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 7^th 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.