Entering Transmasculinity

The Inevitability of Discourse

matthew heinz

• Publisher: Intellect Books
• Year: 2016
• Print ISBN: 9781783205684
• eBook ISBN: 9781783205707
• Edition: 1
• Topic: Theology & Religion
• Subtopic: Sexuality & Gender in Religion

Entering Transmasculinity is a holistic study of the intersecting and overlapping discourses that shape transgender identities. In the book, matthew heinz offers an examination of mediated and experienced transmasculine subjectivities and aims to capture the apparent contradictions that structure transmasculine experience, perception and identification. From the relationship between transmasculinity's emancipatory potential and its simultaneously homogenizing implications, to issues of gender-queerness, sexual minorities, normativity and fatherhood, Entering Transmasculinity the first book to synthesise the disparate areas of academic study into a theory of the transmasculine self and its formation.

Chapter 1

The Transmasculine Patient

Drawing from images, words and voices from transmasculine discourses emerging from print, digital and visual media, this chapter examines how symbolic equations and discursive framing work together to establish a sense of the transmasculine patient and thereby maintain a medicalizing and often pathologizing discourse. The chapter begins with an encounter of the transmasculine individual as suffering from a condition requiring help and accommodation and addresses the significance of expert diagnosis and gatekeeping. The chapter next leads into a discussion of the dominance of a defective physical body in such narratives and the rhetorical divergence of transmasculine narratives where the physical body is concerned. Finally, it concludes with a consideration of the role of consumption and commodification in the pursuit of normative health and being.

Transmasculine Suffering

I did have a self-mutilation problem which was like a drug to me. I hurt myself any way I could just as long as I could because I hated my body.

(A.J., FtM, in Girshick 2009, p. 166)

While the discourses of trans pathology and trans medicalization have been identified, examined, critiqued and challenged on personal (Kailey 2005; Valerio 2006), political (Bahreini 2008; Halberstam 1998), activist (Lysenko 2009), medical (Burke 2011; Park 2007), social scientific (Schilt & Westbrook 2009), natural scientific (Fausto-Sterling 2000, 2012) and cultural (Bettcher 2007) grounds, they nevertheless presents themselves as an initial, self-evident thematic portal through which to access transmasculine portrayals. Why? From autobiographical narratives to media coverage, from video logs to websites offering trans support and advocacy, and from self-help to medical literature, inherent pathology and medicalized conditions live in the web of representations transmasculine people access. While the concept of medicalization denotes the process by which a condition is constructed as a medical condition (which may or may not be abnormal), and while the concept of pathologization denotes the process by which a condition is constructed as abnormal and deviant (which may or may not require medical treatment), pathologization and medicalization are frequently used as a synonyms in popular discourse, and sometimes in scholarly discussions as well. Sara L. Muhr and Katie Rose Sullivan (2013, p. 420) summarize that being transgender is ‘[o]ften coded as a pathology’ and ‘most often seen as a disordered embodiment’ that can be cured via treatment. This web of pathological representations orients transmasculine people along key medicalizing images such as that of the patient – an individual seeking treatment, therapy, or help – in other words, an individual suffering from a diagnosable condition. A transman often enters a doctor–patient relationship with the physician prescribing and monitoring hormones, assessing a patient’s fit for gender confirmation surgery, or obtaining surgery. Identifying as transgender thereby creates a formal condition a trans person has. A 2013 Canadian Press story describes the opening of a clinic for transgender youth at the Sick Kids hospital in Toronto, citing administrators that the clinic ‘will help fill an important gap in care for teens with gender dysphoria’. The story continues with the hospital’s perspective that without proper care, transgender teens can experience negative consequences such as mental health issues and risky behaviour (Canadian Press 2013).

