Changes In The Community
I've been around the paraculture for 18 years, and I've seen a lot of changes, all good. The people today are much more knowledgeable and sophisticated, and much more organized and political. There is a lot more pride of being who you are, a lot more self acceptance and self confidence. I think what is happening is these people are moving in the same direction the gay community was 2 or 3 years ago.
ETVC is incredible. How many people are members now, 500? In how many years, 8? That's incredible. More and more people are coming out of the closet. I was at the gay parade at your booth and you kept running out of literature and people kept showing up asking questions. There was very little hostile judgment, and people were interested. and that's a shift. I know it's San Francisco, but 'I think it's happening elsewhere more slowly.
There's even a radical contingent, which I found out the other night from Telzey, and I think that's good. The Act Up of the transgender community. You meet all types, and we need to get to know each other.
The Catch-22 this community has that others don't is that a lot of you just want to stay in the woodwork. When you're dressed, you want to be like any other woman. You can't go out and be political, because you want to fit in with everybody else. That will always be a problem, I think, but some people don't feel it as strongly as others.
Another thing I see is that the image of the feminine in this community has changed, and this I like so much. It's much more realistic. Eighteen years ago, what I saw when I would come in these rooms was a real Madonna/whore split. Of course, that has been characteristic of our culture, too. s we as women get more choices, what we see in this community also reflects that, and everybody doesn't look alike, and most tend to look more realistic. Eighteen years ago, you didn't do as good a job.
Also, you have a lot more options. Eighteen years ago, unless you were a DSM IIIR transsexual wanting to get rid of your penis, nobody knew what to do with you. And then you had to be heterosexual in the gender you were moving into or you weren't considered a candidate for surgery, so people were lying to us as providers because there is so much variation among transgender people that wasn't being acknowledged then by the providers.
People then were not comfortable with diversity. There's a lot more diversity and options now. There are a lot more people who are living as women, but not electing sex reassignment, or even hormones. The role is what's important to them; being related to as a female is what's important. That's not for everybody, but you now have that option.
I think providers and consumers are closing the gap between them. I was at a meeting of HB1GD4 in Cleveland recently and there is a consumer member on the board of directors of the Harry Benjamin association. I really think this is good, that we're interacting. I know for me, most of what I've learned has been from you, not only in my office, but from associations outside. and I see that that is happening more; there is more exchange. l also I notice that providers are communicating more around the world. There are so few of us, that it is great that we know who each other are and can communicate with each other.
In terms of research, there's a person now, Louis Gooren, who is Chair of Transsexuality, if you can believe this. t the Free University in Amsterdam, there is now a whole chairship for him; he was just installed. So this is exciting, in terms of doing research in this area. It is getting more acceptable.
In Canada they're doing a lot of work in classification. In the United States, work on sissy boys, and in sexual addiction and compulsivity, and that's probably where the money is, unfortunately. The only area I'm aware of where funding is potentially available for research in the gender field is in obsessive-compulsive behavior using Prozac or lithium. The drug companies will pay for that. Otherwise, it's hard to get funding.
Oh, definitely. Yes. It's definitely a more healthy response to anxiety.
Question: and as far as escapism, as long as you don't go into a multiple personality or something and use it as a tool to help cope with real life situations...
You can. See, this is the thing: it varies from person to person. One of the things that you need to strive to do is to use it that way as opposed to using it in ways that can be destructive. Only you can decide how that works for you.
Question: What criteria do you use to judge whether one is a transsexual?
I am not sitting there diagnosing you. We are working together to figure out (a) would you be more comfortable living in the female gender role, and (b) if you would, are hormones or reassignment surgery appropriate. That's again something we do together, because there are a lot of options. I don't have criteria per se. I don't have a list because everybody's different, although I do follow the Standards of Care.
It's not accurate to use DSM IIIR because DSM IIIR says that a transsexual is someone who hates their penis, and some people who are going to live in the female gender role, whom the paraculture terms transgenderists but the literature has no category for that, don't hate their penis; they use it.
Question: In your experience, have you worked with people who have been taking hormones for extended periods who are not surgery candidates who are still living on both sides of the fence and have been taking hormones for more than a few years?
Yes, I have. We don't have good data on that. All I can tell you is to the best of my knowledge, the hormones have not harmed them. There is a concern about someone taking high levels of hormones for an extended period of time, but we just don't know. There's a fellow in Amsterdam, H. Asscheman, who did some very good research on the negative effects of female hormones on the genetic male, but still it wasn't the long term kind of thing.
Question: Obviously high" is going to be relative to the individual.
Yes, but someone who has surgery Immediately goes down in the dosage, so if you're not going to have surgery, you're going to be taking higher levels of hormones than the person who has surgery. Once a person has surgery, required hormone levels drop because that person's body is no longer producing as much testosterone. If you don't have surgery, we don't know what the long term effect is.
Question: I'd like to gather information on the risk factors of taking hormones under a doctor's supervision.
We're trying to get data, but this is something relatively new, so we don't have long term studies, and few people are even trying to collect it. The best advice I can give you is to continue interacting with your doctor on a regular basis and paying attention to the possible effects. There is potential for stroke, and some really horrible possibilities.
Question: If you read the warnings on the bottle, they would scare you to death.
Yes, they are horrible. But in terms of what I have experienced with people, they haven't suffered many medical side effects. What my clients much more commonly talk about is psychological side effects.
Question: The other thing from my personal experience is that I was taking the high but commonly prescribed dose of 5 mg Premarin, 18 mg Provera, and .5 mg Estinyl, and I think that's dangerous. After a few years, I wound up with arrhythmic heart, cramps, all the things that were on the label. On lower doses, I didn't have those side effects.
Thank you. I heard a really good lecture from an endocrinologist who works with female-to-males, and he was essentially saying that you have to self monitor the side effects, and you have to judge for yourself. Like Annie, who decreased her dosage and eliminated the side effects. Everybody's different.
