Thursday, 11 September 2008

Non, Je Ne Regrette Rien

No, I regret nothing. Not even that I didn't transition earlier, for then my son would not have been born.

Some do though, have regrets I mean. Not many, and they usually have other problems too.

I've blogged about one before, Josef Kirchner. Born intersexed, 45x/46xy, a mix of Turner Syndrome Female/Standard Male.He had a partial MtoF natural transition at puberty, took it all the way, lived for 20 years as a woman, then "grew out of it".

NBC has a Documentary about Josef, and another, even more problematic case, that of Michael Berke too.

Michael never did see a gender specialist. He's suicidal and mentally unstable, lived as a boy, lived as a woman (though he didn't have genital reconstruction), and is just as unstable and unhappy as a man.

Both Michael and Josef share three things in common.

The first is that they have been poorly served by the medical profession. Josef's Intersex condition was hidden from him until comparatively recently, and Michael was in the hands of a general psychiatrist, not a specialist. On the other hand, Michael would be dead now if he hadn't (partially) transitioned to female. And back.

The second is that they were even more poorly served by religious "reparative therapy" groups. Ignorance, Bigotry and Prayer is not a substitute for medical and scientific knowledge.

The third is obvious - they lived as boys, then as women, and now as men.

That similarity seems to me, from my observations, more apparent than real though. For Josef, being a woman was always partly acting. His natural gait, his body language when walking, is naturally male. Now he looks like a guy, the act isn't needed: he can walk without thinking. This is a great relief.

I know. My natural gait is female, and I had to train myself from boyhood not to let that show. Now I just relax and am me, not worrying how my hips do or do not swing. (I've been told they do - a lot).

Michael's gait though is female. Despite the bald head, the bad boy look, the tatoos, the deep voice, the Harley. That to me strongly suggests at least partially cross-gendered neurology in some areas of the lymbic system. His history of congenital neurological and cognitive defects, and substantial (pardon the pun) substance abuse, and general mental instability are all indicative of severe neural screw ups, complicated and concealed to some extent by higher-level psychiatric illness that may be responsive to therapy. And he wants to be Michelle again. Maybe. From the Daily Telegraph :
High on prescription painkillers and four days without sleep, Michael Berke raced his Harley to the megachurch where he'd found a home.

He barged into the church office, cursing loudly and wearing a mesh shirt printed with profanity. In his hands he held a picture of a woman with long, red hair and pouty lips.

"This is who I used to be", he said.

"And this, (he gestured to his breastless chest, bald head and red goatee) is who I've become."

After a lifetime as a social misfit, he had transformed himself into Michelle, a saucy redhead.

Then, three months ago, he had become Michael again with the financial aid and spiritual encouragement of Calvary Chapel of Fort Lauderdale.

Now, he wanted to be Michelle again, and he blamed Calvary for making him the man he had become.
It's always someone else's fault.
Realistically, he knows he can't become Michelle again.

"If I do it again people are going to think Im even more unstable," he says. His mom and sister stopped talking to him, he says, when he switched back to Michael.

"I still struggle just living on a daily basis," he says.

Then, minutes later: "Maybe I just need to meet the right woman and have a relationship. Really Im without any sense of direction right now."

If I had to offer an uneducated opinion, I'd say that Josef has found himself. Quite understandably misled by the natural changes to his body, his gender identity finally consolidated 25 years after most people's does. He's a guy who's taken the scenic route to being himself.

Michael - I'm not sure has a gender identity, or a stable identity of any kind. He has partly female neurology, but there are so many co-morbidities, I'm not sure the concept of gender identity can be adequately addressed. A temporary transition to female saved his life, and transition to male saved it again. I wouldn't be sure that that transition won't be temporary too, and there may be others after that. Unlike Josef, he's not in good shape.

There's a case of regret recorded in Australia too, that of Alan Finch. There are certain similarities to Michael Berke's case too.

Now bear in mind that Mr Finch's lawsuit against the Monash Gender Centre in 2004 caused an effective moratorium on all transsexual treatment during the first few months of my transition. This caused me significant difficulty, everyone was running scared. So my objectivity on the issue should be called into question.

Having said that, here's some articles on the subject.

From the Sydney Morning Herald of August 2003:
In his 20s he had his penis and scrotum removed and a false vagina fashioned from the penile skin and inserted into his body, and he became a woman called Helen.

