To Your Health!

One of the more important things that I am both personally and professionally concerned with is the status of our overall well being. It worries me that we don't pay enough attention to our general health and worry most about getting HRT and the surgeries that we want to feel complete. Many of us ignore our health towards this goal by obtaining black market hormones off the street or from pharmacies that sell on line that don't even require a prescription. We don't really know what we are getting from these sources, but the imperative to move our bodies towards a better fit with our minds allows us to take risks risks with our health we would never consider doing otherwise regarding the rest of our health care. It is not entirely our fault, but we share some of the responsibility for this conundrum.

It has been notoriously difficult to find therapists, physicians and other health care providers to provide the care we need, yet more and more health care professionals are willing to treat us and more and more insurance companies are willing to pay for some, if not all of our health care needs on a parity to that comparable with other diagnoses. Many health care systems offer financial assistance based on income. There are also free clinics in many communities that offer health care to those who work, have no insurance and are of limited income. 

When I began working with transsexuals, way before I ever considered that it would be possible for me to transition, I was the only therapist who provided transgender care for the greater part of Virginia. I had one resource for a physician who provided HRT for my male to female patients. I had no resources for my female to male patients, but I had never encountered one until the last 4 years and I was able to find a doctor willing to provide his care.

Today I have developed resources for my patients that include the psychotherapy I provide, substance abuse treatment, treatment for co occurring mental health problems and second letter evaluations (psychiatry), primary care, endocrinology, aesthetic dermatology and voice therapy. Generally, we think of male to female people benefiting from voice therapy, but female to male people can benefit from this service as well. That is because communication within our gender identity does not only include the pitch, tone and inflection, of our voices, but it also includes non verbal communication such as gestures and body movement.

For whatever reason, even if you decide to go the DIYS (do it yourself) HRT route, there are some things that are absolutely necessary and should not be neglected.Please do these to maintain your good health!

1. Blood work: We need to have some blood work done twice a year when first beginning hormone reassignment therapy and after full induction, at least once a year. These tests include a metabolic panel to check the functioning of your organs. The liver and kidneys are particularly stressed by hormone therapy. Having a lipid panel is important as well because hormones can elevate cholesterol and raise the risk of coronary artery disease.

2. Depression, anxiety and substance abuse: These problems are epidemic in our community and we have an overall suicide rate of 41% of those who have attempted suicide at least once. People of color have a much higher rate of attempted suicide than that reported overall.

3. Substance abuse is a particularly severe problem for us and exacerbates depression and anxiety and is often a huge factor in attempted suicides. It has been difficult for us to find substance abuse treatment that is sensitive to us as individuals, but this has been an emphasised area for improvement among substance abuse treatment professionals. This problem is taking too many good brothers and sisters away from us. It is so unnecessary too. There are 12 step programs available. They work for more people than anything else. Check out Alcoholics Anonymous   or Narcotics Anonymous

   . Click on these links to find a meeting near you! http://aa.org/ or http://na.org/ . Some of the groups in some localities are for GLBT people specifically, if you don't feel comfortable with another type of meeting, but if there aren't any of those type meetings available in your area, please don't make that the excuse to not get the help you need. It is truly a matter of life and death.

4. Don't forget your annual mammography! While we generally have a lower rate of breast cancer than genetic women, we are at higher risk with family histories of our moms, sisters and aunts having had breast cancer, especially if they had one of the mutations that cause the more aggressive breast cancers. It is really a painless procedure and will be a life saver. Then there are a couple of tests that we hate as a reminder of having a body we felt was wrong for us. We still have to have the digital examination of our prostate glands. While the risk is reduced, we still are at risk for prostate cancer as we age, even though estrogen and progesterone are treatments used to slow the growth of prostate cancer. We also need to have the PSA blood test done on a yearly basis.

For the guys, it is important to continue to get that pelvic regularly along with a pap smear, and even if you have had a hysterectomy and oopherectomy, you will still need that done periodically, perhaps not as often.

5. See your dermatologist once a year, especially if you have had heavy sun exposure or have a history of skin cancer in your family. It is imperative that you do this yearly if you have has any relatives who had malignant melanoma. This is an extremely dangerous skin cancer and it is too often the case that when it is finally found, it is often too advanced to be successfully treated.

6. See your dentist twice a year! People who are able to keep their own teeth are healthier and live longer. Poor dental health can often lead to heart disease.

7. Don't smoke! It is the most difficult of all addictions to overcome, but it can be done! Smoking is a deceptive addiction, because it doesn't kill you as quickly as some other addictions, but the long term health consequences are devastating and are well known.

8. If you use alcohol, please use it in moderation. Alcohol in any quantity has negative effects on every tissue and organ in the body and is one of the more deadly addictions. Alcohol causes many ruined relationships and injuries due to accidents as well as fatalities. Know when you have had too much and don't be too proud to ask for someone else to drive or take you home. There is no shame in that and it may save some one's life if not your very own life.

9. Get some exercise daily! Even if you can just take 30 minutes and go for a brisk walk, it will improve your overall health as well as cardiac health. It will help you with weight control as well.

10. Be sure to laugh every day! Enjoying humor has been known to benefit general health and one's outlook. Cultivate a positive attitude. It is part of being healthy and attracting positive people. It will be part of being successful and happy in your own life. Smile! positive people are attracted to people who smile and are interested in their well being too.

11. Do something for someone else. It is good for one's outlook and overall attitude to do something nice for someone else. It doesn't have to be anything big, just look for that little opportunity to do something special to help someone else. The return will be ten times what it took to do that little helpful or kind thing!

I hope that you all have a happy and healthy 2012!

So What's In Your Glass?

What's in your glass? Is it half empty, half full or something different? This is the time of year we tend to take stock of our lives and that of what has happened over the past year.

Being of melancholic temperament, I have in past years spent my time dwelling  on things that didn't go well or were exceptionally spectacularly disastrous. This isn't about those experiences. It isn't helpful for me to recount those to others very often unless there is something that the person would learn that would help them to improve their own situation. I am not unique in this regard, we all have those types of experiences in our histories. I do hope that those of you sharing this prose have not had too many experiences like those I refer to! Still, I was able to take them and turn them into something positive, or I would not be able to be sharing these thoughts with you. I have benefited from my own adversity and have been able to use it to help others sometimes.  I hope that you have been able to take the darkest, most difficult times and turn them into something that benefited your own growth or helped others to overcome their own personal adversity as well.

This year, despite some very sad events, my glass is decidedly over half full. Some of the reasons for this have been due to professional accomplishments and some of them are due to achievement on a more personal level.

Professionally, I have been able  to expand the services offered with the transgender care program I put together. I was able to add another provider of HRT, a psychiatrist who will write the second opinion letters of those I recommend for GRS  and are adding voice therapy this month. This is a service that seems to be in great need and hard to find. I'm grateful to the health care professionals who took the time to listen to my talk about the needs of the transgender community and are willing to grow personally and professionally to offer these much needed services. In no small measure this was due to my willingness to become vulnerable and share my life story with them about my life and why I do what I do professionally. For me to have grown to the degree that I was willing to take that risk is no small step in becoming who I have always been, trusting that people who know me will continue to respect me and be supportive of what I need to become self actualized. To me this is a real accomplishment. What makes it most important to me is that it benefits people who will now have choices that never existed for me when I was younger. As time goes on, I hope to expand our services in other areas of health care. The possibilities, I believe, are limited only by my own vision. So this makes it most important that I focus on the positive and not what I haven't accomplished, which would be characteristic of my nature.

