How can you be so sure? 1

Imagine the following scenario: you have an itch on one of your toes, and, without ever entering a doctor’s office and asking for an opinion, you are absolutely sure that you have to amputate your toe. In fact, you are thoroughly convinced that there are only three choices for you: either getting a doctor to safely amputate your toe, or amputate it yourself (and risk the consequences of bleeding to death…), or, well, in case all else fails, commit suicide.

We would clearly classify such a person as being mentally insane (in fact, this neurological disorder is called apotemnophilia, or body integrity identity disorder). Indeed, we would insist that such a person would get in touch with a psychiatrist and be referred to therapy. But it’s not always that easy for the person to ‘let go’ of their desire to amputate one toe (in my example). They will claim to feel ‘incomplete’ or somehow a ‘lesser human being’ unless that part of their body is removed. And, in fact, they might actively resist the good intentions of doctors to prevent them from getting amputated. They want to be amputated, and that’s pretty much it; and not everybody suffering from this disorder will be willing to follow the doctor’s directions. In fact, they might even be suspicious of doctors, who might — for their own reasons — refuse to concede the simple wish of removing a (useless) bit of one’s body (which, actually, is not even seen as part of the body).

Sounds crazy? Or familiar? Welcome to the strange world of neurologic dysfunctions.

‘Identity’ again, and how our brain perceives it

Ask the Dalai Lama, and he’ll be glad to explain that your self, that upon which you bestow your identity, does not inherently exist. That does not mean that it doesn’t exist: it just doesn’t exist by itself, but in dependence of causes and conditions. And what are those? Well, the main ones are pretty obvious: you must be a healthy human being and be in full control of your mental faculties; you need to have a working brain, and possibly not be under the influence of any psychoactive drug. That seems straightforward enough. Of course, Buddhists have come to this conclusion eons ago merely from observation: if someone is unconscious (or dead), they will have no ‘sense of self’ whatsoever. But when they wake up, they will have that again. Why? Buddhists in the 5th century BC did not have a medical answer for that, of course; all they could say is that it requires a complex balance of causes and conditions — they did have a reasonable grasp of medicine in India back then, so they had a good working hypothesis on how some parts of the body worked.

Enter the 21st century and our CAT and MRI scans, as well as all sorts of electrodes, implants, and the many tests in animals, most notably rats, which have given scientists a good clue on the ‘why’. If you read this article in 2020, it’s highly likely that most of what I’m writing in 2016 will be hopelessly obsolete; but that’s a good sign, it means that progress has been made!

In essence we can think of how the brain ‘connects’ the notion of ‘body’ with ‘identity’ in the following way. Think about it for a moment: why do you never bite your tongue when you’re eating? (Well, almost never!) I mean, the tongue is just a bit of flesh, how is it different from any other bits of flesh that you might be chewing?

The answer is obvious, although how exactly it works is beyond us to understand — the brain keeps an up-to-date map of the exact 3D position of the tongue inside the mouth, and that’s how it keeps track of where the tongue is, making sure that the teeth never actually touch it while you’re chewing. Sometimes — and notice how rare this is! — this mechanism might not be working with 100% precision and your teeth will brush the tongue. We call it ‘biting the tongue’, but actually biting through the tongue — a feat that our teeth can easily perform — is really rare. Even drawing some blood from biting the tongue is rare — this shows how accurate the tongue-tracking mechanism actually is!

But, of course, that’s not all. In fact, the brain has to track all parts of the body in real time. Consider how often you ‘automatically’ duck a low passage or arch — because your brain has a very good idea on how tall you are, and we have very accurate vision, enough for the brain to visually estimate how tall certain obstacles are. You can also notice how, when moving through a crowd, if it’s not too dense, you will usually be able to avoid touching other people — even from the back. Uh, no, we don’t have extra-sensory perception, and most definitely no ‘eyes in the back’. But our brain is extraordinarily good at estimating things like relative velocity, precise positioning, and internally mapping your 3D environment in extraordinary detail — so much detail, in fact, that you can even avoid someone to touch you in the backside, even if you technically cannot see them on their final approach, merely by estimating their speed and the point of possible contact between them and yourself.

Most of the time we don’t even realise how amazing our brain is when doing these mental maps. Consider a simple example: as I started to write these lines, I was sitting at a bar, turned against an internal window, with my back to pretty much everything and everybody. However, I can reasonably recollect the whole room behind me — and that includes details like materials and colours. I might even remember a few people sitting at the other tables and couches — I recognise some of their voices (even though they are complete strangers to me), so I know that they are still at the same place. How is all that possible? It is amazing, but all this happened unconsciously, while I walked into the bar towards the attendant: my brain mapped everything and presented me with a 360º panorama image of all the bar, even though I’m just focused on the small display of my laptop!

Of course, a lot of what is behind my back is getting blurry and has little visual detail. But I know that if I briefly turn around, even if just for a second, sweeping my gaze across the room, this will ‘refresh’ my brain’s mapping, and the bar in my mind will, once more, at least for a bit, be vivid and full of bright colours and lots of detail. Naturally enough, it’s easier to do that if you’re in a relatively static environment; for obvious reasons, if you’re in the middle of the crowd going out of an underground train, your brain might not be so good at remembering all the people behind you — you just get the impression of a vague mass of people moving along, but nothing more.

But it’s still uncanny how good our brain is in creating these mental images, even if we are not ‘seeing’ them. And, of course, the other senses — sound, smell — will also contribute to enriching the quality of the image. So the brain is able to compensate. If you walk into the bar, and see a woman laughing, both her visual image and the sound of their laughter will be captured by the brain; if you now sit on a place where you cannot see her, but can still hear her laughter, your brain will know that she is still there, and, although you cannot really see her, your brain presents an image of her in your mind. In fact, the image will not be static, but it will even show her moving — laughing, in this case. Because we know how humans laugh — and we actually saw that woman laughing — the brain can fill in all details on your behalf. Uncanny, but true.

But it’s not real.

Now that’s the fun bit of the whole story. In fact, your brain can construct mental images of things that don’t truly exist, like the woman laughing in your back. Nevertheless, these images are plausible — for all purposes, the woman was laughing again. Is it really so important if she raises her left arm, as she did when you walked in, or the right arm? Or if her legs are crossed or apart? Such details are unimportant; the brain will merely pick a plausible choice (based on your previous experience in watching women laughing) as a ‘filler’, until you actually turn your head and look at the woman again: then you’ll give the brain a choice to refresh the mental image once more, and add more detail here and there.

It’s actually incredible how small the field of vision we’ve got where things are seen with the uttermost detail — in fact, if I remember my sources correctly, it’s not much more than the size of a coin. But we see everything sharp around ourselves! How can that be?

Be a little more observant. If you are really paying attention, only the region in front of your eyes, where they are momentarily focused, will be sharp and clear. Everything else will be blurred. In fact, near the edge of your vision, you don’t even get to see colours. But you still experience everything as being sharp and in colours. How can that be?

Even though we might think that our eyes are static and just focused on a single point, that’s not what happens (except, of course, if you are really focusing with intent and purpose, like reading a book or texting someone). The eyes are sort of doing a sweeping movement around you, with parts coming briefly in focus, and all this is added to the brain’s image of the surroundings. In a strange sense, your brain is sort of presenting you a ‘mental virtual reality’, where everything is sharp and in colour, 360º around you — even though that’s not what your eyes see. It’s what the brain constructs, very quickly, at a subconscious level, and it will constantly add data to that internal image. And, again, it can even calculate positions based on their velocity — speed and angle. To a degree: we evolved as creatures who are not able to run much faster than 30 km/h, so that’s pretty much the limit at which our brain can do all the calculations with precision. And that’s also the reason why we have car accidents — because the car travels much faster than what our poor brain can calculate and integrate in its visual memory of the surroundings. One reason why the Victorians were bedazzled with the first trains was that they were ‘so fast’ that the field of vision (except for what is immediately in front of us, of course) is constantly blurred; this created a lot of confusion in one’s perception, and could therefore result in dizziness, or nausea. We now laugh at all that, because, 180 years later or so, we’re so used to ‘high speed’, that although we are still biologically unable to process all data correctly at those speeds, at least we do not get dizzy or nauseated so easily. Or perhaps we do: as a child, I would always get nauseated when doing long journeys by car or bus. Strangely enough, trains do not have that effect on me.

So you can see that the brain is pretty much constantly ‘tricking’ you, making you see, or rather, experience a reality that you cannot actually ‘see’. Some of it is ‘real’ — what you’ve got in focus in front of your eyes. The rest is ‘fake’, in the sense that it’s just your brain filling in the details, based on what it has seen/heard/smelled, and how often you ‘refresh’ that information by moving your head (or your eyes) around. We scarcely give this ‘simulated mental reality’ a second thought (pun intended!), because we know that we can turn around and see if what is actually there corresponds to our mental image, and, therefore, confirm our expectations of what is ‘real’ and what is not.

There is, however, one particular object from which the brain gathers the most data and presents the most accurate image to you, all the time. And yes, you’ve guessed it: it’s your body.

You can stare out of the window, sitting on a chair, and technically just watching the horizon; however, your brain is constantly presenting you a complete image of yourself, in excruciating detail — so much detail, in fact, that you don’t even need to look inside your mouth — ever! — for your tongue to escape the sharpness of the teeth while you’re chewing your meals. The brain gets all sorts of data from almost all parts of your body, and all this is constantly being updated into the ‘mental body image’ that you’re being fed all the time. It’s even more than that: all your memories also include information on where your body was at the time. That’s why when you get to visit a place that you have only seen in your early childhood it seems ‘much smaller’ than the memory you had — because that memory was captured with information coming from a much smaller body, which of course distorts perspective, giving the illusion that everything was larger than it actually was. We get momentarily baffled with that; but, because our brain knows that we are ‘the same person’ as we were back then, it just compensates — ok, so, well, this place looks smaller, but it’s the same place, I know I have been here before because I have memories of it, and memories of myself visiting it.

Damásio (and probably others) call that the ‘memory of the autobiographical self’ — you can imagine it like a Facebook timeline, to which your brain is constantly not only posting 3D data of the environment you’re in, but also GPS positioning of your body inside that environment. And often it will add stupid details like if you were walking or running, or even what kind of clothes you were wearing. You can read Damásio’s books to understand better why we need such an ‘autobiographical memory’ — although I think it’s pretty obvious why we need a perfect, constant up-to-date mental image of our body: after all, we have to navigate in complex environments — from man-made cities to Nature’s densest jungles — and this means knowing exactly where each bit of the body is, so that we don’t hurt ourselves (or others…) when walking around. It seems logical and obvious.

What is not so obvious is that some neurologists believe that it is the ‘autobiographical memory’ of the brain that provides us with a sense of identity. This is not very easy to prove or disprove, but apparently there are a few humans where the memories of the autobiographical self stopped working. This will give that person the strange feeling that they have a lot of memories, yes, but none of them are ‘theirs’, because their memory of the body is not present. So it feels like you have memories from someone else; and, in turn, it also means that such people are often confused about themselves, or even fail to recognise themselves — most surely they will not recognise pictures of their earlier selves (since none of their memories preserve their bodies).

While this is an area of current research, and every year new things might have been discovered which invalidate all that I’m writing right now, there is nevertheless a simple experiment that you can make to show that the memories stored by the autobiographical self have at least something to do with identity: get from your parents an image of yourself as a newborn baby.

Can you identify yourself as a baby?

Most people will say ‘no’, and that is quite correct: at birth, you don’t have the ability to ‘know yourself’, and that somehow means that our autobiographical memories are still at such an early stage that they don’t capture much information from our bodies. Most certainly we will not recognise our own face at that age. As we become older, though, at some point the memories of the autobiographical self will ‘kick in’ with much better resolution, and that means that most people will recognise themselves from age three and upwards — because that’s an age when ‘a sense of self’ is clearly and unambiguously present (Damásio considers the hypothesis that the ‘self’ starts to be formed around 18 months of age).

Some of you might say ‘yes’, though. Is that at all possible? Maybe. I would believe it to be far more likely that you’ve got a ‘false memory‘. In other words: by having seen images of yourself as a baby so often, these get imprinted in your memory, and tagged as ‘you’. The same happens with descriptions of places and people that you might have met when you were weeks or months old, but because such stories have been told by your familiars so often — maybe with the aid of pictures or even videos! — you know they are ‘true’, and slowly these stories will be tagged in your brain as being ‘real memories’. In a sense they are: after all, it’s true that you were in those places and did meet those people. If you wish, these are ‘virtual memories’ of a past which you didn’t experience directly, but just second-hand, although your brain now registers such events as ‘memories’. But they are merely false memories, even if they do not feel to be false.

I have a good example of such a false memory: my mother had an older sister who died one year after I was born from breast cancer. I have two memories of her: the first is of her extremely high stiletto heels (viewed from an angle very close to the ground, where I did see nothing much beyond the heels and the legs), and the second is of a very elegant woman in a black minidress, looking like a much better version of my own mother, talking to her.

Now I know such memories to be false. They come from the many stories my mother told me over the years of her older sister, whom she adored. The two sisters did look vaguely similar, but my older aunt was petite — and was famous for her supertall stiletto heels. And she dressed quite fashionably for the time, spending all her money with her husband in parties. I don’t wish to bother you with the boring details of my family, but just give you the framework of stories that I have heard both from my mother, my cousins, and my mother’s younger sister, over and over again. And sure, I have seen some pictures of my aunt — not many, and all in black and white.

How can I be so sure that these memories of my aunt are false? Well… because they are in black and white, and I have no reference of where I was in such memories. My early real memories are in colour, and I know very well what I was doing that time. While the image of my aunt’s heels, seen from a viewpoint close to the ground, could conceivably be ‘real’, the image I have of her talking to my mother is obviously false. Of course I don’t know what they were talking about, because by then I didn’t know how to talk! Nevertheless, I’m pretty sure these are all images conjured up by my brain, long ago, and fakely impressed in my memories. They could have been real, though; and we carry with us all sorts of these ‘could be real’ memories. They are not exactly ‘imagination’, ‘fantasy’, or a ‘dream’… but come very close to that… but they are much closer to ‘reality’. It’s not easy to divide the line between both! But it’s also clear that the brain can easily be fooled to believe things that are not real, or, more frequently — especially on patients with dementia — brains can confuse and mix up ‘real’ memories with fantasies or dreams, and believe both to be equally true. Unfortunately, my own father suffers from a vascular dementia which makes him confuse some of his dreams with reality, and being very stubborn, it’s often very hard to make him understand that these memories he has are simply… false.

Identity issues… all sorts of them… including gender

So when does the juicy bit about transgenderism start, you might ask? Well, my point up to now was just to show a glimpse of what neurologists, psychiatrists, psychologists, social scientists, and even Buddhists, think of how the brain works. We mostly understand how it works when it doesn’t. Neurologists like Damásio are constantly coming up with the strangest cases of people with some sort of neurological disorder which makes them behave in the oddest ways; by patiently registering and recording all those ‘weird’ cases, we can create a model of how the brain must work, even if we don’t know precisely how it works (in a sense, we’re much better at explaining things than the Buddhists 2500 years ago, but we still don’t know everything!).

What seems to be reasonable to accept is that we build a ‘virtual environment’ inside our brain (or mind) from input coming from our surroundings (images, sounds, smell), which is much more than merely the sum of the raw input coming from our sensory organs. Such perceptions we have are also affected by what we know — e.g. from simple things like how a woman laughs to more complex details like how a building is made, so that we cannot ‘imagine’ weird things are happening behind our back… — so there is both a social and educational component in the way we perceive things. Edward T. Hall, in The Hidden Dimension, explains how different cultures and societies perceive their environment differently, and this induces them to have different interaction distances between themselves. Thus, while Mediterranean women will greet each other by kissing them on the face, men will generally just shake hands, even if they are well acquainted with each other; Russian men have no qualm in kissing other men on the face, too; Anglo-Saxon women will shake hands with each other, while men, if reasonably well acquainted, are allowed to hug; while such personal contact would be anathema in some Eastern societies, where people just bow to each other without touching themselves (of course, all this has changed in the 20th century…) — each society does it slightly differently.

It’s also reasonable to accept the need of having an accurate internal representation of the body, which the brain is constantly updating. While we might not be able to ‘see’ our internal organs (we can imagine them, though!), we have at least a visual image of our exterior, and even if we are not looking at ourselves in a mirror, we can, in general, have a very good idea on how we look like. Tracking where all our body parts are is actually fundamental for navigating in complex environments, even more so because we’re bipeds, and rather massive ones, and that means also tracking our equilibrium — which does rely on the ‘organic gyroscopes’ inside our ears, but also on visual clues of all sorts.

Body and environment are constantly being tracked, updated — and stored in memory, together. It is conjectured that these memories of the autobiographical self are somehow at the root of what we call ‘identity’. Buddhists meditate on how the body cannot be the identity, in the sense that there is more to identity than the body itself; and that we cannot find even an atom of ‘identity’ in the body, even though we have this perception that the body, in a sense, contributes to identity. Western researchers prefer to explain the need for this self-representation of the body — we need to protect it from harm — and this contributes to the notion that there is an ‘I’ which has a ‘body’ which needs to be ‘protected’. Such relationships are constantly present and are stored as memories, and so we have this idea that even though the body changes (we grow, we get ill, we get older…), there is a continuum of experience which relates the stored memories to the ‘self’ that we are today. In other words, because we have an autobiographical self, we ‘feel’ this ‘sense of self’ that comes from the experience of having all those memories intrinsically connected to the body we had at that time.

Let me state this once more: we know about many of these things because we can observe those extreme cases when such mechanisms are broken. Fortunately for us, such conditions are extremely rare. We can deduce from the rarity of such anomalies that these mechanisms are somehow crucial for us as a species. In other words: to be able to survive as a species, each of us has to develop a pretty accurate internal representation of our body and its position in the environment, as well as memories of past events where the body is positioned inside it. Because this is the norm and there are so many exceptions, we can assume it’s important.

Now of course there is some flexibility. Earlier on I said that our human reactions — the ability to ‘compute’ a model of the environment and be able to react to it in real time — was limited to certain speeds, because humans cannot run faster than that. But we can change this very easily: just put on some roller skates! Or jump on a bike! There, we have just doubled the speed at which we can move!

What happens when we first try these things out? Well, we all know it means a lot of falling and crashing into things and not being able to avoid obstacles. But, eventually, with persistence and training, we will manage to skate or ride a bike with little effort, and, in fact, we will be even surprised at how hard it was at the beginning.

While this might not be immediately obvious, what happens is that the brain adapts its internal representation to include the vehicle we’re now using. In other words, the bicycle becomes ‘part of us’. This is what allows us to navigate with a bike across complex terrain and avoid pedestrians on the sidewalk, because we can very, very accurately measure distances taking into account not only the extra speed, but also the extra length of a bike. In the case of the roller skates, we soon get used not only to the speed at which we can move, but also of the extra height; in fact, I remember that when I took them off after hours of skating, I would get a bit confused at first for being ‘shorter’ — the horizon moved, and my whole internal computations of my body position had to take into account the change.

And it’s needless to say that the same happens even when driving a car — even though the car’s sensors and back mirrors are not ‘connected’ directly to our brain, we use them as ‘extensions’ of our senses, and, over time, our brain gets used to them to further add to our internal representation of ourselves, as well as tracking our position in the environment; and, as you might imagine, events that happen while you’re skating, cycling, or driving a car will also include the vehicle. This is not surprising: you can think of the vehicle as an extension of your body, and every time you ‘use’ such a vehicle, your brain is also tracking things regarding the vehicle itself, and using the vehicle as a reference. In simple words: when you’re stuck in a traffic jam, your brain knows how close you can get to the car in front of you (and behind you…), even though such distances are meaningless from the perspective of your body. So your brain can readjust automatically and ‘think as a car’ if you wish — all distance measurements and speeds are now made in relation to the car’s exterior, and the way the car moves. And to be honest that’s utterly amazing in terms of adaptation, considering that are not supposed to have evolved to drive cars, or even ride horses (but hominids apparently are able to learn to drive some vehicles, and they certainly can ride other animals as well, so somehow this ability must have evolved over time)…

Of course, all of this ought to be obvious to you. Even if you never skated, or rode a bike, there is at least one experience you must have had at least once: grabbing a very heavy bag, especially one loaded with something relatively precious (i.e. a laptop or some food — anything that you know that will come to harm if dropped or if the bag hits something). You will have noticed how your brain totally compensates for the new bulk — and how you will avoid hitting walls and such, in spite of the bag ‘not being your body’. But your brain includes the bag into your overall internal self-image, and all calculations will take into account the bulk, the volume, the weight, the extra inertia, and so forth. The bag will become ‘part of you’.

Now let’s see what happens when a male crossdresses — especially when they go through the pains of using shapewear, a wig, and high heels.

Perhaps not surprisingly, you will have a differently shaped body. This is more obvious if you — like me — are fond of shapewear (because it sits so tight to your own body), but I’m pretty sure the same happens if you don’t use it (because at the very least you will be using clothing that is different from what you wear every day — and possibly a wig, as well as higher heels than usual — and that clothing will have a different texture, or sit tighter, or, well, be different in a more subtle way).

