February 2008

On our way back from Santa Barbara, Mary Jo and I landed at the halfway point to have lunch with Allyson, who you may recall from my December blog postings and to whom I link in the blogroll on the right of the screen.

At a restaurant appropriately called D-vine (wine bar and restaurant), we sat outside in the fresh February sun and the fresh air and talked about family and plans and blogs and transitions and all sorts of things. The three of us had wonderful lunches and a dessert that was almost good enough (three of us sharing one slice) to order another piece.

I found myself feeling large and loving and connected, and Allyson had a lot to do with it. Visiting her was a recharge, both for me and Mary Jo — we’re pretty stable and have good friends, but there is no substitute for a thoughtful person on the same trans* path.

But it’s odd to say “same trans path,” however, because the trans* journey takes as many forms as there are transsexuals, and the “same path” refers to moving in a generally similar direction, rather than walking in a well-worn and constrained rut.

For example, I myself seem to be on an “inside-out” path, meaning I’ve worked on my mind, emotions, social connections, and hormones while still not owning a stitch of clothing. I have only recently bought wigs and makeup and am still borrowing Mary Jo’s clothes when I go out. As my inner self gets more and more relaxed with my nature, and as my friends and colleagues begin trying on the idea of life with Joyce, I think the outer expression of Joyce will emerge, but not necessarily until that point arrives.

Some transsexuals, on the other hand, are on “outside-in” paths, and begin their transition with clothes and makeup and move to socializing in their new role, followed by therapy and hormones. It doesn’t matter which of the hundreds of paths one takes towards transsexual happiness, but meeting fellow travelers is worth the effort.

The path may be solitary, but it’s probably better if you travel with friends and loved ones. Allyson told us of her mother’s love and this story simply filled me with joy — My own mother and father are both dead, and while their deaths may have freed me to pursue this path, I also think they would have been loving, if not a bit perplexed, parents, and I would have enjoyed getting to know them as Joyce. Rather than dwell on their loss, I simply need to look around and recognize that on my own transsexual path, I have an extended academic family around me today — they’ve been supportive and inquisitive and fun to talk to about this transition. These colleagues make up, along with friends like Allyson and Gerald and Helena, the kind of family where I feel like I belong.

Bear with me as I engage you in a thought experiment.

When we (and I guess I mean society) think of sex change, I assume we all have some idea of what we mean by the concept. At the simplest, we imagine the man changing into a woman (or vice-versa for FTM’s). Fair enough, and we can stipulate that this is the fundamental change.

But what does that mean? If we take 50 variables that define us, those that might be thought of as more “man” or more “woman,” then which of those must change before the transitioner and society perceive a change from one sex to the other? Is it necessary to change every single physical/social attribute to affect this transition? Is it possible to change 50% of the variables? 25%? 10%? What is the minimum change necessary?

And “necessary” is an interesting concept, isn’t it? It seems to me that there are at least 2 constituents for “necessary” and probably more like 5+. What the transitioner feels is necessary to “be” the opposite sex may be very different from what her/his family feels is necessary for the transitioner to assume the new sex. And this family sense of “necessary” may be different from what colleagues or general society feel is necessary. I think that “necessary” probably defines something like a set of changes that is perhaps more than minimal but less than average.

For the different groups, “necessary” probably means changing enough variables so that the transitioner falls more or less into the bell curve of the attributes of the target sex. We could empirically test this hypothesis by simply asking a bunch of people if a given person “passes” as their target sex (realizing, of course, that the bias in that question would be inherent and would skew all results, but this is a thought experiment, so it’s permissible).

For the transsexual transitioner, I think there are many more variables that he/she sees as essential to “feeling” like their target sex, but variables that others might not see or even recognize as “necessary.” I would put hormone therapy into that group — softer skin and redistribution of fat are recognizable by others, but I don’t think they could articulate the variable “hormones” unless they were sufficiently current on transsexual transition literature.

Ok, back to the minimum variables necessary.

Beard. Everyone I talk to agrees that getting rid of a man’s beard is necessary for successful male-to-female transition. Unless you’re doing something called gender-queer (or really pushing the boundaries of the binary gender concept), wearing facial hair is probably a bad idea.

Male pattern baldness. Although women do experience thinning hair as they age, the receding hairline is typical of males and would need to be addressed in a male-to-female transitioner.

Heavy body hair. Even though women of certain ethnicities have somewhat heavier arm and leg hair, it’s much thinner than men’s hair, and it seems to me that if you want to wear short sleeves, doing something to minimize your heavy hair is required. This would go for one’s chest and legs, with the understanding that there is a lot of room for body hair on women, so complete hairlessness is not necessary.

