"I cannot say whether things will get better if we change;
what I can say is they must change if they are to get better."
--Georg Christoph Lichtenburg (1742-1799)
Transition. Think about the word. 1 a : passage from one state, stage, subject, or place to another. CHANGE
In other words, a transition is to change from something to something else.
It is a gradual process, implying that the changes occur over time like summer becomes autumn, like child becomes adult, like night becomes day. It may or may not have a specific start, or a specific end. However, I think most would agree that change is universal.
Gender transitions are no different. I feel confident in stating that they are among the most difficult and profound changes that a person can undertake. I don’t need to detail all of the cultural, emotional, physical and technical difficulties involved. I think few of us can even begin to realize the magnitude of the change as we embark on it, kind of like trying to know the width of the ocean as we wade in from the shore. (Actually, I think it's often better that we don't know!)
Ironically, I have learned that at the beginning of our gender transitions we often spend quite a bit of energy trying to convince others, and perhaps even ourselves, that we’re not going to change! We’re still going to be the same person. Hah!
Early in my own transition I read something that I have since come to consider to be particularly profound. Anne Vitale, Phd., in her T Note #8 essay entitled “Relationships: The Bane and the Promise” writes:
Interestingly the first attempt people entering transition make at maintaining old relationships is to reassure family and friends that only their appearance will change. The problem here is that this is simply not true. Sex reassignment far exceeds a simple change of appearance. When one thinks about it, if that is all transition did, it probably wouldn't be worth the trouble. Upon starting to take hormones, people routinely report a profound improvement in their sense of well-being and the rightness of their action. This, long before they or anyone else becomes aware of physical changes. Clearly something far more profound is occurring. As their sense of self changes, their needs in relation to others will inevitably change as well.
Reassuring friends is rarely meant to reassure friends. More often it is a way for the individual going through transition to deal with fears of becoming isolated and unwanted in his or her new life. At the minimum, the transitioning individual can expect personal needs and his or her expectations of others to change. In fact it is common to see the individual going through transition to be the one to abandon old friendships because they are too busy making and enjoying new ones, now that they are freed to be fully themselves.
No matter how supportive the friend or partner may be while transition is still in the talking stage, the first sign of physical change almost invariably forces a reassessment of that support. It may not necessarily mean a complete loss of the relationship, but as the transition progresses, the interchange between the two parties typically undergoes a radical redefinition.
To be sure, transition is all about change. Physical change. Spiritual change. Mental change. They all interact, and they are all critical to a successful and healthy transition.
I would be so bold as to make the statement that the ability to handle/manage change is one of the key skills that one must either have, or learn, in order to make it through a successful transition. I think part of being able to do this effectively is to know what to expect, so here are my own thoughts and experiences.
The very essence of current “treatment” for transsexuals is based on the concept of physical change. How does a male body morph into a female one, or vice versa? It must be changed.
At one point (not all that long ago) this gender “confusion” that we endure was considered to be a psychological aberration, and was treated as such. The goal of the treatment was to “cure” the poor, confused patient. If psychoanalysis alone could not accomplish that, more extreme measures, including electro-shock therapy, and aversion therapy, were used in an attempt to correct the person’s mind and put their gender identity in line with their obvious physical gender.
Needless to say, these efforts failed. It has been proven that, once engrained, gender identity is immutable and cannot be changed. Slowly but surely, the treatment community came to realize this. As a result, treatment plans changed from being mental treatments, to being physical ones. The general feeling became, “If we can’t change the mind to match the body to enhance the quality of life for gender dysphoric individuals, then we can certainly change the body to match the mind.”
The current SOC guidelines are based on this approach.
Hormones are administered to stimulate development of secondary sex characteristics (although, as we will discuss, the mental changes involved are perhaps even more significant). Surgery to make the face or body more masculine or feminine is often performed. And in the end, SRS is often performed (I have heard some people refer to SRS as GRS, standing for Gender Reassignment Surgery, or Genital Reassignment/Reconstruction Surgery). But in the end, the goal is to provide a body that is more congruent with a person’s gender identity.
That being said, it is important to understand that the physical changes involved in this process are not just skin-deep. How we look affects how we feel about ourselves, and how others feel and react to us. It affects how we act. It affects how we interact with our world. As Dr. Vitale indicates, it is about a total change of “self”.
Since others can’t see into our psyche, the yardstick by which they measure what is happening in us is by our appearance. For example, I can provide several personal examples of friends (some of whom I had known for 20 years!) who seemed to be able to accept the surprising news of my situation and intentions at first blush. However, once they actually started to see physical changes, that support started to wane to a point where eventually we lost contact altogether.
