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800 Maynard Ave S, Suite 200, Seattle, WA 98134
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keep your mouth shut
don't advertise your man." -- Sippie Wallace
@10
Duh, obviously Anon's ex-friend is telepathic. I have to sympathize - having bad grammar projected directly into your mind would be pretty annoying. Anon also states that the ex-friend lacks a heart and has an "artificial body." So Anon's friend is a slutty, transgendered Cro-Magnon cyborg with psychic powers and poor language skills. Most unusual.
Inconceivable!
It doesn't matter what this "tranny slut" looks like - her guy is obviously into that sort of person (woman? man? not sure how I should refer to them, since it's obvious there's been some kind of surgery at least)...
And, you should know that it isn't responsible to instantly assign trans-folks diagnoses based on your own bigoted assumptions.
What's a tragedy is how doctors like yourself and society in general treats trans-people. Like they are a problem that needs to be fixed instead of people that are choosing to live their life how they'd like to.
So, fuck this authors transphobic response. One friend who was trans had sex with their partner and now they condemn all transpeople as freaks.
And also, fuck this so called responsible doctor.
Mental illness isn't a bad thing. Depression, which I suffer from, is a mental illness. A transgender person is no _more_ mentally ill than I am. But butchering the body isn't an approtpriate response. They're like addicts who are addicted to plastic surgery. Cutting the genitals doesn't solve the underlying neuropathology.
I am not especially vehement about monogamy but I am a bear for kindness and honesty and a dude who goes behind your back with a friend is neither honest nor kind.
It's easy when you become furious at someone you loved to use their biggest weaknesses against them, in this case a transgender's self-confidence on their appearance.
It is actually kind of noble to use "I, Anonymous" to extract this venom instead of spewing it directly at your former friend. (Unless of course you knew she'd read this column - that would be cowardly)
Those jumping on you for "not holding your man equally responsible" are doing so with very little information.
Anyway, you've had a life lesson on what a "user" is and how they act (not to mention a "cheater"). Don't let people like that into your life again.
You're right, in part- there are always three sides to a story His, Hers and the objective reality...we have only hers and only the part she chose to tell....
but when IA wrote "..... but you decided to hook up with my man after I told you how happy I was with him. Sleeping with him over and over, even after you got caught!" that tells us that she kept the man and that he continued to cheat on her with her (now former) friend- That's about all the information needed to determine that there's a double standard in play.
What a disgusting sack of shit.
I don't think you can judge much of anything from an anonymous rant (although that's the purpose I guess). We're all capable of having shitty instincts and saying regretful things when someone hurts us. Emotions are a bitch.
When you call someone's gender identity a "mental illness," you are not exactly treating them with "respect and tolerance." And if the problem is body modification, does this mean that people who get piercings should be treated for mental illness too?
You seem to be assuming that I consider a mental ilness to be a "bad thing". There's nothing evil or wrong about having a mental illness, any more than having the flu or cancer. It's a disease that needs treatment to prevent irreversible catastrophic damage. Like depression needs to be treated to prevent suicide, or alcoholism to prevent death by systemic deterioration.
Sometimes, and if you are a teen you'll learn this as you get older, treating people with respect means being critical of their own desires when those desires are manifestly not in their own best interest. If your friend wanted to kill herself, would consider the respectful response to be allowing her to do so, or would you look for, I don't know, a responsible doctor?
Gender is, in essence, entirely a matter of self-identification and socialization. So what the hell does it mean to feel like a girl? Am I supposed to like cooking, cleaning, playing house, boys? Do I have to want to be a mom? Should I think spiders are icky? Am I supposed to be made out of sugar and spice? Does any of that have anything to do with being a girl? No. Does it have anything to do with my vagina? No.
But I feel like a girl. And I've felt like one as long as I can remember. So if a bio-boy also feels like a girl for as long as she can remember, who's to say she's not? You? I would certainly hope not, your views on gender and mental illness are sadly outdated, and serve to do nothing more than reinforce dysfunctional cultural norms. Might as well put homosexuality back in the DSM with people like you in charge.
Furthermore, it's up to an individual to determine what's best for them, not a fucking doctor. Try having some respect for the people you treat. If a friend wanted to kill themselves, I'd get them to, say - people who love and care about them, and can help them recognize their worth. Not someone who's first instinct is to play god and drug them into a stupor. And I do think you're the type who likes to play god. The whole attitude of "Transgenderism is a mental illness, I know, I'm a doctor. Here, I'm going to make you better," reeks of narcissism.
Your very argument is nonsensical. If it is only up to a person, and not a doctor, what their gender is, then feel free to try to change your gender without one.
