FOR THE MOST PART, Man Alive is the story of Page McBee’s drive to become a fully realized person in the face of massive psychological and social pressures to stay frozen, to stay asleep. It’s also the story of McBee’s battle with the lifelong fallout from a father figure’s monstrous molestations, and about the transition, through surgery and testosterone injections, from her identity as Page to his as Thomas. The gender change is reported without sensationalism, most of the emphasis falling on the intense “coming to terms” that makes the transition possible.

The strengths of Man Alive are clear right away. A poetic sensibility and an openhearted stance propel the prologue. Page’s childhood desire to understand “what makes a man” is a dance of language: “A real man, a family man, the Marlboro man, man up. The man in the mirror.” Alternate possible beginnings to the story come in a swirl of associated images, across various spaces and times: the drive McBee is taking across South Carolina in order to try to deal with old childhood ghosts, a nearly deadly confrontation in Oakland that had in many ways made the South Carolina trip a psychological necessity, and the deeper past, when in 1985, as McBee puts it, “my father became a monster, and in 1990 when my mom found out he was one. ‘Men,’ she’d said then. And I’d learned to say it the same way, a lemon in my mouth.”

Bitterness would be a valid response to these events, but it plays no part in the story. Instead, hope and resilience predominate. The book’s five sections — “Freeze,” “Flight,” “Fight,” “Rites,” and “Man Alive” — correspond to stages in the process of confronting and transforming the past.

The first part, “Freeze,” opens in 2010 in Oakland. A walk through a dangerous neighborhood shows us McBee’s strong relationship with Parker, a tough, kind, lively, self-possessed woman who comes from the South. Then the story jumps back to Pittsburgh in 1990, in keeping with the poetic, associational structure of much of Man Alive, and into the heart of the book’s remarkably generous stance. Page’s grief-stricken mother, pen in hand, is asking the 10-year-old to describe her father’s molestations, which she does to a point. And how is it possible to survive molestation? McBee writes, “I picked one tiny thing to look forward to and fixated on it. From his bedspread I jumped into tomorrow and felt the soccer ball connect with my foot and fly, high and sweet, into the corner of the net.”

Page sees herself as boy, favoring He-man castles, short hair, and torn jeans. To people who will later say that a blueprint for manhood had always been there, McBee responds, “Maybe that’s true, but let’s not make this the kind of story where I know all the answers.” So what does ultimately drive McBee to transition from Page to Thomas? Is it the will to convert abuse into a powerful, constructive form? Is it the force of an internal blueprint? These questions are never completely resolved, though the story’s emotional heft is weighted strongly toward McBee’s will to confront and transform the past.

The oscillating scenes in “Freeze” — from adulthood with Parker in Oakland to childhood in Pittsburgh — are effective, poetically and psychologically. McBee shows, rather than tells, the past’s impact on the present. “Shut up shut up shut up,” she thinks, as her father apologizes in Pittsburgh — with crocodile tears? with real ones? — for his monstrous abuses. “Shut up shut up shut up,” McBee thinks on all fours in Oakland, almost 20 years later, when a mugger hovers above. The gunman, George Huggins, has recently murdered a man named Jinghong Kang, who was in town for an interview with Google, while leaving Kang’s female companion alive. Now, too broke to afford a cab, Page and Parker have stumbled into his deadly path. But when Huggins registers Page’s voice as female, (McBee describes it as “reedy,” womanly, not a sound that has ever seemed to fit), he says, “Run” instead of shooting. And Page and Parker do run, through the neighborhood, to the safety of a stranger’s car, out of Page’s childhood freeze of dissociation and resistance to change, into a new routine of daily running, described in the next section, “Flight,” in which major questions about identity dominate.

What could make a father freeze up so entirely he was willing to damage a child? This line of inquiry propels the author, flat-chested (two years after “top surgery”), back to South Carolina to try to find out. It’s a mode of questioning that underscores the book’s impulse to turn away from indictments and toward psychological common ground — with an abuser, even with a murderer as it will later turn out.

In “Flight,” McBee is launched out of paralysis and into uncertainty. Jumps between scenes in California, South Carolina (where her father, Roy, grew up), and Boston (where Page went to college), underscore the disorienting questions: How to interpret the appearance of the bearded man who now comes in dreams? How to pass as a man among tough, skeptical guys in Carolina? How, at the home of Roy’s religious brother, John, to pass as somebody who’s not trying to pass as a man, bent on learning the ways in which Roy may have been abused? What to make of it if it turns out that Roy is not the biological father — a suspicion that a paternity test will later confirm?

At the end of the section, as testosterone treatments are seeming more and more like a possibility, Page and Parker marry in Mendocino. The questions multiply. What might be the effect of Page’s physical transformation on the relationship, or on Parker, who is both supportive of Page’s right to self-determination and worried about her own response? What to do about the potential physical risks — cancer, liver problems, diabetes? Uncertainty carries the story into “Fight,” where memories of past abuse again echo loudly in McBee’s adult life.

