Translate this blog.

Sunday, December 29, 2013

Quack! Quack! The Ducks Attack! (Or Were They Attacked??)

Here in the United States, the end of the year "Great Controversy" has been the remarks of the head of a family featured on a popular American "reality show". Reality Show, what a concept! I mean, REALLY??! I've never seen one yet that had anything to do with reality.

The most popular show of this genre in the U.S. is called Duck Dynasty. It is run on a network known as A&E. Its about a family in Louisiana who is passionate about duck hunting and they make their living through a family owned business that makes high quality duck calls.

The present crisis du jour began when the patriarch of the family, Phil Robertson, was interviewed by a widely followed men's magazine here in the U.S. called GQ (Gentleman's Quarterly as it was formerly known). Mr. Robertson is a fundamentalist Christian and he voiced the opinion that homosexual behavior is sinful. He did not state in anyway that gay people should be persecuted, victimized or harmed in any way. The worst that could be said, in my opinion was that he might have been less graphic about sexual acts that homosexual men engage in, but he never advocated any mistreatment or abuse of homosexuals because of their sexual orientation.

His understanding of Christianity is quite literal. He publically endorses a literal interpretation of the Bible and it's proclamation of law. In my opinion, it is the interpretation of an immature Christian. Here is why I believe this: Jesus came to bring us the New Law and the covenant that he brought is a new covenant, much different from the one brought to us in the Old Testament. Mr. Robertson's comments give no indication to any appreciation of the history of the tribe of Israel and the cultural context in which Old Testament scripture was written. Some of what was written had to do with preserving and strengthening the tribe of Israel. Some of what was written had to do with health and hygiene in a time with little understanding of what caused disease. People of that time often thought of states of illness as being the result of sin and Devine retribution.

Some of my comments will address in a cursory manner some of the insights that Mr. Robertson does not seem to understand.

Jesus never made a comment about homosexuals that was recorded in the Bible. (Paul did). However we are told in the New Testament by Paul that eunuchs (the term used for transsexual people, among others who castrated themselves either voluntarily or involuntarily, had a place in Heaven.

In the Old Testament in the same book of law (Deuteronomy), besides a proscription against homosexual relationships and wearing the clothing of the other gender, one must not eat shellfish (Sorry Phil, there go your crawdads (crayfish)!! You must have a rail around your roof (Don't think I saw one on yours, Phil). One must not wear garments of two different fabrics combined among others that I don't think he follows, nor do I. I'm pretty certain that Phil enjoys a good pulled pork bar b que, as well do I. Strictly forbidden in the Old Testament.

Mr. Robertson's shortcoming, in my opinion is this literal interpretation of the Bible. There is no insight into why these scriptures were written. In those days, homosexual sex was frequently associated with sexually transmitted diseases. Today we have more hygienic conditions that allow us to prevent those diseases if people are responsible enough to take the precautions to do so.

The same was true of the proscriptions of certain kinds of foods. Pork carried trichinosis and can anybody really believe that eating shellfish in the middle of the desert after having no source of refrigeration to be anything but a prescription for disaster?

Why did you need to have a rail around your roof? Because it was common for visitors or itinerant people to have been offered a place to sleep on the roof of the house, particularly during the hot summers.

The proscription of wearing garments of the other gender had to do with the customs of worship of the tribes that worshipped Baal. In their fertility rites, priests and priestesses exchanged garments as a part of their religious services in the spring.

The tribe of Israel was small and surrounded by enemies. They did not want people of their tribe wandering over to become worshippers of Baal and they needed their members to have many children to build the numbers and the strength of the tribe of Israel. Gay couples were not going to be able to contribute to that effort. These legalisms have nothing to do with our world today.

Recently GLAAD labeled what Mr. Robertson said about homosexual behavior as hate speech and demanded that he be censored for his remarks. The network A&E made a predictable knee jerk response making a gesture of "suspending" Phil Robertson from the show while recording was on hiatus for the holidays. Then they chose to run a marathon of episodes that included him over the holidays and when filming begins again in January, he will continue to be featured on the show.

I find fault with GLAAD for trying to label what I consider free speech to be hate speech. If what he said was to be considered hate speech, I believe he would have had to advocated violence or advocated some form of violence or deprivation of individual civil rights because of someone's sexual orientation and in fact this was not the case.

One could make the argument that GLAAD engaged in hate speech against Phil Robertson if one wanted to use the same logic that GLAAD did in their attack on Mr. Robertson. In truth, I believe neither case to be true. Mr. Robertson has his opinion (I think he is wrong) and GLAAD has their opinion ( I think they are wrong, too).

If we continue in this climate, I think each side will continue to further alienate the other. Responding to people we don't agree with by inflammatory attacks will do nothing to improve acceptance between people who have differences. It would have been much more helpful for GLAAD to say that they disagreed with Mr. Robertson and lay out a factual argument based on their disagreement, rather than lay out an attack on him as a person. It is always better to win with a persuasive argument than by attacking your opponent. All GLAAD managed to do was to emotionally entrench Evangelical Christians in their beliefs due to an ill advised strategy to respond to Mr. Robertson's personal beliefs.

Now I have no illusions that Mr. Robertson would be accepting of me as a transsexual from his religious views. I'm sure that he would believe that I am living a sinful life for simply being who I am. That is no consequence to me for two reasons. I don't believe that Mr. Robertson means me any personal harm, wants to deprive me of my civil liberties or would in any other way wish to see anything bad happen to me. He espouses the doctrine of "hate the sin, but love the sinner".

Secondly, In my own Christian walk, I don't believe that I am sinning. He and I both believe that salvation rests between each person and God. It is not for someone else to judge. While I am sure Mr. Robertson thinks my life is sinful, I have not heard him presume to judge the status of my salvation.

A&E, however, is the real villain in this whole sad and sorry episode. They initially pandered to the militant gay community. Then they sold them out for the almighty dollar. They have no courage of their conviction. They only want to make money. I doubt they ever had any intention rather than to placate the militant gay community and ensure they didn't lose their #1 money making show. How sad is that? Rather pathetic, I think.

Monday, December 23, 2013

Christmas 2013

"Oh holy night!
The stars are brightly shining
It is the night of the dear Savior's birth!
Long lay the world in sin and error pining
Till he appeared and the soul felt its worth.
A thrill of hope the weary world rejoices
For yonder breaks a new and glorious morn!
   Fall on your knees
Oh hear the angel voices
Oh night divine
Oh night when Christ was born
Oh night divine
Oh night divine

Led by the light of Faith serenely beaming
With glowing hearts by His cradle we stand
So led by light of a star sweetly gleaming
Here come the wise men from Orient land
The King of Kings lay thus in lowly manger
In all our trials born to be our friend

Truly He taught us to love one another
His law is love and His gospel is peace
Chains shall He break for the slave is our brother
And in His name all oppression shall cease
Sweet hymns of joy in grateful chorus raise we,
Let all within us praise His holy name"

Lord, please forgive my trespasses and grant me the grace and strength to forgive those who have trespassed against me.

I am truly blessed and please help me to never forget the blessings you have granted me throughout my life and giving me the strength to come to where I am today in my life. Please help me to remember to always be humble and know that all I have been given is a gift from You as you found me to be acceptable and worthy long before I was able to accept that truth in my life.

I pray this in thy Son's name, Jesus Christ my Lord,


Thursday, November 28, 2013

Thanksgiving 2013

Although I have had many extremely unhappy Thanksgivings in my life, this day has always been my favorite holiday because of the traditional meaning of the day. It is a reflection of my profound faith as a Christian and it is the time of year, along with Christmas where I am focused on the many things I have to be thankful for and not thinking of the difficult things I have come to terms with that have happened in recent years.

