Trans and Intersex Children: Forced Sex Changes, Chemical Castration, and Self-Determination

Children’s lives lie at the center of social struggles over trans gender and intersex issues. If you talk with trans and intersex adults about the pain they’ve faced, the same issue comes up over and over again, from mirror-image perspectives: that of medical interventions into the sexed body of the child. Intersex and trans adults are often despairing over not having had a say as children over what their sexes should be, and how doctors should intervene. Meanwhile, transphobes and the mainstream backers of intersex “corrective” surgery also focus on medical intervention into children’s bodies. They frame interventions into the sexual characteristics of intersex children as heroic and interventions into the bodies of trans children as horrific.

The terms and claims that get tossed around in these debates are very dramatic. Mutilation. Suicide. Chemical castration. Forced sex changes.

We need to understand what’s going on here, because it’s the central ethical issue around which debates about intersex and trans bodies swirl. The issue here is the question of self-determination, of autonomy. Bodily autonomy is the shared rallying cry of trans and intersex activists, though we might employ it in opposite ways. Refusing it to us is framed as somehow in our best interests by our opponents.

In this post we will look at how four groups frame the issue: intersex people, trans people, the mainstream medical professionals who treat intersex people, and opponents of trans rights.

If you talk to people who were visibly sexvariant at birth, you hear a lot of pain and anger and regret about how their bodies were altered. This is crystallized in the phrase of intersex genital mutilation, or IGM. As a result of infant genital surgery, many intersex people suffer from absent or reduced sexual sensation—something mainstream Western medicine presents as unethical female genital mutilation (FGM) when similar surgeries are performed on girls in other societies. There are further sources of pain: as a result of “corrective” surgeries, intersex people can suffer a wide range of unhappy results, such as loss of potential fertility, lifelong problems with bladder infections, and/or growing up not to identify with the binary sex to which they were assigned. It is extremely painful to identify as female and to know one was born with a vagina that doctors removed with your parents’ consent, or to identify as male and to know one’s penis was amputated. Imagine if someone performed a forced change on you--would you not feel profoundly violated?

So the intersex perspective is that no one should medically intervene in a person’s body without that person’s full informed consent. Bodily autonomy is a fundamental right. Nobody except you can know how you will feel about your bodily form, whether you might want it medically altered, what risks of side-effects you’d consider acceptable. Routine “corrective” surgery performed on intersex infants is thus a great moral wrong.

When you speak with trans people, childhood medical intervention again comes up with an air of great regret, but now the regret is that one was not permitted to access it. Almost every person I’ve ever spoken with who wants to gender transition medically, whether they’re 18 or 75, has expressed the same fear to me: “I’m afraid I’m too old!” For a while this mystified me (how is 22 “old”?), until I realized what they meant was, “I’m post-pubertal.” For many trans people, childhood was awkward but tolerable, as children’s bodies are quite androgynous. Puberty, however, was an appalling experience. Secondary sexual characteristics distorted the body—humiliating breasts or facial hair sprouting, hips or shoulders broadening in ways no later hormone treatments could ever undo. Many trans people live with lifelong despair over how so much maltreatment and dysphoria could have been avoided if they could just have been permitted to avoid that undesired puberty.

So for trans activists, advocating for trans children so that they might avoid this tragedy is vitally important. The child’s autonomy is central, as it is for intersex advocates, but here the issue is getting access to medical treatment in the form of hormone suppressants, rather than fighting medical intervention. What trans activists seek is the right of children to ask for puberty-postponing drugs, to give the children’s families and therapists time to confirm that the children truly identify as trans, and fully understand what a medical transition involves. Then the individual can medically transition to have a body that looks much more similar to that of a cis person than can someone who has developed an unwanted set of secondary sex characteristics.

So for trans and intersex people, children’s autonomy is paramount when it comes to medical interventions into the sexed body. No child should have their sex (e.g. genitals, hormones, reproductive organs) medically altered until they are old enough to fully understand what is involved and actively ask for such intervention. Conversely, once a child is old enough to fully understand what is involved in medical interventions into the sexed body, and requests such intervention, then it should be performed—whether the child is born intersex or not.

This is not yet mainstream medical practice, however. Today, one in every 150 infants faces medical intervention into the sexed body to which they cannot object or consent. Doctors routinely perform such “corrective procedures” on babies with genital “defects” and “malformations.” Meanwhile, few trans-identified children are supported in their identities by families and medical practitioners—and great controversy and resistance swirls around them when it does happen.

So let’s look at the arguments made by mainstream medicine and transphobic activists. How do they counter the cry for autonomy, given that self-determination and freedom are such central ideals in Western societies? What we’ll see is that they employ two opposing claims based in medical ethics: the duty to save a life, and the duty to first do no harm. If we want to protect the rights of trans and intersex children, we have to understand these arguments and be able to counter them.

When intersex advocates try to fight the framing of intersex children’s bodies as “defective” and somehow in need of surgical “correction,” mainstream medicine responds with a claim of medical necessity. In some very rare cases, particular intersex conditions can be associated with actual functional problems such as an imperforate anus, clearly a serious medical problem that necessitates surgery. But the vast majority of medical interventions into intersexed bodies take place without any such functional, physical problem exsting. They are responses to a social issue (discomfort with sex variance) rather than a physical one. What doctors do, however, is reframe social issues into medical ones. “If we don’t do this surgery, this child will be mocked and humiliated—“he” won’t be able to stand to pee, “she” won’t be able to have “normal sex,” “it” will never be able to marry. The child will be a social pariah and thus be at risk for suicide.”

Through this line of argument, altering the body of the sexvariant infant is cast as a noble act that doctors perform out of their duty to save lives. To counter this, what we need to do is point out that actual studies of intersex adults show that while we do have a heightened risk of depression and suicide, these are caused by unhappiness with our medical treatment rather than prevented by it. Loss of sexual sensation, feelings of having been humiliated by doctors, pain from years of “repair” surgery after “repair” surgery, and for those who do not identify with the binary sex to which we were assigned, the vast sense of betrayal that those who were supposed to care for us subjected us to a forced sex change—these are what lead to an increased risk of suicide. What would really help is would be for doctors to follow the precept of “first do no harm,” to perform no procedures upon us without our full informed consent, and meanwhile, to provide intersex children and their families with social support.

Invocations of “primum non nocere,” first do no harm, and of despicable medical impositions on the lives of innocents are also raised by anti-trans advocates. Transphobic activists generally frame all medical transition interventions as mutilations, and this rhetoric rises to fever pitch when the issue of trans children arises. Recently, anti-trans rhetoric has framed the medical provision of puberty-postponing drugs as “chemical castration” (e.g. in this blog post).

“Chemical castration” is an odd concept. First off, if you read any medical article on the topic, you will find it starting by pointing out that the term is a misnomer, as none of the medications used in “chemical castration” destroy the gonads. The term is nevertheless employed due its specific history as a treatment being given by court order to “sexual deviants” to suppress their ability to have sex, where some prior courts had employed actual surgical castration. Today, some jurisdictions use “chemical castration” in cases of pedophilia, but it the past it was a treatment imposed on men convicted of sodomy—that is, to gay men in an era in which gay male sex was criminalized. Transphobic activists use the term “chemical castration” to evoke an aura of adult sexual deviance, in a manner calculated to frame doctors who provide puberty-suppressant drugs as sexually abusing children.

