by Amy Bloom
James Green said, “I chose this because, well, I don’t really feel the need for a big one and I like having the range of feeling I always did. This form of sexual pleasure is fine for me and for my girlfriend. And the other costs a lot of money. A lot of money.”
Loren Cameron said, “It’s not all or nothing. I can live this way, as a man with a vagina. If I could get a fully functioning penis, I’d have the surgery. But I’m not prepared to go through more surgery, all of these procedures, to wind up with a pair of plastic testicles and not much more. I know who I am.”
I don’t think the idea of a man choosing to keep his vagina would make sense to Don Laub, although Loren would never find a more skillful or compassionate surgeon.
During the Harry Benjamin symposium, I talk to other doctors besides Laub, and to psychologists, psychiatrists, even psychoanalysts, people who collectively have worked with a thousand transsexuals and their families, in the United States and in northern Europe. Among them is Dr. Leah Schaefer, who is a psychologist, a genetic female, and a past president of the Harry Benjamin Association, and has treated hundreds of people like Loren, James, Luis, and Lyle. She is small and rounded, the right kind of Mittel-europa figure for full skirts, big belts, and a lace fichu at the neck. We meet at her Manhattan office, which is in her home and is itself homey, haimish—dried flowers, ceramic birds, carved boxes, family photographs, and a little sculpture of an Orthodox Jewish man studying Torah. I didn’t expect the mezuzah on the doorway, or that she would have spent twelve years singing professionally, or that we would end up talking about her closetful of shoes, talking with the same shared enthusiasm and tenderness you hear in the voices of boat enthusiasts, golfers, and transsexuals comparing surgical work.
“There are probably more than five thousand postoperative transsexuals in the United States now. You have small-town surgeons setting up shop just like the well-known ones, the ones with years of training. I’ve seen over five hundred people, but no researchers have ever interviewed me or asked for my statistics when they’re gathering information. There’s not a good statistics bank here in America. I’m afraid I don’t know where people get their numbers.”
Later, she brightens when she thinks of “a very wonderful scientist” to tell me about.
“Friedemann Pfafflin’s everything—an M.D., a psychoanalyst, a practicing clinician. He has a better vantage point than a lot of researchers. He’s just wonderful.”
And he’s in New York, it happens, attending the symposium. The first thing on Dr. Pfafflin’s mind when I meet with him and Peggy Cohen-Kettenis, a Dutch clinical psychologist who knows him well and has suggested a joint interview, is where he can smoke.
“It’s amazing,” he says. “In America I don’t feel like a smoker, I feel like a murderer.”
I assure him that I don’t mind smoking, and we go to my hotel room, but he doesn’t smoke there either, because there are no ashtrays.
Dr. Pfafflin absolutely knows where he gets his numbers. He doesn’t seem to think much of American record-keeping, but he has found the data banks in Germany, the Netherlands, Australia, and Sweden to be reliable, and has been doing research and follow-up studies for the last twenty years. He shows me two studies. The first is based on the Bem Sex Role Inventory, a psychological test, oriented differently for men and women, to assess feelings of masculinity and femininity; one of its underlying assumptions is that a mix of masculine and feminine is normal and healthy in both males and females. The study compares female-to-male (FTM) transsexuals, before and after hormonal and/or surgical treatment, with “normal”—that is, genetic—females. The transsexuals test out as high masculine/low feminine before the treatment, and afterward as well-adjusted men who accept their feminine side.
The second study, based on a German psychological test similar to the Minnesota Multiphasic Personality Inventory (a psychological personality evaluation widely used in the gender dysphoria clinics here), has even broader implications. The FTM transsexuals are compared with normal men and with normal women, and I don’t need to read German to understand the charts: they are as clear as cartoons. The good-sized gray bar down the middle is normal men on page one, normal women on page two; green lines that run in and out of the gray bars are the untreated transsexuals, and red lines that run square in the center of the male page and close to the middle on the female page are the post-op transsexuals. “They are completely in the normal range, psychologically, for men, after treatment,” Pfafflin says, running his finger up and down the gray bar. “Even before treatment, they are not so off the norm for women” (which suggests, unpleasantly, that the norm for women contains a fair amount of depression and low self-esteem). Pfafflin also mentions other clinical and research studies showing no unusual levels of psychopathology in the families of transsexual teenagers or in the adolescents themselves.
