Male to Eunuch Standards of Care

[kristoff]

Male to Eunuch SOC

Several folks have “agitated” in the past here and elsewhere for consideration of the notion that a male might wish to transition to eunuch as a valid gender expression or identity. Presumably, in some form, the same might be said for women, though I can’t speak to that.

In dealing with transgender people through the routine course of medical and surgical care, special attention is paid to the Harry Benjamin Standards of Care (HBSOC or just SOC). If M to E transgenderism were to be recognized as a valid expression of gender by the “establishment” medical industry, then presumably an applicable SOC would need to be applied.

In the past we have had some discussions about recommendations and “standards” of sorts for wannabes. I do not think that they, however, were adequate to the task of an M2ESOC.

I would solicit an active discussion of the topic, including what you think the standards should be, who should supervise them (perhaps the HB committee?), who should be the final arbiter of the standards, and so on. What issues need to be explored psychologically, hormonally, physically, and so on. Should age play a role? Is it OK to set an arbitrary minimum age (lets not get hung up on just that issue by itself)?

We have quite a number of functional and surgical eunuchs here – your experience would be valuable. The same can be said of M2F transgender women – there are many here, and they have lots of cumulative experience with HBSOC – perhaps they can shine some light here. I am not sure, but I believe we have one or two members that are F2M; perhaps they can help.

Of course, I would most strongly encourage the input of those who in fact do identify as Male to Eunuch as their physical and or psychological gender.

Lets have a wide ranging discussion - perhaps we can evolve our own SOC.

[gpb3aol (imported)]

Is there a SOC for someone not going all the way to female, now?

[kennath7 (imported)]

There should be a standard of care in the medical profession as of now its like in the sixties when a woman wanted an abortion they had to go in the back allies and risk death

Because castration as of now is taboo

This web sight has a lot of info and I will help you in any way I can

[DonFL (imported)]

As some of you know Ive got my LVN at this point and have started clinical part time working for my PA clinical hours, as im very close to completing my BA of medical science. I work at my hormone replacement therapy doctor's practice.

This is something that has come up at the practice im working at more than once.

We only take care of the hormonal end, but we would also be the patients GP most of the time and the person who recommends to the SRS surgeon for final action. We are not endos but rather hormone replacement specialists for anti-ageing and SRS.

here is what we boil it down to:

Psych screening; make sure the person is of sound mind and understands the nature and effect of the procedure.

a real life test using lupron depot or similar drugs, they require office administration so we know of patient compliance. This is important because someone can fake a RLT easily by just not taking their meds except around test times. This also installs a level of commitment, first 30, then 60, then 120 day increments. This lets us see if a patient can "weather the storm" and if not, we can administer testosterone till the LH inhibitor is worn off to mitigate its effects and abort the RLT. This should last at least a year.

If after such test is over, and the patient wishes to proceed, The 1st letter is combined to our letter for recommendation and the patient is referred to a SRS doctor we have worked with before.

This is not the doctors offical line yet, he is waiting for a standards body to form, but its what the doctor has said he will follow when-if the issue ever comes up.

[BernadetteTS (imported)]

You do not want an Eunuch-SOC. The HBIGDA TS-SOC is not for the benefit of the transsexuals. Back in the 60's and 70's sex change became the hot new thing for clinics, researches and colleges to do. Insurance hadn't discovered putting in exemptions into their policies so it was paid for. It was pretty much anyone who wanted to could walk in, ask for a sex change and get it. There was no pre-existing group of patients to research since hormone therapy and surgical sex change was recently developed.

Then a post op TS sued a doctor. She claimed she was not transgendered. She said she was psychotic the doctor should have recognized that, She wanted compensation. In court the doctor was asked what test he used to confirm the diagnosis of transsexuality. There is no test. He was asked if the existing genitals were malformed or diseased. The doctor had to admit the genitals were normal. Surgery on normal genitalia was performed with no testing to confirm the diagnosis. The doctor lost the case. Sex change research came to a screeching halt. The actions of McHugh didn't help things but that is another story.

