Who has been tested and/or diagnosed?

[LeaP]

Tested or diagnosed "officially", that is, not self-administering a test.

This could be any kind of gender-related testing or diagnosis: genetic, karyotype, hormonal assay, etc. the second question is whether or not you've been diagnosed as dysphoric, TG, TS, with GID, etc.

Lea

[Rianna Humble]

I'm not sure that there is any kind of standard test, but from the fact that a mental health professional recommended that I receive treatment for Gender Dysphoria and that two professionals in the Gender Identity Clinic agreed, I guess you could say that I have been diagnosed. To the best of my knowledge, the clinic does not make a diagnosis of "TS", but they do accept a patient's self-identification as trans.

Personally, I have an intense dislike of the term Gender Identity Disorder because to me it suggest that the person thus diagnosed is suffering from a mental illness.

[LeaP]

I agree with the comment on mental disorders and, unfortunately, that's exactly what a GID code falls under in the diagnosis code structure.

Lea

[Shananigans]

Genetic tests, karyotypes, and hormonal assays cannot diagnose you as a TS. People with genetic disorders (such as Klinefelter's syndrome) have physical and sometimes mental related issues due to an actual genetic disorder. Transsexualism is not known to be a genetic disorder in that most MTF TS have healthy XY chromosomal makeup. In fact, scientists aren't really sure WHAT causes it...it could be anti-testosterone antibody exposure in utero...it could be a lot of things. No one is quite sure just yet.

Furthermore, hormonal assays are not reliable because it has been shown that some MTF TS may actually have excess testosterone in their system. On one TS's website where she gives advice to people who are uncertain if transitioning is right for them, she states that when she had her blood work done before HRT her testosterone levels were way above normal. However, she still had gender disphoria.

Lastly, don't get caught up on "mental disorder." It IS a mental problem in that being transsexual affects your mental well-being. A lot of things affect your mental well-being. I wish society would get rid of this stigma.

[sandra-leigh]

The gender therapist I go to is the only person in my province who is considered qualified to certify GID for SRS. (That is something I only found out a couple of months ago.)

When I told her that I wanted to seriously investigate HRT, to see whether it was even a possibility for my personal biology, and to find out from a professional what the health risks were, her reaction was more or less, "Yay!" As in she considered it past time that I moved on from vague apprehension of what HRT was about and moved on to doing something rather than sitting on the fence.

We had not even talked about HRT a great deal before that: it was not at all like I would spend the sessions dithering about "Should I or shouldn't I?" The strongest I had expressed before that was along the lines of "It doesn't seem like something I would be interested in thinking much about at this time, but I have this nagging feeling that some-day I am going to give in to the temptation to try it and see what it is like."

Was this a "diagnosis"? Well no official syndrome name was written down (at least not in anything I ever saw). But when the best qualified person in pretty much a 1000 mile radius thinks you are overdue for starting HRT, then I'd say that's pretty fair implicit evidence that you are considered to have notable gender dysphoria.

I have never asked my gender therapist whether she thinks I am transsexual. I'm not sure she would answer even if I were to directly ask. She is not keen on labels, only on helping each person find a way of life that is good for them, whatever mix of gender behaviors that might be.

[sometimes_miss]

Lets face it, whether or not we've been 'officially' diagnosed by anyone as having gender identity disorder/dysphoria, everyone here, simply by definition of what we do, has it. Otherwise we wouldn't care what we wear.

[Intertwined]

I have been diagnosed with XXY, I have not been diagnosed as dysphoric, TG, TS or GID.

I know my internal gender identity to be essentially androgynous, both male and female at the same time, may be a bit more on the masculine side.

"Gender Identity" itself, is not a disorder, it only becomes a disorder when a persons "Gender Identity" causes that person a persistent discomfort about one’s sense of inappropriateness in the gender role that society expects of them.

[Rianna Humble]

Lastly, don't get caught up on "mental disorder." It IS a mental problem in that being transsexual affects your mental well-being. A lot of things affect your mental well-being. I wish society would get rid of this stigma.

Hi Shananigans, I love the way you bring so much common sense to your arguments and ally this with your scientific understanding, but I'm afraid I have to differ slightly from you here. I agree with you that being transsexual affects your mental well-being when nothing is being done, but so do many other things which are not mental illnesses.

