Why all the anger at me for knowing what I need?

[Cindy]

Hikari, depression is not regarded as as a comorbidity in gender incongruent people unless it has parasuicidal tendencies. In fact depression is 'normal' and that depression is resolved in GI by access to HRT therapy is extremely common and well accepted.

[Cindy]

Quote from FA
The prevalence of personality disorders would make sense as well, since gender issues are a factor in some, such as BPD. And of course, growing up the wrong gender could well lead to mental health issues.
Unquote

BPD = bipolar disease?

This is the bane of the therapists life. Clinically you have to treat both at the same time and they interact. You have to distinguish between 'true' gender incongruence and the side effects of being bipolar. If you make a mistake you screw someones life.

I have a client at the moment, lets call her Joan, Joan wants breasts and to live as a woman, she really wants breasts. Six months ago she was John, who had no inkling of Joan, John was an aggressive heterosexual male. I asked Joan what would John do if he came back and found he had breasts. The answer was immediate 'He would kill you'. Now ask your self, as a therapist what would you do?

Now I'm easy, I went to a therapist and said 'I'm Cindy, help me please' They did.

You make the call between Cindy, Joan and John. What would you do?

[Colleen♡Callie]

BPD = borderline personality disorder.

And your client Joan sounds like they are suffering some sort of disassociative disorder.  Pretty much screams disassociative over gender dysphoria.

[KelsieJ]

As for professionals in the field who express such silly opinions I would neither consider them professional nor people who should be working in the area as they are demonstrably too ignorant to perform their duty to their clients..

+1

Hugs
Kelsie

[Cindy]

BPD = borderline personality disorder.

And your client Joan sounds like they are suffering some sort of disassociative disorder.  Pretty much screams disassociative over gender dysphoria.

And Joan wants immediate access to HRT, I'm refusing ? So I'm gatekeeping?

[Colleen♡Callie]

Um, nothing I said there implied gatekeeping, so not sure why you are asking that.  Unless you are afraid that is what you are doing.

John/Joan, as I said above scream some type of dissociative disorder, not gender dysphoria.  I hesitate to say it's dissociative identity disorder, given how rare the condition truly is and the way you've describe it kinda leads away from that diagnosis.

However he is dissociating something fierce to the point of display a secondary persona that is far disconnected from his identity with complete wants and desires that run counter to his wants and desires.   Everything in that screams dissociation, especially the fact that two sides being displayed are so at odds in desire that one would kill over it.  Dissociative disorders are far far from gender dysphoria.  They are their own category, and still very much categorized disorder for good reason. 

Not giving the okay for hrt because a dissociative patient's alter (for lack of a more appropriate term) wants it while the core is devotely against is not gatekeeping. Because this patient is not gender dysphoric.  He seemingly has a female alter that has decided she can do anything she wants to his body against his desires.  Heal the dissociative issues that has created the break in him.  Because as Joan stated willingly, transitioning won't do anything but make it worse.

Gatekeeping is withholding hrt and transitioning from a true gender dysphoric person because you disagree with the existence of GD or are too bigotted to help a trans person, but don't want to flat out refuse so they don't go elsewhere to get the okay.  They will usually diagnose some other disorder citing only the dysphoria as a symptom to prove it.

The want to transition was not even a factor in me thinking John/Joan is dissociative and not dysphoric.  Everything else is what screams dissociation, if you are worried that withholding hrt is gatekeeping here, don't be.  And don't be scared to seek a second opinion on your diagnosis from a colleague if you have doubts.

[retransition]

Ironically, a study on the prevalence of four different mental disorders in children and teenagers was just published a couple of days ago.  Here's the punch line: "Compared to the control group, gender variance was found to be 7.59 times more common in participants with [autism spectrum disorder]. It was also found 6.64 times more often in participants with ADHD."  Here's a link to a summary.  The link to the published research appears at the bottom of the page linked to:

http://www.sciencedaily.com/releases/2014/03/140312103102.htm




This is interesting. I just read the summary, but I wonder if the study showed whether more ftms were on the autism spectrum. We have quite a few here and it would make sense, since autism is said to be like having an 'extreme male brain'.
The prevalence of personality disorders would make sense as well, since gender issues are a factor in some, such as BPD. And of course, growing up the wrong gender could well lead to mental health issues.

