The Future of Transsexual Medical Care

This article has been a long time coming. Each time I’d revised it, some new discovery added a pertinent dimension that needed to be addressed. But one thing is certain: the future of medical care for transsexuals is changing — whether this change comes in the form of a delisting of Gender Identity Disorder as a mental health condition, or a revision of GID of any significance in the planned DSM-V, or simply new scientific discoveries akin to the finding surrounding the elongated Androgen Receptor gene or studies of Endocrine Disrupting Chemicals such as diethylstilbestrol (DES) that call for further research.

What is needed right now is to assess what our community itself can do in order to (best case scenario) drive the change toward a better model of transsexual health, or at least to (worst case scenario) avoid a future in which transition and surgery are further restricted or made unattainable to the people who need them. I’ve said that I don’t think that we should scrap the existing diagnosis of GID without another medical model in place. We — and our trans medical professionals, students and allies — strongly need to work toward this alternate medical model now. Finding problems is easy; finding solutions takes much more effort. And I’m not presuming that we can just do this without the checks and balances from professionals that would typically be accorded to any other medical study, but there are some fundamental ways we can help shape the model of care to come.

Because if we don’t, someone will do it for us.

Many in the community call for a complete removal of GID from the Diagnostic and Statistical Manual that governs the current model care. The reason most often given is the stigma associated with the classification of GID as a mental health issue.

I’ve often commented that I would support such a thing when a replacement medical model was established or developed enough to become the new standard. I have quoted several reasons not to remove the current definition until a new medical process is in place:

  1. In places where there is medical funding for Gender Reassignment Surgery (GRS), such as in nations with an inclusive health care plan, or even through personal or company insurance plans, the current diagnosis is used to establish the medical necessity of these treatments. Even where there is no funding, access to care through referrals and through those doctors willing to treat trans patients for trans issues can dry up without an established medical model;
  2. Legal protections and processes such as the changing of driver’s licenses for transsexuals are sometimes (though not always) dependent on the establishment of medical necessity of GID;
  3. With all that occurs during transition, it may not be wise to remove the element of therapy completely (I’m sure that this is probably harder for people that have not had the quality of care that the two therapists here provide to acknowledge), although the process should never have been totally dependent on it.

There is also another serious issue to consider when talking about the removal of GID from the DSM. In the Province of Alberta, we know of 4 psychiatric hospitals that have an established pattern already contrary to WPATH standards of care. Doctors in these clinics have a tendency to dismiss GID as an option (even if previously diagnosed), and choose one of their favorite alternates: Borderline Personality Disorder or Dissociative Identity Disorder (formerly known as “multiple personality”). Under these diagnoses, ECT has sometimes been selected as a method of treatment, as recently as this past fall, during an incident that drove the point home to me. I am concerned that without some medical model that can be pointed to or some established diagnosis, it will not simply be doctors who willfully dismiss transition as a valid method of treatment who will misdiagnose and seriously harm transsexuals who come to them while trying to cope with issues of shame and self-destruction. The diagnosis of Transvestitic Fetish should also be removed from the DSM, but this is not likely and trans activists have been far less interested in advocating for its removal — so this means that there is likely to be yet another alternate diagnosis, one that still has “mental health” baggage, and is thoroughly inaccurate for transsexuals. The diagnosis of TF, in fact, is being reassessed by one of said controversial therapists, who is also the inventor of the theory of Autogynephilia, which is used in a major Canadian clinic as an alternate diagnosis to GID.

And yet, I do recognize that removal will at some point in the future be a necessary step. The selection of therapists that are of serious concern to the community to shape the diagnosis of GID by 2012 (and the APA’s clear andobvious refusal to change the makeup of the Sexuality and Gender Disorders work group) makes this much more urgent. Some of them have been involved with the process before, and the DSM does not dictate treatment, so the change is not likely to be cataclysmic in some ways, but it certainly could feel that way for those who are excluded from treatment by new limitations or changes in definition.

