I am a transsexual woman. Now that I am past most of the public-disclosure stage of my transition, I am gradually making available as resources some of the documents I wrote to help people process my transition. I was going to do this in essentially chronological order, but I’m moving this one to the head of the queue because so many people have asked my wife and me for introductory Trans material, and since I’m picky enough to write my own, I’m also cussed enough to want to refer people to my own. Other people’s, of course, remain available via Google.
This first installment is based on what I handed out to key administrators in my workplace and at my children’s schools. However, because the audience for this is less focused, I have added information and elaboration, and made some jargon more generic. I reserve the right to edit this for clarity and in response to concerns, so that it is a living resource.
I give permission to trans people and allies to use this content as they see fit to aid someone’s transition or to educate. If you quote it directly, I would appreciate attribution. Thanks.
Grace’s Transsexuality 101: An Introduction to Transsexuality and Some Answers to Frequently Asked Questions
This presents my experience of my own transsexuality, and my current understanding of transsexuality in general. Others’ experiences will differ from mine in important and valid ways. Also, because this is introductory material it necessarily elides some finer points.
The greatest obstacle to discovery is not ignorance — it is the illusion of knowledge.
–Daniel J. Boorstin
…not well-understood by almost anyone, though almost everyone feels free to offer an opinion.
Transsexuality is when the gender you were assigned at birth does not match your own mental and psychological experience of yourself, and that causes you enough discomfort that you must physically modify your body to address that discomfort. The discomfort is called “gender dysphoria”. For instance, a person who is outwardly male may experience herself as female. If such a person transitions from living publicly as male to living publicly as female, she is transsexual. A broader term, which includes any gender-variant people, is “transgender”.
gender is like underwear: if it fits ya don’t notice. If it doesn’t you can’t avoid noticing
–LaughrioTgirl, via Twitter
Cissexuality is when your experience of yourself matches what you were assigned at birth.1
A trans woman is an adult who identifies as a woman but who was assigned as male at birth.4
A trans man is an adult who identifies as a man but who was assigned as female at birth.5
Transsexuality is more common than most people think. A good estimate of the lowest possible rate is 1 in 2000, and it’s more probable that the rate is 1 in 500 (which equals 4 in 2000). That means that in a city with a population around 14,000, there would be around 28 transsexual residents.
There are a lot of us around. Even if you know you’ve met transsexual people, you’ve also interacted with us many times without knowing it.
Transsexuality is NOT…
… sexual orientation. A transsexual person can have any sexual orientation.
It’s is not about whom you want to go to bed with; it’s about whom you want to live as.
Transsexuality is ALSO NOT…
… a mental illness or psychological disorder. It is a medical condition. For most transsexual people the main problem is not within ourselves – the problem is how people treat us.
[Gender dysphoria] is not a mental illness. It’s in the [Diagnostic and Statistical Manual of Mental Disorders IV] — but if you smoke, that’s nicotine dependence, and you’re in the book, too. There are a lot of things in the DSM-IV that aren’t really mental illnesses.
–Dr. Frederick Peterson
Because current medical protocols reference the DSM6, gender dysphoria must remain in the DSM in some form. Otherwise, transsexual people would be denied necessary medical care. If not for that, gender dysphoria would probably be removed from the DSM entirely.
Gender dysphoria is a condition that can be treated rather easily. You don’t need to be a rocket scientist to take care of a transgender patient.
–Dr. Norman Spack, endocrinologist
Transsexuality is CERTAINLY NOT…
…pedophilia, bestiality, or any other immoral sexual attraction. People who believe it is are misinformed, to put it as charitably as possible. Trans people are as offended and outraged by assumptions like these as anyone else would be.
So you are experiencing gender dysphoria.
What do you DO with that?
Sometimes the dysphoria is not sufficiently intense, and the person chooses to live with it rather than take on the very real risks of transition.7 If the dysphoria is intense enough to indicate medical intervention, then there is a standard protocol.
