Girls to Guys -- It's on the Rise

San Francisco Examiner ^ | 12/19/01 | Tanya Pampalone

[medlarebil]

At his brother's wedding, the photographer put Marcus Rene Van with the men in the family and his sister screamed, "That's my sister."

Technically -- and biologically -- she's right. But two years ago, the 25-year-old spoken word artist with a tiny goatee swapped genders and went from she to he.

Van is one of a rising number of young women who are opting to live their lives as men -- a trend on the rise in San Francisco's lesbian community.

Business is booming for doctors specializing in chest surgery, clinics that provide hormone treatment and psychologists who offer gender therapy, with one popular surgeon completing twice as many surgeries as he did five years ago.

When Van -- who lives as a man without the help of hormones or surgery -- made the switch, it wasn't a popular thing to do. Now, he said, he's just another trans man living in The City.

Access to transsexual procedures is helping many be true to their chosen gender. But is easy access to hormones and the deluge of information about transsexuality helping those in need, or is it just plain hip right now to be a boy?

"I think (some young) people are going to end up regretting what they have done," Van said of those who might be too quick to take hormones without considering the effects. "If you take hormones for a couple of years, there is no turning back."

Easy access

Dimensions, the lesbian, gay, bisexual, transgender youth clinic in the Castro-Mission Health Center, is where many trans men have been coming since the doors opened three and a half years ago.

The clinic offers hormone treatment and has at least 25 female to male (FTM) transsexual clients who are on testosterone, according to clinic coordinator Laurie Lenrow.

Before a patient is permitted to take the hormones, they (or their guardians, if they are underage) are required to sign a consent form that outlines the permanent damage testosterone can do. Hair loss, beard and mustache growth, deepening of the voice, increased body hair and enlargement of the clitoris are irreversible, and the risk of cancer and diabetes is increased.

The clinicians here, like many who work with the transsexual community, do not closely adhere to what they consider conservative international standards of care for transsexuals, the Harry Benjamin Standard. The guidelines suggest three months of psychiatric treatment for those wanting to take hormones.

But patients at Dimensions do not have to undergo therapy and most are able to start hormone treatment within five weeks of their initial visit, following lab tests and a staff review of the individual case.

Lenrow compares taking testosterone to birth control pills, and points out there are many who don't take hormones or get operations. Besides, she said, most of their clients have been considering transition since they were teenagers and are usually "well-prepared" to make the decision.

Making history

Barely old enough to buy a drink, Chris Tavelli, 21, got chest surgery to remove his breasts in March and began taking testosterone in May.

He said he has known that his gender was wrong for as long as he remembers, but still admits that he made his decision at a young age, even though his family wanted him to wait.

But he doesn't think he'll have any regrets.

"Anything is possible, but I highly doubt I will ever regret it," he said. "You don't get to this decision on the whim. I'm just not a girl."

Still, many in the lesbian community are struggling to understand why so many young women want to change genders. While some view it as betrayal, others are just confused.

Bonnie Barrett, 33, graphic designer, is one of the confused. Barrett has been mistaken for a boy all her life.

"I'm not that old-fashioned," she said. "But (taking hormones) is a radical decision that I think is taken very lightly. What's wrong with just going to gym? What's wrong with just being butch?"

Why not just be a butch lesbian is a question that Van and Tavelli have all been asked a million times.

"It didn't fit," Van said simply. "I wanted to be myself, and myself is male."

Under the knife

A graceful metal robot with big red lips and voluminous breasts greets Michael Brownstein's clientele in his Potrero Hill loft medical office.

The gray-haired plastic surgeon has been doing sexual reassignment surgery in The City for more than 20 years. He has done hundreds of mastectomies and metoidioplasties -- the transformation of external female genitals into male (see inset) -- and business is booming.

Brownstein is doing twice as many surgeries as he did five years ago for clients who are mainly women in their 20s and 30s and want a mastectomy, or top surgery -- the more common of the two procedures that he does.

