Dora Richter

Dora Richter, the first trans woman to complete gender reassignment surgery, worked as a maid in Magnus Hirschfeld’s Institute for Sexual Science. Her testicles were removed in 1922, and in 1931 her penis was removed, and later a vagina was surgically created.

After the orchiectomy, Dr Felix Abraham, a psychiatrist at the institute, published a case study: “Her castration had the effect – albeit not very extensive – of making her body become fuller, restricting her beard growth, making visible the first signs of breast development, and giving the pelvic fat pad… a more feminine shape.” Dora was 31 at the time of that operation. There were eunuchs in the Ottoman Empire until 1923, and while Italy made castration for musical purposes illegal in 1861, the last Sistine Castrato, Alessandro Moreschi, lived to 1922. Dora is part of the Institute, but the psychiatrist feels able to report on her as a subject of scientific study. It seems dehumanising to me. Moreschi had higher status. The recording of his singing made me feel horror and admiration, at a glimpse of a lost world. The Sultan might not want European scientists examining his servants.

I wondered why I had heard of Lili Elbe but not Dora Richter. Lili was an artist. Dora was born to a poor peasant family in 1891 in Germany. Aged six, she attempted to remove her penis with a tourniquet, and after that her parents allowed her to dress as a girl. As an adult, she was arrested several times for cross-dressing and sentenced to a man’s prison before a judge sent her to Hirschfeld’s Institute. In 1925, Dr Levi-Lenz wrote,

It was, moreover, very difficult for transvestites to find a job… As we knew this and as only a few places of work were willing to employ transvestites, we did everything we could to give such people a job at our Institute. For instance, we had five maids- all of them male transvestites, and I shall never forget the sight one day when I happened to go into the Institute’s kitchen after work: there they sat close together, the five “girls”, peacefully knitting and sewing and singing old folk-songs. These were, in any case, the best, most hardworking and conscientious domestic workers we ever had. Never ever did a stranger visiting us notice anything.

Where to start? I am not surprised she was a good worker if she would have been jobless, and arrested, anywhere else. The Institute has too much power, but the doctor makes it sound beneficent. He is so patronising about the five “girls”. I am glad we have control of our own language now: I am a trans woman, not a transvestite. It is not about clothes. I don’t know if she was happy, knitting, or if she had talents rarely realised in peasant children.

Adolf Hitler became chancellor in January 1933, and dictator in March 1933, and on 6 May Nazis attacked the Institute, burning books. “Dora is not known to have survived this attack”. Hirschfeld had gone on a speaking tour in 1931, and been advised not to return to Germany: he died in Nice in 1935. The Nazi party was hoaching with gay men, but that did not stop them hating the gay Hirschfeld, who had been known as “Aunt Magnesia” in the gay community and established the Institute to provide a research base for his ideas that “hermaphrodites, homosexuals, transvestites, are the necessary natural link between the two poles of man and woman”.

Dora showed huge persistence, asserting that she was female, and expressing herself as female. It is because of that kind of courage that I am able to express myself as female today. I will honour her even if those who knew her appeared not to.

Detransitioners

Trans children will face more and more barriers to treatment unless there is a better way potential detransitioners can be protected from it.

My heart goes out to Max Robinson. She started T aged 16 and had chest masculinization aged 17 with parental consent, but by age 22 in 2018 identified as a woman, though her facial hair meant she is often seen as a man. Also in 2018, Carey Callahan claimed to have met seventy detransitioners, and corresponded with a further three hundred. The Detransition Advocacy Network does not give figures but claims to have local chapters around the world. Threateningly, they claim to campaign for “expansion of detransitioners’ … legal options”.

There is a great deal of sympathy for such people. JK Rowling and Julie Bindel among others have said that if they were aware children were transitioning, they might have wanted to. Max tells a common story: she was a happy tomboy until puberty, when she had awful experiences of being sexualised. Around 14 she was diagnosed with depression and anxiety. She explored gender identity on line, and convinced her parents who had been sceptical at first. Her therapist referred her to an endocrinologist, who she said was reluctant, but whom she persuaded. When she had the surgery which she now calls double mastectomy, “I was convinced it would solve a lot of my problems, and I hadn’t accurately named a lot of those problems yet”.

She did not feel happy in the trans scene. She had felt clarity of identity when she started hormones, and again when she had surgery, but that feeling receded. Possibly some unwise transitioners are fixated on the next point in their transition journey, when at last they will feel complete: but that completion never comes.

Ideally, I want trans children to get the treatment they need, but children who desire transition when it is wrong for them not to progress to hormones or surgery. There will be people in a grey area: there is such transphobia in society that even a child who is certainly trans may have periods of extreme discomfort, which may manifest as regret. I don’t know if, in a society without gender norms, people would transition or not. Gender norms have some basis in human nature: otherwise, my feminine sexuality, which I have had such difficulty accepting, would not have persisted.

At this point my relentless inner persecutor speaks up. Ah, it says, your mother accepted you were a pansy, she did not expect anything else of you, she only made you pretend to be a real boy. If you had been brought up as a real boy you would be presenting male now. I write this to show the contortions I go through even now, how hard it is to accept myself. I know I would be no happier detransitioned, but societal transphobia keeps my internalised transphobia simmering. If only it were not this hard!

