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There’s a well-known nursery rhyme that asks, “What are little boys made of? / Slugs and snails / And puppy-dogs’ tails … What are little girls made of? / Sugar and spice / And everything nice.” It’s a tiny piece of a larger puzzle aimed at helping little girls and boys understand their place in the world. For most people, biology is destiny and that’s all -- but for some, biology is a confusing, fraught, and frustrating concept, because their external bodies don’t match their internal feelings.
The following documents the journey of trans woman Laura Smith (name has been changed per her request), a bright, attractive 24-year-old hoping to have gender confirmation surgery (often termed sexual reassignment surgery) to complete her transition — even though her health insurance won’t pay for it.
“It made me hate myself.”
Laura grew up in the small college town of Northampton, Massachusetts. Laura wasn’t born Laura — she was born with male genitalia, and was raised as a boy under a different name, which she declined to provide.* As a child, says Laura, “I was a really happy bright person.” But, she says, “I lost a lot of friends because I was really feminine. The world sort of told me what I was — that I was a boy, and that I was a gay boy. Because my sexual orientation made sense with what they were saying, it was very hard for me to see a different way to understand myself.”
She came out to her family when she was 11, and says that they were, for the most part, supportive.”They sort of adapted to me, instead of asking me to adapt to their beliefs.” School was not so easy. In elementary school, Laura was bullied a lot for being a feminine boy. “Kids who would call me faggot, say they were going to kill me, it made me hate myself,” she recalls.
Things got a bit better when Laura transferred to an arts high school. The bullying stopped, and Laura was able to make friends, but she still struggled with her femininity. At 14, she started dressing as a woman and growing out her hair. “I started to explore myself,” she says, but after realizing that her new feminine self made some of her family and friends uncomfortable, she retreated.
“I consciously decided after that year to not pursue that part of myself because I was too scared of the consequences of being that person,” she says. “It was the best year of my life, and I think if I had kept going with it, I would have known I was a woman.” Returning to a more masculine presentation made other people more comfortable, but it sent Laura into a depression spiral. “I was really lost––totally lost––dressing like a boy, but feeling totally horrible about it. I did it because I wanted to be liked.”
When you’re a teenager whose body seems to be betraying your mind (or is it the other way around?), you begin looking for answers––anything that will explain away the feelings you have. For Laura, it was reading Jeffery Eugenides’ book "Middlesex" that opened up her world. The book, about a girl who grows up and learns she’s intersex, was a catalyst.
She followed that up by reading David Reimer’s memoir. Reimer was born with male genitalia, but after a botched circumcision, doctors recommended that he be raised as a girl, believing that gender was purely a social construction. Reimer grew up to identify as male but struggled with depression and instability his whole life. Reading both stories “was the first time I had thought about gender,” says Laura. “I thought that maybe I’m NOT a boy.”
She began searching for physical signs that her genitalia had been created for her after birth, searching for surgery scars -- desperate for anything that might give her an explanation for how she was feeling. “I created an intersex mythology, even though I’m not intersex. But at the time, it a was the only way to make sense of what I was,” she says. “I had heard the term transgender but that was much more frightening.”
“It wasn’t about being gay.”
To drown out the conflicting voices in her head — ones telling her that she wasn’t actually supposed to be a boy and the others that stressed that she absolutely had to be -- Laura turned to drugs and alcohol. It’s fairly common for transgender people use drugs and alcohol to cope with their feelings. Studies estimate that anywhere between 20 and 30 percent of transgender and gay people abuse drugs and alcohol -- compared to around 9 percent for the overall population. The drugs, says Laura, were a way to close the door to self discovery.
For seven years, there was a cycle: “Every six months to a year I would try to be really masculine. I would try and play the part -- which made me feel like people liked me more (though it was mostly my delusion). It would be painful because I would be so distant from myself, that I would slowly start implementing feminine things into my wardrobe and life. I’d get more feminine and feel real again, but I knew it came at a price. After I got really feminine I’d panic and start regender myself male.”
The drugs and alcohol conflated her feelings, enlarged and twisted them. “I was very lost in my gender, I thought it was my sexuality. I thought maybe I hated being gay. It took me a long time to realize it wasn’t about being gay. I just didn’t understand where I fit in there. I kept trying to be a gay man, I believed I was, but it never really felt right.”
In college, Laura took a gender studies classes. “I was introduced to gender as a construct, and as distinct from sex and sexuality and that blew my mind. I had never heard anything like that in that context.”
But she was still using drugs and alcohol. “I realized I wasn’t uncomfortable with being attracted to men. I was presented with the idea of being trans, and I was still so in denial. It just got so dark, I just hated myself.” In April 2011, after several attempts, friends were able to convince Laura to go to rehab. “Ii changed spiritually, physically and mentally from my first day of recovery. The tenants of my sobriety are honesty, acceptance and gratitude, and living that way, I had to rethink everything my first year of recovery.”
