The World Professional Association for Transgender Health (WPATH) has begun deliberations toward revising its existing Standards of Care document. The SOC lays out the hoops that individuals must jump through as part of their access to care for any sort of transgender condition as a result of “Gender Identity Disorder.” Part of these deliberations will take the form of a series of commissioned articles from many of the “experts” in the field, all of which are to be published in the International Journal of Transgenderism. All four issues this year will be devoted to little or nothing else, with the first issue next year consisting of reactions to the articles. The goal is to have the new standards completed and ready for publication by the summer of 2011.

Prof. Eli Coleman of the University of Minnesota Medical School will be the editor for the series of articles and he wrote a brief introduction to the first issue laying out the agenda and timeline for the revision. Coleman notes that the standards should be “written to be more inclusive of the variety of gender variant individuals, address the full range of transgender experiences, and use less pathologizing language.” Coleman also notes that the International Statistical Classification of Diseases and Related Health Problems (ICD), which is sponsored by the World Health Organization, is under pressure to reclassify GID as a physical disorder, rather than a mental disorder. Those with GID need their bodies repaired, not their minds.

My favorite article in this first issue is by Prof. Sam Winter of the University of Hong Kong. Winter makes a very strong (and I hope convincing) argument for depathologizing gender issues and abandoning the label Gender Identity Disorder in favor of Gender Identity Variance (GIV). This would much more clearly state that humans have a wide range of gender expression that we need to be cognizant of. That the role of professionals is to help individuals both to ascertain and to attain their gender goals. He would have us see “GIV as a difference (not a disorder).” It is clear that Winter sees a much greater variety of possible end points than just “male” and “female.”

Winter also notes that in cultures where gender variance is more accepted than it is in the west, the frequency of public expression is also far greater. Most of the available statistical research is on MtF, where the frequency in some Asian countries is quite high. We know much less about FtM or other variants. He notes that the best estimate for Thailand is about 1 in 300 of those assigned male sex at birth are living as female. In Malaysia the range of estimates is about 1 in 75 to 1 in 150. The hijra in India make up about 1 in 600 of all those assigned male sex at birth. The highest reported incidence is for one town in Oman that was thoroughly studied by Unni Wikan, where she estimated that as many as 1 in 60 birth-assigned men were living as transwomen. Winter notes also that the age of transition is often much younger in Asia, with over half of one large sample of MtFs in the Philippines having begun hormone treatment by age 16, some as early as age 8.

I will add more information later and will try to keep you informed as subsequent issues of the IJT are published. Next month I will attend the WPATH biennial meeting in Oslo to present a paper on Male-to-Eunuch as a valid GIV and to propose appropriate standards of care.

Maybe I'm crabby but why the focus on new naming conventions? Renaming or reclassification doesn't seem to me to be the real issue. For the close minded this won't make the slightest difference. For the people with this issue? Its like calling impotence ED. Not really a change that makes a difference. I dunno... my crabby opinion.

Re F2M transexuals. I think in the general population there is this disconnect on what makes an "F" person into a "M" Don't you think that the majority of F2M transexuals stop at hormone therapy or at most do only top surgery? The point being these folks are "male enough" for their own situation and the costs and effectiveness of bottom surgery is well (In what I've read) kinda poor. And what I wonder is happening is that these hormone only people are not getting classified correctly in surveys etc? And by correctly I suggest a quick spin on Youtube. Search Injection Testosterone and look at the changes this makes in a very short time. Amazing!

BTW kudos for them (At last) suggesting this is "medical" not a "Mental health" issue. I've always thought that the scheme of having a mental health screening before hand to establish that the patient is healthy (Mental health wise) still is a good step for all involved and that "therapy" after that is to learn good coping skills for some of the issues they will face in transition. It not only helps protect the surgeon from later legal issues but is a nice feedback to the patient (This is ok. You are not "weird." This IS medical not mental!) Of course most probably know this already.

If thats NOT what doctors think GID is about I'm very confused and troubled.

