Archive for the 'transitioning' Category

Indonesia: Fatwa against SRS announced

July 29, 2010

A number of fatwas has recently been issued by the Indonesian Ulemas Forum (MUI) on a range of subjects, from the ‘correct’ praying direction [via CNN], civet coffee [via AFP], TV gossip shows [via AFP] – and, at a meeting of the MUI on Tuesday, sex reaffirmation surgery for trans people [via Spero News].

The Jakarta Globe quotes Ma’ruf Amin, head of the MUI’s fatwa body, as saying that enacting legislation based on Islamic values would address the “degradation of morality among Indonesia’s students”, even though he neglected to provide any evidence of any decline in morality in schools.

As the New York Times points out, the aim of this shift towards formalising fundamentalist views seems to be to provide a right wing minority with the figurative ammunition needed to attack anyone who attracts their ire:

While the council’s edicts are usually ignored, they can be cited by religious hard-liners to justify vigilante-style crackdowns on “un-Islamic” activities. It has recently issued a steady stream of edicts including bans on interfaith marriages, smoking and yoga.

In the light of my earlier post about attacks by members of the Islam Defenders Front (FPI) on transgender human rights workshops and HIV/AIDS seminars in West Java, this all seems to indicate, at best a muddying of the waters and at worst a worrying deterioration in the situation for transsexual people in Indonesia.

Ni’am Sholeh, deputy secretary of the MUI fatwa Commission, said that “Intentionally made changing of sex without proper scientific reason is morally not allowed. However, we recommended medical doctors to help people to make their genital more perfect We have issued this fatwa to implement sharia.” In Indonesia, shariah is not law and the fatwa is a religious ban, not a legal one. The Indonesian Supreme Court, in fact, allows sex changes. [via Asia News]

Ni’am Sholeh’s analysis fails in at least two ways: first, the implication that genital reconstruction surgery is carried out “without proper scientific reason” has no basis in any reality that I’m aware of. It wilfully ignores the existence of an internationally recognised body of medical evidence which long ago established the significance of these surgeries as part of a comprehensive process to help people minimise and manage their gender dissonance – as well as the fact that, in many countries the implementation of SRS is often governed, or at least guided, by WPATH’s Standards of Care. The second assertion, that the medical profession “help people to make their genital more perfect” is confusing. If your brain was expecting your genitalia to have an entirely different configuration, how would making what exists “more perfect” even be possible, much less desirable?

The worry is, of course, that religion is being used as a platform from which to marginalise and demonise transsexual people, in the process legitimising violent reactions to our existence as well as completely disregarding issues around our bodily autonomy and human rights.

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Previous posts about trans and intersex people in Indonesia:

London: New private practice gender clinic

May 29, 2010

Via Spectrum London

We have been asked to share the following information after Dr Lorimer contacted us.

Dr Stuart Lorimer, familiar to many of us from his work at the Charing Cross GIC, is setting up a private practice in addition to his NHS work. He’s currently looking at doing Saturday lunchtime slots, starting from July. This will be based also in Hammersmith.

For more details, or to book an appointment, email to enquiries@gendercare.co.uk or phone 07899 929859.

There is a possibility of other services from other practitioners being available too although this is an early stage of working.

Dr Lorimer would also like to stress that this will not alter or reduce his commitment to his work at CX,

There will also be a website sometime soon.

As soon as we have more information we will let you know

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Curtsey to Denise for the heads-up

Turkey/UK: Home Office supports man’s transition

March 17, 2010

Via Hürriyet Daily News:

A Turkish transsexual identified as G.O., 33, has been accepted to a gender-reassignment program and granted a residence permit in England, where he fled eight years ago.

[…] G.O will take the name Dennis after the transition is complete.

The United Kingdom Home Office offered its complete support to G.O and agreed to pay him 60,000 pounds as a first installment for the surgery he needs […].

G.O.’s family in the Black Sea region of Turkey is one with many daughters. When asked how his life was before he fled Turkey, G.O said that he never felt like a girl, even in his early childhood. Because he lived in a conservative community, he said, he felt that running away was his only option to escape scrutiny by those societal values.

