by the person known only as "Aylwin"
I've been developing this FAQ to hand out to supportive friends and family and I thought maybe it had some things in it that might be useful for others on here. I've tried to be as unbiased and up to date as possible, though I am lacking "sources" for some things that I can't remember where I heard them now. Also I've removed some personal info from it where possible. It is obviously written by an MtF [male-to-female], but I have tried to include info on FtMs [female-to-males] where possible as well, since I think it benefits us all for people to hear about all sides of this.
There are some links at the bottom.
* So what's going on exactly? I've been discovering, since about April [2007], that I have a name for a number of mental weirdnesses throughout my life: transgendered.
* What does transgendered mean? First of all you have to say it like Oprah, transgeeeeeendered. Sorry, just kidding. :) The simplest explanation is that the developmental sex of my brain doesn't match the rest of me. Much more involved answers are possible, but I still find that's the one that sums things up as nicely and quickly as possible. It's classified as a DSM mental condition right now but there have been motions to change this in DSM-V so that it's considered an intersex (medical) condition.
* MtF FtM TG Oh My! Yes, the terms are a little crazy. MtF stands for "male-to-female", that's me. FtM is the opposite. TG is transgendered, TS is transsexual (their meanings vary by the individual). That sounded almost like Gilbert and Sullivan there. CD is "cross-dresser", men who like being men but enjoy dressing up as women; I can't say I fully understand this really. TV is "transvestic fetishist", which is actually classified as a DSM paraphilia, meaning that the person is basically having sex with women's (or men's, whatever) clothes; this is often confused with TG issues but has nothing to do with them really. Besides those people being under the same prejudice as the rest of us for not expressing our "phenotypical sex", anyway. IS is intersex, meaning a person's body has physical characteristics of multiple sexes (the classic case being a "hermaphrodite", but that term has fallen out of favor). HBSoC is the Harry Benjamin Standards of Care, which is a medical document describing procedures for "making sure" since there's no easy medical test for this (yet). GRS is genital reconstructive surgery, basically what it sounds like (sometimes also called SRS [sex reassignment surgery]). HRT is hormone replacement therapy, feeding an MtF testosterone blockers and estrogen, and feeding FtMs testosterone. To transition means to "present" yourself as your internal gender, whatever that means for the individual (certainly coming to terms with yourself mentally; generally when people say that they're implying at least HRT). Passing means to be accepted as your mental gender publicly. DSM is the psychiatrists' manual of mental illness, which is currently on edition 4 (DSM-IV).
* Is this like being gay? It's "like" in the sense that it's a brain identity thing you're born with. But no, it's not the same. The latest in psychological thinking is that there are three axes on which you can graph your average vertebrate (this doesn't just apply to humans, actually) -- phenotype ("plumbing", body shape, etc), sexual attraction (androphilic [attracted to men], gynephilic [attracted to women]), and gender identification (male, female, both, whatever). The latter two are pretty well fixed before you're born, though of course you can choose to fight against them and ignore them, usually to bad results. The first is a little more plastic.
* So what does that mean for gender and sexuality? In general it means that people are a lot more varied than just "male" and "female". There are intersex people who are born with some phenotypical traits of one sex, and some of the other. They usually identify with one gender or another mentally. Who they're attracted to is yet another variable. There have even been cases like, for example, a woman who didn't have her period by 21 and went to the doctor, and found out she had XY chromosomes (male phenotype). She was a normal woman in every other way. There are a large number of variations, even though there's a steep curve with the "hump" along the axis of male phenotype/gynephilic/male identity and female phenotype/androphilic/female identity. So most people don't realize how common these variations are.
* What defines a male and a female then? Sorry to say, there is no real definition. Most people don't realize this either. There's no one characteristic that legally defines a male or female at birth. It's basically "whatever the doctors assigned you" combined with "what you think you are" combined with "what everyone else thinks you are". It's a big problem for intersex people, with the emphasis our culture places on gender and sex. Doctors in the past have had this tendency to "fix" whatever they see as the problematic body issues on newborns, often causing even more problems later in life.
THE "DISEASE" ANGLE
* You implied there's a medical connection above, that this is not just in your head. What's up with that? There have been a few studies on MtFs and FtMs post-mortem regarding brain structure. There are a few structures that much more closely match the ones for a brain of the opposite sex. See the bottom for some links.
* Oh so you have some proof for me! No, sorry, I don't. Not unless you want them to kill me and cut up my head for an autopsy ;) You'll just have to take my word and my therapist's word for it that I've got something here. Which leads me to...
* You need help!! Hey, good idea! I'm getting it now. I've been seeing a therapist since July or so. One whose main qualifications are around TG issues and who I feel is uniquely qualified in the subject because, hey, he grew up as a woman.
* Why can't you "cure" this like any other "mental illness"? It's in the DSM isn't it? The DSM tends to be for "curable" mental conditions, whatever their origin. This means modifying the brain through chemicals or other means to "fix" it. Many people are unhappy about it being classified in there since it is not "curable" in that way (even the DSM article admits this!), and in fact there's been serious talk of changing it for the next DSM. Anyone with any sort of intersex physical conditions are already classified out of the DSM definition. Homosexuality was eliminated from DSM-IV for similar reasons. It's variant from what people know as the norms, but it is not something you can change. This is part of a person's brain and their fundamental personality and sense of self. Plenty of ass-backwards psychiatrists tried to "cure" both this and homosexuality earlier in the 1900s. It doesn't work. The only acknowledged fix, if it becomes a problem in day to day functioning (which it has for me) is to fix the external presentation to match the brain. It's also well-known that feeding a trans person's brain the proper hormones acts a great deal like a traditional anti-depressant would for someone with clinical depression, so again, this is part of the "cure".
