Tag Archives: Dysphoria

Can I be non-binary and transsexual?

I talked in a recent blog post about ditching the term “binary trans person”. I want to talk about another binary in this blog, the TS/TG (transsexual/transgender) binary. This is as a result of an admin of a trans group telling me I shouldn’t comment on a thread because it was for “transsexuals only” and “being TS means you identify with the traditional binary”, that non-binary  people “absolutely cannot be transsexual”.

Obviously, I felt hurt and excluded by these remarks, and wanted to explore them. The subsequent conversation left me feeling unwelcome in the group as a non-binary person, and I left. It’s sad, but there are still many trans spaces that feel unwelcoming to non-binary people.

So here we have yet another binary, but also one created so that non-binary (NB) people can be excluded. We can be trans or transgender, but never transsexual, which smacks of the age-old issue of who gets to be “trans enough” and what it means not to be.

One underlying issue that creates this supposed divide is specific to trans women. A frequent complaint I hear from trans women is about happily-living-as-male crossdressers (CDs) throwing their weight around, as people with a bit of male privilege often do, without understanding the oppression and violence trans women suffer. Because many who might once have been called “crossdressers” have now adopted the term non-binary, this has perhaps created a narrow impression of what non-binary means. Some assume non-binary is synonymous with having less gender dysphoria, desiring less medical intervention, or not needing to socially transition. But none of these things is true.

I will fight forever for a diverse community to be held and protected under one umbrella. But we are not all the same. Non-binary covers a variety of people who don’t fit the prescribed and artificial binary that society currently inflicts on us. It does not mean we don’t transition, or don’t experience gender dysphoria, or have less gender dysphoria, or have less legitimately gendered or sexed bodies after transition.

So can transitioning non-binary people be transsexual? Some folks say that NB people cannot be transsexual because the historically older term was coined at a time when NB was not recognised and we had no civil rights. We are excluded because, well, we always have been.

But what’s the difference between a transitioning trans man or woman and a transitioning NB person? I have what some people call gender dysphoria, both physical and social. I changed my name, live in my identity, underwent medical treatment to change my physical sexual characteristics. Many NB peeps have lower surgery, and I’m not ruling it out. But some insist NB folk can never be transsexual. Our dysphoria is not like trans men or women’s dysphoria. Their gender identity carries some meaning and legitimacy that mine does not. Legally and socially that’s currently true, of course, but it still hurts when the trans community perpetuates this separation, particularly because they are people who have themselves faced a cis society that delegitimises their identities.

But what is dysphoria?

Not everyone likes the term gender dysphoria, because it’s associated with medical diagnosis. The opposite of euphoria, it means the clinically significant distress some trans people feel as a result of being trans. Some argue that in a perfect world, being trans should not cause distress, and a landmark Lancet study agrees that being trans is not, in and of itself, a cause of mental illness, but rather the treatment of trans people in society is.

Looking back at the conversation that sparked this blog, the implication was that having “lower dysphoria”, the desire to change your genitals, is what makes a person TS. But how do we know, when people desire to change their genitals, that it always means the same thing or feels the same way? Or if they don’t, might there also be multiple reasons for this?

Let’s look at how trans guys and AFAB non-binary people feel about their bodies. For a start, dysphoria is not just one thing but many strands of experience. You may feel that having a penis is part of being a man or male, and you will be incomplete/not a man without one. That it is impossible to be a man without a penis. This is an aspect of social dysphoria – a feeling created by the way society sees men and thinks about trans men. If you are surrounded by people who accept trans men fully, whether or not they have a penis, this type of dysphoria is less likely to cause you to need surgery. You may be disabled and fear how you will be treated during personal care, or fear personal care when you are older, if your genitals do not match the way you look. The experience of many trans men with their carers bears this fear out. Again, this would be resolved by feeling confident that carers will always treat you as a man no matter what is in your pants. This, too, is social dysphoria. You may fear being rejected by lovers or partners based on what your genitals look like. Again, that’s social dysphoria, and this may be lessened if you are in validating relationship.

Physical dysphoria is something different. Sometimes likened to “phantom limb syndrome” it’s the feeling that something should be there that isn’t. Or shouldn’t be there but is. This can happen with all kinds of body parts, a wiring glitch where the brain does not accurately map onto the body. So, there are people who, for instance, feel like certain body parts do not belong to them. Brains and bodies are weird and the way people experience their embodiment is diverse. So for instance, there are AFAB peeple who feel agender or woman-identified but have strong physical dysphoria, desiring male-typical anatomy.

For some, physical dysphoria is unendurable and the need for surgery is intense. For others, it can be resolved through the use of prosthetics and surgery is unnecessary. For people like myself who are dissociative or out of touch with their bodies, it may be easy to ignore or we may even be unaware of physical dysphoria, as I describe here.

