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OCR for page 195
CHAPTER 1l
'~ecomirlg a Woman
.~
he medical transitioning of trans-
sexuals, from men to women (and
The other way, too), is no longer just
a curiosity, but a business. If not a big business, it is at least a lucrative
business for a few surgeons, who devote their entire practices to it.
Some of them have their own Internet websites and distribute videos
that describe their services and show their results. It seems to be a
rapidly advancing specialty, as well. Cher, who had her genital sex
change surgery only eight years ago, notes somewhat enviously that
neo-vaginas now look so much more realistic, complete with realistic-
looking (and sensitive) clitorises, and labia.Advances are surely driven
in large part by the free flow of information. Few brain surgery pa-
tients study their options more closely than do transsexuals, who trade
not only opinions but also stories and pictures, both informally and on
websites. (Next to a close-up photograph of a neo-vagina spread by
the patient's fingers:"This is a fairly typical Dr. M. result, with a well-
195
OCR for page 196
196
the Plan TAlho Would He Queen
defined clitoris and nice thin labia.The urethral opening here is a little
lower and harder to see than in some examples: Dr. M. seems to be
trimming his urethras shorter recently.") The high-tech websites are
nearly all maintained by autogynephilic transsexuals, but homosexual
transsexuals spread the word about the same surgeons, and the
surgeon's office is one place where homosexual and autogynephilic
transsexuals might well meet. Here are the main medical procedures
that male-to-female transsexuals undergo, in rough chronological or-
der in which they are typically undertaken, with rough costs.
Start with electrolysis, to get rid of the beard. (Electrolysis of body
hair is a lower priority, because it recedes some with hormonal treat-
ment and in any case can be hidden.) Autogynephiles prefer to do this
while still in the male role. Homosexual transsexuals, because they are
younger and possibly have less facial hair to begin with, tend to switch
roles first. Weekly time can range between one to more than five
hours at $40 to $100 per hour. Completion may require less than 100
to more than 700 hours, with an average between 200 and 300 hours.
Typical total electrolysis costs range between $4,000 and $16,000.
Recently, some surgeons have recommended getting electrolysis on
the scrotum between the legs, as well, because this skin is often used to
line the neo-vagina, and should be hair-free. Electrolysis hurts and
leaves red blotches on the skin for a while after each session.
Next, hormones. Female hormones (synthetic or"natural" estro-
gens, the latter taken from animal urine) are taken either orally, by
transdermal skin patch, or by injection, for the rest of the transsexual's
life assuming that she goes all the way. Also, while the transsexual
still has her testes, she usually must take some kind of anti-androgen
hormone as well; this can be discontinued after she is castrated (which
usually happens during sex reassignment surgery). Hormone therapy
is not typically very expensive less than a couple of dollars per day
and can be had either through a physician or without a prescription in
Mexico or even by mail order via the Internet.
If given early enough, hormones prevent masculinization of facial
OCR for page 197
Becoming a Woman
197
and body hair, and facial and body skeletal structures. Early enough for
complete prevention is prior to puberty, and this does not happen in
this country. (In the very liberal Netherlands, hormone therapy to
delay puberty sometimes is given in early adolescence.) But even in
the late teens and early twenties, hormone therapy can prevent a sig-
nificant amount of masculinization that would otherwise occur. This
is one reason why homosexual transsexuals tend to be more convinc-
ing as women compared with autogynephilic transsexuals, who tend
to be older before starting hormones.
Hormone therapy causes breast growth that is typically about one
or two cup sizes less than sisters and mothers reach. Male sex drive
decreases (and this is often experienced as a relief). Fat is redistributed,
causing the face to assume a more feminine shape. Fat leaves the waist
and moves toward the hips and buttocks. Body hair growth slows,
becomes less dense and lighter colored (but not on the head, face, or
pubic area). Many transsexuals say that female hormones make them
feel better, and less depressed. Some transsexuals say that female hor-
mones make them behave more female-like. Some say that it makes
them more attracted to men, for example, and Cher believes that fe-
male hormones make her hold a cup like a woman rather than like a
man. Some of these psychological "effects" of hormone therapy are
probably placebo effects, although it is not unlikely that others are real.
The worst potential side effect of hormone therapy is blood clots that
can travel to the lungs, where they can be fatal. Luckily, this side effect
Is rare.
