Chapter 10
Transgender Teens
Sex is what’s between your legs. Gender is what’s between your ears.
Been There:
“Since I was little I would always lay awake at night and wonder how much better my life would be if I had been born a girl. Then I would think, ‘Oh great, the one thing I really want, I can’t have.’”
—Alexandra, 14
In many ways, transgender (or trans) teens have a greater struggle for acceptance and understanding than other queer teens. Comparatively little is understood about being transgender, so trans teens can feel even more isolation and loneliness than their gay, lesbian, and bisexual peers. However, this is changing.
According to the Human Rights Campaign, knowledge of what the term transgender means, as well as familiarity with transgender public policy issues, is growing dramatically across the United States. This represents an important stride toward a tolerant society. More work definitely must be done to educate the public about the experiences of being a trans person, but acceptance is growing.
While more research about transgender teens has been done in recent years, it isn’t known how many young people identify as trans. The lack of information about being trans has partly resulted from society’s reluctance to acknowledge that being trans is a biological fact (not an emotional choice), and that being transgender is not an isolated experience. As with being gay, lesbian, or bisexual, some trans teens are told that they are just confused or are too young to be sure. Other teens are told that gender is a choice.
Unfortunately, many people still are ignorant of the feelings and experiences of trans people. Even in the medical community, it can be difficult for those who are transgender to find mental health professionals and physicians who are capable of providing educated, compassionate care.
But not everyone is in the dark about being trans. Counseling support and accurate information about being transgender are out there. If you’re transgender or think you might be, it’s important to reach out and seek help. Not because something is wrong with you, but because addressing trans issues is much easier if you have support and access to resources.
A Dance Evolution: Transgender people are becoming more visible and will continue to do so. The New York–based dance group Vogue Evolution made history by appearing on season four of MTV’s America’s Best Dance Crew. The openly gay crew, fronted by transgender woman Leiomy Maldonado, quickly became a fan favorite for their explosive dance moves and for their openness and confidence in expressing who they are. Throughout the season, viewers learned more about Leiomy, the first trans person to appear on the show, and some of her experiences as a young trans person. Since the show, the group has made appearances at a variety of events and has appeared on national television interviews.
What Does It Mean to Be Transgender?
When you’re transgender, you have a gender identity or expression that is different from your biological sex or physical anatomy. A few definitions might be helpful here. Gender identity is your internal sense of being male or female—basically what gender you consider yourself to be. Your gender expression is how you express your gender identity and includes the clothes you wear, your hairstyle, and your body language (how you walk, your posture, your gestures). In society, people often take their cues from someone’s gender expression to assume that person’s anatomical sex.
Transgender is a broad term that covers many different groups. It can include transsexuals (in all stages of transitioning), crossdressers, drag kings and queens, and people who are intersex, among many others (see the following Q&A for definitions of these terms). People who are trans might identify in a variety of ways. (For more about self-describing and its relevance, see “Describing Your Gender Identity.”)
What it feels like to be trans is different for every person, although many describe some common experiences, such as feeling “trapped in the wrong body.” Others describe it more as having an internal sense of self that isn’t reflected on the outside by their bodies. It can be confusing to feel female inside and look at yourself in the mirror and see an anatomical male looking back at you. Still others report that the experience of being a trans person can be incredibly liberating, freeing them from stereotypes and how gender is defined, expressed, and felt.
Been There:
“From a very early age I knew I was different. I always preferred dressing up as a princess rather than a police officer or fireman. This carried on through my childhood and into my teenage years, when I became increasingly frustrated about not being able to be the girl I wanted to be. When I came out to my parents, I explained that I never felt right as a male, and that I always wanted to be a girl.”
—Alycia, 19
Trans Q&A
You might have a lot of questions about what it means to be transgender. If you do, you’re not alone. While the GLBTQ community as a whole is working for greater visibility and more rights, gay, lesbian, and bisexual people still tend to receive more recognition and acceptance than those who are trans. As a result, it’s still common for people to be uninformed about transgender issues. This sometimes is true even within the queer community.