Scenes from the courtroom proceedings for George Huggins, the man who mugged Page and murdered Jinghong Kang, are layered, in this section, with associative links to Roy. In a flashback to 1990, shortly after a police officer has asked 10-year-old Page if she wants her father to go to prison and she has answered “no,” her smart, grief-ridden, probably alcoholic mother is holding her, telling her she’s golden inside, untouched. The adult McBee, waiting for Huggins to arrive in the courtroom, has decided that justice too closely resembles revenge. “I imagined Roy doing sit-ups on a concrete floor beside an open toilet, and for the first time I found that I was glad not to have opted for retribution back when I was 10 and given the chance.” Finally able to meet Huggins’ eyes, McBee decides that “he and Roy were no different from me; not because we were monsters but because we all have the chance to be more than the worst that’s done to us.”

In “Rites,” section four, major changes start to take hold. McBee lifts weights under the tutelage of a trainer, Mike, who recounts a story about defending himself with a firearm. McBee writes, “I thought of how it felt to freeze under Roy’s hand, under Huggins’ gun. I thought of what I knew I needed, deep in the growing core of me.” In Tulum, Mexico, on their honeymoon, Parker and Page endure the bigotry of a hotel clerk, the shame of tourists on the beach gawking at Page’s flat chest, Page’s frayed nerves over choosing which restroom to use. Tulum is a tipping point, convincing Page she has to transition. And the impressive Parker, blinking back tears, tells Page she’d never get in the way of that. Back in Oakland, with Parker’s help, Page starts trying on possible male names, settling on Thomas. They pack to move to the east coast, where Page will undergo a series of injections. On the trip, McBee makes plans to talk to Roy in Bend, Oregon — as Page, not as Thomas — and Parker, tough and caring, wants to go. But she’s weary from Page’s relentless confrontation with the past, with identity, and knows she can’t pick up the pieces if it goes badly. “I can’t handle one more thing right now,” she says.

Page’s meeting with Roy in a tea shop — the last moment in a life as Page — is a chance to work on the ability to be “a good man.” The thought of hitting Roy occurs to McBee, but “power cut with grit” is not an acceptable view of what a man is. Seeing Roy’s balding, liver-spotted head gives Page an immediate understanding of how age has diminished him. He’s the vulnerable one, even though he’s still the abuser. McBee writes, “I could feel myself transported to every movie theater I’d had to leave because a man with a similar crown sat down and threw me into a panic.”

Page lets Roy talk about his past, about his own childhood abuse (some of which he is willing to confide, some of which he can’t acknowledge), and about his present life as construction supervisor, living “with the shame of [his abuse of Page] every day.” When Roy is self-indulgent in his descriptions of the early days with Page’s mother, Page remains silent. At the end of the conversation, having succeeded in seeing Roy as a person rather than a monster, Page tells him, “Don’t let your whole life be about this.” McBee describes the encounter as “in all the ways that matter, a kind of forgiveness.” When Roy walks away from the tea shop and into the fog, Page returns to the motel, finds Parker, and heads into a new life as Thomas.

How does a book like Man Alive come to a satisfying end? As readers, we feel strong allegiances by now, to McBee, yes, but also to Parker, who is such a smart, likable, frank partner, someone who’s struggling vigorously to be ready to love whomever Thomas will turn out to be. And we’re ready to learn about the radical experience of having testosterone trigger genes in McBee that have always been there, dormant: “this one determines how hairy you’ll be, this one your muscle mass.”

Thomas describes the changes in physical terms, “the quick bloom of my beard, the surge of muscle […] my strength a tactile feeling, cool and placid as a lake.” Given the admirable absence of sensationalism throughout the book, we’re primed for deeper questions. Man Alive demonstrates that McBee’s rigorous, wholehearted confrontation with the past has been worth the struggle. But is life as Thomas a satisfying extension of that experience? Is it worth the cost?

The short final chapter of Man Alive doesn’t grapple with these questions at the depth the rest of the book has led us to expect. McBee’s brother and mother do warmly accept McBee’s new identity, a gift, since McBee says he would have given up his mother, if necessary, in order to be Thomas. And of Parker, McBee writes, “I could feel a part of her shrink as I grew broader.” There are no more than a few brief, subsequent glimpses of the couple tentatively adjusting, an uneasy fact, since the relationship has been one of the book’s central affirmations.

For most of the narrative, the unresolved storyline has given the poetic echoes room to do associative work. And in the places where the writing might have fallen flat, where the language of therapy predominates over complexity of scene, our allegiance with the generous McBee powers us through. Toward the end, when our allegiances are more complicated, and when the story has become more linear, the writing sometimes reads as thin, and some of the linguistic tropes feel forced.

Nevertheless, Man Alive stands as a vitally important book. McBee’s story harnesses the power of self-inquiry, of generosity, of a transformation powerful enough to address even the fallout from child abuse. And McBee shows us what it is to have earned a name, “Thomas,” as well as the pronoun “he,” language that McBee applies to himself with a great deal of thought and care — unlike the many of us who stumble along with our names and pronouns almost, by comparison, accidentally.

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Greg Glazner has written the books of poetry From the Iron Chair and Singularity.