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TG 101: Understanding the Diversity of TG People in Hawai‘i
         This was an overview of transgenderedism. As it turned out it was one of the most attended
sessions with thirty or more people. Tracy Ryan introduced the topic by explaining the three basic
ways in which persons might be considered transgendered. They were clothes oriented, body
oriented, and sex oriented. The clothes oriented are primarily males who wish to dress as women, but
not necessarily to change their body or have sex with other males. These persons have been called
transvestites or more recently cross dressers in popular and academic literature. Most are
heterosexual men, many of them married, and with various issues concerning their desires to cross
dress being potential problems with their spouses. Obviously the clothes oriented transgendered area
is one heavily influenced by culture since that determines appropriate male and female dress and
behavior. The body orientation is what we often think of as a transsexual wherein the chief desire is
body modification, either male to female or female to male, to live and assume the full time role of
the desired gender. Here the clothing is secondary to the essential issue of gender identification. In
the sex oriented type we find persons who are homosexual who occasionally dress as members of the
opposite sex for appeal to a straight or straight acting partner or for other reasons appurtenant to gay
subculture. Such persons rarely get any gratification from the act of dressing in and of itself and do
not wish to have any sorts of surgeries performed to further their transgendered expressions
         Dr. Milton Diamond took over the presentation at this point and raised the question of how do
kids know that they are either a boy or a girl. Children make comparisons within their environment.
They are imitating and trying to figure out what is being accepted and what is not from their parents,
and others. Back in the 1950’s the disparity between concepts of “gender” and “sex” was starting to
become more obvious to scientists. The famous case of form GI Christine Jorgensen made
international headlines when she had a sex change in 1953.This differentiated the idea of
transsexualism from simple transvestism.
         Dr. Diamond introduced a scale called PRIMO to explain how individuals might have varying
degrees of male or female characteristics in different areas. The P is for patterns of behavior. The R
is for reproduction, the I for identity, the M for mechanics, and the O for orientation. Any individual
could be more male in one area and more female in another.
         This lead to a discussion of the physical state of being intersexed. An intersexed person is one
born with the genitalia of both sexes or some ambiguity within that sphere. There many kinds of
conditions that produce intersexed people. One of the more common is Kleinfelter. The conversation
got quite technical for a while here. One important thing to remember is that genitals form between
the 8th and 12th week of gestation and issues within pregnancy that come up then can affect the
         There were some questions and answers about problems faced by transgendered folk. There
are different legal issues in different states. For example some states will allow the issuance of an
amended birth certificate with a change in the gender indication after a person has completed sexual
reassignment surgery. Other states will not do this. This leads to some complicated issues over
marriages that predated the surgery of one of the spouses. There are issues of discrimination in the
workforce here, but it was noted they are not as bad as in many other parts of the United States.
Hawaii seems to be more accepting. Indeed it was noted by one of the speakers that many of the
instances of job discrimination here were from supervisors who had recently moved to Hawaii from
the mainland.
        The remainder of the session dealt with the history of TG people here in the 1960’s and 70’s.
The anticipated speaker was not able to attend so Tracy and Milton filled in as best they could. It
seems that by the 1960’s a large and visible group of male to female transgendered persons was out
and about in the Chinatown area nightly. The center of this world was the old Glade nightclub on
Hotel Street. The Glade featured a famous female impersonation show starting in the mid sixties and
running until the city closed it down in 1982. In those days discrimination was much worse and
virtually all the TG’s resorted to work in the sex industry to support themselves. A subculture thus
arose around the elements of the Glade, the Chinatown neighborhood, the sex industry, the military
who came to the Downtown area seeking vice, and the local roots of the many TG’s working there.
The culture developed its own language, hierarchies, and ways of achieving status. These streets
offered the young TG things they couldn’t find elsewhere. Among the important issues were the close
and long lasting friendships that developed with other TG’s working in the sex industry. The sense
of being part of a group and accepted as well as the validation of being paid by men for sex were
strong components in furthering the development of a unique system of by and for the transgendered.
