Journal tomhudson's Journal: Gender Education: Politics And Gender Identity 17
I - Basic Info On Transexuality
II - Are You A Transexual?
III - Social and Moral Implications
IV - Questions by Posters
V - Politics And Gender Identity - this article
VI - What's Involved In A Sex Change
VII - Breaking the News
WHAT: This is the fifth of seven articles I'll be posting over the next little bit about sex, gender and identity.
WHY: Recent journal entries by several people have shown the need.
RULES: As always, any honest reply or question is welcome, and will be answered, and posted as a top-level JE so that others can read it. This is a sensitive topic, and the people who are most affected are in many cases extremely vulnerable. Please show the same compassion for them as you would want for yourself or a loved one if the situation were reversed.
Politics and Gender Identity
This has nothing to do about the current positions of politicians or political parties. It's an overview of the politics involved in the medical, social and political spheres when it comes to dealing with the issue of treating gender identity disorders and transexuality.
The GLBT Coalition
People of like interests band together to have their voice heard. This is what the various Gay, Lesbian, Bisexual, and Transgendered comunities have done in their work to dispell myths and stereotypes about their members, as well as to lobby for equal treatment by lawmakers and the media.
However, there is a fundamental difference between the gay, lesbian, and bisexual communities, and transexuals.
- Transexuals need medical help to be complete people;
- Ttransexuals are classified as such based on their gender orientation, and not their sexual preference;
- Transexuals primary interest is changing their body to match their target sex, not acceptance of their current lifestyle, which they reject
Early view of transexualism - a treatable medical condition
The first "modern" clinic to treat transexuals was established in Germany in 1919,
Magnus Hirschfeld was a German sexologist in the early 20th Century, the first man to systematically describe and work with what we now call transexuals and transgenderists. He considered TS/TG persons to be a form of intersex. Working with surgeons in Berlin through his "Institute for Sexual Science" (Institut füer Sexualwissenschaft) one might say that he established and operated the world's first, modern medical, gender clinic. One of Hirschfeld's clients was Lili Elbe. The Institute was founded in 1919 and closed down by the Nazis in 1933.
- source
What changed?
The sexual revolution of the '60s forced people to confront sex, and sexual preferences, head-on. The wide availability of the pill gave women the power to enjoy sex without worrying about motherhood. Gays and lesbians joined in, becoming more vocal about their right to make their own lifestyle choices. By the '70s, being gay was actually perceived as "cool" on many campuses. The "protest counterculture" of the '60s, with the "summers of love", had become mainstream.
As the years went by, and more people were "out" about their sexuality, it was obvious to everybody what many had already suspected - that being gay or lesbian was not a rare occurence; rather, that a significant proportion of the population was gay.
Through all this, we still didn't hear much about transexuals, though, except when someone in the public eye was "outed" as a transexual, for example Renee Richards, outed in 1976, or Caroline Cossey in the James Bond movie "For Your Eyes Only"
Size does matter - at least in politics and the media
So, while politicians and the media perceived that they had a self-interest in catering to the needs of the gay, lesbian, and bisexual community, who could be accommodated without any extraordinary health-care expenditures, the much smaller number of transexuals, and their much different needs, made them the "poor cousins" of the coalition.
The grouping of transexuals with the GLBT movement was a good thing in many ways, because many of the issues are the same - access to chlldren of the "outed" parent, legal right not to be discriminated against, and public acceptance. Also, many (but not all) transexuals are gay, lesbian or bisexual.
The problem is that the most pressing need for most transexuals is not equal rights, its medical access. Medical intervention on behalf of a transexual is expensive - so expensive that many transexuals have no choice except to continue to suffer in silence for years on end. Politicians who are not sensitized to the issue unwittingly tend to assume that, by addressing the needs of the majority of the community, they've done their job.
(Hint to reality TV show producers - do you want to produce a reality TV series that will help someone and work for social change at the same time? Offer to pay to help a transexual obtain their surgery in return for broadcast rights. There are transexuals who would be willing to sacrifice their right to privacy in return for help, the situation is that desperate in some cases.)
Politics in medicine - it takes time for the radical to become the norm
A few decades ago, doctors thought that the majority of stomach ulcers were caused by stress. This led to all sorts of problems - for example, the custodial parent of children with stomach ulcers would be accused of child abuse or negligence by the other parent, and physicians and psychologists would back them up in court.
Then an amazing thing happened - in 1983 it was discovered that the Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The medical world at first refused to accept the findings, but nowadays peptic ulcers are treated with antibiotics, instead of diet changes and psychotherapy to help cope with stress.
We're now seeing the same thing happen with some forms of heart disease, which also appear to be caused by bacterial infections.
Politics of negociating with the therapist - the "gatekeeper" phenomena
So, what does this have to do with treating transexualism? Up until a decade ago, it was believed that the root cause of the condition was psychological. Unlike people who get ulcers or heart conditions, who doctors treat every day, transexualism is comparatively rare, so pressure to come up with a more cost-effective or streamlined diagnosis and treatment regimen is much lower. For a realistic idea of what barriers a transexual has to overcome, you might want to read the latest SOC (Standards of Care). Sounds reasonable, but I'll be quoting one of their members later.
