Why remove GID from DSM?

[YoungSoulRebel]

Imagine this...

GID is removed from the DSM.

The "professionals" realize it's just a natural variation and not a mental disorder.

The public accepts this and gender is no longer considered unchangeable.

This is a very idealistic ("in a perfect world...") proposition.

Early recognition means early intervention.  Hormonal treatments started around puberty...

Not even countries that do allow some kind of hormonal intervention for TS pminors allow full-blown HRT on pubescent children who are not IS -- the most that Germany, for instance, consistently allows for TS minors is regime of hormonal suppressives.  The TS girl from Germany who had GRS (genital reconstruction surgery) at sixteen is widely acknowledged as a "special case", and I think she may technically have a sort of IS diagnosis that would allow for that in the first place (but seeing as Germany also has doctor-patient confidentiality, it's likely that this was kept out of the press).  But even in Germany, TS persons are still classified as having a "mental disorder" -- it's just that the standards of care for German TS persons is far superior to TS persons in the U$.

... no mastectomy and maybe even no phalloplasty. 

No mastectomy for FTM TS persons having puberty intervened?  Quite probable, but not a guarantee -- at the age of twelve, I was already wearing a DDD bra and I had distinctly noticeable breasts at the age of nine (it's called "macromastia" and my paediatrician also considered me to have "precocious puberty", by all means, look 'em up); and I'm just one example of how your idealist suggestion is not a realistic one.  But "no phalloplasties"?  Are you seriously that ignorant of what TS men's GRS actually entails?  Neither the clitoris nor the penis grow exponentially with age and prolonged exposure to extra testosterone (and I use these words because minute degrees of testosterone are produced in the pituitary gland and, in females, within the ovaries).

As long as there's a book that says it's a mental disorder, it will be treated as such.

I'm really tempted to take this statent to an illogical extreme, but I will refrain because I know(nay, hope) that's not really how you meant it.

But as I've said numerous times already -- treating certain ailments as "mental disorders", like bipolar disorder, is not what causes the stigma in the mainstream medical community.

I keep using bipolar disorder because that's a condition with DSM criteria that has a very real and well-documented physical component:  It is almost always caused by a neurochemical imbalance of seratonin within the brain.  Bipolar disorder is still treated as a "mental disorder" in that it has DSM criteria, and it has DSM criteria because the symptoms affect the person's quality of live by putting the person in severe mental/emotional distress, and also because bipolar disorder has a far greater room for variation than most other physical ailments (like spina bifidia).  A severely bipolar person like my best friend literally needs a lifelong regime of medication to keep her mental state balanced enough to live her life to her fullest potential.  On the other hand, my room-mate is also bipolar, but much more mildly; all he really needs is the occasional Zoloft under periods of extreme stress to help balance himself out.  Both my friends have a proved seratonin imbalance that has resulted in their bipolar disorder; which is slightly more than what I have, in physical evidence, to back up my transsexualism -- my physician did a baseline hormone check and chromosomal analysis to see if I met any IS diagnostic criteria, and nope, I'm just a regular XX and with "high, but not uncommonly so for females" natural testosterone levels.

Basically, I have nothing byt DSM criteria validating my transsexual status.  I never had any sort of brain-scan prior to HRT, so any supposition that I may have had "male brainwave patterns" is purely speculation.  I highly doubt that more than maybe a handful of people in this thread, at best, have anything more than speculation (aside from DSM criteria, that is) to validate their ostensibly hard-wired gender identities.  Any supposition that gender identity is pre-natally determined is, even in the biomedical community, still in the realm of hypothesis -- it's an educated guess, on the part of a vocal population of doctors, based on intriguing evidence, but it's as-of-yet untested.

All we have is the DSM.  While I have a problem with the standards of care for TS persons as pushed by many people in the psychological communities, I see no reason to take GID off the DSM; it's the only way to guarantee that TS persons will receive care.

[Valerie Elizabeth]

I'd like to step back in.

Julie, I think your scenario would be really awesome, but I think it hinges on being able to diagnose GID using blood tests, other type of biochemical test, imaging, or whatever.  I think before it comes out of the DSM, it needs to be diagnosable through some type of lab test.



