Relationship therapist and coach Caroline Franssen advises:
If you, your partner or your child have a growing urge to change into the other sex than the sex you were born in, you face a serious challenge. If you go ahead, you will be taking hormones (possibly by injection) every day of your life and will go through some of the most painful and intimate surgery ever undertaken. Almost certainly your health will be compromised by the medical interventions you will inflict on yourself. Also there is a huge possibility that you will never be perceived by others as a ‘real woman’ of a ‘real man’ as they will see you as a transitioned person. Chances are your peers won’t accept you as a real man or a real woman, even though you feel yourself to be one.
Look at these important emotional issues which may be affecting your decision. They are better tackled by therapy – you can always go ahead with physical alterations afterwards.
The wish to change sex might be a disguise for one or more totally different problems. So before you change your life and your body, please do your emotional homework. There are plenty of surgeons, pharmacists and therapists ready to fulfil your wish. They won’t go away. You can always turn to them and do the irreversible. First please examine some family issues very thoroughly. You want me to take your current feelings seriously, and I do take them very seriously. You should still begin by dealing with the emotional issues before mutilating your body and make yourself dependent on chemical hormones for the rest of your life. If you have any Type 1 diabetic friends who have to inject insulin daily, ask them what effect it has on their life and well-being and how much they would pay not to have to do something you are thinking of doing – of your own free will.
1. Look closely to see if you identify with someone from the other sex in your family-system. For example, do you, your parents or your grandparents have a dead or never-born sibling of the opposite sex? An identification with him or her may be partly why you are hankering. Unravelling this entanglement can loosen up your urge to live her or his life, including their sex. These invisible entanglements can be made visible and transformed in family constellations eg if a child dies (especially a unborn twin of the opposite sex), you may feel the need to replace that child in your family and this may influence your wish to transition to the dead child’s sex. Alternatively, in therapy you can learn to handle the unlived grief and sorrow of the deceased and excluded family members.
2. Are you, born a woman, very intelligent, determined, strong-willed or high-achieving? These are traits seen by society as typically male, and you may have internalised this prejudice. You are right that you would be more privileged if you were a male – men still get more money, prestige and recognition for achievements at a much lower level than women. Less is expected of them in our misogynistic society. Maybe you have bought into this misogyny so much that you don’t want to be a woman any more. Your urge for a sex-change might be a form of adapting to society’s gender roles instead of a real need.
3. Conversely, were you born a man whose character and personal characteristics tend to be labelled more ‘female’ than male and do you tend to go with this labelling? Do you feel more gentle, vulnerable and caring than is acceptable for a man in this society?
4. Problems accepting your sexual orientation can also make you want to change sex. If as a man you are sexually attracted to other males, but being gay or bisexual would not be accepted in your family, religion or social group, or even by yourself, you may wish to transition to make your sexuality more acceptable. Similarly, a woman born who is attracted to other women may find lesbianism difficult to accept. If so, changing your sex is NOT the easy way out here.
5. Sexual violence in the family can also cause an urge to change sex, both by women (who never want to be a victim again) and by men who don’t want to belong to the perpetrator sex.
Questions to ask yourself: are there victim(s) of sexual, physical or emotional abuse or abandonment perpetrated by a male in your family? Such perpetrators are much more likely to be male then female. Also recent mass ‘outings’ of perpetrators in the public eye – Harvey Weinstein, Dustin Hoffman as well as recent revelations about the scale of vulnerable children being coerced into prostitution has heightened many people’s awareness of male sexual violence and its effects. For example, is/was your (grand)father violent? Did your uncle abuse your sisters? Did your father belittle and control your mother? Was anyone exploited in pornography by a male? Was anyone the child of a woman in prostitution? If so, as an empathetic person, you might rightly struggle to identify as male. Your solidarity with your beloved mother, grandmother or sister, may be a big part of why you very literally feel you should become a woman like them instead of the man that you are.
6. Even though you feel special, you have a lot in common with others. Most people benefit from some serious soul-searching and looking the mummy-and-daddy issues in their life. It’s good to give yourself what you didn’t get from mum and dad in terms of love, appreciation, safety, cuddling and acceptance of who you are. Plain therapy or alternative body-mind therapy will help here. This will in any case make you grow as a person, and as a human being. You will become a deeper person, feeling safer and more secure in yourself, more aware of and able to deal with your emotions, and, if you still want to change your sex after all this, you will do so from a balanced position.
Finally think about the motivations of anyone supporting you in this decision.
a. in the medical profession:
As with any elective (self-chosen) surgery, the surgeon, drug companies and private hospital chains, and the share-holders in these institutions, will be making a lot of money out of treating you.
b. Peers who want to transition or are already transitioned
You will feel very at home with others who doubt their sex or already made the change. Don’t be fooled by feeling ‘finally really understood’. Those who have had a sex change have a vested interest in persuading others to do it too. They are not objective, they may want to persuade themselves of the rightness of their choice by pushing you to do the same. Take time to investigate the stories of people who regretted their transition. Look at the work of people who have changed sex and lived with the result for many years – for example Jamie Shupe (the first person in the US to be recognised as a person to be registered as a different gender from birth), and Miranda Yardley in the UK. Also look up ‘sex change regretters’.
When you are driven by the urge to change sex, whenever you have the feeling that you are born in the wrong body, first find somebody neutral to stand by your side. This should be someone who is not supporting transition, and is not against, someone without a vested interest in the outcome of your quest. Ask her or him to do a deep and systemic search of the possible issues. Do your personal homework. Don’t focus on the sex you are in, focus on the feelings you have. Work them out. First find your freedom and happiness inside the body you have.
Caroline Franssen, the author of this article, is a therapist and relationship coach in the Netherlands