Hello Russia!

Russia is the nation with the second most views of my blog for all time after my own country, the USA. For the past month, I've had 600 views from Russia, not many less than my own country's views.

As an amateur student of Russian History and Russian Literature, I am curious about what it means to be a transsexual or transgender person in Russia or in Eastern Europe and in the former member states of the former Soviet Union.

My interest in Russia goes back to my adolescent years when I first saw the movie Nicholas and Alexandra. In my undergraduate studies.  I took a course in Russian History. I began to read literature by Dostoevsky, Chekov, and Solzhenitsyn. I found Ayn Rand on my own and have embraced many) of her philosophical ideas in my own personal philosophy (along with much of the philosophy of B.F. Skinner and Behaviorism). I was also fascinated by the influence of Grigory Rasputin (referred to as the "Mad Monk" over the Czarina Alexandra as well as his own story.

I grew up in the 1960's and 1970's in the era of what we call in America "The Cold War". One of my earliest memories was of the Cuban Missile Crisis. Here in the USA, my early childhood memory was of the adults fearing we were going to die at what seemed to be the beginning of World War III. Thankfully, that event would not become the catalyst of the destruction of two great countries and perhaps the entirety of Western Civilization.

I was a young adult when Ronald Reagan implored Gorbachev to tear down the wall separating East Berlin and West Berlin and saw that wall fall on television along with the disintegration of the United Soviet Socialist Republic, or as we called it, the Soviet Union.

 As an American transsexual who is a mental health professional, my practice is partly devoted to working with transgender people. I am quite interested in how people such as myself fare in other countries. My audience for this blog is truly international. I have readers in every continent, even from Middle Eastern countries and African countries where people such as myself suffer unspeakable persecution, to the point of torture and loss of life because of who they are. There are things worse than dying for who one is or one's religious belief, though, such as being tortured or living under extreme oppression.

I seldom get comments from people from foreign countries who read my blog. My guess is that in some of the countries my readers come from that they dare not leave a trace that they have read what I have written.

As I mentioned, I am quite interested in the lives of transgender people in other countries and other cultures. I would like to invite my Russian readers to participate in commenting on your lives, your struggles and your triumphs to live an authentic life.

Thank you my Russian friends!

Mateo Williamson, Barak Obama and Pope Francis

Barak Obama has decided to welcome Pope Francis to America and to the White House by inviting some guests to help him greet the Pope. He has invited Gene Robinson, a retired Episcopal Bishop who is a gay man, Sister Simone Campbell, who is a pro abortion nun and is the Executive Director of the social justice lobby group Network, and Mateo Williamson who is supposed to be representing "transgender" people to the Catholic church.

First, I must question why Barak Obama is insisting on sticking his thumb in the eye of Pope Francis and by extension Catholics in America and the rest of the world? How will this possibly move the dialogue forward between Christians who are Catholic, and by extension all Christians who are not accepting of abortion, particularly unfettered access to abortion which includes partial birth abortion and the harvesting and sale for profit of the organs of unborn children? How does having a gay man who likes to wear women's clothes advance the acceptance of people who are transsexual with the Catholic Church and the broader body of Christ when he has nothing in common with transsexuals and confuses the public about who transsexuals are?

While the Episcopal church has recognized that gay people have a rightful place as members of Christendom and are just as much children of God as straight people, presenting Bishop Robinson along with Sister Campbell and Mateo Williams discredits the message that Bishop Robinson could bring to meeting with the Pope and diminishes the opportunity and hope for reconciliation between the Catholic Church and the Episcopal and Anglican churches, which is a much desired outcome between these denominations. It certainly isn't going to help me find acceptance in the broader sense of Christendom. Presently, I worship with the Episcopal church, but I long for the day when I can find acceptance as a woman of Christ in the Southern Baptist Convention where I spent my formative years.

It utterly confuses me why Mateo Williams would be included in this meeting. I quote Mateo Williamson from his own words published in Breitbart News: "Today I identify as a gay man and before that was difficult to understand because I thought that in order to be transgender, in order to be a transgender male that I had to be attracted to females but I never have throughout my entire life.”

How he came to the conclusion that he "had to be attracted to women to be transgender" escapes me. I can only conclude he has never been familiar with the professional literature (of which I am very well acquainted dating back to the mid 1960's). In actuality, in the earliest days, professionals believed transsexuals must be attracted to men and there has been considerable debate on whether people who are attracted to women or can only imagine themselves as being women having intimate relationships with men were fetishists. I'm sure Barak Obama could have found someone more grounded and more knowledgeable about transsexualism to greet the Pope if only the President cared about substance over symbolism.

http://www.breitbart.com/big-government/2015/09/16/white-house-invites-trio-catholic-dissenters-greet-pope-francis/

Mateo Williamson is not a woman of transsexual experience. He's a gay man who likes to wear women's clothes for whatever reason. He has had a clear confusion about his identity over the course of his life and that is what the problem with the umbrella term "transgender". His life and his experiences which make him sound by his own words to be a drag queen at best, or just another gay man, have nothing to do with people like me and others I know and have worked with. Presenting him in the context of representing people like me to the Pope devalues my unique identity and experience. People like him and people like me have nothing in common with the exception that we are all human and have the right to be respected for who we are, but other than that, we have nothing in common.

The fallacy of likening people like him with people like me is that his issues, plainly spoken in his own words, have to do with his sexual orientation. My issues are based on my gender identity. To have him publicly be the face of some conglomeration of people in which I am lumped in only makes it harder for the public to understand and become more tolerant of people like me.  