Transgender-identified Jonah likens his body dysphoria to the phantom pain that amputees may experience (FtM Transgender: Why I Quit Testosterone 2014). Some trans people compare using hormonal injections to diabetes patients receiving insulin shots (e.g. B. Smith 2013), an analogy also employed by some medical doctors who identify as FTM themselves. A guide for providers compares transmen on non-prescription testosterone to patients ‘with diabetes mellitus [who] would not be denied appropriate prevention, screening, and treatment despite non-adherence to an ADA diet’ (Gorton et al. 2005, p. 27). Fictional young transguy Finn attends a health clinic with a friend who asks why the clinic only displays information about diabetics, not transsexualism; Finn responds he thinks there are more diabetics than transsexuals (Edwards & Kennedy 2010, p. 190), a brief exchange that again parallels diabetes and male transsexualism. The Winnipeg Free Press quotes a physician who works with the trans community on the lack of basic medical training on trans people’s needs: ‘Managing diabetes is probably more complicated than offering people trans health care’, Whetter says. ‘This treatment is not cosmetic. It’s life-affirming and in some cases, life-saving’ (Vesely 2012, p. 9). Comparisons to diabetes construct both being diabetic and being trans as medical, non-curable conditions that need to be managed under endocrinological care. While research on the long-term effects of hormone use for gender transition is scarce (Becker & Griffing 2011), some transsexual men describe themselves as having a ‘neuroendocrinological condition commonly known as transsexualism’ (de Villiers 2011).

The term ‘patient’ has been attributed to the Latin root patior (to suffer or bear) (Hudak et al. 2003, p. 105), and the notion of suffering or bearing the pain of being trans-identified remains a steady theme in transmasculine discourse, which often constructs transmasculine people as needing help. For example, Jerusalem-born transgender photographer Nitzan Krimsky invited transmen to submit photos to his FTM binder portrait gallery with the following text: ‘I’m working on a photo project, trying to prevail the suffering that is involved with wearing a binder, and the relief of removing it (and the breasts) through portraits and close shots of damage is causes (to posture, rib cage, self-confidence, skin, etc.)’ (FTM Binder Awareness Portrait Project 2011). Some transmasculine discourse directly equates being transmasculine with being in pain. ‘It was his body that had gotten him into all this trouble. And his idiot brain. […] It wasn’t just the Ace bandages that hurt his chest. The pain from inside, deep and deadly’ reflects fictional young transmale protagonist J (Beam 2011, p. 143). ‘Suffering’ emerges as a strong component of the transmasculine patient’s construction and is a verb often used to describe pre-transition being by transmen: ‘Many suffer in similar ways as I did’ (‘I’ve known I was transgender since age 2’, 2013). A traditional, medical understanding of patients has been that of ‘passive persons who subject their bodies to treatments by experts’ (Hudak et al. 2003, p. 104). A 2009 story in The Guardian colours the experience of a 16-year-old transmale teen in the context of suffering and health care access; its sub-headline reads, ‘He suffered years of depression and bullying. Now, as he begins the process of becoming a man, Jon wants to help other transgender teenagers’ (Groskop 2009). The verbs ‘suffer’ and ‘help’, linked with the nouns ‘depression’ and ‘bullying’, establish Jon as a subject needing help, care and support. The story further quotes Jon, ‘All trans people suffer with their bodies to some extent’. The need for physical treatment is emphasized throughout the story, which talks about gender dysphoria ‘affecting’ about 100 British children a year: ‘The only place in the UK where children with gender identity issues can be treated on the NHS (National Health Service) is the Tavistock Clinic in London’. The story explains gender dysphoria as a ‘condition’ and references the existence of ‘evidence’ that this condition ‘may be biologically determined’. An 8-year-old trans boy’s coming out rap, which was widely circulated on the Internet, contained the lines ‘I’ve always felt this way and it hasn’t been fun’ (Scott 2014). A sample coming out letter to one’s parents by a FTM transsexual contains the sentences ‘At one time, I came close to committing suicide, but I just couldn’t do it. I didn’t want to die. I just wanted out of this body!’ (Brown & Rounsley 2003, p. 171) and ‘They’re used to seeing me with a smile on my face all the time. If they only knew the pain and torture I’m going through’ (Brown & Rounsley 2003, p. 172). A series of videos on the YouTube Channel Transguys Ireland captures young FTM perspectives on how one can manage gender dysphoria. Oli (Oli – Managing Dysphoria 2012) discusses that he suffers from both gender discomfort and gender dysphoria as well as general body dysphoria but stresses that ‘if you don’t hate your body you can still be trans’. Oli says that he tries to push away consciousness about his mismatching body parts. He does not have a binder yet and had to stop binding the way he did due to back pain. M.L. Brown and Chloe Ann Rounsley (2003, p. 11), in their handbook for families, friends, coworkers and health care providers, specify that FTM transsexuals ‘are usually very uncomfortable with their breasts, their curves, and the soft appearance of their body’ and link severe gender dysphoria to self-mutilation and suicide. Reudookan (Jin) Lepsungwan of Thailand raised funds for his top surgery in Bangkok via an Indiegogo campaign (Help FTM surgery. mastectomy, 2013). On the fund-raising site, he provides a basic appeal: ‘Please make it happen I need to be having top surgery as soon as possible. Help me stop this pain’. Jin states that coming out as transgender was ‘messy and complicated for everyone around me, including myself. There were lots of tears, heart ache and hurtful words surrounding me’. The photos Jin uses to illustrate his fund-raising appeal include a photo of him with his chest bare; nipples crossed out, and the word ‘painfull’ [sic] blacking out his facial features. Often, discourse generated by transmasculine individuals as much as discourse generated about transmasculine individuals rhetorically equates gender dysphoria with being transgender, an equation that is increasingly being challenged.

