Normal

THE BODY LIES: FEMALE-TO-MALE TRANSSEXUALS

What would you go through not to have to live the life of Kafka’s Gregor Samsa? Not to realize, early in childhood, that other people perceive a slight, unmistakable bugginess about you, which you find horrifying but they claim to find unremarkable? That glimpses of yourself in the mirror are upsetting and puzzling and to be avoided, since they show a self that is not you? That although you can ignore your shell much of the time and your playmates often seem to see you and not your cockroach exterior, teachers and relatives pluck playfully at your antennae with increasing frequency and suggest, not unkindly, that you might be more comfortable with the other insects? And when you say, or cry, that you are not a cockroach, your parents are sad, or concerned, or annoyed, but unwavering in their conviction — how could it be otherwise? — that you are a cockroach, and are becoming more cockroachlike every day. Would you hesitate to pay thirty thousand dollars and experience some sharp but passing physical misery in order to be returned to your own dear, soft, skin-covered self?

Approximately two people in every hundred thousand are diagnosed — first by themselves, then by endocrinologists, family doctors, psychiatrists, or psychologists — as high-intensity transsexuals, meaning that they will be motivated, whether or not they succeed, to have surgery that will bring their bodies into accord with the gender to which they have known themselves, since toddlerhood, to belong. Until a decade or so ago the clinical literature and the unreliable statistics suggested that for every four men seeking to become anatomically female, there was one woman seeking the opposite change. Now clinical evaluation centers report that the ratio is almost one to one.

In twenty years of practice as a clinical social worker, I met men who liked to wear women’s clothing, women who preferred sex in public conveyances to sex at home, men who were more attracted to shoes than to the people in them; I didn’t meet any transsexuals. I encountered transsexuals only the way most people do: in Renee Richards’s story, in Jan Morris’s Conundrum, in Kate Bornstein’s books, and on afternoon talk shows, where transsexuals are usually represented by startlingly pretty young women, sometimes holding hands with their engagingly shy, love-struck fiancés, sometimes accompanied by defensive, supportive wives turned best friends. I wondered, in the middle of the afternoon, where the female-to-male transsexuals were. Even if there were four times as many male-to-female transsexuals, there still had to be a few thousand of the other kind somewhere. But not in mainstream bookstores, not in magazines, not in front of talk-show audiences of middle-aged women standing up to applaud the guests’ ability to “look just like the real thing.”

I thought there must be a reason female-to-male transsexuals were invisible. I wondered if their physical transformations were so pitiful that no one could bear to interview them, if women who wished to be men were less interesting, less interview-worthy than men who wished to be women, or if these people were so floridly disturbed that even the talk-show hosts were ashamed to be seen with them.

Much of the early psychiatric literature about transsexuals, from the pre — Christine Jorgensen 1940s until the late 1970s, leaned heavily toward psychoanalytic explanations and toward clinical descriptions that, however sympathetic to the unhappy patient, emphasized the bizarreness not of the biological condition but of the conviction that there was a biological condition. The next psychiatric wave emphasized “personality disorders” as the root of transsexuality, specifically the popularized borderline personality syndrome, with its inadequately formed sense of self and frightened yearning for symbiosis. In The Transsexual Empire (1979), Janice Raymond dismissed the biological reality of transsexuality and attacked transsexuals as agents and pawns of the patriarchy. Her overwrought theories about the meaning of transsexuality and the training and practice of surgeons who perform transsexual procedures read like the feminist equivalent of some of the Mafia — CIA — White Russian conspiracy theories of Kennedy’s assassination, but her essential point, that transsexuals are psychologically unstable victims of a society that overemphasizes the roles of sexual insignia and gender difference, made sense to me. If the people involved were less nuts and society were less rigid, it seemed, neither transsexuals nor the surgery they seek would exist.

Most of us can understand a wish, even a persistent wish, to belong to the other gender. History and fiction are full of examples, many charming, some heroic, of women who dressed as men throughout their lives. It’s the medical procedures that make transsexuals seem crazy: six months to two years of biweekly intramuscular injections of two hundred milligrams of Depo-Testosterone, which cause an outbreak of adolescent acne, the cessation of menstruation, and the development of male secondary sex characteristics; then a double mastectomy, in which most but not all of the breast tissue is removed, the nipple saved, and the chest recontoured for a more masculine, pectorally pronounced look; and then, a year to ten years later (depending on the patient’s wishes and financial resources), a hysterectomy and one of two possible genital surgeries: a phalloplasty (a surgery to create a full-size phallus and testicles) or a metoidioplasty (a surgery that frees the testosterone-enlarged clitoris to act as a small penis). In short: multiple, expensive, and traumatic surgeries to remove healthy tissue. Who would do this?

Lyle Monelle, a burly man of twenty-eight, lives with his mother, Jessie, in a trailer park in suburban Montana, a state in which I’d never imagined suburbs. The trailer park is neatly laid out beneath a shocking cobalt sky, and all the culs-de-sac have their own blue-and-white street signs, none of which are bent or rusted or facing the wrong way. The careful hand of people who are used to making do, doing without, and trying again is everywhere. Jessie and Lyle are watching for me from the trailer’s little porch, and they come toward the car like a couple of welcoming relatives.

The inside of the trailer looks familiar; it is the Montana twin of my late mother-in-law’s home in northern Minnesota. Sturdy, slightly bowed Herculon love seat and matching recliner in shades of orange; copper mallards hanging on the opposite wall, arching over the TV. The three of us finish two pitchers of iced tea during the afternoon’s conversation, and Lyle and Jessie allow themselves to be sad and occasionally puzzled by their own story, but not for long. All their painful stories are followed by moments of remembered grief but end in the genuine and ironic laughter of foxhole buddies; they know what they know, and they are not afraid anymore.

Lyle is older than I had thought he would be — he’s an adult. He was a patient of three of the people I’ve already interviewed — Dr. Donald Laub, a preeminent plastic surgeon known especially for female-to-male sex change surgery; Judy Van Maasdam, the counselor at Laub’s surgical center in Palo Alto; and Dr. Ira Pauly, a noted psychiatrist — and when they told me about Lyle, they all focused on how young he was at the time of transition, much younger than most people who apply for surgery. Even though I knew better, I had half expected to meet a teenager. He was fourteen when he began hormone treatments, with medical approval, fifteen when he had his mastectomies, but twenty-three before he and his parents had enough money for the phalloplasty, the “bottom” surgery. (That’s what the guys say about their surgeries—“my top,” “my bottom.”) I was horrified when I first heard the stories about this kid, and I imagined meeting his parents and clinically evaluating them as misguided, covertly sadistic, or perversely ignorant, acting out their own unhappiness on their helpless child.

We should all have such parents.

When Lyle entered puberty, his mother and his late father took him from doctor to doctor, looking for explanations for Lyle’s unhappiness and fierce resistance to being treated like a young woman. An endocrinologist who had worked with Don Laub recognized Lyle as possibly transsexual, and Ira Pauly and Judy Van Maasdam confirmed the diagnosis. Then, after extensive hormone treatments, Laub performed the first surgery and the family moved to another state, to allow Lyle to enter high school as a boy. Later, they nursed him after his hysterectomy and his phalloplasty, and used all their savings, and then some, to pay his medical bills.

