Interesting Choice

I was reading a blog today, and with the number of universities providing healthcare and costs for transgender healthcare, some including sex reassignment surgery, for students the person said they planned to pick their graduate school primarily to get free sex reassignment surgery.

I wonder if universities thought about this when they added this coverage. And how do they assess students who knowing apply for admission to the university for the transgender healthcare and even surgery? Or if the student doesn't but later admits they were in transition when they applied?

Don't you think it's a little disingenuous of the student? To pay tuition for the minimum period to get a $20,000+ surgery paid by the university?

I'm not against it. I'm for all health insurance companies covering in and post transition care, especially medically necessary surgeries as recommended by all the medical organizations. It's not only the fair thing to do, it's the right thing and long overdue.

I just thought this was interesting.

What's Not Understood

What's not understood and likely never will be understood by non-transpeople is that no one wants to be born to discover their body and their mind aren't in agreement about what sex and gender they are. No one wants to be transanything let alone transgender.

I've found the only way to get any non-transperson to understand is to ask them the question Jennifer Boylan asked Oprah when Jennifer was a guest on Oprah's show. Oprah couldn't understand why (trans)people felt the way the did to the extent they wanted surgery so the body matched the mind, so Jennifer said,

"What if you woke up (meaning she knew she was a girl) to discover you had a penis and testicles?"

Oprah's answer was the universal one, "I'd have surgery to change it."

And that's the point. It's not about being a label or some classification in some psychiatric diagnostic manual, it's about a human being, a women who has a genetic condition, being born male.

The contradiction isn't with transgender people, they already know who they are. It's with everyone else. Everone is ok with intersex people who want to correct the surgeries they had in the childhood when doctors decided their sex for them, and more often than not, wrong.

They're ok with women getting facial surgery, breast augmentation, labiaplasty, and other cosmetic surgeries without psychiatric consultation. They're ok with men getting facial surgery, even penile enlargement, and other surgeries, again without psychiatric consultation.

None of these surgeries are controlled or decided by psychiatrists. But they're not ok when someone wants to change their body from one sex to the other. It used to be called a disease, then it was a disorder and now it's a dysphoria, but all still controlled by psychiatrists.

If someone in transition wants facial feminization surgery, they need a letter from their therapist. If someone wants sex affirmation surgery (also called sex reassignement) they need letters from a therapist and a psychiatrist or physician asserting their transition and the completion of the period of their real life experience.

The truth is that's all bullshit, for the simple fact 98+% of people who transiton are happier post-transition and simply get on with life as they know they are. It's not about any mental condition, it's a simple physical (body) issue easily correctable with surgery.

And that's what not understood, and why non-transpeople want to control the discussion with labels, moralizing and hate. And yet, they don't take a moment to think of the old adage, "For there but the grace of God go I.", to realize understanding is the key.

But it's not what they want to do. Yet they want us to understand their view. Like we want to in the least, to hate ourselves as they hate us. We already hate ourself for our genes, and we know the solution is there just waiting, if only others understood and more so cared to help.

It really is that simple.

The Word to Avoid

There is this word. A word which to me is the most divisive and destructive word about people who transition from their birth sex to the sex and gender they know themselves to be. A word which has been used by the medical community, the media and the very community which identifies themselves as being.

If, however, you are talking about yourself, meaning your sense of who you are and your transition, it is a word to avoid at any cost. This is because once you use the word, you hand the rights of the definition, interpretation and use of the word about you to everyone else, from the most complimentry to the most degrading and demeaning.

It is a word that automatically changes the perception of someone when it is used to describe you, as an adjective to your being, and more often than not it automatically distinguishes them from the group you identify with and often excludes you.

And the word? Transgender.

It is a word I hate, not as much as transsexual, but still one I hate. It doesn't do anything for the person other than appease others you have some medical conditon which needs treatment, but it leaves the rest in the mind of the other person whether you have mental disorder or a physical condition.

And while it can be a positive word, it is a double-edge sword which carries both sides, from positive reinforcement of your identity to the most negative, even hateful, reinforcement of you as abnormal. You don't get to decide how the other person uses it about you.

