Male to Eunuch Standards of Care

[mrt (imported)]

Lawsuits are the basis of the whole problem and doctors have to be protected. All the plaintiffs lawyer has to ask MOST jurys is "If he was sane, would he have ask you to cut his balls off?" Most people see the desire for castration as defacto evidence of a mental problem. We here are more enlightened to the issue (or all insane...) and see things different than about 99.5% of the general public. Therefore, the need for a legal/medical SOC.

Sadly what you say is also in the mind of some dumb head doctors who think that regardless of the cicumstances you gotta be crazy to want to have your testicles removed.

[kristoff]

Sadly what you say is also in the mind of some dumb head doctors who think that regardless of the cicumstances you gotta be crazy to want to have your testicles removed.

I suspect that if someone were dealing with someone who is a qualified gender doctor, they would know and refer pshrinks who are familiar to the area of concern. Maybe there ought be two principal concerns: 1) simple sanity and capacity to make an informed choice, unimpaired by mental health issues that could cloud judgement (i.e., Obsessive-Compulsion Disorder), and 2) clarity and understanding and comfort with the M2E desires and consequences on the part of the seeker / client.

Further comment?

[thefraj (imported)]

My head is still spinning taking it this in! My experience with doctors about my gender issues and castration desire as I was growing up STILL makes me shudder. I didn't make the right noises to earn the "gender dysphoria" label. Deep down I'm not male at all, but not uncomfortable wearing guys clothes. (or at least not unhappy enough to change completely). I had surgery and I'm happy, despite being at odds with the System.

But despite this, I still believe standards are VERY important, because patients (like customers?) don't always know exactly what they want. The medical community needs some kind of construct or model to help the average doctor give the best care for the patient. I guess we mustn't lose sight that our goal is to help the individual have a good quality of life. And with this we must accept the possibility that the patient (despite their insistence) may not actually benefit from therapy or surgery. That there may (in some rare cases) be an underlying issue that needs working through (whether psychosis, body dysmorphia, extreme sexual fantasies, schizophrenia, etc, etc) And the best way to advise doctors and set any guidelines can ONLY come from a crack team of experts made up of, working intimately with (AND needing the approval of!) people from the transgendered community. But I stress the word guidelines rather than gatekeepers. Guidelines are necessary, to protect both patient and care-giver. But should never be used as an excuse to withhold treatment. I guess there we get into a bit of a paradox.

We are all unique. Identifying the eunuch community must be particularly difficult, as Plix said. We are so diverse you could almost re-categorize everyone here by their castration REASONS. The purpose that binds us is simply the act of cutting (or wanting to!). To narrow it down any further to the gender-identity issue, we would end up excluding those for whom this is a fantasy/lifestyle thing. Is that a good or bad thing? I don't know, but suspect that the approach to giving the care to these two groups would be quite different.

Kristoff, are you basically asking: to cut or not to cut? when should therapy and surgery be offered, or withheld and who has that right? and what guidelines (if any?) should be set.

[Danya (imported)]

I reserve the right to proof this tomorrow night! I'm really tired and need to get to bed but wanted to get this posted.

Right up front, I want to admit that I've had some major and recent frustrations with the Harry Benjamin Standards of Care for Gender Identity Disorders. At the current state of my knowledge, these apply soley male to female and female to male GID. Despite my frustrations, I firmly believe SOC are critical as guidelines in treatment.

I am getting near to transitioning at work from male to female to begin the one year "real life test", sometimes referred to as the "real life experience", to demonstrate how well I function as a woman in every area of my life. This and one year on HRT are requirements that must be completed prior to getting approval for genital reassignment surgery. I was surprised to learn, when I first began my journey in gender, that therapy is not a requirement for treatment. A male person who has successfully lived in the feminine gender role full-time for an extended period, which I don’t think the SOC clearly specifies, would be an example of an individual not needing therapy to receive HRT and ultimately GRS.

