I sat near a lovely young transgender woman as she waited for her surgery consult. She was anxious. She tugged at her skirt and flipped through dated magazines without reading the words. Her plans for that consult would make her more true to herself, more authentic in her identity, more feminine to the viewing world. Her surgery is just one option in the web that is gender transition, and she found her way to this place. She waited for her name to be called.
Intention. The value of intention is never lost on a transgender person.
A 49 year old transgender man injects testosterone into his thigh for the first time. It hurts a little and the needle is unpleasant to say the least, but today marks his transition birthday, and in about a year he’ll look much more like the man he has always wanted to be. He’s excited. He also risks losing his current partner to the imminent changes, possibly going bald over time, and advancement in his career. There are questions about who in his family of origin will support him. Who will call him by his affirmed name or use the correct gender pronouns. But he has made this choice, and the drive to have congruence in his sense of gender inside and outside is powerful. So powerful, in fact, that the risks are accepted.
Risks. Transgender people mitigate risks that are inherent to transition and those that are constructed by society and the ones closest to us.
A child says their name is now Ariel, like the princess. But that can’t be, her parents explain, because that’s a girl’s name. Ariel insists that this is their name now, and by the time they reach first grade, there is some question about how they will be addressed in class.
Persistence. Transgender people are nothing if not persistent.
Most people have the circumstance of being born with the assigned sex that their gender identity conforms with. For these cisgender people, it seems difficult to imagine the alternative, and therein lies at least some of the difficulty in understanding and accepting transgender. It’s as if lack of intellectual conception somehow conflates with denial.
If this equivalency were true, then quantum physics could not exist for most of us.
Transgender people are not only a real function of nature, created in the second trimester by a surge of maternal cross gender hormones, but these differences can be quantified and imaged by modern science. PET scans do indeed show brain contrasts relative to affirmed gender, not birth assigned sex, in transgender men pre-testosterone. So yes, the male and female brain are different from one another, and it follows how you identify, not how you were assigned at birth.
We hear much about gender dysphoria. In fact, it allows for a medical diagnosis to exist- a fortuitous thing for insurance purposes, but it does not mean transgender people are mentally ill. Far from it. One can find it in the Diagnostic and Statistics Manual (DSM 5). Dysphoria, by definition, is not mental illness. It literally means dissatisfaction, and that’s a good description of what it’s like to have an incongruent gender sense and presentation, in its most reductive sense. A transgender person is not satisfied with the gender they have had to conform to, and it’s causing distress to the point of intention, risk, and persistence.
Because that’s what it will take: intention, risk, and persistence. Lots of it, for impediments seen and unforeseen. But the metamorphosis is well worth it, and the regrets are rare among this special group of courageous warriors. I’ve seen us thrive, I’ve seen us happy, I’ve watched us loving our families and ourselves with the incredible boost that comes from authenticity.
Possibly the only thing more powerful than love is truth. Visit your transgender friends this weekend for a helping of each of these.
Happy Pride 2017
Josef Wolf Burwell, MS, PA-C
Trans Spectrum of Arizona