Harry Benjamin had been working with transsexuals. He came up with a series of procedures based on his experience. Put into a program, Harry's program formed the basis of a procedure to treat transsexuals in the absense of a qualitative test or existing pool of satisfied post op patients who could be researched to create a screening test. The SOC became the protocol to confirm a medical diagnosis of transsexuality. In court a doctor could now defend himself by saying, " I followed reasonable and customary protocols to confirm diagnosis and treat this patient." Transsexual care could continue.

HBIGDA came along to formalize a medical diagnosis and treatment for transsexuality. They aquired a monopoloy on access to care, at least to access hormone therapy and surgery with a few exceptions. "Butcher Brown" continued to perform SRS without following the SOC. The sex change clinic in Montreal would accept referals from Dr Spector but that was kind of an unoffical secret.

HBIGDA may have had good intentions. Several things happened that make this a fascinating study about an out of control bureaucracy. HBIGDA had no power over govt or insurance companies to force them to accept the SOC protocols as the accepted medical diagnostic method and treatment for transsexuality. By this time insurance claimed sex change was either experimental and not covered or it was cosmetic and not covered. Govt insurance followed the lead of private insurance. So HBIGDA turned on those it could control, the transsexuals.

http://www.wpath.org/membership_benefits.cfm

Take a look at membership in HBIGDA on the HBIGDA home page. You can be a voting member on transsexual care if you are a doctor, social worker or even a lawyer. If you are a transsexual, you can pay full price for membership but you can not vote since you are only, "an interested third party." Kind of reminds me of the situation in 1800's America where policies over blacks and native americans were made by guys in white suits in Washington. The same situation developed.

HBIGDA gave itself unlimited power and total immunity. Absolute power corrupts absolutely.You can see the lawyers at work in this scenario. If you want a sex change, by default you are mentally ill since the diagnosis is part of the DSM-IV that defines mental illnesses, or at least that is the way it can be portrayed in court. If you want a sex change and they reject you, by their definition, anyone who wants a sex change and is not a transsexual, is mentally ill. Therapists treating the TS were only at risk if they accepted someone.

TS were forced into therapy by the requirement to obtain a "medical" diagnosis. Then therapists often refused to approve them if they did not tell the therapist exactly what they wanted to hear. If the TS was not stereotypically feminine according to the whim of the therapist, they could be rejected. HBIGDA created a narrowly defined definition of transsexual. Anyone who did not fit that narrow definition was rejected. Then after enduring the SOC and paying to get a medical diagnosis of transsexuality, the TS was forced to pay for HRT and SRS since the insurance companies wouldn't pay for cosmetic procedures.

This post is a way oversimplified bit of the research paper I did a few years ago. HBIGDA defined transsexuals on the basis of lifestyle. Any other criteria was ignored since it violated the SOC's mandate of a "real life test" as the essential component of qualifying for surgery. If you want to see how biased HBIGDA was, look at this research on transsexuals who returned to living as male as post op's. Some of them told the researchers that they were happy living as males with a feminized body. Since this violated HBIGDA's definition based on lifestyle, happiness is defined as a sign of regret in one of the catagories of the table of regret; http://www.symposion.com/ijt/ijtc0502.htm

A funny thing happened in the 90's. The Personal Use Import Policy allowed access to HRT without the gatekeepers in HBIGDA restricting access. For the first time the internet let TS talk to each other honestly. Online became a place where we helped each other to make it easier rather than the endurance test designed by the SOC. The biggest TG group on the internet with over 10,000 members is the yahoo group/TSDoItYourselfHormones/ In sociology you cannot predict the action of an individual. But any group will follow the path of least resistance. Research the archives of the DIYers and you will find that not one of them models their own care on the SOC. If the SOC was a valid method of treating transsexuality, then those following a do it yourself program would use it as a model for their own care. None of them do. HBIGDA claimed they were necessary to prevent cases of regret. I researched over 30,000 posts over 4 years and found 2 cases of regret. One case took hormones while continuing a lifestyle of drugs and alcohol. They damaged their liver. The other case stated, "I regret ever starting hormones. My wife found out and now I have to stop. If I had never started I would not know how much I am going to miss it."