Despite my occasional intense frustration with existing SOC, I firmly believe some form of SOC are essential to ensure that clients seeking surgery will be given the green light only when it is very clear that they fully understand the consequences (mentally, physically and socially), that they can handle the potentially massive (and all too frequently negative) changes that can occur in work and family relations and that they are not seeking surgery for the 'wrong' reasons. A self-identified male-to-female client who is in reality homosexual would be harmed by genital reassignment surgery when the real, but perhaps hidden, issue is his internal homophobia. GRS would be a disaster for such a client. Fetishes are also considered by the existing SOC to be completely inappropriate reasons for GRS.

SOC, although they have no legal recognition, are generally recognized in the medical community as the 'gold standard' for making decisions on all aspects of transitioning. As the accepted standard, they offer care givers a degree of protection against lawsuits. Without this, there would be far fewer physicians willing to perform GRS.

Just as with male to female and female to male gender changes, I believe eunuch is a legitmate gender identity. A true gender continuum has been recognized by some researchers at least since the late 1990's. There is even talk of gender being multidimensional. At a minimum, the existence of a gender continuum, vesus a purely binary male or female situation, is becoming more commonly accepted among gender clinics.

The continuum easily allows room for and I would say even predicts the existence of the eunuch gender ID. Someone identifying with a eunuch gender does not feel male but does not feel female either. I am not saying that all eunuchs who have sought castration were dealing with GID. There are other reasons, some possibly related to GID such as BIID (

Body Integrity Identity Disorder

) and others that may not be gender related at all, such as fetishes. Some of these other reasons outside the realm of gender may be perfectly valid and healthy for seeking surgery. For others, there would likely be a clear consensus as to their being invalid. In either case, reasons for seeking castration outside of diagnosed Gender Identity Disorder (eunuch) should be excluded from SOC designed for treating this disorder.

SOC for clients seeking castration who present with a eunuch identity should include some of the same safeguards as the existing SOC for 'transsexuals'. Those clearly seek to screen out inappropriate candidates who, to the best of our current medical and psychological knowledge, will not ultimately by satisfied by surgery and in fact may be gravely harmed.

The concept of the 'real life experience', for eunuchs, never made any sense to me when I first started at the Program for Human Sexuality at the University of Minnesota. I initially self-identified as a eunuch and wondered aloud to my therapist how I could possibly satisfy this requirement for surgery. Was I to walk around for a year with a sign around my neck stating 'I am a eunuch'? She got my point and, very tellingly, had no trouble at all accepting male to eunuch as a legitimate gender transition.

There should be a redefined real life experience for those with eunuch GID that removes the obviously meaningless concept that one would need to be recognized and treated by others as a eunuch for one year before surgery approval. The requirement for hormonal therapy (through testosterone suppression), however, prior to approval for surgery is critical.

[kristoff]

The continuum easily allows room for and I would say even predicts the existence of the eunuch gender ID. Someone identifying with a eunuch gender does not feel male but does not feel female either. I am not saying that all eunuchs who have sought castration were dealing with GID. There are other reasons, some possibly related to GID such as BIID (

1206224640]
Body Integrity Identity Disorder

) and others that may not be gender related at all, such as fetishes. Some of these other reasons outside the realm of gender may be perfectly valid and healthy for seeking surgery. For others, there would likely be a clear consensus as to their being invalid. In either case, reasons for seeking castration outside of diagnosed Gender Identity Disorder (eunuch) should be exc
[/quote]
luded from SOC designed for treating this disorder.

Should there be a parallel or corollary SOC for those who are non-GID (M2E), such as an “Other” category, that can or should be established as an adjunct to the SOC for M2E as a GID? How would one establish a standard for them – Hypersexuality standards, relatio

nship issues, and so on. How would they be evaluated?

There should be a redefined real life experience for those with eunuch GID that removes the obviously meaningless concept that one would need to be recognized and treated by others as a eunuch for one year before surgery approval. The requirement for hormonal therapy (through testosterone suppressio

n), however, prior to approval for surgery is critical

What could be done to evaluate the appropriateness, aside from periodic hormonal assays? Perhaps personality change analysis – personality and / or social testing, interviewing, or other considerations – and what would those be? Perhaps some form of knowledge testing about castration and life as a eunuch?

[Mac (imported)]

.......

