Moving forward

I decided to transition in November 2000. I went to my GP and got a referral to the psychiatrist, and started arranging things like speech therapy and electrolysis. I decided to take nearly two years to sort out transition at work, but my plan was clear. I would dress female not only in accepting spaces like Manchester’s Gay Village, but in ordinary spaces, like the street or supermarket. I put the plan into practice. After a year full time, I started work on arranging the operation.

My friend is moving forward now. She has been working on her voice, and got it to a pleasant pitch above the break. A mixture of laser, electrolysis and epilation has greatly reduced facial and body hair. She goes out neatly tucked and does not particularly like the protruberance, but tolerates it. She is putting into place the career changes she feels she needs to transition. She brings aspects of her feminine presentation into her manly work environment- from baritone her normal speaking voice has moved up to tenor, her body language is different, and she notices that the way people respond to her changes. She likes those changes.

She feels that seeing the GP is the moment crossing the threshold, the moment of commitment. It was for me, but she is feminising before committing to transition, and I never did: almost to the end, I kept my male presentation in my manly pretence, out of fear. I have been wondering if hers was the way to find something better than transition, to ease into a more comfortable, feminine existence without all the faff of clothes, wigs, makeup. We arranged to meet, and I was going to tell her not to transition.

It seemed to me transition is a cul-de-sac. It is so tempting because you know what you have to do, and you feel you are moving forward until you hit the wall- for me an operation with results I did not like was the wall. Dressing works like addiction, I said. At first it is really nice, but eventually you have to do it to make life tolerable.

There is social pressure. I would say “Hello” to my neighbour, no long conversations, but after he noticed me going out for the evening dressed female he started blanking me. I asked his wife, pretending innocence, and she lowered her voice and said “I think it’s because of the way you dress“. But, when I transitioned, he would say hello, again, and he came round to say goodbye when they moved. Transition is grudgingly accepted in a way effeminacy is not.

What about relationship? Women “wearing the trousers”, virago + beta-male, can be made to work. It worked really well for my parents, though that screwed me. It is very tricky for the male, perhaps similarly tricky for the woman in a male-controlled relationship: great if the partner self-asserts to benefit the couple as a team, not so much if s/he simply gets her own way.

I realised that I could not tell her not to, that she was aware and still moving forward. Why would I want to, anyway, it is her life, warning her off might not be right for her and would not mitigate my own loss. Possibly, there would always be one brick wall or another to hit; possibly this is the best it can get. Possibly any path ahead, either it is signposted, and does not satisfy; or overgrown, and hard to find.

not knowing

He recognised the anger and angst that Abigail suffered and fervently hoped that she would be able to love herself. Perhaps he will pray for me. I experienced him, despite his protestations, as hostile, but it is bracing to see oursels as ithers see us.

His career has been successful, and it seems to me our gifts are opposite: he is not terribly bright, though good-hearted, and has been enabled to prosper by self-belief arising from a privileged upbringing. Actually, I make progress on loving myself. I see, intellectually, that I am lovable, and though I more often am frustrated with myself I see the point of nurturing myself, and seek better ways of doing that. Sometimes I even accept emotionally that I am lovable.

Anger and Angst. I thought, Wangst– there I go, pointlessly harsh on myself- but yes, anger, anger is my ground bass. I am sitting in the Quaker meeting thinking of various instances when someone has said, wonderingly, “You’re so angry!” to me. Like that time with the council careers service, keeping me standing outside their door where colleagues passing on their way to work round the corner would see me, rather than letting me in for my appointment. Some irritation was appropriate, possibly not the anger she discerned. The anger I discerned is against myself, mostly, and out of proportion too.

I have been on the edge of deciding that transition is a complete con, that having tried to make a man of myself and failed that trying to make a woman of myself is just the pendulum swinging, as distant as ever from being my natural self, that no-one should transition. And it came to me in meeting that I could not possibly know, because I judge my own decisions so harshly. This was what I wanted more than anything else in the world, and possibly it was just me groping in the dark- from wrong to wrong the exasperated spirit moves- and possibly I could trust my own decision more. I don’t know if it was the best decision. I can’t. Either I am committed to it, as it has involved such an investment of effort and energy, so I can’t admit to myself it could be wrong, or I despise myself so completely that I cannot admit to myself it could be right. I want to know, I want to understand, I want a world map with which I can navigate my world and make decisions based on accurate prognostication, so it is tempting to plump for one of those opposite positions- worst ever decision or moving forward into fulfilment- to have a position on the question.