I want to disagree with the idea of GID not being a mental illness.  I think it is.  When a human being is conceived, the sex is determined as soon as the sperm and egg join; XX or XY (most commonly, yes I know there are rare variations).  Gender Identity, as far as science can tell is caused by weird hormone levels during pregnancy, polymorphic gender specific genes, and a couple more reasons.  I read a ton of medical journals, and a lot of the journal experiments conclusions contradict each other.  They really don't know what causes gender identity, just ideas.

What I am trying to say, is that I think realistically, GID is actually the mind being different from the body, not the body being different from the mind.  In the case of GID, I think it is actually the mind having a problem.  Since there is no known treatment for the mind, the body has to be "fixed".

I know I am going to get flak for that last paragraph, but I felt it important for me to say.

[Miniar]

I do agree that the underlaying cause of my problem isn't "Mental Disorder" but "brain, body, incongruence".
I do however consider myself mentally ill. I do. Because I am "mentally" unable to cope with my current situation without medication.
I've been diagnosed with dysthymia which is in all probability caused by this (and chronic pain and stuff connected with that).
I suffer serious mental pain.

My brain/body mismatch doesn't cause me "physical" pain. All the pain I feel is rooted in my mind.

The only piece of document in the world that acknowledges that pain and makes it treatable is the DSM.

I would love to see a system wherein the brain/body mismatch is documented and accepted. That sees my psychological symptoms as simply a symptom of the mismatch, and treats the mismatch accordingly.
BUT, until we have that mismatch documented and accepted by the medical community, I'm just not supportive of cutting me out of the one medical document that pretty much guarantees me the right to the medical help I need.

If it weren't for the DSM then transsexualism or GID wouldn't be recognized in Iceland.
I would not have any treatment options available to me.

I'm not crazy, I'm a man, but I "am" ill and my symptoms are completely mental.

[Asfsd4214]

What I am trying to say, is that I think realistically, GID is actually the mind being different from the body, not the body being different from the mind.  In the case of GID, I think it is actually the mind having a problem.  Since there is no known treatment for the mind, the body has to be "fixed".

I know I am going to get flak for that last paragraph, but I felt it important for me to say.

What's the difference? If the mind is different from the body, then the body is different from the mind as well. The question is, which one is actually wrong? Is the mind wrong for thinking it's the opposite gender? Or is the mind right in thinking it's the opposite gender, because it is.

If it's the former it's a mental illness, the latter it's not. Maybe it's not as simple as one or the other. My point is that the assumption that the mind is simply delusional in its perception as a different gender to the body is just that, an assumption, an unfounded one at that.

[Shana A]

Check out this link for reasons why GID should be revised and/or removed from DSM. http://www.gidreform.org/wpath2009/

Z

[Valerie Elizabeth]

This is what I got out of the article.  I didn't read it through in depth, but I went through it roughly.  A bit out of order, but what I got.  Care to discuss this?  Feel free to add anything I missed.


     -End discrimination on the basis of gender identity and expression
     -Gender identity and expression that differ from assigned birth sex do not, in themselves, constitute a mental disorder or an impairment in competence
     -Hormonal and/or surgical transition treatments to relieve gender dysphoria are medically necessary
     -Insurance and health care coverage for medically prescribed transition treatment
     -Legal recognition/documentation for all people that is consistent with their gender identity and expression.
     -Reform must fit everyone's needs, but as a social justice movement we must weigh more heavily the needs of those least enfranchised.


The article mentions that there are three groups of people.  I can say that we have seen all three of these people comment on this forum.  I feel like I fall under the third group.

     -Remove fro the DSM, code as a non-mental health disease in the ICD. 
     -Pragmatic: It's in DSM; change it to make it better at helping transpeople.  May believe it's not a mental illness, or may not be sure, or may not care. 
     -Gender Dysphoria is a mental illness, but we can change the DSM diagnosis to make it better at helping transpeople.


