Tag Archive | GRS

Body dysphoria and sexuality

It seems like some of the first questions people think about with regards to trans people are “What’s in your pants?” “How does it work?” and “Who do you have sex with?” In this post I am going to talk about my own experiences with the intersections of body dysphoria and sexuality. This post is going to be quite long and I would like to make a few disclaimers up front. First, I want to make sure it is emphatically stated that gender identity, sexual orientation, and gender social roles are separate things. I will be discussing my experiences of where these intersect, but it is important to keep in mind that they are distinct. My one sentence explanation of the difference between the first two is “Sexual orientation is who you want to go to bed with, while gender identity is who you want to go to bed as.” Gender social roles pertain to how we perform gender in society: males generally perform masculine social roles, but those could easily be performed by someone who identifies as female and vice versa. Secondly, I want to say that my experiences are not to be interpreted as some “universal” trans experience. Every person, trans or cisgender, has a unique sexuality all their own. There may be other trans people who will be able to relate to my experiences of dealing with body dysphoria in their sexual life, but I expect there are many others who don’t have to deal with these specific issues. Third, I want to add a warning that I will be talking a lot about things of a sexual nature. I am going to be open and frank about my own body’s sexual function and how my body dysphoria affects sexual desire and performance. I want to say that just because I, as one trans person, am willing to share this personal information, it does not mean it’s okay to question other trans people about things of a personal nature. If you wonder whether a question is appropriate for a trans person, imagine asking the same question to a cisgender person. If it is inappropriate to ask a cisgender person, it is inappropriate to ask a trans person. So please, don’t ask trans people personal questions unless they has specifically given you permission to do so. But even then, just because you are allowed to ask does not mean you will always get an answer. With that in mind, I want to extend to my readership the permission that you are free to ask me questions. I may not always answer all of them, but part of my intention with writing this blog is to help educate others about the trans experience by sharing my own life experiences. Educating others is not necessarily my job, but it is my hope that as more people understand the trans experience, it will create greater empathy for those of us who struggle with the unique difficulties of being trans and lessen the stigma and discrimination against trans people.

For many trans people, the first step taken towards physically transitioning the body is hormone replacement therapy. For trans men, that hormone is testosterone, or T as it is known in the trans masculine culture. Testosterone is a very powerful hormone. Trans men are repeatedly cautioned about the changes, many of which are irreversible, T will cause before being allowed to start on hormone therapy. Some of these changes include a deepening of the voice, a shift to male pattern hair growth, increased musculature, penile (clitoral) enlargement, shifts in body odor, shifts in fat distribution, cessation of menses, and increased sex drive. Some trans men have also reported changes in facial shape, increases in the size of hands and feet, increases in energy and appetite, and various emotional changes, including shifts in sexual orientation. Many trans men, such as myself, welcome the majority of the physical changes as an affirmation of our true selves. The degree of change in any particular individual is dictated by genes, just as it is for cisgender men. Not all trans men will get a deep bass voice, just as not all cisgender men have a deep voice. Some trans men will get male pattern baldness, just like some cisgender men get male pattern baldness. My own hairline has receded considerably since starting on T. The extent of genetically determined changes to the genitalia, like penile growth, have a profound impact on which lower surgeries will be viable options for relieving body dysphoria.

My top surgery gave me an immense amount of relief from some of the body dysphoria I’d lived with for as long as I can remember, but I still have a considerable amount that affects my life on a regular basis. Some of this dysphoria relates to things I can change, like the female shape of my waist and hips. I have started physical training with a focus on strength training and weight loss to reduce the female shape and build a more muscular, masculine body and testosterone will continue to shift my body’s fat distribution to a more masculine shape. But as I am quite overweight, weight training and hormone therapy will take a considerable amount of time before I see many results. While the female shape of my body does cause me some amount of angst, by far the greatest dysphoria I still struggle with is directly related to my lack of typical male genitalia, which will only be correctable by surgery. Attaining typical, functional male anatomy is a lot more problematic than reshaping my body.