I won't argue the word is there and in common use, and even for a whole community, but it doesn't really begin to describe those who are in transition and distinguish them from others in the community who play at being the other sex or gender. That is where the word belongs, with a community but not with individuals.

What I also hate about it is that society has deemed the word applies to individuals for the rest of your life. It is used to describe and identify legally-recognized (female) women long after they transitioned. They transitioned to be legally women but for all the effort to integrate into that world, they're always separated by that word.

The word has no place in an individual's life. I won't argue they can choose to use for convenience to say, "I'm a transgender woman.", but once said, it never disappears from the mind of others to describe and identify them. Once said, you will always be a transgender woman to them.

And that is why I don't use it or even like it. It is a word to be avoided. It is not you so why use it?

Faceless Voices

Why do some of the outspoken transactivists have blogs, columns, etc with reams and reams of writing, mostly ranting and venting, albeit rightfully fair and honest, about trans issues and not have one photograph of them on any of their Web pages, not even those for on-line or print magazines?

If you do a thorough search for their name, all you find are avatars or drawings of their head, nothing else, no image, photograph or anything to put a real face, a real person to their voice. One even wrote she would be admonished by ciswomen if she were outed because she stealthfully lives in their circle.

She is afraid of the backlash for being stealth, but yet she stands on the highest podium on the Internet and yells her view on the issues. And while I agree with her on many issues, I find it less creditable she won't show her face or herself.

What is anyone supposed to think, publically anonymously yelling at the world without knowing who she is? Free Speech is fine, but knowing who is the voice behind the free speech is better. Stand up and be counted than hiding behind anonymity of your name.

Because that's what it is, anonymity, no more than someone who uses a fake name or just anonymous to identify themself. Not really because we know you're real, but it's worth considering if the reader can't put a face and person to the voice to truly know it's real.

If you believe in what you say, then show yourself. What do you have to lose?

What I Hate

What I hate is having waited all my life, knowing who I am, but didn't get the chance to express, and most of all, be it. The times have changed since I was young, when I was perfect to be a girl, 5'1", 95 lbs with a 24" waist.

Then puberty kicked in late in my life and within two years I was 5'11" but still only 115 lbs with a 28" waist. But I only started to shave which could have been stopped with hormones. But then it was 1968 and the Army classified me 1-A.

And the rest is my life to date. While I love that children can now starting puberty blockers and young people can start and even finish their transition to have a life in the sex and gender they are, I hate I'll never see that chance in me.

And now, the best I can do is make the best of what I am and have, which sadly faces the reality of my existence and possibilities. Such is life, and the life we each must live.

So Much

I want so much to be invisible, but not as I am but as I see myself. Being invisible as a man is easy, but I want to be invisible as an ordinary woman. A woman no one takes a second look because they are attractive or even beautiful, and no one takes a second look to be repulsed by their standards of what a woman should be.

It's not asking for much, just a life, common and ordinary, but most of all invisible as I am than I'm seen.

I Go To Sleep

I go to sleep every night wishing when I wake up the next morning it will all be over, and then I can do what I want to do as I know I am and don't have to do what I am doing to get by. I know that wish will come true some day, but until then it's what I do when I go to sleep every night.

That's what transitions are for, to transition. It's just the time spent there that no one likes, the waiting, the planning and the hoping. Knowing some day it will all be hindsight, a memory of a time past. And you can get on with the life you have and wanted.

For now, it's just the dreams I go to sleep with every night.

So Easy

It's so easy for women who had a successful transition in the 20's, didn't need cosmetic facial surgery, had a small frame and proportioned body where hormones worked quickly and well, didn't need much if any voice practice, and went through the whole transition and their sex reassignment surgery quickly.

I'm not saying life and events they experienced were easy, rare is the transition which doesn't have issues or problems wrapped around them and their transition. I'm saying they as a person and a woman they had it easy to go from their former self to a woman who passes effortlessly.

I'm saying it's so easy for them to criticize those who don't. Don't transition easily and need some to a significant effort including facial surgery to be at best passable most of the time. It's so easy for them to tell you that if you can't be like them then don't transition.

