Deciding to change

Stanford neuroscientist Ben Barres had an unusual life. He began it as a girl, one of four children in a financially struggling New Jersey family, earned an MD and PhD, and became a successful researcher as a woman in a male-dominated field. Barres eventually garnered acclaim for waking up neuroscience to the role of glial cells, the brain’s unsung heroes.

At midlife Barres changed his gender to become male, continued to make path-breaking discoveries about glia and became an advocate for gender equality in science. Then, at 61, he learned he had advanced pancreatic cancer. In the foreword to Barres’ new book, The Autobiography of a Transgender Scientist (MIT Press, 2018), friend and scientist Nancy Hopkins, PhD, said that many people had urged Barres to get his extraordinary life down on paper, to no avail. But in the months before his death at 63 in December 2017, he committed his story to print.

In this excerpt from the resulting autobiography, Barres described making the decision to transition from female to male, about four years after joining Stanford Medicine’s neurobiology faculty. As a child and young adult, he wrote, he was too ashamed about his gender incongruity to speak of it to a single person. It caused him emotional pain, leading him to consider suicide.

He learned of the possibility of changing gender, by chance, while reading a newspaper article about a transgender man. Barres was 40 at the time. The increasing awareness and openness about the topic amazed him in his later years.

“Whenever I see videos of parents talking openly and supportively with their (pretransition) transgender children, I weep,” wrote Barres. “Much progress is left to be made, but I marvel at how far the world has come in recent years.”

Excerpt

I felt an irresistible desire to transition from female to male from the moment I was offered that possibility. But I thought about it for several weeks because I was worried about what the repercussions might be for my career.

Even though I was already tenured and so did not have to worry about being fired — a frequent outcome for transgender people in other professions at the time (in many states, transgender people are still not legally protected from being fired) — there was much to consider.

I did not know of any successful transgender scientists, and I worried whether, if I transitioned, I would be able to get any more grants (it was already nearly impossible). Would new students or postdocs wish to join my lab? Would my colleagues reject me? Would I still be invited to meetings and so forth? Reading about the experiences of other folks in other professions who had transitioned, I strongly feared that a transition would end my career.

“Whenever I see videos of parents talking openly and supportively with their (pretransition) transgender children, I weep. Much progress is left to be made, but I marvel at how far the world has come in recent years.”

For about a week, I was almost unable to sleep from the stress as I pondered whether I should transition or commit suicide. I finally decided to open up to three friends whose opinion I valued very much: David Corey, Martin Raff and Louis Reichardt.

For the first time, I opened up to them about my gender confusion and told them that I was considering changing sex. Did they think that the repercussions would be so bad that it would harm my career? To my great relief, all three were immediately and strongly supportive. Based on their support, I decided to transition.

I sent out the following letter to my colleagues, family and friends late in December of 1997 to let them know of my gender dysphoria and my decision to transition.

Dear friends,

I am writing to disclose a personal problem that I’ve been struggling with for some time. It is important for me to talk about it now in order that I can finally move forward.

Ever since I was a few years old, I have had profound feelings that I was born the wrong sex. As a child, I played with boys’ toys and boys nearly exclusively. As a teenager I could not wear dresses, shave, wear jewelry, makeup or anything remotely feminine without extreme discomfort; I watched, amazed, as all of these things came easily to my sisters.

Instead I wanted to wear male clothing, be in the Boy Scouts, do shop, play sports with the guys, do auto mechanics and so forth. Since childhood, I have been ridiculed and shunned by women and by men. At the age of 17, I learned that I had been born without a uterus or vagina (Mullerian agenesis), and that I had been exposed prenatally to masculinizing hormones. Despite plastic surgical correction of my birth defect, throughout my life I have continued to have intensely strong feelings of non-identity with women.

Perhaps most disturbingly, I feel that I have the wrong genitals and have had violent thoughts about them. My lack of female identity was brought home vividly to me recently after having bilateral mastectomies for breast cancer. This surgery, rather than being an assault on my female identity as it was for my mother, felt corrective as my breasts never seemed like they should be there anyway; the thought of reconstructive surgery has been repellent to me. Since the surgery, people who do not know me often call me sir, but that doesn’t bother me, either. It is not that I wish I were male, rather, I feel that I already am.

It would be difficult to describe the mental anguish that this gender confusion has caused me. Although I have never been clinically depressed, it has been the source of strong feelings of worthlessness, intense isolation, hopelessness and self-destructive feelings. I have never been able to talk to anyone about it because I felt so ashamed and embarrassed by it.

