Preferences changing during transition

[DapperButch]

Originally Posted by Esme nha Maire

Dapper, my thinking is that whilst society has tended to take a simplistic view of gender and sexual attraction (gender binary, and opposites attract), in relity, things are much more complex than that.

Whilst I wouldn't like to rule out the taking of hormones as having an effect on ones sexuality with regard to whom one finds attractive, I have to say I'm mildly skeptical thus far. My guess would be that an individuals innate level of plasticity in regard to sexual orientation is affected by the whole slew of stuff happening in their lives at any given time.

As an example, was I going to explore my feelings about guys when the world saw me as a guy? Heck, no! I am not and never was a gay male. Involvement with women who saw me as male was quite bad enough, thank you, involvement with guys at the time - well, I'd rather have died. Only after the world started seeing me as female did I feel ready to start my explorations, and yes, a change in hormones was a part of that process, but it didn't cause my willingness to explore.

Now, I know from chatting with you, Dapper, that with FTMs they are often effectively Butches and leaning toward the masculine (and perhaps seen as male by the world) for quite some time before coming to the conclusion that they need to transition. Could it be that the decision to take testosterone, aided by its effects, is the last piece of the puzzle that then makes some folk happier to explore their sexuality properly? As in 'OK, now I'm properly a guy, I'm happier, hey, who do I really want to fool around with?!' Or do you think that it really is the testosterone all by itself that is inducing a change in sexuality?

Hi, Esme nha Maire. Yes, I agree with you that it is not the testosterone that causes the "attraction change", but rather is someone becoming more comfortable within themselves, so they are more open to whom they may find attractive. It is interesting when you hear people (in my experience, most often early-mid 20's trans men), say that they realize that they are attracted to cis men after they get on T. Something to keep in mind though with those guys, is that they were young and were maybe just coming into their sexuality.

I have known of some MTFs who were not comfortable dating at all until they had lower surgery, regardless as to if they are attracted to males or females. It is for the reason that you describe....they did not want to be seen, or feel, that they were having sex as males. My experience again, as a gender therapist is that MTFs often don't see themselves as truly female until they have lower surgery. I do not see this with FTMs. Of course, I still see the dysphoria of worrying that others don't see them as "men", but I don't hear them not seeing themselves as men until/unless they have a penis. This may be why I see a much, much greater number of MTFs wanting lower surgery than FTMs.

I think this will surprise you (based on some of your posts), that many trans men do not have an interest in lower surgery. Now, you may have heard how complicated lower surgery (of any type) is for trans men, what with 50% of the time having complications that often require revision surgery(ies), but in my experience (and I think most trans men would tell you that they have seen this too), most do not have enough bottom dysphoria that they get surgery...some do not have any bottom dysphoria at all.

I can tell you, that I would estimate that only 20% of my FTM clients are interested in lower surgery. And all of them are adolescents. The bulk of my work currently is with adolescents, so this is a bit skewed. I can tell you that probably only 5% of my adult FTM clients have shown an interest in lower surgery.

When it comes to my MTFs clients, I would say that 90% have an interest in lower surgery. As you know, lower surgery for trans women is usually very successful and really isn't that complicated, inc comaprison. Is that the reason? I don't think all of it. Is it because society is so focused on "the penis" as a sign of masculinity? I don't know.

Something to note, is that my experience is obviously only with people in the U.S. In the UK, it might be different. I will have to ask some of my friends from England.

I suspect that for you, one of the reasons why you would be surprised to hear this is because you transitioned during a time where it was expected that a person would have lower surgery if they transitioned (along with one or two things I have read in your posts). Also, you are in the UK where insurance has always covered it (I assume). In the early days of people transitioning here 1960's-1970's (before Dr. McHugh at John Hopkins shifted the field into thinking we were mentally ill and all the gender clinics shut down in the U.S.), the insurance companies covered the lower surgeries for our MTF/FTM individuals as well. Back then, it was a requirement in order to be accepted into a gender program you had to be heterosexual (be attracted to the opposite sex from your identified gender). Was it the same over there? Did you have to lie and say you were attracted to males in order to get your surgery like I assume some did here?

