A Tale of Two Boxes

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

The first line of the article is this one:

Bloom: Heterosexual cross-dressers bother almost everyone.

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

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

I don't speak his language

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

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

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

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

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


Kept apart: male and female

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

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

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

The difficulty I have is that none of these things is demonstrably true (and I admit I am a lumper, not a splitter). When I ask those people to explain their viewpoint (or occasionally challenge them) I get three basic responses:

1. Because I don't automatically accept their word, I must be transphobic, just like all those others.
2. I haven't done enough reading, and if only I would read this book or that blog it would all become clear; or
3. I can't possibly understand because I am "only" a crossdresser.

I stress that these people are the minority, and that most trans people I know are lovely, welcoming and inclusive.

The story we tell ourselves

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

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

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

Which one do you think I am?

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

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

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

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

===
Addendum 28th August 2016

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

The Rocket Scientist

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

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

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

Sophia: Rocket scientist

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

Tell us a little about yourself and your trans journey.

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

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

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

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

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

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

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

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

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

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

Fallen from grace?

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

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

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

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

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

What drew you towards commercial space travel?

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

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

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

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

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

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

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

Dinky but dangerous: the BD-5J

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

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

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

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

What draws you to Quora?

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

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

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

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

Tell us more about Sophia the woman?

Are Aviator glasses compulsory?

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

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

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

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

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

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

==

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

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

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

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

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

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

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

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

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.

Top of the Pops

I've got quite a numerical mind, and I am always interested in my statistics. I check my hit counter most days, and I enjoy watching what happens as the posts rise and fall in popularity.

Best chart show ever: TOTP

Sometimes a post from a while ago will experience a curious surge in popularity over a few days. Sometimes my blog will appear to suddenly become popular in a new country (Hello, Ukraine!). Why does this happen? I have no idea, but it's fascinating to watch.

What's very interesting to me is that I seem to have no ability to predict in advance which posts will be the most successful or popular. There are certainly some surprises in the Top 10, posts which are much more popular than I ever expected them to be.

Conversely, some of my favourite posts (in a personal sense) don't seem to have done all that well, and again I wonder why this is: am I completely missing my intended audience? While the blog is all about me, the hit counter is all about you, the reader, and shows me where your interests lie.

If this were a glittering award ceremony, I would be announcing the winners from a golden envelope, in no particular order. However, it isn't, and I am not. Instead, I here are my top 10 blog posts by number of hits (as I write, the total hit counter is 373,416).

(1) Jan Hamilton. The winner, with 10,047 hits. No real surprises here: the former soldier turned reporter has attracted considerable public interest over the last few years, and appears again at number 10 in this countdown.

(2) Jaye Davidson. A close second with 9,635. Again, not a surprise. The ephemeral Jaye Davidson sprang to celebrity in The Crying Game in 1992, playing a beautiful transwoman. After a brief appearance in Stargate, in 1994, he retired completely from acting. Ever since, or so it seems, everyone has been asking: what happened to Jaye Davidson?

(3) Female Bodybuilding comes third with 9,051. This is my first real surprise. I can't really account for why this article has been so popular. I suppose the subject matter must be especially compelling.

(4) Women who Crossdress comes next with 6,008 hits. A fair way behind the top 3, this is another surprise to me. Again, I suppose the subject matter must be interesting. While (1), (2) and (3) are quite close numerically, so are the next four entries.

(5) Leah True, with 5,774. This one doesn't surprise me. Like Jaye Davidson, Leah is beautiful, fascinating, and gone from public gaze. A lot of people looking, and I guess they end up here. I've tried to contact Leah and never managed it.

(6) Men With Long Nails, with 5,457. Again a surprise. Why should this subject be so compelling?

(7) Emma Ballantyne, with 5,423 hits. Scottish Emma has the famous YouTube channel, starrynowhere, which has over a million hits. She also allowed herself to be interviewed by me here, though this post (curiously) has only had 3,288 hits.

(8) Helen Boyd Interview, with 4,741. Helen Boyd needs no introduction at all to anyone even remotely trans. Here she answers my questions. Although she is so famous, she has her own very successful and popular website, which means people don't need to come here to find out her latest.

(9) Gender Variants on Facebook brings in 4,021 hits. This topic was very popular a couple of years ago-- though I notice that they still haven't introduced gender variants in my country. Come on, Facebook! Get with the program!

