The following is a paper written by a friend who knew me before I transitioned. The paper was written for her Human Sexuality class following an interview with myself about my own experiences.
Enjoy!
Transgendered in America:
The Reality behind the Myth
Erica Smith
Human Sexuality
Dr. Piperberg
Millersville University
"There are times I had to ask myself, am I attracted to her because I want her or because I want to be her?" These words, spoken by 25-year-old pre-operative transsexual, Kelli Matthews, beautifully illustrate the internal struggle faced by the men and women living with gender identity disorder. Gender identity is defined as a person's subjective sense of being male or female (Baldwin, 2009). For persons living with gender identity disorder, given the medical name gender dysphoria, internal thoughts, emotions, and desires are not represented by their outward physical appearance. For many living with this disorder, it is the cause of a great deal of frustration, unhappiness and depression. It would be a troubling experience for many to wake up one morning in a body of the opposite sex. It is easy to imagine most of us would do just about anything to make things "right" again. This is the kind of mental experience transsexuals, a person who seeks to transition from one sex to the other by medical means, must deal with on a regular basis (Baldwin, 2009). This paper seeks to raise awareness on the subject of gender dysphoria by examining the facts, struggles and joys of the transsexual experience as told by Kelli Matthews.
The most basic assumption about sexuality is that human beings are divided into two separate and distinct categories-males and females. The Merriam-Webster dictionary defines male as the sex that produces germ cells which fertilize the eggs of a female. The same dictionary defines female as the sex that bears young (Marriam-Webster 2004). However, sexuality is far more complicated than that. There are so many levels of basic maleness and femaleness that scientists have found it necessary to formulate a set of categories to describe human sex, gender, and reproductive capacity fully and accurately (Reinisch, 1990). The Kinsey Institute has identified nine such categories but for the purposes of this paper, I will focus on two, Gender identity/role and Sexual orientation identity.
Gender identity/role deals both with how a person sees his or her self, and how a person's actions cause others to perceive them as male or female. A person's gender identity becomes established between 18 months and 3 years of age. However, this does not purport that children fully understand what it means to be male or female by this age (Reinisch, 1990). Matthews recounts how her parents helped shape her identity as a boy by directing her into masculine activities and dress: "As a baby my parents would dress me in blue clothing. My father in particular liked to buy me Penn State Nittany Lions apparel. I was always pushed toward and encouraged to play with masculine toys and given sports paraphernalia as gifts, even at an early age."
A person's enactment of gender role includes everything he or she says or does which suggests to others that he or she is a male or a female. This includes any outward expression of masculinity or femininity expected in society. It is this aspect of gender that left Matthews feeling confused and out of place in her own skin. Here she discusses this issue in her own words: "The first inkling of wanting to be female was around age 4. I remember, very vividly, being alone playing typical make believe games. I would get "flashes" of myself as a girl in my mind. Even at age 4, the anatomical "bits" that I had seemed so foreign, as if they didn't belong. As I got older, around age 8, I would secretly experiment with my grandmother's makeup. Puberty for me was absolute Hell. Hair started growing in unwanted places and my voice began changing. I remember hoping my "bits" would grow inward during puberty; I would actually try to push them back inside of me. I always felt jealous of the little girls, even in kindergarten. They were pretty, they were soft, and they got to wear dresses. They could be cheerful, gentle, nurturing. But even at that young age, society expects you to be something very different if you're a boy, something that I never was. On some level, I was jealous of the other little boys; they all "fit." They were at ease in the role that they were born into. I felt like a cat being called a dog. I was never what everyone expected me to be."
It is evident in Matthew's testimony that the distinction between male and female is not as cut and dry as most people would like to believe. Although completely anatomically male, Matthews' struggled every single day with a sense of alienation from her own body. Although self-identified transgendered persons are uncommon, research indicates that gender identity may have a more blurred distribution in the general population than is captured by a simple male-female dichotomy (Baldwin, 2009). Craig Kinsley, a neuroscientist at the University of Richmond, argues there is "clear and incontrovertible" evidence that biology -genes, hormones and the brain- is a major factor in creating a wide range of gender identities and sexual orientations (msnbc.com, 2005). Matthews' testimony as a transgendered individual lends strong support to the theory that gender identity is more than just a report of one's genitals. Genetic make-up, hormones, brain development, anatomy, and social and family influences all help to shape a person into the adult man or woman they will eventually become (Reinisch, 1990). It is these same factors that help guide us in our relationships with others, particularly sexual relationships, which we will now examine.
