For Arthur, 17, from Cape Town, taking his time in his transition – and surrounding himself with those who love and support him – has been key.
‘As a young child, with no idea of anything related to being transgender, I can only describe myself as confused and unhappy with who I was. I had no idea why I felt the way I did. I often told myself that this was just low self-esteem, but it wasn’t that. It was because I couldn’t connect with my body in the way I was trying to. I followed the advice of the girls I was friends with, trying to be more “feminine” in an attempt to empower myself in the way that they described their femininity as a feeling, not understanding why it never made me feel better. But I was completely barking up the wrong tree.
‘I couldn’t connect with my body’
‘When I was 14, I joined Tumblr, and learnt about a lot of identities through queer communities there. Before that I only knew about being gay, straight and bi, and I vaguely knew what drag queens were. But Tumblr opened up a whole new world to me. I spent a lot of time questioning various identities. For a long time, I identified as vaguely gender-queer because I was hesitant to consider myself a trans man. But as I explored more online and educated myself on what it really means to be transgender, I began to start experimenting with different things. I learnt about binding – a way of hiding your breasts to achieve a more masculine shape. At first I was terrified to try it, in case it felt right, because I was intimidated by the enormous change that being trans implied. Of course, once I tried binding, it was amazing, and made me feel so much happier.
‘When I was 15, I cut my hair short and people sometimes mistook me for a boy. It felt incredible, and it was absolutely transformative for me. It was at that time, in mid-2015, that I was at the peak of my identity crisis. I didn’t know who I was. I was walking through a shopping mall looking at clothes, and reached a point where I just went and hid in the bathroom and cried because I couldn’t take looking at the gendered clothing and feeling like I had to make this massive choice about how I was going to live: continue trying to be a woman, feeling miserable, or change my life to be at peace. But after spending a few months considering myself and experimenting with different pronouns online, things started to change and I began to understand that I really was trans – and that that was totally okay.
‘I only officially came out as trans and began going by Arthur in May 2017, when I was 17. That’s when I came out to my parents properly, and changed my Facebook page. My mom was just like, “Sh*t, what do you want to do about this? How can we help you?” Earlier in the year I’d dropped out of school, split up with a somewhat conservative close friend, and begun being home-schooled, because it felt safer and helped me cope. But it still took me some time to really admit that I was trans. Being at home, not surrounded by judgement or people whose reactions I couldn’t gauge, I was able to spend the first few months of 2017 starting to understand who I was. It was at this time that I started going by the name Ash online but I eventually changed to Arthur because I felt Ash was too ambiguous. By testing the water with friends and online, I eventually grew the confidence to change my name for good.
‘I eventually grew the confidence to change my name’
‘My parents have always been supportive, from letting me cut my hair to home-schooling me, so I had a safe space to navigate my identity at home. They’re still getting used to calling me Arthur, and the transition journey is also completely new and foreign to them, but they are doing everything they can to educate themselves and support me through the process. My dad finds the whole thing a bit confusing, but not in any kind of malicious way – this is all just way outside of his frame of reference. I’ve been unbelievably lucky not to have any aggression or anger from my parents, like so many other trans people have.
‘In early 2017, as part of me trying to figure out my identity, I began to get contraceptive injections with the intention of preventing menstruation, which was always a huge source of distress for me. Every time I’d get an injection – every three months – I’d have this amazing sense of relief and encouragement, like I was moving forwards and taking a small step towards becoming more comfortable in my body. I’ve taken things very slowly in my transition, and I took my time with coming out because I wanted to really be sure. But I’ve also realised that something so intrinsic in me can’t be “made up” or a “phase”.
‘In November 2017 I finally began hormone replacement – getting testosterone injections to increase masculine attributes such as helping my voice drop and developing facial hair, a process I’ve jokingly referred to as a second puberty. Unlike hormone blockers, which aren’t permanent (they just block your hormones to prevent puberty), this has a permanent effect on my body. I get the injections every four weeks. Luckily, as we don’t have medical aid, the government healthcare system has charged us incredibly reasonable rates for these treatments – a huge relief, since they can be cripplingly expensive privately.
‘Finding a great doctor has also really helped me navigate my transition – Dr Pickstone-Taylor, a specialist in the Western Cape, has been instrumental in helping me and my parents understand the process. He’s also connected us to support groups, which has been very helpful. My mom is also part of some support groups for parents on Facebook, which has allowed her to talk about the journey with other parents of trans people.