It starts with talk therapy. Talk therapy won’t make the mind and body match, but it can be very helpful in unravelling and healing the caustic effects Western society has on people growing up and living with gender dysphoria.
I think it does something to people, to grow up transgendered in this world. It does something to grow up knowing you are considered expendable if not an abomination, that crimes committed against you don’t matter, that laws aren’t for you, that futures aren’t. It does something knowing that in most places the best you can hope for is to be a punchline, and the worst a pulped, shattered, ragged statistic.
—little light, blogger and trans woman
Talk therapy can also help people with minimal dysphoria adapt to it and live with it, as the lesser of two evils, because transition is expensive, involves medical risks, and can cost you your job or your life. But people with more dysphoria will need to take further steps.
Those next steps may include cross-hormone therapy and surgery. Most transsexual women need estrogen, and often androgen inhibitors. Eliminating facial hair requires several hundred hours of electrolysis.8 Cross-hormone therapy will cause the development of secondary sex characteristics for the target gender. For transsexual women, that includes development of breasts, fat redistribution, diminution of body hair (but not facial hair), less upper-body strength, and partial reversal of male-pattern baldness. For transsexual men, that includes a dropping voice, development of facial hair, possible development of male-pattern baldness, and increased muscle mass. Unfortunately, cross-hormone therapy does not UNdevelop secondary sex characteristics which have already developed. Transsexual women must deal with male skeletal structure, facial hair, and deeper voice. Transsexual men must deal with breasts, shorter average stature, wider hips and narrower shoulders. Many transsexual women undergo facial feminization surgery to be able to present as female socially. Transsexual women have to work hard to learn to speak with a female voice.
But I knew, like a lot of trans partners know, that trans people are not crazy, that they’re sometimes confused — as are we all — and sometimes they’re depressed — as are we all — and sometimes they’re angry — as are we all. And they had their reasons, and in fact were astonishingly rational considering the hand of cards they’d been dealt.
—Helen Boyd, author and trans partner
Many transsexual people opt for genital surgery, but not all. People tend to fixate on “the surgery”, by which they always mean genital surgery9, and believe that it is the essential step. For most transsexual people it is not the essential step, though it is often a very important step. Many never have genital surgery at all. Transsexual men have no really good surgeries available, and the existing surgeries are expensive. Many transsexual women cannot afford genital surgery. Genital surgery is not covered by most medical care plans because it is commonly regarded incorrectly as cosmetic surgery, and insurance companies working to compete in the marketplace will limit payouts in any way they can. Some transsexual people have other medical problems which make surgery too dangerous or impossible, but that doesn’t make them not transsexual. In the end, for social transition, genital surgery is the least important step; there are very few situations where other people see your genitals.
Aren’t all of these physical changes drastic?
Why not just treat it with talk therapy alone?
How many hours of therapy do you think it would take to get you to identify, sincerely and happily, as a different gender?
Do you think it could be done at all?
Talk therapy can’t change gender identity. It has been tried with many thousands of people, for decades, and the success rate is essentially zero. The methods involved are essentially the same as the methods used for “reparative therapy” of gay and lesbian people, which are so ineffective that they are now classified as unethical by the American Psychological Association.
Many people who do not understand transsexuality assume that a transsexual person needs therapy. After all, you can look right at them and see what sex they are, right? If, for some reason, they can’t figure it out for themselves, well, they’re obviously confused and we should send them to a psychologist until they see what we see. We all judge people by what we can see. And when you look at a transsexual woman who has not transitioned, you’ll probably assign her a male gender. To you, the outside observer, that has more reality than what the person tells you. You can see that. You can touch that. You believe the evidence of your senses.
But every human being is more than what people can see when they look at her. Every human being has thoughts, desires, and experiences which no one else knows, and which she couldn’t articulate if she tried.
Which is more important, the body, or the mind, the soul?
Which defines what a person is, at their most essential?
You don’t have a Soul. You are a Soul. You have a body.