The psychotherapist decides whether the transexual is eligible for medical intervention or not. This "gatekeeper" function of the psychotherapist, and the relegating of the surgeons and endocrinologists treating the patient for a condition with a physical disorder to a purely support role, though well-intended and inevitable considering the consequences of a wrong decision, poses problems from a doctor-patient point of view. One stickling point is that patients seeking other (or identical) cosmetic surgeries who are not transexuals don't face the same barriers and additional expenses, which is obviously discriminatory, but this is not the real concern.
The "gatekeeper" role of the psychotherapist has also caused many transexuals to lie in order to achieve the approval they need to proceed. This is a serious problem, because not only does it skew the statistics, preventing the development of better diagnostics, but it imposes an adversarial undertone on the therapeutic relationship for many transexuals. Unfortunately, because we lack a proper physical diagnostic, and are unwilling to turn over the role of "gatekeeper" to the patient, we are doomed to continue to "fumble in the dark".
Marginalization at the voting booth
When was the last time you heard of an openly transexual politician? Its a rare breen indeed. It wasn't until 2000 that Georgina Beyer of New Zealand became the first transexual to be elected to any parliament anywhere in the world.
(Note: This may not be completely accurate. There was one magazine that reported an interview with a transexual who was elected to Canada's House of Commons in the Pierre Trudeau's government - that news article was never widely disseminated and has since been relegated to the realm of "plausible deniabiity", though it would have been consistent with the goals of then-prime minister Pierre Trudeau, who removed homosexuality from Canada's criminal code. )
Contrast this with politicians who are openly gay and court the gay vote. Being gay is no longer a barrier in politics - in many cases its seen as a bonus, as political parties of all stripes try to appeal to as broad a base as possible in order to attain or hold on to power.
So what does this all mean
Quite simply, it means that many transexuals don't have timely access to the treatment they need in order to live a normal life. Even in countries with socialized medicine, the necessary psychological and surgical intervention is often not covered, or the surgical options are quite limited if you don't have the means to pay for it yourself. Transexualism is an "orphan disease". There is no equivalent to the Shriners organisation to help raise funds for people needing a sex change. You won't find it on the list of charitable causes supported by the local United Way or March of Dimes, or the beneficiary of a bake sale or telethon. There's no walk-a-thon, no Marathon of Hope, no ribbon campaigns.
Transexuals are pretty much invisible when it comes to raising funds for research and treatment.
This is a problem for two reasons:
- many transexuals either go untreated or seek treatments from people like Dr. Ronald "Butcher" Brown;
- fund-raising is an opportunity to raise public awareness. The average person, if they give any thought to the matter, still equates transexuals with "Dame Edna" - a man in a dress;
One of the consequence of this lack of proper public education and awareness is that media coverage of transexuals is mostly limited to Gay Pride events, giving the impression that transexualism has something to do with sexual orientation rather than being a treatable medical condition.
Negative reaction to publicly funded treatment for transexuals from politicians
Transexuals end up in the prison system, just like any other group. Between the barriers to employment (many employers can't handle people transitioning "on the job"), and the expense of therapy (you can buy a luxury car for what treatment ends up costing over the years) many transexuals are so desperate that they resort to prostitution.
Once in the custody of the legal system, their care becomes the responsibility of their custodians.
Media continually report outrage over the state paying for hormonal treatment (one example - Jan 02 2005)
But some state legislators question whether the state should ever have provided the hormones in the first place.
"This is the most absurd thing I've ever heard of," said state Rep. Mark Gundrum (R-New Berlin), who serves on the assembly's committee on corrections and the courts.
"The taxpayers should not be spending one dime for something like that."
State Rep. Garey Bies (R-Sister Bay), who chairs the committee, agreed. Bies said inmates should not get hormone therapy or surgery on the state's tab.
Negative reaction to publicly funded treatment for transexuals from doctors
However, the most telling quote was from Walter Meyer, a professor at the University of Texas Medical Branch and president of the Harry Benjamin International Gender Dysphoria Association:
Meyer, the Texas professor, said treatment protocols for gender identity disorder call for hormones, and stopping them can have detrimental physical and psychological side effects. Those same protocols call for sex change surgery in some cases, Meyer said. But he doesn't think surgery should be offered free to prisoners, since it isn't covered by most private health insurance plans or Medicaid plans.
"If the prison system started to offer this surgery, there would be people lining up to be in prison," he said. "Some of my patients would commit crimes just to get free surgery."
Even the head of the association charged with formulating treatment policy for transexuals believes that access to treatment should be based on economic ability rather than a patients' needs.
