WHAT would you go through
not to have to live the life of Kafka's
Gregor Samsa? Not to realize, early in
childhood, that other people perceive a
slight, unmistakable bugginess about you,
which you find horrifying but they claim to
find unremarkable? That glimpses of yourself
in the mirror are upsetting and puzzling and
to be avoided, since they show a self that is
not you? That although you can ignore your
shell much of the time and your playmates
often seem to see you and not your cockroach
exterior, teachers and relatives pluck
playfully at your antennae with increasing
frequency and suggest, not unkindly, that you
might be more comfortable with the other
insects? And when you say, or cry, that you
are not a cockroach, your parents are sad, or
concerned, or annoyed, but unwavering in
their conviction-how could it be
otherwise?-that you are a cockroach, and are
becoming more cockroachlike every day. Would
you hesitate to pay thirty thousand dollars
and experience some sharp but passing
physical misery in order to be returned to
your own dear, soft, skin-covered self?
Approximately two people in every hundred
thousand are diagnosed-first by themselves, then
by endocrinologists, family doctors,
psychiatrists, or psychologists-as
high-intensity transsexuals, meaning that they
will be motivated, whether or not they succeed,
to have surgery that will bring their bodies
into accord with the gender to which they have
known themselves, since toddlerhood, to belong.
Until a decade or so ago the clinical literature
and the unreliable statistics suggested that for
every four men seeking to become anatomically
female, there was one woman seeking the opposite
change. Now clinical evaluation centers report
that the ratio is almost one to one.
In twenty years of practice as a clinical
social worker, I met men who liked to wear
women's clothing, women who preferred sex in
public conveyances to sex at home, men who were
more attracted to shoes than to the people in
them; I didn't meet any transsexuals. I
encountered transsexuals only the way most
people do: in Renee Richards' story, in Jan
Morris's Conundrum, in Kate Bornstein's
books, and on afternoon talk shows, where
transsexuals are usually represented by
startlingly pretty young women, sometimes
holding hands with their engagingly shy,
love-struck fiances, sometimes accompanied by
defensive, supportive wives turned best friends.
I wondered, in the middle of the afternoon,
where the female-to-male transsexuals were. Even
if there were four times as many male-to-female
transsexuals, there still had to be a few
thousand of the other kind somewhere. But not in
mainstream bookstores, not in magazines, not in
front of talk-show audiences of middle-aged
women standing up to applaud the guests' ability
to "look just like the real thing."
I thought there must be a reason
female-to-male transsexuals were invisible. I
wondered if their physical transformations were
so pitiful that no one could bear to interview
them, if women who wished to be men were less
interesting, less interview-worthy than men who
wished to be women, or if these people were so
floridly disturbed that even the talk-show hosts
were ashamed to be seen with them.
Much of the early psychiatric literature
about transsexuals, from the pre-Christine
Jorgensen 1940s until the late 1970s, leaned
heavily toward psychoanalytic explanations and
toward clinical descriptions that, however
sympathetic to the unhappy patient, emphasized
the bizarreness not of the biological condition
but of the conviction that there was a
biological condition. The next psychiatric wave
emphasized "personality disorders" as the root
of transsexuality, specifically the popularized
borderline personality syndrome, with its
inadequately formed sense of self and frightened
yearning for symbiosis. In The Transsexual
Empire (1979), Janice Raymond dismissed the
biological reality of transsexuality and
attacked transsexuals as agents and pawns of the
patriarchy. Her overwrought theories about the
meaning of transsexu- ality and the training and
practice of surgeons who perform transsexual
procedures read like the feminist equivalent of
some of the Mafia-CIA-White Russian conspiracy
theories of Kennedy's assassination, but her
essential point, that transsexuals are
psychologically unstable victims of a society
that overemphasizes the roles of sexual insignia
and gender difference, made sense to me. If the
people involved were less nuts and society were
less rigid, it seemed, neither transsexuals nor
the surgery they seek would exist.
Most of us can understand a wish, even a
persistent wish, to belong to the other gender.
History and fiction are full of examples, many
charming, some heroic, of women who dressed as
men throughout their lives. It's the medical
procedures that make transsexuals seem crazy:
six months to two years of biweekly
intramuscular injections of two hundred
milligrams of Depo-Testosterone, which cause an
outbreak of adolescent acne, the cessation of
menstruation, and the development of male
secondary sex characteristics; then a double
mastectomy, in which most but not all of the
breast tissue is removed, the nipple saved, and
the chest recontoured for a more masculine,
pectorally pronounced look; and then, a year to
ten years later (depending on the patient's
wishes and financial resources), a hysterectomy
and one of two possible genital surgeries: a
phalloplasty (a surgery to create a full-size
phallus and testicles) or a metoidioplasty (a
surgery that frees the testosterone-enlarged
clitoris to act as a small penis). In short:
multiple, expensive, and traumatic surgeries to
remove healthy tissue. Who would do this?