With the internet to help each other, hormones without a prescription and surgery available in Thailand with no SOC letters of approval needed, HBIGDA must deal with market forces or they are doomed. My personal observation is the bureaucrats are resisting the loss of their power and won't understand what is happening until it is too late. One of the indicators HBIGDA does not want to give up their power is the lack of research on 10's of thousands of post op patients over 30 years to create a screening test instead of a year of therapy, real life test and bureaucratic power over the TS's life.

Contrast the British branch of HBIGDA where the bureaucrats still controls

access to care under the national health care system. The British response to do it yourselfers was to institute a policy that anyone who wants to be treated under the NHS, must be off hormones 1 year (might be 2 years) before they will be accepted into the system. Notice that these policies are not bases on what is best for the patient and no research whatsover involving the patients was done before instituting the policy. It was the bureaucracy attempting to maintain thier authority.

I said that so you can consider what you are asking for if you want an SOC style bureaucracy defining who can be a eunuch and who can not. Are you willing to act in a sterotypical eunuch lifestyle as defined by a bureaucracy where you have no vote, then undergo 1-2 years of therapy costing thousands of dollars, undergo a period of therapy defined by the whim of the therapist to first live a eunuch lifestyle without benefit of prescription drugs, then a period of supervised prescription lifestyle, telling the therapist only what they want to hear or be rejected. Maybe you would make it through their protocols but 75% to 90%+ or those entering HBIGDA programs quit or were rejected before approval of treatment. In contrast try to find a regret or I dropped out post on the online support groups.

Submitted for your consideration

I hope the night finds you well

BernadetteTS

[kristoff]

Bernadette,

Yours is definitely a consideration worth noting and is part of the discussion I am trying to generate. There may be others who have other perspectives, and I would like to see them, as well. It may well be that you are absolutely correct about not wanting an SOC. But then, if those desiring this change collectively establish a standard or guideline, would that not side step the type of history you are presenting? Thanks for writing!

K

[Uncle Flo (imported)]

I favor establishing guidelines by consensus of those who have the biggest stake in success or failure of a plan; that is the ones who are recieving the treatment( us, of course) along with guidence from interested, sympathetic researchers. --FLO--

[gpb3aol (imported)]

I hear what your saying, (BTW you said it very well). But what do we do. My doctor is great but she doesn't know what to do with me. She has no problem giving me spironolactone, but Hormones are something else, does she treat me as a TS in which case I need a shrink. If not, on what grounds does she give me hormones, let alone a castration. She needs some rules to protect her.

So I believe we need some rule(s) to give good doctors some cover and also rule out the whacko’s (a scientific term).

Pauline

You do not want an Eunuch-SOC. The HBIGDA TS-SOC is not for the benefit of the transsexuals. Back in the 60's and 70's sex change became the hot new thing for clinics, researches and colleges to do. Insurance hadn't discovered putting in exemptions into their policies so it was paid for. It was pretty much anyone who wanted to could walk in, ask for a sex change and get it. There was no pre-existing group of patients to research since hormone therapy and surgical sex change was recently developed.

Then a post op TS sued a doctor. She claimed she was not transgendered. She said she was psychotic the doctor should have recognized that, She wanted compensation. In court the doctor was asked what test he used to confirm the diagnosis of transsexuality. There is no test. He was asked if the existing genitals were malformed or diseased. The doctor had to admit the genitals were normal. Surgery on normal genitalia was performed with no testing to confirm the diagnosis. The doctor lost the case. Sex change research came to a screeching halt. The actions of McHugh didn't help things but that is another story.

Harry Benjamin had been working with transsexuals. He came up with a series of procedures based on his experience. Put into a program, Harry's program formed the basis of a procedure to treat transsexuals in the absense of a qualitative test or existing pool of satisfied post op patients who could be researched to create a screening test. The SOC became the protocol to confirm a medical diagnosis of transsexuality. In court a doctor could now defend himself by saying, " I followed reasonable and customary protocols to confirm diagnosis and treat this patient." Transsexual care could continue.