Abnormality, mental illness, these are not terms of judgement. Depression is a mental illness. Alcoholism is a mental illness. These things may be atypical by comparison to the cohort of the entire population, but they aren't evil or wrong or bad.
We don't treat depression with death. We don't treat alcoholism with bourbon, and we shouldn't treat gender identity disorders with radical irreversible surgery.
Treat the actual problem, not its symptoms.
@39, what does it feel like, this "I feel like a girl" feeling? I've been a girl my whole life, but I don't know if I feel like a girl or a boy. I don't feel particularly comfortable in my skin, though I don't associate my discomfort with my genitals in particular, except during my period. I guess, like many things in life, it's a spectrum. Some bio-girls "feel like girls" and some bio-boys "feel like girls," and some of us just feel like awkward people, and don't really understand how anyone experiences gender as either right or wrong.
I really hope you're not a doctor. Or, that you're not in change or sex reassignment surgery.
"Abnormality, mental illness, these are not terms of judgement."
"Abnormality" is not a term of judgment? Since when? The concept of normal does nothing but exclude what is considered abnormal, and has historically been the basis of pretty much all oppression throughout history. Those who do not fit the dominant, "normal" paradigm are ostracized, marginalized and/or subjugated. While some of the things we consider "abnormal" have that label with good reason (i.e. sociopathy, cancer, etc.), a shit-ton of what was once considered abnormal no longer carries that label (i.e. homosexuality, divorce, women's lib).
The fact that you don't see your opinions as judgmental speaks volumes about your lack of self-awareness. I sincerely hope you're not a medical provider... you're representing the profession terribly.
I'd like to know what exactly "Responsible Doc" thinks is an appropriate neurological treatment for gender dysphoria... is that like when the medical profession used to (and religious fanatics now) try to "re-educate" homosexuality?
As for homosexuality, I see nothing inappropriate about it and am proudly in favor of gay marriage and gay adoption. Infants with ambiguous genitalia is far from my specialty and I can't claim anything other than standard lay-knowledge of the subject.
For Gender Dysphoria, I would generally prescribe psychiatric treatment by a qualified physician, or psychologist working in close collaboration with a physician, as dysphorias frequently require anti-depressant medication.
Those in favor of gender reassignment should explain why they favor an irreversible surgical procedure when it has been shown recently that suicide is one of the highest causes of death among post-op transsexuals (Asscheman, Giltay et al, Eur. J. Endochrin., 2011).
The surgical treatment is known to be ineffective in the epidemiological treatment of gender dysphoria. But because it is politically incorrect to treat these suffering individuals with appropriate care, many people are needlessly dying.
As for your implication that I think that there is some religious treatment, that's absurd. Religion has no place in medical treatments at all, and has been falsified as a source of medical interventions along with all such quakery as homeopathy and naturopthy.
You might be a proud supporter of gay rights, but people like my dad have the same attitude toward gay people that you have toward transgendered people: he thinks they're mentally ill. According to him, if gays could just get help and "get over" this idea of wanting to be with people of the same sex, they could get married and have kids -- like nature intended -- lead normal lives and be accepted by everyone.
I have nothing but respect for the transgendered, and have known a few. They're just like anyone else.
I don't think they need to "get over" it any more than an alcoholic needs to "get over" alcohol. You and others are imagining a lot of hate, and then acting as if I feel what you imagine I feel. My sole interest is in getting people, all people, the best care. And surgery is manifestly not the best care for persons with gender dysphoria. It is a horrible, grotesque option that preys on people who can be better served in myriad other ways.
Sadly, we can't do proper testing in these circumstances, as there's no ethical way to do a randomised trial. We can't just take 1000 gender dysphoric persons, change the gender of 500 of them, and watch what happens, using the population of non-gender dysphoric persons as a control.
Extant retrospective studies (Such as: Scull, Gibson et al, 2006 Endo. Abstr.) are of very small sample sizes (perforce), and show horrifically high suicidalism in both MF and FM persons.
I suppose my characterization of those surgeons is harsh because I firmly believe that they are doing a terrible dis-service to both their patients and to medicine. We don't have perfect evidence here, and acquiring it is akin to giving more thalymide to pregant women to more thoroughly understand the process by which it deforms fetuses: perhaps enlightneing, but criminally unethical.
What I want to know is what this means: "not only did you lose a sexual exploit, you lost a genuine friend."
Does that mean Anonymous was sleeping with the suspect too, and blowing a fuse that her man was as well? Turnabout's fair play.