What happens? At the very beginning (and this certainly happens to me every time I dress up!), your brain will register the difference, and find it ‘anomalous’ — in the sense that these are not the usual sensations you get when you dress as a male. I can truthfully say that, during the first minutes — let’s say that this can go on for about an hour or so — I’m quite self-conscious about how tight the corset might be (chafing at certain spots in my skin, for example), just to give an example. Or how the wig’s hairs are tickling my neck — a wonderfully pleasing sensation, by the way! All this gets registered by the brain because it’s unusual, in the sense that the brain is ‘not used’ to have to deal with all those ‘new’ sensations.

As enough time passes — and of course this time becomes shorter, the more I dress up — then the brain somehow ‘switches’ to a different state. I cannot really describe it in detail, because I’m not paying enough attention — that is, I’m not aware at the precise moment when this happens. All I know is that, all of a sudden, my brain stopped registering ‘unusualness’. My best shot is that this happens around the time I’m driving away from home, and it’s consistent with the whole theory: after all, I have to ‘adapt’ to driving a car, which, as said before, ‘becomes an extension of me’. Somehow, because the brain now has to deal with the much more important issue of ‘driving a car’, it seems to ‘forget’ that all my shapewear, the silky clothing, the wig and so forth, are ‘unusual’. When I pay attention to myself once again — perhaps a few minutes after being on the motorway, especially if there is not much traffic to distract me — the whole sensations have changed completely: now that the corset has warmed up to body temperature (as well as the silicone breast forms and hip pads), it ‘feels’ as a part of myself. This pretty much happens to everything I have on as Sandra — even the clip-on earrings which sometimes hurt the ear lobes so much — and it’s almost uncanny how quickly my brain adapts. But perhaps I shouldn’t be surprised: isn’t it exactly what happens when you go skating, cycling, or, well, driving a car?… You don’t want to go through all the incredibly self-conscious experiences during driving lessons! It’s only natural that your brain adapts so quickly!

On my early articles, from several years back, I liked to write about how ‘natural’ it felt for me to ‘be Sandra’, and how easily it was to ‘slip’ into Sandra-ness — in the sense that I wouldn’t even think much of walking in high heels, or if my gestures were ‘naturally feminine’, and so forth. My latest fascination, for instance, was how quickly I adapted to long fingernails — not only when picking tiny objects, but also when typing fast on the computer, and so forth.

Well, I believe I was being a bit naïve. I somehow assumed — and now I can see how wrong I was — that all of these small things were a sign that there was an ‘innate femaleness’ in my brain. In other words: I felt those things to be ‘natural’ because, well, I’m supposed to identify as a female, and those little things are natural for a woman.

As you can see, once more, things related to the body start influencing our mind. In other words: because our brain is so good at adapting to ‘extensions’ to our body, and make them our own, we generate an inner self-image of our ‘new’ body (in the sense that our femme look is different in many regards from the usual, everyday male look), because that’s how the brain works, and it’s this self-image that now becomes the locus of what we identify with. In other words: now that we wear female attire (and shapewear!), the brain will give us a strong sensation — an unshakeable one, in fact — that this is what our ‘identity’ is. I put ‘identity’ between inverted commas because we must now differentiate between two kinds of identity:

  1. The ‘identity’ that happens at a subconscious, or semi-conscious level: the brain needs to continue to update the autobiographical self with memories, but it has now a ‘different’ body to deal with, and it’s this ‘different’ body that gets registered with those memories. This means that, from the moment we dress as females (especially if that involves a lot of differences!), the brain will now assign our ‘female body’ (or the ‘feminised body’ if you prefer) to those memories. Remember that what we ultimately identify as ‘self’ is the continuum of those autobiographical memories: we now have a rupture with the memories of ‘we as male’ and ‘we as female’, because a part of our experiences are gathered while we are dressed as female. So our brain has two sets of memories attributed to the autobiographical self: some are part of the ‘male continuum’, some are part of the ‘female continuum’. Both, however, are experienced as coming ‘from the same person’. (It’s actually a bit more complicated than that; see below.)
  2. The identity (without inverted commas) which we experience as a conscious level. As said, this is a strong sensation that comes from the sequence of memories captured by the autobiographical self. Unless our brain is seriously damaged (as Damásio found out!), we have no choice but to identify with the body (and its ‘extensions’) captured in those memories. This is so important that I will state it again: what we experience as identity comes from the sequence of memories captured by the autobiographical self, a mechanism that our brain does automatically and over which we don’t have much influence — except in changing the body so that the memories are recorded with a different self-image. The sequence of all those self-images in our memories is what we effectively call identity, or, perhaps said in a different way, this is what we experience as identity.

In other words: identity (again, without the inverted commas!) is a deep feeling we have, which is partly (but most definitely it’s a big part!) assigned consciously to the sequence of memories we have with our bodies. As the body changes (due to aging, disease, etc.), different self-images are recorded with those memories. Nevertheless, the brain continues to tell us, subconsciously, that ‘it’s the same person’, that is, you.

Naturally enough, this ‘sense of self’ — what we might call identity — has to take into account the different body modifications we have. It’s not only growing up and aging that produces different self-images in our memories. It’s also when we skate, cycle, or drive a car — or even when we carry a bag on our backs. In all those cases, not only the brain has to take into account the ‘body modifications’ — for the purpose of equilibrium, for deciding how to walk/move, etc. — but also because such body modifications, or extensions, will be recorded on our memories by the autobiographical self as well. But our brain needs also to let us know, at a conscious level, that these memories come from the same person (i.e. ourselves). Just because we wear a hat, we cannot suddenly experience being a ‘different’ person, and get hopelessly confused (and yes, in those people where the memory recordings are broken or deficient, such confusion may actually happen!).

There is, therefore, a threshold within which the brain still registers as ‘being the same person’, and as you can see from the many examples, the brain is quite liberal in stretching the definition of ‘self’ by allowing all sorts of ‘extensions’ — even piloting an Airbus A380, currently the largest commercial airplane in operation, and possibly one of the biggest ‘extensions’ you can ‘add’ to your self-image, will still produce the same ‘sense of self’. Pilots still identify with themselves when piloting such a huge aircraft.

But of course there must be thresholds. For instance, if a mother is picking up her baby, this means that the brain also has to compensate for the extra weight, make sure that the mother doesn’t bump into walls with the baby, and so forth. So for the purposes of calculating balance or the space around you, the baby has to be taken into account. However, when such memories are registered, the brain knows very well that the baby is not the mother. Those memories will be registered with the mother’s self-image plus the image of the baby. There will be no confusion. Sure, the mother will have a ‘sense of motherhood’ in those memories, but there will be absolutely no mixing up between her and her baby. The same, of course, happens with a pair of dancers, who have to precisely coordinate their movements together: again, the brain needs to take into account all the complexities of a bipedal organism executing movements that tax the balancing mechanism, with the extra complexity of having to deal with a second person doing complementary complex movements as well. The memories, of course, will feature both dancers — but each is completely aware of their own body in those memories. What might linger is a ‘sense of dancing-ness’, but not more than that. And, finally, and obviously enough, the same applies to sexual activity in bed: note how we have even inherited so many expressions like ‘two bodies fused into one’ and similar concepts to express this idea: two partners, sharing the most intimate experience that human beings can have, will have their self-images in their memories so close to their partner’s images, that sometimes it feels that both are ‘fused together’. We can still separate both, of course, but there is the sensation of the strongest bonding that humans can feel between each other (at least, humans who are not related to each other — one might conjecture that the mother/child bond is even stronger, for exactly the same reasons).

And, similarly, most cisgender people (if not all, per definition) will assign all the attributes typically associated with one gender to one’s own internal body representation. Even though, as a child, we lacked all secondary sexual characteristics, we nevertheless still know that this young child, with whom we identify (we’re ‘the same person’), is ‘male’ or ‘female’ — even if, from an external point of view, and most likely from the point of view of our own memories, we cannot really explain why that almost-genderless person we were at some point in time was labeled as ‘male’ or ‘female’. However, we will still be able to say: ‘because in my memories I was wearing boys’ clothes, a boyish haircut, and went to toilets for boys’. This, in fact, is exactly how we are sociologically conditioned (and reinforced in that conditioning) in ‘thinking gender’ from our earliest days; in fact, our gender identity, which is usually stable for most (cisgender) people, is a complex mental construct — part of the identity we build from the memories of our autobiographical self — which starts relatively early, not with our sexual organs (because they were so immature and underdeveloped at that time), but much more likely because of one’s external associations with gender. I’m not saying that ‘gender’ is merely a side-effect of certain memories we have; that would be an oversimplification. No, instead, what happens is that we have a sequence of mental images in our memories, in all of which we present according to the gender we were assigned at birth; such presentation is, naturally enough, determined by social circumstances and the epoch and society we live in; but we accumulate those memories, and, since there are clear (social) differences bestowed upon the two classical genders, the result is that the identification with one of them becomes part of our identity. In other words: it’s not merely identity tied to the body itself, but also to a lot of mental and social constructs we have been exposed since birth: we are taught that we are humans, that we belong to a certain ethnicity, country, and so forth. All our memories are tagged with such descriptions, so, over time, they become ‘true’ parts of our identity. In other words, it’s not natural for a human being not to feel to be a human being, even though the concept of what a human being is and what it isn’t is mostly a mental construct, based on external observation of certain attributes. Gender is not different: because we learn that certain attributes ‘belong’ to one gender and not the other, recognition of such attributes result into the identification of which gender we are, and that will ensure that we pick the ‘right’ (opposite) gender to procreate with. Felix Conrad, naturally among others (most prominently Charles Darwin himself) proposes that the ability to recognise one’s own gender and those of others is a crucial evolutionary advantage (it means not wasting time to figuring out with which potential partners sex will ‘work’ for reproduction); I will not repeat what I have said before in other articles, just mention that the reason why our brain attributes a ‘sex’ and ‘gender’ to ourselves and others, even though those are merely social constructs, is mostly because we are supposed to figure out with whom to have sex with in order to procreate. So, figuring out one’s gender and the gender of other people of the same species of homo sapiens becomes a crucial evolutionary step. And the ‘best’ way to make sure that we know with whom to partner is to tag one’s ‘gender’ to one’s identity — precisely what the brain does. That’s also why so many cisgender people have a difficulty in understanding how one’s gender identity can be different from one’s observed gender attributes; that’s because, in cisgender people, there is a one-to-one correlation between such attributes and the consequent gender identity. We will shortly see how messy things can become because of that.

Now, if you have been closely paying attention (and I’m sure most of you are asleep by now!), you might have noticed that the brain clearly seems to attribute ‘identity’ to the body, but… there is some flexibility in that attribution. If you’re rollerskating, you + roller skates = still you. Ok, a slightly different you, and a ‘you’ that moves much faster, but it’s still you. Like your ‘you’ from yesterday is slightly different from the ‘you’ today, but your brain still registers both as ‘the same you’. Or almost the same. That’s irrelevant: sure, yes, minor differences here and there, yes, but you’re still the same you, for the purposes of your brain. More to the point: the autobiographical self will continue to update the same set of memories with a representation of ‘your body’ and will still tell you that you’re the same person, even though each of those representations will be slightly different from each other.

You can see the trap you’re falling into?

When ‘you’ is not ‘yourself’ (= ‘your self’)

Let’s get back to the strange neurological disturbances. One way to look at body integrity identity disorder (BIID) is to conjecture that, in some obscure way, the autobiographical self is writing ‘errors’ in the memories. Even though I have no scientific proof to make this claim, I believe that what happens with BIID is that the autobiographical self is updating those memories with the wrong body representation. In the case of apotemnophiliacs, there is a clear divergence with one’s body and one’s internal representation of it: limbs or part of the body feel as if they are ‘wrongly’ there, and there is a strong desire of getting rid of them. In other words, one’s identity is at odds with what the brain (visually) perceives to be one’s body: there are ‘extra limbs’ which are not in the internal body representation, and, as such, the brain ‘rejects’ them altogether — at a conscious level, this manifests itself as an extreme desire to get rid of such limbs or parts of the body, an urge which becomes obsessive (since childhood at least) and extremely uncomfortable, to the point that apotemnophiliacs are prone to self-harming themselves in order to get rid of the unwanted members. This behaviour is very likely not simply psychological in nature, but also neurological: in other words, yes, there is something wrong with the brain, which is unable to correctly register/update the internal representation of the body with what’s actually there.

Not surprisingly, such a condition has been compared to Body Dysmorphic Disorder (where one perceives themselves, or a part of themselves, to be excessively ugly or deformed, in spite of strong evidence to the contrary), where the urge or desire for corrective surgery is at similar degrees of intensity, and clearly the same is happening with the autobiographical self: the internal body representation is being updated with a different image than the one seen on a mirror. We can also see some types of eating disorders, such as bulimia nervosa, where one’s self-image, as registered by the brain at the level of the autobiographical self does not correspond to what is actually seen. Even though such people can be pointed out that there is nothing wrong with their bodies — i.e. they are not ugly nor overweight — and logical and rational arguments, with factual information, can be brought up to substantiate that claim, those people, no matter how logical or rational or intelligent they are, simply cannot perceive themselves in the way others perceive them. In other words, the mechanism that conveys identity is ‘broken’ in the sense that it is recording memories with a wrong body representation, and this means that the person is at odds about what the autobiographical self tells them how they look like, and what they see in the mirror: clearly there is a strong difference, and there is an urge as strong to deal with it — lest ‘discomfort’ turns into anxiety and depression.

As stated elsewhere, I actually can understand that quite well. In my case, I have a very mild form of body dysmorphic disorder, which, to be honest, I have pretty much ignored for thirty years — that’s why it’s clearly a very mild form. In my teens, after getting rid of my shyness in order to attract a girlfriend, I noticed that I still didn’t get one, even if the shyness was gone. Incorrectly, I thought that I was simply physically unattractive, end of story, and there was nothing I could do to compensate for that. Looking back, of course it’s now easy for me to pinpoint the traumatic experience of a teenager, desperate to get a girlfriend ‘like every other guy’, to conclude that their appearance was repulsive (the only plausible explanation after eliminating the alternatives); naturally enough, I had to accept my ‘destiny’ of having to live inside an ugly and repulsive body for the rest of my life, and this acceptance actually happened quite quickly — before high school was over, I was already completely surrendered to the idea that I was a very ugly person, and, naturally enough, when watching myself in the mirror, I would find all those flaws that people (in my wild imagination) would deem as being ugly.

Because I live in a country where politeness is the norm and not the exception, when people complimented me on my looks, I just smiled and thanked them — but never really thought much about the ‘compliment’, since I always assumed it was done out of politeness, and not with sincerity.

Not much later, in my mid-20s, when I did my first crossdressing experiences — already pretty much resigned to be ugly forever — it dawned on me that when I had all that makeup on I was actually quite attractive — to myself, at least. If you have followed me across several social media until the early dawn of this blog, you might have noticed how enthusiastic I was about the power of makeup, which could transform dramatically someone who was ugly into something resembling ‘normality’ if not even ‘attractiveness’. Because there had been inside me a decade-long desire of somehow overcoming my ugly looks (I grew a beard for a while, long before it became fashionable, in a misguided attempt to hide the worst of my face; but eventually I had to give the beard up, because crossdressing became far more important to me than what I looked like every day), anything that restored the hope of eventually rising above my sea of ugliness was very, very enticing and alluring — even erotic!

What is not so obvious is that this feeling did not last long. Now, of course, when I apply reason and some knowledge to analysing the issue, it’s all quite self-evident: people with body dysmorphic disorders are not allowed any surgery to make them ‘look better-looking’ because it will never be enough. They quickly become ‘surgery addicts’ and start changing things on their faces and bodies over and over again, but never truly finding relief (see what happened to Michael Jackson). The correct procedure to deal with BDD is to do therapy to learn and accept that one’s looks are not what is perceived, that there is nothing wrong with their bodies, and therefore there is no point in doing any kind of surgery.

So it’s not surprising that a ‘little makeup’ would not be ‘enough’, at least to have a long-lasting effect. Sure, I could partly disguise my ugly nose, but there is a limit to how much it can be hidden; and after learning some contouring basics, I was momentarily euphoric, as it seems that I could achieve rather convincing results. But, at the end, my brain keeps falling back to the traumatic experience, and no matter what technique I use, the makeup will simply ‘camouflage’ the worst of my ugliness, but it can never eliminate it, at least in my eyes.

For decades, as said, I was pretty much resigned to that experience. I didn’t even realise what ‘body dysmorphic disorder’ truly meant, as I did not consider that label to fit me: some people are really not good-looking, and that’s the end of it. So it actually came to me as a big shock when I realised that many people were not really complimenting me because they were polite, but because they really meant it.

It still feels very strange that so many people really like the way I look; there is a ‘rebellion’ inside my brain about that, because such a thought is actually unacceptable to me. It’s not that I think that people are deliberately lying to me, with the best of intents; it’s just that I have such a certainty about the way I look that I reject any other comment which goes contrary to my convictions! But, of course, now I’m fully aware that this is a problem I have: when everybody else is saying the same thing and only you disagree, the chances that you are wrong and the others are right are very high! In other words: it’s just crazy people who believe that everybody else is crazy and that they are the only sane ones. When you experience such a perception… then it’s almost certain that you are wrong.

So I go ahead in my life, baffled about the incredibly strange way people perceive me, which is so completely different from what I see in the mirror, that it is really, really hard for me to ‘believe’ that I’m the only person who is wrong! Nevertheless, I’m lucky that I just have a very mild form of BDD — in other words, I really don’t think much about it, I never felt the urge to go through intense surgical procedures to re-map all my face (even though I always wanted to do so, if I had enough money!), and because I had resigned myself so early to being ugly, it never really affected the way I related with other people, and never was really a ‘handicap’ or a source of worries. Now that I’m aware that my perceptions of myself are different from those of other people, I’m baffled, sure, but I’m not in denial, nor going through extreme confusion, just merely accepting that perceptions differ, and, in this particular case, I’m the one who has the wrong perceptions.

I can only imagine how hard it must be for those affected with severe cases of BDD, but one thing is for sure, if they cannot handle the way they look, BDD can truly become an incapacitating disease. To make matters even worse, it will be mixed up with ‘vanity’, and often disregarded by others, even close friends and familiars; but it has nothing to do with ‘vanity’, just with wrong registrations in one’s memories. There is just a broken autobiographical self who registers an imagined ‘version’ of ourselves, and this ‘imagined’ version looks different enough from what we see in the mirror that there is a strong sense of discomfort (in my case, the autobiographical self is recording memories featuring Ugly Me in the starring role; it feels like what I see in the mirror is Fiona the Ogress, but everybody sees Fiona the sexy princess).

If you cannot truly understand how someone can see a ‘different’ person when a image on a mirror ought to be crystal clear and identical for everybody… well, you’re not alone. In fact, that’s pretty much what happens with many cisgender people when they start talking to a transgender person for the first time, trying very hard to understand what is going on in their minds but not really ‘understanding’ (in the sense of being able to acquire enough information to make an empathic connection). I can see that clearly with my wife, for instance. Because she is an eminently logical and rational person, she can understand what I feel as a transgender person just up to a point, that is, as far as logic and rationality go. But there is always a ‘jump’ made from one level to the next — i.e. ‘feeling to be a woman inside’ and ‘taking unnecessary risks by dressing up as a woman and going out to public places’ — where there is a certain amount of irrationality. I cannot explain what I cannot understand myself: either the answer is very simple (‘because I love the adrenaline rush!’) or very complicated (‘going out in public as a woman and interacting with others who treat me like a woman gratifies my ego and rewards my efforts at revealing myself as the person I think I am, and yes, that sometimes means taking a little more risk, but it’s well worth the effort for the sake of my sanity’), but, whatever the answer might be, it cannot be answered by logic alone.

There is this old saying about how you know that you’re crazy: it’s when you perceive everybody else as being crazy. In other words: even though all our perceptions will be different, it’s hard to logically continue to argue for one’s own perception when everybody else perceives a different thing.

As I try to apply this logic to my own issues (namely depression), it has become clearer and clearer how often I believe to be ‘the only person who is sane’, or ‘the only person who is right‘. In fact, these are crystal-clear signs that my perceptions must be incorrect; at the very least, I should be the first to question them. In other words: we human beings have a natural tendency to ‘believe’ that we are right and the rest of the world is wrong. We often find people sharing that belief, and then we become polarised: ‘we’ are right, the rest of the world is wrong. One possible reason for the outcome of the USA 2016 elections (and the Brexit referendum before that) is that certain people (Trump, Farage, Johnson… and these days, Marine Le Pen and others) suddenly started repeating what a vast majority of people thought, but were afraid to voice out publicly, because they thought they were the only ones thinking that way. In other words: even though we have this tendency to believe that we’re the only ones that are right, we are also trained to look at the definition of insanity and learn that we cannot be always right alone. Our strong convictions must be shared by others (preferentially by many others), or else we must question why we believe something nothing else believes. You cannot be a fundamentalist and remain sane at the same time: either you’re an insane fundamentalist, or you are part of a group of fundamentalists which happen to share the same opinions. That means that radical, extraordinary, out-of-average thought needs peer validation — or else it’s just plain insanity. Or at the very least it’s just a fantasy, just wishful thinking.

This is what pushes trans* people so hard to find a ‘community’ — that’s how they can validate that they are not insane, they are merely expressing a borderline case of diversity, but one that is shared by millions and millions of people around the world. I remember quite acutely the first time that I wore women’s underwear — I was absolutely sure that I was insane, simply because nobody I ever knew had ever done what I did, or felt what I did! Trust me, I was really worried! And this reaction is absolutely normal for homo sapiens: as a gregarious species, we need to act and behave according to how our ‘tribe’ acts and behaves, or else we suffer alone; if one’s behaviour departs too much from the way the ‘tribe’ behaves, then we feel uncomfortable about it — that’s supposed to be the way we humans ought to feel (and no, I won’t repeat what I have already written on the subject before!).

