Texas Federal Judge Grants Injunction to Group Who Wants to Discriminate against Trans People's Right to Health Care

Yesterday, I read an article online in the Washington Examiner that a Federal judge in Texas granted a temporary injunction against regulations in the Affordable Care Act that mandates health care providers provide medically necessary health care services to people who identify as transgender.

 "The Catholic Benefits Association, which represents more than 700 Catholic employers including many hospitals, filed a lawsuit in federal court Dec. 28 in an effort to get its members exempted from the rule. Five states and several other Christian healthcare providers are already fighting the requirement in another case against the rule. A Texas judge halted the rule over the weekend.

The rule, which went into effect Jan. 1, says that doctors can't refuse to provide medically necessary health services within their scope of practice because of a patient's gender identity. For instance, a gynecologist couldn't refuse to perform a cervical Pap test for a transgender man .The rule doesn't explicitly require doctors to perform gender transition services, but it says providers can't refuse services they already provide based on discrimination. The Department of Health and Human Services wrote that it would deal with complaints of discrimination on a case-by-case basis, by looking into whether a doctor provides the same service when it's not related to gender transition.

"These provisions do not … affirmatively require covered entities to cover any particular procedure or treatment for transition-related care," the rule says." ( Washington Examiner 1/3/16)

Those who are suing believe that the rule can be interpreted so that medical providers would be compelled to specifically provide medical care for medications and procedures that are directly related to transitioning, such as prescribing hormones, gender reassignment surgery, feminizing voice therapy, or mental health services.

I think that their argument is specious at best; no health care professional can be compelled to practice in an area that they have no training or expertise (or interest for that matter). As a transsexual, I would not wish to place my health care for specific services that related to my own transition in the hands of a provider who did not have expertise in those areas related to my transition and ongoing medical care.

However, there are many areas of health care that we receive that have nothing to do with our transition. For instance, everyone needs to have the blood chemistrys, lipids and blood counts done done once or twice a year as part of routine health care. People need to be treated for high blood pressure and screened for breast cancer, colorectal cancers and other health conditions related to aging, regardless of their gender identity if they are biologically at risk for these conditions. I'm reminded of Robert Eads, who had ovarian cancer and was unable to find health care professionals in Georgia who refused to investigate symptoms that suggested cancer until it was too late for him to be cured and he died needlessly due to blatant discrimination based on his identity. I think such callous treatment of any human being is criminal.

It is concerning that some members of the new Trump Administration appear to be opposed to transgender rights established by the Obama Administration, notable Vice President elect Mike Pence. The nominee for the Health and Human Services Tom Price has also voiced opposition to the Obama Administration's policies as well, but Obama's agenda included allowing those who have not had gender reassignment surgery to use locker rooms and showers with cis gender individuals and personally, while I am for free access to public rest rooms, I think the Obama Administration's position on locker rooms and shower facilities were only trying to create a political wedge issue and there would have been much less opposition to enacting rules that allow for bathroom use only. 

It is difficult to find whether these individuals are strictly anti trans in every circumstance or whether they have more nuanced views. Primarily, I find the truth difficult to come by because the media is openly biased and does not report the news objectively any more. Transpeople are lumped in with GLB coalitions and people don't even understand who we are. The media certainly doesn't distinguish in reporting news that pertains to us. In any case, I think that if a health care professional refuses to provide medically necessary treatment that is non transition in nature, that health care provider should lose their license to practice.

 Again, time will tell. Mr. Trump himself appears to be at worst, neutral towards transgender people, and in some instances has expressed support for us.

I think it is incumbent for us to communicate with our legislators of every political persuasion by writing to them and writing in a respectful and well reasoned tone about what we believe. If one wants to persuade a legislature, one should not engage in hyperbole or be antagonistic in nature. We have more to gain by respecting civility, rather than engaging in a rant. 

