Wednesday, February 6, 2013

The Cutting Edge-March 2013

Barbara F. Anderson, Ph.D., LCSW

As promised last month, I’ll devote part of this column to the updated Standards of Care developed by the World Professional Association for Transgender Health (WPATH). To reorient the reader, the Standards of Care is a manual of clinical guidance for the best medical and psychological treatment for individuals dealing with gender concerns.  The current document is the 7th since 1979, each subsequent version incorporating the best practices of the time.  As the current manual is 120 pages in length, this article can only summarize its high points.

              1)      In an effort to de-pathologize atypical gender presentation, professionals                     acknowledge  that this is not a mental illness and does not require medical treatment.

2)      It adds gender non-conformity as a valid identity, such as third gender or genderqueer.

3)      It removes all criteria that were previously required for a step-by-step process to transitioning.  One may or may not engage in psychological treatment for a specific number of visits or period of time, take hormones or observe inflexible waiting periods.

4)      A 1-year real life test or experience is no longer required.

5)      However, a mental health screening or assessment is needed for referral for medical treatment for gender dysphoria.

6)      The term “gender dysphoria” rather than the diagnostic term “Gender Identity Disorder” is considered to be less stigmatizing.  This is consistent with changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

In a future column, I’ll summarize the changes with regard to gender variant behavior made by the American Psychiatric Association in the newest revision of the DSM-V.

A regular column, The Ethicist, appears weekly in the NY Times Sunday Magazine.  In the Feb. 3, 2013 edition, a reader writes the following. I’ve been living the life of a married man for 20 years. I have a successful career and 3 children.  All this time, however, I have battled gender dysphoria and the deep sadness that comes from living a lie. To summarize, the writer states he has been unhappy as a man his whole life and plans to transition.  He asks if it is ethical to follow this path even if it ends his marriage, stresses his career and damages the emotional stability of his 3 children.  The Ethicist answers: you need to decide if your psychological damage from gender dysphoria greater than the psychological damage that its restoration will inflict upon the lives of any (or all) of your children. If “yes”, proceed, if “no”, don’t. The original article is well worth reading either in print or online.

 Also in the NY Times, January 29, 2013, a story out of Vicco, KY indicates that the City Commission of this town (pop. 335) recently passed an ordinance banning discrimination against people based on sexual orientation or gender identity.  It is notable that such a law has not yet passed in New York State.  The Gender Expression Non-Discrimination Act is currently blocked in the State Senate.  FYI, 16 states and the District of Columbia now have similar protections.

In brief:  Among professionals, there has been some buzz about the number of people identifying as transgender.  A survey in Mass. of 25,000 households found an incidence of .5% (1 in 200) households in which a person answered YES to 2 questions identifying a member as transgender.  (BTW, respondents were found to be healthier than the general population, possibly because they see physicians more often.)  Other studies of incidence found .4% and .9% in contiguous states.  The UK Equality and Human Rights Commission did a survey that found 1% of the population experienced some degree of gender variance.

The Cutting Edge- Feb. 2013

By Barbara F. Anderson Ph.D., LCSW

 “LGBTQIA” is the name of a lead article by Michael Schulman in the STYLES Section of the New York Times, Jan. 10, 2013.  Surprisingly, it focuses on the T of the title.  It features several young people who experience atypical gender identification, the most notable of whom is Stephen Ira Beatty, 21, born Kathlyn, the trans son of Warren Beatty and Annette Bening.  The article goes on to describe several universities’ manner of accommodating trans students.  The Advocate magazine ranked the University of Pennsylvania among the top 10 transfriendly schools.  It offers gender-neutral housing and its medical insurance program covers SRS. According to a survey by Campus Pride, “at least 203 campuses allow trans students to room with their preferred gender; 49 have a process to change one’s name and gender in university records; and 57 cover hormone therapy.  In December, the University of Iowa became the first to add a ‘transgender’ checkbox to its college application.”  The times, they are a changin’.

An article in the BBC News, Liverpool, Dec.13, 2012 notes that April Ashley, one of the first Britons to undergo SRS has received an MBE (Member of the Most Excellent Order of the British Empire) for her work contributing to transgender equality.  The actress and campaigner was born George Jamieson in Liverpool in 1935. She underwent experimental SRS in Morocco in 1960 at which time she was told she had only a 50% chance of surviving the operation.  Following surgery she had a successful modeling career.  She applied for a divorce from her husband 10 years later, but was denied because the judge ruled she was still a biological man and her marriage was invalid. She was granted an annulment instead.  (Can you explain that!!!)  This ruling ended the hopes of transpeople marrying until 2004 when the Gender Recognition Act allowed people to legally change gender.  Upon receiving the honor at Buckingham Palace, she modestly declared, “it was the normal thing to do,” referring to her half-century of work on behalf of the LGBT community.

 Along the lines of “we could learn something from Britain,” (see above article), a story in The Pink News, Europe’s largest gay news service, Jan. 2, 2013, is entitled “US: TG man faces difficulty in getting a divorce from wife.”  It features Thomas Beatie whom the Guinness World Record recognized as the “1st Married Man to Give Birth.”  Mr. Beatie, a female-to-male father of 3 is trying to get a divorce from his wife of 9 years.  He gained attention after giving birth to his 1st child in 2008.  He went on to have 2 more children on ’09 and ’10.

 Before marrying, Mr. Beatie had transitioned from female to male in 2002.  However, he didn’t have his female reproductive organs removed.  After transitioning, he registered legally as a man and married.  Now getting a divorce in Arizona is proving difficult.  A judge has questioned first, whether the state’s same-sex marriage ban prevents him from ending the union and if, in fact, the marriage is valid, even though the individuals are of opposite genders.  Stay tuned.

 “Contemporary Sexuality,” the Nov. /Dec. 2012 newsletter of the professional sexuality organization, American Association of Sex Educators, Counselors and Therapists (AASECT) did a review of the updated Standards of Care.  The SOC is a manual of clinical guidance to healthcare professionals working with the TG community.  This document dates back to 1979 when the organization was known as the Harry Benjamin International Gender Association (HBIGDA).  The current version is the 7th in a series of modifications aiming to guide professionals in the state of the art medical and psychological care.

 I will devote next month’s column to a discussion of specific updated changes and their rationale.