The discovery that there is a greater-than-typical occurrence of an elongated Androgen Receptor Gene among male-to-female transsexuals than in the general population is not a definitive finding. It does, however, demonstrate that there are likely biological factors that will eventually be linked to transsexuality. The science is not there yet, but it is slowly developing. Science is not yet ready to demonstrate specific biological triggers in order to establish a physical / non-psychiatric medical diagnosis. It may be ready, however, to establish a likeliness that can justify continued medical classification and treatment, but it will take more than what is available now. This is where we can affect the change in TS care. More on that in a minute.

In fact, removal from the DSM is becoming urgent — how urgent depends on how much the current definition is to change in 2012 from being in the care of the APA’s revision work group (it won’t be cataclysmic, but it won’t be an improvement either). As a consequence, we need to begin everything that we can do *now* to push toward the development of a medical model that is not dependent on the diagnosis of GID.

For those of us in trans advocacy with no medical or scientific background, this means that we need to:

  1. Network the best we can with allies in the medical and bioscience communities in hopes of finding more allies and fostering new work (and maybe be prepared for conclusions to not always be what we want them to be — we’re better in the long run to reach accurate conclusions than to skew things the way we might want to see them).  We need to develop a larger diversity outreach strategy to educate medical professionals about the transsexual experience;
  2. In those instances where funding fails because of lack of pharmaceutical company interest or other reasons, such as has happened with research of DES, we need to try to inspire medical students and / or faculties to take up those projects from a purely desire-to-know basis or the possibility of breakthrough findings;
  3. Perhaps most importantly, we must record (and encourage the sharing of) the experiences of the willing in our community, in order to build a weighty body of evidence to demonstrate those things that we do know for certain. Current medical studies are hampered by a lack of case studies. If we create a body of case studies, with care to ensure that it would meet a medical standard for research, there will be a voluminous, demonstrable collection of evidence (anecdotal, perhaps, but until the science is further along, the only thing any side in the discussion has is anecdotal) of the medical necessity of transition and surgery for those with severe gender identity variance.

A global trans case study project, perhaps. Should an organization be formed to drive and organize such an approach? Are there viable collections already available to be built upon? Is there an existing organization interested and positioned well enough to be able to develop such a thing (and willing to let the collection remain in the hands of the trans community should they someday choose or be forced to abandon the project)?

Because it may be enough for us to simply know what we need to do to put ourselves together, but the next generation may very well have to prove it.

Crossposted to The Bilerico Project, which is a finalist for Best LGBT Blog in the 2008 Weblog Awards (Show your support!). Permission is given to circulate this article, provided no one else claims ownership of it.

41 thoughts on “The Future of Transsexual Medical Care”

  1. “(and maybe be prepared for conclusions to not always be what we want them to be — we’re better in the long run to reach accurate conclusions than to skew things the way we might want to see them).”

    You Get It. Yes, exactly.

    My efforts at the ANU to get an fMRT study going will be ramped up. It’s not so much a matter of getting the funding, as getting people interested.

  2. Yes Leigh, in the brave new world of “transgender” the last people allowed a voice are those who actually when through the process in favour of crossdressing men, female impersonators and of course those with penises who wish to keep them while invading women’s spaces.

    And they wonder why the psych professionals think they are insane.

    It’s to late for the DSM V revision. That has actually already been written with an expanded transvestic fetishism section and autogynophilia listed as the end stage of that condition. They are leaving some wiggle room for classic transsexuality but really tightening up who is considered in that group. It’s a done deal at this point and what the committee is doing now is quietly rounding up professionals to come out in favour of this to offset the tranny shitstorm when it’s made official.

    The only people who believe in “non op transsexuals” are those who classify themselves that way, such as the Helms, Juros and Sandeens to avoid dealing with the fact they are essentially full time crossdressers in the eyes of greater society and the various psych communities. Shortly this will be made official and the real world results will be surgical requirements for any gender marker change and possibly even a name change. All that is needed to defend this position is a simple google search of the insanity that has been posted and viciously defended by trans-activists. Blame them.

  3. Leigh Ann, who better than someone who has tried to resolve mind and body without surgery and can explain very clearly why she was unable to?

    Cathryn, I do agree that it is too late for anyone to make a difference in the revision. However, nothing is written in stone yet — basically they have to write proposals and then the APA has others put this through analysis and testing. This will go back and forth for the next couple of years. Ray Blanchard has yet to devise a form of study of autogynephilia that can withstand scrutiny, be repeatable and not be explained by other factors.

