How do you "become" a woman?

[Marleena]

@ Jorja

I'm curious how you managed to find transition help. Where you lived, etc. You can PM me if you like.

The first time I hit the wall, my ex- wife, a nurse, said that female hormones should help. It was pre-internet days and although we heard of "sex changes" I had no idea where to look for help and remain anonymous and not get commited.lol. It was scary.

[Kaitlyn Michele]

maybe pink you are the one projecting your own feelings about gender to validate yourself ..

all the ts women I know are pretty darn certain about what they are..

.....

the reason we as TS people share our stories is to help comfort people that may feel very alone in the feelings you aptly describe, and we share our stories to help give ideas to people about how to cope...

you are right that after the fact it doesn't matter how you got to point a to b...but if I have a problem(being ts) I sure as heck want to know how others dealt with the same problem..

[LeaP]

Interesting, I thought the response was thoughtful.

The notion of going from "one transgender type to another" is valid in a limited way. That is, considering being cross-sexed in some regards, even after SRS, one may be considered a trans woman or woman in a male body with male chemistry and configuration to a trans woman or woman in a male body with female chemistry and configuration. Trans-ness is a point of view (i.e., depending on context) that is as valid as no longer being trans. They can be mutually true. The problem (if you have one with this) is semantic, not conceptual. I don't particularly like the "transgender type" language in several respects either, but I think it does neatly capture the idea expressed above. ("One transsexual type to another" would have worked as well, however.)

Re: dramatic changes ... Yes and no. Logically this cannot mean physical changes, which are OFTEN dramatic. Ditto mental health. So I took this to mean core personality, and I'm inclined to agree.

I had to take some creative reading license with the invisibility comment. Kathryn, your comment about universality is true, but it is also true that many TS don't perceive how obvious their true gender is to others. How many instances have we all read of someone announcing a transition only to hear that someone responded with something like it was about time, I wondered when that would happen, that makes sense, etc. So from that perspective, some trans people are struggling to hide things that are, in fact, not so hidden? If this is what Pink intended (and I am guessing), no problem. I can, however, read some further implications that I don't like, including that the problem is ONLY a cognitive dissonance issue.

[sarahcsc]

As I am one of only a few here that transitioned fairly early, age 22, I really cannot understand how many of you could wait so long. For me, it was a driving need, a must, I simply had to transition as soon as possible or die. How did you manage to put off the intense feelings for so long? I understand family obligations, career obligations etc... Was it that you just did not realize it at that time?

Actually Jorja, for me, it was hope and lots and lots of distraction. I haven't undergone SRS but I am saving up money when the timing is right (and I don't know when), and I've been on formal HRT for 6 months and informal HRT for 2 years before I began formal HRT (I know, its bad. But I was desperate!)

I always hoped that "it" would pass when I hit a certain milestone in life but it never did. When I first realized it at age 7, I was baffled and frightened, but held out for puberty. When nothing changed during puberty, I held out for my first girlfriend, thinking that having a girl in my life would force me to stop. And when nothing changed after having my first girlfriend, I started to panic a bit, but I still held out hope for change because I thought this would go away when I meet my future wife. And when I met who I thought was my future wife (long boring story), I knew I had to tell her because I still couldn't get the idea out of my head and we broke up.

As you can see I used the word "it" instead of anything else because I don't believe I fit neatly into any diagnostic boxes and neither did I have words to describe "it" at the age of 7 except an urge to dress up and look like the opposite sex.

You can argue that this sounds like denial but I never denied that "it" existed except I always hoped that like a wandering traveler, "it" would stay for a while and move on when the seasons change.

There were a lot of distractions too which prevented me from focusing on myself. My family was pretty dysfunctional that they kept the drama coming while I created another perfect distraction which was my studies. Now that I've left home and finished medical school, I suddenly realized that there was very little to distract me from "it" and my thoughts.

But no, I was never as distressed as you Jorja. I can't explain why this is but maybe we're all on a severity spectrum where you are placed on the far end of being severely gender dysphoric.

