Stop Trying to "Fix" Trans People

[Miniar]

Problem is, at this point in time, there's nothing we can do to prove that GID is a biological condition. It is, for all intents and purposes, the incongruence between who we are mentally and who we are physically that causes us distress. There's nothing wrong without genitals and chests other than they don't match who we mentally are.
If it can't be diagnosed physically, and we don't want it diagnosed mentally, then how are we to expect it to be considered an Actual condition for which we need medical help?

[metal angel]

We do not want to be 'corrected' or 'fixed', just the freedom and opportunity to be who and how we want to be.

The only place that "fixed" ever appearred was in the headline the OP wrote? this whole time i have been talking about "treatments" and "solutions"?

If the meidcal community have a propper definition of the problem they are trying to assist with, it facilitates study and discussion, and it more will likely improve the opportunities you have for accessing medical services you want than hinder them?

It is just a definition. As is stated many times on this site, cis-genderred people don't understand the needs of transexual people. Definitions are helpful for fascilitating communication.

thanks Miniar, you said it in a lot less words than i did.

[Julie Marie]

Well that's another miss-match problem, her beard did not match the rest of her body, but in that case both are easily recognised externally.

I think we are getting closer.  You recognize hirsutism as a mismatch because you see a woman who is happy being a woman with a condition that is typically gendered male. Women should not have beards.  This is social conditioning.  And women who do have beards should be covered under insurance to have them removed.  We seem to agree here.

But what if the "woman" is actually a transman and welcomes the onset of male facial hair growth?  And what if his parents see this as a mismatch and force him to have electrolysis? 

If society accepted a transwoman with a beard is mismatch, just like the genetic woman above, then the transwoman would also be covered by insurance for her electrolysis.  Again, social acceptance is key.

What is so bad about having a mental disorder?!?!?

Maybe you are okay walking around and telling everyone you have a mental disorder, but that's not my cup of tea, especially when it's not true.  Do that and watch the people around you walk away. 

When I went to visit a friend of mine in the hospital just after she had GRS, I was talking to a nurse.  She said GRS was new to the hospital and when the staff learned one of their doctors would be bringing in GRS patients, "We were afraid", she said.  Imagine, nurses, doctors and staff at a hospital being afraid because transsexuals were coming to their hospital.  That's the power of the stigma attached to having a mental disorder.

Meta Angel, we can agree to disagree and that's fine.  And if you want to go out on the mountain tops and scream "I have a mental disorder!", feel free to.  But please, don't try to drag the rest of us with you.  We don't want to go.

If it can't be diagnosed physically, and we don't want it diagnosed mentally, then how are we to expect it to be considered an Actual condition for which we need medical help?

For a long time fibromyalgia was considered to be a mental condition.  Doctors could find no way to diagnose it or find any physical symptoms for it.  So it became a "it's all in your head condition".  But because it was reported by so many patients and they realized there was a pattern forming here it became recognized as a medical condition.  Today they diagnose it based on the patient's description of their aliments.

Transsexuals have a long history of symptoms they have given to psychologists and doctors.  The Harry Benjamin Standards of Care addressed this and came up with a solution that works and most doctors follow to this day.  This is a tried and true treatment and it works far better than the treatment fibromyalgia suffers get.  So common sense says, accept it until you come up with something better. 

The AMA has accepted it.  We just need to get the insurance companies to do the same.  But they won't until it is removed as a mental condition.

Julie

[Shana]

OK gang,

I have been going over and over the original article and the posts and links here and I really wish I had something more intelligent to interject. To be more concise, I would have to do quotes and pastes of Metal Angel which would be about a yard long if printed.

First: Thank you Metal Angel for your time and patience in doing the research and footwork you have.

Second: I have to agree with nearly everything MA has said. I think there was a belief early on that MA was specifically advocating for Dr. Zucher which I have not found in re-reading the posts.

Third: I agree with the concept that until there can be found a medical/biological causation for GID, it is best left under the heading of Psychological Disorder whether specifically listed in the DSM or not. Most of our primary contacts are with the psychological community and it is their standards we first must meet.
I agree that the Benjamin Standards of Care are the preferred method of treatment and diagnosis, however, I am sure most would agree that even they should be upgraded to fit modern experience.