As to M2E as a standard. I wonder if stating some clearly obvious cases of how this would be perfectly rational would help? People with out of control sex drives for example? If they accept this then is it not still valid for those who sex drives are 189 degrees from their partners? ie a Women in Menopause married to a man with a 24:7 sex drive? If you find one valid reason you can more easily move forward. It might be of value to equate female castration numbers and how this is offered as treatment for a variety of reasons.

To take a cue from the changing GID to a kinder gentler phrase I wonder if the scary word "Eunuch" ought to be "Testicularly Challanged" TC...

JesusA (imported) wrote: Fri May 15, 2009 3:33 pm My favorite article in this first issue is by Prof. Sam Winter of the University of Hong Kong. Winter makes a very strong (and I hope convincing) argument for depathologizing gender issues and abandoning the label Gender Identity Disorder in favor of Gender Identity Variance (GIV). This would much more clearly state that humans have a wide range of gender expression that we need to be cognizant of. That the role of professionals is to help individuals both to ascertain and to attain their gender goals. He would have us see “GIV as a difference (not a disorder).” It is clear that Winter sees a much greater variety of possible end points than just “male” and “female.”

Ah wonderful! GIV is much closer to reality than GID. I've always felt that calling anything a disorder marginalizes it. GID implies there is something wrong with you. It just reinforces the stigma and gives license to discrimination.

mrt (imported) wrote: Sat May 16, 2009 6:06 am To take a cue from the changing GID to a kinder gentler phrase I wonder if the scary word "Eunuch" ought to be "Testicularly Challanged" TC...

I am NOT "Testicularly Challanged". I am nutless! --FLO--

Then I am Silicone Enhanced!

Then I am Silicone Enhanced!

Breasts or balls. What the hey!

...

JesusA (imported) wrote: Fri May 15, 2009 3:33 pm Prof. Eli Coleman of the University of Minnesota Medical School will be the editor for the series of articles and he wrote a brief introduction to the first issue laying out the agenda and timeline for the revision. Coleman notes that the standards should be “written to be more inclusive of the variety of gender variant individuals, address the full range of transgender experiences, and use less pathologizing language.” Coleman also notes that the International Statistical Classification of Diseases and Related Health Problems (ICD), which is sponsored by the World Health Organization, is under pressure to reclassify GID as a physical disorder, rather than a mental disorder. Those with GID need their bodies repaired, not their minds...

I attended a transgender health fair today at which Walter Bockting was a speaker. Bockting is a colleague of Coleman at the University of Minnesota and the next President of t

JesusA (imported) wrote: Fri May 15, 2009 3:33 pm he World Professional Association for Transgender Health (WPATH,

the successor to the Harry Benjamin Society.) He is an excellent speaker. I wish I had the opportunity to speak with him individually because I had a number of questions and comments. I will check to see if I can get a copy of the slides he presented.

My therapist, for a reason unknown to me, considers me 'sassy' - in a good way. As Bockting spoke, I was quietly giving her my impressions. At one point, I said I was starting to feel particularly sassy. I told my therapist that Bockting had just revealed a bias toward one line of treatment. She was not surprised by my comment, but shook her head 'no' - meaning Danya, do not say anything.

Today was the first day of the health fair and intended mainly for professionals in the field and providers. My gender therapist thought I would enjoy today's talks and encouraged me to attend. Tomorrow is considered of more general interest for the TG community.

In another post here, I will describe some of the concerns expressed by participants at Bockting's presentation.

Bockting's presentation was based, in part, on an online survey sponsored by the University of Minnesota. One of the listener's asked if people of color were fully represented in the study, the point being that the way a black trans man experiences the world, for instance, is not the same as that of a white trans man.

Bockting (I'm fighting the urge to refer to him as Walter ) responded that the results showed people of color were under represented. They made up only about half as many of the survey participants as one would expect from a random sample of the US population. Rural areas, on the other hand, were will represented as were, if my memory is not faulty, poor areas.

