Heather Brunskell-Evans: Transgender body politics

I mourn a dead friendship. I am “Emily”, referred to in the prologue of this book.

I have written about Heather Brunskell-Evans, and the time I spent at her house, so can hardly object to her writing about me. I have written about my gender surgery here, so she is not outing me. She has given me a pseudonym. She told me she was considering writing about me, though did not tell me that she had. I am grateful for her calling me “glamorous”, which I take as a compliment.

Surgery is a private matter, usually, and trans surgery is unique in that transphobes feel entitled to police it on trans people. They demand to know if we have had surgery, and feel if we have not we would not be entitled to the grudging tolerance of a “genuine” trans woman. Heather discussing my surgery so casually reinforces this attitude.

She claims many “men” (trans women) follow a trend of no surgery. This myth is debunked over and over again, and designed to make people transphobic. She claims I had “foregone genital pleasure”, another casual falsehood: I still orgasm. Nor do I feel I am “a medical patient for life in a never-ending battle with [my] body”- taking two pills a day is hardly onerous, and I rarely see doctors.

She saw that I “needed to take on a stable, coherent, ‘feminine’ identity”. That’s a lot better than saying it is a matter of “men’s feelings”, as if we could just get over it. I could distinguish identity from “who I am”- identity is “who I think I am”, which is different- but they are close enough. A feminine identity would not fit if there was nothing feminine about me. And “feminine” would not exist as a concept if it did not relate in some way to women. It is not merely oppressive.

She told me she saw me as a man, and I did not challenge her. She doesn’t think I believe I am female. Well, it’s complicated. The only coherent definition of the word “woman” includes me. However if someone demands that I prove I am a woman to their satisfaction, or wishes to persuade me that I am not, I can’t be bothered arguing. And, I have internalised transphobia: any belief that I am not a woman raises echoes in me. Heather should understand, as she knows about internalised misogyny: that she does not shows difficulty empathising with trans people.

She says that at the time she saw my trans identity as something which should elicit kindness, generosity and tolerance. Similar arguments are used in many situations: she used to think as decent people do, before she fell down the rabbit hole- or attained enlightenment, take your pick. However it is belied by the story later in the prologue, of hearing of a teenager who identified as trans. She sympathises with the “stricken” mother, is horrified, and said her duty was to prevent transition. She told me at the time. I know the identity of the mother, though I will not say: I remember Heather telling me if I did “I will fight you”. I don’t know if the person has transitioned since.

I went to one, rather staid, party at her house, and find her exaggeration odd. Moving her furniture, I took off my wig because I was too hot, and three of us women struggled with a mattress which a man, single-handed, was lifting up to an upstairs window for us to drag inside. I was trying to help! Her claim that I lifted furniture as well as the man present did is no doubt intended to reinforce the idea that trans women could equally well be in men’s sport.

Her article on Caitlyn Jenner, written before I helped her move furniture into her house, shows she was already committed as an anti-trans campaigner, or at any rate someone prejudiced against trans people. Her casual misgendering of me gives the lie to the common trans-exclusionist claim that they would use our pronouns “as a matter of courtesy”.

She dedicates the book to her grandchildren, hoping they will not have transgender alterations to their bodies during childhood. Trans is rare (Heather’s figure is “less than 1%”) so this leaves me wondering if she has some reason to believe one or more are trans. It shows an inability to see that transition could benefit someone, even though she knew me. That disqualifies her from writing about trans people: everything she writes comes from her lack of comprehension. Its only value is in demonstrating the ignorance of trans-excluders.

I remember the tale of the birth of the youngest grandchild, which only increased my admiration of Heather. Having edited or written three books, made many speeches, and contributed to several websites, she appears to be a full-time anti-trans campaigner, believing that trans acceptance is in some way a threat to women. It is a tragedy.

Demedicalising trans

If trans people are not sick, and not defined by the psychiatrists, what are we? Is it something we are- really of the opposite sex or gender- something we desire, or something we do, transition? Is it about gender roles, or about sex? Is it defined by other people- you know that self-righteous way they have of cornering you and asking if you’ve had your bits chopped off- in a sneaking, sideways manner, not straight out. One asked me if I’d transitioned “with a big T or a little t”. Or the trans groups, by turns expressing delight that we are having operations, or bemoaning the long wait, or the psychiatrists’ gatekeeping. “I know it won’t grow back,” we say. “I don’t want it to!”