So… to recap… when a trans* person, wherever in the spectrum, suddenly becomes aware that they are not like other people — they think, act, behave, dream differently from what the average person does — there is a ‘sense of wrongness’. One’s so-called ‘self’ is ‘confused’: we don’t know what to do about ourselves (‘our selves’!), because we clearly ‘don’t fit’. Where, exactly, is our ‘true self’? Why must we hide it? On the other hand — why must we pretend in front of everybody else that this ‘true self’ doesn’t exist?

It’s partially by finding elements of the trans* community — or at least meeting with scholars or even doctors — that there is some reassurance that we’re neither insane nor mentally ill — and this is crucial for us as human beings. We need to somehow ‘belong’ to a group which tells us that what we are — what our selves are — is perfectly natural, normal, and acceptable. The kind of empathy that has been denied to us — to the hidden self — is what we get when we connect with each other, with researchers, doctors, any kind of allies of the trans* community: they erase our fears, they validate our existence as ‘complete’ human beings, they make us feel whole in a way that we have not experienced before.

This, in turn, allows us to express (or manifest) our ‘true selves’ — because we now are comfortable in doing so. The way this ‘self’ is expressed/manifested follows certain ‘tribal rules’, and, as such, our evolution-conditioned gregarious mechanism of ‘belonging to a tribe’ is satisfied. Within the community we blossom and thrive; so much, in fact, that we can even go beyond the community in safety, now sure that ‘we’re not the only ones’ — but merely part of a fantastically diverse group of human beings who just happen to have other values, other behaviours than what we would call ‘mainstream’ or ‘average’. In fact, once we have acquired enough self-esteem and confidence in expressing ourselves as we are (as opposed as how ‘others’ wish us to be), many trans* people might even completely blend in the mainstream and become invisible — this is one of the many things that makes the researchers’ task of elaborating statistics about trans* people so hard: so many are able to ‘blend’ and disappear, drop out from the trans* community, simply because they are now perfectly able to be accepted by the mainstream cisgender community as ‘one of them’ that they don’t need to rely on the trans* community any longer. It’s a bit weird, yes, but some trans* people need to be part of the community while they are going through their process of self-discovery, but, sometimes, once they have completed their process, they move on — leaving the community behind. This is especially true for the most passable transexuals, for instance (but there are more such cases).

Anyway, I’m slightly getting off track…

Cortical (sensory) homunculus (Source: Wikipedia)

Gender dysphoria can be seen, or presented, or even explained, as a ‘special’ kind of ‘autobiographical malfunction’, in the sense that the internal body representation (also known as the cortical homunculus) does not match exactly with the body as it is in reality. It is much more complicated than what happens with body dysmorphia, although naturally a certain parallel has (in the past) been drawn between both. With gender dysphoria, the problem is not in the body itself, but rather in a more abstract and complex concept, that of gender, which is a social construct based on certain yet-to-be-confirmed physical characteristics of the brain — in other words, the notion of gender identity as ‘truly existing’ is something that, unfortunately, remains a scientifical conjecture, since it is the easiest explanation for what is actually going on, but, so far, we don’t have 100% empirical evidence that it works as we think it works.

Nevertheless, the notion of gender identity can be inferred through a logical process known as induction, which I love to bring up, because it annoys a lot of fundamentalist, profoundly logic people — who tend to argue that only ‘deduction’ is a way to obtain ‘scientific proof’ of theories. They are just partially correct: we can obtain such proof using logic, and, in that case, there is deductive logic, abductive logic, and inductive logic. The latter is more interesting because it does not give us a ‘100% certain proof’ but still allows us to elaborate hypothesis that give a probable explanation based on partial data. That is what we humans actually use most of the time for our daily lives — for instance, if we see smoke, we can assume that there is a fire somewhere: even though there are other ways to have particles in suspension that look similar to fire-induced smoke, but that are not smoke — just think about e-cigarettes, for instance — but in most cases, smoke will come from fire. So, inductive reasoning, even if not precise and absolute, can give satisfactory answers to many issues, and, as a survival strategy, it’s often better to trust to induction (and be wrong) and survive! (Nobody will annoy you if you think there is a fire because you quite clearly saw smoke, dialed the emergency number, and then tried to escape!)

Induction is, unfortunately, very often confused (sometimes deliberately so!) with what people call ‘insight’ or ‘intuition’. Wrong! Those two refer to a different mechanism when our emotions compel us to ‘believe’ that one answer is better than another, without any factual evidence to support that answer: ‘I’m right because I feel I’m right’. Induction, by contrast, works only with factual evidence — it’s just that it’s incomplete. Nevertheless, based on that factual evidence, we can still elaborate good explanations about what is going on. Insights or intuition — emotion-produced ‘answers’ — have really nothing to do with logic or rational thought, and while they might be right some time, this is more often due to luck than anything else (remember, by throwing a coin to get a yes/no answer to a complex question, you will be right half of the time — which is not too bad! — but that’s simply not good enough).

So, back to gender identity. As far as I can understand some of the elaborate definitions that I have been reading for the past two decades or so, it seems plausible that we can infer the existence of some kind of mechanism in the brain, affecting the higher cognitive levels, which take into account our internal body representation, recognise its sexuality, and, as a result of that, places ourselves (as well as any other people we observe) into one of two possible social gender groups. As I mentioned elsewhere, even small kids who have no idea what is ‘proper’ social behaviour for the genders will know that they want to be ‘part’ of one gender or another — without anybody telling them so. Boys will want to play with boys; girls will want to play with girls; even if such kids, when asked why they want that — or even if they know what games they will be playing — they might not know the answer at all. They might at least point to their clothes and haircut and say: ‘I’m a boy, so I want to play with other boys like me’.

As said, we are good at recognising gender — and assume that it’s tied to a specific sexuality — because that’s how the human species managed to reproduce and populate the whole planet. We must therefore have an inborn ‘gender recognition system’: something which checks for subtle patterns (some of which are socially conditioned — like a preference for clothes and hairstyles and certain colours — but others which are not, like secondary sexual characteristics, even if we, as very small children, don’t know what these are for) and immediately — and infallibly! — attributes the ‘correct’ gender to that person. As we see ourselves in mirrors and check for the same patterns, we assign ourselves the ‘correct’ gender as well, and that happens when we’re very, very young. We don’t need to learn that we ‘belong’ to one gender or another; over 90% of all humans will instinctively know the gender they belong to.

Well, ‘instinctively’ is one of those words that contemporary biology has a problem with, because it doesn’t mean anything but that some areas of the brain are supposed to have been ‘wired’ together in advance of our birth. We know now that things are way more complicated than that, and as we progress upwards the Life Tree towards more complex species, we know that not all neuronal connections are pre-wired before birth. Most, in fact, are not. We need to learn things in order to get those connections working. And this is not just with humans; even dogs and cats need to learn how to play or how to use the litter box; they most certainly learn how to react to sounds, to the environment, what they can do and what they are not allowed to do. A very young cat does not even know how to trigger the self-cleaning reflex; they will eventually learn it from their mothers, or from other cats who will lick them clean. It’s actually fun to watch how the little kittens learn all those things 🙂 We would expect that much more behaviour would be wired-in, but it’s not: they will need to be taught, either by their mothers, other cats, eventually even by humans. House-bound cats, for instance, ‘learn’ how to meow in a way that the humans take notice of them; feral cats rarely meow (they are, after all, silent predators…), except when very young to attract their mothers. So our pets — in fact, most domesticated animals — have not only been bred for certain physical characteristics but also for some of their mental ones: in short, they will learn how to deal with humans — a completely different species, and a very dangerous predator! — and adapt their ‘animal behaviour’ in order to be able to interact with us. And yes, that happens even with chickens, possibly one of the less intelligent birds out there 🙂

All right, so we know that we humans are naturally predisposed to correctly identify our own gender, and to identify the gender of others. All the rest — how exactly each gender presents themselves socially and how they behave and interact — is socially conditioned. But at the core of all this social behaviour and presentation is something much deeper and profound, and that is what we can assume to be ‘gender identity’.

What happens if someone looks at their body in a mirror, perhaps for the first time, and suddenly realises that the body belongs to the ‘wrong’ gender? In other words: one’s ‘gender recognition system’ most certainly works well — they can still identify each gender — but it gives a ‘false positive’ towards one’s own image: even though that person knows they belong to a specific gender (because the inborn ‘gender recognition system’ tells them so), they also know that something is very wrong with the image staring out of the mirror, since it clearly does not belong to the same gender.

I’m simplifying the issue, of course, because I’m leaving out a lot of possibilities — like not recognising one’s gender at all, or recognising one belongs to both genders at the same time, or to none, or to a specific gender according to the mood, the hour of day, etc. etc. etc. My point here is to illustrate the simplest case and assume that the most complex cases — which are also rarer — are merely elaborations of the same mechanism ‘gone wrong’.

‘Recognising’ the ‘wrong’ gender in one’s body, by itself, is not gender dysphoria, even though it’s a form of transgenderity. Gender dysphoria happens when the difference between one’s gender doesn’t match one’s body and causes suffering (from mildly annoying to extreme suffering leading to suicide). It’s important to say things that way, because the implication is clear: for people suffering from gender dysphoria, gender comes first, the body comes next. In other words: it’s quite important to understand that gender dysphoric individuals will see their body as flawed, not their minds. This is not only reasonable to admit, but it follows the same mechanisms that happen with body dysmorphia and body integrity identity disorder: the person afflicted is aware that their mind, as well as their internal body representation has no problem whatsoever, it’s just their body that is flawed and does not match with the internal representation. In the case of gender dysphoric people, it’s not only the body that is ‘wrong’ but the body’s gender which is wrong as well — and this, in turn, will also mean that the body’s sexual organs are not aligned to the gender identity either, which will cause conflicts at least at puberty — but, as we all know, such conflicts tend to start much, much sooner than that, especially in this age when we are able to get access to so much information. In other words, even young children start to understand at a very early age how their bodies will change — unlike in past centuries, when such things would be mysterious and not talked about — and a transgender child will very likely be scared of such a change, since it clearly will be in the wrong direction.

Why is a transgender person so sure about their gender identity?

My own conjecture is that not only our ‘sense of self’ comes from the sequence of memories written by the autobiographical self, but also our ‘sense of gender’. In other words: the body representation that is written to those memories is not merely ‘my body’. It has a gender and a sexuality tagged to it as well.

With gender dysphoric people, there will be a real problem with such memories, since they will be tagged not only with the wrong body, but also the wrong gender as well. In other words: transgender people’s memories are forced to be registered forever with the wrong gendered body. This causes suffering — constantly so, since the autobiographical self works 24/7, even if we might not recall all our memories.

My reasoning comes from a common narrative among post-op transexuals, who, even if their resulting surgeries rendered their bodies exactly matching the gender they identify with, and they will lead perfectly normal lives in that gender role, they will nevertheless regret not having had a childhood in the correct gender. And such memories cannot be re-edited. Because this narrative is so frequent, it looks to me as reinforcing the conjecture that the gender identity is something that needs to be closely tied to the autobiographical self. It’s not merely obvious that the internal body representation is gendered; it ought to be obvious that all our memories get a ‘gender stamp’ — if I might call it that way — as well.

Thus, what a transgender person has in their autobiographical memories is a sequence of events in the past where there is a different representation of themselves (including a representation of their gender) than what they can see in the mirror. And here we can have several possibilities, all of them probably leading to the same result.

Let’s see a few examples. Suppose that a certain person has a gender identity of ‘male’; their ‘gender core’ identifies with ‘male’ and there is no doubt about it. However, their body is clearly female; and their autobiographical memories, reaching into the distant past, are all female as well. What happens here is that the autobiographical self is registering the internal self-image correctly (according to the external physical appearance), but both the current self-image as well as all the memories in the past are wrong for that person’s gender identity: they feel a deep feeling of rejection, towards their past and present, because their own brains are conspiring against themselves and the gender identity they have.

A different possibility is that the brain’s self-imagining processes — the updates it does on the cortical homunculus as well as the registration of the memories — is completely aligned with that person’s gender identity. In the example given before, this would mean that this person would have an internal representation of themselves as male, and all their memories in the past would feature that internal representation — in other words, all memories would be of that person as a male, and the continuum of all such memories would strongly reinforce a ‘male sense of self’. Nevertheless, when that person looks at himself in the mirror, the body is of a woman. This makes no sense for them, there is shock and surprise, and a refusal to believe in one’s own eyes. It will also make them feel that there are body parts missing, and other body parts that simply shouldn’t be there. This looks very similar to the ‘phantom limbs’ present in amputees, as well as the ‘undesired limbs’ experiences by apotemnophiliacs — such a person, in fact, would experience both at the same time, and it’s quite clear for them that their body is nowhere near what they internally feel that it should be. The dysphoria comes from the deep discordance between one’s internal representation (and memories) which is at odds with what the senses actually perceive.

Another alternative, of course, is a mix of both — sometimes the person gets a ‘wrong’ internal representation, and one that even gets tagged into the memories of the auto-biographical self; and sometimes that representation is actually correct for the body they have. This can produce all sorts of dysphoria — not being sure about one’s gender identity, for instance; or being very sure of it, but being clueless about why some of the memories are simply ‘wrong’ for that gender identity. But it can also produce very healthy transgender individuals — those that are genderfluid, gender oscillating, genderless, a different gender, or a mix of both male and female. In other words, the fact that the brain ‘sometimes gets it wrong’ (from the perspective of what the external biological body looks like) is not a reason for concern for those people, because they expect it to happen in their particular case of transgenderity.

And we should never forget that all the above can be felt in different intensities, from very mild to such a high level of intensity that suicide is the only option to deal with the dysphoria. Again, nothing, not even this description of the autobiographical self, ought to be taken as ‘black and white’, but always, always, as points in a spectrum.

I can obviously only give my own example — I know that many will find similarities in it, but the experience of others will be completely different, and none is ‘better’ or ‘correct’, all are possibilities in the vastness of the transgender spectrum.

For instance, in almost all my dreams, my self-image is female. Not necessarily a ‘female version’ of myself, but just ‘female’ in some regards. When I was very young, around 10 or so, that self-image was of a very skinny girl with very long straight hair, reaching well below the waist. There was no sexualisation of the image, because, honestly, I probably didn’t have a clue yet about how such things worked. This self-image does not remain the same. It changed and evolved over time. It became often a ‘fantasy body’ which clearly had nothing to do with myself; but, as I improved some of my makeup and dressing skills, it is often very close to what you know as ‘Sandra’. Interestingly enough, the more this self-image in the dream resembles the real ‘Sandra’, the less I feel it’s a dream.

Am I male and seeing a woman on the mirror, or is the mirror reflecting the woman I am — in spite of being male?

I don’t dream that much, and practically all my dreams are nightmares of some sort; but I have also to be honest to myself and admit that in some of my dreams, I’m clearly male, even though the dream might have a crossdressing element somewhere in it. What exactly that means is anyone’s guess, but I would claim that there has been little room for my ‘gender core’ to be free to evolve as it ought to, and naturally enough, it comes back with a vengeance — in my dreams. In fact, the worst nightmares usually involve myself as a male; those are comparatively rare, though; and I’m so used to nightmares (most of them induced by… chocolate! I’m not joking!) that the milder forms are sometimes more intriguing than frightening, even though if I’d describe them, there would always be some sense of impending doom, something horrible that is going to happen, like reading a well-narrated horror story, where the overall scenario seems apparently to be fine, but you get more and more hints that something is wrong and it can only get worse from there…

During the waking hours, however, things become a bit more interesting. There is an intrinsic ‘sense of self’ that is not particularly male or female; it’s just ‘being myself’. In my early crossdressing attempts, it was clear that I was somehow ‘expressing my (other) self’ — on other words, I had this notion that I was expressing a different part of my self. But it soon became obvious to me that this allegedly ‘different’ part wasn’t different at all!

This was interesting enough for someone who had read so much about the subject. Many ‘early’ writings about crossdressing (and I’m actually referring to things written by crossdressers in the mid-1990s) spoke about how MtF crossdressers, by ‘releasing their inner female’, would act and behave differently, adopting a ‘female persona’ which had nothing to do with their male one. Although I have watched such behaviour happening on the fetishist end — MtF crossdressers who would never dare to speak and behave in public if they were in their male social role — the truth is that the more we abandon the sexual/erotic aspect of crossdressing, and the more we move in the transgender spectrum towards crossdressing as an expression of a gender identity, then, strangely enough, the ‘difference’ between male and female roles either become too subtle to be noticeable, or, by contrast, in some cases they become so pronounced as to become completely different personalities.

But there is a third, more bizarre alternative. A few reports of detransitioning MtF transexuals show that their desire to ‘become 100% woman’ — possible thanks to an investment in surgery, often with less than usual psychological overview — made them ‘adopt a different persona’ which they felt it would be more appropriate for their new social role as a woman. Such acting — because, analysing it coldly, that’s what it is — became ‘boring’ after a while (a period of time measured in months, years, or sometimes even decades). Suddenly such persons realised that they did not want to ‘act a role’ all the time. It was fun for the novelty value; it was interesting at the beginning, after overcoming certain limitations inherent in ‘mere crossdressing’, but soon they had to deal with the concept that they were unable to ‘undress themselves’ from a certain personality which they had created in their minds and given life through extensive body surgery. In other words: ‘the show must go on’ — they had no other choice but to continue to act the role they had chosen. The only way to ‘give up’ this role and ‘go back’ to their former male role was to detransition (with the physical consequences that things would never be the same again, from a purely surgical point of view).

Where does such ‘confusion’ come from? One might think that such cases are extremes, and that the vast majority of MtF transgender people know very well what they want and what the consequences of their choices will be. This, fortunately, is the case — because in most places, there is a psychological and psychiatric evaluation coming before the actual Real Life test, and in most of those cases, the real life test is ‘real’ in the sense that people will start living in their new social roles (and not idly spending their time locked up in their rooms, waiting for the hormones to have some effect on their appearance). However, the number of those who nevertheless transition outside the protocol established by the WPATH is not exactly zero. And even those cases with good medical oversight are sometimes victims of a misdiagnosis of their condition.

I think we can extrapolate from these examples and see what is actually going on. Let’s do another recap:

  1. Our ‘sense of self’ is determined by a sequence of memories, linked together, where our own body (and our position/location) is part of those memories.
  2. Such memories are also ‘gendered’, in the sense that we attach a gender tag to that body (because I’m assuming that we have an inborn mechanism to ‘detect’ gender based on physical attributes, both in others and in ourselves). This is mostly from where our ‘sense of gender’ comes from.
  3. We can all have false memories, i.e. the memories created by the autobiographical self can be tagged as ‘true’ (as opposed to ‘dream’ or ‘fantasy’) even if they aren’t.
  4. Even though we use our senses to experience the external world, sometimes our brains refuse to accept what the senses are telling us, and we create an abstract representation of what we experience that does not match with reality.
  5. The more our perceptions of ourselves are different from what we truly are, the more we suffer (and this is true for the many body dysmorphic issues, as well as gender dysphoria).
  6. There is a difference between ‘being’ a certain gender, ‘becoming’ a certain gender, or ‘acting’ a certain gender role. All can be part of the transgender spectrum, but not all are equally evaluated as ‘gender dysphoria’ and needing transition as a cure.
  7. Because our brains can have false memories, and can ignore perceptions of ‘reality’ and create their own explanation, or narrative, there is a strong possibility for creating a false ‘gender narrative’, and this narrative will ‘feel’ as strong as a real one, and create as much suffering.

The last point, of course, requires a bit more explanation. It is a central tenet of Buddhism in general that all sentient beings suffer (or, if you prefer, feel insatisfaction) — but also that it is irrelevant if that suffering is ‘illusion’ (like some Hinduistic schools might teach) or ‘real’. What matters is that the suffering is real for the sufferer, no matter what is ‘real’ or not, and Buddhists try to alleviate that suffering, even if it’s illusory.

In other words, and relating to our issue here: from the perspective of the brain, it is not really relevant if someone is tagging one’s memories with the wrong gender, or if one’s current perception of one’s body is that it’s wrong for the gender one identifies with (or both things at the same time). What matters is that such a person feels strongly that there is a discrepancy between one’s inner gender feeling (what we can call the ‘gender core’) and what others experience their gender to be based solely on physical attributes (and therefore expect such a person to behave all the time according to that specific gender). Whatever the mechanism, what matters is that such a person is suffering from gender dysphoria.

We can say that there is a ‘normal’ mechanism for identifying one’s own gender — remembering that ‘normal’ means a mathematical function explaining averages, not an ethical/moral imperative — which, in the case of people suffering from gender dysphoria, is broken, in the sense that it does not work as it is supposed to work. We should always have in mind that all diseases — physical, mental, or even imaginary — cause a degree of suffering, and it’s actually irrelevant what causes the suffering: what matters is that there is suffering, even if the cause is something simple, something extremely complex, or something ‘made up’. The hard task for a doctor is figuring out how to alleviate the suffering, knowing that it can come from different causes.