I'm saying it's so easy for them to look at you and then walk away afraid you'll embarrass them if someone discovers or realizes who they were and they'll be seen like you. It's easy to be hard and harsh. Many are and some aren't.

We judge ourself during and after our transition relative to two standards, one of being a woman and one of not being seen or identified as having been a transwoman or transgender. It's so easy to run away from the label faster than they run away from those who don't pass well if at all.

That's their fear. And why it's so easy being stealth and to bitch about and at those who can't be, be like them. And they never realize how much it hurts, deeply, and hated by others for just trying to be who you are but don't measure up to their standard.

It's that easy to be cruel. To turn your fear into hate and they dump it on someone else. Without remorse. So easy to do and so hard not to.

I am

I am my own woman. Similar and different than other women, than all women. Unique in myself as each woman. And while I may not have been born to be naturally a girl and grew into being a woman, it doesn't change my reality, my sense of being who I am. I am my own woman.

Goal

The goal of women who transition is just to be an ordinary woman, like all women, lost in the shuffle of the whole of women. Nothing more, nothing less. Just a woman, like all women. And just themselves as women.

What Some Women Are

What some women are not.

They don't care to wear, let alone be obsessed with, makeup.

They don't have shopping their highest priority in life outside of work.

They don't care how they dress when they don't have to dress for some reason.

They don't care they have to feel "pretty" just to be pretty or attract men.

They don't follow fashion styles or trends.

They don't read fashion magazines or visit fashion Websites.

They aren't giddy, giggly, or anything "girly" to be accepted or cool.

What some women are.

They like to wear whatever clothes fits, men's or women's.

They like subtle or earth colors than bright "women's" colors.

They're comfortable just being than being something someone demands of them.

They're interested in almost anything but what people think they should.

They just are themselves.

And some of these women were born male and transitioned to be and live as women.

Where Are They

To all those who are arguing for Michelle Kosilek, an inmate serving a life sentence in Massachusetts, to have taxpayer paid Sex Reassignment Surgery (SRS) after a federal judge ordered it, where have you been and where are you now arguing for the right of all transwomen who are identified for SRS to be paid by the person's health insurance companies?

Huh? All I've heard is talk about this inmate's right to SRS because of their designation of Gender Identity Dysphoria (GID) which has a prescribed treatment for the patient to become physically women and then can become legally women.

All I've heard is this inmate's right under the Constitution as a prisoner. But what about all the women who have transitioned and paid for SRS out of their own pocket, or most the women who will have surgery and have health insurance but are denied coverage for GID, including SRS?

Very few transwomen get SRS paid by their employer (most) or the health insurance company (few, and only when employer requires and pays for it). No one is denying the inmate's right to SRS, we're only saying the responsibility to pay for it is the inmate's and not the State of Massachusetts.

Instead of yelling for the inmate's rights, I'd love to hear more voices about the rights of all the free women needing a medically prescribed proceedure covered by their health insurance. Where are they? Where are those voices?

Freedom

Consider that (trans)women, and especially those who are post-transtion, think being a woman is the greatest freedom in the world. Women (born female) may not agree because they were born to a sex and gender many experienced as oppressed or suppressed, and while that is true to a large measure, women don't realize that just being female is also a great freedom.

Women (born male) don't have a female's experience of birth, puberty and life innate to oneself. They've had to live inside a body which defied their own mind. They didn't care for the privilege of being male or a man, it isn't who they are. They were oppressed by their role and suppressed by the body.

So, when they transition and are recognized as women, they are freed from their bonds, given the greatest freedom they most wanted. Being a woman. Woman may take their being for granted and worry about the world around them and live in, but they could learn from transwomen the simple freedom of being a woman.

Women know this freedom, it often gets lost in their lives. Transwomen don't know this freedom until they achieve it. And in the end, it's just the simple and great freedom of being a woman. What's not to understand? What's not to share as women?

Maybe Now

Do you think maybe now health insurance companies will not only remove bans on "sex transformation" proceedures and service, which often includes therapy, drugs and most of all, Sex Reassignment Surgery (SRS)?