Thanks for that link.  This is something that needs attention. I was just reading DSM-V in school library about comorbidity associated with gender identity issues and I find it kind of scary that various autism spectrum disorders are common comorbidities for many of the children and adolescents being accepted for gender reassignment.  I think this is a huge huge issue.

I typed out the entire section from the DSM-V on Gender Identity Comorbidities for my own reference.  Here it is, I am sure there are typos:

Clinically referred children with gender dysphoria show elevated levels of emotional and behavioral problems—most commonly, anxiety, disruptive and impulse-control, and depressive disorders.  In prepubertal children, increasing age is associated with having more behavioral or emotional problems; this is related to the increasing non-acceptance o gender-variant behavior by others. In older children, gender-variant behavior often leads to peer ostracism, which may lead to more behavioral problems  The prevalence of mental health problems differs among cultures; these differences may also be related to differences in attitudes toward gender variance in children.  However, also in some non-Western cultures, anxiety has been found to be relatively common in individuals with gender dysphoria, even in cultures with accepting attitudes toward gender-variant behavior.  Autism spectrum disorder is more prevalent in clinically referred children with gender dysphoria than in the general populations.  Clinically referred adolescents with gender dysphoria appear to have comorbid mental disorders, with anxiety and depressive disorders being the most common.  As in children, autism spectrum disorder is more prevalent in clinically referred adolescents with gender dysphoria than in the general population. Clinically referred adults with gender dysphoria may have coexisting mental health problems, most commonly anxiety and depressive disorders.

[Cindy]

Um, nothing I said there implied gatekeeping, so not sure why you are asking that.  Unless you are afraid that is what you are doing.

John/Joan, as I said above scream some type of dissociative disorder, not gender dysphoria.  I hesitate to say it's dissociative identity disorder, given how rare the condition truly is and the way you've describe it kinda leads away from that diagnosis.

However he is dissociating something fierce to the point of display a secondary persona that is far disconnected from his identity with complete wants and desires that run counter to his wants and desires.   Everything in that screams dissociation, especially the fact that two sides being displayed are so at odds in desire that one would kill over it.  Dissociative disorders are far far from gender dysphoria.  They are their own category, and still very much categorized disorder for good reason. 

Not giving the okay for hrt because a dissociative patient's alter (for lack of a more appropriate term) wants it while the core is devotely against is not gatekeeping. Because this patient is not gender dysphoric.  He seemingly has a female alter that has decided she can do anything she wants to his body against his desires.  Heal the dissociative issues that has created the break in him.  Because as Joan stated willingly, transitioning won't do anything but make it worse.

Gatekeeping is withholding hrt and transitioning from a true gender dysphoric person because you disagree with the existence of GD or are too bigotted to help a trans person, but don't want to flat out refuse so they don't go elsewhere to get the okay.  They will usually diagnose some other disorder citing only the dysphoria as a symptom to prove it.

The want to transition was not even a factor in me thinking John/Joan is dissociative and not dysphoric.  Everything else is what screams dissociation, if you are worried that withholding hrt is gatekeeping here, don't be.  And don't be scared to seek a second opinion on your diagnosis from a colleague if you have doubts.

Oh I have no doubts on her condition and she is under treatment by a psychiatrist, I purely act as a support therapist. My point was that we need to be careful on what individuals may say about their 'apparent' lack of professional support. Sometimes the individual may not report the full details.

I am very fortunate to know the OP (Suzi) and she, as I am, is a normal healthy well adjusted woman who requires no medical 'gatekeeping' but there are others who may report such opinion that may not be completely true when the full circumstances are known.
Medical intervention is needed for many of us who suffer GI, but as others have posted that intervention needs to be targeted to the conditions that require treatment and true professionals in the area know that and provide it with appropriate standards. Inadequately trained professionals give those who do care a bad name very quickly to the detriment of us all, both carers and clients.

