Era of the Gender Crosser
Buoyed by the success of gay liberation and freed by medical advances, the transgender community has found a voice. Still, life often remains complicated.

By MARY MCNAMARA, Times Staff Writer

     Once upon a time in San Francisco, two people fell in love, broke up, got back together, joined their names and had a baby.
     A conventional love story, except for one detail: When Patrick and Matt Califia-Rice met 10 years ago, they were women. Women who had felt, from the time they were small, that they should be men.
     Matt was the first to exchange desire for reality. On the day the two broke up, he began taking testosterone. He grew a beard, had his breasts removed. They got back together five years later, and though they could not legally marry, they took each other's names. Patrick, who was still living as a woman, began thinking that he too would become a man.
     Then things got complicated.
     The couple decided they wanted to have a child. With their unusual history, adoption would be difficult if not impossible, and Patrick had undergone a hysterectomy for medical reasons years before.
     The only option, they felt, was for Matt to conceive. Plagued by hormone-induced migraines, he had already stopped taking testosterone and had begun to menstruate again; his doctor had advised a hysterectomy.
     Instead, they found several sperm donors, and the handsome, bearded 37-year-old computer network analyst entered the world of morning sickness and water retention. During Matt's third trimester, Patrick began taking testosterone and contemplating chest surgery.
     A year ago, their son was born, into a family of two male parents and a world that 10 years ago did not even exist.
     Since the story of Christine Jorgenson hit the New York tabloids in 1952, transsexuals have hovered on the edge of public imagination, stock characters in a myth that went something like this: Due to a mistake in nature or biology, a woman is born trapped in a man's body. After years of denial and mental torture, he has a sex change operation and goes on to live life as a traditional heterosexual woman, revealing her past only as the result of a medical emergency or as a guest on "Jerry Springer."
     But in 2001, that scenario is outdated, if not obsolete.
     Gender identity disorder, as defined in medical manuals, is characterized by a "persistent discomfort about one's assigned sex." It has no known cause. Numbers are hard to come by in a still-mostly closeted population, but those who are "out" make up an exceedingly diverse group. There are as many female-to-male transsexuals as male-to-female, and they come from every race, religion and cultural background.
     Some transsexuals are straight, some are gay and some are bisexual. Some have children before they make the change, some have children after. Many have sexual reassignment surgery, many do not; many take hormones to change their secondary sex characteristics, some do not; many dress and live as close to the traditional definition of male and female as possible; others are androgynous.
     In fact, transsexual, with its historical implications of surgery, is being replaced by the broader term "transgender," which includes cross-dressers, people who identify themselves as stone butch lesbians or flaming queens and anyone who feels or acts outside the traditional gender norms. Within the transgender community, the word "transition" has become a verb to describe what used to be called a "sex change."
     Buoyed by the success of the gay and lesbian liberation movement, freed from enforced isolation by changes in the medical and psychiatric establishment, and brought together by the Internet, the transgender community has emerged in the last five years as a new voice in social activism.
     This voice suggests that, although gender is an identity we are born with, an identity that no amount of social influence can sway, it is too great and varied a force to shoehorn into those ubiquitous boxes marked F and M. While human desires--for love, passion, work, respect, friends, family--remain constant, the way those desires are felt and expressed cannot always be categorized at the moment of birth. Anatomy, as feminists have long argued, is not destiny.
     "This is the last phase of the sexual identity movement," says Vern Bullough, a USC adjunct professor of nursing who has written extensively on sexuality in America. "The community is much more organized than it was five years ago. It's learning to live with its own differences, and becoming more mainstream. The long-term effect will be interesting. Certainly, it will blur gender lines even further."
     It seems a natural extension of arguments made by feminists, gays and lesbians--and transgender people have found solace, aid and allies in both those communities. But they have also encountered rejection and hostility. Change is difficult, even for revolutionaries.
     "Many mixed-race people are saying that race, as a means of categorizing people, no longer works," says Robert Dawidoff, a history professor at Claremont Graduate University. "Transgender people are showing us that gender, as a similar construct, has no meaning either. Which is, of course, very frightening to many people."

     A Difficult Pregnancy for Matt and Patrick
     For Matt and Patrick, that was clear right away. It was a difficult pregnancy, physically and emotionally. Tasks most couples take for granted--finding a doctor and a birthing class, telling family and friends--became dramatic events.
     To strangers, Matt looked like a man trying to hide a beer belly with bigger and bigger overalls. His appearance at a birthing class caused a stir.
