To add subtlety to your thoughts, there is some evidence that I suffer either from androgen insensitivity syndrome (AIS) or reduced androgen production. I have petite hands and feet in spite of my height (6’2”). If pictures of my appendages were put in a line up with those of cis women, no one would pick me out as male. I have an ectomorphic body shape (tall and slender) and lack the square jaw and prominent brow ridge anthropologists typically use to identify skeletal remains as male. I lack a prominent Adam’s apple. When my voice changed it took decades for my vocal track to lengthen enough for my voice to drop into a typical male baritone or bass range. I have never had an abundance of facial, pubic or body hair. While I do not have overly androgynous features or a feminine voice or mannerisms, when I was a teenager and young adult, I often attracted the attention of gay and bisexual men who would often comment on my bedroom eyes (before I had any idea what that meant).

My hormonal profile is also unusual—a bit of a hybrid. When younger my normal testosterone was 100 ng/dL (male range 300-700, female 15-70) and estradiol was 122 pg/mL (male range 10-40, female 30-400). Shortly after beginning HRT, my testosterone quickly dropped to 8 (due to the effects of Spironolactone), but my estradiol barely budged (126) after being on 4mg daily for over a year. In spite of my low testosterone, for most of my life I had a high metabolism and no problem maintaining a lean body mass. I also had no fertility problems and fathered 3 children. Accordingly neither my PCP nor my Endocrinologists paid much attention to my metabolism. As I got older, I began suffering from massive BPH in my 50’s. I was treated with high dose (5mg) finasteride. I reacted badly. I exhibited 20 of the 28 symptoms of post finasteride syndrome as established by the National Center for Biotechnological Information (NCBI), including most significantly, pronounced gynecomastia (small C cup), atrial fibrillation, virtual loss of all body hair, severe sexual dysfunction (including not only ED, but anorgasmia and anejaculation) and massive weight gain (50lb). To say my experience was disastrous would be an understatement. In an attempt to correct this, my Urologist prescribed 100mg weekly testosterone injections, which I continued for about 6 weeks. The results were both predictable and surprising. I lost 30 lbs in a month with no change in diet or exercise. My energy increased. My libido went through the ceiling, but my sexual orientation totally flip flopped. I became desperate for a man to make love to me as a woman. Previously I had been heteronormative in preference. I became weepy and emotionally volatile in a way that is similar to that experienced by some pregnant women or those with extreme PMS.

Over the decades I have been put through batteries of psychological tests for a variety of reasons unrelated to mental illness. some of the more significant findings include that I have a high level of empathy suggesting that my prefrontal cortex has the kind of complex interconnection more typical of females than males. I also have well developed nurturing instincts and little interest in controlling others. I am more collaborative than controlling. Classically male pursuits such as hunting and fishing, NASCAR, and boxing hold little appeal. I have never paid much attention to women’s butts and breasts; eyes and grace of movement are far more fascinating.

So what am I? Most would say that I am male. However, even conservative treatment with HRT has quickly reshaped my body and features into a distinctly feminine shape, further stimulated breast growth and areolar granulation and development, restarted hair growth on my head which 6 experts said would never happen (it now appears that I will need little hair restoration) and had a dramatic positive impact upon my mood. I am quickly being feminized just from the metabolic changes. I have long known that I was a woman at my core. There is some objective medical evidence which tends to support this. I may not be intersex per se or exhibit extreme AIS, but my physical, mental and metabolic characteristics vary dramatically from most males. At the end of the day I am female regardless of what others may think and am quickly evolving to the point where there will be no question in their minds either. It is just unfortunate that appearance is such a big factor in acceptance by society at large. The determining factor of my identity resides firmly in the structure and metabolism of my brain in the same way as it does with each of us.