With electrolysis and hormones, the other thing to get started on
early is the voice. Female hormones do not feminize the male voice,
once it has changed.The voice is a big hindrance to many transsexuals
in their quest to pass. It is particularly difficult to pass on the phone,
when they cannot convey their otherwise (in many cases) very femi-
nine presentation. The medical solution to the voice problem, "voice
surgery," involves tightening of the vocal cords so that the pitch of the
voice is elevated. It is convenient to get a tracheal shave at the same
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the Plan TAlho Would He Queen
time (Adam's apple reduction), for a total of $4,500 or more. However,
voice surgery is still not considered very reliable it has produced too
many bad outcomes, such as hoarsenes and most transsexuals opt for
a few sessions with a voice therapist. The voice therapist teaches ways
to sound more like a woman.The most important and obvious focus is
raising the pitch of the voice to be as high as possible. Singing is good
practice for this. Even aside from pitch, men and women talk differ-
ently.Women have more jumps in frequency than men, conveying a
more singsong effect. They have more precise articulation. They ask
more questions and talk about feelings more. In my experience, the
transsexual voice remains the most problematic piece of the feminine
puzzle. I have met many transsexuals whose physical appearance does
not give them away, but I have met only a few whose voice provides
no clue.
Get rid of the beard, grow long hair, and put on a dress and even
with good breast growth, some transsexuals look like men in dresses.
Male and female faces differ, and everyone sees the face. Men, espe-
cially older men, have higher hairlines, broader chins,"brow bossing"
(a prominence of the male brow ridge), lower eyebrows, narrower
cheeks, and more prominent, angular noses. All these masculine fea-
tures can be somewhat feminized with surgery. Facial plastic surgery
is expensive, potentially the most expensive thing that a transsexual
will buy. Total costs can exceed $30,000, but this varies greatly. Some
transsexuals (especially the homosexual type) need relatively little, and
others need a lot of work.
Although hormones cause some breast growth, many transsexuals
elect to get breast implants as well. Homosexual transsexuals almost
invariably do this, and their tastes run large.They want to be noticed.
(One homosexual transsexual I know got her sex-change surgery sev-
eral months earlier than she had originally planned because after she
got her breast implants, she immediately obtained a boyfriend who
wanted to have sex. Another told me that the most unrealistic aspect
of the portrayal of Dil, the transsexual in lithe Crying Game, was that she
OCR for page 199
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199
had not managed feminine breasts.) This surgery is well known to
genetic women these days, and costs about $5,000. One surgeon offers
a discount if the implants are done at the same time as genital surgery
(not recommended by some, because there is then no comfortable
part of the body to put weight on). More than one transsexual told me
that the aftermath of breast implant surgery was far more painful than
that of genital surgery.
Women's hips and bottoms are wider than men's, so some trans-
sexuals get silicon injections there. Silicon injections can be dangerous.
Silicon can enter the bloodstream and travel to the lungs, causing a
fatal embolism. Also, because the silicon is loose rather than enclosed
in surgical implants, there is concern that the silicon will eventually
migrate to other places and look bad. (I have been unable to find
anyone to whom this has happened, but it is well documented in the
medical literature.) Many people consider physicians who administer
silicon injections to be disreputable. Homosexual transsexuals have
more motivation to attract men in the short term and seem less con-
cerned with long-term consequences, so they are more apt to get the
silicon injections. Ideally, these should be done in series, waiting for
each layer to harden before putting another one on. Currently in Chi-
cago, the person who does this procedure for most transsexuals is,
herself, a transsexual who works out of her apartment. Facial injec-
tions cost $125, hips $600, and bottoms $400.
The most exotic procedure though not necessarily the most ex-
pensive is vaginoplasty, or the construction of a neo-vagina.There is
more than one way to accomplish this. In any method, the first step is
to remove the testicles and the erectile tissue (insides) of the penis.A
"vaginal" cavity is created between the urethra (urinary tube) and the
rectum. In the most common form of the operation, the penile skin is
inverted to form the lining of the neo-vagina. If the patient has a short
penis (less than 5 inches), the surgeon can graft skin onto the new
vagina to lengthen it. (If the scrotum has been cleared of hair by elec-
trolysis, this skin can be used.) The glans (head) of the penis is used to
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200
She Plan TAlho Would He Queen
construct the clitoris. Because the glans contains the nerves that pro-
duce most of the penis's erotic sensations, the neo-clitoris is usually
sensitive (just as a genetic woman's is). A part of the scrotum is used to
make the labia (vaginal lips). These days, the best surgeons offer a
second, optional, labiaplasty operation, in which the labia are thinned
and a clitoral hood is formed, making the overall appearance generally
more realistic.The most interesting variation in the procedures I have
outlined is that some surgeons can use a segment of bowel tissue to
line the vagina. According to some reports, this makes the vagina
lubricate naturally, but this kind of vaginoplasty is more expensive and
carries a greater risk of complications.Typical vaginoplasty fees range
from less than $8,000 to more than $15,000, and some surgeons charge
as much as $30,000. The optional labiaplasty is only about $3,000.