Detransitioners say that it is too easy to get hormones and surgery, and there is insufficient exploration of their other issues. On exploration, I agree. I don’t want a trans child to wait any longer than necessary for treatment, but if there were more psychiatrists available there could be a more in-depth assessment and greater confidence that the decision was correct. WPATH says “Before any physical interventions are considered for adolescents, extensive exploration of psychological, family, and social issues should be undertaken.” Detransitioners say that does not happen in practice. I want to ensure that there are as few mistakes as possible, because otherwise there will be an outpouring of anger- against “trans ideology”, against trans people saying our experience of transition is a good thing, and against all trans treatment, including that which benefits actual trans people. Some will never believe there are true trans people, only seeing us as mutilated simulacra, and detransitioners angry about their mutilation will make such people more convinced.

Both detransitioners and trans people could agree that to avoid mistakes we need, not greater suspicion, gatekeeping and delay, but more intense diagnosis, and treatment of any mental health problems. Possibly a trans child will have a supportive family and no mental health problems, and can progress immediately to hormones. A psychiatrist could gain a better picture of a child from their family, and even their teachers. That needs more funding, but surely such an important decision, which could lead to a lifesaving transition and a fulfilled life in the true gender, is worth the money? The alternative is detransitioners and anti-trans campaigners in an unholy alliance, making treatment for children unavailable.

I want trans children to be able to find out about transition from trans people, but detransitioners see them too. Claire saw the youtube channel of Miles McKenna when she was twelve, and began to wonder if she was trans. She researched it, including looking into binders and hormones. She struggled with mental health problems, and this article by Jesse Singal clearly implies the distress was exacerbated by her investigation of trans. If only she could have been protected from trans ideology! Fortunately, by age 14 she is certain she is a girl.

How do parents and the general public find out about trans children? How do children find out- peers who we want to support and accept trans people, trans kids themselves, and potential detransitioners like Claire who felt she was trans before rejecting the idea. Singal blames the youtube algorithm.

We need proper diagnosis on a humane timescale. Psychiatrists will suffer for every trans diagnosis they make when the person detransitions. We need to be talking about protecting detransitioners too, or anti-trans campaigners will persuade the general public that transition is too risky for children.

Living as male again

As he was being wheeled in to the operating theatre in Thailand in 2006 for his vaginoplasty, Daniel was thinking “Don’t do it”. Waking up was hard. His thighs were black and blue. He had a bit of relief for six months after, but then the depression set in. In 2016, he was praying and he heard the voice of God, saying, “I created you male, you are walking around in a female role that is not your creation. You need to turn around and go back to your birth gender.” The same morning he emailed his pastor, sister and friends, and went on a mission to remove all traces of his Danielle identity from his home.

Or so he says now. We reimagine our histories and memories when we recall them, laying them down anew. He had an unhappy childhood. He lived with his mother after his father divorced her because of her alcoholism. She would bath him, and pay great attention to his genitals, telling him men were bad. He started wearing his mother’s and sister’s clothes when he was eight. He feared being male. He became alcoholic, and when he got sober in1994 he had a social transition, dressing female but without hormones or surgery. It was a shock to his US Bible-belt community. People avoided him. The isolation was too much, so he reverted, and moved north as a man. But then he was reading about transition, and got “tunnel vision”- he thought if only he could transition medically he would be happy.

He feels he was dishonest with the psychiatrist: he did not tell her he was abused as a child, and she did not ask him. (Odd- mine took a full history, back to childhood.) “I was living in fear of exposing those deep dark secrets.” Possibly, he has a different view of them now. Now, that experience of being bathed is a big thing for him. Perhaps then it did not seem so fundamental to his experience since. After all, trans women generally believe we have an innate gender identity. Having reverted, he has to find some reason why he was wrong to transition. So now he says his transition was his fault. He had breast removal and T injections to get his manly shape back. He has recently had an assessment for a phalloplasty operation, but the doctors found his liver function was not good enough. He will be reassessed.

Surgeons did not want to consider phalloplasty when they heard he was reversing a vaginoplasty. Eventually he found Miroslav Đorđević, who has completed thirteen phalloplasties for such patients. He has inserted a penile implant for sexual intercourse in six, and the others are awaiting assessment; and he has 25 new candidates. He says candidates are not properly assessed before vaginoplasty, and the patients are very distressed, regretting not just the result but the wrong decision.

He has found a wife through a Christian dating site. She is Latina, and they were using a translation app to communicate.

Trans people sometimes say most regret is because the result is sub-optimal, rather than because the decision was wrong. Dr Asa Radix, of the WPATH Standards of Care revision committee, says few patients have returned to tell her that they are detransitioning without some external factor, such as feeling unsafe on the streets, or losing their job. That would seem to indicate there had been no misdiagnosis, that the psychiatrists had been right.

In 2004, in Thailand, a psychologist at the hospital asked me if I was sure. She said they would be delighted for me to preserve my genitals.