I can’t know. I am not equipped to judge, certainly not rationally, and as for how I feel about it, that changes under the influence of other things. Therefore I can’t know I was completely, self-destructively wrong.

I told the person sitting next to me I had had a blessing in meeting, and they said they knew. Not something to minister about, though, just for myself.

Living unapologetically

Karis Wilde will appear in a film called “Make Love not Walls”. The genderqueer dancer and model oscillates elegantly between conventional male and female gender distinctions, in one clean fuck you to so-called norms. She likes both male and female pronouns. He says,

It was very difficult being as queer as I was- there was no hiding it.

What would that mean? I hid it. I was not popular, but I was seen as nerdy rather than queer. So, I am less queer than Karis, or more suppressed? I think more willing to suppress, less able to tolerate my real self.

I think I just started living my life unapologetically. For a while I tried to be a little more masculine – that was a bit of train wreck – and then I tried being a little bit more feminine but nothing felt genuine. Nothing felt right, so I just ended up choosing to be myself.

I tried to fit in as a man, and transition was yet another attempt to fit in. If I can’t manage being a man, perhaps I will manage being a woman. But-

But it was very difficult – even a lot of gay people don’t think outside of the box, they just think in a different box.

Gender queer. Just be. It is far more difficult than those two words appear- we follow tracks, of normal, queer, exuberant, boisterous, how we are supposed to be, bothered when others look surprised.

Aged 21, he found very open, loving and accepting people. As I have said, I have some faint hope for my fifties.

I don’t think people respect anyone who is insecure about themselves. I think it’s just built into them to stomp on weaker people. So once you start being comfortable with yourself, you command respect, and it’s a different way that you carry yourself. That was definitely true in my instance. I felt a shift in not only how people viewed me but also in how I viewed myself. I think everything changes in that instance.

Why would you do anything? Is it because you like it, or to curry favour which will not be given anyway? Even if not “stomp”, we do not like weaker people, or want to be with them. There is the-

how could I start that?
Am I ever like that?
Is it just that I notice the lacking conviction, trying to fit in me, and not the-

It is as if I am shut down, and trying to reactivate myself. One learns these things. Being and seeing, trusting or knowing that I be and see…

I think everyone is so raw and hurt right now that when you actually speak about love it hits a different tone. People are starting to feel very alienated and very forgotten so I think that the word love has taken a deeper meaning.

He is a campaigner for social justice. I feel such envy.

Karis Wilde interview.

Karis Wilde is wonderful, and then I saw this other quote here: You may suddenly decide you’re part of all these groups, but the world has its own idea of who you are. They won’t let you just get on with that. Some manage, some do not.

The arguments for transition

It lets you be yourself.

You may become obviously a trans woman. You may become impotent and infertile because of hormones or surgery. You may spend a great deal on transition, on clothes finding a style that works, on hair removal, or on baldness treatments. You may suffer all of this. But it lets you be yourself.

You will still find it difficult to “be yourself” in certain situations. At work, you will probably do some things you do not enjoy doing, with people you do not like- not all the time, but some of the time. You will find places you can be yourself in your own time, such as Doctor Who cosplay, perhaps, channelling aspects of your character you cannot express elsewhere, or extrovert, even exhibitionist tendencies.

You should be able to be yourself with your family, but some families prevent this. Possibly most do, to some extent. That is how we develop blind spots, where we don’t know things about ourselves which others see clearly. We put up a façade to try to fool others, and even sometimes to fool ourselves, and there are parts so deeply repressed that no-one can see them. You should be able to be yourself with a partner.

I don’t believe I have a female spirit, soul or essence. I am a materialist. Professor Brian Cox puts it this way: CERN shows how particles interact. If there were spiritual forces interacting with matter, we would have observed them. Spiritual understandings still explain observed phenomena- “I have a female spirit” is a useful way of putting it, because people understand, but there are better ways of saying the same thing: “I have characteristics seen as feminine in my culture”.

