Transition and Individual Choice (1999)

©1999, 2013 by Dallas Denny

Source: Denny, Dallas. (1999, March). Transition and individual choice? Who has the moral authority? Transgender Community News, 8-9, 25, 27.

I’m happy to say HBIGDA changed on its own initiative. Today it is the World Professional Association for Transgender Health and is working to depathologize all gender-variant people.

 

The vignettes which follow are based upon real people, but names and circumstances have been changed to protect their identities.

 

Transgender Community News Pages (PDF)

Transition and Individual Choice

Who Has the Moral Authority?

By Dallas Denny

 

My friend Kristin was facing a brutal transition. Saddled with every conceivable male physical and behavioral characteristic, she stood a big-boned six-foot-four, with a jutting chin, heavy brow ridges, protruding adam’s apple, male pattern baldness, a hirsute body, a booming voice, and a hulking masculine walk. She had not fared well in the transgender lotto, either in physical terms or in preservation of family and community ties. Her hole card was NASA, an employer determined to support her. Kristin had been working with the company’s Equal Opportunity Office, and her therapist had made several trips to the workplace to educate management about transsexualism in general and Kristin’s planned transition in particular. Things were shaping up nicely for her eventual transition.

 

And then Kristin jumped the gun and screwed everything up.

 

Although Kristin was on hormones and had been having electrolysis twice weekly, they had not yet had any appreciable effect, although her ponytail, long lacquered nails, and tweezed brows did make her look somewhat effeminate. Kristin, used to being the most male-looking of males, was not coping well with the stares and smirks she was getting at filling stations and malls. She had convinced herself she could no longer pass as male, although to my eyes it seemed that what she could no longer pass as was a masculine, presumably heterosexual male.

 

And so Kristin rushed into transition while her therapist was still in negotiations with the brass at NASA. She sailed into work one day, without announcement, in high drag—a wig, heavy makeup to cover her killer beard, a short leather skirt, and high heels. This would have been bad under any circumstances, but was a formula for disaster in a plant with four thousand employees. At shift’s end, several thousand men and women lined up around the time clock to watch her punch out. Kristin did something I would never have found the courage to do; she walked the gauntlet of catcalling co-workers with chin high, put her time card in the machine, and clocked out.

 

You may imagine Kristin had a hard go of it at work—yet she persevered despite ridicule and harassment from her coworkers. She would probably have made it had her closest friend not been murdered, causing Kristin to crash and burn.

 

I visited Kristin in the mental hospital where she stayed for two weeks. After her release, she put her nose back to the grindstone, living in the female role and eventually physically growing into it.

Sandy used to laugh and say hers was the world’s longest transition. She had attended a gender program in the 1970s, staying a patient until its abrupt close in 1979, and had been on hormones on-and-off ever since, but she never began to cross-live. Although married and the father of two young boys, by the time I met her, Sandy didn’t pass as male. She looked and sounded like any 50-year-old woman, and it always seemed incongruous to see her in male clothing at support group meetings. In fact, when she first appeared, looking female but wearing mens’ clothing, most of the other group members thought she was a trans man.

 

Sandy’s marriage, troubled as it was, had withstood 25 years of gender exploration, and Sandy and her spouse remained a couple when she finally transitioned—which happened quite by accident. She applied for a job, wearing male clothing and giving her male name, Allen, and was read as a female and hired with nobody suspecting she was anything other than a female with the unusual name of Allen.

 

Although Sandy would like to have surgery, she has no immediate plans for SRS, as it would exceed the comfort level of her wife.

Chris’ transition was slow and steady. When I first met him he had just stopped wearing skirts at the insurance agency at which he worked and was cultivating an androgynous look. He had asked his employer and co-workers to call him Chris instead of Christa, without explaining why. As time wore on and he became more and more masculine in dress and demeanor, and especially when his body began to masculinize under the influence of testosterone, Chris’ changes were impossible to miss but nonetheless remained a non-topic of conversation. His supervisor, co-workers, and clients never brought up the matter, and neither did Chris. Gradually, female pronouns became too awkward and were replaced by male pronouns. Eventually, Chris wore a beard and a man’s business suit and was known to his clients and co-workers as a man, but his transition had never been discussed in the workplace—not even when he took two weeks off to have top surgery.

Roberta’s transition was bass-ackwards according to most folks’ standards. After a course of hormones and electrolysis, she began working as a woman. Away from work, she lived as a man, since her wife was uncomfortable being seen with her in female clothing in their home town. Gradually, the wife began allowing Roberta to emerge at home and while shopping. Within two years, she was living full-time and had set a date for her surgery.

Much human misery is caused by the insistence of some people that things be done a certain way. Transsexuals have certainly suffered from such notions, which have been forced on them by helping professionals who were often neither helping nor professional. For many years, the coin of the treatment realm was subjectivism and caprice as transsexuals had their feet figuratively held to the fire by psychologists and physicians who required their transsexual patients to restructure their lives according to their often naive and sexist beliefs. It was not unusual for therapists to dictate to transsexuals the clothes they must wear, their occupations, the sex of their lovers, which surgeries they would and would not have, and even their names. If the patients didn’t comply, they were denied hormones and surgery. The psychomedical literature is replete with accounts of this often well-meaning blackmail. In other words, the scoundrels documented all of this malpractice in medical journals, holding it forth as good practice.