He got married illegally and was later in another relationship that fell apart when his male partner discovered Helen was born a boy.

Then he had a relationship with a woman, who encouraged him to become a man again.

"I knew with my whole being that was what I wanted to do," Mr Finch, 36, of Melbourne, said.

About five years ago, he began taking male hormones, something he says now was "a roller-coaster ride emotionally". He was angry at himself for having been so gullible that he was sucked into the fantasy that becoming a woman would solve his identity crisis.

And he was angry with his then-girlfriend. "I blamed her for having awakened this in me, and I just pushed her away. And there was this total confusion again wondering if I could function as a man, let alone function as a man who has been mutilated to this degree."

Like about 10 per cent of people in Australia who have the operation (about 80 a year in Sydney, Melbourne and on the Gold Coast), he was desperately unhappy with the result.
The 10% figure appears to be unevidenced. Or based on figures 10 to 30 years old at the time.
The final hurdle before the surgery that would effectively castrate him was the psychiatric test.

First time around, he failed. Then he learned how to fudge the test and answer the questions to put him into the female zone. The operation got the go ahead.
He deliberately and consciously faked it to get what he wanted. Right.

From Polare #61 , the magazine of the Sydney Gender Centre.
Quite by chance I found in my files an article from Woman's Day, 19 December 1989, headed "Goodbye Alan, hello Helen ... and happiness" it tells the heartwarming story of Alan Finch who, "because of a chromosome imbalance" spent his early life feeling like a girl. At seventeen he read about sex change and for the "first time understood what was wrong". Blood tests showed that Alan was "missing a male chromosome" [sic] and he was given the option of going on to male hormones immediately or waiting until he was eighteen and going on female hormones. At eighteen he decided he wanted to be a woman and transitioned as Helen. In 1986 he, his mother and sister emigrated to Australia and after saving the SRS fee he had the irreversible operation "which she says she will never regret." In June, 1989 he used his British passport, which had been amended after the operation, to marry illegally. It made Helen angry to discover the marriage was void. "I will fight it. I am going to campaign for the law to be changed. I haven't got a problem any more. I see it as a problem I had which has been solved."

Yet now, Helen has reverted to being Alan and wants to sue the Monash Clinic, despite admitting to having cheated on the assessment tests and despite the long history of unhappiness in the male gender role and long-standing desire for gender reassignment.
A transcript of Mr Finch's story as told to the ABC is revealing:
JOAN FINCH (Alan's Mother): He'd had the Boy George look, he'd had the Adam Ant look, he tried the Marilyn look with the dreadlocks....
ALAN FINCH: When I was 20, the doctors requested that I have a psychiatric assessment to see if I was suitable for the final surgery. My psychological responses were not only masculine, but they were more masculine than they would expect from an average man at my age. And I just couldn't believe it. I mean, it was like my whole dream had fallen apart. Eight months later I resat the testing and by that time I had learned what I should be saying, so in ink blots, instead of saying, "Oh, it's a blob," or, "I really can't see anything," well, then, there was a flower there, or a daisy. And the results came back and it said that the answers I'd given were more socially desirable, and, um, from a defensive pattern, but anyway, they agreed to do it.....
When I woke up after the operation, I just couldn't believe it because I felt like I'd been conned actually. I felt like I'd been ripped off. I thought I was going in for a soul transplant. I didn't feel transformed. I felt mutilated. The core of who I was, I felt, had been cut out. That's what it felt like.
Anatomically, I was never really a woman. It was creating a battleground within my own body. It's just rearranging flesh, but the tissue that's used is still male tissue. I never was able to have any orgasm or sexual pleasure. Everything was fake about it from top to toe.
DR BYRON RIGBY:Given that the operation is irreversible I think the gender reassignment surgery that was done on Alan - I can't imagine how it could be medically justified in the absence of much, much more adequate counselling than what I understand he received. And the tests showed that he, in fact, even in the presence of oestrogen treatment, was well on the masculine side of average. In fact, he's more masculine than I am, if you like. So I would think that a great spotlight should be placed on this kind of surgery in general and this case in particular.

