Written by Anastacia Tomson, with additional reporting by Kim Bell for Longevity magazine.
I rifled slowly through the racks of dresses, feeling the different fabrics between my fingers. It had been months since I had last been in the men’s section, long enough that the memories had started to fade, but I was sure that those textiles had never felt quite as soft as these.
“Good day, ma’am,” the shop assistant chimed. “Anything I can help you with?” After 29 years of being called “sir”, one might have expected that this new epithet would feel alien or foreign. The truth is, it felt anything but. For nearly three decades I had kept up the pretense, and I became quite the skilled actor. But “sir” had always jarred me, even before I was able to understand why.
Anastacia Tomson’s Childhood Experience:
My upbringing, by all accounts, had been a rather cloistered one. I attended a conservative Jewish school, one that separated boys from girls before puberty began to rear its troublesome head. I lived far away from my classmates, and my social interactions outside of school hours were limited, to say the least.
I was a quiet youth, occupying myself with pursuits as noiselessly as possible, so as to attract the least amount of attention from an overbearing and domineering father. Outside of school hours, I’d read, explore the still-young Internet, or watch more TV than a child should. On occasion I’d write, one of the few artistic fields in which I had any talent. Britney Spears, Sarah McLachlan and Michelle Branch would keep me company in my hours of solitude.
I didn’t know the explicit details of what my classmates got up to in those days – what I did know was that I didn’t especially want any part of it. I was never very good at “hanging out with the boys” – they seemed always to be talking about sex, making vulgar jokes, or bullying each other mercilessly. At the time, I suppose I’d just considered myself to be above that sort of juvenile behaviour; it never really made much sense to me, and that never really worried me.
The High School Hallways:
I’m sure that high school was made easier for me by virtue of my intellect. I was always at, or close to, the top of my class, and I was always quite forthcoming when it came to helping those less gifted than myself. My acumen at school was a commodity that I used to my advantage, exploiting it to ensure my passage through the unforgiving single-sex school halls was utterly uneventful, despite my woeful inability to fit in.
University was a slightly easier prospect. Moving from a class of 30 to a class of more than 200 afforded me a degree of anonymity that came as a tremendous relief. I always felt the eyes of the world upon me, and this was an opportunity to blend in and disappear. Initially, I was somewhat of a lone wolf, eschewing whatever opportunities I might have had to make friends and meet people. I kept to myself, as I had become so accustomed to doing. When I was forced to find a group to slot in with, I gravitated to one predominantly comprising girls. It didn’t occur to me at the time, but none of them were the least bit threatened by my presence.
At this stage, it was still difficult to put my finger on what exactly it was about me that didn’t fit. I would rationalize and make excuses. I told myself that I was just different from most other men, and I reassured myself that it was okay. I avoided my male classmates, knowing that I felt uncomfortable around them, and recognising that I needed to put on an act to try to avoid their scrutiny. But I failed to realise just how unusual that was. Subconsciously, I normalised the abnormal, and I did so with finesse, never missing a step or stopping to question myself.
I declined invitations to bachelor parties, boys’ weekends, strip clubs and golf courses. I accepted invitations to watch the ballet, and I enviously longed to be a part of my friends’ kitchen teas. My jaw dropped in horror when friends related stories of how they’d been objectified, harassed or mistreated by the men in their lives. I struggled to understand the behaviour of “men”, a group I’d been conditioned to identify with, despite how foreign it always felt to do so.
I reminded myself that I was “not like other guys”, and convinced myself that was enough to answer or avoid all of the uncomfortable questions I should have been asking myself.And all the while, that pervasive feeling of discomfort and unease continued to grow, insidious and unrelenting. I had to muster my courage even just to walk out my front door to go the shops, gripped constantly by an ambiguous anxiety – the sensation of being watched and scrutinised, and measured against some bizarre metric that never made any sense to me.
Transgender in The World Of Medicine:
As a profession, medicine was no comfort. The demographics of doctors might be shifting, but the establishment itself remains an old boys’ club. It’s a field in which endurance and machismo are prized above empathy and self-care. It’s admirable, even noble, to work until your body collapses, to withstand the most inhumane of conditions, and to avoid, at all costs, any kind of meaningful communication.
Patients are to be seen and treated as objects, not people. Problems of anatomy are solved by knives, and problems of biology by pills. It’s a discipline of hammers and nails, nuts and bolts, wrenches and saws. The rigorous hours of internship and community service in a rural hospital left me with little time or energy to devote to the pursuit of furthering my understanding of myself. All I knew was that I again avoided the men as best I could, because I found it tiring to maintain the pretense of fitting in, and I needed all the energy I could muster just to keep myself from burning out.
And still, the abnormal was normal. I had taken it for granted, as so many of us do, that sex and gender were one and the same, entwined completely and definitively and inflexibly. Boys and girls were differentiated at birth on the basis of their genitalia, and there were no circumstances under which that designation could be erroneous.