Summary:

      -It's about Dysphoria
      -Respectful Language
      -Not too Big; Not too Little; but Just Right
      -Accurate Classification Placement
      -Remove Tranvestism/Fetishism Categories

Our main points are:
1) gender dysphoria is the conceptual center of the diagnosis
2) use respectful language in nomenclature and description of individuals
3) include those who are in need of inclusion, do not include those who should not be
4) move the diagnosis out of the sexual and gender identity disorders chapter
5) and remove transvestic fetishim.


Summary of Proposed Diagnosis:

      -Dx Criteria – Both A and B
      -A: Strong and persistent distress with physical sex characteristics, or ascribed social gender role, that is incongruent with persistent gender identity.
      -B: Distress is clinically significant or causes impairment in social, occupational, or other important areas of functioning, when this distress or impairment is not solely due to external prejudice or discrimination.
      -GD in remission
      -No longer meets criteria, needs treatment to maintain remission
      -'Exit clause'
      -No longer meets criteria, doesn't need treatment to maintain remission


Location in the DSM:

GID Dx in Sexual & Gender Identity Disorders is neither clinically accurate nor palatable to many transpeople

Alternate Location in the DSM?

      -Separate section within Axis I
      -Disorders generally first diagnosed in infancy, childhood, or adolescence
      -Anxiety disorders


Inclusion of Those Who Need Care :

Clarify anatomical dysphoria to include:

      -Distress with current incongruent characteristics
      -Deprivation of congruent characteristics

Include full spectrum of human diversity as legitimate gender identities and expressions.

      -Remove binary language of 'other' and 'opposite' sex from criteria and supporting text
      -An InRemission specifier to provide care to those no longer dysphoric


Reduction of False-Positive Diagnosis:

Limit Dx to those experiencing dysphoria
Exclude those who are merely gender non-conforming

      -Remove gender expression stereotypes from Dx
      -Exclude gender non-conforming children who are not distressed by anatomy or birth assignment

[Janet_Girl]

It really does not matter how much we debate this issue, it is still up to the powers that be.  If they do go with the suggestions that were listed, it will become a medical issue even though it is still mental.  Changing the body makes more sense than trying to change the mind.

In my case I have always hated being male.  I have tried several times to alter the body to match, or just end the fight.  I am now in a personal state where at least dressed I am a woman.  I do not look at my body naked and I hide mirrors when showering.  When and if they ever decide that surgeries are to be part and partial of treatment and it gets covered by insurance, whether by private or public means, then and only then will hundreds of us be able to be true contributing members of society.


Janet

[Hannah]

Maybe it doesn't matter what we think, but it's a fascinating topic for discussion nonetheless and it's good for us. Kinda like mental weight lifting if you will 

[YoungSoulRebel]

I want to disagree with the idea of GID not being a mental illness.  I think it is.  When a human being is conceived, the sex is determined as soon as the sperm and egg join; XX or XY (most commonly, yes I know there are rare variations).  Gender Identity, as far as science can tell is caused by weird hormone levels during pregnancy, polymorphic gender specific genes, and a couple more reasons.  I read a ton of medical journals, and a lot of the journal experiments conclusions contradict each other.  They really don't know what causes gender identity, just ideas.

What I am trying to say, is that I think realistically, GID is actually the mind being different from the body, not the body being different from the mind.  In the case of GID, I think it is actually the mind having a problem.  Since there is no known treatment for the mind, the body has to be "fixed".

Agreed.

There are some oft-touted hypotheses about gender identity, but you're right, some studies are conflicting.  I think that, considering the scarcity of the condition (of being TS) and the severity to which those who are TS have it, that it may just be a hard-wired neurological trait, but neurobiologists have yet to discover what actually causes gender identity, without a doubt.  All there currently are, are hypotheses that have yet to be tested and re-tested to the point of proving them sound theory.

[...snip...]
My brain/body mismatch doesn't cause me "physical" pain. All the pain I feel is rooted in my mind.

The only piece of document in the world that acknowledges that pain and makes it treatable is the DSM.

[...snip...]

If it weren't for the DSM then transsexualism or GID wouldn't be recognized in Iceland.
I would not have any treatment options available to me.

I'm not crazy, I'm a man, but I "am" ill and my symptoms are completely mental.

