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.

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.

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.
===
Addendum: 15th September 2017

The BBC reported this week that Helen Webberley has been "probed" for giving hormone treatments to children as young as 12. She has been blocked from unsupervised practice with transgender patients. Predictably, other media outlets have reacted with a more sensationalist spin on the story.

I am very disquieted by this news. As I stated above, I am impressed by Helen Webberley's stance on gender disorders. When I interviewed her, she told me that she had already been subject to scrutiny from the GMC as a result of complaints by others.

I know none of the details of the story, of course. But I find myself hoping that Webberley's clinical supervisor reports to the GMC that she is practising in good faith, within the boundaries of good medical practice and good medical ethics, and that she will be permitted to resume her normal practice. Transgender patients need good doctors, and that may mean that a few brave doctors need to blaze a trail for others to follow.

Abigail Austen

If you could look at my hit counter, you would see that one of the most popular blog posts I ever wrote was the one concerning Jan Hamilton, the elite British soldier who underwent transition and was firmly in the public eye a few years ago. The documentary Sex Change Soldier, followed her journey through transition, and every time it airs somewhere around the world, I get a bump in the hit counter as people get online to try to find out the latest. But there hasn't been any for years.

You can also see (from the comments under that post) that lots of people are interested in making contact with Jan, and I even went so far as to contact the producers of the documentary to ask if they could put me in touch. Nothing.

Abigail Austen

Then, out of the blue last week I got an email from Jan herself-- except she isn't Jan, she is Abigail Austen ("Abi"). I knew that already, of course, but I hadn't published that info on my blog because I believed that Austen was trying to move on with her life and try to find some anonymity.

But since she got in touch, I couldn't pass up the opportunity to interview her, and she agreed. It turns out there is a lot to tell. As always, I was a bit nervous about what questions to ask: I have never before interviewed someone who has been thoroughly trained to resist the most probing of interrogations! Here is how we got on:

It's been 8 years since the documentary about your transition. Can you tell us briefly what's been happening in your life since then?

I decided to quietly get my life into order, away from what had become a very intrusive press. It got so bad, I had to move out of my home for a bit. Journalists were hiding out in my garden!

The Scottish Police were looking for people, so I joined there for a few years. I enjoyed being a cop, but my profile made it difficult to avoid a fight. I was causing more aggravated assaults by myself than the rest of my division put together, merely for being me.

After three years, I was offered a job with NATO in Afghanistan. I went to Kandahar with the US Army, right into the heartland of the Taliban. I stayed on combat operations continuously for three years, coming home late 2014. After that, I took some much-needed time off and wrote a book about it all, called Lord Roberts’ Valet. Then, I took off for the Ukraine, where I work in security operations.

Can you tell us why you changed your name to Abi Austen? Was that an attempt to become anonymous again after the negative publicity associated with the name Jan Hamilton?

No, it was because my family rejected me. I didn’t want that name anymore. My grandmother was an Austin, and I loved her very much, so I went with that, and added a little Jane Austen twist to the spelling.

You briefly pursued a career as a police officer. How did that pan out?

Mentioned a bit about that above. The senior management were supportive of me, but it was a hard gig with some of my fellow officers. I had a publicised spat with them over the pension fund when they insisted in enrolling me as a man, which I am patently not. By the end, it was all becoming waaay too stressful… So I swapped it out for going back to war!

After how badly the military treated you, it must have been very difficult to return to a career in the armed forces, however tangential. What made you decide to return?

I have always found military service enjoyable, rewarding and exciting. So it actually wasn’t that hard. I love Afghanistan. I’ve travelled there for over twenty years. The offer from NATO was a real opportunity to put my life into order, and it all came good. It’s all in the book. My move back to Afghanistan was as much because I wanted to go back there (I do love the place) as any desire to work with the military. I am not some sort of military nut. Far from it. In fact, the book is quite scathing about military culture

What sort of reaction did you have from your colleagues when you returned to the military? Were they accepting? Or is there still an undercurrent of transphobia?

Back to the action: Austen

Well, I didn’t arrive with a rep where the Americans were concerned. They just saw me as another chick: and I had skills they wanted. So the Yanks were just great. I really owe the United States. They are a country of second chances, and they really helped me change my life about. Kandahar turned into one of the great adventures of my life and I will always admire and respect America for the sacrifice they make for all our freedoms.

You worked for the US military, not the British. Is this because they were more accepting of you, or because you didn't want to work for the Brits, or some other reason?

