Friday, 31 October 2014

brain gender

Quite a while back I posted about the case of David Reimer who was reassigned as a female after a botched circumcision inadvertently removed most of his penis. Reimer eventually committed suicide at the age of 34.

Recently, I found a reference online to a New England Journal of Medicine article dating back to 2004 which dealt with genital reassignment surgeries performed on patients suffering from Cloacal exstrophy which is a severe birth defect that occurs in approximately 1 in 400,000 live births. One of the most pronounced characteristics is severe phallic inadequacy, or the complete absence of a penis in genetic males. Historically, doctors have treated cloacal exstrophy by surgically altering, or "reassigning" these babies as female.

John Gearhart, M.D., director of pediatric urology at Johns Hopkins Children's Center and an expert on exstrophy complexes, and colleagues challenged this standard treatment by studying 16 genetic males from 5 to 16 years of age, 14 of whom underwent surgical conversion to female sex. They found that more than half of them identified themselves as male; six individuals were so unhappy with their female sex of rearing as to pursue gender reassignment back to male. All 16 had interests and attitudes that were considered typical of males.

This leads to once again to fortify the idea that gender identity is primarily rooted in the brain and that performing genital reassignment on non dysphoric individuals will not change their internal sense of who they are.


Cloacal exstrophy

Thursday, 30 October 2014

heterosexual versus homosexual

I posted two distinct sections from the same chapter of Ray Blanchard’s book over the last few posts in which he made the distinction between his heterosexual and homosexual dysphoric patients.

In his heterosexual group, he explained the difficulty in predicting the difference between transvestism and transsexualism and showed, like Harry Benjamin, that there was a blurring of the line in some of his patients. He suggested that transvestism could be a stunted form of transsexualism.

His homosexual gender dysphoric group were found not to be as variable in adulthood as his non-homosexual patients, but were also found to differ in the degree of cross-gender identity and intensity of gender dysphoria. Mild intensity dysphorics might end up like drag queens in using episodic dressing (minus the erotic component) while high intensity dysphorics would need to have hormone treatments and surgery. These were the same patients that Harry Benjamin would have identified as types V and VI.

So far so good as both make the same types of observations.

However, in finding no etiology for his patients’ dysphoria, Blanchard then proposes two distinct explanations; both involving sexual motivation. Target location error was proposed for his heterosexual patients while a desire to attract heterosexual male partners was given for his homosexual group.

Since we have no scientific evidence for the causes of gender dysphoria it’s easier to fill the void with pseudo-scientific theories such as Blanchard’s and in the vacuum created after Benjamin’s death we even saw the invention of a nonexistent disorder called Harry Benjamin syndrome to help homosexual dysphorics who had transitioned feel better about their decision. Transition worked for them but not necessarily for the reason they hoped as any simple genetic test would prove.

Here is where the power of belief takes over and people do what they must to feel right in their own skin. It comes down to what works for them.

What should matter most to us is that we have improved the treatment methods and expanded the options available to help people suffering from gender dysphoria which makes me very glad.

Wednesday, 29 October 2014

gender dysphoria in homosexual men

The following is another excerpt from Chapter 3 of the same book I referenced the other day. This time it deals with gender dysphoria in homosexual men:

"Homosexual Gender Dysphoria

Definition.

Homosexual gender dysphorics are those who, from the time of earliest sexual awareness in childhood or puberty, feel attracted only to men. The individual's masturbatory fantasies and romantic daydreams are of males; if he also has sexual encounters or love relationships in real life, these are exclusively or almost exclusively with men.

Description.

The natural history of homosexual gender dysphoria is strikingly different from any of the syndromes examined so far. This difference, which has led many theorists to conclude that homosexual gender dysphoria must have a separate etiology, is already apparent in the individual's earliest gender role behavior. The childhood behavior of homosexual gender dysphorics, unlike that of heterosexual, analloerotic, or bisexual gender dysphorics, closely resembles the DSM-III-R diagnosis of gender identity disorder of childhood, described in Chapter I. As boys, they are unusually deficient in, or afraid of, physical competitiveness: They avoid rough-and-tumble play, are frightened of fistfIghts, and strongly dislike team sports. They prefer to play with girls, to play girls' games, and to play with girls' toys, in particular, Barbie-type dolls.

