In The Den with Mama Dragons

Becoming a Visible Man

• Mama Dragons • Episode 112

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Coming out as a transgender man in the late 1980s—before the internet, before mainstream conversations about gender identity, and before widespread access to information and affirming healthcare—Jamison Green found himself navigating a world where resources were scarce, and community was hard to find. Instead of being deterred, he became a guiding light and a leader in the fight for trans visibility and rights. Now, with his latest book, A History of Transgender Medicine, he takes us on a journey through the evolution of trans healthcare—chronicling the struggles, victories, and ongoing battles for equitable medical care. Today In the Den, we’ll explore Jamison’s incredible journey, the legacy of those who came before him, and the future he envisions for transgender rights and healthcare. 

Special Guest: Jamison Green


Jamison Green, Ph.D. is an author, educator, public speaker, independent legal scholar, and expert policy consultant in transgender health and employment discrimination litigation. He is best known for his influential book Becoming a Visible Man, first published in 2004 and updated in 2020. This work is considered a classic in transgender literature, offering valuable insights into the experiences of trans men. Dr. Green began working for transgender visibility and rights in San Francisco in 1994 when a newly implemented non-discrimination ordinance (which he co-authored with city attorneys) placed the city in violation of its own Equal Benefits Ordinance. It took until 2000 to win on the issue, and a trans-inclusive policy went into effect in 2001.


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SARA: Hi everyone. Welcome to In the Den with Mama Dragons. A podcast and community to support, educate, and empower parents on the journey of raising happy and healthy LGBTQ+ humans. I’m your host, Sara LaWall. I’m a Mama Dragon myself and an advocate for our queer community. And I’m so glad to be part of this wild and wonderful parenting journey with all of you. Thanks for joining us. We’re so glad you’re here.

Coming out as a transgender man in the late 1980s, before the internet, before mainstream conversations about gender identity, and before widespread access to information and affirming healthcare—Jamison Green found himself navigating a world where resources were scarce, and community was hard to find. But instead of being deterred, he became a guiding light and a leader in the fight for trans visibility & rights. 

Following in the footsteps of the late, great Lou Sullivan, he took on the vital work of keeping the FTM community connected, ensuring that transgender men had a space to find each other, to share experiences, and to push for visibility at a time when trans narratives were still widely misunderstood.

His impact extends far beyond individual connection. Through his leadership in organizations like the World Professional Association for Transgender Health (WPATH), he has been instrumental in advancing access to affirming healthcare and fighting for the dignity and rights of trans individuals. His memoir, Becoming a Visible Man, broke ground as one of the first widely recognized accounts of the transmasculine experience, offering honesty, vulnerability, and hope. 

And now, with his latest book, A History of Transgender Medicine, he takes us on a journey through the evolution of trans healthcare—chronicling the struggles, the victories, and the ongoing battles for equitable medical care for the trans community.

Today, we’ll explore Jamison’s incredible journey, the legacy of those who came before him, and the future he envisions for transgender rights and healthcare. 

Jamison Green, welcome to In the Den!

JAMISON: Thank you so much, Sara. It’s a real pleasure for me to be here with you.

SARA: My goodness, you are a legend. You have been in this work for decades and have contributed to so many important rights and spaces for trans folks. It’s really an honor to meet you and be in conversation with you.

I’ve been reading Becoming a[n In]Visible Man and it is extraordinary and comprehensive. You not only share your own personal story, which is really moving, but your story helps paint this long arc of trans history and trans masculine issues in particular with lots of specifics on all of the aspects of trans identity and medical transition and health care. So let’s start right there. I’m curious to know what inspired you to decide to write this book and what were your hopes for how it would impact your readers?

JAMISON: I’m a writer. I’ve always been a writer. I wanted to be a writer clearly from the time I was 7 years old. And I worked as a writer for many, many years in many, many fields. One of my first jobs was in the medical device manufacturing business. And I was the only writer in the company and I wrote both technical implementation and marketing materials. I’m a very versatile writer. I can speak in many voices and to many audiences. But I always wanted to write short stories and fiction and novels. And yet, to make a living, I had to do all this science-y stuff. I also was involved in the computer industry early on in the late 70’s, early 80’s working for computer design and manufacturing companies. And then I went into finance. My last actual full-time job was as Director of Technical Publications for VISA. So I also became skilled at managing creative people in corporate settings. So writers and artists were often the people who reported to me. So either, I was the only writer in the company, or I was one of a few, or I was in charge of many. And through that kind of experience in the workplace, I actually learned how to leverage knowledge to create change. And the first time I did it was in 1980 as a result of having knee surgery which was arthroscopic surgery which was deemed experimental by insurance companies. So it wouldn’t be paid for. And I documented intraocular microsurgery devices which are smaller versions and they were actually the precursor of arthroscopic devices. And so I knew how arthroscopic surgery went. And my boss, who was the Vice President of Research and Development for the company I worked for, sent me to the Oakland Raiders Team Physician for diagnosis. And then he said, “Don’t let him operate on you because he’s a great diagnostician, and he’s a friend of mine, but he’s not the best surgeon. So if he says you need surgery, you’ve got to go to the Chief of the College of Arthroscopic Surgery.” And so that’s where I went. And because I understood the instruments and what he was going to do, he liked me. And he agreed to accept $25 a month for the rest of my life to pay for the surgery because I couldn’t afford it and made very little money at the time. And the surgery was incredible and it was a very good result. I had a bucket-handle tear in my meniscus from a sports injury. And I walked out of the hospital. It was incredible. Of course, I did have to retrain and stuff and I was careful with it. But I’ve never had a problem since. And after about six months of paying $25 a month to him, I decided to write a letter to the insurance company and explain what the difference was between standard technique that they would pay for and what was being done. And a couple months later, I received a letter from the surgeon saying, “The insurance company has paid for your surgery, all but $300.” And he said, “I’ll give you $300 dollars for permission to use this letter to help other patients.” 