[Colleen♡Callie]

Thanks for that link.  This is something that needs attention. I was just reading DSM-V in school library about comorbidity associated with gender identity issues and I find it kind of scary that various autism spectrum disorders are common comorbidities for many of the the children and adolescents being accepted for gender reassignment.  I think this is a huge huge issue.

Speaking as one of these comorbid ASD & GD individuals, I respectfully disagree on it being a huge huge issue.  ADD and dyslexia are often comorbid of each other and ASD.  I have ADD and mild dyslexia.  The fact they are comorbid is simply how it is, and not an issue.  My ADD is no less real because it is comorbid with ASD, as opposed to being on its own.  And my GD is no less real or serious because I happen to be autistic.

Comorbidity isn't an issue, it's an observation.  That diagnosis A and B tend to show up together in patients at a high frequency.  They aren't inaccurate diagnoses, one isn't a symptom of the other masking itself as a separate diagnosis.  They are both 100% real true separate diagnoses often found together.

This merely suggests that the origin and cause behind them are extremely similar causing a high likelihood that both will develop under the shared conditions that create them.  For example, brain scans of autistics have confirmed our brains are literally wired differently.  We actually used different parts of the brain than neurotypical people to do the same tasks.  Brain scans of trans people are starting to reveal differences in brain structure and wiring than that of cis people.

You have two diagnoses, both showing notable differences in wiring and structure as root factor of their existence.  It makes a lot of sense if both are caused by a something wiring and developing the brain different than normal, than that same thing has a high likelihood of causing both to develop along side each other.

The comorbidity hints at shared origins, and shared affected regions and aspects of the brain, that is all.  Their development are in someway similar and shared.  They are not a case of mistaking one for two.  And comorbidity is never an actual issue.  It is nothing but observation.  Both diagnoses stand as true and real as those diagnosed without having comorbid conditions.

[Colleen♡Callie]

Oh I have no doubts on her condition and she is under treatment by a psychiatrist, I purely act as a support therapist. My point was that we need to be careful on what individuals may say about their 'apparent' lack of professional support. Sometimes the individual may not report the full details.

I am very fortunate to know the OP (Suzi) and she, as I am, is a normal healthy well adjusted woman who requires no medical 'gatekeeping' but there are others who may report such opinion that may not be completely true when the full circumstances are known.
Medical intervention is needed for many of us who suffer GI, but as others have posted that intervention needs to be targeted to the conditions that require treatment and true professionals in the area know that and provide it with appropriate standards. Inadequately trained professionals give those who do care a bad name very quickly to the detriment of us all, both carers and clients.

Which is why I have and will always support psychiatric assessment for transitioning.  It is necessary.

[retransition]

Speaking as one of these comorbid ASD & GD individuals, I respectfully disagree on it being a huge huge issue.  ADD and dyslexia are often comorbid of each other and ASD.  I have ADD and mild dyslexia.  The fact they are comorbid is simply how it is, and not an issue.  My ADD is no less real because it is comorbid with ASD, as opposed to being on its own.  And my GD is no less real or serious because I happen to be autistic.

Comorbidity isn't an issue, it's an observation.  That diagnosis A and B tend to show up together in patients at a high frequency.  They aren't inaccurate diagnoses, one isn't a symptom of the other masking itself as a separate diagnosis.  They are both 100% real true separate diagnoses often found together.

This merely suggests that the origin and cause behind them are extremely similar causing a high likelihood that both will develop under the shared conditions that create them.  For example, brain scans of autistics have confirmed our brains are literally wired differently.  We actually used different parts of the brain than neurotypical people to do the same tasks.  Brain scans of trans people are starting to reveal differences in brain structure and wiring than that of cis people.

You have two diagnoses, both showing notable differences in wiring and structure as root factor of their existence.  It makes a lot of sense if both are caused by a something wiring and developing the brain different than normal, than that same thing has a high likelihood of causing both to develop along side each other.

The comorbidity hints at shared origins, and shared affected regions and aspects of the brain, that is all.  Their development are in someway similar and shared.  They are not a case of mistaking one for two.  And comorbidity is never an actual issue.  It is nothing but observation.  Both diagnoses stand as true and real as those diagnosed without having comorbid conditions.