They also prefer the company of adult women to that of adult men, and they like to take part in women's conversations. They often become mothers' helpers, and they take an unusual interest in domestic pursuits such as cooking, sewing, and decorating. They are keenly interested in women's clothes, hairstyles, and makeup. Many entertain themselves by drawing pictures of glamorous women; those whose mothers will allow it like to pick out their mothers' dresses, brush their hair, and make up their faces.

Some of these boys also dress themselves up as women, although this might not occur as regularly in the childhood of homosexual gender dysphoncs as in that of transvestites. Cross-dressing, when it does occur, is often accompanied by playacting various romantic roles such as princess or ballerina. Cross-dressing in homosexual gender dysphorics is not sexually arousing, either in childhood or later.

It is not clear whether, or at what age, these children explicitly formulate the wish to be female. Adult homosexual gender dysphorics frequently date such wishes to earliest conscious awareness, but such retrospective reports cannot be assumed to be valid. Even when they are not engaging in any obvious cross-gender behavior, these boys are observably effeminate. This may manifest itself in feminine speech patterns, gestures, or gait. As these children reach middle or late childhood, their schoolmates begin to notice the subtle as well as the obvious signs of effeminacy and respond by labelling them " sissies. " When they reach puberty, the taunts of "sissy" tum to "queer," "fruit," and "faggot," and these children begin to be ostracized by their peers.

Although it is true that the great majority of adult homosexual gender dysphorics were feminine boys, it is not conversely true that the majority of feminine boys will end up as homosexual gender dysphorics. The majority of feminine boys do, in fact, end up in adulthood as homosexuals, but they are fully content with their male sex and have few, if any, gross
cross-gender behaviors (Green 1987; Zuger 1984). It appears that, in this majority of cases, the boy's femininity spontaneously' 'bums out" around puberty (Harry 1983; Whitam 1977; Zuger 1978). Puberty, then, may be a kind of developmental crossroads, separating gender dysphoric from ordinary homosexuals. It is unknown, however, whether environmental factors at puberty determine which course the individuai will follow, or whether the degree of a boy's femininity determines whether he will defeminize at puberty, or whether boys who defeminise and boys who do not are qualitatively different from the beginning.

Homosexual gender dysphorics are not as variable in adulthood as non-homosexual (heterosexual, bisexual, or analloerotic) patients, but they do differ in degree of cross-gender identity and intensity of gender dysphoria. Some individuals with milder cases might feel feminine without ever acting this out; others engage in episodic cross-gender behaviour as "drag queens," a group cited by DSM-III-R as examples of homosexual GIDAANT. Many, perhaps most, of those with milder cases never seriously entertain the thought of seeking sex-reassignment surgery; some do so in a halfhearted way and soon give up the idea. The most strongly gender dysphoric individuals-the homosexual transsexuals~eventually attempt to establish themselves in society as females, if this is at all practical, and begin to explore the available routes to surgical sex reassignment. It should be noted that, in contrast to the heterosexual type, homosexual gender dysphoria does not tend to be progressive. The homosexual individual's transsexual wishes are probably as strong as they are going to be by age 20 or 25; in some cases they may even decline in postadolescence.

One of the most striking features of full-blown homosexual transsexualism is the effect of gender dysphoria on the individual's sexual behavior. The majority of preoperative homosexual transsexuals do have intercourse with male partners from time to time, but these encounters are regulated by various constraints. They generally avoid letting their partners see them naked, and they often wear panties or some other type of undergarment to hide the penis and scrotum. The transsexual strictly functions as the insertee in anal or oral intercourse; the partner is not even allowed to touch the transsexual's genitals. Indeed, a sexual partner who showed any interest in the transsexual's penis would be regarded as undesirable, for reasons explained below.

Homosexual gender dysphorics maintain that their sexual interest in other men is actually heterosexual, because "inside" they really are women. They also prefer partners who are heterosexual or who claim to be so and who concur with the transsexual's self-evaluation that he is "really" a woman. Transsexuals, therefore, reject lovers who show an interest in their male genitals, not only because they hate their genitals to be touched in the first place, but also because they conclude (probably correctly) that these men are homosexual.

Some homosexual transsexuals simply prefer to avoid the emotional conflict and practical difficulties involved in sexual intercourse altogether. As one preoperative patient stated, with unintentional humor, "I guess I'm just an old-fashioned girl-I don't believe in sex before surgery." As I have previously stated, the reluctance of such individuals to engage in intercourse preoperatively should not be interpreted as "asexuality.'

After vaginoplasty, of course, homosexual transsexuals are better equipped both to copulate as they wish and to attract heterosexual men. It is therefore not surprising that they are then more likely to become involved in love relationships (Blanchard 1985a; Blanchard et al. 1983)."