I don’t have a female brain, and nor do androphile trans women. There are certain sex differences between brains, and trans women can have certain female characteristics in their brains, but it is not true that trans women before treatment have clear female sexual dimorphism of the brain, or that anyone does.

Patriarchy through culture oppresses women, feminine and gender diverse people. It is hard for a man to be feminine. So I suppressed my feminine self, which I could only express through cross-dressing, and otherwise tried to hide from everyone.

I am meeting someone for the first time in at least fifteen years, and will advise her not to transition. Don’t make the same mistake I did. “There was a door you did not see”. This is based on the above rational case; but people do not do what is in our rationally chosen best interests. It misses out the other argument for transition- that I wanted to, more than anything else in the world.

It is compulsive. It is sexually arousing. I tend to feel it is sexually arousing because it is compulsive, rather than the other way around, but still. I tend to feel it is compulsive because

It is a way to be yourself!

It is a way to be able to accept being yourself, to be yourself, let down your guard, know yourself, admit yourself, tolerate yourself, stop acting and pretending and feel less that you are wrong and inadequate. It is water in a desert, sunshine and flowers when you have been locked in a cellar. It is the best truth many people can find.

The masculine act is not you. Can you find another way to be yourself other than transition? Transition if, despite the consequences- mockery and prejudice, infertility, and cost and effort- it is the best way available to be yourself.

Trans ideology

So many stories! I have the brain/spirit/soul/heart of a woman, I am really a woman, provoking research into psychology and brain physiology, and legal or social responses. I don’t care whether it is true or not, but how it liberates or constrains us. Does it permit you to do what you want to do? Does it prevent you? How does it affect others’ resentment or tolerance of you?

It would be lovely to be able to say, with scientific precision, “I am a woman”, because that would make everything simple. Of course transition would be right, and I would be allowed in women’s spaces. Of course society and the law would treat me as a woman, and anyone who dissented would be clearly wrong. I can’t do that because it is not so. The concept of “woman” is not so clearly divided from that of “man” as the transphobes would think, but useful scientific definitions relating to reproduction call me clearly a man. What I am left with is a social or cultural concept, so I say “I am a woman” according to the modern English definition of the word, which includes trans women. This liberates me to transition, and to argue that others should accept me, but that is a circular argument- I am a woman, because people call me a woman.

If a transphobe argues that I am not a woman because I have a Y chromosome and any scientific wiggle-room about intersex people does not apply to me, the question is Why. It could be because they want to enforce Complementarian “biblical” gender roles, or because they want to direct feminist energy against me, calling me part of the Patriarchal Oppression of Women.

If you are deciding whether to transition or not, this is good and bad news. The bad news is that you will never be able to state with complete certainty that you are a woman, and therefore must transition. You have to find what you feel. What do you want? Will transition make you happy? The good news is that if you really want to transition, nothing should stop you. If you want to transition, you are trans. No-one can tell you not to transition because you are not trans. There are unscientific, cultural stories around arguing that you are not, such as “Autogynephilia”, but do not worry. It is a myth. “Female embodiment fantasies” explains the phenomenon far better.

It also widens your options. No, you are not objectively, scientifically a “woman” but you have particular characteristics, desires and needs which make you desire transition. Are there alternatives which might make you happy with less effort?

It means that you will never convince the transphobes. You cannot point to objective scientific evidence that you should be able to use women’s changing rooms. However, the people who really care and want to stop you are a small minority. Most people don’t see what the fuss is about, and so those who do care are desperate to convince them. But the more they exaggerate the threat of trans women in women’s loos, the more reasonable people they drive away.

What is Trans?

What does “Trans” mean? There are many answers, and this is mine.

Trans starts with the concepts of “masculinity” and “femininity”, which do not fit men and women as we really are. At its worst, toxic masculinity rejects the expression of emotion apart from anger and derision. Boys and men are expected to put on a manly mask which suffocates them. Women are objectified, valued for their looks, treated as weaker and needing looked after by men while made responsible for most housework and care of children, the disabled and elderly. Feminists call this “patriarchy” and differ in their emphasis on how it affects men, but it hurts everyone apart from a very few high-status men.