These are some of the conclusions Walter Bockting has reached over the last several years, based on his extensive research and many years experience as one of the leading spokespersons on transgender health. Keep in mind, these are not my 'talking points', and as I list them here the context of his entire talk is missing. Things that may sound controversial, might seem less so on hearing his entire argument. I do not list these in the sequence of the talk, because it was so detailed I cannot recall it without notes:

1. A sizeable percentage of persons identifying as transsexual do not fully identify as the gender to which they want to transition. I really wanted to speak with him about this result, because I was fascinated. He was speaking about male-to-female and female-to-male persons.

2. I was aware the University of Minnesota program was generally very supportive of the concept of the gender continuum. For several reasons, related to my own experience at the U of M, I was not certain Bockting was. He definitely is and the opening slide listed what was really only a sampling (my interpretation) of the variety of possible gender identities and expressions.

3. Bockting seemed to question the value of the Real Life Experience, not that he was advocating anyone rush into anything either. Far from it.

4. Bockting is at least starting to believe, if he's not already there, that transsexual is an outmoded term. I suspect part of this is due to the survey results listed in item 1. He stated that transgender (not transgendered, by the way) people of all stripes have much more in common than previously thought, in certain respects.

5. He noted something discussed in at least one other thread here: There tends to be pressure in TG support groups to conform, of all things! I don't get this, I mean why? I have never experienced this pressure but I have never been to a support group. My gender therapist, who was sitting next to me today, was nodding her head in agreement. She runs one such group. A second client of hers also attended today. She agreed with my therapist; she's been to this support group. I am perhaps the only client my therapist has admitted does not need the group. Late this afternoon and earlier this evening I was not so sure, but I'm getting off topic.

6. Somewhat counter intuitively, Bockting went on to describe the importance of support groups. Even more so for younger TG people in their teens, where peer acceptance is critical to healthy maturation. The group, including Bockting, agreed that any teen transgender support group needs sympathetic adult supervision of some type to at least question group pressure towards conforming to particular gender identities or expressions.

7. Bockting discussed efforts to remove the stigma from being transgender. He noted that they have been finding that many other US states are not nearly as understanding of gender identity, and accepting, as Minnesota. At this point, I was hoping 'they have been finding' meant they have found this for years. One only has to read the news to understand this.

[This is where the audience discussion heated up. Of course, everyone was in favor or stigma removal! They had concerns, however, on the effect of these efforts on continuing health care coverage for those seeking medical treatment. I will describe some of these in my next post here. For now, I will note that Bockting appreciates these concerns.]

8. Walter Bockting stated that there is too much emphasis placed on passing. He qualified this, though, and my memory is not good here. He said that for at least a certain subset of TG persons, the ability to pass is positively correlated with happiness. I've got to get more information on this. I will call his office.

9. Bockting questioned the validity of the 'cross-dresser' identification for some of these individuals. Many men who cross-dress will state in front of their wives that they have no desire to be women. They tell a different tale when their wives are not present. Some take cross-gender hormones. Other's describe a deep need to be a woman. I got the impression that he had concluded most cross-dressers are really somewhere else on the gender continuum. I want to track this down with his office, too.

10. The University of Minnesota views the proper role of the therapist as, first and foremost, presenting new clients with options once they are diagnosed with GID (current terminology). They encourage exposure to different parts of the trans community and, hence, different ways of expressing oneself that lead to the most satisfying results. They in no way push hormones, or transitiong to full-time living in a new gender role, as the answer for everyone.

JesusA (imported) wrote: Sat May 16, 2009 6:28 pm Breasts or balls. What the hey!

Its really much the same. I can't tell you how many "debates" I've had over having replacments put in or not. Many men have told me "My wife doesn't care. No one will see this. and I don't need them to be A MAN" And my favorite "They are FAKE balls" SIGH.....

My take is this. If a women lost her breasts to cancer and said "I would really like cosmetic surgery to regain my natural look - and even make them better?" What guy would say "Suck it up you don't need that!" I think zero...

The doctors say that this is about "Body image" and that mostly women subscribe to this. Men are starting to be more concerned but its still 20:1 women in the Cosmetic surgery at least.

Not a topic I know your working on but... Maybe in the next series of papers????