Normal

THE BODY LIES

FEMALE-TO-MALE TRANSSEXUALS

What would you go through not to have to live the life of Kafka’s Gregor Samsa? Not to realize, early in childhood, that other people perceive a slight, unmistakable bugginess about you, which you find horrifying but they claim to find unremarkable? That glimpses of yourself in the mirror are upsetting and puzzling and to be avoided, since they show a self that is not you? That although you can ignore your shell much of the time and your playmates often seem to see you and not your cockroach exterior, teachers and relatives pluck playfully at your antennae with increasing frequency and suggest, not unkindly, that you might be more comfortable with the other insects? And when you say, or cry, that you are not a cockroach, your parents are sad, or concerned, or annoyed, but unwavering in their conviction—how could it be otherwise?—that you are a cockroach, and are becoming more cockroachlike every day. Would you hesitate to pay thirty thousand dollars and experience some sharp but passing physical misery in order to be returned to your own dear, soft, skin-covered self?

Approximately two people in every hundred thousand are diagnosed—first by themselves, then by endocrinologists, family doctors, psychiatrists, or psychologists—as high-intensity transsexuals, meaning that they will be motivated, whether or not they succeed, to have surgery that will bring their bodies into accord with the gender to which they have known themselves, since toddlerhood, to belong. Until a decade or so ago the clinical literature and the unreliable statistics suggested that for every four men seeking to become anatomically female, there was one woman seeking the opposite change. Now clinical evaluation centers report that the ratio is almost one to one.

In twenty years of practice as a clinical social worker, I met men who liked to wear women’s clothing, women who preferred sex in public conveyances to sex at home, men who were more attracted to shoes than to the people in them; I didn’t meet any transsexuals. I encountered transsexuals only the way most people do: in Renee Richards’s story, in Jan Morris’s Conundrum, in Kate Bornstein’s books, and on afternoon talk shows, where transsexuals are usually represented by startlingly pretty young women, sometimes holding hands with their engagingly shy, love-struck fiancés, sometimes accompanied by defensive, supportive wives turned best friends. I wondered, in the middle of the afternoon, where the female-to-male transsexuals were. Even if there were four times as many male-to-female transsexuals, there still had to be a few thousand of the other kind somewhere. But not in mainstream bookstores, not in magazines, not in front of talk-show audiences of middle-aged women standing up to applaud the guests’ ability to “look just like the real thing.”

I thought there must be a reason female-to-male transsexuals were invisible. I wondered if their physical transformations were so pitiful that no one could bear to interview them, if women who wished to be men were less interesting, less interview-worthy than men who wished to be women, or if these people were so floridly disturbed that even the talk-show hosts were ashamed to be seen with them.

Much of the early psychiatric literature about transsexu- als, from the pre–Christine Jorgensen 1940s until the late 1970s, leaned heavily toward psychoanalytic explanations and toward clinical descriptions that, however sympathetic to the unhappy patient, emphasized the bizarreness not of the biological condition but of the conviction that there was a biological condition. The next psychiatric wave emphasized “personality disorders” as the root of transsexuality, specifically the popularized borderline personality syndrome, with its inadequately formed sense of self and frightened yearning for symbiosis. In The Transsexual Empire (1979), Janice Raymond dismissed the biological reality of transsexuality and attacked transsexuals as agents and pawns of the patriarchy. Her overwrought theories about the meaning of transsexu- ality and the training and practice of surgeons who perform transsexual procedures read like the feminist equivalent of some of the Mafia–CIA–White Russian conspiracy theories of Kennedy’s assassination, but her essential point, that transsexuals are psychologically unstable victims of a society that overemphasizes the roles of sexual insignia and gender difference, made sense to me. If the people involved were less nuts and society were less rigid, it seemed, neither transsexuals nor the surgery they seek would exist.

Most of us can understand a wish, even a persistent wish, to belong to the other gender. History and fiction are full of examples, many charming, some heroic, of women who dressed as men throughout their lives. It’s the medical procedures that make transsexuals seem crazy: six months to two years of biweekly intramuscular injections of two hundred milligrams of Depo-Testosterone, which cause an outbreak of adolescent acne, the cessation of menstruation, and the development of male secondary sex characteristics; then a double mastectomy, in which most but not all of the breast tissue is removed, the nipple saved, and the chest recontoured for a more masculine, pectorally pronounced look; and then, a year to ten years later (depending on the patient’s wishes and financial resources), a hysterectomy and one of two possible genital surgeries: a phalloplasty (a surgery to create a full-size phallus and testicles) or a metoidioplasty (a surgery that frees the testosterone-enlarged clitoris to act as a small penis). In short: multiple, expensive, and traumatic surgeries to remove healthy tissue. Who would do this?