I also gave six workshops in places that I haven't presented at before. I met a lot of wonderful people who came to my workshops and I had the opportunity to meet and spend time with people I have admired for years. I learned that there are a lot of people who think what I am doing is important and that I have something special to contribute to the lives of people like myself. I've always had a difficult time believing that. ( I'm not fishing for compliments). Because of the experiences I have had and the people I have met, I am beginning to actually believe I have something to offer others. I don't think at the end of last year I could have said that because I didn't believe it. I'm not going to attempt to single each of you out. Each of you who read this will know that you are one of the people I am referring to, though not all of you might have the opportunity to see this in the written word. Many of these accomplishments would not have happened without the generosity and kindness that characterize the kind of person you are. I thank you all from the bottom of my heart and soul. It is a great gift you have given of yourself freely to me.

Others have simply granted me the gift of friendship and acceptance. This is no small thing to me. It is a rare and treasured thing.

One of the most important things I was able to find was a church and faith community where I feel at home and most importantly I feel wanted. I can be myself and am given the gifts of being ministered to and nurtured by other women in this church. It is a place for me to explore my spirituality as a woman and grow in that aspect of my spirit. It is something that has always been an important part of my life and I found the first fleeting vision that I could have this in a Baptist church in New Jersey when I had gone up there to give a workshop and stayed with a dear friend who attended that church. It was even more special as not only was it the first time I was able to worship as I am without a facade, but I took communion that day as well. Now I have a church where I can receive that sacrament every time I attend.

The most important thing that I have that makes my glass well over half full is the love and commitment of my marriage with Patty. It takes a very special woman to be able to take this journey with me. We are every wife's nightmare, more often than not. There are a lot of special women like her, but so many more who cannot go through a life with a transgendered spouse. I hope that I will be worthy of the ongoing pledge of love and commitment that I have been given. It is truly a gift freely given.

It is so very clear to me that this year I have been blessed. I hope that no matter how difficult and painful your year has been, there are some things that each of you count among your blessings too.

How Do You Tell Who You Tell?

Though I have helped many, many tell  others they care about that they are transsexual or transgendered, telling the most important people in my life leaves me confounded and creates some level of anxiety.



 It's not so much that telling people I know on a social, less personal basis is so hard. I don't have the emotional investment in them that I have with other people. If they can't deal with it, well that is not such a big thing for me.But with those who I am most closest, the process of who to tell, when to tell and why to tell becomes an issue that is anguishing at times. I'm a person who is an introvert and I have just a few close friends who are not also transgendered.

Specifically, I'm thinking of my two best male friends who I have ongoing relationships that spans decades ( NO I SAID!! I am NOT going to tell you how OLD I am! A lady never tells her age... and NIKKICOLE, you don't know EXACTLY how old I am either!). My one friend B. and I have been friends since the first week of my undergraduate education and my other friend K. I've known since the end of my graduate education. Both are and have been wonderful and loyal friends and to have such close relationships over that length of time is something truly to be cherished.

What makes this difficult is not the fact that I need to tell them, but how to tell them and when to tell them. It hardly mattered when I never held out the possibility that I could actually become self actualized and live an authentic life. Now the time is at hand and I need to take care of this soon. The biggest obsticle is that B. lives in Oklahoma and K. lives in Arizona, where before B. lived here in Virginia, and J. lived in Alabama. B. lived close enough that I would see him at least every other week and K., being in Alabama, I got to see at least once a year. This is something I do not feel comfortable telling them over the phone and certainly I wouldn't disrespect our friendship by tossing off a letter to them, no matter how well I crafted the letter. This has to be done face to face.

The distance involved makes it more difficult. I haven't gotten to Oklahoma or Arizona on one of my magical mystery tours of workshops to date, or even near there yet. Most of the workshops I do are done out the desire to help other trans people and have been paid for out of pocket. That doesn't leave me much money for leisure travel. Yet I must do this in person with them. I don't think it is fair to them or to our friendship to do it any other way.

Then too, because of the distance and time since I've gotten to see them, it worries me to no end what their reaction will be when they do find out. One friend is extremely liberal and he loves everyone and everybody. I don't think it will be a huge issue with him. You never know though. Some people who are very liberal are some of the people I would never have guessed would have trouble with a trans person turn out to be the most bigoted and prejudiced against trans people and some of the conservative people I know who I would have thought would be the most unable to accept transpeople turn out to be some of the most accepting people I know. It's a funny world. I'm very conservative and that it would turn out this way was something I never would have dreamed possible. Of course, there are many liberals who are accepting of trans people and many conservatives who aren't. You just can't figure it out by someone's political philosophy.

I had an experience tonight that reassured me that I will be able to tell B. and K. and the outcome will be good. I was speaking to B. tonight and I mentioned the workshops I've been doing as I had done quite a few east of the Mississippi this year and he asked about what they were on. I told him that they were on helping transgender people and he was interested. He noted that they have often had difficult times in life and that more and more we are finding this to be a biologically based issue. I was surprised that he knew that much about it, but then again, he IS a LIBRARIAN, so it wouldn't be unusual that he had read some things about transgendered people, plus he had lived in Minneapolis- St. Paul which has a reputation for being extremely tolerant of transgender people. I feel much more hopeful about the outcome of this coming conversation and I think that he and I will make the transition in our friendship without too much difficulty. I just have to figure out how to get out to Oklahoma to see him for a couple of days.

K. and I have been good friends for quite a long time, not as long as B., but long enough that he is just as important to me and I have to sit down with him too. In some ways, I expect it will be easier with him. He and I have both had friends who are gay and he knew a couple of transgender people that I don't know from Alabama. He has always seemed accepting of them and I have never heard him make a derogatory comment about them. His middle name should be Tolerance! Since he moved to Arizona, he has gotten married. He knows that I am doing extensive work in the area of transgender care and his wife has a nephew who is an f2m transman. I'm pretty sure he will be ok with this, and I had always thought that he would be the easier of the two to tell, but then I've had these experiences where the people I think will be tolerant are not and the ones I think won't are.

My biggest worry is that they may be upset that I kept this hidden from them for so long. In my defense, most of that time I was fighting as hard as I could not to be transsexual (I wonder if there are ducks fighting hard not to be ducks?). I worry that they will be upset and may feel they don't know me at all because I hid this from them for so long.

The other relationships I'm worried about are my parents and my wife's family. My parents are very elderly and I would hate to ruin our relationship now when they really need me. On the other hand, I worry what this revelation may mean for my wife's relationship with her family. I've wondered if I can avoid telling her family, make token appearances far and few between in an androgenous manner and leave it at that. My parents are a more delicate situation because we live so close. Can I do the same with them? I'm not sure that those are viable options.

In the end, I know that it will be what it will be. If I lose their friendship, it will break my heart. If I am able to preserve these friendships I think the bonds will be even stronger than ever. In any event, my life will go on and it is up to me to make of it what it will become. It is my choice to be happy or sad. One can look to the future or dwell on what was lost in the past. I prefer to look to the future.

