Wednesday, July 17, 2013

More From The "I Regret GRS" Club

Another pseudo-anonymous letter allegedly from a transsexual who regrets having GRS has been posted on Walt Heyer's blog.

Why do I say "pseudo-anonymous"?  Because, frankly, I'm not at all sure that Heyer hasn't written it himself - there are some significant overlaps with aspects of Heyer's own story which I have critiqued in detail already.  I am not at all convinced that we aren't looking at a sock puppet.

However, even if it is a 'sock puppet', it is worth taking a closer look at what is said - in part because it attempts to critique the latest edition of the WPATH Standards of Care.

I have tragically come to realize my story is fairly typical of most MtF persons. I was molested by my "trusting" grandfather at age 3, father was killed at age 5 and while my mother remarried; you could essentially say I grew up without a "father figure" or role model.

There are a couple of things here that set off alarm bells for me.  First is the "I was sexually molested" line, and the attempt to link it to "most MtF" transsexuals.  The religious right wing, aided and abetted by people like Heyer love to try and associate transsexuality with some kind of flawed upbringing - in particular sexual abuse or the absence of an appropriate father figure - both are common tropes, with no basis in evidence.  Yes, a percentage of transsexuals were sexually abused as children, but so are a percentage of non-transsexuals.  Any attempt to declare a causal link here is sloppy reasoning or wishful hypothesizing.

By my late thirties, this feeling of a "feminine core" continued. It led me to purchase online and experiment with Estrogen and an Anti-Androgen. My body slowly started to feminize. I dieted and exercised feverishly and got my body down to an acceptable female weight. I felt great; this must be who I am?
I remarried again in my early forties to a wonderful woman. Yet, the programming in my mind was so scrambled by then that it was difficult to differentiate between reality and fantasy. By the time I started seeing a gender therapist and a surgeon they were as convinced as I was that I was female.
Since I was already on estrogen, the endocrinologist felt morally/ethically obligated to continue that same protocol and at least monitor it and prescribe it legally. I received my first letter for surgery after a year and the second after two years. My childhood issues were jotted down by the therapists almost as if a side note. (A very common failure in approving surgery.) At no time did I tell my family, consider my career or even consider talking to the love of my life of my plans. This "sickness" and it is a sickness, consumes and takes over your life! You will lie to everyone around you as you continue to lie to yourself to get it done.
Thought number one here:  The person seems to have started by self-medicating - taking hormones apparently without the supervision of a doctor or even a psychologist.  I've seen this line before - almost always from people who attempted transition that shouldn't have in the first place.

The second point here is that the person does not appear to have engaged with a therapist until they had walked a long ways along the physical transition path.  This is consistent with Heyer's own biography, in which he clearly did not engage with a therapist on any consistent basis.  It has long been my opinion that there is nothing wrong with regularly being in contact with a therapist during gender transition.  While it is not essential to transitioning successfully, an objective cross-check cannot hurt.

The author does not tell us how long he engaged with therapists to gain the letters for surgery, and ethically, the therapist is only obliged to do an assessment.  Unresolved issues related to past abuse are ultimately up to the patient to decide if they are willing to pursue and resolve them prior to having surgery.

Lastly, and perhaps most importantly, the author clearly could not be living full time at the point where they acquired the letters for surgery.  Not only were they not working in their chosen gender, but even their spouse was not aware of their plans.  Given the dramatic effects of hormones, I am somewhat puzzled how this could possibly be, unless communication in the relationship had broken down to the point that the couple were keeping separate rooms.  I find this particular aspect of the story far too close to Heyer's own story.

The recently published WPATH Version VII has simply allowed the medical community to open the "floodgates" for this very tragedy to unfold. To get on cross gender hormones and then have surgery has become almost as simple as going to the convenience store for a pack of gum. If the client wants it, give it to them. "Real Life Test"? Maybe, maybe not, depending on your circumstances, occupation, etc. It is a billion dollar industry that thrives on your illness.
The most recent edition of the SOC does not make it "easier" to get access to hormones - an assessment and referral letter is still needed.  Whether or not all doctors who see transsexual patients implement this requirement is another matter entirely.

