When a quiet high-school boy in Nanaimo, B.C., began dressing like a girl, residents in the staid Vancouver Island city were abuzz. The gangly, freckled teen grew his hair long, donned skirts and sweater sets and changed his name.
"God, I wore tacky clothes," she says today, grimacing as she remembers her early days as a girl. "I had this ugly green blouse someone gave me."
Her fashion sense has evolved since then. With her silky brown hair, slender limbs and cropped T-shirt, Candace, now 20, looks every bit a fashionable young woman, right down to her exposed navel and hip-hugger jeans.
From her earliest memory -- long before the day three years ago when she first came out -- she thought of herself as female. "I felt like my penis should be cut off," she says. "I hoped when I grew up, it would disappear."
It didn't, though she is hoping that one day it might. She would like a sex-change operation. It would make her life easier.
Across the Strait of Georgia, in Vancouver, Sacha Fink, 24, is a university student who was once convinced that she should be a man.
Like Candace, Sacha has vivid childhood memories of longing to be the opposite sex. Since Day One, she felt and acted like a boy.
"I had the short haircut. All my friends were boys, and I hated wearing skirts. I didn't think I was a boy, but I knew that I wanted to be one. . . . Not just in the kind of activities I would be able to participate in -- I wanted a boy's body."
She first entertained the notion of getting a sex-change operation when she was 8.
After high school, Sacha moved to Vancouver and four years ago enrolled in a gender clinic with the goal of qualifying for sex-reassignment surgery.
She passed a battery of tests, began living as a man and took steroids, which deepened her voice and packed muscle onto her narrow shoulders.
Ten months into the program, she changed her mind. A friend asked her why she wanted to become a man. "She said, 'Would you be doing this in a perfect world?' " Sacha recalls. Realizing that her answer was no, she called off the operation.
Today, she is content to call herself a feminist and a lesbian. She is slight of frame, with shoulder-length wavy brown hair, but carries herself with the confident bearing of many men. She leans forward to talk and looks you directly in the eye, stabbing the air with her finger to make a point. And her voice is several octaves deeper than most women's, the irreversible result of 10 months of male hormones.
She is finishing her first year in the engineering program at Simon Fraser University -- a career plan, she says, laughing, that will surely bring her two things often associated with men: money and power.
And she now considers sex-change surgery "sanctioned violence," and she says the procedure is a symptom of the restrictive roles society places on how men and women are supposed to behave.
Do we want a society where men and women "undergo multiple, invasive surgeries to alter their bodies in accordance to stereotypes that we don't agree with in the first place?" she asks. "Or do we want a society where our bodies are okay the way they are?"
Both "women" have a different view of transsexuality. And as more and more transsexuals come out of the closet, debate over what gender is -- and whether it can, or should, be reassigned -- is sure to continue.
On university campuses, topics dealing with gender -- especially notions that gender can't be confined solely to male/female, he/she definitions -- are the hot courses on the curriculum.
A conference called "Sexual Realities" taking place this weekend at the University of Guelph features transgendered issues prominently in its program, including a one-day workshop aimed at "giving service providers the knowledge and skills necessary to make their services more accessible to transsexual/transgender people."
A controversial murder trial before a jury this week in California revolves around the death of a young transgendered teen.
And in Canada, school administrators are starting to grapple with questions raised by transgendered students like Candace, who lobbied for access to the girls' washroom after she made her transition.
Activists say the transgender movement is poised to become the fourth great human-rights movement, following the fights against racism, sexism and homophobia. Transgendereds have even been described as the "new gays" in sympathetic magazine articles, and they reached a milestone last month by launching their first Transgender Rights Awareness Week. But as they fight for recognition, they are also grappling with fundamental issues of identity.
At the heart of the debate are some basic questions: What is a man? And what is a woman? Is a person's gender in his or her mind, and can it be switched with the careful work of a scalpel? Or is changing sexes a deception promulgated by the medical and psychiatric professions? If a man cuts off his penis and testicles and takes hormones to grow breasts, does it really make him a woman?
"Transgendered" is an umbrella term for a variety of people who act, dress or live in a manner that differs from their biological anatomy. It can include cross-dressers and drag queens, and people who split their time living in both genders.
Cross-dressing and other forms of experimentation with gender roles have existed since the earliest records of humanity. On the South Pacific Island of Samoa, a sect of men called the Fa' fafine have for centuries dressed as women, from childhood onward, with many eventually marrying women. (It is thought that the practice originated when families with no daughters needed a child to perform domestic chores, and gave these tasks to a boy dressed as a girl.) In India, a caste of teenaged boys called the Hijra castrate themselves just before puberty to avoid the onset of secondary male characteristics.
Transsexuals, whose genitals and chromosomes define them as either male or female, suffer extreme mental anguish because they identify psychologically with the opposite gender. Many, like former Vancouver police officer Roger Shakespeare, seek relief through surgery.
