Tuesday, 30 August 2016

Faking It - Part Two

It's taken me a while to come round to writing the second part of this article. You can read the first one (written in March 2015) here. Now that I read that article again, I am amazed to realise how far my journey has come.

Much as I adore Freakonomics Radio, that wasn't where I first heard the idea of Faking It. Instead, it was a British TV show which premiered in the year 2000. The premise was simple: they would take an unlikely ordinary person, have them intensively transformed and coached by a team of experts in a particular field--for a short time--then the contestant (known as the "faker") would have to perform in front of a panel of judges (who know they are looking to spot a fake), to see if they could pass.

Title card for the show
As one example, take the very first episode. Alex Geikie, a gentrified English youth from the Home Counties of England, who liked to ride horses, had to pass as a hard-man bouncer in an East London pub. He was coached by Tony Agastini, a kick-boxing champion. Alex shaved off his hair, gradually ditched his pukkah accent in favour of East-End hardman talk (think Guy Ritchie movies), learned to fight by getting beaten up by Tony's girlfriend (!) in the boxing ring, got fake tattoos, and finally worked as a bouncer for a night, among real, hard-bastard bouncers.
Guardian: At RADA, Alex was coached in talking common: "The word fuck is desperately important to all Londoners. Fuck you, fuck me, fuck off! Lengthen the vowel. Let the breath be the impetus. Farkin' 'ell! Don't smile! Mean it." In grammar: "I was, you was, she was, they was."

After a month's training, Alex was one of several bouncers at the Hippodrome on the night of the England v Germany match and the head of security failed to spot the imposter ("Nah! Honestly?") Tony was much moved. "It's like seeing your kid walk and talk for the first time, innit? Very proud. Very proud. But he should be proud of himself too."
The show drew very positive reviews (such as this one from the Guardian, which is where the quote above comes from, written by Nancy Banks-Smith). Subsequent episodes featured burger flipper Ed Devlin who was trained to be a chef (by Gordon Ramsay, no less); classical cellist Sian Evans who was trained to be a nightclub DJ; and cleaner Sharon Pallister who was trained to become Scarlet Fever, a burlesque performer, by Immodesty Blaize with input from Dita von Teese. You can see this last one starting here on YouTube.

Not yet faking it: Spence Bowdler
I've already mentioned on this blog how I believe that there is something liberating about stepping outside your normal life, and being someone else for a while, and how I wonder if some actors and other performers enjoy this aspect of their work. It's this, I think, which the show attempts to recreate.

The show has several brilliant features. First the "fakers" are deliberately selected to be hopelessly inappropriate for their adopted roles. Almost all are quiet, soft-spoken, lacking in self-confidence, set in their ways. They all have a metaphorical mountain to climb to pull off their new roles. Second, the mentors, often in initial despair or exasperation, become fond, and eventually proud of the fakers. Third, the fakers almost always manage it: to pass unnoticed by judges and onlookers. Finally, it's clear that the experience of the training--and the faking--opens up new and undiscovered vistas for most of them; they discover qualities in themselves that they never knew they possessed. In short, it is visibly life-changing, and often this is very emotional for them. It all makes for extremely compelling television.

The producers made at least one follow-up episode, where they revisited the fakers a couple of years later. Almost without exception, they had reacted positively to the experience. I notice, for example, that the Scarlet Fever episode was uploaded by Scarlet Fever herself on her own YouTube channel.

Drag: Dave Lynn
And that brings me on to Spence Bowdler. If you live in the UK, this episode (in fact, the whole series) is available to watch, free, on the Channel 4 website. If you live outside the UK, you may as well forget it: I've been trying for days. There are only a few episodes of Faking It available on YouTube, and this is not one of them. However, the Guardian reviews are very helpful and give a real flavour of the episodes.

Bowdler, a 30-yr old ex naval officer, and self-confessed macho man, was to fake it as a drag queen. His mentor for the show was veteran British drag queen Dave Lynn. This episode was one of the most popular episodes of Faking It ever produced. The normal hour-long episode was stretched out to 76 minutes, because there was so much good material to include.
Guardian: There's an ancient affinity between drag queens and sailors - where you find one, you will usually find the other at no great distance.
Lynn and Bowdler strike up an unlikely friendship, helped perhaps by Lynn's straightforward, matter-of-fact approach to a man shaving his legs, wearing stilettos and false eyelashes, tucking ("you sort of shove them back in their sockets"), and all the other activities required to become a drag queen.

We follow Bowdler through a series of increasingly uncomfortable experiences. The most powerful is when Lynn shows him a rack of frocks to try on, and it dawns on Bowdler that he is going to be expected to wear a dress for the first time ever in his life. He has a visible meltdown, retreats from the camera, and won't come back into the room. The producers may have thought that was the end of their show.

Getting the lippy on: Spence
But come back he does, and carries on. Later, he struts his stuff on the stage, in full drag, under the drag queen name Britney Ferry. And the judges don't spot him as the fake. At the end of the show, Bowdler muses about his initial prejudices; how he felt he had overcome them, and how shallow and misplaced he now felt they were. It's a powerful moment.
Guardian: But what made Faking It so gratifying were the clear, measurable results of the experience for both student and mentor. Spence was euphoric in his realisation that life is a great big fruit salad, and that "prejudice is just balls" (and therefore best tucked out of sight). Dave Lynn, the hardened old pro, softened up and admitted that he'd learned even more about his place in the world. The two bosom buddies closed with a duet of Stand By Your Man; seldom have the words "sometimes it's hard to be a woman" rung so true.
The episode resulted in Dave Lynn getting a considerable boost in popularity, and he made several subsequent appearances on TV. There is a great interview with him here. And the Guardian review of this episode, written by Rupert Smith, is here.

So what relevance does this show have for me? I don't especially have any affinity for drag as an art form. I've never been to a drag show. I think drag is a form of performance art, whereas Vivienne feels very much part of my identity; an inextricable part of me, not some persona that I adopt when I get dressed.

I suppose the first part of it is that I am envious. Bowdler gets four weeks of intensive tuition in performing as a woman: make-up, clothes, hair, shoes, gait, the works. Perhaps four weeks would be too much, but I certainly feel I could use a few tips from the experts about how to improve my overall look as a woman. (Clue: I'm trying not to look like Bowdler in the picture!)

Second, there is permission. All of the fakers in the show get encouragement, verging on a requirement, to step outside their ordinary world and embrace something entirely new: a new way of doing just about everything. Some of the rest of us (i.e. me) hesitate at every tiny step outside the comfortable boundaries of what others expect of us. The fakers blasted those boundaries wide open, and did it with the support of those around them. And for each of them, that must have been a very powerful and long-lasting experience. Faced with the end of my marriage, I am contemplating what the new me will be like. Some of those boundaries will need to be redrawn: but which? And I will need to make my own permission to make it happen.