Brian Belovitch, as a young gay man, ran away from an abusive and prejudiced working class neighbourhood to a trans ghetto. As a child, he had been mistaken for a girl. He became a vivacious woman, Natalia, a hostess on the New York club scene. He took heroin and crack. He felt he had four choices- being a trans woman with a penis, gender confirmation surgery, suicide, or undoing the hormonal changes and accepting himself as a gender non-conforming pretty man. So he identifies as gender fluid, and talks of retransition not detransitioning- he is moving on, not turning back.

We need to see these options before we have the gender surgery. The problem is transnormativity, the belief that gender dysphoria should be treated by a binary medical transition, and gender stereotypes, often with grudging acceptance of people who go through that transition greater than of people who are gender non-conforming.

Lilian Huck reverted because when she started oestrogen she had heart problems, so it was stopped. She found herself developing chest hair again. So she reverted. Then she saw a suicide prevention psychologist, who asked her how she would like to be buried- in a dress. She is living female again. None of these decisions are easy.

From the BBC World Service documentary he2she2he.

Genuine trans women II

How many trans women have genital surgery? Do trans women generally have surgery?

I thought I’d look at this because of an article suggesting that no matter how cultivated their ‘feminine’ outward appearance, ‘trans women’ (as opposed to transsexuals) have penises. I don’t know what the writer was thinking. She holds herself out as an expert on trans issues, and speaks about us, and then writes this stunningly ignorant thing. Few people call ourselves “transsexuals” nowadays, just as few people identify as “homosexuals” rather than as lesbians or gay men. The word sounds scientific, a classification from outside. We are all trans women now.

This is the final end of the “genuine trans women” argument. When the current campaign was getting going in Summer 2017, there was the pretense that the trans-excluders were not against “genuine” trans women, but wanted to exclude men who would use a liberalised gender recognition law to access women’s spaces. The definition of “genuine trans women”, whom the excluders swear they do not hate and do not want to harm, gets stricter and stricter until it disappears entirely and they call us all “men”. They want to feel good about themselves. They’re not hostile to trans women, just the bad ones. But it gets more and more difficult to find a “good” one, in practice rather than in theory, who does not experience hostility from them.

Those seeking to inspire fear and hatred of trans women, or to justify their own, suggest we don’t have surgery, and that having a penis in some way makes us dangerous. Well, in a loo you don’t expose your crotch until you are safely in a cubicle, where no-one can see, so it hardly matters there. It only matters to us and to our sexual partners. But I’d thought I’d check. How likely is it that a trans woman has had surgery?

There are huge waiting lists. A friend said that she had been waiting twenty years for surgery. I don’t know when she dated that from- ceasing to present male, or seeing a doctor about it, perhaps. Waiting lists are growing. In January The Sun claimed that the waiting time was nine months for adults and about half that for children, but as the NHS does not provide gender surgery for children that is confused. It published the report under its heading “Fabulous”, which covers fashion, beauty and celebrity “news”, pinned onto something about Caitlyn Jenner, deadnaming her.

You have to have a referral before you count as being on a waiting list. Women often talk of trying to get treatment, and the refusal of the psychiatrist. “It won’t grow back,” a psychiatrist patronised one I know. Of course. We know that. We know what we want.

Gender Identity Clinics are a “tertiary” service, that is you need a referral from a psychiatrist, rather than from your GP. There is delay at all stages: the GP might delay before referring to a local psychiatrist; then there are three waiting lists, for the local psychiatrist, the GIC, and the surgeon. The GIC waiting list is around three years, and then it requires a second gender psychiatrist to give an opinion, a wait which can last a year; and each expert can decide to see you again (and again) before making the next referral. You don’t count as being on the waiting list before you get the referral. You wait years for surgery. That begins to explain my friend’s twenty year wait, though I hope twenty years remains exceptional. Another person I knew waited about fifteen. There are 7,500 people waiting for a first GIC appointment.

The Guardian is more trustworthy than The Sun. 60% of trans women referred to Charing Cross GIC sought genital surgery. So yes, that trans woman you see in the loos might have a penis, but that does not mean she is not genuinely trans. There is clearly no moral difference between a trans woman who has had surgery and a trans woman who wants it and is waiting for it, as far as access to women’s space should go. Having an operation does not make you any more of a woman. And the trans woman with a penis is no more of a threat than a cis woman.

I am against surgery. I don’t think it does us any good, and I think we seek it to be seen as real trans, rather than for what it enables us to do. Gender dysphoria need not be body dysmorphia. Yet delay is not the answer. You sit in limbo, unable to get on with your life because you consider this thing you are waiting for to be the most important thing on Earth. It is a paradox that as the transphobes talk of “genuine trans women” they put pressure on us to have surgery, even though they decry it.

I wanted to produce some statistic about how many surgeries there are. From 2000 to 2009 there were 853 NHS surgeries though many, like me, went to Thailand or had private surgery. In the government LGBT survey, 16% of trans respondents had gone abroad for “medical treatment”: what else but surgery? To get a percentage of trans women who have had surgery, you would need to know how many are expressing ourselves female, and how many have had surgery (and are still alive) and these figures are not available. I don’t accept that you need to have or desire surgery to be a “genuine” trans woman, but anyone who suggests you must should not spread falsehoods about how many do.

Here is a trans woman expressing regret about surgery.

