Trans Gender Body Mods: Who is "Obsessed"?

Many—though by no means all—trans people seek at least some body modifications (hormone replacement therapy, hair removal, surgery, etc.).  

In this post I want to talk about why we do this, and to critique the way seeking trans body mods is often framed.  The common medical framing presumes a cost-benefit analysis in which reduction of internal psychological distress is weighed against medical risks.  And the common layperson’s framing centers the problematic idea of us seeking to “pass.”

In my last post, I explained why I believe the language of “passing” is damaging.  I know that there are some trans people who get upset by such critiques, because they hear an attack on the language of passing as a dismissal of the pain of their gender dysphoria or the intensity of the transphobic violence and disrespect they face.  This post should make it clear that I want to do the very opposite of that.  I just want us to approach this discussion in a way that facilitates change.

Let me start with a personal example.  

A while back I participated in a study on chest binding. In filling out the questions, it became clear to me that the researchers framed chest binding in terms of a risk-benefit analysis.  They presented the benefit of reducing bodily dysphoria by binding the chest as balanced against physical risks associated with binding.  This is a framing that I find to be commonplace today in medical circles.  A trans person is presented as engaging in practices considered physically risky (binding or tucking, taking hormones that increase cardiovascular risks, undergoing surgeries that cause pain and always involve the danger of infection, a poor reaction to anesthesia, etc.). If these physical costs are seen as outweighed by the mental health benefit of reducing psychological dysphoria with the body, then the physical risks are justified. 

This is such a very American professional framework for transition: economic, rational, and individualistic. In its deployment by many cis laypeople, the same framework is given a rather sadistic moral cast.  Undergoing painful and dangerous body modifications is understood as the price trans people must pay if we want to be respected in our identified genders. (This is why, I believe, many cis people feel they have the right to ask us whether we’ve “had the surgery,” despite our protests that other people’s genitals are none of their business.  They feel that if they are being asked to respect our gender identities, they deserve to know if we have paid in coin of blood for that recognition.  The idea that we should not have to pay to have our genders respected any more than they do is apparently novel to them.)

Anyway, back to the study: the tension that I saw in the survey is one familiar to many people seeking medical transition services: paternalism.  It seemed to me that the researchers believed some binding practices (such as the use of duct tape or ace bandages or binding for extended periods of time) are too risky to be justified by any psychological benefit.  This will sound familiar to many trans people who have sought medical transition services.  Often we are turned away, as medical gatekeepers have declared hormones or surgery too risky for us.  My own spouse had had a doctor refuse to refill her prescription for estrogen because her total cholesterol level on one blood test was 201, 1 point into the “high” range.  It was blindingly obvious to my wife, to me, and to most any trans person that the risks involved in withdrawing transition services were much higher than the risk posed by a single cholesterol point of possible added cardiovascular risk.  But under medical paternalism, it is not the trans person zirself who decides if the benefits of medical transition outweigh the risks—it is the doctor.  This gives a doctor’s idiosyncratic beliefs about trans people a great deal of power. This is evident, for example, in how many genderqueer people seeking medical transition services have found they have to present themselves falsely as having a binary trans identity in order to access those services.  Presenting as genderqueer/agender/etc. is a disadvantage because doctors often impose their personal belief that nonbinary identities are weak, wishy-washy, impermanent, or insufficiently “real” to justify the risks of treatment.

After being rejected by paternalistic medical gatekeeping to transition services, some trans people just give up, resigned to lives of psychological misery.  Other, shall we say, more self-actualizing individuals simply turn to the grey and black markets, for example by buying hormones online.  Responding to this reality, the modest number of regional trans clinics mostly operate under the “harm reduction” philosophy, under which clients are advised of the risks involved in hormone replacement therapy, permitted to sign an informed consent form, and then allowed access to hormones.

I’m fully in favor of the harm reduction approach, which grants trans patients the human dignity of being allowed to make informed decisions for ourselves. But the framing of decisions about transition under harm reduction is just as individualistic as the paternalist model.  It’s about a contract being signed by a rational actor weighing physical risks against psychological benefit.

As no man, woman, person of any other gender, or person of no gender at all is an island, I find this pretty silly.  

We are not atomized individuals free-floating in space, making decisions about whether and how to modify our sexed bodies.  We are social creatures, with employers and coworkers, partners and offspring, schoolmates and neighbors.  And so many of the current risks and benefits of trans body modifications are social in nature, not medical.