Finally, though, the people in the show are faking it. After the credits roll, they can, if they choose, return to their previous lives and pick up where they left off, as if nothing had happened. This is not true of me: Vivienne remains an awkward, uncomfortable part of my life, and my future life will need to include her, one way or the other. The faking it, for me, was pretending Vivienne didn't exist.

Saturday, 27 August 2016

Sex and Gender in Sports: Part Two

In my previous article I considered the distinction between male and female athletes competing in top competitions such as the Olympic games. Right at the nub of the issue is whether women with naturally high levels of testosterone have an unfair advantage against women with lower, or "normal" levels of testosterone.

But what about transgender or transsexual athletes? Those born in an apparently ordinary male body, who legitimately transition to the female sex? What happens to them?

Renee Richards
Renee Richards is the first example I have to offer. Born Richard Raskind, the child of two doctors, Richards was a successful male athlete, and also obtained a medical degree. In 1975 (which puts her age at 41), she pursued a career as a professional woman tennis player. However, in 1976 the US Tennis Association had introduced Barr body testing (a type of genetic testing) that year. Richards refused to take the test, and was therefore banned from top tennis tournaments, the US Open, Wimbledon and the Italian Open that year.

Richards took the US Tennis Association to court, alleging discrimination by gender in violation of her human rights. She won her case, and was allowed to play in the 1977 US Open tournament.

Richards' tennis career was quite short-lived, and she retired from professional tennis in 1981, just 4 years later, and returned to medical practice in ophthalmology.

Richards' case provoked considerable discussion. Official sports governing bodies were very uncomfortable. According to Wikipedia, the US Olympic Committee stated:
IOC: There is competitive advantage for a male who has undergone a sex change surgery as a result of physical training and development as a male.
And indeed, it's hard to argue with that viewpoint. But in addition to official perplexity, Richards faced consternation from the general public too. My correspondent Rhonda wrote "I recall it being said that Renee had an advantage because she competed in a new category, unique to her: 'Mixed Singles'." And even her own fellow athletes were unhappy: when Richards was allowed to play as a woman, 25 of 32 competitors promptly withdrew in protest from the Tennis Week Open.

In this article describing her life and career, written by Emily Bazelon, Richards herself comments on her status as a transsexual athlete. I quote the final paragraph in its entirety:
Bazelon: The science of distinguishing men from women in sports remains unsettled. And Richards has come to believe that her past as a man did provide her advantages over competitors. “Having lived for the past 30 years, I know if I’d had surgery at the age of 22, and then at 24 went on the tour, no genetic woman in the world would have been able to come close to me. And so I’ve reconsidered my opinion.” She adds, “There is one thing that a transsexual woman unfortunately cannot expect to be allowed to do, and that is to play professional sports in her chosen field. She can get married, live as woman, do all of those other things, and no one should ever be allowed to take them away from her. But this limitation—that’s just life. I know because I lived it.”
Michelle Dumaresq
Wikipedia has a list of transgender athletes, both female-to-male and male-to-female. There are, unsurprisingly, few Olympic type events, though there are cyclists, such as Canadian mountain biker Michelle Dumaresq, and fighters, such as American mixed martial artist Fallon Fox. Caitlyn Jenner is of course mentioned.

In 2003, the International Olympic Committee drew up regulations to cover transsexual athletes. To me, at first glance, they seem pretty reasonable:
  1. The athlete must have undergone sexual reassignment surgery, including changes to the external genitalia and gonads.
  2. The athlete must be legally recognised in their desired sex.
  3. The athlete must undergo hormone therapy for at least two years.
These guidelines were modified in 2015, due to recognition that it might not be acceptable to require surgery in otherwise healthy people, and that some countries refuse to grant legal recognition to people who change sex. Therefore, the regulations were changed. The requirement for surgery was dropped, and the only stipulation now requires that the athlete's testosterone level be under 10 nmol/l. (See my previous article for why this might be problematic).

Chris Mosier
As for these games, the UK Daily Mail reported that two unnamed male-to-female athletes were considered for inclusion in Team GB to compete in Rio, but the Internet has been silent about whether they managed it. Meanwhile, Chris Mosier competed as a triathlete for team USA. As a female-to-male, Mosier needs to take testosterone, though a Therapeutic Use Exemption means it's acceptable. The Wikipedia article states that "two closeted transgender athletes competed" at Rio.

The first transgendered sportsperson I recall ever hearing about was Mianne Bagger, a professional golfer from Denmark. According to Wikipedia, Bagger was only the second high-profile transgendered athlete who won recognition from sports' governing bodies to compete in their desired sex, after Renee Richards. A 2004 article from the Guardian newspaper reports that Bagger experienced a slightly warmer welcome from her fellow professionals than Richards did. Subsequently, Lana Lawless sued the Ladies' Professional Golf Association in 2010, which at that time was clinging to a rule that women golfers were required to have been born female. In 2014 another doctor, Bobbi Lancaster, was permitted to play in an LPGA tournament, and this article describes her as the first transgender woman golfer to compete in such a tournament.

So much for the professional athletes. What about those lower down? Una over at TransasCity has produced a couple of relevant articles, and you can read them here and here.

Judit Polgar
I want to close this double article with a shout out to one of my heroes, Judit Polgar. Polgar, 40, is the strongest female chess player in history. The youngest of three sisters, the Polgar girls were intensively coached in chess by their polymath father, Laszlo Polgar, who believed that "geniuses are made, not born".

Everybody "knows" girls aren't as good at chess as boys. Even FIDE, the world chess governing body, awards separate women's titles. The Woman Grandmaster (WGM) title is easier to attain than the Grandmaster (GM) title. But try telling that to the Polgar sisters. They refused to compete in woman-only tournaments, from the beginning, bringing them into some conflict with the Hungarian Chess Federation. However, the Polgars persisted. Laszlo wrote:
Laszlo Polgar: Women are able to achieve results similar, in fields of intellectual activities, to that of men. Chess is a form of intellectual activity, so this applies to chess. Accordingly, we reject any kind of discrimination in this respect.
And his daughters went on to prove him right. Judit achieved an astonishing series of accomplishments: she achieved the rank of full Grandmaster (not WGM) at the age of 15, then the youngest person ever to have done so. She was ranked 55th best player in the world at age 12. She is the first ever (and so far, only) woman to achieve an Elo rating of greater than 2700, and she peaked at number 8 in the world in 2005. Now, of course, FIDE allows players of both sexes to compete in tournaments, but of 1441 GMs in the world, only 31 are currently women, so the women do have some catching up to do. And I bet nobody even bothers about their testosterone levels.

I wonder how much chess is like golf. In most Olympic sports, muscle mass, lung capacity and other physical measures of fitness really matter. In that circumstance, one could say that the extra physical size of someone born male could offer an advantage if they transitioned. However, in golf, this is less obvious, and Mianne Bagger has insisted that she has no physical advantage from being born male.

