Post Traumatic Stress Disorder and the Transsexual Experience

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

Consider the diagnostic criteria of PTSD in DSM V

Criterion A: stressor

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (1 required)

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

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (1 required)

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

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event: (1 required)

1. Trauma-related thoughts or feelings.
2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event: (2 required)

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

Criterion E: alterations in arousal and reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (2 required)

1. Irritable or aggressive behavior.
2. Self-destructive or reckless behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems in concentration.
6. Sleep disturbance.

Criterion F: duration

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

Criterion G: functional significance

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

Criterion H: attribution

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

Specify if: With dissociative symptoms.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
2. Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").

Specify if: With delayed expression.

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

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

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

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

Gender Dysphoria
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2 or more of the following indicators:

1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]
3. A strong desire for the primary and/or secondary sex characteristics of the other gender
4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning,  or with a significantly increased risk of suffering, such as distress or disability**
Subtypes

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

Specifier
Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).

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

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

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

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

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

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

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

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

What do you think?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When I Was In Second Grade

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

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

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

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

I Told My Best Friend on Thursday

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do Transsexuals Discriminate Against Each Other?

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

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

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

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

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

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

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

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

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

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

I'm so glad you are my friend Amanda!

The Face of Trans Today

Over the past few months, I've begun to think about the question, "In the predominant culture (the United States, my culture) today, what is the image of being transgendered today?" I'm not sure that this is as easy a question to answer as it would appear on the surface.

This is something I've been thinking about since my adoptive niece Erica, made a comment about the featured speakers and content of the conference workshops at Trans Philadelphia Health Conference. Over the past few years, the content of workshops and speakers reflect a trend towards those who identify as "gender queers", particularly in the Northeast and West Coast.

According to the National Transgender Discrimination survey approximately 13% of people who were included in the survey identified as gender queer. Those who identify as gender queer are much younger than the general population obtained in the survey. 67% identified within the gender binary of male or female. Another 20% identified themselves as sometimes living as male and sometimes female, but still clearly identified with the gender binary concept to a large degree. 71% were under the age of 44 years, so the study does not accurately reflect the age distribution of transgendered people. 20% were in school at the time of this survey. It was also limited to those with internet access, so there are some confounding variables to this survey. In other words, the results cannot be considered statistically valid or reliable.

However, it remains the most important study on discrimination transgendered people face in the United States conducted to date. In my opinion, despite the limitations of the survey, it is the most accurate reflection of the life experiences of transgendered people in the US today.

 Individuals who identify as gender queer appear to be heavily influenced by an extreme left feminist ideology that is fashionable in academia at colleges and universities. It is known as third wave feminism. They advocate the ideological belief that individuals who identify with the gender binary schema are hurt by it as their lives are limited and scripted by having to conform to either a male or female identity. Instead, they argue, we must create a genderless society.

In October 2012, a Gallup Poll reported that a survey conducted from June 1, 2012 through September 30, 2012 found that approximately 3.4% of Americans identified as being transgendered. These are very similar results as reported in several other surveys since 2006 and can be considered a good estimate of the general population of the U.S. These surveys have a much higher degree of internal validity and reliability of the findings.

It is a more difficult task to ascertain how the culture perceives transgendered people. There are several ways of coming up with a general idea. One can look at how transgendered people are portrayed in the media such as in movies and television. Another way is to look at how transgendered people are portrayed in news sources. A third is to look at the programming presented at transgender conferences.

Curious to me, is the image that Jerry Springer provides on his television show. I'm also surprised that someone as strongly identified with liberal politics gets away with the way transgendered people are portrayed on his show and that he is so revered by the left. He regularly brings on the worst examples of transgendered people in our society. If one watches his show, one would draw the conclusion that transgendered people are promiscuous, adulterous, drug addicted and essentially shiftless people who engage in outrageous low life behavior. I do not dismiss the thought that at least some of what he portrays is staged, but I also think that some of the people he has on the show are real people. How Springer gets a pass on this from the transgender community is beyond me, but I see more far more attacks on conservatives who make negative comments about transgendered people and I can't ever recall anyone complaining about Springer. Yet he damages the image of transgendered people tremendously. Why is that? I wonder...

