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Archive for June, 2010

Drama Reconsidered

Remember back when I was being all dramatic about going to the college reunion? Ahem… I might have mentioned something about comparing myself to a sacrifice?

Well anyway, there’s a reason E and I fit together so well. She was able to persuade me that I was being a wee bit over-dramatic about things. It’s really not that big a deal. No one is going there looking to have it out with me over my transition. If I chicken out at the last minute, no big deal, but she really doesn’t think I ought to.

Her position is undeniably more rational than mine. No one is going to throw bottles or rotten tomatoes when I show up. If I get a few strange looks, that’s nothing I don’t deal with already in other venues. Besides, if people disapproving of my transition is scary and prohibitive to me, how would I ever expect to survive it?

So I’ll be going. And tempting as it might be for comedic effect, I will not arrive in a ball gown and a tiara. I’ll leave that to the fabulous world of drag performers (I wonder if anyone at the reunion is secretly one of those.). Transsexuals are typically more “jeans and a comfy top” kind of people, though I’m pretty sure most people at the reunion won’t realize there’s a difference.

Anyway, the time off work has now been approved. The dates are on my calendar. Let the countdown begin.

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I met with the HR rep again today. Things seem to be going swimmingly on the work front preparing for my transition. We’re planning to meet every two weeks from now until “show time.” So there’s some nice momentum.

Interesting discovery of the day: When I first told my supervisor about my impending transition, I heard a rumor that one other person had gone through transition at my employer previously. Later I learned from my HR rep that this description was misleading… we had one person who had completed transition before joining the company, but no one who actually transitioned on the job here. Well after asking around among the HR department, my HR rep has discovered that three other people have transitioned on the job here previously. I find that somewhat comforting.

I haven’t talked to the benefits people yet, but the HR rep has done so a few times. They’re trying to get everything together to have a solid plan laid out to get my name and gender markers changed; stuff like “you need to fill out these forms; present these two forms of ID; bring in proof of this so we can submit that.” That kind of thing. Exciting, no? But it’s all part of the light-hearted frollic we call “transition.”

One thing I brought up to the HR rep is a topic that I always feel sheepish about mentioning – whether they will re-examine their benefit coverage in light of transition related expenses. The HR rep said she would follow up with the benefits folks and see what they know about that, and they might be invited to our next meeting to talk about it.

I’m torn about how assertive I ought to be in this area. On the one side, the company is being fantastically supportive. If there is such a thing as a best case scenario for transitioning on the job, this company seems committed to making that happen. I do not want to mess that up.
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About Last Night

So… last night was not one of my happy times. Transition is awfully lonely at times. Relationships you thought you could rely upon disappear with regularity. When that happens it would tend to make one feel sad even if they weren’t hopped up on a second-puberty dose of hormones. This is not news to anyone who has gone through the experience. It might be news to those who have not.

Last night I was stuck in a rut of remorse, mourning relationships I’ve lost, and one relationship in particular. And I was frustrated realizing how hard it is to replace such deep relationships with new ones.

But even through the emotions, I did have a point I was trying to make in regard to an ongoing complaint / running joke with my therapist around transsexuals supporting one another through transition. There’s just something darkly amusing about the situation. I can only explain the humor in a roundabout way, so bear with me.

Transition – by its very nature – is a self-centered kind of thing. I don’t mean this in the bad, egotistical, “the world revolves around me” sense. It’s self-centered because it’s purpose is to redefine yourself. This involves releasing formerly hidden aspects of your personality and core identity and mingling them with the identity you previously presented to the rest of the world as “yourself.” This stuff changes you as a person. It changes your goals; your relationships; your likes and dislikes. In the process you rediscover and reinvent yourself in a fundamental way. If you think I’m overstating it, I’m not. If anything I’m understating it.

During this process you really need strong relationships – friends and family who can be like the rocks you cling to in a storm tossed sea of identity redefinition. You bring more than enough chaos and self-focus to the table during this time. You need other people to bring stability, constancy, and predictability into your world.

Here’s the paradox. The only people who truly understand the depth and importance of this need – mean truly understand – are others who have gone through it themselves. People who have not done this simply do not, and perhaps cannot, understand the unique kinds of strain the experience puts upon a person. That would suggest that the best people to support someones’ transition are other transsexuals. However, remember that point about “stability, constancy, and predictability?” The LAST group of people in the world likely to bring those traits into a relationship are transsexuals undergoing their own transition.

That’s where the dark humor lies. We are at once uniquely positioned to support one another, but simultaneously at a time in our lives when we’re least capable of offering that kind of support. Lean on me… just not now.