    I’ve also been hearing that the APA is giving serious consideration to delisting, independent of the work group.

    Those things being the case, the above concerns hold just as valid for those you deem “classic transsexuals” as anyone else. In practice at the CAMH (where Drs. Zucker and Blanchard practice), in fact, it is people who most resemble “classic transsexuals” in narrow classification that are dismissed, and the rare person who seems to fit Blanchard’s profile of “Autogynephila” and who is thought to be a danger to themselves unless allowed to undergo surgery that are approved. You can see how they will want to sway the discussion.

  4. I really find it offensive that a non-op would even consider him or her self qualified to speak on medical matters that effect those of us whom have had corrective surgery.

    How can someone who has no need for reconstructive surgery speak on any intelligent level regarding this subject.
    Someone who proposes laws to enforce their inability to assimilate into mainstream society as a female.

    This is no different then a Man putting himself in the position of being an authority on abortion rights.

    Miss Allen What gives you the right?

  5. “Ah HBS people. I think mercedes meant you when stating “and maybe be prepared for conclusions to not always be what we want them to be”

    Um, nope, that’s for everyone. History is full of people who have drubbed on despite the evidence, and damaged people in their wake (witness John Money and followers). If I’m wrong, I want to know about it. While I do believe the evidence will support my theories, I don’t expect to be 100% right, either. I’d rather know that conclusively and refine things accordingly. I’ve admitted on this blog when I’ve been wrong before (i.e. “Scaremongering”).

    Sue, you’ve apprently missed part of the story:

    Again, who better than someone who has tried to resolve mind and body without surgery and can explain very clearly why she was unable to?

    And no, Leigh Ann, I’m not likely to change my mind.

  6. Mercedes, I’m going to be blunt without intending to insult. Who better?……not you, not with psych professionals and I’ll explain it to you.

    When I write about TGs vs AG and crossdressers it’s not just my opinion or the “HBS” line, it reflects the accepted framework almost everyone in psychiatry works within. Harsh, ain’t it? When you blew on to the scene and attacked classic transsexuals (which you did) became one of the voices of the TGs (which you did) and THEN started talking about connections with “alternative” sexual lifestyles like S&M and bondage etc, the very first reaction from a psych professional will be “autogynophile”, fits the profile to a “T”g…..which is viewed professionally as end stage of transvestic fetishism and a counter indication of classic transsexuality.

    That’s how it looks from their point of view.

    I spent the better part of a decade warning trannies what was coming which is now arrived. Classic transsexuality is an easy concept to understand, even a right wing christian bigot like Pat Roberson got it, even Muslim clerics can get it……Joe the Plumber can understand it. In fact about the only two groups who seem unable to get it are gay men and transgenders. No one, I mean no one gets someone who has, wants to keep a penis who says “she’s” a woman, no one. That’s just freaky to everyone except transgenders…. and it smacks of sexual deviance.

    Zucker, Blanchard etc all accept the reality of classic transsexuality, they just feel the majority of those presenting for surgery these days aren’t classic transsexuals but autogynophiles and I happen to agree with them. I’m the one who gave them the simple marker to tell the difference which was based on the concept that classic transsexuality is a neurological intersexed condition of the entire central nervous system and autogynophilia does also exist as a mental disorder that mimics transsexuality but has no neurological basis. And the theory works in the real world and has been tested but not published. Sorry about that….. Zucker and Blanchard know about the marker, they both use it.

  7. Sorry Catcisser, Sue and Leigh Ann.

    Wenn I here Autogyniphilia it rings to me either bbl (who speeks of homosexual transsexuals and autogenyphilics or HBS, wich divides between true transsexuals and autogenyphilics.

    Why is this? Because I am of european origin and the concept of autogyniphillia seems pretty much to be found in that groups and nowhere in european medical theories. Obviously thats quite a cultural view.
    Only diagnosed or treated tspeople where subjects in the studies so far and sexual orientation or preferences of the subjects where not object of the studies. What gives you people the idea that non ops cannot have the same neurological basis to a lesser degree? Nature isn’t binary, even if you think you are. Thats just wishfull thinking. And sexual orientation or preferences are located in different neurological areas. They are just as real and to a certain dregree as measurable.

