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.

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 “1^st 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 1^st 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 7^th 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.

 

The Cutting Edge-January 20, 2013

The Cutting Edge

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 achangin'

 

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 “1^st 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 1^st 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 7^th 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 blog to a discussion of specific updated changes and their rationale.

 

The Cutting Edge December 21, 2012

THE CUTTING EDGE-December, 21, 2012

By Barbara F. Anderson, Ph, D., LCSW

 

The Transgender Law Center’s Legal Director was featured on ABC’s public affairs show,
"Beyond the Headlines,” on Nov. 18, 2012.  The focus of the show was the “widespread discrimination faced by transgender people,”  especially, employment and health challenges.  Statistics were cited indicating that trans people face unemployment at twice the national rate.  Also mentioned was San Francisco’s Health Commission which voted to establish a program that includes SRS as part of the City’s universal health care plan, making San Francisco the first city in the US to approve such a measure.

 

Along the same lines, the ACLU issued a paper, Discrimination Against Transgender People, (undated) but viewed on Dec. 10, 2012.  It speaks of the organization’s  commitment to trans people who meet “a wide variety of discriminatory barriers to full equality.  They sometimes face difficulties meeting their basic needs (getting a job, housing, or health care) or in having their gender identity respected (like in the simple act of going to a public restroom).”  The article goes on to note that trans people “face a range of legal issues that LGB people rarely do: identity documents not reflective of one’s gender, sex-segregated public restrooms and other facilities, dress codes that perpetuate traditional gender norms, and barriers to access to appropriate health care.”  The ACLU believes that “the struggles against anti-LGB and  anti-transgender discrimination are best waged collaboratively.  Much of the discrimination faced by transgender people comes from the same place as does anti-gay discrimination:  LGBT people challenge society’s norms on how men and women ‘should’ act (in their gender expression and in the relationships they form).  Truly eliminating LGBT discrimination depends on eradicating gender stereotypes, and fighting gender identity discrimination does that directly.”

 “Gabrielle Ludwig, Transgender Basketball Player, Makes Championship Game Debut” is the headline in the online, HuffPost Gay Voices article, Dec. 2012. Fifty year old, m-t-f Ludwig, is a twice divorced mother of 3 who made news after playing on a California junior college basketball team.  She last played college basketball in 1980, more that 20 years before she transitioned.  “Though decades older than some of her teammates (and at 6ft 8in, substantially taller),” she was praised by her coach as being “the most dangerous player in the state.”   Her statement to USA Today follows:  “If they see me as a normal person and we are not the bogeyman and love life and raise kids just like you, maybe some of this mystery of who these people are will be taken away and there can be more blending into society.  People are afraid of what they don’t know.  I am willing to put myself out there.  It was not like that before.  It was just about playing basketball.  It’s about more because I see an injustice.”

 

The Cutting Edge-November 21, 2012

                                                   The Cutting Edge-November 21, 2012
                                                    
                                                     Barbara F. Anderson, Ph.D., LCSW

A directive issued by the Department of Veterans Affairs is about to expire Nov. 30, 2012.  It deals with the provision of health care for transgender and intersex veterans.  Its purpose is to establish policy “regarding the respectful delivery of health care to transgender and intersex Veterans who are enrolled in the Department of Veterans Affairs (VA) health care system or are otherwise eligible for VA care.”  It states that treatment provided is “compatible with generally accepted standards of medical practice … to promote, preserve, or restore the health of the individual.”  While treating those before, after and not interested in sex reassignment surgery, they do not”provide SRS or plastic reconstructive surgery for strictly cosmetic purposes.”   For more information about this directive and whether another is to follow upon its expiration, contact Specialty Care Services: (202) 461-7120

Let the Dandelions Grow: A Poetic Portrait of a Transsexual Journey and the Human Condition is a newly published volume of poetry by a woman who spent her first 65 years as a man.  It deals with the experience of aging and facing one’s mortality with anger and wit.  The author, a professor and therapist, Lee Ann P. Etscovitz, Ed.D., MFT, tells of the pain and frustration of being born into the wrong body in a unique verse form.  It is available from Amazon.

Boy? Girl? And Other Questions is the title of a NY Times movie review of Nov. 12, 2012.  It refers to “Turning’ a documentary about the band, Antony and the Johnsons.  “Turning” follows the group as it plays cities like London, Rome, Madrid and Paris.  The Johnsons perform Antony Hegarty’s songs, one of which begins “I asked him, ‘Are you a boy or a girl?’” while behind a screen “13 women and  transsexuals pose on a rotating stand…” Thus the title of the movie.  Interviews by Antony Hegarty of the 13 individuals reveal their struggles—with varying degrees of insight. 

