TransMed
Professional Guidelines--Are They Necessary?
Part One
By Sheila Kirk, M.D.
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Part One | Part Two
As a physician who is transgendered, I try hard to approach and understand, in an objective way, both sides of every medical issue concerning my sisters and brothers. My transgendered spirit and empathy are always active and alive. So is my professional spirit, which always seeks to be compassionate, concerned and committed in assuring that our community gets the best and most qualified care. So, I come to you as a sister as well as a caring, experienced physician who takes the responsibility of her profession very seriously and her love and concern for you equally so. I strive always to bring you both responsibility and realism. It is from these two perspectives that I share the following.
The first and most important question to ask, and then to answer is: "Do I believe there is a need for criteria at all in the hormonal and surgical care of Transgendered individuals?" More succinctly, should this medical and surgical management be given to those requesting it on demand?
And my answer: there is no place for this kind of care to be offered on demand.
There has to be criteria and guidelines for hormones and genital reassignment. There are criteria and guidelines for medical and surgical management of every other description in the care of human beings no matter what the condition or disorder. I can see no reason whatsoever to make this an exception. There are reports in our medical literature and in the lay press quite often of individuals whose lives are lost and broken because of a self-determined course of medical and surgical treatment. This is tragedy in its most stark form.
Now, if I subscribe to criteria (or as guidelines, which is how I like to refer to them), what is it that I accept and require? What is it I think needless and reject? To begin with, the guidelines should not be rigid rules but truly suggestions for management. There should be allowance for the level of experience and knowledge of the psychologist who assesses the client. The history and experiences of the client must be an integral part of the assessment as well. A knowledgeable therapist could refer a mature and developed client for surgery in half the time that would be necessary for one not so advanced and ready. Hence a year or two for some maybe in excess while six months could be appropriate for others. But it all depends upon the client's development and the professional's skill. This is an important point and not all mental health care professionals know this. Also be sure all potential candidates for hormones or surgical procedures accept the fact that they may not become actual candidates at some time in their counseling process; simply because they aren't ready. Needless to say, the ideal; a well- positioned Transsexual and a skillful therapist coming together is not common. Would that it were more often the case! But it does happen and when it does, these individuals should not be obstructed or delayed.
However, the greatest number of individuals seeking to move into a contragender role do need help. They need to sort out their lives, to put aside some concerns and to assume others. Fantasy accompanies many as they begin to evolve. Many need to put that fantasy into it's proper place and take serious hold of reality. Some mis-diagnose themselves and can be brought to correct assessments of self with experienced counselors, when they allow it. Many believe that hormones and surgery will solve their difficulties and problems and they don't realize that life goes on, often with new difficulties and problems developing as they complete their physical transformations.
Even during the difficult and joyous months spent in transition there are obstacles, of many different kinds, that need the insight and valuable advice of the experienced mental health care professional. That need for advice may extend even into post-operative months and for a few years afterwards for a few individuals. Many of us don't understand that years of socialization and attitude, habit and the burden of guilt, have to be undone, have to be unraveled. A whole new mode of behavior and thought may be necessary to learn.
Applying makeup everyday does not make one a woman. Growing a moustache does not make one a man. Our gender identification is strongly confirmed in early years for some, and slowly matures for others. It is the spirit, the very core substance that resides in us all. Many things take place as we grow in mind and body. We assume many attributes and attitudes that must be discarded or refashioned as we move into the contragender role. This is where the knowledgeable, experienced counselor is most important. They are the devil's advocate, the reminder's of realism. Yes, the Gatekeeper, if you will and they are needed to help sort out, redefine, re-establish and help us to give to ourselves all that is necessary to make life in our new existance a joyous one. So, to those not accepting the importance of the psychologist or social worker or even the psychiatrist; I tell you, you are wrong. Even you, the most stable, the most centered, the most capable and gifted, need counseling to some extent and for some period of time. Remember, when you speak against the value of the mental health care provider you speak only for yourself, either correctly or incorrectly. You can never assume the position of speaking for another who has an identical goal but a whole different set of conditions in their life. So again, is counseling necessary? There is no doubt in my mind. Therefore, the questions are twofold a) for how long and b) by whom?
We'll explore the answers to those questions next month as well
as examine the modifications that I feel should be considered in the new
Standards of Care.
©1998 Sheila Kirk, M.D.
Sheila Kirk, M.D. is a board-certified obstetrician/gynecologist specializing
in transgender medicine and in private practice in Pittsburgh, PA. She is a
board member of the Harry Benjamin International Gender Dysphoria
Association. She is the author of several books including "Masculinizing
Hormonal Therapy For The Transgendered" and "Medical, Legal and Workplace
Issues For the Transsexual" Dr. Kirk can be contacted by phone Tues/Thurs
10A-5P EST (412) 781-1092, 24 hour fax: (412) 781-1096, by post: P.O. Box
38114, Blawnox, PA 15238 or by e-mail: SheilaKirk@aol.com
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