At the Broken Places

by Mary Collins

  My mom worried that attending Group would give me ideas and push me headlong into radical decisions. I understood her worry as having two distinct parts:

  1. The fear that I was delusional and that Tony and the kids would irresponsibly validate and encourage this delusion to permanent ends.

  2. The bigger, more abstract fear that I needed something she couldn’t give and that I would seek it out wherever I could find it, whether she was included or not.

  I have to admit: she was right about that second one.

  I came out at seventeen. Tony came out later in life, in his early forties, and I always wondered if listening to a bunch of young adults talk about their gender dysphoria was frustrating for him. He never showed anything but patience and care with us. The frustration was my own projection, I think, as I personally always wished I had come out sooner and avoided the hell on earth of my first puberty. I held a kind of oscillating envy towards kids in the group who were younger and more “ahead” than me, or whose parents had pledged acceptance and advocacy off the bat. The over-comparative tendencies of those years was (and maybe still is?) pretty normal but ultimately unproductive.

  Rather than urging me down new, corrupting paths, Group gave me company on the path I was on. I met other kids who shared aspects of my identity, who needed the same things I did. Even better, I met trans kids whose identities were entirely different than mine and who needed completely different things for themselves. In a journey that began at Group, and continues still, I learned that “trans” didn’t mean the same thing to everyone.

  At the time, as much as I loved the queer space, I didn’t want to be queer. I wanted to be the Most Regular Boy in the World. If these kids wanted to live queer, I thought, more power to them. But I would be better; I would blend and blend until I had nothing in common with them anymore. I was filled with anger and frustration directed at my body and its refusal to command the male social validation I needed. I may have identified as trans, but I was far from understanding that identity in context. I was a hypocrite, steeped in toxic stereotypical ideas about gender, and my discomfort with queerness stemmed from this combination of pain and lack of education. You can’t value a space outside yourself and devalue that same space within yourself.

  The summer of 2011, I left the circle of Group, my immediate family, and all their disconnections for my college (and gender) future in Boston. Throughout the next four years, I incurred many costs—financial, emotional, and physical. Sometimes I wondered if I could pay them all, and if it was even worth it. I’m still paying, and it’s still worth it.

  Puzzling my way through medical institutions and private practices, reaching out blindly to LGBTQ orgs, untangling the red tape, and making it all work, I acutely noticed the absence of my mom. Yet I was never alone, and during my transition I built some of the strongest friendships of my life. These friendships, including those at Group, often became their own sources of conflict. My mother felt cast aside and disrespected when other families provided the support and encouragement she could not.

  Writing this book and looking back on the milestones of my transition, I’m not judging my words and actions but instead interrogating their meanings. My favorite professor, Tulasi Srinivas, uses the word “parse” to this effect: to examine or analyze minutely. It is this analysis, constantly evolving, inherently self-absorbed and self-bettering, that has led me to a contextual understanding of my own identity and of the barriers my mother and I faced as I claimed it.

  12/2/2011

  To get pumped up before my first endocrinology appointment, I gave myself a haircut.

  I had been long possessed by the notion that if I could just get my hair short enough, that if my short hair looked just right, people would understand that I was a boy, and all the confusion would be over. This never happened, and my shoddy, uneven haircuts made me even more self-conscious, projecting the barely-getting-out-of-bed aesthetic only severe depression can cultivate.

  My hair has always been something of a miniature battleground between my mother and me. As a child, I expressed the desire to cut it more than once, and my dad, Andrew, who raised me in my biological father’s absence, would shrug why not, but my mom always fought me. The resulting compromise was a Charlie and the Chocolate Factory trim, hanging just beneath my ears. It gifted eight-year-old me with an androgynous surfer vibe and contributed to an (admittedly) outstanding second-grade class photo of me in a Hawaiian shirt.

  I ended up covering my homespun buzz cut with a brandless, baby-blue snapback in keeping with my “it’s a boy!” look for the trip, along with baby-blue checked shirt, baby-blue sweater. I don’t even look good in the color.

  In preparation for the endocrinology appointment, I had saved up my class skips. I left early the day before, catching a bus to New Haven, where my friend Skylar’s family picked me up. The plan was to stay the night with them and make the short drive to the doctor in the morning before catching a bus back to Boston.

  I met Skylar Spear on my first day at Group, and he became one of my closest friends. When we met, he was a handsome fifteen-year-old with great socks and a prodigious LGBTQ advocacy record. Neither of us had started hormones, although we both wanted to. Over the next several years, he became my best friend, my benchmark, and my sibling.

  During the Group stage of our friendship, I struggled with comparisons. I admired Skylar greatly and wanted to be more like him. He “passed” better than me, and his family was bigger than mine and supportive of his gender. He seemed to have a grip on himself when I was still in a place of shame and confusion. He readily accepted the word “queer” as an identifier and was unapologetic about his queerness. And he was three years younger.

  Sometimes I had trouble being friends with Skylar and would retreat because I was jealous or sad or too darn concerned with my own problems to recognize that he had his own. Despite my various shortcomings, he treated me with unconditional support and respect, and his family welcomed me at their table.