On Tuesday, Nov. 20th, a day of remembrance was held for transgender persons throughout the world who have been killed for their spiritual journeys in the last year. In Chicago, Denver, Tucson, Ariz., New Orleans and many other U.S. cities, candlelight vigils were held, during which a litany of names of those who have died violent deaths was sounded. Day of remembrance.  This article was written by James and Evelyn Whitehead, Nov. 19, 2012.  This is an edited reprint of their article.
Catholics joined in this celebration as November is the month in which they honor All Saints and All Souls, remembering those who have gone before. Another claim on the Catholic community is the church's commitment to social justice. The violence against transgender persons -- including bullying of children, the adult experiences of discrimination at work, physical intimidation and even murder -- cries out for protest from a faith community that has a commitment to peace and justice.
More and more Christian communities are becoming aware that the transition the transgender person faces is, in fact, a spiritual journey. The United Methodist Church has published a valuable guide, "Made in God's Image." In it, they write, "We understand our gender diversity to be a gift of God, intended to add to the rich variety of human experience and perspective," and "the problem is not in being different, but in living in a fearful, condemning world."

A Lutheran parish in San Francisco has created a renaming ritual to celebrate the completion of a transgender person's transition and welcome the person into the community. In doing so, this gathering is following our tradition of renaming individuals who have come through life-transforming changes.

A Catholic sister has developed Trans Awareness Evening to introduce more of the faithful to the challenges and hopes of transgender members. She also offers simple ceremonies of blessing for persons preparing for gender-confirming surgery.
Such ministries are responding to the Christian heritage of a community of faith as both sanctuary and sacrament. In medieval times, the church building often served as sanctuary to protect the life of fugitives; today, churches might renew this ministry of welcome and protection of transgender members.
In the broader US culture, a process of appreciating the experience of transgender lives is under way. Film director Lana Wachowski ("Cloud Atlas") talks openly of beginning life as Larry before transitioning to Lana. Transgender young adults find their transitions less fraught by years of denial and fearful pretending.
But even as these encouraging changes take place, it behooves us to pause in respect for those transgender members of our community who have been victims of violence. So we gathered in solidarity and in prayer on Nov. 20.
James and Evelyn Whitehead have long been associated with the Institute of Pastoral Studies at Loyola University Chicago. A major focus of their teaching and writing is the vital links between sexuality and spirituality. Currently, they are examining the experience of transgender adults and the pastoral responses of communities of faith.]

The Cutting Edge-October 23, 2012

                                                               The Cutting Edge-Oct 23, 2012
                                                 
                                                Barbara F. Anderson, Ph.D., LCSW
“Born Free and Equal: Sexual Orientation and Gender Identity Booklet” has just been released by the United Nations Human Rights Office.  It is a new publication listing human rights laws for LGBT people.  The 60-page booklet highlights 5 main obligations requiring national attention:
                      Protecting people from homophobic violence
                      Preventing torture
                      Decriminalizing homosexuality
                      Prohibiting discrimination
                      Safeguarding LGBT people’s freedom of expression, association and peaceful assembly
For more details: www.ohchr.org/documents/publications

An article, Transgender Malaysians Challenge Religious Laws (New York Times Oct. 7, 2012) discusses Shariah (Islamic) law and its impact on transgenders and others who crossdress.  “Muslim men are banned from dressing or posing as women … and offenders may be sentenced up to six months in prison, fined as much as $325.00, or both.”  Four Malaysian transwomen challenged the law in civil court, arguing that it violates their constitution which guarantees freedom of expression and bans discrimination.  Support groups say that in the 1980’s, a fatwa (a religious edict) was issued forbidding Muslims from having SRS.  If the plaintiffs receive a positive ruling, they will no longer be prosecuted for dressing as women in the state in which the case was heard and will set precedence for future cases in other localities.  One day later the suit was dismissed.

“Transgendered Kids can Use Whichever School Washroom they Wish”   is an article appearing in the Toronto Sun (Oct. 3, 2012) the Toronto District School Board ruled that choice should be determined by the child’s “view of whether they’re a boy or a girl.”  No doctor’s note or “identity documents” will be required.  This decision is a result of a “human rights decision in 2011 that was based on a complaint by a transgendered student.”  www.torontosun.com/2012/10/03/

“California has become the first state to ban the use for minors of disputed therapies to ‘overcome’ homosexuality….” So begins an Oct. 1, 2012 article in the New York Times.  Reading further, the article expands the focus from homosexuality to “gender expression,” thus prohibiting treatments designed to discourage cross gender identification.  Opponents of the law maintain this is a “violation of free choice,” implying that some children may wish to rid themselves of their transgender feelings.

October was Domestic Violence Awareness Month, a time to recognize that 1 out of 4 individuals – of any gender identity or expression, of any sexual orientation – has experienced domestic violence.
There is a widespread myth that domestic violence is a crime in which men abuse women. The reality is that 25-33% of all individuals have been in abusive relationships and both abusers and victims can be of any gender. Some studies suggest that transgender and gender non-conforming individuals may
experience domestic violence at rates higher than the national average. Possible reasons transgender
people may have elevated rates of domestic violence include never having learned healthy relationship skills or believing that violent relationships are the best a transgender person can hope for. (Sounds like blaming the victim to me!!!)