Further Along: Back From My Hiatus

Well here I am again. I've decided that it is time to return to writing on my blog again after an extended absence that came as a result of the Islamic terrorist attack at the gay nightclub in Orlando Florida and subsequent news that there was a hit list of names that ISIS had released. A published map showed that targets were listed in both Charlottesville, VA and Staunton, VA. I happen to live between those places and chose to become less public for a time while things settled down.

I wish I could say they have, but the recent political unrest after the election of Donald Trump and then the Islamic terrorist attack at Ohio State University last week indicates otherwise. Nevertheless, I am finding things that I want to write about and share with all of you.

To catch up.....How I Spent my Summer.......

This year I have spent a lot of time taking stock of what it would take to survive some sort of catastrophe either weather related or man made. I decided to buy long term storage food to last 60 days and I planted my first garden in about 20 years. It was done in raised beds, so I found it easy to care for once the beds were constructed. I'm very glad that I won't have to build more frames this year and then prepare the beds inside the frames. That was really hard work. We had a decent harvest despite a super wet spring followed by a lot of drought. I will need to improve my ability to water the garden this coming year and work out a few other problems, but we were able to can and freeze enough vegetables to get through the winter into next growing season. I'm going to keep the garden the same size next year and focus on improving upon what I have put into place. It was a lot of hard work but in my opinion, well worth the effort.

We made other preparations for difficult times. I bought some camping stove burners and canned fuel so that we could have hot food and a coffee pot to use with it. I put 8 bags of charcoal away for such occasions as well. Hard times call for the little things that boost morale.

Safe heat to keep us warm is still an issue, but I bought chemical warmers that will have to do until we can do something better that will be safe in the house. Long term plans will include a generator and perhaps solar panels for electricity, but in the meantime we have 8 LED lanterns that will provide us enough light. For entertainment we will have books and the radio as well as a battery operated CD player.

We also found that a vacuum sealer by the Foodsaver company will allow us to keep frozen meats and vegetables in top quality for around a year and I would recommend this product highly to anyone for long term frozen food storage.

Some of you may know that I love to play golf and it is a spiritual meditation and discipline for me as well as a source of exercise. I had a bad fall in March and was unable to play until the end of June due to back problems. I was able to enjoy playing most of the rest of the summer until the week before Thanksgiving only missing a week here and there when my back wasn't feeling too good or the weather didn't cooperate.

Work was difficult over the last six months due to the financial hardships my employer (a community hospital) faced due to the negative impact of OBAMACARE. We were threatened with the possibility of our mental health outpatient clinic being closed throughout the summer but were granted a reprieve for the coming year at least and will remain open. Faced with the prospect of having to go back into private practice, I learned that the rate hikes in the health care exchange here in Virginia was going to raise the premium by $400.00 a month which would have made health insurance unaffordable for someone in a solo private practice. It would have cost me $900.00 a month. I would not have made enough money to live on with a premium like that, so I am very thankful that our practice at the hospital was spared for another year. All over I see clinical services being cut back and rationed due to OBAMACARE and I am hopeful that most of its provisions are scrapped with the exception of keeping the ban on exclusion  of preexisting conditions. It is my hope that competition between health insurance companies will no longer be restricted within states and they will open up competition between health insurers nationally. By just that action alone having a nationwide pool of insured people will reduce the cost of premiums for individuals and make insurance more affordable for small businesses to provide that benefit to their employees.

I hope that you, my readers have had a great summer and I look forward to writing more frequently over the coming months.

It Seems Like Being an American Citizen Doesn't Mean Much Anymore

Today, I saw a news report from a source called "The Daily Caller" that reports an illegal alien who is also a convicted felon under our law (besides having entered the country illegally) was granted asylum because she claims she is a person who is transgender and alleges she was abused sexually by family members.