A careful reading of the current SOC is pretty clear, and there is a lot of clinical flexibility in the system.  Given the incredible diversity of gender variant people that are being identified, and the fact that they all have somewhat different needs, this is not surprising.  Again, for someone considering transition, it is more important than ever to engage with a treatment team that includes experienced professionals who understand the subtleties and shades of grey appropriately.
Get help. Don't mutilate your body. The psychiatrist, psychologists, and surgeons will enjoy a wonderful life. You, however, could end up with a tortured life, ending up penniless, possibly unemployed, without family or friends and maybe even homeless. And that's if you haven't tried or committed suicide by then! All so you can become the girl you "think" you are inside and wanted to be! People, God or whatever you believe in made you in the correct gender. It is encoded in your very DNA. If you think differently, get real help; but, DON"T CHANGE IT.
Gender is not just physical sex;  even if all aspects of it are somehow encoded in our DNA, such a perspective is a gross oversimplification.  It is well known that genes are expressed differently in each individual.  The biochemical system that is the human body is not absolute and deterministic in nature or function.

Lastly, the implicit notion that transsexuals are somehow lying to themselves has been tested and disproven repeatedly.  Even the DSM IV test clearly established the difference between delusion and the transsexual's experience.  A story like this is, to me, a cautionary tale - one that tells us all that when undertaking something as subtle and complex as gender transition, that there is much to be said for being cautious in how you approach the subject.   If you find yourself having to lie, or cover things up, then you better get to a place where those lies are no longer necessary and see if you can live with yourself openly.

8 comments:

Anonymous said...

Ah - the new JT LeRoy club.

If you don't show yourself - you don't exist.

Kathy

Davey said...

I stumbled on that guy's blog. He seems to be mentally ill? Def he assumes that all trans* are suicidal, left God, lie a lot, and will lose everything...including love and career.

He should have met the men and women I met. There are a few married for decades, adopting children, buying a house in the country, have their own business or work for the federal government, and parents although confused love them...and one, no make it two, are Catholics!

I like honest discussion and logical debates about is there any dangers to aspects of transitioning. With a name change in the works, and been on T half a year, I would hate to make a costly mistake! However, the good news is nobody forces me to do anything...at any point I can say this is all I need, and be done. When I ponder if I should go back to "female" I look in the mirror and see someone I like and identify as "me", I notice how I am getting used to and proud to hear "sir" and cringe when someone calls me female pronouns or "sweetheart" assuming I am some woman. You know how complex it is. It is not as simple as XX and XY. I do hope that my life will show Christians I know that being trans is not "evil" or "of the devil" as that guy makes it seem, but instead just one more thing some of us go through...and an excellent opportunity for them to practice the gifts of the Spirit such as kindness and love and gentleness by being there for me.

A pastor once said that the best thing a friend can to is shut up and listen. We do not need advice, or lectures, by those who have not walked in our shoes. I do not expect understanding for same reason. I just expect to be treated as an equal, a 1st class citizen, and not be condemned for a new name and body shape. After all, it is still me. I just may smile more. ;)

MgS said...

@Davey:

I wouldn't want to guess at his psychological state. I have my suspicions based on his writings and the logic of them.

I think there are some serious problems with his position and the logical consistency of it.

It remains undecided for me whether it is a case of Heyer playing a particular narrative out or if he is being an opportunist.

Danielle White said...

Even as someone who regrets SRS the way transition is cast in that letter annoys me. A major part of why I regret was overly-strict access to transition, for example being told by cis women who were my therapists and doctors that my transition was "too easy" because I didn't lose family, marriage, and jobs, and, instead, after transition interviewed for and landed a far better job. Who put me through an extra year of RLE, with the constant threat of losing access to HRT if I didn't proceed to SRS (and who even went as far as to look up my salary and assert "you are paid enough that you have no excuse to not have SRS.")

I firmly believe the problem is too much power in the hands of the gatekeepers. The system is relatively harmless if they behave well, but get ones intent on enforcing certain requirements and it causes serious problems.

I did have a time of being suicidally depressed; it was after being effectively taken off of Estradiol (reduced to a tiny dose.) My then-doctor insisted that proved I needed to be off of E completely and permanently...WTF?

In the end, I had SRS to secure my permanent access to HRT, which I badly needed, and be able to be done with the requirement to remain in monthly therapy sessions, which were merely a financial drain at that point and frustrating as they were all about enforcing that I be the "right" kind of woman.

I regret having SRS as it was wrong for me, but I have no regrets for my transition, and I am glad that I have secured certain things which I had to have SRS to secure. I just disagree that things like being able to update the gender marker on my driver's license or stop being jerked around on HRT should ever have required that I have SRS.

MgS said...