Here are some common questions and answers about being transgender:
Q: Why are people transgender?
A: According to PFLAG, many in the scientific community believe that being transgender is the result of complicated biological factors that are determined by the time someone is born. This means that you don’t become transgender or choose to be transgender—you’re born a trans person.
Q: Is being transgender a mental disorder?
A: The mental health community labels one aspect of the transgender experience as gender dysphoria—a term for the pain, anxiety, and confusion that can result when a person’s gender identity and biological sex don’t match. The pressure to conform to accepted gender roles/expression and a general lack of acceptance from society also can contribute to gender dysphoria.
Mental health professionals often diagnose transgender people with gender identity disorder (GID). Transgender activist and health researcher Jessica Xavier explains that some trans people struggle with the advantages and disadvantages of being diagnosed with GID. A diagnosis of GID enables access to mental and physical treatment, which can be especially helpful for people trying to physically transition their genders. The downside of a GID diagnosis can be the stigma of being diagnosed with a mental disorder, which might encourage people to treat trans people like they’re sick or mentally ill.
It’s important to note that although the GID classification is labeled as a disorder, it doesn’t mean that trans people are mentally ill. Treatment for GID generally (though not always) involves physical modifications to help bring one’s body into harmony with one’s emotional and mental self—not vice versa.
Q: Do all trans people want to have surgery to change their anatomies?
A: No. Many people do, but others do not. According to the Gay and Lesbian Medical Association, roughly 1,600–2,000 people undergo gender reassignment surgery in the United States each year.
In an effort to deal with their gender dysphoria, many trans people do go through a period of gender transition. During this time, they begin to change their appearance, and often their body, to match their gender identity. This might mean that they start wearing different clothing and changing their hairstyles to reflect the gender they feel they are on the inside. People may also change how they walk or move and adjust the sound of their voices. Some undergo minor cosmetic procedures such as electrolysis (permanent body hair removal) as well.
Gender transition doesn’t necessarily mean surgery. It is a misconception that all trans people want to change their anatomies through sex reassignment surgery (SRS). Sex reassignment surgery modifies primary sex characteristics (the genitals) and is sometimes accompanied by surgeries on secondary sex characteristics as well (such as breasts or the Adam’s apple). People who don’t identify with the sex they were born as, and who might change their bodies through hormones and surgery to reconcile their gender identity and physical sex, are referred to as transsexual. All transsexual people are considered transgender, but not all transgender people are transsexual.
Nonoperative transsexuals might not be interested in or able to have surgery (which can be very expensive). They may or may not take hormones as part of the transition process. Some trans people take hormones and go no further in physically transitioning. Others are preoperative transsexuals—they might be in the process of transition and plan to have sex reassignment surgery. Other trans people are postoperative transsexuals, which means they have had the hormone therapies and surgeries needed to complete a physical transition. Surgery is usually restricted to those over the age of 18, although this matter is the topic of much debate.
A Victory for Trans People: On February 2, 2010, the U.S. Tax Court ruled that Rhiannon O’Donnabhain, a postoperative trans woman, should be allowed to deduct the cost of her sex-change operation (about $25,000). O’Donnabhain had deducted the expenses when filing her taxes, but the IRS rejected the deduction on the grounds that the surgery was not medically necessary. In its decision, the U.S. Tax Court stated that the IRS’s position was, “at best a superficial characterization of the circumstances” that is “thoroughly rebutted by the medical evidence.” The legal group Gay & Lesbian Advocates & Defenders represented O’Donnabhain.
Q: What does intersex mean?
A: Intersex people are born with both male and female genitals, or with ambiguous genitalia. Some intersex people have surgeries, often in infancy and throughout childhood, to definitively assign them one anatomical sex. The surgery doesn’t always result in a physical sex assignment that matches the person’s internal gender. As a result, some intersex people grow up with gender identity issues that mirror those experienced by transgender people.
