Inside Out
Transsexuals struggle to reconcile physical body with self-identity
By - Dale Bryant
The first time Los Gatos therapist
Mildred Brown came face to face with a transsexual, she was flustered, embarrassed and,
frankly, speechless. That was 18 years ago, when a man she had gotten to know at a
week-long conference on sexology showed up on the last morning as a woman. "Millie,
don't you know me? I'm Nick," he told her. At the time, she was completing her
doctoral degree and clinical training in sexology. The experience taught her that her
textbook knowledge of gender identity problems hadn't prepared her for the shock of
realizing someone she actually knew was a transsexual.
That experience not only led to her therapy practice with gender-conflicted people, but also gave her insight about the feelings of those who learn that a coworker, friend or relative is a transsexual. Those are the people she had in mind when she wrote (with Chloe Rounsley, a Santa Clara Valley journalist who now lives in San Francisco) True Selves (Jossey-Bass Publishers, San Francisco, 1996). Brown is the only South Bay therapist south of Palo Alto who specializes in working with transsexuals.
She wrote the book to help educate people like the ex-wife of one of her clients who wrote to her former spouse, "You are an immoral freak who will inherit misery as a companion. I will never forgive you and will pray that your insanity has not invaded further on our family's gene line. You will grow old without anyone who cares if you live or die."
Friends and loved ones often believe that transsexualism is something that the person will get over; they worry that the decision to live as a member of the other sex is impulsive, Brown explains. "I wrote the book to document the pain of my clients. I wanted people to know that a person doesn't become a transsexual on a whim."
In the book, Brown relies in large part on information provided by her clients about their personal journeys. She also includes some facts, figures, history and theories, including:
 | Transsexuals are people whose inner self-identification does not match their physical body. Many people mistakenly believe transsexuals are gay, but transsexualism is not about sexual orientation; it's about gender identity. |
| It's not known how many transsexuals there are in this country. By 1988, 6,000 to 10,000 transsexuals had undergone sex reassignment surgery; there are, however, many transsexuals who do not go through the surgery. |
| Transsexuals usually know in childhood that something is terribly wrong with them. By puberty, many know that who they are inside does not match who they are physically. |
| Most Americans first heard of transsexualism in 1952, when an American soldier named George Jorgensen traveled to Denmark for a sex-change operation. After the surgery, Jorgensen took the name Christine. The pro tennis player Renee Richards is a male-to-female transsexual. |
| No one knows what causes gender dysphoria; there are both nature and nurture schools of thought. One theory points to a prenatal neurohormonal explanation: Since the genitalia of the human embryo begin to develop in the 12th week, while that portion of the brain that deals with gender identity doesn't begin to develop until the 16th week, some researchers believe a hormonal imbalance during that critical four-week period may set the stage for gender dysphoria. |
| Estimates of attempted suicide by transsexuals range from 17 percent to 20 percent. |
| Some transsexuals cross-dress and live in the world as the gender that matches their inner identity. For most, however, that is not enough, and they turn to hormone treatment and/or sex reassignment surgery. |
Brown's decision to work with gender-conflicted people came shortly after her awkward moment with Nick 18 years ago. "He offered to take me to the only support group at that time in the Bay Area for people who were gender-conflicted," Brown recalls.
"At that meeting," she writes in the preface to her book, "I saw a level of emotional pain that was greater than I had previously imagined possible." When she learned that the people in the group had no professionals to go to for help, she vowed that night to dedicate herself to working with gender-conflicted people.
To celebrate the publication of the book and her 18 years in the field, some 250 friends, many of them clients, gathered recently for a party at the Billy DeFrank Lesbian and Gay Community Center in San Jose. Brown was particularly moved by a woman who told the group she had been standing on a bridge ready to jump before she found Brown. "She asked how many people in the room believed their lives had been saved because they met me," Brown says. "Forty or 50 hands went up, and the whole room burst out in tears."
The pain Brown documents in True Selves includes the recalled childhood experiences of clients who spent their early years trying to hide their natural inclinations. Many transgendered boys, for instance, must suppress their desire to dress like a girl or to play with girls, to avoid the company and games of boys. Often, their parents pressure them to do what feels at odds with their inner image. Since transgendered children have a hard time fitting in, they often become isolated; many are loners and suffer from depression.
The teen years are even more traumatic, as puberty forces on them the realization they are not ever going to develop the bodies they feel they should. "Some children believe that when they reach puberty, they will finally develop the right body," Brown explains. Male-to-female transsexuals are often the targets of bullies. The expectation that they will begin dating presents a whole new set of problems.
Brown's clients are usually in their 30s, although she's currently working with two 17-year-olds. "I was a little uncomfortable about that," she says. "But so many of my clients swear they've known from the time they were very young. The mother of one of these clients told me that she knew when her son was 3 that he should have been a girl."
Brown has even had clients in their 60s. "They're willing to go through all this just so they won't be buried in the wrong body," Brown says.
When she says all this, she is referring to the roller-coaster ride of emotional, physical, social and financial problems that most transsexuals experience.
"What they sacrifice to live in the body they know is right is unbelievable. Many are reduced to poverty; they are shunned by family and friends; many are forced out of jobs either by their employer or by the actions of their coworkers," says Brown. "Still, these people don't have much choice. For most of them, it's either do this or become alcoholics or drug addicts or spend their entire lives in depression to the point of suicide."
Although surgery to physically change a man to a woman or a woman to a man now exists and is commonly practiced in many hospitals, some transsexuals opt not to have surgery--often the decision is simply financial, as insurance does not cover sex reassignment surgery.
Most transsexuals do eventually take hormones that help their bodies develop in a way that is more closely aligned with their self-image. Early in the transition process, males transitioning to female usually undergo electrolysis, a painful procedure for permanent hair removal. Brown says to remove the approximately 30,000 hairs on their faces, transsexuals undergo 300 to 500 hours of treatment at a cost of $40 to $65 per treatment. "It can cost as much or more than sex reassignment therapy," Brown says.
Although transsexuals are gradually transitioning into the sex they believe they need to be, most have suppressed their natural tendency to behave in that role, and so they look to their therapist for help.
"It's so complicated," Brown says. "I have to help them adjust to a whole new way of living. Imagine going through puberty at the age of 40 or 50."
As transsexuals begin the transition, they must change every official paper accumulated throughout their lives--from drivers licenses and credit cards to military service records and college transcripts. "It's actually the one area that has become easier in recent years," Brown says. "The DMV, for instance, now has papers to fill out for name change and preferred gender."
While some companies work with the transitioning employee to announce the situation to coworkers and support the employee, the workplace often adds greatly to the tension of transitioning, Brown says.
One example from her book tells of a male-to-female transsexual who, prior to transitioning, was a corporate executive and chief design engineer for a major auto manufacturer. After she came out as Rachel, according to Brown, a representative from the company came to her house and demanded her corporate credit cards and eliminated her job.
Rachel went for more than 200 interviews for jobs in the automotive industry but could not find a position. She ended up taking menial jobs. Eventually, she lost her home and her car and moved into a friend's garage.
Brown says the story is not unusual. "Transsexuals must be prepared to deal with this kind of situation," she says, "even though protection is available through the legal system in most states."
When Brown first meets with clients, she tries to paint for them a realistic picture of what their future may hold. "I tell them they should expect to spend every penny they have in the world to go through more loss than anyone can imagine."
Still, she says, the need to become the person they feel they are inside is powerful. "No one has ever turned away because of the picture I paint of what will happen."
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