DAILY CALLER NEWS FOUNDATION

Federal Court: Illegal Immigrant And Convicted Felon Can’t Be Deported Because He’s Transgender

Blake Neff reports:

"A federal appeals court has ruled that an illegal immigrant and convicted felon can’t be deported back to Mexico because he identifies as a transgender woman, which leaves him vulnerable to torture back in his home country.

Edin Carey Avendano-Hernandez was born male in Mexico, and claims to have been raped by his brothers and suffered other torments. In 2000, he illegally entered the U.S. and took up residence in Fresno, California. Avendano-Hernandez also started taking female hormones and began living openly as a woman in 2005. In 2006, he committed two separate drunk driving offenses, the second of which injured two people and resulted in a felony conviction. After serving a year in jail, he was deported back to Mexico in 2007.

Back in Mexico, Avendano-Hernandez claims to have been subjected to more harassment from family and neighbors and to have been raped by members of the Mexican army. He illegally entered the U.S. again and, after being arrested, petitioned for sanctuary in the U.S. under the U.N. Convention Against Torture (CAT), arguing that deporting him would violate the CAT because he would more likely than not experience torture at the hands of Mexican authorities.

An immigration judge and the Board of Immigration Appeals (BIA) both rejected Avendano-Hernandez’s arguments on the grounds that he had committed a serious crime (felony drunk driving) and was not likely to face official torture.

Now, a three-judge panel on the Ninth Circuit Court of Appeals says Avendano-Hernandez must be allowed to stay in the U.S., because he “more likely than not” will be tortured if returned to Mexico.

Judge Jacqueline Nguyen, an Obama appointee, chastised immigration officials for improperly handling Avandano-Hernandez’s gender identity.“The [judge] failed to recognize the difference between gender identity and sexual orientation, refusing to allow the use of female pronouns because she considered Avendano-Hernandez to be ‘still male,’ even though Avendano-Hernandez dresses as a woman, takes female hormones, and has identified as woman for over a decade,” Nguyen’s decision says. “Although the BIA correctly used female pronouns for Avendano-Hernandez, it wrongly adopted the [judge’s] analysis, which conflated transgender identity and sexual orientation. The BIA also erred in assuming that recent anti-discrimination laws in Mexico have made life safer for transgender individuals while ignoring significant record evidence of violence targeting them.”

Nguyen cites the repeated sexual abuse Avendano-Hernandez claims to have endured as evidence of de facto torture, and furthermore concludes that these actions were not crimes co“Avendano-Hernandez provided credible testimony that she was severely assaulted by Mexican officials on two separate occasions: first, by uniformed, on-duty police officers … and second, by uniformed, on-duty members of the military. Such police and military officers are “public officials” for the purposes of CAT,” Nguyen wrote. She added that this torture was likely to resume should Avendano-Hernandez ever return to Mexico.

The belief that Avendano-Hernandez was raped and tortured in Mexico appears to be based entirely on his own claims, which were deemed to be “credible” by his immigration judge.

Nguyen said it did not matter that in recent years Mexico has passed laws intended to protect its gay community, arguing that those laws don’t extend far enough to protect the transgendered.

The belief that Avendano-Hernandez was raped and tortured in Mexico appears to be based entirely on his own claims, which were deemed to be “credible” by his immigration judge.

Nguyen said it did not matter that in recent years Mexico has passed laws intended to protect its gay community, arguing that those laws don’t extend far enough to protect the transgendered.

“[L]aws recognizing same-sex marriage may do little to protect a transgender woman like Avendano-Hernandez from discrimination, police harassment, and violent attacks in daily life,” she said. She added that Mexican police sometimes target the transgendered for extortion and sexual favors, and said the country has an alarming number of unsolved murders of the transgendered.

The decision technically doesn’t spare Avendano-Hernandez from deportation, but it means his deportation will be delayed until he no longer faces a risk of being tortured.

While the decision only applies to Avendano-Hernandez, it could encourage more transgendered Mexicans to seek asylum in the U.S., as Nguyen’s description of torture in Mexico is quite general."