Tuesday, 28 October 2014

less might be more

I remember once meeting a fellow patient while I waited for my gender appointment. He was in the early stages of transition and could barely strike up a conversation with me or even look me in the eye. After I went inside, Helene told me that he rarely spoke to strangers and had some communication issues.

That meeting stayed with me.

People who follow this blog know that I am on record as not being against transition. However I do propose that one get their house in order before embarking on such a journey. Gender dysphoria is a formidable opponent to be sure and it must be dealt with all of your faculties in good working order. If you have low self esteem, suffer from depression or have family problems then your transition will not repair them and potentially only make them worse. It may be tempting to think that these issues are in part due to our incorrect gender role designation.

I found that it was only when my psyche was at peace that I able to properly tackle my dysphoria. It was when I was most conflicted that my mind raced from place to place in search of a solution.

Perhaps the best approach might be to work on understanding ourselves as well as we can and to do only what is minimally required to improve our happiness. For some this may be occasional cross gender expression while for others it may include hormone treatments or androgen blockers. We are all different.

On another note, a recently discovered that a well written blog I like may henceforth be haunted by two familiar, predictable and polar opposite characters. One is from the dysphoria as fetish school while the other is from the discredited HBS crowd who adopts the clarion call "my bell has rung ergo I am a woman" but must bolster herself by discrediting the transgendered. The author of the blog I refer to appears to be well read, intelligent and hopefully up to the challenge of tackling these two.

Meanwhile, my blog will continue to very happily dispel falsehoods and use current and past research to help people with medium to strong dysphoria find alternative solutions to deal with their condition. This is particularly important for those of us who are heterosexual.

As I have posted here lately, the resources are out there for you if you need them.

Monday, 27 October 2014

gender dysphoria in heterosexual men

The following is an excerpt of Chapter three of the book entitled “Clinical Management of Gender Identity Disorders in Children and Adults” by Ray Blanchard which was published in 1990. The chapter, called “Gender Identity Disorders in Adult Men”, describes the condition of Gender Dysphoria in heterosexual males. What is particularly interesting to note is how, like Harry Benjamin, Blanchard illustrates how difficult it is to distinguish between pure transvestism and transsexualism in some patients (Benjamin's type IV) and how both conditions may be related or one can progress to the other.

While I have always had my reservations about his Autogynephilia theory and still do, this chapter describes very well my own life plus the difficulties inherent in making an accurate diagnosis in this area. I presented for treatment at the age of 44 instead of his average age of 39 years described below:

"Heterosexual Gender Dysphoria

Definition.

Heterosexual gender dysphorics may be defined as men who, although they are sexually attracted to women, nonetheless strongly desire to become women themselves to be rid of their male genitals and live pennanently in society as females. It should be noted that the DSM type labels, heterosexual, homosexual, and so on, do not change according to the individual's current surgical status or cross gender convictions. Thus, a surgically reassigned male to female transsexual living as the lesbian lover of a biological female would still be classified as a heterosexual transsexual.

Description.

The early histories of heterosexual gender dysphorics resemble those of transvestites: most take part in normal boys' activities without outward signs of effeminacy, and most experience sexual arousal when they first begin cross-dressing. There are also many external similarities in early adulthood: heterosexual gender dysphorics tend to work in male-dominated occupations. and the majority get married at least once. When they are not deliberately feminizing their attire, their anatomy, or their presentation, they are unremarkably masculine in demeanor and appearance.

External differences between transvestites and heterosexual gender dysphorics typically start to appear when these men reach their early 30’s. This is the average age at which cross-gender wishes begin to escalate in the latter group. From this point, heterosexual gender dysphoria resembles a progressive disorder that sometimes goes into remission. The exact course of this escalation varies from person to person, depending on individual circumstances and personalities. In some, for example, the first indication of this process is an increasing desire, on the part of a man who had previously cross-dressed only in private, to be regarded by other people as a woman. In the majority of cases, an increasing frequency of cross-dressing is accompanied by a decreasing tendency to become sexually aroused by this activity.

The desire to go out cross-dressed initially creates great feelings of conflict in heterosexual gender dysphorics. Many have realistic fears about their ability to "pass" as women; others fear having their anomaly discovered by their families, friends, or colleagues at work. A common compromise is going out in women's attire for a solitary walk or drive, usually late at night when there are few people around. As the individual gains confidence, he eventually attempts to pass among strangers, for example, in a shopping mall.

