Wednesday, August 29, 2012

The Cutting Edge June 2012

                                                                        THE CUTTING EDGE
                                                                  Barbara F. Anderson, Ph. D., LCSW
A notice dated March 27, 2012 has come to my attention describing an organization that provides monetary grants for sex reassignment surgery.  The JIM COLLINS FOUNDATION “is a non-profit, all-volunteer organization whose mission is to provide financial assistance to transgender people for gender-confirming surgeries.  Founded by two transgender people in 2008, the organization operates on individual donations and is run by a board comprised of medical professionals, attorneys, and activists.  Last year the JIM COLLINS FOUNDATION gave away its first grant to Drew Lodi, a transgender man on Medicaid who resorted to collecting cans toward his surgery expense.

“‘Not every transgender person needs surgery as part of their transition.’  says Dru Levasseur, co-founder of the JIM COLLINS FOUNDATION and national transgender rights attorney.  ‘However, we’ve seen first-hand the significant harms that transgender people face when they cannot access treatments that their doctors deemed medically necessary.  The JIM COLLINS FOUNDATION is proud to provide some assistance to people who face discriminatory barriers to coverage in public and private health insurance.’

“This past year, the foundation received over 300 applications, many from people who were desperate for assistance.  A nation-wide selection committee comprised of anonymous transgender individuals chose the 2012 grantees based on financial need.  Thanks to the generous donation of pro bono services from Dr. Christine McGinn at the Papillon Center in New Hope, PA, the foundation is able to fund two surgeries this year.  Dr. McGinn is one of the nation’s leading surgeons specializing in gender-confirming surgery and an out transgender person herself.”  Their website is

A revision of the current Diagnostic and Statistical Manual, rev. IV, is in process as we speak. The DSM is the “bible” of mental disorders to which mental health professionals pledge obeisance when they complete the insurance forms presented by trans clients at the time service is rendered.  Along with other information, insurers require that a diagnosis be given in order for treatment to be covered. Currently, most trans clients receive a diagnosis of Gender Identity Disorder (GID).

 A prominent Bay Area physician objects to this diagnosis saying, GID “is a misnomer.  The ‘afflicted’ individuals often have no doubt about their gender identity; it just doesn’t match their genitalia or societal expectations.  The real problem is gender dysphoria, the discomfort with one’s assigned gender or the profound feeling that one is in the wrong gender.”  He suggests an alternate category, Gender Dysphoria Disorder (GDD), which emphasizes the significance of the discomfort and depathologizes the client’s sense of his/her own cross-gender identity.  He adds, “gender variance [alone] is not a sign of a mental disorder” and illustrates this by citing trans people, the bi-gendered (those who present at alternate times), androgynous (those who present ambiguously) and intersex people (those with ambiguous genitalia) who may not suffer from gender dysphoria.  Nor is complete transition an indication of the resolution of gender dysphoria.  In future columns I hope to point out progress made on improvements in diagnoses impacting on the trans population in the DSM revision

More will follow on this subject as developments occur.

In brief:  The Advocate’s commentary featured an article, “14 Reasons That Made 2011 Great For Trans People.”  Here are some of them:
                  More state and local laws have passed TG anti-discrimination laws in 2011 than in any prior year.
                  The White House has hosted 2 major meetings—one with a group of advocates to discuss a range of trans-related policy issues and another with trans anti-violence advocates.
                  The 1st openly trans actor, Harmony Santana, got a major award nomination for her portrayal in “Gun Hill Road.”  She was nominated for best supporting actress by the Independent Spirit Awards.
                   Trans health policy improved with the American College of Obstetrics & Gynecology issuing a policy statement on proper treatment of trans people.
                   Shaun Donovan of HUD, became the 1st sitting Cabinet Secretary  to give a keynote address to a major trans organization, the National Center for Transgender Equality. He acknowledged that he was the first “but I will not be the last.”  He also has the distinction of being the highest ranking U.S. official to support marriage equality.
                    The results of the 1st National Transgender Discrimination Survey were published. Sixty-five hundred people responded and the study has become the most up-to-date resource for understanding the extent of barriers facing trans people.
                    The US Department of Veterans Affairs issued a directive spelling out what constitutes the respectful treatment of trans veterans.