Updates to the blog....... 12/11/12

In addition to the new post on Transitioning, Stealth and Passing, yesterday and today I have added some new links to transgender conferences that I regularly give workshops at and a link to the Canadian Professional Association of Transgender Health. I've also added to the list of blogs I follow. Fiat Luxe is the blog of the Rector of St. Paul's Memorial Church where I attend. I also added the link to the blog of my friend from Facebook, Katherine Bradford. Its called Crumbs From the Cosmic Muffin Top. Finally I added a book to the list, Sandra Samon's When the Opposite Sex Isn't. I hope that these additions will make your visit to my blog more enjoyable!

Transitioning, Passing and Stealth

Most of us have thought at one time or another that when we transitioned we could live in stealth, living our lives without others knowing of our transgender past. When I was in second grade, I had a fantasy after reading The Box Car Children that I would run away to another town where no one knew me.  The Box Car Children had lost their parents and had been in an orphanage. They learned that they were going to go live with their grandfather who they had erroneously decided was a mean old man who didn't care about them. So they ran away and found a railroad box car on an abandoned spur off a railroad track in the woods that they came across in their travels. This turned out to become a wonderful home for them! They fixed it up nicely so that it was homey and comfy. There was a creek close by that they dammed up and had a nice place to play and swim. And of course, they went to school and had everything they needed. Eventually, their grandfather did arrive on the scene and turned out to be kind and loving, so they went to live with him. If I remember correctly, he was pretty wealthy too. He had the box car moved to his home so they would have that forever.

 I decided this was a pretty good plan for me to become the girl I knew myself to be! I would live in a cave and go to school as the girl I really was! PERFECT!! (Only I hadn't thought about where I was going to get an adult to enroll me in this new school in this new town, or buy me all these new clothes, and I wasn't particularly mindful about where my meals would come from or who would take care of me when I got sick or was afraid, or had a nightmare.....).

I thought that when I finally would run away, I would have all the clothes I could want or need to be the perfect little girl! To that end, I poured over the Sears and J.C. Penney catalogues looking at the clothes a 2nd grade or 3rd grade girl would wear and picked out the pretty dresses I liked. I would draw pictures of pretty girls wearing the clothes in the catalogue with my colored pencils. I wonder if my mama ever saw those pictures that I drew? I was careful when I did this that she was elsewhere in the house doing mama things while I was doing Michelle things. That was my first name I picked for myself and that was the name my BFF Christina Lang knew me as when she met me in an IRC chat room in either 1996 or 1997. At some point I decided that Michelle was way too close to my male name and really didn't reflect my personality anyway! Thus, Sherri Lynne was born (already all grown up)!

I don't know why I never ran away but I guess as I got a bit older, I realized that there was no way I could, as a child, make this plan work. I mean, really, how was I going to afford ALLLL those clothes?? I didn't get more than about a quarter a week allowance back in the day (NO, I'm STILL not going to tell you how old I am!!). Even into my adolescence and young adulthood, I held out the thought I would finish college and transition, go to graduate school and transition, graduate from graduate school and disappear as I transitioned. In those days there were no resources available where I lived or where I eventually moved to in order to accomplish this thing I wanted so badly, so it never happened. I knew there were others like me. By this time I had read literally dozens of books and hundreds of journal articles, but where could I find the help I needed within a reasonable distance? I couldn't. I knew that if I did move somewhere where no one knew me that I would have to break off my relationship with my family to accomplish becoming the person on the outside that I was on the inside. I would disappear and my friends would never know what happened to me. I would start life all over again and that this would be the price to be paid in order to live my life in stealth.

So for one reason (or was it an excuse?) and another and another, I chose not to transition until three years ago. As time goes on, my transition picks up the pace. I've come to the realization over this period of time that there is no perfect stealth for the vast majority of us. I'm sure some people have been able to establish perfect stealth, but I think they are far and few between. Given that we are such rare people to begin with according to best estimates, the numbers of us who have achieved perfect stealth are even infinitely rarer.

For instance, if I were to achieve perfect stealth, I would have to lose all of the following things: my family; all my present friends; my career; my home; my community; ties to the college and universities I attended. In other words, I would have to move somewhere where I have never been, have no contact with those I left behind, and likely give up a career in which I have been very successful in and not be able to claim all the years of experience that I have in my career. That would be a very steep price to pay for a chance at something that might be successful for a while, but I would always be looking over my shoulder in fear that I would run into someone who knew my past or knew someone I knew who had a story about someone they knew who...  You understand what I'm saying here. Is it farfetched that it could happen after all that sacrifice?

Consider this experience I had one time. I was flying back from Kansas City after taking part in a substance abuse treatment conference. The first interesting thing was that Richard Petty of NASCAR fame was on the same plane, but then something even more amazing occurred. The flight was bound for Charlotte where I had to make a connection. I became engaged in a conversation with a man from Florida seated next to me. He had been out west on a business trip and was on his way home, also changing planes in Charlotte. We got to talking and I told him I was on my way to Charlottesville. He told me that he grew up there and of course my curiosity was piqued. I asked him where he went to elementary school as I had gone to school there and it turned out that not only had he gone to the same school, we were in the same class in first and second grade, were playmates, and later were in Scouts together. Small world, huh? That's an example of why I don't think perfect stealth will ever be an option for most of us and certainly not for me.

Rather, I think that stealth exists in degrees or like layers of an onion. There will be people who will always know that you once lived in a different gender you are today. I wonder if any of them can really see me as a woman and not quickly think of the person I used to be in my former gender. My guess is that at some times that will happen and others they will remember who I used to be. That isn't my ideal, but I can accept that reality, as long as I am treated with dignity and respect and as the woman I am. I think the younger a person transitions, the degrees of stealth increase. My reasoning on this is that there is much more life to be lived and many more new people coming into one's life who never knew the young person in a differently gendered life.

 For some people this will be important to them, for others not at all. When I think of those who it is unimportant to, I think of those folks who identify themselves as "gender queer". Perhaps it is a function of the times I grew up in, but I can't relate to that identity, personally. I have always had a clear identity as being female, and view my male body as a birth defect. I don't loathe the body I was born in as the stereotype of transsexuals that exists, I just have always known it wasn't the one I was supposed to have.

It would be really difficult to continue in my chosen profession if I were to disavow my past professional life in order to live in stealth. I have too many years in my profession, too many accomplishments that I would have to leave behind, and with that decision the prospect for a job that is commensurate with my knowledge skills and abilities and with my salary requirements would all but be impossible to obtain. I wouldn't have any references and wouldn't be able to list prior work experiences because the person I am interviewing with may possibly know another professional I used to work with. Any google of my name would also lead to my prior identity because of the types of psychotherapy I practice as well as my true identity. Instantly, my illusion of stealth would be shattered. For most of us in the age of the internet, stealth is becoming more and more of an illusion.

When one considers stealth and what it means, we are often talking about our transition and passing. In the first few years before I seriously considered transitioning, I did go out as myself, with generally unhappy outcomes. Though I dressed nicely, I didn't pass. So at that time, stealth wasn't even on the table as something possible. I would catch funny looks out of the corner of my eye or people frankly staring and that was really painful for me, to feel that something that seemed so right to me, made me at best a curiosity and at worst the target of derision or being seen as a freak.

