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/

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

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

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

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

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

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

Transphobia: How do you victimize yourself?

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

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

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



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

Consider the following statement:

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

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

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

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


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

Practicing What I Preach: My Life With the WPATH SOC

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

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

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

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

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

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

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