Q: Who are crossdressers?
A: Crossdressers (once called transvestites) are people who dress in clothing traditionally worn by the opposite sex. They might do this in private or in public. Crossdressers can be male or female, and they may be straight, gay, lesbian, or bisexual. Crossdressing does not necessarily indicate that a person is trans.
Q: Are transgender people also gay, lesbian, or bisexual?
A: Some are, but many are not. It’s a common misconception that transgender people are all gay, lesbian, or bisexual. In fact, many trans people are straight. Some trans people are assumed to be lesbian or gay because of their gender expression.
However, some straight trans people might at first come out as gay, lesbian, or bisexual. Even though they have a different gender identity, they’re attracted to persons of the same anatomical sex, but they haven’t explored the possibility of being transgender. Other people who eventually realize they are transgender may initially perceive feelings of being of the opposite anatomical sex to mean that they’re gay or lesbian. This is probably because gay and lesbian people are generally more visible in society than transgender people. It might not be clear to a teen that he is transgender because he doesn’t know (or know about) transgender people or just hasn’t reached that point yet in his identity formation.
Been There:
“I spent a period of my life going out with other girls, as lesbians. But something didn’t quite feel right. I’ve always wanted to be a guy, physically.”
—Kevin, 18
Q: If many transgender people are straight, why are they often lumped together with gay, lesbian, and bisexual people?
A: Transgender people share much of the same struggle for acceptance, recognition, and civil rights as gay, lesbian, and bisexual people. The issues of gender expression and sexual orientation often overlap. Frequently anti-queer bias and behavior have a lot to do with gender expression (rather than sexual orientation).
A female who wears her hair short and prefers to wear traditionally male clothing might be harassed or called a lesbian because she’s stepping outside her traditional gender role. She might be lesbian or bisexual, she might be transgender, or she could just like having short hair and wearing more traditionally masculine clothing. People aren’t reacting to her sexual orientation, they’re responding to her gender expression. Some people feel threatened or afraid and might discriminate or get angry when they see people expressing their gender in nontraditional ways. Gay, lesbian, bisexual, and trans people often face this same discrimination when they don’t conform to other people’s ideas of gender. It’s also possible for straight people to face this form of discrimination.
Transgender people have at times even faced discrimination from the gay, lesbian, and bisexual communities. This has been due to a lack of understanding about trans issues and an unwillingness to work together for greater acceptance of all GLBTQ people. One of the great things about GLBTQ teens today is their increased willingness to be inclusive and not draw lines between what it means to be gay, lesbian, bisexual, or transgender.
Describing Your Gender Identity
Because transgender is a blanket term that covers several distinct but related groups of people, self-description can be important to many trans people. People who are transgender may use a variety of different terms to describe themselves (self-identify).
There is some debate in the trans community about what terms can be applied to who. For example, some postoperative transsexuals—those who have taken hormones and had surgeries to more accurately reflect their gender identities—don’t call themselves transsexuals. As far as they’re concerned, they have become members of the opposite sex.
In the end, how a person identifies is a very personal decision. No one but the individual can choose what label to use. People choose to identify in many different ways: transgender, female-to-male (FTM), male-to-female (MTF), genderqueer, gender neutral, multi-gender, transman, boi, and many others. How you identify (if you choose to at all) should be, first and foremost, comfortable and meaningful for you.
Been There:
“I came out to my family at the age of 15 as a lesbian. At the same time, I was questioning whether I was really a boy or girl. Many times I would let the issue go and then come back to it. Finally, at 25, I was ready to really try to figure it out.”
—Lee, 26
How Do You Know? Figuring Out If You’re Transgender
As with figuring out if you’re gay, lesbian, or bisexual, self-discovery is a process. Maybe you’ve felt like someone of the opposite sex for as long as you can remember. Or perhaps you’ve only had a vague feeling of being different that you haven’t been able to define. You might arrive at the conclusion that you’re transgender relatively easily, or it could take months or years to figure out.
