Saturday, May 25, 2013

Walt Heyer, Detransition and the WPATH SOC


Running around the internet, and speaking in various venues is a somewhat rare creature by the name of Walt Heyer who claims to be an "ex-Transsexual".  For the most part, I would ignore the man's claims, but I think it is important to review his position, as he continues to be a very vocal opponent of the treatment options open to transsexuals today - in particular he is overtly hostile to the idea of GRS (referring to it as "fraudulent", but also he is overtly hostile to the legal accommodations such as changing of gender markers on legal identification documents.  
As such, he represents a significant problem to the advocacy for equal rights for transgender people as a whole.  I spent a considerable amount of time a while ago reviewing Mr. Heyer's autobiography and his "Paper Genders" book.
Mr. Heyer’s case presents an excellent example of the importance of the principles embodied in the more recent standards of care, as well as serving as a counter-argument to those who argue that medical treatments related to cross-gender identity should be available “on demand”.
Mr. Heyer presents himself as a “former transsexual” or “ex-transsexual”.  He claims to have transitioned, had Gender Reassignment Surgery and subsequently de-transitioned after several years living as a woman.  He is actively campaigning against the treatment currently made available for transsexuals, mostly within the circles of the religious right wing of American political discourse.
However, much of Mr. Heyer’s assertions need to be understood in the context of his own history, and how his past aligns with respect to the WPATH SOC. 
[Warning - This is a lengthy essay]


[Note:  All bibliographical references to Mr. Heyer's books refer to locations in the Kindle digital edition of those books]