There were some Brit special forces in Kandahar. Reaction was mixed, which reflects society. I don’t really stand out in any way, I’m just a chick, but some of them obviously knew who I am from all the media stuff in the UK. For people under 30, nobody really cared. In fact, many of the young ones wanted their picture taken with me. Over 30, and it was more mixed. The army is a big ball of testosterone and men somehow feel threatened by people like me. I don’t know why, but it can be difficult sometimes.

Do you think attitudes to transgender people in the military are changing? In what way?

The military are a reflection of the society they represent. However, it is also a conservative organisation, so attitudes lag. The military is beginning to understand that gender dysphoria is a medical, not a psycho-sexual issue, so they are beginning to discuss it in adult terms. However, I think it will be a generation before gender is openly discussed in wider society, and the military will always be behind that curve of popular opinion because of its own internal culture.

Do you think the changes have something to do with you personally?

In my own small way, I think I have helped change attitudes. However, there are others out there who have fought the good fight. I’m about to take part in an exhibition here in the UK, on transgendered service personnel, called Dry Your Eyes, Princess, which will tour Liverpool, Belfast and Manchester. I did a three-hour taped interview for that exhibition which covers many of the details of my life.

I do know that the US is currently lifting their own ban, and my example in serving in Kandahar helped alter concerns on operational robustness. I met several very senior officers and politicians on that very subject. But I’d also say, I regard that part of my life as something from the past. These days, I am just a chick.

Now you have a book out. Can you tell us a bit about it?

Got it covered: the book

Lord Roberts’ Valet is the story of my 1,000 days in Kandahar, at the eye of the storm. It’s the inside track on how the war was fought and all the mess-ups we made over there. I experienced everything from the frontline, to the politics of the White House: and it’s all there in the book. The historic context, the story of the war, the sacrifice, the tears, the laughter and the madness. I genuinely don’t think there’s been a book quite like this before on Afghanistan and I’m quite proud of it. There’s a fair amount on the web now on it. Check out the website here:  http://www.lordrobertsvalet.com

Did Kristin Beck's book Warrior Princess have anything to do with your decision to write it?

Kristin Beck? Nope, good luck to her, but this is a different story.

How did you choose the title?

Lord Roberts’ Valet is about my war and the war the West fought. The story behind the title is in the book, so I won’t spoil it. I have a follow-up coming out later this year called Sugar and Spice, which will chronicle my own journey to where I am now.

What are your next plans? More armed conflict? Or have you something else in mind?

I’d like to think I have one more mission in me. My time in Kandahar proved to me that my skills are just as sharp as ever, no matter what physical form I live in. I also know that being me has made me a much happier and better person to be around. I have never regretted a single day of my life as Abi. I have a few irons in the fire right now, but I’ll hang onto those dreams for now...

You've been "stealth" for years; what made you decide to re-emerge?

I don’t like that term. I just call this living life. I’m proud of all that I am and all I have achieved. I’ve never hidden away at all. Right now, I have a book (and soon two) that I think worthy of a read and I’m just doing what any author would do: telling folks about what’s on offer. I’ve never hidden away. If anybody wanted to speak to me, I’ve been there; and, over the years, I have talked to and helped many people on their own particular journeys. That part of life will always be with me, but I regard the ‘trans’ part as ‘transformation’ and ‘transitory’. It’s history, nothing more. I am a female, and a very happy one too. There comes a point where you don’t need to fight anymore, and I am at that point.

Can you tell us a little about your personal life these days? A relationship?

Yep, very happily in love. My partner and I have a lovely life and we intend getting married quite soon. It’s all good….

What interests or hobbies do you have?

Love Zumba, I actually have an instructor’s certificate in it. And I still go running, but I’m not really made for sprinting these days.

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


Not all fighting: Afghanistan

To be honest, I’ve met an awful lot of famous people already. Some I’ve liked, some I have wondered what all the fuss was about. I don’t judge people on their fame. I just like genuine people for themselves. So; happy to meet anybody, they don’t have to be famous, just real people.

Do you have a message for people out there who have been thinking about you?

I’d like to say ‘thank-you’ to everybody who has written to me and sent good wishes through the years. My documentary is still in rotation around the world and I get notes from the most unlikely places. I think that there are a lot more folks affected by this issue than have ever been able to express their true selves. I wish everybody true happiness and love. I’ve been on my own particular road. If my own experience is any use, I know it can have a very happy ending.

