Before Patrice Golgata pushed through all the crying and questions, before she started looking for a surgeon, before she got in the car to drive her unhappy son from New Hampshire to Philadelphia on what she considered a life-saving mission, she was feeling pretty good.
She was a single mom of three, and worked as a nursing assistant. Her family’s problems seemed routine. Money required managing; the kids always needed something. But the good outweighed the bad. Even her son’s odd behavior was only a nuisance.
At 15, Shane held “good kid” status. Painfully shy, his long hair covering his eyes, he spoke little. He had a few close friends, and they played video games for hours. But he didn’t get into fights, didn’t sneak out, didn’t experiment with drugs and alcohol. So Patrice wasn’t all that concerned when she caught him stealing his sister’s clothes.
She would enter Shane’s room to put something away and there they’d be—skinny jeans, tank tops, underwear, folded in a tight pile in a drawer or under blankets.
What’s this about? she thought. “I was just fooling around,” Shane would tell his mother. And that was enough.
Then she found small plastics bags filled with water, lolling incongruously in his sock drawer. Oh, she’d think, he and his friends must be having water balloon fights.
In his sophomore year of high school, Patrice told her son: Stop the nonsense. Then she found her daughter’s underwear and skinny jeans in his room for the sixth time. Or was it the 12th? She’d lost count.
She sat down at her computer, opened a Web browser, and typed in various combinations of words, all meaning: My son habitually steals his sister’s clothing. The computer spat back one explanation, link after link, page after page:
My boy, she thought, wants to be a girl?
Patrice Golgata didn’t understand what was happening, didn’t understand that more kids than ever, at younger ages, are stepping forward to say they are physically trapped in the wrong body, the wrong gender.
No way, she thought. Not Shane.
Even in the midst of denial, however, she was already on her way—to a different life, and to Philadelphia, a city that has quietly become one of America’s leading hubs to help you when the child you always took to be a boy, or a girl, comes and tells you that God has made a terrible mistake.
For many, the idea of “switching” genders suggests some mental illness, kink or sexual preference. But scientists explain transgenderism in biological terms. John doesn’t become Jane by choice, or out of confusion. In the brain that creates our sense of self, he is already she—even before birth.
These studies started appearing in the 1990s, when a team of researchers in the Netherlands performed autopsies on six male-to-female transsexuals. Previously, neuroscientists had discovered that the bed nucleus, a region of the hypothalamus with receptors for male and female sex hormones, is much larger in men than women. But in each of the six transsexuals—all born male—the bed nucleus was far closer in size to a female’s. The findings suggested that neurologically, transgender people are born, just as they always claimed, in the wrong body.
Since then, researchers have confirmed and expanded these findings. Today, while there isn’t a medical consensus yet, medical experts believe transgenderism is related to hormone exposure during pregnancy. In other words, being “trans” is biological—something a baby acquires in utero. “The science has been very helpful,” says Jacsen Callanan of the Mazzoni Center, the health and wellness center for the city’s LGBT community. “Parents, and trans people themselves, can say this experience is rare, but naturally occurring.”
But there remains a deep cultural bias against transgenderism. From the moment a pregnancy is announced, the question is asked: Boy or girl? The answer becomes the foundation of our identity. Legally speaking, the transgender can have the sex on their birth certificates changed. But politically, language can get tricky when you tell a transgender person’s life story. (For the purposes of this story, we shift pronouns—from he to she or she to he—at the moment the characters in the story “transition” to live publicly as the opposite gender.)
While the transgender have become more visible in the past few years, they’ve been among us far longer. In the 1970s, Rachel Harlow, a Philadelphia transsexual formerly known as Richard Finocchio, ran the fashionable club Harlow’s on Bank Street; she became the center of a scandal when she began an affair with City Councilman John Kelly Jr., the brother of Grace Kelly. Four decades later, the transgender remain shrouded in myth. The desire to wear the other sex’s clothes—for a supposed boy to steal his sister’s underwear—is often mistaken for cross-dressing, a sexual fetish. But for the transgender, putting on the opposite sex’s underwear is an attempt to alleviate a source of suffering—to make the outside match what’s inside.