Looking beyond the substantial issues in Heyer’s forays into gender transition, some attention must be paid to the way that Heyer is trying to inject himself into the public policy dialogue related to trangender people, and the potential consequences of his efforts to take things into the court of public opinion.  
Mr. Heyer’s own transition journey from Male to Female needs to be reviewed in order to understand the depth and degree of failings that existed throughout his explorations of his gender identity issues.  The majority of this review is based on his story as he chose to describe it in his autobiographical book “Trading My Sorrows”.
Moving beyond Heyer’s own narrative, there are significant signs that political opponents of equality for transgender people are exploiting the narratives of Heyer and others who have similar stories to justify their continuing opposition to initiatives such as Bill C-279 which would have enshrined recognition of transsexual and transgender people explicitly in Canada’s human rights laws.
Mr. Heyer claims that his cross-gender explorations started when he was very young, however his journey even at this level bears a considerable deviation from the pattern so often described by transsexuals.  Instead of taking an active ownership of the cross-gender desires, he appears to pin them on an external source, his grandmother.
... But it was my Grandma Mamy who started a ball rolling that became the most destructive force in my life, the purple dress.  As part of our playtime together, Grandma would help me play dress-up in her clothes.  She was a great seamstress and she embarked on making me (a very young boy under ten years of age, I’m not sure of my exact age) a purple chiffon full-length evening dress.  I do not know if I requested it or if she just did it all on her own.  I stood on a footstool as she fashioned that dress, piece by piece, just for me.  I liked what she was doing.  To keep it a secret, the dress remained at her house, to be used when I stayed over without my brother for the weekends.  It became a regular part of my playtime to dress up in the purple chiffon evening dress in Grandma’s walk-in closet, with Grandma helping. ... [1. Heyer, Walt “Trading My Sorrows”, Xulon Press, 2006; Kindle Location 207] 
It seems particularly important that he declares that he cannot remember if he asked for the dress to be made or not.  In itself, this seems to be a small point until you consider that in later chapters of the book he describes being diagnosed with Dissociative Disorder.  While not conclusive in itself, the absence of certain key aspects of the memories associated with that dress is something of a flag that there is more to the story than just the dress. 
Dad exploded, not at me, but at my mom for having a mother who would make me a dress.  A major screaming fight broke out between Mom and Dad over that dress.  My dad threw it in the trash and emphatically reported that he was not having any sissy for a son.  He would make sure of that.  The worst of it was the reaction of my father’s parents and his adopted brother, my Uncle Fred.  My father’s parents became standoffish, and Uncle Fred made fun of me because I had worn the dress, shaming me.  Without any malice intended on her part, Grandma Mamy with her gift of a purple dress unwittingly set the table not only for my next painful and disturbing experience, but for a lifelong struggle with my identity as a man.
Only in his early teens, Uncle Fred was a little crazy by any standard and he snuck alcohol during the many family get-togethers.  Uncle Fred delighted in making fun of me having a purple chiffon evening dress.  He focused on my private parts:  pulling my pants down, grabbing me there, and calling me a sissy.  This was repeated time and again over the course of a couple of years.  
...
When my dad got home, my mom told him what I had reported so that since he was a policeman, he would clear this up.  He went over to see his brother and ask him what happened.  Uncle Fred said I was lying and that none of what I had said had happened.  That’s the way it would remain with my family - that I was making it all up.  ... [ 2. ibid 1, Location 204 ]
No doubt, this would have been deeply traumatic for the young Walt Heyer, and it appears in some respects to set the stage for much of what happens later on in his life and colours much of his behaviour with respect to gender issues.
 For a time, I withdrew into my own silent world, safe from the painful conflicts and discipline dispensed by my mother and father, where I spent my time imagining what it would be like to be a girl. [ ibid 1, Location 268 ]
The inner imagining of what life would be like as a member of the opposite sex is no doubt fairly common among transsexuals.  Even the idea of hiding it from their family is going to be routine.  However, this appears to have more to do with setting the framework for the dissociative issues that Walt Heyer reveals later on, as he seems to be using it to separate himself from a very difficult family situation.
During his adolescent and teenage years, Heyer describes some very troubling narratives that were going on in his head that should also be considered.  While they are superficially consistent with many transsexual narratives, they contain some significant deviations that will be highlighted.
The conflicts I faced now were all internal.  The girl with the purple chiffon evening dress had become like a bad neighbor who would not stop making noise and interrupting every good train of thought.  That girl in the purple chiffon dress was growing up with me, demanding more and more of my time.  She was always disruptive, and I wanted her to take her purple dress and move out of my life, but inexplicably she became stronger and stronger.  Although I was only a child, I had taken to cross-dressing in Grandma’s clothes, my mom’s clothes, evening sifting through neighborhood trash in search of discarded clothing to use to cross-dress.
Always hiding, I became great at covering it all up.  No one ever confronted me about my cross-dressing, so I knew I had successfully kept my secret.  But indulging cross-dressing is like feeding a small fire - it just gets bigger and bigger.  This fire was out of control.  Inside I was divided.  I desperately wanted that growing female to go away, but I enjoyed being a female so much that I desperately wanted to keep her alive.  At the same time I wanted to be completely Walt.  I felt like I was being torn in half. [ibid 1, Location 282]
The sense of division, and the fight within between Walt and “the Girl in the Purple Chiffon Dress” expressed here is deeply troubling from the perspective of understanding a transsexual narrative.  While some degree of dissociation can occur in transsexual narratives, it is more of a conflict between the inner person and the social role rather than what appears to be a conflict between two inner persons fighting for control.  
When Walt Heyer got married, he made a classic assumption that many transsexuals do - that somehow being married would be sufficient to enable them to overcome their conditions.  So many transsexuals find out that being married or starting a family has very little impact on their need to transition.  Similarly, other psychological conditions are unimpeded by marriage.  Internal conditions legitimately affect one’s inter-personal relationships, but it is unlikely for even a marriage relationship to stop the kind of internal conflict that is being described here.
As a husband and a man, I wanted very badly to detach myself from it all, to find a safe place free of conflict.  Being married by itself wasn’t doing it.  Just as I kept digging when I was a young boy with my red-handled shovel to carve a playing field out of a hill, now in my twenties, I kept search to find a path to restoration, healing and wholeness. I reasoned if marriage alone wasn’t the answer, perhaps if I could just pour myself into a career and be successful then the torment and obsession to cross-dress would go away. [ibid 1. Location 488]
While transsexuals do seek relief from the conflict between their inner truths and the image that they feel obliged to present to the world, few would ever say that they sought to make the cross-gender identity go away.  From a transsexual’s perspective, the attempts to live “a typical life” have a different focus - one of finding a refuge from the conflict, rather than to make the internal pressures and conflict go away.  
Much of his transition takes place within the context of working for Honda during the late seventies and early eighties.  By his own admission, while working at Honda he started drinking again.
... I was starting to wear down by the repeated requests to join him.  He wanted to know about my drinking habits.  I explained that I had stopped after years of too much drinking to excess.  He told me that this job required drinking with dealers, that they would think it odd if I did not drink at least a little. ...
... I needed to be successful at my career, so a drink would not be such a bad thing.  And after all, I had the strength of a year of sobriety and Jesus on my side.  I thought I was invincible.  So I made the choice that night to develop my relationship with Dan, whom I had known only for one day, to get in his favor, to show him I was one of the good old boys, by having a drink right now.  What I could not foresee was that my appetite for alcohol was unquenchable. [ibid 1. Location 573]
Of some interest is how Heyer describes the intersection of his drinking and his cross-gender feelings.
...The excessive drinking at work and the associated shame of hiding it from my family increased my raging desire to become a woman.  [ ibid 1. Location 631]
In the way this is worded, there is a subtle point that deserves consideration.  This is the second time in his biographical narrative that Heyer has described using his feminine desires as something to take refuge in from the pressures of his life.  The need to transition is no refuge from pressure.  In reality it is a huge pressure in itself for transsexuals and one that permeates into all other aspects of their lives.
A “girl” at the Roadrunner Bar who was a transvestite knew how to get on track for the surgery.  I went to the doctor she recommended and started taking female hormones.  The hormones didn’t seem to do much other than have a slight tranquilizing effect and lower my libido.
Under the premise of a “business trip” to one of my dealerships in Lake Tahoe, I had large breasts implanted by a plastic surgeon known for his work in the transsexual community.  After the surgery, my disheartened wife wanted nothing to do with me sexually, which didn’t matter to me, since my desire for sex was gone anyway.  I was too selfish to care about anything but me and my desire to be female.  To hide the breasts under my business suits, I flattened them out by wearing a wide strip of elastic.[ibid 1.  Location 649]
At this point, we start to journey into the chaos of Heyer’s attempts to transition.  Sadly, we start off with a number of red flags.  First off, it’s quite clear that Heyer has acquired hormones without availing himself of appropriate psychotherapy.  Second, it is surprising that anyone would willingly undergo breast augmentation without living full-time.  Binding is not a comfortable experience at the best of times, and in the first months after breast augmentation, it is doubly so. 