(10) Abigail Austen has rushed into the top 10, despite being one of my more recent posts. Not a surprise, since her latest documentary, and book launch, have brought her once more into the public eye.

Writing is better with nice nails

When I look at this top 10, I can see two clear patterns. First, celebrities (Abigail, Jaye, Leah, Emma). Between them these four are responsible for a lot of internet traffic; no surprises at all that some of it should find its way here (though my article about Caitlyn Jenner has scored only 408 hits). The second group seems to be articles about the boundary (the sometimes uncomfortable boundary) between male and female: female bodybuilders, female crossdressers, men with long nails. In this theme, I've also written about women with beards, and men in skirts. My article about That Whole Bathroom Thing, another ongoing issue, can be found here.

While we wait for the applause to die down and the speeches to finish, I would like to point your attention to some of my posts from the archives, which I think are deserving of a little more attention than they received at the time. These are in temporal order, starting with the oldest. These are some of my favourite posts. Why not take a look, and maybe even leave a comment?

(1) Lyn Tornabene and the Red Queen was one of my better early posts. Written back in 2012, it has gathered in only 574 hits. In it, I discuss the theme of pretending to be something other than your natural self, and how this relates to my own feelings about crossdressing.

(2) The More Things Change... was also one of my favourite posts from 2012, and has managed only 480 hits. It discusses one of history's most famous crossdressers, Lord Cornbury.

(3) Subfuscation! has scored only 427 hits. It's a whimsical discussion of the clothing restrictions facing students at Oxford University.

(4) My article about Japanese artist Yasumasa Morimura has managed only 738 hits, despite featuring Morimura's homages to Audrey Hepburn and Marilyn Monroe.

(5) My article about Alex Reid, a transvestite cage fighter who married a topless model, managed only 861 hits. Are you seriously telling me you don't want to read that one?

The final very interesting hit count is the About Me page, which has scored 9,471 hits, making this page the third most popular overall on the blog. That's very satisfying for me personally. I am always delighted when people email me to say they came across the blog and found it interesting or thought-provoking.

So please keep coming, keep reading, and tell your friends!

Outcomes of Sex Reassignment Surgery

My recent consideration of the book Galileo's Middle Finger and my previous interview with Helen Boyd have prompted me to think again about the science of sex and gender. As I have mentioned many times before, there isn't a lot of hard, reliable science out there.

You might consider that science isn't the best tool with which to view transgenderism. To me, that's a little like saying that counting isn't the best tool with which to view how much money you have.

Opposed: Prof Paul McHugh

Since the study of transgenderism is such a huge field, let's narrow it down to one, relatively well-delineated question: should genetic males be offered sex reassignment surgery? You might already have an answer to this question, one way or the other, but let's look a bit more closely.

Detransitioning is the process whereby someone post sex reassignment surgery, living as the opposite sex, regrets their decision, and returns to their original sex. We know it happens, and that means that sex reassignment surgery isn't for everyone.

Paul McHugh, an eminent psychiatrist, and University Distinguished Professor of Psychiatry at Johns Hopkins in Baltimore, went so far as to discontinue sex reassignment surgery at Johns Hopkins in 1979, after studying the outcomes. He wrote:

McHugh: We saw the results as demonstrating that just as these men enjoyed cross-dressing as women before the operation so they enjoyed cross-living after it. But they were no better in their psychological integration or any easier to live with. With these facts in hand I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia.

You can read his whole 2004 article here. I can see how some of his terminology could be inflammatory, but he comes across as someone who believes what he is doing is right. Before you dismiss him completely, read the whole article. In particular, his review (in the same article) of the previously-misguided surgical treatment of intersex children is very balanced and enlightened, and I find it very difficult to disagree with any of it.

Benefits and harms

Suppose you have heart disease. Your doctor suggests you take aspirin, because there is good evidence that aspirin prevents heart attacks. You take aspirin, confident that you will not have a heart attack, because you are doing the right thing.

But it isn't as simple as that. Not everyone with heart disease will suffer a heart attack, so not everybody needs to take aspirin. And some people who take aspirin will still suffer a heart attack, meaning that aspirin is incompletely successful at preventing heart attacks.

Balanced; benefits and harms

All we can say is that aspirin reduces the risk of heart attack. The actual reduction of risk per person is unexpectedly low. It's only when this small benefit is multiplied by thousands of people across a population that it becomes demonstrable. Multiplied across tens, or hundreds of thousands, aspirin can be shown to prevent hundreds of heart attacks.