It seems to me that our government is not so concerned with protecting our U.S. Citizens and guaranteeing the rights of law abiding transgender citizens as they are trying to weaken the rights of American citizens across the board. It amazes and appalls me that our courts find that illegal aliens have the right to bear arms under the second amendment of the United States Constitution. Sanctuary Cities are allowing to illegal aliens to vote in their elections.

It seems to me that under the current government's interpretation of constitutional law, law abiding natural born citizens, including law abiding transgender citizens are not being afforded the Constitutional protections we are entitled to, while those whose rights have been suspended or removed due to criminal conviction, or because they are here because they entered the country illegally (which is in of itself a felony) are being afforded more protections and freedoms than the rest of us.

It really doesn't mean much to be a law abiding transgender American citizen, much less any American citizen anymore. Convicted felons who identify as transgender get better health care and more access to transgender health care up to and including sexual reassignment surgery. Anyone who claims they are transgender who are illegal aliens get asylum and get all kinds of access to social welfare programs and transgender healthcare no matter what crimes they commit, in addition to entering the country illegally.

Those of us who are natural U.S. citizens who go to our jobs and work every day and meet our daily obligations are pretty much short of luck in getting the health care we need. On top of that, to add injury to insult, we have to pay the government to take care of the people who have committed felonies and come here illegally. If we protest, then we are branded as racists and inhumane. We have to pay to provide transgender health care for convicted felons that we can't afford for ourselves. What a crock of junk this is for us to have to swallow. So yeah, I'm pretty disgusted at this point and to me it really does seem that being an American citizen doesn't mean much anymore. There's not much left to take pride in.

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.

Sweet Home Alabama

Here I am with Patty in Birmingham, Alabama. We left for vacation on Wednesday morning and had a really nice drive down. Alabama is probably my most favorite place to be and I really do miss living in Tuscaloosa, where I went to graduate school at the University of Alabama School of Social Work, even after all these years. I haven't been to Alabama in about 5 years, I think.

The occasion of this trip is mixing business with pleasure. I am here with Patty to attend a workshop given by Thomas Moore, who writes of all things spiritual and is giving a workshop on finding spirituality in a secular world. It is an occasion to continue my education for maintaining my licensure as a Licensed Clinical Social Worker as well as visiting well loved places and enjoying things that I miss.

We are in Birmingham until Saturday and then move on to Tuscaloosa. Today we dined at a restaurant in downtown Birmingham called the MIX and enjoyed that. Then we went to the Birmingham Museum of Art where we were treated to some very fine collections of ancient Chinese, Japanese and Korean art from the times of antiquity. They also have a wonderful collection of Wedgewood china and porcelain.

After that, we returned to the room to rest a bit and then went on to Bessemer for dinner at the Bright Star. Anyone who is travelling through the area and is looking for a fine dining experience with down home hospitality should make it a point to visit the Bright Star for dinner.

Their specialty is southern cuisine with a Greek spin to it. We enjoyed fried green tomatoes with shrimp and salsa and a hollandaise sauce, shrimp and crab gumbo for appetizers and I had red snapper prepared in a greek style, a greek salad, shrimp and crab au gratin and eggplant.

One of the owners came by to visit and I told him that it had been a much overdue visit since the last time we had been to the Bright Star, about 10 years and that we had made it a point to come on our vacation. He was so touched that after we were done with our meal and had paid our tab, our waiter asked us to wait because the owner had something for us. He said that the owner had said that our comments touched him and had made his evening! We were served with coconut cream pie and their special peanut butter pie. It's the small kindnesses such as this which makes me miss it here so much. What a wonderful way to end our day!

Tomorrow, we plan to go visit the 16th Street Baptist Church, which was bombed in 1963, killing three little African American girls during the darkest time of racial hatred against African Americans in our country. It is my intention to go and pray for them and for bigotry and hatred to be driven from our society in what ever form it may take. We have come a long way, but we have so far to go as it takes so many forms against so many people for too many reasons, none of which can be tolerated.