I agree that it is a hint at a possible shared origin. I also know that just because someone is on the autism spectrum (or has any other psychological comorbidities) that does not make the gender dysphoria any less real.  I have no issue with this because I have lived under these conditions for almost 50 years.

Your attitude about how these comorbidities define (or, more accurately, don't define) you as a person is appropriate and of course healthy. Obviously many people are finding relief for the suffering that GD usually brings by transitioning.

However, if we can get to a place to where people have more options on how to manage that GD - especially at an earlier age - that do not necessarily lead to the extreme surgical and hormonal nullifications of the body's natural ecosystem I would want that to be available to others.  Even better yet, if we can figure out how to prevent GD in the first place by looking into this important area I think this is crucial too.  The same goes for autism spectrum of course - yes if you are on the spectrum that is nothing to be ashamed of and arguments can be made that it is not a disability at all (and that this diversity is an essential ingredient to the human race) but if there is something going on that is not natural (i.e. toxins, artificial hormones or other as yet unknown agents) is causing kids to be this way I think it is really important for us to keep looking deeper for answers.  Correlations give us clues of where to go with this and of course you are right they do not imply any particular causation.

I wouldn't wish GD on anyone.  And in my case, just me personally, I now feel that the desire I once had to be female is much different than actually somehow "being female".  I think for some people that distinction is important.  I also think that it is important for non trans people to understand - that  many people transition not because they are somehow wired to BE the opposite sex but that some people are wired to WANT TO BE the opposite sex.  Does that distinction matter?  I have my own thoughts on this, but more importantly it is a question that our society, that is just starting to address trans issues, hasn't even begun to talk about. Eventually we are going to have to get around to it.

[Adam (birkin)]

Sorry, but I have to take issue here with what you just said, so I hope that you take it in the spirit in which it's meant and not as an attack for saying it.

There is a high incidence of depression among transgender people. Most of it is caused by the pressure to conform, needing and wanting to "pass", to "fit in", to be "accepted" and to be seen as "normal". There is also a large proportion who feel that surgery will correct all of that for them, when surgery is merely a part of the process for people who choose it. The HRT portion of transition is the most important part, but comes with a price tag - and that is that it can cause depression to worsen on occasion. It can also lift depression in some people. The key to transition is not to single out someone with a psychiatric condition in the trans* community, but to understand that a large portion of what you may be observing, is merely situational and due TO their transition and unrealistic expectations of what transition means. This is why I always recommend that anyone considering a transition works with a therapist, even if they do not appear to have any depression or other psychiatric condition.

Kelsie

Actually, that makes a lot of sense and I might have to think a little bit more about my viewpoint. What I was thinking of, in particular, is detransitioned FTMs. A very common thread I have noticed is that they either have eating disorders (and that was what caused their dysphoria - not the desire to be male, but the association of hips/boobs/femaleness with fat), or there's been a few I've seen who have borderline personality disorder (like one on a documentary).

But with what you said, about the transition sometimes worsening depression, and surgery being seen as a way to achieve normality makes sense to me too. I can speak from personal experience - I knew I wanted surgery, for me, when I thought HRT was going to be the primary part of my transition (at least socially). But now that I have gotten farther in, and a lot of dysphoria has been fixed, I have noticed some new issues that can be challenging. One of which is the "not feeling normal" - rather than feeling like I'm trapped in a female body, I feel like I am trapped in a inbetween body, kind of like a "deformed male" (no offense to anyone, that's only my own dysphoria). And it makes me wish I could have surgery even sooner. Fortunately I thought enough about surgery before so I know it's not a "cure all" for my lack of feeling "normal" or fitting in, and it's something I want solely for my own comfort, but I can see how someone might feel a lot more pressure to get it and then later not be happy about that choice.

