Prohibition Party!

It’s one of my favourite things to get an invitation where the person says “Vivienne is welcome too”. A few weeks ago I got an invitation to a friend’s birthday party. It was to be fancy dress, with a Prohibition theme. While I could use this article as an opportunity to show more pictures of myself (and I will!), there are actually other aspects to it which I’ve been reflecting on since.

How do I look?

As I’ve mentioned before, I don’t normally enjoy “dressing up”. It feels like pretending to be something I’m not, while dressing as Vivienne feels like doing something that I am. But this was an opportunity to do the latter while pretending to do the former—I don’t know if that makes any sense at all!

There were several obvious problems. I don’t possess the elegant willowy figure of the 1920’s flapper—or the gangster’s moll. But secondly I had no idea where I would come up with any sort of costume to wear.

Missy’s mum came to the rescue and had very nearly everything. She’s extremely fond of rummaging in flea markets, op shops and charity shops, and has a huge collection of all sorts of amazing stuff. She provided the dress, the wig, the fascinator, the feather boa, the pearls and rings and necklace. Even a vintage black clutch bag (foreground).

The white gloves and choker came from a dress-up shop, and the tights and shoes (which you can’t see) were model’s own. I had to take the gloves off for the mirror selfie because my phone screen wouldn’t register my touch when I had them on!

I spent ages getting ready. Among other things, I had never worn stick-on false eyelashes before. I took an hour to put them on in any sort of reasonable position, and I had to take them off and reposition them several times!

Meanwhile Missy decided to go as the gangster: the fedora, the black shirt and white tie, and a plastic gun from the dress-up shop. It was a great outfit and she looked fantastic. In fact, everyone did; it was like walking around in a scene from Bugsy Malone.

Flapper girl in a Gatsby world.

As we walked in, I realised, for the first time, that aside from a few people that we know, most people would be strangers--and not necessarily expecting to see me turn up in a frock. There were a couple of dozen people there, including teenagers, and everyone seemed to react positively. One or two of the men looked slightly taken aback when I introduced myself, but after that nobody showed the slightest discomfort. One of the women asked me where I got my tights, and I asked her where she got her corset. (Interestingly, two of the women were also dressed in male gangster gear, and looked fantastic).

The house had been done up beautifully as a speakeasy with darkened windows, decorations and soft lighting. There was a very well-stocked drinks table, and plenty of nibbles. There was even someone "on the door" and we had to pretend to give the password. But the most impressive feature was a full-on gambling den, with a full-sized roulette wheel, a blackjack table, and a professional croupier to run the whole thing. No money was won or lost--we played only for chips, though there were prizes for the biggest winners.

The croupier kept referring to me as "the gentleman with the green chips". I wasn't in the least bothered about this; I really just found it funny. In fact I joked with him: "What have I got to do here to get treated like a lady?!"

The chat and the company were outstanding. We mingled and met some lovely new people. We played roulette and blackjack. We enjoyed the nibbles and drinks. I felt wonderful. From time to time, I was suddenly struck by the realisation--all over again!--that I was out, dressed, and feeling fabulous.

Baby needs a new pair of shoes!

Looking back on this splendid evening, my first impression is how far I have come. An evening like this one--glamorously dressed and having a wonderful time with a group of lovely people--would have been pie in the sky only a few short years ago. Every time I've looked back on it, it's given me a little emotional boost.

My second reflection is that, perhaps in some sense I was also being an ambassador for trans people in company. Perhaps the people at the party hadn't come across someone like me before, and perhaps having a laugh and a chat with me might make them feel more comfortable encountering other trans people in their lives.

But the third boost it gave me is that I had told quite a lot of people, including people at work, that I was going to be going to a party "in drag". And naturally they wanted to see the photos afterward. And so I've had the experience of showing people who don't know about Vivienne some photos of Vivienne! I've had nothing but positive comments from them; many of them said they thought they were looking at a woman in the photos, although they obviously recognised it was me.

All of this makes me feel just that little more confident in myself, a little more confident about coming out to more people (slowly does it!), and a little less nervous of future encounters. How can any of this be a bad thing?

Now, let's blouse. I gotta go iron my shoelaces. Don't take any wooden nickels!

Opening the Closet

In the last couple of weeks I've finally come out to all my children.

This was a surprisingly difficult thing to do. Not because I didn't want to, but because there were significant obstacles in the way. Those of you who know me (and followers of this blog) will already know how much my ex-wife loathes cross-dressing, and how manipulative and obstructive she can be.

Without going through all the exhausting and tedious details (and there are many!) I managed to navigate the worst of her obstacles and finally do the Big Reveal.

Having been very careful in making this move has allowed several things to happen. It has allowed me to contemplate seriously, and for the first time, what my life might look like if I didn't have to hide who I am. For many years, I had to deal with a wife who told me how disgusting, how shameful, how unacceptable it is to enjoy wearing feminine clothing. This was very corrosive to my self-esteem.

During this time, hiding and pretending felt normal. It felt safe. It felt like a boat I didn't want to rock, because I was still very fearful of further negative consequences, and I didn't think I had the strength to weather them.

But the idea of no longer having to hide was beginning to take hold. Looking ahead, I could see light for the very first time--a light which I didn't dare to dream would ever shine on me. When my ex-wife's protests began to mount, the thought of moving backward was intolerable.