When I write my articles, I try to write them for you: the people who read them. I only write about personal things when I think there is benefit by sharing my privacy with you. Then again, what I write I want to be interesting to you as well. As I share the things that I am grateful for, I am aware that this might not be so interesting to you, but I hope the thought that even under difficult circumstances that you might be experiencing, no matter how sad or painful, we do have things to be thankful for and when we remember those things, it makes the difficult things easier to bear.

Most of all, I am thankful for my wife Patty. I am very blessed that she has chosen to remain with me through my transition. Many, if not most marriages do not survive transition. I know that my decision to transition was and continues at times to be painful for her. Through it all she has chosen to stay with me and I am so thankful for that.

I’m also thankful that I found Dana to be my therapist. She is very gifted and guided me through my transitioned. She asked the hard questions and threw up every possible or potential roadblock or challenge I had to overcome and it resulted in my decision to transition with no regret. She helped me to finally put to rest past traumas and they don’t bother me anymore for the first time I can recall in many years. She “held my hand” when I was afraid and helped me find my courage to do what I needed to do to be happy. Thank you so much for all you did to help me, Dana.

I’m thankful for my dog Jack the bipolar beagle and my cats Taffy, Callie Sue and Jill. I’m especially thankful to still have Taffy who was diagnosed with cancer a year and a half ago. He is still happy and active and is not in any pain. He is very special to me as he “picked” me as a kitten. He was a stray I found down at the country store. He was one of a litter of kittens down there. He wouldn’t have anything to do with anybody and no one could catch him, I was told. For some reason he came running up to me and he has always loved me best. Yellow cats are special, indeed!

I’m thankful for having a home and plenty of food to eat. There was a time when I didn’t have enough, though I can’t say I was starving, but I definitely was hungry a lot of the time and there was even a short period of time when I was homeless in a new city through my own stupid decision making. Sometimes it takes not having enough to eat and not having a place to live to make you remember to always be thankful for and never take for granted something as simple as having enough food and a home.

Even though at work we no longer get raises based on performance and no longer get cost of living increases in our wages, I am very grateful to have a job in my chosen career. This may not be true in the future with the coming of Obamacare when specialized care will become less available and strictly rationed as in other countries with socialized medicine that I read about, but that is not happening to me at the moment. Rather than worry about that day coming, I choose to be thankful for what I have today.

I’m thankful for my health and the health care providers I work with who take care of me and keep me well. I know they respect me and I am treated with the dignity I deserve.

I’m thankful that I had the opportunity and access to higher education. For any of us who are transsexual, education, whether academic or vocational in nature is the key to preventing many of the horrible things that happens to some of us.

While this may be difficult for some of you to understand, I am thankful for my father’s passing away peacefully last year three days after Christmas. He had suffered a great deal over the past two years of his life and spent most of it, especially in the last year, either in the hospital or in rehabilitation facilities when he would have preferred to be home. I miss him so much, but I also grieved for him a lot over the last two years and in his death I found relief from my own grief. He is at peace and home with God. He was a man of strong faith and it is the most important gift he gave to me as a child.

I’m thankful to have a very rich spiritual life; my faith in God has carried me through all of this, in good times and in difficult times.

Even though I hate winter and cold weather, along with the long dark nights, I am thankful for winter because without it I would not appreciate the beauty of spring, the warm long summer days and the beauty of autumn.

I know that some of you who read this are going through some difficult or even terrible times. I hope that this might be a small gift in some way and that it will encourage you to remember things that you have in your life that you can be grateful and thankful for, even if it is some of the little things you might not think about on a day to day basis and that will make today a little bit better for you.

Wednesday, November 20, 2013

Judge Not, Lest Ye Be Judged: Is it Possible You Might be Cisphobic?

I had an experience this past week that I would like to share with you. It does not reflect the best of me, though it turned out well. I think the lesson I took from this is one I would like to share because we can all benefit from it. It is a lesson that has been profoundly repeated at least weekly, if not almost daily since I made the decision to complete my transition over the past 6 years or so. It occurs so frequently now that in many ways I have begun to take it for granted. It is the more poignant examples that I now find to be emotionally moving.

There is another type of bias and prejudice that I have described in vague ways. It is something that we must search within ourselves and sit in judgment of ourselves. It is a form of oppression of the worst kind. It is oppression of the self and it is called CISPHOBIA. It occurs when we expect cisgendered people to discriminate against us, hate us, or perpetrate violence against us with no basis for that expectation. It is rarely discussed and even more rarely described.

Do cisgendered people at times discriminate and publically express hatred towards us, even to the point of having perpetrated violence against us solely for the reason we are transgendered? That is an unequivocal YES. It is the legacy that I grew up with, the same type of virulent hatred also characterized by racism and homophobia, however we must also recognize the tremendous advances our society has made in accepting us and recognizing our right to participate openly in a free and just society with respect to our Constitutional rights. There is, however much that remains to be done to further the progress we all have made. That progress benefits cisgendered people as well as transgendered people.

Incumbent upon us is that we also reflect and identify those areas of potential and/ or unrecognized cisphobia that impair our ability to experience a fully free and self actualized life. It is also incumbent to make necessary changes in our own personal attitudes when necessary to eliminate cisphobia in our lives.

The example I would like to share with you involves a former patient of mine who I had not worked with for about two years. Quite frankly, the experience of informing all of my current patients that I was transitioning, while very successful (I retained over 97% of my patients), was also very stressful, at times exhausting, and it was an experience that I am glad is over. On occasion, I still have to disclose to a former patient who is insistent about wanting to work with me. I don't look forward to the times I have to do this. I just want to live my life without having to review the past, but in my choice of work, that is not always possible. Here is where the problem arises and it is where I have personally struggled with an area of cisphobia.

This patient came to the office two weeks ago, unaware that I had transitioned. He had asked to see me for a few minutes, but because of the unanticipated nature of the visit and that I had already seen 9 patients with a serious crisis patient in the afternoon I was not prepared to deal with the situation.

My thoughts were that due factors of his cultural background, his religious background and his personality that there was no way that he would be accepting. In other words, I made a cisphobic judgement about him. It turns out that I was grossly unfair to this gentleman.

The front office staff did an admirable job handling the situation. They began to try to explain without discussing my transition that I (my former male self) was no longer there. Out of genuine concern and care, he pressed them to tell himwhat happened to me as he was clearly worried that something tragic had befallen me. So they explained in simple terms that I had undergone a gender transition. His response to them was that it did not matter a bit to him and that he felt that because of the work I had done with him that I had saved his life. (No I didn't save his life, I was simply the tool he chose to use to save his own life).

The front desk staff relayed this information back to me and I asked that he come by on another occasion. It had indeed been a very long day and I was tired.

Yesterday my patient had an appointment with me and saw me for the first time. The first order of business was to apologize to him for my misjudgment. He graciously told me that no apology was necessary, but I insisted that I had been wrong, apologized to him again and thanked him for his acceptance of me.

In the past, I have seen opinions expressed that people who are oppressed cannot be oppressors themselves because of their oppressed status. I have always sharply disagreed with that opinion. By the act of being bigoted, prejudiced or biased against people, whether they are members of an oppressed class of people, or by the act of being bigoted, prejudiced or biased against people who are members of a class of people who have been oppressive towards another class, we perpetrate the impedance of societal progress. We injure those we have unfairly judged. We injure ourselves by depriving ourselves of the opportunity to take advantage of the progress we have made as a society. We slow the process and the progress of our own full integration into society.

Now I am someone who believes I am fully assimilated in daily life; I do not fear going to the ladies room, using the ladies dressing room in stores, nor do I fear an encounter with the police, going through TSA when I travel or interact in any way with the predominant culture. I generally don't see myself as a person who is cisphobic, but there are these areas of cisphobia that apparently do exist in my life.

