The Cutting Edge - June 2013

Barbara F. Anderson, Ph.D., LCSW

 

Does the name Rituparno Ghosh ring a bell?  He was an award-winning, internationally known Bengali film director who died last month at the age of 49.  Most relevant to this column is the fact that he was “an unabashed cross-dresser [who] cut a striking figure in Indian culture as he frequently sported lavish clothes, dangling earrings and eyeliner.”  He is reported to say, “I don’t consider myself a woman, and I don’t want to become a woman.”  The obituary goes on to say he reveled in his ‘gender fluidity—the fact that I am in between.’”  He identified as a “womanist” rather than a feminist and his films dealt with “complicated and sensitive subjects like divorce, widowhood, homosexuality and gender identity.”  (New York Times, June 2013)

 The NYTimes reports “South Carolina: Sex Surgery Unnecessary, Lawsuit Alleges.”   The Southern Poverty Law Center, a legal advocacy group, claims that the State of So. Carolina “should not have surgically altered a 16-month old child in its custody who was born with both male and female genitalia.  The suit was brought on behalf of the child’s adoptive parents and is intended to restrict the practice of medically unnecessary sex assignment surgeries on infants.”  The child, now 8, Identifies as a boy, according to his parents who state, “They disfigured him because they could not accept him for who he was… not because he needed any surgery.”  In recent years physicians and those once identified as hermaphrodites recommend that at birth a gender assignment be made but that no surgical intervention occur until the individual is old enough to participate in any medical action.  BTW, the currently accepted term for such individuals is intersex. (May 15, 2013)

 A mailing I received from WPATH (World Professional Association for Transgender Health) advises members that the World Health Organization is currently developing the next version of the International Classification of Diseases (ICD-11) and there are proposed changes to the section dealing with gender identity.  We as members of WPATH are invited to participate in internet-based field-studies of the proposed diagnostic guidelines.  I’m pleased to belong to an organization that is so highly recognized as having sufficient expertise in the field of gender identity studies to be invited to participate in this venture.

 A notice from The Transgender Law Center advises that “CA Bans Insurance Discrimination Against Transgender Patients.” California’s Department of Managed Health Care (DMHC) “has ordered California’s health plans to remove exclusions of coverage based on gender identity and expression.”  Masen Davis, president of the TLC says this move “will save lives.”  The directive applies to HMOs and PPOs regulated by the DMHC and insures that insured individuals cannot be arbitrarily denied medically necessary services simply because they are transgender.

 Also from the TLC, “Victory for 9-Year-Old Transgender Student!”  When 9-year old, Trace, told his classmates he was a boy, He was summarily suspended from school for 3 weeks.  Upon his return his “special education plan…severely limited his ability to interact with his peers.”  From general education classes he was reassigned to special ed. with severe restrictions.  TLC wrote a letter to school officials advising them that their actions were illegal and in response, Trace was reinstated in his prior school program.

 Yet another notice from the TLC states, “American Medical Association Supports Accurate Birth Certificates for Transgender People.” In the article they “hail the recent decision by the AMA to pass a resolution stating that, they support policies that allow for a change of sex designation on birth certificates for transgender individuals based on verification by a physician that the individual has undergone transition according to applicable medical standards of care.”  Additionally, the TLC is working to pass a bill in California to simplify the costly and burdensome process of amending one’s birth certificate.

 Two new books of interest are on the stands. “Stuck in the Middle with You, A Memoir of Parenting in Three Genders,” by Jennifer Finney Boylan, a transgender parent, is described as a “brilliant work on raising--and being--a child…. It includes conversations with Edward Albee on the essential qualities of parenthood; Anna Quindlen on marital love; [and] Augusten Burroughs on lasting parental influence.”  It is described as blending intimacy and wit, soul-searching and humor, happiness and pain.