So eight years later, I’ve come to the realization that I have to transition. I’m working as a manager of writers in a computer company, actually Sun Microsystems. And I’m called an Engineering Group Manager. And I’m in charge of system software documentation. And I’ve just been accepted to the sex-reassignment program at Stanford which took me a year to get into. And I looked at my insurance documents at work and they said anything having to do with transsexualism or – transgender wasn’t a word at the time – or sex change, will not be covered. And I said, “Oh, OK.” Well, I sort of expected that because it had never been covered. But then I thought, well why? Why are they doing this? And I realized that I had some skills that I could apply to try to change that paradigm. But I wasn’t really motivated to do it until after I had joined Lou Sullivan’s group which was just a small group. He sent his newsletter at that time to about 232 subscribers. And that was in 1989 roughly. I mean, I met him in ‘87. And I began my transition in ’88. And I continued to attend his group meetings which were every three months. They weren’t frequent. And his newsletter just went to a few people. But they went around the world. They were not just confined to a local audience because he was an inveterate correspondent. He loved writing letters to people. And he would get letters from people all over the world and he would write back long, detailed, long-hand letters. And so anyway, I stayed active in his group just because it was one of the only places you could get information at the time. And I met more and more people. And the number of people that came to the group at that time was about anywhere from 6 to 20 as a general rule. And that was every three months. So this was not a big deal. It was very underground, if you will. And Lou Sullivan was not famous. He was not legendary. He was just a guy who was interested in the topic, who was interested in communication. He liked writing his newsletter and putting it out every three months.

SARA: And that’s how you met him. You discovered the newsletter and the FTM community and met Lou Sullivan and then got involved in all of the work and the community itself.

JAMISON: Yes. But I can’t say it was a community at the time. We only met three times a year. So if you went to a meeting and you met somebody that you sort of felt you had a kind of connection with and wanted to go for coffee or something, if they lived in your city or your neighborhood you might hang out with them for a little while. And maybe you decide you didn’t like them. And you’d see them again at the next meeting. Whatever. It was very, very low key. And the goal at the time, for everybody, was disappearing, not being visible.

SARA: Yeah. I want to talk about that. I’m curious about that because you do spend a bit of time in your book talking about your own experience in the early days and talking about the idea of passing. The goal for a trans person – or what was thought of as success for a trans person – was not being noticed as trans.

JAMISON: Right.

SARA: And even you got a lot of compliments early on in the workplace of people who knew you were transitioning and said, “Oh, you look so good. You can’t even tell.” And it’s really complex about thinking through what does it mean to be a “successful” – I’m putting that in air quotes – trans person? What does that look like? How has your own experience and thinking about all of that evolved over the years?

JAMISON: Yeah. That’s a very good question and I raise that issue early on in the book because it’s a crux issue for trans men in particular. I think it’s different if people who are trans women come at it a little differently. And I think part of that has to do with the sexist system that we all grow up in. But looking at trans men specifically, we often are perceived as men before we transition. Not always. Not always. There is no constant, “Everybody experiences this in the same way.” But the general idea of what we go through is: we know that our gender is not the same as our sex. We know that our gender and the way we want to live in the world – because the gender is the communication we have with other people – and that we feel best when we are perceived as male. So it starts out maybe as a teenager and somebody says, “Hey, kid. Hey, boy.” And you go, “Oh, but I have a female body, what do I do with that?” But you realize, “Oh, I like it when they say that because that feels like who I am.” And then you have to put all that together and think about, “Well, how do I want to live in the world?” So, to put the short version on this because it is complex, it is problematic when you know you have this experience and other people assume things about you because of how they perceive you. That is true no matter what body you’re in, no matter what gender you are, no matter whether you transition or not. But people who don’t transition never have to think about it in the way that we do. So for us, yes, it’s nice to hear that people perceive us the way we want to be perceived, which is what everybody gets validated when they get called by their proper pronoun. So it’s nice for us when we experience that as well, like everybody else. At the same time, we know more than that. We know a different kind of experience. A kind of experience that transcends those barriers and can actually reflect on that condition of sexism. And yet, are we responsible for that? I don’t think so. I think we don’t have an obligation to explain it all to people. We don’t have an obligation to behave any differently than exactly as anybody else like us would behave. But we have this knowledge. And some of us have the capacity to reflect on it in a way that is educational and can help other people understand the limitations that we put on other people just by our perception of them.