Because the transgender often undergo surgery to refashion their sex organs into their opposite, we think of them strictly in sexual terms. But psychologists suggest a mental exercise: Imagine, they say, you are a man who wakes up one day to see that your penis is gone; you now have a vagina.
Imagine the freakishness, the sense of woundedness and alienation, you’d feel from your own body.
Sit with that.
The transgender feel this way every day. One family told me their five-year-old daughter insisted on wearing underwear into the shower because she couldn’t bear to see the body her brain rejected. “Transgender people often report identifying so much with the body opposite to theirs,” says Maureen Osborne, a psychologist in Malvern, “that puberty comes as a shock. They tell themselves as children that somehow this will change on its own. And when it doesn’t, it’s devastating.”
For generations, being transgender has stood as a kind of death sentence. Ostracized by families and communities, the transgender suffer greater-than-average rates of poverty, homelessness and drug addiction. According to statistics gathered by the National Transgender Discrimination Survey, 26 percent of trans people have lost a job for being trans. Trans people are also assaulted at rates higher than any other minority. In December 2002, Nizah Morris, a trans woman, was found on the side of the road in Center City, bleeding from a fatal head wound just minutes after she’d been loaded into the back of a police car. (The police claimed officers let her off unharmed; the police and D.A.’s office have been criticized for withholding information. Only the dogged reporting of Timothy Cwiek of the Philadelphia Gay News has kept the murder in public view.) A stunning 40 percent attempt suicide. Yet despite existing as a kind of lower caste, the transgender are advancing, from lonely nights and thoughts of suicide to life, out here, with the rest of us.
Up until five years ago, the transgender tended to transition—to live publicly in a new gender—only after decades of misery. “All my life I knew something was wrong,” says Renee Ramsey, an 81-year-old trans woman who recently moved to Summerville, South Carolina, from Bergen County, New Jersey. “My birth name was Richard, and everyone thought of me as a man. But inside, I always felt different.”
Richard Ramsey identified with the females he knew. He experimented, playing traditionally feminine games like dress-up and house. But he remained “Richard.” He stole his mother’s underwear, and wore it when he was alone. When he was caught, his parents took him to a psychiatrist, who declared his desire “a phase.”
What followed is now known by psychologists as the “flight to masculinity.” Richard joined the military; he married, twice, conceiving four children, and got divorced. “I tried,” Renee says today, “to make the best of it.”
In fact, Richard spent a lifetime fighting to “be a man” before consulting Sherman Leis, a Bala Cynwyd plastic surgeon, about “gender reassignment” surgery. The desire to live in the right body for some measure of days before dying compelled Ramsey to undergo the physically draining procedure at age 77. “I’m finally happy,” she says.
In the past several years, there’s been something of a generational shift in who is “coming out” as transgender. Statistics are scarce, but local surgeons and psychologists report that the number of young people seeking treatment, sometimes including surgery, has grown drastically, from maybe five percent of their practices to 30 percent today.
There are a number of reasons for this. More trans people are outing themselves in the public eye (see: Chaz Bono; former Navy SEAL Kristin Beck). But the most important shift may be the availability of information. Just 15 years ago, learning about transgenderism involved an anxiety-producing trip to a public library. Now a child, or a parent like Patrice Golgata, can research without leaving the house. The result is a watershed moment for the transgender. As (most of) America celebrates the Supreme Court’s recent ruling in favor of gay marriage, the transgender likely stand on the cusp of their own battle for civil rights—with Philadelphia at the epicenter.
Of the dozen or fewer doctors in North America who regularly perform sex reassignment surgery, three operate in the Philly suburbs; one of the leading psychologists helping transgender kids and their families is located in Wayne. This all happened largely by accident. But the result is that a great, even historical drama is playing out here, in which some parents are acting—spurred by primal emotions of love and fear—to do nothing less than save the lives of their children.
Patrice Golgata never forgot what she read. And a few weeks later, while performing household chores, she heard an ad for an upcoming TV show. “Trapped in the wrong body!” the announcer shouted. “Meet the youngest transgender person to undergo sex reassignment surgery.”
