Sunday, August 23, 2015

The Cutting Edge-August 23, 2015
Barbara F. Anderson, Ph.D., LCSW

Much to my surprise I found myself quoted at length on SFGate (June 6, 2015) in an article titled, “As transgender discussion increases, workplace improvement still needed.”  The article begins with a bow to Caitlyn Jenner, moseys through several examples of workplace violations leading to law suits, segues to the importance of mental health care and bingo!! There I am.  Six paragraphs are devoted to my philosophy of treatment, services offered and an example of a successful case.  After another page and a half of other professionals’ take on the field of TG care, the author winds up.  Aha!  The signature tells me that this was written by a Stanford University Journalism student who interviewed me months ago.  I wondered how that article turned out!!!

Caitlyn’s at it again.  According to the NYTimes, July 23, “I Am Cait” is a new E! reality series.  It premiered July 26th and “chronicles Ms. Jenner’s new life….”  Ms J’s children from her first and second marriages have refused to participate but (surprise!) Kim and Kanye, Kylie and Khloe will be in attendance.  On a more serious note, Caitlyn may face a manslaughter charge as a result of a fatal car accident on the Pacific Coast Highway in February of this year.  The NYTimes reports that “Ms Jenner was driving in a manner ‘unsafe for the prevailing road conditions’ when her sport utility vehicle rear-ended a Lexus, pushing it into traffic.” (Aug. 21, 2015)

With all the recent exposure of transgender issues in the media, interest has arisen concerning the number of transgender people.  In their column, The Upshot, the NYTimes, June 9, 2015, “Searching for a Best Estimate of the Transgender Population” addresses this matter.  Difficulty in getting an accurate count is due to several factors.  The Census Bureau does not inquire about gender identity; being fluid it is hard to define on a multiple choice list of options (there are more than 50 options on Facebook); accuracy is difficult to guarantee as many people are reluctant to admit to a non-conforming gender identity to avoid discrimination.  However, better data is important for policy-making in health, education, criminal justice, social services, sports, and the military.

nterestingly, the Census Bureau published a paper recently in which they “analyzed people who most likely were transgender, based on the fact that they had changed their name or sex with the Social Security Administration.”  Since the inception of the Social Security Administration in 1936, 135,000 (rounded off) people have changed their names to one of the opposite gender, and 30,000 changed their sex as well.  Of these, 65% were female-to-male and 35% were male-to-female.  A caution in considering this data:  people who have not changed their names, who have not notified the SSA, who transitioned before age 16, or don’t have a social security number, are not represented in the paper.  A second study, using survey rather than administrative data, estimated that 0.3% or 700,000 people identify as trans.  Gallup is continuing to study the matter using a sample of 350,000 people.  If you have not been rendered unconscious by the detail above, stay tuned for updated information.

How young is too young?  The New York Times is onto that issue as well.  In a June 17, 2015 story entitled, “New Girl in School: Transgender Surgery at 18,” Katherine Boone’s story is told. She is an 18 year old high school senior in Cazenovia, NY who experienced depression in her freshman year associated with the onset of puberty. Symptoms included suicidality and cutting.  At 16 she began estrogen and spironolactone.  There is no law against minors receiving hormones or surgery but insurers, including NY’s Medicaid, have refused coverage for these youngsters.  The question providers wrestle with is “whether  teenagers, habitually trying on new identities and not known for foresight, should be granted an irreversible physical fix for what is still considered a psychological condition.”  A surgeon who has done more than 30 operations on children under 18, is quoted as saying, “We’re trying to find the sweet spot….The problem is it’s not an age, it’s a situation.”  Dr. Paul Mc Hugh, a psychiatrist, is skeptical of surgery for sex reassignment “for a psychological condition and even more so for children.”

 The physician who opened the first sex-change clinic in an American hospital died July 31, 2015.  Howard W. Jones, Jr. (1910-2015) helped found the Johns Hopkins Gender Identity Clinic in 1965. Prior to that, he had pioneered gynecological surgery, primarily in infants born with ambiguous genitalia.  He is also credited with being the first American physician to fertilize a woman’s egg outside the uterus, 3 years after this was accomplished in England. (NYTimes, Aug.1, 2015)