Anyone who gender transitions does so because they wish social recognition of their gender identity.  If it is enough for us to know in our own minds what our true gender is, then being forever misgendered by others matters not at all, and transition is unnecessary.  Note that I am not equating gender transition generally with medical transition—many people transition socially without the use of hormones or surgery.  But whether we choose to and are able to access medical services, choose not to do so, or try but are unable to access them, the acts of coming out to others and of asking that others change the pronoun by which they address us are social in nature. 

And this brings up the thorny issue of being accepted in our identified genders.  For many binary gender transitioners, this is conflated with the idea of “passing,” or being perceived as a cis person of one’s identified gender.  (I’m very critical of the term “passing”—you can read my full critique here if you like.)  In my ideal world, gender identities would be accepted in the same way that, say, religious identities are: we just take someone’s word for it.  If someone tells you they are Catholic or Hindu, you say, “OK.”  If someone tells you they have converted to Judaism, you say, “Oh, OK,” and maybe you ask them about their experience, but you never say, “I refuse to acknowledge your Jewish identity because you don’t have a Jewish nose.  If you get a nose job maybe I’ll think about it, but since you didn’t grow up Jewish, I really don’t think you can know what it is to be a real Jew.” (By the way, I’m Jewish, and I am aware that there are some Jews who see Jews-by-choice as less authentically Jewish, though that is against both Torah and rabbinical advice.  But I’ve never in my life encountered a person, Jewish or otherwise, who has said “I won’t acknowledge you as a Jew unless you get plastic surgery to make your nose look Jewish.”)

Unfortunately, my ideal world where gender identities would be respected when announced, without regard to physical appearance, is far from the world we live in today.  

In the real world we have no choice but to negotiate, not only is transphobia, or hatred of trans people, rampant, but so is cissexism.  Cissexism is the belief that cis people’s gender identities are authentic, innate and unquestionable, while trans peoples’ identities are questionable performances.  One aspect of cissexism is the belief that one has the right to choose to respect a trans person’s gender identity or not—that one sits in judgment on our identities and presentations.  And central among the criteria that cissexist people use in deciding whether to respect or mock us is physical appearance, especially bodily configuration.  To be deemed “worthy” of the pronoun “she,” cissexism holds, one must have a body that looks like that of a cis woman.  To be granted the right to the pronoun “he” requires a body appearing cis male.  And to be acknowledged as genderqueer, a person is expected to be completely androgynous in physical form.

Now, the prize that cissexism dangles before us turns out often to be illusory.  Cissexism is deeply bound with enforcing the gender binary and essentialist notions of binary sex.  No matter what a person’s body looks like, it turns out, cissexist people generally treat all nonbinary genders as jokes, refusing to use nonbinary pronous or just “forgetting” all the time to try.  A trans man can bulk up, grow a beard, and get top and bottom surgery, but no matter—many cissexists will assert that he doesn’t have a “real” penis, and is thus a poor simulacrum of a man they will call “he” out of pity.  And transfeminine peole have it worst of all.  Transmisogynistic hatred focused on trans women is intense, presenting them as deceivers of straight cis men, potential rapists of cis women, and some unspecified but ominous threat to children.  Cissexist gender policing of trans women’s bodies is most extreme, inspecting necks for adam’s apples, staring at the size of hands, scrutinizing chests, and monitoring jawlines.  If they are visibly trans gender under this scrutiny—as so many trans women are—they are the subject of constant ire and harassment, mocked as “shemales” and “he-shes.”  Only the most model-perfect are granted the prize of being treated as women.  And even this prize turns out to be booby-trapped, because their very cis-conformity is reframed in romantic and sexual contexts as a sham, a trap, tormenting cis straight men by somehow making them gay.

So: cissexism is rampant in our society.  Its claim that it will grant us respect, if and only if our bodies “match” our identities, is largely a sham—and yet it is compelling to so many of us as trans people.  It keeps masses of trans people in the closet, convinced they can never transition because their bodies appear too stereotypically cis male or female.  We transition so that others will respect our gender identities, and if we are convinced no one ever will respect us because we don’t have the price of a nice suburban home to spend on plastic surgery, or that even if we spent a million dollars, it would never be enough, then many of us decide there’s no point in even trying.