Jessie says, “I want everyone to know who reads this that this wasn’t easy — it was a really terrible shock. I didn’t understand. I said to the first endocrinologist, ‘Where did we go wrong?’ and he said nowhere, it was biological. I called every single — I’m not kidding you — every single insurance company in the USA, and they said, ‘No, it’s cosmetic.’ ”

Lyle interrupts — the only time I’ll see him openly angry. “Yeah, right. Like I wanted a nose job. Cosmetic. Well, it was only my life.”

Jessie makes soothing hand gestures, reminding him that it’s all right now. “And of course, the money,” she says. “Our other kids resented it. I understand. But what could I do? What could we do? If your child has a birth defect, you get help. We understood — we understood even when he was little that something wasn’t right. And we knew, when the doctors told us what could be done — we just knew what we had to do. When the doctors said he was transsexual, I felt that I knew that.”

After hearing Lyle’s stories about his hated girl name, his astonished, frightened tears and protracted battles over party dresses, Mary Janes, and even girl-styled polo shirts, and his deep, early sense of male identity — the same stories I would later hear, with minor variations, from almost every transsexual man I spoke with — I ask him about life since the transition. He gives me a glossy friend-filled account highlighted by a two-year romance with an older woman (twenty, to his seventeen) and a successful football career cut short by an ankle injury.

And after high school?

Finally, a bit of trouble: “I had a little money problem and a little drug problem. I got some counseling, came back from Las Vegas, started college. Now I’m taking classes, paying off my bills, working for the state. Eventually, I’ll get my bachelor’s.”

He sighs, and Jessie says quickly, “That’s all right. Lots of older kids are in college these days. Aren’t they?” I say I know quite a few, and we sip our iced tea.

“I did a lot of partying, some wild times,” Lyle continues. “I think maybe I was frustrated. Maybe I did drugs partly because I was so frustrated at not being able to get my bottom surgery right away. Maybe. I just felt not quite right, but the surgery didn’t make the difference I thought it would. It just made me feel me — not macho, just me. Uh, sexually.” He looks at his mother. “It helped me out mentally, not really physically. But it cost so much. Not that Don Laub wasn’t fair — he was. And when it was over, all I wanted to say was, ‘Thank you, Dr. Laub, for letting me be reborn.’ But if it hadn’t been for that I’d have a very nice house by now.”

He laughs and Jessie laughs. “Me too,” she says. “We’d have two very nice houses.” Not looking at him, she goes on. “There is another surgery he could have, to get all the feeling”—a surgery in which a nerve taken from the forearm is run through the phallus—“but we just don’t have the money.”

I didn’t ask any questions, because at the time I didn’t know much about the different kinds of phalloplasties and I thought that it was rude to ask people about the working condition of their genitals, constructed or otherwise.

Lyle says, “What does it cost? Another forty grand? To have more sensation? It’d be nice, I guess, but I’d rather pay off my debts and buy a condo. What I have is fine. I need to get back on my feet financially and own my home more than I need to—” He laughs again and looks at his mother, who laughs too.

“And anyway,” Jessie says, “he wouldn’t ever let us see it, even after we nursed him following the surgery.”

“Did you want to?” I ask.

Lyle is laughing and shaking his head no.

“Well, yes,” Jessie says, slightly injured. “He’s my son. I wanted to know.”

“No, Mom. I’m twenty-eight. I maintain the boundaries here,” Lyle says to me, and his mother smiles, a little puzzled and hurt that this is the thing he won’t share.

“I’m pretty darn happy now. I want to finish school, and when I’m ready I’d like to marry, have a family. I’m not ready yet for a serious relationship. Psychologically, I’m just getting ready to date again.”

He sounds like a lot of the young men in AA or NA, a little ashamed, a little proud of his hell-raising days, understanding that it’s time to grow up, and a little sorry that’s so.

We take a break, and Lyle shows me the photographs I’ve asked to see. It seems absurd to describe the child I’m looking at as a little girl; even in a ruffled blouse, this is a little boy: a sturdy little boy looking adoringly at his dad while happily playing with his electric train, and then a cocky kid in cowboy hat and boots, and then a handsome, shaggy graduating senior being kissed by a pretty girl, and then Lyle as he is now, a friendly, beefy man with thinning blond hair — exactly the look of many West Coast high school football stars ten years down the road.

James Green, a transsexual man who has organized a get-together for me at his Oakland condo, sits beside me in the rental car while I look for the dimmer switch. I’m parked in his parking space, since he has chivalrously moved his car a block away to make room for me. I find the headlights, I find the interior light. I find the wipers. I cannot turn off the brights. James reaches across me with his left hand and adjusts the dimmer switch. The brights go down, and he looks at me exactly as other men have on such occasions: affectionate, pleased, a little charmed by this blind spot of mine. We smile at each other and I shrug. He shrugs too. “It’s innate,” he says, and he laughs, not taking his eyes off me.

We are dining unfashionably early, in an austerely hip neighborhood café, before the other men arrive at James’s place. A huge plate of food is put before James, and he hunches over slightly and begins eating. I notice that he does not say, “Gee, this is a lot of food,” or anything of the kind. Like a man, he just starts eating. I ask him how he met the girlfriend he’d mentioned earlier.

James puts his fork down and gives me the full effect of his green eyes. “She’s a writer. She was interviewing me.” A quick unfolding of a Jack Nicholson smile, and then, with slow mock-shyness, he goes back to his dinner. I smile too.

After dinner, we drive to his condo, which is clearly the home of a writer and a noncustodial father: eclectic reference books spill off the bookshelves, the refrigerator door is bedecked with drawings by and photographs of a cute little girl, dolls and coloring books make a pink-and-purple jumble in a corner of the living room. When James was a lesbian, the woman he lived with had a child, whom he regards as his daughter; after his surgery, they broke up, but he now sees the little girl as much as he can.

The doorbell rings, and James introduces me to Loren and Luis, guys from the local transsexual community.

Loren Cameron, a blond bantamweight photographer, is wearing a billowing tank top and black shorts. He has a tight, perfect build, and startling black stripes tattooed across his chest, on both forearms, and on his thighs. A cross between Mercury and Rob Lowe, he looks like a not uncommon type of handsome, hairless, possibly gay man one sees on beaches and boardwalks.

Loren has been romantically involved with a massage therapist named Elizabeth for the last six years. When I speak to her later, I’m not surprised to learn that she is a former dancer and a fitness fanatic, and to find out for myself that she is marvelously, mellowly narcissistic.

“Well, Loren and I are a striking-looking couple,” Elizabeth says. “We’re both very fit, and I know that people look at us when we walk down the street. After all, I’m about four inches taller than he is.” Elizabeth describes her two previous lovers: a beautiful Amazon and an unusually sensitive man. “But with Loren, he can communicate, for the most part, like a woman, and he makes love like a man. When I met him, he was a very attractive woman. Now he’s an even more attractive man. And that’s that.”

Luis is a slightly built, gentle South American man, a chemist in Silicon Valley, thirty-five years old, single and bisexual, primarily involved with women.

“I was twenty-two when I went to Don Laub for my surgery,” Luis says. “It was the right thing for me — I can go to the gym, go swimming, and I don’t have to feel vulnerable or be afraid. I was always athletic, and I didn’t want to give that up. And it feels right for sex. What I perceive and what my partner perceives now match up. Inside and outside, I’m a man.

“The surgeries made a huge difference for me. I had the genital surgery, not the full phalloplasty. I don’t know what Dr. Laub calls the other one now, but that’s what I had. The easier one [the metoidioplasty]. I have days when I think about a phalloplasty, but I’d rather save my money, for travel, for my future, for investing. The gender issue isn’t at the center of my life.” He sighs.

