Originally developed to help amputees, the procedure has been modified so that a triangle of flesh, cut and rolled, can be made functional on a female pelvis. The operation involves complex severing and reattachment of veins and nerves, but if the procedure is a success, a transman -- the preferred term for a female who surgically becomes a male -- should have at least a partially operable penis.
But what keeps transmen from flocking to the Klinik Sanssouci in Germany, where rock-star surgeon Dr. Jean-Paul Daverio has performed 242 phalloplasties, is sheer cost. The BMW of artificial penises will set you back $48,000.
That's why most elect to go in for the cheaper, less risky alternative. Metoidioplasty involves working with the existing female equipment to make it all look and feel masculine -- without aiming for the full-size model.
Incisions free the clitoris (which enlarges somewhat, thanks to testosterone injections) from its base, and silicon implants in the labia are made to look like testicles. Sensation is great, standing up to urinate is possible, and hey -- lots of guys have small dicks.
It's hard not to be curious about this stuff, but it's not the kind of thing you want to ask Jake Nash about, because A) it's personal, and B) it's ancient history.
In 2002, after he'd been on intimate terms with urologists, endocrinologists, plastic surgeons, and psychiatrists for years, Massachusetts sealed his original birth certificate and issued him a new one that reads "Sex: Male." It was a moment of triumph, but primarily for symbolic reasons.
For all practical purposes, Jake already was a guy -- a sentimental, devoutly Christian guy -- to everyone who knew him. He had a serious girlfriend, a deep involvement in his church, and a job helping the mentally ill find work.
But the arrival of his updated birth certificate promised new happiness -- he and Erin Barr could finally be man and wife. Surgically transitioning from female to male is a radical act, but Jake is deeply conservative at heart. He didn't want to live in sin.
Yet Trumbull County Judge Thomas Swift was more interested in the organ between Jake's legs. He interrogated Jake in court on the particulars of his genitals. When Jake refused to answer, the judge refused to grant a marriage license. Despite the miracles of medicine, he ruled, Jake is still a woman.
Queer Girl/Straight Guy
Jake was once a mischievous little girl named Pamela, who liked to hide her uncle's car keys, put beans in her ears, and escape to the lake to go fishing.
But as much as she loved her funny niece, Martha Kaluback had a nagging feeling that something was wrong. Pamela never did get the hang of dating. Was her niece a lesbian? Martha wondered. She never said anything. Neither did anyone else. Their family was too conservative to talk openly about such things.
Pam knew that she wasn't a lesbian. Although she liked women, it wasn't that simple. She tried to fit in -- even married a man at age 31 -- but something felt fundamentally wrong.
A Discovery Channel documentary changed her life. She watched in amazement as men and women told stories that paralleled her experience. She saw people undergoing surgery and hormone therapy to change their sex, and for the first time in 33 years, she knew that happiness was possible.
It became a reality after she began treatment. And after she met Erin Nash -- a tough-minded West Virginia native -- it doubled.
Erin was five when her family moved to Warren. Her part-Seminole mother converted to Catholicism to give her children an uncompromising view of right and wrong, and Catholic school reinforced Erin's faith.
But as an adult, while attending a music festival, she met a Native American woman who made her curious about traditional Indian beliefs. Erin came to believe in the "two-spirit" tradition, which holds gay and transgendered people in high regard, because they are thought to have a special purpose.
Erin and Jake met on the internet in a Christian chat room. Weeks of instant messaging led to the discovery that they shared an appreciation for Broadway musicals, Robert Frost, and big dogs.
Three weeks into their electronic relationship, Jake broke the news: He was born a woman. To his surprise and delight, she told him about the two-spirit tradition.
After two months of e-mails, Erin found herself driving 12 hours to New Hampshire to meet Jake in person.
They liked each other, yet Erin drove home the next day. Jake was so uncomfortable and nervous, it was hard to relax around him, she remembers. He says that was partly because of sex -- they had never discussed it, and he didn't know what, if anything, was expected of him. Jake does not believe in sex before marriage, but he need not have worried-- Erin just wanted to talk and hang out.
They cut that first visit short, but on the drive home, Erin felt compelled to pull off the road. She called him from a pay phone, and they talked about faith, inhibitions, and relationships for three hours.