For those of us who do come out, bod mods often become almost an obsession.  If you take a look at the mass of trans support sites, and you will find a million posts entitled “How well do I pass?—X months on HRT.”  Go to some genderqueer support groups, and you will find masses of people binding their chests, agonizing over whether they would look more androgynous if they took a little estrogen or testosterone, or commiserating over wanting some of the effects of HRT but not others.  The way this is framed by psychotherapists and doctors is as an individual preoccupation that is a keystone of the formal diagnosis of gender dysphoria.  It’s treated as an internal psychodrama of alienation from one’s flesh, the idea of feeling “born in the wrong body.”  And it’s certainly true that many trans people are driven to transition in part by a sense of unhappiness with their curves or lack thereof.  But this feeling does not emerge in a vacuum.  It is born from a life lived in the context of cissexism and its insistence on “passing” as cis gender as the gateway to respect for trans people. 

We’re the ones diagnosed with a mental illness, but it’s society that is sick.  Doctors say that we as individuals are weirdly obsessed with our sexed bodies, but it’s gender policing by a cissexist society that makes us rationally preoccupied with how our bodies appear. 

I’ve had conversations with various trans friends that start, “If you were living your life alone on a desert island. . . ,” as we have tried to disentangle personal wishes for body modification based on internal dysphoria from social forces pushing us toward them.  It’s an impossible exercise on many levels, because we’re never going to live such a life, and because social forces have shaped our feelings and understandings on an unconscious level.  Still, it’s interesting to me, because while some friends have said nothing would change for them, other people I’ve had such conversations with have said they’d want fewer body modifications.  Personally, if I were living on that proverbial desert island, or, slightly less implausibly, in some sort of trans gender utopian commune, what would change for me is my attitude toward top surgery.  I want it now, living in my Midwestern American context, but I wouldn’t in an ideal or asocial setting.

If nobody was around gender policing me, I could deal with having moobs.  I mean, I wouldn’t mind looking like Michelangelo’s David, but I'm a middle-aged guy with reasonable expectations and hardly obsessed with having a model body.  Early in my transition, I wore my binder every waking hour, but now, as soon as I get home from work, unless there’s company, I immediately take it off and relax.  Let’s face it: for most of us who wear them, binders are really uncomfortable.  But my attitude of relaxation and body acceptance has very little effect on my binding behavior outside the house—I bind tightly, whenever I’m stepping out my door, which often means for 12-18 hours a day.

Now, here’s where I return to that study I mentioned (remember the binder survey?).  According to the health information given with the survey, binding for more than 8 hours a day is medically risky.  As a rational individual, I should balance my dysphoric urge to bind against physical risks, and apparently I'm doing a poor job of it—I’m too obsessed with my body, making me put it at risk.

But I’m not obsessed with my body.  

I’m not binding for long days due to psychological reasons.  I don’t want top surgery because my body revolts me, or because my moobs feel like alien flesh somehow appended to my chest, or because I have a desire to live “stealth,” hiding my trans status.  I am responding to a social context in which the risks of my not binding or getting top surgery are huge.  I teach large lecture classes full of Midwestern undergraduates.  I sit in meetings with Midwestern administrators.  They all know I'm trans—I’m not in the closet—and there are rough patches, but mostly I get by pretty well by wearing jacket and tie, growing my beard, and binding my chest to pass muster with gender policing.  I recognize that in this I am privileged. But if I suddenly showed up with size D breasts bouncing around under my shirt, I have no doubts that it would trigger a cissexist freak-storm.  It’s one thing for your standard cissexist onlooker to see that I’m short and wide-hipped for a man, and have a somewhat odd-shaped chest.  I fall short of the masculine ideal, but it’s clear I’m making an effort.  Presenting as a man with a free-flying and quite substantial set of breasts, however, is a crime according to the gender police.

Unintentionally violating the cissexist law that gender identity and body must “match” gets you stigma, but overtly flouting this law is treated as a much more serious crime.  Now, the results are generally much worse for the transfeminine than they are for transmasculine people like me.  But there would be consequences—material consequences—for me, for example in the form of poor student evaluations and negative interactions with colleagues, and I am the sole economic support for a family of three.  Furthermore, the other members of my family have physical disabilities, meaning they must rely on me to do tasks like the shopping that would be made much more difficult and potentially dangerous if I appeared, not just as trans, but as “flaunting” a nonconforming body.

I know that there are people in the U.S. walking around in public with the combination of beard and big breasts and an androgynous body, if not in the Midwestern setting I live in.  Frankly, I’m in awe of their strength.  If I were single, maybe I would find out if I am strong enough to take the body I’m comfortable with in the privacy of my own home, and live with it in full view of a cissexist society.  Maybe I could dare to swim in a public pool, furry moobs exposed, or mow the lawn with my shirt off, like my cis male neighbors do, and dare the police to arrest me for bodily nonconformity.  Certainly I’d love to give the finger to our society’s gender policing, sexualization of body parts deemed female, and general body shaming.

