Media

Ambiguous Androgyny (Part 1): Recognizing an Optical Illusion

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~ Part 1 in the Ambiguous Androgyny series ~
Part 2: Deconstructing an Optical Illusion
Part 3: What You See
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my-wife-and-my-mother-in-law

Despite my detailed descriptions of the anatomic dysphoria associated with gender dysphoria, it has remained very difficult for me to explain my experience to other people in a way that is concrete and understandable to them. But the process of putting words to a such a vague yet distressing combination of thoughts and emotions has been extremely helpful for me, because it forces me to analyze my own perspective in a way that makes it more clearly defined in my own mind.

Anatomic dysphoria is often portrayed as the distress arising from a mismatch between physical attributes and an intrinsic cognitive “gender identity”. In a previous post, I described the problems with the concept of “gender identity” and argued against the idea that “gender identity” is an inborn, innate, and immutable property. So “gender identity” does not serve as a useful means of understanding my own experience. I have continued searching for other ways to conceptualize my physical dysphoria.

Re-reading previous posts on this blog and reflecting on the language that I use to describe my experience to others, I noticed that I commonly return to the analogy of an optical illusion:

“An accidental glimpse of this girl-face in the mirror feels like a baffling optical illusion, an odd reflection of a face I know so well but can never quite call my own.”

“I continue to stare at those reflections and images of myself with the unsettling mixture of curiosity, frustration, and disorientation that comes with trying to unravel a particularly puzzling optical illusion.”

I have also described the rapid and involuntary shifts in perception that occur when I view my physical image:

“My appearance seems to change dramatically within the space of just a few minutes or hours.”

And I have alluded to the deliberate cognitive process involved in attempting to interpret my mirror image in a way that is more coherent and less distressing.

 “…my reflection jabbing back at me with the familiar unfamiliarity that haunts my mirror image. But this time I don’t try to fit those female fragments into a coherent structure.” 

 I have found only sparse references to this optical illusion effect in the writing of other trans authors, but what they describe about seeing their reflection closely mirrors my own experience.

“I know that what happens between my eyes and my brain and the body in the mirror is like some sort of twisted optical illusion trick.” – Malachi

 “Were the optical illusions I saw reflected really me?” – Grace Stephens

 “I have entered an ambiguous time in my transition. Like the color of the tiles in the checker shadow illusion, how my gender is perceived is often entirely context dependent… When I look in the mirror, sometimes I can see two different versions of myself, depending on which cues I focus on. When I focus on the cues that my brain interprets as ‘male’, I can see myself as I know myself to be, every week more aligned with my internal self-image. When I focus on the cues that my brain interprets as ‘female’, I feel dysphoric and upset.” – It Doesn’t Have to Be This Way

“Every day, my face looks different… The feeling invoked when I look in the mirror is the same as when I view these [optical] illusions. They are confusing, disorienting, and unsettling. To me, these emotions are the defining characteristic of body dysphoria.” – Amy Dentata

In light of my personal experience and these sporadic references from other trans writers, I expanded my investigation of optical illusions. The results of my research suggest that using the analogy of an optical illusion to describe my experience of body dysphoria is extremely accurate.

One particular optical illusion that is especially relevant to my experience is the image called My Wife and My Mother-in-Law. This illusion closely aligns with my experience of anatomic dysphoria because it generates two very different interpretations of a human face based on unchanging physical features. The photo at the top of this post is my own drawing of this well-known illusion.

I recently used My Wife and My Mother-in-Law to help explain my experience of physical dysphoria to my psychiatrist. He admitted that he had seen the image before, but prior viewing does not detract from my explanation. I asked him what he saw when he looked at the picture. He said that his first impression is that of a young woman with her face turned away, but because he knows that an old woman’s face is also there, he can intentionally re-interpret the image to visualize the old woman. (The young woman’s chin becomes the old woman’s nose, and the young woman’s necklace becomes the old woman’s mouth). I asked him what he felt while looking at that image and seeing the young woman’s face alternate with the old woman’s face. He said he felt a brief and mild sensation of confusion and discomfort, but his mind naturally reset the lines back into the young woman’s face which restored a more neutral emotional response to the image. I explained that for me, the image never settles on one face or the other for very long, it constantly shifts back and forth between the young woman and the old woman, which makes the viewing experience very disorienting and confusing. Then I told him, “Imagine that the image doesn’t shift between young woman and old woman, but instead shifts between young woman and young man. Over and over and over. Imagine that the image never settles into a consistent comfortable interpretation. Imagine that you see this constantly alternating image every time you look down at your body, every time you look in the mirror, every time your reflection stares back at you from a cell phone screen or a darkened store window. Imagine that. That’s what my physical dysphoria is like, an optical illusion where my real image (young woman) and my brain’s expected image (young man) are constantly competing and my perception of the image is constantly changing to align with one or the other. I end up feeling disoriented and unsettled and completely detached from my own body.” He considered this – very carefully, very thoughtfully, as is his way – and then nodded. He truly seemed to have an accurate and empathetic understanding of my experience of anatomic dysphoria.

My Wife and My Mother-in-Law belongs to the class of optical illusions known as ambiguous images. (Podvigina 2015) Examples of other ambiguous images include the Rabbit Duck, Rubin’s Vase, Necker’s Cube, Winson Figure, and Spinning Dancer.

Many types of optical illusion create a perceived image that differs from the actual components of the figure based purely on the physical properties of the visual stimuli itself, properties such as shape, texture, contrast, and continuity of lines. These are often called literal optical illusions. Ambiguous images differ from literal optical illusions because the visual stimuli of ambiguous images allow multiple coherent cognitive perceptions to arise from the same image components. Literal optical illusions create a single inaccurate perception. Ambiguous images create multiple spontaneously shifting accurate perceptions – this experience is called multistable perception.

Multistable perception occurs when a static sensory stimulus is ambiguous and consistent with two or more mutually exclusive subjective interpretations; each interpretation is discrete and stable for a short period of time, but perception alternates between these different interpretations. (Leopold 1999, Eagleman 2001, Sterzer 2009, Schwartz 2012, Podvigina 2015)

[Note: multistable perception can occur in response to visual, auditory, olfactory, and tactile stimuli, but this phenomenon has been most extensively investigated with respect to visual sensory input. (Schwartz 2012) The rest of this post will focus exclusively on multistable perception in a visual context].

Characteristics of multistable perception include:

  1. Exclusivity: conflicting visual representations alternate but are never simultaneously present. There is no “average” or “combined” interpretation. (Leopold 1999, Schwartz 2012)
  2. Inevitability: alternations in perception are initiated spontaneously. (Leopold 1999, Schwartz 2012) The alternation process cannot be completely prevented, but alternations in perception are subject to limited voluntary control and may be influenced by the intention of the observer; control over the rate of perceptual alternation and stability of each percept improves with practice. (Leopold 1999, Sterzer 2009, Podvigina 2015)
  3. Randomness: durations of successive intervals of transiently stable percepts are unpredictable and characterized by sequential stochastic independence. The statistical properties of multistable alternations show similar distributions of dominance phases (which percept is dominant) across different types of stimuli and between individuals. (Leopold 1999, Schwartz 2012, Podvigina 2015)
  4. Dependence on awareness: perceptual reversals are very rare or even absent when observers do not know that alternative interpretational possibilities exist. (Podvigina 2015)

These traits of multistable perception also characterize my experience of anatomic dysphoria:

  1. Exclusivity: conflicting interpretations of my physical appearance seem to alternate but are never simultaneously present. I have been unable to achieve any consistent “average” interpretation of my physical features. My androgyny seems to be its own form of ambiguous image: androgynous ambiguity is consistent with two mutually exclusive interpretations – male and female – leading to multistable perception in my mind.
  2. Inevitability: these alternations in perception are initiated spontaneously. I cannot prevent them from happening whenever I see my body or my mirror image. I have limited voluntary control over which perception is dominant at any point in time.
  3. Randomness: the rate of alternation between conflicting perceptions of my physical appearance seems to be unpredictable and variable, which makes the experience confusing and unsettling.
  4. Dependence on awareness: perceptual reversals are very rare or even absent when observers do not know that alternative interpretational possibilities exist. I am constantly aware of multiple interpretations of my own appearance, so this trait is more obvious when I consider other people’s perceptions of my appearance. In situations where other people initially assume that I am either male or female, perceptual reversals occur only when the situational context later indicates that their interpretation of my sex may be inaccurate. The best example of this is when I’m standing alone in a public womens’ washroom. When women enter the washroom and first see me, their facial expression often indicates surprise (and sometimes alarm) because they interpret my appearance as male. Occasionally they ask me if I’m in the right washroom, but more often they step outside the washroom, check the sign on the door, and then, having confirmed that they are in a space designated for females only, they re-enter the washroom and re-evaluate my appearance. Now that they are aware of an alternative interpretation of my appearance, their facial expression shifts towards relief and acceptance as their mind realigns my features in a pattern recognizable as female. The Women’s Washroom Double-Take used to make me feel guilty for making someone else feel uncomfortable, but now generates more neutral interest as I observe their perceptual reversals in real-time.

“Ambiguous figures provide the experience of having one’s perceptual awareness switching between different options while at the same time remaining fully conscious that no physical stimulus change whatsoever underpins these vivid perceptual changes.” (Kleinschmidt 2012) This statement from an article reviewing the literature on multistable perception bears striking similarity to previous description of my own experience: “My appearance seems to change dramatically within the space of just a few minutes or hours… My image remains familiar and recognizable, but constantly different… I know with certainty that it is not physiologically or anatomically possible for any human body to change that much in such a short period of time. I know this. I remind myself of that over and over. Yet what I keep seeing with my own eyes, right there in front of me, incontrovertible visual evidence, is this shape-shifting mirror-ghost of a body that I cannot imagine I actually inhabit.”

Unlike many optical illusions which create illusory perceptions primarily due to deficits in the visual system, ambiguous images (a form of multistable stimuli) are unique in allowing neural activity related to subjective conscious perception to be distinguished from neural activity related to objective physical stimulus properties. (Eagleman 2001, Sterzer 2009, Schwartz 2012) Evidence from several lines of empirical neuroscience (including functional magnetic resonance imaging and transcranial magnetic stimulation in humans and non-human primates) suggests that continuous processes in the frontal and parietal cortex are involved in constantly re-evaluating interpretations of sensory input and initiating changes in subjective perception, which results in the rapid and spontaneous perceptual alternations characteristic of multistable perception. (Leopold 1999, Sterzer 2009) These processes occur unconsciously during normal vision (almost all visual stimuli contain some degree of ambiguity that is rapidly and accurately resolved by this processing). This re-evaluation of perception only becomes consciously apparent when ambiguities in visual stimuli are maximized. (Leopold 1999, Eagleman 2001, Sterzer 2009) Multistable perception thus appears to be one component of an adaptive global process that generates a unified and coherent interpretation of the world, even though the information available to interpret is often fragmentary, conflicting, or ambiguous. (Sterzer 2009, Schwartz 2012) Multistable perception represents a kind of “stable instability” in subjective interpretation. (Schwartz 2012) And it seems that physical androgyny represents a particularly ambiguous image that is difficult for many people – myself and others – to interpret coherently.