These physical changes in ourselves can have a significant impact on us, especially at the beginning as we struggle to put it all into perspective. They can be tremendously exhilarating, but also very frightening. It’s one thing to put on some makeup in private, as it washes off and we feel relatively safe that our secrets will remain private. Once you begin hormones and suddenly start to notice little titties poking out of your T-shirt, the realization that suddenly others may learn of your situation (if they do not know already) is suddenly staring you right in the face. Suddenly, the time to make decisions that will have a permanent impact on the rest of your life is at hand.
For those of us who felt that, for a long time, nothing was happening, suddenly seeing concrete proof that we are “changing” is very exciting. In a very real way, it is a late adolescence…a late bloom that we have dreamed about since early childhood. Many of us had come to accept defeated resignation of being trapped in a body that would never experience these changes. The fact that we have suddenly and seemingly miraculously changed that sad destiny is often a minor miracle in and of itself.
I fear, however, that these physical changes, if not accompanied by corresponding mental and spiritual changes, is based on the faulty assumption that this transition is merely a physical one. Such transitions must either face a significant re-evaluation once they have progressed, or may be doomed to failure. I also feel that far too many people tend to take the physical changes at face value without realizing the underlying psychological changes that are taking place. The concept of an iceberg is a good example, in that we can see some it poking above the surface of the waves….unaware at the huge mass of ice that sits below the surface.
Let me provide an example. Many of us undertake some type of facial feminization surgery. Many more of us would do it if we could, but cannot afford these expensive procedures (I’d argue that facial surgery can be more important than SRS, and provides a better quality of life for the money in many cases, but perhaps that is a topic for a future discourse). Why do we do it? Why do we spend 20, 30, 35 thousand dollars, plus go through all of the pain and trauma of such invasive surgeries?
Some may argue that it is all about vanity. I do not agree. Perhaps these people are only looking at the tip of the iceberg.... the part that floats above the waves. There are no guarantees from these surgeries. Certainly, the features will be more masculine or feminine. But to think that I’d allow someone to re-build my skull with power tools for the sake of being “pretty” to others is ridiculous. Those who would make such charges may be so shallow as to do that. I am not.
The day before my facial surgery the doctor will meet with you to discuss all of the things that can go wrong. If is part of the “informed consent” process. Numbness. Loss of muscle control. Constant drooling. Other nasty complications. All are possible. Are you willing to risk being able to risk the sense of feeling on your nose or your head for vanity? I hope not.
Rather, how many people can look into the mirror and see a new person looking back at them? THAT is where the REAL value is. It upset me to feel that my features were particularly “male” looking, so no matter what I did I kept seeing that same face staring back at me. Hair couldn’t hide it. Makeup couldn’t disguise it. It was the same face that I had seen for so long…that “male” face…looking back at me in the mirror. As my hair grew out, I didn’t feel it made me look more “feminine”. It made me look like Fabio. It affected how I felt about myself. It affected how I felt others reacted to me.
After my FFS, that changed. The person in the mirror was different. The image was far closer to who I felt myself to be on the inside. Whether it was “pretty” or not was not the issue. The fact that it improved how I felt about myself, and my confidence level, and my ability to live the kind of life I wanted to live….THAT is what made it such a life-changing event for me.
The bottom line? The physical changes are huge…sometimes incredible. The corresponding mental changes, however, are even more substantial.
I find the mental changes to be, by far, the most incredible and important part of a successful transition. Such a statement would seem to be obvious, but somehow we tend overlook it. I mean, our expectation is to go from a psyche full of fear and guilt and frustration, to one of peace and acceptance. Do we expect that the physical changes alone will get us there? I hope none of us would be so naïve. In fact, I would go so far as to argue that the physical changes we undertake are done in an effort to help support the mental changes that we are hoping to experience, only we rarely look at it in those terms.
Let’s me give some personal examples.
I have found a good tool to use to depict this process is the 5 Stages of Grief, as identified by Kubler-Ross.
Do these emotions look familiar? Does this process look familiar?
I don’t define these stages merely as stages of grief. I define them as stages of acceptance, as the process described here is not limited to grieving. To be sure, we may not always experience each and every emotion here, in this sequence, every time we experience something. However, coming to terms with our gender confusion must necessarily begin with acceptance within ourselves, and the mental changes we go through in ourselves to get there.
How many of us have asked, “Why me?”. “Poor me”. “This must be a phase. I’ll outgrow it.” “I promise not to dress anymore.” Look at where each fits in the acceptance process.
Understanding this process can be very helpful, especially as others learn of our intentions to transition. They, too, may experience these phases…especially family, husbands, wives, children. There is an acceptance/bereavement process involved, as many will often complain that the person that they knew is “dead”.
