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.

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.

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.

Further Along....... The Human Resources Meeting

Yesterday I met with the senior managers of Human Resources of my health care system along with my immediate supervisor. I was very surprised that two of the senior executives were present and both assured me that I was a valued employee and that they would unconditionally support my transition at work. I am so pleased that the fear that I had that asking to transition would be the kiss of death of my career there was misplaced. I have been working at my health care system for 11 years and my worst fear, as many of us have, is that I would suddenly become an expendable.

Instead I was told that the organization would do everything possible to make my transition easier and addressed the issue that my health care has not been covered. They will address that with our insurance company so that my health care needs are covered and will look into the coverage of any surgeries that I need to become whole.

Initially, I was to meet with my supervisor and one of the senior management team but both the Director and Assistant Director were both present to convey their support for me. We talked about other concerns and they assured me that they would do everything within their power to ensure that my transition would be smooth and they would make sure that I would be shielded from the small town media, particularly the two local newspapers. Of course, this could be a big story in a rural setting and being a quiet and introverted person, any attention of this kind is something I am keen to avoid.

Two weeks from today, my coworkers will learn of my decision to transition at our January staff meeting. I will not be there, but my supervisor will discuss this with the staff, pass out a letter that I have provided to my coworkers and some pictures to assure them I will have a polished and professional image. I will invite them to come talk with me if they would like and do every thing in my control to make this as easy for them as possible.

I have decided to transfer out all my adolescent patients. I do not wish to complicate their already troubled lives with having to cope with my transition. Some people may criticize my decision and that they should deal with my transition as a normal part of life. I counter that position with the idea that adolescence is hard enough in the best of our lives. Troubled young people should not have to deal with my transition adding to their distress as they cope with their problems and form their own emerging identities.

I anticipate some of my patients leaving my care because they are unable to deal with my transition. I think most of them will be male and most of the women I work with will be able to weather the transition more easily and be accepting, even welcoming. Some men seem to have an innate fear of the feminine and some will not be able to cope with the idea that I have given up male privelege and become a woman.

I think I may lose between 15 to 20 % of my caseload, but with the flood of new referrals we are experiencing, I should be able to make up the deficit in about two to three months, if even that long.

I feel very blessed to have such a supportive employer. Some people who know me will no doubt say "told you so!!" and they are right. Just as importantly, I have the support of Patty, which is my number one concern and I have assured that I can continue to provide the things for her that I bring to our marriage without undue or unnecessary distress to her more than what a gender transition already brings.

Tonight I am a happy woman!

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.

But Enough About Us, Sherri! How About You?

Well my dears, I've had a lot of things to talk about lately, but I haven't been sharing about what I'm doing and what's going on in my life. It's time to catch up!

It's been a rollercoaster in some ways, I have been involved more with my mother and father since my father's heart attack in the beginning of May. We were told that he likely would not live more than six months and more likely two months due to the extent of his decline over all from old age and the failing of several organ systems. He has been ill for years and never recovered from his heart valve replacement which resulted in vascular dementia due to having some strokes during the operation. Because of this, I  have been grieving him for years as I watched him decline and was quite prepared for this perhaps being his last illness. That has been a rollercoaster in that it appeared he was near the end and since then he has rallied, to all of our surprise and it appears possible that he may be able to return home in a month or so. That is where the emotional ride gets bumpy for me as I become more hopeful that he will get better and be more active when he comes home, rather than slide back into his decline. It seems that perhaps being in the nursing home rehabilitation unit has given him much better care than he was getting at home with Mom. I have been making comments to my mother about how well he is doing and that he should stay there until he has gotten the full benefit of his rehabilitation potential, or at least until I return from vacation in mid July. My mother is in significant denial of his health problems and particularly of his dementia. One of the big problems for someone with dementia is apathy and she see's this as his being petulant or wanting to be catered to, which is not the case. He simply has no volition to engage in anything active and the structure of the rehabilitation unit pushes him to be active. As a result, he is more active than I have seen him in the past year. He is appetite is much improved and he is beginning to walk again when he wouldn't move out of his chair at home. I hate to have to say this but I think both he and my mother will both live longer if he stays there permanently. They tend to feed off each other and they both seem highly anxious together. Mom seems to have benefitted with him being away and being under less stress. she is more relaxed and more pleasant.