I do understand that what I rail against here means very little, but I do have a voice and a separate identity that should not be subsumed under some term like transgender or like LGBTQI (Et Cetera Ad Nauseam) that blurs my unique experience for some larger political lobby that does not represent me or care about my rights or needs. Because under that paradigm, any hope for advancement or gaining access to health care, or other basic human rights are slowed to a snail's pace.

The 2015 National Center For Transgender Equality Trans Survey

I'm sorry to have overlooked posting this sooner, but an important opportunity is at hand. The National Center For Trans Equality is seeking respondents for its second survey that is the most important study to identify transgender issues about access to health care, employment discrimination, mental health, substance abuse, public access to activities and education, to name some of the very important things that we as members under the umbrella "transgender" face.

The first survey revealed important information that was brought to public attention and made a tremendous contribution to the expansion of our freedoms and access to healthcare. It is important that no matter how you identify under the umbrella of "transgender" that you participate in the survey, even if you responded to the survey the last time it was offered. Don't believe your voice makes a difference? Maybe not in a lot of circumstances, but here it really does and it is worth the 20 to 30 minutes to take your time and respond to the survey!

A big and heartfelt THANK YOU to Mara Keisling and all the folks at the National Center For Transgender Equality.....

Here is the Link to the survey:  http://www.ustranssurvey.org/

Whose Rights Matter Here?

I saw two news reports today involving two transwomen. In one case the question is raised about the rights of the individual vs. the rights of society, in this case, the rights of other teenage girls to be afforded a dressing room without a preoperative teenage transsexual girl sharing the locker room with them. The other case involves the rights of an adult transsexual woman to complete her transition by having gender reassignment surgery vs. her parents' desire to block her from having the surgery. In that case, a Pennsylvania judge has issued a stay preventing the woman from having her surgery until the case can be heard.

Because the transsexual girl is a minor, I have chosen to delete her name from the news report by the CBS news affiliate who did publish her name. I don't think publishing her name is the proper thing to do.

In the first case, the CBS affiliate in St. Louis, Missouri reports: " Over 150 Missouri high school students voiced their displeasure about a transgender teen using the girls’ locker room by walking out of class.

Students at Hillsboro High School staged a two-hour walkout Monday over 17-year-old  (the student), a student who has identified as a female since she was 13, using the girls’ locker room during gym class.

The school offered (the student) a gender-neutral bathroom, which she turned down. St. Louis attorney Timm Schowalter says, “All students have a right, under Title 9, to access the bathroom of their choice.”

Family members of high school students were also holding a protest.

“Boys need to have their own locker room. Girls need to have their own locker room, and if somebody has mixed feelings where they are, they need to have their own also,” protester Jeff Childs told KMOV. Childs was holding a “Girls Rights Matter” sign.

Tammy Sorden, whose son goes to Hillsboro High School, believes it’s not right to give (the student) special treatment “while the girls just have to suck it up.”

“The girls have rights, and they shouldn’t have to share a bathroom with a boy,” she told the Post-Dispatch."

As a preoperative transsexual myself, I find myself agreeing with the female students of the high school. I don't think they should have to share a locker room with a preoperative transsexual. That is an environment in which there is not the privacy afforded in a regular women's bathroom. This is an environment in which women are fully disrobed in front of each other and I do think it is important to be sensitive to their feelings about this situation. Personally, at this point in my own transition I think it would be terribly disrespectful to subject genetic women and postoperative transsexual women to my presence in the locker room. In the news report or in the protests by the high school students, I do not see any mention of the girls objecting to this preoperative transsexual girl sharing the regular restrooms. This indicates to me that this particular school's students and faculty are rather tolerant of the transsexual students presence in another intimate place, albeit not as intimate as a locker room. To me the transsexual student is being insensitive to the feelings of the very people she is trying to assimilate with. This is not the way to go about it, in my opinion.

In the second case, I will include the name of the transsexual woman because she is an adult.

The Associated Press reports " A transgender woman whose parents went to court Wednesday to block her gender-reassignment surgery in Pennsylvania said she would rather die on the operating table than continue living with male anatomy.

Christine Kitzler, 48, said during a break in the emergency hearing that the risk factors her father raised - including complications from her HIV and Hepatitis C diagnoses - were worth enduring to have her body match the gender she's identified with since growing up in suburban Cleveland, Ohio.

The surgery, temporarily halted earlier this week by a suburban Philadelphia judge as he considers a longer stay, would also save her from backsliding into alcohol and drug addiction, Kitzler said.

Her parents, Klaus and Ingrid Kitzler, contend Kitzler is not competent to make an informed decision to have the surgery because of depression and a childhood learning disorder, and want a temporary guardian named.

"I might die from this. But it's worth dying," Kitzler said. "I would rather die than live the way I was and return to my bad addictions, like alcohol, because I can't do it and I won't do it."

Kitzler's surgery had been scheduled for Tuesday in Pennsylvania, but Bucks County Judge C. Theodore Fritsch Jr. stopped it after her parents' lawyers filed for an injunction and asked for time for reflection before she goes through with what they called an irreversible surgery.

Testifying at the hearing, Klaus Kitzler underscored his concern for his daughter's health. He said he would accept her surgery if an independent psychiatrist deemed her fit to make the decision.

"I accept it, but I want to stop it," Kitzler told the judge. "I would love to have a son back who goes to church with us on Sunday mornings."

Christine Kitzler, who lives in Myrtle Beach, South Carolina, has already been through 16 months of pre-operative preparation, including a 24-hour fast before Tuesday's scheduled surgery, and has received clearances from mental health professionals that she is knowingly and willingly undergoing gender reassignment, her doctor said.

Her lawyer, Angela Giampolo, said she had never seen competency invoked to block a gender-reassignment surgery.

