DR. HOOK- Change up: Transgenders seek understanding

Transgender people are the bravest people in the world. (If Barbra Streisand ever makes a sequel to Funny Girl, she can add those lyrics to her song "People.") In the USA, gender roles are narrowly defined and stringent. That's why I don't go to comedy clubs anymore– 99 percent of all jokes are about how men and women are different or bashing gay people. I'd rather go to an Aryan Nation meeting. 

 So for a man to become a woman or for a woman to become a man in this society is harder than Rush Limbaugh and Michael J. Fox going out on a date.

 Transgender means a person feels he or she is the opposite sex. So male-to-female (M◊F) transgender persons are genetically male but identify themselves as female and want to change their sex to female to match their self identity. Female-to-male (F◊M) transgender persons are genetically female but identify themselves as male and want to change their sex to male.

 Why do transgender people believe they were born the wrong sex? We don't have an answer. But does it really matter? For those who think it's unnatural to consider yourself a different sex than you were born, consider this. One in 2000 births involves an intersex baby, a baby whose sexual organs are not clearly identifiable as either a boy or a girl. Also not everyone is born with an XX or XY chromosome set. Sometimes there are extra chromosomes. 

Also not everyone responds to their genetic sex hormones, so there are some "hot babes" in Hollywood with XY (male) chromosomes. But does that make them weird? Or does it mean we come in many varieties?

 Oh, to be clear, transgender is not about sexual orientation or about cross-dressing. Sexual orientation is about whom you love, whom you are sexually attracted to. Cross-dressing is about wearing the opposite sex's clothes but doesn't point towards gender identity or sexual orientation. 

Transgender is about gender identity. I know many transgender folks who change sex and are attracted to the same sex (e.g. M◊F is a woman now and in a relationship with a woman). "Free Your Mind" as En Vogue would sing.

 Unfortunately, there are a lot of physicians who are uncomfortable with, if not cruel to transgender people– and gay people– and minorities (even at an academic medical institution near where I live, though you would hope they would know better). That is really heartbreaking because without medical help, it is impossible for transgender folks to make the transformation to the other sex. Instead, they face prejudice and barriers. For transgender people, being in the wrong sex body is very disturbing and often leads to depression or self-destructive behaviors. The transformation from genetic sex to their identified sex through hormonal and surgical therapy can help.

 My partner is an endocrinologist who works with transgender folks, and I have transgender patients as well. Unfortunately, many come from hundreds of miles away because they face so much discrimination with their local doctors. (And with the cost of gasoline...) Going from M◊F or F◊M is a process that affects family members, friends, and colleagues. We work with a terrific therapist who helps in this process. Hormones are needed, and eventually gender reassignment surgery can become an option. But it's expensive, and insurance usually doesn't cover it. 

 Could you imagine if Endora from Bewitched waived her hands and changed your sex to the other sex? Probably you would feel very uncomfortable being in the wrong sex, living a different sexual role, and feeling forced to watch ESPN vs. The View depending on which gender change you went through. Maybe the book Men Are from Mars, Women Are from Venus should be renamed, "We All Are from Earth."

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.