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

[Neshkav]

Recently part of some thoughts I've had regarding the legality of transitioning.

It stems from the fact that decades ago, people fought to have homosexuality removed from the list of mental diagnoses over the span of 1973 to the late 80s, wherein the name of the 'diagnosis' of being gay has changed before it stopped being in the manual altogether.

I've only recently found a couple pdfs that share my view that part of getting the status of being transgendered is to have it removed from the manual and to have the process of changing one's legal name and gender marker to be a matter of choice than a matter of satisfying a diagnosis, and said reading material has also mentioned that a con would be the lack of insurance coverage for the physical treatment. Although I would certainly have no solutions myself, I could imagine that at least hormones and blood testing could be covered under the idea that once ovaries/testicles of the transgendered person have been rendered unable to provide hormones themselves, the HRT would be necessary for maintaining a healthy range of hormones for physical and mental stability.

The problem with this opinion I have is that I don't know of a lot of opinions of too many other transgendered people on this subject. There always seems to be only the argument between people who don't accept ->-bleeped-<- and people who want the diagnosis to be covered.

[Sammy]

They should clearly be out of psychiatric section - which will happen in the edition of the ICD (not really familiar with the DSM structure). As far as treatment goes, the medical practitioners would be confused because they will have no code to refer when prescribing medications.... The contemporary trend is that GD is not mental condition, yet it is still medical condition and comparison with homosexuality is not very helpful here. Once somebody comes out as gay the consequences are mostly social. However, if somebody comes out as transsexual and intends to transition then there is only one known route at the moment, which is medical....

[Neshkav]

Under DSM, it's under the collective title 'gender dysphoria'.

I do know that I like the ICATH model, which I'm transitioning under, as it treats the decision to transition as a conscious decision being made by an adult and not as some dreadful last resort everyone wants to keep you from doing. The 'informed consent' model they follow for getting a legal hormone prescription might be the best approximation I've got.

I suppose a lot of it is that I'm sick of seeing both sides agree on this idea of surgery being 'mutilation' and the result of a disorder. Tattoos aren't considered mutilation driven by a disorder, it's considered something you consciously have done after (hopefully) some degree of forethought and a business transaction.

[FTMax]

If you de-medicalize something, you remove the need for insurance companies to cover treatment.

I am all for removing the stigma of a mental health diagnosis, but only if we find a way for general practitioners to be comfortable making a diagnosis. I think informed consent could evolve to do this.

[Neshkav]

Although I would certainly have no solutions myself, I could imagine that at least hormones and blood testing could be covered under the idea that once ovaries/testicles of the transgendered person have been rendered unable to provide hormones themselves, the HRT would be necessary for maintaining a healthy range of hormones for physical and mental stability.

HRT, in the interest of monitoring blood and keeping the levels in healthy ranges, could and would necessitate a degree of medicalization in the interest of the physical health of the individual at least. And I'd argue would make identity less within the need of a mental health diagnosis.

[FTMax]

That avoids the question of medical necessity though, which is why insurance companies pay for things in the first place.

If you have a bad sore throat and go to the doctor, you might get a diagnosis for strep throat. They will then prescribe you medicine to clear this up. Your insurance will likely cover the cost of the medication because antibiotics are considered necessary in the treatment of strep throat.

You would first need to define why the administration of HRT is medically necessary to the individual in order to get to the point of making monitoring it a medical necessity.

[Neshkav]

Having a legal hormone prescription already requires blood work from between every few months to once a year under such things such as the ICATH model. If one for example has committed enough to physical transitioning to get bottom surgery, and would thus have no natural source of hormones if they quit using their prescription, there would be negative health consequences. That's a situation where insurance might be needed to cover hormones.

[FTMax]

Which is what I stated above. Informed consent could evolve to take the place of a mental health diagnosis. But the responsibility would shift to require practitioners to make the call themselves, as opposed to having a mental health professional do it.

Even the situation you describe may not constitute a medical necessity to an insurer. 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.

The biggest complication to your original question is the insurance system in the United States. If you want to remove the entity that they rely on to determine the necessity of transitional care, they're going to want something in its place to ensure that they aren't needlessly spending money and therefore losing profit.

[Neshkav]

And my answer to that is that, admittedly, one would not be using any insurance for things like surgeries. The surgeries would be a voluntary thing that an individual could do at their own choosing, but they would have to pay for it themselves. I would argue that the need for say, bottom surgery, could be determined by how well the individual could handle externally-recevied hormones after a given period (rather than the rather arbitrary "how well do you do in society" standard that mental health uses). Without being listed as a mental health diagnosis, proceedings with physical changes could instead simply be based on the fitness of the individual and whether or not there's much in the way of negative effects from the hormones. I mean frankly, that's what I thought the whole basis for waiting or bottom surgery was based on myself when I was getting myself started on testosterone.

[FTMax]

That's one option, but it's by no means a viable solution if surgeries remain as financially inaccessible to most people as they are.