In chess, of course, physical fitness is irrelevant, provided you can deal with the stress of the games and tournaments. I believe that the low number of female grandmasters is not a reflection of women's ability to play chess, but a reflection of how few women take up chess seriously. I did a quick Google search for transgender chess players, but didn't turn anything up. As always, comments are welcome. Meanwhile, whether it's golf, chess, cycling or whatever, keep doing your thing.

Sex and Gender in Sports: Part One

It's just been Olympic time again, and that means we are overdue for a topic which I have been considering for a long time: how do you separate male and female athletes? This article was prompted by the Olympics, but has relevance to sporting competition in all spheres.

The modern Olympic games has been going for more than a century. Revived by Baron Pierre de Coubertin in 1896, the modern games started to allow women to compete in the 1900 games, held in Paris. But it took until 2012 (the London games) before every competing nation sent women athletes to the games, and the 2012 games were also the first to have women competing in every sport in the programme.

It turns out that men do better, in general, than women at sporting events. As just one example, the four-minute mile has been routinely broken by men, since it was first achieved by Roger Bannister in 1956, but no woman has ever achieved it; the fastest woman is still 12 seconds away. So it makes sense to segregate male and female athletes, so that the competition is fair.


Dora Ratjen
This throws up some problems. First, how do we actually decide who is a man and who is a woman? It hasn't ever been easy. Dora Ratjen was an intersex individual, born with ambiguous genitalia, assigned female at birth and raised as a girl. Ratjen competed for Germany in the women's High Jump in the 1936 Summer Olympic games, and finished fourth. In 1938, Ratjen competed in the European Athletics Championship, and won a gold medal in the high jump. The following year, Ratjen broke the World Record for the High Jump. After an official investigation (following a complaint from another athlete), Ratjen was, at that time, discovered to be working as a male waiter under the name Hermann. He was stripped of his title. Ultimately Ratjen chose the name Heinrich, and lived out the rest of his life as a man.

Wikipedia mentions two other athletes from this period, Zdenek Koubek, and Mary Weston, with similar biographies. These were intersex people with ambiguous genitalia, raised as girls, who competed as women. In common with Ratjen, Koubek and Weston each later transitioned to male.

US Olympic Committee president Avery Brundage called in 1936 for a system to be set up to examine female athletes to make sure they were actually female. Unfortunately, physical examination was the only way to do this. I do not doubt that those examinations were undignified, uncomfortable, and unreliable.

It took another 30 years for chromosome testing to be adopted, in 1968. Surely this would sort everything out, using hard science. Everyone knows that human males have the chromosome pattern 46XY, and females have the chromosome pattern 46XX. So there's your answer.

Maria Jose Martinez-Patino
Except that it isn't. Most individuals with androgen insensitivity syndrome have the chromosome pattern of a male, 46XY, and produce testosterone. However, their bodies are not sensitive to the testosterone, which means they develop as women. Such women are infertile, and lack a uterus, but are externally indistinguishable from 46XX women. Spanish athlete Maria Jose Martinez-Patino was disqualified from competition in the 1988 Summer Olympic games because she failed such a chromosome test, though she was reinstated for competition in the 1992 games. She has since become an academic, and has written about her experience here in the Lancet.

Likewise, some people have the chromosome pattern 47XXY (Klinefelter syndrome), or are mosaics (in other words, not all their cells have the same chromosome pattern).

So, once again, the testing lets us down. The problem is that, even at the chromosome level, the actual level of the DNA itself, humans don't fall neatly into male and female categories.

In 2011, the IAAF came up with yet another idea: that athletes should be separated according to how much testosterone they have. There is a good discussion of this ruling here. The focus on testosterone is because it's considered that a high level of testosterone is what provides men with their athletic advantage. The IAAF ruled (among other things):
  • Athletic competition will continue to be divided into men’s and women’s categories
  • A female with hyperandrogenism who is recognised as a female in law shall be eligible to compete in women’s competition in athletics provided that she has androgen levels below the male range (my italics)

  • The new testosterone limit was set at 10 nanomoles per litre of blood. This level was chosen because it's three times higher than the upper limit of normal for women, and it was reasoned that very few women would naturally have a testosterone level this high. It's at the very bottom of the normal range of testosterone for men under 50.

    This does solve some problems. It does away with examining physical characteristics and chromosomes (though not the indignity of subjecting someone's identity to detailed scrutiny). It even allows for athletes to potentially change sex and still compete as their new sex, provided their hormonal profile fits.

    Caster Semenya
    But once again, there are different problems. Enter Caster Semenya. This South African athlete became the centre of another humiliating sex-testing furore in 2009 aged 18, when she won the 800m gold medal. She was cleared by the IAAF to compete as a woman in 2010, and has, most recently, won Olympic gold in Rio in the 800m event.

    Details of Semenya's medical profile are somewhat sketchy, because she her test results have (rightly) been ruled confidential. The BBC reports that she has hyperandrogenism, which means her testosterone level is much higher than an ordinary woman, and even higher than many ordinary men. Indian athlete Dutee Chand has hyperandrogenism too.

    The pressure on athletes to succeed at the top level, where the difference between success and failure can be measured in milliseconds or millimetres, is enormous. Therefore, it's understandable that athletes want to take every possible step to maximise their performance (and understandable--but not forgivable--when some resort to cheating to make this happen). And it's understandable that their opponents may be angered by what they perceive as an athlete with an unfair advantage being allowed to compete against them.

    Because of the 2011 ruling, female athletes with hyperandrogenism were sometimes required to take medication to lower their testosterone to the "normal" female range. But it gets worse still. In 2016, the United Nations Special Rapporteur on health reported that "a number of athletes have undergone gonadectomy (removal of reproductive organs) and partial clitoridectomy (a form of female genital mutilation) in the absence of symptoms or health issues warranting those procedures". In other words, some athletes have been having surgery they don't need in order to ensure they don't fail a sex test. The UN is outspoken in its condemnation of this, and there are some more details here.

    The testosterone restriction was removed for the 2016 Rio Olympics, allowing Semenya (and other hyperandrogenic women) to compete, free of testosterone suppression, because the Court of Arbitration for Sport (CAS) ruled that the limit should be abandoned for two years to study whether testosterone provides an unfair advantage to athletes. But the debate continues, and there is a powerful article here.

    All of the athletes we have discussed have been competing as women. There seems to be no restriction on anyone who wants to compete as a man. The IOC released a statement in 2012 which said this:
    IOC: In the event that the athlete has been declared ineligible to compete in the female category, the athlete may be eligible to compete as a male athlete, if the athlete qualifies for the male event of the sport.
    Faster than Caster: Usain Bolt
    The next point I want to make is that nobody here is cheating. Dora Ratjen was raised a girl through no fault of her own, and competed as a woman at a time when intersex conditions were poorly recognised or understood. Maria Jose Martinez-Patino has androgen-insensitivity syndrome. And Caster Semenya has hyperandrogenism. None of those people has deliberately done anything to improve their performance other than training. The notion that Semenya and other hyperandrogenic women should have their testosterone levels deliberately suppressed seems no more "fair" to me than the notion that Usain Bolt should have some of his thigh muscles removed, or his legs shortened, to make his performance "fairer". Intersex people have a long history of being "normalised" by medical treatments.