This, despite acknowledging, in the same quote, that some transexuals are so lacking in options that they would commit crimes, give up their freedom, get a criminal record that will follow them for life, endure all the risks of being a transgendered inmate, if it would give them access to treatment. (Side note: Meyer's term as president came to an end earlier this year)
This is the reality transexuals face - even those who are supposed to be helping them find solutions want public policy to continue to limit treatment to those who can afford it. This promotes a Catch-22 situation. In order to obtain the funds for treatment, transexuals have to continue to masquerade as someone they're not, which causes them continued harm, interferes with their job performance, and ultimately results in the loss of the very income they need to pay for treatment to break the cycle.
It's pretty devastating for someone seeking help to hear "If you really want help, you'll find a way to pay for it.*" To the patient, the implied message is that, if they don't have the economic means, they can't really be serious about their issues.
(*Note: yes, this is an actual quote from the head of the Gender Identity Clinic at one hospital)
Most people don't have an extra $400/month for psychologists visits, $100/month for hormones, $5,000 for electrolysis, $15,000 to $30,000 for GRS, $5,000 for implants, $7,000 for a trach shave and vocal chord surgery, $15,000 to $20,000 for facial feminisation surgery, etc. You might as well tell them to go rob a bank. Or blow their brains out.
This is a public health issue
Its time that people acknowledge the simple facts - this is a public health issue. It is not realistic to expect individuals to be able to afford such outlays. Its also not possible for many transexuals to get medical coverage for their condition in countries with a user-pay health care system. Only the public purse has the resources necessary.
Most countries subsidize treatment of other high-cost conditions, such as AIDS, and there are public fund-raisers for many other conditions, but let's face it - we'll never see a telethon for transexuals. Transexuals are not on an equal footing with other groups. This is their reality. They need access to the public purse to help cover their health needs. The question is, how will they get it, when, at the political level, they're still invisible?
- tomorrow: the nitty gritty. What's involved in a sex change
(not for the squeamish).
Re:question (Score:2)
The "usual suspects" to look for when you hear "SRS is wrong - I regret it"
There are a lot of people with vested interests pushing this line, and most of them share one common factor - they are religious groups, mostly fundamentalists, with an agenda. To them, transsexualism is a denial of God's sovereignty. They believe that transsexualism is a sin, and that prayer, confession, and giving your life to Jesus can cure it. They also believe that gays and lesbians and unmarried people living together are s
Re:question (Score:2)
Glad I could be of some assistance. Its good to know that soeeone's getting something good out of it :-)
Good luck, and, of course, any other questions - no problem.
Re:question (Score:1)
Some years ago, in the Netherlands, there was some concern about the benefits/risk of operating on transsexual teenagers.
The benefit was that they do not have to suffer years of mismatched body/mind experience and could 'use' their early twens to 'grow' in their new gender (bad English, I hope you know what I mean).
The risk was that some of the teenager were not really transsexual but suffering borderline syndrome (bad body image, cutting, etc).
It was a very interesting discussi
Re:question (Score:2)
Your english is fine, and the idea that they could "grow" in their new gender is better than I would have phrased it (I would have said "grow into", which, on reflection is not nerly as good as your version, which gives a more positive message :-).
There's always going to be a risk, but you have to look at the overall rick/benefit package - and in this case, its decidedly in favour of "younger is better", from a psychological viewpoint (spares years of anguish, as well as not having to miss out on importa
Interesting (Score:2)
Now, as for the cost of gender reassignment surgery: the way I look at it, it's a matter of cost vs
Re:Interesting (Score:2)
Its rare enought that people aren't going to pick up on it in normal conversation unless the other person says "I think I'm a [wo]m
Re:Interesting (Score:2)
On a completely unrelated side not, hat $75K to keep 1000 Ethiopian kids from starving to death?
Foreign aid programs that were designed when oil ws $1.34 a barrel and unlimited don't work when you hit the resource wall. Even the US is going to have to take severe measures over the next generation.
How long before the US becomes a net importer of food?
Re:Interesting (Score:2)
I've taken a small break from posting the next installment (got other things to do, etc) but I WILL be adding the last 2 items later this week.
This last journal really resonated with me (Score:2)
Re:This last journal really resonated with me (Score:2)
It reminds me of the scientist who cuts off a frogs legs, tells it to jump, and then notes in his records "Cutting off frogs legs makes them deaf." Its one way of looking at it, but its nowhere near the truth.
I'll be adding some more entries later on - I took a break because it IS a lot of writing, and I don't want it to be stale or rote. Gotta let the wel
Re:This last journal really resonated with me (Score:2)
snip
Our current system is under attack from HMOs in the US seeking the right to operate here. If push comes to sh
Re:This last journal really resonated with me (Score:2)
Each system has its pluses and minuses. I know that when I needed some really hi-tech major intervention (including surgery while in a CT scanner - something I didn't even know was possible)
Re:Ohhhh. (Score:2)
People really should read that link. It says a lot about the complexity of the situation, in concrete terms.
Re:Ohhhh. (Score:1)
I understand this series of posts addresses the much deeper problems in the world and not just the geeks vs breasts dilemma in the tech world but I must admit