Out On The Couch
By Jacob Rostovsky, MA
Keywords: Gay, Transgender, Penis
For some individuals, to be a transgender male (someone who is assigned female at birth and identifies as male) in this time is hard enough. But when you add in identifying as gay (attracted to men and identifying as male), it can make life even more difficult. As a transgender gay male, I know this first hand. As a therapist who has worked with many transgender men who also identify as gay, I know that it is common for gay trans men to experience a flooding of thoughts when being out in the gay male community. Some of these involve anxiety and fear, especially when going to bars and clubs. Most of these clients share the fear that not having a penis could put them in a precarious situation. Their thoughts generally fall into the following themes:
- Would someone find out they don’t have a penis?
- Would someone hurt them, or even sexually assault them, because they don’t have a penis?
- Will they be able to go to the bathroom without worry and bother?
- Is someone going to make rude comments, or fetishizing ones, or tell them they don’t belong?
- How much of their night is going to be spent in this state of anxiety?
- Does the cost of experiencing these thoughts outweigh the benefits of going out?
These fears are not completely irrational and often come from previous negative experiences. Often these clients end up giving in to anxiety and cancelling their plans in order to stay home where they feel safe. Of course, this can lead to feelings of shame, envy (toward friends and individuals who do get to go out and enjoy themselves), and defeat. I think of this experience as a kind of “penis envy” that differs from the traditional Freudian concept.
Let us take a moment to define envy as it will be used in this article. In a broader psychological sense, envy is a state of mind in which you experience yourself desiring the advantage or privilege that another individual, usually someone who you admire, has. This advantage is often granted from something the individual is born with, like a personality trait or physical part of the body. In this article, I look at the relationship between transgender male individuals and their envy toward cisgender males and the many perceived advantages they have simply because they were born with a penis. These advantages could look like the ease to use the restroom without giving it a second thought, or more easily navigating sexual relationships. While subtle, this envy often occupies the mind for a great while and stays with the individual for a long period of time, often coming with the individual regardless of their current situation.
Envy adds to feelings of shame. This shame builds up over time and leads to feelings of persecution, frustration, guilt, and what I’ve most commonly seen in transgender males who identify as gay; self sabotage. Envy can be frustrating for an individual because quite often we admire the same people we are envious of. When you are trans male and gay identified, this admiration could also be feelings of sexual attraction or romantic desire. When rejected by someone who you envy, it makes these feelings even more difficult to sit with.
For transgender male individuals, gay identified or not, the negative symptoms of penis envy seem to develop rapidly. These symptoms usually look like heightened feelings of anxiety and depression that prevent individuals from leaving the house and mimic the hyperarousal and fear states commonly seen in PTSD. In the extreme stages, these feelings become panic. Unfortunately, there aren’t a lot of spaces for transgender gay men to discuss their fear, shame, and envy outside of the therapy room. Therefore, it’s highly necessary for therapists to be able to understand where these feelings and processes come from in order to avoid situations like the one described above. Being informed about this kind of thought process and how it shows up differently in people is extremely important. It’s time to open our minds and understand this different form of penis envy.
Many gay transgender males feel envious of the freedom that being assigned male at birth offers a person. This feeling comes from a desire to experience the freedom to be in spaces that require a penis to fully let your guard down. It also comes from the desire to walk into a gay bar and know that if there aren’t stalls on the door you can still pee. Some trans males carry around a feeling of being less-than alongside the knowledge that they are not able to share a common connection with someone based on having the same genitals and understanding what it feels like to have them.
Transgender gay men are not the only type of gay man who experience this type of penis envy. In fact, it also runs rampant amongst cisgender men who identify as gay. As a society, it’s not something we talk about. How could cisgender gay men be experiencing negative mental health symptoms directly related to something thing that defines them as gay men? I’ve seen this type of envy lead to heightened anxiety, depression, isolation, and unhealthy sexual behaviors. I’ve heard cisgender male clients talk about their self-esteem being drastically lowered in a matter of seconds because they assume their penises are not good enough because they didn’t get the response they were looking for when sending a dick pic. While not true of all gay men, many that I’ve known and worked with base their value on their penis. Thus, if their penis isn’t enough then how can they be enough?