“I don’t get the chance to talk about this, it’s not a conversation I’d have with other men. Gender is slippery. I used to see it as black and white — men, women, that’s it. I wanted to be perceived as male, in a male role, with male attributes. I don’t hold on to that anymore. Male, female — I don’t even understand that anymore. Now that I’ve been in a female body and in a male one and spent all this time thinking about this issue, I see that it’s nebulous. You can’t hold on to it and find meaning. Gender is an illusion, an illusion we cherish because we think we’ll ultimately find something clear and meaningful. And we don’t, we won’t. And I find, after all this, it doesn’t matter much.”

The four of us talk for two hours, and Loren and James cheerfully interrupt each other, disagreeing, raising their voices, picking holes in each other’s logic; Luis and I listen, and from time to time we point out the issues on which James and Loren do agree, which seems to matter to us but not to them.

They agree — they both know at first hand — that a number of transsexual men have emerged from the lesbian community, a world in which each of them could maneuver with some success but not with complete ease. “I was excluded from lesbian events even before I started the transition,” James says. “I was just too male — not butch but male. I crossed some line somehow, and everyone, the other women, felt that there were things about me, despite my female body, that were just not female.”

Loren, apparently irritated by James’s calm, even superior acquiescence to rejection by the community that was their world for so many years, adds, “The loss makes me mad, losing the women’s community. And the lack of acknowledgment. Transsexuals are never really accepted, by anyone.”

Luis says, very quietly, reluctant to antagonize the activists, “I’m not really very political. I take calculated risks, I do a little public speaking. I have a lot of other things I like to do and develop besides politics. My parents are apolitical, my whole family is. I’m not a separatist, of any kind. I find separatism ugly. I understand straight men at least as well as I understand gay women. I used to hate and fear men, at least all the ones I knew. Now I don’t. Probably you don’t have to become anatomically male to stop hating men.” He smiles. “But it is effective. I can now meet men that I can trust, I can care for.”

And his view of women?

“I was like a fly on the wall in my childhood world of girls. I grew up with girls, in their world, and I saw how they were treated. I didn’t feel like one of them, but I saw how women were disrespected, were diminished, and I haven’t forgotten that.”

We wind up talking about Virginia Woolf’s Orlando and weightlifting and fathers and children and photography. I like these men, and I know, whatever “knowing” means, that they’re men. I expected to find psychologically disturbed, male-identified women so filled with self-loathing that it had even spilled onto their physical selves, leading them to self-mutilating, self-punishing surgery. Maybe I would meet some very butch lesbians, in ties and jackets and chest binders, who could not, somehow, accept their female bodies. I didn’t meet those people. I met men. Some I liked, some I didn’t. I met bullshit artists, salesmen, computer programmers, compulsive, misogynistic seducers, pretty boys inviting seduction, cowboys, New Age prophets, good ol’ boys, shy truck drivers saving their money for a June wedding, and gentle knights. I met men.

Ira Pauly is one of the acknowledged titans of transsexual psychiatry. He is professor emeritus and former chairman of the department of psychiatry at the University of Nevada School of Medicine. In his bunkerlike office at the university, he cautions me that he hasn’t kept up with everything in the recent literature, which represents a huge body of work and new ideas. He says that he has met a few people who have had regrets after their surgery, but only a few, out of hundreds, and that whatever the etiology of transsexuality may be, there are those for whom surgery is the only true solution.

Pauly is a modest, very smart man with big hands and a UCLA plaque on his desk showing his college football history. He became chairman of the department of psychiatry partly on the strength of his pioneering research on transsexuals. He is always clear, reasonable, fair, and extremely contained. He showed strong feeling only once during our interview — when he talked about Louis Sullivan.

A female-to-male transsexual, Sullivan was also a gay man with AIDS, and he called Pauly in the late eighties in the hope of educating the professionals in the “gender community” about the difference between gender and sexual orientation: that a “real” man might prefer sex with men to sex with women; that the sexual object one prefers says nothing at all about one’s gender, or even about one’s masculinity or femininity. Sullivan encountered massive resistance, even from physicians and mental health professionals who regularly supervised and facilitated transsexual transitions. “But if you want to sleep with a man,” they said, in effect, “why not go on being a woman? It’s so easy.” As if only a nutty transsexual would believe that sex with a man, as a man, is different from sex with a man, as a woman.

In his search for treatment, Sullivan went to several gender dysphoria clinics (“gender dysphoria” meaning that the presenting complaint is one of deep unhappiness with one’s gender). For transsexuals, Ira Pauly told me, such clinics are the only gateways to reputable surgeons committed to meaningful standards of care: under the supervision of a clinic, the patient lives full-time as a member of the opposite sex for two years before surgery and receives documented treatment by a licensed mental health practitioner (the process recommended by the Harry Benjamin International Gender Dysphoria Association, an organization of gender dysphoria professionals — psychologists, social workers, psychiatrists, surgeons, endocrinologists, the occasional lawyer). Sullivan was rejected by the clinics because he not only knew that despite his female anatomy he was male, he knew that he was a gay male.

Pauly loaned me three hours of videotaped interviews he had conducted with Sullivan. The setup reminded me of public access TV: a ficus tree keeps brushing Sullivan’s ears, the carpeting clashes with the chairs, the camera occasionally seems stuck on the sock sliding down Ira Pauly’s bare shin or on Louis Sullivan’s pale hands fumbling with the mike. If you missed the sections on surgery and hormones, you would simply be moved by this increasingly gaunt, youngish, mild-mannered man so ferociously determined to make use of his AIDS death sentence to educate the rest of us.

“They said, ‘It can’t be,’ and I said, ‘It is,’ ” Sullivan says on one of the tapes. “They told me that I must not really be transsexual. After all, they thought, if I just wanted to sleep with men, why go to all the trouble? So, I told them. Again and again, until they got it.”

The notion that gender has a continuum, a fluid range of possibilities, seems to produce such anxious rigidity in many of us that we ignore everything we’ve learned through our own lives about the complexities of men and women, and seek refuge in explanations and expectations of gender that are more magical, romantic, and unrealistic than any attitude I encountered among the transsexuals I met. Ever since Christine Jorgensen, there seems to have been a lot of confusion about what now, thanks to Louis Sullivan, seems so unconfused to Ira Pauly and others in the field. Male is not gay or straight; it’s male. We may not know what it is, but we know it’s not about whether male or female sexual stimuli inspire your erection. Maybe it’s not even about the ability or the equipment to have an erection. Maybe it’s closer to the sensation of inner arousal pushed out — a sense of erectness, of intact outerness — than to the source or object of one’s erotic desires. There are gay men, heterosexual men, bisexual men, masculine men, feminine men. We know that neither the object of desire nor the drinking of beer nor the clenching of fists makes maleness. We don’t know what does, and neither do the transsexual men, and neither do the people who treat them, psychologically and surgically.

I ask Dr. Pauly, who has expressed caution about the usefulness of transsexual surgery — and even more caution about those psychiatrists who wish to have the surgery declared a problem rather than a solution — if he would recommend surgery if he had a transsexual child.

“I would hope not to have a transsexual child; that life is no easy thing, with or without the surgery. I hope that the follow-up studies support the studies we have now. I hope these patients are happier.”

I press him.

“I would probably try to intervene early in childhood. But you know, those studies of strongly effeminate boys — a lot of them grow up to be gay, but they don’t grow up to be transsexual. You’re looking at five in a hundred for male homosexuals, one in fifty thousand for transsexuals.”