If he returned to Turkey after the gender-reassignment procedure, G.O said, it would result in his death. He made his case on that basis to the Home Office, which granted him a residence permit allowing him to stay in the U.K.

This report is a rare example of even the usually fair Hürriyet falling prey to what Julia Serano calls trans-objectification (“reducing a person to their body parts rather than viewing them as a whole person” [Via]), which only furthers the marginalisation experienced by trans people – hence my redaction of certain parts of the quoted article. No doubt the more small-c-conservative elements of the British mass media will have a field day with knee-jerk reactionary ‘shock horror outrage’ stories, unfortunately. I can only hope that the likely hate speech will not add to the distress and trauma that Dennis must already have experienced.

But the underlying facts of the story are encouraging, at least. If only there was a way to make these resources available to all trans people resident in Britain, regardless of their backgrounds – and if only Turkey would step up and take responsibility for its own compliance with EU and Human Rights legislation.

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Previous related posts:

*What* reproductive rights?

August 18, 2009

West Australia:

Two West Australian female-to-male transsexuals have won the right to be considered men without having to undergo surgery on their reproductive organs.

[…]

“[The State Administrative Tribunal] accepted the evidence of each applicant that he intended to continue testosterone treatment for the rest of his life.”

“It accepted the medical evidence that each was, and would remain, infertile for as long as he continued testosterone treatment”.

(Via the Sydney Morning Herald)

Latvia:

[At a] meeting of secretaries of State the amendments specifying sex change for single individuals were approved.

[…]

Having surgery, it will be prohibited to keep reproductive function that is inherent to the previous sex of the person.

(Via TGEU listserv)

In each case, the outcome is the same – to stop trans people becoming parents to their own children – only the means of achieving it varies. One requires sterilisation by means of hormone therapy; the other requires sterilisation by surgical means.

The medical profession which pathologises and stigmatises us, is now being used to police us and yet again, the gatekeepers overrule the facilitators.

Well, we can’t have these awful trans people breeding, now, can we?

Asylum seeker wins judicial review against deportation

August 6, 2009

Flag of the Islamic Republic of PakistanI know I should stay away from newspaper articles on trans issues, especially tabloid newspapers, but I’m seeing one story being endlessly re-linked around the web with no comment on its content – content which I find objectionable on several grounds. So I guess I’ll just have to do it myself, she muttered, hefting the pink sparklehammer of deconstruction and casting a jaundiced eye over the offending tabloids.

The reposted link is to a piece which appeared last Friday (31 July) in the Daily Express (link here). I’ve since found another report in the Worthing Herald (slow-loading link here).

The gist of the story concerns a trans man who came to Britain from Pakistan in December 2007, when he claimed asylum. Apparently he came to Britain to undergo his medical transition because, as the man’s solicitor, Toufique Hossain, said: “The claimant has a well-founded fear of persecution as a transgender male if returned to Pakistan”.

In the intervening 21 months between coming to Britain and finally winning his case it seems that not only has his transition been delayed, but he has also been held at Yarl’s Wood immigration detention centre in an all-female unit. I wonder what kind of a field day the tabloids would have had if this had been a cis man held in an all-female detention centre.

I digress. The point is that this is a fairly short news article even though the case itself is notable as the Home Secretary has been made to reconsider a decision to refuse asylum to a trans man. This apparently follows a series of previous decisions to refuse asylum to trans people. In the words of the anonymous asylum seeker’s solicitor, Toufique Hossain:

“The [Home Office’s] acceptance of this case now amounting to a genuine fresh claim is a significant development in the treatment of transgender applicants within the immigration/human rights context.”

You would think there were substantial issues arising from this case that would merit further analysis and discussion. Instead, we have the story picked up by only two tabloid newspapers, each of which displays varying degrees of cissexism and transphobia in its coverage. The Daily Express’ treatment is noticeably more offensive, not least for its insistence on misgendering the asylum seeker from start to finish. As if that wasn’t enough, it then quotes a representative of the clearly reactionary TaxPayers Alliance as saying:

“This is yet another example of the myriad of ways in which people can gain free access to taxpayers’ money and residency. While it is right that we are a safe haven for those in fear for their life, the definition of what qualifies for asylum has gone too far.”

