My Story - How I came to realize I was "trans"

So, it all started one day when I realized I had boobs. I'd had them since my early twenties, possibly earlier, but I was just not willing to admit it. I didn't even think it was possible, for most of my life, for a man to grow actual breasts. One day, however, I decided to measure myself as though I were measuring for a bra, fully expecting end up seeing I had AA or, at most, A-cup breasts. That would be, at most, a one inch difference between “band” and “bust.” As it turned out, my band was 37” (38 in bra size) and my bust was a bit over 39” (B-cup in bra size). I was so shocked by this that I had my wife do the measurements because I thought I had done it wrong, but she came to the same result. I also noticed for the first time, dense tissue at the core of the breast. There was no doubt at that point. I had boobs, and they were getting bigger.

The medical term for this condition is “gynecomastia.” It can be caused by a number of different things, but the one that made the most sense for me was natural age-related testosterone decrease. It was a few years early for something like that, but not really outside the realm of possibility. I decided to make an appointment with a doctor to make sure it wasn't something more severe, but since this all happened when I was switching doctors, it was several months before I could get an appointment.

Since I have, over the course of my life, developed a deep and abiding mistrust of the medical profession, I decided to use that time to do a little research (Those who know me will get the joke – “a little research” usually involves 20-30 medical journals and 3-4 textbooks just to get the basic idea so that the real research can begin). Medically, even in the most detailed journals, the answer came back just as I expected. Gynecomastia was caused by a hormone imbalance - most likely a testosterone drop, in my case. I had always thought of sex hormones as “estrogen” and “testosterone,” but I soon learned it was way more complicated than that. I already knew “estrogen” is just a category of hormones, and there are several hormones with vastly varying functions that are called “estrogens.” I also knew testosterone is it's own thing, but it is also one of a set of compounds called “androgens.” What I learned was there are numerous hormones and enzymes that are classified as sex-specific. In total, there are about 26 compounds that all interact in a variety of different ways in either males or females.

When I finally got in to see the doc, he diagnosed gynecomastia and ordered testosterone and total estrogen tests. He also ordered a mammogram to confirm actual gynecomastia and not pseudo-gynecomastia (unusual fat distribution that resembles breasts, but is not actual breast tissue). We both expected confirmation on the mammogram, and extremely low testosterone (100 – 300 ng/dL). The mammogram confirmed actual breast tissue, but the hormone tests were surprising. Normal testosterone for this particular test was about 264 ng/dL – 916 ng/dL. My result was 952 ng/dL. Normal estrogen range was 40 ng/dL – 115 ng/dL. My result was 148 ng/dL. Nothing I had read up to that point could explain these numbers. My primary care doc also couldn't explain it, so he referred me to an endocrinologist.

One of the compounds I learned about during this time was “aromatase.” It's job is to convert excess testosterone into estradiol, one of the estrogen compounds. This is why people who take steroids or testosterone boosters to bulk up usually also take “aromatase inhibitors,” to prevent estradiol from forming while their muscles use up the extra testosterone. Given the fact that I had such high levels of testosterone, the fact that I had high levels of estrogens made sense to me. Aromatase was doing its thing, which left me with high levels of “feminizing” hormones. The testosterone levels themselves made no sense, whatsoever.

I searched medical journals and online forums related to gynecomastia for months trying to find any reference that would explain my situation. While doing so, I learned that most men who had this condition wanted desperately to have their breasts removed. Even men with AA-cup gynecomastia – something that is not even visibly apparent on a male frame – were seeking surgeons to have their breast tissue removed. I learned about the complications related to those kinds of surgeries and that most medical insurance, at least in the US, considers this surgery in men an elective procedure and will not pay for it. It didn't matter to me because I had no intention of getting rid of my breasts. I liked having them.