I have no qualms about the fact that the clinicians who are overseeing my treatment are mental health specialists, but I see their role as ensuring that I get the right treatment to prevent me from developing a mental disease or defect rather than in treating one that already exists.

Whilst I am an active campaigner against the stigmatisation of people with mental illness, I do not wish to have this stigma wrongly attached to me. What I have is a condition that can affect my well-being, not something that is caused by a lack of mental well-being.

[Josie Rose]

In order to get funding from the UK National Health Service (NHS) and be placed on to their gender transition pathway, I had to go through a number of steps of analysis, diagnosis and tests.

1. Ask GP if I could be considered for a gender transition. He wrote to our local Primary Care Trust (PCT, the local NHS funding body) for instructions because he had never experienced such a request! They informed him and I moved to next step.

2. A local (non-gender specialist) psychiatrist interviewed me to ascertain I was mentally balanced. He referred me to a the West London Mental Health Authority Gender Clinic with Charing Cross hospital (CHX).

3. At CHX, I was interviewed by the clinical lead gender specialist psychiatrist who sent me for hormonal blood tests referred me on to an endocrinologist and a second gender specialist psychiatrist. NB: Two gender specialist psychiatrist diagnoses are required to enter NHS gender transition pathway.

4. I met with endocrinologist at CHX who sent me back for further blood pressure tests and a testicular scan to clear me of a problem perhaps indicated by one blood test result. These proved OK and the endocrinologist responded that I was OK to proceed given that next step was OK.

5. Met with second gender specialist psychiatrist at CHX who agreed that I could proceed. He wrote to my GP that I was to be prescribed oestrogen HRT. :) Oh happy day!

6. At regular intervals of 4 months, I see the lead gender specialist psychiatrist at CHX and a gender specialist nurse practitioner, who is at the CHX and communicates with their endocrinologist. They both communicate with my GP and so I advance in my hormone therapy with is now the daily application of 3 1mg Estradiol gel sachets (HRT) and a 12 weekly injection of Decapeptyl (a testosterone inhibitor).

7. When my 8 weekly blood tests indicate my oestrogen and testosterone levels reach the required female levels I will be referred to a gender specialist surgeon at CHX or even elect to go private.

Throughout all this I am in regular contact with:
1. local psychotherapist - she is lovely and gives me a foot in reality
2. my GP
3. local psychiatrist
4. gender specialist psychiatrist at CHX
5. gender specialist nurse practitioner at CHX
6. endocrinologist at CHX.
7. anybody else who needs to be consulted about my Crohn's disease, diabetes, blood pressure, prostate problems (I had a scare where most my carers above focussed until they were sure it was OK).

At no time was it even hinted I might have a mental disorder. The term "gender dysphoria" was never used either. I questioned this and I was told by the lead gender specialist psyschiatrist at CHX it was not a condition, merely a symptom and that I was the only one who could say I was gender dysphoric - "a bit like a runny nose", he said lol

Of course, there were hiccups on the way, mainly with funding at the PCT, but I am on my way and I am confident that I am being cared for professionally and holistically. I feel really fortunate to have such a team working on my side...

[noeleena]

Hi.

Well i spos if i escaped from the assylum i must be okay , oh did you mean mentaly insane, well yes i am just i knew who i was,

no i did not have tests i just told our Dr's i am a female / woman & im going to live as one i was never asked any ? 's just was given what i needed & basicly told get on with your life,

I paid for my surgerys & what i needed, no hoop jumping , over the years i have had a number of surgerys so no probs there, im not T s / T G or dysphorc as to karotype thats only a miner detail & theres a whole raft of combos,

being I S helped tho *& it was a lot different for me so really its been great,

...noeleena...

[Leanne2]

After three months of gender therapy I was diagnosed to be a male to female transsexual with sexual attraction to women. Leanne

[LeaP]

I had a few thoughts in mind in asking the question. It was initially triggered by the realization that I lack a comprehensive view of available physical tests and test process as it related to gender-related diagnoses. (The psychological side I understand.)

The next thought was to ask. Here I assumed that a fair number of members might have had some testing performed if for no other reason that there is such intense interest in discussing biological causes for TG identity. Even with those who are closeted, surely might be some who were assessed as children?

Next was applicability to me - what might be worthwhile, enlightening, or interesting. Alternatively, what testing results in ambiguity, is expensive, perhaps even controversial.

Last, I thought it might bring to light emerging testing and research areas.