There is also a third kind of dysphoria some people call internal dysphoria – neither physical nor social, it is about how the person feels inside of themself, outside of a physical or social context. Again, this varies hugely from person to person.

dysphoria diagram

Let’s not forget also that for AFAB trans people reproductive organs are more than just external genitals. Some people, like myself, feel far more physically dysphoric about our internal reproductive systems (owning a womb, having periods, hormone cycles, potential of pregnancy) than we feel about the size of our erections.

Because with or without intervention, AFAB people get erections! We have our very own erectile tissue. And when we take T, it generally grows (a bit, don’t get *too* excited). And for many of us, this growth is sufficient for our needs. Or we might be much more focused on chest reconstruction. Or just hysterectomy. And if we do decide we need more length, or want to stand to pee, there are a range of options from the very simple clitoral release, the more difficult metoidioplasty to the very complex surgery of phalloplasty. And of course, many disabled people and people without access to funded healthcare find lower surgery unavailable to them, however dysphoric they feel.

Am I defined by my gender or my sex?

I’ve written about how gender and sex are far more interconnected entities than we would like to believe. The reason transgender as a term has gained traction over transsexual is, I think, an acknowledgement of how much trans lives are affected by social gender (including birth assignment) rather than simply the shape of our genitals/size of our gametes. It’s the social consequence of our body shapes that affects us more than our bodies themselves. We are trapped in people’s perceptions of our bodies, as the saying goes.

The other reason the term transgender has gained traction is because more trans people now consider their gender to be something pre-existing a desire to transition – transition does not create us, it helps us be more comfortable. So I, for instance, feel I was trans as far back as I can remember – that my experience of gender, and the way I was treated, is not the same as the experiences of women who are my contemporaries. In other words, transition doesn’t make me trans, I just am.

But the term transsexual persists, usually meaning a trans person who alters their sexual characteristics medically. Let’s take it down to brass tacks – sexually, what am I now, with a male hormonal profile and secondary sexual characteristics, but XX chromosomes? If I can’t be described as transsexual, then how can that term carry any meaning at all?

I have so many questions about how this TG/TS distinction could possibly work in practice, and even more about why it is needed. Of course the reality is, it’s just some people preferring one term and some the other, and the terms thoroughly overlap each other.

Divide and conquer?

We know TERFs want the TS/TG distinction because they are trying to convince trans women that a special exception will be made for them if they have had all the available treatment, that they will be allowed civil rights and be partially treated as women as long as they hold the line against the rest of us gaining any rights. A classic divide and conquer tactic which alas seems to work all too well, playing into a widespread fear that non-binary rights are just going too far. But trans women already have civil rights, and these were never TERF’s to bestow. Whether or not they have surgery, they can have their gender recognised. The Equality Act 2010 defines “transsexual” as “proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.” Transitioning non-binary people are understood to be covered by this wording.

So in law, I am transsexual. In my gender doctor’s notes, I am transsexual. It’s not my favourite word, and I tend to prefer my trans umbrella to be wider rather than narrower, but if TS is to endure as a term, can we at least make it mean something that isn’t NB erasing? Because saying my transition is so fundamentally different from a trans man or woman’s transition that it needs a separate word is unbelievably othering.

What is the underlying fantasy in all this? That there are clear lines dividing transsexual from transgender, non-binary from trans men and women, and that we can pin everyone down clearly, with no bodies straying over the lines? But many “crossdressers” are “true transsexuals” waiting for the right moment to take the plunge. Many NB people have more medical intervention than people who identify as trans men or women.

Ultimately (trust me on this) when you drill down into people’s experiences, the words they claim to describe themselves are often used in unique and idiosyncratic ways, and we are all still floundering around for the right universal language. So there are people who identify as non-binary transsexuals, some others who see the word transsexual as old hat, and some who think it signifies a binary, because it was coined by people who hadn’t imagined anything more than a binary.

Who gets to decide? That’s always an interesting question. Who are the gatekeepers of any community, the holders of the keys, who get to set the terms? Personally, I believe “transsexual” will remain with us as a term. Some people like it, some loathe it, but as long as it’s alive, and used by some people to self-identify, it’s valid, and we shouldn’t be denigrating its use. Is using it a valid way of creating spaces and discussions that explicitly exclude non-binary people? No, that would be really oppressive.

Do non-binary and other trans people need to reflect whether they have relative male privilege, or whether they are comfortable enough in their assigned sex they will never need to socially or medically transition, and so are exempt from particular aspects of trans experience? Sure. I know I’ve had moments of anger when someone happily living and working as a man has taken a place on a podium speaking as a trans woman.