        During this period the infamous badge era arose. In about 1969 a court had ruled that
transgendered persons were “deceiving” military personal into having sex with someone thought to
be a woman. This crime could be addressed if the TG’s clearly identified themselves as such. For
almost two years the TG’s worked their streets with badges on created by the Glade that said “I’m a
Boy”. This was finally ended when another court realized there was no actual law against what they
had been doing in the first place.
        Other aspects of the Hawaii TG community were discussed. It was noted that appearance is a
very important issue for TG’s as for many gender consistent people (sisgendered). Status is achieved
by being passable, beautiful, etc. Other issues are success in the straight world, community service,
and generally being kind and helpful to other TG’s.

E waiho i ka lei hoʻohihia a e lei i ka lei hoʻohiehie o ke ola
        Heather Lusk began this topic of health and risks with an overview of how transgender data
collection. She discussed the various issues that relate to transgendered persons and the harm
reduction movement. The topics include health issues, violence, HIV, drug use, suicide, problems
with hormones and silicon, and other trans-specific health needs. She explained the for more trans-
sensitive health care providers to get the best care for this community.
        Judy Strait-Jones discussed suicide. The data is very important if we are discussing
prevention. Suicide is the second leading cause of death in the youth age group of 15 to 24. We need
to understand suicidal behavior, thinking about suicide, etc. Orientation as a cause of suicide is not
broken out in the data. Nor are transgendered specifically cited. Trans data is needed. It is difficult to
monitor suicidal rates amount the LBGT youth. How does harassment and violence experienced by
this group affect rates? Teachers and students need to be trained in suicide prevention. Life skill
training needs to be offered and resources for LBGT youth need to be accessible.
        Cathy Kapua made a presentation about the work being done by the Life Foundation. This is
the State’s leading private entity in fighting STD/HIV and AIDs. Capacity building is a key. They
target high risk populations for prevention. Distribution of condoms and HIV testing are done. The
majority of clients are in the 25 to 34 year age group. Much of the work is done with the Hawaiian
and Polynesian communities. Help with assessing safer sex tools. The S.I.S.T.A. project is aimed at
born women. The T.I.T.A is transgendered specific. Retreats are found to be very helpful with this
TG group. Case workers, outreach workers are carefully chosen to affect the best relationships with
clients. Utopia Hawaii a local Gay and TG Polynesian group is helpful.
        The Life Foundation has Nate Hawaiian specific programs such as Ke Ola Pono. They have
prevention for positives program which includes a retreat. They also provide care services for those
suffering from AIDS.
        Needs continue for more Hawaiian based services, case managers, and capacity building.
Funding is always an issue. The Life Foundation puts on the Pua Mona art show to raise money for
HIV positive people. They also work with and help Gregory House that helps those with active AIDs.
        December 1st, is World AIDs Day.
        Ashliana spoke on behalf of Kulia Na Mamo. She was a sex worker for 19 years and is
currently the Executive Director of Kulia Na Mamo a local non-profit that helps mahuwahine. She is
a product of the trans community with deep roots and a broad knowledge of TG culture in our
islands. She spook about the work Kulia does including HIV related and their Hep C program that
recently lapsed due to funding. She discussed the ongoing Passport program that is a peer based
employment preparation tool. Many TG’s coming from work in the sex industry, drug addiction, or
incarceration, don’t understand what will be required of them in legal jobs. Such things as being on
time, appropriate dress, and manners are included with resume preparation and other traditional job
hunting areas.
        Kulia Na Mamo’s entire approach is peer based. Staff consists of mahuwahine trans people
with a history of drug abuse, sex work, or other issues that directly relate to the experiences of the
client base. This leads to the most capable efforts in preventing young people from being entrapped
in the sorts of harmful life choices that so many TG’s experience.