It's the scientific-rational-linguistic part of me, which is admittedly a huge part. If one word can have two opposing meanings at the same time, then its definition is meaningless. I suppose this could simply be a failure of the English language to handle the vagaries and ambiguities of physical sex and perceived gender. We need single, precise words that mean MTF transgender, FTM transgender, and so on, which aren't sociolinguistically offensive (like "it").
Let's look at this rationally, free of emotion and social stigma. From purely a classification point of view, we really need new words. People shouldn't be put down for their gender/sex organ identity, nor should we have to bend language to the breaking point to spare feelings.
And for the record, I have no problem calling a person with XY chromosomes 'she' if that's what the person wants. I just object to a surgeon cutting them apart. It's bad medicine.
I'd also like to point out that gender reassignment surgeries are in their infancy, so it is only natural that suicide would appear to be the greatest cause of death among post-ops... They haven't had much time to die of other so-called 'natural' causes. If the statistic is, instead, pointing out that the yearly rate of post-op suicide is greater than that of pre-op or the 'normal' population, that is a different matter.
Medical transition, including SRS, saved my life and I am not in the minority of transsexuals. Not by a fucking long shot.
As for the next commentator, 'ohnoyoudidnt', explosive rages and vituperation hardly paint the picture of mental health. Your uncited 'surveys' don't carry any weight. I'm glad that you self-report an improved condition, but you're comparing it to an unknown, possibly superior outcome. Self-report is among the least reliable of all metrics for medical condition, and based on your demeanor, I'm not particularly inclined to believe you.
QALY is the standard measure of outcomes for major surgeries, and as is pointed out by Dynomite, we don't have the longevity to make excellent determinations. Particularly given the abnormally high death rates among post-op transsexuals.
To answer your other question, I'm not sure the best case, but I imagine treatment would best be similar to that for body-dysmorphic disorder. But there are persons who seek elective amputation (easily locatable by googling 'elective amputation' on google scholar), and we don't oblige them. The only reason SRS is done is that it is seen as politically inappropriate to oppose. No matter how terrible the consequences to the victi... I mean patient.
Gender reassignment surgery is currently accepted as a treatment, and is funded by many govt. insurance plans in Canada. It isn't something done by "butchers" motivated solely by profit.
And your use of the term "abnormal" is extremely inappropriate. Anyone with an ounce of clinical experience knows what a judgement-laden term that is, and would never use it when discussing a sensitive issue with a patient (or anyone else for that matter). You can quote Webster's dictionary all you want, but that doesn't change the fact that it's insensitive and unprofessional to use that term in this context.
And remember, you aren't the only one on Slog with a medical background- you're just the only one who is invoking it for cred while slamming a minority.
As for staying on topic, the writer of this letter seems like a poor judge of character. If the boyfriend hadn't cheated with the tranny, he would have just done it with someone else eventually.
You raise some really interesting points I'd never considered. I understand your issue with treating a recognized mental disorder (and transsexualism/gender identity disorder IS in the DSM, people) with major surgery. However, putting aside for a moment the fact that this physical cure for a mental problem is cutting cure, don't we use physical means to deal with mental problems all the time? Isn't that what drugs do, (from SSRIs to hormone replacement) affect one physically? What about those transsexuals who receive hormone therapy (which can certainly have irrevocable physical effects), but not opt for the surgery, as so many FTMs do?
Concerning the surgery itself, I see where you're coming from on the issue of "optional" surgery, but I'm not really buying the elective amputee parallel. The effects of those surgeries are demonstrably and necessarily physically harmful. I certainly wish no offense to anyone who has lost a limb, but I don't have a problem calling that a bad thing. I don't like the idea of comparing choosing to have a vagina with choosing to have your leg cut off.
I certainly wouldn't suggest that gender is all social/mental. Cases like David Reimer quite sadly suggest that this is not so. But there is also evidence to suggest a biological component to transsexualism that may well be more difficult to address in therapy than on the operating table. If sexual orientation isn't alterable through therapy (and evidence right now suggests that it's pretty much impossible), then why should we be surprised to find that gender identity is the same? More to the point, what if you could alter a psych treatment, but a patient felt THAT change would be more radical than a surgical one. If my sexual orientation were maladaptive for the society in which I lived, and I were offered a "cure," I would have to refuse. It may be that, to the patient, the therapy would feel more like a denial of self and fundamental truth than you seem the think the surgery is.
How much of your opinion is affected by the relatively still unsophisticated nature of the surgery? Let's get science fictionally abstract here for just a moment Let's say this is the year 3011, and we are capable of growing full sets of opposite-sex reproductive organs in a lab for transgender patients (for all I know, not so far off as 3011). With improved hormone (and maybe gene) therapy and with the ability to become the desired gender even to this point... Would your view still be the same?
