Sara-Jane Cromwell, CEO of Gender Identity Disorder Ireland, writing in the Irish Medical Times (link here) provides a useful overview of the process of transitioning. And this assertion in the opening paragraph certainly caught my eye:
Gender identity disorder (GID)/gender dysphoria is a little known but much misunderstood congenital intersex condition, which is clinically diagnosable and treatable. The growing body of evidence points to GID being neurobiological in nature and has nothing whatever to do with fetishistic compulsions or lifestyle choice, with which it has been too long associated.
First – and as I’ve said elsewhere – I’m not comfortable with the terms gender identity disorder and gender dysphoria: for one thing, I don’t consider myself to be ‘disordered’ and for another, ‘gender dysphoria’ is inevitably linked to the tired old cliche that we are “trapped in the wrong body” – an analogy which really doesn’t work for me at all. I’ve yet to hear a more accurate (for me) descriptive phrase than Julia Serano’s gender dissonance.
I agree that there is a growing body of evidence suggesting that transsexuality is at least partly neurobiological in nature, but the idea that gender dissonance is an intersex condition – although not new – is, I think, not especially widespread, as well as likely to be quite controversial to some.
Ms Cromwell’s account of a discussion she had with her endocrinologist is illuminating:
My endocrinologist went on to explain the great difficulties he had in getting his colleagues to engage with patients diagnosed with GID. Their objections seemed to stem from their misperceptions regarding GID being a lifestyle issue rather than being medical in nature, and therefore felt the provision of hormone treatments to be inappropriate.
This gatekeeper attitude of healthcare professionals is unfortunately far too common and has caused (and continues to cause) many problems and much distress to a number of trans people. As Ms Cromwell points out:
These difficulties are very grave indeed and an immediate response is required from health service providers. The vacuum created by the lack of healthcare for GID patients is also the result of a wrong association being made between people diagnosed with GID and those who engage in sexual fetishes.
She goes on to give a more detailed description of what she calls GID; it’s a useful summary of the various hoops through which trans people must jump if we are to be allowed to transition medically (assuming, of course, that this is a transition path that we want to follow). And again she states her opinion that it’s an intersex condition:
GID is a congenital intersex condition which leaves the individual with a psychological gender identity at odds with their physical sex and gender indicators. One of the simplest ways of explaining it is that the person feels themselves to be a female when their body, and gonads in particular, indicate that they are male, e.g. male to female (MtF) and vice-versa.
And that paragraph, I have to say, doesn’t entirely sit right with me. The Organisation Internationale des Intersexués (OII) states that:
An intersexed person is an individual whose internal and/or external sexual morphology has characteristics not specific to just one of the official sexes, but rather a combination of what is considered “normal” for “female” or “male”.
As a group, intersex people are not transsexuals. However, some transsexuals are in fact intersex and this is the reason for their desire to correct their wrong sex assignment. Dr. Milton Diamond and some other experts do consider certain forms of transsexuality as an intersex condition.
But regardless of any possible differences of opinion about whether transsexuality is an intersex condition, Ms Cromwell makes one very important point about transitioning:
As difficult as it is (and it is difficult) to find a qualified practitioner for the purpose of providing a diagnosis and referral, matters become even more difficult when it comes to accessing treatment from a local GP.
General practitioners play a vital role in the ongoing monitoring of patients throughout the reassignment process and they can make a very significant difference to the overall outcome of the treatment process.
For me, although finding a GP remains an unfulfilled aim, I think it bears repeating that, to see any GP, one first has to run the gauntlet of receptionists and practice nurses, who can and do make their hostility to trans people glaringly obvious.
I’m a little concerned at Ms Cromwell’s apparent emphasis on surgery as the goal of transitioning; my own feeling is that transitioning is an ongoing process and surgery just another step on a very long path. In addition, it must be remembered that not everybody transitions medically, or undergoes surgery.
Nevertheless, the article is generally a useful reminder of the complexity of the medical treatment of gender dissonance, and I hope it will generate a reasonably intelligent level of debate around the subject.