QUESTION: I am 24 years old. I was born in Iran with partial androgen insensitivity syndrome (PAIS) although it was not diagnosed at first. My genitals were male but very tiny with a penis that resembled more an enlarged clitoris than a proper penis. I was assigned as male and brought up by my parents as a boy. When I hit puberty around the age of 12-13, my body did not respond at all to the male hormones and instead reacted to the female hormones the testis secreted. I developed a wider pelvis, rounded buttocks and the appearance of breasts. My voice did not break and neither did I grow any any facial hair. My penis shrunk to almost nothing but a very sensitive opening above my small testis. I also got a very feminine face. All of this caused me intense embarrassment such that I was unable to show my face in public as a boy.
I grew very depressed as a result of this and attempted suicide twice. I still thought of myself mentally as a boy and the idea of being a girl in the future distressed me quite a lot. My parents approached several doctors who all recommended that I have my gender reassigned as female since it would be impossible for me to lead a healthy sex life in the future as a man. So my parents decided to send me away to live with my aunt who would teach me how to dress and behave as a lady and allow me to start afresh as a girl without any of our close acquaintances and relatives knowing that I was transitioning. So at the age of 14 I went to live with my aunt in rural Iran far away from where I grew up in Teheran. There she introduced me to feminine mannerisms and clothing and behavior. I found that female clothing appeared more palatable to me than I had once imagined. I enjoyed the feeling of wearing a skirt and feeling the wind rush underneath or the silky soft undergarments. I even enjoyed the restriction of the chador which all girls have to wear in public. This continued for several years. I even completed my education as a girl and four years ago went with my aunt to stay in Australia to avoid the reach of the authorities since in Iran even though sex change operations are legal it is illegal to live as inter-sex.
Around three years ago I met a wonderful man with whom I began my first sexual relationship. He was fine with me being inter-sex and we have anal intercourse instead of peno-vaginal sex. My problem is that although all my friends and family now refer to me as a girl I see myself as being a boy in girls clothes. I think am probably bisexual and would have begun a normal heterosexual relationship if I had developed as a normal male. My boyfriend is not gay. He doesn't see our relationship as a homosexual relationship but as a normal heterosexual relationship. He is patiently waiting for me to have my sex change surgery. Except for my genitals I am almost entirely female. I can even wear a bikini and no one notices that I am inter-sex. I am really apprehensive about genital surgery and the consequences of losing my testis. Is it possible to retain the testis during the construction of an artificial vagina? I know that my boyfriend wishes to marry me and adopt kids to begin a family. Is it possible to lead a double life, appearing as a woman to everyone in the world even my own husband even though I am a boy inside who just loves feminine clothing and has a boyfriend because he is bisexual? I don't even know what I am. I am not a girl but neither am I a boy. Can you advice me on what I should do?
Thank you very much for your question. I have to admit I needed to educate myself a bit on some of the terms you mentioned. Due to the political situation for the past 30 or so years between Iran and the U.S. there hasn't been much sharing of culture between the two nations so I've never heard the term "Chador" until today. In the states we would most likely refer to that as a "Burka" but now that I've read up on it I see they are different. I've never had the pleasure to travel outside of the United States and some of the customs in Iran and other Muslim dominated countries I'm not familiar with. However I do know most of the middle east is very male dominate and women are given 2nd, and sometime 3rd class, citizen status. I cant say I truly understand all your struggles as I'm not inter-sexed, but I can say I appreciate them and will offer you the best answer I can.
Some of the things you asked are outside of my expertise. I'm not a doctor and anything regarding surgery would have to be deferred to a medical professional. However I do know a bit about the various forms of AIS and I've known 2 people who have the condition. One was partial and the other was complete. Both were beautiful ladies and I considered it an honor to know them.
Just so we are on the same page I want to make sure my understanding of AIS is correct. If I'm wrong in any part of this let me know. Basically the person with AIS is in essence allergic to androgens that cause the male body to develop. Thus testosterone is changed to estrogen and the body responds to it as a biological female would. However the person does not have ovaries or a female reproductive system. Testis are usually present and can be either inside the body cavity or outside in the scrotum. The people with this condition are usually infertile but some with very mild cases may be able to father a child. If any part of this is wrong feel free to correct me.
Now to get to the underling question.....
You seem to be very scared about having a sex change or (genital reassignment surgery) I can totally understand. When you were born you were born different. Not wrong just different. At the time we enter the world the doctors look at us and say "Boy" or "Girl". Society has a very binary view of gender however as you are very aware not everyone of us fits into those categories. Some of us are a bit of both and others are just born into the wrong body. Transgenderism is a universal human condition. It occurs in every culture across all of time. There is not a single place in the world where there is not documented cases of people with what is now considered to be transgender in some form or another. However those born different are expected to conform to society for the greater good. Even here in the United States it was considered a standard practice when a baby was born with "dis-ambiguous" genitals to declare the child to be a girl and then perform "corrective" surgery as soon as possible. Usually within a few days or weeks of birth. If it was discovered the "girl" did not have ovaries she was to be given estrogen and other hormones as soon as she came of age to begin a female puberty. Often the "girl" wasn't even told why she was different or would not be able to have a baby until she was an adult. It wasn't until the 1980's when DNA testing became available and affordable that doctors began taking a 2nd look at this practice and deciding to allow the parents and the child to make that decision when the time was right. Personally I think you were fortunate that your genitals were "male enough" to prevent this procedure happening to you. You were able to grow and develop and now decide for yourself what is right and what is not. The people I've met and have read about who have had the decision made for them were very unhappy later in life. Usually raised as girls, their minds are male and began living as a male. Some find it very difficult to be a woman and accept traditional female roles. Some transitioned back to being male. Some kept their female persona but preferred a "lesbian" lifestyle. Others have had "corrective" surgery to go back to being what they were before they were surgically changed.