As you saw on this section, we have a very complex mechanism that makes us feel that we have a ‘sense of self’ — it involves a complex coordination of several brain functions, from the memories written by the autobiographical self, to the mechanism which tags memories as real or as false, the system that links those memories together (so we recognise ourselves when we were small kids — even though not when we were babies!), the mechanism which tracks the location/position of the body (the cortical homunculus) and that records that location/position on those memories, and social constructs that label certain physical attributes as being part of a specific gender. Roughly speaking, all these working together provide us a strong ‘sense of self’, an identity, which also includes a gender identity. Because having such an identity is crucial for our survival as an individual, these mechanisms resonate with each other to provide us that identity, to a point that most of us will strongly feel that they are essentially a mix of their bodies, their memories, and their cognitive abilities. We cannot avoid feeling that (although we can train ourselves to do that!) because such a strong feeling is deliberately created by the way our brain is wired. In other words: all these functions of the brain work together with the purpose of creating this strong feeling of identity, this unshakeable ‘sense of self’.

If some (or several) of those very complex functions are not properly working for some reason (and it matters little if such reasons are actually physical — i.e. ‘real’ in the biological sense — or merely imagined, that is, ‘unreal’, or fantasies, or merely erroneous perceptions due to a malfunction of some of the underlying cognitive systems), then we get a different ‘sense of self’. In fact, if we take into account the extraordinary amount of complexity in all those brain subsystems working together, it’s actually incredible how we don’t get things wrong most of the time! My point, however, is that a malfunction of those subsystems will still create a ‘sense of self’ that is as strong as any other — because ‘strength’ of that ‘sense of self’ seems to be what we have evolved to have — even though that ‘sense of self’ might be misaligned with certain biological features.

This is what is so hard for cisgender people to understand (and sadly also for some trans* people regarding others in the spectrum): that for a transgender person, their sense of self and of gender is as strong as any cisgender person, the only difference being that something is not working correctly at some level, producing a misalignment between ‘external reality’ and ‘internal representation’ of that very same reality. In other words, it’s pointless to yell at a MtF transgender person: ‘you are a man in a dress, get over with it!’ and expect them to drop their gender dysphoria instantly (it’s as pointless as yelling at a depressed person: ‘snap out of it!’). Rather, what happens is that such a MtF transgender person will have as strong a sense of ‘being a woman’ as any other cisgender woman: all the mechanisms that create the sense of self and the sense of gender are as strong in them as in any other person; the only problem is that their physical body is not aligned with the gender they internally feel to be, and because of that, this person can experience severe suffering (= gender dysphoria) — merely because all other (cisgender) women have the ‘right’ kind of body for their gender, while a MtF transgender person doesn’t.

To conclude this section: the strength of the conviction of belonging to one specific gender (or both, or none) comes from a very complex mechanism which was designed (in the sense of biological evolution, obviously!) to do just that; it matters little if the person is cisgender or transgender, that sense of self/gender will be as strong in one case as in another. The only difference between both cases is that one function of the brain is not working correctly, namely, the perception of one’s real, physical body is not aligned with one’s gender. But the intensity of the feeling of belonging to that specific gender (again, or both, or none…) is exactly the same!

Yes, but sometimes it all gets confused… especially among peers!

If all the brain mechanisms that I mentioned in this article worked perfectly all the time, and if we could precisely identify them in the neuronal interconnections (say, with some sort of brain scan), then it would be relatively easy to tag people as being cisgender or transgender, and, among the latter, see which of those were truly affected by gender dysphoria, and which would not. In other words: in a perfect world, with a perfect understanding of all such mechanisms, a doctor could very easily figure out that the problem with a specific transgender person is that their body is wrong for their sense of gender, and, therefore, recommend that person to undergo corrective surgery (what we these days call gender affirmation surgery), to align that body as much as possible (within the limitations of current medical technology) with that person’s sense of gender.

In reality, there is only a tiny minority of transgender people who ‘fit’ in that particular classification — on average, as few as one in ten thousand individuals with a physically male body, and one in thirty thousand with a physically female body. The number of people who suffer from some sort of gender dysphoria might be, however, much higher; and there is an even larger number of individuals who do not technically experience gender dysphoria but are nevertheless as transgender as the others (in other words: suffering is most definitely not a requirement for being transgender; but it’s also important to recognise that a vast majority of transgender people suffer from a lot of reasons — transphobia being one of them — even if, from a medical perspective, they do not suffer from gender dysphoria).

What happens in the less clear-cut cases is a bit more confusing. Remember that it is actually not very hard to acquire false memories — and, indeed, some scientists apparently can induce such false memories using a few tricks. Such false memories persist for a long time (that article mentions five months), that is, they are not merely optical illusions or similar ‘brain trickery’ to produce an amusing effect, which, however, will not last long; rather, we are talking about deliberately pushing people in creating a false memory that will enter the realm of long-term memory, and be indistinguishable from all other memories.

I would actually claim that there are even more devious ways to achieve false memories and behaviours according to such memories, and this comes from what we would loosely call brainwashing. Perhaps the problem with this term is that it always implies some sort of forceful conversion to certain beliefs, almost always anti-ethical contrasting to ‘normal’ social values, and used by subversive groups and cults to ‘indoctrinate’ their victims, which will, after a forceful breakdown of their sense of self, be ready to accept a new set of beliefs as their own.

Brainwashing, in this sense of the word, has obviously never been tested scientifically in a direct way — because such ‘experiments’ would be utterly immoral and against most countries’ constitutions. Experts in the field are left with indirect evidence coming from reports of organisations and groups who have, at some point, claimed to ‘brainwash’ some members.

Now, the word ‘brainwashing’ is actually an umbrella word describing a lot of different techniques. If you search a bit around the net for what researchers have figured out about brainwashing, there are a lot of interesting techniques (in a negative way, of course). But what caught my attention was a certain form of bullying that produced the desired effect.

In essence, brainwashing starts by disconnecting a victim’s identity — making them question themselves, who they are, what they are — and, through coercion, force them to accept a new identity based on new social values. Although it seems that some people cannot be ‘broken down’ so easily, much less get them to accept those new values, there is a surprising number of people that can be thoroughly manipulated that way. And the more scary aspect is that sometimes it does not even need torture and violence — at least, not what we would describe as physical torture. There are forms of mental torture as well, and these seem to have been used by certain fanatic cults to successfully change the way their followers think and how they behave — and what they ultimately believe their identity to be. And although this sounds familiar — the kind of techniques used by, say, the so-called Islamic State — we cannot say that all fanatical terrorists have been ‘brainwashed’ that way, although it’s easy to see the parallels.

It’s more easy when the person already starts in a confused state of mind and requires validation by others to assert their own identity. A typical example is how women were, for centuries, coerced to believe that they were worthless unless they got a husband; then their identity became that of a ‘wife and mother’. A spinster — a term that makes no sense in the 21st century! — was something horrible and terrible to avoid at all costs. Because women were unfortunately educated not to think for themselves, but blindingly accept what was told them, it was relatively easy for men to manipulate them, so that they truly believed that the only point of their existence was to become good wives and caring mothers. Even today, sadly, many women are coerced to think that way.

Peer-pressure, or its more violent form, bullying, can indeed push people to question their identity, and most importantly, their values, through the desire to be accepted, to be part of a group; and that means sacrificing one’s own values and ideas, and adapting those of the group instead. We all go through this to a degree during our teens; it’s supposed to be ‘a phase’ and that we eventually grow out of it. Some, of course, do not.

Now, when we turn our attention to transgender people, we can see that most of them, at least at some stage of their lives, are rather confused about themselves (no matter how much information is available on the Internet these days). They are already questioning their gender identity; and that also often means questioning their identity as well. If transgenderity is still viewed negatively in their social group — which will be the case in most parts of the world (but fortunately not all!) — it’s likely that they have created a world-view where transgenderity is negative, undesirable, a sin, an abomination of nature, etc. These are the values they have been grown up with and that they have incorporated into their own personality and identity. However, the misalignment of their gender core with their actual physical body starts to put all that in question.

At this stage, a lot of things can happen, of course, from suppressing such ‘transgender feelings’ even deeper, from seeking medical help, even suicide for not being able to bear the suffering from the dissonance between one’s adopted values and one’s gender reality. But perhaps not surprisingly another typical thing that happens — especially nowadays, thanks to the Internet — is that they come in touch with other trans* people, some of which apparently are exactly like them.

This naturally validates their own internal feelings, and eases suffering: after all, it cannot be all that wrong if so many people feel pretty much the same thing! As the involvement with such groups increases, however, a change starts to develop: that person will slowly discard their own values and world-views, and start adopting those of their peers. It’s not just merely a question of wanting to ‘belong’ to a group — as we all might have done during our teens. It goes beyond that: it’s not just belonging to the group, it’s actually desiring to be just like all members of such a group, because they, unlike that particular person, seem to be happy about their situation. But that means discarding a lot of ideas that make up one’s personality and adopt those ideas of the members of the group.

There is some tension here, which is natural enough. On one hand, there seems to be an easier road to travel: by discarding one’s world-views, social values, behaviours, etc. — effectively ‘destroying’ one’s personality and adopting a new one — there seems to be some hope of future happiness, merely by observing how others who have further ‘advanced’ along that road seem to be so happy about their choices. On the other hand, it’s never easy to make such profound changes on one’s personality — especially when we are aiming at the core of everything, what defines us as an independent human being: our deepest identity.

This process can be more gradual or more abrupt. Some groups of trans* people are very strict on their rules and norms, and to be part of that group requires adopting a lot of changes — from styles to wear, from specific social behaviour in public, to attitudes towards others (both cisgender and transgender people). Sometimes it means tracing red lines — you can do this, dress this way, but go no further — which the person is supposed to obey, or lose all contact with the group.

In effect, what I’m describing here is pretty much the opposite of what a ‘support group’ is supposed to be! If we take again the example of Alcoholic Anonymous (or similar organisations using the same principles), the whole point of the group support is to join people who have gone through the same issues and learn new behaviours to get rid of the addiction, while, at the same time, enjoying the social contact with those who have already done the same and know exactly what they need to go through. The final goal is to get rid of the addiction, keep one’s mind in control, and be able to ‘resist temptation’, if I may use that phrase without any religious overtones.

Among some trans* groups, however, the reverse seems to be happening: members are encouraged to behave in a certain, pre-approved way to become ‘more addicted’ to being transgender. While that means acceptance — which, by itself, is actually very good — it sometimes also means having to get rid of certain aspects of one’s personality and adopting new ones. In effect, what such groups try to promote is a certain — stereotyped! — idea of what a trans* person is supposed to be, and impose that idea to all members in the group; while, at the same time, deeply ingraining the idea that all other people are wrong. It’s actually amazing how often some trans* groups are absolutely transphobic towards all other groups — except themselves.

In other words: when a ‘newbie’ steps on the red carpet of such a trans* group, they are effectively saying: ‘Welcome aboard! Celebrate your transgenderity and your right to diversity! Now get rid of your old self, and we will tell you how to behave properly!’

Because many trans* people are in a weak state of mind, full of self-doubts, and so often with low self-esteem, questioning their own thoughts, their own identity, and so forth… it’s actually not hard to extrapolate and see how easily they can be manipulated to ‘believe’ in what those groups are telling them to do. Because they wish so hard to stop their own suffering, they will gladly reach out for the first friendly hand that is extended to them.

Now, in all what I’ve written above, it’s very important to understand that this does not apply to all groups, but just to a few. Nevertheless, it’s not unlikely that the groups which are more long-lived, better organised, and have more members will be those who are much more stricter about the conditions of ‘belonging’ to that specific group. Also note that by ‘group’ I’m not really thinking about large organisations or complex entities, but such ‘groups’ can simply be informal gatherings of a handful of members. Because most of those groups will shun all others, they may very well be small. Sometimes, however, they’re not small, and they are more easily found (via the Internet or through LGBT-friendly organisations, or even doctors).

Consider therefore what happens to such people joining one of those groups. We start with someone confused about their gender identity, and, because that gender identity may be at odds with the basic tenets of their personality — constructed over decades of acquiring social rules, values, principles, and so forth — they might even be confused about their identity altogether. Now we have seen that what we call ‘identity’ is strongly correlated to a narrative that our brain creates, based on one’s memories — I would claim that ‘identity’ is that narrative, but that’s just my conjecture, not hard scientific fact — and that we can change the narrative, change the memories (acquiring new ones, false ones, which will however be perceived as ‘real’ by the brain). In the example given, this new person will now face a group of people towards which they strongly feel attracted — they want to be part of that group. So they will need to erase parts of their ‘identity narrative’. Perhaps, after all, they ‘remember’ playing with dolls when they were very young. Perhaps the number of times they dressed up in their mother’s clothes was much more frequent. Perhaps they dreamed of being a woman since early childhood and went through school thinking about it all the time. It matters little if that narrative is real, in the sense that it is based on actual facts, truthfully remembered: as we can see, the brain can be tricked to believe in false memories as strongly as it believes in real ones.

Those trans* people will therefore start to retroactively change their narrative, even though they might not be aware of that change. What happens — or rather, what it feels like — is that new memories seem to pop up which will validate their ‘belonging’ to the group. Because being accepted by the group is so important to them, they will, without being conscious of it, start to ‘reinvent’ their personality in order to ‘fit’ in the group. If this also requires now to present themselves according to the rules of the group, then they will easily start to believe that it is ‘right’ to do so — because there is somehow a certain imperative at work here: in plain English, because now that person has a narrative validating their transgender identity according to the values and principles set by the group, they are compelled to act, behave, feel, etc. accordingly. They assume this new transgender identity, borrowed by the one presented by the group as being the ‘correct’ one, as being their own identity. And after a while, the combination of those false memories and the new narrative that explains them becomes so strongly validated — and is so encouraged by their peers — that they cannot even remember a time when they thought differently: instead, they will constantly find new excuses to self-validate their newly acquired personality, based on reinterpretation of their memories, both real ones but also false ones that have been borrowed by the group.

It is therefore not so surprising that an incredible amount of trans* people personal biographies are so similar (or at least that can be so easily grouped in separate categories): depending on what group(s) they have encountered while trying very hard to make sense of their gender identity, they will adopt a specific narrative that validates themselves as an individual. Sometimes their narrative might actually differ in one or another point (‘yes, I did play with dolls when I was a kid, but only at my grandma’s place’ or ‘although I wore my mother’s dresses and tried out her high heels, like everybody else in the group, I never actually wore any of her lingerie before I was 15’). Such differences are harmless (from the perspective of the group, that is) and just emphasise the idea that each person is an individual; but the core narrative will be reasonably similar to others in the same group.

Now, I’m not claiming that all people who question their gender identity are pushed — or brainwashed! — to believe that a certain narrative applies to themselves, even if it doesn’t, and adopt it as part of their identity as a person. Some narratives are genuinely correlated to factual evidence: there are no false memories there, just a sequence of events that have really occurred, and a plausible narrative which makes sense to explain such events. But there are a surprisingly high amount of narratives that clearly have been ‘borrowed’ and incorporated as part of one’s identity.

Also, I cannot claim that this so-called ‘new identity’ is fake. We are reinventing ourselves every day: as we learn new things, or acquire new experiences, this is all incorporated into our autobiographical self. That means that ‘identity’, as we describe it, is a fluid process, something that is not stuck in time and is immutable. Rather, we are changed — and this change goes as deep as our core identity! — by events and phenomena, all of which will trigger certain actions and reactions, which, in turn, will produce new memories, which will be incorporated into the ongoing narrative. ‘Identity’ is literally not written on stone!

Instead, what I’m saying is that because identity is something fluid, plastic, and susceptible of change, particularly the change that comes from incorporating narratives to explain new experiences (which become memories), it’s relatively easy — given the right person with the right incentives — to ‘switch tracks’, so to speak, and ‘acquire’ a new identity based on external explanations of one’s memories. Such explanations ‘become’ the new narrative; that person, in effect, has changed their identity, in order to become more accepted by certain groups.

Also note that I’m not exactly talking about some nasty, evil, subversive, manipulative groups, who are constantly hunting for new victims to brainwash. No, I actually truly believe that the vast majority (and perhaps even all) of them have the best intentions of their members in mind. What happens is that this ‘coercion’ or ‘bullying’ comes from a certain peer pressure that can be (mostly) involuntary; in other words, veteran members of such groups feel the need to impress on the newbies the ‘correct’ way to express one’s transgenderity, because they have been impressed in a similar way by the oldest members. In that way, certain ‘typical’ narratives will predominate and be carried from one generation of trans* people to the next.

And finally, I’m most definitely not claiming that ‘transgenderity comes from manipulative people trying to brainwash helpless victims’ — in an absolute way! This would mean that I’d been completely blind to what a large number — possibly even the majority! — of trans* people are actually feeling.

But the numbers should give us a hint. Of course doctors are not allowed to talk about their patients (much less in this area!), but sometimes they at least volunteer some numbers. To take my own country in account: why do so many trans* people apparently get rejected by the system? We are aware, around here, that ‘thousands’ have in a way or another contacted doctors for medical advice in the area of transgenderity; why are only ‘hundreds’ going through transition?

I can only speculate, of course, since the actual reasons might be confidential between doctor and patient. I believe that the majority of ‘rejects’ for actual transition come from those illusionary cases where a narrative has been constructed, almost from scratch, by borrowing ideas, concepts, values, and forms of behaviour from groups that encourage a specific behavior according to one’s transgenderity. At some point — sometimes even before the real life test!) — those people realise the illusion they are living in. The 90% of rejects come very likely from those for which the scales have fallen from their eyes, and they only now fully understand the consequences of their actions (going through HRT or gender affirmation surgery, or even get breast implants!).

In other words, one of the consequences of engaging the real life test is that we cannot hide from ourselves any longer: we are forced to live, sometimes without the benefit of hormone therapy and/or surgery, in the role we identify with. But if that ‘identification’ is just a very elaborate narrative based on false memories and misrepresented (true) memories, then at some point during transition this will become (hopefully!) clear, and the person might simply give up. Sometimes, people will just lie to say the kind of things that doctors want to hear; or what the members of the group(s) they belong to are constantly saying; in that case, that narrative might collapse at a point in the future. Doctors hope that this will happen during the real test phase, but sometimes the 1-2 years are not enough, for several reasons.

Looking at some stories of those who have detransitioned, some common arguments are:

  1. Facing transphobia is too hard: Many trans* people, especially those who are MtF and will not ‘pass’ well before HRT and/or surgery, might have expressed themselves publicly only in limited areas, namely, LGBT-friendly clubs, bars, restaurants, or at support groups, at the doctors, and so forth. Once they start interacting with the public in general — doing their routines like going to the supermarket or the laundry – they are fully exposed as trans* people, something which they might not be able to hide, and, depending on where they live, the lack of acceptance might just be too hard to deal with.
  2. Being a woman/a man is too hard: Such trans* people have lived for years in one role, which, even though they dislike, they are used to its lifestyle and social role. Even perfectly passing trans* people might suddenly realise that the way they are treated in the role they identify with makes life unbearably hard, and therefore they give up. This is more common with, say, white MtF transexuals, used to white male privilege, suddenly facing discrimination at work just because they are ‘a woman’; getting interrupted all the time by males, or having them ignoring their opinions, might simply be too much to handle (FtM transexuals, by contrast, tend to pass much better with a little training, and might suddenly acquire a lot of new privileges they didn’t have as ‘women’, and therefore their transition might be much easier). Also, the new social role might impose a different routine with different costs (again, MtF transexuals will suffer more) and less time for themselves.
  3. Being a woman/a man is actually disappointing: This might actually be surprising, but some people who have transitioned without much psychological support (basically they could afford having the surgeries without any questions asked, and have skipped the real life test), after a while, suddenly realise that their desired gender role is, after all, much less interesting than they thought it would be. Particularly for MtF transexuals, life as a woman might not have the glamour they thought it would have — and possibly the sex life is not as interesting as they imagined it would be. I know that these are extreme cases, but they certainly pop up in the media…
  4. Adopting a new persona feels too much like acting and it’s not ‘real’: An interesting aspect of Third Way Trans‘ (TWT) detransitioning process is when he refers feeling a lot of tension due to forcing himself to ‘act female’. In his own words: ‘I discovered that much of my tension was caused by holding my body in ways to appear more female, and that attempting to speak in a voice that would be perceived as female was inauthentic.’ Third Way Trans is currently a certified psychologist and undergoing research on former MtF transexuals who have detransitioned back to male; he is actively pursuing this field in order to add scientific knowledge on an area that unfortunately has not received enough attention by both the scientific community and the media.
  5. Gender dysphoria persists even after transition: This case is not only reported by TWT as well (it applies to his case) but by many contributors of his website — essentially, we are talking about a clinical misdiagnosis. The feeling that one’s body is not aligned to one’s (gender) identity, as we have seen, can have multiple causes. Understandingly, many of those causes are related to childhood trauma of some sort (for instance, child abuse by an elder familiar; a bad first sexual experience with a partner; being ‘forced’ by parents to humiliating oneself in public; etc.), but there are many more. Because there is such an overlap of similar symptoms, doctors are not perfect (they are human after all) and, in some cases, they may be biased according to their own training (for instance, if they are clinical sexologists used to diagnose gender dysphoria) and will sometimes miss the more obvious choices.

