The Brave New World in Which Gender Reassignment is No Longer Medicalized

[Beth-Lock]

Today, we have moved towards a Brave New World in which the treatment of our fellow human beings with mercy, is being replaced by the idea that everyone must be left more and more to the perilous salavation of their own actions and their own private financial resources. Governments love this, since they are able to shed responsiblity for providing charity, (an old word for love), and dodge social responsibility for such things as taking care of people with psychiatric illnesses, and any other problem which can be off-loaded.

The result in the form of de-institutionalization of psychiatric cases, has been disasterous. Suicide is no longer seen as something of high priority to prevent, but a personal choice, one that is too hard to prevent anyway, so just not worth trying very hard to prevent.
The consequences for this movement, starting to be advanced in the increasingly right wing European venue, for transsexuals, is likely to be off-loading gender transition surgery and care of transitioning patients, to professionals receiving a fee from the client, and reducing their liability to government medicare systems. Governments never did get on board with the mental patient liberation movement, but adopted some of their radical program, in order to cut spending on psychiatric care. Now the seriously mentally ill are filling prisons and roaming the streets in aimless poverty, instead of being taken care of in hospitals.

Look for the countries with something like socialized medicine to now delist breast surgery for transsexuals, as it is in less socialized countries in North America, ($7,000), delist a lot of gender transition counselling, so TS people will be forced to pay, $100-300 an hour for it, and ultimately, to pay for their own gender correction/reassignment surgery, ($20,000-30,000).

Yes, governments love to transform a health issue into a private choice matter, which is of course a private expense. They can then point to how everyone has freedom, though the fact that only a well-off minority can afford to embrace this freedom by using their own money to go through gender transistion, is ignored.

God save us from the libertarians.

[Kaitlyn Michele]

Your post highlights a moral quandary, and isolates "libertarians" as people we need to be saved from.. But it offers no ideas around solving for the problem..

There are real issues that get in the way of our little problem. Saying our 7000$ for breast surgery should bepaid for by someone highlights the problem. No way do I want to work all day and then give half my hard earned money for your breast augmentation. Economists can argue whether capitalism or socialism is a better system...but certainly we could agree that a system where the overall quality of life is better in general , thats a better system...my opinion, is the us has it right...it's certainly unfair in many ways..but freedom is better than no freedom...we fight here, but our problems are solved by votes.

We all have a responsibility to help those in need, and many people would ignore that responsibility. The deep divides in our world between systems is in the news everyday. I don't have the answers....but I am inclined to say the answer is not more wasteful and corrupt government.

It's ironic Beth.. I had $7000 a month ago, and I am trying to open a small store...my township sent me a letter that informed me they needed to do a "study" because my permits were not complete as they related to the Disability act and my employee bathroom.. Which btw, has a big sliding door and a rail..the cost to me$2500!!! The study came back, and the township forced me to spend $2000 t fix something that to my eye looks like nothing..and they forced me to use union labor...I think my dad could've done what they did in two hours... All in...A delay in opening my store, which cost me about two grand of wasted marketing, plus the build and study.. About $7000...
This was a nightmare.
Oh well...



So forgive me but pls save me from the government.

[HenryHall]

Interesting.

I haven't seen reports that gender reassignment is moving towards being de-medicalised, and I would like to see them. Have you any URLs you can share?

I do see movements towards de-psychopatholigsation and towards de-pathologisation of re-assignment, but of course those are quite different from de-medicalisation.

At a practical level, some people would like to see transsexual medicine on a similar basis to other (arguably other?) non-pathology (no disorder is present) medical services. For example pregnancy, vaccinations, family planning contraception, in-vitro fertilization etc. That of course is not gender reassignment as such, still less de-medicalisation, and in my view is very unlikely to happen. Simply because it is not politically popular.

Others would like to see complete de-psychopathologisation and de-pathologisation of gender medicine (not merely transsexual medicine) in general. The STP-2012 campaign takes this position, that everyone should be allowed treatment in any gender. This moves away from any so-called gender binary construct and so cannot be considered to be gender reassignment either. It does indeed, in large measure, deconstruct most rationales for government and insurance funded medicine in this context. Again I don't think it is at all likely, but it is less unlikely than the scenario in the previous paragraph.

Then we have the European human rights movement. Again this is not de-medicalisation of gender reassignment, but rather de-pathologisation (probably through an ICD Z9* non-pathologising classification). What this means in practice is that gender reassignment is medicalised but not pathologised and as a first step in the process. It is important to realize that this form of gender reassignment is nothing more than changing a patient's paperwork (modernly computer-record change) . And because it is only a matter of record-keeping and nothing else, the cost is quite low.
Thus to illustrate by an example, as a patient your medical records used to say M and as a direct and immediate consequence of being classified (for example) Z91.92 they newly say F (or vice-versa). No pharmaceuticals, surgery or psychiatry are involved it is only a change on paper.
This is not to say that such people don't have medical disorders but rather that such disorders are NOT dealt with on a basis of gender reassignment. For example, it implies that a transwoman seeking breast augmentation would get it, or not get it, on the same basis as an equally situated (flat-chested) non-trans woman who also wants breast augmentation. Not treated any better nor any worse. If psychiatric clearance is imposed on non-trans women seeking BA then it would be imposed in exactly the same way on transwomen, no more and no less. Same with vaginoplasty for a woman (trans or non-trans) who was born without a vagina. Same with estrogen - an estrogen-deficient transwoman is treated the same as non-trans woman who has no ovaries. Same with psychotherapy, a transperson or a non-trans person might be depressed, bullied, traumatised, anxious, discrimiated against, in need of pastoral care or whatever but equally for trans and non-trans. That is the EU HR resolution (among other things), but again it is not de-medicalization.