. Right up front, I want to admit that I've had some major and recent frustrations with the Harry Benjamin Standards of Care for Gender Identity Disorders. At the current state of my knowledge, these apply soley male to female and female to male GID. Despite my frustrations, I firmly believe SOC are critical as guidelines in treatment. .......

I believe that the SOC are way too rigid. Both society's norms and the SOC place undue barriers on people. Life would be much better, we would be more respectful of one another, and have fewer sexual hang-ups if the current social barriers and restrictions were eliminated.

Here is a reprint of an article which I included here a couple years ago. Some of the things mentioned in it have a lot of merit.

Gender Equality

IN THE BEGINNING: The human male and female were created equal (like the other creatures) with no sexual inhibitions or hidden secrets. We were at peace and in harmony with God, the universe and each other. Gender issues, as we know them today, did not exist. Then, we created many artificial differences that resulted in unnatural problems, secrecy and gender tensions.

CLOTHING: We first created clothing, not to protect us from the elements but to hide our physical differences from each other. This resulted in stereotyped female and male clothing to further disguise and promote our differences. It created unnatural secrecy, curiosity and tensions between female and male. What a giant step backward!

Today, the clothing trend is starting to reverse. It is now acceptable for the female to wear all traditional male styled clothing. However, there is still a real bias against the male wearing any traditional female styled clothing (skirts, dresses, blouses, underwear, lacy and frilly items).

RESTROOMS: Next, we created an unnatural secrecy around basic bodily functions by establishing separate restrooms for female and male users and implementing different levels of secrecy for both. The female was always provided private stalls with 6-foot walls and doors. However, the male was given open urinals and inadequate stalls. Male stalls were either non-existent or had only 4-foot walls (sometimes without doors). This secrecy only promoted unnatural curiosity and perversion.

Today, due to long lines, females frequently use male restrooms. However, the male is still prohibited from using the female restroom unless he can pass as a female. The family restroom addresses some aspects of this bias by permitting opposite gender assistance for children, elderly and handicapped. However, true unisex use is prohibited (even for married adults).

BATH, DRESSING, & SPORTS: When the concept of a bath was established, we again created separate facilities for the female and male. Heaven forbid they should see each other without clothes. We provided privacy curtains for the female, but not the male, in dressing and shower areas. Why the difference? We even added basic health and fitness as secret and forbidden differences by creating separate exercise and recreational facilities. Why so much secrecy?

OTHER GENDER BIAS: We continued these exclusions and differences to all areas of human life: employment, sports, recreation, family life, and etcetera. Fortunately, some of these biases are now being eliminated. However, the rate of change is much too slow.

CONCLUSIONS: We must establish true gender equality for everyone. Making all clothing acceptable for both sexes will abolish one stereotype. True unisex restrooms with adequate stalls for privacy will eliminate another bias and provide additional security for both female and male users. Bath and dressing facilities must be designed for unisex usage and individual privacy. Sports, health and recreation facilities must offer shared usage for both female and male users. Gender biases must also be eliminated from employment and all other social areas of our life.

[Danya (imported)]

I spoke earlier in this thread about "

major and recent frustrations with the Harry Benjamin Standards of Care for Gender Identity Disorders

". What I've copied in here is from an email I sent to Jesus on this subject. I wrote it the morning after a visit with my gender therapist. After that session, I was really angry with the entire system build around SOC for transsexuals. I've edited this to remove the names of the people involved at the university.

I want to make it clear that it is my hope, despite my frustrations, to continue on with the University of Minnesota program. They have a world-class reputation, I have a very good rapport with my gender therapist and I believe everyone I work with there is trying to do what is best for me. Of course, they are quite naturally concerned about potential lawsuits, too. What medical professionals aren't?

I had thought of writing something 'new' on my frustrations but I think this describes them fairly well. What I had written to Jesus the day before, soon after my session, was more of a rant that was good for letting off steam but not so good for making a rational argument for changes to the system. I wrote this, OTOH, after I'd had a chance to calm down and figure out what it was about the system, as I was experiencing it, that was bothering me.

While my reaction as written here is to transsexual SOC, many of the issues I talk about are potential trouble spots for any proposed SOC for eunuchs, too. I've got other problems with SOC that I may post at another time. This does not at all mean I think SOC are unimportant. I do think the existing SOC could use some major revisions. In the end, much of this post reflects my dissatisfaction with the operation of the program at the University of Minnesota. I suspect, though, that similar problems are common in other gender clinics.

