Changing the direction of a huge and conservative establishment is a long and difficult task. My colleagues and I have been at it for a dozen years and have published over two dozen articles in the relevant medical and psychological journals. We have made a number of presentations to local, national, and international conferences of medical personnel and of psychiatrists/psychologists. We have consulted on an individual and small group basis with professionals in our general areas of the U.S. and Canada.
Progress has been slow, but there definitely HAS been progress. Our efforts have moved the World Professional Association for Transgender Health to include genders beyond the binary. Eunuch is implicitly included. We are working on very minor revisions on an article that will push (again) for explicitly including "eunuch" as a possible target gender for transition. It may happen as soon as next year!
Anyone wishing to find a counselor willing to prescribe anti-androgens and/or to write a letter toward obtaining surgery can now go to the WPATH website (
www.wpath.org) and use the on-line member directory to find someone who will follow the WPATH Standards of Care, 7th edition). You should ask them specifically on the telephone if they are using the current version (which is also available to you as a free PDF download on the WPATH site). WPATH now has cooperating surgeons scattered across the United States, at least, who are willing to perform surgery with a single letter -- all that is required in the WPATH SOC-7. Outside the U.S. it's still difficult, but getting easier. There are WPATH members in many countries, though many are more conservative in their approach than those in the U.S. and Canada. (I will be presenting at the next WPATH conference in Amsterdam and hope to persuade more European members that "eunuch" is a valid gender identity.)
Our group also worked with the American Psychiatric Association in the revision of their current version of the Diagnostic and Statistical Manual (DSM-5). They were willing to change the terminology from "Gender Identity Disorder" to "Gender Dysphoria," recognizing that it is NOT a psychiatric disorder. The new version also changes the wording from helping those with a desire to transition to the "opposite" gender to helping to transition to a "different" gender. We tried, but were unable to get "eunuch" specifically mentioned this time around, although it is implicit in the wording of the DSM. We also failed to get Xenomelia (Body Integrity Identity Disorder) specifically included, even though we had the editor of the previous edition of the DSM as one of the co-authors on the proposal. Since there is increasing work on Xenomelia as a physiological function of the sensory cortex of the right parietal lobe of the brain and not a psychiatric issue, there is hope for having it properly recognized despite its lack of mention in the DSM.
We were asked to submit a proposal toward revision of the International Classification of Diseases, which is the World Health Organization encyclopedia of known conditions that require treatment -- gender dysphoria included. Our hope is that in the next edition it will fall into the same sort of chronic condition as allergies or other conditions that require continuous medication (e.g., hormones), but is not considered debilitating once treated. (Get your medications and/or surgery and you no longer have GD.)
In addition to the article for the journal of the WPATH which is back for minor revision (both reviewers actually wanted us to add more footnotes), we have one article accepted and in press and two more submitted for review in different medical journals.
Progress is slow, but there IS progress.
One of our next steps will be another large survey of the EA members (and anyone else they can convince to take it) to provide further data to push the medical and psychological establishments.