For readers bewildered by how to make sense of gender today, a new book by sociologist Arlene Stein, "Unbound: Transgender Men and the Remaking of Identity," recently published by Pantheon Books, follows the journey of four patients: Ben, Parker, Lucas, and Nadia as they prepare to receive surgery to masculinize their chests on the same day in the Florida clinic of Dr. Charles Garramone, a specialist in this field.
The four patients, and more than a hundred others, opened up to Stein about how they conceived their identities and sexuality, how they decided to transition, the impact on their families and communities, and the challenges they faced post-transition.
Stein explores the internal experience of gender identity, its fluidity, and the lived reality of transgender men, focusing primarily on younger transgender people as they question society's assumptions about what it means to be men and women, to view gender as a matter of choice rather than something fixed at birth.
Having received rave reviews, for those wanting to learn more about transgender people, especially as their issues continue to make news, "Unbound" serves as a useful primer, including a glossary of new transgender terms.
Stein, 49, identifies as a lesbian and is a professor of sociology at Rutgers University. She's also the director of the Institute for Research on Women. She agreed to be interviewed by the Bay Area Reporter via email.
Stein was asked what led her to studying trans men.
"A few years ago, a friend of mine told me about a doctor who performed top surgeries - chest masculinization - in Florida, and about the long line of young transmasculine people in his office," she wrote in the email. "I am a sociologist who has studied gender and sexuality for 25 years, but I didn't really have a way of understanding the scene in the doctor's office. So, I went down there to find out more.
"I wanted to hear the stories of some of those who were seeking out top surgery, and those close to them, including their friends, significant others, and family members," she added.
Stein had seen Ben's crowdfunding page online and had contacted him. Ben never identified as a woman and having large breasts he struggled continually with body image. Having a supportive family, he started taking hormones and eventually decided to undergo top surgery. He immediately agreed to let Stein follow him during this surgery week and for a year afterward.
"His openness and interest made the whole project possible," she wrote.
Stein was intent in correcting misconceptions that both LGBT and straight people have about transgender men.
"The first misconception many of us have is that transgender men barely exist," she wrote. "In actuality, there have long been female-assigned individuals who have identified as male - but they have not had access to body modifications until fairly recently.
"Another popular misconception, derived from early medical narratives, is that transgender men are 'men trapped in women's bodies.' While some transgender men describe themselves in these terms, the range of transgender experience is much broader than this, as the millennials I interviewed showed me. I'm not sure that female-to-male transitions are more common today than male-to-female ones, but the population of transgender men is certainly growing at a faster pace than that of trans women," she added. "That's because it had been suppressed until fairly recently."
Stein said today's trans men have greater access to knowledge about transitioning, mostly thanks to the internet.
"The lesbian subcultures of my youth are also on somewhat more precarious ground; as we know, the last lesbian bar in San Francisco (and other cities) has recently closed. Many individuals who may have identified in the past as butch lesbians are today seeking out body modifications - because they can," she wrote. "The fact that the lesbian bar communities which once provided a refuge for masculine females are somewhat more difficult to access today may also be a factor leading to the rise of transmasculine identities."
Many transgender men have top surgery but not bottom surgery.
"Phalloplasty is extremely expensive and often surgically risky," Stein wrote. "Some transgender men would sign up for it if that weren't the case. Currently, only a miniscule percentage of transmale-identified individuals undergo bottom surgery. It's a practical decision, in part. But many younger transgender men also have a more expansive understanding of gender: they believe they can be men and retain their 'original plumbing.'
"Many transgender men decide to modify their bodies as a way of aligning their bodies with their sense of self, or identity," she added.
"Those who seek to 'fully' transition and present themselves in the world as men must figure out what that means - which is often a complicated process. What makes a man a man? The answer to that question is not simple or straightforward. That means that gender transitions are never simply a medical 'fix.'"
Some of Stein's subjects had some ambivalence about masculinity, especially the toxic variety in this #MeToo period, yet they decided to embrace their maleness.
"Three of my subjects identify as transgender men; a fourth identifies as a butch lesbian. They had all been shaped by feminist ideas: they recognize that men continue to hold the upper hand in many aspects of society," Stein wrote. "Today, as we know, the occupant of the White House is an unapologetic sexual harasser. The transgender men I profile seem acutely aware of the fact that they are embracing their masculinity at a time when masculinity can be particularly fraught."
But there are still advantages of male privilege. Stein writes in her book, "Two-thirds of the individuals interviewed, some of whom were open as trans men on the job while others were stealth, reported that becoming men led to increases in workplace authority, a perception of competence, and more rewards and recognition for their hard work, including higher salaries."
Concepts challenged
Even long-accepted concepts in the transgender field are being challenged, such as gender dysphoria, Stein said.
