Actually, if you were more educated, you'd know that chemical castration is a very effective treatment as well. But you're obviously not ...

What do you think hormone replacement therapy is? I was chock full of testosterone, now I'm full of testosterone blockers and estrogen. Shockingly, that's not very good for the male reproductive system. The dosages are different, but I'm basically on 'chemical castration' meds. Because that's what hormone replacement therapy is.. The treatment you're promoting (which you seem to think will 'cure' trans-ness) is actually what's needed to transition!

Except that ... well, there is [hard evidence as to what causes people to be gay or trans]. Look, I'm all for letting you live your life the way you want to, but I'm 100% against disseminating false or misleading information. You're pushing an ideology that isn't aligned with FACT.

Do you have any studies to back up that claim? I'd be really interested in reading them. As I said, there are some interesting clues as to how trans people's brains and bodies are different than typically gendered people. But - from everything I've read - no one is willing to make claim a causal relationship. Or, if they are, they admit they're not sure which way it goes: does having an atypical brain structure make one trans, or does some other (genetic/hormonal/etc) cause of trans-ness result in an atypical brain structure?

There are lots of people that aren't comfortable in their bodies. Not just transgendered individuals. There are people who claim that they should be born as animals, because their spirit is truly that of an animal. Do I believe their arguments? No. I'm close minded like that. In other words, I'm a logical empiricist. Show me proof that you're in the wrong body, and I'll believe you. Until you have something more tangeable than feelings, your opinion and your feelings are just as valid as mine

The proof of the pudding, as they say, is in the eating. That is, I was previously suicidal and depressed. Now, after going on hormones and transitioning, there's been a significant drop in my depression. Mental health professionals don't (usually) send for lab results before putting patients on antidepressants, they talk with the patients and use their training to judge the patient's state. Transitioning works, logically and empirically, and your argument about 'people who claim they should be animals' is on par with people saying gay sex is wrong because it will lead to bestiality: a ridiculous, unfounded, and (quite frankly) illogical argument.

Furthermore, gender is complicated, even though many people pretend it isn't. There are ample examples across the animal kingdom of animals - sans therapist or hormone replacement therapy - expressing 'wrongly' gendered behavior. Why should humans be any different?

1) Is there a phsycological element? can some form of mental treatment not help?

It's not totally clear what causes people to be trans, in the same way there's no hard evidence as to what causes people to be gay. (Or straight, or have particular kinks.) That said, there have been some interesting studies indicating trans folks do have some sort of physiological and/or neurological differences compared with the typically-gendered population. I don't know of any peer reviewed studies indicating ex-gay or ex-trans therapies work, which to me says it's not (solely) a psychological issue which should be treated like depression or any other mental disorder.

2) If it isn't phsycological and it is due to some hormonal imbalance, then does taking medication to further change your gender away from your physical gender not simply exacerbate the problem?

That's an interesting question, and not one I have good answers for. Speaking for myself, my hormones were at typically male levels before I went on estrogen. That is, my doctor ran my blood work and showed me that there didn't seem to be any hormonal reasons for my gender discomfort, as the reports indicated I was hormonaly male. I don't have any broader surveys of the trans community, but anecdotal evidence seems to point to the same thing: most (although certainly not all) trans folks didn't suffer from any detectable hormone imbalance. If that were the case, however, the doctor and/or therapist the trans person was working with should be able to help detect that. I think there should be less of a medical gateway before getting hormones than what currently exists, but I do think hormonal transition should include a doctor's care.

3) If it can be treated by altering hormones then why - if a choice is made to take medication for life - is a choice made to alter hormones in the direction of the sex you wish you were, rather than the sex you actually are? Would the latter not make more sense in that you would simply be able to live your life without even having to worry about prejudice, and without having to go through a presumably very painful operation or set of operations?

That's an excellent point, and kind of gets to the hear of the trans experience. It would have been great if there were a pill I could take that would result in the sensation of "Oh! I am male!" But - just as ex-gay therapy hasn't been proven successful - no amount of repression or therapy or abuse or pigheadedness has been able to 'cure' any trans person I know or anyone I've heard of through the news or the grapevine. All the studies and surveys I've read - along with a heap of anecdotal evidence - indicates being trans isn't 'curable' in the sense of bringing comfort to the person in their physical sex.

