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Becky Blog

 


December 19, 2009

Life Happens...

…when you’re busy doing other things.

Six months went by just like that. It’s not that I haven’t had anything to say; I just haven’t had the time to sit down and say it.

I’ve been President of the GLMA Board of Directors for three months now. Yes, it’s as much work as (or more than) I was expecting. Lots of afternoon and evening conference calls. Planning for our Board meeting in Phoenix and the Annual Conference in San Diego in 2010. And most challenging, and in many ways the most interesting, the actual strategic planning process for a national organization. How are we perceived? Is this the perception we want? What changes do we make to remain relevant in the world of LGBT health? Do we focus more on policy and advocacy? Do we give top emphasis to education, especially the Annual Conference? Or do we continue to emphasize both, while cultivating support for our membership base? It’s exciting to be a part of the decision making process.

Between my work with GLMA and my cardiology practice there is very little time to even follow the news related to transgender people. In the last few weeks I’ve seen two items which deserve some comment. One is a sad bit of news, and the other is an opinion column which causes us to examine the feelings that some gay men have about trans people.

A Death That Shouldn’t Have Happened

From the Los Angeles Times, November 29, 2009:

Mike Penner, a longtime Los Angeles Times sportswriter who made headlines in 2007 when he announced that he was transsexual, has died. He was 52.

Penner was pronounced dead Friday evening at Brotman Medical Center in Culver City, a Los Angeles County coroner’s official said.

The cause of death has not been determined but was believed to be suicide.

In April 2007, Penner surprised colleagues and readers with an essay in The Times’ Sports section announcing that he was “a transsexual sportswriter.”

“It has taken more than 40 years, a million tears and hundreds of hours of soul-searching therapy for me to work up the courage to type those words,” he wrote.

Times Associate Editor Randy Harvey, who was the paper’s sports editor at the time, said the essay allowed Penner to explain in his own way a decision that “we realized would be a human-interest story and a news story. We didn’t want it to be filtered through someone else’s lens.”

In the essay, Penner said of his transgender decision:

“I gave it as good a fight as I possibly could. I went more than 40 hard rounds with it. Eventually, though, you realize you are only fighting yourself and your happiness and your mental health — a no-win situation any way you look at it.”

Writing as Christine Daniels, Penner started a column for the paper’s website in May 2007 called Day in L.A. and a blog about the transition, then in July began writing for the paper again.

He returned to using the Mike Penner byline in October 2008.

Let’s be clear: no one knows for certain why Mike ended his life. (I say “his” because that was Mike’s decision when he stopped the transition process.) We can only speculate. But there are several facts we do know.

Fact: Christine Daniels became an instant celebrity/spokesperson/role model on Day One of her transition. NO ONE is ready for such responsibility. I remember when I began my transition in 1993. I was a psychological mess, leaving a relationship, a professional position, and the state where I had spent all but one year of my life. I had already been the subject of months of gossip and jokes in Jackson, and it was wearing me down. I just wanted some anonymity and the chance to start over, away from the spotlight. Christine couldn’t have that. She remained in her job as a Times sportswriter. It does seem that the newspaper handled her transition in a sympathetic and professional manner, but you know there must have been feedback in the male world of sports news. And not all of it was positive. How did Christine handle the stress? Surely her therapist was helpful. What about friends? What about other trans people?

Fact: The “Community,” if we can so designate this herd of cats, embraced the new celebrity eagerly. Christine was invited to all sorts of transgender conferences and conventions. People couldn’t wait to have their pictures taken with the new media star. But who offered a listening ear? Who offered unconditional friendship? Was there anyone for her to speak with when she was struggling with the decision to “de-transition”? Mike doesn’t seem to have talked about it at all after the return to male name and pronouns was made. Who was there to care? Did the “community” drop Mike Penner like a hot potato, embarrassed over having given too much praise to someone who “let them down”? Maybe not. But we have to wonder.

Fact: “That Bell Can’t Be Un-Rung.” (That’s a Dr. Becky original quote.) People de-transition for several reasons. Perhaps they feel they have lost too much when they lose spouse or family relationships. Although some of us do retain our marriages, the majority do not, and I can verify how hard it is to lose someone you cared for very much. I knew I couldn’t go back. Perhaps some feel they can. But it won’t be the same again. There’s always the knowledge of “what you did” which will keep that relationship from being the same as it was before disclosure, before the original transition.