I will be on Lorraine Kelly’s ITV show on 05 November, here in the UK. Could you also mention that I have a Facebook page and a YouTube video will be up this week. All folks have to do is Google "Lord Roberts’ Valet".

===

As with all my interviews, a little discussion and analysis now follows.

First, I admit I was concerned about Austen. Having heard nothing about her life, I naturally assumed that she had fallen into obscurity and perhaps misery. And let's face it, the documentary doesn't exactly end on a high note. So I was delighted to hear that she is not only doing OK, she is actually doing brilliantly. My first emailed question to her was: I just want to know you are OK.

Second, I was intrigued to find that she had gone back to working with the military. On the one hand, this must have been a tough decision. The military treated her extremely badly at the time of transition, and it must have been very painful to consider returning. And yet, by her own admission, she loves what she does. She is extremely highly trained, and has a lot of valuable experience to draw upon. And, from the excerpt from the book (available on the website) it's clear she has lost none of that traditional coolness under pressure.

As I have mentioned elsewhere on this blog, I view the military with very mixed feelings. On the one hand, I admire the job they do. On the other, I find most military types to be intimidating, and I find their rigidity and inflexibility of thought to be stifling at times. But I can imagine that, if the military is your thing, you might find nothing in civilian life quite hits the spot. And the opportunity to do that thing, the thing you are trained for and love most of all, while being accepted as your true self, must be a very powerful experience. The press-release for the book contains this quote from an unnamed senior US general:

I don’t care if you are a man, woman, Martian or dachshund. My only question is whether you can do the job required or not. Welcome to the team.

Third, I'm a little surprised at one particular word which Austen uses more than once: chick. It doesn't quite fit for someone who is so trained and so capable, to refer to herself as "just a chick". It's not a word that I personally would feel comfortable applying to any woman, whether I myself was presenting as a woman or a man. Likewise, if someone applied it to Vivienne, it would make me bristle slightly because of its connotations of sexism. So why does Austen use it in reference to herself?

Fourth, I came away from this interview feeling that, while Austen has told us a lot about her career, she has told us surprisingly little about herself. This tone also comes across in our email exchange. My questions were intended for the reader to get a sense of Abi the woman, Abi the person, and yet she gives us little to go on: very brief details about her grandmother, her partner, Zumba, and some hints of "irons in the fire". That makes it very hard to get any sense of Austen's real personality. I guess she might say: read the book!

I can understand why Austen may feel a little bit reluctant to let too much slip. I suppose it would be easy for some tabloid journalist, hungry for a story, to take some little detail out of context, and blow it up into an article to fill up some column inches. So I am not blaming her for her reticence, just a little disappointed. I suppose I had hoped that we (she and I) might click a little over some common ground. That may yet happen.

Meanwhile, I await the Sugar and Spice memoir with some anticipation, and I will be sure to let you know if I hear of anything.

===

My thanks to Abi for taking time to answer my questions and send me her photos. The website again is here. The contents of this post are copyright © Vivienne Marcus and Abigail Austen 2015. No reproduction of any part of the text is permitted, altered or unaltered, in printed or electronic form, without permission. All photographs are copyright © Abigail Austen and used by kind permission.

Galileo's Middle Finger - Part Two

This is the second of my articles discussing the book Galileo's Middle Finger, by Alice Dreger. If you haven't already, it makes sense to start reading at Part One, which discusses intersex individuals.

Dreger: When people ask me how transgender is different from intersex, I usually start by saying that that intersex and transgender people have historically suffered from the opposite problems for the same reason. Whereas intersex people have historically been subjected to sex "normalizing" hormones and surgeries they have not wanted, transgender people have had a hard time getting the sex-change hormones and surgeries they have wanted. Both problems arise from a single cause: a heterosexist medical establishment determined to retain control over who gets to be what sex.

Manly: legs

Here she is, shortly into chapter 2, Rabbit Holes, and characteristically getting right down to the nub of the issue. (For my own, similar take on intersex vs transgender, I refer you to this post, though you might need to scroll down a bit).

Dreger: In the great majority of cases, medical scans won't detect any intersex feature in a transgendered person's body. Nevertheless, many people believe that transgender must be a special form of intersex involving the brain.

This fits with my comment that some transgender individuals look to the existence of intersex individuals to provide justification for their behaviour.

Dreger: Although there is very little science to support it, this has become the most popular explanation of transgender, probably in part because it is the easiest one for uptight heterosexuals to accept. (...) In practice, this story of transgender can function as a kind of get-out-of-male free card for men who seek to become women anatomically. When that card is played, the comforting narrative of "true selves" is preserved.