As I said, you were born different, not wrong. Although your body may not fit into the male or female norm, it is your body and there is nothing wrong with the body you have. I don't know if you believe in a higher being but if you do you can say that you were made the way you are for a reason. It seems like you are being forced to make a decision to please someone other than yourself. (i.e. family, boyfriend, society, etc.) It's your body and you need to do with it what you want!!!!.... If you don't want to loose your testes than I hope you have the balls to stand up and tell everyone you are going to keep them!!!!... If your boyfriend is expecting you to do this ask him what he would do if you never had the surgery? If he says he expects you to than I wouldn't want him as a partner... After all he should love you for who and what you are, not just societies expectations for your body.
Can you live a double life? I don't know if you need to live a double life. How often do people go around with their genitals on display? Other than a nude beach or a nudist colony I cant think of any. As you are in Australia now you are not required to follow the strict Muslim code for female attire. You can appear as you want when you want. If you enjoy female attire than enjoy it. If people assume you are female than why let it bother you. It's none of their business what you have down there. If someone was to notice something different about you or was to ask then you can tell them you have P.A.I.S. and educate them on the condition. Most people have never heard of it and don't even know it exist. I don't think you have to hide your situation but you don't have to advertise it either. As you are only 24, your still very young and you have a very long life to live. I would hate to see you regret doing something at this point in time that could impact you for the next 60 to 70 years.
I'm not telling you not to have the surgery, I'm just saying if you want it it needs to be 100% your choice and not from an outside pressure to take this step. It is an irreversible procedure after all. I would speak to a doctor and a psychologist before you do anything and get real professional medical advice. If you would like to continue this conversation I would love to hear more from what you have decided to do and where you want your life to go... Just respond or send me an e-mail at firstname.lastname@example.org
I hope this helps
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QUESTION: Thank you for your prompt reply. You are mostly right about AIS. AIS occurs when the cells in the body do not respond to the male hormones but the person is otherwise biologically male. The result of this is incomplete masculinization of the male genitals at birth and an inability to develop male secondary sexual characteristics at puberty. The testosterone is converted to estrogen in a process called as aromatization that results in the development of very normal female secondary sexual characteristics as happened in my case. There was a period in which I went from having a body of an average sized boy to having small breasts and rounded buttocks in only a couple of years.
What I meant by a double life is that I identify more with being male psychologically, so that is the main reason I am hesitating to have surgery that will lose my testis and committing myself to a life with a man where I will have to keep up the pretense that I am mentally a woman for the rest of my life. I was raised male. It's very difficult for me to shift to a new gender even though I have been trying to do so for the last 10 years. I didn't choose for my body to develop in this way. I am attracted to men since I am bisexual not because I am a heterosexual woman. I am comfortable dressing as a woman and appearing as a woman to the outside world, because I enjoy wearing women's clothing not because I am a woman.
This doesn't mean I want to go back to being a boy simply because it would lead to too many upheavals in my life. Both me and my boyfriend are practicing Muslims and I dress modestly as a woman should. I do hope to one day go back to Iran which my boyfriend has agreed to do once I have my surgery. Sometimes I wish I could simply do it and get over with it and have a vagina like all women do but I am scared to lose my last vestige of a male. You have to understand that since I am a Muslim it is simply not permissible for me to stay as inter-sex. We can either be male or female not anything else.
One thing I would really appreciate is if you can find out whether it is compulsory to remove the testis during the creation of an artificial vagina. I have looked all over the internet and nowhere is it said that the testis are preserved during an SRS. But most of those who went through SRS were non AIS men. There is precious little information on PAIS men who underwent a similar procedure. I am thinking that since the testicles actually preserve the female body shape by secreting hormones that are converted to female hormones there should be a strong imperative to preserve them. I wonder if because I have small testis, can they be accommodated within my body itself or is it an impossibility?
I don't think I can really answer your question. Everything I have read about and from speaking to post op TG's is that the testicles and scrotum have to be removed. The location of the vaginal opening is where the scrotum is located. I've never heard of someone being able to keep them but all TG's I've spoken with wanted the full SRS. However to have your testis relocated into the body cavity may be possible. I just don't know. You would need to speak to a physician who knows much more about the procedure than I.
Trans-women have to take hormones to feminize their body. Even after SRS they must continue to take them for the rest of their life. If you have your testis removed you will have to begin HRT (Hormone Replacement Therapy). So it may be better for you not to have them removed as you stated, your body is converting the testosterone to estrogen naturally. Your case is very unique and would require a very unique procedure. It may be the first of it's kind. I just don't know or have the answer you seek... Believe me I wish I did.