Over the ensuing months, they dated long-distance until Erin finally got on a plane to New Hampshire and brought her man back home to Warren in a U-Haul. A year later, Jake got down on one knee while a hired violinist played songs from Phantom of the Opera -- the tragic romance of a man who cannot show his face to anyone.
In retrospect, there is only one thing he would have done differently: He would have asked Erin to move to New England.
Instead, today they are fighting for the marriage license they applied for two years ago. It happened like this:
Jake moved to Trumbull County before he'd completed his sexual reassignment. But by that time, he'd received testosterone treatment for more than a year, so he looked, talked, and walked like a guy. Only his name was still Pam.
A name change is at the top of the agenda for most transmen, but Jake had a hard time settling on one. He wanted it to be something his mother liked, and he wanted it to have meaning. He decided on Jacob, after an Old Testament character who, he says, literally wrestled with God, refusing to let go until God gave him his blessing.
It would be a fitting metaphor, for his coming struggle would be not only with the men representing the law, but those representing God.
Jake moved in with Erin (they slept in separate beds) and got a job helping the mentally disabled. After the one-year residency requirement for name changes in Trumbull County was met, Pamela became Jacob.
He remembers Magistrate Thomas Norton asking hard questions about his gender, as if to impress upon him the seriousness of his petition. The magistrate read the doctors' and psychiatrists' letters that Jake pressed on him and, once satisfied, signed off on the change. It was a pivotal moment in Jake's life, but his task wasn't quite complete.
Jake's birth certificate would read "female" for another two years, while he endured rounds of arduous surgeries. When he was all sewn up and the doctors and shrinks had signed off on their work, he petitioned Massachusetts, his state of birth, to legally become a man. His original birth certificate was sealed, and a new one was issued.
Jake felt great. He liked his job, he was in love with Erin, and they'd found a church that satisfied his need for spiritual stringency. Warren's North-Mar Christian and Missionary Alliance Church follows an exacting interpretation of the Bible that appealed to him.
Erin and Jake were soon active members. Jake, who had once toured with the well-known gospel choir the Continental Singers, tried out for North-Mar's version, known as the Worship Team. He recalls the person in charge being delighted with his original guitar compositions.
Erin jumped in with both feet too, volunteering at the church day care on Sunday mornings. They joined a supper exchange for devout couples and went to premarital counseling sessions with a senior pastor.
That winter they set a wedding date -- August 31, 2002. Soon the pair was accepting hundreds of RSVPs from friends and family. The church was reserved, Jake's dad paid the deposit for the banquet hall, and a white limousine was hired.
But they didn't foresee the storm clouds ahead.
Trouble in Eden
Soon after reserving the church, Jake says, he received a disturbing call from Pastor John Temple, who had counseled the couple and was supposed to marry them.
"I was told your name used to be Pamela," Jake recalls Temple saying. "Have you been truthful with me?"
When Jake stammered that he had been truthful, Temple lost his tact: "Do you have a penis?"
The groom-to-be was humiliated. Had it been anyone else, he might have lost his cool, but he respected the man who had been his confidant for almost a year. Jake says he mumbled something vague about a medical condition; about having had some problems "correcting" his anatomy. He doesn't remember exactly what was said after that, because he suddenly felt sick to his stomach.
The pair says that Temple wanted to get Jake, Erin, and Jake's "accuser" -- Temple refused to name her, but Erin believes it was one of her stepsisters -- together to lay everything on the table. Jake refused, considering it beneath his dignity.
So that week, Erin met with the pastor and his wife alone. She came home in a rage, reporting that the pastor had said he would do everything in his power to help her get out of the relationship, because Jake was clearly "possessed." Temple told her that he had encountered another parishioner like Jake, who had been married at North-Mar before he got there, and that he had personally tried to get their marriage annulled.
When Erin made it clear that she didn't want the pastor's help, she was told that they were no longer welcome to participate in church activities. She couldn't work in the nursery, and Jake would be asked to leave the choir. They could come to services, but that was all.
Jake was scared. He felt intuitively that a preacher like Temple, an excitable conservative activist, would not keep this information under his hat. "I knew we hadn't heard the last of him," Jake says.
Temple tells an entirely different story: He never provided premarital counseling, and he never agreed to marry them. He also goes to great lengths to distance his church from the couple. There is a difference between people who simply show up on Sundays, he argues, and those who are "true members of the congregation." Erin and Jake were never true members.
