Impacts of Race and Class

Image of Aiden facing the camera Though it is not immediately clear here, race and class are possible factors in how trans men may approach their transition: most of the videos in this essay were made by white men; most also appear to be solidly middle class if not upper class, though that is notoriously hard to read, even with the greater number of cues available in video.

There's probably one good reason for the number of white men I've archived: this surgery and T itself is expensive. As with other LGB communities, transmen (and women) may face more difficult access to health care in general. As Lea Mollon has noted:

Research has linked discrimination to a higher incidence of substance abuse, suicide and suicidal ideation, psychiatric disorders, and limited health-seeking behavior. Social stigma and negative stereotypes have been linked with frequent experiences of violence and victimization against LGBT people. In 2008, more than 2,400 LGBT people were victims of hate crimes due to their perceived sexual orientation and gender identity▀[. . . .]
In addition to higher rates of violence, LGBT people also bear the chronic stress associated with systemic discrimination and barriers to access of necessary health services. It is estimated that the ratio of uninsured gay and lesbian adults to heterosexuals in America is two to one.6 Lack of legal recognition of same-sex relationships prevents coverage of same-sex partners under some employee health plans. Coupled with lack of support for alternative family structures, LGBT people and their families are more likely to be without health insurance coverage. They may therefore be financially limited in receiving basic, preventive care services.

Of course, the social construction of gender does not rely upon economics. Some prominent FTM activists have cogently argued (as does Charles in his many videos) that the transgendered condition transcends practices such as surgery or T-use, that people can be quite happily and successfully transgendered without any use of any aids such as T or surgery at all.

But still—it's easier for some FTMs to get good access to medical care, because of their demographic position. As Annette Gardner and James G. Kahn note,

Obtaining regular health care is a problem for many Americans, with some populations experiencing greater barriers than others: among those facing the most daunting barriers are people who lack insurance, minorities, particularly Hispanics and African Americans, and, low-income populations. There are many barriers to receiving timely and appropriate health care, including linguistic, cultural, racial, ethnic, geographic, and organizational factors. Some of these barriers (such as financial barriers or chronic illness) are at the patient level, while others reflect the structure of the U.S. health care system (a complex insurance marketplace and uneven distribution of services). Lack of insurance coverage strongly correlates with reduced access to health care.
Such access to tied to many factors, as noted above; one of the largest factors, at least in the U.S. is poverty, which may well preclude both T-therapy and surgery, too often seen as elective. It is certainly expensive for self-payers. The National Center for Transgender Equality (located in the United States points out that "Medical costs are high and are often not covered by insurance. The majority of transgender people cannot afford to pay these costs out of pocket." (5). As with all medical treatments, poor people and people of color are(in most countries) less likely to have access to T and to surgery.

Access is complicated by geographic location. At least two of the men presented here are Canadian—at the time the videos were made, most of Canadian provinces provided Sex Reassignment Surgery (SRS) to transgendered individuals. It was possible, therefore, for most young Canadian FTMs to get doctors to prescribe T and the therapy necessary to proceed to surgery. This is currently in flux, but at this moment in 2013, 94% of Canadians in seven provinces have access to SRS and hormone therapy.

The diaries of FTMs from other countries than Canada, the UK and the US (such as Romania or the Czech Republic, for instance), are very different documents—full of the need to pass and not to reveal one's transgendered status for fear of getting beat up or even killed. I don't know of any formerly Eastern bloc FTM who is on T unless he moved to one of the countries listed above. T is just not an option.