Transgender Transitions

A loved and respected Methodist minister in North Carolina, a father of two boys, married to his second wife for over thirty years:  This describes the person a small community in North Carolina knew – or thought they knew – when Duane Flynn made a life-saving decision to cease hiding his true self.  Duane, now Dawn, had been concealing gender dysphoria for five decades.  In a series of events that Dawn describes in her recently published memoir God Does Love Me, My Trans Journey to Finding my True Self, she describes how the public revelation that she had been keeping this secret didn’t so much emerge as it did erupt, toppling her carefully constructed facade, yet freeing her to become the woman she has always known she is. For Dawn, pursuing  gender reassignment was not her original goal, but as she transitioned more and more, first in secret and later more boldly in public, the surgery became, for her, the only way she could feel complete.  Dawn has told me that her penis was abhorrent to her, an appendage that had to be removed, and she likens this to having a cancer that needed to be cut out.

When you look in the mirror, what do you see?  What would you change if you could?

I am learning that the decision to transition for people born with gender dysphoria doesn’t always travel the same path and doesn’t always include gender reassignment surgery.  For some, the transition starts in childhood with the support of parents and the medical community. The video Living a Transgender Childhood  follows a young girl from very early childhood until she closes in on puberty.   For others it is a more gradual awareness that they wereTrans 2 born with an unacceptable condition.  Whenever the transition starts, it often isn’t a straightforward process.   Some transgender people will never publicly reveal their gender dysphoria and will confine their gender identity expressions to dressing the part of their true gender in the safety of their homes, never venturing out as their true selves.  Others attempt – and sometimes succeed – in publicly living as the gender they identify with and stop short of surgery, and others will eventually decide that their body is intolerable and a surgical reassignment of genitalia is the only way they can live comfortably.

If your child, brother, sister, or friend told you they are transgender and will begin the transition process, how will you respond?

For many, and no matter which transition choice they make, isolation, and fear of rejection is common.  Suicidal thoughts are also commonly reported, but usually before the transition begins; Dawn relates that she considered suicide, and the topic comes up over and over again on web sites dedicated to transgender stories and support efforts. The  National Geographic “American Transgender”  documentary follows three young adults who have transitioned, and lets them, their friends, and their families describe each of their respective journeys with their transgendered loved one. Throughout this blog series I keep returning to the theme of understanding and acceptance, but one family member in the National Geographic documentary makes another point:  She says that in order to accept her new daughter, she had to first mourn the loss of her son.

The World Professional Association for Transgender Health is the recognized source of guidance for medical professionals who treat transgender individuals as they transition from their birth gender to their true gender. The standards of care are available here: (WPATH).   As I read through the guidelines I couldn’t help thinking about how determined a person would have to be to endure a process that, by design, can take years to complete.  In many cases – and in all cases that will lead to any type of surgery or legal change of gender on official documents – the transition process must include professional counseling.  It is during this stage that decisions are made about living publicly as your true gender – called Real Life Experience (RLE) which is  a requirement in the standards of care. For some people, living as their true gender has already begun, and the psychotherapy is used as a necessary step toward receiving the letters of recommendation that will be required by surgeons if surgery is a goal.  Hormone therapy is introduced and it consists of two stages: first the introduction of hormones for the desired gender, for instance estrogen for a male to female (mtF) transition, and hormone blockers to stop the progression of the birth gender development.  These are carefully introduced because there is only a short window of time before the effects are irreversible, usually three months.

There are many more steps along the way, none the least of which include navigating through society and work environments while the changes are occurring.

What can we do to help make the transition easier?

It almost sounds too simple to say that we should take care with the pronouns we use, but often these are the first ways in which a transitioning transgendered person begins to feel accepted.  Once a transition begins, using the pronoun “he” or “she” matters a great deal, and the proper pronoun to use is that which refers to the gender identity, not the birth gender.  So, a male to female transition would dictate the use of “She” and vice-versa for a transition from female to male.

How much does a transition cost and who pays for it?

transsymbolSome European countries include transgender transition therapy and surgical reassignment in their national healthcare plans.  Belgium, Denmark, Norway, and Sweden stand out for their progressive treatment of transgendered and transsexual individuals.  In the United States, where there is no national health care, coverage is a mixed bag.  Some treatments are considered cosmetic, and most insurance policies will not cover cosmetic procedures.   Expenses associated with full transition are typically reported to be over $50,000, from initial diagnosis to surgical reassignment, but the costs don’t stop there, because hormone therapy must be continued for the lifetime of the individual.

I first met Dawn  two months after her gender reassignment surgery.  This was nearly 2 ½ years ago, and I was profoundly affected by that meeting.  Although Dawn was not the first transgendered person I had met, she was the first one who was open about the process and as a result I wanted to learn more about her journey, and the journey of other transgendered people.

If you are gender dysphoric, if you know someone who is, or if you simply want to learn more about the issue, please join me in this online conversation. I welcome your comments below.


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