There isn’t a checklist that can clearly indicate if you’re transgender, but trans people do tend to share some common experiences. Perhaps some of these are familiar to you:
Have you ever felt like there is a conflict between your body and your mind? People often describe the experience of being transgender as feeling like they’re trapped in the wrong body. Today’s teens, though, because of increased openness toward exploring a variety of gender roles and ways of expressing gender identity, sometimes describe being transgender as feeling gender neutral, gender different, or simply “other.” Some trans teens feel confusion over issues of gender while others are comfortable mentally and emotionally residing in that more fluid gray area of gender identity.
As you grow up, especially as you go through puberty, it’s common to have some feelings of gender confusion, or of openness to gender exploration and fluidity of gender expression. That doesn’t necessarily mean that you’re trans, or even gay, lesbian, or bisexual. Part of being a teen is evolving into a stronger sense of yourself. For many, that evolution continues for years, possibly an entire lifetime. And as long as you understand that whoever you are is okay at any stage of your life, that’s a good thing.
Been There:
“When I was a kid, everyone else seemed to know they were boys or girls or men or women. That’s something I have never known; not then, not today. As a kid, I just figured I was the crazy one; I was the one who really had some serious defect.”
—Writer/Performer Kate Bornstein, from Gender Outlaw: On Men, Women, and the Rest of Us
Do you dislike or avoid activities and interests that are usually associated with people of your birth sex? Dr. Milton Diamond writes that many trans people describe disliking and avoiding activities that are traditionally associated with people of their anatomical sex. Instead, they strongly prefer activities and behaviors that are traditionally linked with the sex with which they identify more. Often these likes, dislikes, and ways of behaving are obvious from an early age. For example, a young boy might enjoy playing with girls rather than roughhousing with other boys. He might hate sports, avoiding them in favor of playing dress-up and experimenting with his mother’s makeup.
It’s important to remember that being uncomfortable with or failing to embrace traditional gender roles doesn’t necessarily mean someone is transgender. Many young people who are not transgender engage in a variety of activities and behaviors that aren’t necessarily associated with their biological sex. In the case of most transgender people, however, it goes beyond exploring. They have very strong, almost overpowering feelings related to their interests and behaviors.
Do you have thoughts of wanting to be the opposite physical sex? It’s one thing to occasionally have a thought like, “Life would be easier if I were a guy,” or, “I wonder what it would be like to be a girl?” It’s another to have a persistent desire to actually be the opposite sex.
Been There:
“I’ve always been fascinated with the idea of being a girl, I guess. I used to watch this show about a boy who suddenly acquires the ability to become a girl when he comes into contact with hot water. I could never really understand, though, why he was so very distressed about being a girl.”
—Chris, 19
Do you identify strongly with experiences of people who are transgender? One way to explore your gender identity is to find out more about trans people. It can be helpful to read about their experiences or talk with someone who identifies as transgender. You could find that, while people use different language to describe their experiences and feelings, what they’re talking about really resonates with you and is something you can identify with.
Dirt Diva: Professional mountain bike racer Michelle Dumaresq is a postoperative trans woman. Dumaresq entered her sport in 2001, six years after completing SRS. She appeared in Dirt Divas, a film about female mountain bikers, and is the subject and star of the documentary 100% Woman. Dumaresq’s participation in female competitions has not been without controversy, as some believe she has an unfair advantage because she was born male. Dumaresq has commented, “I never set out to change the world or anything, I just want to race a bike.”
Been There:
“It’s hard to say definitely how I became aware of my gender identity. I think it was really while I was surfing some websites and reading stories about transsexual people that I realized not all guys fantasize about growing breasts or have dreams of suddenly and inexplicably being changed into a girl.”
—Andrea, 19
Now What? Options for Trans Teens
What do you do when you realize you’re transgender? This is a complex question, and it’s one that has many possible answers. You could wait and think about things. You could come out as transgender. You could decide to change your name or start dressing differently and possibly start transitioning socially into your gender identity. Or you could decide that you need your body to reflect your identity and start looking into procedures for physically transitioning.