There's an old joke about if men had breasts, women would be lonely, or some variation of that. When I say that I liked my breasts, it was not in a way that was meant by that old joke. It was more like a feeling that they should have been there all along. It was just a deep acceptance of the reality that I had breasts, right from the beginning. This was completely unlike any of the men I'd encountered in the forums who had gynecomastia. Even those who'd accepted it and were living with their situation (men with sizes ranging from B-cup to H-cup) went through a long psychological process to reach their point of acceptance. At the time, I honestly thought the difference was with them – that they should be able to just accept the reality that was placed before them. I didn't think that the difference was with me. But then I made my next discovery.

After what was probably a couple of years, I had learned a few things that verified I definitely had some sort of hormone imbalance. The more I learned about the potential complications of a hormone imbalance, the more it looked like a photocopy of my medical record, including my issues with anxiety, irritability, and depression. In addition, I had lost a little weight, so my bra size was now a 36B, but growing rapidly into a C-cup. I decided to do some body measurements during this time and discovered my shoulders were about 5-8 inches too narrow for my build, on average for a male, but were exactly proportional for an average, though slightly chubby, female build. My hips were also about two inches too wide for an average male build, but were only slightly below average for a female build. This explained a lot about my wardrobe.

All of my life, I never could find clothes that fit. Shirts either fit properly in the shoulders but were too tight in the chest, or they fit in the chest and were too big in the shoulders. Pants would fit in the hip, but be too big in the waist, or they would fit in the waist and be too tight in the hip, unless they were pleated. I never could find clothes that fit my body, as it turned out, because my body never grew into male proportions during puberty when those changes would have occurred. Understanding that, I started shopping for jeans and shirts that were cut for a woman's body, but still presented as “masculine.” Technically, at this point, I was wearing “women's clothes,” but I wasn't “cross-dressing” as that term is usually used in our society. For the first time in my adult life I was wearing clothes that fit my body and I liked the way I looked.

It was about this time that I made the discovery I mentioned earlier. In my research I'd learned a lot about disorders of sexual development (DSD), or what is more commonly known as “intersex” conditions. I plan to write an essay later about this research, but for this story all that really matters is that none of those conditions actually applied to me. One, called “androgen insensitivity syndrome” seemed promising, at first, but I just didn't fit the clinical profile – until one day I started seeing information about a “mild” variant of this condition. Basically, it is a genetic variation in which the body, or some portion of the body, is incapable of processing testosterone.

In the “complete” variation, this happens en utero, and the person who is born has X and Y chromosomes, but the genitalia of a female. They do not have a uterus and have underdeveloped, undescended testes, but in all other ways, they appear female. They even grow breasts in puberty. What struck me most about these individuals is that despite having an X and a Y chromosome, they almost universally identify as “female” from birth.

In the “partial” variant, which is even far more rare than the “complete” variant, the individuals universally have some sort of deformation or ambiguity in their genitalia and are typically unable to father children. Neither of those descriptions fit me, as I was not deformed and I had fathered three children. Most of the historical research focused on those two variants, but in the mid 2000's, research started emerging about a “mild” variant of this condition. This condition may lead to some sporadic infertility, undermasculinized body features (shoulders, hips, Adam's apple, facial/body hair patterns/thickness, etc.), gynecomastia, symptoms related to hormone imbalance – basically everything up to that point that I was experiencing. In addition, it would mean a build-up of testosterone in the bloodstream, since the body, or at least parts of it, could not process it properly. That, in turn, would lead to high estrogens in the blood stream because of aromatase trying to convert the excess testosterone. The puzzle had come together, and I finally had an explanation for what was happening. I had some kind of androgen insensitivity. My body could not properly process testosterone.

I was about 4 years into my research and learning a lot about how the body functions with respect to sex steroid hormones, learning fascinating things about the hypothalamus-pituitary-adrenal/gonadal axes (HPA/HPG axes). I may write a separate essay just on that topic, because there's a lot of information to it, but the conclusion I found was that the hypothalamus plays a crucial role in how we react to positive and negative stress in our environment. It plays a crucial role in how we interact with one another socially, as well. In other words, it controls a lot of the processes that differentiate men from women on what many perceive to be a psychological level, and it does this because of the differences in sex steroid hormones that men and women have.