Trapped in the wrong body?
She imagined Shane, suffocating.
She called down the stairs: “Shane, I need you to come here.”
He came up, hair dangling in front of his eyes.
She blurted it out: “What are the chances you’re one of these people who feel like they’re trapped in the wrong body?”
“Yes” was all he said.
Shane’s father had long been out of the picture; the responsibility for what to do next fell squarely on Patrice. She felt panicky, unsteady, but willed herself to remain calm. “Okay,” she replied. “I don’t understand anything about this. So I’m going to have a lot of questions.”
Shane left the room. Patrice started crying. And kept crying, for weeks.
Ashley, a mom in Montgomery County, learned about her son when he came home for summer break from college. He hunted and fished with his dad. He seemed happy. Then, one day at her job as an office manager, she received a text from him. A photo. There he was—face expressionless, hair flat-ironed, eyelashes thick with mascara. “I need to talk to you,” the message read.
In West Chester, Julie and Jeff found out gradually. At three, their daughter told them she was a boy. At five, when her teachers divided the room by gender, she threw tantrums. And at 10, she stood in front of the bathroom mirror and hollered: “If God’s so smart, why did he give me the wrong body?”
However a parent learns the truth, the revelation occurs as a kind of death. “It is a loss,” says Wayne psychotherapist Michele Angello. “Finding out your daughter is your son means losing everything a parent imagines for a child’s future.”
Parents must accept never seeing their daughter in a wedding dress or their son in a tuxedo. And they must also mourn the past. All the joyful times mom and dad thought they provided were, for their child, often painful lies. All those birthday cards to “Our Darling Daughter” or “Handsome Son” suddenly sting. Family history is rewritten, pruned—sometimes forcibly. Family photos of trips to Disney World are either tucked out of sight or destroyed.
But the truth is that most parents never make it that far. Overwhelmingly, they reject the news entirely. “It’s still rare to see supportive parents,” says Robert Winn, medical director of the Mazzoni Center. “I’d say more than 90 percent of our young trans clients under 25 don’t have parents supplying emotional or financial assistance.” Mazzoni counselors often advise high-school or college-age kids to remain closeted until they no longer need help with basics like tuition and housing.
Angello runs a support group for parents of trans kids to help them reframe things: The perceived death of the child you thought you had is actually the birth of the child you really have. Kids and their parents sometimes even celebrate “rebirthdays”—the date of a sex reassignment surgery or name change. But the distance from stunning revelation to cake and candles is long.
“I was supportive,” says Patrice Golgata, “from the very beginning. But privately, it took time for me to process. I just—I remember looking at the suicide statistics, how high they were. And I was scared. I thought, You know, my kid needs me.”
One day almost about 30 years ago, Bala Cynwyd plastic surgeon Sherman Leis greeted a new patient, one who asked that he perform “sex change” surgery.
Leis demurred, saying he wasn’t familiar with the procedure. But Janice Meyers persisted, explaining that no one in the area performed sex change surgery. Intrigued, Leis did some research and discovered that the transgender had to travel—to Canada, or Colorado—for surgery. And there was precious little literature available, just a few articles in Plastic and Reconstructive Surgery. In Janice’s case, the surgery would involve removing a tube of tissue from her abdomen, molding it in the shape of a penis, and attaching it just above the clitoris.
“I was not intimidated by the surgery at all,” says Leis. “If you have experience and understand a surgery conceptually, the technique is already there in your hands.”
Leis performed the surgery. Janice adopted a new name of Jan, married his girlfriend, and moved to Florida. “That was it,” says Leis. “No one else came seeking that sort of surgery, and I had a busy practice as it was.”
More than 20 years passed. Then, in 2004, Christine McGinn walked into Leis’s office. She didn’t know he’d performed a previous “bottom” surgery. She told him she wanted to conduct her residency in his practice, and one more thing: She hoped he would begin performing transgender surgeries.
She had a very personal reason.
