BEIRUT: From a young age, Lore knew that the body he was born with didn’t align with how he felt inside. His birth records categorize him as female, but growing up, he felt at odds with the pink decor of his bedroom and the way that family urged him to act feminine. He felt pressure to conform and hide his feelings.
Lore, now in his early 20s, is a Lebanese trans man. “I knew I was a boy the day I drew my very first well-endowed stick figure,” he writes in a blog entry on Sept. 30, 2014.
Notions of gender are often hardwired and difficult to change, as is the human impulse to categorize people as either male or female. “People want to continue living with their neat little boxes, where they can shove you in once they are done figuring you out,” Lore told The Daily Star, “when you don’t get shoved into a box, when you fall in the cracks, you either become too visible, or you become invisible. “
Lore’s words resonate with accounts of other transgender individuals. While each lived experience is different, a common theme threads through: the desire to be understood and accepted without being categorized.
The transgender experience is typified by feelings of incongruence, and sometimes unease, with the gender assigned at birth.
Trans individuals in Lebanon endure difficulties in navigating the law and receiving health care. Doctors and advocates say that biases and discrimination toward those who identify as lesbian, gay, bisexual and transgender (LGBT) still exist in the medical community. A 2014 study on LGBT health found that meeting the community’s needs remains a challenge, due to social stigma and some physicians’ unwillingness to provide service.
A March 4 seminar held by the American University of Beirut, entitled, “The Journey from Gender Dysphoria to Gender Euphoria,” shed light on important research on the transgender experience. Senior lecturer of health promotion and community health at AUB, Faysal El Kak, led the discussion, and spoke of updates in the field which hold important implications for the Lebanese medical community’s treatment of the transgender people.
Speaking of the Lebanese health care context, Kak told The Daily Star that practitioners shouldn’t project their cultural beliefs on their approach to treatment. Nonetheless, he explained, “some health care professionals might feel uncomfortable dealing with situations that are nonconforming or embody certain sexual attitudes and behaviors. Other times, health care professionals might lack the necessary skill and capacity to deal with sensitive cases and sensitive issues due to lack of training or prejudice.”
In 2013, the “Diagnostic and Statistical Manual of Mental Disorder” released its fifth edition (“DSM-5”), which replaced the previously used term, gender identity disorder, with gender dysphoria, meaning a state of unease or dissatisfaction. This was a progressive step, Kak said, as “it moved the thinking and arguments [on trans people] from a pathology or disorder to diversity, which is a positive approach that will impact research, advocacy and services.”
As explained in a 2015 study exploring the legal situation for transgender people in Beirut, identification as one is not “specifically criminalized” by the law. Further, those who have “fully” transitioned through surgery and hormones may update their identification to reflect their chosen gender and name. However, financial limitations and health risks may present barriers to a full transition.
According to the study, transgender people are required to “start and complete sex-reassignment surgeries in order to be eligible to change their identification papers and vital records.” However, Kak said that a court order is necessary for gender reassignment, which requires supporting documents from two specialized physicians – something that isn’t always feasible.
Cynthia El-Khoury, program coordinator of Marsa Sexual Health Center, said that some doctors still view transgenderism as a disorder, despite the “DSM-5” updates.
As for roadblocks in the legal system, Khoury explained that, when judges ask for medical expertise during the transition process and correction of identification documents, many doctors don’t want to provide expert opinion for these cases.
“They are not willing to advise judges because of their own value system or simply because they lack information regarding [transgender] issues, which delays the final step in the process of the transition.”
In the seminar, Kak told the audience that a growing body of research underlines the need to recognize a range of gender identities, particularly in medical settings, which still categorize patients as either male or female. He also pointed to studies that demonstrate the variety among transgender experiences. “A lot of individuals with gender incongruence might experience an incomplete cross-gender identity. Sometimes, they don’t want hormone therapy, they don’t want surgery,” Kak said.
Research on transgenderism has tried to determine psychological, environmental and biological causes, but evidence remains varied and inconsistent. Kak explained the findings of a highly cited study from 1995, that proposed a neurobiological basis for transgenderism by showing a “female brain structure” in male-to-female trans people.
Some are wary of concluding that brain-structure differences explain feelings of gender incongruence, but Kak said that the neurobiological theory was “the most solid in showing evidence related to brain sexual differentiation.”
It has been two years since Lore came across the label “transgender,” which helped to make sense of how he’d felt for so long.
“It all fell into place that I had been feeling this way since I was a child. I just thought I was a freak, I thought I was weird. When I finally found the term transgender and I started reading up on trans men ... it all sort of clicked. I felt so relieved.”
Lore has not yet explicitly told his family, for fear of disownment. He has, however, transitioned to presenting himself as a male, which he described as “a very observable shift.” He cut his hair short, practiced deepening his voice and began clothes shopping in the men’s section. He also began binding his chest to reduce the appearance of breasts.
Lore said that he is not currently seeking hormone therapy or surgery, but acknowledged that these procedures typically give people greater comfort with their bodies, and enable them to pass in public with less harassment. Lore emphasized that trans individuals shouldn’t need to justify their identities through hormones and surgery.
“I don’t want to have to do this for the sake of other people,” he said.
Over time, Lore has grown more comfortable with his identity, and he closely follows academic research on gender studies. He critiqued the way that some medical studies have treated transgenderism as an abnormality, and stressed the need for research to question cisgenderism as the accepted norm. Cisgenderism refers to those who are comfortable with the gender they were assigned at birth.
Lore also expressed concern over studies that try to explain gender identity through biology or genetics, as he feared that findings overlook the aspect of individual choice.
“I don’t want to have my whole identity reduced to my genetic composition, or my molecular make up, or whatever it is that allows people to make more sense of me,” he said.
People “want to justify my identity genetically so that I am not held personally responsible for who I am, but whether or not that is the case, I don’t care, my agency is my own.”
