Gender Equality, Social Justice, Think

Untangling Transgender

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From the transgender actress Laverne Cox on Orange Is The New Black to the famed transformation of Bruce Jenner to Caitlyn, the spotlight is on gender identity and transgender issues right now. This is no fabrication of the popular media; transgender people really are everywhere. And the culture is scrambling to play catch-up.

Screen Shot 2015 11 03 at 3.37.41 PMEve Alas: “I’m an artist, I was on a successful career path in the military that was cut short. I like to skydive and dance. I have so much life experiences that there are very few things I could say have not happened to me or that I haven’t tried. That can make life feel a little dull.”

Screen Shot 2015 11 03 at 3.39.19 PMKyle Toler: The author’s 19 year old nephew, Kyle, hails from Tampa and is on a pre-med track at Hillsborough Community College

The number of Americans who report knowing a transgender person has doubled in the past seven years. An estimated 700,000 Americans (0.3% of the population) are transgender, with a full 1% of millennials (those born 1980-2000) identifying as such. What does it mean to be transgender? I’m a really friendly and openminded person —but I was shocked at my own vertigo upon realizing that not only was one of my good friends transitioning to a different gender, but a niece of mine—now my nephew—was, as well. I felt like my sense of reality had been totally upended. How was it that other people’s sense of themselves could be so different from my perceptions of them? I hadn’t realized how much I just didn’t know.

I decided the best way to begin to understand the transgender experience was to hear people’s stories. My nephew Kyle and three transgender friends of mine (Henry, Eve and Dominique) all talked with me, as did therapist Breeze Hanna­ford, LCSW, who works with transgender people at the U.S. Depart­ment of Veterans Affairs; also Dr. Rixt Luikenaar, a local surgeon who specializes in transgender medical care and who is also the mother of a transgender child.

Gender vs. sexuality

Most of us were raised in a culture that conflates gender and sexuality, and sees only strict binaries in both of those areas: In gender, you are either a man or a woman. In sexuality, you are either gay or straight.

Even though transgender people are usually identified with the gay population, as in the common acronym LGBT, being transgender isn’t at all the same thing as being gay. Homosexuality and heterosexuality are terms that define who you are attracted to, but transgender describes who you are in yourself. If you are a man attracted to other men, you are gay; but if you have a man’s body but you feel like you are really a woman, you are transgender.

glossaryThere is also no absolute relationship between gender identity and sexuality. A transgender man attracted to women will still be attracted to women even if he starts to present as a woman.

This can be hard to wrap your head around, but there’s more: As with sexuality, gender has its spectrum. Just as you can be bisexual or even asexual, you can also be genderqueer (somewhere between male and female) or even without gender.

The younger generations—digital natives who have always been able to compare notes over the Internet—have much less of a problem than the over-40 population handling these concepts. Indeed, the experience of being transgender has been profoundly different for Kyle, 19, than it has been for Dominique, 59.

How do you know you’re transgender? The transgender people I talked to all knew that there was something different about them, even as little kids. There’s sometimes a perception that transgender people make a “choice” to be that way—but this is not how they experience things. As my nephew Kyle puts it, “Being Nicole never felt right to me. It felt like I was backed into a corner. I knew when I was at least five, because I remember running around the house saying ‘I’m a boy! I’m a boy!’ and my siblings making fun of me for it.”

“I knew when I was four or five that I was different,” says Eve, 34, who was assigned male gender at birth. “I knew there was something I had to hide, because I had behaviors that adults were correcting me over. On my sixth birthday I asked if I could have a pink dress, and I was punished for asking! I learned that whatever the reason I asked and wanted the dress was what was wrong with me, and that part of me had to be squashed.”