Orchiectomy III

Testicles have such strong cultural associations. They are the symbol of manliness, in its best sense: the man who toils and does not look for rest, who does all that is demanded of him and achieves his goals. If he doubts his ability to do something he is told to “grow a pair”. Does he have the balls to take on a task? Even women are asked that.

You have committed to transition, and you are taking oestrogen and a testosterone suppressant. My psychiatrist used this as a diagnostic tool: a sexual fantasist would not want to, as their libido would decrease. They would be cross-dressed without arousal, and might get bored of it. Or, the test is whether you like the way you are on this treatment. If you like it, it is right for you.

Unfortunately, some patients don’t see it that way. They have decided that transition is right for them, and they see transition as being a single process, involving set steps. You get hormone treatment, before or after changing your name and ceasing to present male. You have hair removal and possibly facial feminisation or baldness treatments. Vaginoplasty completes the process. We observe that we pass better as we have more practice, so the “real life test” shows life getting better as there is less abuse in the street, and we find presenting male more and more unpleasant.

I was willing to tolerate discomfort, in the belief that life would get better. I also felt that vaginoplasty was part of transition. Now, I want to help others in transition consider it as a matter of discrete steps. It is not just one process, one binary choice, either stay presenting male or change name and have hormones and surgery. It is, what is right for you? One person I knew felt she had to stay presenting male for her career, but had GRS.

I also want it to stop being a question of identity. “I am a trans woman. Trans women need surgery.” I am a human being. Human beings pursue a variety of paths.

The alternatives- transition as one process, involving change of name and presentation, hormones and surgery, where you go through the process tolerating the discomfort believing life will get better, or give up completely and revert; and transition as a number of choices,

Transition is often seen as one process involving surgery: there are reports of people feeling elation after surgery, because the process is completed, only to suffer depression up to a year later, because their lives have not improved.

So one of the choices is whether to have an orchiectomy. This is far less invasive surgery than vaginoplasty. It means you stop needing testosterone suppressants. And, though taking oestrogen with testosterone suppressants will reduce your sexual desire, fertility, and ability to sustain an erection, doctors assert that while fertility changes may be irreversible, changes to erectile function and libido may be reversible. Orchiectomy drastically reduces your natural production of testosterone, and is irreversible.

Cordelia Fine asserts that these characteristics of pluck and determination are seen as Manly not because of the effects of testosterone, but because of Patriarchy. It takes balls to have an orchiectomy- it is a sign of courage and commitment.

What I want, for people considering transition or surgery, is to reduce their symbolic power. As a symbol, testicles are a sign of Manliness. But as Germaine Greer said, “I don’t believe a woman is a man without a cock”. Oestrogen and testosterone suppressant will help you pass better. Orchiectomy will help you pass better. But it won’t make you less of a man, more of a woman, or even less of a weirdo. You can’t escape being a weirdo, I am afraid: that you are considering surgery makes you very unusual indeed. But being a weirdo is not a bad thing.

Why would you want the effects to be irreversible? That’s a symbol, again, of your determination and commitment, and certainty that you have chosen the right path. Symbols are expensive. You have a right to be you without bearing so much cost.

FtM

I consider the issues for trans men are so different to mine that I want to be a good ally, rather than imagining myself able to speak for them. I am blogging to thrash out what I think; that’s a starting point from which I want to get to being an ally. Knowing where I am, I might find a route towards being an ally.

I have been writing about the vaginoplasty, which I find wrongful in almost all cases; only acceptable where sexual activity is unbearable using a penis, and the person can only countenance being penetrated. I consider that so many people have vaginoplasty as a symbol rather than reality- because it symbolises being a real woman, or at least a real transsexual person, for them; because they cannot imagine a person like them as a man rather than a woman, and cannot imagine a woman like them with a penis. Whereas penises are great. And many people are dissatisfied with the result. Several people talk of those who cease dilation (though some keep it up).

I think top surgery, chest masculinisation, is different. It means you can stop binding, and so breathe better, and I understand binding can cause health problems. You have two large scars under where your breasts used to be, so going topless is difficult, but passing when you have a top on is much easier.

The main difference is that T gives you facial hair, male pattern baldness, and helps your voice break. Sometimes people’s voices don’t break well, but generally unless you are cursed with very wide hips, or being particularly petit, or a particularly feminine skull you will pass. You become gentle, caring men. You gain male privilege. Am I envious? Yes. I would like to pass as normal, I crave straight privilege. Passing is not guaranteed, but there is some indication before you start whether it will be possible.

I know we say, it is not a choice. I know we say, it is irresistible. If you think you might, but are not sure, you are not true trans- and such stories help put off those who desperately want to transition but are frightened and not sure they will manage it. Lots of people who are not sure, or who are delaying transition, will make a go of it. And for anyone it’s a lot of time, effort and money.

So it is a choice. People put off transition, or avoid it completely. This does not make them less trans, just means that their circumstances are particularly against transitioning.

Can I be an ally, and hold out the possibility of accepting being yourself in your own body? And, accepting yourself, you find you are accepted by others- at least enough others, in the tribes and the enclaves you discover? Then you would not be dependant on synthetic hormones life long, with the risks that entails. Not transitioning, in other words, would be the better option, rather than the thing you do because you are forced to. Passing makes being trans easier.

