A few weeks ago I went along to a live recording of the Caustic Soda podcast. It was a bit of dumb thing to do, because I hadn’t yet taken my methadone, it was a Sunday, it was running until eight, and the pharmacy closes as eight. So I had a nice (read: HORRIBLE) night and subsequent morning going through all kinds of nasty withdrawals. But still, I had a great time. I love the podcast, I love gross, weird, creepy, horrible, fascinating things, I love my friends, and all of that was there in abundance.
Though watching the show live, and seeing the images as we went, certain little aspects of the humour started to creep up on me that suddenly felt very uncomfortable. With images of people like the man with the immensely swollen tongue on a screen in front of us, I couldn’t entirely shake the sense that there was a human being beneath the deformity and human stories beneath the superficial analysis we were all, collectively, making and deriving our humour and entertainment from. Where did simply fascination with particularly unique medical phenomena, simple sciencey wonder and curiosity, end and the Coney Island Freak Show begin? Having been subject to the Freak Show Audience’s gaze myself, the notion of being complicit in such a thing, and of deriving my own entertainment from participating in that gaze did not sit well with me. I couldn’t ignore it, and couldn’t simply forget what it feels like to be on the other side of that relationship.
This all got very, very explicit when suddenly the subject of “pumping” came up. Pumping is the practice whereby women (the vast majority trans) inject free cement or silicone into their buttocks, hips, thighs or breasts to achieve a curvier, more feminine appearance. It’s extremely dangerous, yes, but also an extremely nuanced issue. But suddenly, there on the same screen where previously we had seen The Demon Core- Devourer Of Souls, The Man With The Giant Tongue, Dr. Jenna’s Worm-Addled Foot, The Man With The Immensely Swollen Testicles (or did he come later?), we now had a young, black trans woman who had been “grotesquely” shaped by the practice of pumping. And I was now in a room that expected me to laugh along.
The conversation, somewhat expectantly, given the skeptic-oriented panel and audience, went in the all-too-easy direction of chastising these women for having made such a “stupid” decision about their health. For having clearly just not thought things through. For having such an absurd (by THEIR white, middle-class, heterosexual, cisgender standards) idea of beauty and thinking they’d look better doing this. Why didn’t they just see a doctor? Why not pursue standard medical care? Why on Earth would anyone do something like that to their own body? Ewww!
It’s a pretty creepy feeling when someone poses a rhetorical question, meant to only elicit a response of “I know, WTF dude?!” and actually have an answer. Or at least a general sense of the scope of the question, where it leads. A sense that answers exist.
So I walked up to the mic and attempted, as quickly, politely and non-intrusively as I possibly could, to address some of the issues they’d missed. But I was intensely nervous, and could feel the blood rushing to my face and my legs shaking uncontrollably as I waited to be spoken to. For all my moral indignation it’s still fucking TERRIFYING to actually try to stand against the vibe of a room, to stand up to an entire crowd of people who are laughing along with something and try to vocalize that it’s not really much of a joke, and their WTFs actually have answers if they’d take the time to look. There’s an immensity of social pressure there, to cave, to laugh along, to participate, to not spoil everyone else’s fun. Especially when so many of them are your friends. People you need to continue to see.
For days afterwards, I was still apologizing, in typical Canadian manner, to Joe and Toren and people who’d been in the audience, for spoiling the mood, for not being funny, for ruining the joke, etc.
Social conditioning for the win?
But there was a lot I didn’t manage to include in my stammering, terrified, nervous response. I didn’t, for instance, even remember to hint at the racial and economic dynamics involved, which are extremely important to understanding pumping given how it is an issue that primarily (very primarily) manifests amongst black, latina, and working/under-class trans women. All that and I feel like I still let down the women that were being laughed at.
I’d like to make up for it.
The truth is that it’s not as simple as a person being presented a choice between pumping and the mainstream medical options for transition via exogenous endocrine therapy, lower surgery, and various professional, in-hospital “cosmetic” surgeries like breast augmentation, voice surgery or facial feminization. It’s not like, say, electing for ear candles and homoepathy when you should be seeing your doctor. The fact of gatekeeping remains in play, and continues to push trans women out of the established medical community, continues to alienate us, continues to demand that we jump through numerous arbitrary hoops before being eligible for various treatments (hoops that may simply be unreachable for many), continues to often treat us in extremely insulting, dismissive, condescending and pathologizing ways, continues to be extremely costly, and continues to create a situation where “proper” transition is only available to people who live in certain areas, and have a certain amount of money.