‘I hope to get top surgery in the future, so I won’t need a binder and will be able to take my shirt off – especially in summer. It’s pretty unpleasant to be wearing a binder under a shirt when it’s 35°C outside! I’ll have to go onto a waiting list, though. I believe the waiting list is really, really long, which is frustrating – and it’s a pricey ordeal. And the waiting list for bottom surgery is even longer, which can be devastating for those who need it.
‘This year, I’m super-excited to see how much more my body changes as I continue to take testosterone. I’ve also gone back to school, although to a more laid-back, accepting school where I knew there were other trans teens already there.
‘I’m super-excited to see how much more my body changes’
‘There are so many things I wish people knew about the trans community. Mostly, I wish more people understood that a trans man is not “a woman who wants to be a man”, he’s a real man, and a trans woman is a real woman. And just because someone is trans, doesn’t make it okay for you to ask them personal or invasive questions about their bodies. You should also always refer to someone with their preferred gender, pronouns and name. It’s also quite rude and inappropriate to ask someone what their birth name is. It’s a dead name – it’s not who they are any more.
‘Gender isn’t defined by how you present or how your body looks. It’s defined by how you identify and feel. This isn’t a disease or illness. It’s who I am.’
Transgender is Not a Choice
‘There’s been a lot of scientific research into the causes of transgender,’ explains Dr Simon Pickstone-Taylor, a psychiatrist who works at The Neurodiversity Centre close to Franschhoek in the Boland, as well as at the Red Cross War Memorial Children’s Hospital in Cape Town. ‘It has been exhaustively proven that parental upbringing has absolutely nothing to with being transgender. Your gender identity is almost certainly biological; it’s not a choice.’
Medically, What Help is Out There?
‘The World Professional Association of Transgender Health has guidelines based on the best medical evidence that tell us to support young people with their gender expression and by helping bring their bodies in line with their gender identity with hormones. These are the guidelines all medical professionals should be following,’ explains Dr Pickstone-Taylor.
‘We have overwhelmingly positive results from hormone-blocker treatment on young adults and don’t find any teens who later regret their decision or transition. Allowing their body to stop developing in conflict with their gender identity during puberty dramatically reduces the suicide rate (which is 50% in unsupported trans teens) to close to zero percent. Hormone blockers are only started in the second of five stages of puberty, not before. Different children reach this stage at different ages. Hormone blockers are completely reversible; they just put puberty on ice.’
How Do I Get Treatment in SA?
‘Gender Dynamix is a great resource,’ advises Dr Pickstone-Taylor. ‘You can phone them and they know providers who are trans-friendly, and can recommend a GP, specialist or endocrinologist closest to you who can help you – including on the government system. There are also good resources online so do Google things.
‘If you’re close to Cape Town, you can ask a therapist or GP for a referral to the Red Cross War Memorial Children’s Hospital, which is a state hospital where we can provide further care on the transition process. What I would do then is an evaluation to really understand who you are, if you need other support, for example getting your parents on board, and if it’s appropriate I would then refer you for hormones to a paediatric endocrinologist at Groote Schuur Hospital.
‘Anyone can refer a young person to the Gender Identity Development Service at Red Cross, although a referral from a GP is preferable. If you or your parents’ income is below a certain amount, hormone blockers and cross-sex hormone treatment (such as testosterone) is at present paid for by the government. If you have private healthcare or high income, you can be seen by the endocrinologists at Groote Schuur Hospital, but the state will not fund hormones and you would need to take this up with your health insurance. Though medical aids typically have not paid for hormones yet in South Africa, we expect that they will soon. Cross-sex hormones are usually given at around 16 years old, but each young person’s situation is assessed individually.
‘When it comes to surgery such as top surgery, this also doesn’t have a strict age limit and depends on the individual,’ adds Dr Pickstone-Taylor. ‘You can have top surgery done in a state hospital if you are below a certain income bracket, but this does have a waiting list attached to it. You’d need to speak to your specialist in order to explore this process.’
Trans Rights Are Human Rights
According to LGBTQI+ organisation Love Not Hate, 15% of transgender South Africans have been threatened with violence and 13% have been physically attacked because of their gender identity, while 51% have been discriminated against when it comes to education. A horrifying 41% of LGBTQI+ people in SA say they know someone who’s been murdered because of their sexual orientation or gender identity.
Gender Dynamix is a local NGO established to advocate and lobby for transgender and gender-nonconforming human rights and social justice, and assist trans people in southern Africa who have experience discrimination and victimisation. They are also able to advise you on well-informed, trans-friendly GPs and specialists across South Africa who you can make an appointment with if you would like to find out more about transitioning in South Africa. Call them on 021 447 4797 or e-mail firstname.lastname@example.org.