Fifty Shades of Gender podcast graphic with Alys Wilfred Earl (2)
This is the second conversation with Fred for the podcast – you can find the first one from December 2018 (episode 2) here if you’d like to listen to that first.

Episode 9

Another conversation with Alys Wilfred Earl


32 min. Recorded on 25 August 2020.

Alys Wilfred’s (Fred’s) pronouns are still they/them or xie/xir (or he/him if you insist), and they identify as trans-masculine, non-binary and genderfluid.

We talk about the minor and major effects of testosterone (or T) injections including voice changes and mental health, body dysmorphia versus gender dysphoria, recovering from top surgery and being topless, options for bottom surgery (phalloplasty versus metoidioplasty or meta for short), and why the term ’sex change’ doesn’t do it justice.

“People quite often refer to this sort of thing as a “sex change”…my experience of it has been a lot more; a sort of curative set of therapies where rather than becoming somebody else, I was actually permitted to inhabit the world as myself.”

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TRANSCRIPT [expand to read]

Esther: Hello and welcome! What’s your name?

Fred: Hi, I am Alys Wilfred and I am back. This is a re-recording.

Esther: Yay! That’s right, that’s right. So the last time we spoke, or the episode we recorded, was I believe it was in December 2018, so that is quite a while ago, that is like a year and a half ago, or a bit more. So tell us what has been happening?

Fred: So when we last spoke I was about to start hormone replacement therapy in testosterone, and I was a a couple of weeks away from that, so now I have been on that for nearly two years. I have also had some gender-confirming surgery, top surgery, it is called a bilateral mastectomy, which was back in March this year. So the sort of physical state of my being has changed a lot. My voice, I am sure anyone listening can tell, has dropped an awful amount.

Esther: Yes.

Fred: It has been a time of real, quite intense, change, people quite often call it a second puberty. It has felt a lot that way, let’s be honest.

Esther: That sounds bad, I mean remember the first one I had and that was bad enough to be fair {laughing}. What’s that been like?

Fred: It has been intense; I am not going to lie. It is very odd; hormones have a much bigger part to play in our mental health than people realise. Something I noticed after I had my first t-shot [testosterone-shot] was just about ten minutes later, this sense of enormous calmness and wellbeing, just sort of tingling through and I can tell when I am getting towards the end of a cycle because I get really tired and a bit irritable and sometimes a bit weepy. It is quite interesting, I have got a 28-day cycle still, which is familiar at least.

Esther: You mean between injections, are you still having testosterone injections?

Fred: Yes—they are four-weekly, so, I could get very technical about all of it!

Esther: Feel free to get a bit technical, anything that you think is useful for other people to know and understand about it really.

Fred: The drug I am on is called ‘Sustanon’, which is a synthetic testosterone and it is an intramuscular injection every four weeks as sort of your base line and then they adjust your levels regarding that. I haven’t been able to have my levels checked this summer, which was meant to happen, but my last two lots have been normal, so they say about four weeks seems to be about right for me. What that does then is it suppresses my oestrogen cycle so that I don’t menstruate any more and makes the dominant sex hormone in my body testosterone. With a cis [cisgender] guy, their testosterone tends to be highest in the morning, peak then, and then drop off through the day and have this jagged cycle. But obviously, if you are having four-weekly injections you have this large peak at the beginning of the month that slowly drops off. It is quite interesting following that but, as I said, 28-day hormone cycles are quite familiar to anyone who has been through what they call female puberty.

Esther: Yeah! What else have you noticed since taking testosterone? Has anything else major changed? Because you said about hormones having a very big influence on mood. So what else have you noticed?

Fred: So my mental health is a lot better, I don’t get so much anxiety anymore, I feel just a lot more comfortable. Before I went on HRT I kind of referred to it as ‘magic T’, everyone seemed to act like it solved all their problems and what I didn’t realise is that it sort of does! It is the most remarkable stuff, it is almost like I have been running on slightly the wrong fuel, you know how with old cars if you put premium fuel in once in a while they quite like it. It is a bit like that. My body is going, ‘yep, that was the stuff, we just didn’t have enough of that. Here, have fewer personality disorders’.

Esther: {laughing} That’s nice, thank you!