=======

Everybody here is so well versed and knowledgeable with gender concepts and diagnostic criteria which never ceases to impress me. I am learning so much!

Patients often ask me what is wrong with them and why are they thinking the way they do and I generally offer them a broad formulation of what I think is the origins of their problems but very seldom do I give them a formal diagnosis unless they need it for social support or additional government funding. I refrain myself from labeling people because of the implications a mental health diagnosis can carry. But I can see why some patients are relieved upon receiving a formal diagnosis because it gave a name and a form to their disorder in which they could identify. After all, it is much more daunting fighting something you don't even know exist!

I think I've mentioned this before, that I wasn't terribly surprised when I was given the diagnosis of GD but I had to admit that I knew the criteria well and knew exactly what to say to my therapist. To me, it was merely a passport to HRT and I knew that I'd continue to self-medicate via other means if I didn't get the diagnosis. I understand the limitations of the current diagnostic classification systems and there will always be inherent flaws in those especially when we're trying to objectify a subjective experience. But at the same time, I had faith in the humaneness and intelligence of the therapist , so much so that I know that she won't attempt to reduce me to fixed set of criteria which was agreed upon by a group of middle-aged white psychiatrist in America.

She gave me the diagnosis, probably because she knew I needed it, not so much because I fitted it.

And as a therapist myself, I found myself doing the same for my patients too. I often reply "why do you want to know?" when they ask me for a diagnosis. I ask because a diagnosis will mean different things to different people. For some, it is a relief, while for others, it is curse. To give a diagnosis in the latter scenario is unwise and maybe even unethical because it often causes more harm than good.

To feel wanted and to feel like we belong is a basic human need. Children who are severely neglected emotionally during infancy actually die despite feeding. These children often just refuse to feed and die and even if they do feed, they have smaller head circumference and later develop cognitive disabilities. Therefore, it is not surprising that people with GD will do whatever it takes to earn acceptance and love even if it meant denying or repressing their true feelings because the other alternative is possibly death. Of course, this is also a double edged sword because a lifetime worth of denial and repression often leads to other problems as well both physiological and psychological.

=======

I continue to learn every day about myself and "it" and I suspect this is a never ending process. If you asked me, I don't want to be defined nor do I want to fit in a box. So what if it offers me a "peace of mind" knowing what I've got when it denies me authenticity. Late-onset or early-onset TS is immaterial because it rarely translates into any real life contribution. What translates into real life utility is my resilience (to bounce back every time I fall), my courage (to press on in the presence of fear), and my ability to tolerate the unknown (to be constantly curious and willing to learn and adapt).

It matters little what diagnosis your therapist or whatever forum(s) assign you compared to the diagnosis you assign yourself.

Don't you think?

Love,
Sarah

[kimdl93]

First, my obligatory disclosure. I do not consider myself TS, but rather a middle pather with a rather pronounced slice...towards the TS side of the gender identity spectrum. Sarah's use of "it" resonates with me. For most of my early life I had no appropriate term in my vocabulary and the one supplied by siblings...houseboy...seems terribly demeaning. I tried to compensate for or disguise whatever behaviors I'd exhibited that lead to that label.

Later, I learned the terms used to describe transsexuals, but little else, and feared that, given the chance, I might be one of them. Fear and a desire for all the things humans need...approval, companionship, career, children, these kept me from more openly and honestly facing the person I was.

And the results were mixed. I got married, had kids, a career, a network of friends....and a dull ache, an inexplicable volatility and a measure of self loathing. I didn't begin to escape the latter elements until I began to accept myself.

Am I becoming a woman? Not really. I feel I'm revealing myself after a long burial in the sediments of repression. Rather an appropriate analogy because I'm something of a fossil. After all these millennia, I'm mostly silicafied, but a little of the DNA remains.

[Kathryn Martin]

It matters little what diagnosis your therapist or whatever forum(s) assign you compared to the diagnosis you assign yourself.

Don't you think?