Let me know if you have any questions. I know this isn't something many people have reason to know much about, so I'm always happy to help educate folks who are honestly curious.

-Rebecca

My question, then, would be how should society handle people who have chronic illnesses that are nevertheless not catastrophic, and can't afford treatment? Things like diabetes or early stage cancer treatment. Who should pay for that if the individual is unable to afford it?

The 'free market' solution would be that those people get sicker and sicker until ERs, which are required to treat regardless of ability to pay, can cover the immediate issues. But I'd much rather live in a society where that cost is spread out over everyone, so no individual needs to worry about whether they can afford to go to the doctor.

I was oversimplifying and I'm sorry I came across as a member of "that part" of the trans community. I know exactly what you mean, and you're right: I absolutely need medical intervention. My issue is that GID is listed as a mental - as opposed to physical - disorder. With your cleft palate example, it's not something you need therapy to get verified as a 'real' cleft palate patient.

I would however, be down for reclassifying GID as a neurological or neuropathic condition, rather than a psychopathology...

It sounds like we're pretty much on the same page. I'm sorry my posts came across otherwise.

No, their attitude - as far as I can tell - is wanting to use their service and have them pay for medical expenses is less profitable than insuring healthy people who don't need treatment. In Illinois (where gender identity is a protected class) I have had no problem getting treatment paid for by my insurance when I was under my parents' plan, and have none now that I'm in the state high risk pool. So once insurance companies grudgingly accept me in their system, they acknowledge my concerns are medically valid. But if I can't get into that system, what happens then?

(Illinois, fortunately, does have a high risk pool, and I can - at least for the time being - afford it. But there's a reason trans people have much higher instances of suicide, poverty, sex work, drug addiction, and substance abuse than the general population: because it's really difficult to live in a society that doesn't support you.

My status as a trans woman seems to have split the discussion, and for that I apologize. I don't think the government owes me any help maintaining an Internet connection or a computer (beyond providing those things in public spaces like libraries). My point was that for people with chronic, preexisting conditions, the term "insurance" is something of a misnomer. As some pointed out during the healthcare debate, you can't buy insurance to fix a car you have already crashed. But we place fixing people on a morally higher ground than fixing cars. And rightly so. The question, then, is how do we - as a society - deal with people who require medical treatment they can't afford? Personally, I think the answer is a national, single-payer healthcare system. You're welcome to disagree with me. But it was people who said "the free market will solve it" who really frustrated me, since health care is a situation where the free market response may be "guess that person is going to die." Which I don't think is a good decision to make on a societal level.

Bringing the topic back to trans issues, I have some issues with the DSM's classification of trans people, but I think it's a good place to start. And the fact that there's medical consensus that being trans isn't a "lifestyle" (nice use of that rhetoric, BTW) makes me feel it should be treated like any other medical condition.

When wanting breast implants or a nose job or tattoos or a nice car is listed in the Diagnostics and Statistics Manual of Mental Disorders, we can talk about equating being trans and wanting a nice car. Until then, I think the slope is neither particularly slippery nor particularly steep. My position is as follows:

• 1) Society should collectively fit the bill for medical expenses that individuals cannot afford
• 2) The medical expenses that society should pay for should, furthermore, be determined by medical consensus, not by a poll of the general population
• 3) There is medical consensus in the mental health profession that being trans is not 'fixable' by psychotherapy, but should be treated with hormones and (if needed) surgery
• CONCLUSION: Gender identity disorder should be treated like any other medical condition, from the stand point of society's collective footing of the bill

It sounds like, more broadly, you have a (legitimate!) concern as to where your tax dollars would be going. That's entirely reasonable. But medical consensus indicates treatment for trans folks is not elective, and I therefore don't think it should be up for public debate in the same way a nose job might be.

Ummm...yes? Your point being? ::Gasp:: I'm trans and interested in dating? That I use the Trillian_1138 moniker elsewhere on the web? That I don't have a particularly deep divide between my Internet and 'real' life?

. It means that one day we may be able to treat the root cause and let them be happy in their natural bodies. With physical disorders, that's not an option.