What's surprised me so far - with limited responses, of course - is the seeming lack of rigor employed by health care providers suggested by some of the responses (Josie's being a major exception). On the positive side, not being diagnosed with GID is probably a good thing for most people, as it does fall under the category of mental disorders. One caution here, however: It is perfectly possible for a provider to code for GID for billing purposes without actually delivering that diagnosis to a patient. There are a variety of reasons for this, but the point is that in this case one should ask - and check - on the codes ultimately used by the provider. (My wife was a practice administrator for a surgical practice at one point, and had oversight of coding, billing, and insurance reimbursement). This is the sort of thing that can show up on background checks.

Lea

[lynnmcarthur]

The key here is about how one feels and what she wants and hopes would happen. I have been classified as TS by the major gender program in my area at the University of Michigan. It is clear that I could move toward RLT and hormones with surgery at the end. For a variety of reasons well thought out, I have decided to walk the tightrope of the dual life. I am grandpa, dad and the guy in the next office who very clearly belongs in the TS group.

[Kaitlyn Michele]

Lea,....outside of intersexed people, there is no physical test...i think that is the whole point.

I guess its possible they will find some genetic or biological marker someday...but today, diagnosing what's going on in somebody's mind, diagnosing issues related to identity and a person sense of themselves is inherently risky, difficult, and almost impossible to look at in a quantitative way..its so subjective that a person can go to one person and get "diagnosed" differently...its just the way it is now..
plus as you point out, different therapists and docs use different codes for insurance and other reasons..

frankly i do not believe in the "diagnosis" of ts or other gender issues... you know in your heart and mind...sometimes people can help you get there...they can show you ways of thinking that are hurting you, teach you to think objectively,
and help you overcome shame and guilt...etc..

but to "diagnose"? no thanks... what help is there in the diagnosis if you are not going to transition...it seems to me its just something that will make you more miserable..

you will either benefit from transition or not... a good therapist can help you figure this out...to me that should be the end of the story....

[LeaP]

Lea,....outside of intersexed people, there is no physical test...i think that is the whole point.

.

Oh, I fully understand that point, and I can see where mixing the topics of testing and diagnoses leads to some thread confusion. The testing question goes more to what lengths people have gone in a quest for self-understanding. They will talk about digit ratios, for example. Anyone had X-rays for exact measurements? Certain brain structures ... Anyone perhaps participated in a study and had a scan done? Genetic testing of any type? Anyone intersexed and how was it determined (one yes on that one - XXY). Sperm count & motility? Hormone assay? Hormone sensitivity? Anyone with symptom clusters typical of some gender issues (e.g. Depression) and was there a correlation made by a provider? And so on ...

It's not that any or all of this must be done. It doesn't for a psych evaluation. But who has pursued any of it in this group of intensely interested people? Hopefully this explains the topic better.

Lea

[Sally24]

I went to one of the well known gender therapists in Massachusetts. After meeting several times she explained that she thought I was TG but didn't seem to have any body disphoria. As I seemed comfortable with my male life she didn't think I was TS and recommended that I probably should not consider any serious body modifications. Hair removal and skin treatments seemed likely to be able to be incorporated into my life without upsetting the balance. She mostly confirmed what I thought myself but she also was able to guide me in what things I could do to make both sides of me happy.

I don't have any problem with the syndrome and disorder labels. If you are seeing some sort of professional you have a "problem". I don't care if they classify it as a disease, a complex, a syndrome, or whatever let's them sleep at night. It's all semantics. Also, if it isn't a medical problem, food luck getting any insurance to pay for it. You can't have it both ways.

[Shananigans]

Hi Shananigans, I love the way you bring so much common sense to your arguments and ally this with your scientific understanding, but I'm afraid I have to differ slightly from you here. I agree with you that being transsexual affects your mental well-being when nothing is being done, but so do many other things which are not mental illnesses.

I have no qualms about the fact that the clinicians who are overseeing my treatment are mental health specialists, but I see their role as ensuring that I get the right treatment to prevent me from developing a mental disease or defect rather than in treating one that already exists.

Whilst I am an active campaigner against the stigmatisation of people with mental illness, I do not wish to have this stigma wrongly attached to me. What I have is a condition that can affect my well-being, not something that is caused by a lack of mental well-being.

I should probably explain what I mean in greater that 2 sentences because this is pretty important as far as where transsexuals are going to stand with health care professionals and drug companies.