Love,
Sarah

I understand your thought, but I have one caveat: is experience of self a diagnosis of a condition. For me these were two different things.

There are very subtle layers to the experience of my self in the reality of my life. One (and by no means the only) aspect of self experience is the experience of the relationship between I and world. I was born as a girl, which does not mean I knew I was sexed from the earliest conscious moment. My gendered experience of self arise from a conditioned response of the world to my genitals. For me the experience of my body being part of the world was early and very strong because my body lied about my self. My socialization, as a result, was gendered male. The clash between this and my experience of self was evident as early as eight years of age which is the time my consciousness began to be aware of my reproductive reality. I once wrote this:

In unremembered distances
When the first rumblings
Of a world below the belt
Crashed consciousness, I said
I am who I am


Yet the World said
It’s not a world but you!


surrounded by so little
before I saw the abyss in every direction
and that world, a part of World but not me;


Truth told I, but body belied

KMD (c)

Experience of self is a living reality not a diagnosis. We cannot diagnose ourselves because the criteria for diagnosis are set against an objective standard. I was diagnosed as a moderate intensity transsexual or Type 5 HBS transsexual against criteria of not my own making. The criteria however, while including DSM descriptors and conditions, go far beyond just that.

The real diagnosis of the reality if self does not come from the medical style diagnosis but rather how the reality of experience of self is witnessed by the world in which you live. While this a confirmatory process it is the most accurate than anything else including our self experience which is always subject to self delusion.

Anyway - what do you think Sara?

[arbon]

The real diagnosis of the reality if self does not come from the medical style diagnosis but rather how the reality of experience of self is witnessed by the world in which you live. While this a confirmatory process it is the most accurate than anything else including our self experience which is always subject to self delusion.

Krisi's comment might be phrased in an unfortunate manner, but hers is essentially another version (albeit a more positive one) of the mental disorder or mid-life crisis explanation. It substitutes a decision or conversion experience for the irresistible motivational aspects of the others. Another, less savory version of the decision approach is the depraved, fetish manipulator who transitions to deceive men. All of them presume taking on a non-native identity. Doubtless the version that is selected depends on what naturally appeals to the observer. Someone intimately familiar with the religious conversion experience could easily project that onto transition motivation.

Y'all are making my head hurt!

Why does it need to be so complicated?

[sarahcsc]

I understand your thought, but I have one caveat: is experience of self a diagnosis of a condition. For me these were two different things.

There are very subtle layers to the experience of my self in the reality of my life. One (and by no means the only) aspect of self experience is the experience of the relationship between I and world...

...Experience of self is a living reality not a diagnosis. We cannot diagnose ourselves because the criteria for diagnosis are set against an objective standard. I was diagnosed as a moderate intensity transsexual or Type 5 HBS transsexual against criteria of not my own making. The criteria however, while including DSM descriptors and conditions, go far beyond just that.

The real diagnosis of the reality if self does not come from the medical style diagnosis but rather how the reality of experience of self is witnessed by the world in which you live. While this a confirmatory process it is the most accurate than anything else including our self experience which is always subject to self delusion.

Anyway - what do you think Sara?

Hi Kathryn,

I'm not quite sure what you're saying Kathyrn... so please correct me if I'm wrong but I believe you're saying that there is a fundamental difference between a "diagnosis" and the "experience of self", right? And that the latter is the result of a dynamic interaction between you and the world you live in?

I'm sure you are right, Kathryn. "I think, therefore I am" said the famous philosopher René Descartes. You know that you exist because you are thinking but the rest is up for interpretation. A "diagnosis" is but a human construct which pales in comparison to your internal reality (the way you experience yourself and the world you live in). A "diagnosis" is assigned to you and you have the option to accept or reject it and even so, acceptance or rejection causes little change to your internal reality. A "diagnosis" is an attempt, albeit quite a flawed and futile attempt, to put into words your internal reality for the sake of convenience so that we can use these words as a referrence point in the real world. For example, I can't put down "Sarah's internal reality" on my driver's license under the the gender section because the road cop would be baffled!