There is a curious twist in this matter of “chemical castration,” in that universally when court-ordered in the past, and often still today, it did not consist of testosterone suppression drugs as you would expect. Instead, injections of estrogen and/or progesterone were (and are) given. In essence, it caused a forced sex change. Thus, for example, when codebreaking British war hero Alan Turing was convicted of homosexuality in 1952 and sentenced to “chemical castration,” he found the unwanted sex changes in his body so horrifying and humiliating that he committed suicide two years into “treatment.”

In the case of trans-identified kids today, the use of the term “chemical castration” is thus a double misnomer. Firstly, no child is castrated—instead, puberty is simply postponed so that if the child, family, and therapist all agree later that a medical transition is appropriate, unwanted secondary sexual characteristics will not have developed. Plenty of adolescents are “late bloomers” by nature; in fact, puberty today occurs many years earlier than it did through most of human history, when human diets lacked sufficient fats and nutrients to support early puberties. So postponing puberty carries no significant dangers. Further, the point of hormone suppression is not to cause a sex change, in contrast to court-ordered “chemical castration treatments.” The point is merely to buy time to ensure that the trans child in question fully understands zir gender identity and the implications of medical transition.

So: we’ve seen a lot of charged language, of claims and counterclaims regarding mutilation versus vital treatment, cruel withholding of medical assistance versus the imposition of sex changes on unconsenting children. How should trans and intersex advocates respond?

What I would do is to point out that strange and conflicting ideas about children’s autonomy and free will are presented by our opponents. When specialists in intersex “corrective” treatments speak to parents or write in medical journals, they urge that genital surgery be performed in infancy, before age two and a half if at all possible. They claim that this way the child will not remember the treatment and will thus adjust well to the altered genitals and/or sex status. (As if medical monitoring and intervention did not often extend throughout the child’s life, and the procedures left no scars and caused no loss of sensation, so the child would “never notice.”) The age of two and a half came out of now largely-discredited ideas of a milestone of “gender constancy” occurring then, based upon notions of the developing brain that directly relate to autonomy. Before age 2.5, it was basically argued, the baby is irrational and lacks agency, and thus thinks magically about bodily sex, including accepting the “crazy” idea that the sex of the body can change. So, in urging very early intervention into intersex bodies today, conventional medicine is urging the total avoidance of the child’s rational thought and agency.

When it comes to treating trans children, on the other hand, instead of rushing things, all sorts of actors want to draw them out. Most doctors and clinics only provide transition services to legal adults. Those few who treat trans children are extremely cautious about providing any medical interventions other than the postponing of puberty.

Both of these approaches deny children autonomy over their bodies and their lives.

What we must urge is that society consistently respect the rights of children. No children should ever be subjected to sexual surgery without their consent. No children should be forced to have cosmetic surgery. But as children mature, they become able to consent to medical treatment that they do actively desire.

How old is “old enough” to agree to medical interventions into the sexed body? That answer depends on the given child—but 2.5 is certainly too young, and 18 is in most cases too old. What I suggest is that when addressing a medical practitioner urging genital surgery on an intersex infant, that we ask, “Would you perform a sex change on a child of this age who was not intersex?” Conversely, when facing transphobic activists saying that no one who is not a legal adult can be old enough to consent to medical transition services, we should ask if our opponent would say the same if the child were intersex. For example, a child with congenital adrenal hyperplasia may be born with a penis externally, and a uterus and ovaries internally. At around age 12 or 13, if there has been no medical intervention, that child can begin to menstruate through the penis, develop breasts, etc. Would the opponent argue that the child could not be old enough to say that he identifies as male and wants to take testosterone (or that she identifies as female and has decided that she wishes to have surgery to feminize her genitalia)? Would the opponent argue an intersex pubescent child should not at least be able to take puberty-postponing medications to avoid unwanted penile menstruation if they and their family and support professionals were still unsure whether to commit to any more permanent intervention?

What we must ask is that society treat intersex and trans-identified children consistently. We all raise our children to learn to make good decisions, so that they can lead good lives. We must nurture children’s autonomy as they grow, understanding that there are some decisions only they can make for themselves. To force a person to live in a sex with which they do not identify is cruelty; to impose unwanted bodily alterations unconscionable. Wishing happiness for our children, we must nurture and then defer to their right to self-determination over interventions into the sexed body.

TSA Body Scanning and the Trans Body

Recently I had an unpleasant experience while travelling: for the first time, I faced TSA screening at the airport with an “Advanced Imaging Technology” body scanner. These are the devices that see through clothing, with the supposed intent of revealing hidden weapons or explosives. While they haven’t yet foiled any terrorist plots, they do lead to a great loss of physical privacy, and for trans people, add a new level of anxiety to air travel. And as my experience illustrates, that anxiety is justified. We are treated as if our bodily differences pose some sort of potential terrorist threat.

I am a trans man. While I am legally male and my ID reflects that, like many trans people I have not had any reconstructive surgery. It is expensive and not covered by my insurance, and while I would like chest surgery, as someone born intersex I am not interested in genital reconstructive surgery. I therefore wear a chest binder and a genital prosthesis. Wearing the binder and genital prosthesis is very important to me. While I’m not in the closet about being trans, I am fortunate in that with my beard and substantial body hair, while wearing the binder and prosthesis my male identity is rarely questioned by strangers, despite my lack of surgery. This gives me the privilege to avoid a lot of harassment that trans people suffer all the time when their trans status is visible to the public.

Traveling while trans is anxiety-producing. Many trans people, especially trans women, have had experience facing harassment from police officers and others in uniforms, and having to be screened by stern-faced uniformed TSA officers isn’t comfortable. Any “discrepancy” in ID is cause for being detained and denied access to one’s flight, and this includes a perceived discrepancy between the gender marker on one’s ID and the TSA agent’s reading of one’s gendered appearance. I’m fortunate enough that no agent has ever questioned the M on my license based on a visual inspection. But body scanners see beneath clothing. . .

I’ve traveled by plane a fair number of times since my legal transition, but always managed to be screened through a standard metal detector before. Though I’ve been concerned about being outed in the process, I’ve never had a problem. In March, however, that luck ran out, and while flying to a conference to present on intersectional identity and intersex issues, I wound up having to go through a body scan. After stepping through, I was told that the scanner revealed "multiple anomalies.” I looked back at the display and saw four markers appearing over the outline of my body: two at the top of my left ear where I have two earrings, and two on my chest, one over each nipple area.

I’d always been most worried about being found to be wearing a genital prosthesis. Other trans men have had problems when outed as wearing them during TSA screening in the past. Complaints about this have in fact helped lead to the one explicit TSA screening policy said to protect trans people: “travelers should neither be asked to nor agree to lift, remove, or raise any article of clothing to reveal a prosthetic and should not be asked to remove it.”

But what the scanner picked up on, besides the fact that I have a couple of earrings, were “chest anomalies.”