[Colleen♡Callie]

However, if we can get to a place to where people have more options on how to manage that GD - especially at an earlier age - that do not necessarily lead to the extreme surgical and hormonal nullifications of the body's natural ecosystem I would want that to be available to others.  Even better yet, if we can figure out how to prevent GD in the first place by looking into this important area I think this is crucial too.  The same goes for autism spectrum of course - yes if you are on the spectrum that is nothing to be ashamed of and arguments can be made that it is not a disability at all (and that this diversity is an essential ingredient to the human race) but if there is something going on that is not natural (i.e. toxins, artificial hormones or other as yet unknown agents) is causing kids to be this way I think it is really important for us to keep looking deeper for answers.  Correlations give us clues of where to go with this and of course you are right they do not imply any particular causation.

First I agree wholeheartedly, but finding a wider range of offered treatments has little to do with the comorbidity of GD an ASD, and doesn't have anything to do with it being scary and a huge huge issue.  Finding a wider range of better treatment options is something that is needed with or without ASD comorbidity.

I wouldn't wish GD on anyone either.  I seriously wish I wasn't trans, but at the same time, there is no universe where that wish translates to identifying as male for me.  I'm not a man, never have been, never will be, and would not sacrifice myself to be feel comfortable in my body, even if that meant being free of the dysphoria  I wouldn't be me.  Just like if you were to cure me of my autism I wouldn't be me.  Why?  You can't rewire and restructure a person's brain without completely destroying the person.  Oh sure the newly minted consciousness will probably have a lot of similarities to who I was, and remember being me, but they won't be me.  You will have killed me, and replaced me with a close approximation.  (FYI this is why Autism Speaks "Cure" has nothing to do with actually curing or helping living autistics.  They know it's not remotely possible right now to rewire a brain and if it were, would have too many hurdles to be a possible treatment.  No, much more realistic to develop a pre-natal screen that will allow mothers to abort autistic fetuses, while using propaganda and scare tactics to make this the more favorable option)

Evidence of Autism and GD have been around for about as long as humanity has been.  They were unknown during their time, and never mentioned directly, and are seen as "new" conditions.  They aren't.  The growing number of autism diagnoses creating the epidemic fear, is merely that we've come a long way from our understand of it in the 60s when it was considered to be "infantile schizophrenia".  That's right, it was so poorly understood that it was considered schizophrenia at first.  And infantile because the schizophrenics were stuck in an infantile state of mind.  It was also the mother's fault.  Not even hugs and holding them as babies.  Then we discovered it wasn't schizophrenia but it's own condition.  Debunked the mother not holding enough cause.  Discovered that autism had nothing to do with low mental ability, that was simply the many cases that had mental retardation as a often seen comorbid condition.  Start to better understand what Autism is and how it present.  Allowing us to better evaluate, assess and give treatment to those, like me, who would have been too high functioning 20 years ago to be diagnosed as autistic.  The numbers haven't changed, only our ability to understand and recognize those who are on the spectrum a lot better.

Also it's not a male oriented condition, this past year a lot of advancement has finally be done in studying and recognizing how autism and asperger's present in females which is similar but different than how it presents in males.  This understanding has already shown a large number of autistic girls and women that had been misdiagnosed due to the poor understanding of the differences, and we'll most likely see in the years to come the stats of boys and girls on the autism spectrum balance out.

((As an interesting aside, I fit the female presentation of autism symptomology almost perfectly, and at least 5 times better than I fit the male presentation.))

Gender Identity and dysphoria is exactly like Autism.  Very very very new interms of labeling, recognizing and studying.  It popped up around the 50s and 60s just like autism did, and out knowledge of it has grown exponentially since then.  In both cases the growing numbers coincide merely with our better understanding of them.  Which is also allowing us to recognize historic cases of them.


As for the distinction of wired to be versus wired to want to be, if they are truly dysphoric, heavily heavily dysphoric and transitioning shows success in improving quality of life significantly in both cases, is there really a difference? 

Should we let the one that is suspected to be wired to want to be the opposite sex suffer the unbearable dysphoria because "They aren't trans enough?"