The testosterone has been as generous as I could have hoped in giving me penile (clitoral) growth. I had a bit of an advantage, though. Before I started on T, I already had a considerable amount of natural testosterone produced by my own body, enough to grow a small but visible goatee on my chin. This testosterone also gave me a head start on penile growth with a clitoris that was on the larger side of average and positioned a bit more forward than it is for some women. Now that I have been on T for 2 years, my genitalia look more intersex than strictly male or female. What was my clitoris has developed into a small but distinct penis. It has grown in length to approximately 6 cm (2.3″) flaccid and about 8.5 cm (3.3″) erect (yes I do get erections just like other guys). It has a fully formed glans head complete with crown. The clitoral hood is now a foreskin that covers the glans. While the top of my penis now looks male, the underside still has remnants of the female anatomy. The foreskin is attached to labia that extend down from both sides of the shaft and the labial folds form a split that runs from the base of the penile head down to the vaginal opening. Some of this tissue swells with the rest of the shaft on erections giving me some added girth, usually from about the width of a pinky finger when flaccid to a bit wider than a thumb when erect. Even with this growth though, I do not have the ability for penetrative sexual function. Because the female clitoris is held under the pubic bone by ligaments, my little guy is pretty much stuck pointing due south. The lower surgery I have decided on getting is called a metoidioplasty and is often referred to as a clitoral release since it releases the ligaments holding the penis under the public bone and allows it to be moved up to a more male position. The ligaments are then used in the penile shaft to add girth and the skin of the labia minora is used around the shaft. The metiodioplasty is often performed in conjunction with a scrotoplasty where the labia majora are stretched and stitched together to form a scrotal sack for testicular implants. This surgery will help give me a more male appearance, but unfortunately it will not give me anything close to an average male size, and it is unknown if I will gain the ability to perform penetrative sex.

Our society places an enormous value on a male’s ability to engage in penetrative sex. So much so that for many years, babies born with ambiguous genitalia were assigned to be male or female based on the size of the penis and the future potential of penetrative sexual function. If the baby’s existing penis was too small, the child was emasculated and female genitalia was constructed so the child could be raised as a girl. It was deemed that males could not lead a satisfied life if their penis was considered too small. I am glad that these views are beginning to change and that people with intersex conditions have started to gain a voice in the medical field to advocate that surgical corrections only be performed when serious physiological complications are present. As much as I disagree with the medical field’s surgical correction of males deemed to have too small a phallus (mainly because it robs the infant of any personal choice and often causes loss of sexual sensation), I do understand some of the concerns about living as a man with a small penis. I know it is not impossible to have a satisfying sexual life, but it can present some difficulties.

It can be very frustrating to deal with desires, of any sort, that cannot be fulfilled. We don’t have much choice over what we desire, but we do have choices about how we will act on our desires. We make these choices based on the benefits we will gain or the consequences we will avoid, and sometimes we have to choose between competing desires. I get up early three times a week to work out because my desire for a strong, fit, manly body is stronger than the desire to sleep in. I go to work every day because my desire to be able to take care of myself and my family is more important than the desire to stay home and goof off. There are some situations where people would say they have no choice because the consequences of a choice would be too much to bear, but that does not actually negate the fact that a choice was made. But what do you do when you have a desire that can’t be fulfilled because there really are no choices?

I am a man who has the typical male desire to engage in penetrative sex, a desire left unfulfilled due to the lack of functional anatomy. Most of the time it is manageable, but at times the desire gets strong enough that it leaves me feeling impotent. Along with the impotence comes a whole flood of fears and doubts about my worth as a man, or even my right to call myself a man. Oddly enough, the frustration over the lack of ability to function like a typical male has increased with the changes to my genitalia from the testosterone. It’s as if the closer I get to actually having a penis, the stronger the desire and expectation my brain has to be able to use it like a penis. While there is no question that I have the innate physical desire to engage in penetrative sex, I do often wonder how much of my fears and doubts about my worth as a man are influenced by the societal expectation that in order to be a real man you have to have a functional penis capable of penetration. I don’t actually believe that a penis is required to be a man, and I don’t believe that all trans men must try to attain one. But for me, having a penis is something integral to my identity as a man, and I fear that I will always feel a bit less of a man without one.

To complicate things even more, I also experience the desire for sexual pleasure from using my female genitalia for receptive penetration. As someone who has always been highly sexual, I learned to use the existing anatomy to fulfill my desires the best I could, so I have not had an aversion to receptive penetration as some trans men do. In fact, as a teenager I often wished that I had been born a hermaphrodite, with a functional penis and vagina (with no internal female organs). I thought that this would be the best of both worlds as I could be a man, but still be able to engage in the pleasure of receptive penetration. I think the lack of dysphoria with my vagina (even though I have had a lot of dysphoria with the internal female anatomy) was a large part of why it took me so long to figure out that I am a trans man. I always wanted a penis, but didn’t necessarily want to give up having a vagina. When trying to live in the black and white world where penis = male and vagina = female, I thought I couldn’t be a man because men didn’t have vaginas. Luckily I have been able to move past this biological essentialism to understand that your genitalia actually have very little (to nothing) to do with your gender. It so happens that most men have penises and most women have vaginas. But some men have vaginas and some women have penises and that’s okay.