Is gender reassignment being de-medicalized in America perhaps? Are some insurances dropping "transsexual" coverage, even as some are reportedly adding it (as part of their mental illness coverages)?

Those are the prospective changes I see in the pipeline, but none of them are exactly de-medicalisation of gender reassignment. De-medicalisation of gender reassignment does sound interesting though and some people would definitely support it!

[Melody Moore]

I am not even going to bother explaining to this brilliant mind with all the answers NOT! how the new
WPATH Standards of Care is a very valuable instrument that is forcing governments to make policy changes,
just like the new laws that have been signed in California. Many people knew these changes were coming in
the SoC and for the most part have been a breath of fresh air not only for transgender and gender
non-conforming people, but for the transsexuals that often have the biggest hurdles to overcome.

So OK Einstein, let's hear your better solutions for improving transgender health and giving people back their legal rights?

[Starling]

Since this thread is already overtly political, I'd just like to say that there are lot of medical procedures that cost 50-100 times as much as HRT, SRS, FFS and a Ford F-150, put together. Nobody who isn't rich could possibly afford to get a heart or kidney transplant, for instance, unless the "risk" (a lovely term implying that one might get sick before he/she finally dies) were spread around a large pool of insured. I happen to favor the national model of health coverage used in every other modern industrialized country except the US, because by expanding the risk pool to include everyone, it makes the individual freer to take chances--such as starting a business and employing people--which can redound to the benefit of society as a whole. But no matter what the system, we are all paying for someone else's medical care, as they are for ours, regardless of who does the actual insuring.

Kaitlyn, I'm sorry you got socked for all that money. Times are tough, and governments are resorting to unfair measures to raise funds. Here's a schedule of California traffic fines.

:sad: Lallie

http://www.southshoresha.org/Portals/14/California%20Traffic%20&%20LA%20City%20Parking%20Violation%20Fines.pdf

PS: I just received notice that my health plan is once more raising eligibility requirements, deductibles and maximum out-of-pocket limits. As the economy continues to go down, I fully expect to lose my insurance. This is something that simply does not happen in countries with universal health care.

[Frances]

Look for the countries with something like socialized medicine to now delist breast surgery for transsexuals, as it is in less socialized countries in North America, ($7,000), delist a lot of gender transition counselling, so TS people will be forced to pay, $100-300 an hour for it, and ultimately, to pay for their own gender correction/reassignment surgery, ($20,000-30,000).

I live in a county with socialized medecine and breast augmentations are not paid for by the government. Also, SRS was only paid for until a year ago if one went to a governemet-run program forcing the patients/clients to see a psychologist weekly for years at a cost of $300 a month. My own therapy cost me $15,000. Hair removal cost me over $20,000. SRS was paid for in the end, but I am in bankruptcy for the other $35,000. Nothing's perfect, and I have no more money for a BA.

[Beth-Lock]

HenryHall references: http://www.pinknews.co.uk/2011/09/29...-mentally-ill/

In one of the first reader comments in that, someone points out that depsychiatrising transition could result in some services to the TS being considered "elective," and so, not be paid in whole or in part, by the medicare systems in Europe. Of course the worry is that enough may be left unpaid to make the process unaffordable as a general rule, to all but the well secured.

So, I am not the only one to realize the possibility of a connection. But I do admit my knowledge of European medicare systems is fragmentary at best, so better to take it from someone like that reader, who knows better.

Frances points out that in her province, Quebec, (health care is in large part a provincial matter regarding regulation, in Canada), medicare does not necessarily cover the whole thing, unlike apparently the case in many European countries. In fact in her experience what is left out is apparently punishingly expensive.

In Ontario, the medicare program introduced originally by the Progressive Conservatives in the 1960's, (not the socialists), as it stands today, breast enhancement, hair removal and the counselling services of a psychologist or social worker in private practice, are not covered, in the case of the first two because they are judged cosmetic, and so not affecting the health of the patient or at least not directly enough. Medication is also not covered, unless you are on welfare or are a senior citizen, (65 or over), and even then, not 100% in all cases. The Ontario system is best described as a public/private partnership rather than socialized medicine, I have begun to believe, though it is a system of universal medicare funded by the government.