But I am not just an individual with political goals and psychological impulses.  I am embedded in a society and in a family.  And I have duties to my spouse and child that mean that since I cannot afford top surgery, and my insurance excludes coverage of transition-related services, I have to bind my chest for more hours a day than is medically approved.

Any study or theory of trans experience that presents us as acting solely in response to internal psychological impulses deeply misrepresents our lived reality.  And a medical establishment that withholds hormones or surgery based on a cost-benefit analysis that only takes into account medical risks, and not the social stigma, unemployment, and violence that those of us transitioning in a cissexist society risk without those services, does trans people a great disservice.

At the same time, it’s very important to me to resist naturalizing and internalizing gender policing by evaluating myself using the language of “passing.”  Besides implying that my presenting myself as a man is deceptive, the language of “passing” puts trans people in an impossible position, where the “success” of our transitions are determined by something we cannot control: the way we are treated by others.  No matter what body mods we seek, or voice training we do, or how carefully we choose our clothing, other people can still mispronoun us, either consciously and cruelly, or based on their unconscious cissexist ideas about bodies without actively intending to be cruel.  We cannot control whether we “pass”—we can be passed as cis gender by others who honor our gender identities, or not passed as cis gender by those who do not, and control of that lies with them, not us.

So I want to emphasize that I am advocating for the great import of trans body modification and access to medical transition services largely because of our social context of constant gender policing.  Ideally, I believe, what requires change are not trans bodies, but society.  It’s cissexism that drives so much of our preoccupation with body mods.  What we must most fight for is the social acceptance of visibly trans bodies as being fully as valid and attractive and as deserving of respect as cis bodies.  In an ideal future, when all gender identities are fully supported and respected, I believe trans people will seek to change our bodies less than we do now.  But since we live neither in that ideal future, nor on desert islands, we must cope with the fact that social change is slow, and we have to live in the world as it is now, even as we fight to change it. 

Right now, trans people of all genders pursue body modifications for three reasons: (1) to reduce the social risks of stigma and mistreatment that are aimed at visibly trans bodies, (2) to get the social benefits of respect that are currently granted only to cis-appearing bodies, and (3) to reduce internal gender dysphoria.  The first of these, reducing mistreatment, I see as a necessary evil: something we rationally try to do to protect our safety, but much more effectively addressed by putting an end to transphobic discrimination and violence, making protective camouflage unnecessary.  The second of these, seeking to appear cis to get respect, I see as a dangerous illusion, because we cannot control whether people will grant us that respect, and because it perpetuates the idea that trans bodies like ours are inferior.  It’s only the third—seeking changes in our bodies that reduce our personal, internal gender dysphoria—that I believe would persist, in a world that moved beyond transphobia, transmisogyny and cissexism.

May that day soon arrive.

Nature, Nurture, and Hormonal Transition

We are all constantly flowing with a complex mix of hormones. They cycle like tides, they interrelate in fascinating ways, and they are always shifting in response to our physical and social environments. Among these are the “sex steroids,” such as estrogen, progesterone, and testosterone. All of us, whatever our sex, normally produce both the “female” and “male” sex hormones—in fact, calling them “male” or “female” is very odd, considering that a man requires estrogen to produce viable sperm, and a female relies on testosterone for healthy muscle tone. It is the relative balance of estrogen and testosterone—not the absence of one or the other—that determines our secondary sex characteristics, such as the development of breast tissue or facial hair. This balance varies from person to person, because all sex characteristics exist on a spectrum (with some of us living in the middle intersex territory).

We like to tell a simple story in which people have a biological sex, over which is laid social gender (such as the clothing we wear, what we do with the hair on our heads and bodies, or what careers our society deems appropriate for us). Our physical makeup is presented as asocial and unchanging. In fact, we are naturally social beings, born to have our biological makeup affected by our social experiences. For example, humans are born with a capacity for language, but what language we learn depends on the society into which we are born. And the language we learn, in time, affects our brains. Depending on what phonemes are used in the language(s) we learn as children, we become capable of distinguishing some sounds and not others. If we learn a language in which compass-point direction is incorporated when referring to objects, we develop a much stronger innate sense of direction. If we learn to communicate in sign language, the centers of our brain recruited to produce communication develop quite differently. The brain is a “plastic” organ, shaped by social experience.

