An F.T.M. Perspective

Written by Jasper, in consultation with Max and George, presented at the Health In Difference Conference

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

There have always been cross-dressing women for as long as there has been a human history. With the advent of lesbian and feminist communities this century, these historical figures have been claimed as either feminists before their time, or adventurous lesbian heroines. Only recently have a few, strident but isolated voices from the International F.T.M. fraternity, begun to question the validity of these claims, and call many of these women of history their transgender brothers.

Such historical invisibility, and careful removal of evidence, have plagued women for centuries, and not the least, lesbians. However the ultimate crown of invisibility must be given to F.T.M.s, whose very existence was a mute point up until five years ago, even in our own community. It is understandable that this should be so, for the question of the existence of F.T.M.s is fundamentally a women's issue, and like most women's issues, has been conveniently ignored until shouted about.

The social ramifications of this has been a story of many transgender men who have braved their self-determination in silence and isolation, or who have worn the painful cloak of compromise within the lesbian community. It has to be said, of course, that not all trany men stem from the lesbian community, however, a significant percentage do so.

Historically over the past 50 or so years, the polarity of butch/femme has allowed the F.T.M. to find love and friendship, as well as limited male expression within a social construct reflective of the wider community.

With the advent of lesbian, feminist separatism in the 70's and most of the 80's, it became politically incorrect to exhibit overtly male characteristics within certain circles. The late 80's and early 90's gave rise to the 'femme revolution' which meant that traditional Butch role-playing was deemed very unfashionable. In the last couple of years we have seen a subtle resurgence of Butch/Femme identity, as those who subscribe to this lifestyle begin to reassert their right to validation.

We have also seen an explosion of gender-fuck in the club based lesbian scene, and beyond. Girl/boys abound, glue-on moustaches are flourishing, and dildo sales have never been better. It seems, in lesbian queer quarters, that it's okay to be Butch, femme, effeminate, masculine, a gay male, a drag queen or king, neither, none or all.

But where does this leave the humble F.T.M., who more often than not, identifies exclusively as male, and wishes to be just seen as one of the boys? An invisibility of a different nature begins to occur.

For those trany men who make a physical transition, the outward results are astounding. So much so that there could be an F.T.M. sitting next to you and you would never know. This has meant, that up until a few short years ago, many transmen became absorbed into the wider community, leading relatively integrated lives and becoming the men they always knew themselves to be. If they had emerged from the lesbian community, the idea of being able to remain there was unthinkable. These days it can be a different story.

This ability to visually integrate so well is a double-edged sword - on one hand, it makes life easier and less hostile, yet on the other hand, it means that there hasn't been a sense of community, history, or experienced elders consistently available to us. We have had to rely upon chance meetings in medical waiting rooms, vague introductions from a friend of a friend, and the generosity of doctors.

However, five years ago, a loose national network of trany men was formed, and still exists, albeit rather fragmented today. The emergence of the Gender Centre, from Tiresias House, has also provided a stable, and essential encounter point for F.T.M.s. These two facilities combined have meant that new transmen, if aware of these services, have the ability to connect with each other for peer and social support, and access limited information and resources.

As the area of F.T.M. has historically been under-resourced, if at all, outside of medical journals (and even then in significantly diminished ratio to our F.T.M. counterparts), this has meant that research into transmen's health and welfare has been practically non-existent. Even basic and consistent information on hormone intake, until a few years ago, was unheard of, and many men were left floundering with irregular dosages and scripts.

There is a definite need for transmen hormone intake to be administered and monitored on a regular basis. There are a number of reasons for this which include:

• In order to maintain an overall state of health and well-being;
• Testosterone increases the risk of heart disease;
• An excess of testosterone can cause psychological instability;
• There is a need to effectively manage heightened levels of aggression;
• Excess testosterone is converted by the body into oestrogen which is counter-productive to the gender transition;
• There is a need to monitor kidney and liver function, which can be affected by long term hormone use; and
• Testosterone can also result in significant weight gain which adds to the risk of heart disease.