Being an ally would involve separating out my own feelings about myself and my choices. And supporting the choices people make. They are able to make their own choices. Only if regret rates are significant does regret become relevant. Only if people transition, alter their bodies, and then wish they had not in large numbers is it a reason for restricting treatment. That is a number we need to know, and somewhere between 0.6% and 4 in 13 is not good enough. My own regret is not a good enough reason to try to persuade people not to, unless there is robust evidence of others’ regret.

Or, the number who have transitioned is large enough to show it might be right, and yet small enough that if it is wrong it is not a huge disaster, to support transitioning as a course of action.

In summary I am against vaginoplasty and agnostic/guardedly in favour of chest masculinisation. A person like you should be able to live as a woman; but in the Patriarchy, when certain qualities are disparaged as unmanly and projected onto women, that’s difficult. I want you to have the best life you can, and trust you to decide how you will achieve that. Then I want to be a supportive ally.

Vaginoplasty or labiaplasty?

If you are having GRS, should you have vaginoplasty or labiaplasty? Vaginoplasty creates an orifice, perhaps seven inches long, inside you. Labiaplasty creates an orifice about an inch long, which has the urethra, but not a vagina opening onto it. An alternative name is “vaginoplasty without vaginal cavity”, used by GRS Montréal, which uses the term “labiaplasty” to mean a later alteration to the labia.

The vagina needs to be lined, with the skin of the penis or scrotum. You do not want hair growing inside, so that means either laser or electrolysis hair removal before, or a lengthy procedure removing each follicle as carried out by my own surgeon, which lengthened the time the operation took. GRS Montréal says the surgery without the vaginal cavity takes 1½ hours, with admission on the day of the operation, two days in the hospital after, and returning to sports after six to eight weeks.

Surgery with the cavity in 2004 took seven hours, but in Montréal it is two. That surprised me, and shows I should check the current conditions before pontificating. Anyway. What about dilation? It seems far less onerous than it was 14 years ago. After my op in 2004, I was told to dilate for two hours in the morning and two hours in the evening, on top of time spent preparing and cleaning up afterwards. I did this early before work, and noticed that even though I was lying on my back, it was not restful. I could not sleep with the stent in. After six months, I had been told that I could reduce it to one two-hour session a day, but that immediately resulted in a narrowing of the opening, which I found so distressing that I gave up. A surgeon in England told me “There are no rules”: you find what you need to do to maintain width and depth, or you stop. Those are your choices. If dilating is not keeping the orifice open, dilate more.

Montréal recommends four times a day in the first month, but never more than half an hour in total, and after the first year once a week. This is considerably less. If you are having penetrative sex to the full depth- what a friend jokingly called “organic dilation”- you do not need your stents at all.

You need to keep your orifice clean. To the tune of “Keep young and beautiful”:

Whereever you have been
You must keep your new vagina clean
Hibiscrub and betadine, every morning and night
To help you feel serene
Or only just to feel fit to be seen
Hibiscrub and betadine, every morning and night.

Montréal, however, only recommends salt in the douche, but gives a graphic account of what happens if you don’t do it properly: abundant, smelly and bloody vaginal discharge, deterioration and enlargement of the wound surface, risk of infection.

OMG!!!!

While it is less onerous than it was in my day, dilation and cleansing is still a significant drain on your time. I don’t know what research they do to check whether the dilation times and frequencies recommended succeed. How many people give up? How many still have the full depth and width, five years later?

 ♥♥♥

Yet, unless you want to be penetrated, why would you have this operation? The comments on my previous post give some clue. Joanna referred to it as “full transition”- so expressing yourself female is in some way not enough, the operation completes transition. If you have a partner, could they accept your body without such an alteration? Can you? Can anyone commit to living in the world as their real self, without altering their body?

The person variously known as “trans heretic”, “sock puppet” and “the sceptic” writes she was “surgically corrected”, because of a need deep within me to correct a fundamental physical wrongness with my body. However badly the cultural concept of trans including surgery fits others, it fits her perfectly. It was right for her. Apparently, it still is. “Transgenderism” is my physical reality, wrote someone on facebook. That was what I believed, then. It is not what I believe now. I see no way of being certain if anyone else would cease to believe it, but if it’s tied up with the idea of yourself as fitting into society alternatives would include becoming able to bear not fitting in, or finding your own tribe to fit. I don’t think we are accepted as trans women, not really. No-one who would not accept you as a feminine man will accept you as a trans woman.

If you want male partners, it makes sense to have the orifice. If you don’t, it is less clear to me. Then the orifice is part of your self-image as a woman. You would have a uterus transplant if you could, but given that you can’t at the moment you go as far as you can. So it’s about being genuine, being a real trans woman, rather than about what the alteration will accomplish. It is about ideas and not reality. It is all in your head.

I fear that the concept of a woman with testicles makes no sense to us. We say we are women, and some say not trans women but “women with a trans history”- trans is crossing over, and that is in the past. I fear that the operation is seen to complete transition, rather than to achieve what it achieves.

