Sexual Confusion — Is It More Than Hormones?

“I’m heterosexual and proud of it.  Do you need a reference from my husband?”

Such was my response to a drop-dead-gorgeous male transvestite who sidled up to me once, at one of the unusual affairs my husband and I were accustomed to attending at the time, and wanted to know if I had been born male.

RuPaul

Oh, there were a couple like me, she said, and even if I were a lesbian, it would be so wonderful to have someone like me, a “professional” woman, for a friend.

Oh, there were a few like me, she said, who did not care as much as they ought about appearance, and she wanted desperately to have an opportunity to make me up a bit, and maybe even lend me some clothes.

I declined, as politely as I could.  I actually gave her a card, told her we could have lunch, if she wanted.  She (I had learned to call people by their publically identified sex) told me she had run out of cards.  I told her to just call, and I would be available for lunch, and I was certainly open for friendship.

I am heterosexual and proud of it — and yes, the reference from my husband is available, has been offered frequently, but rarely taken.

I had opened an office in a modern Bohemian quarter of a rather conservative city where alternative lifestyles abounded.  I was delighted to see the faces of people who were slow to trust, as their hearts and spirits had been broken in the past.

They represented every kind of alternative (which generally means “alternative sexual” in at least this world) lifestyle of which I had heard and a few of which I had not.

If I had to choose the basic beliefs about humankind that seem to dominate my world, one of them would be a belief in the individual. People need and identify with groups, of course, but all too often they are asked to sublimate their individual identities to be a member of a group. The exceptions are not just more interesting, but also more compelling.  They are the reasons that your friend’s diet tip or lifestyle or doctor does not work for you.  As we said in France, “vive la différence!” (I honor the differences)

So when I was building my practice initially and talking to therapists of all sorts, a therapist told me she worked with transgendering folks and they could use a medical doctor.  I told her I would be that doctor, and I was.  After all, I had attended men who were transitioning to female status while working in the California prison system.  My talents in the “outside world” were rare then, and may be even now.

It is more mainstream than you might think. Most insurance companies pay for sex changes, (“only one per lifetime,” according to State employee Blue Cross in California). Also, there has been a rather incredible insurgence in the amount of research literature on hormones and what they do to people in various states.

People who have what is called Gender identity disorder (GID) feel a severe conflict between their physical gender and the gender with which they most identify.  Literally, they feel trapped in the wrong kind of body, which can cause anything from a mild dysphoria to more severe problems.

The bottom line is that they need and deserve treatment.

I am a mind-body doctor, with a more holistic approach than most, employing more subtle treatments for little-known or overlooked problems of the human physiology and psyche.  The subculture, the psychosocial challenges, the nutritional and psychological symptoms — that is where I live and work.  I want everyone to have the full, rich lives they enjoy.  Everybody.

Even definitions of terms are still under question in this field. There are a few basic ones that may help the caring bystander, or even the patient.

Gender confusion: There are plenty of people, mostly teens, who may simply be “confused” about what gender they are or should be. These people are simply too young for me to see.  I am glad that they are recognized, though, because we do know that the prognosis for people who have gender disorders is very much improved when the problems are identified early and steps taken to both identify and fix them. There are many medical professionals who suggest that using drugs to delay puberty may help.

GID is recognized as a psychiatric disorder, and describes fairly well the patient who believes that he or she has been born the wrong sex.

As far as I am concerned, this is simply a “disagreement” between someone’s physical and psychological sex.  Several medical causes have been documented.  I feel very strongly that the others are simply the result of a medical cause that we do not yet understand yet.  The treatment is hormones.

There is little enough research done that it is necessary to find a doctor who has a great deal of experience, can rule out the dangers, and can handle (or refer) the immense psychosocial changes in life that accompany this.

Once the process, or at least the majority of the process, has been completed, patients generally tell me they have never felt so “right” in their lives.

I always recommend folks at least check out the World Professional Association for Transgender Health (formerly the Harry Benjamin Society, named after the physician who pioneered the treatment of this sort of thing).

There are only a few transgendered or transgendering folks that come to social affairs like the one I described earlier. These folks come mostly for the camaraderie.  Most of them are:

Transvestites:  These are generally people who enjoy dressing up like a member of the opposite sex.  I have seen incredibly glamorous men dressed as women, who put on incredibly glamorous shows for a variety of charitable purposes.  Some of them have told me privately that although they absolutely love the attention that they get, and may even be compelled to dress this way at regular intervals, they have understanding wives and even families at home.  Yes, most of them are heterosexuals. The men say that they “love” women, and that women’s clothes are a way of getting close to women.  Somewhat fewer women than men are transvestites, but they also tend to be heterosexual and are often involved in a “straight” relationship which may include having children.

Homovestites:  Somewhat more rare, but I have seen a few of these at the above affairs.  They are usually there for charitable purposes, or because they have someone in the family who is part of these identities or causes, but at least one has admitted to me that she loves dressing up in a way too glamorous for her to appear on a public street.  There are simply too few places where she can do this in current society.  The ermine boa, she told me specifically, was not something she would wear elsewhere.

Biology seems to determine more of ourselves than we want to believe – Nature more than Nurture.  I thought I had worked enough on my brain that my emotions would not be entirely a function of my endocrine secretion.  Unfortunately, they are, at least a lot.

My husband – not a professional practitioner, but a highly adept student of medicine due to our nearly 20 years of marriage – (and far more so than anyone I ever tried to teach in medical school) has learned this part all too well.  He knows how and when to remind me.