Fourth: Getting back to the initial article; I think there is fear that the appointment of Dr. Zucher gives him fiat and steering power over the committee. Here are the words from the APA itself regarding the new DSM and how the process evolved.

http://www.psych.org/dsmv.asp

Fifth: I do believe we, especially those of us who seek the surgeon's knife or hormonal therapy, must admit that what we seek is medically radical. And, being that the solutions are so very radical there must be a viable diagnostic procedure and regimen. The argument that "they removed Homosexuality so us too".. is not a valid comparison. For the Doctors, Endocrinologists, Psychologists, Psychiatrists, Pharmacists, and the entire food chain of professionals, they must have the backing of their professional community and standards to ensure themselves from suit, fraud and malpractice. Without them, we have nothing but our yearnings and no avenue of relief.

And lastly: We can not just have a "come on in.. you say you're transgendered.. ok, here's your pills, surgery is a week from tomorrow" approach. Most of us go through years of struggle and turmoil before we finally have just had enough. I went under the knife. I am ever so grateful I did.  My SO, who was also MtF when we fell in love was seeing the therapists, going to the doctors, on hormones and thought that surgery was for sure in her future. Over the years she wavered. Now he is a happy, quirky, androgynous male and I have never seen him more comfortable and relaxed with himself.

Our providers need to take their time. Need to be absolutely certain.. within their own minds before giving us our papers. It is their own conscience riding with us.  If they have doubts then they are obligated to stop and hold, for our sake as well as their own.

Sometimes the fix is the knife, sometimes it is attitude, sometimes it is finding the place you are comfortable and sometimes it is just letting Johnny find out how to be a boy who likes dolls.

Just my opinion.

[Miniar]

For a long time fibromyalgia was considered to be a mental condition.  Doctors could find no way to diagnose it or find any physical symptoms for it.  So it became a "it's all in your head condition".  But because it was reported by so many patients and they realized there was a pattern forming here it became recognized as a medical condition.  Today they diagnose it based on the patient's description of their aliments.

Not exactly...
They listen to your description, then run a whole set of medical tests to rule out other causes, and then they do a physical exam where they apply pressure to a set of points on your body that are tender/sore in cases of fibromyalgia.
So there is a physical diagnosis system for fibromyalgia.

[heatherrose]

I seem to have the ability to kill threads with a few taps on my
keyboard, I hope this is not once again the case with this posting.

Nature or nurture, psychological or biological, this is the
problem, we as the sufferers of this "condition", in the last three or
so days, have not been able to come to a consensus as to what the
basis of our problem is. Yet, we shake our fists at the "establishment"
when they balk at sticking their professional and financial necks out
and expect them to foot the bill, for tens of thousands of dollars, to
"cure" a problem which for their bean counter brains defies diagnosis.

[Just Kate]

If we accept the idea that all people should be able to do whatever to their bodies they want without condition so long as they have the will and the money, then there is no argument to be had.  We should remove it from the DSM.

However, if we are not willing to accept that argument and believe there is a specific obligation amongst medical professionals to decide which procedures to perform and which not to regardless of money, we must have a specific criteria to determine when those procedures are and are not advisable.  That criteria can come in many forms.

Right now, GID is not able to be determined through any medical test.  By default, fortunately or unfortunately, it is considered a condition of the mind.  A seemingly well functioning male/female for some reason believes they are actually a female/male.  The best we can go with (currently) is that there is something up with that person's mind.

So if we believe that medical professionals have an obligation to decide who to and to not treat, and we accept they must have criteria to determine this, and we accept that right now GID is only diagnosable mentally, we need a mental-based criterion by which to judge it.

So where do we find a place that will allow medical professionals to determine criteria for mental conditions?  In at least America, the DSM.  Perhaps there are other places such criteria can be found in an official, peer reviewed place, ones with less of a stigma.  But even if we cannot find one, such criteria is not out of place in the DSM.