Whether or not he overcomes his fear of going in public crossdressed, the heterosexual gender dysphoric is increasingly confronted with another, more serious problem: the frustrating conflict between his desire to live as a woman and his reluctance to abandon his wife, children, or career. This is the point at which these patients typically present for treatment. At our clinic, their average age at initial presentation is around 39 (Blanchard 1988). This is about 13 years older than the average male or female homosexual gender dysphoric (Blanchard et a1. 1987). At the time he presents, the heterosexual gender dysphoric may have already resolved to pursue sex reassignment, or he may be just asking for help to go one way or the other.

As I have previously indicated, the course of heterosexual gender dysphoria is highly variable, and this is equally true of its outcome. In some cases, an episode of acute gender dysphoria subsides spontaneously or else responds to psychotherapy, and the individual continues his life largely ashe was before.

Another group, called marginal transvestites by Buhrich and McConaghy (1979), resolve their gender identity conflict with a specific request for partial feminization, usually moderate breast enlargement by means of estrogenic hormones. In many instances, the individual has already decided on this course of action before he presents to the clinician.

DSM-III-R does not include a separate" diagnostic category for such individuals. In this revision of DSM, they would probably be classified under the heading of gender identity disorder not otherwise specified. Marginal transvestites give various reasons for their requests. Some indicate that having a vagina is simply not that important to them; others indicate that they are unwilling to suffer the diminution in sexual responsiveness associated with vaginoplasty. Still others state that, ideally, they would like to live full-time as women and undergo complete sex reassignment, but that they are prevented from doing so by prior commitments to wives, children, or careers. This last rationale undoubtedly has some truth in it, but it also seems likely that marginal transvestites, as a rule, are less strongly driven by gender dysphoria than full-blown transsexuals.

There are, finally, those heterosexual gender dysphorics who disengage themselves, wherever necessary, from their previous lives and undertake to live full-time as women. A large proportion who go that far eventually proceed to sex-reassignment surgery. As a group, however, heterosexual gender dysphorics are somewhat more likely to vacillate in their resolve to live as women than homosexual gender dysphorics (Kockott and Fahrner 1987).

Many heterosexual transsexuals hope that, after reassignment surgery, they will find themselves attracted to men and settle down with a male partner. Surgical sex reassignment has little impact on their sexual preference for women, however, and postoperative patients are equally or even more likely to become involved in lesbian relationships with biological females.

The various similarities between transvestism and heterosexual transsexualism suggest that these conditions may be basically one and the same disorder. This notion is reinforced by the fact that many cases of heterosexual transsexualism seem to have developed out of transvestism. This apparent progression was described in memorable, if somewhat lurid, terms by Lukianowicz (1959): "a hitherto typical case of transvestism becomes acutely disturbed, ... turns, as it were, malignant, and degenerates into a full-blown picture of transsexualism with its gloomy prognosis" (p. 52).

The relationship between these two conditions obviously requires some explanation. One view proposes, in essence, that heterosexual transsexualism arises as a complication of transvestism (Lukianowicz 1959; Meyer 1974; Person and Ovesey 1974). There is no objective evidence for this view, which is based entirely on clinical impressions; one might just as well turn this interpretation on its head and propose that transvestism is an arrested form of heterosexual transsexualism. A third plausible hypothesis is that transvestism and heterosexual transsexualism are related syndromes that share one or more etiological elements; that transvestism in its purest form does not follow a progressive course, whereas heterosexual transsexualism does; and that heterosexual men who become acutely gender dysphoric in adulthood were probably somewhat different from pure transvestites from the beginning. Because we do not actually know the etiological factors in either condition, it is quite difficult to sort out these various interpretations at present."




compulsion

Rewind to about 1966.

Upon receiving the message from my mother that little boys do not wear dresses my activity went underground. I would role play in my room or wait till no one was home to raid my mother’s closet. It was fun and it was my little secret.

As I got older and puberty hit I started realizing that this part of me was going to potentially be in conflict with my normal sexuality and my burgeoning interest in girls. I had begun getting inadvertent and unwelcome erections and orgasms which immediately prompted a promise to never go back to raid the wardrobe closet. I began to learn to suppress in earnest.

In my world, Roman Catholics did not ever masturbate or have premarital sex so imagine how I saw myself.