And there are scientific papers (such as this one) which seek to demonstrate anatomical differences in the brains of trans people. Though mostly their brains are very similar, some studies purport to demonstrate subtle differences in tiny regions of the brain (for example, some regions in MtF transsexuals are less like men and more like women). Most of these studies have small numbers of non-randomised participants, and even if these findings are robust (and I am nowhere near convinced that they are), correlation is not causation.

Science may indeed unlock some of these puzzles in time, but the only thing I am convinced of is that the science is pretty unconvincing so far.

Controversial: Bailey

It's at this point in the narrative that Dreger introduces Professor J. Michael Bailey, the author of the controversial work The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism, published in 2003. Bailey drew on the work of Ray Blanchard, and is therefore supportive of the autogynephilia model, to which I subscribe, as you probably already know. See here for a fuller discussion of this model. In that link, I also discuss how the autogynephilia model makes me feel uncomfortable about myself, because it insists the root of my crossdressing is in sexual desire.

Dreger points out that the French translation of autogynephilia is amour de soi en femme (love of oneself as a woman) which is a much nicer expression.

But where I feel uncomfortable about the autogynephilia model, a lot of people felt a lot worse.

Dreger: Before Bailey, many trans advocates had spent a long time working to desexualize and depathologize their public representations in an effort to reduce stigma, improve access to care, and establish basic human rights for trans people. (...) This is similar to how gay rights advocates have desexualized homosexuality in the quest for marriage rights, portraying themselves in living rooms and kitchens instead of bedrooms, in order to calm fearful heterosexuals.

Indeed, a few retrograde clinicians, like Paul McHugh, a psychiatrist at the Johns Hopkins School of Medicine, still actively use the idea that male-to-female transgender is really about perverted sexuality and mental illness to argue against access to sex-transitional hormones and surgeries.

For Bailey or anyone else to call someone with amour de soi en femme an autogynephile or even a transgender woman-- rather than simply a woman-- is at some level to interfere with her core sexual desire. Such naming also risks questioning her core self-identity in a way that calling the average gay man homosexual simply can't. One really must understand this if one is going to understand why some trans women came after Bailey so hard for naming and describing autogynephilia. When they felt that Bailey was fundamentally threatening their selves and their social identities as women-- well, it's because he was. That's what talking openly about autogynephilia necessarily does.

Lynn Conway by Charles Rogers

It's worth digressing here to make a couple of remarks. Just because a scientific theory makes you uncomfortable, doesn't make it wrong. And just because you insist upon something, doesn't make it right. If you want to convince me, you need to do a lot better than insist. I respond to evidence, not vehemence. This has occasionally caused me to get into uncomfortable debates with other trans people when I dare to question them about their views and beliefs. Sometimes, when they are unable to explain themselves, they resort to some variant of: "Of course, you couldn't possibly understand. You're only a crossdresser, where I am a woman".

But back to the book. Dreger goes on to describe how a prominent transwoman called Lynn Conway, at the University of Michigan, started "what became a war" against Bailey, assisted by Andrea James and Deirdre McLoskey. Together they began to systematically ruin Bailey's reputation. They campaigned to have the book removed from consideration for the 2004 Lambda Literary Award. They cooked up stories about him practising psychology without a licence, doing research without appropriate ethical oversight, and even having sex with one of his research subjects. And Dreger digs deeply and thoroughly into all of this, interviewing as many of the original people involved as possible.

Dreger: As a result of all this, Bailey came across pretty clearly as an abuser, a trans-basher, and a sexual pervert.

After nearly a year of research, I could come to only one conclusion: the whole thing was a sham. Bailey's sworn enemies had used every clever trick in the book-- juxtaposing events in misleading ways, ignoring contrary evidence, working the rhetoric, and using anonymity whenever convenient, to make it look as though virtually every trans woman represented in Bailey's book had felt abused by him and had filed a charge.

But why did Conway, James and McLoskey feel they had to do all those things?

Dreger: "Narcissistic injury," the physician-researcher Anne Lawrence said to me, by way of explanation. "Followed by narcissistic rage." That, she told me, was the only real way to explain what happened to Bailey. The whole thing had been an attempt to kill the messenger bringing a message that Lawrence guessed wounded the accusers' sense of self.

