taxpayers to pay for shemaleyum models sexchange

[d]

isn't this the same chick from tony vee's shemales volume 1?



FREE TO BE HE-SHE
CITY-PAID GENDER OP
By JANON FISHER and LEELA de KRETSER
PrintEmailDigg ItStory Bottom

February 25, 2007 -- Talk about a tax cut.

A judge has ordered taxpayers to foot the bill - up to $20,000 - for a sex-change operation that will make a 21-year-old man into a woman.

In a ruling to be released Thursday, Manhattan Family Court Judge Sheldon Rand said the city must provide the subsidized snip because the woman wannabe, identified as Mariah Lopez, had been in the care of the Administration for Children's Services as a youngster.

The judge said the agency has a duty to pay for all "necessary" medical care to the kids in its charge.

Rand ruled that Lopez suffers from a diagnosed gender-identity disorder and that surgery is the recognized treatment.

"I don't think it's hit me yet. The consequences are so far reaching," a jubilant Lopez told The Post after learning of her victory in the legal battle, which started before Lopez was 18 and cared for by ACS.

"This court has recognized that gender-identity disorder is a real condition and there is a real solution to it and people don't have to suffer from it."

The city's senior lawyer on the case, Julian Kalkstein, said, "We respectfully disagree with the judge's decision and are going to be appealing the case."

Lopez said the surgery would cost between $15,000 and $20,000. The city has already paid for a laser hair-removal procedure around Lopez's genital area.

Lopez's father, who lost custody when she was 6 because of his drug use, said, "She's my son-daughter, I love her.

"If it's in her blood to be a woman, so be it.

"I think if it helps other gay people, I'm all for it."

Lopez, who was named Brian at birth, told of feeling like a girl trapped in a boy's body at 6 years old.

"I didn't know I was a boy. It was a rude awakening. I thought you could choose your gender," Lopez said.

Lopez - who is still physically a man - dresses as a woman and has taken hormones since age 15 in order to go through puberty as a girl, get breasts and develop a higher-pitched voice. Lopez also likes to be referred to as "she."

In his decision, Judge Rand wrote, "Mariah L. should be treated in order that she may go on with her life and be in a body which blends with the gender with which she identifies."

It is the second time the judge has ruled that ACS should pay for Mariah L.'s surgery. His original decision of January 2006 was put on hold so the city could appeal.

ACS lawyers said that Mariah L. had not complied with previous psychotherapy and does not have stable housing or employment.

Lopez claimed the city had already decided to appeal. "They are compromising my health and safety," she said.

[Caleigh]

it's fucked up that she should have a necessary medical treatment paid for by the state?

or it's fucked up that the state is trying to weasel it's way out of paying for a necessary medical treatment?

or it's fucked up to think that SRS is a necessary medical treatment?

[flabbybody]

I don't accept the judge's premise that transgenderism is a disorder that needs medical treatment. SRS is a personal decision, not a cure for a disease.

But I'm glad she was smart enough to manipulate the system to get what she wants. That strategy is usually reserved for the wealthy and powerful.

[peggygee]

Well it's nice to see that the Post is still hiring such
gifted journalists as Janon Fisher, and Leela de Kretser.

With such eloquent writing, I am sure that they must
have graduated top of their class from the Columbia
School of Journalism, if not that at least from one of
those schools on the back of a matchbook.

Having said that, our tax dollars in the form of Medicare,
Medicaid, free care, and other subsidized forms of
medical are already used in the treatment of a wide
variety of illnesses and medical issues.

Gender dysphoria has been deemed a disorder, by
the APA (American Psychiatric Association), and the
American Psychological Association

As well as having a codification in the ICD - 10,
(International Classification of Diseases) of the World
Health Organization (WHO).

http://www.icd9data.com/2007/Volume1/290-319/300-316/302/302.85.htm

http://www.icd9data.com/2007/Volume1/290-319/300-316/302/default.htm

Canada, a number of countries in the EU, even a few
countries of the so-called Third World such as China
currently recognize this and will assist it's citizens
accordingly.

As has been discussed many times on this forum, SRS
is not always the mandatory course of treatment for
all transwomen. Many women elect to remain non op,
with a relatively small minority opting for SRS.

Bottom line, adequate health care is a right, not a privilege.

[Kriss]

thats ur example of how fucked up america is? ...thats a fuckin problem!!!

Word! $20,000 is nothing compared to the dollars draining into bush/cheyney/blair/vatican's pockets.

[Kriss]

Canada, a number of countries in the EU, even a few
countries of the so-called Third World such as China
currently recognize this and will assist it's citizens
accordingly.
[/b]

Interesting point, how much help do TS women get in the European Union? Is there adequate financial assistance with things like hormones, medications, procedure, etc? Is the help with medication and surgical procedures of the quality you require? What shortcomings have you experienced in dealing with government appointed specialists?

[peggygee]

its fucking bullshit and a total waste of money.

Wow, with your analytical mind and concise, cogent, and
articulate command of the English lanquage, I bet you
would be a shoo-in at the Post.

Here is their employment link, if you're interested.

http://atwork.nypost.com/careers/employerDirectory/detail/id/36152

Tell them, Peggy sent you. :roll:

[Kriss]

its fucking bullshit and a total waste of money.

It's not YOUR money. So accept it. There is nothing you can do to possibly alter the fact that this girl will probably get the cash and have a chance at life without having to do 500 porn shoots. Good. I doubt very much that you have scrupulously paid every single cent you should in tax. I doubt that you will even generate $20,000 in your mean, resentful lifetime, let alone pay that in tax. You're just passionate about yourself.

[Felicia Katt]

its fucked up people should have to pay for something she wants.

I agree. Its fucked up that the State should pay for all that dialysis that people with kidney disease want and all that insulin that those diabetics crave. And all those heart bypasses that are so popular now, not to mention that chemotherapy that is all the rage among cancer victims.

Its medical treatment for a medical condition. What she wants is what anyone with any condition wants. The right and best care she to which she is legally entitled

FK

[BrendaQG]

fuck you both, its a fucking waste of money, $20000 to MAYBE make ONE person feel better, cos lets face it, some do regret doing the change, so its a total waste of time and money for something that is option and not life saving.

Right. Some do regret SRS. People like...Renee Richards who had various fantasies and illusions of what life as a woman would be like. People for whom realizing those fantasies was the driving motive behind their transition. Yes such people exist.

The subject of the news story is not such a person. How do I know? She just does not fit that Renee Richards like profile. Having lived as a femal for so long and dealt with the B.S. and hard realities of it she will have no illusions about her post SRS life. After having SRS someone like her will be able to go on with a reltively normal life and perhaps need never tell anyone ever that she was not born exactly as she is.

That and after SRS being able to wear something as tight as you want without any self conciousness would be worth it.

[peggygee]

Canada, a number of countries in the EU, even a few
countries of the so-called Third World such as China
currently recognize this and will assist it's citizens
accordingly.
[/b]

Interesting point, how much help do TS women get in the European Union? Is there adequate financial assistance with things like hormones, medications, procedure, etc? Is the help with medication and surgical procedures of the quality you require? What shortcomings have you experienced in dealing with government appointed specialists?

As regards the UK, here are a few reports. Though I am
sure that the ladies from across the pond will have some
better first hand insights.

http://pb.rcpsych.org/cgi/content/full/26/6/210

What services are available for the treatment of transsexuals in Great Britain?
Sarah Murjan, Specialist Registrar in General Adult Psychiatry
Nottinghamshire Healthcare NHS Trust, Stonebridge Centre, Cardiff Street, Carlton Road, Nottingham NG3 2FH

Michelle Shepherd, Consultant in General Adult Psychiatry

Derby City General Hospital

Brian G. Ferguson, Consultant Psychiatrist

Nottinghamshire Healthcare NHS Trust


Abstract
Top
Abstract
Introduction
The study
Findings
Discussion
References


AIMS AND METHOD

We conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care.

RESULTS

Eighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment.

CLINICAL IMPLICATIONS

There are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.


