by Robyn Ryle
TRANSPHOBIA
n. /ˌtranzˈfō-bē-ə/
Hatred for or prejudice against transgender people.
As a trans woman, you might feel that the changes brought on by hormone therapy create the type of gendered body that fits your sense of who you are. Or you might feel that sex reassignment or gender-confirming surgery is what you need in order to create the right body for yourself. If that’s the case, you’ll probably have to take hormone treatments for one year before you can have surgery. The process involved in getting access to gender-confirming surgery depends on where you are.
You’re in the United States. GO TO 96.
You’re in Thailand. GO TO 97.
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You decide not to have surgery, because there are as many ways to be a trans woman as there are to be a cisgender woman. A body unaltered by surgery feels okay to you. Maybe you don’t take testosterone blockers or estrogen, either. Dressing as a woman, changing your name, and asking people to use feminine pronouns might feel just right to you.
You might find yourself having to explain to other people why you’re not having gender-confirming surgery, which is weird. No one tells cisgender people what surgeries they should or shouldn’t have, so why do people—both within and outside of the transgender community—feel compelled to tell you what you should or shouldn’t do with your body? In fact, the ability to not have people, even sometimes complete strangers, ask you questions about your genitalia, is a good example of a cisgender privilege that you don’t have as a trans woman. What you do or don’t do with your body should be no one’s business but your own, but that’s probably not the way it will work.
If you don’t have surgery or use hormone therapy, you might find it harder to achieve social femaleness. It might be more difficult for people to interact with you as a woman, because their gender attribution doesn’t line up with your feminine gender identity. Gender attribution is the process by which people see you and say, “That’s a woman,” or “That’s a man.” We all engage in gender attribution when we see people, drawing on a long list of cues to help us out. What people look like is an important part of gender attribution, but so is who they’re with, how they interact, and how much power they have in a given situation. For example, if you see a couple holding hands or kissing, heteronormativity might dictate that you assume one of the people is a man and one of them is a woman. Heteronormativity is the assumption that heterosexuality is normal and right. If you see someone wearing the trappings of power—dressed as a police officer or in the uniform of a high-ranking military officer—you might be more likely to assume that person is a man. These and other cues help us decide on the gender of the people with whom we’re interacting.
GENDER ATTRIBUTION
n. /ˈjen-dər ˌa-trə-ˈbyü-shən/
The process by which an observer guesses which gender they believe another person to be. Once a person makes an attribution, it can be difficult to change their mind if they happen to be wrong about the person’s gender.
We believe that we’re pretty good at gender attribution, so most of the time, it’s automatic. You don’t have to stop and think about the gender of people you see, even if a lot of the time, you might be getting it wrong. Gender attribution usually rises to the surface of our consciousness only when there’s some gender ambiguity—when we can’t tell for sure what someone’s gender is. This is more likely to happen to you, as a trans woman, and not fitting into people’s preexisting gender categories can be a dangerous thing. In 2016, twenty-two transgender people were murdered in the United States, and the majority were trans women. Trans women of color are especially vulnerable to violence—almost half of those murders were committed against trans women of color.
As a trans woman, you’re at a disadvantage when it comes to gender attribution. Our default mode when we’re sorting people into different genders is man. That is, we assume that people are men until something proves us wrong. That means that it might be harder for you to achieve social femaleness—for people to assume that you are a woman and interact with you on the basis of that.
GO TO 50.
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Puberty starts for you before it does for the rest of your friends. Your voice starts to get all squeaky before settling into a deeper range. You get wet dreams at night and embarrassing erections during the day. Hair starts growing in new places (on your face and in your armpits and between your legs). Being first is good.
There are certainly aspects of puberty for boys that can be embarrassing or annoying—like your squeaky voice. But the social meanings attached to this transition are pretty positive for you. To become a man is to become powerful. If you develop earlier than other boys, they’ll most likely be jealous of your deeper voice and the way your body starts to bulk up. You might tease the other boys who are lagging behind.
Puberty is one part of how your experience of gender will be embodied, which means that gender as a category interacts with our bodies in important ways. One of those ways is through ability or disability. Gender intersects with the degree to which your body is seen as abled or disabled. In other words, is your body seen as “normal” and capable of doing the things required of bodies in your society, or is it viewed as incapable to some extent of doing the things expected of “normal” bodies?
You have a temporarily abled body. GO TO 98.
You have a disabled body. GO TO 99.
92
It feels like everyone else’s voice is settling into a deeper range, while yours still sounds like a girl’s. Your body is still smooth and hairless. Being last sucks.
