Dysphoria after transition

Transition to expressing myself female was what I had to do. It was liberating. After trying to make a man of myself, I was able to be me. And the work of liberation has continued, and been difficult, over the sixteen years since.

I grew up with definite ideas of what it meant to be a man. It meant fighting, if necessary. Being dominant, athletic, not expressing emotion- the concept fits, even fulfils, some folks.

I had possibly my first celebrity conversation recently. “I feel as if I know you,” she said. She had been on the tiered seats at Yearly Meeting, looking down on me as I spoke before hundreds of people, and then read my articles. Modestly, I pointed out the new outreach leaflets which have my words about me in them. Oh, wow.

I want more of that.

So I was telling a friend, and she observed that I am expressive when I am delighted by something: it is always quite clear. Same with dislike. This expressive self might not be 20th century British, with the “stiff upper lip” ideal, but we are all more expressive now. I am not sure it is “feminine”, particularly, more extreme extrovert, or perhaps for those more powerfully connected to feeling- it was a lot of work to suppress my feelings. Given that I am like that, I am glad to be able to express it without an internal censor. Even if it is no more “feminine” than “masculine”, I don’t think I could express it without having transitioned. I was too buttoned-up. Forty years after some teenagers find it, I finally realise I can be Fabulous! And my attempts are as in need of practice as theirs; and my trans woman’s self doubt and judgment are as strong on this as anything.

It is not just my femininity I have liberated, it is all of me. And yet the constraints on me, my own beliefs about what I must suppress in myself, continued to hurt after transition. It has been a long road, and is not over yet. My discomfort and embarrassment at who I am continued. It may be hard for anyone not trained into it to attain dignity, but self-acceptance is essential and transition was only the first step.

I was still embarrassed, and especially in the first year I faced a gauntlet of mockery, derision and hatred walking down the street. That will increase self-doubt unless, with tremendous strength, you ignore the opinions of the haters and decide to love yourself regardless.

Andrea Long Chu, writing in the NYT, says she is suicidal since transition. She is conscious of her appearance- she is a trans woman, so she looks like a trans woman, with some mannish characteristics. She picks on the length of her index fingers, and denies that she is beautiful. Hormones make her weep, and all the pent-up pain of having to present male for decades has exploded. She wanted to be a woman, and she gets to be a trans woman. Her vagina is a “wound”, not a human organ linked to a womb. “There are no good outcomes in transition,” she writes. We are not made well, just made better- it is a choice between two dark shades of grey. So psychiatrists and surgeons should recognise that incremental improvement, and be satisfied with it. It is what we want. It is the way they can “do no harm”.

My hips are narrow, my waist and shoulders relatively wide, and my face mannish. Facial feminisation may be more important and more beneficial than vaginoplasty. I am conscious of my mannishness; but also intensely conscious of being a body, a physical animal, loving to walk barefoot, to cycle, and to feel wind or sun on my bare limbs. Before, I was stuck in my head. And this increase of conscious feeling has involved intense emotional pain. If you want equanimity, not to be troubled by strong feeling, do not transition.

The doubting, blaming and hating of myself continued after transition, and to an extent still does. I am not the woman I wish to be. I am dysphoric. Yet I am more myself, I see myself and love myself better. Transition was what I had to do. I can’t be certain I would be alive without it.

Trans identity

Some people are trans. How much of that is innate, and how much cultural? I say effeminate men might find transition attractive. Others say that people with the sexual orientation of autogynephilia transition- in that case I am bisexual between an autogynephilic orientation and a gynephile orientation, as I am attracted to women other than myself. The real world is more complex than theories can portray.

Others say the phenomenon is Trans, where female souls/brains/psyches in male bodies are only happy once transitioned, and children as young as three can experience bodily dysphoria, loathing their penises. This is the “trans ideology” so hated by the TERFs. If I am really a woman, of course I should be allowed in women’s space. I say I am sort-of culturally a woman, an anomaly, so should be tolerated in women’s space, because the majority of women so tolerate me, and because I am harmless and we are mostly harmless.