Introduction
Top
Abstract
Introduction
The study
Findings
Discussion
References


Transsexualism is a desire to live and be accepted as a member of the opposite gender, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic gender and a wish to have hormonal treatment and surgery to make one's body as congruent as possible with the preferred gender (World Health Organization, 1992). Gender dysphoria, gender identity disorder and transgenderism are other recognised terms for this rare disorder, the prevalence of which is estimated to be 1/34 000 for men and 1/108 000 for women (Hoenig & Kenna, 1974).

Treatment is generally sought when the person's concerns become so intense as to be judged the most important aspect of his/her daily life. The conviction that gender reassignment is the only solution is a well-established feature and the general goal of treatment is to maximise psychological well-being in the chosen gender role. The Harry Benjamin International Gender Dysphoria Association (1998) has produced standards of care for treatment that are internationally recognised.

Management includes diagnostic assessment, supportive psychotherapy, the ‘real life experience’ (Harry Benjamin International Gender Dysphoria Association, 1998), hormonal therapy and surgery. Initial assessment should confirm the diagnosis and ensure that the condition is not a manifestation of a major psychiatric disorder such as schizophrenia. Conventional interpretative psychotherapy is not indicated in most cases and the current approach includes information regarding possible treatment options, exploration of the person's expectations of gender reassignment, as well as more in-depth evaluation of personality and social functioning. During the real life experience, the transsexual is expected to function in the chosen gender role in all areas of his/her life, including work and personal relationships.

Hormonal therapy with the sex hormones of the opposite gender is used to induce development of secondary sexual characteristics, some of which are irreversible. Surgery includes genital reconstruction, hysterectomy, mastectomy or breast enlargement and cricothyroid cartilage surgery in men. Other components of treatment include speech therapy and hair removal. A large body of research on the outcome of gender reassignment surgery indicates that, for the majority of those who undergo this process, the result is positive (Carroll, 1999).

The rights of people with gender identity disorder to be recognised in law in their chosen gender and not to be subject to discrimination have been fought in the courts and employment tribunals. In 1995, in the case of P v. S and Cornwall County Council, it was recommended that the principle of equal treatment for men and women should be held to cover transsexuals (Court of Justice of the European Communities, 1996). In July 1998 the European Court criticised the UK government for not addressing legal problems and protecting the transsexual person's right to privacy, although it ruled that a violation of European law had not occurred. In December 1998 the High Court ruled in favour of three transsexual women who contested Lancashire Health Authority's refusal to fund surgery (Royal Court of Justice, 1998). However, a number of organisations representing transsexual groups have complained that the nature of the clinical services offered to transsexuals varies considerably across Great Britain and some do not meet the standards of care established by the Harry Benjamin criteria. This study was designed to clarify the current commissioning arrangement for these specialist services.


The study
Top
Abstract
Introduction
The study
Findings
Discussion
References


Questionnaires were sent to public health directors for each health authority/board in England, Scotland and Wales (n=120). They were asked if they had a local service for transsexuals and if so, whether this included psychiatric assessment, hormonal therapy and/or gender reassignment surgery. If there was no local service, they were asked to identify the tertiary clinics that they commissioned. From these initial questionnaires, tertiary gender clinics were contacted in writing and by telephone for further information.


Findings
Top
Abstract
Introduction
The study
Findings
Discussion
References


Ninety-eight questionnaires were returned, indicating a response rate of 82%. Of the health authorities/boards that responded, 20% (n=20) stated that they had a complete transgender service available locally, although it was clear that not all of these centres had facilities for surgery.

Sixty per cent of the remaining health authorities/boards (n=59) stated that they provided no local service, but could refer elsewhere for psychiatric assessment, hormone treatment and surgery. Of these commissioning authorities, 41 referred cases to one national centre in London (Charing Cross). Seven others used established provincial centres, and seven authorities utilised a combination of specialised gender clinics in various locations.

Three health authorities/boards stated that treatment for transsexual people was a low commissioning priority for which funding was not normally provided. One reported a willingness in principle to refer for treatment but had no occasion to do so, and another confirmed that it would pay for psychiatric assessment and treatment but would fund surgery only in exceptional circumstances. A further authority confirmed that it would only fund psychiatric treatment alone and had an established policy of not paying for surgical reassignment. The implication from such a policy is that transsexual people could receive irreversible hormonal virilisation or feminisation without recourse to surgical reassignment, thereby creating a permanent pseudo-hermaphrodite state.

Six per cent of health authorities/boards who responded (6) stated that they had a local arrangement that consisted of an assessment by a named psychiatrist only, but were able to refer elsewhere for further services if indicated.

Eleven commissioning health authorities provided responses that were characterised by a distinct lack of clarity. Four reported that there was no local service but did not have an established policy of referral to a nominated specialist centre. Two authorities indicated that they referred cases to specific surgeons but made no mention of the necessary psychiatric assessment or treatment. Three health authorities/boards stated that they referred cases elsewhere but identified centres and specialists that either did not exist or mentioned staff who had retired sometime before. Two responses indicated that there was no specific commissioning arrangement and left the matter of referral to the local psychiatrists.

In total, health authorities/boards listed 20 gender identity clinics to which they referred cases for management. When contacted by the research team, only 12 of these clinics were able to organise a complete service and six of them consisted of single-handed practitioners working in isolation from other colleagues; in contravention of the Harry Benjamin International Standard. Four of the centres contacted did not have a specialist service at all, two others consisted of a surgeon only and one offered psychotherapy without other forms of specialist input.


Discussion
Top
Abstract
Introduction
The study
Findings
Discussion
References


From the above it can be seen that most transsexual people have access to NHS services for the treatment of gender dysphoria. However, this will only be available on a local basis to a minority (i.e. those living in the catchment areas of 21% of responding health authorities/boards). For the rest, specialist treatment involves long distance travelling to appointments that are likely to be scheduled over a fairly lengthy period of time. Specialist services that are very distant from the patients' homes may experience considerable difficulties in supervising the real life experience because of unfamiliarity with local circumstances. In those cases, transsexual people may feel that they have to ‘prove’ their credentials and subsequent interactions with the clinic may assume a distorted pattern, as the transsexual person may perceive the staff as representative of a barrier to be overcome rather than as a resource provided to help him/her achieve maximum psychological well-being. Also, distant services may lack knowledge of local support groups and may not be able to deliver the high level of liaison with conventional medical services, which is required post-surgery. The obvious implication from such findings is the need to consider regional structures that have sufficient catchment populations as to allow the development of specialist local expertise.

The initial assessment of transsexual people frequently takes place in primary care or generic psychiatric settings and is followed by referral to a more specialised gender clinic. The quality of initial assessment varies to the point whereby inappropriate treatments such as hormone therapy are commenced prior to the confirmation of the diagnosis. Some transsexuals are so convinced of the need to proceed to gender reassignment that they place significant pressure on inexperienced clinicians to prescribe hormone therapy before full multi-disciplinary assessment. Clearly there are dangers of clinicians working in isolation in this complex area. The Royal College of Psychiatrists has recently recognised the need in adolescent transsexualism for a standardised multidisciplinary approach based on agreed criteria and has supported the development of a national consensus (Royal College of Psychiatrists, 1998). Currently, only six adult transsexual clinics appear to be established along such lines and therefore it is unlikely that treatment is delivered in a standardised manner across Great Britain. Despite this, there are a number of very good existing local initiatives that aim to provide more comprehensive and standardised services.

There is evidence of confusion among those responsible for commissioning in some health authorities/boards as to what services were available to them. Inevitably, this must translate into confusion for the service users and their doctors at the first point of contact. It may serve to alienate them further and reinforce the perception that their needs are being denied or ignored. Commissioners of health services have responsibility for ensuring that the contracted service delivers a reasonable standard of care and it is clear that this vital function is not being addressed by some health authorities.

Many health authorities/boards have different commissioning priorities that result in substantially different rates of referral from the populations served. In the case of some health authorities, treatment of gender dysphoria was considered to be of a ‘low priority’ and they do not normally fund NHS surgery. Given the 1998 High Court ruling against Lancashire Health Authority's refusal to fund treatment, they may be considered to be in breach of the Human Rights Act. The cost of legal action is high and paradoxically might exceed the cost of providing the clinical service in the first place.


References
Top
Abstract
Introduction
The study
Findings
Discussion
References


CARROLL, R. A. (1999) Outcomes of treatment for gender dysphoria. Journal of Sex Education & Therapy, 24, 128-136.

