%expand(%include(D:\http/ads/ads0.html))
TransMed
A Defense for Contrahormonal Treatment In Non-Transsexuals
by Sheila Kirk, M.D.
Who should be considered appropriate to take medications that can
alter the body in profound ways and when is it reasonable to initiate them?
Most of us are aware of the controversies that exist in determining what individuals
are candidates for contrahormonal therapy and when a regimen should be initiated and
monitored for those individuals. The Harry Benjamin International Gender Dysphoria
Association conference held this September in Vancouver highlighted in its program the
presentation of criteria revisions on this very point, trying to answer these very
difficult concerns.
A committee of very experienced and knowledgeable physicians, surgeons and mental
health care professionals, under the guidance of their chairperson, Dr. Stephen
Levine, have labored vigorously to find answers to those questions along with others
of complexity and decided importance. All are extraordinarily experienced in the
diagnosis and management of the person with gender identity disorder. Some are
transgendered themselves, others not, but all once again are gifted in their
knowledge and experience. And they gave hours and days into weeks and months during
a year or more to set criteria that will prove acceptable and beneficial to the
patient/client and their professional caregivers. Professionals will review their work and
use their wisdom in their approaches to those they care for in the future.
And here I come ---proposing another concept-- another idea in the management and
treatment plan of us; the Transgendered person. The spectrum or continuum of the
transgendered individual can be complex and lengthy for some of you whose gender
identity and even gender role is not clear. Some of you may go only so far in their
assessment of self -- and never move beyond a certain place.
Others may move into more open and defined expressions of self -- into open contragender living or even full time
roles and some of you may go on to consider genital reassignment and considerable
cosmetic surgeries. You may go in and out of these modes. Sadly, some of you might
even offend society, destroy family, carelessly decimate finances and work place
status and carry various personality disorders into your lives in the contragender
role to the point of destroying yourselves.
Others of you, probably most, are much
more stable, cautious and thoughtful of what you intend but still you are unknowing,
naïve, and in deep need of someone to talk with, discuss with, plan with, even to a
degree, argue with.
That someone is the counselor, the therapist-the mental health
care provider!
I vigorously endorse the involvement of the trained-therapist who is
additionally trained in transgender gender care and management-and that is in strong
disagreement with many I know who believe that they alone know what they want and
need and will demand, without professional guidance. But I also believe that there
are a number of gender confused or conflicted or as I like to think of us, gifted
individuals who can be candidates for contra hormonal regimens even though:
a) they
may not consider themselves as candidates for genital reassignment in the future or
b) even though, here and now, they are not considered by an experienced counselor to
be candidates for surgical reassignment-at a later date-they may become candidates.
In essence, I am saying that hormonal therapy should be offered to a choice number of
individuals who for whatever reason or reasons, who will not be candidates for genital
surgery or even for a partial or full time assumption of a contra gender role. Now
that is a stance that without doubt can create controversy like the
controversy that surrounds the question of when to start hormones-before the start of
the real life test or sometime after it is begun?
Why have I come to this thought and
a comfortable acceptance of it? Because frankly, I have had so many experiences with
individuals who want this approach, who feel it vital to their nature and spirit, who
find it an appropriate therapy to their souls-if not at all a therapy to their
bodies. Believe this: the number of calls I receive from you who want some
opportunity for hormone use, far out distances the patient/client contacts
professionals have with individuals who do want genital reassignment and who do want
to bring conformity to their lives, in mind and body.
In the beginning many years ago
I told all those not heading for GRS, it was not possible. That such a meddlesome
approach to the human body's homeostasis was out of the question. That this kind of
tampering with the genetically programmed biochemistry and physiology of our physical
being was foolish, even ridiculous, because this very involved process was only for
those who had to have a change in their anatomy. It was not appropriate to even
contemplate such treatment on a lesser scale.
To "tiptoe" into hormones was not reasonable. One must plunge into the hormone
pool and expect to come out drenched and transformed to whatever extent that was
possible in the individual's organ capability and tissue responsivity. After a time,
I began to think about those requests. I began to analyze my statements about
"having one's cake and being able to eat it too"-about "having voluptuous breasts and
penis quick to erect and bring satisfaction to the owner and to the partner." I began
to think that maybe there was something else to consider. I began to think that
between the extremes of the fetishistic crossdresser and the true high intensity
transsexual, there were many compartments -- a few more than Dr. Harry Benjamin had
allowed for in his sex orientation scale -- and that for whatever the reasons and the
circumstances, people often moved through those compartments and their positions were
not always stationary or static.
I began to think that they may impose restrictions
upon themselves or have restrictions imposed upon them, to keep them in a compartment
for a time but when permitted, they could advance to the very end of the spectrum or
to some place near to it. And I began to believe that they needed some help, some
therapy or treatment to assist them in that movement, rapid or slow as it may be, and
that asking for that help deserved an answer a great deal less rigid that I had been
offering.