HBIGDA came along to formalize a medical diagnosis and treatment for transsexuality. They aquired a monopoloy on access to care, at least to access hormone therapy and surgery with a few exceptions. "Butcher Brown" continued to perform SRS without following the SOC. The sex change clinic in Montreal would accept referals from Dr Spector but that was kind of an unoffical secret.

HBIGDA may have had good intentions. Several things happened that make this a fascinating study about an out of control bureaucracy. HBIGDA had no power over govt or insurance companies to force them to accept the SOC protocols as the accepted medical diagnostic method and treatment for transsexuality. By this time insurance claimed sex change was either experimental and not covered or it was cosmetic and not covered. Govt insurance followed the lead of private insurance. So HBIGDA turned on those it could control, the transsexuals.

http://www.wpath.org/membership_benefits.cfm

Take a look at membership in HBIGDA on the HBIGDA home page. You can be a voting member on transsexual care if you are a doctor, social worker or even a lawyer. If you are a transsexual, you can pay full price for membership but you can not vote since you are only, "an interested third party." Kind of reminds me of the situation in 1800's America where policies over blacks and native americans were made by guys in white suits in Washington. The same situation developed.

HBIGDA gave itself unlimited power and total immunity. Absolute power corrupts absolutely.You can see the lawyers at work in this scenario. If you want a sex change, by default you are mentally ill since the diagnosis is part of the DSM-IV that defines mental illnesses, or at least that is the way it can be portrayed in court. If you want a sex change and they reject you, by their definition, anyone who wants a sex change and is not a transsexual, is mentally ill. Therapists treating the TS were only at risk if they accepted someone.

TS were forced into therapy by the requirement to obtain a "medical" diagnosis. Then therapists often refused to approve them if they did not tell the therapist exactly what they wanted to hear. If the TS was not stereotypically feminine according to the whim of the therapist, they could be rejected. HBIGDA created a narrowly defined definition of transsexual. Anyone who did not fit that narrow definition was rejected. Then after enduring the SOC and paying to get a medical diagnosis of transsexuality, the TS was forced to pay for HRT and SRS since the insurance companies wouldn't pay for cosmetic procedures.

This post is a way oversimplified bit of the research paper I did a few years ago. HBIGDA defined transsexuals on the basis of lifestyle. Any other criteria was ignored since it violated the SOC's mandate of a "real life test" as the essential component of qualifying for surgery. If you want to see how biased HBIGDA was, look at this research on transsexuals who returned to living as male as post op's. Some of them told the researchers that they were happy living as males with a feminized body. Since this violated HBIGDA's definition based on lifestyle, happiness is defined as a sign of regret in one of the catagories of the table of regret; http://www.symposion.com/ijt/ijtc0502.htm

A funny thing happened in the 90's. The Personal Use Import Policy allowed access to HRT without the gatekeepers in HBIGDA restricting access. For the first time the internet let TS talk to each other honestly. Online became a place where we helped each other to make it easier rather than the endurance test designed by the SOC. The biggest TG group on the internet with over 10,000 members is the yahoo group/TSDoItYourselfHormones/ In sociology you cannot predict the action of an individual. But any group will follow the path of least resistance. Research the archives of the DIYers and you will find that not one of them models their own care on the SOC. If the SOC was a valid method of treating transsexuality, then those following a do it yourself program would use it as a model for their own care. None of them do. HBIGDA claimed they were necessary to prevent cases of regret. I researched over 30,000 posts over 4 years and found 2 cases of regret. One case took hormones while continuing a lifestyle of drugs and alcohol. They damaged their liver. The other case stated, "I regret ever starting hormones. My wife found out and now I have to stop. If I had never started I would not know how much I am going to miss it."

With the internet to help each other, hormones without a prescription and surgery available in Thailand with no SOC letters of approval needed, HBIGDA must deal with market forces or they are doomed. My personal observation is the bureaucrats are resisting the loss of their power and won't understand what is happening until it is too late. One of the indicators HBIGDA does not want to give up their power is the lack of research on 10's of thousands of post op patients over 30 years to create a screening test instead of a year of therapy, real life test and bureaucratic power over the TS's life.

