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Posts tagged ‘transitioning’

A Response to New York Times ‘Ethicist’ Chuck Klosterman

In the February 3rd New York Times Magazine, Chuck Klosterman (‘The Ethicist’) addresses the following Question from a reader:

I’ve been living the life of a married man for 20 years. I have a successful career and three children. All this time, however, I have battled gender dysphoria and the deep sadness that comes from living a lie. From the earliest age, I’ve been unhappy being male. I believed I would find happiness only once I was true to myself. I recently had my self-diagnosis confirmed, and I’m initiating a transition to living as the real me. There is a cost involved: pain to my family and stress on my career. Ethically, is it right to be “true to myself” even if that authenticity ends my otherwise happy marriage and damages the emotional stability of my three children? If I had to maintain the lie, the emotional cost would be tremendous; a transition would share the pain with all who love me but might result in happiness. What’s the ethically correct thing to do? NAME WITHHELD, MASSACHUSETTS

The following is my response (which I also sent the the New York Times).

In Response to Chuck Klosterman’s February 3rd ‘Transition Point’.

Ethical Issues Gender TransitionChuck Klosterman (The New York Times ‘Ethicist’) response to a (natal) Massachusetts man’s question on gender transition wraps itself around the idea of measuring happiness.  He talks about the potential happiness of the transitioning man vs. the loss of happiness of his wife and kids.  He notes that there already “is happiness in your life”, and that the transition “might do damage” to the children who “lack the intellectual and emotional maturity to comprehend what’s really happening”.

What is really happening?  As a therapist who has specialized in Transgenderism for the past 18 years I know that people of this age come to see me when they can no longer live with their Gender Dysphoria.  It’s not about happiness; it’s about no longer being able to continue as they have in the past.  Gender Dysphoria is an intense, psychologically painful and anxiety laden state which can intensify over time to the point of being intolerable.  Gender is our first and most intimate identity, and to have that be wrong in some way is deeply disturbing.  I have had many people say some form of:  “there is no choice, it’s either this or I kill myself”.  Furthermore, transitioning is a process of becoming who one authentically is.  I think that’s a pretty good lesson for kids.

The ‘problems’ inherent in all this is that there is significant stigma and discrimination around being transgender in our society.  The only way to combat this is for brave people to acknowledge and be who they are and try and maintains good relationships with those around them.   I think if we envision a person in other (and now less) stigmatized groups in Mr. Klosterman’s article, the issue becomes clearer.  For example – an African American man in, say 1940 wanting to marry a white woman, or a gay person of the same era wanting to be an “out” school teacher… all things that the individual’s family would have not been too happy about.  Transgenderism is at the point in its own unique history of discrimination evolution where these groups were 30 years ago.   Is it easy to have a family member who is a member of a stigmatized group?  No.  Is the answer to have that person disavow their membership and suffer in silence in order to not embarrass anyone?  I don’t think so.

Mr. Klosterman’s “advice” is a good example of a person attempting to grapple with the issue of Gender Dysphoria while possessing only surface knowledge of the subject.   When public figures, doctors, psychiatrists and others do this – they do harm.   This is decidedly ‘un-ethical’.  Mr. Klosterman  – please do your homework and write a better response.

Ami B. Kaplan, LCSW

New York City Psychotherapist

Member of the ‘Policy and Procedures’ and ‘Child and Adolescent’ Committees of WPATH – the World Professional Association for Transgender Health.

www.amikaplan.net, www.tgmentalhealth.com

Book review: Letters For My Brothers: Transitional Wisdom in Retrospect

Letters For My Brothers

Edited by Megan M. Rohrer & Zander Keig. 2010 Wilgefortis. Kindle Edition.

With writing by: Jamison Green, fAe Gibson, Cristopher Bautista, Chase Ryan Joynt, Malcolm Himschoot ,Lou Sullivan,  Reid Vanderburgh, Aaron Raz Link, Elliott Anthony Brooker, Aaron H Devor, Patrick M Callahan , Zander Keig, C.T. Whitley, Raven Kaldera, Tucker Lieberman, Lyle Blake, Keith Josephson,  Evan Anderson and Matt Kailey.

The book provides the newly-transitioning man with the wisdom of nineteen older brothers who have traveled the road before and offer their views, advice and thoughts on the trip.   As one of the editors – Megan Roher notes in the introduction to this Kindle book “Transmen, who rely solely on online materials to learn about transition, miss out on the wisdom that can only be found in a mentorship experience.”

The short, to the point chapters are a refreshingly devoid of artifice.  The standouts (for me) are Christopher Bautista’s essay which expresses the powerful impact of acceptance:

 …reading that little piece of paper was the most terrifying thing I had ever done. But the entire class of a hundred something people, all of them, started clapping for me. All of that previous frustration from the quarter melted away. I had made my declaration to the class, and they had accepted me. I had never thought this would happen. I no longer had to pour so much effort into trying to pass as a guy, to dress like one, act like one, talk like one, like I had to do in the outside world. My class was fine with who I was, awkwardness and all. And for the first time that quarter and in my whole life, I felt like I belonged somewhere. It felt like home.