What didn’t help was that all of the information available to me about the subject was negative. "Transvestite" was a dirty word and it was associated with perversion. Entries in encyclopaedias were short and misleading and I had never heard of Harry Benjamin or of his book. Therefore my feelings about what used to be natural began to grow progressively more negative. I began to see my activity as a compulsion instead of something that was helping me bridge a gender gap in my brain. What followed for many years was behaviour patterned after short binges of indulgence followed by long periods of suppression.

No wonder I saw myself as a compulsive person. I was mirroring the behaviour of a dieter who denied himself and then reached for the cookie jar when he could no longer contain himself. This actually magnified my view of this desire as a perverse abnormality.

Once this was engrained in my psyche it took many years to undo the harm.

Now I know better and so does the clinical world which now deals with what we appropriately term gender dysphoria.

Saturday, 25 October 2014

Sherry

Rewind about 10 years and my dysphoria was starting to bubble to the surface after decades of denial. I had made some earnest attempts at establishing some online presence and met some kindred spirits but also others whose path would take a different trajectory. One of those people was Sherry.

She was a transitioned young woman who was establishing her life in the world as the person she was meant to be. She just needed to make the physical adjustments to have her mind and body match. She is a beautiful and petite woman who you would never guess had been raised for part of her life as an unhappy boy.

She was one of the first people to bolster my morale when things were confusing and dire for me. She recognized through our online chats that there was something different about me and more than met the eye to the desire to express myself as a female. I miss chatting with her and we seem to never be online at the same time anymore.

This is just my little ode to her and if she reads this I want to let her know that she left her permanent mark on my life when I needed support.

Thank you Sherry.

Friday, 24 October 2014

two halves make a whole

The last number of posts I've been boring you with gender theory and summarizing some of the things I've learnt over the years. It's the work I needed to do to make sure I wasn't crazy, perverted or deranged and that I hadn't created all of this in my mind. Maybe you don't find any of it comforting but I did because as difficult as it is to come to terms with accepting you have gender dysphoria it's made just a little more digestible by knowing that it's not your fault.

What I do know is that partial self acceptance does not work. This condition demands full and head on acceptance which restablishes your self esteem and your own sense of normality. No you are not statistically normal but who cares about statistics.

The risk of partial self acceptance could have you thinking that only a full transition is the right solution and, while this may very well be the way to go for you, it may just not be. Being in an uncomfortable middle can be disconcerting because feeling neither fully male nor fully female can seem like a purgatory. But if we remember that our sense of gender identity has a lot to do with what's between our ears we can then exert some form of control over what we think and feel and the set point you are looking for may not be as far away as you think. As it turned out mine wasn't as far fetched a proposition as I thought but I never allowed myself to attain it due to my perennial existence in a zone of self created indecisiveness and fear.

Self love and dignity are pivotal here. You cannot think that your current state as an abnormal male is a failure when in fact it is anything but. Adversity makes us stronger and being challenged in this area for most of my life has made me stronger than ever. My male and female animals are now united and I own them both without reservation. I am whole.

If transition is for you, shouldn't the point at which you love yourself be the spring board for a future transition instead of a point of despair and rejection of your maleness?

Thursday, 23 October 2014

the illness model

I’ve abandoned the “gender dysphoria as illness” model. I used to espouse it but I found that it was getting in my way of treating my gender incongruity so I now just do what feels right without hurting my partner or my children.

Whether gender dysphoria is due to a birth anomaly or not the fact of the matter is that we suffer more from the slings and arrows of societal rejection than from anything else. If no one cared how we expressed gender, then transgender people wouldn’t be conflicted. Our parents and our peers would accept us exactly as we are and we would see very little turmoil over this issue. This happens now in certain cultures like Samoa, Thailand or India where third genders are more tolerated than in the west. But even here we are starting to come around slowly.

I know some people reject any form of discussion of gender dysphoria being an abnormality and prefer to speak of their inner female. All of that is fine by me since no one understands where all of this comes from anyway. The most important thing is that you need to be mentally and physically functional to live a healthy life; whatever encourages that personal happiness while allowing you to meet your commitments is going to be the right answer for you.

N has suffered throughout most of her life from severe episodes of clinical depression for which she takes medication. She is kind, intelligent and I love her but her condition does not define her as a person. Our dysphoria shouldn’t either.

You need to live your life with something that you can see negatively or positively. I have chosen to see the positive and after having tried the alternative I have no intention of going back to it.

Wednesday, 22 October 2014

understanding what we are

Ray Blanchard’s Autogynephelia theory is offered as the explanation for men suffering from transvestic fetishism resorting to surgery to become facsimiles of women. But why would a fetishist wish to take hormones and have surgery and why are they still content years after their procedure?