"This isn't a competency hearing. This isn't a guardianship hearing. It's a difference of opinion," the prominent Philadelphia gay-and-transgender-rights lawyer said.

Giampolo said Kitzler's parents are trying to prevent her from living an authentic life. They said they fear Klaus and Ingrid Kitzler want to bring her back to Ohio, win a court action there and permanently block the surgery.

"They have a daughter. They don't have a son," Kitzler said. "I'll have the parts. I am a woman." "

Ms. Kitzler is an adult and she has made a carefully informed decision that having gender reassignment surgery is necessary for her to have a quality of life that makes life itself worth living.

In my opinion, the arguments that she has suffered from depression, has a history of addiction and has a learning disorder are all specious arguments. And here is one reason why the WPATH standards of care exist. 

Let's take this point by point: 1. Ms. Kitzler is an adult and as an adult it is her right to pursue gender reassignment. 2. Show me a person who is transsexual and never suffered from depression to one degree or another. I don't believe there are enough of individuals who have not been depressed in people who are transsexual to be considered statistically significant. 2. Transsexual individuals experience higher rates of addiction and substance abuse than the general population. 3. Having a learning disability in no way impacts the decision to make a gender transition. 4. Having HIV and Hepatitis C infections does not necessarily preclude one from having surgical procedures. 5. None of the above factors generally diminish legal competency.

Because of the guidance of WPATH standards of care, Ms. Kitzler was screened by mental health professionals and found that her mental health and substance abuse issues at this time are not a barrier to treatment and that she is making a well informed and competent decision to pursue gender reassignment surgery. Her physicians have assessed her and found her to be a good surgical risk and are willing to perform the procedure. This should be the end of the story, but it isn't. Her father's sole reason for seeking the court's intervention is that " I just want to have a son who goes to church with us on Sunday mornings." 

If the truth be told, he never had a son, though I do believe he didn't know that for many years. Transsexuals become skilled at living a life and acting out a life that is not authentic. Wouldn't if be more loving and affirming if her father had said, "I'll be looking forward to having my daughter to go to church with us on Sunday morning." 

When this sad episode is over, I'm guessing he will neither have a son or a daughter. My guess is that Ms. Kitzler will never wish to speak to her parents again, or at least for so long a period of time that there will not be much time left in life for them to share. Really, how sad is that? What a terrible thing to happen.

An Essay on the Transgender Healthcare Experience

Today I would like to share an essay that I wrote for a contest for the University of Virginia health care system. Unfortunately, I missed the deadline to submit my essay, but I think that my readers would like to read about my experience interacting with health care in the United States during and after my transition. Here is what I wrote about my experiences:


 Identity seems like such a simple thing, but it can be anything but that. Identity can be as simple as seeing a beautiful bird and thinking, “Oh! There is an indigo bunting!” or seeing a piece of crystallized rock and saying to a friend, “That’s quartz.” Sometimes identity is not so simple; does this fish have 17 dorsal spines in its fin or are there only 16? It can make a difference in what species of fish you are identifying.

Identity in the health care system is something that we hold to be so important that a whole canon of law on how to go about correctly identifying a person, about protecting that person’s identity as well as her identifying health care information has emerged.

What happens when someone whose true identity has been hidden for many years, perhaps almost all of one’s life suddenly becomes known to the health care system? This is the situation a transsexual finds herself in when she makes the decision to live an outwardly authentic life that reflects her true identity. It is also the situation health care systems find themselves in when the patient who has always been identified as male becomes a woman outwardly and legally, matching her experience of her internal identity with her outward appearance and her day to day social life.

When a person such as myself transitions and begins to live authentically in public after many years of maintaining a false pretense, it is not necessarily easy, especially at first. However it becomes natural after a relatively short period of time. I have always known who I was, the difficulty was in shedding the layers of armor built to protect anyone else from knowing who I was. It didn't take very long at all though to feel as natural and comfortable as any other woman in my daily life.

Fortunately, I was able to recognize that while my very public transition was voluntary for me, it was not voluntary for my coworkers and patients as well as my loved ones. Those who have remained in my life, thankfully almost everyone who involuntarily transitioned with me did so with fairly little difficulty and successfully made the transition with me.

Yes, mistakes were made along the way. What I found to be most helpful in facilitating my transition for these people was to grant them grace and not get upset when mistakes were made by using my old name or using the wrong pronoun in referring to me. Being mindful of the involuntary nature of their position was a way for me to extend good will and gratitude for finding acceptance and understanding with my transition.  They were getting a more open and authentic person to work with. Who wants to work with someone who has to live a lie? I wouldn't and I would feel sad for that person and would want them to be who they are and be all they can be. It’s why I do what I do for a living.

Working in health care as well as being a recipient of health care has been an interesting experience in becoming public with my identity. For most of my life a change of public gender identity, was just not done. Health Care, just as the rest of society, is slow to react to the truth that not as rarely as we once thought, poorly understood biopsychosocial factors create a split between gender identity and a  body habitus that does not match one's gender identity. My experiences have ranged from inconvenient to mildly embarrassing to being subjected to flat out discrimination by Health Care. Mostly my experiences were those of being inconvenienced and on one occasion it was rather embarrassing. On that occasion I was pretty sick with the flu which only added to my misery at the the moment.

Because I work in healthcare, I also transitioned on the business side of the organization and I can only say wonderful things about my supervisor and Human Resources. The transition happened with very little fanfare which is how I hoped it would be. I am very thankful to my employer.

