Saturday, 30 May 2015

The next phase

I've had to teach myself to be a transgender person. It's been like a second puberty for me.

After so many decades of fighting it feels good to embrace who I am but it has taken a while to work out the kinks and it's been a bit like using muscles that were left to atrophy from disuse. So much has changed inside and yet its happened so slowly I almost didn't realize just how massive its been. The transition from feeling I was letting everyone down to accepting that I can be myself and still meet my parental role and be a partner to N has been like jumping the grand canyon but in slow and painfully drawn out slow motion.

I thought I would leave this blog behind after that but no I still have things to say, albeit with less urgency. I no longer need to write but still feel I want to. I am still fascinated by the science (or lack thereof) and on the social changes that are happening all around me almost daily.

The world that I knew as a young teen has disappeared and has been replaced by one that is entirely different. That change has been for the better and for the worse but then this is the way the world has always worked. Things don't always happen smoothly but rather in jagged and uneven spurts after what seems like an eternal wait for something to happen.

The person that I was 10 years ago is gone. That person: full of fear, apprehension and fixed and unflinching ideas about how life waw supposed to work has finally learned their lesson. Not everything can be controlled and sometimes our creator throws us a curve ball that we need to grapple with; sometimes it takes the form of a physical deformity, lost limb, chronic depression, tragic loss or even gender dysphoria. These are the types of challenges that people face every day and our greatest triumph is to deal with them with dignity and resolve with the fringe benefit of helping others to surmount theirs.





Wednesday, 27 May 2015

Crossroads

Sandra Lopes has offered a long and very thorough synopsis and analysis of the work of Blanchard, Bailey and Lawrence in a recent post on her blog. It was well written and researched to be sure and it offers a nice summary about where we have come and where we are going with the science behind the causes of the transgender condition. I urge you to read it here.

The fact is that we are once again a crossroads between the mental disorder/trauma model of the Blanchard, Bailey and Lawrence triumvirate and the biologically rooted gender identity that most transgender people prefer to espouse.

I have made no secret that I favour the school of Benjamin and Vitale but primarily because I have found the BBL work to be shoddy, mean spirited and thoroughly unscientific. It never addresses other scientific work such as the John Hopkins Cloacal exstrophy study nor the mistaken theories of John Money who thought that a gender identity could be acquired through socialization; an assertion which has now clearly been proven to be false.

People who favour the emasculation trauma theory must hinge on something happening during childhood that is not even consciously perceived by the child but I have trouble buying it. Sure you can have a case where the grandmother dresses the little boy in skirts and ribbons (as happened to Walt Heyer) and perhaps he develops some psychological trauma but most of us have never experienced that. The idea that an event or events are as innocuous as to not even be remembered seems like a stretch.

But the reason all this is important has more to do with the way science sees us than how the average person does. After all, most people have not read anything on the subject of gender variance or dysphoria (in fact many of us don’t either much to my surprise) and we find all kinds of opinions out there on the subject. Yes there is empathy for the transgender because teens are committing suicide at an alarming rate and because the public sees that intelligent people are willing to uproot their lives and that of their families in order to become who they deem to be their authentic selves.

The question remains whether this is a form of mental delusion or a biologically predetermined condition. In either case experts agree that it must be dealt with and even Blanchard recommended surgery for people he was convinced were male on the premise that he was alleviating their mental suffering. He must have thought of it as medicating the schizophrenic as he does not personally believe that there is any such thing as a female gender identity for a male bodied person. In any event, Blanchard’s opinion on the subject is losing weight by the year and, as I used to tell my dear sister, it’s easy to pronounce yourself on something you have never personally experienced.

While it would be nice to have conclusive proof in scientific terms, in the interim we need to deal with acquiring credibility through public education and awareness. The more people we are out to, the more they will realize that most of us are well adjusted and intelligent people who are as sane as anyone else and I might argue we might be a degree or two saner after living with the weight of dysphoria for many years. Many of us have had to train our brains to ignore or refuse to acknowledge something that gnaws at us from our earliest awareness in order to conform.

I continue to read some of the blogs of other transgender people and see varying degrees of contentment which hinge on the following criteria:

• Acceptance from their loved ones
• Acceptance of themselves
• Acceptance at their workplace (if one transitions)

There is no getting around that we want to be loved for who we are. In that way, we are like everyone else and while some people will have little trouble with us, the most important of the three is your own acceptance. Without that you will be weakened by self doubt, worry and trepidation and will have little fight in you to deal with the ignorant and mean spirited of this world.