I know that I am getting off topic here, but I don't believe the OP will be returning.

Also, something that I want to make sure that I always say is that this is just my experience in my corner of the U.S. However, with that said, I have a great deal of contact with the busiest and most experienced clinicians in the field here in the U.S. I have heard similar information from the other providers, but some of this is anecdotal evidence. I have not read any research on number of trans people desiring which surgeries. We are still such a young field and working with small numbers of individuals in our studies. Obviously, the numbers are getting larger.

ETA: FTMs desiring top surgery is something different. I have yet to meet a trans man who didn't want top surgery and didn't have intense dysphoria about their chest. Maybe because our society views women's breasts as the epitome of femininity (womanhood) in the way we view the penis as masculinity (male). Of course, there must be some trans men out there who don't, I am again, just stating my experience as both a gender therapist and as a trans man in the trans community.

[Esme nha Maire]

Hi Dapper!

It's the low level of genital dysphoria that you report that surprised me, Dapper, rather than the low level of desire for surgery. Knowing how chancy FTM genital reassignment surgery was, I wasn't surprised that some or even many might choose not to undergo it despite bodily dysphoria - but I was, until quite recently, assuming that FTMs had genital dysphoria just as strongly as MTF's do. Not surprised that FTMs get strong dysphoria about their breasts.

I frankly didnt give a monkeys what society's views were on genitalia or breasts as epitomising one gender or the other - I simply knew that my body was equipped with the wrong bits, and it needed to be equipped with the right bits to bring me inner peace. And reassignment surgery below plus breast development up top DID bring me inner peace. My body felt right, my brain is wired for this body, not the one I had.

Yes, certainly on the MTF side, it was expected that bodily dysphoria would be present, that the patient would at least want to have reassignment surgery. Whether or not they could might be another matter, depending on medical situation, like obesity, heart problems etc, but if there were no medical problems preventing, it was epxected that the individual would be wanting to go through surgery yes.

I do not understand your reference to insurance - that's actually something that I have been meaning to ask you privately for a while. Insurance had nothing to do with it. Gender reassignment treatment here is free on the NHS. That's it. I don't even understand where insurance could come into the picture (caveat - this hits an area in which I am, to this day, unworldly, so if it involves insurance and isn't utterly straightforward, I might not understand).

With regard to sexuality, it did seem to be expected that us MTF's would have at least some desire for guys, yes. I told the truth, which in the first instance was that I had had crushes on people of both genders, but that my libido had gone quiescent, and I really wasn't too worried about that until after I'd had surgery - I'd work things out in the end. Perfectly true at teh time. This did not seem to cause any concern.

I do know that a significant minority of MTFs deliberately told psychiatrists exactly what they believed the psychiatrist wanted to hear, irrespective of the truth, simply to try to ensure that they obtained surgery. I did not realise this for some while. I really do not know what I might have done had I been aware that I was lesbian at the time - but if any lying had been involved, it would have been as minimal as possible. I never lied about my interests, which I know a lot of the others did, to try to appear socially more femme. I didn't see the point - one wouldn't have to try very hard to spot the lie.

I ran into problems with a rogue psychiatrist before I realised I was lesbian, and the psychiatrist who oversaw my case later didn't see any problem with my being lesbian. He was only concerned that I had been living as a woman for several years, had held down jobs, changed jobs etc as a woman.

[DapperButch]

My thoughts are in blue.

Originally Posted by Esme nha Maire

Hi Dapper!

It's the low level of genital dysphoria that you report that surprised me, Dapper, rather than the low level of desire for surgery. Knowing how chancy FTM genital reassignment surgery was, I wasn't surprised that some or even many might choose not to undergo it despite bodily dysphoria - but I was, until quite recently, assuming that FTMs had genital dysphoria just as strongly as MTF's do. Not surprised that FTMs get strong dysphoria about their breasts.

