In Focus

www.thelancet.com/diabetes-endocrinology Published online April 25, 2014 http://dx.doi.org/10.1016/S2213-8587(14)70094-4 1

Loneliness, confusion, unhappiness, and fear. These emotions are just some of those reported by young people growing up with gender dysphoria—a condition in which an individual does not feel that their biological sex and gender identity match. But in New Haven, CT, USA, children and teenagers facing this diffi cult issue do not have to do so alone. Tony Ferraiolo has dedicated his life to ensuring they feel supported and understood, as a documentary entitled A Self-Made Man shows.

Lori Petchers’ fi lm opens with Tony explaining that although he was born a girl, he always felt that he was a boy. He recalls going outside to play football when aged 5 or 6 years, and taking his shirt off when his brother did. Tony’s mother explained that “only boys take their shirts off ”, but Tony did not understand why he could not act like the other boys did. In scenes dotted throughout the fi lm, Tony explains that living as a girl and then a woman made him incredibly unhappy; he intended to end his life on several occasions. After 41 years living as a woman, Tony transitioned in 2005. As a female-to-male transgender person, he now feels like his mind and body match.

However, when he fi nally realised who he was and what he wanted to do (after watching a documentary about a transgender man), Tony explains that he was afraid because he did not know anyone else who had transitioned. In 2008, Tony began two groups to provide somewhere for young children and teenagers to go to discuss their feelings and learn about how to move forwards with their lives: Create Yourself is an art group for children younger than 12 years, and Translation is a support group for transgender teenagers. These gatherings, along with sessions of a support group for parents called TransPACT, feature heavily in Petchers’ documentary.

Early in the fi lm, Tony is shown leading a session in which teenagers are asked to share their stories and openly discuss issues aff ecting their day-to-day lives. The viewer quickly gets the sense that members of the group feel safe and almost relieved to be able to talk about how they feel without judgment. By contrast, talking is not a big part of the sessions with the younger children, because Tony wants to give them the opportunity to just do art in a loving environment. The children and teenagers are shown laughing and having fun in their group sessions, which contrasts starkly with Tony’s recollections of his own childhood and life before transition. Petchers adeptly cuts between lighter scenes and those in which Tony talks about his unhappiness when he was young.

Full gender-confi rming surgery is expensive, and Tony explains to the camera that many transgender boys use binding to fl atten their chests while they raise the money.

In one scene, Tony is shown off ering teenagers free binding, and the excitement is palpable. Hormone therapy can be an important part of a full transition: gonadotrophin-releasing hormone analogues can be used to suppress puberty, and testosterone and oestrogen are used to alter physical appearances and how an individual feels. However, one of Tony’s friends explains that there is a lot of confusion even in the transgender community about what happens when individuals start using hormone therapy. Viewers see a group discussion, in which teenagers—clearly relaxed—discuss the pros and cons of hormone therapy. They bat ideas back and forth, and the laughter is infectious. As at other times in the fi lm, Petchers provides a contrast by fi lming Tony alone in his bathroom injecting himself with testosterone. He then sits talking to his friend Dru—also a transgender man—about the physical changes caused by testosterone therapy. This scene is one of the only ones in which Tony struggles to talk to the camera, and Dru is the one to explain the eff ects of the hormone on their sex lives.

Petchers does not touch on Tony’s work with the Jim Collins Foundation, which provides fi nancial assistance for gender-confi rming surgeries. The non-profi t organisation gained worldwide media attention in 2013, when college student Donnie Collins pledged to donate surplus funds from the fraternity house campaign to raise money for his surgery. But Petchers’ focus on Tony and his support groups means that she is able to show him in both his most outgoing and quiet moments, and the viewer gets a sense for the internal confl icts that aff ect transgender individuals. Overall, A Self-Made Man is a truly moving documentary that depicts a kind, passionate person working to better the wellbeing of young people. Tony is giving young people the opportunity to create themselves, as he once did himself.

Abi Cantor

FilmHow to create yourself

Lancet Diabetes Endocrinol 2014

Published OnlineApril 25, 2014http://dx.doi.org/10.1016/S2213-8587(14)70094-4

A Self-Made Man, directed by Lori Petchers, 2013. USA, 56 min

For more on the Jim Collins Foundation see http://jimcollinsfoundation.org

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