01 October 2008

Trans-Consumerism for Transsexual Women

I apologise if this post is somewhat disjointed and not fully fleshed out. I decided it was better to post what I had than to continue playing around with it and never post it.

Fall has arrived. I could really use some fall skirts and tops. I could also really use electrolysis. Welcome to the world of trans-consumerism for a femme transdyke.

I started thinking about this thanks to two recent posts Sublimefemme has made about queer, especially femme, consumerism in response to a current article in The Advocate titled "The Cost of Being Gay". Consumerism is hardly limited to queer culture in America. America relies on its cultures and communities being soaked in consumerism.

As I think Sublimefemme has covered consumerism for the queer femme rather well, I'm going to look at the consumerism facing the transwoman. One immediate point to make is that consumerism for transwomen is very much a class issue, moreso than usual consumerism because of the staggering costs involved in some choices. But, like all consumerism, none of the following choices must be chosen, but some bring comfort to me as a transwoman and some bring more correct gendering of me by others (at least, theoretically).

The cheapest consumer choices for a transwoman are beauty rituals such as shaving, tweezing, plucking, and so on. Slightly more expensive are clothes and makeup (though these can get hideously expensive, of course). All of this is in common with ciswomen and is about as accessible (with the possible exception of buying women's clothing the first time) with respect to class.

Next up the ladder is hormone therapy. This requires medical and usually psychological clearance and so is more than a bit of a step up. Then there's the cost of the hormones themselves. I can't imagine handling this part without health insurance and drug coverage which also cost. This is definitely where class starts to be a factor not only in the question of monetary resources but also in dealing with the psycho-medical establishment, since one normally needs to know how to go about getting a diagnosis of Gender Identity Disorder, a reference to a physician/endocrinologist, and possibly even having to educate that person on what the appropriate course of treatment is.

Next we enter the world of what is commonly called cosmetic surgery. This includes procedures for electrolysis, facial feminisation, breast augmentation, orchiectomy, and vaginoplasty. One does not have to have any or all of these surgeries, but isn't that the point of consumerism? We don't have to have it, we're led to want it. However, these can cost tens of thousands of dollars as well as pain, time, and significant hurdles put in place by the medical industry.

Even if I were rich, I have issues. Let me start with my major issue: surgery. I've had emergency surgery twice in my life, and I can tell you I'm not a big fan of surgery. While I believe in bodily autonomy, my right to do to my own body what I want to improve it (if you will), I'm disturbed by the cosmetic medical industry and how it feeds off insecurities about looks and fitting in as a woman. I'm thinking here mostly about breast augmentation and facial feminisation. But one can certainly argue vaginoplasty falls into this category. In the otherwise despicable "The Transsexual Empire", Janice Raymond does an analysis of the traditional psycho-medical industry of sex-reassignment surgery (as it was then called) which is well worth reading. Unfortunately I can not currently locate my copy to quote from it.

Let me take breast augmentation as an example. It's apparently a common procedure for transwomen. I just had an argument over this procedure with a cisfriend of mine who wants breast augmentation for herself even as I think her breasts are beautiful the way they are. There's a tension between what we think of our own bodies and what society expects of our bodies. A common feminist tenet is that women's bodies are public property. I have to agree. For myself, that comes up as a question of what looks "normal" on my frame. "Normal" is not only a question of what is average but what is socially constructed as an appropriate size. And right now, apparently I have "man boobs" size. So, if it were just a question of conformity, I'd scrape up the cash and buy me some breasts. But, I do question social standards and consumerism.

So, what's a mindful gal to do? I don't know. I'd not be shy in telling you if I did. So, I encourage y'all to tell me what you think, what questions you have, and (if you're kind) critiquing my post.


  1. Hi Lucy, so glad you did this post!
    Since I'm probably a more than a few years older than you and indeed could be one of your professors (if you have any gorgeous femme queer theorists this semester;-)), I hope you'll permit me to pass on a little advice to you.