In my last post I critiqued the argument that having a trans identity should be understood as an intersex disorder of the brain, necessitating genital sex reassignment. I critiqued this argument because (1) I'm intersex and abhor the argument that it is “necessary” to surgically alter our genitals, and (2) the experience of the intersex community cautions that if there were indeed a medical test for some morphology deemed to represent a "trans brain," the result would be eugenic abortion. I got a lot of negative feedback on that post. Interestingly, some people thought it implied an argument against medical transition, which it is most assuredly not my intent (I've transitioned hormonally). My argument was only with the idea that the way to win civil rights is to champion a biological etiology for trans identity. As for etiologies of gender identity or sexual orientation, my take is that I'm sure they're incredibly complex, but also that they are as irrelevant as the etiology of identifying as a "cat person" versus a "dog person," or, less flippantly, the etiology of identifying with a particular religion. Many people affiliate with the religion (or lack thereof) their parents expect them too, but some do not, and either way, their religious identities should be respected, without needing to look for a biological etiology of religious preference to justify respect.

In any case, in this post I'd like to discuss the interrelationship of biology and social factors in hormonal transition.

In my own life, I've lived under four different hormone balances. First, I had the standard prepubertal hormonal milieu of low sex steroids. At puberty, my gonads kicked in and I developed secondary sexual characteristics—and because I had three gonads (two ovaries and an ovotestis), I developed a lot of them. In later adulthood, my internal reproductive organs were removed, and my sex steroid levels soon fell to almost nil (with less testosterone, estrogen or progesterone than what would be expected for a 90-year-old menopausal woman). And several years later I began hormone replacement therapy with testosterone, or “T,” leading to my living with typical male levels of T, unaccompanied by the usual male levels of estrogen or progesterone. I duly note that none of the three hormonal balances I have lived under as an adult are typical ones. What I can report on is what I experienced with a high, estrogen-dominant hormone load, what it's like to live with no sex steroids, and what changed when I went from no sex steroids to T alone.

There is no doubt that hormone replacement therapy has biological effects. When a person takes estrogen, “E,” (sometimes accompanied by progesterone, “P”) to gender transition, she develops breasts, deposits fat around the hips, and develops softer skin and ligaments. When a person undergoes HRT with T to transition, his voice changes, his phalloclitoris enlarges, and he grows more facial and body hair. But we often talk about other changes. In the contemporary U.S., we think of men as aggressive and dominant, and women as empathetic and emotionally labile, and we expect these conditions will develop with HRT. Often, friends and family worry that a trans man will become violent if he undergoes hormonal transition, or that a trans woman will become irrational. It's as if people see testosterone as the Hormone of War, and estrogen as the Hormone of Overwhelming Emotion (helpfully pictured in my little graphic above). In fact, the effects they produce are much less drastic.

Changes that follow HRT are real. But this does not mean that they are only biological, not social. Consider something simple, like voice. A few months after starting HRT, my voice changed. I was very happy about this, as I was never comfortable with my voice. Clearly, T precipitated changes in my vocal cords and larynx. But a lot of the changes in my voice over the course of my transition have been socially produced. First, there's the fact that I consciously chose to “work” at my voice so that I spoke out of a lower part of my register. It's extremely likely that this has affected my physical vocal apparatus, just as a singer's vocal cords are affected by voice training. But many of the changes in my speaking voice were not conscious, while hardly being biological. They emerged from my being perceived as a guy, without my much noticing what was happening.

Consider this: have you ever noticed that you can often guess the gender of the person a guy is speaking to on the phone by how he is talking? Men in the U.S. today tend to speak with a higher pitch and to articulate more clearly when speaking to women, while speaking in a more mumbled, lower range to other guys. “Hi, Mia. Oh, sure, I can meet you at 4 instead. See you then!” vs. “Hey, bro. Uh-huh. Yeah, well. See ya.” So I found myself on the receiving end of bro-talk, and as a result, the way I speak changed. My spouse teases me about my grunted, blasé “uh-huhs.” Social interactions changed the way my voice sounds. You can't tease out the physical sex and social gender effects, because they interact to produce my voice, but they are both there, each influencing the other. And both components are equally “real.”

So: even the embodied changes during HRT that seem physical and simple are both biological and social. The social effects on the more social aspects of our masculinity/femininity are almost certainly more pronounced. Let's consider the idea that men are more aggressive, that this must be biologially caused by T, and thus that HRT with T will make a person more dominant and violent. This belief is shaped by two things: first, by a cultural ideology shared by all patriarchal societies that men's dominance of society is natural, and secondly, by media reports on the phenomenon of “roid rage” in cis men who use T illegally to build muscle mass for sport or body building.