Responses, reactions and corrections are welcome.
Dr Anderson can be reached at

The Cutting Edge May 2012

                                                                   THE CUTTING EDGE
                                                          Barbara F. Anderson, Ph.D., LCSW
This is the first article of what I hope will be a monthly column designed to bring to readers of DEVIL WOMAN issues that are currently being discussed by professionals dedicated to the welfare of the transgender community.  I hope to report on topics discussed in the media, at conferences, in journals, chat rooms and on listserves.  Where appropriate, I will give citations for those of you who wish to follow-up on a particular matter.  Entries will be brief, pithy (I hope) and engaging, stimulating your curiosity and hopefully, your optimism.  My ultimate intention is to encourage you to educate and advocate for yourselves in the realms of health care, legal rights, and other arenas that impinge on the well-being of your community.

A sampling of topics to be aired follows: pregnancy in transwomen; denial of hormones to the incarcerated; proposed changes to the DSM5; therapy and support groups that include both transmen and women; financial aid for SRS; the role of midwives in the care of pregnant transmen and many other subjects as they come to my attention.

Therapists are discussing the virtues and downsides of mixing transmen and women in support/therapy groups.  The plusses are that this could encourage a coalition of disparate groups.  There is little interaction between these groups although they have interests in common.  They both have to interface with the medical and psychological community; they both have a history of victimization and discrimination in employment and use of public facilities; they struggle with evaluating whether being diagnosed in the DSM is in their best interests and lastly, they tell me their clothes don’t fit right.  On the other hand, passing is less challenging for FtoMs; surgical options differ greatly; and the issues of growing up trans seem to affect individuals in each group differently.  For better or worse, it was agreed by most participants in the discussion that homogeneous groups fare better as common interests and experience make for a more congenial and trusting group environment. This has been my experience as well, but it was interesting for me to hear the issue raised again.

A discussion about pregnancy in male-to-females was very interesting.  It was initiated by a psychotherapist on behalf of her client who had read of such a possibility and was inquiring of the larger professional community if this is a realistic expectation.  Several cases were described in which natal women carried extra-uterine and abdominal pregnancies to term and which resulted in live births. A physician participating in the discussion felt this to be a very risky process and suggested encouraging transpersons to consider sperm donation, cryopreservation, or adoption as safe and proven satisfying methods of creating a family.

A discussion on the dangers to transgender people of travel abroad garnered advice from an attorney in response to a tale told by a traveler to Turkey.  She described being “grilled by the border guard and customs officer.”  Unwisely, she was travelling under her femme name while having a passport in her given male name.  She had declined to carry the letter given to her by her therapist attesting to her transition.  Inexplicably, her medications were confiscated before she was allowed on her way.  The attorney stated that, “travel is problematic where the documentation carried does not match the presentation of the traveler.  Everyone should emphasize a ‘Know Before You Go Approach.’  A simple call to the Department of State would have alerted this person to countries where entry would be difficult.  Also, this is not just a problem of international travel (though that is where we hear most
about it.)  Within the United States, since the laws vary as to the identity of trans individuals, the same rule applies…”Know Before You Go.”

Brief notes: An article in Bloomberg Business Week (3/26/12) reports that the US Supreme Court refused to consider reinstating a Wisconsin law that banned hormone administration or SRS for prison inmates.  Bypassing all the double negatives, that translates into the affirmative statement that inmates are entitled to treatment.  If SRS is ever provided, I’m sure it’ll make the news as well.

A forthcoming publication that sounds useful is “Transgender Family Law: A Guide to Effective Advocacy” by Jennifer Levi, Dir. of the Transgender Rights Project.