     "We had found an instructor whose partner was transgender," says Patrick, a psychotherapist and the author of several books, including "Sex Changes: The Politics of Transgenderism" (Cleis Press, 1997), "so that was no problem. But the class was pretty frosty."
     "Matt was very clearly a man when he walked in," says midwife Kim Touevs, whose classes are geared toward lesbian families. "And he was also very clearly pregnant. Everyone was very respectful, but they were waiting to hear what Pat and Matt had to say in the introduction circle."
     The two were very open, says Touevs, who has since had two other transgender parents in her class, and by the end of the session, everyone seemed comfortable, or as comfortable as a room full of expectant couples can be.
     "We had to buy a lot of chocolate," Patrick says. "I have always found that it's kind of hard for people to say nasty things after you've fed them."
     A man, however, cannot have a baby without someone taking umbrage, and to the couple's dismay, the most hurtful criticism came from some of their friends.
     In San Francisco, they were part of one of the largest and most visible transgender communities in the world. But within that world, they were a scandal.
     "A lot of [female-to-male transsexuals] are very invested in seeing themselves as 'real men,' " says Patrick. "And they said 'real men' don't have babies. But Matt said 'real men' don't have hysterectomies either. He refused to be shamed."

     Support Groups Emerge Across U.S.
     "I know I'm not a man," wrote transgender activist and playwright Kate Bornstein in her book "Gender Outlaw," "and I've come to the conclusion that I'm probably not a woman either, at least not according to a lot of people's rules on this sort of thing."
     Bornstein transitioned from male to female almost 20 years ago, and when she wrote her book in 1994, she reported seeing the beginnings of a "transgender revolution."
     Since then, across the country, organizations providing information and support for transgender people, their spouses, children and relatives have emerged, with members in the thousands.
     Many gay and lesbian organizations also offer transgender services. Late last year, the Los Angeles Gay and Lesbian Center added the transgender community to its mission statement, reflecting a trend among national organizations as well.
     But more than anything else, the Internet, with hundreds of sites devoted to the subject, has helped transgender people break their silence and isolation.
     "There is an inherent problem with trying to define a transgender community--it covers so many different people, from casual cross-dressers to transsexuals. But there have been some positive changes in the last few years," says Sara Herwig, director of operations at the International Foundation for Gender Education, publisher of Transgender Tapestry magazine, which has a circulation of several thousand. "I think it's in the process of becoming a social force."
     Many transgender men and women have stories about how things have gotten better in the last five years. Some point to the decision Feb. 8 by San Francisco to expand health benefits to include psychotherapy, hormones and surgery for city transgender employees, or to a recent court decision in Brockton, Mass., that allowed a transgender female to wear women's clothing to high school, or to the growing number of people able to transition on the job.
     Others refer to the mainstream adulation of the Oscar-winning film "Boys Don't Cry" and "Ma Vie en Rose," or to the recent change in the Associated Press guidelines to require that a transgender person be referred to by the pronoun of his or her choice.
     But as with any liberation movement, the catalyst for the community's activism is the overwhelming sense of injustice. Every transgender person also has a story of fear and loss and often physical abuse. The well-publicized murder of Brandon Teena (the inspiration for "Boys Don't Cry") symbolized for many the problem of violence against transgender people.
     Although national health care plans in many European countries pay for sex reassignment, there is little coverage in the U.S. Obtaining new ID remains a problem, and partnership benefits are almost always out of reach.
     And many institutions refuse to acknowledge that a person can change from one gender to the other. The Texas Supreme Court recently nullified a transgender woman's legal marriage when she attempted to file a wrongful death suit against the hospital where her husband died. Although her birth certificate and driver's license had been legally changed to identify her as female, the court found that male chromosomes do not change with either hormonal treatment or sex reassignment surgery. "Biologically," wrote Chief Justice Phil Hardberger in the deciding opinion, "a post-operative female transsexual is still a male."
     (Ironically, some same-sex couples in which one partner is transgender have turned the laws to their advantage by using their pretransition genders to marry, which can result in a perfectly legal same-sex union.)
     Unlike race, religion, gender or sexual orientation, gender expression has no protection under antidiscrimination law. Attempts to explicitly include transgender people among those protected by a proposed employment nondiscrimination act have failed thus far.
     Transgender people may be denied housing, fired from their jobs, expelled from schools, banned from social clubs or businesses--simply because their boss, landlord or principal does not feel comfortable around them.
     In a highly publicized case two years ago, a Sacramento school board voted to fire teacher Dana Rivers after several parents complained that she had discussed her transition with her students. Many students, teachers and parents protested, and Rivers sued. The case was settled out of court--she agreed to resign and received a $150,000 settlement.