Gender is the last bastion of certainty that people wish to believe is immovable but gender identification and birth sex are not always clearly delineated nor closely related for every person. For most of us it’s actually a graduated spectrum that usually has gender and birth sex well aligned. But for the small minority where there is sufficient misalignment, there is a problem to contend with and it’s mostly socially constructed because given the carte blanche to behave and dress as they want most gender variant children would simply have no issue. It’s only when their desires clash with the norms and dictates of their society that the problem arises.

We may be coming to a future where gender identification will not necessarily involve (for many) having reassignment surgery to the other role but will be more a matter of how we identify in our brains. Given the freedom to express themselves as they wish, some men would dress as women and some women as men and what of it? The idea is to allow them the liberty to do so without persecution even if it sticks in the craw of people who see gender as an infallible and rigid structure.

Conchita Wurst is an example of a gay male who presents and wishes to be addressed as a female but has not had surgery or taken hormones. She may be more acceptable as an entertainment curiosity than as a plausible employee of a fortune 500 company and yet who knows what the next decade will bring.

I am surprised every day.


Tuesday, 19 May 2015

The Gendered Self

Back In 1965, John Money of John Hopkins thought that gender self identification was largely a matter of socialization and he counselled David Reimer’s parents to raise their child as a girl following a botched circumcision where the majority of his penis was accidentally severed. As I have written previously in this blog, David Reimer (raised as Brenda) eventually resumed living as a male once he understood his origins but tragically committed suicide in his thirties.

A New England Journal of Medicine article dating back to 2004 chronicled the genital reassignment surgeries performed on patients suffering from Cloacal exstrophy which is a severe birth defect that occurs in approximately 1 in 400,000 live births. One of the most pronounced characteristics is severe phallic inadequacy, or the complete absence of a penis in genetic males. Historically, doctors have treated cloacal exstrophy by surgically altering, or "reassigning" these babies as female.

John Gearhart, M.D., director of pediatric urology at Johns Hopkins Children's Center and an expert on exstrophy complexes, and colleagues challenged this standard treatment by studying 16 genetic males from 5 to 16 years of age, 14 of whom underwent surgical conversion to female sex. They found that more than half of them identified themselves as male; six individuals were so unhappy with their female sex of rearing as to pursue gender reassignment back to male. All 16 had interests and attitudes that were considered typical of males.

So there is strong evidence that our brains are to some extent gendered at birth and that what follows is a process of socialization that then tempers and adapts our biological predispositions. What we do not know is to what degree our socialization can alter our perception of our own gender and whether it can sway the biology to skew some individuals towards the opposite gender.

In some cases the cross-gender feelings resolve themselves and the child turns out to be gay or lesbian but in others there is a strong and unwavering insistence that they can no longer pretend to be the gender they were born as. Today we call these children “trans kids” and many end up successfully transitioning under the watchful eye of specialists trained in their field and loving parents who want them to grow up with a positive self image.

From the 1940’s through the 1960’s the endocrinologist Harry Benjamin believed that this phenomenon had a biological explanation and saw a great many patients over his career whom he graded according to the degree which they felt estranged from their birth sex. His scale had 6 classifications - the sixth being the strongest and most severe and the one that most often led to gender reassignment surgery. He chronicled his findings in his landmark 1966 book titled “The Transsexual Phenomenon”. After a lifetime of dealing with gender dysphoric patients, Benjamin died in 1986.

By 1989, the Clarke Institute’s head of psychiatry Ray Blanchard proposed a psychological origin for his patient’s distress in the form of a sexually fuelled mental disorder but failed to find universality by conveniently ignoring female to male transsexuals whom his theories could not adequately fit; if he could not explain their transitions he would simply disregard them. For his male to female patients he proposed they were either in love with their own image as women or in love with increasing their selection of partners depending on their sexual orientation. Kurt Freund, who had a background in testing homosexuals and sex offenders with a penile plethysmograph (which measured sexual arousal in men), was replaced at Toronto’s Clarke institute by Blanchard and their collaboration helped hatch the pseudo scientific idea of Autogynephilia (or AGP for short). Therefore it’s not hard to see how the focal point could be rerouted towards the idea of gender variance as sexual deviance.

Blanchard’s legacy left us with one dubious theory for male to female gynephilic transsexuals, a tenuous explanation for androphilic transsexuals and none for female to male transsexuals.

AGP did not explain why someone transitions because there are people who we used to call transvestites and now term cross dressers also experience arousal but they do not necessarily need or desire to modify their body. Why then were some people advancing beyond a limit and others happy to stay where they were?

