Op-ed: Where'd You Get That Body From?

I am a person with few boundaries in my relationships. I've always peed with the door open, taken my clothes off in front of a potential lover at the first hint of attraction, and I've told the world (well, make that 5,000 friends and 986 followers via Facebook and Twitter plus my seven non-virtual friends) everything about my naughty thoughts, bodily functions, sex drive, and the nappy dugout itself. I am an open book.

My husband? Not so much. He was raised Catholic, in rural Idaho, and if that Puritanical streak doesn't get in the way, the fact that his body and his mind haven't always matched up does. He was an awkward lesbian, but even when he first came out as a transgender man, he had months (maybe years) before his body felt like his own. For months, he wore a binder to flatten his chest while we cobbled together the money for his top surgery. Many trans men wear binders, some wearing two or three binders at once (if they can afford it) or Ace bandages if they can't (the latter is particularly dangerous as Ace bandages constrict the rib cage, block lymph nodes, inhibit breathing, and damage breast tissue, thus making top surgery much harder in the long run).

For Jake, the day he got his double mastectomy and chest reconstruction -- the process that removed his breasts, relocated his nipples and shrunk them to the size of nickels instead of quarters, and showed off new muscle contours we didn't know he had -- was the day he started loving his body.

Dennis Croft, star of AMC's Small Town Security, understands that well. In the season finale earlier this month, Croft, who has been living as a man for years, had his own top surgery, after days of resistance from his best friend (and boss) whom everyone calls "Chief."

The episode even showed Croft's nerve-wracking mammogram, a procedure of particular concern for trans men because any problem can hold up or cancel the surgery. "I did not think about the health risks of having corrupted tissue would be a factor of concern," he says. "After all I was having them removed, so what was the point?" [Ironically, if any kind of tumor or growth is found, the breast can't be removed."]

Still perhaps the biggest roadblock to surgery was Chief. I asked Croft if he was surprised by Chief's resistance. "No I was not," he says. "Chief cares for me a lot and it was a procedure that required going under anesthesia, which always includes risk of death. With that it was also a finite point of no return. She was worried about my well-being."

I had the same concerns the day Jake went under the knife. In one fell swoop, my wife of 16 years was becoming a man, which was traumatic enough. But I had just signed away my right to sue in case of his death (some standard surgery center waiver), so I sat in the parking lot in my car and cried for two solid hours until they called me and told me he was still alive.

The thing is, like Croft, Jake was instantly happier with his body.

"I feel normal like I never had a female body," Croft tells me now, two months after his surgery, even though his recovery (which includes stints for fluid drainage) took weeks longer than planned. "I woke up from a dream that lasted a lifetime. I have some more steps to complete but now it is more like I just have to give cosmetic adjustments. That may sound odd since I am missing a big part of the male anatomy but the prosthetic masks the lack of."

In fact, Croft (pictured at left) speaks for a lot of trans guys. For the unfamiliar, let me explain surgery for trans men. Top surgery gives you a chest instead of breasts. It is the most common surgery for trans men. It is also the stopping point for many men. Bottom surgery for men often includes a hysterectomy and oophorectomy (removal of the uterus and ovaries, respectively) and some form of genital reconstruction surgery. There are two basic types: Phalloplasty will create a penis using skin grafted from other parts of your body like your legs and arms. In some cases the penis can get erect on its own; others will always require you insert a pump for anal or vaginal sex. It costs between $50,000 and $150,000, requires multiple surgeries as well as electrolysis (otherwise your penis will grow hair). It's flawed, expensive, and not covered by insurance. I know dozens of trans men personally; very few have had a phalloplasty.

The second option is metaoidioplasty, which costs anywhere between $2,000 and $20,00 depending on what procedures accompany it. When trans men are on testosterone, their clitorises grow larger; metaoidioplasty is an operation that releases that clitoris and turns it into a small penis. Sometimes testical implants are added (made from the labia), the urethra is re-routed so men can pee through the new penis, and a hysterectomy and oophorectomy can be done -- each additional procedure adding to the cost. Some men get metaoidioplasty and don't have their vagina sewed up, meaning they have a small dick and bonus hole; this is a popular choice for some gay FTMs. (FTMGuide.org has a pretty careful listing of surgery definitions with thoughtul pros and cons.)