SARA: Right. I think the tricky part is that in our culture as we are continuing to expand our understanding of the spectrum of gender identity and expression, this idea of passing – which some people may feel really passionate about, that’s really important to them – but it’s tricky because then it also requires trans folks to reinforce gender binaries and gender stereotypes. And that’s at odds with the way that we’re then trying to remove the barriers of those stereotypes in contemporary culture.

JAMISON: Yes. And I think one of the reasons it’s complicated is that stereotypes exist because they are generalizations that are true. It’s just that when you apply them broadly, indiscriminately, because of your perception of certain things, that’s when people are hurt by them. And that’s true in sexism and racism and any kind of ism like that. That assumption that you make about other people based on whatever you cue in on and then you lay this big tarp over them and make them something that they are not.

SARA: You have this beautiful quote in the book that says, “If all we had to do was look good and pass, we would be reinforcing the stereotypes and that’s not realistic or healthy.”

JAMISON: Right. And I think one of the things that that transgender experience brings forward is the ability to survive without conforming. And to demonstrate that conformance is not necessarily the be-all, end-all of existence.

SARA: Right. For any of us.

JAMISON: Exactly. For anyone. Trans people have a lot to communicate to non-trans or cisgender people. And I think that you cannot blame somebody if they do conform to a stereotype. Nor should you blame them if they don’t.

SARA: Right. That makes a lot of sense and I hope that’s where we’re headed. I know that is still a struggle for folks. But I appreciate folks are naming that struggle and really working through it. Folks in our community in particular. 

Right at the beginning of the book you talk about when you are invited to guest lecture in a college classroom and some of the thought provoking questions you ask the students before you share anything at all about yourself and your identity. And I was really taken by those questions. And I’m wondering if you’ll share some of those with us.

JAMISON: Sure. I’ll say too, that I was aware always, whenever I enter the classroom to give a guest lecture like that, the students already know the topic. They know there’s going to be – in the old days – there’s going to be a transexual there. I come in and they think, oh, I guess the transexual couldn’t make it. Because they’re idea of a transexual is a man in a dress. So I just start talking in a very calm, casual way. And present a lot of facts and things. And I don’t talk too much about myself because I want to lull them into trusting me as a speaker. And then I out myself later on. And then that’s a big surprise moment. And that way, they remember. They remember what happened. They remember how they were feeling. They remember what they thought. And they remember how their mind was opened. And I can tell you from years of experience that many years later, often, I would walk into a store or approach someone selling newspapers on the corner and the person there would say, “I remember you. You came to my sociology class at San Francisco State University. That was amazing. It totally blew my mind.”

SARA: I think one of the questions that really struck me that I hear a lot of people in this world and in the queer community asking a lot of folks is, “How do you know you’re a man or a woman? How do you know?” And really getting people to think about. And you share the process of getting those students to really think about what is it that makes you a man or tells you you’re a man.

JAMISON: Yes. I tell them sex and gender are not the same thing. Who can tell me the difference between sex and gender. And they come up with lots of things. None of which are usually correct. People now have learned a little bit about this. Sometimes you’ll have a student in the classroom who actually does understand this. And now there are more trans students all over the place. But back then, there was nobody. And we go through a whole dialogue here in the book with what these students are responding with and what they think. And I throw out scenarios about, you may see a very beautiful woman with long hair and a gorgeous body and think of her as very feminine. But when all of the sudden she lifts up a park bench and says, “Not another step closer or I’ll shove this down your throat!” in a deep menacing growl, you may realize there’s more to her than meets the eye. So if you had that experience, what would you think? Well, “She’s really a man,” someone will suggest. After all, they may know I’m there to discuss transsexualism. They want me to get to the juicy part. And I haven’t finished laying the foundation yet. So I say, “What makes you think that?” And we go into the stereotypes. This is pretty typical discussion.

SARA: It’s a great way to think about it, though. It’s really provocative. It really makes you pause and chew on these things that many of us just take for granted, really. You transitioned at a time – as I mentioned in my intro – when there was very little public understanding of transgender identities, particularly as you share the unfolding in the book trans masculine identity which you talk about still struggle with visibility even today. And I will admit, that was new learning for me. And I’m curious if you can say more about that. A little bit of your experience with that and why do you think it is that that particular identity and visibility was so non-existent and resisted by others?