After the big operation, the patient must stay in a hospital for about
three days (included in the total cost), and when she can, she must
dilate her new vagina regularly, with dildo-like plastic rods.
I suspect that 10 years from now, this section of the book will have
to be much longer to provide even superficial coverage of available
options. And some ofthe procedures I have described will seem primi-
tive by comparison. But even in the recent past, desperate transsexuals
without much money have been subject to far more rudimentary and
dangerous surgery by quacks eager to exploit them. One notorious
doctor, John Ronald Brown, was named one of the nation's worst
surgeons by Vogue in the late 1970s, served time for illegal medical
activities, then reopened his sex change shop in Tijuana.Transgender
activist Dallas Denny, who wrote an expose on Brown, described the
"Tijuana experience":
Many of the transsexual people who went to Mexico for gender reassign-
ment surgery in the seventies and eighties wound up mutilated, with geni-
talia looking like they belonged to one of the creatures in the bar scene in
"StarWars," and not like something likely to be found on a human being of
either gender. Some of these people, expecting vaginoplasties, received
simple penectomies, leaving them looking somewhat like a Barbie doll.
Others ended up with something that looked like a penis that had been
OCR for page 201
Becoming a Woman
split and sewn to their groin which is essentially what had been done.
Some ended up with vaginas which were lined with hair-bearing scrotal
skin; these vaginas quickly filled up with pubic hair, becoming inflamed and
infected. Some ended up with peritonitis, some with permanent colosto-
mies. Some ran out of money and were dumped in back alleys and parking
lots to live or die. Some died in those parking lots or back in the States, of
complications from the surgery.
201
In 1998 Brown was arrested for performing an illegal amputation
that led to the death of an elderly man. Speculation is that the man
had an"amputee fetish" (yes, this exists, and can be explored thor-
oughly on the Internet) and found Brown after legitimate surgeons
refused him.
*********
Sex reassignment surgery is the easy part. The difficult part for
many transsexuals is the social transition that usually precedes surgery
by several years, and that continues for years after~vards.This transition
is especially difficult for autogynephilic transsexuals, and is worst for
those with wives and children and jobs that require them to interact
with the public. Most physicians and mental health professionals who
work with transsexuals adhere to the Standards of Care for Gender
Identity Disorders, promulgated by the Harry Benjamin International
Gender Dysphoria Association (named for the revered father of
transsexualism). Among other things, the Standards of Care specify
that prior to medical treatment (such as hormones or sex reassignment
surgery), transsexuals must participate in "real-life experience," living
full time as the sex they will become.
The Clarke Institute of Psychiatry has a very conservative real-life
experience requirement. Transsexuals who want to become women
must first live for a year as women before receiving hormone therapy.
(This is motivated by concern for genetic females who want to be-
come men. Once they receive testosterone, their voices will perma-
nently deepen. Genetic men who receive female hormones do not
risk analogous permanent effects. However, Blanchard does not want
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202
the Plan TAlho Would He Queen
to risk accusations of gender bias, so he holds both female-to-male
and male-to-female transsexuals to the same requirements.) During
this time, they must work, volunteer 20 hours a week, or attend school
full time, while maintaining a female identity. They must submit
proof either tax forms or letters from bosses or supervisors that
they are known by an unambiguously female name."Pat" would not
count;"Patricia" would. Once they begin hormone therapy, trans-
sexual patients must live for another year (two total) as women before
receiving official authorization for sex reassignment surgery. Currently,
the Clarke Institute arranges to have successful applicants' sex reas-
signment surgeries performed in England by surgeons Blanchard
thinks are top notch.
Many transsexuals find the Clarke Institute's lengthy real-life ex-
perience requirement to be onerous.They believe they should be eli-
gible for hormones and surgery much sooner. There have even been a
few cases in which impatient patients mutilated their own genitals.