Very well-said -- all of it, but snipped for length and to highlight two things to said to illustrate a point I've been trying to make:

It's not the fact that GID/TS persons are listed in the DSM that causes so much grief -- it's the standards of care in the U$ that is.  I really don't mean to see anti-American here (I was raised part-time in the UK and in the US I was mostly raised by British grandparents, so I know i have tendencies to seem such, at times), but I've noticed that many people in the US seem to have this idea that their experience is the same as everywhere else in the world -- even when this is proved to be the opposite case.  Ultimately every anti-DSM argument I've seen on dozens of TS/TG fora over the last decade has been a victim of the Corelation Does Not Equal Causation fallacy -- it's the recommended approach (which is incentive for most insurance agencies not to pay for treatment) to care that is the problem in the United States, not the fact that TS persons are included in the DSM, in and of itself.

Check out this link for reasons why GID should be revised and/or removed from DSM. http://www.gidreform.org/wpath2009/

That page hosts what is ultimately a call for revision, not removal.  And personally, I don't see how it's not a sex-gender dysfunction -- I mean, if my dysfunction (id est, mental distress and anguish) is gender-related, then it's a gender dysfunction.

But even this proposal makes it clear that GID / TS people Stateside would benefit from greatly improved standards of care, and proposes that standard care may greatly improve with a highly revised DSM criteria.  That's basically what this is saying -- it's not saying "eliminate TS persons from the DSM".

Maybe it doesn't matter what we think, but it's a fascinating topic for discussion nonetheless and it's good for us. Kinda like mental weight lifting if you will 

LOL!  Well, that's one way to look at it, but as I've noted, I've been in and out of the on-line and off-line TS/TG community since 1999 -- I've seen this debate come up at least once every six months in that time, and from where I stand, it feels like the mental equivalent of shifting from neutral to fifth gear with the parking brake on; I've never tried that personally, but my autoshop teacher assured us that the force would send everybody in the front of the car through the windscreen. 

[Julie Marie]

I have a thorn in my paw.  I can't remove it.  No one can see it.  It hurts.  I walk with a limp.  I get crabby and irritable.  I snap at people and sometimes I eat them even though I'm not hungry.

There's a book that says this is a mental disorder.  After all, no one can see the thorn.  It's too deep inside my paw for anyone to see it.  I know it's there but if they can't see it, they don't believe it.

I go to my doctor.  He can't find the thorn because he can't see it.  He says maybe it's all in my head and I need therapy and there's a book to back his diagnosis.  My family and friends agree... I have a problem. 

I say all I need is the thorn removed from my paw.

[YoungSoulRebel]

Interesting metaphor, Julie, but that doesn't really support anything more than a serious revision to the recommended care for TS/TG persons.  As Miniar pointed out, TS inclusion in the DSM is the only thing in Iceland that guarantees proper care -- which he is ostensibly receiving, as I recall a post where he's at least implied that he's getting HRT started soon.

The problem is NOT NOT NOT that we are included in the DSM -- the problem ABSOLUTELY is that the USofA has a highly backwards conception of what is best for us.  I mean, if most of the people here were in the UK, where we're covered under their NHS, this would be a non-issue because even genital reconstruction is covered under the UK NHS.  And UK Transsexuals have a "mental disorder", as well.  Advocating total removal from the DSM won;t have the effect that many people here seem to think it will.

[Arch]

The problem is NOT NOT NOT that we are included in the DSM -- the problem ABSOLUTELY is that the USofA has a highly backwards conception of what is best for us.  I mean, if most of the people here were in the UK, where we're covered under their NHS, this would be a non-issue because even genital reconstruction is covered under the UK NHS.  And UK Transsexuals have a "mental disorder", as well.  Advocating total removal from the DSM won;t have the effect that many people here seem to think it will.

This may be the case for many people, but it sure doesn't apply to me. For me, the problem IS that I'm in the DSM as having a mental disorder. And one problem is that there's no way OUT of the DSM even now that I have transitioned and am legally male. That's freaking insulting.

