Mercedes Allen

'Sorry' Is Not the Non-Operative Word

Filed By Mercedes Allen | June 12, 2013 2:30 PM | comments

Filed in: Living, Transgender & Intersex
Tags: gender identity, GRS, non-op, non-operative, SRS, surgery, trans, transsexual, transsexualism, transsexuality

When it comes to genital reassignment, the non-operative word among trans people should not be "sorry."

That's not a very popular statement in transsexual communities. But as much as I don't like "rules" for being trans, I have arrived at one guideline:

Do as much or as little as you need to achieve the peace that you need.

It's not quite that clear and simple, of course, especially given the pressures to conform and integrate as either male or female, which have been idealized as binary opposites in society. Trans -- that is to say, both transitioning from one sex to another and/or living between genders -- challenges those absolutes, but it's also a lot to ask, for someone to remain a life-long challenge to society. And phrasing it as a "pressure to conform" oversimplifies something that also includes fears about going swimming or to public places of semi-nudity, going through airport scanners and traveling internationally, being in sex-segregated spaces like homeless shelters or correctional facilities, or the possibility of being challenged in a public restroom.

transgender_symbol.jpgRelationships can also factor into the equation. Genital reassignment surgery is inevitably going to change a dynamic within intimate relationships, and raise questions about our sexualities and those of our partners. While the decision for or against GRS shouldn't be dictated or coerced by our partners, when we love someone, it's inevitably going to be on our minds. Some individuals will be able to consider foregoing surgery as an act of love and sacrifice, while for others it would be far too much to ask. We'll see why shortly.

The lines are further blurred by the fact that we live in a nation where our enfranchisement in society is largely determined by our identity documents. Here in Canada, only the province of Ontario allows one's birth certificate to be changed without multiple verifications of surgery; in many provinces, the same is true of lesser documents like driver's licenses. While our Social Insurance card does not display a gender marker, potential employers can run an S.I.N. check which displays a gender marker in the resulting report -- and that, too, cannot be changed without a new or amended birth certificate. If a trans person's ID is incongruent, it potentially exposes them to harm and/or discrimination when they're carded, when they try to access services, and at many other stages of life and work.

At no other time is any person's enfranchisement in society dependent on them having surgery. But because that is the status quo for trans people in Canada and most parts of the U.S., it remains a major concern for the time being.

Medical issues can also be factors affecting whether or not one can obtain surgery. This might take the form of a serious health condition that precludes undergoing other procedures (some of these -- such as diabetes or HIV -- can be worked around by finding surgeons with better hospital access, but other conditions can be completely prohibitive). It might also refer to fear of undergoing a major invasive surgery, an aversion to the medical process overall, a desire to wait until techniques improve, or living in a province where GRS is not funded and being unable to afford it. Occasionally, health care funding is an influence for GRS, such as situations where vaginoplasty or phalloplasty are funded by insurance while orchiectomy, metoidioplasty or other options are not.

But for the moment, let's put all of these things -- health, cost, relationships, social pressures, legal identification and enfranchisement -- aside. In an ideal world, the decision to have surgery should hinge on an individual's needs and the advice of their doctor.

This may seem a little confusing for people who have read my writing about surgery being a medical necessity. I still maintain that its availability is, and that when surgery is necessary for an individual, it is an absolute necessity. Relationships and legal enfranchisement obviously underscore this need, and there is also an economic benefit to resolving gender identity conflicts, so that a person is better able to function and be productive. But it's also important to remember what GRS is designed to do: alleviate distress.

Gender dysphoria encompasses a number of aspects: body dysphoria (in which genital configuration causes anxiety, revulsion, discomfort, or unease), social dysphoria (in which the social dynamic that we experience with people is ill-fitting), and self-identification (the inner core of who we are and the face we need to present to the world). Each of those can vary in degree, and trans individuals can experience emotional, psychological and/or physical distress and anxiety about their body. Living as the gender we identify with will often alleviate the social and self-identification conflicts; only surgery addresses the body dysphoria.

Body dysphoria is not always a conscious thing, but can be experienced as a discomfort or aversion to the genitalia, or a sense that those parts are out of place and don't make sense to be there. At its most extreme, this aversion can become violent, driving a person toward self-harm or self-destructive behaviour. For people who experience it less severely, it can be a discomfort toward sexual intimacy in general, or a feeling of being out of place without knowing why. Obviously, in these situations it makes sense to align the body with who a person understands that they need to be. At the lower end, the stress may not be as urgent, although a sense of closure might still be needed.

Not everyone experiences this. Sometimes transition alone -- without surgery -- is enough to resolve a person's dysphoria, while other factors pose more significant reasons not to have surgery.

bigstock-Human-Gender-Icons-30597875.jpgNon-operative trans women are sometimes considered button-pushing because they challenge the traditional trans narrative (there is often an exception made for trans men because of the limitations of phalloplasty and metoidioplasty procedures), in the same way that some bisexual people are unfairly seen as a challenge to the "born this way" narrative of sexual orientation. The idea that we are fixing a predominantly medical condition seems undermined by the existence of people who don't want to completely "fix" their bodies through surgery. And yet, individuals exist who genuinely need to transition and live as their identified sex, but don't urgently need or want GRS.

In transsexual culture, there's a school of thought that believes that all roads lead to the holy grail of GRS, and that after one has the surgery, one has "arrived." Part of the reason that so many post-operative trans women and trans men leave the community is because once they've reached that point, the weighty discussion about GRS is no longer relevant to them. The GRS-heavy emphasis has also tended to exclude non-operative and other trans people, because of the implication -- intended or not -- that they "must not be real" if they choose not to pursue surgical methods.

Yet GRS was only ever supposed to be one step toward self-resolution. It's neither all-completing, nor is it always a final endpoint (and this calls for a discussion of post-traumatic and minority stress), although it does have the ability to bring closure when that body distress exists. By comparison, cissexual (non-trans) women never stop discovering what it means to them to be a woman; cissexual men likewise. One does not "arrive" simply from the flick of a scalpel.

The basic reality of the trans condition is that our bodies do not define us. If we allowed that to happen, we'd have never been able to start a transition -- we would still be living in the misery and shame of having to live up to everyone else's expectations.

The trouble with a heavy (or exclusive) focus on GRS as the "endpoint" of our transition is that we can become so intent on becoming "wholly" female or "wholly" male that we abandon, hide, or feel ashamed of characteristics and histories which make us truly unique, perhaps embracing stereotypes instead. It's important that surgery does not become a case of simply trading one mask for another.

The overarching focus on surgery also does people an injustice, as it means that we fail to talk about bodies, hygiene issues, sex, the downsides of post-operative care, and those things that we fear might cause a person to have doubts about or stray from the One True Path™ of GRS.

And sometimes -- oh, not for everyone, but sometimes -- non-operative-by-choice trans people arrive at a point of personal resolution from transition alone, and find that they can take pride in how unique they've become. That perspective is hard-won. It's a shame to bury it. Once in awhile, it's important to embrace one's uniqueness, and take pride in it.

Anyone who fails to understand this needs to take themselves out of the comfort zone of their own experiences for a moment, and remember that one size rarely fits all. Because the non-operative word is not "sorry."

In the end, we are who we need to be. Nothing else matters.

(As I was wrapping this up to post, Helen at en|Gender pointed to Non-Op. For those who want to know more, it looks like an interesting resource.)
(Crossposted to Dented Blue Mercedes)


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