Something I have grown to wonder over the last few days

[jaybutterfly]

Since being told I do not meet the diagnosis for transsexualism despite having a 'seemingly' female identity according to my doctor and various other things, I've had some thinking about a lot of things, and about how the gender identity services are run. I began to look into philosphy again, and I recently got into reading the works of Michel Foucault and looking at history.

I wonder now, why do we pathologize identity now? Why must being trans be considered something I need to justify to panel of people who do not know me or do not live my life? Why must trans and lgbt people need to justify themselves? Why not de-medicalise and de-pathologize being trans? Does it not force us to jump through so may hurdles? If we didnt, would we not need to worry about the oppression that comes with the ignorant shunning of what others claim to be 'mentally ill?'

I find it quite surprising how in a time where we talk about equality and diversity rights that there are so many ways to make it seem difference and non-conformity to make everything seem like a defect. My social isolation is 'a symptom of autism' rather than a desire for true friends while I struggle to find them.

Im starting to wonder if we as a society need to back the up on how we look at variance in humans as 'wrong'

[Alice (nym)]

The question you need to ask yourself if you are looking at Foucault is who created the trans label? When did a diagnosis define a group of people, gave them a label, put them in their box, and created a set of rules on how they are expected to behave? 
I spent over 7 years researching this stuff... if gender is a social construct as a means of controlling a deviant population, then I am going to reject the label and not be put in that box. I am going to fight to be me. Everyone has multiple identities for different situations (student, employer, employee, doctor, nurse, Muslim, Christian, Atheist, married, single... etc.) and no one label should define our entire being. We should be allowed a voice using one of our other identities too. Gender should not be the sole thing that defines who we are as people.

You know what I realised this last week...

without the label this forum wouldn't exist and all these brilliant people here who have helped me wouldn't be here to support me in my hour of need.

I've not had a chance to work out what that means in terms of my academic research... but it makes me want to shout it loud and clear, I am proud to be trans because I am glad to be associated with the people who have helped me this last week. Sadly, it will have to wait a little longer... but I no longer feel shame for who I am... and that is a massive step.

I am going to see the doctor on Thursday, and I was a little concerned that he might not refer me... but then I thought, you know what brought me to this point... I couldn't tick a box that said male without having an anxiety attack. That is all the evidence I need. The fact that you are here questioning your identity and are upset at the result should be all the evidence that the panel needs. You need to contact them and tell them how upset their decision has made you feel and use that as your evidence of gender dysphoria.

[Devlyn]

I'm not clear from your post if the 64.0 diagnosis (transsexualism) is a requirement for treatment where you live. I was diagnosed 64.9 (gender dysphoria) and received HRT and surgery. From your description you would certainly be in that territory. Best wishes in working this out with your providers.

Hugs, Devlyn

[Virginia]

Since being told I do not meet the diagnosis for transsexualism despite having a 'seemingly' female identity according to my doctor and various other things

Would you mind sharing why your doctor told you you do not meet the diagnosis for transsexualism and if she diagnosed you with another condition? There are many conditions that can cause a person to have a "'seemingly' female identity." The  "other things" your doctor said are important to understanding her diagnosis.

[Maid Marion]

I think it is important to separate the need for a label and the need for treatment.

They get mixed together because insurance companies often require the proper label for treatment.  But, if you are paying for stuff out of your own pocket, I am pretty sure it doesn't matter as much in practice.

There are people who just need a label.  An old guy on disability may want to put a name on his situation, so he can place the blame.  He isn't going to get any benefits in services or money with a diagnosis.

Labels can also be misused.  A kid with diagnosed with autism may be eligible for all sorts of therapies she doesn't need.  In fact, that much treatment can be counterproductive to someone with autism, but the doctors won't get paid as much if   she doesn't sign up for everything.  Seriously, do you think someone with a social disorder that needs routines wants to be pulled away or interrupted to see the doctors and therapists, on their schedule?

[julia-madrid]

A very interesting discussion.

I think we are in fact seeing a gradual normalisation and, to some degree, a de-patholisation of the trans identity, but it varies greatly even among more open societies. 

Certainly there are countries where it is now possible for people to change their legal name and gender marker with no need for involvement by anyone else.  And the publicly run Center for the Treatment of Gender Identity Disorder here in Madrid has recently dropped the "Disorder" from their name, which is an important step, although I suspect this is more to normalise the public perception of transgender treatment and remove stigma.  In the UK some of the criteria are being relaxed, maybe because the demand for services has increased massively in the last few years.

The thing, though, is that most of us still seek treatment in one form or another, and let's be clear that none of this treatment is in any way trivial, nor should it be treated as such:  HRT results in body alterations and sterility, gender surgery even more so, and psychological services are by no means a benign intervention.  Therefore, I do think that, while we may want to relax certain assessment criteria,   we should take care not to trivialise what, for most of us, is probably the life event of biggest consequence in our whole lives. 

I do a fair bit of semi-formal counselling in the MTF community, and my first recommendation is for the person to take very active steps to know their own mind, and to try separate out the various strands of their gender issues.  And this is partly to avoid the person making a terrible mistake.  For example, one of the people I counsel seems to most likely be a submissive crossdresser rather than a transwoman, so my advice to the person is to work with a psychologist, and only then seek a diagnosis.  And with that diagnosis would come the pathology and subsequent treatment.

Not sure how much of this makes sense.  I do not wish to suggest that my view is the only way to approach the issue, but I am a cautious person, and, over my 4 years on this excellent forum,  I have seen too many people head down the wrong path (in some cases), and cause themselves significant damage and harm.