There might be a few more cases, but let’s stick to these for starters (after all, researchers like TWT are supposed to be more systematic than me, right? 😉 ). The three first cases are clearly cases where people either forfeited the real life test or… cheated. We know from the media that case #3 (being disappointed with the ‘new’ gender role) is almost always connected to people who have enough money to skip as many tests as they like, and jump straight into their new role with hormones and surgery and totally ignoring the WPATH Standards of Care. I mean, let’s take Caitlyn Jenner as an example. Did she, or didn’t she, go through a real life test? We have pictures from the paparazzi showing that they had suspected that something was going on. We also know that Jenner had toyed with hormones and was a frequent crossdresser in the past. But… the big question is… did she follow WPATH or not? If she did any kind of ‘real life test’, when and where did that happen? Allegedly, she ‘dressed at home’ well before her announcement… but… is ‘dressing at home’ a valid real life test or not? Most doctors I know would answer ‘no’. So, even though I have no doubt that Caitlyn Jenner has been totally sincere in her ‘coming out’, and the work she has been doing in bringing the trans* community into the limelight is peerless, but… what if she announced in 2017 that it was all ‘a big mistake’ and that she ‘doesn’t really want to continue her life as a woman any more’?

The media would go wild with that, and there would be a huge backlash on the trans* community, so I’m really hoping that such a dreadful scenario never happens. Still, the point here is that skipping the WPATH SoC can lead to catastrophic results. It’s not that the SoC are a guarantee that everything will work out fine; it’s not the case, of course every procedure and protocol has a rate of failure; but, in general, a strict adherence to those guidelines means a much higher probability of success.

In other words: if you haven’t really spent several months living in a different gender role, no matter what you feel about it, it’s very likely that you will have doubts and regrets at some point, and start learning about tradeoffs: no, it won’t all be rosy and wonderful. There will be highs and lows. The whole point is dealing with the difficulties and overcoming them before doing anything permanent to one’s body.

Cases #1 and #2 are similar. The whole point of the real life test is to learn to deal with transphobia and the difficulties of living in a new role. MtF transexuals will suddenly be deprived of their male privilege, and that might come as a huge shock — more likely in the small details (like the above mentioned constant interruptions and having one’s opinion completely ignored) and not in the larger ones, but the small irks will accumulate. FtM transexuals will suddenly be subject to people loading all their troubles and problems on top of their shoulders and ‘demand’ that they find a solution (and be quick about it!), and to show a high self-esteem and project confidence all the time. When someone is just taking their first baby steps through transition, still with their emotions very raw — while absorbing the ‘novelty’ of everything — getting the whole package all of the sudden may simply be overwhelming.

During the real life test, transexuals in transition are supposed to learn to deal with all of that. And, yes, they are supposed to talk to their doctors about it, be quite frank and open with them, ask for advice when they suddenly face an obstacle (is it really so important if you get occasionally misgendered? do you really need to wail and tear out your hair over it? isn’t it better to focus on the cases where other people got your gender and the pronouns right?).

However, there is a catch. When you start the real life test — and that truly depends on the country you’re in, and the kind of doctors you have — you may not have the benefit of a ‘full body transformation’ through hormones. Even if you are on hormones, and depending on how well your body reacts to them, this process can take a lot of time to actually have a visible effect — and in the mean time, precious months will pass while you need to work at your job, go shopping for food, stay in queues to pay your taxes, whatever. You may have to deal with all of that by clearly being misgendered — again, that will depend on how androgynous your body is when you start transition, how good you’re at passing, and how tolerant your country is. Can you deal with all that?

In effect, the real life test, for many people, is much harder than ‘real life’ itself — a ‘real life’ where you will have the benefits of hormones, surgery, and an ID card or passport in your real name and gender. But this is on purpose: by having to face the huge obstacles at the very beginning, and overcoming them, doctors will assess your mental stability in dealing with those situations, because, to one degree or another, you will face them for all your life. A lot of people give up during transition — and that’s actually not ‘bad’ per se: it just means that they had an illusion or fantasy of what their ‘real life’ would be, and when faced with reality, they start to have serious doubts. The whole point is that, after the real life test is finished, you should have no doubts whatsoever.

And yes, it’s hard. So how do many people deal with it?

They cheat.

Of course I’m not going to name names — but the truth is that many of my acquaintances are so eager to go through transition, and get the benefits from hormones and surgery, that they cannot wait to do the real life test at all. They simply tell the doctors that they are doing it — while they actually are remaining in their assigned gender role, and just occasionally (sometimes not at all) spend some time in public as the gender they identify with.

It’s not all glamour: sometimes you need to pay the water bill…

… and yes, you need to pay the gas bill too.

This has been for me a huge source of confusion. Some people simply stay at home, refusing to leave the safety of their rooms, before the hormones have any visible effect. And then, when they finally come out — sometimes 18 or 24 months later — they are shaken by the obstacles they have to face. Anxious personalities will be overwhelmingly worried about ‘passing’, and terrified of being misgendered. But… that’s what you are supposed to train while you’re doing the real life test!

It baffles me especially when I see some good acquaintances of mine with less experience in dealing with daily issues in the gender role they identify with than me — and they’re pumped up with hormones, sometimes already having done some minor cosmetic surgery, sometimes already with an ID card with the correct name and gender on it. They still hesitate when going out ‘alone’, fearing that they will not ‘pass’ yet. They get insanely furious when someone misgenders them (and why would that be surprising? if you hide at home, you might get the physical benefit from a hormone treatment, but you have no experience in interacting with others in the gender role you identify with — and that means doing ‘social blunders’ all the time, simply because you have not trained enough). And the list goes on. When I face them with a direct question (and those who know me well also know that I hardly ever do that) — namely, if they have really started their real life test, and how often they actually spend time in the gender role they identify with — then I get elusive answers, like ‘oh, I dress at home al the time when I come from work’ or ‘I go out dressed with some LGBT friends — we go to one or two LGBT-friendly bars’ or even ‘now that my vacation is coming up, I will start dressing every day for a few hours’.


Shopping for food — for me, for my wife, and for my cats…

Ok. Reality check here: this is what every non-transitioning crossdresser already does — and much more, in fact! You are supposed to be in transition — and yes, that means going to work every day dressed in your gender role. It means remaining 24/7 in that gender role. It means doing all the boring stuff, including cleaning your house or going to the laundry, in the gender role you identify with. It does not mean that you get ‘time off’ once in a while to take a rest from that gender role!

So what those people are doing is either a) agree something with their doctors which the doctors should never have accepted in the first place; b) lie.

Now, doctors cannot watch their patients 24/7; we are all supposed to be adults here, and understand the whole point of these procedures. It is in our best interest to follow those protocols. It’s not as if the doctors get extra points or bonuses for pushing people through transition; rather, if the transition fails for some reason, the doctors will be blamed (once more I refer you to TWT’s blog, when his doctors clearly failed in diagnosing certain mental conditions which would also cause symptoms very similar to ‘classic’ gender dysphoria, while being something entirely different). Therefore, the doctors ought to be wary about what they recommend. They are also liable to lawsuits or at least being denounced at their associations, get their license revoked, and so forth. At the very least there is always the tabloid media, eager to follow up on a juicy story of a malpracticing doctor. So if the doctors insist in following the WPATH SoC, that just means they are protecting their patients and protecting themselves as well. Cheating during the real life test will lead to nowhere!

Case #4 is not quite the same as the previous ones, and I find TWT’s description of his own case absolutely fascinating. It is evident from his narrative that he was diagnosed with gender dysphoria, and, as a consequence, besides the physical changes (hormones and surgery), he was expected to adopt a new persona more consistent with his ‘new’ gender role. This persona, after a while, felt ‘fake’: it was just role-playing, merely acting, and being forced to ‘act’ in that role all the time, TWT was becoming more and more stressed.

A few cases reported by the media (not by researchers — at least I couldn’t find any, so far) seem to have very similar experiences to TWT. Thanks to the miracles of modern cosmetic surgery, certain MtF transexuals with enough money created out of their body a woman worthy of any wet dream. And they certainly enjoyed creating a persona that was stereotypically associated with such a bombshell — the image of the dumb, lusty blonde comes to mind. At the beginning, they loved to tease with men and enjoy watching them falling helpless in their hands. But… the truth was that this was just an act. One particular case that comes to my mind was from a well-to-do manager of several successful companies who switched to a sexy, sultry female persona for a while, but of course that would never be fulfilling for someone so used to managing businesses. So while it felt like vacations for some time, this did not last long.

Similar cases have been reported here and there, and they are often used by anti-LGBT fundamentalists to ‘prove’ that transexuality is ‘wrong’ and that transition ought to be banned — because there are enough cases where people ‘pretend’ to be what they aren’t, and, at some point, get thoroughly disappointed — or stressed and frustrated because, well, this ‘new persona’ is not their selves.

Now, this might actually sound a bit strange for many people in the transgender spectrum, especially those who are ‘merely crossdressers’, genderfluid or gender oscillating — in most of those cases, there is no ‘different persona’ that ‘comes out’ when presenting as one gender or the other (or none!). There is just one persona. And, indeed, most transexuals, after transition, are not really ‘acting’ — they are who they always have been, just with a body that looks much more like the gender they identify with. The question of personas does not even apply.

Still, there are cases of people who clearly exhibit two (or more) different personas, depending on their gender presentation — and such personas are completely different from each other, in many crucial aspects, and some more subtle ones (like sexual preferences or even sexual performance in bed). Such people, if they transition, will very likely completely discard one of the personas and fully adopt the other; but such exceptions are really quite different.

In reality, most of us — except, perhaps, for professional actors — cannot consistently ‘put up an act’ to pretend to be someone else, all the time; even the most foul politician will drop their mask at home with their family (yes, even Trump 🙂 ). It is therefore to be expected that someone who forces themselves to ‘act’ a different persona, all the time, just because that new persona is something expected from them, will be subject to an enormous mental anguish, stress, and ultimately frustration: it’s simply not natural to be like that!

Of course, there are some things that can be learned and trained, and which are not really related to what we would call a ‘persona’. For example, it’s no surprise that men and women talk differently: they have a different vocabulary. Adopting such a vocabulary is pretty much like learning a different language: just because you speak in English or German, you are not a different person. Nevertheless, using the vocabulary and grammar that is appropriate for the gender role is something that is expected and that can be trained.

And there are some very obvious changes, of course — like, well, getting used to walk in heels, if you present as a woman. Now one might argue that a lot of women hate heels, just wear flats, and, when ‘forced’ (for social reasons!) to wear a pair of high heels, will humiliate themselves in public by being unable to walk gracefully in them. That’s absolutely correct, and I wince every time I see a gorgeous woman crossing the street in absolutely lovely heels — but cannot walk in them, and it shows! That’s true, of course, but there are some advantages to stick to some stereotypes if you wish to get more accepted and ‘pass’ better. You’d be surprised at how many people totally ignore me in public — even in crowded malls or supermarkets — merely because I can walk in heels gracefully (at least most of the time!), and I walk with a lot of self-confidence, as if I had been born that way. Not even my height (and width!) will catch much attention. Sure, I turn some heads, and I’m absolutely aware of that; but the ratio of people who totally ignore me to those who actually notice something strange is perhaps 50:1 or more 🙂

Just because I’m wearing heels on a queue to pay at the supermarket, that does not make me a woman!

So… walking in heels does not make me a woman… nor saying ‘dang!’ instead of ‘f*ck you, motherf*cker!’ all the time. These are not really things I associate with a persona, but merely with a gender presentation. Again, as discussed in other articles, we have two realms here — that of identity (what we are inside) and that of presentation (what we show others). All the examples so far are much more connected with presentation, and little with identity. What TWT and others have reported, however, goes way deeper than that: they are truly pushing themselves to think differently (not merely to act differently), and, without knowing what you’re doing, this either leads to stress and frustration … or boredom.

Here the problem is not necessarily the real life test; TWT, again as an example, seemed to have no trouble with the real life test, and actually managed to live twenty years in the female role, not merely one year or two. In other words, it’s conceivable that you might be able to pull off acting as a different persona for a long while — definitely way beyond the horizon of the real life test. In these cases, the real life test does not make a difference.

Rather, it would be up to the doctors to analyse the different persona, and figure out — with the patient — why exactly they feel it’s necessary to adopt that persona. My opinion here is that at some point people confuse identity with presentation (and, as I explained previously, this should not come as a big surprise — we project our identity in our presentation, and, conversely, others induce our identity based on our presentation) and at what level their ‘efforts’ should be. It’s acceptable to change one’s presentation to ‘fit’ better into the ‘new’ gender role, and that means much more than wearing a different set of clothes. But, in my opinion, something is seriously wrong when the person feels that they have to change aspects of their identity as well.

As I have argued before, identity and gender identity are naturally tied together, in the sense that our gender identity is part of our identity (even if we claim to be genderless, the fact that we are genderless is part of our identity). I would now argue that all of us need to have a gender identity (whatever it might be, and let me repeat again: any gender is fine, a combination of genders is fine, and being genderless is fine as well!) as part of our identity. So far, so good: but just because we are transitioning, that does not mean that we have to change our identity as well.

One might argue that this happens anyway, since, well, the gender identity changes during transition, right? So the identity, as a whole, will change as well. I would argue the contrary: a transexual will not change their gender identity whatsoever — they have always affirmed that gender identity since birth, it’s just their body that is wrong for the gender identity they identify with. So, during transition, only their body will change. Their identity and gender identity (as well as sexual orientation, and so forth) will remain exactly the same. Sure, their presentation will change (or not!), but that has little to do with the identity itself.

Those who ‘feel’ that they have somehow to change their identity to ‘fit better’ into the new social gender role after transitioning have been deluding themselves at some point. This, in fact, is what TWT has found out the hardest way possible, and he most certainly is not alone in that. Here we can put some of the blame on the doctors: they should be able to figure out that this particular person, during the real life test, is pushing to ‘fit’ into a specific persona, with which they do not identify with, but which they nevertheless adopt as their own, because they think that this is what is expected of them. Doctors should be able to figure this out through some objective questioning; it should be something to be weeded out during the real life test, or even before it, because clearly there is something not consistent with the typical gender dysphoria diagnosis when that happens.

And finally we have case #5. Here we have a blatant clinical error — a misdiagnosis. As TWT so well puts it, transgenderity is a condition which has a plethora of causes, some biological, some genetic, some environmental, some mental… and possibly, as this area is more and more researched, we will possibly find even more causes. However, the symptoms of gender dysphoria (or at least one of the symptoms, i.e. the persistent feeling that someone is in the wrong body for the gender they identify with, and this is a cause of distress, frustration, anger/anxiety, depression, compulsive behaviour, and so forth) can be caused by several other conditions. The problem in this case is that a clinical sexologist might not be qualified and/or experienced enough to identify other conditions that might trigger symptoms similar to gender dysphoria. A solution to this dilemma, of course, is to have a multidisciplinary team of doctors analysing the patient — not just a psychologist trained in clinical sexology, but several others as well. And, of course, I have absolutely no idea what clinical sexologists learn at university, but I can imagine that they will learn to do a proper diagnosis by eliminating some causes for gender dysphoria and keeping others. What I do know is that this is a very touchy area, where even the most complex and thorough test might not give the ‘correct’ result, but merely some idea or guideline along which the therapy sessions ought to proceed.

In other words: yes, gender dysphoria is hard to diagnose, and can be confused with other mental issues; it requires a good team of professionals to figure out exactly what the causes are, and sometimes transition is not a solution; fixing a childhood trauma, for example, may produce far better results in some cases (when the childhood trauma actually triggers the gender dysphoria, that is).

I do know of a lot of borderline cases, which have the strangest reasons for going through transition. Interestingly enough, those cases are not so often discussed by the media, but that’s not all: scientific medical publications tend to discard the borderline cases; it’s mostly the social sciences who find them interesting. Some of them actually managed to persuade their doctors to allow them to transition; others have been successfully ‘weeded’ out well before they started.

Perhaps the oldest case I remember is a former collaborator of one of my companies. At that time, we hired a lot of freelancers all around the world, who would work from home, and communicate through electronic media. One of them had a personality which was the equivalent of a computer geek, but he was actually a digital artist/web designer. He did know some basics of computer programming, of course (because web designers, these days, cannot avoid that), but his field of expertise was really digital imagining. Anyway, he was so geekish, so geekish, that after several months of working together he sort of confided in me that he wasn’t having any luck with girls, and that frustrated him a lot, so… he was going to change his sex, to see if he had more luck with attracting men.

Imagine my surprise! And he actually went through transition (with full surgery!) not many weeks afterwards. It turned out that he (or should I now say ‘she’?) was intersex, the doctors delivering him at birth noticed the confused genitalia and did their best to make them plausibly masculine, and so he was granted the male gender after that surgery. He lived in the UK, during a period when intersex people were allowed to go through transition if they wished with next-to-zero psychological evaluation; it was deemed to be a right of intersex people, because they had been ‘mutilated’ at birth without having had a saying in their choice of gender. As a consequence, and as some sort of ‘compensation’ for having the doctors of the National Health Service taking away the choice of gender at birth, well, Her Majesty’s government granted intersex people this ‘bonus’: if they wanted to switch gender and needed surgery and hormones, they would get it, no questions asked (well, not many…). The protocol was actually very simple and very straightforward; as said, my former colleague quickly became a woman, from the legal perspective, and got all the surgeries and hormones s/he wanted. The UK government even got him a nice little stipend so that he could shop for women’s clothes, which he would now need (I’m not joking — I have no idea if this is still the case, but this happened in 2008 or 2009, a bit before the crisis set in, and intersex people in the UK really got a bit of money to get shopping!). Ironically, because we did all our work remotely, and used nicknames and such during conversation, my colleague never realised that I wasn’t a cisgender female… and she asked me for lots of advice in clothing afterwards 🙂

But of course my ex-colleague did not change the personality. She continued to be exactly the same geek type as before. And although I have never seen any pictures from before or after, I learned from mutual friends that the difference was not really great — basically, the only real difference was between her legs. I don’t really mean to sound rude, of course, and I actually felt a lot of compassion towards that former colleague (we still kept in touch for a few years afterwards), but the reasons for transition were totally wrong — i.e. trying to get different sex partners! — and I can only imagine that there was not much of a difference afterwards…

Intersex conditions are especially rare, so it’s not very likely that there are many intersex individuals like my former colleague, i.e. wishing to change their genitalia just for the sake of it, and hope against hope to be sexually attractive to partners that way. But there are a few parallels in other cases I’m aware of.

Among those acquaintances who are in MtF transition, I also found very curious that a few have come out as gay a long time ago (sometimes as early as their teens), but, once having had sex with homosexual men, they found it not satisfying. In fact, they did not feel any attraction for homosexual men at all: what really excited them were heterosexual men. But now this created a problem for them: heterosexual men, by definition, do not find other men attractive! So these acquaintances of mine reasoned that to become sexually interesting for those men they found attractive, they had to become women.

Now, a lot of literature on the subject of transgenderity explains that MtF transgender people do not ‘want to become women’ — they are women, and always have been, they just haven’t got the correct body for that gender. This is the classical transexual narrative, and this is what is ‘acceptable’ from the perspective of a doctor.

But when actually analysing the community, things are not so simple, but rather they are constantly crossing established borders. For instance, there is a group of people that are keen on body modifications, something which modern cosmetic surgery can provide to an extent. Some people want to look like cartoon characters (a very typical case), or like Barbie and Ken (fully knowing that they will become artificial). Even in the less extreme side of the spectrum, there are cosmetic surgery addicts, who are always thinking about their next surgery, adding this or removing that. And I’m not really talking just about celebrities, which, to a degree, society tends to ‘apologise’ for, since they are expected to look good all the time, and to revert aging as far as possible. No, I’m talking of much profounder body modifications — like people really wanting to have surgery to make their face look like a feline, to give another extreme example — which go far deeper than merely ‘cosmetic’ surgery to fix something that Nature didn’t endow you properly. This is not just adding a few boob implants: one famous example is a couple of two artists, where the husband underwent plastic surgery to look like his wife as much as possible — and although his wife already died, he continues to undergo more and more surgery to ‘complete’ his work. We’re really not talking about gender issues any more, but we’re crossing the line towards a different phenomenon, a wholly different community of people who use their physical body as a canvas to express themselves — through plastic surgery.

Now, in many of those cases, the media only interviews those who are artists or performers of some sort; these tend to admit that they are deliberately challenging society’s norms by being provocative. But there are many more who are completely invisible to the media who also engage in extreme body modifications. And yes, some of them are men adding women’s parts to their bodies, and vice-versa, and it has nothing to do with ‘gender’ issues. In some cases it might have to do with sex: some so-called she-males, a pejorative name that describes a MtF transexual who has gone under surgery (and hormones) to feminize their bodies, but didn’t change the penis into a vagina, and who works in the sex industry. Now many of these are perfectly normal transexuals, currently going through transition, having little money or support from their family, and therefore forced to work in the sex industry — she-males are especially desired for a lot of male fetishes. Some of them eventually make enough money to complete their transition — and stop working in the sex industry, because a trans woman who is physically identical to any other cisgender female prostitute tends to lose the ‘novelty value’ for those who fantasize with women having a penis…

Such examples are still in the realm of gender issues, of course; but there are some intriguing cases where it’s not so clear: when some people clearly identify as one specific gender but wish to surgically change themselves to add physical attributes from another gender (or remove those from their own gender). Now, don’t get me wrong, there is nothing intrinsically ‘wrong’ with that. My own opinion is that you’re the owner of your own body; you ought to have the freedom to do whatever you wish with it, so long as you don’t hurt others by doing so. However, doctors don’t see it that way: there are ethical limits to what they are allowed to do. When cosmetic surgery started to make its appearance — as opposed to reconstructive surgery — such ethical questions were already asked: should a doctor be allowed to change a perfectly healthy body through surgery or not? Even today, some old-school surgeons will frown upon their colleagues in cosmetic surgery because they still believe that the science and art of surgery should not be used for vanity purposes, but only for healing the sick and those who suffer.