I was taken aside for a patdown. I asked that this be done in privacy, and was taken to a room by two TSA (cis) male agents. One blocked the closed and locked door, and the second stood in front of me. They asked me to answer yes or no, did I have any medical implants or a pacemaker, and I said no. I was then given a through full body patdown, which took some time. The agent doing the patdown seemed concerned that I was concealing something under my shirt. I could have explained what the issue was, but the TSA agent, while acting thus far in a detached and professional manner, had not given me any opportunities to speak spontaneously, but just allowed me to answer yes or no to his questions. The question he asked me next was whether I was wearing a back brace. I said no.

The TSA agent then asked me to open my shirt. While I am uncomfortable revealing my chest wearing just my binder, I did so. The two TSA agents then stared at my chest in the binder for a while. The TSA agent doing the patdown finally asked me what my garment was. I said that it was a chest binder, which I wore because I was a trans gender man. The agent said, “A what?” I had to explain what that meant. The agents looked both dubious and uncomfortable.

I was extremely concerned that I was going to be asked to remove the binder, but, after some silent staring and thinking, the TSA agent told me he would screen the garment for explosives with swabs while I was wearing it. While less humiliating for me than being forced to reveal my breasts, the screening for explosives involved having the agent thoroughly rub a series of small swabs over the entire surface of the binder: sides, back and front. This was quite psychologically disturbing for me. The TSA agent’s expression was one of controlled distaste.

After my binder was indeed found not to be a terrorist weapon, I was allowed to leave. The process was not only humiliating, but time consuming, and I had to rush for my plane.

As my experience reveals, it is obvious that the TSA agents need additional training on dealing with trans gender travelers. The TSA agents who screened me were not only completely unfamiliar with what a chest binder is, they had apparently never even heard of trans men. Their standing there staring at me in me with my shirt open to reveal my chest binder while apparently trying to evaluate whether what I said was plausible was very embarrassing to me. The thorough swabbing of my binder involved what was essentially a groping of my chest. Trans people like myself who have not been able to access the reconstructive surgery that we wish are often very private about our bodies. Having to expose my chest triggers dysphoria for me, and I wear my binder even in intimate situations with my spouse.

Some trans organizations have been quite encouraged by the federal policy stating that TSA agents are not to ask travelers to reveal or remove their prosthetics. A group of which I am a member posted the TSA website, including this policy and the link to a complaint procedure for violations of TSA regulations. So I followed the link and filed a complaint. In it I noted that TSA agents such as those who screened me obviously need training in dealing with trans passengers. I wrote “This training must include the fact that the majority of us have not ‘had the surgery,’ because of the high uncovered expense, and that our nonconforming bodily status is something we keep deeply private. The training should spell out the prosthetic devices and garments we may wear, such as penile prosthetics and chest binders for trans men, and breast forms and tucking underwear for trans women. No passenger should be asked to reveal these prosthetic items or garments or to remove them. Furthermore, if a body scanner reveals ‘anomalies’ in the chest or groin areas, TSA agents should be instructed to ask if the passenger is trans gender and is wearing any special undergarments or prosthetics because of that. If the passenger says yes, then the ‘anomaly’ is explained.”

Unfortunately, my complaint led to no results. The official who reviewed it for the TSA Office of Civil Rights and Liberties did not find a violation of policy (I presume because in his view, I was not asked to reveal or remove my genital prosthesis, and a chest binder is not a prosthetic). He viewed the complaint as one not of violation of my civil rights, but as an issue of professionalism, and forwarded my complaint to the TSA Contact Center to be addressed. That office sent me a form letter “response” from a do-not-reply email address. The form letter merely repeated the information posted on the TSA website: that passengers must be screened; that body scanning equipment will detect prosthetics; that if an “anomaly” is revealed, the passenger must accept a pat-down or be refused access to the terminal; and that passengers may request a private pat-down. I wrote back to the Office of Civil Rights asking that I receive an actual response to my request for further TSA training, but never got a reply.

After my experience, I do have some advice for trans travelers. If you wind up in line for a body scanner, be aware that you can ask to skip it and have a pat-down. If you do go through the scanner, if you look back at it you will see a small simplified display with an outline of a body, and colored rectangles over any detected “anomaly,” which will let you know, if you are called aside for further screening, what part of your body they will focus on. You can then, if you wish, pre-emptively state to the agents that you are wearing a binder or breast forms or whatever seems the likely issue. I’d suggest calmly stating that TSA policy forbids requiring a passenger to reveal or remove a prosthesis. You also have the right to request a private screening (although, if the TSA agent seems hostile and you fear mistreatment, a public screening may in fact be safer, even though it involves more public stares).

I’d also suggest that if you are subjected to bodily scrutiny as a trans person that makes you uncomfortable or delays you, that you complain to the TSA Office of Civil Rights and Liberties. I didn’t get a response, but perhaps if you specifically state that you believe your right not to have to reveal or prosthetic was violated, you would. In any case, the more complaints they receive, the more likely it is that eventually something will be done, or at least that someone can document how many complaints have been filed with no result.

For now, anyway, as trans people we have to deal with a system that treats us as potential terrorists because of our bodily differences, which is nonsensical and insulting.

On Sex/Gender Checkboxes

Day in and day out, sex and gender minorities are boxed in by being confronted with sex/gender checkboxes. This starts the moment we are born, when a binary sex must be checked on our birth certificates: “male” or “female.” For individuals who are born with visibly intersex bodies, this requirement causes a crisis. Families and doctors make hasty decisions about which box they'll force us into, and we have to live with the consequences all of our lives. Having checked off a binary “M” or “F,” those with authority over our infant bodies often feel that trying to reshape our bodies conform to the box they've picked is unavoidable. Thus, genital surgeries are routinely performed, despite the deep unhappiness so many intersex people voice about the results as adults. Great pain might be avoided if parents were allowed to acknowledge our physical truth on birth certificates which included an intersex checkbox, or if the gender marker requirement were simply removed.

For people who are trans gender, gender transitioning is made traumatic in large part due to the checkboxes we must face daily. Binary gender markers are everywhere: on our drivers' licenses and passports, on loan applications and job applications, and on websites everywhere (from Facebook to shopping sites to online radio stations). Once you've checked off one box, changing it is bureaucratically and legally difficult—and sometimes there's no way to change it at all. This leads to all sorts of hassles and embarrassment, as we're “outed” in odd contexts. Worse still, if the gender we're living in doesn't match the marker on our ID, we're subject to being banned from flying, arrested by bigoted police officers, and denied employment.

For folks who don't identify with a binary gender, the world of checkboxes constantly denies our very existence. We go institutionally unrecognized, with no way to even try to say “I am here!”

Sex and gender minorities have some protection in institutional settings that bar discrimination on the basis not only of sex, but of gender identity or expression. But often, such policies are adopted with no follow-through on what it really means for a university or company or city to protect gender identity and expression. Unaware of our needs, administrators think only of ensuring that trans people aren't being kicked out just for gender transitioning. While this is certainly important, there are many more needs that must be addressed. And central among these are that sex/gender checkboxes protect the rights of sex and gender minorities.