    But Joanna Harper, herself a transgender athlete and medical physicist, argues differently. My quotes come from Sarah Barker's excellent article here:
    Barker: ...success in sports is one of the greatest advancements in women’s lives. If we value women’s equality, it is imperative that we protect the ability of all women to succeed in sports. I believe that billions of potential female athletes deserve the right to compete with some semblance of a level playing field, and that requiring all women to compete within a given testosterone range is the best way we currently have to create such a playing field.
    Is testosterone everything? Surely not; otherwise Caster Semenya would surely be able to run a four-minute mile. The exact role of testosterone remains unclear; there is even a 2014 paper which analyses testosterone levels in 693 elite athletes. It discovered that 16.5% of men (and remember, we are talking about elite athletes) had low testosterone levels, while 13.7% of women had high levels, overlapping with the men. The papers authors concluded:
    Healy, et al: Hormone profiles from elite athletes differ from usual reference ranges. Individual results are dependent on a number of factors including age, gender and physique. Differences in profiles between sports suggest that an individual's profile may contribute to his/her proficiency in a particular sport. The IOC definition of a woman as one who has a ‘normal’ testosterone level is untenable.
    So the debate clearly has a way to go. I think my bottom line is this. If you are going to separate men and women in athletic competition, you need to draw the line somewhere. This will--inevitably--provide advantage to some people and disadvantage to others. If you draw that line as the body you were born with, then hyperandrogenic women like Caster Semenya will surely come to dominate women's sports. If you draw it at an arbitrary level of testosterone, then you will force some athletes to take medications (and in extreme cases, to have surgery) in order to compete.

    No easy answer. I had planned to include transgender athletes in this article, but, as usual, I have found too much material, so I will split this article into chapters. In the next section, I shall consider transgender (rather than intersex) athletes.

    ===
    If you enjoyed this article, you might be interested in my article about Female Bodybuilding.


    Sunday, 7 August 2016

    The Man from Venus

    This post follows on from my previous post about how society at large considers that there are only two gender categories.

    Pop psychology agrees. For example, the famous book by John Gray, Men are from Mars, Women are from Venus. (There are others too, such as the two books The Male Brain, and The Female Brain by Louann Brizendine. My wife bought me a copy of the former. I think she was trying to tell me something).

    In any case, I thought it was worth unpacking some of the detail around that.

    Mars
    The Roman god Mars was the god of war. The planet Mars has been known since antiquity (the Greeks called him Ares). It was named by the ancients because of its obvious red colour; clearly associated with blood and therefore violence. In association with Mars, we have words like martial, meaning "to do with fighting", such as in martial arts, martial law and court martial.

    I had never appreciated that the planet Mars has a different colour, until I moved to the Southern Hemisphere. Using an app for my iPhone, I can easily find Mars in the night sky, and it's amazingly red (actually more like orange). In the Northern Hemisphere, I struggled to see anything of the night sky at all; down here you can see the Milky Way and other celestial objects very clearly.

    The astronomical symbol for Mars is a stylised depiction of Mars' circular shield, with his spear behind it. This symbol is very familiar to us; not only is it used to depict Mars in astronomical shorthand (with which few of us have any real association), but it has also been borrowed to represent the male gender. Wikipedia says the symbol can also represent iron.

    So there we have it. Mars: red and bloody; iron; warlike; spear and shield. That's obviously what men are supposed to be all about.

    Everyone knows that Venus was the Roman goddess of love and beauty, whom the Greeks called Aphrodite. The planet Venus is one of the brightest objects in the sky, and has long been recognised as the Morning Star and the Evening Star.
    Venus

    The astronomical symbol for Venus is a stylised depiction of Venus' hand mirror. When you are the goddess of love and beauty, you have a reputation to live up to, so you have to make sure you are always looking good.

    Wikipedia says this symbol is associated with copper, as well as being borrowed for use to depict the female gender.

    Adjectives to do with Venus are less well-known, and come from the Roman genitive form veneris. The obsolete term for sexually transmitted disease is venereal disease, and my dictionary says that venereal refers only to sexual intercourse. In anatomy, the pubic mound is known as the mons veneris; the mound of Venus.

    So there we have it again. Venus: beautiful; luminous; sex; hand mirror. That's obviously what women are supposed to be all about.

    Society tells me I should identify with Mars, when instead I feel much more affinity with Venus. The title of this post suggests a cheap B-movie, with a hideous villain (believe me, I feel like one sometimes).

    But the truth is this: men are not from Mars. Women are not from Venus. Humans are all from Earth, all of us. And that means we need to recognise that, instead of being two separate groups, we are all one group, with considerable overlap between male and female. We don't do ourselves any favours (or any justice) if we pretend otherwise.

    Saturday, 6 August 2016

    A Tale of Two Boxes

    Back in 2014 I wrote a post called Frightening the Horses, which largely discussed a 2002 article by American writer and psychotherapist Amy Bloom, entitled Conservative Men in Conservative Dresses, which was published in Atlantic Monthly.

    The first line of the article is this one:
    Bloom: Heterosexual cross-dressers bother almost everyone.
    When I first read that line, I found myself agreeing with it. In fact, some of them even bother me, and I am one! If you missed Bloom's article, it's well worth a read in its entirety. I think it's also worth having a read of my post; it certainly generated a lot of discussion.

    I've been thinking about why it is that crossdressing bothers us so much. As Bloom says, drag queens don't bother us. Nor do female impersonators (she cites several American examples; instead I point you to Danny la Rue, and Hinge and Bracket as popular British examples). She even points to those women in history who have had to adopt the male persona in order to succeed. And transsexuals don't bother us.
    I don't speak his language

    I cross-dress whenever I can, which is not as often as I would like. The rest of the time I live my life as if I were an ordinary man.

    But my whole life I have been different from other boys and men. I am sensitive. I cry easily. I loathe many of the trappings of “traditional” masculinity (field sports, big rugged vehicles, hunting and fishing, weapons, coarse behaviour, macho posturing, or the objectification of women). I especially loathe it when other people (men or women) ascribe those things to me, or assume I must have some affinity with them, just because I was born a boy.

    You might say that I should just learn to be a sensitive man and to find ways to explore and express my sensitive, caring, nurturing side in the world of men (and stick two fingers up to the knuckle-dragging bottom-feeders who would persecute me for it). But I don't: instead I choose to express those aspects of myself by attempting to experience the world of women. It's not just the clothes and the lipstick: those are merely the external manifestations of something which goes right down to my core identity as a human being. I feel much more comfortable in the company of women. I espouse feminist principles very openly. I suspect (but cannot, of course, be sure) that I have been imprinted (at a young age) to associate femininity with the aspects of my personality I cannot easily express as a man. In other words, it’s too late to change.