The experience of multistable perception shows considerable individual variability. The rate of perceptual fluctuation tends to be consistent for a given person but varies by as much as an order of magnitude from one person to the next. (Leopold 1999, Schwartz 2012, Kleinschmidt 2012) Individual variation in the rate of perceptual alternation is associated with genetic factors, differences in brain structure (particularly in parietal lobe regions), and personal attributes including intelligence, creativity, and even mood disorders. (Leopold 1999, Kleinschmidt 2012, Podvigina 2015) Not only are there large individual differences in perceptual switch rates, there are also individual differences in preference for one percept over another – the preferred (dominant) interpretation of an ambiguous image is observed for a longer duration than the non-dominant interpretation over a period of spontaneous perceptual alternation. (Podvigina 2015) Certainly my personal experience aligns with this data. From my conversations with others regarding My Wife and My Mother-in-Law, it seems that I experience a much faster rate of perceptual reversal than most people: for me the image fluctuates very rapidly between the young woman’s face and the old woman’s face, while others describe something similar to what my psychiatrist described where perceptual switches occur less frequently and are more dependant on deliberate effort. It also seems that I experience less pronounced perceptual dominance than most people: I usually see the old woman’s face on first glance but during subsequent perceptual alternation it doesn’t feel like either face represents a more stable observation, while others generally describe that the perception of the young woman’s face is heavily dominant. So I wonder: do my individual characteristics associated with more rapid perceptual alternation and less pronounced perceptual dominance in response to multistable visual stimuli also contribute to my rapid shifts in perception and my difficulty maintaining a consistent interpretation of my own mirror image?

I think the optical illusion analogy is very valuable to help explain my experience of physical dysphoria. I have now refined this optical illusion analogy to refer more specifically to multistable perception that arises in response to viewing ambiguous images (particularly ambiguous images involving human faces). This new framework supports discussions with other people on the topic of anatomic dysphoria, and also provides a more concrete scaffold for me to construct a better understanding of my own experience.

Al Seckel, formerly considered one of the world’s leading authorities on illusions, referred to optical illusions as an experience where “expectations are violated” (TED, 2004). On my journey through Genderland thus far, I have radically re-evaluated personal and cultural expectations that I previously took for granted. I have deliberately distanced myself from restrictive and oppressive societal gender stereotypes and expectations. But now, I think I need to challenge myself even further. Does this multistable perception of my mirror image indicate the presence of some problematic expectations that my ambiguous androgyny somehow violates? Is it possible for me to deconstruct this distressing optical illusion to create a more comfortable, more coherent, and more stable cognitive interpretation of my physical appearance?

 “As much as I’d like to believe there’s a truth beyond illusion, I’ve come to believe that there’s no truth beyond illusion. Because, between ‘reality’ on the one hand, and the point where the mind strikes reality, there’s a middle zone, a rainbow edge where beauty comes into being, where two very different surfaces mingle and blur to provide what life does not: and this is the space where all art exists, and all magic.”
– The Goldfinch (Donna Tartt, 2013)

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References

Eagleman DM. Visual illusions and neurobiology. 2001. Nature Reviews | Neuroscience 2(12):920-926.

Kleinschmidt A, Sterzer P, Rees G. Variability of perceptual multistability: from brain state to individual trait. 2012. Philosophical Transactions of the Royal Society B: Biological 367(1591): 988-1000.  

Leopold DA, Logothetis NK. Multistable phenomena: changing views in perception. 1999. Trends in Cognitive Sciences 3(7):254-264. 

 Podvigina DN, Chernigovskaya TV. Top-down influences to multistable perception: evidence from temporal dynamics. 2015. International Scholarly and Scientific Research & Innovation 9(11):3849-3852.

 Schwartz J, Grimault N, Hupe J, et al. Multistability in perception: binding sensory modalities, an overview. 2012. Philosophical Transactions of the Royal Society B: Biological 367(1591):896-905. 

Sterzer P, Kleinschmidt A, Rees G. The neural bases of multistable perception. 2009. Trends in Cognitive Sciences 13(7):310-318.

“Gender Identity” Needs To Disappear

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Box Man (1)

I have spent much of the past two years researching gender dysphoria and exploring what it means to be transgender. This process has often been frustrating and confusing, as I have had considerable difficulty reconciling my intense physical dysphoria related to the female aspects of my body with the absence of any internal sense of “gender identity”. But after this prolonged immersion in the online trans community, in-depth review of the scientific literature on trans issues, and personal experience with transgender support groups and mental health professionals, the most prominent source of my chronic confusion has become apparent.

The “gender identity” concept, typical transgender narratives, and the criteria for diagnosis of gender dysphoria all depend on gender stereotypes – stereotypes which are increasingly irrelevant in modern society and which research overwhelmingly suggests are cultural constructs with limited biological underpinning. “One of the first steps to liberating people from the cage that is gender is to challenge established gender norms.” (Reilly-Cooper 2016) I think the dependance of “gender identity” discourse, trans narratives, and gender dysphoria diagnostic criteria on these gender norms actually serves to reinforce outdated and restrictive stereotypes rather than dismantle or challenge those stereotypes.

Much of this post will directly quote statements made by other authors in scientific review papers or online articles (bold indicates my own added emphasis). My goal here is not to simply repeat what has already been so eloquently stated elsewhere. I refer readers to the sources referenced at the bottom of this post for more thorough discussion of various related issues.

Instead, I wish to organize these statements within a coherent framework. This framework demonstrates a troubling and self-reinforcing cycle: the concept of “gender identity” relies on problematic gender stereotypes, the typical trans narrative relies on “gender identity” as an explanation and justification for choices regarding transition, and the diagnostic criteria for gender dysphoria use conventional gender norms as the frame of reference for assessment and diagnosis. In a clinical context, trans people are thus motivated to present their experiences in a way that aligns with opposite-gender norms to facilitate diagnosis of gender dysphoria and gain access transition options. But aligning themselves with cross-gender stereotypes necessarily (and paradoxically) requires acknowledgment of the restrictive and oppressive nature of those stereotypes which are associated so strongly (but unjustifiably) with biological sex. To counter this contradiction, trans people then invoke the concept of a discrete and inborn “gender identity” to assert the legitimacy of their experience.

(Note: This is a lengthy post with dense content. However, my conclusions are carefully derived from in-depth analysis of the concepts and research outlined throughout this post, so I encourage readers to work their way through my arguments slowly and sequentially to fully understand my final conclusions).

(1) “Gender Identity” Concept

“Gender identity is a highly problematic concept.” (Hird 2003)

Typical trans narratives strongly emphasize behaviors and preferences that align with cross-gender stereotypes as evidence of an intrinsic “gender identity”, based on a faulty assumption that there are inherent qualitative differences between men and women to support the existence of those stereotypes in the first place. The conceptualization of “gender identity” as an innate internal property is the “crucial tension at the heart of gender identity politics”. (Reilly-Cooper 2016)

“In this research, ‘gender identity’ is characterized as a sense of oneself as male, female, or indeterminate, whereas ‘gender role’ is characterized as behaviors, personality traits, and interests that society applies to these aspects, and the way that people are measured against stereotypical attributes.” (Davy 2015) But is it really possible to separate “gender identity” from those “stereotypical attributes” that constitute “gender role”? To what extent do those “stereotypical attributes”, and the values and judgments that society assigns to those attributes, contribute to the development of “gender identity”?

I think “gender identity” is best understood as a constructed cognitive self-perception arising from internalized cultural gender stereotypes. “Gender variance may be conceptualized, as gender variant people apparently already do, as a multidimensional or sometimes idiosyncratically conceptualized, multicategorical construct.” (Cohen-Kettenis 2009) “It is clear from feminist research that behaviors are not intrinsically masculine or feminine, but change through time and in different spaces… Gender constructionist research suggests that biological imperatives are few in the human, and consist only of procreative imperatives. Other behavioral aspects such as sartorial preference, aggression, empathy, and intelligence, among a number of other characteristics, are not sex specific and are often adaptable… recent research situates behavioral sex differences firmly within a social role model… This unresolved debate weakens any possibility of arguing that there is something inherent in masculine and feminine behaviors. (Trans) people have never been subjects of an independent masculine or feminine type, and combinations of what is deemed masculine or feminine at any one time can be found within all humans, albeit performed with different intensities.” (Davy 2015)

Indeed, research regarding the development of identity during childhood consistently describes “gender identity” as an aspect of self-perception that develops and evolves over time in response to many internal and external factors. Factors contributing to the construction of gender identity include genetics, hormones, socialization, and progressive cognitive understanding of gender. (Hines 2011, Reiner 2011) “Gender development is multidimensional, and developmental processes involved in each dimension are likely to differ.” (Hines 2011) Gender identity is an “evolving sense of self as one sex or the other.” (Reiner 2011) Evidence suggesting that “gender identity” develops and changes over time in response to many different factors directly contradicts the commonly held belief that “gender identity” is an innate and immutable property. The low rate of persistence of childhood gender dysphoria into adolescence also contradicts the idea that “gender identity” is an inborn and unchanging entity.

“Gender identity is woven pervasively throughout identity.” (Reiner 2011) It is also clear that “gender identity” is simply one of many facets of identity which develop over time. Therefore, “gender identity” cannot be regarded as something discrete and separate from overall identity, and “gender identity” cannot be regarded as immune to the internal and external factors contributing to the ongoing development of overall identity.

“The precise mechanisms of gender identity development are complex, the interactions of the mechanisms poorly understood, and the outcomes not entirely clear, except that children and adolescents nearly always dichotomize.” (Reiner 2011) This tendency to dichotomize “gender identity” reflects persistent societal adherence to opposing gender stereotypes. Gendered socialization and the influence of this socialization on cognitive understanding of gender are major factors contributing to the development of “gender identity”. “Socialization factors also gain in importance, as parents and then peers and eventually teachers encourage children to engage in gender-typed play. The child also begins to develop the understanding that he or she is male or female, and this knowledge produces motivation to imitate the behavior of others of the same sex.” (Hines 2011) As described above, this gendered socialization occurs despite the overwhelming evidence demonstrating that gender stereotypes have limited biological underpinning and that behaviors, preferences, personality traits, and cognitive functioning are not sex-specific attributes. (Hines 2011, Davy 2015) It is well established that societal gender stereotypes vary widely across different cultures and across different historical time periods (Hird 2003). This argues against any innate human “gender identity” giving rise to subsequent behaviors and preferences stereotypically associated with biological sex. Rather, it supports the idea that socially constructed gender norms give rise to individual “gender identity”.