After, that I hope we can have time to visit the Birmingham Zoo as they have a wonderful elephant exhibit and are one of the leaders in helping to find ways of preserving wild elephants in their natural habitat. We also hope to have time to go see the statue of Vulcan, the Roman god of Fire, who symbolizes Birmingham's history of manufacturing iron and steel.

Saturday afternoon, after the second half of the workshop, we head on to Tuscaloosa, where we plan to see a University of Alabama baseball game.

On Monday, I have an interview with the Dean of the School of Social Work to explore the possibility to return to teach there.

Of course there are some favorite places to see and places to eat, especially the Waysider for breakfast, Buffalo Phils for Buffalo Wings, and then the other two dining highlights, Dreamland who have the best BBQ ribs anywhere and the Cyprus Inn overlooking the Black Warrior River.

It should be a delightful time for us both!

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.

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.

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!

Trans Conventions: Why Should You Go to One?

Each year, there are opportunities to attend one or more trans conferences around the country. As time has gone by, there are more and more conferences available to attend regionally, providing opportunities to learn more about ourselves, meet people like ourselves, have fun and find out about options for medical and aesthetic care. At some conventions there are also continuing education tracks available to educate professionals such as myself. We are taking the responsibility for finding professionals who can educate other professionals who are interested in helping us and providing these important opportunities. I have both given workshops to other professionals and received a substantial amount of continuing education over the past two years. That has allowed me to solely focus on studying sanctioned curricula by my profession and teach to other professionals. Because of these opportunities, I have completed 73 hours of continuing education in the last two years on top of the self directed studies that I have been engaging in over the past 16 years. That is equivalent to 4.5 semester hours in a graduate program.



Since 2009, I have been attending conferences to offer workshops on the history of mental health treatment of transsexualism and what is the present state of the art in transgender care. I do my best to provide education to other professionals and seek out the best education opportunities that I can find, as well as unravel the misconceptions about the WPATH Standard of Care, and myths that abound in the gender community to the members of our community.

I have not been to all the conferences available to go to, but have been going to Southern Comfort Conference each year. Southern Comfort is the largest conference I have attended and is one of the longest running and largest conferences in the U.S. This year will be my fourth time presenting a workshop there. This conference is the most dear to me because Southern Comfort gave me my first opportunity to present a workshop on my area of specialization.



 I have given a workshop at the Trans Philadelphia Health Conference, which is the largest health conference in the world on the topic of transgender care and last year chaired the mental health workshop selection committee for this conference. I have also attended the Keystone Conference in Harrisburg, Pa., TransOhio Conference in Columbus, and Chicago Be- All and I have to say, I have enjoyed them all. Besides the opportunity to give or get these educational opportunities, I have treasured the friendships I have made at the conferences and the opportunity to spend time with many wonderful friends that I have across the nation thanks to the Internet and through the past four years that I have been a member of Pink Essence. I attended five conferences last year.

What can you expect at these conferences? Be prepared to meet all sorts of people from every walk of life and from all over the U.S. It is not unusual to meet people from all over the U.S.



You will have an opportunity to attend workshops on various topics that include counseling, etiquette, how to move in a feminine manner, fashion styling, medical health issues such as hormone regimens, aesthetic and gender reassignment surgeries, voice therapy, how to transition at work, improving family and spousal relationships, sexuality, spirituality, substance abuse, laser and electrolysis hair removal, legal issues in identity management, advocacy and participating in the legislative process. There are many more topics too. If you are a female to male transperson, there are plenty of topics for you too!

Just as importantly there is time for FUN!! Usually there will be organized activities and excursions to see local points of interest, to shop, and get pampered in salons.