However, the pattern that this suggests is reinforced repeatedly in Heyer’s narrative.  The pattern is one of taking enormous, concrete steps such as breast surgery while not yet living full-time in the chosen gender role.  This is profoundly troubling, and no doubt sets the stage for a number of disasters that befall Heyer.
... Using the information I gleaned from the bar patrons and staff, I arranged a meeting with Paul Walker, Ph.D., to lay the groundwork for the surgery.  After only two visits, Dr. Walker diagnosed me with gender dysphoria and approved me for the surgery.  He had seen me on many occasions at the Roadrunner Bar.  Imagine!  I was married with children, a successful executive with a major automobile manufacturer, and had approval for this radical surgery.
And so it came to be that in 1981 I decided to end the lifetime of waiting and do the one thing I believed would make my mental anguish go away, once and for all.  I scheduled the surgery in Trinidad, Colorado, in the skilled hands of Dr. Biber, the renowned (in transsexual circles that is) surgeon who pioneered the surgical treatment for gender dysphoria.
Depending on whom you talked to, I was going on a “business trip” as I told my family, or taking a “vacation” as I told my employer.  Lying came easily to me now.  There’s a saying: “How can you ell if an alcoholic is lying? His lips are moving.”  My true destination was Trinidad, Colorado.  My true purpose was surgery.  I shared the details with you earlier:  how I panicked and walked the streets of town, torn apart by the conflict raging in my head, and finally I backed out, and returned home to tell my wife what I had almost done.[ibid 1.  Location 669]
Unfortunately, Heyer doesn’t tell us if he consulted with Dr. Walker after this aborted attempt to undergo GRS.  If he did not, it suggests a fairly serious failing on Heyer’s part to acknowledge and deal with what appears to be a very serious internal conflict over GRS on his part.  Someone who is not entirely ready for a procedure that will affect the intersection of identity with their body is likely to be setting themselves up for serious consequences subsequently.
It is, to say the least, surprising that Dr. Walker saw fit to approve anyone for surgery on the basis of only two visits.  If Dr. Walker was only providing the second letter and just doing a psychological assessment, it is possible.  However, Heyer  seems to imply that Dr. Walker was providing the only recommendation for surgery.  If this is the case, in the context of the current SOC documents (both version 6 and version 7), this appears to be a significant failure to implement the SOC protocol appropriately.  
I was totally alone.  Separated from my family, and on leave from Honda, I scheduled counseling visits with the director of Forest Home Christian Conference Center, Bob Kraning.  Bob knew of the intense turmoil, anger and pain I was causing my family, particularly my daughter.  He heard it first-hand in his separate counseling sessions with my wife and children.  He tried to get me to see the reality of what I was doing.  But more often than not, I was intoxicated and therefore unreceptive and incapable of listening.  The same was true of my sessions with Dr. Dennis Guernsey, the Ph.D. from Fuller Seminary. [ibid 1. Location 746]
To Heyer’s credit, he does seem to reach out for help.  I do note that it is not Dr. Walker that he engages, but two people whose qualifications to deal with cases like this are not clear.  What is clear is that he is clearly in crisis on multiple fronts of his life.  Heyer admits that his marriage is failing, his career is in jeopardy and he just experienced a serious personal conflict over surgery.  All of this is further compounded by alcohol addiction and growing internal pressures to have surgery.
I was so mixed up.  I took out the breast implants, trying to take away the power that the girl in the purple dress exerted over my mind.  She morphed from “Christal” into “Andrea”.  Funny thing about Andrea, she had different eating habits, different handwriting and a mellower demeanor than Walt.  She was a part-time person, appearing in full force when I was home alone.  Andrea was hell-bent on having the surgery to become a woman.  Walt wanted a normal life as a man. [ibid 1.  Location 758]
This paragraph is exceptionally informative.  First of all, it shows a strong partitioning between Walt and his feminine personas.  The second aspect of it all is that it strongly suggests that he was not working towards integrating “being feminine” with his life.  In fact, by having such strong partitions internally, he is setting up to never make that integration.  He assigns all of the desire for GRS to “Andrea”, as if she is an entirely different person than Walt.  This is considerably at odds with the kind of integration that takes place during a conscientious and well thought out gender transition.
... I again gained approval from the psychologist Dr. Paul Walker to allow Dr. Biber to perform the surgery.  This time the surgery was set for April, 1983.
Alcoholics can be baffling and incomprehensible in their way of thinking.  I formulated a simple plan for living my life after surgery.  I would live as two people, living simultaneous lives.  The male, Walt, would continue to work as a male after the surgery, using a male identity.  Off-work time would be reserved for the female persona known as Andrea West.  This way I thought both the female and the male could each reign supreme, and my conflict would be resolved.  This seemed very logical and workable.  I thought I would finally be at peace. [ ibid 1.  Location 781]
To a transsexual, the logic of this kind of a scheme is somewhat baffling.  It also further underscores the fact that Heyer was not living full-time in the female gender role prior to undergoing GRS.  While not entirely inconceivable, it does seem at odds with the kind of readiness checks that should be done prior to being referred to a surgeon.  Again, Heyer doesn’t tell us anything about whether he discussed this plan with Dr. Walker or not.
It’s hard to describe how the desire for surgery takes over, especially when combined with abuse of alcohol.  It took on the appearance of an obsessive-compulsive disorder, like a bulldozer pushing me relentlessly and single-mindedly toward surgery, while destroying every obstacle in its way.  Lying, cheating, and manipulating were my tools of the trade.  I became expert at persuading everyone that surgery was the treatment I needed.  In my compulsion to have surgery, I plowed right through and over everyone and everything that stood in my way.  Too bad hindsight always comes too late for us to see how truly stupid our process is. [ibid 1. Location 787]
Now it becomes clear why there are so many puzzling inconsistencies in Heyer’s story regarding his pursuit of GRS.  He basically admits to lying to anyone whom he thought would stand in his way.  This calls into question the honesty and clarity of his assessment sessions with Dr. Walker.  We do not have transcripts of these sessions, nor do we have Dr. Walker’s notes.  However, it is reasonable to assume that Walt Heyer was not entirely up front with Dr. Walker about his experiences on the basis that much of what he was experiencing would have called into question his suitability for GRS.
Laura, Laura, can you hear me?”  It was the surgical nurse trying to wake me up.  Walt traveled to Trinidad for surgery; Andrea signed the authorization papers, but told the attendants that a new name would identify the new woman:  Laura Jensen.  Not Andrea, not Walt, not Christal West, just Laura Jensen.
I had the most wonderful feeling that the weight of the world had been lifted from me.  I was in a place of rest deep within me with no battles, no confusion, and no tormenting thoughts.  This sense of serenity was unlike anything I had ever experienced before at any any other time of my life.  I felt good, real good.  I was very much at peace, very happy.  At forty-two years old, I was finally a woman, or was I?
My boss at Honda granted my request for two to three weeks of medical leave, which I said was for gall bladder surgery.  It wasn’t a complete lie.  I needed gall bladder surgery, so I deliberately scheduled it back-to-back with the other surgery.  I figured it made a great cover-up.  I had gender reassignment surgery in Colorado on Tuesday, was released from the hospital and flew back home on Friday, then on Monday, drove about a hundred miles to the other hospital for preoperative gall bladder preparations.
My gall bladder surgeon was surprised when I told him about the previous week’s surgery.  Upon a complete “up-close and personal” inspection he said that Dr. Biber had performed it well.  But he was concerned that my strength would be challenged by having a second surgery so soon.  Recuperating from one surgery wasn’t easy, from two was certain to be difficult.  I convinced him to go through with it. [ibid 1. Location 802]
This little tale contains a number of aspects that are red flags.  First on the list is the fact that Heyer seems to have felt it necessary to conceal from his employer the nature of the surgery he was about to undergo.  Even accounting for the fact that this was the early 1980s, this is a nonsensical move unless Walt Heyer was not living full-time as a woman.  Even more troubling is the implication that he would have had to conceal this same reality from the therapists who would be writing the letters for surgery.
There is a second aspect of this that is difficult to make sense of.  Heyer describes having two major surgeries within a week.  Short of a life threatening emergency, it seems unlikely that any surgeon practicing with reasonable ethics would do such a thing.  At five days after GRS, the patient is still severely swollen around the surgery site, and there are a significant number of stitches in place that have to be removed by a nurse.  It seems unlikely that Heyer was in any shape to undergo a second surgery so soon after undergoing GRS, or even travel as he claims he did.
As one might expect, Heyer didn’t exactly handle his workplace situation any better than he handled his family, or for that matter himself when it comes to the whole process of transition.  
In mid-October, six months after my surgery, my boss Tom and I met for one of our regular evening meals together.  Somehow I managed to get the words out:  that I had undergone gender reassignment surgery and my new name was Laura Jensen.  
...
... They had their ducks lined up.  In return for six months’ severance pay, I was to go away quietly.  I wasn’t ever to tread on Honda property again or discuss my termination with anyone.  If I resisted or fought them, they would justify their decision to “lay me off” by saying that my position had been eliminated. [ibid 1. Location 842]
At this point, a review of Heyer’s post-operative life as he describes it in Trading My Sorrows is worth a few moments.  We know that he spent six months after surgery concealing the change from his employer and colleagues.  When he did reveal it, he found himself fired.  This isn’t terribly surprising, since his narrative seems to give very little room for his workplace to appropriately set the tone for such a transition.
More significant is that Heyer had GRS done at a point in time when he wasn’t living full-time, nor had he even begun dealing with alcohol and drug abuse problems.