A diagnosis will always fall short of the real thing, that is your internal reality, which is yours and yours exclusively. And any attempts to describe it with words is going to be met with failure but we do it nonetheless because otherwise we would have no ways of interacting with the world we live in.

The question is, why do people focus so much on a "diagnostic label" despite knowing its inherent and irrepairable flaws?

I have some rough ideas why, but what do you think?

Love,
Sarah

[Frances]

People focus on the diagnostic label so much for the same reason they hang on to the idea of having an atypical kariotype. It has a lot to do with legitimacy in the context of repudiation from others and the lack of desire to take responsability for their lives. It's much easier say: "see, the doctors say I have a problem." Ultimately, however, transition is a decision (if transsexuality is not) and people are going to get hurt (most of the time).

[LeaP]

Terrific response, Frances.

Kathryn, there is no such diagnosis. Even taking a definitional (and proper) approach broader than one of the frameworks like the DSM, Benjamin's type classification (which was intended as a diagnostic AID) is far too loose and is not in itself a classification of conditions or diagnoses. Benjamin himself said almost all patients would cross categories. And it includes aspects which are quite outdated besides.

In my opinion, about the closest you can get to something like a diagnosis from Benjamin's scale are the groups. Group one is "transvestites." Group 2 is "transsexuals, nonsurgical." Group 3 is "true transsexuals." In more modern usage, I might rename group one "cross-dressers and fetishists." (Benjamin conflates these.) Group 2 would be "gender variant." And group 3 would be "transsexual." Those original groups are the primary groups we still talk about today! If you abandon the antiquated language, it rather pops into view!

[Pink Person]

I use the word transgender in its inclusive sense that describes people with transgender and/or transsex issues. I do this because sex is a subset of gender, and sex and gender issues are often interrelated even when they are not intersecting.

No one has to agree with my point of view or get hysterical about it.

I find the whole notion of men changing into women (and vice versa) to be absurd and derogatory in all its variations. If someone is a transwoman after modifications then you can be certain they weren’t all manly before them. Cismen (and ciswomen) don’t participate in these types of transformations.

For some transgender people, putting on a dress or a dress and a new body is all about communicating something to themselves and to other people that can’t otherwise be seen. The unseen you, the core beneath your shell, doesn’t transform very easily. Our shell selves are relatively mutable, but our core selves persist in comparison.

Shell transformations are important because they tell us something about a person’s core identity that doesn’t change as much. Prattle about becoming something you are not or being something you are not diminishes the core identities of transgender people of every stripe. I take it for granted that transgender people are not all the same, even though this concept seems to be incomprehensible to some of you.

[Rachel Smith]

Kelly your post #69 is great. The way you refer to pain and pain management as a way to cope is very astute IMO. Something I have never pondered but perhaps I should have. Thank you for bringing it to light.

[Kathryn Martin]

A diagnosis will always fall short of the real thing, that is your internal reality, which is yours and yours exclusively. And any attempts to describe it with words is going to be met with failure but we do it nonetheless because otherwise we would have no ways of interacting with the world we live in.

The question is, why do people focus so much on a "diagnostic label" despite knowing its inherent and irrepairable flaws?

I have some rough ideas why, but what do you think?

Love,
Sarah

Sarah, one of the reasons that diagnoses fall short of the real thing is because there are generalized criteria which describe the condition. If you come with a certain narrative then the diagnostician will diagnose with what this narrative describes. I could narrate a set of "facts" which would lead inevitably to a diagnosis of cancer. This would be followed up with tests which then would show that cancer is not present. The fallacy of a psychological diagnosis is that there are no tests which would rule out the condition that was tentatively diagnosed. For instance your carotype if tested will show that you have xy chromosomes (in most cases at least), which is no help in this instance.

But what is the narrative that really indicates you are transsexual? Much of what is the common narrative has little or nothing to do with the transsexual condition. Because the narrative is perpetuated over the internet, albeit increasingly refined, they jarr the listener.