A woman as been granted authorization for SRS through her health insurance company after twice being rejected and losing internal company appeals. After threatening to sue and expose the company to conducting medical diagnoses, ie. second guessing doctors, and not heeding recommendations by the AMA and two APA's.

The woman, story here, had only her surgery to go to become physically and legally female after finishing all medical requirements and living for years as a woman. While this only involved a case with one insurance company and not a court ruling, it continues to support the argument the insurance companies are violating good faith medical practice with the ban.

Even the Office of Personnel Management which oversees the Federal Health Insurance Benefit Progam has only recommended the health insurance companies in the program remove their ban on this coverage for a known and accepted medical condition.

That was two years ago, and while there are only a few active or retired employees who would use the coverage, it's clear it's critical for their well-being and life, and like any other medical condition, should be covered as part of the standard policy coverage.

For now, though, it's one more health insurance company which has removed the ban. Somehow, I think it would have been better if they had taken this case to court to get a new ruling everyone can use, not just this one woman this time, which still give other companies an out.

We can hope better now?

Yes & No

Update (10/3/12).-- This issue doesn't seem to be going away, at least until the case goes through the court system, but I think it will linger far longer and equally divisive in the transcommunity. Some support the ruling because it's good medical practice, but they overlook the fact the person is serving a life sentence.

And there are those, like me, who look at the larger issue and picture. I won't argue about the medical decision, it's fair and proper, but for all, which it does, but the difference here is that the State of Massachusetts is paying the bill, as noted below, and all the rest of us have to write our own checks for the surgery.

And that's the real issue, not the surgery or the mandate, but who's paying the bill. When a woman was denied in California for the same reason this inmate was approved, who's right? But in the end, I still think the State of Massachusetts has the right to say no to non-life threatening surgery, and this surgery is it.

In addition, to those who think the inmate will do better in the women's prison, do we really think this inmate will be treated any differently in a women's prison when they know he had surgery?
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Update (9/28/12).-- The State of Massachusetts has decided to appeal the initial ruling against the DOC and order SRS for the inmate. While you can argue both or either side, this is a good idea, to take the case as far as it will go, if only to determine if the state is required to provide non-life threatening but medically "necessary" proceedure. 

Remember this is more than the surgery alone, it will include the travel, lodging, post-op care facility, the extraneous medical costs, and above all, the security while he is away from prison. Remember he's serving a life sentence so he will require 24-hour security so he doesn't escape.

And all this presumes the DOC finds a surgeon willing to provide the surgery. In all, the state could easily be looking at upwards of $100K for the surgery. You can argue all his rights in the world, you can equally argue the state's right to say no.

And let's not forget an inmate in California was denied surgery and she will be released in the future to have a real life outside prison. The State said no to her and the federal court agreed with them. No surgery. So why should an inmate in Massachusetts be treated differently?

And my view expressed here hasn't changed.
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Original Post (9/5/12).-- An article today, see Huffington Post, noted a federal judge in Massachusetts ordered the Department of Corrections (DOC) to provide sex reassignment surgery (SRS) for an inmate currently housed in the men's prision with a life sentence without the possibility of parole and undergoing transition from male to female under medical supervision.

The inmate sued the DOC in 2000 to provide the surgery as the inmate was diagnosed with Gender Identity Disorder (GID), described in the American Psychiatry Assocation DSM-IV years before during a previous incarceration, and after years of litigation, the court issued the ruling.

Well, this has split the transcommunity. Some in the transcommunity feels people with GID should have the full complement of treatment to transition to who they are, and paid by whatever means necessary.

Usually it's the individual and sometimes the employers and less often the health insurance companies. The question in this case is that should SRS, which can cost over $30,000 in the US for travel, surgery, medical care and lodging, be fully paid by taxpayers, which is what the judge ordered for the inmate.

And that's the conumdrum and the split in the community, those arguing it shouldn't be free to inmates, or paid for those on Medicare (not plan B) or Medicaid (some states have provided it but none on record do now), and those arguing it's a condition to be treated and care is care, however it's paid, taxpayers, insurance or individual.

I'm for getting insurance companies to add GID coverage to their policies as the vast majority don't and only then when the company specifically wants and pays for it. It's the one mental condition deliberatly indentified and not fully covered under health insurance.