Which smacks as a variation of the very racist trope usually heard as something like “Damn foreigners, coming over here and stealing our jobs”. It’s a frankly ludicrous assertion in the light of Judge Mark Ockelton’s comment that he had “real difficulty” in understanding why the Home Office persisted in defending its decision despite the “strong evidence” in the asylum seeker’s favour. Toufique Hossain again, demolishing in one sentence the outraged whining of the political-correctness-gone-mad brigade:

“It is unfortunate that the Home Secretary only reached this decision with the assistance of the High Court – significant public funds would have been saved if an earlier and sensible decision was made.”

But perhaps the award for the most subliminally racist, Islamophobic and scaremongering quote should go to the Worthing Herald for this toxic little paragraph:

Human rights lawyers believe the case could set a precedent for other transgender applicants from Muslim countries who say they fear ill-treatment because their condition is not understood in the Islamic world.

It first tries to give itself objectivity by referring to (unspecified) human rights lawyers, before playing on the racist and xenophobic fears of middle England. The idea that every trans man in Pakistan will now be on the next plane over because of Britain’s “completely lax immigration policy” defies belief. And where is “the Islamic world”, anyway? You’d think it was on another planet and its inhabitants had to hop aboard a flying saucer to come here with their apparently single-minded aim of “squandering taxpayers’ money”. Never mind that the outcome of this case makes it clear that they’d actually have solid, legitimate health reasons for doing so. And meanwhile, how many Brits are heading abroad as so-called “medical tourists”? I’m not seeing much of an outcry about that from these journalists.

The tabloid press, pfft.

Real Bras™? They’re not for trans women…

July 16, 2009

Transforms Black Lace Enhancer Bra - image from Xtra WestOn a slightly less surreal, but possibly more absurd note than the trainwreck that is VWHC’s trans exclusionary policy comes this report in the Vancouver (where else?) section of Xtra West (link here).

See, us trans women, we’re so speshul™ that we even get our own speshul™ underwear now.

So, assuming that you’ve been able to find a pharmacist who’s been willing to sell you your prescribed hormones, you may well find that sooner or later you’ll need to buy a bra. Isn’t nature wonderful? Now, I don’t know about anybody else, but I usually buy mine from the lingerie department of a certain well-known high street chain store. They’re nothing speshul™, nothing fancy, just plain ol’ common-or-garden everyday bras like a lot of women wear.

Mistake! Apparently, what I should have been doing, is buying bras that are “specifically designed for transitioning women”.

They will hold the girls in place while offering the right amount of support and comfort in a beautiful black lace package.

Don’t they look just like Real Bras™ that Real Women™ might wear in Real Life™? And you get to out yourself as trans when you go shopping for them!

Fantastic…

Now, if someone would be kind enough to write me a suitably sarcastic closing paragraph containing the words ‘trans misogynistic’ and ‘cissexist’, I’d be very grateful. I have this overwhelming urge to go and put a few more dents in my forehead…

GIRES Award 2009 announced

July 5, 2009

GIRES logoThe Gender Identity Research and Education Society has announced its Award for 2009:

The Award recognises the excellent work of eight eminent clinicians, who developed “Guidelines on the Endocrine Treatment of Transsexual Persons”

The Guidelines include a clear recommendation that suppression of pubertal hormones should start when girls and boys first exhibit physical changes of puberty, but no earlier than Tanner stages 2-3.

[…]

The Award is made in recognition of influential published work that will improve the lives of gender variant people.

The 2009 Award recognises the importance and excellence of the Endocrine Society “Guidelines on the Endocrine Treatment of Transsexual Persons”.

[…]

The Guidelines include a clear recommendation that suppression of pubertal hormones should start when girls and boys first exhibit physical changes of puberty, but no earlier than Tanner stages 2-3. That treatment is already available in highly reputable centres in Australia, Belgium, Canada, Germany, Norway, the Netherlands and the USA. The guidelines should now provide a substantial impetus to improving treatment in other countries, such as the UK, which require these young people to endure inappropriate full pubertal development before any physical intervention is offered.