But what if the observer(s) (note the switch in activity) actually witnesses you as you truly are. And all of the sudden the world actually speaks with you with all of it's wonders and terrors, not because you describe the right things but because they realize the living reality?

The reason why people find a "diagnosis" so important is because it provides a medical justification for the dissociation of the perception of the individual who is being observed. It excuses their oddness.

Kathryn, there is no such diagnosis.

Lea, with all respect to you this was exactly how I was diagnosed, with those words with the add on of meeting DSM 4 criteria for gender identity disorder (still valid in 2011) and lack of Axis 1 and 2 criteria.

To both of you: I find diagnoses important for procedural, that is gatekeeping, reasons. It opens the door for Standards of Care applications. The most detrimental effect of diagnoses however is that most people take them to absolve them from responsibility for their own self. The all so common effects of transition of loneliness, retreat, anger, sensitivity to perceived slights and micro aggressions, have much to do with last point.

I do this because sex is a subset of gender, and sex and gender issues are often interrelated even when they are not intersecting.

Wow Pink, that really is turning the world on it's head. Sex determines what gender you are, given that gender is a complete social construct created to set off the sexes. That is the only interrelation.

[kathtx]

As I am one of only a few here that transitioned fairly early, age 22, I really cannot understand how many of you could wait so long. For me, it was a driving need, a must, I simply had to transition as soon as possible or die. How did you manage to put off the intense feelings for so long? I understand family obligations, career obligations etc... Was it that you just did not realize it at that time?

Good question with no simple answer. At 22 I was in denial, telling myself this was just a crossdressing thing. I'd contemplate transition but then push the thought away. Because I was (and still am) attracted only to women, I'd assumed transition would cut off any relationship possibilities. It took me a while to realize that, duh, I didn't have to stay male to have a female partner. Seems obvious in hindsight, but it was a big worry for me. Otherwise, there were just many other things to deal with at that age: getting through grad school, recovering from the aftereffects of adolescence in a dysfunctional family, episodes of severe depression. Many things on my plate, of which gender dysphoria was only one. Transition didn't become a driving need until my early 30s, when I'd worked through most of the other issues.

[sarahcsc]

People focus on the diagnostic label so much for the same reason they hang on to the idea of having an atypical kariotype. It has a lot to do with legitimacy in the context of repudiation from others and the lack of desire to take responsability for their lives. It's much easier say: "see, the doctors say I have a problem." Ultimately, however, transition is a decision (if transsexuality is not) and people are going to get hurt (most of the time).

Hi Frances,

Your observation is astute but the very same observation raises other important questions.

"How much responsibility should a person assume over their lives?" and "When does it become appropriate for them to relinquish responsibility or have their responsibility taken forcibly by society?"

The idea of responsibility is closely linked to the idea of freedom as the famous saying goes "with freedom comes responsibility". Therefore, if what you said was true, that if a patient's wish to hold on to a diagnosis is because of lack of desire to take responsibility for their lives, you must assume that they are also giving up their freedom to be. This certainly can't be good... or is it?

Coming from the East, I can't help but be astonished at times the amount of freedom people get in the West, yet be baffled by the lack of responsibility they assume. Why is this? There seems to be a lot of advocacy for "freedom" in the West particularly in America (please correct me if I'm wrong) but I wonder if I can say the same for "responsibility". Freedom was not given to me, I had to earn it. And even so, I had to be very careful with it because it can be taken away very easily by my parents or society. The culture of children moving out of their homes when they hit a certain age was certainly foreign to me because it is just not customary for Asians in general to move out unless they have earned their freedom (i.e. good job, stable income, getting married, wanting to build a family) and this could take many years which explains why some middle age Asian males continue to live with their parents. How much responsibility do you think these males have over the course of their lives?