Even though violence occurs across all genders, services are not always offered on a gender-inclusive basis, with male-identified victims often being refused services.  Transwomen have also reported many experiences of discrimination when attempting to access domestic violence services.  This disparity between who is impacted by domestic violence and who can access services makes it vital that the Violence Against Women Act (VAWA) include a provision prohibiting discrimination against LGBTQ victims.  This information was abstracted from a news item dated Oct. 9, 2012 on the FORGE website  >www.forge-forward.org>.  FORGE, founded in 1994 provides peer support to the TG community.  It is the 1st organization to receive significant direct federal funding.  Statement in parens is by the author of this column.

In Brief:  “A Transgender Story: My Daughter, My Son” appeared in the LA Times Oct. 7, 2012.  It is a mother’s perspective on watching her daughter’s transition.  www.latimes.com/news/opinion/commentary

The University of Victoria houses The Transgender Archives, a tremendous resource for community members, researchers and students.

The Cutting Edge September 22, 2012

                                                              The Cutting Edge- September 22, 2012
                                             Barbara F. Anderson, Ph.D., LCSW
The cover article of the Sunday Magazine of the New York Times, August 12, 2012, was entitled, “What’s Wrong with a Boy Who Wears a Dress?”  The author, Ruth Padawer describes her article as “a new approach to parenting gender-fluid children.”  The accompanying photos by Lindsay Morris were taken at a weekend camp gathering for boys who enjoy expressing their femininity with other like-minded peers as well as their families and siblings.  The article features vignettes of families in which there is a “pink boy,” one who occupies that middle space between traditional masculinity and femininity.  For an up-to-date approach that has moved beyond stereotyping and corrective therapy, this article fits the bill.

The American Psychiatric Association (APA) issued an official position paper on Aug. 16, 2012. They recognize that transgender and gender-variant individuals can benefit from medical and surgical intervention.  They advocate for the removal of impediments to care and support health insurance coverage for gender transition treatment.  They oppose exclusions of coverage for such medically necessary treatment when prescribed by a physician.  The full report can be accessed at: www.psychiatry.org/advocacy

A Transgender Parents’ Support Group meets on the 3rd Saturday of the month (10am-12noon) at the San Francisco LGBT Community Center.  Their advertising blurb reads:  “Are you or your partner a transgender parent?  Or thinking of becoming a parent?  This is an opportunity to connect with your peers and get mutual support.  The first half of the hour is usually spent socializing, with the remaining time dedicated to group discussion.  Drop-ins are welcome, but ongoing attendance helps to establish group rapport.”  BTW, I asked to attend in order to see if the meeting would be helpful to any of my clients but was refused. 

An article on Examiner.com (September 4, 2012) reports “Prisoner’s sex change surgery ruled as the ‘only adequate treatment’ for her.”  A convicted murderer, who has been living as a woman in an all-male prison, has been granted the right to have sex reassignment surgery.  She has been receiving female sex hormones and will now get surgery under her Eighth Amendment Right to adequate treatment for a “serious medical need.”  Influencing the judge’s decision is the fact that the inmate had tried self-castration and attempted suicide while incarcerated.  On a somewhat inflammatory note, the article states that “taxpayers will be footing the bill for this medical procedure…. It is not known if the Massachusetts Department of Corrections will be filing an appeal.  This is likely to spark an outrage since the people of Massachusetts will be paying for the prisoner’s sex change surgery.  The ruling is highly controversial on many levels and will drive further debate over the subject of sexual identity.”

Concerning retaining or restoring fertility in a male-to-female individual taking feminizing hormones, a physician states, “I know of several documented cases where an MTF pre-op, having dropped or diminished estrogen use, was able to [impregnate], sometimes inadvertently….  My best advice for fertility preservation … is to go off hormones for at least 6 months.  [In]fertility is most certainly reversible although libido and erectile function may be less so on a long-term basis….”


On a related subject, there has been some buzz about the possibility of a male-to-female individual becoming impregnated and carrying a fetus to term.  At this time there is little optimism that this will ever be possible, but who knows?  Research on the subject of Transplantation of Female Genital Organs by Brannstrom & Diaz-Garcia in 2011 focuses on transplantation between genetic women.  The authors state that “considerable advances have been made in research during the last 25 years…. Uterus transplantation has been proven to be a feasible procedure” in animal models and researchers predict the first successful attempt in humans will occur within 2-3 years.  On Sept. 18, 2012, the NYTimes published an article saying doctors in Sweden have performed the first two mother-to-daughter uterine transplants.

Brief notes:  Springer has published “Men Trapped in Men’s Bodies: Narratives of Autogynephilic Transsexualism” by A.A. Lawrence.   According to the publisher's blurb, this book is the "first to document extensively the feelings and experiences of autogynephilic male-to-female transsexuals in their own words.... [It is also] first to address comprehensively autogynephilic eroticism as motivation during sex reassignment."  This rarely covered and controversial subject is a must read for professionals as well as consumers.