I frankly didnt give a monkeys what society's views were on genitalia or breasts as epitomising one gender or the other -

Right. When I was talking about society, I was talking about what we would have internalized unconsciously that might impact one's body dysphoria.

Too, and this is something that I didn't mention before, but that you might not know, is that the clitoris on a female bodied person enlarges quite a bit when they take testosterone. Many people don't realize how similar male and female bodies are. Some of the differences is only how they are configured.

A natal female's clitoris is really just a very small phallus, with the clitoral hood being the same as the a natal male's foreskin (or you can see it as vice versa...the male phallus being just a very large clitoris). Anyway, on testosterone, a FTM's clitoris grows on average to .5 - 1.5 inches. If you pull back the foreskin/clitoral hood, a perfectly circumcised phallus is underneath. The scrotal tissue of a natal male is the same tissue as the labia majora tissue on a female. The difference is that the labia majora tissue closed up during development in the womb in males. That is why you see the line between down the center of the scrotum. It is the labia majora tissue closing. And, of course, the testes are likened to the ovaries.

I got off track, but my point is that I think that one of the reason why FTMs have less lower genital dysphoria is that they have what would be termed a micropenis from testosterone.


I simply knew that my body was equipped with the wrong bits, and it needed to be equipped with the right bits to bring me inner peace. And reassignment surgery below plus breast development up top DID bring me inner peace. My body felt right, my brain is wired for this body, not the one I had.

Do you know if the NHS will pay for breast implants for MTFs? Here is is seen as cosmetic for trans women, the same as it is seen for cis women. Not all trans women get much breast growth though.

I do not understand your reference to insurance - that's actually something that I have been meaning to ask you privately for a while. Insurance had nothing to do with it. Gender reassignment treatment here is free on the NHS. That's it. I don't even understand where insurance could come into the picture (caveat - this hits an area in which I am, to this day, unworldly, so if it involves insurance and isn't utterly straightforward, I might not understand).

Right, I know how the NHS system works. Trans people in the U.S. have been jealous of ya'll in the UK and Canada for years, what with your free surgeries! In the U.S. one can have private insurance (employer and/or you pay for), or insurance provided free from the government for people who are below the poverty level or for people who are on disability. Until the last 5 years it was very, very, super, super rare that any of the insurance companies paid for transgender surgeries. So, if you wanted top or lower surgery, you had to pay out of pocket. Now that more insurance companies are covering (paying for) surgeries, we are seeing a dramatic increase in surgeries for both sexes. Back in the day (mid 1960's-mid 1970's) at the old time "gender clinics" (I know you guys still have those, and use that term), surgeries were covered. The gender clinics where through university hospitals. I don't know who paid for the surgeries, the government or the private insurance companies, but somehow, back then, if you were determined to be transsexual you got your surgery. That stopped when the clinics closed in the later 1970's.

With regard to sexuality, it did seem to be expected that us MTF's would have at least some desire for guys, yes. I told the truth, which in the first instance was that I had had crushes on people of both genders, but that my libido had gone quiescent, and I really wasn't too worried about that until after I'd had surgery - I'd work things out in the end. Perfectly true at teh time. This did not seem to cause any concern.

Well, here in the U.S. you would be denied trans health care if you were gay. There was a FTM, Lou Sullivan, in the 1970's, who was denied acceptance to the gender clinic 10 times because he was gay...he actually was a pioneer who essentially "started" the coming together of the trans community in the U.S.

I never lied about my interests, which I know a lot of the others did, to try to appear socially more femme. I didn't see the point - one wouldn't have to try very hard to spot the lie.

They also turned you away if you weren't seen as feminine enough if you were MTF. The whole thing was so freaking ridiculous.