Fred: It is really lovely. I get tired less often. I get less anxious; I am less depressed. I still have depression, it has not magically cured it, but it is much easier to manage.

Yeah, and then obviously there are all the physical changes, my voice broke, which was probably the hardest bit of it for me, and it is still not back to…I still don’t have the control and sort of the possession of it that I used to have. I don’t always know where my voice is and that is still an ongoing process. I have gained a fair bit of muscle mass which is always really nice. Exercise works better with a higher ‘T’ [testosterone] level, it feels very unjust. I am hairier, which is a mixed blessing. Smellier, so much smellier! (God I have to shower probably about twice a day now!) It is so bad, honestly. Before I had top surgery, so last summer, I would be wearing my binder and there was no way my body could be cool enough, you run hotter on testosterone. It is only by a little bit but if you have got that kind of tight, restricting, garment on, you just kind of melt which is horrible. Facial hair which is a win, and I haven’t gone bald, which is also a win, because that is one of the risks.

It is just that… it is odd, people quite often talk about ‘T’ [testosterone] as, it is quite an aggressive hormone, it doesn’t make you aggressive as a person but it enacts change; everybody has oestrogen and testosterone in their bodies but testosterone is a very active hormone so it causes bodily change to your metabolism, to your mood, to your physicality, it is what triggers the male-pattern-baldness gene. It causes, and this might be a bit TMI, but it causes genital changes as well. Obviously, it suppresses your oestrogen, so it stops your menstrual cycle, it redistributes fat. Whereas oestrogen is a much, it is a changing hormone, but it is far more of a baseline hormone for the human condition regardless of your birth sex. It doesn’t cause the same level of changes, people quite often say for trans-masculine people that is the main part of your transition, whereas I know for trans-feminine people often surgery plays a much bigger role. So the big difference I have noticed is that, even though I am only five foot three, most people read me as male now.

Esther: So going back to what you said about your voice, and that is that it is a bit unpredictable, almost, that is a curious thing. Is it almost like you have to get your voice all over, can you speak a bit more about that?

Fred: Yeah, yeah. It was one of the big unpredictable changes, they don’t know what you voice will do. It will drop but they cannot tell you how swiftly, by how much, by any kind of recognisable measure. One thing people got hold of is, ‘what do the men in your family sound like?’. Even that you don’t know, it is going to be how it goes. I used to have a contralto voice, so quite a low woman’s voice. And very, very, rapidly it started to drop, possibly because of the way I used my voice, I am not sure. I had a really rough break and I think a lot of trans-men, trans-masculine people, because they are using the gels, the testosterone gel, it breaks more gradually. Whereas I essentially lost my voice, I was very croaky, very tight, very sore, speaking became very, very, painful.

Esther: Really?

Fred: You would go to make a sound and you wouldn’t be able to depict where that would come out, which obviously for a performer is quite a distressing thing, it is something I rely on, knowing when my voice is going to come out. I had some speech and language therapy which was absolutely brilliant and it talked a lot about relaxing and carrying your voice in your body, and finding ways of relaxing the muscles in my throat and my back, which meant I was carrying it a lot more from lower that gave me a lot more control. What it meant was that I would get used to it being where it was, I had this lovely tenor voice for about six weeks, it was absolutely beautiful, and I knew exactly where everything was, and I could sing, and it was great and then it dropped again. {laughing} It just kept on doing this for a bit and it seems to have settled where it is now, it still sort of wobbles a bit but not anything like it was at first.

Esther: So is it relatively stable now? Has it been consistent for a while now?

Fred: Yeah, they say two to five years, for the major changes but it is the first two years and I am nearing the end of that now.

Esther: Wow that is incredible. So you also mentioned top surgery earlier this year, what has that been like for you?