I have written a Best Practices guide that is under discussion at my university. It lays out a plan for rewriting sex/gender checkboxes that is meant to address the needs of intersex, trans gender, and gender variant people, in this case, in a university setting. There are some inevitable compromises in it between institutional desires for simplicity and brevity, and our desires as individuals to have our identities recognized in all of their fullness and uniqueness. But I wanted to share it here so that other people who are looking for a guideline to use in seeking to better the way institutions around them limit sex/gender choices would have something to start with. It doesn't address the problem of birth certificates, for example, since universities don't issue them. It does, however, address the question of how sex and gender and sexuality should be measured in research in some detail.

Please feel free to share and employ at will.

Best Practices for Identification of Sex/Gender

Compiled by Dr. Cary Gabriel Costello

I. Foundational Principles

Institutions which commit themselves to protecting against discrimination on the basis of sex and of gender identity or expression (GIE) must give individuals the right to self-identify their sex/gender.

Whenever data are gathered about sex/gender, the rights of GIE minorities (intersex individuals, trans men, trans women, and individuals with alternative gender identities) must be protected.

II. Definitions

“GIE minorities” include intersex individuals, trans gender individuals (trans men, trans women, and individuals with alternative gender identities), and people with variant gender expression.

Intersex Persons

While it is common to believe that sex is binary—that is, that all people are born either male or female—in fact, sexual characteristics exist as a spectrum. There is a great deal of variation in chromosomes (XX, XY, XXY, XYY, etc.), hormones (relative levels of estrogen, progesterone and testosterone), secondary sexual characteristics (breasts, hair distribution, etc.) genital configurations, and gonads (ovaries, ovotestes, testes). Intersex people are individuals whose sexual characteristics fall toward the middle of the spectrum. Approximately 1 in 150 people are intersexed according to medical diagnostic criteria. Most are very private about this status, though some are public about it.

Trans Gender Individuals

Individuals whose gender identity does not match the sex they were assigned at birth are deemed trans gender. A trans man was assigned female at birth but identifies as male; a trans woman was assigned male at birth but identifies as female; a genderqueer individual may identify as neither male nor female. Trans gender individuals often transition to their sex of identification, though they may do so in different ways. Some transition socially by changing name, pronoun, and dress. Others also take hormones (testosterone or estrogen/progesterone) to alter their bodies. In addition, some get surgery to change their chests or genitalia. Because surgery is quite expensive, may not be covered by insurance, and because it carries serious risks, many trans gender individuals in the U.S. do not seek or are unable to access surgical transition services.

Variant Gender Expression

People of any sex or gender may have an atypical gender presentation—male femininity, female masculinity, or androgyny.

III. Best Practices in Collecting Data about Sex/Gender

The best practices for collecting data about sex/gender depend on context. If collecting data about sex/gender serves no purpose for the individuals from whom it is collected, then eliminating the question is the best practice. If data are being gathered to protect the rights and well-being of individuals, then individuals should be given self-identification options that allow GIE minorities to self-identify. These options include a shorter form for ordinary uses, and longer forms to be employed in research contexts.

Eliminating Unnecessary Requirements for Individual Sex/Gender Identification

There are many institutional contexts in which people are routinely asked to identify their sex/gender based on common marketing practices or institutional tradition rather than an intent to protect the individuals from discrimination on the basis of their sex/gender. (For example, this is a common requirement in registering to use website services.) In this situation, the best practice is simply to eliminate the unnecessary requirement of declaring sex/gender.

Standard Best Practices Short Form for Sex/Gender Identifications

In contexts in which data is collected order to ensure equal treatment and respect for all, information about sex/gender should be collected in a manner that protects GIE minorities. The goal in implementing sex/gender categories for general data collection is to protect the rights of all people, whatever their physical sex status or gender identity, including intersex individuals, trans men and trans women, and individuals with alternative gender identities. Thus, the inappropriate single question (“Sex: Male__, Female__”) should be replaced with a three-stage approach.

1. Gender identity: Woman __, Man __, Alternate Self-identification (please write in) ______________.
2. Do you have an intersex condition (disorder of sex development)? Yes__, No__.
3. Are you trans gender? Yes__, No__.

In order also to ensure nondiscrimination on the basis of sexual orientation, best practices add a fourth question unrelated to GIE:

4. Sexual orientation: Heterosexual __, Lesbian__,  Gay__, Bisexual__, Queer__, Pansexual__, Asexual__, Alternate Self-identification (please write in) ______________.

AVOID poor practices which undermine individuals' identities instead of protecting them. A common poor practice is to use a single additional checkbox: “Male__, Female__, Transgender___.” This is inappropriate for several reasons. First, it does not allow intersex individuals a way to identify themselves. Secondly, it discriminates against trans men and trans women by framing trans gender identification as incompatible with “real” male or female status. And thirdly, it does not allow for recognition of the distinct needs and identities of individuals who identify as neither male nor female.

Best Practices Long Forms for Research Contexts

Data about sex and gender are often collected in the course of research. If data are to be analyzed along the dimensions of sex and/or gender, two sets of needs must be met. The first relate to the rights of research subjects, who must be protected from harm, including the harm of discrimination on the bases of sex, gender identity or gender expression. In conducting research with human subjects, researchers will inevitably recruit research subjects who are intersex, trans gender, or variant in their gender expression, and are ethically obliged to treat them with respect. The second issue relates to the need of the researcher to have research questions carefully worded in a manner that subjects will understand and respond to in a reliable and valid manner.

Many scientific studies today continue to use “sex” as an independent variable, and measure this in a binary fashion. This is a methodological flaw, as well as discriminating against GIE minorities. It does not allow the researcher to measure what actually accounts for observed variance in the dependent variable: is it physical sex status, internal gender identity, gender-conformity or nonconformity? Just as a study that uses religion as an independent variable is improved when it not only identifies subjects as “Christian,” but allows the subjects to identify a more specific denomination, asks them how religiously observant they consider themselves, and inquires as to how often they attend church, increasing the sophistication of sex/gender questions improves study results. The following measures are suggested:

1. What gender do you identify with? Man__, Woman__, Other (please write in the identity)________________.
2. What sex category were assigned at birth? Male__, Female__.
3. As far as you know, were you born with an intersex or sex variant body? Yes__, No__.
4. Please indicate how masculine or feminine you are in your dress and manner on the following scale: (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.

In order also to ensure the study is not discriminating on the basis of sexual orientation, and to gather better data, best practices suggest that subjects also be surveyed on their sexual identity. Problems are often raised by the traditional method of asking subjects if they are “heterosexual, homosexual, or bisexual.” For example, people who are gender transitioning or who identify as neither male nor female are often unable to use these sexual orientation categories to classify themselves. Furthermore, it is well established that there is a difference between how many people identify their sexual orientation and the sexual activities in which they actually engage. This may be addressed through questions such as the following:

1. To whom are you attracted, sexually and romantically? (1) only men, (2) mostly men, (3) a bit more toward men than toward women, (4) equally toward men and women, (5) a bit toward women than men, (6) mostly women, (7) only women.
2. With whom have you been sexually involved? (1) only men, (2) mostly men, (3) a bit more men than women, (4) equally men and women, (5) a bit women than men, (6) mostly women, (7) only women.
3. Are the people to whom you are attracted (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.
4. Consider the idea of a partner who identifies as neither male nor female, but as some other gender such as “genderqueer.” Do you find that (1) very appealing, (2) moderately appealing, (3) a bit appealing, (4) I feel neutral about it, (5) a bit unappealing, (6) moderately unappealing, (7) very unappealing.