Playing devil's advocate, there are studies showing trans people are physically and biologically different than their typically gendered peers. What if being trans stems from hormonal development in the womb? Or a gene misfire? Or neurological development? It's premature to say being trans is "all in their head" (by which I mean that it's a psychological issue) when it may very well turn out to be a physical issue.

. I just can't get my head completely wrapped around it. Based on my (perhaps willful) ignorance, I don't know that I want to pay for you to be transgendered. I'm not for it, and I'm not opposed to it: I frankly haven't put any thought into the concept until just now.

I respect someone who can say "I haven't thought much about this, so I don't have a huge opinion." Let me try to lay out where I'm coming from.

First, being trans (or gender identity disorder, GID) is listed in the Diagnostics and Statistics Manual of Mental Disorders(DSM), published by the American Psychiatric Association (APA). While I have some issues with GID's listing, I'd rather go with the APA's view of what should and shouldn't be treatable than the general public's. That's why we have doctors, and don't make medical decisions based on democratic vote.

But I know appealing to authority - "The doctors say it's real!" - isn't going to convince anyone it's real. So lets talk about what it means to be trans, and why it's different from " a girl who feels she's grossly inadequate because of her bustline."

I The largest difference, I would say, is the pervasiveness. Very often, trans people (myself included) were aware of their gender incongruity long before puberty. Being trans isn't a 'sex' thing, it's an identity thing. Similarly, I - and most trans people I know - would continue on hormones and presenting as I identify, even if I were the last person on earth. Because it's about me, not solely about how others perceive me.

Likewise, transitioning works. For myself and for lots of other people. Where ex-gay therapies and the like fail, time and time again, a caring and appropriate medical team to help with a transition (or, for gay folks, a caring and appropriate therapist to help with coming out and feeling accepted) have better results than 'fixing the problem.

As for worrying about people doing something just for kicks, that's an issue right now with certain painkillers. But rather than saying "No one can have opiates," we regulate them and have medical providers help determine what's medically necessary. But I really think that's an unrealistic worry. (As a side note, I think we should be moving toward a more informed consent model for helping trans people, but that's a different conversation.)

If you're interested in more information as to why this is an important issue, check out Injustice at Every Turn, a report on trans Americans' experiences. Some 'fun' statistics: 90% of trans people have been harassed or discriminated against at a job, and 26% (including me!) have been fired because their trans. 28% have been harassed by a medical provider, and 19% have been refused service outright. And 41% have attempted suicide, versus 1.6% of the general population.

-Rebecca

I'm taking estrogen, progesterone, and testosterone blockers as part of hormone replacement therapy, along with anti-anxiety meds due to longstanding anxiety issues.

Going slightly off topic, one of the things that frustrated me during the debates about healthcare in the '08 election was how folks (I particularly remember McCain) would talk about the free market. If insurance companies won't insure you (due to preexisting conditions) the free market kinda fails for that consumer, doesn't it? Whether or not a business should be required to take a customer - which is what banning preexisting condition refusals would mean - is a different question, but don't pretend the 'free market' can automatically solve everything for everyone.

More broadly speaking, the healthcare debate following Obama's election once again frustrated me due to its language. Lets be honest: I and others like me who have preexisting, chronic conditions don't need insurance, to insure us against catastrophe, we need assurance, assurance we'll have help paying for medication and treatment we can't always afford. Because yeah, from an insurance company's point of view, I'm a shitty costumer. They know they're gonna have to pay out, $X, monthly, for the rest of my life. If I were running an insurance company, I sure wouldn't want trans clients (or clients with cancer, or diabetes, or any other chronic condition). Where's the money in that?

What I would have liked to see the debate be about instead was what type of medical care, as a society, do we want to provide to people who can't afford it? What do we do with them? Who - at the end of the day - pays for their treatment? That would at least be an honest discussion about values, instead of a veiled discussion about false rhetoric.

-Rebecca

Awesome use of scare quotes, but repealing DADT still leaves trans people in the dust. Ignoring the fact that (as someone mentioned below) trans people and gay people aren't the same thing (it's a Venn diagram with some overlap, just like straight and trans have some overlap) the US military will still be discriminating against trans people. Don't worry.

(How preventing a trans person like myself, with a tech background and a desire to serve her country, from entering military service helps keep our country safe is a whole different issue.),

PS - Is anyone else having trouble with the comment box? I wasn't able to paste properly,