Here goes:

"This SOC business with the university has got me thinking quite a bit. At this point, I’m mostly considering how the interactions of the professional and client community could be handled better. For now, I’m left feeling that I’m being treated without fairness or thought for my feelings and concerns.

"This problem could have been largely avoided if the Program in Human Sexuality provided clear communication from the beginning on how the system operates. The clients need to be given a much better understanding of what they can expect, including potential reasons for decision delays and a realistic time frame for a decision on HRT. I should not have been left guessing after my first visit with the university physician as to why I wasn’t prescribed estrogen on the spot. All she told me was that she needed to take up my situation with her staff because of concerns about my age and my family’s medical history. No one told me until weeks later that this subsequent meeting with staff is standard procedure for everyone. If I’d known this from the beginning, I would not have been upset about her response. What I knew at that point was that an acceptable qualifier for HRT was a minimum of three months of psychotherapy with evid ence of a consolidation of gender identity. My therapist had interpreted my MMPI results and concluded that there was no contraindication for HRT or surgery. During my last visit with her before seeing the physician, she said ‘you’re free to try whatever hormones you want’. Clearly, this was not the case and, although it makes sense to me that they be cautious about medical issues, I went to the doctor appointment with unrealistic expectations.

"If the university is truly adhering to SOC, they should be able to handle things more efficiently and smoothly, too. Being told yesterday that I would need to take two additional psychological tests left me feeling angry that they hadn’t provided the tests sooner. I realize now that I am angry, after all, at my therapist for forgetting to administer one of these when I started. The second of these recent tests is a new requirement for the program. If I had not made yesterday’s ‘extra’ appointment with my therapist, I would not have found out about the requirement for these tests until late April. By that point, it may have been too late for the university to get the results before the next monthly meeting of my committee in early May. Then there would have been even more delay.

"There was also an initial delay of several weeks for the doctor's office to contact me about getting my first appointment. I had to keep badgering my therapist that I hadn’t yet heard from them. This left me feeling that I was at the mercy of an uncaring and poorly functioning bureaucracy that couldn’t get its act together.

"The fact that the university, to the extent of my experience with the program, is very insular in its attitudes is another problem. They apparently have few contacts with professionals beyond their own domain and they don’t seem terribly interested in establishing any. When I suggested yesterday that they talk with my own psychiatrist to get his opinion, my therapist thought it was a good idea – finally. I can understand that they might want an ‘official’ evaluation by their own psychiatrist (mine is scheduled for May 2) but if they are following clear SOC why didn’t they officially request this earlier? The idea of seeing their staff psychiatrist was first suggested to me by my therapist a few weeks ago and at that point it wasn’t a requirement of the committee. She may have realized that they would likely ask for this and wanted me to get an appointment as soon as possible. My initial concern when she suggested this, which m ay be totally invalid, was that the committee would hear that I’d made the appointment and then use that as a rationalization to extend the decision time further. ‘Aha, he/she’s already got an appt with our shrink, let’s wait another month to hear how that comes out.’

"Then there was the much earlier issue of my therapist practically having to beg her boss to release her MMPI interpretation to me. It appears that I speeded that up by threatening to demand to speak with her boss myself if the official report were not released to me. It is my legal right to have this report.

"All of these factors leave me feeling that I’m not being treated with respect as a client who is paying them and deserves to be kept better informed atevery step of the process. I know how universities tend to do things so all this shouldn’t surprise me. On the other hand, I’ve always hated the excuse that ‘that’s the way it is’ or ‘it’s always been this way’ as rationalizations for poor performance and service. I absolutely think standards are important but clinics are going to drive many folks away if they feel they are not being heard and treated with dignity."

[JesusA (imported)]

As we work toward developing a Male-to-Eunuch Standards of Care document to present to the medical community, one critical piece needed will be about those who know that they are not-male at a young age. For those members of the Eunuch Archive community who know that they are neither male, nor female, who feel themselves to be androgynous or “other” in gender, we would like answers to the four questions below. These can either be in the form of posts to this thread (where everyone can read them) or in a <Private Message> to me (where you will remain anonymous and only part of the statistical tally).