@Danielle,

You don't specify when you had surgery, or where you were located at the time of these unfortunate events in your life.

Have you examined the most recent version of the WPATH SoC, or the changes made in creating the Gender Dysphoria section of the DSM 5?

I ask because there is a significant amount of change aimed at recognizing and supporting people who need to transition and do not necessarily need or desire GRS.

I am sorry that you have had to be subjected to what seems like a hostile group of treatment providers.

Danielle White said...

Sorry that I didn't see this before, MgS.

I was in the US at the time, southeast, roughly midway between Atlanta and Washington, D.C., and it was mid-2008 through when I had surgery in mid-2013. Even under the previous SoC what they did was not in keeping with it. They simply opposed transition without SRS (and they also opposed other surgeries that trans women may want, like BA and FFS.) None of them were involved in trans healthcare before 2000, by which time such an approach was definitely not all that common or universally accepted, so I can only imagine that they individually decided that it was too permissive.

In the region where I was there were few known providers at the time, just two therapists and three doctors. One doctor was good but, alas, she hadn't been accepting new patients since before I moved to the state. The other two doctors were effectively identical in their approaches. I only worked with one of the therapists because I knew enough via friends about the other to know that if I switched to him all I would gain is more delays (he made one friend be full-time for more than a year before he would write her HRT letter, knowing that an HRT letter was mandatory to get an appointment with the HRT docs in the area regardless of RLE completed.)

Incidentally, I don't feel the regret about SRS now. Sure, what happened with my transition was majorly screwed-up, but since I posted above a lot of recovery has happened and I'm doing far better.

MgS said...

Hi Danielle,

It sounds to me like you encountered people who had been trained by the former Clarke Institute in Toronto (now CAMH), probably the last survivor of the 1970s strict and almost overly conservative gender clinics. I'm very familiar with both the V6 and V7 SOC from WPATH, and neither of them are written so that HRT is withheld until after 1 year RLE. In my opinion, doing so is simply cruel, since hormones can have a huge impact on body image and self concept.

Unfortunately, there are still practitioners floating around who are at best only loosely affiliated with WPATH (if at all) who come up with all sorts of strange hoops to jump through.

I am very glad to hear that you are doing better and feeling more comfortable with your decisions.

Danielle White said...

They weren't associated with Clarke at all (as far as I can tell) and were WPATH members. They did keep up on it but, honestly, they "rules lawyered" it. That is, they looked for ways that the flexibility of the guidelines allowed them to be more strict than intended. So while the SoC doesn't specify anything like 1 year RLE for an HRT letter it doesn't prohibit it which they interpret as being allowed.

Some information and personal experiences in the past month have made me realize that it is now largely an artifact of the past in my area. There are far better options available today. Basically, the modernization that came to many of the major urban centers of the US in the 1990s has finally worked its way into places like Raleigh-Durham.

Incidentally, I did some introspection about what happened that lead to me feeling regret. I realize it was a combination of issues hitting at a particularly bad time. When I was about 3 weeks post-SRS, which is a point where the aftercare is still a lot and I wasn't able to do much but stay at the house (which, as an extrovert, sucked) I had simultaneous issues with prescriptions. My HRT dose was massively reduced due to surgery, not only stopping the t-blockers but halving the E, which was my then-doctor's interpretation of the SoC's statement that "HRT dose is often reduced after surgery" - she read it as requiring that it be cut by 50%. At the same time there was an interruption of my anti-depressant prescription which meant I ran out for a few days, and that's a really bad thing to have happen. There were some additional issues but they're not ones I'm comfortably discussing publicly at this time.

Call it something of a perfect storm, and it messed me up but good. I finally got off of the anti-depressant last summer and I'm seeing a different therapist to help resolve the remaining feelings. This one gets that one could have issues with one step of transition, such as surgery, while being content with all of the rest. My prior experience with therapists in the area was that they viewed it as monolithic - that if I regretted one aspect then I had to regret all of it. You can probably imagine how well being pushed to detransition settled when I was happier after transition! Those therapy attempts actually made things worse.

FWIW, I'm seeing an HRT doc in another state and we finally got that straightened out. 2015 saw my first ever HRT appointment - after about 15-20 over the years - where my dose wasn't changed, and the second plus approval to go to annual follow-up at long last. All those dose changes in prior years didn't help me be or feel settled. Instead it lead to huge amounts of anxiety - I went into every appointment fearing that they would take away my HRT access! It's such a relief to not feel that now!