I think the biggest weakness of the “gender identity” concept is that it is promoted as being real, immutable, and innate (endogenous) yet it remains so vague and poorly defined by those who claim to experience it. “The [trans] advocates’ websites rarely offer any indication of what feeling like a man or a woman is like.” (Davy 2015) Attempts to describe what “feeling like a man” or “feeling like a woman” means invariably fall back on conventional societal (exogenous) masculine or feminine stereotypes. This creates a frustratingly circular logic: “gender identity” is a property that is supposedly experienced internally (and therefore cannot be denied by an external perspective) but which cannot be defined in any way separate from externally imposed gender norms.

This has been extremely perplexing for me. This is why I have tried very hard to describe my experience of gender dysphoria in a concrete and clearly defined way that does not depend on reference to an internal “gender identity”. My previous blog posts (here, here, and here) have recounted the distressing thoughts and emotions that arise in response to seeing or touching the female secondary sexual characteristics of my body. This is the only way I can explain my experience without resorting to dichotomous gender stereotypes.

I do not know WHY my female anatomy generates such intense distress for me. I only know that it DOES. It would certainly be convenient to say that my physical dysphoria is secondary to a mismatch between my anatomy and my “gender identity”. But I fail to understand the concept of “gender identity” and I refuse to align my personal preferences and behaviors and interests with problematic and oppressive gender stereotypes for the sake of convenience. My female body (and the irrational but undeniable distress arising from my perception of it) and my human personality (my preferences, behaviors, and interests) are two separate things. “Gender is the value system that ties desirable (and sometimes undesirable?) behaviours and characteristics to reproductive function. Once we’ve decoupled those behaviours and characteristics from reproductive function – which we should – and once we’ve rejected the idea that there are just two types of personality and that one is superior to the other – which we should – what can it possibly mean to continue to call this stuff ‘gender’? What meaning does the word ‘gender’ have here, that the word ‘personality’ cannot capture?” (Reilly-Cooper 2016)

Some might argue that my claiming an absence of “gender identity” merely represents an “agender” or “non-binary” identity along a “gender spectrum”. But those terms are simply variations on the original “gender identity” concept, and therefore remain inapplicable. Rebecca Reilly-Cooper presents an excellent series of arguments explaining why the conceptualization of gender as a spectrum is not really any more progressive or inclusive than a gender binary with two opposite poles. Rather, the concept of gender as a spectrum is illogical. I encourage readers to review her essay in full but will summarize her conclusions here: “If gender identity is a spectrum, then we are all non-binary, because none of us inhabits the points represented by the ends of that spectrum… Once we recognize that the number of gender identities is potentially infinite, we are forced to concede that nobody is deep down cisgender, because nobody is assigned the correct gender… at birth. In fact, none of us was assigned a gender… at birth at all. We were placed into one of two sex classes on the basis of our potential reproductive function, determined by our external genitals. We were then raised in accordance with the socially prescribed gender norms for people of that sex. We are all educated and inculcated into one of two roles, long before we are able to express our beliefs about our innate gender identity, or to determine for ourselves the precise point at which we fall on the gender continuum. So defining transgender people as those who at birth were not assigned the correct place on the gender spectrum has the implication that every single one of us is transgender; there are no cisgender people. The logical conclusion of all this is: if gender is a spectrum, not a binary, then everyone is trans. Or alternatively, there are no trans people. Either way, this a profoundly unsatisfactory conclusion, and one that serves both to obscure the reality of female oppression, as well as to erase and invalidate the experiences of transsexual people. The way to avoid this conclusion is to realize that gender is not a spectrum. It’s not a spectrum, because it’s not an innate, internal essence or property. Gender is not a fact about persons that we must take as fixed and essential, and then build our social institutions around that fact. Gender is socially constructed all the way through, an externally imposed hierarchy, with two classes, occupying two value positions: male over female, man over woman, masculinity over femininity.” (Reilly-Cooper 2016)

(2) Typical Transgender Narratives

As a highly pathologized, stigmatized, and marginalized community, trans people are placed in a very difficult position with respect to how they describe their experience. In a clinical context, trans people must present their narrative in a way that meets the established diagnostic criteria for gender dysphoria (criteria which are based on “cross-gender identification” and evidence of behaviors and preferences stereotypically associated with the “other sex”) in order to gain access to transition therapies. In a public context, trans people must present their stories in a way that is understandable to society at large, in order to promote awareness and acceptance. Because gender stereotypes are so deeply woven into the fabric of our society, describing trans experiences in terms of strong preferences for opposite-sex stereotypes arising from an innate “gender identity” allows a publicly palatable and understandable (albeit oversimplified and problematic) narrative to emerge from within an already well-established gender framework.

“Research has suggested that adult transpeople often think that if they do not express stereotypical masculinities and femininities… they will not fit the model that may steer them to the transitioning healthcare pathways… many transpeople are reluctant to relay anything to gender clinic psychiatrists that might be viewed as different from the perceived “correct” trans narrative. In previous research, I have demonstrated that transpeople tend to tailor their clinical narratives because they realize that psychiatrists have the power to stop their transitioning process… transpeople retrospectively claim to have participated in stereotypically gendered play and behaviors when they have sought transitioning technologies, and have often interspersed expected gender inflections into their clinical narratives… These inflections seem inevitable because the diagnostic criteria expect cross-gendered play and behaviors to be performed prior to the granting of transitioning technologies…  the clinically expected expressions of gender do not correspond well to gender role play or leisure pursuits apparent in contemporary society.” (Davy 2015)

The typical or “correct” trans narrative seems to include these main elements: strong retrospective emphasis on the early onset of gender dysphoric feelings in childhood which persisted into adolescence and adulthood, gender dysphoric feelings arising primarily from discomfort with societal gender stereotypes, assertion of a supposedly intrinsic and fixed “gender identity”, and physical dysphoria portrayed as a secondary consequence of a primary mismatch between the brain’s “gender identity” and the body’s “assigned sex”. To put it more simply, the typical trans narrative says: from a young age my personality and preferences did not align with conventional binary gender roles and gender stereotypes, therefore I must have a cross-gender or non-binary “gender identity”, therefore I must be transgender, therefore I am trapped in the wrong body, therefore my body needs to be changed to align with my “gender identity”. “Transpeople have often defined their trans gender identities through a ‘‘wrong body’’ narrative.” (Davy 2015)

Typical trans narratives not only emphasize the concept of an innate “gender identity”, they also imply that this cross-sex “gender identity” is the result of pre-natal biological factors. “Trans advocates’ essentialist claims of gender dysphoria seem to assume that society will be more accepting of transpeople if they are understood to have been ‘‘born this way”… [due to] the relative power that biogenetic discourses maintain in society and particularly in medicine.” (Davy 2015) The etiology of gender dysphoria is not clearly understood, but one of the most common theories is that exposure to altered levels of sex hormones during fetal development leads to “sex-atypical cerebral programming that diverges from the sexual differentiation of the rest of the body”. (Hoekzema 2015) However, “no evidence thus far has linked normal variability in the early hormone environment to gender dysphoria.” (Hines 2011) Additionally, people with disorders of sexual development (intersex conditions) that do cause abnormal exposure to sex hormones in utero overwhelmingly maintain a “gender identity” that aligns with the sex they were assigned at birth, rather than with the sex that their pre-natal hormone exposure more closely mimics (Hines 2011, Reiner 2011). “The majority of intersex people identified their gender as their sex assigned at birth.” (Reiner 2011) For example, female fetuses (XX chromosomes) with congenital adrenal hyperplasia have a genetic defect in adrenal enzyme pathways that leads to accumulation of androgens (such as testosterone) in the fetus’ body and causes pre-natal virilization of the female genitals. These infants are assigned female at birth. Despite high levels of pre-natal androgen exposure and masculinized genitalia, 97% of women with CAH identity as female from childhood into adulthood (Hines 2011). Male fetuses (XY chromosomes) with androgen insensitivity syndrome have normal testes and normal androgen production but lack androgen receptor molecules, which means that testosterone produced by the testes has no effect on the developing fetus. Androgen insensitivity impairs the masculinization of male genitalia in the developing fetus and the development of male secondary sexual characteristics during puberty. These XY individuals are often raised as females (particularly in cases of complete androgen insensitivity) and maintain a female “gender identity” despite having a male chromosomal configuration. (Reiner 2011) These examples provides strong evidence that “gender identity” is influenced more strongly by socialization and external gender expectations than internal biological factors like sex hormone exposure or sex chromosomes.

The typical trans narrative centers around a supposedly innate “gender identity” as an explanation for their discomfort in the body and the social role associated with their biological sex and as justification for their choices regarding transition. But as I outlined above, the concept of “gender identity” as a fixed internal property has no logical or scientific basis and relies entirely on an external frame of reference (societal gender stereotypes). “Trans advocates’ essentialist claims of gender dysphoria… and the desire to transition to a particular gender tend to mirror the simplistic dualisms from biological research, in which masculinity and femininity are regarded as natural, rather than socially constructed, characteristics.” (Davy 2015) So the emphasis on, and continued perpetuation of, the “gender identity” concept by trans advocates only serves to reinforce outdated and oppressive stereotypes.

(3) Gender Dysphoria Diagnostic Criteria

“Gender dysphoria is not always a straightforward diagnosis. This can be ascribed to the fact that international classifications are quite general and have significant short-comings, there are no objective criteria, and gender dysphoria can present in a great diversity of forms, situations, and experiences.” (Fabris 2015)

Most of the medical and psychological research regarding gender dysphoria has been based on diagnostic criteria in the American Diagnostic and Statistical Manual of Mental Disorders (DSM). I have focused on articles published since 2000, which usually refer to the diagnostic criteria for gender identity disorders in the DSM-IV and DSM-IV-TR (published in 1994 and 2000, respectively) or the criteria for gender dysphoria in the DSM-5 (published in 2013). However, some recent studies still refer to the criteria for gender identity disorders in the WHO International Statistical Classification of Diseases, the ICD-10 (published in 1993).