JAMISON: Well, historically, I think one of the major things is that people in female bodies didn’t have money to approach doctors to get care. And it was unimaginable that there was any surgery that would help them. Unlike trans women who – Christine Jorgernsen in the early 1950’s became a household name in the United States. And she set the example for what a transexual was: White, middle class, educated. That was the “good transexual” which was hard for a lot of people.

SARA: You talk about being at one of the very first conferences you went to which was led by trans women, MTF women, and how some of those women didn’t even believe the experience of trans men, couldn’t wrap their minds around it, except I think I’m remembering the one woman who said, “Except for you.”

JAMISON: Right. She was a famous trans woman named Virginia Prince. She passed away, I don’t know, ten years ago, maybe twenty, fifteen years ago. I can’t remember. But she was very, very influential in the trans women’s community. But she started out promoting cross dressing. And as the community of trans women grew – and this is particularly white trans women also, I must say – they had networks all across the country. And there were meetings every month in every major city of trans women, all over the place. And almost nothing for trans men. And so some of the leaders of the International Foundation for Gender Education which was based outside of Boston that was the sponsor of that particular meeting that I describe in the book. They were trying to be more conscious about the existence of trans men and bring trans men into the organization. But when they’d get up at their luncheon and they would say, “Welcome Ladies.” Never “Welcome Ladies and Gentlemen.” Never. And I remember one time, I’m sitting at a table and this one woman is having trouble with her purse. It keeps falling off the back of the chair and all these things. And she feels all awkward about it. And I’m sitting next to her at this big round table of ten people. And she goes, “I bet you never had problems like this when you were a woman.” I said, “I never carried a purse. Are you kidding? I wouldn’t have been caught dead with a purse.”

SARA: Do you think that this struggle with trans male, trans masculine disability still exists today?

JAMISON: Yes it does. It absolutely does. And I’m actually on the board of an organization called The Intentional Man Project which is all about supporting trans men and sponsors an organization, or an activity actually, called Camp Lost Boys which happens in various places around the country. It’s very well curated. It’s extremely well monitored and very, very supportive and very spiritual in many ways. And it’s an eye-opening experience for so many trans men to be in the presence of other trans men. And to be out in the woods, many of whom have never been camping before. They’ve never been out in the woods, particularly men of color. And we make sure to try to get at least 40% men of color at every camp. And it’s true. It’s still true that trans masculine experience is completely overlooked. For example, all this stuff about trans women athletes in the Olympics, there are trans male athletes in the Olympics, but nobody notices them.

SARA: Right. Nobody seems particularly fearful of them.

JAMISON: Nobody’s afraid of them, because why? “They’re just women. They can’t hurt anybody. They’ll never really be men.” This is what people think. So “We don’t have to worry about them.” There aren’t that many of them because medical literature in the 1960’s talked about the fact that there were probably 1 in 100 trans women, 1 in 100 people would be a trans woman. But 1 in 1000 would be a trans man. Those numbers are not actually accurate. But that’s symbolic of the disparity. And it was a psychologist from the University of – actually he was at the University of Oregon for a while and then he was at the University of Nevada – he did a lot of research with trans people. And he wrote one of the first articles about trans men, trans masculine experience. And acknowledged in this article, which I think was published in the Archives of Sexuality. I’m not sure. I could look it up. But it’s cited in A History of Transgender Medicine in the United States from Margins to Mainstream, the new book. But his name, the doctor's name is Ira Pauley. And he admitted that “We don’t know anything about this population and I'm sure our estimates are absolutely wrong.”

SARA: Really.

JAMISON: And even so, we didn’t get much kind of traction or attention from the medical community until the 1990’s.

SARA: That’s so interesting and still a little surprising although I understand that the underlying misogyny and sexism makes a lot of sense as to why that’s happening. But there’s another part that’s in play that I’m curious about that I’ll admit I’ve thought. Is that for trans men, you inherit a kind of instant male privilege.

JAMISON: Well, you can if you want to assume it. But if you’re going to stay a conscious human being, it’s very difficult to do. And yes, there are some trans men who you would never in a million years imagine that they had ever had any kind of experience in any other body. And they believe the sexist tropes and they act on them. But the majority of trans men are not like that. And especially now-a-days. Most of us have had some kind of exposure to feminist thought. And we don’t disparage women. We don’t think that there’s anything wrong – personally, I don’t think there’s anything wrong with being a woman. I just don’t happen to be one. It’s just that simple.

SARA: I’m curious if, when you transitioned, you experienced that maleness differently, the male privilege people put upon you.

JAMISON: I became aware that I didn’t have to be quite as frightened in public, just random on the street. But at the same time, as a man, I was also more subject to random violence than women usually are. Women become targets. But random violence happens to men quite a bit. And yet it’s completely irrelevant of who you are. It just happens because people feel that they can hit you if they need to. But I think, really, fundamentally, the problem is whether or not you accept the trope of male privilege and capitalize on it. And I don’t. So, yes, sometimes people defer to me in the grocery store. And if I know that I have been waiting less time than this woman standing there and they’ve just acknowledged me first, I will say, “No. No. She was here first.” I am always conscious of how I’m functioning in a social setting.