The Big Reveal

I've always found it amusingly ironic that a common metaphor for facing up to something difficult is to "put your big girl panties on". This was definitely one of those moments!

The star of the show was the eldest boy, in his late teens. He accepted it immediately and completely, and was so mature. He was the one I was most worried about, as he’s grown up believing his dad was an ordinary guy (albeit a geeky, scholarly one), and I wasn’t sure how he would take the news.

The one I expected would be no trouble was the eldest girl, in her middle teens. She’s very “woke”, very pro rainbow people, and has often made statements in support of minority causes. Although she also wasn’t expecting this announcement, I thought she was the one “primed” to be accepting. Instead she was quite upset, and took herself off to her mother’s place immediately.

The younger two have been fine, especially the one who is already a bit rainbow.

What I told them all is: this isn’t a secret any more. I didn’t want to pull them into the closet with me, but instead to open the door a lot wider. What that means (for me) is no more hiding. While I’m not going to wave Vivienne in people’s faces, nor am I going to be hiding away and hoping I don’t meet anyone who might recognise me.

Aftermath

I’m still processing all this. My daughter’s reaction hit me especially hard. Instead of feeling relief, or satisfaction, or triumph, I felt deflated and disheartened for a couple of weeks. It made me wonder whether I had done the right thing at all: did I push it too hard? Should I have waited longer?

I’m gradually feeling slightly better, and early indications are that she is coming around a bit more. But I still feel it’s too soon to be celebrating.

The person who has made all this possible has been my amazing partner, Missy, who has unfailingly supported me, gently coaxed me away from my tendency to catastrophise everything, and used wisdom and gentleness to help me reframe my feelings more positively. I still wonder how I’ve ended up being so fortunate.

Out, and Proud?

The word Pride is often used by rainbow people. We have Pride parades in many cities every year. They have gone from being protest marches against oppression to being (in the main) colourful parades suitable for the whole family, which is a wonderful thing. The struggle isn’t over, of course, and in some countries things seem to be actually going backwards.

It's nice to finally meet you!

But the notion of Pride is a powerful one. It’s retaliation against the sense of shame and exclusion that many of us have felt. (I know that what I’ve experienced is a drop in the bucket compared to what others have experienced!). The concept of Pride is for rainbow people to be able to say: here I am; I am a worthy person; and I am proud of who I am.

As of today, I’m not feeling proud of myself--yet. Perhaps this moment will come. And, as one person after another learns about Vivienne and responds with warmth and acceptance and curiosity, rather than revulsion or scorn, my self-image is gradually changing. And my wardrobe is improving and my makeup is looking better and I’m feeling more comfortable and natural when I go out. The overall trend is upward.

When I started talking to my trans friends and acquaintances and Facebook groups about coming out, several of them clearly saw it in very different terms from me. They saw it as a thing to celebrate. Have a party, they said (a gender-reveal party!). Make it a special day! Enjoy it!

This had never once occurred to me. Until recently, coming out has been something I dreaded, and was not looking forward to it at all. (Missy spoke of “ripping the plaster off”). Having a party to celebrate? It’s definitely something I’m thinking about, and it might make a turning point.

So what is the future going to look like? That light in the distance is beginning to look a whole lot closer. And the face that I'm going to show to the world is going to look like this one a whole lot more often.

Bits and Bobs

I've been collecting a few items of news, which aren't really worthy of a blog post all by themselves, but I have decided to put them together here.

Ukraine

Obviously, as much of the rest of the world is, I am appalled by Russia's invasion of Ukraine.

Zi Faámelu

Before this invasion, I knew very little of Ukraine. On the other hand, I was surprised to find that if you rank my blog hits by country, Ukraine comes in 10th. This is almost three times higher than my own country, New Zealand! It won't come as a surprise that hits from Ukraine have all but disappeared since the start of the invasion.

The number of hits from Ukraine made me realise that there is a trans population in Ukraine which is trying to reach out across international boundaries. I took comfort from this--until I started reading. Until recently, being trans in Ukraine could result in you being institutionalised. Ukraine ranks 39th among the 49 countries in Europe for LGBT+ freedoms and rights. Gay marriage, for example, is still illegal.

Then I read stories like this one, which describe how transwomen attempting to flee Ukraine have been detained and turned back at borders. One transwoman, Zi Faámelu, describes in Rolling Stone magazine how she was repeatedly turned back at the border, because in Ukraine, military service is now mandatory for all males, and her passport still states she is male. Eventually she escaped by swimming across the Danube river into Romania. She is now living safely in Germany.

I can understand how the presence of war, plus a country just beginning to experience a little awareness and acceptance of rainbow people, is making life extremely difficult for trans and other rainbow people. But if Ukraine isn't friendly to trans people, Russia would undoubtedly be a lot worse. Russia ranks 46th on that list, and Vladimir Putin has described gender fluidity as "a crime against humanity".

One thing is for sure: the Ukrainians are showing that they are not willing to give up their freedoms and submit to the oppression and restrictions of Mother Russia. Hopefully once they send Mr Putin back to Moscow with a bloody nose, they can get on and grow in freedom and tolerance, as they have been over the last few years.

Ukraine has also won the Eurovision Song Contest for this year. As I've written before, the contest isn't so much a competition of musical talent as a sort of political popularity contest. This victory is definitely a message of support and encouragement from the rest of Europe to the people of Ukraine.

