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.

Understanding trans and gender

Fifteen years after transition, this is where I am with trans and gender. Gender and transgender are cultural, not innate. There is no psychological characteristic of one sex which the other does not have, or which is not good or bad in the same way. The greater physical size of males can make males more physically demonstrative of dominance or anger. The difference comes from socialisation, which is pervasive from birth, performed by adults and children, and enforced by violence including ostracism, mockery and physical force. Gender and status are intertwined: non-conforming gender marks you down, though particularly gifted individuals can be recognised within alternative communities.

If the culture were different, valuing all gender expression by all, whether male or female, that would free everyone. To varying degrees, everyone would be gender-fluid, and non-binary gender would cease to have meaning. No-one can know what trans would look like, because trans is affected by culture.

I oppose people being poisoned and mutilated by hormones and surgery. I would be interested to know what proportion of people who have a vaginoplasty manage to dilate it to accommodate a penis comfortably, and how many use it for penetrative sex. The research has not been done, but I could not dilate enough, and my friend who was penetrated said her partner’s penis was sore afterwards, as the neovagina is not as accommodating as natural vaginas. I sympathise with people with breasts who do not want them stared at; it is as if you are an appendage to a pair of breasts sometimes; and binders are painful and constrict breathing. No-one should have to have their body altered to escape oppression.

Natural bodies are beautiful and best allowed to develop naturally. A human not tortured by shame will love their body from childhood, be led to value the changes of puberty, and will care for their body, without needing compulsive behaviours which damage it as a way to escape reality. All bodies have a wide range of gender.

Hormones have made my emotions fluctuate wildly, and make me overheat when I exercise. That emotional volatility is not the whole reason I ceased being able to work, but is part of it.

Sex is potentially far more costly for women than for men. Culture could ameliorate that but instead exacerbates it, with “sluts” and “incels” alike shamed, and all that Me too has revealed to the half of the population unaware of it before- if they have been listening.

Trans is a response to the culture. At first it was strongly repressed but it still burst out, in Molly clubs and solitary individuals. Then the culture sought to manage it: just as English Law protects “transsexual persons” narrowly defined, certain expressions of transgender are tolerated, and there is social pressure to conform to those expressions. Social pressure causes people to have hormones and surgery.

The whole range of transgender activities in AMAB folk is associated with erotic arousal. Arousal is not the sole cause, but may exacerbate the compulsive nature of it. If AFAB people feel aroused by trans activity society is less aware of that, which echoes the Victorian attitude to same sex attraction: gay men were criminal, lesbians were not believed to exist.

There is no feminist campaign which is not weakened by hostility to trans women. The disgust freely expressed at trans women by some feminists is phobic, and should be recognised as phobic- gently worked around, not encouraged as a source of pride and group-identification. Trans women subvert gender norms by ostentatiously flouting them, upsetting conservatives.

The cost of diversity in society is paid by the people who are different. Conformity is prized, but diversity is a beautiful gift. If everyone was free to express their whole self everyone would be happier, and society enriched. However as things are now, a lot of people are happier after transition, and should be allowed to. It makes people’s lives better.

Resisting shame

There are three ways people attempt to overcome shame. We move away from the stimulus, by disappearing into our own lives; move towards it, by trying to prove ourselves, attain perfection, people-please; and move against it, by using anger and trying to shame others. All of these dig us into the hole deeper, and move us farther from our present selves. They remove a little of the pain, only for it to come back later.

(What is the alternative to being present in the moment? Being stuck in the past, in failed past tactics for dealing with problems.)

These strategies do not work. They attempt to disconnect from the pain, but we must feel it, accept it and let it go. With a woman who tries to do her down, Brené Brown repeats her mantra: Don’t shrink and be small for people, don’t puff up and get arrogant and cocky, just stay on your sacred ground. Actually, that sounds quite perfectionist.  In shame, trying to respond rather than react after the woman pushes her buttons she says to herself do not talk, text or type. She has to bring matters to consciousness and soberly assess what the facts really are.

She says, face the shame and heal it with conversation; and with laughter, not as defence or deflection but recognition that I am not alone in this.

I am ashamed of my ways of dealing with shame. My mother taught me to people-please, to pretend to be the way I ought to be; to hide away; to be perfectionist. I am hiding away in my reclusive state, and ashamed of it, because I should not need to.

Much of this has been unconscious. It is all what I do, or what I ought to do, just the way the world is and reality is. I need to bring it into consciousness because otherwise I do not see what a burden it is. In order to go out to work, to face the world again, I need to turn my life around, and like a supertanker with a relatively small rudder I see what a big deal that is. Suddenly that expression is particularly meaningful. It’s huge.