    “Crossdressing makes you comfortable,” I am sometimes told. No. Slippers make me comfortable. Crossdressing (using that as a convenient shortcut for the whole package of stepping out of the male role and embracing the female one) is a necessity for my psychological wellbeing.

    So it's a simplification (and a hurtful one) to say I just “like to dress up” or “it's all just a bit of fun”, or I am just “getting in touch with my feminine side”. It goes much deeper than that. I have powerful and irrepressible yearnings to dress, and when I do, it feels right on a level which is difficult to fully articulate. It isn't an act. It isn't a pretence. It doesn't feel like a sham.
    
    Kept apart: male and female

    I can see why some people need that feeling all the time. In other words, I think what separates me from them is not some huge gulf (“a cross dresser is only pretending to be a woman, while a trans woman is a woman”), but actually a considerable degree of overlap.

    I have found that suggesting this makes some trans women uncomfortable: men who cross-dress in our society (and don't I know it!) are treated as figures of scorn or ridicule (or worse, sexual perversity), and I can completely see why trans women would want to distance themselves from that. But from my perspective, it is the truth.

    As a male-to-female crossdresser, I do feel that some fully-transitioned people look down on me. They seem to be saying "We are nothing alike, since you are 'only' a crossdresser. Our motivations are not the same. Our behaviour is not the same. The reasons why we do what we do are not the same".

    The difficulty I have is that none of these things is demonstrably true (and I admit I am a lumper, not a splitter). When I ask those people to explain their viewpoint (or occasionally challenge them) I get three basic responses:
    1. Because I don't automatically accept their word, I must be transphobic, just like all those others.
    2. I haven't done enough reading, and if only I would read this book or that blog it would all become clear; or
    3. I can't possibly understand because I am "only" a crossdresser.
    I stress that these people are the minority, and that most trans people I know are lovely, welcoming and inclusive.
    The story we tell ourselves

    But here is what I think: society has a story we tell ourselves. That story is that there are two genders, male and female. The most "acceptable" people are those who start off on one side and stay there. But most people are (I think) comfortable with people who start off on one side and go all the way across to the other, because that just about fits the story.

    I think it’s easier for cisgendered people to accept a person who “was” once a man but “is” now a woman, and it’s harder for them to accept that, actually, there are a lot of us somewhere in the middle zone (perhaps the rainbow zone?) between those two boxes (including some people who might identify or “qualify” as cis-gendered). (Likewise, it's acceptable to be a drag queen, who is male in his normal life. Putting on a dress is only an act, right?)

    But society is very uncomfortable with people in that middle zone, because they don't fit the story: it might be people who choose to be neither one nor the other gender, intersex people, or people (like me) who trespass across the middle zone from time to time. (I think that explains why there is tremendous pressure on intersex people to align themselves to one or other gender).
    Which one do you think I am?

    Of course, the story is wrong, at all levels from the cell, to the person, to society as a whole. But that is still the story we tell; even some trans people tell it. I think a lot of trans people overtly, or subconsciously, reinforce that gender binary. I think it helps them to feel more comfortable about themselves, and I think it helps cisgendered people to feel more comfortable about them.

    I don’t identify as an ordinary man. I don’t identify as a woman either. I am not quite sure what I identify with! I sometimes describe myself on Quora as a "part-time woman". And I want to say to those people who think they are so different: we have more that unites us than divides us, and we should concentrate on our commonalities, not our differences.

    As for the stereotypes of men and women, they are created by society. But I am a member of society. I cannot simply step aside from its conventions, nor ignore its rules (whether they please me or not). Even though there are many, many people who don't fit the stereotypes, the stereotypes persist. It does seem, though, that society is changing: it is becoming more acceptable to not fit the binary.

    Come and join me in the middle zone. There are plenty of comfortable seats, and the wine has just been opened!

    ===
    Addendum 28th August 2016

    My thanks to Patricia for sending me a link to this article by Rebecca Reilly-Cooper. It's articulate, forthright and powerful, and adds another perspective to the idea of the "spectrum of gender" You can read the full thing here.

    Sunday, 3 July 2016

    The Rocket Scientist

    Of late, I have been spending a lot of my screen time on Quora. To the detriment, I must add, of this blog, for which I apologise. The nice people at Quora voted me a Top Writer for 2016, which was very affirming. I enjoy answering the questions, and I really enjoy learning new and interesting things from other people, especially where I knew little before.

    One of the other Quora Top Writers for 2016 is Sophia de Tricht, who describes herself on her Quora profile as a published writer, a transwoman and a rocket scientist. It also says she has been described as "Our aerospace engineer that fell from grace," which Sophia says she found mildly flattering. Her online resume suggested she was part of a team renovating and rebuilding a very interesting aircraft. She is currently a student at the Embry-Riddle Aeronautical University, where she is specialising in commercial space flight.

    Clearly she sounds like someone who has some interesting things to say, and I am always interested in hearing from inspiring people. As a result of reading her CV, I learned what an aerospike engine is: trust me; it's cool. I contacted her for an interview, and she responded immediately.
    Sophia: Rocket scientist

    So here is Sophia, sitting on my virtual couch, answering my virtual interview questions:

    Tell us a little about yourself and your trans journey.

    Well, let's see. I was raised in a non-permissive conservative Christian environment. A series of them, really. My dad sold computers in the halcyon years of the dot-com boom. Then he jumped ship (wisely) and went into medical supplies, but retained approximately the same territory. As the child of a salesman, I moved around a lot, but never to big cities. Atlanta was something I was aware of without having ever been there. We lived in swamps and dusty onion fields and recklessly racist nowhere towns. A couple of relatively nice places, but nice places in the middle of not-nice is its own kind of not-nice. The first time I ever went to a genuinely big city was when I left for boot camp at 18. It was in Chicago.

    I never knew an environment of understanding. It was always an environment of shame and what I consider un-Christian practices. My family has always been heavily opposed to my being trans and I don't speak with them very much anymore and I always end up regretting it when I do.

    Because I moved around a lot as a kid, I didn't really have good social skills, so I found it difficult to make friends. I had crushes, but once and only once in my entire school experience were they ever requited. I am the poster child for the unrequited crush. It was my normal.

    But I tell you all that to tell you this: I didn't have the words to describe what was happening to me until I was 28 years old, when I came out. I was recently divorced and I had been asking a lot of big questions and it just seemed like the right time to explore and I did. I knew from the very first time that I felt right. I was in the military for about nine months before I was found out and discharged.

    Can you tell us a bit about your career in the military? How did you get along being trans in the military?

    I joined the Navy when I was 18 years old, in 2002. I joined to be a linguist. I failed the school and did some time as a deck seaman, doing general mariner work, then I got orders to intelligence school and I aced that and did that for the remainder of my time in the Navy.