(These have all been autogynephiles, according to Blanchard.) Indeed,
there is no hard evidence in favor of the Clarke's policy. (To get hard
evidence, one would have to randomly assign transsexuals either to the
two years of real-life experience or to a shorter requirement, and then
follow them up to see which group fared better. No one has done
this.) There is new evidence that transsexuals who have had real-life
experiences as short as six months can do fine after surgery. Still, the
Clarke gender staffthinks the two year period is a good idea. Blanchard
simply believes that the likelihood of regrets is too high with a shorter
period. Maxine Petersen emphasizes the importance of learning:"The
feeling of belonging to a different gender and the actual experience of
what it is like to belong or to live in that gender role and be accepted
as female are quite different. Until one has done it the idealized exist-
ence is likely to dominate." In part, Petersen is referring to experi-
ences that all women confront, such as being patronized by garage
mechanics. She is also referring to transsexual-specific experiences.
Many transsexuals will have to contend for the rest of their lives with
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203
other peoples' stares, smirks, and whispers, and a real-life experience
presents them with the opportunity to know if they can live with that.
Most homosexual male-to-female transsexuals do not know about
the Standards of Care, much less attempt to adhere to them.Yet even
for them, there must be an ultimate decision to stop using a male
identity and to adopt a female identity full time. My impression is that
this is an easier, less traumatic transition for them than for the
autogynephiles. For example, most homosexual transsexuals I talked to
felt sufficiently confident about their appearance when they
transitioned full time that this was not a source of major discomfort.
On the contrary, by the time they go full time, most homosexual
transsexuals have had feedback from other transsexuals and from
straight men that they can pull it off.The two groups most likely to
have problems with their transition family and employers are less
difficult for homosexual transsexuals. Homosexual transsexuals are
more likely to be estranged from their families, in which case they care
less what their families think. And whether or not they are estranged
from them, the families are hardly likely to be completely surprised by
the homosexual transsexuals' decisions. More often, parents and sib-
lings will react with "What took You act lone?" As for work hc~mc~-
~ ~ -D -
sexual transsexuals are less likely to hold conventional jobs, and those
that do would have been recognized as being quite feminine and un-
doubtedly gay long before their transition.
In contrast, many autogynephilic transsexuals have both families
and employers who will be shocked and disturbed by their decision.
Although the autogynephile's wife often knows about his cross-
dressing, she has typically discounted the possibility that this would
lead to her husband's becoming a woman, often due to his assurance.
(Early in their marriage, he probably doubted that this would occur,
too.) Their children typically have no clue. Because the autogynephile
is not usually outwardly feminine and has conducted his cross-dressing
secretly, his coworkers and boss have probably never suspected any-
thing either. For these men, there is no avoiding a crisis, one that
usually causes profound alterations in their lives.
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the Plan TAlho Would He Queen
Some autogynephilic transsexuals would like to diminish the
trauma of transition by easing into it. It is not uncommon for them to
request gender clinics to allow them to gradually feminize their bod-
ies, becoming increasingly androgynous, and change their female iden-
tities only after most people start treating them as women. Some actu-
ally attempt this Petersen says that one such sign is an otherwise
unremarkably masculine man who begins wearing clear nail polish.
The Clarke Institute does not count such gender"blurring" toward
the two years of real-life experience. The concern is that it avoids
precisely the kind of information that transsexuals need what it is
like to live as a woman. Furthermore, Petersen thinks that transsexuals
who try to adopt an ambiguous outward gender role might create
more of a sense of discomfort or confusion among others than the
actual transition would. Instead, she recommends that before
transitioning, the transsexual should explicitly notify those who need
to know what is going on. At work, this should be the boss first.
"Bosses don't like hearing about this secondhand," says Petersen. In-
creasingly, employers are behaving sympathetically toward their trans-
sexual employees.The most difficult situations are those in which the
transsexual's pre-transition job required a great deal of interaction with
the public (sales, for example). In this case, the employer might reason-
ably be concerned that the transsexual's continued employment in
that position will cost the company business.