McGinn is a commercial-grade knockout, a camera-ready, sunny blonde. She is also transgender, and in 2000 completed her own transition. She has dedicated her career to performing sex reassignment surgery to help others like herself. McGinn encouraged Leis to travel to Colorado, where trans surgeon Marci Bowers ran a practice. Leis watched Bowers perform surgery for a week. “It was interesting,” he says. “But that wasn’t the reason I altered my practice.”
As a plastic surgeon, Leis explains, “I help people feel better about themselves.” In that context, bumping a woman from a B cup to a D cup is fine work. “But gender reassignment surgery is truly life-altering, life-saving surgery,” he says. “You can see it in the way patients react when the procedure is over.”
And so Leis began to expand gender reassignment surgery at his practice. McGinn and a second surgeon, Kathy Rumer, performed their residencies with him. Rumer now conducts gender reassignment surgeries in Ardmore. McGinn, who has appeared on Oprah and also starred in the documentary TRANS, which covered her journey from Lieutenant Naval Commander Christopher McGinn to her current identity, today has her own New Hope-based practice.
Transgender surgery (including facial and chest procedures) represents about 90 percent of Leis’s business. About a year ago, his secretary took a call from a new client. Her name was Patrice Golgata, and she was inquiring for her child.
Life, the birthdays and celebrations, the fights and family meals, the games and the endless procession of days, delivered a singular message: “I always knew I was weird.”
He never liked playing sports.
He watched girls, felt drawn to them—not from a sense of otherness, but similarity. His name, he understood, was “Shane,” which means “God is gracious.” But he was skeptical that God existed at all.
He hated the clothes he wore. He hated being a boy. As he grew, he got to make choices. He favored big jeans and baggy sweatshirts, clothes that billowed about him like a dress and hid the form from which he felt so disconnected. He stayed mostly silent. His mother, Patrice, called him shy. Maybe he was hiding, scared he might be discovered, this girl in the boy’s body.
Video games helped, rendered him a new body, an avatar on a screen.
Trips to the bathroom hurt. He didn’t recognize the boy. His penis seemed useless. He looked at other people, so content by comparison, and wondered how they could look at him and not see a girl.
He didn’t know that anyone else like him existed. He simply suffered, alone, until he was 13 years old.
It was 11 o’clock on a school night, and he sat in his bedroom, flipping channels. He stopped at South Park, an episode titled, “Mr. Garrison’s Fancy New Vagina.” And his life changed.
The opening scene depicted Mr. Garrison, a teacher, undergoing an operation to become Mrs. Garrison, because he is “transgender.”
There it was. The word he needed.
He wasn’t crazy or alone. His sense of self was real, had a name.
He got a little bolder then. Crept into his sister’s room, taking underwear, blouses, skinny jeans. He filled little plastic bags with water and stuck them inside his shirt, like breasts. And he looked in the mirror to see the girl on the inside finally reflected on the outside. Wearing his sister’s clothes calmed him. It felt natural. But life remained anxious, expressed in monosyllables, until the day his mother called him upstairs.
Do you feel trapped?
Initially, he thought his mother knowing the truth might be enough. But after a few weeks, after watching the girls at school—the way they moved, airy as butterflies, the way they spoke and dressed—he knew he needed to go all the way. He needed to live as a girl.
He let his mother do the research; he wanted only the result. And to let his mother choose a new name. That was how, in a single word from her mother’s lips, Jill began.
Trans kids come out in stages, to relatives, friends, the neighborhood. “It takes a couple of years for a person to transition from one gender to another,” says Angello, “and that’s if everything goes right.”
Doctors often require trans patients to live in their new gender identity, under a psychologist’s care, for a year prior to surgery. Two therapists must write letters affirming that the patient is truly transgender and psychologically stable enough to deal with the stress of transitioning. “It’s a lot to manage,” says Patrice.
Let’s start with drugs.
Trans children can take drugs that delay puberty’s onset or suppress it, preventing facial hair or breasts from developing. There are also hormone treatments—estrogen for the male-to-female transsexual, testosterone for the opposite.