People may also de-transition for economic reasons, because they can’t find work in the new role. Most of these people will go back to work and make enough money to pay for their transition expenses, then return to the transition process. Finally, people may de-transition for religious reasons. I know of several, including close friends, who have gone all the way through transition, even surgery, only to have a religious experience and be told “you are deceiving yourself and you must return to your original status.” They expect peace and joy from this de-transition, and they wonder why it doesn’t happen. I could write much more about this complex dilemma, but I’ll just say I know this from personal experience also. No amount of prayer, “repentance,” or other religious commitment is going to change one’s gender identity. If it could, I wouldn’t be writing these words now.

I don’t think there are any published studies, but it would be worthwhile to survey people who de-transition. I am guessing the incidence of unhappiness, depression, and yes, even suicide, are increased significantly compared to people who successfully remain transitioned.

There are no easy answers here. I feel Christine/Mike was let down in numerous ways by numerous folks. Maybe even me – I never tried to make contact, before or after the de-transition. Perhaps it wouldn’t have made any difference. But I can only speculate.

More later on the “opinion column” I mentioned above.


June 21, 2009

An Internet Cautionary Tale

Margaux and I organize Arizona Day of Remembrance every November at the Arizona State Capitol. Every year, we read the names and tell the stories of transgender people who have been murdered during the past twelve months. There are always between twenty and thirty – and that’s just the ones we know about. Transgender people are vulnerable for many reasons: many are without family support and without a steady income, relying on dangerous work to earn enough for food and shelter. Others are so anxious to experience life as the person they desperately want to be, they take chances and venture into bars or clubs on the wrong side of town. Many are physically recognizable as trying to present as the gender opposite their birth.

People who prey on transgender persons often act out of extreme anger. There are times when this is related to a sexual encounter, with disclosure coming after the fact. At any rate, it’s often not enough to dispatch a trans person with a single clean bullet. No! We are stabbed – dozens of times, all over; beaten over the head with the nearest blunt object; strangled or garrotted; then bound hand and foot and tossed in the river. Or in the trunk of a car which is set on fire. The murders are horrendous, and if anything ever is a hate crime, these murders surely are.

So it is understandable that a report of another such murder would stir anguish and outrage in the community. But sometimes things are not always what they seem. Here’s the account, as posted secondhand from a moderator on the transgender support site where the “victim” had been active for at least a year:

I am having a very difficult time right now. I am a moderator on another site and we have a Forum and we have a Chat. Raychel ‘Roo’ was 18 in March. She died in intensive care last night. One of our teen Moderators, she lived in New York and was a post op teenage girl, and a dancer. She was headed to the Juliette School in the Fall. Now she is dead.

Her father was killed and her mother lost her arm in a terrible car crash last month. At one of the trials on this, one of the lawyers outed her. Her town had a very negative reaction.

She had life threats, she and her mother. The police had them under protective surveillance. The police left at noon yesterday. By two o’clock she was assulted. Last night she died.

She rode her bike to go to the store. She never came home. They found her bike in a dumpster. Late that evening they found her. She had been assaulted with a sledge hammer, they think, judging from the bruises all over her body. Her knee caps had been broken. She had been gang raped. They buried her alive.

She worked her way out of the almost grave and crawled for three hours to get help. She was put in the ICU and given little chance to survive. Last night she died.

The facts are skimpy, speculation reigns. Supposedly kids from a nearby school came after her in a van. There were no fingerprints. She had no semen after the rapes so it shows premeditation as they used condoms. She was so beat-up her organs just went into shock and she died.

Our whole group is sick and horrified. I am having a difficult time just writing this. I need to for two reasons, to tell her story and to say ‘please be careful!’ Last night we lost a sister, and one of our own.

This sounds horrible! And it’s not a total stretch of the imagination to believe it happened. But soon after this report came in, people started checking local and national news sources. No word of a teenager dying after a brutal attack. After 24 hours, still no word. People started looking back at the report and finding items that didn’t make sense. The family auto accident was one month ago, and the trial was already held? That’s not the legal system we have. The “Juliette School” may be a typo, but it still suggests lack of accurate information.

Finally the site administrators admitted: this appears to be a hoax. This person had joined the forum, given good advice, and even served as a mentor for others. Now no one knows who she (?) was. Apparently the person grew weary of the performance and decided to go out with a dramatic exit.

