While many University students spent Thanksgiving with family and friends, University student Audrey spent her Thanksgiving alone in Arizona. Nine days and $17,000 later, she came back to the University to tackle the end of the semester.

After years of struggling with an identity that did not align with her biological gender, Audrey, who was born male and did not want her real name used, returned to the University as a woman. She spent her time in Arizona having and recovering from gender reassignment surgery.

“A lot of people don’t understand that it’s a matter of life and death,” she said about getting the surgery. “When your identity is completely screwed up, it becomes more and more difficult to live with yourself.”

Before her surgery, she said she felt embarrassed and ashamed of her biologically male gender.

“What I’ve got right now is pretty disgusting, and it feels like I can take myself more seriously as a girl,” she said.

Living with a physical identity that was completely wrong for her was a terrible burden, she said. The transgender community has seen a high rate of suicide because of that burden, she said.

After years of bearing the burden, it became too much. Audrey said she became exhausted with her self-hatred. She entered therapy and decided to transition, or start living as a woman, during her sophomore year at the University.

The transition road

Audrey said that she realized her biological gender did not match her identity while paying attention to a biology class in middle school. She was 13 years old. The class discussion focused on hormones, and Audrey learned that men who take female hormones can acquire some female traits, such as breasts.

While other students found the information uncomfortable, Audrey said, she found it enthralling. She said it summed up the odd feelings she couldn’t place.

“I was like, ‘I want to be a girl,’ ” she said. “I envied any girl that passed me, and the possibility of being a girl made me thrilled and happy.”

Audrey said that she originally wanted to transition when she started attending the University but did not do so until her sophomore year. Although most of her classmates do not know about her transition, she said, more people know about it than she would like.

Her transition also became a point of contention with her family, she said.

“They freaked out completely,” she said. “It was one of those things we didn’t talk about for a long time.”

She said the lack of family support saddens her.

“I’d like to be recognized as who I am with my family,” she said. “But we’ve reached this point where we’re at a happy medium, where everyone’s not freaking out anymore.”

The stereotypes about transgender people are not entirely perpetuated by straight people. Audrey said people of other sexual orientations also stigmatize transgender people.

“Transpeople are in the ghetto,” she said. “In-between genders are basically stepped on by the gay community and ignored. It’s almost like we’re nonentities, and it’s really sad.”

She said people do not understand the self-hatred and anger transgender people encounter.

“I’m just trying to be me, and people don’t get it,” she said.

Audrey said that after her transition, she no longer identified as a transgender person. Instead, she now identifies as a woman.

As part of her transition, Audrey started hormone therapy. Although she did not notice immediate physical changes, she said, it completely altered her emotional state.

“I was a really sour person before I transitioned,” she said.

After transitioning, she said, she became more content and was able to express her emotions better. Physically, her skin became softer and she began to develop breasts and a more “feminine” shape, she said.

After starting hormone therapy, Audrey worked toward the next phase of her transition. She said her insurance company would not cover any medical procedures, because it considered the changes cosmetic.

“At first, I didn’t think I would be able to afford it,” she said. “If you go to the best (surgeons), it can run over $20,000. It’s extremely expensive.”

Audrey said only 5 percent of transgender people can have gender reassignment surgery because of the cost.

But she worked, saved and obtained loans to accumulate the $17,000 she needed to have gender reassignment surgery this fall.

She did, however, have some reservations. She said she was scared of hemorrhaging and dying on the operating table. But she said she found support in her partner, her friends and her journal.

Despite the presurgery anxiety, the benefits outweighed the risks for Audrey. One important aspect of having the surgery was the ability to change government documents. Postoperation, she could finally change her gender on documents such as her driver’s license, Social Security card, birth certificate and passport.

“It will be much less embarrassing if I get pulled over for a speeding ticket or I’m trying to get a job,” she said.

But Audrey said that in the future, she would not be surprised if states or Congress pass bills against getting government documents amended and making it impossible for transgender people to function in society.

Despite the weight of societal and personal factors, she said the impact of her decision did not hit her on the plane ride. It hit her the day before the surgery, when she was not allowed to eat. That fear returned the day of the surgery, she said.

“When they were prepping me with the I.V., I had the urge to bolt because I was nervous about the surgery,” she said. “But the next thing I knew, I was waking up.”

A clinical perspective

A candidate for gender reassignment surgery should be stable, have a long history of being uncomfortable with his or her biological gender and be prepared for the social consequences of changing genders, said Walter Bockting, the University’s Program in Human Sexuality Transgender Services coordinator.

It is common for transgender people to suffer from anxiety or depression, said Bockting, who is also a professor in the University’s Medical School.

Rejection from family, friends or the social stigma associated with transgender people can fuel such depression.

“Our society does not always understand or accept transgender people,” he said.

Bockting’s office provides services such as therapy, support for social transitions, coming out to family and facilitating transitions on the job.

He said the office offers hormone therapy but does not have a surgeon on staff. But he said some surgeons at the University have performed the surgery.

To get medical intervention, such as hormone therapy or gender reassignment surgery, Bockting said, a person must first be diagnosed with gender identity disorder.

“It is considered a disorder when people are experiencing clinically significant distress because of their gender conflict,” Bockting said. “Once they are no longer experiencing distress, they no longer meet the criteria for this disorder.”

He said diagnosing a person with gender identity disorder is controversial, because it classifies transgender people as having a mental disorder. Homosexuality was also considered a mental disorder until the 1970s, he said.

But Bockting said the difference between homosexuality and being transgender is that transgender people might need medical intervention, while homosexual people do not.

“(Transgender people) only have access to (medical intervention) in the current health-care system when the diagnosis justifies the treatment,” he said.

The gender spectrum

Owen Marciano, the assistant director of the Gay, Lesbian, Bisexual, Transgender Programs Office, said that there is nothing psychologically wrong with people because they identify with genders different from the ones assigned to them at birth.

“I think our culture and society relies on this binary of male and female in terms of categorizing people’s bodies,” he said. “It’s really a social expectation, not a psychological disorder.”

Marciano said gender is not static; it changes. For example, in the 1950s, women did not wear pants to work, but today, that social expectation has changed.

“Transgender” is considered an umbrella term that encompasses millions of individual identities, he said.

Gender is a spectrum with men and women on opposite ends, Marciano said. People might fall anywhere on that spectrum or might not fall on the spectrum, he said.

“Anyone who doesn’t fit in that (binary) structure, we’re calling them problematic instead of calling the structure problematic,” he said.

Marciano said how people define their genders depends on what they feel comfortable with and the language they use to describe themselves.

Peace of mind

When Audrey first awoke after her surgery, she glanced at the clock. It was 1:20 p.m.,

and her surgery had started at 7:45 a.m. Tubes encircled her body, but she was not afraid, she said.

Bedridden for two days, she sustained herself with ice cream, “Star Trek” and other movies. The pain was endurable, but she was sore. She spoke to her partner every day. Nine days after her surgery, she was released.

Audrey said she came back to the University to face the world with a new sense of tranquility. Aside from the stress of finals and papers, she said, she feels peaceful and happy.

“I’m really glad I got it done now,” she said. “I feel like I can live my life now. It isn’t hanging over me anymore, and it feels so good.”

Audrey said she was realistic about the procedure and did not expect her issues to be “cured.” But she said she has never been so content with herself until now, and she feels empowered to live her life.

“I didn’t expect it to change my entire frame of mind,” she said.

Audrey said she is confident that once she graduates, she will be able to live without the dread that someone will unearth her past. But she said that dread will always tug at the back of her mind.