"I know that I am making the right decision because whenever I think about changing my gender role, I am flooded with feelings of relief."

By: Ben Barres

Shortly before Ben Barres death in December 2017, the pioneering neuroscientist sent his friend Nancy Hopkins a heartbreaking email in which he told her hed been diagnosed with advanced metastatic pancreatic cancer and probably only had a few months left to live.

Barres, who was known as much for his advocacy for gender equality in science as for his groundbreaking work on glial cells, the unsung heroes of the brain, spent his final months writing The Autobiography of a Transgender Scientist, which was posthumously published in 2018. In the excerpt featured below, Barres candidly describes making the transition from female to male in the late 1990s and shares a coming-out letter he wrote to friends and colleagues. This has been a difficult decision because I risk losing everything of importance to me: my reputation, my career, my friends and even my family, he tells them. I know that I am making the right decision because whenever I think about changing my gender role, I am flooded with feelings of relief.

After about four years at Stanford, I was promoted to associate professor with tenure. One morning, I was reading a local newspaper, the San Francisco Chronicle, and came across and read with astonishment a four-page article about Jamison Green, a female to male transgender person and transgender rights activist. He was one of few openly transgender people at the time. In the article, Green described in detail his personal experiences with gender identity and to my surprise they mirrored my own very closely. This was the first time that I understood that there were others who had the same gender identity discordance that I had. It was also the first time that I had heard the word transgender.

The article mentioned the clinic of Don Laub, a Stanford plastic surgeon who was a Bay Area pioneer in helping transgender people. As I started to read more about other transgender people, I realized that I was likely transgender. I made an appointment to be evaluated at his clinic. It was the first time I was able to discuss my gender confusion with anyone. I met with Dr. Laub, as well as with an experienced psychologist who had worked with him for many years. The clinic concluded that I was transgender and offered to help me to transition from female to male.

At that time, transsexuality was still listed as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, a classification of mental disorders published by the American Psychiatric Association. Proponents of this view argued that it was wrong and harmful to help people change their sex. Did I have a mental illness? I did not think so. Moreover, reflecting on my experiences during psychiatry rotations during my neurology training days, my impression was that the incidence of serious mental illness was likely far higher in psychiatrists than in transgender people. So I did not see why they should get to categorize me as mentally ill! Moreover, I had been exposed to a testosterone-like drug during fetal development and my masculinization was consistent with relevant animal and human data.

I felt an irresistible desire to transition from female to male from the moment I was offered that possibility. But I thought about it for several weeks because I was worried about what the repercussions might be for my career. Even though I was already tenured and so did not have to worry about being fired a frequent outcome for transgender people in other professions at the time (in many states, transgender people are still not legally protected from being fired) there was much to consider.

Would new students or postdocs wish to join my lab? Would my colleagues reject me? Would I still be invited to meetings and so forth?

I did not know of any successful transgender scientists, and I worried whether, if I transitioned, I would be able to get any more grants (it was already nearly impossible). Would new students or postdocs wish to join my lab? Would my colleagues reject me? Would I still be invited to meetings and so forth? Reading about the experiences of other folks in other professions who had transitioned, I strongly feared that a transition would end my career. For about a week, I was almost unable to sleep from the stress as I pondered whether I should transition or commit suicide. I finally decided to open up to three friends whose opinion I valued very much: David Corey, Martin Raff, and Louis Reichardt. For the first time, I opened up to them about my gender confusion and told them that I was considering changing sex. Did they think that the repercussions would be so bad that it would harm my career? To my great relief, all three were immediately and strongly supportive. Based on their support, I decided to transition. I sent out the following letter to my colleagues, family, and friends late in December of 1997 to let them know of my gender dysphoria and my decision to transition.

Dear friends,

I am writing to disclose a personal problem that Ive been struggling with for some time. It is important for me to talk about it now in order that I can finally move forward.

Ever since I was a few years old, I have had profound feelings that I was born the wrong sex. As a child I played with boys toys and boys nearly exclusively. As a teenager, I could not wear dresses, shave, wear jewelry, makeup, or anything remotely feminine without extreme discomfort; I watched amazed as all of these things came easily to my sisters. Instead I wanted to wear male clothing, be in the boy scouts, do shop, play sports with the guys, do auto mechanics and so forth. Since childhood, I have been ridiculed and shunned by women and by men. At the age of 17, I learned that I had been born without a uterus or vagina (Mullerian agenesis), and that I had been exposed prenatally to masculinizing hormones. Despite plastic surgical correction of my birth defect, throughout my life I have continued to have intensely strong feelings of non-identity with women. Perhaps most disturbingly I feel that I have the wrong genitals and have had violent thoughts about them. My lack of female identity was brought home vividly to me recently after having bilateral mastectomies for breast cancer. This surgery, rather than being an assault on my female identity as it was for my mother, felt corrective as my breasts never seemed like they should be there anyway; the thought of reconstructive surgery has been repellent to me. Since the surgery, people who do not know me often call me sir, but that doesnt bother me either. It is not that I wish I were male, rather, I feel that I already am.