It is my hope, through my own personal growth in this area and by bringing this potential problem to the attention of other transgendered people that we can do our part to make our society a more free and open society.

Tuesday, November 5, 2013

Ain't That America?

Today was a day that made me proud to be an American! We hear so many stories about how awful our country is and how we as people of trans experience are hated and driven to despair. That isn't always the case and we need to focus on positive things. We can overcome adversity and we can have happy, fulfilling lives!

Today, I had a very positive experience interviewing with the Veteran's Administration for a job that has a lot of opportunity for advancement. The five people who interviewed me were all very positive and seemed interested in my experience and skills as a Social Worker. They informed me that I was a finalist for the position and they indicated that they would be in touch no later than the first of next week about the position.

Then I went to vote. It was the first time I ever voted as Lauren, here where I have lived a male life out in rural Virginia since 1992. I grew up here before leaving for college and grad school.

It was a very comfortable experience. There were no challenges to my right to vote and the election officials were very polite and professional.

The world is a much better place for us, even as recently as twenty years ago. I live in one of the most conservative (both politically and religiously) areas in the U.S. here in the Shenandoah Valley.

If I can do it, so can you! Yes, there have been obstacles along the way. My biggest obstacle was my own fear.

I hope that you will follow your dreams and become the best you that you can be!

Wednesday, October 9, 2013

Sage Smith is Still Missing!

DaShad Laquinn Smith 2

Sage Smith continues to remain missing since December of 2012. Two other young women who have gone missing since then may be vindicated by a recent arrest of a man from this area (Charlottesville, Virginia) but Sage's suspected assailant who was identified, Erik McFadden who is from Minnesota and met her on Facebook, remains at large. He came to Charlottesville to meet her and was seen with her at the local Amtrak station, and has not been seen since an initial interview by police who named him as a "person of interest", but was allowed to leave and has not been heard of since.

My belief is that if she were a cis gendered woman and not a transsexual woman, and if she were not a woman of color, more effort would have been brought to bear in apprehending her perpetrator. Much unlike the effort focused on recent cases of missing women who were murdered or not found to date.

If anyone has heard of Erik McFadden, come across him on social media as someone who is attracted to transsexual women, please contact the Charlottesville, Virginia Police.

Please join me in prayers for Sage and if, by a miracle, you read this and happen to have even the tiniest shred of information that might be helpful in solving this missing person case, please call the Charlottesville, Virginia Police at 434-977-4000

Friday, October 4, 2013

Prequel: Gathering information for an article I am writing on Transsexual Regretters

This discussion will tie into something I've recently taken an interest in and am writing an article about; transsexual regretters. What role, if any, does the  informed consent model contribute to the rate of transsexual regretters? I am looking at statistical outcomes for my article. If 5% of people who have come to regret their decision to transition and have grs, that becomes significant and can become an argument against informed consent, or even providing the means to have access to HRT and GRS via WPATH SOC.
Do you believe this is a significant issue? To be honest, and in the interest of full disclosure, I advocate for the WPATH SOC and am a member of WPATH.  I am a psychotherapist who is post transition and pre op. I have chosen to adhere to the SOC despite having the means to circumvent the process because I believe that WPATH's SOC is a reasonable and thoughtful approach for people coping with our issues. I am, however very open to other points of view. I don't believe I have the lock on what is "correct" or "right".
When I look at the recent study by NCTE and their statistics on substance abuse, poverty, victimization and attempted suicide rates (> 30%) which are magnitudes above the general population, then read what those who regret transitioning and their perspectives, I recognize that something significant has occurred and there seem to be far too many who think they made a terrible mistake.

Many of those who regret their decision to transition do not take much personal responsibility for their tragic regrets. They indict a system that allows almost no review in the process they undertake and see tragedy as a result.

Others rail against any kind of system that compels a person to engage in a process of examining their motives and potential for poor or disastrous outcomes in the hopes that system will provide better outcomes for those who transition from a biopsychosocial perspective.

I am exploring why those who regret their choices are so vocal in opposition to allowing others to proceed in this process and why whatever decisions they made to transition ended in such tragic results.

There are no clear compelling arguments for the extremes of each position here. What is your opinion?

Friday, September 20, 2013

Gender Dysphoria, Transphobia and Post Traumatic Stress Disorder

Having written on the topics of gender dysphoria, transphobia and posttraumatic stress disorder, I would like to explore how they all interact with each other to negatively impact the lives of transgender people.

 I have experienced my life as a transsexual woman, observed and facilitated the process of well over 450 trans people's experience as a therapist. I have worked with individuals across the developmental life span over quite a dynamic time in the lives of trans people from the late 1950's to this time in history. I have been afforded the opportunity to experience both my private experience, echoed in my clinical work with people who have sought me out to help them find their unique path in expressing their gender identity with a sense of congruence.

Most have transitioned socially; some have completed their goal of gender reassignment surgery, while others have found a middle ground that they can be comfortable with and a few chose not to transition at all, usually because of relationships that they cherish and are not willing to lose. Despite the pain of living in a compromised manner, they have found a place where they can be their true selves to a degree that is manageable.

There have been a few who could not transition at all, instead choosing to suffer secretly or they were not candidates to transition due to medical reasons. There are also a very few who have experienced gender identity conflicts that are not clearly transsexual and come to find that hormonal reassignment is not right for them nor would transitioning to a different gender social role bring them a sense of comfort and peace or be a solution for their lives.

In almost all cases of these individuals, myself included, the forces of institutionalized transphobia, internalized transphobia and social stigmatization have played a role in the marked emotional distress they have experienced. In most cases, these social and emotional forces have resulted in various degrees of Post Traumatic Stress Disorder. Some people's experiences of being traumatized have been mild and easily resolved through treatment with the use of medications and with psychotherapy, or by simply transitioning and  there are others  who were severely traumatized and have been left with life long significant impairment and disability in their social functioning despite their decision to transition.

I spent some time working with Viet Nam Veterans (God Bless you and thank you for serving our country at such great personal sacrifice in so many ways), learning from more experienced therapists in that field that one common predictor of how a combat veteran would fare psychologically had a great deal to do with their pre combat adjustment.

Soldiers who grew up in stable family environments with two parent households where the children were well cared for and free of physical, emotional, and sexual abuse and did not have addictions to alcohol or drugs fared much better than those where were victimized as children, had unstable households and came from broken homes. Now this is not true of any given individual situation. Some combat veterans were also biologically more resilient to extreme distress, but these factors have had a great deal of prognostic value in predicting outcomes. I believe that the same parameters operate in the lives of people with a cross gender identity as well.  These same parameters seem to have a great deal of value in determining who will experience greater trauma as a result of having a transsexual identity as opposed to those who will be able to manage the experience and have happier, better outcomes.

In Western cultures, we have seen a profound sea change in the degree that institutionalized and internalized transphobia has decreased over the past 50 years and particularly since the mid to late 1990s . In turn, I have seen better emotional and functional outcomes in young adults as opposed to people of my generation.

Indeed, the cultural changes we have experienced since then were instrumental in my own ability to come to terms with my own identity and complete my transition over the past 5 and a half years. I simply wasn't able to see a way through prior to the mid 1990's to become socially the girl and then the woman I have always experienced myself to be.

In the context of my culture's views of people like myself, which were internalized from the time of my recognition of my identity as a small child, this was simply unacceptable to myself and the culture I grew up in. Yes, there were a few people who were emotionally strong enough to do what I yearned to do from such a young age, but they were thought to be so rare that there was no way the majority of people like me could even comprehend becoming who we truly were, so I and most of my transsexual peers lived silent, tortured and desperate lives.

