Transsexual Nation

By David Tuller

In the summer of 1991, bored with his job and craving adventure, David Tuller "flew to Russia and became an American sex spy." A a reporter for the San Francisco Chronicle, his book, "Cracks in the Iron Closet" is the product of that and other visits back to the former Soviet Union.

Oksana did not act like someone about to receive her long-awaited vagina. In fact, she appeared thoroughly sanguine about the upcoming operation; more like someone having a mole removed, not her unwanted penis. Chatty and agreeable, she sprawled casually on her hospital bed. Soft bangs hung over her eyes. One delicate lock curled up her forehead.

Raised in an orphanage, Oksana had always known she was not a boy. "I liked cooking, cleaning, playing with dolls. When I was older, I spent a lot of time with homosexuals, but I understood that I was different from them. I felt like a woman, not a homosexual." She smiled coyly. "I'm twenty-five-that's already considered not young for a transsexual. But I didn't know there was an operation for this until I saw a television program about it a few years ago. After that, I had hope."

A saleswoman in a provincial town several hours from Moscow, Oksana had been taking female hormones and living as a woman for some time. She said she had never had sex with a man; like many transsexuals, she was revolted by the thought of engaging in physical intimacies while occupying a body with the wrong parts.

Still, she was not nervous about her prospects after the change. "I know I won't be lonely, because even now on the street men come on to me." Her legs poked out from under her orange bathrobe. She dangled them over the side of the bed. "But I don't know whether I'll get married or not. If it happens, it happens."

One of her doctors entered the room. Oksana waved her hand in the direction of her lap. "I'm ready, just take all of it away," she said cheerfully.

Though Oksana still had her penis, she was already-officially-a woman. Her documents said so. In Russia, documents were everything: wherever you went it was papers, papers, what do your papers say? This was true for visitors like me and even more so for citizens-passports, workbooks, residency permits, official stamps and approvals were required for every transaction in the course of a life.

I didn't fully grasp how important this concept was until I learned the way it applied to transsexuals. Here's how the process worked: First a person obtained an official psychiatric assessment that he or she was actually a member of the opposite sex. Then she or he took his or her passport to local bureaucrats, who would change the document's designated sex so that it would conform to the official psychiatric assessment. Then-and only then-could a doctor operate so that the body would conform to the revised passport.

Actually, from the legal perspective, the operation itself was superfluous: whatever the passport indicated was already the truth. Still, the operation was not superfluous to those, like Oksana, who suffered from the certainty that they were born in the wrong body.

With Oksana's permission, her primary surgeon, Aleksei Okulov, had invited another American journalist and I to witness the operation, which took place in November of 1994.

My colleague, Genine Babakian, worked for the Moscow Times, the capital's leading English-language newspaper; she was funny and charming and one of my best friends in the city. Okulov, the surgeon, was a short, energetic man with white hair and powerful hands. He always seemed on the verge of laughter. His specialty was the reconstruction of sexual organs, not only for transsexuals but for people injured in accidents and children born with both male and female sexual characteristics.

Two other surgeons were to assist Okulov during the six-hour operation. We all donned blue hospital gowns, white booties, and masks. I assumed Genine and I would be watching from above or outside the operating chamber, but the doctors ushered us into the room alongside them. By this point, Oksana was lying on a table, unconscious, with her legs up in stirrups; her flaccid penis flopped over to the right. The anesthesiologist checked her eyes.

The surgeons made a small incision to the left of the penis. After much manipulation of tissue and flesh they sewed up the hole with tweezers and blue sutures and made another cut on the right side. One of the doctors explained that they were diverting the semen canal. "Oksana doesn't need that anymore," remarked the anesthesiologist helpfully.

Lots of little noises-mask-muffled murmurings, scissor snips, the beeps and sighs of medical equipment-punctuated the quiet atmosphere. Genine and I were free to move around as we pleased. First I stood behind Oksana's head. Straining to see, I tripped over my booties and-oops!-stumbled toward the huge anesthesiology contraption hooked up to her. I caught myself and glanced around furtively; no one had noticed. I switched positions and stood for a while at Oksana's feet, behind Okulov, peering over his shoulder as he wielded his scalpel and dragged it along the length of the penis.

The process of removing the organ surprised me. I assumed they would just sort of slice it off with one quick, clean flick. Instead, they began to peel the skin away slowly, layer by excruciating layer-as if the penis were an onion or an artichoke. They did this by using a handheld drill-like instrument to burn a tiny hole in each successive layer. Every time the instrument touched the flesh, a puff of smoke would rise, a black spot would appear and spread, and the doctors would tug at it with tweezers.

As they pared the flesh away, they left it all attached at the base of the shaft; they were saving it, I assumed, to construct Oksana's new genitalia. A nurse jotted down notes.

Okulov kept dumping blood-stained gauze behind his back; everything landed in a little wastebin next to me. At one point, after much snipping and tying, he gripped something with his gloved fingers and tugged gently. A mass of red pulp slid out of the body. He handed it to the nurse; she flipped her hand and the red thing whizzed by me into the bin. I looked at it.

"Testicle," said the nurse casually.

The surgeon repeated the procedure. "The second," advised the nurse, as she dumped this lump next to the other.

"Is there a third?" quipped the anesthesiologist.