It seemed that it must be my fault, that somehow I should be able to make myself be a woman. This is how things stood until two months ago, when I read in the newspaper about the existence of a gender clinic at Stanford. They found that I have a condition known as gender dysphoria. To my amazement, I learned that I am not alone and that my story is stereotypical of all of those who have this condition.

So what is gender dysphoria (also known as being transgendered or as gender identity disorder)? Those who have it feel, from childhood, a strong mismatch between their anatomical sex and their brain sex (gender identity).

The cause is unknown but is thought to be biological, as some cases are clearly associated with a history of hormone exposure during development. Although it is not treatable by psychotherapy, the dysphoria is substantially lessened by a change in gender role. Treatment with testosterone induces normal male secondary sexual characteristics within six to 12 months.

Most patients also opt for mastectomies, which I have already had, and hysterectomy, which nature has already done for me. In my case, testosterone treatment would have the added benefits of substantially lowering my chance of new or recurrent breast cancer, because it lowers estrogen levels, and would block the osteoporosis and menopausal symptoms that will otherwise follow when I have my ovaries removed because of my cancer susceptibility mutation.

After much reflection, I have made the decision to take testosterone. I will thus become a female to male transsexual. This has been a difficult decision because I risk losing everything of importance to me: my reputation, my career, my friends and even my family.

Testosterone is a far from perfect solution; I’m still not going to be “normal” and social isolation will undoubtedly continue. But testosterone treatment offers the possibility that, for the first time in my life, I might feel comfortable with myself and not have to fake who I am anymore. I know that I am making the right decision because whenever I think about changing my gender role, I am flooded with feelings of relief.

I will begin taking testosterone in February. A change in my appearance will not be visible for several months. By summer, I will begin to dress in men’s clothes and will change my name to Ben.

Throughout this process I will continue to work normally and to conduct myself in all ways as usual (except that I will only use single-occupancy bathrooms). Although the idea of my changing sex will take some time for you to get used to, the reality is that I’m not going to change all that much. I’m still going to wear jeans and T-shirts and pretty much be the same person I always have been — it’s just that I am going to be a lot happier.

“In my heart I feel that I am a good scientist and teacher. I hope that, despite my trans sexuality, you will allow me to continue with the work that, as you all know, I love.”

Many transsexuals change jobs after their “sex change” in order to retain anonymity, but anonymity is obviously not an option for me — nor is it one I desire. I am tired of hiding who I am. More importantly I owe it to others who unknowingly endure this condition, as I did, to be visible.

Despite my seven years of medical training, which I undertook to understand what was wrong with me, until two months ago, I had never heard of gender dysphoria (oddly, I somehow picked the right organ to study!). Had it not been for the transsexual who allowed himself to be the subject of the news piece I read, I would still not know about it.

Sure I knew that sometimes there were male-to-female transsexuals, but I had thought that these people were perverts. I am not a pervert; I don’t seek pleasure — only relief from pain. Most transsexuals hide because of shame and fear, perpetuating ignorance and oppression about their condition. Their suicide rate is so high that some experts have called gender dysphoria a lethal disease. This is why I cannot hide.

In my heart I feel that I am a good scientist and teacher. I hope that, despite my trans sexuality, you will allow me to continue with the work that, as you all know, I love. I am happy to answer any questions.

Sincerely,

Barbara A. Barres

Despite support from David, Martin and Louis, sending out this letter was still very scary. I found that my family was immediately supportive and so were all of my colleagues. I heard back from many of them very quickly. Here is the very first response that I received. It is from Chuck Stevens at Salk, a colleague I had long admired for his science and his wonderfully generous mentorship of so many young scientists:

Dear Barbara,

Thanks for the letter and the personal info. I have always been fond of the person in there and the gender makes zero difference to me — I expect you will find the same with all of your friends. Let me know when to change to “Ben.”

Best regards,

Chuck

All of the other responses I received were similarly supportive. And there it was: This shameful secret I had held inside of me for 40 years was out, and within a few months I had transitioned to Ben … My career went on as before without a hitch. I am not aware of a single adverse thing that has happened to me in the past 20 years as a result of my being transgender, but there was the immediate relief of all emotional pain as a result of my transition.

Never did I think of suicide again and I felt much happier being myself (Ben), no longer having to pretend to be a woman. It is hard to explain how much relief I felt and how much happier I became. It was as if a huge weight had suddenly been lifted from my shoulders.