It is because of the process of stigmatization; the process of internalizing institutional (or cultural) transphobia that we have such high rates of suicide, addiction and alcoholism, as well as being victims of crime that we do in our community. The reason people resort to cope with drugs and alcohol place themselves in situations in which there is an increased risk of victimization and destroy themselves rather than continue to suffer in misery is because they have been traumatized and lack the coping skills to overcome their traumatization.

It is the result of internalizing societal messages that we are unacceptable as members of our society, as well as to ourselves and that we will never be able to participate in life as equals with others who have value and worth.

We come to internalize the idea that we are deviants and do not have the right to participate in life to become the best we can be and we are not worthy of loving others or being loved. As a result we become unable to love and accept ourselves and fall into a state of helplessness and hopelessness. It is a state of despair.  It can become a terminal condition when a person does not see a way to integrate her cross gender identity and see herself as a whole and healthy person worthy of loving and being loved, with value as a member of our culture. It is the result of having a guilt and shame based identity, so common in people with post traumatic stress disorder.

In the taxonomy of human problems that my chosen profession addresses, we have refined the definition of the problem at hand, not as a problem with having an identity that does not match the physical body, but it is that of the distress of the recognition that the physical body habitus is not congruent with our gender identity. (Keep in mind that the diagnostic categories we have created are partly reflections of cultural norms and values.) The problem is two fold. One is the biological conflict we experience psychologically from having a gendered body that is not congruent with our gender identity. The other problem is that we recognize that this is not a state of existence that our society considers within the norm and that we have internalized that value that as a result we are not "normal" and as a result, this recognition is traumatizing.

Therefore, in reality, gender dysphoria is a symptom of having been traumatized. Gender dysphoria is not a disorder; it is a symptom of post traumatic stress disorder. In our next iteration of categorizing and diagnosing mental disorders, we need to find a way of capturing gender dysphoria as a symptom of post traumatic stress disorder and not keep it as a stand alone diagnosis, though we must preserve a way of keeping it as a legitimately recognized source of distress that is a focus of treatment and also a treatment that is reimbursed by health care insurance.

There may be those who object to this being categorized as a symptom of post traumatic stress disorder, but the only other alternative diagnostic category would be under the classification of adjustment disorders.

The migration of these diagnostic categories from a stand alone gender disorder to recognizing it as a trauma disorder or adjustment disorder will be predicated on mitigating institutionalized transphobia and the process of stigmatization that results in internalized transphobia. This will result as our evolving society becomes more and more accepting of transsexuals and other transgendered people.

We have seen this happen with increasing speed in society and as these changes in accepting trans people have come about we have witnessed the changing conceptualizations of how to identify and help people with gender dysphoria in the iterations of the DSM over the years. As society changes, we will continue to see this reflected in future DSM volumes. We will see people markedly less distressed about having a cross gender identity and they will be able to participate fully in the dominant culture without being stigmatized or internalizing a stigmatized identity in our society's future.

Thursday, August 29, 2013

Post Traumatic Stress Disorder and the Transsexual Experience

One of the most frequent features of the vast majority of transsexuals I have worked with in my experience is the extremely high rate of Post Traumatic Stress Disorder symptoms that are common to the vast majority of us. It is also probably the most often overlooked and underdiagnosed problem that is not a focus of treatment. This is an often important aspect of gender dysphoria that has been mostly overlooked. It is not well represented in the literature, nor does it seem to be a frequent consideration for treatment.

Consider the diagnostic criteria of PTSD in DSM V

Criterion A: stressor

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (1 required)
  1. Direct exposure.
  2. Witnessing, in person.
  3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
  4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (1 required)
  1. Recurrent, involuntary, and intrusive memories. Note: Children older than 6 may express this symptom in repetitive play.
  2. Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
  3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
  4. Intense or prolonged distress after exposure to traumatic reminders.
  5. Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event: (1 required)
  1. Trauma-related thoughts or feelings.
  2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event: (2 required)
  1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs).
  2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous.").
  3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
  4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt or shame).
  5. Markedly diminished interest in (pre-traumatic) significant activities.
  6. Feeling alienated from others (e.g., detachment or estrangement).
  7. Constricted affect: persistent inability to experience positive emotions.

Criterion E: alterations in arousal and reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (2 required)
  1. Irritable or aggressive behavior.
  2. Self-destructive or reckless behavior.
  3. Hypervigilance.
  4. Exaggerated startle response.
  5. Problems in concentration.
  6. Sleep disturbance.

Criterion F: duration

Persistence of symptoms (in Criteria B, C, D and E) for more than one month.

Criterion G: functional significance

Significant symptom-related distress or functional impairment (e.g., social, occupational).

Criterion H: attribution

Disturbance is not due to medication, substance use, or other illness.

Specify if: With dissociative symptoms.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
  1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
  2. Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").

Specify if: With delayed expression.

Full diagnosis is not met until at least 6 months after the trauma(s), although onset of symptoms may occur immediately.

Of the over 400 gender dysphoria patients I have seen personally, the majority of them exhibit enough symptoms to justify a diagnosis of PTSD. It is empirical from my practice experience that from the time one realizes one's body's sex does not match their gender identity, this is going to become a severely traumatizing event and the effects of this trauma can have the potential to be profound as a result of not being addressed early in life when the realization of this incongruence manifests itself. The mediating factor in the severity of PTSD appears to be the resiliency of the individual; some people appear to be extremely debilitated by their trauma symptoms and some individuals appear to cope better and minimize to some degree the impact of the trauma of gender dysphoria on their overall quality of life.

DSM V is a major improvement in the conceptualization of what is the focus of treatment in the transsexual individual. The DSM IV- TR diagnosis of Gender Identity Disorder wrongfully conceptualized having a cross gender identityas being a psychological pathology. In fact, it isn't the identity that is pathological at all: its the intense distress at having a cross gender identity. To improve conceptualizing the problem and to this end, DSM V now has the Diagnosis of Gender Dysphoria and I have listed the new criteria here.

Here are the proposed criteria for adults and teenagers for the upcoming DSM-V.

Gender Dysphoria
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2 or more of the following indicators:
  1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]
  2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]
  3. A strong desire for the primary and/or secondary sex characteristics of the other gender
  4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
  5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
  6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)
B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning,  or with a significantly increased risk of suffering, such as distress or disability**
  • With a disorder of sex development [14]
  • Without a disorder of sex development
Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).

Over the years, I, as a mental health professional, and as someone who is a transsexual have struggled with the proper place of transsexualism and gender dysphoria in the pantheon of mental health disorders. To my way of thinking, anything that creates as much distress as the incongruence of one's gender identity being in conflict with one's physical sex rightfully has some place in the DSM and is worthy of being addressed in a manner to relieve that distress. I am also of the mind that it is not one's gender identity that is disordered and that is why I like the move to change the diagnostic nomenclature to Gender Dysphoria. It implies that it is environmental factors, not an innate etiology, that is responsible for our distress, much like the diagnostic category Adjustment Disorder.

This seems straightforward enough and also provides a mechanism to get the services we need to successfully transition. I know that there are many who don't like that descriptor either, but I think it is a step in the right direction and for a condition as obscure as ours, it will take many more years before this is correctly sorted out.

I have come to believe that perhaps many if not all of the symptoms we experience from having a gender identity that does not match our physical body habitus can be better accounted for with the diagnosis of PTSD and that the criteria should be expanded to include symptoms of gender dysphoria. As is true of the degree of gender dysphoria we experience, ranging from mild to severe, so the relative degree of PTSD affects a person differently due to a number of biopsychosocial factors.