Neither Pfafflin nor Cohen-Kettenis appears to be particularly impressed by the surgeons in their field. Cohen-Kettenis, consistently more tactful, shrugs slightly when I ask about the exchange of ideas between the surgeons and the mental health people here at the conference. Pfafflin laughs. “Well, they are naïve, like children. They love to build. I will build a little clitoris, I will build a little penis.”
Cohen-Kettenis smiles. “Not a little penis. Only big ones.”
Although they attend the surgeons’ presentations (ten to twenty minutes of endless, blurring slides of penises and vaginas and recontoured chests and abdominal flaps and forearm donor sites and Y-shaped incisions), they don’t expect the surgeons to attend the psychological presentations. Laub has told me that the surgeons do. He does.
Cohen-Kettenis says, “We need to know about the surgery for our patients, to provide information. The surgeons don’t need to know what we do, or think.”
“And they wouldn’t understand,” Pfafflin says, and then corrects himself, perhaps remembering that his colleagues might read this. “Some of them wouldn’t. Anyway, they have their psychologists and so on screening the patients for them, so they don’t need to know.”
When I find Don Laub again, in a meeting room filled with energetic, well-dressed men and women whose genetic origins are impossible to know, I ask him about the root of high-intensity transsexuality, the kind for which surgery seems to be the only solution. “I believe it’s biological and behavioral,” he says. “A behavioral problem with a surgical solution. There have been a number of experiments, corroborated over and over, at Wisconsin, at Oregon, at Stanford. They injected lab mammals—cats, rats, dogs, and monkeys—with opposite-sex hormones shortly before birth. And that was it. No matter what kind of conditioning you used on those mammals, they behaved consistently like the opposite sex, like the gender of the hormone with which they were injected. And I think that that’s what we’ll find, eventually: a biological answer.
“Of course, we’re the true believers here. We know we’re right. I’ve been doing Interplast for years now, and it’s taken off, people understand, they give money to it. But with this, with gender dysphoria, people still don’t get it, they don’t accept it. For twenty-five years I’ve been doing this work, and the only people who really understand it are all at this meeting. Or they’re the patients. When plastic surgeons begin doing this work, a lot of them just see the technical challenge, the professional opportunity. They dislike the whole idea of transsexuals, but they’re fascinated by the challenge. But when they meet the patients, they change—they become more empathetic. They see the people and they are forever changed.
“You know, this is the ultimate body-image surgery. And if people are fundamentally at peace with themselves, like any other cosmetic surgery, they’re likely to have a good outcome. I’ve learned from my gender patients: I screen my cosmetic patients better now. A forty-five-year-old woman with small breasts, whose real agenda is to have breast augmentation because her husband works for an international corporation and when he’s on the road he takes out every big-busted lady he can find—she’s not a
good candidate. After she’s happy, after she’s worked out her marriage, then she’s a good candidate, if that’s what she wants. These gender patients, they cross-live, they have therapy, they’re evaluated over and over. By the time they have the surgery, they’re successful economically, socially, psychologically, usually sexually too. Those are good candidates for plastic surgery. And that’s how the other patients should be too, but we don’t usually do that kind of screening, we don’t expect it of the patient or of the surgeon.”
I ask Laub what developments he anticipates in his field.