But he maintains that having surgery -- or even changing genders -- is not a fad.

"It's not a trendy thing," he said. "It's not like a rave party. This is a real condition."

Brownstein said the reason for the increase in procedures is that there is more acceptance of transsexuals, and more access to information via the Internet.

As chairman of the ethics committee for the Harry Benjamin International Gender Dysphoria Association, he makes certain that his clients are ready to make the decision for surgery. But Brownstein doesn't require a letter from a therapist in every case, as is required in the guidelines.

"Someone who is 40 and has lived as a male for 20 years successfully, I wouldn't have much reservation," he said. "But a 22-year-old doesn't have that same degree of experience."

Getting equipped

Riley Richard is considering his options.

The 26-year-old with a sweet round face and tattoos running up his arm is going to therapy to figure out if hormones are the right treatment for him.

A few months ago, Richard decided to switch genders and went from she to he. Inside, Richard is all man.

"I'm a boy and I always have been," he said behind black-rimmed glasses and a ski cap pulled around his face. "I just don't have the biological equipment."

Richard has made the choice to go by "he" in a workplace that is accepting of his new gender, even though he was blessed otherwise.

Pronouns are important at Good Vibrations, where Richard works as a warehouse clerk. Sometimes it's the only word that gives away a person's gender in the sex toy distribution company where up to 15 percent of the employees are transsexuals -- the majority of whom are female to males transsexuals in their 20s and 30s.

But while Richard contemplates taking hormones, chest surgery is something he plans to do as soon as he can save the money.

Van doesn't plan to have surgery, top or otherwise.

"I want to keep my body intact," he said. "But there are things I can't do. I can't wear a tank top, I can't walk into a men's locker room."

But taking testosterone would change some of that. It would stop his periods, put more hair on his face, move fat off his hips and into his abdomen. It would make his bones bigger, his voice lower. With so many friends taking hormones, it's something Van has been contemplating.

"I think about it every day," he said.

E-mail Tanya Pampalone at tpampalone@sfexaminer.com

[GovernmentShrinker]

Most people are obviously one gender or the other. However, there are quite a significant number who are born with ambiguous anatomical features. Most of these are surgically assigned to one gender or the other in infancy, and a few are left alone phsyically but fairly randomly assigned to be raised as "female" or "male" (usually female, because a fully functioning penis is often viewed as essential to being male). And in a few really awful cases, infant boys who have suffered serious complications from circumcision have the problem "corrected" in infancy by being surgically turned into girls.

In my opinion, people who are perfectly normal physically should be left that way by responsible physicians. But at least some of the people who seek surgical and hormonal gender reassignment were born with some real problems in this area, and may have had some questionable decisions made without their input when they were infants. They should have our full sympathy and compassion, even if they make some choices which sound unwise to the rest of us.

A couple of years ago there was a story in Time or Newsweek about a 15-year-old who was physically male, but who, with his parents support, had been living as a girl for many years. If you just read the story, you'd think the parents were off their rockers for going along with this. But the picture of this "male" told another story -- he was an absolutely feminine knock-out blonde. No matter how hard I squinted at that picture, I just couldn't imagine him as a normal male. Something was clearly wrong there, and it would have taken lifelong hormone therapy to make him feel male or look male to anyone else. So I wouldn't have argued with the decision he and his parents had made to have him live as girl until he was older and adolescence had sorted itself out, and then, if things were still the same, go ahead with reassignment surgery. He was attending a private Christian school, which had discovered his peculiarity, and announced its intention to expel him if he continued dressing as a girl (this is what gave rise to the publicity). Interestly, even in this conservative environment, other students and their parents were defending him, and asking the school to reconsider.

Now as for twenty-somethings who are pursuing careers in the sex toy industry in San Francisco, I'm a lot more skeptical. Gotta think that living in a normal environment for a while would be worth a try, before resorting to irreversible hormone treatments and/or surgery.