After two failed marriages and years of dressing secretly as a woman, Roger became Roz. Now 52, she says the sex-change surgery saved her from alcoholism and a mental breakdown. "I felt complete," she said in interviews after her surgery in 2000. "I felt as though finally I was in the right place, the right body, with all the right parts."
North America's first and most famous man-to-woman operation was Christine Jorgenson, a Bronx-born ex-GI who sailed to Denmark for surgery in 1952 (it was not performed in North America then) as George and returned as Christine.
Ms. Jorgenson's glamorous looks and love of the spotlight brought her a degree of fame, if not acceptance, but by no means prompted a stampede for sex-change operations. Transsexualism remained on the periphery of mainstream society, lumped in with homosexuals and deviants. Clinicians attempted to "cure" them of their condition through electric-shock treatment or aversion therapy.
Then, in the 1960s, hundreds of transsexuals came under the care of Dr. Henry Benjamin, a physician who believed that transsexualism had no link to homosexuality. He coined the phrase "gender identity disorder" and promoted hormone treatment and surgery as a cure for the transsexual's suffering.
His position put him at odds with John Money, the head of psychiatry at Johns Hopkins University, who believed gender was the result of upbringing. He was the doctor who suggested that David Reimer -- the Winnipeg man who became the subject of a bestselling book called As Nature Made Him, and committed suicide last month -- be raised as a girl after a botched circumcision burned his penis. The experiment failed, and Dr. Money's theory has now been largely discredited, bolstering the transsexual argument that gender identity, like sexuality, is innate.
But the sight of a transsexual is still unsettling to the majority of the population. A tall, broad-shouldered figure walking down the street in a skirt prompts double takes. In some, it evokes rage and violence.
Vancouver transsexual Kimberley Nixon, 46, underwent a sex-change operation in 1989. Today, she is still leery of taking public transit because she is subjected to sneers and insults. Once, a woman threw hot coffee on her in a lineup at a snack truck.
"Transphobia is very real," Ms. Nixon says. "It's based on fear."
Candace, who lives as an outcast in Nanaimo, can provide plenty of examples. The very sight of her on a city bus makes some people switch seats rather than sit beside her.
In high school, her house was egged. At one point, a school counsellor called the police to stop the harassment, but Candace said the bullies simply got more subtle. Despite winning a scholarship to college, she dropped out and now is unemployed, her future a question mark. She spends her days holed up at home, the curtains drawn, listening to music and surfing the Internet. Her mother struggles to understand her. An older brother is hostile.
She has attempted suicide and admits she cuts herself with a razor blade to numb emotional pain. "If I'm hurt by something someone says, it helps it go away," she says, shrugging. "I'll live. It's a lot less destructive than other vices."
In their literature and academic writing, transsexuals often note the existence of intersex babies who are born with ambiguous sexual organs to argue that gender has never been a neat either/or matter. There are babies, for instance, with a male's XY chromosomes who are born with genitals that look like a girl's, though they lack female reproductive organs. Genetically male, they are usually raised as girls.
Activists also point to research that suggests that gender identity, like sexual orientation, is "hard-wired" in the brain of a fetus, depending on the kind of hormones that imprint themselves during the early stages of pregnancy.
Hence, the transsexual's early childhood memories of feeling at odds with their bodies. For Roz Shakespeare, it was an intense desire to emulate women.
She remembers sitting on the front steps of her aunt's house when she was 3, watching people go to work. "There was this one woman who I was absolutely captivated with. And one day I went inside and told my aunt that I wanted to look like her when I grew up and we had this little conversation and she said, 'You can't, honey, because little boys don't dress like that. That's for little girls.' "
Roz, who now works as a diversity consultant, says the right to choose your gender is indeed personal, but for most transsexuals, it's a life-and-death matter. She considered castrating herself, she says, had she not qualified for surgery.
"Clearly all of us have those male and female characteristics that need to be expressed," she says. "But this goes to the core of my identity."
Like gays, transsexuals say they are born to their condition. The only way to fix it is to live in the gender in which they identify, and then, if they choose, undergo sex-reassignment surgery.
But experts are divided on the subject. Toronto psychologist Ray Blanchard, one of Canada's leading -- and most controversial -- gender experts, argues the transgendered movement is rife with delusion. "This is not waving a magic wand and a man becomes a woman and vice versa," he says. "It's something that has to be taken very seriously. A man without a penis has certain disadvantages in this world, and this is in reality what you're creating."
Dr. Blanchard, who heads Clinical Sexology Services at the Toronto-based Centre for Addiction and Mental Health, has treated hundreds of transsexuals since the 1980s. He says gender-identity disorder is a psychiatric disorder, not unlike anorexia, in which the sufferer believes she is overweight, and recommends sex-change operations to only a handful of the 45 patients he sees each year.