  Being trans, I’ve always, sometimes stubbornly, oriented myself as “behind” in a way. I’ve had to work extra hard to achieve the things other boys were guaranteed at birth, whether it was body parts, chemistry, a name, or the right to wear baby blue. In college I got pissed when my guy friends, with minimal effort, had the slim, tapered torso I wanted, while I stayed late at the gym. Sometimes I got so caught up in this Me vs. Him vortex that I couldn’t celebrate any of my accomplishments. I held my own body and masculinity to a ridiculous standard that I didn’t hold anyone else to. I never let myself rest or feel proud, and I burned out because of it.

  We’re obsessed with the physicality of trans bodies, but so much of the long-haul gender-identity work is mental and emotional.

  At the time of my endocrinology appointment, my mother and I weren’t doing great. I had begun my freshman year at Emerson College in the Visual Media Arts program, where I was pursuing a BA in screenwriting. I lived in the largest dorm on campus, ironically called the Little Building.

  “I know what you’re thinking, but it’s named after a man and not its size,” I would later recite on campus tours.

  In the LB, I occupied a single room on the seventh floor, which was weird. Most freshmen live in doubles, triples, or suites. But since my gender hadn’t been legally changed, the college told me they couldn’t allow me to room with boys; freshman rooming was same-gender only. It was girls or a single. I love girls, but after four years in high school women’s dormitories, I picked the single.

  Even at a “progressive” and LGBTQ-friendly college like Emerson, these restrictive policies exist. They lurk in the back files of higher administration until some queer kid trips the wire.

  My mom moved me in, and we corresponded during my first few weeks at Emerson. In November, my birthday month, I called to tell her I was starting testosterone. I had scheduled an appointment with a well-known doctor in the New Haven area, recommended to me by some people from Group.

  I don
’t think she was surprised. We had discussed early on her opinion that I should “wait” until graduating college before making any alterations to my body. Four years without progress on my terms meant four years wasted. Four unhappy years. I couldn’t handle it.

  My mom emotionally reiterated her opinion regarding physical changes, this time with a new action stage: She didn’t feel comfortable having me in her home if I was starting hormones. She couldn’t handle it. But, as she pointed out, I was legally eighteen.

  “You can do what you want,” she said sadly, a statement rather than the endorsement I wanted.

  The call marked the beginning of a six-month period of estrangement. We didn’t talk to or see each other. I didn’t go home for my birthday and spent Christmas and New Year’s at a friend’s house. The Spearses and my endocrinologist were only forty minutes from my mom’s, but I didn’t consider reaching out to her when my bus arrived in New Haven.

  Time and again, during our mending years, I felt the burden of tearing open the wound by bringing my medical experiences into the room. Things are good: “Mom, I’m getting top surgery.” Things are good: “Mom, I’m having a hysterectomy.”

  Family members encouraged me to stay strong regarding my relationship with my mom, and I know they said the same to her. My grandmother and aunt were instrumental in helping maintain the delicate balance, emphatically supporting us both as we tried to work it out. But I never got the feeling my family wanted to hear about the ins and outs of my trans life; rather, I got the explicit sense that they didn’t.

  It seemed natural then that I would gravitate towards Skylar and his family. Theirs was a living room where queer stuff was just a part of the conversation, not a conversation stopper. I could express myself and inhabit my cherished normality at the same time.

  The Spears are a rare, dynamite combination of rural and urbane. They live in a pastoral town outside New Haven, where they have a vegetable garden and a massive dog named Ajax. In another life, I can see our two families sharing hikes, dinners, and movie nights. Skylar’s mom participates in local politics and runs an agricultural high school. His sister studies zoology, and his stepfather helps companies responsibly manage their toxic waste. Everything in their house is organic or vegan-friendly. They’re like human trees, soaking up bad vibes and putting out good ones.

  The morning of my endocrinology appointment, they scrambled to iron out logistics. Skylar had school, and his mom, Melissa, and step-dad, Roger, were taking their own cars to work.

  “Why don’t you take the van?” Melissa suggested, offering up the only other vehicle they had.

  “Sure,” I said, trying to sound chill.

  The van was an empty white Ford, some years old, sitting up off the path of their driveway. I had never driven a van before, only my AAA driving school’s long-suffering Mitsubishi Lancer and my mom’s Volvo station wagon.

  Like most manual cars, the Spears’ Ford had idiot-proof gear options. I just so happened to be immune and chose “L,” eventually correcting my mistake a few strained miles down the road. I had a car phase in my masculinity spiral, but I think I missed the practical points.

  The drive was mercifully short. I found my doctor’s address, parked, and waited. I was almost an hour early. Skylar texted me good luck.

  Dr. H. is like the human embodiment of a cheerful wink. I trusted him immediately, though the stuffy atmosphere of his waiting room didn’t forecast his winning character. Small TVs showed close-captioned talk shows and last year’s People magazines were spread out on tables. Everyone there, except for another trans person my age, looked over sixty and struggling. The woman at reception exhibited saintly patience as I fished out ID cards from my overstuffed backpack.