Gatekeeping is so entrenched that DIYing one’s hormones, by ordering them from InHouse Pharmacy or something, is a completely accepted and common practice, including amongst educated, reasonable, rational trans people that completely understand the risks but come to the (often quite accurate) conclusion that that is the best decision for their health. It’s so common that most experienced doctors won’t even blink when you inform them what you’re already taking.
And a bit of a hush-hush secret that no one ever seems to talk about (and I myself have consistently neglected talking about) is the fact that gatekeeping standards are often much more strictly imposed on women of colour than on white trans women. That during the infancy of transsexual care, while white trans women had to play along with an absurdly complex and demanding game of telling doctors what they wanted to hear, trans women of colour wouldn’t even get the chance to tell the doctors anything.
So when you’ve set up a situation where an impossible set of roadblocks exists between a given community and accessing the treatment they desperately need, when you totally ignore those needs and don’t bother factoring such a community into the decisions and structures of the medical community, when you place philosophical, sociological and cultural concerns ahead of the needs of the patients, when you unfairly hold them to unreachable standards of “proving” their condition and need for treatment, when you make “proper medical care” a near impossibility for people who NEED that medical care, they WILL access it elsewhere.
And all the better, when it’s a world of white, professional-class, cisgender doctors setting up those barriers to treatment and saying “no”, to come across someone like yourself saying “I can help you. I’ve been there. You can trust me.”
It’s available. It’s cheap. It’s fast. It gets the job done. It’s offered by another trans woman, and likely another trans woman of colour, who has had enough confidence to have undergone it herself, someone you can trust.
Which is not to say that I think that wholly excuses the actions of those trans women selling pumping to other women, only that I can wholly understand why someone would want to pursue that option, and why their sense of who they should place their trust in might be different than what we’d expect.
And in addition to the ways that gatekeeping particularly targets and impedes WoC (women of colour), and the ways that the expense of transition particularly excludes those who are economically disadvantaged, especially in the United States and other countries that don’t cover transition-related treatment under public healthcare (if I were down there instead of up here, I don’t think transition would have been possible for me, nor would I have survived much longer. Heroin is cheaper than an HRT regimen and laser sessions), it’s important to bear in mind the intense risks of violence targeting trans WoC. This is a group at a statistically higher risk of being murdered than any other comparably broad demographic. In this context, “passing” becomes a much, much more loaded issue. Not an individual choice of politics and identity, but a necessity for survival.
What good is taking the slow road of hormones and doctors, and what good are its long-term health benefits contrasted against the risks of pumping, if you don’t stand much of a chance of surviving for more than a year, avoiding being murdered for more than a year? What’s the point of trying to make it through the long androgynous phase of early transition if being visible as such is may prevent you from ever seeing the end point? They live in a world where “pass or die” and “be beautiful or die” become extremely meaningful propositions, meaningful choices to make. Even though not every visibly gender variant WoC ends up being a victim of violence, the risk and the threat alone are sufficient to throw off such a shallow and superficial question as “why would anyone do something like that instead of seeing a doctor?”
It’s not my place to describe or articulate the experiences of trans WoC or speak for their issues or propose any solutions. It’s not even my place to say this is a “problem”. But what I can do is at least be aware of nuance and complexity in a given subject, understand and know enough to understand and know that I don’t really understand or know. To have enough humility within my ignorance of the exact experiences of these women to not point and laugh and say how “stupid” a “decision” it is to go with pumping or DIY or whatever rather than just seeing a “proper” doctor.
Just seeing a proper doctor.
There’s a lot of arrogance in these justs. A lot of assumptions. A lot of privilege. A lot of ignorant thinking that things like seeing a doctor or not needing to worry all that much about how you look or learning to live with your body the way it is or making it to next Christmas without getting killed are all as easy for everyone else as they are for you. Whether it’s a “just” from a group of white, straight, cisgender guys laughing at the body a scared, alienated, disenfranchised trans woman felt she needed to have and asking why she didn’t just settle for hormones, or from an HBSer saying that another trans woman is really a man because she didn’t just get a job and arrange her priorities such that she could afford SRS, or from a rad-fem asking why we don’t just accept gender as an illusory social construct and stop investing so much of ourselves into it, or from an old friend from college asking why I couldn’t just be a femme gay guy, it’s always the same: the assumption that one’s own privileges are universal. That everything is as easy for everyone. That we’re on an equal playing field.
Why can’t you just accept that other people’s experiences, needs and barriers are different than your own? Why can’t you just accept a level of humility in addressing these issues, remember that there’s almost certainly something you don’t understand going on?
Why can’t you just listen and learn?