Eventually though, with enough experience in being out and about, and as the hormones changed the way I looked, the way I carried myself publicly, and the more comfortable I became in social interactions, people stopped staring and I became able to go about my business and became comfortable interacting with people, I realized that I was "passing", even in situations with close contact, such as shopping in the Bare Escentuals store for makeup or dining out by myself or with my friends. Even in the most difficult tests of all, being in proximity with teenage girls (notorious for being able to scope us out) and in the ladies room.

Now if it is the case that I am passing well, then I have accomplished a level of stealth that in many ways is the only stealth most of us will ever experience. Even if I am being read as a transsexual woman, the fact that I am being treated with dignity and respect as a woman is really all that is necessary for me to live my life in a manner that allows me to be who I am.

I also have a new church that is welcoming to transgender people, though to my knowledge I am their only trans woman. I don't mind it because they have all been so nice to me, made me feel at home and wanted as part of the congregation. They treat me as a woman and I don't have to think about being a trans woman at this point there which is always a nice way to live. I've spent way more time than I ever wanted to thinking about my gender as it is.

To continue to work in my career at the same health care system, means that there will be no stealth for me whatsoever, as I interact with nearly every clinical service that is available there. However, the important thing to me, again, is that I be treated respectfully and with dignity. To me it’s that people get the name and the pronouns right when they speak to me or about me. I certainly have no thought " they won't know". Indeed, it is the colleagues closest to me where I work who will have the most difficult time with the transition. Patience on my part will be required as they will not get it right 100% of the time in the beginning. As long as they are making the effort to try to get it right and are improving, then I can roll with it during the learning curve.

 I would hope that new professionals who join us as others leave will only know me as a woman. I also know that it would be unusual if there weren't one or two who know me and said to the new coworker, "Yeah, and you won't believe this but Sherri used to be a guy!!" Such is human nature. I'm sure in most cases it wouldn't be meant maliciously either, knowing the people I work with. I wouldn't be happy if it occurred, but in the grand scheme of things I could handle it. I would be assertive in asking the person involved not to do that again. I think I know my coworkers well enough that if that were the case they would stop after being asked.

Dealing with family is an entirely different subject. It is my hope when I engage a patient for therapy who is transgendered if problems within the family system over a family member's transgender status develop that I have an opportunity to intervene. My hope would be to prevent people becoming estranged with their family of origin. I'm almost certain that almost no family member will ever think of their relative other than their birth gender, even if they are loved and accepting of that relative. It's almost impossible to forget all that shared history. But it is possible to accept and embrace their relative. More and more often, even if there is a period of estrangement, families are staying close to their transitioned family member. The bonds of family are very strong. Even in the cases I've worked with where children are abused or neglected, they more often do remain close to their families, even after having been removed and placed into foster care until the age of majority.

I think that in more public situations is where stealth exists and perhaps in business situations when dealing with other businesses and perhaps even in the place of employment if different from the place of employment where one transitions. As relationships become closer, the degrees of stealth diminish. Is that necessarily a bad thing? I think not. I want the people who are closest to me to really know me for who I am. Even this most painful part of my life (my prior male existence) after my transition is complete. After transition, I believe that I will simply see myself as a woman; being in a "trans" state will be over. I could very well be wrong about that though.  This is not to say I think that when my transition is complete I have arrived at the destination. Life is a voyage, a journey. The arrival is when we reach the end of our time here and go on to what’s next. I'm rather thankful that life is that way too.

Just What Kind of a Girl Are You Anyway?

So just what kind of a girl are you exactly? Really. Do you know?
"What kind of girl am I really am??" - Roseanne Cash

One way of figuring this out is by taking the Myers- Briggs Personality Type Indicator test http://www.humanmetrics.com/cgi-win/JTypes2.asp . This easy to take test is based on Carl Gustav Jung's work with personality temperaments, has been studied and found to be exceptionally reliable and valid. Validity has to do with how well a test measures what it purports to and reliability has to do with the consistency of it's results over the passing of time.

It features 4 continuums of personality characteristics: introversion versus extroversion; sensing versus intuiting; thinking vs feeling and judging versus perceiving. In combination, they result in 16 personality types that describe all people. Some personality types are relatively common, some are rare. Each of these traits exists in relative degrees in people and the test can tell you how strong you personality is on one trait versus it's opposite. For instance, one can be either mildly extroverted or extremely extroverted. You can get a brief overview of the various personality type descriptions here http://www.myersbriggs.org/my-mbti-personality-type/mbti-basics/the-16-mbti-types.asp or do a search for your type and read more extensive descriptions

I first became fascinated with this test almost, ummm, well, a long time ago when I took a graduate level course in personality development at James Madison University. It never ceases to amaze me that I have gotten the same personality profile every time I take it with the exception of a few times in my life when the judging- perceiving aspect was reversed. That is because my Judging is closely balanced with perceiving, though most often tests out on the judging side. My profile is INTJ. It's one of the most rare profiles. I'm not sure that is a good thing or a bad thing. I guess it depends on the circumstances. As a woman, it can be off putting to people because it isn't a profile that is associated with traditional femininity, but then again as a transsexual what would it be that is traditional? I'm ok with that, though.

Though this test has been normed, found to be valid and reliable over the many years and used with many different populations, to my knowledge after an exhaustive literature search using medical database search engines, there have been no studies done on transgender people and I'm quite interested in doing a research project about this topic.

I'd invite you to take the test and find out what your personality type is. Please feel free to share with us your personality type and how accurate you think the results are.

So Just what kind of a girl are you anyway? Really?

I've Added Some Useful Information!

For those of you who want to learn more about the history of Transgender Care, I have added a bibliography at the bottom of the blog. Some of these books are well worth the trouble to seek out even though they are out of print and may be difficult to find, particularly the "foundation" books from the late 1960's through the mid 1980's. This list is not complete and will be updated periodically, so please check back if you are interested for your own edification or you are a serious scholar of the subject. I really hope that you will find this useful!

You will also find a list of blogs that I am following and I encourage you to visit them often as they are updated.

Either by the end of today or tomorrow, I will add some links to some resources that I think you will find informative and helpful.

As always, I am very thankful that you take the time to read my blog!

Choosing the Right Therapist For You (It's Not As Hard As You Might Think)

Finding the right therapist for someone who is transgendered is not an easy task, as most of you know already. Many trans people would prefer that their therapist not only be well versed in providing transgender care, but also be transgender themselves. As difficult as it is to find a therapist who is well experienced in this area to begin with, the therapist who is transsexual, such as myself, is an even more rare thing to find. As many of you know, my practice is in a rural health care system in the heart of the Shenandoah Valley. I am the only therapist for over a three hour's drive radius who practices transgender care and there are no other therapists who do practice in this area who are transgendered themselves to the best of my knowledge. I do know most of the therapists in Virginia who provide this type of therapy. So when I went searching for my own therapist, I had to find someone who although had no experience specifically in transgender care and wasn't transgendered, yet would be able to provide me with competent care to the best of her abilities.

I did a quick survey of the top 40 graduate programs in my own discipline of Social Work. Of the handful I surveyed, only two had practice course work that had the keyword transgender in the course title. The program I attended at the School of Social Work at the University of Alabama had no courses in this area when I attended (NO! I will NOT tell you the year I graduated!! A lady NEVER reveals her age!!!!).