I think that one's earliest recognition that their gender identity does not match their physical sex is extremely traumatic and that the experiences we have along the way in attempting to reconcile this most often contribute to life long traumas being experienced for much, if not all of one's life until they are able to facilitate a successful transition. Some people experience this in profound ways which is why there is such a high rate of attempted suicide and addiction as well as other negative outcomes in the members of our population. Even in successful post transitioners, PTSD symptoms can remain debilitating and are a potential point of intervention.

Including symptoms of gender dysphoria under the diagnosis of PTSD will resolve the problems we face trying to get insurance coverage for the services we need to improve our quality of life as PTSD is an accepted diagnosis by the health insurance industry.

Critics may argue that no reference to any gender disorder should be included in the DSM and that it is stigmatizing to individuals. I disagree based on my clinical experience. I have not met anyone who was not distressed by their conflict between their identity and their physical body and have not been helped by facilitating a process in which they can decide and obtain what is necessary to have a quality of life each and every one of us should have.

Some people do not experience any dysphoria over their gender identity and they should not be diagnosed as having a problem that does not exist for them. They are best served by being offered case management to inform them of options available to them for gender transition and to plan for, link to and serve as a coordinator to help the person who is ready to complete their transition or by simply identifying resources to explore on their own.

Whether transgender individuals in emotional distress would be better served with a stand alone diagnosis or whether gender dysphoria should be subsumed under Post Traumatic Stress Disorder is a debate worth having.

What do you think?

Sunday, May 19, 2013

"The Other Side of the Mountain" OR "Today is the First Day of the Rest of Your Life"

Two weeks ago I went to work for the first time as myself for the first time. While I thought that I would be nervous as I got ready, I felt just like I did on any other day. I felt quite content and happy with my decision to transition and was glad that (FINALLY!!) my day had arrived. I would never have to tell another patient that I was intending to transition. I was looking at starting out with a full caseload for the week.

By the end of my period of preparing to transition at work, I had informed over 70 patients of my intention. I am very pleased to report that a little over 96% of the patients that I told either chose to continue to work with me or to begin to work with me. These are important figures because it represents enough data points to be categorized as a large N sample as opposed to a small N sample which makes the 96% more powerful statistically speaking. Using a one tailed T test to analyze the data demonstrates that people from a rural environment in Virginia conclusively are willing to work with a health care professional who is transsexual and transitions on the job. In other words, the results of this data are valid for this geographic area.

Unfortunately, there is no way to test the reliability of this data. In order to do so, I would have to gather another sample of more than 64 patients in order to attempt to replicate the results. I would have to inform them of my transition and I am not willing to do this. My intention from the beginning has been to live my life as a woman, not as a publically trans- identified person. Informing so many people about my transitioning at work has been a quite stressful, but quite manageable experience. I just don't wish to repeat it.  

I think it is notable to report that of the 4% of people who did not wish to work with me, 75% of them were new patients for who I completed an assessment and disclosed my transition at the time of the assessment. There were no differences in the numbers of each gender: two males and two females declined to work with me. Two were fundamentalist Christians, the other two had no particular expressed religious beliefs other than being Christian. The age distribution was not significant. But enough of those dry statistics. Suffice it to say, it is often a better world than we are led to believe.

Despite having a full schedule for the week, on my first day only three patients kept their appointments. As the day wore on and more patients did not show up, I began to think "Oh my God, what the hell have I done?" I was having periods of anxiety and was thinking that the decision to transition at work was the biggest mistake of my life. But then I would think, you've been waiting all your life to do this and my sense of peace and contentment would return. I called the patients who didn't keep their appointments and they rescheduled.

Most of the week this pattern of patients not keeping their appointments continued until Thursday. It was then that I discovered my patients were not getting their reminder calls. While I was off to take care of the necessary legalities involved in my transition, the office staff removed me from the automated system. They had not put the new reminder message into the system by accident. Discovering this oversight was a tremendous relief for me and our staff called my patients individually to remind them of our appointments for Friday and my schedule was full for that day.

Having taken 8 business days off and then not having my patients notified took a toll on my schedule this week as well. It usually drops after returning from a vacation and my patients not being notified for 4 days did not help the situation. But last week my schedule rebounded and I saw almost enough to meet my productivity goal for the week. Next week my schedule is soft and I may be forced to take some time off, but I am confident that it will soon be back to full strength. I feel just as confident and at ease working with my patients as I did before my transition and my patients have all responded positively to my actual transition on the job. The new patients I have seen in the past two weeks seem quite comfortable working with me as well. I am glad for that and grateful to God for being by my side through this part of life's journey.

Before I returned to work, I thought to myself that while my work transition was a monumental personal accomplishment, it is not the destination, nor is my transition complete.

Life itself is a transition. Now I must continue to live and work in a life that feels as congruent outwardly as I experience it inwardly. I can now live my best life with all the joys and sorrows that necessarily come along with the human condition. I have no idea whether life will be easier or harder. It does not matter. My life could become difficult and painful for so many reasons having nothing to do with who I am. Conversely, it can become filled with joy for nothing to do with who I am. That's just the way life is. I am certain that I will experience both the joy and pain of the human condition in the future. I will no longer carry the oppressive burden of not being outwardly who I am inwardly. That brings me a simple sense of comfort and contentment.

While I was off from work, I spent some time in reflection. I spent a lot of time thinking about and writing about the little girl that I was, the little girl that no one knew and I didn't want to be. I had spent so much of my life not wanting to be who I am and not wanting to think about her. I was able to remember a lot of things I had forgotten about her and what she was like. I was able to remember what she was like and the things that she liked and dreamed about and hoped for. That helped me to heal some of the wounds from my past and made me feel much better about who I was when I was little. I can't think of many things sadder than a child who hates herself or an adult who hates the child she was simply for being. I no longer hate that little girl for the simple fact of her being alive. I can see her for who she was with clarity and I can embrace her now as a good and healthy part of who I am. She was who made me someone who is kind and has a lot of compassion for others. She is with me always looking out and seeing the world through my eyes, even when I pretended that she was never there.

There is another thing I knew at some level, but perhaps wasn't always consciously aware of a lot of the time that also became clear just prior to returning to work. It is something I hope that will help you on your own life's journey, no matter where it leads and the experiences you encounter day to day.

Many people don't realize that fear is not the opposite of being brave or having courage. If they experience fear, they often think it means they are cowards, especially if they don't act because of their fear. In reality being brave or having courage has nothing to do with fear. My fear may have gotten in the way of allowing me to become who I am, but it ultimately was an act of courage to be outwardly who I am. While fear may have slowed the process of becoming way down, fear could not defeat the courage to do what I needed to do. Being brave allowed me to act in my own best interest to become outwardly who I am. Ultimately, no amount of fear could have prevented me from what I needed to do for myself.

On your own journey, I hope that you also will find the courage to be true to yourself, despite the sometimes overwhelming fear that comes along with life's journey at its worst moments. Sometimes it takes time to find that courage, but it is there inside you to find.

I have not spent time condemning myself for not having transitioned when I was 18 or 22 or 25 or when I was 36, all ages and at turning points in my life when I seriously considered it. The past is gone. I shall not regret it. It would be a detriment to myself to dwell on it. I prefer to remember all the good things that did happen and while the life I led did not allow me to live outwardly as I am, good things did happen to me and I did good things as well. That allows me to have a sense of peace and acceptance about my past life.

Tomorrow is not promised to me or anyone. I have to live in the present and make the most of today. It is my most sincere wish and hope that you are able to do so as well, no matter what your day to day circumstances may be and never give up your hope. We must be mindful that there is no such thing as perfection. I think that sometimes we have to recognize the incremental progress we make, even if at times we seem to be standing still.  If we sustain our hope, things will improve over time and that belief will carry us from day to day.