Shame at my effeminate self made me attempt to make a man of myself, joining the territorial army (just about the place I least fitted) and then a woman, by having my testicles removed. It would have been a small price to pay to be normal, to have nothing to feel shame about, if it had worked.

Shame keeps me hiding away.

From Dr Brown’s assessment, self-esteem, considering my gifts and qualities, will not ameliorate shame by itself. Now, it seems that I am ashamed of everything, of all that I am and that I do, and even that I should be so shamed and so incapacitated by it. I fear being shamed if I go out, and then ashamed of not going out. These are powerful buttons for others to push. I am ashamed of what I do to resist feelings of shame. I am ashamed of my life, of the little I have made of it.

I deserve better.

Of breasts and trans men

Breasts have huge cultural and personal importance. I remember the delight of a friend, on hormones just before I was, on finding her nipples were sensitive. I enjoy the sensitivity of my own. I will never suckle a child, but that is not their sole purpose; they are sexually selected, attracting gynephiles. Other mammals have nipples, but not breasts.

Breasts can disappoint their bearers, as too large or too small. A friend said she had envied friends’ larger breasts, when younger, and the way they drew men’s eyes, but they could cause back pain, and weigh you down. NHS reductions are available, not just for trans men. Getting the bra off in the evening could be a huge relief. As one whose eyes are sometimes drawn below chin level, I can report that sometimes quite small breasts- even bee stings- can catch my eye. I am embarrassed. I would rather keep my gaze at eye level, or look down or away, but sometimes I catch myself-

I appreciate that woman’s feelings. Her breasts had suckled her children, and given sexual pleasure, and the thought of losing them appalled her; and that is not how everyone feels about them. They get in the way of people seeing a trans man as he wishes to be seen, treating him as he wishes to be treated. So men bind their breasts, enduring the pain, sometimes more than is healthy.

The surgery is chest masculinisation. It’s not mastectomy, a removal, but creation of a manly shape. I can entirely understand wanting to be seen as a man. I too want my external appearance to match, culturally, my gender. For their eighteenth birthday my friend’s father bought them a man’s suit, and I share their delight in recalling/imagining the experience. It is not the same as my own delight, but mirrors and complements it.

Gender norms and enforcement have changed over fifty years. Women are no longer expected to be housewives; girls are more and more rigidly princesses in pink. One way to escape those norms is transition. If you find the norms oppressive, why on Earth can you not sympathise with others who seek a way to escape them, even if you would not choose it yourself? “Her chest was hollow. It was horrible.” It is the height of arrogance to define others’ feelings and actions by your own. We all do our best under difficult circumstances. You are unlikely to know better than someone what is good for them. They are delighted. Their chest looks just as they want it.

My own breasts have been a bit of a disappointment. Only this year, fifteen years after transition, have I begun regularly wearing a bra with no padding at all. I would welcome divorcing femininity from female, allowing everyone to find their own precise gender, without the conditioning and repression both sexes mete out. I am sure that would profit some of us far more than it profits others, and I don’t think all the outliers choose to transition. But, as things are now, we need the choice.

Weaponising “autogynephilia”

“Autogynephilia” is a discredited theory. “Female embodiment fantasies” fits how people think and feel so much better. Yet the idea of autogynephilia is still used to attack trans women, sometimes by other trans women.

Go to Urban Dictionary and vote down the third definition, which imagines two kinds of trans women: homosexual transsexuals, and autogynephiliacs. “Ashley has randomly transitioned from male to female despite being age 55. I think she’s autogynephilic.” “Rose just spent her children’s university savings on sexual reassignment. She’s in the throes of autogynephilia.” “I just danced all over Ally last night, and didn’t even know she used to be male. Her movements and voice are so femme. I don’t think she’s autogynephilic.”

It creates a complete dichotomy. No homosexual transsexual transitions over age 25. All gynephile trans women are autogynephiliac. Most laughs in the Urban Dictionary are snark, but even by their standards this is a strong attack. I wonder if the statistic that 90% of trans women are gynephile has any basis in reality. Most cis people are straight, so that could just mean that the proportions of gynephile and androphile trans women are the same as in cis men.

It seems to me that more people transition without GRS, and this is out of a desire not to be mutilated. Why should you have your genitals altered? What good does it do? People talk of wanting the “poison glands” taken away, and orchiectomy means you don’t need testosterone suppressants- it is less invasive in the long run- but possibly we are altered because of social pressure. We desire a woman’s role, and everyone said that required body modification. Or, possibly we gynephiles are sexually passive, and that means we feel greater dislike for male organs. Anyway, gender dysphoria was popularly understood to mean body alteration, and now many trans folk don’t seek that.