Meanwhile, to any Ukrainian people reading this blog, I salute your courage, and I hope that the war ends soon and you can rebuild your country.

PATHA

As a doctor, I'd known that the World Professional Association for Transgender Health was a thing. However, because I was still being very stealth, I didn't really want to put my hand up, because I thought I might be traced, and that might be a "bad thing".

However, that's changed now. New Zealand has an affiliated branch of WPATH, called the Professional Association for Transgender Health Aotearoa, PATHA. I got in touch with them, and they were delightful. I've paid my membership fee, and Dr Vivienne Marcus is now a full member of PATHA.

I'm not sure what this will mean for my future. At the moment I'm just trying to cautiously reach out to the other members. It's that equivalent of slipping in at the back of the lecture theatre and hoping nobody notices you. But I'm confident of full acceptance from them.

What's not so clear is how I can contribute to the cause. I don't particularly look after trans people in my daily work. I don't think being a PATHA member is going to really change anything about how I do my job. What I am good at is writing and teaching, and I've explained that to the executive on my application. It remains to be seen what (if any) contribution I can make. I will certainly notify you of anything momentous I end up doing.

Lofi Girl

I can't remember where I first saw an animation of Lofi Girl, but it struck me immediately as being both pleasing and familiar.

Lofi Girl is the name of a French YouTube channel and music label, which, which provides an endless stream of what Wikipedia calls lo-fi hip-hop, accompanied by an endless animation of a young woman sitting writing in a diary. The music is intended to be relaxing, background music, which can be used to accompany study, relaxing or other activity; in essence, audible wallpaper.

I like lots of things about this. First, I like the animation, which is clearly inspired by the sort of Japanese anime typical of the wonderful Studio Ghibli, whose work I adore. In fact, Wikipedia says they originally used a short segment from the film Whisper of the Heart, before being legally required to take it down. Since then, they have commissioned an artist to recreate an anime-like character (whose official name is Jade) to feature.

Vivienne as Lofi Girl

The Lofi Girl sits, looking thoughtfully at her book and writing by hand. She's listening through headphones (presumably to what we hear), deep in thought. From time to time, she pauses and looks up at the cat, which sits on the windowsill looking out of the window. Then she carries on. This provides just enough action for me to sit and watch it for hours. From time to time, the weather changes outside the window, and day turns to night and vice versa.

What I love about this is that she sits exactly the way I do. I love to write in my journal; I use a gorgeous fountain pen, and delicious inks from Jacques Herbin in Paris. And while Lofi Girl is a leftie and I'm not, I do sit with my chin in my hand while I write. And from time to time I pause and look up into the middle distance. Journal writing is my happy place; both an intellectual and a sensual pleasure.

Surprisingly, the part about Lofi Girl which attracts me least is the music. There's nothing particularly wrong with it, but I find it quite samey after a few hours.

Amazingly, the Lofi Girl website allows you to customise the appearance of the Lofi Girl and create a still image. So this is what she would look like if she were Vivienne--complete with dog!

Doctors as Gatekeepers

Let me open this first post of 2022 by wishing all of you a very happy and productive New Year, and let me also hope that COVID-19, in whichever variant, doesn't interfere too much with your plans and your lifestyle.

I came across a cartoon this week on my Facebook feed*. It was drawn by Sophie Labelle at Serious Trans Vibes. She also has a Facebook feed called Assigned Male Comics. Some of her comics have been anthologised into printed volumes which are available from her website store in both English and French.

According to the Wikipedia page, the comics have been produced since 2014, and have received positive reviews from critics. Certainly she seems to attract very positive and supportive comments on Facebook, although she has also occasionally been the target of hate. From my perspective, the medium of comics is a very effective way of communicating transgender topics, and I've written about this before, here and here.

Here's the cartoon which caught my eye*. I hadn't come across any of Labelle's work before. I did not recognise the character depicted (it turns out to be one of Labelle's main characters, a young trans-girl called Stephie).

As of today, 15th January 2022, this cartoon has had over 6,700 likes, 172 comments, and 1,700 shares, although these numbers seem to be par for the course for Labelle's cartoons on Facebook.

But what troubled me about it was the implication that that doctors are deliberately obstructive to trans people; deliberately causing them to experience "unbearable pain or intense suffering"; and deliberately inflicting "torture" upon them. This view struck me as unfair and I wanted to explore it further.

Being both a trans person myself, and a doctor, I'm aware of the tension that exists between the two groups. I'm aware (of course) of the frustration that exists from trans people who cannot get doctors to listen to them, believe them, or treat them. And I'm aware (of course) of the antics which some trans people sometimes resort to, such as lying or manipulation, to try to get their way. Others resort to hormones they buy online, or travel overseas to get surgery.

And I want to explain why I think "gatekeeper" is very much the wrong metaphor for what doctors are doing.

There is definitely a problem

Before I go further, I want to state that there is definitely a problem in the medical treatment of transgender people. I am, in my professional and online lives, trying to help to put it right, and I have discussed this matter before on this blog, for example here.

I wrote a long comment on Labelle's page, attempting to explain a more balanced view. She deleted it, and posted this:

Labelle: got a few truscums who wrote 10 pages long comments on how gatekeeping is essential to be truly trans, I got to delete their comments before anyone saw them, as a morning treat! I hope they didn't save their essays anywhere and they're lost forever.