"Many, but not all, of the individuals I interviewed embrace the medicalized term 'dysphoria' as a way of making sense of their lives and gaining access to body modifications. (Hormones, on the other hand, are increasingly available these days without a formal diagnosis.) The word 'dysphoria' speaks to a sense of distress that some experience growing up in this society as masculine individuals who have been given female gender assignments," Stein wrote.
"To access surgery, and to gain the support of their families, many use the term 'dysphoria,' especially if they are undergoing 'full' gender transitions. I think gender fluid individuals are less likely to identify with this term," she added.
Gender fluid, or genderqueer, is defined by Stein as "identities that signal a critical stance toward the gender binary, as well as a gender presentation that lies outside the categories of male and female; also referred to as nonbinary."
Stein profiles the work of writer and activist Leo Caldwell, who has developed a cube model of gender, representing it three-dimensionally.
"Each side of the cube represents a different axis of gender; a self identity (how you feel when you are alone), axis (x); a social identity (the way one is perceived at work, home, or among friends), axis (y); and a cultural identity (how a stranger sees you), axis (z)," wrote Stein.
Each axis, she explained, "is visualized as a spectrum: masculinity on one side, femininity on the other with the exact middle as gender-neutral. Thus, Caldwell defines himself as 3Xm, 2Yf, 3Zm."
Stein summarized the importance of Caldwell's work as suggesting that gender is both highly subjective and also socially embedded.
"How we feel, how we experience our 'authentic' selves, is never simply a matter of 'who we are,'" Stein wrote. "We make sense of our embodied desires and feelings in relation to the messages others give us about our bodies, the categories societies create to order those bodies, and the ways we make sense of ourselves in relation to those categories."
Understanding Caldwell's model, it is not hard to see why Facebook recognizes 56 custom gender options. At a trans health conference Stein attended, she noted how there are even more categories to choose from, "that our gender identity is so deeply personal that the only thing each of us can say for sure is that we alone possess it."
While many younger transgender people see gender as a choice, rather than something assigned biologically at birth, Stein doesn't think it is entirely correct to say that gender is "chosen."
"There are elements of gender that are chosen and others which are not chosen at all," she wrote. "Many people think of their gender as just 'how they are.' But the act of modifying one's gendered body, and claim a non-normative gender identity (as trans, queer, gender-nonconforming, and so forth) is certainly a choice, at least in part."
This choice component, Stein believes, may account for the right wing's antipathy to transgender people.
"Collectively, the right stands for the reinforcement of racial, ethnic, class, gender, and sexual hierarchies and the belief that those hierarchies are natural and/or God-given," Stein wrote. "The existence of transgender people is threatening to them because it suggests that many aspects of who we are as individuals aren't really fixed at all. The rise of LGBT people, which challenges the belief that our gender, our sexuality, and, indeed, our identities, are fixed at birth, is a continuation of that long movement toward personal autonomy. It declares that individuals should have the capacity to invent ourselves and make our own choices. That is precisely what is so unsettling to those who oppose transgender rights.
"Movements for social justice, on the other hand, have long been organized around the idea of individual and collective self-determination," she added. "I hope the transgender movement, and the gay/lesbian movement with which it is now allied, continues to think imaginatively, offering alternatives that go beyond simplistic 'born this way' arguments."
Trump unraveling protections
Stein was clear that President Donald Trump is unraveling policies that have expanded rights for trans people.
"Trump is trying to undo everything President Obama did to protect the rights of vulnerable populations in this country and to expand access to medical care and other essential services they need," Stein wrote.
"Transgender people are among the populations who are threatened by this administration, though of course they're not alone," she continued. "Many transgender people, who were becoming more visible during the past 10 years, have been pushed further underground by Trump's policies, and by the culture of bullying he champions."
However, Stein sees a saving grace in Facebook and Twitter.
"Social media plays an enormously important role in the mobilization of transgender people - it has helped them to find one another, gain access to knowledge about how to live, and how to transition if they wish," she wrote. "Older trans people were much more likely to create face-to-face communities in major cities. Younger people have the capacity to create virtual communities in the places of origin - and even find others like themselves while still living under their parents' roof."
And this new technology can aid in mobilizing and resisting Trumpian bigotry, including trying to repeal the Affordable Care Act, which made it illegal for health insurance companies to refuse coverage to patients with pre-existing conditions, including gender dysphoria, thus threatening the well-being of transgender people.
Stein is honest in writing how her encounter with her four subjects and the research she did for her book challenged her own beliefs about gender.
"We baby boom feminists saw gender as something that could be tamped down and minimized. Our goal was to create a society in which gender distinctions would play little, or no, role," she wrote. "This generation, in contrast, is claiming gender as a source of personal meaning and as a key aspect of identity. It's a bit mind-boggling to some of us older feminists and queers. Many of us are trying to play catch-up. I hope that my book helps to play a role in helping general audiences understand the brave new world of gender politics. Gender doesn't come in only two flavors - there's a lot that is in between male and female."