[Equality 7-2521]

That's pretty simple for me. I see a penis. Fortunately, I'm also sexually attracted to (some) females so I'm certainly male.

However, there are those born with both sets of equipment and I'm sure they'd find it a little more difficult to determine which gender they are. I'm guessing here, but I imagine that most of those people would align themselves more with whichever gender they hold a weaker sexual attraction for.

Then you've got the people who you think "it should be obvious," the only problem with your assertion is that it either wasn't obvious to that person or it was obvious but not because of physical characteristics but rather emotional and psychological ones.

We were all the same gender when we started out and the only difference is that some of us have a Y chromosome and some of us don't. But you know something, there are rare occasions where someone will be born as a female even though they have a Y chromosome and there are even rarer occasions when a those without a Y will be born resembling a male. There are also occasional male calico cats, but they are always sterile. The problem is that the whole system is imperfect. Whenever there's an imperfect system it leads to questions of what's "obvious" and what isn't.

[Equality 7-2521]

I've never thought that I'm wiser than your god, that would require me to first believe in it.

Even if I did believe in your god, I would have a hard time comparing myself to it since whenever I build or create something, I'm taken to task on every flaw.

[jla]

So every cause has an effect.
What effect brought your little chromosome snafu to be?
And please, will you people please stop comparing humans to animals in an attempt to legitimize your case.

[Big Guy and Rusty 99]

I don't know where you live but, my wife and I live in a Lesbian heavy area. All the lesbians there look like men. They are like carbon copy lesbian stormstroopers. If they didn't want to be like men, why would they want to look like men? If they didn't want to be like men, why do they want to act like men? If they didn't want to be like men, why would they use certain 'utilities' which simulate a man's 'member'?

[Equality 7-2521]

What effect brought your little chromosome snafu to be?

An imperfect system that was somehow designed by a perfect being?

[Dimensio]

I don't know where you live but, my wife and I live in a Lesbian heavy area. All the lesbians there look like men. They are like carbon copy lesbian stormstroopers.

I wasn't disputing that many lesbians sport the "butch" look -- I was disputing your assertion that "lesbians want to be men".

If they didn't want to be like men, why would they want to look like men? If they didn't want to be like men, why do they want to act like men?

I really don't know why the lesbians living near you want to look and act like men. It does not prove that all lesbians want to be men, because not all lesbians look and act as you describe. Even if lesbians as you describe are in the majority it only takes one exception to disprove your generalization.

If they didn't want to be like men, why would they use certain 'utilities' which simulate a man's 'member'?

I wouldn't know. Since you are so knowledgable about your lesbian neighbours' sexual practices, why don't you ask them?

[Mini-14]

Look down the front of your pants, the answer should be obivous.

For some people, this is apparently not the case. http://www.nlm.nih.gov/medlineplus/ency/article/001180.htm

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Testicular feminization

Contents of this page:
Illustrations Alternative names Definition Causes and risks Symptoms	Signs and tests Treatment Prognosis Complications Call your health care provider if

Illustrations

Male reproductive anatomy

Alternative names    Return to topAndrogen insensitivity syndrome

Definition    Return to top

A syndrome found in a person who has X,Y chromosomes, but who is resistant to androgens (male hormones). As a result, the individual has the physical characteristics of a female.

Causes and risks    Return to top

The syndrome is caused by various genetic mutations on the X chromosome. The mutations make a developing male baby unable to respond to androgens. (Androgens are responsible for male physical characteristics.) This prevents the development of the penis and other male body parts. The child is born appearing to be a girl.

At puberty, female secondary sex characteristics (e.g., breasts) develop, but menstruation and fertility do not.

Symptoms    Return to top

In its classic form (complete androgen resistance), the person appears to be female but has no uterus, and has sparse armpit and pubic hair. Some people with this condition are not diagnosed until they try to become pregnant and find that they are infertile.

Sometimes only partial resistance to androgens occurs. In these cases, a person may have both male and female physical characteristics, or sometimes just a low sperm count.