I have been mutilated. I wish I hadn’t. If it was a mistake for me, is it for anyone else? Hormones and surgery reduce libido and sexual responsiveness. That was a relief at the time, and now is aching regret. How can you accept yourself as you are?

Here’s Grace Petrie (pronounce Pee-trie, whose pronouns are she and her). If you are not weeping by the time she bites her lip, I don’t understand you. She is trans-affirming, gender non-conforming, and female.

Don’t have GRS

Personal stories of why people wanted genital surgery, and why they regret it.

The way transgender is understood in Anglo-American culture, in the theory and practice of law and medicine and in the way trans people understand ourselves (until it’s too late) puts overwhelming pressure on trans women to have genital surgery which is not in our interests. When we regret hormone treatment and surgery, there is pressure on us not to say that in public. I regret surgery, so I have an interest in this- to save others from my mistake, as I cannot rectify it- but I am not alone, evidence of regret is suppressed and evidence of satisfaction exaggerated.

The circumstances of MtF and FtM around motives for surgery are completely different.

The diagnostic criteria for gender dysphoria in the DSM and gender incongruence in the proposed ICD-11 both require a strong desire to be rid of primary and secondary sex characteristics and to have the characteristics of the opposite sex. The Equality Act protects people who want their sex reassigned, or have had their sex reassigned, though the heading is “gender reassignment”.

At the time I changed my name and went full time, I was ambivalent about surgery, but a year later I passionately wanted it. Why would you want surgery? I believe I wanted it at the time because I wanted social acceptance, or possibly to accept myself. Where a person male by genes gonads and genitals wants to dress as a woman, there were two categories they could fit- transvestite and transsexual. The transvestite is considered to be a sexual fetishist, which I found unattractive, but the transsexual had a medical condition, which I found more congenial. I felt my personality was feminine, a concept which now I consider meaningless.

If there were more acceptable categories, protected against discrimination by law, not involving surgery, perhaps I would not have wanted surgery. Medicine tends to categorise health problems which require the intervention of doctors to cure, but possibly we could reconceptualise gender dysphoria. Gender incongruence type 1 is a desire to live in the role of the opposite sex. The treatment is to live in the role of the opposite sex, using an appropriate name and clothes. Gender incongruence type 2, a distinct condition which may or may not co-exist with type 1, is a desire for hormones. Type 3 is a desire for surgery. Type 4 is a desire to subvert gender, by not fitting any particular gender role, and the treatment is to be allowed to present as you want, male, female, androgynous.

There should be the freedom to present as you want anyway, without the need for medical affirmation, but I did not feel free and medical affirmation, or a category defined by doctors, might have helped me accept myself. The health problem would be shame and distress rather than cross-gender behaviour, and the treatment to alleviate the shame and distress rather than to change the behaviour. As the medical model is about desiring cross-sex characteristics, the GICs can’t cope with non-binary people. They still demand change of name, as Charing Cross did when I first went there in 2001.

I would have said, I want surgery because I am transsexual. I am a woman and my penis distresses me (it did). In the bath I want bubble-bath to hide it (I did). I now feel I wanted surgery to be classed as transsexual and so to be socially acceptable, as demonstrated by the available legal and medical categories. If there had been different types of gender incongruence recognised by medicine and protected by law, I might not have wanted surgery or hormones.

Transsexual support groups enforced the desire for surgery because it differentiated us, the real TSs with a medical condition, from all the weirdos and perverts, just as law, medicine and the wider culture did.

Hormones can reduce fertility, possibly permanently. I wanted to reduce my sex drive because my attractions shamed me. Self-acceptance would have been a better way.

Surgery is irreversible. I mourn being mutilated, and the pain is keener because it was my choice. That choice was socially constrained, and I am moving from self-blame to rage against those constraints.

A great deal of research reports high degrees of satisfaction with treatment, and low rates of regret of surgery. I am unsure why. Possibly it involves people surveyed shortly after surgery, when I and others experienced euphoria; possibly people feel shame about our regrets. I certainly do. People are unwilling to score below Neutral in a satisfaction survey, marginal people are less likely to complain of bad treatment, and while we might open up to a qualitative researcher we might not on a survey. In my case, I have been loath to speak out because I don’t fit the accepted understanding of trans women, and might spoil it for those wanting surgery now; and I want to maintain links to trans groups. Though Johns Hopkins stopped doing GRS as they decided it did no good.

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Sylvia Morgan undertook qualitative research, trying to find difficult to reach trans people rather than using the customary routes of gender clinics and trans support groups. Post-op, most people lose touch with those sources and that might be a reason why some research reports such high satisfaction rates. Four out of thirteen post-op trans people expressed regret. That is a huge figure.

People report long waiting times to see gender clinics, and long waiting times for surgery referral once there- perhaps seven years. A friend waited longer. Another friend said the psychiatrist kept challenging her desire, saying that it won’t grow back once it’s cut off, as if she did not realise that. Of Dr Morgan’s research subjects, Lady G who wanted penetrative sex had to wait many years because she had to work in male role, as a lorry driver, and the protocols demanded the “real life test”. She also refused to fit the stereotype of a “woman trapped in a man’s body”- “I don’t know how women feel. I just know how I feel. I’m definitely not trapped. All I want is the wee operation down there.” She passes as a woman, unlike most of the MtF research subjects, and has a strong sense of being one.