Patriarchy fits no-one. Everyone needs to deny part of themselves to fit in. Those who particularly do not fit are trans, or trans-like people. To call myself a “feminine” man is ridiculous, as “feminine” relates to women, but the word has come to denote qualities prescribed by patriarchy for women, such as being sensitive, empathetic, compassionate, communal, unselfish, supportive, motherly, nurturing, gentle, forgiving, and caring. These are my natural qualities, though my attempt to be a “Real Man” has twisted me.

Femininity can also refer to certain mannerisms, body language, or physical appearance.

I am mostly interested in trans women. Some of what I say could also apply to trans men, and I could use inclusive language, but will discuss trans women only. Trans women may be Gynephile, attracted to women, or Androphile, attracted to men. Androphiles are called “Homosexual” by the researchers, denying that they are women, and Gynephiles are called “Non-homosexual”, which I find demeaning, even though some of us present as bisexual or asexual. If I am not a woman then I am heterosexual, attracted to women. Trans in androphile and gynephiles may be different phenomena with different causation.

There is research on trans, and on the wider question of whether femininity and masculinity have any reality separate from culture. There is a wide range of masculinity and femininity in men and women, but by and large women are more feminine. Whether nature causes this, or nurture, culture and society, is strongly disputed. I would not accuse researchers of fitting the evidence to their preconceptions, but the questions are so political that they might choose research projects to confirm their claims, and interpreters can be wholly political. I read one conservative Christian sniffing that trans women’s brains are different because we obsess about trans, promoting dendrite growth in particular areas. And even if parents of both sexes expect a toddler boy to slide down a steeper slide than girls the same age, what could that mean? I do not have the time or education to assess individual research papers, leave alone the wider questions.

Studies show some brain differences- in the 1990s I was aware that brain dissection had found the BSTc, the central subdivision of the bed nucleus of the stria terminalis, is twice the size in men as in women, slightly larger in gay men, and female size in trans women, but what could cause that or what it could mean is a mystery to me. We could use it for large claims, that trans women are apart from men, really women, and some do, and there is a huge backlash. Brain research does not justify the large claims of some trans folk.

There is no clear cut-off between trans and cis-gendered. There is a spectrum of masculinity to femininity in men. So other circumstances will decide whether you transition, such as whether you have a partner and what they feel about it, what your job prospects are, or how well you pass. I read of a person who had been the subject of a documentary on transition, but stopped when he found a male partner.

Some men are aroused by cross-dressing, or by thoughts of themselves as women. This is more likely a by-product of being feminine than the cause of transition. Some are satisfied with recreational cross-dressing: at the Northern Concord, it seemed to me that some were just blokes down the pub, who happened to be dressed rather strangely, and some were feminine.

My particular interest is the gynephile trans woman, especially me, and her counterpart the masculine woman: viragos and harridans, sissies and pansies. This is the sexual orientation that has only hurtful names- the woman “wears the trousers”, the man is “pussy-whipped”. “Beta male” may be a more positive term, or “Alpha female”, but both these terms are claimed by other groups. My parents were like this, terrified of people finding out, and inculcated in me terrible shame. My mother would not let me play with Action Man because “boys should not play with dolls”. My father objected to women on Radio 4, claiming to loathe the sound of their voices.

In the Underground last week I saw a woman, her leg crossed, her foot against the shin of her man, holding his hand and squeezing or pinching it. I felt they might have such a relationship, and felt envy. It is not the same as BDSM.

I don’t know how the desire to present female and actual femininity are related. I tend to feel that some men feel that their characteristics are more acceptable in women, and it is in part a desire to fit in with social norms. I lay on the floor weeping “I am not a man”- if only I could have realised I am not that kind of man.

Though I had the operation, I oppose it. I had it because I thought that it would make me part of an acceptable class, that it was better to be transsexual than transvestite, rather than because I wanted it for itself. Before, I had been ashamed of my slim wrists and arms, but after I found them beautiful, so it enabled me to love my body- but I wish I had found some other way. For a time, it all seemed to fit: I was a “woman”, so I felt this way, and was pleased to appear this way. Possibly we have the operations because doctors wanted to be seen to be doing something, or even wanted a subject to experiment on. I feel some people want the operation simply for itself, and should be allowed to have it. In a world without patriarchy, we could know.

