Transitioning: The Power of Fiction

For those of who read the New York Times “Modern Love,” column, we know that every now and then, there’s one that resonates but not because of a shared experience. In fact, it’s just the opposite. It rings so close to the heart because we may not have shared the journey but we shared the emotions.

That’s how I felt when I read Laurie Frankel’s essay last fall about her six- year-old son transitioning from identifying as male to female. She wrote so honestly about wanting to cater both to her son’s happiness but also wanting to protect him from the potentially harsh ramifications, potential bullying.

As a mother of four children, I know there are the abstract conversations (“this is what I would do, if…” ) as we role-play perfect parenting. And then there’s the reality of what we do when we are in the thick of it, when we say the wrong thing, when we are not sure what to do to help our kids immediately making sure it’s best for the long term.

I read Frankel’s essay and was so impressed with her as a writer and as a  parent, that when I read in her byline just released the novel This is How it Always is, I clicked on my Amazon app and got it the next day.

After writing and researching medical and emotional issues of transgender for my forthcoming book (digging into historical archives, reading memoirs, scouring a trove of scientific articles, interviewing those who are transgender, parents of transgender children, along with doctors who offer medical treatment and therapy to the transgender community) I was intrigued to see what a novel would offer that I hadn’t gleaned from non-fiction.

A lot.

Frankel intentionally sets up a situation including a family with five kids. She is the mother of one child. She wanted to make the point that being transgender is one thing that complicates growing up, but it’s certainly not the only thing. She also wanted the family to have to cope with the responses not just by parents and the community but by siblings too.

Midway through the book, the mother expresses her willingness to go along with her child’s wishes to transition but expresses her fears of the hormone medication and concerns about the permanence of it all.

“You think Poppy will be the only kid to feel betrayed by her body when it goes through puberty? All teenagers feel betrayed by their bodies when they go through puberty. You think Poppy will be the only woman to hate the way she looks?…..The drugs, other drugs, yet more drugs, a lifetime of drugs, the surgeries, the stuff that can’t be made whole regardless of surgery, these things are huge. These things are scary. These things are mysteries, unpredictable, uncertain….There are hard decisions she’s not old enough to make. There are decisions that just shouldn’t be made for you by your parents. If she is a girl, if deep inside this is her truth, if she needs this, if she wants this, if she must, if she’s sure, then yes, of course yes, thank God yes, we will support her and help and do all all we can and much we can’t yet but will have to figure out, as we have already , as we do for all of our children…”

I spoke to Frankel recently, and I thought she answered two of my questions so well, I wanted to share her answers rather than paraphrase:

RHE: Why Fiction and not memoir?

LF: You know the nice thing about fiction is that parts of it can be true and taken from your own life, but it doesn’t have to be. My hopes and fears drove this whole book. This is probably true of all novels. Also, we are really lucky to live in a community where it was just an easy supported transition in really every way—school, friends, community. It was exactly the way you would want your kid’s life to go. That would have been a short and boring memoir. I also remain keen to protect my kid’s privacy. Everyone knows it was a very public transition. But ten years from now when, who knows who she will be and what she will want other people to know. That would have been impossible in memoir form.

RHE: How do you think your book relates to all children, not just those who are considering transitioning?

LF: I think my story serves as a metaphor. The child you thought you knew turns out one morning to be someone else. That’s what parenthood is like and that’s what childhood is like. And kids change in ways you very frequently don’t know what do to about. You kind of think, here’s the thing: I obviously still love you but I have to think about what to do about it and I have to do the best I can.

RHE: Your book incorporates stories within stories, including a fairytale, and mothers sharing stories. How does the power of storytelling influence transgender rights?

LF: Everything is about story telling. Everyone is reporting and putting their story out, Snapchatting, instagramming. How do you tell your story well and honestly? I teach a college course in literature and we always start with fairytales. They are so problematic for trans kids, for all kids, because what comes first is the whole story. The transformations are instantaneous and painless and permanent and always forward looking and not backward looking. This isn’t a great model for kids with whom the transformation is everything and protracted. They may want to wipe out everything but their parents have no desire to wipe out the past. I’ve been talking to parents and trans kids about how to honor the past, making it part of the story.