        Ashli mentioned their S.P.A.S.M. group that is aimed at supporting those with suicidal
thoughts. She discussed mental health issues that affect TG’s. The difficulties of giving up drugs,
transitioning out of prison, and other problematic situations are added to the TG concerns about
obtaining hormones, and good overall medical care. She went on to spell out problems for TG’s
within the prison system and how important it is that they retain access to hormonal replacement

Transform Me: the How’s of Changing Gender
        Connie Diamond moderated the first session and Milton Diamond the second one. The first
thing to understand is that surgery to change one’s sex is very expensive. It is not always an option
for people. Kaleo who is F to M discussed the history and background of these issues. Maddie talked
about her history as an M to F.
        Harvey Milk was a visionary politician. The killings of Barndon Teena and R*-ita Hester
were mentioned. There was a discussion on the history of “mahu” as a cultural term and the genesis
of the terms māhūkāne and māhūwahine. These last are new Hawaiian words to describe people who are in a
gender transition stage. Different aspects of gender were discussed, including gender identity, sexual
orientation, gender, assigned gender, and gender roles. TG’s can include drag queens or kings, fish queens and
others. In looking at this it is important to see the difference between sex and gender.
         Some of the F to M pioneers were Alan Herb, Michael Dillon, and Jamison Green. The M to F
pioneers included Lili Elbe, Christine Jorgensen, Renee Richards, April Ashley, and Becky Allison. Marci
Bowers is a M to F who was a medical doctor and later learned the surgeries for sex reassignment from the
famous Dr. Biber in Colorado.
         Transitioning is a multi step process. A well thought out transition starts with a finding a good mental
health professional. At some point an individual should begin what is called the “real life test”. This refers to
living full time in the new gender role. It is dealing with the world of real life in one’s preferred gender. This
happens before surgeries and is a recommended prerequisite for surgery approval. As part of the real life test
the gender change may include hormonal therapy. For F to M’s this means pills or injections of male
hormones. (It should be noted that so called male and female hormones exist in both sexes naturally, but in
much smaller doses for the opposite sex hormone). When a female takes testosterone or other androgenic
hormones she begins to develop male characteristics such as a deepening of the voice caused by enlargement
of her vocal cords and voice box. There may be a growth spurt of sorts. There is often an increase in libido
and other elements experienced by males at puberty. For males taking female hormones a softening of the
skin, reduction of body hair, and of the gonads is typical. Fat distribution begins to take on a more female
pattern including the development of breasts. Breast development can be a long and slow process leading
many M to F’s to opt for surgical enhancement.
        As the F to M progress through the real life test the now “he” may begin to look seriously at
various surgical options. A mastectomy is desired for removal of the excess breast tissue. This is
typically performed along with a cosmetic procedure to reduce the areola and nipple to more
masculine proportions. Options for genital surgery include metodiaplasty and phalloplasty. In the first
case the clitoris is partially detached from the vulva area and allowed to swing in a manner of a small
penis. Enlargement of the clitoris is an expected result of hormone treatment anyway.
        Phalloplasty is a much more complicated procedure in which an artificial penis is constructed
with materials from other parts of the body. Costs for this and the other surgeries and F to M may
desire can run from a little over $20,000 to as much as $50,000. Due to cost issues many F to M
people are not able to complete all desired procedures.
        For the M to F’s breast augmentation is a frequently chosen procedure. In addition genital
reassignment surgery is completed by many. This surgery involves a careful removal of the penis to
preserve the nerve endings that lead to the most sensitive areas below the head. These nerves are put
into a clitoris constructed with remaining penile material. A vaginaplasty is performed at the same
time which is the creation of an artificial vagina. Lining the vagina, and preventing it from simply
closing up are issues that must be properly addressed. Some of the created vaginas are lined with skin
from the removed penis. Others are lined with borrowed sections of intestine. Some are
combinations. The borrowed intestine method is promoted by some as it may be self lubricating. For
some months after surgery the new women must keep a stent in her vagina to prevent it from closing
up and resealing. This is basically an object resembling a dildo.