I have fellow-feeling with radical feminists, even TERFs. They are revolted by body-modification, and some lack any sense of proportion about trans women, as if we are the only feminist issue they care about, but they are often masculine women, and not fitting Patriarchy in a complementary way to me- how could I not sympathise? I would put them in a group with trans folk, those who are gender non-conforming, who do not fit patriarchal views of gender. We have so much in common, it is hard that we do not work together. We are oppressed by Patriarchy in such similar ways.

The basic phenomenon is feminine men and masculine women, but how we respond to that is shaped by the culture and our experience. I suppressed it, and tried to be Real Manly for years. There is transphobia, and internalised transphobia, which prevents us from flourishing. We learn to be ourselves better, but still in ways twisted by oppression. We must build coalitions and learn to resist oppression more effectively.

The words you use to describe the phenomenon affect how you understand it. But we don’t understand it, not really, so we need to keep playing with the words. I would ask potential transitioners, Who are you? What would really fulfil you- is it really this off-the-peg solution? I would refer to “gender diversity” rather than trans, for “gender-diverse” is how people are, and “trans” or even “gender-non-conformity” are choices, ways to deal with the pressures of Patriarchy on gender diverse folk.

berthe-morisot-summer-day

Truth and narrative

“True story” is an oxymoron.

I phoned the Tax Credits helpline for advisers, and got nowhere. “You’re being very condensating,” said the man I was referred to, and after half an hour my brain was so cabbaged that I knew he meant something else, but did not know the word for it. Thank you, you don’t need to say it now, I worked it out for myself later.

In the nineties I knew a man, still the most boring man I have ever met. I can’t remember his name, but it ended in an í sound, a contemptuous diminutive, Nicky or Ricky or Donny or something- anyway, he got very drunk on whisky, and ever thereafter could not drink it. He found a sip nauseating. Dismissively contemptuous, Neil said he probably had had no head for it anyway, he got drunk on a couple of glasses.

I associated those stories. “Condensating” was the moment I got nowhere with the benefits authorities, that I could not take any more. I cannot bear it. I could not bear another such conversation, it nauseates me.

Another myth. Margaret saw me as Clare for the first time, and said, “It’s as if you are acting when you’re Stephen, just you when you’re Clare”. Aha, I am a woman really, I am right to transition. The story becomes my conclusive evidence that I am right, the judgment of another person which I cling to, and take out for reassurance from time to time. It is my self-image: I know who I am, and “you’re just you when you’re Clare” is part of it.

Then about a year ago, I took off my wig and put on my cycle helmet, appearing androgynous, but continued talking, and H said “You have this lovely male energy”. Her beliefs, her politics, or her individual judgment of me need have no bearing on me, but have had. I could if I wanted call that comment on Wednesday 2 March 2016 the decisive moment

where my lies came apart
where my truth was undermined

Several times I have picked on particular dates where all changed, changed utterly for me. H has changed my view of the world. I am not sure if I have ever been entirely sure that I am a woman- I joked “I don’t know, and neither does my psychiatrist”, and said “I’m both and neither and in between”. Her word “lovely” just makes the blade sharper.

Either it is liberating- yes, I am a man, I need no longer assert a falsehood that I am a woman- or terrifying and destructuring, and I try to piece together the shards of my framework, world map, understanding which lets me navigate the world. “I am a man, but transition was the best I could do,” I say. “Bad things happen to good people.”

Or I create a new narrative. “I am a trans woman”. I have the right to be this way.

Brexit and Trump, and possibly this year Fillon and AfD, change my comforting narrative, one which is probably yours too. It is a debased Whig version of history: just as the Battle of Bosworth Field in 1485 was a decisive moment of progress, which changed the way of doing politics in England from battles to individual murders, a clear improvement, so Obergefell v Hodges was a step into the light, which could not be reversed. A Tory version of history, that there are random events with no broader significance, is reasserted, so that Trump’s Muslim ban is not a pathetic attempt by the failing forces of reaction, but a random event of quite as much significance as Obergefell.

We need to change our stories. Since 2016, our stories have not been the Truth, but a comforting lie to help us get through the day without collapsing on the floor, screaming. The words “male energy” are a stake through their heart, as is the Muslim ban. “Do your duty, Republicans,” says the New York Times. “Prosecute him!” Trump meanwhile promises a new Muslim ban which will be less vulnerable to judicial scrutiny.