Traditional transmasculine discourse that equates gender dysphoria with body dysphoria with being trans upholds the experience of menstruation as physically and psychologically painful. Posts such as “How do I deal with my periods (FTM)” (MyNameisAdam 2013) highlight that menstruation is often not raised in transmasculine discourse despite its psychological effect on many transmasculine individuals. MyNameisAdam posted the following comment on a public GLBTQ discussion board: ‘I know this is an awkward question, but menstruating always means dysphoria for me and I’m lost on how to deal with it. It’s worse because I’m irregular, so I never know when it’s coming and it leads to a lot of self-loathing and, sometimes, suicidal ideation. […] I mean, what kind of guy would be comfortable with bleeding out of their genitals for a week?’ A Reddit discussion (Dysphoria and the menstrual cycle 2014) began with an FTM post asking whether others also experience heightened dysphoria the week before their period. The question drew 18 responses, all of which affirmed links between menstrual cycles and dysphoria, although in different patterns. Responses such as ‘No kidding, someone fetch me a knife’ and ‘crippling depression the week before and during’ affirmed the pattern. One respondent observed that since considering the possibility of being trans, ‘dysphoria has been on the rise’ and ‘practically unmanageable the last week or so, which perfectly corresponds to the start of shark week’. A genderqueer transmasculine blogger in Canada writes that the ability to stop menstruating is a major factor in his consideration of testosterone because menstruation forces him to encounter his most dysphoric body part (Dowd 2014).

The figure of the ‘patient’ is visually reinforced by the sheer quantity of patient-like transmale images on the web – pre-op, post-op or injecting testosterone, such as B. Smith’s (2013) blog illustration of a syringe and a vial of testosterone, Daniel Brosh’s (FTM bottom surgery (phalloplasty) post-op 2013) account of a series of bottom surgeries in which he shows his surgery scars, or Leo Green’s video recording of his first testosterone shot (First T-shot 2013). Presenting as patient may arise to a lesser degree from intentional choice and to a larger degree from the banal, unavoidable necessity of functioning within societies whose linguistic registers link everyday transmasculine being to being a patient, in need of care, and in need of accommodation. Given the dominance of medicalizing images, it is not surprising that coming out as trans often translates into coming out as a patient. Young adult fictional character Finn reflects on calling a doctor’s office to make an appointment for a medical assessment in the following words, ‘It was simple, just like when I had a sore throat or busted knee’ (Edwards & Kennedy 2010, p. 37). Earlier medical and social scientific literature approached transmen as a comparatively small and rare marginalized patient population (Whittle 2000), estimating transmasculine populations to be significantly smaller than transfeminine populations and equating FTM expression with an (often undiagnosed and/or untreated) medical condition. In the last two decades, international research has documented the rising visibility of transmasculine-identified people and conjectured about eventual equal rates for the occurrence of identification on the transmasculine and transfeminine spectrum, respectively (DeCuypere et al. 2007). Thomas D. Steensma (2015) observed such a change in the Dutch context, noting that before 2006, more natal men and since 2006, more natal women (transmasculine individuals) have presented for care. It has therefore become more common to encounter transmasculine individuals seeking assistance with social and physical transitions. Now, transmasculine individuals often think of themselves as suffering from a recognized medical condition and seek assistance in physical transition from the health care system:

