Diagnosis Gender Identity Dysphoria
“A Medical Condition
That Trouble and Confuse So Many Lives”
Sonja Christine West
Garner, North Carolina 27529 USA
Photographed: Sunday, February 06, 2005
Compiled by: Sonja Christine West
Diagnosis Gender Identity Dysphoria
“A Medical Condition
That Trouble and Confuse Many Lives”
This is the booklet of a pre operative trans woman living in the United States.
This booklet contains helpful information pertaining to understanding
transsexualism for families, friends, coworkers, helping professionals, and a
variety of community resources.
The main purpose of this booklet is to provide practical information about
transsexualism for laypeople, but it is also intended as a resource for
physicians, and therapists.
The booklet's primary goals are to
* Provide information to help friends, family, and helping professionals
understand the transsexual experience and related personal and therapeutic
* Provide guidance to help family members and friends cope during the difficult
* Separate fact from fiction regarding transsexualism
Compiled by: Sonja Christine West
Updated: Saturday, March 26, 2005
All about Sonja ―Who I Am‖
My name is Sonja Christine West a pre operative Trans woman living in the Triangle
Area, North Carolina. I have a diploma from Watauga High School in Boone, North
Carolina with some college. I have been in full time transition since 2001.
I am well versed in transgenderism and transsexualism as a transsexual individual
and have been diagnosed three times by the medical and mental health profession
with a medical condition called, ―Gender Identity Dysphoria‖ that is a life threatening
The journey from one sex to the other has been long and treacherous, dealing with
discrimination, emotions, issues, violence, ridicule, rejection, and alienation from
employers, and society in general.
Along with having to, confront and deal with fear, emotions and issues, depression,
hopelessness, anxiety, and attempting suicide that have become an integral part of
my Gender Identity Dysphoria.
When it comes to my family and friends they accept me for who I am, especially my
father, who has been there when I needed him the most. It has taken me five (5) years
to realize that I still have the love of my family and friends which has been the biggest
fear of all for.
Fear is the emotion that I and others like myself struggle with the most that have
affected every area of our true existence and can be so all-consuming. The following
are some of our common fears:
Fear of challenging the status quo and losing family, friends, and everything I
Fear of losing my livelihood and becoming indigent
Fear of the unknown and what will become of me: Will I function well or ―crack
up‖ under the stress?
Fear that I will never ―pass‖ that people will always be able to tell that I am
Fear of societal intolerance, persecution, and discrimination
Fear of being ridiculed, rejected, beaten up, or even killed
Fear of never having anyone love me again or never being in an intimate
relationship, of being alone for the rest of my life.
At times my Gender Identity Dysphoria dominates my life at to such an overwhelming
extent that daily functioning becomes difficult, if not impossible.
In my earlier years as young as age five years old, I had strong feelings about my
gender of wanting to be a woman.
I started out wearing tights and leotards, and then as I got older I moved up to wigs,
makeup, dresses, skirts, bras, panties, nylons, pantyhose and other women‘s apparel.
As years past it was the same old thing day in and day out wanting to be a woman. I
tried to suppress my feelings and each time they would come back stronger. Also like
many I have often tried to reject my true self, by trying to mould into conforming male
gender orientated schemes.
From the beginning of my life at birth until now I find that weather I have been through
one sex to the other I have had the same amount of problems, except one thing! In
changing genders from one to another discrimination, emotions, issues, violence,
ridicule, rejection, and alienation from friends, employers, and society in general has
been the biggest factor in my life to deal with today.
Over the years I sought help for my Gender Identity Dysphoria problem in the town
where I lived and got no where or no answers. As time past I realized I wasn't getting
any younger and thought I would call the NC Medical Association and asked if they
could give me information of the nearest Transgender Therapist to my home town.
I was lucky, they had a listing about 50 miles from home and I call to setup an
appointment. Through my counseling I have decided to come out "proper" and accept
who I am and what I am.
I am simply Sonja, no different from any other person except I am a MtoF transsexual.
Plus, self acceptance is the path to true happiness for all people of all walks of life.
Reference to Learning Gender Identity Dysphoria:
Transsexual's Survival Guide II - To Transition & Beyond:
Family, Friends and Employers.
Thursday, November 18, 2004
Gender Identity Dysphoria is the most difficult medical disorder for many people to
understand, especially if it happens to be a loved one within the boundaries of the
immediate family and society in general.
They suppress there feelings in trying to understand and pass judgments, criticize,
evade or punishing the transsexual individual for being true to themselves. Denying
transsexuals the rights to exist within society for a normal life.
But like many transsexuals they hide in fear staying off to them selves and only come
out when they feel the time is right and safe. Fear of discrimination, emotions, issues,
violence, ridicule, rejection, and alienation. Transsexual individuals are misunderstood
and taken for granted in not understanding there fears and pain.
Like many transsexuals they find them selves not knowing which way to turn for
answers or help. A state of confusion, depression, hopelessness, anxiety, and
attempting suicide takes place. Fighting to hold on, until the transsexual has no more
strength to live and wants to die.
Saturday, November 20, 2004
Going through crises for a transsexual individual is frightening when dealing with
issues caused by there Gender Identity Dysphoria. But also being sent to the wrong
mental facility is just as worse, especially when the facility is not setup for male to
female or female to male transsexuals in the earlier or late stages of there transition.
Mental Health Emergency Agencies and Hospitals should be aware and concern of
the transsexual patients mental heath and successful recovery before admitting them
to a mental or medical facility. State Hospitals for instances, they are ―NOT‖ geared for
a transsexuals situation especially in the beginning stages of transition, and Private
Hospitals are better because they are more geared to the transsexuals situation.
The reasons for putting a transsexual in a private hospital are as follows:
State hospital facilities ―DON‘T‖ have wards for male and female grouped
together and private hospitals do. State hospitals have individual wards for
male and female that divided the male and females from each other.
Transsexuals in early and late stages of transitioning mental health need to be
considered very carefully before attempting sending them to a state hospital of
The environment in a state hospital cause confusion, fear, emotions and
issues, depression, hopelessness, anxiety, and attempting suicide increase
within side a transsexual patient if put in a state hospital of any kind.
The societal intolerance, persecution, and discrimination also come into play
with a lot of caregivers towards the transsexual individual and denying there
rights as a patient. But this goes for state and private hospitals as well, can‘t
wait to release you because they don‘t know how to treat a transsexual
individual and freak out because of never seen a transsexual before.
… And lastly there dignity, gender and rights are denied the transsexual patient
interfering with there true existence within a state hospital. In some private
hospitals there are in some instances there are a few medical and mental
health staff respond the same way in these matters.
Physicians, therapists, mental health workers, case managers, and social
workers need to have an open mind and a clear understanding in regards to the
transsexual patient’s mental and medical condition if help is to be given
especially when a mental hospital is going to be involved.
To be able to give treatment to a transsexual individual one must fully understand
them and what they are having to deal with and there actions and negative responses
to there ―Gender Identity Dysphoria.‖
Tuesday, December 07, 2004
To finalize this section I have lived it, did it, and have done it within the world as a
transsexual. Facing treacherous odds in a world that others don‘t want to understand
and displayed to the public like a freak in a painting, mocking and laughing not caring
who they hurt because of who we are.
As a transsexual I live in constant pain and suffering were discrimination dictates a
transsexuals destiny to weather they live or die. Unable to allow transsexuals with the
same privileges, rights and happiness that‘s given those in society that one would
consider or call normal.
Transsexualism is real and Gender Identity Dysphoria is real. A medical condition that
and individual is born with at birth. An individual that can‘t help or change what God
has made them to be. But society goes on with there deceit, lies, discrimination,
violence, ridicule, rejection, and alienation toward the transsexual refusing them a life
Wednesday, June 30, 2004
"The journey that transsexuals make from one sex to the other can be long and
treacherous. They must listen to the inner voice of their true selves and re-create
themselves as they emerge a new, integrating all that they value from their old selves.
And because of what they must go through--things that most of us will never have to
face ourselves--transsexuals have a truly unique perspective. They've seen life from
WHY Families, friends, coworkers, helping professionals ask, why one would want to
change genders? A life someone who is constantly struggling and facing challenges
(and probably will continue to do so throughout life). Plus, there are few welcome
places for transsexuals in this world.
The ―ANSWER‖, Gender Identity Dysphoria. Gender Identity Dysphoria is one of the
most devastating birth disorders that someone can have. It is a hidden birth disorder
that is not known for many years. The latest studies indicate that a person is born with
gender Dysphoria. All fetuses start out as female. Those fetuses that are to be male
receive a testosterone flush across their brain. This produces what is called the brain's
hardwiring, or subconscious mind. When this does not happen the brain develops with
a female subconscious mind and the body develops male. Years later the conflict
arises when the brain and body do not agree. Gender Dysphoria does not go away. It
can be buried and suppressed but it always rears its ugly head. Each time this
happens it gets harder and harder to bury, finally one day it can no longer be buried. I
have often wondered how many suicides that have no known reason were because of
The American Psychiatric Association has listed gender Identity Dysphoria in
DSM-IV. The diagnostic features for Gender Identity Disorder as outlined in DSM-IV
are shown below.
"There are two components of Gender Identity Disorder, both of which must be
present to make the diagnosis. There must be evidence of a strong and persistent
cross-gender identification, which is the desire to be, or the insistence that one is of
the other sex (Criterion A)."
"This cross-gender identification must not merely be a desire for any perceived
cultural advantages of being the other sex. There must also be evidence of persistent
discomfort about one's assigned sex or sense of inappropriateness in the gender role
of that sex (Criterion B)."
"The diagnosis is not made if the individual has a concurrent physical intersexed
condition (e.g., androgen insensitivity, syndrome or congenital adrenal hyperplasia)
"To make the diagnosis, there must be evidence of clinically significant distress or
impairment in social, occupational, other important areas of functioning (Criterion D)"
"Adults with Gender Identity Disorder are preoccupied with their wish to live as a
member of the other sex. This preoccupation may be manifested as an intense desire
to adopt the social role of the other sex or to acquire the physical appearance of the
other sex through hormonal or surgical manipulation."
Adults with this disorder are uncomfortable being regarded by others as, or functioning
in society as, a member of their designated sex. In private, they may spend much time
cross-dressed and working on the appearance of being the other sex. With cross-
dressing, hormones and electrolysis many individuals with this disorder pass
convincingly as the other sex.
"There is no diagnostic test specified for Gender Identity Disorder. In the presence of
a normal physical examination, karyotyping for sex chromosomes and sex hormone
assays are usually not indicated. Psychological testing may reveal cross-gender
identification or behavior patterns".
"There is no recent epidemiological study to provide data on prevalence of Gender
Identity Disorder. Data from smaller countries in Europe with access to total population
statistics and referrals suggest that roughly one per 30,000 adult males and one per
100,000 adult females seek sex-reassignment surgery".
There has been a lot of conversation on the various gender bulletin boards concerning
the Harry Benjamin International Gender Dysphoria Association Standards of Care.
There are those who feel surgery on demand is their right. Some feel that the
Standards of Care are too demanding and are unnecessary. The majority of those
who have gone through transition and had sex reassignment surgery and the majority
of those in transition feel that the Standards of Care are there to protect the patient.
There are documented cases where individuals have lied and gone to surgeons who
do not follow the Standards of Care and received their surgery only to regret their
decision at a later time.
The pertinent parts of The Harry Benjamin International Gender Dysphoria Association
Standards of Care are given for your information. The hormonal and surgical sex
reassignment of gender dysphoric persons (Revised Draft 1/90) contains a series of
principles and standards to be followed by the psychiatrists, clinical behavioral
scientists and surgeons who are involved in reputable gender clinics.
The basic minimal requirements for sex reassignment surgery as outlined by the Harry
Benjamin International Gender Dysphoria Association Standards of Care (Revised
Draft 1/90) are discussed in the following paragraphs.
In order to be considered for sex reassignment surgery the individual must have been
on hormone replacement therapy for a minimum of one year. The individual must have
successfully completed one year of living full-time in his or her chosen gender. They
must prove their ability to earn a living in their new gender.
The individual must have two recommendations for sex reassignment surgery. One
recommendation must come from a psychiatrist and the other from a psychologist who
has a background in gender Dysphoria or from a licensed social worker who has a
Master Degree and is known for his or her work in gender Dysphoria counseling. The
second recommendation can also come from a second psychiatrist. The final
requirement is that the patient be HIV negative. The HIV test is done upon admission
to the hospital, and surgery will be done only if the initial test is negative.
There are several reputable surgeons all over the world who perform sex
reassignment surgery and follow the standards of care of the Harry Benjamin
International Gender Dysphoria Association. A partial list of these surgeons includes
the following: Dr. Eugene A. Schrang, Neenah, Wisconsin, Dr. Toby Meltzer, Portland,
Oregon, Dr. Stanley Biber, Trinidad, Colorado, Dr. Royal, London, England, and Dr.
Yves Mennard, Montreal, Canada.
One of the former requirements for sex reassignment surgery has been dropped. It is
no longer necessary for the individual to be divorced. More and more couples are
staying together through transition and after sex reassignment surgery has been
Also noted on the various internet genders related bulletin boards and on the internet
relay chat is that, as a general rule, sexual preference does not change through
transition and after sex reassignment surgery.
Those individuals that were attracted to females usually end up in lesbian
relationships and those individuals that were attracted to males prior to transition and
sex reassignment surgery normally stay attracted to males and
End up in what would be considered a heterosexual relationship after surgery. The
reason for this is not known other than sexual preference is a trait that you grow up
with and is somehow wired into the subconscious mind. It should also be noted that
many of the ladies experiment with male and female sexual partners after surgery and
generally return to their pretransition sexual preference.
Volume 1, Number 1, July - September 1997
Reprinted with permission by the authors from NATURE, 378: 68-70 (1995)
A Sex Difference in the Human Brain and its Relation to Transsexuality
By J.-N. Zhou, M.A. Hofman, L.J. Gooren and D.F. Swaab
Citation: Zhou J.-N, Hofman M.A, Gooren L.J, Swaab D.F (1997) A Sex Difference in the Human Brain and its
Relation to Transsexuality. IJT 1,1, http://www.symposion.com/ijt/ijtc0106.htm
Transsexuals have the strong feeling, often from childhood onwards, of having been born the
wrong sex. The possible psychogenic or biological etiology of transsexuality has been the
subject of debate for many years [1,2]. Here we show that the volume of the central
subdivision of the bed nucleus of the stria terminalis (BSTc), a brain area that is essential for
sexual behaviour [3,4], is larger in men than in women. A female-sized BSTc was found in
male-to-female transsexuals. The size of the BSTc was not influenced by sex hormones in
adulthood and was independent of sexual orientation. Our study is the first to show a female
brain structure in genetically male transsexuals and supports the hypothesis that gender identity
develops as a result of an interaction between the developing brain and sex hormones [5,6].
Investigation of genetics, gonads, genitalia or hormone level of transsexuals has not, so far,
produced any results that explain their status [1,2]. In experimental animals, however, the same
gonadal hormones that prenatally determine the morphology of the genitalia also influence the
morphology and function of the brain in experimental animals in a sexually dimorphic fashion
[6,7]. This led to the hypothesis that sexual differentiation of the brain in transsexuals might
not have followed the line of sexual differentiation of the body as a whole. In the past few
years, several anatomical differences in relation to sex and sexual orientation have been
observed in the human hypothalamus (see  for a review), but so far no neuroanatomical
investigations have been made in relation to the expression of cross-gender identity
Figure 1: Schematic frontal section through two subdivisions of the bed nucleus of the stria terminalis (BST) that
are hatched. III: third ventricle; AC: anterior commissure; BSTc and BSTv: central and ventral subdivisions of
the BST; FX: fornix; IC: internal capsule; LV: lateral ventricle; NBM: nucleus basalis of Meynert; OT: optic
tract; PVN: paraventricular nucleus; SDN: sexually dimorphic nucleus; SON: supraoptic nucleus.
We have studied the hypothalamus of six male-to-female transsexuals (T1-T6); this material
that was collected over the last eleven years. We searched for a brain structure that was
sexually dimorphic, but not influenced by sexual orientation, as male-to-female transsexuals
may be "oriented" to either sex with respect to sexual behaviour. Our earlier observations
showed that the paraventricular nucleus (PVN), sexually dimorphic nucleus (SDN) and
suprachiasmatic nucleus (SCN) did not meet these criteria ( and unpublished data).
Although there is no accepted animal model for gender identity alterations, the bed nucleus of
the stria terminalis (BST) turned out to be an appropriate candidate to study for the following
reasons. First, it is known that the BST plays an essential part in rodent sexual behaviour [3,4].
Not only have oestrogen and androgen receptors been found in the BST [8,9], it is also a
major aromatization centre in the developing rat brain . The BST in the rat receives
projections mainly from the amygdala and provides a strong input in the preoptic-
hypothalamic region [11,12]. Reciprocal connections between hypothalamus, BST and
amygdala are also well documented in experimental animals [13-15].
In addition, sex differences in the size and cell number of the BST have been described in
rodents which are influenced by gonadal steroids in development [16-18]. Also in humans a
particular caudal part of the BST (BNST-dspm) has been reported to be 2.5 times larger in
men than in women .
The localization of the BST is shown in figure 1. The central part of the BST (BSTc) is
characterized by its somatostatin cells and vasoactive intestinal polypeptide (VIP) innervation
. We measured the volume of the BSTc on the basis of its VIP innervation (Fig. 2).
Figure 2: Representative sections of the BSTc innervated by vasoactive intestinal polypeptide (VIP). A:
heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female transsexual. Bar=0.5 mm.
LV: lateral ventricle. Note there are two parts of the BST in A and B: small sized medial subdivision (BSTm), and
large oval-sized central subdivision (BSTc).
The BSTc volume in heterosexual men (2.49±0.16 mm3) was 44% larger than in heterosexual
women (1.73±0.13 mm3) (P<0.005) (Fig. 3). The volume of the BSTc of heterosexual and
homosexual men was found not to differ in any statistically significant way (2.81±0.20 mm3)
(P=0.26). The BSTc was 62% larger in homosexual men than in heterosexual women
(P<0.005). AIDS did not seem to influence the size of the BSTc: the BSTc size of two
heterosexual AIDS-infected women and three heterosexual AIDS-infected men remained well
within the range of the corresponding reference group (Fig. 3). The AIDS-infected
heterosexuals were therefore included in the corresponding reference group for statistical
purposes. A small volume of the BSTc (1.30±0.23 mm3) was found in the male-to-female
transsexuals (Fig. 3). Its size was only 52% of that found in the reference males (P<0.005) and
46% of the BSTc of homosexual males (P<0.005). Although the mean BSTc volume in the
transsexuals was even smaller than that in the female group, the difference did not reach
statistical significance (P=0.13). The volume of the BSTc was not related to age in any of the
reference groups studied (P>0.15), indicating that the observed small size of the BSTc in
transsexuals was not due to the fact that they were, on average, 10 to 13 years older than the
hetero- and homosexual men.
The BST plays an essential role in masculine sexual behaviour and in the regulation of
gonadotrophin release, as shown by studies in the rat [3,4,21]. There has been no direct
evidence that the BST has such a role in human sexual behaviour but our demonstration of a
sexually dimorphic pattern in the size of the human BSTc, which is in agreement with the
previously described sex difference in a more caudal part of the BST (BNST-dspm) ,
indicates that this nucleus may also be involved in human sexual or reproductive functions. It
has been proposed that neurochemical sex differences in the rat BST may be due to effects of
sex hormones on the brain during development and in adulthood [22,23]. Our data from
humans however, indicate that BSTc volume is not affected by varying sex hormone levels in
adulthood. The BSTc volume of a 46-year-old woman who had suffered for at least 1 year
from a tumour of the adrenal cortex that produced very high blood levels of androstenedione
and testosterone, was within the range of that of other women (Fig. 3: S1). Furthermore, two
postmenopausal women (aged over 70 years) showed a completely normal female-sized BSTc
(Fig. 3: M1, M2). As all the transsexuals had been treated with oestrogens, the reduced size of
the BSTc could possibly have been due to the presence of high levels of oestrogen in the
blood. Evidence against this comes from the fact that transsexual T2 and T3 both showed a
small, female-like BSTc (Fig. 3), although T2 stopped taking oestrogen about 15 months
before death, since her prolactin levels were too high and T3 stopped hormone treatment since
a sarcoma was found about three months before death; also a 31-year-old man who suffered
from a feminizing adrenal tumour which induced high blood levels of oestrogen, nevertheless
had a very large BSTc (Fig. 3: S2).
Figure 3: Volume of the BSTc innervated by VIP fibres in presumed heterosexual males (M), homosexual males
(HM), presumed heterosexual females (F) and male-to-female transsexuals (TM). The six transsexuals are
numbered T1-T6. The patients with abnormal sex hormone levels are numbered S1-S4. M1 and M2:
postmenopausal women. Bars indicate mean±SEM. Open symbols: individuals who died of AIDS. METHODS.
Brains of 42 subjects matched for age, postmortem time and duration of formalin fixation were investigated. The
autopsy was performed following the required permission. For immunocytochemical staining of VIP, the paraffin
sections were hydrated and rinsed in TBS (Tris-buffered-saline: 0.05 M tris, 0.9% NaCl, pH 7.6). The sections
were incubated with 200 µl anti-VIP (Viper, 18/9/86) 1:1000 in 0.5% triton in TBS overnight at 4° C. The
immunocytochemical and morphometric procedures were performed as described extensively elsewhere [25-27].
In brief, serial 6 m m sections of the BSTc were studied by means of a digitizer (Calcomp 2000) connected to a
HP-UX 9.0, using a Zeiss microscope equipped with a 2.5x objective and with 10x (PLAN) oculars. Staining was
performed on every 50th section with anti-VIP. The rostral and caudal borders of the BSTc were assessed by
staining every 10th section in the area. The volume of the BSTc was determined by integrating all the area
measurements of the BSTc sections that were innervated by VIP fibres. In a pilot study, the size of the BSTc was
measured on both sides in eight subjects (five females and three males) and no left-right asymmetries were
observed: the left BSTc (1.71±0.16 mm3) was comparable in size to that of the right BSTc (1.83±0.30 mm3)
(P=0.79). No asymmetry was observed in the BNST-dspm either . The rest of our study was therefore
performed on one side of the brain only. Brain weight of the male transsexuals (1385±75 g) was not different
from that of the reference males (1453±25 g) (P=0.61) or that of the females (1256±35 g) (P=0.23). The cause of
death of the six transsexuals was suicide (T1), cardiovascular disease (T2,T6), sarcoma (T3), AIDS, pneumonia,
pericarditis (T4) and hepatitic failure (T5). Sexual orientation of the subjects of the reference group (12 men and
11 women) was generally not known, but presumably most of them were heterosexual. Sexual orientation of nine
homosexuals was registered in the clinical records . Differences among the groups were tested two-tailed
using the Mann-Whitney U test. A 5% level of significance was used in all statistical tests.
Our results might also be explained if the female-sized BSTc in the transsexual group was due
to the lack of androgens, because they had all been orchidectomized except for T4. We
therefore studied two other men who had been orchidectomized because of cancer of the
prostate (one and three months before death: S4 and S3, respectively), and found that their
BSTc sizes were at the high end of the normal male range. The BSTc size of the single
transsexual who had not been orchidectomized (T4) ranged in the middle of the transsexual
scores (Fig. 3). Not only were five of the transsexuals orchidectomized, they all used the
antiandrogen cyproterone acetate (CPA). A CPA effect on the BSTc does not seem likely,
because T6 had not taken CPA for the past 10 years, and T3 took no CPA during the two years
before death and still had a female-sized BSTc.
In summary, our observations suggest that the small size of the BSTc in male-to-female
transsexuals cannot be explained by differences in adult sex hormone levels, but is established
during development by an organizing action of sex hormones, an idea supported by the fact
that neonatal gonadectomy of male rats and androgenization of the female rats indeed induced
significant changes in the number of neurons of the BST and suppressed its sexual
Considered together with information from animals, then our study supports the hypothesis
that gender identity alterations may develop as a result of an altered interaction between the
development of the brain and sex hormones [5,6]. The direct action of genetic factors should
also be considered on the basis of animal experiments .
We found no relationship between BSTc size and the sexual orientation of transsexuals, that
is, whether they were male-oriented (T1,T6), female-oriented (T3,T2,T5), or both (T4).
Furthermore, the size of the BSTc of heterosexual men and homosexual men did not differ,
which reinforced the idea that the reduced BSTc size is independent of sexual orientation. In
addition, there was no difference in BSTc size between early-onset (T2,T5,T6) and late-onset
transsexuals (T1, T3), indicating that the decreased size is related to the gender identity
alteration per se rather than to the age at which it becomes apparent. Interestingly, the very
small BSTc in transsexuals appears to be a very local brain difference. We failed to observe
similar changes in three other hypothalamic nuclei, namely, PVN, SDN or SCN in the same
individuals (unpublished data). This might be due to the fact that these nuclei do not all
develop at the same time, or to a difference between these nuclei and the BST with respect to
the presence of sex hormone receptors or aromatase. We are now studying the distribution of
sex hormone receptors and the aromatase activity in various hypothalamic nuclei in relation to
sexual orientation and gender.
We thank Mr. B. Fisser, Mr. H. Stoffels, Mr. G. van der Meulen, and Ms. T. Eikelboom and
Ms. W.T.P. Verweij for their help, and Drs. R.M. Buijs, M.A. Corner, E. Fliers, A. Walter and
F.W. van Leeuwen for their comments. Brain material was provided by the Netherlands Brain
Bank (coordinator Dr. R. Ravid). This study was supported by NWO.
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Del Abril, A., Segovia, S. and Guillamón, A., Dev. Brain Res., 32 (1987) 295-300.
Guillamón, A., Segovia, S. and Del Abril, A., Dev. Brain Res., 44 (1988) 281-290.
Allen, L.A. and Gorski, R.A., J. Comp. Neurol., 302 (1990) 697-706.
Walter, A., Mai, J.K., Lanta, L. and Görcs, T.J., Chem. Neuroanat., 4 (1991) 281-298.
Claro, F., Segovia, S., Guilamón, A. and Del Abril, A., Brain Res. Bull., 36 (1995) 1-10.
Simerly, R.B. and Swanson, L.W., Proc. Natl. Acad. Sci. U.S.A., 84 (1987) 2087- 2091.
De Vries, G.J., J. Neuroendocrinol., 20 (1990) 1-13.
Pilgrim, Ch. and Reisert, I., Horm. metab. Res., 24 (1992) 353-359.
Swaab, D.F., Zhou, J.N., Ehlhart, T. and Hofman, M.A., Brain Res., 79 (1994) 249- 259.
Zhou, J.N., Hofman, M.A. and Swaab, D.F., Neurobiol. Aging (1995) in press.
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Swaab D.F. and Hofman M.A., Brain Res., 537 (1990) 141-148.
Correspondence and requests for materials to:
J.-N. Zhou, M.A. Hofman and D.F. Swaab
Graduate School Neurosciences Amsterdam
Netherlands Institute for Brain Research
1105 AZ Amsterdam ZO
Department of Endocrinology
Free University Hospital
1007 MB Amsterdam
Friday, July 02, 2004
For a transsexual with Gender Identity Dysphoria, one should not be so down, or so
hard on them. They have enough to go through as it is. Society already has them
―marked and labeled‖ for being ―weird and not normal‖. Who is to say ―what is normal,
and what is not‖. If you would really think about it we are all different in someway or
another. That is what makes us what we are. We can‘t ask to change something that
is in our jeans anymore then we can change each other.
We all have to be true to our selves and who we are. Trying to change one another to
conform to which you want them to be, has devastating consequences. One for
example is depression, suicide and confusion, and making it worse for the
A transsexual goes through a lot of changes that some don‘t understand. Changes like
hormones that some would say that is there main problem when taking them and that
is what is causing there problem. Usually it is not the case of the problem. They are
going through the changes that they have to do in order to be there true self. We
should open up and talk to them and ask questions instead of running away.
Understand who they are instead of what they are.
We have no right to judge our fellow man and woman. We are born who we are, and
none of us can change it. They have a medical condition and have to do what needs
to be done to survive. Try to support the transsexual, and don‘t bring him/her down,
you only make it worse for them. How does one support a transsexual and what not to
do or to do?
The following information on the next following pages can explain how:
Some Do’s and Don’ts
For Friends and Family of GLBT People
Do listen to what your loved one‘s life
Don‘t blame your own feelings on
is like, and what kind of experiences
your loved one.
he or she has had in the world.
Do take the time to seek information
about the lives of GLBT people from Don‘t rush the process of trying to
parents of GLBT people, friends of understand your loved one‘s
your loved one, literature, and most sexuality or gender identity.
of all, directly from your loved one.
Do get professional help for anyone
in the family, including yourself, who
Don‘t assume that your loved one
becomes severely depressed over
should see a professional counselor.
your loved one‘s sexuality or gender
Do accept that you are responsible Don‘t criticize your loved one for
for your negative reactions. being different.
Do help your child (or loved one) set Don‘t expect your child (or loved one)
individual goals, even though these to make up for your own failures in
may differ drastically from your own. life.
Do try to develop trust and openness Don‘t try to force your loved one to
by allowing your loved one to choose conform to your ideas of proper
his or her own lifestyle. sexual behavior.
Do be proud of your loved one‘s Don‘t blame yourself because your
capacity for having loving loved one is gay, lesbian, bisexual or
Do look for the injured feelings Don‘t demand that your child (or
underneath the anger and respond to loved one) live up to what your idea
them. of what a man or woman should be.
Do defend him or her against Don‘t discriminate against your loved
Do respect your loved one‘s right to
find out how to choose the right Don‘t try to break up loving
person to love and how to make relationships.
Don‘t insist that your morality is the
Do say, "I love you."
only right one.
True Selves - Understanding Transsexualism
Dr. Mildred Brown
for a Gender Therapist in your area > GenderTherapist@FemImage.com
Author of "True Selves": Understanding Transsexualism - For
Families, Friends, Coworkers, and Helping Professionals
Available at amazon.com: Price here is $20.00 New
what is it like to grow up in the wrong body? Are transsexuals considered
homosexuals? Filled with real-life stories, actual letters, and touching poems, True
Selves paints a heartfelt portrait of the risk-taking, confusion, and--ultimately--the
courage that transsexuals face as they struggle to reveal their true being to
themselves and to others.
Transsexuals struggle to reconcile physical body with self-identity
By Dale Bryant
The first time Los Gatos therapist Mildred Brown came face to face with a transsexual,
she was flustered, embarrassed and, frankly, speechless. That was 18 years ago,
when a man she had gotten to know at a week-long conference on sexology showed
up on the last morning as a woman. "Millie, don't you know me? I'm Nick," he told her.
At the time, she was completing her doctoral degree and clinical training in sexology.
The experience taught her that her textbook knowledge of gender identity problems
hadn't prepared her for the shock of realizing someone she actually knew was a
That experience not only led to her therapy practice with gender-conflicted people, but
also gave her insight about the feelings of those who learn that a coworker, friend or
relative is a transsexual. Those are the people she had in mind when she wrote (with
Chloe Rounsley, a Santa Clara Valley journalist who now lives in San Francisco) True
Selves (Jossey-Bass Publishers, San Francisco, 1996). Brown is the only South Bay
therapist south of Palo Alto who specializes in working with transsexuals.
She wrote the book to help educate people like the ex-wife of one of her clients who
wrote to her former spouse, "You are an immoral freak who will inherit misery as a
companion. I will never forgive you and will pray that your insanity has not invaded
further on our family's gene line. You will grow old without anyone who cares if you
live or die."
Friends and loved ones often believe that transsexualism is something that the person
will get over; they worry that the decision to live as a member of the other sex is
impulsive, Brown explains. "I wrote the book to document the pain of my clients. I
wanted people to know that a person doesn't become a transsexual on a whim."
In the book, Brown relies in large part on information provided by her clients about
their personal journeys. She also includes some facts, figures, history and theories,
* Transsexuals are people whose inner self-identification does not match their physical
body. Many people mistakenly believe transsexuals are gay, but transsexualism is not
about sexual orientation; it's about gender identity.
* It's not known how many transsexuals there are in this country. By 1988, 6,000 to
10,000 transsexuals had undergone sex reassignment surgery; there are, however,
many transsexuals who do not go through the surgery.
* Transsexuals usually know in childhood that something is terribly wrong with them.
By puberty, many know that who they are inside does not match who they are
* Most Americans first heard of transsexualism in 1952, when an American soldier
named George Jorgensen traveled to Denmark for a sex-change operation. After the
surgery, Jorgensen took the name Christine. The pro tennis player Renee Richards is
a male-to-female transsexual.
* No one knows what causes gender Dysphoria; there are both nature and nurture
schools of thought. One theory points to a prenatal neurohormonal explanation: Since
the genitalia of the human embryo begin to develop in the 12th week, while that
portion of the brain that deals with gender identity doesn't begin to develop until the
16th week, some researchers believe a hormonal imbalance during that critical four-
week period may set the stage for gender Dysphoria.
* Estimates of attempted suicide by transsexuals range from 17 percent to 20
* Some transsexuals cross-dress and live in the world as the gender that matches
their inner identity. For most, however, that is not enough, and they turn to hormone
treatment and/or sex reassignment surgery.
Brown's decision to work with gender-conflicted people came shortly after her
awkward moment with Nick 18 years ago. "He offered to take me to the only support
group at that time in the Bay Area for people who were gender-conflicted," Brown
"At that meeting," she writes in the preface to her book, "I saw a level of emotional
pain that was greater than I had previously imagined possible." When she learned that
the people in the group had no professionals to go to for help, she vowed that night to
dedicate herself to working with gender-conflicted people.
To celebrate the publication of the book and her 18 years in the field, some 250
friends, many of them clients, gathered recently for a party at the Billy DeFrank
Lesbian and Gay Community Center in San Jose. Brown was particularly moved by a
woman who told the group she had been standing on a bridge ready to jump before
she found Brown. "She asked how many people in the room believed their lives had
been saved because they met me," Brown says. "Forty or 50 hands went up, and the
whole room burst out in tears."
The pain Brown documents in True Selves includes the recalled childhood
experiences of clients who spent their early years trying to hide their natural
inclinations. Many transgendered boys, for instance, must suppress their desire to
dress like a girl or to play with girls, to avoid the company and games of boys. Often,
their parents pressure them to do what feels at odds with their inner image. Since
transgendered children have a hard time fitting in, they often become isolated; many
are loners and suffer from depression.
The teen years are even more traumatic, as puberty forces on them the realization
they are not ever going to develop the bodies they feel they should. "Some children
believe that when they reach puberty, they will finally develop the right body," Brown
explains. Male-to-female transsexuals are often the targets of bullies. The expectation
that they will begin dating presents a whole new set of problems.
Brown's clients are usually in their 30s, although she's currently working with two 17-
year-olds. "I was a little uncomfortable about that," she says. "But so many of my
clients swear they've known from the time they were very young. The mother of one of
these clients told me that she knew when her son was 3 that he should have been a
Brown has even had clients in their 60s. "They're willing to go through all this just so
they won't be buried in the wrong body," Brown says.
When she says "all this," she is referring to the roller-coaster ride of emotional,
physical, social and financial problems that most transsexuals experience.
"What they sacrifice to live in the body they know is right is unbelievable. Many are
reduced to poverty; they are shunned by family and friends; many are forced out of
jobs either by their employer or by the actions of their coworkers," says Brown. "Still,
these people don't have much choice. For most of them, it's either do this or become
alcoholics or drug addicts or spend their entire lives in depression to the point of
Although surgery to physically change a man to a woman or a woman to a man now
exists and is commonly practiced in many hospitals, some transsexuals opt not to
have surgery--often the decision is simply financial, as insurance does not cover sex
Most transsexuals do eventually take hormones that help their bodies develop in a
way that is more closely aligned with their self-image. Early in the transition process,
males transitioning to female usually undergo electrolysis, a painful procedure for
permanent hair removal. Brown says to remove the approximately 30,000 hairs on
their faces, transsexuals undergo 300 to 500 hours of treatment at a cost of $40 to
$65 per treatment. "It can cost as much or more than sex reassignment therapy,"
Although transsexuals are gradually transitioning into the sex they believe they need
to be, most have suppressed their natural tendency to behave in that role, and so they
look to their therapist for help.
"It's so complicated," Brown says. "I have to help them adjust to a whole new way of
living. Imagine going through puberty at the age of 40 or 50."
As transsexuals begin the transition, they must change every official paper
accumulated throughout their lives--from drivers‘ licenses and credit cards to military
service records and college transcripts. "It's actually the one area that has become
easier in recent years," Brown says. "The DMV, for instance, now has papers to fill out
for name change and preferred gender."
While some companies work with the transitioning employee to announce the situation
to coworkers and support the employee, the workplace often adds greatly to the
tension of transitioning, Brown says.
One example from her book tells of a male-to-female transsexual who, prior to
transitioning, was a corporate executive and chief design engineer for a major auto
manufacturer. After she came out as Rachel, according to Brown, a representative
from the company came to her house and demanded her corporate credit cards and
eliminated her job.
Rachel went for more than 200 interviews for jobs in the automotive industry but could
not find a position. She ended up taking menial jobs. Eventually, she lost her home
and her car and moved into a friend's garage.
Brown says the story is not unusual. "Transsexuals must be prepared to deal with this
kind of situation," she says, "even though protection is available through the legal
system in most states."
When Brown first meets with clients, she tries to paint for them a realistic picture of
what their future may hold. "I tell them they should expect to spend every penny they
have in the world to go through more loss than anyone can imagine."
Still, she says, the need to become the person they feel they are inside is powerful.
"No one has ever turned away because of the picture I paint of what will happen."
This article appeared in the Los Gatos Weekly-Times, December 18, 1996. ©1996
Metro Publishing, Inc. All rights reserved
Guidelines for Support,
"How You Can Help the Transsexual"
In times of personal crisis, we all look to important people in our lives for support.