[Neshkav]

As one who earns just enough to be slightly above the poverty line, I find that taking the option of going to my doctor with "Here's a form to sign. Boom. Here's your hormone kit that costs $60 and lasts at least four months. Come back for blood work at this date." to be more financially viable and accommodating for saving up for surgeries then when I was previously arguing with a therapist for nearly a year who kept dodging the issue and telling me to watch this set or buy more clothes or travel to this group all the way in the next county or overall expecting me to spend my time and money on things that are beside the point.

[FriendsCallMeChris]

Maybe splitting hairs, here. But my insurance covers gender dysphoria, not being diagnosed as transgender. 

[FTMax]

First, I'm sorry that your experience in therapy doesn't seem to have been good.

But your circumstances are your own. Many people would not be able to even dream of paying for surgeries or other parts of their medical transition without help from insurance. I make a fair amount of money and it will still take me several years of saving +$1000 per month in order to afford bottom surgery. For people that can't spare that much money per month, their wait stretches out indefinitely. Nevermind those moments when life happens and you have to clear out your savings because you got evicted or your car broke down, etc.

Ultimately, if we do see gender dysphoria come out of the DSM, I think the mental health barrier will be replaced by a greater degree of involvement on the part of the patient's doctor.

[Neshkav]

How is the involvement going to be any greater than under the ICATH model where the doctor just takes blood tests and explains what all the patient has to do if there's any sign a problem could arise?

Edit: Also,

Maybe splitting hairs, here. But my insurance covers gender dysphoria, not being diagnosed as transgender. 

It still means transgendered people, if choosing WPATH, have to be diagnosed by a therapist who'll probably call you transphobic because you tell her, "No. I will not watch Ma Vie En Rose. Especially not with my family. We're hippy/redneck hybrids, this will mean nothing to us. This movie has naught to do with you talking to a man in his mid 20s."

[FTMax]

Coming into this conversation with a negative view of the mental health community colors your view of the situation. Not all therapists are like the ones you saw. There are some great professionals out there who genuinely care about our ability to transition of our own accord in a supportive environment.

Without a diagnosis, patients cannot get insurance coverage for transition related medical expenses. The only way I could see them removing gender dysphoria from the DSM while retaining the ability to diagnose is if we shift the responsibility of the diagnosis to another medical professional. That gives it the legitimacy needed for insurance companies.

[Neshkav]

I would argue that there wouldn't necessarily be a diagnosis, more that in the vain of ICATH they would have a form where you confirmed that you had your own understanding of the sociopolitical expectations and that your bloodwork pre-HRT showed that you were of satisfactory physical condition.

I've seen an argument between two people; one a guy who didn't understand and had issues with trans people having bottom surgery to transition. The person who was on the side that trans people should be allowed to transition honestly put forth the argument, "If there was a pill to okay with having a male body, I would take it, but there isn't, so surgery is what trans people have for treatment." If there's more pro-have-my-surgery-covered-by-insurance types of trans people with this view of themselves, I have to really wonder if having to get a therapist, or anyone's grant us permission to get a hormone prescription is doing us as much good as one would like it.

[BenKenobi]

I see no benefit in having transgender removed. The reason homosexuality was removed is because it doesn't fit the qualifications of a disorder. It causes no harm or discomfort other than what society pressures.

Transgender people do not have this privilege. Gender dysphoria is not something that someone can just shrug off. It is a real mental distress. Due to this reason that is why it is in the DSM. Perhaps HRT qualifications could be more lax but having insurance companies cover that plus surgeries can only benefit. I dont know what benefit or justification you have for removing it from the DSM but it is clearly misguided

[Oliviah]

I think jargon has changed too much, and people are confusing things.  Transexuals have dysphoria and suffer a medical condition that is alleviated through medical and often surgical transition.  It is a condition that requires professional help.

Transgender is the umbrella term that covers all who's gender expression doesn't match the sex they were assigned at birth.

Transexuals don't want the it out of the DSM mostly to pay for treatment, but also so we are not just confused with people who dress for sexual fantasy fulfillment or any other reason not associated with dysphoria. 

[Swayallday]

As one who earns just enough to be slightly above the poverty line, I find that taking the option of going to my doctor with "Here's a form to sign. Boom. Here's your hormone kit that costs $60 and lasts at least four months. Come back for blood work at this date." to be more financially viable and accommodating for saving up for surgeries then when I was previously arguing with a therapist for nearly a year who kept dodging the issue and telling me to watch this set or buy more clothes or travel to this group all the way in the next county or overall expecting me to spend my time and money on things that are beside the point.

Right?

I can't afford treatment otherwise.

[Swayallday]

It still means transgendered people, if choosing WPATH, have to be diagnosed by a therapist who'll probably call you transphobic because you tell her, "No. I will not watch Ma Vie En Rose. Especially not with my family. We're hippy/redneck hybrids, this will mean nothing to us. This movie has naught to do with you talking to a man in his mid 20s."

Huh?

Then just lie to your therapist if it's dumb stuff like that. I know women who do fight sports and only watch horror movies, are they not women or something  ?