[Esme nha Maire]

Dapper, I was already well aware about the great similarities of the clitoris to the penis (SERIOUS science geek, personal interest in the surgery that was done to me, etc.. :-}). Might be news to others that read it here though, so no problem. I'm still surpised at the low level of genital dysphoria in MTF's you report, but then that's hardly surprising because I've never experienced the condition you guys have.

Nope, socially internalised didnt come into it. I'm surprised you'd even suggest that - to me it sounds puzzlingly as if you're talking about bodily dysphoria as being due to social brainwashing there, and that is emphatically not the case, as I would imagine you are well aware. The whole point of the process of going through the system at Gender ID clinics was to try to separate those who genuinely had bodily dysphoria from those who had some kind of other problem making them think that maybe they should transition.

It may be that our use of terminology is slightly different though - to me bodily dysphoria rules out all factors external to the individual concerned. Stuff involving external factors is more social dysphoria, to me. I had that as well, sure, but only because the world didn't see me as the woman that I knew myself to be! Contrast that with cases where someone thought that 'maybe' they should have been a woman because they couldn't fit the expectations society has of males. Social dysphoria in both cases, but different things driving it, internal in one case, external in the other.

Yes, I was offered the choice of having breast implants at the time of my surgery - I declined, as my brain was happy with the level of breast development I had from oestrogen alone. Slightly bigger would've been nicer, but THAT's simply because I'd then have filled out dress tops a bit better and more interestingly; aesthetics, if you will, and I'm hardly the only woman in the world that wished her boobs were a tad different for aesthetic reasons. I think I can live with being normal :-}

Sorry, but I am still none the wiser as to where and how insurance companies enter the picture over there. Based on my admittedly limited understanding of what insurance is and how it works, I cannot conceive of a sane way in which an insurance company would be involved in paying for reassignment surgery as a general thing. There's clearly something about the situation that I fundamentally do not understand (or have not realised) involved. Please don't feel that you have to try to get me to understand though - it's not important to me, I'm merely mildly curious about it.

Yes, they expected a certain level of 'normal femininity' here, too - I looked conventionally femme back then (one GP actually told me that had I not mentioned that I was trans when I signed up to his surgery after I'd moved home, that he wouldn't have been able to tell short of an internal examination). I was working and living as a woman, accepted by colleagues at work as a woman, clearly doing OK in society. The fact that my interests included military history and wargaming, and my being a science geek as well apparently wasn't sufficient in their minds to override my loving clothes and pretty and cute things and having a 'wifey'/'supportive' mindset. So yes, they had a frankly risible expectation of 'normal femininity' of us MTFs, one which not a few cis-females would not meet, but I largely fitted within their expectations.

[DapperButch]

Originally Posted by Esme nha Maire

Dapper, I was already well aware about the great similarities of the clitoris to the penis (SERIOUS science geek, personal interest in the surgery that was done to me, etc.. :-}). Might be news to others that read it here though, so no problem.

Yes, it was actually more for the other readers. I wasn't sure if you knew about the enlarging of the clitoris though. I do think that helps some trans men feel better.

I'm still surpised at the low level of genital dysphoria in MTF's you report, but then that's hardly surprising because I've never experienced the condition you guys have.



Nope, socially internalised didnt come into it. I'm surprised you'd even suggest that - to me it sounds puzzlingly as if you're talking about bodily dysphoria as being due to social brainwashing there, and that is emphatically not the case, as I would imagine you are well aware. The whole point of the process of going through the system at Gender ID clinics was to try to separate those who genuinely had bodily dysphoria from those who had some kind of other problem making them think that maybe they should transition.

It may be that our use of terminology is slightly different though - to me bodily dysphoria rules out all factors external to the individual concerned. Stuff involving external factors is more social dysphoria, to me. I had that as well, sure, but only because the world didn't see me as the woman that I knew myself to be! Contrast that with cases where someone thought that 'maybe' they should have been a woman because they couldn't fit the expectations society has of males. Social dysphoria in both cases, but different things driving it, internal in one case, external in the other.