Chase Ryan Joynt’s essay expresses doubt and uncertainty about what type of man he should be and will be.

…I struggled for a long time with the various versions of masculinity that were represented in my community. Upon reflection I think that I subconsciously attempted to fit myself into the versions of trans that I thought were acceptable and available…

Reid Vanderburgh gives clear advise and reassurance on various tricky points in transition, such as:

Let yourself feel lonely. You’re losing your lesbian community, and you don’t yet have community to replace it. That’s okay. You didn’t fit that identity, and now that you know it, you really can’t stay. Know that in the future, your individual lesbian friends are still going to be there, but it’s not going to be the same.

Aaron H Devor, an academic writes particularity well on discoveries about male privilege:

…everything I say now sounds more authoritative, or more ominous, or both. Sometimes that works in my favour. Sometimes, especially with women, that evokes fear, resentment, or hostility. I think that I’m just making a plain statement. They see and hear me throwing my weight around. I get tense and may raise my voice a bit in anger because I’m hurting. They perceive me as being scary and abusive.

There are more examples, but I recommend getting the book!

On the down side the writing was uneven, as can be expected in a group project and there was some subtle anger towards male to female trans folk:  “…I have quit working at [].. Felt I was wasting my time on all those male-to-females.” and  “In hindsight, not being in that group was one of the best things that could have happened to me, as it was led by a domineering transwoman who had a ‘my way or the highway’ attitude about how transition was supposed to work.”

However, that aside, there’s a lot of wisdom, comfort and inspiration to be found in these pages and any newly transitioning trans-man will want to read them at least once if not more and hopefully will also be inspired to go out and find some real-live brothers to connect with.

On Regret of Gender Transition

There are some people who undergo a gender transition (either fully or to some extent) and then regret having done so and “de-transition”.  This post attempts to explore this phenomenon.

Some reasons why this might occur include:

  •  The person is not transsexual.  The person may have found by going through their transition that they are not in fact comfortable living in the other gender and that they feel either gender queer or more closely aligned with the natal gender.  Certainly instances of transitions involving surgery might have been prevented if there were a greater attempt to determine this beforehand; however, just like with non-trans issues, we often go ahead with things we think are right for us only to discover that they aren’t.  Sometimes the discovery just isn’t possible without trying it out.  The ‘real life experience’ (see WPATH’s standards of care) is an attempt to systematize this discovery process before any major surgeries.
  • Regardless of whether the person is truly transsexual or not, it’s possible that because of having lived so long with gender dysphoria and accompanying social and physical dissatisfaction, one may think of a full gender transition as a magical ticket to happiness.  I have seen this (sometimes unconscious) wish accompanied by other unrealistic expectations such as:  the idea that one will have a social community, better social skills, be more popular, etc.  When this turns out not to be true, there can be confusion and uncertainty that tends to focus on one’s gender transition.  It may be that the gender transition was in the person’s best interest, yet other causes of unhappiness and personal problems had not been sufficiently explored and worked through.  Sometimes with gender variant people, work on other problems are delayed because the gender issues tend to take precedence.
  • The person encountered too many problems with transition (i.e. dissatisfaction with their post-transition life).  These problems could include lack of family support, loss of partner, problems with transition in the workplace, disappointment with the outcome of surgery and problems “passing” as the new gender.  Additionally, transitioning is hard.  There are many hoops to jump through and one enters into a group of discriminated against people.  This can be exceedingly disconcerting for some.

Levels of regret

Certainly a person who has made a gender transition can have certain regrets that are not extreme enough to cause them to wish to de-transition.  The WPATH Standards of Care notes that “cases are known of persons who have received hormone therapy and sex reassignment surgery who later regretted their inability to parent genetically related children”.  Other less extreme regrets can involve loss of certain benefits of privileges commonly associated with one gender or another.

Some research on regret:

Pfafflin F., Junge A. (1992) Sex Reassignment: 30 Years of International Follow-up Studies after SRS: A Comprehensive Review, 1961-1991 [publication online]. Translated from German  into American English by Roberta B. Jacobson and Alf B. Meier. IJT Electronic Books.

This study looked at 70 previous studies and reviews on outcomes following sex reassignment surgery.  These included 2000 individuals from 1961 to 1991.  This doesn’t take into account individuals who transition without surgery.  About 70% of MTF individuals were satisfied and 90% of FTM individuals.

Krege S., Bex A., Lummen G., et al. (2001). Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients. BJU International. 88:396-402.

 This study shows little or no regrets possibly due to surgical advances.

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you. email: info@amikaplan.net

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