While transsexuality has a higher incidence than Wegener’s Granulomatosis, SCID, and Ewing Sarcoma, patients with those diseases could reasonably expect a physician has received at least some minimal formal education about their illness and would be able to refresh her memory relatively easily by consulting common medical texts.

(Gorton et al. 2005, p. 71)

The previously traditionally strong associations of transmasculine identities with mental illness are weakening. While some governments and some medical professional bodies have taken steps to uncouple trans identification from mental health illness, which discursively hovers near the borderlands of madness and insanity, medical system coverage in practice still requires identification as a patient and a documented mental health need to warrant care in most nation-states. The debate over the inclusion, exclusion or modification of what emerged as Gender Dysphoria, from the previous Gender Identity Disorder, was at the core of the political struggle (Knudson et al. 2010) over the most recent version (fifth edition) of the Diagnostic and Statistical Manual of Mental Disorders (Beredjick 2012). Gender dysphoria was renamed and, after much discussion, moved out of the sexual disorders category and into a category of its own. Within a European context, recent political trends have supported depathologization of transsexualism and transgenderism, including a 2003 British government policy declaring that transsexualism is not a mental illness (‘Government Policy concerning Transsexual People’ 2003), the French government’s 2009 declassification of transsexualism as a psychiatric condition, and the European Parliament’s 2011 call upon the European Union Commission and the World Health Organization to depathologize trans identities (Transgender Europe 2011). The World Professional Association for Transgender Health 2012 Standards of Care urged de-psychopathologization of gender nonconformity worldwide (Coleman et al. 2012). The metaphor of the patient is no longer as pervasive or naturalized as it has been in the past, and even within transmasculine discourse that invokes it (for example by soliciting recommendations for sensitive health care providers in an online discussion forum), it is often contextualized. Photos that show a bare-chested post-op transman playing outside with his children may emphasize the temporality of patient suffering; text that notes that seeking a trans sensitive psychiatrist is motivated by the need of navigating access to medically covered services rather than a mental illness reframes the patient–doctor relationship. Debates about the ethics involved in requiring trans-identified individuals to document both sound mental health and an ‘authentic’ trans identification have begun in medical and public discourse. The Atlantic, for example, pointed out that

A non-trans man who suffers from chronic pain of the scrotum, for example, can elect to have an orchidectomy—a procedure to remove both testicles—without a mental-health referral. Nor would a non-trans woman seeking a hysterectomy be asked to see two mental-health professionals.

(Eveleth 2014)

Accommodating the Transman

However, I asked my boss whether I should reveal the secret to everyone. He was more than comfortable with it. I sent the e-mail, with a copy marked to my CEO, and his reply was nothing less than a gift for me

(Siddhant Singh 2014)

Associational clusters reflect the company words keep (Burke 1973); they contain cultural values that link images, words, and concepts. Transmen who reject pathologizing and medicalizing identifications and do not seek any form of medical intervention may still end up engaging the discourses of accommodation and accessibility by requesting employer or governmental recognition of new names, gender markers, gender identity expressions and access to bathroom facilities. Guidebooks and resource books, whether aimed at transmasculine individuals or their family members, and whether written by trans-identified individuals (e.g. Kailey’s [2012] My Child is Transgender) or not, maintain the cultural construction that transpeople need help, that their very existence poses problems that can be handled, challenges that need to be managed, and that they (or their family members) need resources. Book reviews for Stephanie Brill and Rachel Pepper’s (2008) The Transgender Child: A Handbook for Families and Professionals – which are overwhelmingly positive – reflect this perspective in language such as ‘a series of chapters dealing with all aspects of how to deal with the child’ (Parker 2008), ‘a “must have” guide for anyone who interacts with transgender kids’ (Garza 2008), or ‘if you are a parent of a TG child or you are dealing with a TG child’ (Dunn 2009).