    Don't start a post with an apology! A much more experienced blogger than I recently pointed out to me that bloggers do this way too much. In your case, you have absolutely nothing to apologize for b/c this is an excellent, thoughtful post and not at all disjointed.

    One question I had while reading this is about the question of insurance coverage. If I decide to go out an get a boob job to augment my A-cup breasts (not something I'm planning on BTW!), I assume it won't be covered by insurance b/c it's considered cosmetic. However, what happens for a transwoman who's been disagnosed with GID? Do doctors write Rx's for these surgical procedures?

    My only "critique" (I love that you invited them) would be that you seem to suggest that there's one way of getting these medications/ products. But for poor and working-class trans folks in Harlem and other marginalized communities, isn't there a different, much more dangerous way of getting hormones, for example? I remember hearing about the disastrous results of African American trans working girls injecting themselves with industrial silicone back in the day.

    Thanks for writing this!

  2. Thanks, SF, for your comments and questions. Let me address them. First off, I apologise for apologising at the start of the OP. ;-) Which is to say, your point is well made. Oh, and I may well be older than you since I've returned to university after a career. Sadly, we have no specific queer theorists professors here, femme or otherwise, gorgeous or pedestrian. I understand they're planning to hire one for the Women's Studies Program (not even a department, sadly) just as I plan to graduate. So, if you're looking for a faculty position at a business/architecture/engineering/everything-but-humanities university in a podunk college town in the mountains, I can give you details. ;)

    Insurance coverage for GID surgeries in the US is pretty much non-existent. Thanks to the shutting down of the gender clinics in the US in the late 70s/early 80s most insurance companies specifically exclude it (check your own policy, I bet it's there) for being cosmetic, "experimental", elective, and the like. Yes, we are the hobgoblins of little minds. I understand that this is not the case in Canada and the UK's national health systems.

    One doesn't quite get prescriptions for surgeries. For the main genital surgeries (orchiectomy and vaginoplasty) there are the almost totemic Standards of Care that many surgeons follow. The Standards call for documentation of GID to be presented to the surgeon along with other things that have to be done(the other things being very contentious; a good place to find out more about them is at the TS Roadmap's webpage on the standards.)

    You have a very valid criticism. There is no one true way to medications and products. I did indeed provide the standard middle/owning class approach to them. There are other different, sometimes deadly, ways to get things such as hormones and surgeries. Sometimes, for instance, people obtain them online from overseas or questionable pharmacies with or without a prescription. Thus people going this route may or may not be taking actual hormones, tainted or untainted. There are also natural hormones, but these tend to be more expensive, and I also have to admit to not knowing anything about them. The horror of using industrial silicone just makes me shudder. Just say no.

  3. I'd argue that vaginoplasty is not cosmetic procedure that's sold to us as something we need - it's something that I wanted before I even knew it existed, and I think that for a lot of trans women, it's a vital part of being comfortable with their bodies (and I include myself in this group). That this isn't a need that's sold to trans women, but something that's deeply ingrained in trans women's sense of ourselves. At least, specifically, transsexual women. I also think (but I'd have to dig up my copy to make this useful) that Raymond's analysis is limited by her apparent assumption that the medical industry invented transsexuality or that it pushes trans women into vaginoplasties when it's more accurate to point out that the medical profession is primarily focused on keeping trans people from surgery.

    I also think that body modification tends to be weighted rather heavily to the point that people oppose it on the basis that "your body as it is by default" is somehow the superior state to be, but this tends to lead into people making other bodies their business, and it can get pretty invasive when you have someone telling you what you should be doing with your body, and perhaps not understanding your reasons for wanting piercings, tattoos, breast augmentation, face lifts, vaginplasties, and so on - or even making assumptions about your reasons that end up simply being alienating.

    I think that bodily autonomy is vital, and more important than the assumption that unaltered bodies are better than altered bodies. We need to be able to be comfortable in our skins, and not justify every decision to alter that skin.