I’m not finger pointing, because to the extent there is any blame to be had here I am every bit as guilty as anyone else. I struggle to keep up on my end of any relationships these days, mostly because I’m the most “needy” person I know … except for all the others undergoing transition.

I don’t want to give the impression that I’m feeling hopeless, because I’m not. I strongly believe this stuff gets better if one has the strength to make it through. Most days I feel like I’m a strong enough person to do that. Now and then I feel my weaknesses and start to doubt myself. But hey, who doesn’t feel like that sometimes in any walk of life?

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Second Intermission

Some nights I just want to curl up into a ball and wait for the world to pass for a while as I contemplate the paradox of the transsexual experience.

We live the earlier part of our lives trying to make ourselves fit in and seem normal to everyone else. Meanwhile we’re gradually shriveling up and dying inside, as we see our lives drifting farther and farther away from anything our true selves could ever find a place within. We grow ever more miserable even as we accumulate various accouterments of success.

Call that Act One.

At some point we realize we can’t continue like that. We find the resources and courage to confront the situation. We decide it’s time to be honest about what has been held inside our whole lives.

We lose a lot in the process. We become near pariahs, cast out from ordinary social circles and clinging to any scrap of social acceptance we can find. The only ones who truly seem to understand the devastation are fellow transsexuals. However, as if the universe conspires against us, such people are by definition struggling through their own journey. In their haste to move ahead toward their own goals, they can seldom offer lasting support. We mostly exchange a few kind words and then fade out of each others lives. And then, afterward and individually, we complain about our loneliness.

Call that Act Two

Now I love a good sad story. But can you blame me for looking forward to Act Three?

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Today is Fathers Day. It’s not a major holiday, like Christmas or Thanksgiving, but it’s celebrated enough that any man with kids can expect the question “did you do anything special for Fathers Day?” It’s not like people are expecting anything elaborate but, you know, it’s a little weird for a man to just ignore the day. You’re supposed to do something to mark the occasion.

This puts me in an awkward position because this is the first time we’re not celebrating Father’s Day at all in our house. And I don’t really know how to explain it to those people asking about what “special” things we did. We’re not celebrating it upon my request. It’s not a punishment. It’s a relief.

I love my kids, and treasure the fact that they’re part of my life. And that’s part of what Fathers Day is supposed to be about. You’re celebrating the fact that you have kids, and celebrating the bond between father and child. Men who don’t have kids don’t get a fathers day. It’s supposed to be special.

But as I’m  going through transition I’m working through some really strange things, such as realizing that I never wanted to play the “father” role. I wanted to be a parent, and show my love for my kids, and actively engaged in raising them. But all the time I tried to handle this in the ways that fathers are supposed to it felt alien and unnatural. I’m not saying I held myself up to some standard of fatherhood perfection and struggled. I’m saying I tried to emulate every “good father” example I saw, and I just sucked at it. I could be a parent to my kids, but the “father” thing wasn’t working out. Not in the cultural sense of what being a “father” typically means. And ultimately not in any sense at all.

Fathers are supposed to be the role models children learn from in order to understand what an adult man is supposed to be like. This influences their choices about themselves, in the case of boys, and all the men in their future in the case of girls; whom to be with, whom to avoid, what’s normal, what’s strange. There’s always this comparison between adult males and what you learned from dear old dad about what such creatures supposed to be like. It’s a pretty big deal.

And for me it was a constant pressure because I didn’t feel like I was really a man at all. I’d try to talk to other men about parenting and it always felt like I was talking to another species. I used to have great anxiety about that. I worried that my kids were growing up warped because I was failing in my attempt to emulate a proper adult male for them. I knew I didn’t “get it.” I was failing when I tried. And then when I failed I was scared about failing again, so I started withdrawing from them.

Part of the decision to transition was driven by this. I couldn’t tell myself that I needed to hold off until after the kids grew up because they needed a father. I knew they weren’t going to get a real father out of my pathetic attempts. And they were also eventually going to feel emotionally abandoned by this dysfunctional man they called “dad.”

I couldn’t be my kids’ father. But I wanted to still be their parent. Does that make me their mother instead? No. That didn’t feel right either. They already have a mother. There’s a woman in their lives who actually gave birth to them, quit her job to stay home and raise them, and whom they have always called “mom.” Trying to step in with the demand that we now have to share that role feels like a ridiculously arrogant presumption. I’m sort of like A mom, but I’ll never be THE mom to them.