Researchers who choose specifically to study GIE minorities should consider them a vulnerable subject pool for IRB human subject protection purposes. In cases of studies recruiting intersex, trans gender, or gender-variant subjects, procedures should be set in place to protect these vulnerable subjects, and the questions asked about sex and gender carefully designed to accord all subjects with full respect for persons. Confidentiality should be strictly protected, data collected in a location where subjects will not be at risk of having others see or overhear their responses, and information sheets listing appropriate support groups and links to mental health resources distributed to those recruited to participate.

Transphobia, Racism, and Segregation

I want to talk about some contemporary issues, and how they relate to American history. The exclusion of trans people from facilities and organizations is not often framed as segregation, but that is exactly what it is, and I want to illustrate that. This will be a rather “heavy” post, but it's important to talk about recurrent patterns in American social history, so that we can learn lessons from our collective past. I'll be discussing patterns and parallels, not equivalences. Racial segregation in the U.S. came into being in the aftermath of racial slavery, the most extreme form of oppression our nation has seen, and one that, as a white man, I cannot claim fully to comprehend. Transphobic segregation does not have this terrible history directly behind it, for which I am grateful. That said, trans people suffer from segregation every day, and to understand the problem, and gain insight into solutions, we have to examine patterns of the justification of segregation across history.

Sometimes, as a trans person, it seems like every day brings another news story about some transphobic incident or initiative. At times there's a ray of light, but often it's followed by a dark cloud of backlash. I have two situations of this sort on my mind right now, both having to do with segregation. These situations illuminate a common thread in American history: the enactment of bigotry through segregation policies that are justified as somehow “protecting the innocent” by oppressing a minority group.

The first of these situations relates to an incident in which a trans woman was shopping at Macy's. When she took some items to a dressing room to try them on, she was denied access by a sales clerk. The customer went to the manager, who told the clerk to let her in to try on her items. The clerk refused, shouting that God doesn't recognize “transgendereds” and that the customer was thus just a man in a dress, about to violate a private women's space. Embarrassed by the scene and by the employee's noncompliance, the manager fired her. The clerk soon acquired a circle of religious advocates demanding her reinstatement, but Macy's actually quietly refused. (See here.)

The day that I read about Macy's asserting a nondiscrimination policy, I was pleasantly surprised. The store would not put up a symbolic “Cis Women Only” sign above the changing room. But, sadly and predictably, a lot of backlash followed. In just one of the actions taken in retaliation, Rep. Richard Floyd, a Tennessee republican, introduced a state measure prohibiting transgender people from using public bathrooms or dressing rooms that conflict with the sex listed on their birth certificates. (Tennessee, by the way, does not permit people to change the sex on their birth certificates when they gender transition.) What uproar this would have led to when bearded Tennessee-born trans men dutifully entered ladies' rooms, one fortunately has only to imagine, as the state sponsor of the bill chose to withdraw it as distracting the legislature from pressing economic issues. While the withdrawal brought me a sigh of relief, I keep hearing the words that Rep. Floyd spoke when introducing the bill:

“I believe if I was standing at a dressing room and my wife or one of my daughters was in the dressing room and a man tried to go in there — I don’t care if he thinks he’s a woman and tries on clothes with them in there — I’d just try to stomp a mudhole in him and then stomp him dry. Don’t ask me to adjust to their perverted way of thinking and put my family at risk. We cannot continue to let these people dominate how society acts and reacts.” (See here.)

Floyd's words follow a time-worn groove in the politics of bigotry in America. A minority group is framed as posing some imaginary threat to privileged innocents, and segregation and violence against that minority are thus framed as justified. The U.S. saw such violent “logic” on a vast scale after the end of the Civil War and the manumission of all who were enslaved. Here are the words of Sen. Benjamin Tillman of South Carolina, speaking on the U.S. Senate floor in March of 1900 in favor of racial segregation and against voting by African Americans: “As to the Negro's 'rights,'— I will not discuss them now. We of the South have never recognized the right of the Negro to govern white men, and we never will. We have never believed him to be equal to the white man, and we will not submit to his gratifying his lust on our wives and daughters without lynching him.” (See here.)

The wave of racist violence against African Americans in the wake of Reconstruction took place on an appalling scale. Between 1889 and 1940, 3800 lynchings of African American men and women were reported—and doubtless, many more went unreported. There was a claim that most of these were in retaliation for black men raping white women in what was termed the “New Crime,” supposedly caused by black men reverting to a “savage type” once the “civilizing influence” of slavery was removed. In fact, as activist and author Ida B. Wells found in her research on 728 lynchings, the majority of lynching victims were not even accused of rape, but of crimes such as “quarreling with Whites” and “incendiarism.”

There is a difference of scale in the level of violence faced by African Americans after Reconstruction and by trans people today. But contemporary transphobic policies and violence follow this historic pattern of blaming the true victim. Rather than owning their bigotry, legislators, street thugs and shop clerks claim that the trans people they exclude or assault “started it.” We don't enter a restroom to use the toilet, they claim: we come in to sexually assault those in the women's room or challenge those in the men's room, so segregating us and/or assaulting us is justified. Any violence against us is framed as merely self-defense, or as defending the honor of women and children. The fact, of course, is that trans people are the victims, and our “offense” is not attacking the “helpless,” but challenging the worldview of an angry, privileged, insecure group.

And so we see our first theme: the projection of violence onto the victims of bigotry.

Justifications for both racial segregation and the segregation of cis and trans people are unfortunately often based on religious worldviews—as the sales clerk justified her actions at Macy's. Many religious organizations are firmly in favor of trans people's rights. But in the U.S., transphobes often present their ideologies as dictated by the Bible. The standard claim of contemporary transphobic Christians is that gender transition violates God's plan:

“Most basic to our understanding оf sex іѕ that God created twо (and оnly two) genders: “male аnd female He created them” (Genesis 1:27). All the modern-day speculation abоut numerous genders—or еven а gender “continuum” wіth unlimited genders—is unbiblical. . . God’s creation оf еаch individual muѕt surely include His designation оf gender/sex. His wonderful work leaves no room for mistakes; nо оnе іѕ born with the 'wrong body'. . . In the Law, transvestism / transvestitism wаѕ specifically forbidden: 'A woman muѕt not wear men’s clothing, nor а man wear women’s clothing, for the Lord your God detests аnyone whо dоes this' (Deuteronomy 22:5). . . Transgenderism іs not genetically based, аnd іt is nоt simply a psychological disorder; it iѕ rebellion аgainѕt God’s plan.” (See here.)

(The fact that sex is indeed a spectrum, which is something that as an intersex person I am aware of every day, raises a problem for this worldview. I once asked an evangelical leader how he could reconcile his claim of divinely-created gender dyadism with my intersex birth status, and the prevalence of intersexuality in all species. He responded that God did not intend for me to be intersex, but that in a world of sin birth defects occurred, and that in the world to come there would be no “errors” like me. . . which conflicts with the simultaneous claim that “His wonderful work leaves no room for mistakes; nо оnе іѕ born with the 'wrong body'.” There is a great illogic in claiming that people born with intersex bodies that bother the majority have defects that must be medically corrected, but nonintersex trans people cannot seek these same medical services because God makes no mistakes.)

