What's So Important About Transition?
Like it or not, the only constant is change. For all of us.
Nobody quite asks the question the way I worded it in the title up there. It comes in a few different forms: “You really think you need the surgery?” or “Aren't clothes and makeup enough?” or even “What if this isn't what you want after all?”
Especially that last question, I can only answer by saying I researched, I dug into the stories of many people, so that I knew what I was getting into frontwards, backwards, inside and out -- even the stories of a few who fully transitioned, surgery, hormones, the works, and at the end realized it wasn't right for them after all. (Some of those regret stories felt a little stereotypical, a little spurious, as if penned by people who wanted to put little fictions out there in order to deter a few trans newbies.)
Back to my point (yes, I do have one): I studied up until I truly felt I knew what I was getting into. And I did it: I got through my transition, and I have no regrets. I would never consider surgery to reverse the excellent work Dr. Burke did.
What he did was no less than a miracle. And along with him, my primary physician Dr. Eric Southard, my psychologist Dr. Tom Mazur, my psychiatrist Dr. Jarod Masci, my counselor Matt Couch and my endocrinologist, Dr. Howard Lippes, also brought their skills and caring to no less a project than saving my life. That is no overstatement.
So what does the term transition refer to, as I use it? Short version: gender confirmation transition is a process by which an individual who suffers because the soul inside does not match one's physical gender gains physical attributes and appearance more in agreement with what we like to call the authentic self. (Okay, that wasn't exactly short.) It's especially important as one of the two known effective cures for gender identity issues.
The other, of course, is death.
For approximately 70 years now (90 if you go back to the 1930s case of Lili Elbe, as seen in recent film The Danish Girl), transition has meant survival to several million people like me, some becoming female, others becoming male. There is no question it works: I am living proof.
At one time, the late 1960s to early 1970s, sexual reassignment, as it was then called, tended to follow one template: the patient was evaluated mentally and physically in the first gatekeeper step, at which “candidates" might be culled due to mental instability (!), or because they were judged “somatically inappropriate" -- meaning they would not pass for women no matter what work they had done; then, if the gatekeepers finally decided to swing open their gates, the patient would be cleared to begin hormones, and after a couple of months undertake the Life Test, a full year living and dressing as one's intended gender, with all the joys, surprises and terrors one already nervous trans person could possibly stand.
And then, if the prospective lady completes that year, the psychiatrist and one other doctor, preferably on the patient's treatment team, might -- might -- each write a letter certifying the patient is a good candidate for SRS, sexual reassignment surgery, and direct them to whichever surgeon the patient is going with. Two certification letters are required.
In late 2001 when I started seeing Dr. Mazur, one of the few local psychologists specializing in psychosexual issues, that was the roadmap for gender transition, as laid down by Dr. Harry Benjamin of John’s Hopkins University Medical Center over thirty years earlier. Then, about three years later, my life was complicated by job loss, lack of health insurance, problems with the health (mental and physical) of nearly everyone in my family, and I was forced to go on hiatus with Mazur. I wasn't well enough set up to see him again until 2016; I started my Life Test in the spring of ‘17.
A couple of years later, I'm sitting in a coffee house in downtown Buffalo, telling a transgender support group my story, making a point of saying I'd done very well with my Life Test, which got a few approving nods. Then the twenty-barely to my right, with the interesting ideas about eyeshadow and hair color, leans closer to me and says, “Uh, nobody really does that anymore.”
I thought about responding that I had done it, and it had held pretty damn major significance for me. (I may also have thought about forcibly introducing my elbow into one of this person's eye sockets, but only for a femtosecond. Wouldn't have been ladylike. There's another antique notion for you.)
But after a bit of thought, I went on the net and pulled up articles bearing on the latest gender confirmation procedures and protocols. I was immediately glad to see that “sexual reassignment" and even “gender reassignment" were no longer the accepted terms of art. The implication that doctors had the god-like power to assign a person's gender was finally expunged. The idea of confirmation suited my view of the process much better.
Things have indeed changed since Harry Benjamin's day. There's a little less insistence on the doctors and psych professionals involved in gender confirmation staying below the radar. (Mazur's office when I was first seeing him was in the labyrinthine basement of Buffalo Children's Hospital. There was no sign on the ground floor; Mazur's secretary would send you instructions to follow once you arrived at Children's for your appointment.) People who would once have been hit with the somatically inappropriate label now transition and lead happier lives than they could ever have dreamed of. The patients themselves, myself included, are not as afraid of being in the open now. Trans people are still being attacked and worse on occasion, but fewer of us are being driven back into hiding.
Certainly not me, and I used to hide my true self all the time. But no more. Like male life, that's something I will never go back to.