COURT OF JUSTICE OF THE EUROPEAN COMMUNITIES (1996) P v. S & Cornwall County Council. Times Law Reports, May 7. (see http://www.pfc.org.uk/legal/pvs-judg.htm ).

HARRY BENJAMIN INTERNATIONAL GENDER DYSPHORIA ASSOCIATION (1998) The Standards of Care for Gender Identity Disorders (5th edn). Minneapolis, MN: HBIGDA.

HOENIG, J. & KENNA, J. C. (1974). The prevalence of transsexualism in England and Wales. British Journal of Psychiatry, 124, 181-190.[Medline]

ROYAL COLLEGE OF PSYCHIATRISTS (1998) Gender Identity Disorders in Children and Adolescents. Guidance for Management. Council Report CR63. London: Royal College of Psychiatrists.

ROYAL COURT OF JUSTICE (1998) Regina v. North West Lancashire Health Authority. See http://www.pfc.org.uk/legal/nwl-hc.htm .

WORLD HEALTH ORGANIZATION (1992) The ICD — 10 Classification of Mental and Behavioural Disorders. Geneva: WHO.

[peggygee]

A slightly less positive review.

http://uk.gay.com/headlines/11056

NHS slammed over trans abuse
Hassan Mirza, GAY.COM
Wednesday 14 February, 2007 14:47 | More from this date | Today's headlines





The NHS has come under harsh criticism from health care experts and transgender rights advocates for failing to address for needs of LGBT patients.

Derbyshire nurse and psychotherapist Janet Smith told the Nursing Standard that NHS service providers are often insensitive to health issues regarding gender and sexuality.

“There are staff who deny [that] they have any lesbian, gay, bisexual or transgender clients on the grounds that their service is for older people,” Smith says.

Smith cited the story of Karen, a post-op transsexual, whose confidentiality was broken at the GP practice, revealing details of the procedure to her former partner.

Smith concluded that health service providers are quick to dismiss a patients’ sense of identity.

“The results can be an increase in anger and self-loathing and an increased risk of isolation, depression and self-harm.”

Christine Burns, trans rights campaigner and advisor to Department of Health civil servants, also condemned the NHS’s attitude toward transgender people, saying their failings could easily qualify as abuse.

“The NHS is failing transsexual and transgender people right across the board.” Burns told GAY.COM.

“A report soon to be published by the Trevor Phillips’ Equalities Review, and based on questioning of 870 trans people in Britain last autumn, is expected to show that over 20% of trans people have experienced GP’s refusing to treat them.”

“Of the remaining 80%, the GP’s who would like to help say they are unable to do so because they lack the knowledge. They end up being taught by their patients.”

“When it comes to people seeking help with their gender issues it has been unlawful to refuse referral to a clinic since 1999. However, all over the country we see PCTs doing just that. They claim to operate ‘exceptional cases’ policies, but cannot describe what would constitute an exception to a flat ‘No’.”

“Others present distressed patients with waiting times of two or three years just to be seen by an appropriately trained gender specialist. I’ve never met a transsexual person who was offered a choice of where to be referred, in spite of this being a Government commitment to everyone else. Discrimination is writ in big bold letters across every NHS threshold, ‘NO TRANNIES HERE’.”

“The Equalities Review research also highlights the immense suicide risk among people denied help and support though. Our research indicates almost a third of trans people had at one time contemplated or attempted suicide one or more times prior to receiving treatment. Transsexual people are literally being sent away to die. I saw a documented case of this kind in Wales only 2 or 3 weeks ago.”

Health proffessionals who are part of LGBT awareness groups also face ill-treatment from health- care providers.

Jason Warriner, one of the founders of the Royal College of Nursing’s lesbian, gay, bisexual and transgender support group RCN Out!, says: “I know nurses who have had to leave work because of harassment from colleagues. We are meant to be in a caring profession but if you have colleagues acting like that, it makes you wonder how they treat patients.”

[Felicia Katt]

you have to be a stupid american to put medical conditions that are life threatening in the same fucking field as one that is optional and WILL NEVER EVER SAVE ANYONE LIFE.
No, I'm a very smart American who also takes the time to inform herself on the issues.

A growing body of research literature has provided the estimate that gays, lesbians, and bisexual youth attempt suicide at a rate 2-3 times higher than their heterosexual peers. Some studies indicate that the rate of attempted suicide for transgender youth is higher than 50%.

It is life threatening, and better access to better care will save lives. Most treatments are "optional" You can live with out them, just not as long or as well.

The ttreatment you need for your ignorance, education, is, sadly, optional, but should be mandatory.

FK

[Kriss]

you have to be a stupid american to put medical conditions that are life threatening in the same fucking field as one that is optional and WILL NEVER EVER SAVE ANYONE LIFE.

You are so wrong, I'm sure PeggyGee has access to the figures but sometimes people who are suffering great mental anguish DO take their own lives. You are way out of your depth here so admit you don't know what the fuck you are talking about and shut the fuck up. If you don't like reality go watch fox news or read the daily mail you bitter, ignorant fool. And don't throw up some cancer figures to pretend that you have a moral standpoint.

[Kriss]

As regards the UK, here are a few reports. .

Wow! Lots of info.Thanks Peggygee, you never disappoint.

[peggygee]

You think it's not life threatening, you think it doesn't
sometimes negatively impact quality of life.

Then take your time and read this.

(If you must, skip to the hi-lited, underlined portions)

http://www.trans-health.com/displayarticle.php?aid=7

WHAT WE DON’T KNOW: The Unaddressed Health Concerns of the Transgendered.

To better understand why there is such a need for more health-related services aimed at transpeople.

By George J. Wilkerson, Ph.D. (aka Bobbi Williams)


Special thanks to Moonhawk River Stone, a psychotherapist, consultant, and educator in private practice in the Albany, New York area and an out, open and proud FtoM, who provided invaluable input and feedback for this article. All introductory and unattributed quotes come from the LGBT Health Issues Companion Document, issued in the fall of 2000 as part of the Federal Government’s HEALTHY PEOPLE 2010 initiative.

There’s really not much truth in the old aphorism that “What you don’t know, can’t hurt you.” And less so if you’re transgendered. The majority of transgendered people do not self-identify as transgendered. The stigma still looms too large. As a result, we know even less about ourselves than lesbians and gays. Research studies, even those labeled “LGBT,” usually fail to include the ‘T’ and nearly always overlook the closeted transgender population. These members of our community still float beneath the surface, most of them invisible, like the unseen portion of the transgender iceberg, This problem, which has not been adequately addressed, does more to hinder the collection of meaningful data than any other factor.

The LGBT Health Issues Companion Document, part of the Federal Government’s HEALTHY PEOPLE 2010 initiative, issued in the fall of 2000, dramatically underscores this shortcoming. Though not enough, there is some data on many of the important lesbian and gay health concerns. But what the document brings to light most is the lack of information about the bi-sexual, and the dearth of data on the ‘T’ community. Reading through it, one soon realizes that what we don’t know far exceeds what we do know (and what we need to know) about the health needs of the transgendered.

NO DATA. AND NO EFFORT UNDER WAY TO CHANGE THE SITUATION.
“…there are no probability studies of transgender people reported in the literature and no effort underway to develop measures for inclusion in Federal surveys.” (p.15)

The closest thing we have to an estimate of the number of transgendered people in the United States comes from the psychiatric literature where estimates are that “one percent of the population may have had a transgender experience” (a phrase which lends a strange, surrealistic aura to the notion of being transgendered.) This number is derived from data which are supplied by mental health services 1 and does not account for those of us who have never self-identified or don’t ever come out to the psychiatric community. It is solely based on the numbers of those who actively seek psychiatric help.

The only other date source is from the approximately 25,000 U.S. citizens who have undergone Sexual Reassignment Surgery (SRS). The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (1987) estimates the prevalence of transsexual persons to be 1 in 30,000 for male-to-female (MtoF) transsexuals and 1 in 100,000 for female-to-male (FtoM) transsexuals. If this data were used to conservatively estimate the transgender population, it would mean there are at least 175,000 - 200,000 transgendered people in the nation. But we must also consider that much of the data is collected from urban populations; it is skewed away from suburban and rural areas. (The Companion Document confirms that “there is substantial, disproportionate representation of transgender individuals in urban centers.”)