I've always learned that mental health is "A state of complete physical, mental and social well-being, and not merely the absence of disease." Therefore, gender dysphoria would be affecting your mental health and could lead to a disorder. It would be disordered if it affecting how you can perform your normal day-to-day functions. Luckily, it has psychiatric diagnostic measures and different effective methods of treatment. It actually can be cured.

If I was performing a mental health assessment on you, and I suspected gender dysphoria...I would document this as an "abnormal finding." Doesn't really mean you are abnormal, but what it means is that something is going on that could affect your mental health and therefore your physical health. (The two are related). After a mental health assessment with an abnormal finding from a healthcare professional, you would then get recommendations to a psychiatric nurse practitioner, a psychiatrist, or a psychologist (depends on your insurance coverage as to who you will go to).

This would be the same if I suspected that anxiety or depression was affecting your day-to-day functioning. There's nothing wrong with having something going on with your mental health, but getting it left untreated can be devastating. You could say that transsexualism is BOTH a mental and physical disorder. And, as we know, depression and suicide is high in the transsexual population so finding gender dysphoria, documenting it, and getting the person into treatment is my highest priority.

Your mental health can be disordered without having an actual "disease." Just as depression is extremely common, it's still a disorder and needs treatment and therapy.

To say that transsexualism is not a disorder is counterintuitive to transsexuals getting health coverage for SRS and hormones. When society starts seeing it as disorder that needs treatment, there can be better therapy with better coverage. But, the more people see it as a choice, the less likely it's going to be accepted as "non-elective procedures."

There's currently a big debate on GID and it being labeled a disorder. I know people don't like the labeling. But, it's really hard for people to get funding for the treatment that they need, and labels that YOU NEED TREATMENT may be necessary...

[Kaitlyn Michele]

i actually believe i misspoke and there may be a brain study out there that looks at transsexual brains..

i think one issue was that the scans were done after HRT, which could've impacted the result...

one practical issue is that there are so few of us....another issue is that if you need a physical test, then you are probably a long way from doing anything about the issue..

i go back to the idea of transition as something that will benefit a transsexual.. a woman that was born and raised as a man...
...if you transition well, your quality of life will improve...if you transition poorly, you may suffer life issues, but you will still benefit from gender confirmation... its that simple...

all the dsm, soc, GID , labels...etcetc are part of means to an end..they are imperfect at best..

only the person knows...if you don't know yet, that doesnt mean you are not transsexual, but it does mean that you unlikely to benefit from transition at that point and you should evaluate other options to improve your quality of life

i don't see physical tests as anything more than an imperfect tool..

[Amanda22]

I've been diagnosed as a "trans-woman" by one of the leading gender psychologists in the U.S.

[StephanieH]

I've had two different doctors tell me I had VERY low testosterone levels while doing testing for other stuff and they wanted to give me shots for it, but I politely declined.

I've been wanting to get tested for being XXY simply out of morbid curiousity but haven't done it yet. Wouldn't be surprised if I was tho, because I sure do seem to have most of the signs/symptoms of being wired up that way.

Take care! :)

[Shananigans]

I've had two different doctors tell me I had VERY low testosterone levels while doing testing for other stuff and they wanted to give me shots for it, but I politely declined.

I've been wanting to get tested for being XXY simply out of morbid curiousity but haven't done it yet. Wouldn't be surprised if I was tho, because I sure do seem to have most of the signs/symptoms of being wired up that way.

Take care! :)

Klinefelter's syndrome doesn't mean you are "wired up" like a woman...at all...No. There is no scientific causal relationship between transsexualism and Klinefelter's syndrome.

Klinefelter's syndrome can cause problems physically, socially, and with language development. Kids with Klinefelter's syndrome are sometimes "late talkers" and may not know the appropriate words and expressions to describe their feelings. They usually have difficulties with learning to read an write in comparison to their peers. They're usually pretty quiet because of this.

Klinefelter's isn't making a man a woman. Girls develop language skills usually at faster rates than boys. Girls usually read and write better than any other skills and are great with expressive language. This isn't seen with Klinefelter's even though there is an extra X chromosome. The fear with having a child with this condition is that he develops socially with his peers without struggling through milestones. In the past, XXY babies were aborted (I think the stat was like 58% of the time) because of the fear of retardation. We know now that the severity of social and cognitive development will depend on the child. The child might have severe impairments, or he may have none. He may have severe physical malformations, or he may have only slight physical malformations.