Via http://www.gires.org.uk/awards.php

China issues first draft of clinical guidelines on SRS

June 19, 2009

Flag of the People's Republic of ChinaMy first reactions on reading an article in the China Daily (link here) reporting that the Ministry of Health (MoH) has issued its “first clinical guideline on sex-change surgery” were surprise that China doesn’t already have such guidelines, and curiosity about how many trans people there might be in China.

Taking the NHS’ estimate that “one in 4,000 people in the UK is receiving medical help for gender dysphoria” (link here), and the CIA’s estimate (link here) that the population of China is 1,330,044,544, as being accurate, then that suggests there may be some 332,511 trans people in China.

No wonder, then, that the guidelines have been compiled as part of a process of “regulation and standardisation“. And the idea that appropriate medical support is currently only available in an uncoordinated and haphazard way isn’t such a big surprise when one considers such things as the infamous postcode lottery for healthcare access in the UK.

—————

The draft document sets out minimum criteria for both trans people and medical institutions. To that extent, it seems to be trying to achieve a similar result to the widely-followed WPATH Standards of Care for Gender Identity Disorders (SoC) (direct link to PDF here) without actually referring to them directly, for whatever reason. The China Daily reports that the MoH lists three main criteria for diagnosing gender dysphoria:

  • Candidates for the surgery must be older than 20 and single
  • They are also required to prove a persistent desire for a sex change, to live for at least five consecutive years full-time in the new gender role, and to engage in mental therapy for at least one year.
  • Before surgery can take place, a candidate must receive a recommendation for the operation from a psychologist after an appropriate series of therapy sessions.

So how does this compare with the SoC?

To begin with, the minimum age requirement for surgery is described in the SoC as being the “legal age of majority in the patient’s nation“; in the UK, this is 18. As far as I’m aware, there’s no specific requirement in the SoC that one must be single, and the inclusion of this is a telling demonstration of how a moral code is interwoven with the more empirical medical criteria.

The first part of the second clause (“to prove a persistent desire for a sex change“) in principle echoes the SoC – or, more accurately, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10), to which the SoC refers.

The ICD-10 is quoted as saying that one of the criteria of transsexualism is:

The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment

And the SoC quotes the DSM-IV-TR’s diagnosis of Gender Identity Disorder (GID) as applying to:

those with a strong and persistent crossgender identification and a persistent discomfort with their sex or a sense of inappropriateness in the gender role of that sex

—————

The second part of the second clause – the requirement for five years’ Real Life Experience (RLE) – seems draconian in comparison to the SoC. Its section IX, The Real-Life Experience sets no specific time period; although elsewhere it requires a minimum of “12 months of successful continuous full time real-life experience” as one of the criteria for surgery.

However, even this prerequisite seems flexible: a person transitioning under the UK’s NHS is likely to be required to undergo at least 24 months RLE, whereas the Thai surgeon who carried out my surgery asked for only 6 months RLE. It remains to be seen if the Chinese proposal will be strictly enforced.

—————

The third part of the second clause – “to engage in mental therapy for at least one year” appears to overlap with the third clause which demands that a “recommendation” for surgery is required from a psychologist “after an appropriate series of therapy sessions“. The SoC, however, states that:

Not every adult gender patient requires psychotherapy in order to proceed with hormone therapy, the real-life experience, hormones, or surgery.

—————

It seems that the main proposals of the Chinese model have more similarities with the SoC than they have differences, albeit with some significant variations in detail.

However, the Chinese proposal also includes two additional, quite specific legal requirements that must be met:

The candidate must provide proof from police that he or she has does not have any criminal offenses in the past.

Police must also agree to change the sex status on the identity card of the prospective receiver before the operation can take place.

I have to say that I really don’t understand why the police need to be involved in the transitioning process at all. I’m not aware of any comparable requirements in the SoC although, in addition to medical and social aspects, it’s not gone unnoticed that my own transition includes legal elements too. However, these relate, not to criminal law, but civil. For example, to qualify for a Gender Recognition Certificate, which “enables transsexual people to be legally recognised in their acquired gender“, I had to follow the procedure laid down in the Gender Recognition Act 2004. Having successfully jumped through those hoops, I am now “legally recognised for all purposes in your acquired gender“. This includes being able to obtain a new birth certificate showing my “legally recognised gender“.

