Transsexualism at Sixty: Part II

©2013 by Dallas Denny

Source: Denny, Dallas. (2013, February). Transsexualism at sixty: Part II. TG Forum.

I’ve been taking a look at a paper I wrote twenty years ago. Forty years had passed since Christine Jorgensen’s return to the U.S. after sex reassignment in Denmark and the world went crazy for five minutes, so I called the piece Transsexualism at Forty. Now my paper is twenty years old and transsexualism is sixty.

 Last month’s column launched the retrospective; this month I finish what I started.

Observation 7: Transsexualism is an Industry

I wrote:

The system which arose to replace the university-based gender clinics is based on free enterprise. Physicians are not constrained by the experimental model; this allows them to treat their transsexual clientele as patients, rather than as subjects. An army of caregivers–psychologists, psychiatrists, endocrinologists, surgeons, electrologists, aestheticians, and others–has arisen to meet the needs of those seeking treatment, and organizations such as the Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA) have formed to regulate treatment practices.

One look at a Saturday speaker’s schedule at a transgender conference like Southern Comfort yields instant proof that providing transsexual people with medical care can be lucrative. Saturday is industrial day; it’s when all the surgeons speak.

SRS isn’t cheap (well, mine was, relatively, but I’ll save that tale for another time). These days a vaginoplasty can cost $40,000 or more. Plastic procedures like breast enhancement, facial feminization, and laryngoplasty for male-to-females and male chest contouring and metadoioplasty for FTMs are expensive too—so much so that surgeons from all across North America travel to transgender conferences to give talks about their procedures—and, not coincidentally, line up prospective patients for surgery. More likely than not, a free assessment results in a future patient. It’s a cost-effective prospecting trip for surgeons.

Every transsexual who takes human sex hormones — aside from the fools — gets a prescription from a physician. Optimally, that physician will be an endocrinologist. Half a dozen endocrinologists here in Atlanta have one or more transpeople in their waiting rooms at any time. Their trans clients pay the bills on their Porsches. I dare say most American cities have at least one physician with a similar practice.

Because transsexualism can be — to say the least — emotionally devastating, it’s a good idea to see a therapist from time to time, especially while in transition. But even those who don’t want therapists require them; the WPATH Standards of Care require mental health professionals to sign off on hormones and genital surgery.

While they’re not averse to meeting prospective clients, therapists don’t actively fish for them the way physicians do. They’re not allowed to recruit patients — nor are they allowed to divulge the names of existing patients. By way of contrast, one year at Southern Comfort I saw five carefully made-up, blonde women walking behind facial surgeon Douglas Ousterhout; they looked rather like baby ducks following a parent, partially because having had the same work done on their faces, they looked rather like sisters. This is not a dig at Dr. Ousterhout; he does good work and, unlike therapists, plastic surgeons are allowed to socialize with former patients. Ethical therapists won’t even acknowledge a client or former client unless that client initiates. But there are plenty of therapists at trans conferences, and more than a few specialize and derive a sizable portion of their income from seeing transgendered clients, most of whom are transsexual.

Electrologists don’t typically come to trans conferences, but on occasion one will give a presentation about hair removal. I assure you, male-to-female transsexuals who bother to remove their facial hair spend a LOT of money removing hair from their faces.

Many male-to-female transsexuals have electrolysis on other parts of their bodies, too — their arms, legs, chests, backs — and, since AEGIS distributed a medical advisory back in the mid-’90s, on their genital areas just before SRS.

Most electrologists have one or more transsexual clients, and some have many. Ahoova and Hannah Mischel, electrologists here in Atlanta, have extensive experience with transsexual clients. Back in the day when I was seeing them (I no longer need to, thank goodness; I was cleared more than twenty years ago), their waiting rooms were filled with mostly transsexual patients.

I would estimate that just in the U.S., some several thousand surgeons, endocrinologists, therapists, and electrologists derive most or at least a good part of their incomes from treating transsexual people. That’s not a large industry compared to say, the electronics or automotive industries, but it’s indeed an industry.