    All you people do is to a) fighting for the same naturalistic views that makes it hard for any transpeople and b) practice a sort of elitism

    Its not likely, your ideas would stand such a study.


  8. Bad Hair………whatever, yawn the same old tired elitism crap? What gives me the idea that non ops are full time crossdressers?…..the marker works, the theory holds. One either has a female neurology or a male one. So you want to keep a penis? Fine, but don’t tell me you are a woman then because dsyphoric imperative is a real phenomenom and eventually a female neurology rejects having a male anatomy. And yes, sometimes it’s that simple

    As for hard for transpeople? I don’t give a crap after all I’ve endured from transpeople. They dried up all the milk of human kindness in me towards them.

  9. Hello Catcisser

    So as a open transphobic you can evaluate whos the best person to bring up that certain idea (of engaging in more science to the medication)?

    That speeks for itself. Does catcisser mean felixcatusophile?


  10. The problem here, as I see it, is mostly an ideological one. Some people just don’t like to think of transsexualism in the same way that others do.

    I think Mercedes hit the nail on the head when she said “we’re better in the long run to reach accurate conclusions than to skew things the way we might want to see them”. We don’t know if transsexualism is a “neurological intersexed condition” as Catkisser stated, because while there is some evidence to suggest that it is, the evidence is still far too weak to make that statement conclusively. That said, we ALSO don’t know if transsexualism is a psychological condition or not beyond any shadow of a doubt, and as much as we may firmly believe one way or the other, without being able to prove our beliefs nothing will change.

    I agree with Mercedes wholeheartedly about her main point, however: the GID diagnosis, for all its repugnance, is a necessary evil for the time being. Until medical professionals can say what really causes transsexualism, and until they can establish a treatment model that both helps everyone who needs to transition to do so, and helps those for whom transition would be a mistake, GID is better than nothing.

    It doesn’t really matter who’s an autogynophile, who’s got HBS, and who is just transitioning for the heck of it, the point remains that we all need medical help (and more often than not, financial help too) in order for us to be able to exist within our bodies.

    Though I have to admit that the tone of Catkisser’s posts could, maybe, be a little less aggressive ( 😛 ), she makes a clear point that could very likely be truth. Being TS is not the same as being TG, and they likely don’t share a cause either, but that doesn’t mean that we need to start acting like children and excluding each other out of spite. As a TS person, I have almost nothing in common with most of the LGB people I spend time around, but we do share some issues that are best discussed as a group.


    P.S. Did I make my point clear? Sorry, I’m really tired.

  11. Kiera;
    I object to Mercedes just pulling ideas out of thin air and proclaiming those as answers to the “problem.”
    She hasn’t the qualifications ether in her daily life or academically.

    As far as cost goes;
    I can’t have a lot of sympathy for those who whine about the high cost of transition. I did it living well below the poverty level in any state of the US you want to pock and did it here in California to boot.

    Pardon me for being blunt;
    Most people who whine about the cost of transition never had to work very hard for anything in their life.
    Too much of the good life in North America.
    Anybody who uses the excuse of cost isn’t emotionally ready to transition, and most likely are NOT a well adjusted candidate for transition in the first place.


  12. Okay, two threats gets Leigh Ann banned. I didn’t think I’d ever need to censor a post, let alone ban someone, but apparently someone knew just the right buttons to push.

  13. Eh, Sue, don’t throw stones if ya live in a glass house. The different situations that people live within vary considerably across the population. I was merely suggesting by my money comment that there’s a large number of trans people whose lives would be considerably improved with financial assistance for transition, but I’m really no more qualified to make that statement than you are to deny it.

    Like most blogs, I read this one as being the opinions of the blogger, it’s kinda hard to take anyone seriously in this debate honestly, and Mercedes has the advantage of being articulate and of presenting a strong argument.

  14. Since I don’t consider transpeople (transgenders) in the same category as transsexuals (people who do need to transition)
    My discussion is only limited to those who are truly in need of transition. People who need to transition, those who ARE borne with a birth defect that is characterized by a brain / body mismatch and not related to some sexual fetish will find a wan to pay their way through transition. There are many birth defects not covered by medical insurance providers that are considered to be “cosmetic” Most of the people who are borne with those birth defects find a way to deal with them, they don’t spend their lives whining about how bad off they are.

