dresses. If you are a doctor, you have to wear a dress to go to the clinic. You have to wear a dress to funerals and weddings. Having to go to my sister’s wedding and wear this flowery dress. These are amongst the big traumatic experiences of my life!
And that sort of discomfort (because I’ve only changed my sex over the past few years) has characterized most of my life. Just this very, very uncomfortable feeling about being female—every aspect of it. But I didn’t understand it and I was always very confused about it. When I went to college, I was diagnosed with mullerian agenesis.
They realized that I didn’t have a vagina or uterus. I remember the doctors going up and looking for testicles that were undescended, checking my karyotype. They never told me the results of the kary-otype, so I just assumed that it was normal. I remember talking to these doctors and they were saying that they were going to construct an artificial vagina, and I never had any say in the matter. They never asked me if I wanted it. I remember thinking, “God, I’m just an interesting case to them.” They would come in and they would go out, but they would never ask me how I felt. And I had feelings! I felt very confused about the whole thing, like why are they going to do this, and I really don’t feel female, and I didn’t think that I particularly wanted a vagina. But on the other hand, I was a girl and I should have a vagina. It didn’t seem like there was any choice really. And I had a boyfriend at the time—I’m attracted to men, by the way, weakly, not strongly—so I thought if I’m going to have sex with him, I guess that I should have a vagina. But I never really had an interest in vaginal sex. But they did it anyway.
And then I remember when I was in medical school learning about testicular feminization [the discarded name for androgen insensitivity syndrome, a condition in which the lack of cellular receptors for testosterone and dihydrotestosterone creates a female-body morphology even though the person is of XY chromosomal sex], and that seemed to me to be the thing that explained it all when I learned it in class. I still remember that day etched vividly in my mind. It just explained it. I thought, “Okay, I’ve always felt like a guy, and I just have testicular feminization and they just didn’t tell me.” I remember going through the literature when I was in medical school and trying to understand. I assumed that the reason I felt so different about myself was the mullerian agenesis. That’s an aspect that a lot of transsexuals don’t have—they don’t have this physical problem. But for me it was a confounding thing, and a confusing thing. I think it kept me from realizing my transsexuality for a long time. I thought that everything was somehow related to that.
I also knew that my mother had been treated during her pregnancy with an androgen-like drug—not DES, one of the androgenic proges-terones. My sister asked the doctor who treated my mother with this hormone many years ago (he’s long dead now) and she was told that it was definitely not DES, but rather an “androgenic progesterone.” I was never told the exact name. Anyway, I’ve always assumed that my gender variance was due to that drug, and that’s what caused this reproductive defect. But then in fact if you look at the [scientific] literature, there really isn’t a correlation between androgen exposure and mullerian agenesis; there is no evidence that mullerian agenesis is caused by hormonal anomalies. And in addition, women who have mullerian agenesis feel like women. They don’t have this gender disturbance. And again I found that very confusing.
So, I just thought, “Well, there hasn’t been a lot of research, and what do they know anyway?” It was really only after I moved to the Bay Area and read a newspaper article about James Green [a well-known Bay Area transman and activist] that I realized that there was anyone else out there like me. I had never really talked to anybody. I just felt kind of ashamed of it.
No, I never did. Partly because while I was in high school, college, and medical school, I never read the newspaper. I never watched TV. I was very intense about my studies. I knew a lot about science, but I didn’t know a lot about other stuff. I was a typical science geek, and I really had no other interests. It wasn’t until I came here [to Stanford] that I started reading the newspaper. I was just very driven. I worked seven days a week, fifteen-hour days, right through training. So I didn’t hear a lot about those people.