Henry, 43, grew up in a deeply Mormon household in Utah. “I was adopted but generally fit in and had a pretty carefree childhood. My family was dysfunctional in many ways, nothing over the top. But I was always different. I attributed most of my feelings of being out of place to the adoption thing for many years. I did have a lot of ‘tomboy’ behaviors: I preferred BMX racing to Barbie, and I played war with stick guns with the neighborhood boys and got into fist fights. I was not interested in playing house or any of the other activities that little girls gravitate towards.”

Dominique, 59, is part of the transgender old guard. Growing up male in a Brigham City family of eight kids, she knew she was different. “In Mormon-speak I was a sinner, and I was having these temptations—that’s all I knew. I played sports and was a really active kid, but I remember getting caught sneaking into my sisters’ clothes and getting the crap beaten out of me. I remember my mom breaking a broomstick over my head!”

Things have gotten easier for transgender kids over the decades, but it has perhaps always been a little easier for trans boys than it has for trans girls. Our culture accepts “tomboy” girls much more blithely than it accepts “sissy” boys.

Gender dysphoria

Puberty is a particularly rough time for trans people. Up until that point, all little kids’ bodies look largely the same, and there is much less of a cultural emphasis on gender conforming. Once hormones start to kick in, though, things quickly get serious.

Until very recently, transgender kids had no choice but to go through the body changes that their genetics dictated, and for many this felt intolerable. It’s at this age that suicidal ideation becomes common among transgender people. These days, transgender kids have the option of being treated with hormone blockers that delay puberty long enough for them to really consider how they feel, and to fully understand the consequences of medical transition: Surgery to become transsexual is irreversible, and results in sterility.

While still debated in the medical community, the standard of care is that suppression of puberty should be offered when the long-term consequences of delaying treatment are likely to be worse than the likely long-term consequences of treatment. If your kid is frantic and self-harming at the idea of going through puberty, the kindest thing is to delay puberty and to take them to therapy to help work through things.
Screen Shot 2015 11 03 at 3.38.44 PMDominique Storni: Father, Civil Rights Activist, Sales Consultant, Corporate Trainer, Writer, Feminist, Educator, Actress. Dominique Storni was reared in a devout Mormon family. Her life has been filled with travel, education, jobs, teaching, tragedy, affirming and healing experiences, She was married for 17 years and fathered six children. She transitioned when from male to female and has lived as a single mom since 1996.Around age 14, if they are still strongly dysphoric, they may be offered replacement hormones. Many of the body changes that replacement hormones create are reversible if the child goes off hormones, butGenerally, a strongly gender-dysphoric child can be put on hormone blockers at the first signs of puberty, usually around age 11.

some (like breast development) are not reversible without surgery.

Finally, surgical intervention can be appropriate for some transgender people once they reach adulthood and have been through thorough counseling to confirm their ongoing dysphoria.

Transgender kids now have a chance of avoiding the trauma of going through a puberty that will only magnify their bad feelings about their bodies, but older transgender people had no choice and often no real concept of what was happening to them, because they didn’t have language to describe it and had never met anyone else like them.

In fact, the word “transgender” didn’t even exist until the 1990s, and Eve and Dominique both report that they didn’t know there was such a thing until they were adults. “I always thought it was some kind of a curse growing up, because of the temptation to cross dress and the religious judgment I had,” Dominique says. “I was 27 before I even heard the word ‘transsexual.’” [A transsexual is a transgender person who has undergone a medical transition to be the gender they identify with.] In those days there was no difference between gender identity and sexuality. You were just a sexual deviant, and they wanted to find some kind of pill to fix you.”

For Eve, things were similar: “I didn’t find the word ‘transgender’ or any other people like me until I was in my 20s. I would dress in secret, purging often—that’s when you get rid of all the clothes you’re not supposed to have. Finally, I wanted to be myself so badly that I made a new Myspace account as a female, and I found similar people…cross dressers, drag queens and so on…but after a few months I met a girl named Kathy and I knew I was like her when she told me what she was: transgender. I was shocked. I didn’t want it to be real. I studied and researched, because I wanted to make it go away, to fix myself.”