SARA: That’s great. That’s interesting. That’s an interesting thing to think about. You spend some time in the book also sharing this experience that you had early on in joining a men’s group and how transformative that experience really was for you. And the off-shoot, this was The Sons of Orpheus. And then helping lead an off-shoot of that, The Sons of Sons, I believe you called it.

JAMISON: Yep.

SARA: Can you share a little bit about why that particular experience was so meaningful for you?

JAMISON: I think the real reason is that it helped me break down my perceptions of other men because I have been exposed to all the same stereotypes that everybody else is exposed to. And there was such a broad spectrum of men in this group. And there were some gay men, there were some men of color, there were mostly straight men, and there were guys who you would look at them and say, “Oh, that’s the guy who in high school that tortured everybody. That’s the guy who when I was a kid was the one who beat up the other kids.” And what we did in that group, which was based on musical performance, actually. But it was also fundamentally based on connection between men. The group started because the leader of the group and his wife experienced a stillborn child. And the woman had huge amounts of support, tons and tons of support from other women, from various groups, from everything. And there was nothing for him.

SARA: Wow.

JAMISON: And he was a therapist and he was a drummer, a professional drummer and a drumming instructor. He was a musician but also a therapist. So he was a very conscious thinker. And he realized, “If I’m experiencing this lack of connection and I have nowhere to go with my feelings. How do I process grief? How do I process with other men so that other men realize we have feelings?” And that’s what the group was about. So we performed as a percussion ensemble which was amazing, wonderful. We were trained to do it. It wasn’t just “Let’s all go out in the woods and beat on drums.” No. We did actual multi-part compositions of percussion. And also marching band stuff and carnival parades and stuff. It was really fun. And I saw that all these men – because of the structure of the group where we had to do these soul-making activities where we learned to listen to each other and learned to support each other – I saw men break down. I saw men having the same kinds of feelings that I was having and going through the same kinds of experiences that I was experiencing. And I realized, “Oh, these are actual human beings, not just men out there. They’re not just men.” It was very powerful. My father was a wonderful man. I was blessed to have a father who was as kind and conscious and gentle as he was. And yet, we argued all through my junior high and high school years even though I never, ever felt that I risked losing his affection. He was training me, if you will. He was being a parent. And I had a younger brother who was a good man. He’s a good father to his own children. He’s kind and conscious. And so it wasn’t like I came from a broken home or came from some kind of situation where men had been abusive. Nothing like that. And, yet, people used to think that about trans men. One of the theories is that women become trans men because they’re afraid of other men or because they want to protect their mother who is being abused, or all these other kinds of things. And while there may be experiences like that, that is not where this condition comes from. That is not where being a trans person originates because there are plenty of people who experience those things who don’t become trans. So these men were incredible. And it took me a year to get up the nerve to come out to them. And it was a very, very powerful moment. And I was so accepted by them. And I tell the story of that in the book. When the book first came out, I would go to do readings in book stores and stuff and I would read from that passage and I would make myself cry while I was reading because it’s so powerful.

SARA: That passage really moved me and I was moved by the whole story. But I was also really moved about the moment when you were invited and it took you some time to finally tell the whole group your whole story outside of the leadership. And the way in which you shared your story and the language that you used was so moving and so interesting and different than I’ve heard that kind of story – a coming out story or an identity story – told before. And in particular just the way that you really talked about yourself as male, man, in a female body, a female bodied person. And it was really lovely to hear it like that.

JAMISON: Thank you. Thank you. I appreciate that. It took me a while to come up with that. And that is exactly what I did in the group. But it took me a few months to come up with that approach. And I’m glad that it resonated for you. I know it resonated for the guys in the group.

SARA: It really helps in the understanding of somebody saying, “This is who I’ve always been. I’ve just struggled in a different body.” I think at some point in the book you talk about the hardware and the software not talking to each other. Also, a helpful metaphor for me because I think we can get so wrapped up in all the external things, we forget about the internal identity.

JAMISON: Yes. Exactly. So, the new executive orders that say sex is only male and female and there’s no gender identity, there’s no such thing – and that’s a gender ideology – that is a false premise. There are so many more variations than we know right now. We are still learning about human sexuality, sexual differentiation, the variety of experiences that people can have. And, again, that’s some of what is discussed in the history book, and it shows some of that evolution. And to deny all of that is basically putting everyone, every single human being in this country, in jail.