Lyle Monelle, a burly man of twenty-eight, lives with his mother, Jessie, in a trailer park in suburban Montana, a state in which I’d never imagined suburbs. The trailer park is neatly laid out beneath a shocking cobalt sky, and all the culs-de-sac have their own blue-and-white street signs, none of which are bent or rusted or facing the wrong way. The careful hand of people who are used to making do, doing without, and trying again is everywhere. Jessie and Lyle are watching for me from the trailer’s little porch, and they come toward the car like a couple of welcoming relatives.

The inside of the trailer looks familiar; it is the Montana twin of my late mother-in-law’s home in northern Minnesota. Sturdy, slightly bowed Herculon love seat and matching recliner in shades of orange; copper mallards hanging on the opposite wall, arching over the TV. The three of us finish two pitchers of iced tea during the afternoon’s conversation, and Lyle and Jessie allow themselves to be sad and occasionally puzzled by their own story, but not for long. All their painful stories are followed by moments of remembered grief but end in the genuine and ironic laughter of foxhole buddies; they know what they know, and they are not afraid anymore.

Lyle is older than I had thought he would be—he’s an adult. He was a patient of three of the people I’ve already interviewed—Dr. Donald Laub, a preeminent plastic surgeon known especially for female-to-male sex change surgery; Judy Van Maasdam, the counselor at Laub’s surgical center in Palo Alto; and Dr. Ira Pauly, a noted psychiatrist and when they told me about Lyle, they all focused on how young he was at the time of transition, much younger than most people who apply for surgery. Even though I knew better, I had half expected to meet a teenager. He was fourteen when he began hormone treatments, with medical approval, fifteen when he had his mastectomies, but twenty-three before he and his parents had enough money for the phalloplasty, the “bottom” surgery. (That’s what the guys say about their surgeries—“my top,” “my bottom.”) I was horrified when I first heard the stories about this kid, and I imagined meeting his parents and clinically evaluating them as misguided, covertly sadistic, or perversely ignorant, acting out their own unhappiness on their helpless child.

We should all have such parents.

When Lyle entered puberty, his mother and his late father took him from doctor to doctor, looking for explanations for Lyle’s unhappiness and fierce resistance to being treated like a young woman. An endocrinologist who had worked with Don Laub recognized Lyle as possibly transsexual, and Ira Pauly and Judy Van Maasdam confirmed the diagnosis. Then, after extensive hormone treatments, Laub performed the first surgery and the family moved to another state, to allow Lyle to enter high school as a boy. Later, they nursed him after his hysterectomy and his phalloplasty, and used all their savings, and then some, to pay his medical bills.

Jessie says, “I want everyone to know who reads this that this wasn’t easy—it was a really terrible shock. I didn’t understand. I said to the first endocrinologist, ‘Where did we go wrong?’ and he said nowhere, it was biological. I called every single—I’m not kidding you—every single insurance company in the USA, and they said, ‘No, it’s cosmetic.’ ”

Lyle interrupts—the only time I’ll see him openly angry. “Yeah, right. Like I wanted a nose job. Cosmetic. Well, it was only my life.”

Jessie makes soothing hand gestures, reminding him that it’s all right now. “And of course, the money,” she says. “Our other kids resented it. I understand. But what could I do? What could we do? If your child has a birth defect, you get help. We understood—we understood even when he was little that something wasn’t right. And we knew, when the doctors told us what could be done—we just knew what we had to do. When the doctors said he was transsexual, I felt that I knew that.”

After hearing Lyle’s stories about his hated girl name, his astonished, frightened tears and protracted battles over party dresses, Mary Janes, and even girl-styled polo shirts, and his deep, early sense of male identity—the same stories I would later hear, with minor variations, from almost every transsexual man I spoke with—I ask him about life since the transition. He gives me a glossy friend-filled account highlighted by a two-year romance with an older woman (twenty, to his seventeen) and a successful football career cut short by an ankle injury.

And after high school?

Finally, a bit of trouble: “I had a little money problem and a little drug problem. I got some counseling, came back from Las Vegas, started college. Now I’m taking classes, paying off my bills, working for the state. Eventually, I’ll get my bachelor’s.”

He sighs, and Jessie says quickly, “That’s all right. Lots of older kids are in college these days. Aren’t they?” I say I know quite a few, and we sip our iced tea.