The drugs cause a cascade effect. Estrogen triggers breast development; testosterone produces facial hair and a deeper voice. The outward changes render “coming out” an imperative, forcing kids and parents to deal with a whole host of social and family issues. Families are advised to draft a list of whom to tell and in what order, perhaps even preplanning some sensitive bits of the conversation. “It becomes all-consuming,” says Patrice. “For a while, everything revolves around this. I used to think: Why couldn’t my child just be gay? It would be so much easier!”
The surgeries can be tough and costly. Male-to-female surgery, including testicle removal, a vaginoplasty and breast augmentation, runs about $30,000. Only five to 10 percent of such surgery is covered by insurance.
Finally, no matter how much better someone might feel, the rest of the world is still there. In the year she spent living as a girl in the run-up to surgery, Jill got harassed by a couple of boys when she wore skinny jeans to class. But a couple of girls ate lunch with her and talked, well, just like girls. School administrators supported her, but Jill faced the same controversy every trans kid does: Which bathroom should I use?
“It seems ridiculous,” says Angello, “but that’s the big thing everyone gets worked up about: the bathroom. They are afraid someone is going to get hurt. But I tell them: ‘If you have bathrooms in which kids aren’t safe, you have a bigger problem than a trans student on your hands.’”
In the end, Jill’s school settled on the bathroom in the nurse’s office. “I don’t mind,” says Jill. “I think everyone’s been great.”
Some people face harsher roads.
Ashley, who found out her son was her daughter via the texted photograph, is afraid to see her family’s name published. Her child, whom we’ll call Sarah, is now moving toward surgery, taking hormones and living as a girl. Sarah has the support of her father, but her grandfather won’t acknowledge her. She ducks old friends from high school entirely and has spent most of the past year hiding out in her parent’s house. “We’re not out to everyone yet,” says Ashley. “Friends or family.”
Being supportive is only a parent’s first step. The rest of the journey runs mostly uphill, through doctors’ offices and past countless cultural and personal dragons. Jeff and Julie, whose child cried out about God’s mistake, still worry: Will their son find someone to love and accept him? But as for their kid being transgender, “We’re past it,” Jeff says. “Hale is just my son, and we’re a family. The fact that he was born with the wrong anatomy is just part of our history.”
“I’m going to call it,” the nursing assistant declares.
“Go ahead,” Sherman Leis replies.
The assistant reads off the name of the patient: “Jill Baringer.” Then the name of the procedure: “Gender reassignment surgery.”
By this time, Jill, now 18, has been living as a girl for a year. The surgery will align her body with that fact. She lies on a heavy surgical table, anesthetized into unconsciousness, her legs in stirrups. Just minutes ago, Leis performed a “feminizing” procedure, opening Jill’s throat to shave away four millimeters of the milky white cartilage that protects her voice box.
“This was sort of a warm-up,” Leis tells me, backing away from the table. “Next up is the main event.”
McGinn calls her practice “The Papillon Center”—papillon being the French word for butterfly, suggesting that trans men and women lie cocooned inside their own bodies before surgery’s big reveal. As metaphors go, the butterfly is sentimental and apt. But this imagery also misses something—about the desire, so great that the transgender ask for this; about the clarity they have, to look past our judgment. To see what they could and should be.
(A note: The descriptions of this surgery are graphic.) Leis makes his first incision, drawing blood from the skin just beneath Jill’s testes. Deploying a Bovie, which both cuts and cauterizes, he works in a slow, careful circle till he can peel away the entire skin of the scrotum, raw and gleaming, in one single sheet. This is the start of the four-hour procedure, during which Leis, 71 and thin as a wire doll, takes just one brief break.
He hands the scrotal skin to an assistant, who performs electrolysis on it and trims away fatty tissue before wrapping it around a stent—a phallus-shaped tube of medical-grade plastic maybe 10 inches long. Leis will use this skin later. He pulls Jill’s testes taut on the cords that carry sperm, maybe six inches from the body, and cuts them free. He proceeds to “deglove” the penis: He makes a new incision just below the head, then slowly fillets the shaft, all the way down to the base. The effect is like seeing the facade of a building torn away to reveal the steel beams and wire guts. The urethra and the pair of corpus cavernosa, which fill with blood to produce an erection, retain a phallic shape, but loom now as supporting pillars in a structure being methodically torn down.