I bring this up because your observation although astute, forgotten to mention the real reason why people are so reluctant to take responsibility for their lives and that is because of fear. Responsibility is the ultimate test reality throws at you. Like a bird who is about to flap its wings for the first time but at the same time daunted by the sheer cliff it was about to plunge off. A person who is refusing to take responsibility, to me, is just a person who is scared. And sometimes they are scared because of their fear of falling, but sometimes also because of how far they think they might fly (and subsequently never return).

Perhaps, just perhaps, I'm saying this with a lot of skepticism on my part as well, that for these people, a diagnosis, serves as a temporary platform in midair, kind of like a floating airstrip where the bird can first try out its wings by leaping instead of flying. The airstrip catches them, and once again gives them the option of attempting flight when they are sure their wings are functional. Its an odd analogy but its the best I can come up with, sorry... There is certainly a danger that they will remain on the airstrip forever and not wanting to attempt flight but what do you do about that? Because if you advocate for "freedom", can you not also advocate for the freedom to give up freedom? Its mind boggling...

I've seen many of my patients who appeared relieved following an initial diagnosis, only to disavow it later because they have transcended the need for that. Then there are those who know the DSM V manual better than I do but totally ignored it because none of the criterias apply to them. Or those who are hellbent on getting diagnosed. So what does a diagnostic label mean to them? The airstrip in midair that is neither helpful nor unhelpful. But to a therapist, their need for a diagnostic label informs me of the kind of person they are. And I am open minded to whoever I'm treating because I understand very well that every individual brings along their fears of taking responsibility and I recognize that my role as a therapist, is to help patients transcend their fear and most importantly, NOT judging them.

That fear is not transcultural as far as I know because in Asian cultures, children are normally very well prepared before they are allowed to take on responsibilities. Moreoever, they have to prove their ability to take on responsibilities before they are given the freedom. Hitting a certain age means little or nothing in my culture. There's no such thing as a "sweet 16" or a big "21st birthday". Freedom and responsibility doesn't come with age, it comes with acquired achievements. No achievements means no freedom. Lol. I invite other Asian forum users (or from other cultures) to critique my statements because I may be highly biased in this. I can only speak from my experience and what I understand about traditional Chinese culture.

And as with the other question I asked "When does it become appropriate for them to relinquish responsibility or have their responsibility taken forcibly by society?", I thought about people who are either so destructive to themselves or to others that freedom is simply something that society cannot afford to give. Depressed people who are acutely suicidal, the psychotic person who lost contact with reality, the psychopathic murderer, or the genocidal dictator. But what about the compulsive cheater who go around breaking hearts with little remorse? Or the narcissistic person at work who puts people down in order to elevate their own status? The backstabbing friend at school? Society as a whole decides when to take a person's responsibility/freedom depending on the severity of their actions.

Remember Alan Turing? Hailed as a hero of WWII for decoding Nazi secret messages, he was also chemically castrated because he was homosexual. That is how far society will go to take away a person's freedom back in the days. I'm glad things are changing albeit too slow for my liking! Lol..

So coming back to the original topic: To me, a person's who rely on a diagnostic label to conduct their lives is probably too afraid to fly, but not too afraid to leap. Some people continue to live productive lives bearing a diagnostic label while some are totally disabled by it either by true or imagined disability. It is not up to me to judge if what they are doing is right or wrong because I sincerely believe that everybody should be allowed the freedom to live lives however they want to as long as they are not causing harm to themselves or others. I also believe that with time and opportunity, they will eventually transcend the need for a diagnosis and learn to live a truly authentic life. I'm still learning in many ways to do that myself and I am humbled by how convinced some people are of their identities.

The reason why people find a "diagnosis" so important is because it provides a medical justification for the dissociation of the perception of the individual who is being observed. It excuses their oddness.

...I find diagnoses important for procedural, that is gatekeeping, reasons. It opens the door for Standards of Care applications. The most detrimental effect of diagnoses however is that most people take them to absolve them from responsibility for their own self. The all so common effects of transition of loneliness, retreat, anger, sensitivity to perceived slights and micro aggressions, have much to do with last point.