With respect to the DSM criteria, there is a glaring lack of validity studies or evidence supporting inter-rater reliability in the diagnostic process (Cohen-Kettenis 2009). It has been suggested that validity of the DSM diagnostic criteria can be inferred from studies evaluating sex reassignment as a treatment procedure. “Sex reassignments based on DSM diagnoses primarily resulted in satisfying results, in terms of alleviating the discomfort about one’s sex or the ‘gender dysphoria.’ Although diagnosis and response to sex reassignment are not very closely connected, and the reported findings are certainly no ‘‘proof’’ of the correctness of the diagnosis, they suggest that the elements of the DSM diagnosis are clinically useful.” (Cohen-Kettenis 2009) However, in the studies referenced by that statement, most of the subjects underwent “complete” sex reassignment. So the inferred clinical utility of DSM criteria may only apply to those who desire all aspects of sex reassignment, which is not representative of the transition goals of all trans people. “Indeed, clinicians in gender identity clinics are increasingly confronted with treatment goals other than complete sex reassignment.” (Cohen-Kettenis 2009) So the utility of the existing diagnostic criteria is, at best, limited to a subpopulation of the diverse transgender community.

One of the primary criticisms regarding the diagnostic criteria for gender identity disorder in the DSM-IV and DSM-IV-TR was the inability of the criteria to reflect the diversity of gender variance. “A problem with the current criteria is that gender identity, gender role, and gender problems are conceptualized dichotomously rather than dimensionally. For instance, the DSM-IV text states that adults with gender identity disorder are preoccupied with their wish to live as a member of the other sex, manifested as an intense desire to adopt the role of the other sex or to acquire the physical appearance of the other sex through hormonal or surgical manipulation. Within the gender identity disorder criteria, a concept such as ‘‘cross-gender identification’’ also assumes that there are only two gender identity categories, male and female.” (Cohen-Kettenis 2009) I have previously discussed my frustration that even supposedly dimensional (rather than dichotomous) scales used to measure the intensity of gender dysphoria (such as the GIDYQ-AA) leave little room for non-binary responses, and interpretation of the questions on the survey relies heavily on the reader’s alignment with stereotypical roles behaviors associated with men and women.

Prior to publishing the updated version of the DSM (DSM-5) in 2013, a workgroup was developed to revise the gender identity disorder criteria. One of the biggest revisions was a change in diagnostic terminology from gender identity disorder to gender dysphoria, to emphasize the distress associated with gender variance as being a form of psychopathology rather than gender non-conformity being considered pathological in and of itself. The goal of the workgroup was to revise the criteria in a way that would help destigmatize trans people while maintaining a diagnostic category that medical insurance companies would accept to provide financial support for transition treatments. (Davy 2015)

However, despite those revisions, the current DSM-5 criteria for gender dysphoria remain problematic. “The diagnostic framework in the DSM-5 for all transpeople continues to be underpinned by essentialist, heteronormative assumptions that situate binary sexes – male and female – with corresponding genitalia as the anchor from which gender dysphoria is judged… I would argue that the criteria proposed by the DSM-5 are derived from stereotypes applied in the gender identity clinics serving transpeople, rather than empirically developed from biological imperatives.” (Davy 2015)

Particularly disturbing is the fact that the research and clinical experience taken into account in revising the DSM-5 diagnostic criteria was based heavily on trans peoples’ clinical narratives, which (as I described above) are often tailored with added gender inflections to align more closely with the previously established criteria in order to gain access to transition options. “The DSM-5 Workgroup has disregarded the plethora of work in feminist social science which criticizes the inherency of gender roles, gender identities, and sex differences, as well as research in transgender studies that depicts non-dysphoric transpeople, desires for different embodiments, non-conventional transitioning trajectories, and sexualities. In the pre-publication reports, the Workgroup considered only the views and evidence derived from sexological research. As such, the review reflects a form of expert clinical consensus based on transpeople’s tailored narratives and questionable ideas around masculinity and femininity.” (Davy 2015)

Such a narrow-minded approach to developing diagnostic criteria based on increasingly irrelevant and biologically unjustified gender stereotypes creates a self-perpetuating cycle: trans people present their experiences in ways that align with the criteria, and the criteria are then perceived as being reinforced and validated by their alignment with trans people’s narratives. “The criteria used to diagnose gender dysphoria help psychiatrists to determine whether someone is experiencing distress about incongruence with their experienced gender through a gender normative frame… Arguably, this leads to the situation where transpeople must express incongruent behavior and demonstrate to the psychiatrist that they have most often preferred activities that are traditionally gendered and opposite to those gender norms applied to their assigned sex at birth. Within the DSM-5, these traditional gendered expressions seem to be required in spite of the lack of stark behavioral differences between the genders in Western societies today.” (Davy 2015)

And the ongoing emphasis on “gender identity” as part of the typical trans narrative and as a core diagnostic criterion further reinforces restrictive societal stereotypes. “[Most gender clinic psychiatrists] adhere to gender identity as both ‘‘real’’ and fixed. This adherence then facilitates the continued use of highly stereotyped notions of gender to provide the framework for assessing and treating transsex individuals.” (Hird 2003)

Neither the diagnostic framework nor the professionals involved in the diagnostic process seem to recognize these problems. “Most of the clinicians seemed to take the view that individual solutions are to be sought rather than societal change – there was little suggestion that society requires any change… the clinician’s job is not to reinforce gender boundaries defined by society.” (Hird 2003)

(4) Transition as Self-Determination

I have outlined the major issues regarding the concept of “gender identity”, typical transgender narratives, and the criteria for diagnosis of gender dysphoria. I have expressed my concern that the continued dependence of “gender identity”, trans narratives, and diagnostic criteria on traditional gender norms serves to reinforce restrictive and damaging stereotypes.

My conclusion is that an inborn, immutable, intrinsic “gender identity” DOES NOT EXIST. “Gender identity” is a cognitive aspect of self-perception constructed from internalized societal gender stereotypes. The idea of an innate “gender identity” is a crutch that trans people are forced to use to legitimize their experience in the face of a society that revolves around these oppressive gender stereotypes and a psychiatric establishment that retains these troublesome stereotypes as the frame of reference for assessment and access to transition options.

A self-determination and human rights model of trans identities views the “diagnostic use of stereotypical gendered expressions associated with boys/men and girls/women as erroneous, and that they have little to do with actual contemporary gender identity formations. Accordingly, any gendered expressions, regardless of which birth-assigned sex one is given, should not act as criteria for diagnosing transpeople.” (Davy 2015)

For those who argue that inclusion of gender variance under the umbrella of psychiatry is necessary to allow access to medical and legal transition options, I would point out that some countries have already set a precedent where this is not the case. “Psychiatric involvement in healthcare pathways and legal assistance for those people who want to have a different body and/or corrected legal gender assignment should not be a requirement. They have succeeded in securing this in France, Denmark, Argentina, and Malta. In these countries, transpeople are legally recognized and are given access to healthcare services despite psychiatry being removed as the gatekeeper, because of transpeople demanding healthcare and legal recognition through a self-determination model of gender variance.” (Davy 2015)

“The solution is not to reify gender by insisting on ever more gender categories that define the complexity of human personality in rigid and essentialist ways. The solution is to abolish gender altogether. We do not need gender. We would be better off without it. Gender as a hierarchy with two positions operates to naturalize and perpetuate the subordination of female people to male people, and constrains the development of individuals of both sexes… You do not need to have a deep, internal, essential experience of gender to be free to dress how you like, behave how you like, work how you like, love who you like… The solution to an oppressive system that puts people into pink and blue boxes is not to create more and more boxes that are any colour but blue or pink. The solution is to tear down the boxes altogether.” (Reilly-Cooper 2016)

“Gender identity” needs to disappear. “Transition” should be removed from a gender context and the term “transgender” should be rendered obsolete. Instead, the medical, legal, and social aspects involved in “transition” should be viewed – simply and respectfully – as a human right to self-determination. “Assuming an inner-self who desires such a transformation, gender transitions are thus situated in a non-essentialized experiential framework, anchored in self-determination.” (Davy 2015) People – ALL people, not just trans people – should be free to modify their physical attributes, adopt social roles, and pursue interests that align with their personal preferences and desires. We are all of us “transitioning” all the time, as we learn and grow and adapt to an ever-changing world. “Transition” (in a transgender context) is just one of many ways that people strive for self-expression that makes them feel comfortable. “Transition” (in a human context) is an ongoing process for each of us to create an authentic self in this vast ocean of human diversity.

“If there’s no meaning in it, that saves a world of trouble, you know, as we needn’t try to find any.”
– The King (Alice’s Adventures in Wonderland, 1865)

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References

Cohen-Kettenis PT, Pfafflin F. The DSM diagnostic criteria for gender identity disorder in adolescents and adults. 2010. Archives of Sexual Behavior 39(2): 499-513. 

Davy Z. The DSM-5 and the politics of diagnosing transpeople. 2015. Archives of Sexual Behavior 44(5): 1165-76. 

Fabris B, Bernardi S, Trombetta C. Cross-sex hormone therapy for gender dysphoria. 2015. Journal of Endocrinological Investigation 38(3): 269-82. 

Hines M. Gender development and the human brain. 2011. Annual Review of Neuroscience 34: 69-88. 

Hird MJ. A typical gender identity conference? Some disturbing reports from the therapeutic front lines. 2003. Feminism and Psychology, 13: 181–199. 

Hoekzema E, Schagen SE, Kreukels BPC, et al. Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. 2015. Psychoneuroendocrinology 55: 59-71. 

Reilly-Cooper R. Gender is not a spectrum. 2016. Aeon. Accessed online 2016-07-10. (Quotes in this post were extracted from the Aeon article. However, a similar essay also appears on the author’s personal blog More Radical With Age: “Gender is not a binary, it’s a spectrum: some problems”, January 2016).

Reiner WG, Townsend Reiner D. Thoughts on the nature of identity: disorders of sex development and gender identity. 2011. Child and Adolescent Psychiatric Clinics of North America 20(4): 627-38. 

Gender Dysphoria Diagnosis (Part 3): Childhood Gender Non-Conformity

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————
Part 1: GIDYQ-AA Personal Reflection
Part 2: Psychological Benefits of Diagnostic Confirmation 
~ Part 3 in the Gender Dysphoria Diagnosis series ~
Part 4: DSM and ICD Diagnostic Criteria 
Part 5: GIDYQ-AA Full Text
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Jantina Cow

That’s me. A child dressed in baggy boy’s clothes, peeking out from underneath shaggy bangs – hair longer than she wanted but parentally forbidden from getting it cut – playing with her heifer calf named John. A child who knew she was a girl but desperately wanted to be a boy instead.