But the first thing you’ll need to do is accept yourself. Try to resist any urges you might have to label yourself as odd or abnormal. This can be very difficult for some people. Being a trans person doesn’t mean something is wrong with you. It’s part of who you are and there is nothing wrong with that. It might take time to come to terms with being transgender, and you might need help to work through what being trans means for your future.
Coping with Negative Emotions
Even if you’ve realized and accepted that you are transgender, your process probably isn’t over. According to PFLAG, unlike gay, lesbian, and bisexual people who feel conflicted largely as a result of an emotional dilemma, trans people feel conflicted because of a physical dilemma. A disparity between gender identity and physical self can create an ongoing struggle.
That continuing struggle can have devastating emotional effects, particularly if the trans person believes there’s no hope for change or progress. According to a study published in the Journal of Homosexuality, 33 percent of trans teens have attempted suicide. That’s one-third.
Because you’re working through emotional and identity issues that can be very complicated, it’s important to get help. Here are some ways to do that.
Find support. You might reach out to family members, friends, adults at school, or others you trust. It’s important to find support from those who are nonjudgmental. The people you talk to should listen to you and your feelings with your best interests in mind, not push their own agenda onto you. Talk with those who will take time with you and who won’t discount your feelings as “a phase.” Even if you have family and friend support, it’s a good idea to talk with a trained professional at some point, preferably someone knowledgeable in transgender issues. Being transgender can evoke a lot of complex feelings, and it’s helpful to talk to someone who understands that.
If you don’t feel comfortable talking with someone you know, don’t give up. A lot of resources are available to you. In addition to national organizations, many local groups support trans people. A variety of websites have bulletin boards, forums, or chats where you can communicate with other trans people. See “Organizations for Transgender People” for a list of resources.
Seek counseling. Researcher and transgender activist Jessica Xavier advises trans people to seek counseling, not because something is wrong with them that needs to be changed, but because it’s a way to get needed support. Therapy should be aimed at helping you understand, accept, and feel good about your personal identity. (If your counselor tries to convince you to deny your gender identity or conform, seek out someone else.) It’s common for people to feel uncomfortable about gender issues and internalize fears about trans people. A skilled counselor can address these issues and help you understand that absolutely nothing is wrong with who you are. You might start your search for a counselor by contacting a local or national GLBTQ or trans organization.
Camp Aranu’tiq: Ever wish you could be around others who understand what it’s like to be trans? Camp Aranu’tiq is a weeklong, tuition-free overnight summer camp held in Southern New England for transgender and gender variant young people ages 8–15. Aranu’tiq is a Chugach (an indigenous people of Alaska) word for a person thought to embody both the male and female spirit. Such people were revered because of their ability to transcend traditional gender norms. For more information, visit camparanutiq.org.
Coming Out
After you realize you’re trans, you might decide to come out. It could be to only a few close friends or family members, or it could be to many people. This is particularly important if you want to start living in a way that better reflects your gender identity. Transgender people who wish to transition their genders are usually forced to come out because changes are so obvious to others.
Coming out—whatever the circumstances—can be a stressful process for everyone involved. And just like coming out as gay, lesbian, or bisexual, the people you’re coming out to might react in many different ways. Some may be accepting, others might be confused, sad, or angry. (See Chapter 3 for advice on coming out.) The people you’re coming out to also might be confused if you’ve previously come out to them as gay, lesbian, or bisexual.
According to Jessica Xavier and PFLAG, parents especially might have serious difficulties dealing with their children coming out as transgender. Some believe they’re losing a son or daughter. When a teen tells family adults that she wants to live her life as someone of a different gender, they might experience feelings of grief similar to death. It might feel like the daughter they raised has suddenly been taken from them.
The people you come out to might not understand what it means to be transgender and may have a lot of questions for you. It can be hard for your parents and other people who care about you to learn that you have been struggling with such difficult issues. They might worry about you and your future. However, they might want to help and support you.