During the emotional upheaval that can occur after coming out, transsexuals need
the help of family and friends.
They look to the people closest to them to understand the changes that are going on
and ultimately to accept and love the new emerging opposite-gender person. The
friendly acceptance of coworkers makes the transition smoother too.
It's not always easy, but friends, family members, and coworkers can make the
journey upon which the transsexual has embarked immeasurably more comfortable
with their empathy and support. If you can reach out to the transsexual in some of the
following ways, there is a good chance that you will maintain and strengthen an
* Recognize how important your love, acceptance, and support are to the
* Listen and be willing to hear what the transsexual has to say without judgment,
anger, argument, or confrontation.
* Learn more about the person's condition and struggles. Show that you care
enough to make an effort to read, ask questions, and educate yourself.
* Communicate. Don't shut the transsexual out or give him or her the silent
treatment. Keep the lines of communication open between the two of you, even if at
first your communication is about your fears and pain.
* Respect the person as a human being. Transsexuals don't want to be treated like
freaks or oddities. They are not sick or perverted. They have a medical condition.
Offer the same respect, courtesy, and compassion that you would like to have in
return if you were to announce that you have a medical condition that requires radical
Remember that being transsexual involves perpetual inner conflict and that you
are dealing with someone who is constantly struggling and facing challenges (and
probably will continue to do so throughout life). There are few welcome places for
transsexuals in this world. Try to create one for them with you.
Trust that what the transsexual is doing is right for that particular person and
that he or she has not made this decision frivolously but rather after years of
struggle and soul searching. Remain warm and affectionate even if you
experience discomfort with the situation at present.
* Admire the courage and determination of the transsexual to do what must be
done to survive, and let the person know this.
* Understand that the basic character, temperament, and personality of the
transsexual remain the same as before, with all admirable qualities intact.
* Empathize. Try to put yourself in the transsexual's shoes. Envision what it
would be like to have to go through the lifetime of emotional pain that the
transsexual has experienced. Consider how hard it would be to tell people, "I've
switched my gender, my name, everything. You've been an important part of my
life, and I'd like you to continue to be." If that were you, wouldn't you want them to
continue to care about you?
* Anticipate the pleasure of a more positive relationship. If the transsexual in
your life seemed troubled and unhappy in the past, with the source of the
happiness now finally known and addressed, you can look forward to a more
Finally, it is often in small but important kindness that your empathy and love
can be demonstrated. Wordsworth called them "the little unremembered acts of
kindness and love."
For example, you can invite your transsexual friend or loved one to your
home and include the person in your activities and celebrations. Give gender-
appropriate gifts and cards on the person's birthday and other special occasions.
Compliment the person's appearance or courage. Always treat the person as the
gender, with which he or she self-identifies, and use the preferred name and
gender-appropriate pronouns. If the transsexual is your own child, fill in the gaps
in his or her socialization--teach MTFs what you would have taught a daughter
and FTMs what you would have taught a son. Most important for everyone in the
transsexual's life, listen to the person's hopes and fears and maintain a warm,
loving, friendly attitude and manner. Your grateful transsexual relative or friend
will appreciate your sensitivity and support.
* TRUE SELVES UNDERSTANDING TRANSSEXUALISM FOR FAMILIES,
FRIENDS, COWORKERS, AND HELPING PROFESSIONALS Chapter 10
Guidelines for Support, "How You Can Help the Transsexual", p. 223-225
Saturday, July 03, 2004
It has been found that in the United States that there are a few states that have
―Only‖ a few medical and mental health professionals that specialize in treating
transsexuals and are very far and in between for a transsexual to carry on or start the
journey that they are forced to achieve. Even the cost is so high that a transgender
individual has to struggle to get the medical help they really need.
In the state of North Carolina where I live there are very few medical and mental
health professionals that specialize in treating transsexuals. Like myself I have
searched to the point of commenting myself in to the hospital. After searching and
going in and out of hospitals I found it was futile. This has gone on for about five
years and there have been times that I have been lucky and found close to the help I
There is another side of the coin, needing medical treatment and some medical and,
mental health professionals refuse to treat you because you are a transsexual, or
treat you and you end up in a horrible episode when they do. It is very frightening that
if you have a serious emergency situation that you feel you want get fair and safe
treatment in a hospital.
But the transsexual individual today is ―NOT‖ the only one that has a hard time
getting good or fair medical treatment; it is also society in North Carolina where
doctors that specialize in certain areas have to leave because of insurance
companies that charge a high price to cover them. Our officials in public office are
allowing such insurance companies get away with this.
And there is malpractice suites by lawyers that are filling there pockets on cases that
should never be filed. Malpractice suites that caused insurance companies to charge
a high premium, to where doctors can‘t give the proper medical help one need. If our
officials in office don‘t do anything our medical care will be obsolete in North
Then there is hormone treatment that an individual goes through. One needs to be
carefully monitored by a physician qualified to prescribe them. ―NOT‖ buying them
over the internet, or getting them from some unknown source. Taking them without
knowing the full picture can cause great harm. Hormones have so many good and
bad side effects that one does not no about when taking them without supervision.
One needs to consider the following PRO’s and CON’s below before attempting
taking any kind of hormones.
I urge anyone who is considering this step not to do so lightly or without the proper
medical information and attention. Introduction of chemicals into the body, especially
for the purpose of affecting physical changes is a serious matter, whether those
chemicals are prescription medications or over-the-counter, "natural" supplements and
should not be done without regular checkups by a physician that you trust.
Some Things You Should Know About
For Male-to-female Trans People
Compiled by Holly Boswell
Chemical intervention in one's hormonal system has profound, sometimes
unpredictable consequences. Given variations in physiology and genetic backgrounds,
each person may respond differently. Whether administered orally, transdermally, or
by injection, we must continue to be monitored at least annually by an endocrinologist
or other qualified medical professional.
Injection should be considered over oral use, so as not to compromise the liver over
A mild but continuous regimen of enteric aspirin is strongly advised to prevent blood
Smoking and most alcohol use must be curtailed.
Certain effects, such as breast development and genital atrophy, tend to be
irreversible after a few years.
Generic and non-domestic forms of medication can differ drastically from name brands
in regard to quality and do safe, and should generally be avoided.
One should be patient in achieving effects of the therapy, and take as modest a
dosage as possible.
In most cases, optimum feminization can be achieved from estrogen, without
If only breasts are desired, implants would entail far less impact on the body.
The chemical shift will produce a subtle, inner feeling associated with feminity.
Secondary sex traits (breasts, softer skin, finer body hair...) will develop, at least
One may be able to pass a little more easily, or maybe not.
The ability to cry is enhanced, thereby providing emotional release.
Masculine temperament is softened.
Certain Allergies (e. g. hay fever) may be relieved.
In later life, enlargement of the prostate may be relieved or prevented.
More likely to experience depression and emotional instability.
Loss of muscle mass and significant weight gain over time.
Does not alter the voice, eliminate the beard or balding.
Will produce significant genital atrophy and eventual sterility.
Impairs sexual functioning and reduces the libido profoundly, often to zero.
Can produce blood clots which may result in stroke, heart attack, or
Can produce cancers in breasts, liver and gall bladder.
Can contribute to osteoporosis in later life, like other women.
Creates a serious dependency on a foreign substance to maintain normal hormonal
If discontinued, one will experience menopausal withdrawal, possibly followed by a
return of pubescent, hormonally-driven angst.
The side effects of long-term use are virtually unknown, since there is no reliable data
FAQ: Hormone Therapy for
This document contains a list of frequently asked questions and their answers
regarding hormone therapy (secondary sexual reassignment) for male-to-
female transsexuals. More generally, this document contains information about
gonadal hormones and anti-hormones, so it can be a helpful reference for the
treatment of androgen and estrogen-sensitive conditions--for example, certain
cancers of the reproductive organs and breasts.
Sponsor Advertisement Space
The answers in this document are collected from a variety of sources: medical literature,
pharmaceutical company advertisement, verbal advice of medical doctors, second-hand anecdotes,
and personal experience. Despite the authoritative tone of this document, it is presented for educational
interest only, not direct advice. It contains opinions, sweeping generalizations, and at least one mistake.
The author is not a medical doctor, and makes no claim or warranty as to the suitability of the
information in this document for application to any particular individual. You, the reader, take sole
responsibility for interpretation and application of this information. Form your own opinions by doing
your own research. May your favorite deity curse you if you seriously consider suing the author for
misinforming you? The endocrine feedback system is intricate, delicate, and poorly understood. Even
the experts do not entirely agree on how to best meddle with it. Hormone therapy is fraught with risk as
well as promise. Be sure you have fully considered the implications before you start. Work with a
medical doctor who is qualified to interpret your signs, symptoms, blood tests, and development in the
context of your personal medical history. Do not take hormones that you did not obtain directly from a
licensed pharmaceutical distributor; the quality of drugs obtained through other channels is not only
suspect, but possibly dangerous--especially those in inject able form.
o The words "female" and "male" refer to the original physical form, not to
o This document does not address hormone therapy of the individual with
an endocrine system disorder.
o Pre-op hormone dosages are determined mainly from verbal advice of
medical doctors, second-hand anecdotes, and personal experience.
o Post-op hormone dosages are determined mainly from the Physician's
Desk Reference (PDR) according to the recommendation of hormone
replacement of normal gonadal hormone production.
o Drugs are ranked by the following criteria:
1. Safety and efficacy: excellent, good, fair, unknown, or poor. This
is based on normal indications (i.e., when the primary indication is
female hormone replacement, it is suitable for transsexual
hormone therapy), delivery method (sustained-release injectibles
and transdermal films are easier on the liver than oral tablets),
literature, medical doctor advice, anecdotes, and other factors
noted in the individual hormone comment field. Safety and
efficacy are generally closely linked, so the ranking is combined
for all drugs except anti-androgens.
2. Source: unknown, animal by-products, or live animals
o Of the injectiable hormones and anti-hormones available, only those that
are sustained-release (requiring injection less frequently than once per
week) are listed.
o The adverse effects listed in this document are gleaned primarily from
drug information sheets and the PDR. They are translated from
medibabble into English where possible. While this information should
not be taken lightly, it should be viewed with slight suspicion, since it is
first and foremost advertisement and legal copy from pharmaceutical
companies. To attempt to reduce their exposure to lawsuits, they list not
only the effects reasonably shown to be caused by the drug during
clinical trial(s), but also every other adverse effect that the patients
experienced while taking the drug--or any other drug of the same class--
whether or not the effect was proven statistically relevant by controlled
study for the drug in question. In particular, the reader should not be
unduly worried about the mention of increase of body hair and loss of
scalp hair from estrogens, nor about increase of body hair and
deepening of voice from androgen receptor antagonists and GnRH
Finally, adverse effects are only listed here if they make sense in their
application to transsexuals, i.e., adverse effects on uniquely female organs are
not listed for drugs intended for male-to-female transsexuals, and vice-versa.
o One should really read the PDR for the drugs of interest in order to
provide context for the adverse effects listed in this document.
What Are Hormones, and How Do They Work?
Hormones are long-range chemical messengers of the body, manufactured and
controlled by the endocrine system. Hence the title of endocrinologist for
The hypothalamus produces gonadotropin-releasing hormone (GnRH). This
signals the anterior pituitary gland to synthesize and release luteinizing
hormone (LH). To a lesser degree, GnRH also triggers the synthesis and
release of follicle stimulating hormone (FSH). Subsequently, LH and FSH signal
the gonads (ovaries in females, testes in males) to synthesize and release
hormones that cause differentiation of the body tissue into female or male form:
estrogen, progesterone, and testosterone. A small quantity of testosterone is
also produced by the adrenal gland. Proportionally, females have more
estrogen and progesterone than males; males have more testosterone.
Estrogens include natural and synthetic Estradiol, estrones and estriols. They
excite estrogenic receptors, causing the body to differentiate into female form
and function. Natural and synthetic estrogens are hereafter referred to simply
Progestin‘s / progestagens / gestagens (synonyms) are synthetic progesterone
analogues. Progesterone and progestin‘s excite progesterone receptors, which
in cooperation with estrogenic activity, because the body to further
differentiates into female form and function.
Various testosterones are collectively known as androgens. They excite
androgenic receptors, causing the body to differentiate into male form and
function. Natural and synthetic testosterones are hereafter referred to simply as
Anti-hormones can be useful in transsexual hormone therapy because they
block hormone action or production. The basic mechanisms are:
o Androgen receptor antagonist: blocks the action of androgens at certain
o Androgen conversion inhibitor: blocks the conversion of one type of
androgen to another.
o GnRH agonist: briefly over stimulates then effectively suppresses
pituitary LH and FSH production.
Aggressive exogenous hormone therapy indirectly reduces endogenous
(natural) gonadal hormone production by fooling the pituitary into thinking that
there are plenty of hormones already in the body; consequently, the pituitary
reduces the LH and FSH signals that stimulate the gonads.
Postnatally administered hormones do not cause development of genitals
opposite those of birth. However, postnatal contra sexual hormone therapy
does cause development of secondary sex characteristics as subsequently
described in this document.
What Are Normal Endogenous Androgen and Estrogen Levels?
The normal endogenous androgen range in a male is 300-1100 nanograms per
deciliter. Estrogen is generally below 50 picograms per milliliter.
The normal endogenous androgen range in a female is 10-100 nanograms per
deciliter. (Within this range lower numbers are not necessarily considered
better; remember, free-circulating androgens cannot bind to receptors very well,
and therefore cannot cause much harm, if an androgen blocker is being used.
Note, also, that if the androgens are at the bottom end of the scale, then libido
and overall energy will likely be lacking as well.)
There are dramatic cyclic and individual variations of estrogen (simple sum of
Estradiol and estrone) in females, with 100-400 picograms per milliliter being
the most usual, with 25-700 being possible depending on the individual. 400
are considered a nominal "mid-peak" (ovulation) level. 200-250 is considered a
reasonable target for exogenous estrogen treatment.
Note that only natural estrogens can be meaningfully measured, so it you take
any estrogen besides Estradiol vale rate or Estradiol, you will not be able to
accurately judge the results of a blood test.
Unfortunately, serum hormone levels cannot be used as a foolproof device for
titrating exogenous hormone dosage, because there is no widely available test
for sensitivity to the hormones, which varies considerably between individuals.
Levels should be considered a means rather than a goal.
After all, M2Fs undergo hormone therapy for transformation of secondary
sexual characteristics, and do not have ovaries or a uterus which would impose
obvious limitations on hormone levels; non-male-to-female women have
entirely different reasons for undergoing hormone replacement therapy which
generally requires only a low (endogenous) level.
What effect does female hormone therapy have on a male, and how soon?
The longer after puberty hormone therapy is started the less effective it is--but
not a linear scale, e.g., results are considerably more dramatic in an 18 year old
than a 28 year old, but results are not on the average dramatically different
between a 38 year old and a 48 year old.
The following effects have been observed in varying degrees--anywhere from
little to moderate--with extended treatment. With effective and continuous
dosages, most of the changes that a particular body is genetically prone to start
within 2 to 4 months, start becoming irreversible within 6 to 12 months, start
leveling off somewhat within 2 years, and be mostly done within 5 years.
The leveling generally takes longer if the testes are not removed. High levels of
estrogen will cause faster development up to a point, but not better results in
the long term than moderate levels of estrogen.
Fertility decreases. Sperm count drops rapidly. Sometimes it returns to almost
normal if hormonal treatment is discontinued within the first couple of months,
but permanent sterility can occur in as little as six months. However, this should
not be counted on for birth control, because a miniscule sperm count might
remain until the testes are surgically removed. Estrogens, progesterone,
progestins, and gonadal androgen production inhibitors are the chemicals
responsible for lowering fertility. It appears to the author that the other types of
anti-androgens do not necessarily affect fertility--but one would be wise to take
frequent fertility tests if one chooses to employ only the other types of anti-
androgens with the intent of maintaining fertility.
Male sex drive decreases. Directly stimulated erections can become infrequent
and difficult to maintain. Spontaneous erections usually stop. Semen secretion
decreases, usually resulting in less intense ejaculatory orgasms (however, the
ability to achieve a satisfying orgasm--even with little or no semen--is
determined more by psychological factors and frequent practice than anything
else). The testes and prostate atrophy. The penile skin also shrinks if erections
are not regularly encouraged.
Breast size increases. Typical growth is one to two cup sizes below closely
related females (mother, sisters). The growth is not always symmetrical--neither
is it for females. Sometimes the areoles and nipples swell, but generally not
significantly, unless the body is less than a decade past puberty.
Fat is redistributed. The face becomes more typically female in shape. Fat
tends to migrate away from the waist and toward the hips and buttocks.
Body hair growth (not including head, face, or pubic area) generally slows,
becomes less dense, and may lighten in color.
Blotches (cloasma) appear on the skin of some people during hormone
therapy. This is the same effect as the "mask of pregnancy" and probably
related to other dermal changes as noted below.
Many people also report the following effects, but they are not verified in any
medical literature that the author has read:
Outer skin layer becomes thinner, lending a finer translucent appearance and
increased susceptibility to scratching and bruising. Tactile sensation becomes
Oil and sweat glands become less active, resulting in dryer skin, scalp, and
hair. Sometimes, tear glands also become less active, resulting in dryer eyes,
which can cause some discomfort for those who wear contact lenses.
Dermal gland activity trends can generalized with the formula (A+P)/E where A
= androgens, P = progesterone and progestin‘s, and E = estrogens. Synthetic
estrogens seem to be especially likely to reduce activity.
Scalp hair becomes thicker, and male pattern baldness generally stops
advancing. In some cases, fine fuzz may grow back along the line of where
scalp hair was recently lost--but only from the living follicles, not dead ones.
Fingernails become thinner and more brittle.
Body odors (skin and urine) change. They become less "tangy" or "metallic"
and more "sweet" or "musky".
If exercise is not increased, some muscle tone is lost.
Metabolism decreases. Given a caloric intake and exercise regimen consistent
with pre-hormonal treatment, one tends to gain weight, lose energy, need more
sleep, and become cold more easily.
Some middle-aged and older transsexuals who start or resume hormone
therapy report improved memory and overall mental faculty.
Internal emotions are amplified, becoming more apparent, distinguishable, and
influential. Some people report reduced anxiety and increased sense of well-
being. This could be a placebo effect. Changing the hormone therapy (adjusting
dosages up or down in the regimen) sometimes causes a week or two of
depression and otherwise unexplainable emotional angst.
"Female" sex drive and enjoyment increase. This observation is obviously
completely subjective since males have no way to directly compare the
experience. Non-ejaculatory orgasms become more likely for those with the
predisposition to have them, if for no other reason than the fact that ejaculatory
orgasms are difficult or impossible to achieve, and the need for sexual release
forces a rewiring of perceptions and responses.
It has been occasionally reported that sensitivity to air-born allergens
Female hormones do not:
Cause the voice to increase in pitch.
Dramatically reduce facial hair growth in most people. There are some
exceptions with people who have the proper genetic predisposition and/or are
less than a decade past puberty.
Change the shape or size of bone structure. However, they may change the
bone density slightly. < Philosophies? Treatment Popular the Are>
The following estrogen dosage philosophies are popular for treatment of male-to-
female transsexuals: Adjust estrogen to achieve a serum estrogen level in the normal
range of a female; more or less ignore the serum androgen level.
The body cannot make good use of more estrogen than a female would naturally
generate Androgens do not directly compete with estrogens for estrogen receptor
sites A higher level of exogenous estrogen might cause adverse effects B Administer
consistently low dosage of estrogens 2
Adjust estrogen for gross empirical results while paying extra attention to health See
discussion below 3 A Adjust estrogen to achieve a serum androgen level in the normal
range of a female; more or less ignore the serum estrogen level
The body might be able to make good use of more estrogen than a female would
naturally generate Androgens might compete with estrogen for estrogen receptor sites
High levels of exogenous estrogen over a limited period, i.e., less than 3 years, do not
usually cause adverse effects in a person with a very healthy liver. B Administer
consistently high dosage of estrogens.
Table 1: Estrogen dosage philosophies
Clearly, philosophy 1 and 3 reasoning‘s flatly contradicting each other. There
are good endocrinologists in each camp, which demonstrates that we still really
do not know exactly how hormones work. However, there is more compelling
evidence for the reasoning of philosophy 1.
In some people philosophy 1 might have a not have quite as steep of a ramp of
results as philosophy 3--but, with patience, the results are often just as good.
The A philosophies adjust to the body's assimilation of the estrogens, whereas
the B philosophies assume "one size fits all."
Philosophy 2 occupies an awkward but extremely important space in between,
where we acknowledge that in some cases neither endogenous nor exogenous
hormone levels are great indicators, because the levels in "typical" post-
pubescent non-transsexual bodies do not always relate well to the plethora of
absorption and response factors in a given post-pubescent transsexual body,
especially when anti-hormones are added to the mix.
If there is unusually little development after, say, 6 months of hormone therapy,
then consider using gross empirical results, e.g., breast growth and fat
redistribution, as the primary rather than secondary indicator, provided ones
health (especially blood clotting and liver function) is not compromised.
Finally, note that the endogenous level of estrogen in females (F2M) seems to
be a less important factor for development than the endogenous level of
androgens in males (M2F) anyway.
The following estrogen co administration philosophies are popular for treatment
of male-to-female transsexuals: Add anti-androgen the remaining endogenous
androgens (including those from the adrenal gland) can be more safely and
effectively fought with an anti-androgen than by mega-dosing with estrogen.
Spironolactone and finasteride are recommended.
Post-ops rarely find any ant androgen useful except for finasteride. Of
transsexuals taking estrogen, those who are older than 25 or so seem to find
the anti-androgen much more important than those who are younger.
Add progesterone or progestin Progesterone administered with estrogen helps
promotes breast growth: estrogen stimulates cell mitosis and growth of the
ductal system; while lobular development and differentiation seems to be
dependent on progesterone (breast fat accretion seems to require both).
Progesterone consistently administered with estrogen seems to reduce the risk
of fibrosis, cysts, and cancer from administration of estrogen alone. On the
other hand, synthetic progesterone (progestins) can partly reverse the lipid
(cardiovascular) benefits of estrogen. Moreover, progestin‘s had a slightly
androgenic effect in some people, and apparently can even antagonize
Non-synthetic progesterone (as opposed to a progestin) is very rarely reported
to have any adverse effect, and seems to provide a healthier balance for an
aggressive estrogen dosage, as well as improving libido and overall energy
level. Add another estrogen This may cause faster results for some people, but
generally not better results in the long run.
Table 2: Co administration philosophies a name=cycling>Cycling
It is possible to vary the hormone dosages on a monthly basis so as to
roughly mimic a female menstrual cycle.
Cycling hormones before removal of the testes is not recommended. The
gonadotropin axis (feedback mechanism) is already precarious in a pre-
op under hormone therapy; small fluctuations in the hormone regimen
can translate into large variations in the endogenous androgen level,
causing significant physical and emotional discomfort.
Cycling in post-ops is a more interesting topic. Unfortunately, therapy
results are even more difficult to evaluate than the usual non-cycling
hormone therapy, due to the increase in variables and decrease in
There is mounting anecdotal evidence, and the theory put forth by at least
one reputable endocrinologist, that estrogen receptors can become
saturated, temporarily reducing the sensitivity and/or quantity of available
receptors. If that is the case, then giving the receptors a rest would
improve hormone therapy results.
For example, many people have reported a significant surge in breast
development when estrogen dosage is sharply increased after months or
even years of a very conservative dosage. In some cases, the surge in
development continues for quite a few months if the estrogen is cycled.
Development often trails off again after 3-6 months, after which, it seems
that another, or longer, rest is called for.
Cycling is worth trying for those post-ops who have not achieved
significant breast development (sub-A cup). If the estrogen boosts are
administered via intramuscular injection or transdermal film, and the
patient has no history of adverse reactions to hormones (e.g., blood
clotting or prolactin problems), it is generally considered to be a safe
If one is going to cycle, given the current lack of data to suggest
otherwise, one may as well more or less mimic a 28 day female cycle,
rather than picking another cycle out of the air. This can be roughly
achieved by intramuscular injection of estrogen in oil on day 1, then
taking another shot of 1/2 dosage on day 13. Some people will experience
menopausal symptoms (hot flashes, night sweats, severe mood swings,
etc.) in the days preceding each shot; if the discomfort is unacceptable, a
small, constant dosage of oral or transdermal estrogen can be used to
provide a "floor" serum estrogen level.
If progesterone is part of the regimen, it can be cycled by intramuscular
injection in oil on day 8, or by ramping it orally from days 1-14 with the
peak on day 8. Some say that cycling the progesterone is more important
than cycling the estrogen; other say that the progesterone must be
constant to best avoid breast cancer. Of course, many variations are
possible. There is no formula better for a transsexual than "do what
"If enough people report that a different cycle is more appropriate, that
will be reflected here in the future.
Estradiol cypionate probably has a longer half-life than Estradiol vale
rate. If even it is not available but ec is, consider eliminating the
oral/transdermal floor, as it might not be necessary.
Cycling in this manner usually results in at least some noticeable
development for 1-3 months, then the rate of improvement generally trails
off in an asymptotic curve. In any case, one should revert to a very
conservative regimen for 3-6 months (whether it be either low-dosage
non-cycling or low-dosage cycling) before trying again. If one does not
achieve any result whatsoever from cycling within a few months of
starting, it will likely not help to continue the cycling.
Aggressive cycling is meant to facilitate bursts in development, and is not
appropriate for pre-ops or lifetime maintenance. However, lifetime post-op
cycling can be done safely with more conservative dosages.
For reference--endogenous androgens in genetic women generally peak
just before ovulation and again just before menstruation--that is, on
roughly days 13 and 27 of the cycle as defined in this document. How Are
Advantages Disadvantages Injection Less liver stress than oral delivery.
Inexpensive, Less steady hormone level. Pain and slight infection risk from
hypodermic needle usage. Oral Convenience. Possibly more beneficial for
blood cholesterol levels than other methods. Increased stress on the liver since
it has to process the hormones multiple times, resulting in an increase in
clotting factors Transdermal film Less liver stress than oral delivery.
Hormone level more steady than injections. Inconvenience and skin irritation.
Multiple simultaneous patches required for pre-op dosage. Expensive.
Sublingual/Bucosal Uncoated tablets can be placed under the tongue or
between the cheek and gum.
Consider this a blend of transdermal and oral methods: if most of the drug is
absorbed sublingually/bucosally, then one gains the same benefit to the liver as
transdermal delivery; however, some is also dissolved in the saliva and
swallowed. In any case, it is certainly not any worse than immediately
swallowing a full oral dose, so try this if you can stand the taste of the tablet.
Cream, Suppositories, and Pessaries Less liver stress than oral delivery.
Absorption through a mucosal membrane is best; absorption through scrotal
skin is not as good as mucosal, but better than through other skin (need more
data about typical doses and absorption). Beware non-prescription creams from
"transformation" stores: if the cream is not strong enough to require licensing, it
is not strong enough to have significant effect on development.
Table 3: Delivery methods
Note that the absorption of oral preparations varies greatly among
individuals. With some the absorption is poor; in that case, another
delivery method is indicated.
Sustained-release intramuscular inject able hormones are suspended in
oil. This is the usual procedure for administration:
1. If you are very sensitive to pain, obtain 2 new needles for each
administration: 1 to fill the syringe (18-22 gauge), and another for
the injection (22 gauge). That way the injection needle will be
entirely sharp. Be careful not to drag the injection needle across
anything, even skin, before the injection, because that will dull it.
2. If you are fairly tolerant of pain, or cannot afford 2 needles for each
injection, then use the same new needle (22 gauge) to fill the
syringe as to make the injection. Do not under any circumstances
reuse needles between injection periods, or between different
3. Warm the vial (ampule) between your hands for a moment to help
the oil flow more freely.
4. Cleanse the top of the vial and the area for injection with a swipe of
povidone-iodine (10%), or if you cannot obtain that, use rubbing
alcohol (95-99%) or hydrogen peroxide (3-5%).
5. The best intramuscular injection sites are the upper outer quadrant
of the buttock, or upper outer thigh. Either is fine, as long as you
are hitting at least two inches of fat and muscle, not bone or an
6. Securely mount the drawing needle on the syringe, then if you are
using a rubber-corked vial, pull back the plunger about 1/4-1/3 cc
farther than the intended injection amount (e.g., if you intend to
inject 1 cc, then draw back 1 1/4 - 1 1/3 cc of air).
7. With the vial right-side-up, insert the needle in the top, such that
the needle end is in the bottle air, but not the oil. Inject all of the air
from the syringe into the vial.
Be sure the needle end is in oil (not air, and not bumping against the glass),
then slowly but firmly draw back the plunger until you have a bit more than the
You will probably see some small air bubbles; that is normal. Inject the extra
solution, along with the top bubble, back into the vial. If you have a rubber-
corked vial, this is easiest if the vial is upside-down.
Spironolactone has caused tumors in laboratory animals. Talk to your doctor about the risks
and benefits of using this medicine for your condition.
Why is this medication prescribed?
Spironolactone, a 'water pill,' is used to treat high blood pressure and fluid retention caused by various
conditions, including heart disease. It causes the kidneys to eliminate unneeded water and salt from the
body into the urine. Spironolactone is also used to treat certain patients with hyperaldosteronism and in
certain patients with low potassium levels.
This medicine is sometimes prescribed for other uses; ask your doctor or pharmacist for more
How should this medicine be used?
Spironolactone comes as a tablet to take by mouth. It usually is taken once a day in the morning with
breakfast or twice a day with breakfast and lunch. Follow the directions on your prescription label
carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take
spironolactone exactly as directed. Do not take more or less of it or take it more often than prescribed
by your doctor.
Spironolactone controls high blood pressure but does not cure it. Continue to take spironolactone even
if you feel well. Do not stop taking spironolactone without talking to your doctor.
Other uses for this medicine
Spironolactone also is used in combination with other medicines to treat precocious puberty or
myasthenia gravis. Spironolactone also may be used to treat certain female patients with abnormal
facial hair. Talk to your doctor about the possible risks of using this medicine for your condition.
What special precautions should I follow?
Before taking spironolactone,
tell your doctor and pharmacist if you are allergic to spironolactone, sulfa drugs, or any other
tell your doctor and pharmacist what prescription and nonprescription medications you are
taking, especially aspirin; captopril (Capoten); digoxin (Lanoxin); enalapril (Vasotec); lisinopril
(Prinivil, Zestril); lithium (Eskalith, Lithobid); medications for arthritis, diabetes, or high blood
pressure; potassium supplements; and vitamins. Do not take this medicine if you are taking
amiloride or triamterene.
tell your doctor if you have or have ever had diabetes, gout, or kidney or liver disease.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you
become pregnant while taking spironolactone, call your doctor immediately.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking
you should know that this drug may make you drowsy. Do not drive a car or operate machinery
until you know how this drug affects you.
remember that alcohol can add to the drowsiness caused by this drug.
What special dietary instructions should I follow?
Follow your doctor's directions for a low-salt or low-sodium diet and daily exercise program. Avoid
potassium-containing salt substitutes. Limit your intake of potassium-rich foods (e.g., bananas, prunes,
raisins, and orange juice). Ask your doctor for advice on how much of these foods you may have.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip
the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for
a missed one.
What side effects can this medication cause?
Although side effects from spironolactone are not common, they can occur. Tell your doctor if any of
these symptoms are severe or do not go away:
enlarged or painful breasts
irregular menstrual periods
If you experience any of the following symptoms, call your doctor immediately:
muscle weakness or cramps
rapid, excessive weight loss
slow or irregular heartbeat
unusual bruising or bleeding
yellowing of the skin or eyes
What storage conditions are needed for this medicine?
Keep this medicine in the container it came in, tightly closed, and out of reach of children. Store it at
room temperature and away from excess heat and moisture (not in the bathroom). Throw away any
medicine that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed
or is not breathing, call local emergency services at 911.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked
regularly, and blood tests should be done occasionally.
Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling
Last Revised - 04/01/2003
Is the Shot Right For You?
"The shot" is an injectable progestin-only prescription method of reversible birth control. It contains a hormone that is
similar to the progesterone made by a woman's ovaries to regulate the menstrual cycle. The shot is also known as
DMPA. The D stands for "depot," the solution in which the hormone is suspended. The hormone is medroxyprogesterone
acetate. The common brand name for the DMPA shot is Depo-Provera.
A shot of DMPA can prevent pregnancy for 12 weeks. It
usually, prevents the ovaries from releasing an egg (ovulation)
less often, thickens cervical mucus to prevent sperm from joining an egg
The shot is one of the most effective reversible methods of birth control. Of every 1,000 women who use it correctly and
consistently, only three will become pregnant during the first year of use. Three in 100 women will become pregnant with
Protection is immediate if you take the shot during the first five days of your period. Otherwise, use a backup method of
contraception for the first week. Protection lasts for 12 weeks.
The shot is not effective against sexually transmitted infections. Use a latex or female condom to reduce the risk.
Advantages & Disadvantages
can be used by women who cannot take estrogen
can be used while breastfeeding
effective for 12 weeks
helps prevent cancer of the lining of the uterus
no pill to take daily
nothing to put in place before vaginal intercourse
must receive shot every three months
pregnancies, which very rarely occur, are more likely to be ectopic (in a fallopian tube)
may not be used continuously for more than two years unless no other method is right for you
takes an average of nine to 10 months — or sometimes more than a year — to get pregnant after getting the
Possible Side Effects
Irregular bleeding is the most common side effect for women using DMPA. It is more common in the first six to 12 months
Periods become fewer and lighter for most women, and often stop altogether. The longer a woman uses the
shot, the more likely her periods will stop. It may take up to a year for periods to return after a woman's last shot.
Some women will have longer, heavier periods.
Some may have increased light spotting and breakthrough bleeding.
Women who use DMPA may have temporary bone thinning (See below for further explanation.)
Less Common Side Effects
change in sex drive
change of appetite, weight gain
hair loss, or increased hair on the face or body
skin rash or spotty darkening of the skin
There is no way to stop the side effects of the shot — they may continue until it wears off (12-14 weeks).
Serious problems are rare. Tell your clinician immediately if you have
a new lump in your breast
severe pain in the stomach or abdomen
unusually heavy or prolonged vaginal bleeding
yellowing of skin or eyes
Who Can Use the Shot?
Most women can use the shot.
It may be especially appropriate if you
want very effective long-lasting contraception
cannot take estrogen
are unable to use barrier methods routinely or take a daily pill
Usually women who use the shot need special medical supervision if they have
current serious blood clotting conditions
high blood pressure
high risk for heart disease
a history of severe depression
liver disease, such as hepatitis, abnormal results on liver function tests, or a history of liver tumors
You should not use the shot if you
cannot put up with irregular bleeding or loss of your period
are taking medicine for Cushing's syndrome
are or might be pregnant
have a known or suspected breast cancer
have unexplained bleeding from the vagina
want to become pregnant within the next year
Women should not use the shot continuously for more than two years unless no other method is right for them.
Women who use DMPA may have temporary bone thinning. It increases the longer they use DMPA. Bone
growth begins again when women stop using the shot. Whether or not there is a complete recovery of bone mass is
Whether or not temporary bone thinning leads to greater risk of bone fracture from osteoporosis much later in
life is also unknown.
To protect your bones, get regular exercise and get extra calcium and vitamin D — either through your diet or by using
How to Get the Shot
Your clinician will take your medical history. Depending on your medical history, you may need a partial or complete
Your clinician will give you an injection — you may have a temporary bruise.
You will need an injection every 12 weeks for as long as you want to prevent pregnancy.
An exam, if needed, may cost between $35 and $125. Further visits cost between $20 and $40. Each injection costs
between $30 and $75. The total cost for each year of use will be between $235 and $585.
Medicaid may cover these costs. Private health insurance coverage for birth control varies. Family planning clinics
usually charge less than private health care providers.
If you are more than two weeks late for your injection, you may need a pregnancy test before having the next one.
Pregnancy tests cost about $20.
Current updated version by Jennifer Johnsen
Original version by Jon Knowles, 1995
© Revised November 2004. Planned Parenthood® Federation of America, Inc.
Original copyright 1992 PPFA. All rights reserved.
For medical questions, or to schedule an appointment with the nearest Planned Parenthood health center, call toll-free 1-
800-230-PLAN or 1-800-230-7526.
Planned Parenthood affiliate health centers provide culturally competent, high quality,
affordable health care to nearly five million diverse women, men, and teens every year.
Planned Parenthood welcomes everyone--regardless of race, age, disability, sexual orientation,
Hormones: Ah sweet estradiol, the greatest of all substances. Hormones
change the look of your face and skin, making it softer and prettier. They
arrest scalp hair loss. They lessen or eliminate body hair. They provide
breast and hip and butt development. Since taking
hormones for the past 10 months, I‘ve gained 4 inches in the hips and
almost 4 in the bust.
That is way more than typical, but it‘s in my genes to be hippy. I wear a 34
or 36 B bra. I‘ve also lost 2 inches from the waist (fat gets deposited in
The mental changes are even more profound. You will have real emotions!
Your feelings will control you! You won‘t know why you feel suddenly happy
or sad and you just have to go with it. It‘s wonderful!
Of course hormones will also reduce or eliminate your male sex drive. If this
is not a welcomed effect, then you‘re probably not a transsexual!
Hormones are more effective the earlier you start – preferably in utero :-)
There are quite a few Stunningly beautiful young transitioners out there who
are absolutely indistinguishable from ‗genetic females.‘
Before SRS I took 4 mg estradiol (estrogen) and 200 mg spironolactone.
Spiro is an anti-androgen. This means it helps reduce testosterone levels,
and thus helps the estrogen take control of your system. Post SRS I take 2
mg estradiol and no spiro. I also take small
amounts of progesterone. Progesterone might (it‘s controversial) aid in
breast development (the development of milk-producing tissues).
