WO/MAN

What does it mean, to be a woman? Or to be a man?

Now that Bruce has transitioned to Caitlyn and been photographed by Annie Leibowitz, there is comment, there is bemusement, there is chatter and judgement and well-wishing and confusion. Bruce was living a lie, and Caitlyn is now free. But what does it all mean?

Superficially, Caitlyn is a woman. She seems feminine, wears make-up and has long hair and wears dresses and heels. Her breasts are full and plump,  her skin is hairless and smooth (and the photoshopping is VERY smooth, Ms Leibowitz, for let us not forget that Caitlyn is 65 years old) and she looks very attractive. Let us not spoil the party by saying that she has male genitalia and XY chromosomes, for that is irrelevant. Caitlyn is a woman. And, since gender identity and sexuality are two separate entities, Caitlyn is a lesbian, I believe; she still loves women but is no longer married to one.

I am a woman. I don't have beautiful glossy hair, long nails or wear heels. Until I was 40 I hardly wore makeup and didn't have a manicure. When I was a kid I didn't like dolls or tea parties and I never owned a thing that was pink. When I was 18 I had long flowing hair and wore long flowing dresses and tried walking around barefoot, a faux-hippie chick who never smoked pot, studied hard, and got into med school. When I was 21 I cropped my hair and wore pants and drank whisky and smoked cigars, a faux-tough chick/lesbian-who-wasn't. Fast-forward a few years and I was married with 7 kids, having had an epiphany of sorts, and the Orthodox lifestyle and philosophy stuck. But I still love Acca Dacca and turn the car radio up to 11 when 'Jailbreak' comes on.

I'm nearly 60 now, younger than Caitlyn, and I don't look nearly as hot as her. My (small) boobs sag and I have stretch marks and varicose veins, and my post-menopausal skin tends to dry out if I don't use industrial-strength moisturiser. My ovaries are now a liability, because my mother and grandmother both died of ovarian cancer so I plan on finally having them removed surgically later this year. And when they, along with my long-passed fertility, are gone, I will still be a woman.

I may have mentioned that, many years ago, I worked in the field of Gender Dysphoria. That is to say, in 1980 I worked as a trainee psychiatrist in the old Queen Vic hospital which later relocated to Monash Medical Centre, under Dr Trudy Kennedy, dealing with patients who strongly felt that they were born into the 'wrong body' and were of the opposite sex. In the main, these were men who strongly felt that they were women. In their heads, they were women. They wanted to be rid of the accoutrements of masculinity and they wanted to live as women in an approximation of the body of a woman. Some of these people were mentally ill, and a sex-change operation was never going to fix that. But there were many who were not psychotic or crazy, but they were miserable in their bodies and only transitioning would help them.

Apart from that year at the coal-face, I worked for many years in General Practice in St Kilda which  catered to the denizens of St Kilda including a fair number of trans-people. There were many who came from far away as well because the doctor who had worked there some years before was known to be tolerant and non-judgemental. So the transwomen came for their Oestrogen and Androcur prescriptions, but also for coughs and colds etc etc. During that time, I only saw one person who had changed his mind, i.e., was born a boy, started transitioning with hormones age 16 - all very shady, not through a clinic- but then realised that he was a 'normal gay male'- his words- and he wanted the breasts off. I referred him to the GD clinic at Monash but he never turned up, so goodness knows what happened to this poor kid. I only saw him once but this particular guy was no doubt a person who had been poorly parented, probably abused, and was confused about a lot of things.

I have a friend, a very conservative surgeon, who scoffs at the whole phenomenon. He said to me, 'If I had a patient who came to me and said, 'Doctor, I'm not a man, I'm really a giraffe', I wouldn't paint spots on him and teach him to eat leaves and stretch his neck. I would say that he was crazy and send him to a psychiatrist. Same thing if a man tells me he's really a woman.'

And yet.

It's a real thing. It's a source of much suffering. It's not a lifestyle choice. It's associated with a terrible rate of attempted suicide and suicide in young people. It's not good enough to 'giraffe' them.
It's not entirely clear, however, that hormonal and surgical treatment is going to fix these problems. Although there is some subjective satisfaction after gender reassignment surgery, the rates of suicide attempt and psychological distress is still very high.

It's not a simple problem. And I think that the field of paediatric GD is a minefield. I have never worked in this field. There is a GD clinic at the Royal Children's Hospital here which is run by a respected psychiatrist, Dr Campbell Paul, which treats children from as young as 5 to age 17, after which there is the Monash GD Clinic.

Now, I think this is even more vexed. If a 5 year old girl says that she hates being a girl and she wants to be a boy, what is she saying? Is she saying that she never wants to have babies? Is she saying she hates the idea of menstruation? No. She is usually saying that she wants to play with trucks and get  muddy and wear boys' clothes, or she has been bullied by the mean girls, or perhaps worse. Does she really understand what it means to be a woman or not in the arc of life? Ditto for a boy. Surely in this day and age we can respond to this by saying, cool, Shiloh Jolie-Pitt, wear ties and trousers, climb trees, that's alright, and it doesn't make you a boy. Instead we are seeing this stuff about how we have to accept the reality that 'some boys are born with vaginas and some girls are born with penises'. I know that people who are saying this think that they are being very liberal in their understanding and acceptance of gender fluidity, but in fact, I think it reflects the opposite. I think it reflects real rigidity in understanding gender roles. My mother never said that I was not a real girl because I would rather play in the mud than with dollies. GD is more intense and complex than this example, but the more interviews I hear from transgendered people, the more I hear how many grew up hearing that they couldn't do this or that because they were a boy or a girl. I wonder how things might have turned out differently with more blurring of what is acceptable gender conforming behaviour. It's not so long ago that an athletic girl was called a 'tomboy', but now that we accept athleticism in girls, we hardly hear the term.

So I'm not dismissing Gender Dysphoria, and I hope I don't come across as if I am. I think it is a thing that we are going to hear more about as our society becomes, for better or worse, more unstitched about matters of gender and sexuality. It's not that common, but it is a tremendous source of misery and it must be flagged and dealt with by trained professionals in the context of accepting families, or, in the absence of a supportive family, then a supportive community. We need to be less judgemental and more educated. Just as being accepting of gays doesn't make people more gay, accepting trans people won't make more people want to transition. The answer might not in the end be surgery and hormones; the answer might just be accepting that there are those who just don't fit into the gender binary of male and female (even the Talmud recognised 6 genders) and helping them get the help they need, which will be different in every case.

Good luck, Caitlyn, I hope you really have found what you were looking for.