One example of this is the difference in the way men and women, in general, react to horror movies. Most people should instantly get a picture in their heads that clearly illustrates this difference. Also, men and women socialize within their peer groups in completely different ways. It's the whole basis for the “Men are from Mars; Women are from Venus” types of self-help books. It's not just because women and men are raised differently or learn to think differently; it's because estrogen and androgen compounds activate the hypothalamus in very different ways.

This led me back to the “complete” androgen insensitivity situation I mentioned earlier. People with this disorder almost universally identify as female. What if the reason for this phenomenon is that their hypothalamus can't respond to testosterone? They experience socialization, stress, and other environmental inputs through a feminine “lens” or “filter,” so to speak. They have no problem accepting this to be true because their bodies, at least externally, are feminine. They look like girls and they experience the world like girls on a neurobiological level, so they easily and readily see themselves as girls.

I had that referral from my doc for an endocrinologist about my odd hormone levels, but through a series of administrative snafus, I hadn't been able to schedule an appointment. I knew going in that I would have to get testosterone blockers to prevent the excess testosterone from building up in my system, but I learned I would also need to take at least some level of estradiol to help prevent some of the complications that would come from that – basically, my treatment would be “transition” hormones, or HRT. If the treatments worked, I had a long list of things I expected to see, the biggest of which would be improvements in my depression/anxiety/irritability symptoms and improvement in my electrolyte balance.

I also expected to see some potential side effects. Infertility was not an issue for me, given my age and the fact that I'd had a vasectomy decades ago. Osteoporosis was, and continues to be, a possibility, but there are ways to manage that risk. My breasts would continue to grow, and probably become a bit more dense, but I was already a full 36C. My hips would probably grow a bit. My body hair would probably become thinner, but it was already thin and patchy in a lot of places. (By the way, anyone who says these treatments are “reversible” is either misinformed or outright lying.)

So, the risks in my personal and specific case were minimal, while the potential benefits were quite positive, but it forced me to face a question head on. Do I treat the “cause” and take the hormone treatments, or do I treat the “symptoms” and seek surgery to remove my breasts, along with several other medical interventions that would be necessary? Taking the treatment would accelerate the feminization of my body, but possibly cure many of my other medical issues. Not taking it would cause me to be on a variety of treatment regimens for the rest of my life, involve a risky surgery, and still not stop the natural feminization of my body that was already happening. When I saw it that way, the answer seemed pretty clear. The problem, to me, was how would I present myself to society?

During all of this research and reflection, my wife was an invaluable partner. She knew me in high school (we dated) though we went our separate ways after graduation and came back together years later. As we learned more, it became clear that I interpret social interactions in a very feminine way, similar to those individuals with the complete form of androgen insensitivity. In addition, she pointed out that I have always been perceived by others as far more feminine than masculine. There was something about myself, no matter how “masculine” I tried to be, that would always be interpreted as “feminine.”

One example of this was that, many years ago, I noticed that my social interactions were...odd. Many times in social conversation, she would have to repeat, verbatim, what I had just said in order to get the other person to understand it. As an experiment one year, I grew a goatee. I couldn't grow a full beard due to the androgen insensitivity – I can't grow facial hair on my cheeks and my sideburns are patchy, at best. With the goatee, however, I did not have that problem as frequently. I later learned that the goatee is a masculine “signal” that is picked up by the other person and triggers a response in the social endocrine system. As long as I wore a masculine “mask,” I was better received in social situations.

Given all of the research, all of the input from my wife, and all of my experience, I knew that a feminine presentation was the best option for me. I struggled for a long time trying to find a way to describe it. Privately, my wife and I just used the word “trans” as I began my hormone treatments. I had accepted that I was “trans,” though not as that term is used in social media. I did not choose it; I discovered it. I was not changing from a man into a woman. I had never been a woman and never would be. I didn't care about “he/him” vs “she/her.” All of the rhetoric around that term just didn't apply to my situation.