So as for "fixing" transsexuals, we have a current method that works for many (the SOC), but for it to work the best, we need criteria for those standards to guarantee the happiest results for those seeking this treatment for this condition.  To do that we need research.  A lot of research has already gone into the SOC.  But the nature of research is one that is never ending.  Just because we have one cure doesn't mean we should stop all research.  We hardly know everything there is to know about transsexuals, gender identity, or about potential treatments.  Because of this, research must continue, and we must not resist it.  Right now one of those foremost researchers, love him or hate him, is Dr. Zucker. 

We need more researchers.  We need more actively engaged in learning all they can about us - people who won't hold to archaic ideas about what it is to be male and female and are willing to look at us with a new eye.  We also don't need people so set in their ways on how to treat transsexuals; we need people researching new ideas and thinking outside of traditional treatments in order to find better treatments. 

The very nature of research is that often findings will make people uncomfortable.  Why?  Because they change our perception of our world.  Some of us like our world, we don't want it to change, but we should not stand in the way of this progress.  The best progress will occur so long as there is something to research.  Removing the condition from the DSM might diminish research from those who are working to help us as they put their efforts toward other listed diagnosable conditions.  Perhaps you think this is a good thing.  I personally do not, but that is my opinion. 

Bottom line: I don't wish to discourage research, and I believe that we need criteria to be used by medical professionals to know who and how to treat.

[Julie Marie]

Not exactly...
They listen to your description, then run a whole set of medical tests to rule out other causes, and then they do a physical exam where they apply pressure to a set of points on your body that are tender/sore in cases of fibromyalgia.
So there is a physical diagnosis system for fibromyalgia.

Today, maybe, but when one of my kids was going through being tested, they had nothing to go on but the patient's word.

The first thing they did was rule out psychological causes.  (Sound familiar?)  Then they listened to the symptoms and tried to treat it with whatever they thought would work.  The doctor said the medical community had only just begun serious analysis of the problem because it was only recently considered a medical condition.

The important point here is, until fibromyalgia was no longer seen as a psychological condition, the medical community didn't bother to take it seriously as a medical condition and therefore there was little or no studies conducted to understand the cause.

As long as TG is considered a psychological condition it will continue to be treated as such and there will be very little progress in studying and understanding it's physical origins.

Julie

[metal angel]

I think we are getting closer.  You recognize hirsutism as a mismatch because you see a woman who is happy being a woman with a condition that is typically gendered male. Women should not have beards.  This is social conditioning.  And women who do have beards should be covered under insurance to have them removed.  We seem to agree here.

well actually i think women should keep their beards, the world could do with a bit of variety, but not everyone feels as comfortable being unusual as i do, so if a womaan needs her beard off to fit in that's ok, and if a guy has that condition where he's wolf-faced then i think he should keep it, but if he doesn't want to he can have insurance/gov pay for removal.

But what if the "woman" is actually a transman and welcomes the onset of male facial hair growth?  And what if his parents see this as a mismatch and force him to have electrolysis? 

well i'd see that as wrong to force someone to change themselves, i think that would be very cruel. But no more cruel for a transman than a Frida Kahlo.

If society accepted a transwoman with a beard is mismatch, just like the genetic woman above, then the transwoman would also be covered by insurance for her electrolysis.  Again, social acceptance is key.

Well i would happily accept someone with a beard wearing female clothing, performing a generally female social role etc. But if said transwoman needed it removed to function, then i'll pay my taxes for them to have it removed, cheaper than antidepressants.

I've said this whole time that transsexuals have every right to do whatever they want with their bodies, and that if it is a need rather than a mere want (they need GRS to function in the world) then it should even be state funded.

Maybe you are okay walking around and telling everyone you have a mental disorder, but that's not my cup of tea, especially when it's not true.  Do that and watch the people around you walk away. 

No, i don't "(walk) around and telling everyone (i) have a mental disorder" because it's private, i'll even pretend i have something more vague if i can "i don't feel well". But i'd do the same if i had a gynocological problem, i wouldn't want the doctor writing the details of my medical condition in either of those areas on the sick note for my boss. But just out of a sense of privacy about both areas.

Post Merge: August 30, 2009, 06:10:56 AM

The first thing they did was rule out psychological causes.  (Sound familiar?)  Then they listened to the symptoms and tried to treat it with whatever they thought would work.  The doctor said the medical community had only just begun serious analysis of the problem because it was only recently considered a medical condition.