In a previous post, I discussed my overwhelming doubts about whether or not I truly have gender dysphoria given how atypical my experience seems to be in comparison to the more commonly portrayed trans narratives and the established diagnostic criteria. My experience since puberty has been predominantly characterized by intense physical dysphoria regarding female body characteristics, in the absence of any cognitive gender identity. So I didn’t consider myself “transgender” and I didn’t even know that gender dysphoria (formerly called gender identity disorder) was an established phenomenon or that transition options existed until two years ago – I just thought I had a very unusual and very severe body image disturbance. I have also previously described the powerful relief and peace I felt after having the gender dysphoria diagnosis confirmed by a specialist.

But despite the relief, acceptance, and confidence that followed after receiving expert confirmation of gender dysphoria, I found that after a couple of months those familiar doubts started creeping back in. Contributing to this resurgence of doubt was my ongoing difficulty understanding the significance of my childhood gender experience with respect to my current adult gender experience. Throughout my exploration of the trans community and investigation of transition options over the past two years, I have never been sure to what extent my obvious childhood gender non-conformity (obvious in memory and in family photos) and my distinct childhood desire to be a boy would necessarily add support to an adulthood diagnosis of gender dysphoria. I kept asking myself: how relevant is my childhood gender non-conformity?

Jantina Dress

That’s me too. A child posing awkwardly in a dress, a child forced into that dress by her rigidly insistent mother, a child hating that dress with a feisty little rage because dresses are impractical and frivolous garments, a girl who wanted to be a boy and resented being forced into a conventional girl’s uniform, but pulling off an admirably convincing smile to please her father holding the camera.

Typical trans narratives on personal blogs and from high-profile trans advocates usually emphasize that they “knew” they were the “opposite” gender since they were extremely young.

“As a child I knew everyone was telling me that I was a boy but I felt like a girl.” – Laverne Cox 

“Ever since I could form coherent thoughts, I knew I was a girl trapped inside a boy’s body. There was never any confusion in my mind.” – Jazz Jennings

“For me, I tend to refer to my childhood as one of a transgender child. When I was four and began asserting myself as the girl I knew myself to be… all I knew was that my internal sense of gender, what spoke to my soul, did not align with my body. But my prepubescent body had not grown into this battle I had to fight against.” – Janet Mock

“As far back as four or five I felt like a boy and wished I was a boy.” – Chaz Bono

“My earliest memories were that of wanting to be a girl even before I learned to spell.” – Jade Starr

Most trans people seem to interpret early childhood behaviors and preferences that align with opposite-sex stereotypes as incontrovertible evidence of their gender dysphoria. But research suggests that childhood gender non-conformity is relatively common. “Surveys report that 2-5% of children aged up to seven, as reported by their parents, ‘behaves like opposite sex’ and 1-2% ‘wishes to be of opposite sex.'” (Kaltiala-Heino 2015) And among these gender non-conforming children, only a small minority (ranging from 2-37% in various studies) will retain gender dysphoric feelings into adolescence (Kaltiala-Heino 2015, Smith 2014, Steensma 2013, Wallien 2008). “The evolution of a gender nonconforming child is unpredictable, and it is therefore impossible to determine whether the condition will persist into adolescence or adulthood.” (Meriggiola 2015)

And of course, assessment of whether a child’s behavior is “gender non-conforming” is based on a troubling frame of reference: cultural gender stereotypes and the sexist attitudes associated with deviation from those stereotypes. “Cultural issues likely play a major role in whether a child’s behavior is perceived as gender atypical. Consultations due to gender identity are generally more often sought for boys than girls, which may suggest greater gender variation in boys, but also that effeminate behaviors in boys are perceived as more of a problem than tom-boyishness in girls… that natal boys were more commonly bullied because of gender presentation suggests that effeminate characteristics in boys are less tolerated than masculine self-presentation in girls.” (Kaltiala-Heino 2015)

Research also shows that childhood gender non-conformity is more often associated with adolescent and adult non-heterosexual sexual orientations than with gender dysphoria and transgender identity. “Another issue regarding the psychosexual outcome of children with gender identity disorder is the relation between the child’s gender atypicality and sexual orientation in adulthood. Early prospective follow-up studies indicated that a high rate (60-100%) of children (mostly boys) with gender dysphoria had a homosexual or bisexual sexual orientation in adolescence or adulthood and no longer experienced gender-dysphoric feelings… in accordance with retrospective studies among adult homosexuals, who recalled more childhood cross-gender behavior than heterosexuals. Adult individuals with childhood gender dysphoria are thus much more likely to have a nonheterosexual sexual orientation than a heterosexual sexual orientation.” (Wallien 2008)

In light of that information, I have always been uncomfortable with the strong emphasis that many trans people place on their childhood gender non-conformity. It left me feeling very unsure about how to integrate my own childhood experience into my current perspective regarding a diagnosis of gender dysphoria. And their emphasis also makes me deeply uncomfortable because it perpetuates the idea to the general public (who likely don’t know the statistics regarding low rates of persistence of childhood gender dysphoria into adolescence but who seem to have an exaggerated perception of the association between childhood gender non-conformity and future homosexuality) that childhood cross-sex behavior means their kid is trans or gay. These ideas potentially lead to inappropriate suppression of that behavior by the parents (if parents are homophobic or transphobic and believe they can prevent their kid “becoming” trans or gay). “There is evidence that some clinicians and parents have offered or requested treatment for children with gender identity disorder, in part, to prevent the development of homosexuality.” (Davy 2015) Or these ideas may lead to premature medical or psychological intervention (if parents are supportive of their child’s cross-gender interests but perhaps somewhat misguided and overenthusiastic in pursuing early transition). And clinical experience suggests that it is often the parents’ concern about their child’s gender non-conformity that leads to psychological assessment, rather than the child’s own distress about their gender non-conformity. “Parents of children with gender identity disorder are often ‘unable to cope’ with gender uncertainty… parents most often bring their children to clinical attention… in these cases, it is the parents whose children do not adhere to normative expectations of gender performance who experience ‘distress’.” (Hird 2003) I felt so confused and conflicted about all of this, and I have therefore intentionally avoided discussing my childhood gender experience in any great detail on my blog until now.

Laverne Cox has spoken out about the psychological advantages of puberty suppression in adolescents with gender dysphoria, a procedure which scientific evidence strongly supports as having substantial therapeutic benefit and which allows for more satisfying physical transition outcomes (Smith 2014, Kaltiala-Heino 2015, Meriggiola 2015). But Laverne Cox also promotes transitioning in early childhood, “With transition, the earlier the better. I think if your child knows that they are transgender – and we usually know – then it is life-saving.” I think that is an extremely irresponsible statement for an influential transgender advocate to make, given the existing evidence about the unpredictable psychosexual outcomes in gender non-conforming children.“Medical interventions are not warranted in pre-pubertal children.” (Kaltiala-Heino 2015) Research about the management of gender dysphoria in children recommends a supportive but cautious monitoring approach, with further assessment and consideration of puberty suppression if gender dysphoria does in fact persist past the onset of puberty. “The percentage of transitioned children is increasing and seems to exceed the percentages known from prior literature for the persistence of gender dysphoria, which could result in a larger proportion of children who have to change back to their original gender role, because of desisting gender dysphoria, accompanied with a possible struggle… the clinical management of children with gender dysphoria in general should not be aimed to block gender-variant behaviors.” (Steensma 2013)

To summarize the results of numerous studies: childhood gender dysphoria seems to be associated with an increased likelihood of future homosexual or bisexual orientation, and childhood gender dysphoria may or may not (and usually does not) persist into adolescence. “In clinical practice, gender-dysphoric children and their parents should be made aware of [these outcomes] and, if this would create problems, be adequately counseled.” (Wallien 2008) But of course, childhood “gender non-conformity” may simply represent the beautiful freedom and remarkable creativity inherent in children’s innocent pastimes viewed through an adult lens of social gender stereotypes. Childhood “gender non-conforming” behavior may also be a vital process in the development of their individual identity, not something that requires any parental intervention whatsoever. Let them be kids. Let them figure out for themselves who they are. “It is with seasoned modesty that we emphasize, to different degrees, the changeability of children during growth and development… what children desire of themselves as children is rarely what satisfies them as adults.” (Reiner 2011)

Revisiting the scientific literature on these topics has also had substantial personal relevance, allowing me to reframe my own childhood and adolescent experiences in a way that gives me more confidence in a current diagnosis of gender dysphoria and gives me a deeper understanding of assorted fragments of my increasingly coalescent story.

Knowledge of the factors associated with persistence versus desistance of childhood gender dysphoria into adolescence is limited (Steensma 2013). However, from this limited research, it has been demonstrated repeatedly that one of the most important factors associated with higher rates of persistence of gender dysphoria from childhood into adolescence is the intensity of childhood gender non-conformity or cross-sex identification. “Presentation [of gender dysphoria] is heterogeneous in childhood, with some children exhibiting extreme gender non-conforming behaviors accompanied by severe discomfort and other children showing less intense characteristics. Not all adolescents with gender dysphoria experience symptoms in early childhood, but those who do often present with more extreme gender non-conformity.” (Smith 2014) “Taken together, the prior research suggests that persistence of childhood gender dysphoria is most closely linked to the intensity of the gender dysphoria in childhood and the amount of gender-variant behavior.” (Steensma 2013) My childhood gender non-conformity WAS extremely intense, with a very strong and persistent desire to “be a boy” (in the context of a childish understanding of gender and a naive perception of masculine and feminine stereotypes) and drastic efforts (within a child’s limited scope of control) to create a boyish physical appearance through choice of clothing and hairstyle. The above research lends major relevance to the intensity of my childhood gender dysphoria, rather than the mere presence of it. Which adds diagnostic value to that aspect of my own story, and also allows me to understand the significance of my childhood experience without perpetuating the troublesome misconceptions about childhood gender non-conformity that I described above.

In terms of persistence of childhood gender dysphoria into adolescence, I now understand the significance of my own response to the physical changes accompanying puberty. “Gender dysphoria which intensifies with the onset of puberty usually persists… At puberty, the development of secondary sexual characteristics can lead to increased distress, sometimes leading to severe extremes such as depression, anxiety, self-harm, suicidal tendencies, substance abuse, and high-risk sexual behaviour. Reactions to early pubertal changes have a high diagnostic value.” (Meriggiola 2015) Several other studies also reinforce the “high diagnostic value” of teenagers’ response to development of secondary sexual characteristics in early puberty (Smith 2014, Steensma 2013, Wallien 2008). In contrast to cognitive gender identity (which I suppose I would have described as “wishing to be a boy” when I was a child, but which seemed to fade away at the onset of puberty), my physical dysphoria increased dramatically in response to early pubertal changes. I was so intensely distressed by my budding breasts and broadening hips and my first few periods, that I immediately initiated a regime of strict dietary restriction and excessive exercise to starve away all traces of physical femaleness. These behaviors quickly progressed to full-blown anorexia nervosa, which persisted for the next six years. In retrospect, this experience now has high diagnostic value and is strongly consistent with gender dysphoria.