Responses, reactions and corrections are welcome.
Dr. Anderson can be reached @

Monday, August 13, 2012

The Cutting Edge- July 2012

 Barbara F. Anderson, Ph.D., LCSW
An article in the LA Times dated April 15, 2012 carries the headline, LAPD plans separate jail for transgender suspects."  A 24-bed facility will be opened in an effort to avoid violence by the general population of inmates against transprisoners.  This unit will house "biologically male and female suspects who identify themselves as members of the opposite sex...."  Until the present time, these prisoners were housed with those of the same biological sex.
This has come about as part of a larger policy of concern about the welfare of trans inmates.  Officers are instructed to treat such individuals with respect and courtesy on the street and are prohibited from searching suspects for the sole purpose of determining their sex.

Chair of the Transgender Working Group, Karina Samala said, “This is a new LAPD.” The TWG was formed in 2007 to work with the police department on developing  TG-friendly policies.  Many meetings were held, a survey was developed and a report with recommendations for policy changes was issued.

In the same vein, the newest edition of the Standards of Care was published by the World Professional Association for Transgender Health (WPATH) in Sept. 2011. According to Dr. George Brown, the  updated the section on “Institutionalized” persons was tested in court and the ruling was that a “real life experience” a prior condition for SRS, can occur in prisons.  More about the newest edition of the SOC in future columns.

The NY Times of April 27, 2012 featured Carletta Sue Kay, a k a Randy Walker, in their article, “His Wig May Be Askew, but This Singer Has Range.”  The article goes on to say, “When Carletta Sue Kay takes the stage, it can take the uninitiated by surprise.  The singer is over six feet tall, with a figure more like a wrestler’s  than an ingenue’s, and is typically a mess; wig askew, vintage dress often missing a sleeve or other home-made alterations, red lipstick unevenly applied.

“Is this a performance art piece?  An elaborate joke?  But then Carletta—also known as Randy Walker, 47, … veteran of the San Francisco music scene for the last 15 or so years—opens his mouth, and  all doubts fade.”  He is said to have a “dynamic range and sings with his whole body” and his “female alter ego has been enthusiastically received by local audiences since he started performing as Carletta around 2007.

“Mr. Walker said his fan base was largely straight and he did not consider himself a drag queen, per se or ‘a trannie.  I hate that people try to work that as a marketing stratagem,’ he said.”  Later in the article he “wonders if he has become a transvestite since he began performing as Carletta.”

Last month, in my brief section, I noted that Shaun Donovan of HUD, became the 1st sitting Cabinet Secretary to give a keynote address to a major trans organization.  To expand on that, he pointed out several advances made by the administration in the interest of transgender people.  Transwoman, Amanda Simpson, was appointed to the Office of Personnel Management which prohibits discrimination on the basis of gender identity.  Most recently, the Office announced that federal departments must include gender identity among its protected classes of employees.  Metro Weekly on April 27, 2012 covered this story in detail.  78% of transgenders say they’ve experienced workplace discrimination.  However, this policy can be overturned by the Supreme Court.  For now, activists see this breakthrough as “one more locking piece in that puzzle.”  For more detail,

In brief: The Transgender Economic Empowerment Initiative (TEEI) is a collaborative program between the SF LGBT Community Center, the Transgender Law Center and JVS (?).  Their promotional material says they match dynamic people  with sustainable jobs in safe workplaces.

In the “rose by any other name” category, a plastic surgeon in Chicago objects to the terms, “sex change operation, gender reassignment surgery and genital reassignment.”  He sees these terms as suggestive of making a choice to switch genders and  thus, inappropriate.  Instead, he performs “gender confirmation surgery.  This is not about choice; it’s about using surgery as one of the therapeutic tools to enable people to be comfortable with their gendered self.”