Masculine scull. Most women don’t have the “brow-bossing,” or the strong jaw, or the square chin, or the long distance between the bottom of the nose and the top of the lip, at least not all in the same natural woman’s face. Changing these features in men is the cornerstone of FFS (facial feminization surgery) and seem to make sense to me from a purely biological perspective. Just which variables one is “required” to change, however, is up for grabs.

I’m running out of ideas here because for my thought experiment, I’m looking at lots of women who dress like men, don’t wear makeup, are tall or broad, who aren’t chesty, and who don’t wear makeup. If you take any one of those variables and ask yourself if it’s absolutely necessary for the category “woman,” I think most of you will realize that none of these variables is required — you may have your own aesthetic ideas about women and femininity (we all do), but what I’m asking is whether the lack of eyeshadow or breasts or skirts would necessarily negate the category “woman” in a person. And if they aren’t required of genetic women (or the cisgendered), then they’re not required for transgendered.

Note: If one is aiming for complete stealth such that no one knows of their birth sex, then genital surgery would be a requirement, assuming that normal people would seek normal sexual relations and would want their genitals and their gender presentation to be aligned. I'm not going to engage this issue here, although it's important for some transsexuals -- I'm more interested in social presentation than sexual activity since Mary Jo and I are going to continue as a couple. Those of you who are aiming for stealth transitions could weigh in on this issue with a lot more authority.

You may be saying, “Ok, I get the theoretical part of this argument, but the fact of the matter is that you, George, cannot present successfully as Joyce if all you do is fix your beard, get a wig, and lighten your arm hair. It is true that there are women with strong chins, and women who are taller than average, and women who wear jeans all the time and don’t own a skirt or a dress. But you rarely see a woman who ‘violates’ more than one or two variables.”

You make a fair enough argument, and if these observations are the case, then is there something like synergy at play? Would a reasonable person say that there is a kind of general impression created by all these variables such that society doesn’t raise an eyebrow at jeans or strong chin or arm hair or no makeup as long as the rest of the variables fall into the norms of what we think of “woman?”

Don’t we see this concept employed in fashion or makeup when we read/hear advice about maximizing your good features and minimizing your bad features? “Good” and “bad” are categories we supposedly agree on, (and that’s a pretty huge assumption), but might we agree that some good features of women would be those that accentuate femininity, approachability, and fertility, and “bad” features might be those that accentuate masculinity, unapproachability, and infertility? Or maybe it’s more superficial than that, such that “good” means busty, feminine, and model-like? I don’t know, but the concept of “fixing” your features via clothing and makeup is definitely omnipresent in marketing and in interpersonal advice.

With this in mind, we might note that women with certain types of chins or jaws are advised to avoid certain necklines; those with long faces are advised to avoid certain lengthening hairstyles; those with high- or low-waists are advised to wear certain types of waists and hems and accessories. Is this type of camouflage what we’re talking about when we’re talking about synergy in the sex and gender variables regarding transsexuals?

I’m prepared to agree–as long as we acknowledge the following: it appears as if cisgendered men and women are under the same obligation to “fix” their abnormal features as are transsexuals. If this is the case, then I’m brought back to my original question about what is absolutely necessary for a transsexual to fix to be considered his/her target sex.

If most of what counts as “man” or “woman” is something like collective social hypnosis (i.e sleight of hand, camouflage, and and adhering to some of the variables that count as “man” or “woman”), then would it be possible for a transsexual transitioner to simply begin portraying him/herself as the target sex, insisting to friends and family and society that she/he is now the opposite sex, but without changing any but the “required” variables? What would that be like?

More specifically, what would it be like if I, George Bailey, got rid of my beard and my body hair and either got sufficient hair transplants or a wig to get rid of my receding hairline, and then simply declared to everyone that I am now Joyce? No dresses, no makeup, no voice work, no accessories. But clearly not doing gender-queer, either, meaning that I adopt an acceptably female face (no facial hair), perform acceptably feminine body language, use an acceptably feminine name, and consistently perform feminine presentation.

Would this type of minimalist sex change be perceived (because we’re talking about perception, aren’t we, and not reality) as legitimate or would it be perceived as a hoax? Could I tell everyone I’m changing my sex and then not make a huge leap across the binary to the totally opposite side of the gender binary? And if I did that, and if I did that consistently, would my attempt at collective social hypnosis work on everyone around me? Or would I be living in a delusional state of self-hypnosis with everyone around me laughing inwardly at the emperor’s new clothes? How much of my gender presentation is in my own head (i.e. how much I believe I’m a woman) and how much is externally-observable (i.e. how much others believe I’m a woman)?