Kyle, at 19, has a different life course in front of him than his older peers had at his age. He’s had parental support and acceptance from his high school friends and the adults around him. “Even my teachers have supported me in ways that amaze me,” he says. “When I was running for prom king, I had one teacher I really liked, but I didn’t want her to sign the paper for my campaign because I didn’t want her to get in trouble. She said to me, ‘I don’t care, I’ll go to bat for you and you know it, too!’ I loved that, and it meant so much to me.”

Acceptance for Henry, Eve and Domi­nique was a much longer time coming. Henry lived for years as a lesbian, where his butch behavior wouldn’t mark him out as different, and found some refuge in that community. Dominique, a good Mormon boy at the time, went on a mission, came home, got married and had six kids.

Transgender and the military

Eve took a common route in trying to manage her dysphoria. “The Army came along when I was at the end of my high school career, doing their recruiting, and I thought wow, this might fix whatever’s wrong with me! Because of course I didn’t know there was such a thing as transgender until years later. So I joined up, and went to basic training during the first summer after I joined.”

Screen Shot 2015 11 03 at 3.38.09 PMBreeze Hannaford, LCSWBreeze Hannaford, an LCSW who works with trans veterans at the VA, says that Eve’s reasoning is pretty typical for transgender people, both trans men and trans women. “For trans women, the military is seen as an organization that’s going to ‘make them a man’ because of the emphasis on conformity and hypermasculinity. For trans men, too, it’s attractive because it’s one of the few places in society where they can be as masculine as they want. They can cut their hair short, act like a dude, and nobody’s going to look at them sideways because acting that way just means they’ll be a better soldier. By percentage, there are five times the number of trans vets than there are transgender people in the general population, so you can see that the military is very alluring to them.”

According to the National Center for Transgender Equality, at least 134,000 U.S. military veterans identify as transgender (that’s about six out of every 1,000 vets), and more and more of them (and their civilian cohorts) are coming out of the closet.

“In general, trans people enter the military because they crave community, and also because they have a very strong need to be of service to a community,” says Breeze Hannaford. Of course, the ideal of joining the military and the actuality are often quite different. “Trans women who presented a bit more effeminate have been more likely to be a victim of some kind of assault while they’re in the military,” Breeze continues. “And then they would blame the part of themselves, their ‘trans-ness,’ for the attack, rather than blaming the perpetrator or the environment in which that kind of attack was permissible. Trans women who don’t present effeminately often suffer a different kind of trauma, where they will volunteer for absolutely the most dangerous missions possible; partly to prove masculinity, and partly because there’s a death-wish because of the dysphoria and they think ‘at least I can die a hero this way.’”

Unfortunately, Eve was one of those trans women who suffered an assault. “I tried really hard to fit in, but the military is so conformist, and they could just tell I was different. I was a good soldier, though, and good at defending myself. I got attacked a lot of times, but in a one-on-one situation nobody ever got the best of me. However, finally, when I was posted in Colorado, a group of soldiers drugged me and then tied me down and tortured me. I remember them yelling ‘don’t ask don’t tell, faggot!’ and ‘you’re not the boss of us!’ because at the time I was a sergeant in the commander slot, in charge of 200 people plus a unit of 10 specialists.

“And no, I never reported the attack. Don’t ask, don’t tell, remember? And it wasn’t just because of that, but in the culture, you see anyone report anything and it gets pushed back on them. If the brass have to admit that this happened in their unit, it makes more work for them and it makes them look bad because they can’t control their unit. After I was attacked, I transferred myself to St. George, to a small unit, and just kept my head down. I did my time and got my honorable discharge two years later. Before the attack, I was ambitious. I wanted to be a warrant officer. After that, whenever I was offered a leadership position I turned it down. After I got out, I wanted nothing else to do with the military. I am still dealing with PTSD today.”