    As far as glass houses go.
    I transitioned I know what I am talking about.
    What about you?

    Sorry you took my post a little too personal.
    I don’t guzzle Tranny Kool-Aid.


  15. And Bad Hair has the advantage of mastering the art of debate by insult, a TG skill set either learned by Karl Rove from TGs or vice versa….research on this isn’t in yet.

    Meanwhile we get the same old “not enough evidence” crap on the neurological intersexed nature of classic transsexuality despite 15 years of studies demonstrating it, and the right wing tactic of claiming the evidence isn’t in on it being psychological when there has never been even a shred of credible evidence to support that……..someone also believing that the fossils of dinosaurs were put there by Jesus to test faith in creationism perhaps?

  16. Hello Catkisser (sorry for missspelling your name)

    First. What brings you to the idea to define me as TG not knowing anything about me? Isn’t that an insult? Isn’t calling TGs autoghynephil an insult?

    >As for hard for transpeople? I don’t give a crap after all I’ve endured from transpeople. They dried up all the milk of human kindness in me towards them.<
    an attack?

    So please analyse this tactic thing once more in a way thats less likely to backfire.


    PS: You surprised me by not labeling me autogynephyl. That was what I expected.

  17. Transpeople don’t have any literacy when it comes to the life experience those of us who are classical TS have.

    They cannot understand;
    to put it in simple terms it’s like trying to explain Buddhism to a life long Christian.

    The history or the clarity of thought isn’t there.
    To put it another way, it’s like trying to explain modern economics to a Cat.

    A crossdresser who is honest will tell you;
    “I get a thrill out of dressing in women’s cloths. I pretend to be a woman because it activates a part of my brain that I derrive pleasure from.”

    A True Transsexual is conscious of their female identiey and the body they are trapped in.

    A Transgender will tell you “I have the right to act and dress the way I feel like even if I don’t fit into gender and sex roles that are a part of mainstream society. The transgender goes on to say :I don’t give a F&^K what others think I will be whatever the F*&K I want to be. They basically are anti-social and will never succeed in society, always being on the margins of society and will forever be looked down upon as being loosers.

    Those are the facts.

    Those who say they are TG and successful in society lie to the very Transgenders they make those statments to.

    Have a really nice day everyone.


  18. Hello Sue.

    Thank you for pointing out the problem. You don’t understand TGs. Thats no wonder, its a wider area where different things are packed into (like full time cds). But on the more TS related end you have people like blogger Riftgirl (Leigh) who are non op, expieriencing the same gender dysphoria, when it comes to secondary sex charakteristics but simply have the male primary organ in their body map. I cannot see how that is anything but ts with a small difference in brain development.
    The measurements we have today (fMRT, counting neurons, measuring the sice of brainparts) are not exactly fine enaugh to locate such minor differences (to self labeled classical TS). So research today is only for diagnosed ts who got the full package, so to say. I think it will get very interessting when that resarch finally goes deeper into the posssibities.

  19. BHD, some people simply refuse to see anything beyond their own personal experience. Personally, I can only engage that for so long.

    I know there will always be people who insist that I’m not real — it doesn’t change what I know to be true for myself and what I need to do to bring peace to my life. Likewise, their comments made behind the vantage point of a keyboard don’t change the real observations we make by being out and involved in the community frequently, and among more than just a few bad eggs. No “Kool Aid” here, it’s just seeing and doing, getting to know real people on a personal level, and learning things I hadn’t expected from them.

    Ultimately, that’s good enough for me and I’m content to leave the disagreement at that.

  20. Actually Bad Hair;
    I know a great deal about TG’s I run a support group that contains about 50% TG members. And we don’t allow TG Kool-Aid guzzling.
    They know the difference between a transgender and a TS.
    This group has NOTHING to do with the GLBT and has been around since 1985.

    TS have surgery to correct their birth defect.
    TG’s don’t.

    Your self labeled friend simply is not TS, just like any other so called non op.
    There is no such category as a non op TS.