Let me talk about “roid rage” first. This occurs in people who abuse T because they take it in large and irregular doses, causing big hormone spikes. And hormone swings do make people irritable. This is seen, for example, in cis women who experience premenstrual mood swings, because the level of P rises, then falls abruptly before the menstrual period. I can report from my own experience that swings in P level made me much more irritable than changes in T level. Note, however, that we call a woman who is hormonally irritable “bitchy” rather than “raging,” and see her as less threatening. . . In any case, my experience on T has been that since my T level remains fairly constant as I use a moderate and regular dose, I don't “rage” at all. My irritability levels are no higher than they were when I was completely empty of sex steroids, and are much lower than they were under the three-gonad-circus levels I produced naturally before gonadectomy.

What's really interesting, though, is that my behavior has become a lot less dominating and aggressive than it was before my hormonal transition. I used to be very vigorously argumentative. As an academic who was read as a woman, I had to be quite assertive in order to have authority in a classroom or at a conference. It's part of our gender culture that men interrupt women, assuming greater authority in conversation, and engage in the phenomenon of “mansplaining” (i.e., explaining to a woman something she already knows in a patronizing manner). To avoid loss of social prestige as an academic, I was therefore very assertive in conversation, so as not to allow myself to be interrupted or to appear “weak” in the presentation of my ideas to (male) students or colleagues.

After some time on HRT, I found myself taken aback by how I was being perceived. People had become more reserved around me, and somehow more hesitant in conversation. I made a couple of female students cry when critiquing their comments. My behavior had not changed at all—but my social gender had. The level of dominance I'd asserted for many years was now coming across, not as simple authority, but as intimidating. I wonder if some people thought T had made me “mean,” or that I was acting in the gender-stereotyped manner cissexism claims to be characteristic of trans people. In any case, I had to consciously modify my behavior. It took me a while to retrain myself to be more restrained and gentle in my presentation. It was kind of amusing to learn how much more intimidating the assertive comments of a person who is 5'2” would be taken once he was understood as male—but also sad proof of the greater authority granted men in our society. Such is male privilege. . .

So: my take on the idea that T biologically induces rage and dominance is that it is pretty much bullpucky. Big fluctuations in the level of T can cause irritability, as do big swings in the level of E and P, but that's about it.

I don't mean to come across as saying that none of the changes that we associate with temperament and relate to sex hormones have any biological basis. One that I can speak to is crying. For many years, with my high hormone load being dominated by E and P, I cried a lot, and I hated it. The crying stopped when my gonads were removed, and did not resume when I started taking T, to my great relief. And I see that my friends on HRT with E cry much more easily. The thing is, this does not mean I don't get sad or frustrated any less often than I did in the past, or that they used to be emotionally insensitive and now are oversensitive. One of my trans women friends sees being able to cry when upset as one of the greatest gifts of HRT, because people will finally acknowledge the depth of her feelings. I am happy that I don't tear up easily anymore because I have always enjoyed being treated as having an emotional even keel. These relate clearly to gender roles, in which being emotionally expressive is valued in women and devalued in men. Hormones may affect how often we cry, but it's society that gives that great meaning.

Consider this: like crying, hiccups are also related to higher levels of estrogen. I used to get the hiccups a lot; now I don't. However, since hiccups are not burdened by any gender meanings in our society, nobody else has noticed or gives a fig leaf how often I hiccup. Also related to estrogen are more mobile bowels—people with high E suffer from irritable bowel syndrome a lot more than people with low E. A less irritable bowel is another thing I've enjoyed about my T-only hormonal balance that is clearly biologically-induced, but given no social meaning in my transition. The fact that I don't cry much anymore, however, has been remarked upon a lot, and is treated as highly significant.

So, the relationship between nature and nurture in producing “sex difference” is complex. What is clear is that since humans are such profoundly social beings, social forces shape even those things that are usually thought of as “purely biological,” like the effects of sex hormones. It's one of the things that makes understanding humans fascinating.

Photos of My Gender Transition

I'm making this post to provide some photodocumentation of my gender transition. That's what you see here: a tic-tac-toe of headshots of me over the course of the past 5 years. You can click on it to see it larger.

I feel some reluctance about posting these photos. I know many trans people fear to post transition photos under their real names for fear of losing their jobs or risking their safety in a transphobic world, but having postponed my transition until my career and family life were pretty secure, it's safer for me than for most to be open about my trans status. I'm white, I'm a man, and I have a professional position—privileges enough to make me feel a duty to be open.