While disclosure of the hoax was devastating to persons who had trusted “Raychel,” the episode does serve to remind us that some people we “meet” online are not who they claim to be. Kim Pearson posted the following “Internet Safety 101″ which is an excellent summary:

1. People you ‘meet’ on the internet are NOT real. No matter how real they seem, unless you have met them in person they are NOT real…be careful.
2. Chat forums are not safe places to share the most intimate moments of your life because you NEVER know who is listening and taking notes…be careful.
3. There are bad people in the world. They can use information you provide to hurt you mentally and physically…be careful.
4. Even carefully restricted, monitored and moderated lists cannot protect themselves completely from those who do not have honorable intentions…be careful.
5. If something doesn’t seem quite right listen to your gut instincts…be careful.
6. If you don’t want the whole world to know something about you then you might not want to post it any where on the internet…be careful.

I would add: If someone you “meet” online wants to meet you in person…be careful. Do so in a very public place with lots of folks around. Bring a friend, perhaps. Do not agree to go to a secluded place and do not reveal too much of your personal life.

It’s a scary world out there.


June 15, 2009

Some Things Haven't Changed

Lest we become too giddy congratulating ourselves on how far we’ve come, there are always stories like Darlene’s in places like Memphis.

Ex-fighter pilot listens to feminine voice he’d tried to ignore

From the Memphis Commercial Appeal, June 7. Excerpts below of an all too familiar story:

Two years ago, David, a retired Air National Guard Lieutenant Colonel who served as a navigator and fighter pilot, told his wife, Mary, something he’d kept inside all his life. He was a woman in a man’s body.

It tore through their 37-year marriage like shrapnel, and formed a chasm so wide between Darlene and her son that the young man now considers his father dead. They haven’t spoken in two years. Darlene is forbidden from seeing her two grandsons.

Ask about the pain of thousands of plucks of electrolysis to remove hair, facial feminization surgery, breast augmentation and finally genital reassignment surgery, and Darlene explains professionally like an officer.

Mention her grandchildren or the pain she caused her wife and son, and tears stream down like rain.

Some things are no different from 1993.

When David was a child, before he knew about gender roles, he put on dresses. He played the mother in a game of house, says his sister Lillie, who is 23 years older.

But Darlene’s ex-military father wouldn’t have it.

He spent most of David’s life beating the sissy out of him with a razor strap that hung on a nail in the hall closet. He toughened the skin and mind that imprisoned the girl inside the boy.

…David advanced in security levels in the military, becoming a deception officer, one who creates alternate plans so the real strategies aren’t discovered.

“I flew fighter planes, parachuted on secret missions,” Darlene said. “I was good at stealth because it was how I was living my life.”

Darlene was rejected by everyone dear to her. Her son told her she could never see him – or her grandchildren – again.

This was a very difficult read for me.

Then there’s the “church in the deep South” saga repeated.

She was asked to leave her church. She was turned down by five churches when she asked to join. Friends told her never to speak to them again.

“The minister at one of the churches told me I should go home, put on a man’s suit and kill myself,” Darlene said.

Whoever he is, he is a sorry excuse for a “man of God.” There are many accepting, welcoming churches. They just may not be in Memphis. Or maybe they are, but they are small and hard to find. Never stay where you aren’t wanted.

At any rate, Darlene succeeded in having her surgery, and is retraining for a new career. Darlene, if you read this, please know that I applaud your amazing courage and send you my very best wishes.

The “Comments” section did indeed include many of the usual disparagements from people who will never understand, but a surprising number of letters of support. Perhaps some things are changing.

The final section made me feel good about the future and our part in shaping it:

Transgender facts

The American Medical Association classifies gender identity disorder as a serious medical condition in which a person’s body is one gender while his or her brain believes it’s another.

Left untreated, GID can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to medical care and treatment, death.

In a survey, surgeons who have performed genital-reassignment surgery said 80 percent of their patients do not have sex with another individual for the rest of their lives. They say the patients wanted the surgery to live peacefully, with mind and body congruent.

The AMA says third-party insurance companies should pay for reassignment surgery for transgender individuals because it qualifies as a diagnosed illness.

Word is getting out.


June 14, 2009

Back on the Blog: GLMA

This is the last of three updates on my medical activism work since I ended the old blog.

The Gay and Lesbian Medical Association is the organization which takes up more of my time and resources than all the other organizations at this time, and that’s the way I want it to be. GLMA is a home for GLBT physicians, medical students, residents, physician assistants, nurses, and even behavioral health counselors. I’ve been a member since the mid 90s, and on the Board since 2004. This fall, at our annual meeting in Washington DC, I will take office as the 26th president – and the first trans president – of GLMA.