That's not a business decision by them but a moral one, which the courts should rule for the rights of the patient. Even President Obama has not ordered it covered under the Federal Employees Health Benefit Plan (FEHB) which is paid by the government and employee/retiree. And the VA does not provide SRS for transitioning active or retired service personnel.

It's not that expensive and not that common, far less than some of the more serious and even rare diseases, illnesses and conditions now covered. And it's a one time deal where the patient is cured so it won't come back to bite them. It's, as they would see, cheap insurance.

But I don't agree the taxpayers to pick up the tab for the whole treatment. Otherwise, it's a free ride for the individual to be diagnosed and get their transition paid by the rest of us. Let's understand this person killed another person and will never leave prison.

This person will be a victim of violence in either a men's or women's prison. This person had the chance to transition outside of prison in between sentences and chose not to transition but commit crimes and be reincarcerated. This person deserves care for life-threatening reasons but SRS is not it, not life-threatening.

The arguments for this person to have SRS focuses on SRS and overlooks this person's character and status as a "lifer" who'll never see the outside of a prison. They don't need SRS to be an inmate, especially at taxpayers expense.

First Protect Yourself

There's been a lot of discussion lately in the media about whether a transitioning woman should disclose to anyone on their first date who, and really what, she is, where many people, including some very out transpeople, have not just recommended but advocated, disclosure.

Personally, to me, it's all about first protect yourself, which means, don't disclose your status as a transwomen (in-transition) or your history (post-transition) until there is good reason, you know the other person more, and you're in a safe place (not their place where you're trapped).

I don't agree with Buck Angel and the lot of them who say being out from the start is good, it's not. It's dangerous to you, and can be life-threatening if other people, not just those you're with, but those who hear, know or discover, decide they don't like you and take their anger, hate and rage out on you.

This wasn't an argument years ago when the leading post-transition women were advocate privacy until it a necessity to disclose, like intimate relationships, and you know, which is really hope, your partner is  understanding. But history and the data have shown, that's rarely the case.

There are many good reasons for being stealth, and despite the anger of some in the transcommunity about being stealth, especially post-transition, it's the best advice and best bet. And the worst advice is listening to the likes of folks like Buck Angel, etal. on this subject.

Always think about your personal safety and security first. And screw the rest of them if they don't get it or don't like you for your decision. They don't live your life, you do, and that's your priority.

Observation

A really good article with excellent following comments about gender identity issues and the medical community can be read here. It's excellent with one small correction noted in the comments about the statistics of suicide among young transpeople, the author calls "mortality rates."

That said, treatment for gender identity has been available for several decades now, but mostly out of reach all who want to transition with sex reassignment surgery, which many folks like me use sex affirmation surgery, except for the few who afford it, often mortaging their home, their future or other debts, or have employer insurance.

This is because while employers are covering the treatment for gender identity, which runs $25-30,000 minimum depending on the extent of physican care and oversight for hormone replacement therapy and surgery, noting feminine facial cosmetic surgery and breast augmentation surgery aren't covered by any insurance, health insurance companies aren't offering coverage in their plans.

Almost all health insurance companies do not cover treatment for an established medical condition, defined and described in the DSM-IVTR and upcoming DSM-V with the full description of treatment. This is one of the very few conditions not covered by health insurance except when state and local governments or companies pay for it or add it for their employees.

Right now even the Federal Employees Health Benefit Plan (FEHB) does not cover and specifically denies coverages with "Sex transformation services not covered." The Office of Personnel Management has yet to act on a Presidential directive to order coverage included in the next round of changes to plans for active or retired employees.

They didn't even recommend the change let alone mandate the change for 2012 and they haven't said if they'll do it for 2013. There aren't that many employees and retirees in transition to make this a big deal, but to them it's significant when each are looking at $20-25,000 out of pocket expense for the final surgery on top of any additional cosmetic surgeries.

It only makes me wonder if the medical community really cares about transpeople. I know some do as they provide care for transpeople, but overall, it smells of morality at work in people's minds than their oat to "First, do no harm."