Furthermore, it’s not unreasonable to assume that the data follows a pattern of invalid reporting, not unlike that of the early figures on sexual abuse, which initially declared that two males were abused for every ten females, but later determined that the numbers were roughly the same. This suggests that the number of FtoM transsexuals is likely to be as high as the MtoFs.

This acute lack of information and skewed interpretations must be kept in mind when we look at the sparse information we do have regarding health concerns affecting the transgender population.

SPECIFIC AREAS OF CONCERN
Cancer
“There has been very little research concerning cancer among transgender persons. One population-based study from the Netherlands suggests that overall cancer morbidity and mortality rates among transsexuals are comparable to those of the general population. Nevertheless, transsexuals’ exposure to hormone therapy over an extended period of time might be expected to increase the risk of certain hormone-related cancers.” (p. 104)

Huge sums of money have been spent on cancer research, but the only information we have about cancer and transgenders comes from the transsexual population. Those reports indicate that “estrogen is a risk factor for cancer of the breast…and it has been suggested that testosterone therapy may be a risk factor for such cancers in FtoM transsexuals.” 2
But what of the danger for MtoFs who are still biologically male and not aware of the need for preventive urological care and prostate examinations, as well as mammograms? Or of the FtoMs who may remain at risk for cervical cancer and require regular Pap tests as well as gynecological care and mammograms for remaining breast tissue, even if they have had breast removal? We can only speculate, since the Companion Document reports that “there are no existing data on actual risk.”

Nutrition and Weight Management
“No empirical studies on the nutritional and weight management practices of transgender persons have been conducted.” (p. 246)

In this area, too, there’s no reliable data. But, as the Companion Document suggests, “it is reasonable to expect individuals who are transitioning to the opposite gender (to) modify their diet, eating behaviors, or perception of weight to appear more like the desired gender.”

How many FtoMs try to raise their Body Mass Index (BMI) to make themselves more masculine looking? What are the rates of eating disorders among MtoFs who diet in order to look more feminine? Or of compulsive exercise to increase muscle? Consider these behaviors in light of the fact that the use of hormones (in some cases, illegally obtained) can cause weight gain and effect lipid profiles, thus increasing the chances of cardiovascular disease.

Once more, the focus is on the transsexual population (since that’s the only source of data.) But what of the closeted cross-dresser or transvestite who is taking so-called ‘natural hormones’ or is suffering from an eating disorder, but won’t (or can’t) mention it to his or her doctor?

In addition to these direct links, there may also be co-occurring trauma issues. Serious research is needed in all of these areas and education and intervention programs should be developed.

Aging and the Elderly
“Little research exists on health promotion or special health concerns for older transgender individuals.” (p. 135)

As the ‘boomers’ grow older and the population of the country shifts in their direction, so does the number of older transgendered people. Of course, many of the problems of the elderly are the same, regardless of gender identity, but what of things like long-term hormone use and the interactions of hormones with other medications often prescribed for chronic conditions? And conversely, problems are initiated when one decreases or eliminates the use of hormones. We should also be concerned with diseases of the elderly, like “polycythemia vera,” an acquired disorder of the bone marrow, which causes an overproduction of white and red blood cells and platelets . Occurring more frequently in men, there is no known cure, but a possibility that it is affected by male hormone use. In these kind of matters, our concern should be not only for transsexuals, but for the transgendered who are closeted as well.

Perhaps those who need educating more are the service providers who encounter a transgendered person in a Nursing Home or during a home visit. The attitudes toward transgendered individuals usually are not positive. It’s not something we like to think about, but we need to recognize that transgendered persons who are forced by insensitive health care workers to suppress their transgender nature are likely to suffer depression and even contemplate suicide. Studies are needed to identify the level of such incidents and workers in institutions housing the elderly need to be educated and sensitized to the needs of their transgendered clients.

Being transgendered is not something that goes away with aging. There are likely to be circumstances where the death of a spouse causes a sense of freedom for the individual who has led a closeted existence. Releasing one’s transgender nature may result in a flurry activity that can seem strange to those unfamiliar with it.

Furthermore, there are an increasing number of transgendered people who decide only later in life that they are transsexual and choose to transition despite their years. These individuals have very special medical and psycho/social needs.

Violence & Hate Crimes
“…although most people who were polled believe that gay and lesbian people should have equal civil rights, they also continue to rank gay people among the most disliked groups of people in the country. And secondly, no public opinion data have been collected nationally on bisexual and transgender persons.” (p. 117)

Despite some strong rhetoric by a number of organizations and a few influential people, recent data challenge the notion that the United States is totally antigay.3 This three-decade move toward opportunity is tempered by findings which suggest that even though behavior has changed, attitudes have not. Anti-LGBT societal attitudes continue; acts of discrimination which perpetuate disparities and limit opportunities are simply more covert now.

And while the lesbian and gay communities have promoted legislation to support anti-discrimination, they continue to sacrifice the ‘T’ in LGBT as necessary for the legislation to pass. Only recently have cracks developed in this wall. Polls now show an increasing willingness on the part of those who ‘talk the talk’ to ‘walk the walk’ as well.

The saddest aspect of these circumstances is that the majority of assaults against transgendered persons are never reported to the police. This situation exists because trans-gendered individuals have little social support and limited or no access to legal recourse. (To report the crime is to ‘come out.’) Sexual violence against MtoF transsexuals is common, but such incidents are rarely prosecuted in the criminal justice system.4 Of the transgendered individuals sampled in the Washington Transgender Needs Assessment Survey, 13.5 percent reported having been the victims of sexual assault. 55

Transgendered people may experience greater disparities than any other group in being the victims of violence. And transgendered people have been excluded from almost every hate crime bill, whether at the Federal, State or local level.6 (Only four states have included transgendered people in their hate crimes laws—Minnesota (1993), California (1998), Vermont (2000), and Missouri (2000).7) The first major study on violence and discrimination against transgendered people in the United States8 found that 60 percent experienced some form of harassment and/or violence sometime during their lives, and 37 percent experienced some form of economic discrimination.9

The most socially acceptable, and probably the most widespread, form of hate crime, especially among adolescents and young adults, is targeting LGBT people. 10 , 11 , 12 , 13 Is it any wonder, then, that among visibly transgender adolescents, refusal to attend school is a common problem? According to the Harry Benjamin International Gender Dysphoria Association, collaboration between school officials and treating professionals may be necessary if transgender adolescents are to continue their education.14 The Association encourages early hormonal interventions in profoundly transgender adolescents as a way to contribute to school completion because treatment delays commonly result in educational and social delays. 15

While more documented research is needed, almost all transgender people, whether female-to-male (FTM) or male-to-female (MTF), admit that preventing the experience of violence within their lives is a ubiquitous aspiration.16 This includes subtle forms of harassment and discrimination, as well as blatant verbal, physical, and sexual assault.

Mental Health
“Transgender people are likely to experience some form of victimization as a direct result of his or her transgender identity or gender expression. A link between these experiences and mental health disorders such as post-traumatic stress disorder is widely suspected, but has not been adequately documented.” (p. 220)

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)113 lists four specific diagnoses that are applicable to transgendered persons:

GENDER IDENTITY DISORDER (GID) in adolescents and adults (302.85)
GENDER IDENTITY DISORDER in children (302.6)
GENDER IDENTITY DISORDER not otherwise specified (GIDNOS; 302.6)
TRANSVESTIC FETISHISM (302.3)
(Note: The numbers in parentheses represent the numerical nomenclature of the International Classification of Diseases, which is the basis for classifying mental disorders within DSM-IV and used by clinicians, medical record librarians, administrators, benefit claims representatives, researchers, epidemiologists, and program planners.)

Being Transgendered does not Mean You’re Mentally Ill
Under the DSM-IV, these diagnoses require evidence of distress or impairment in functioning. Functional impairment that is solely due to societal prejudice based on perceived social deviance does not meet this criterion.17 So, under the DSM-IV, being transgender does not in itself constitute a mental disorder.