Thursday, April 4, 2013

When I Was In Second Grade

When I was in second grade, I found a book called the Box Car Children. It was the story of three children, an older brother and sister, and a younger brother. They had a nice dog too! They had been orphaned and were to go to live with their grandfather. They were afraid of him and didn't want to live with him and ran away. On the edge of a town on an abandoned railroad spur was an old box car. They made the box car their nice little home and made their surroundings nicer and more fun! They went to school and were clean and not starving. No one knew they lived all by themselves because they were doing so well!

Then I had this wonderful idea! I could run away, with a whole new wardrobe of clothes appropriate for an 8 year girl and live in a cave just outside a town where no one would know me! I could go to school and no one would know. I could be just like the Box Car Children!! I look back in real amusement at how sweet but impossible that idea was. I even put some planning towards it! I looked through the Sears and JC Penny catalogues so I would know what clothes I liked and to buy so I could do this. I even looked at a Virginia map! I saw some cities near by, but I didn't see any caves on the maps, so maybe that's why I never did that.

 My heart goes out to the little girl back then. Who was going to feed this poor little waif? How was she going to keep her clothes clean and who was going to hold her and tell her everything was fine and she was safe when she was scared? Who was going to take care of her if her tummy hurt?

Then I think about her vision for becoming herself and I'm so proud of her! For even then, at that young age, she was trying to figure how to get where I am today. And she only thought about how much better it would be than to be where she was, even back then. As she grew up, she never really gave up, and here she is today! And now I'm feeling kind of proud of that little girl too!

Saturday, March 30, 2013

I Told My Best Friend on Thursday

As my actual work transition date comes closer, I was becoming considerably more anxious because I had a major task to complete before I felt that I could do this. I had to tell my best friend "Janet" who I mentioned last summer in an article as the friend I like to play golf with. I have a few "best friends" Of course, my very, very best friend is my wife Patty, but she enjoys the elevated category within "best friends" as my wife and soul mate.

Janet is my very best female friend for several reasons. I have known her since I was 18. I have one other best friend who has known me that long and like Janet, I went to college with him. Janet and I also had the same major so we spent a great deal of time together in college. She is someone I can honestly say has never hurt me or betrayed a trust, no matter how small and seemingly insignificant. I think that is pretty rare.

After college, Janet and I went our separate ways and I didn't see her again for 31 years. When I would think back to college, I would remember our friendship fondly. I had gone to some college reunions in the past, but the ones I had attended, she didn't, which was disappointing because I had wanted to see her more than anyone else in my class.
A year from this past October was the reunion for the class after mine, so I had no plans to go. Out of the blue, I got a call from Janet asking me if I would like to come up and have lunch with her and her friend "Martha". I talked with Patty and she said she would be ok with me having lunch with them, so I went up to Bridgewater and met up with them to eat at our old favorite pizza place. It was good to see them both and they both looked wonderful! Just as I had imagined them! Janet and I picked up our relationship as if we had not missed a day even though it had been 31 years since I last saw her. That is the mark of a true friendship.

After that, she and I have gotten together every other month or so and played golf or gone to lunch and I have looked forward to each time so much. I wish we lived closer so we could see each other more often.

Because of the closeness of our friendship, I found that telling her was one of the hardest things I had to do in order to move forward with my life and the anticipation of doing this was horrible. I was so afraid that she would not be able to accept this and that I would lose my friend. I was so anxious that I spent a great deal of time talking this over with my therapist Dana.

Even though I knew Janet loves me as a dear friend and I knew she would accept me, I was still afraid. She and I are both devout Christians. God and my angel have been with me through this whole process, which has resulted in a sense of peace when the time comes for me to accomplish something important in my transition.

Before I could tell Janet, however, I had accidentally outed myself to Janet's daughter "Christi"! In November, when my father was in the hospital and Patty was also in the hospital with a kidney problem, I got a message from what I thought was another friend who knows about me. The message asked me what I was doing that day. I was off of work to take care of both Patty and my father and that was the day I was also changing my gender marker on my driver's license. So I replied that I was going to do that on that day. I got a message back, "Why would you want to do that?". I thought that was odd, but as it was early morning and I was half asleep, I wrote back "Because I want to be a woman." "You do?" was the next message.

By then I was wide awake and wondering what had I done. "Who is this?" I messaged. "Christi...."

 OMG!!!!!! THE WORLD TURNED UPSIDE DOWN for a brief moment and then Christi messaged "Call me..."

That was when the calm returned. God had been with me the whole way and I thought to myself, this is a good thing and it will be ok. I called Christi and we had a long talk about my gender identity. She wanted to know if I had told her mother and I said I hadn't. She wanted to call her and tell her, but I told Christi that Janet and I were such close friends that nothing less than telling her face to face would do. I asked Christi to keep the confidence and not say anything to her mother until I could tell her face to face.

With my father's terminal illness, his death and informing my supervisor, hospital administration and coworkers, there wasn't any time to talk to Janet until mid January. Christi and I chatted off and on and she was as anxious for me to tell Janet as I was.

We set several dates to get together, but things would come up at the last minute that necessitated Janet's cancelling out. This was making me even more anxious as I wanted this part of my transition to be over. I felt I couldn't move forward and transition at work unless I told Janet first face to face.

This must have been so hard for Christi as she must have been bursting at the seams to tell her mama. But Christi is her mother's daughter through and through and kept my confidence for four months. What a tribute to Christi's character!

Thank you for helping me do this the right way for me Christi, I'm proud of you and I know your mama is so proud of you too! I know it must have been hard not to tell her.

Finally the day came two weeks ago when I was able to sit down with Janet and tell her. I was so nervous that I could hardly eat my lunch. The restaurant was too crowded to discuss something this personal, so we talked in her car. We ended up talking for three and a half hours and though I was so anxious, Janet reassured me that we will always be friends and that she was proud of me for coming to terms with this and being who I am instead of living with such a painful secret.

The lesson I learned once again is that people are kind and caring. I believe my relationship with Janet is deeper and we are more connected than ever. Through this experience, I also gained a new friend too,Janet's daughter Christi! How truly blessed I am!

In this journey, the biggest discovery for me has been the spiritual growth that it has provided. When I made the decision to transition, I never thought that the biggest and best part of my journey would be the spiritual aspect of it. And it has!

What are the fruits of the spiritual growth that I have harvested from transitioning? Most importantly, I have grown closer to my personal Lord and Savior and I am comforted by my walk with the Lord. The friends that I have talked to about my authentic self have all embraced me. The support from my employer, my supervisor, my coworkers and my patients has been overwhelming in the caring and support they have demonstrated towards me. This has also drawn Patty and I closer as well. Our marriage, I think, has grown stronger with each passing day. I am truly blessed and truly thankful for all that has happened and all I have been given. I never would have dreamed it possible.

Friday, March 15, 2013

Do Transsexuals Discriminate Against Each Other?

I was exchanging emails with my friend Amanda who is a relatively new friend I met on Pink Essence. Amanda is a very sweet lady who is coming to terms with her gender identity later in life. This is not unusual for people in their 40's, 50's, 60's and even 70's or older. There just weren't any resources readily available to people of our age.

The few sources of medical research and psychological research suggested in the 1960's and 1970's that people such as me were extremely rare, so rare that the estimate of our population was around one in 33,000 (1:33000). In 1970, when I was 12 and went to the public library in Charlottesville, Virginia to read about people like me in books by Harry Benjamin, Robert Stoller and Richard Green, the principle authors of the time, Charlottesville, in 1970,  had a population of about 30,000. I knew this because on the Interstate signs for the exits for Charlottesville, they posted the population at that time.

