Sunday, January 15, 2012

Sometimes it feels like the "anti-trans" crowd is like a broken record, making the most assinine claims over and over as if repeating their lies will somehow grant them a degree of truth.

Over at Mr. Heyer's blog of "my failed transition means nobody else should transition", we find him arguing Hormone Blockers -- Criminal Experimentation, and getting it dead wrong.

Let me start off with something that I want to make abundantly clear.  I am very clearly aware that the work of Dr. Spack and others is controversial even within the treatment community that deals with transsexuals.  I acknowledge the significant and legitimate ethical questions that his work presents, but I do not believe for a minute that it is ill-intentioned or that it is necessarily doing harm.  However, I'll come back to this in a few minutes - after I have taken some of Heyer's commentary to task.

In reality it is impossible for a person to change their sex. Our sex – male or female is written on every cell of our body.

The sex change surgeons tell us it is impossible to change genders. Dr. George Burou, a gynecologist from Morocco and a surgeon who has performed over 700 SRS operations, admitted: “I don’t change men into women. I transform male genitals into genitals that have a female aspect. All the rest is in the patient’s mind.”
This is a common argument made by the anti-trans crowd.  Because the results of GRS are necessarily limited, they argue that the person who has undergone GRS is "not really a woman" (or not really a man if they are FTM), largely on the basis that such a person cannot reproduce.

If they are being a little more subtle about it, they try to pull out the argument about chromosomes.  Essentially they argue that someone who is XY is necessarily male, and therefore must live necessarily as a man.

However, this overlooks the key aspect of the transsexual experience.  In general, transsexuals are fully aware of their gender status.  They are also fully aware of the unshakable experience of feeling that they should be living in the social role of the other gender.

Dr. Burou is quite correct, 98% of being transsexual is between the ears.  Those who transition do so, often after years of struggling to live "as society expects them to", and failing miserably at it.  The litany of problems from broken people, failed relationships, failed careers and so on that pile up in their wake as they try to survive without transition is astonishing and sad. 

The brutal fact that the anti-trans people like Mr. Heyer are forgetting is that for transsexuals, it is impossible to shake that feeling.  The argument that one should "accept" that if you were born male, you must be a man simply doesn't hold up when you talk to transsexuals who have transitioned successfully.

When you make the "chromosomes determine all" argument, ask yourself what it is to be a man or a woman in our society.  Nobody will argue that biological dimensions play a role, but let's face it, the social aspects of being a woman in society have relatively little to do with chromosomes - at most that affects one's ability to bear children.  Everything else is rooted in the roles that play out in social environments.  If it is necessary for someone to transition in order to live in the role that feels natural and comfortable to them, why should that be a problem? 

Transgenders are not formed in the womb–they are the result of psychological or psychiatric issues.

Transgenders need a psychologist not hormone blockers. 75% of transgenders suffer from psychological disorders, such as schizophrenia, personality, mood, dissociative, and psychotic disorders, a Dutch study shows.(“Psychiatric Comorbidity of Gender Identity Disorders: A Survey Among Dutch Psychiatrists”)

I know this is true, I was one of the children who wanted to become the other gender, yet all the hormones in the world, freedom of gender expression and even the gender surgery did not resolve my dissociative disorder. That took a psychologist to help me resolve.
There is so much wrong in this set of assertions, I almost don't know where to begin. 

The first, and most serious error that Heyer makes is the implicit assumption that comorbidity of conditions means that transsexualism is a result of those other conditions.  This is not necessarily the case.