PERSONAL IMPLICATIONS
* I don't get it, you were born a man, what's wrong with being a man? Don't you know being a woman is hard? Hey, try being a woman who's treated like and expected to behave like a man. That's hard. (I recommend the book "Self-Made Man" by Norah Vincent, on this subject. It's a little caricature-ish but it's insightful still.) Technically I was not born a man, just raised as one, and of course parts of me developed that way. I have more female friends than male because I find their company more in line with my own outlook on the world. I don't even get to "enjoy" male privilege because I generally don't exercise it... I didn't even realize until recently that this was the phrase to describe why men in our culture sometimes (often?) act in a way that seems rude or overbearing to me. (In fact I'm probably considered wimpy or gay for not exercising it.) This is not a social thing for me though. I want to stress this. I want you to imagine for a moment that you're under disguise in a sci-fi by being put into another body, and then you lose the ability to get your old body back. It doesn't even have to be one of the opposite sex, just someone else's body. Not much fun, huh? You might think you could get used to it, and maybe some people can, but it's very hard in practice.
* But you never had another body. How did you figure this out? Well, this gets interesting. I'm not sure there's a succinct answer for this without cataloguing N years' worth of random experiences, but suffice to say that I've nearly always looked to women for socialization cues, I've looked to them for fashion tips (which I couldn't exercise, to great frustration), and I've had a desire to be one ranging from "hah, that'd be nice" to "OMG [Oh my god] NOW NOW". Like so bad that if I had the ability to steal someone's body I might've done it. It comes and goes. In many subtle ways I think and behave more like a typical woman. There are no hard and fast rules about what a man and a woman are like, socially, but in general, there are things. I have no porn collection and never have (I prefer a nice romantic story any day). Unless the testosterone is raging some day I generally prefer to cooperate than to compete. I prefer to be open and share my feelings with people when I feel comfortable with it (this is a toughie when one is considered to be a man, and thus not supposed to do this). There are a lot of things, but those are a few examples.
* What can you do about it? The simplest is to do nothing about it and accept it as a weirdness. This works for some people (a miniscule number of people who actually "come out" on the issue, but who knows how many just never say anything), but I doubt it will work for me. I'll explain why in a moment. The most extreme reaction is what I like to call "the meal deal" :) -- hormone therapy, random plastic surgery (depends on the person), GRS; many people who go through all this are indistinguishable from genetic men or women (whichever way they're going) when they're done. You might even know some and not realize it.
* What are the implications of HRT? Well, for one thing it tends to have an anti-depressant effect on the person, assuming this was the right thing to do. Your brain is built for one set of hormones and it's been fed another your whole life; it's sort of like putting leaded gas in a modern car. Maybe it'll sort of work, but it's not very comfortable. For another, if you're lucky, it lets you take on "secondary characteristics" of your mental gender like body shape (for MtFs, that's the typical breast/hip shape, facial fat distribution, muscle distribution, softer skin, etc).
* Why are you doing this? You have to realize you've only been seeing a small part of my personality this whole time; the better parts of that are not going away. I'm just expressing myself fully, on a social level. On a physical level I need to feel like myself. It was said best on the recent Oprah special about this topic: you don't just dislike one part of your body like your hips or some flab, you dislike your whole body. The whole image is wrong. It looks like someone else staring back at you. Even if I never get to where I "pass" I'm looking forward to feeling like I'm a little more right. I don't magically expect this to turn me into my mental image of myself; that's impossible. I'm just trying to work with what I have.
* You mentioned depression. Are you depressed now? Well, actually, yes. I apparently hide it pretty well but I've been depressed for years. Pretty severely lately, actually. For me, early on, especially growing up in a very conservative area, I learned subconsciously to block and repress all of this, and redirect it into "coping mechanisms". One of these is an extreme dissociation, which has grown over the years until today it feels like I'm walking around half-asleep and someone else is living my life. It really can't go on much longer like this. Another was a kind of curious sexual behavior that I'm not going to get into here. But I decided to try to stop all of that to expend all my sexual energy on and be totally present for my wife, and it sort of broke open the dam. Both of these experiences are pretty common among trans people. Another common mental symptom (which the therapist brought up before me, but it was sort of a weird experience to hear him describe something about me so precisely) is that we feel like young teenagers inside in many social and developmental ways. Because we never really experienced puberty. Our brains split around the time our bodies started developing the "wrong" direction, and we just hang around waiting for it to work itself out for years. Of course we learn to do our best to pretend, but in many ways I'm more like a ~13 year old in an older body.
* Other issues of "body dysphoria", like people losing a limb, can't be "fixed" at all and they learn to live with it. Why can't you? I was making due, it may be possible. I explained that above; living sort of half a life. Sorry, but if there is something available to me to fix things I'm going to do it. I'm sure if they could re-grow limbs no one would have any qualms about "fixing" that person either. I have no desire to suffer so that some people's narrow views of gender can be fulfilled and they can stay in their comfort zone.
* Do you ever regret ____? Yes, I have many regrets. I regret losing out on a childhood of my mental gender. I regret waiting this long to deal with things, because it makes it harder for HRT to have any effect, and I've gained a lot of social connections as a man (such as I am). I regret throwing away my male persona in many ways because he's not awful or something; just not right for me. I sometimes wish I could just "fork" us and let him proceed on his way as a real man. I regret the disappointments I will inevitably hoist upon others as they learn I'm not who they thought I was. Sucks. All in all though, I can't change the past and I got a lot of out of going the path I did: a wonderful wife and plenty of years to ruminate on this until I was ready. Like Popeye said, Iyam what Iyam.