But aspirin isn't harmless. As well as its benefits, aspirin causes harms. Again, per individual, these harms are tiny, but multiplied across a population, aspirin can be shown to cause an increased risk of bleeding events. We tend to think of these as risks, but to me (and others) this is an unhelpful word, as it implies that risks are avoidable, where in this case they are not: they are inevitable. It creates the irony that some people will take aspirin and experience only the harms (even though most people expect only the benefits!).

There is therefore a bargain to be struck, between the benefits and the harms of any treatment. In the case of aspirin, we can see that the benefits strongly outweigh the harms, and therefore it makes rational sense to take aspirin. For some treatments, the balance of benefit versus harm is not so clear-cut.

There are also people who are already at risk of having a bleeding event. Those people have a different balance of harm versus benefit. For some of them, it may still make sense to take aspirin; for others, it may make sense not to.

So aspirin is a simple example (there is an excellent discussion of aspirin in this context here on Alvin Lin's blog). This article is about the benefits and harms of sex reassignment surgery.

More complicated than aspirin

Once again, we are faced with a population: people born male who request sex reassignment surgery. It's clear that, if we provide that for all of our population, some will receive benefits, and some will receive harms. Some will receive a mixture of both benefits and harms.

Confusing: statistics

As ethical, and rational people, what we want to do is to maximise the benefits and minimise the harms. Our best efforts may mean that more people have benefit than harm, or more correctly that the total sum of benefit outweighs the total sum of harm. (But it may be hard to judge between a hundred people feeling better, but one person losing their life: which is the greater sum?) If we decide that the balance favours performing the surgery, that's an argument for offering the surgery. If, however, we decide that that the balance favours not performing the surgery, then that's an argument for not performing it.

This is the argument put forward by Paul McHugh, but he is missing one important point: that even if the balance of harm and benefit favours not performing the surgery, this applies to a population, and not individuals, and there may therefore be individuals for whom the benefit is greater. In other words, even if, on the whole, surgery is more harmful than beneficial, there will still be some individuals for whom surgery would be the right thing.

The corollary of all this is that, even if surgery is shown to be more beneficial than harmful, there will still be some people for whom surgery would not be the right thing; in other words, surgery still wouldn't be for everyone!

I'm sorry if I am making your head spin. What's the answer to this conundrum? Science, and plenty of it.

Counting your blessings: estimating benefits and harms

The first question is this: taken as a population seeking sex reassignment surgery, how does the sum of benefit compare to the sum of harm?

You might think that's easy: just find a load of post-op transsexuals and ask them if they are happier since they transitioned. Most of them will say yes. So there's your answer, surely? But a sceptic like me would say: hang on. You might not be counting everyone. Some people might have detransitioned. Some people might have taken their own lives (this number is non-trivial where gender dysphoria is concerned, as this study reminds us). Some people might be so miserable that they declined to answer the survey. This is sampling bias, just one of the many biases potentially associated with research.

I came across this useful paper here at the Bournemouth and Poole Joint Strategic Needs Assessment (JSNA) page. It seems to cover the whole UK, and it has a lot to recommend it: it's short; it contains excellent information including great statistics, and it seems to have a very good idea about the priorities in the care of transgender people. On the other hand, it doesn't say who its authors are; it gives no date, and no sources for its figures. I would really like to know if this is some sort of annual report, and if so, where it comes from.

What it says (in brief) is that sex-reassignment surgery is becoming a lot commoner in the UK, but that trans people face a lot of difficulties in schools, in the workplace, and in their personal and emotional lives. So does sex reassignment surgery result in a greater quality of life?

It's difficult to estimate quality of life. You can't measure it directly; you can only ask people to report it. As a result, it is very prone to error and bias, and people telling the researchers what they think they want to hear, or telling them what they wish were true.

Thankfully for us, Una over at Transas City has done the homework for us, and presents a magnificent, detailed meta-analysis of 34 studies from the literature, together with a very detailed discussion of the strengths and limitations of each study. To save you going through it, the bottom line is this: transsexual treatment (not just surgery) is usually (but not always) associated with a better quality of life afterward, though some problems (such as social integration, difficulties finding employment, and so on) persist. I can't praise Una's article highly enough; she has really put in a lot of hard work to bring this data together.