The work is delicate, careful, bloody and mind-blowing. The hours pass in a speedy haze of activity. Leis turns the shaft of Jill’s penis and the scrotum inside out and sutures them around the tube-shaped stent, to be used, later, as a vagina. He inserts a catheter. And he destroys three pillars—trimming the urethra and removing the corpus cavernosa. At each stage he switches the Bovie to cauterizing mode, sending up small puffs of smoke as he sears Jill’s tissue with electricity to stop the bleeding.
By now, almost the entire groin is torn open—a bloody mass of fascia, muscle and fat. All that is left of the penis is the head, attached to the body by a thin strip of tissue, as if the final pillar of the building has been winnowed, but for its top, and knocked over. Carefully, Leis’s long, narrow fingers feel their way, and he carves a pea-shaped section from the head of Jill’s penis to create what is called the “neoclitoris.” Folding the tissue gently to preserve all the nerve endings, he places this new clitoris carefully. Pink and undamaged, it suggests an end to the brutal facts of surgery. Leis then takes a small section of the urethra and places it on Jill’s groin, directly under the glans, to comprise the minor labia. He sutures each into place.
Finally, it’s time to create the vagina.
Leis cuts an incision between Jill’s anus and the patch of raw tissue that once held her scrotum and inserts the tube of skin created from her genital tissue. Then, using his fingers before switching to the hard metal of a speculum, he slowly deepens and widens this new canal, by force. And something about this entire operation seems to speak to everything that came before.
As a culture, even a secular one, we are still influenced by the Christian notion of the Refiner’s Fire—the idea that we are made into something more perfect and pristine when great heat has burnt away the extraneous us. We lean on this image in tough times—trust and hope that the death of a loved one, the loss of a treasured job, will, when the pain passes, reveal in us some harder, stronger form. In this sense, Jill’s hard times came prior to surgery—in the years she spent struggling with the knowledge she’d been born into the wrong body, locked in a life of secrets and alienation from her own shape, shunted into what her own mother dismissed as weirdly dramatic shyness.
All was burnt away, so that when her mother finally asked if she felt trapped, she could respond, without hesitation, yes. And at the end, after Leis reshaped her so that her outside could match what was inside, he sewed her back together. He brought her legs down in the stirrups of the surgical table so her skin bunched around the new physical facts of her. Jill finally looked just like the girl she always knew herself to be.
One day this summer, in Michele Angello’s monthly support group for parents of transgender kids, a mom starts crying almost from the moment she opens her mouth. “I am just afraid that no one will ever love my son,” she says. “I mean, who will ever be able to accept him, and love him, and be intimate with him and be there for the rest of his life?”
Her fear resonates with every parent in the room. “It’s true,” Angello says finally. “The dating pool for your children will be much smaller. Your children will have to be patient, resilient and careful. But there are some other things you may not be considering.”
She admits that men or women who choose a transgender partner will need to push beyond the person’s past to see who he or she is now. They will need to be strong enough to withstand the looks and questions they might draw from others. But that means trans children won’t wind up with any ordinary partner. Such children will—because they must—find someone special.
By the time Angello finishes, everyone in the room is crying. “It’s always like that in group,” she says afterward. “There is always some new, tearful epiphany.”
Five days after her surgery, Jill Baringer reclines in bed, her shoulders in the thin straps of a tank top, her body covered by blankets.
Prior to surgery, Jill was so difficult to engage in conversation that just being around her could be awkward. But today, she is relaxed and smiling constantly.
She will skip her senior year of high school, secure a GED, get a job, and start community college. Because this, she says, is a time of new beginnings.
She feels normal now. Comfortable in her own skin. And when she looks down at the result of Sherman Leis’s surgery, she feels “happiness. It never should have been there in the first place. I’m glad it’s gone.”
“Do you think,” I ask her, “that the surgery may make you less shy?”
Jill Baringer throws her arms up over her head, as if she’s throwing open a window. “Oh,” she says, her voice rising an octave, “I think I already am.”