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12 March, 2020
Bureau Report
BERLIN: Studies suggest that most people who transition to another gender do not have second thoughts but after two Trans men met and fell in love, their personal gender journeys took an unexpected turn, to a destination neither had foreseen.
“I always felt we have a very special history. We have special bodies, and a special connection based on the physical experience we had.”
Ellie is 21 and Belgian. Her German partner, Nele, is 24. Both took testosterone to become more masculine, and they had their breasts removed in double mastectomy surgery. Now they have de-transitioned, and live again as female – the gender they were assigned at birth.
“I’m very happy I didn’t have a hysterectomy,” reflects Nele. “It means I can stop taking hormones, and my body will return to looking feminine.”
Last year, they both made the decision to end their use of testosterone and start using the female pronouns “she” and “her” again. Slowly their own natural estrogen has begun to re-feminize their bodies.
“I’m very excited to see the changes,” says Ellie.
Their faces have softened, their bodies become curvier. But years of taking testosterone has had one profound, irreversible effect.
“My voice will never come back,” says Nele. “I used to love singing and I can’t sing any more – like my voice is just very mono-tone, it works very differently. When I call someone on the phone, I get gendered as male.”
The stories of these two young people are complex.
They may not be typical of people who have transitioned to another gender. And they are not a judgment on the decisions of other trans people, be they trans men, trans women or non-binary.
Ellie does not remember being uncomfortable as a girl when she was a child. But that changed as she became adolescent.
“I realized I was doing a lot of boy things, and some people weren’t fine with that – especially other kids. I remember being called things like ‘hermaphrodite’.”
Tall and athletic, Ellie’s love of basketball was identified as, “a boy thing” too. At 14, she realized she was attracted to other girls, and later came out to her parents.
“I was dating girls and happy about it,” she says.
Then Ellie told her sister she was a lesbian.
“My sister told me she was proud of the woman I was becoming. And somehow that rang a bell for me. And I remember thinking, ‘Oh, so I’m a woman now? I don’t feel comfortable with that.’ It wasn’t that I wanted to be a boy – I just didn’t want to be a woman. I wanted to be neutral and do whatever I wanted.”
At 15, Ellie believed becoming a woman might limit her choices in life. For Nele too, growing up female was not fun.
“It started with puberty, when I was around nine years old – with getting breasts before I even realized what it means to have them. My mother forbade me from going outside bare-chested. We had a lot of fights because I was like, ‘Why can my brother go out bare-chested?’ Obviously, my mother wanted to protect me, but I couldn’t understand at the time.”
As Nele matured, there were also lecherous men to contend with.
“I experienced a lot of catcalling. There was a street next to mine, and I couldn’t go down there without a man hitting on me. I’m slowly realizing now that I internalized all of that – that I was perceived in society as something sexy, something men desire, but not a personality.”
With her body developing fast, Nele saw herself as too large. She would later develop an eating disorder.
“Too fat, too wide – the thoughts about needing to lose weight started very early.”
Nele was attracted to women, but the thought of coming out as a lesbian was terrifying.
“I really had this image that I would be this disgusting woman, and that my friends wouldn’t want to see me anymore because they’d think I might hit on them.”
At 19, Nele came out as bisexual – that seemed safer. But the experience of unwanted male attention and the discomfort she felt with her female body stayed with her. Nele fantasized about removing her breasts. Then she learned trans men get mastectomies.
“And I was like, ‘Yeah, but I’m not trans.’ And then I was like, ‘Maybe I could fake being Trans?’ And then I was doing a lot of research and I realized a lot of those things Trans men say are very similar to what I experienced – like ‘I always felt uncomfortable with my body, and as a kid I wanted to be a boy.'”
The distress Trans’ people feel because there is a mismatch between their gender identity and their biological sex is called gender dysphoria. Nele thinks her own dysphoria began around this time.
“I thought, actually, ‘I don’t have to fake being trans. I am transgender.'”
Nele could see only two options – transition or suicide. She sought help from a transgender support organization. They sent her to a therapist.