Getting the health care system to identify me correctly was not as easy as managing the rest of my legal identity. It was a pretty simple process to get the world to legally say that Lauren Tancyus is a female. Legal name change: file the court form that I filled out myself and pay a fee. Driver’s license: one form to be signed by a health care professional to change my gender to female on my license and one form to get my legal name on my license along with a small fee. The court notified vital statistics in the state I was born and my new birth certificate (unfortunately with the WRONG gender due to that state’s laws) was sent to me with my new legal name. I went to Social Security and filled out the form to have my name changed. I notified the Board of Social Work and they changed my name and gender on my Social Work license for free. All in all it was fairly simple with no frustrations along the way to become legally identified as who I am.

Now getting the health care system to recognize me as female and my legal name change was not as smooth and seamless as getting my legal identity changed. I knew that my medical information needed to reflect who I am. I coordinated with my wonderful office manager Carmen to change my identity in the system with permission from our Health Information Management department. I provided the needed legal documentation which was entered into the system. All seemed right with the world!

About 5 months later, I went to one of my health care system’s prompt care outpatient offices on a weekend. Imagine my surprise when I registered with my legal female identification and my health insurance card reflecting my correct identity, only to be called back by my male name by the health care professional who would treat me. It was extremely embarrassing to me. Much worse was when I got to the pharmacy and found the prescriptions in my male name even after I explained to the treating physician that my legal identity was now female. I did not have any old identification with me and felt too sick to go home and come back. My only option was to out myself to the pharmacy staff, personal and private information they did not need to know to perform filling these prescriptions, if only Health Information Management had performed this task correctly when I gave them my new legal identity information.

  Fortunately, they were wonderfully kind and under the circumstances quite merciful to me in not insisting I go home to get the old identification in order to fill my prescriptions. They also made no issue of my gender transition. That at least, was a very positive experience during that unhappy episode of my health care.

I contacted Health Information Management about this experience and told them how embarrassed I was on top of being pretty sick at the time. They investigated the complaint and found that while some things had been changed to reflect my gender and name change, others had not which resulted in my unpleasant experience. I was assured that policy and procedure would be updated so that this did not happen again to someone else. I was also given a very sincere apology from the director of medical records. As far as I’m concerned, in correcting this problem, health care worked well and I consider my grievance with the health care system resolved. I think that this reflects my attitude in that for Health Care, my transition was involuntary for them while it was voluntary for me. Health Care can be behind the curve in this area, but I do see an effort being made to change these problems and get up to speed.I'm glad that my experience will pave the way to make life easier for someone else in the future.

In all of Health Care, there is only one area that the transsexual interacts with that fails most of us catastrophically. It is within the domain of Health Care Insurance, or for me at least with my health insurance to be subject to bigotry and discrimination and that is the failure to cover my health care expenses related to the treatment of my gender dysphoria. Not a dime of my treatment was or is eligible to be covered by the insurance coverage I have through my employment in Health Care. Even though my condition is medically recognized and the treatments I have had are considered medically necessary, I am left with no avenue to become whole. I am blessed however that I was able to personally pay for most of the medical care that I need. There are so many more like me without the resources even to do that. Imagine how they must suffer! I can certainly say that my quality of life would be so much better even as improved as it has become. To deny my healthcare insurance coverage for transgender health care is unconscionable. It puts medical care out of reach for some of my most important health care needs.

The message received is that as far as my healthcare insurance company is concerned, my identity is not a valid identity. It is a very stigmatizing message from my insurance company, in my opinion.

In terms of providing quality health care for transgender people, I would give my health care organization pretty high marks. I have one of the largest mental health practices in Virginia serving transgender patients and generally see 5 or 6 individuals a week. I have been able to successfully coordinate other health care services for transgender people to be provided by our organization. We offer speech therapy, endocrinology, aesthetic dermatology, psychiatry and gynecologic services all leading to referral for gender reassignment surgery and we provide the necessary services for after care post gender reassignment surgery. We offer every needed service except for gender reassignment surgery itself all in one system. I see this as tremendous progress for people whose identity changes in the health care system and I am very proud of that accomplishment for Health Care.

Pink Essence: Why I Chose to Discontinue My Membership

I was a member of Pink Essence for a number of years and I recently decided to discontinue my membership as did Patty.

There were many benefits that I got from being a member and my decision to end my membership in this community ultimately has to do with a decision that Chloe Prince made to open up Pink Essence access to the World Wide Web.

I have known about this decision for quite a long time and at times worried about what the personal implications for my private life might be. Then again, I have this blog which would throw into question why I might be so concerned about my privacy. After all, I have given a great number of workshops around the eastern U.S. over the past 5 years and I have documented my transition here as well as on Pink Essence.

However, when I decided to write my own blog, I made the decision to be more public. When Ms. Prince made the decision to open Pink Essence up to the internet at large she made a decision that has the potential to harm many people who are not prepared to be potentially discovered by family or employers or by friends. It is a difficult path that we walk and for those who are not ready to deal with being outed at a time when they are just coming to terms with themselves, this is potentially disastrous. When  one considers that we have a rate of over 40% of us who attempt suicide at some point in our lives due to the heavy price we pay for attempting to come to a place of peace with ourselves and the associated losses of families, friends and careers, among other things, perhaps Pink Essence is no longer a safe haven for those who are just coming to terms with themselves.

In my situation, family did discover my presence on Pink Essence and it did recently cost me and Patty some relationships that we held dear. I don't fault Pink Essence for my own losses, but I think someone not as far down the path as I am and who has not worked as hard at self acceptance as I have may not be as emotionally prepared to pay the price that Patty and I just paid by not ending my membership when I first became aware of the new policy opening up Pink Essence to the World Wide Web.