I had no idea what a truscum is, although it's obviously intended to be an insult. You can find a discussion of its meaning here on Wikipedia. From what I have read, that description doesn't apply to me.

This exchange was not the most heartening opening to a discussion I've ever had. I contacted Sophie Labelle again for her comments, and she blocked me. But I nonetheless thought it was worth exploring the two aspects of it: why do (some) trans people feel that they are being tortured by doctors, and what could actually be going on from the doctors' point of view? And, most pertinently, can anything be done to fix it?

Why is it so hard to get good transgender medical care?

I want to begin this section by pointing out that I believe most doctors genuinely want to help transgender people, and that good gender treatment is fully in accordance with good medical practice. But there are several obstacles to achieving this, some larger than others.

Road ahead closed

First, most doctors have very little or no training in gender treatment. That means that few doctors have personal experience to draw upon. In addition, guidance from professional bodies is extremely sparse. When I was a medical student, in the last century, gender identity problems were not taught at all, though we did learn about intersex conditions in paediatrics. In endocrinology, we learned about people with hormone disorders: too much of this, or too little of that, and how to help, but none of this was in the context of people who want hormones to help with their gender.

Second, many (but not all) doctors are commonly faced with patients asking for (even demanding) treatments which could be potentially harmful. Strong painkillers are a great example, and I've seen patients who have resorted to ingenious methods to circumvent the system to obtain them. We've all been bitten, sometimes very hard, by such patients, and therefore many of us are understandably suspicious of people who don't seem genuine.

Put another way, if you are lying to your doctor, there is a very good chance that your doctor knows or suspects that, and this is likely to erode their sympathy and work against getting their cooperation. There is often a distrustful undertone to the relationship between the doctor and the transgender patient, where neither of them feels that the other is being completely open or completely helpful. The whole purpose of this post is to try to improve that situation.

Third, there is a very good rule of medicine: first, do no harm. This advice is so old and venerable that people think it was written by Hippocrates. (It wasn’t). But the meaning of the statement is clear: before you give a treatment you hope will help, you need to really make sure it isn’t going to make things worse. It encapsulates a theme of being cautious in the practice of medicine, which in general is a good thing (I believe). And its core is the patient’s wellbeing, which is paramount. If you are asking for a treatment which your doctor thinks may harm you, they are very unlikely to comply.

No doctor wants headlines like this.

Fourth, there is little good science in the field of gender treatment. What good science there is is drowned amid flag-waving, virtue-signalling, politics and wishful thinking. See my post here for a detailed discussion of these issues. This is especially true for gender treatment in children.

Fifth, those few doctors who have courageously taken on the treatment of transgender people sometimes run into serious professional trouble, threatening their career or livelihood.

Dr Helen Webberley (whom I interviewed here) has been treating thousands of transgender patients (including children) for some years, but has got into some serious hot water with medical authorities in the UK. (As I write, Webberley is still under suspension from practising as a doctor, and her tribunal is ongoing).

This sort of thing acts as a powerful disincentive to doctors to advocate for transgender people or treat them. Those doctors who are interested in training in gender issues will be looking at Webberley's case, and some will decide that the risk of getting into trouble is just too great. 

All of these things make it very difficult for doctors to effectively treat transgender patients.

The fictional case of "Bob"

I've created this fictional scenario to illustrate how an ordinary family doctor, without any training in gender treatments, might approach a consultation with a late-transitioning person. I'm not trying to suggest every transgender patient presents like this. I'm not trying to suggest every doctor would feel the same (and in particular, I would not). But hopefully this scenario will illustrate some potential ways of medical thinking.

Imagine you are that ordinary family doctor, and a patient comes to see you. You have known Bob and his family for 10 years. He is 52. He likes golf and fishing. He was a bank manager until last year, when he lost his job. Since then he has put on a lot of weight and begun to drink more heavily.

Bob tells you he is transgender. He is actually a woman inside, something he has felt for his whole life, but kept hidden from everyone, including his wife. He has been cross-dressing in secret for many years. But now he feels he cannot remain hidden any more, and wants to transition. He wants hormones. He wants surgery. He wants a legal name change.

Burdened: Bob

How do you react? You’ve been Bob’s doctor for years, but he has never mentioned this before. Nothing about him seems remotely feminine.

From one perspective, the story is true. Bobbie could have kept her feelings and behaviour hidden successfully for years, but could carry the burden no longer. This is her chance to be true to herself; to finally become a woman. You look up the referral pathway to the nearest gender clinic, which has a waiting list of two years. Bobbie says she can’t wait that long and wants to travel to Thailand for surgery. She asks you to prescribe female hormones for her, but you are not familiar with these treatments, their doses, or their side-effects. You really want to help Bobbie, and you tell her you will try talking to some colleagues for advice, and you will do what you can, but from Bobbie’s perspective, what you are offering is not enough, and far too slow.

Are you acting as a “gatekeeper” here? I argue not, though Bobbie might feel that you are. Who is right?

From another perspective, Bob’s story doesn’t ring true for you. Bob has always looked and acted like a man’s man: coaching the football team, golf, fishing, powerful cars. Losing his job hit him really hard. He is probably clinically depressed. He is certainly drinking too much, and you suspect his marriage is in trouble. He certainly isn’t the first middle-class, middle-aged guy who has had an unexpected mid-life crisis, even if most of them buy a motorbike or get a tattoo. You think that it would be better for Bob to sort himself out: cut down the drinking, get another job, lose a bit of weight, take more care of himself. You offer him antidepressants and recommend exercise. You tell him that if he still feels the same once those other things are sorted out, you will help him with his request to change sex, but you think in a year or so Bob’s feelings could well have changed and he might feel very differently.