Sexual orientation identity refers to the dimension of personality that describes a person's sexual feelings toward persons of the opposite sex, same sex, or both. Research has supported the notion that, like gender, sexuality cannot be described as simply as heterosexuality and homosexuality. In his pioneering studies, Alfred Kinsey developed a 7-point scale of sexual orientation, known as the "Kinsey Scale," that ranged from group 0 (persons exclusively attracted to the opposite sex) to group 6 (persons exclusively attracted to the same sex), with the intervening groups defining various degrees of bisexuality (Baldwin, 2009). Although later research has reduced this scale to 5 points, the notion that sexual orientation falls along a continuum has remained the predominant opinion among researchers. As seen in the studies regarding gender, most scientific theories on the causes of homosexuality reflect the classic debate on whether a person's makeup is the product of biology or environment. Many researchers speculate that homosexuality is a bi-product of upbringing while others argue instead that there are physical causes, such a brain structure or hormone exposure while in the womb (Bender, 1993). Attempting to attribute a label (heterosexual or homosexual) to one's sexual preference is a much more difficult experience for a transsexual individual. It is important to stress that for transsexuals, the gender represented by their outward appearance is not the gender with which they identify, making it difficult to place a definitive label on their sexuality.
Transsexuals who share similar life histories also share similar sexual orientations. Most female to male transsexuals, who also identify by the term transmen, report feeling as though they are boys trapped in girls' bodies from a very young age. These feelings typically lead to feelings of attraction toward females. Thus they are "homosexual" with respect to their birth sex, but they do not identify as homosexual or lesbian. Rather they identify as heterosexual men (Baldwin, 2009). In the case of male to female transsexuals, otherwise known as transwomen, two contrasting types have been reported. So called "classical" transwomen report the reverse experience of most transmen. They report feeling as though they are girls trapped in boys' bodies and reject their maleness and the gender role society expects of them. These individuals are usually sexually attracted to men and identify as heterosexual women rather than homosexual men.
It is the second, lesser known, category of transwomen into which Kelli Matthews falls. These individuals tend to be only slightly gender non-conformist throughout their early years, some not at all. Many grow up sexually attracted to women, identifying as heterosexual with respect to their birth sex. It is usually during the teenage years that interest in women takes an unusual course for this class of transwomen. In many cases, this interest is colored with fetishistic elements, such as the desire to dress in drag (Baldwin 2009). Many of these individuals form healthy relationships with members of both sexes and often identify as bisexual. Here Matthews discusses this issue in her own words: "Throughout my teenage years, I had several long lasting relationships with females. It was at the end of a three year relationship with a woman that I decided to allow myself the freedom to explore the feminine feelings I had been harboring most of my life. I started going out to a gay club where I met a man who introduced me to drag. I loved the way I felt in drag. Somehow it felt normal; it felt right. Outside the club I was living androgynously and about a year later I made the decision that I wanted to transition (to a woman). I had always had a sexual fascination with men which I allowed myself to explore during that time. However, my appetite for female companions hadn't waned at all. My current relationship is with a bisexual man who accepts the fact that I still crave friendship, companionship, and physical intimacy with females. We both embrace the knowledge that both gender and sexual orientation are fluid and that is what allows our relationship to flourish."
The examination of sexual habits found in transsexuals may prove useful in the quest for a better understanding of homosexuality. There is much debate over the issue of homosexuality in America, and elsewhere, today. A May 2008 Gallup poll showed that just over half (48%) the population of the United States still considers homosexual relations immoral. This classifies homosexuality as one of the most divisive of 16 major social and cultural issues measured in the survey. Only doctor-assisted suicide and abortion come close in splitting public opinion (Saad, 2008). Perhaps a better understanding of gender will help to shed a more positive light on this highly controversial topic. Listening to the stories of transsexual men and women and the ways in which their thoughts and feelings are in opposition to their birth sex may allow for a better understanding of sexuality as an emotional, rather than purely physical, experience. These testimonies lend strong support to the notion that sexuality is not simply a choice and that variations in sexual orientation, like variations in gender identity, may instead be the result of differences in brain structure.
It is a widely accepted fact that no amount of psychiatric treatment can bring a transsexual person's gender identity into concordance with their biological sex. In fact, any attempt to do so would be experienced as a violation of personhood (Baldwin, 2009). It is for this reason that medical science has come together with therapists to create gender reassignment surgery. Gender reassignment surgery, also known as a sex change operation, is a surgical procedure that changes a person's external genital organs from those of one gender to those of another (Gale, 2006). This surgery is performed in order to help transsexual individuals create a balance between their anatomical sex and their social gender role. Gender reassignment surgery can play an extremely important role in alleviating much of the depression and anxiety associated with gender identity disorder. Here Matthews recalls the emotions surrounding her decision to begin the process: "At the beginning I was completely terrified. I wanted the desire to go away. I just wanted to be a normal male. I didn't know anyone who had undergone the process and was not sure what to expect. The loneliness I felt was tremendous. There came a point in time when I simply made the decision that I had to be true to myself. I wanted to look in the mirror and see the person I felt I was on the inside. Beginning the process was the most terrifying times in my life but it turned out to be one of the best decisions I ever made. I met others who felt like I did and, even in the earliest stages of my transition, I knew I had made the right decision."
The decision to undergo gender reassignment surgery is not one that should be taken lightly as these surgeries are irreversible and life altering. It is for these reasons the World Professional Association for Transgender Health (WPATH), the largest worldwide professional association dealing with the treatment of gender identity disorders, has published standards of care that are followed by most reputable surgeons offering genital surgery. WPATH has laid out several stages in the sex change process. As of the early 2000s, patients requesting gender reassignment surgery must undergo a lengthy process of physical and psychological evaluation before receiving approval for surgery (Gale, 2006).