But he's clearly unnerved by the subject. He refused to let a reporter speak with anyone involved with the church, and he cut short two interviews with Scene.
Of course, it could be embarrassing for Temple to acknowledge that he had allowed someone "possessed" to sing in his choir and mix in his Bible groups, without his having a clue.
When told of Temple's response, Erin says simply, "We pray for him."
The Incredible Disintegrating Wedding
Erin and Jake found a new church in Warren, with a supportive pastor who didn't have a problem with Jake's sexuality. (The couple refuses to give up the minister's name, for fear that it might cause him trouble.) He agreed to preside over their wedding, which was then a few months away.
But having survived the hit from Preacher Temple, they were about to get slammed by the state.
In August 2002, Erin and Jake filled out their marriage-license application for the Trumbull County Clerk of Courts. Erin remembers being in a rush because she had a 4:30 hair appointment. They paid the $44 dollars, swore the oath, and made arrangements to pick up the license. A week later, everything went wrong.
When Jake returned to the courthouse, a clerk quickly fetched Magistrate Thomas Norton, who informed Jake that the county would not sanction the marriage.
Apparently, when Jake's Social Security number was entered into a computer, his former name popped up. Norton considered Jake a woman, and same-sex marriage is prohibited. (The magistrate declined comment.)
Jake was humiliated again. He remembers saying something like "That has been corrected." But even after being shown Jake's new birth certificate, Norton was unmoved.
Jake was late picking up Erin, who worked in the billing department of a Youngstown medical-equipment company. When he arrived, he found her surrounded by a gaggle of excited co-workers. She wanted to see the license, but before she could get the question out, he shook his head no. Her face crumpled, and they drove home in silence.
They decided to go ahead with the ceremony. Both Erin and Jake have close families, and Jake was expecting a sizable Massachusetts contingent. They put their energies into making the day as special as possible, license or no. But once again, the holy man chickened out.
On the 6 o'clock news, Judge Thomas Swift had explained to a Channel 33 reporter that Magistrate Norton had made the right decision -- no matter what Massachusetts says, Jake was still a woman. It was the lead story, and that week other TV stations and the newspapers picked it up. The couple became the target of gawkers throughout Warren.
The publicity scared their new pastor. When they showed up at church that Sunday, eight days before the wedding, he requested a private meeting, in which he told them that he was unable to follow through. The two don't want to speak ill of him, because they believe that he personally supported their union. A group of deacons pressured him into backing out, says Erin.
But with no pastor, the ceremony seemed doomed. Worse, members of the wedding party were dropping like flies. They lost a groomsman, who was freaked out about the newscast. Then they lost the little ringbearer, Erin's five-year-old nephew, whose father had a change of heart. After the newscast -- to the chagrin of his wife and the rest of his family -- he announced that he wasn't going to let his kid participate in the wedding of "two fags."
Then Erin's best friend and maid of honor apologetically explained that, as a schoolteacher, she couldn't afford the negative publicity.
Disaster seemed imminent. The day before the ceremony, Erin was poring through the Trumbull County phone book, looking for a preacher. She finally reached Reverend Rick Schumacher of the Unity Church Center in Liberty Township. To her relief, he was not interested in the history of her fiancé's organs. The unusual couple came to him for help, and he was glad to give it. But because there was no license, he officiated over a commitment ceremony, not a wedding.
The lack of paperwork didn't make much difference to the 150 guests. Jake's uncle, Mike Kaluback, in a Boston tough-guy accent, calls Schumacher "an absolute je-wel!" and says that in spite of the glitches, they "pulled it off good."
Belinda Stein, Erin's aunt, remembers how loved ones rallied to make the ceremony a success: Erin's niece and the child of a friend eagerly took on the missing ringbearer's duties. Erin's little sister was upgraded to maid of honor.
Yet Belinda, a Catholic, still finds herself having to defend the couple. She gives the example of a family member who wouldn't stop arguing that Jake is really a woman and that to endorse a "gay" marriage would be a sin.
"I know people disagree," Belinda says. "But I believe some people are born into the wrong sex. Now that we have [the technology] . . . they have the right to change it."
More important than Jake's surgically altered anatomy is the loving way he treats Erin, she says. The doting aunt likes what she sees: He buys her niece flowers for no reason.
