Coming to terms with being forced into transsexuality

The most ironic thing about my intersex condition will probably always remain that I could not have known about it sooner because I simply did not know that it existed until I practically tripped over the term and read up on it at Wikipedia. For about a week during early 2005 I figured that I had to be transsexual because I had just realised that I really felt more comfortable in a female role, rather than the assigned male role.

After that revelation and subsequent roller coaster of events, it culminated in an MRI scan on the 21st of December 2007 which showed that I have both male and female genitals in addition to a feminine skeleton. During the following twelve years my body would gradually change, with the sudden arrival of a second puberty at the end of 2014 kick-starting changes that would see me not only drop hormone therapy fully, but find myself grasping at physical changes that simply could not be happening. Changes that essentially transform my body from that of an adolescent female into that of an adult woman.


Winding the clock back more than a decade, the struggle that I had to deal with was that the doctors at the VUmc gender team as well as those elsewhere in the Netherlands, the UK, US and so on, had virtually no clue about 'intersex'. I got told that it was not possible that I could be intersex. That they had found no sign of intersex on my body. That I likely was suffering some kind of psychological delusion that made me perceive my body improperly.

Imagine defending your views against doctors and psychologists for more than a decade, as first one group tells you that you are obviously a true hermaphrodite based on the MRI scans, ultrasound and ultimately an exploratory surgery and biopsy of undeveloped testicles. Then the next group will happily tell you that your body is totally that of a male, but that they'll gladly help you transform into a 'beautiful woman' if I only just would accept that I am not intersex, but just a transsexual male with a desire to become a woman.


A big part of my post-traumatic stress disorder (PTSD) comes from those experiences. Where people in positions of absolute authority would consistently repeat those statements, which had been contradicted by their colleagues months or even days before. It forced me to really think about myself, about this thing called 'gender' and what it meant to be a 'woman' or a 'man'.

Looking back, I can see that the role which I was forced into was essentially that of a female-to-male transsexual, made possible by my outwards appearance as a child being that of a male child since none of the primary female characteristics were visible from the outside. As puberty approached, however, this became problematic.

The development of secondary male characteristics on my side were rather spotty and ultimately highly ineffective, with no real change in my voice or facial hair growth noticeable, even as I got feminine hips and a slim waist. Later it would be found that my testicles had essentially not developed to the point where they would have produced more than minimal levels of testosterone. The natural production of estradiol by ovarian tissue on the other hand was apparently strong enough to start some breast development and kick-start a monthly cycle that started off with a super-painful first menstruation event when I was eleven.

Not knowing what was going on with my body, I was forced to suffer in silence as I believed that my body was that of a regular male, even as the secondary female characteristics were becoming ever stronger, with this sudden second puberty seemingly finishing what got started back then.


Doctors ever really helped me with this. Aside from this one Dutch urologist and the one German surgeon, it's been mostly me against the world, trying to understand what it was that made people want to make me believe that I had to be transsexual, and just what in blazen's name my real identity and body are.

With nearly fifteen years of intense experience and plenty of time to think about it all, I think that I have reached a point where a lot of it is beginning to make sense. The concept of 'male' or 'female' has only meaning in so far as they apply to the biological, sexual elements. There's no such thing as 'gender', just one's personality. There's no way to define a 'man' or a 'woman' outside of those crude biological terms.

As for transsexuality, it's always irked me that it was so hard to pin down, and to understand how such a term could conceivably apply to me. Quite recently I wrote a bit on the topic of Body Identity Disorder (BID, also called Body Integrity Dysphoria) [1]. This disorder/dysphoria seems to provide a lot of insight in the topic. The main characteristic is a person with BID feeling like they are 'born in the wrong body', with one or more parts of their body not being part of it, and extreme measures such as amputation being the only reasonable course of action.

As noted by R. Bou Khalil and S. Richa in their December 2012 published article "Apotemnophilia or body integrity identity disorder: a case report review" (doi: 10.1177/1534734612464714), a literature study shows a strong correlation between BID and transsexuality. While detailed research is still spotty, one could state that for a person to be transsexual they need to have BID, with a strong desire to get rid of those elements (genitals and/or secondary characteristics) that feel 'wrong' to them.

Generally people with BID have these fantasies of themselves in their 'new' body, living this different life in which they are happy, unlike in their current existence. This fantasy and the differences between themselves in it and their current reality is what causes their psychological suffering. So far only amputation (i.e. giving into their desires) has shown any reasonable success in resolving their BID.

Why then the insistence on 'transitioning' if a simple amputation of the offending body parts could suffice, skipping the hormone replacement therapy and big risks of sex reassignment surgery? One could postulate here that the concept of 'transitioning' gives those who suffer from genitals-related BID an acceptable way to deal with their problem. Acceptable in the sense that moving between the two binary states that are ingrained into society can be presented as an extreme but acceptable solution to this form of BID.

The misfortune then is for other types of BID patients that there is unlikely to ever be a socially acceptable way to present the amputation of a body part that doesn't have such a counterpart, or another state that they could transition to. To lose a limb or two, lose a hand or even become paralysed from the neck down are things that usually result in the affected person being met with pity at best and them getting shunned at worst. Not by celebrities championing their 'right' to undergo limp amputations. Here one would truly wish for a less tragic solution.


For me then, as someone whose body has so made it so clear that a binary sex is a nice theory but in reality unworkable, to me I find peace in such knowledge. That there's nothing wrong with my body. That there's no sex binary, and that there are no 'male' or 'female' roles, just societal roles which differ per culture. That we're all just individuals with our own personality, and that 'gender' is an obsolete, archaic term without relevance on a modern way of thinking.

Yes, there is still a lot of suffering out there, but most of it seems to be inflicted through society's strict and old-fashioned roles, as well as our ignorance on how the brain works when it comes to understanding things like the mapping between the body and mind. Those are things which still need a lot of research. With our current knowledge we can already clearly see just why performing non-medical genital surgery on intersex infants is so incredibly harmful, as it ignores this mapping between mind and body.


Yet above all, working through all of those different aspects of a topic that so consumes humans has allowed me to take my distance from it. Through a better understanding it has lessened my agony about how I got treated by doctors and psychologists. By gaining an appreciation for how things fit together and my own place as a decidedly non-binary person in this whole, it has given me a much deeper understanding of what it means to be simply human.

Because in the end, the thing to strive for is to simply be a human being.


Maya



[1] https://en.wikipedia.org/wiki/Body_integrity_dysphoria