–C. S. Lewis
For a person who is born missing a hand, the best treatment could be to give her one (if she wanted one). We cannot create fully-functional limbs, so we do the best we can with prostheses.
What we do not do is say to that person, “Look, you have one hand. It can’t be changed. You’re just going to have to learn to accept it, no matter how difficult that is. Here’s a therapist who will help you to understand that.” And yet, that is what some people want transsexual people to do: we should seek therapy and learn to be happy in the bodies we have.
We’ve tried. How we’ve tried. Every transsexual person out there has tried to adapt to society’s dictates, and found that he or she couldn’t. That’s what dysphoria is.
If someone’s legs are not the same length, which leg is “wrong”? The problem is not the lengths; it is the mismatch. The most practical solution is to alter whichever leg can be treated most effectively. So we lengthen the short leg with a shoe insert. We don’t cut the long one short.
For transsexual people, the body is like the shorter leg. There is no way to change gender identity, but we have some very effective methods for changing bodies.
So, a transsexual person is faced with an intolerable conflict between how she knows she is at her deepest core, and how she looks on the outside and presents in society. She cannot reliably change her core, however much she tries. But she can alter her body and make it a better fit for her mind.
Small wonder that she might choose to do so.
…from the standpoint of people who reject the gender they were assigned at birth, transition and its related activities can be seen as taking what has been inside and bringing it out into the world for others to experience. The brain is ordered, it is simply that the brain’s orderliness is obscured for others by the screen of our bodies. In this sense, transition isn’t changing so much as revealing.
–Diana Powe, retired police officer and trans woman
Well, this isn’t something I would choose to do, but…
Of course not. You’re not transsexual.
I didn’t choose to be transsexual. I am choosing, in a sense, to transition…
We cannot change the cards we’re dealt — just how we play the hand.
–Randy Pausch, diagnosed with pancreatic cancer at 45 and dead at 46
Gender dysphoria is a matter of constant discomfort. For some of us, the discomfort is enough that we have to transition.
It’s a bit like a degenerating joint. If your shoulder is painful and is getting progressively worse, you can get by for awhile. Your limit your activities and range of motion. You take pain meds. On any given day, you can get by for another day. But if it’s getting more painful every day, eventually you opt for surgery, even though surgery has risks and even though surgery and physical therapy are also painful and limiting for awhile.
Did you choose surgery? In a sense, yes. You could have gone another day. But also in a sense, no: for some people, the pain grows to make them so miserable, or becomes so debilitating, that they opt for surgery.
Someone with a degenerating shoulder didn’t choose to be arthritic, but they can choose surgery to address it.
The same is true of gender dysphoria.
How is your wife with this?
She is fine with it. Our marriage has always been strong, and never stronger than in the last few years, as I have started to transition. She was my editor for this document.10
How are your kids with this?
They’re fine with it. They’ve known since they were very young. When we came to understand that I would be transitioning someday, my wife and I discussed the alternatives we faced: we could model living with something difficult, or we could model lying to our closest, most beloved family members. We chose not to lie to them. We have worked with their community of faith and are now working with their teachers to ensure that they have broad support.
Our kids have known since they were 3-5 years old. Here is how you explain this in age-appropriate language: You know that most people have a boy body or a girl body. Some people also have a boy spirit or a girl spirit. Most people with boy spirits have a boy body, and most people with girl spirits have a girl body, but a few people with a boy spirit have a girl body, and a few people with a girl spirit have a boy body. Some of those people find out that in order to be happy, they have to change their bodies to match their spirits.
After that, we simply answered their questions as they asked them.11
How are your friends with this?
My friends have been great. Not a single one has rejected me. One of my closest friends, not long after I came out to him, asked me to stand up with him at his wedding, and I did.