The dick pic, while not exclusively found in the gay male community, is treated as a type of currency by gay men. Many relationships begin with the exchange of pictures online of each other’s penises. Transgender men who have not had penis related surgery such as phalloplasty and metoidioplasty, do not have the option of sending a dick pic. I’ve listened to clients who have witnessed the fetishizing of one’s self and others based on penis size. Others report feeling inadequate because their penis may look different than the ones they’re used to seeing. Cisgender gay male clients have told me of times they’ve engaged in using a large number of drugs to maintain an erection for hours and hours of sex, because their penis is one of the only tools they feel gives them worth. There still aren’t enough data or anecdotes about how transgender gay men fit into this scenario. The cisgender gay male community is also facing issues around internalized misandry (Nathanson & Young, 2006). Due to a lack of transgender gay role models, many transgender gay men learn what it means to be gay identified from watching and emulating cisgender gay men.
In my own experience working with the transgender gay male population, a lot of time in therapy is spent revolving around self-love and exploration. This is achieved by providing a safe enough space to have an open and honest dialogue about what it means to be a gay male who was assigned female at birth. One of the key aspects to providing this safe enough space is being as educated as you possibly can about transgender individuals while still being able to leave all of that information outside of the therapy room when needed. This means having the knowledge to understand the fundamentals around transgender identity while also acknowledging that those fundamentals do not apply to everyone’s personal journey. For example, we are taught as clinicians that in order to be diagnosed with gender dysphoria one must have a “strong dislike of their sexual anatomy.” However, there are plenty of transgender men, gay or not, who love their vaginas. They love how it looks and how it makes them feel.
To add further complexity, transgender individuals can both love their anatomy and wish to experience what life would be like if it was different. Many therapists don’t understand this concept and may try to convince their client that they hate their body parts, or the therapist could discount penis related feelings of jealousy and shame because the client also experiences positive feelings associated to their vagina. When a therapist questions their client’s reported dysphoria and envy, this enhances the anxiety and depression the client is feeling rather than lowering it.
With all this mentioned, I have also noticed that many therapists have a hard time understanding how gay identified transgender men are satisfied with their sex lives, or how their cisgender partners get fulfillment. I see a lot of problems associated with this lack of understanding throughout the many trans male clients I’ve worked with. Here’s a sample vignette that might help clarify. A transgender gay man and his partner are attending couple’s therapy to work on issues unrelated to sexual intimacy with another therapist. I see the transgender gay male in individual therapy. My client then comes to me one week distressed because the couples therapist spent the whole session trying to convince my client and his partner that their sex lives were lacking because there was a missing penis, and after all, gay men need penises in their lives to feel fulfilled. Up until that point, my client and his partner never gave thought to the idea that the lack of another penis in the bedroom may be less fulfilling sexually. In fact, my client was fully satisfied with his anatomy and never felt fear or envy. But because of the therapist’s prodding and insisting that there had to be something missing in the relationship, my client began to question everything he once thought about himself and his relationship to being both transgender and gay. Now, my client has begun to question how truthful his partner was about the lack of penis in the bedroom and thus begins a cycle of self-doubt and shame.
As clinicians, it’s extremely important to familiarize ourselves with issues the transgender community faces beyond the more common topics such as coming out and approval for medical transition. From a professional and personal account, there is nothing worse than spending time trying to educate a therapist on a topic instead of being able to process it. When it comes to the transgender gay male community specifically, the work can involve, but not be limited to, processing grief around lack of anatomy, addressing internalized shame, working on resilience and processing the need to assess for safety in mostly cisgender gay male spaces. In future articles I will explore what these processes can look like for clinicians and their clients. Our job as clinicians is to create an environment in the room, regardless of theoretical orientation, that allows our clients to explore these ideas without fear or judgement. To be educated and aware of the not so common topics is incredibly affirming and validating for clients. This article only begins to address the idea of working with the envy and jealousy transgender gay men often face around not having a penis at birth. There is still so much exploration to do around the anxiety, depression and fear that comes with being a part cisgender gay male spaces and the community as a whole. It is my hope that as clinicians we continue taking active steps in educating ourselves about the topics in this article and continue the appropriate processing and dialogue not only with our clients but with each other.
Learn More about working with Transgender and Nonbinary Clients
Nathanson, P., & Young, K. (2006). Spreading misandry. Montreal: McGill-Queen’s University Press.