SARA: Yeah. It’s really disheartening to watch and read and listen to. And I was really struck because this whole story that you tell about being in these communities, the Sons of Orpheus and then FTM communities and the value of community and the value of being supported and how parents would come to you with questions. And there’s one story you tell about a young boy named Ryan and his parents. And his parents reaching out to you with Ryan’s story, understanding himself as transgender at the age of 7 and coming out to his peers at school and how the parents worked with the principal to go talk to every class and teach them about pronouns. And the eighth grade class wrote him a letter about his courage. And I listened to that with some tears because I thought, that wouldn’t happen today in many schools.

JAMISON: Unfortunately, you’re right.

SARA: And it’s devastating. Why do you think we’re regressing?

JAMISON: Well, there’s a movement that is based in a certain Judeo/Christian philosophy and interpretation of the body and the roles of human beings that is trying to assert dominance over knowledge.

SARA: It just seems like such a stark contrast. And hearing that story, I was kind of amazed that that was the experience of some years ago now of this family and this young man.

JAMISON: They were quite worried. And they live in another state, a midwest state. And I was there to speak at a conference and they came to the conference specifically to see an example of an adult trans male person so that they could have some assurance that their child had a future.

SARA: Yeah.

JAMISON: That was just stunning. They came up to me after I spoke. I did a keynote address. And afterward, they came up to me and introduced themselves and told me about their son and said why they had come. They needed to see somebody. There were no role models, no role models for people to understand that their child might have a future. And now we have a lot of role models, except we’re being suppressed.

SARA: Right.

JAMISON: And we are still invisible.

SARA: Right. I think as a parent, and I know this for many of the parents in our Mama Dragons community, it’s so important and valuable for me and for my child to see successful, healthy trans adults living lives in amazing professions, doing amazing work. It does offer a lot of inspiration and hope for the future.

JAMISON: That was one of the reasons why I decided at some point to – and I announced it in the pages of the FTM Newsletter – that I was going to be more public. I was going to start doing trainings about gender diversity. And I did a lot of work in workplace settings because work is sort of the common denominator, in a way. Not only is it where we get our healthcare, through our employer-funded health care plans, but many people, that is where they get their healthcare. Otherwise, they don’t know how to get it. And it’s a place we all need to be. We all need an income. We all need to survive. So we need to work. So workplace education, I thought, was pretty crucial to our communities’ survival. And that’s why I focused a lot on that in the beginning of my activist work.

SARA: And that activism just continued and grew and grew and grew. And so much of your work has been about improving transgender health care and access and standards and insurance.

JAMISON: Yes.

SARA: Beginning in, I think you started right in the city of San Francisco securing health care coverage. What were some of the other big battles that you’ve had to fight on that front?

JAMISON: San Francisco, that took six years.

SARA: One of the battles that I know you’ve talked about is this, the whole world of diagnoses and the DSM.

JAMISON: Yes.

SARA: And part of your work has been changing the perception that trans identity is a disorder or a mental illness, and the language the medical community uses in diagnoses. Tell us more about that.

JAMISON: Yes. Well it’s interesting. First of all, I have a theory about the DSM. I believe that it comes from the establishment in the 1800’s of diagnostic codes that were meant to help judges evaluate and penalize people who were perceived as sexual perverts. And it was a man who came from a family of lawyers and judges who was an early psychologist. And this is documented also in the History of Transgender Medicine in the United States because of where this came from. The DSM started in – oh gosh, I forget what year it is now – but it hasn’t been around all that long. But it’s a document that’s created by the American Psychiatric Association. It’s a consensus-based document. People get on the committee who are members of the association. They get on the committee and they work out among themselves what they think the criteria for diagnosis ought to be. And they make up all this language to describe how to diagnose somebody for various things. And they’ve cataloged all of these things much like this man in the 1880’s did. And as a result, there’s a lot of judgement that comes into diagnoses in some cases. In some cases it’s pretty clear-cut, scientific, there’s clarity on things. But very few mental health disorders actually have that level of clarity. So there was a concept that came up in the 70’s called “Gender Dysphoria” and that was thought of as confusion. And you see that reflected in some current anti-trans documents, it’s gender confusion. And, no, we’re not confused. There may be some people who are confused. And I have to say there’s validity to that for some people. But not all trans people fall into that category. So gender dysphoria was around for a little while but the categories for tracking diseases, like in the ICD, remained transsexualism until 2019 when it finally got changed officially. 2013 was when DSM-5 came out, as I recall. By that time, it had become, in the mid ‘90’s it became Gender Identity Disorder.

SARA: Still disordered.

JAMISON: Yeah. Clearly, disorder was in the name. So it would go in the medical record, “gender identity disorder.” And that’s a value judgement. That’s an assumption not based on fact or experience. And so I really resisted that category description. And there were battles, I know, between psychiatrists and psychologists working in this field. There was one very well-known clinician who said, “Gender Identity Disorder will never change. Over my dead body.”

SARA: Oh, my.

