The following was written by Louis, who recently experienced an appointment with “Dr Jiff” that unfolded pretty much as outlined.

“But let me tell you, this gender thing is history. You’re looking at a guy who sat down with Margaret Thatcher across the table and talked about serious issues.”
– George H. W. Bush

One morning, as I awoke from anxious dreams, I discovered that in my bed I had been transformed into exactly the same body as I had been the night before.

Examination of my whole organic structure proved this to be true, and as my mother greeted me normally in the kitchen, my feeling of de-centralised horror was crystallised. Most people, upon waking to find themselves the same, would find reassurance in the stability of their own identity – unchanged by the nights stargazing. To the average man or woman, the roaming of a well-gendered mind at rest is a pleasure. I, however, on that morning, realised that my unprecedented disquiet was the beginning of something. I was right. I have not been quite at home with myself since.

Psychology today is a noble hobby, halfway between a humanity and a science. I tend to lean towards the side of art.

On the 9th December, 2010, I find myself sitting in the office of Dr Jiff in University Hospital Coventry. It’s the psychiatric clinic. I’ve spent half an hour waiting outside, before being beckoned, with a smile, into this room, where I am to give the performance of my life. My part: Myself, as the National Health Service wants to see me. The office is large and sparse, with high, grey windows and navy blue carpet. It’s warm, however, and my chair is comfortable. Not a couch, but a plain lavender seat by the doctor’s desk. Dr Jiff himself is something of a surprise. After all I’ve heard, here is a man in his twilight years: rotund, moustached, with yellow sweat patches under his arms. A fair tie, mind you – M&S perhaps.

He has an affable face, and is delightfully frank in all things… though as usual for a psychiatrist, his eyes are mirrored walls. This is our first meeting. As I write, I expect many more: my performance this day is a surprising success.

To begin to understand the nature of my madness, I would first have to explain what madness actually is, in a social context at least. I’m sure you have your own ideas on the matter, but here’s my take on the state of things. Madness is a state of mind which society as a whole (or perhaps the ideal that society projects of itself, and never seems to actually get to) finds to be outside the bounds of “normal”. Sometimes madness is considered genius. Sometimes geniuses go mad. More often than not, madness is considered a rather dangerous or undesirable thing to have around. The more cutting amongst you may have noticed that I didn’t define what “normal” is. That’s because I truly have no idea.

In Psychology and Psychiatry, different kinds of madness are categorised and given different names. The name for my particular type of madness is Gender Dysphoria. It has an average occurrence, according to the NHS, of about 1 in every 4000 people in the UK – though it is important to note that these are only those individuals seeking treatment. Estimates have been made suggesting that 1 in every 1000 people may experience gender dysphoric feelings, or even 1 in every 120. Some psychiatric organisations have suggested that there are perhaps 500,000 gender dysphoric people in the UK, and 10,000 who have successfully asked for, and received, treatment. Statistically speaking, you’ve probably met at least 3 people with some level of gender dysphoria within the last 5 years of your life. Whether or not you were aware is a moot point.

The treatment of my disorder is seen with some contempt by the general populace – it requires the breaking of ancient rules of civilisation. This sounds more exciting than it really is. In day to day life, I’m perpetually astonished by how seriously people take gender labels, and how violently they will react against those individuals who wish to put their hand up halfway through the lesson, and say “Excuse me, I think you got that bit wrong.”

On the 19th of August 1992, a gender dysphoric person was removed surgically from its mother’s stomach and placed (screaming, purple and bloody) into the world, possessing all the appearance of female genitalia. Because of this, a somewhat tenuous, but deeply historic and traditional, social categorisation was made, and it was assigned the gender role of “female”. However, the gender label which it now identifies with, if it has to at all (and that is a whole other debate), is “male”. Some people interpret this in the following way:

“She wants to be someone else” OR “She wants to be a man.”

A gender dysphoric person find this degrading and frustrating. As far as they are concerned, they have always been the same person, and will always be the same person, in one form or another. I summarise the following:

“He is a man, and if society wishes to hang so much meaning and status on gender pronouns – a figment of language no less – then it can at least have the decency to let people identify themselves, rather than thrusting identity upon them at a stage where they can’t argue back.”

Dr Jiff’s office, on the 9th of December, is a pleasant change from the usual hostility. To begin with, he has assured me that there are “unlikely” to be any problems in my referral. I explain the issues I have had when trying to achieve this in the past, and he shrugs off the ignorance of some in his profession with a simple:

“Some people just don’t go to enough conferences.”