A therapist who has herself as a patient is a fool. Someone asked me me why I don't do my own therapy in all seriousness and it was a fair question to ask. It's because I lack the objectivity that one would get from a therapist when it comes to myself. The decision to transition is one of the most important ones of my life and I have only one chance to do it right). This might seem like it would be impossible to find someone who could get the job done, but that isn't true. My own therapist has never worked with a transgendered person before me and she has done an excellent job. At this point I would recommend her to anyone seeking transgender care. She has some characteristics that ensured that she would be competent to do the job, and I knew this when I selected her to be my therapist at the beginning of my own care. I want to share with you how I was able to find someone to help me. It isn't that hard when you know how to go about it.

The secret in finding the right therapist for you is really simple: You are hiring someone to do a job for you and you need to do your homework up front, just as you would if you were hiring an electrician or a plumber. There are things you can do to make sure the person you hire is competent to do the job, just as hiring anyone else. Remember, the therapist works for you and you are interviewing candidates to fill the position, just like any other job. This can be an intimidating prospect for most people because they don't have the same knowlege base as the therapist and they don't feel like they can pick someone who will be competent, so they make appointments with someone and see if it works. That can get expensive, especially if you see two or three before finding THE ONE. Plan on interviewing three or four, if at all possible. It's nice to have a number of options.
If a therapist isn't willing to spend 15 to 30 minutes speaking with you on the phone about what your needs are, then he or she will not be a good candidate for you to contract with. When you are interviewing, it isn't so important that you completely understand the answers to some of the questions you ask, just write them down. You can look up some things afterward on the internet which will help you make an informed decision on who to pick for your therapist.

The first thing you will want to do is look in the yellow pages and see if anyone uses the term "gender and sexuality" in their advertisement. That one key phrase brought me tremendous numbers of trans patients when I had my private practice. The other resource was people who found information about me on the internet. A number of websites provide lists of therapists who are competent in gender therapy.

More and more insurance companies are paying for transgender therapy. The easiest way to find out if you will be covered is to call your insurance company or the mental health managed care entity who handles this for your insurance and ask them if the the  DSM IV- TR diagnostic code 302.85 is covered under you insurance policy. Almost every insurance company I am a provider for, with the notable exception of Coventry administered by Southern Health and their mental health managed care company MhNet cover this therapy and that includes Virginia Medicaid and Medicare.

When you are speaking on the phone interview you will want to ask the following questions:

1. Do you accept my insurance plan and what are your rates? If my plan doesn't cover this service, what is your fee for service? (If there are valid reasons that you can't pay the full rate) Do you have a sliding scale?

2. What is your theoretical orientation? There are many theoretical schools of psychotherapy. Some of the major ones are:  Behaviorism and it's derivitives, Cognitive Behavioral Therapy and Rational Emotive Therapy; Humanism; Gestalt; Transactional Analysis; Psychoanalysis and it's derivitive, Object Relations and Feminist Therapy.

My undergraduate education was strongly rooted in Behaviorism and I practice mostly Cognitive Behavioral therapy and Rational Emotive Therapy. I am well versed Humanistic therapy, Gestalt and Transactional Analysis and have a working knowlege of Psychoanalysis and Object Relations, though I only use them to conceptualize therapeutic issues when I find it useful and do not practice their techniques as I have not been supervised to practice in that area.

Over the years I have been concerned when I hear that a therapist describes their therapy as "eclectic". Too often that means that a therapist has not mastered any particular school of psychotherapy and just draws techniques to use in their practice because they feel right to them for the situation. They often can't articulate why the selected a particular intervention and the theory base behind it. Not all therapists who say they are "eclectic" though don't operate without a philosophical underpinning it is just important to know they understand why they select their interventions.

After you have interviewed the therapists you have selected, it's time to hit the internet and look up the information they provided you. You can then decide which therapists' theoretical orientation seem to be in tune with your own belief system and make a wiser choice in your decision.

3. If they have no transgender treatment experience, then enquire if they have worked to any extent with gay and lesbian individuals. If they have experience with them, they are more likely able to be helpful to you. While our issues are not identical to their's, they do overlap to some degree. This was the deciding factor in my choice for my own therapist.

If they do have transgender experience, ask them if they are a member of the World Professional Association of Transgender Health. If they are a member of WPATH, that is the gold standard for transgender care. If they are not, ask them if they are familiar with the new seventh version of the WPATH standards of care. If they are knowlegable of them or the prior version, then you know they are at least well enough acquainted with transgender care that they are likely to be able to provide you with quality treatment.

If they don't, but have other experiences that place them into serious consideration to become your therapist, then ask them to what degree they are willing to educate themselves to be able to help you. Are they willing to dig up resources and learn on their own? If so, you will most likely find a good therapist to help you, though they might be inclined to follow the standards of care more to the letter of the law. That can be frustrating. We all want what we want when we want it in terms of our gender issues and transition and I am no different in that respect, but someone who is going to be careful before signing off on your hormones and surgery rather than just going along with what you want may just be what is best. At least you will be sure they erred on the side of caution, if they erred at all.

Too many of us have rushed into decisions they knew were right for them without consideration how they will support themselves, who will be supportive of them and who will abandon them merely because they are differently gendered. Too many times thre have been disasterous outcomes. Our community has about an 800% higher rate of attempted suicide than the general population and an astronomically higher rate of substance abuse and addiction as well.

I hope that these thoughts and strategies will help those of you who are looking for a therapist. If anyone has any other ideas that will help my viewers, please do contribute your thoughts to the discussion.

Transphobia: How do you victimize yourself?

When most of us think about transphobia we generally think of the most obvious form such as when we are physically assaulted, denied access to services, harassed, denied employment or educational opportunities. Almost of all of us have experienced this to some degree, myself included.

Then there is the more insidious form, institutionalized transphobia. Institutionalized transphobia happens when you are denied access to a public restroom for example. When you go to the ladies room, you go into a stall with the door closed and sit down. Nobody knows whether you are pre op, post op, non op or intersexed. When confronted, the person who accuses you makes a judgement on your physical appearance on whether you are male or female without regard to your physical sex and your expression of gender identity. This is based on the institution that men use one rest room and women another. I've heard some activists refer to this as "gender apartheid" I for one, don't want to share a restroom with a man, I'm not in favor of unisex bathrooms unless they are SRO's (single room only).
I experienced this one personally once in a major department store and it was very humiliating.

Another example of institutionalized transphobia that I experienced as a result of this episode happened when I was sharing the example with a female friend who is very supportive. She said, "Well what if a mother with her 7 year old daughter had been going in while you were in there? "She might be afraid for the safety of her daughter." My friend didn't recognize that she had internalized a fear based on fear and bigotry; much of society fears us because if we are transgendered, then we must pose a threat as a potential sex offender. Ouch. That really hurt and when I pointed this out to her, she was immediately apologetic. She recognized that her statement was based on a bigoted stereotype that is in fact not true, but that is how deeply ingrained institutional transphobia can be. It was stated without any real thoughtfulness involved.



Overt and institutionalized transphobia can be confronted, but because internalized transphobia has become rooted in our subconscious, it is much more difficult to overcome.