It was in London, England while on a lecture tour that I had opportunity to
speak with Dr. Russell Reid on several occasions about his management of a large
group of transsexuals in his practice. As we spoke of a number of things he told me
of his early use of low dose hormonal therapy to aid him in his impressions and
subsequent diagnosis of individuals as candidates for hormones and eventual surgical
treatment. He told me of how it helped to sort out those who self-diagnose
erroneously and how even low dose medication assisted the anxiety and stress of
individuals struggling with so many issues in their lives. Thinking about this I
recalled Dr. Benjamin's sex orientation scale-in his category IV, the
transsexual-non-surgical patient, hormones were a real potential and often needed for
comfort and emotional balance in that patient.
I began to revise my thoughts, my
black and white belief that hormones must be reserved for the well-defined, 'moving
forward' transsexual. Was there perhaps a person or two who could be a candidate
for low dose hormones? What evaluations would be necessary? What criteria
established what education and instruction needed? This was not a venture for the
light hearted or flippant. It meant careful evaluation and selection, monitoring as
was planned and executed for the confirmed transsexual and most important, clear,
precise and in depth education of the patient/client. There must be no place for
fantasy or false expectations. The patient/client has to know what ground they are
going to tread upon, and with continued counseling to resolve issues that have to do
with confusion in self and perhaps a goal and a plan for reaching it in later life.
Truly, it means close cooperation with counselor and physician and patient/client.
It means that no one is offended or destroyed in the process-wife, children, native
family in particular. It means rational and realistic understanding of what this is
all about and perhaps what it is leading up to.
Who are candidates for such a
program?
When we look at the MTF and FTM perspectives:
1) The need for absolute
comfort with a spouse and other involved family members. No one can embark on a
regime that can lead to marital disruption. This in practice can be a real
difficulty for many.
2) There is no place for dare-deviling or embarking on
programs in excess of the regimens limits
3) Some degrees of ongoing counseling is
necessary and important. Life situations change. Individuals will find stimulus or
reason to move to another place on the continuum. Whatever it may be with such
potentials, individuals need to assess and reassess what they are doing or intend to
do.
4) Medical monitoring is vastly important. Any ill health developing
independently or because of the regimen must be guarded against and dealt with fully
and competently by the physician who understands and is empathetic to the individual.
This can be a problem of major importance.
To begin with what do I suggest for
individuals who want low dose medication such that they can retain their male
characteristics and activities including sex and yet feel a degree of contragender
change and attitude?
Natural occurring medications, which not a worthwhile approach
for the person seeking energetic feminization or masculanization, are still very
acceptable to this person wishing to attain a lesser level of accomplishment.
While we have no good data on dosages in various preparations and no good control
studies that I'm aware of in individuals wanting some degree of contrahormonal
changes-they can be very satisfying and bring about huge amounts of psyche comfort
and a small degree of physical change. Though not near to the results of prescribed
medications.
Do they need medical monitoring still? Absolutely and because there
products are easily obtained without a prescription, good rapport and understanding
is absolute between patient and the professional.
Low dose prescription
medication is also possible in these patients. Marital and family circumstances and
social/workplace situations could allow for low dose therapy properly monitored.
These patient/clients can be selected with care and good success. And what of
individuals with no marital or family ties with no special impediments to hormone
use-are they not in a position for even more in depth consideration? Are the results
rewarding to the patient and to the therapist and physician? They are, unreservedly,
and my clinical experience tells me this is so. Irreversible problems of major nature
may not be encountered with individuals who want to feminize.
They are encountered
with genetic females who want to masculinize. In real terms, testosterone is much
more powerful and energetic in reversing many systems in the female body than is
estrogen in the male body. Many of these disruptions are truly permanent and
irreversible. In summary, I add a new concern, a new problem, to ones we are trying
to resolve.
I could be considered a maverick transgendered physician in my approach
to the treatment of my patients. But my pleas are for the Transgendered individual no
matter where they reside on the spectrum. Our population is underserved so often in
so many ways. Thoughtful, careful and considered evaluation and care is a mandate
for all caring for our community.
Sheila Kirk, MD is a Transgender Medicine Specialist, board-certified in
Obstetrics and Gynecology and in practice in Pittsburgh, PA. She is on the board of the Harry Benjamin International Gender Dysphoria
Association. She is also a well-known author and leading authority on transgendered medical care and research. Dr. Kirk
provides international and national consultations and referrals to the TG
community and health care professionals who assist in their care.
She can be reached the following ways:
E-mail: SheilaKirk@aol.com
Phone: (412) 781-1092 Fax: (412) 781-1096
mailing address: Sheila Kirk, P.O. Box 38114, Blawnox, Pa 15238-8114
|