Physically, Klinefelter's syndrome means you will have a small penis, small testicles, gynecomastia, and infertility.

I just want to make this absolutely clear to everyone because it's REALLY not fair to transsexuals that aren't XXY and it's not fair to people with Klinefelter's syndrome who just want to lead a normal male life.

It's a pretty common genetic disorder, so I know there are TG people that have Klinefelter's syndrome. But, let me reiterate ONE MORE TIME that there is no causal relationship between the two.

If you do not believe me, go to your local genetic testing clinic or lab and see how many males are beating themselves up over it/getting breast reductions/getting testosterone therapy/trying to find a way to have children.

If you want affirmation that you are transsexual (or not), go to a psychiatrist that has expertise in TG therapy. Getting approval for hormones or SRS does not come with a hormonal assay test or karyotype testing for a reason...because these are not the ways to test for being a TS.

[Kaitlyn Michele]

I like the idea of confirmation much more than i like the idea of diagnosis...

maybe its just splitting hairs, i'm thinking about how many people go to therapists and let them run everything...
if you have a decent sense of where you are going, or just need a little push, a diagnosis/confirmation probably helps alot..

shananagins,...i remember seeing 20/20 and chloe prince did a special and they showed it like she got a bee sting, found out about her kleinfelters and therefore she is transsexual!!! ugh...what a disservice to both transsexuals and people with KS

[LeaP]

Most people with XXY do not have Klinefelter Syndrome.

I'm more curious than anything else. It irks me a bit that there are no markers for DES - I would like to know if I was exposed. Hormonal levels would be interesting. I don't exhibit any of the traits associated with KS, so a finding of XXY wouldn't seem terribly useful.

Oh well. I may see a therapist at some point, as I associate several issues strongly with TG suppression. Trained perspective would be helpful, and I could benefit from more active assistance on a couple of them.

Lea

[Aprilrain]

Yes i have been diagnosed with GID by a psychiatrist. My therapist would only use that diagnosis for insurance reasons.

[Dawn cd]

I love Shananigans. I look up to her as The Authority on almost every subject.

[Shananigans]

Most people with XXY do not have Klinefelter Syndrome.

I'm more curious than anything else. It irks me a bit that there are no markers for DES - I would like to know if I was exposed. Hormonal levels would be interesting. I don't exhibit any of the traits associated with KS, so a finding of XXY wouldn't seem terribly useful.

Oh well. I may see a therapist at some point, as I associate several issues strongly with TG suppression. Trained perspective would be helpful, and I could benefit from more active assistance on a couple of them.

Lea

Klinefelter's Syndrome is having an extra X chromosome. A normal male chromosomal set is XY, so an extra X chromosome would be XXY. It was named after the scientist that discovered it, but for some reason people don't like to say Klinefelter's Syndrome anymore...so, they say XXY.

All of my genetics professors have been really old men, so they said "Klinefelter's Syndrome."

There's probably more to the shift in name that that...but...

I think a therapist trained in gender issues could help you with transsexuality issues way better than genetics counselor. Everyone is searching for things on a genetic basis these days and I really respect that. We are trying to find everything from the gay gene to the God gene. I suspect that we will find a transsexual gene. However, the expression of that gene may or may not be "turned on." So, we get into some ethics questions about what this means.

I think if you are TS, you probably know it on some very deep level. Would a black and white test be what gets you on the wagon of SRS and hormones? Do you need a piece of paper to say, "Yes, it's confirmed!"

Idk...I know sexuality and gender are not the same, but I have an example. Sexuality is pretty important (lol) and I grew up most of my life knowing I was bi. I might not have really admitted it to myself for a while, but believe me I knew.

Do I need someone to do a genetics test on me to say, "Yep, you have the bi gene right there." That would be cool, but I kind of already knew the result...so...just kind of wasted a ton of money that I could have spent on shoes. Would a therapist trained in sexuality be able to peg me as bi? In a heartbeat. And, before seeing the therapist, I would already KNOW the result. However, a therapist can give me advice on what all of it means and how it affects me as an individual. A piece of paper that says, "Yep, you got dis here gene" cannot do that.