Transphobic Christians see in gender transition more than a case of “individual sin;” they see a danger to society as a whole. The entire LGBT community is framed as sexually perverse, polluting society with the belief that sexuality need not be limited to the confines of a marriage between one person who was assigned male at birth and one person who was assigned female. Trans visibility is seen as carrying a further seductive and contagious danger: the idea that both physical sex and gender roles are mutable, which will spread to children and confuse them about their “true” sexes, making them rebellious. In questioning their sexes, they believe, their children will question God's plan as manifested in human bodies since the creation of Adam, and Eve from Adam's rib. Children who question their sex also question Adam's superiority and Eve's submission to him. Thus, trans people threaten the “proper” order of all gender relations in society.

This framing of a persecuted minority as posing a threat to the plan God made manifest in the body also has a long history in the U.S.. Consider this editorial published in a Madison, Wisconsin newspaper, the Daily Argus and Democrat, on September 11, 1857. The editorial advocates in favor of racial segregation, and bases its argument on the idea that segregation will prevent interracial relationships, which are against God's plan:

“Our Creator clearly never intended these two widely dissimilar races to fraternize; if he had wanted them to be one, he would have so made them—but he has placed, with his own finger, a mark , in color, intellect, physiognomy, and other strongly marked characteristics. Whenever these lines of demarkation are endeavored to be obliterated by amalgamation, the white race has been degenerated, enfeebled, and degraded, as a natural consequence.”

Though written a century later, the 1959 order of the trial court in the case of Loving vs. Virginia uses quite similar language. (It would eventually be overturned by the Supreme Court, putting an end to bans on interracial marriage in the U.S.) In sentencing Mildred and Richard Loving to jail under Virgina's Racial Integrity Act of 1924 for having married out of state and returned to Virginia, the trial court wrote: "Almighty God created the races white, black, yellow, malay and red, and he placed them on separate continents. And but for the interference with his arrangement there would be no cause for such marriages. The fact that he separated the races shows that he did not intend for the races to mix."

So we see another recurrent theme: a claim that bigoted civil policies follow God's plan as made clear in the color and shape of the flesh.

I want to examine one more theme—the way that gender and sexuality play out in enforcing marginalization. To do this, I want to turn to another story in the news: that of a 7-year-old Colorado trans girl, whose application to a Girl Scout troop was first denied, then accepted, leading again to lots of backlash. I've already noted that LGBT communities are framed as sexually perverse by bigots. Now, trans people are a gender minority, not a sexual minority. Gender transition does affect sexuality (a person who had been perceived as a straight man is categorized as a lesbian after transitioning, for example), but this is epiphenomenal rather than the cause of gender transition. We gender transition based on our gender identity, not for sexual reasons. Still, gender transgression is so linked in the popular imagination with “homosexuality” that it may seem inevitable that trans people would be viewed by bigots through a sexual lens. But the evocation of sexuality in American bigotry predates LGBT rights movements, and plays out even when sexuality should be deemed a nonissue.

Trans women have been slandered as men costuming themselves as women in order to gain access to women's private spaces to peep upon and sexually assault them by all sorts of groups. Excluding trans women from women's bathrooms, locker rooms, and other “safe spaces” is justified through a familiar Western system of sex/gender ideologies which frames “good women” as fragile sexual victims, to be put on a pedestal in a gilded cage. This same belief system frames even good men as sexual aggressors, able to control themselves around chaste good women, but naturally and excusably provoked by the actions of bad women to take sexual advantage of what is “offered.” Trans women suffer the doubly-negative fate of being framed as sexually aggressive men when in a woman's space, and as bad women who are “asking for it” in a men's space.

But Bobbie Montoya, Girl Scout aspirant, is seven years old. We contemporary Americans should see her as asexual, an innocent child. And yet the rhetoric deployed against her is remarkably unaltered from that directed at adult trans women. First of all, she's trying to enter a girl's space, so she's constantly being framed as a boy. The large majority of news reports blare “Boy Wants to be a Girl Scout,” or something similar. (See, e.g., this.) More importantly, she's framed as posing some sort of ominous threat by transphobic organizations. Three Louisiana Girl Scout troops that disbanded to protest the Colorado troop's action described the admission of trans gender children as not only “extremely confusing” for “normal” children, but as posing a danger to girls. (Here.) In a viral video calling for people to boycott Girl Scout cookies over the trans girl's admission, a 14-year-old Girl Scout says not only that the “radical homosexual agenda” of gender transition can't be permitted and that the trans girl is a boy, but that her presence endangers the other girls' safety. (Here.)

Bobbie Montoya is a button-eyed tot, not even four feet tall, living under extreme scrutiny. She poses no risk to anyone. And yet those fighting against allowing her to desegregate a cis gender Girl Scout troop continually evoke some sexual risk, some nameless dread. What this makes clear is that the justification of segregation as self-defense against a sexual risk has no relation to reality. It is a strategic claim, a trope. The fact that it emerges in the case of trans kids just makes this more obvious.

The gendered nature of the claim of sexual risk means that the bigotry faced by trans people differs a lot by gender. Trans women get the short end of the stick, attacked as victimizers when framed by the prejudiced as men, and sexually victimized when framed as women. Trans men suffer too, but not quite as dramatically. When framed as men, we can be attacked as victimizers, but when framed as women (as we often are by transphobes), though sometimes we are sexually victimized as “bad girls” who are “asking for it,” often we are put in the less physically dangerous (if unpleasant) position of being treated by bigots as pitiful and ugly self-mutilators who must be protected from ourselves.

This pattern of gender differences echoes the dangers faced by African American women and men after Reconstruction. Black men faced a great risk of being physically attacked by racists because they were framed as the most dangerous of male sexual aggressors. White fantasies about black male size and sexual violence were quite potent. For example, one white man who joined a mob of people flocking to look at the body of a lynching victim wrote that “the crowds from here that went over to see [the victim] for themselves said he was so large he could not assault her until he took his knife and cut her, and also had either cut or bit one of her breast off.” (Here.) In fact, stories like these were urban (or rural) legends, fantasies with no relationship to the actual cause of the lynchings, which were usually retaliation against the victim acting in a nondeferent manner, challenging a white man, rather than some accusation of rape. But these violent stories allowed white mobs to feel justified in torturing victims before lynching them, and in mutilating their bodies afterwards.

African American women in the period after the Civil War were the group that actually suffered from an epidemic of transracial rape, in a reality that was an inversion of the myth of the “New Crime.” Evidence of this lies in the marked increase in the proportion of mixed-race children born to African American mothers in the period after the war.

What we see in the case of racial violence after the Civil War is a series of projections, in which a bigoted white majority reversed the positions of victim and attacker. This pattern is echoed by transphobic assaults today in the “trans panic” defense. A cis man who encounters a trans woman and finds her sexually attractive is viewed by bigots as justified in assaulting her for “tricking him” into finding her alluring, her very status as trans woman inviting violence. A cis man who kills a trans woman and claims she initiated a sexual encounter with him, after which he discovered her trans status, routinely walks away with little or no jail time—even if that claim seems patently implausible (see, e.g., this). Conversely, trans men are at risk of becoming victims of “corrective rape” by transphobic straight cis men who find them attractive, their trans status being seen as a provocation, with the chances of prosecution being slim.