 Can you imagine how alone I felt as a 12 year old? It was a terrible feeling and I continued to feel that sense of terminal uniqueness until about 1990 when I got a subscription to Compuserve and found live time chat called "CB channels". Compuserve was very expensive at the time. It cost over $6.00 USD an hour over the basic plan. It didn't take too long for someone who was dire in need to talk to people who were like me to run up a huge bill and this limited how often I could talk to another transsexual after weeding out the fetishists and people with various interests other than realizing their internal gender identity.

Just before that, I had taken a "mental health" day off from work and watched Geraldo Rivera's daytime talk show that afternoon. Marsha Botzner was on his show. She was (and is) the director of the Ingersoll Center and the next day, I called her in Seattle where she is located. She was the very first person like myself I had ever spoken to and that gave me a tiny glimmer of hope. She was extremely encouraging with me, but it wasn't until 1997 that I made the decision to begin taking baby steps to actively seek my own transition and stop living with the misery of living with my secret.

My dearest friend Christina and my wonderful beautiful wife Patty were my rock in beginning the painful process of coming to terms with myself and the world I live in. Although I had been helping other transgendered people, it wasn't until 5 years ago that I found the strength to seek therapy for my own gender dysphoria. I deeply appreciate what my therapist Dana has done to help me find my way on a difficult life journey. She had no experience with people such as me. I'm the only therapist around for about a 3 and a half hour drive who works with adult transgender people. She is a highly skilled therapist and had the courage and compassion to stretch herself in her own growth as a professional to help me. I could have easily skirted the standards of care in obtaining my hormones, but I followed the process that I ask others to follow. I believe in the WPATH Standards of Care and cannot exclude myself from following them.

Along the way, from time to time, I would run into someone who would tell me that because I hadn't already transitioned, gone on hormones and had my genital reassignment surgery, that I wasn't a transsexual and that I was something else, less than the person who made these observations and not worthy of being friends with this person. I was "otherized". I found this reaction to be very painful and it would often increase my sense of emotional isolation and being unacceptable. I know my sister Christina experienced a lot of the same treatment by some of the other transsexuals with who were we were acquainted online.

It saddened me greatly to learn that Amanda had formed a close friendship on a transgender social website with another person who identified herself as a transsexual. After being friends and with someone who Amanda considered a close friend for a while, the friend learned that Amanda has chosen to honor her spouse's wishes that she not begin hormonal reassignment therapy and to not appear publically in her authentic gender identity. Her friend was not supportive of her, instead she was quite incensed that Amanda has chosen to make a compromise to preserve the relationship of many, many years with her spouse. In fact, she was so upset with Amanda's decision that she decided to "unfriend" Amanda. Amanda, understandably, was quite hurt by her friend's shallow an insensitive attitude towards her.

Now I do not know who Amanda was referring to and I do not care to know her identity. I think that this person must be very insecure with her own identity to insist that every transsexual follow in lockstep and begin HRT and eventually (the sooner, the better?) have genital reassignment surgery. it really matters not a whit, in my opinion whether someone begins HRT or has the surgery to confirm they are, indeed, a transsexual. There are many among us, particularly those who are older and in committed relationships who choose to not make our gender identity not "all about me". We love our spouses and want to remain with them for the rest of our lives. So, we make compromises that we are able to live with.  We try to find a middle road that our spouses can support as well as what brings us a level of congruency that allows us to live as comfortably as we can. It isn't the best of all possible worlds, but it is what works for us as individuals.  Gladys Knight and the Pips got it right in their song, Leaving on That Midnight Train To Georgia- " I'd rather live with him in his world than without him in mine".

Relationship is about compromise. To be in an intimate relationships, we have to find a middle ground with our partner. It doesn't matter what that compromise is, as long as we can live with it. Having a transsexual identity has nothing to do with what we do about it. It's simply about the identity.

We transsexuals frequently resent being lumped into the "transgender" umbrella. To me this is understandable because we don't care for the thought that we are identified by the public as being many things we are not. However, that has never influenced my choice of my friends. They are my friends because of their character and not because of their identity. It is particularly distressing to me that some of us who identify as transsexual will choose to denigrate others who identify as transsexual because of the compromises they choose to make to preserve the most important relationships in our lives.

I'm so glad you are my friend Amanda!

Tuesday, March 12, 2013

The Face of Trans Today

Over the past few months, I've begun to think about the question, "In the predominant culture (the United States, my culture) today, what is the image of being transgendered today?" I'm not sure that this is as easy a question to answer as it would appear on the surface.
This is something I've been thinking about since my adoptive niece Erica, made a comment about the featured speakers and content of the conference workshops at Trans Philadelphia Health Conference. Over the past few years, the content of workshops and speakers reflect a trend towards those who identify as "gender queers", particularly in the Northeast and West Coast.
According to the National Transgender Discrimination survey approximately 13% of people who were included in the survey identified as gender queer. Those who identify as gender queer are much younger than the general population obtained in the survey. 67% identified within the gender binary of male or female. Another 20% identified themselves as sometimes living as male and sometimes female, but still clearly identified with the gender binary concept to a large degree. 71% were under the age of 44 years, so the study does not accurately reflect the age distribution of transgendered people. 20% were in school at the time of this survey. It was also limited to those with internet access, so there are some confounding variables to this survey. In other words, the results cannot be considered statistically valid or reliable.
However, it remains the most important study on discrimination transgendered people face in the United States conducted to date. In my opinion, despite the limitations of the survey, it is the most accurate reflection of the life experiences of transgendered people in the US today.
 Individuals who identify as gender queer appear to be heavily influenced by an extreme left feminist ideology that is fashionable in academia at colleges and universities. It is known as third wave feminism. They advocate the ideological belief that individuals who identify with the gender binary schema are hurt by it as their lives are limited and scripted by having to conform to either a male or female identity. Instead, they argue, we must create a genderless society.
In October 2012, a Gallup Poll reported that a survey conducted from June 1, 2012 through September 30, 2012 found that approximately 3.4% of Americans identified as being transgendered. These are very similar results as reported in several other surveys since 2006 and can be considered a good estimate of the general population of the U.S. These surveys have a much higher degree of internal validity and reliability of the findings.
It is a more difficult task to ascertain how the culture perceives transgendered people. There are several ways of coming up with a general idea. One can look at how transgendered people are portrayed in the media such as in movies and television. Another way is to look at how transgendered people are portrayed in news sources. A third is to look at the programming presented at transgender conferences.
Curious to me, is the image that Jerry Springer provides on his television show. I'm also surprised that someone as strongly identified with liberal politics gets away with the way transgendered people are portrayed on his show and that he is so revered by the left. He regularly brings on the worst examples of transgendered people in our society. If one watches his show, one would draw the conclusion that transgendered people are promiscuous, adulterous, drug addicted and essentially shiftless people who engage in outrageous low life behavior. I do not dismiss the thought that at least some of what he portrays is staged, but I also think that some of the people he has on the show are real people. How Springer gets a pass on this from the transgender community is beyond me, but I see more far more attacks on conservatives who make negative comments about transgendered people and I can't ever recall anyone complaining about Springer. Yet he damages the image of transgendered people tremendously. Why is that? I wonder...
Another problem I see is very complicated and is a conundrum with no easy solution. We have a very high rate of suicide attempts, unemployment, addiction and alcoholism. Those of us who have been disenfranchised by lacking an education because of dropping out of school are also often marginalized and often end up working in the sex trades. I was very fortunate that despite being physically and emotionally abused in school for a significant portion of my high school years that I was able to endure that and later a brief period of homelessness (directly related to being who I am) and manage to overcome those experiences. I was fortunate to have overcome these experiences and I know that it was only by the grace of God that this happened. The majority of transgendered people are also people of color and in addition to the burden of institutionalized racism, bear the stigma of being transgendered.
Having said this, I clearly want to say this is not an attempt to "blame the victim". People do what they do to cope with being stigmatized. Transgendered people don’t have the same access to the opportunities that people who are not transgendered have and they experience a much higher rate of being victimized physically, emotionally and sexually.
 Remember, when you were in grade school on "career day" and the teacher asked the classroom "What do you want to be when you grow up? No one is raising their hands and waving them wildly exclaiming" I want to be an alcoholic and addict when I grow up!!" or "I want to prostitute myself when I grow up!!!!!"
But we do have a responsibility to overcome the illness of addiction with treatment and 12 step programs, seek help for mental health disorders such as anxiety, depression and post-traumatic stress disorder. We do not have the luxury of just rolling over and giving up, as tempting as that may seem at times.
I looked at the content of workshops offered in recent years at transgender conferences as a way to understand how we are portraying ourselves to the public. I'm not sure that this is a way of discovering what the public's perceptions are, but based on the percentage of workshop programming devoted to gender queers. I do know that they are a very vocal and public image of the "transgender community", much as drag queens and kings" draw a lot of attention and possibly could be a strong influence on the perceived image we have by the predominant culture.
 Another element that influences the public image of transgendered people is something that I have seen decried frequently in our community. That is the tendency for transsexuals who have successfully transitioned to end their involvement in the transgendered community. Their attachment to the broader transgender community is often more tenuous than other transgendered people. They are often criticized harshly for not "giving back" to other transgendered people who are coming along and finding their own way on the long and winding road of successfully transitioning. Because they "disappear" into the predominant culture, the public has little context for these individuals in our society and this further skews the public perception of transsexuals (as opposed to transgendered individuals not including transsexuals). While this is ultimately the goal of most transsexuals, it is not necessarily what is desired by other transgendered people who have a strong attachment to the transgender culture.
My interpretation of what this represents is that the majority of transsexuals do not identify with other people considered to be transgendered and they do not share the same sense of community with drag kings and queens, cross dressers, gender queers, and other diverse identities that consider themselves members of the transgendered community.
In my opinion, a transsexual who has managed to transition and does not wish to continue being involved in the community has every right to do so. She does not owe the community or others coming behind her anything. Her sole responsibility is to herself. In the words of Oprah Winfrey “… to live your best life...”
Because of my profession and my experiences as a transsexual, I will remain active in the transgendered community to a large degree to help individuals with their transition and in overcoming addictions and mental health issues that we all too frequently have. This is a choice I make voluntarily as a professional, not a personal responsibility. This necessarily means that I will have less privacy about my identity than I desire, but because of my special set of skills I will continue to make my skills available to the transgender community.
These are just my observations. What do you think is the image of the transgendered community and what are the reasons for this? I'm very interested in your opinions and I hope you will share them!




