Andy Warhol Was a Hoarder (19 page)

Clinicians, not to mention the public, vary dramatically on what they believe is appropriate, and clinics differ on the treatments they provide. On one extreme are medical experts who
believe that early treatment is appropriate and even crucial in some cases; it may save children from their own internal angst, compounded by teasing or bullying from peers, and even death. In a survey of transgender and “gender nonconforming” Americans, a staggering 41 percent reported that they had attempted suicide, nearly nine times the national average. Doctors who believe in early treatment do not want to see that statistic edge any higher. They encourage parents to allow their children to dress in the gender they identify with and to change their names. Medical treatment starts with puberty blockers, drugs that are prescribed shortly after the onset of puberty to stop the development of male and female sex characteristics. The effects of the drugs are reversible, so children who stop using them resume ordinary development. Those who continue, however, would be spared the torment of maturing physically in the “wrong” sex. As older teenagers, they could then take hormones of the opposite sex (testosterone or estrogen), allowing them to embrace the gender they identify with more seamlessly.

Experts at the other end of the spectrum believe it is unethical to diagnose and treat children who are still too young to understand what gender means. Their goal is to attempt to uncover the potential psychological roots of the child's atypical gender identity. Parents are counseled to help their children feel comfortable with the gender that matches their biological sex rather than endorsing a shift. They should not call their daughter “David,” for example, and let her socialize only with boys, nor should they allow their son to wear a ponytail and play solely with dolls. Above all, these experts caution, children should not be treated with hormones, which can have immediate and long-lasting side effects, including an increased risk of heart disease and cancer. The most outspoken critics—one of them a Johns Hopkins psychiatrist who helped halt
sex-reassignment surgery there in the 1970s—argue that giving hormones to children borders on child abuse.

Both sides stand strong in their convictions. An accurate diagnosis is the most critical step. Clinicians must have in-depth discussions with the child and his or her parents, assessing the intensity of behaviors and feelings (some children will talk specifically about wanting to cut off their penis or grow breasts) and how long they have endured. Studies so far show that only about 15 to 20 percent of children who report strong transgender feelings early in life turn out to be what clinicians call “persisters,” meaning they have a gender dysphoria that will not disappear after puberty has started. The rest, “desisters,” will lose those feelings over time; many of them, it turns out, will grow up to be gay or bisexual. Differentiating between the two is not always easy, which is why researcher Cohen-Kettenis has staked out something of a middle ground. Although children should be allowed to pick their friends and their toys early on, she says, parents should not accommodate requests for name changes—nor should they call their daughter “he” when she's really a “she.”

Research shows that when gender dysphoria does persist through adolescence, it is likely to endure into adulthood. Cohen-Kettenis, who has been studying and treating transgender children, adolescents, and adults since the 1980s, believes cautious intervention during the early stages of puberty is appropriate for the right candidates. She and her colleagues pioneered the use of puberty blockers in children starting at around the age of 12. This is a time, she says, when early desires crystallize one way or the other, and when persisters usually make their wishes very clear. “Their impression is that they didn't have a choice,” she says. “This was the only way to go.” In these cases, Cohen-Kettenis and her colleagues believe that the benefits of careful treatment outweigh the risks.

In a study of 70 adolescents who received puberty blockers, she and her team reported that symptoms of depression and emotional and behavioral problems decreased during treatment, and day-to-day functioning improved, making their quality of life comparable to non-transgender youth.

How will they do over the long term? It's too early to say. Alice Dreger, a bioethicist who has written extensively about sex and gender, advises parents to be wise consumers and strong advocates for their children. “The shape love should take is often unclear,” she writes, “but love is what we as parents must shape out of our fears, anxieties, desires, and hopes.”

T
HE TRANSGENDER WORLD HAS EVOLVED
dramatically since Jorgensen shipped off to Copenhagen in 1950. Jorgensen broke new ground at a time when transgender had no face; she fought a very personal battle when even the experts had little information to offer. Today, with a mobile device in hand, trans men and women can instantaneously connect for meet-ups, figure out where to get hormone therapy, and map out gender-neutral bathrooms on college campuses. Guidance on options that would have been inconceivable just a few decades ago—such as how to freeze eggs or sperm before transitioning from female to male or male to female—is now readily available with just a click of the mouse.

As
Time
magazine recently declared on its cover, the transgender movement is “America's next civil rights frontier.” Advocates are pushing to remove long-standing requirements stipulating that the only way to change gender on official documents, like driver's licenses, is to show proof of a surgical sex change. Many states require this, but the American Medical Association adopted a new
policy in 2014, saying that provision should be eliminated for birth certificates since surgery is not considered essential to living as male or female. The State Department has removed a similar requirement for passports. Transgender proponents are pushing for changes in the health care arena, too, where they are lobbying insurance companies to pay for treatment. In one landmark case, a 74-year-old Army veteran who was born male, but had been living as a woman for many years, filed suit against Medicare for denying coverage for sex-reassignment surgery. An appeals board ruled in her favor. “Ever since the first story about Christine Jorgensen came out, I knew that's what I needed to do,” she told the
New York Times
. “[I] want congruence between what I am as a human and my body.”