Hugs
J

[Melinda@heart]

I don't understand why some doctors deny HRT to their patients. I met with a shrink 1 time for 30 minutes and she wrote me a referral to a Doctor for HRT. I met with that Dr a few days later, had blood work drawn and picked up my prescription later that day. According to both of them requirements have changed. The shrink basically said it's my body and if I want to make it more feminine it was my right to do so. She mentioned Wpath standards had changed. I haven't looked into it, but maybe you just need a different doctor.

As far as labeling us goes, I'm use to labels. It's the human way. It's how we understand things. We label it, put it in a box and then we place it on a shelf in it's own space. Is it right? Is it good for anybody for that to happen? Doubtful. It's taken years for trans people just to get the few benefits we have and those benefits are in danger of disappearing everyday.

The good thing for me is seeing people openly discuss these issues and even being on TV. You may not agree with one of the more well known individuals, but she certainly has put our cause out there for people to see and learn about. Sorry for rambling on... 

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[Sarah1979]

Personally, I find the irrevocable nature of the transition process to be rather comforting.  It means that no matter what happens politically or socially, they can't take it away from me.

[Lucca]

My therapist doesn't believe in gatekeeping at all, and has referred me to doctors and clinics that are "informed consent" and don't require any "proof" of being transgender, whatever that may be. I agree with her. It's not my or anyone else's duty to prevent people from making mistakes; if they do, it's their own responsibility.  No one else should tell me what I can do with my body. Any number of other body modification procedures also have a risk of social repercussions or regret, and no one's suggesting gatekeeping for them.

[jaybutterfly]

Would you mind sharing why your doctor told you you do not meet the diagnosis for transsexualism and if she diagnosed you with another condition? There are many conditions that can cause a person to have a "'seemingly' female identity." The  "other things" your doctor said are important to understanding her diagnosis.

The doctor claims autistic traits and autism screenings as preferable, but also claims my gender issues are possibly an attempt to be noticed by my family unit. While I understand some concerns due to the dynamics at play in my family where emotions can be stiffled, I personally disagree with this, especially the implications this would have that I am doing some form of attention seeking.

Additionally, I spent nearly my entire education up until college with learning support for dyspraxia, being assessed yearly for other issues. Autism was never confirmed, but dyspraxia is what was run with, which does overlap with autism in some areas, and according the the Dyspraxic association, if they believe Autism is more likely, then that is the favoured diagnosis. The wording seems to be 'could be' and 'possibly' which makes the letter vague. I requested a second appointment. I also noticed they referred to me as a crossdresser, something I have stated I do not consider myself to be in the assessment.

I guess all of this has me thinking perhaps there is a focus on the need to label and highlight differences as if they were flaws or faults, rather than just human variety? To my understanding, Autism would not explain gender-incongruence, but is actually supposedly common among trans people if studies I have read are to be believed, and one does not rule out the other in a 'youre not trans youre autistic' manner.

In the letter, there is a part that I would describe as the 'howevers' in the letter are

-ambivalence to vagina construction
-concerns of infertility in treatment and wishes to delay hormones until gamete storage can be afforded (not provided by the service)
- Seems to have a poor sense of identity due to lack of room within family dynamics for emotional reality and need to hide out.

Definitely feels like for whatever reason I don't seem to qualify as 'trans enough' for this doctor.  The problem is, the letter doesn't confirm a diagnosis for anything specific, just maybe this, maybe that, but admits I have signs of a female identity. It's a bit of a headscratcher.

[Lucca]

It certainly doesn't seem very helpful; if they're not going to consider you to be transgender and give you the go-ahead for transition, they should be giving you clear direction about what they think your condition is instead and give you direction on how to proceed.

[Sephirah]

I wonder now, why do we pathologize identity now? Why must being trans be considered something I need to justify to panel of people who do not know me or do not live my life? Why must trans and lgbt people need to justify themselves? Why not de-medicalise and de-pathologize being trans? Does it not force us to jump through so may hurdles? If we didnt, would we not need to worry about the oppression that comes with the ignorant shunning of what others claim to be 'mentally ill?'

One answer to that is sometimes painfully simple, sweetie. Fear of repercussion. Fear of allowing the individual to feel for themselves, only to come to a point later on in life where they realise those feelings were wrong, and that someone must be to blame for it. There are some people who would rather "play it safe" than be wrong. Even if they aren't. The possibility is there.

It's a very tricky situation, because however many hoops you may be made to jump through, or tests subjected to, at the very most it's clutching at straws. Even with that clutching being the most educated it can be. Hoping those straws are the right ones. Ultimately no one can be inside a person's head but them. No matter how much training someone has. How many other people they've seen with similar situations... every person is different, even if those differences are slight.

In an ideal world, what you say would be the case. But in an ideal world people wouldn't try to blame others for something which they felt they wanted. People wouldn't try to avoid responsibility for their own decisions and try to say it was someone else's fault for "not realising what was really wrong with them." It isn't an ideal world. It happens. And since treatment is in the domain of medical practitioners, they take the blame. They're in the first line under fire.

As a result, there are some who take a very defensive stance. Who would rather be wrong and not let you change your body, than be wrong and have you come back to them in 10 years saying "It's all your fault!".

[Virginia]

Thank you sharing, jaybutterfly.

Seconding Lucca's post:

if they're not going to consider you to be transgender and give you the go-ahead for transition, they should be giving you clear direction about what they think your condition is instead and give you direction on how to proceed.

[krobinson103]

Takes me back about a year. I talked to the doctor about wanting to transition. He accepted readily enough but wrote Gender Identity DISORDER in my notes. Yes, its necessary to get the treatment but I do not and never will feel that my identity is a disorder. Made me a bit grumpy.

[DustKitten]

They never do stuff like this to cis people.

"We're sorry, but we don't think you're cis enough, so you're going to have to transition."