Jake's family seems to agree that the two are good together. Martha Kaluback, Jake's aunt, says that she never was able to pinpoint exactly what made her sister's oldest child seem so awkward. But since Jake found Erin, he seems more content in his own skin.
Martha remembers unhappier days. About 15 years ago, when Jake was in his early 20s, his sister had to be fitted for her wedding dress. It was decided that Jake -- who was then Pam -- would try on a dress as well. The gown was beautiful, Martha remembers, but when Jake saw his reflection in the mirror, he broke down crying. His aunt didn't know what to make of it, but in retrospect, Martha considers it a telling moment.
Here Comes the Judge
The Defense of Marriage Act was still just a twinkle in state Representative Bill Seitz's eye when Magistrate Norton refused to sign the license, but the court's stand was unremarkable: Gay marriage is still not legal in any state.
More interesting is Trumbull County's decision to label Jake female, despite the fact that Massachusetts has judged him male. Most recently, Judge Diane Grendell of the 11th Ohio District agreed that Jacob and Erin are a same-sex couple. Their lawyer, Randi Barnabee, says they are now contemplating a federal suit against Ohio for refusing to recognize the Massachusetts birth certificate.
"Like most states, Massachusetts lets physicians make these decisions," says Barnabee. "According to the Constitution, Ohio has to accept Massachusetts' [legal documents]."
Yet Ohio happens to be one of only three states that resist changing birth certificates retroactively. One thing is certain: Transsexuals occupy a shadowy legal space.
Sexual reassignment has been viable for only a few decades, and there are no laws explicitly banning unions of transgendered people. Transsexuals marry all the time -- sometimes to people of their own sex, sometimes to people of the opposite sex, depending upon the vigilance or mores of the county clerk who signs the paperwork.
But Barnabee cautions against losing sight of the person under the microscope. From the first hearing on, Jake's loved ones say, he has been studied and scrutinized like a lab monkey.
At the initial hearing on the license, held less than a week after the ceremony, Judge Swift asked Jake point-blank about his organs and surgeries. Sitting attentively in the courtroom was Pastor John Temple.
Understandably, Jake found the questioning intrusive. Barnabee advised her client to stay silent.
In the end, however, the judge chose not to rule against Jake and Erin on the basis of Jake's toolbox. He used Jake's previous marriage instead.
Skeleton in the Closet
Before Jake met Erin -- and when he was still called Pam -- he was briefly married to a man in New Hampshire. It ended in divorce, and although Erin knew about it, the two never discussed it. Regrettably, when Erin filled out the probate clerk's questionnaire, she checked "no" to the question of whether either of them had been married before. Jake didn't notice.
Erin says that her fiancé's former life had completely slipped her mind, because the man she loves has never been married to another woman.
After Magistrate Norton gave them the bad news, they submitted an amended application, with Jake's former marriage and divorce duly noted. The court accepted the new paperwork, but Judge Swift would cite their original failure to disclose in ruling against them.
Barnabee says that the whole thing is a moot point anyway. The judge had already made up his mind, she believes, and was just looking for reasons to support his decision.
Now that Grendell has denied their appeal, Jake and Erin have one card left to play: They can sue in federal court to force Ohio to abide by Massachusetts' ruling.
The court battle has taken a toll on Jake's health. He suffers from debilitating ulcers and relies on monthly disability checks to pay the bills.
There have been bright spots. Thanks to the internet, they've spoken with many others in similar situations, and last year Jake and Erin surrounded themselves with nearly 1,000 transmen at the True Spirit Conference in Washington, D.C. For the first time, Jake and Erin hooked up with Christians they knew from their transsexual Yahoo group.
The pair has since been introduced to another church in Akron, Emmanuel Fellowship. The now-retired pastor is a lesbian, but members stick to a mostly literal interpretation of scripture. Jake has even taken a leadership role: He was asked to be a part of the search committee for a new preacher.
Unfortunately, the prognosis for getting married remains poor. The couple could move to another state and try their luck where nobody knows them, but that would be a lonely road. And there's no guarantee that their Ohio experiences wouldn't be repeated.
They're suffering from battle fatigue, but they know that fighting it out in federal court could benefit others down the road. Then there's the issue of children. Erin remembers what she told a television reporter who asked her why they didn't just back down and settle for "living together."
"Because if we decide to have them, we want our kids to know we loved them enough to do this," she said.