    Have a nice day.
    I will.


  21. Sorry you have to deal with these crazy bigoted stalkers, Mercedes. They try to justify themselves to the world by co-opting the experiences of actual intersex people (I have Klinefelter Syndrome) because the modern world tends to trust what a machine tells them over what a person tells them, and they want in on that. Yes, there probably is a neurological basis to transsexuality. But you know what? Nobody is anywhere near understanding how the brain works. NOBODY is “qualified” to speak authoritatively on this issue, least of all psychologists who mostly practice voodoo with lab coats. Sorry for the campus imperialism, but I am a mathematician, my father is a biology professor and the methodology that’s used in a lot of psychological “research” is unconscionably bad.

    It’s really pathetic to see these HBS people crawling on their knees, begging society to accept them. See, we’re just like you, not like those freaks over there, they say. They don’t have the courage to simply live their lives as they please, and have to excuse themselves to the world.

    You know what “society” really cares about? Looks, and nothing else. Yeah, I went there. But it’s the truth. It’s the elephant in the room that nobody will talk about. Passability is everything, which is why early intervention is absolutely essential.

    I transitioned. I had surgery. I had the “dysphoric imperative.” The whole fucking works. Yeah, I’m anti-social, but I’m also successful.

    Mercedes, I have nothing but admiration for you and the work you do in the face of everything, with Canadians’ awful anti-native racism on top of that. Don’t let them get you down.


  22. Hello Sue
    > TS have surgery to correct their birth defect. TG’s don’t.

    Leigh is not a friend, but a great blogger, espacially when it comes to explain gender dyphoria. You seem to think its all about primary genitals? Thats sad. But actually not unheard of. I know at least one person that skipped hormons after surgery.

    I’m happy you will havce a nice day, its later here and I will have a nice evening.


  23. Bad Hair…….I didn’t call you names because I don’t know anything about you and I don’t engage in that sort of thing.

    Saying I don’t give a wet handful of whatever about what makes things “easier” or not for transgenders is actually not transphobic except in the mind of someone with an inability to grasp simple concepts. I don’t fear transgenders, I don’t hate them, I just don’t give a crap about them. And if you are interested this is based on a decade of them outing me, libling and slandering me, turning me in as a terrorist, death threats, attempts to leave me homeless when I was taking them in to keep them from being homeless. Seems you should find out more about someone before you throw your verbal stones, eh?

  24. Hallo Catkisser.

    It doesn’t surpise me, when your attitute is reflected. What surprises me is that you post here, when the life of others is of no interest for you? In that respect even yur first post was an insult, more based on your conception of someone posting it who is in your definition not valid, than on anything of its meaning (which would have been valid if formulated by a drag queen, either)

    You see, I really have problems to understand your motivations.


  25. It amazes me that those who have arbitrarily adopted the label of TS don’t realize that their “future medical care” lies in waiting in their post-transition life.

    I just want to clarify things a little here;
    Are we talking the future of Transsexual or Transgender health care. The former already exists, as I have mentioned when you transition you are female and can enjoy the same high quality health care I do in the mainstream as a member of Female Society.

    Transgender health care….
    Well that is an issue that this blog entry doesn’t address.

    The two are not the same.

  26. That’s enough of the personal attacks. It’s not necessary, and not going to accomplish anything anyway. And that means everybody.

    “I just want to clarify things a little here;
    Are we talking the future of Transsexual or Transgender health care.”

    I’m talking about availability of GRS to TS people in the future.

  27. Pardon me but I made no Personal Attacks
    If you take my definition of what a TS is as a personal attack then I I would ask you to reconsider.

    Is this how it is going to be;
    when a TG is on the loosing end of a debate it becomes a personal attack?

    I thought you were above that.


  28. Hello Sue

    If you mean Mercedes, she was attacked by being called less than a true transsexual. Primarily by calling her an autogyniphil.

    When it comes to the TG discussion, that was mostly my part in reaction to certain claims made, which now has switched over to Zoës blog (on ) which is a good place to discuss that).

    I think its a good ddea to seperate the validity of Mercedes call for further research encouregded by TS people themselve and the TG discussion over there, cause there its not driving away good energy from a good cause by seperatism.