1) At about what age did you first realize that you were not fully Male?

2) At about what age did you realize that you were not female either?

3) In what way(s) did you express your discomfort with your assigned male gender to those around you, before you turned sixteen (if you did so at all)?

4) What, if any, actions did you take toward becoming not male before you turned sixteen?

[SplitDik (imported)]

Okay, the solution is to have a series of reasonable steps to ensure a degree of sustained intention, but make it so any psycologist is just a monitor not a gatekeeper.

For example, if a man takes chemical castration for a year, then that should be the gate. The only letter the surgeon should need is confirmation that the patient has completed the chemical castration cycle..

This eliminates the issues pointed out about psychologists withholding their approval, but would also weed out some temporary urges that some might regret.

[davidtup (imported)]

As a eunuch who has gone further, ie now what could be considered to be a pussy boy. I have done some research into the subject. I'd had a desire for castration for many years and also considered the possibility of going further ie having a vaginaplasty. In 2002 as part of a psych screening due to my seroconversion to HIV. I was referred to a clinic in Toronto that dealt with gender identity issues. It did not take me long to get a referral from the doctor to get surgery. The problem as he said was actually getting a doctor to do the operation. ie the castration. In the intervening time I did a lot of research. The major problem is not so much the psychiatric profession but the surgeons them selves and the interference by the malpractice insurance industry insisting on the HB protocol to be followed especially in the US.

I chatted with several persons under going the full transition and they found the same problem. The surgeons were not willing to do the vaginaplasty but were very willing to do all the ancillary operations first. ie breast enhancement, facial feminization surgery, etc, etc.

This insistence by the malpractice insurance industry and their strict interpretation on who is an appropriate candidate forces many persons to go to persons who are not fully qualified to perform the surgery.

In chatting with plastic surgeons they have found that many of their patients who are requesting surgery for other than the genital area should be the ones who should seek serious psychiatric help.

A couple of years ago I moved with my husband to the southern Caribbean and met a doctor from South America who does the surgery. He found that the HB protocol was stupid, and said many doctors he knew agreed with him.

Firstly he said that the first thing that should be done is a psychiatric evaluation to ensure that the patient was relatively stable and had a true desire for the operation. The patient should then be castrated and the erections disabled either temporarily or permanently. Then after 6 months to a year on HRT and they are stable the operation should then be done. The castration should be done before any female hormones are administered as their long term use can cause problems ie increased chance of cancer and also emotionally as with the testicles in place they will up their production and larger and larger doses of female hormones are then needed.

For those who are not fully transitioning staying outwardly male and just desiring a vagina the intervening period ensures that their dosage is stable and provides a real life experience. My self I'm an exclusive gay male bottom and had no desire to intercourse or receive penile stimulation from my partner.

The problem as We see it, myself and the doctors I've talked to, is that like gay people in the 40' and 50's. The psychiatric profession only saw the really sick ones so they considered that all were sick. With the opening up of society and attitudes many are coming out and saying they don't like their genitals. More and more research is being done. ie One of the counseling services in the US for people with HIV has noted that a large portion of their clients have

genital issues ie either want to be castrated or nullified or have a vaginaplasty.

There is also the group that desires the outward appearance of being female yet retain their male genitals as they are primarily sexual Tops. The she males aka chick with a dick types. The surgical professionals are more than willing to provide them with the operations they desire.

The HBSOC protocol was ok for it's time with the knowledge they had, and their black and white digital attitudes, no shades of gray. But it's time has long gone. Not all persons want to transition, to the 1950's ideal of a woman and many are unable due to various reasons. In fact many transsexuals I've ever met look like guys in womens clothes. Even if I wanted to transition completely I couldn't due to allergies to perfumes, and makeup. That and the fact that I, and my husband, think that tits are ugly.

As a note my doctor only requires a certified letter from a counseling professional stating that the patient is relatively stable and it is a true desire on their part to have the surgery. Any other conditions would not be aggravated in their opinion by the surgery. Many other doctors as well as him will insist that they also have a sexual partner.