The third option of course is to not have surgery at all. I know plenty of men, damn fine masculine men who could go stealth if they so choose, who have gone this route. Why? Because you can buy a cock, pick out one you like, get many for different occasions, and get a packer that fits in your boxes like any old penis and no one is the wiser. Comedian Ian Harvie, who stars in the new documentary, Ian Harvie: Superhero, which is making its Los Angeles debut at Outfest July 18, is one of those guys. Harvie's standup is always funny, no-holds-barred, and yet somehow non-threatening, and in the doc (which was directed by Liam Sullivan and executive produced by Margaret Cho) he talks candidly about bottom surgery, or really the lack of. He's not having it, and he's fine with that. He jokes about how sad he feels for people who can't pick out their own penis as he did and about his current surgery-free bottom half (he has an acronym -- FUPA -- but you'll have to see the film to understand it).

Harvie, though, is one of many trans men who are reinventing what it means to be a man. Whether trans men have bottom surgery or don't, they have to confront a culture where size matters, where many see a penis (not store bought) as the main difference between a man and woman. While some trans men fall into that trap (penis equals man), a great number do not. Because gender is in your head, not your genitals. Trans men are showing other men that their identity has to be about more than their dicks. Some of the most attractive trans men out there will be frank, and funny, about their bodies, about parts that some will consider non-normative, but in a world of non-normatives aren't trans men part of the majority.

I think it was Rocco Katastrophe, the first out trans hip hop star (though his music is so much more) who first told me he was "hung like fucking gerbil" but damn proud because it was all his. Or maybe I read it in his trans boy 'zine, Original Plumbing, or in Morty Diamond-edited anthology, From the Inside Out: Radical Gender Transformation, FTM and Beyond. I forget at this point and it may not even be Katastrophe's quote. But it reminds me of the bravery it takes to be a transgender man, to confront transphobia as well as the basic challenges of being a man in a culture that is putting increasing emphasis on the male body.

Which is probably why you'll find bulimia, anorexia, and cutting at higher rates among trans men then their cisgender brethren, if anyone cared to study that. Ryan K. Sallans (pictured below), who wrote about his body image, eating disorder, and transition in last year's memoir, Second Son: Transitioning Toward My Destiny, Love and Life, knows eating disorders well. He's written and spoken extensively and done trainings around eating disorders and body image, using his own experience as a transgender man who was anorexic, as a jumping off point.

Years ago, after nine months of being sick, Sallans looked at an online check list for anorexia. "I felt a rock in my stomach as I looked back over the check list and realized I fit every single criteria," he recalls. "It took me another three months before I finally went to a therapist and sought help. My health and spirits were rapidly declining and my life was empty. Eating disorders are not glamorous, they punish you and those that love you, and the recovery takes a lot of work. Work that will continue throughout your life."

The renown public speaker and recurrent Larry King guest says that "there isn't just one factor that causes someone to struggle with an eating disorder...there are several contributing factors that lead to the thoughts and behaviors. Being transgender was one of the factors that contributed to my illness, but I would feel uncomfortable saying that gender identity is the root cause of my struggle."

But he does know he's seeing an increase in trans men who can be diagnosed with eating disorders. "This may seem more than other men because the trans community is much smaller, but it has me concerned," he admits. "What makes me even more concerned is that treatment facilities aren't yet prepared or trained on how to work with transgender clients. They are currently struggling with how to even serve men, let alone trans men."

The numbers are telling: eating disorders in men are up, in some areas they've risen 40%. Though most men never seek treatment, about 10-15% of people with anorexia or bulimia are male, according to the National Association of Anorexia Nervosa and Associated Disorders. Of gay men, nearly 14% appeared to suffer from bulimia and over 20% appeared to be anorexic. Trans men aren't studied as a group, but some activist believe their numbers are even higher.

It's not a surprise considering trans men are often raised and enculturated as girls regardless of what their mind feels, living in a gender discordant body, often trying hard to match up to media images of men like Vin Diesel and G.I. Joe. Jake tells other guys that no matter how much you want gender reassignment surgery, it isn't a magic bullet. It won't solve all your problems. It won't make you look like Vin Diesel.