Another problem I see is very complicated and is a conundrum with no easy solution. We have a very high rate of suicide attempts, unemployment, addiction and alcoholism. Those of us who have been disenfranchised by lacking an education because of dropping out of school are also often marginalized and often end up working in the sex trades. I was very fortunate that despite being physically and emotionally abused in school for a significant portion of my high school years that I was able to endure that and later a brief period of homelessness (directly related to being who I am) and manage to overcome those experiences. I was fortunate to have overcome these experiences and I know that it was only by the grace of God that this happened. The majority of transgendered people are also people of color and in addition to the burden of institutionalized racism, bear the stigma of being transgendered.

Having said this, I clearly want to say this is not an attempt to "blame the victim". People do what they do to cope with being stigmatized. Transgendered people don’t have the same access to the opportunities that people who are not transgendered have and they experience a much higher rate of being victimized physically, emotionally and sexually.

 Remember, when you were in grade school on "career day" and the teacher asked the classroom "What do you want to be when you grow up? No one is raising their hands and waving them wildly exclaiming" I want to be an alcoholic and addict when I grow up!!" or "I want to prostitute myself when I grow up!!!!!"

But we do have a responsibility to overcome the illness of addiction with treatment and 12 step programs, seek help for mental health disorders such as anxiety, depression and post-traumatic stress disorder. We do not have the luxury of just rolling over and giving up, as tempting as that may seem at times.

I looked at the content of workshops offered in recent years at transgender conferences as a way to understand how we are portraying ourselves to the public. I'm not sure that this is a way of discovering what the public's perceptions are, but based on the percentage of workshop programming devoted to gender queers. I do know that they are a very vocal and public image of the "transgender community", much as drag queens and kings" draw a lot of attention and possibly could be a strong influence on the perceived image we have by the predominant culture.

 Another element that influences the public image of transgendered people is something that I have seen decried frequently in our community. That is the tendency for transsexuals who have successfully transitioned to end their involvement in the transgendered community. Their attachment to the broader transgender community is often more tenuous than other transgendered people. They are often criticized harshly for not "giving back" to other transgendered people who are coming along and finding their own way on the long and winding road of successfully transitioning. Because they "disappear" into the predominant culture, the public has little context for these individuals in our society and this further skews the public perception of transsexuals (as opposed to transgendered individuals not including transsexuals). While this is ultimately the goal of most transsexuals, it is not necessarily what is desired by other transgendered people who have a strong attachment to the transgender culture.

My interpretation of what this represents is that the majority of transsexuals do not identify with other people considered to be transgendered and they do not share the same sense of community with drag kings and queens, cross dressers, gender queers, and other diverse identities that consider themselves members of the transgendered community.

In my opinion, a transsexual who has managed to transition and does not wish to continue being involved in the community has every right to do so. She does not owe the community or others coming behind her anything. Her sole responsibility is to herself. In the words of Oprah Winfrey “… to live your best life...”

Because of my profession and my experiences as a transsexual, I will remain active in the transgendered community to a large degree to help individuals with their transition and in overcoming addictions and mental health issues that we all too frequently have. This is a choice I make voluntarily as a professional, not a personal responsibility. This necessarily means that I will have less privacy about my identity than I desire, but because of my special set of skills I will continue to make my skills available to the transgender community.

These are just my observations. What do you think is the image of the transgendered community and what are the reasons for this? I'm very interested in your opinions and I hope you will share them!

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

Further Along: The Transition at Work

I've been negligent about keeping up my blog. I haven't been nearly as prolific about writing anything as of late and usually I'm researching and writing, but all my energy has been poured into the transition at work.

