I know and have known quite a few M-to-F ladyboys* working as entertainers here in Japan. Most that I’ve met are post-op and in their 30s to 40s. The younger ones I’ve met tell me they are pre-ops.
I’m curious about this. Did the youngster have ambiguous physical sexual characteristics, or is it a case of a psychological gender identity dysmorphia?
I may be revealing some ignorant bigotry here (and I’m open to folks correcting me if I’m wrong) but isn’t that age when little kids mix and match and switch their ‘identities’ on a fairly regular basis? If I was a parent of a 3yr old, I’d be biding my time a bit before formally allowing my child to identify as the opposite gender. Maybe by seven or eight years, but before that I’d just want them to explore their preferred identity. Having it officially recognised (i.e. enrolling at kinder or school) also locks them in at a time when all they might need is flexibility in the way they express themselves.
Apart from that, I know two. One was a workmate who was MtF. The other was previously the mother of a young friend of mine…who after 3 kids decided a FtM reassignment was the go. It was terribly difficult for the children (young adults at the time) to have to renegotiate their relationship with their mother who is now male. Whilst it’s relatively easy to think of dealing with one of my own kids or family members undergoing such a transformation, I can’t begin to imagine the struggles of being a child of a parent in the process of transgendering.
There’s a small but significant number of friends that I’ve got from high school and college years that are either gender questioning or transgender in various stages of transition; I’m fairly comfortable with the concepts and issues, but I am glad I am not in their shoes. While in college, I knew a few post-op transgender folks, along with folks who represented all other letters in LGBT. For me, it was never a big deal-- they were showing who they were on the inside by having the outside match. This included a professor at the university where I studied-- she had some problems with students who decided to disrupt her classes during exams because she was MtF transgendered.
I had one friend whom I correspond with on social networks from college who was a questioning lesbian at the time we were social face-to-face; at this point, he is partially transitioned as a FtM transgender person. He’s at least thought about gender reassignment surgery for the lower half, but for now, he does appear to match his transitioned gender, though he was always a bit androgynous to start with. I have another friend whom I correspond with IRL who is genderqueer; from what I understand, he does waver between identifying as male (his biological sex) and identifying as female, but he seems to be more questioning of gender boundaries than “I don’t belong in this body” levels of questioning. Either way, he appears to be figuring out what he wants and how he identifies himself, and it’s not my business to advise, judge or really ask him about it unless he wants to volunteer that information.
This is outside my area of expertise, but IIRC it is typical for a three year old to identify very strongly as either a boy or a girl and to have very narrow, “traditional” views about gender roles. I have a friend who’s a doctor, and when her daughter was about this age she started insisting that Mommy wasn’t a doctor, Mommy was a nurse, because girls can’t be doctors!
Anyway, it’s my (limited) understanding that a child of three typically does not switch back and forth between identifying as a boy and a girl, but will feel quite strongly that he is a he or she is a she. This does usually line up with their physical sex, but I have heard from transgender adults that they too were aware of their own gender identities from a very early age. I’m sure there are exceptions to all this, but I don’t think there’s anything odd about a three year old having a firm gender identity.
Sometimes you know at 3. I definitely did, and it made the next 20 years a living hell. I’m so so so so so unbelievably glad that young transition is becoming a common thing now.
Transition at a young age is the utmost in flexibility. They live as the person they feel they are, express themselves as such, and experience a life that’s vastly less stifling and confusing than they otherwise would if they “waited until they were sure” (once they’re adults and have already gone through an indescribably horrible puberty that puts them at serious risk for self-harm or harm from others. No medication is administered to the kids, and the most that would be administered to young teens who weren’t absolutely certain (and again, I cannot reiterate enough how possible it is to be certain at that age) would be hormone blockers to give them more time to decide.
Also, in general, anyone who thinks it’s too easy to obtain access to medical treatment for transsexuality has no idea what they’re talking about and should be ignored completely on the topic. Some tremendous strides have been made in the past decade or so, but a huge number of trans people (especially trans people of color) still have great difficulties receiving treatment for a vast number of reasons ranging from finances to living in hostile areas (which, in the case of trans people, can be almost anywhere) to being kicked out of their homes at 16 for coming out to any other number of possible situations. Trans treatment isn’t covered under most insurance, so even those who find non-hostile/unwelcoming providers they have to be treated for “hormonal imbalances.”