Transitioning

The older cohorts of transgender people often did not attempt to transition to the gender they identify with until after they’d gone through years of attempting to fit into society in different ways. The pro­cess of first learning about being transgender, and then accepting it and deciding to act on it, usually took a long time.

Screen Shot 2015 11 03 at 3.39.05 PMHenry Malus is a native Utahn who returned to Salt Lake City in 2011 after living in Portland, Oregon for twenty years. He graduated from medical school in 2010, completed his residency in Salt Lake City, and then joined an integrative medical practice in Midway. His practice focuses on complex, chronic disease and anti-aging related treatments. Henry lives happily with his partner and two dogs in Sugarhouse.

Henry, living as a lesbian, found it difficult to disentangle what exactly was going on for him. “There are so many feminist, philosophical reasons that I had to not want to fit into the role of female, and I needed to figure out what was driving me. It took a long time to figure it out. Finally, the physical discomfort [of the dysphoria] was the tipping point that made me realize I am fully transgender, and that I wanted to go through the expense and trouble of medically transitioning.

“Starting hormones was an amazing experience. It was probably only three days after I took my first shot of testosterone that I felt the release of that physical dysphoria that I’d felt since puberty. If you’ve ever experienced chronic pain and had it treated, you may understand what this feels like. You’ve sort of gotten used to the bad feeling, and it becomes this background noise that you just try to live through. When it dissipates you wonder —how the hell did I live with that for so long? And this…just feeling normal…this is awesome!”

Dominique was in the trenches as part of the first wave of trans women to seek hormonal and surgical transition. “It started when I was still married, and I would sneak my wife’s birth control pills,” she says. “I finally was able to start taking some hormones in 1995, but it was tricky, because even if you could get a prescription, you couldn’t find anyone to fill it. And the hormones cost $100 to $200 per month. But I felt so much better on estrogen that I kept trying. I found this doctor at Hill Air Force Base who was also a trans woman, though of course she couldn’t transition because she was military. But she wrote me some prescriptions and gave me a diagnosis of male gynecomastia (breast enlargement) so that I could get my insurance to cover the hormone bloodwork. Finally I just made a run for the border—I went to Mexico for myself and a bunch of other girls. For $800 I got enough hormones for a year for six of us!” Hormones in Mexico were available without prescription and, over the years, Dominique made many trips to get them.

Hormonal therapy only goes so far in treating severe gender dysphoria, though. In 2003, Dominique decided it was time to have surgery. “My breasts developed naturally, but for my bottom surgery I went to Thailand. This Thanksgiving will be my 13th birthday of that! I was on the Internet in some transgender AOL chatrooms, and I found the name of this surgeon. It turns out I chose the wrong one, because he didn’t do a very good job. I’ve had six surgeries here in Utah to fix things and it all works great now. At the time I did the surgery I could have gone to Oregon, Wisconsin, Montreal or L.A., and it would have cost me from $18,000 to $25,000. In Thailand, the whole thing including travel and lodging was $7,500. I spent every penny I had on it. It was such a relief to have the surgery. Even though my surgery wasn’t that good, I don’t regret it. I’d do it again in a second. I knew I couldn’t cope with life in a male body.”

Dr. Rixt Luikenaar, a gynecological surgeon in South Salt Lake, also performs female-to-male (FTM) procedures such as hysterectomy, and she says that surgery is tricky for transgender people. “It’s covered by insurance in only a handful of states, so it’s too expensive for most. Top surgery is more affordable at about $6,000 currently, but hysterectomy is over $20,000 and so is a vaginoplasty. Phalloplasty—creating a penis—is even more expensive.”

