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.