Valuing a choice: the “luxury” of bodily alignment


As soon as the conversation turns to transgender issues, the American public’s current reflex is to think about bathrooms – more specifically, the common and much-hyped worry that “men” (or “boys”) dressed as women (or girls) will intrude on the safety and sanctity of America’s public toilet facilities or girls’ high school locker rooms. Why would they do such a thing? Surely this wasn’t about attending to a call of nature or an urgent need to change gym clothes; these “confused” or “perverse” people are up to no good. Just ask any conservative or evangelical American talk show host.

The stereotype of transgender women in public restrooms being described as men in drag intent on the pursuit of nefarious ends (e.g. as sexual predators or voyeurs) is now the usual assertion in attacks on the dignity of transgender women in this country.  Governor Pat McCrory of North Carolina, as well as the majority of citizens in Houston, Texas are certainly convinced. The inconvenient fact that there isn’t a single instance of any person who has been properly diagnosed with gender dysphoria (i.e. being transgender) ever having done such a thing in America is simply ignored, as is the whole logic that if you exclude transgender women from ladies’ restrooms, aren’t you also expecting transgender men to use those very same ladies’ rooms? When will the American public think through the prospect of a muscle-bound, deep-voiced, bearded transgender man in their public ladies’ rooms?

And as the reader ponders that visual image, stop to reflect that while it may seem hard to believe – it wasn’t always about bathrooms.

Before America’s fixation on the toilet habits of transgender persons and the egregious (and undoubtedly sinful) threat that we surely pose by our very presence in such gendered spaces, the natural reflex reaction to the transgender conversation used to be quite different. In those days, the prurient fascination of the public was all about our surgeries. For most Americans “transgender” was nearly synonymous with what was then called (and often still is) “gender reassignment surgery”, or simply as “sex change surgery”. Once you were out as being transgender, the public felt entitled to ask you the most intimate details. Even if we chose to attempt an answer, i.e. to describe our medical procedures associated with transitioning gender, such surgeries were nearly always ultimately dismissed as “cosmetic”. Gender confirming surgeries (as I prefer to refer to this procedure) are still frequently portrayed in scandalous, demeaning, or sensational terms, with the focus (as always) being almost exclusively on those transgender persons who are transitioning from male bodies to female bodies. Transgender men (transitioning from female to male embodiment) have barely been on the radar.

Bathrooms aside, gender confirming surgeries still exert a preponderant influence on any discussions about transgender persons, despite the reality that many transgender persons elect not to pursue surgical interventions. This decision is complex and very individual; some trans folk are comfortable inhabiting their bodies and making them authentically gendered from the inside out. Others, both here in America and around the world, have either inadequate financial means or no access to properly trained surgeons to opt for such a costly procedure. In the developing world – the Global South – gender confirming surgery is only accessible to a tiny elite of transgender persons who can afford the travel, medical costs, and related support. For everyone else who is transgender, however, achieving a body that aligns with their deeply perceived sense of gender identity is barely worth thinking about. After all, throughout the Global South there are so many other demands on limited resources; an operation that many political and development policy experts regard as “cosmetic” and a “choice” doesn’t get on anyone’s agenda.

And there the situation remains. The transgender advocacy community and their allies are very busy just trying to keep transgender women safe from violent (and often fatal) attacks, to help them to find opportunities for safe and meaningful work, and to have a future with some prospect of hope. And yes, transgender men again barely make an appearance in the dialogue.

Seven years ago in Montreal, Quebec on this very day I walked up the stairs at Centre Metropolitain de Chirurgie Plastique and checked in to room 101-A. The next morning, on August 10th of 2009, the renowned Dr. Pierre Brassard (pictured above) performed an invaluable service in the “course correction” that had become my most essential project: claiming a life of authenticity and hope. My two young children, my then-wife (and still dear friend), and my sister-in-law were all there at my side, and their bravery, love, and steadfastness made that surgical part of my transition possible. So yes, seven years ago in Montreal that most important journey of my life – the journey to claiming bodily wholeness and becoming truly alive – began in earnest. Gender transitions involve so much more than surgery, and both before and since that day it’s sometimes been a rough and painful journey, and financially devastating. And while I flinch at the thought of growing elderly with no remaining savings or retirement prospects, I am the beneficiary of so many blessings simply because I had that opportunity to walk up those stairs to Dr. Brassard’s clinic.

When I have the honor to spend time with my transgender brothers and sisters in the Global South, we almost never discuss what took place in Montreal. What’s the point? The prospect of affordable and available gender confirming surgeries throughout the Global South is decades away (if even then) although some courageous transgender people such as Audrey Mbugua in Kenya are taking a fiercely principled stand in demanding such opportunities. So far, Audrey has yet to prevail with Kenyan health authorities, but she’s never been the kind who gives up. Go girl!

In the world of international development, health care receives by far the greatest share of donor funding. Transgender people constitute such a tiny minority, and those large budgets would be negligibly impacted even if all the transgender persons around the world decided to pursue such interventions. Still, it remains politically incorrect (and often is deemed morally or religiously suspect) to even begin the discussion about health systems offering coverage for gender confirming surgeries. Despite what is now a well-established body of medical knowledge based on decades of research that has long since concluded that gender confirming surgeries are a fundamental part of the medical standards of care for those with gender dysphoria (transgender persons), the whole notion that those in the Global South deserve such opportunities strikes many decision-makers in the health community as either curious, or simply absurd. After all, they will be quick to point out, most countries in the Global South have yet to build and sustain medical systems and infrastructure to offer the public even basic preventative care for everyday health challenges, much less any capacity to achieve acceptable standards of quality for treatment of the full range of health challenges that typically afflict the public.

The medical needs of a tiny minority aren’t likely to attract anyone’s attention, nor their requisite allocation of resources. It should. Only when international development begins to take seriously the notion of basic human dignity will the needs of marginalized persons who currently fall well below that threshold of what can be described as a “truly human” life ever be addressed. This includes many persons with disabilities, others who are marginalized by race, ethnicity, sexual orientation, age, or other attributes. Yes, that’s where you will find most transgender persons. Only by spending a relatively small proportion of health budgets to bring all persons at least to the threshold of human dignity – which includes offering transgender persons who seek gender confirming surgeries the opportunity to have the bodies that make their lives make sense – will the larger and critically important dignity message of international development become compelling.

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