There’s already so much pressure on trans people in this society, and being pre/early-transition is an even more vulnerable place and makes dealing with the arbitrary hoops of the old gatekeeping style even harder. It has vastly more potential to cause harm to patients than the informed consent model that is becoming the norm. Gatekeeping has caused untold numbers of suicides and has driven many of my own friends to the brink at times (thankfully, I can’t recall one of them who hasn’t kept pushing forward and gotten to a much better place in their lives since transitioning).
I took a nursing continuing ed class on LGTB Elder issues recently (and, omg, do you have any idea how hard it is to become educated as a nurse on these issues?! Not a single word in nursing school. Not one.) and we learned that many trans people who finally do get the help they need and do find their niche and do live their life openly as who they truly are…one day get old and sick. And they go to skilled nursing facilities or nursing homes or rehab/PT centers or low income housing where they’re suddenly forced back into the closet. Resident rules state they must wear clothing of the gender that they aren’t, and use the restroom of the gender they aren’t, and cut their hair in an “appropriate” hairstyle that isn’t.
I literally started to cry when I heard that. What. The. Fuck. So fucking unfair. I would like to apologize to you and every other trans person in the world for the assholishness with which my fellow medical professionals are prone to treat you.
I knew someone in my social circles in college who was trans. She presented as a woman. I don’t remember if she was a man already transitioned or she was a woman planning on eventually transitioning to a man. Never talked directly with her about it. She seemed cool and I registered it in the “hmm interesting” category of my brain.
No one I know has transitioned while they were in my radar, but I have plenty of friends who are gay or poly or pagan or numerous other non mainstream things that I can’t imagine it making a difference to me.
Wait, what? Seriously? Why? What possible difference could it make which clothes they wear or what’s considered a “gender appropriate” haircut? Why would anyone even care? I can sort of see the bathroom thing (I don’t agree with it, necessarily, but I can kind of see it) but the others…that’s just messed up.
Reasons given as reasons given:
It makes the other residents uncomfortable.
It confuses the other residents.
It may provoke violence between residents.
It may compromise patient care (eg. cause a delay of care or incontinent episode if a male urinal is brought to a patient without a penis).
It may complicate supply orders and laundry.
Problems to which I personally (as well as the lovely people who created and taught the class) think we need to find other solutions.
It’s purely psychological, physically she is a normal XY child. She started seeing one of the most famous/accomplished children’s psychologists specializing in gender identity issues when she was 3; her doctor fully supports her parent’s recent decision to allow her to transition, at her current age of 5 (something which she explicitly requested over years and clearly desires with her whole being) before beginning formal schooling. There is quite a bit of research now on gender identity issues in children, I suspect that there are many good reasons beyond the personal that they all feel this is a correct and healthy choice. 
Needless to say this case goes far, far beyond the average, normal ‘gender bending’ that many young children engage in. This isn’t something any family could undertake lightly.
If she ever wishes to be a boy again, her parents will fully support that choice as well. They are really some amazing people IMO.
When pre-pubertal children transition, at puberty they are given the choice of ‘hormone blockers’ which will prevent puberty from fully changing their bodies, giving them more time to make a decision on hormone therapy, surgery etc. It’s very rare for trans kids to do anything ‘permanent’ before age 16 or 17.
As you imply, those also sound awfully like post facto rationalizations for transphobic, controlling attitudes.
Apology accepted. You bring to light the basic source of the anxiety I get around seeking medical care. I’m fortunate to live in an area with an LGBT clinic where I feel safer and more respected. I don’t imagine that all LGBT clinics are necessarily that un-transphobic, though. The transphobic attitudes are so pervasive and heavy pretty much everywhere you look… I’ve gotten that anxiety under control, anyway.
I very much hope that medical professionals like you find such transphobia-free solutions and make them the norm throughout the profession. Soon.
All of these excuses are appalling, angry-making, but this:
made me want to yell at someone, “Or maybe you could do your fucking job, get to know your patients, and perhaps read a medical chart every once in a while!”
Holy crap.
That sound you might have heard was all of the air exiting my lungs. I’ve long since accepted the endemic transphobia of most institutions, but hadn’t considered how horribly older trans folk would be treated in that kind of facility. That’s outright torture. Wow.
