Past Passing
This article is in response to a reader's request for my views on the male-to-female transsexual who, despite having little chance of passing, requests and is approved for hormonal therapy and SRS.
One of the cruelest ironies is that M-to-F transsexuals do not seem to be any more likely to be petite, free of body hair or have high-pitched voices than does the average biological male. Nor does hormonal therapy prompt major feminization in a man's appearance. A tall, balding, hairy man who seeks sex reassignment will be a tall, balding, hairy woman after hormone administration and cosmetic and genital surgery.
Does that mean that such an individual, who has the experience of being a woman in the wrong body, should be denied the opportunity to take feminizing hormones and anti-androgens and to have whatever cosmetic and surgical procedures she believes will facilitate her feeling more complete and comfortable within herself?
In the past, passing was one of the criteria applied to clients in psychotherapy prior to being given approval for hormonal and surgical reassignment. Even if the applicant accepted that she would never pass as a genetic woman, but still elected the procedures, she was denied them. Some individuals had lived for years in the feminine role, knew the pain of being read and were thwarted in their desire for reassignment because of the mental health practitioner's well-meaning desire to protect them from society's rejection.
Today, the philosophy of those of us who work with the gender community has shifted to one of client empowerment and self-determination. Our emphasis is on education, self-awareness, advocacy and referral to appropriate resources. Rather than expecting clients to conform to an image of femininity that only a fraction of M-to-Fs can attain, therapists seek to assure that clients are fully capable of understanding the process of transitioning, the importance of cross-living for one year, and ultimately of giving their informed consent for desired procedures.
The role that the therapist plays in an individual's successful transition is first to provide a competent evaluation. Is the person truly transsexual? If so, the second function is to assess where the client is in the process of transition and what are his/her goals. Third, the therapist is a guide on this journey providing information, referrals and support. This may include individual or family therapy, vocational counseling, and information about resources necessary to facilitate transition. Last, the therapist may write a letter to a physician endorsing a medical or surgical treatment. At no time should the client's appearance be a factor in the decision to approve such treatment.
As I write this I have in mind a former client, C., who coined the expression that I have used as the title of this article. She was a large person, 50ish, with a dark, glossy wig and a resonant voice. She was clocked frequently in her San Francisco neighborhood and accepted the inevitability of this occurrence. She told me often that she was "past passing" and concentrated on getting on with her life which despite her inability to pass strangers' scrutiny, was now happier than at any other time in her past.
Dr. Anderson is located at 1537 Franklin St, Suite 104, San Francisco, CA 94109, 415-776-0139.
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