... I remembered a lady from my days at Renault who had told me if I ever wanted to get sober she knew someone who could help me.  I stumbled into a coffee shop near the park and made the call.  The following day she picked me up and took me to my first Alcoholics Anonymous (AA) meeting.
I was a disgusting, messed-up sight by any standard:  a half-man, half-woman smelling of vomit and body odors after a night spent sleeping outdoors.  Beard stubble poked out in patches on my face where electrolysis still needed to be done. ... [ ibid 1. Location 887]
Mr. Heyer only appears to have attempted to live as a woman for about two years before he starts to transition back to living as male.  Based on much of his narrative, it seems fairly clear that he likely only lived a small portion of that time “full-time” as a woman.
It was late 1985, about two years after my termination from Honda, a few months after arriving in the loving arms of the Thompson family, with about a year of sobriety.  Now I was realizing I was a man wrapped in a woman’s masquerade, a fake, a fraud, a mutilated man. ... [ ibid 1. Location 1037] 
Heyer’s foray into gender transition is a litany of risky choices, with disastrous outcomes almost every time.  By his own admission, Heyer was not fully honest with anyone during the course of his attempts at transition.  It is the lack of honesty that likely undermines most of Heyer’s efforts.
Additionally, it seems quite clear that Heyer never actually lived full-time as a woman prior to undergoing GRS, and after having surgery, he doesn’t seem to have actually lived full-time as a woman for very long either.   This is not a reassuring start at all.
There is a list of other issues that should have been addressed as part of his transition.  His own narrative regarding his childhood cross-gender experiences suggests some issues which should have been addressed during the earlier stages of his journey.  Also, being addicted to alcohol seems like a serious enough condition to warrant needing to be under control well before Heyer would be a candidate for something as life altering as GRS.
Most significant though is that Heyer does not seem to have maintained a working relationship with a psychotherapist knowledgeable in the treatment of gender identity issues.  His statements regarding Dr. Walker suggest that he did not attend with Dr. Walker on any kind of long term, regular basis.
Much later in his life, Walt Heyer does consult with a psychologist again, this time he seems to have been sufficiently distressed that he was able to give the psychologist enough of his overall story to come to a completely different diagnosis than gender identity disorder - one of dissociative disorder.  Once he starts to address things from this context, he appears to become much more grounded in himself.
I clung to the revelation that Dr. Walker had made in his letter the year or so before:  “I assure you that I share, as best I can, some of your pain that this mistake has caused to you” (italics mine)
Seeing the word “mistake” in a letter from the expert who approved me for surgery gave me an important piece of truth which began the healing of my innermost being.  The surgery was all a mistake, performed as treatment for a disorder I didn’t have.  I wasn’t a man trapped in a woman’s body.  I was an alcoholic with dissociative disorder trying to escape the pain of my childhood. [ibid 1 Location 1539]
In the context of the WPATH SOC (7th Version), Heyer’s forays into transition become all the more troubling.  In the section “Tasks of Mental Health Professionals Working with Adults Who Present With Gender Dysphoria”, we find the following:
Mental health professionals assess clients’ gender dysphoria in the context of an evaluation of their psychosocial adjustment (Bockting et al., 2006; Lev, 2004, 2009). The evaluation includes, at a minimum, assessment of gender identity and gender dysphoria, history and development of gender dysphoric feelings, the impact of stigma attached to gender nonconformity on mental health, and the availability of support from family, friends, and peers (for example, in person or online contact with other transsexual, transgender, or gender nonconforming individuals or groups). The evaluation may result in no diagnosis, in a formal diagnosis related to gender dysphoria, and/or in other diagnoses that describe aspects of the client’s health and psychosocial adjustment. The role of mental health professionals includes making reasonably sure that the gender dysphoria is not secondary to or better accounted for by other diagnoses. [19 Coleman et. al. “Standards of Care For The Health of Transsexual, Transgender and Gender non-Conforming People, Version 7”, WPATH 2012, P. 23]
With respect to the late diagnosis of Dissociative Disorder, one cannot help but wonder if Mr. Heyer’s story might be quite different had he been working consistently with an appropriately qualified mental health professional all along.  
At the very least, it seems quite significant that in the late 1970s when Heyer is making his first forays into transition that the issues he identified related to his childhood experiences, as well as the alcohol abuse are not adequately treated.  Even going back to older versions of the Standards of Care, concurrent conditions such as alcoholism need to be appropriately dealt with as part of the overall treatment of a client.
The Ten Tasks of the Mental Health Professional. Mental health professionals (MHPs) who work with individuals with gender identity disorders may be regularly called upon to carry out many of these responsibilities:
1. To accurately diagnose the individual's gender disorder;
2. To accurately diagnose any co-morbid psychiatric conditions and see to their appropriate treatment; [HBIGDA SOC v6 - Retrieved From http://www.wpath.org/documents2/socv6.pdf Sept 17, 2012]
If nothing else, these requirements in the SOC make it clear that diagnosis and treatment of patients presenting with Gender Identity conditions must be handled carefully.  Those who attempt to transition without adequate mental health support may well be doing so on the basis of an incomplete or, in Heyer’s case, outright wrong, understanding of their motivations for wanting to transition.
Among the interesting aspects of Heyer’s personal narrative is that he appears to have been able to acquire access to cross-sex hormones without a referring letter from a psychologist or psychiatrist.  This represents one of the troubling failures in Heyer’s transition experiments.  The prescribing physician appears to have been either unaware of the SOC, or unfamiliar with the protocols of the various gender clinic programs that were in operation during the 1970s and 1980s.  Few, if any of the formal programs from that era would have supported providing hormones without a supporting recommendation from a psychologist or psychiatrist.
Again, the absence of consistent involvement with a mental health professional shows up in the fact that Heyer’s experience of hormones is relatively negative.  He expresses disappointment at the effect that they seemed to have on him, and only notes a mild change in his sex drive.  This is considerably at odds with the experience that other transsexuals often describe with respect to taking hormones.
Many male-to-female transsexuals who begin hormone therapy report that the hormones have a calming effect on them and they seem to reduce tension and anxiety.  Whether this is due to bio-chemical changes or to the placebo effect, is not clear.  It may well be a combination of these two factors. [Stuart, K.E., “The Uninvited Dilemma - A Question of Gender”, Metamorphous Press, 1991, P. 86] 
While not conclusive, the fact that Heyer describes little or no effect from the hormones, and goes off to have breast augmentation performed surgically suggests that his focus was very external, rather than internally focused.  The physical changes that hormones induce take months and years, but the frequency with which positive mental changes are reported cannot be ignored.  A patient reporting little or no desirable effect may warrant further therapeutic investigation.  
Here again, Heyer’s experience is well outside of the general framework that the WPATH SOC lays out.  He obtained hormones apparently without a therapist’s involvement, and does not describe any ongoing follow-up regarding the hormones and his experience of them.  
With respect to surgeries, Heyer describes undergoing many procedures to feminize his appearance in addition to undergoing GRS.  It is somewhat surprising that Dr. Biber was apparently willing to accept Heyer as a patient with only a referral from Dr. Walker.  Even the older versions of the SOC appear to be consistent about the two letter requirement.  However, we do not know the extent to which Heyer may have lied to various providers, including therapists to gain the approvals needed for surgery.[Note that in the text referred to in citations 13 and 14, Heyer admits to lying to others in his rush for Gender Reassignment Surgery.  This calls into question the degree of culpability that he attempts to pin on the treatment community in his book “Paper Genders”.]
Further, given that it takes more than a couple of sessions for a psychologist to do an assessment of someone for GRS, and Heyer is claiming that Dr. Walker referred him for surgery on the basis of only two visits.  Here, we find one of the rare times when there is a mitigating circumstance that demonstrates a potential breakdown on the treatment provider side of the equation that does not hinge almost entirely on Heyer’s actions, or lack of them.
I interviewed Dr. Paul Walker in his Union Street office three times during the 1980s.  Over a period of about six years we exchanged letters and notes with our thoughts and views regarding failures and the approval process.
Dr. Walker was a homosexual psychologist, and a strong advocate for gender surgery.  He admitted to me that he regretted approving at least one or more surgeries when he was under the influence of addiction to prescription medication and alcohol.  He told me that his addiction came as a result of a spiral leg break.  He claimed he was being open and transparent with me as part of his recovery, that admitting when he was wrong was a way toward healing.[23 Heyer, Walt “Paper Genders”, Make Waves Publishing, 2011, Location 1336]
Addiction to pain killers certainly could have impaired Dr. Walker’s judgment.  It is hard to say to what degree this was the case.  While this does to some extent mitigate Heyer’s personal responsibility with respect to GRS, we cannot ignore that it was Heyer who approached Dr. Walker for that referral, and we do not know the extent to which Heyer engaged in full disclosure when being referred.
In the case of Walt Heyer, it leads to the inevitable conclusion that either he was some kind of genius in terms of concealing his alcoholism, or his therapist failed to pick up on the clues.
I clung to the revelation that Dr. Walker had made in his letter the year or so before:  “I assure you that I share, as best I can, some of your pain that this mistake has caused to you” (italics mine)
Seeing the word “mistake” in a letter from the expert who approved me for surgery gave me an important piece of truth which began the healing of my innermost being.  The surgery was all a mistake, performed as treatment for a disorder I didn’t have.  I wasn’t a man trapped in a woman’s body.  I was an alcoholic with dissociative disorder trying to escape the pain of my childhood.[ibid 1. Location 1539]
  