The report goes on to state that the diagnosis of GID is generally applied to transsexuals, while Transvestic Fetishism is reserved for crossdressers. In what might be the report’s biggest understatement, they add that the “diagnoses of GID and Transvestic Fetishism are considered pejorative by many in the transgender community.” They explain that the terms stigmatize by declaring the behavior as non-normative, the same way that homosexuality was pathologized before 1973, when it was removed from the list of mental illnesses by the American Psychiatric Association.

What studies there are have concluded that GID and Transvestic Fetishism are innate and, therefore, ought to be considered a normal part of the diversity in human nature. This has been supported most recently in the work of William Reiner of John Hopkins and that of Milton Diamond, a biologist at the University of Hawaii and Keith Sigmundson a psychiatrist from Victoria, British Columbia.

Depression
Transgendered people often avoid seeking treatment for depression because they fear that being transgendered will be assumed to be the cause of their symptoms. While there’s some truth to that, there’s no evidence of any direct link. The depression that arises more often than not stems from the difficulty the transgendered person has dealing with the social stigma and as a result the person may actually be underdiagnosed.

Sucidality
In the Washington Transgender Needs Assessment Survey, the suicidal contemplation rate was 35 percent, while the attempt rate was 16 percent.18 Of suicide deaths, another study of more than 2,000 cases found only 16 possible suicide deaths following surgical sexual reassignment.19 In a third study, of 479 MtoF and 285 FtoM transsexuals, about 25 percent and 19 percent respectively had attempted suicide prior to transition.20 Most other studies report a pre-transition suicide attempt rate of 20 percent or more, with MtoFs relatively more suicide-prone than FtoMs.21

Another form of self-harm in transgender persons is attempted or completed autocastration or genital mutilation. A study of a cohort of transgender individuals who applied for services at gender identity clinics reported that genital mutilation was attempted by 9 percent of the males, while breast mutilation was attempted by 2 percent of the females.22

Clearly, contemplating, attempting, and succeeding at suicide is not uncommon in the pre-op transsexual population. Given the high cost, the lack of health insurance coverage, and other difficulties involved in obtaining Sexual Reasssignment Surgery (SRS), as well as the social pressures, this should come as no surprise. If anything, it ought to provide evidence of how deeply transsexuals feel the need for SRS.

There is also some evidence that changes related to gender identity significantly affect partners. This often unsettles relationships, causing significant emotional stress to both individuals.23 Additionally, when initially introduced to their partner’s transgender status, spouses, partners, and significant others often question their own and their partners’ sexual orientation. Partners’ symptoms can be severe and sometimes resemble those of post-traumatic stress disorder.

As in many of these areas, while significant data exists about the transsexual population, there is no solid research into suicides involving transvestites, cross-dressers and other gender-conflicted individuals.

Alcohol and Other Drug Abuse
“Not only is there a lack of data for the bisexual and transgender population in particular…Many substance use programs are not sensitive to the needs of transgender individuals, and few have the capacity to address the realities faced by the transgender population.’ (p. 334)

Alcohol and drug abuse studies have focused primarily on lesbians and gay men. Few include bisexual or transgender persons. And most substance abuse treatment programs don’t deal with transgender issues. The Transgender Substance Abuse Treatment Policy Group of the San Francisco Lesbian, Gay, Bisexual, Transgender Substance Abuse Task Force reported that “transgender clients in substance abuse treatment programs experienced verbal and physical abuse by other clients and staff; requirements that they wear only clothes judged to be appropriate for their biological gender; and requirements that they shower and sleep in areas judged to be appropriate for their biological gender.”24

The transgendered tend to be “invisible” in program evaluation, intake, and assessment. Treatment programs rarely consider the identities and needs of transgender persons and treatment personnel often require transgender persons to conform to the gender of their birth sex. In the case of inpatient treatment programs, this may result in persons who live full-time as women being housed with men or being required to use male bathrooms. They may also inappropriately require transgendered persons to stop using cross-gender hormones as part of a treatment or detoxification protocol. In addition to the obvious mental distress, this can reduce the likelihood that the transgendered person will ‘stay with the program’ after it’s over and he or she has been discharged.

The Companion Document reports that “LGBT-specific standards for treatment services are severely lacking, and LGBT-identified and LGBT-appropriate programs for those who need and could benefit from them are not widely available.” This may even be more critical for the transgender community.

Sexually Transmitted Diseases (STDs)

“No prospective studies have been done on the risk of STDs for transgender persons.” (p. 309)

Sexual activity in the transgender community may be its darkest secret. While the risk for HIV and other STD transmission has been widely publicized in gay and lesbian circles, many transgendered people have neither the infrastructure nor even the awareness necessary to confront the associated dangers. In some respects, post-operative transsexuals may be better off in this regard. While still at risk for STDs, the MtoF or FtoM can still face the situation more squarely and take measures to protect him or her self. The situation isn’t so simple for others who are transgendered.

Transgendered persons who are sex workers face an even greater risk of STDs from their ‘Johns’ and from the injection of hormones and other intravenous drugs obtained on the street. Concern for these individuals is even more discriminatory because of society’s judgmental attitudes toward what is viewed as immoral behavior (and, therefore, deserving of punishment.) What is generally overlooked is that for many of these persons, there is no alternative. Sex is the only commodity they have which can earn them the kind of income needed to pay for the high medical and psychological cost of sexual reassignment surgery.

For the closeted transgendered person, their closet represents the biggest problem. There are no doctors there, no medical resources, and a much greater likelihood that medical problems may be improperly diagnosed. Again, there is no data, but anecdotal evidence suggests that the number is significant and that the members of this group, while publicly denying their sexual activities, engage in behavior which puts them at risk. To put it bluntly, there are many MtoFs who are not sex workers who privately engage in oral and anal sex with multiple partners of both sexes while vociferously denying it. A further complication to this is with the population of so-called ‘admirers,’ with whom transgender s (including pre-op transsexuals) have sex. Many of these individuals are married and not only carry STD’s from one transgendered partner to another, but also take them home to spouses. These include lesser known STDs like Chlamydia, Genital Warts, and Hepatitis B.No studies have been done, but they are certainly warranted. Research is needed to ascertain the degree of sexual activity on the part of transgender persons and, of those, how many are at risk.

The Less Publicized STDs
Chlamydia a less publicized sexually transmitted disease (STD), is caused by a bacteria. Approximately 75% of women and 50% of men with the infection have no symptoms, so most people infected with chlamydia are not aware of their infections and therefore may not seek health care. When diagnosed, chlamydia can be easily treated and cured. Chlamydia is also common among young men, who are seldom offered screening. Untreated chlamydia in men typically causes urethral infection, but may also result in complications such as swollen and tender testicles

Genital warts is one of the lesser known and yet one of the most common STD’s. An estimated 40 million Americans are infected with HPV, with 1 million new cases each year. Most HPV infections are subclinical--that means that there are no visible signs. Visible signs include soft, pink, cauliflower-like warts to hard, smooth, yellow-gray warts. In women, they may develop inside the vagina, where they are hard to detect. They may also appear on the lips of the vagina or around the anus. In men, they usually appear on the penis, but are sometimes found on the scrotum or around the anus. These signs appear within 3 weeks to 6 months after having sex with someone who is infected. This time period makes it difficult to track the infection as it is passed from partner to partner.

Hepatitis B is an infection of the liver caused by a virus. It's 100 times more infectious than HIV. About 300,000 Americans get hepatitis B each year. Most people recover, but a few become chronic carriers with increased risk of serious health problems later, such as permanent liver disease and cancer of the liver.

Genital herpes is a chronic, lifelong viral infection. Again, an estimated 40 million people have it. Each year, about 500,000 new people get symptomatic herpes. Most people have no noticeable symptoms. Those who do probably notice them 2 to 20 days after having sex with someone who is infected. Early symptoms may include a burning sensation in the genitals, lower back pain, pain when urinating, and flu-like symptoms. A few days later, small red bumps may appear in the genital area. Later, these bumps can develop into painful blisters, which then crust over, form a scab, and heal.

Pubic lice (often called "crabs") and Scabies (itch mites) are tiny insects that live on the skin which are sometimes spread sexually, but can also be picked up by using the same bed linen, clothes, or towels as an infected person. Scabies, an itchy rash, is the result of a female mite burrowing into a person's skin to lay her eggs. Pubic lice infect hairy parts of the body, especially around the groin and under the arms. Their eggs can be seen on the hair close to the skin, where they hatch in 5 to 10 days.

