Shapeshifters by Gavin Francis

Author:Gavin Francis
Language: eng
Format: epub
Publisher: Profile
Published: 2018-05-03T04:00:00+00:00

Following the simple vaginoplasty of Gohrbandt, it wasn’t until the 1950s that Dr Georges Burou in Morocco began to use inversion of the penile skin to create a vagina – a neater, and from the perspective of healing, more successful method of vaginoplasty. Hundreds of trans women are said to have passed through Burou’s clinic through the 1960s and 1970s. ‘I do not transform men into women,’ he announced in 1973. ‘I transform male genitals into genitals that have a feminine aspect. All the rest is in the patient’s head.’

In a sense, Burou could be said to have been correct: it’s now known that there are structures in the brain, constituting parts of the hormonal and emotional regulatory systems, that exhibit differences between the sexes. A postmortem study from Holland found that the hypothalamus of trans women shared neuronal characteristics with natal women. Whether these similarities pre-date or post-date the surgical transition (i.e. whether they were innate or consequent to behavioural or hormonal changes) wasn’t clarified by the study. But either way, in their ‘heads’ and in their ‘brains’, the trans women were identifiably women.

There is much still unknown about gender, sexuality and the developing brain. It’s becoming apparent that there are critical moments in the womb that determine whether we grow up identifying as male, female or somewhere in between, and neuronal structures within the brain come to reflect these different positions. This isn’t to deny that the expression of identity is enormously influenced by our individual contexts and cultures, or to contest the evident truth that elements of our identities shift ceaselessly through different social interactions.

The next few years are going to see a gathering appreciation of the many determining factors involved in the expression of gender identity, as well as improvements in surgical techniques. Many elements of transition thought impossible are now looking achievable: uterine transplants have become technically possible, and in 2014 a recipient of such a transplant gave birth. Though no trans woman has yet successfully received a uterine transplant, many have expressed the wish to do so, and it would be surprising if one isn’t announced within the next few years.

As a doctor, my role is to ease suffering and promote health; my interest in gender reassignment (or ‘confirmation’ as many trans men and women prefer it) is primarily whether it eases the distress of the patient consulting me, and helps them live their lives. Gender variance holds a mirror up to the polarisation of gender in our society, which instructs us relentlessly and emphatically to choose. It’s known now that forcing this choice can be harmful, and isn’t backed up by the scientific evidence – we all benefit from allowing elements of our identity to be in flux. In her book The Argonauts, Maggie Nelson quotes her partner’s impatience with the idea that anyone with an ambiguous expression of gender must be on a journey to one binary extreme or the other (‘I’m not on my way anywhere’), and points out that all

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