One has to imagine that had Heyer been working consistently with a therapist who applied the current SOC throughout his forays into transition that many of the issues that ultimately led to a diagnosis of Dissociative Disorder could have been dealt with without Heyer ever undergoing GRS.  The transition process is lengthy and takes multiple years to complete.  It is very difficult to maintain falsehoods over such lengthy timeframes, and it seems quite likely that a skilled therapist would have picked up on Heyer’s admitted attempts to manipulate and lie to achieve specific goals.
In some respects, someone like Walt Heyer is an example of someone who attempted transition without appropriate supports as described in the current WPATH Standards of Care.
Consider his approvals for surgery with respect to the requirements for GRS as they are defined in today’s WPATH SOC document:
Criteria for metoidioplasty or phalloplasty in FtM patients and for vaginoplasty in MtF patients:
  1. Persistent, well documented gender dysphoria; 
  2. Capacity to make a fully informed decision and to consent for treatment; 
  3. Age of majority in a given country; 
  4. If significant medical or mental health concerns are present, they must be well controlled; 
  5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (un- less the patient has a medical contraindication or is otherwise unable or unwilling to take hormones). 
  6. 12 continuous months of living in a gender role that is congruent with their gender identity;[ibid 19. P 60]
Based on Heyer’s own narrative, it is not at all clear that that he met any of the last 3 conditions adequately.  Certainly, his alcoholism had not been addressed by this point in time, nor had he even begun to address the issues that had arisen from his childhood experiences.  Certainly he had not been living full-time in his chosen gender at that time.  He may have been taking hormones for a sufficient length of time, although that is unclear from his narrative, since he doesn’t really discuss taking them beyond how he initially got access to them.
When it comes to hormone treatment itself, Heyer would not have met the basic requirements under the SOC either.
Criteria for hormone therapy
Initiation of hormone therapy may be undertaken after a psychosocial assessment has been conducted and informed consent has been obtained by a qualified health professional, as outlined in section VII of the SOC. A referral is required from the mental health professional who performed the assessment, unless the assessment was done by a hormone provider who is also qualified in this area.
The criteria for hormone therapy are as follows:
  1. Persistent, well-documented gender dysphoria; 
  2. Capacity to make a fully informed decision and to consent for treatment; 
  3. Age of majority in a given country (if younger, follow the Standards of Care outlined in section VI); 
  4. If significant medical or mental health concerns are present, they must be reasonably well- controlled. [ibid 19.  P. 34]
First, Heyer’s own narrative makes it clear that no psychosocial assessment was done prior to starting hormones.  Chances are very good that many of the childhood issues that Heyer describes would have been identified at that time, and some kind of meaningful treatment could have been started.  Similarly, it is possible that his alcoholism would have been identified at that time.  
It is difficult to say what course Heyer’s life would have taken had he been working with the treatment framework that the WPATH SOC version 7 lays out, but it seems far more likely that he could have stopped himself from making the more disastrous choices that he describes, especially after his first aborted attempt to undergo GRS.
Given the growing demand from some sectors of the transgender community for on demand access to hormones and surgeries without any assessment, Heyer’s story represents an example of how badly awry things can go in such circumstances.  In the process of his failed forays into transition, he repeatedly makes critical errors which a more coherent treatment team could have helped to avert.  
Similarly problematic is the “outside” view of the opponents of transsexuals and the treatment of the community which exploits people like Walt Heyer to portray both transsexuals and the treatment professionals who help them in an extremely negative light.
Michael Coren has interviewed at least two “ex-transsexuals” on his SunTV program, Walt Heyer [27 Coren, Michael, “Gender Bender” - The Arena, SunTV October 11, 2011, Retrieved from http://www.sunnewsnetwork.ca/video/search/all/source/the-arena/gender-bender/1213355193001/page/2 Sept 18, 2012] and one fellow whose pseudonym was “John” [28 Coren, Michael, “Transsexual Trauma” - The Arena, SunTV September 11, 2012, Retrieved from http://www.sunnewsnetwork.ca/video/search/all/source/the-arena/transsexual-trauma/1834824166001 Sept 18, 2012]
.  In both interviews, Coren and his guests make allegations that should be considered very problematic for the treatment community.  A brief survey of archives on SunTV’s website turns up one to two references to gender disorders a month since late 2011.  This suggests the beginnings of a concerted political campaign aimed at discrediting not just transsexuals, but also those who provide treatment to them.
Consider the following excerpt from Coren’s interview of Walt Heyer on October 11, 2011:
Coren:  This is fascinating because I’ve seen this in Canada and I wanted to ask you about the US and perhaps the rest of the world.  If someone goes to a psychiatrist and says “I feel that I am a woman trapped in a man’s body”, I’ve heard psychiatrists in Canada say that if we say that this is a disorder and we can help you with it we could actually lose our license.  If there was a complaint made we could be in severe trouble.  Is that true in the states too?