This type of despotism was almost universal until about 1990. As the ’90s draw to a close, it has become rather less common, but it still occurs, and under a seal of approval. It is codified in the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, which give lip-service to individualized treatment but keep the feet of transsexuals to the fire. Transsexuals continue to be subject to the whims of therapists, who can withhold permission for hormones or surgery for as long as they like, or forever for that matter, with no obligation to tell the transsexual what he or she may expect in the way of permission letters, and with nothing to expect from their therapist peers but a pat on the back and a hearty “Well done!”

Finding a good therapist is critical for a transsexual who wishes to transition, but is usually more a matter of good fortune than good judgement. Transsexuals entering transition generally have no idea of what to expect from their therapists, and all too often their therapists have no idea about what their own role should be. Transsexuals sometimes spend thousands of dollars on unsatisfactory therapists before finding one who is a good match. Many therapists remain mired in archaic views of transsexualism as a pathology and view their transsexual clients as mentally ill or at best limited. It is practically impossible for someone with such a viewpoint to help a transsexual build a healthy life because the focus is not upon excellence, but upon controlling psychopathology, and that means treating transsexuals as if they were damaged and not the healthy, well-informed, competent individuals that they generally are.

Just as there are many ways to build a house, there are many ways to transition. Who is to say what is right and what is wrong? Who has the moral authority to tell another legally competent adult how to structure his or her life, what job to have, what clothes to wear, what their name should be, when to begin crossliving? Decisions about the how, where, and when of transition should be left to the individual, who, I believe, will usually make good decisions based on his or her circumstances.

Take as a case in point the four vignettes with which I opened this article. There was Kristin, who bolted into what most would consider a premature transition; Sandy, whose transition took what many would consider an unduly long time; Chris, who defied conventiona; wisdom by choosing not to inform his employer about his transition; and Roberta, who went about her transition in a unique way. Would these individuals have benefited from a therapist who told them how to transition, and at what pace? Absolutely not. Each made the decision that was individually best. Kristin was severely gender dysphoric. She made the decision to transition with a gun barrel in her mouth. She was so miserable in the male role that she chose to face the societal reaction that comes with being a nonpassing transsexual over even one more day as a purported male. Sandy, by pacing her transition, kept a shaky marriage together and maintained contact with her daughter, from whom she would almost certainly have been distanced had there been a divorce. Chris, weighing the atmosphere of his workplace, chose not to inform his employer or coworkers of his transition, and changed roles without a hitch. By making every effort to keep her wife at ease with her transition, Roberta, like Sandy, managed to keep her marriage together, and even strengthened it.

Kristin, Sandy, Chris, and Roberta all had good outcomes. Each responded to internal and external pressures, weighing and balancing them and making decisions about transition which fitted their individual circumstances. A therapist, however, well-meaning, would have had less information and would have been less able to make good decisions based on their complex lives. Fortunately, each of the four had therapists who were nondirective, and who let them decide upon the circumstances of their transitions and helped them through the period of change without holding them hostage to hormone and surgery letters. Many therapists would not have had such a hands-off policy.

During the nineties it has generally come to be understood that transgendered people, including transsexuals, are not mentally ill, and that the stigma with which they have so long been burdened is more properly placed not upon them but upon a society which rejects and mistreats them. Unfortunately, practice often lags far behind theory, and that is the current situation. The 1997 revision of the Standards of Care is based upon obsolete and incorrect notions of transsexualism as psychopathology, and is full of demeaning and patronizing language—this despite input from a number of HBIGDA members, myself included, who urged the document-in-progress be scrapped and rebuilt from the ground up.

It is time to either discard the Standards of Care or bring them into line with the times. Unfortunately, the ranks of HBIGDA remain full of reactionaries who would limit the freedoms of transsexuals and continue to allow therapists control of transsexual lives. Change, while forthcoming, is likely to be slow, unless someone stirs the pot. I would like to stir the pot.

To that end, I call for transsexuals and transgendered people to lobby The Harry Benjamin International Gender Dysphoria Association, which publishes the standards, and demand reform. Actually, they should do more than that. Transsexuals and other transgendered people with graduate degrees in the helping professions should join HBIGDA, attend and present at the biannual conference, and vote in officers who will remove the imbalance of power from the Standards of Care and drag HBIGDA, whether screaming or willingly, into the twenty-first century.

Dallas Denny doesn’t hold herself to be an expert on transsexual and transgender traditions, but she transitioned myself and in her position as director of AEGIS she assisted in some way with several thousand transitions and directly and indirectly witnessed several thousand more. She has also written extensively on the subject, so she will admit to being, ahem, somewhat experienced.