It would be difficult to describe the mental anguish that this gender confusion has caused me. Although I have never been clinically depressed, it has been the source of strong feelings of worthlessness, intense isolation, hopelessness and self-destructive feelings. I have never been able to talk to anyone about it because I felt so ashamed and embarrassed by it. It seemed that it must be my fault, that somehow I should be able to make myself be a woman. This is how things stood until two months ago, when I read in the newspaper about the existence of a gender clinic at Stanford. They found that I have a condition known as gender dysphoria. To my amazement, I learned that I am not alone and that my story is stereotypical of all of those who have this condition.

So what is gender dysphoria (also known as being transgendered or as gender identity disorder)? Those who have it feel from childhood a strong mismatch between their anatomical sex and their brain sex (gender identity). The cause is unknown but is thought to be biological, as some cases are clearly associated with a history of hormone exposure during development. Although it is not treatable by psychotherapy, the dysphoria is substantially lessened by a change in gender role. Treatment with testosterone induces normal male secondary sexual characteristics within 6 to 12 months. Most patients also opt for mastectomies, which I have already had, and hysterectomy, which nature has already done for me. In my case, testosterone treatment would have the added benefits of substantially lowering my chance of new or recurrent breast cancer, because it lowers estrogen levels, and would block the osteoporosis and menopausal symptoms that will otherwise follow when I have my ovaries removed because of my cancer susceptibility mutation.

After much reflection, I have made the decision to take testosterone. I will thus become a female to male transsexual. This has been a difficult decision because I risk losing everything of importance to me: my reputation, my career, my friends and even my family. Testosterone is a far from perfect solution; Im still not going to be normal and social isolation will undoubtedly continue. But testosterone treatment offers the possibility that for the first time in my life I might feel comfortable with myself and not have to fake who I am anymore. I know that I am making the right decision because whenever I think about changing my gender role, I am flooded with feelings of relief. I will begin taking testosterone in February. A change in my appearance will not be visible for several months. By summer, I will begin to dress in mens clothes and will change my name to Ben. Throughout this process I will continue to work normally and to conduct myself in all ways as usual (except that I will only use single occupancy bathrooms). Although the idea of my changing sex will take some time for you to get used to, the reality is that Im not going to change all that much. Im still going to wear jeans and tee shirts and pretty much be the same person I always have beenits just that I am going to be a lot happier.

Many transsexuals change jobs after their sex change in order to retain anonymity, but anonymity is obviously not an option for menor is it one I desire. I am tired of hiding who I am. More importantly I owe it to others who unknowingly endure this condition, as I did, to be visible. Despite my 7 years of medical training, which I undertook to understand what was wrong with me, until 2 months ago I had never heard of gender dysphoria (oddly I somehow picked the right organ to study!). Had it not been for the transsexual who allowed himself to be the subject of the news piece I read, I would still not know about it. Sure I knew that sometimes there were male to female transsexuals but I had thought that these people were perverts. I am not a pervert; I dont seek pleasureonly relief from pain. Most transsexuals hide because of shame and fear, perpetuating ignorance and oppression about their condition. Their suicide rate is so high that some experts have called gender dysphoria a lethal disease. This is why I cannot hide.

In my heart I feel that I am a good scientist and teacher. I hope that despite my trans sexuality you will allow me to continue with the work that, as you all know, I love. I am happy to answer any questions.

Sincerely,

Barbara A. Barres

Despite support from David, Martin, and Louis, sending out this letter was still very scary. I found that my family was immediately supportive and so were all of my colleagues. I heard back from many of them very quickly. Here is the very first response that I received. It is from Chuck Stevens at Salk, a colleague I had long admired for his science and his wonderfully generous mentorship of so many young scientists).

Dear Barbara,

Thanks for the letter and the personal info. I have always been fond of the person in there and the gender makes zero difference to meI expect you will find the same with all of your friends. Let me know when to change to Ben.

Best regards,

Chuck

All of the other responses I received were similarly supportive. And there it was: this shameful secret I had held inside of me for forty years was out, and within a few months I had transitioned to Ben simply by taking testosterone (mastectomies had already been done, but I did have my ovaries removed soon thereafter as they were a cancer risk because of my BRCA2 mutation; the testosterone prevented menopausal symptoms). My career went on as before without a hitch. I am not aware of a single adverse thing that has happened to me in the past twenty years as a result of my being transgender, but there was the immediate relief of all emotional pain as a result of my transition. Never did I think of suicide again and I felt much happier being myself (Ben), no longer having to pretend to be a woman. It is hard to explain how much relief I felt and how much happier I became. It was as if a huge weight had suddenly been lifted from my shoulders.