This sort of partial coverage (in Canada), seems to be the direction in which the European countries with generous medicare now, (compared to Canada), may possibly move if TS problems are depsychiatrized. In the more general case, of TS issues being demedicalized, (not needed to preserve the life or health of the patient), it is even more certain. Unfortunately, the two would seem to go together, pehaps not being as separable in actual practice as HenryHall thinks. It is a political matter and politics is a crude art loaded as it is with emotion, compared to the thinking of intellectuals who can make very fine distinctions and keep to them.

[HenryHall]

... In one of the first reader comments in that, someone points out that depsychiatrising transition could result in some services to the TS being considered "elective," and so, not be paid in whole or in part, by the medicare systems in Europe. ...
Most obviously, psychiatry is paid for today and that will be lost for sure. A good-sized cost savings for the health system since psychiatrists have high salaries.

But psychiatry will not become elective. Rather, for transfolk, it will become unavailable within an NHS (paid or unpaid). And the psychiatrists will presumably be redeployed to help non-trans people who really need psychiatry (and there are lots of those, schizophrenia etc.).

[Frances]

Most obviously, psychiatry is paid for today and that will be lost for sure. A good-sized cost savings for the health system since psychiatrists have high salaries.

But psychiatry will not become elective. Rather, for transfolk, it will become unavailable within an NHS (paid or unpaid). And the psychiatrists will presumably be redeployed to help non-trans people who really need psychiatry (and there are lots of those, schizophrenia etc.).

In Quebec, Canada, the two letters can now come from psychologists, and following the SoC to the letter is not mandatory. While I went through a strict program with years of therapy at my own expense, people transitioning now opt for a therapists with a more modern approach. They require only 6 months or so of therapy, and no more than one session per month, before writing approval letter. No psychiatrist is needed, and SRS is still paid. I transitioned before this and had to pay a lot of money for the therapy. Then again, I needed a lot of therapy!

I have been reading a lot of complaints on the forum lately about the SoC and the transition process from different people (new and old members), and while I understand the idea of fighting for a more just and more respectful system, don't y'all want to transition? If it means playing their game, and towing the line, so what? Nobody in the medical system owes it to you to change your body. You have to convince them that it is absolutely needed.

[Beth-Lock]

Most obviously, psychiatry is paid for today and that will be lost for sure. A good-sized cost savings for the health system since psychiatrists have high salaries.

Actually TS is rare enough, some say 1 in a thousand max, that the savings would not be very high. Schizophrenia and the polar disorders, taken together, represent something like 3 to 5% of the population. Treatment of such sufferers tends to be a lifelong thing too, while TS treatment is usually short-lived, unless it coincides with another psychiatric condition.

In the case of Ontario, gender correction surgery was delisted for a while due to ideological reasons during the regime of a neocon/libertarian government and that measure had a lot of appeal for rabble-rousing demogogues, apparently. Otherwise it made little sense, especially economically.

[Starling]

Maybe folks are more broad-minded in Transylvania.

:heehee: Lallie

[Traci Elizabeth]

Maybe folks are more broad-minded in Transylvania.

:heehee: Lallie

Let me "Count" the ways we are different...well that is after I have my morning cup of "&$#*)_%" well you get the idea.

[SabrinaEmily]

Meanwhile, I look around and, while I don't know about, say, Europe, the USA is spending more on social programs than ever, and every level of government is continuing the trend of regulating every aspect of human action. A judge in Wisconsin ruled that farmers don't have the right to drink milk from their own cows, for instance. Favored businesses can always count on an infusion of taxpayer money while others are raided and destroyed on trumped-up charges. This isn't a free market, and hasn't been anywhere close in a long time. Libertarianism is not an ideology of consequence in American state or federal governments. Regardless of words, actions prove this.


Actually TS is rare enough, some say 1 in a thousand max, that the savings would not be very high. Schizophrenia and the polar disorders, taken together, represent something like 3 to 5% of the population. Treatment of such sufferers tends to be a lifelong thing too, while TS treatment is usually short-lived, unless it coincides with another psychiatric condition.

In the case of Ontario, gender correction surgery was delisted for a while due to ideological reasons during the regime of a neocon/libertarian government and that measure had a lot of appeal for rabble-rousing demogogues, apparently. Otherwise it made little sense, especially economically.

One in a thousand, minimum, would be more correct. Lynn Conway, apparently unlike generations of psychiatrists, looked at the data about ten years ago and found that 1 in 2500 Americans born male had already undergone SRS, twelve times higher than the figure of one in thirty thousand that everyone had been repeating from each other while calling it "citing the published literature". From that she estimated (due to people who were on their way to transition, which had been and is on the increase, and people who were unable to transition for whatever reason) that the actual prevalence would be roughly 1 in 500 -- that's for transsexual women only, not including other sorts of transpeople. (And the lower bound -- the number who had already completed transition -- would undoubtedly be higher if this analysis were redone today.)

But yes, given that treatment is not lifelong and that the prevalence is still reasonably low, there are not going to be any great savings from cutting care for transpeople. It's just a convenient target for some.