Sallans agrees: "Every time I conduct a training or speak with other trans men I always say, 'You can't put all of your eggs into the surgery basket.' You first have to work on your emotional and internal self before looking toward physical changes. I know several guys who move forward with surgeries thinking that they will no longer feel uncomfortable after their surgery is completed, only to find out that their emotions are still the same. For example, they could come out with a great looking penis, but still feel unsatisfied in life. Our emotions run deeper than our exterior skin. When working with guys that already have severe body image disturbance or an eating disorder, there is an extra layer of emotional work that they'll need to do."

No slouch in the looks department, Sallans says that he's "completed every surgery and have genetics that many say are attractive, but I still struggle with my body image. I have found that I struggle more during times where I feel unsettled, whether it be financially, in my romantic relationship, or with my family. When I feel insecure and vulnerable I always turn to my body and start shaming the parts of me that I don't think are 'perfect.' Fortunately, I am aware of this now, so when my mind starts attacking my physicality, I stop myself and say, 'Okay, Ryan, what is really going on here? What are you really feeling?' This has helped me a lot, but I still have my struggles. That is the tricky thing about eating disorders, they are a mental illness; one can't cure a mental illness."

I ask Sallans how trans men survive in a culture where size matters? "Being in a culture where physical appearance is focused on more than intelligence, where sexuality is splashed all over magazines, billboards and the internet, it is hard to move past thinking about appearance and comparing what attributes we have compared to all the air-brushed images on our screens and pages," he admits. "What really matters isn't our size, it is our relationships with ourselves and those around us, which includes how we respect ourselves and those around us. I know that I have moments where I wish my penis were bigger but then I laugh because I'm just like any other guy, always wanting something bigger than the other guys. After I laugh it off, I realize I need to be happy with what I have, and I need to put my energy into more important things like being present, helpful and loving."

Croft says that being the opposite gender of one's body is a "mind prison -- a person has to either escape, be freed, or become institutionalized. Escaping means, to me, suicide, alcoholism, drug addiction, or a combination, etc. Becoming institutionalized means, to me, living in the cage and following the regimental framework of society's role for you. Being freed, to me, means to pick yourself up, walking through the gates and into the world with no one but yourself to rely on. The choice is ours which way to go." He says he was public with his surgery, and with living out his trans life in small town America onscreen, not just to help himself but to help others like him who don't realize he options they have. "They have not been shown examples of all of the alternatives. I am open about myself to allow others to understand their options."

Still, all these men agree that finding peace with your body is a process every trans man goes through. Jake covered himself with a towel quickly the other day when I walked into his shower. Is he just shy? (Could be familial: I didn't see his parents show any PDA until we had been married 15 years.) Or was he plagued with body issues that day? He pokes at his belly, muscles his arms, then generally crashes on the sofa in a heap with me, happy in knowing he'll never be a muscle man. He's a very hot geeky guy and I love him. But, he has issues. Many guys do, even if they aren't allowed to give voice to them.

Sallans still gets those thoughts: If only my abs were more defined, if my stomach were tighter, if my arms were stronger. These are a variation of the "what ifs" women have had for decades, the ones men seem to have more and more these days thanks to everything from internet porn to Diet Coke ads.

"I remind myself that what we see every day in media is not reality," Sallans says. "Unless reality is having millions of dollars, a trainer, personal chef, plastic surgeons, and hours upon hours of allotted time by a producer, manager, or director to spend in the gym. When I start to attack myself, I think of what really matters in life and also that I shouldn't take my current abilities for granted. I have found the importance of moderation and balance, and feel like I am in a better place because of it. I can say because I spent six intensive years in therapy that my chest surgery, hysterectomy, and metoidoplasty procedures have definitely helped my external self feel whole. I love what surgery has done for me and when I am in museums where they have a sculpture of David or Greek gods I say, 'Hey, look at that, my penis looks just like theirs.'"

DIANE ANDERSON-MINSHALL is the editor in chief of HIV Plus magazine and the Advocate's editor at large.