Meanwhile, Elizabeth Hungerford over at Sex Matters presents four different studies, which suggest increased risk of mortality (including suicide) in transsexuals, increased criminal behaviour, and a disconnect between the subjective reporting of outcomes (most people reported improvement) and the objective reporting of outcomes (a lot of complications were reported). She writes:

Hungerford: As this brief review of long term studies illustrates, positive patient satisfaction should be separated from objectively measurably negative outcomes in order to fully understand the efficacy and “success” of “sex reassignment” procedures. We must be skeptical and refuse to accept emotionally motivated claims of “necessity” that are not supported by long term evidence. We must subject these studies to rigorous, unflinching analysis.

And I really think she has a point. Sometimes, giving people what they want isn't the same as giving them what they need. What should a good doctor, using the principles of medical ethics to guide them, offer the person who asks for sex reassignment treatment?

So where does that leave us?

Cumbersome: scientific research

The ideal scientific study will never happen. In it, a large cohort of gender-dysphoric individuals will present for treatment. They will be subjected to an intense battery of psychological testing, designed to demonstrate every facet of psychological function, and every hint of psychiatric illness. They will then be randomised into at least two arms (preferably three). In one arm, they get full treatment: hormones, surgery, the works. In the second arm, they get the next best treatment: counselling, cognitive-behavioural therapy, maybe antidepressants. In the third arm, they get no treatment at all, but get observed to see what happens if you have no treatment at all. The three groups get followed up for a long period (e.g. a decade) to see what the outcomes are. We decide, based on the result, what the best possible treatment for gender dysphoria is.

The reason this study will never happen falls into several areas. First, to enrol patients in a study, you need to fully inform them of what might happen. Tell someone seeking sex reassignment surgery that they may be randomised to a group which doesn't receive it, and they will instantly withdraw from your study. Second, you need a large cohort of people to get robust results, and it's very difficult and expensive to conduct large studies on large groups of people. Third, the longitudinal followup required means that many researchers cannot devote the time required. A PhD, for example, would normally require all the research to be done in a few years. But unless we wait for a lot longer, we might only observe a "honeymoon period" where everything seems rosy (or potentially the opposite: a period of turmoil and unhappiness while settling into a new life which is ultimately more satisfying). Finally, as described here, nobody really wants to touch this sort of research any more.

One solution: real informed consent

By what means can we identify people, in advance, who will ultimately benefit from sex reassignment surgery? Or who won't? The answer is: we cannot. Nobody can tell the future. Doctors are no more able to tell the future than anyone else. And there are a lot of surgical procedures where the outcome is far from certain in advance. Coronary artery bypass grafting, for example, improves lives for many thousands, but opening someone's chest with a saw and plumbing their major blood vessels into a pump (in order to carry out the surgery) is risky, difficult, and expensive.

Informed: consent

Nonetheless, there is a solution, and it is the same as for any type of surgery. We fully inform the individual of the very best information we have, and let them make the choice. We make the assumption that the adult acting with capacity is the best judge of their own best interests. Note that Paul McHugh has already made up his mind--doctor knows best--and he is happy to make the decision that he knows better than his patients what is best for them. Having decided that transgenderism is a mental illness, he may possibly be more comfortable with the notion that transgender people lack capacity to judge their own best interests. This sort of medical paternalism is (thankfully) well on the wane.

Informed consent for surgery might look something like this:

Sex reassignment surgery is likely to be painful and leave you subject to several complications, including incontinence, scarring, bleeding, infection, wound breakdown, blood clots, and even your own death, though this is very rare. The surgery will be permanent and cannot be reversed. You may not have full sexual function afterward, and you may never be able to experience orgasm. Afterward, you are likely to feel better in yourself, but your risk of suicide will remain high, and you may still experience difficulty integrating into society. If you still want the surgery, sign here.

In my experience, most surgical consent forms tend to stress the negative. They need to be seen to make it clear to the patient that while everyone hopes the surgery will go well, and tries to bring about a great result, that might not actually happen.

But making people clearly aware that surgery might go wrong, and even if it goes right, it won't solve all their problems, is a big step forward from saying "no, you can't have surgery". People should be given this information early and often during the consent process for sex reassignment surgery, so that they can really weigh the decision.

I haven't had sex reassignment surgery, so I don't know what the consent process is like. Those of you who have, please post your experiences and comments below.

Meanwhile, we can only hope that particles of good science continue to be done, and that meta-analysis of those particles can clarify the picture for everyone.

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.

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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.