The Effect of Physical Appearance on Identity

In 1994, I moved from Southern California to Northeast Georgia.

I had little desire to relocate; I didn't move for fun or profit. Instead, I began graduate school in Analytical Chemistry - location was unimportant in comparison to education.

As a native of Southern California, I was average looking: not too tall, not too thin, not especially pretty. My hair was curly and golden blonde from 23 years of California Sun, but even that detail was average. Every Surfer Girl and her brother had the same hair.

By the end of 1994, however, I carried myself as a goddess in Georgia.My hair - long and resplendent - was a lustrous blue-black. My skin was pale and translucent, my makeup rife with lavish liquid eyeliner and shiny black lipstick. I stood slender, proud, statuesque.

I had transformed over several months from an unnoticeable, grungy Plain Jane into an exotic incarnation that channeled Siouxsie Sioux, Kate Bush, and Sarah Brightman.

For the first time in my life - my humble, drab, unremarkable, Southern California life - I experienced the heady power of truly expressing the woman who had screamed inside my head for release.

Oh - one other thing. I also presented almost full-time as a man.

Assigned other at birth

I was Assigned Male at Birth. When I was born, a doctor glanced at my anatomy and assumed my identity would follow suit.

I don't blame the doctor. The practice of assigning a child's identity was common in the 1970s, and has continued even to this day.

Western society persists in the belief that physical structure defines sex, which defines gender, which defines the fantasies of our sexuality. Despite millennia of human experience to the contrary, we live and operate in a world that assumes the cisgender and heterosexual experience is not only the default, but "normal."

Homosexuality has only recently been declassified as a pathology. Transgender still languishes in a state of almost-accepted by psychology, its victims in dire need of counseling.

Again, I don't entirely blame medicine. Its practice follows closely behind science, and both are funded by politicians, who must satisfy enough of their uninformed or unconcerned constituency to be re-elected.

Further, I never believed who I am - a pansexual, transgender woman - was entirely "normal." I could always feel I was different.

I saw the looks of Chemistry graduate students as they tried to figure me out (finally simply labeling me "from California" as opposed to challenging their default beliefs). I endured losing friends when the truth came out along with my sexuality and gender.

I had experienced a sense of Other my whole life, and only began to unravel it in 1994, lonely and depressed in Northeast Georgia.

But the lack of family and friends to support me also granted me the courage to dive into who I am and express her in real life. I discovered my physical appearance helped drive this shift in identity.

Who I am on the inside grew and developed in no small part from how I presented on the outside.

As inside, so not always outside

I am no longer lonely, depressed, or living in Georgia. Today I am an advocate of the transgender community, and I teach physical structure is not our only component of identity. At the very least, we also express ourselves through our thoughts, our emotions, and our behavior.

When I began gender transition in 2022, I believed how we look is unimportant in the face of how we interact with our social environment. Being transgender is not our clothes, our makeup, or our hair - it is the sense of who we are inside.

I still believe transgender is not dependent on physical presentation. However, when I received gender-affirming surgery in July 2024, I found a lasting sense of peace settled over me.

I recognize my physical structure significantly affects my thoughts, my emotions, and the behavior I exhibit. The inner experience of who I am is not defined by how I look, but how I look certainly influences every aspect of my inner peace.

The first topic I considered when I began writing is the mismatch between the role we play in our social environment and the person we know we are inside. I called that mismatch "The Reflection," and postulated it as the source of dissatisfaction in many human experiences: from gender dysphoria to midlife crisis, from anorexia nervosa to toxic masculinity.

But the truth of it only became clear after surgery, when the gravity of what I had carried all my life dropped away. It was not until I sensed a lack of pain that I understood the magnitude to which I had hurt.

Blurred lines of biology

Since receiving surgery and the calm it brought, I searched for other stories similar to mine. The first stories I found are similar - but tell of an experience in the opposite direction.

Two friends of mine - both Assigned Female at Birth (AFAB) - described their battle with endometriosis that ended with a total hysterectomy: the complete loss of uterus and ovaries.

Both of my friends asked me directly whether I perceive any difference among us after their surgeries and mine. None of us possesses a uterus. None of us possesses ovaries. All of us require hormone replacement therapy (HRT) to manage emotional and biochemical stability.

The genotypes of both my AFAB friends presumably shows an additional X chromosome where mine shows a Y chromosome. But decades after Chromosome Pair 23 affected our in utero development, does it matter?

To a medical professional, the difference among my friends and me is likely negligible - implementation details of long-term maintenance of our human machines. I will need to have my prostate gland checked annually via blood test; they will not. Other than that, we differ very slightly as functioning humans.

That is, save one major difference.

From loss, both gain and pain

When I lost part of my body through surgery, I gained a greater sense of who I am. My identity shone forth as an inner glow - others saw it and commented on it. I feel integrated into a single person.

Although my friends and I all bear scars, I changed my physical structure more dramatically on the outside, and I revel in my changes. I feel far more of a woman than I ever have in my life - even in Georgia in 1994. The prospects for the remainder of my life are bright.

But when my friends lost parts of their bodies through surgery, they lost a sense of who they are. Both of them feel far less than the woman they were before - even though both are already mothers and did not plan more children.

Losing the parts they no longer intended even to use damaged their sense of self. Their lives are now clouded, their identities unclear.

This phenomenon is not unique to my two friends and me. I know one woman energized by a double mastectomy to address breast cancer. Another woman was devastated by a unilateral mastectomy. Both are alive; only one is glad of it.

When I wrote naively that identity is less about the outside and more about the inside, I had not experienced what I have today, did not know what I do today, had not correlated the effect of my outside on the process of my inside.

I know better now, and I am ready to revise my understanding of The Reflection.

Waves of identity

Experiencing the mismatch between the role we play in our social environment and our internal knowledge of the person we truly are can be existentially painful. Every transgender person understands this deep discomfort.

But as we change aspects of our external expression - even those invisible to others - whether we perceive ourselves differently depends on how important that expression was. A small physical change could trigger great changes in our perception of self.

All aspects of identity - physical, cognitive, behavioral, and spiritual - act synergistically, reinforcing or dampening our human experience like four interfering waves on a pool of water.

Gender-affirming care - particularly gender-affirming surgery - is highly effective by working on all aspects of identity at once. We experience physical changes, our hormonal balance affects thoughts and emotions, our behavior shifts to less erratic, and the way we view ourselves as part of the Universe improves.

Western medicine is designed to treat a woefully insufficient, purely physical level of imbalance. But the human experience is not purely physical, it is a holistic integration of who we are and our capability of expressing it within our social environment.

I have discovered what it means for all my aspects of identity to be in alignment. I hope our medical establishment learns this same lesson soon: no patient is truly healed until they know they feel better.