It appears that Autogynephelia does nothing more than point to a reality that everyone as far back as Magnus Hirschfield observed and acknowledged. It is not really an explanation for the origins of gender dysphoria which is why it is best relegated to the category of pseudo-science. It hangs its very premise on the notion that prepubescent children can fall victim to fetishes. Harry Benjamin noted it but did not focus on it in his 1966 publication because he believed it to be a result of gender confusion and not a driving force. He preferred to focus on his disorientation scale.

People who go to fetish clubs dressed in body hugging latex and high heels are perfectly happy in their skin as males. They suffer no dysphoria and have no interest in going to the mall and having coffee with the girls or going out and being perceived as real women in the world. These people do not seek out hormones or surgery because there is no gender dissonance in their brain.

Similarly, a person like Thorin who was kind enough to comment in my blog that he used to suffer from a sexual addiction was able to curb his dressing because he also does not suffer from gender dysphoria.

Gender dysphorics understand that their feelings predate any sexual association that puberty may have brought with it. I have addressed that correlation in a previous post but the basic idea is that a heterosexual dysphoric male melds in his mind his love for women with his desire to be one. The problem with Blanchard's proposition is that it can only work if his fetish concept begins far before puberty which runs counter to the personal experiences of most transgendered people.

Anne Lawrence in her essay "Becoming What We Love" goes out on a limb to support her mentor Blanchard. In it she states: "There are two case reports of boys younger than age three who expressed a desire to wear cross-sex clothing and who experienced penile erections when they did so (Stoller 1985; Zucker and Blanchard 1997).These boys plausibly displayed an early form of autogynephilic arousal". Needless to say, Lawrence accepts herself as an autogynephilic transsexual. Personally I never had an erotic feeling about being a girl and not so much as an erection until I was well into puberty and I doubt most of you have either.

Those of us with this condition can trace its origins to our early childhood. We knew something was amiss but were either afraid to acknowledge it or were castigated for exhibiting any signs of it. We bought into the idea that we could become normal for others. Many of us in our early lives want to think of ourselves as fetish dressers because that would give us a possible out with our dysphoria. If we don’t suffer a condition beyond our control then we can just cure ourselves and lead normal lives. It took me many years to admit that I had dysphoria after refusing even to entertain the notion. As I progressed further into reading and looking into my inner self I realized and finally accepted that I had a lifelong condition to manage.

Thankfully science is progressing and the individualized treatment methods used to treat dysphoria today are working very well. Helene Cote’s group has a variety of people in it who are in varying degrees of transition. Some will never do so while some are well on their way towards gender role transition. She and all serious therapists and theoreticians working in this field acknowledge the existence of dysphoria and this blog regularly relies on their publications.

But all that aside, the hardest part of this process involves understanding yourself and how much of your condition is within your control. If your dysphoria is of a manageable magnitude you may be able to find a solution that does not overly disrupt your current existence.

Tuesday, 21 October 2014

hiding in plain sight

There are many of us out there but we are not always visually distinct. We represent a sliver of the general population but we are even less apparent than that due to our ability to blend in and hide. In 2 weeks I will be 52 years old and I have not felt like hiding for quite some time now. Although I have not come out to absolutely everyone those who need to know about me have been informed.

Being out in the open has benefited me much more than it has them. Their lives have not changed for the better or for the worse while mine has decidedly taken a turn for the better.

For those of you still struggling with the impacts that your condition has on others I would beseech you to take some initiatives to make your case known. When my pot threatened to boil over, going into a gender clinic offered me an oasis where I could have my thinking questioned by someone else; someone who did not harbour the same prejudices and preconceived notions I held about my situation. The ideas I held were questioned and inspected and during that process I learnt much about myself.

We tend to think we are to blame for our feelings and what we require is fortitude and self control but that does not work. I am one of the most controlled people I know and my life is a testament of will and discipline and yet I could not defeat my dysphoria. Instead I needed to befriend it and learn to understand it without necessarily caving in to its demands.

As I posted here yesterday, the WPATH standards recommend whatever method works for you as a transgendered person. The trick is to have those methods fit within the constraints of your family and your work environment. This is by no means an easy thing and if it were there would have been no need for me to have started this blog. I started this blog because this process is very hard.

I can’t promise you that your path will be easy either but at a certain point in time you may simply run out of gas and no longer care about being discovered.