The above paragraph was what went in the Trans 101 document we handed out. It was true. (And, even if it were not true, I would not dwell on the haters in my Trans 101 document, where I’m trying to model acceptance.) As of this writing, it is still true. However, my experience in this regard is so opposite to the general lived experience of other trans people as to be genuinely bizarre. Many of the trans people who advised me prior to transition, or whose experiences I read about, recommended that I be ready to lose everything: job, all family, all friends. I’m going to try to explore why I think this didn’t happen to me, but it’s outside the scope of this post.
For this post, let me suggest some support resources which have been helpful to me:
The My Husband Betty boards. Helen Boyd is a fantastic thinker and writer, author of My Husband Betty and She’s Not The Man I Married. (If you want insightful personal experience from a trans ally, coupled with academic rigor, these books are for you.) She and her spouse, Rachel Crow, founded and run an online forum which is open to both trans people and their partners. The level of discussion is consistently high, and often scathingly honest. This is not your pink fuzzy cheerleading support group; it’s your challenging, engaging, thought-provoking support group. Trans men and their partners are welcome, but in practice seldom seen on these boards.
TCOPS-International. I’m a police officer. Historically, trans people have suffered a lot at the hands of police officers who were acting out their own bigotries or enacting the institutional and cultural bigotries they were given. This suffering is real. At the same time, there are many honorable police officers out there who have not done such things or who have learned not to do them and repudiated them. These officers, in trans circles, can run into blowback in trans communities, which makes it difficult to get support. TCOPS is an organization of trans-identified police officers and police support personnel, and Words cannot express how important it was for me to be able to talk to people who understood BOTH what it’s like to be a cop and what it’s like to be trans.
( TEMS-Fire. There is also a Fire/EMS equivalent group, run by the same good people. I technically qualify, but my credentials were in a box somewhere and I never joined. It looks like it might be moribund, but sometimes all it takes is a new member to get things moving again.)
What causes transsexuality?
I will address this question in detail in a later post.12 Bottom line: the question itself is gravely problematical, and we don’t know the answer, but there is enough scientific evidence to suggest that (a) transsexuality, like cissexuality, is within normal human variation and (b) gender identity arises, or can arise, physiologically.
So you’re transsexual! That’s pretty funny!
Yes, there are parts of it which are funny, and sometimes I have to laugh. There are also parts of it which are no fun at all, mainly due to how a lot of people treat transsexual people. If you feel compelled to joke about it, I’ll do my best to be a good sport, but please keep an eye on how I’m taking it. Thanks.
Hey, have you heard the one about the tranny who…
Stop. Yes. I’ve probably heard it. I don’t want to hear it again.
Also, please be aware that the word “tranny” is offensive to many transsexual people, similar to how the “n-word” is offensive to many people of color. If you use it after this point, I’m probably going to be offended.
So what happens next?
[Note: I drafted this section, but we did not use it. Instead, we included this information in a “Letter to Coworkers”, which I will post later in the series. However, some of my editors thought that this section should be included for people who are going to use this as a model or guide, so I present it here, too.]
For the last several years, I’ve transitioned in private, and I’ve gone as far as that will take me. The next steps will have to be visible. I’ve been working with our administration to do this in the most professional way possible, to minimize disruption. I have spent an enormous amount of time and effort to make this work smoothly for everyone. I am committed to making this work. For instance, I have been on cross-hormone therapy for almost three years, which means that the levels of testosterone and estrogens in my body have been female-normal for almost that long. That makes it a lot harder to maintain or gain upper body strength. Despite that, during those years, I have passed my physical evaluations. It hasn’t been easy, but I’ve put in the hard work to make it happen.
With your help and the help of our coworkers, everyone will process this for awhile and then we’ll all go back to more important things. I just need you to accept me and work with me.
In the near future, I’ll start presenting full-time as a woman, including at work. This will involves logistics which we are still working on. One of these is that I should be referred to with female pronouns, and called by my soon-to-be-legally-recognized name, Grace. There will be awkward moments, and at times I will make mistakes. You probably will, too, but as long as you’re trying I’ll be happy.
I still don’t get it.