Organizations for Transgender People:
Human Rights Campaign (hrc.org). Human Rights Campaign offers the latest information on advocacy for transgender people. Visit their site for the latest on legislative issues.
Been There:
“Coming out trans was the most nerve racking thing I have ever done. I had my doubts, but I had made up my mind it had to be done. My parents were shocked, as I expected, but they seemed to be happy that I’d told them. We talked about the possibilities for me for hours. They said as long as I’m happy, they’d support me in whatever I wanted to do.”
—Alycia, 19
“My dad discovered I was trans when he saw some sites I’d been looking at online. He eventually just said, ‘So, let’s talk about what you look at on the Internet.’ This was my cue to explain to him everything. He asked a lot of questions. He was very curious about me. He had done an amazing amount of research on the Internet himself. He looked up sex reassignment surgery doctors, including how much the procedure would cost. He found out all he could on hormones, and he even contacted a male-to-female trans person for information that might help me out. It did. It helped me out immensely just to know that there is someone who cares about me.”
—Amanda, 18
When you come out, it’s important to let your family and loved ones know that resources are available to help them, too. (See “Organizations for Transgender People” for a list of transgender resources.) Many national transgender organizations will help you find local support via websites or phone referrals. Your local phone directory might list additional resources. PFLAG also offers services for trans people and their families and friends, including an excellent brochure titled “Welcoming Our Trans Family and Friends.”
Changing Names
One of the first things many transgender people do is change their names to better reflect their gender identities. As a teen, you can’t legally change your name without a parent’s consent. But some teens do change their names in practice, asking families and friends to use their preferred names.
Changing your name to one that reflects who you are can be a positive way to assert your true identity. It can sometimes be difficult to get people to take your name change seriously or to accept it. Some parents, friends, and school administrators will be very supportive and accepting. Others will reject the idea completely.
If you’re certain that you are transgender and you’re thinking about changing your name, here are some things to consider:
Come out first. Telling your family and friends that you’re transgender and, in the same breath, asking them to call you by a different name can be a lot for people to process. It’s likely that they’ll have a lot of questions about what it means to be transgender. If you can help them understand that, they may be in a better place to understand why you want to change your name. However, if your parents seem fairly receptive to your coming out, you might want to discuss your name of choice right away. It’s up to you, but take it one step at a time and allow your family and friends to do the same.
Try to be patient. Some people will be respectful of your request to use your new name. Others will not. Even those who are respectful will probably need time to get used to the change.
According to clinical psychologist Dr. Sandy Loiterstein, a name change can be very difficult for parents to accept. They may see it as a rejection of something very personal they have given a son or daughter. Changing names can also deepen the grieving process many parents of transgender people go through because it can emphasize the idea of loss.
If your parents are struggling, it can be helpful for you together to see a therapist knowledgeable about transgender issues. Counseling can help them understand what you’re facing and help them adjust to your transgender identity.
Choose your name carefully. Put some thought into your new name. Choose one that’s representative of your personality or meaningful for you in some way. Also, it’s usually a good idea to choose a somewhat conventional name. If you ask people to call you something outrageous, chances are they won’t take you seriously.
Some trans people choose names that are feminine or masculine versions of their birth names. So Sam becomes Samantha and Charlotte becomes Charles. Others choose gender-neutral names, such as Alex or Chris. Some people might choose another name entirely. The most important thing is that you pick a name that feels like you.
If you want to change the name you use at school, get your parents’ support. It can be extremely difficult to get teachers and staff to use your new name at school. But having your parents behind you can help. They can be sources of support as you’re talking with your principal, school counselor, or teachers. Sometimes changing your name at school is easier if you’re starting classes in a different building or a new grade. People might have less to associate with your previous name.
Some transgender teens choose to use their birth names at school (or have to if their school refuses to use their new names) and use their chosen names at other times, depending on who they’re with and where they are. And some trans teens decide to wait until they’re older to change their names, either legally or in everyday life.