The important point here is, until fibromyalgia was no longer seen as a psychological condition, the medical community didn't bother to take it seriously as a medical condition and therefore there was little or no studies conducted to understand the cause.

I think the key problem was that in the case of fibro' the lack of explanation led to a lack of cure. In the case of TS there is a physical treatment which can work, so as long as the problem can be defined (even if currently that's only possibly psychologically) the medical comunity will play along.
Post Merge: August 30, 2009, 07:17:53 AM
i agree with everythng Shanawolf said, very well put

Interalia, i agree with what you said about research. In fact research into the most unusual conditions (e.g. GID) can tell us a lot about the human body and brain work which could help far more people than expected.

I've been reading your blog too, maybe some personal perspective from you would help Julie Marie and Janet understand that their approach might not be right for everyone. I feel a bit dodgy doing a cut-and-paste job from your blog though. Care to tell us a story?
Post Merge: August 30, 2009, 08:20:33 AM
Post post post script, the article in my signature (which there is another thread around here somewhere about) is another well put defence of GID in the DSM. From a more TS-perspective too, rather than my perspective which is that of a gender-queer sicentist.

[Janet_Girl]

I have no problem with research.  Maybe we can finally get GID recognized as a medical issue, not a psychological issue.

But what I fear is the thought process that we have to be made to feel comfortable in our birth gender.  I transitioned once back 25 years ago and detransitioned after a year.  And for those 25 years I attempt suicide three times.

Transitioning isn't for everyone, but for those of us who it is right: why must we be punished or discriminated against for trying to correct a birth defect?  I have never been happier than I am now.  I am finally being myself.  The only thing that is left is SRS. 

And because it is called 'cosmetic', insurance will not pay for it, so I am stuck half way in between till I can raise the monies.  Is it right or fair for those of us stuck in this transitional phase to be refused medical treatment?  It is life saving for many of us.  what would it take to have SRS covered by insurance?  Another attempt to take my own life, because some people just don't understand?

Janet

[metal angel]

I was thinking about this last night, given SRS is so expensive, and is not something any normal  male would want, i think it should alwayse be coverred by insurance/gov and psychological assessment be made on patient choise and "best interest" of the patient. If those who needed it got it free and those who wanted it had to pay, too many people would be trying too hard to convince the system they really "needed" it and that would get in the way of propper care.

As for who gets the other bits and pieces and who pays... i think you'd need a health economics degree and a psych degree to work that out...

some people want all the rest but not SRS, and probably really "need" the all the rest bit, but how do you assess that, a guy who just doesn't like shaving should pay for his own electrolisis... gets real complicated...
Post Merge: August 30, 2009, 04:09:36 PM
I still don't get what's so bad about it being psychological?

If it is a mind-body missmatch, how is the body any more wrong than the mind? they're both wrong for each other, but each is (arguably) fully functional in it's own right. It's just a perspective issue as to which is wrong.

Would "neurological" be an improvement? My ex was bizarely proud when he found out that he had epilepsy not skitzophrenea, i don't understand why. Meant he got right meds, so i can see why he was pleassed, but not why he was proud.

[Miniar]

It's easier to rewire the body than the brain.

[tekla]

Are people answering the question based on their own experience and understanding, or on simple financial considerations?

[heatherrose]

I am seeking answers based on my experience, the input from my peers
and the knowledge gleaned from the research of others. I have come to
this point only after the headyness of the early days of transition, have
worn mundane. Other than the surgery and some hair removal,
I'm done. I feel I understand who and what I am, better
than I have in my entire life. Now the question is, WHY.
That is the basis of my assertions and questions.

[metal angel]

Are people answering the question based on their own experience and understanding, or on simple financial considerations?

which question?

[tekla]

which question

Is it easier to fix the body or the brain, nether or both?

[juliekins]

Would "neurological" be an improvement? My ex was bizarely proud when he found out that he had epilepsy not skitzophrenea, i don't understand why. Meant he got right meds, so i can see why he was pleassed, but not why he was proud.