In the end, after edging up on saying that he would advise surgery if he had a transsexual child, Dr. Pauly shrugs and nods yes but doesn’t say it, and I stop. There is some kind of gift in having been in both a male and a female body in one lifetime, but it is not a gift anyone wants for their child.

At Don Laub’s surgical center in Palo Alto, I stand in the doorway of the waiting room, observing two women in the courtyard, wondering if they are “genetically female,” and wondering if I can bring myself to ask such a rude question. But if I believe, as I now find myself believing, that transsexual men and women are men and women, what would make the question rude? The implication that something tipped me off, that their femininity was imperfect, that there was some trace of the masculine in their appearance? I have been noticing traces of the imperfect, traces of the other gender in people, for two days now, ever since I met with Lyle and Jessie and with the guys at James’s condo.

The person on the side of the courtyard nearest me is blond, pretty, curvy, lightly made up in suitable-for-blonds colors. Conservative navy dress, white trim. Suntan hose and navy pumps. Could be, I think. Good makeup, but maybe just a bit stereotypically feminine, maybe a little overboard. She gestures to her companion forcefully, and I think, Ah, those hands. Very strong, even at a distance. I look at the companion. Thin and angular, in loose black pants and a loose black-and-ivory shirt. No visible curves at all. Reddish wavy hair gathered back tightly from a long, shining, intense, and makeupless face. But the narrowness of the forehead, the size and shape and prominence of the eyes. I don’t think so. And she laughs, showing her braces, and I think, Can’t be. This red-haired person, although not particularly feminine or womanly, is a genetic female.

I go into the courtyard, and the blond calls my name and introduces herself: Dr. Gail Lebovic, Dr. Laub’s associate. She introduces me to Selena, a visiting medical student. We sit in the courtyard a while longer, waiting for Don Laub, and I watch for tall, big-handed women, short, wide-hipped men with scraggly facial hair. A broad-shouldered, potbellied woman with a bad dye job comes through the courtyard, bandy-legged and squat. The cleaning lady. Genetic female. There’s a slim, wispy-mustached young man in the corridor. Sean, the new office worker. Genetic male.

We are joined by Dr. Laub, graying and clean-shaven, utterly conventional and conservative in a dark-suited, reptie way, except for eyes so brightly intense they seem silver rather than blue-gray. He went to Jesuit schools, has been married forever to the same woman, and has five children, one of whom is a microsurgeon in Vermont, and one a registered nurse. He is also the founder of Interplast, a charitable organization that sends plastic surgeons to poor countries to provide free corrective surgery for children and adults. As of this writing, Laub’s center has done 798 female-to-male surgeries, most performed by Laub himself before he retired in 2001. Of that number, two female-to-male transsexuals asked to have their phalloplasties reversed and to return to female bodies. Although both reported that they were happy in their lives as men, they had become born-again Christians, and had been advised that their sex change surgeries were not God’s will.

Don Laub and Gail Lebovic show me some photograph albums of their female-to-male patients — dozens of head shots, before, during, and after hormone treatments. It begins to seem to me that what we take as the immutable biological fact of our existence is, after all, largely hormonal and unnervingly fluid. Many of the pictures of the same patient at various stages of his transformation look like family portraits — younger, middle, and eldest brother. The faces broaden; the foreheads slope forward and down more roughly to the eyebrows from receding hairlines; the necks and shoulders widen. Strength training is recommended for female-to-male transsexuals, to deal with the weight gain, but many of the men in the photographs are somewhere between stocky and fat. A few of them are handsome, more than a few are attractive, most are average. One guy looks like Don Ho, another looks like Don Knotts, another like Richard Gere. Some are homely, with bad skin, bad haircuts, cheap eyeglasses and overwashed shirts, ugly mustaches, pouchy eyes, jowly necks. But no one in his right mind would take them for women.

Lebovic clears her throat and shows me the other pictures. I’ve seen them before, the pictures Don Laub sent me of phalloplasties and metoidioplasties; I flipped through them at home and tried to study them, but they were black-and-white photocopies. The originals are in brutal, Polaroid-type color, in which brown skin has a dappled, froglike quality, and white skin has the sheen and color of bad pork.

Lebovic occasionally points out items of interest. “See, with this surgery”—the phalloplasty—“we keep the clitoris. Here, underneath, just above the scrotum, so when the penis is either rubbing against it or pulled out of the way, there’s full sexual response. Isn’t that great? We make the scrotum with the labia, by inserting skin expanders, just a little bit, week by week. After the skin has expanded, we insert the testicular implants, stitch it up the middle a bit, to create the look. Otherwise you just have one big ball, like this. Picture a small deflated balloon — that’s the expander. We put one in each labium, sew the labia together, and expand each compartment so it’s just like testicles. Then we put in the implants, just silicone balls.”

She describes the painful electrolysis of the abdominal area (all hair must be removed from the skin that will be used to make the phallus), and then the surgery. Two vertical incisions are made, three inches apart, stopping short of the navel. The surgeon lifts up the skin and soft tissue while it’s still attached at the ends, and rolls it up lengthwise into a tube. This inside-out tube is covered with a skin graft from the hip. The soft, skin-covered tube is still attached in two places, at the navel and the bikini line, and will be left that way, a pulsing hot dog growing on the abdominal field, for at least three months, so that it will develop its own blood supply. The second stage requires detaching the tube at the navel end and allowing the newly developed phallus to drop down. Function, of course, in the form of urination and ejaculation, is another matter. Urination through the phallus can be arranged, but the production and ejaculation of sperm is not yet possible.

The photograph Don Laub shows me next must be a picture of something gone wrong. Underneath the penis is a huge, brownish, fuzzy red ball, a little bigger than a tennis ball. Nothing wrong, Lebovic says a little dubiously, it must just be a fresh post-op. Laub reassures me later that there wasn’t anything wrong in the case, just something a little unusual.

“This was a very macho Mexican guy, and he felt that he really needed it — them — to be big, so I expanded the labia way out so the scrotum would hang properly large.”

We come to some terrible pictures. These are of men, genetic men, who’ve had penises created after disease or trauma. “Burn, cancer, tree shredder,” Lebovic says gently.

Next we look at an album of various completed phalloplasties, which is much easier than looking at the squirming reds and yellows and acres of flaccid, anesthetized skin in the surgical procedures used to construct them. The penises here are long, blobby tubes with no real heads, no color.

“These are the early ones,” Lebovic says. “You see the shape is not so great. And of course, Dr. Laub was making them huge. I mean, really.” She shows me a photograph with a ruler held up to the penis. I’m reluctant to lean closer to read the number of inches. “Nine,” she says, laughing. “Well, Dr. Laub is a guy. I guess he figured that if you want one, you may as well get a big one. Now they’re a little closer to average. And there’s no erectile tissue, so you wouldn’t want it too small.”

The penises are starting to look more familiar, more penis-like. I’m getting used to the black, hard-looking stitches. The guys in the photo album are predominantly white, but transsexuals come in every ethnic and racial group.

On to the metoidioplasties — a surgery sometimes called clitoral release. These penises look, just as Laub’s articles say they do, like the penises of small boys, or like “what you’d see in a men’s locker room on a chilly day,” as he writes. “I don’t really understand why anyone has this surgery,” Lebovic says. “I mean, if you’re going to have a penis …”

She flips back to the first photo album and points to a WASPy middle-aged businessman with the silver flattop I associate with California Rotarians.