     "Seeing a man in a dress would be a distraction," one of the students who supported Rivers' dismissal told this newspaper at the time. Regarding gender, she added: "God doesn't make mistakes."
     But where before there was silence at such treatment, there is now a growing chorus of protest, and with it signs of change.
     Several years ago, Richard Odenthal, then a Sheriff's Department captain in West Hollywood, realized that his deputies were having trouble dealing with the growing transgender population of the city. Working with several support groups, he created a briefing program to answer questions such as how to address a transgender person and what makes a person want to change gender.
     "Like anything else," says Odenthal, now West Hollywood's director of public safety, "there were some people who got it right away, some who need a bit more information, and some who still did not like the idea at all. But they know that they are expected to behave professionally and with sensitivity, and I think things have improved."
     In fact, the city of West Hollywood recently appointed a seven-member task force to study the needs of the growing transgender population.
     "There have been major strides in the last five or six years," says Richard Horowitz, a Los Angeles internist and nephrologist (kidney specialist), who has worked with hundreds of transgender patients for more than 12 years. "In the mainstream, and in the medical community, there is much more acceptance."
     Gary Alter, a surgeon at Century City Hospital who has performed sexual reassignment operations for seven years, is more blunt: "It used to be people looked at transsexuals as freaks. Now they realize these are just normal people trapped in bodies that don't suit them."
     Both doctors say they are seeing more transgender patients than ever.
     Medically, a transition begins with hormone treatments, which cause the development of secondary sex characteristics, such as the development of breasts or facial hair. After that, several surgeries may be involved. Male-to-females usually have breast implants. Many have genital surgery. This can cost $10,000 or more. There is often electrolysis to remove facial and body hair, and some undergo surgeries to feminize the face--to make the nose smaller or the brow less prominent, to remove the Adam's apple.
     Most female-to-males take testosterone and many have mastectomies. Fewer have genital surgery. At $70,000 and up, it is often prohibitively expensive, and far less successful. Part of the myth of the transsexual was that the process began and ended with surgery and that success was judged by how much of a woman or a man one resembled, how well one "passed." Lately, however, some are rejecting these criteria, arguing that transgender, rather than man or woman, is an end in itself.
     "The problem with the traditional model," says Patrick Califia-Rice, "is that it . . . doesn't reflect the reality that many of us are never going to pass."
     Before transition, his was an hourglass figure with D-cup breasts, and although hormones have shrunk his breasts and hips, he says he looks neither like a traditional man nor a traditional woman.
     He is still debating whether or not to have his breasts removed. "I don't know if fitting into my Brooks Brothers shirts is worth such an invasive procedure, with possible loss of sensation," he says.
     Influencing his decision is the knowledge that within the transgender community there is a perceived surgical hierarchy. "People on top are those who've had all the surgery; under those, partial surgery; under those, people who pass with just hormones; under those no hormones; under those, those who just don't pass."
     Having lived outside the boundaries of traditional conformity, he says, he doesn't relish the idea of capitulating to transgender conformity.

     Many 'Standards of Care' Are Loosened
     In 1966, New York endocrinologist Harry Benjamin published "The Transsexual Phenomenon," thereby giving a name to a syndrome and establishing a list of "standards of care" by which it should be treated.
     As recently as 10 years ago, the standards required, among other things, that before transitioning, the patient quit his or her job, move and live for at least a year, without benefit of surgery or hormones, as the desired gender. This included taking a new, "gender appropriate" job, which could mean for a prospective male-to-female, exchanging a law practice for a secretarial post. After surgery, the patient was evaluated regularly, encouraged to keep the reality of his or her life a secret and discouraged from associating with other transgender people.
     "Which flies in the face of mental health," says Michelle Kammerer, co-director of the Center for Gender Sanity, a resource and support group. "You were supposed to cut off all communication with your support group at a time when you needed the most support, supposed to quit your job at a time when you needed lots of money."
     Kammerer transitioned rather famously more than 10 years ago while a station commander with the Los Angeles Fire Department. Although her bosses were supportive, many members of her crew were not. She eventually transferred; she is now a station commander in West Hollywood.
     She and her spouse, Janis Walworth, a nontransgender woman, founded the center six years ago. Walworth has written two guides, one for employers and one for employees, that are used across the country.
     From the couple's home in Westchester, they try to explain the realities of transition to anyone who would like to know--the novelist attempting a transgender character, the mother who doesn't understand what her child is talking about, the woman who cannot live one more day in a man's body.