Gender Transitioning
For some people, a change in name is the first step in gender transitioning. Gender transitioning is a complex, multi-step process of starting to live full time as a person of a different gender. Transitioning doesn’t, by definition, include surgery or other physical changes, though for some people it does. It primarily involves factors that affect how you relate to others and how they relate to you. It might include changing your name, dressing differently, and altering other aspects of your appearance (like hair or makeup). It can also mean changing your mannerisms, voice, and how you move.
Gender transitioning can also involve many physical changes for some trans people. A physical transition might include taking hormones or other substances under the supervision of a medical professional. For some, transitioning may also include surgery. This is an option almost always reserved for adults. As a transgender teen it is very unlikely that you can undergo sex reassignment surgery, although you might be able to work with an endocrinologist who can assist you with hormone treatments. It is rare to find physicians willing to prescribe hormones to those under 18, but some will.
Been There:
“Perhaps it all began when I was but a child, maybe six years old, watching Saturday morning cartoons—specifically, Bugs Bunny donning a dress and wig. I was enthralled at the transformation. This, I decided, was what I would aspire to. That’s as far back as I can recall about my ‘difference.’”
—Zelia, 15
Physical Transitioning
Undergoing a physical gender transition can be a long and complex process. For some transgender people who wish to undergo a full physical change, it can be a vital and rewarding process. Many steps and medical professionals are involved, and some services can be very difficult for those under 18 to obtain. It is extremely rare that minors are allowed to undergo full physical transitions. Sex reassignment surgeries also are very expensive, and many people save for a long time to afford them.
The physical transitioning process takes a long time for many reasons. Some physical changes take months or even a few years to complete. Medical professionals must supervise the physical transitioning process, and they can help you explore feelings and decisions along the way.
If you want to transition, especially if you want to pursue sex reassignment surgery (SRS), you’ll need to know about the Standards of Care. These guidelines were created by the World Professional Association for Transgender Health (formerly the Harry Benjamin International Gender Dysphoria Association). They are the standards under which most trans people obtain hormone therapy and SRS. Few surgeons perform SRS, but most, if not all of them, follow these standards.
The Standards of Care include a period of psychotherapy (to confirm someone is a trans person), the beginning of hormone therapy (which is a lifelong process), the administration of the Real-Life Experience (living full time as your intended gender for a period of time), and finally, if desired, SRS.
Typically, a period of psychotherapy is required before a person begins taking hormones. The therapy and assessment period can last for three months or longer, depending on the mental health professional and the person receiving treatment. Young people often feel like the validity of their transgender identity is being questioned. It might seem like the professionals assessing them believe they’re going through a phase or overreacting. It can be frustrating to feel like others are second-guessing something you’re very certain about. Try to release those feelings in a positive way, like by writing about them in a journal. (See Chapter 8 for more ideas for dealing with negative feelings.)
Been There:
“I think the most difficult part of being transgender is the way my gender identity and my body just don’t match. It’s a constant source of frustration and annoyance for me. I’m not currently on hormones because I have not had enough counseling yet. One of the things that annoys me most is others having the attitude that they have to protect a young transsexual from herself.”
—Rylan, 19
The Real-Life Experience is a period (a minimum of one year) during which a transitioning person must live and work, if he is in the work world, full time as someone of the sex that matches his gender identity. In other words, a female-to-male (FTM) person would have to live as a man for a minimum of one year. This isn’t a traditional test, as you might think of one. It’s more of an experience monitored by medical professionals. According to the Standards of Care guidelines, the purpose of the experience is “to allow you to overcome awkwardness, establish new behavior patterns, and approach unfamiliar situations with an unforced inner confidence.”
Only after successful completion of the Real-Life Experience (as determined by a supervising physician) can a person become a candidate for SRS. “Success” in this case is not an indicator that the person has done something correctly, but that the experience has confirmed that the person truly wants and can handle the physical transition.