“He was my first. I had just come over from Stanford to spend time with Dr. Laub. Reconstructive breast surgery was my strong interest, and he’s incredibly good at that. He says to me, ‘How do you feel about working with transsexuals?’ And I said, ‘Oh, fine.’ Because I had no idea — I went to Berkeley, I figure I’m open-minded, it’ll be all right. Dr. Laub points me to one of the examining rooms, and I go in and find a middle-aged couple. I don’t even know who the patient is, but I look at the chart and I see it’s him. I ask him how he’s doing, he says, ‘Not too bad,’ and I’m trying to make an educated guess, to figure out what’s wrong, what kind of cosmetic surgery he’s here for. Finally I ask him, ‘Have you had any previous surgeries?’ and he says, ‘Why, yes, the double mastectomy and the hysterectomy.’ And I thought, But you’re a man. People outside the field always say, ‘He, she, whatever,’ in that tone of voice, you know the tone I mean. But that question never arises once you meet them, once you open yourself up to the danger.”

What danger?

“The danger of questioning everything we take for granted. The danger of questioning yourself.”

I arrange to meet Don Laub again in New York City, at the Harry Benjamin International Gender Dysphoria Symposium. Harry Benjamin came from Germany in 1913 to do his residency in endocrinology; he stayed in America and began a private practice, pursuing his fascination with the aging process and the study of glands. Alfred Kinsey, wanting an endocrinological assessment of a puzzling young man, sent Benjamin his first transsexual patient, in 1948, and changed the focus of Benjamin’s career. In 1966, Benjamin published The Transsexual Phenomenon, still widely used as a reference. He was, by all reports, the most lovable of men. He retired at ninety and died in 1986 at a hundred and one.

I haven’t yet understood the mechanics of all the intricate surgical procedures, and at my request Laub is going to explain them to me again. The conference is being held at the Marriott Marquis Hotel, and we sit down at a little table in a corridor that also functions as a lounge. Laub demonstrates the various genital surgeries for female-to-male transsexuals on lined yellow paper, using his pen point as a scalpel.

The four options are the basic phalloplasty, with external devices for erection and urination; two deluxe models, both of which provide the capacity to urinate in the typical male position (one also affords some physical sensation); and the metoidioplasty. All four are major surgeries, with more than one step. Mastectomies almost always precede the genital surgeries, which include hysterectomies and testicular implants.

Before long, Laub and I are surrounded by large and small yellow penises and one Red Grooms — style paper sculpture, with which Laub has walked me through three stages of the deluxe phalloplasty that includes the removal of a nerve from the forearm and its placement within the newly created phallus, running from the glans of the new penis to the nerves of the still existing clitoris and allowing a full range of sensation.

“I call this the postmodern one. Like those buildings over there.” He waves vaguely toward the newer architecture of Times Square.

I’ve heard transsexual patients and others — especially Stanley Biber, the grandfather-king of male-to-female surgery — talk about the horrifying scarring of the forearm when the skin and nerve are used to make the tube for the phallus. Laub shows me just how much of the forearm is taken for the standard flap, and I cringe as he runs his pen over most of the underside of my arm.

“I don’t do the standard flap. The goal is always, in surgery, the least ‘expensive,’ meaning least traumatic, donor site.” He describes stretching the thin, hairless skin of the forearm with tissue expanders so that when the skin and nerve and an artery are removed there’s only a thin incision, nothing worse. “It’s less than two inches across,” he assures me, “and then you’ve got urinary function and sensitivity. I got tired of other people making presentations, and showing the basic phalloplasty with the baculum [one of the devices used to maintain erections] and the urinary assist device, and saying, ‘Well, here’s the traditional method, as used by Don Laub.’ That’s still the one most patients choose. It’s functional, it’s much less expensive, in both senses, and you don’t burn any bridges. I’ve done about a hundred and fifty of those. A hundred and forty-eight. You can always go back and reconstruct at a later date.”

Including the mastectomy, the whole procedure for the basic sex change surgery costs twenty thousand dollars; if your insurance company is persuaded that you truly have the psychiatric disorder of transsexualism, for which surgery is a necessary part of the treatment, you might get reimbursement from them — after you’ve agreed to go through life with an official diagnosis probably comparable in many people’s minds to necrophilia. The prices at Laub’s surgical center haven’t gone up for years, and are a little lower than those of some other surgeons, including many who are still learning the techniques.

“This other kind of phalloplasty, which allows for natural, unassisted urination, calls for a year of electrolysis in a very sensitive place, the pubic region and lower stomach. And sometimes even then the hair grows back. But you see”—he quickly makes an incision in the paper and rolls up the tube—“you can’t have urination through the tunnel if there’s hair. The skin has to be hairless, so you either have to find hairless skin”—he taps my forearm—“or make it.”

He draws a long spoon. “With the first kind of phalloplasty, the one I’ve done the most often, this [urinary assist] device is what they use. You slip it in from the meatus [the opening for urination] right through the phallus. It’s very soft, flexible plastic. And after all, in men’s bathrooms, men are like this.” Don Laub stands up, hand placed over his belt buckle, and stares ahead with slight trepidation. His eyes dart from left to right and then fasten on the opposite wall. “The norm is not to look. With peripheral vision, all they’re going to see is some guy fumbling with his shorts and then urinating. That’s all. It works.

“Now, the metoidioplasty — it’s from meta, meaning ‘toward,’ oidio, for the male genitals, and plasty, ‘change.’ ” He draws and dissects another set of female genitalia, carving out a small penis and folding over the lips of the labia majora to make a very neat, actually rather cute scrotum. “I don’t think the patients really prefer this — I mean, if money were no object. Maybe some, some who are not such high-intensity transsexuals. Sometimes their wives don’t want the penises — they’ve been married eight, ten years, and I’m showing them the choices. I sit there like an encyclopedia salesman, showing them the different models, and maybe the wife says, ‘We want the metoidioplasty.’ And the husband says, ‘We do? I don’t think so, honey. I want the phalloplasty.’ And that relationship is in trouble. Because, for the most part — again, if money’s no object and this is a younger man — he wants a penis. Men want penises. But the metoidioplasty mimics nature, and that’s appealing. The testosterone enlarges the clitoris. It’s the way men and women both are in utero — an enlarged clitoris, which does or doesn’t become a penis. And it’s one-stage surgery, less expensive than the other, and obviously sexual and urinary functioning is intact and they can go on having sex however they had it. Like lesbians do.”

“You mean sex without intercourse? That’s all that they don’t get, right? No penile penetration.”

Laub pauses. “Well, yes. It’s only about an inch and a half, maybe two inches. So they can go on having the kind of sex they had before. Dildos, whatever.”

Laub next describes the four different devices that allow the men to have erections (a minority of those who have the forearm flap surgery won’t even need a device). The devices fall into two categories: pumps and inserts. One pump, the most discreet, is small, ball-like, and implanted in the scrotum. When activated, it pumps fluid from inside the ball into the penis, which remains erect for about ten minutes. There is also a syringelike external pump, which is attached to a condom. When activated, the pump evacuates the air from the hollow tube of the penis, forming a vacuum within it and hardening the outer casing—“like making Styrofoam,” Laub says. Of the two inserts, one is permanent, and the other is used only as needed. Laub is wary of the permanent implant, a woven silver-wire tube within a silicone sheath, which gives the penis some rigidity, whether pointed up or down. “It’s dangerous to have implants where you have no feeling,” Laub says. He recommends the baculum, slightly thicker than a ballpoint pen, coated with Teflon, and tailor-made, rather inexpensively, for each patient. It is inserted before intercourse, extends from the tip of the penis back to the clitoris, and allows for tireless intercourse and full sensation from the pressure on the clitoris, now located above the scrotum.