Or I could say that I am Different, so for the comfort of the Normal people I have to be shoved into a box, and when I could not tolerate the Man box the Transwoman box was the other one available. The goal of Diversity is that no-one should be shoved into a box.

Possibly what you want to do governs what you think about it. I wanted to transition, so I thought I was transsexual. And what your identity is affects what you do. I thought true transsexuals had sex reassignment surgery, so I had sex reassignment surgery. So there are different names for it, validating it- gender confirmation surgery is the latest I heard. Neovagina, says the surgeon, making it sound good. “Fxxk hole”, says the radical feminist, communicating her contempt.

This post about identity is written by someone who opposes transition. People approach medical services saying they are trans, and seeking medical reassignment. Their identity is that of a trans person. They believe they are a trans person, and that that means hormones and surgery. Lisa Marchiano wishes to treat gender dysphoria as a symptom, and explore with her patient what that symptom means. Gender dysphoria causes distress. The identity model says the person is trans, and the way to alleviate the distress is medical transition. Marchiano is against transition: it is a “drastic, permanent medical intervention”, leading to “permanent, life-long sterility 100% of the time”. One never reads in such articles that transition makes some people happier and higher-functioning, but it does. I would be happier if the writers admitted the value of transition for the patient in some cases.

She values self-identity. We tell ourselves stories about ourselves. I identify as Quaker, Scots, English, cultured. These things matter to me. The therapist accepting them empowers me. The therapist only challenges them if they lead to maladaptive behaviour. Yet how can I know myself? I identified the Real Me as female, but now identify it as feminine. I am a pansy. My self-identification often is changed by the words I use. I seek more accurate words. She says gender dysphoria does not mean necessarily that I am trans, but that the therapist needs to explore the meaning of the symptom and be open to what emerges. That she questions self-identity as trans does not mean she treats the symptom as unimportant or illusory.

She breaks down gender dysphoria into separate symptoms, including alienation from ones body. I hated the slimness of my arms, because it seemed weak and unmanly. Now I love my arms and hands, which I find beautiful. Finding a way to accept me as me, rather than accept aspects of my body because they fit “woman” and I identify as “trans woman”- accepting what is, and finding the good in it- would have been better than transitioning, if only I could have pulled it off. Teenage girls are alienated from their bodies by porn culture, and she says they decide transition is the answer due to a social contagion: it is the answer they find, and they latch onto it, then seek out evidence to confirm it, which they find in many sites providing mutual reassurance. (As do the radical feminists who decide we are monstrous then seek evidence and reassurance to confirm that.) I was homophobic and femmephobic- a man should not be feminine, I thought. It was not internalised transphobia, but femmephobia. How much better to relieve my self-loathing than to force me into the trans-woman box which I thought fitted my feminine self!

She says there are often other mental health conditions. One doctor said I had narcissistic personality traits, another denied it, and those traits might cause or be caused by the dysphoria, but finding a way of alleviating them might make the dysphoria less serious.

I see no evidence that she accepts transition as an appropriate course for anyone. She attacks “transgender ideology” as incoherent. She says there is no basis for a “gender identity” (her scare-quotes) that supersedes “objective biological sex”. This makes her assessment of research on outcomes suspect, though I doubt you would find an objective meta-analysis, untainted by any desire to affirm or deny transition as a treatment. Her reference to “a late-transitioning MtT autogynephile” links to Anne Lawrence. That is hostile. Here she writes that trans people exist, and should be protected; but she would rather manage gender dysphoria without transition. I feel her position has hardened further since. But I agree that we should explore the anima and animus, male and female, within ourselves.

I love her desire to explore deeply the sources of distress and seek varied possible solutions. That is not the NHS model, which favours quick fixes, even bodges. We would see the person in front of us in all of their miraculous complexity, and not just as a “gender identity,” she says. If only!