Heyer:  Yeah, that’s exactly right and this is where Kinsey many years ago started this whole process of, you know, just being crazy with gender and being crazy with homosexuality and today it’s just kind of taken over.  People who need good psychiatric and psychological treatment cannot get it because they’re taking these evaluations out of the DSM the manual that allows the psychologist or psychiatrist to evaluate people. [ibid 27] 
  • Emphasis Added

The suggestion that somehow where transsexualism is concerned that “needed psychological care” is unavailable the moment that a client asserts that they are transsexual.  This is patently false, especially when the WPATH SOC is so explicit about the management of concurrent conditions.
 In part, these misperceptions are political in their origins, but we cannot ignore the impact of the “treatment on demand” advocacy from within the transsexual community.  At the forefront of this are organizations like the “Harry Benjamin Syndrome Information” society ( http://www.shb-info.org ), which has published their own “Standards of Care” document on their website, the outline of which is loosely derived from the version 6 HBIGDA SOC.  In their comments about diagnosis, we find the following:
VIII. Diagnosis and Treatment.

Psychological follow up is very useful for a proper diagnosis of this condition and its physical treatment afterwards can correct it completely. The early treatment of Harry Benjamin Syndrome can eliminate virtually all the symptoms of the condition although it can be reasonably assumed that having suffered the long terms effects of untreated Harry Benjamin Syndrome may result in the need for some proper and effective counseling to eliminate or diminish the lingering and possibly damaging after effects. [30 
Goiar, Charlotte,  Proposal of Standards of Care For Harry Benjamin Syndrome, May 2006.  Retrieved from http://www.shb-info.org/id34.html Sept. 18, 2012.] 
The implications of these demands are clear.  The patient is to be given access to hormones and surgery without there being any kind of psychological assessment in place.  To someone unfamiliar with the WPATH SOC, these kinds of documents can be very misleading about the situation, and provide fodder for people like Heyer to argue against making transition available as an option for transsexuals at all. 
Anyone has the right to undergo elective or cosmetic surgery on his or her own body.  But we as taxpayers should objct when we are expected to pay for it in some way, such as through taxes or insurance premiums.
Is the gender surgery medically necessary?  The definition of medically necessary is treatment that is absolutely necessary to protect the health of the patient and if withheld could adversely affect the patient’s condition.
The activists say sex-change surgery is as much a medical necessity as treatment for diabetes or high blood pressure.  Really, high blood pressure and diabetes equal to gender surgery?  Let’s be real - the gender surgery is only cosmetic.  It hardly rises to the level of medically necessary.
One way to arrive at an answer is to look at court rulings.  I would assume that if the medical necessity of the surgery has been proven, the courts would order that it be given to prisoners, for example.  If a prisoner were denied surgery to remove a ruptured appendix, they would die.  Not so easy to see in the case of gender disorders. [ibid 23.  Location 1246]
Heyer’s assertions regarding the availability of treatment and how it is delivered mostly seem to be “it was wrong for me, therefore it’s wrong for everyone” arguments.  Obviously, such arguments are generally weak, but they should not be ignored, either.  Especially in the context of the obvious problems in Heyer’s own transition story.
The loudest complaints appear to be coming from people who have transitioned outside the WPATH SOC, and failed to adequately address some of their core issues.  They are now making sweeping statements that are not substantiated by objective evidence, and these statements are being used in the political arena to limit the ability of transgender people to actually access supporting treatments.
We should be careful about how we understand some of the claims being made by “former” transsexuals and how they are being exploited by the right-wing media as part of their campaign against not just transsexuals, but against equality rights for all sexual minorities.
While it is unavoidable that some people will attempt gender transition who are not strong candidates, it is important to recognize that those cases do not represent all who transition, nor should they be seen as anything other than a cautionary note for those who are considering or pursuing transition.  
Given the obvious issues in Mr. Heyer's story with respect to transition, it is important to recognize that his own decisions significantly influenced not only his transition, but the outcome.  His unwillingness to take responsibility for resolving some obviously key issues in his life prior to attempting gender transition, or at least in parallel with his gender transition efforts, call into question the validity of his claims that he was mishandled by the treatment professionals he interacted with.  
His insistent projections that what happened to him describes the norm for treatment of transgender people simply does not make sense.  He continues to twist the results of legitimate studies of transsexuals on his blog.  Given the problems with his positions  
Work Cited
  1. Heyer, Walt  “Trading My Sorrows”, Xulon Press, 2006, 
  2. Heyer, Walt “Paper Genders”, Make Waves Publishing, 2011
  3. Coleman et. al. “Standards of Care For The Health of Transsexual, Transgender and Gender non-Conforming People, Version 7”, WPATH 2012
  4. HBIGDA, “HBIGDA SOC Version 6”, HBIGDA, 2001 - Retrieved From http://www.wpath.org/documents2/socv6.pdf Sept 17, 2012
  5. HBIGDA, “HBIGDA SOC Version 5”, HBIGDA, 1998 - Retrieved From http://www.tc.umn.edu/~colem001/hbigda/hstndrd.htm  Sept 17, 2012]
  6. Coren, Michael, “Gender Bender” - The Arena, SunTV October 11, 2011, Retrieved from http://www.sunnewsnetwork.ca/video/search/all/source/the-arena/gender-bender/1213355193001/page/2 Sept 18, 2012
  7. Stuart, K.E., “The Uninvited Dilemma - A Question of Gender”, Metamorphous Press, 1991
  8. Goiar, Charlotte,  Proposal of Standards of Care For Harry Benjamin Syndrome, May 2006.  Retrieved from http://www.shb-info.org/id34.html Sept. 18, 2012
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Appendix A - Transcript 