Boys who hit puberty later are certainly likely to get teased. You and other boys might compare how big your muscles are. If you hit puberty late, you’ll probably lose these contests, as you take longer to bulk up in the way boys do around this age. You might start shaving your face even if you haven’t started growing any facial hair, because that’s what grown men do. Though there are unpleasant aspects of puberty for boys, becoming a man is generally seen as a good thing. It’s something you’ll probably look forward to eagerly, even if it comes a little later.
Puberty is one part of how your experience of gender will be embodied, which means that gender as a category interacts with our bodies in important ways. One of those ways is through ability or disability. Gender intersects with the degree to which your body is seen as abled or disabled. In other words, is your body seen as “normal” and capable of doing the things required of bodies in your society, or is it viewed as incapable to some extent of doing the things expected of “normal” bodies?
You have a temporarily abled body. GO TO 98.
You have a disabled body. GO TO 99.
93
You have a temporarily abled body. Your body is only temporarily able because at some point in our lives, all of us will be differently abled. You’ll break a bone and need to use crutches. You’ll hurt your back and walk slower than you used to. If you grow old enough, your mobility will eventually become limited. As a woman, if you become pregnant, certain restrictions will be put on you, and your body will, for several months, be unable to do many of the things that it usually can.
Pointing to the temporary nature of ability helps to highlight the way in which disability itself is socially constructed. That means that we create the boundaries and norms that make up what it means to be differently abled. Many people are unable to use steps. But if we lived in a culture where we made all of our buildings without steps, using elevators or ramps instead, many of these people would suddenly not be defined as differently abled or disabled. Some people are seen as disabled or differently abled because they can’t process written information as well as they can oral information. In a world where information was equally available in both formats, they would no longer be classified this way. The way we structure our society draws the lines between who is and isn’t seen as differently abled or disabled.
Nevertheless, for now you have a body that is defined as abl
e. That doesn’t mean that your experience of gender isn’t still deeply tied to the type of body you have and what your culture tells you about that body.
You feel good about your body. GO TO 111.
You feel bad about your body. GO TO 112.
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You have a disabled body, and that can mean a lot of different things. You might have a physical disability, which means that your body is incapable of accomplishing some tasks defined as essential in your particular society. Maybe you’re paralyzed and can’t walk. Maybe you have bad knees and can’t use stairs. Maybe you’re blind or deaf. You might also have a learning disability. Maybe you’re dyslexic and have trouble reading. Perhaps you have a mental disability, or you’re developmentally delayed.
Regardless of the particular disability you have, your experience of that disability will be shaped by the fact that you’re a woman. As a disabled woman, you’ll find it harder to live up to the beauty ideal for women in places like the United States. The beauty ideal is an ever-changing but always unobtainable standard for what women should look like in order to be seen as attractive and, in many ways, worthy. The important thing to remember about the beauty ideal is that everyone falls short. If your disability is visible, you’re even more likely to fall short of those standards. Disabled people in general are perceived as people who are neither sexually desirable nor particularly interested in sex themselves.
It will be difficult for you to keep these messages about the desirability of your body from affecting the way you feel about yourself. But your experiences of gender will remain deeply tied to your bodily experiences.
You feel good about your body. GO TO 111.
You feel bad about your body. GO TO 112.
95
You like gender the way it is and think it should stay the same. You might argue, Hey, it’s a lot better than it used to be, right? In some ways, yes. In other ways, no.
We like to believe that history is a straight line moving upward in terms of progress—including our views about gender. We want to believe that things just keep getting better, but that isn’t necessarily the case. The gender pay gap, or the difference between the average income of women and men, has pretty much stalled in the last thirty years. Even though more women than men are graduating from high school, college, and graduate school, so far those gains aren’t translating into women making more money. Some people argue that with the spread of European-influenced ideas about gender to the rest of the world, gender inequality has actually gotten worse, rather than better, over time. And people who don’t fit into society’s neat categories of cisgender, heterosexual male or female struggle every day with a lack of understanding and acceptance, as well as unequal access to opportunities and even some of the basic civil rights that many people take for granted.
Maybe gender as a social system now is better than it was in the past, but it’s fairly certain that things won’t stay the same. History doesn’t work that way, and there’s always the chance that things will get worse instead of better.
Pick another gender ending: TURN TO 148.
Or GO TO THE END to read the conclusion.