The value of Pink Essence is mostly for new people who are coming to terms with their gender identity. They are also the most vulnerable people on Pink Essence. Having made the decision to open up Pink Essence to the World Wide Web puts the most vulnerable of us at risk.

Unfortunately, I have seen a huge turnover in membership. This is most likely because many of us who have transitioned and accomplished what we set out to accomplish (a successful transition), have no need for what Pink Essence offers. Other people who have successfully transitioned stick around to offer advice on what worked and what didn't on our journey to becoming whole.

I believe that opening up Pink Essence is a huge disadvantage to those who have transitioned and want to live a private life, even if they wish to contribute in a positive way to the lives of others who feel lost and are trying to figure out how to be happy and live a fulfilled life.

It is also a huge disadvantage for those who need a safe and private place to discuss the often painful issues that we face on our way to finding peace and happiness.

I only wish Chloe Prince well, as well as future success. I hope that those who join Pink Essence find what they need on their journey, but I also hope people will be aware of the risks associated with membership on Pink Essence and make a wise decision if the benefits of membership will outweigh the risks involved.

To read an article I wrote about the benefits of belonging to social websites such as Pink Essence that I wrote earlier, please follow this link:

http://twoworldstranstherapist.blogspot.com/2012/08/in-praise-of-pink-essence-and-social.html

Transsexual Spirituality (Connecting Body, Mind, Soul and Spirit)

If you are on the path of being a transsexual, it is vital for your holistic sense of wellbeing to recognize that this is necessarily a spiritual journey and to the degree you can develop your spiritual life as you travel this road, you will feel more balanced and have a greater sense of wellbeing as you face the inevitable adversities along the way. It will allow you to become more thankful and have more gratitude for the kindnesses, often unexpected that are extended to you along the way as well on your individual journey.

Developing a rich spiritual life will help you to keep from becoming bitter when those who are supposed to love you and care about you unconditionally, fail to fulfill the love and support you have expected from them. It allows you to forgive them so you can move on and extend them grace if they should come to you and ask for forgiveness so that you will be able to once again have a loving and mutually supportive relationship with them.

If the ones who have hurt you never do attempt to make amends, then you will be able to move forward by creating new supportive and loving relationships with others rather than react by withdrawing from others and becoming bitter, isolating yourself from other caring people in the future who will come into your life.

Last week I attended a two day workshop in Birmingham, Alabama given by Thomas Moore, who has written a number of books on living a spiritual life. His best known book is probably The Care of the Soul and his most recent book on which the workshop was about is entitled Creating a Religion of One's Own. He is a former monk and lived a monastic life for 14 years. He and I both share the belief that psychotherapy is a spiritual practice and that we care for the soul of the patient who chooses to engage in psychotherapy. We believe that the emotional pain that one experiences and leads one to seek help is a spiritual affliction. Dr. Moore's workshop was entitled "Creating a Religion of One's Own".

This workshop had nothing to do with the topic of being transsexual and did not touch on the subject in any way, but there are profound ideas that I found to be very relevant to our spiritual development.

In the next series of articles I will be writing about his concepts and how they can help you live a more spiritually fulfilling life on the journey of living with a transsexual identity. To begin this series, I will leave you with this idea....

"We do not create or choose our lives, but we are destined to follow our paths. It is not predestined. It is about our experiences and what they lead to and it is about the meaning we find in them" - Thomas Moore

Disowned, the Story Continues, Oddly Enough

Surprisingly, I find that my Daughter in Law is apparently aspiring to become my cyber stalker. For someone who made it clear to Patty a little over 24 hours ago that she wants nothing more to do with us, she was on the phone again bright and early at 8 am this morning to continue to harass Patty over what I had published here less than 8 hours before that about her uninvited verbal attack on us.

She told Patty that what I had written was a "pack of lies", but Patty who then read my blog after the phone call found nothing I had written to be untrue.

If I were dead to her and did not exist as she informed Patty yesterday, one would think she would have better things to do with her time than obsess over anything I might write about.

Perhaps it has something to do with her failed attempt to turn Patty's daughter against us. She seemed to have a need to call her to tell her all about this but my stepdaughter's response was that if her mother and I were happy together then it was no concern of hers.
Considering how she attacked my stepdaughter's husband two years ago, calling her was a rather pathetic move on her part. Her behavior is becoming rather laughable! Quite a change for Patty and me in less than 24 hours.

I thank God my prayers to Him asking him to bind her from harming Patty and me have been answered! Once again, it has been proven in a powerful way that God always answers prayer.

Patty and I were discussing these developments this evening after I came home. We began thinking about what she would do if one of her children came to her and told her that they were transsexual. Given that no one asks to be transsexual because of the hatred and disgust people like my daughter in law harbor towards us, we wondered if she would tell them they too were vile, disgusting and perverted as she thinks about me and about Patty whose only transgression is to love me? For my grandchildren's sake, I pray this does not come to pass. It is sad to know that so many transsexual young people are thrown away by their families like garbage. She seems to be someone who is capable of being that way in my opinion.

It also gives me pause to worry that as a health care provider, would her bigoted and hateful attitudes translate into abusive or neglectful care of a transsexual patient if someone like me would be unfortunate enough to be placed under her care. It is highly likely she will encounter a number of patients like me before her career is over and she retires. I know I would be fearful to have someone with her attitudes responsible for my care.

It is both my and Patty's wishes that she do what she said she would do last night; leave us alone and stop bothering us. Enough said.