I agree that there has to be a treatment path. I agree that, inevitably, mental health professionals will need to be consulted in trans cases because of the unique nature of our situation. I do not agree that removing us from the DSM will have a magical effect on how we are treated, and I don't believe that a lot of other trans people believe that either. But neither do I agree that my "GID," as they call it, qualifies as a mental disorder--certainly not the way it is described now, and perhaps not at all.

If we look at our situation simplistically, as a mind-versus-body incompatibility, we see how complicated it is to simply call this a mental disorder.

Well, I'm going to start going around in circles, so I'll shut up. But I do resent that transsexuality is in the DSM--at least as an incurable condition. Because that's essentially how it's described at present.

[YoungSoulRebel]

Then you've made an argument in favour of revision, at most.

Even so, I don't realy see what you feel so insulted by.  Unless you've had implanted flesh-and-blood testicles that are producing their own testosterone into your body, you're still taking HRT for the rest of your life, aren't you?  Under what conditions do you propose continuing your prescription for it?

Maybe it's cos I've been around people with "mental disorders" my whole life, and know that it's really no big deal as long as it's being managed, but I really don't see what's so "insulting".

[Muddy]

So with that logic, should we remove ADHD from the DSM, so they are allowed to enlist?

ADHD has the potential to hinder someone's ability to perform their duty as a member of the military.

Furthermore, people with ADHD CAN enlist, provided they have been medication free for one year prior to enlistment.

I fail to see how GID hinders my ability to serve as a member of the Armed Forces... seven years of service, thus far, and it hasn't impacted the quality of my service at all.

[Miniar]

I have a thorn in my paw.  I can't remove it.  No one can see it.  It hurts.  I walk with a limp.  I get crabby and irritable.  I snap at people and sometimes I eat them even though I'm not hungry.

There's a book that says this is a mental disorder.  After all, no one can see the thorn.  It's too deep inside my paw for anyone to see it.  I know it's there but if they can't see it, they don't believe it.

I go to my doctor.  He can't find the thorn because he can't see it.  He says maybe it's all in my head and I need therapy and there's a book to back his diagnosis.  My family and friends agree... I have a problem. 

I say all I need is the thorn removed from my paw.

You have a thorn in your paw. No one can see it.

There is no book no-where that says anything about thorns in paws so no one knows what to do about it.

You go to a doctor and he doesn't see a thorn. He gives you a painkiller just to get you out of your office.

No one acknowledges that you have a thorn as no-one sees it at all and pretty soon, people stop acknowledging that you're in pain.

People start telling you to "get over it", and they don't stop.
Pretty soon you stop looking for help because you realize that there is none to be had at all.

You stop saying you have a thorn in your paw and suffer in silence... for as long as you can.

[Julie Marie]

I don't have gender identity disorder.  I never did.  Any diagnosis to the contrary was wrong.  What I had was a physical condition called Incomplete Gender Assimilation (IGA).  It is often confused with the mental disorder, GID.  It is characterized by a body that is incongruent with brain gender.

People with IGA who live in socially repressive environments often grow up being pressured into a gender presentation opposite their real gender and this often causes emotional distress and dysphoria (traumatic stress).  Removal of the individual from the socially repressive environment typically results in cessation of emotional distress.  Depending on the individual, surgery may be necessary to complete treatment.

I no longer have IGA.  It's been treated and I'm cured.  But there is some residual post traumatic stress I still need to work on and a lot of educating to do.

Julie

[Deanna_Renee]

Two questions Julie,

1. If you don't have GID and never have, then why the concern over removal from DSM? Why should those of us who have it suffer because those who don't have it don't want to be associated with them?

2. What are the fundamental differences between (diagnosed) GID and IGA? How is IGA diagnosed? Is the treatment for IGA the same as GID (i.e. HRT, SRS etc)?

I don't mean to come off as antagonistic, I'm just looking to become better educated. I am still trying to understand the particulars of my situation, so I have not developed a viable opinion as to whether I consider myself mentally ill, physically ill, etc. I cannot say whether I am for or against being listed in the DSM and I have read some decent arguements on both sides of this thread. What I am not seeing, with the limited exception of your suggestions a page or so back, is what is being proposed as a effective standard of care (if this is unoffensive).