Transgender men and women are gaining footholds in art, culture, and entertainment. Chaz Bono was the first transgender contestant to appear on
Dancing with the Stars
, where he tangoed to “The Phantom of the Opera.” “I came on this show because I wanted to show America a different kind of man,” Bono said in front of a standing ovation after he was voted off the season. “If there was somebody like me on TV when I was growing up, my whole life would have been different.” Laverne Cox was bullied as a child in Mobile, Alabama; she grew up to be a star on the hit drama
Orange Is the New Black
and the first transgender person featured on
Time'
s cover. In a breakthrough ad campaign, Barneys New York produced a spring catalog featuring trans men and women wearing clothes from high-end designers like Balenciaga and Manolo Blahnik, shot by celebrated fashion photographer Bruce Weber. “What is between my legs is not thoroughly who I am,” says one model. “If gender is black and white, I'm gray.”

Transgender individuals often lead fairly conventional lives. Jennifer Finney Boylan, who transitioned from male to female in her 40s during her tenure as a popular English professor at Colby
College in Maine, has written extensively about her life as both James and Jennifer. With a sharp wit, she has shared her ups and downs, including the impact of her transformation on her wife—to whom she has remained married for more than 25 years—and her two sons. In a column she wrote for the
New York Times
, Boylan described her fear that her transition, which took place when her boys were under the age of ten, would affect them negatively. So when her son Zach summoned his parents to tell them he had made two important decisions, she was filled with trepidation. The big news: Zach wanted to be a pacifist, and he'd decided to switch from tuba to Irish fiddle. In a television interview several years later, Zach championed his parents. “If normal is a family that has a mom and a dad and two kids and a white picket fence, then no, I don't live in a normal family,” he said. “But if a normal family is one where everyone treats each other as equals and with love, then yeah, I live in a normal family.”

One of the most dramatic evolutions of the last 50 years is how people think about gender. In Jorgensen's day, it was viewed as two distinct categories: male and female. If you strayed from one or the other, you were categorized as gay. Today, gender is viewed on a spectrum. You can be “genderqueer” (you identify as neither male or female), “gender fluid” (your gender identity shifts over time), “cisgender” (your gender aligns with your sex), and any number of other delineations. Facebook offers these and dozens of other gender options in its drop-down menu, from “androgynous” to “gender questioning.” In her memoir
She's Not There
, Boylan put her finger on this changing conceptualization: “The line between male and female turns out to be rather fine. Although we imagine our genders as firm and fixed, in fact they are as malleable as a sand castle.”

A
FTER HER RETURN TO THE
U
NITED
S
TATES
in 1953, Jorgensen reunited with her family and built herself a house in Massapequa, Long Island. Early on, the press and the public could not get enough of her. Not everyone approved—far from it—and there were plenty of tasteless jokes. Journalists described her as “mankind's gift to the female species” and the “latest thing in blonde bombshells.” Jorgensen, who dressed elegantly and spoke straightforwardly, did her best to present herself as a thoughtful but determined human being, rather than some kind of sexualized freak. It helped that most of the thousands of letters she said she received from people around the globe were supportive and encouraging. Her parents, who lived with Jorgensen in her new home, stood by her. “She's ours and we love her,” she remembered her father telling the press.

In the 1950s, Jorgensen created a life on the stage, launching a nightclub act that took her from the Copa Club in Pittsburgh to venues in Detroit, Philadelphia, New York City, and even Cuba. She was, after all, a celebrity, whether she liked it or not. Dressed in sophisticated gowns, Jorgensen entertained her audiences with a mix of singing, dancing, and banter. Some clubs refused to book her on moral grounds, but others promoted the new star, happily filling their seats. She was derided by certain reviewers—the British press ridiculed her act before she even appeared—but lauded by others. Through it all, she retained a sense of humor. One night while dining with friends at a Manhattan restaurant, Jorgensen noticed the celebrity specialties on the menu—the Bing Crosby sandwich, the Frank Sinatra dessert. “I said casually, ‘All these items named after famous people, and there's not even a mixed salad named after me,' ” Jorgensen recounted in her memoir. “There was a shocked silence at the table. I didn't realize what I'd said, until suddenly there was a great shout of laughter from my friends.”

Jorgensen later appeared in theater, taking on a variety of roles including the character of Miss Western in the theater adaptation of Henry Fielding's 18th-century novel
Tom Jones
. In 1967, more than a decade after her return from Denmark, she published her autobiography, which sold almost 450,000 copies in paperback. Jorgensen was engaged to men twice but never married. One engagement was called off. The other, to a labor union statistician, was stymied when New York's marriage license bureau rejected the couple's application on grounds that Jorgensen's birth certificate listed her as “male.” Jorgensen went on to lecture about her experience and spoke out on behalf of transgender people and their rights. She lived the last two decades of her life in California, where she was diagnosed with bladder and lung cancer. Jorgensen died on May 3, 1989, in San Clemente, three weeks short of her 63rd birthday.