But we need to remember if we were to exclude those with assumed “male privilege” we might also exclude the most vulnerable of trans women and NB people. I know many trans people who are unable to access trans medical treatment because of other, pre-existing physical or mental health conditions. If you’re homeless, access to healthcare, to clothes, to shaving equipment and all the other means to present in your gender may be inaccessible, not to mention how unsafe it can be to present as trans or gender non-conforming while homeless. Other trans people are awaiting the result of asylum applications before embarking on transition because they would not be safe in their country of origin. Some are not safe to transition for economic reasons (they would lose their income, home, or other security), others are waiting for elderly parents to die, for whom they are sole carers, or for children to grow up. Or perhaps they are children themselves, with unsupportive parents. Still others are in abusive family situations where it would not be safe to come out. Some of us had to work through complex mental health issues before coming to terms with our gender.

Non-binary people have the additional hurdles of trying to live within genders not legally or socially recognised, which restricts our choices and means there is no clear transition pathway for us. Many non-binary people have publicly transitioned and are living in their gender as much as they are able yet their identity is perpetually erased and defaulted back to their birth assignment, and this is certainly not a privilege. So “living as” is not the same as “identifies as” is not the same as “perceived to be”.

Not forgetting that NHS waits are 2 years now, and everyone deals with that wait differently.

There is a variety of privilege, and a range of experience within this community. But is there a TS/TG binary? A TS/CD binary? Is there a clear dividing line between non-binary and trans man or woman? The hell there is. Life is just not that simple. We all exist on a continuum. We are who we are, all our self-identities are valid, but gross generalisations need not apply.

Surgical liberation

CN: discusses top surgery and associated body parts in some detail (with post-surgery photo), also trigger warning for references of child sexual abuse, trigger warning for anyone with emetophobia

Today was the big reveal, my post-op appointment 10 days after chest reconstruction surgery with Mr Kneeshaw at Castle Hill Hospital, near Hull. This has been such an emotional ride, and I feel the need to share some of the highs and lows. When I made the choice to have surgery, it felt more like a necessary evil than something I longed for, so I was completely unprepared for the joy I would feel when it finally happened.

I was never one of those people that hated their breasts. I was happy with one aspect of them for many years – being an inconsequential AA cup size meant nobody had ever ogled them, catcalled me because of them or even really noticed them. Then I got fat, and they grew (a little), and for a while I enjoyed the fleeting sensation of being womanly.

I was always at odds with my gender, wanting to be a woman or at least feeling I ought to work at being a woman, and finding it impossible to achieve in a way that felt authentic. This despite enormous effort on my part to feminise my voice, my clothes, my behaviour, my walk. So for a while, having (still fairly inconsequential) boobs felt like an accomplishment, but soon enough, they began to feel like an anachronism, a lie.

But even after starting to take testosterone, it took me a long while to consider having my chest surgically reconstructed. At first, I bound them with commercial chest binders, but these caused me pain, (curse my fibromyalgia), and were difficult for me to get into and out of. I could at this point wax lyrical about how little we talk about the health risks of chest binding. Eventually I passed my binders on (please consider sending your cast-offs to Morf) and I made my own binder, a much looser garment created from an old bra, with a flat panel sewn in at the front in place of the cups.

After the surgery, I had a ritual burning ceremony for this by now exceedingly manky piece of kit. It made me wonder about the (somewhat apocryphal) bra burners of the 1960s, and whether any of them were actually suffering from dysphoria.

[image: a home made binder burning in a galvanised steel bucket]

Would I have felt more comfortable with my breasts if they had not been constantly associated with social gender labels like “ladies”, “she” and “ma’am”? Would I have felt my gender dysphoria more keenly had I not suffered from such extreme dissociation for much of my life that it’s hard for me to connect to my body at all? It’s impossible to say, because what we go through makes us who we are. But I had a lot to untangle to get here.

How abuse stopped me hearing my dysphoria

I have spent a lot of time lately diligently reflecting on the journey my breasts and I have taken together.

At times, I was grateful to my breasts, because when they grew, the abuse I suffered throughout my childhood stopped. I don’t want to get into the head of my abuser, but he left my two sisters alone, and treated me in many ways like a boy, so I have little sense that the abuse I suffered was specific to my birth anatomy rather than my gender presentation.

It’s hard to mention abuse in conjunction with being trans, but here’s the reality – AFAB or AMAB regardless, around 50% of us are sexually abused as children, a figure that’s much higher than for cis women. A potential reason for this is because as non-conforming children we are less valued, looked after, believed, and socially supported. Easier to isolate and prey upon.

Because of the negative way society thinks about trans people, it’s easy to internalise “did abuse make me trans?” and ignore the reality, that abuse can interfere with the clarity with which we understand our trans selves.

If anything, abuse blocked the intensity of feeling I had towards my body, and pushed me towards thinking of myself as a woman, which was far from a natural inclination. I also thought of myself as a woman because society equates sexual abuse with femaleness and erases the high levels of abuse in minority populations such as trans, queer, racially oppressed and disabled.