Fred: I mean, life-changing. It is hard to quantify quite how life-changing considering I came out of surgery into lockdown, which was fun, but it was just the drop in body dysphoria, distress, is enormous. The fact that I can look at and touch and accept the presence of my chest without having to do a lot of mental self-care is very difficult to quantify it for somebody who has not been through it. It is almost the equivalent of taking off a very uncomfortable jumper or a stone out of your shoe, or something like that. It is the persistent pain that you have just got used to being there stopping—just the brain quiet of that. The surgery itself was quite straightforward, I went to Mr Kneeshaw in Hull, he does private work, he also does surgery on the NHS. He is one of the best guys in the business, very professional, a very, very, nice man. It was really lovely, and everyone was really respectful and kind. I know some people have quite dehumanising experiences in surgery, it was nothing like that, but then obviously I was off my face on codeine for two weeks, you know. The world was being very, very, strange and so I have not quite come down from that.

Esther: So you just mentioned, actually what was it? I am thinking of the terms, is it, ‘gender dysphoria’ and ‘body dysmorphia’, is that right? Did you experience both? Or mostly just one? What was that like for you?

Fred: So, gender dysphoria is the feeling of unease in one’s body as a result of gendered characteristics or perception. And then there is body dysmorphia which is perceiving your body in a way that it is not—that is quite common in eating disorders. So you perceive yourself as really bloated or really scrawny or really kind of… therefore you do things to… Quite often they run together I think in transgender mental health, in that it is very hard to know where one begins, and one ends. I think part of that is because in your head when you think about your body you see it differently to how it appears in the world. So seeing it in the mirror as how it is, or seeing it looking down as how it is, can create this feeling of absolute alienation and horror. And it is that body dysmorphia or is that gender dysphoria? Or is it body dysmorphia caused by gender dysphoria? And I couldn’t say with any real confidence other than that is bloody horrid! Whatever it is and however it happens. And certainly, one aspect of it for me was hormone imbalance which I did not expect, my background dysphoria pretty much evaporated about a week after I started on ‘T’.

Esther: That’s amazing.

Fred: Yes, there isn’t really a lot I can say to explain it, it is just that my body was like, ‘yeah, you don’t have this anymore’. Everything because a lot more manageable but then obviously there was the physical reality of my body causing distress in other ways and it almost made that aspect of it sharper because I wasn’t constantly aware of my body being wrong, of myself being slightly at odds with itself. It was instead that kind of clicking into place of my mental image of myself and my feeling of myself in my skin, so when I looked down and see breasts, my brain just sort of went into a kind of meltdown, if that makes sense?

Esther: Yeah it does. What you said about, what I remember from what you just said that really stood out, was having this stone in your shoe that is just annoying and you can’t get it out. I think that is a very relatable thing and most people can know the horror of that even though it is a small thing or seems like a small thing but it is constant, it is persistent and grating and that kind of thing.

Fred: Yes, yes. I quite often try to come up with analogies for transgender experience for people who haven’t felt it, who say, ‘how can you feel like you are in the wrong body?’. And I don’t feel like I am in the wrong body, I just sometimes feel like my body is wrong. Another example I use is when you are walking up a flight of stairs and you expect there to be a step and there isn’t. Or you forget that there is another step at the top and it is that sudden bringing to and that sense of loss of balance, because what is happening in the world doesn’t match.

Esther: So I wondered about how things have been with your family? How is everyone else getting used to the new you in a way, how has that been?

Fred: That has been in terms of extended family I have barely seen them.

Esther: Because of lockdown.

Fred: Because of the lockdown. So that is going to be quite an interesting one when we are free to move and meet. I am asthmatic so I have been, not shielding but being very careful about being out and about. The people I live with, my children thought it was intensely gross when I took my bandages off, when I pointed out to them that they didn’t have to come into the bathroom while I was doing it! {laughing} So that big tearful reveal that a lot of trans people put on their instagram that is all very moving was interrupted for me by children charging into the bathroom {laughing} and they told me I looked like Frankenstein.

Esther: Right!

Fred: They are fine with it now. I think healing surgical stuff is quite upsetting for children to see, I don’t think they like that kind of reminder of vulnerable bodies, but they were very sort of blasé about it now that it has healed. I think kids are lots more resilient than we given them credit for.

Esther: Yeah, so they are all used to it now?

Fred: Yes. It is quite hard on a relationship. There are all sorts of things that I couldn’t do. I couldn’t sleep on my side for a very long time. For the first few weeks I had to make this little throne of cushions around me so that I could sleep sitting up, to stop me rolling in the night, because that can pull stitches and all manner of horrible things. And so shifting from, obviously I sleep with my partner, and I am apparently quite cuddly in the night, so not having that for a long time and then being able to do it again when I was half way better but not being able to turn very comfortably and getting quite sore was really hard.