One eventually gets tired of hiding in plain sight.

Monday, 20 October 2014

dysphoria treatment according to WPATH

The following is an excerpt from the most recent edition of the WPATH Standards of Care for Transsexual, Transgender and Gender Non-Conforming people. Of particular interest to some of you will be the approved methods to treat dysphoric individuals:

"Advancements in the Knowledge and Treatment of Gender Dysphoria

In the second half of the 20th century, awareness of the phenomenon of gender dysphoria increased when health professionals began to provide assistance to alleviate gender dysphoria by supporting changes in primary and secondary sex characteristics through hormone therapy and surgery, along with a change in gender role. Although Harry Benjamin already acknowledged a spectrum of gender nonconformity (Benjamin, 1966), the initial clinical approach largely focused on identifying who was an appropriate candidate for sex reassignment to facilitate a physical change from male to female or female to male as completely as possible (e.g., Green & Fleming, 1990; Hastings, 1974). This approach was extensively evaluated and proved to be highly effective. Satisfaction rates across studies ranged from 87% of M-t-F patients to 97% of F-t-M patients (Green & Fleming,1990), and regrets were extremely rare (1-1.5% of MtF patients and <1% of FtM patients; Pfäffin,1993). Indeed, hormone therapy and surgery have been found to be medically necessary to alleviate gender dysphoria in many people (American Medical Association, 2008; Anton, 2009; The World Professional Association for Transgender Health, 2008).

As the field matured, health professionals recognized that while many individuals need both hormone therapy and surgery to alleviate their gender dysphoria, others need only one of these treatment options and some need neither (Bockting & Goldberg, 2006; Bockting, 2008; Lev, 2004). Often with the help of psychotherapy, some individuals integrate their trans- or cross-gender feelings into the gender role they were assigned at birth and do not feel the need to feminize or masculinize their body. For others, changes in gender role and expression are sufficient to alleviate gender dysphoria. Some patients may need hormones, a possible change in gender role, but not surgery; others may need a change in gender role along with surgery, but not hormones. In other words, treatment for gender dysphoria has become more individualized.

As a generation of transsexual, transgender, and gender nonconforming individuals has come of age – many of whom have beneftted from different therapeutic approaches – they have become more visible as a community and demonstrated considerable diversity in their gender identities, roles, and expressions. Some individuals describe themselves not as gender nonconforming but as unambiguously cross-sexed (i.e., as a member of the other sex; Bockting, 2008). Other individuals affirm their unique gender identity and no longer consider themselves either male or female (Bornstein, 1994; Kimberly, 1997; Stone, 1991; Warren, 1993). Instead, they may describe their gender identity in specifc terms such as transgender, bigender, or genderqueer, affrming their unique experience that may transcend a male/female binary understanding of gender (Bockting, 2008; Ekins & King, 2006; Nestle, Wilchins, & Howell, 2002). They may not experience their process of identity affrmation as a “transition,” because they never fully embraced the gender role they were assigned at birth or because they actualize their gender identity, role, and expression in a way that does not involve a change from one gender role to another. For example, some youth identifying as genderqueer have always experienced their gender identity and role as such (genderqueer). Greater public visibility and awareness of gender diversity (Feinberg, 1996) has further expanded options for people with gender dysphoria to actualize an identity and fnd a gender role and expression that is comfortable for them.

Health professionals can assist gender dysphoric individuals with affrming their gender identity, exploring different options for expression of that identity, and making decisions about medical treatment options for alleviating gender dysphoria.

Options for Psychological and Medical Treatment of Gender Dysphoria

For individuals seeking care for gender dysphoria, a variety of therapeutic options can be considered. The number and type of interventions applied and the order in which these take place may differ from person to person (e.g., Bockting, Knudson, & Goldberg, 2006; Bolin, 1994; Rachlin, 1999; Rachlin, Green, & Lombardi, 2008; Rachlin, Hansbury, & Pardo, 2010). Treatments options include the following:

• Changes in gender expression and role (which may involve living part time or full time in another gender role, consistent with one’s gender identity);

• Hormone therapy to feminize or masculinize the body;

• Surgery to change primary and/or secondary sex characteristics (e.g., breasts/chest, external and/or internal genitalia, facial features, body contouring);

• Psychotherapy (individual, couple, family, or group) for purposes such as exploring gender identity, role, and expression; addressing the negative impact of gender dysphoria and stigma on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; or promoting resilience."



Sunday, 19 October 2014

just keep on...