This is How it Always is speaks not only to the transgender community, but to any of us who have questioned who we are and who we want to become.

Hormones & Sexual Harassement

In the 1950s, Dr. Frank Beach fiddled with the testosterone levels of rats, the more testosterone the more they wanted to mate with female rats. He did the same for dogs, with less success. Some dogs were finicky and, regardless of the testosterone, injections, didn’t try to mount a bitch.

This led Beach to predict that the more complex the brain, the less direct control of testosterone and mating behavior. Beach, now considered a founder of the field in behavior and hormones, was onto something.

For the past five years, I’ve been interviewing experts, digging into archives, talking to patients who have had hormone ailments or have been treated with hormone supplements for my forthcoming book, AROUSED: The History of Hormones and How They Control Just about Everything.

It used to be that when I talked hormones, I got one of three responses: Women of my age want to know if I’m including menopause and whether I’m a pro or anti hormones for menopause. Men, around my age, want to know the deal with testosterone gel, will a little rub help rewind the clock? And the last responses are just a bunch of unfunny wisecracks or puns on the word hormone.

Lately, I’m asked about the role of sexual harassment and hormones.

One thing that often gets confused is that the animal studies of testosterone investigate mating behavior, which is different from libido (we can’t study that in animals) and it’s certainly different from bullying and humiliating. Most of the stories we are hearing lately do not have anything to do with mating or libido but have everything to do with the abuse of power.

Some studies have suggested that watching your sports team win leads to a fleeting uptick in testosterone. Perhaps bullying someone does the same. But bad behavior that bumps up a hormone level is far from an excuse or rationalization. That’s the tail wagging the dog explanation.

Nor can anyone claim “my hormones made me do that.”
That was tried that nearly one hundred years ago, during the 1924

murder trial of Nathan Leopold and Richard Loeb, two rich kids from Chicago who tried to get away with murder. They killed another rich younger kid from their neighborhood. Their trial became known as the Crime of the Century, turned into two feature films, one novel and at least three non-fiction books.

These were the days before testosterone was isolated or named. These were the days before we could measure hormones. Still, their parents hired a hormone expert who used a hormone defense. He claimed the boys lacked inhibition because of a stiff pineal gland. (We now know the pineal controls circadian rhythms but it was considered a seat of the soul then). The judge said (and I paraphrase): This burgeoning field of endocrinology sounds fascinating and I’m glad we are making advances, but it won’t get these kids off the hook for murder.

The thing is that we know that we can manipulate the mating behavior of rats quite simply by manipulating their testosterone; dogs not so much. It seems that most humans have higher cognitive functioning than rodents so with increased brain complexity, it’s hard to make one-to-one ties to upticks in hormone levels.

To be sure, the word “hormone” is not typically mentioned in articles about the recent cases of sexually harassment. But it is implied. When articles talk about people dismissing some behavior as “that’s just Charlie being Charlie,” or that’s just how some of the men here are. They are saying that it’s their chemistry. And if that’s the case, it’s something that colleagues should learn to deal with.

We’re learning a lot more about hormones and behavior and more about the impact of testosterone. We can measure fluctuations down to the billionth of a gram. But testosterone levels do not and should not provide men (or women) an excuse for harassing, bullying, or sexually assaulting other humans.

Making Sense of Hormone Therapy, BioIdenticals

Making Sense of Hormone Therapy

My mother is my news aggregator, better than any computerized algorithm. She culls stories for me that range from breaking news and general essays, to the arts, obituaries and every so often a wedding announcement. At 84, she’s sharper and more engaged than a lot of folks half her age. Last night, she shared with me an article posted on Facebook by one of her friends, an obstetrician-gynecologist.

I was enraged.