Your proposed outline sounds potentially effective treatment for the youth of the future (5-10 years), but seems to me to be very exclusive of those of us who are well past puberty and have been dealing with/struggling with (whatever the commonly preferred term is, if not GID) and are trying to seek treatment. In any situation, there would need to be (IMO) some manner of diagnosis. I know of many people here who are 'confused', 'trying to figure what's wrong with me', 'why do I feel this way?", if this is removed from the DSM and is deemed no longer a mental (whatever you wish it to be called) and, as others have proposed, make it an elective/cosmetic procedure, then how do those who suffer,  and have no idea what they suffer from, know that they have whatever-it-is-to-be-called and how to get treated?

I prefer YoungSoulRebel's analysis of rewriting the DSM and SOC to include more up to date information and define the treatment to be more definitive (HRT, SRS being a necessary path not optional). But, even this can have problems - if HRT and SRS are declared necessary treatment for GID, then those who don't want surgery will be 'required' to undergo this necessity.

I don't want to elicit any tirades or a regurgitation of all of the same arguements that we have all read over and over in these past 5 or 6 pages. I, again, don't have an opinion or strong feelings of whether is should or should not be in DSM, but am more concerned about what viable option is proposed that takes its place and how that effects ME and others who are still trying to start transitioning and have long, long since past puberty.

Thank you for playing nice.

Deanna

[Julie Marie]

Two questions Julie,

1. If you don't have GID and never have, then why the concern over removal from DSM? Why should those of us who have it suffer because those who don't have it don't want to be associated with them?

2. What are the fundamental differences between (diagnosed) GID and IGA? How is IGA diagnosed? Is the treatment for IGA the same as GID (i.e. HRT, SRS etc)?

Well, first of all I was trying to make a point, that being, there are many of us who don't want the label of being mentally disorded attached to us.  As I see it, there are no useful benefits to that.

If your reason is to get proper care, there are better ways to accomplish that without having to endure all the negativity that comes with the mentally disordered label.  The AMA has already recognized what I call IGA.  The next step is for WPATH to change their recommendations for treatment so those who feel they have GID can be separated from those who feel they have IGA.  That way those with GID can get the psychological help they need and those with IGA can get the physical treatments they need.

Because we live in a world where genitals are considered sacred, suing a doctor for performing bottom surgery on you will always be a major concern for surgeons.  Therefore they will still need some documentation to ease their mind (or the mind of their insurance carrier) before agreeing to perform bottom surgery.  So some psychiatric evaluation will have to still be done until society comes around to accepting IGA as a naturally occurring event.

But instead of a therapist focusing on your depression, anxiety, etc and trying to resolve that, it will be widely understood these are typical reactions to IGA.  So the focus will turn to, would you truly be happy living life in the gender opposite your birth gender?

From there, it's a simple letter and making an appointment with the surgeon of your choice.  If your insurance covers it, they will need the letter before approving the coverage.

To answer your questions:

1. I created IGA to allow for a separation between those who cling to GID as their proper diagnosis and those who want nothing to do with it.  Thus the claim I never had GID.  My concern isn't personal but universal.  No matter what the DSM says, it will affect my life little or not at all.  But I know what I lived with for over half a century and I don't want anyone to have to endure anything like that ever again.  That may be idealistic to some but so was ending slavery.  We have to work to end discrimination.  It just doesn't happen.

I want a better world for all, even if I don't personally benefit.

2. GID is a mental disorder, as it states in the DSM.  If you want that diagnosis, you are free to accept it and all that it offers.  IGA is a physical condition.  You won't find it in the DSM (if it were recognized) because the treatment for it is HRT and any other physical procedures that will help in aligning the body to better match brain gender.  You can't change brain gender.

One can initially accept GID as their correct diagnosis and later discover they have IGA.  But if one feels they need a lot of psychological treatment because their mind is where the problem exists, then they should pursue the GID treatment.  But if you know your body is the problem, then choose the IGA treatment.