Contrast the British branch of HBIGDA where the bureaucrats still controls

access to care under the national health care system. The British response to do it yourselfers was to institute a policy that anyone who wants to be treated under the NHS, must be off hormones 1 year (might be 2 years) before they will be accepted into the system. Notice that these policies are not bases on what is best for the patient and no research whatsover involving the patients was done before instituting the policy. It was the bureaucracy attempting to maintain thier authority.

I said that so you can consider what you are asking for if you want an SOC style bureaucracy defining who can be a eunuch and who can not. Are you willing to act in a sterotypical eunuch lifestyle as defined by a bureaucracy where you have no vote, then undergo 1-2 years of therapy costing thousands of dollars, undergo a period of therapy defined by the whim of the therapist to first live a eunuch lifestyle without benefit of prescription drugs, then a period of supervised prescription lifestyle, telling the therapist only what they want to hear or be rejected. Maybe you would make it through their protocols but 75% to 90%+ or those entering HBIGDA programs quit or were rejected before approval of treatment. In contrast try to find a regret or I dropped out post on the online support groups.

Submitted for your consideration

I hope the night finds you well

BernadetteTS

[BernadetteTS (imported)]

I hear what your saying, (BTW you said it very well). But what do we do. My doctor is great but she doesn't know what to do with me. She has no problem giving me spironolactone, but Hormones are something else, does she treat me as a TS in which case I need a shrink. If not, on what grounds does she give me hormones, let alone a castration. She needs some rules to protect her.

So I believe we need some rule(s) to give good doctors some cover and also rule out the whacko’s (a scientific term).

Pauline

I have given this a lot of thought as it applies to transsexuality. The group /TSDoItYourselfHormones/ has over 10,000 members and probably 100,000 posts if you add in the previous versions of the group. A good sociologist could use the info in the archives to create a support and care protocol rather than a gatekeeper/make it so difficult procedure that anyone who survives it won't sue us system. It has to be something than a one size fits all program.

If I was designing a TS system it would include the following; There would be a point system based on age. Say 100 points up to age 20 then decreasing 2 points per year of age. A young person has a lot to lose if they make a mistake. An older person has already made life decisions like career, military service, marriage, children. There are fewer consequences to life as people age.

Take the power away from the therapists to grant or deny care. Let therapists do what they were trained to do. They can help the person sort out their thoughts. They can support them. They can direct them to where they can get care but can not be the gatekeeper.

Create a way to start in secret. This could be as simple as a website where the TS can create an account and get a case number. Then the TS downloads a pdf form sort of like a pilot's log book. All the elements involved in transition are given a point value. When the TS has enough points, they can give it to an MD or surgeon for HRT or SRS. Things like living full time, working as a female in the case of M2F TS, electrolysis, months on hormones, counseling with a therapist, outing yourself to family, etc all have a point value. If the TS is competent and used to being in charge of thier own life, the might not need any couseling. If the TS is a 6' 4" former football lineman who couldn't pass for female in a dark basement at night with the lights off, they could could build up enough points by counseling and HRT. Don't force the unpassable to endure living as a man in a dress if they can not do it. This does not mean they can not be content haveing a sex change and being satisified with as much femization as they can achieve that remains hidden while living a male lifestyle. The TS gets to decide where their money is best spent.

Don't use therapists as gatekeepers who line their pockets by requiring thousands of dollars of office visits over years. A court can order a competency hearing that can be completed in a matter of hours. Take the TS logbook to a judge and it allows the judge to order a competency hearing. If necessary to include an artificial delay, then require a second competency hearing 6 months or a year later. But if the person passes both hearings, they are competent to make the decision to have surgery. The decision is left to a judge who has no economic interest in the outcome rather than a therapist who is earning a living by requiring the TS to make office visit after visit.