Marriages usually end. Individual wives' reactions vary from sym-
pathetic and understanding to angry and hateful, but even in the best
cases, women dislike the embarrassing notoriety and the loss of their
husbands. (After all, they are not lesbians.) As in all divorces, the degree
of animosity between parents is a major factor in how children come
to view the noncustodial parent. Petersen thinks that it is important
for the transsexual parent (ideally, but not necessarily in alliance with
the other parent) to explain to the children before any transition, to
emphasize that it was nothing they caused, and that the transsexual
parent will continue to be a parent. This is an emotional issue for
Petersen, because of her own experience. A postoperative transsexual,
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205
she has not seen her children since she transitioned socially into the
female role in 1991.When Maxine Petersen was a man, on the day he
planned to begin a slow process of talking to his children, gradually
explaining the transition to them and getting them used to the idea,
his then-wife talked to them first. Although he spent several hours
with them afterwards, they were sufficiently traumatized that there
was no hope of reaching them. Afterwards, the children told him they
did not want to see him anymore. Petersen has called the children
regularly and remembered birthday and Christmas presents, which she
leaves at the front door. She also writes them occasional long letters."I
tell them that I love them and that the change has been only on the
outside. On the inside, I am the same person who raised them, read
them bedtime stories," she says, tearfully. I believe her.
~ ~ << ~ ~ ~ . ~ ~
*********
Different nations range widely in the compassion and assistance
given transsexuals. In the Netherlands the government pays for sex
reassignment, even, in some cases, for adolescents. In Canada, the gov-
ernment used to pay, provided the applicant was treated through the
Clarke Institute, but in 1998 the government ceased public funding. In
England, transsexuals cannot currently legally change their sex, though
they can get their medical expenses paid by national insurance. In
Japan, sex reassignment surgery was not permitted until recently, when
the first case (a female changing to male) was sanctioned. Islamic coun-
tries are especially intolerant. In Malaysia, for example, 45 contestants
of a drag queen show were recently arrested for female impersonation;
needless to say, sex reassignment surgery is not subsidized there. In the
United States, of course, transsexuals can both obtain surgery and
change their legal sex. However, private insurance almost never pays
for the surgery, or for anything else involved in sex reassignment. Pri-
vate insurance companies are motivated to keep costs to a minimum,
and there are too few transsexuals to comprise a constituency to be
reckoned with.
Almost certainly, refusal to cover sex reassignment surgery is also
OCR for page 206
206
the Plan TAlho Would He Queen
motivated by moral ambivalence. My undergraduate students at
Northwestern are surely more liberal than average (at least until they
get their first jobs or advanced degrees and begin to protect their
assets), but even most of them balk at the idea that the surgery should
be subsidized. They are especially hesitant to support surgery for
nonhomosexual transsexuals, once they learn about autogynephilia.
The idea of men sexually obsessed with having vaginas is incompre-
hensible to them, and like most Americans, they are too puritanical to
give sexual concerns much priority in the public trough. But even
when I invoke the standard transsexual narrative "Imagine that you
have felt your entire life that you had the body of the wrong sex"-
they balk.When I press them, they say something like the following:
"But they don't have the wrong body.They are mentally ill."
Paul McHugh, chairman of the Department of Psychiatry alohas
Hopkins University, used a more sophisticated version of that argu-
ment to close Hopkins's renowned gender identity clinic. McHugh
objected that clinicians naively accepted transsexual patients' histories
of having been quite feminine, when there was ample evidence in
many cases that the histories were false (for example, a married man
who presents as conventionally masculine).This objection is often cor-
rect, though it has no obvious relevance to the advisability of sex
reassignment. Furthermore, and more importantly, McHugh argued
that it is simply wrong for physicians to "mutilate" perfectly good
organs because the transsexual patients troubled mind wants this:
"tThe focus on surgery] has distracted effort from genuine investiga-
tions attempting to find out just what has gone wrong for these
people what has, by their testimony, given them years of torment
and psychological distress and prompted them to accept these grim
and disfiguring surgical procedures."
McHugh's concerns are worth taking seriously. Consider the case
of the man erotically obsessed with having his leg amputated.Would it
be advisable or even ethical to remove the leg? And McHugh is cor-
rect that interest in sex reassignment medicine has far exceeded inter-
~ . ~ . . ~ ~ ~
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207
est in changing the minds of transsexual people so that they do not
want to change their sex.Transsexualism is, after all, a condition of the
mind and brain.
One problem with McHugh's analysis is that we simply have no
idea how to make gender dysphoria go away. I suspect that both
autogynephilic and homosexual gender dysphoria result from early
and irreversible developmental processes in the brain. If so, learning
more about the origins of transsexualism will not get us much closer
to curing it. Given our present state of knowledge, saying that we
should focus on removing transsexuals' desire to change sex is equiva-
lent to saying that it is better that they should suffer permanently from
gender dysphoria than that they obtain sex reassignment surgery.