Not only do reactions to early pubertal changes have “high diagnostic value”, there is also diagnostic value associated with the response to puberty suppression. “Treatment with a GnRH analog [puberty suppression] is thought to be a diagnostic aid as well as a therapeutic intervention for this age group because stopping the progression of the physical changes of puberty would be expected to partially alleviate gender dysphoria symptoms in true gender dysphoria. The first prospective study of psychological outcomes in adolescents… showed a statistically significant improvement in behavior, emotional problems, and general functioning after puberty suppression.” (Smith 2014) I experienced intensified body aversion at the onset of puberty, but through extreme and prolonged starvation I basically created my own puberty suppression protocol (which ideally should have been achieved with appropriate drugs under medical supervision but I wasn’t aware of those options at the time so I did what I could on my own to suppress my confusing physical dysphoria). Anorexia virtually halted further pubertal development: the drastic weight loss induced amenorrhea which lasted from age 13 to 19 and prevented any further increase in chest and hip size, so that I floated through my teenage years in a rail-thin, nearly pre-pubescent, and highly androgynous body. During those years, my eating disorder was its own source of distress (food-related thoughts were incessant and abnormal eating behaviors were pronounced). But that all seemed such a small price to pay to achieve a tenuous and provisional satisfaction and comfort with a less feminine body, a “partial alleviation of gender dysphoria” secondary to “stopping the progression of the physical changes of puberty”. Which aligns precisely with the description in the above study. Once again, this evidence provides very definitive support for a true diagnosis of gender dysphoria in my case.

When I was 19, I experienced my first episode of major depression and I gained nearly 100lbs over a nine-month span. Menstruation resumed, acne worsened, my chest and hips increased in size, and my body basically went through normal puberty after a six-year starvation-induced delay. Following the weight gain and further pubertal development at 19 years old, my body became more feminine and my physical dysphoria escalated to a previously unprecedented intensity, to the point that I could no longer tolerate the sight of myself and began avoiding mirrors and showering in the dark. Moving uncomfortably through the next five years in a much heavier and more feminized body, I would often reflect on my androgynous teenage thinness with an excruciating sense of loss tainting all of those fond memories, a desperate feeling of hopelessness of ever regaining such a genderless and comfortable body. Only in the past year, after having lost some of the weight that I gained six years ago and developing a much more rigorous weightlifting routine to increase my upper body muscle mass, have I been able to create a more satisfying and comfortably androgynous appearance without depending on a dangerously low body weight. So now, when I reflect on my teenage body, those memories are no longer pained by desperation and loss. Instead, those memories have become just one more part of my story that now makes sense. I have finally let go of those last remnants of doubt: I DO have gender dysphoria. Atypical gender dysphoria, sure. But “atypical” tends to be my typical way of life.

Jantina Rope Ladder

That’s me. A skinny teenager sweating in the heat of August summer, her smile genuine this time from the satisfaction of building a rope ladder from sawed-off poplar branches to scale the walls of a hay bale fortress. I can still feel the comforting looseness of those tattered jeans around my narrow hips. I can feel the freedom and lightness and vitality in that slender androgynous body. It is only the slightest rise of my pectoral topography through the kid-sized purple T-shirt that hints at the biological truth I tried to deny.

Jantina Dirtbike

That’s me. A scrawny kid taking her first solo ride on her brother’s dirtbike, a little wobbly and a little cautious and a lot exhilarated. I can still feel the weight of my brother’s heavy boots on my feet, still feel the wind snatching my breath away as I tossed caution aside and revved up into top speed, still remember how alive I felt in that slim boyish body.

Jantina Peter Pan

And that’s me too. A lean little nymph leaping so lightly across the scattered hay bales, her favorite green Peter Pan sweater billowing around her weightless self. In the moment before the jump, I felt like I could fly, I felt alive inside my body, and I trusted my body to do what I wanted it to do. So all the muscles in my legs contracted, my feet pushed down hard against the hay, and then, recklessly, I tossed my stick-thin Peter Pan body up… and up… and up… towards a genderless Neverland in the dusky evening sky.

“Lastly, she pictured to herself… how she would keep, through all her riper years, the simple and loving heart of her childhood; and how she would gather about her other little children, and make their eyes bright and eager with many a Wonderland of long ago; and how she would feel with all their simple sorrows, and find a pleasure in all their simple joys, remembering her own child-life, and the happy summer days.”
– Lewis Carroll (Alice’s Adventures in Wonderland, 1865)

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References

Davy Z. The DSM-5 and the politics of diagnosing transpeople. 2015. Archives of Sexual Behavior 44(5): 1165-76. 

Hird MJ. A typical gender identity conference? Some disturbing reports from the therapeutic front lines. 2003. Feminism and Psychology, 13: 181–199. 

Kaltiala-Heino R, Sumia M, Työläjärvi M, et al. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. 2015. Child Adolescent Psychiatry and Mental Health 9: 1-9. 

Meriggiola MC, Gava G. Endocrine care of transpeople part I. A review of cross-sex hormonal treatments, outcomes and adverse effects in transmen. 2015. Clinical Endocrinology 83(5): 597-606.

Reiner WG, Townsend Reiner D. Thoughts on the nature of identity: disorders of sex development and gender identity. 2011. Child and Adolescent Psychiatric Clinics of North America 20(4): 627-38. 

Smith KP, Madison CM, Milne NM. Gonadal suppressive and cross-sex hormone therapy for gender dysphoria in adolescents and adults. 2014. Pharmacotherapy 34(12): 1282-97. 

Steensma TD, McGuire JK, Kreukels BP, et al. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. 2013. Journal of the American Academy of Child and Adolescent Psychiatry 52(6): 582-90. 

Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. 2008. Journal of the American Academy of Child and Adolescent Psychiatry 47(12): 1413-23. 

Not Applicable

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Not Applicable

A friend sent me that photo of an intake form for a youth program. The list of check-box options in the gender section is highlighted, and the form also provides space for chosen name and preferred pronouns. Compared to so many of the forms and surveys that I fill out on a regular basis, the form in that photo shows an impressive list of gender options – far more inclusive than the standard “M” or “F”, and much more specific in the options offered than even the more ambitious forms that provide “other” in addition to the lonely M and and rigid F.

Some online arenas offer even more inclusive gender options, Facebook for example. Users were originally offered four gender options: male, female, private, or < no answer >. In February 2014, Facebook added a “custom” gender option for users in the United States, which included at least 58 different pre-populated gender options. This update also allowed users to choose their preferred pronouns. Facebook’s decision to expand their list of gender options was highly praised by the trans and genderqueer communities as a milestone of recognition and a beacon of hope. When this change was implemented for users in the United Kingdom in June 2014, the list of gender options had grown to more than 70. In August 2014, Facebook added gender-neutral options to describe family members. In February 2015, Facebook broadened their gender horizons once more, allowing an essentially infinite number of gender identity descriptors by providing a free-form field for users to fill in the blank.

Well done, Facebook. Here’s a round of virtual applause. Compared to paper forms, online forms have more versatility because they are not restricted by physical space. Given the physical restrictions that apply to paper documents, I very much respect the inclusive efforts made by the authors of the form pictured above. They also deserve a round of virtual applause.

Gender: check all that apply. Okay. Reading all the options listed on the intake form, I tried to imagine which ones I would check if I were filling out the form myself. I quickly became confused and frustrated. Every single one of those check-boxes could, perhaps – if stretched a little here and shrunk a little there – apply to me. And yet every single box feels as awkward and ill-fitting as an outgrown T-shirt. Nor was there any combination of boxes that could approximate a more accurate answer. After much fuming and deliberation, I eventually decided that I would check only one box: “other”. And then, on that inviting blank line, I would write “not applicable”.

Not applicable. These words are a defiant slogan for so much of the uncertainty in my life. Not applicable. These words are my defensive withdrawal from the identities it seems that other people understand and claim so easily. Not applicable. These words are a burden of crushing doubt and a window to a world of limitless possibility.

Gender: check all that apply. Gender: fill in the blank. Gender: why is it even included on so many forms? Asking for a person’s gender on a form, seems, in many ways, as irrelevant as asking for their favorite color. Color and gender are both vast supersets that include an infinite number of items, making it impossible – even ridiculous! – to attempt to define the answer within a finite series of boxes or on a single blank line.  Like favorite color, gender is constant and permanent in some people and fluid and changeable in others. Like favorite color, gender means quite a lot to some people and very little to others. And, like knowing someone’s favorite color, knowing someone’s gender tells you nothing about who they really are and merely conjures up in your own mind your perception of the label they chose. Some might argue that gender is directly relevant on forms related to medical or reproductive issues. I argue that even in a medical context, gender isn’t relevant – what IS relevant is the presence or absence of certain organs and the concentration of certain hormones in the bloodstream – haven’t feminists and LGBT advocates been fighting so hard for so long to challenge rigid binary assumptions that tie gender to biology? I would like to see Facebook’s increasingly inclusive effort taken one step further to remove gender entirely from the available fields on a user profile.