Are you acting as a “gatekeeper” here? Maybe yes (Bob would certainly think so), but are you a bad doctor for doing so? For listening to your patient, making the very best, compassionate, objective assessment of what you think is really wrong, and trying to put it right? I would certainly argue no.

Aye, there's the rub!

And that's where the scissor-point is. Bob's story is fictional, of course, but there is enough truth to it that many elements are recognisable. A doctor, with either perspective of dealing with Bob, is practising good medicine. They are not being a bastard. They are not being cruel. They are not, in any way, deliberately attempting to hurt Bob or cause him distress. They are not torturing Bob! And they are not acting from a perspective that "gatekeeping is essential to be truly trans".

No way, sucka!

The image of the doctor as gatekeeper requires that there is this wondrous place, filled with bountiful hormones and surgery and unlimited gender treatments, but there's a huge steel door, and like a big mean bouncer, your doctor is looking you up and down and saying in a gravelly voice: Yer name's not down, yer not coming in.

But no such bounty exists! From a doctor's perspective, the official pathways are swamped and waiting lists are long. Some transgender people have other issues: depression, drug and alcohol use, self-harm, which can complicate the picture. (If you treat Bob’s depression, will his desire to transition go away?) Some transgender people point to gender as their one biggest problem, and play down other concerns, even though they seem important from the doctor's viewpoint. Some transgender people seem to have unrealistic expectations of how rosy their lives will be after treatment, even though this isn’t necessarily what happens. And some people change their minds about what’s best for them, as their lives unfold.

I'm not saying that trans people who are trying to get treatment are not suffering. I am not trying to suggest they should just suck it up and forget the whole thing. Instead I am trying to point out that what doctors do is not deliberate cruelty. The situation involving children is even more fraught. Gender services for children are even fewer than for adults, and a child who is growing rapidly creates even more pressure in an already pressured situation.

So what's the solution?

The solutions are clear, but none of them is easy. First we need good science to inform medical practice. That, in itself, is difficult, slow and expensive. As I've written here, if your science produces conclusions which some transgender people find unpalatable, you are likely to face powerful negative repercussions. That in turn provides powerful disincentives to scholars to pursue the science around transgenderism.

Second, we need better training for doctors in the treatment of gender conditions. The good news is that there is some evidence that this is starting to happen, although obviously it will take a while to work through the system.

Third, we need clear professional guidance from professional bodies to existing doctors, about treatment regimes, referral pathways, and so on. Again, this is happening, with organisations such as WPATH setting out standards of care (currently brewing up their 8th edition) for transgender people worldwide.

Fourth, we need better investment and funding for those systems which currently exist, to match the increasing demand for their services, cut waiting lists, and improve access to treatment. For these outcomes, you need to lobby your politicians, not your doctors.

Meanwhile, transgender people, and the doctors looking after them, will struggle to make anything successful happen with what already exists out there.

How can I get the best out of my doctor?

The first thing to say is that doctors are people, which means there are some who are brilliant, some who are dreadful (sadly I've met some of them), and most of the rest are perfectly OK in the middle somewhere. Most of us went into medicine because we actually want to help people, after all. We are also aware that the power-balance in the doctor-patient relationship very much favours the doctor. While medical paternalism is still (unfortunately) a thing, the old notion that "doctor knows best" is obsolete, and practised only by a few, aging doctors.

But if you understand how your doctor is thinking, it is likely to result in a better outcome all round. You will be able to reassure them and defuse some of their reluctance. You will be able to put forward your goals in a way which seem to be in accordance with good medical practice, not against it.

It doesn't have to be a conflict.

If you happen to run into a dreadful doctor, get another doctor! If your doctor is uncaring, brusque, unsympathetic, or otherwise unsuitable, vote with your feet. Change to another doctor in the practice, or change to another practice entirely. There is likely to be a social media page for trans people in your area. Ask around for recommendations about a supportive doctor near you.

If your doctor seems willing to help, but unsure what to do, point them to the WPATH website, which is positively bursting with resources to help: medical guidance, standards of care, a comprehensive reading list, a search facility for colleagues and experts around the world. If they really want to talk to an actual transgender doctor, I'm happy for them to contact me by email.

Try to work with your doctor, not against them. Try not to take it as a personal attack if they don't fall over themselves to do whatever you ask. It's fine to negotiate, with statements like "I know that if I start with the higher dose, I might have more side-effects, but I'm willing to accept that risk for myself, and I will cut down the dose if I start to run into problems". Most doctors will respond very well to this approach, and many doctors like it if you've done your homework first: "I know I will have to keep an eye on my blood pressure and my blood sugar too, but I've been losing weight and keeping fit".

Plain honesty is likely to work very positively. "Look, I know it wasn't very smart, but I'm desperate, and I've been taking these hormones I got from the Internet. I brought you the box so you can take a look at them. They don't seem to be working very well. I really want to be on something safer and more effective".

Manipulation, lies ("Oh no, doctor, I would never take anything that I bought online") and subtle threats ("If you don't prescribe these for me, I'm going to start getting them online anyway, so you might as well") are likely to make things very rocky.