Laub is more comfortable with the men who choose penises and intercourse and who have clear-cut, easily identifiable heterosexual preferences, but he not only does the metoidioplasties, he does them extremely well and teaches other surgeons to do them. Still, as is so commonly the case in the medical world, the doctors and the patients involved in these procedures often understand their relationships in radically different ways. The doctors are trained to believe that they know, not only how, but also what and why and for whom. Patients, whether they have breast cancer or AIDS or colds, often want to be active partners in a treatment process marked by dialogue and exploration. At worst, patients see doctors as arrogant technicians; doctors see patients as self-endangering fools. Many of the men I interviewed preferred metoidioplasties, but never for the reasons offered in the literature or by the surgeons. The gender professionals say that patients choose metoidioplasties because they’re older and don’t want to go through the more complicated surgery, or because they have other medical conditions that contraindicate surgery, or because they were lesbians before transition and their partners don’t like the idea of sex with a man (as though if your partner had a beard, a deep voice, and no breasts, you would think you were in bed with a woman). But every transsexual man I spoke to who’d chosen metoidioplasty said, in essence, “I don’t need a big, expensive penis; this little one does just fine, and I can use the money to enhance my life.” It was like interviewing a bunch of proud and content but slightly bewildered Volkswagen owners and, across town, some slightly miffed and equally bewildered Mercedes dealers.

James Green said, “I chose this because, well, I don’t really feel the need for a big one and I like having the range of feeling I always did. This form of sexual pleasure is fine for me and for my girlfriend. And the other costs a lot of money. A lot of money.”

Loren Cameron said, “It’s not all or nothing. I can live this way, as a man with a vagina. If I could get a fully functioning penis, I’d have the surgery. But I’m not prepared to go through more surgery, all of these procedures, to wind up with a pair of plastic testicles and not much more. I know who I am.”

I don’t think the idea of a man choosing to keep his vagina would make sense to Don Laub, although Loren would never find a more skillful or compassionate surgeon.

During the Harry Benjamin symposium, I talk to other doctors besides Laub, and to psychologists, psychiatrists, even psychoanalysts, people who collectively have worked with a thousand transsexuals and their families, in the United States and in northern Europe. Among them is Dr. Leah Schaefer, who is a psychologist, a genetic female, and a past president of the Harry Benjamin Association, and has treated hundreds of people like Loren, James, Luis, and Lyle. She is small and rounded, the right kind of Mittel-europa figure for full skirts, big belts, and a lace fichu at the neck. We meet at her Manhattan office, which is in her home and is itself homey, haimish—dried flowers, ceramic birds, carved boxes, family photographs, and a little sculpture of an Orthodox Jewish man studying Torah. I didn’t expect the mezuzah on the doorway, or that she would have spent twelve years singing professionally, or that we would end up talking about her closetful of shoes, talking with the same shared enthusiasm and tenderness you hear in the voices of boat enthusiasts, golfers, and transsexuals comparing surgical work.

“There are probably more than five thousand postoperative transsexuals in the United States now. You have small-town surgeons setting up shop just like the well-known ones, the ones with years of training. I’ve seen over five hundred people, but no researchers have ever interviewed me or asked for my statistics when they’re gathering information. There’s not a good statistics bank here in America. I’m afraid I don’t know where people get their numbers.”

Later, she brightens when she thinks of “a very wonderful scientist” to tell me about.

“Friedemann Pfafflin’s everything — an M.D., a psychoanalyst, a practicing clinician. He has a better vantage point than a lot of researchers. He’s just wonderful.”

And he’s in New York, it happens, attending the symposium. The first thing on Dr. Pfafflin’s mind when I meet with him and Peggy Cohen-Kettenis, a Dutch clinical psychologist who knows him well and has suggested a joint interview, is where he can smoke.

“It’s amazing,” he says. “In America I don’t feel like a smoker, I feel like a murderer.”

I assure him that I don’t mind smoking, and we go to my hotel room, but he doesn’t smoke there either, because there are no ashtrays.

Dr. Pfafflin absolutely knows where he gets his numbers. He doesn’t seem to think much of American record-keeping, but he has found the data banks in Germany, the Netherlands, Australia, and Sweden to be reliable, and has been doing research and follow-up studies for the last twenty years. He shows me two studies. The first is based on the Bem Sex Role Inventory, a psychological test, oriented differently for men and women, to assess feelings of masculinity and femininity; one of its underlying assumptions is that a mix of masculine and feminine is normal and healthy in both males and females. The study compares female-to-male (FTM) transsexuals, before and after hormonal and/or surgical treatment, with “normal”—that is, genetic — females. The transsexuals test out as high masculine/low feminine before the treatment, and afterward as well-adjusted men who accept their feminine side.

The second study, based on a German psychological test similar to the Minnesota Multiphasic Personality Inventory (a psychological personality evaluation widely used in the gender dysphoria clinics here), has even broader implications. The FTM transsexuals are compared with normal men and with normal women, and I don’t need to read German to understand the charts: they are as clear as cartoons. The good-sized gray bar down the middle is normal men on page one, normal women on page two; green lines that run in and out of the gray bars are the untreated transsexuals, and red lines that run square in the center of the male page and close to the middle on the female page are the post-op transsexuals. “They are completely in the normal range, psychologically, for men, after treatment,” Pfafflin says, running his finger up and down the gray bar. “Even before treatment, they are not so off the norm for women” (which suggests, unpleasantly, that the norm for women contains a fair amount of depression and low self-esteem). Pfafflin also mentions other clinical and research studies showing no unusual levels of psychopathology in the families of transsexual teenagers or in the adolescents themselves.

Neither Pfafflin nor Cohen-Kettenis appears to be particularly impressed by the surgeons in their field. Cohen-Kettenis, consistently more tactful, shrugs slightly when I ask about the exchange of ideas between the surgeons and the mental health people here at the conference. Pfafflin laughs. “Well, they are naïve, like children. They love to build. I will build a little clitoris, I will build a little penis.”

Cohen-Kettenis smiles. “Not a little penis. Only big ones.”

Although they attend the surgeons’ presentations (ten to twenty minutes of endless, blurring slides of penises and vaginas and recontoured chests and abdominal flaps and forearm donor sites and Y-shaped incisions), they don’t expect the surgeons to attend the psychological presentations. Laub has told me that the surgeons do. He does.

Cohen-Kettenis says, “We need to know about the surgery for our patients, to provide information. The surgeons don’t need to know what we do, or think.”

“And they wouldn’t understand,” Pfafflin says, and then corrects himself, perhaps remembering that his colleagues might read this. “Some of them wouldn’t. Anyway, they have their psychologists and so on screening the patients for them, so they don’t need to know.”

When I find Don Laub again, in a meeting room filled with energetic, well-dressed men and women whose genetic origins are impossible to know, I ask him about the root of high-intensity transsexuality, the kind for which surgery seems to be the only solution. “I believe it’s biological and behavioral,” he says. “A behavioral problem with a surgical solution. There have been a number of experiments, corroborated over and over, at Wisconsin, at Oregon, at Stanford. They injected lab mammals — cats, rats, dogs, and monkeys — with opposite-sex hormones shortly before birth. And that was it. No matter what kind of conditioning you used on those mammals, they behaved consistently like the opposite sex, like the gender of the hormone with which they were injected. And I think that that’s what we’ll find, eventually: a biological answer.

