspondence with the muscle/bone increase. Any sport activity for the first two years of hormone therapy should be approached with this in mind. The voice usually begins to change at two months and settles at about nine months. Body hair appears within the first two months and can continue to grow in new places up to seven years. Balding is a very real possibility. It can begin as soon as three months into hormone therapy. Fat distribution shifts: thighs and hips may flatten out. However, fat frequently does not disappear, it merely shifts to the sides and the gut. Depending on the FTM’s body type and diet, the person will gain or lose weight.

Testosterone enanthate&emdash;Since this is a sesame seed oil suspension, it is usually easier for the body to absorb. The secondary male sex characteristics usually take longer to manifest than with the cypionate – usually the process is 3 – 6 months behind, though this can vary, too. This slower body adjustment can make it easier on the tendons and ligaments, however, the risk for injury still exists. Acne is less of a problem, and for some has been non-existent.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

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

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