“The future has three parts,” he says. “FTM surgery’s going to improve, aesthetically and in other ways. I learned something here at the conference. I’m going to start doing it right away. They showed how to construct the glans, how to build up a corona. I’ll start doing that. And they tattoo a pinkish color onto the head—that helps too. I’m going to do that. And in the future there might be transplants, if we can figure out how to reduce rejection. I don’t think the government will fund penis transplants, but we’ll try to persuade it to. And there’s the chemical approach, trying to prevent problems, handling tissue receptors differently, correcting. And then we come back to surgery, and we keep trying to make it better. Because that’s what the patients need, and that’s what we strive for: the best anatomical solution to the problem, since the problem has no other solution.”
Until fairly recently, pragmatic, solution-oriented approaches like Don Laub’s were anathema to clinical theorists, whose diagnoses and suggestions for treatment focused primarily on male-to-female transsexuals and on the inevitable opinions about preexisting family pathology. Absent fathers, overinvolved mothers—that was the traditional psychoanalytic explanation for male homosexuality, and for transsexuality as well, though some clinicians have taken the opposite view: dominant fathers, submissive mothers. The other two major psychological theories are that parents of transsexuals encourage cross-gender identification and play, and that parents of transsexuals strongly discourage cross-gender identification and play. That about covers it. I can’t imagine that with the dominant and absent fathers, the passive and active mothers, and the encouraging and discouraging of cross-gender behaviors, we’ve left out too many American families (except the single parents, and they have their own problems). According to these theories, there should be millions of transsexuals in America alone, and McSurgery centers in every good-sized town.
No one cares at all about theory at what I’ll call the American Fantasia conference. It’s a big get-together of crossdressing men and their wives and a smaller group of transsexual men and women and their partners, held behind a homemade curtain of pink tablecloths, down the most remote corridor of a smallish motel in a Southern suburb.
American Fantasia is organized by a man whose name I can’t use: although many at the gathering know that he’s transsexual, his neighbors don’t, his colleagues don’t, the psychiatrists and psychologists and social workers to whom he regularly lectures on transsexuality don’t. I don’t know either, until he tells me, halfway through the interview. In his earnest, slightly old-fashioned suit, with his tidy hair and beard, he looks like a behavioral psychologist or a very effective insurance salesman. He has a deep, manly chuckle that gets on my nerves, especially when it punctuates his belittling remarks about male-to-female crossdressers and the amusement with which female-to-male transsexuals regard them. I’m annoyed until I realize, with surprise, that he’s just another courtly, charming Southern man whose notion of appropriate physical distance is somewhat narrower than my own—a nice man who doesn’t really like women (the ladies, God bless ’em).
I’m at ease with most of these men, though, even when they compare handiwork, after a presentation by one of the plastic surgeons, and the guys who are most pleased with their mastectomies begin lifting their shirts. It’s like being in a room full of cardiac surgery survivors; everyone is telling stories, wagging fingers, showing what his doctor did for him. I see the scars from a distance, but it seems that the men wouldn’t mind if I got closer. I take my cue from Aaron, a transsexual man in his late forties, enough like Joe Pesci to be his shorter, Southern brother. Aaron is taking photographs for his newsletter for ReCast, a nonprofit organization that provides information, referrals, and support for FTM transsexuals, and he is acting as my guide. When I am speechless, he acts as my interpreter.
One guy whose chest Aaron and I study looks like a blond sailor from the cover of a 1946 Life magazine. “It takes about three years for the body to settle down,” this guy says, and as he rolls up his T-shirt to show the incision lines, tan and thickly ridged against his muscular torso, another man, middle-aged and narrow-chested, moves his tie and shyly opens his white shirt and shows me the incision marks around his nipples. I see, as I have never properly noticed, that the male chest, from nipple to collarbone, is configured completely differently from the female.
I’m cold, but Aaron unbuttons his cuffs. “Look around you,” he says. All the guys have loosened their ties and rolled up their shirtsleeves. “Testosterone heats up the system. We’re all comfortable, but you’re gonna freeze your butt off.”
After the conference, Aaron provides introductions to some wives and significant others. The first one I talk to is Aaron’s girlfriend.