Trichomoniasis ("trich"), attacks 2 to 3 million Americans every year. Many people experience no symptoms. Women may experience itching, burning, vaginal or vulval redness, unusual vaginal discharge, frequent and/or painful urination, discomfort during intercourse, and abdominal pain. Symptoms tend to worsen after menstruation. Men are usually asymptomatic, but symptoms can include unusual penile discharge, painful urination, and tingling inside the penis.


HIV/AIDS
“There are now sufficient recent studies to document high HIV seroprevalence rates among some groups of male-to-female (MTF) transgender persons in the United States… rates appear to be especially high among African American MTF transgender persons.” (p. 184)[/b]

The Companion Document reports that there are now “sufficient recent studies to document high HIV seroprevalence rates among some groups of male-to-female (MTF) transgender persons in the United States. Seroprevalence rates ranging from 22 to 47 percent have been documented within urban subpopulations of MTF transgender individuals across the United States.25, 26, 27, 28, 29 HIV seroprevalence rates appear to be especially high among African American MTF transgender persons.”30,31

As with STDs, even though studies show high levels of HIV infection and high-risk sexual behavior among MtoF transgender individuals, prevention needs continue to go largely unaddressed. Very little is also known about the HIV risks for female-to-male (FTM) transgender individuals, who constitute a largely invisible population with regard to sexual risk behaviors.32, 33 In a recent policy statement, the American Public Health Association urged that both MTF and FTM transgender individuals should be recognized by research and health care communities as populations whose needs are unique and distinct from those of gay men and lesbians.34

OTHER TRANSGENDER HEALTH ISSUES
More research is needed, but “small surveys suggest that successful communication and ease of sexual orientation (and gender) disclosure may positively affect health risks and screenings.” (p. 129)

Lack Of Disclosure
The Companion Report pointed to the importance of disclosing one’s sexual orientation to a health care provider, saying it “is crucial to the provision of appropriate and sensitive care that is tailored and responsive to each individual’s unique needs.” The same can also be said of disclosing one’s gender identity. Like everyone else, medical professionals classify their patients as male or female solely on the basis of physical characteristics. But if, as the report states, a “failure to establish rapport and communication between physicians and patients is associated with decreased levels of adherence to physician advice and treatment plans, and decreased rates of satisfaction,” 35 when it comes to sexual orientation, then the same will hold true for gender identity.

If a clinician is not aware of a patient’s gender identity, he or she may fail to accurately diagnose, treat, or recommend appropriate preventive measures for a range of conditions. A 1997 study of lesbians in Oregon,136 showed that “90 percent disclosed their sexual orientation to providers, and of these, 92 percent raised the issue themselves.”37 How many transgendered persons, apart from pre- and post-operative transsexuals, are as likely to disclose their status? Until such time as the transgendered are open (or even better, proud) and willing to share this information with medical professionals errors in diagnosis and treatment will continue to occur.

[b]Health Insurance
Uninsured levels are highest among transgendered people. A 1997 survey in San Francisco found that 52 percent of the almost 400 transgender individuals surveyed lacked health insurance,38 while the Washington Transgender Needs Assessment Survey, conducted between 1998 and 2000, found that 47 percent of respondents lacked health insurance.39 A December 1999 survey by the New York City Department of Health found that 21 percent of transgendered respondents reported having no health insurance of any kind. Within these transgender communities, people of color are likely to be disproportionately uninsured—a finding that mirrors statistics on people of color throughout the Nation.40,41“

Lesser” Health Problems
In addition to the areas cited above, there are a number of less obvious circumstances which present health problems for the transgendered, most especially those who are closeted. For example, allergies, that can often develop later in life, and infections caused by transgender related practices.

If a physician or other health care professional is unaware that a patient is transgendered, he or she may not think to include it in the diagnosis. The transgendered can experience an allergic reaction and may not realize it’s the result of new make-up or a hair (wig) spray. And since the M.D. is unaware of the individual’s status, he or she is not likely to ask what sort of makeup the patient uses.

Similarly, there may be problems like nail infections, resulting from the use of false nail glue, and eye infections caused by false lashes or mascara, as well as ingrown hairs from improperly shaven legs or injuries from high heeled shoes and corsets. To some these may seem comical, but to the transgendered person, who must invent an explanation because he’s too embarrassed to inform his doctor, they are another illustration of the injury caused by being in the closet. And these kind of health problems, though they may seem minor at first, can have serious consequences if not properly addressed.

WHAT TO DO
As an individual, the need for full disclosure us essential. The transgendered person’s physician should know the entire patient. And the patient should be assured of confidentiality. On the public front, the LGBT Companion Document, issued as part of the Federal Government’s Healthy People 2010 initiative, effectively points out the need for extensive and thorough research into the health care needs of the transgendered. The document also contains many invaluable recommendations on a variety of fronts.

Medical Boards and other groups that license or certify health care professionals should ensure that their examinations include questions on health care for the transgendered.
Academic departments of health should encourage, if not require, an internship or a rotation at a community center or health center that includes service to LGBT people.
Home care agencies should be trained to be culturally sensitive and respectful of transgendered elders. Medical Boards and other groups that license or certify health care professionals should ensure that their examinations include questions on health care for the transgendered.
Health care providers of all disciplines should be provided with education and training on how to communicate with transgendered consumers and families in a culturally competent way and how to reduce barriers to effective communication.
Health insurance companies should extend coverage to include transgender issues and remove barriers to the transgendered obtaining coverage.
Workers in alcohol and drug abuse programs should be trained in understanding the needs of their transgendered clients and made aware of the relationship between gender issues and addiction.
With so much to do, one may wonder where to begin. At this stage of the situation the answer is clear: start anywhere…but start now. And the best place to begin as an individual is with your own doctor. One by one, if we educate the members of the medical profession and make them sensitive to our unique needs, we can look forward to a document titled Healthy Transgendered People 2010.