My spouse is very supportive and has been lovely throughout, but that particularly was hard, it is the physicality of being in the world. You can’t do an exuberant hug, for the first weeks you can’t lift your hands about your head. And I am a very active person and quite independent in a lot of ways and it was really tough trying to get somebody to do literally everything for me.

What has been absolutely lovely is, on some of the hot days we have had, being able to go to the beach and swim now it is better.

Esther: Oh lovely yeah. So how are you with that? You can be, I assume, are you happy being topless in a situation where you are all on the beach and stuff?

Fred: I think the trouble people are having is getting me to keep a shirt on these days.

Esther: {laughing} Oh you hussy!

Fred: Yes absolute disaster of a person! It is customary to do five buttons on your shirt up, I know lots of people leave the top one undone but…! It is just really nice!

Esther: Yeah, that must be very different because obviously guys are used to that in a very different way, it is not something that women do or can do or allowed to do.

Fred: No and it has been very strange balancing the innate embarrassment of having my chest out with the literally no one is going to bat an eyelid.

Esther: How do you feel yourself? I assume when you went to the beach you were topless at some point, how was that? How did you experience that yourself, leaving aside the feelings or reactions you might get from others, I am sure that doesn’t go unnoticed as it were, but how does it feel for you?

Fred: It felt, certainly the first couple of times, quite vulnerable. There is a huge mental block I think if you have been told, ‘you must absolutely cover your chest at all times, it is completely indecent to have it on display’, and in fact the dysphoria of having your chest out makes you panic and makes you enormously uncomfortable and can lead to all sorts of self loathing and fear and upset. Then, ‘no it is fine, you can just take your top off’. Not only are you allowed you are not going to have this whole emotional backlash against yourself, was really scary the first couple of times, but then I got in the sea and it was lovely. So…

Esther: That makes a lot of sense actually. As a woman you are just used to…it is not something you do. You don’t just go and take your top off anywhere because that is just not… I can’t even imagine it myself. In a way even though, you might have had that all changed surgically, but the feelings of that might take a bit longer to go away?

Fred: No, not automatically, they don’t, they don’t just vanish, so that was an adjustment and I think it will be, it will come up again when. for example, I am able to go swimming in a public swimming pool.

Esther: Yeah, the next level of it.

Fred: Yeah because when you are on a beach you are away from other people; it is not big a deal.

Esther: Moving forward, are you planning any more alterations or are you quite happy with the way things are now? Or are you just going to see how it develops? What are your thoughts on it?

Fred: So this is, this is really what I am thinking about at the moment. Currently I am being read almost all the time as male, which is quite quiet in my head, it is lacking in stress and I admit I quite like it, but I am not a man, I am not a binary man. It is quite odd, and I want to let that conflict in me settle before I make any decisions. There is also… in order to have metoidioplasty or phalloplasty which is lower surgery on the NHS I would need to wait until I have been on testosterone for two years, and then I would need to have two appointments at the GIC after that, both of which would need to be about 30 months apart, given the current waiting times, it is bloody ridiculous. It might not be 30, it might be 20 months apart and 30 for your first one, but it is just ridiculous, it is absurd at the minute. So I have got plenty of time to make up my mind, I am not paying to go private for it. I don’t think I will, but I am not willing to sign up to that yet, because I can see that it is an enormously invasive and complicated procedure and I would want to be very, very, certain before signing up to it and I am not very, very, certain.

Esther: Well it is kind of a big deal, right?

Fred: Yes.

Esther: Good grief, yes. So you mentioned two types of surgery you could have, bottom surgery. So the phalloplasty I have heard of. The other one what was it called?

Fred: Metoidioplasty.

Esther: yeah, so what is the difference? I thought phalloplasty was the only option to be honest, so. What is the difference between the two.