Again, Laura dabbled in wearing women’s clothing. “I sat around my house in drag gear. And then I started running home in the middle of the day and putting on that stuff. Then a friend suggested I come to work like that. When she said that, I knew that’s what I wanted. I realized I wanted I could look like that every day. But I got really scared of how much I had gotten okay with my femininity.”
And here’s where Laura says something so critical –– about how difficult it can be to live in the wrong body. “I was always trying to be a boy. I was always trying to transition to male my whole life. I wanted to be a man so badly.”
“Transition has saved my life.”
Laura’s moment of true self-acceptance came swiftly and suddenly. “I saw a story about a trans woman online and I was infatuated with it. Within 24 hours, I finally accepted that I was trans. It took 23 years to get to that point, but the second that happened, all the fear and anxiety melted away. Once I had an answer for what I was, I was free. I knew I wasn’t a boy. I didn’t know if I was a woman, I just knew that I was trans.”
In a matter of months, Laura had gotten sober, begun living as a woman, and accepted her trans identity. Next came hormone therapy.
“Hormones have been opening a gateways to myself. It feels like being dropped back into a body you see far away,” she says. “For so long, I hadn’t feel like a human being. I felt like I was either an alien, I didn’t understand myself, I’d relate myself to, like, a tree. Which made no sense to anyone I told, and now in retrospect I realize that was gender dysphoria.”
After a year of taking hormones, Laura’s next step is Gender Confirmation Surgery, previously termed sexual reassignment surgery. Laura applied to have a vaginoplasty — that is, a vagina molded from her current male genitalia -- but her insurance company denied it, claiming that the surgery was purely cosmetic. Many insurance companies don’t cover the surgery, or have strenuous requirements for patients to ”prove” that the surgery is medically necessary. (Check out Aetna’s policy for example). Even if your employer or school wants to be able to cover it, many insurance companies will refuse to include it in their plans.
According to the Human Rights Campaign, “historically, transgender people have often been categorically denied health insurance coverage for medically necessary treatment, irrespective of whether treatment is related to sex affirmation/reassignment. Up until the last few years, nearly all U.S. employer-based health insurance plans contained “transgender exclusions” that limited insurance coverage for transition-related treatment and other care,” though thankfully, that’s changing. Some insurance companies offer coverage, though their subsidiaries will opt not to, which is the case for Laura.
Gender Confirmation Surgery is not simple, quick or cheap. Male to female gender confirmation surgery can cost upwards of $24,000, while female to male surgery can be significantly more (it costs a lot more money for phalloplasty surgery.). And that’s why Laura, with the support of her employers, the Brooklyn consignment store Beacon’s Closet, has launched an Indiegogo fundraising campaign for her surgery.
“Having the right genitalia — having a vagina — will really set me free in my body. It will allow me to finally live my life in a way that is representative of me fully,” explains Laura. “I won’t be able to be wholly comfortable in my body if I don’t have that surgery. Medical necessity is about being well, and what will make you well. I’m not a miserable person — I just know what I need for myself. I know what my body needs and I understand the limitations of the body I have now.”
Why is Laura’s story important? Why have I spent the last 2,000 words telling you Laura’s life story? Because I believe that it’s everybody’s right in this world to live as the person they believe they are. We’ve seen too many trans kids and adults — who don’t see themselves positively reflected in media, in culture, in their communities -- struggle and suffer and yes, die, because they can’t be the people they were meant to be.
Laura’s story isn’t every trans person’s story –– it’s her story –– but it reflects a very real reality for thousands of people. This is a personal glimpse into not only the pain of gender dysphoria, but also the joy felt when you finally become the person you always knew you were.
For Laura, the past couple of years of living in full acceptance of herself has been phenomenal.
“I wish that I had someone tell me that it was okay to be this person when I was a kid, and I didn’t have that. I wish I had a relevant role model or archetype, and that’s why I established my blog.”
The journey has been long and tiring, but it’s well worth it. “I thought I was unacceptable. I thought that my difference was shameful. I thought there was no space for me in this world. I thought that life was something to endure but not to enjoy. It’s not easy being trans, but that’s okay. It’s okay to be this way. It’s more than okay, it’s beautiful.”
*If you’re wondering why I’m not referring to Laura by her previous male name in this part of the story, it’s because as Laura explains, “I have read so many stories of trans women where they talk about her with her male name pre-transition and male pronouns, and its so bad for trans people. Once the public sees that name and that pronoun they believe that’s who the person really is.” In other words, Laura doesn’t want to dilute the power of her identity as Laura with her past identity.
Reprinted with permission from The Frisky.