Sex reassignment surgery involves the permanent refashioning of the sexual anatomy. Beyond genital surgery, many trans people undergo additional procedures. Male-to-female trans might have facial and body hair removed, an operation to reduce the size of the Adam’s apple, and various cosmetic surgeries to achieve a more feminine-lookingface and body. Some might also have breast augmentation surgery, though many just rely on their hormone treatments (which cause the body to develop breasts) and/or surgery on their genitalia. Female-to-male trans might have their breasts removed and/or surgery on their genitalia. Even with these procedures, being able to “pass” as your new physical sex isn’t guaranteed. Some people never pass completely. But many do.
Some teens get impatient with the transitioning process or find it difficult to obtain hormones from a doctor or clinic, so they buy hormones on the street. This could have serious negative physical and legal consequences. As with other drugs, hormones bought on the street could contain anything and their strength and dosage is unknown. Hormones should be taken only under the supervision of a doctor, preferably an endocrinologist, and at the proper dosage (which varies from person to person). If you’re under 18, you might have to wait a while to obtain hormones legally.
Trans Pride: Responding to Transphobia
Transphobia is still common because traditional ideas about gender and gender roles tend to be so deeply rooted in society. The general lack of understanding about what it means to be trans can make it difficult for transgender people to find acceptance from their families, school officials, and society as a whole. Transphobia can lead to name-calling and discrimination and can also escalate into harassment and even violence.
As with homophobia, you can respond to transphobia in many different ways—by ignoring it, speaking up, attempting to educate people, or getting involved in working for change. However, be very careful to assess the situation before deciding how to respond. According to GLSEN, trans students and others who challenge traditional gender roles in obvious ways often endure the greatest harassment and worst physical attacks. While safety is a big concern for gay, lesbian, and bisexual students, it is a huge concern for many transgender students.
If you’re being harassed at school and adults there refuse to act, you can get help. Organizations such as GLSEN, the National Gay and Lesbian Task Force (NGLTF), and the American Civil Liberties Union (ACLU) can help you fight discrimination in your school. Transgender and gender rights advocacy groups can help, too. Contact information for these groups can be found in this chapter or in the Resources section.
Facing Discrimination
Social pressures to conform to gender stereotypes can be extreme. Because gender expression is so visible and obvious, it’s easy to find yourself facing unwanted attention or harassment. Trans people who are transitioning, or those who can’t pass, can be especially vulnerable to harassment and physical abuse. While there are currently few legal protections for trans people, the climate is starting to change. For example, there is a push to add transgender people to protections that include sex and sexual orientation. The Matthew Shepard and James Byrd Jr. Hate Crimes Prevention Act, passed in 2009, covers crimes motivated by a victim’s actual or perceived gender, sexual orientation, gender identity, or disability. For information on the most current legislation, visit the HRC website (www.hrc.org).
Just as with gay, lesbian, and bisexual people, discrimination against and abuse of trans people is never okay and it is never justifiable. If you have been attacked, report the attack to the police. If the police refuse to recognize your claim or file a report, a national organization such as Lambda Legal (www.lambdalegal.org), the National Gay and Lesbian Task Force (www.ngltf.org), or the ACLU (www.aclu.org) might be able to help. Many transgender groups can also help (see “Organizations for Transgender People”). These organizations advocate for trans people and lobby for their legal rights. You do not have to suffer alone or in silence.
Trans people also can face discrimination at work, in part because the transition process is so readily apparent. In 2009, transgender activists succeeded in getting an amendment added to the Employment Non-Discrimination Act (ENDA). If passed, this act would make discrimination in the workplace based on sexual orientation or gender identity illegal. (For more on ENDA, see Chapter 11.)
In spite of the harsh discrimination many trans people face, increasing numbers of people are coming out as transgender. This increased visibility will help educate others about what it means to be trans. Transgender people can face difficult issues, but many live very meaningful, fulfilled, and happy lives. The most important thing you can do is accept yourself for the wonderful person you are.