Doctors used to prescribe premarin as a source of estrogen (which is made
from horse pee – and involves cruelty to the horse donors), but estradiol is
becoming more common. If you have an older doctor they will likely try to
give you premarin, but most are flexible and will give you what you want. I
feel that estradiol works faster and more effectively.
But please see an endocrinologist if you are considering taking hormones.
Your health is important!
It's also important to note that the earlier you begin hormones the better the
results will be. If you start at or around puberty, you can have a 'normal'
female puberty. Since testosterone won't have the time to poison your
system, your jaw, chin, nose, and forehead won't be
'made mannish.' You likely won't need to endure the pain expense and
heartache of electrolysis. Your breasts will develop to their full potential.
Your body will be slighter and more feminine. In short, you'll become a
woman, pretty much like any other girl. Unfortunately, without the support of
your parents, transition in the teens is almost impossible. Unless they are
extremely intolerant (like mine), you need to work with them to get them to
understand your condition. If they are extremely intolerant, I'd advise waiting
until freshman year of college, and going to college as far from home as
possible. Getting thrown out and living on the street is not the way to go.
Besides, starting at 18 ain't so bad!
If you want some advice on how to educate your parents - and early
transition advice in general - go here: http://www.antijen.org/index2.html or
Here‘s some more information about hormone regimens:
Herbal Hormones: Certain plants like black cohosh have weak estrogenic
effects. These are often used in the menopause relief products you see in
the supermarket. The problem is that if you are pre-op, you have too much
testosterone for these to work. There are also herbal anti-androgens like
chaste tree berry to reduce testosterone.
While waiting for my hormone letter, I took a product called Evanesce, which
is an herbal blend. There were some slight effects in 3 months (especially
nipple sensitivity), but I got 10 times more in 3 weeks of estradiol. I also had
very low testosterone levels to begin with.
Hey, I used to wear makeup!!!
These pictures were taken back in July of 2003. They are
me after about 6 weeks of hormones. The one on the left is
important to me, because it was the first time I saw myself as
being 'pretty.' It's also the first time I saw myself as a totally
different person - who didn't even look like her brother. When
I saw this picture I was stunned, and all I kept thinking was,
'who is that girl?'
Even so, I think it's pretty clear that I look better now - after 10
months of hormones - a lot softer.
Monday, July 05, 2004
In my experience going through hormone treatment, depression, suicide, PMS,
emotions, confusion, mental and physical effects occur. Among other effects that
occur. A lot of changes take place when going through hormone treatment. One must
be prepared and think long and hard before attempting such a move. Also, hormones
can enhance ones depression.
But hormones aren‘t the ―ONLY‖ medications out there on the market that can cause
or enhance depression or suicide. Your anti-depressant medication can cause
depression or suicide along with other systems as well.
Thousands of people in society today take some kind of anti-depressant medication
and don‘t realize what there medication can do, or the side effects that they have. I
mention some of these medications because I have been told that when I wasn‘t doing
well and my depression was getting to me that the main problem was the hormones
that I am taking. Which is not always the case?
A transsexual is always constantly struggling and facing challenges (and probably will
continue to do so throughout life), which everyone needs to understand if you are
families, friends, coworkers, helping professionals. This is ―NOT‖ a choice for the
transsexual to become this way. It is forced upon them by nature herself.
A transsexual goes through hell and back to accomplish there True self in life. Being
who they are isn‘t easy and what they have to face isn‘t either.
Transsexuals face many issues during there transition, go through a lot of hardships,
losses and apart of society that don‘t understand them because they are different.
Even getting the right medical or mental health that a transsexual needs is impossible
because they are a unique breed of people.
Plus, a transsexual has to watch out for those they do seek for help that don‘t
specialize in transsexual behavior can give wrong advice that can really mess things
up for you.
SOME CONSIDERATIONS IN
COMING OUT TRANS
TO YOUR PARENTS / FAMILY
By Mary Boenke - TSC 2001
I have come to believe that when you come out to your parents as a transgendered
person, they need to know that:
--- You still love them,
--- You are not doing this to hurt them,
--- You've had these feelings since...
--- You resisted coming out to yourself for... You really struggled with it, but it wouldn't
go away; it's SUCH a compelling feeling...
--- You are now pretty seriously considering... because you have talked extensively
with a counselor, met many other trans folks, have done some reading and / or...
--- At this point you believe... about yourself,
--- If / when you change your presentation or your gender, you will still be the same
person inside in many ways,
--- You will still have much of the same personality you always had,
--- You will probably still have the same corny sense of humor,
--- You will still love music, cats, them, loud shirts, short hair (whatever),
--- You will still work at... go to college, keep your friends, go to church, love your
children... (some things that are important to them)...
--- You might also change in some ways - voice, hair, walk, talk, dress, ect Be honest
about what changes to expect,
--- You might look like your twin brother / sister,
--- You will give them all the time they need to get used to the new you, You didn't get
used to the idea overnight yourself,
--- You know the new name is hard; they even get the grandchildren mixed up
--- New pronouns are harder. After all your mother changed your diapers a thousand
times and knows your body... Cut them some slack here... (I still slip up after 5 years!)
--- Your love life - what do you expect about your marriage, current partner, future type
/ gender of partner; might as well be frank here. (I tell my friends I never cared about
life after death, but love after transition - THAT concerns me...
--- You realize they may go through an emotional process, too - shock, denial,
bargaining, anger, guilt, sadness, acceptance....Know these symptoms and help them
to recognize them,
--- Believe it or not, some parents even get a stage of celebration!
*** I often suggest writing a letter to parents or family; read it over, sleep on it, does it
say everything you want to say, and in a loving way. Then THEY get to read and
reread and respond thoughtfully. Plenty of time to talk in person later.
ABOUT THE CHILDREN - Your own, nieces and nephews, neighbors
--- Children do not usually need therapy to understand and except your transition,
--- They need the significant adults in their lives to accept the changes to take them a
little casually, answer questions directly, but minimally, until you are sure they want
more information. (Why is Daddy wearing dresses? Because he feels better in
--- Even young children can understand that some of the things we believe and talk
about at home may not be acceptable to others; they can learn to deal with questions
at home and not with neighbors, friends, teachers... until you tell them it's OK,
--- Older children need to know transgenderism is not contagious and hardly ever
inherited; they are not likely to be trans just because you are,
--- One parent explained to her young children that being trans felt like going to a
Halloween party, coming home and never being able to take off your costume nor
convince people that isn't who you really are.
Transitioning is like finally taking off your costume so people can see who you really
are. (This seems to help a lot of adults, too.)
IF PARENTS ARE REJECTING
--- Some parents are rejecting for even several years, but then gradually come
around. You can give them things to read, send them a greeting card now and then,
reassure them of your love, tell them a bit about your life. You can't force them; it's not
your fault if THEY can't handle it.
--- That's why we caution even gay, lesbian and bisexual youth not to come to family
until they have an alternate support group; same for you.
There's no real substitute for your family of origin, but you CAN live without them,
even have a full and very happy life,
--- and Let this tough experience make you wiser, gentler, more loving, not bitter,
distrusting, and cynical. Let it not have been in vain.
If you need to talk:
--- Contact some of us in PFLAG'S Transgender Network; we know you are beautiful
JUST the way you are and we would love to talk with you.
Karen Gross, HELP line: 216/691-4357 (HELP) or Kittengr@aol.com, Mary Boenke,
TNET Chair, 540/890-3957, firstname.lastname@example.org
Parents reject son who became daughter
Sunday, March 2001
from Dear Ann Landers Column
Dear Ann Landers:
I read with interest the letter from "Headache in Santa Cruz, Cal.," whose mother
stopped speaking to her two years ago because she thought the grandchildren "had
no manners." You said "Headache" should tell Mom she wants to try again, and you
couldn't imagine a mother who would not agree to keep the door open. Well, don't be
so sure, Ann. My parents want absolutely nothing to do with me, and I have extended
the olive branch twice.
Seven years ago, I came out of the closet, and informed my parents that I was a
transsexual and planned to have surgery to become a female. I know this was a shock
to them, but since my confession, they have treated me like dirt. When I asked them to
please call me by my female name, "Madeline," they said they could never do that.
When I tried to see them after my sex change operation, my father slammed the door
in my face. They have made it clear they will never accept me as a female.
My parents do not miss me, they miss the person I used to be, and that is who they
want to see. But it is not possible. I have decided to stop trying. I live a thousand miles
away and am attractive and successful. I know they read your column, Ann. Perhaps
they will see this and realize how wrong they are to exclude me from there lives. --
Estranged and Hurting in Denver
I feel sad for you and truly regret that I cannot offer some sort of viable solution. I hope
that you, on the other hand, will try to understand how difficult it is for parents who had
a male child and are asked to call that child "Madeline."
The organization PFLAG (Parents, Families, and Friends of Lesbians and Gays) offers
transgender assistance and may be able to help you bridge the gap with your parents.
Please write to T-Net, c/o PFLAG, 1726 M St. N.W., Suite 400, Washington, DC
20036 (www.pflag.org). Good Luck!
Transgender doctor settles discrimination
suit against hospital
The Associated Press
Last Updated 12:48 pm PST Sunday, March 28, 2004
ALLENTOWN, Pa. (AP) - A transgender podiatrist who claimed she was forced from a
top hospital position has settled her gender discrimination complaint against the
In a settlement with Gwen Greenberg, St. Luke's Hospital-Allentown agreed it would
change its patient bill of rights to include gender identity language and offer education
to hospital staff on gender identity and sexual orientation issues.
Other details, including whether Greenberg would be reinstated or receive back pay,
were not released. Greenberg, her lawyer and hospital officials declined to comment
beyond a joint statement that said all matters had been "privately and amicably
Greenberg, who directed the hospital's podiatric surgical residency program for 13
years, filed a complaint in November with the Allentown Human Relations Commission
and another in December with the Pennsylvania Human Relations Commission.
In it, she said her contract as program director was terminated last May, two weeks
after she informed administrators that on July 1 she would start talking, dressing and
living as a woman.
Greenberg, formerly known as Gary Greenberg, received counseling and hormone
treatments before changing his name and persona to that of a female. She said she
had long suffered from Dysphoria, a condition characterized by intense feelings of
being the wrong gender.
Over the last five (5) years, out of all the obstacles that I have had to face as a
transsexual, are the people I love that can‘t except or deal with my medical condition
and who I am now. We have to realize that we cannot dictate to others on how we
should live our lives, or to conform to our wishes. If we try, results of destruction and
pain will occur.
Tuesday, July 06, 2004
Over the past years people in society have a misconception about the transsexual, in
regards to lifestyle, sexual preference, sex and gender. To explain this is as follows:
Being transsexual is ―NOT‖ a lifestyle, it is a medical condition, nor does it fall in line
as a sexual preference. As to gender or sex they each have its own definition as to
The terms sex and gender are typically used interchangeably in our culture today, but
it‘s important to keep in mind that there are distinguishing characteristics between the
two. Sex refers to the biological classification of being either male or female and is
usually determined by external genitalia. Gender refers to the culturally determined
behavioral, social, and psychological traits that are typically associated with being
male or female.
But in today‘s society they say they are one of the same thing, and it is ―NOT‖ so. A
transsexual comes under the heading of being transgender, along with others in the
Wednesday, July 07, 2004
When a transsexual individual decides to live in he/she opposite gender they start
thinking on changing there birth name to there gender name.
When a transsexual decides to go ahead with there name change they must realize
that when they do, the past you leave behind will be like a new born child with no
history at all. Transitioning isn‘t easy at all for some. There are two ways of
transitioning when a transsexual individual changes there name.
One is transition while on the job since one is already established there, and
have some kind of job history.
Transition without a job with no or little job history. Being without a job and
never had worked before one tries to seek help from other sources or on there
There are two options in going about changing your name. The first option is doing it
yourself which is the easiest and cheapest. The second option is an attorney and pays
several hundred dollars to do it for you. On my website transsexualprincess.biz it has
information and forms on how to do a name change.
But neither of the two is easy when transitioning. In the first one, transitioning on the
job could cause one to lose there job and acceptance. The second one you have a
bigger problem with no history.
In regards to both though, they have its problems. It has been known that a
transsexual individual may ―NOT‖ find a job for a long time depending on help
somewhere or options that could lead to depression, hospitalization, attempted
suicides or ending in suicide.
What I have written in this booklet is to try to educate individuals within society about
the transsexual and there medical condition ―Gender Identity Dysphoria‖, and know
what one can do to overcome there shock of ―WHY‖. To Be Who you are, you have to
be yourself and listen to your heart. Being True To Yourself is the key of being happy
A famous Lesbian writer wrote, "We have to dare to be ourselves, however frightening
or strange that self may prove to be."
If we can‘t be ourselves then who can we be? Be what society and others wanting us
to conform to be, ―NO‖! Being miserable is NOT the thing to be, being happy and
except who ‗YOU‖ are.
When it comes to dating relationships for the Pre-op transsexual there are some
medical and mental health professions advise against it. From my experience I would
For me, it enhances confusion, conflicts, and problems within the early transition
stages. At the moment I am in a relationship with some one and what had turned out
to be a great thing, has turned into complications.
But even though I am in this kind of relationship, the person I am seeing I love very
much. And I also know that I must talk to them about how I feel within the relationship,
but doing it is hard to explain things to them. As to how they feel about me they love
me very much and accept me for who I am.
It is in the morning Thursday, September 02, 2004 and my relationship that started out
as a great one has turned into a lot of mental issues, depression and suicide
problems. I have tried to talk to my sweetheart and all it has done is made things
worse along with them ―NOT‖ listening to a word I say in explaining our relationship
If a pre-op transsexual individual ask me today weather they should go into a
relationship with someone, I would advise ―NO‖, or use very extreme caution in make
such a decision. One needs to be in a position to be able to deal with problems that
they might incur down the road.
How this relationship ended was tragic and bitter between us. I no that it is very painful
to me, and at times I want to end it all. But I hold on for the day things will be at peace
Work transition for transsexual women
This section is about my own experiences and those of friends who had successful
on-the-job transitions. There are already several excellent sites for information on
The Center for Gender Sanity has some good books for HR people, employers, and
coworkers, as well as a fantastic collection of transgender employment links.
The Transgender At Work project also has some great employment resources.
My thoughts on work transition
Too many TSs are unemployed or underemployed because they didn't plan carefully
or just hope things will work out for the best. You can't plan for every possible
scenario, and some things may be out of your control, but the more planning you do,
the better your chance of success. I'll be writing at length about this soon, but here are
the salient points:
Decide if you will transition on the job or move.
Stealth is more often a fantasy than a reality, especially once you've
established a career. If you think you'd like to go stealth, you will need to take
the following steps:
o Be accepted as female without question or suspicion 100% of the time
o Get references whom you can trust not to divulge your past
o Work in an industry where it's unlikely that you‘re past achievements or
coworkers will have contact with you.
o This is a very tall order. Most of us, me included, would be unwilling or
unable to meet these requirements.
Do you need recommendations if you plan to stay in the same field?
If you work for yourself or deal with the public, do you think clients/customers
will be OK? Be honest.
If your job is in an intolerant field, should you switch now before you're in a
bind? For instance, if you're teaching 3rd grade at a Christian military reform
school, you might want to leave *now*.
Do you (and be honest) think if you were fired, you could interview and get
hired in female mode without being clocked, or at least without your transsexual
status being an issue for the person hiring you? If not, it might be wise to wait to
come out at work until you can function in society in a female role.
I recommend gathering copies of any memos, commendations, performance
reviews, dates of raises, etc. and keeping them at home. Also, get copies of
any relevant discrimination policies from your employee manual, etc.
I recommend keeping a work journal during transition that outlines what you did
at work that day, and documents any trans-related comments you get. This
could come in handy, if not in a discrimination suit, in a wrongful termination
I recommend trying to find TSs who transitioned in the same company or field
and find out what they did right (or wrong).
Have your resume and everything updated in case you need to interview
Finally, I'd suggest consulting with a lawyer well in advance of coming out at
work to determine options in your case.
Most TSs makes the bulk of their transition decisions based on financial constraints.
For that reason, it is absolutely essential to think about how you are going to pay (or
not pay) for all of this.
Plan for the worst, hope for the best.
J 's guide to work transition
My friend has written the finest document I've read regarding work transition, and
she's been kind enough to let me include it here. The whole thing should be
highlighted, but I've put important points in purple and vital information in red.
She began her transition at a small company on the west coast, before leaving to
pursue her Ph.D.
Thoughts about workplace transition
Try to be yourself, long before your transition, specifically with regards to your
feelings, and ways of relating to people. This doesn't mean so much trying to
display a flamboyant manner, as it means being especially (if not
conspicuously) sensitive to people and their feelings.
It is definitely possible to do this, while still keeping your ties with the old-boys-
club, but people will notice, you will win friends, and those friends will have a
much easier time accepting and believing the notion that you are a woman
when you make your announcement. Besides this, it should help you to be a
happier person, and less stressed out in the time when you know you want to
transition, but can't. It will also make things easier because you won't feel the
need to change your personality and way of relating to people when you
transition; that can be really upsetting to an awful lot of people. It is very helpful
if you can be like in Virginia Woolf's Orlando, "Same person, just a different
Try to be outgoing. Try to be a hero. Never turn down a chance to save the day,
even if this means working all night. Do it with a smile on your face. The more
visible you are, and the more everyone has come to know they can count on
you for work and friendly attitude, the more likely management is to realize that
you're an asset, no matter what your gender. Also, the more likely they are to
realize that they're going to destroy morale if they try to get rid of you.
The closer you get to disclosure, the more you will think that everybody knows.
The truth is, you never know what people know until you tell them.
Keep in mind that the time leading up to your transition is far more stressful
than the transition itself.
Try to have all the money you need for your transition before you go full time.
Not only does this protect you, but it will also keep you more sane (i.e. you
won't be thinking, "Oh my gosh! If I lose my job I won't be able to pay for
surgery!"). You need to be as calm and collected as you can manage.
Be adequately prepared for your transition: facial electrolysis almost completely
done, hormones for some time, etc. People really do judge others (especially
women) based on their appearance. You will be surprised how much even
something as simple as one electrolysis session to clear regrowth will impact
how kind and respectful people are of you. Sad but true.
If you're thinking of leaving a professional position (such as a research,
engineering, professional, skilled position), it might be a good idea to wait until
after your transition, to know what you're getting yourself into. You'll be
surprised how badly women are treated in general, and a professional position
can have more value than you can imagine. Not only will people accept you
because of your skills, but without exception in my experience, acceptance and
tolerance is directly proportional to education and status. The cruelest people of
all will be people with less status, unskilled labor, and basically anybody who
might see themselves as down-trodden. The most accepting people of all are
the most advantaged and privileged.
This is amazing, and startling, but in my experience it is true. I have never (knock
on wood) had so much as a *doubtful glance* from Joe Schmoe, M.D. and Ph.D.,
straight, white, male, married, 2.5 children, and successful. I imagine it has to do
with the fact that people treat others the way they've been treated themselves. I
should also add that being able to go to work each day and be appreciated for
what you do can really help you retain your self esteem if things get tough outside
Make sure you have the personal moral support that you need in case
everything goes off the rails.
Whatever you do, don't just show up one day in a dress; this has to be the
quickest way to get fired. Make your announcement through the usual
management chain if possible, and be as professional as possible. You want
them to know what an important thing this is for you and that you've thought
this through very carefully.
By the time you make it to this point, you should be absolutely sure of your
decision; whatever you do, don't oscillate between genders (if you want to be
accepted in a conservative environment). Long before my own announcement,
I was at a lunch get-together where I heard some of my co-workers talking
about another person who had transitioned in another employ of theirs, but had
oscillated. The gist of what they were saying was that they could manage the
notion of transition, but "make up your mind!". People in general have a very
hard time with any notion other than the usual "two gender system".
A successful transition is going to depend on your understanding and
empathizing with other people's feelings, no matter how fascist you believe
them to be.
Go in expecting nothing, because that may be what you end up with, and it
won't hurt as much if you do. Also, it will be ten times more wonderful if people
reach out to you with love and open arms.
When negotiating your transition, and afterwards, be *really* over-compliant.
Never mention your rights, if you are lucky enough to have them where you
live, it will only make them angry and drive a wedge between you and
everybody else. Besides, your rights are nothing but a nice thought, anyway.
They can get rid of you anytime they want. Go out of your way to express how
much you love working with your co-workers. You want them to know you're
one of them, and you want to find a solution everybody is happy with. You have
to say that you'll do whatever they think is right, even if in your heart you
believe what they're doing is wrong.
After Initial Transition:
Dress conservatively, perhaps even a little androgynously. You have a long
process to undertake, to discover how you want to present yourself, and what
kind of clothes suit you. If you aren't a frilly person, you aren't a frilly person,
and while you're trying to figure out if you are, you can't go wrong with a pair of
khakis and a pretty sweater.
If you are well-liked, etc., etc. and luck is on your side, the time to get fired /
demoted is not when you transition; it will be a few months to a couple of years
after your transition. i.e. when people genuinely start seeing you as a woman.
The problem is that a woman has to be 10 times what a man has to be to hold a
given position. When people *genuinely* start to see you as a woman, they're
liable to all of a suddenly start thinking, "Wait a minute. How did you get that
position? You don't have what it takes to be there. We need to fire / demote you".
The other problem is that you are going to be going through major personal
changes during your transition (including the occasional crisis). They're going to
compare you to the hyper-focused wonderful person you used to be; while they
may still see that you're still a wonderful person, they'll be very overly-sensitive to
any temporary decline.
Also, the more you become accepted as a woman, the more you're going to feel
social pressure (like pressure to devote huge amounts of your time to family and
friends). As it is for all women, it's going to become harder and harder to be a
Again, if they knew you in both roles, they're going to see a decline, which you
could avoid by being in a new position where nobody knew you before. There
must be people who don't run into these problems, but I've never met one.
While in-place transition can be a beautiful experience, the best solutions I've
heard are to either to change places (in a large company) to somewhere that
nobody knows you, or transition in place and then a while later (before the above
start to become an issue) find a new position.
Assuming you have plans already laid out, you can even tell your present employer
as part of your initial transition announcement that you're going to leave them in a
few months. This may even make them more likely to want to keep you in the short
term, and having had some experience in your new role will definitely help to make
you more comfortable when you begin your new position.
If you transition in a new workplace, absolutely, whatever you do, avoid telling
anyone about your situation. You may think everyone reads you, but you may
be surprised (see #4). The workplace can be the best gender cue; it can be
surprising how much the context of your work will help your acceptance as
female. In fact, in addition to this, it's surprising how much people don't want to
They just want to know you for you, and at best (at the very best) they will see
what you share as an irrelevant piece of very personal information, and at
worst, they will feel angry and betrayed. This includes best friends and
significant others (or perhaps this is perhaps most applicable to best friends
and significant others). You will also discover that the same people who would
have stood by your side, and told you how courageous you were had you told
them before your transition, will never speak to you again if you share this news
after your transition.
Try to prepare yourself for social 'oopses' you will make during the course of
your transition; it is going to happen. Just try to see every mistake as a learning
experience. Try to prepare yourself emotionally for the possibility that you might
lose a position. If it happens, whatever you do don't take it as a criticism of you
or your skills. You are still the same wonderful person you always were, it's only
a symptom of the position and situation you're in. As you grow and become
more comfortable in your new role, things will become more and more
Treasure every moment, now and forever, because you're finally the person
you always wanted to be. Look forward to the day that you forget all about your
past, and are just living, "life as usual".
Thanks again to my friend for that excellent overview! I'll be adding my own thoughts
soon, but until then, I've added my letter to coworkers below. You're free to use any or
all of it for your own letter. For those who plan to compose their own letter, I've
included a few tips below.
Coming-out letters to co-workers
A lot of people have written fantastic coming-out letters. Here's one from a reader:
Mine is next page.
The primary purpose of your letter is to make your transition easier by putting people
at ease. All good coming-out letters have the following:
They're appropriate for their audience
If you work in a conservative place, your letter should reflect that. I work in a
fairly open environment that encourages creativity and humor, so my letter
reflected that. Write in your own style, if appropriate. If you are writing it in
memo form, it should read like a memo. People in medical jobs may write
something with more medical information than others. My co-workers are all
extremely conversant in pop culture, so my letter had a ton of cultural
references. You get the idea.
They make a connection
Pick a co-worker friend who will be reading your letter and write it to them. Re-
read it, thinking of your boss. It should make a connection with anyone who
may read it.
They're short and simple
I tend to ramble. This letter isn't the time or place.
They're professional and not emotive
People don't really want to hear about how hard your life is. This isn't the time
They stay focused on the purpose
Your letter is to inform people about your change. What co-workers want to
know most is, "how does this affect me?" They want some cues about how to
act. Answer questions about:
why you're doing this
how you're doing this
how they should address you (include name pronunciation if it's unusual)
how things should be handled with clients or customers
what they should say to someone who hasn't heard
what bathroom arrangements will be
what to do if they use the wrong name/pronoun
They deal with misconceptions
Even though you think about TS stuff all the time, most people never give
gender issues any thought. Maybe they've seen a special or read something,
but most will have never met an out transsexual and have no idea what to
They answer questions
Beyond wondering how your change will affect them, many people are quite
curious about transsexualism, since it's very unusual. This is your chance to
make the main points you want to emphasize. A lot of people will be afraid to
stop by and ask questions, so get it done in your letter.
Some companies will request that you not send out information. At the least, you
should let management read your letter first. In my case, I was asked to sign a copy of
mine before they would pass it out.
Make sure that your letter is passed out appropriately:
Passed out at a meeting about your situation
Sent or e-mailed via inter-office mail like any memo
Mailed to people's homes
Delivered personally by you or boss
Leave extras with your boss, secretary, human resources, or anyone who might get
questions about your status. Most important-- leave copies where people can pick
them up without asking anyone or without anyone knowing. Many more people
will pick up copies and read them if they can do so without talking to you or anyone
I taped up a manila folder outside my office, and stuck about 20 copies of my letter in
it. I had to refill it about every other day for two weeks. It's a very important thing to do!
My coming-out letter to co-workers.
Our upper management handled telling co-workers of my transition perfectly. Our
department director called a mandatory meeting with my group and asked me not to
come. This let people talk freely or express concerns without worrying about offending
me. Our department director kept it very upbeat and light, but he basically said,
"Here's the deal. You may or may not like this whole thing. That's your decision, but
this is a work environment and as far as that's concerned, I expect you to act
professionally and respectfully." Afterwards many people stopped by to tell me how
well he'd handled it, and how everyone felt pretty comfortable about the whole thing.
For this meeting, our department director asked me to write a note, which I've included
Transsexual fun facts
[Our Executive Creative Director] asked me to write up a little information that
addresses common questions I get.
How did you choose your name?
I changed my last name to my first because I wanted some connection to my birth
name, but I wanted it to be a little indirect. It's also the last name of one of my favorite
novelists (Henry) as well as that of a notorious outlaw (although I learned from the
Brady Bunch not to idolize Jesse).
I chose my first name mainly because it's common, but not too common, and because
I had no major associations with that name. Some rejected names were: Fontasia
L'Amour, Anita Drink, and Amanda B. Reckonedwith...
Wow, so you wanted to be even trendier than Ellen DeGeneres?
It's nothing new, but it's been in the media more lately. Transgenderism appears
throughout history and is documented worldwide. Medical advances in this century
have made it possible for male-to-female transsexuals to achieve nearly identical
physiology as genetic females.
Most people don't differentiate between sex and gender. Basically, sex is biological,
gender is social. There really isn't much difference between men and women
physiologically-- just a chromosome and a couple of chemical levels.
The bulk of the difference is social. From the earliest age, boys are expected to act
this way, and girls are expected to act that way. Because these social pressures are
so pervasive, they almost seem natural unless you step back and think about them.
So, this is a sex issue?
Because the word transsexual has the word "sex" in it, people often think it's mostly
about sex. While that's sometimes part of it, transsexuals are usually more interested
in getting their bodies to match their feelings. For me, it's really about how I am
perceived in day-to-day situations.
So, this is a gender issue?
Yep. There are many kinds of transgendered people, and among them are
Transgendered is a general term for crossdressers, transsexuals, female and male
impersonators, drag queens/kings, Intersexual, gender dysphoric, and those for whom
other gender labels do not fit. I usually tell people I'm a transsexual to be specific, and
that I'm part of the transgendered community, which encompasses all of us.
I totally understand your situation. After all, I saw "Tootsie."
No, it's not like "Tootsie," or "Some like It Hot," or "Bosom Buddies" or "Mrs. Doubt
fire." Comedies like those are funny because the male characters are forced by
necessity to dress as women, after which the hilarity and hijinks ensue. The Ladies'
Night guys for Bud Light are funny in the same way, because in the real world they
would never pass as women. Let's hope I'm not humorous for the same reason.
So, more like RuPaul?
Um, no. RuPaul is a drag queen, as is Dolly Parton. They are entertainers who use
excessive femininity in their acts. Torch Song Trilogy, La Cage Aux Folles, Priscilla
Queen of the Desert, the Birdcage, and Paris Is Burning-- they're all about drag
queens. In the same vein are female illusionists whose goal is to portray a convincing
act of femininity onstage and sometimes off. Maybe you saw The Crying Game or
have been to the Baton nightclub. Those would be examples of very good female
illusionists (they get touchy about the word "impersonator," and you don't want one of
them mad at you.
So, more like Mary Albert?
Um, no. Mary had a cross dressing fetish of some sort. Same with Dennis Rodman, J.
Edgar Hoover, and a huge list of other rather masculine men. Crossdressers get
sexual or emotional satisfaction from touching or wearing women's clothing. Almost all
are straight males. The generally accepted number is around 1 in 50 men.
Do the math, and that means there's about one on every floor at here (except 41, now
that [my ex-boss] left).
So, like a hermaphrodite?
I've been describing what I'm not to clear that up first. One last thing I'm not is
intersexed. An Intersexual (hermaphrodite) is a person who is born between (inter)
sexes, having partially or fully developed pairs of female and male sex organs.
"Intersexual" is usually preferred over the word "Hermaphrodite". These conditions are
genetic and occur about as frequently as twins. And no, I have no inside info on that
urban legend about Jamie Lee Curtis being one.
OK, OK, you're a transsexual. What does that mean?
Transsexuals feel their body does not match the way they think and feel, and they
seek to remedy this by changing their body to match their mind. There are almost as
many female-to-male transsexuals as there are male to female. For some reason,
FTMs are largely ignored-- probably because they almost invariably are
indistinguishable from genetic men. The effects of testosterone on females are more
dramatic then the effects of estrogen on males (think East German Olympic
swimmers). Plus, I've never met a female-to-male whom I could tell without their
outing themselves to me. And no, I have no inside info on that urban legend about one
of the Victoria's Secret models being a transsexual.
So are you, like, gay or something?
Gender identity and sexual orientation are separate traits, although most people
don't think about them as separate. There are straight transsexuals and gay
transsexuals, etc. I haven't felt like dating much anyway, so it hasn't been an issue. In
other words, there are also loser transsexuals.
While transsexuals are different from gays and lesbians, we have many of the same
issues, since we are all going against what society has constructed as appropriate
gender behavior. The Stonewall Riot that sparked the gay rights movement in this
country was instigated by drag queens, which is why they marched first in the
Stonewall 25 parade. Several women's groups have also embraced our issues, most
recently the National Organization of Women. NOW has acknowledged that
transsexuals totally disrupt gender-based stereotypes by forcing people to think about
how much of it is merely social instead of "natural."
How did you get this way?
Plain truth is, nobody knows what causes this, although theories abound. Many
people believe there is a biological component. The most common theory involves
hormones affecting fetal brain development. But again, no one knows for sure.
Personally, I don't really care what the cause is, anyway. I've felt this way as long as I
can remember, and I think it's better to look forward than backwards.
I don't think of being transsexual as a blessing or a curse. I just think of it as a trait,
like being right-handed or tall. Unfortunately, any trait carries with it certain social
stereotypical presumptions. The misconceptions transsexuals have to deal with are
that it's all about sex, or that we're just gay people who hate being gay. I just find that
living and interacting with others as a female feels right.
How did you know?
I knew something was up from earliest memory. I have several specific memories from
around age 4 or 5. I was frequently thought to be a girl when I was little, which I didn't
mind at all. By the time I was 8 or 9, I knew what a transsexual was, well before I even
knew the facts of life. I was scared to death to tell my parents how I felt, though. By
the time I got to middle school, I was starting to have a lot of problems with
classmates because I was effeminate, so I made every effort to act the way boys were
expected to. This strategy worked, and I decided that I'd be better off putting all that
behind me. Eventually, I decided I could manage my feelings without doing anything
By a few years ago, I started to realize that I was getting more and unhappy because I
wasn't addressing those feelings. I started therapy and quickly concluded what I
suspected early on. I began planning for transition several years ago, getting
everything taken care of prior to going full-time.
This included telling everyone outside of work, having electrolysis to remove my facial
hair (yeouch!), starting hormone therapy, growing my hair, developing a female voice,
and some cosmetic surgery. I have also legally changed my name and all documents.
How did you go about this?
The medical community has developed its own standards of conduct regarding sex
reassignment surgeries. They were created at a conference in the mid-60's and were
adopted as the world standard for sex reassignment surgeries. My transition has been
done according to these standards.
How long have you been doing this?
I got serious about it three years ago, and I've been living as female outside of work
for over a year. All my friends and family know, and everyone has been great so far. I
hope you'll continue that trend.
Why are you switching at work?
The final stage of the Standards of Care is the Real Life Test (RLT), which involves
living as a member of the desired sex for a period of time. This is to help transsexuals
determine if sex-reassignment surgery is right for him or her. Most psychiatric
professionals require a minimum of one year RLT before giving their approval for sex-
reassignment surgery. That's the stage I'm at now, and that's why I came out at work
Sex Reassignment Surgery (SRS) is the final event in the sex-reassignment
procedure. Although transsexuals have no reproductive organs (uterus/ovaries) the
final result is cosmetically and functionally indistinguishable from that of genetic
females. Some decide not to have this surgery, but I currently plan to have it.
What bathroom are you going to use?
I don't want people to feel uncomfortable about this, so I have volunteered to use the
bathroom in the workout room to avoid the issue. I've been using women's restrooms
when necessary for over a year without any problems-- it's just a bathroom, after all. If
some great need arises, I'll use one that's closer, but I'll do my best to plan ahead.
Are you doing this with insurance?
Our small numbers make transsexuals vulnerable to all sorts of discrimination, notably
from insurance companies. They classify transsexualism as "experimental," even
though the same hormonal therapy is covered for non-transsexuals, as is genital
surgery using many of the same procedures. The trend today is towards a full denial
of benefits for "transsexual surgery and related services."
It's exclusion #14 on Needham's CIGNA policy. In other words, if a healthcare provider
mentioned I was transsexual on an insurance form, my claim would be denied. So I
don't even bother trying to fight them. My transition costs have been out-of-pocket so
far, and I don't expect that to change. I've spent about $60,000 to date, with another
$20,000 to go.
So, when do you appear on Jerry Springer?
Every group has its share of kooks and idiots. Unfortunately, that's true of
transsexuals, too. Problem is, the morons who go on shows like Jerry Springer end up
getting more media coverage than the doctors, lawyers, and other professionals I
For example, my four closest transsexual friends are: an engineer, a geology
professor, an art student, and a computer programmer. They lead very normal lives
and seek to blend into society rather than stand out. That is my goal as well.
The other groups of transsexuals who get noticed are those who are visibly gender
variant. While they should get as much respect as those who are accepted as female,
they must deal with additional discrimination and harassment. They also have become
the cliché of what a transsexual is, since those who are accepted as female well do
not get noticed.
I'm sure you have encountered several transsexuals without even knowing. I have
been fortunate enough to go about my life without getting "read" or "clocked" very
often. While I'm not ashamed to be a transsexual, I hope it eventually becomes a very
incidental part of my life so I can get on with more important things.
When does your she-male porno flick hit the stores?
Another thing that doesn't help the misconceptions about TSs is the sexualization of
our condition by the sex industry. Some people consider transsexuals exotic. Because
all of this transition stuff is very expensive, and since a lot of teenage TSs are kicked
out of their houses or driven out of school, they have limited financial options.
Some turn to sex work to survive. And the porn industry is always ready to exploit
fetishes, so it's a lucrative option for some. I feel they have every right to do what they
must to survive. However, it doesn't help those of us who don't want to be objectified
or considered sexual novelties. Last thing I need is Eddie Murphy offering me rides in
exchange for fondling my feet (as is his habit, according to my sources).
What if I call you the wrong name?
I know that's going to happen. It took my family and friends a while to switch, too.
Don't worry about it. You'll use the other name, other pronouns etc., even if you're
trying hard. I'm not touchy, and I try to have a very good sense of humor about the
whole thing. I know this is prime comedy material, and I can laugh along with good-
natured joking. A perfect example is [my boss's] e-mail he sent me after I told him.
THAT cracked me up.
What should I do if I have other questions?
1. Everyone is welcome to stop by and talk with me. I'm happy to answer any
questions (well, almost any), and I assure you I will tell no one what you asked me.
Obviously, I'm pretty good at keeping things secret.
2. If you don't feel comfortable talking with me, you may ask [our department
manager], who can then get an answer from me and get it back to you anonymously.
I have also left with Jan a book that addresses the common questions in greater
depth. It's titled Transsexuals: Candid Answers to Private Questions by Gerald
Ramsey. It's by a therapist, and his emphasis is on therapy matters, but he covers all
the big issues. While I don't agree with the whole book, I think it's pretty good.
3. If you don't feel comfortable talking with Jan or me, I've listed some books, articles,
websites and movies I feel deal with the subject in a good way. I have copies of all in
my office or you should be able to browse or buy most of these in a larger bookstore
like Borders or in any of the gay/lesbian bookstores in Chicago:
Transgender Warriors, by Leslie Feinberg. (Beacon Press, 1997) Leslie is a
female-to-male, and she's compiled an excellent historical overview of
Sex Changes: The Politics of Transgenderism, by Pat Califia (Cleis Press,
1997) Pat has written an outstanding outline of transsexual history in the U.S.
since the mid-fifties, focusing on contemporary issues.