I don’t know about you, dear reader, but this thought experiment hurts my head because in the past I always thought that changing sex meant going from typical (and easily identifiable) male to typical (and easily identifiable) female, changing as many variables as possible so as to adhere to every single physical and hypnotic variable out there: hormones, breasts, beard, underwear, makeup, body language, voice, dresses, bows, pretty purses and accessories, feminine (or even frou-frou) gestures. After engaging in this thought experiment, however, I realize that I know almost no real professional women who look like that or act like that, and that realization tells me that this image must have little to do with reality and everything to do with a mass-hypnotic belief in a strong gender binary.

How do we wake up from the hypnotic state? Do we, like Neo in The Matrix, want to wake up? And what advice do we give to those of us dealing with image issues (whether transsexual or anorexoric or breast-size or nosejob or any one of a hundred types of desires that our society supposedly believes in)? What is “necessary and sufficient” for all of us to modify/exaggerate/minimize for us to simply “be” ourselves and to live happy and productive lives?

We’re in Santa Barbara for a few days, and I am reminded about how much I like the west–the beauty of the mountains, the vastness of the ocean, the depth of culture. Tonight, Mary Jo and I heard a band called The Excellent Tradesmen at a little bar called Cold Spring Tavern. Not only was the band inspired, but the audience was attentive and friendly, creating an atmosphere that felt very warm and homey to me, even though it was cold and rainy outside.

The Excellent Tradesmen blend the genres of surf music with Johnny Cash with Mexican cantina to create a sound that’s imminently familiar while being just a bit unfamiliar. And it’s not just the choice of songs that make them worth seeing — the band’s arrangement borders on the cosmic. The cornerstone of the sound is Rob’s monstrously proficient and eclectic guitar, heavy on the reverb, demonstrative in the hand and finger movements, flawless in the execution. Round out that guitar with John’s smooth vocals, Ed’s flawless drumwork, Rick’s rock-solid bass, and creative touches like Rob’s accordion and Jerry’s pedal steel and mandolin, and you’ve got a sound that takes you from Hawaii’s surf to the desert southwest. The main singer’s voice is poised and confident with a hint of irony in his delivery, but the high-lonesome harmony from Jerry is what makes the songs really soar. I think I’d prefer the band transpose their songs up about a fourth because the singer’s vocals often drop out of hearing range in the lower registers.

The first set started out strong and never let up, achieving a self-sustaining energy of the type that the Grateful Dead described when they sang that “the music played the band.” From easy two-step dance numbers to wicked surf instrumentals, this set made the tavern simply buzz with energy. The second set had more ups and downs, but also revealed a lot of risk-taking in songwriting and instrumentation, suggesting a mature and growing musical presence.

I would love to hear an entire CD and encourage the Santa Barbara boys to make it happen, or at least put those songs out on GarageBand or the video on YouTube. You’re too good to remain a west coast secret.

Dear Joyce:

I enjoyed meeting you at this year’s First Event in order to discuss facial feminization options. As we also discussed on a phone call in December, I believe that you would benefit greatly by undergoing an endoscopic biplaner browlift that will reduce the height of your forehead, lift your eyebrows, advance your scalp and sculpt your bone with burring. The biplaner approach does leave a fine scar in front of the hairline. The sensation to the scalp is preserved, however, and fat grafting is also performed to reduce the temporal hollowness and give the forehead a rounder, more feminine appearance. This would be combined with an upper and lower eyelid blepharoplasty, Medpor cheek implants, a vertical lip lift, a feminizing rhinoplasty and septoplasty, chin bone burring with soft tissue reshaping, a tracheal shave and a retroauricular variant neck and jawlift. Fat grafting to the lips would complete this. We also discussed otoplasty (ear pin back). This combination of procedures will give you a more beautiful, refreshed, youthful and naturally feminine appearance.


  1. Feminizing biplaner endoscopic browlift with orbital rim burring/scalp advancement and temporal fat grafting
  2. Upper and lower eyelid blepharoplasty
  3. Feminizing rhinoplasty/septoplasty
  4. Medpor cheek implants thru a lower eyelid approach with screw fixation
  5. Chin bone burring with soft tissue reshaping, tracheal shave and a retroauricular variant neck and jawlift
  6. Vertical lip lift
  7. Fat grafting to the lips folds
  8. Otoplasty (pin back of ears)

See also
Alexandra’s virtual FFS assessment of my face
Dr. East’s surgical assessment
My consultations with Drs. East and North in Boston in January 2008

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