The only reason I care about this so passionately is because I don't want anyone else to suffer what I did.  It's like the person who was found guilty of a crime they didn't commit and was imprisoned for 50 years.  When they get out they become an activist for all falsely imprisoned people.  While they will never be able to get back the 50 years they lost or benefit from any change in legal procedures, at least they can take some comfort in knowing the chances of that happening to someone else will be greatly reduced by making the public aware through their activism and subsequent education.

I hope I explained myself properly Deanna.

Julie

[Deanna_Renee]

Thank you so much Julie for taking the time to clarify, this is what I was looking for. But, please excuse my ignorance, I am intrigued by the possibility of a different optional path. If you wouldn't mind clarifying the, I guess functional, differences between GD and IGA? I understand that in practice GID is regarded as a mental disorder and retains certain stigmas and prejudices, but the somewhat accepted treatment is HRT (for hormonal balance) and SRS/GRS (to bring body in congruence with the brain) in order for the patient to become less dysphoric (I apologize if I have any of this wrong or overly simplified).

For me, I know that my problem is not mental in the same way as other mental disorders, but that my mind sees my body as being wrong. The only solution that I can foresee to alleviate that dysphoria is HRT, SRS and possibly FFS, BFS. This sounds, to me, as though I may fit more in the class of IGA, but I am only now hearing the term so I completely ignorant of it. I am currently seeing a therapist (psychologist, if that has any worth) and will actually be seeing him tomorrow and I guess what I am wondering is how would I go about seeing about diagnosis of IGA (if that is what I have)? Is there a clinical difference between GD and IGA? I may have already asked that. You mention SRS as treatment for IGA, does that also include HRT? I understand that HRT is a necessary prerequisite for SRS, correct? Does diagnosis of IGA require RLE?

I am quite certain that the only way I will feel 'right' is by way of changing my body's sex to that of a female. As long as I look and feel like a male, then I will be in anguish and suffer from dysphoria (by any other name, still affects the same). If this is IGA or GD I don't know. I also know that it may be a very long time before I will be able to afford to pay for transition out of pocket. I am also unemployed at the moment, but looking at getting a job soon (been interviewing) with insurance. Are insurers more open to, accepting of, IGA diagnoses as a necessitating HRT and SRS as treatments?

Oh, so many questions and even more confusion than I had a day ago. I am happy that you were able to present some viable solution. Again, thank you Julie I appreciate your experience and tolerance of my ignorance.

Deanna

[Miniar]

I understand your postion, but let's look at it this way:

What if I have a design (the genes) to build a computer (a person), but I misinterpret the design and accidently put in the wrong processor (the brain) so the computer doesn't work? Is the processor suddenly broken? No it isn't, it's a perfectly ok processor. It's the mismatch between the processor and the rest of the computer that is the problem.

The same can be said about GID. The brain is perfectly ok. So is the body. It's the mismatch between the two that is the actual problem. I wouldn't call that a mental disorder.

I agree with you fully on the whole "both brain and body are perfectly fine" front.
This is why I can't say that "my body is wrong" because there's nothing wrong with it (aside from fibro and.. BUT that's not the point). It's a perfectly normal woman's body.
And my brain is a perfectly normal man's brain.

The "problem" I have is the "mental" anguish that the "mismatch" causes me to experience.

I Would Love to see transsexualism be completely accepted as I see it and treated from that perspective and that would mean it wouldn't be seen as a mental illness per say, but a quirkyness of nature that "can" cause a mental illness and should be treated on a physical level to cure that problem. (And let's face it, severe depression, suicidal tendencies, feelings of disgust towards your own body, etcetera, all these symptoms of brain/body mismatch combined "are" a mental problem.)

But, until we can prove that brain/body mismatch definitively, all we can prove exist is our mental symptoms.
And I'd rather have someone acknowledge my pain even if they aren't sure why I'm in pain, than to have no acknowledgement at all.

That's all I'm saying.

I'm all for the DSM and SOC being refined, rewritten, made more accurate, but we can't expect them to take our symptoms out of the DSM until there's something else to cover our problem, and I wouldn't want them to.
I think instead of asking to be taken out of the DSM that a more productive approach is to ask for more research into the causes of the symptoms.