Conundrum, by Jan Morris (Henry Holt & Co.). Jan is a world-renowned travel
writer. She has written a fascinating autobiography recalling her days
accompanying the first expedition to scale Mt. Everest, up through her sex
change and life after. It's easily the best-written account.
My Story, by Caroline Cossey (Faber and Faber, 1991). Caroline's
autobiography tells of her sex change and subsequent career as an
international model under the name "Tula." Her appearance in a James Bond
movie and growing fame led to her outing by the British tabloids. Maybe you
saw her photo in an obnoxious Sauza Tequila ad a couple of years ago that
said "she's a he" across her chest.
"The Third Sex" by John Taylor. Esquire Magazine, April, 1995, pp. 102 ff. This
is a very accessible article that should be available in Needham's Info Center.
The internet has been an excellent resource for transsexuals, since we're
scattered all over the country. America Online has the Transgender Community
Forum (Keyword: TCF), and the other commercial providers have similar areas.
Here are a couple of good websites:
o Dr. Anne Lawrence is an physician and friend who maintains a website
about medical issues for transsexuals at:
o Diane Wilson is a friend who maintains an updated version of the
transgendered FAQ (frequently-asked questions) at:
The best movie on transsexualism that I've seen happens to be playing at [a
local theatre] this month. It's a Belgian film called "Ma Vie En Rose" (My Life In
Pink). It's in French, subtitled, and tells the story of a six-year old dealing with
transsexual feelings, and how that affects his family and their neighbors. The
director was deeply influenced by Tim Burton in his attempt to capture the
mindset of a six-year-old. I highly recommend it, not just because of the subject
matter. It has a very refreshing tone and look, and was one of the best films I
saw last year-- very funny, very sad, and very sweet.
I got really great feedback from this letter, because it was the right mix of facts and
entertainment for my audience. If yours is right for your audience, it will make a
tremendous difference in how smooth your transition is.
My first weeks full-time
Shortly after I came out at work and passed around the document above, I received
notes not only from coworkers, but even partners and spouses of co-workers. One of
these responses was from a freelance writer interested in profiling my work transition
in the Chicago Reader, a weekly focusing on social and cultural news from a generally
I've excerpted the sections that outlined why I was reluctant to do so:
Luckily, I've managed to keep this job and its badly-needed income level. I handled
things about as well as I could, and I've seen an outpouring of support greater than I
could possibly have imagined. This may sound silly and clichéd, but it actually
restored my faith in humanity. However, I know very well there's a side at work I don't
My work partner is ambivalent at best. For a while he asked to work with someone
else, but now we have an uneasy arrangement to continue. Management has been
great, but I don't work with management on a daily basis.
Where you find this all fascinating, a lot of people are deeply disturbed by it and find
the whole thing sick and repulsive, especially guys. It's gotten back to me that some
guys at work have expressed their horror "that someone would actually want to cut
their dick off." The fact they reduce the whole thing to that inaccuracy says a lot about
how misunderstood I still am despite my best efforts. It also makes me wonder just
how many people feel this way about me. A very smart woman said, "Don't count on
people at work for validation," and I haven't. But those sorts of comments evoke the
bad old days of middle school, or the bad old days in 1996 when I pretty obviously
transgendered and would get ridiculed if I ventured outside.
As long as I stay at this job, I will always be "the transsexual." Some people will get
past that; most won't. The only reason I've stayed in advertising (or even started, for
that matter) is because I need a great deal of money quickly that didn't require much
mental energy. The people here who are disturbed tend to stay far away, but I feel the
less attention I draw to myself, the better. The initial buzz is finally dying down now,
and I worry an article might stir things back up.
The other problem with an article on me is that I'd basically be exposing myself to the
criticism and judgment of an even larger audience at a time I think I'm still too fragile to
weather that. I'd also be jeopardizing my precarious work situation.
It can throw me into a funk just to have someone at work accidentally say "he" when
referring to me. Even though I'm sure a lot of the Reader letters and co-worker
interviews would be positive, I'm not sure I'm ready for strangers commenting on my
looks or attitude or "lifestyle" with absolute candor.
This whole situation is just barely under my control now. To introduce an element over
which I have no control makes me very nervous. I had a similar offer in 1996, when I
was approached by Dateline NBC. They were looking for someone articulate to follow
during a year of transition. They wanted someone just starting out. I couldn't come up
with a good excuse for having a camera crew following me around work, so I ended
up reluctantly turning it down.
They ended up profiling a very clever FTM Harvard student named Alex. Since then,
he's been slammed all over the place, including a 10-minute slam fest on Politically
Incorrect on 3/19/98.
In the case of Dateline, it was mainly timing, but also the privacy/fragility concern. I
feel like a wobbly-legged newborn fawn not yet ready to face the jackals. My instinct is
to hunker down in the grass till I'm stronger.
The profile that gives me even greater pause is the PBS documentary "Man Into
Woman." In it, a smart, humorous, gentle, and very emotionally delicate woman was
kind enough to let a filmmaker follow her.
A large part of it was about her work situation-- she did graphic design in an open
environment. She was able to keep her job, but eventually she left. This happens to
almost all TSs. As with your thoughts for a story, they interviewed co-workers about
their feelings. They spoke the thoughts I have no doubts are being thought by my co-
workers: "I'll always think of him as a man," "guy in a dress," etc. It was a great
documentary, but very honest, brutally so.
So much for what a hothouse flower I am. There's another important aspect of privacy.
While I will always identify as transsexual, I want to keep the option of "going stealth."
Being accepted as female without question is a privilege few transsexuals ever enjoy,
and those who do usually try move on to a life where no one knows. It's hard to
describe how powerful a draw this has: to be able to live my life in a way that feels
right to me, in a situation where no one is able to judge me. The trade-off is you live in
fear of being outed. I still have a lot of decisions to make, and I feel the more private I
remain, the more options I have. I suspect I'll end up being pretty public about my
identity, but I have to look again at the price I'll pay for that. In the meantime, I'm
savoring the bliss of being accepted as female for a moment.
So, to sum up: I have declined, and it may well stay that way. However, I'd be happy
to meet and talk at some point. I appreciate the interest and respect you've shown,
and I'd be happy to answer any additional questions. I also have a few prurient
curiosities of my own about the twisted lifestyle of a freelance writer.
A reader writes with good advice:
Most transsexuals are eventually faced with the same dilemma, lake of job to actually
finance the transition costs. Social welfare is usually the only choice, that and
I have been in this situation, which is NOT enviable in the least, I have learned that
there are much better ways to discover one's sexuality, but I had no choice, it was
either that or not be able to eat. I did it for 6 months and it left traces that will be in me
for the rest of my life.
How to prevent that one may ask? By finding a job is the first and foremost answer,
which is usually replied by: yes but I get refused everywhere I apply for.
Yes, it is true. I am in Computer Programming, my Resume can get me appointments
in 24 hours, but when I am forced to give them my actual legal papers, POOF! No
news of them and if I push the issue, they give me stupid reasons for not hiring me
like: The client took someone from the inside to fill in the post, we are looking for
someone that actually currently live in the correct city, no, if you move it will not do.
And tones of stupid things like that. But there IS hope.
First thing you have to do is work out your PHONE VOICE!!!! One thing I learned,
voice is feminizable if you really work at it. Tape yourself and listen. One good way is
to use answering machines services from your phone provider; you talk over the
phone and leave a message. Listen to it and see how you sound over the phone. First
time is traumatizing but with practice, you can have a feminine voice, especially over
There is a couple of good voice feminization listed on Anne Lawrence's web site at:
http://www.annelawrence.com/speechindex.html and they do work, i managed to get a
99% pass rate over the phone and 95% pass rate in person... Very rarely, when i am
tired or sick, those numbers may go down but with carefulness the voice is ok.
Getting a job:
I have discovered by chance that there is one work area that doesn't look at what you
look but rather at your performance and that is phone surveys and phone solicitation.
In one year, I went from earning around 6000$ Canadian to earning 12000$ Canadian
per year. Some might say it is not much, but it is still double what you can get from
being on social welfare and so twice the amount of money for transitioning.
First thing is to find a place that do things like fund raising for charity organizations,
those places will hire ANYONE that wants to work and will give you the chance to start
learning the tricks of the trade. Me I spent 6 months there and learned. Then, Find a
better place, one that pays a regular salary. Me I now work for a Survey firm in my
town, it pays me good money for a steady shift (35 hours a week) and with patience
and good work I made it to senior interviewer. I now have an assured job for my
transition time. It is not the same as my old salary but it IS a salary.
I hope this info helps someone out there, those firms (survey, charity funding, phone
clientele service etc) are ALWAYS looking for someone to hire and will hire ANYONE
with good communication skills, no education needed and will accept and usually with
a little talking understand what and who you are, me at work for everyone I am a
woman even though they all know I am a transsexual. On top of earning money I have
the satisfaction of being accepted as I am.
As with most women who transition, I left the job where I transitioned about a year
after I came out. After about a year of freelance, I took a job making about twice what I
was making before transition. I am treated differently at my new job, and it's allowed
me to be much more comfortable. I generally recommend switching jobs, transferring,
etc. if it's an option.
Unfortunately, my experience is not typical. In order to have a chance at a smooth
transition that does not cause a career setback, it's vital that you plan very carefully. I
can also say with confidence that the primary reason my work transition has gone well
is because I pass pretty well. I know that's sad, unfair, etc., but it's a simple fact of the
world at this time. Someday the world will judge people on their merits rather than their
appearance, but most people are not that enlightened yet.
I consider myself very lucky to have avoided many of the pitfalls of work transition.
Much of my luck is simply because of my race, income bracket, and level of education.
However, maintaining my self-esteem, planning carefully, and focusing on appearance
and assimilating into mainstream society allowed me to remain in corporate America.
With a little luck and a lot of planning, you too can not only survive, but flourish.
Corporate America served me well as far as a good income during transition, but I am
now in the process of moving into entrepreneurial work I couldn't do during transition.
It's great to be able to take a chance without worrying about losing much-needed
transition income. With any luck, this new direction will allow me to focus full-time on
creating projects that will help people and make them think, all while earning a living.
It's scary, but exciting. Once you have successfully navigated transition, don't stop
there. You have done something most people could never dream of doing. In fact, you
have been able to achieve your childhood dream-- how many people can say that?
While you have that confidence and momentum, I urge you to keep pushing and follow
your heart with the same energy and conviction you used to pursue transition. Just
imagine what else you can do if you can do that? Challenge yourself again-- you know
you can do whatever you set your mind to!
©1996-2004 Transsexual Road Map. All rights reserved.
This page last updated September 16, 2003
Early transition: Coming out to parents
Coming out to parents
This is an extremely delicate thing which must be done after considerable thought. My
parents reacted very differently than I expected (mom freaked, dad was totally cool).
Everyone reacts differently.
Before you come out to your parents, read this section and check out this page of
questions to consider before coming out.
I think the common things that make parents freak out are:
They think it's their fault
Mine did. They'll think it's because they were too lax, too strict, let you play with a doll,
dressed you in pink once, and didn‘t keep your hair short, all kinds of things. Try to
assure them you were born this way.
A lot of parents will lump TS stuff right in with being gay. They'll start quoting the Bible
and dragging you down to see the minister, etc. You might check out my page on
religion for information if you think your parents are going to have a religious
meltdown. Also, this might sound weird, but a lot of religious parents are actually more
tolerant if you're TS than if you're gay. If you like boys but are a girl, you still fit into the
heterosexual mode for them. Also, some parents see being TS as something you can
be born with like an intersexed condition. Some people have had luck explaining this
They like to think they totally know their kids
I think this was my mom's big problem. My news totally rocked her world. She did not
see it coming at all, even though I was often thought to be a girl by strangers when I
They fear the unknown
I told my parents before I was presenting in girl mode. I'm sure this conjured up all
sorts of images for them. They probably thought I'd look like Mrs. Doubtfire or Fred
Flintstone in a dress. Once they saw that I could walk around in the world without
anyone noticing anything unusual, they got much more relaxed and accepting.
They worry about your future
It might be hard to believe at times, but your parents love you and want you to be
happy. Sometimes they think you have "chosen" a difficult path in life that will be full of
loneliness and hard times. Parents tend to protect their children, and they worry they
cannot protect you from the cold world out there.
They're afraid what others will think
Besides their own fears that they did something to cause this, they will probably worry
that others will think the same thing about them. This can seem kind of selfish
sometimes, but many parents do this. My mom was very worried what her ultra-
religious dad would say. In fact, she still hasn't told him, though my grandmother
knows. They will worry what neighbors, friends, coworkers, family, etc. will say and
think, not just about you, but about them, too.
They think you've been brainwashed
They'll think this here internet or the Jerry Springer Show or something has gotten a
hold of your brain, or you have been recruited by some gay person or TS. If you are
seeing a therapist, they might blame the therapist, too.
Read these pages!
Here's a great FAQ page you can send your parents to or print out.
OutProud has a copy of a great brochure.
The Human Rights Campaign has a HUGE section on coming out.
Questions to consider before coming out <-- MUST READING!
Check out this coming out info. This is written for Asian Pacific Islanders, but it works
Random thoughts about coming out
Sometimes in life we end up displeasing our parents. Often that's OK, even
We can't pick our parents, and they can't pick us.
Some parents might use threats like kicking you out of the house, cutting you off
financially, or even physical abuse. Some might even threaten suicide in an attempt to
control you. However, there are things beyond their control, which can be very
troubling for them. When you are under 18 and living at home, you are completely in
their control. That means you have to work within their control.
Many people fear change, even if it would be change for the better. Not just parents,
either. You might, too.
You should count on ZERO support from your parents, financially or emotionally. Do
everything you can to get their support, but don't assume it's going to happen for sure.
It may take time and effort. If they come through, it will be a pleasant surprise. Don't
count on it until you're done, though.
You obviously love and accept your family despite some of their characteristics. They
should reciprocate for you. If they don't, then something is getting in the way of their
Transition requires realistic expectations and self-acceptance. You must be OK with
who you are before you come out to your parents. Without realistic expectations and
self-acceptance, you‘re coming out and your transition will not succeed.
Many TSs spend so much of their lives trying to please others that they don't take the
time to look inward and do what would please themselves.
If you know in your heart that you should transition and have no doubts, then you
should share this with your parents in a carefully planned way.
This page last updated June 27, 2003
Support – Commonly Asked Questions
Questions and Answers
Is there something wrong with being gay, lesbian, bisexual or
No. There have been people in all cultures and times throughout human
history who have identified themselves as gay, lesbian, bisexual or
transgender (GLBT). Homosexuality is not an illness or a disorder, a fact
that is agreed upon by both the American Psychological Association and the
American Psychiatric Association.
Homosexuality was removed from the Diagnostic and Statistical Manual
(DSM) of the American Psychiatric Association in 1974. Being transgender
or gender variant is not a disorder either, although Gender Identity
Dysphoria (GID) is still listed in the DSM of the American Psychiatric
Being GLBT is as much a human variation as being left-handed - a person's
sexual orientation and gender identity are just another piece of who they
are. There is nothing wrong with being GLBT - in fact, there's a lot to
What are wrong are discriminatory laws, policies and attitudes that persist
in our schools, workplaces, places of worship and larger communities.
PFLAG works to make sure that GLBT people have full civil rights and can
live openly, free from discrimination and violence.
What is sexual orientation?
A person's sexual orientation is defined by their enduring emotional,
romantic, sexual or affectional attraction to other people. Heterosexual (or
straight) refers to people whose sexual and romantic feelings are primarily
for people of the opposite sex.
Homosexual (or gay and lesbian) refers to people whose sexual and
romantic feelings are primarily for those of the same sex. The term lesbian
refers to women who are homosexual.
Bisexual (or bi) refers to people whose sexual and romantic feelings are for
people of both sexes. Other terms that people use to describe their sexual
orientation are "queer" and "questioning."
What is gender identity and expression?
A person's gender identity is their internal sense of being male or female.
Gender expression is how someone presents their gender to the world. We
all have a gender identity, and we all have ways of expressing it. Our
society has a narrow view of what it means to be a woman or a man, and
we learn that from an early age. Those who are visibly gender-variant face
increased risk of harassment in school, unemployment, homelessness, and
hate violence, lack of access to health care and loss of custody of their
children. But many create supportive communities where they can be who
they are. PFLAG envisions a society that embraces everyone, including
those of diverse gender identities.
What does Transgender mean?
A transgendered person is someone whose gender identity or expression
differs from conventional expectations for their physical sex. The term
transgender is used to describe several distinct but related groups of
people who use a variety of other terms to self-identify. Transgendered
people can include transsexuals (not all transsexual people need or want
sex reassignment surgery), masculine women, feminine men, drag
queens/kings, cross-dressers, gender queers, two-spirit, butches,
transmen, transwomen, etc. Like other people, transgender people can be
straight, gay, lesbian or bisexual. More about trans issues.
Who are intersexed people?
Intersexed people are individuals born with anatomy or physiology, which
differs from cultural and/or medical ideals of male and female.
The medical term "hermaphrodite" has been commonly used, but is not
accepted by many intersex people. It is standard medical practice to assign
a sex at birth to individuals born with intersex/atypical anatomy or
physiology and to perform surgeries beginning in infancy and often
continuing into adolescence, before a child is able to give informed
consent. The Intersex Society of North America has labeled this practice
genital mutilation and opposes surgery on infants and children.
How are sexual orientation and gender identity determined?
No one knows exactly how sexual orientation and gender identity
determined. However, experts agree that it is a complicated matter of
genetics, biology, psychological and social factors. For most people, sexual
orientation and gender identity are shaped at any early age. While research
has not determined a cause, homosexuality and gender variance are not
the result of any one factor like parenting or past experiences.
It is never anyone's "fault" if they or their loved one grows up to be gay,
lesbian, bisexual or transgender.
If you are asking yourself why you or your loved one is GLBT, consider
asking yourself another question: Why ask why? Does your response to a
GLBT person depend on knowing why they are GLBT? Regardless of cause,
GLBT people deserve equal rights and to be treated fairly.
Can gay people change their sexual orientation or gender identity?
There are religious and secular organizations which sponsor campaigns and
studies touting that GLBT people can change their sexual orientation or
Their assertions assume that there is something wrong with being GLBT -
the largest problem is, in fact, society's intolerance of difference. PFLAG
believes that it is our anti-GLBT attitudes, laws and policies that need to
change, not our GLBT loved ones.
Many of the studies and campaigns are based on ideological bias rather
than solid science. Claims of conversion from gay to straight tend to be
poorly documented, full of flawed research with a lack of follow-up.
No studies show proven long-term changes in gay or transgender people,
and many reported changes are based solely on behavior and not a
person's actual self-identity.
The American Psychological Association has stated that scientific evidence
does not show that conversion therapy works and that it can do more harm
than good. More on "conversion therapy."
How does someone know they are gay, lesbian, bisexual or
Some people say that they have "felt different" or knew they were
attracted to people of the same sex from the time they were very young.
Some transgender people talk about feeling from an early age that their
gender identity did not match parental and social expectations.
Others do not figure out their sexual orientation or gender identity until
they are adolescents or adults. Often it can take a while for people to put
a label to their feelings, or people's feelings may change over time.
Understanding our sexuality and gender can be a life-long process, and
people shouldn't worry about labeling themselves right away.
However, with positive images of gay, lesbian, bisexual and transgendered
people more readily available, it is becoming easier for people to identify
their feelings and come out at earlier ages. People don't have to be
sexually active to know their sexual orientation - feelings and emotions are
as much a part of one's identity. The short answer is that you'll know when
Why do people "come out"?
Coming out is a way for gay, lesbian, bisexual and transgendered people to
live their lives openly and honestly. Hiding one's sexual orientation or
gender identity can be very stressful, lonely and isolation. Coming out is an
affirming way for GLBT people to connect with others in vibrant and diverse
GLBT communities. GLBT people come out because staying "in the closet"
keeps the important people in their lives from knowing about a big part of
Coming out can be a difficult decision, because many GLBT people fear
rejection from their families, friends, employers and religious institutions.
It is important to turn to supportive people for advice, and to have a plan if
a person has reason to fear how their parents, employers, classmates or
teachers will respond to them coming out. PFLAG can help.
For many, the stress of keeping a secret from the people they are close to
ultimately outweighs the fear of losing acceptance and love. Coming out is
an important decision that people should be able to make on their own
terms - when they want to, to whom they want to.
How do I come out to my family and friends?
There are many questions to consider before coming out. Are you
comfortable with your sexuality and gender identity/expression? Do you
have support? Can you be patient?
What kind of views do your friends and family have about homosexuality
and gender variance? Are you financially dependent on your family?
Make sure you have thought your decision through, have a plan and
supportive people you can turn to. And be prepared for the stages that
your family or loved ones may go through upon learning you are gay,
lesbian, bisexual or transgender.
Coming out can cause shock, denial, guilt and grief. However, PFLAG was
founded because of the unconditional love of parents for their gay
children. Your loved ones will need time to adjust to your news, the same
way you may have needed time to come to terms with yourself. However,
true acceptance is possible, especially with education and support.
What do I do if someone comes out to me? How can I support my
GLBT loved one?
Learning that a loved one is gay, lesbian, bisexual or transgendered can be
a difficult discovery. It can send you on an emotional roller coaster ride.
You may feel like you have lost a loved one. Remember that this person is
the same one that you loved before they came out to you - they have just
shared another part of themselves with you. Feelings of grief, guilt and
denial are natural given some of our society's attitudes towards
homosexuality and gender variance. However, you owe it to your loved
one -and yourself- to move towards acceptance and understanding.
Whatever your reaction, reassure your loved one that they still have your
love. PFLAG offers local support and education to help with that
process. Dos and Don'ts for Families & Friends.
Can gay people have families?
YES. Gay, lesbian, bisexual and transgendered people can have families.
Same-sex couples do form committed and loving relationships. In the
United States many same-sex couples choose to celebrate their love with
commitment ceremonies or civil unions, although these couples are not
offered the rights and benefits of marriage.
In Vermont, same-sex couples can have a state civil union that offers some
of the benefits of marriage to resident couples. More and more GLBT
couples are also raising children together, although state laws on adoption
and foster parenting vary. And of course, many GLBT people have the
support of the loving families they were born into, or the families that they
have created with their other friends and loved ones.
How can I reconcile my or my loved one's sexual orientation with
This is a difficult question for many people. Learning that a loved one is
gay, lesbian, bisexual or transgendered can be a challenge if you feel it is
at odds with your faith tradition. However, being GLBT does not impact a
person's ability to be moral and spiritual any more than being heterosexual
Many GLBT people are religious and active in their own faith communities.
It is up to you to explore, question and make choices in order to reconcile
religion with homosexuality and gender variance. For some this means
working for change within their faith community, and for others it means
leaving it. There are many resources to help you in this journey.
What about HIV/AIDS?
Since the onset of the HIV/AIDS epidemic, many people have viewed
HIV/AIDS as a gay issue. The GLBT community mobilized early in the
epidemic to formulate a response that included educating communities,
creating visibility to reduce stigma, developing prevention strategies and
advocating for appropriate care and treatment options for People Living
with AIDS (PWAs).
Yet the epidemic has continued to progress and take its toll on many
communities globally. Still, despite overwhelming statistics documenting
the spread of HIV/AIDS in other communities, many people still choose to
view HIV/AIDS as a gay issue.
The truth is that being GLBT does not give you AIDS. Certain sexual
practices, certain drug use behaviors and other factors can put you at risk
for catching HIV, the virus that causes AIDS, as well as other sexually
transmitted diseases (STDs). Everyone needs to get the facts about
HIV is spread by sexual contact with an infected person, by sharing needles
and/or syringes (primarily for drug injection) with someone who is infected,
or, less commonly (and now very rarely in countries where blood is
screened for HIV antibodies), through transfusions of infected blood or
blood clotting factors. Babies born to HIV-infected women may become
infected during birth or through breast-feeding after birth.
While research has revealed a great deal of valuable information, a lot of
false or misleading information, often fueled by homophobia, continues to
be shared widely through the Internet or popular press, so be sure to
consider the source when educating yourself about HIV/AIDS. More
information about HIV/AIDS.
If your loved one is presently HIV-positive or has AIDS, they now need
your support more than ever. You should know that you are not alone.
There are numerous local and national organizations that can help you with
medical, psychological and physical care. PFLAG can refer you to other
parents, families and friends in similar situations, and resources specific to
Why should I support gay, lesbian, bisexual and transgender
GLBT rights are not special rights. PFLAG works to achieve equal civil rights for all
people, including our gay, lesbian, bisexual and transgendered (GLBT) loved ones.
Because our GLBT children, friends and family members deserve the same rights as
our straight ones; because discrimination based on sexual orientation and gender
identity is still legal; because a GLBT person can be fired from their job simply
because of who they love or how they express their gender; because same sex
couples cannot legally be married anywhere in the United States; because GLBT
youth face constant harassment and abuse in schools across the country; because
the road to full equality and acceptance is a long one - PFLAG NEEDS YOU to stand
up and join us in our work. YOUR LOVED ONES NEED YOU to take a stand for
fairness. By being open about yourself and your family you are already helping to
dispel misinformation and fear. You can take the next step by joining PFLAG as we
support, educate and advocate for a better world.
Another reader sent along the following tips based on her experience:
How have they responded to other "crisis-proportion" events in their life?
This is a pretty good metric of how they will respond to this. Has a sibling done
something (unexpected pregnancy, eloped, life crisis, etc) that unsettled everyone,
and how did they respond? How did they respond to their friends' kids crises (although
this is not as reliable a guide).
Do not fight with them during disclosure.
(I know it's hard - after all my planning I still did it). Calmly explain and listen calmly
and hear them out.
Do they have trouble listening to you, or taking you seriously?
Has your track record of past "hobbies" (funny they seem to look at it like this) been
flaky or are you serious about follow- through? Have you meant what you said in the
past, and said what you meant? (Not a show-stopper, but for the inconsistent it might
influence how they disclose - like through a letter, or just showing them progress over
time if this is possible in your situation)
Be prepared for a tidal wave of emotions to hit you from within after disclosure.
This knocked me off my feet - I experienced raw fear, even though I'm in my thirties,
haven't seen them for over a decade, and live across the country from them. Makes
me wonder what happened when I was younger that they aren't talking about (and
most likely never will). I still wish I could have seen this one coming - so if this can
help anyone, I'm happy :-) As a follow-on, keep a therapist on "standby" when you do
I found that once my parents knew, telling the rest of the family was easy, relatively
speaking. One sibling surprisingly sided with me, and even chewed my parents a new,
um, perspective, for what they did.
Finally, I guess I should have known better: I had tried to explain this to them back
while I was in college, but didn't even get to the "gender" part (I said that I wanted to
switch my major to psychology because I was "discovering something incredible").
They essentially shamed me into silence (I was away at school and the fear of losing
my newly found freedom caused me to hide this away deep inside). Sad that over
twenty years later the reaction was much the same, except this time I was stronger
and was more able to handle it. (Advice: Work on your self- image and self-confidence
before you tell them, particularly if they are the authoritative or religiously conservative
type. You may need to be strong for them as well as you). And, should the worst
happen (I pray for you that it doesn't), be prepared to walk away. Sad, but sometimes
it is necessary. I guess the song was right: "Know when to hold 'em, know when to
Another reader sent along this excellent piece:
A lot the ideas below are not specific to coming out. They are certainly not all from me
personally; I just collected them under this topic. Some are general remarks about
confrontations with a difference of opinion and a difference of interest. Some contain
some (known) psychological tips.
Some might sound standard advice to Sales people. That's not so strange as you
have to sell a difficult story. These remarks are all ingredients, you have to come up
with the recipe for the occasion and pick the right ones. Some are very personal
observations, so be sure to think this through for your situation.
Work on self confidence before you come out. If you show yourself more
certain, it is less likely that people will start picking on you.
It is easier for another person to accept a convincing attitude. An
uncertain attitude can give rise to fear an aggression. This you do by
preparing. Know very clearly for yourself what you want and why want it.
Write it down on paper. Question yourself critically. (Cfr. the preparations
you have to do for your financial planning). If you have thought this
through well, you can deal with any questions and remarks which might
come. The three following observation can help to raise your self
1. Your feelings and struggle are not something to be ashamed of.
They are caused by a (medical) condition which is not well known
and poorly understood. It is not a choice you have or have made.
Even if you would push them away it now, they will certainly come
back later. Therapists can back up your statement.
2. You might have the impression that at a certain point you made a
choice. Most likely what you experienced is that you accepted
yourself as you are and not as what other people expected you to
be. That is not what I call would make a choice, but a good step
towards developing a more harmonious life.
3. You don't have to be ashamed for the therapy you want to follow
(HRT and SRS). For a TS person, the only known treatment with
an acceptable chance of success is to transition. This is
scientifically proven. All other treatments tried have a chance of
success which does not even come close.
4. The cause of TS is not known to date, although there are some
hypotheses. Possible reactions of others (typically parents or
other close relatives) to blame it on certain circumstances, on
their behavior or on them make no sense. They are completely
speculative. As the causes are not known, no one is to blame, as
no could have known. So don't blame yourself either.
Beware of your body language. Pay attention not to send out conflicting
messages (e.g. having an insecure pose while you say you feel
confident or vice versa). Say what you feel and feel what you say.
Stress the pain you feel from your current condition and the problems
you have in functioning like this. Doing nothing will not improve your
quality of life; quite likely things would get worse.
Most people will be more open to this (who would want to see someone
suffer) than the desire you feel to complete the transition and live in the
other role. Most people cannot relate to the latter or come close to
understanding. It is more likely to be rejected as whims. However, IMO,
the pain and the desire are both sides of the same coin, only most
people can read one side better than the other.
Adapt your message to the person or group you are addressing. Pay
attention to sensitivities and try to avoid them. Maybe you do not want to
stress your all your objectives immediately, and drape them with other
aspects of transition which your audience is more sensitive to. You can
decide to tell things gradually during multiple conversations. You might
have the feeling that you are holding back, but you are not. You just look
for the right timing.
Look for the right timing. This can be difficult. You might be almost
bursting to tell your story while something happens which makes the
atmosphere totally unsuitable for your message. In that case, hold your
breath, however difficult. You will not regret this.
Adapt your style to the style of your audience. If the person or group is
direct, be direct. In most cases people understand better if things are
expressed in a way they would express it. So is your audience direct,
indirect, rational, emotional, extrovert etc.
Try to put yourself in the position of the person or group you are talking
too and imagine yourself explaining from there point of view. Try to
imagine what your reaction would be if you were them.
Addressing a group as a group assures a well structured and uniform
communication to all members of the group. It also shows courage which
most people are susceptible to. Depending on the group, I think it is
important to brief the leader of the group first and assure his presence.
This does not have to be a leader in true sense, but maybe (one) the
most respected people by the group. He/She can control the group‘s
reactions while communicating and back you. The disadvantage is of
course that a lot of reactions can come to you simultaneously and that
one triggers another (escalation).
Addressing members of a group individually and selectively has the
advantage of having better control over the conversation and its
circumstances. However, your communication will not always be the
same or understood in the same way by different people.
Soon you risk that conflicting messages flow through the groups informal
communication network (yeah, nice words for gossip and backtalk). So
timing is very important. I think contacting all (most) individuals before
they start talking to each other is key. So this is most appropriately if
these people don't see each other to frequently or you can rely on their
Emotions: be prepared for emotional shockwaves. You will now best
who to expect them from. Sometimes they will come from unexpected
corners. Emotional responses are not necessarily a negative sign. They
will sometimes come from people who really care about you. The
response means that they are concerned with what will happen to you. I
personally find this most difficult to deal with because of the emotional
response which it can trigger within me. This will cloud my perception
and handicap me to react appropriately. If anticipated however, I stand
Not all emotions are what they look like. Anger and aggression can
sometimes be another face of fear. This can be fear for what the future
will bring for you, but most surely fear for what the future will bring for
them. How will they tell this to other people?
How will people react to this situation? How will this affect their lives?
Preparing some answers for them is key. Personally I like the idea of
using a printed folder with explanations and background. This can be
self-made but maybe better from an institute.
It brings the subject on a more neutral, objective terrain (this is not just
something from you) and gives it a serious label.
An emotional response to an emotional response can be quite all right
too, as long as it does escalate the original response. For example,
becoming angry because the other party is angry is often not a good
idea from my experience.
It might be well different for you. I had on several occasions tears in my
eyes because I felt hurt, treated unfairly or completely misunderstood.
The tears just came and passed on the right message to the other party
which backed off and tried to be more understanding. In my case, people
were not used to see me crying so this was a strong signal.
Again this might be different for you. Maybe becoming silent or the
opposite will do the same for you? The key thing is that the emotional
message should be a strong indicator that this is dead serious for you.
When things get too emotional, it is mostly a good idea to break off the
conversation. People won‘t be listening anymore anyway or are likely to
interpret statements incorrectly and twist them. However you need to
have an idea on how to follow-up. A second try is in general more
On the other hand, it gives everyone time to let the dust settle down and
think things through. Leaving something like your statement or a folder
can be of help there. Next time, you do not need to start from scratch.
PFLAG 1726 M Street, NW Suite 400 Washington, DC 20036
ph: 202.467.8180 fx: 202.467.8194
To Pass or Not to Pass? Is That the Question?
For years I've avoided trans spaces because transfolk are often so hung up on the passing issue.
You've probably noticed this, but it's not uncommon for hierarchies to be established based on
appearance and the perceived "seriousness" of the trans person. For example, in a large trans
support group, I've observed that the hierarchy usually goes something like this:
1. Attractive post-operative transsexuals
2. Attractive full-time pre-operative transsexuals
3. Passing (but not conventionally attractive) post-operative transsexuals
4. Passing (but not conventionally attractive) full-time pre-operative
5. Attractive full-time non-operative transsexuals
6. Passing full-time non-operative transsexuals
7. Passing full-time transgendered people
8. Pre-transition transsexuals
9. Other non-passing transsexuals
10. Cross dressers
11. Fetishist cross dressers
In a lot of situations it's almost like a caste system. You're not allowed to associate with people
who are significantly lower in the hierarchy than you, and this is enforced with a penalty of
social ostracism. I used to be mocked for hanging out with my friends who were cross dressers
because... well, I dun no, maybe because it would rub off on me and I would get cross dresser
cooties or something?
I have always hated these hierarchies, and ignored them as much as I could. I have a hell of a
lot more in common with an SM dyke who likes to put on chaps and a leather vest and be
called "Jack" than I do with a post-op transsexual woman who does not acknowledge that she
It's easy enough to criticize this sort of attitude because most people with a political
consciousness about inclusion and marginalization realize how stupid it is.
What I'm also noticing, though, is that over the last few months I'm feeling excluded from
radical trans spaces because I do place some stock in and build at least part of my identity upon
the fact that I'm a woman.
A trans woman, yes, no doubt, and that fact is fundamental to who I am. But sometimes I just
want to be me, ya know? I don't want to have to make a political statement with everything I
do. I don't want to have to out myself to every single person I meet in every single situation.
Do other dykes have to meet people on the street and say, "hi, I'm Julie, and I'm a lesbian?" Of
course not. It's rough enough to out myself to other dykes and have them immediately become
totally disinterested in me. Why in the world would I subject myself to that if I didn't feel up to
I am an activist. Trans Health is one of my activist forums, but it's not the only one. I am also a
vigorous supporter of queer rights, economic equality, feminist causes, and an advocate for
women in technology. I kind of feel like I've paid my dues and that I should at least sometimes
be given the benefit of the doubt.
I'm interested to hear what Trans Health readers have experienced in these areas. I think the
most important thing we can do is get this stuff out in the open so we can learn from it and
figure out how to respect the differences in people rather than judging and excluding them for
Want to be heard? Write your letter to the editor and email it to email@example.com. We
reserve the right to print your letter in an upcoming issue of Trans-Health. Your email address
will be withheld except upon request.
Choosing a gender therapist
Choosing a therapist
You will make some important choices of service providers in your transition:
Therapists (primary, and a second opinion for surgery letters)
Hair removal practitioner (see my page on choosing an electrologist or laser
Physician(s) (general, and possibly another one for hormones)
Plastic surgeon(s) (SRS and/or other feminizing procedures)
Financial adviser (recommended, not required)
Legal adviser (recommended, not required)
Key point: all of these people are being paid to provide you with a service. If you are
not satisfied with the service, say something. If that doesn't help, find another provider.
Finding a therapist
Self-acceptance and coming to terms with your feelings are the first order of business
in transition. For that, it's very useful to see a therapist. Even if you know how you feel
and know what you want to do.
Ask TG people and organizations in your area for recommendations. The key is
getting first-hand experiences and personal recommendations. To find people for this
Ask local TS women
This is the best way to get candid information. If you don't know any, try the
methods below to get in contact with someone.
Ask local providers of TS services
TG-friendly electrologists, doctors, etc. might be able to point you in the right
direction or put you in contact with patients for first-hand information.
Look through a national TG group
I recommend gender.org's resources by state, or the IFGE's site.You can order
Transgender Tapestry Magazine, which also lists therapists and TG groups by
Look through a local TG group
You can also use the TGForum's website to search for local TG groups who
can help you. Local groups are an excellent source of information. Most have a
newsletter you can get, and some even have hotlines. You might also consider
attending a meeting-- many people find the group support very important in
their transition, and the people there can help you find local resources.
You might try GLITSE (Gay Lesbian International Therapist Search Engine).
Look through newsgroup posts via Google:
Go to Google Groups advanced search.