If you are not having physical problems, I would save the money and not get a genetics test. If you have gynecomastia, lack of facial hair, etc. and suspect XXY and WANT to get RID of the gynecomastia and gain facial hair...genetics testing would be beneficial so that you can get testosterone injections. But, if you are happy with having some boobage and no facial hair...what's the point?

It's expensive. Better spent on shoes and therapy.

But, if you are really curious, I'm sure there is some poor grad student out there that is doing his/her thesis on genetic links in transsexualism, so you may be able to sign up for a project and get genetic testing fo' free.

Plus, if you are diagnosed as a TS, you can donate your brain to science because they are trying to see if there are differences in the brains of transsexuals. (There has already been one published study on this). I mean, if you all are looking for scientific links, YOU will be the test subjects so YOU have to get on the bandwagon to kind of help scientists out.

But, I am a little biased because I am donating my body to science.

lol Dawn, I'm by no means an authority. I just hope the 100k (luckily mostly in scholarships) that I have spent in my science education gets me somewhere. I'm supposed to tutor people in pathophysiology and I just had my mind blown by a classmate a few minutes ago when we were talking about right and left-sided heart failure. So, yeah, I really don't know a lot of things, but I try to be helpful when I can.

[Rianna Humble]

I have an intense dislike of the term Gender Identity Disorder because to me it suggest that the person thus diagnosed is suffering from a mental illness.

It seems that the World Prefessional Association for Transgender Health may tend to support my idea that being TS is not a mental illness. On page 6 of the latest version of the Standards of care, they say


Thus, transsexual, transgender, and gender nonconforming individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available. The existence of a diagnosis for such dysphoria often facilitates access to health care and can guide further research into effective treatments.

[Shananigans]

The DSM still lists it as GID, which is gender identity disorder (GID) if I am not mistaken. (And, there is currently controversy over this). The DSM is what the therapist would use to diagnose patients. A mental disorder is defined as a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture.

I'd say gender dysphoria fits that bill. It's not the every day normal experience and it affects an individual's life and causes usually causes distress.

But, as society has shown, we dislike "dirty words." Disorder sounds dirty now, so we have to call an apple by a different name and offer the same treatment strategies.

I have OCPD and I don't mind saying DISORDER, DISORDER, DISORDER. It's not something that your Joe Blow has to handle and sometimes I need a little help with it. Am I a crazy freak? Nah, not really.

As long as transsexualism begins to be recognized as [insert another word for disorder] and can allow people to seek better therapy and treatment, I'm all for it. As it stands, it really isn't recognized as a problem that merits insurance companies forking out dough for treatment.

Insurance companies fork out dough though for my disorder on a monthly basis. I'll call it disorder all day long as long as I only pay a copay.

But, that's just my view.

[Josie Rose]

I was never actually diagnosed with anything by the psychiatrists and the Charing Cross gender clinic. Not GID, not gender dysphoria, not mentally disordered. Never mentioned. Simply put, I was interviewed twice by separate psychiatrists and they decided I was a suitable candidate to be placed on the NHS gender transition pathway. I believe that things such as GID, gender dysphoria and things you decide for yourself and thus act accordingly. The function of the psychiatrists appeared to be, in my case at least, to determine that I am not having delusions or am otherwise psychotic and that my approach to my transition was rational and realistic and that my expectations were plausible.

The only tests I have had were to clear me of obvious medical problems (high BP, testicular cancer, prostate cancer and some hormonal conditions that can complicate things) and to keep a track on my hormonal balance as I head towards the required levels to "hit the ground running" for referral for GRS.

At NO time did I ever feel or was made to feel that I had an illness or had a DISORDER. As far as the NHS is concerned I am a woman seeking help with certain hormone problems and one or two physical issues. It is certainly how I feel.

[Rianna Humble]

The DSM still lists it as GID, which is gender identity disorder (GID) if I am not mistaken. (And, there is currently controversy over this). The DSM is what the therapist would use to diagnose patients. A mental disorder is defined as a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture.

I'd say gender dysphoria fits that bill. It's not the every day normal experience and it affects an individual's life and causes usually causes distress.

The new Standards of Care are over 5 times as long as the old ones and cover the latest thinking by a whole body of health professionals involved in caring for Transgender, transsexual and gender non-conforming people. Last year, this body made a very well reasoned submission to those who are drawing up the next DSM explaining why in their opinion it is inappropriate to psychopathologise these conditions. They recognise that some people with Gender Dysphoria will also have Gender Identity Disorder.