Remove all stereotypes from outcomes. Imagine it this way, create a graph. The vertical scale is lifestyle. The horizontal scale is physical change. The bottom left corner is male. The upper right corner is female. John Wayne, in a monster truck, tailgating before a football game, with his hunting dogs and beer would be stereotypically in the botton left corner. A 1950's sitcom stay at home mom of 2 children, living in the suburbs where she puts on pearls and high heals to vacuum the carpet is in the upper right hand corner. The current SOC requires that the TS travel from the bottom left corner straight up to the left upper corner, man in a dress zone that crossdressers visit on a temporary basis, and live as a man in a dress for 6 months or a year before they are granted access to hormones that allow them to move to the right on the graph. The /TSDIY/ support group shows that most leave their current lifestyle unaffected and begin moving to the right on the scale first. When their body is feminized to some extent, there is much less resistance when they decide to out themselves and move upwards on the scale. Instead of the social resistance TS experience when recognized as a man in a dress, society encourages those with a female body to live a female lifestyle. Transition is easy rather than an endurance test. Lifestyle elements could be written into the graph depending on whether they are primarily male/female or enjoyed by either gender. The TS could circle the elements they want to keep from their male life and what they want to add to their transistioned life. This keeps the therapist from requiring them to abandon wholesale all elements of their male life and adopting female elements whether the TS really wanted to do those things or not. There is a lot more room for personal fulfillment rather than the one size fits all, stereotypical outcome requirements under the current system.

I do not know enough about eunch views, motivations and lifestyles to define a system of care and support. For some eunuchs I have read about it seems to have a basis in self identity. In others it is lifestyle driven. Some seem to want to control their own bodies that are out of control the way nature designed them. Others are driven by submissiveness, sacrifice and service. So don't create a system that requires those seeking access to care to fit into the procedure. Create a system that is flexible in regards to the individual but meets specific criteria at certain points to access professional services.

Or maybe you are looking at this from the completely wrong perspective. Instead of creating a system where the current system must adapt to you, you should look into a simpler way to make the system work to your advantage. Consider, how many drugs and chemicals exist that can be accessed with no restrictions that are known to cause cancer? Instead of looking for prescription items that are restricted, research a simple cancer inducing cocktail for testicular cancer anyone can mix up at home from available products. Might be as simple as turning on your cell phone and carrying it in your jock strap for a few months, hint, hint. Or make sure your scrotum and testicles get a good sunburn and tan to induce a malinoma requiring surgical removal. Instead of avoiding the things that increase your chance of prostrate cancer, indulge in them so the testicles must be removed. (I just now came up with this idea but the concept leads to some interesting story lines that could be posted on this site.) How many "legal" ways are there that lead to medical castration by a doctor and how can I cause that to happen with minimal fuss.

Hope I made you think

BernadetteTS

[kristoff]

I do not know enough about eunch views, motivations and lifestyles to define a system of care and support. For some eunuchs I have read about it seems to have a basis in self identity. In others it is lifestyle driven. Some seem to want to control their own bodies that are out of control the way nature designed them. Others are driven by submissiveness, sacrifice and service. So don't create a system that requires those seeking access to care to fit into the procedure. Create a system that is flexible in regards to the individual but meets specific criteria at certain points to access professional services.

Or maybe you are looking at this from the completely wrong perspective. Instead of creating a system where the current system must adapt to you, you should look into a simpler way to make the system work to your advantage. Consider, how many drugs and chemicals exist that can be accessed with no restrictions that are known to cause cancer? Instead of looking for prescription items that are restricted, research a simple cancer inducing cocktail for testicular cancer anyone can mix up at home from available products. Might be as simple as turning on your cell phone and carrying it in your jock strap for a few months, hint, hint. Or make sure your scrotum and testicles get a good sunburn and tan to induce a malinoma requiring surgical removal. Instead of avoiding the things that increase your chance of prostrate cancer, indulge in them so the testicles must be removed. (I just now came up with this idea but the concept leads to some interesting story lines that could be posted on this site.) How many "legal" ways are there that lead to medical castration by a doctor and how can I cause that to happen with minimal fuss.

Hope I made you think

BernadetteTS

I don't want to be trapped by any view or requirement. I dont want to be trapped by an approach you arent defending against one as well. I like your notions -- I think you are leaning toward what I am looking for: a construct or an idea, or even a playbook around or with which to build an acceptance. It doesn't have to be an SOC, but it needs discussion if folks want some acceptance. It is a place to start. It needs more than platitudes by some, and more than the well-thought position of one serious thinking individual such as yourself. Notions folks?