Conceivably, some cosmetic surgeries might improve one’s self-esteem, even if that person starts with a perfectly healthy body. A typical example: in a society where men value large breasts, getting breast implants might raise a woman’s self-esteem — and be therefore justified. But the problem is figuring out where to stop — how big ought those breast implants be? When do we cross a line, where another augmentation may actually harm the person’s health — thus breaking the surgeon’s Hippocratic Oath? It’s a question that is not easy to answer, and, as we all know, there are always surgeons eager to make some extra cash and forfeiting the ethical argument, even endangering their patient’s health, so long as they are happy about their choices.

With Gender Affirmation Surgery (GAS — formerly known as Sex Reassignment Surgery), the ethical question is, from a physical point of view, rather complex; however, there is no question at all when viewed it from the mental perspective. In other words: when constructing a neovagina (which will not suit any reproductive purpose) out of a perfectly healthy penis (which has a reproductive purpose), surgeons are effectively ‘crippling’ an otherwise healthy individual, rendering them infertile (at the very least) and possibly causing them other difficulties (there are always risks that something goes wrong; after all, GAS is a major surgery!). This was an ethical problem for a long time; it was solved once it was clear that this was the only solution for transexuals to achieve mental health. That’s one of the reasons why doctors want to make sure that this surgery is really adequate and will really provide that person with happiness; this, in turn, means that doctors want to have a saying when a transexual individual decides to change their body to match the gender they identify with.

But when we analyse the borderline cases… the ethical question remains. What if a perfectly healthy individual, who has no doubts in identifying as male, wants to get breast implants? Should a cosmetic surgeon do the surgery or not? What if that person, while still claiming not to have any sort of gender issue, nevertheless affirms that they feel that something is missing in their bodies, and only with breast implants they will feel ‘complete’, and, as a consequence, much happier and with a higher self-esteem? Would the surgery be acceptable in that situation?

In practice, there will always be unscrupulous doctors willing to do any sort of surgery, so long as they get paid; and there will always be some patients who can afford to pay those doctors; but the question remains, even if it can be relatively easily avoided.

And if you claim that, at the end of the day, surgeons are supposed to provide people a certain degree of happiness through their interventions in a patient’s body, and therefore, all these surgeries which contribute to mental health improvements ought to be allowed… then we will have to scroll back 25K words and ask ourselves: yes, but what ought we do about those who suffer from apotemnophilia? The argument that any surgery is allowed so long as the patient is happy as a result applies here as well! Or does it not? One might argue that apotemnophilia is, indeed, a mental disease, a paraphilia of some sort, and, as such, what the patient wants and what actually will bring them happiness are two different things. That sounds reasonable. But where do we draw the line? So amputating one’s leg (because for the patient, it feels as if the leg does not ‘belong’ there) is forbidden, but getting breast implants (even if one does not identify in the least as a woman) is allowed?

Where do we draw the line?

Or, to be more precise and to the point: how can a doctor (or anyone else really…) know what a patient is actually feeling, and how do they know what is best for them (especially if it runs contrary to their desires)?

Or, if you prefer: how does someone know that going through certain procedures will grant them more or less happiness? How can this someone make a decision based on a real need, as opposed to a fantasy (or even a fetish!), merely wishful thinking, or — worse! — a completely wrong assessment of one’s own condition?

The dilemma: we are who we believe we are

I know, this article is long. But you must have noticed, if you have been following this elaborate train of thought, that we have come full circle. We started with the extremely bizarre condition of apotemnophilia; we looked at how the brain perceives the body, and how it constructs mental images of that body — precise enough to allow you to chew without biting your tongue — which, in turn, are saved to memories, and help you to gain a ‘sense of self’. We saw how the brain is flexible enough to adapt those mental images it has of the body: this is what allows you to ride a bicycle, by considering it an extension of your body; but it also allows you to keep distinct images of your body across the memories — for instance, because you grow in your youth and age, those images are not the same, but the continuum of memories still gives you a sense of self. We then saw how relatively easy it is to get false memories, and how we construct them. And we addressed the peculiar but characteristic way transgender people experience the disconnect between their sense of self, their identity, their gender identity, and what their body looks like, both to themselves and to the others. And finally we came to extreme body modifications… and closed with apotemnophilia again.

I hope you got the overall idea of my argumentation here. It’s not really surprising: we are who we think we are. Or perhaps I should emphasize the idea that we are who we believe to be. ‘Belief’ is a bit stronger than ‘thinking’ — thinking, in general, is based on questioning, creativity, logic. Belief is mostly emotional and, in general, it’s not questioned (by definition, you believe things based on an emotional drive, not a logical cogitation). But it’s not all emotional: it also comes from an inductive principle, where we take a few facts for granted and induce the rest through belief. For instance, by merely counting our arms and legs and seeing that we walk erect on two feet we can induce that we are human beings — we don’t really need much more data, because very few animals are bipeds, and those who are, are mostly birds. So, in general, our inductive reasoning can construct pretty solid beliefs, which are often correct, or at least correct enough to allow us to make reasonable decisions based on that belief.

The belief about who we are is derived mostly from a small set of facts: the most important, at least for me, is our narrative, that is, the story we tell about ourselves, explaining (even to ourselves) who we are, where we come from, how we relate to others, how we are similar to them and yet different, how we grew up to be who we are today. Such narratives convey the experience we have acquired, our social interactions, and an attempt to explain, or make sense of, our memories. Another important fact is, of course, our own body, and how our brain perceives that body. There might be a few more things (Buddhists, for instance, list many more causes for the sense of self), but I think that we can simplify and say that our identity is formed from our narrative (which includes the memories of the autobiographic self and all experiences we had by interacting socially, including, of course, what we learned from our society) plus our body.

This narrative has several aspects, which we would then assign to different aspects of the self, or perhaps more correctly, the ‘sense of self’. I prefer to talk about the ‘sense of self’ because it implies two things: first, that it is a sensation, an emotion, a feeling, ultimately, a mental construct of our brain, based on a lot of inputs; it does not have a separate existence from those sensations and feelings but rather emerges from an assembly of them. And secondly, that this ‘sense of self’ is anything but solid and immutable, but that it constantly changes, as we add further experiences to our memories, through learning, acquiring information, and so forth. One strong source of change is, of course, the experience of our own body as it grows and ages — we are not the same person as we were when we were kids. Nevertheless, our narrative binds that distant creature in time to our current perception of our body through the memories recorded by our autobiographical self. In essence, therefore, we could look at what I call a ‘sense of self’ and equate it with the way this autobiographical narrative binds memories together.

But I have also pointed out how many things can go wrong with this process (Buddhists would say that anything that makes people ‘believe’ that they have an immutable, inherently existing self is already wrong from the beginning), namely, the aspect where false memories are thrown in the middle of real ones, as well as wrong perceptions of one’s own body which can confuse the whole narrative.

So the big question, again, is how to make sense of all this — and how people can be so sure about what they experience.

Remember how I was so specific about the idea of believing in one’s sense of self, as opposed of merely stating ‘this is how I am’? The question which quirks me is this belief, and probably I wouldn’t ask the question if I weren’t constantly questioning my own beliefs. In other words: I do not believe in my own sense of self. I believe, instead, that what I call the self is an incredible amount of circumstances and past experiences which make my brain think as it does about my self (= myself). If I put things that way, I must immediately ask why. Why did this particular circumstance change my sense of self? Why do I believe this to be who I am? What are the causes? What are the conditions that triggered that belief? You see, this is automatic for me, I cannot avoid asking all those questions constantly. You might imagine that someone who is so unsure about her self must be insane, or going insane, or something like that. Not at all! As I keep saying all the time, this is precisely what all Buddhists are supposed to practice: not to become ‘without a self’ (you can’t get rid of something that does not intrinsically exist in the first place), but to question why we believe so strongly in that sense of self. In fact, this belief is really so strong that almost everybody takes for granted that they are what they believe to be.

In other words: for an overwhelming majority of people, they don’t consider their self to be a matter of belief: instead, one’s self is, well, just what it is. And what it always has been, and always will be.

We ought to know better. Let’s take an example from our own transgender community.

Suppose that you, like me, a typical Generation X, have grown up without instant access to the Internet. At some point in your early life, you might have discovered something unusual about yourself: that you react to things differently than other boys (if you have been assigned male at birth) or girls (if you have been assigned female at birth) the same age as you. You might not be interested in their games, or their conversation. You might long for the dresses that the so-called ‘opposite gender’ wears. You might dream all the time of being a girl, if you have been told by your parents that you’re a boy, and vice-versa. In any case, and no matter how strong those feelings were, at some point it will become clear to you that you are different. Other people simply do not think like you do. And this can become very confusing.

Later in your life (and, fortunately, this happens much sooner these days) you might stumble across the word ‘crossdresser’ or ‘transexual’. All of a sudden, you learn something new: that several people in the world actually have reacted like you did in your earliest childhood.

What happens next? Because you have learned something new, all your memories get now tagged with you as a crossdresser/transexual. In other words: because you did not know that such terms existed, you simply tagged yourself as ‘different’. But now that this difference has a name, your brain replaces in all your memories that ‘difference’ by a classification. We really don’t understand how the lower levels of the brain work, and how these inform the higher levels (perhaps there are not really such things as ‘lower’ and ‘higher’ levels in the brain); however, we can describe what we feel at the cognitive level: our narrative has changed, and such a person will now identify themselves as crossdresser or transexual, and strongly believe that they had always been that way since birth.

The way I write this seems to imply that such people were not transexual or crossdressers since birth, but that’s not what I’m saying. What I’m saying is something a bit more subtle: acquiring information changes our narrative by re-tagging or re-classifying all our memories, backwards in time; because our ‘sense of self’ actually comes from this narrative (or at least it’s strongly correlated to it), it means that our sense of self changes. If you wish, our identity changes. We are not the same people as before we acquired that information.

Granted, such changes happen every day, the difference probably being that we do not face existential questions every day! Also, a lot of information might not trigger a re-tagging of all memories. Consider the following example: you have had a wonderful night out with friends, and are driving back home. Suddenly, a car appears from nowhere at a crossing, and you crash into it. Fortunately there are no victims, just material damage, and the police is called. They insist on doing an alcohol test, and yes, you register as positive, and a tad above the legal limit. What happens? Your brain has acquired new information — ‘you are drunk’ — and it starts back-tagging your recent memories to the point where you start recollecting that you really had a bit more than your share. And yes, maybe the way you found that guy so attractive was just the alcohol speaking. However, your brain will not tag all your memories back to infancy with the new category, ‘drunkard’. Instead, it stops — you do not usually drink too much. This was just an exceptional case. You haven’t changed your identity, your narrative, just because of the accident.

Now suppose that the police would never have been called, and that you managed to settle it out in a friendly way with the other driver. In that case, you might never become aware that you had been driving under the influence of alcohol. You would just drive back home, get some good night’s sleep, and wake up the next morning, perhaps just with a slight headache, and not really a hangover, so you would never have tagged your memories as ‘having been drunk’. Others, including your friends at the party and the driver you collided with, might have tagged you as being drunk, but you didn’t.

So as you can see, the kind of experiences one has will change their narrative, and tag memories backwards. How deep that goes obviously depends on the experiences; the deeper it goes, the more it affects the sense of self.

But the interesting aspect (at least for me) is that the tags get changed, and that means that the continuum of experience which is your life’s narrative — from which your sense of self emerges — can get changed, and with relative ease (very likely it is happening all the time, you’re just not aware of it). Just take a look at what happens when you wake up from an especially vivid nightmare: the memories of your nightmare persist in the waking stage, and they seem as ‘real’ as anything else you might have experienced, but, at some point, the brain steps in and starts flagging all those nightmare memories as ‘dream’ or ‘unreal’. Not many minutes after you have woken up, even if the memories of the nightmare linger, you can safely ignore them, because your brain has already tagged them as being ‘not real’.

But how does the brain know what to tag as real and as unreal?

I’m sure that this question will remain unanswered for a long, long time. Buddhists, by the way, have a partial answer to that. They consider that the world we live in is conventional reality (as opposed to absolute reality). That is to say, even if things are not really what they appear to be, if they are validated by others (meaning that they also share the same perceptions as we do), then they are part of conventional reality. A typical example: if we can all agree that a table is present in the room, then, even though a ‘table’ is nothing more than a convention to designate a vague area where complex atomic interactions are occurring (in reality, physics teach us that most of the table is empty space — the atom’s nucleons are tiny, and the even tinier electrons are the ones carrying crucial information to keep the table standing in its place and becoming visible to us). Even though we all might have a different perception of the table (just consider its colour: if it’s ‘burgundy’ to a woman observing it, it might just be ‘some sort of red’ for a man 🙂 ), we can still agree that the table is present. Now this is just ‘conventional reality’ — it’s far easier to talk about ‘a table’ than to exchange information about the precise state of each and every atom in it. So, physics might say that the ‘real reality’ is just particles interacting with each other, but at the level of what our mind can perceive, we can really see tables — and we can all agree what a table is (so long as someone taught us to identify that object as a table).

Anything which we perceive that is not perceived by others is not conventional reality, or, if you prefer, a dream or a fantasy.

Of course this is an oversimplification. Over the years, we accumulate knowledge to allow us to distinguish ‘conventional reality’ from ‘dream/fantasy/illusion’ and we don’t need the confirmation of others. Let’s take a simple example: a very young child wakes up from a very intense nightmare where she dreams she’s falling. Suddenly waking up, she tells her mommy that she was falling, and therefore scared to be hurt. Her mother tells her that it was just a bad dream and comforts her. So the child’s brain learns to tag that experience — falling — as being ‘highly likely a dream’. The next time the same dream appears, the child knows it’s a dream. Well, perhaps not necessarily on the next time — some very intense nightmares might require a little more reassuring that they are ‘not real’ until, at some point in time, the person will simply know that such things cannot be real and ignore them (in the sense that they don’t pay attention to dreams as they do to ‘conventional reality’).

So we acquire so-called ‘common sense’ rules which allow us to immediately flag things as ‘real’ or ‘unreal’. Sometimes we get things wrong, of course, but we spend most of our lives constantly updating such experiences (or, rather, the memories we have of them) as being real/unreal, because we need to function properly in this conventional reality. People who cannot distinguish between real and unreal have serious psychiatric disturbances (schizophrenia comes to mind, for example).

But… like everything else, there are grey lines. Not everything is so simply black-and-white. We can confuse an especially ‘realistic’ dream with an actual memory of an event — in some subtle way, the real memory and the memory of the dream can get mixed up together. Are these false memories, like the ones we discussed before? Well… yes and no. Technically, the brain is mixing up things, and so the memories are ‘false’ in the sense that they are partially extracted from a dream, but… reality was possibly so close to the dream that the difference is irrelevant. A typical example — dreaming about one’s wedding day. Some ‘facts’ might be different inside the dream (i.e. having a cream dress instead of a white one), but after years and years, such details might be irrelevant — we might not be able to distinguish between the wedding we dreamed of, and the memories of the actual event, and that doesn’t mean we’re crazy: it’s just one of those many fascinating quirks of the way our brains work.

Teaching something is effectively pushing some kind of information to someone, repeating it over and over again, until that information is stored in memory (we can, of course, learn by ourselves as well, using the same mechanism). In other words, this is a conscious effort to acquire new information, which, in turn, may have an impact on our narrative, our sense of self — depending on how we react to that new information. Education, therefore, is not merely acquisition of facts; it will also affect a person’s identity in a way, because that information will have an impact in our memories, and, consequently, in our continuum of experiences, which, in turn, makes up what we call the ‘sense of self’.

Now let’s put it all together.

My point here is that if you get certain information repeated over and over again, some memories will change. There will be a flipping of tags and categories. Something which might just have happened in a dream is now flagged as ‘real’. Or some information which is acquired is suddenly attached to one’s body inner self-image, and gets erroneously stored that way — thus, making us believe that what we read or saw also applies to us as well.

In the case of many transgender people (but of course not all!) this is a typical mechanism by which a person recognises themselves as transgender. At the beginning, when a ‘transgender experience’ was first encountered, there might not have been yet a ‘name’ for it. The experience, however, was still there, and gets conveniently stored to memory. Until, at some point, we learn about what that experience actually is. Then the brain starts backtagging all the existing memories — some of which, of course, may be utterly false! Nevertheless, even if we are aware that some memories might be false, we can somehow confirm that a lot of those images, at least, relate somehow to what we perceive our identity to be.

The Internet is perhaps one of the most intense ways to acquire knowledge that changes one’s mind (and one’s sense of self!) because of the sheer amount of input we can get from it, all the time, 24/7. We can see some of the impact of the Internet in delivering alternative visions of reality, for instance, in the Brexit referendum and in the Trump election. Issues that were believed by individuals were suddenly being addressed by populist politicians, which, in turn, repeated these issues over and over again (and the Internet magnified this effect!), until people started to believe they were true. Remember that one of the ways to flag reality as conventional (as opposed to being a dream) is getting positive, affirmative recognition by others. If more and more people repeat the same idea over and over again, it becomes part of conventional reality — it is much more than merely a ‘belief’ (which may be individual, and not confirmed by others).

While this applies to all areas of human knowledge (just consider religion, for example… or any political ideology), it has a profound implication on transgender issues. Essentially, transgender people are craving for information — and often also for peer recognition. This means that the validation of certain ‘feelings’ by the community will slowly but assuredly become part of their ‘belief system’. In other words: even though someone had no idea why they were ‘different’ at a very tender age, once such a person starts reading the information about transgenderity on the Internet, or gets the same information from transgender support groups, the notion that all their experiences in the past were linked to transgenderity in some form will become such a strong belief (because so many memories in the past were going to be tagged with ‘me, a transgender person’), that it will be experienced as real.

Now let’s step back a bit. I’m not claiming that transgender people are self-deluding themselves, and that ‘transgenderity’ is somehow ‘produced’ from social interaction with one’s peers. Transgenderity is real, even if you don’t have a name for it. My point is slightly different: even though people are born transgender or cisgender, the way this issue is incorporated in their identity (in this case, gender identity) can be accomplished in many different ways, from ‘believing’ a doctor’s diagnostic to peer pressure from other transgender people. This is hard to explain in proper, simple language, without making it sound like I’m claiming that somehow transgenderity is merely one’s own imagination or something like that, and that it’s not ‘real’, but merely conceptual.

La Chevalière d’Éon (Source: Wikipedia), 1779

Well, no, I’m trying very hard to tell the opposite. Sure, at a certain level, namely when we are talking about language, we might not have the ‘concept’ of ‘being transgender’ without first learning what transgenderity is. In the late 18th and early 19th centuries, for instance, all men who for some reason dressed as women were called eonists, because the most well-documented case of a transgender person living full-time as a woman and being acknowledged formally as such was the Chévalier D’Éon — who even got King Louis XVI to accept that he was a woman under the condition that he dressed as one full-time (and the king was generous enough to provide funds for the clothes!). Later in the 19th century, as Sigmund Freud started to attribute practically all mental diseases to sexual issues of some sort, ‘eonism’ subtly became ‘transvestism’, and it was seen as merely one form of sexual perversion that could somehow be ‘cured’ through psychoanalysis (which of course it wasn’t). By the mid-20th century, thanks to work done by Dr. Harry Benjamin (an endocrinologist and sexologist who also worked with the famous sexologist Alfred Kinsey), transvestism and transsexuality started first to become separate issues, and studied independently from so-called ‘sexual perversions’; the well-known WPATH Standards of Care still revere Benjamin’s work. We certainly progressed a lot since then, and studied the transgender diversity much deeper (Benjamin was still a victim of prejudice held in the 1940s-1960s from the Victorian and Freud legacy on sexuality and morals), but the truth is that we can attribute to Benjamin the idea that we can classify ‘levels of transsexuality’ by identifying certain traits (like sexual orientation, desire to undergo surgery, etc.). In other words: it was about the mid-20th century that we started giving things a name. Before that, people like, say, Lili Elbe, really had no idea what was wrong with them or what exactly they were feeling and why; transgenderity didn’t ‘fit’ in any established scientific model, and, as such, it didn’t really ‘exist’ in the purely conceptual, linguistic sense: the condition obviously existed, we simply had no name for it.

Nowadays, however, the opposite is true. Transgenderity is a field researched by several different sciences: psychiatry, psychology, neurology and embryology (in the sense of understanding what mechanisms in the brain create a ‘sense of gender’ and how such mechanisms may have been modified during gestation in the womb), sociology, anthropology, and so forth. Each approach is different, of course, and provides different scientific answers to the phenomenon, not all of them agreeing with each other. But we can say that there is a rough consensus of what the several aspects of transgenderity are. We might not be able to fully describe the whole spectrum, much less understand its causes, but we have documented enough cases to get a good taste of the diversity — but also a way to look for clues to identify and classify each case, and, if needed, provide medical support.

Now what I mean is that such scientific research has given us a lot of models to describe transgenderity, using different narratives, observing different traits, and so forth. Some models are more frequent than others; others are less frequent but very clearly identified. Someone who fully identifies with a ‘classical’ transsexual narrative, for instance (‘I have no idea why people started treating me as a boy when I was young, because I have always been a girl, and cannot explain why my body never developed as the girl I know I am’), can be easily validated as being a good candidate for a successful transition to the gender they identify with. And it’s much easier for such people to ‘come out’ and talk to doctors (and family), because such narratives are now well-known, well-researched, and even the media start getting them right — so the public in general is more informed, and more acutely aware of the signs that may show that someone is transsexual and suffering from gender dysphoria.