1. Search for your city name in the top field
2. Type in newsgroup names in the newsgroup field: "alt.support.srs" then
repeat with "soc.support.transgendered"
3. Copy the email addresses of anyone from your area who has posted
4. Write to them privately, asking for a therapist recommendation.
What to ask clients
Ask about rates, hours, schooling, etc., but the main thing is to ask about the
therapist's style, opinions, and policies. Some therapists require more than others
before they'll recommend hormones or surgery. Some use a kind of weeding-out
policy, trying to test your conviction. Some feel they are gatekeepers who must keep
people from making mistakes, and require a lot of sessions. Others are much more
open or easy-going.
What to ask therapists
How many TS patients do you have?
How many women have you recommended for surgery?
How long have you been working with TSs?
What is your educational background?
o Remember, one of your SRS letter writers must, according to the
Standards of Care, be from a doctorate-level clinical professional: "If the
first letter is from a person with a master's degree (M.A.), the second
letter should be from a psychiatrist (M.D.) or a clinical psychologist
If the first letter is from the patient's psychotherapist, the second letter
should be from a person who has only played an evaluative role for the
What books on TS issues most influenced you?
Have you written any books or articles on the subject?
What got you interested in working with transsexuals?
What is your basic philosophy about how to treat this condition?
What is your opinion of the Harry Benjamin Standards of Care?
What is your hourly rate?
What length of session do you usually prefer?
Is it possible to do longer or shorter sessions?
How long do you usually see patients before you might OK them for hormonal
Are you affiliated with any endocrinologists or plastic surgeons?
Are you part of my insurance network?
Would you be willing to classify our sessions as depression in order to meet
What are your hours?
Do you have weekend or evening appointments?
Do you work from your home or from an office?
Don't be afraid to switch to another if necessary
I say this because too often I hear people say their therapist isn't being responsive to
their requests. If you feel that's the case, you should speak with them candidly about
that, and listen to their reason why. Keep an open mind, because they may be right.
However, if you are not satisfied with their reasons, don't get depressed or angry. Go
Continuing in a frustrating therapy relationship can be counterproductive and even
dangerous. It can lead to a point where unresolved issues boil over.
It doesn't have to. If you look around, you can always find a way to get things done.
Example: I have a friend who went to a gender therapist who said, "You're not TS...
you're just a swishy little faggot." No lie. While most people won't run into that extreme
an example, if it looks like your therapeutic relationship is not going to lead to the
outcome you desire, you should go elsewhere. My friend had her SRS this year, and
got letters from other therapists.
Don't stay with a therapist if the outcome you desire looks hopeless. Think of your TG
professional relationships like romantic relationships: if you're unhappy, you need to
talk about it. If you feel the relationship is worth keeping, you should try to work
through the issue at hand. If it seems hopeless, you should move on. Simple as that. I
had several service providers give me answers I didn't like, so I left. Don't settle. It's
your money. If no is their final answer, move on.
People say, "But I've made an investment in this therapist of this many sessions and
this much money." Well, you may need to write that off. Yeah, that sucks. If you want
to avoid wasting time or money, talk to others before choosing a therapist.
The best way to avoid getting in an unproductive therapeutic relationship is to read the
My general opinions on therapy
Keep in mind that if there's a specific thing you seek (such as hormones), you may be
able to get those directly from a physician without therapy.
However, I feel seeing a therapist is very important. I learned a lot in therapy, about
myself and about the best way to transition. I believe self-acceptance is the key to
transition, and therapy can help with this. The other important thing is realistic
planning and expectations, and again, a therapist can be very useful for helping shape
your plan based on your specific needs.
The biggest problem with therapeutic relationships involving a gatekeeper mentality is
that clients are prone to hold back information that might jeopardize their chance to
get the approval letters they seek. This can make therapy lees about helping you
adjust and more of an adversarial relationship. It's best to find a therapist you trust.
I have continued therapy after SRS and have found it very helpful. Often, emotions
and problems that were not adequately dealt with during transition can catch up with
you upon completion. I opted to go to a different therapist who has no experience with
gender issues following transition.
This page last updated March 30, 2002
Early transition: Safety
Part of my ongoing series of articles for young TS and TG women.
TG women face potential violence not only as young women, but also as
transgendered women. Because we have not had as many years of socialization as
women compared to others our age, especially when just starting out, it's easy to
forget that young women in their teens and twenties are the most common targets of
many violent crimes. Being a young woman is a very different dynamic than being a
young man. You might still feel like you, but others will perceive you and act toward
you in a very different way.
Violence and harassment against the lesbian, gay and transgender community is real.
Although violence is actually somewhat rare, it's important to remember that about
one TG woman a month gets killed in the US, and many more are seriously injured.
Even something as seemingly small as verbal harassment can be pretty terrifying
under certain conditions. I myself had a couple of touch-and-go moments before I was
passing well, but it's possible to reduce your risk by avoiding common problems.
I have met many young TG women who tend to take more risks than non-TG women
their age, like walking or taking the train alone, or taking drugs. However, the highest
risks we take can be when dating, especially if our date doesn't know our TG status.
A good friend of mine once called me from a restaurant and said triumphantly, "I'm on
a date with someone who would beat the shit out of me if he knew!" While this may
seem like some sort of ultimate validation that you pass, it's an excellent way to find
yourself in an extremely dangerous situation.
Many young TG women, especially in large cities, don't have cars and have to walk or
take public transportation a lot. If it gets past a certain time of night, you might
consider a cab or a ride from someone you know before heading out on foot. Even a
bicycle is a better option than walking. I have been walking alone in relatively safe
places like midtown Manhattan or Chicago's loop and been approached by men in
very aggressive ways.
Being out on the street at night is especially dangerous, even more so if you're alone.
For TG women, groups of young men are often the most dangerous types of street
encounters. They can sometimes get a pack mentality, especially if you are clocked.
It's very important to be careful when walking alone, especially at night or in unfamiliar
If you're going out, there are certain types of bars and party situations where you need
to be even more careful, and they usually involve young men (and probably alcohol).
Most of this is common sense, but I think it's worth reviewing. Learn to recognize
potential problems and warning signs in your daily routine. Not every attack can be
prevented. There are things you can do reduce your risk, though.
The most dangerous myth
There's a false notion that most violence against women is done by a stranger
jumping out of the bushes. The truth is this:
You are far more likely to be assaulted or killed by a date, coworker, or a friend
than by a stranger.
Being safe while out and about is important, but don't get fooled into thinking that
familiar situations with acquaintances are safe.
Most people think of kicks to the groin and blocking punches when they hear the term
"self-defense." However, true self-defense begins long before any actual physical
contact. The first, and probably most important, component in self-defense is
awareness: awareness of yourself, your surroundings, and your potential attacker's
The criminal's primary strategy is to use the advantage of surprise. Studies have
shown that criminals are adept at choosing targets that appear to be unaware of what
is going on around them. By being aware of your surroundings and by projecting a
"force presence," many altercations which are commonplace on the street can be
Stay alert at all times and tuned in to your surroundings, wherever you are. Awareness
is your best self-defense; know what is happening around you. Be especially careful if
you are alone or drunk. Watch where you are going and what is going on around you.
The same principles of defensive driving should be used when walking or going about
your daily activities: Look for potential problems, and be prepared to react to them.
The wearing of headphones while on foot or on public transportation can reduce your
level of alertness.
Trust your instincts
If you feel uncomfortable in a place or situation, leave right away and get help if
necessary. Don't assume a false sense of security because you are either surrounded
by people or in a remote area. If you think something is wrong, remove yourself from
the situation. Trust your gut -- if it doesn't feel right, it probably isn't.
Familiarize yourself with the area
Get to know the neighborhoods and neighbors where you live and work. Find out what
stores and restaurants are open late and where police and fire stations are located.
Plan your route in advance, and vary your routes whenever possible. Evaluate and be
aware of your surroundings. Use well-lit, busy streets. Keep a safe distance between
you and others, and always have an out (somewhere you can turn to run if you feel
Walk with friends or a group. When you are out late at night, having a friend
accompany you - don't go alone. Let someone know where you will be going and
when you will return. Avoid shortcuts, dark alleys, deserted streets and wooded
If you feel uneasy, trust your instincts and go directly to a place where there are other
people. Walk on the part of the sidewalk close to the street and away from shrubbery,
trees, or doorways. On less busy streets at night, it is sometimes safer to walk in the
street rather than on the sidewalk.
Walk as if you know where you're going. Stand tall. Walk in a confident manner, and
hold your head up. Keep your hands free and keep them chest high in crowds. Stand
tall and walk confidently. Don't make it obvious if you are in unfamiliar territory.
Handbags and accessories
A good purse is one with a flap that folds over the opening and fastens at the bottom,
and often has an interior zipper. The easiest purse for you to open is also the easiest
for a pickpocket to steal from. Flaps should be secured and turned toward the body at
all times. Backpacks are very easy to steal from; since it's less likely you'll feel
someone reaching into it.
A reader writes with advice on how to wear your purse:
Under a garment is fine, but be careful of wearing it diagonally across your shoulders
like that. I've taken a couple defense classes designed for women, and it was
demonstrated quite effectively to us that modern purses are NOT fragile. The strap is
often very strong. A man grabbing that strap and pulling on it will take your whole body
with him, and it's very easy to get hurt that way. Better to let him have the purse than
end up in the hospital with a broken ankle.
Wallets should be carried in an inside coat pocket and cash in a front pants pocket. A
rubber band tied several times around a wallet can increase friction and make it easier
for you to notice if you are being pick pocketed. Avoid wearing excessive jewelry. In
particular, keep necklaces and bracelets inside your clothing.
Don't carry large sums of cash. If you do carry cash, do not display it in public. If
possible, carry only identification, phone numbers, and the credit cards you will need.
Keep a list at home of credit cards and other important material you would need to
replace in case of loss. Separate your house keys from your car keys. Women should
keep their keys in places other than their purses. That way, if your purse is snatched,
you will still have your keys. Keep names and phone numbers of relatives or friends
on your person, in the event of an accident or emergency.
Elevators and entryways
Attacks often happen when you have your keys out: when you're closing up at work, in
the vestibule of your building, at your front or back door, at your laundry room, at your
car, or in elevators. Be especially aware as you enter or leave a building or car.
Before entering an elevator, look at the persons already in the car. If you are uneasy,
wait for the next elevator. If a suspicious person enters an elevator and you are
uneasy, and then get off right away.
If you notice a person in an elevator has not pushed a floor indicator button, do not get
off at your floor. Go back to the lobby and report the suspicious activity. Stand near
the control buttons. If threatened or attacked, sound the alarm and push several floor
buttons if possible.
Always park your car in a busy, well lit area. In multistory car parks, try to park as near
to the pay kiosk as possible. It is best to park in attended lots. If you must leave a key
with the attendant, leave only the ignition key. In all other cases, lock your car. When
going to your car, have your keys in your hand.
Also, holding them so that the sharp part of the key protrudes through your fingers
gives you a weapon. Always check your car before getting in - to make sure that no
one is hiding inside. Have your house keys in your hand before you get out of the car,
and vice versa.
Do not leave ANY packages or personal items in open view in the car. Place them in
the trunk. If you are in danger of being harmed or robbed, while in your car, start
sounding your horn until assistance arrives. If you feel you are being followed, drive to
the nearest police or fire station, or open filling station.
While waiting for a bus, train, etc., stand near others who are also waiting. Upon
arriving at your stop, be aware of those who get off with you. If you feel you are being
followed, go to the nearest occupied building and ask for assistance. After dark,
attempt to get off the bus in well-lighted areas. Use only well-lighted streets to reach
your final destination.
Carry a defensive item
Noisemaking device (recommended)
Consider carrying a whistle or other noisemaker, and sound it loudly if you are
accosted or feel threatened. I think those metal whistles that double as key chains are
a good idea.
If you're in an area where you feel uncomfortable, have your whistle in your hand and
ready. Hold your keys when going to and from your car, home and business. This will
save time and give you some security in having protection.
A reader wrote suggesting carrying a rape alarm (also called a personal alarm): "The
two I've got make the most god awful noise imaginable. A nice alternative to a
There are pros and cons to these. They are loud (like 130 dB or so), which might
scare an attacker off before they get to you, but they probably won't be as effective at
summoning help in some circumstances. Some come with a bright flashing strobe,
which can also disorient an attacker long enough to get away.
One advantage over a whistle is that these are hand-operated and don't require you to
blow in them. You can use them while running more easily, and you can be yelling
something at the attacker or to others while they're going off.
Other slight disadvantages are that they are sometimes a little on the bulky side, and
they're battery-operated, so you need to check the power regularly. Another reader
noted the ones with electronic sounds can sound like car alarms and might get
ignored by bystanders.
There are also aerosol-based products that are like the little air horns you hear at
sports events, but with a whistle sound. The problem with these is they only hold a
dozen or so short blasts, where the electronic devices emit a sound as long as the
battery holds out.
Some TS women can only scream loudly in their "boy voices," and some are reluctant
to do so, even in a potentially dangerous situation. A noisemaking device can be a
real boost to the decibel level you can generate.
A lot of larger hardware stores carry this stuff, but you might need to order them
online. Here's one place: http://www.securityplanet.com/alarms-pa.htm
Pepper spray, tasers, and other incapacitating devices (less recommended)
Any device you carry for protection may be used AGAINST you. Select such security
devices carefully. Pepper spray, tasers, etc. are somewhat controversial for this
reason. Surprisingly, 15-20% of people will not be incapacitated even by a full-face
spray. Also, if you're carrying it in your purse, you will only waste time and alert the
attackers to your intentions while you fumble for it.
Never depend on any self-defense tool or weapon to stop an attacker. Trust your body
and your wits, which you can always depend on in the event of an attack. A whistle will
often scare someone off before an encounter even happens. Don't just have it in your
purse if you're in a potentially unsafe situation. Have it out in your hand. If you feel
threatened, blow your whistle, bang garbage cans, honk your horn, or shout "fire!" to
Knives, guns, and other deadly weapons (not recommended)
I feel there are many pragmatic reasons not to own or carry a gun:
1. Many gun owners are incapable of using their guns in a combat situation with
sufficient expertise, either to prevent an armed criminal from taking innocent lives, or
to be sure of not hitting bystanders with their own stray bullets. Just buying a gun will
not protect you. You will need to pay for extensive training if you want to use it
2. Most homicides involving guns occur between victims who knew each other. Having
guns around greatly increases the chances you or someone you know will be hurt or
killed by one, compared to households without guns.
3. Suicides are the majority of gun deaths every year. I remember Dana Rivers on
Oprah proclaiming with seemingly perverse pride that she knows what her revolver
tastes like. Given the suicidal tendencies among some in the community, it seems like
an extremely bad idea for many TG women to own guns.
4. According to a 1998 FBI report, there were only 95 justifiable handgun killings in the
U.S. that year, where people defending themselves encountered an assailant
previously unknown to them. Out of 280 million people. More people are struck by
lightning each year than use handguns for a justifiable homicide against a stranger.
Then, of course, there's the moral issue of participating in the culture and economy of
gun violence... But we'll not go into that complicated matter.
A reader writes:
If your plans or thoughts about safety or self-defense include any sort of weapon,
please consider training both to help you work
through the question of whether this is right for you and, if it is, to give you basic skills
in the safe use of it and an understanding of legal issues
surrounding the use of force.
Certainly, for firearms, there is any number of NRA-affiliated local gun clubs where
volunteer instructors donate their time for inexpensive classes in gun safety and
defensive use of firearms. But you can also turn to some women's organizations for
help... You can also ask your local police for the names of instructors or organizations
in your area.
If you feel threatened...
By someone else on foot: Turn around to let the person know you've seen them. Try
to get a description: height, weight, clothes, age, ethnicity, hair color and style,
anything else distinguishable. Cross the street, change directions, run to a place
where there are other people, or walk closer to traffic. Step out in the street on the
other side of parked cars. Be alert when someone moves into your space, that three
foot radius around you.
By someone in a car: Get the license plate number and a description, if possible.
If you are attacked
What if the unthinkable happens?
If you are suddenly confronted by a predator who demands that you go with him–be it
in a car, or into an alley, or a building, it would seem prudent to obey, but you must
never leave the primary crime scene. You are far more likely to be killed or seriously
injured if you go with the predator than if you run away (even if he promises not to hurt
you). Run away, yell for help, throw a rock through a store or car window--do whatever
you can to attract attention. And if the criminal is after your purse or other material
items, throw them one way while you run the other.
Get them "off their script." Most attackers have an idea in their head of how their crime
is going to go. If you do something unpredictable, the surprise can throw them off.
Throw your bag at or past them and run the opposite direction.
The following works well for getting both strangers and acquaintances off their scripts:
If he's attempting a sexual assault and has you pinned, pretend to have a seizure or
pee your pants. This might freak them out and throw them off their script. Many sexual
assault perpetrators expect you to scream and beg. Some suggest using that time of
negotiation to get them to think about what they are doing by asking them pointed
questions: what happened today that made you decide to do this? Try to get them to
think of you in the same way they think of someone they love, like their sister, etc.
Getting them to see you as a person instead of a generic victim might get them to stop
or to be less violent.
Going out on dates can be really fun and exciting, especially once you can start dating
as the real you. However, don't let the initial thrill cloud your judgment.
Again: You are far more likely to be assaulted by a date, coworker, or a friend
than by a stranger.
The Queer Resources Directory has a great list of dating tips:
Find out who your date is.
Ask for your date's first and last name, where they work and live, and what they like
and don't like.
Ask around to see if anyone knows the person.
Introduce your date to others (e.g., your friends, the bartender.)
Tell a friend where you're going, or call your own answering machine as if you were
calling a friend.
Make sure your date knows you spread the word about them.
Choose public places, such as malls or restaurants, for first meetings. Leave your
date‘s name and telephone number with that person. Never arrange for your date to
pick you up at home.
Provide your own transportation, meet in a public place at a time when many people
are present, and when the date is over, and leave on your own as well. A familiar
restaurant or coffee shop, at a time when a lot of other people will be present is often
a fine choice.
Avoid hikes, bike rides or drives in remote areas for the first few dates. If you decide to
move to another location, take your own car. When the timing is appropriate, thank
your date for getting together and say goodbye.
Protect your valuables. Don't carry extra cash.
If you bring someone home, don't leave your wallet, cash, or valuables in sight. Your
possessions -- and the person you brought home -- could all be gone while you're in
the shower or asleep.
Watch for red flags. Pay attention to any displays of anger, intense frustration or
attempts at pressuring or controlling you. Acting in a passive-aggressive manner,
making demeaning or disrespectful comments or any physically inappropriate
behavior are all red flags. You should also be concerned if your date exhibits any of
the following conduct without providing an acceptable explanation:
Provides inconsistent information about age, interests, appearance, marital status,
profession, employment, etc.
Fails to provide direct answers to direct questions.
Never introduces you to friends, professional associates or family members. This is an
especially big problem for TG women with tranny-chasers. Not only is it insulting and
degrading, but it's a sign that they are not secure with their own sexual identity.
This might prove to be a serious problem at a later point, whether it's heartbreak or
even a dangerous situation where they take their self-hatred out on you.
If you decide to bring someone home, introduce her or him to a friend, acquaintance
or bartender so that someone knows who you left with.
Never do anything you feel unsure about. If you are in any way afraid of your date,
use your best judgment to diffuse the situation and get out of there. Excuse yourself
long enough to call a friend for advice, ask someone else on the scene for help, or slip
out the back door and drive or run away. If you feel you are in danger call the police.
It‘s always better to be safe than sorry.
I highly recommend reading Jennifer Reitz' excellent dating guide.
A note on transfans
I went out with my share of tranny-chasers when I first went full-time. Most of them
were very nice (and some were extraordinarily hot), although several of them had
pretty serious hang-ups about their own feelings. They seemed to be pretty
uncomfortable with the fact that they liked transsexuals. A couple of them seemed to
pin their own self-loathing on me. Their reactions ranged from
Drugs and alcohol
A lot of younger TGs, especially in the club scene or in college, are going to encounter
drugs and alcohol. I've personally made a number of bad decisions when drunk or
high, from sex partners to other unsafe activities like going someplace with complete
Alcohol is by far the most common problem. I like to drink, but it's important to stay in
control, or at the very least, stay with someone who is in control (i.e., not drinking or
Get/mix your own drinks: There may be a reason a person insists on getting or mixing
you a drink. Getting you drunk or giving you "knockout drops" is an easy way to cloud
The date rape pill has been discussed a lot on television and in magazine articles.
Personally, I think the scare is a little over hyped, since alcohol, ecstasy, and
depressants are the most likely to impair your judgment. The following safety habits
can protect you from a bad experience: When going out, if you have a friend you trust
with you, you are safer.
Watch out for your friends and make sure they are watching out for you when you are
places with lots of people or people you don't know and trust like at a party or in a
coffeehouse or in a bar. Be aware.
Now that you know about the date rape pill, it is your responsibility to watch out for
yourself and people you care about. Don't go home with someone you don't both know
and trust and don't accept drinks when you are alone at a house where there are
strangers (like at a party).
Watch when someone pours you a drink. Better yet, get your own drink. Make an
agreement ahead of time with friends that you won't let each other leave with people
you haven't planned to go with. Don't leave your drink or food unattended at a party or
coffeehouse or lounge or anywhere else that people you don't know and trust could
have access to it.
If you are going to use drugs and/or alcohol, try do do it with a group of friends, and try
to have one who is going to take it easy that night and watch out for everyone else.
Make sure your friends don't let you go off by yourself with someone you don't know
Never worry or feel embarrassed about your behavior if you feel threatened.
Get out of an elevator if it doesn't feel right, even if it seems silly or rude. Run away
yelling, even if it seems embarrassing. Slip out the back way while on a date. Your
safety is much more important than someone's opinion of you. If you get a bad vibe in
any situation, do whatever you need to in order to protect yourself.
Most people are basically good, and physical attacks are fairly rare. Don't let fear of an
attack rule your life. Go out. Have fun. You've earned it after all you've been through.
Just make sure you stay safe. The vast majority of attacks can be avoided by taking a
few simple precautions.
So have fun, but be careful, OK?
©1996-2002 TSroadmap.com. All rights reserved.
This page last updated April 14, 2002
14 Things I Should Know About
Being Lesbian, Gay, Bisexual and
Transgendered in NC
Legal Status of Homosexuality, Bisexuality, and Transgenderness
1. Is homosexuality, bisexuality, or transgenderedness illegal in North Carolina?
No. The law in North Carolina, neither by its terms nor by its judicial interpretation,
makes it illegal to be homosexual, bisexual, or transgendered.
2. What is North Carolina's Crime Against Nature (CAN) law?
North Carolina General Statute § 14-177 states: "If any person shall commit the crime
against nature, with mankind or beast, he shall be punished as a Class I felon." Class
I felonies are punishable by up to one year in prison. N.C. Gen. Stat. § 15A-1340.17.
This law applies to everyone, regardless of sexual orientation.
3. What sexual acts are prohibited under the CAN law?
Although the language of the law is vague, case law clearly identifies certain acts as
crimes against nature. The following acts are illegal under the CAN law: fellatio,
cunnilingus, anal intercourse, and any sexual activity involving animals. Cunnilingus
and fellatio refer to the oral stimulation and penetration, however slight, of female or
male genitalia. Anal intercourse is the penetration of the anal opening of another
person's body by any object. Evidence of penetration, however slight, of or by one's
sexual organs, is necessary in order to be found guilty of violating the CAN law;
however, a conviction for attempting to violate the CAN law does not require evidence
4. North Carolina's hate crimes and anti-discrimination laws do not cover LGBT
individuals. Would the enactment of LGBT hate crimes and/or anti-discrimination laws
create special rights for LGBTs?
No. These laws not only protect LGBTs they also enhance the penalties criminals
receive for committing acts of violence that are motivated by biases against an
individual's race, religion, gender, national origin, or other personal characteristics.
The language used in LGBT anti-discrimination statutes in other states makes it illegal
to discriminate against individuals because of their sexual orientation or gender
expression, whether they are heterosexual, homosexual, bisexual, or transgendered.
Similarly, hate-crimes legislation, would enhance the punishment for conduct
motivated by biases against individuals because of their sexual orientation or gender,
whether they are heterosexual, homosexual, bisexual, or transgendered. The ACLU,
however, opposes poorly written laws that create punishments for an individual's
thoughts, opinions, or beliefs.
Legal Relationships Among LGBTs
5. Are marriages between two members of the same sex legal?
No. North Carolina only recognizes marriages between partners of the opposite
biological sex.1 In addition, North Carolina will not honor marriages between
individuals of the same biological sex created "by common law, contracted, or
performed outside" the state. Thus, two individuals of the same biological sex can not
go to another State, return to North Carolina, and have their union be legally
recognized under the laws of North Carolina.
6. May transgendered individuals marry?
It depends. Under North Carolina law a valid marriage may only occur between
individuals of opposite biological sexes. (i.e., between a biological male and a
biological female.) Therefore, transgendered individuals may marry regardless of their
self-identified gender, so long as they marry a person of the opposite biological sex.
On the other hand, two biological males, who self-identify as belonging to opposite
genders, may not marry.
7. Since the laws that apply to married couples without a will do not apply to same sex
couples, how can I leave money or property to my LGBT partner in the event of my
Wills: If you or your partner die without having a valid will, then your estate will be
subject to the North Carolina intestate succession laws. These laws determine how
your estate will be distributed between and among your heirs and/or spouse. The law
defines the term "heir" to mean only those individuals of a blood relationship to the
deceased. The only applicable exception to this is the distribution of an estate to one's
spouse. Marriage is the only formal partnership that determines one's legal status as a
spouse. The law will not consider, for example, either partner in a homosexual
relationship, to be the spouse of the other. In order to prevent intestate succession
laws from determining who receives the distribution of your estate you must make a
valid will naming your partner as a beneficiary.
Life Insurance: You may make your partner the beneficiary of your life insurance
1 Statutory and case law use the term gender to mean one's sex or genetic identity
while the term gender has recently come to represent not only one's sex but one's
cultural identity as a male or a female. For the purposes of this brochure the term
biological sex is used to mean an individual's genetic identity as either a male or a
8. Is it illegal to live with my partner?
No. Under North Carolina's fornication and adultery law it is illegal for individuals of
opposite biological genders, who are not married, to cohabit and partake in sexual
intercourse together. On the other hand, two individuals of the same biological gender
may live together as partners and not violate this law. However, any sexual activities
prohibited by the CAN law that they may engage in are illegal.
It is important to note that a relationship between homosexual or transgendered
individuals is not itself illegal; rather, some of the sexual acts that the individuals
participate in may be illegal.
9. Can my partner and I make important decisions about each other's healthcare when
one of us is incapacitated?
Yes, under certain circumstances. There are two forms of control you can assume
under North Carolina law that will allow you to make decisions about your partner's
healthcare. The first is known as a durable power of attorney and provides a broad
amount of control, allowing an individual to conduct property, financial, and estate
transactions for another individual as well as make healthcare decisions on his/her
behalf. An additional method of assigning decision-making power to your partner is a
health care power of attorney. This method is much more narrow in its scope and only
yields the right to make health care decisions for another individual. Absent these
steps, neither you nor your partner are legally empowered to make health care
decisions for one another.
10. What are the rights of LGBT parents?
LGBT people are not prohibited from adopting children or from being the custodial
parent of their biological children. However, sexual orientation and gender expression
are often used against LGBT people in custody battles. It is important to note that LGB
people can only adopt as a single person; their same-sex partner cannot adopt the
child as a second parent. The same-sex partner of the legal parent therefore has no
natural legal rights and responsibilities toward the child. A written contract, power of
attorney, or custody order may provide the co-parent with limited rights. LGBT couples
should consult with an attorney to best protect their wishes for the child in the event of
death or breakup.
12. Can I be fired for being LGBT in North Carolina?
Private Employment: North Carolina is known as an at-will employment state.
An at-will employee does not have an employment contract. At-will employees
may be terminated for no reason or for arbitrary or irrational reasons, but they
may not be terminated for an unlawful reason or purpose that contravenes
public policy. While it may appear that firing an individual because of their
sexual preference or self-identified gender should be a violation of public policy,
there are no cases supporting this proposition. Thus, private employees can be
fired because of their sexual orientation or transgenderedness.
13. Public Employment: Although it is unclear, North Carolina law may provide
some protections for public employees. North Carolina case law holds that
employees can only be required to answer questions related to job
performance. Questions about one's sexual orientation have been held to be
outside of the scope of one's performance.
Since sexual orientation does not affect one's job performance, public employers
probably cannot fire an employee for refusing to answer questions concerning their
sexual orientation. There are no other state laws in North Carolina protecting LGBTs
from being fired under other circumstances. There are, however, a few municipalities
(Carrboro, Chapel Hill, Asheville and Raleigh) in North Carolina that explicitly prohibit
employment discrimination based on sexual orientation for individuals who work for
LGBTs and the Public Schools
12. Is it illegal to discuss homosexuality in the public school setting?
No. While it is not illegal to discuss homosexuality in the classroom, teachers and
other school administrators, when instructing students about sexually transmitted
diseases (STDs), must make the legal status of homosexual acts known to their
students when such acts are recognized as being a significant means of transmitting
diseases like AIDS. N.C. Gen. Stat. § 115C-81.
In other school settings it appears that an instructor may discuss homosexual acts
without discussing their legal status. The law does not prevent instructors from
mentioning the legal status of heterosexual acts that are recognized as being
significant means of transmitting STDs. (see questions 2-3)
13. Can LGBT student groups be excluded from meeting on public school grounds
and from forming officially recognized/sponsored organizations?
LGBT student groups have the same rights as other student groups. Under the Equal
Access Act, schools creating limited public forums may not discriminate against
student groups based on the content of the material they wish to discuss. Therefore, if
other student groups are allowed to meet on school grounds, then LGBT groups must
be allowed as well.
If a particular school restricts meetings on school grounds to student groups related to
the curriculum, then LGBT groups may only be excluded on the same terms as other
In addition, civic groups or associations are free to enter schools, on the same terms
as all civic groups, and instruct students, teachers, and administrators on issues of
tolerance and diversity with relation to LGBTs. See the Equal Access Act 20 U.S.C. §
4071-74 for further clarification.
Confidentiality of HIV Testing
14. Are HIV tests results anonymous?
No. North Carolina law abolished anonymous testing several years ago. However, all
HIV testing is confidential, meaning that any information regarding a person who is
HIV positive must be reported to local health directors and the regional HIV/STD
control branch and will be held strictly confidential.
Such information includes "the specific name of the test performed, the source of the
specimen, the collection date, the patient's name, age, race, and sex, as well as the
submitting physician's name, address, and telephone number." Strictly confidential
information is not a matter of public record and may not legally be released except
under the following circumstances:
1. the information is released for statistical purposes and does not identify the
2. written consent is given by the individual or his/her guardian to release his/her
medical record, or
3) the information is given to health care personnel providing
medical care for a patient.
For other exceptions see N.C. Gen. Stat. §§ 130A-143(1-11).
Lambda Legal Defense and Education Fund
120 Wall Street, Suite 1500
New York, NY 10005-3904
Equality North Carolina Political Action Committee and Equality
North Carolina Project
PO Box 28768
Raleigh, NC 27611-8768
1743 Connecticut Ave, Northwest, Suite 400
Washington, DC 20036
North Carolina Gay and Lesbian Attorneys
PO Box 2164
Durham, NC 27702
PO Box 65
Kensington, MD 20895
It's Time-North Carolina
5036 Holly Brook Drive
Apex, NC 27502
The source for a substantial amount of the information contained within this brochure
comes from The Legal Guide for Lesbians and Gay Men in North Carolina, 6th ed.
(2000), which is published by NC GALA and Equality NC Project. You may order a
copy by calling 919.829.0343.
This is intended to serve as a brief summary of your rights. Please seek more specific
legal advice from a licensed attorney.
National Transgendered Organizations and
PFLAG National Staff
1726 M Street, NW, Suite 400
Washington, D.C. 20036
Fax: (202) 467-8194
PFLAG T-NET (Transgender Network)
Support: Karen Gross, 216-691-4357 or KittenGR@aol.com
To Order Publications: PFLAG T-NET publishes a pamphlet entitled "Our Trans
Children" which is an excellent introduction to transgenderism.
It is a comprehensive resource for any parent or family member dealing with their child
or family member coming out as a transgendered person. Cost: 3 for $3, 25 for $18,
50/$34, 100/$65, 250/$155, 500/$295 Mary Boenke, 540-890-3957 or Mary
Boenke@aol.com 180 Baily Blvd., Hardy, VA 24101 www.Youth-Guard.Org/pflag-t-
For email information and support, send the message -- subscribe TGS-PFLAG
(and your email address)-- to: listproc@Youth-Guard.org or contact the list owner at:
The American Boyz
P. O. Box 1118
Elkton, MD 21921
website: http://www.netgsi.com/~listwrangler is a national organization with local
affiliates for FTMs and their significant others, friends, families, and allies. Site has
resources for Arab and Moslem, Asian Pacific Islanders, Black, deaf, elder, Jewish,
Latino/a and Native American people.
The American Educational Gender Information Service (AEGIS)</B> is an excellent
source of information, books and referrals. AEGIS also publishes the journal Chrysalis
which deals with transgendered and intersexed issues, and maintains the National
Transgender Library and Archive. AEGIS, PO Box 33724, Decatur, GA 30333. Phone:
(770) 939-0244, internet: AEGIS@gender.org
FTM International, 1360 Mission Street, Suite 200, San Francisco, CA, 94103, phone
415/553-5987, provides information and support for female-to-male persons and
publishes an excellent newsletter.
The Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA), 1300
South 2nd Street, Suite 180, Minnesota, MN 55454, phone 612/625-1500 provides the
"Standards of Care", a guide for professionals treating transsexuals.
The International Conference on Transgender Law and Employment Policy (ICTLEP),
PO Box 1010, Cooperstown, NY 13326, phone 607/547-4118, email at:
ICTLEP@aol.com, provides information regarding transgendered legal issues.
The Gender Political Advocacy Coalition is a group of transgendered organizations
and citizens dedicated to the pursuit of gender, affectional, and racial equality. For
more information, contact Gender PAC, 733 15th Street NW, 7th Floor, Washington,
DC 20005. Phone: (202) 347-3024
The International Foundation for Gender Education (IFGE)</B>, PO Box 229,
Waltham, MA 02254-0229, phone 617/899-2212, email at: IFGE@world.std.com, Web
site: http:// www.ifge.org provides information, referrals and books and also publishes
the fine quarterly magazine "Transgender Tapestry".
The Intersexed Society of North America (ISNA), PO Box 31791, San Francisco, CA
94131, email at: firstname.lastname@example.org, website: Website: www.isna.org provides support for
intersexed persons as well as educational information for both the medical professions
and the public.
It's Time, America! (ITA), P.
O. Box 65, Kensington, MD 20895, 301/949-3822,
http://www.GeoCities.com/WestHollywood/Heights/7979, ITA's 25 state
chapters research the local laws, document discrimination and violence,
educate and lobby for political and social change.
The Renaissance Transgender Association, Inc., 987 Old Eagle School Road,
Suite 710, Wayne, PA. 19087, 610/ 975-9119, email Angela@ ren.org, has
chapters and affiliates around the country, primarily for crossdressers.
The Society for the Second Self (Tri-Ess) 8880 Belaire B2,
Suite 1104, Houston, TX 77036, Email to: TRIESSINFO@aol.com Web site:
http://tri-ess.org/domain.htm country-wide, has traditionally provided
social/support events for heterosexual male crossdressers.
TransBoy Resource Network. (for Trans youth)
http://www.geocities.com/WestHollywood/Park/6484 Email list for Trans
People of Color http:/www.erols.com/nadyalec/subscribe.html Habla Espanol:
Calico: 617-268-4603; Email: email@example.com (Boston) (Spanish) Website
En Espanol: http://members.xoom.com/crisalida/mainpub.html
Support organization for couples in a transgendered
Transgendered Reading List
Boenke, Mary, ed. Trans Forming Families: Real Stories about Transgendered
Loved Ones. Walter Trook Publisher, 1999, available from Mary Boenke, 180
Bailey Blvd., Hardy, VA 24101, firstname.lastname@example.org
Bornstein, Kate. Gender Outlaw: on Men, Women and the Rest of Us. Rutledge Press:
Bornstein, Kate. My Gender Workbook. Routledge Press: 1998.
Brown, Mildred and Rounsley, Chloe Ann, True Selves: Understanding
Transsexualism for Family, Friends, Coworkers and Helping Professionals. San
Francisco: Jossey-Bass, 1996. This book is highly recommended.
Bullough, Vernon and Bullough, Bonnie, Cross dressing, Sex and Gender.
Philadelphia: University of Pennsylvania Press, 1993.
Burke, Phyllis, Gender Shock: Exploding the Myths of Male and Female. New York:
Cameron, Loren, Body Alchemy: Transsexual Portraits. San Francisco: Cleis Press,
Ettner, PhD Randi Confessions of a Gender Defender: A Psychologist's Reflections on
Life among the Transgendered. Chicago Spectrum Press, 1996.
Feinberg, Leslie. Transgendered Warriors: Making History
From Joan of Arc to RuPaul. Beacon Press: 1996
Israel, Gianna and Tarver, D., Transgender Care: Recommended Guidelines,
Practical Information, and Personal Accounts. Philadelphia: Temple University Press,
Just Evelyn. "Mom, I Need to be a Girl" To order send $10 (inclusive of tax and s/h) to:
Just Evelyn, 3707 Fifth Ave, #413, San Diego, CA 92103 or
Kirk, Sheila and Rothblatt, Martine, Medical, Legal and Workplace Issues for the
Transsexual. Watertown, MA: Together Lifeworks, 1995.
Moir, Anne and Jessel, David Brain Sex: The Real Difference between Men
And Women. Dell Pub/Bantam Doubleday: 1992.
Rudd, Peggy J. Crossdressers and Those Who Share their Lives. Katy, TX: PM
Stuart, Kim, the Uninvited Dilemma: A Question of Gender. Portland, OR:
Metamorphous Press, 1983
Sllivan, Lou, Information for the Female-To-Male Cross-dresser and Transsexual.
