Second Lives, Second Chances by Donald R. Laub M.D

Author:Donald R. Laub, M.D.
Language: eng
Format: epub
Publisher: ECW Press
Published: 2019-04-02T00:00:00+00:00

Eight

Shape Shifting

When I first became involved in gender confirmation surgery, “passability” was one of the key ways to gauge whether the transition from male to female was successful. Learning stereotypical female behavior was considered important to adjustment. By the 1980s, the Gender Dysphoria Program’s ideas had evolved as we came to understand that passing undetectably as another sex isn’t important to everyone. There’s no right way to be a postoperative trans person, nor is the word “postoperative” always appropriate — some transgender and gender-fluid people want breast augmentation or removal and some don’t; some want genital surgery and some don’t.

But back in the late 1960s and early 1970s, in the early days of the program, medical professionals dealing with trans people focused on surgery and established an international organization — the Harry Benjamin International Gender Dysphoria Association — and developed a set of guidelines for the safe, successful, and humane surgical treatment of gender dysphoria.

Surgery was the culmination of a lengthy and complex process, each step of which was documented by an attorney, from the sharing of expectations to the disclosure of risks to informed consent for the procedure. Before surgery, the patient would spend a year or two on hormones appropriate to the new sex and undergo whatever cosmetic procedures would allow them to pass undetectably. At the beginning, all of our patients were undergoing a male-to-female shift, so our emphasis was on living as a female, adjusting psychologically to the new sex, earning a living, and having a fulfilling social, romantic, and sexual life.

One of the dumbest things I ever did was to invite Truman Capote to teach trans women feminine behavior. It didn’t seem so crazy at the time; he thought it was intriguing and eventually signed on to narrate a documentary on transsexualism, Second Chance, that seems never to have gotten made. But he didn’t have much advice to impart about passing; his thing was stylized effeminate behavior. After that, we started what I called the Finishing School, a series of workshops led by cis women — women whose gender identity matches their sex assigned at birth — designed to teach trans women who were to be our patients “socially acceptable feminine graces” such as how to sit or how to bend over to pick things up. The patients seemed to appreciate it. Eventually, the Finishing School was obsolete.

There was some rancor — patients balked at the lengthy run-up to surgery. They would say things like, “We want surgery and you ivory-tower gatekeepers are delaying our right to surgery by making artificial rules.” Gradually, some came around to the rules. At the same time, our patients educated us about what really makes a happy change of gender. Eventually, passing became passé.

Many of my transgender patients have become friends, and they enjoy teasing me about the raising of my consciousness over the years. Sandy Stone, now a professor emeritus at the University of Texas and founder of the academic field of transgender studies, likes to tell stories about the times we clashed during preparations for her gender confirmation surgery in 1977.

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