I have been very involved with two of our committees: Education and Board Development. I help with the planning of the Annual Conference – this will be my fourth year to do so – selecting plenary speakers and workshop presentations. In years past I have secured speakers such as Vivian Namaste, Kate Bornstein, and Marci Bowers, and arranged a program on insurance coverage of transgender medical costs with Andre Wilson and Hawk Stone. This year I am excited to have Norman Spack presenting a plenary on medical care of the transgender adolescent.

My gay friends have learned a lot from our trans speakers. I remember in 2005 in Montreal when a speaker from Chicago was giving data on outcomes in boys who displayed effeminate behavior, noting that a certain percentage of them grew up to be “straight” while the rest grew up to be gay. I raised my hand and asked “How many grow up to be girls?” He was quite dismissive of the idea that any of his patients might be transgender. The subsequent years have seen a number of speakers who contradicted his viewpoint. I’m confident that my participation on the Board has opened the eyes of many of our members to the importance of competent, compassionate care of trans patients.

We still have mountains to climb on insurance coverage of transition related expenses, but with the help of GLMA and the AMA we are making steady progress. I also want FDA approval of cross gender hormone therapy, which may take longer, but we are not going to give up.

I have tried to bring a good mix of new Board members and feel we are making progress, but I still want one or two transgender doctors to join me on the Board. Hopefully that will happen soon.

In terms of policy GLMA has continued to be active. We are participating with the AMA in a long term survey, contacting thousands of physicians in the U.S. to find out their knowledge of GLBT health issues and their willingness to treat GLBT patients. We will use this for information to distribute to medical schools and combine it with our educational materials on the health needs of gay men, lesbians, and transgender persons.

We also have played a role in educating hospitals and providers who are not cognizant of medical and medicolegal needs of GLBT persons. We’re working now with a hospital which denied visitation rights to the partner and children of a critically ill woman. Recently we advocated for a couple who were denied artificial insemination by an obstetrician who objected to their “lifestyle.” We were able to get the state medical association to change its position and speak out in favor of the patient.

We also maintain an online directory of providers who are trained in caring for GLBT patients. It’s accessible on our site at http://glma.org and is searchable.

GLMA is doing many good things, and now that my AMA term is ending, I will be investing even more of my time into this organization for the next three or four years. It’s worth it.


June 13, 2009

Back on the Blog: The APA

I’m still in Chicago, but a few hours before the full group activities start. I thought I’d take a little time to tell about our experiences at the American Psychiatric Association meeting in San Francisco last month.

By way of background, and many of you already know this, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is in its planning phases. The current edition, DSM-IV, contains a diagnosis of “Gender Identity Disorder” in the general category 302, “Sexual and Gender Identity Disorders,” which also includes… well, in this blog for all to view, let’s just say the category focuses on the activity rather than the identity.

We Who Should Know – who are labeled with this diagnosis – maintain that our identities are fixed from earliest life, and do not change despite the most intense and (sometimes) well intended efforts to modify identity through modifying behavior. Such efforts have consistently produced worsening unhappiness up to, and including, suicidal thoughts and actions.

The identity is not what changes, and the identity is not disordered.

The process which does work is that which we call transition. Transition is both physical and social. Physical transition, of course, involves hormone treatment and specific surgical procedures. Social transition can be appropriate even for some children too young for physical transition, if they have been carefully evaluated by a specialist and found to have gender identity at variance with their physical sex. Whenever it begins, earlier or later in life, transition works and produces a positive outcome of a functional person, at peace with his or her identity and body.

So we seek to reform the DSM. One reform will be the name “gender identity disorder.” The word “disorder” is stigmatizing and fuels the accusation sometimes heard that we are all “mentally ill.” Yet some description is necessary. I have used the term “gender variance” but I am agreeable to any term which is clear and correct.

Gender variance should be removed from the section on sexual disorders. Gender variance is not about “what we do.” It’s about “who we are.” If it remains in the DSM at all it should be in a separate section, perhaps as a “V Code” which does not designate disease but rather a condition that modifies such disorders as anxiety or depression. I acknowledge there should be some means to allow coding and billing so insurance can – when it will – cover transition related medical and surgical expenses as well as visits to a therapist.

With all that background, I was invited to participate in a symposium called “In Or Out? – Gender Identity Disorder and the DSM-V” at the 2009 meeting of the American Psychiatric Association. I was honored to be part of a speakers’ group which included my friend Dr. Kelley Winters, a strong advocate for years for reform of the GID diagnosis.