Perhaps the best indicator of the health of the treatment industry is the World Professional Association for Transgender Health. Formerly the Harry Benjamin International Gender Dysphoria Association, Inc., WPATH publishes Standards of Care for the treatment of transsexual and other transgendered people. The organization, which was more or less moribund during the 1980s, was revitalized in the 1990s and is thriving at present. If WPATH membership is any standard, professionals who specialize in treating transpeople have increased several fold since I wrote Transsexualism at Forty.

Observation 8: Transsexual People are BioPsychoSocial Engineers

I wrote:

With the help of medical and other professionals, transsexual persons physically deconstruct and reconstruct their bodies, their behavioral patterns, and their social roles in order to bring them into consonance with their gender identities. This makes them biological, psychological, and social engineers; never before in history has there been such profound self-engineering.

Back in the bad old days at the gender clinics, interdisciplinary teams comprised of physicians, psychologists, and nurses made the important life decisions for transsexuals. The team decided not only when and if their patients got the hormones and surgery they wanted, but all-to-often told them what to wear, who their friends should be, where they should work, and who to sleep with.

Ironically, even as they were being controlled by the gender clinic, transsexuals were manipulating the teams in hopes of getting hormones and surgery — and let me say, if they hadn’t policed their presentations and what they told the teams, most would never have been allowed to transition. It was absolutely necessary to game the system. If you’ve not read Sandy Stone’s eloquent essay The Empire Strikes Back, please look here.

The famous transsexual conniver was “Agnes,” a male-to-female patient of psychiatrist Robert Stoller. Unlike many of Stoller’s patients, Agnes was feminine and feminized. Stoller, who had written extensively about transsexualism, believed she had androgen insensitivity syndrome, or perhaps an estrogen-producing tumor. Nearly a decade after first coming to Stoller, Agnes admitted having been on female hormones all along. Read ethnologist Harold Garfinkel’s 1967 account here, and a later analysis by Leia Armitage here.

Things are different these days. Transsexuals make their own decisions about hormones and surgery, and plan (sometimes well, and sometimes, alas, poorly) their transitions. Partners, family, and therapists can help, but the transsexual calls the shots.

This is what, twenty years ago, I called biopsychosocial engineering. Transsexuals make decisions about their bodies (medical), make drastic changes in their lives (social), and somehow manage to cope with the resulting chaos (psychological). Every transsexual is his or her own interdisciplinary team — but then, so, back in the early 1950s, was Christine Jorgensen. She enlisted the aid of endocrinologist Christian Hamburger so she could gain access to feminizing hormones, but she called the shots all the way.

I wrote:

This human re-engineering, and not the actual genital surgery which morbidly fascinates the American populace, is the true significance of transsexual change. What is significant is not that penises and scrotums can be fashioned into vaginas or phalluses made from the skin of the arm, but that someone who is easily identifiable as a man can come to be identifiable as a woman, and vice-versa, by sheer will of self-determination (with hormonal assistance). This is exciting stuff, subject matter for science fiction stories, and it happening now, in every city in America and practically every small town in America.

I would say I called this one correctly.

Observation 9: Transsexual People Seek Change in the Face of Adversity

I wrote:

Not only are transsexual people self-designers of their new selves, but they must do their work in the face of the generalized ignorance and in the face of the hostility of society, and despite their own feelings of guilt and self-doubt. They re-engineer themselves without specialized training, usually without assistance of parents, spouses, authorities, and helping professionals, and often in the face of extreme financial adversity. They forge these new frontiers not with federal dollars in spotless laboratories, but under battlefield conditions, trying to change their bodies while simultaneously trying to preserve social relationships, get educations, keep jobs, have their teeth cleaned, and maintain the other trappings of a normal life.

The last two decades have seen an amazing change in public attitudes toward transsexualism and a dramatic increase in legal protection for job discrimination and bias-related attacks. Information, once so scarce, is now, thanks to the internet, available in quantities too great to process. And yet transsexuals continue to lose their families, their jobs, their homes, and their lives. Negotiating transition is still like walking through a minefield; things can go south at any moment, and often do. Sadly, not all that much has changed.

Observation 10: The Real Issue in Transsexualism is Freedom of the Body

I wrote:

Much more than abortion, transsexualism is the logical gameboard on which to determine the freedom of the individual to his or her own body. No other individual or potential individual is involved to cloud the issue; there is only one person, and his or her desire to change the genitals and secondary sex characteristics.

