In “Born to Be,” Tania Cypriano’s moving and fascinatingly forward-looking documentary about the Mount Sinai Center for Transgender Medicine and Surgery in New York City, we meet a handful of eager, at times desperate folks who are engaged in the existential medical conundrum of doing everything they can to become the people they are.
One of them, Mahogany Phillips, is getting surgery to reduce the downward-sloping masculine curve of her forehead. The physician who’s working with her, Dr. Jess Ting, explains that he’s going to drastically cut back the bone — which may give you a queasy shudder, since the bone he’s talking about encases that thing called the brain. This is no mere rhinoplasty or cheek implant; the procedure sounds drastic. But then the surgery happens, quite successfully, and we see what Mahogany looks like afterwards, the reduced size and slope of her forehead appearing as elegant and natural as could be. Mahogany was once a famous and successful (male) fashion model in South Africa, and the images of her from the ’80s are stunning. But in “Born to Be,” she beams and, in a way, she relaxes. She’s at home in that more feminine face.
Making the person you are on the outside match the person you are on the inside is the mission of the Mount Sinai CTMS, the first hospital center of its kind in America. In 2015, New York State passed a law requiring health insurance to cover transgender-related services; it’s the ninth state in the country to have such a law. That tells you, in raw numbers, how new all of this is — not trans culture, which is as old as human nature, but the treatment of trans culture as a proud and healthy dimension of our society.
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Twenty-eight years ago, when I reviewed Jennie Livingston’s 1991 documentary “Paris Is Burning,” which is acknowledged to be a pop-culture foundation stone in the greater awareness of trans people’s inner lives and their struggle to be embraced without prejudice, that movie, even in its liberation (and despite its influence on a show like “Pose”), created an image that may now look stuck in time. The movie was about trans people from the inner city who had next to nothing materially and lived bedraggled lives; they were lit up by performing in Harlem balls yet torn by drugs and prostitution. There was a poignant humanity to their passion and their struggle, but one that may have fed a certain image of the trans community that now, at least, looks limiting. Trans people, like anyone else, come in all shapes and sizes, from all class backgrounds, and this is a moment when the democratization of trans culture is only going to escalate.
“Born to Be” gives you a glimpse of what’s coming: a time when, in all of America and the rest of the world, trans people, and the medical care and procedures they need, cease in any way to be exotic. But that’s not where we are now. Most of “Born to Be” takes place in the fluorescent-lit corridors, examination rooms, and operating theaters of Mount Sinai, where Dr. Ting and his associates are cultivating the science of trans medicine as we speak. They are exploring, and expanding, the possible, all with one overwhelming goal: to increase people’s happiness. That goal is more than desirable. It’s utterly necessary, given the drastic number of trans people who attempt suicide.
In addition to Mahogany, we meet Devin, a sharp-featured beauty who’s exhilarated at the thought of transitioning (she renames herself Garnet) yet remains a deeply troubled soul, and Jordan, who is receiving a phalloplasty, with a penis created out of a chunk of skin removed from their forearm. The movie, which Cypriano has directed with a lively journalistic eye, shows us the meetings between doctor and patient that lead up to a procedure this invasive. For years, trans people relied on a black market of hormone treatments and surgery — a pioneering but fundamentally unsafe and, at times, exploitative universe. A woman named Cashmere, who got a ton of work done back in the days before the surgeons who did this were licensed, has a face that looks like it’s swollen with silicone implants; her face needs to be rediscovered.
What the Mount Sinai center represents is a paradigm shift, if not a revolution: the normalization of trans care. As the movie captures, however, few of these procedures are time-tested. At one point, Dr. Ting explains how he got a sudden inspiration to create a new technique to perform a vagioplasty, using the soft tissue that lines the abdomen. At that moment, his spirit hearkens back to that of Dr. Christiaan Barnard in the late ’60s inventing the heart transplant. Yet it’s a brave new world, and the film could probably have shown us more about the physical complications that some patients endure, even at a hospital as advanced as Mount Sinai.
Dr. Ting is the film’s central figure — the energetic, light-spirited motor of this clinic, a charismatic physician with an idiosyncratic background. He started off as a double bass player at Juilliard (he still plays in his apartment, and is clearly a master musician), but he fell out of that world and into science; until a year and a half before the film was made, he had never even done trans surgery. Yet he’s now a man with a mission, and his impish personality is part of it — the way he eases patients’ fears and leads them to feel good about their choices. As much as any doctor, he has to be a kind of therapist.
For those who want to visit the CTMS, there’s a six-month waiting list, with 400 patients on it. That’s one reason the clinic is strapped and understaffed. It’s still an oasis compared to the way things used to be, but medicine, like anything else, should obey the law of supply and demand. Just as our attitude toward medicine in general (e.g., health insurance) inevitably reflects our values as a society, the existence of clinics that serve the trans community is about utilizing resources that very much exist, once we grasp the value of allocating them.
“Born to Be” takes its title from the 1978 French disco song “Born to Be Alive,” by Patrick Hernandez, which the film treats as an anthem of existence, asking: What does it mean to be alive? Is it just about living, or is it about owning your identity? The movie builds up a considerable interest in what Cashmere will look like after her surgery, once Dr. Ting takes the old bulgy silicone out of her face. Then, at the end, it does something surprising by refusing to show us. I found that poetic. We have to imagine what Cashmere will look like. But in nudging us to do so, the film gets us to imagine something larger: what the future will look like.