You are misinterpreting me here. I agree with what you are saying wholeheartedly. It isn't important enough though for me to clarify.
Too, please don't think I was referring to your experience.

Yes, I was offered the choice of having breast implants at the time of my surgery - I declined, as my brain was happy with the level of breast development I had from oestrogen alone. Slightly bigger would've been nicer, but THAT's simply because I'd then have filled out dress tops a bit better and more interestingly; aesthetics, if you will, and I'm hardly the only woman in the world that wished her boobs were a tad different for aesthetic reasons. I think I can live with being normal :-}

Sorry, but I am still none the wiser as to where and how insurance companies enter the picture over there. Based on my admittedly limited understanding of what insurance is and how it works, I cannot conceive of a sane way in which an insurance company would be involved in paying for reassignment surgery as a general thing. There's clearly something about the situation that I fundamentally do not understand (or have not realised) involved. Please don't feel that you have to try to get me to understand though - it's not important to me, I'm merely mildly curious about it.

Right. I was only sharing it with you for conversation's sake...I read your post as being curious about our system. I am fascinated by talking about how different countries handle their citizens with gender dysphoria who desire surgery. This is the reason why I asked about breast implants. Over here they are seen as cosmetic.

I hope that my post clears up where I was "coming from" in my comments. I was talking in generalities.

[Esme nha Maire]

(chuckle) No problem,Dapper. I was under huge stress re college work at the point when I wrote that (just had a very welcome email that's taken a huge weight off my mind!), and not expressing myself well either. Yes, I got that you weren't talking about me in particular, it just struck me that you worded things oddly (IMO), and other readers of what you've said might misinterpret, so I used myself as an example to demonstrate what I meant.

I am mildly curious about the system over there, but only because the weird-sounding insurance thing piqued my curiosity. I gather it's pretty horrible still compared to here. IMO they still aren't great here; I have some knowledge of the current situation due to a former work-colleage (and previous to that aquaintance on the Goth scene as long as 20-25 years ago) transitioning recently.

Apparently once in the system now, things go far easier for folk, but the big problem is getting that first appointment - it's about a couple of years wait just for an initial appointment (in my case, it was a matter of a few months). I suspect this is due to a relatively sudden increase in numbers of folk coming forward with gender-related problems as it's a topic more talked about than it used to be.

So folk are realising younger that there IS help for what ails them, and older affected folk are feeling more able to come forward and ask for the help they've long needed. I advised my friend that under those circumstances, then the sooner they socially reassign, the better, as there is still the requirement to live en femme for a couple of years - might as well get that done whilst waiting for that first appointment!

Did you want to talk about that other issue re MTF trans folk here or elsewhere Dapper?

[Esme nha Maire]

Just a quick additional comment; I woke up fuzzy-headed with a slew of random stuff rattling around my brain when something from my past surfaced and I had a lightbulb moment: Dapper, I wasn't concerned about my lack of breasts until I hit my teens, at which point I became VERY upset that I wasn't devloping/hadn't developed them. And my lack of concern, when breasts did develop under the influence of oestrogen, mirrors the relative lack of concern re genitalia amongst FTMs. I'mthinking aloud here, but..

It's as if the brain is wired so that as long as there is a certain minimum amount of appropriate development in the one area, it doesn't get too upset, whereas too much development in the other makes it very unhappy. Which end causes distress from lack and which from excess is invese between the genders. And as you pointed out, the timing difference between MTFs and FTMs over when distress sets in is down to the 'normal' developmental processes causing problems early in MTF girls and late in FTM guys.

There's a kind of symmetry to that. My inner pattern-recognition geek is satisfied now :-}

Sigh - life. It's all so very complicated! And no user manuals! It's no wonder, given the over-simplistic view of life that was/is thrust at us early on that so many feel confused or distressed unless they are given suitable information or role models to help them understand that things aren't always simple!

There's a kind of symmetry to that