    I got out in 2010. Things were not going very well economically. So really I had only one choice: go back into the coast guard as an intelligence specialist.

    Before I came out, I was... complicated. I attempted to drown out everything in ridiculous masculinity while mocking relentlessly all the trappings of masculinity. I loved to hate gym bros and dudes who put glass packs on their cars. I played airsoft, I tried to go for special operations, I qualified as a rescue swimmer... I was ridiculous. Just in general.

    My military friends are a diverse lot. Most of them understand, some of them do not. There's not much of a conclusion you could draw from the demographics.

    And you were an intelligence officer for a couple of years. Did they give you a cool car with machine guns behind the headlights, and an exploding pen?

    Fallen from grace?
    The intelligence thing is fascinating, but there's only so much I can say about it. I like to compare it to playing chess with foreign naval commanders. It was my job to know, through my various tricks, what they were going to do before they did. Then I told my commanders what the other commander was going to do.

    Did they discharge you from the military because you came out as transgendered?

    Yes. I was discharged because I was "unavailable for worldwide deployment."

    Tell me how you acquired the title "aerospace engineer who fell from grace"?

    I came to Embry-Riddle to be an aerospace engineering student. I took on several engineering projects and then I was seduced by the power of the dark side and went to commercial space operations. That's the "fall from grace" bit. It's flattering because I was never an actual engineer.

    What drew you towards commercial space travel?

    Gosh, when I was in 4th grade, my science text book had a false-colour image of Saturn and I was just enraptured by it. I had to know everything there was to know about that place. And so one of my enduring loves has always been space. Commercial space operations seemed to me to be a very lucrative way to work with space.

    When one thinks of commercial space travel, one thinks of booking flights to the Moon, to a 7-star hotel under a giant dome. Realistically, however, space tourism is likely to mean Low-Earth Orbit, at least for the next couple of decades, surely?

    Heh. Not even that. In the near future, it'll be suborbital flights. It's way easier to escape the atmosphere than it is to enter orbit. Blue Origin, Virgin Galactic, XCOR, and WorldView are the passenger services and they're all suborbital at this point. The orbital stuff is all cargo right now. Human flights to the International Space Station will start probably next year, if all goes to plan. That said, there is a company that can get you a ride on a Soyuz, which is the only manned vehicle to go to orbit right now. And there's one that's just starting up that's trying to go to the moon for a very steep price.

    I can imagine space tourism being a popular, but very niche industry. What other applications of commercial space flight might we be looking at?

    Well, the very fabric of our lives in this modern age depends on space applications. I'll finish typing this answer and hit send, it will travel through the wi-fi and through some lines and it'll be beamed to a satellite and piped down to you. Then, in the morning, I'll get up, turn on my GPS and drive over to spend time with a friend. This weekend, I'll be using Google maps, which relies on remote sensing satellites as well as ground vehicles. And so on; the list is nearly endless.

    Fun fact: basically all of that stuff is not just a space application, but a commercial space application. Satellites have to be replaced occasionally. Cargo has to go to the International Space Station, and trash has to leave. Asteroids can be mined. Agriculture can be greatly improved by affordable remote sensing satellite access.

    What are you going to do with your BD-5J MicroJet once you get it airborne again? Looks a bit dangerous to me!

    Dinky but dangerous: the BD-5J
    Well, the aircraft is dangerous for the unexperienced pilot, and it's very difficult to get the required experience. It started off as a cool project for which I held a very impressive title. Otherwise, it was kind of a joke.

    The current leadership on that project decided that once it was complete, it would become a static display. Permanently. I'm no longer involved with the project. But when I was, I was in charge of flight and occupational safety. On the one hand, I had to make sure that everyone wore their hard hats and safety glasses. On the other hand, I had to make sure that the aircraft was safe to fly, which in my case meant understanding where it had failed in the past and getting my proposals for a fix rejected. I started to rewrite the pilot's operating handbook, but the idea was also junked because of bureaucratic pressure.

    You are fluent in several languages. How did that come about?

    I don't know; it just kind of happened. It started with Japanese, because I thought it would be a challenge that me and my brother and my dad would do together. Of the three of us, I'm the only one who speaks it at all. I learned French in high school (my French is terrible), Norwegian because I was thinking about relocating there, Spanish in Latin America (three of my four deployments and my one shore station were all in Latin America--I should own a winter home in Panama), Persian in linguist school. Oddly, quite a bit of Arabic, Mandarin, Russian, and Korean as well; Mohawk because it's a dying language and I think it's kind of nifty to be the keeper of arcane knowledge, Tibetan and Mongolian because I thought they'd be fun.

    What draws you to Quora?

    Originally, I came across it when I googled a question I had. I stuck with it because I like sharing what I know, and as of this writing, I've been able to share my knowledge and views with 5.1 million people. I've been published in Forbes thrice and once in Newsweek. It's good exposure. Quora has a team of people that liaise with the publishers. They're the best.

    If you could wave a magic wand and change one thing for trans people, what would it be?

    Employment, hands down. I am sometimes asked to give talks about trans issues in the workplace for some bizarre reason. I'm comfortable with public speaking and I know trans issues, I assume. Anyway, I tell them all a couple of different things, one of which is "The only thing that is required for the success of transgender people in American society is that employment discrimination be eliminated." Look, it's easy to discriminate against trans people in employment. Even in places with strict laws in place. If that goes away, we'll start making money. A vast majority of our problems can be ameliorated to some extent by gainful, meaningful employment. Not as short-order cooks, but in corporate America.

    I've been turned down for a lot of jobs (three years worth) after interviews that began with the manager falteringly not knowing how to handle speaking to me.

    Tell us more about Sophia the woman?

    Are Aviator glasses compulsory?
    Sure. I love dancing. I belly dance and I'm trying to get proficient enough to perform, and I can flamenco a bit. Belly dancing is a great workout and it makes you feel very sexy once you get it down.

    When I was in the coast guard, I qualified as a cutter surface swimmer which is like the more traditional rescue swimmer, but instead of a helicopter, we jump off the ship in a storm. I love swimming. I've swum in the deep ocean. I hear people say the idea terrifies them. I didn't mind it much. It's all time and practice and not thinking about it. It's salt water. You'll float in it if there's breath in your lungs. And you never swim far from the ship.

    I fancy myself a funny lady. My father does stand-up back where he's from, we're an amusing lot. Granted, my two routines are essentially my best two sea stories--they're foul!

    And who doesn't love a good wine? Some other things... I don't do much right now in my free time because I haven't got any. But on the rare occasion I do get some time off, I do enjoy heading out to see old friends and visit new places and drink and dance. Nothing finer.

    What famous person would you most like to meet and why?

    Hm. Lindsey Stirling, maybe? I quite fancy her. I dunno. I don't think I care much. I'm not actually very good at social interactions. It would almost certainly be awkward.

    ==

    So, as always, a little reflection is in order.