But if I’m not their father and I’m not their mother, what the heck am I? I’ve still been a parent who has lived with them their whole lives. I was there for every one of their births  and all the subsequent birthdays. I’m the one who earns the money which pays for all their needs, and a heck of a lot of their wants. I’m also there to dry their tears, put band-aids on owies, wash their dishes, fold their laundry, play games with them, and all the other hundreds of things you do when you’re a parent. I’m certainly not nothing to my kids, and whatever I am is definitely not a stranger.

We decided that if I’m going to be a parent, and if I’m not going to be dad, or mom, we need a name for who I am. Having the kids call me Diana, which is what they’ve been doing, feels sort of weird. I don’t call my parents by their first names. It would feel distancing if I did.

E put this question to our eldest boy – J – offering him the word “mom” in every language, and asking if any of those felt right to call me. He chose the word Nai.

So that’s who I am now. I’m still Diana. But to my kids I’m also Nai. And Nai isn’t the relationship you celebrate on Fathers Day. So we won’t.

Somewhat serendipitously my friend Erica recently told me about a new celebration day which she’s been involved with: TransParentDay.

TransParentDay is a day to celebrate being a parent without concern of the stereotypes of gender. So whether you are MtF for FtM this is a day for you the parent to be celebrated with your children.

So don’t get to worried about our decision to skip celebrating Fathers Day. We’re still going to celebrate my role as a parent in our kids lives. We’re just going to do it on the first Sunday in November, and the cards are going to be made out to “Nai,” rather than “Dad.” Today I’ll be wearing my special wristband to remind me.

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A Brief History of Transsexual Treatment

Before we get into what the latest science shows about transsexuals, it’s probably a good idea to cover some of the history of transsexual treatment. It’s not as if transsexuals just popped into existence around the time someone figured out how to perform a “sex change operation” (as genital reassignment surgery is still sometimes crudely referenced). We’ve been around for a long time, throughout history and across all cultures. Sure, we’ve been mostly hiding in our closets, but not all of us and not always.

The first approach scientists and therapists tried with transsexuals was to cure them by making their minds stop insisting they didn’t match their bodies. This was the dawn of the “change the mind to match the body” approach. Zoe Brain provides a pretty good summary of the situation, which I’m going to reference with some commentary here.

In the dim, distant past, little distinction was made between homosexuality and transsexuality. It was thought that gay men were really wannabe-women, and that transsexual women were really gay men who were taking things to the logical extreme. Various crypto-religious psychiatric theories were proposed about some form of “feminine essence” or “female soul” that all gays had to some degree, and transsexual women had to an extreme amount. Some of the very first surgeries were performed on this basis – and in 1940’s Germany, in the extermination camps, not on willing volunteers.

Later on, the persistent demands by transsexual women and men, and the catastrophically high suicide rate, persuaded some medics to try all sorts of therapies. Amongst them – lobotomy, leucotomy, “aversion therapy” involving administration of nauseating drugs and electric shocks to genitalia and eyeballs, all sorts of “gestalt” therapy, “neuro-linguistic programming”, “cognitive therapy”, psychoanalysis, electro-convulsive therapy with dosages far higher than would be permitted today, and often without anaesthetic, psychotropic drugs, masculinising hormones…quite literally every tool in the arsenal of psychiatry was tried. Even “spirit release therapy” and exorcism, using bell, book and candle.

This speaks directly to those who persist in believing that transsexuals ought to seek therapeutic cures to fix their confused minds, rather than seeking hormones and surgeries to alter their bodies. We have about a century of that approach being attempted upon thousands of different transsexual identifying people. Before telling people they should go down that road, it makes some sense to see where that has lead in the past. And you don’t have to look very far before a very distinct pattern emerges – total failure.

Long-term follow-ups showed temporary remission of symptoms in many cases, especially those involving the more extreme forms of aversion therapy that left 2nd degree burns, but no improvement over the long-term. Not without some unfortunate side-effects, such as the patient’s IQ being lowered to the level of a cabbage due to over-enthusiastic brain surgery. And patients continued to die.

The emphasis above is mine. For roughly a century therapists from all fields have attempted to cure the minds of transsexuals with every tool in their respective arsenals and it didn’t work. Not ever. Somehow it has become a common belief that transsexuals could be cured by some therapeutic means, even though it has been tried over and over without success. Even the ones who insist they succeeded are proven wrong by long-term followup studies. We long ago abandoned trying to “cure” homosexuals this way for this kind of reason (except for some crank therapists with more Jesus than sense). But somehow people continue to believe transsexuals have some kind of viable option here.