         Costs of the breast and genital surgeries for the M to F can be over $20,000. Many also opt
for additional cosmetic surgeries that run the costs up further. Facial feminization surgery that can
involve reduction of brow ridges, jaw width, nose jobs, cheek implants, and other elements can run
up to $40,000. For the male with an overly masculine face and the money to spend this can be a very
desirable path.
        Those without financial means resort to various little tricks that transgendered people have
used probably for centuries before modern medicine created hormonal and surgical options. For F to
Ms this means binding the breasts to achieve a flat looking top and packing the crotch area with
something extra to represent a penis. For M to F’s it means covering beard shadow with cosmetics,
putting falsies into a bra, and tucking the penis between the legs and scrotum into the body area from
which it originally descended.
        Many other issues confront the would be gender changer. Legal status on documents, name
changes, and records all put one at the mercy of officialdom. Lack of insurance coverage for trans
related medical procedures is another obstacle to overcome. Efforts by activists to improve these
situations are ongoing, but so far have only met with limited success. Legal protections under civil
rights laws have been extended in various areas around the country.

State of the Industry: Sex Work
        Tracy Ryan introduced the topic with Pam Vessels adding comments from her many years
working with sex workers. It is very difficult to know the number of TG people working in
prostitution. There are only estimations than can be made due to the industry’s character and stigma.
People selling sex prefer to be called sex workers or sex industry workers. Good social service
organizations often use the initials SIW to refer to these folks.
         Transgendered sex workers tend mostly to due street work. This means they walk the streets
waiting for johns to approach them. The majority of all sex workers locate clients in others ways such
as through internet ads. Only about 10 to 15% of sex workers are street walkers. These are the most
heavily studied group, probably because they are the most accessible. Transgendered sex workers are
much less understood than their genetic female counterparts. Other areas that are little researched are
johns and pimps. TG sex workers do not have pimps. They do face a variety of problems such as
high rates of drug addiction, occasional violence, and the ever present threat of arrest and
         Pam Vessels and Nioi Kalua-Heleloa (who came near the end of the discussion to add her
perspectives) attended the Desiree Alliance Conference this past July in Las Vegas. This group is an
alliance of various sex workers rights groups throughout the United States. Some of the best known
are PONY, COYOTE, and BAYSWAN. Many people don’t even realize there are groups of sex
workers who have organized and are attempting to have their work decriminalized. There are large
and very successful SW rights organizations in many foreign countries. It is more difficult for these
people to organize in the US since this country has some of the most punitive laws against
prostitution in the world. Human rights advocates rank the US with Saudi Arabia and the People’s
Republic of China. Evan many Islamic nations are less abusive than we are of sex workers’ rights.
         Pam discussed how important it is to help sex workers be safe and to be better in their work.
Being better is empowering. It is the only real way for disempowered people to find the way towards
a better life. Nioi spoke about her years as a sex worker, addict, and convicted criminal. How much
better she might have been had there been more people willing to recognize her as a sex worker and
to empower her as she felt at Desiree.
         Tracy discussed the situation in Chinatown. Chinatown has been an open vice district in
Honolulu since the 1920’s. Prior to the First World War prostitution was centered in an Iwelei brothel
district. The authorities closed this down as part of a national campaign to protect service men from
sexually transmitted diseases, and under the ill considered guise of saving young women from “white
slavery”. This apparently created other problems which lead to a reopening of brothels in the River
Street area in 1930. For the next 14 years these establishments operated quasi-legally under
regulations set by the police. After they were closed in a second wave of moral panic visible
prostitution was chiefly street walkers.