I should also say that Stanford as a whole was very supportive, including the provost, dean, and all my faculty colleagues. To be honest, I feared that some of the faculty in my department might be embarrassed by my transition. Back then the internet had only recently come into existence and there was still much ignorance about transsexuality. If they had any qualms they did not mention them and they were all completely supportive even the curmudgeonly clock is ticking guy!

I am not aware of a single adverse thing that has happened to me in the past twenty years as a result of my being transgender, but there was the immediate relief of all emotional pain as a result of my transition.

I would like to think that I eventually accomplished enough to fit in. I was elected to the National Academy of Sciences (NAS) in 2013. I was proud to be the first transgender scientist to be elected to NAS and was upset when the academy president refused to mention this in the NAS press release on the grounds that the academy had to deal with religious people. I was deeply disturbed by this as it denies LGBT people proper attribution for their accomplishments, particularly given the great need of LGBT students to be aware of successful role models. Fortunately other news writers soon mentioned it in pieces about me.

How did taking testosterone affect me? It is powerful stuff! There were some of the expected side effects such as increased sex drive for a while (almost like going through a second puberty) and the development of a male hair pattern. I was delighted to be able to grow a mustache and beard, but less thrilled with the rapid onset hair loss that began almost immediately upon start of testosterone (my photograph shows the extent of these effects). All cellulite quickly disappeared. Fat distribution changed from hips and buttocks to abdomen (but a lot stayed everywhere else too). I became much stronger even without doing any exercise. I had never been able to do a single pushup as Barbara, but after about six months of taking testosterone, I noticed that my triceps were beefing up. To my surprise, I was able to do ten pushups (and soon thirty, although I never really worked at it).

I did not particularly notice any change in mathematical, spatial, or verbal abilities, although I did notice on a test that was given to me before and after testosterone that my verbal abilities seemed a little worse and my spatial abilities seemed a bit improved. I still get lost every time I get in a car. Perhaps the most surprising and unexpected effect, though, was that I largely lost the ability to cry. Before testosterone I cried easily, and often cried myself to sleep because of the gender anguish. But after testosterone I found that I was almost entirely unable to cry any more. In response to some very strongly sad stimulus, perhaps I would shed a tear, but the feeling would almost instantly pass. Many other transgender men have told me this has happened to them also, whereas transgender women gain the ability to cry much more easily.

I hope that kids who are able to transition early will be spared the anguish of growing up in the wrong gender with the wrong body, will be able to have more normal social and romantic interactions, and will not have to keep shameful secrets from their families.

When I transitioned in 1997, it was thought that only one in about 20,000 people were transgender, but now, in 2017, it is thought that at least one in 200 people are transgender. LGBT people are often high achievers. Many LGBT people in my generation share growing up with a shameful secret and consequent low self-esteem. Perhaps this may drive us to work hard to succeed in order to prove our self-worth. Things are changing fast for transgender people. The internet has enabled relevant information to be easily researched and accessed, and the public is now being rapidly educated. TV shows often feature transgender characters, and transgender people can now serve openly in the military. There are still some battles being fought, such as gaining protection from being fired for being transgender, as well as bathroom protections, but the public is mostly sympathetic to and supportive of LGBT people, so I believe these battles will soon be won.

Most important, clinics are popping up to help trans children. As a result of public education, trans kids often self-identify, or are identified by their parents, even at grade school age. As they approach puberty, if their transgender identity persists, these kids can be treated with puberty blockers so they do not undergo permanent bodily changes inconsistent with their gender identity. Then when they are of age, at about sixteen years old, they can make the decision about whether they wish to transition. Up to now at least 40 percent of transgender people attempt suicide. I hope that kids who are able to transition early will be spared the anguish of growing up in the wrong gender with the wrong body, will be able to have more normal social and romantic interactions, and will not have to keep shameful secrets from their families. How I envy them!

I am happy to be an openly transgender scientist and to serve as a role model for young LGBT scientists. I hope that I have helped ease their way a little bit. LGBT students and postdocs at Stanford and other institutions frequently contact me to discuss whether or not to be open in their applications to various training programs. I always counsel them to be open about who they are, as it seems to me that currently the advantages far outweigh the risks. The vast majority of academics are highly supportive. It is very difficult to live life in a closet. It does not make sense to do this because of an occasional bigot. I have yet to have anyone tell me they regretted their decision to be open.

Ben Barres (19542017) was Professor and Chair of the Department of Neurology at Stanford University and one of the worlds leading researchers on the role of the brain cells known as glia. This article is excerpted from his book The Autobiography of a Transgender Scientist.

Read the rest here:
The Coming Out of a Transgender Scientist - The MIT Press Reader

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