This is mainly due to having to disclose to all my patients. Considering that my gender identity was a carefully guarded secret until I was almost 40.  Even after that, my true gender was only known to my ex wife and my present wife. The exception was that of a handful of other transgendered friends online up until about 4 years ago when I made the decision to begin my protracted transition that I am just now completing.

While I am very comfortable in every day life, this has not been the case with my primary work activity as a therapist locally. I can't say that I have really been distressed from disclosing to over 75 people since November, it hasn't been comfortable at times, particularly with my established patients. I haven't felt as much stress over telling my new patients that I wish to work with individually. I have nothing invested in them to begin with and they haven't formed an attachment to me in one session to the degree my other patients have.

The wonderful news is that to date, I have been able to retain 100% of my established patients, somewhere over 45 patients. With the new patients, I have had  82% who wish to work with me after my disclosing that I am transitioning soon. These retention rates are beyond my wildest expectation. I had shared with my supervisor at the beginning of this process that I expected to lose somewhere between 20 and 30% of my patients.

Until I actually transition, sometime in early to mid April, I continue to disclose to new patients and the very few established patients I have left who I see infrequently. I will be glad when this is over and when I see a new patient they meet Lauren and no explanation will be necessary nor offered.

Overall this process has been very easy; the people I work with have been quite wonderful and totally supportive. The women of the office have really reached out to make me feel like "one of the girls". Recently, Patty and I were invited to a coworker's home for dinner and another female therapist was a guest. It was the first time they had had an opportunity to meet me as I really am. They were as comfortable with me as I was with them and this further raises my confidence in making a smooth work transition.

The thing I think that was most critical in paving the way to a successful transition at work is that I have emphasized that while my transition is voluntary, theirs is not, and I recognize that for them to make this adjustment after having known me for so long, many of them for almost 12 years, is a huge adjustment. I think they have all been admirable in making the adjustment and it is a constant reminder that I am very blessed to be working where I am without fear of losing my job and with such wonderful people. I know so many who have not had that experience.

Further Along: The Work Transition or " So Where Have You Been For the Last Month??"

Over the past year or so, I have been relatively prolific in my writing, but since December I have had very little extra energy and I have not been writing anything at all.  Since I made the decision to transition at work, I have felt a peace and contentment I have not known in years. My mood has been so much better and I can't even remember the last time I felt this good on a consistent basis. It has to have been about 6 years to the best I am able to recall.

I really can't say that this is all due to my decision to complete my transition. I see now that I have been grieving over my father's long decline, especially the last two years of his life. While I was and remain sad about his passing, which is about my loss, I felt a tremendous burden of grief removed because he is no longer suffering. I don't think he enjoyed the last two years of his life and watching him endure that was incredibly painful to me. What I am left with is a sense of serenity I have not had for so long.

While finally being able to engage in completing my work transition is a happy occasion for me, it is pretty stressful due to the nature of the work I do. It isn't an easy process. Theorists who study stress inform us that there are two types of stress: Eustress and Distress. We are all familiar with distress. Its painful and nobody likes feeling distressed. Most people are less familiar with the concept of eustress. Eustress is the stress from things that occur or that we do that are positive. Some examples of eustress would be getting a new job that pays more and has more responsibilities that requires personal growth. Another example might be the work involved to get through an academic program that challenges you in some way. For me that would be completing a degree that includes a lot of math such as statistics. Things like getting married, having a new baby or perhaps giving a presentation in public on a topic in which you are very knowledgeable about if you don't have the opportunity to speak in public very often.

What I find to be the main result of all this eustress, is that I have lower energy, though the energy I have is positive. I have found myself going to bed at 8:30 or 9:30 at night as opposed to my usual bedtime of 11:30 or 12:30. That seems to be so strange to me as I am an habitual night owl! I often will stay awake even to 1:30 or 2:00 if I am reading a book, or writing. Otherwise, everything else is great!