Again, you bring up some interesting questions. I know a little (a very little) about the issue from a few books and a few people I've met in passing (post ops who seem much happier), but my information is primarily anecdotal. It is, as you saw, awfully hard to study this on a sizable scale or in a vacuum. One can only hope that, as time passes and the social stigma of transsexualism dissipates, we will gain a clearer picture.
Incidentally, I think it's unfair to assume that the surgeons themselves are in it for the money. Halons Razor, Responsible Doc. Even if your reasons to disagree are valid, it seems too far to suggest that theirs must be selfish.
And @66: RD isn't a troll Caralain. I've heard nothing but measured dialogue there. Trolls look for fights. This is a discussion, which is nice to have on a discussion board once in a while.
Here is the study to which ohnoyoudidnt referred:
http://transequality.org/news.html#surve…
Here is the study to which ohnoyoudidnt referred:
http://transequality.org/news.html#surve…
And I hope you take particular note of the Health section, and the difficulties faced by trans-identified people when they try to access healthcare. Your attitude is (unfortunately) well-represented in the medical profession, much to the detriment of trans-people's health outcomes.
It is an important argument against SRS remaining an approved treatment.
And once again, I feel compelled to reply, I have nothing at all against transgendered people, or persons who would like to transition. It is alarmingly apparant that commentators here cannot tell the difference between the statement: "A is not good for you" and "You are bad for wanting A". I assert the first and I deny the second with respect to SRS.
You're right that it is unfair to assume the surgeons do it only for the money. However, it is commonplace among all medical personnel who are personally remunerated by procedure to recommend ever more radical and dangerous, and thus lucrative, operations. But yes, I was committing the same fallacy that others were: the specious generalization that because some do, all do.
As for elective amputation, I think the metaphor is perfectly apt. The patient is not 'choosing to have a vagina' (or penis). They are choosing to have a graft of a prosthesis which superficially resembles a vagina or a penis, while discarding healthy tissue to do so.
I appreciate the response in the middle of busy times. I understand your view on the docs doing the cutting, RD, and it seems to come from an honest concern for patients. However, keeping in mind that many countries with socialized medicine provide, and even cover the cost of, the surgery–it seems unwarranted.
I'm still not buying the voluntary amputee analogy, partially because I'm not buying the starkness of the distinction you're drawing between a human sculpted vagina and a that of a biological female. If Beck Weathers has a nose, then Jennifer Finney Boylan has a vagina. Even more to the point, the voluntary loss of original genitals seems to me to be less of a handicap than the loss of an arm or leg. I stress the voluntary there. I'd personally keep my genitals over an arm or leg, but I'm not transgender. However, if one does not which to procreate, then the result of surgery is arguably 100% non-maladaptive aside from the social stigma attached to transsexualism. There is the risk of a loss of sensation, but that's a risk we seem to be getting better at minimizing.
I'm not convinced that a surgical answer might to be appropriate to address a mental issue if the informed patient decides that the physical change would be more desirable or even LESS radical than a change to the mental condition.
It's not a medical study; it is a qualitative study of an ostracized population. And it is absolutely methodologically sound, and adheres to established standards of scientific rigor for social science research (though I suspect you don't respect social science as "real" science).
Of particular note is the following:
- "Survey participants reported that when they were sick or injured, they postponed medical care due to discrimination (28%)" (p. 72)
- "Respondents faced serious hurdles to accessing health care, including... Lack of provider knowledge: 50% of the sample reported having to teach their medical providers about transgender care" (p. 72)
And regarding a patient's autonomy:
- "The majority of survey participants have accessed some form of transition-related medical care despite the barriers" (p. 77)
So tell me.... Where does the bioethical principle of a patient's right to self-determination fit into your view?
Though you (and I) may disagree with him, RD isn't a troll.
Trolls don't contribute to conversations in a meaningful manner. Trolls use aggressive and often personal attacks to provoke an emotional response. RD has clearly done his level best to have an interesting and rational discussion in which all participants might actually learn something, including perhaps why the other side thinks the way they do. That's way more valuable than the conversation over the "I, Anonymous" letter, which was pretty much over anyway.
If I go areund proclaiming myself to be NAPOLEON and insisted on SURGERY to make myself into "Napoleon", I would be LOCKED UP and MEDICATED, right? But these sick freaks can freely go around declaring themselves "women" and insist on surgery to "make them into women" (as if being a woman was all about "externals") and everybody falls all over themselves to 'accommodate' them! How sick is THAT, eh?