The conferences provide special attention to first time attendees, so they will not feel frightened. For some, this will be the first time she will have had to be in public and this can be very overwhelming. Some conferences will offer a "big sister or big brother" to help first time attendees. There are sad stories about people coming for their first time who were too afraid to even come out of their room and hid the whole time they were there. Often there are 12 step meetings available for our recovering brothers and sisters.

An illustration of the important role conferences play in some of our lives can be seen frequently on the last night. You will see many people who stay up all night that last night with friends who they wont get to see for another year. Most poignant is watching those who are sad that they will not have an opportunity to express who they truly are for another full year. They look so forlorn, it is heartbreaking. That is exactly how important these conferences are.

If for no other reason, this is an opportunity to learn more about yourself and sometimes you will learn a little bit about other people, different from yourself, but in some ways the same.

I hope to see those of you who I have met and meet many of you I have only met through the Internet this year!

Obama Care is Constitutional

Last week, the Supreme Court of the United States ruled that Obama Care is constitutional under the right of the government to tax the citizens. Personally, I was surprised that it was upheld. In my opinion, there were several areas of the Constitution that had been violated. I do not represent myself to be a very learned scholar of the U.S. Constitution, nor am I an attorney. I do read quite a bit on law and politics and I do not restrict my reading to sources that are sympathetic to my beliefs. I do interact often with the legal system and do a lot of case research for the times when I appear before the court. I am not interested in presenting an arguement about whether this legislation is constitutional. Perhaps I might write about this aspect of Obama Care in the near future.

But I want to explain why as a health care provider, I am opposed to a socialized medicine system. Personal Disclaimer: I am going to be severely financially damaged on a personal level by Obama Care. There are two reasons for this. One is because of massive raises on  individual federal income tax rates. Consider that just less than 50% of people pay federal income taxes. The second reason is because it will seriously degrade the health care system in the United States. This is what I would like to discuss.

Essentially there are two ways to have a health care plan on a national level. There is the system that we have had, mostly funded by private insurance providers for profit, along with a basic safety net of  health care that by varying degrees is funded by private insurance policy holders and the government's funding through the confiscation of an individual's wealth through taxes. There is a social contract that we as a nation have agreed upon to provide indigent people with health care. This is mostly provided by Medicare and Medicaid. My hospital also gives away millions of dollars each year for uncompensated health care, as do many health care facilities and private providers of health care.  Locally we also have the Health Department programs and a regional Free Clinic.  The other major social program for health care is that under the Veteran's Administration for those who have sacrificed so much for our freedom.

The other system is what we commonly call "socialized medicine". It includes health care systems of Canada, Mexico, and the member states of the European Union for example. Many people tend to think of these systems as providing "free health care" but the reality is that health care is not free and that the taxes needed to sustain socialized medicine come with tangible and less tangible costs and in no small measure  are the reason that the European Union is in an economic crisis that will not likely allow it to survive. We have seen the EU cast aside member states who have become too large a sinkhole of capital. One or two of the member states who are subsidizing the European Unionwill likely decide to pull out before they reach the point of no return economically. All this may become a death nell for the "Global Economy" that every president since George H. Bush supported in 1988, Bill Clinton supported in 1992 George W. Bush supported in 2000 and Barak Obama supports. Note that there are two Democrat presidents and two Republican presidents, so the idea of the world economy is pervasive across the U.S. political landscape. I can't say the same holds the same for those who identify as conservative and those who identify as liberal. There are clearly drawn lines on which group thinks one or the other is the wiser economic model to implement. There will be millions of individuals who will be irrepairibly damaged through increasing federal demands for tax revenue to move to a socialist model of health care. No government can even be described as one as benevelently as Machiavelli is referred to as a "benign despot". Then again, I believe Machiavelli first referred to himself that way, not his peers.

My objections to socialized health care is that is doesn't improve the level of health care for a nation, it actually degrades accessibility to specialized care and leads to even more rationing of health care than exists under private insurance and managed care health plans. People who participate in the present system of care who have government entitlement services, specifically Medicaid and Medicare use medical services more often than those who have private insurance and are more inclined to go the the emergency room for issues that could wait for a primary care physician. They are less likely to access primary care first.