But don't you see? Your ex did not want the Stigma of having a mental illness. Epilepsy is seen as a neurological problem and not a mental illness. This is Julie Marie's point in starting this thread.

Yes, I would like to have had my surgery paid for by my insurance company. That said, I don't think the trade off of the stigma label is worth it. Religious groups see that we are located near pedophilia and other parafilias in the DSM, and jump on the fact that we are whacked. I know of families where transpeople aren't allowed to see their nieces and nephews because we're not stable or a good influence. I once spoke to a nurse in a hospital that now treats patients having SRS. She said that until she got to know us, and got comfortable, that she was afraid of us. Haven't we seen Hollywood in the past even depict trans people as psycho killers?

I feel that being included in the DSM gives employers and others license to discriminate. That we can't be trusted with responsiblity or a security clearance. It also provides family or friends grounds for distancing themselves from us. Sure, I wish mental illness didn't have these effects, but that's reality.

[Julie Marie]

Are people answering the question based on their own experience and understanding, or on simple financial considerations?

For me, totally from experience.  Things I have learned in my life tell me if someone thinks you have a mental disorder, then you're nuts.  Your brain is screwed up and you're not normal.  "Get thee to a shrink!"  Nothing more can be done for you until the psychiatric experts fix your screwed up brain, if they can.  And most know if you're nuts you probably always will be.

Now, if you have a physical ailment, a birth defect, a disease, there's hope for you.  And, most importantly, it's not your fault!  So society gathers around you and cheers on your recovery.  After all, they may find themselves in your shoes some day.  But no one thinks they will end up "nuts" some day, unless it's Alzheimer's.

I grew up hearing people be considered "keep away" material because they were "mental", "screwed up", f----d up in the head".  You just didn't go near those people because you never knew what they would do next.  Even in prison, where you have the the worst of the worst, prisoners often steer clear of the mentally insane for the same reason.  People who would just as soon kill you as know you are afraid of those they think are nuts.

The stigma for being mentally "deranged" is deeply sewn into the threads of our society.  They tried to fix gays when homosexuality was listed in the DSM.  They ignored those with fibromyalgia until it was no longer considered "all in your head".  And they will continue to treat TG as a mental disorder until we get it removed from the DSM.  Don't count on it being covered by your insurance until it is.

We suffer dysphoria, the opposite of euphoria.  It is not a mental disorder.

That's my view, based on my experience, in almost 60 years of life on this earth.

Julie

[Miniar]

Are people answering the question based on their own experience and understanding, or on simple financial considerations?

Practical understanding.

[metal angel]

I think that homosexuality, crossdressing, and TS are all traits of the mind. Difference being that CD and homosexuality are just unusual, they are not pathological because they require no treatment. In an accepting culture they cause no distress just slightly atypical behaviour. Almost like a skill, some people have minds with an unusual tallent for some particular skill, but homosexuality and CD are not a skill, just a neutral non-positive non-negative part of the normal variation.

But, correct me if i'm wrong, TS seems to cause trouble even in an accepting culture? And some people require treatment to be content, the most effecting treatment being physical transition?

If you are doing it purely as a choice then that's not a mental illness. If you COULD live as your birth gender, just you prefer not to, that's your choice, and it's certainly unusual, but not pathological. That's kind of how i used to see TS. But i keep hearing from the TS here that they NEED to transition? and i keep hearing that it's a medical condition, but there does not seem to be any identifiable symptom or functional deficit in the body? All the SYMPTIOMS are in the mind: distress, depression, anxiety etc. (as a point of interest euphoria is a symptom too, seen in bipolar for example, as part of the mania).

A lot of mental illnesses have a very organic cause, the ones we understand are often due to an excess or lack of certain chemicals in the brain. TS has some organic cause that canot yet be identified. Your theory about it being a healthy mind in a healthy miss-matched body may be right, but then there is in a weird way no illness... or you could say it's in both, the brain is wronong for the body AND the body is wrong for the brain.

I think of the DSM and similar lists as a list of all the eccentricities of the mind (not "defects" just differences) which have the potential to lead to distress.

I am really getting sick of you perpetuating the stigma of mental illness, running from the concept like the plague, i'm worried by how you'd treat a person who was associated with this concept you find so vile?