I myself have heard both direct and implied questions about this in my own case. Wouldn’t it be easier to learn how to live with yourself through therapy and some happy pills rather than by something as radical as transitioning into life as a woman? I get these questions even after I explain that I have done a LOT of therapy, and I took my happy pills, and I found myself spiraling downward all the same. I was right at the edge of suicide before I ever even nudged in the direction of transition. And this is not some kooky transition variation of my own, but a common description among older transitioners. We’ve tried our whole lives to find a cure, or cure ourselves, or find a lifestyle to appease us, or just hold it in and ignore the feelings, and eventually it just became too hard. We couldn’t continue like that.

And again… this is not a new story. It was observing exactly this result that lead some folks  to try another approach about 60 years ago.

In the spirit of “what the heck, nothing else works”, from the early 50’s, some surgeons in Europe tried the first “production-line” (as opposed to “experimental”) genital reconstruction surgeries, in conjunction with feminising hormones…. and they started getting some dramatic improvements. By the 1960’s, French surgeons in Casablanca, Morocco were doing several surgeries per week, at a cost in today’s terms of about a quarter of a million dollars each.

Zoe’s got more, but you get the idea. This was a big change. This was the first time people tried to cure transsexuals by changing their bodies to match their minds, rather than changing their minds to match their bodies. We’re not talking about something motivated by hard scientific evidence either. We’re talking about a bunch of therapists out of ideas for what else they might try, and a few surgeons volunteering to perform the slicing and dicing.

And you know what the results of that approach were? Really quite good. I mean amazingly good if you consider that the previous approaches had a success rate that you didn’t even need fingers to count (i.e. zero). Suddenly you had a body of transsexuals coming out of  treatment and living healthy, happy lives which were actually supported by long-term followup studies. And as the costs for the surgeries came down, the number of people who could try this shot up (thank you supply and demand).

I don’t want to overstate the case. Until very recently the vast majority of people identifying as transsexual were not allowed the hormone / surgery option for reasons a lot more arbitrary than you might believe (Most places, if you weren’t young, pretty, and sexually attracted exclusively to guys, you could pretty much forget it. Professionals guided by time honored principles like “no fat chicks” literally ran the show until around the 1990’s). Throughout this period the “fix the mind not the body” paradigm still ruled when it came to treating transsexuals. The point is the numbers did slowly grow. And the evidence slowly poured in, convincing ever more psychiatrists, psychologists and other therapists that it might be a good idea to stop trying to change the mind to match the body, but rather to try it the other way around.

And here we’re getting about as close as social sciences can come to establishing a scientific fact: hormone / genital reconstruction options seems to work for transsexuals.  Changing the body to match the mind is as close to a “cure” as psychiatric professionals have been able to devise for transsexualism, and it is definitely NOT because they haven’t tried all other options first.

It’s not a perfect cure. It doesn’t remove all the pain from living a life within the transsexual condition. It doesn’t change stupid and destructive choices made by transsexuals in their past. But it’s demonstrably, repeatably, and reliably better than any other approach that has been attempted. Not just a little better, but a lot better.

Zoe wraps our little “fix the mind not the body” therapeutic history lesson this way:

The point is, that even if you regard this as “mutilation” rather than “reconstruction”, and say “they should try alternative treatments”, the problem is that there *is* no “alternative treatment” to try. Not that works. Religiously and Ideologically motivated mental health professionals are still attempting to turn lead into gold, leaving an unbroken line of corpses and psychic cripples to mark their 0.000000000 batting average, but they still keep trying. But while there’s literally hundreds of studies showing the effectiveness of the “triadic therapy” involving hormones and surgery, and even some studies showing the effectiveness of hormones alone on less severe cases, there’s none where someone who meets all (not just some) of the diagnostic criteria that have ever shown improvement in long-term follow-up.

The widely-held belief that “they don’t need surgery, they need psychiatric help instead” is not borne out by any actual evidence. Not a skerric, jot or tittle.

It was this complete lack of success that led to the speculation in the late 60’s about a biological cause, rather than a psychiatric one.

That was my emphasis again. It’s the note I want to close this post on, so let me hit it again. We are not lacking evidence about the treatment of transsexuals. But for some reason most of society is pig-headedly acting as if the evidence shows the opposite of what it actually does.

The “fix the mind not the body” approach has been tried. It doesn’t work. No evidence suggests that it can. Some of those closest to this evidence started realizing this before I Love Lucy aired for the first time. We’ve got evidence going back to that time period attempting the “fix the body, not the mind” approach instead. That one does seem to work in most cases.

The basics of this question are already known. We’re past the point where this stuff is seriously argued about by anyone with any respect in the field. A person now has only to be diagnosed as transsexual and triadic therapy (a real life experience in the intended gender role, hormone therapy, and genital reassignment surgery)  is becoming almost routine. Indeed, those closest to the evidence are now to the point they’re arguing that this stuff needs to be covered by insurance companies as medically necessary (skeptics, please check out the citations at the end of that link, particularly the sixth footnote).