Saturday, March 9, 2013

The Commonwealth of Massachusetts, Transgendered Minors and Bill O'Reilly

A friend had sent me a message that Bill O'Reilly had a segment on his Fox News opinion show about something to do with transgender. She didn't mention what it was but wanted to let me know. I think she watched it, but I was engaged in something REALLY important at the time, watching my beloved Crimson Tide whip the stuffing out of Auburn in basketball. There are few things in the sporting world that give me such pleasure as Alabama whuppin' up on Auburn in any athletic endeavor, so I taped it and put it on the back burner. The airing date was on 2/26/2013.

I usually find a lot of common ground with Mr. O'Reilly. I did have some serious problems with what I initially interpreted to be a condescending tone in his voice towards people who are transgendered, but later changed my mind and decided his tone was directed towards the Department of Education in the Commonwealth of Massachusetts or whatever the governing agency that oversees education there is called. I think he is actually sympathetic towards adults who are transsexuals, but not necessarily "transgendered" which tends to be a catch all phrase for people with various gender identities that may or may not be congruent with their somatic sex.

His guests who were debating the Commonwealth's policy with the broad category of students were Alan Colmes, a frequent Fox News contributor who represents liberal points of view and Monica Crowley, who is also a frequent Fox News political commentator and represents conservative points of view. In my opinion, Mr. O'Reilly could have found much better people who were imminently more qualified to comment on this topic who might share different points of view. Ummm, perhaps my good friend Mara Keisling, the Executive Director of National Center for Transgender Equality (who I respect and admire and who is doing extremely important work, though we are on opposite ends of the political spectrum) and myself, for instance.

The following topics were introduced; cross gender competition in sports;
the ever controversial bathroom and locker room issue; and parental rights to notification that the school system is assisting students not of the age of majority to pursue living a cross gender life that is congruent with their identity without the knowledge of the parents.

It seems to me that these students, most likely have not had the benefit of being hormonally reassigned. It is by simple declaration of an adolescent or child, for that matter, that the government of  Massachusetts' educational system, will allow students to compete in sports that are designated men's or women's sports, as well as allow them to use restrooms and locker rooms designated for cisgendered individuals.

There are several problems that I see with this policy. First, if male bodied athletes are allowed to compete in cis women's sports, and have not been hormonally reassigned, they have a significant advantage over ciswomen physically in most cases and this has a negative impact on women's ability to have opportunities to compete in sports that schools offers given the limited number of roster spots on scholastic teams. There exists a possible conflict with Title IX which was enacted to give women equal access to sports in schools, as men traditionally have had. That would result in uncounted rounds of legal battles to resolve these issues, likely to ultimately be decided by the United States Supreme Court.

If a male bodied student has been hormonally reassigned, this levels the playing field and I believe they should be allowed to compete in their identified gender identity because generally they are at a physical disadvantage compared to cis males and if they can make the team it would clearly be by their athletic talents and skills. For the female to male identified student, competing in men's sports is not such a disadvantage to cis males

The bathroom and locker room issue has always been controversial. My opinion is that there should be separate facilities available for rest room and locker room needs for students who have not been hormonally and surgically reassigned. I think this is just a matter of respect towards cisgender people, just as they should respect us. I think the IN-Your- Face attitude of people whose somatic gender is not congruent with their gender identity creates more ill will towards us than helps us advance our rights as members of a democratic society. What good comes of making the vast majority of people uncomfortable in the name of insisting we be treated the same, though in fact when we have not had surgical reassignment we are not the same? To me it is a simple matter of courtesy and respect, just as I expect to be treated with respect.

For those who are undergoing hormonal reassignment and live full time in our true gender identity, the restroom issue is moot. We should and do use the appropriate gendered restroom. More and more states are issuing legal identification with the proper gender marker to our identity and in those situations, there is no question about which restroom is appropriate to use.

To me, though, the most important problem is the systematic violation of parental rights by the Commonwealth of Massachusetts. The Commonwealth's position is that simply by the student declaring he or she is transgendered and does not wish his or her parents to know, will facilitate the student's gender transition at school. While if there is a real threat of physical, emotional or sexual abuse, or neglect, a child should be removed from the parent's home. To simply bypass the parents and facilitate this cross gender life at school only without any proof of abuse or neglect, in my opinion, is extremely harmful to the family unit and is a prescription to ensure long term alienation of family relationships.

Mr. Colmes argued that extensive evaluations and documentation must be conducted or provided for the school to be allowed to intervene this way, but Dr. Crowly argued, and I believed correctly, how will these extensive evaluations be conducted without the parent's knowledge? It seems to me that it is highly unlikely that that could occur and I think this governmental interference in family life in both the short run and long run, does much to hurt the individual and the individual's family, and is a set back in normalizing acceptance of transsexual people in our culture. I think that this removes the opportunity to provide services to the family to help the entire family unit to adjust and make positive changes so that the transsexual individual may preserve family relationships, not permanently alienate them from their families. The role of the government should be to strengthen families, not to destroy them.