Two key things to remember here. First, this process is gradual and takes time. Do NOT accept first reactions, or even second or third reactions, to be the final outcome. Be sensitive to the process and give it time to work itself out, if that is to happen. Second, not all people make it all the way to acceptance. People get stuck at anger, or denial. There is no guarantee that acceptance is the inevitable outcome. However, you cannot let yourself wallow in guilt for “making” them get stuck there.
The key in discussing these phases is not just to explain this process. I never sat down to do this sort of clinical explanation of my own transition. It is merely to demonstrate the mental changes that we have all gone through just to get to the point of even considering a transition.
Once the transition begins (we’ll discuss at some future point just how difficult it is to pinpoint such a milestone), an entirely new set of challenges suddenly bubbles to the surface. Relationship issues. Work Issues. Self-Doubt issues. Fear Issues. Disappointment Issues. These issues are certainly not isolated to gender transitions. However, each must be faced and handled in one way or another in order for us to move forward.
There is no easy self-help step-by-step guide to handling these issues. Trying to guess how they will affect you, or how you will handle them, would be futile (at best) for me. Instead, let me give some examples of issues I faced early on, and the mental changes that I noticed that helped to address them.
Example #1
At the very beginning, I was very concerned about going out in public. My fears of being “outed”, or harassed, or the source of snares and snickers, caused me significant anxiety. In those early days, if I was dressed and was in a supermarket, and heard some kids laughing a couple of aisles away, I was SURE they were laughing at me. Of course, that they probably had no clue I was even in the store, but such is our super-sensitivity at those awkward early stages.
At the time I lived in Phoenix, and my electrologist’s husband owned a restaurant. It was a very eclectic little place, and was considered to be a safe “haven” for anyone in an alternative lifestyle. In fact, several T gals worked there, including a friend Tina (names have been changed to protect the innocent!).
Tina was a waitress at the restaurant. She was comfortable with who she was. She had gone full-time several months before. She was balding, had a very deep voice, had somewhat masculine features, but none of that seemed to phase her.
I used to sit and watch her as she went from table to table. Once she greeted a new table, I would watch the faces of the guests as she walked away…sometimes curious, sometimes laughing, sometimes friendly. None of it seemed to matter to her. She went about her business, seemed to be enjoying herself, and didn’t let fears of being “accepted” even enter into the picture.
I envied that. I wished I could get to that point where it wouldn’t matter to me, either. I felt frozen in place until I could get over that hump.
Needless to say, I got there. I can’t point to a time, or a thing, that made it happen. I remember events that proved to me that indeed it had happened, like the time I was invited to Happy Hour in Dallas at a cowboy bar and didn’t think twice about the unpleasant possibilities. Or the times I have had to make presentations in front of executives at work, and felt totally at ease. The point being -- something in me changed, and helped me to feel comfortable as myself.
Example #2
A year after my SRS my mom told me that she felt that I was very at-ease with myself. She said that I had “grown into my skin” over that past year, and she felt the difference was noticeable. I hadn’t realized it. I mean, as far as I was concerned I was just as comfortable in here at SRS as I was a year after the fact. All I know is that if my mom noticed it, and made a point to mention it, it must have been significant.
Example #3
I cried. I had not cried in nearly 30 years. Shortly after beginning hormones, I went by myself to a not-so-sad movie. On the way home I suddenly felt overcome with by a tidal wave of sadness, and cried. It would be easy to attribute it to the hormones, as the emotional impact of estrogen is certainly significant. But I think even more profound is the fact that I allowed myself to cry. There had been times when I had felt moved to tears, but I felt the need to choke back the emotion before it bubble to the surface. To make that step towards allowing myself to cry, to be emotional, to be vulnerable, was huge for me.
Example #4
As a guy, the thought of being attracted to a man never even crossed my mind. I found my first meetings with psychologists who had experience with gender issues to be frustrating in that they seemed to dwell on sexuality issues; I knew that my gender issues had absolutely nothing to do with my sexuality. However, as my psyche changed, so too did the resistance I had built to being attracted to a man. The more natural my new role felt, the more open I became to this as a possibility to explore. For now, I’ll just leave it at that….
Example #5
Originally, I would have guessed that my best friends would be able to accept my transition, and would be able to stick by me on my journey. I was to learn that the opposite was true. The friends that were the closest had felt they knew me best, and that my disclosure to them somehow put the basis of our entire friendship in question. Little by little, they backed away until they eventually bowed out altogether.
Part of the reason I found this so disappointing was my new “neediness” from my friends. My male self was a pretty low-maintenance guy. “Hi. Howya doin? Did you see the football game on Sunday? Whatchya been up to lately? Cool. Well, gotta go. Take it easy!” Such might be a typical conversation with Dave. I’m not saying I was shallow (actually in comparison to where I feel I am now….I guess that IS what I’m saying) so much as I’m demonstrating that I invested very little in my need for friends, and as a result our relationships were usually pretty shallow.