All of this has taken my full attention and much of my energy.  I have to help Mom more with her home and visit with him, which I don't do enough because after a full day of doing therapy, I have little energy to visit during the week. I do a fairly good job of keeping healthy boundaries and taking care of myself. I do enjoy mowing, being out in the sun and this is my time to meditate, enjoy the sunshine, watch wild life and pray.

What is frustrating about this situation, is it has slowed down my coming out at work, which is the most major task left to accomplish before I can transition there. My therapist Dana, who has helped me so much with managing a lot  the coming out process. She suggests that I start applying for jobs as myself and if I get a job offer then I have a bargaining chip in case the hospital decides they no longer require my services. I think this makes sense. I would like to stay at the hospital, I've been there almost 11 years and have 14 to go so I can have a 25 year pension there. I would also not wish to lose my transsexual patients. I want to be able to continue to coordinate and build upon the comprehensive health program I developed. It would be a loss for me. But it would allow me to live as who I am in that aspect of my life. That is important to me. A lot of my friends will be frustrated to see me throw up a road block delaying my journey. I do have to think about Patty who is unable to work due to disability. I bring home a majority of the income and provide the health care insurance, so it is important to me that I take care of her as best I can. We have huge medical bills.

Of lesser concern is the ongoing and growing realization that there will be a low likelihood of any kind of stealth while I live in this area for a variety of reasons. Not long ago I was introduced to a retired therapist who knew me as a male and is good friends with my department head. That was very uncomfortable to me at the time and I am concerned that my work situation could turn into another coming out at a time and on a field not of my choosing.

Interestingly, (to me anyway) was the fact that last weekend my High School had a reunion of multiple classes with many people with who I went to school. I had absolutely no desire to attend. There are only three people I care to keep up with, three women from my class. The experience of high school was very painful to me as I suffered years of physical and emotional abuse there and no one intervened to stop it, though it was quite visible in such a small school. It has taken years of therapy to deal with it. Therapy helps; I have nowhere near the guilt, shame and anger that I carried for years, nor do I suffer to the extent I have with the severe depression I've had over the past five years.

I was quite interested in the idea of going to one of the events held in a restaurant as myself so I could watch the dynamics and not have them see me. Then I decided they weren't worth it. I would most likely become angry/ sad/ depressed over thinking about what happened to me, so it would serve no good purpose for me.

Looking at the pictures posted on Facebook from the reunion, it dawned on me that if I had gone, it could have been a disaster. It turns out that one of the people from school who was a year or two behind me also goes to my church and is a member of the Vestry (that is a Deacon, for those of us with a Southern Baptist heritage). He knows me now as Sherri and not as who I was. If I had gone, he likely would have recognized me from church and then I would again be in a situation of coming out at a time and a field not of my choosing again and I find that very wearing, as I have written about in the past here.

Soon I do intend to let my three women friends know about me soon and I expect that at that point it will work its way around the alumni of my High School, and that will be ok. The difference being that I told who I wanted to tell who matter to me and if at that point, the rest of them find out, I don't care really.

What I don't like about the situation is my lack of the right to privacy, which we refer to as stealth. I become more and more aware that stealth for me at my age and situation is mostly not going to be. So I have been readjusting my thinking about how important is stealth in my life. After all, even if people do know about who I was, is it really a problem if I am treated as a woman and people interact with me as the woman I am? Is it realistic for me to expect any more given my dual professional identity and my presence in the community I grew up? I think that the expectation of my having a lifw where no one knows of my male past is unrealistic. It sets me up for feeling bad about myself, rather than enjoying the life I should have taken responsibility to have made happen literally decades ago.

The obverse of that coin is that I can't afford to dwell on the "wasted" years. Really? Wasted? No, not really. I have accomplished a lot, both personally and professionally. Rather, it is much better to be living in the moment of now, which is a much happier time in my life and look towards the future in which I will be who I always was, but hid so well.

So what about the man at church I know who went to school with me all those years ago? I think it is time to tell him. That will be good thing, I'm sure.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Transphobia: How do you victimize yourself?

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

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

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



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

Consider the following statement:

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

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

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

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


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