Signs and tests    Return to top

Signs may include:

• small clitoris and labia minora
• vagina present but no cervix or uterus
• normal female breast development
• testes in the inguinal canal, labia, or abdomen
• inguinal hernia with palpable gonad

Tests:

• Testosterone levels -- in the male range
• Luteinizing hormone (LH) levels -- high
• Follicle-stimulating hormone (FSH) levels -- normal
• Sonogram -- shows an absent uterus or an intra-abdominal testes
• Androgen receptor studies (research setting) may confirm the syndrome

Tests which may distinguish androgen resistance from androgen deficiency (or 5-alpha reductase deficiency):

• Increased basal and hCG-induced testosterone
• Normal dihydrotestosterone

Treatment    Return to top

Treatment may include:

• Removal of testicular tissue (which can become cancerous in 5 to 20% of cases after puberty)
• Estrogen replacement after puberty
• Support of gender identity

Prognosis    Return to topThe outlook is good if at-risk testicular tissue is removed.

Complications    Return to topComplications include testicular cancer and infertility.

Call your health care provider if    Return to topCall your health care provider if you have any signs or symptoms suggestive of the syndrome.

Update Date: 9/15/2001

Updated by: Sheila Feit, M.D., Department of Endocrinology & Metabolism, North Shore University Hospital, Manhasset, NY. Review provided by VeriMed Healthcare Network.

The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2000 adam.com, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Copyright, Privacy, Accessibility, We welcome your comments.
Last updated: 3 October 2001

[GallopingGhost]

Adadictome bump.

[wideawake]

LOL!!!

[MissMillie]

As far as I'm concerned, we're a free country and if some woman wants to live her life as a male, then so be it. Same things goes for men wanting to live as women.

Life is difficult, beautiful, but difficult. I have enough to concern myself with than someone else's choices--choices that don't really harm anyone else.

[MissMillie]

If they didn't want to be like men, why would they use certain 'utilities' which simulate a man's 'member'?

Of course, only lesbians use such "utilities", right?

[jla]

An imperfect system that was somehow designed by a perfect being?

Don't answer my question with one of your own. You're backpedaling, and you're remarks regarding God are disingenuous as well as being untruthful.
Ya see, God didn't want to just create a bunch of robots, so he gave mankind a free will, of which we are now reaping the 'benefits' of...on account of those who became pretentious & vain.
So, can I assume that you're an atheist?

[independentmind]

As soon as doctors begin to get sued for malpractice for performing such procedures (as well they should), this practice will come to an abrupt halt.

There is all sorts of evidence that significant, irreversible cognitive differences develop in fetuses approximately5-6 weeks after conception. How an operation on a mentally disturbed adult will change any of this is something doctors never tell their patients.

[Dimensio]

Don't answer my question with one of your own. You're backpedaling, and you're remarks regarding God are disingenuous as well as being untruthful. Ya see, God didn't want to just create a bunch of robots, so he gave mankind a free will, of which we are now reaping the 'benefits' of...on account of those who became pretentious & vain.

I think the argument goes along the lines that since God is both omnipotent and omniscient, He could easily have created beings with free will who would choose, through their free will, lifestyles in accordance with God's desires.

[Paul C. Jesup]

Interesting article, medlarebil.

And to the rest of you.

How many of you here who posted, took to time to do a little reseach on this subject before you posted? As apposed to posting in complete ignorance on the subject of the article in question.

[jimt]

Barely old enough to buy a drink, Chris Tavelli, 21, got chest surgery to remove his breasts in March and began taking testosterone in May.

The warped use of gender specific pronouns and adjectives in these articles always drives me nuts. Maybe it had its breasts removed, but his in the above sentence is oxymoronic.

These folks who want to mutilate themselves deserve our sympathy. But that doesn't mean we should pander to their delusions.

[jla]

You can't cure mental illness with surgery.

That would explain the ultra-high suicide rate among these 'transsexuals'.