JAMISON: And there were others who said, “This diagnosis is damaging to people. It is not a disorder for many people. There may be disorders of other kinds that overlap with this that are mixed in with this for certain individuals. But just being a trans person is not a disorder.” And if you have to have a diagnosis in order to get access to care, which is how our system works, you need to be able to have treatment that is effective and then you don’t have the disorder anymore. So you can’t just label somebody with a disorder for the rest of their lives when there’s no social dysfunction.

SARA: Right.

JAMISON: So those are the arguments that we were having and then I was able to sit down with a group of people, psychologists and psychiatrists, to hammer out the definition of gender dysphoria that is the current one. Do I think it’s perfect? No. These things always have iterative – just like legislation – they have iterative evolutions.

SARA: Have you given much thought to what might be the next evolution beyond gender dysphoria?

JAMISON: I think gender dysphoria in itself is a valid thing. For example, you don’t have to be trans to have gender dysphoria. I’ve known of women who have had cancer, breast cancer, and have had double mastectomies and then they begin, after a while, after they recover from that surgery in general and they’re settling back down and they begin to experience actual gender dysphoria. They cannot conceive of themselves as a woman without breasts. And that’s gender dysphoria.

SARA: That’s a really good point. Yes. So it levels the playing field. It doesn’t make it only about trans folks.

JAMISON: Exactly. And that’s what we did in 2013.

SARA: That’s great.

JAMISON: So it’s there. But then again, now since 2019, the International Classification of Diseases which is the medical coding book that’s global – not just the American Psychiatric Association's DSM but the global thing – is about Gender Incongruence. And that is not part of the sexual perversities that transsexualism and transvestism were in the older editions of the ICD. It is in a category of sexually related conditions including pregnancy.

SARA: Wow. It sounds more aligned with how we understand trans identity today.

JAMISON: I think it is. And I was on the committee that worked on that. And I do think that it’s an improvement. I’m not sure yet whether we have all the answers. But what you see around the world is that when a child is born, as it grows it becomes 3, 4, 5, 6 years old, parents perceive a gender incongruence in the child. And, historically, if it’s been a male-bodied child and that child expresses some femininity, feminine characteristics, feminine mannerisms, things like that, many times in many cultures those children are destroyed by their parents because of their parents’ shame. And that’s one of the things that the gender incongruence diagnosis as a global health category is meant to address, is to get help for the parents.

SARA: Yes.

JAMISON: Literally.

SARA: Yes. 

JAMISON: But we have that here in the United States as well. We have that level of gender oppression that cannot abide the mixing of the qualities of masculine and feminine. So the masculine body, in this case of a male-bodied child, the masculine body must predominate because that – forgive me – is closest to God.

SARA: Well, you’ve already said that there’s this seed of this regression right there and that’s been kind of at the core of the patriarchy for hundreds of years.

JAMISON: Exactly. So working on trans issues and trans identity is really, it’s a culturally evolutionary project. It’s not going to happen overnight.

SARA: For sure. I want to shift a little bit, but this is related, to talk a little bit about access to health care because we still see that accessing competent, quality, medical care for trans folks is a struggle, as is affordability, and even insurance coverage. And so based on your experience and your research for the new book A History of Transgender Medicine, can you talk a little bit about that evolution? And do you see a possibility for the future that is the next frontier in trans health care?

JAMISON: Well, let’s talk about the evolution first. The evolution is that we broke down the resistance to covering a medically necessary procedure, or medically necessary treatments for this condition – whatever it is – that basically, the main objections were: “It will cost too much.” We’ve proven that it doesn’t cost anything compared to many other conditions. We’ve also proven that as soon as you broke down that argument, I can say from my activism, argumentative years, as soon as you break down the cost argument, then it’s “Well, if we let anybody do it, then everyone will want to do it.” No. The slippery slope argument, you know? Which is what they used to justify exclusions for plastic surgery. “If we let one girl have a nose job, every girl will want to have a nose job, or a boob job.” Literally, that’s the way they think. But the cost of treating trans people, trans people are not that many. Not all trans people need surgery. Another myth that they have is that “Everyone would have every possible procedure and they’d have it year after year after year.” Yeah. They actually would argue that. No. Total misunderstanding, total incomprehension of what a trans person’s life is like, and who trans people are, and the fact that during all of these recent in the last few years, state legislature debates about trans access to anything, have been that they won’t listen to trans people and rarely listen to their parents. They just won’t listen.

SARA: Nope.

JAMISON: They’ve made up their mind. Now that is the situation that we’re in now. And the advantage that we have now is that we have a lot more practitioners in the field of medicine and mental health, who understand trans people better. We’ve done a lot of education over the last decade, tremendous amounts of education. And we have more allies than we have ever had in the past, ever. And that’s the only thing that gives me hope because I don’t know how to argue with somebody who will not listen. I don’t know how to have a conversation with somebody who will not listen. And that is something we have to find a way around. I’m not sure what the way around it is.