The hardest part (understandably) is to be patient with your doctor if they seem too slow. You may well be that doctor's first ever transgender patient. Your interaction with them will likely colour all future interactions with trans patients. Most doctors (as I've said before) will be willing to work together with you toward you meeting your goals, which will be rewarding for you both, and will likely make things easier for the next trans person that doctor has to treat.

The situation is changing. I know it's too slow for many people, but it's going to be better. Meanwhile, let's all try to understand one another a little better.

===

* I believe that my sharing of this image on this page consitutes Fair Use. The original cartoon was published on a public forum (Facebook), where it has been viewed many thousands of times. I have not changed or altered the image in any way. I have attributed the artist, and added links to her Facebook stream, her website, and her Wikipedia page. I have not attacked the artist or the image, but used it to illustrate a discussion point which is very strongly in the interests of the trans community--in other words, my use is in alignment with the implied original purpose of the image. I do not earn money or other reward for this blog. The image has already been shared over 1800 times without apparent objection from the artist, which indicates implied permission for its being shared online.

The Red-Nosed Reindeer

Since Christmas is fast approaching, every shop and radio station is playing Christmas songs all the time, and one which has always stood out for me is Rudolph, the Red-Nosed Reindeer.

I'd always thought Rudolph had started life as a song, but Wikipedia says the story was originally written in verse for the Montgomery Ward chain of department stores in the US in 1939, and only became a song in 1949, popularised by Gene Autry.

Rudolph leading the other eight

Before Rudolph came along, the names of Santa's other reindeer had come from the familiar poem A Visit From St. Nicholas by Clement C. Moore, first published in 1823. It's the one that begins 'Twas the night before Christmas. The poem gives the names as Dasher, Dancer, Prancer, Vixen, Comet, Cupid, Donder and Blitzen. (Not Donner, although he did name the last two reindeer after thunder and lightning).

In any case, Donder has now become Donner, and the list of reindeer that every scholarly child (such as I was) commits to memory is the eight names above, plus Rudolph, who is of course the youngest.

From the famous song, here's the bit which troubled me then, and still does today, enough to want to write about it here. Everybody knows that Rudolph isn't like the other reindeer. His shiny red nose marks him out as different:

All of the other reindeer used to laugh and call him names.
They wouldn't let poor Rudolph join in any reindeer games.

When I was a child, I didn't have a shiny red nose, but there was definitely something palpably different about me. I didn't fit in with the boys, no matter how I tried, and therefore I was always an outsider, yearning to be accepted. I remember being lonely and perplexed, wishing I could like football, wishing I could like rough-and-tumble play, and wondering what it was that was so intangible, and yet at the same time so inescapable. Not only were the boys unwilling to play with an atypical boy, so were the girls.

For Rudolph, the story ends happily. One foggy Christmas Eve, Santa realises that Rudolph's shiny red nose is just the thing to light the way for the sleigh. Hurrah.

All of the reindeer loved him, and they shouted out with glee
"Rudolph the red-nosed reindeer, you'll go down in history!"

As a child, I thought the other reindeer were a bunch of two-faced bastards. Santa decides Rudolph is cool, so suddenly they all change their tune? Partly I wanted Rudolph to tell the other reindeer to bugger off: partly I was pleased for Rudolph that he found the acceptance he had craved.

Happy Christmas to all, and to all a good night!

You may say (and you could be right) that I'm completely overthinking all of this. It's just a children's Christmas story, after all, and therefore it requires a happy ending with a perfect resolution.

But there is, I think a deeper interpretation, which is that those people who seem to not fit in--the one that other people laugh at, and call names--not only have something valuable to contribute, but can actually lead, and become popular, and become famous. Can, in fact, "go down in history".

So if I have one Christmas wish for us all, it is this. I wish that we get recognised as being special, and wonderful, and that we are loved, not just by Santa but by everyone.

Wherever you are, I wish you a glorious, sparkly, magical Christmas.

Ten Year Anniversary, but Still Not Brave Enough...Yet!

Since I started writing this blog, almost exactly ten years ago, so much has changed.

When I first started writing, I was unhappily married, with two small children, to a woman who despised everything to do with crossdressing. We had some counselling, but nothing changed. What really made a difference was coming out to a close friend. My ex-wife was determined that nobody should ever know--I mean, what would people think?

It turns out that people wouldn't mind very much at all, as I found out when I continued to come out to close friends and family members. Then there was the divorce, which was unbearably awful, and then a period of readjustment to my life as a divorced person.

Bluestocking Blue: Ten Years On

Then I met someone, whom I call Missy on this blog. I told her very early on, and to my delight and astonishment, she was completely supportive. We moved in together, and blended our families, with the usual bumps along the way.

Since then, my life is completely transformed. We go out together when I'm dressed. Admittedly, with a bunch of kids who have swimming lessons and sports fixtures and music lessons and all that, there isn't an abundance of opportunity for us, but it's unfailingly amazing and never gets old. We were invited once to a friend's birthday party, and I turned up as Vivienne to meet a houseful of strangers--who were all lovely.

My fem clothes hang in the wardrobe, next to my drab male clothes (not hidden in the suitcase in the attic). My heels are next to my man shoes. My makeup is in the drawer. She borrows my nail polish remover; I borrow her foundation brush. She helps me pick out what to wear.