Then:

“Do you masturbate?”

(Don’t tell me that wouldn’t knock you off balance a bit.)

“Yes.”

“Any particular fantasies?”

“Hmm.” I pull the face which I always pull when planning to politely lie. “No, just generic men.”

(Really, I have an imagination.)

“How do you identify – put into words?”

“Gay male, polyamorous.”

“Do you dream in colour or black and white?”

“Colour.”

“How do you place yourself within your dreams?”

(I want to say ‘the victim’, but I don’t.)

“Omnipresent.”

“And male or female?”

“I don’t see.”

“Any suicidal tendencies?”

“Nothing unusual. I saw a counsellor, it’s all in my notes and over with.”

And so on.

This stream of banal, sometimes cryptic, often probing questions, will determine the course of the rest of my life. In the end I “perform” so well that I achieve the referral and more: a fast track to a new clinic, with treatment as good as guaranteed in 3 months. The gatekeeper has been defeated. Apparently, the land of maleness is mine for the  exploration, chatting-up, styling, drawing, eating, sucking, dressing, drinking, writing, injecting, rubbing, wanking, fucking, and taking. And the clothes. I’ll be able to wear a pair of trousers on hips that aren’t just-too-wide, and a suit tailored to fit a new figure – simple pleasures hard won. Why choose soft curves when you can have hard lines? I know which I find easier to follow. But I digress.

“What do you know about the surgical options?” Doctor Jiff asks.

“First you have to ‘live the life’ for 2 years.”

“Yes that’s right, how long’s it been for you now?”

“2 months. Facebook proves it.”

“Good. And what were you considering?”

“Phalloplasty looks generally crap. I want top-surgery though.”

“Yes. The success rates for breast reduction and removal are excellent. How big are your boobs?”

(I can’t describe the impact of words like ‘boobs’ leaving this man’s lips.)

“Small.”

“Well it will be a question of finding the right surgeon, but I can help you.”

“Thanks.”

“Phalloplasty, though, is a tricky one. In 2 years time when you’re eligible, things may have changed completely, but at the moment it’s a poor sport. What you really want is to be able to feel and to experience, which as things stand in the field is not particularly attainable, so unless you suddenly become desperate for a penis, it’s worth avoiding for now. I mean, can you have a really good orgasm with what you’ve got?”

“…Yes.”

“Then that’s good, and anyway, there are things you can do with a strap-on, especially anally, that just can’t be done by natural men.”

(It’s only after I leave the room that it occurs to me to laugh and laugh.)

The question of my sexuality is only mentioned in passing. I have heard several, interesting viewpoints on it. My good friend L___ was rather surprised when I suggested that there was any problem. “But 80% of the female population are straight,” he argued, “So surely 80% of transmen are gay? It’s just logic.” I thanked him for this excellent piece of reasoning.

Others, however, have been less supportive. The first psychiatrist I saw to try and obtain a referral was quite obstinate in her belief that a transman couldn’t possibly be gay, because all transmen must surely be lesbians who just couldn’t face up to their sexuality. “I like anal sex,” I told her, just for the hell of it. She didn’t appreciate that. Of course, there lies another minefield of debate: my under-eighteens counsellor pointed out that with my total lack of sexual  experience of any kind, how could I possibly know what I was attracted to? This, to me, seems like a rather foolish question, and leads me to assert a rather controversial fact:

Nobody knows a person as well as they know themself.

That point made, it is interesting to note the breadth of reactions that a trans or gender dysphoric person may receive in their exploration of this idea. Imagine meeting someone you have known since infancy for coffee. The two of you make small talk and enjoy each other’s company, then out of the blue, your friend tells you that they have to say something important: they are not really brunette at all, they are actually blonde. To the evidence of your own eyes, this is ridiculous, and you say so. No, they explain, the brown is dye. I’ve been covering this up for my whole life.

Of course, hair colour is a somewhat less mind-bending issue than gender, but the premise is similar. Imagine the same conversation, but instead your friend reveals that they are homosexual. This is slightly more controversial. To   someone like me it doesn’t matter at all, but of course to many people, this is a genuinely world-altering piece of information. Now, imagine your friend putting down their coffee cup, and telling you that they are actually the opposite gender.

Imagine walking away with that information in your mind.

Surely you know them better than that? Don’t you?

If you need to stick a label on them to understand them, do you really know them at all?