SARA: I don’t know either. I live in that world and it’s really frustrating. But I appreciate the hope that you shared. And it’s wonderful to know the growth of medical practitioners that are learning and growing and advocating and fighting for trans folks and trans kids.

JAMISON: Yes. Absolutely

SARA: That is so encouraging. And I also appreciate, Jamison, you remind readers in your book, on this topic, that surgery isn’t required to live as a trans person, that medical care and surgery, they’re expensive. And that sometimes our government and our policies and documents are at odds with that, that we’ve been in places and spaces where some policies and states have required surgery in order to change documents, etcetera. So it’s a funny space. But I appreciate that reminder that you give people.

JAMISON: Yeah. I think we’re in a space now where we’ll be lucky if we get acknowledgement for people who have had surgery. And I’m hoping that that space doesn’t last for very long. Because the right thing to do is to treat people as they are for who they are. Some people will require surgery. And some people won’t. And because they don’t have surgery, doesn’t mean it’s a reason to disrespect them or to treat them as anyone other than who they are.

SARA: Thank you.

JAMISON: For those who need it, they should have it. It’s not the most expensive thing in the world. It’s not going to break the bank. It’s not going to hurt anybody. And people talk about fertility issues. Yes. There are fertility issues. In some cases there are fundamental tradeoffs here. But they are manageable trade-offs. We have technology to overcome all of those tradeoffs. If you want to look at it like we live in the biblical age, there are no tradeoffs. There are no ways to fix it or ways to overcome the tradeoff. But now, we have those.

SARA: Yeah. That’s a great point and I think that’s really helpful. And it’s always so interesting to me that the hangups around trans legislation for those states in particular that are passing gender care bans and health care bans, the hangups all seem to be really attached to this fertility and reproductive freedom or no freedom issue as if that is the sole purpose of human existence, particularly those humans that have a uterus.

JAMISON: Yes. And I think that’s particularly indicative of a certain world view. That doesn’t mean that everyone has to agree with it. It’s not a fact. It’s a belief.

SARA: Yes.

JAMISON: And we don’t have to agree with everyone else’s belief, or anyone else’s belief. This is why we live in a pluralistic society that allows people to believe whatever they want but not infringe on the rights of others. And what we have now is a situation where those beliefs are being crammed down everybody’s throat.

SARA: And infringing upon rights.

JAMISON: Mm-hmm.

SARA: I’m curious when you look back at your career, what are you most proud of and what legacy do you hope to leave for future generations?

JAMISON: I think that it might not be a real obvious achievement. But I think the thing I’m most proud of is being able to stand up in front of other people and say, “We have no reason to be ashamed of ourselves.” And to have them believe it.

SARA: That's beautiful. That is, and would be, a fantastic legacy.

JAMISON: Thank you.

SARA: Throughout the book you state several times and I hear it with great appreciation, that there is no one way to be a trans person, no singular trans experience. And you’re really clear that one's transness or true expression of their identity does not depend upon other people’s perception or medical intervention or legal documents. And I just want to thank you for that reminder and offer it here as a reminder to all of us.

JAMISON: Thank you. That means a lot to me.

SARA: This has been a really fantastic conversation and I could go on and on. You have had such long lived experience and done so many things we could just continue to talk. And I like to end my interview by asking the same two questions to every guest. And the first question has to do with the Mama Dragons name. The Mama Dragon’s name was born out of this idea of fierce protection, of fierceness for our kids. And so I like to ask my guests, what is it that you are fierce about?

JAMISON: I’m fierce about protecting the trans community. I’m also a parent and I’m fierce about protecting my own children. And I am fierce about protecting all of our ability to love other people.

SARA: That’s beautiful. Thank you. And my last question is, what is bringing you joy right now? Particularly in these times when we all really need to experience and find as much joy as we possibly can.

JAMISON: I think the thing that most delivers joy to me is how much we are reaching out to each other in our community and talking to each other and assuring each other that we care about each other. And that we commiserate about various things and we sometimes rant and rave a little bit. But we are not alone. I think that is the thing that gives me the most joy. And I’m grateful to see our communities coming together and coming up with ways to fight back, to seek sanity, to seek peace, to seek order, to seek affirming care for each other, whether that’s gender-related care or not. We all need to be affirmed.

SARA: Yes. And we can do that joyfully. Thank you for that reminder. I really appreciate it. Thank you, again, for this conversation and for your extraordinary work on behalf of the trans community.

JAMISON: Thank you, Sara. I appreciate it very much. It’s been a pleasure.

SARA: Thanks so much for joining us here In the Den. Did you know that Mama Dragons offers an eLearning program called Parachute? This is an interactive learning platform where you can learn more about how to affirm, support, and celebrate the LGBTQ+ people in your life. Learn more at mamadragons.org/parachute. Or find the link in the episode show notes under links.

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People on this episode

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Sara LaWall

Host
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Jen Blair

Producer