Now attention turned back to the penis itself. They kept snipping and slicing, pulling and paring, burning and peeling-gradually whittling it down. I stared, spellbound and revolted, as it got thinner and thinner. Black burn marks speckled it. I suddenly realized that I was clenching my teeth fiercely. I glanced out the window: a few birch trees, patch of lawn, soggy sky.

I looked back. The penis was now the width of a pencil.

I found this a bit unsettling to watch. In the past I had smugly regarded transsexualism as a mental disorder; those afflicted with it, I assumed, were convinced that they possessed the wrong bodies simply because they believed too deeply in immutable psychological differences between men and women. But this graphic demonstration of Oksana's willingness to rid herself of something that was so important to me forced me to reconsider that facile notion. What was gender, anyway? Was it nothing more than a few layers of flesh, so easily stripped away? Was it in the genitals, the hormones, the head, the heart? I had no answers.

Maybe the question was so personal that it demanded a thoroughly personal response. Oksana knew who she was. I knew who I was. It was that complex-and that simple.

Genine was ready to leave, and so was I. We had been there for almost two hours; I didn't think I could bear another four, and I had little desire to watch the penis vanish entirely. One of the nurses scolded us as we made our escape: "But you're leaving before the most interesting part!"

Although the Soviet health ministry did not officially acknowledge transsexualism as a classifiable condition until the late 1980s, a few doctors had been performing sex-change surgery quietly for more than twenty years. But given the lack of public discussion of the issue, only a minuscule number of people learned about the procedure and sought help. In the years of perestroika, greater media awareness of transsexualism led to increased demand for the operations.

With the collapse of the Soviet Union and the advent of market-oriented changes in the medical delivery system, a growing number of doctors entered the field and began charging for what was once offered for free. But the fees could still be astonishingly low. Because Oksana earned only a small salary as a sales clerk, the hospital billed her just $100; Okulov, the lead surgeon, said he earned the ruble equivalent of one dollar for the operation.

As a male-to-female transsexual, Oksana was actually among the minority of those seeking sex-change operations. In Russia, Okulov and other doctors routinely reported that four to ten times more women wanted to be men than the other way around. Those statistics contrasted sharply with the situation in the United States; American doctors have long asserted that male-to-female transsexuals far outnumbered their opposites, although some experts now suggest that the ratio may be close to parity. Still, a female-to-male sex change is a far more complicated proposition. The process-in both Russia and the United States-can include up to half a dozen operations to remove the breasts and uterus, construct a penis using tissue from the back or elsewhere, create a scrotum, and implant synthetic testicles. While no artificial penises are fully functional, doctors say that some surgical techniques allow patients to maintain "pseudo-erections" sufficient for intercourse.

Given the difficulties of penis construction, why were there so many more Russian female-to-male transsexuals than the other way around? No one knew. Okulov and his colleagues spoke eloquently of their conviction that transsexualism was not an illness but a congenital condition and that those afflicted with it were as psychologically sound in other ways as those who were not. Yet these specialists shrugged their shoulders when asked to explain the statistics.

I raised the question at the dacha, too, and my friends there offered a typically jaundiced theory: Russian women have such a hard life that it's simply more pleasant to be a man, so of course many would seek a change.

One possible explanation was that many male-to-female transsexuals - at least until the repeal of the sodomy law - were fully aware that few medical and law enforcement authorities were sensitive enough to distinguish homosexuality from transsexualism. Fearing prosecution as homosexuals, they declined to seek help, and the percentage of female-to-male transsexuals appeared disproportionately high. Another factor was that some doctors routinely sought to persuade gay women that they were, in fact, men. The literary journal Gay Slavanye, for example, published a letter from a nineteen-year-old lesbian whose mother dragged her to see a sexopathologist.

"The doctor took a urine sample and said that if, according to the results, I am a man, then he could send me to Moscow to get an operation!" wrote the distressed young woman. "But I don't want to be a man! I am completely satisfied with my body. I just want someone to love me as I am."

This incident took place at a time when social attitudes toward homosexuality were already changing; doctors in the pre-perestroika era held such views even more fiercely. Undoubtedly some women must have taken this advice to heart, must have convinced themselves that cutting up their bodies was the appropriate response to their attraction to other women. Olga Lipovskaya, one of the country's few self-proclaimed feminists, certainly believed that to be the primary cause of the female-to-male transsexual phenomenon. "They have women's bodies, so how can they be men? Of course they are women," she exclaimed with exasperation during one of our conversations on the topic.

Still, there was no way to know for sure whether or not Olga was right. As I met those who identified as female-to-male transsexuals, I soon gave up trying to figure it out and simply sought to accept them on their own terms. Almost to a man, they were good-natured and appealing, eager to discuss their lives. All hated their female bodies, but many had decided not to go through the pain and expense of altering their anatomy. Most had girlfriends but, if they had not undergone a sex change, refused to allow their partners to touch their breasts and genitals.

They also espoused stereotypical beliefs about gender and sex role differences: men were stronger, women gentler. But then, the vast majority of my Russian friends-gay and straight, male and female-professed similar views. This was, after all, a culture in which a genuine feminist movement had barely arisen, a society whose government had discouraged all efforts at gender analysis for decades. So it was hardly surprising that transsexuals, like virtually everybody else, considered it a self-evident proposition that men and women were different-inherently, essentially, and eternally.

(to be continued...)