And also, even hormones take a several months to years to show any obvious, truly irreversible effects (facial hair for trans men and breast development for trans women, for instance). The widely-accepted narrative that trans people just wake up one day, decide to switch genders, and get The Surgery™ a little while later as something other than step #7,147,262 in the process is so ill-informed and depressing.
I do feel like I should clarify that not ALL Elder housing is like that. Some places are good and competent and allow self-identification of gender and gender expression. I wish I could say, “So shop around and find a good and compassionate one!”, but the reality is, many elders of all stripes have to take the first place that has a bed open. Poor folks don’t get a lot of choice in their nursing homes.
I don’t know what to do, except to continue wearing my little rainbow ribbon lapel pin when I visit patients and hope that they trust me enough to be honest with me so I can give them the best care possible. I still have a whole lot to learn, and a lot of it, all y’all have to teach me as we go along, 'cause there aren’t many medical pros who know this stuff yet.
[emphasis added] Coming back in late to say – I really appreciate the open attitude. However, I think it really is important to point out that an important way for supportive medical and para-medical staff to be supportive is to look for their own information, which is available, rather than rely on their patients (I realize as I type this that “all y’all” is ambiguous and need not refer to patients necessarily).
The reason I bring this up is that I know many people who’ve been called upon by their caregivers to give Trans 101 while they’re suffering and looking for care and therefore have the least wherewithal to do so.
Some caregivers – obviously, not thoughtful ones like you – have even copped attitude with my friends of “well, if you’re not going to teach me all about being trans [while you’re in the emergency room and barely conscious from an accidental overdose], I’m basically freed from my obligation to provide you with any kind of professional and understanding care.” This is a true story and it happened to an ex of mine.
I think it’s really important to foster a culture of caregivers taking the initiative to educate themselves about gender identity and expression, as well as other diversity topics, and understand the factors that mean that their patients shouldn’t be expected to do the educating.
I don’t mean this to criticize you directly, but I’m grateful for the opportunity your post afforded me to talk about this.
Here’s a great guide for health and social service providers working with trans people, put out by an advocacy group here in Montreal. Some of it (the legal information and information on accessing hormones and surgery) is specific to Quebec but much of it is of general application. For best practices in transition related care specifically, check out the World Professional Association on Transgender Health (WPATH)'s Standards of Care, 7th (2011) edition (link to large PDF).
Thank you so much, matt_mcl. That link is exactly the sort of thing I’m seeking.
By “all y’all”, I suppose I meant those in the LGBT community who are willing to talk about it, whatever the setting. You’re right in that it’s not my patients’ responsibility to be my teacher, but it is in their nature. It’s the nature of the kind of nursing I do (home health) and the luxurious extended nursing time and relationship I get to enjoy. I certainly don’t expect anyone to regain consciousness in the ER to give me a lesson in transman fashion…but I was quite grateful for one young man teaching me in a calm and safe moment that chest binders are often slipped over the head, and have no fasteners. I didn’t realize - I thought they were like flat fronted corsets, with strings, or maybe hooks. Now that I know that, if I’m ever in an emergency situation and it’s safe and needful to do so, I can pull off a patient’s chest binder to access the abdomen, instead of cutting it free like so often happens today. I won’t waste any time looking for hooks, or laces to pull.
Sometimes it’s the big stuff you don’t know, and yes, that has to be addressed professional to professional*. But sometimes it’s the really small details that will make someone’s day. Waking up to find not only your life saved, but your $60 chest binder intact so you can leave the hospital looking like yourself? Bonus.
*And that means more research and educational grants, so that we know what to teach and are given the opportunity to teach it.
I’ve been friends with three transgendered people.
The first friend lived in Saskatoon, the other two were in St Louis, MO, for school. But one was recently from Japan and the other from South Africa. None of which are bastions for alternative lifestyles. Granted, I went to grad school for a degree in musicology… so kind of artsy.
Anyway, one of my friends kept asking me for fashion advice, which is pretty ironic because I am a lesbian, and not exactly the lipstick type. But we did make a pilgrimage to the department store makeup counter to get her some less hooker-like products. It was delightful to see her transform over a few years from an awkward and uncomfortable young man to a confident, beautiful woman.
Also, a more recent friend’s young nephew insists he wants to be a girl. His dad is unfortunately narrow-minded… so I fear that the child will have a rough time growing up.