The cis police us, and we police ourselves. I remember strong doubts expressed that a “non-op” could be a “true transsexual”, even though she said she had a heart condition and no doctor would anaesthetize her.

What would the cis police think of a trans woman before her op? Possibly treat them as suspiciously as they would treat someone who was Not Transsexual. When someone corners me like that, it feels that it’s grudging toleration on offer, if I am anatomically correct, and torches and pitchforks if not- for, otherwise why ask?

If we are not sick, and we do not need psychiatry, or counselling, or correction so that our gender identity matches our sex, why do we need our bodies altered? Is that what “being trans” means- the desire to alter your body and approximate sex characteristics of the acquired gender?

I wonder if “knowing you are of the opposite gender, or wanting to be of the opposite gender” is who we are, a question of being, or how we explain ourselves, just the words we have learned to use to describe ourselves. “I knew I was a girl when I was six,” we say, but what did you think a “girl” was? A girl, dressed differently, playing different games, going to grow up to be a Mummy who was different from a Daddy. But the cultural differences between the two change over time and the anatomical differences may not be so noticeable to that six year old.

In the Keira Bell case the judges said that at 14 you don’t know what sexual fulfilment would be like, or whether you will want children of your own.

The concepts, the verbal formulae, come from psychiatrists or scientists, observing us like a primitive tribe or a mental illness. They are hammered out in the press, talking of sex changes and giving a stereotyped story of My Transsexual Struggle. We then become jealous of them. If this is the price of continued toleration in society, we want to fit the Rules, and exclude anyone who might not more ruthlessly than the straights do.

Is how we conceptualise ourselves the most important thing, what we do, or what we desire? I would say desire and action- the person, desperate yet terrified to transition, or who transitions. If there are ten times more transitioned people in the UK than there were twenty years ago, this shows that more will transition as we learn about it and see it is possible, and the societal opposition decreases. But then, the conception can create the desire. If the operation is the symbol of acceptability, we desire that symbol, and might imagine we desire it for itself, rather than because the cis require it of us.

Don’t have GRS. If you tuck, there is almost no visible difference unless you are naked. You might find a use for that penis. If we are not sick then we don’t need treatment, including hormones or surgery. Be certain you want the surgery for itself, not as the symbol of True transsexuality. Transition should not be a process involving changes to expression, role, and body, but a series of discrete choices.

In the “stable version” ICD 11, there was a long definition of gender incongruence, involving desire for the other sex’s sexual characteristics. Now that has been dropped, and the definition is this:

Gender incongruence is characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex. Gender variant behaviour and preferences alone are not a basis for assigning the diagnoses in this group.

ICD 11 does not say what, if anything, should be done to such people. Don’t define yourself by what other people demand of you.

Georges Burou

Georges Burou was one of the first surgeons to complete gender reassignment surgery as a matter of routine. He was a gynaecologist from Algeria who had been struck off by the French Order of Physicians for performing illegal abortions, and set up a practice in Casablanca, Morocco, where he continued performing abortions. He used penile and scrotal skin to line the neovagina.

His first GRS was on the singer Coccinelle (Jacqueline Charlotte Dufresnoy) in 1958. She had sung and acted, as a woman, since 1953. She said later, “Dr Burou rectified the mistake nature had made and I became a real woman, on the inside as well as the outside. After the operation, the doctor just said, ‘Bonjour, Mademoiselle’, and I knew it had been a success.” After her legal name church, the Catholic Church married her to a man, Francis Bonnet, in 1960.

Burou’s ninth GRS patient was April Ashley, the first British person to have GRS, in 1960. He was said to have operated on the singer Amanda Lear, Salvador Dali’s muse, but she has always denied she is trans. Her birth date has been given as various dates between 1939 and 1950, and her place of birth given as Saigon, Hong Kong, Singapore or Switzerland. She posed naked for Playboy in the late 70s.

In 1974 Dr Burou told Paris Match, “I started this speciality almost by accident, because a pretty woman came to see me. In reality, it was a man, I only knew it afterwards, a sound engineer in Casablanca, 23 years old, dressed as a woman … with a lovely chest which he had obtained thanks to hormone injections.” What makes a man, I wonder.