Still, surgery can be key in addressing dysphoria. “For trans females, bottom surgery is usually very important, but unfortunately they often can’t afford it. On the other hand, most trans men don’t really care about bottom surgery, but they will want top surgery (mastectomy) because that’s the most major issue for them, as it’s the breasts that cause the primary dysphoria.”Screen Shot 2015 11 03 at 3.38.29 PMDr. Rixt Luikenaar with transgendered actress Laverne Cox made famous by the Netflix hit “Orange Is The New Black”

Luikenaar doesn’t perform mastectomy, phalloplasty or vaginoplasty, but she does help her patients prepare for surgery and offers post-operative care. “For example, trans women who are healing from a vaginoplasty have to dilate five times a day. I make sure they do it right, so that their wounds are healing correctly and they are achieving good vaginal depth and width.” She has prescribed hormone therapy for the transition of over 1,000 patients. She works closely with mental healthcare providers, a plastic surgeon and a urologist.

In conservative Utah, it hasn’t always been easy to be a trans-friendly surgeon. “I’m in solo practice because of my transgender clinic,” Rixt says. “Former partners of mine, often LDS and male, were not comfortable with me treating these patients. My practice now, however, is doing very well. I have over 1,700 patients after having had my practice for a year and a half. Most of my cisgender [gender conforming] patients are openminded and for equality and diversity.”

Rixt has a very personal reason for having gone into working with the trans population: She has a trans son. “My youngest child was born female, and we named her Sophia. She never had any desire for skirts or dresses or wearing ponytails in her hair, though. Five years ago she refused to wear any further girl clothes—she wanted boy’s underwear and clothes, and to wear her hair short. In 2014 she told us she wanted to go by Alix, and for us to use ‘he’ pronouns, which we now do. Of course I am a supportive parent, and he knows I love him no matter if he is Sophia or Alix. I take him to a club at the Pride Center for gender variant kids called Kids Like Me.”

Transitioning as a kid is very different from transitioning as an adult, and parents of trans kids have some very specific struggles.

“That has got to be one of the hardest things for any parent,” Breeze Hannaford says. “Parents want to do whatever they can to make the world safe for their kid, and to realize that no matter how much you try to protect them, they’re going to struggle…that’s got to be terrifying.” The good news is that kids who transition, even with all of those struggles, suffer less psychological trauma than people who transition later. “Kids are allowed to play,” Hannaford continues, “and play is the most important piece of this. As adults we rarely give ourselves the opportunity to play. But how do you know if something’s going to work for you if you don’t try it on first?

Gender fluidity

“The reality is, it’s a spectrum, and we need to allow for gender fluidity, not just the traditional man/woman binary. Maybe your trans kid really is the completely opposite gender, but maybe they might be comfortable somewhere in between as gender fluid or genderqueer. Even with adults, we start with the least invasive methods. It’s not necessary for everyone to be on hormones or to have surgical intervention in order to feel comfortable in their own skin.”

These sentiments are echoed in Kyle, Eve and Henry’s advice for people who might just now be realizing they are transgender. “I’d tell others who are going through this to first do as much research as possible because you can stop the physical changes at any point, but some things aren’t reversible,” says Kyle. “They also have to know there’s a whole world out there and no matter what, they can always find support.”

Eve echoes this need to research. “Look up the DSM [Diagnostic and Statistical Manual] psychological diagnostic tests, and be honest with yourself. Take baby steps, start slow—you might be surprised where you end up! Some people flow in both genders. Find what’s right for you. Make yourself happy to be alive. And if you’re a trans woman, do your nails! Those little things are really what make you feel good.”

“The best advice I think I’ve heard during my own transition process was just be awesome,” says Henry. “No matter the awkwardness of the stages of transition or the likely dramas that will infiltrate your life while you go through this, people will still notice more your level of awesomeness in whatever else you are doing in your life. Going through puberty twice is not something anyone would choose to do if they could help it. Making the decision to transition is a long road and there are many barriers—financial, emotional and physical. You have to be committed to get through those things and you have to have some stability in order to keep healthy on all those levels. Community can help. It can also hinder. You have to be self-reliant and just keep being awesome; you’ll get through it.”

Are there really more trans people now?