When I went through recovery, there were no books for sexual abuse survivors who weren’t women. It was as if being a woman was the only kind of oppression in existence. This forced me to think about my gender in a particular way that was ultimately unhelpful. I was urged to learn to “love my body” by an old-fashioned and puritanical feminist rhetoric that disallowed the possibility of making your body more comfortable to live in. I worked through the abuse, but in the process got tangled into some very simplistic messages about gender, that delayed me fully acknowledging my transness.

I realise now, I freed my body from the abuse I experienced as a child, but handed it over to the control of a particularly toxic kind of feminism (other, wonderful, intersectional feminisms are available). Suddenly my body was owned by, and politicised by, a clumsy kind of second wave feminism. And amidst all the other liberations, surgery has also cut me free of that trap.

Getting my body back

In the last year, as testosterone slowly made me happier with some parts of myself, I allowed myself to connect to my breasts and was shocked to discover the strength of feeling I had about them. I had thought the intense body dysphoria of other trans guys was altogether alien to me. Instead, I discovered it had been carefully and thoroughly suppressed. And as I let go, it was like discovering some hidden programme running in the background that’s hogging all your processing power – dysphoria is a truly disabling mental state, and when you unearth it, the relief and overwhelm is indescribable.

As surgery neared, I began to feel my fear of the anaesthetic’s impact on my fibromyalgia (and thanks to fibro pals especially womandrogyne, I took this warning card with me for the anaesthetist, which seems to have helped a whole lot). But there was another, growing feeling – excitement. Unambiguous, uncomplicated pleasure at the thought that I own my body and can shape it to be more comfortable for me to live in. My guilt, perpetuated by the mini-TERF that lives in my head, began to slip away. Perhaps, after all, a procedure that would allow me to connect to my body more and love and take care of myself and be happy is not so drastic. Not a mutilation, but an alteration, a sending to the menders of something that simply didn’t fit right no matter how hard I wriggled around in it.

The double incision procedure that I had is relatively simple. Two curved incisions, removal of tissue, nipple re-sizing and re-placing. You’re usually left with scars and loss of nipple sensation with this procedure. It’s an overnight stay. Under Dr Kneeshaw, you come home from the hospital with two drains concealed in fabric bags that the hospital lends you. I was given two very flowery bags, and a kind nurse offered to swap them for something more “manly”. Of course, I declined, but with gratitude for her sensitivity. For bigger folks the procedure’s technically trickier, sometimes revisions are needed.

I see a lot of overjoyed faces beaming through anaesthetic haze when my friends go through this. I wasn’t expecting to be one of them. But there I was, post-anaesthetic, lying in bed with a huge grin on my face. Even the projectile vomiting a couple of hours later didn’t completely wipe the smile away.

Pure joy. I thought it was perhaps some drug-induced high, but it hasn’t left me. A weight off my chest, indeed.

Transition hasn’t been easy for me. However much my story overlaps with that of trans men, it doesn’t quite compare and that has left me out on a non-binary limb. I don’t get the same civil rights as my partner. I’ve experienced job discrimination, and astonishingly bad behaviour from some members of the lesbian and gay communities. Testosterone has taken its sweet time to make changes and I’ve felt in limbo. I fell into a pretty bad pit of depression and got well and truly stuck there. And I was afraid that surgery and too much time to myself during recovery would only make things worse.

I simply had not anticipated the possibility of being happy about my new chest. But here it is, in all its rawness, freshly revealed; and it does make me feel incredibly happy – so happy that I’m sharing a picture of a bit of my body, not something I am used to doing.

[image: a freshly revealed chest post reconstruction, with two curved incisions below the grafted nipples}

It is curious the way I can connect to my body now in a way I never could, and this gives me hope for being able to care for myself better in the future, and potentially make health gains because of this. I feel not the slightest regret. Surgery was the necessary price of my wellbeing, and I’m confident that what I give back to the world can be greater now I no longer struggle under the burden of dysphoria.

I am unbelievably grateful to the NHS. It took time for me to realise I could not do without this op, that it was as necessary as any other procedure available in our increasingly beleaguered healthcare system. The nurses and doctors at Castle Hill are amazing. Mr Kneeshaw* is one of the kindest and most down to earth surgeons I’ve ever met; his results are good, and he’s not huffy about doing revisions if needed.

This procedure is life-changing and potentially life-saving, and I am simply overjoyed and full of gratitude.

PS – after the post-op, Robin and I treated ourselves to vegan rocky road brownies from Blondes in Cottingham – life really couldn’t get any better than this!*

[image: vegan rocky road brownie with edible glitter]

*nobody is paying me for these endorsements