  29. I was talking about rising hostilities on all sides. It hasn’t descended into name-calling yet, but the undertones are there. As I said, it’s not necessary, and not going to accomplish anything.

  30. What I mean, let seperate this. It wont do any good over at Zoes but she has defenatly more solid ground for everybody in that discussion.

    Think about it. You had a good idea and everytihing that followed was a sicussionn avout TG vs TS issues. Get our asseses over to Zoe when it comes to that discusson. Let it be here as good starting point if someone (“heres me!”) likes your point.

    The main point for me is: How can I help

  31. Elitist and transphobe aren’t insults? I realize that among the transvestite/transgender crowd it is the normal rhetoric, but it’s still insults. Mercedes, when I commented before I think you understood I wasn’t calling you an AG but noting that the psych professionals would label you as such before you even started. Big difference lost on someone who apparently has English as a fourth language.

  32. Please put a “hold on” here, people. I’ve been searching all evening and found this original article and I’d like to respond to that without offending anyone’s personal issues. There is a greater issue… survival. What happens when you are pre-op and post transition, six years “remodeled” by HRT, fully qualified by the old standards of care, yet disabled by depression and unable to afford gender re-assignment surgery because no reputable surgeon will accept medicare? Each year gets more difficult to get through. Therapy is no longer an option, it has no real value. I know fully who I am and cannot achieve a balance of mind and body. By definition, (the DSM’s) my only affordable option is to admit myself to a mental health institution because suicidal behavior is covered, not the treatment for a medical condition causing my depression. Is there anyone fighting/speaking/tearing down walls for this issue?

  33. It’s a longshot, but as the U.S. moves toward a national health care system, the more insurance companies that start funding GRS now, the more pressure there would be for a national system to do the same. We need a demonstrable database to indicate the medical necessity of surgery, in order to put the fires under the toes of the people making those decisions.

  34. I agree, and I am in the process of composing a letter to send to the new administration in this regard. Searching for supporting evidence brought me to this site. Sadly, I found (as of yet) no doctors posting articles or petitions of support for govt. funded GRS. I’ve read your post on your two-spirit understanding and having other two-spirit friends I appreciate your views and writings and the fact that you know that some of us have no choice in the matter.

  35. Jane;
    There is always a way, always an opportunity to take advantage of.
    Disability didn’t stop me, I wasn’t going to give up because is is such a quality of life issue.

    I sincerely hope you and others who haven’t found their opportunity yet will soon.


  36. Mercedes. you might be interested to know that the Quebec medicare system is agreeing to pay some of the cost of GRS performed at a “private clinic,” which would be Dr. Brassard’s. Details are still being worked out, but this is a huge victory for transsexuals here.


  37. Jillian, does this cover surgery for FTM’s as well and do you know which surgeries are covered? I just came across this topic in a fellow guy’s vlog on youtube. Would you point me in the right direction so I can gather as much info as possible? Thanks.


  38. I am a 54-year-old MtF TS scientist who brought my company (3000 people) “out of the closet” by founding and being the first president of a LGBT group, alongside the existing Women’s, Black, Latino, and Asian groups. We obtained protection in the corporate policies for our members (including transgendered protections), and my successor obtained DP benefits. This was not terribly difficult to do since many corporations offer DP benefits. But I would like to obtain TS medical benefits, but this is much less common. Again, someone asking for any information I can get that will help.

  39. Well, the debate goes on.
    Personally being a person who was diagnosed with GID at the ripe old age of 58, I think that whatever happens it must be done early. After a person reaches their mid thirties the body starts to change and so can the mind. Psychiatiric events take place and one is often finacially able to follow ones whims.
    Chronic pain, nervous breakdowns can all trigger psychosis that may be long lasting and for many getting rid of the responisbility of being a male is a way out of ones present prediciment. Late Onset Genger Identity Dysphoria is and should always remain a psychiatric disorder and needs at least 4 – 5 years of counselling before any doctor or surgeon can prescribe HRT or surgery. I am not alone, its happened to me and, it has happened to many people I know. WE NEED BETTER CONTROL NOT LESS of this dramatic life changing psychiatric illness.

    Jasmine Hoansen ( Western Australia)

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