“When I arrived, I was like, ‘Yeah, I think I might be trans.’ And he directly used male pronouns for me. He said it was so clear I’m transgender – that he’s never been as sure with anyone else.”
Within three months, Nele was prescribed testosterone.
Ellie too became determined to access male hormones – in her case when she was just 16.
“I watched some YouTube videos of Trans’ guys who take testosterone, and they go from this shy lesbian to a handsome guy who is super-popular. I liked thinking of myself having that possibility – it felt like I should have a male body,” but being so young, she needed parental approval for any medical intervention. The first doctor she visited with her parents said Ellie should wait – she thought that was trans-phobic and found another medic who was positive about her desire to transition.
“He told my parents that all the effects were reversible – which is the biggest lie. I had done my research, and I knew that this doctor could not be trusted. But I was just so happy that he said that, because then my parents were OK with it.”
Ellie’s dad, Eric, was worried about the impact testosterone would have on his child’s health, but the doctor reassured him.
“We were still in shock from having a girl who wanted to be a boy,” he remembers. “And the doctor said hormones would be better for her.”
Eric and Ellie’s mum felt all at sea in this new world of changing genders.
“I would’ve liked to have met someone to give me the words and find arguments to make her wait and think about it longer, but there was no-one,” he reflects.
At first, testosterone made Ellie feel emotionally numb. Then she felt much better. At 17, she had a double mastectomy. Later, she graduated from high school, and left Belgium to go to university in Germany.
Transitioning to male had not ended Nele’s feelings of despair. She was still suicidal, and her eating disorder was manifesting itself in extreme calorie-counting, and an obsession with her diet. Nele began to think testosterone was the only good thing in her life – and she still wanted a mastectomy. But she did not feel she could be totally honest with her gender therapist.
“I was very ashamed of my eating disorder. I mentioned it in the beginning, but I didn’t dare talk about it more because of the shame – I think that’s normal with eating disorders.”
Nele was worried her transgender treatment might be halted if there was any doubt about her mental health.
“It’s a very tricky situation in Germany, because the therapist is the one who gives you the prescriptions for hormones and for surgery.”
There are few studies exploring the link between eating disorders and gender dysphoria. One review of the UK’s Gender Identity Development Service in 2012 showed that 16% of all adolescent referrals in that year had some kind of “eating difficulty”. But bear in mind that most referrals are young people assigned female at birth – natal girls, as they are called, who are more vulnerable to eating disorders than their natal male counterparts.
Brian and Daniel have been on a similar journey to Ellie and Nele but from a different starting point. Both were assigned male at birth, transitioned to female, and later de-transitioned to become male again.
Some clinicians have suggested that eating disorders develop as a response to gender dysphoria, says Anastassis Spiliadis, a UK-based psychotherapist who treats patients with eating disorders and gender identity issues.
The theory is that if you treat the gender distress, the eating disorder will diminish. This can happen, but it is not what Spiliadis has seen among many of his clients – natal females in their 20s who, like Nele, are de-transitioning.
“They thought transitioning to a different gender would alleviate the eating disorder and the dysphoria, but things have been much more complex. They regret the decision to take testosterone and have surgery but what’s really worrying is that some of them still have an eating disorder.”
He believes someone who is suffering from anorexia or bulimia may not be equipped to make irreversible health decisions.
“We know that eating disorders affect people at a bio-psychosocial level. Those who are medically and physically, but also cognitively compromised might have a distorted view of themselves or their bodies.”
Spiliadis believes good practice in this field should mean screening young people with gender identity issues for eating disorders. And because they are life-threatening, eating disorders should be treated before responding medically or surgically to the distress caused by gender dysphoria.
As a new student and trans man in Germany, Ellie thought her own dysphoria was a thing of the past, and she was getting on with life.
“I was passing as a man – I was passing so well. I got so many comments from people telling me my transition was such a success, because they couldn’t tell I was Trans,” but an ambivalence about her male identity crept in.