Samantha, forty-two, met Aaron through a personal ad. “I had dated women, and I had a bad dating experience with a genetic man, so I was looking at the personals: gay, straight, and alternative. And this was alternative. I didn’t have to go through the anguish of his transition—I just met this man. And although I wasn’t attracted to him physically right away, I was very attracted to his energy and his vigor. That testosterone, it’s really something.
“I thought it would be very different from being with a genetic man, but it turns out to be not so different after all. There’s nothing female about him. Sometimes I wish there was … just a little more female style in him. I said to my friend Mitzi that men are all wrapped up with their cocks, whether they have them or not. It’s still all testosterone and power and having balls, one way or another.”
Bridget is the journalist who became James Green’s girlfriend.
“I thought, as a feminist, This is horrible—these are crazy women, self-hating women who find these unscrupulous, misogynistic surgeons to lop off their breasts. I had met a few of these guys, and I had read a few books by feminists on the subject. Transsexuals seemed pretty wacky.
“But after two hours with Jamie, I was very attracted, and I think I fell in love with him the next day. I went for a walk and began fantasizing about him sexually. I had asked him, for the article, to show me the surgery, and we were both embarrassed, we laughed, but he showed me. And my first, my spontaneous response to what I saw was, ‘Oh, that’s so cute!’ And it was. I have friends—straight friends—who think I’ve given up something important because he doesn’t have a regular penis. It wasn’t a loss to me. We have a lot more variety. We make love to each other, after all, not to organs.”
Her tone of fond reminiscence, the affection she holds not only for the lover but for the joy the lover has given, frays, and her voice tightens to a sharp New York buzz. “I saw him as a combination of female and male, and he was sane and he was a feminist … sort of. I thought, I’m tired of men, I’m tired of women, here’s someone completely new. But now we’re dealing with the same old man-woman thing, like with any other man. And we’re struggling. Suddenly, I can totally relate to my friend who has been complaining about her husband for years.
“I’m convinced—I know otherwise, but I’m convinced—that he was never really a woman.”
Lucy Davis, widowed after eighteen years of marriage and with two teenagers, thinks that meeting Forrest was her destiny. She saw Forrest’s name on the patient roster at the hospital where she’s a social worker, and the name struck her, although she couldn’t imagine why. “I just knew that I would know this man. I finally met him two years later in a store. He flirt
ed with me, I recognized his name, and I knew he was the one.” After they dated for a while, he told her about his surgery. “He told me with his eyes closed, he couldn’t look at me. And when he opened them, he said, ‘You’re still here?’ And I said that it wasn’t a problem. We’ve been together ever since 1982.”
Forrest is an editor, and no one in New Hampshire, not his in-laws, not his stepchildren, certainly not his colleagues and neighbors or the guys on his softball team, knows. “We’re pretty paranoid here in the closet,” Lucy says. “Otherwise we’re like all other heterosexual couples, up and down over the years. I can live with his body and his scars. He always says he has a cock, it’s just a little bit smaller than other guys’. That testosterone, you know. I never had a lesbian relationship, and I still haven’t had one. I like guys. I love this one.”
Michael is the pseudonym he has asked me to use for him, and I cannot describe his comfortable home or the company he runs. He does not go to events like American Fantasia. His former therapist contacted him, and he agreed to talk with me on neutral ground, at a friend’s apartment. We’re meeting in the late morning, and I buy three sandwiches, a dozen cookies, and two kinds of soda at a fancy deli, but he doesn’t eat. He is a serious, dark-skinned black man dressed in corporate casual for a Saturday with his relatives, whom he announces he plans to join before too long. I take him for thirty-eight or so, but he is ten years older than that. (I don’t know if I have just never noticed that men usually look younger than women their age, or if it’s something in the skin of these particular men—some vestige of former female smoothness—or if it’s having had a second, hormonally powerful adolescence later in life, but all the transsexual men look to me at least five years younger than they are.) After two hours, Michael is less nervous than when we began, but he is never relaxed. About half an hour before he leaves, he takes a cookie and a sip of club soda.