I mean because, hell, if we can’t change our sex, it isn’t America, is it?

In all seriousness, transsexuals once walked the cutting edge. There was discussion in the surgical community about the danger of being arrested for mayhem (deliberate maiming) and the ethics of cutting and removing  healthy tissue. Nowadays pretty much everyone knows what transsexualism is and treatment procedures are well-established. No surgeon is likely to be arrested for mayhem. So let’s face it, we transsexuals are not as far out there as we once were.

And who’s out there now? All those nontranssexual transgendered people blurring the edges. Think genderqueers. Think neutrois. Think off all the bigendered, trigendered, pangendered, third-gendered s/hes and sies and hirs out there inventing new gendered identities and confusing the hell out of people. I gotta say—I love it!

Observation 11: Transsexualism Does Not Occur in a Vacuum

I wrote:

[Transsexuals’] social roles demand that they fill [their pre-transition] roles in appropriately masculine and feminine ways; gender variation is not tolerated well in our society–especially in males. The discovery of mere crossdressing can shatter marriages, ruin careers, alienate parents from children. The revelation of deep-seated transsexual feelings and a wish to change gender can be devastating to the individual’s life. Transition can result in alienation and anomie, loss of job, loss of family, loss of friends, loss of status. And not only the transsexual person is affected. Everyone who knows him or her is affected.

This holds true today. Consider the emergence of gender-affirming parents who confront the issue of their young child’s transsexualism and allow transition. The family supports the child, often at considerable personal cost — usually, hostility from neighbors, school officials, other parents, and family members. And consider also the numbers of wives and husbands, sons and daughters, mothers and fathers who are emotionally affected by the coming out of a transsexual relative — and devastated when the individual transitions.

Things are better today — just.

Observation 12: Transsexual People Will Help Us To Move Toward a Gender-Just Society

I wrote:

Margaux Schaffer has said that when it is safe for a known transsexual person to function in society without harassment, without prejudice, and without discrimination, then all varieties of gender expression will be allowable, and we will have a gender-just society. In 1992, we do not have a gender-just society, although we are a lot closer than we were in 1952.

When I penned those words, society was beginning to loosen its slavish devotion to rigid John Wayne / Marilyn Monroe (Rambo/Bimbo) gender presentations. Movie stars from the ’30s and ’40s were starting to look like the caricatures of masculinity and femininity they indeed were.

Women, who had been locked out of traditionally male jobs from time immemorial, were pounding on the glass ceiling and, surprise, wearing pants while doing so. Shannon Faulkner was about to win a lawsuit against The Citadel, an all-male military school which had denied her admittance.

Not only women were changing; many men were feeling comfortable projecting a softer image. Long hair, once considered scandalous, had been commonplace for more than a decade — and NFL great Rosie Green had been crocheting for two. Manscaping and metrosexualism were a decade or so in the future,  but men were loosening up.

And yet those who transgressed gender beyond the new norms were sexually suspect and subject to disapproval in all its forms — up to and including murder. Even as gay men and lesbians began to feel more comfortable with disclosure, transgendered people felt compelled — with cause — to remain in the closet.

These days armies of activists around the world are pushing, often successfully, for trans rights. We lose some, but we win more — nondiscrimination ordinances, hate crimes laws, police sensitivity training, access to shelters, trans-friendly bathrooms and college dorms.

I’m old enough to realize that when a fight reaches this level, victory is inevitable — eventual, but inevitable. In twenty years gay marriage will be a right in every state, and the last holdout — probably Alabama or Georgia or Mississippi — will be a national embarrassment. Full rights for every transperson will no doubt take longer, but it’s coming. It’s coming. And when it arrives — when we can live our lives without being harassed, without being ridiculed, without being murdered, without losing our families and our jobs, when we finally get justice, everybody will have justice.

So there you have it: transsexualism at sixty.

If I live another twenty years, and can still write, perhaps in 2033 I’ll take another look at transsexualism. Of course I’ll call it Transsexualism at Eighty.

Tags: Activist, bias crimes, Christine Jorgensen, conference, Dallas Denny, Facial Feminization Surgery, featured, hate crimes, nondiscrimination, Plastic Surgery, Transgender, Transition, Transsexual, transsexualism

Category: Transgender Body & Soul, Transgender History