On your other point, quite possibly.
And persons with gender identity disorder seek out enabling surgeons to cut them up and make them superficially resemble the other gender. But the fact that a mentally ill person, or their enablers, believes that this is the best thing for them is not evidence that it is the best thing for them. Things are not true just because we would really really like them to be true. There's no Santa Claus.
Look: if there were evidence that this surgery were a panacea, and that the people who received it were epidemiologically better off afterwards (physically and mentally), or if the surgery were casually reversible, then we'd not be having this conversation.
But the evidence is quite clear: the suicide rate is dozens of times higher among those with GID, and the surgery has no demonstrable effect one it. The second leading cause of death among those post-SRS? AIDS. So the top two causes of death among SRS victims are at least 99% preventable by not attempting suicide and basic sexual hygiene and prophylaxis.
These are not epidemiologically relevant causes of death among mentally healthy, circumspect individuals in the USA. And yet, there we are. Our treatment of GID, as a society, has been a total failure. It's time to start giving those with gender dysphoria mental health care. Not prosthetic sexual organs.
Because I'd think that anyone is actually trans-gendered could be probably do with a bit of therapy. Not because *they* are crazy, but because there isn't really a very good societal "niche" for people like us. And, as with many folks in such a difficult position, I think we tend to get scraped up a bit, by everyday life. So a bit of prophylactic (heh) counseling--to lance some of the wounds and build up the, eh, "coping skills" is not a bad idea.
Which is a little different than trying to "fix" the problem (as with alcoholism?), yes? Less a manner of making someone an un-tranny than making them a "happier" tranny. Because, unlike something like alcoholism or depression--being transgendered is a component of the self, rather than a hindrance to its full actualization...
... and I'm not necessarily hugely into the medical fix myself (because I'm cheap. and lazy. and I don't even take, you know, aspirin if I can avoid it... so the "hormone" thing is a little daunting) but that doesn't mean that it's a bad choice. A lot of the folks I've known have felt much better after having a little... work done.
So, what I'm wondering--are you advocating "ameliorative" therapy (to make it easier for trans-folk to be "trans") or a more "corrective" sort of thing?
Because I'd think that anyone is actually trans-gendered could be probably do with a bit of therapy. Not because *they* are crazy, but because there isn't really a very good societal "niche" for people like us. And, as with many folks in such a difficult position, I think we tend to get scraped up a bit, by everyday life. So a bit of prophylactic (heh) counseling--to lance some of the wounds and build up the, eh, "coping skills" is not a bad idea.
Which is a little different than trying to "fix" the problem (as with alcoholism?), yes? Less a manner of making someone an un-tranny than making them a "happier" tranny. Because, unlike something like alcoholism or depression--being transgendered is a component of the self, rather than a hindrance to its full actualization...
... and I'm not necessarily hugely into the medical fix myself (because I'm cheap. and lazy. and I don't even take, you know, aspirin if I can avoid it... so the "hormone" thing is a little daunting) but that doesn't mean that it's a bad choice. A lot of the folks I've known have felt much better after having a little... work done.
So, what I'm wondering--are you advocating "ameliorative" therapy (to make it easier for trans-folk to be "trans") or a more "corrective" sort of thing? Would clarify things a bit, maybe.
And that's part of the problem: I acknowledge that there is very little we know how to do here. It is clear from the evidence that surgical treatment of GID is totally ineffective at best, and likely harmful. It is certainly irreversible.
I don't know if GID can be resolved in a way so as to make a person comfortable and happy expressing as their birth gender. I don't think that good mental health counselors go into treatment with goals of that kind. The goal should be to help the person deal with their dysphoria, recognize, as you describe, the core-self issues at stake, and attempt to find a way to be an effective person without resorting to body modification as a short circuit of the cognitive processes at stake here. Because we know that surgery doesn't improve the condition as a rule.
--and I halfway agree with you, actually. Because although, as I've said, I've seen folks whom the... eh... modifications have made happier--I'm not sure that surgery is sufficient to resolve, completely, the subcutaneous aspect of things. That requires, I think, a bit more thought. It might be a dicklet now, but it was still--y'know--part of your big toe at one point. It's not quite... the real thing. Which is, perhaps, something I'd like to see discussed (slightly less the rhetoric) more often. But, then again, that's a personal point of view.
I've not heard of, myself, any instances where "modification" did harm. And I have seen it do some good--relieved a bit of the pressure, as it were. So why not? Just because its not perfect, doesn't mean that it isn't sometimes helpful. I'm not sure, with all the checks in place, that it's possible to go that route "uninformed".