People are curious about the process of gender transition, and I do want to participate in demystifying it. I know that before I decided to transition physically, I looked at as many photos of trans people and their transition experiences as I could find, and I believe I should pay that forward, as it were, for other people who are considering gender transitioning. I also want to help cis people who are trying to educate themselves about trans experiences.

Still, I'm reluctant, because I'm unhappy with the way trans people are usually portrayed in transition photos: with the “before-and-after picture.” This started with the very first person reported to medically transition—Lili Elbe, who received an orchiectomy and vaginoplasty in 1930 in Germany. They spread around the popular media during the publicity over the transition of Christine Jorgensen in 1952. I've posted these classic images here. These photo diptychs misrepresent gender transitions in important ways.

A central problem is that the “before-and-after” photo trope presents gender transition as a purely physical process, one in which a doctor waves a magic wand and changes one thing into its “opposite”: EX GI BECOMES BLONDE BEAUTY. It hypes a dyadic, polarized vision of gender, where three piece suits and uniforms switch to glamorous pearls and bonnets, perpetuating the idea that trans people are walking stereotypes, invested in binary ideas of gender. Many of us have much more flexible ideas of gender, and much less binary identities, but you don't see that in the before-and-after trope.

Note that the “before-and-after” presentation frames doctors as the real actors in gender transition. It's physical changes wrought by hormones and surgeries that are the focus. All of the difficult and spiritually transformative work that we who gender transition do—coming out to ourselves, our friends and families, our employers; negotiating the legal hurdles to transition; deciding which if any medical interventions to seek and trying to access them, often at great financial cost—is rendered invisible. One minute we're one thing, and in the next frame we're another. The challenging journey is missing.

This is why I put together nine headshots in picturing my transition thus far. I wanted to present snapshots of my journey, awkward and transformational at points that aren't pictured in the before-and-after dyads.

Here's a narrative to go with the photos: the first headshot shows me in early 2006 in standard “girl” presentation. That's the supposed “before” photo, but what does “before” mean? As an intersex person, I was never of the female sex. And I had, in fact, taken tentative steps toward transitioning back in 1991, but that was before accommodating gender transition was on the radar for most any business, and the “liberal” firm I was working for instituted a dress code just to stop me from wearing men's suits and ties. (Well, the code applied to everyone, but the lead partner of my law firm sat me down and explained that the partnership had drawn it up with me in mind. It required “women” to wear “professional feminine dress” including pantyhose and “light makeup.”) I abandoned the idea of social transition and turned my energies toward reproductive pursuits instead. I went with the flow, lived in my assigned sex, and did the best I could to present in a gender I didn't identify with.

Looking at the second photo of me in the blue shirt, you might see little difference, as I was still presenting as a woman, but major changes had happened. One was physical: I'd had my atypical set of internal reproductive organs removed, as they were causing problems for me. But while this physical change might be framed as an important medical transition step (as in addition to my three gonads I'd had my bicornate uterus removed), it wasn't the important thing that had happened in terms of my transition process. What was truly important was that I'd made new gendertransgressive friends, most importantly the woman whom I would later marry—an intersex person who had gender transitioned--and they were inspiring me. I was rethinking my life. I was dressing more androgynously, though that may not be visible to you. It felt real and important to me, though.

The third photo is the happiest one. This was the centerpiece of my gender transition. Again, you may see little difference. I was still wearing clothing from the women's side of the rack, though I'd cut my hair and stopped wearing much makeup. What was important wasn't something visible though: it was something internal. I'd made the decision to gender transition, and had started the social process. My close friends were all calling me “he” or “ze.” Making the decision and taking these first social steps felt profoundly liberating and spiritual to me, and I was transfigured. I think you can see it in my face. This is my key transition photo, and it's not one that would ordinarily be included in a before-and-after pair.

In the fourth photo, where I'm wearing stripes, my expression is very different. I think I look pinched and tired. This was a very trying period in my transition—the one in which I was pursuing legal and medical transition without yet having much luck. I hadn't yet found a way to get the therapists' letter I'd need to change my gender marker on my license or to access hormone replacement therapy with testosterone. I was worried about the timing of so many things—how to make my transition work with getting married to my partner, with coming out at work. And I was living a sort of double life, trying to present as male at home while having to live with being treated as a woman everywhere else.

The central fifth photo is the first one you see of me as an "official" male, at the end of August 2009. I'd been on testosterone, T, for only eight weeks and my name change was still in progress, but the school year was about to start, and I'd decided to come out to the world with the start of the semester to make things more manageable at work. What's interesting to me about this photo was that really, there had been little change in my body after just two months on T, but I look different anyway. That's the power of social transition. Coming out to the world and asserting my male status changed something subtle but important about how I lived in my body.