I settled on a title called “Aligning Bodies With Minds: The Case For Medical and Surgical Treatment of Gender Dysphoria.” (That’s another term – “dysphoria” – that I don’t like, but I wanted to speak to my audience in their terminology at first. We segued into Gender Variance soon enough.)


Addressing the APA, May 2009. Photo by Margaux

The text of my presentation is reproduced here. To summarize, I told my audience I would take them down a brief side trip into cardiology, which they hadn’t worried about since medical school days. I kept their attention speaking for a few minutes about “microvascular angina,” which causes all the symptoms of typical angina pectoris but isn’t associated with blocked coronary arteries. Treatment with appropriate medicines (nitroglycerin, calcium channel blockers) relieves the symptoms.

Then I asked, “is microvascular angina a mental disease?” They quickly saw where I was going. ”If you came to me with chest pain, and I found you had normal coronary arteries, would you rather be treated with antidepressants? Or nitroglycerin?”

“If I come to you with a typical story for Gender Variance, and you know hormone treatment will relieve my symptoms, are you going to give me hormone treatment or try to ‘cure’ my condition behaviorally?” (Everyone knew the answer.) ”So how is Gender Variance a mental disease?”

I thought it was well received. Kelley’s presentation, as always, was superb, and my hope was that we caused enough psychiatrists to think more deeply about the reasons these changes are so important to us.

Transition works. Outcomes matter.

Outside the meeting hall, Margaux and I joined over a hundred transgender people in a peaceful and well organized protest of the inclusion of GID in the DSM, as well as the use of the label “transvestic fetishism” (in the paraphilia section, no less) for our friends who cross gender boundaries in other ways. We both took our turns addressing the group in the chilly evening. Quite a few meeting attendees stopped to chat and learn.

All things considered it was a very good day. In a presentation which ran concurrent with ours (a huge scheduling error by the conference committee) Drs. Sidney Ecker, Norman Spack, and Milton Diamond presented their data on brain gender identity and treatment of transgender adolescents. These topics are being discussed with more frequency, and at more meetings, every year.

Whether this will change the views of the writing group for DSM-V, I can’t say. There are large obstacles in the form of some of the persons on the group. But others are much more progressive and there is still hope! More about that later.

 

June 12, 2009

A Typical AMA Committee Meeting

So, when I speak of the “AMA Advisory Committee on GLBT Issues,” what is it that we do? My fourth and final, for now, Annual Meeting began yesterday, with our six-hour business meeting. It was my turn to chair this meeting, try to get input from all the members and give each one approximately equal time to speak, while staying roughly on schedule.

We threatened to bog down early on an item not originally on the agenda: the New York Times story of the same day – a misleading story, certainly a misleading headline. ”Doctors’ Group Opposes Public Insurance Plan,” they wrote in a story characterizing the AMA as a stumbling block to any Administration plan. Not so, said AMA President Dr. Nancy Nielsen; the AMA “would accept a public plan that competes on a ‘level playing field’ with private insurers.” But doctors should not be forced to participate in a public plan if they choose not to do so.

Our group spent some time discussing the merits of public and private plans as they relate to GLBT persons. Some of our particular health issues include:

Higher rates of uninsured or underinsured persons under current plans
Losing employer-based health insurance as a consequence of the recession
Failure to get coverage for chronic illness (e.g. HIV)
Lack of coverage for most transgender related health expenses

There are many reasons for GLBT people to benefit from a public option, and we will continue to offer that point of view.

I updated the committee on our presentations to the APA. The members offered helpful comments and support. One psychiatrist suggested we consider using Gender Variance as a “V Code,” which in the DSM/ICD manuals refers to a related condition which is not the primary diagnosis. So a transgender person with anxiety disorder would have the primary code for anxiety with a V Code for gender variance as a secondary diagnosis, which does not imply gender variance as a mental disorder. I’ll have to look into that further.

We had reports on our continuing projects such as the recently produced educational video for providers on “How to Take a Sexual History,” for which several of our members served as consultants, working with the AMA’s Science and Public Health staff. Our goal is for all physicians to view this video and incorporate its principles of taking a sexual history into their practices.

There’s also a joint AMA/Fenway Community Health Interdisciplinary Grand Rounds program on GLBT Health which is being promoted for teaching hospitals across the country; an ongoing survey of medical school deans and medical students sponsored by the Stanford University Medical Student Group with AMA Assistance; and of course the ongoing AMA/GLMA survey of physicians nationwide to learn the level of knowledge of GLBT health concerns.

