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She doesn't always dress as a woman ("It's a lot easier to mow the lawn without a wig on," she explains). But she does look forward to the day when she can live full time as a woman and forever leave "boy mode" behind.
"I feel like I'm lying," she says, describing what it's like to dress as a man now. "People don't really know me. I feel like I'm not expressing myself the way I want to express myself. Like I'm not being seen the way I want to be seen."
Even though she's traveled far from her early fear and anxiety, Anne knows that the path ahead won't be easy. Understanding her condition is, as she puts it, an amalgam of extremes--good news and bad news, highs and lows.
"I pretty much felt like I knew when I called PHS," Anne remembers, a little wistfully. "Still, there was a part of me that hoped I was wrong. When they confirmed it, it was both kind of a relief, and kind of, 'Oh rats. It's true.'"
The scientific term for the condition when the gender of the body and the gender of the mind are incongruent is gender dysphoria. According to True Selves: Understanding Transsexualism, a 1996 book by Mildred L. Brown and Chloe Ann Rounsley, it's difficult to estimate the number of people in the United States affected by gender dysphoria. The country doesn't have a centralized reporting system. But even if it did, there would always be people who went undiagnosed or remained closeted.
Nonetheless, Brown and Rounsley write, data from smaller countries in Europe indicate that one in 30,000 adult males and one in 100,000 adult females seek sex reassignment surgery--less than 0.01 percent of the population. In the United States, approximately 6,000 to 10,000 transsexuals had undergone surgery by 1988. But again, the book points out, the figures don't include people who, for whatever reason, have opted not to have surgery: "Experts say that it is reasonable to assume that there are scores of unoperated cases for every operated one."
Walter Bockting is the coordinator of Transgender Health Services at the University of Minnesota's Program in Human Sexuality. "The basic gender of being a man or a woman is very much tied to the body--genitalia and biology. For transgendered people, that's not always the case," he explains. "For most of us, those things are in sync--or sufficiently in sync. If it weren't for transgendered people, we would not have known that it's a separate dimension. Sex is not identified by a single thing."
Bockting is a slender man with a quick stride. His words are polite but guarded--perhaps in part because of the crisp accent of his native Netherlands--and he is protective of this community he's so connected with. A gay man, he notes that his firsthand knowledge of being a minority has helped him understand some of what transgendered people go through. Bockting took an interest in transgender issues while studying clinical psychology in the Netherlands in the 1980s. When a friend underwent a gender transition, Bockting wanted to understand more about it. He later came to the U of M for further training; he's been with PHS since 1988.
The University of Minnesota's first documented treatment of a transgendered person was in 1966. In 1969 the U's psychiatry department established a program to take care of transgendered patients. (It was only the second of its kind in the country.) Today it is part of a larger U effort, the Program in Human Sexuality, and is the longest continuously running university-based program dealing with transgender issues.
PHS is one of very few institutions that does research and education, as well as clinical service to help treat transgendered individuals. It provides individual and group therapy for clients, holds educational seminars to teach the public about gender and health issues, trains therapists, and performs research studies to learn about the transgendered and, by extension, the larger population.
(The program's long history is one of the reasons that the Twin Cities is considered such a safe and friendly place for the transgender community. It also helps that Minnesota is one of two states that legally protects transgendered individuals from discrimination.)
When Bockting started in the field, the idea of treatment was to help transgendered people transform, or "transition," via hormone therapy and surgery, from the sex of their birth to the sex they were more comfortable being. But that wasn't always a successful solution. While some people were able to easily "pass," or effectively look like a member of the other sex, not everyone had that privilege.
And, more important, passing sometimes effectively moved people from one closet (a transsexual who wants to transition) to another (a transsexual who has transitioned). Their pasts were still the same, and they were still different from their peers in their newly actualized gender. And nothing--not surgery, hormones, clothing, hair, or force of will--could change that.
Male-to-females, or MTFs, would never menstruate or bear children; even after surgery, they would still have their prostate, and would need to watch out for cancer. Female-to-males, or FTMs, were more likely to have chest surgery but not "lower surgery," and would still need to worry about the risks of cervical, uterine, and ovarian cancers.