My GP is an exceedingly nice guy, and he's not - can't be expected to be - a trans* expert. He performed the last(?) of his gatekeeping duties for me this morning with endearing humility, constantly apologising for being so "challenging" as he asked me probing questions. As he explained, in future referrals, people were going to be similarly challenging, trying to make sure that I wasn't making a bad decision.
Although I can just about get my head round a world in which this has to happen (so what if I made a "bad decision"? why would it matter if I stopped taking testosterone after a few months then spent the rest of my life as a slightly hirsute woman with a low voice and clitoromegaly?), I was somewhat perturbed by the thought that, in order to access treatment, I would have to have my identity, my confidence in myself, constantly "challenged", and to constantly defend it. No wonder the referral process is so emotionally draining for the more fragile of us (and bear in mind that our experiences are likely to have made us fragile).
But what disturbed me more was the idea that the healthcare "professionals" who stand in our way might have such a simplistic, unprofessional idea of gender as was displayed in his questioning. I have been thinking about my gender for over half my life, off and on; as remarked an FTM acquaintance of mine (who on the face of it is the most masculine-conforming obvious candidate for the treatment), you have to deconstruct the binary before you can work out where you stand within it (and then, if appropriate, you put it back together with yourself firmly in the "other" bit). I have read blogs, books, resources, theory; I have answered for myself to my own satisfaction nearly all of the questions that feel relevant connected to the decision to "change sex".
I do not count among them the question "so if you're not planning to have surgery, what would happen if you started a relationship with someone?"
I am a very lucky person. I have an "alternative" worldview and I live in an "alternative" world which supports, celebrates and nourishes it. Very rarely does the "real" world intrude, the one where people aren't broad-minded and over-intellectualising, the one where people eschew critical thinking in favour of shocked instinctive reactions when faced with a "she-man". I've
Perhaps it's unreasonable of me to raise an eyebrow at the question; I'm sure there are plenty of candidates for medical transition who don't want to be turned into freaks, or who honestly haven't thought about these things, or who would respond with an "unhealthy" plan for how they'd deal with such matters. But I would really hope that, rather than just being rejected for referral (which might seem to the "professionals" like the "safer" way of dealing with "confused" people, but in actual fact might lead to much greater distress and confusion than an ill-advised partial transition), such people would be given access further down the line to appropriate counselling. And by "appropriate", I mean "grounded in queer-positive theory": giving them the tools to accept that their genital configuration (whatever it is currently, whatever they would like it to be, and whatever it's likely to actually end up as) doesn't make them "freaks", doesn't mean they won't be able to have successful relationships, and doesn't make it "wrong" for them to obtain whatever sexual pleasure is available to them.
Easier said than done, perhaps, if said people are surrounded by that tiresome "real" world in which acquaintances disapprove of their actions. But even if they come to an understanding of themselves, their genders and their bodies which the "normal" people around them will never take the time to understand, it might be the key to their own self-acceptance and self-confidence - things which, if they've reached a point of suspecting themselves to be trans*, might otherwise remain a lifelong problem for them.
I freely admit that I'm an idealist, and perhaps naive with it. But that's because, in some respects, I live in an ideal world. By lucky chance, I've landed in a life situation where, as yet, my trans* status has not once caused me to be harassed, lose a friend or family member, or encounter friction or prejudice at work or in other social groups. I hear about less fortunate people, am "challenged" by my GP to consider how I'd feel if transition led me to encounter one of these negative scenarios, and I'm determined to prove that trans* life doesn't have to be like that. Maybe it won't happen; maybe I will get knocked back by a homophobic (or acephobic, but I've had relationships with men, so in their eyes, who's counting?) consultant, maybe work colleagues will start to swallow their acceptance once they realise it comes with facial hair. But that's the "real" world, and I never liked the sound of it much. I've already proven that, with a measure of good fortune and some boldness in seeking out progressive people, a trans* person can build eir own little world in which ey can live out eir gender happily.
Who really lives in the "real" world, anyway? We must pander to its demands and live under its conditions, and we can desire to change it or try to change it, but all of our happiness and security, all of our meaningful encounters, all of our little everyday triumphs and despairs that together mount up to "living", come from our Own Little Worlds. And the best we can possibly hope for, regardless of what the "real" world thinks of us, is to seek out or build or stumble upon a little world which feels right. I like mine. And if one day someone wants, really wants, to come and live in my corner of it with me, I guarantee that ey will not care about the shape of my genitals.