It becomes clear when examining the way that gender and sexuality are filtered through bias that those who are the victims of segregation are also the victims of sexual assaults and sexual myths. And yet segregation is justified in the name of protecting the “innocent” majority from a supposedly dangerous, deviant minority group.

What lessons can we draw from the parallels we've seen? In enacting segregationist policies, whether in the case of race or gender identity, there are two bases commonly drawn upon. The first is a claim that the marginalized group represents a sexualized threat to the majority—a claim that is inversely related to actual victimization. The second is a religious claim that God has written an intent that the minority be discriminated against in the flesh—in the color of the skin, or the shape of the body—and that religious order demands enforcement of discriminatory policies. The first claim can be opposed by marshalling the facts to point out empirical reality. The second can be countered by noting both the diversity of religious opinion and the constitutional separation of church and state in America.

The lessons of history show that fighting segregationist policies requires social movements, not just logical arguments. It took many marches and sit-ins and protests to bring about racial desegregation. Furthermore, ending segregation at law doesn't end it in practice. The results of racial desegregation in the U.S. have included the gradual defunding of integrated public transportation, white flight from integrated neighborhoods, and the ongoing de facto segregation of schools by neighborhood. Today, I live in the most racially segregated major metropolitan area in the U.S., so this reality is clear to me. The suburb next door, a former segregated “sundown town,” is now under 2% African American, while African Americans make up about 35% of the total area population. (Map.) So I don't want to come across as implying that ending formal segregation is a sufficient solution to the problem. It isn't. But we live in a time of great flux for the rights of trans people, with nondiscrimination policies and discriminatory policies both being added to the books around the country. I do believe that if advocates for trans people can make clear the continuity between regulations excluding us from facilities and organizations, and the laws that enacted racial segregation in the U.S., it would affect the way some people see us. It's not a panacea, a magical solution, any more than ending legal racial segregation has solved the problem of racial inequality—but it is something worth doing.

So, please, if you have a discussion about discrimination against trans people, use the term “segregation” to refer to our exclusion from schools, public facilities, and organizations. Because segregation is exactly what it is. And point out that the supposed sexual risk posed by integration is a myth—as is abundantly clear in the case of letting a little trans girl into the Girl Scouts. We're not out to “get” cis people. We just want to be able to use the bathroom like anyone else.

What is the name of my community?

The collective names used by marginalized people get "used up."

As new generations rise in marginalized communities, they often reject the collective term used by the previous generation, seeing it as saturated with the negative connotations given it by the privileged majority. So they assert a new collective term. Asian American, not Oriental. "Disabled people" replaces "people with disabilities," which replaced "the handicapped." There's a period of resistance, and the new generation is energized by the feeling they're really changing things as they struggle. The privileged majority squawks: “Why are you people always changing your names and expecting me to care and keep track of it? Why is saying 'colored people' offensive when 'people of color' is not?” Some do get educated as a history of inequality is explained to them, and this energizes the activists.

This period of struggle over a new collective term is not limited to fights with the privileged majority. The older generation of people within a marginalized community can also resist giving up the term on the banners under which they fought. Hence we still have the NAACP—the National Association for the Advancement of Colored People. When the Gay Community became the Lesbian and Gay Community, there was a lot of bickering. The struggle to expand that to Lesbian, Gay and Bisexual Community was vigorous. Getting large organizations that spoke in terms of “gay rights” to add trans people and speak of LGBT rights was a substantial battle. And these struggles continue, with intersex people and asexual people and others trying to expand the community umbrella to cover them, and the experiences of cis gay men and lesbians still centered.

I've been through many of these struggles myself, having been involved in queer community activism since the 1970s. And so when I hear a new generation, full of fire, claim that a new term should be used because it will Change Everything, I feel a bit old and jaded. I've seen new terms get accepted, a number of times—after which things settle down—and some change has been effected, but it's slow and incremental, and the group is still marginalized. Then a new generation rises under these conditions, sees the current group name as weighed down with bias, and seeks a new collective identity term.

Not that I'm arguing against changing collective names. I think it's an important part of the struggle of marginalized groups. Consider the reclaiming of the term “queer” in the 1990s. People got excited about asserting an identity as queer for several reasons. Some saw it as signifying a more rebellious, activist philosophy. Others saw it as joining fractured communities with their own names—lesbian, gay, bisexual—into a united whole. Some embraced queer theory, and the idea of destabilizing categories and identities, exploding possibilities for identification and subverting troublesome institutions. And some saw using the term as a way to bring trans people and gender transgressors into the center of the movement. All of which are things people still care about, and still fight for.

But it seems to me the power of the term “queer” is getting used up. Certainly there's been progress in the last 15 years—especially for cis lesbians and gay men. A majority of young people in the U.S. support same-sex marriage, “Don't Ask, Don't Tell” has been repealed, and more and more institutions give some benefits to domestic partners. But as for progress for sex and gender minorities—intersex and trans people—not so much. I get quite frustrated going to events that are advertised as “queer,” attended by people who describe themselves as “queer,” and at which trans people are marginalized. As my trans woman partner said to me, “If I'm going to go to a 'queer' event and still be treated as a freak, then I need a term beyond queer.” If people draw the acceptable querity line at lesbians showing up to a party in mass-produced commercial stick-on moustaches, “queer” isn't particularly radical.

I know the label queer still has powerful meanings for many people—I still like it, conceptionally. But as a matter of practice, it's not doing what I want it to do. The needs of queer people like me are not being met.

It's hard to get those needs met with the collective names we use today. I've been at meetings for several LGBT organizations where I've tried to get the group to add an “I” for intersex people, since, as an openly intersex person in a world in which most of us are still hidden and treated as medically disordered, I consider it my duty to make our presence and needs visible. And in ALL of these conversations, people who identify with the LGBT label objected that it would confuse people looking up the group, and justify the complaints of the majority that we have too many letters in our name. Then, a person or group who identified as queer argued that the term queer includes everyone, and should be used instead, so future marginalized others could also feel represented. I pointed out that based on my experience as an intersex trans person, the term queer as it is actually used is not the panacea people claim it is. The majority then asserted the term queer was too radical to be accepted by the university/LGBT center board/funding sources, and since there was no consensus that making the group name longer was a good idea, each group declined to include the “I” for intersex.

No term is a panacea. But new community labels do have a beneficial effect for a time, in shaking up assumptions and giving people an opportunity to assert unmet needs. Trans and intersex people have a lot of unmet needs that I want to see addressed. So, anyone out there in the new generation of rebels and activists have a better term? One that explicitly centers sex and gender diversity? I'm all ears.

Meanwhile, in my own writing and teaching, I'm using the term “queer” a lot less, and speaking more often in term of sex, gender and sexual variance.

Genderqueer Individuals and the Trans Umbrella

Let me start off this post by saying that personally, I like my gender bent. I'm an intersex trans man who currently presents in a pretty generically masculine way, but I've always identified as genderqueer, on the femme side of manhood. As an intersex person I am perpetually aware of the medical violence done to my intersex kin in the name of enforcing dyadically-sexed body norms. I think that breaking down the insistence that there must be two and only two sexes, two and only two genders, is all to the good. I like a rainbow of bodies and identities. This doesn't mean I disrespect the large majority of people whose identities have developed in the context of our dyadic gender norms. But it pleases me to see people rock the gender binary boat, and I'm glad when trans people do it.