Fred: What happens when you are on testosterone is that clitoris grows, between an inch and two inches long and it is essentially becomes a little sort of proto-deck, if you have metoidioplasty what they do they remove the clitoral hood and they move it to the position that a penis would be at. You probably wouldn’t be able to penetrate someone with it but it would look a bit like and it would potentially in terms of non-penetrative sexual use be a bit more like They can also realign your urethra so that you can pee through it, if that is a big dysphoria thing or a safety thing for you it can be quite useful. In terms of penetrative sexual function it is not really much use, but it is a smaller surgery and some people finds it meets their needs. And then obviously there is phalloplasty where they will construct a penis which is a more intensive and invasive set of operations—they are all intensive and invasive operations but…

Esther: Yeah, you would have to be pretty damn sure to have that part of your body, which is kind of highly sensitive, altered in a major way. I couldn’t even imagine it…

Fred: Yeah.

Esther: So for phalloplasty they have to take skin grafts and things like that right?

Fred: Yes whereas with metoidioplasty they sometimes do.

Esther: That is something to consider as and when I suppose.

Fred: Yes I am giving it a lot of serious thought.

Esther: Of course, of course. It makes sense to make things settle and get used to it because I guess the changes are constant. You mentioned even your voice as being one aspect of it, it is not like it changes and then it is changed, it changes and then it changes again and again and again. It is like a real journey there and that makes sense to get used to a situation before taking the next step.

Fred: Yes, I am still getting to know this body. I have had so much change in the last two years that I certainly don’t want to knock myself out for another 18 weeks, I don’t want to… I want to be in this body enjoying it and to see where the limits of that enjoyment are and where the limits of my comfort in it are before I do anything else drastic. Since I have healed up it has been so good. And if that changes then that changes and I will rethink. But it is really hard to quantify the sheer positive change it has brought to my mental health, to my relationship to my body, to my relationship to my life. There are silly things that don’t feel transitional related but genuinely are, like I never learned to drive and a couple of weeks ago I applied for my provisional driving licence and I am going to learn to handle a vehicle. Which is a huge thing and one of the reasons I think I had never done it was because I never felt like a real person in the world.

Esther: Wow!

Fred: And now I do, and I have kind of got to get used to that, you know?

Esther: That is incredible, hearing you say that that is something I would never have even considered. That’s exactly why I love having these conversations, wow, amazing. That sounds beautiful and I am so glad that it is doing more than agree with you obviously but that you seem to be thriving with all the changes and progress that you have made, that is brilliant. Is there anything else you would like to add before we wrap up?

Fred: I think, I want to address head on the idea of a sex change, I think people quite often refer to this sort of thing as, ‘it is a sex change, you have become a man’, and I think my experience of it has been a lot more as a sort of curative set of therapies, rather than becoming someone else I was actually permitted to inhabit the world as myself and being given the confidence and space to do that it is… I don’t think anyone should need to transition medically, I don’t think that is a requirement to being transgender but I think the difficulty in living your life in a certain way when your physicality is constantly read as being at odds to that, when there are very simple surgeries and therapies you can have to realign that, is an enormously stressful thing and having access to those has been life changing even if I haven’t had much chance to go out in the world and do that yet.

Esther: Yeah, yeah. One thing I did want to ask you, which I normally start the conversation with is, has anything changed with regards to how you feel you identify with your labels and your pronouns? Or is it still the same as when we last spoke?

Fred: No I am still gender fluid, trans-masculine, and non-binary. My pronouns are still they/them although I will take he/him at a pinch, so yeah it is all the same really.

Esther: Brilliant, thank you.

Fred: Thank you. 


About Fred

Alys Wilfred Earl (aka Fred) is a writer, storyteller and folklorist who lives in Suffolk. They studied literature and creative writing at UEA before specialising in orality, and medieval and early modern textual cultures. Long fascinated with the interlocking histories of gender, sexuality and childbirth, all these concerns feed in to their performance sets and original fiction, mixed with a good dash of horror and gothic aesthetic. Their debut novel, Time’s Fool was published by Unbound in 2018.

They came out as non-binary in 2015, and use they/them or xie/xir pronouns. To this day, they can be found wandering the wilds of East Anglia, haunting various libraries, or just mouthing off on Twitter.

You can find out more about Fred on their website,, and on Twitter, @alysdragon.

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