The Vocabulary That Set Her Free:
I had lacked the vocabulary, the frame of reference and the knowledge of concepts that are supposed to be fundamental with which to interpret my experiences. Those words and those concepts were the keys that unlocked mysteries with which I had struggled all my life. They made sense of the confusion, they illuminated the murky darkness that I clumsily tried to navigate for so many years.
The body and the mind are not always in congruence. Gender and sex are cousins, not twins. “Identity”, “expression”, “binary”, “genderqueer”, “gender nonconforming”, “transgender”, “dysphoria” – it was a whole other language. But it was one that gave credibility and validation to experiences that I had relegated to the deepest recesses of my subconscious. There were words for what I was feeling, and what I had always felt. There were others who had felt this way before me.
The abnormal was, in fact, normal – just not in the way I had always tried to convince myself. I toyed briefly with the notion that I might be non-binary. That, deep down, perhaps some part of me did, actually, identify as male. That maybe there would be no necessity for me to transition, that I could live some part-time life in between two genders, and be satisfied and comfortable, and at ease. Those ideas were quickly dispelled by my growing dysphoria.
Dysphoria As Part of The Transgender Experience:
Dysphoria is a demon and a trickster. I often call it a shape shifter. It lurks in shadows and dark corners, gnawing away quietly, but incessantly. The sensation of being watched, of being judged, of feeling out of place in my own skin – that was dysphoria. And now that I knew what it was, and where it came from, it manifested so much more clearly. Now it pointed out the flaws with my body – the thin, wiry hairs that covered my body, the flatness of my chest, the straight edges of my hips. The coarse stubble and the rough skin and the bulky arms. The “sirs” and the “misters” and the “howzit bros”.
The expectations of society as to what makes a man, and the unshakable feeling that those measurements should never have been applicable to me. I knew I had to reconcile my body with my sense of self and my identity. I admitted to myself that anything “male” felt foreign, and uncomfortable, even painful. I knew that I needed to transition, and I knew that, although the path might be difficult and grueling, it was a journey that would save my life.
I began seeing psychiatrists and psychologists, jumping through the requisite hoops to “prove” myself worthy of medical intervention – in a healthcare system that fixates itself on gatekeeping, paralysed by fear of prescribing hormones to people who don’t need them, but oblivious to the danger of withholding that potentially life-saving treatment from people who do.
The process took a few months, but it felt like an eternity before I was finally given the “medical approval” to start hormonal therapy. I’d resisted the strong temptation to self-medicate, despite the ease with which I could have. I knew that I wanted to undertake this journey with as much support, professional and personal, as I could.
I earnestly began taking the medication that would rectify the horrific hormonal mismatch of which I had been a victim for nearly 30 years.And once I’d started, I knew the next step would be disclosure. To face up to those closest to me, family and friends, and tell them this startling, shocking, horrifying truth about myself.
Coming Out To Family & Friends:
Coming out is not a singular event. I came out to my mother, to my brother, to my employer. To high-school friends and university classmates. To doctors and therapists and acquaintances from the Internet. It’s a process that never ends, and a process that never gets easier. The anticipation and the dread and the fear don’t ever subside, and the consequences never become predictable. It’s a crap-shoot more than it is a precise surgical strike.
On occasion, I met with acceptance from the outset. More frequently, I met with shock or surprise. Sometimes I met with hostility. The common thread was my overwhelming sense of relief and liberation that followed the anxious admission. The truth freed and empowered me.
Barriers that had always stood between me and my loved ones came crashing down – I no longer needed to keep them at a distance, afraid of what they might see if they got too close. For the first time, I knowingly confronted what I had always perceived as abnormal and consciously made it normal – this was who I was, and it was not a thing to hide or a thing of which to be ashamed.
As my body began to change, and I grew into myself, my confidence started to blossom. I finally felt like myself instead of someone else. I set free the body language and mannerisms that I had worked so hard to suppress. I allowed myself to be expressive, warm, compassionate and authentic. Fuller hips, budding breasts and softening skin made me more comfortable in my own body. I began to rebuild the relationships that dysphoria had caused me to neglect. Hope and optimism gradually replaced despair and self-doubt, and it became easier by the day to look at myself in the mirror.
The Transgender Transition:
Transition is a life-long journey, and one that is often arduous. It’s a commitment to lifelong medical treatment; it’s hours of painful laser hair removal; it’s being forced to answer humiliating and invasive questions from the clerks at Home Affairs in order to have your official documentation line up with your identity. It’s a constant battle against societal norms and prejudices – a fight to constantly establish your humanity in the face of those who would deprive you of it.
I picked out a light-blue dress off the rack, admiring the floral print as I ran my fingers over the soft fabric. “I’ve found what I want, thanks,” I said as I beamed a smile back at the shop assistant. I nodded in appreciation as she pointed the way to the fitting rooms, scarcely giving me a second glance. Though I loved the colour and the print, I had my doubts about the dress – empire lines seldom do much to flatter me. It didn’t matter if the dress didn’t fit; I was fortunate now to live a life in which almost everything else does.