Once a month I go to a very nice beautician (recommended by Missy) who does my leg waxing. We gossip like she would with any client, and she's super lovely. And I've been getting makeup tips from a local makeup artist, who had never had a trans client before but again is super lovely.

I'd love to say that I can be Vivienne whenever I want, but this isn't true. Overall, though, I could not have envisaged the direction my life would take. Where will it lead? I do not know, of course, but I am reminded of a line from the theme song of Ally McBeal (remember that show?), which resonated with me at the time: One by one, the chains around me unwind.

I even "came out" on this blog and admitted I'm a doctor, having previously pretended to be something else. I've been exploring the situation of transgender doctors, and have now made contact with several, as well as other professionals (an artist, a statistician, a novelist).

Which box should I be ticking?

I've also seen an increase in rainbow awareness happening around me. The other day, I met a medical student who was wearing a name badge which said "<Name>, Medical Student, Pronouns she/her". Formerly I'd always assumed that people who put their pronouns up front like this were either trans themselves, or had a close friend or family member who was trans. But no. Apparently there are lots of students wearing these badges now.

Once a year, however, my hospital sends around a staff survey. It asks for lots of details, such as what your hours of work are, what mode of transport you take to get to work, whether you feel safe leaving in the dark, and so on. I assume they are trying to make sure that the requirements of staff to get safely to work are met. They also ask about ethnicity, and I'm assuming that they're trying to make sure that the ethnic makeup of the staff is a reflection of the ethnic makeup of the community.

But they also ask about gender orientation.

When that question comes up anywhere else, in online applications, or other form-filling, I click on "non-binary" or "other" or whatever third option they give other than "male" and "female". But at work, I don't. I still click on "male".

I've found myself reflecting on why I do this, but basically, it's a form of cowardice. I know other people, more out than I, who have experienced real difficulties created by their gender identity. Yet, they persist, driven by courage, or determination, or the desire perhaps to blaze a trail for those who follow. Like water on stone, eventually the stone will be worn away. Why don't I click that third box, and prepare myself for whatever follows?

Because a close friend once warned me that our city is still quite conservative. You can only come out once. There could still potentially be adverse consequences of being open. She would know; it's happened to her.

And so, for the moment, I don't click the box. It turns out, that, even ten years on, I am still worried about what people would think.

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While my input to this blog has dwindled a bit since I started writing (far too much!) on Quora, I'm delighted to find that I'm still ranked at number 55 on the Feedspot Top 60 Crossdressing Blogs and Websites, updated on 11th December 2021, so I suppose I'm still allowed to have my gold medal displayed on the home page.

Transgender Actors

Here's a question. You want to make a film where a transgender character is the lead. Do you need to cast a transgender actor or actress in the role?

Victor Polster in Girl (2018)

For mainstream cinema at least, the choice is easy: you pick a cisgender actor or actress and cast them. That has been true over many years, from Felicity Huffman in Transamerica to Cillian Murphy in Breakfast on Pluto, to Terence Stamp in Priscilla, right up to Eddie Redmayne in The Danish Girl and most recently Victor Polster in Girl.

For some trans people, this is definitely a problem. The film Girl, which I haven't yet seen, has stirred up quite a lot of protest, in particular because there seems to be a lot of depiction of genitalia. Several questions about transgender actors have been debated on Quora, and some of the answers and comments are very interesting. All of the quotes come from Quora and are unchanged from the original authors' text, though they are not all in response to the same question.

The first comment people make is that there are plenty of trans actors out there now.

Elliott Mason: There are hundreds of working trans actors, of all stripes and appearances. If none of them are considered "bankable" it's because productions won't cast them to play cis, but won't let them play trans either.

Eddie Redmayne in The Danish Girl (2015)

This is a very fair point: if you are a trans actor, then you might find yourself stuck between a rock and a hard place: no trans roles-- and no cis ones either!

The next point is that it’s not acceptable to have black or Asian parts played by white actors in makeup—and for the same reason we should have trans actors playing trans characters.

Joanne C Wittstock: There was a time when women were not allowed on stage. Then a time when no suitable black actors were available and the roles went to whites. For decades there were apparently no Asians with theatrical skills. The frontier is slowly moving. To a large extent trans people are the visible minority of this moment.

I completely take this point. One of the things which spoils what would otherwise be one of my favourite ever movies, Breakfast at Tiffany's, is the dreadful "comic relief" turn of Mickey Rooney in yellowface as Mr. Yunioshi. And one of the best of the classic Doctor Who stories, The Talons of Weng-Chiang, features John Bennet in the role of the villainous Li H'Sen Chang. This time, it's not played for laughs, but the show still manages to throw in some dreadful Chinese stereotypes. The few actual Asian actors in the production are relegated to non-speaking parts.

Another common theme is the failure of Hollywood to recognise the legitimacy of trans people themselves; instead making them out to be a pretence.

Helena Almagest: The persistent practice of Hollywood to have cis men portray trans women and cis women trans men promotes the misconception that transgender is merely a disguise, and that trans women are merely men dressing up, and trans men, women dressing up. A misconception that gets us killed. (her emphasis).

A trans woman should be portrayed by a woman. It needn’t even be a trans woman (although suitable trans actresses are out there and desperately seeking jobs), it could also be a cis woman. Just not a man.

Likewise, a trans man should be portrayed by a man, trans or cis.