We reviewed the 2009 House of Delegates Handbook for items of business relevant to our charge. For example, a report on “Handling Derogatory Conduct in the Patient-Physician Relationship” included references to patients who may be abusive or threatening to their physician for any reason. GLBT physicians who present visual cues of difference may be one such group at risk. A resolution “Eliminating Questions Regarding Marital Status, Dependents, …Sexual Orientation…During the Residency and Fellowship Application Process” needs to be amended to include Gender Identity. I’ll speak to that one. ”Support of a National HIV/AIDS Strategy” and “Medical Decision Making For Same Sex Couples” were two other resolutions we will discuss and observe.

An item of new business which the committee will begin to consider and seek opinions was presented: the health effects of “Don’t Ask Don’t Tell” on GLBT service personnel. The strain of living “stealth” in the military could bring on stress related illness up to full blown PTSD, and persons with health related issues such as STD exposure may be afraid to discuss them with their military physician for fear of being outed and discharged. It’s a very important subject and I know next year’s committee will give it a close examination.

We heard from our Board of Trustees liaison who has been such a good ally for us over the years, and we had time to meet with our speaker for Friday night’s caucus – who is going to be terrific! More about that later.

So tomorrow night we have our GLBT caucus. This is where our committee members get together with the other AMA attendees, especially the GLBT students, residents, and physicians who are not committee members but who want the fellowship and security of our group. I look forward to caucus every year. This year Dr. Caitlin Ryan of San Francisco State University will be speaking on the landmark Family Acceptance Project on which she has been working for years.

The rest of the time will be spent attending actual HOD sessions and educational programs, a Joint Section Leaders Caucus, and testifying before reference committees. Unfortunately my flight home is already booked to leave about the time President Obama is addressing the AMA on Monday morning. I would have really enjoyed hearing him in person. But I’m sure it will all be archived for later viewing.

I have grown to enjoy this over four years. It’s going to leave a gap in my travel and activism time, which I’m sure will be more than filled by my GLMA presidency starting at the beginning of October. But I will always remember a productive, pleasant experience with the AMA, and be grateful for the chance to play a role in advancing our cause.


 

June 7, 2009

Back on the Blog: the AMA



It's a shortened work week coming up: I will be flying to Chicago midweek for the Annual Meeting of the American Medical Association. This marks the last meeting of my four years of service on the AMA's Advisory Committee on GLBT Issues, and the end of my one year term as Committee Chair.

Everything happens this weekend. By being in Chicago I will miss the Trans Health Conference in Philadelphia, as well as - and this really makes me sad - my high school class reunion in Greenwood, Mississippi. This is the first reunion I've missed in many years and I'm disappointed.

The tour of service on the AMA Committee has been eventful. When I took the position I was aware of the opportunities and my responsibility to make the most of them. "I can't drop this ball," was the expression I used. Looking back, I think I held onto the ball well enough.

I spent the first two years getting to know the way business is done in the AMA, how new resolutions are introduced and debated in reference committees. At an educational meeting for the Medical Student Section, I gave a presentation titled “Your Transgender Patient,” which was very well received and helped the student group and I get to know one another. This was important groundwork for the next two years.

In 2007, several resolutions were introduced to the reference committee on bylaws, prohibiting discrimination against patients, medical students, or physicians on the basis of gender identity. I didn’t author the resolutions. They were introduced by my friends in the Medical Student Section, the Residents and Fellows Section, and the Young Physicians’ Section, as well as a few progressive state medical societies. My role was to give testimony before the reference committee regarding how my practice and my patients might be affected by discrimination, and how these resolutions would be personally valuable for me. Essentially I “outed” myself to the AMA to personalize these resolutions. I was delighted to see that all of them passed both the reference committee and the House of Delegates, and were incorporated into the Bylaws of the AMA as accepted policy.

The next year we built on our earlier successes. In 2008 Resolution 122 was introduced by a similar group of our allies in the House of Delegates. This resolution cited the policies of the AMA relative to gender identity, and discussed the need for a successful transition in persons with gender identity disorder. The “resolved” clause stipulated

That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by a physician.

Once again, I addressed the reference committee on the importance of completing transition, and how insurance coverage of medical expenses is essential to a successful outcome. I am proud to say that Resolution 122 passed in the reference committee and in the House of Delegates, and this support for insurance coverage for transition related medical expenses is the official AMA position.

So that’s one effort which has occupied much of my time and thoughts. In the weeks to come (don’t expect a daily update!) I will talk more about the things I’ve been doing with GLMA, the American Psychiatric Association, and other aspects of the medical side of trans folks.


 

 

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