April Ashley wrote that Dr Burou told her, “there was a 50-50 chance I would not come through”. I don’t believe her. There would be a fair case that death in surgery with such a risk would be murder, an intentional killing, or at least wickedly reckless. Eric Plemons however says the loss of blood was immense, and the surgery has only become safer since the 1980s. I wonder if Dr Burou performed alone, or had assistants and an anaesthetist. In 1952 there was surgery where the heart was stopped and restarted.

In February 1973, the disgrace of having been struck off did not prevent Dr Burou presenting to the Medical Congress of Transsexuality at Stanford University.

Dr Burou, a keen sailor, died in 1987 when his boat capsized in a storm.

I got much of this from Oliver Bennett in The Independent. However Bennett writes that “By the 1970s, Dr Burou had performed between 800 and 3,000 such operations, though the true numbers are difficult to measure in a semi-clandestine milieu. Those seeking GRS with him had to put in the groundwork, find out the location of the clinic and deal with the considerable logistics.” Wikipedia explains the divergent numbers: there were 800 vaginoplasties, and 3000 patients in total who may have had other surgery. Bennett tells a little of the history of GRS,

Jan Morris wrote that Burou did not bother too much with diagnosis. He said he did not ask his patients too many questions, but that he judged his patients had “a distinct feminine appearance or character”.

Falsehoods on detransition

A trans man commented on twitter that of 22,725 trans people operated on, only 62 regretted the operation, and only 22 of those “changed gender identity”- I think he means detransitioned. So I asked him where he got the information. He referred me to this article from PRS Global Open, the International Open Access Journal of the American Society of Plastic Surgeons.

Dr Sara Danker and others wrote to about 150 surgeons who had registered for the WPATH or USPATH, World or US Professional Association for Transgender Health, and asked them how many patients they had treated, and how many patients had regretted their transition or sought detransition care. 46 surgeons responded, and they had seen between them about 22,725 patients. 49% of respondents (I don’t know how it could be other than 50% or 48%) had never encountered such a patient. 12 surgeons had had one patient, the rest had encountered more, and the total was 62. 13 regretted chest surgery. 45 regretted genital surgery. 16 trans men, 37 trans women, and six nonbinary people sought detransition, a total of 59.

22 said their gender identity had changed. Eight said they were rejected by family and social support, and seven said they had difficulty in romantic relationships. Of the trans women, seven had vaginal stenosis (shrinking of the orifice, which is unsurprising. If you regret surgery you won’t dilate as much), two had rectovaginal fistulae- holes between their rectum and their vagina- and three had chronic genital pain. Two trans men had a urethral fistula and one had a urethral stricture.

If I detransitioned, I probably would not seek further genital surgery. Any surgery would have a risk of reducing sexual sensitivity even further. If I could afford it, I consider a hydraulic penis would be a poor substitute for the original. If I had a fistula, which sounds appalling, I would not go back to the surgeon who had originally performed the surgery, whether it was his fault or not.

To check the figures, I would want to know the incidence of recto-vaginal fistulae in post-operative trans women. If the incidence was greater than 0.0088% then I would not trust the incidences given here of regret or of other problems. I’m blogging. No sooner written than done: I googled “recto-vaginal fistula in transgender” and found this study, where 1082 trans women had 25 fistulae between them- that’s 2.3%.

I don’t trust the three in 20,000 figure for pain either. A trans psychotherapist, Iore M Dickey, says trans people experience higher rates of chronic pain. I would not go back to a plastic surgeon for pain relief.

I don’t trust this study. I have no idea how many trans people have transitioned or detransitioned. The Detransition Advocacy Network don’t give figures. Fantasist Walt Heyer, who has made a career of speaking and writing against transition after he reverted, claims “up to 20%” regret, but “up to” makes the “20%” meaningless. He writes of being “safe in the arms of Jesus”, to attract the batshit Evangelical market, and writes for The Federalist.

62 regretters out of 20,000 operations. Would that it were so. I regret my operation, and say so repeatedly, though I am not going to revert. I consider I had the operation because of social pressure, and it would be better for trans people to find a way of enjoying sex with the genitals they have rather than have them altered. I consider trans people are mostly glad of transition, and if some people regret, enough benefit that it should not be made difficult. It would be good to have the figures of those who benefit, but that short article is not it.

Hendrick ter Brugghen, ladies and gentlemen, follower of Caravaggio. The painting of fabric is exquisite, especially the clothes of the bagpiper, and the command of light and darkness follows the master well- in execution, but not in subject. He could not paint Judith like Caravaggio did, though there is foul sexual power here, and strong antisemitism.

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.