Surely the most relevant data are transsexuals' own feelings before
and after transitioning. Are they glad they did it? By now, hundreds of
transsexuals have been followed after changing sex, and the results are
clear. Successful outcomes are much more common than unsuccessful
outcomes. In the typical study perhaps 80 percent of male-to-female
outcomes are judged successful, about 10 percent unsuccessful, and
about 10 percent uncertain. (The results of genetic females who
become men are even more successful.) "Success" has been defined
differently by different investigators, and has included such things as
absence of regrets, and success in work and sexual relationships. No
one claimed that transsexuals were without problems, only that they
seemed to have adjusted well. Furthermore, the few studies that had
adequate control groups found that as transition progressed through
hormones and then surgery, patients' well-being also increased and
surpassed that of those waiting sex reassignment.
Those patients who did have regrets tended to have had poor
surgical outcomes, work-related problems (for instance, dismissal be-
cause of transitioning), or poor functioning to begin with. There was
also some indication in a couple of studies that autogynephiles were
more likely to have regrets. In a late-1980s study by Blanchard, about a
third of a small sample of nonhomosexual transsexuals had some re-
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the Plan TAlho Would He Queen
grets. Both Blanchard and Petersen believe that the regrets rate among
autogynephiles would be much lower now because of greater toler-
ance among employers and a more cautious approach to recommend-
. . ~
ng parents tor surgery.
As vaginoplasty has become more and more sophisticated, trans-
sexual patients undoubtedly have been increasingly satisfied. Juanita
was initially unhappy with the look of her neo-vagina after phase one
surgery, but after the second phase, she was delighted. She had been
insecure that her partners would detect that her vagina was not real
before; now she doesn't worry. In the past, neo-vaginas tended to be
shallow. In one study from the 1 980s, they averaged about three inches,
and the researchers speculated that transsexuals who had sex with men
might use sexual positions that minimize depth of penetration.With
the recent trend of using skin grafts to lengthen the vagina, this is
becoming less of a concern, if it ever was one. None ofthe transsexuals
I met complained about vaginal depth. Some of the~particularly
the homosexual transsexuals had been concerned before sex reas-
signment surgery that they would lose erotic sensation and become
anorgasmic. And this does occur, though most transsexuals retain the
capacity for orgasm. In fact, several transsexuals claimed to me that for
the first time in their lives, they were experiencing multiple orgasms.
Blanchard is skeptical about such accounts, because he suspects they
are trying to convince themselves or others that they are like genetic
women. However, they have convinced me that there is something
really going on. Do they have multiple orgasms just like some genetic
women do? I am not sure, because as a man I cannot understand the
phenomenon; nor has it been well understood scientifically.
Although there have been a number of follow-up studies of trans-
sexuals, these studies have been quite limited in terms of their out-
come measures, among other things. Because of this, perhaps the best
indication that sex reassignment is usually successful is that transsexu-
als continue to seek it.They do not seek it blindly. On the contrary, as
I have mentioned, transsexuals are highly motivated and educated con-
OCR for page 209
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209
sumers of sex reassignment. Many know the scientific literature, and
all of them closely question other transsexuals at more advanced stages
of transition. If, from their perspective, sex reassignment were a bad
idea if transitioning routinely led to unhappiness they would not
go through with it.
Of course, there are other perspectives that deserve to be weighed.
Most obviously, the wives and children of autogynephilic transsexuals
might well be less happy after their husbands and fathers change their
sex. I think their suffering is understandable and unfortunate. (I am
less sympathetic toward disapproving families of origin of homosexual
transsexuals, who do not depend on them.) However, I do not think
that this real suffering should be used to discourage transsexuals from
sex reassignment. Most are plenty conscious of the suffering they might
cause their families and proceed, if they do, with regret about this.And
in a society in which nearly half of marriages end in divorce, often
caused primarily by boredom, it is difficult to understand why
autogynephilia is not sufficient reason to end a marriage.
*********
Do transsexuals find partners? Certainly, homosexual transsexuals
find sex partners after their surgery, but do they get steady partners?