The Facts on A Transgender Transition:
The decision to transition is not one to be taken lightly, and involves a holistic team of doctors and specialists who need to be understanding and open. According to the American Medical Student Association (AMSA), transgender is an umbrella term, but is often used by those who feel comfortable in a gender they were not biologically assigned to at birth. Many use the shorthand “trans”, and for every person, the journey is a unique one, which doesn’t always have a fixed beginning or end.
Some will take hormones or undergo surgeries to feel more comfortable in their bodies; others won’t. But whether someone has undergone treatments, surgeries and other adjustments or not, or whether they want to or not, does not affect their identity as being transgender and the person they know they are. Descriptors male-to-female (MTF) and female-to-male (FTM) are often used, as are transgender man or transgender woman.
The terms cisgender male and cisgender female are often used to refer to non-transgender people. As the AMSA states, doctors and healthcare professionals should allow patients to define the way they see their own identity, without making assumptions. The journey starts with the decision to transition by the individual person; this is followed by a diagnosis by a psychiatrist or psychologist.
There is still much controversy surrounding transgender identity and the field of mental health, reports the AMSA. Currently, transgender people are diagnosed as having gender dysphoria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. However, many believe that transgender identity is not a mental disorder, and should rather have a medical diagnosis. Nevertheless, says the AMSA, the social stigma associated with identity can create difficult situations for those who have transgender feelings.
Many of those who are transitioning choose to take hormones so that their bodies more fully match their gender identity. Those who seek hormone treatment don’t always want to do so through a doctor, choosing instead to buy over the Internet, or, worse still, using the contraceptive pill in order to self medicate.
Hormone therapy should take place under the guidance of an understanding medical professional. This is usually done through an endocrinologist or GP, but needs to be done with a specialist who has experience in dealing with hormones.
Hormone therapy is much like hormone replacement therapy undergone by perimenopausal and menopausal women and andropausal men. The concept is similar: you are replacing hormones that are currently deficient in your system. The side effects are again much the same, which means you may be at risk of stroke, clots, etc. However, for many transgender men and women, these side-effects are far outweighed by the feeling of being more complete and more comfortable in their skin. There is not enough research to know if bio-identical hormones are better or the same as synthetic hormones.
The World Professional Association for Transgender Health (WPATH), in its Standards of Care, no longer requires you to live full time in your experienced gender as a prerequisite for treatment.
However, many doctors still believe this is a necessary requirement. Dr Maddie Deutsch, speaking at the 2008 Gay and Lesbian Medical Association Conference, recommended that patients have more autonomy, using “informed consent” for those adults who desire hormone treatment.
Many may choose aesthetic and plastic surgery, along with voice lessons, so that their physical body better resembles the person they are on the inside. More often than not, the sexual organs remain the same as their birth gender, due to the specific nature of the surgery involved in this. Not only is this surgery extremely expensive, but not many surgeons locally are skilled or experienced enough in this field, leading to patients seeking surgeries in Thailand. These gender-affirming surgeries have a long and sometimes complicated recovery process, and you are not guaranteed that you will be happy with the results. The risks are many, and include losing nerve sensation.
The AMSA says surgeries for affirmed males include “top” surgery, which is the conversion of the chest from female appearance to male appearance, hysterectomy, metoidioplasty (release of the suspensory ligament of the clitoris to create a small phallus without standing urination), ring metoidioplasty (rearrangement of the urethra so that standing urination is possible through a small phallus), testicular implants, and phalloplasty (creation of a penis from skin on another part of the body, such as the forearm). Surgeries for affirmed females include breast augmentation, genital surgery (creation of a vagina, labia and clitoris), and tracheal shave (reduction of the thyroid cartilage to minimize the “Adam’s apple”). Anastacia adds that it is important to understand that an individual’s gender identity is not contingent on surgery to validate. She adds that there are varying reasons, including health conditions, that may preclude surgery. But this doesn’t make anyone less trans because they haven’t had surgical intervention. “It’s about being who you are on the inside.”
The other issue that transgender men and women face is that their internal organs still remain the gender they were assigned at birth. This can become problematic, as if you don’t find a doctor or specialist you are comfortable with, you may avoid routine, and very necessary, checkups. The AMSA says an affirmed male may still have a cervix, in which case he will need to go for annual pap smears, while an affirmed female will most likely still have a prostate, and so she will need to be screened for prostate cancer at the appropriate times and age. It is therefore important that you find a medical team to whom you can relate, and which understands the sensitivities and how vulnerable you may be.
There are resources available to those who wish to find out more. These include:
- http://www.facebook.com/doc.ana.tomson or Twitter @anaphylaxus
- CtrlAltGender: Twitter @CtrlAltGender and Facebook: CtrlAltGender