“Of course, we’re the true believers here. We know we’re right. I’ve been doing Interplast for years now, and it’s taken off, people understand, they give money to it. But with this, with gender dysphoria, people still don’t get it, they don’t accept it. For twenty-five years I’ve been doing this work, and the only people who really understand it are all at this meeting. Or they’re the patients. When plastic surgeons begin doing this work, a lot of them just see the technical challenge, the professional opportunity. They dislike the whole idea of transsexuals, but they’re fascinated by the challenge. But when they meet the patients, they change — they become more empathetic. They see the people and they are forever changed.

“You know, this is the ultimate body-image surgery. And if people are fundamentally at peace with themselves, like any other cosmetic surgery, they’re likely to have a good outcome. I’ve learned from my gender patients: I screen my cosmetic patients better now. A forty-five-year-old woman with small breasts, whose real agenda is to have breast augmentation because her husband works for an international corporation and when he’s on the road he takes out every big-busted lady he can find — she’s not a good candidate. After she’s happy, after she’s worked out her marriage, then she’s a good candidate, if that’s what she wants. These gender patients, they cross-live, they have therapy, they’re evaluated over and over. By the time they have the surgery, they’re successful economically, socially, psychologically, usually sexually too. Those are good candidates for plastic surgery. And that’s how the other patients should be too, but we don’t usually do that kind of screening, we don’t expect it of the patient or of the surgeon.”

I ask Laub what developments he anticipates in his field.

“The future has three parts,” he says. “FTM surgery’s going to improve, aesthetically and in other ways. I learned something here at the conference. I’m going to start doing it right away. They showed how to construct the glans, how to build up a corona. I’ll start doing that. And they tattoo a pinkish color onto the head — that helps too. I’m going to do that. And in the future there might be transplants, if we can figure out how to reduce rejection. I don’t think the government will fund penis transplants, but we’ll try to persuade it to. And there’s the chemical approach, trying to prevent problems, handling tissue receptors differently, correcting. And then we come back to surgery, and we keep trying to make it better. Because that’s what the patients need, and that’s what we strive for: the best anatomical solution to the problem, since the problem has no other solution.”

Until fairly recently, pragmatic, solution-oriented approaches like Don Laub’s were anathema to clinical theorists, whose diagnoses and suggestions for treatment focused primarily on male-to-female transsexuals and on the inevitable opinions about preexisting family pathology. Absent fathers, overinvolved mothers — that was the traditional psychoanalytic explanation for male homosexuality, and for transsexuality as well, though some clinicians have taken the opposite view: dominant fathers, submissive mothers. The other two major psychological theories are that parents of transsexuals encourage cross-gender identification and play, and that parents of transsexuals strongly discourage cross-gender identification and play. That about covers it. I can’t imagine that with the dominant and absent fathers, the passive and active mothers, and the encouraging and discouraging of cross-gender behaviors, we’ve left out too many American families (except the single parents, and they have their own problems). According to these theories, there should be millions of transsexuals in America alone, and McSurgery centers in every good-sized town.

No one cares at all about theory at what I’ll call the American Fantasia conference. It’s a big get-together of crossdressing men and their wives and a smaller group of transsexual men and women and their partners, held behind a homemade curtain of pink tablecloths, down the most remote corridor of a smallish motel in a Southern suburb.

American Fantasia is organized by a man whose name I can’t use: although many at the gathering know that he’s transsexual, his neighbors don’t, his colleagues don’t, the psychiatrists and psychologists and social workers to whom he regularly lectures on transsexuality don’t. I don’t know either, until he tells me, halfway through the interview. In his earnest, slightly old-fashioned suit, with his tidy hair and beard, he looks like a behavioral psychologist or a very effective insurance salesman. He has a deep, manly chuckle that gets on my nerves, especially when it punctuates his belittling remarks about male-to-female crossdressers and the amusement with which female-to-male transsexuals regard them. I’m annoyed until I realize, with surprise, that he’s just another courtly, charming Southern man whose notion of appropriate physical distance is somewhat narrower than my own — a nice man who doesn’t really like women (the ladies, God bless ’em).

I’m at ease with most of these men, though, even when they compare handiwork, after a presentation by one of the plastic surgeons, and the guys who are most pleased with their mastectomies begin lifting their shirts. It’s like being in a room full of cardiac surgery survivors; everyone is telling stories, wagging fingers, showing what his doctor did for him. I see the scars from a distance, but it seems that the men wouldn’t mind if I got closer. I take my cue from Aaron, a transsexual man in his late forties, enough like Joe Pesci to be his shorter, Southern brother. Aaron is taking photographs for his newsletter for ReCast, a nonprofit organization that provides information, referrals, and support for FTM transsexuals, and he is acting as my guide. When I am speechless, he acts as my interpreter.

One guy whose chest Aaron and I study looks like a blond sailor from the cover of a 1946 Life magazine. “It takes about three years for the body to settle down,” this guy says, and as he rolls up his T-shirt to show the incision lines, tan and thickly ridged against his muscular torso, another man, middle-aged and narrow-chested, moves his tie and shyly opens his white shirt and shows me the incision marks around his nipples. I see, as I have never properly noticed, that the male chest, from nipple to collarbone, is configured completely differently from the female.

I’m cold, but Aaron unbuttons his cuffs. “Look around you,” he says. All the guys have loosened their ties and rolled up their shirtsleeves. “Testosterone heats up the system. We’re all comfortable, but you’re gonna freeze your butt off.”

After the conference, Aaron provides introductions to some wives and significant others. The first one I talk to is Aaron’s girlfriend.

Samantha, forty-two, met Aaron through a personal ad. “I had dated women, and I had a bad dating experience with a genetic man, so I was looking at the personals: gay, straight, and alternative. And this was alternative. I didn’t have to go through the anguish of his transition — I just met this man. And although I wasn’t attracted to him physically right away, I was very attracted to his energy and his vigor. That testosterone, it’s really something.

“I thought it would be very different from being with a genetic man, but it turns out to be not so different after all. There’s nothing female about him. Sometimes I wish there was … just a little more female style in him. I said to my friend Mitzi that men are all wrapped up with their cocks, whether they have them or not. It’s still all testosterone and power and having balls, one way or another.”

Bridget is the journalist who became James Green’s girlfriend.

“I thought, as a feminist, This is horrible — these are crazy women, self-hating women who find these unscrupulous, misogynistic surgeons to lop off their breasts. I had met a few of these guys, and I had read a few books by feminists on the subject. Transsexuals seemed pretty wacky.

“But after two hours with Jamie, I was very attracted, and I think I fell in love with him the next day. I went for a walk and began fantasizing about him sexually. I had asked him, for the article, to show me the surgery, and we were both embarrassed, we laughed, but he showed me. And my first, my spontaneous response to what I saw was, ‘Oh, that’s so cute!’ And it was. I have friends — straight friends — who think I’ve given up something important because he doesn’t have a regular penis. It wasn’t a loss to me. We have a lot more variety. We make love to each other, after all, not to organs.”

Her tone of fond reminiscence, the affection she holds not only for the lover but for the joy the lover has given, frays, and her voice tightens to a sharp New York buzz. “I saw him as a combination of female and male, and he was sane and he was a feminist … sort of. I thought, I’m tired of men, I’m tired of women, here’s someone completely new. But now we’re dealing with the same old man-woman thing, like with any other man. And we’re struggling. Suddenly, I can totally relate to my friend who has been complaining about her husband for years.