Consider the following statement:

             "If there is no shame in being a woman, why should I be ashamed of wanting to become a woman?"

I think this captures the deepest most damaging aspect of internalized transphobia. It is the guilt and shame we experience for merely being transgendered that is the worst. Of course, this wouldn't have happened without the presence of transphobia or institutionalized transphobia, but the reality for people of a (ahem) a certain age, things were so much worse that we can easily see the changes for the positive and how rapidly things are beginning to get better. Make no mistake, we are still seriously discriminated against and we are not able to go about our lives without being vigilant for our safety in certain places. We do not enjoy the same access to health care as other people do. That has been getting better. Every insurance company I work with as a mental health professional (with exception of my own (COVENTRY, ADMINISTERED BY SOUTHERN HEALTH AND THE MENTAL HEALTH MANAGEMENT GROUP MHNET), cover mental health services and most of them to the best of my knowledge are paying for hormones, blood work, physician visits, and preventive care such as mammography based on what my patients report to me.

I do not fear every moment I am out living my life publicly. I fly, get passed through TSA, rent cars, get hotel rooms, shop, use dressing rooms and have only had one negative restroom experience. I have a church that not only is welcoming but wants me as an active member of their community to meet my spiritual needs. I am able to go to the grocery store, do my banking, get my oil changed and all those little mundane things that make a normal life normal, the things cisgendered people don't think twice about. These are all good things, but the National Center for Transgender Equality and their executive director, Mara Keisling, work tirelessly to advance our civil rights and we owe a lot of gratitude to  NCTE and Mara, as I do, that things are improving. We have a long way to go. The results of their recent survey documenting how far we have to go show how hard life is for many of us and even more so if we are a person of color.

One of the most important things we must do, is examine the ways we handicap ourselves. Do we allow ourselves to live with guilt and shame? Do we tell ourselves that no one will treat us with dignity and respect, so we avoid living our lives publicly and hide away living a lonely life? Do we get involved in service work to the larger community we live in and make a difference, for the good it does us spiritually and to be an example to the community that we are regular people going about our daily business leading normal lives? Do we take risks in going after opportunities presented to us or do we avoid them because we "know" it won't turn out well. We have to challenge all those self defeating thoughts and actions that are based on transphobia. Even when you think you have rid yourself of all of these negative thoughts and actions that are self nullifying, you might just still be hanging on to something that is holding you back.


Just for today, I'd like to challenge you to take some time and look at what transphobic thoughts and beliefs that you have about yourself and remove those obstacles from becoming the best you that you can be!

She Gave Me Hope a Long Time Ago

As I had mentioned previously, When I was 12, I went to the library and started reading about people like me. That started a life long search in the literature to learn more about myself. I'd go to the library quite often and read the books about Transsexualism. I'd re-read the books that I had read before and read the new ones when they came in. I was too afraid to check them out so I could only read them for an hour or so at a time. This went on all through junior high and then high school. I was very fortunate that the Charlottesville Public Library had these books. In high school, I worked at U.Va. Hospital and then had access to the medical school library. Jackpot!! That gave me access to medical and other allied health care journals as well. The thing that struck me most (aside from THIS IS WHO I AM!!) was that there were so few of us that I felt so alone and so different in the world. I also thought that this is such a shameful thing that no matter what, I must let NO ONE know the truth about who I was. It continued into college, after college and then through grad school at the University of Alabama. Every time I went to the library, I'd almost inevitably get side tracked and go read the books about people like me. Even today, if I go to Barnes & Noble or online to look at books I still get sidetracked by looking for books on transgender themes and I have quite an extensive library that even includes all those old books long out of print that I read at the beginning when I was 12 and up.

A year after I graduated from the School of Social Work, I got married for the first time. The only thing I will always hold myself accountable for in the failure of my marriage was I didn't tell her the truth about myself before we married. No matter what her transgressions were, that is something that I was totally responsible for. She didn't deserve that. In my defense, I, like many of us who marry, thought it would go away. It didn't take long, maybe 6 months or so, to figure out that being transsexual wasn't nor will it ever go away. It wasn't until after my ex left that I came to the conclusion that I better make friends with this or it was going to kill me. Literally.

About a year after I was married, I made a decision that seemed inconsequential, but really gave me that first hope, just a glimmer of hope, that maybe there was a way for me to become the person I truly as I continue in the process of self-actualization today.

I had been working at the state hospital as director of the forensic unit, a unit whose mission is to care for those who were adjudicated Not Guilty By Reason of Insanity, or had not been able to be restored to competency to stand trial. This is a particularly political position for a mental health professional, and my assessments potentially had a controversial impact on communities and courts across the state of Alabama, as well as United States Federal Court in some instances as Bryce Hospital was still under Federal receivership due to the Wyatt vs Stickney landmark legal decision. That case resulted in nationally set standards for the care of institutionalized mentally ill people and is considered the "Bill of Rights" for institutionalized mentally ill people. While it was a very good job with the potential for rapid professional growth, it was also very stressful, and here is where I made a decision that changed the course of my life a bit. I decided that I needed to have a mental health day ( I called in sick). I really didn't do much of anything, I just really wanted to have a day to myself alone.

Early in the afternoon, after playing Ms Pacman for the 100th time or some of the other computer game I had (we're talking 1989 and the IBM XT. I was 32 years old), and talking to people on Compuserve, I decided to watch some TV. During those years, Geraldo Rivera had a day time talk show. That particular day, Geraldo has a guest whose name was Marsha Botzer. I didn't know who she was, but it turned out that she was a transsexual woman who had founded the Ingersoll Center in Seattle, Washington in 1977 (To put it into historical perspective, in 1977 I was finishing up my Freshman year at Bridgewater College).

I was rivited; never before had I ever seen or heard another person who was like me. I remember how nice and respectful he was in that interview towards her. I wanted to talk to her badly, but I knew I couldn't call her from home because my wife would question the phone call. I had no idea how to tell her about my most carefully guarded secret. Until this television show, I never talked to or heard another person like myself. I had thought that people like me were so rare that it would be nearly impossible to find or even to talk to someone like myself who could understand the depth of the emotional pain with that I lived.

The next day, back at work, I knew I had to take a risk. I used the work phone to call directory assistance in Seattle, got the number for the Ingersoll Center and after a few minutes of anxiety, called the Ingersoll Center and asked to speak to Marsha. I remember being really shy and telling her how I had seen her on TV the day before the day before. I told her about myself and that I had never known anyone else like me and it meant a lot to me that she would take a few minutes to spend on the phone talking with me. I told her that I was a clinical social worker and about my life growing up. She asked me if I would like some information about the Ingersoll Center and sent me a couple of brochures that I still have to this day. I've always remembered this experience and from time to time have shared that story with others.

As some of you know, this past September, I attended the Southern Comfort Conference where for the past three years I have presented my workshop and The World Professional Association of Transgender Health International Symposium. What a once in a lifetime experience that was for me! I met so many wonderful people, many I have only read about and never dreamed I would have the opportunity to meet.

After the morning workshop on Saturday, I was walking around feeling a bit alone and shy as I often do in new situations and found myself within speaking distance with Marsha. She now sits on the WPATH Board of Directors. Now, this was one of this OMG!! experiences for me! I just had to meet her and tell her what that experience so many years ago meant to me and thank her for that!