[Satinjoy]

I must have gotten really lucky with my shrink.  The lack of courtesy to the OP is infuriating, both by the TS folk in facebook, and by the medical community.  This is why I believe in using people I trust.   It took a while for me to get my letter, but when I did it was eyes wide open, and I wanted that.  And HRT has been a huge blessing for me.  SRS in my case with my dysphoria is not needed....yet?...but if I had to see a psychiatrist for it they'd better be fluent in trans and dysphoria, and respectful.  It takes courage to be trans.

Attitude.  So important. 

By the way HRT ended depression, anxiety, inability to concentrate.... drivenness....deception.... and the body looks like it feels to me.  Huge.  Hence, letter valid.  No mistakes.

[Satinjoy]

Quote:  Should we let the one that is suspected to be wired to want to be the opposite sex suffer the unbearable dysphoria because "They aren't trans enough?"

Well I sure would have been screwed and in agony since I keep it hidden well socially wouldnt I.

[Colleen♡Callie]

Same, to the point my sister who had for years corrected all feminine behavior is very skeptical that I am, because beyond a few small behaviors, there apparently has not been anything to even hint at it according to her.  She's never seen it were her words. 

[Satinjoy]

Amazing what relentless negative reactions to our female nature creates the hardened mask that becomes a survival mode and hard to let go of.  They spent 55 years crushing the female part out of me, that shouldn't have happened.

Maybe thats why I totally refuse to cut my nails, socially male or not.  Let them deal with it.

[retransition]

As for the distinction of wired to be versus wired to want to be, if they are truly dysphoric, heavily heavily dysphoric and transitioning shows success in improving quality of life significantly in both cases, is there really a difference? 

Should we let the one that is suspected to be wired to want to be the opposite sex suffer the unbearable dysphoria because "They aren't trans enough?"

I appreciate your taking the time to reply and your thoughtful post. Everything you have said makes sense.  Autism is something that I have not spent much time thinking about until very recently - I have just had the vaguest of understandings of its diagnostic criteria, the various hazy theories about causation and even a lot of the political/cultural issues within the ASD community that accompany the phenomenon.  For a number of reasons, I have been trying to learn about this over the past few months.  It is interesting to me how a lot of the identity politics that exist with thin the trans space also have their counterparts within the spectrum community.  For example I can't help but note how similar some of the talk of, for example aspie (having aspergers) vs NT (neurotypical) mirrors talk I see here of trans vs. "cis". 

I do suspect that there MAY be an underlying "something" behind both GD and ASD (in SOME cases) but I also know science if far from understanding what that is.

To answer your question about if there really is a difference between being wired to want to be the opposite gender vs being wired to actually BE the opposite gender  - first of all I am not sure if ANYONE is wired to be the opposite gender - I believe that to varying to degrees it is a matter of a desire to be the opposite gender.  Of course some people are naturally more comfortable and better suited to live their lives in a way that is opposite to societal expectations of their birth "gender".  But I think that there it is fair to say that there is some identity difference in living in a gender because you want to vs that is that is just how you were born.  Maybe it is a very slight difference. There is going to be a difference in identities between someone born into a certain religion vs someone who converts, someone who is born as a citizen of a country vs someone who has immigrated there.  So at the very least this needs to be recognized, even if it is no big deal.  But I also have to say that, as a born male, my mental construct of what it feels like to be a woman is just based on my own observations and speculation. If I chose to once again call myself a woman should I be offended if someone in a women's only space objected to my presence in some activities because of this fundamental reality?  I think that if there is a boundary there it probably needs to be respected, at least at this time. Ideally one day gender wouldn't matter at all but for now it does and I think that assigned birth, while irrelevant 99.9% of the time in some instances still matters.

[Hikari]

....first of all I am not sure if ANYONE is wired to be the opposite gender - I believe that to varying to degrees it is a matter of a desire to be the opposite gender....

I vehemently disagree. I am the way I am, and that makes me not male, but female. It isn't some phase and it isn't just some sort of desire, it is the core of what I am.

[retransition]

I vehemently disagree. I am the way I am, and that makes me not male, but female. It isn't some phase and it isn't just some sort of desire, it is the core of what I am.

And you know what - I am not you and can never know what it feels like to be you so all I can do is respect your right of self-belief while I remain agnostic. I know you are sincere.