Seattle: Ingersoll Gender Center, 1990.
Transgender Community - Supportive Merchants, Caregivers
and Service - Providers
Bland Clinic, P.A.
Veita J. Bland, M.D.
Family Practice/Office Surgery, Gynecology, Pediatrics
1317 N. Elm St., Ste. 7
Greensboro, NC 27401
Tel (336) 373-1557
Pierre Brassard, MD, FRCS
Plastic Surgery, (SRS)
1003 East St-Joseph Boulevard
Montreal, Quebec H2J 1L2 Canada
Tel (514) 288-2097 * Fax (514) 288-3547 * Email email@example.com
Brookview Women's Center
Donald E. Pittaway, M.D. PhD,
"Reproductive Endocrinology, Gynecology. Specialist in Infertility, Laparoscopic and
Tubal Surgery, Micro & Laser Surgery, Endometriosis"
Suite 105, 3333 Brookview Hills Blvd,
Winston-Salem, NC 27103
Phone: (336) 765-1464 or FAX (336) 760-2492
Carolina Speech & Voice Consultants
Ellen S. Markus, MA, CCC-SLP, DMA
Linda F. Hube, MS, CCC-SLP
Phone: (919) 490-5866
An Integrated Approach to Improving Communication Skills:
Voice, Speech, Foreign/Regional Accent, Presentation Skills
Carolina Surgical Arts, P.A.
Todd G. Owsley, D.D.S., M.D.
Oral, Maxillofacial, Facial Cosmetic and Reconstructive Surgery
Christy Neal, R.N.
Skin Care Consultant
2516 Oak crest Ave. Suite B
Greensboro, NC 27408
(336) 288-0677 * Fax: (336) 288-0784
Carolina Treatment Associates
M. Anne Hendrix, M.A.
Child, Adolescent & Adult Mental Health Services
419 Second Street, Northwest
Hickory, NC 28603
Mailing address: PO Box 2445
Hickory, NC 28603
Tel (828) 324-8191 * Fax (828) 324-8373
3722 Battleground Avenue
Greensboro, NC 27410
Tel (336) 288-8244
Jane Sargent-Trollinger, MSN, RN, CS
Psychiatry/Mental Health Therapist and Consultant
3410 Hillsborough Street
Raleigh, NC 27607
Tel (919) 838-0804 * Fax (919) 833-6430 * Email firstname.lastname@example.org
272 Four Seasons Town Center
Greensboro, NC 27407
Yvon Menard, MD, FRCS(C)
Plastic Surgery & (SRS)
1003 Boul St-Joseph Est
Montreal, Quebec H2J 1L2 Canada
Tel (514) 288-2097 * Fax (514) 288-3547 * Email email@example.com
University of North Carolina at Greensboro
Department of Psychology
Walker and Mclver Street
Greensboro, NC 27402-6164
Phone: 336.334.5662 * Voicemail: 336.334.5665 * Office: 336.256.0058
Graduate Student Therapist
Dr. Irvin Lugo
Metropolitan Community Church
"Church Of The Foothills"
Sunday service 11:00am
Meets at: 109 11th Ave. NW
Hickory, North Carolina
Rev. Christine Oscar
Church # (828) 310-9788 * Home # (336) 288-0242
Christ's Church United Of Boone
A Church For All Who Embrace Christ!
Services Sunday @ 7 PM
Cindy Long, Pastoral Leader
Box 504, 318 West King Street
Boone, North Carolina 28607
St. John's Metropolitan Community Church
805 Glenwood Avenue
Raleigh, North Carolina 27605
Belva Y. Boone, Rev
Business: (919) 834-2611 * Fax: (919) 834-2036
St. John's Metropolitan Community Church (firstname.lastname@example.org)
St. Mary's Metropolitan Community Church
504 Edwardia Street
Greensboro, NC 27404
Sunday Worship Services, 10:30am and 6:00pm
Pastor's Office Hours: Mon.-Thurs. 7:00am-11:00am, Tues. 4:00pm-6:00pm
(336) 297-4054 * email@example.com
The mission of St. Mary's MCC is: To share the GOOD NEWS of GOD'S love And
forgiveness, to be a place of worship which welcomes all people, and to be a
community which shares God's gift to us with the world.
Unitarian Universalist Fellowship of Raleigh
A Diverse Spiritual Community for Growth and Learning
3313 Wade Avenue
919.781.7635 * fax: 919.881.2153 * Email: UUFRaleigh@uufr.org
OFFICE HOURS: Monday-Friday 9 am - 4:30 pm * Sunday: 8:30 am - 1:30 pm
Park Cities Counseling Center provides individual and group counseling for children,
teenagers, and adults.
Address: 3520 Cedar Springs Road
214.526.3374, * firstname.lastname@example.org
The professionals at Park Cities Counseling Center provide a wide range of services
promoting personal growth and self acceptance. Listed below is just one Senior Staff
of highly qualified, extremely skilled that deals with the transgender community and is
a very caring therapist.
Feleshia Porter, MS, LPC
Licensed Professional Counselor
"As a self-esteem specialist for the gay, lesbian and transgendered communities, I am
best known for my work with transsexuals who are seeking or are considering gender
transition. Though my focus is gender, sexuality and relationships, I also have
experience with abuse recovery, depression, eating disorders and anxiety."
Phoenix Transgender Support is an open support group for Crossdressers,
Transsexuals, Transgenderists and others in the gender community, their partners
Southerners on New Ground (SONG) work on multiple issues, racism, classism,
homophobia, transphobia and community-building. Contact: Kim Diehl,
Phone: (919) 667-1362 * Email email@example.com
Post Office Box 79087
Greensboro, NC 27417
Specializing in Weddings, Photo Copying, Passports,
Commercial and Private Photography
Triad Gender Association Homepage (TGA) - We are a social/support group for
transgendered individuals in North Carolina. We are an open group that is here to
offer support and assistance wherever we can. For more information:
E-Mail Andrew at firstname.lastname@example.org * Phone (336) 475-7289
Located in Greensboro, North Carolina.
The following is a medical, mental health, healthcare, community base service,
mentor, professional and pair professional list within the Raleigh-Durham, North
These are agencies that “DON’T” specialize in transgender clients, but take
Medicaid individuals who are transgendered, and are on limited incomes.
I am at present seeing these agencies and recommend these services to other
transgender individuals who are trying to seek help.
WAKE COUNTY HUMAN SERVICES, MENTAL HEALTH EMERGENCIES AND
EVALUATIONS, Raleigh, North Carolina, 919.250.3133
N.C. DIVISION VOCATIONAL REHABILITATION SERVICES, DEPARTMENT OF
HEALTH & HUMAN SERVICES, 436 N. Harrington Street, 2803 Mail Service Center,
Raleigh, North Carolina 27699-2803 Phone: 919.733.7807 Fax: 919.715.0813
AREA SERVICES AND PROGRAMS, 134 Wind Chime Court, Raleigh, North Carolina
27615 Voice: 919.256.0736 Fax: 919.256.0730
ADVANCED HEALTH RESOURCES, 152 Wind Chime Court, Raleigh, North Carolina
27615 Phone: 919.845.5590 Fax 919.845.5125
STANDARDS-BASED SOLUTIONS, Behavioral Healthcare Resources, 3708 Lyckan
Pkwy. Suite 103, Durham, North Carolina 27707 Phone: 919.403.2200 Fax:
TRIUMPH, 901 Jones Franklin Road, Suite 110, Raleigh, North Carolina 27606
Phone: 919.852.5352 Fax: 919.852.5323
The Harry Benjamin International Gender Dysphoria
HBIGDA MEMBERSHIP DIRECTORY
listing states from North Carolina, South Carolina and Virginia
1300 South 2nd Street, Suite 180
Minneapolis, MN 55454
Voice Mail: 612-625-9547/612-624-8078
Hall, Blaine Paxton Physician's Associate Internal Medicine, Nephrology
Duke University Medical Center Phone: 919-660-6860
Box 3014 Fax: 919-684-4476
Durham, NC 27710 USA e-mail: Hall0058@mc.duke.edu
Leve, Gerald MD Endocrinology
P.O. Box 97965 Phone: 919-859-5955
Raleigh, NC 27624-7965 USA Fax: 919-859-5659
Rogers, David Price PhD Psychology
Triangle Psychology Services Phone: 919-968-8070
5425 Turkey Farm Rd Fax: 919-968-8070
Durham, NC 27705 USA e-mail:
Powell, Judith C. PhD
1135 Kildaire Farm Road Suite 200
Cary, NC 27511 USA
Kaplan, Barbara MHDL
4 Woodlawn Green #136
Charlotte, NC 28217 USA
Wheeler, John T. PhD
720 East Blvd
Charlotte, NC 28213 USA
3410 Hillsborough Street
Raleigh, NC 27607 USA
Hahn, Louise O. MA, NCC
844 W. Fourth Street
Winston-Salem, NC 27101 USA
Driver, Frances MD Phone: 828-258-3771
Asheville, NC USA Fax:
Rose, Zantui MA
395 Lakey Gap Acres
Black Mountain, NC USA
102 Wappoo Creek Drive
Charleston, SC 29412 USA
Lloyd, Christine PhD
198 Rutledge Ave
Charleston, SC 29403 USA
Chubb, Maggie LCSW Affiliated Clinical Therapists
Allies in Healing Phone: 757-623-2228
142 W York Street, Ste 710 Fax: 757-623-7186
Norfolk, VA 23510 USA e-mail: email@example.com
Criswell, Eleanor PhD Clincal Psychologist
8296-C Old Courthouse Rd Phone: 703-748-4900
Vienna, VA 22182 USA Fax: 703-356-8342
Edgerton, Milton MD
UVA Medical Center
Department of Surgery
Charlottesville, VA 22908 USA
Gilbert, David A. MD
Plastic Surgery Associates
400 West Brambleton Ave
Norfolk, VA 23510 USA
Gilbert, Deborah R.N. Plastic Surgery
400 West Brambleton Ave Phone: 757-274-4000
Ste 300 Fax: 757-274-4001
Norfolk, VA 23510 USA e-mail:
Trengove-Jones, Guy MD, PC Plastic Surgery
160 Kingsley Lm. #202 Phone: 757-423-2166
Norfolk, VA 23505 USA Fax:
Transgender hate crimes 2003
Transgender hate crimes are an international issue. There have been 35 victims of
transgender hate crimes this year. Every one of them was a special life. Every one of
them will be missed. The following are there names:
Amanda Jofré Cerda
Cause of Death: Murdered, allegedly by Winston Michelson del Canto
Date of Death: November 24, 2002
Source: IGLHRC and TravesChile
Amanda Jofré Cerda, then 23 years old, was found dead in Michelson del Canto's
apartment. Michelson del Canto is a known as a drug dealer and manufacturer. It is
also rumored that he likes to keep underage transgender sex-workers locked in his
apartment for days. Nevertheless, Michelson del Canto was unanimously acquitted of
any wrongdoing, and escorted home by police.
Cause of Death: Shot to death, allegedly by a military police officer
Date of Death: December 2002
Source: IGLHRC (rights organization)
An investigator into this case -- Marcelo Cruz -- was also assassinated, and a member
of a local rights organization has been threatened over this case.
Fernanda (Boris Javier) Covarrubias
Location: San Felipe, Chile
Cause of Death: Mutilated
Date of Death: December 4, 2002
Source: La Cuarta, January 27, 2003
Covarrubias was a sex worker in San Felipe. She was taken from the area by an
individual in a red truck, who was likely a former john of hers. Her mutilated body was
found in a river bed some time later. Local activists suspect a member of the military
and/or a neo-Nazi group.
Chandini, aka Nazir
Location: Bangalore, India
Cause of Death: Burned to death.
Date of Death: December 1, 2002
Source: Sangama (rights organization)
Chandini was a 22 year old hijra, or transgendered woman. While police has declared
this to be a suicide, strong evidence suggests otherwise.
Location: Highland Park, Michigan
Cause of Death: Shot to death
Date of Death: December 21, 2002
Source: WXYZ-TV Detroit, December 14, 2002
Tamyra Michaels was a transgendered woman who had been living full-time since age
17. She was shot by an assailant that she described as a white male with a foreign-
sounding accent, on December 14th. She passed away while in the hospital.
Location: Auckland, New Zealand
Cause of Death: Beaten with a baseball bat, allegedly by Joe Tua "Bucket" Coleman
Date of Death: December 22, 2002
Source: New Zealand Herald, December 23, 2002
Matehaere's face was hit five times with a baseball bat on December 16th by
Coleman, a gang member. Matehaere managed to get herself to a local hospital after
the beating, but was promptly discharged. She was returned to the hospital via
ambulance. She died six days later of her injuries. Her last words before she lost
consciousness were a plea for peace. Diane Henare-Wynyard, Coleman's significant
other, helped Coleman evade police for some time, so that he wouldn't be imprisoned
Roberta Nizah Morris
Location: Philadelphia, Pennsylvania
Cause of Death: Blow to the head
Date of Death: December 24, 2002
Source: Philadelphia Inquirer, December 31, 2002
Morris was a popular transgender performer. Police initially attempted to assist her on
December 22nd, but released her after she refused medical treatment. She was later
found by a passing motorist, and died in the hospital on Christmas Eve. While a
medical examiner has declared this a homicide, the police want to assume it to have
been an accidental bludgeoning. Many in the community have wondered why the
police have been so difficult to work with on this case.
Timothy "Cinnamon" Broadus
Location: Fort Lauderdale, Florida
Cause of Death: Shot multiple times
Date of Death: January 8, 2003
Source: South Florida Sun-Sentinel, January 8, 2003
Broadus, a 21 year old transgendered sex worker, was shot several times by the
driver of a Honda Civic or Accord. She ran a few steps from the car, collapsed, and
died on the street. Very little else has been reported in this case.
Location: Green Oak Township, Michigan
Cause of Death: Gunshot Wound
Date of Death: February 21, 2003
Source: Ann Arbor News, February 25, 2003
Nikki Nicholas was a 19-year-old African-American transwoman. She was making a
living as a female impersonator at nightclubs around Detroit, and was well-known for
her impersonations of singer Beyoncé. Her body was discovered during a routine
property check of an abandoned farmhouse.
Danisha Victoria Principal Williams
Location: Bradenton, Florida
Cause of Death: Murdered
Date of Death: February 28, 2003
Source: Sarasota Herald Tribune, March 4, 2003
Williams was very open as a transgendered woman. She was discovered in her
apartment after neighbors discovered a trail of blood in the hall which lead to
Williams's bathroom. Her body had been left in her bathtub.
Unknown Transgendered woman
Location: Cali, Columbia
Cause of Death: Stabbed several times
Date of Death: March 6, 2003
Source: Vanessa Foster
This transgendered person was roughly 25 years of age. She was dumped from a car
alongside a highway. Reports indicate that she died of six stab wounds in different
parts of her body.
Ronald Andrew Brown
Location: Frenchville, North Rockhampton, Australia
Cause of Death: Stabbed to death, allegedly by Jason Edward Piper
Date of Death: March 7, 2003
Source: The Courier Mail, March 8, 2003
Brown, who was 16 years old, was widely known as a crossdresser. Browns body was
found in the home of Jason Edward Piper, an up-and-coming jockey. Brown died of
multiple stab wounds, presumably from a kitchen knife in Piper's home.
Merlinka (Vjeran Miladinovic)
Location: Belgrade, Serbia
Cause of Death: Beaten to death
Date of Death: March 22, 2003
Source: Politika, May 20, 2003
Merlinka, also known as Vjeran Miladinovic, was known as the first out transwoman in
Serbia. She wrote a book, Terezas' Son, and had been in two Serbian films. She was
murdered in Belgrade on March 22nd, and her body was found a month later. Two
men, one of whom is a minor, have been arrested in this case.
Jorge Rafael Cruz
Location: Guatamala City, Guatamala
Cause of Death: Murdered
Date of Death: March 25, 2003
Source: Guatemala Hoy, March 26, 2003
Several individuals dumped Cruz's body in Guatamala City. Local authorities do not
expect that they will be able to find Cruz's murderers, as transgendered people in the
area are known to have "many enemies." Cruz was 19 years old.
Kim Mimi Young
Location: Washington, D.C.
Cause of Death: Stabbed to death, allegedly by Corena Niko Watkins
Date of Death: April 9, 2003
Source: Jessica Xavier
Mimi was a transgendered sex-worker in Washington, D.C., and had also been a key
prosecution witness in a murder trial in 2000. She was initially found on the 9th,
gasping for air, by a D.C. resident. She had been stabbed, and succumbed to those
injuries later that morning. 34-year-old Watkins has been charged with this murder.
Location: New Haven, Connecticut
Cause of Death: Stabbed multiple times, then burnt
Date of Death: May 9, 2003
Source: New Haven Register, May 11, 2003
Jessica Mercado was a 24-year-old transwoman. Mercado's body was found draped
across her mattress in the charred remains of her apartment. She has been stabbed
multiple times before the apartment was set on fire. Mercado was laid to rest in her
native Puerto Rico.
Hendricks Thomas aka Tanesha Starr
Location: Birmingham, Alabama
Cause of Death: Stabbed multiple times
Date of Death: May 22, 2003
Source: Birmingham News, May 25, 2003
Hendricks Thomas was a drag performer who also went by Tanesha Starr. Thomas
was found stabbed and died in route to the hospital. In spite of a $2000 reward put out
by the local LGBT community, this case remains unsolved.
Shelby Tracy Tom
Location: North Vancouver, British Columbia, Canada
Cause of Death: Murdered, allegedly by Jatin Patel
Date of Death: May 31, 2003
Source: Xtra! West, June 12, 2003
Tom was a 40-year-old Asian transsexual. Her body was discovered in a shopping
cart behind a North Vancouver laundromat. Jatin Patel, a 29-year-old, was charged
with 2nd degree murder.
Michael Charles Hurd
Location: Houston, Texas
Cause of Death: Shot to death
Date of Death: June 18, 2003
Source: Houston Chronicle, June 18, 2003
Little information has been provided on this case, other than that Hurd was found shot
to death in a car, and was found wearing a wig, makeup, and feminine attire.
Location: Guatamala City, Guatamala
Cause of Death: Shot
Date of Death: July 1, 2003
Source: La Hora, July 1, 2003
Valverde was shot multiple times in the streets of Guatamala City. Paramedics called
to the scene did attempt to stabilize her wounds, but she passed away in intensive
care at a local hospital.
Rogelio Jiménez Cortez
Location: Guatamala City, Guatamala
Cause of Death: Shot
Date of Death: July 4, 2003
Source: La Hora, July 4, 2003
In the second killing of a transgendered woman in a week, Cortez was gunned down
at a bus and taxi stop in Guatamala City.
Ericka (Erick David) Yáñez
Location: San Pedro Sula, Honduras
Cause of Death: Shot and killed, allegedly by a police officer
Date of Death: July 15, 2003
Source: Amnesty International
19-year-old Honduran transgendered woman Ericka Yáñez was allegedly attacked by
two police officers, one of whom reportedly killed Yánez with his service revolver. Both
officers have been arrested and charged, one -- police agent Carlos Ivan Contreras --
for the murder, and the other as an accomplice. Contreras has escaped custody, and
death threats have been received by a witness to the crime, another local
transgendered woman known as "China".
Cinnamon (Kendrick) Perry
Location: Houston, Texas
Cause of Death: Shot to death
Date of Death: July 20, 2003
Source: Houston Chronicle, July 20, 2003
Perry, a 32 year old African-American, was shot by a passing car while walking down
a street in the Montrose area in Houston shortly after dawn. She was taken to a local
hospital, but died that afternoon.
Location: Indianapolis, Indiana
Cause of Death: Shot to death, allegedly by Paul Anthony Moore
Date of Death: July 22, 2003
Source: Indianapolis Star, July 26, 2003
Nireah Johnson, a 17-year-old African-American transwoman, was known for being
sweet and funny. Her and a friend, 18-year-old Brandie Coleman, were shot in the
head while sitting in a SUV. The murderer, allegedly Paul Anthony Moore, then set the
truck on fire. Their bodies were burnt beyond recognition. A second person, Curtis L.
Ward, has been arrested as a possible accomplice to Moore in this killing.
Location: Indianapolis, Indiana
Cause of Death: Shot to death, allegedly by Paul Anthony Moore
Date of Death: July 22, 2003
Source: Indianapolis Star, July 26, 2003
18-year-old Brandie Coleman, while not a transgendered woman herself, was a close
friend to Nireah Johnson (above), and was also shot in the head while sitting in
Coleman's mother's SUV with Ms. Johnson. She had recently become a mother just
two months prior to the murder.
Location: Council Bluffs, Iowa
Cause of Death: Stabbed several times
Date of Death: July 31, 2003
Source: Daily Nonpareil, August 2, 2003
Álvarez-Hernández was a resident of Nebraska, and worked at an Omaha
meatpacking plant, and was last seen alive leaving an Omaha bar. Álvarez-Hernández
was found stabbed several times and unconscious on the lawn of a house in Council
Bluffs, and was pronounced dead a short time later at a nearby Hospital.
Location: Guatamala City, Guatamala
Cause of Death: Shot to death
Date of Death: August 3, 2003
Source: La Hora, August 3, 2003
Like Jorge Rafael Cruz, 28-year-old Amirilis was murdered by several individuals. Her
killers made several passes around her in a car, first making complimentary
comments before penting her with water balloons, then tossing an apple at her on a
return trip. When Amirilis made angry comments back at them for pelting her, they
shot and killed her.
Marcelo Cesar Goulart
Location: Criciúma, Brazil
Cause of Death: Stabbed several times
Date of Death: August 8, 2003
Source: da Folha, August 8, 2003
Goulart, a trasvesti in Brazil, was found dead by police. She was naked and had
suffered several stab wounds above the heart. Not much information beyond this has
Location: Washington, D.C.
Cause of Death: Shot, allegedly by Antoine Jacobs
Date of Death: August 16, 2003
Source: Washington Post, August 18, 2003
Bella Evangelista was a popular entertainer in D.C., and periodically performed at
Club Chaos. She was shot multiple times at close range. Antoine D. Jacobs has
admitted to the murder, but claims it was in self-defense. Police do not believe his
story, and are treating this murder as a hate crime.
Emonie Kiera Spaulding
Location: Washington, D.C.
Cause of Death: Shot, allegedly by Antwan D. Lewis
Date of Death: August 20, 2003
Source: WMAR, August 21, 2003
25-year-old Emonie Kiera Spaulding was from Massachusetts and North Carolina, and
had been living in D.C. for about two years. According to her Uncle, Spaulding loved
music as a child and sang in a church choir. Her partially nude body was discovered
by police in a field. She had been shot but also had severe head wounds. There was a
second near-fatal shooting of a transgendered woman the same evening, which police
do not feel was related.
Cassandra "Tula" Do
Location: Toronto, Ontario, Canada
Cause of Death: Strangled
Date of Death: August 26, 2003
Source: Toronto Police Department, August 26, 2003
Cassandra Do, or "Sandra" as her friends knew her, was working as a sex-worker
under the pseudonym "Tula" in Toronto, saving up for genital surgery and nursing
school. She had many friends. She was found in her 11th-floor apartment. An autopsy
concluded that she was strangled to death.
Location: Napoli, Italy
Cause of Death: Burned
Date of Death: August 30, 2003
Source: L'Unità, August 30, 2003
Taglialatela, a 39-year-old transsexual woman, was attacked by four individuals on
August 19th who initially tried to proposition her, then assaulted her when she refused.
They also poured benzine on her and set her on fire. Others helped her to a local
hospital, though she was later transferred to a larger facility. She suffered serious
burns on 70% of her body. She died from these burns on the night of August 30th. Her
killers have been jailed.
Ricardo "Sindy" Cuarda
Location: San Pablo, California
Cause of Death: Shot multiple times
Date of Death: September 30, 2003
Source: Contra Costa Times, October 3, 2003
24-year-old Cuarda lived in Richmond, California after emigrating from Acapulco,
Mexico about two years ago. She had been working as a hair stylist. Police Officers
found Cuarda, wearing a blouse and pants, bleeding heavily from several gunshot
wounds in the driveway of a business in San Pablo. She died a short time later at a
medical center. While police would not confirm details of this murder, a friend of
Cuarda's stated that she was shot in the chest and genitals.
Location: Trastevere, Italy
Cause of Death: Bludgeoned
Date of Death: October 10, 2003 (approximate)
Source: Chiudi, October 15, 2003
Johana was a young Columbian transgendered woman living in Italy. Her body was
found by a friend in the bathroom, in only a bra and slip, leaning over the tub. Her skull
was shattered by a blunt object. She had been dead for several days before she was
Adrian Torres de Assuncaov
Location: Brescia, Italy
Cause of Death: Bludgeoned and dumped along site the road.
Date of Death: October 7, 2003
Source: Il Giorno, October 15, 2003
Torres de Assuncao was a 24-year-old Brazilian native living in Italy. She was
discovered along the roadside, and taken to a local hospital. She passed away at the
hospital, after surgeons attempted to save her life.
ALL USA 2003 USA
1 0 - - Amanda Jofré
2 0 - - Ze Galhinha
3 0 - - Chandini, aka Nazir
4 0 - - Fernanda (Boris Javier) Covarrubi
5 1 - - Tamyra Michaels
6 1 - - Georgina Matehaere
7 2 - - Roberta Nizah Morris
8 3 1 1 Timothy "Cinnamon" Broadus
9 4 2 2 Nikki Nicholas
10 5 3 3 Danisha Victoria Principal Williams
11 5 4 3 Unknown Transgendered woman
12 5 5 3 Ronald Andrew Brown
13 5 6 3 Merlinka (Vjeran Miladinovic)
14 5 7 3 Jorge Rafael Cruz
15 6 8 4 Mimi Young
16 7 9 5 Jessica Mercado
17 8 10 6 Hendricks Thomas aka Tanesha Starr
18 8 11 6 Shelby Tracy Tom
19 9 12 7 Michael Charles Hurd
20 9 13 7 Dayana Valverde
21 9 14 7 Rogelio Jimenez Cortez
22 9 15 7 Ericka (Erick David) Yánez
23 10 16 8 Kendrick "Cinnamon" Perry
24 11 17 9 Nireah (Gregory) Johnson
25 12 18 10 Brandie Coleman
26 13 19 11 Selena Álvarez-Hernández
27 13 20 11 "Amirilis"
28 13 21 11 Marcelo Cesar Goulart
29 14 22 12 Bella Evangelista
30 15 23 13 Emonie Spaulding
31 15 24 13 Cassandra "Tula" Do
32 15 25 13 Enrico Taglialatela
33 16 26 14 Ricardo "Sindy" Cuarda
34 16 27 14 Adrian Torres de Assuncao
35 16 28 14 Erika Johana
1 of above is from Australia
2 of above are from Brazil
2 of above are from Canada
2 of above are from Chile
1 of above is from Columbia
4 of above are from Guatamala
3 of above are from Italy
1 of above is from Honduras
1 of above is from New Zealand
1 of above is from Serbia
Friday, August 13, 2004
The best way to describe the worst fear of a transsexual‘s life is society‘s lack of
knowledge and understanding of ones that freak out when they ―DON‘T‖ really know
when is a transsexual until it is revealed to them. Finding out later, they feel they are
being lied to with deceit on the identity of the transsexual.
The following below is a movie that is based on a live true story called Boys Don‘t Cry
about a transgender female to male and what she had to deal with in her life, along
with tragedy that ended her life.
Boys Don’t Cry
CAST & CREW
Peirce and Andy Bienen
Jeffrey Sharp, John Hart,
Eva Kolodner and Christine Vachon
Hilary Swank, Chloe Sevigny,
Peter Sarsgaard, Brendan Sexton III,
Alison Folland, Alicia Goranson
The Story - (A True Story)
From the middle of America emerged an extraordinary double life, a complicated love
story and a crime that would shatter the heartland.
In Falls City, Nebraska, Brandon Teena (Hilary Swank) was a newcomer with a future
who had the small rural community enchanted. Women adored him and almost
everyone who met this charismatic stranger was drawn to his charming innocence.
But, Falls City‘s hottest date and truest friend had one secret: he wasn‘t the person
people thought he was.
Back home in Lincoln just seventy-five miles away, Brandon Teena was a different
person caught up in a personal crisis that had haunted him his entire life.
Like many young people, he made costly mistakes and when he inadvertently
trespassed between his new love Lana (Chloe Sevigny) and her reckless friend John
(Peter Sarsgaard), the mystery unraveled into violence.
In a single, short life Brandon Teena was at once a dashing lover and a trapped
outsider, both an impoverished nobody and a flamboyant dreamer, a daring thief and
the tragic victim of an unjust crime.
Boys Don‘t Cry explores the contradictions of American youth and identity through the
true life and death of Brandon Teena. What emerges from a dust-cloud of mayhem,
desire and murder is the story of a young American drifter searching for love, a sense
of self and a place to call home.
U.S. Senate approves hate crimes measure
Christopher Curtis, PlanetOut Network
Tuesday, June 15, 2004 / 05:12 PM
With a bipartisan vote of 65-33, the U.S. Senate passed on Tuesday the Local Law
Enforcement Enhancement Act (LLEEA), which would add sexual orientation to
federal hate crime laws.
Hate crimes in the news
For the third time since 1999, the U.S. Senate passed a hate crimes bill on June 15,
2004, that protects gay and lesbian citizens who are victimized by acts of anti-gay
The death of Brandon Teena was the first anti-transgender
murder to receive media attention largely due to Boys Don't Cry,
an award winning film that tells the story of Teena's life and his
Initially, the murder of Gwen Araujo prompted media attention
because a production of "The Laramie Project" was in rehearsal
at Araujo's high school. A large and organized transgender
community in the San Francisco Bay area (where Araujo lived)
helped bring attention to Araujo's death, and community response to inaccurate and
sensational media coverage of the murder resulted in extensive changes in the way
local and regional media outlets cover transgender issues.
Remembering Our Dead
"There have been 29 reported cases of anti-transgender violence -- 14 in the United
States alone -- since the brutal murder of 17-year-old Gwen Araujo. Further, there
have been 159 reported cases in the decade since Brandon Teena was raped and
later killed in Nebraska. More than one case reported every month, and this figure has
been steadily rising in the last couple of years."
I find myself often having to answer the same query time and again: ―why I founded
the Remembering Our Dead Project.‖
On the surface, I started it because I was angry. I had just heard about the 1998 death
of Rita Hester in Massachusetts, and was surprised to find that two other previous
murders in that state -- one of which that shared many similarities to the Hester killing
-- had been largely forgotten. It made me angry that we would so quickly forget those
we've lost, and that our forgetfulness may be indirectly responsible for additional
losses. That anger led to the Remembering Our Dead project.
A year later, after a successful independent memorial in San Francisco, the
Transgender Day of Remembrance was formed as an offshoot of the Remembering
Our Dead website. This is a public memorial designed to focus on those we've lost in
the previous year, focus attention on the issue of anti-transgender violence, and
provide a time when the community can come together to speak out. The event has
grown to become the largest multi-venue transgender event in the world.
Unfortunately, the Remembering Our Dead project remains necessary, as the issue of
anti-transgender violence is not going away easily. There have been 29 reported
cases of anti-transgender violence -- 14 in the United States alone -- since the brutal
murder of 17-year-old Gwen Araujo.
Further, there have been 159 reported cases in the decade since Brandon Teena was
raped and later killed in Nebraska. More than one case reported every month, and this
figure has been steadily rising in the last couple of years.
It is enough to make a person angry, and more than plenty to keep the projects going.
Supporting Diversity and Building the Campus Community through Tolerance of
Marye Anne Fox, Chancellor October 19, 1998
On Thursday, October 8, 1998, Matthew Shepard, a gay 21-year old University of
Wyoming student, was savagely attacked, burned, pistol-whipped and left to die for up
to 18 hours while tied to a wooden fence, allegedly because of his sexual orientation.
After being found by passing motorcyclists, who believed his battered body to be a
scarecrow, Matthew remained in a coma and on life support until he died on Monday,
October 12, 1998.
Matthew Shepard's death brings great sorrow to any thinking and feeling human
being. The NC State Community joins in the grief of Matthew's family and friends. We
also grieve, in astonishment, for Russell Arthur Henderson and Aaron James
McKinney, the men who are accused of viciously murdering Matthew Shepard. Hatred
is not innate; it is taught and must be learned. If guilty, apparently these two men gave
in to an environment of hate, and Matthew's death is a product of that despicable
hatred. Finally, we grieve for the entire nation, for the ignorance that permits violence
as an unchallenged response to differences among people, and for the reality that a
human being could so brutally and violently take the life of another.
In response to this tragedy, the NC State University community must renew its
vehement opposition to any expression of hatred and violence directed toward any
individual or group based on sexual orientation, race, gender, religion, national origin,
or disability. All forms of harassment and discrimination are completely incompatible
with the values and goals of NC State and will not be tolerated on this campus. Here
at NC State, students involved in acts of violence or intimidation against other
students will be charged with a serious violation of the Student Code of Conduct and
will be prosecuted aggressively under the student judicial system. If found guilty,
students could face suspension or expulsion.
NC State University's position has long been that educational and employment
decisions should be based on an individual's abilities and qualifications and should not
be based on factors or personal characteristics that are not germane to academic
abilities or job performance.
Traditionally we have viewed race, sex, religion, and national origin as among those
factors which are not connected with academic abilities or job performance. An
individual's sexual orientation is another factor which is not relevant to educational and
employment decisions. Only relevant factors will be considered in such decisions.
Furthermore, equitable and consistent standards of conduct and performance will be
applied to all members of the North Carolina State University Community.
NC State is a diverse community that extends a nurturing embrace to men and women
of different races, national origins, religions, sexual orientations, and varying physical
and mental abilities.
All of us, faculty, staff, administrators, and students, must work together to build a
community that is inclusive and welcoming to all people, both tolerating and
celebrating these personal characteristics. Only then can NC State achieve its mission
to actively integrate teaching, research, and extension to create an innovative learning
environment that stresses the mastery of fundamentals through intellectual discipline,
creativity, reasoned problem solving, and individual responsibility.
It is imperative that each member of the NC State University community, as a
responsible citizen, respects each other and treats each fellow human being as he or
she would like to be treated. Only to the extent that we can together eliminate hatred
and violence can our nation be considered a civilized and safe place for all people.
For more information about Project SAFE, please contact any of the individuals listed
below. These individuals are all trained Project Safe facilators. Also, you may contact
a SAFE Ally.
Justine Hollingshead Tim Blair
University Housing University Housing
Carrie Zelna Lisa Zapata
Student Conduct Student Affairs
Gay, Lesbian, Bisexual and Transgender Health
Safety and hate crimes
Anti-GLBT hate crimes are those in which victims are chosen because of their actual or
perceived sexual orientation or gender identity. Hate crimes are also committed based on
religion, disability, race, ethnicity and national origin.
Hate crimes may include property crimes (like robbery), threats, intimidation or actual acts of physical
violence. Hate crimes are unique because they send messages to entire groups - as well as to their
families and other supporters - that they are unwelcome and unsafe in particular communities. Most
anti-GLBT hate crimes are committed by otherwise law-abiding young people who often believe that
they have societal permission to engage in anti-gay violence.
"It is the policy of your police department to investigate by all
means possible all reports of anti-gay malicious harassment. This
department will commit the necessary resources to investigate
anti-gay malicious harassment crimes. Anti-gay malicious
harassment has no place in our community."
~ Seattle Police Department
Definitions of Terms
Transgender: describes an individual born as one gender but living as another. May
be a pre or post-operative transsexual, crossdresser, shemale, transvestite, and male
or female impersonator
Transsexual: describes an individual going through hormone therapy, ―who has‖ or
―has not‖ undergone sexual-reassignment surgery (SRS).
Transvestite: describes an individual (frequently straight) who derives sexual or
emotional fulfillment from wearing clothes intended for the opposite sex.
Gender identity: regardless of physical appearance or sexual orientation, gender
identity is the gender an individual considers his/herself to be
Sexual orientation: describes an individual's romantic desires for the same or opposite
"Boys Don't Cry" official site
Remembering Our Dead
Honors those who have been killed because they were "non-gender conforming"
The International Foundation for Gender Education
Resources for and about female-to-male transsexuals
The International Conference on Transgender Law and Employment Policy
Writings on famous writer’s
"When we ignore the calling, when we ignore the truth, when we ignore our
experience of ourselves of somehow mysteriously transcending the binary gender
system, a deep psychological and spiritual wound is inflicted."
―Like dogs chasing our own tails, we are bedeviled by the ‗why‘ question, which
conjures up its twin, the devilish ‗how‘, how to change. The pursuit of happiness
becomes the pursuit of answers to the wrong questions.‖
A famous Lesbian writer wrote, "We have to dare to be ourselves, however frightening
or strange that self may prove to be."
Gay, Lesbian, Bisexual and Transgender Health
These pages are about the special health concerns of
transsexual people, those who want to change their bodies
to be like the other sex. The process of changing the body,
through hormones, surgeries, and other means, is
commonly referred to as "transitioning."
Transgendered people are a diverse group, including people who feel a strong identification with the
other gender; people who cross-dress occasionally or regularly; and people who actually change their
bodies to look and feel more like the other sex.
People whose genes, genitals, or reproductive organs aren't clearly male or female are Intersexual. To
learn more about intersexuality, visit the Intersex Society of North America website.
What does transsexual mean?
Transsexuals are persons who identify so strongly with the other sex or gender (biologic females who
identify as men and vice versa) that they change their bodies, through hormones and sometimes
surgery, to look and feel more like the other sex. Following transition, transsexual people often function
quite normally in society in their sex of reassignment, and often those around them do not know that
they were born the other sex. They may be straight, lesbian, gay, or bisexual -- gender identity is
neither the same as, nor is it necessarily related to, sexual orientation.