In the next stage of the process, known as "real-life experience," the patient is advised to live as a member of the sex they desire to be. During this time, usually a period of 1 to 2 years, the patient will take on the appearance of a member of the desired sex and fully identify as such. Matthews recalls the day she first stepped into society as a woman, "I felt exhilarated, alive, and at peace with myself." The purpose of this stage is to prepare the patient for life as a member of the opposite sex and to ensure their ability to function fully and without regrets.
If, like Matthews, the client chooses to advance to the next stage of treatment, he or she will then undergo a period of several years of hormonal treatment to change the body contours, vocal pitch, and other traits associated with the desired sex. This is the stage of treatment in which Matthews currently resides. Here she discusses her current experiences: " I am currently taking 6 milligrams of a hormone called estradiol and 400 milligrams of another hormone called spironolactone. Estradiol is used to increase the estrogen levels and support the feminizing of the body. Spironolactone is a potassium sparing diuretic used to suppress, lower, and eliminate testosterone levels while eliminating sperm production." As explained by Matthews, estrogens are given to males to support the feminizing of the body while androgens are given to females to support masculinization. The effects of estrogen on a male body include changes body fat distribution, decreases in the frequency of erections, a cessation of ejaculations, and breast enlargement (Baldwin, 2009). The effects of androgen therapy on a female body include the appearance of a beard, deepening of the voice, and body fat redistribution (Baldwin, 2009).
The final stage in gender reassignment surgery is the actual surgical procedure. For major transgender surgery, most clinics will require letters of recommendation from psychologists, physicians, and/or therapists prior to surgery. These letters must state the individual has sufficiently completed the first 3 stages of the process, is of sound mind, is healthy enough to undergo drastic surgery, and is in the care of a medical professional for any and all co-morbid psychiatric conditions, such as depression and anxiety. According to the Encyclopedia of surgery, the number of gender reassignment procedures conducted in the United States each year is estimated at between 100 and 500 and comes with a very substantial price tag. The cost for male to female reassignment is $7,000 to $24,000. The cost for female to male reassignment can exceed $50,000 (Encyclopedia of Surgery, 2010).
The process of converting a male anatomy to female anatomy requires the removal of the penis and testicles, reshaping of the genital tissue to appear female, and the construction of a vagina. A vagina can be successfully formed from a skin graph or by using an isolated loop of intestine (Gale, 2006). In many cases where hormonal therapy was not sufficient in producing sizeable breasts, breast augmentation will also be performed. The process of transitioning from a female to a male is more challenging; however, as the tissue gained from the removal of female genitals is not substantial enough to form a functioning penis. Although it is possible to construct a functioning penis with a natural appearance, it s a very costly and multistage process and the results are far from ideal (Baldwin, 2009). For these reasons, many transmales will choose to simply transform the clitoris into a small penis, not useable for coitus, through a procedure known as a phalloplasty. Prior to surgery, both transgendered males and females are able to experience orgasm, or at the very least, a reasonable degree of erogenous sensitivity (Gale, 2006).
Unfortunately, the psychological aspects of gender identity disorder do not end after surgery. There are many personal and social challenges post operative transsexuals must face on a daily basis. Establishing and maintaining intimate relationships can often be difficult and many struggle with the problem of whether or when to tell their prospective partners about their histories (Baldwin, 2009). There can also be many challenges associated with a reemergence into a family or workplace as a member of the opposite sex. Perhaps most troubling, is the fact that legal protection for transgendered people falls short of what is provided for gays and lesbians, even though the transgendered population is at greater risk for violence and discrimination. Currently, only 8 states, 91 jurisdictions nationwide, explicitly protect people based on gender identity/expression. Only 5 additional states and the District of Columbia protect transgendered individuals against discrimination judicially or administratively (National Center for Transgender Equality, 2010). Discrimination on the basis of sexual orientation is as damaging to the foundation of America as it is to those it affects. The United States of America is country founded on liberty and justice all. It is the duty of every American citizen to raise awareness and fight for change in places where liberties are being denied. The best way to bring about this type change is open our ears and minds to the testimonies of people like Kelli Matthews whose hope for the future is that "one day our culture will view gender and gender roles a fluid, without conditions, labels, or judgments so every American citizen, male, female, or otherwise can enjoy a life free from discrimination and social stigmas."
Perhaps Charlotte Bronte said it best, "Prejudices, it is well known, are most difficult to eradicate from the heart whose soil has never been loosened or fertilized by education." There is no denying the fact that pre-conceived notions of what it means to be male or female are prevalent in Western cultures. Even in our advanced society people are still being judged and condemned over issues of gender and sexual orientation. It is through the testimonies of people like Kelli Matthews, men and women who see the unconventional aspects of sexuality from the inside, that we get the clearest picture of true sexuality in America. Allowing these individuals the freedom to share their stories is the first step in tearing down traditional gender roles and paving the way for a more accepting tomorrow.