I did not have facial feminisation surgery, but have known gynephile trans women who did. It involves grinding away the bones of the skull. I find the idea horrible, but again it could be that there is not the same social pressure. You will pass better after FFS, and that makes life easier, however much we assert that people should be treated differently according to other criteria, and not whether they pass or whether they are beautiful. Passing privilege and attractiveness privilege exist. A trans woman with a clear eye to her own interest might have FFS rather than GRS.

The writer hedges his/her bets with the words “common” and “generally”. All generalisations are wrong; but either the dichotomy is real, or it isn’t. There is no rational basis to this hostility- if it comes from anywhere, it is the idea that we make them look bad, that people would accept androphile trans women if the gynephiles weren’t messing it all up by being so revolting. But no-one who is intolerant of trans women would think the difference mattered at all.

What of this assertion? Generally, the two types of trans women don’t associate with each other in any way. If you are an androphile trans woman, please leave a comment. I find that trans women do not associate with each other generally, whatever their orientation, particularly after transition.

Fulfilment

I understand some people get pleasure from sex. Not everyone, and not all the time, but some people occasionally. It is not only a source of shame, self-loathing, misery and isolation.

My strongest term of condemnation has always been “self-indulgent”. It is the height of wickedness, the sin against the Holy Spirit from which all other sin proceeds. One could reframe self-indulgence as self-care, exploring or accepting.

“It is being creative,” says Tina.

Then again, some people find sex a burden, a compulsion they wish to escape. I escaped the compulsion with surgery. And then I found myself masturbating to climax. It took over an hour, and it did not happen often, but it happened. I used pictures of women in the trappings of Domination- leather, pvc, whips etc. I find my choice unobjectionable- everyone has quirks, “normal” is a moralistic not natural concept, ought not is. I like the DSM idea that a sexual predilection is only pathological if it disrupts the person’s life, or the lives of others.

Have you ever been to a kink session? she asked. She tells of an asexual colleague who went to a weekend gathering, with seminars on consent or techniques, and stalls. One had a “Wartenberg wheel”, used for stimulation. “Turn round,” he said, and ran it over the back of her neck- and “though I am asexual, I tingled all over,” she recounted.

The thought of being passive and vulnerable terrifies me. It makes me freeze.

I had nocturnal emissions as well, and then a couple of times, including a day or so ago, I have awoken after what I think is an erotic dream even though I have forgotten it, with no emission but a painful sense of pressure in the bottom. I understood the prostate gland drained into the urethra. I wondered if scar tissue from my slowly-healing neo-vagina was blocking its exit, and if that could cause a health problem. I should see a doctor, I hope to set my mind at rest.

Though “Will bad things happen?” is never a good question for expert or ignoramus. “Possibly, but not certainly” is usually the best answer. “Worry if they do.”

I think deferring gratification is a good thing, and can talk sensibly about it. One should just enjoy onesself sometimes. It is a balance, and which is right at any time depends on circumstances. One can be right enough- mistakes are often acceptable, as they do not have terrible consequences. I put a very high premium on talking sensibly.

I had deep pain and shame around sex, expected and experienced. There have been a few moments when I liked something, when I might have found a way into enjoyment- holding hands that time, that evening… To imagine that sex could be pleasurable, but that I could have no possible path to that pleasure, and that scar tissue might take even my faintest hope from me! It is alright to like what I like– only to realise that when it is too late! Finding a path could be impossibly complex and difficult! Only now do I see myself at all clearly, rather than repressing…

I value moderation. Moderation is not enough, she says, all parts of you need space and a voice and time. You cannot be moderately self-indulgent. It makes me think of the quote from Fyodor Dostoevsky’s Notes From Underground (1864). The nameless narrator says,

I, for example, would not be the least bit surprised if suddenly, out of the blue, amid the universal future reasonableness, some gentleman of ignoble or, better, of retrograde and jeering physiognomy, should emerge, set his arms akimbo, and say to us all: ‘Well, gentlemen, why don’t we reduce all this reasonableness to dust with one good kick, for the sole purpose of sending all these logarithms to the devil and living once more according to our own stupid will!’ That would still be nothing, but what is offensive is that he’d be sure to find followers: that’s how man is arranged.

Moderation could be rational, and imposed from outside- a prison you would do anything to tear down- or organic, arising from within.

I value understanding, and being able to talk of these things intellectually.

I got that quote from the New York Times. I love the NYT, and read it a lot- fascinating topics and good writing style, with the occasional gorgeous sentence or trick of article construction.

Feminists mentioning trans

Here’s Gloria Steinem, on why some films are called “chick flicks”, because they have more dialogue and less violence, and appeal to women, and some films are just films, which appeal to men. Her suggestion for an adjective for “men’s films” is a pure delight.