    First, Sophia seems to fit into the theme, touched on in some of my other posts, that some trans women attempt to become uber-masculine, as a way to "prove", to themselves and others, that they are men. Almost always, this causes great suffering. As I have mentioned before, no amount of military discipline can "make a man out of you", no matter what the common beliefs around this might be.

    Second, and again in common with other trans people I've spoken to, Sophia admits to some difficulty with social interactions. Difficulties at home growing up, difficulties at school; those things would be enough to make any adult awkward and ill-at-ease socially. I know I love to be among friends, but among crowds of strangers I often hang back, unsure how to break in. (And I can so relate to that comment about free time? What free time?)

    Third, I always find it interesting to talk to high-functioning trans women. It's clear that, to succeed in any field, a trans woman must overcome considerable obstacles: in order for her brilliance to shine, she needs to be accepted, and given an opportunity. A very few (that I can think of) have made it that far (Sophie Wilson and Jan Morris spring to mind). Those are people for whom the thought would be "this is a very successful individual, who happens to be a trans woman" rather than "this is a trans woman who happens to be successful".

    Here is someone who has the potential to be extremely valuable and productive for any company which hires her. And yet, by her own admission, she is struggling to get employment (and she points out the same is true of many other trans people). I can well imagine that discrimination is common: "I'm afraid you're not what we're looking for right now" may be an acceptable, euphemistic version of "We're not sure that hiring a trans woman is OK with our management team right now".

    So if you happen to live in Tibet, or Mongolia, and want a commercial space specialist who can speak your language, give Sophia a call.

    But I am sure Sophia is right. There is probably an untapped reserve of trans talent out there: professional, qualified, experienced, hard-working, ready to step into the labour market (albeit in tights and heels, but who cares?). Employing those people is a win-win: a win for trans people, who will get better recognition, better self-esteem, better wages, better acceptance; and a win for the companies, who will get capable, loyal employees to work for them.

    Perhaps those companies should have a re-think. After all, it's not exactly roc-- oh, wait a minute.

    Sunday, 8 May 2016

    The Gender GP

    I was browsing one day through Quora. It takes up far too much of my time, though I can’t seem to get away from it. As you might expect, one of the topics I follow on Quora (among plenty of others) is gender, and I was delighted to come across a doctor writing openly about gender issues, in particular trans-gender issues.

    Helen Webberley: Gender GP
    The doctor is Helen Webberley, a General Practitioner from the UK. Her website, www.gendergp.co.uk, offers amazing access to a sympathetic doctor: “advice on gender issues, counselling and diagnosis, blood tests and monitoring, prescription medication”. And it comes with a plethora of means to get in touch: an email address, a mobile phone number, and the option to do face-to-face video conferencing with Helen. There is also a series of short videos explaining her own views about transgenderism and its treatment, and explaining how Helen can help.

    If you’ve read any of this blog at all, you will know how much I am looking for answers to my questions, not just about my own gender, but about the medical treatment of transgender people. You will also know how sceptical I am about the current state of the science behind gender treatment. I have (several times) approached doctors who treat transgender patients (including surgeons who perform sex reassignment surgery ) and also doctors who are themselves transgender, for their own perspectives. They have all quietly declined to be interviewed publicly.

    So I wasn’t filled with confidence that Helen would agree, but I got in touch, and she replied immediately and very positively. Here she is, sitting on my virtual couch:

    How did you first get interested in treatment of transgender people?

    I have always been interested in equality and diversity – it has always appalled me that anyone should be bullied due to their size, colour, hair, gender, preferences, religion etc. I got very interested in Sexual Health in the 90s and did lots of specialist training in this area, and then taught widely on how the medical profession should not judge differing sexual behaviours.

    When I became a GP in Wales, I had a transgender person asking me for help, and the nearest clinic was in London. I made it my business to find out more about gender issues and how to treat them, and how to help this person who couldn’t possibly travel to London. It was fascinating, and very rewarding.

    What made you decide to pursue it as far as you have (the website, etc)? Why not just treat patients in your own region?

    I love technology, and was intrigued as to why healthcare was so far behind the rest of business when providing services online. I made my own website www.mywebdoctor.co.uk offering free advice to those who couldn’t get in to see their GP. I thought it would sit at the bottom of the huge pile of websites in the sky, but I was surprised at how many people asked for help.

    I had an idea to offer specific help for transgender people, so I made a special dedicated Transgender page. When I woke up the next morning, I realised just how big a need it was!! From here it has progressed to www.GenderGP.co.uk .

    Do you still have a normal GP practice?

    Doctor, doctor! Gimme the news!
    Until April 2016 I was the senior partner in a GP practice in Wales. My interest and work with the transgender community has meant that I have had to let this go, as I no longer had time to do both. After a brief spell of ill health, I decided to pursue my current interest and now I am a freelance GP and a full-time gender specialist.

    What opportunities exist for other doctors who want to specialise in the treatment of transgender people?

    There isn't really any official training available in transgender care. But with access to the Internet, there is now endless opportunity for doctors to read policies, guidelines and research to help them to understand more about the needs of the trans community and how best to help them.

    I really believe that gender care should be a routine part of General Practice, just as contraception and menopause treatment is. GPs are good at dealing with stress, family issues, workplace problems and hormones. These are the nuts and bolts of gender care and GPs should be offering this routinely.

    I have found that a lot of the dysphoria that gender variant people suffer is not due to their variance, but the attitude and responses from society and, ashamedly, the medical profession. If we sort that out, we are a long, long way toward making gender care very simple and easy and less demanding on the doctor and the patient. Trans people are startlingly well-informed: listen to them about their diagnosis and management plans – they have done most of the work for us.

    I am presenting a piece of work at the WPATH this year – "Gender dysphoria or medical dysphoria: what causes distress amongst trans patients?"

    I find myself concerned about transgender children. How does one determine whether it's ethical to treat children for transgenderism, especially since no long-term studies have been done looking at the outcomes?

    The children I have met have been amazing. The diagnosis is often so clear cut, and allowing them to go through a life-changing puberty, that so clearly doesn’t match their true gender, is bordering on inhumane.

    By blocking puberty and giving them time to mature and understand what they want and need for their future, you are preventing them from having to have life-threatening surgery in the future, and a life of mismatch and potential humiliation.

    I so totally agree with you about the lack of evidence, and that we are guessing and feeling our way, hoping it is right. But we need to prevent transgirls developing into big hairy men, and transboys developing into shapely, delicate females. There is a reason why the suicide rate is so high in this group, and we must stop their bodies developing wrongly.

    If you could wave a magic wand, and change one thing about the treatment of transgender people, what would it be?

    Allow them to help shape and dictate their care. If they want to try hormones, take hormones, have an operation, change their bodies – make it easy for them, not the huge struggle they seem to face at the moment.

    It seems that transgender issues seem to have burst onto the public stage in the last couple of years. Do you have any thoughts about why this might be? And where it might all lead?