In 2003, Anne Vitale (a PhD in psychology who dealt with gender variant individuals) wrote an essay called “The Gender Variant Phenomenon – A Developmental Review”. Vitale, like Benjamin believed that there was a biological explanation for her patient’s gender confusion and proposed that it was due to, at least in part, the insufficient or inappropriate androgenization of the brain at a critical stage of embryonic development. In her essay she described the 3 types of gender variant individuals (a sample of 350 people between 1978 and 2000) which she saw in her practice:

Group One (G1) consisted of natal males with a high degree of cross-sexed gender identity. In these individuals, she hypothesized that the prenatal androgenization process--if there was any at all--was minimal, leaving the default female identity intact.

Group Two (G2) consisted of natal females who almost universally reported a life- long history of rejecting female dress conventions along with, girls' toys and activities, and with a strong distaste for their female secondary sex characteristics. These individuals rarely married, preferring instead to partner with women who may or may not identify as lesbian. Group Two was the mirror image of Group One.

Group Three (G3) was composed of natal males who identified as female but who acted and appeared normally male. We can hypothesize that prenatal androgenization was sufficient to allow these individuals to appear and act normally as males but insufficient to establish a firm male gender identity. For these female-identified males, the result was a more complicated and insidious sex/gender discontinuity. Typically, from earliest childhood these individuals suffered increasingly painful and chronic gender dysphoria. They tended to live secretive lives, often making increasingly stronger attempts to convince themselves and others that they were male.

She came up with the term Gender Expression Deprivation Anxiety to describe the struggle that her patients felt and concluded that their gender dysphoria shared symptoms often associated with Dissociative Disorder, Depression and Generalized Anxiety Disorder.

According to Vitale, gender identity issues could become a life-long condition for those who found it too difficult to deal with directly. Each life stage presented new dilemmas and decisions in relation to this core issue and the more the individual struggled to rid themselves of gender dysphoria by increasing social and physical investments in their assigned sex, the greater the generalized anxiety and the harder it became to restart life sexually reassigned. For those individuals who, despite all obstacles, could transition to a new gender role, it has been shown that gender transition that includes psychotherapy, hormonal therapy and--in most cases--gender reassignment surgery, significantly reduce and eventually eliminates the anxiety entirely.

I have found that Vitale’s work complements the findings of Harry Benjamin and shows the same level of empathy and understanding but most importantly, it removes the focus from a sexually driven motive to one, at least partly, rooted in biology.

In 2010, after having worked with over 500 patients, she wrote the book “The Gendered Self” which, besides Harry Benjamin’s “The Transsexual Phenomenon” is one of the best books on the subject that I have ever read. Her invention and use of the term gender expression deprivation anxiety (which she uses in lieu of gender dysphoria) is a spot on descriptor for what often ails the transgender person before self acceptance.

WPATH recognizes that not all gender variant individuals need to transition. The idea is to find the right amount of gender expression that will ease their anxiety and, after many years of depriving themselves due to religious beliefs, family rejection or guilt and shame issues, some individuals can be happy by simply crossdressing on a regular basis. Of course for the more intense cases, only gender reassignment can resolve the anxiety.

In the end, the litmus test of whether the individual has done the right thing will be their level of contentment and freedom from a problem that has always plagued them. Once they get a taste of life without the societal and self-imposed road blocks, they realize that they proceeded correctly.

The key is to enter into a truly honest reflection free from fear, guilt and shame and only then will they have their answer.

To quote from the conclusion of Anne Vitale’s “The Gendered Self”:

“The goal for therapists working with gender dysphoric individuals should not be limited to helping clients to transition, it should instead be to relieve the client of the chronic gender expression deprivation anxiety associated with gender dysphoria. That opens up a whole realm of possibilities, ranging from encouraging responsible cross-dressing/cross-living to referring the client to a physician for exploratory doses of cross-sex hormones, and helping the client undergo full gender-role transition, with or without surgery. No one has the right to determine what gender role anyone else should live their life in.

The therapist’s goal should simply be to help their client to live a happy and productive life rather than make gender-role decisions for them. We know with certainty that taking cross-sex hormones can be a very effective psychotropic medication in certain cases. Combine this with sex reassignment surgery and we reach the upper limit of what is physically possible. From there on forward, success in the new gender role depends on the individual’s attitude, support network and willingness to accept life as it is and not as one would have wished”


Tuesday, 12 May 2015

the next frontier

Many transgender people talk about an inner female identity that they can trace to their earliest memories to and, while I cannot argue with their sentiments at all, this may or may not be an accurate portrayal of what is truly going on.

Most of us learn to take cues from our parents, teachers and peers about which type of gender behaviour is acceptable or not for our birth sex. To what degree certain traits are genetically encoded and which can be attributed to socialization can be put into question because from an early age we learn to conform to expectation and many keep their secret desires to themselves once they experience disapproval.