 “The Rebellion of Miss Lucy Ann Lobdell” is described as “a well-crafted ‘memoir’ of an unforgettable person.”  Although apparently fictitious, no author is listed.  Ms. Lobdell’s obituary in the NYTimes dated Oct. 7, 1879 described her life as a child in the backwoods to her participation in dancing school which she attended disguised as a man, winning the heart of a young woman.  She passed for years on the western frontier, was arrested and tried for the crime of wearing men’s clothes and broke out of jail with the help of her wife to whom she had been unwittingly married by a judge.  Could this be the first same-sex marriage in America? (New York Times Book Review)

 

The Cutting Edge- May 2013

The Cutting Edge-May 3013

 Barbara F. Anderson, Ph.D., LCSW

 Ooops!!!  An astute reader and lawyer gently corrected me on a statement in last month’s column.  Regarding an article on the website of the Human Rights Campaign in which I repeated their assertion that there is no federal law protecting against workplace discrimination, the reader states that in fact, Title VII does offer such protection.  The case is Macy v. Holder and was decided in 2011.  Interestingly, the complainant in the case was Mia Macy, a resident of the Bay Area.  Subsequently I returned to the HRC site and reread the article but was unable to find any way to comment on or correct the post.

 Several months ago I featured the Jim Collins Foundation, the only national non-profit organization with a mission to fund gender-confirming surgeries for trans people who cannot afford such services They recently announced the names of their 2013 grantees.  Nicky Roberts and Mac Anderson were selected from hundreds of applicants who demonstrated urgency and financial need.  The President and Co-founder of the organization stated, in making the awards, “Nicky and Mac, like so many of our applicants, have demonstrated a life or death need for surgery.  Without this grant, they would not be able to live productive, healthy lives…. We are thrilled to be able to help them become the people they need to be.”

 The State Department has updated its policy regarding the issuing of passports that reflect a person’s current gender.  While in the past documentation of SRS was required, now “you can obtain a full 10-year passport with an updated gender if you have had CLINICAL TREATMENT determined by your doctor to be appropriate in your case to facilitate gender transition.”  Any licensed physician familiar with your transition-related treatment can provide a letter.  For more details on how to apply for a passport see the US State Department Foreign Affairs Manual, 7 FAM 300 Appendix M: Gender Change @ http://www.state.gov/documents/organization/143160.pdf

 In an online article in The Hill, “HHS withdraws plan to reconsider coverage of sex-change operations” by Sam Baker, the Health and Human Services Department has withdrawn its proposal to reverse an earlier ruling (1981) that sex-change procedures are experimental and should not be covered by Medicare and Medicaid.  This ruling was motivated by an assumption that the use of taxpayers’ money to fund such procedures would “attract criticism from Congress.”  Initially HHS invited public comments for the next 30 days on whether to reexamine this decision.  However, I understand this offer has been rescinded. 

 An article, “Dispute on Transgender Rights Unfolds at a Colorado School,” appeared in the NYTimes, 3/18/13.  It recounts the story of Coy Mathis, 6 years old.  Born a boy, Coy identified as a girl and part way through kindergarten her parents requested that she be treated as one.  A few months into 1^st grade, Coy’s parents removed her from school because she was not allowed to use the girls’ bathroom.  Instead she was offered a gender-neutral facility.  A legal battle has ensued “that is likely to test Colorado’s anti-discrimination law, which expanded protections for transgender people in 2008.” Stay tuned.

 An April 7 article in the New York Times, “When Criminality Becomes Attached to Wardrobe Choice,” exposed a situation in Queens, N.Y. in which transgender individuals have been targeted by the police with charges of prostitution.  A survey of 300 residents of Jackson Heights found that “while 28% of straight respondents reported having been stopped by the police, 54% of gay, lesbian bisexual and transgender respondents reported this kind of treatment….  Another component of this is the much-denounced use of condoms as evidence.  ‘It can depend on which side of Sixth Avenue you are standing on in the Village…. If you’re a student carrying condoms, you’re practicing good public health; if you’re a transgendered person of color, you’re a prostitute.’”

 In brief:  A new book, “The Transsexual Scientist, “ by Thomas Bevan, Ph.D. (Amazon Kindle) is “an autobiography and scientific story of the author’s search for the causes of transsexualism and transgenderism.”

 

Experience Counts!, Barbara F. Anderson, Ph. D., LCSW, Good Therapist / Counselor in San Francisco, CA 94110. Best Therapist / Counselor San Francisco, CA 94110

Experience Counts!, I was born and raised in Queens, New York and received my undergraduate degree from Queens College and my Masters in Social Work from Columbia University. In 1987 I received a doctorate in Sexology from the Institute for the Advancement of Human Sexuality and have specialized since then in working with people with sexual and gender identity concerns.  In addition, I have a general practice n the treatment of depression, anxiety, low self-esteem and relationship distress.
Since moving to San Francisco in 1993,  I have taught at City College, coordinated a mental health program for transgenders in the Department of Public Health, and had a private practice. I have published 3 chapteres in edited books on treatment issues and presented at conferences and seminars on issues of sexuality and ehical practice.