It has taken me a long time to develop this provisional (dis?)comfort with the words “not applicable”. And here’s a difficult confession: I don’t understand what gender identity is, I don’t know what it’s supposed to feel like, and I’m beginning to suspect that I don’t even have a gender identity. The chronic physical distress associated with the female features of my body remains the only indicator of gender dysphoria. When I first started exploring gender and considering transition to a more masculine body, I felt so confused and alienated by statements that surfaced so incessantly from famous trans people:

“My brain is much more female than I am male. That’s what my soul is.” – Caitlyn Jenner

“I didn’t have to learn how to act like a man because in my head I’d always been one.” – Chaz Bono

“I knew in my heart and my soul and my spirit that I was a girl.” – Laverne Cox

“When I was four and began asserting myself as the girl I knew myself to be…” – Janet Mock

Similar sentiments echoed from many FTM and MTF blogs. So often it seemed that even in trans discourse, the definitions of “man” and “woman” and “male” and “female” hinged on outdated stereotypes regarding socialized preferences and behaviors. I was left more bewildered than ever, wondering if I even deserved shelter under the trans umbrella given my lack of gender identity. This statement finally resonated with my own aching and unlabeled nonidentity:

“That really begs the question: what is a man? And what is a woman? And how much of that is societal bullshit anyway? None of the labels fit me. None.” – iO Tillet Wright

Then I thought that reading about the experiences of people who identify as agender, bigender, genderfluid, genderqueer, and various other non-binary terms might feel more comfortable. But still I felt so estranged from those perspectives. I could not understand what often seemed like such an aggressive gender neutrality:

“I tend to paint my nails if I feel like I am going to be particularly expected to behave like a man. It creates a dissonance with expectations that I enjoy… I shop in the men’s and women’s sections, cobbling together a look that could confound the most attuned gender-assignment identifier from a few feet away.” – Rae Spoon

It has never been my intent or my desire to deceive anyone with my androgyny. I also could not relate to the conviction that seemed to characterize many non-binary genders:

“My gender is not all that unique or special. My gender is not all that queer or all that different. My gender is not rebellious. My gender is not something you should be jealous of… My gender is not about hating binaries. Really, the binaries are hating my gender. My gender is not about how limiting the binary is, and it’s not about liberating myself or anyone else from any binary… My identity is not about men or women. It’s about me, about how I understand myself, how I live my life, how others understand me, and what makes sense.” – Kae

That statement sounds so enviously confident. But I don’t know what any of it means. It became more and more apparent for me that existing labels were, as ever, not applicable.

The comments about gender that have most accurately captured my own confusing experience come not from the trans or genderqueer community, but from insightful people on the autism spectrum. (Jack 2012)

“I was sailing blind through a world full of gender signals.” – Jane Meyerding

“I’ve never seen any purpose for genders. They don’t reflect anything real, since they take “this sex is likely to do this” and turn it into a set of rules, making “likely” into “has to”… and I don’t identify as either because of that. It’s arbitrary and doesn’t fit anything about me.” – BlackjackGabbiani

“i don’t consider myself to have any sort of “internal” gender identity whatsoever – it always feels like “gender” is simply not a valid category in which to place myself. When i see “gender” as a tick-box category on a form, i feel similarly to if, on a form asking for details of a vehicle, it asked for “miles per gallon” when my vehicle was powered by something completely different (and that can’t be measured in gallons), like say solar electricity – i just don’t really consider myself to belong to the category of beings that have gender.” – Shiva

The absence of gender identity, the utter inapplicability of gender as a concept for me, is so eloquently described in those comments. The article also describes how disorienting and painful this experience can be.

“For some autistic people, gender does not easily serve as an available resource for identity… for some individuals, gender disorientation can be emotionally painful and having a term to describe oneself can be tremendously important… the malign persuasion in question here might be the fact that lacking a term or word with which to identify might persuade people that they do not fit, that they are anomalous.” (Jack 2012)

“I’m upset because I feel like there’s no word to describe my gender expression. It’s probably silly to be upset about not having a word for something, but because I don’t feel represented in either straight or queer communities, I do have a desire to articulate what it is that I am.” – Amanda Forrest Vivian

However, even those statements do not incorporate the intense and distressing incongruence between my female body and my brain’s resistance to that body. This physical discomfort combined with the absence of any cognitive gender identity feels impossibly bewildering.

For me, “not applicable” extends even beyond gender to other areas that serve as important aspects of identity for most people. Most standard forms don’t ask respondents to classify their sexual orientation, but those that do almost universally fail to include “asexual” as an option. For example, one study described the survey used to gather data on a large population: “Sexual orientation was assessed with the question: “Which of the following best describes your feelings? (1) completely heterosexual (attracted to persons of the opposite sex), (2) mostly heterosexual, (3) bisexual (equally attracted to men and women), (4) mostly homosexual, (5) completely homosexual (gay/lesbian, attracted to persons of the same sex), or (6) unsure. Respondents were categorized according to their orientation identity as reported in that question.” (Roberts 2012) Had I filled out that questionnaire, I suppose I could have chosen “unsure”, but, in this context, unsure implies not an absence of sexual attraction but simply indecision regarding the other available options. In fact, only 3 out of 8968 respondents chose “unsure”, a mere 0.03%.

A different study specifically investigating the prevalence of various sexual orientations in the British population did include a category to represent asexuality. “The measure of sexual attraction was introduced as follows: “I have felt sexually attracted to…” Six options followed: (a) only females, never to males; (b) more often to females, and at least once to a male; (c) about equally often to males and females; (d) more often to males, and at least once to a female; (e) only males, never to females; and (f) I have never felt sexually attracted to anyone at all.” (Bogaert 2004) The results of the study showed that 1.05% of 18 876 respondents reported being asexual (“I have never felt sexually attracted to anyone at all”). The authors explain, “This rate [of asexuality] is very similar to the rate of same-sex attraction (both exclusive same-sex and bisexuality combined: 1.11%). However, binomial tests indicated that there were more gay and bisexual men than asexual men, and more asexual women than lesbian and bisexual women.” (Bogaert 2004)

Despite this data suggesting that asexuality is not only relatively common (1%) but actually more common than homosexuality and bisexuality among women, asexuality remains largely ignored as a legitimate sexual orientation. I am still hesitant and uncertain about claiming an asexual and aromantic identity, but these words seem like the best available descriptors for my experience. A big part of my difficulty in accepting an asexual or aromantic orientation with any confidence is that there is so much lingering uncertainty: how do you definitively confirm the absence of sexual and romantic attraction without really knowing what those things feel like? An asexual blogger eloquently described this distressing uncertainty:

“Perhaps the most insidious part of this is that, to some degree, asexuality is a provisional identity. Unlike other sexual orientations, which at least have a frame of reference for what sexual attraction feels like, asexual people must rely on guesswork. When other people figure out their orientations, they can look at specific incidents of attraction and behavior. But asexual people have to look for a void – how do you find a void? How can you know sexual attraction isn’t present, if you have no frame of reference for distinguishing it? You have to compare yourself to other people and make your best guess.”  – Anagnori

The authors of the first study that did not include asexuality in the survey (Roberts 2012) note that in their study, “People “unsure” of their feelings were excluded.” Somehow I feel like that exclusion of people who are uncertain about their sexual identity extends beyond the parameters of that particular study and applies broadly to the world at large. Sexual orientation: check all that apply. Sexual orientation: fill in the blank. Sexual orientation: not applicable.

Our culture emphasizes romantic love as a central pillar of happiness and the foundation of family structure. Our culture considers sexual attraction one of the most fundamental traits of being human – indeed, of being animal. Our culture pathologizes the absence of sexual attraction as a medical or psychological disorder. Our culture, while it has become somewhat more inclusive and more accepting of gender diversity, remains doggedly adherent to indefinable and irrelevant distinctions between “men” and “women”. Our culture insists that, while gender can sometimes bend the rules, it can never disappear. When these core beliefs and assumptions comprise the infrastructure of our society, being agender, asexual, and aromantic – imperfect descriptors for me but no better words exist – is an experience of profound invisibility. In most of the categories that my world deems important, I remain: not applicable.

“It’s exactly like a riddle with no answer!”
– Alice (Through the Looking-Glass and What Alice Found There, 1871)

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References

Bogaert AF. Asexuality: prevalence and associated factors in a national probability sample. 2004. The Journal of Sex Research 41(3):279-287.

Jack J. Gender copia: feminist rhetorical perspectives on an autistic concept of sex/gender. 2012. Women’s Studies in Communication 35:1-17.

Roberts AL, Rosario M, Corliss HL, et al. Childhood gender nonconformity: a risk indicator for childhood abuse and posttraumatic stress in youth. 2012. Paediatrics 129(3):410-41

————

This post was awarded Tiffany’s Gender-Bender Award for May 2016.

Gender Bender Award Graphic

Proximity and Power

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Boxing (1)

I begin by skipping rope.

tap     tap     tap     tap     tap

The rope taps briskly against the floor, slow at first as I warm up, calf muscles clenching and protesting before they ease into the rhythm. I count to 200.

tap   tap   tap   tap   tap

Faster now. 400.

tap  tap  tap  tap  tap

Faster still. 600.

tap tap tap tap tap

The rope just a blur. 800.

taptaptaptaptap

Until, breathless, I stop and toss the rope aside. 1000.

I roll my shoulders, loosen up. Start shadow boxing at the darkened studio window, my reflection jabbing back at me with the familiar unfamiliarity that haunts my mirror image. But this time I don’t try to fit those female fragments into a coherent structure – I ignore the body and watch the motion, each movement detached and isolated, mechanical and yet alive with a deceptive hidden power. And I can feel the gratitude snaking through those fluid lines of chest and shoulder, gratitude for this gift of graceful motion.

I pause to wrap my wrists and knuckles. Slip my hands into well-worn gloves, bite down on the velcro strap, jerk my head back to tighten the cuff – the sweaty synthetic taste of it somehow grounding. I turn my back to the window. Now it’s just me, my body, and the bag.

The bag is old and tattered. Several layers of tape mend tears in the fabric. Formerly cylindrical, the sides have been flattened by a decade of heavy beating. I have gained precision in my aim and timing, trying to land my punches on the flat faces as the bag rocks and rotates.

Boxing has been described as a “romance of masculinity” and as “the most dramatically masculine sport”. Certainly boxing can be an avenue of aggression and anger and violence. But this – right here, this moment – this has nothing to do with masculinity. This has nothing to do with anger. This has nothing to do with violence. It has everything to do with peace: finding peace in the strength and stamina of a beautiful body that my brain so often refuses to accept.

I am the only female-bodied person in the gym. I can hear loud groans and heavy grunts from the men lifting weights across from me, perhaps from genuine exertion but more likely from their sense of entitlement, their unquestioned privilege to demand attention and invade even the auditory space. But my space – my sweaty ring around the swaying bag – is silent up until the split second of contact.

The sound of each strike cracks the silence. The impact of each punch echoes through my body as I pull back to hit again. The lyrics of this music thrum through my mind and hum through my muscles.

Jab
Crack

Jab
Crack
Cross
Crack

Breath
Shuffle back
One two
Rear hook
Crack

Breath
Head flicks
Sweat flies

Jab
Crack
Cross
Crack
Jab
Crack
Uppercut

Breath
Shuffle forward
Breath
Sweat drips
Breath

Lean in
Leap back
Duck
Jab
Crack
Jab
Crack
Jab
Crack
Cross
Crack

Breath
Breath
Breath

The bag is swinging wildly now. I must have fallen just a little out of tempo. Thinking too much. My body knows what to do if my mind doesn’t interfere. I step forward, cradling the heavy bag in my arms, letting my body absorb its momentum, ushering it gently back to stillness. I hear a cranky metallic clank from the chain suspending the bag. I stay there for another second, my face pressed against the fabric, a rough seam digging into my cheek. Then I shuffle backwards, tap the bag with one curled glove – respect, dear friend – and begin again.