I never got a call back from Helene Cote. I had left her a message telling her that she could call me back to discuss the possibility that I could come speak to her group but that seems to have fallen by the wayside. Perhaps it’s just as well.

Aside from this blog I don’t deal with the transgendered world and it’s not because I don’t want to. I think it’s due to the difficulty inherent in finding someone who shares this condition who you also happen to click with. I have interest in meeting many of the people who read my blog and have commented on it as well as those whose blogs I have read but that is unlikely to happen.

Years ago I would try and arrange for meet ups but they would never work out or there was insufficient connection to go beyond an initial meeting. This is why I ended up turning to the cisgendered world and have Joanna establish some presence there. To date, I have not regretted that decision.

The other night I was out dressed and ended up in a store I used to frequent. The cashier instantly recognized me and struck up a brief conversation by mentioning I hadn’t been there in a while. It was a very genuine and pleasant exchange and reinforced once again why I need to keep doing what I’m doing.

Saturday, 18 October 2014

expression and identity

If Anne Vitale is right and this condition should be termed Gender Expression Deprivation Anxiety Disorder then part of the answer for sufferers is to dole out the right amount of expression to soothe that anxiety. Many of the people whose blogs I read are in a situation where their level of expression or lack thereof is leaving them frustrated and conflicted. They are of course thinking about their families and respecting their rejection of a desire that no one understands and which we have imbedded in us since early childhood.

But if the desire to express femininity is rooted in insufficient androgen exposure in eutero then we shouldn't feel conflicted about dealing with this condition in a positive and healthy way. If part of the solution involves regular cross gender expression then we need to try and find an arrangement that our families can accept. This will necessarily involve having them understand that this for us is not a choice but a requirement for mental health and stability.

The WPATH standards of care mention that the course of treatment for some gender dysphoric people can stop at this junction and need not even lead even to HRT. The idea is to assuage the anxiety to allow for sustained mental health.

I was in the unfortunate position of having to deal with the turmoil of a divorce and an illness virtually at the same time but I am here to say that rebuilding and strengthening far beyond my expectations is possible. I've never felt as mentally sharp as I do now.

I can keep my identity as a male bodied person and express my gender in the way I choose but still respects my life commitments to others. That balance is difficult to attain and it requires tweaking and adjusting.

John Hopkins medical center, which no longer performs reassignment surgeries, recently completed a study that followed transgendered people some having had surgery many years ago and some not. The results showed that there was not a significant difference in the level of life satisfaction in either group.

There is an answer that fits you.

Friday, 17 October 2014

authenticity

In a recent post in his blog Thirdwaytrans states:

“Basically everyone agrees that many people who transition MtF have erotic fantasies of being feminized or becoming female. Where there is a difference is in the causal relationship between these fantasies and dysphoria. The trans community believes that these fantasies are a sign of a repressed female identity and a sign that one is “really trans” and must transition. Otherwise, according to the community, these fantasies will persist and get worse and worse until they become overwhelming and the only alternative is transition. Critics of the trans community tend to take the reverse position, that the fantasies are driving the gender transition and therefore dismissing transition as the product of “delusion” or “fetish-driven behavior”. People that are questioning are caught in the middle and I see numerous people questioning “whether they have a transgender identity or a fetish”, attempting to determine which causes which.”

Then at the end of the same post:

“I think people really are letting go of a false self in the process of transition, the trick is not to just adopt a second one...”

I think that no one disagrees with that opening paragraph. Whether you read Benjamin, Blanchard, Vitale or anyone else this is an observation of fact. What not everyone agrees with is the origin of the dysphoria.

ThirdWayTrans’s ending statement relates to something I can viscerally understand. Back when I was questioning my gender identity and whether I needed to transition, I was perhaps fooling myself into thinking that a true and more authentic self awaited me. I have heard other transsexuals say this: “my authentic self”. But what is that? Is your current self who happens to have a penis inauthentic?

I consider my identity just as I am to be completely authentic; including the reality that I happen to have gender dysphoria. What I have done over the last few years is to let go of my inauthentic self by acknowledging that I have this difference which I can now celebrate instead of reject.

Wednesday, 15 October 2014

back in 1999

I know I don't post photos of myself here very often.

The one below was a selfie taken in 1999 when I was 37 years old. It shows me smiling and yet a few years later by age 45 I was in crisis mode and trying to figure out what to do about my dysphoria. The answers have came slowly and painstakingly and I still discover new things about this condition and myself all the time.