My extensive education and many years of experience have prepared me to work with a variety of individuals and couples and I consider myself a competent and ethical practitioner.





Barbara F. Anderson, Ph. D., LCSW, Good Therapist / Counselor in San Francisco, CA 94110. Best Therapist / Counselor San Francisco, CA 94110

Ann Vitale writer

Ann Vitale writer

The Cutting Edge - April 2013

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

 As promised in the last column of “The Cutting Edge,” I will describe some of the changes made by the American Psychiatric Association regarding their diagnostic category relating to gender variance.

The term” gender dysphoria” is to replace Gender Identity Disorder (GID) in the 2013 release of the Diagnostic and Statistical Manual of Mental Disorders, revision 5. In 2008, the APA organized the Sexual and Gender Identity Disorders Workgroup and charged the members with assessing the appropriateness of the current diagnostic category of GID.  They gathered suggestions from mental health providers, activists, and advocates and 3 years later set forth their new recommendations.  Ironically, they resuscitated the term gender dysphoria, which had been used in the 3^rd edition and which was rejected for the 4^th in favor of GID.

 Some consumers resent the listing of gender dysphoria as a mental disorder stating that it is stigmatizing, vague, and stereotyping.  They recall when homosexuality was viewed as a mental disorder prior to 1973 and completely removed from the manual in the 1980 revision.  Others wish the diagnosis to remain in order that trans people qualify for insurance coverage for medical and mental health services. A compromise suggested is that gender dysphoria be listed under the International Classification of Diseases (ICD) used by medical providers.  Stay tuned….

 The state of Oregon now provides health insurance coverage for all medically necessary treatment related to “gender reassignment surgery.”  While that’s good news, I think “gender” reassignment is a misnomer.  A trans person’s gender is just fine—it’s his/her genitals that need reordering.  But back to the story.  Alec Esquival, 41, sued the state and the Public Emplyees’ Benefit Board when coverage was denied for a hysterectomy recommended by his doctor as part of his transition from F-to-M.  For more info, www.statesmanjournal.com.

 Related to the above story, the NYTimes of Feb. 13, 2013 reports that a growing number of the nation’s elite colleges are offering student health insurance for “gender “ reassignment surgery.  While not one school offered such treatment 6 years ago, now 36 colleges do so.  25 more, though not covering surgery, do provide for hormone therapy.  While this issue affects  but a small number of students, it does send a signal to the much larger number of students that the rights of transgender people have taken a place alongside gay rights as a cause that matters.

 In another court case, in 2010, the US Tax Court issued a ruling that treatment for the diagnosis, Gender Identity Disorder qualifies as medical care and therefore related expenses may qualify as a medical deduction for federal income tax purposes.  The article, “Win in O’Donnabhain Tax Court Case” appeared on Jan 24, 2013 in an e-publication called “Gay & Lesbian Advocates & Defenders.”  Its website is www.glad.org.  They have a Legal InfoLine @ 800-455-GLAD.

 “Coming Out in the Workplace” is an excellent article on the Human Rights Campaign’s website www.hrc.org/resources.  It discusses risks and benefits; the lack of federal law protecting against discrimination; and several available resources should you be considering such a move.

 “A Transgender Elected Official Reflects an Evolving Cuba” is an article appearing in the NYTimes, March 16, 2013.  It refers to Adela Hernandez, the 1^st transgender elected to public office in Cuba.  According to the article, “she would sooner cut a lazy bureaucrat to size with her sharp tongue than chop sugar cane with a machete.  And you would more likely catch her hauling water to her house in platform heels than trudging the streets in fatigues and work boots.”  She represents 2,000 residents of a destitute neighborhood in the municipal council of a seacoast town.  In her day job she is a medical technician and makes occasional cabaret appearances as a drag queen.  She is considering SRS which has been available free in Cuba since 2008.  Until a transgender woman has this surgery, she is considered legally male.

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.