Captivating: the book

By this point, we are barely a third of the way through the book. Several things stand out. First, the book is extremely readable, and the narrative is told in a personal, conversational style. Second, Dreger's scholarship is impeccable: many hundreds of hours of interviews and research have gone into this book (you should see the references), and Dreger seems uncompromising in her search for the truth. Third, it's clear that a great deal of her personal energy has been invested, not just in writing the book, but in sympathising with the people in it, befriending them and becoming part of their lives. Fourth, writing this book has taken considerable courage, and Dreger has herself come under fire, risking her own career and reputation (drawing parallels with Galileo, of course).

Overall, the book is a phenomenal read; gripping as a thriller, scholarly, yet incredibly human. There are so many points in the book where I thought: I can't believe I am actually reading this! I can't recommend it highly enough.

We part company with the book at this point, partly because this blog post is already way too long, and partly because the book leaves the subjects of gender and sex as Dreger finds other (compelling) subjects to sink her hungry scholastic teeth into.

I think the world of gender is changing more rapidly than it ever has before. The emergence of transgender celebrities like Laverne Cox and Caitlyn Jenner has caused mainstream society to become much more aware (and thankfully, accepting) of trans people and trans issues. Nonetheless, I am very uncomfortable about what happened to Bailey: vilified for his views, not because they were wrong, but because they made people uncomfortable. Dreger points out (and I don't know why I didn't think of this before) that as a result of Conway's attack on Bailey, "no one in sex research will touch male-to-female transsexualism with a ten foot pole any more. Which must have been just what Conway meant to do". That explains why there isn't good science: because scientists fear personal retribution if they publish results which are unpopular.

The way to enlightenment is not to silence people, even the ones who disagree with us, but to engage in open, civil, respectful debate; to seek out the best evidence, and incorporate it into the picture, recognising that the picture isn't complete and may yet change as new discoveries come to light.

Dreger's book has inspired me to be a little more upright, a little more outspoken in defence of the truth, a little more questioning of the "facts", than I was previously. And perhaps, therefore, a little more willing to extend my middle finger, just like Galileo.

Galileo's Middle Finger - Part One

My book this week is called Galileo’s Middle Finger, and it was recommended to me by my friend Patricia. You need to read this book, she told me. It took me a while to get around to it, but she was dead right.

Alice Dreger

Galileo’s Middle Finger is written by Alice Dreger, professor of clinical medical humanities and bioethics at the Feinberg School of Medicine in Chicago. I had not come across her work before. Her book is a personal account of her own involvement in a series of medical and ethical issues, over two decades of her life. For readers of this blog in particular, the first three chapters will be of greatest interest. The first discusses intersex people; the second and third transgender people. There is so much to talk about that I am going to split this article into two blog posts.

One of the themes of this blog (one I am always going on about) is that, when it comes to the study of sex and gender, hard scientific knowledge is pretty lacking. In its place is often entrenched dogma, coming from people (scientists themselves and their supporters) who insist on a particular paradigm or point of view; and the equally entrenched opposition of the activists and pressure groups, waving flags and making demands.

If someone comes up with a new idea, it can easily fall foul of one or even both of those groups, not because it is wrong, but because it challenges the way people think, and people (even scientists) can find themselves attacked and vilified, especially in this age of instant social media and viral messages.

Dreger is my kind of scholar: the one who is most interested in the truth above all, "a belief in evidence even when it challenges [her] political goals". In her book she describes how she has been on both sides of these debates; at times siding with the activists, pushing hard against dogma and accepted wisdom. At other times, she has sided with the scientists, defending them against unfair or personal attacks from critics.

Let’s cover some concrete examples. In the first chapter of her book, entitled Funny Looking, Dreger comes right to the point on the very first page.

Dreger: This was my stance: Children born with genitals that look funny but work fine should not be surgically altered just because their genital appearance upsets or worries some adult. Big clitorises shouldn't be shortened, and baby boys with very small penises shouldn't be sex-changed just because their phalluses induce Freudian crises of conscience in their caregivers.

Neither fish nor fowl: intersex

She is talking, of course, about intersex children, that 1 in 1000 or so babies who are born with genitalia which seem to be neither quite boy nor girl. In some (rarer) cases, intersex people can possess both testicular and ovarian tissue in an ovotestis. Cases of intersex people have been cropping up in the medical literature for centuries (I recall coming across them as a student) and are depicted in medical textbooks naked, in black-and-white, with a bar over their face to cover their "anonymity".