I realized the problem began with the fact that adjectives are mostly required of the less powerful. Thus, there are “novelists” and “female novelists,” “African-American doctors” but not “European- American doctors,” “gay soldiers” but not “heterosexual soldiers,” “transgender activists” but not “cisgender activists.”

Ooh! A feminist mentioning trans in a way which does not seem completely hostile. The article is not about trans, but about oppression, and it has a list of oppressed groups at one point, and one of those oppressed groups are trans folk. Thank you, Gloria Steinem. Wow, Gloria Steinem, in the pantheon of Feminist Pioneer Intellectuals, being nice about trans people. It almost makes up for a certain Australian intellectual being horrible. The article is not about trans. It mentions homophobia too, and I think it is wrong about that, quoting a playwright: if we look at all real homophobia, it’s anti-feminism. It’s really misogyny dressed up, or pointed at men. No, it is anti-feminine. Not all women are feminine, and many men are, and this is a good thing, oppressively policed by femmephobia. Feminism has to be for the harridan as well as the feminine.

I first noticed this in an article by Eve Ensler, author of The Vagina Monologues. I can’t remember what it was about, now, but it mentioned trans in a positive way as an aside. Something like they’re women too and they have a hard time. I had read a radical feminist critique of this, and it poisoned my understanding. The rad-fem said that she only says that because she is terrified of the all-consuming power of the

Trans Activists!!!!!

who will ruin her career unless she is a cringing, fawning lick-spittle to them. I had definitely been reading too much TERF stuff. Gloria Steinem, with a huge list of awards and honours including several “most important or influential woman” appreciations and a Doctorate of Human Justice, is above that. It is merely true that women, people of colour, gay people and trans people have less power than men, white people, straight and cis people.

In 1977, Dr Steinem expressed concern about sex reassignment surgery, concern which I share. In my own case, I thought I wanted my body altered, where I now believe I really felt that having my body altered made me part of an acceptable category of feminine men, and I wanted to be acceptable. Explaining her stance in 2013, she said We need to change society to fit individuals, which is my current position. It would then be clear why people wanted genital alteration, and those who still wanted it could have it.

I believe that transgender people, including those who have transitioned, are living out real, authentic lives. Those lives should be celebrated, not questioned. Their health care decisions should be theirs and theirs alone to make.

Trans folk disagree about surgery. It is deeply emotive. It should be our discussion, first- not the doctors’, and not wider society’s, but ours, our theory, understanding, choices and ideological struggle. And Gloria Steinem is an ally against the femme-phobia.

Gloria Steinem, What about men?

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Research on trans

A combination of hormone therapy and surgery improves gender dysphoria and other areas of psychosocial functioning. So says WPATH, the World Professional Association for Transgender Health. You would think they should know, and would back up their assertion with evidence; you would be right.

A study may consider patients through the treatment process, or assess patients after treatment. Because the researchers are making the assessment at all times, a prospective study is more reliable. A prospective study of 325 patients reported in 2005 that psychological function improved after therapy, as did body-satisfaction. Surgery alleviated gender dysphoria, and fewer than 2% expressed regret after therapy.

I went to the study abstract. It is even more positive: After treatment the group was no longer gender dysphoric. F-M and “homosexual” (ie, F-M attracted to women, M-F attracted to men) functioned better than non-homosexual and M-F. Two non-homosexual M-F people expressed regrets. Clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance, says the abstract, who may require more therapeutic guidance.

That is, people need support throughout the treatment process. It is not a mere medical matter of administering hormones and surgery, but psychotherapy. Perhaps psychotherapy without gatekeeping or assessment for hormones: a claim of gender dysphoria should be sufficient to get hormones.

Surgery has continually improved, and there has been a steady increase in satisfaction with its outcomes, especially after the Standards of Care were published. Johns Hopkins University medical school ceased to provide treatment after its study found no improvement after treatment; but that study was in 1979. Even in 1981, before the Standards of Care, in a retrospective study of 283 MtFs 71% reported improved social and emotional adjustment.

I wondered if the reference to “observational” studies meant that outcomes were discerned by the researchers, rather than reported by the subjects. That does not appear to be the case: an observational study is one where the researcher cannot randomise assigning the subjects to a control group or a treatment group. Patients would not participate in a study where they could be refused treatment, and researchers could not be unaware which patients had received treatment and which had not, so a randomised controlled trial is impossible as well as unethical. In a review of studies conducted between 1961 and 1991, involving over two thousand patients, 86% were assessed by researchers as stable or improved in “global functioning”. 14% were worse, but who could know how they would have progressed without treatment?

We live in society, where we do not fit. We transition whether we receive hormones and surgery or not, though many are encouraged to transition by medical support. The real control would be a society where diversity was welcomed as the gift it is.

Treatment is justified, and is improving. Doctors providing treatment act ethically. You can entrust yourself to their care.

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