The idea of “curing” the mind is coming to be seen as not only unsuccessful, but probably unethical based on the evidence. That most people don’t know this is a point of frustration, but it doesn’t make it any less true.

So that’s the history of the clinically unsuccessful and (hopefully by now you’ll agree) factually untrue belief that transsexual minds can be changed to match their bodies. But that’s all just the “soft science” side of the equation. What we need to get to next is what researchers are finding once they start looking for the underlying biology to explain why this is so. That research has been finding out some really interesting things. I’ll start to get into them in the next post.

Previous Posts:

Transsexuals – Facts Not Opinions Part I

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One of the most persistent challenges transsexuals receive is some variation of the statement: “I think it’s wrong for people to indulge their fantasies about being the opposite sex by mutilating their bodies. If you’ve got male parts, you’re a man. If you’ve got female parts, you’re a woman. End of story.”

A nicer version of this same challenge suggests we should really, really try to get “cured” through some form of psycho-therapy, rather than with hormones and surgeries.

I’ve got no illusions about this being a fringe opinion held by an ever-shrinking minority. This is the mainstream opinion on the matter. In my experience it doesn’t really matter whether people are more liberal or more conservative in their overall outlook – this is almost always their perspective on transsexuality. If you’ve got a male body you’re a man, and believing you’re something else doesn’t really make it so. In this perspective, I can’t ever really be considered a woman, but it might be possible to tolerate me as some kind of poor, deluded man deserving of pity. [I could keep qualifying all these by adding the female to male equivalent phraseology, but that would get pretty tiresome, so please just understand this applies to all of us changing in either direction. I’m coming from the male to female angle, so it’s easier for me to write in that direction. – D]

The traditional transsexual response to this has been the old cliche “I’m a woman trapped in a man’s body.”  Something about that phrase has always bothered me, even though I sometimes use it myself. Let’s just say, it wouldn’t have become such a cliche in our community if it didn’t capture some pretty significant and commonly held truth. But it doesn’t really tell the whole story.

One of the flaws in this “woman trapped in a man’s body” phrase is that it decouples the mind from the body. It suggests some kind of “spiritual” or at least non-physical nature of our trans-ness. My body is male but my mind is female? The mind is something other than a physical thing then? What’s the nature of the mind, then? Where does it reside? We’re walking right into philosophical areas debated and never settled since the time of Socrates and Plato if we go in that direction. Rhetorically we’re re-framing the debate from something un-winnable into an area where we have a debater’s chance of contending the point. But by doing so we’re also conceding that it’s going to remain a subjective rather than objective matter. Our very existence is being cast as a matter of opinion rather than fact.

And that’s a problem. I don’t believe my being transsexual is a matter of opinion. I believe it’s a matter of fact. It was this very realization which provided the key turning point which resolved my life-long depression and identity confusion. I was not a man because my body looked like one, and no amount of debating or persuasion was ever going to make me one. There was no “cure” to make me feel like my mind and body match one another, because it was not – in fact – true.

But if this is a fact, and not a matter of opinion, it should be something which could be studied and understood by fields beyond those like psychology, queer theory, or gender studies. Medical science should be able to tell us something about what distinguishes a transsexual from others in quantifiable and measurable terms. If you assume that the brain is where this “mind” thing resides, that sounds like the most sensible place to look.

And you know what? I’m not the first person to follow this line of reasoning. Others got there before me, and some of those others were scientists in fields like neurobiology. Their findings bear directly on the central question: Are the physical structures of the brain truly different for transsexuals, or are they not? Because if they are, then we’re not “mutilating” our bodies by hormones and surgeries any more than we’d be mutilating our minds trying to force our brain to behave like something it’s not. The brain is part of the body too, isn’t it?

Toward this end I intend to share what I have learned about the scientific study of transsexuals. I intend to write about it in easy to understand, layman’s terms, but also leave you links to source material if you’re inclined to be skeptical. I’m going to be shamelessly and extensively linking to Zoe Brain’s series of posts with Ron Goldman discussing this very question (highly recommended if you’re curious – part 1 of 7 is here. From there you can follow the links at the bottom to get to the rest), but I’m not simply going to rehash what she wrote. I’ll be putting my own spin on her points and coloring it up with some of my own experiences.

This is something I believe it’s important for people to know, and yet the vast majority of people have no clue about it. I want to give it the attention it deserves.

More soon.

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