->-bleeped-<- should be out of the DSM?

[Tysilio]

Neshkav, what you propose would eliminate being transgender from having any standing whatever as a medical condition that needs to be treated and put it squarely back in the realm of "lifestyle choices." It's taken years of struggle to begin to dent the attitude that gender-affirming surgery is medically necessary for some people, and it would be a tragedy if it were shoved back into the box of purely elective cosmetic surgery.

There are plenty of people for whom paying out of pocket even for safe, monitored hormone therapy will never be possible, and there are even more for whom paying for surgery is even more unattainable. This isn't any sort of moral failure or failure to "want it enough." It's the consequence of a truly effed-up social and economic system, in which things like race, class, education, and health status put vast numbers of people at a huge disadvantage.

It has taken a long time to get to the point we've now reached, where it's increasingly accepted that being transgender is a condition which, for many people, requires medical treatment and should therefore be covered by insurance. The problem is that the people qualified to give the medical treatment (surgeons, endocrinologists, and some primary care physicians) aren't qualified to make the diagnosis, which depends on psychological traits. This means that mental health professionals have to do that.

On the other hand, barriers to medical treatment, including financial ones, are among the major reasons trans folk suffer from psychological problems, with depression and self-harm, including suicide, among the most prevalent.

So, yes, treatment does need to be covered by insurance, and, no, gender dysphoria shouldn't be removed from the DSM. It's rational for insurers to want to be sure that treatment is actually needed, i.e. that this (or any other) condition is properly diagnosed, and this is the best mechanism we're likely to get.

To state the obvious, the reason some of us want gender id not to be in the DSM is that "mental disorders" in general are heavily stigmatized. Even those of us who should know better are scared by them; we often regard them as moral defects or personal failures rather than biologically based medical conditions -- which they actually are.

That is the basic problem here. By buying into the notion that ->-bleeped-<- shouldn't be in the DSM because "we're not like those people," we are contributing to their oppression. No one with any condition listed in the DSM deserves to be stigmatized for it.

[HughE]

Castration or a hysterectomy without the introduction of hormones can produce some uncomfortable side effects in people, but the medical community from what I've read seems torn on the subject in terms of its usefulness and necessity.

From what I've read and from chatting first hand with people suffering from hypogonadism (males with abnormally low testosterone production), and from chatting with some DES daughters who've experienced premature menopause, having insufficient sex hormones causes you to develop all sorts of chronic health problems as you get older, as well as completely destroying your quality of life.

It's true there is quite a large faction within the medical community who are of the opinion that hormones are an optional accessory, but then not so long ago, doctors were telling people that bloodletting was the cure for all ills, and that there was no need for them to wash their hands or practice any kind of hygiene because "a gentleman's hands can't carry disease". Most of what doctors do isn't based on science at all, but rather on "expert opinion" (which all too often later turns out to be completely wrong). This is just another example.

http://www.ncbi.nlm.nih.gov/pubmed/18567642
Androgen deprivation therapy, insulin resistance, and cardiovascular mortality: an inconvenient truth.

"Prostate cancer (PCa) is the most common cancer in men. Androgen deprivation therapy (ADT) is used in the treatment of locally advanced and metastatic PCa. Although its use as an adjuvant therapy has resulted in improved survival in some patients, ADT has negative consequences. Complications like osteoporosis, sexual dysfunction, gynecomastia, and adverse body composition are well known. Recent studies have also found metabolic complications in these men. Studies show that short-term ADT (3-6 months) results in development of hyperinsulinemia without causing hyperglycemia. Studies of men undergoing long-term (>or=12 months) ADT reveal higher prevalence of diabetes and metabolic syndrome compared with controls. In addition, men undergoing ADT also experience higher cardiovascular mortality. "
(Androgen Deprivation Therapy is the medically induced suppression of testosterone production in men)

If you look at the full text of the study, it's not just a small increase in metabolic disorders and mortality in the androgen deprived group either.
"The results showed that 55% of the men in the ADT group had metabolic syndrome, compared to 22% and 20% in the non-ADT and control groups, respectively."
"men receiving ADT were 2.6 times more likely to have cardiovascular mortality than non-ADT controls"

Although I don't know of any actual studies off hand in women, I've been told that much the same applies there too (except the hormone involved is estradiol rather than testosterone obviously).

This is why trans women shouldn't put up with being underdosed with estradiol by their doctors. It doesn't just give you poor results as far as feminization and overall feelings of wellbeing are concerned, it's actually putting your health and your life in danger.