Her friend, who also lived around the corner from us growing up, promoted a piece about “optimizing your hormones optimal health and wellness.” It linked to a company that sells pills touted to be better than the ones your standard doctor prescribes. The article also said that she is part of group of doctors who have earned fellowships in Anti-aging Regenerative Medicine.

This whole thing infuriates me for so many reasons. Let’s start from the bottom:

To earn credentials from the American Association of Anti-Aging Medicine is about as worthy as having the Wizard of Oz place an award around your neck and tell you that you’re not longer cowardly or that you really do have a heart. It may boost your ego, but that’s about it. The anti-aging organization is not recognized by the American Medical Association nor do their board certifications count among the the American Board of Medical Specialities. If you want to read more, there’s a full account) in Arlene Weintraub’s Selling the Fountain of Youth. I went to one of their meetings and asked a doctor who was paying thousands of dollars to get board certified why he was doing it. He told me the piece of paper (you get a certificate) would impress his patients.

Bio-identicals, which my former doctor-neighbor is touting, means that the hormones mimic the exact chemistry of your body’s hormones. That may be a good thing. Some hormones have similar but not the exact chemistry and some studies show the ones that are “bio-identical” may have fewer side effects. I’m okay with that. What I’m not okay with is the insinuation that you have to go outside of the medical establishment to get them.

Bio-identicals are often confused with so-called “compounded” hormones. You’ll see advertisements, such as the one my mom forwarded to me, touting “bio-identical compounded hormones.”

Compounding is different. It means the hormones are tailor-made to fit the customer. That sounds all well and good. The point of compounding hormones is for the rare patient who is allergic to an ingredient in the mass produced pills, such as peanut oil; or the patient who can’t swallow a pill and may need a drinkable version. But in the last few decades, the compounding industry has skyrocketed. It’s not marketed to anyone, with the insinuation that it’s the organic version of drugs. It’s not. It’s the opposite. Compounded drugs are not within the FDA’s purview—that means that you may not be getting what you think you’re getting. There’s no quality control.

If you are thinking you want a hormone that is closer to the hormones in your body, there are standard drug companies that make them. Prometrium, a kind of progesterone that mimic’s the bodies hormone, is sold by pharmaceutical companies that are monitored by the FDA. For many women—who are taking hormones for menopause—this version may not have the same bloating, nauseating, moodiness impact that other forms of progesterone have. You don’t need to pay extra to see one of these anti-aging doctors, who are part of a multi-billion dollar industry.

My mother’s friend’s article (really an advertisement) gets worse. It tells patients that another mix of hormones also cures adrenal fatigue. Adrenal fatigue doesn’t exist! It’s a disease invented by folks who want to sell you a product for a fake ailment. You might as well sell me shampoo that claims to turbocharge by brain cells.

Doctors peddling cockamamie hormone treatments is nothing new. In the 1920s, a Kansas doctor became a mult-millionaire by selling goat testicles. Clients could shop at his farm, choose their own goat, and have the surgery done in the doctor’s kitchen. He wasn’t a surgeon. In the 1950s, a journalist published a book called, “Physical Attraction and Your Hormones, a Modern Guide to Beauty, Vitality, and Health.” It instructs women how to use hormones to find fulfillment, which was defined this way. “Woman,” Nina Katherine Lunn wrote, “is equipped by nature to be, first, a lure to man then, mother to the race.”

The Facebook message my mother forwarded to me was pretty much the same hogwash as this book written more than half a century ago, and not too different from the goat-gland doctor.

I am not against hormones to treat diseases. I’m not against hormones for menopause. I’m taking them, including prometrium (the bio-identical hormone) that my doctor prescribes and I get the old-fashioned way. (meaning a prescription that is covered by insurance.) What I am against is the insinuation that to get the safer versions of hormones you need to go outside of medicine and see doctors that have a silly credential and pay extra.

So buyer beware. To be clear, my mother—my news aggregator—did not send me this article to promote the wackiness of it all. She was curious about what her friend was up to. I detected a tone of skepticism in my mother’s voice. We’ll be talking about this as soon as she’s done with her morning water aerobics.