Destigmatization Versus Coverage and Access: The Medical Model of Transsexuality

In recent years, the GLB community has been more receptive to (and even energized in) assisting the transgender community, but regularly asks what its needs are. One that is often touted is the “complete depathologization of Trans identities” (quoting from a press release for an October 7, 2007 demonstration in Barcelona, Spain) by removing “Gender Identity Disorder” (GID) from medical classification. The reasoning generally flows in a logic chain stating that with homosexuality removed from the Diagnostic and Statistical Manual (DSM, the “bible” of the medical community) in 1974, gay and lesbian rights were able to follow as a consequence – and with similar removal, we should be able to do the same. Living in an area where GRS (genital reassignment surgery) is covered under provincial Health Care, however, provides a unique perspective on this issue. And with Presidential candidates proposing models for national health care in the U.S., it would obviously be easier to establish GRS coverage for transsexuals at the ground floor, rather than fight for it later. So it is important to note, from this “other side of the coin,” how delisting GID could do far more harm than good.

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Counting The Cost

(Crossposted to Transadvocate.com) 

If my previous post seemed a little scattered and emotional, there’s a reason for it.  The first trans community function I ever attended was a TDoR function, as was the first event I ever MCed outside a support group.   I’ve been sensitive to transphobic violence at every step, and my own transition began with violence.  But seeing the settings for it shift to schools was not something I was prepared for.

At or around November 20th of every year, the transgender community commemorates a day of remembrance (TDoR) for transgender folk who have died as a result of transphobic or homophobic violence.  Since that memorial, fifteen more homicides involving transgender victims have occurred:

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“Sometimes, We Just Have to Pay Full Price.”

(Crossposted to Transadvocate.com) 

My partner is a nut about sales.  If it isn’t on sale, it doesn’t get purchased.  So sometimes, when we run out of a breakfast staple and such, I have to remind her of that basic fact of life:  “sometimes, we just have to pay full price.”

And then, the phrase comes back to haunt me.  This usually happens around the evenings, these days.  She’s been talking about returning to work in a capacity which would take her out to job sites with contractors and crew, some of whom could know from her previous 20 years of work in that trade that she is trans.  And I’ve been having troubling dreams about both that and my own job, where I’ve been back for several months with no trouble beyond the occasional rude exchange, and now all of a sudden I’m dreaming repetitively about getting shot in the head.  The latter is not something I’m actually afraid of during the light of day, so I’m wondering what is bringing this all on.  Am I sensing something nasty coming, or am I just reading the trans-related news way too much?  And that’s when that dirty little voice says to me, “sometimes, we just have to pay full price.”

And that’s when I start thinking about how far we’ve come… or haven’t as the case may be.  The first GRS surgeries were performed in the 1940s, and with the rise of Nazi Germany and its pogroms, the invention of “stealth” soon followed.  We’ve been in hiding ever since.  Don’t get me wrong — I’m on record as defending a woman’s and man’s right to go stealth if they feel it’s best for them.  We earn that.  But the wholesale movement toward stealth — the lack of barely anybody to stay behind and educate the masses — has meant that we’ve only made small strides during that time.  The first known piece of trans-inclusive legislation didn’t happen until 1993, and most of those strides have been since then.  And without adult transfolk there to lay that groundwork, a crisis has developed.  Because now it is children on the front lines.

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Human Rights Tribunal Hears Access-to-Services Case in Ontario

I’d like to draw attention to a recent case in Canada brought to the Ontario Human Rights Commission (OHRC), which as far as I can see, has so far only made waves with right-wing folk — such as the Ezra Levant crowd and Margaret Wente’s article in the Globe and Mail.  The case involves two complaints of denial of services against a plastic surgeon, Dr. Robert Stubbs, who specializes in tidying up and shaping genitalia.  Both complainants were refused services because they are transsexual.

The first complainant, Michelle Boyce, had GRS (Genital Reassignment Surgery) in 2001, performed in Wisconsin.  The result was flawed: one labial fold was larger than the other, and another intrusive flap of skin made sex painful.  In a consultation with Dr. Stubbs, she received a good price quote and then later in the examination room — when he found out that she is a post-operative transsexual — he abruptly ended the consultation and invited her to leave.

 The other complainant, Jenn Finnan, was refused treatment to augment her breasts.

 Dr. Stubbs’ case states that structure of genitals and chests of post-operative transsexuals differ from those of natal females, and therefore being transsexual was medically relevant.  While there is some virtue to this with regard to genital surgery, it is far less relevant with regards to the difference between a natal female chest and a developing female chest.  And even so, in both cases, there was no explanation given at the time, no discussion with clients of their alternatives, there was just an abrupt end-of-meeting refusal to treat transsexuals that would probably not have happened if the refusal stemmed from some other biological or physical condition — an indication that a personal bias was very likely at work.

 There is some discussion about the right of a doctor who performs elective surgeries to refuse treatment.  It takes on far more serious overtones, however, when other options are not available.  And when my own experience has shown me that refusal to treat is far more common among cosmetic surgeons than willingness (I know of only one doctor in the entire province of Alberta, for example, who will perform breast augmentation, and two others who only on rare occasions have relented in the past), and that those willing doctors tend to charge far more for those services, this does become an access-to-care issue. 

While the lack of treatment is not life-threatening in these cases, there certainly are such precedents in North America, most notably Robert Eads in Georgia (who was profiled in the documentary Southern Comfort), and was refused treatment for ovarian and cervical cancer by over two dozen doctors before finally finding a clinic once the cancer was too far gone to save him.  So the potential implications extend far beyond these cases.

But this story isnt written yet:  I challenge those in the Canadian GLB and T communities to watch this one, and, when / if they can, get involved.