I've mentioned my take on the psychological implications of a "diagnosis" but also mentioned earlier in post #79 about the practical implications as well, which you have touched on here as well. In the real world, you can't get help unless you are given a diagnostic label and that must be accepted. Like me, you are also aware of the potential detrimental effect of a diagnostic label but again, that risk is inevitable therefore it is better to learn to accept and manage it rather than trying to avoid it altogether.

As to what you said about it being a "medical justification for the dissociation of the perception of the individual who is being observed. It excuses their oddness.", I think I may have to disagree with that one. Because what is more attention drawing than to have a big diagnostic label attached to you? Odd people, although less accepted, are nonetheless tolerated. However, attach a diagnostic label to them like "Gender Dysphoria" or "schizophrenia" will result in downright abhorrence and rejection. It probably draws more attention to the oddness than anything else! And worse, it opens up the oddness to more negative interpretation. Don't you agree?

Another problem I see sometimes in my practice, is the lack of continuity of care. I imagine a good therapist is one who takes into consideration the practical and psychological implications of a diagnostic label before dishing it out to their patients. Also, a good therapist tries their best to help their patients make well informed decisions, which includes telling them that things aren't necessarily going to get better following the diagnosis or even after transitioning. But most importantly, when it comes to continuity of care, the therapist has a role and responsibility to help their patients manage their mental health prior and after transition as part of the transitioning process. To simply apply a diagnostic label and then leave them is in a way, very irresponsible. But that's just me being idealistic perhaps.

Love,
Sarah

[Frances]

My response was not that philosphical. It was more an obersavation on the "my wife won't let me" comments that I hear all the time on this forum. It's easier to say that than acknowledging fear and guilt. There is no blood test and lots of people will not believe the transitioner, especially relatives and close friends. A diagnosis makes it easier to sell it. Incidently, I went through a very rigourous gatekeeping style of program. I was never given a diagnosis.

[Kaitlyn Michele]

I was never given a diagnosis (what I mean to say is that my path was chosen BY ME..at which point I got a letter that technically would be the diagnosis)

In psychiatry is it "anxiety" or "depression" or both? I realize there are standards that are usually followed, but they are different by country, and there is a lot of leeway in how doctors apply them.. then there is the issue of what to do about it....for depression and anxiety there is a laundry list of medicines and therapies that work for each, and many doctors use their experience to decide how to advise their patients, and will use medicines that are not prescribed for the official diagnosis...

unfortunately my family has a history of dealing with this and after 4 medicines and 3 psychiatrists I found a cocktail of meds that improved my quality of life, and the cocktail included one medicine that is totally off label for my situation but has been shown to help and it hugely improved my quality of life!!!

I think this is applicable to this discussion the idea of a purely medical diagnosis for transsexuality.
I believe transsexuality is a medical condition...but there is no more magic to it than being diagnosed with depression or anxiety disorder...
and its not always easy to diagnose, and then the whole what to do about it part can be very easy or very hard depending on the person.... that's why personal responsibility is so hugely important..

for me to take paxil or Prozac or abilify of Ativan are all things that I can test by just taking a pill... whether I do cognitive, ACT or mindfulness therapy are things that are easy to try on for size and see if I progress.... but its still my responsibility to report back to my doctor how I felt on the paxil... its my responsibility to apply the therapies suggested by my doctors, and the doctor still has to make judgments on the veracity of my statements and decisions about proper dosages....I think its all applicable to what goes on with us...

I never even thought of the idea of a diagnosis....maybe that's because throughout my therapy I kept trying to poke holes in the idea I was transsexual....my own nature is pragmatic and an intuitive decision maker....I do not like being told what to do....I had a good therapist and she "learned me" she never said to me "you are a...." ....she didn't lead me to water, but she kept it close enough for me to find the water and in my own specific case, my therapy simply helped me take responsibility for my own life... my therapist says today, "oh for sure I diagnosed you as transsexual"...but her feeling is never to say that to the patient...its too powerful...its her belief the person has to get there themselves because if they cant, then they are not ready to deal with it...

if you can't take personal responsibility for simply naming what it is that you are , then you are not ready to own it, and you are not ready for the responsibility of dealing with it...especially if its transition..

in the end, that is what this is all about... taking responsibility for your own life... its sooo hard to get there...read the posts... we are all over the map with how we get there!!!

that's a testament to the difficulties of getting well if you have this fricking problem many of us share, and its why I tend to have huge respect for transsexuals that are able to live a great quality of life ..