Lyle Monelle, a burly man of twenty-eight,
lives with his mother, Jessie, in a trailer park
in suburban Montana, a state in which I'd never
imagined suburbs. The trailer park is neatly
laid out beneath a shocking cobalt sky, and all
the culs-de-sac have their own blue-and-white
street signs, none of which are bent or rusted
or facing the wrong way. The careful hand of
people who are used to making do, doing without,
and trying again is everywhere. Jessie and Lyle
are watching for me from the trailer's little
porch, and they come toward the car like a
couple of welcoming relatives.
The inside of the trailer looks familiar; it
is the Montana twin of my late mother-in-law's
home in northern Minnesota. Sturdy, slightly
bowed Herculon love seat and matching recliner
in shades of orange; copper mallards hanging on
the opposite wall, arching over the TV. The
three of us finish two pitchers of iced tea
during the afternoon's conversation, and Lyle
and Jessie allow themselves to be sad and
occasionally puzzled by their own story, but not
for long. All their painful stories are followed
by moments of remembered grief but end in the
genuine and ironic laughter of foxhole buddies;
they know what they know, and they are not
afraid anymore.
Lyle is older than I had thought he would be
- he's an adult. He was a patient of three of
the people I've already interviewed-Dr. Donald
Laub, a preeminent plastic surgeon known
especially for female-to-male sex change
surgery; Judy Van Maasdam, the counselor at
Laub's surgical center in Palo Alto; and Dr. Ira
Pauly, a noted psychiatrist and when they told
me about Lyle, they all focused on how young he
was at the time of transition, much younger than
most people who apply for surgery. Even though I
knew better, I had half expected to meet a
teenager. He was fourteen when he began hormone
treatments, with medical approval, fifteen when
he had his mastectomies, but twenty-three before
he and his parents had enough money for the
phalloplasty, the "bottom" surgery. (That's what
the guys say about their surgeries-"my top," "my
bottom.") I was horrified when I first heard the
stories about this kid, and I imagined meeting
his parents and clinically evaluating them as
misguided, covertly sadistic, or perversely
ignorant, acting out their own unhappiness on
their helpless child.
We should all have such parents.
When Lyle entered puberty, his mother and his
late father took him from doctor to doctor,
looking for explanations for Lyle's unhappiness
and fierce resistance to being treated like a
young woman. An endocrinologist who had worked
with Don Laub recognized Lyle as possibly
transsexual, and Ira Pauly and Judy Van Maasdam
confirmed the diagnosis. Then, after extensive
hormone treatments, Laub performed the first
surgery and the family moved to another state,
to allow Lyle to enter high school as a boy.
Later, they nursed him after his hysterectomy
and his phalloplasty, and used all their
savings, and then some, to pay his medical
bills.
Jessie says, "I want everyone to know who
reads this that this wasn't easy-it was a really
terrible shock. I didn't understand. I said to
the first endocrinologist, 'Where did we go
wrong?' and he said nowhere, it was biological.
I called every single-I'm not kidding you-every
single insurance company in the USA, and they
said, 'No, it's cosmetic.' "
Lyle interrupts-the only time I'll see him
openly angry. "Yeah, right. Like I wanted a nose
job. Cosmetic. Well, it was only my life."
Jessie makes soothing hand gestures,
reminding him that it's all right now. "And of
course, the money," she says. "Our other kids
resented it. I understand. But what could I do?
What could we do? If your child has a birth
defect, you get help. We understood-we
understood even when he was little that
something wasn't right. And we knew, when the
doctors told us what could be done-we just knew
what we had to do. When the doctors said he was
transsexual, I felt that I knew that."
After hearing Lyle's stories about his hated
girl name, his astonished, frightened tears and
protracted battles over party dresses, Mary
Janes, and even girl-styled polo shirts, and his
deep, early sense of male identity-the same
stories I would later hear, with minor
variations, from almost every transsexual man I
spoke with-I ask him about life since the
transition. He gives me a glossy friend-filled
account highlighted by a two-year romance with
an older woman (twenty, to his seventeen) and a
successful football career cut short by an ankle
injury.
And after high school?
Finally, a bit of trouble: "I had a little
money problem and a little drug problem. I got
some counseling, came back from Las Vegas,
started college. Now I'm taking classes, paying
off my bills, working for the state. Eventually,
I'll get my bachelor's."
He sighs, and Jessie says quickly, "That's
all right. Lots of older kids are in college
these days. Aren't they?" I say I know quite a
few, and we sip our iced tea.
— Amy Bloom
Chapter One, 'Normal' - ISBN 0-679-45652-X
Random House, 2002