Back to Top

REFERENCES
Rosenberg, H.M.; Mauer, J.D.; Sorlie, P.D.; et al. Quality of death rates by race and Hispanic origin: A summary of current research, 1999. Vital Health Statistics 2(128): 1-20, 1999.
Kinsey, A.C.; Pomeroy, W.B.; Martin, C.E.; and Gebhard, P. Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders, 1953.
Kennedy, N.J. Behavioral medicine: The cost-effectiveness of primary prevention. In: Gullotta, T.P.; Hampton, R.L.; Adams, G.R.; Ryan, B.A.; and Weissberg, R.P., eds. Children’s Health Care: Issues for the Year 2000 and Beyond. Thousand Oaks, CA: Sage Publications, 1999, 229-282.
Xavier, J. Final Report of the Washington Transgender Needs Assessment Survey. Administration for HIV and AIDS, Government of the District of Columbia. 2000.
Xavier, 2000
Cochran, S.D., and Mays, V.M. Depressive distress among homosexually active African American men and women. American Journal of Psychiatry 151:524-529, 1994.
Derogatis, L.; Meyer, J.; and Vazquez, N. A psychological profile of the transsexual. I. The male. Journal of Nervous and Mental Disorders 166(4):234-254, 1978.
Dixen, J.M.; Maddever, H.; Van Maasden, J., et al. Psychosocial characteristics of applicants evaluated for surgical gender reassignment. Archives of Sexual Behavior 13:269-277, 1984.
Cole, S. A transgender dilemma: The forgotten journeys of the partners and families. Paper presented at the 16 th Biennial Symposium of the Harry Benjamin International Gender Dysphoria Association, August 1999.
Tross, S.; Hirsch, D.; Rabkin, B., et al. Determinants of current psychiatric disorders in AIDS spectrum patients. In: Programs and Abstracts of the Third International Conference on AIDS. Washington, DC, June 1-5, 1987.
Bradford, J.; Ryan, C.; and Rothblum, E.D. National Lesbian Health Care Survey: Implications for mental health care. Journal of Consulting and Clinical Psychology 52(2):228-242, 1994.
McGrath, E.; Keita, G.P.; Strickland, B.R.; and Russo, N.F. Women and Depression: Risk Factors and Treatment Issues. Washington, DC: American Psychological Association, 1990.
Oetjen, H., and Rothblum, E.D. When lesbians aren’t gay: Factors affecting depression among lesbians. Journal of Homosexuality 39(1):49-73, 2000.
Laumann, E.O.; Gagnon, J.H.; Michael, R.T.; and Michaels, S. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago, IL: University of Chicago Press, 1994.
Michaels, S. The prevalence of homosexuality in the United States. In: Cabaj, R.P., and Stein, T.S., eds. Textbook of Homosexuality and Mental Health. Washington, DC: American Psychiatric Press, 1996, 43-63.
Beatrice, J. A psychological comparison of heterosexuals, transvestites, preoperative transsexuals, and postoperative transsexuals. Journal of Nervous and Mental Disorders 173(6):358-365, 1985.
American Psychological Association. Hate Crimes Today: An Age-old Foe in Modern Dress. Washington, DC: American Psychological Association, 1998.
Xavier J. Final Report of the Washington Transgender Needs Assessment Survey. Administration for HIV and AIDS, Government of the District of Columbia. 2000.
Pfafflin, F., and Junge, A. Sex reassignment: Thirty years of international follow-up studies after SRS—A comprehensive review, 1961-1991. 1992. English translation available at http://www.symposion.com/ijt/pfaefflin/1000.htm. 1998.
Dixen, J.M.; Maddever, H.; Van Maasden, J., et al. Psychosocial characteristics of applicants evaluated for surgical gender reassignment. Archives of Sexual Behavior 13:269-277, 1984.
Pfafflin and Junge, 1998.
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Doctor, R.F., and Prince, V. Transvestism: A survey of 1032 cross-dressers. Archives of Sexual Behavior 26(6):589-605, 1997.
Transgender Protocol Team. Transgender Protocol: Treatment Services Guidelines for Substance Abuse Treatment Providers. San Francisco, CA: Lesbian, Gay, Bisexual, Transgender Substance Abuse Task Force. 1995.
Deneberg, R. Report on lesbian health. Women’s Health Issues 5(2):181-191, 1995.
Engardio, J.P. OuTransgenderoing Marlboro man: Document reveals new details on how tobacco companies target gays. San Francisco Weekly, February 16-22, 2000.
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Brucker, E.L. Out and Free: Sexual Minorities and Tobacco Addiction. Seattle, WA: King County Health Department, 1997.
Fiore, M.C.; Bailey, W.C.; Cohen, S.J.; et al. Treating Tobacco Use and Dependence. Clinical Practice Guidelines. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, June 2000.
Millman, M. Access to Health Care in America. Washington, DC: National Academy Press, 1993.
Dean, L., et al. Lesbian, gay, bisexual, and transgender health: Findings and concerns. Journal of the Gay and Lesbian Medical Association 4(3):101-151, 2000.
Bradford, J., and Ryan C. The National Lesbian Health Care Survey. Washington, DC: National Lesbian and Gay Health Foundation, 1988, 76-85.
Deneberg, R. Report on lesbian health. Women’s Health Issues 5(2):181-191, 1995.
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Sorensen L., and Roberts, S.J. Lesbian uses of and satisfaction with mental health services: Results from Boston Lesbian Health Project. Journal of Homosexuality 33(1):35-49, 1997.
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von Schulthess, B. Violence in the streets: Anti-lesbian assault and harassment in San Francisco. In: Herek, G.M., Berrill, K.T. (Eds). Hate Crimes: Confronting Violence Against Lesbians and Gay Men. Newbury Park CA: Sage Publications, 1992.
Safe Schools Coalition of Washington. Eighty-three Thousand Youth, Selected Findings of Eight Population-based Studies as They Pertain to Antigay Harassment and the Safety and Well-Being of Sexual Minority Students. May 1999. www.safeschools-wa.org.
Waldo, C.R.; Hesson-McInnis, M.S.; and D’Augelli, A.R. Antecedents and consequences of victimization of lesbian, gay, and bisexual young people: A structural model comparing rural university and urban samples. American Journal of Community Psychology 26(2):307-334, 1998.
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Topics
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Justin's Columns
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--------------------------------------------------------------------------------

[GroobySteven]

Yep, she's worked on Shemale Yum.

It's good that it's being recognised a genuine condition and when millions are paid through state and healthcare to eating disorders, depressed individuals and other potential problems of the mind, that transgenderism is recognised as being in the same field as that. If you disagree with this, then stop all healthcare for the above illnesses or conditions. I suspect those who protest too loudly are the same who whine if a girl wants SRS because they prefer her cock.
The poster whinging about "fucked up America" is certainly right in some aspects. The medical profession in the US is out of control. We pay $275 a month for health insurance, yet when my girlfriend was taken off in an ambulance last month, where the crew was with her for less than 30 mins, for a 3 min ambulance ride, it was billed to the insurance company for over $2500 - making her co-payment $500. How can that possibly be charged? Her over all co-payment for a in-patient routine operation, was $1500. So we pay the $3000+ a year for what? The great American rip off!

seanchai

[wendy48088]

* Deleted *

[Caleigh]

one of the dangers of a for-profit health system

[Felicia Katt]

and its still just as high as those who have had the full treatment, so in fact it might not stop her from killing herself, and still optional.

provide a cite for that fact, sweetie. This girl was a ward of the state, and as such,they are obligated to pay for necessary medical care. That they are trying to deny it to her is wrong. Not having access to affordable treatment is of the many problems that can push a transgender to the brink. Sure, there are others like prejudice, and discrimination and ignorance that need to be addressed too. You can help there by not being so harsh and poorly informed when you post.

FK

[Mugai_hentaisha]

I will side with FK and the others on this one, although I had worked in the MH field for a number of years and saw the Fed Gov't just gladly hand out money to our transportational services just to take a client shopping. I have heard this quote 1 time then I have heard it a billion in the 3 years I worked for a local mental health facility; "Don't worry we can get you the money and you won't have to do a thing." Is it right??? tough call I would rather have the money there and get abused from time to time than not have the money there and people who really need it go without. (medicare has been getting better at spotting fraud like that, and I hope that "Don't worry..." phrase becomes a thing of the past soon)

I agree that this is a disorder and that if they meet the guidlines to get local/state/federal help then they ought to get the treatment.

If you want to get into the whole "well this is more important than that issue" you can, but realize you are throwing a really big rock at a small glass house. Because what might be life important to you may not be that serious to any one of us. So do your research and try seeing things from other people's POV.

[peggygee]

As regards the UK, here are a few reports. .

Wow! Lots of info.Thanks Peggygee, you never disappoint.

Thanks Kriss, wherever the forces of ignorance, hatred,
or bigotry abide, there we shall be.

http://i92.photobucket.com/albums/l2/magi43/batsignallogic.jpg

Gee force away, to the G-spot.
http://i92.photobucket.com/albums/l2/magi43/girl_jump4x2.jpg :wink:

[GroobySteven]

if someone wants to off themselves cos they cant become a ts then they don't need surgery they need a fucking shrink.

its a waste of money to spend it on something to make one person feel better, which in the end i might not do.

she wants to be a ts then she should do it the same way as everyone else, GET A FUCKING JOB INSTEAD OF BEGGING.

...and the shrink says that they need SRS to make them a complete person, to help their gender dysphoria and to stop them wanting to be depressed enough to kill themselves ? Then what.

You just sound like a bitter, twisted, un-educated, ignorant, self-righteous twat.
seanchai

[yodajazz]

if someone wants to off themselves cos they cant become a ts then they don't need surgery they need a fucking shrink.

its a waste of money to spend it on something to make one person feel better, which in the end i might not do.

she wants to be a ts then she should do it the same way as everyone else, GET A FUCKING JOB INSTEAD OF BEGGING.

One fact that you are overlooking is that this person as a child was removed from the guardianship of her family, and the state assummed responsibility. State have come to recognize that they bear some responsiblilty after the age of 18 for their well being, instead of putting them out on the street at thier 18th birthday and pretending that now everythilng is normal.

But leaving aside any moral argument, it makes practical sense for the goverment to help individuals. If this operation could help that person be a productive citizen, that person becomes a taxpayer and funds the goverment. 40 years at 25,000 a year is one million dollars, that person could earn. A twenty percent tax rate on that would be 200,000 dollars return on their $20,000 investment. Also that person is using the rest of their salary to purchase goods and services which circulates through the economy.