Kylie, though, felt hurried. She was not sure how she felt and questioned the conclusion of her first half-hour consultation that she had “insight” and an “excellent understanding” of the transition process.

People used The Script, saying they felt trapped in the wrong body, felt they were not of their assigned gender from very young. “People play the game to get what they want.” Dr Morgan reports that discussions in support groups are dominated by medical procedures and visits to the GIC, and I observe that on facebook, with regular delight at getting surgery or despair at the delay. It is a way of getting status in the groups, that you are seeking surgery. Four said they had never considered medical procedures before joining support groups.

Phoenix felt pushed through a process. She had said she did not particularly want surgery, but had it three years after her first referral to the GIC. She drifted through the process and does not know how she got where she is, post-op.

Vida first went to the GIC in March 2010, and had surgery in October 2012, having pushed for it. She was processed quickly because she demanded progress. There appears to be little consistency in procedures and protocols. Waiting times appeared arbitrary. One psychiatrist was described by many participants as condescending, patronising, clock-watching. Trans women felt disrespected, as I did.

We want medical recognition in order to get legal recognition, so we have surgery as that is what the medical model requires. The participants wanted a vagina in order to “feel fully female”, rather than for what one would do with it: gynephile trans women still go to surgeons who can give depth. The psychiatrists generally did not attempt to dissuade them. (We would hate it if they did, denouncing them as cruel gatekeepers.) Yet the surgery is a symbol of being a woman or truly transsexual, rather than a choice because of what the penis and testicles can do, or the neo-vagina can do.

Dr James Bellringer, who does NHS vaginoplasties, said the backlogs were “spiraling out of control”. In 2013/14 they received over three hundred referrals yet did 180 operations. “The nature of gender surgery is that the vast majority of these referred patients will go on to GRS,” he said.

Iain, a gender queer trans man, thought better of it. The effects are irreversible… there’s so much that can go wrong… it sounds like a world of pain and struggle and scarring and infection.

Oestrogen is a symbol too. Subjects perceived it as enhancing emotions and gentleness, but one reported that her powers of concentration were a lot worse, another that she was considerably weaker, making her job more difficult.

As hormones and surgery are primarily symbolic, that one is really trans, entitled to legal recognition, others as well as I feel euphoria after finally having surgery. But then Carina reported that reality hit her like a big sack of potatoes. Surgery does not mean social acceptance, necessarily, and the body has to heal its effects. The neovagina is in effect a wound, so you have to fight the healing process with dilation.

Vida felt recovery took two years, and had further depression ten years after surgery, “because there is no aftercare or support”. Dolores said she had not understood how difficult and time-consuming dilation would be: “A lot of girls just don’t bother with the dildo, they just let the vagina close up”. Lily agreed. “Nothing really prepares you for what happens afterwards.” I think when some people go for the gender reassignment there is a hope for changing your life, starting a new life, but then it’s still just you with your same problems, and after the surgery you have more to worry about… Some of them just give up, they stop dressing in female clothes and everything.

Sally hoped surgery would give her psychological relief and social acceptance, but it brought neither. She had had profound ongoing depression since transition. Trans support group organisers told me not to talk about my personal problems, not to talk about being depressed since my surgery.

People determined to get the surgery are kept in the dark and fed on bullshit. Nine out of 28 participants had attempted suicide, some more than once.

While people are taking hormones and having surgery for validation as a true trans person rather than for the actual results treatment will provide, there will be inappropriate treatment, and social pressure to have treatment. I know what the desire for the operation feels like. I felt it. Now, I feel betrayed.

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When T-Central linked to this post, Calie wrote, The last two T-Central featured posts were based on very successful transitions. One from Halle, who has transitioned, and the other from The Transgentle Wife, the spouse of one who has transitioned.

This post is from Clare Flourish who has regrets. It is important to read both sides.

I will add that I know many who have transitioned and are happy and I know some who are not. In all cases, it seems that the lack of love in the life of those with regrets, or the lack of a job, is often the case.

Clare mentioned in a comment to her post that there is pressure to physically transition. I have seen this and know several who gave in to that pressure. Some are happy. Some are not. Clare is one of my favorite bloggers. She is just lovely in her pictures and I do hope things will turn around for her.

I am grateful for the link and kind words, but I am glad I transitioned. It was how I found myself. I feel transition could mean something different, that it does not need the monolithic full-time + hormones + surgery. I feel people should be encouraged to find those parts of transition which work for them, without imagining they must come as a package.

Some of the comments below go into these issues in depth.

Social pressure III

People want hormones and surgery, because it gets us what we want. Radical feminists speak out against surgery even while putting more pressure on us to have it.

Surgery means that you do not have to take hormone suppressors, which have side effects. Sex can be difficult before surgery: people feel alienated from their genitals, and accepting after. I am a woman. At last, I can function as a woman. And now, when I feel that what surgery achieved for me was a sense of authenticity- I am truly a [trans] woman, because I have had surgery and take hormones- I accept that not everyone agrees, because the magic would not work if you understood it. People believe it proves they are real [trans] women, and makes them more likely to be accepted. I would rather get that sense of authenticity, and permission to express who I am without hiding, by some other means than the mutilation of my body.