Dr. Blanchard does not go so far as to say transsexuals should be counselled out of their disorder, but he thinks surgery should be used as a last resort. A sex-change operation and treatment requires that a patient receive hormones for the rest of his or her life, which can cause liver damage. As well, there have been numerous cases of botched sex changes, which have damaged urinary tracts and even perforated bowels.
He has also raised questions about the motivations for sex-change requests, and has promoted the idea that there are subsets of transsexuals that include, among others, some homosexuals and a group of heterosexual men who are sexually aroused by the idea of having female genitalia.
His views are reviled by most transsexuals, but the psychologist makes no apologies. "That doesn't mean that I think transsexuals are delusional or not competent to live their lives. . . . It simply means that I don't think that the desire to have your genitals removed and replaced with those of the opposite sex is an innocuous decision like deciding whether you're going to wear slacks or a dress today."
As a group, transsexuals have never created the kind of political noise that the gay movement stirred -- until now.
In terms of political acceptance, the transgender movement is in its infancy. At the rallies and dinners during Transgender Awareness Week last month, they called for inclusion of sex-reassignment operations in the procedures covered under provincial health care (Ontario has delisted them) and tougher protection under human-rights legislation, among other things.
The statistics are grim: More than 40 per cent of transgendered people are unemployed, and about 25 per cent drift into the sex trade.
They have been called everything from freaks and perverts to modern-day lepers to liars. But one of their biggest hurdles is overcoming the hostility they face, which can sometimes turn to deadly violence. When they are homicide victims, transsexuals are often subject to what police call "overkill," murder in a rage by someone who learns their true identity.
Among the more extreme examples of transphobia is the case of Gwen Araujo, a California teenager who was born a boy, but identified as a girl. The 17-year-old high-school dropout was savagely beaten at a house party in a San Francisco suburb in 2002. Prosecutors in the case said Gwen was killed by four young men, three of whom had had sexual relations with her, after they learned she had male anatomy. Police say Ms. Araujo was beaten with a skillet, a soup can and a shovel before she was strangled.
The Araujo killing was not an isolated event. Advocacy groups say the number of crimes against transgendered people has risen dramatically in the past five years. In 2002, the U.S. National Transgender Advocacy Coalition said there were 25 killings of transgendered people that year, making it the deadliest year on record.
"People say the most appalling things to them," says Vancouver lawyer Barbara Findlay, who has represented Candace in her fight to use the girls' bathroom at school. "They're seen as freaks."
In the 1970s, the transgender movement piggybacked on the gay-rights movement as it lobbied for civil rights. But the fit was never a natural one. Then, in the 1990s, gender discussions became the hot topic on university campuses, largely focusing on the notion of gender as a fluid concept, with identity being a personal decision.
Intersex bathrooms sprouted on campuses, as did the fashionable fad of dressing in a deliberately androgynous manner. The transgender movement seemed on track to become the "it" movement among progressives -- until some high-profile feminists weighed in. In 1995, Kimberley Nixon tried to sign up as a volunteer at the Vancouver Rape Relief Centre. The centre, which has a female-only hiring policy, turned her down. The reason? She wasn't a real woman.
A few hours into the training session, during a coffee break, a trainer asked to speak to her outside. Her stomach sank. She was asked about her gender and she replied she was transsexual. The trainer told her she wouldn't be "welcome" back after the break.
"Inside, I thought, 'What business is that of hers?' I became very upset. I was crying. I thought, 'This is very, very wrong.' " Ms. Nixon, who had a sex-change operation in 1989, took her case to the B.C. Human Rights Commission and won. But the Rape Relief Centre appealed, and later a court overturned the decision. The matter is still before the courts.
The case pitted the transgender movement against feminists. Some argued that Ms. Nixon's lawsuit against a financially struggling rape crisis centre was indicative of aggressive male behaviour.
Noted feminists sided with the centre. Columnist Michele Landsberg weighed in, casting doubt on Ms. Nixon's femaleness.
"What makes a woman?" she wrote. "If a man cuts off his penis, pumps himself full of hormones, gets silicone breasts and electrolysis and stuffs his feet into high heels, is he/she a woman?
"To me, that surgically and chemically altered person is a walking testament to the craziness of our cultural rigidity. If all children weren't crammed into pink or blue categories, with prescribed sets of feelings, beliefs and behaviours, maybe the gender-ambiguous wouldn't be driven to such harsh medical extremes."
Transgender activists felt betrayed. Ms. Findlay compares the feminist backlash to the early days of the suffragette movement, when black women were excluded.
"Not to put too fine a point on it, but it's about changing our ideas of what it means to be human," she says. "What we want is the understanding that male-slash-female is a pretty limited way of understanding gender."