  Dr. H. sat with me for an hour, explaining how testosterone worked, why I was starting at the dose he was prescribing, and when my blood would be tested. He drew a little picture of a line graph, a floating hill representing the effects of T in my system over the two-week shot intervals.

  “The goal,” he explained, “is that your waves aren’t too up and down. We want the shots to keep the level of T in your body as consistent as possible.”

  Health-care professionals like Dr. H., who are welcoming, communicative, and trans-positive, are in high demand and short supply.

  Diabetes is the most common endocrine disorder, followed by thyroid diseases like goiter and Hashimoto’s. Hormone replacement treatment, as developed for non-trans people, started in the 1930s to aid menopausal women and men with hypergonadism. Around this time, trans medicine was just getting on its feet.

  One of the most famous endocrinologists in this new field was Harry Benjamin (1885–1986), a German-born doctor and colleague of Magnus Hirschfeld (1868–1935), the renowned sexologist whose Berlin-based Institute for Sexual Science pioneered the study and understanding of gender and sexual diversity. Nazis burned the institute’s library in 1933, which led Hirschfield to flee for France, where he would remain until his death, two years later. Benjamin set up practice in San Francisco, where he soon became known as “the leading medical authority on transsexuality,” collaborating with other progressives such as Alfred Kinsey.

  However, while Benjamin advanced the medical interest and understanding of trans health needs, he also contributed to a set of treatment guidelines that placed psychiatrists and doctors in total control of who was allowed medical treatment.

  Trans people who were “chosen” for surgical and hormonal treatments had to check off a ridiculous list of prerequisites to please their cis gatekeepers. Ambitious physicians and researchers thus exploited a desperate population; those willing to submit to observation and invasive research in order to get medical care.

  The Diagnostic and Statistical Manual of Mental Disorders (DSM) sets the medical-industry standard for diagnosis and treatment “for every psychiatric disorder recognized by the U.S. healthcare system.” Until 2012, “gender identity disorder” (GID) was the diagnosis for trans people. When I was approved for my top surgery, my insurance validated me as a “true transsexual,” a phrase that goes all the way back to Benjamin’s 1966 book The Transsexual Phenomenon. The DSM has since replaced GID with “gender dysphoria,” attempting to acknowledge the emotional distress of gender dissonance and not infer mental illness.

  In May 2016 Lambda Legal released an updated (and free) publication called Creating Equal Access to Quality Health Care for Transgender Patients, intending to aid physicians and medical centers in effectively and respectfully treating trans patients. The updated release followed on the heels of the Obama administration confirming discrimination protections for LGBTQ people in medical environments under the Affordable Care Act.

  The safety of trans people in health care and the controlling way health-care systems treat trans people are coming under scrutiny and are on the slow road to reform. But a diagnosis is absolutely still needed to attain treatment promptly and legally. I’ve had four therapists, two psychiatrists, three general physicians, three endocrinologists, and two surgeons, and they were always sending each other letters about me.

  Today, hormone replacement is becoming a more culturally recognized option in trans-related health care; however, in part due to the recentness of its acceptability, we still don’t know a lot about its long-term effects. We do know, through the use of hormone therapy in cis men and women, as treatment for menopause, prostate cancer, or chronic “low” hormone levels, that there can be significant risks, including an increased likelihood for cancer and cardiac problems.

  Like the word “trans,” hormone treatment is different for everyone and should ideally be tailored to an individual. Not everyone needs it or wants it, and there is a broad range of starting doses. Hormones can be administered by shot, taken orally as a tablet, rubbed on in the form of a gel, and even time-released subdermally via surgically inserted “pellets.”

  People are often surprised to learn that I will take hormones for the rest of my life. For me, right now, that means a sho
t a week. Since I’ve had a hysterectomy, without testosterone, my body would produce no dominant hormone on its own, which is not healthy and can lead to osteoporosis (brittle bones). I also really like the chronic effects of being on T. Some changes, like my lower voice, are permanent, but others, like my weight and muscle distribution, only occur if I maintain my levels. For trans people on estrogen (E), these effects are different: hair and skin soften, breast tissue develops, muscle mass decreases, and fat moves to the butt and thighs. The voice, however, is unaffected by E, and many trans women arduously modulate and train their voices to a higher, more stereotypically “feminine” range.

  As of 2016, I have been on T for five years, firmly monitored by health-care systems. To get this care covered, I have literally run all over for consultations, taken trains and buses to doctors, switched policies, switched back, won some claims, lost others, and sacrificed around 75 percent of my credit on the blue “medical” slice of my bank’s pie-graph spending report.

  Treatment, and the ability to tailor it safely, is a massive issue of access and privilege in the trans community. According to the National Transgender Discrimination Survey, 20 percent of trans respondents reported being uninsured. Among those incarcerated, 17 percent reported being denied hormones outright. And although 62 percent overall had experienced hormone therapy, respondents weren’t asked how they got their hormones. Unable to find or fill prescriptions, many trans folks procure through backdoors, sharing with friends, buying online.

  Testosterone instigated a complete sea change across my entire life. I began to feel invested in my body and actually started taking care of it.