Coren, Michael, “Gender Bender” - The Arena, SunTV October 11, 2011, Retrieved from http://www.sunnewsnetwork.ca/video/search/all/source/the-arena/gender-bender/1213355193001/page/2 Sept 18, 2012 
Coren:  Transgendered, Transsexuals, sex-change and so on.  The whole issue is soaked in propaganda.  So we thought we’d speak to someone who was directly and personally involved.  Walt Heyer joins me now from Los Angeles.  Welcome to you!

Heyer:  Hi, How ya doing?

Coren:  I am well.  Let’s begin.  Please tell us your story.

Heyer:  Well, as a young child I had a grandmother who apparently I gave some impression to her that I should be a female or that I wanted to be a female and so my grandmother at the young age of five or six or seven made me a purple chiffon evening dress and I was on the journey to changing genders for next thirty five years. 

What I found out is that this struggle with gender issues people just do not understand that they really evolve out of psychological or psychiatric issues.  The gender issue is only a symptom of something of a much deeper problem within children like it was with me.  And I had been suffering actually a dissociative disorder because of some sexual abuse that I had suffered from; from physical abuse that I had suffered and it came out in a way that was wanting to escape the gender I was in.  so ... 

I eventually had the gender surgery at age 42 and lived as a female, Laura Jensen, for about eight years until I realized that the gender surgery first off not one person has ever actually changed  their gender as a result of the surgery.  You have to be sort of cooperating with the madness to assume a different gender.  This surgery does not change your gender and I think that’s important to understand.  It’s a cosmetic procedure it does not change your gender at all.

Coren:  Now, my heart goes out to you because what your grandmother did initially was so irresponsible if not abusive.  What you’re saying now, I guarantee you, after people see this, there will be complaints to human rights commissions in this country.  We’re not allowed in broadcasting to even use this sort of language.  Someone is what they say they are and to refer to someone as a he if they claim to be a she you can be punished for this in Canadian broadcasting.  Can we have a debate about these issues, are we allowed to any more?