We began telling some people in our social group about my androgen insensitivity and my inevitable breast growth. I was already wearing women's clothes, though they were fairly androgynous and no one had even noticed, or if they did, they never said anything. I avoided using the word “trans” in these conversations, but since I was presenting as more and more feminine, it's the term that seemed to stick. People seemed much more ready to accept me as trans than I had anticipated, so we just started using the term, but at that point I needed to find a better way to describe why I made the choice to present myself as feminine rather than masculine.

I am a male. I do not pretend to be anything different, and if I meet someone new and we become friends, I am clear that I am trans and not female. In casual social interaction, however, I present as feminine as an invitation to interact with me on a feminine level, because that's what works for me, and that's what, historically, people have responded to within me. I use a feminine name and feminine pronouns, and most people seem to naturally use those based on my appearance. They have chosen to accept my social invitation and interact with me on that level. Some either recognize me as male or are told by others that I am trans and then choose not to accept that invitation. They use masculine pronouns and, if they know it, my masculine name. To me, that's perfectly fine for them to do so. It clearly defines for me where we are in our social interaction. As I recently told a close friend, I would still be willing to have a beer or coffee with them, and I would even pick up the tab. I would find it difficult to relate to them and that relationship probably would not develop beyond that as a result, and that's perfectly fine. I hope to write another essay at some point that more fully explains my view on pronouns and forced acceptance that we see in today's society, but to put it succinctly – it's crap.

As I said earlier, I had already started hormone treatments, and the effects were unbelievable. As expected, my breasts growth accelerated (it's now a 36D – well beyond what most trans people experience on hormones alone), my body hair thinned, my hips began to widen slightly, and there were other bodily changes that I had researched and expected to happen. Unexpectedly, my face actually began to change due to a more feminine fat distribution throughout my body. I see pictures of myself from several years ago and my face looks very different. My electrolyte imbalance issues began to correct themselves. Most notably, though, all of my symptoms related to my depression/anxiety/irritability disappeared within a few weeks, and I do mean “disappeared” – completely. I had expected some form of gradual dissipation, assuming everything I had read about hormonal imbalances was correct, but this was like someone flipped a switch. This is what my wife has to say about it – “my spouse was suddenly, practically overnight, more playful and happy. She seemed less anxious. Things that would have caused an emotional spiral lasting for weeks were shaken off within hours. She seemed much more free with her positive emotions, in a way I had never seen. This was the person underneath a layer of depression and irritability that I had only glimpsed occasionally. It was, and continues to be, an amazing transformation.”

Socially, I was presenting fully as feminine. A few people who knew me before this transition began still referred to me as male; a couple did so out of principle, but for most it was just out of habit. Most new people I met at this point simply referred to me as female, sometimes in very surprising ways. When my wife and I started going to a new local liquor store, the manager at one point thought we were sisters. A new friend we made and had met several times at our local game shop was shocked when I casually mentioned in conversation that I was trans (I thought she already knew). Up until that point, I just assumed people who referred to me as feminine were doing so out of politeness. My wife did, as well, but more and more situations came up where people seemed to genuinely think I was female. It was truly surprising for both of us, but what was more surprising was my new-found ability to “fit in” to a variety of social situations. Things just seemed to click in ways they never had before. In a lot of clear and measurable ways, transitioning has had a very positive affect on my life.

The research and self-reflection I did over the course of those 5 or so years were vital for me to understand what was happening and why it happened the way it did. The trend we see these days of people transitioning on a whim and the stories we see of those same people “de-transitioning” in such high numbers is a tragedy. Transitioning works for some people and has a profoundly positive impact on their lives, but there is no way to know instantly who those people will be. It takes research, medical analysis, self-reflection and analysis (sometimes with the help of a therapist), risk assessment – all of which take time. The rush to transition is the result of a cult-like ideology that has infected our society, and I hope my experience, in some way, can push back against the ideological narrative and show that “trans ideology” is something far removed from “being trans.”