Disowned

In the span of a little over an hour, my life took another radical change again. At first, I thought it had taken a serious turn for the worse. It felt catastrophic and I wanted to vomit. Then I felt empty and could not put any words together. I wanted to die, but I had no urge to kill myself. I was not suicidal. I just wondered why my life goes on and why can’t it just be over. I had no answers for those questions, but that all turned around in a rather short period of time as you will see.

What happened was that shortly after I got home from work, my daughter in law called to tell Patty that they (she and my stepson) knew the truth about me and what a pervert I was. She went on to tell her that she was vile and disgusting and that as far as she was concerned that we were dead to them and she would tell our grandchildren that we do not exist. She also said that she would also call Patty’s other two children to inform them so that they would be sure to disown us as well. Poor Patty endured this venomous spew from this unlovely person and never returned an angry word.

Patty, of course, is devastated. We had agreed that I would not present myself to them as I truly am out of consideration for Patty’s feelings. It was a small sacrifice to me for someone I love, as we were pretty sure of this type of reaction as my daughter in law has been a very destructive force in the family dynamics on so many levels over the years. She has ensured that her husband is alienated from his brother and has created major problems in the family relationships with her husband’s sister’s husband, his brother in law, our son in law. Now, when we try to arrange a family get together, our son in law will not attend. Once in awhile, my step daughter attends and I have tried to avoid these occasions because I know my daughter in law doesn't want me around. Patty has sensed the same thing over the years. We are never asked to spend any time with our grandchildren except when my daughter in law is present. We have never been asked to babysit and have never spent any time with them unless she ensures she is present. This is true even if I weren't involved. My daughter in law has always excluded my wife from spending time alone with the grandchildren, unlike the access she has allowed her family.

It seems though in the aftermath of this, it has become a very freeing experience for me. It was a painful sort of rebirth of which I have experienced many such along my journey.

I am free of having to pretend that I feel accepted and a part of Patty’s family. I have almost always felt like an unwelcome outsider, particularly by my daughter in law over the years. That was going on way before my daughter in law’s discovery about me today. Now I will never see them or interact with them again. My daughter in law, once again has shown us her black heart.

However, the pain that my truth causes Patty once again, just by my truth of being me becoming known to others, is heartbreaking for me. I don’t know how I can ever make up to her that her choice to remain in a relationship with me cost her relationship with at least one and maybe all of her children. It may not be possible to do that at all.

In two days we leave to go on a vacation we have both been looking forward to a long time to a place we both enjoy when we visit. I’m not sure either one of us cares at this minute about that vacation any longer. Hopefully though, this will be an opportunity to become even closer through experiencing the unreasoning and ignorant hatred of my daughter in law. I hope we will just forget about this over the next week and focus on us having fun and relaxing together.

What is positive from this horrible experience is that I feel no need to retaliate in kind, though I have first hand knowledge of things my daughter in law has done that would jeopardize her professional career and reputation, due to the same destructive need to maliciously gossip about people.

Her treatment towards my wife shows her to be a low and common person, someone who enjoys inflicting pain on others and she lacks the courage of her convictions to say them to my face over the phone.

However, they failed to recreate the feelings of guilt and shame that are common to people who grow up knowing they are transsexual. This is a reflection of the hard work and growth that I have accomplished in self-acceptance.

My God requires that I forgive her and I have made a lot of progress this evening towards that goal.  In this sense, it is a purely selfish act. It is only for me and not meant to benefit her in any real way. It allows me to feel the full grace of peace and love that God has for me. I bind her from doing emotional harm, something she seems to crave the need to do to others, as evidenced by the many examples over the time I have known her. My most sincere wish is that she is also bound from harming Patty in the same way. I simply won’t think of her in the future.

What I Did For Football, What Football Did to Me

I want to be absolutely clear that the intent of this article is NOT to malign the sport of football, which one might infer from the title. To the contrary, I continue to enjoy watching football to this day and I believe that my prior participation in the game helped me to build the internal strength and courage to successfully face my gender identity issues and finally be able to live an authentic life, despite the consequences I endured from playing the game.

I was 12 years old when I stepped onto the field to play real football with the big boys. I would be entering the 7^th grade that fall, but the rest of the boys who came out for summer practice were mostly 16 and older and no one else was younger than 15. They were for the most part four to six years older than me. We called summer practice “Captain’s Practice” and it began the last week of June for four weeks. We were to get into shape to begin organized practice that began in the last week of July and went on until school started the first week of September and the season began the first Saturday in September.

The Junior Varsity team would not form up until the school started and played their first game in late September. I couldn’t afford to wait that long to begin playing football because I had something to prove. I had to prove it to everyone else but more importantly I had to try to prove a lie to myself about who I really was. In all truth, back then, I secretly wanted to one of the cheerleaders rather than be a football player, but I knew that could never be.

Why else would someone who was outweighed by anywhere from 40 to well over 100 pounds subject themselves to full contact football? The other question that came much later in life, was what kind of judgment were the adults who ran this particular program exercising to allow someone so much younger and so much smaller to engage at this level of competition with the high probability of injuries which were inevitable in this situation?

However, ultimately, the person who decided to do this was me. The more important question is why would I engage in such a foolish and dangerous activity? That is a question that can only to be answered by me. Simply put, it was because I had something to try to convince myself of that was not true. It was something that was not true to convince everyone else who had no idea what it was I was trying to prove, because I was unwilling to face my own truth.

As I’ve written about earlier, I knew I was not a boy and was really a girl, no matter what my biological reality was when I had the language to identify it. That was around age 6. I also knew the word for people like me at that time, but this, the summer of my twelfth year, was also the summer that I began to read the professional books about transsexuals and learn more specific information about myself. What I read terrified me because I was reading about my truth and my reality. These learned professionals were describing me in detail and they had no way of knowing me. Yet they were writing about me in such accurate detail that it was truly terrifying.  I in no way wanted to be one of those people who I was reading about. Yet I could not keep from going back over and over again to read everything there was about people like me. I had to know the truth even if I was a long way from being able to accept that truth and was very desperate to prove to myself and to those that I imagined could see who I truly was, that I was not like those people I read about.