While I have not had much dysphoria with having a vagina, I have had a considerable amount about the internal female plumbing, which apparently came as some surprise to my wife when discussing this the other day. Her thought was “Since it is all inside and can’t be seen, how could it be causing dysphoria?” For me, my femaleness didn’t come from having a vagina, it came from having the uterus, ovaries and monthly cycle associated with those internal organs. The vagina was merely a means to sexual pleasure. The monthly cycling was the constant reminder of being female. Some of this dysphoria subsided when the T caused my cycles to stop. Unfortunately, it seems that my body is still doing some cycling and causing me problems with headaches, spotting, and depression. Within the next few months I will be scheduled for a complete hysterectomy which should relieve the dysphoria and other symptoms I have from the internal female plumbing. I will be very happy to see them go. The hysterectomy will leave the vagina in tact, but there will come a day when I will have to make a permanent decision about whether or not I want to keep it.

In addition to complications from anatomy, my transition has brought a slight shift in my sexual orientation towards a greater desire for sexual experiences with other men. I have always been bisexual so this shift is not some drastic change, but there has definitely been an increase in my desire for sex with men. I have occasionally wondered how much of this shift is exacerbated by my strong desire for a penis of my own. How much of my desire to be sexual with a man is influenced by my own frustration of wanting what I don’t/can’t currently have? I also wonder how much of my discomfort about my weight and my “female” shape is due to my pessimistic belief that no gay man would ever be interested in an overweight trans man without a penis. It doesn’t actually matter that I’m not looking for a male sexual partner. It’s more the fact that in my perception of myself, there is no male partner who would want me. Maybe I have internalized too many of the stereotypes about how gay men are supposedly only interested in muscular guys with washboard abs and large penises. I read an article the other day on Gawker titled “The Real Reason Gay Men Don’t Get Fat.” It was a bit of a depressing read. The article postulated that gay men’s fear of being alone and unwanted drives them to get fit and stay fit under the assumption that gay men only care about bodies. While this may be true for a subset of gay men, I am not willing to accept it applies to even a majority of gay men. But the article did make one interesting note that I have been pondering on for the past few days. It said that gay men are attracted to themselves and will often remake their own bodies into what they desire in a mate. I started thinking about this premise and how it intersected with my questions about how much of my desire for a male sexual partner was driven by my desire for a male body and how closely the image of my own ideal body for myself matches with traits I am attracted to in other men.

While gender identity and sexual orientation are separate things, in lived experience they do intersect and influence each other, sometimes in ways that can be quite unpredictable. A difficulty that I, as a trans person, have faced in my own self discovery is trying to sort out where all the lines are drawn, wondering how my body dysphoria has shaped my desires. I know that not all of my desires for sex with men are caused by my desire for a male body, but I do question how much that desire would change if I had fully functional male genitalia. And how much has the testosterone influenced the shifts in my sexual orientation? How would my view of myself change if I believed I could attract male partners? How are my desires for performing penetrative sex influenced by my longing to have a penis capable of everything an average cisgender male can do? Will I still want to keep my vagina, and would my decision change if I could get a fully functional penis? And how do I deal with the frustration of genitalia that doesn’t function like my brain expects it to? I don’t yet have answers to these questions, and I predict it is going to be some time before I have much of it figured out. But I think it is important that we can ask ourselves these kinds of questions. We spend so much time reiterating and detailing how gender identity is different from sexual orientation or social roles that we don’t take much time to look at how these things intersect and interact with each other. Maybe we spend so much time and energy trying to keep these separate because we are afraid that if we acknowledge that they do intersect, we will be perpetuating myths that conflate them and contribute to discrimination and invalidation of our identities. But we do ourselves a big disservice when we allow our fear to keep us from looking at our lived experiences as a whole. Gender identity, sexual orientation, and social roles do intersect and interact with each other in life. In understanding both how they are independent and how they influence each other, we will better understand ourselves.

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Eating our own

I have spent the past few weeks struggling to get this post completed. It has been difficult for me to form my thoughts and feelings into words when dealing with such emotionally charged issues.  I have spent a lot of time lately thinking about the infighting I have seen within the trans community. I know that every community has to deal with some infighting. We are, after all, only human and no matter what the topic, people are going to have strong feelings about their opinions. But in the trans community there seems to be an inordinate amount of eating our own.

It is often said that those who are abused are at greater risk to become abusers themselves. So what happens when the lowest group on the social ladder is marginalized and abused? There isn’t anyone else on whom to take out our anger, so we fracture our community into further sub-classes and abuse each other.