         By the 1960’s Chinatown had become a center of activity for the transgendered community;
although that term had not yet been invented. Mostly they called themselves “queens”. Drugs,
prostitution, and gambling, existed along with tattoo parlors, strip clubs, peep shows, seedy bars, and
a steady flow of military personal to support these activities. Although vice remained tolerated until
the 1980’s, the same was not true for the queens. This was an especially difficult time as few square
jobs were available to the transgendered and they faced much official abuse while working in the sex
         Sex work in Chinatown as in many other areas of the world is segmented by geographic
locations. A track is a section of territory that is walked by a group of street walkers. Street walkers
of a common type and level will walk on the same track. So genetic female sex workers will not
usually be found on the same track as TG’s. There are also high tracks and low tracks. This division
has to do with appearance and earning capacity. A low track sex worker is likely to have a bad drug
habit, may be homeless, and probably doesn’t take good care of herself. This shabby look is not
welcome by the better dressed, better coiffed works on a high track. TG sex workers of Chinatown
have long had a high track on Merchant Street. The SIW of Merchant Street were often called the
“Penthouse Girls”. SIW with bad drug habits were not welcome here and had to work the low track
areas around River Street. Today the pimped female SIW work around Longs. They are a higher
track group than the hard core addicted women who do not earn enough money to make pimping
them worthwhile. So the Long’s area is a mini high track for female SIW. Waikiki is a higher track
still, but sometimes girls are rotated due to arrests and other issues.
         Drugs have had a bad impact on the TG sex workers of Chinatown. Fifteen years ago the
Merchant Street area had over twenty of the thirty of so TG’s doing sex work down there. There were
only about six TG’s with serious drug habits with the rest sticking primarily to marijuana. Today
almost all the TG’s are on meth or crack or something bad. There are only two clean TG’s working
on Merchant.
         The men who date TG sex workers are varied. Many are what are sometimes called
“admirers”. These men are attracted to women, but desire a sex act that requires a partner with a
penis. They have gay sex, but are attracted to feminine looks, dress, and manners. This leads to issues
for the TG sex worker. Some of them will agree to play the male (inserter) role in sex act, others will
not. The most preferred dates are straight men who simply want a BJ.
         Problems can arise when a man believes he has been fooled as to the actual anatomic gender
of the person he has hired for a sex act. This happens a lot less frequently than one might imagine,
but when it does it can lead to violence. Tracy mentioned one friend who was shot at with a shot gun.
         The prospect of a bad date wherein violence or robbery occurs is always out there. To combat
this SIW watch out for each other, take down license plate numbers of cars that pick up their friends,
and attempt short conversations with new johns to check them out. It is always desired to go with a
regular date who has hired the SIW in the past. Many TG’s as well as SIW in general who leave the
streets continue to see a few regular dates for years thereafter. It is very hard to say no to the money
even when one has “retired” from the life.
         Some other things to know are that TG’s are disproportionately represented as prostitutes in
the sex industry. Tracy noted that of about 75 male to female transgendered people she knew in
Hawaii today 44 were current or former prostitutes. She was only sure of about a dozen who had
never done this work. She did add that there were likely many closeted folks who had made their
transition without being involved in the TG community the percentage is still staggering when you
consider how few genetic females ever do sex work. Almost half the streetwalkers in Hawaii are
transgendered although genetic women outnumber TG women by a factor of 500 to 1. Most of the
TG’s who have had male to female sex reassignment surgery have probably paid part or all of the
costs with money earned prostituting. So when people are running their mouths about the evils of
prostitution and the need to abolish it as a form of slavery one should remember just how harmful
their agenda is to TG’s.
         There are other reasons than money that appeal to the TG in sex work. One is the long term
deep friendships that develop between TG sex workers. Much of sex work involves standing around
on a street corner for hours at a time. You really get to know the people you work with. You also find
an acceptance from them that you may well have lacked in school or with your family. If you are
young and new to this you find a sense of validation as a woman as men pay you for sex acts.
         Making the transition out of sex work is very difficult. Learning the basics of being
responsible to an employer can be more challenging then learning a job skill. Adapting your
appearance and mannerisms from those of a street culture to those appropriate to an office can also be
a daunting prospect. Kulia Na Mamo and other organizations provide help for people with these

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