I agree that hormones and surgery harm people, by making us sterile and by altering our hormone balance. My temperature regulation is poorer, and it may affect me in other ways. My emotions have been more labile. International human rights law says we should not have to be sterilised to get gender recognition.

For F-Ms, breast surgery, and hormones promoting beard growth, make us pass better. Even for M-Fs, hormones taken along with electrolysis produce a softening of the skin and perhaps an alteration in odours and pheromones, so we pass better. Passing is important if someone might be hostile. Though now it feels as if I am not noticed, not considered worthy of attention, rather than not read.

Walking with Drea- she exclaimed “Oh, he’s beautiful!” of a passer-by. I had not noticed the man, except to avoid collision. Then I heard someone introduce a man to her sister, and he said “Hello, it’s lovely to meet you!” in such a forceful yet warm way that I felt his personality reach out to envelop hers, and even mine- yet Drea did not notice. We pay attention to different things.

When a radical feminist tells me she can tolerate me in women’s toilets because I have had the operation, it reinforces the idea that surgery confirms our trans status. They talk of the danger of penises in women’s space, yet say that surgery is mutilation and wrong. It seems they want to have it both ways, excluding us and de-legitimising us. The effect is to increase our desperation for legitimacy, which we seek in surgery. Though we need to have it both ways- being accepted in women’s space, yet not needing surgery. You don’t need a penis altered to have sex, you just need to use it differently.

Then again I want it both ways- access to women’s space, no surgery required. There is so much anger and fear in the conversation, and some radical feminists feel a need to delegitimise us completely- we look like men however much we spend on facial feminisation surgery, we are a violent threat even after genital surgery- so that we will not be in their space. It’s the Principle of the thing. Yet however great the anger, we do not go away.

S objects to any body alteration, even shaving her legs or plucking facial hair. It is her body, she should not have to alter it or go through this long grooming process of make up, nail varnish, cleanse-tone-moisturise etc. It should be acceptable as it is. It may be that she wears clothes for practicality, though social signalling is unavoidable in the way we dress.

It’s not a useful conversation. “How can I be myself?” I ask. “NOT THAT WAY! GO AWAY!” some people yell, though others are accepting, and I feel wounded, even wronged. Though to see it from another point of view, a man in women’s space is objectionable and that is the wrong to be righted first. How might we meet each other without anger or fear?

Sex dysphoria

Some find that the most distressing thing about the dysphoria they experience as trans people is their physical sexual organs.

For me, transition was an attempt to express my true self. My gender is feminine, I am most comfortable responding in a feminine way, and part of my problem is that I conflated the symbols of femininity, such as the soft floral sweater, with the underlying reality, the will towards support and reconciliation; or that symbol of masculinity, the penis, with what you do with it- do you penetrate, or become enveloped?

People conflate symbols and reality. How could I communicate my femininity except by transition? Body language can communicate femininity without particular clothes. We also conflate transsexualism with transgenderism- the protected characteristic in the Equality Act is “gender reassignment”, the protected group “transsexual persons”, and doctors give hormones and surgery to a man who is feminine.

There was one thing I could do: become transsexual, which means expressing myself differently, but also dressing like a transsexual and altering my body like a transsexual.

That tweed skirt suit with the frumpy little frills on it, fashionable some time in the 1980s, that you like because you know no better- or those gorgeous elastic-sided long boots, with a bit of a heel- these things are unnecessary, and some make a thing of it. “I wear jeans far more than I wear skirts”. And I would rather wear dresses. It makes me feel more comfortable. Using the symbol gives me permission to express myself in that way.

And “I am female. Being male hurt” said someone. I read that, I may be wrong, as needing the body to be changed. That is not a signal, as you show it to very few people- unless it is a signal to yourself. Yes, I am a true transsexual, I have had the operation. I feel I had the operation because of social pressure. It was expected.

It is a package. Way of being + way of presenting + physical changes. If I could have tolerated the way of being without the way of presenting, that would have been better, but it seemed impossible to me. Then, if I could have had the way of being and the way of presenting and realised that did not necessitate physical changes I might regret…

I understand that some people have physical changes without fully transitioning. AMAB people who present male but have had surgery, or hormones meaning they need a binder to get through the working day. So I have heard, but never heard from anyone like that directly. If this is you please do say. And some have the operation because it is what matters most, and transition, but don’t go for the “feminine” presentation. Though women wear jeans, and can use them to look feminine/signal femininity.

Just because I now feel I had the operation because of social pressure does not mean that everyone does, and certainly not that anyone else would believe that of themselves. Dysphoria arises from my place in society, and I felt that surgery would alter that place- it did, but not enough. Still there is the feeling that real trans women want surgery, as well as the feeling that trans women should not have to be sterilised to be recognised, both held strongly.

We could accept each others’ variation if we did not feel so scrutinised by the general public. You do not need an excuse to be as you are. Neither do I, it just felt that way. I do not need to find excuses for others- this fat person has a slow metabolic rate, that gay person was the opposite sex in a former life; but people do.