Tara Nitka: Hollywood has made me quite skeptical about the ability of cis people to write and portray trans characters, but that might only be true of Hollywood.

But ultimately, casting cis men and boys to play trans women and girls sends the message that we’re men pretending to be women. If you can’t cast a trans girl, at least cast a girl.

Felicity Huffman in Transamerica

From the (short) list of famous movies at the start of this article, only Transamerica would meet with approval here, with Felicity Huffman cast as a transwoman.

Sara Clarke: When we cast a cis person to play a trans person, we’re at the mercy of that person (and their most likely cis director and writer) to tell us what trans people look and act like, how they feel about things, what choices they would make, etc. Considering how ignorant most cis people are of the trans experience, that’s not doing anybody any favors: either other cis people learning about trans issues through the lens of other cis people who may or may not know what they’re talking about, or other trans people who want to see authentic versions of their lives represented in the media.

These are powerful points. The criticism is that the films don't depict trans people, or how they feel, but only what cisgender people think trans people are like, and how they feel. I definitely share this point of view: several times during The Danish Girl, I found myself thinking that elements of the plot didn't strike me as real.

Chrystal Andros: My issue is what is called agency. With women it used to be (and still is in some aspects) that men define what is good for them. They cannot speak for themselves, so they have to have someone else speaking for them.

In the same way in Hollywood, managers and focus groups define what is good for the audience and define their selection of actors.

With trans-actors and trans-actresses they fit into a certain category - they are becoming more mainstream, but they are considered like women from 1950s who go out and become professionals - the freaks of today.

Three of the films I have mentioned have received very positive reviews. On Rotten Tomatoes, Priscilla has a 96% approval rating; Girl has achieved 84% and Transamerica has 76%.  Meanwhile, The Danish Girl managed only 67% and Breakfast on Pluto achieved 57%. So the filmmakers are doing something right (if not exactly breaking box-office records with any of them). But of course, if these are films made by cisgender film-makers, pitched for a (predominantly) cisgender audience, I suppose that doesn't necessarily mean they please transgender people.

Cillian Murphy in Breakfast on Pluto

But not everyone agrees with the sentiments above. Some commentators reported that, as long as the actor does a decent job, it shouldn't matter whether they are cisgender or transgender.

Mark Grinstein-Camacho: Actors play different characters all the time. It is their job. You can find actors who play straight people, gay people, billionaires, emperors of the galaxy, penniless street urchins, genius computer programmers, or zombies hungry for human flesh.

Studying for those roles and preparing for them is a big part of an actor’s work. Maybe it means watching Hitler’s speeches, or spending a day at a boot camp, or attending a conference. Maybe it means learning to play the violin for a year. Maybe it means watching other movies. Maybe it means interviewing people who were there. Any good actor can do this.

Karissa Cook: One point that most people seem to miss with these questions is that an actor acts. That is what they do.

Would it be a good thing for more transgender actors to get cast? Absolutely! Should we get bent out of shape about who is portraying trans characters? Not unless they are doing a poor job.

Look folks. If you want only trans actors to have trans roles then you aren't really looking for actors, you are looking for representatives.

Actors play a part. Their job is to make us believe that they really are the characters they portray. Stop worrying about who is playing the role, just pay attention to how well or poorly they did.

Benedict Cumberbatch as Alan Turing

This is also a point I have some sympathy with, although my own point of view comes from a different angle. Film-making is driven by economics. Film-makers make films because they want people to pay money to see them. Along the way, they may inspire, entertain, or inform--they may even achieve art--but those are very secondary considerations.

In The Imitation Game, Benedict Cumberbatch plays cryptanalyst Alan Turing (who happens to be one of my heroes). Turing was gay, but Cumberbatch isn’t; nonetheless Cumberbatch gives an extraordinary performance.

People have criticised the considerable liberties with historical events which the director took. But the director Morten Tyldrum has said that the film was really about using the medium of film to give the audience a flavour of what Turing was really like (rather than to just make a historical documentary). In this, I think he succeeds. The role of the tortured genius has been done dozens of times, but Cumberbatch manages to bring a nuanced performance which includes the awkwardness, the vulnerability and the arrogance of the character, without ever feeling forced or unnatural. Though we sympathise deeply with Cumberbatch's portrayal of Turing, he doesn't make the character necessarily likeable.

By casting a star like Cumberbatch in the role of Alan Turing, I believe people will watch the film who otherwise wouldn’t. And I believe that, unless they have hearts of stone, they will come away feeling sympathy for Turing and how he was treated, perhaps in a way they haven’t sympathised with gay people before. Other recent films which show gay men in a very positive light are Rocketman and Bohemian Rhapsody.

Jeffrey Tambor in Transparent

I think that we are in this place right now. I believe it’s more important for the public to see us, and to sympathise with and accept us, (even using the medium of fiction and the artifice of film) than it is for trans actors to be cast in those roles. Some cisgender actors have also done a wonderful job, such as Jeffrey Tambor in Transparent.

I hope that the day will come when trans actors are just actors. We are not there yet. Meanwhile, cisgender actors playing transgender parts is fine by me. What I want, right now, is awareness and exposure, and for people to view us with sympathy rather than scorn or discomfort. I think overall that we should be pleased that films with a transgender theme are being made and released. While they may not be perfect, I think that the casting of cisgender actors in transgender parts is doing more good than harm.