.

[Marleena]

It was more an obersavation on the "my wife won't let me" comments that I hear all the time on this forum. It's easier to say that than acknowledging fear and guilt. There is no blood test and lots of people will not believe the transitioner, especially relatives and close friends. A diagnosis makes it easier to sell it.

This sounds an awful lot like me. When I first started in this section I used my diagnosis to try and show I belonged here. That diagnosis was reached by my support group leader who I turned to for help. She had all the health care connections that could help me with the GD. I remember her saying "you appear to be transsexual" and that scared me. I remember telling her I didn't want to be transsexual! I wanted a different answer. I was looking for somebody to tell me it wasn't true and that never happened. I began to realize it's the only thing that makes sense for me though. Some of you had absolute clarity while I just couldn't understand what was going on with me. I just knew it was gender issues.

[LeaP]

Kathryn, I know that is how you were diagnosed. My comment was that it was not really a proper diagnosis. The DSM portion of the diagnosis was perfectly appropriate. And it, of course, was important most of all because it provided access to care, not because it defines the condition… Which it does not, as you know. The "type five" add on, however, does not describe the condition at all. It is a loose collection of behavioral, physical, intensity, sexual, and other such things lumped into observational categories. The only condition – actual condition – that you have, especially with the lack of comorbid issues (which are really a separate set of considerations anyway) is that you are transsexed. Intensity itself is not a condition so much as it is a treatment consideration. As with many other medical conditions, many manifest over a range of intensity. Same condition and sometimes requiring treatment, sometimes not.

The most important part of the Benjamin scale is the groups. One is transvestites, two is nonsurgical transsexuals, three is true transsexuals. If you bring the terminology up-to-date, it basically boils down to cross-dressers and fetishists (Benjamin conflates these), gender variant, and transsexual. I.e. the same things we are still talking about today, and which Benjamin separates along treatment lines, supporting a point you often make.

[Beth-Lock]

For the first ten years of my life, nobody in my neck of the woods knew that you could change sex. Christine Jorgenson offered us rumours about sex change, though it was thought a joke, and only when I was already ten years old. Psychologistsin those days were consumed with the idea that the individual should adjust to their situation, and understand what their situation was, as society defined it, and the job of the psychologist was to help the patient adjust. The psychologist treated maladjustment. Cross-dressing was bad, because so their script went, it broke up marriages, so the job of the psychologist was to get the patient to stop it, and save their marriage.

It was difficult to avoid repression, when there was no name or concept in the conscious world to give on a handle to grasp the reality of the transsexuals' being. I think the younger members do not understand why so many late transitions are only taking place now, and these few remarks might lead them back to some historical research in that line. Many think the flow of late transitioners will decloine, as people are starting to be able to transition earlier, and have ready models to understand whether they are trans or not, to the point of commencing analytical and diagnostivc therapy before say, retirement/senior years. When I was young, it was thought that there was no reason to rebel, because society was not flawed in its social psychology. Even political rebellion might sometimes be traced back to a deprived childhood, as in "Come Over Red Rover," a case of Lindner. Therefore, there was the "Rebel Without a Cause," accoirding to that 1940's prison psychiatist,( Robert Lindner). (He worked his way past that point in his thinking, just before he died of cancer.)

[Rianna Humble]

This thread is so far from its origins, I'm not sure if you could get back even with a Sat Nav. Time to close it.

If you want to continue discussing the philosophy of diagnosis in relation to TS folk, please start a thread about that. Equally if someone wants to discuss the doctrine of personal responsibility, they can start another separate thread about that insofar as it relates to transsexuality.