In talking to her, I became emotional and I could see that what I had said had touched her as well, just as I had been touched by her generosity with a few minutes of her time so long time ago. Then, the highlight of the conference for me and one of the highlights of my life was that she invited me to have lunch with her! WOW! That was such a wonderful experience. I'll never forget that.

You know, life is pretty short. We never know what little act of kindness, something we wouldn't think twice about doing, will have a profound impact on someone else's life. I think it's really important to let those people who touched your life in a meaningful way know what they have meant to you when that opportunity comes. You never know if you might ever have that opportunity again. It's always gratifying to be able to make someone else aware that they are appreciated for the things they do that makes things just a little bit better for others when the opportunity presents itself.

Practicing What I Preach: My Life With the WPATH SOC

I'm sure that some people must imagine that because I am a therapist that I can scoot around the Standards of Care and get what I want using my professional connections with other professionals who work with trans people, but I don't believe that would be in my best interest for my own health care. So I abide with the Standards of Care in my own life. Would you want to have open heart surgery by a doctor who didn't have a standard of care for that procedure?

I have been an advocate for the Standards of Care long before I became a member of WPATH. I know that some people deeply resent the existence of a standard of care and being required to follow a process. Consider this though; The National Center For Transgender Equality (Transequality.org)  and The National Gay and Lesbian Task Force commissioned a survey that reported a number of terribly sad statistics of what many of us have experienced, some things I have personally experienced over the years. 41% of trans people who were surveyed had attempted suicide at least once as opposed to the general public whose rate of attempted suicide is only 1.6%. For those of us who are unemployed, lost a job due to discrimination, or have been forced into sex work, the rates are much higher and for people of color the attempted suicide is 49%. I find these rates appalling and unacceptable.

Addiction and substance abuse are also terrible problems for us. 70% of the survey reported current problems with substances overall. 3% have been denied access to substance abuse treatment programs and 4% have experienced mistreatment while participating in substance abuse treatment programs. As a professional who also has spent a significant part of my practice in substance abuse treatment, I recognize that it can be absolutely crucial to catch a person at the moment they are willing to get into treatment or that moment will be lost and not come around for quite a long time, if ever. If you miss that opportunity, it could literally be fatal. 25% experienced either denial of care or being treated poorly by doctors' offices or hospitals and 16% were denied help or were mistreated in emergency rooms. 12% reported denial of help or were mistreated in mental health clinics. Simply unacceptable.

Another reason to seek out healthcare professionals who use the framework of the Standards of Care is because of the discrimination we face from healthcare professionals which bothers me quite a bit both personally and especially as a health care professional.  Professionals who use the standards to guide practice will likely have a network of local health care providers who can be sure that you have equal access and are treated with the dignity any person is due.

Half of us report we have had to educate health care professionals on our needs and how to treat us. Fortunately, there is a national effort directed by the National Institutes of care to educate the health care community to provide us with competent care. Having WPATH's Standard of Care, provides health care professionals a quick way to get up to speed on how to work with trans people.

One of the pitfalls that some health care professionals fall into is solely relying on the standards and not tailoring them to the needs of the individual. The SOC clearly state that they are not to be rigidly used and state they are a guide to practice. They were not meant to be followed by rote with each patient. Often in the beginning of the learning curve, a professional will tend to rely on them more often ver batim, but as experience is gained the professional often feels more comfortable in relying on their own clinical judgement. I think that I would prefer a practioner who followed them as written rather than practicing in ignorance and possibly making a serious mistake in my own care.

SO all in all, I think having the WPATH SOC benefits us and that is why I use them personally and professionally.

Little Things Make a Difference in My Life

In daily life, I, like most women like me, sometimes wonder in the back of my head if I'm really being accepted in public as any other woman, or are people reading me as a transwoman and being polite. At this point, I'm very comfortable with daily activities. I go shopping for clothes, go to the grocery store, now have a church I feel comfortable attending and am welcome to be there by congregation. That was a huge milestone for me in my comfort in public as well as in feeling accepted by others.

Over the last three weeks, I have had a couple of experiences that tell me that I am making progress in being seen as just another woman, which is what I see as my goal in the transition process. What has happened is that twice now I have been asked by another woman for assistance. The first time I was on my way into the grocery store and a woman stopped me and asked me if I could look at her receipt from the grocery store. She was concerned that she had paid too much for an item that was on a buy one get one free special. I explained that usually you only get charged half price for one item, but she had been charged a little over half, maybe three quarters. She was asking if I thought she should ask the managers about it, as if she was going to have to pay that much, she would go back and get the second item in that case.

Now being a Social Worker by profession, I just have that natural urge to help people. I guess it's like a pointer who hunts birds (No smart remarks PLEASE!!!! LOL!) So, naturally it gives me a good feeling to be able to do something, even if it is a little thing like that for someone else. But being able to do that little helpful thing gave me so much more. I felt accepted as just another woman!

The day before yesterday, I went to see my doctor for a horrible case of bronchitis I'm dealing with and then had to drop off a prescription. Now Walmart is always a mixed bag for me. On the one hand, I get all my HRT prescriptions there and they cost me a lot less because my insurance doesn't cover it. Two out of three of my prescriptions are on the $4.00 list. Ironically, because my insurance won't cover me for those, I save a dollar on two of them because it's a dollar less than my normal copay! What a little twist that turned out to be, in my favor for once!!

Otherwise, Walmart pharmacy has been a pain to deal with for some other reasons. I really don't like the long lines and the waiting. I also had one of the very few unpleasant experiences there during my transition interacting with their staff at the beginning of my relationship with that pharmacy. But, we got that straightened out and things have been ok with them since then. I can forgive and move on. Still, it's not the most convenient place to get my presciptions.

Dr. Laura Jean had called in my antibiotic to Walmart since it was closest. I was feeling very poorly and knew it would be a little while, so I went grocery shopping. That took about 45 minutes and then I went to Walmart (Here in the sunny south we call it "Walmarts" or if we go to Kmart it's pronounced "Kmarts". I don't know why, it just is!). After the perfunctory long wait, I learned it would be another 45 minutes, so I left and went to Books a Million to hang out.

When I got back, on my way in I noticed a woman in a handicapped parking spot and she was on oxygen. She called out to me and I went over. She was struggling to change out an oxygen bottle. She was literally crammed in her car with all her groceries and I wondered how she would ever get all those groceries into her home without a lot of physically agony from oxygen starvation. She asked me to change out her bottle for her. I told her that I worked in the medical field and knew how to do this. It's pretty easy actually and I've done hundreds of them over the years. So I was able to help her out and she was very grateful for my help.

But it was really me who got the help! I got another affirmation that people look at me as just another woman out there taking care of her daily business. To me, these two women gave me something more than I gave them. They gave me confidence that I can lead a regular life and be seen as who I see myself; another woman leading her life in an ordinary everyday way.

Were you exposed to D.E.S?