But, as said, our minds are much more trickier than that. Late on-set transexuals, for instance, have often a dilemma that has bothered them for all their lives: they somehow have always felt not to be in the right body, but couldn’t give that feeling a name. Such ‘feeling’ has always caused them problems, sometimes even depression, most certainly anxiety, and they have fought hard for ages to get rid of that feeling — people assigned male at birth, for instance, might have tried to succeed at a typically male job, like becoming a construction worker, a lorry driver, or getting a career in the military; and they most certainly have strived to get a family, get married, have children, and stifle their strange ‘feelings’ they always had that something was not right about themselves. At some time later in their lives — typically around what we would call the ‘mid-life crisis’, i.e. somewhen between 35 and 65 years of age — these feelings become too intense to be ignored further. Not many decades ago, this would simply lead to crossdressing, without even having a name for that. These days, however, we can read all about transsexuality on the Internet.

And then something strange starts to happen in the brains of those people. By reading the narratives of so-called ‘classical’, or early on-set transsexuals, they start to identify with that narrative as well. Suddenly they realise that their narrative is not different — the difference is that they have suppressed the desire to ‘come out’ and start living as a woman. But the tell-tale signs were all there: the confusion about what they ought to be playing with when they were three or four (cars and guns, or dolls?); the dressing in their mother’s clothes or of a familiar, and the strange, pleasurable feeling they had when doing that; the confusion during their teenage years, when they felt strongly attracted to women — but actually wanted to be them, not exactly have sex with them; and the constant urges to dress and live as a woman full-time, when all that felt somehow ‘wrong’. But at least they could now give their ‘feelings’ a name — they were transgender all the time, they just didn’t know that’s what it’s called.

There are a lot of similar narratives, and all of them are strangely familiar to each other. The picture of a man in woman’s clothes seen on a magazine that suddenly triggers the desire to do the same; the dominatrix forcing a man into sissification, which strangely feels incredibly erotic; the supermodel or singer or artist who reveals in public that they have been assigned male at birth but have transitioned early and now are incredibly gorgeous women, which evokes the notion that such people are free, happy, successful, look gorgeous… and that it is actually possible to become ‘one of them’. Well, you know what I mean: sociologists have been gathering these narratives and so many more for decades now, and, while each case is individual and unique, they certainly share a lot of common characteristics. Enough, in fact, to allow to do a diagnosis of gender dysphoria.

Because these stories and narratives have grown in number and are of much easier access, it also means that transgender people, or at least people who question their binary gender assigned at birth in some way, have access to all that information, and, at some point, it is inevitable that they will identify with one narrative or two. They will recognise some of the distinctive signs of transgenderity in themselves; perhaps not all, but enough to convince themselves that they also share the same transgender issues, to a larger or lesser degree; and so very often there is a catharsis, a moment of euphoria, when suddenly they realise that they are, after all, exactly like so many other transgender people, not a ‘freak’ of nature, but just someone who is part of a rather large group of others exactly like themselves, and, yes, the good news is that there is a ‘cure’ for dealing with those feelings and urges, and it’s called transition (in the sense of getting hormone replacement therapy and gender affirmation surgery). Perhaps the best news of all is that doctors are also aware of the same narratives, and are open-minded enough to accept them as patients, and eventually point them towards a ‘cure’.

This has a profound effect on someone’s psyche, and it’s just because I have observed so many cases of sudden euphoria in the discovery (counting myself!) that I have also observed something else: somehow, the more that person learns about transgenderity, the more that person’s narrative changes to become similar to such narratives. Notice that I’m including myself in this as well!

At the start of Jerome K. Jerome’s classic novel Three Men in a Boat, the main character reads a medical encyclopedia listing all known medical diseases with its symptoms and characteristics, and reaches the conclusion that he has all the diseases except two. This is meant as a satirical criticism of the problem of getting people self-diagnosing themselves — something which was as popular in the beginning of the 20th century as it is at the beginning of the 21th century. What happens in these cases — what happens with many hypochondriacs — is that the knowledge of a symptom produces the disease, or, at least, obsession/anxiety with the possibility of having that disease. A typical example: being affected with frequent headaches and truly believing that they are due to a tumour in the brain. Such cases, when they are extreme, might even develop a paranoid streak: when they are thoroughly tested by doctors, who fail to find any tumour, nor any neurological reason for the headaches, may actively believe that the doctors are lying to them, hiding the ‘real truth’ (the existence of a tumour) for some reason. This, in turn, will lead to discrediting the medical class, because they cannot be trusted to ‘tell the truth’.

Unfortunately, this is also the case with a lot of transgender people I’m acquainted with. I cannot generalise, but it’s definitely true that, once such transgender people get acquainted with the symptoms which are supposed to tell that someone is transgender, then they start feeling those ‘symptoms’ as well, or, more precisely, they start backtagging all their memories with themselves as ‘transgender’ (or a different gender than the one assigned at birth). In other words, the episodes where they played with dolls as a 3-year-old toddler suddenly become memories of ‘feeling like a girl’ at that age; the memories of dressing in one’s mother’s clothes reinforce the idea that they put on these clothes because ‘they felt that these were the clothes a girl should dress’ (while all memories of dressing in their father’s clothes get erased — not deliberately, not consciously, but they effectively disappear). In effect, once the ‘discovery’ of one’s transgenderity is made, one’s narrative suddenly starts making sense because we backtag all memories as being the memories of what a transgender person ought to have. And, because our sense of self, our identity — including our gender identity! — is pretty much tied to the continuum of memories we carry with us, it’s natural that, all of a sudden, we get the strong belief that we identify as transgender.

We’re not merely the sum of our memories and experiences, but those certainly are a big part of makes us be us. In other words, if we view our own memories and experiences at the light of a certain concept (in this case, transgenderity), and that concept all of a sudden starts making sense out of the jumbled mess which is our personal narrative, then it’s highly likely that our mind will grab fiercely at that concept and not let go of it — after all, it validates our identity, and we are very strongly attached to everything which is part of our identity.

For a doctor, the problem now is to figure out the ‘chicken and the egg’ precedence: is that person transgender, and therefore has a transgender narrative; or does that person have a narrative which can be read as a transgender narrative, and therefore believes very strongly to be transgender as well? You can say that both are the same thing and I do agree; however, I would also claim that both cases are treated differently.

In other words, a doctor might have figured out other causes for someone having a ‘transgender narrative’ — say, for instance, some kind of childhood trauma, a bad sexual experience in their teens, or a dramatic moment in their lives like the loss of a person very close to them. All such events might also trigger a ‘transgender narrative’. However, they are different causes, which ought to be treated differently; when a doctor suggests that to a person (something which, hopefully, is addressed in a very delicate way…), there can be a strong negative reaction against the doctor — because that particular doctor is refusing to accept one’s narrative which validates one’s identity. The doctor, in fact, becomes a threat to one’s own identity! As such, those people will immediately reject doctors, and pursue their own goals (for instance, going through transition) on their own. Some, indeed, become activists to get rid of the role of doctors in making decisions about the lives of their transgender patients.

The key word here is ‘might‘. Some doctors, obviously, follow their own prejudices. The difficulty here is to figure out when a doctor is making a diagnosis about gender dysphoria that comes from their own prejudice… or when the diagnosis is actually correct, it’s just the patient that cannot agree with the doctor’s opinion, because they have internally assumed a certain self-diagnosis, created a mental narrative that supports that diagnosis, and are truly and utterly convinced of what they believe to be their case — and can, indeed, offer ‘proof’ and ‘evidence’, by telling their narrative and showing how all the key elements are in it.

Again — this is not merely repeating the old doctor’s adage (made famous by the irreverent character of Dr. House): ‘patients lie’. I cannot claim that these people are really ‘lying’ in the common sense of the word, i.e. telling deliberate falsehoods because they want a certain benefit to themselves, although we know from the literature on transgenderity that such an approach was common in the late 1980s, early 1990s, because of the very strict criteria regarding transition; those transgender people who did not fit 100% in the established models would get their application for hormone therapy and surgery rejected because they didn’t ‘fit’ — and, as a result, the community quickly figured out what the ‘right’ answers are to make sure one gets profiled according to the strict view of transsexuality. The meme of ‘being a woman in a man’s body’ comes from that time, as well as the whole narrative of the ‘classic transsexual’, so often repeated, that any candidate to surgery and hormones would have their story well researched. This was, indeed, ‘lying’, in the colloquial meaning of the word: those transgender people knew they weren’t ‘classic transsexuals’ but they nevertheless wanted access to hormones and surgeries, so they learned how to tell a story in a convincing way to persuade doctors to give them what they wish.

Fortunately for all parties involved, not only the criteria changed dramatically, but both doctors and patients are aware that such lies were so common in the past that a) doctors know how to identify them easily (not everybody is a good liar!); and b) patients know that lying will get them nowhere, and, in any case, ‘lying’ is not a requirement for getting access to hormones and surgery, because the diagnosis, these days, rests on a whole lot of different criteria from those of the 1980s and early 1990s. This, in turn, protected patients much better (a much lower case of disappointments and detransitioning) while at the same time allowing a much wider group of transgender people to get some medical help to deal with their condition, even when it wasn’t ‘classic transsexuality’ but merely one possible expression along the very complex and vast spectrum of transgenderity.

Nevertheless, the ‘classic transsexual’ narrative is very powerful, very compelling, so often repeated by the media, and it is also known to produce a slightly higher level of acceptance from society in general: usually, at least as far as I can observe, it’s those who are somewhere in the transgender spectrum who are less understood (and more often victims of transphobia), especially if they clearly don’t visually match the expectations of a binary gendered society.

So what happens in this case? I think — I cannot offer proof, merely anecdotal evidence — that such transgender people, once learning a bit about their condition, will start self-analysing themselves deeply, and they will try to ‘fit themselves’ in one of the many possible boxes. This is, in a sense, a conscious effort, and that’s why the result is actually believing (with a strong conviction!) that a narrative they have learned to be part of a specific type of transgender people is similar enough to their own; in other words, they start backtagging their own narrative to ‘fit’ a specific kind of transgender model. Because such a process will, indeed, start replacing actual memories with ‘false’ memories — or, rather, existing memories where, for instance, one’s self-representation in those memories is now differently tagged — the continuum of experiences upon which relies our sense of identity will also change. Putting it differently: such transgender people, by ‘changing the past’ (more precisely, their recollection of the past, stored in their memories produced by the auto-biographical self), also change their present identity (which, as said, is also a sum of all memories and experiences — it’s more than that, but that continuum of memories and experiences certainly contributes towards a major, substantial part of one’s sense of identity), so that the current way they identify themselves is precisely aligned with their memories, which are now being differently represented.

Therefore, such memories of the past where one questioned what kind of toys to play with, or when dressing surreptitiously in one’s mother’s clothing, which are true memories, become subtly altered so that the explanation for those memories is now viewed from the perspective of someone who affirms their identity to be female because of those memories. It’s like getting a ‘reverse explanation’, or a reverse implication: instead of taking one’s continuum of experiences and memories and letting it produce a certain identity, they start from a ‘desired’ identity, and backtag all past memories and experiences as leading to that ‘desired’ identity.

Again, we must be very, very careful with overgeneralization: I’m by no means saying that this happens all the time, or that it happens with most transgender people! Rather, I think that this is an exception to the rule, and actually much rarer than the ‘classic transsexual’ narrative. Nevertheless, just because it’s an exception, and it’s rare, it doesn’t mean that it should be totally ignored or discarded because it’s unimportant.

Now, I have to admit that I would need a larger group of people to come to conclusions. What I have noticed recently is that, in certain cases, some people get an immediate diagnosis of gender dysphoria, and are on hormones a few weeks after their first session with a therapist. In some of those cases, I have talked to those people way longer than any of their doctors did, and it completely baffles me how they have come to that conclusion so easily — in other words, I can easily ‘see through’ these people and notice that they have changed their narrative to ‘fit’ a certain transsexual stereotype (and not the other way round). And how can I know that much? Because when I first met these type of people, they have a past clouded with some traumatic experience, which can take many forms — as said, the most frequent being a traumatic sexual experience during childhood or puberty, the loss of a person close to them, sexual frustration (in the sense of not getting the ‘right’ partners), and so forth. Such traumatic experiences are often hidden from casual acquaintances, but, as a friendship deepens, they pop up in conversation; in certain cases, it’s the whole behaviour that clearly points to a certain traumatic experience in the past.

Such people will then happen to come across the transgender community, very often by pure chance, but they immediately identify with the group. I have also talked to some acquaintances who also have similar experiences with ‘new’ members of their own groups — such stories seem to be rather frequent, or, at least, they are far less rare than one might imagine. The triggering event is somehow coming across the image of a transsexual after transition; of a typical crossdresser; or even watching a transgender person in public… whatever the triggering event is, somehow there is some light shed in that person’s mind which says: ‘I can be like that, too!’

Of course, one might argue that this is what happens to all transgender people, but it’s not entirely correct; for instance, the ‘classic transsexual’ does not need a ‘role model’ or anyone to tell them that they are in the wrong body for their gender — they have that experience pretty much since birth, even if they cannot give it a name. And on the far end of the spectrum, crossdressing fetishists might have strange dreams and fantasies, but it’s often only when they learn that others have the same kind of fantasies — men dressing up as women to have sex — that they suddenly realise that it’s perfectly healthy and normal to engage in the same kind of activity. Again, I’m not saying that there is some sort of self-delusional mechanism going on; because the overwhelming majority of human beings do not get ‘triggered’ by such events to ‘become’ transgender, I still maintain that transgenderity must be something inherent which makes us act differently from cisgender persons. In other words: the image of a man dressed as a woman will ‘trigger’ nausea, repulsion, hate, or laughter from a cisgender man (and often from a cisgender woman as well!), while for a transgender person, it either will confirm their secretly held belief that such things are possible, or it will trigger a strange erotic attraction to that image, or, well, it might trigger some envy and jealousy (or even frustration!) that we cannot be the person in that picture (for some reason). No matter what the reaction might be, it’s quite clear that transgender people react differently from cisgender people to such ‘triggers’, and I would say that this would be a very simple test to prove that someone is, in some form, transgender, even though it might not help us immediately to figure out where in the transgender spectrum they are located.

Nevertheless, just ‘being transgender’ is not enough; there is always the issue of gender expression, and this can take so many different forms — from crossdreaming without any external expression (at least not on one’s physical body) to full-blown body modifications through surgery and hormone replacement therapy. Somewhere in the middle we have all sorts of crossdressing activities, in public or private, interacting with the public in general or just within a small community of similarly-minded people. Every single one of those expressions are perfectly legitimate: none is ‘better’ or ‘worse’. But each and every one of them also can bring some degree of pain, of suffering, of confusion, of frustration, eventually depression and anxiety. This is connected to one’s ‘adopted’ auto-biographic narrative, yes, but there are differences. A crossdreamer who only dreams about being the opposite gender, and has done so from the dawn of self-conscience, most certainly has a life-long narrative of strongly feeling that they are, indeed, much more connected, or drawn to, the gender they dream about being. And this naturally causes a disruption between the mind’s ‘core gender’ and the physical, biological body, which is at odds with what the mind dreams about. That certainly can cause gender dysphoria — with more or less intensity, with more or less associated issues (such as depression and anxiety) — and, as such, crossdreamers are perfectly entitled to precisely the same support (and eventual treatment) from doctors. They are not ‘lesser transgender people’ just because they do not express themselves outwardly as ‘classic transsexuals’. The suffering that both go through can be exactly the same; this is the same issue that we Buddhists discuss when we say that the pain an ant feels is the same as the pain the elephant feels — both are pain, both are suffering, of course adapted to each form, size, and complexity of neuronal interconnections. But we cannot say that ants feel less pain just because they are tiny! They just feel pain differently than an elephant (or a human being), but ‘different’ does not mean ‘less’.

In other words, sure, even a crossdreamer can commit suicide if they do not get some relief from eventual gender dysphoria they might feel.

Now the whole point of this article is to answer the question on its title! And the question, as we can see, is not that easily answered. Since I’ve been addressing crossdreamers, one might ask: how do we know that crossdreamers without any external gender expression have a ‘core gender’ that is different from the gender assigned at birth — or that they merely imagine that they have such a ‘core gender’? In other words: when transgender people do not ‘fit’ into a classic transsexual narrative, what is their core gender? What kind of ‘treatment’ should they be subjected to (if at all), if they exhibit symptoms of gender dysphoria? In some cases (which are not so rare as that!), crossdreamers who never manifested any wish or desire to externally assume the gender they identify with, all of a sudden want to go through all surgeries and hormone therapy — often not even wanting to wait for the ‘all green’ from their doctors, but simply jumping to some country where such surgeries and therapies are handed out with few questions. So clearly these people, albeit starting with a completely different narrative than so-called ‘classic transsexuals’, tend to follow exactly the same narratives as, say, late on-set transsexuals. But nothing would have been apparent before they started transition all of a sudden; and, yes, in many, many cases, it is really sudden!

A few scientific reports I have come across explain this phenomenon merely through a suppression mechanism — in other words, since such crossdreamers suppressed their ‘real gender’ for so long, not even daring to manifest themselves externally according to that gender, the drive to a sudden ‘release’ of the decade-long suppression becomes very quick indeed — they do not want to wait longer, they have already suffered in silence way too long, now it’s time to acquire some happiness, and get it quick!

Another thing which still baffles doctors is why hormone replacement therapy has such a calming effect on transgender people who finally made that step. Early medical research in the 1950s, when male homosexuals and MtF transsexuals were ‘cured’ by injecting them with testosterone, shows very ambiguous results in terms of mood changes (usually the patients became worse, i.e. more agitated, more irritated, more depressed), and, of course, it never ‘cured’ them of their sexual orientation and/or gender identification. But when we start to read reports from the late 1980s, almost all of them are unambiguously reporting a ‘calming’ effect on MtF transsexuals under HRT, which will dissipate their anxiety and depression on their own, as well, as expected, reducing their gender dysphoria to virtually nil.

A common explanation is that reducing testosterone levels will decrease irritation and aggressivity, and, therefore, inducing a sense of calmness. But doctors are aware that, in the case of FtM transsexuals, because they get testosterone shots, doctors would expect an increase of irritation, anger, and aggressivity — however, what is observed is exactly the same calming effect as in MtF transsexuals. This cannot be easily explained in terms of pure biochemistry. The currently more plausible explanation is that HRT acts as a placebo, in the sense that it gives the transgender person the notion that they are doing something to stop their gender dysphoria and finally aligning their bodies with their gender identity, and, as a consequence, the mere act of ‘doing something to get cured’ is enough to reduce dramatically the symptoms of depression, anxiety, and, ultimately, of gender dysphoria as well.

This, however, does not happen in all cases; I’m personally acquainted with a few MtF transsexuals who exhibited a high level of anxiety before going through transition (to the point that doctors usually wanted to treat them first for anxiety, but they refused to wait any longer), and such levels of anxiety persisted clearly even after HRT (and surgery), the focus of their anxiety just changed: in some cases, for instance, the sensation of gender dysphoria was replaced by the fear of not ‘passing’ (perhaps it’s ironic that those people I know personally are counted among the ‘most passable’ trans women I ever met!).

So my conjecture is that there are several issues at play here, and all of them interfere with one’s autobiographical narrative. On one hand, we have a mechanism of identification with a specific narrative, and, as I showed, people will backtag their memories so that they ‘fit’ into that specific narrative (even though the ‘late on-set transsexual’ narrative is the most common one — and the one the media are so fond of — it’s by no means the only possible narrative). The feeling of gender dysphoria persists during this ‘narrative change’, and, in some degree, one may claim that the dysphoria increases after the process of identification is completed, because by adopting such a narrative as their own, those transgender individuals will also adopt the same kind of suffering that is present in such narratives. Please note that there is not just one ‘classic transsexual’ narrative, so naturally each case is different (as different individuals will pick the narrative that fits ‘best’ to their personal case); on the other hand, and I’m just talking from personal experience here, we can fit many of those narratives in specific categories, and also, in each case, track them back to specific (traumatic) events in the past which triggered a particular narrative (as opposed to a different one). The most clear case of distinct narratives was found out by Blanchard himself, when he suddenly realised that not all MtF transsexuals were attracted to men; this made him curious, and the idea that there are ‘two types’ of transsexuals (the ones he call ‘homosexual transsexuals’ and the ‘autogynephilic transsexuals’) was born. In reality, what Blanchard ‘found’ out makes no sense, since his own data does not even support the notion that there are only ‘two types’ of transsexuals; it’s just by coercing the data to display what Blanchard wanted to prove that he could come up with his crazy theories, full of moral/ethical implications, when reality is hardly that simple.

Nevertheless, we can identify some prominent transsexual narratives, and, even if transsexuals do not exactly ‘fit’ in those ‘major narratives’, these are the cases that they will have heard about and understand better, so it’s more likely that they will identify with them — and, as a consequence, backtag all their memories (and therefore also changing their identity!) to ‘fit’ to a specific narrative.