If they followed it they would see the rate of suicide drop among transpeople. They would see the health and happiness of transpeople improve. They would change lives for the better than impose a restriction based on nothing but personal morality than medical science and above all practicing good medicine.

We can hope but few transpeople are holding their breath anymore.

Why

Why is that the given a person's gender identity issue, being a self-diagnosing condition that a medical professional can't refute or confirm, that the medical professionals are the one who get to decide if you are who and what you are and what criteria you have to meet to get approved for treatment?

Why do those same medical professionals, who never studied let alone proved, gender identity is an abnormal mental condition except just to say it is, get to decide your fate, meaning get to decide if you're telling the truth, get do decide if you get hormones and get to decide if you get surgery?

Why do they when they can't confirm or refute you? They can only issue an opinion from what you say and how you present yourself which they disguise as professional judgement based on some standards which are more a social morality criteria than anything?

Why do they get to decide whether you are a woman or not? Why you have a female brain? Why do they, in the absence of any physical or other test, when can't really determine anything except what you say?

Why do they get to deny you the one surgery which is the treatment for the condition and require you to perform a months-long test which makes you vulnerable to embarrassment, humiliation, verbal and physical abuse, assault and even being raped or killed?

Why do they put your life at risk when a surgery would prevent it? Why do they call it an acceptance test when you already know the results? Who's acceptance? And is it more about just surviving it than anything else?

Why do they, when you survive, do they get to then say, "Ok, you're a woman, here's your letter for surgery."? Couldn't they just have done it at the beginning and come up with the same answer?

Why do they get to be the gatekeeper to your happiness and future? Who gave them the power they haven't earned or proven it's necessary?

Why?

What happened to "First, do no harm?' view of treating people, to put them through a months-long ordeal for nothing?

When 90+% of post-transition women are the same through their transition, meaning they know themselves to be women and want to live the rest of their life as a woman, why is all the months-long "treatment" necessary outside of helping them understand the realities of it?

Is that what it should be, helping not hurting? So why, when do transitioning women at the end of their transition feel the whole medical community hurt them far more than helped them?

I won't argue some are helped by therapy, but the vast majority go through therapy with two goals, get the drugs and get the letter for surgery, and then get on with their life. They knew from the first visit they wanted to transition and only spent the time convincing the therapist.

Everyone knows it's the game that's played, so why do we continue the sham?

Inside & Outside

To explain it simply, like everyone else, we all see who we are on the inside and want to show it on the outside, while everyone else sees what's on the outside and projects that to the inside. The only difference is that while everyone else's inside and outside general match, transgender people have a mismatch between the two.

The inside is the same as society sets for sex and gender standard, so everyone else thinks our outside is our inside when it's the opposite. Only the few who can pass as expected by society are lucky not to be faced with the embarrassment and humilitation, and often the hate, anger and violence, and always the discrimination.

The lucky ones don't like to be seen as and with the other transpeople, so they become silent, living stealth as it's called, and then usually turn and walk away, not a word said to help. They don't want their history to be public, their life to be jeopardized, and their person to be a target. So they don't do anything.

And the unlucky ones face it everyday they walk out the front door. Their inside is who they are, not their obvious outside others see and society condemns. And all the protections in the world won't help them against people who don't understand, don't accept and don't feel a reason not to act against them.

All because of their outside which isn't who they really are, it's the inside, no different than anyone else, just as normal as everyone else, and just wanting to get through life like eveyone else. It's not rocket science to know and understand, it's human nature.

Two Parts

It's about being yourself and being seen as yourself. Not being what is expected of you or as society thinks you should be by some standard, like your sex. Not being seen as yourself, but seen as someone abnormal, someone less than everyone else, someone worthy, in their eyes, of discrimination, embarrassment, humiliation and even violence.

That's what transwomen know when they walk out their front door. Every day. The world as they know it. And for everyone else, maybe they should remember John Bradford's words, "There but for the grace of God go I."

We are born to who we are, our sex and gender. Given and not always in agreement, and the best we can do is make the best of our life as much as we can, being ourself and being seen as ourself.

Is that so hard to understand and accept? For wouldn't we want as much if we were born that way?