There are masculine women and feminine men who are not only at ease with their gender expression but with their physical bodies and yet for the transgender person there seems to be something else going on. The argument for an innate female identity can be argued back and forth however, in the complete absence of genetic proof that would allow us to point to something that makes transgender and transsexual people markedly different; we are left without a definitive explanation.

The opposite argument for an innate female identity is the idea that this is an abnormality borne out of fetish, trauma or a combination of both. This explanation has resonated with some who have found it to be a plausible answer for the origins of their own gender variance. Indeed after the vacuum created following the work of Harry Benjamin, Ray Blanchard was only too happy to fill it with his own ideas which have yet to be fully accepted most especially by transgender people themselves who see the idea of a mental disorder as an anathema.

But regardless what you believe about the origins of gender dysphoria and the reason why some people choose to transition, the reality is that this is happening every day somewhere in the world. The almost carnival freak show novelty that was the Christine Jorgensen case back in the 1950’s has been morphed into a more common (if albeit small) occurrence that can no longer be ignored by society. Doctors, lawyers, business people are transitioning; some early in life and some later.

It is possible that as the stigma of a transition lessens, some who were previously on the fence may be tempted to go forward with one. The danger of course is that not everyone who considers one should necessarily go through with it and may in fact regret doing so at some point down the road.

The formal gates are there to prevent people from may be tempted to think it’s a viable solution to their depression; self image problems or childhood trauma. Walt Heyer, for example, who had a multiple personality disorder as well as substance abuse issues and now advocates against the transgender condition may be a good cautionary tale for people who should not transition. He rails against the charade of thinking you can change genders but the fact is that transitions do work for some people.

But what about the people who do not desire full surgery and only want hormones or to simply live as the opposite gender without altering their body? The issue then becomes one of legal protection and of tolerance. This tiny percentage of the population that was previously marginalised and even hidden from view is now requesting full-fledged recognition and protection under the law. Of course not everyone is comfortable with this and it has catapulted the discussion about bathrooms and classrooms and workplace transitions into our everyday lives as well as challenging some people’s religious beliefs about what is a man and what is a woman.

But at its roots, this is really about treating a small and little understood minority with some degree of dignity. Regardless of people’s opinions about something they cannot personally relate to, the transgender have a right to exist and live in relative happiness and without fear of persecution. This will greatly depend on the fortitude of those on the frontier lines as well as on the political bravery of those who hold the reins of power.


Tuesday, 5 May 2015

Under the magnifying glass

One of the interesting things about the Bruce Jenner story is that it has rallied a large number of people to express their opinion on a matter they cannot relate to personally. As a former Olympian and (of late) reality television personality, he becomes by default the most high profile person to come out as a transgender with the stated intent of transitioning; and doing so very publically.

I must admit that I was hesitant to watch the Diane Sawyer interview because I feared that it would be tabloid fodder but my curiosity got the better of me and I began viewing it with the mindset of switching off my television if it degraded to such a level. I was pleasantly surprised to see that not only did ABC treat the subject with a high degree of sensitivity, but that Bruce Jenner came off as likeable and sympathetic.

Much of his story resonated with me because I saw parts of my life in his.

Now with the program behind us, the internet has been full of stories about his next steps and attempts at capturing candid photographs of Bruce in a dress. Along with those stories have come a plethora of derogatory comments from people who not only understand little of the transgender condition but are also saddled with lower grades of intelligence and empathy than some of us might like.

Such is the human condition I’m afraid.

Still, there are others who have rallied to Bruce Jenner’s side and supported his bravery for speaking so openly about his life experience in dealing with this challenge. If nothing else it’s out there in the spotlight for all to see and discuss. It’s the next area to be tackled after homosexuality and perhaps it’s part of the process that all the crevices be exposed before we can deal with the issue in a more positive way.

I recently wrote an article on Jack Molay’s blog Crossdreamers where I praised the new generation for being more open about their sexuality and gender non conformance. The last time I spoke to my seventeen year old daughter about these issues only reinforced my belief that society is making great strides towards understanding and accepting human diversity in all its forms.

In the end, Bruce Jenner and I are the same but we are also very different. When he was here in Montreal winning the decathlon, I was a fourteen year old high school student who secretly crossdressed when nobody was home. Both of us were far from admitting to ourselves that we had bigger gender issues than we thought.

He is also a Republican and I am a just left of center Liberal.

Being transgender does not mean we are cut from the same cloth and I discovered this over the years as I ventured slowly in my awkward attempts to reach out to others who shared this difference of ours.

I have come to the conclusion that we are just the same as everyone else. We bleed, we laugh, we cry and we rejoice in the same things others do. Whether we have much or little in common with each other depends more on shared life experience and age than on whether we suffer from gender dysphoria or not.

Perhaps when we are more exposed to the light, people will see that we are not such human aberrations after all.