Not so long ago, the DSM allowed for people with Gender Dysphoria to be "treated" via Electro Convulsive Therapy. It was changed when enough people made the powers that be recognise the error of their ways. My question is should we roll over and allow a wrong definition to continue to be promulgated, or should we rage against the injustice?

[Shananigans]

The new Standards of Care are over 5 times as long as the old ones and cover the latest thinking by a whole body of health professionals involved in caring for Transgender, transsexual and gender non-conforming people. Last year, this body made a very well reasoned submission to those who are drawing up the next DSM explaining why in their opinion it is inappropriate to psychopathologise these conditions. They recognise that some people with Gender Dysphoria will also have Gender Identity Disorder.

Not so long ago, the DSM allowed for people with Gender Dysphoria to be "treated" via Electro Convulsive Therapy. It was changed when enough people made the powers that be recognise the error of their ways. My question is should we roll over and allow a wrong definition to continue to be promulgated, or should we rage against the injustice?

(Note that I have been talking about transsexuals and not the umbrella term of transgendered people. Psychiatric evaluation for everyone that goes under the term TG is a huge can of worms that I can even exhaust myself to go into. Also note that disorder=/= psychosis. Psychosis is loss of contact with reality. So, after I go in to talk to someone, they might turn to their partner and say, "Wow, that airline stewardess was very kind!" This is not what a disorder is).

Well, what is your definition of a disorder?

To play devil's advocate, I'll just say I am an insurer. Why should I offer you coverage for SRS and hormone therapy?

And, to go back to the OP, what tests are going to be conclusive to show that you are TS if no disorder exists? If being in a male body when you supposedly have a female mind is Not a disorder, then it therefore does not cause any complications in carrying out your daily functions and living and it does not effect you on a psychological level. (By definition of a disorder).

Therefore, without conclusive tests and with no disorder, I think all TS should just have to suck it up and fork out the money on their own. They should receive no coverage for counseling, HRT, blood work, SRS, or anything.

Because, how do I know that this is even a real phenomenon??...if it's not a disorder and not affecting you at a psychological level, isn't it all just a choice then? SRS and hormone therapy are therefore elective and not really "needed", because they aren't treating any underlying problem.

If there are no genetic tests to prove someone is a TS and there is no accompanying disorder, then it must be choice.

(These are of course not what I actually think, but we had to have a mock debate in a gender class I took some time ago where these same issues were addressed. This debate has been going on for a loooooooooong time. And, this is probably why the TS population is underserved medically).

This is what the DSM says about GID:
"Strong and persistent gross-gender identification."
"Persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex."
"The diagnosis is not made if the individual has a concurrent physical intersex condition."
"Clinically significant distress or impairment in social, occupational, or other important areas of functioning."

I can buy that not all TG people have GID, but a TS??? Isn't this the reason that it's harped on all of the forum that TS have a mind of one gender and the body of the wrong gender? Is this not why depression is very high in this population and suicide is a great risk?

I know a huge debate is if you are diagnosed as having GID, then you will still technically have it even after you have transitioned and as fixed because it stays on your medical record forever. OH, THE SOCIAL STIGMAS!!!

Look, your medical records are no one's business but your own. It's a huuuuuuge HIPAA violation for anyone to have access to medical records but your health care provider, you, and whoever you allow access to the record. So, if you are diagnosed with a disorder in order to gain the appropriate medical treatment, which cures the disorder...isn't this what you want?

I've read that people are comparing GID to homosexuality being a described as a disorder in the past. And, I can somewhat see the comparison...except there is no "cure" for homosexuality and it usually doesn't involve a disorder when societal expectations are alleviated.

However, no matter what society says...a TS is still someone of one gender mentally and another gender physically. So, you would think that it would cause:
"Strong and persistent gross-gender identification."
"Persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex."
"The diagnosis is not made if the individual has a concurrent physical intersex condition."
"Clinically significant distress or impairment in social, occupational, or other important areas of functioning."

This is definitely not true of all TG people, and the DSM needs to do a better job with not lumping it all together. (Even though the TG community kind of did that backwards step IMO by putting everyone under the umbrella as "TG" because it also means fetishists are "transgendered.")

None of it makes sense. And, it gets more convoluted as we go on. At this rate, no TS except those of the top tax bracket is going to be able to afford appropriate care...and, I find this sad.