But if you like visiting the emergency room, especially like on a Friday evening- this is going to be your thing when you go to the primary care doctor. It will be just like that every time. Bring a book or your favorite electronic pastime. It's going to be awhile.

I can cite examples of problems both from what I have personally encountered with a friend and I can tell you of two example from my professional experience of a number of others in various countries in both North America and Europe. No one talks about nationalized health care in South America or Africa or China. We only tout the best of a failing system of health care emulate. How very capitalistic of a socialist ideal. That's what sells it.

The first example comes from my own profession in Great Britain. A woman fell into a terrible post partum depression. Despite A. Beck's evidenced based research that medication AND cognitive behavioral therapy work better than either one or the other alone and also better than doing nothing at all, she was determined too ill to benefit from psychotherapy. She went to the bottom of an 18 MONTH waiting list to get psychotherapeutic treatment. This was determined by a medical review board that functions to make treatment decisions. They are a function of the government NHI plan in Great Britain.

The tragic outcome of this sorry decision making was that the woman deteriorated to the point where she needed long term institutionalization and even more unfortunate was the eventual need to subject her to electroconvulsive therapy to due the extremely agitated and highly suicidal quality of her depression. that could have been avoided with psychotherapy.  This was printed in the British Journal Of Psychiatry.

A situation I personally know of is that of a Canadian citizen who in about 1996 blew out three lumbar vertebrae. I mean, destroyed the discs with near crippling pain. She was told that she could not have any surgery until she was actually unable to walk by the National Health Service. By then, severe nerve damage would continue to develop that would result in a life time of chronic pain. This is a person who would be in chronic pain anyway, but this plan of care resulted in unnecessary misery and further permanent debilatation.

I had an interesting conversation with some medical personel at the WPATH International Symposium this past year. They were from an European Union country and were explaining how superior their health care system was because they paid for gender reassignment therapy. They seemed quite proud to tell us about their 900 patient waiting list for the surgery itself after qualifying for it. Ok, I did the math on this. Based on the average of 5 a week, I came up a 4.5 year waiting list to have the surgery. I used the number of 5 based on doing surgery three days a week, scheduling six a week and bumping one due to complications during surgery at least once a week. I factored in time off for vacation and travel for professional activities. I factored in three week days in clinic and not in surgery for preop visits, consultations and post op care.

Here in the U.S. a number of private insurances are funding more and more transsexual services. the average wait to have surgery is 6 to 9 months depending on the surgeon. Who wants to throw three years of their life away waiting to have their surgery and be whole?

Lastly, please recognize that Canada's national health care system has dropped coverage for gender reassignment surgery in some provinces due to their system collapsing under the costs their system requires. Also, please remember that even Candada's Premeir came to the U.S. for open heart surgery because in their system of care, there wasn't anyone he wanted operating on him. If that is the one of the shining examples of excellence in health care that the leader of a great nation has to seek health care outside of his country, then this example is highly tarnished.

Do the Gender Police Confront You?

Sheri Berenbaum led a thought-provoking discussion about the often-debated topic of gender differences. An inquisitive crowd kept Berenbaum on her toes as she answered questions concerning whether gender differences are innate or learned. Drawing on over 15 years of research on congenital gender disorders—and using props such as Legos and make-up kits to illustrate her points—Berenbaum challenged the audience to "think outside the box" about the mix of social and biological factors that make us male or female. Sheri can be found on the web and also at her University, Penn State.

The Gender Police have drawn hard lines on people of my experience. We have the extreme Right who would say our very existence is an abomination and we have the extreme left who insist that we must identify as some blend of gender that is neither wholly male or wholly female. I find one as constraining as the other.