I have been reading of stories. Here’s Rachel Cusk in the NYT:

In psychoanalysis, events are reconstructed in the knowledge of their outcome: The therapeutic properties of narrative lie in its capacity to ascribe meaning to sufferings that at the time seemed to have no purpose. The liberal elite are in shock; they fall upon the notion of the victors’ regret as a palliative for their mental distress, but because the referendum result is irreversible, this narrative must adopt the form of tragedy.

And, writing of her mother

She didn’t care what she said, or rather, she exacted from words the licentious pleasures of misuse; in so doing, she took my weapon and broke it before my eyes. She made fun of me for the words I used, and I couldn’t respond by threatening her with death. I couldn’t say “I could kill you” because it wasn’t true, and in language I had staked everything on telling the truth. I have had that experience debating Creationists: I try to persuade, using truth, they simply assert their Beliefs. “It cannot be so, because of Genesis.” It was bad enough debating a blogger on the other side of the world- how much more terrifying, to face your own mother’s assertions?

Thus saith the LORD.

There is no answer to that. Tim built an impenetrable wall of language to shield him from- the truth? Or just, my understanding of the World? The defeated liberal is abashed, so less confidently assertive.

Anna Blundy, in a completely different essay- a short column not a hefty work like Rachel Cusk’s- also addressed making sense of truth with words. Language distances us from our real thoughts and feelings in an almost defensive way (the fact that it makes us feel better to have named something, perhaps is even indicative of that)… we’re trying to repackage something into a digestible form that will make the symptom of the sufferer more bearable.

Surely it is better to face the unvarnished truth? This essay says that news broadcasts and advertising alike end up telling stories… the mastery of danger, the satisfaction of desires and the ultimate restoration of morality. But here, an effort is made to lead people to believe that the story accurately depicts people and events. As a result, all end up profoundly falsifying what they portray, once again mixing faithful and manipulated images, and fact and fiction in seamless ways so that it can be hard to tell where one ends and the other begins. The attack is mitigated by the fact that the essay itself has a similarly comforting structure, where the restoration of morality is us all becoming more sceptical about the media.

It is not at all reassuring to say that I can’t bear another phone conversation with the benefits authorities. I could say, well I had hundreds before, many of them successful, or simply that I should eschew predictions of the future, which may just be paranoia, and concentrate on the actual task. I know what the task involves. Fear of what bad things will happen and how I will respond when I fail just get in the way.

This is my two thousandth post, on a blog about me, truth, trans, the world, and everything that interests me. I do it to be read, and achieve less of that than I would like. Joanna wrote a short post recommending one of mine, and I am grateful for the recommendation, because my post got more than three times the views from it, than 75% of my posts get from all sources. This is my least worthwhile goal, to see that I have had more views. Writing of Donald Trump stretches my writing, but gets fewer views, as most of my readers come from a Trans site, so I restrict my choice of subjects to get more views. Posting daily gets more views. I get a tiny dopamine hit when I see my page-view numbers have increased- nearly 198,000 views in five and a half years.

I might be better to write longer essays. I could develop an ability to analyse an idea in greater depth. This is not that: I have quoted undigested screeds from three essays and some of my own thoughts on truth, rather than explained the essays, created a satisfying narrative argument in my own words, and polished it. Writing around 500 words a day is good practice, but I want to edit and structure something more satisfying than these short pieces. I have published just one 2000 word article. I love Rachel Cusk’s essay- how I would love to write something like that!

I blog to tease out my understanding, as well. It is psychoanalysis for me, repackaging reality into that digestible form. So I have written how transition or surgery was the best thing I could have done, and the worst, in separate pieces, and wonder how to unite them.

St Clare

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.

gwen-john-the-convalescent

 

Inspiration

Where, in the late 1970s, would you get the idea of cross-dressing from, anyway? Dick Emery, perhaps:

Or there was an orgy scene in I Claudius, where the bra of the fleeing coquette is seen to be stuffed.

Where did I get the idea of cross-dressing from? I just wanted to, so I did. Arousal, compulsion, shame followed almost immediately-  not in my memory of the first time I did it, but ever thereafter. I knew no-one must know I did this awful thing, but then people keep sexual matters private. The people I saw in women’s clothes were women.