Heyer:  Well, you know, we really should be allowed to tell the truth and the truth is that people who are presenting a different gender are really not a different gender at all.  It’s just total madness and I think what’s happened is that political correctness is now cooperating with a madness and people aren’t getting the psychological treatment and psychological evaluations that they need.  Especially with children such as we see Dr. Spack who at the Boston Children’s Hospital is giving hormone blockers to children.  And he claims that he started this procedure because of a Dutch study and in my book “Paper Genders”  I started to write about the Dutch study and the Dutch study says you really shouldn’t be doing these hormone blockers on young kids that 61% of the people who present gender issues are actually suffering from mood disorders or identity disorders or dissociative disorders or psychiatric disorders.  And what’s happened now is that the political correctness prevents people from actually going to a psychologist or psychiatrist and getting the treatment that they need so that they can actually avoid doing surgery or changing genders.

Coren:  This is fascinating because I’ve seen this in Canada and I wanted to ask you about the US and perhaps the rest of the world.  If someone goes to a psychiatrist and says “I feel that I am a woman trapped in a man’s body”, I’ve heard psychiatrists in Canada say that if we say that this is a disorder and we can help you with it we could actually lose our license.  If there was a complaint made we could be in severe trouble.  Is that true in the states too?

Heyer:  Yeah, that’s exactly right and this is where Kinsey many years ago started this whole process of, you know, just being crazy with gender and being crazy with homosexuality and today it’s just kind of taken over.  People who need good psychiatric and psychological treatment cannot get it because they’re taking these evaluations out of the DSM the manual that allows the psychologist or psychiatrist to evaluate people.  I had what they said was a dissociative disorder and they said I had thirteen different personalities.  Now that was only discovered because I was working as a chemical technician in a psychiatric hospital and the psychiatric doctor noticed things in my behaviour that caused him to raise questions about my having multiple personalities.  So it was only a result of working in a psychiatric hospital that I was able to be evaluated properly and then to be treated properly and then to be able to return to my birth gender.  I get letters from people frequently who are returning to their birth gender.  People are going from male to female and back to male again because the surgery does not resolve the psychiatric issues that people suffer from and the advocates won’t let you get the treatment that you need so that  you can avoid surgery.

Coren:  You know, we have to address this again because we haven’t go any time left. Would you come back on the show? 

Heyer:  Oh, I’d be happy to do so.  I’d love to.

Coren:  But I guarantee that there will be repercussions even that we have dared have this interview.  Thank you for your courage and your time.


8 comments :

HenryHall said...

Cracked Crystal Ball writes: ...counter-argument to those who argue that medical treatments related to cross-gender identity should be available on demand

Actually the opposite conclusion is reachable and Heyer is a case in point as to why treatment should be available on an informed consent basis. (Which is not exactly on demand, since physical fitness at least is required).

Heyer's problem, put simply, is that Heyer has not grown up. Nothing more. Heyer fails to take adult responsibility for Heyer's own decisions. Instead Heyer relied on medical diagnosis, which obviously lacks validity (at best) and is a breach of human rights at worst.

Adults need to be empowered, not subjugated and forced to face taking adult responsibility for major life decisions. Heyer has been damaged by medical colonization of the transgender transsexual journey. And now blames medicine, society, and indeed anyone but Heyer.

Anonymous said...

I happen to know a thing or 3 about Dr. Walker's clinic at UTMB in Galveston, Texas and I can't believe that he would have approved surgery for someone he met only twice. Folks who went through that program knows that there were group meetings you were expected to attend, lots of proving yourself to the docs and lots of hoop jumping. Also, NO TRANSSEXUAL would be approved for surgery if they were married. Walker wrote the standards of care in 1979 and that was one of his standards.

I call BS. He may have seen Paul Walker, but without seeing proof - as in a letter signed by Walker or medical records - I'm thinking that this guy isn't being truthful.

MgS said...

@HenryHall: There is an enormous difference between "informed consent" and "on demand".

HenryHall said...

@MgS Yes of course there is a huge decision between informed consent and on demand.

Just about no-one would propose on-demand surgery where somatic (physical health) requirements are not met. The issue centers around mental health diagnosis and mental health services.

The European parliament has called for removal of the GID and similar diagnoses from ICD-11 and that the transgender transsexual journey should be without mental health services (in most, not all, cases). Involving mental health services gives people false confidence (they believe diagnoses that lack validity ) and enables them to shirk adult responsibility.

Mental health services are the problem, not the solution.

MgS said...

@HenryHall:

I will respectfully disagree with your assessment regarding the importance of mental health issue management as part of gender transition.

That is, however, a somewhat complex topic which I will endeavour to address in more detail in a post of its own, not in the comments for this post.

In many respects, I would argue that Mr. Heyer's case is in some respects a case-in-point as to why practitioners such as surgeons are going to continue to insist on some kind of psychological assessment prior to surgery.

As an aside, given the general lack of clarity that most politicians have with respect to transgender people in general and transsexuals in particular, I am reluctant to accept the European Parliament's position as definitive on the matter.

As I said earlier, I will clarify my thoughts on the matter in a subsequent post.

HenryHall said...

Intended as a communication, rather than for publication

>> That is, however, a somewhat complex topic which I will endeavour to address in more detail in a post of its own

Good, the issue needs addressing, a very valuable thing to do.

One of the criteria of the EP in its decision is that under the ECHR, the medical exception to the human right of privacy of family life applies to diagnosis and to infectious diseases. It does not apply to treatment of non-infectious conditions.

Which is why psychiatry in a context of so-called RLE (as contrasted with diagnosis) is unethical on a basis of human rights.

That RLE is an effective treatment does not (of itself alone) create grounds for violation of human right to a private family life. It was very much the same for homosexual psychopathology.

MgS said...

@HenryHall:

Do you have the complete text of the resolution? All I can find on an initial dig is a press release which does not seem to support the allegations that you are making with respect to the SOC treatment guidelines and human rights.

http://www.lgbt-ep.eu/press-releases/who-must-stop-treating-transgender-people-as-mentally-ill/

HenryHall said...

Full text is at http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P7-TA-2011-0427+0+DOC+XML+V0//EN&language=EN

Note particularly, but not only, paragraphs 13 and 16

No psychopathology and no psychiatry are two separate issues, both formally supported by the EP.

EP (27 nations) is not CoE (47 nations) but the EP rationale arises from the CoE ECHR right to a private family life. Medical exception is limited to infectious conditions. RLE is incompatible with private family life hence a violation of human rights.