In my case, my work transition includes necessarily telling all of my patients of my planned transition. For someone who never spoke to anyone about my gender identity until they were 33 and then not again until 1996, this is tremendously stressful, even though every person I have told, be it colleague or patient has had a positive response to my plans to transition. That isn't the response I had been emotionally preparing for. I still have more patients to inform, and I have postponed telling some of them because of their clinical needs at the time of their session. There are times when they are not in a space to receive this information because of what is going on in their lives and then there are a very few who will need to be transferred to another therapist because they are unable to deal with my transition.

Some people have expressed the opinion that it shouldn't matter what they think, but I have an ethical responsibility for my patient's emotional wellbeing. This transition isn't all about me. Transitioning is purely voluntary on my part. Everyone around me has to make a transition too. For them this is not voluntary and I am mindful of this. As I tell my coworkers and patients, I'm fine with who I am and with my decision, it's my responsibility to do everything I can within my power to make this as easy and comfortable for everyone around me as I can. I believe this attitude will make it easier for everyone I deal with professionally.

People wonder why I have proposed such a long time line for my work transition as my tentative date is April 1. The first reason is because I need to take care of my patients and make sure my coworkers are comfortable with this (They are). The second reason is that I have only one chance to do this right, or as close to right as humanly possible. I believe I have accomplished this, though at this point I feel like a 6 year old little girl waiting for Christmas! I think though, in the long run, it will be worth the wait for this to come about. There is a light at the end of the tunnel and I feel certain it isn't an oncoming train at this point.

What am I learning from all of this? I'm learning that people are much more accepting of us than we tend to believe, especially when they see we are happy and content. I learned that my own fear has been my worst enemy over the years and that I don't have to be afraid of what people might say, think or do. Yes, there will be people who find me distasteful, but for the most part even those people will prefer just not to have anything to do with you rather than being hateful to me or desire to hurt me.

"Well, Lauren, that's because you work with educated people who are of a more liberal persuasion because of your career." That is not necessarily true. That does not describe about half of my patients. So far they have been overwhelmingly supportive, though I don't expect 100% of the few I have left to talk to about this will all be accepting and want to continue to work with me. And that is ok. The thing is, I have also had to inform each new patient I see who I will continue to see after completing their assessment and not one of them has said they would be uncomfortable working with me.  I find that to almost be extraordinary and it is a positive comment on being a woman of trans experience in a rural southern environment, when the folklore of trans people suggest quite the opposite experience.

"Ok, Lauren, I'm happy for you, but what would you have done if this blew up in your face?" I actually carefully considered that possible outcome. I began looking at other job opportunities in the area and in other regions that I would enjoy living in way before approaching my employer. It's always nice to know you are wanted by other employers and my resume strongly indicates my interested in providing care to transgendered people. It suggests that there is a possibility that I am also a trans woman, so I know that the responders are interested in my professional knowlege and skills. My desire though, has always been to continue where I have been for the past 11 years and work with the people I enjoy working with. It appears that dream is coming true at last!

The Name Game: Anna, Anna Bobanna, Fie Fi.......

I changed the name of my blog because I have been given a name and I chose a name that makes it feel more right than Sherri Lynne. It is rather late in the game to do this, but I have had a series of events that led me to the conclusion that the new name suited me better.

The person who suggested the new first name is someone I have a deep respect for and someone I admire. My middle name Elisabeth is a family name and the name of my favorite aunt and great aunt.

Upon reflection of over a year, I have decided that the new name seems to "fit" me better and I have also decided to make it my legal name in about 3 months.

 More often than not, we have our names given to us and we do not name ourselves. My previous name was one I chose to try to capture a sense of identity to individualize my identity as a southern woman in the modern South. I think I was able to capture that spirit, but there are other spiritual aspects of myself I would like to enhance expressing who I truly am! This name given by people who love and loved me and I respect somehow just feels right.