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The group, which met every three weeks, was composed primarily of F. Most of the kids had adopted new names and pronouns, but only a few were on hormones or had undergone surgery. Some had dealt with repeated hostility from their peers. In the past, that trajectory would have been strikingly uncommon: a typical F. In any case, it was all a little gauzy and theoretical. Skylar considered his sexual orientation a more distant matter than his gender identity. Sometimes I forget that coming out in terms of sexuality is still a big deal.

In trans circles, it is a given that sexual orientation and gender identity are separate matters. It can be hard for some of us to imagine a sexuality that is not inextricably linked to our gender. But Tony often makes reference to a handy pictorial that was designed by trans activists. Would gay men want to date him?

Biological Connection

His mother relented. At freshman orientation, Layne met Mimi, an outgoing girl from Seattle, and felt an instant connection; they started dating and, as sophomores, were still together. Love it. Now, what do you want to be when you grow up? This counsel of patience can be tough to get across. At one meeting, a girl in her mid-teens, who was starting the process of becoming male, mentioned feeling behind the curve. Many of the kids in the younger group, who were doing messy art projects in a room down the hall, were socially transitioning in elementary school.

When somebody announces that he or she has started taking cross-gender hormones, or is scheduled for surgery, the others clap. His endocrinologist and his therapist had recommended a plastic surgeon named Melissa Johnson, in Springfield, Massachusetts, who was willing to operate on kids under eighteen. After the kids stopped cheering for Skylar, they asked questions: Did he have a lot of pain when he woke up from the operation?

What did the drains that were put in after surgery feel like? Was he totally psyched? She recalled when Skylar asked to buy a binder—a nylon-and-Spandex vest worn under clothes to flatten breasts. And I really hate that idea. This is what he wants. One afternoon, Melissa and I picked up Skylar at the True Colors Conference, an annual event for gay and transgender youth, at the University of Connecticut, in Storrs. Skylar had co-taught a workshop on breast binding. But he also felt an obligation to keep talking about being trans: to journalists, to school administrators, to questioning youths at conferences.


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Such thinking informed a choice that Skylar had made before having the mastectomy. There are two types of procedure: one of them leaves scars; the other does not, though he might need a second surgery. He got the one that leaves scars. She, too, had a teen-age daughter who was becoming a son. She requested a pseudonym to protect the privacy of her child, who declined to be interviewed.

Her daughter, who was about to start college at an art institute, had a history of depression. Anna was a dreamy girl who loved drawing, chafed at the strictures of school, and was beset by anxiety.

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Still, Danielle had not seen Anna as unusually masculine, or even androgynous. When Anna was in her last year at an alternative high school, she wrote Danielle a letter saying that she wanted to start taking testosterone and then have sex-reassignment surgery. Danielle took her to see a psychiatrist who specialized in gender issues. The idea worried Danielle: making art had always sustained Anna.

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Danielle, who was divorced, had younger children at home, too, and they readily accepted the proposition that their sister was trans. While Danielle was at her college reunion, on the East Coast, he took Aidan to a clinic that administered testosterone. But a lot of these kids are sad for a variety of reasons.

Maybe the gender feelings are the underlying cause, maybe not. Danielle said that she had met many teen-agers who seemed to regard their bodies as endlessly modifiable, through piercings, or tattoos, or even workout regimens. She wondered if sexual orientation was beginning to seem boring as a form of identity; gay people were getting married, and perhaps seemed too settled.

The drug culture of the sixties was like that and the sexual culture of the eighties, with AIDS.


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  • History is replete with examples of men and women who cross-dressed, and some of them, no doubt, would have remade their bodies, had the option existed. Before the twentieth century, it did not. In the nineteen-tens, German and Austrian scientists interested in the new field of endocrinology began attempting to change the sex of animals. Success with guinea pigs and rats encouraged doctors to respond positively to the human beings who yearned for gender metamorphosis.

    In , in Berlin, a German waiter named Rudolf Richter had sex-reassignment surgery, becoming Dora. That same year, Einar Wegener, a Danish artist who had undergone several operations to become Lili Elbe, died after a failed procedure to create female reproductive organs. In , a psychiatrist named David O.

    The endocrinologist Harry Benjamin took the lead in promoting this idea, wresting gender discontent away from the psychoanalytic realm, where it was diagnosed as a disorder of sexual desire curable through will power and talk therapy , and defining it as a problem of having been born in the wrong body fixable through hormones and surgery.

    Benjamin helped establish a protocol requiring patients to receive a diagnosis of gender-identity disorder from a physician before taking hormones or undergoing surgery.

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    Many transgender people have resented this kind of medical gatekeeping—and particularly the implication that they suffer from a mental illness. A diagnosis has its virtues—it allows some insurance plans to cover the transition process. The first American to go public about a gender reassignment was Christine Jorgensen, a glamorous twenty-six-year-old who, in , had been obliged to travel to Copenhagen for the procedure.

    The patients most likely to be accepted for surgery were men who, like Jorgensen, seemed as if they could successfully live as straight women and not upset traditional roles all that much once they made it to the other side. Fewer women sought operations, in part because the surgical techniques that were available lagged behind those for men. They still do. Many F.

    Such surgery costs around fifteen thousand dollars. Creating a penis, a procedure known as phalloplasty, can cost more than a hundred thousand dollars. Patients are usually responsible for most, if not all, of the cost. Estimates of the number of transgender people have never been particularly reliable and have almost certainly undercounted them. An often cited Swedish study, from , included only people who had received treatment for gender-identity disorder, and showed one in thirty-seven thousand for biological males and one in a hundred and three thousand for biological females.

    There are many published articles on linguistics: 61 articles 2. Literature in this field also accounted for a disproportionately high number of primary research articles when compared to other topics discussed in this review. There were articles 7. The most common theme was dealing with the challenge of puberty in the transgender adolescent.


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    • Since the introduction of puberty blockers, researchers have debated who should get them, 14 when they should get them, 15 who should prescribe them, 16 and, most recently, who should pay for them. Few articles have investigated the persistence of childhood onset of gender dysphoria through puberty and beyond, and only one has investigated factors that may help predict the persistence of gender dysphoria.

      Through our search, we identified a total of 11 articles 0. Very little data exist on the long-term effects of hormone therapy in the aging transgender population, and there are no articles on end-of-life care for transgender individuals. Fifty-five publications 2. The literature follows the progression of social acceptance over time, and, in some respects, the law had to adapt in response to the progress in the medical field and with gender confirmation surgeries.

      The majority of these articles focused on increasing trans-inclusiveness as a part of the education of medical, nursing, and pharmacy students. Examples include changes to the curriculum 22 and a simulated transgender patient encounter.

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