Andrew to Audrey: A case of genes, wiring and choice

Andrew Mbugua, who has changed names to Audrey to reflect what she considers a new sexual status. Photos/JOSEPH KIHERI

What you need to know:

  • Those who have seen her on TV, where she has given numerous interviews, agree on one thing: If she walks like a woman, talks like a woman, and even blows her nose like a woman, then she probably is a woman.
  • Audrey’s is a case of gender dysphoria — or what is popularly known as a gender identity disorder (GID) — a condition where an individual born of a specific gender feels as if they are of the opposite sex, behaves like members of the opposite sex, and will express discontent at the birth-acquired state. 

A Google search for the name Audrey Mbugua gives upwards of 75,700 results while that of Andrew Mbugua gives 141,000 results.

If you search for images of the two names, the engine pops up several pictures of different people, but there is one face that is prominent among the search results under both names. It is a very familiar face, at least from the papers and news sessions, where one young woman has lately been a major source of attraction.

The inconsistencies in the life of Audrey Mbugua are not very hard to pick out. He was born a man and, according to media reports, she is either 29 years old (The Standard, June 4, 2013) or 26 (NTV a few days earlier).

Audrey and her father were so close that, by the age of 13, he had taught him how to drive and he knew quite a lot about boxing legends. But at 19, and feeling more like a woman than a man, he (Andrew) plaited her (Audrey) hair.

A few years later, she sought a sex-change surgery but was stopped in her tracks. What she wanted, and which many could not understand, was to go under the knife and remove her male reproductive organs, which she would then replace with female genitalia.

Those who have seen her on TV, where she has given numerous interviews, agree on one thing: If she walks like a woman, talks like a woman, and even blows her nose like a woman, then she probably is a woman.

Audrey is here, unapologetically and bald-facedly demanding a name change. She will not be cowed by any ridicule and will sacrifice her all, including her privacy and the skeletons from her past, to stand up for what she believes is her right to be whoever she feels like — or rather, who she is.

But what, exactly, is going on? What would compel Andrew to want so much to be Audrey? How come he grew up under the keen eye of her father and enjoyed male-oriented activities, only to turn to plaiting her hair and demanding a sex change?

Some people believe that these are things that are predestined, others that nature can be courted and made to go the direction one wants. Many more, like Audrey, are “tweeners”, caught in the middle and swimming in unchartered waters where the very few who go this way prefer the dark, hidden depths.

But Audrey has come to the surface, close to where the sun rays hit, and now she is in the eye of a storm.

Sociologists, doctors, lawyers, and the public would want to know more about Audrey, they would like to know what she hopes to achieve by coming out to demand a name change, they would like to know how she feels, they would like to know what she wants to do after this... and many other things that most people take for granted.

But she is not alone. Last week doctors and counsellors explained to this writer that Kenya has so many people pinned down by the battles Audrey has fought for years that if they all decided to “come out”, the country would pause, take a step back, and re-angle its aggregated debate.

Audrey’s is a case of gender dysphoria — or what is popularly known as a gender identity disorder (GID) — a condition where an individual born of a specific gender feels as if they are of the opposite sex, behaves like members of the opposite sex, and will express discontent at the birth-acquired state. 

Most of them either learn to live with it (through continuous counselling and medical interventions), while others demand sex-change procedures, which involve surgery and hormonal therapy
The manifestations of GID are as varied as its “victims”.

While walking the streets or the tracks in the villages, it is often not uncommon to meet a man with a feminine, high-pitched voice, or a man with pear-shaped hips, or yet another with overgrown breasts. There are also women who speak in deep basses, are quite muscular, and sport beards. The answers to these peculiarities lie in biology and science. In Audrey’s case, doctors believe both biology and the psycho-social part of her life come into play.

It all starts in the womb, says Dr Mary Oguna, a counsellor and psychologist. The hormonal levels of the mother, regardless of the sex-determining chromosomes of the unborn child (XY chromosomes for men and XX for women), can influence the predisposition of the child towards certain GID conditions.