I am a little biased, I must say. My concern is less with labels of "disorder" versus "dysphoria" and more about what we can do to get insurers to see this as something that needs to covered and not just elective procedures. But, in order for it to be seen that way, there has to be a very real problem that affects you to where you cannot function optimally without treatment. And, that is hand-in-hand with the definition of a disorder. My concerns are less with title because I'm not a TS, but my concerns are with making sure that people get adequate health care. But...transsexuals aren't getting adequate healthcare...not by a long shot. And, it's because insurance companies don't see it as a real problem, and many surgeons see it as a purely cosmetic procedure as well.

We have a long ways to go in a lot of areas, my friend.

Here's some fun reading material: http://www.tgender.net/taw/tsins.html read this first. Then, read this: http://www.tc.umn.edu/~colem001/hbigda/hstndrd.htm

It's really good lobbying ground for insurers...but, it does use the foundations of GID when formulating plans of care that are medically necessary (aka should be insured).

It also goes into tests/diagnostic qualifications that I hope the OP will find interesting.

[LeaP]

"for some reason people don't like to say Klinefelter's Syndrome anymore...so, they say XXY."

Kleinfelter described symptoms (or a cluster of symptoms). The underlying cause was identified years later. As most XXY males don't present symptoms, it really doesn't make sense to associate the syndrome with the symptomless majority.

See http://www.nichd.nih.gov/publications/pubs/klinefelter.cfm

Excerpt from the above:

" I never refer to newborn babies as having Klinefelter's, because they don't have a syndrome," said Arthur Robinson, M.D., a pediatrician at the University of Colorado Medical School in Denver and the director of the NICHD-sponsored study of XXY males. "Presumably, some of them will grow up to develop the syndrome Dr. Klinefelter described, but a lot of them won't." For this reason, the term "Klinefelter syndrome" has fallen out of favor with medical researchers. Most prefer to describe men and boys having the extra chromosome as "XXY males."

Lea

[LeaP]

(Note that I have been talking about transsexuals and not the umbrella term of transgendered people. Psychiatric evaluation for everyone that goes under the term TG is a huge can of worms that I can even exhaust myself to go into.
...
I can buy that not all TG people have GID, but a TS??? Isn't this the reason that it's harped on all of the forum that TS have a mind of one gender and the body of the wrong gender? Is this not why depression is very high in this population and suicide is a great risk?
...
I know a huge debate is if you are diagnosed as having GID, then you will still technically have it even after you have transitioned and as fixed because it stays on your medical record forever. OH, THE SOCIAL STIGMAS!!!

Look, your medical records are no one's business but your own. It's a huuuuuuge HIPAA violation for anyone to have access to medical records but your health care provider, you, and whoever you allow access to the record.
...
Here's some fun reading material: http://www.tgender.net/taw/tsins.html read this first. Then, read this: http://www.tc.umn.edu/~colem001/hbigda/hstndrd.htm

It also goes into tests/diagnostic qualifications that I hope the OP will find interesting.

Thank you for the thoughtful responses. On several points:

Please do comment on TG evaluation, if you care to, as that's most applicable to me. I don't identify as TS.

Your point on GID for TS vs TG makes intuitive sense to me, as I can't quite imagine why, other than GID, someone would transition (ignoring pathologies). You may be glossing over psychological issues among the TG other than GID, however. In particular, I can testify emphatically on the depression point, to the level of frequent suicidal ideation.

I have a different view of medical records, risk, and stigma. First, HIPAA provisions are violated casually, frequently, everywhere. I've never walked into a medical office without seeing a violation - ever, not once - but then, I know what to look for. Second, at least some industries, like mine, signing a medical information release is a routine background screen item. Naturally, you don't have to sign one, but if you don't, you can't be screened and you will not be employed. It's rather like the arguments people have over homeowners' associations: they're voluntary contracts, people say - live somewhere else where there are no covenants or association. That flew for a while - until they became so ubiquitous that in some parts of the country they are almost inescapable. In my opinion, medical privacy is being violated more routinely than ever ... "voluntarily."

I appreciate the links, especially the first, which I had not seen. Though it's TS-focused, there's a lot of information there.

Lea

[Deborah]

If i were diagnosed (which i'm pretty sure i would be) i still wouldn't be able to do anything about it. (My children being my main reason)