Gender Identity Disorder and the “real-life experience”

I stumbled across a post by a trans woman discussing the beginning of her “real-life experience,” a former requirement for some medical treatments involved in transitioning.  The WPATH (World Professional Association for Transgender Health) Standards of Care (SOC) still require some time living in the “desired gender role,” but over time, as far as I understand, they have lessened this requirement and made it more flexible (e.g. SRS used to require two years and now only requires one).  As far as I can tell (not yet having had the time to sit down and read the whole SOC), the real-life experience requirement for hormone therapy has been completely removed.

The WPATH Standards of Care are a fraught issue, and I won’t pretend to be fully informed about their trajectory.  The common argument against them is that they have the effect of pathologizing gender issues.  And though on some days I am right there with the activists, ready to declare my displeasure at being labeled “disordered,” on other days I really do feel like this is a sickness – not in the sense of needing to be “cured” of feeling this way, but in the sense that action must be taken to align my body with my mind or I will continue to feel terrible.  I wonder how we can make people understand why SRS and hormones are necessary without allowing ourselves to be labeled as “disordered.”

Again, I don’t really know where I fall on this issue, or know a lot about it (then why am I blogging about it, you ask? Shhh…).  But here’s the comparison that always pops into my mind:

I have ADHD.  I was diagnosed as a young child.  At first, I balked 100% at the idea that I had any sort of disability.  I was embarrassed, upset and confused.  But as I got older, I realized that it was just a part of who I am.  I can’t help that my neural pathways are different, or whatever.  As I progress in the law school application process, I have read an alarmingly large amount of vitriol by the uninformed about how people with ADHD are just dumber, shouldn’t be allowed to practice law, etc. etc.  And what I realized is that having the “disabled” label is the only thing that stands in the way of those people having their way.  There are people with ADHD and similar disabilities who could not get by without the accommodations provided by the ADA.  Though there will always be angry people on internet forums railing about how dumb we are, everyone deserves a chance at a level playing field.

Am I a lesser person because I have a disorder that you can find in the DSM-IV?  I don’t think so.  I think the ranters on the internet forums are the dumb ones for not seeing the logical fallacies and unnecessary anger that provide the foundation of their arguments.  Do I think of myself as a “disordered” individual?  No, not really.  ADHD, as far as I am concerned, is a part of who I am, a part of my personality.  It informs the way that I think so much that I am not sure who I would be without it.  And I like who I am, ADHD and all.

I see my transgender identity the same way.  The DSM-IV tells me that I have “Gender Identity Disorder,” and as much as a part of me balks at the “diagnosis,” I am also happy that the medical profession has acknowledged the need for medical transition.  Do they need to fix at least some of the language used?  Hell yeah.  I would never deny that some aspects of the DSM diagnostic criteria (trans children needing to have a distaste for “roughhousing” or dolls, etc., for example) are completely ridiculous and depend entirely on gender stereotypes.  And I understand that there are dangers inherent in allowing something like this to be classified as a “mental disorder” in a world where people can be executed for being part of the LGBT umbrella and in a country where people think we transition just to spy on people in bathrooms.  But I am still glad that there is an acknowledgement of the reality of gender dysphoria.

Anyway, back to this blog post I found.  “Hear Me Roar,” discussing the real-life experience, writes, “It turns out that the Real Life Test is not, after all, about seeing if you can live life as a woman.  It’s about seeing if you can live life as a man in a dress” (http://open.salon.com/blog/hear_me_roar/2009/02/21/i_changed_sex_and_died).

And I think that she has a fantastic point.  The problem with the real-life experience is that some people cannot safely “test” their new gender identities until they transition.  I am lucky that I live in an environment where I can be safe while still living “in between” genders.  But many are not that lucky.

She continues, “Changing sex isn’t something that can be done in private.  You have to do it right in front of everyone in your life: family, friends, coworkers, boss, neighbors, the grocery checker…

Your first task is to announce to everyone in your life that you are going to have a sex change.  This isn’t an easy thing to do.  You find out that people who are supposed to love you unconditionally – parents, children, siblings, best friends – don’t.  You start to lose people as you tell them.  Some transsexuals suffer nary a loss; others suffer substantial losses.  I lost everyone…

All told, I lost everyone in my life, my home, my job, my family, and my income.   My creditors stayed with me, though.  Changing sex cost me over $150,000, which was a good three years’ income.  It would have taken me 20 years to save that much money, so I did a lot of it on credit.  And though I lost my income, I did not lose my debts.”