Archive: Conversion Therapy In The Womb?

The article that this references goes back in time, and this article is no longer timely to it, I suppose. But some of the thoughts and ramifications might still be valid, and a little chilling.
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It looks particularily creepy, the AP headline subtitle:  “Seminary president Rev. R. Albert Mohler Jr. says gayness is probably biological and that in-utero ‘ex-gay’ treatment would be justified.”

It demonstrates how quickly genies can sometimes get out of the bottle.  Reading Mohler’s original blog ( http://www.albertmohler.com/blog_read.php?id=891 ) does in fact verify his later refutations:  he doesn’t actually state that homosexuality is genetic in origin (what he says is that he believes that science will eventually make that case, and that he pre-emptively doubts the veracity); he also doesn’t advocate tinkering with genetics, but speculates that it could happen.  He does, however, reassert the traditional Church position that sexual orientation is a choice and all that one has to do is simply not choose it.  We’ll get back to that.

But the genie is out of the bottle.  Mohler has been painted as the new granddaddy of eugenics, and the wars of words are on. 

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Walking Through the Valley of Shadows

(As I’d mentioned, it’s time to move on from the previous discussion.  I admit, I probably wouldn’t have reacted as badly if the debate hadn’t touched on something that was freshly raw for me personally, but as it is still a raw nerve, we’ll leave the HBS thing be.  I thought I’d go with something far less controversial.  Politics is being overdone right now, what with all the stuff on the primaries, so I thought I’d take on Religion.)

Modern churches do an excellent job of creating an equation between the questioning of fallible teachers, preachers, copyists and translators, and the questioning of God Himself.  You can do one without necessarily doing another.  But “all scripture is given by inspiration of God…” (2 Timothy 3:16) is usually used to rebuff any inquiries about the many interpretations of those scriptures. Continue reading

Tall Poppy Syndrome (Or, The Earthworm Manifesto)

In a show of taffy endurance,
Little heads poke from the soil and waver in unison under the breeze.
Poppy faces, crimson and flecked, spread out uniform,
Proudly awaiting the gardener.

Far below, they gather conspiratorially. Up, on a podium on a stage on a glen, the little chorus finishes with a brief minuet and Professor Glory slides to the spotlight. Above him, there’s a banner… “EARTHWORMS OF THE WORLD UNITE” is what the canvas sez, yes, here’s an exemplary specimen taking the stand, to deliver this, his greatest manifesto.

(And mama says, “Why can’t you be more like your brother?”)

This is the show:
The bereaved and bereft file through,
Troubled by life and its mysteries and loss,
Only to find themselves in the poppy garden.
Tended oh-so-precisely,
Each little scarlet showgirl
Sways with the group as though all
Were some semi-aqueous mass.
And somehow, perfection and precision
Implies its peace and wonder
Upon sorrowed eyes.
Somehow, in the midst of this tragedy,
Is bliss and tranquility.
The heart wonders.

Inside the great outside’s mini microcosm, the earthworms gather for the discourse. And the speaker says, “There is a grave danger all about us, and its name is Concrete. For too many years, our kind have flirted with the concrete in the rains,” (and at this, the crowds’ collective shoulders sink, suddenly realizing that this is another wholesome-lifestyle lecture), “climbing aboard that menacing mass in order to soak in its wet glories. And too many of our boys have gone, and too many have never come back.” Some of the earthworms slink away. Some listen, hoping the discussion will take a turn. Most listen, and recall the moments they’ve spent, writhing in a puddle of water, ecstatic in its cool touch, euphorically unaware for the first while that the skies have cleared and the rain has let up. And they sniff in disdain. ‘So what?’ they scoff. ‘It’s in our nature. It’s what we were meant to do. Why question it?’

Paranoia is the new religion.
Everything is an offense,
Or part of a conspiracy.
Passing in traffic becomes an attempt to get ahead.
In this way, the individual becomes a threat,
The not-a-team-player of our synthetic reality,
Where the desirable ideal
Is heterosexual monogamy with parenthood;
The day-by-day labor-and-save,
The measuring-tape of human value.
The power of the question
Becomes a menace,
Betraying the carefully-constructed facades,
Where romance is a pool of the moment,
The blissful victim oblivious to the porous stone’s deadly thirst;
Where the shortest distance between two points
Is not a Jack Van Impe sermon;
Where children flip on the television,
Bask in its Lite Brite glow,
And no longer have to do anything difficult,
Like think.

And the Professor continues, “my colleagues and I, we have devised a plan of demolition. We plan to obliterate this concrete — fissure it into millions of harmless fragments, as it were — and spare us this heavy toll on our society.” Well, they don’t like THAT, no, they start realizing, ‘this is no crackpot, this is someone who could really jeopardize our way of life.’ In a fit of sudden and heavy disgust, they shudder violently with wrath, and gather together their knives and pitchforks, and drag this poor creature down from the podium, pulling him like the sackful of hammers they believe him to be, over to an oaken sliver, pinning him there. This sliver is then pushed up, erected into the heat of the sun, pushing him up into the dry hostile elements which could kill, then left there with its captive to die. Bloody prophets.

In a show of taffy endurance,
Little heads poke from the soil and waver in unison under the breeze.
Poppy faces, crimson and flecked, spread out uniform,
Proudly awaiting the gardener.
And one little poppy, brazen and excited,
Pokes up further than the rest.
It’s the ambition of youth, the quest for achievement.
And the caretaker finally arrives, to trim and to tend,
Little poppy beams.
“Look at me; look at me!”
Single soul above the crowd.
At this, the gardener approaches,
And lops her pretty head off.
Thus, the serenity of the garden is maintained.