“I’m convinced — I know otherwise, but I’m convinced — that he was never really a woman.”

Lucy Davis, widowed after eighteen years of marriage and with two teenagers, thinks that meeting Forrest was her destiny. She saw Forrest’s name on the patient roster at the hospital where she’s a social worker, and the name struck her, although she couldn’t imagine why. “I just knew that I would know this man. I finally met him two years later in a store. He flirted with me, I recognized his name, and I knew he was the one.” After they dated for a while, he told her about his surgery. “He told me with his eyes closed, he couldn’t look at me. And when he opened them, he said, ‘You’re still here?’ And I said that it wasn’t a problem. We’ve been together ever since 1982.”

Forrest is an editor, and no one in New Hampshire, not his in-laws, not his stepchildren, certainly not his colleagues and neighbors or the guys on his softball team, knows. “We’re pretty paranoid here in the closet,” Lucy says. “Otherwise we’re like all other heterosexual couples, up and down over the years. I can live with his body and his scars. He always says he has a cock, it’s just a little bit smaller than other guys’. That testosterone, you know. I never had a lesbian relationship, and I still haven’t had one. I like guys. I love this one.”

Michael is the pseudonym he has asked me to use for him, and I cannot describe his comfortable home or the company he runs. He does not go to events like American Fantasia. His former therapist contacted him, and he agreed to talk with me on neutral ground, at a friend’s apartment. We’re meeting in the late morning, and I buy three sandwiches, a dozen cookies, and two kinds of soda at a fancy deli, but he doesn’t eat. He is a serious, dark-skinned black man dressed in corporate casual for a Saturday with his relatives, whom he announces he plans to join before too long. I take him for thirty-eight or so, but he is ten years older than that. (I don’t know if I have just never noticed that men usually look younger than women their age, or if it’s something in the skin of these particular men — some vestige of former female smoothness — or if it’s having had a second, hormonally powerful adolescence later in life, but all the transsexual men look to me at least five years younger than they are.) After two hours, Michael is less nervous than when we began, but he is never relaxed. About half an hour before he leaves, he takes a cookie and a sip of club soda.

“I grew up in a nice, materially comfortable middle-class life. But. I carried a deep, dark secret around with me. I was pretty strange anyway. I was not an easy child to raise — my mother had her times with me. I believed that my feelings mattered, even though I was a child. I was an offensive child. I would not be taken advantage of, I would not be ordered about. I was just a short person, but a person. I know a kid just like that now. Completely obnoxious. I love him.

“I hate to sound like Mario Thomas, but I just wanted to be free to be me, whatever that was. And I didn’t know, although I kept going to the library, trying to find out. Until I was six, I was a happy child. Boy games, boy clothes, even a little girlfriend up the street. And after going off to school, horrified that I had to go in what felt like drag, sure that everyone would laugh at me, I knew that I’d better get used to it, because this body was not becoming male and it clearly made a difference to the world. I tried to do what I was supposed to in adolescence, tried to be the Last Lady, like my mother and my sisters, which I did pretty well. I didn’t even bother trying to be a tomboy, it would have been absurd by then. My breasts were huge — they were ridiculous, size 46 double Z. But Joan of Arc did it for me, explained me to me, when I encountered her in school at the age of nine. I thought, Well, here we go, and when I was twelve, finally, I found a book on transsexuals.

“After graduate school,” Michael continues, shaking his head over another five wasted years, “I thought, Well, maybe I’m a lesbian. Could be — I know I’m attracted to women. I went to consciousness-raising meetings, and I’d listen and feel like a fraud. One girl said, ‘What makes each of us feel like a real woman?’ and while they went around the room answering, I thought, Nothing. Absolutely nothing on earth makes me feel like a woman.

“I’m just a plain old heterosexual man, and I didn’t want to spend my life having relationships with women who had never, ever been with a woman before and didn’t know why they were attracted to me. I wanted a life. I’m not a professional transsexual. I don’t think of myself as transsexual anymore. I was one, I made that transition, now I’m just a man.”

Michael says, “Let me tell you about my terminally polite family.” And although he himself borders on the terminally polite, he tells me funny, sad, outrageous family stories, the kind we all use to entertain company, deflect sympathy, and connect without too much feeling. His father, born early enough in this century to have heard stories of slavery from his father, always told Michael that he was entitled to be happy, and that God would not have put such an unusual child on this earth without purpose.

“He said to me, ‘You’re not the first freak in the family, and you’re not likely to be the last.’ My poor mother. I’m dead to her. We see each other, we love each other, but the loss of her daughter was terrible. And I feel her pain. But I couldn’t do otherwise. I know she would have preferred the husband, the kids, the house, and the Valium, but I couldn’t. The first time someone suggested I might want to kiss a man, I thought, Don’t be ridiculous.”

At funerals and weddings, the old folks who had known Michael before puberty as a tough little girl nicknamed Butch were comfortable with him. And the young kids would call him over to their table at the party and brag to their friends, “Go on, Uncle Mike. Tell them how you used to be a girl. Tell them.” One elderly uncle approached him at a funeral. “So, you’re a man now. Well, well. How you doin’? How’s your health?” And when Michael said that his health was fine, thank you, the old man sat him down for twenty minutes so they could talk about his rheumatism.

“They figured I had my health, I had a job, God bless me. My aunt figured my mother needed a strong man to lean on, so God sent me. Indirectly, of course. I keep my blinders on, they serve me. I kept not receiving family wedding invitations, and I was so dense I’d call and say, ‘Where’s my invitation?’ And since in my terminally polite family there’s no way you could tell someone they weren’t invited, I kept showing up. After I found myself seated with the unemployed third cousin and his trashy girlfriend, I knew I wasn’t wanted and I kept thinking, Why didn’t they say so? But they couldn’t say so, and I finally figured it out.”

“And did you keep going anyway?”

“Hell, no.” He sits back and opens his tight hands. He makes himself smile, and his dimples show. “I was born black. I don’t expect people to like me, to accept me. Some transsexuals, especially the white MTFs, they’re in shock after the transition. Loss of privilege, loss of status — they think people should be thrilled to work side by side with them. Well, people do not go to work in mainstream America hoping for an educational experience. I didn’t expect anyone to be happy to see me — I just expected, I demanded, a little tolerance. Hell, I transitioned on the job. I didn’t even tell people what was going on. You remember I said I was an offensive child? A friend of mine said, ‘Uh, don’t you think you ought to say something? People want to know.’ And I said, ‘Let ’em ask.’ The transition was hard, but once I was completely male, people relaxed.

“I’m the same personality — a little more visually responsive erotically, maybe a little more aggressive, but I was always aggressive. You know what’s different? I have a toolbox. My whole life, I never thought about one, I’m not a big fixer. But now, every once in a while, I find myself buying another wrench, or one of those very small screwdrivers. That’s different.

“I’m prepared to make my own way. And I am. I’ve been fortunate — I’ve been loved, I’ve been married, I’m not an addict, not unemployed, not dysfunctional. I’m a decent person, I’m not ashamed. I don’t know why this condition chose me. We, people who have been through this transition — we are among the few people in the world who have overcome obstacles and fulfilled their lifelong dreams. All these obstacles, and I am who I dreamed I’d be, who I wanted to be. I’ll marry again, I’m going ahead with an adoption as a single man, my work’s going well. I’m damned fortunate.”