For instance, when an expectant woman is on medication that raises her oestrogen levels (a primarily female hormone) yet she is carrying a male child, it is highly likely that the presence of the extra oestrogen in the mother could affect the child, leading to a male child who behaviourally leans towards the female side.

But Prof David Ndetei, the director of Africa Mental Health Foundation and a psychiatry lecturer at the University of Nairobi, believes it is all in the mind.

“The question of feeling like and wanting to act like members of the opposite gender is an issue of the mind,” he says. “It is an inclination, though most of the times it is driven by hormones. But gender is genetically determined due to chromosome pairings.”

Prof Ndetei gives the example of transvestism, where an individual, say a boy, can decide to walk, talk, dress, and imitate the mannerisms of girls. This, he argues, is an issue of the mind. As the boy develops into a young adult driven by teenage hormonal imbalances caused by hormonal upsurges at that age and an underlying cause — for instance, a tumour — in the brain or an abnormal cell in the body, they will start to exhibit secondary characteristics of a different gender, but now in a mature and conscious way. This, he believes, is what happened to Audrey at 19.

But when it reaches the point where one now wants to change their gender surgically and medically, Prof Ndetei believes that certain hard questions need to be asked. These include the legality of the process and whether the law has provisions that allow the individual’s new identity to be formalised.

Prof Ndetei also cautions that, even where the law recognises such procedures, the patient must be counselled so that they understand that it is only their sexual organs that will change, not their genetic make-up. The upshot of it all is that a man who becomes a woman will still not be able to naturally conceive even when hormonal injections are used to help him grow breasts.

Dr Francis Kimani, the director of medical services at the Ministry of Health, says hormonal imbalances cause some of the biological oddities that people find hard to understand. For instance, when a teenage boy shows signs of developing breasts, it could be that he is experiencing an inhibition of androgen (the hormone responsible for the development of male characteristics), while oestrogen (the hormone responsible for the development of female characteristics) is secreted in large amounts.

“Since teenage is a transitional period, it is expected that his hormones will balance out and androgen will be secreted in required quantities,” explains Dr Kimani. “This will automatically correct the situation.”

The problem is that in some instances, the hormones fail to balance out, hence the cases of men with female voice intonations or females with masculine bodies and voices.

Where that happens, doctors believe medical interventions are possible. For example, Andrew could have been put on androgen pills and shots to rejuvenate and make dominant his male orientation if he wished to remain male. But since he wanted to be Audrey, he was put on oestrogen pills and injections or supplements, and this helped him grow breasts as he slowly transformed into the smooth-skinned woman that she is today.

Dr Oguna says some environmental factors could also lead to gender complications and so, when faced with such instances, as she does often in her daily work, she first seeks to have a brief history of the person, including where the individual grew up, the family setting, role models, and relations with other people.

She says that apart from hormones, the environment where one grows up has a key role to play in how one turns out. Using the African proverb: It takes a village to raise a child, Dr Oguna says that in the past, when children behaved in an “odd” way, they would be assigned older relatives, say, aunts or uncles, to teach them the proper way of handling themselves.

Women were expected to be at the knees of their mothers and grandmothers, just as the boys were expected to carry their three-legged stools for their fathers and grandfathers. In this way, the young ones had a clear idea of what their gender roles and expectations were.

However much the society has progressed, Dr Oguna believes that people still do not understand what to do when young ones start exhibiting tendencies of the opposite gender. Most of them will admonish and rebuke a seven-year-old boy who likes to apply his mother’s lipstick, or the young girl who just loves wearing her brother’s clothes.

From a psychological point of view, she says this will not work. “When you admonish and grow tough on them, they grow adamant and will not listen to you. Psychotherapy should begin even before the age of eight once a parent notes any odd behaviour.”

Counselling, positively telling them how good it is to be whatever gender that they are, and letting them work out on their own how they feel about themselves and about the opposite sex is the way to go, says Dr Oguna. “The greatest and most important thing is about the mind. It is always about the mind. From that young age, confusion should be cleared from their minds.”

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