Were you born between between 1938 and 1971? I was. Chances are good that your mother was administered a powerful synthetic estrogen either by prescription to prevent miscarriage or in prenatal vitamins that were not sold only by prescription. As a result, an estimated 5-10 million pregnant women and the children born of these pregnancies were exposed to DES. Physicians prescribed DES to pregnant women on the theory that miscarriages and premature births occurred because some pregnant women did not produce enough estrogen naturally. At the time, physicians thought DES was safe and would prevent miscarriages and pre-term (early) births. In 1953, published research showed that DES did not prevent miscarriages or premature births. However, DES continued to be prescribed until 1971. In that year, the Food and Drug Administration (FDA) issued a Drug Bulletin advising physicians to stop prescribing DES to pregnant women. The FDA warning was based on a study published in 1971 that identified DES as a cause of a rare vaginal cancer (clear cell adenoma) in girls and young women who had been exposed to DES before birth (in the womb).

In 1985, the Center for Disease Control turned it's attention to DES sons and the problems they are experiencing as a result of in utero exposure. Frequently observed consequences include testicular hydroceles ( fluid filled cysts in the testicles), Vericoceles (abnormally formed blood vessels that supply the testicles) and epididymal cysts ( cysts on the cords that conduct sperm from the testicles), infertility, poor semen qualtity, undescended testicles, micropenis and higher rates of transsexualism than would be expected for the general public. It should be stated though that there are no accurate statistics on the true numbers of transsexuals. Figures such as 5: 30k have been bantered about, but in my own anecdotal clinical experience, my guess is probably as high as 10% of the population. I base that on the fact that I practice in a very rural environment and my patients come to see me in about a 4 hour driving radius that includes most of Virginia, and a large portion of West Virginia. I've seen about 250 individuals over the last 15 years. That's quite a few folks! Consider the stigma, guilt and shame that transsexual people experience who may have lived with a dark and shameful secret (their perception) and never breathed a work to anyone about it. My opinion is that there are as many of us as there are gay folks.

So with all that said, there is a good chance that you may have been exposed and not know it. Many women were prescribed this drug or took it in their prenatal vitamins. How many women took DES and the over the counter prenatal vitamins that contained DES? Many women do not recall if they took it or not and if it was included in the formulary of their prenatal vitamins, they would most likely be clueless about that.

So with that in mind, our friendly friends at the CDC have come up with a screening test that you can take at www.cdc.gov/des/consumers/guide/assessment.html. This self assessment can tell you whether you are at high risk to having been exposed. Turns out that I am one of the high risk folks. Of course, I am always trying to figure out the "whys" about myself. It's just an academic pursuit to understand myself and how I came to be a transsexual. In the long run, "I am what I am and that's all that I am", as Popeye the Sailor Man used to say. Reductionism seems futile.

You can find more information about DES sons and support groups at www.desaction.org/dessons.htm and www.antijen.org/transadvocate/id28.html, plus a whole lot more if you do a seach under DES SONS.

I'm curious about how many of us are DES sons. Take the assesssment and let me know, I'd be interested!

Harry Benjamin, Robert Stoller, Richard Green and John Money

I started reading these books back in 1968 or 69. I already knew who I was; a transsexual. Benjamin's book came out in 1966, Then Robert Stoller was next in 1968 and Green and Money in 1969. Those were the first "BIG FOUR" in the field; I think after Benjamin, who advocated biological determinants, is where the wheels started coming off the bus, slowly at first and then it took a radical wrong turn with Money, which is a very strange story.

With Stoller, the etiology of transsexual being due to a psychoanalytic disturbance began to creep into the discussion. Psychoanalytic theory or Object Relations as it is more often practiced today, views us as deeply disturbed, severely personality disordered and deviant. You do not see that kind of language with Benjamin, except in the sense that it is an anomalous, statistically significant rarity. Psychoanalytic theory blames the maternal relationship for just about every problem under the sun from schizophrenia to transsexualism and all sorts of other mental maladies. Psychoanalytic theory is based on mythology and that the powers of myths describe human conflicts which are why Psychoanalysis is such an arcane practice. We do have to note that the Greek and Roman mythology was created as an explanation of human behavior which makes psychoanalysis of value.

Things get worse with John Money, a Feminist. He fully ascribed to Social Learning theory of personality development and this is where feminism chimes in. They believed in John Locke's idea of Tabula Rasa: the mind is a blank slate and you can take a baby regardless of biological potential and raise it to be anything, doctor, banker, lawyer, male, female, whatever; all by environmental determinations. Biology plays no role in this and there is Money's infamous destruction of one child's life that he had recommended to reassigned female after a terribly tragic circumcision accident that destroyed his penis. That was passed off as a great success for so many years until the truth came out after that poor person suicided. Money advocated the promotion of pornography and suggested that pedophilia was not necessarily an unhealthy practice.

 Feminists believe the same thing about social learning as did Money. They believe that much of feminine behavior is societally enforced through a coercive patriarchy. They believe that women who are traditionally feminine and take more traditional roles are sell outs to the patriarchy.

There is a hierarchy of science: Physics, Chemistry, biology, Psychology and Sociology, Economics and Political science. You can see where things stand from that hierarchy. Psychoanalysis tends to be a blend of psychology and sociological theory.

BTW, 1:500 males have Klinefelter's mosaic which a portion of cells are XY and a portion of cells are XXY in various proportions. This is usually discovered in men who are infertile and they have a higher rate of transsexualism than XY males. Of course there are the more severe cases of Andorgen Insensitivity Disorder, Congenital Adrenal Hyperplasia and questions about other more subtle brain changes due to hormonal washing at different times in life.

As we become more sophisticated in neurophysiology, I think more will be learned that Transsexualism is by and large a biological condition and not as a result of any social learning theory.

                   

Hello, I'm Sherri Lynne

Hi! I'm Sherri Lynne. I'm a psychotherapist and I am a transsexual. I am a Clinical Social Worker and hold the Diplomate, the highest credential in my field. Although I do many other kinds of therapy, I am a gender specialist, scholar and educator. I am engaged in one of the largest gender programs in Virginia which I created. I've developed a comprehensive program that includes my services as a psychotherapist, a psychiatrist who writes my second opinion letters, aesthetic dermatology, primary care, hormonal reassignment specialists and in January we will be offering voice therapy. All but the services I have offered and HRT (Hormonal Reassignment Therapy) have been initiated in the last two years, so my program is extremely dynamic and represents the state of the art of transgender care. I maintain relationships with a number of surgeons who perform surgical gender reassignment around the country and in Canada.

Over the past three years I have been giving workshops all over the eastern U.S. at transgender conferences and at Universities, some for continuing education credits for mental health professionals. Recently I founded a consulting business, E.I.T.C. (Excellence in Transgender Care), whose mission is to help build comprehensive health care systems that will provide competent and compassionate care. E.I.T.C. also is involved in providing professional education opportunities. I am a member of the World Professional Association of Transgender Health.

I do stay busy! I am also writing a professional text from the perspective of a transgender person who is also a psychotherapist. My goal is to write a book that is accessible to the general public but is informative for mental health professionals as well as practical. I hope it will also lend insights to professionals on what it is like to live at odds in the mind-body continuum and how to apply the WPATH standards of care in the spirit to which they are intended, not as a rigid set of rules that must be followed by rote, as explicitly stated in the SOC.

So, I hope that you will find my blog interesting, informative and thought provoking. I look forward to getting to know my readers and learn from you all as well!

Sherri Lynne