There's often bickering and conflict in any community about where to draw the boundaries for group membership. For the trans community, such as it is, one central debate is whether genderqueer people belong under the trans umbrella. Some trans folk believe that the boundary for who "counts" as trans should be easy to cross: anyone who self-identifies as trans on any basis that matters to them should be welcomed. Others define the "truly trans" around formal gender transition: anyone, genderqueer or binary in their identity, who seeks to take some transitional steps legally and/or medically can stand under the trans umbrella. Yet others are much more restrictive, seeing only binary gender-transitioners who transition surgically as "really trans," and others as confused people who deserve to stand out in the rain until they "make up their mind" and follow the medically-normalized, binary pathway to "sex change."

I'm inclusively-inclined, and don't feel marginalized communities do themselves any good by trying to define people out of the group. I hate it when people turn to a community for support, and instead face gatekeeping checks: "Prove you're intersex. Prove you're trans. Prove you're disabled. Prove you're Asian." So I accept as part of the trans community anyone who says they belong. However, I believe community membership entails duties to the community, and central among these are understanding the diversity within any community, recognizing one's own privileges, and working never to marginalize the most marginalized among us.

So it's from this position--full inclusion, celebration of gender diversity, and a demand that all of us be respectful to community members--that I address the issue of genderqueer people as members of the trans community.

I believe that sometimes genderqueer people are among the most marginalized of trans people, and other times, among the most privileged. As someone who ran the gauntlet of legal transition and seeking access to hormone therapy I can testify to the fact that this process is much more difficult for someone who tries to assert a genderqueer identity. I didn't have the strength to do it. I kept my lack of allegiance to the gender binary a secret and tried to answer all the gatekeeping questions in a traditionally masculine way and present myself as a standard guy. There's something very ironic in having to pass as something one is not (a manly, manly man) in order to be permitted to stop passing as something else one is not (a woman). And it makes passing through the gatekeeping system more complicated and nervewracking. However, I'm sure my experience was much easier than that of a person who tried to, say, assert a totally neutrois identity while seeking access to hormone therapy. I can but salute anyone who attempts to take the difficult path of seeking openly to transition to a nonbinary sex, and recognize that the barriers they face make them among the most marginalized of trans people.

At other times, however, genderqueer people are privileged in comparison to other trans folk. I acknowledge as having the right to trans community membership anyone who identifies with a gender other than one conforming to the sex they were assigned at birth. But it's important to distinguish between gender identity, gender presentation, and seeking to access gender transition services.

Anyone who doesn't identify with the gender society pushes on them suffers the pain of gender dysphoria. Our psychological suffering is equal and deep when we are misgendered by others, however we dress or groom ourselves and no matter what our transition status. A FAAB person who identifies as genderqueer but who presents as a gendernormative woman shares the emotional pain of a MAAB trans woman who has just come out at work when the two are called by the wrong pronoun by a customer. However, the material consequences are likely to be very different for the two individuals. The first person gets to go to work without facing transphobic harassment, while the second person's career is endangered.

There is a huge difference in the levels of harassment and marginalization faced in everyday life between those whose genderquerity is always visible to cis people and those who identify as genderqueer but who generally pass as cis people. Again, I can testify to this personally as a trans man who identifies as genderqueer but who is now often perceived by cis people to be a generic guy. I certainly enjoy wearing eyeliner and fishnets to a queer party, but most of the time I dress like a standard metrosexual male professor. I can teach, go shopping, attend my kid's school play and just go about my business. When my more androgynous trans woman spouse does the same things, she has to endure a barrage of stares and whispers and binary-enforcing confrontations ("Are you a dude or a chick?"). It's clear that because I can choose to present as genderconforming and I usually do, I am privileged. True, my privilege can evaporate in an instant when my trans status is revealed (and I've certainly had the experience of having a guy touch my chest and realize what I keep bound up in there). And there are plenty of circumstances in which I can't try to present as a cis man--any context requiring disrobing, for example. But by having the choice to be able to present as a binary man and by taking it, I enjoy privilege--albeit discreditable--that I need to acknowledge.

Genderqueer individuals who pass as cis people in a way that can't be discredited by a random touch enjoy even more privilege, and must acknowledge that too. People who are usually perceived by others to be members of the sex they were assigned at birth, whose ID cards all match that sex, and whose bodies present the expected genital configuration enjoy cis privilege. They may not want it, any more than I desire male privilege or white privilege, or any more than a MAAB individual who wishes to but is afraid to transition desires male privilege. But we all have to acknowledge each of the privileges we have, and how we benefit from them. To deny I get many privileges from being white would be racist. To deny I enjoy male privilege would be a sexist act. Not acknowledging one's privileges makes one complicit with marginalization.

An analogy: I had an acquaintance who identified as a person of color due to being Jewish. She was deeply aware of the fact that Jews were considered a “dark race” by Europeans a century ago, and how 6 million were exterminated as racial others in the Holocaust. She didn't identify with the experiences of Anglo Americans, and so she refused to check off “white” on forms and instead marked “other” and wrote in “Jewish.” She had an absolute right to identify as she did, and to seek to subvert our current definitions of race. But she was fair-skinned and blue eyed. When she would speak of her “experience as a person of color” and fail to distinguish between her lived experience in the contemporary United States and that of, say, a dark-skinned African American, I considered her way off base. She might not identify as white—but she enjoyed white privilege. By failing to acknowledge the difference between her nonwhite identity and the fact that her daily lived experience was one of a person perceived as white who was not trailed by store security, presumed to be in grad school due to affirmative action rather than merit, or any of the thousand other indignities faced by people of color, she was acting in a way I'd deem complicit with racism.

What I ask of genderqueer-identified people who are not seeking to transition legally and who pass as binary cis people in their ordinary daily lives is that you acknowledge the material cis privilege you enjoy, and how great it is, even if you suffer from the emotionally painful dysporia all trans people share. Don't equate your experiences as someone whose gender identification isn't reflected back to you by the cis masses to those of people who have gender transitioned and are often misgendered. Both of you may feel psychic pain, but the material consequences of the misgendering benefit a person who is not perceived as trans, and endanger a person who is. Use that privilege to speak up for your trans siblings and fight transphobia. But don't presume to judge a less privileged trans person who doesn't report an act of police harassment against them, or doesn't refuse to use the basement bathroom their boss orders them to use, or doesn't correct a teacher who misgenders them in front of a classroom full of people. Actions that may be safe for you may not be safe for them.

What I want from binary-identified trans people is that you accept genderqueer identities as equally valid gender identities. Don't presume that someone who says they are genderqueer is just "taking the easy way out" or "going through a stage." And please acknowledge that your genderqueer trans siblings who seek transition services are treading pathways even more difficult that your own, that put their access to transition services at risk if they refuse to keep their genderquerity in the closet.

What I want from everyone in the trans community, as a genderqueer-identified trans man, is that we do our best to walk under the trans umbrella together, being as careful as possible not to tread on one another's toes.

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.]