“Hear Me Roar” points out the obvious issues of the real-life experience: “My therapist declared that I was now ready to embark on the Real Life Test. That’s where you live for at least one full year in the “target gender,” after which – if you’re still alive and can afford therapy – you may (or may not) be approved for sex reassignment surgery.  The idea is that you live for a year as a woman to see if you like it, or whether you come to your senses and decide to keep your penis and live as the man God meant you to be.

I had never so much as put on a pair of women’s shoes before.  Now I was required to dress as female (and how was I going to afford a whole new wardrobe?), adopt a female name, and live my whole life as a woman.

Only problem was, I still looked like a man.

It turns out that the Real Life Test is not, after all, about seeing if you can live life as a woman.  It’s about seeing if you can live life as a man in a dress.  It is the most humiliating, terrifying, soul-killing exercise one can perform in America.  The result, for me, was homelessness and becoming unemployable. I couldn’t even get a minimum wage job.  I guess I must really have been a sight.”

But, as terrifying as the “real-life experience” can be, she went for it: “Of course, I was warned.  My therapist told me – so kindly and with great sadness – that I might never “pass” as a woman, and that I might forever have to live in a ghetto of fringe people, always on the periphery of society.  She reminded me that 75% of transsexuals are chronically unemployed, and 40% die, either at their own hands or at the hands of those expressing their disapproval.  Did I really want to do this?

After much soul searching, my answer was that I didn’t have a choice.  I could no longer live another day in a lie.  I had to be me, whatever that was, and whatever the consequences.”

I will let you read the rest of the post if you so choose (and I highly recommend that you do), since I have already spent half of my blog post quoting hers.  But the fact remains that the real-life experience can be just as terrible as living in denial.  I am glad that the WPATH is moving away from that requirement.  As much as I understand the idea behind making sure a person knows what they are getting themselves into, there are better ways.  The therapy requirement is already barrier enough for people who decide to transition on a whim (if those people even exist) or for the wrong reasons.  And, in the end, medical transition itself and all that it entails also acts as a barrier.  It is a very frightening prospect, even when you know it will lead to future happiness, even when you know that you need it.  I could have done my full “real-life experience” in the time it took me to be ready to admit that I was trans and that medical transition was even what I wanted.

But in reality, your gender identity is not a switch that you can flip on and off; it is a part of who you are, just like ADHD or liking spicy food or hating cold temperatures or having a phobia of clowns.  You don’t wake up one day and say, “Today, I begin my real-life experience.  Today, I change my gender identity.”  Your gender identity has always been there, whether you suppressed it out of necessity or let it bleed through and dealt with the consequences meted out by our binary world.

Links:

http://transgenderequality.wordpress.com/2011/09/26/the-top-10-things-trans-people-should-know-about-the-new-standards-of-care/

http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf

http://en.wikipedia.org/wiki/Gender_identity_disorder

http://www.msnbc.msn.com/id/24664654/

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“Gender Identity Disorder and the ‘real-life experience'” by https://growingupgareth.wordpress.com/ is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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8 Responses to Gender Identity Disorder and the “real-life experience”

  1. “As much as I understand the idea behind making sure a person knows what they are getting themselves into, there are better ways.”

    They *say* it’s about doing this, but I don’t believe it. I believe the idea of these barriers is to convince a person not to, or just make them so discouraged they don’t bother.

    I feel like I have a disorder. I don’t think that it *has* to feel this way, but it does, because of other people. I would still want the T, and possibly or not the top surgery, but if I could be accommodated as a transgender male looking the way I do right now, by my society, it would be *so* much easier to bide my time till then. If I could only speak about myself on my own terms and other people be respectful enough to follow my lead. And if there weren’t such barriers and gatekeepers, that would remove a lot of the disordered-feeling, too. As much as I want to change, I am *not* looking forward to dealing with these people. I don’t question my courage to modify my body; I don’t question my courage to be seen in society as a man, but I do question my courage to deal with hostile doctors and therapists. This threat that I live with, without having even spoken to them, is the first in the line of barriers.