One of the starkest dividing lines is between those who are pre-op and those who are post-op, as if it’s the surgery that makes a person a man or a woman. This is in reference to the surgical procedures known as Sexual Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS). The surgery is a physical correction needed for some transsexuals to align the body with a gender already present in the brain. But these surgeries are not necessary for every trans person. There are some whose body dysphoria is so great that it is difficult for them to function in a body that does not match what their brain expects. I fall into this category, so surgery for me is necessary. But I know others for whom SRS/GRS surgeries are not necessary to feel comfortable with their body.  There are still others who need surgeries but cannot get them due to cost factors or medical complications that make the surgeries impossible. This is one of the reasons that requiring SRS/GRS in order to obtain corrected legal ID documents or anti-discrimination protections is such a harmful practice. It would exclude a great number of people who are unable to get these surgeries due to a lack of medical/financial resources or contraindications for surgery. It would also force those who are comfortable enough with their bodies into invasive and unnecessary surgeries that actually have the potential to increase their body dysphoria.

There are those who are afraid that if we allow surgeries, then surgery will become mandatory for every person. On the other side there are those who are afraid that if we do not make surgeries mandatory, then surgeries will be considered optional and will become harder to get for those who need them. This black and white, all or nothing, fundamentalist-type thinking only works to divide us and will guarantee that none of us will get what we need. There IS a middle ground, and it is the same approach that ought to be used for every other medical decision made in every medical facility all over the world. A doctor treating a patient tailors the care of that patient based on the needs of the individual. Every individual is unique, and there is no one-size-fits-all treatment in standard health care. We should not be advocating for such treatment in trans care either.

While the dividing line on surgery is an issue that brings up a lot of heated discussions within the trans community, there is another dividing line that often does not get discussed. It is the dividing line on “passing.” I really hate the term “passing.” To me, it implies a deception to “pass” myself off as something I am not. I am transitioning to become my true self, not to deceive others into believing some false identity. If anything, I “passed” perfectly well as a woman, even though that is not who I am or who I have ever been. I recently read an incredible article on this subject on the Transadvocate’s website. The article is titled On “Passing” written by Dr Cary Gabriel Costello. I highly recommend it. One of the things he talks about is how the push to “pass” is driven by cissexism. Here is a quote from the article that I want to elaborate on further.

“To think of a trans man as a “fake” man is the essence of cissexism. This is why every time I listen to one of the many people I’ve met who are afraid to transition cry, “I can’t—I’ll never be able to pass as a man/woman,” I sigh, because I know that the real battle they face is not their bodily structure, but their internalized cissexism, which tells them they don’t have the right to claim their true gender identities because their bodies trump their inner truth. Cissexism holds that appearance is all, and that trans people who don’t conform to binary sex ideals are fakes, freaks who deserve to be mocked and harassed. As if cis men never looked down at their bodies to find themselves short, or sporting moobs, or sparsely haired. As if cis women were never tall or flat-chested or strong. As if people were never born intersex, like me.”

Trans people are held up to an impossible standard by a cissexist, transphobic world. We are placed in the impossible situation such that if we do not conform to every stereotype of our affirmed gender after transition, we are decried as “fake” for not looking and acting like “real” men or women. Yet at the same time, if we do conform to gender stereotypes we are decried as “fake” for looking and acting like stereotypes. It’s the perfect catch 22. But the sad part is that the trans community has those within it who would use these kinds of arguments against other trans people. In a desperate attempt for some small measure of legitimacy in the eyes of the greater society, they have adopted the language of their oppressors to use against those whom they view as “less than” or “freaks.”

Those with more privilege tend to distance themselves from those with less. Those with “passing” privileges tend to distance themselves from those who can’t “pass.” We draw arbitrary lines in the sand in an attempt to categorize who is worthy of certain labels or legal protections and who isn’t. But while we are busy arguing and nit picking amongst ourselves over who is “true” or “authentic,” those who oppress us not only do not see our differences, they don’t care. They don’t care how you identify or what surgeries you’ve had. They don’t care if you can “pass” because if they ever find out you are trans (or a “person with a medical history” if you don’t identify as any type of trans), your “passing” privilege goes out the window.  To them, we are all the same. We are all deviants. We are all freaks. At least until one of them actually gets to know a trans person and sees how we are not so very different than they are after all. We are humans trying to find our way in this world. We were just given a few extra obstacles to overcome. Once that acceptance begins to grow, we are no longer seen as a label, but as a person and potentially a friend.  As each person better recognizes the common humanity in another, our differences no longer have to divide us.

If those who are not trans are able to support us as individuals, I think we owe it to ourselves and the rest of the trans community to support each other as individuals, each with unique needs and challenges. We are defined by our own declarations of who we are, not by a set of medical procedures. It’s time for each one of us to take a long look at ourselves in the mirror and admit our own bigotry and prejudice towards those whom we see as “other.” Then take time to get to know someone from a different side of  the dividing lines. Take time to understand their decisions of identity and their fears of erasure. Explain to them your own. Find some common ground and then start to work together towards a better world for us all. How can we expect the rest of the world to listen and accept us if we can’t even do that for each other?

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Zander Keig, MSW

Social Worker, Educator, Editor

a gentleman and a scholar

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