Even people who embrace gay-equality rights can't get their heads around the notion of transsexuality, Vancouver psychologist Olive Johnson says in her book The Sexual Spectrum. "The very idea of changing into another sex seems preposterous; it makes them feel uncomfortable and anxious, or else irritated and angry," she wrote.
Until now, transgender activists have aligned themselves with the gay and lesbian movement. But activists say that union was never a natural fit.
Toronto transsexual Rupert Raj says the transgender movement isn't about sexual orientation. "It's about who we are," he says, not whom they are sleeping with.
Mr. Raj, who was born female, says he is aware that critics say transsexuals are deluding themselves by thinking they can switch genders.
"It's not that I believed I was a boy," he says. "I was a boy in a female body. It's not a belief. It's a core precept."
Transgendered activists want the life stories of people like Roz to reveal the anguish of transsexuals who live with the certainty that they are trapped in the wrong body. And they are happy to talk about a younger generation of transsexuals, especially in big cities, who are less tentative about living openly -- like William, a 24-year-old Toronto youth worker and activist.
William has tried not to let his gender switch overtake his life and pursuits. "People think there's a whole lot of focus on it, but . . . for me, it's very simple. I guess I'm transsexual. But what it really comes down to is, I'm just a guy in a girl's body and I'm fixing that."
The activists aren't quite so keen on people like Sacha, who now believes the desire to change genders has its roots in sexism. Women who want to become men do so because they crave the power and autonomy enjoyed by males, she says. Similarly, men who want to be women are avoiding the ridicule of manifesting feminine characteristics. If these men were truly interested in revealing their feminine side, they would remain men and work to eradicate sexist stereotypes.
"It's much more difficult and progressive and radical for a man to actually be himself and risk exhibiting traits that might be considered feminine and unmanly and still consider himself a man . . . than to say, 'Oh, I guess if I'm doing these things, I must be a woman,' " Sacha says.
As for Candace, she seems to be tiring of the need to define herself as either a male or female. She will probably have the surgery, she says. But it won't make her any more female than she already feels now.
"I don't think in terms of male or female any more," she says with a sigh. "I'm just me. I'm an original."
Jane Armstrong is a reporter in the Globe and Mail's Vancouver bureau.
How it's done
U.S. physician Harry Benjamin, considered the pioneer of sex-reassignment treatment, was the first clinician to suggest that hormone treatment followed by surgery is in the best interests of many transsexuals.
Today, psychologists and surgeons follow the standards of care he developed for diagnosing and treating transsexuals wanting to qualify for a sex-change operation.
Male-to-female surgery is still more common than female-to-male. Typically, patients undergo a vaginoplasty, which involves removing the penis and testicles and creating a vagina using the skin tissue from the removed male sex organs. Patients can also receive other feminizing procedures such as electrolysis to remove body hair, vocal cord tightening to make the voice higher, even shaving the Adam's apple.
Male-to-female surgery costs $20,000 to $30,000. In Canada, the procedure is covered by provincial health plans, except in Ontario and the Maritime provinces.
Female-to-male surgery typically involves hormone treatments, a mastectomy and hysterectomy. Some female-to-male transsexuals undergo a phalloplasty or creation of an artificial penis, but the procedure is costly (about $100,000 and not covered by provincial health plans) and the results are imperfect.
To qualify for surgery under the Harry Benjamin standards of care, patient must undergo a round of psychological tests, which is followed by hormone therapy. Patients must then live in the other gender for at least one year but up to two to three years before surgery.
Roz Shakespeare says the hormones changed her personality as well as her features; her driving became less aggressive and her conversation with friends seemed less linear and "more flowery."
A private clinic in Montreal is the only institution that performs sex-change operations in Canada, but health-care plans can cover operations performed in the United States. Roz's surgery was approved in Canada, but she flew to Portland, Ore., for the procedure.
She says she is "thrilled" with the results, but some postoperative transsexual women experience urine emissions that spray. Others report that their penile stump still becomes enlarged when sexually aroused.
One of the most serious complications is a perforation of the bowel that can occur when surgeons create what they call a "neovagina." In those cases, fecal matter can leak into the new vagina.
As for female-to-male surgery, gender expert Ray Blanchard said he has seen few credible, artificially created penises. "They get a kind of lump that in the best, most expensive, $100,000 cases, kind of, maybe, look like a penis from across a room."
There is no central database on how many sex-change operations are performed each year.
Some activists argue that the treatment should begin earlier than most legal jurisdictions allow (in Canada, the age is 18), saying reassignment is most effective when begun during puberty.
In Australia recently, in a case that has riled critics, a family judge allowed a 13-year-old girl to begin a hormone-treatment plan to delay menstruation. At 16, she will begin taking male hormones with the goal of undergoing surgery at 18.