    • sirgarreth says:

      I guess I just have to hope that they are moving beyond the idea of trying to convince people not to. At the very least, they claim that they have figured out how unethical it is to try to get people to accept their birth sexes. I do understand that these are just words, and words are much more easy than actual though patterns or values.

      I do agree that other people’s perceptions make the whole thing a lot worse. But for me the disordered feeling comes very much from inside. I honestly can’t tell you how much that would change if people were more able to go with the flow. But anything medical I’m going to do it’s because I don’t feel right without it. I guess it’s hard to separate out what needs to change because it needs to change and what needs to change because I have been taught it is necessary, but the need is there either way.

      I hope that when you do start dealing with the doctors/therapists, you find some that are not so hostile. They are definitely out there. I don’t know how few and far between they are.

  2. Tracy says:

    You hit on a nerve of mine with trans being pathologized and GID being in the DSM. Before my therapist wrote my needed letter for surgery and hormones, she had me read it to make sure it sounded accurate. And it did, except for the part when she stated that she had diagnosed me as having GID. I cringed. A lot. And while I understand including that diagnosis was necessary for the hormones and surgery, it royally pissed me off and made me feel downright awful about myself (not at my therapist of course). I most certainly do not have any sort of gender identity disorder or confusion. I know who I am, and just because it’s not socially acceptable does not mean that I have a disorder. The interesting thing to me is that on the other hand, in order for insurance to cover some of the medical treatment (hormones, surgery) for trans people, having GID be in the DSM is helpful (although many insurances don’t cover trans stuff anyway–go figure). I think eventually, just like homosexuality was removed from the DSM, GID will be as well. To me, the issue is clearly a physical one–we were born in the wrong anatomical bodies–rather than a mental one.

    • sirgarreth says:

      Yeah, my therapist apologized profusely before even handing me the letter, “If I could avoid putting GID in there I would, but I can’t, you have to have it.” I think that softened the blow a bit. That’s a really good point that you make, “I know who I am, and just because it’s not socially acceptable does not mean that I have a disorder.” But the “disorder” does pave the way, in some respects, as much as insurance companies have gotten out of covering trans-related medical expenses for the most part.

      • Tracy says:

        I think it’s an unfortunate thing that we need to have that “disorder” label just for the insurance coverage. I mean, I’m technically diagnosed with depression/anxiety so my mental health sessions and SSRIs get covered, but on some level, this is way different to me. It’s just frustrating that they’re essentially having their cake and eating it too. Not only are we big freaks because we have a “disorder,” but we can’t get coverage for it. If we have the disorder, it should be covered! If it’s “by choice” as many people think, then it shouldn’t. Rather it’s an unfair combination of both. Major ugh.

  3. SarasNavel says:

    If I may? Taken as an aggregate, it seems the APA creates a need and then fills it, continuously during the transition processes (a formal process they helped to create, btw). Simultaneously “treating” a client while making them dependent upon the therapist to get better. Not due to the therapist’s skill in helping the person navigate the real world, but by helping the person navigate an obstacle course determined by…the APA. It’s downright dysfunctional.

    I have a feeling that SOC v7 is going to be seen as a small step toward moving medical and social transition away from the APA’s realm and into that of the AMA. As I’ve said before, their insurance codes work just as good, if there’s coverage. The next move is going to be the APA’s when they release the DSM-5. I have a sneaking suspicion that they will inadvertently increase their irrelevancy…

    • sirgarreth says:

      Hello, and welcome! Thanks for stopping by. You make a really good point that the AMA insurance codes would also work. You have also drawn out the more monopolistic qualities of the process. I don’t have much but old news about how the process with the DSM-5 is going, but I hope that they move in the right direction.

    • sirgarreth says:

      Okay, so I’ve been thinking more about this, and here’s my question. What will stop the AMA from becoming the same sort of monopoly? I understand that there is an instantaneous benefit of no longer being classified as having mental issues, but what happens when the AMA comes up with its own process? We will still be at the mercy of potentially hostile medical professionals.

      And, also, is there any concern that the AMA might not be as flexible in terms of individualized transitions? I would be afraid of going back to the days where doctors were measuring the parts of intersex babies and determining such things, or emphasizing too much one’s biological sex.

      Will we still be able to have the flexibility to determine what we personally need to get out of transition? What do you think?

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