Biologic females who transition to live as men are also called transgendered (transsexual) men or FTM
(female to male). Biologic males who live as women are called transgendered (or transsexual) women
or MTF (male to female).
Why do transsexual people have special health
Transsexual people face a unique set of emotional health issues. Living in a body that
feels foreign, and being perceived widely as a gender that feels wrong and unnatural is
enormously challenging. In addition, the process of transitioning to the other sex brings
up a myriad of specific challenges, some anticipated and others harder to predict.
Transsexual people typically take cross-sex hormones throughout their lives and they
may also undergo surgeries to change their bodies. Both the hormones and the
surgeries can have specific health effects that need to be acknowledged and monitored
to maintain the good health of a transsexual person.
Emotional issues for transgendered and transsexual
Persons who are contemplating the process of transitioning from male-to-
female (MTF) or female-to-male (FTM) may encounter a range of emotional
reactions both in themselves and among those around them. Some of these
reactions may be anticipated and prepared for; others may be unanticipated
and difficult to manage.
From a very early age, our culture makes a large and specific set of assumptions about individuals
based on perceptions of gender. Sex role socialization is a powerful force that our culture uses to define
"appropriate" and "inappropriate" boundaries and activities for each gender. Transgender individuals
often experience anxiety and stress as they attempt to fit into a gender role that may match the outward
appearance of their physical body but not their emotions or their more internal sense of their gender.
The decision to transition is often the result of a long and difficult process. Many transgendered
individuals identify a sense of great relief that comes with finally being able to acknowledge their true
selves and live in the body and gender role that is most natural for them. Transgendered people often
feel enormous satisfaction at watching their bodies change with hormone treatments and surgeries, and
at being seen by others as they feel themselves to be inside.
Although societal acceptance of transsexual and transgendered people is far from complete, there is a
growing and active community of transgendered people, both MTF and FTM, particularly in the coastal
areas of the United States. There are also increasing numbers of books and online information and
support for people transgendered people.
The transitioning process can also bring with it a new set of difficulties (and sometimes dangers) that
result from the reactions of acquaintances, loved ones and the larger society to the transitioning
New problems that may arise include:
Employers and colleagues who are not prepared for, understanding of or sympathetic to the
issues of transgendered individuals. Many individuals find themselves either fired from their
jobs or facing workplace hostilities that force them out of employment. The risk that individuals
will experience acts of hostility and even violence directed against them is real.
Family members and friends who are not able to understand or accommodate the change
process. Many transgendered persons begin the transition process long after they have
married and raised their own families. Spouses, domestic partners, parents, children and close
friends may be confused by the transition that is occurring and will need education and support
to help them deal with what is happening. Some relationships end; others are able to survive
the transitioning process.
Sometimes children remain emotionally close to the transitioning parent; at other times children
have taken years to reconcile with the transitioned parent, if they ever come to terms with the
issue at all.
Most importantly, the person who is in the midst of transition her or himself may be surprised at the
feelings that emerge during the process. Being able to identify and work with a counselor or therapist
who has expertise in transgender issues is critically important as the individual begins to explore the
realities of becoming more fully themselves. Individuals socialized and seen their whole lives as male
may experience significant difficulties as they begin to live and function as female, and visa versa.
The journey across the gender divide is rarely an easy one. The combination of physical and emotional
issues that can emerge can make the transitioning process a time of increased stress and risk for
symptoms of depression, substance abuse, and anxiety.
Despite this reality, most transgender individuals report that the joy they experience in becoming more
fully themselves makes the journey worthwhile.
Frequency of mental health problems in transgendered
While research is scant, transgendered persons appear to be at similar risk for mental health problems
as other persons who experience major life changes, relationship difficulties, chronic medical
conditions, or significant discrimination on the basis of minority status.
There is some evidence that transgendered persons may be less likely to seek treatment for
depression-fearing that their gender issues will be assumed to be the cause of their symptoms,
and that they will be judged negatively. Because of these and other factors, depression
associated with gender transition may be under diagnosed.
Victimization and Post Traumatic Stress Syndrome (PTSD)
Many transgendered persons experience some form of victimization as a direct result of their
transgender identity or presentation. This victimization ranges from subtle forms of harassment
and discrimination to blatant verbal, physical, and sexual assault, including beatings, rape and
even homicide. The majority of assaults against transgender persons are never reported the
police. A link between these experiences and mental health disorders such as Post Traumatic
Stress Disorder (PTSD) is widely suspected, but has not been adequately documented.
Suicide and self-harm
Both suicide attempts and completed suicides are common in transgendered persons. Studies
generally report a pre-transition suicide attempt rate of 20% or more, with MTFs relatively more likely to
attempt suicide than FTMs. There is some evidence that transsexual people are less likely to attempt
suicide once they have completed the transition to the other sex.
Another form of self-harm in transgendered persons is genital mutilation. This is most common among
transsexuals, although cross-dressers have done this as well. A 1984 study of a cohort of
transgendered individuals who applied for services at gender identity clinics reported genital mutilation
by 9% of the biologic males and breast mutilation was attempted by 2% of the biologic females.
Updated: Wednesday, September 15, 2004 at 10:28 AM
All information is general in nature and is not intended to be used as a substitute for appropriate
professional advice. For more information please call 206-296-4600 (voice) or 206-296-4631 (TTY
Relay service). Mailing address: ATTN: Communications Team, Public Health - Seattle & King County,
999 3rd Ave., Suite 1200, Seattle, WA 98104 or click here to email us.
Friday, September 17, 2004
Over the past five years during my transition I have come across a few people that
have made there religious present known on what I was doing wasn‘t right, and that I
needed to pray to God about it.
In taking there request seriously, I did so, and prayed to the Lord asking him if he
would please take my medical condition away. But no such luck in resolving the
issues. I even have talked to a few ministers about my prayer and ways told it wasn‘t
done that way.
As a transsexual individual one has to accept it as a gift from God. Being transsexual
we have a purpose and what it might be some of us don‘t know. Listed below are a
few bible passages in support of transgendered people that I hope will help to relieve
the religious issues toward a transgendered individual within society‘s beliefs. We all
have to be True to Ones Self.
Bible Passages in Support of Transgendered People
A wonderful collection of scripture, complied by a Tran Family member, that
offers support for Trans people.
[Gen 1:27.15] So God created man in his own image, in the image of God he created him;
male and female he created them.
(Notice that it doesn't say "male or female", it says "male and female." We are not one or the
other. We are not Barbie and we are not Rambo. All of the people God created are somewhere
between these two extremes.)
[Mat 22:34-40] But when the Pharisees heard that he had silenced the Sadducees, they came
And one of them, a lawyer, asked him a question, to test him.
"Teacher, which is the great commandment in the law?"
And he said to him, "You shall love the Lord your God with all your heart, and with all your
soul, and with all your mind.
This is the great and first commandment.
And a second is like it, you shall love your neighbor as yourself.
On these two commandments depend all the law and the prophets."
Jesus was referring to this passage:
[Lev 19:18.20] You shall not take vengeance or bear any grudge against the sons of your own
people, but you shall love your neighbor as yourself: I am the LORD.
Jesus was telling how it's important to love your neighbor, not to attack, harass, or judge him or
[Mat 7:1-4] "Judge not, that you be not judged.
For with the judgment you pronounce you will be judged, and the measure you give will be the
measure you get.
Why do you see the speck that is in your brother's eye, but do not notice the log that is in your
Or how can you say to your brother, `Let me take the speck out of your eye,' when there is the
log in your own eye?
These passages show that it is not the place of any Christian to judge others, to proclaim them
as sinners, or to deny them the rights and privileges available to everyone else. Judging is
[Gal 3:28] There is neither Jew nor Greek, slave nor free, male nor female, for you are all one
in Christ Jesus.
Jesus makes it clear that God does not distinguish between people based on race, freedom, or
sex, he considers us all one and all equal.
[Wis 3:14.5] And blessed is the eunuch, which with his hands hath wrought no iniquity, nor
imagined wicked things against God: for unto him shall be given the special gift of faith, and
an inheritance in the temple of the Lord more acceptable to his mind.
Eunichs were the closest people to the transgendered in Biblical times. God said they were
Why are Transsexuals so mean to each other?
Dear Madeline, Thank you so much for your insights and
comments. They are truly appreciated. My holidays were very
enjoyable. ... I've not posted to this list (TRANSGEN) because
it really seems like all they really do is bicker with one
another? ... Sort of sad to see this here and elsewhere on the
web. I guess I'm a little naive and idealistic. Aren't we
supposed to give each other the benefit of the doubt and look
for the good in each other's words and actions instead of
jumping on each other for every perceived miscue? I can be
about as thin skinned as anyone I know but the last thing I'm
going to do is attack. Well, I could' resist responding this
morning when I saw your email but I have to get back to my job
Thanks again and I'll be patiently waiting ... I know it will
be worth the wait. ~ Gail
... That's really disappointing to hear Transgen is still a lot of bickering. I heard they
were trying to make it better. It's so sad, but I know you're going to hear a lot of mean-
spirited things if you spend much time in 'trans-world.' What happens is, I guess,
something like this.
All of us (i.e. anybody who's gender questioning) have a lot of mental health issues
like low self-esteem. It's really hard to feel good about yourself if you can't see how
you fit in and it's especially bad for MtF transsexuals’ b/c society has an especially
negative view of boys who act girlish. It gives all of us a lot of anxiety. No matter how
certain a transsexual might seem about his/her gender, he/she still doesn't 'know'
because it's just so convoluted. (Then again, maybe some do. I just know it was not
something so obvious for me.) Think about it, if you transition you're going against
things you've been told since probably the day you were born. I really mean it! I do
research with infants (like 5 months old) and when a baby "John" retrieves a toy I (as
the experimenter) say "good job John!" but his parent inevitably says "good boy!"
Anyway, since we're going against everything society tells us, most of us really need
'external validation' of our gender identities. That's a way too academic way of saying
that we need other people to tell us we're okay so we know inside that we're okay. We
really need to know that we're "real transsexuals" (whatever on earth that means). But
all of us (men, women, & anybody else) has boyish and girlish aspects of their
personality and behavior. And we see other transsexual 'mess up' by getting read or
acting girlish when they're an FtM transsexual or whatever. Really this isn't messing
up; it's just being a person. But it can really affect us because inside each of us is this
deep fear that we're not "real boys", "real girls", or "real transsexuals." When we see
somebody else 'mess up', wouldn't it be wonderful if we could console our friends
when they need us?
But often we can't because *we* really need to assure *ourselves* that, "I'm certainly
not like that." And so a lot of us feel this need to put others down in order to feel better
about ourselves. And many of us are hypersensitive to 'criticism' so we can often
misread an innocuous remark as though it was saying something invalidating about us
But that's only the *first* layer!!!!! Some gender questioning people transition and
some really need to assure themselves that they did the right thing. And many of them
get ideas that how they transitioned is the 'right' way to transition (whatever that
means). And sometimes when they talk it comes across to the listener as a little too
much like a personal judgment about what's 'right' to do instead of as advice. The
speaker often needs to say things forcefully to make sure he/she really believes it
himself/herself. And the listener often is very sensitive to that force so it sounds more
judgmental than maybe it was really intended. This all comes out of our personal fears
and our needs for external validation.
BTW, I don't mean to exempt myself from this which it might sound like because I
talking about my 'observations' rather than about my 'experiences'. I've certainly
experienced this too. It's *really* hard to avoid doing any of this!!! I guess the best way
to try and avoid this is to remember that everybody else is just a person, like you and
me, and no matter how mean-spirited they act, they're just trying to get through life
and survive a critical society as best they can with whatever coping skills they have
developed. Please try to be gentle in your thoughts about those you meet. Even when
they act mean it's often their insecurities more than themselves speaking.
I hope I'm not leaving you with a sense of hopelessness about us and the way we can
all easily slip into being mean-spirited. Many transsexuals get pass things like this
(having been more or less mean-spirited along the way). I no longer care so much
about getting external validation of my gender identity. Though I sometimes need it
and it's still nice!! :-) What's changed is I just know *inside* that I'm happy. I'm no
longer neurotic (at least not as much) and I can just be myself whether boyish or
girlish or whatever and I know I can really relate to other people without following any
scripts like 'okay boy behavior'. It's like if anybody really bothered to challenge if I'm a
"real girl" or a "real transsexual", I would just go "whatever" and think they really need
to get a grip and not waste so much of their time deciding what I 'really' am.
Lots of transsexuals reach this happy point too. But most transsexuals abandon the
transgender/transsexual community by then because they can't stand the bickering
anymore. I can't deal with it either which is why I'm no longer on any
transsexual/transgender mailing lists like TRANSGEN or Trans-Theory. But these
groups really can be helpful while you're trying to sort things out. We just need to try
an be gentle with others. But maybe what's most important is that we try to be gentle
with ourselves. Remember you're a good person! :-)
Rebecca Anne Allison, M.D.
Update July 2002:
The Women's Health Initiative (WHI) Trial
This is an update on the paper I originally wrote in 1997 for the Second International
Congress on Sex and Gender Issues. The original paper is left intact at the end of this
page for historical purposes.
Much has changed since 1997. My original update in 1999 discussed the results of the
HERS study (see below), which involved women with a history of heart disease who
were taking estrogen (Premarin) and progesterone (Provera). The results of this study
indicated an increased risk for those women of new cardiac problems, compared to
women with a history of heart disease who were not taking the hormones.
I summarized the HERS results as follows:
In the August 1998 Journal of the American Medical Association, the results of the
Heart and Estrogen/Progestin Replacement Study (HERS) were published. (10) This
was a randomized, placebo-controlled, clinical trial involving 2, 763 postmenopausal
women with established coronary disease, averaging age 67. Patients were
randomized to either an estrogen-progestin combination or placebo.
Over the average follow-up of 4.1 years, there were 172 coronary heart disease (CHD)
"events" (coronary death or nonfatal myocardial infarction) in the hormone treatment
(HRT) group, and 176 "events" in the placebo group. Hormone treatment had no effect
on the risk of coronary events, despite favorable effects on the lipid profile (11%
reduction in LDL-cholesterol, 10% increase in HDL-cholesterol). HRT appeared to
increase the risk of CHD events during the first year of therapy and then decrease the
risk after two years. In other words, there was a clear trend for benefit if patients
tolerated the therapy for at least two years without an event.
HERS investigator Roger S. Blumenthal wrote in an editorial for Cardiology Today his
hypothesis that the early increase in CHD events is due to a thrombogenic effect in a
small percentage of susceptible women. Over time, these negative effects were
outweighed by the positive effects on vasomotor tone and improvements in lipid
One very large-scale trial, and three smaller trials, is continuing to look at the effects of
HRT on heart disease. The Women's Health Initiative (WHI) involves 27, 500
women with no prior history of CHD. This study will test both estrogens alone (in
women who have had hysterectomy) as well as combined with progestin. The trial
is scheduled to run for an average of nine years. The WAVE (Women's Angiographic
Vitamin and Estrogen), WELL-HART (Women's Estrogen/Progestin and Lipid Lowering
Hormone Atherosclerosis Regression Trial), and ERA (Estrogen Replacement and
Atherosclerosis) trials will enroll up to 450 women each, using angiography to
determine the progression of atherosclerosis in women with known coronary disease.
The results of the HERS trial, while disappointing to cardiologists treating women with
CHD, are not necessarily applicable to populations without CHD. Perhaps screening for
thrombotic disorders (protein C resistance, factor V Lei den mutation) will identify a
group at high risk for HRT and give more assurance in treatment of low risk persons.
We did not have to wait nine years for the WHI results. On July 17, 2002, the Journal of
the American Medical Association (JAMA) published an article entitled "Risks and
Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal
Results From the Women's Health Initiative Randomized Controlled Trial".
The study population was large: 16,608 postmenopausal women aged 50-79 years
with no history of heart disease, and without a history of hysterectomy.. (There is
another segment of the study which is still ongoing, evaluating the use of estrogen
without progesterone in women who have had a hysterectomy. No early trends have
yet been reported from this study.)
Participants were randomized to placebo versus active treatment, which consisted of
conjugated equine estrogen (CEE), 0.625 mg daily, plus medroxyprogesterone acetate
(MPA), 2.5 mg daily. (We know these drugs by their brand names, Premarin and
Provera, but I will refer to them by the abbreviations.) The primary outcomes were
coronary heart disease (CHD), as measured by new heart attack or cardiac death; and
breast cancer. Secondary outcomes were stroke, pulmonary embolism, endometrial
cancer, colorectal cancer, hip fracture, and death due to other causes.
On May 31, 2002, after a mean of only 5.2 years follow up, the WHI data and safety
monitoring board recommended stopping the trial of estrogen/progesterone versus
placebo because of a significantly increased incidence of breast cancer and CHD in the
treatment group. Of all the outcomes measured, the only ones with a favorable "risk
ratio" were colorectal cancer and hip fractures.
Absolute risks were reported in units of "person-years." A unit of 10,000 person-years
corresponds to 10,000 persons taking the drugs for one year, or 5,000 persons taking
the drugs for two years, and so on. (The point being that the positive or negative risk
ratio is magnified by the number of years a person has been taking the drugs.)
The absolute risks were as follows, in number of cases of disease greater or less than
expected per 10,000 person-years:
Breast cancer +8
Pulmonary embolus +8
Hip fracture -5
Colorectal cancer -6
The absolute excess risk of all events included in the global index was 19 per 10,000
The study group drew this conclusion: "The risk-benefit profile found in this trial is not
consistent with the requirements for a viable intervention for primary prevention of
chronic diseases, and the results indicate that this regimen should not be initiated or
continued for primary prevention of CHD." (Emphases are mine)
In interpreting the results of this
study for an audience of male to
female transsexual patients on
hormone therapy, I must take A much more
into account many factors. extensive bio-
First: The specific reason for statistical analysis
of the Women's
treatment in the study population, Health Initiative
as mentioned above, is for the results, by Sarah
primary prevention of chronic Fox, Ph.D., is
diseases including coronary presented here.
heart disease. In that context,
the benefits of treatment do not
equal the risks of treatment.
So much of medicine is about this "risk-benefit" ratio. Any intervention involving a
person's body involves some risks. The question is whether the benefits to be expected
from the intervention are greater than the risks involved.
For example, in my specialty of cardiology, it is generally recognized that angioplasty
and stenting of a left main coronary artery is very high risk. For these patients, coronary
bypass surgery will produce the same benefits and is actually lower risk - safer - than
the less invasive stent procedure. I sometimes find myself in the position of trying to
explain the risk-benefit ratio on a rather urgent basis.
So we see that CEE/MPA hormone treatment has been found to have a risk for
coronary heart disease and breast cancer that overshadows the expected benefits.
This study does not address the other uses of hormone therapy. Specifically omitted
from the list are menopausal symptoms, which can be disabling for some women, and
which are quite preventable with hormones.
In the case of transsexual medicine, the risk-benefit ratio will likely be quite different
from that of postmenopausal women. The benefits of estrogen therapy are obvious in
the physical feminization and the emotional stress reduction that nearly every MTF
transsexual experiences. Many of us will look at the data and conclude, with our
physicians, that the benefits outweigh the potential risks, even taking into account the
results of the WHI study. Given this different risk-benefit expectation, I cannot make
any blanket recommendation unfavorable to hormone treatment for transsexual
Still, there are serious issues which we must address regarding the safety of hormone
First of all, I must stress that the risk-benefit ratio changes drastically in persons with a
history of cardiovascular disease. A transsexual person who has had coronary disease
or stroke is in a higher risk group than one who has no such history. I strongly
recommend all such persons undertake HRT only under the supervision of a
cardiovascular specialist, who can help with other medical treatments (blood pressure
and cholesterol lowering, blood thinner medicines) to further reduce risks. HRT is not
absolutely contraindicated in these persons, but it is more problematic.
Next, let's look at the actual hormones which were used in the WHI: conjugated equine
estrogens and medroxyprogesterone. It is my strong opinion, which is shared by other
TS physicians I know, that these two drugs are inferior and outdated. CEE has long
been known to increase risk of blood clotting problems, and is sometimes poorly
metabolized by the liver. There are also, of course, humanitarian reasons to avoid CEE
due to the likelihood that the horses who furnish the urine from which CEE is made are
subject to cruel treatment.
A much better drug is Estradiol, a naturally occurring estrogen. It is available as tablets
of 1 or 2 milligrams (generic or brand name Estrace). The usual dose for pre-op
treatment is 4 milligrams daily, and for post-op 2 milligrams. These tablets are also
dissolvable, and many doctors (including gynecologists I have spoken with)
recommend letting Estradiol dissolve under the tongue rather than swallowing it.
This not only gives better absorption, but avoids the metabolism by the liver which
might stimulate more blood clotting problems. Estradiol can also be given by injection
or by transdermal patches, but the sublingual route seems to me to be the best. I
believe the use of Estradiol rather than CEE will reduce a person's health risks, and
urge physicians to change their patients to Estradiol.
The use of progesterone is still open to question. I have often wondered just how much
benefit we get from adding progesterone to estrogen treatment. Personally, I haven't
taken progesterone for years. Still, I recognize there are TS persons who swear by its
benefits, and we must consider how to best prescribe it. I feel very strongly that natural
progesterone (brand name Prometrium) should be used in preference to MPA. Natural
progesterone, as far as our present knowledge goes, does not have the adverse
effects of MPA on blood cholesterol or blood pressure levels. There are no studies
demonstrating health risks of natural progesterone. I recommend that physicians
change their patients from MPA to Prometrium.
Cardiologists often speak of "risk factors" for heart disease. We refer to cigarette
smoking, cholesterol, diabetes and blood pressure as treatable risk factors, as opposed
to age and family history of heart disease, which are not treatable. When we cannot
eliminate a risk factor, we simply become more diligent in screening for possible
existing problems and in reducing those factors which are treatable.
Even if we do consider HRT as a "risk factor" for cardiovascular disease (and I'm not
saying we must), we can choose to continue it under medical observation, and we can
do everything possible to reduce the other risk factors. Keep your weight, blood
pressure, blood sugar and cholesterol under control.
And for the sake of your overall health, by all means DO NOT SMOKE CIGARETTES.
This is the single most important intervention for many persons. The risk of CHD and
stroke is magnified many times in persons who smoke cigarettes while taking estrogen
in any form. I know that quitting is not easy, but it must become a life priority for you, or
sooner or later you will pay the price.
I am writing from the viewpoint of a cardiologist who also happens to be a male-to-
female transsexual person. These recommendations are my opinion only, and are not
to be taken as specific instructions or orders. Readers should discuss them with their
personal physician prior to making changes in their medical treatment.
To the best of my knowledge, this paper reflects the state of the science in 2002. If
other studies are reported which will change the recommendations, I will give them
Rebecca Allison, M.D., FACP, FACC
Original 1997 Presentation
In my cardiology practice, I have observed the same patterns of disease incidence as
my colleagues: prior to menopause, females have a much lower incidence of coronary
heart disease than males. We may infer that female sex hormones convey a protective
effect against cardiovascular disease.
This inference is confirmed by large studies such as the Nurses' Health Study (1),
designed to follow women with no known coronary disease prospectively. 48, 470
postmenopausal nurses were enrolled in this study. The risk for significant coronary
artery disease was found to be twice as great in those women who did not take
hormone replacement therapy.
How do these findings relate to hormonal treatment of male to female transsexuals?
Three Cardiovascular Effects
I will discuss the effects of estrogen and progestin‘s on three aspects of cardiovascular
physiology. The effect most recognized as beneficial is the effect on blood lipids -
primarily cholesterol and its components. Elevated levels of LDL-cholesterol (low
density lipoprotein cholesterol) lead to incorporation of cholesterol into the endothelium
(internal lining) of the blood vessels, which begins an atherosclerotic plaque. HDL-
cholesterol (high density lipoprotein cholesterol) has an opposite effect, promoting
clearance of the harmful LDL cholesterol from the blood and aiding regression of
The effects of estrogen on blood clotting are more controversial. A study published
more than twenty years ago, the Coronary Drug Project (2), evaluated the effects of
five different drug regimens which were considered to have beneficial effects on
cholesterol levels. Two of those drug regimens involved estrogen, and the study
showed an increased tendency to thromboembolic (blood clotting) disorders.
I will discuss the reasons this study should not be extrapolated to today's treament of
male to female transsexuals. Some effects of estrogen may even promote thrombolysis
(dissolving of blood clots).
Finally I will mention estrogen effects on vasoreactivity: the ability of the blood vessels
to dilate and constrict appropriately in response to stimuli.
The loss of normal vasoreactivity or vasomotor tone is associated with both an
increased incidence of hypertension, and an increased tendency to endothelial
dysfunction and atherosclerosis.
Do the Data Apply to Transsexuals?
Of course, most published data on the effects of female sex hormones on the
cardiovascular system have been from studies performed on genetic females, rather
than male to female transsexuals.
One could question whether these studies are applicable to the transsexual population.
Evidence suggests that they are, certainly in respect to vasoreactivity, and probably in
respect to cholesterol.
Lipids (Cholesterol, Triglycerides)
The PEPI (Postmenopausal Estrogen/Progestin Intervention) Trial (3) comprised three
treatment arms: estrogen alone; estrogen with medroxyprogesterone acetate (Provera);
and estrogen with micronized progesterone. The LDL cholesterol was lowered in all
treatment groups. The HDL cholesterol was higher in all groups, but the highest levels
were obtained in women taking estrogen alone or with micronized progesterone.
Numerous other studies have confirmed the PEPI findings. In the August 28, 1997,
New England Journal of Medicine, a study compared estrogen and progesterone with
simvastatin, a standard drug treatment to lower cholesterol. It was found that estrogen
increased HDL cholesterol comparably to simvastatin, and reduced both LDL-
cholesterol and Lp(a), another lipoprotein which increases cardiac risk. (4)
When we consider the unquestionable benefits of lowering LDL-cholesterol, proven in
many large scale trials, it becomes clear that estrogen therapy may play a beneficial
role in preventing the cardiovascular complications of hypercholesterolemia.
Most studies indicate that estrogen increases plasma triglyceride levels. The
significance of an elevated triglyceride in the absence of an elevated cholesterol is
probably minimal, and the addition of progesterone seems to prevent much of the
It has been thought that the risk of venous thrombosis and/or pulmonary embolism is
increased in persons taking estrogen. In 1975 the Coronary Drug Project (2) evaluated
five drug regimens reported to lower cholesterol.
These drugs included conjugated estrogens in 2.5 mg and 5 mg dosages, as well as
thyroxine, niacin, and clofibrate.
The estrogen components of the study were terminated early because of increased
incidence of thromboembolism and nonfatal myocardial infarction. It should be noted
that the test subjects were elderly males with a known history of coronary disease.
No controls were established with regard to other cardiovascular treatment, especially
aspirin use and cigarette smoking. These results should not be extrapolated to the
younger, healthy transsexual population.
The Lancet in 1996 reported a slight increased incidence of venous thromboembolism
in women on postmenopausal hormone replacement, but the absolute numbers were
very low: one in 5000 had venous thrombosis and one in 20,000 had pulmonary
The incidence of thrombotic complications is significantly increased in women taking
the higher doses of estrogen found in oral contraceptives, especially if they also smoke
This is a good reason to counsel transsexual patients against taking excessive doses
of estrogen. Lower doses are much less dangerous.
In low doses, estrogen inhibits platelet aggregation and reduces PAI-1, plasminogen
activator inhibitor. (6) This promotes thrombolysis and helps to dissolve smaller
Certain persons may have an increased risk for spontaneous thromboembolic
disorders. The Leiden Factor V mutation occurs in 2 per cent of the population and
increases risk of thrombosis 30 fold in women on oral contraceptives. These may be
the persons who experience complications on low dose estrogen. Other abnormalities
predisposing to blood clotting include deficiencies of Protein C or Protein S.
To summarize, "The effects of estrogen on hemostasis and thrombosis are highly dose
dependent... in general, the balance is shifted away from thrombosis with low dose
estrogen, and towards thrombosis with high dose estrogen." (7)
The layer of smooth muscle which surrounds the arteries constricts and relaxes in
response to certain stimuli. The major stimulus is the biochemical pathway called the
Angiotensin, an inactive precursor compound, is enzymatically converted to a strong
vasoconstrictor called angiotensin II, which produces elevation of blood pressure and a
tendency to endothelial dysfunction. Opposing this effect are the vasodilating
compounds thromboxane, bradykinin, and nitric oxide, which stabilize the blood vessel
and increase its ability to dilate.
Estrogen has definite effects on vasoreactivity in women and in men. It produces
increased plasma renin activity, but diversion of renin-angiotensin activity away from
angiotensin II and towards other compounds which are not vasoconstrictors. Estrogen
increases production and activity of nitric oxide, functioning as an antioxidant.
Two studies in the June 1997 Journal of the American College of Cardiology reported
on arterial reactivity in transsexual males taking estrogen (8), (9).
They studied male to female transsexuals on long term estrogen, compared with
matched male controls (8), (9) and female controls (9). They found significantly
enhanced vascular reactivity in the transsexual groups, comparable to genetic females.
The significance of this is that vascular reactivity allows for arterial relaxation and
Conclusion and Recommendations
In conclusion, a regimen of relatively low dose estrogen, with or without micronized
progesterone, can be expected to confer long term reduced risk of cardiovascular
disease in postmenopausal females and in male to female transsexuals.
General evaluation of cardiovascular risk factors should include a measurement of
blood pressure and a lipid profile (total cholesterol, LDL- and HDL-cholesterol,
triglycerides) before and after initiation of therapy. Persons who smoke cigarettes
should be emphatically urged to stop smoking, and should be made aware of the
consequences and greatly increased risk of cardiovascular disease if they continue to
The routine use of low dose (81 mg) aspirin in male to female transsexuals, especially
over age 40, should be considered, for persons who have no bleeding disorders or
contraindication to taking aspirin. This low dose may help to counteract any possible
increased incidence of thrombotic events. Transdermal or injectable estrogen may
have a reduced risk for thrombotic problems, since they are less likely than oral
estrogen to stimulate the liver to produce proteins involved in the clotting process.
Certain persons may be at increased risk of cardiovascular disease, and should have
special evaluation prior to the initiation of estrogen therapy. Persons with a history of
hypertension should be followed closely and treated appropriately, preferably with
medication which inhibits angiotensin-converting enzyme. Persons with a past history
or family history of blood clotting disorders should have laboratory evaluation for
conditions such as Factor V Leiden mutation.
Persons with a family history of cardiovascular disease should have more extensive
screening, with electrocardiograms and probably treadmill exercise testing. The finding
of coronary heart disease should be managed in the usual manner. Such persons
should not be automatically rejected for estrogen therapy. If appropriate attention is
given to reducing other risks, an informed decision may be made between patient and
physician to proceed. Several alternatives may be considered, including the use of a
more powerful anticoagulant such as warfarin. Orchiectomy may permit lower doses of
estrogen to be administered more safely.
Physicians treating transsexual patients should be encouraged to report results of long
term followup with regards to the incidence of cardiovascular disease, so future data
can be directly applicable to transsexual medicine rather than inferred from general
1. Stampfer MJ et al., "Postmenopausal estrogen therapy and cardiovascular disease: Ten-year follow-
up from the Nurses' Health Study", The New England Journal of Medicine, Vol. 325, 1991:756-62
2. The Coronary Drug Project, Journal of the American Medical Association, Vol. 231, 1975: 360-81
3. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial: Effects of estrogen or
estrogen/progestin regimens on heart disease risk factors in postmenopausal women, Journal of the
American Medical Association, Vol. 273(3), 1995:199-208
4. Darling GM et al., "Estrogen and Progestin Compared with Simvastatin for Hypercholesterolemia in
Postmenopausal Women", The New England Journal of Medicine, Vol. 337, No. 9, August 28, 1997:
5. Daly E et al., "Risk of Venous Thromboembolism in Users of Hormone Replacement Therapy", The
Lancet, Vol. 348, October 12, 1996: 977-80
6. Julian D, Wenger NK, Heart Disease In Women, Mosby 1997, p. 253
7. Ibid., p. 252
8. McCrohon JA et al., "Arterial Reactivity Is Enhanced in Genetic Males Taking High Dose Estrogens",
Journal of the American College of Cardiology, Vol. 29, No. 7, June 1997:1432-6
9. New G et al., "Long-Term Estrogen Therapy Improves Vascular Function in Male to Female
Transsexuals", Journal of the American College of Cardiology, Vol. 29, No. 7, June 1997:1437-44
10. Hulley S et al, "Randomized Trial of Estrogen Plus Progestin For Secondary Prevention of Coronary
Heart Disease in Post-Menopausal Women," Journal of the American Medical Association, Vol. 280,
International Bill of Gender Rights
(As adopted June 17, 1995 in Houston, Texas, U.S.A.)
The International Bill of Gender Rights (IBGR) strives to express human and civil rights from
a gender perspective. However, the ten rights enunciated below are not to be viewed as special
rights applicable to a particular interest group. Nor are these rights limited in application to
persons for whom gender identity and gender role issues are of paramount concern. All ten
sections of the IBGR are universal rights which can be claimed and exercised by every human
The International Bill of Gender Rights (IBGR) was first drafted in committee and adopted by
the International Conference on Transgender Law and Employment Policy (ICTLEP) at that
organization's second annual meeting, held in Houston, Texas, August 26-29, 1993.
The IBGR has been reviewed and amended in committee and adopted with revisions at
subsequent annual meetings of ICTLEP in 1994 and 1995.
The IBGR is a theoretical construction which has no force of law absent its adoption by
legislative bodies and recognition of its principles by courts of law, administrative agencies
and international bodies such as the United Nations.
However, individuals are free to adopt the truths and principles expressed in the IBGR, and to
lead their lives accordingly. In this fashion, the truths expressed in the IBGR will liberate and
empower humankind in ways and to an extent beyond the reach of legislators, judges, officials
When the truths expressed in the IBGR are embraced and given expression by humankind, the
acts of legislatures and pronouncements of courts and other governing structures will
necessarily follow. Thus, the paths of free expression trodden by millions of human beings, all
seeking to define themselves and give meaning to their lives, will ultimately determine the
course of governing bodies.
The IBGR is a transformative and revolutionary document but it is grounded in the bedrock of
individual liberty and free expression. As our lives unfold these kernels of truth are here for all
who would claim and exercise them.
This document, though copyrighted, may be reproduced by any means and freely distributed by
anyone supporting the principles and statements contained in the International Bill of Gender
Comments, suggestions or questions regarding the IBGR should be forwarded to Sharon
Stuart, IBGR Project, P.O. Box 930, Cooperstown, NY 13326 U.S.A. Telephone: (607) 547-
4118. FAX: (607) 547-2198. E-Mail: StuComOne@aol.com.
Universities, libraries, academicians, attorneys, judges, government officials, social workers,
and others may obtain bound proceedings from each of the annual ICTLEP conferences for
$65 each (300 plus pages per volume). Contact ICTLEP, 5707 Firenza Street, Houston, TX
77035 - 5515 U.S.A. E-Mail: firstname.lastname@example.org.
The Right To Define Gender Identity
All human beings carry within themselves an ever-unfolding idea of who they are and what
they are capable of achieving. The individual's sense of self is not determined by chromosomal
sex, genitalia, assigned birth sex, or initial gender role. Thus, the individual's identity and
capabilities cannot be circumscribed by what society deems to be masculine or feminine
behavior. It is fundamental that individuals have the right to define, and to redefine as their
lives unfold, their own gender identities, without regard to chromosomal sex, genitalia,
assigned birth sex, or initial gender role.
Therefore, all human beings have the right to define their own gender identity regardless of
chromosomal sex, genitalia, assigned birth sex, or initial gender role; and further, no individual
shall be denied Human or Civil Rights by virtue of a self-defined gender identity which is not
in accord with chromosomal sex, genitalia, assigned birth sex, or initial gender role.
The Right To Free Expression Of Gender Identity
Given the right to define one's own gender identity, all human beings have the corresponding
right to free expression of their self-defined gender identity.
Therefore, all human beings have the right to free expression of their self- defined gender
identity; and further, no individual shall be denied Human or Civil Rights by virtue of the
expression of a self-defined gender identity.
The Right To Secure And Retain Employment And To Receive Just
Given the economic structure of modern society, all human beings have a right to train for and
to pursue an occupation or profession as a means of providing shelter, sustenance, and the
necessities and bounty of life, for themselves and for those dependent upon them, to secure and
retain employment, and to receive just compensation for their labor regardless of gender
identity, chromosomal sex, genitalia, assigned birth sex, or initial gender role.
Therefore, individuals shall not be denied the right to train for and to pursue an occupation or
profession, nor be denied the right to secure and retain employment, nor be denied just
compensation for their labor, by virtue of their chromosomal sex, genitalia, assigned birth sex,
or initial gender role, or on the basis of a self-defined gender identity or the expression thereof.
The Right Of Access To Gendered Space And Participation In Gendered
Given the right to define one's own gender identity and the corresponding right to free
expression of a self-defined gender identity, no individual should be denied access to a space
or denied participation in an activity by virtue of a self-defined gender identity which is not in
accord with chromosomal sex, genitalia, assigned birth sex, or initial gender role.
Therefore, no individual shall be denied access to a space or denied participation in an activity
by virtue of a self-defined gender identity which is not in accord with chromosomal sex,
genitalia, assigned birth sex, or initial gender role.
The Right To Control And Change One's Own Body
All human beings have the right to control their bodies, which includes the right to change their
bodies cosmetically, chemically, or surgically, so as to express a self-defined gender identity.
Therefore, individuals shall not be denied the right to change their bodies as a means of
expressing a self-defined gender identity; and further, individuals shall not be denied Human or
Civil Rights on the basis that they have changed their bodies cosmetically, chemically, or
surgically, or desire to do so as a means of expressing a self-defined gender identity.