As for begging, rich people beg as much as poor people, only it is called lobbying. All kinds of corporations, industries, etc hire people to attemp to influence goverment policies. For example I heard one or our Presidents talk about giving tax incentives and grants to oil companies to develope alternative energy sources. And they already have jobs. Someone from their industry was begging, oops I mean lobbying for goverment breaks.

It is not a waste of money to help a person cure a diagnosed illness and become a productive citizen.

[loki]

If people can get money for having numerous babies because they have a crap job and still continue to pop them out then why is this bad?These people are trying to fix a bioligical mistake they had no control over.I don't mind my taxes being used to fix or help with a mistake someone had no control over.But people can chose not to make babies while not having the means to support their own children.Damn i'm not looking forward to the responces to this post!

[loki]

fuck you euro trash.

[quote]Euro trash.That's fucked up comment.

[loki]

[quote="passionatelover"]fuck you euro trash.

[quote]Euro trash.That's fucked up comment

[loki]

passionatelover"]fuck you euro trash.

That is a fucked up comment!!!If it weren't for people like seanchai we would not have so many beautiful women to look at.And what is YOUR definition EURO TRASH?

[loki]

yeah lets all thank the old fat cunt whose taking pix and vids of ts for guys like you who sit around jerking off all day wishing you had the real thing.You still did not answer the question.What is the difference between having lots of babies and knowing you can't support them without taxpayer money and so get free money to do it for you and fixing a biolical mistake.And what is your definition of euro trash.

[loki]

i said, the trailer trash should be forced to have their tubes tied.On that i agree.I love debating.I believe in personal responsibility of ones own actions. But on this subject they had no choice on how their bodies decide to develop.So on this subject we disagree.

[Felicia Katt]

i said, the trailer trash should be forced to have their tubes tied.

Why stop with trailer trash? lets sterilize the developmentally disabled. why stop there? lets go ahead and neuter those with genetic disorders. Since we are on a roll, lets go after anyone who isn't genetically pure. Then lets invade Poland.

You are in Europe, right? You should really know your history better. For shame.

FK

[AllanahStarrNYC]

On a roll to a ban.........................

[loki]

I REALLY hope your not talking about me. Allanah :cry:

[AllanahStarrNYC]

no- its not about freedom

it s about being respectful of the other posters and not lashing out at everyone and being an disruptive asshole for the sake of being one. and managing to insult everyone for the sake there of.

it's called tact.

agree to disagree with a some level of intelligence to prove your point.

you have been warned.

[loki]

no- its not about freedom

it s about being respectful of the other posters and not lashing out at everyone and being an disruptive asshole for the sake of being one. and managing to insult everyone for the sake there of.

it's called tact.

agree to disagree with a some level of intelligence to prove your point.

you have been warned.If i have been tactless or disrespectful i'm sorry.

[tubgirl]

it s about being respectful of the other posters and not lashing out at everyone and being an disruptive asshole for the sake of being one. and managing to insult everyone for the sake there of.

it's called tact.



with all due respect allanah, there are a few seasoned members here who don't worry about this "rule". why should he?

[AllanahStarrNYC]

loki- i was not talking to u babe

and tub i do my best to read as much as i can on here and call it went i see it. a lot of post get deleted and people do get warned.

[loki]

loki- i was not talking to u babe

and tub i do my best to read as much as i can on here and call it went i see it. a lot of post get deleted and people do get warned.Cool.

[Felicia Katt]

your a stupid fucking thing arent you, i suppose think its ok for teenage chicks to have kids and sit on their ass getting paid from the government, and by the time their are 30 have 4 or 5 kids and not able to support them.

no im not eurotrash.

The way you act on here, I'm guessing that was ok for your mom. LOL
Your full of hate and bitterness and resentment. I feel sorry for you.

FK

[chefmike]

Suits me just fine.

I'd much rather have my tax dollars be spent on things like that, as opposed to giving it to BushInc. and Halliburton...

[chefmike]

its fucking bullshit and a total waste of money.

[johnie]

The issue here is not what the treatment is, but rather that the city has a responsibility to provide proper treatment to anyone who is under care (or was) of the ACS. Whether the treatment is for eyeglasses, appendicitis, foot surgery etc. it is irrelevant.

[oneandonly]

this is funny to me.

This is not necessary to live, This is a want. I 'm sorry it's not in any way necessary

I have heard time and time again, and I'm sure most if not every TS has said at some point in time" Gender is between your ears not your legs".

So that saying is B.S. and just something TS's say to make them selves feel better. So every ts with a penis is a man, no matter what they say they are men.

I beleive that most of you are in favor of this for the wrong reasons.

[trish]

It’s fucking bullshit that the government should have to pay for SRS. Think of all the johns Lopez would’ve made happy as she tried to scrape up enough money on her own to treat her condition. It’s just not right to rip young thing like that out of the hands of those who would’ve exploited her condition and furthered the cause of capitalism on the street.

[peggygee]

It’s fucking bullshit that the government should have to pay for SRS. Think of all the johns Lopez would’ve made happy as she tried to scrape up enough money on her own to treat her condition. It’s just not right to rip young thing like that out of the hands of those who would’ve exploited her condition and furthered the cause of capitalism on the street.

Co-sign.

[oneandonly]

It’s fucking bullshit that the government should have to pay for SRS. Think of all the johns Lopez would’ve made happy as she tried to scrape up enough money on her own to treat her condition. It’s just not right to rip young thing like that out of the hands of those who would’ve exploited her condition and furthered the cause of capitalism on the street.
/\are you serious.

yeah, because being a hooker is the only way TS's can make money. a regular job would be impossible.

[olite71]

its fucked up people should have to pay for something she wants.

Well then by that reasoning the tax exemption on mortgage interest is fucked up b/c it subsidizes (with taxpayer dollars) everybody who "wants" to OWN a home. You don't "need" to own a home. You need shelter and that can be (and is) provided to tens of millions by renting.

I'm not advocating any tax exemption per se--but the fact that they exist is testimonial to our government's desire to influence behavior and mold the "wants" of the populace based on economic incentive....it's a powerful, if not the most powerful, carrot and stick that congress has at its disposal.

So every day the public subsidizes the wants of their own.. It would therefore be a fallacy to criticise one example of that in general terms...either criticise all examples, or admit that you disagree with THIS particluar "want."

[the Adrienne Barbeaubot]

I have read every post on this thread and have come to the conclusion that Passionate Lover is a total hateful piece of shit. I apologize Allanah but he's had this coming.

[signupjustforthis]

this is funny to me.

This is not necessary to live, This is a want. I 'm sorry it's not in any way necessary

I have heard time and time again, and I'm sure most if not every TS has said at some point in time" Gender is between your ears not your legs".

So that saying is B.S. and just something TS's say to make them selves feel better. So every ts with a penis is a man, no matter what they say they are men.

I beleive that most of you are in favor of this for the wrong reasons.


Are you a transsexual? How do you know what every transsexual need?


Transsexual women still consider themselves women regardless if they had the SRS or not; but that does not exclude that transsexual women don’t need SRS. What kind of an idiot are you?

You would think a site that is about admiring Transsexual women would have a tiny more fucking respect and more importantly, KNOWLEDGE, for the very women they are “admiring”.

Lot's of the same people arguing for welfare surgeries are the same people who argue that gender is in the mind.

[GroobySteven]

I have read every post on this thread and have come to the conclusion that Passionate Lover is a total hateful piece of shit. I apologize Allanah but he's had this coming.

Yeah he's a piece of shit. He used to post here under a different name and kept getting busted, so he changed his name and came back with the same nasty, hate all attitude that's typical for people with self-esteem issues as his.
seanchai

[tsntx]

...

[GroobySteven]

yeah sure what ever, come on then eurotrash dumb ass fucking cunt, wheres your fucking proof i used different name.

oh right you have no fucking proof cos this is the only fucking name i have ever fucking used, of course being a stupid fucking retarded cunt i wouldnt expect you to be able to fucking think

T
I
L
T

Still obsessed by me huh?

seanchai