There is also the issue of osteoporosis, which until recently, was never really considered a health concern for F.T.M.s. However, preliminary research, and common medical sense, shows that transmen are at great risk of acquiring osteoporosis due to fluctuations in hormone intake, and also due to the leaching of calcium from the body which occurs with the intake of testosterone. This has meant, that many F.T.M.s who were led to believe that their testosterone intake would be downgraded, in line with their long term vision, were now faced with incurable osteoporosis. Preventative, and educational methods are therefore an absolute necessity.

Having started out as genetic females, transmen are still at risk of diseases associated with female reproduction, such as cancers of the uterus and cervix, cysts, F.T.M.s and the like. As such, it is absolutely important for transmen to be still encouraged to take annual pap smear tests. This is difficult, for many F.T.M.s may find such an examination acutely humiliating, yet it must be done. Long-term testosterone intake atrophies the ovaries, and the results of this have never been assessed. There is no long-term research, that I am aware of, of the dangers inherent in this region.

A Hysterectomy is not necessarily the answer, and not all F.T.M.s would seek this option, though many do. According to the U.K. F.T.M. Network, it is now recommended in Britain that only 25% of transmen need a hysterectomy in their early years of treatment. In these cases it is because of breakthrough bleeding due to cervical erosions. It is now recommended that the remaining 75% of F.T.M.s wait until they reach post-menopausal age, when there is an increased risk of developing cells in the cervix. Not having an early hysterectomy also proves useful at the time when phalloplasty, or neo-penis surgery is performed.

In light of the recent Anti-Discrimination legislation, this causes a problem. The current legislation requires transmen to have womb surgery performed before they will be legally recognised and covered by that legislation. Now that it is recommended that most of us wait to have a hysterectomy, if at all, in order to minimise health risks, then many of us may fail to meet this legal requirement. This is a point that should seriously be considered by the A.D.B. and other legislative bodies.

Phalloplasty, and other related surgeries, are still highly experimental and fraught with side-effects. An Australia, the availability of such surgery is limited to one or two surgeons whose techniques do not necessarily reflect overseas progressions. At the most extreme, phalloplasty can cause death due to complications and infections. Permanent incontinence is another major risk, along with the death of healthy tissue. The main area of difficulty is extending and creating a workable urethra, with fistulas more often the norm. For those men who choose phalloplasty, the results can vary dramatically, which seems to suggest a pot-luck outcome. I have not met one F.T.M. who has had this surgery, who hasn't experienced complications, or loss of tissue.

Phalloplasty also requires a number of complex procedures which can tax the patients health and stamina. In the past, there was a tendency for surgeons to rush the patient through these stages, not allowing enough time for the body to heal between surgeries. These days, this is being redressed.

Another consideration is, that because there are only two surgeons in Australia performing this surgery, and one has already indicated his unwillingness to continue in this area, it absolutely essential that new surgeons be trained to fulfill this role. Sadly, this is not, as yet, on the horizon.

As with any specific health group, there needs to be the implementation of long-term research, and analysis into the health and needs of female to male transsexuals. Whereas our F.T.M. sisters have had limited focus so far, transmen are yet to be given any attention necessary for their continued well-being and quality of life. Our surgical options are extremely limited, and our invisibility keenly felt. We hope that the near future will see an improved awareness and concern, for our situation, by the government, and medical profession. In the meantime, The Gender Centre, and our own loose network are providing avenues for working toward the fulfilling quality of life we all seek.

Polare is published in Australia by The Gender Centre Inc. which is funded by the Department of Community Services under the S.A.A.P. Program and supported by the N.S.W. Health Department through the AIDS and Infectious Diseases Branch. Polare provides a forum for discussion and debate on gender issues. Advertisers are advised that all advertising is their responsibility under the Trade Practices Act. Unsolicited contributions are welcome, though no guarantee is made by the Editor that they will be published, nor any discussion entered into. The editor reserves the right to edit such contributions without notification. Any submission which appears in Polare may be published on our internet site. Opinions expressed in this publication do not necessarily reflect those of the Editor, The Gender Centre Inc.I, the Department of Community Services or the N.S.W. Department of Health.