Accommodation and accessibility, however, are predicated on having been identified/marked/diagnosed with a condition worth accommodating. Even for those seeking social transition only, it is difficult to evade the discourse of pathology because inevitably, choices such as changes in pronouns, clothing or name require justification. This justification often is traced back to a ‘need’ felt by the individual, and that need is often understood to be the result of a physical and/or mental condition. Transmasculine discourse allows for two different but easily conflated interpretations here: the ‘need’ to receive treatment or access therapy can be understood as a biological response to a physiological need caused by a ‘defect’, or the ‘need’ to receive treatment or access therapy can be understood as a psychological or physiological condition onto itself. The latter interpretation opens itself up to three-fold perspectives: being transmasculine means being mentally ill, being transmasculine means being ill or being transmasculine means being mentally and physically ill. Authors, whether trans-identified writers, health professionals or community supporters, offer templates designed to help transmen announce their transitions; these templates typically employ the vocabularies of disability accommodation and/or medicine as do manuals designed to help employers with employees’ transition. The Canadian Labour Congress (2010), for example, makes available an online guide titled ‘Workers in Transition: A Practical Guide about Gender Transition for Union Representatives’. This guide includes anecdotes and illustration from members who identify as trans or have transitioned. It provides an excerpt (p. 5) from an article by Jesse Invik (2006–2007), a self-identified female-to-male transsexual, in which he reflects on the problematic of discussing his medical need with his employer:

Every time I have to ask for time off for yet another doctor’s appointment I worry that he thinks I’m just trying to skip work. I wonder if I should tell him I’m seeing a psychiatrist so he’ll accept my need for medical appointments as often as every three weeks. […] When I ask for two days off to go to Toronto for some minor revision surgery, I am truly concerned that he thinks I am pulling one over on him.

The guide affirms the medical model of transitioning by noting that ‘Just like any other worker’s personal medical situation, nobody in the workplace is entitled to any information about the transitioning worker’s medical issues’ (p. 10). It continues to characterize trans workers’ health care needs as those that ‘should be treated in exactly the same way as any other medical requirement. Transition-related health care needs are not cosmetic’ (p. 14). The discourse of accommodation goes beyond legal contexts; it offers one way of approaching cisgender people’s communication with trans people. A wikiHow entry aimed at cisgender friends of trans people advises how to be ‘a good friend to someone with Gender Dysphoria’ (wikiHow n.d.). The article, which had been read 8,384 times as of 20 June 2014, recommends:

Compliment your friend. […] Transguys like this too! If they seem especially ‘manly’ or handsome that day, they'd probably love to hear it, even if they grumble and try to act like they don't care. If they don't look good, mental qualities are very safe ground for true compliments. She's got an eye for fashion. He's great for remembering all the sports scores. Things that they are genuinely strong in. Don't always keep it to appearance or they may start to feel even more self-conscious about how they look.

The mere existence of this entry establishes gender dysphoria as a condition and transpeople as individuals who, by virtue of being trans, require special care and attention in social interactions. It presumes that transmen are self-conscious about their appearance and appreciate comments that compliment stereotypically masculine looks or performance. As Dean Spade (2011, p. 11) observes in reflections on his work for a non-profit law collective: ‘gender is an organizing principle of both the economy and the seemingly banal administrative systems that govern everyone’s daily life, but have an especially strong presence in the lives of poor people’. Like the rest of the population, transmasculine individuals must navigate their ways through such ‘seemingly banal administrative systems’ using se...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• TRANSformation: Damian Siqueiros
• Foreword
• Preface
• Introduction
• Chapter 1: The Transmasculine Patient
• Chapter 2: Norming Abnormality
• Chapter 3: Finding One’s (Male) Self
• Chapter 4: A Man’s Man
• Conclusion
• References
• Index
• Back Cover