I think it warrants a full investigation at a governmental level. Any thorough history taken by a competent psychiatrist or even non-specialist, would reveal what was apparent to me within three or four sessions - he had never had any role-modelling. His father was a very violent man, and the whole reason he attempted to take refuge in womanhood was simply that he couldn't learn from his father how to be anything he'd want to be.
An interview with Mr Finch on video. In it he says "There's only one person responsible..." and my immediate reaction was to expect the word "me" to follow. He admits to "gaming the system" after all. But no, the one person responsible is... the surgeon. The surgeon should have known he was lying, you see. It's not his fault.

As I said, my objectivity is open to question. Certainly Mr Finch's actions have caused misery to hundreds, and probably a few deaths too. For me it was a mere minor delay.

For those who want to know what the regret rate in the early days was, it's available at Sex Reassignment. Thirty Years of International Follow-up Studies After Sex Reassignment Surgery: A Comprehensive Review, 1961-1991 by Friedemann Pfäfflin and Astrid Junge (Translated from German into American English by Roberta B. Jacobson and Alf B. Meier)
Regarding the global percentages of unsatisfactory results, resp., of worsening, they range from about 8.1% for females in the early reviews (Pauly, 1981), over 10.3% (Lundström et al., 1984) to 13% (Green & Fleming, 1989). For males, from 6% (Pauly, 1981), over 9.7% (Lundström et al, 1984) to 3% (Green & Fleming, 1990). Abramowitz (1986) found in 7% of the operated and not differentiated by gender patients, severe complications to which he counted, amongst others, desire to revert back, psychotic episodes, hospitalization and suicide.
Later figures show a failure rate of about 3%, with less than 1% showing regret.


Bad hair days said...

Regret. Well there is some, that I didn't have the ressources that are available nowadays - I would have changed before puperty. But than it occoured to me, that my pasts and my struggles and the fact of a masculinezed skeleton are well worth it. It made me the person which I am today. One that is very confident for example. And that is a point. It's not statistical relevant, but I heard of a lot of young transitioners who, despite of their natural grace seek lots of operations to make them more perfect, often very unhappy with themselfs.
I had to learn confidence in myself to survive the time before I finally transitioned and I can say I'm a bit proud of that. I think if I'd transitioned that early I would always have lived up to social expectations of women. And I would have a typical underpaid (but satisfying) Job - I wanted to become a kindergardener, but the fact that it is so underpaid you can only do it, if you can rely on a partner with better income (and as being male gendered by others I think I would often have had to fight against preduidice). But I found a job that was both satisfying and well paid later in my life (Software Engineer), and I established a hobby that is typically male gendered by society in classical sportscars. And now I'm grown enough and rest enough in myself to be me.

By the way, I have no children, but I think that is the best cause not to regret.

Battybattybats said...

Clearly significant study needs to be done into the failures and those with regrets, especially to determine the cause of said regrets, how much is due to poor surgical outcomes, how much is due to later cultural/social factors and how much due to the surgery having been innappropriate for those individuals.

That way a reliable screening process can be developed that will ensure less people get surgery that is innapropriate for them and when surgical outcomes are the cause further investigation into that could further improve surgeical techniques to minimise that further.

But until such studies are done a nice chunky 'at your own risk' disclaimer should suffice.

That and there needs to be an utter rejection of surgery required for recognition or for treatment paths that presume a surgical outcome.

Clearly restricting access to surgery is bad and forcing people to surgery is bad.

So essentially the rational decision is to make surgery an option, a choice made by the patient after consultation with doctors and ensuring they are informed of all the facts pro and con and all possible outcomes.

The unhappiness of a significant minority certainly shows more work needs to be done to meet the needs of these people whether 10% or 1%. However the pausing of treatment of so many people, 90%+ being happy with the results, because of it? Is that even precedented?

Leah said...

You won't say it Zoë, but I will: Finch is an ass. Then again I said about Josef 2 years ago. Turn out Josef still had issues to work out and is now at peace. Maybe Finch will eventually too?

Nica said...

Yes, I caught that docu on MSNBC by chance, Zoe. The weight-lifter person seemed very content having changed back to male. Interesting tho how he had developed huge male pecs and gave a little tease for the camera at the end by pulling the muscle-T down in front. I wonder what was up with that. The motor cycle person seemed very much like they were presenting a fake exterior, or shell, and did not seem content or stable at all. I felt sorry for that person. A lot of suffering there. Hi, Leah.

Lisa Harney said...

Not commenting specifically as to his identity, lots of trans people lied to get treatment because of the cisnormative and heteronormative requirements for treatment. :(

Sucky, though.