The answer in my head was "I want you to help me work that out". But it would have been the wrong answer.
I was there for a diagnosis of Gender Dysphoria, and if you have Gender Dysphoria, then by definition, you must want gender confirmation therapy. You must want to do everything within your power to make your body conform to the right binary gender... no matter what the risks.
There was one question he hadn't asked me. In fact, there was one whole topic he hadn't even touched on. He hadn't asked me how I felt about my body.
He hadn't asked me if I felt nauseous, alienated, at seeing my naked female-phenotype form. He hadn't asked me if in glancing at my hands I subconsciously felt as though they must be someone else's - as though my hands, surely, would be bigger, hairier. He hadn't asked me if instinctively I reached for a penis that wasn't there, if I was overcome with fresh horror every month at the reminder of the thing between my legs that my brain just couldn't process.
In short, he didn't ask me - not even in crude, insightless terms like the ones above - he didn't ask me if I have body dysphoria.
On the whole, I don't. Not every trans* person does. For those that do, of course, gender confirmation therapy is a strongly desirable course of action - the bodies they have cause them genuine pain, pain which hormone therapy and surgery are extremely effective at relieving.
But me? Huh, well. Maybe if I had stubble, I'd get ma'amed less often.
I've blogged about this before; I've been wavering about medical transition for years. It always comes down to this: there's very little I think I'd miss about my female-phenotype body if I put it through a second puberty. And at times, that "very little" feels like a cheap price to pay to escape the pain of being constantly misgendered. But at other times, the scales tip the other way. And at those times, it seems frustratingly ridiculous that in order to be seen as my true self, I should have to change something - my body - which I just do not feel has any connection with my sense of self.
So that was the question I wanted to ask. What can I do? What should I do? How best can I navigate living as a man without having to break things that don't need fixing?
But I know what the answer would have been: if I have no desire to change my body to conform to the male phenotype, I have no business living as a man.
Popular conceptions of transsexualism are frequently - overwhelmingly - boiled down to issues of the body. In laypeople's eyes, "being transsexual" just means "wanting a sex change". (It never seems to occur to them to ask why one would want it. Funny, that, since it's by far and away the most interesting aspect of the thing.) Indeed, it's often argued (by people I have no desire to link you to) that transsexualism didn't, couldn't, exist before the development of medical techniques for gender confirmation. And, when you're a trans* person, the path is so neatly laid out in front of you - hormone therapy, chest/genital surgery, starting a new life and going 'stealth' - that you sometimes forget it can be (has been, might one day be) any other way.
Three days after those questions (the one that was asked, and the one that wasn't), I went on a walking tour of Brighton, focusing on its LGBT history. We heard the story of Dr James Barry, a celebrated surgeon in the 19th century, who travelled the world on army postings as a Medical Inspector, and performed one of the first known Caesarean sections in which both mother and baby survived. It was only when he died, and his body was - against his instructions - examined, that he was discovered to have been assigned female at birth. Had his wishes been respected, nobody would ever have realised.
Nobody would ever have realised.
And then there was the story of "Colonel" Victor Barker, whose exploits with the National Fascisti in the 1920s remind us that trans* people can be flawed human beings just like anyone else (and whose Wikipedia page genders him as female), but who played the role of a retired colonel like such a natural that his peers never suspected that he was legally female until it was revealed during a court case. And those are just the famous stories - the ones where the "truth" was uncovered, the ones where the person involved was important or notorious enough for the story to hit the news. Who knows how many other lives have been lived contrary to assigned gender?
What it means to be trans* has changed a lot over the years. For untold centuries before our modern, medicalising era, it could simply mean putting on the right clothes and forging yourself a new life. That's if you were one of the lucky ones, of course - if you had the means and connections to start afresh, and if you 'passed' well enough to go unsuspected (which, I'm well aware, is often far easier for the male-identified than for the female-identified). But it's notable that after Dr Barry's posthumous outing, acquaintances were quick to step up and testify to his smooth skin and high voice. If his female-coded attributes were such a giveaway, how come nobody challenged him when he was alive? It's conceivable that back when gender roles were much more rigid and segregated, the idea of anyone female-assigned putting on trousers and going through medical school was so unthinkable that not even a whole host of 'giveaway' cues would arouse suspicion.
I certainly don't want to idealise the past with that observation, but it's intriguing in the light of the following: Gender confirmation therapy first started to become widespread in the 1970s, a time of unprecedented freedom of expression for both genders, and yet its gatekeepers would only treat those trans* people who rigidly conformed to "traditional" ideas of masculinity or femininity. Trans* women ran the risk of being refused treatment if they didn't attend appointments wearing skirts and makeup, a situation which persisted long after such sartorial expectations became outmoded even for cis women - and woe betide you if, in-role as your chosen gender, you identified as anything other than 100% heterosexual.
The simple fact is, a lot of people who like to consider themselves "normal" have a lot invested in the idea of the gender binary. And for them, the existence of transsexualism is scary: it raises the possibility that they might not be as "normal" as they thought. It makes them feel better if they can claim that only the manliest FAABs and womanliest MAABs ever want to transition; that everybody who transitions is at least upholding good old traditional gender roles in the bedroom; that nobody would ever want to admit to such a shamefully not-normal thing as having a trans* history; that nobody would want to transition to anything other than "male" or "female". For decades, gatekeepers have pandered to such people's gender anxieties when setting up the hoops for transitioners to jump through. And slowly, slowly, many of these requirements have been eroded away, as even the gatekeepers admit that they're starting to look outdated. But it's too late for anyone who, in the seventies, desperately needed relief from eir body dysphoria, and was faced with the choice, for one reason or another, between lying or losing out.
We can't say for certain whether Barry and Barker were "actually" trans men. "Trans man" is a label which, like many others ("lesbian", "genderqueer", "asexual"), belongs to our time - it only makes sense within the context of modern (and Western!) ideas of "man", and of "transness", and of the interplay between them. We don't know their motives, we don't know their true desires, and we don't know how they would have identified, or what steps of transition they would have taken, if they had lived today. All we can say is that they did what they felt they had to in order to forge out a satisfactory life within the society they had to live in.
And that's all that anyone who's lived contrary to their assigned gender has ever done - whether they took hormones or not, whether they had surgery or not, whether or not they [would have] identified with the label "trans*" (or "fa'afafine", or "hijra", or any of the dozens of other non-Western cross-gender identities). If I did undergo medical transition, I'd undoubtedly feel more comfortable within the society I have to live in (and, note, that is definitely not to be sniffed at). But I would always be uncomfortable knowing it's not the society I want to live in. I would always, deep down, rather live in a society where the phenotype of my body mattered as little to other people as it did to me; one where I could politely explain I was a man and that was that. And I would always worry that our society might never reach that stage without
As my clinician was fond of mentioning, he's been "doing this" - that is, diagnosing people's genders - for 25 years. (I doubt he would have taken the point that so have I.) But in that 25 years, much has changed. And - with any luck - I'm going to be living as trans* for another 25, 50, maybe even 75 years. Do I really want to sacrifice my voice, my surgical virginity, my comfortably post-pubescent hormonal cycle, on the altar of what cis people expect of me now?
Some men have breasts. If I can't get over that, then who will?