Really, it was far easier to go out every day and endure the extreme physical punishment I experienced every time I played with the others than to face up to and accept the reality of who I was. The older boys seemed to relish every opportunity to hit me as hard as they could since they couldn’t deliver the same degree of physical punishment to boys their own age and size. The coaches seemed to also relish matching me up against the oldest and biggest team members as well. After all, isn’t that what someone like me deserved for being such an abomination? Perhaps I was hoping they would literally beat the transsexualism out of me. Looking back, I realize what a sad mindset that was for a young child.

It’s really no surprise that the first year playing with them that I broke my nose, had a very painful tailbone injury and in hindsight I recognize that I suffered at least three concussions of one degree or another. Eventually, I had to have cervical spinal surgery due to injuries sustained from helmet to helmet hits which were legal at the time. These are particularly dangerous on kickoffs and kickoff returns.

A culture of hazing existed as well, fostered by tradition and encouraged by the adults who ran our program. Instead of garnering respect for what I did, something that I had desperately hoped for, something that no one my age did until we were all 15 and then only two other classmates (in my third year of playing), participated in, I was the subject of physical, emotional and eventually on one isolated occasion the victim of sexual abuse. Because of the emotional abuse and that one incident of sexual abuse I became convinced that they knew my secret, but in hindsight, I know this not to be true. They were simply abusive and probably were acting out many things that had been perpetrated upon them coming up through the same system. The difference between me and them were that some of them were gifted athletes and I was not. They did not , however, to my present degree of knowledge, harbor a secret that caused them tremendous guilt and shame. I did.

What I was able to accomplish was accomplished through my sheer willpower and determination. I was the only one in my class to play football 6 seasons at my school. I was the only one to earn 4 varsity letters in football and three Junior Varsity letters. I was the only one to start offense and defense during my Sophomore, Junior and Senior seasons and I set two school records at the time in my Senior year for fumble recoveries in a game and in a season. Not being a skill player, I accomplished these things as an undersized offensive and defensive lineman. I accomplished this through having learned to take heavy physical punishment and doling out my own when the opportunity presented itself.  I earned my accomplishments through willpower and desire, not through any athletic talent because I am not talented athletically.

Over the years between that first year and my last season, I had probably suffered 4 or 5 more concussions. Nobody paid attention to that back then and hitting each other helmet to helmet was expected. I injured a shoulder, a knee, broke a finger, and one year experienced such severe staph infections all over my body that they nearly resulted in my hospitalization because I hid the extent of them until the season ended and I missed the next two weeks of school because I was too sick to attend after the season was over. Years later I required surgery to fuse my cervical spine as a consequence of way too many helmet to helmet hits, particularly on kickoffs and kickoff returns. That sort of dangerous contact was legal back then.

Really, it was far easier to go out every day and endure the extreme physical punishment I experienced every time I played with the others than to face up to and accept the reality of who I was. The older boys seemed to relish every opportunity to hit me as hard as they could since they couldn’t deliver the same degree of physical punishment to boys their own age and size. The coaches seemed to also relish matching me up against the oldest and biggest team members as well. After all, isn’t that what someone like me deserved for being such an abomination? Perhaps I was hoping they would literally beat the transsexualism out of me. Looking back, I realize what a sad mindset that was for a young child.

It’s really no surprise that the first year playing with them that I broke my nose, had a very painful tailbone injury and in hindsight I recognize that I suffered at least three concussions of one degree or another.

A culture of hazing existed as well, fostered by tradition and encouraged by the adults who ran our program. Instead of garnering respect for what I did, something that I had desperately hoped for, something that no one my age did until we were all 15 and then only two other classmates (in my third year of playing), participated in, I was the subject of physical, emotional and eventually on one isolated occasion the victim of sexual abuse. Because of the emotional abuse and that one incident of sexual abuse I became convinced that they knew my secret, but in hindsight, I know this not to be true. They were simply abusive and probably were acting out many things that had been perpetrated upon them coming up through the same system. The difference between me and them were that some of them were gifted athletes and I was not. They did not harbor a secret that caused them tremendous guilt and shame. I did.

What I was able to accomplish was accomplished through my sheer willpower and determination. I was the only one in my class to play football 6 seasons at my school. I was the only one to earn 4 varsity letters in football and three Junior Varsity letters. I was the only one to start offense and defense during my Sophomore, Junior and Senior seasons and I set two school records at the time in my Senior year for fumble recoveries in a game and in a season. Not being a skill player, I accomplished these things as an undersized offensive and defensive lineman. I accomplished this through having learned to take heavy physical punishment and doling out my own when the opportunity presented itself.  

Over the years between that first year and my last season, I had probably suffered 4 or 5 more concussions. Nobody paid attention to that back then and hitting each other helmet to helmet was expected. I injured a shoulder, a knee, broke a finger, and one year experienced such severe staph infections all over my body that they nearly resulted in my hospitalization because I hid the extent of them until the season ended and I missed the next two weeks of school because I was too sick to attend after the season was over.