Then after two years of being here, I got breast cancer, which runs in my family. My mother died of it when she was my age. So when I had breast cancer I remember going to have the surgery, and even though they had picked it up early and it hadn’t spread, I begged my doctor to do a bilateral mastectomy, even though only one breast needed to come off. I said to him, “You know my mother died of this. I think it’s genetic and I think it would be best to do it [the double mastectomy] as prophylaxis.” This was before the [BRCA] gene test was available. It turns out that a couple of years afterward, I did have the gene test and I did test positive. Anyway, I finally did manage to convince him to cut it off, over a lot of objections. This was one of the things that made me feel very comfortable about the gender change later because I remember leaving that doctor’s office feeling like this was the best thing that had ever happened to me. And I remembered that when my mother went through it, she just had one breast cut off, and it was so traumatic for her. So incredibly traumatic. And I experienced nothing like that. I was happy to have them cut off. I was relieved. “Relief” is a really good word to describe it.
But at this hospital where I had my surgery, they also did sex changes, and I remember one of the nurses talking about this person who’d changed from male to female, and I remember thinking, “Man, what a pervert. How weird.” I think I had the same reaction that everybody else had: “What a bunch of weirdos.” And I never related that to me. I don’t know what that’s about. Here I am, a doctor. I’ve been confused about my gender my whole life, but I didn’t—maybe it’s some form of denial—but I still find it fantastic that I didn’t make the connection. And then you read this article, and it’s like in your face. It was so moving. It was like everything he said was the story of my life. And in the article it mentioned this clinic right down the street and how you need to get this evaluation. So I just contacted them, filled it out, and the next thing you know they were seeing me and saying, “You are a classic case. Would you like to change your sex?”
It was all done very quickly. There was a period of a few weeks where I was pretty stressed because I was thinking, “Do I really want to do this?” And you know, a lot of transsexuals, when they change their sex, they move somewhere and change their entire identity. But I am internationally known, and my whole career rests on my not changing my last name at least. So that was rough, wondering if I would lose my career, lose my job, wondering whether students would still come to my lab. So I thought about it a lot. And I actually talked to some senior people here about what I was thinking about doing, and when they said that they didn’t think that it would hurt my career, that made me feel good.
I really felt by that point that life had been so hard on me—I never feel like I really do a good job of explaining what it was like, but I didn’t sleep a lot of nights, I was suicidal, life was so uncomfortable. Don’t get me wrong, I’ve really enjoyed my life, but somehow it’s like it was split into two parts. The personal part, which has been very uncomfortable, and the professional part that’s been a pleasure, that I’ve really enjoyed. But the personal part was just so uncomfortable that sometimes you think, “I’ve had enough.” It’s that distressing.
So, at the time I went to the clinic, I just felt like it was either this or suicide. I didn’t see any other alternatives. And it all happened very quickly. Within a few months of being seen, I was on hormones and then within a few months after that, I had my ovaries taken out—which was actually prophylactic surgery for the genetic mutation that I had, although female-to-male transsexuals really should have their ovaries taken out anyway. Then when I came back to work after the oophorec-tomy, I had begun shaving, and I sent a letter out to a few people in the department letting them know that I was changing my sex. It’s amazing how when you are well known, how quickly rumors get around. Really, within a day or two after sending out that letter, everybody around the world knew. Especially with e-mail, you can imagine how quickly the news spread, and of course there was a lot of talk, but after a couple of months it died down. Everyone here at Stanford has been fantastically supportive, from students, my faculty here, the deans.
Some people made funny comments about it, but most people just didn’t say anything. I’m sure they were shocked. The hardest thing is pronouns. It’s very hard for people to switch. Most of them are very good about that, but every once in a while they’ll slip, particularly if they’ve had any alcohol. I have trouble with it myself sometimes. I was just interviewing a young female-to-male transsexual who lost her job when she … he announced that he was changing sex and came to talk to me about the possibility of a job here, and throughout the whole interview I kept calling him “her.” Once I know, even I do it. And I had to keep checking myself. I don’t care if someone accidentally calls me “she.” I care if they do it systematically and as a form of harassment. Fortunately, that hasn’t happened to me.