As I changed, my expectations and needs from my friends changed, too. I needed to talk about how I was feeling. I needed to share my emotions (and let me tell you, there were lots of feelings and emotions). The friends that I used to have couldn’t understand my new-found “neediness”. I tried to explain that this was not the same old relationship….it was a brand new one. Dave was low-maintenance. Donna was not….especially not then. As frustrating as that was, they could not, or would not, be there. So the friendships died.
Example #6
Once I started on estrogen, everything felt different. I learned first-hand that one of the main differences between men and women is that women are very “sensual”. Everything was heightened for me. Colors were brighter. Taste, smell and touch were amplified. Things had “feelings” attached to them…and caused some sort of emotional reaction in me, whereas that was never the case in the past. In the beginning, this new flood of sensuality scared me to death. I was not prepared to handle the magnitude of it all. In fact, it scared me so much that I went off hormones for a couple of months to get my bearings and re-assess the life path that I was headed down. Once I calmed down and collected myself I started back up, and haven’t looked back since.
One friend said something very profound to me once. She said "My hope for you is for you to fall in love now that you're on estrogen". Based on how everything else is so much amplified, I don't know that I'll survive such an experience!
Example #7
At the beginning of my transition, I had specific ideas (preconceptions) of what type of woman I expected to be. I had ideas as to what I needed to do in order to be percieved as feminine. All too often, I think we hold on to these ideas for WAY too long, and they eventually become crutches, but I won't go into that here...
Anyways, as I progressed through my transition, those ideas gradually changed as I had some real experience to be able to make more realistic decisions. I found I didn't need to wear a wig, as there are as many women with short hair as there are with long hair. I found I could go out without any makeup. I found I didn't need to wear a dress every day if I didn't want to. Little by little, my preconceptions of what type of woman I would become evolved into something much more comfortable.
Example #8
How many people know about Maslow’s hierarchy of needs? It has been a staple in psychology classes for years. I find it to be a very interesting concept. It looks something like this:
Just as I used the stages of grief to represent stages of acceptance, this model is very useful in discussing our needs and development as me move through transition, and through life.
At the very beginning of my transition at work, I was at the lowest level of this hierarchy. All I wanted to do was go to work, be left alone, be allowed to get my work done, and go home. Pretty simple. I didn’t mind the fact that, for days on end, nobody would come into my cube. I didn’t go out of my way to be included in group events. I didn’t care that I was asked to quite the fantasy football league because some of the guys felt “uncomfortable”. The fact that I was allowed to be at work, as Donna, was all that mattered to me. Anything else was gravy, as far as I was concerned.
Well, as time went by, I needed more. I needed validation (the topic of a future diatribe). I needed to have a sense of “belonging”, of accomplishment, of pride. Just being allowed to show up every day wasn’t enough for me any more. As people intentionally used the wrong pronoun, I would write emails to correct them, or invite them to speak with HR if they had any questions on proper behavior. I became resentful over the fact that I was working harder than I ever had, but didn’t get the recognition or credit that should have been forthcoming. My path up the hierarchy was fueled by whatever changes I was going thru in terms of self-confidence, in terms of socialization, in terms of expectations.
Eventually, I outgrew them. I realized that they would never accept me as anything more than Dave in a dress. I had grown to the point where that was no longer acceptable. So I resigned. That is a far cry from those early days of huddling by myself in my cube, just happy to be there.
* * * *
I don’t want to beat a dead horse to death here, so I hope you get the picture. Expect mental change. Embrace mental change. Enjoy mental change.
Let me finish with one additional thought. SRS is often deemed to be the “end” of transition. It is a significant milestone, and one which some people use to indicate that they have arrived at their destination. To be sure, it is the pinnacle of the physical changes that we have discussed here, and in that sense perhaps SRS is the end of the physical transition.
However, the mental transition continues long after SRS. Actually, if we take the gender aspect out of it, mental transition continues….period! The changes we go through as we assess our needs, and we assess our goals, and we assess our circumstances, and we assess our expectations…. they will continue.
The things we thought would happen after SRS often change. For example, when I moved to a new city to start fresh, I made a promise to myself not to tell anyone about my situation. I didn’t want to have to deal with the stigma. However, as I started to make friends and felt the need to share intimacies and talk with others about myself, I broke that promise. As we begin to experience, and explore our new situation, mental change is inevitable.
Transition equals change. In a more holistic sense, transition does not end. Therefore, change (mental, physical, spiritual) does not end, either. It’s just part of life......