That’s okay. It’s not an easy topic, and at the most visceral level, it’s probably impossible to understand it without being trans yourself. If you want to grapple with it, I would suggest that you identify those areas which seem strangest, at first blush, and try to answer the questions which pop to mind first. As long as you are willing to examine that sort of thing closely, you’ll probably do fine.
The role of gender in society is the most complicated thing I’ve ever spent a lot of time learning about, and I’ve spent a lot of time learning about quantum mechanics.
The main thing: I’m a contributing member of our community. I want to be judged by my actions and my job performance, not by something in my background which I can’t change.
And so it is those we live with and should know who elude us. But we can still love them — we can love completely without complete understanding.
–Norman Maclean, in A River Runs Through It
Comments rules for this series:
1. In this series, I am not going to debate my right to exist or my sanity. Comments which do that to me or to any other trans people will probably be deleted, and get the poster banned. If you cannot control this impulse, vent it somewhere else on the Internet. This is your only warning. I will not debate this. If you feel insulted by this or do not understand why I must be so emphatic about it, know that you have enjoyed a sheltered life, at least in this respect.
2. Do not comment until you have read all the comments, or the first two hundred, whichever comes first. By the time there are that many comments, it is almost certain that someone has already said what you are about to say
, and better.
- This term is new, and still sometimes hotly debated. Many trans people like it because it normalizes “transsexuality”; without it, there is “transsexual” and “normal majority which needs no label”. Imagine if we had the words “gay” and “homosexual”, but not the words “straight” and “heterosexual”. Some people object to being labelled “cissexual”, and most of those do it from a position of privilege. At least one person whose thinking and writing I respect very much dislikes “cis” as a descriptor for herself, though I don’t recall if she draws the same line with the more particular “cissexual” and “cisgender”. Note also that there is arguably room for people to be neither transsexual nor cissexual, but that discussion is beyond the scope of this document. [↩]
- There is a strident minority of transsexual people who object to being classified in any way whatsoever with anyone other than people who are transsexual by their own definition, which is usually carefully calibrated to include themselves and omit as many others as possible. These people have a curious and irritating inability to understand the concept of a Venn diagram. [↩]
- I did not include transgender in the original document, exactly because I did not want to get into the fight over terminology or the fight over crossdressers. I am perfectly willing to discuss these topics elsewhere, but in this introductory document I could not give the topics the attention they deserve, and as I am not a crossdresser the fight was not directly relevant to my transition situation. [↩]
- The term is deliberately vague as to whether the person it identifies is transsexual or transgender. Many of us are tired of that fight, and sidestep it thus. [↩]
- The term is deliberately vague as to whether the person it identifies is transsexual or transgender. Many of us are tired of that fight, and sidestep it thus. [↩]
- The Diagnostic and Statistical Manual of Mental Disorders. The current edition is IV, and 5 is about to be published. In 5, the have renamed “Gender Identity Disorder” as “Gender Dysphoria”. This is a step in the right direction. [↩]
- Most people would say that such a person is not transsexual. However, note that some people can adapt for a period of time, but then find that they must transition, so they turn out to be transsexual after all. Other people may be transsexual but did not have a chance to transition in their particular circumstances. Some people are fond of labelling other people as trans enough or not trans enough without consulting the people they are labelling, and that can be very damaging. That’s not what I’m doing here, in providing general definitions. [↩]
- I am at over 200 hours, and counting – pretty close to done. Some people with very dense, tough facial hair have required upwards of 400 hours. [↩]
- Also called SRS (Sex Reassignment Surgery), GRS (Gender Reassignment Surgery), or, rarely, GCS (Gender Confirmation Surgery). [↩]
- Transition strains marriages, for many reasons beyond the scope of this post. Most don’t survive, though some do, and it is becoming more common. The best online resource I have found to help trans people and trans partners with their relationships is the My Husband Betty discussion boards. [↩]
- My wife intends to write a more comprehensive post on this topic for later in this series. [↩]
- In my original packet, there was a section on the science, but I am breaking that out into a separate post. [↩]