The Right To Competent Medical And Professional Care
Given the individual's right to define one's own gender identity, and the right to change one's
own body as a means of expressing a self-defined gender identity, no individual should be
denied access to competent medical or other professional care on the basis of the individual's
chromosomal sex, genitalia, assigned birth sex, or initial gender role.
Therefore, individuals shall not be denied the right to competent medical or other professional
care when changing their bodies cosmetically, chemically, or surgically, on the basis of
chromosomal sex, genitalia, assigned birth sex, or initial gender role.
The Right To Freedom From Psychiatric Diagnosis Or Treatment
Given the right to define one's own gender identity, individuals should not be subject to
psychiatric diagnosis or treatment solely on the basis of their gender identity or role.
Therefore, individuals shall not be subject to psychiatric diagnosis or treatment as mentally
disordered or diseased solely on the basis of a self-defined gender identity or the expression
The Right To Sexual Expression
Given the right to a self-defined gender identity, every consenting adult has a corresponding
right to free sexual expression.
Therefore, no individual's Human or Civil Rights shall be denied on the basis of sexual
orientation; and further, no individual shall be denied Human or Civil Rights for expression of
a self-defined gender identity through sexual acts between consenting adults.
The Right To Form Committed, Loving Relationships And Enter Into Marital
Given that all human beings have the right to free expression of self-defined gender identities,
and the right to sexual expression as a form of gender expression, all human beings have a
corresponding right to form committed, loving relationships with one another, and to enter into
marital contracts, regardless of their own or their partner's chromosomal sex, genitalia,
assigned birth sex, or initial gender role.
Therefore, individuals shall not be denied the right to form committed, loving relationships
with one another or to enter into marital contracts by virtue of their own or their partner's
chromosomal sex, genitalia, assigned birth sex, or initial gender role, or on the basis of their
expression of a self-defined gender identity.
The Right To Conceive, Bear, Or Adopt Children; The Right To Nurture And
Have Custody Of Children And To Exercise Parental Capacity
Given the right to form a committed, loving relationship with another, and to enter into marital
contracts, together with the right to express a self-defined gender identity and the right to
sexual expression, individuals have a corresponding right to conceive and bear children, to
adopt children, to nurture children, to have custody of children, and to exercise parental
capacity with respect to children, natural or adopted, without regard to chromosomal sex,
genitalia, assigned birth sex, or initial gender role, or by virtue of a self-defined gender identity
or the expression thereof.
Therefore, individuals shall not be denied the right to conceive, bear, or adopt children, nor to
nurture and have custody of children, nor to exercise parental capacity with respect to children,
natural or adopted, on the basis of their own, their partner's, or their children's chromosomal
sex, genitalia, assigned birth sex, initial gender role, or by virtue of a self-defined gender
identity or the expression thereof.
Establishing Empathy with the Transgender Condition
Imagine that you are the person you are right now, but only on the inside. On the outside, you have the body of a
person of a different gender. Everyone knows you as this other person--the one they can see, rather than the one
you know to be real. When you interact with other people, you do so as the outer person, the one you know to be
The inner person is very special to you; you'd like to be that person, and put an end to all the lies about who you
really are. But you know that if you act as that inner person, or dress as that inner person, people will think that
you are strange. They will reject you. They will not know you, even when you say, "Look! It's me! I'm the same
person you've always known." You will be alone.
This is the closet from which the transgendered person emerges.
Imagine that you are going out in public as the inner person, the person no one else knows. It feels good, and it
feels right. You look at yourself in the mirror, and you see the inner self emerging at last! But the image is
mixed with the outer person that everyone knows. Will anyone else see this? Will you see anyone who knows
you? What else could give you away... Your voice? A gesture? Is your clothing appropriate for the occasion?
You feel right long before you look right in your new gender role. You look right long before you have the
behavior, the voice, the vocabulary, or anything else. One thing that you'll never have is the history of growing
up in the gender role you'd prefer to have. You were never the gender of your birth, but you'll never completely
be the gender of your choice, either. But that's all right; somehow, you'll be OK.
Transition is many long and difficult journeys, all taken together, all without end. Emotional, physical,
behavioral, and social patterns must be challenged, perhaps shattered and rebuilt. Each person finds some of
these to be easier than others, and some are harder. Each journey is unique, and each is taken in many small
steps. Each step is full of surprises.
Yesterday my partner gave me a black turtleneck sweater. I tried it on and looked in the mirror. The sweater fit
perfectly. Summer was just ending, and it was the first time in months that I'd tried on anything knit and
clinging, so it was the first time that I'd ever seen what such clothing would do for my new breasts.
I've been out in public as a woman on many occasions. Before I had breasts, I'd stuff a bra with foam rubber,
then forget about it. I knew the day would come when I could go out without padding, but this was the first time
I'd realized that from now on, when a man looks at my breasts, he'll be looking at me. I covered my breasts with
Welcome to my world!
Copyright © 1995, 2001 by Diane Wilson. All rights reserved.
Permission is given to copy freely under the conditions that this material will not be included in
publication for profit, and that passing this information on to others will be done free of charge. This
copyright statement must be part of any copy.
GLAAD Statement on President Bush's Announced
Support for an Anti-Gay Constitutional Amendment
media center > media releases > GLAAD Statement on President Bush's Announced
Support for an Anti-Gay Constitutional Amendment
February 24, 2004
Contact: Sean Lund, National News Media Coordinator
Phone: (323) 634-2008 Email: email@example.com
GLAAD EXECUTIVE DIRECTOR JOAN M. GARRY --"As America has watched images in
the media of thousands of gay and lesbian couples who have joyfully made formal
commitments to one another, they have seen something President Bush has obviously
missed completely: that true equality under the law is something that every American
yearns for deeply -- and is entitled to.
"This is a day of great sadness for all Americans who believe in that principle of
equality. The president's statement today calling for the first amendment to the U.S.
Constitution that would target a group of Americans for discrimination demonstrates
just how terribly out of step this administration is with what fair-minded Americans
understand in their hearts.
"In his nearly four years in office, President Bush has still not publicly uttered the words 'gay'
or 'lesbian.' And he has refused to recognize the lives and families that would be so terribly
devastated by his callous call to codify discrimination.
"We call upon all Americans who care about equality to recognize and acknowledge the
families and lives at the heart of this debate - and trust that media will help all of us
understand the real-life impact of the president's decision today."
The Gay & Lesbian Alliance against Defamation (GLAAD) is dedicated to promoting and
ensuring fair, accurate and inclusive representation of people and events in the media as a
means of eliminating homophobia and discrimination based on gender identity and sexual
Employers Who Discriminate Against Men Who Wear Dresses and Makeup May Face Liability
For Sex Discrimination
February 15, 2005
The Federal Court of Appeals for the Sixth Circuit recently held that a transsexual male employee could
maintain an action for sex discrimination based on allegations that his employer discriminated against
him due to his gender-non-conforming conduct.
In Smith v. City of Salem, 378 F.3d 566 (6th Cir. 2004), the Plaintiff Jimmie Smith was employed by the
city of Salem, Ohio as a lieutenant in the Salem Fire Department. He worked for the Fire Department
for seven years without any negative incidents. Smith is biologically male but considers himself a
transsexual and was diagnosed with Gender Identity Disorder ("GID"). After being diagnosed with GID,
Smith, following medical advice, began expressing a more feminine appearance on a full-time basis.
Smith's co-workers noticed the change and commented that his appearance and mannerisms were not
"masculine enough." Smith informed his supervisor about his GID and treatment, which he anticipated
would eventually include medical transformation from male to female.
Smith's supervisor informed his superiors, and city officials devised a plan for terminating Smith's
employment, which involved requiring Smith to undergo three separate psychological examinations
with the hope that Smith would either resign or refuse to comply. If he refused to comply, city officials
planned to terminate him on grounds of insubordination. A few days later, the city suspended Smith for
an alleged policy infraction.
Smith then filed a lawsuit in federal district court asserting a claim for sex discrimination and retaliation
under Title VII. The district court dismissed Smith's claim on the grounds that transsexuals are not a
class of employees protected under Title VII, which prohibits discrimination on the basis of "race, color,
religion, sex, or national origin." Smith appealed the district court's ruling, arguing that he had stated a
claim for sex stereotyping, which the Supreme Court held unlawful in Price Waterhouse v. Hopkins, 490
U.S. 228 (1989). In Price Waterhouse, the plaintiff, a female senior manager in an accounting firm was
denied partnership because she was considered "macho." She was told that she could improve her
chances for partnership if she were to walk, talk, and dress more femininely, including wearing make-
up and jewelry. The Supreme Court held that such treatment was unlawful sex discrimination based on
an individual's failure to conform to sexual or gender stereotypes. According to the Sixth Circuit, Smith's
discrimination claim against the city was no different:
After Price Waterhouse, an employer who discriminates against women because, for instance, they do
not wear dresses or makeup, is engaging in sex discrimination because the discrimination would not
occur but for the victim's sex. It follows that employers who discriminate against men because they do
wear dresses and makeup, or otherwise act femininely, are also engaging in sex discrimination,
because the discrimination would not occur but for the victim's sex.
While the Smith case may seem unusual or even extreme, an individual's failure to conform to gender
stereotypes is often the reason that such an individual suffers harassment or discrimination at the
workplace. Employers should review, and if necessary, revise their anti-harassment and discrimination
policies to include harassment or discrimination based on gender stereotypes as an example of
prohibited conduct. Further, employers should train their managers on how to recognize and prohibit
discrimination claims based on gender stereotyping. Finally, this case serves as a reminder that sex
discrimination and harassment claims can be brought by both men and women.
HARRY BENJAMIN INTERNATIONAL GENDER DYSPHORIA ASSOCIATION
TRANSGENDER REFERRAL SOURCES
For information regarding sex reassignment, transgenderism, and/or referrals and providers in
your area, please contact one of the following organizations. These reputable organizations
disseminate reading materials, general references regarding gender dysphoria, or will provide
referrals to professionals or organizations in this field.
These organizations may be able to provide you with referrals to qualified professionals.
1. American Association of Sex Educators, Counselors, & Therapists (AASECT)
PO Box 5488
Richmond, VA 23220-0488
Phone: (804) 644 3288
Fax: (804) 644 3290
2. Gay & Lesbian Advocates & Defenders (GLAD)
GLAD is New England’s leading legal organization doing work on behalf of transgender
individuals and all people who reflect a diversity of gender expression.
30 Winter Street, Suite 800
Boston, MA 02108
Phone: (617) 426-1350
3. The Institute for the Advanced Study of Human Sexuality
IASHS is a graduate program in sexology.
4. International Journal of Transgenderism
Friedemann Pfaefflin, M.D. & Eli Coleman, Ph.D., Editors
5. The Society for the Scientific Study of Sexuality (SSSS)
SSSS is an international organization dedicated to the advancement of knowledge about
sexuality. They maintain a list of schools that have an emphasis in sexology in the USA and
6. The Transmedicine Discussion Group
The transmedicine discussion group, located at: http://groups.yahoo.com/group/transmedicine
is a forum for health professionals, primarily physicians, to discuss aspects of transgender
medicine. The focus is on hormone therapy, research, access to care, and billing issues.
7. World Association for Sexology
Rua Traipu, 523- Perdizes Website: www.worldsexology.org
01235-000- Sao Paulo- SP Brazil Email: firstname.lastname@example.org
Phone: (55-11) 3666-5421
FAX: (55-11) 3662-3139
Consumer Based Advocacy Groups
The following are consumer based advocacy groups.
1. The American Boyz (AmBoyz)
The American Boyz is an organization which aims to support people who were labeled female
at birth but who feel that is not an accurate or complete description of who they are (FTMs)
and their significant others, friends, families, and allies (SOFFAs).
The American Boyz, Inc. Website: www.amboyz.org
212A S. Bridge Street #131 Email: email@example.com
Elkton, MD, 21921
2. Children of Lesbians and Gays Everywhere (COLAGE)
COLAGE is the only national and international organization in the world specifically
supporting young people with gay, lesbian, bisexual, and transgender parents.
3543 18th St #1 Fax: 1 (415) 255-8345
San Francisco, CA 94110 Website: www.colage.org
Phone: 1 (415) 861-KIDS (5437 E-mail: firstname.lastname@example.org
3. FTM International (Female to Male)
160- 14th street CP 63560, CCCP Van Horne
San Francisco, CA 94103 USA (or) Montreal, Quebec
Phone: (415) 553-5987 Canada, H3W 3H8
4. Gay and Lesbian Alliance Against Defamation (GLAAD)
The Gay & Lesbian Alliance Against Defamation (GLAAD) is dedicated to promoting and
ensuring fair, accurate and inclusive representation of people and events in the media as a
means of eliminating homophobia and discrimination based on gender identity and sexual
Los Angeles, California New York, New York
5455 Wilshire Blvd, #1500 248 West 35th Street, 8th Floor
Los Angeles, CA 90036 New York, NY 10001
Phone: (323) 933-2240 Phone: (212) 629-3322
Fax: (323) 933-2241 Fax: (212) 629-3225
5. Gender Identity Research and Education Society (GIRES)
GIRES is officially registered in the UK, although it has many contacts in other countries. It
promotes research and provides education to professionals and to families. Its aim is to
improve the lives of people who experience atypical gender identity development. Its
website contains valuable scientific and practical information to help transgendered people
and those who care for them.
6. Intersex Society of North America (ISNA)
The Intersex Society of North America (ISNA) is devoted to systemic change to end shame,
secrecy, and unwanted genital surgeries for people born with an anatomy that someone
decided is not standard for male or female.
7. The Society for the Second Self, Inc. (Tri-Ess)
Tri-Ess is an international educational, social and support Society for heterosexual
crossdressers and their spouses, partners and families.
8880 Bellaire Blvd., B2, PMB 104
Houston, TX 77036-4621 USA
8. PFLAG (Parents, Families and Friends of Lesbians and Gays)
PFLAG promotes the health and well-being of gay, lesbian, bisexual and transgendered
persons, their families and friends through: support, to cope with an adverse society;
education, to enlighten an ill-informed public; and advocacy, to end discrimination and to
secure equal civil rights. Parents, Families and Friends of Lesbians and Gays provides
opportunity for dialogue about sexual orientation and gender identity, and acts to create a
society that is healthy and respectful of human diversity.
1726 M Street, NW Suite 400
Washington, DC 20036
8. Renaissance Transgender Association
The mission of The Renaissance Transgender Association, Inc. is to provide the very best
comprehensive education and caring support to Transgendered individuals and those
close to them. This is accomplished through offering a variety of carefully selected
programs and resources focused on the factors affecting their lives. Renaissance sponsors
local support groups where individuals can find safe space to learn about transgender
behavior. At present, there are 11 Chapters around the country. The Renaissance
philosophy is open, non-discriminatory membership for everyone. Renaissance publishes
a monthly magazine, Transgender Community News that provides an open forum for
discussion of gender-related social, political and legal issues, as well as basic information
about events within the transgender community. Renaissance is a nonprofit organization
incorporated in Pennsylvania.
Website: www.ren.org Email: email@example.com
9. Transgender Law & Policy Institute (TLPI)
A non-profit organization dedicated to engaging in effective advocacy for transgender
people in our society. The TLPI brings experts and advocates together to work on law
and policy initiatives designed to advance transgender equality. TLPI’s website provides
a wealth of information on US and international laws affecting transgender and
transsexual people, and legislative advocacy tools and information.
10. Gender Education & Advocacy, Inc. (GEA)
GEA is a virtual organization that provides web-based educational materials for local
gender educators to use in their own presentations and trainings about transgender and
11. Press For Change (United Kingdom)
Press for Change is a political lobbying and educational organization, which campaigns
to achieve equal civil rights and liberties for all transgender people in the United
Kingdom, through legislation and social change. It is NOT a support group, but its
website does include links to support organizations, and a wealth of information about
social issues faced by transgender and transsexual people.
12. C.A.R.I.T.I.G. (France)
Center for Assistance, Research, and Information on Transsexuality and Gender Identity.
A support, information, and advocacy group based in Paris, with a multi-lingual website.
“Feminine Movement and Helpful Hints on Passing”
By Denaë Doyle
Keep the makeup, as light as possible. If your eyes
are light, use light lipstick. Dark eyes can use red lips.
Keep your body at angles, not a letter “I”. The more
you curve and twist your body, the more feminine you
will appear in that first three second impression.
Always stand with your shoulders, head and all your
weight back...and don't lean forward with shoulders.
Hands together, knees together and feet as close
Slow your walk down, smaller steps, softer steps, roll
the shoulders, tilt the shoulders. Tilt the head, again
not letter “I”. Women are animated speakers and
listeners. Use a lot of animation in your body
Almost, like a dance. For voice, think of the words you use. Speak with your teeth
and lips and even up between your forehead. Form each word, and pronounce it. The
resonance will come from the teeth and the tongue and forehead.
Hear your voice, inside your head, and keep the voice up and in your throat.
Transition takes time. Go slow and you will get better as you go.
What does Denaë believe the key to being a woman is?
"Being a woman is combining one's inner feelings with one's outer appearance,
allowing one's self to be softer, kinder, and perhaps even vulnerable at times, while
also being more nurturing and loving. It also means letting go of some of your male
strength, which is controlling, aggressive, or competitive."
Learn What Makeup Suits You Best!!!
Part of the fun of putting on makeup is mixing and matching various colors and
shades for different looks and effects. But it's important that when you choose a
color, it must suit your skin type, skin color, and eye color. If you have dark skin
tones, bright red blush won't blend into your skin, no matter how hard you try to rub
it in. And if you're pale, black eyeshadow won't win you any admirers - instead,
people will be asking you who won the fight (or maybe they'll just think you're
Goth). So be realistic and keep reminding yourself that certain colors and ingredients
look better in their packaging and on other people.
Now onto the nitty-gritty details of what to look for in each makeup product:
Facial makeup (concealer, foundation, and powder) was invented to make your
skin look flawless. Nobody has flawless skin all the time. As for the remaining
99.99% of you, the chart below explains what kind of facial makeup you need:
Skin Type Facial Makeup Type
Dry Liquid or Cream
Normal to Dry Liquid or Cream
Normal to Oily Oil-free liquid or Powder
Oily Oil-free liquid with a matte finish
Combination Liquid, Cream, or Powder (whatever
balances your face)
When picking out a facial makeup, you have no choice: you have to get the color
that's closest to your own skin color. If you fail to obey this rule, you'll end up
looking as if you got a really weird tan, or like a female Michael Jackson (neither of
which is desirable). Don't test facial makeup on your hand or arm; apply it to your
neck or face for a more accurate match. Here are the different types of facial
Concealer. Concealer (a.k.a. "cover stick") goes under foundation and is
used for spot treatments. It's great at hiding baggy eyes, pimples, and other
blemishes. It comes in liquid bottles and tubes (which are thinner and good
for drier skin), and sticks and compacts (which are thicker and good for oilier
skin). Choose a concealer that is slightly lighter than your regular skin color -
the foundation that you apply over it will even it out.
Foundation. Foundation goes on all over your face to make it looks uniform
and smooth. It comes in three types: liquid, cream, and powder. Make sure
that your foundation is oil-based for dry skin, oil-free for oily skin, and water-
based for combination skin.
Powder. Powder can be applied over foundation to help "set" it, but its main
purpose is to help keep your face looking fresh as the day wears on. For that
reason, powder usually goes in portable, easy-to-use packaging. While lots of
people like loose powder, we prefer pressed powder - it's just neater and it
seems to last longer.
Eye makeup (eyeliner, eyeshadow, and mascara) is arguably the most fun type
of makeup. With a quick sweep of a sponge-tipped applicator or cute little brush, you
can go from girl-next-door innocent to positively trampy. Here's a handy little chart
to help you figure out what colors would best suit your eye color:
Brown eyes: Shades of slate blue, gray, and plum will help brown eyes stand
Green eyes: Shades of pink, salmon, mauve, and brownish-pink will help
green eyes look even greener.
Blue eyes: Shades of brown, camel, and taupe will help blue eyes appear
Eyeliner. Eyeliner belongs on the base of your lids, and its purpose is to
enhance the size and shape of your eyes. Some people also like to line the
bottom of their eyes, which really has a dramatic effect. Eyeliner comes in
many different colors and forms, including pencil and powder (ideal for a
"natural" look), and cake and liquid (for a more "dramatic" look).
Eyeshadow. Eyeshadow goes on each entire lid and sometimes in the space
between your lids and your eyebrows. It comes in a variety of colors and also
several different forms, including cream (good for dry skin), matte (good for
oily skin), and pencil (good for all types of skin).
Mascara. Mascara only used to be available in black, but nowadays you can
find it in all sorts of colors. So while black mascara was used for the sole
purpose of making your eyelashes stand out without calling attention to the
fact that you have mascara on, colored mascara is now used to make a bold
statement. If you choose a colored mascara, we recommend that you stick to
darker colors like navy blue or plum, as opposed to light blue or green. The
latter is just too bizarre and unnatural for our tastes. Mascara comes in a
wand with a tube; there are straight wands, and there are curved wands. The
shape of the wand is a matter of preference so you have our permission to
experiment with both.
Experts argue over whether you should apply lipstick or lipliner first, and we've
translated this to mean that you should just try it both ways and see what turns out
better on you. The makeup masters all agree on this fact though: your lipstick and
lipliner should match and blend together. NEVER apply a liner that's darker to
your lipstick in an effort to make the liner stand out. That was an awful, awful '90s
fad, and everyone was glad to see it pass.
Lipstick. Even girls who don't usually wear makeup have been known to slap
on some lipstick from time to time. There's gloss lipstick (which comes in a
little pot or tube with a wand), and frost, matte, and cream lipsticks (which
come in the famous lipstick stick). Try out all the different kinds of lipsticks to
find out the ones you are most comfortable wearing (they are all quite
different in texture). If you don't have any money, buy a cherry popsicle and
give it a suck before going out the door (if you like that "6-year-old returning
from camp" look).
Lipliner. Lipliner goes around the perimeter of your lips and is used to define
them and keep lipstick in place. (Lipstick clings to the lipliner and is therefore
less likely to rub off or "bleed"). Lipliners typically come in pencil form.
Blush should go on after all of your other makeup because it is the final touch and
should match the rest of your makeup, not vice versa. Choose a blush color that
resembles the color on your cheeks after you've exercised. Anything darker
than that will look fake. Blush is the one thing you should not have to blend,
because if you do, it means it's too bright for your skin. Blush comes in powder and
gel/cream forms. Powder is easiest for beginners to use because it's easy to brush on
and it doesn't get streaky. Gel or cream makes good daywear because it gives off a
fresh and dewy look.
Courtesy estate of May Sarton
May Sarton (1912-1995) left an impressive legacy of over fifty books, including
novels, poetry, memoirs and journals. Her appeal lay in her ability to "sacramentalize
the ordinary" by probing everyday subjects such as flowers, gardens, animals,
changing sunlight and personal relationships in order to find deeper, universal truths.
She examined such themes as the need for solitude, the role of the muse in the act
of poetic creativity, and the role of the female artist in society.
Born in Wondelgem, Belgium, May grew up as an only child. Fleeing the German
invasion in 1914, the Sartons eventually moved to Cambridge, Massachusetts where
her father George Sarton, a noted historian of science, taught at Harvard University
while continuing his research. May's mother, Mabel Elwes, had been a designer of
furniture and fabric in Belgium, but after moving to the United States, Mabel made
these artistic interests secondary in order to care for her husband and child.
Although her parents were not connected with any church, Sarton as an adult felt
that their teachings were not far removed from the religious views of the Unitarian
Universalists. Interviewed in The World in 1987, she told Michael Finley, "My father
and mother believed that, though Jesus was not God, he was a mighty leader, and
the spirit of Jesus, the logos of him, is the worship of God and the spirit of man."
At the age of ten May was introduced to the Unitarian church by her neighborhood
friend Barbara Runkle, whose family attended the First Parish in Cambridge. May was
impressed by the minister, Samuel McChord Crothers, whose sermons she thought
"full of quiet wisdom." One sermon in particular, she recalled in her memoir At
Seventy, 1984, "made a great impression on me—and really marked me for life. I
can hear him saying, 'Go into the inner chamber of your soul—and shut the door.'
The slight pause after 'soul' did it. A revelation to the child who heard it and who
never has forgotten it."
May's formal education began at the Shady Hill School in Cambridge, an open-air
alternative school. She credited her love and appreciation for poetry to the genius of
Agnes Hocking, poetry teacher and founder of Shady Hill. In the November 1978
issue of Boston Today, Sarton told Maureen Connelly that Hocking "did not tell us
about poetry, but made us live its life." May later attended Cambridge High and
Latin, graduating in 1929. Her first published poems, a series of sonnets, appeared
in Poetry magazine in December 1930—when she was just eighteen years old.
Although she had a scholarship to Vassar, college was not Sarton's choice. She had
dreams of becoming an actress even while continuing to write. She had fallen in love
with the theater after seeing actress Eva Le Gallienne perform in "The Cradle Song."
Much to her father's concern, May did not attend college but worked as an apprentice
actress for Le Gallienne's Civic Repertory Theatre in New York, 1929-33, and later as
director of her own Associated Actors Theatre, 1933-35. When the Great Depression
and lack of funding brought about the demise of these efforts, Sarton withdrew into
exhaustion. "All this was a kind of education," she later judged, "different perhaps
from college, but I believe now immensely valuable for me as a writer, and I do not
Throughout her time in the theater, Sarton had continued to write poetry. Her first
book of poetry, Encounter in April, was published in 1937. During the early years of
writing poetry and novels, Sarton held a number of varied jobs, from film script
writer at the Office of War Information to part-time instructor at Harvard, Wellesley
and Radcliffe. In 1940 she undertook the first of what were to become annual poetry
reading and lecture tours at colleges throughout the United States.
It was on one of these trips to Santa Fe, New Mexico that Sarton met Judith Matlack,
the woman with whom she would share her life for many years and with whom she
found the greatest stability and compansionship. In spite of early love affairs with
men, it was with women Sarton found her muse.
In the journal At Seventy Sarton wrote, "Judy was the precious only love with whom
I lived for years, the only one. There have been other great loves in my life, but only
Judy gave me a home and made me know what home can be." It was for Judy and
their life together that Sarton wrote the poem "A Light Left On," which appeared in
the volume Land of Silence, 1953.
In 1954 Sarton wrote her first memoir, I Knew a Phoenix. This and subsequent
memoirs brought her a tremendous audience of readers and correspondents. Her
forthright novel, Faithful Are the Wounds, 1955, and her acclaimed book of poetry,
In Time Like Air, 1958, were each nominated for National Book Awards. In Time Like
Air was one of the few volumes of her verse to receive a warm initial reception from
the majority of critics.
After the death of her parents, Sarton lived in an old house in Nelson, New
Hampshire, 1958-73, which she made the subject of her second memoir, Plant
Dreaming Deep, 1968. Scholar Carolyn Heilbrun wrote of this book that it affected
"more single or lonely lives than any other memoir published in recent years."
Journal of a Solitude, 1973, Sarton's second memoir, was written to counteract the
benign picture projected in Plant Dreaming Deep by unveiling some of her more
Mrs. Stevens Hears the Mermaids Singing, 1965, is often referred to as Sarton's
"coming out" novel and one she admits she could not have written while her parents
were alive. With its reissue in 1974, to which Carolyn Heilbrun contributed an
important introduction, Sarton's work gained academic recognition, especially by
feminist critics. Subsequently her work began to be studied in literature classes and
college women's studies programs. Although she appreciated the recognition, Sarton
believed that the label "lesbian writer" might limit and distort perception of her work.
She wanted to be read as a writer who dealt with themes of universal interest. She
had, in fact, already written novels about family and married life.
The women Sarton loved were the catalyst for her poetry. In the presence of the
muse and in the creative act of writing poetry, Sarton found a "spirituality." In her
June 1974 article "The Practice of Two Crafts" for the Christian Science Monitor,
Sarton says "Perhaps every true poem is a dialogue with God" and "when we are
able to write a poem we become for a few hours part of Creation itself."
In Journal of a Solitude Sarton describes what she meant by prayer. "If one looks
long enough at almost anything, looks with absolute attention at a flower, a stone,
the bark of a tree, grass, snow, a cloud something like revelation takes place.
Something is 'given' and perhaps that something is always a reality outside the self.
We are aware of God only when we cease to be aware of ourselves, not in the
negative sense of denying self, but in the sense of losing self in admiration and joy."
As an adult Sarton did not become a member of any Unitarian church nor did she
regularly attend religious services. She believed, however, that the Unitarian
Universalists helped her "get over the hump" from small poetry audiences to larger
In 1972 at the Unitarian Universalist Association General Assembly, Richard Henry,
minister from Denver, presented a special service based on Sarton's work,
"Composing a Life," to an audience of five hundred. Following this event, other large
audiences gathered at various Unitarian Universalist churches to hear Sarton speak.
In 1976 Sarton was invited to lecture at the Unitarian Universalist Thomas Starr King
School of Religious Leadership in Berkeley, California, from which she also received
an honorary Doctor of Humane Letters. In 1982 she delivered the Ware Lecture,
"The Values We Have to Keep," to the Unitarian Universalist General Assembly.
President Eugene Pickett introduced her as "our poet." In addition, she received
Ministry to Women Award from the Unitarian Universalist Women's Federation.
In spite of these positive associations, Sarton could be critical of Unitarians. "I feel
them a little sentimental," she wrote in a letter in 1978. "Perhaps because the
emphasis is almost entirely on human relations."
When she read her religious poems at the Unitarian church in Brattleboro, Vermont,
she was not satisfied with their reception. "I suppose it went all right," she recorded
in Journal of a Solitude, "but I felt . . . that the kind, intelligent people gathered in a
big room looking out on pine trees did not really want to think about God. His
absence . . . or His presence. Both are too frightening."
Sarton's work and life strayed beyond the boundaries of traditional faith. Writing in
1948 (a passage first published in May Sarton, Among the Usual Days, 1993) she
observed that "At its best the Catholic mind seems to me much wiser than the
Protestant, wholer and saner and also more gentle, more human. But I also think it
is almost impossible to be a converted Catholic. The strain of belief is too great and
one has to accept too many impossibles.
The essential Christian wisdom . . . after all . . . comes back to what one can dig out
If Sarton can be labeled at all, she was a humanist. She told Michael Finley, "We're
humanists, you see—the extreme right considers us devils, and that's something else
in our favor." Sarton was less interested in organized religion than in something she
saw as broader—the spirit, or perhaps humanity. Terms such as God, Christ, heaven
and hell were used only metaphorically in her writing.
Yet a sense of the transcendent animated her work. In Journal of a Solitude she
wrote, "There is really only one possible prayer: Give me to do everything I do in the
day with a sense of the sacredness of life. Give me to be in Your presence, God,
even though I know it only as absence."
In her poem, "Of Prayer," Sarton wrote
It is a mistake, perhaps, to believe
That religion concerns you at all;
that is our own invention,
Longing for formal acceptance
To a formal invitation.
But yours to be the anarchist,
The thrust of growth,
And to be present only in the
Prayer that is creation,
In the life that is lived,
Love planted deeper than emotion,
Pure Idea that cannot break apart,
Creator of children or the work of art.
In sympathy with beliefs of Teilhard de Chardin, Sarton was convinced that
constructing a soul is the great human enterprise and responsibility. In order to
compose a life, like composing a poem, one must remain transparent and allow life
to flow through oneself. In Journal of a Solitude she wrote: "One must believe that
private dilemmas are, if deeply examined, universal, and so, if expressed, have a
human value beyond the private. . . I am willing to give myself away and take the
consequences, whatever they are."
During her last two decades in a house near the sea in York, Maine, Sarton remained
productive as a writer, even after her life had become constrained by illness and
physical challenges. During the 1980s Sarton wrote three novels, a book of poetry,
and a journal, At Seventy, 1984. Reflecting on growing older she wrote, "I am more
myself than I have ever been." After a stroke in 1990 Sarton was unable to write or
concentrate for several months. Partially recovered, she used a tape recorder to
dictate subsequent journals, affirmative works celebrating her love for life even in
the shadow of death. On the videotape Signs of Love: Honoring the Final Voyage,
her friend, Susan Sherman, related, "I think in a very important way May was ready
to die. But the truth is, she was not ready to stop living."
In her work Sarton provided fresh insight into solitude, the process of mythologizing
one's own life and the seeking of truth within oneself. Recalling her childhood
minister's admonition to "Go into the innermost chamber of your soul and shut the
door," she spent a lifetime seeking the solitude that would allow her to probe within.
Solitude, she learned, was "No shelter but a grave demand,/ And I must answer,
never ask." ("Moving In," Cloud, Stone, Sun, Vine, 1961). Thousands of her readers
believed that she understood them and that she had become their closest friend.
Despite her neglect by the literary establishment, these readers have kept her books
in print. "There are never more than a few in any generation who can share the
world of the spirit with us, to make us know that we are greater in thought or feeling
than we believed we were," wrote William Drake in Forward into the Past, "but May
Sarton is one, and we are grateful."
Many of Sarton's papers are in the Berg Collection at the New York Public Library in
New York City. In addition, the Maine Women Writers Collection/ University of New
England houses a substantial archive of Sarton materials, including her personal
Selected letters have been published in three books, all edited by Susan Sherman:
May Sarton: Selected Letters 1916-1954 (1997), Dear Juliette: Letters of May Sarton
to Juliette Huxley (1999) and May Sarton: Selected Letters 1955-1995 (2002).
Interviews can be found in Earl G. Ingersoll, ed., Conversations With May Sarton
(1991) and Sarton's critical essays in Writings on Writing (1980).
For a comprehensive list of works by and about Sarton see Lenora P. Blouin, May
Sarton: A Bibliography, 2nd edition (2000). See further materials see Bradford
Dudley Daziel, ed., Sarton Selected: An Anthology of Journals, Novels and Poems of
May Sarton (1991) and Richard Henry, Composing a Life: A Celebration Based on the
Work of May Sarton (1973).
May Sarton's literary output is large; over the course of her writing life she produced
over nineteen volumes of poetry, seventeen novels, nine journals and three
memoirs. Of her volumes of poetry, In Time Like Air (1958), A Private Mythology
(1966) and Coming Into Eighty (1994) are three of the more significant. In addition
many of Sarton's poems are gathered in Collected Poems 1930-1993 (1993).
A smaller collection is Serena Sue Hilsinger and Lois Byrnes, eds., Selected Poems of
May Sarton (1978). Of significance among the novels are Faithful Are the Wounds
(1955), The Small Room (1962) and Mrs. Stevens Hears the Mermaids Singing
(1966). Sarton is probably best known for her journals, the seminal work being
Journal of a Solitude, published in 1973 and still in print.
The memoirs, which Sarton distinguished from her journals, include the important
account, Plant Dreaming Deep (1968), of her house in Nelson, New Hampshire and
World of Light (1996), the celebration of lifelong friendships.
Works about Sarton include Constance Hunting, ed., May Sarton Woman and Poet
(1982); Elizabeth Evans, May Sarton Revisited (1989); Carolyn G. Heilbrun, "May
Sarton's Memoirs," Hamlet's Mother and Other Women (1990); Susan Sherman, ed.,
Forward Into the Past: A Festschrift For May Sarton on her Eightieth Birthday
(1992); Susan Swartzlander and Marilyn R. Mumford, ed., That Great Sanity: Critical
Essays on May Sarton (1992); Marilyn Kallet, ed., A House of Gathering: Poets on
May Sarton's Poetry (1992); and Constance Hunting, ed., A Celebration of May
Sarton (1994). Short portraits of Sarton can be found in Maureen Connelly, "May
Sarton—A Profile," Boston Today (November 1978) and major critical analyses of
Sarton's poetry in Constance Hunting, "May Sarton," Dictionary of Literary Biography
Richard Henry and Susan Sherman provided kind assistance in the preparation of
Article by Lenora P. Blouin
Famous Lesbian Writer
May Sarton Quotes
Each day, and the living of it, has to be a conscious creation in which discipline and
order are relieved with some play and pure foolishness.
Everything that slows us down and forces patience, everything that sets us back into
the slow circles of nature, is a help. Gardening is an instrument of grace.
Help us to be ever faithful gardeners of the spirit, who know that without darkness
nothing comes to birth, and without light nothing flowers.
In a total work, the failures have their not unimportant place.
It is the privilege of those who fear love to murder those who do not fear it!
May we agree that private life is irrelevant? Multiple, mixed, ambiguous at best - out
of it we try to fashion the crystal clear, the singular, the absolute, and that is what is
relevant; that is what matters.
Most people have to talk so they won't hear.
No partner in a love relationship...should feel that he has to give up an essential part
of himself to make it viable.
One must think like a hero to behave like a merely decent human being.
Self-respect is nothing to hide behind. When you need it most it isn't there.
The creative person, the person who moves from an irrational source of power, has
to face the fact that this power antagonizes. Under all the superficial praise of the
"creative" is the desire to kill. It is the old war between the mystic and the
nonmystic, a war to the death.
The garden is growth and change and that means loss as well as constant new
treasures to make up for a few disasters.
The more articulate one is, the more dangerous words become.
There is only one real deprivation... and that is not to be able to give one's gifts to
those one loves most.
True feeling justifies whatever it may cost.
We have to dare to be ourselves, however frightening or strange that self may prove
Women are at last becoming persons first and wives second, and that is as it should
An Unknown Transsexual Sister wrote:
Please don't judge me by my face,
By my religion or my race.
Please don't laugh at what I wear,
Or how I look or do my hair.
Please look a little deeper
Way down deep inside,
And although you may not see it,
I have a lot to hide.
Behind my clothes, the secrets lie.
Behind my smile, I softly cry.
Please look a little deeper,
And maybe you'll see,
The lonely girl inside me.
Please listen carefully to her,
She'll show that she's insecure.
Please try and be a friend to her,
And show her that you care.
Please just get to know her,
And maybe you'll see,
That if you look deep enough
You'll see the real me.
This book was compiled by Sonja Christine West, and the information acquired
from varies websites. Only a very small portion was written by Sonja Christine