     In the last decade, many of the "standards of care" have been relaxed. As the number of transgender people increased, it became clear that most were not suicidal or pathological.
     A diagnosis of gender identification disorder is required before hormone therapy or surgery can take place, and people are generally still required by their doctors to live for at least a year as the gender to which they aspire. But the expectations are more realistic--a prospective male-to-female patient will not be denied surgery if she eschews makeup or wears slacks rather than skirts. And whereas once doctors and psychiatrists would refuse someone not planning to live as heterosexual after transition, now most do not.
     Even the trial year has many critics--after all, by the time most people make their way to a doctor's office, they have been questioning and denying and fighting their desires for decades. "Most of us have tried everything else," says Kammerer.
     Everything else includes being straight, being gay, being celibate, getting married, having kids, getting divorced, joining the Armed Forces, moving across the country, abusing drugs and alcohol, spending years in psychotherapy, even taking religious vows. Most transsexuals say they knew they wanted to have surgery, or at least live as the other gender, at a very early age but were simply too afraid.
     In most states, one's gender on a driver's license can be changed, and in some states even on birth certificates. Passports can be changed as well. But all require a letter from a doctor and/or psychiatrist stating that the individual has had reassignment surgery or has been living as the requested gender for at least a year. For those who do not have surgery or hormone treatments, getting a new driver's license or passport can be impossible.
     This is one reason it is difficult to find an accurate count of transgender Americans. The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Assn. says that one in 30,000 men and one in 100,000 women suffer from gender identity disorder, but this is based only on those who seek psychiatric help. A number that is commonly used--that about 1,000 Americans have sexual reassignment surgeries each year--does not take into account the many who go to Europe or Mexico for their surgeries, or those who do not have any surgery at all.
     But numbers are important politically, and so the relatively small community has sought various alliances. Many people coming to terms with their gender issues turn to the gay and lesbian community, says Marie Keller, director of the Gender Center in Los Angeles, because there really hasn't been anywhere else to go.
     Some of the issues the two groups face are similar, she says--how to cope with the often-traumatic effects of coming out, how to learn to be honest about who you are--but the diverse nature of both groups has made the alliance an often-uneasy one, with each side having to confront its own bigotry.
     Last year Norah Vincent, a columnist for the gay-oriented periodical the Advocate, took issue with the transgender community's use of language, winding up her argument by asking why "transsexuals mutilate their bodies in order to make them conform to the fashionable version of the opposite sex and gender" instead of living "with all the polymorphy God gave you, body and soul."
     In the big coastal cities, Kate Bornstein says, gays and lesbians have become so accepted they're almost chic. "But," she says, "it's still OK to laugh at trannies."
     Bornstein says she used to feel bitter about the lack of what she sees as real inclusion from the gay and lesbian movement, but now she's not so sure it is a natural alliance.
     "Gays and lesbians are more about fixed identities--they have a lot more in common with heterosexuals," she says.
     Gwenn Baldwin, executive director of the Los Angeles Gay and Lesbian Center, says she became convinced that the organization should specifically include transgender men and women after hearing someone use the term "gender nonconformity."
     "We had been serving the transgender community for years," she says, "but we hadn't really been talking about it. But then I realized that we are all gender nonconformists in one way or another."
     The phobia exists on both sides, says James Green, co-director of Gender Education and Advocacy, a support group with offices in Oakland, Washington, D.C., and Decatur, Ga. Many straight transgender people do not want to be allied with gays and lesbians, often because they have been mistakenly dubbed homosexual during their pre-transition lives. But the alliance is a necessary one, he says, because "the reason people are getting bashed is because of gender signals."
     Many female-to-males who lived for years in the lesbian community or as radical feminists say their decision to transition was seen by many as a betrayal.
     "I had to overcome the attitude that the good people are women, which I had bought into for so long," says Patrick Califia-Rice. "Although, after taking testosterone, I have to admit most men are pretty well behaved, if they're experiencing what I'm experiencing."
     "I lost some friends," says Mike Hernandez, a lawyer living outside Los Angeles who transitioned 10 years ago. "When you go from being a lesbian separatist to being a man, well, there are going to be some problems."
     Many transgender people say they wish they had simply been born in the "right" body, but that is not what happened. Instead their lives followed unmarked paths in the darkness beyond the pale, paths of fight or flight and then surrender--to a transformation that neither begins nor ends with the traditional definition of man or woman.
     "One of my girlfriends said during an argument, 'I can't believe you were ever a woman,' " says Green. "And I said, 'I wasn't. That's the whole point. I was something else.' "
     How does he think of himself now?
     "I am a man," he says, "with an unusual history."

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