    The true prevalence of transgenderism of any degree (remembering that gender is a spectrum on which we all lie, somewhere between 0 and 100%) is massively underestimated, I expect. In the 80s, people felt more confident to come out as gay, and the same is happening now for the trans community. We are about to see the true extent of exactly how common it is to have some variance with your gender. Is ‘male’ and ‘female’ a human generated idea – and have we got it all wrong?

    Human X and Y chromosomes
    The concept that there are two genders is wrong (in my view). There are two sex-determination systems – XX and XY – and our society has presumed that our gender identity matches those and has made this dictate everything from what you should wear, to what job you should have, to what role you should take in life, to what bathroom you should use, to what gender you should choose to marry.

    In the olden days, we also presumed that our sex-determination system also matches our sexual identity (who we are attracted to), but look how wrong we were about that. Again, society dictated that there would only be one sexual identity and we made all the rules about marriage and commitment to fit that. Latterly we have had to re-write the rulebook.

    I believe that everyone is on a spectrum of gender (identifying as male or female or somewhere in between) and identity (fancying men or women or anywhere in between) and preference (liking pink or blue or fairies or sport or animals or trains). Society shapes this and suppresses our liberty to express somewhere else along the spectrum. I would love to see what happened in a new society, born without rigid rules and constraints and expectations. Would I have been a very feminine heterosexual?

    My video talks about the sphere of diversity, and in that sphere are lots of spectra, and where we lie on each spectrum gives us a unique point within the sphere, unique to you and to me, and excitingly different.

    Do you ever refuse to treat someone for gender issues? How do you determine if a person is suitable to be treated or not?

    I would be very concerned about someone whose gender issues seemed to stem from a bad experience in earlier life. For example a person who wanted to hide from their genitals and sexuality due to a previous history of sexual abuse.

    As my service is a remote service, I do not treat anyone who is shown to have manipulated the system in order to get medication.

    Most people are absolutely honest and genuine and so grateful to have the chance to get the care they need, but sometimes I have to signpost people back to their GP.

    Have you ever come under criticism from colleagues or the public for what you do?

    Oh yes. In one year I have been reported to the GMC twice (but they have found no concerns) and threatened to once – all by leading doctors in this field in the UK.

    AMAB? I thought you said...
    A transmale counsellor working in the field said I wasn’t qualified. A well-known psychiatrist said that I wasn’t qualified and did not do a comprehensive enough assessment. If the diagnosis of an AMAB who has been cross-dressing for years, and would now like to develop some soft skin, breasts and shapely thighs isn’t a clear enough self-diagnosis, what is? Gay people don’t need a psychiatric evaluation before they are allowed a same-sex marriage. Not all people with abdominal pain are excluded for delusions before taking out their appendix.

    Some of these healthcare professionals are supposed to be caring and helping the trans community, but the stories I hear of people’s experiences in their GIC make my toes curl, so I am not surprised that I am not always treated with respect. I wonder whether they are just keeping the GIC waiting list so long to fuel their private practice. I can’t see any other reason that they would not welcome an experienced GP who is helping relieve the burden of their work.

    One of them publically wrote about how gender care that is straightforward should be delivered by people’s GPs, and in the same month I received a letter of concern from him via the GMC for doing just that!

    Gender care needs to be brought under the auspices of General Practice, and done by good old (modern) GPs who are used to dealing with everyday people, every day. If we don’t start encouraging GPs to embrace this field of medicine, then the waiting lists for the GICs will soon be 10 years, not 2!

    The public have been great, I have received so many letters, cards, reviews, testimonials – and every one has been truly complimentary. I have changed many lives for the better, and I expect saved a few desperate lives of people who thought they had nowhere else to turn.

    Do you have any thoughts about the autogynephilia model of Bailey and Blanchard?

    I had never heard of it so I just looked it up. The majority of transgender patients I have had the pleasure of treating could no way fit into this model. I guess that these ideas could be made to fit some people, but to generalise and say this theory explains gender issues is outright wrong.

    I have never really thought about the philosophical arguments so much. I have always concentrated on the physical, psychological and social needs of my patients, so the theory is interesting but a bit mind boggling!

    Which famous person would you most like to meet, and why?

    My family and friends laugh at me because I just have no interest in ‘famous’ people. I would like to be famous for really transforming gender care in the UK and the rest of the world. I would like to shake hands with my future self for helping trans people to access safe and easy healthcare without fear of humiliation, prejudice or judgement.

    ===

    As always in my interviews, I like to reflect a little about the answers.

    First, Helen seems to be extremely unusual: a doctor who treats trans people and is willing to talk about it openly and willingly. She seems so open, so inviting, in contrast to the attitude of many other (but not all) doctors, which seems to be to be with awkwardness and silence (a vestige, perhaps, of the “shame, secrecy and trauma” which Alice Dreger talked about with intersex children).

    Accepting: Webberley
    In addition, Helen offers a multitude of ways for people to get in touch with her, which leads me to wonder how she can possibly get any work done. I seem to be forever answering emails, and I don’t have people all over the world asking me about hormones!

    I approached a surgeon who performs sex reassignment surgery, and he declined to be interviewed. In fact, he was barely polite with my request. He would not consent to be named publicly. When I offered him an anonymous interview, he was sure that he would be recognised by his answers.

    So I guess my point is: so what? If you are a doctor, and you are performing perfectly legal operations, believing in good faith that you are acting for the benefit of your patients, why should you hide? Surely you either believe in what you do, or you don’t. And if you don’t, why are you doing it?

    Helen comes across as completely the opposite. Open, friendly, non-judgmental. Willing to discuss some very sensitive issues very freely. I see her very much as a step in the right direction: the direction which says that you don’t need to hide if your gender doesn’t quite fit the slot, but are deserving of sympathy and acceptance and respect. She isn’t hiding; instead she is out there trying to be noticed.

    I found myself surprised (read: astonished) that she had never come across the autogynephilia model. I thought everybody knew about that one! But again I find this refreshing: that someone can come to a field (you might say a minefield) like gender, and just apply their own take on it, and be so positive, without being subject to what other people want you to think about it.

    I couldn’t help challenging Helen on some of her practices. I believe medicine should be guided by science, and yet the science is lacking in a lot of areas. Again I found her answer refreshing: “guessing, feeling our way, hoping it is right”. How humble, and how different from the dogmatic certainty of people like Paul McHugh.

    I am impressed (in case you couldn’t have guessed) with Helen. I find myself hoping that she is in the vanguard of a new wave of doctors: open, receptive, non-judgmental, willing to listen to trans people instead of dictating to them . I wish there were a hundred like her—and perhaps soon there will be.

    My thanks, as always, to Helen for her patience, not just with my questions, but with my flurry of emails requesting clarifications on several points. My thanks, too, to her husband Mike for reviewing the final draft.

    Form an orderly queue, please. The doctor will see you now.