The rest of the photos are rather less interesting to me, which is ironic, since they're what tend to interest people unfamiliar with gender transition. These four photos document the changes in my face over the two years I've been on T, two from the first year and two from the second. Initially, to give clear signals to others that I was presenting as male despite my scanty facial hair, I got a pair of very classically male glasses and kept my hair very short. I'm not really a crew cut sort of person, though, so after the first year as my facial hair grew in more robustly, I started to let my hair grow out. In the first year I looked boyish and many years younger than I had the previous year. I was constantly being mistaken for a college student. Now I look like an adult again, though I know from surveying my students that people still underestimate my age by fifteen years. Transitioning to male is amusing that way.

And so we come to the last “after” photo, but hardly to the end of my journey. Again, the reason others tend to focus on for my not being “done” is physical: I've not had the top surgery I very much want. (It's not covered by my insurance and I can't afford it while supporting a family of three that includes two people with substantial disabilities and two gender transitioners.) But for me, the more important thing is that I'm not at all done with my evolution in my presentation as male. My masculine presentation has been quite conventional thus far, as I've felt it necessary as I try to address the percentage of the time I'm misgendered by others and called “she,” especially at work. But after two years of being officially a male professor, I feel I've done my part to give physical reminders to people. If others keep misgendering me, that's their problem and not mine, and I want to be more free in my selfexpression, and not have to be the most conservatively dressed man in the room at work. So I'm sure how I look will continue to evolve over time.

Having displayed my transition in photographs, I feel another spasm of anxiety. I feel hesitant to post images of my earlier life because I've had experience in how they are received by a good number of people--and it's because I looked fairly cute during the many years I passed as a woman. We have a sort of cultural narrative in the U.S. in which gender transition is sometimes tolerated, so long as it fits within a particular framework, and that framework focuses a lot on appearance. If you now look indistinguishable from a cis person, and you strike people as looking depressed and unconvincing in the gender you were assigned at birth, then people are more likely to accept you. And I strike people as having looked perfectly fine living as a woman. For this reason I've found that if I show people photos of my prior incarnation, they are suddenly less likely to see me as "really" a man, and to slip and call me "she," beard and all.

This is a sad and unfair state of affairs for most trans people. The entire basis of trans experience is that bodies do not determine gender identity. And while some trans men were gifted by birth with tall, uncurvy bodies, and some trans women by the luck of the draw found themselves with bodies that developed short and slight and hairless, that is not the majority experience. I'm more than a foot shorter than the trans woman to whom I'm married. I've had people shake their heads ruefully and tell me, "That's too bad," since it makes it unlikely we can "pass" together as cis people. And I find that just bizarre: you're sorry for me because I met the love of my life? That's not how love works ("Sorry, I can't date you because we might fall in love and you're not under 5' tall").

If someone meets the love of their life, and that person is the "wrong" color or gender, they may face serious pressure from family and community to give up on their love. But I would hope they would by willing to face discrimination and disapproval for the sake of love, rather than let some arbitrary aspect of the body in which their beloved was born weigh more than love's joy. And gender identity works just like love: it is based on valuing the self and soul over social understandings of bodies, because the flesh we're born in is arbitrary.

So: I know that some people will look at these photos and see my masculine identity as somehow falsified by how "normal" I appeared presenting as female. They expect to see that prior to transition a "real" trans man would have looked like a linebacker forced to dress in drag.

But in fact, when I look at my former self, drag is exactly what I see. It's just that as in everything I do, I tried to do it well. If you were forced to live years of your life as a gender you don't identify with, what would you do? I treated it as a show I had to perform, and I did my best to do so with campy panache. I wore leopard prints and rhinestones and ruby lipstick, and people were entertained. If you're going to do drag, it should be fun.

The thing is, what really makes drag fun is that at the end of the day you get to take off the costume and relax and live your normal life. And for decades, I couldn't do that. I was trapped, and it was exhausting. What I feel when I look at these photos is the great relief of finally getting to wash off the mask of makeup and relax as myself.

I hope you can appreciate my relief as well, and wish me well on my ongoing journey.

[Note: I retain the copyright on my selfportraits, but make them available under a Creative Commons license to those who wish to use then for noncommercial purposes, with appropriate attribution. They may not be published in any book, article, or other commercial medium or setting without my prior permission.]