Are there really more trans people nowadays, or does it just look that way because they’re in the media
so much?
Dominique thinks there’s a reason for all the trouble she went through as a kid: “I’m pretty sure I am a DES baby,” she says. Diethyl­stilbestrol (DES) is a synthetic estrogen and known endocrine disruptor (it interferes with normal human hormones). It was given to many pregnant women in the 1950s and ’60s in the mistaken belief that it would reduce the incidents of miscarriages. In the 1960s DES was also used as a growth hormone in the beef and poultry industries.
Indeed, DES exposure has been implicated in a higher incidence of intersex babies (formerly called hermaphrodites), and also in a higher percentage of male individuals who self-identify as male-to-female transgender.
“Why are we seeing so many transgender people now? I think it’s partly because it’s safer for us to transition publicly, but I think it’s also chemical,” Dominique concludes.
Henry, a doctor, is more equivocal. “Awareness is huge,” he says. “Being able to get the right recognition through counseling is something that my generation missed out on. There were a few brave souls who paved the way for us to be able to get more standards of care in place for mental health, primary care, hormone therapy and surgery such as the World Professional Association for Transgender Health…a maturing of these things, the media coverage, and in some ways I think it might be a generational thing.”
As to whether there may be a chemical reason? “I don’t think it’s useful to speculate. The fact is, this is us, and this is who we are.”

Local transgender advocacy group

Screen Shot 2015 11 03 at 3.39.46 PMCandice Metzler is the new executive director of the Transgender Educational Advocacy of Utah (TEA), replacing Connie Anast-Inman who held that position for the past four years. TEA offers community classes (e.g. Trans 101, a basic understanding; Trans 201, beyond the binary; trainings for employers and schools), employment resources and transition resources including legal/identity issues.

CATALYST: What are some of the challenges of being transgender that are specific to Utah?
Candice Metzler: You know, everyone thinks it would be the LDS Church, but I have to be candid—it’s the fact that we’ve been overshadowed by the LGBT (Lesbian, Gay, Bisexual, Transgender) movement. The “T” part of that always has just been tacked on there at the end, but now that the [gay] marriage issue is out of the way, people are starting to tune in to the transgender community. It’s been a big frustration for us to feel like we haven’t had a voice, because the issues of transgender people are quite dire; the levels of homelessness, unemployment and underemployment have been a serious issue in Utah. We are just looking for a chance to be heard.

What’s your relationship with the Pride Center?
Historically it’s been a little tenuous, but we are enthusiastic about Marian [Edmonds-Allen] coming on board as Executive Director last August. Her leadership and awareness around these issues are great, and they’ll foster a better relationship between the transgender community and the Pride Center. We are working with them on a number of projects already, and look forward to expanding that work.

What is your relationship with the LDS Church?
We don’t actually have any kind of relationship with the LDS church, and it would be great if we did.
The church has a sort of “no policy” policy when it comes to transgender people in their membership, and they leave a lot up to individual pastors and bishops.

What changes have you seen in Utah over the past five years or so? What does the future hold?
People are just starting to come on board with the idea of transgender, but their minds are blown when you start to talk about gender fluidity.
In the youth group I’ve facilitated at the Pride Center for almost five years, most of my youth by far identify as genderqueer rather than transgender. This is not a blip on the screen—it’s actually probably the future. What makes people nervous is that we have a system set up to serve people on the basis of binary gender. Gender­­queer people don’t fit this system.

November is Transgender Awareness Month.

Sat., Nov. 15: 7th Annual Genderevolution Conference. 8:30am-6:30pm. Rowland Hall/St. Mark’s School, 843 Lincoln St., SLC. $25. GenderevolutionUtah.org

Nov. 20: Transgender Day of Remembrance and Night of Action. Utah Pride Center, 7pm. Speakers, music, reading of names or transgender people who died by violence, and refreshments afterwards. Facilitated discussion will be held prior to the event.

Alice Toler is a regular CATALYST contributor, a visual artist and a DIY architect with a mad passion for reading, research and discovery. She is awesome.