I’ve listened in on some conversations about telemedicine and distance counseling with transclients.  Talk has been positive with regard to evaluating people in prison when highly skilled professionals are not available to assess applicants for hormones or surgery.  More controversial is on-going psychotherapy with transpeople who live in remote areas or who are too closeted to seek counseling locally.  I for one, have had positive outcomes with clients I have already known and counseled in a traditional setting.  The downside is that insurance will not reimburse for sessions that are not face-to-face in person.

Responses, reactions and corrections are welcome.
Dr. Anderson can be reached @

The Cutting Edge August 2012

                                                                 THE CUTTING EDGE
                                                         Barbara F. Anderson, Ph.D., LCSW
In his newest book, “In One Person”  the noted writer, John Irving, introduces the reader to Billy Abbott, a teenager beset by confusion about his sexual orientation and gender identity.  According to the NY Times reviewer, Janet Maslin, humor yields to pathos as time passes and he encounters the era of AIDS.  Ms Maslin criticizes the author for “his blunt politicking for a full understanding of gay and transgendered identity [which] sits uncomfortably with his zany side.”  Although a mixed review, sounds like a book worth reading.

On a less literary note, a well-received episode on the TV show, “Glee” featured a transgender character, Unique.  This contrasts with “Work It,” a short-lived show that focused on 2 unemployed men who try to counter the effects on their lives of the recession by seeking work as women. It met disdain on several fronts by viewers as well as two advocacy groups and was cancelled after 2 episodes.  A NY Times review of recent TV offerings addressing LGBT lifestyles asks, “What’s missing? The outrage.  The cultural battlefield of television has changed markedly since the 1990’s, when conservative groups and religious figures objected to Ellen DeGeneres coming out and ‘Will & Grace’ coming on.”

A Business Wire article on The Depository Trust & Clearing Corporation, described its recent policy offering employees “new transgender benefits that include sex-reassignment surgery and related prescription drug treatment…. It illustrates our commitment to an open and non-discriminatory environment where transgender persons are welcomed to our diverse and inclusive organization.”  In formulating their benefit package, DTCC has followed the guidelines set by the World Association for Transgender Health (WPATH), an international organization committed to establishing and promoting the highest standard of health care for trans people.  Other financial services organizations offering TG health benefits to their employees are American Express, Bank of America, Barclay’s Capital, Credit Suisse USA, Goldman Sachs, JPMorgan Chase & Co. and Wells Fargo & Co.

A CBC (Canadian Broadcast Company) 2-part radio show, “Ideas” aired recently. The Gender Trap, Part 1 deals with the belief that men’s and women’s brains are hard-wired to learn differently.  This has been used to justify gender stereotyping and to route men and women into discrete occupations.  It has also given rise to a number of best-sellers such as; Men Are From Mars, Women From Venus; The Female Brain; and The Essential Difference.  The program explores both sides of the debate. 
The Gender Trap, Part 2 describes the Toronto family that decided not to reveal the gender of their newborn baby to any but a few people.  When the story of Storm became public, a “storm” of controversy ensued.  This program describes the story fully and the resulting debate.  The programs can be heard on podcast-

Brief notes: In an e-mail exchange, a psychiatrist posits that trans children “may in general be more advanced cognitively…I think of this in terms of having to think creatively…i.e. when a 2 and a half year old discovers that he/she is in the wrong body... it takes on a need to think creatively on how to deal with the world in ways the average child does not need to deal with.”  The writer continues, “studies of creativity in children have a checkered past and most have found it is a difficult subject…to assess.”

Argentina became Latin America’s 1st nation to legalize gay marriage 2 years ago and in May 2012 passed a gender rights law.  It gives people the legal right to officially change their gender without a court appearance and obligates health care companies to provide them with surgery or hormone therapy on demand.
HUD secretary, Shaun Donovan, states that new regulations being proposed by HUD will “prohibit discrimination on the basis of sexual orientation or gender identity in several of the federal agency’s programs—from government-backed mortgages to public housing.”