Originally, of course, medicine had nothing to offer those people. But over the last few decades, increasingly intersex children have been dealt with surgically. Big clitorises (and I'm sorry for wearing my geek hat long enough to point out that the official plural of clitoris is clitorides) were surgically shortened to look more normal (but often causing scarring and the inability to achieve orgasm). Small penises were sometimes completely amputated, and the child raised as a girl. Unfortunately surgery on children's genitals rarely turns out right.

I stress this was usually done with the very best of intentions by most doctors. I believe (and Dreger does too) that the doctors thought they were doing the right thing by these children. They believed that rigidly enforcing an anatomical binary would spare these children growing up different, and make them fit more comfortably. They believed if they did not provide the surgery, the children would commit suicide in puberty.

Dreger: Modern medicine now sought to reinforce the "optimum gender of rearing" by early management of children born with sex anomalies by means of "sex-normalising" surgeries, hormone treatments, delicate euphemisms, and sometimes lies.

This was also the system that led to a lot of really angry intersex adults who discovered that they had been harmed by the medical care meant to "save" them and who knew that the basic system was still being used on children who would likely grow up as hurt and angry as they were. In the early 1990's, a core group of these people formed the intersex rights movement I eventually joined. Some of these intersex adults had been physically harmed--left with damaged sexual sensation, incontinence or repetitive infections. Many had been psychologically harmed--left with a sense of having been too monstrous for their parents to accept as they came, of being sexually freakish, of being fountains of familial shame. All were left with a burning desire to try to save others from going through what they had.

Things were made worse by the actions of people like Dr. John Money. Money's most famous case was David Reimer, a healthy (non-intersex) boy whose penis was destroyed during a botched circumcision attempt. Money suggested that Reimer be raised as a girl, and he underwent removal of his testicles as a baby, together with hormone treatments intended to feminise him. Unfortunately, none of this worked: Reimer always identified as a boy (despite a rigid "girl" upbringing). Worse, Money continued to publish fraudulent reports (in what became known as the "John/Joan" case) that Reimer was doing well as a girl, and his reputation and prestige meant that other doctors followed his example of treatment. Money was a charlatan whose harms extended far beyond this one patient.

How do you measure up?

Together with intersex friend Bo Laurent, Alice Dreger formalised the Intersex Society of North America into a non-profit, tax-exempt organisation. Its purpose was to provide solidarity for intersex people, to realise they are not alone; to campaign to the medical profession for better, more understanding treatment of intersex individuals; and for more acceptance from society for intersex individuals.

Dreger: The problem in intersex care wasn't a problem of gender identity per se. The problem was that, in the service of strict gender norms, people were being cut up, lied to, and made to feel profoundly ashamed of themselves. Bo said it as plainly as she could: Intersex is not primarily about gender identity; it is about shame, secrecy and trauma.

Gradually, they began to gain some traction with doctors. One tool they used was the Phall-O-Meter (pictured), a ruler which is designed to measure the size of a newborn baby's genitals. Calibrated in inches, it was a way of showing how ridiculous it is, that one could use a ruler to categorise something as profound, as far-reaching, as a human being's sex. (This example misses out the humorous captions like "Phew! Just squeaks by!" for a barely acceptable penis).

Dreger: When I would ask treating physicians, "What is the goal of pediatric intersex treatment?" I was amazed at how often they could not articulate an answer. ... It would have been much easier if all these doctors had been evil. Instead they were good-- human, scared. They tried hard to write us off as evil, but when they met us, they realized that we were also good-- and human, and scared.

Giving the finger: Galileo

This is my second reason to love the book: that Dreger talks with compassion and a deeply-sensitive humanity. She adds more than a dash of her own personality to the book, so that, instead of reading like a dry academic treatise, it reads like a personal memoir, and is therefore approachable, funny and poignant. Alice, I would love to have dinner with you!

After some years involved in ISNA, Dreger decided to leave. It is here that the next chapter begins, the chapter involving transsexuals. But I wanted to finish this article by pointing out that the intersex community was very fortunate to find an ally in Alice Dreger: passionate, committed, articulate and seemingly fearless.

You might be wondering where the book's title comes from. It comes from the fact that one of Galileo's fingers (his middle one, of course) is preserved in a jar in the Museo Galileo in Florence. The museum insists that the finger is mounted pointing upward to the heavens which Galileo loved so much. But, because Galileo was fearless in speaking out against the Establishment of his time (getting himself in trouble with Pope Urban VIII over his views of celestial mechanics), Dreger impishly points out that an alternative interpretation is that Galileo is still sticking his middle finger up in the air against stubborn orthodoxy and entrenched dogma.

Join me for Part Two.