Transsexualism is inherently traumatic for the individual.  Imagine, if you will, waking up every day with a body that doesn't match who you are inside.  Consider trying to live in social roles where you cannot even begin to understand the rules of the game because you keep getting the wrong rulebook handed to you.  Then think about crying yourself to sleep every night, hoping beyond hope that some intervention will happen in your sleep to correct the hurt you are feeling ... and knowing just as clearly that you will wake up again the next morning to repeat the cycle.  (Think of the movie "Groundhog Day", only it goes on for decades)

Is it possible that such repeated pain could result in other psychological conditions developing that need to be addressed?  I would say yes.  Just as the stresses a soldier faces in a combat zone may result in the development of serious psychological disorders like PTSD, unrelenting patterns like what I have described above could also result in serious psychological distress for transsexuals.  (and then there is the distress that can arise simply as a result of social proscriptions against cross-gender behaviour)

The 7th edition of the WPATH Standards of Care addresses the treatment of concurrent conditions quite clearly:
Possible concerns include anxiety, depression, self-harm, a history of abuse and neglect, compulsivity, substance abuse, sexual concerns, personality disorders, eating disorders, psychotic disorders, and autistic spectrum disorders (Bockting et al., 2006; Nuttbrock et al., 2010; Robinow, 2009). Mental health professionals should screen for these and other mental health concerns and incorporate the identified concerns into the overall treatment plan. These concerns can be significant sources of distress and, if left untreated, can complicate the process of gender identity exploration and resolution of gender dysphoria (Bockting et al., 2006; Fraser, 2009a; Lev, 2009). Addressing these concerns can greatly facilitate the resolution of gender dysphoria, possible changes in gender role, the making of informed decisions about medical interventions, and improvements in quality of life.
* Emphasis added

 Please note the fact that the language of the SOC is quite careful about not making any statements that infer a causal relationship between co-existing conditions.  That's for the very simple, coherehent reason that there is no evidence that suggests that being transsexual is inherently caused by these other conditions.  (also known as 'coincidence does not equal causality')

The last error of reasoning in Heyer's assertions here is the implicit suggestion that his gender identity issues were ultimately best handled by treating a dissociative disorder that this much be true for most other people with transsexual leanings.  This is a classic logic error of assuming that what applies to one person is correct for all other persons. 
The use of hormone blockers is criminal, psychological abuse of children, not a medical procedure.

Suppressing puberty with a view to sex-change surgery, when no one knows the side effects, I and others feel constitutes human experimentation. Dale O’Leary writes:

"Starting treatment at age 11 presents many problems. Is a child of that age able to give truly informed consent to the risks involved in numerous surgeries required, to the burden of life-long hormone treatments needed to sustain the illusion of the other sex, and to the permanent loss of the ability to have children?

"Puberty does not just change the sexual organs; it also affects brain development, bone and muscle development. No one knows all the potential side effects of administering puberty-delaying hormones on children; it constitutes human experimentation.
"(, “Suppressing puberty with a view to sex-change surgery”, 2 February 2009)
Talk about 'appeal to false authority' for an awful bit of logic.  Dale O'Leary is not a specialist in the treatment of transsexuals.  Dale O'Leary is a religious opinion writer who happens to have opinions about transsexuality.  None of which that I have read amount to anything other than uninformed rantings based not in the evidence about transsexuals, but rather are firmly rooted in ignorance of what it means to be transsexual.  (The usual arguments about it being "an immoral choice" and other nonsense that more or less mirrors the arguments that "religious" thinkers throw at homosexuality as well) 

I might consider Dale O'Leary an authority on transsexuality if he had actually done some real research on the subject.  Publishing from within the echo chamber of "Christian" conservative dogma doesn't count.

Which brings me around to Heyer's claim that providing puberty suppressing treatment to transgender children until they are old enough to make their own choices on the matter.  Acknowledging all of the potential problems that exist in providing such treatment to youth who are suffering from being transsexual (including the trickiness of making the diagnosis accurately at such a young age), the fact is that suffering into adulthood isn't an effective treatment either. 

To date, there are a small, but significant number of people who were able to transition before puberty, and we should be looking at how they are doing as they move into adulthood.  Jumping to the conclusion that because we are suppressing puberty in them, we are doing a "bad thing" without actually examining the evidence and the cases available to us - both those who choose to transition fully and those who do not - is irresponsible. 

Children who are transsexual are suffering as much as anyone else who has a serious medical condition.  It is even more egregious when we decide not to provide treatment simply to assauge our prejudices about the condition itself.

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