Here’s Johan Zoffany, The Last Supper.

john-zoffany-the-last-supper-detail

Zoffany, like most artists, used real people as models for his Last Supper. St John, leaning on Jesus’ left shoulder, is WC Blackwell, police sergeant of Calcutta, a cross-dresser who would round up criminals while dressed as a woman. Very fetching she looks, too. At different times, there are different levels of acceptance, and sometimes we can be brazen. You hear about other people who do it: I read two articles in the Mensa magazine by Christine-Jane Wilson, and got in touch. Her magazine published my poem, but we never met. But we do it spontaneously, before we get the idea from others.

Rachel the Trans Philosopher wondered how she knows she is trans. She does not have direct knowledge that she is female, contrary to The Script, “I knew I was a girl from the age of five”. She infers she is trans from her desire to transition and her delight in proceeding with it. Either it’s circular: I have the desires, therefore I am trans, therefore the desires are right for me; or it is “I can do what I like”: I need no excuse to follow these desires. I judge them harmless.

I don’t think I would have transitioned without the example of other people.

I read of a man executed by drowning in the Nor’ Loch, where Princes St Gardens are now, for bestiality. It was done at 4am, because he told his trial that he got the idea from a previous execution. It has never appealed to me, but I condemn it less than others might because of my own inexplicable desires.

Explanations tend to be descriptions- I express female because I want to, with no justification for the desire, because it needs none; or rationalisations- I am in some way a woman, which sounds good until someone asks what that could mean. We may tell ourselves stories about it because they are the stories we have heard, or we make up our own, but we start cross-dressing spontaneously, because that is what we want to do.

The effects of hormones

Taking oestrogen reduces your blood pressure. Or not.

There was a study published in 2015 of 23 trans women and 34 trans men commencing hormone treatment, measuring blood pressure, BMI, lipids and sex hormone levels at the start of treatment and six months after. Trans men continued menstruating throughout the time. The trans women’s blood pressure reduced from 130 to 120.

When a doctor takes my blood pressure I become tense, and they tell me this may give a falsely high result. Trans women beginning treatment are likely to relax. They are on their way, so their stress will reduce. So blood pressure reduces. These people are undergoing such an extreme life change that it is impossible to isolate one possible cause of change of blood pressure. “The study had insufficient power to detect other associations,” the summary says, and I wonder, decades after doctors started giving us hormones, that so little has been done to find what they do to us.

I wanted to read the article Priorities for Transgender Medical and Health Care Research, but it will be published on 1 April.

From 2007, there is an NHS leaflet, addressed to both trans men and women. The aim of hormone therapy is to make you feel more at ease with yourself, both physically and psychologically. That is, the fact of taking hormones, whatever effect they have physically, affirms your transition so makes you feel better. Some people find that they get sufficient relief from taking hormones so that they do not need to change their gender role or have surgery. I had decided to transition: I am transsexual, therefore I will transition to expressing female. A more fluid way of proceeding, trying things out, would have been better. I railroaded myself.

Hormones will affect your appearance, but you need to be realistic (the leaflet says). Fat may be redistributed, hair loss may reduce though probably not significantly reverse, facial hair may be easier to electrolyse, you may grow breasts though that might take years- ten years, in my case. You may have blood clots in brain, heart or veins: a woman I met in Thailand had a stroke a few months later. You should stop smoking, which increases risk: I was told you could not have hormones until you stopped.

If you start to feel better this is a good sign that you are having the right treatment. However, I railroaded myself. I committed to the whole thing. Moving forward on that track made me feel better, because I thought I had the solution, waiting at the end of the track.

You may find erection and orgasm harder to achieve. You may become infertile: it is not known when. You may become less interested in sex. This was a good thing for me, as I was so thoroughly ashamed of it, but I might have found better ways of living with it.

It is unethical and impossible to conduct a study comparing transition with other modes of treatment. People wait for years to see an NHS psychiatrist, and have definite ideas of what treatment we want. From Lili Elbe onwards, doctors have seemed delighted to have a subject they could try things out on, rather than merely wanting to find the best way to help, which might be to do nothing.

“You will need to take hormones for the rest of your life.” I was told I had to, to avoid the risk of osteoporosis.

Study: Effects of Cross-Sex Hormone Treatment on Transgender Women and Men.

Patient leaflet– A guide to hormone therapy for trans people, pdf.

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