Over these six years, I continued to read every professional book that came out on transsexualism. By the time I was in my last season of playing I had lost the enthusiasm for trying to hide by playing football. I didn’t show up for summer practice, preferring to work at my job at the hospital as a nursing aide. I questioned why I bothered playing at all at that point. I simply didn’t care. It was clear to me that I was not like the others

either at the most fundamental level. Football is a game for men and I was never a man. I was a woman. I just couldn’t accept that fact at that time, though I knew it to be true. The only reason I continued to play was to finish what I started. I knew I didn’t have the talent or physical size to play at the collegiate level, though I tried to convince myself otherwise and spoke with several Division III coaches of schools I was considering attending. None of them encouraged me.

Looking back, I am glad that I had the experience of playing football and enduring what I did. I learned to take beating after beating. Sometimes I wonder how I got back up each time after each one, but I know that learning to endure and survive that experience year after year gave me the internal strength and fortitude to be able to finally come to terms with myself and go through a gender transition. Not many people who grew up in the times that I did have been able to do that. Gender transition is probably one of the hardest human experiences one can undergo. Many of the things I learned about myself back then and the willingness to endure what I willingly endured gave me the strength to do what I had to do to live my life authentically. The tolerance to pain, both physical and emotional in nature gave me the courage and emotional resiliency to undergo my gender transition. I paid it forward. It was worth the price.

on my team. I could never be. It wasn’t my fault, and it wasn’t really their fault

either at the most fundamental level. Football is a game for men and I was never a man. I was a woman. I just couldn’t accept that fact at that time, though I knew it to be true. The only reason I continued to play was to finish what I started. I knew I didn’t have the talent or physical size to play at the collegiate level, though I tried to convince myself otherwise and spoke with several Division III coaches of schools I was considering attending. None of them encouraged me. This time I decided to listen.

Looking back, I am glad that I had the experience of playing football and enduring what I did. I learned to take beating after beating. Sometimes I wonder how I got back up each time after each one, but I know that learning to endure and survive that experience year after year gave me the internal strength and fortitude to be able to finally come to terms with myself and go through a gender transition. Not many people who grew up in the times that I did have been able to do that. Gender transition is probably one of the hardest human experiences one can undergo. Many of the things I learned about myself back then and the willingness to endure what I willingly endured gave me the strength to do what I had to do to live my life authentically. The tolerance to pain, both physical and emotional in nature gave me the courage and emotional resiliency to undergo my gender transition. I paid it forward. It was worth the price.

Remembering Gianna Israel

Did you know Gianna Israel? She was one of the most remarkable women I've ever met. I met Gianna before she met me, reading her columns in Transgender Tapestry. What she was writing about us and our lives was better than anything else I was reading about overcoming our struggles and how to overcome them, keep the people we love in our lives and to be happier in our affirmed gender.

I sent her an email and to my surprise and joy, she answered back. This was in 1996. I never think that people who have accomplished so much will have time to spend on me. I'm always wrong about that. Happens every time. Now, in some ways that is a pretty sad comment on how I feel about myself at times, but on the other hand, imagine how happy I am when someone of her stature writes back to me and even better, we become friends! That's the part I mainly end up thinking about.

Gianna and I wrote back and forth, then we started calling each other on the phone from time to time. I'll always remember her wonderfully hilarious sense of humor; once she had been complaining to me about her little dog, a Yorkie, for a while. Her dog was lavishing her affections on her roommate and ignoring Gianna, much to her disgust. She used to refer to that dog as "that farm animal" and was always talking about getting rid of it and getting another dog. I about rolled on the floor laughing the first time she called her a farm animal, and after that I always had to get updates on the farm animal!

 One day she sent me a picture of the dog over the internet labeled "farm animal. jpg. When I opened it, there was this little dog sitting on the roasting pan in the oven surrounded by potatoes, onions and carrots looking at the camera with her little bright eyes and a doggie smile on her face! I just about died laughing and still laugh when I think about it today.
Another time I had been complaining about how long it took to shave my legs and body. She said she had something that really helped her speed up the process and sent me this picture of a disposable razor with three heads! She was just about the funniest woman I ever met.

As our friendship grew, we would call each other once or twice a month between our emails and I would call upon her to consult with me on my transgender patients when I had just started working with others, or just for some nice girl talk.

As a professional courtesy, she did my evaluation for HRT, but I didn't use it until 2006 due to my own fear and indecisiveness about whether to transition or not. I kept the letter all these years and used it for the doctor I was going to see originally, who I have been referring to over the past 15 years. I have that letter in my scrap book I am making and I cherish it.

What was the most interesting thing about Gianna, was that even though she had been a throw away transsexual street kid and never even earned her G.E.D., she was highly self educated and was one of the best gender scholars I have ever known. She wrote and edited the book Transgender Care as the principle author with Donald Tarver M.D. The book discusses in depth how to provide quality comprehensive services for transsexuals and proposed revisions and additional recommendations that informed the American Psychiatric Association and the World Professional Association of Transgender Health of which she was a member, (At the time of the publication of her book, this organization was still known as The Harry Benjamin Gender Dysphoria Association) on revisions to enhance the quality of lives for people uncomfortable with their assigned birth gender.

But what I admired most about Gianna was that she had the most remarkably kind attitude and love for life despite having been thrown out on the streets as a very young teenager, having to cope with a seizure disorder and was suffering from AIDS. She eventually succumbed to neurological complications while writing and editing another book on treating transgendered people that I was supposed to write a chapter for on family preservation.

When we lost Gianna on February 22nd, 2004, we lost a bright shining light of love and hope in our community. In my own little way, to honor her presence in my life and that I may never forget how much she meant to me as a friend, I still keep her name and phone number on my cell phone as it gives me a reminder of who she was and of our friendship.

Sage Smith is Still Missing!

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

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.

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**
Subtypes

• With a disorder of sex development [14]
• Without a disorder of sex development

Specifier
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?