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In the United States, gaining access to gender-confirming surgery is a long and complicated process. You’ll first have to be diagnosed with gender dysphoria, which means that you’ll have to convince a psychiatrist or other mental health professional that the mismatch between your gender assignment and gender identity are causing you serious distress. This also means that the decision about whether gender-confirming surgery is right for you isn’t yours alone.
In the 1960s through about the 1980s, the process by which doctors decided who was allowed to have sex-reassignment surgery and who wasn’t could be somewhat arbitrary. As a trans woman, your surgery was more likely to be approved if you already looked like a feminine man. One physician at Johns Hopkins, one of the handful of hospitals that performed sex-reassignment surgery in the mid to late twentieth century, described bullying trans women who came to him seeking surgery. He would use their reactions to decide whether they were truly in need of the procedure: he claimed that true trans women would cry, while gay men would get aggressive. Physicians like him served as gatekeepers, but as word spread through transgender communities, those seeking surgery learned what they should and shouldn’t say in order to be approved.
In the United States today, you’ll probably have to live as a woman for a period of time before your surgery. If your doctor follows the World Professional Association for Transgender Health (WPATH) standards of care, you’ll have to live as a woman for a whole year before having gender-confirming surgery, though some experts and patients consider those standards too strict. During this year, you’ll change your name and go through all aspects of your daily life living as a woman. At the end of it, you’ll have to prove to your surgeon that you have been successfully living as a woman.
What does it mean to “live successfully” as a woman? In the past, WPATH standards of care used a list of set criteria to judge your success living as another gender. You had to undertake some combination of maintaining full-time or part-time employment, functioning as a student, or volunteering in a community-based activity. In other words, you couldn’t hide in your house for a year and successfully live as a woman. You were also required to acquire a legal, gender-appropriate name and to provide documentation that someone besides your therapist knew that you were functioning in your new gender. So you’d have to adopt a “feminine” name and get someone to testify to the fact that you’ve been living as a woman. These criteria might seem a bit excessive, and in 2011, the standards of care were revised to be more ambiguous. They now require “twelve continuous months of living in a gender role that is congruent with their gender identity.” What that means is left up to individual therapists and surgeons to decide.
Once you’ve cleared all those hurdles, you’ll be able to have gender-confirming surgery. Your surgery will most likely involve the removal of your testicles and most of your penis. Your urethra will also be shortened (cisgender women have shorter urethras then cisgender men), and some of the skin from your testicles will be used to create a functioning vagina. A clitoris of sorts can also be created from your penis that retains some sexual sensation. You’ll keep your prostate. The alterations to your genitalia make up what’s sometimes called bottom surgery. You might also elect to get top surgery, which means breast implants. Some trans women also have surgery to remove or reduce their Adam’s apple or to change their facial structure to look more feminine. You might also have certain types of surgical procedures while forgoing others. Maybe you decide on bottom surgery but elect against breast implants. Or vice versa.
GO TO 50.
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You’re not alone in heading to Thailand for your gender-confirming surgery—it’s one of the world’s most popular destinations for transgender people seeking this medical procedure. At just one of the nearly two dozen gender clinics in Thailand, surgeons perform two to three gender operations per week. As of 2015, there were at least one hundred Thai doctors qualified to perform gender-confirming surgery.
Why is Thailand such a popular destination for gender-confirming surgery? The surgery is much cheaper in Thailand than it is in many other places; it costs about a third of what it would in the United States. And there are a lot more clinics and doctors available in Thailand to perform your surgery.
You’ll also find it a much quicker process to get gender-confirming surgery in Thailand than in the United States and many other countries. It takes less time in Thailand because, unlike in the United States, there’s no protocol requiring you to live for a year as a woman before you can have access to gender-confirming surgery. Doctors in the United States and other places that follow the WPATH (World Professional Association for Transgender Health) standards of care would require you to demonstrate your full commitment before surgery by living as a woman, but this isn’t the case in Thailand.
Your ge
nder-confirming surgery will most likely involve the removal of your testicles and most of your penis. Your urethra will also be shortened (cisgender women have shorter urethras then cisgender men), and some of the skin from your testicles will be used to create a functioning vagina. A clitoris of sorts can also be created from your penis that retains some sexual sensation. You’ll keep your prostate. The alterations to your genitalia make up what’s sometimes called bottom surgery. You might also elect to get top surgery, which means breast implants. Some trans women also have surgery to remove or reduce their Adam’s apple or to change their facial structure to look more feminine. You might also have certain types of surgical procedures while forgoing others. Maybe you decide on bottom surgery but elect against breast implants. Or vice versa.