Do they get married? I have already mentioned my impression that
homosexual transsexuals are not very successful at finding desirable
men willing to commit to them. In part, this reflects the difficulty that
men have with the notion of coupling with women who used to be
men (no matter how attractive such women may be), as well as the
difficulty most transsexuals have keeping their secret. But it also re-
flects the choices that homosexual transsexuals are prone to make. My
impression is that they would rather have a relatively uncommitted
relationship with a very attractive man than a committed relationship
with a less desirable partner. Although the homosexual transsexuals I
have met are all searching for "Mr. Right," perhaps in vain, their sex
lives have all clearly improved after surgery. They can hide their past
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She Plan TAlho Would He Queen
identities for a while, at least, and so no longer have to worry about
how to respond to attractive men who hit on them in bars.
When I began writing this book, I had never known a homo-
sexual transsexual who married. However, in 1999 Juanita invited me
to her wedding. Her engagement story was quite romantic, in an odd,
transsexual kind of way. She met her fiance on the Internet a couple of
years after her vaginoplasty. When they began dating, she didn't tell
him her secret. They were on vacation in Mexico, and he proposed.
She began her answer with,"There's something I've been meaning to
tell you." After she confessed, he was stunned, but he told her he
wanted to marry her anyway.
The wedding was small, touching, and hilarious. ~uanita's fam-
ily mother, father, three brothers, and three sisters all attended, and
of course, they knew that Juanita used to be Hector. As did the four
transsexuals, including Cher, whom Juanita invited. However, neither
the groom's parents nor his son from his first marriage had any idea.
Juanita was radiant, but when I spoke privately with her, she revealed
that she was having second thoughts about becoming stepmother to a
teenage boy and living in the suburbs. But she reminded herselfwhat a
great catch her husband was.
Just a year later Cher told me that Juanita and her husband were
separated. Apparently,Juanita's doubts had only grown, and she missed
the excitement of living in the city, and of dating new partners. She
had also begun to work again as an escort she had done this before
meeting her husband. Juanita had achieved the dream that nearly all
the homosexual transsexuals I've met have told me they want, and she
let it go.
Nearly all the homosexual transsexuals I know work as escorts
after they have their surgery. I used to think that somehow, they had
no other choice because conventionally happy lives were beyond their
grasp. I have come to believe that these transsexuals are less constrained
by their secret pasts than by their own desires. And these desires, in-
cluding the desire for sex with different attractive men, do not make
conventional married life easier.
~ ,
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Becoming a Woman
211
Autogynephilic transsexuals tend to lead very different sex lives
than homosexual transsexuals, both before and after surgery. Auto-
gynephiles are more likely to seek one single partner. A few remain
with their wives, though much more often, wives divorce them. A
significant number of autogynephiles find lesbian partners. It is not
uncommon for autogynephilic transsexuals to pair up with each other.
My impression is that a substantial proportion of autogynephilic trans-
sexuals do not get partners (even casual sex partners) after their sur-
gery. However, this doesn't mean that in these cases sex reassignment
surgery has failed. Autogynephilic transsexuals do not primarily seek
. .
sex reassignment In arc er to attract partners.
*********
Cher has been having a rough time lately. She has fallen out with
Amy, a homosexual transsexual who used to be her closest friend.
Cher thinks that once Amy got her surgery, she no longer needed her,
and she feels used.When she goes out with Juanita, who has become
her best friend, men are constantly approaching Juanita (who is 15
years younger and very sexy), but they approach Cher cautiously, if at
all. Cher also admits that she is strongly attracted to both Amy and
Juanita (and I wonder if she has fallen in love with them). Of course,
they have no romantic or sexual interest in her, or for anyone who is
not a man, and so her lust is unrequited. Cher sounds depressed some-
times and worries that she will never find anyone. She is also broke,
and is being sued by her relatives for her father's inheritance.
I ask her if she ever regrets becoming a woman, and she does not
hesitate."No, that is one thing I know was right," she says."I do not
regret that, and I am not ashamed of anything."
Despite her troubles, she continues to visit her circle of (primarily
transsexual) friends, helping them plan their transition, listening to
their boyfriend problems, and urging them away from those areas of
transsexual life of which she disapproves prostitution, for instance.
She is a good friend to them, although her advice is not always appre-
ciated or heeded.
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She Plan TAlho Would He Queen
I think about what an unusual life she has led, and what an un-
usual person she is. How difficult it must have been for her to figure
out her sexuality and what she wanted to do with it. I think about all
the barriers she broke, and all the meanness that she must still contend
with. Despite this, she is still out there giving her friends advice and
comfort, and trying to find love. And I think that in her own way,
Cher is a star.
Representative terms from entire chapter:
homosexual transsexuals