I wonder where it came from that if we were free and perfectly healthy individuals that if we identify as women, we are not respected as women or if we identify as men, we are not respected as men. This is the problem of the extreme Right. We simply want to live our lives and be left alone to the right of privacy as any other American Citizen.

The other side of the equation exists from the extreme fringes of Feminism and is solely an extension of Womens' Studies professor Janice Raymond's ideology. Even today as she rewrote a foreward to her book The Transsexual Empire: The Making of the SheMale.  Even with her new forward, which is a rather shallow apology to transsexual women, she still sees us as victims of a patriarchy. She was unable to and continues to fail to recognize that we are woman who for many different reasons ended up at odds with our assigned gender. The majority of these do not involve obvious anatomical variations. For this reason being politically coerced into a continuum known as "Gender Spectrum" includes vastly different presentations because of vastly different etiologies, makes us pawns in a political struggle between Left and Right.

Interestingly, the most negative people about the realities of our lives both as individuals and in varying collectives include the extreme Right and the Extreme Left.

For one group, our very existence on the earth is anathamema. For the other group, our very right to a unified gender identity is sacriledge. I find both extremes both nullifying simultaneously.

At this time in our culture, very few who wish to fall under the umbrella  of transgender identify as gender queer. They have every right to that identity. It's not my identity. I do not consider them to have the same orientation of gender or have much in common with me other than a political desire to be left alone and become the best me I can be.

Similiarly people who feel a mix of their genders but have no burning urge to match their physical being to their identity, may be known as transgenders, crossdressers or by other labels that they define themselves by, have every right to be left alone and become the best people they can be.

Simply put, I am a woman. This is not a sociological statement, nor is it a political statement. It is who I am. There are more women who were correctly assigned at birth and individuals such as myself who were not, but sought to correct that error. I do not identify as a third gender or a fourth or a fifth. I'm just a woman.

This is a dual journey that I travel. I am the gender therapist and the gender patient, I bring my experience, professional and personal to the therapeutic alliance. All therapists do that. It is somewhat more unique for my patients as I am also someone who has been going through a legitimate process per the standards of care established by the World Professional Association of Transgender Health, a body of which I am proud to me a member.

As many of you know, I have been developing a comprehensive health care system for transgender people in the Shenandoah Valley of Virginia. I have been instrumental in initiating the Speech and Language Department of my health care system to offer voice and communication therapy for transsexuals in order to be able to communicate in a gendered manner that is congruent with our identity.

In announcement to a health care online network, this program was rebuked with a harsh and in my opinion, unwarrented attack. The author of this attack who is a faculty member of a large institution of higher learning, stated that she found it highly offensive that such a program would state that the therapy offered would improve the ability to communicate in a more masculine or feminine style, depending on the preference of the patient. She stated that because of this, she would not wish to refer anyone there for voice therapy.

Personal disclaimer: I was involved in the initiative to develop these services, provided a number of training resources and linked them with other Speech and Language therapy professionals who are members of the World Professional Association of Transgender Health in their field who could be of further help in developing the program that we offer. In my opinion, they have developed a quality program that I myself have participated in and am so more than just comfortable in referring my patients who are interested in these types of services.

What I find to be most outrageous of this experience is the lack of forethought in the reckless condemnation of a service that person has no personal knowlege of, just a blind conviction of an ideology leading to  the same type of rigid results that the extreme right can be accused of (and rightfully so at times).

This is why I always say that I have found as much as bigotry, prejudice and hatred on the far right and the far left.

The issue at hand that I object to is that this person made a judgement that this person knows better for you than you do, therefore would not even grant you the opportunity to decide if this service would be helpful to you or not. Considering the philosophical orientation of this person, I find as much patriarchy in the Third Wave Feminist theory as they railed against in the Second Wave of Feminism. Each wants to control you, just to a different end, but neither will be the one of your own determination.

A pity, isn't it? I've seen absolutely no growth since Janice Raymond. 

To Your Health!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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