Boxing is not about masculinity.

Boxing is a dance.

Boxing is a dance
of proximity and power,
of precision and peace,
of silence and space,
of gratitude and grace.

Our lives
Are better left to chance
I could have missed the pain
But I’d have had to miss
The… dance…
– Garth Brooks (The Dance, 1989)

Not A Simple Question

/ TomCat / Leave a comment

Ashes

There are numerous articles and blog posts discussing the many ignorant, intrusive, and inappropriate questions that are all too often aimed at transgender people. These articles are on popular websites (Everyday Feminism, BuzzFeed, Astroglide, Huffington Post, Cosmopolitan, Autostraddle), as well as on personal blogs written by trans people (janitorqueer, American Trans Man, Matt Kailey’s Tranifesto). There are even artistic projects devoted to this issue (A Series of Questions). There are differences within the trans community regarding willingness or unwillingness to answer these types of questions, depending on their relationship with the asker, the context in which the questions are asked, their desire for privacy, and the extent to which they want to educate others. I will not rehash what has already been discussed so extensively on other sites.

But, from here in my small corner of the internet, I would like to add something to this ongoing conversation. This is a question that I have not seen mentioned in any of the existing articles, but one which I have heard multiple times and have always found difficult to deal with:

“Which is harder, coming out as gay or coming out as transgender and going through transition?”

In my more generous moments, I want to believe that people who ask this question are making an honest attempt to use an experience they think they understand (coming out as gay) to provide a frame of reference to help them understand an experience that seems more foreign (coming out as trans and going through transition). In a neutral frame of mind, I might view this question as the idle curiosity of an interested audience. But I cannot ignore the dismissive presumption inherent in that question, the way those words reflect a simplistic desire to neatly rank and categorize unfamiliar experiences along a linear scale of difficulty, the way those words erase the incredible diversity of individual experiences with the assumption that one person can speak for everyone who is gay and everyone who is trans.

So whenever someone asks me that question, I feel an odd mixture of anger and resentment conflicting with my effort to be tolerant and give them the benefit of the doubt regarding their intentions. I could choose not to answer the question. But so far I have always chosen to answer, because my desire to be understood exceeds my desire to disengage.

“Which is harder, coming out as gay or coming out as transgender and going through transition?”

This is what I say to people who ask me this question: I think the question is irrelevant and impossible to answer. Each person’s situation is so different. The challenges each individual faces and the distress they experience are dependent on so many complicated factors: their social support system, their home and work environments, their personality, concurrent physical or mental illnesses, economic status, race, perceived gender, the list is long. And I think perhaps one of the most powerful factors influencing LGBT experiences is a person’s own acknowledgement and acceptance of their sexuality or gender identity. The internalized homophobia and transphobia generated by a lifetime of societal conditioning can create such deeply entrenched and overwhelming shame – shame like a slow-burning bonfire that eats away at the edges of your soul until you are entirely consumed by the raging heat.

Speaking only for myself: the constant physical dysphoria that comes from living in a female body with a brain that resists this body so intensely – this incongruence made so glaringly evident in every mirror, every motion, every moment – and the physical effects of the hormonal and surgical aspects of transition are a notable difference between my experience and the experiences I’ve heard gay friends describe. The physical aspects of gender dysphoria and my fears and uncertainties about the medical aspects of transition are more disturbing to me (though no less important) than my fears about the social repercussions of transitioning.

Speaking once more for myself: despite the physical distress that is so painful, my journey so far has allowed me to accept gender dysphoria, authentically and shamelessly, as part of who I am. My shame has stopped burning and now I sift through the ashes to reassemble the charred pieces of myself. And though my landscape still looks bleak and scorched, I get to decide where I go from here. This acceptance has given me an extraordinary freedom that many trans people and gay people have not yet achieved if they remain burdened with shame or denial. For this part of my experience, I have the utmost gratitude.

“You ought to be ashamed of yourself for asking such a simple question.”
– The Gryphon (Alice’s Adventures in Wonderland, 1865)

Present Tense

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Clock (1)

Depression has a curious way of disturbing the passage of time.

On depression’s terms, time  s t r e t c h e s . . .  o  u  t  .  .  .  s   o   .   .   .   s    l    o    w    l    y    .    .    .    with a maddening and mocking languidness.

Remembering and sequencing the events of today becomes an overwhelming challenge, my mind trudging grudgingly through the heavy fog that clouds those recent memories. The last few days and weeks and even years are stacked haphazardly, an inseparable scatter of all things past.

More cruelly, depression amputates the future. Tomorrow and next year are equally incomprehensible. This missing sense of future is deeply unsettling. It is like losing your peripheral vision – only when it’s gone do you realize, with horror! – how casually you took it for granted, how much it used to guide your behavior and perception, and how without out it you feel lost in a narrow and distorted world.

I have also seen these wrinkles in time described by people with terminal physical illnesses. Most eloquent of these descriptions was written by Paul Kalanithi in the days leading up to his death from lung cancer:

“Verb conjugation became muddled. What tense was I living in? The future tense seemed vacant and, on others’ lips, jarring. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.”

The relentless suicidal ideation that accompanies depression seems, in many ways, very similar to the last months of a fatal physical disease. To outsiders, the most salient difference between those two is the illusion of choice.

I think that a coherent sense of future can also be a casualty of gender dysphoria, especially for those of us with uncertain transition goals and unpredictable transition outcomes.

“I have had a hard time visualizing my future, as either female-perceived or male-perceived. Needless to say, this is a bit of a dilemma, as it can create the sense of moving into an enigmatic, inconceivable oblivion. Now, I don’t think it’s healthy to focus too much on the future, but I do think it’s normal to have some sort of future projection of yourself to hold onto – and I think that’s something that transgender people are plagued with – with not being able to visualize their future self during uncertain times, particularly when they are considering medical intervention.” – gendermagik

The point where depression and dysphoria intersect is a terrifying discontinuation of the mental and the physical, an inescapable Möbius strip of mind and body locked perpetually in the painful present tense.

The broken clock is a comfort, it helps me sleep tonight
Maybe it can stop tomorrow from stealing all my time
I am here still waiting, though I still have my doubts
I am damaged at best, like you’ve already figured out
– Lifehouse (Broken, 2007)

“You do not get the time back. Whatever time is eaten by a depression is gone forever. No matter how bad you feel, you have to do everything you can to keep living, even if all you can do for the moment is to breathe. Wait it out and occupy the time of waiting as fully as you possibly can. Hold on to time.”
– Andrew Solomon (The Noonday Demon, 2001)

Somebody Told Me

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Somebody Told Me - Album Cover

This gender journey is a constant hopscotch between the past, the present, and the future; where I was, who I am, what I want. The past is a jumbled collection of pieces from a dozen different puzzles and rummaging through it all – with the cold clarity of retrospect – has allowed me to start connecting those pieces into images that finally make more sense.

One of those old puzzle pieces comes floating up from time to time on the radio, leaping through the speakers with a smile and a wink – hello darling, didja miss me?

Somebody Told Me was released in 2004, the second official single from The Killers’ debut studio album Hot Fuss.

Well somebody told me
That you had a boyfriend
Who looked like a girlfriend
That I had in February of last year
It’s not confidential
I’ve got potential –

I remember hearing this song so many times on the dusty bus ride to and from my junior high school. It became for me an anthem of potential, striking a chord that I could not then articulate. I was enchanted by the idea of a boyfriend who looked like a girlfriend, captivated by the aching naked androgyny in those lyrics, and I wondered – drawing circles in the dirt on the grimy school bus windows – if a girlfriend could ever, maybe, look like a boyfriend. And then the song would lean back down and taunt me with the possibility…

I said maybe, baby, please
But I just don’t know now
When all I want to do is try –

New York Times Trans Voices

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The New York Times has an ongoing editorial series about transgender experiences (Transgender Today), with an online section for submissions from trans people to share their own stories (Trans Voices).

I found that most of the stories in that series described the experience of gender dysphoria in terms of social gender roles and traditional gender stereotypes, without much reference to the physical distress that is so prominent for me. The blog American Trans Man has an excellent series of posts describing body dysphoria (What Does Body Dysphoria Feel Like?), but I did not see my own experience represented there either.

So I wrote this piece in an attempt to describe my profoundly physical dysphoria, which was challenging within the 400 word limit. I submitted my story to the New York Times online in June 2015, however it was not accepted for publication. My original submission is below.

————

I am not a woman. And I do not know what it means to feel like a man. But I do know this: my brain believes my body should be male. I know this too: living with a female body is a thousand daily torments, a relentless rain of knife-sharp wounds, a constant cacophony of noise in my mind and a disorienting disconnection from my physical self.

An accidental glimpse of this girl-face in the mirror feels like a baffling optical illusion, an odd reflection of a face I know so well but can never quite call my own. The soft, hesitant, distinctly female voice that emerges from my mouth feels like some kind of cruel deception. The shape of my shadow, a perfect hourglass,  is a barbed and bitter insult. Menstruation brings with it a dark and bloody tidal wave of despair, an overwhelming urge to claw open my own abdomen and rip out the offending uterus with my bare hands. For years I have showered with the lights off so I don’t have to see this foreign female body naked, but even in the darkness I feel a surge of revulsion when my soapy hand slips between my legs or slides quickly over my chest. A kaleidoscope of images now… the absurd roundness of these girl-hips, the obscene feminine heaviness of my upper thighs, the fragile slenderness of my fine-boned hands, the ugly narrowness of my unmuscled shoulders, the terrible width of my flared iliac crests cradling a soft smooth belly, the raw red ring around my ribs from a too-tight sports bra… all inescapable, all excruciating, all wrong. WRONG! WRONG! WRONG! The same refrain always buzzing in my head, the same anxiety always crawling just below my skin.

All this I know, every minute of every day.

But I do not know what comes next. I am confused. I am terrified. I am drifting on a sea of fear and uncertainty, paralyzed by indecision. I feel a desperate urgency to make a choice, to finally find some peace.

Testosterone, mastectomy, hysterectomy. Those are the options that could tear my life apart. Those are the options that might mold parts of me into a more masculine form. But is that where I want to go? Will that ever be enough to stifle these sirens screaming in my brain? What does silence sound like?

————

“Take care of the sense, and the sounds will take care of themselves.”
– The Duchess (Alice’s Adventures in Wonderland, 1865)