No police officers required…

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I have much the same feelings about the Chinese guidelines as I do about the WPATH Standards of Care which govern my own transition. I can understand and – to some extent – even agree with the need for support and assistance from healthcare professionals regarding the medical aspects of transitioning. But I’m deeply uncomfortable about the amount of the involvement of the state. Just as I don’t understand why a trans woman in China should need police approval to change her ID card, neither do I understand why I needed a covering letter from my doctor to change my passport.

To be honest, most of the questions and discrepancies arising from the SoC look to me that they will simply happen under the Chinese proposals too.

It’s hard to see how things like the ‘no-match’ situation (where a person’s official documents don’t match the state’s records for that person) won’t occur under these proposals. It’s hard to see where non-binary ID’d trans people fit into the picture, too.

But most of all, it’s hard to see how the proposals will be implemented in such a way that trans people in China aren’t pathologised and stigmatised in the way that trans people are in other places, which in turn exposes us to unacceptably high risks of discrimination, bigotry and violence from cis people.

Sugar and spice and all things neurobiological

March 31, 2009

tg_black-on_pink_100x107Sara-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”.

(Via)

It continues:

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.

(Via)

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.

Are careers still stunted by discrimination when it comes to sexuality?

March 12, 2009

tg_black-on_pink_100x107Big long piece in The Independent newspaper about discrimination in the workplace. Although focused on gay and lesbian people coming out in large organisations, nevertheless there is some mention of the experiences of trans people transitioning at work too:

[…]

It’s not just employers that have moved the LGBT agenda at work forward. The Employment Equality (Sexual Orientation) Regulations 2003 bans discrimination on the grounds of sexual orientation in employment and vocational training. Meanwhile, trans people are protected by the Sex Discrimination Act 1975, the Gender Recognition Act 2004 and the Gender Equality Duty. What is clear, says Kath Browne, a senior lecturer at the University of Brighton who has researched the working lives of LGBT people in the Brighton area, is that when properly implemented this equalities legislation really does benefit everyone. “One of the women I spoke to as part of the research was going for her gender reassignment and was very nervous she would get her P45, but in fact her employer had already put in place all the statutory requirements, as well as thinking through their policy. She kept her job and felt very loyal to the employer.”

Nevertheless, she adds, “We also found that, particularly with trans people, they are very often unemployed or in unstable or unsuitable jobs because they choose to live in their gender roles. Others lose their jobs because of being trans. There is still a lot of discrimination out there and it’s not just overt. People can be subtly bullied.”

Stephen Whittle OBE, professor of equalities law at Manchester Metropolitan University, transitioned from female to male in the Seventies. “People have really extensive employment rights now, but we still find people who suffer terribly in their jobs. Research shows that 45 per cent of trans people do not transition because they fear losing their job.”

[…]

‘My employer was very supportive during my transition’

Daniel Hooper is a technical specialist at the Environment Agency who underwent a gender transition from female to male.

“When I went through my transition, I was very open about what was happening and why, along with the timescales. I encouraged my employer, who was very supportive, to surround it with a lot of humour, and that really worked. It meant that when mistakes were made inadvertently, it didn’t have to be a huge deal. For example, if someone got my name or my pronoun wrong, we’d just laugh it off.

I work in an area of the business that is considered to be very judgemental and is mainly male dominated. But I’ve never suffered from any harassment.

I hear about many trans people who try to keep the fact that they’re trans a secret at work. For me, that was never an issue because the psychology of such a closed life has never appealed to me. In any case, I think it helps to show others that trans people are normal people doing normal jobs.

The few people who are trans in the Environment Agency have helped write up the organisation’s trans policy. The benefit is that it addresses our needs as we perceive them, rather than being made up by someone who doesn’t really understand the issues. One example of the policy is the section on what is the appropriate language to use.”

Hmm. I come away from this thinking that, while it’s good that there’s been progress in recent years, trans people in particular are still a long way behind gay and lesbian people in our everyday experiences of transitioning at work. But it was ever thus, I suppose.

…*le sigh*…