Such ‘adopted narrative’ becomes a new reality. It is quite solid: people who adhere to such a narrative will not easily question it, and have little doubts to trust it to be anything but the truth, because, as said before, the narrative becomes the identity, and we all are very reluctant to ‘let go’ of our self. Instead, we reinforce the self, by providing a narrative that confirms its current, present situation. Those transgender narratives explain why the self feels as it does; they give the self a sense of completeness, of purpose, of ‘being right’. And when such persons are actually suffering from gender dysphoria (a situation where one is already questioning part of one’s identity, namely, gender identity), I have no idea if it’s a good idea or not to start to have them questioning themselves (as in: questioning not only their gender identity, but their whole identity, namely, questioning if their memories are real or fake).

In this particular issue, I can only give my own experience as an example, and by all means I’m biased! Over the past few decades, I identified myself with many different transgender narratives. First I identified with what used to be called crossdressers (these days, we would actually call them transgender crossdressers, or something similar, to differentiate them from transvestic fetishists). This provided me with a reasonable explanation of what I was feeling and thinking, and why the whole idea of ‘myself as a woman’ excited me so much (and note that this ‘excitement’ was not simply sexual in nature, but mostly the effect of an adrenaline rush — although occasionally it also included sexual excitement, often with an erection, at least at the very beginning).

Over the first years, however, it seemed clear to me that I didn’t share some of the attributes of many ‘classic’ crossdressers. It was for me unclear what it meant to ‘be in touch with one’s feminine essence’. It implied a certain disconnect between a male and a female essence; and the act of crossdressing somehow ‘switched’ from one state to the other. Indeed, there was some advice for those who ‘were in touch’ with their ‘feminine essence’ and suffered from that (because of the urge to constantly crossdress) to work towards a fusion of both essences, anime and anima, ying and yang, and become ‘complete’ when such a state was achieved. Felix Conrad, our crossdreamer/transgender philosopher, seems to advice something similar — in other words, recognise that ‘being transgender’ might mean exactly (literally) that people will ‘transit’ (or ‘transform’) from one gender into a different one (and back again), while at the same time constructing a new identity that is not fully one gender or the other, but a merger (or fusion) of both.

Somehow, however, that was not really what I felt. I don’t see a ‘disconnect’ when dressing as a male or a female; I don’t really feel a ‘switch’ occurring, turning me into someone I’m not. Even though I certainly recognise how this really happens with a substantial amount of my crossdressing friends, it’s not my case: I’m ‘the same person’. I had therefore to conclude that I didn’t really ‘got in touch with my feminine essence’, but rather, when presenting myself as female, I was just expressing what has always been the case. The excitement I feel is merely the joy of finally being able to present myself as I enjoy presenting myself — while I have no particular joy in presenting as a male (and, for the past decades, I have even loathed it).

So, digging deeper in the Internet, I somehow came across Blanchard’s crazy theories — something which, unfortunately, is unavoidable. I didn’t find Blanchard’s scientific publications, but rather, some texts written by his followers (sometimes not even given credit to Blanchard), attempting to explain the strange concept of ‘being attracted to one’s self-image as female’.

No matter how wrong Blanchard is when he presented his conclusions based on this factual evidence, he does make one correct point: some men, indeed, feel strongly attracted to their self-image as female (we now prefer to use the neutral expression crossdreamer to designate such individuals). Such attraction is often erotic (Blanchard claims it’s always sexual in nature) but it truly depends on the person and on how each individual deals with that ‘attraction’. Maybe the word ‘attachment’ would be more correct — ‘attraction’, unfortunately, is a loaded word which somehow always implies a sexual/physical/romantic connection. Attachment is more neutral.

The more I read about this fascinating subject, the more I started changing my own narrative. Indeed, I cannot deny that there is a strong attachment to my self-image as female. However, unlike Blanchard, I don’t think this is an unnatural (i.e. paraphiliac) feeling; I think that most women feel attached to their self-image as women, as it is proper and logic. Some might think they are too fat, too ugly, whatever, but there is still an ‘attachment’ there, in the sense that they worry about their bodies, and wish it to conform to a certain self-image they have of themselves. I have met a few women like that (my wife being a very good example), and my conclusion is that there is nothing out of ordinary if a woman is attached to a certain female self-image of themselves.

Now, one might conclude (like Blanchard) that when a man is attached to his self-image as a woman… then something is seriously wrong! I would, instead, call the argument invalid, because the premises are invalid: Blanchardians tend to assume that an autogynephilic transsexual thinks of himself as a man, but dreams of being a woman. While there might be some people like that, this would simply fall in the (harmless) realm of a sexual fantasy and nothing more; even the strong desire to become the woman they’re dreaming about is just an extreme act of body modification.

Rather, what I believe is that those individuals never were men to start with. In other words: their ‘gender core’ was never male. One might argue what it was, then — especially on late on-set transsexuals: were they ‘suppressed people identifying as women’ all time long, or ‘somehow male’ but not really sure about their ‘maleness’, or simply ‘conforming to be male but eventually giving up on that gender role’? There are many more alternatives, of course (Blanchardians rarely worry about those alternatives). Felix Conrad twists himself out of the dilemma by simply saying that those people are transgender: the defining characteristic of ‘being transgender’ is not really fitting in pre-established gender role models, so it’s pointless to argue if such people are ‘more male’, ‘more female’, ‘male with a feminine essence’, ‘a fusion of male and female’, ‘identifying as male but seriously questioning their gender’, and so forth. Simply put, if you’re happy with the gender you’ve been assigned at birth, you’re cisgender. If you’re somehow not happy, or questioning your gender, or questioning your gender expression, well, then you’re transgender — it matters little where exactly in the spectrum, because there is really so much variety.

Needless to say that this narrative felt much more ‘attractive’ to me as well. It avoids the old trap of deciding if ‘I’m a woman in a man’s body’. How do such people know that? They have never experienced what it means to have a woman’s body before transitioning; it’s certain that after transition they can now feel to be ‘women inside a woman’s body’ (because they have a way to compare what they felt before and after transition), but the truth is that such a person can only say that they are not ‘men in a man’s body’. Or, to be more precise (and this is much better aligned with what transsexual children say), that they feel that their body is not aligned with their gender identity.

Because gender is not binary, just having one’s body not aligned with one’s gender identity does not mean that one has to identify with the opposite (binary) gender. In other words: just by not feeling ‘male’, it does not mean automatically that one is ‘female’. This is a typical fallacy, but we have been stuck with a binary gender for so long that it’s almost impossible to avoid the binary gender trap.

And, indeed, society (and doctors!) tend to ‘encourage’ the ‘classic transsexuals’ to transition (even conservatives will not be absolutely against that), because classic transsexuals are believers of a binary gender — they just have the wrong body for their gender, that’s all. If such a person already has a lot of physical attributes typical to the gender they identify with (namely, if they are already androgynous), then it’s far easier to accept someone who truly believes in the male/female binary gender divide than others who… are somewhere in between.

During my past three years, I have looked very deeply into my own mind, and try to figure out how such narratives apply to me. It’s clear that the so-called ‘late on-set transsexuals’ have very appealing narratives. There is a certain match between my own narrative and theirs: for decades I have strived to be a ‘good male’, in the sense of coming as close possible to the physical and social stereotype of a ‘male’ (even if only as a ‘weak male’ — you know, those that still are allowed to have emotions 🙂 ). But I have failed horribly: in so many cases where it was socially desired to display my ‘maleness’ (I’m talking about mental attitudes here… not sexual ones!) to fix a certain problem, I utterly failed. The more it was demanded from me to ‘behave as a male’, the harder I would fail. This was repeated so often that, well, I can pretty much imagine that my doctors might believe that it became a traumatic experience, and that some of my questioning of the ‘male gender’ role comes from those experiences. In other words: although I was not absolutely sure about my gender, I suspected that I was no good as a ‘male’ since at least my teens (and since I was 11 years old, I most definitely was attached to my self-image as a girl; before that, my memory is vague), but nevertheless tried very hard to ‘fit’ in the male social role, to the best of my abilities — and utterly failed, over and over again. So my helpful brain, unconsciously, started to add 2+2 and came up with… well, something like 3.999999998. Although I cannot ever be sure about any conclusion (because I can always question it, especially when I come into possession of more relevant information), this is pretty much my current reasoning:

  1. When I was very young, I was raised almost ‘genderless’, in the sense that there weren’t really ‘boy stuff’ and ‘girl stuff’: both had to do pretty much the same stuff.
  2. Later, I found it confusing that I somehow had to play with the boys but the teachers wouldn’t let me play with the girls; I didn’t really understood why, but I complied with their orders, just to make sure I wasn’t going to be yelled at for doing the ‘wrong’ things.
  3. With 8 or 9 years or so it was clear that I had little in common with what the majority of boys were doing. I had no taste for sports, for rough-and-tumble activities, climbing on trees, and so forth. And sure, I was bullied because of that — mostly verbally, sometimes physically. I didn’t mind, because I wasn’t the only one. During most of school, I simply hang out with similarly-thinking friends. Most were male (I’d call them ‘weak males’ now), a few were girls. In my dreams I would often be a girl, or sometimes just an invisible camera, watching the kind of girl that I found attractive, and wishing I could be like that. But it wasn’t a strong feeling, and even then, I was aware it was just a dream.
  4. With 11 years, it was now clear that I could only achieve an orgasm when thinking of myself as a girl. Believe me, I tried to masturbate by not thinking of myself as a girl, and it simply didn’t work. Even today it’s extremely hard to get an erection when thinking of myself as a male. It’s not exciting enough.
  5. With 15 years, I thought I was too shy to get a girlfriend; I changed my attitude totally, and became an extrovert, but still couldn’t get a girlfriend. I figured out that I was physically repellent to women (and to people in general), but once I figured that out, I actually felt calm and relieved — I couldn’t change the way I looked, so there was nothing to worry about it. This traumatic experience was so intense that even today I believe to look like a monster — in spite of having enough factual evidence to show that I’m the only person thinking that. This came to me as a huge shock (although it certainly explained some things in my past).
  6. I lost my virginity late (already an adult). It was not particularly interesting (although she was a nice, good-looking girl — ironically, an American). Afterwards, with other women, the way it tends to work better is if I think of myself as being a woman as well — not exactly ‘easy’ because I have all the wrong bits, but it definitely works better that way. And yes, I prefer women on top (somehow I have this feeling that I might crush them if they’re below me…). And no, I’m definitely not into men. Ugh. Just the idea makes me physically sick. It simply doesn’t work for me like that: I have heard how we all are bisexual to a degree, but it certainly is not my case!
  7. With 27 years or so, I did my first crossdressing session — and was utterly shocked about the intensity of the emotions, as well as the sexual discharge. I (seriously!) thought I was going insane. It coincided with a complicated time in my life — starting a new company, losing a girlfriend, being forced to spend a few months in compulsory military training, getting a new girlfriend — so I was in panic, there was simply too much I had to handle already, I couldn’t start dealing with my insanity now. Fortunately, there was some information on the Internet about ‘men who dress like women’ — I thought that my condition was unique and hoped to get some hints on what kind of doctor to ask to treat and cure me, and, as you can well imagine, I was even more shocked to find out that there were millions of people out there just like me, and that what I felt was perfectly normal.
  8. Since then, I have tried to make sense of my own narrative, and see where I can ‘fit’.

The truth is that the sum of those experiences are unique to me. Sure… at some points… I might ‘fit’ into one transgender narrative or the other. I might just be a ‘weak male’ who doesn’t like to be male. I might just be a transvestic fetishist who loves to feel to be treated like a woman in public. And I might have always been a transsexual, completely confused about my condition (especially because I’m strongly sexually attracted by women… and put some emphasis on that ‘strongly’!), having repressed my ‘inner true nature’ for so long that I ‘lost’ somehow my gender identity — I’m clearly not a ‘male’ but I cannot truly say that I’m ‘female’, because, in all honesty, I never lived as a female in a female body, so how can I truthfully claim to be ‘female inside.

But this narrative is so different from the two most usual ones I hear all the time, from my circle of acquaintances. The first is what I would call the sexual transsexual: basically, these are late on-set transsexuals who finally figured out that their whole sexual life is a complete mess because they simply are in the wrong body for the kind of people they want to have as partners! Not to be able to get the ‘right’ partner because one has the ‘wrong’ body causes extreme gender dysphoria, but, eventually, those people will go to a doctor who will ease them along their transition, and they might finally get the kind of partners they desire, and live a happy life afterwards (and yes, I fortunately know at least one good example with a happy story!… but there are more, many more).

The second kind is almost asexual, mostly due to some traumatic childhood experience (often including rape or as close to rape to be indistinguishable from it), and has a strong hate towards men and maleness. They are often very strongly attracted to women, both physically, but especially at the mental level, identifying with them, making friends easily, because they are attuned so much to the wonderful ‘world of women’ that they want to become one of them. Some of them want clearly to ‘escape’ their male role, once and forever, because, somehow, their ‘maleness’ is still linked to that traumatic experience. Most of them are also very anxious people (some might be mildly depressed in addition), strong-willed, and very stubborn, except when it comes to learn all about the ‘women’s world’, where they are always open-minded and eager to learn new things.

You might wonder how on Earth the above narratives ‘fit’ in the classic model of the late on-set MtF transsexual, and if you’re baffled, so am I. The truth is that such people are speeded along their transition as fast as legally possible; they are beating world records in terms of becoming the woman they want to be. The current record is held by a friend of mine who needed just a few months to get the two official reports to label her as a trans woman, get shots of female hormones (to get some effect faster; later she switched to patches), get all surgeries (at the same time!!), and start living her life full-time as a woman, with ID card showing her new name and gender and all. There was not even time for any ‘real life’ tests or anything like that — she was already living full-time as a woman when she attended the first sessions with the doctors. You’d imagine that this would be an exceptional case, but it’s not — I’m aware of several similar cases, where their transition is really rushed ahead as quickly as possible. One of my acquaintances got her doctor starting to pencil her in for gender affirmation surgery on the very first therapy session she had! (And yes, that was in the public service, the same one, in fact, which just allows me to go there, say, once every three months, because allegedly my case is too boring for them…)

It’s unfair for me to be jealous of those friends of mine, but the point here is that some people allegedly ‘fit’ a certain narrative so well that the doctors have absolutely no doubt about rushing them through transition. Not being a doctor myself, I cannot imagine what made them decide so quickly. I sometimes know these people for months, or even years, talking to them quite often (sometimes even at a daily basis), and, if I were a doctor, I would have serious doubts about their intentions. It’s not that they do not classify as transgender — they are, all of them, very clearly somewhere on the spectrum. It’s also very clear that they seriously want to change their bodies and their whole lives, and have already shed all bonds with close family (namely, getting a divorce) in order to facilitate the process (it’s almost impossible to get through transition if you’re in a ‘conventional marriage’ and have no intention to get a divorce). In most cases they have some ‘plans’ for the future; in the remaining cases, they have a close relative (a parent or sibling) where they can stay for a while until they can get their life settled down in their new gender role.

Now the WPATH Standards of Care recommend that all patients with gender dysphoria start first to address all other (mental) issues before their transition begins. In the cases I’m aware of, it seems clear to me that certain traumatic experiences in their childhood must have been omitted when talking to the doctors; in other cases, their mental issues are so evident, even to a layperson, that it’s utterly baffling for me to understand how the doctors could have been so sure about their diagnosis.

One might think that such people would eventually ‘fail’ their transition at some point (they don’t) or even start thinking about detransitioning, once they figure out, like ThirdWayTrans, that the root causes of what they feel as gender dysphoria actually spring forth from traumatic experiences in their childhood, much suppressed for decades. But no: as far as I know, there have been no ‘detransitioning’ cases in my country, although obviously there have been many people who have entered the real life test and gave up.

But I’m aware of so many people who cheat with their real life tests, as well as those who start hormones (administered by doctors!) well before they have a diagnosis of gender dysphoria, not to mention the many cases of multiple mental issues, any of which might trigger similar symptoms to gender dysphoria, that I seriously wonder what exactly those doctors are thinking that they are doing. Because they have such high success rates, I suppose that they must be right in some way. I’m also aware that those people present to their doctors a well-rehearsed ‘classic transsexual narrative’, either with more or less sexual undertones, and the doctors, allegedly, are fine with that story. Why do I say ‘well-rehearsed’? Well, again, I have talked a lot with some of those people. They most certainly had a different narrative before they considered transition; and, once they start transition, their new narrative is suspiciously close to the so-called ‘classic transsexual narrative’ — it’s almost ‘too perfect to be true’. But do not think that these people are acting, or that they are inconsistent in their narratives; rather the contrary, when in their minds they have eliminated all doubts about their transsexuality, their narrative (and identity as trans women) is so firmly established that it truly seems like they have always been like that. I know otherwise because I had learned their previous narrative, and their current one is so different — nevertheless, when they talk about their current narrative, they are much more confident than when talking about their previous one; it most certainly sounds much more convincing. Maybe it’s that acquired confidence with a new narrative that finally convinces the doctors to give them the thumbs up…

In other words: the diagnosis (of gender dysphoria that requires transition to be ‘cured’) revolves around the issue of having the patient backtag their memories with the ‘correct’ narrative, which, in turn, will make them feel much more at ease with their current identity (and gender identity). Although this happens to all people at some point in time, I can only wonder what exactly is going on here at the many cognitive levels of the brain: do such people actually deliberately or subconsciously change their narratives to ‘fit’ better in established models, or have these narratives ‘always been there’, just somehow clouded and inaccessible (because they were so suppressed), and it’s at the moment when the decision of going through transition is made that this narrative is actually retrieved into the conscious part of the brain, accepted as real, and, most important, accepted as ‘always having been there, just hidden’? The latter would be consistent with the meme ‘I have always been a woman; I was just born with the wrong body’ — transsexuals do not want to ‘become’ something they’re not, they want a validation of the narrative they always had, and which always defined their identity.


In sociology and anthropology, the role of the researcher is often a very questionable one. In the past, it was assumed that sociologists and anthropologists had to ‘watch from afar’, in order not to interfere in what they were observing (we all know from quantum physics that the observation changes what is being observed!). The idea is that the researcher ought to position themselves as being ‘neutral’, distant, and not biased, towards what they were relating about human interactions.

However, this is often impossible, because certain facts can only be acquired if the researcher becomes an active member of the group they are studying. Social science researchers in the field of transgenderity cannot ‘watch from afar’: they need to earn the community’s confidence first, and be accepted as a member (an ‘ally’ in this case), and only then will they be able to extract any relevant information. However, the process of being integrated as a member of a group currently in research will transform the perception of the researcher — they will not be unbiased any more, but will learn to analyse what they see in their group through the lens that the group provides.

This dilemma is part of scientific research today, and, in general, it has been deemed acceptable for researchers to become active members of the community they are researching — any bias they might have can eventually be minimised by future researches made by different people, each with their own bias, each differently acquiring information and being differently affected by the community they are studying. Overall, therefore, it’s better to have a handful of potentially biased reports than no reports at all for ‘fearing’ contamination with the community’s ideas and perceptions.

As a member of the transgender community, somewhere in the spectrum (and eventually even shifting along that spectrum!), it is therefore hard to me to be ‘neutral’ about what I observe. On one hand, I have the best study object ever — myself, because I can read my own mind, something I cannot do for anyone else 🙂 Then, because I’m also transgender, it means that other transgender people are much more at ease with me, and they have no fear of talking about their innermost secrets with me. However, I’m utterly biased: the best I can offer is a comparison between the way I think and the way others think. But there is no neutral analysis here: it will always be distorted according to my own perceptions, to the answers I have given myself to so many questions over the years, and the results, invariably, will not be ‘neutral’. That’s why this long article is published in a blog and not in a scientific journal!

Just because I claim to be able to introspectively analyse my own mind rather deeply, that is no advantage in this specific area — almost all transgender people are introspective anyway, since, at some moment in their lives, they have questioned their gender identity. In fact, much of what makes my own personal narrative make any sense has come from the deep introspective work done by previous generations of transgender people who fortunately were kind enough to leave their discoveries in writing. By reading what they thought about themselves, a clearer picture was formed in my mind about what I was really looking for.

But, ultimately, I will not be able to escape my own bias, my own perspective and point of view, my own perceptions about reality. And at this stage of my life, I pretty much question everything. I’m aware that there are certain areas where I simply cannot trust my own perceptions: the idea that I’m physically repulsive, for instance, was one of the many eye-openers — I have lived practically my entire life with a totally wrong perception of myself. And even if I intellectually can now understand that people see me differently from what I see in the mirror, it’s still hard to swallow. Oh, let’s be more honest: no, I haven’t persuaded myself in the least that this is the ‘truth’. My perceptions in that regard are so skewed, and have been so for over three decades, that I really cannot feel that everybody else is right and I’m the only one to be wrong!

There are plenty of other cases like that. The more I explore the workings of my own mind, the more doubts I have about my perceptions. I have searched for decades for ‘certainty’: am I a crossdresser? a transsexual? an abomination upon the eyes of the Lord? merely a fetishist? all of the above, or none of them? At each stage of my life, I somehow wanted very eagerly to say: ‘ok, finally, I’ve figured out who I am, and what I am, now I can relax’. But the truth is that the more I search for ‘certainties’, the more questions I have, the less satisfactory those answers seem to be, and the more doubts I have about who I am and what I am.

Ultimately, like one of my doctors is always fond of saying, I’m just a person. That’s probably the only thing I can really be sure of.

All the rest, well, I guess that sometimes I simply question too much. Sometimes there are no answers to find, even if the questions are the right ones. Sometimes you simply cannot be sure of something: you will have to work with a best guess and be content with that.

  • L.A. L.

    Very insightful thoughts. Thank you.