December
13th 2010
Trinidad hospital slays the goose that laid the golden egg

Posted under: American history, Bodily modification, Gender, GLBTQ, jobs, local news, unhappy endings

Marci Bowers, MD

After years of being an internationally-renowned place for sex reassignment surgery for forty years, Trinidad, Colorado no longer has a doc in town to do the work.  The Denver Post reports that Dr. Marci Bowers, herself a transgender surgery patient at one time, has moved to San Francisco because of what sounds like an extremely stupid business decision on the part of the local hospital:

Her work has been recorded in documentaries, magazine articles, TV shows — attention she has welcomed, even courted.

Mt. San Rafael Hospital, not so much.

Bowers views the publicity as part of her work.

“It’s important. It educates people,” Bowers said.

The hospital viewed it as an intrusion, an inconvenience and a royal pain. Crews dragging cameras, wires and microphones through the 24-bed hospital disrupt patient care and cost money, said chief executive Jim Robertson.

That prompted an unusual policy. Media must get hospital permission 60 days in advance before visiting and pay for access.

It was that policy, Bowers said, that drove her away.

“In September, I finally said, ‘Look, if I’m going to stay here, we’ve got to address this media policy,’ ” she said.

The hospital and its board weren’t about to do that.

“There are many residents of Trinidad who would like to have the city known for something other than gender-reassignment surgery,” said board member Dr. Jim Colt.

Uh, right:  let me guess.  I’m certainly no businesswoman, but does anyone really think that the one gynecologist the hospital has hired to replace Bowers and the new “cardiac diagnostic tests” are really going to bring patients from around the world to Mt. San Rafael Hospital?  Bowers put 100 patients a year in that hospital, patients who needed extensive pre-op counseling and post-op care, prescriptions, meals, nights at local inns, and the like along with accommodations for their partners, friends, or family members.  What an awesomebusiness decision for a small town in the midst of the Great Recession!  (Don’t miss Bowers’s claim in the Denver Post story that she was driven out of town because the local yokels think they’re going to make a go of selling their luxury golf course to hoards of tourists!  As Ed Grimley would say, “Gimme a break!”)

Hospitals are a little nuts these days about how the changes in health care funding are going to affect them.  There’s a lot of (in my opinion) stupid, petty empire building going on among the hospitals in my area these days.  But, is there anything dumber than driving out of town the one physician who provides the one rather highly-specialized service for which your community of 10,000 people is well-known?

Before she hightailed it out of this state, I saw a lecture Bowers gave at Moo Moo U. here in Potterville last spring.  She’s quite a show-woman and every inch the competitive surgeon she has been for all of her professional life.  She even showed explicit slides of her work–and I have to say that I was incredibly impressed with both her M to F and her F to M work.  Amazing.  How sad for Trinidad that she couldn’t stay.

36 Comments »

36 Responses to “Trinidad hospital slays the goose that laid the golden egg”

  1. Bardiac on 13 Dec 2010 at 7:47 am #

    I’ll bet a lot of those patients were paying full freight, too. Bad business decision!

  2. TexasTodd on 13 Dec 2010 at 7:55 am #

    Thanks for sharing this Historiann. While I was familiar with Dr. Stanley Biber’s pioneering work in the field, I did not know that Dr. Bowers continued the tradition in Trinidad. I’m sad to hear that no one is taking over at San Rafael Hospital. A good chunk of my family is from Trinidad and how a very hardscrabble and economically depressed town–especially after the mines all closed–became a sex change capital is a very interesting story. Dr. Stanley Biber did general surgery in Trinidad for years and he treated many members of my family. I met him once right before my grandfather died. I always thought it was cool that Biber continued to do general surgery even as his renown as a sex-change expert grew. It was also very interesting that no one really seemed to care all that much about his sex-change practice, at least among our family and friends. I think that the general view was that if Dr. Biber could change someone’s sex then anything else would be comparatively easy. These were pretty conservative people–ranchers and ex-miners–but they respected Biber’s expertise and seemed to think that if people wanted to come to Trinidad to get a sex change then that was their business. I was interested to see that this view is still shared by some of the folks interviewed in the article. Given how rough the town can be I was also surprised that some of Bower’s (and perhaps Biber’s?) patients stayed in Trinidad. It’s a bummer that it’s all ending….

    If anyone is interested, here is an NPR obit of Biber:

    http://www.npr.org/templates/story/story.php?storyId=5163832

    It also strikes me that the story of the practices of the two doctors would be a great topic for an oral history project, dissertation, or book. Do you have any intrepid graduate students that might want to make the trek to Trinidad, Historiann?

    As a side note, the whole golf course BS is the latest in a long series of failed revitalization programs big and small that do nothing for the community but somehow manage to line the pockets of local pols and developers. There is this ongoing fantasy among some civic hucksters that the town can become some sort of more northerly Taos or Sante Fe tourist mecca: “build a golf course and the will come.”

  3. Historiann on 13 Dec 2010 at 8:28 am #

    That’s a good suggestion, Todd–our Public History program requires students to take a research seminar in state and local history. I’ll keep Trinidad in mind for students interested in LGBTQI issues. (Since I’m not a Western historian I don’t teach the class, but I usually know the grad students who are interested in queer history topics.)

    And as for tourism: I personally am about as likely to go someplace for a golf course as I am to schedule an appointment with a gynecologist at a community hospital 4-1/2 hours and 250 miles away.

    Dumba$$es!

  4. ianqui on 13 Dec 2010 at 8:42 am #

    It’s so weird that you post this today, because I literally just finished reading Trans-Sister Radio yesterday. (For people not familiar with the book, the character’s operation takes place in Trinidad.)

  5. Janice on 13 Dec 2010 at 9:59 am #

    Wow, talk about cutting off your nose to spite your face! I wonder what Dr. Jim Colt’s medical specialty is and how much attention he missed?

    Yes, regular media intrusions in a workplace, especially one as harried as a hospital, are a pain. But 60 days’ notice and pay for access is punitive, nothing else. So the next time there’s a big emergency or news story at the hospital, are they going to make the local papers wait two months to be able to interview anyone on site or cover the story there. I bet not!

  6. Feminist Avatar on 13 Dec 2010 at 11:11 am #

    Nobody likes to imagine that the success of their town is beholden to one person- and by person I mean woman. That might even mean admitting she has power or something- and we can’t have that.

  7. Historiann on 13 Dec 2010 at 11:41 am #

    FA–it occured to me that the hospital muckety-mucks might not have resented a Dr. Mark Bowers (her pre-op identity) as they have a Dr. Marci Bowers. As I tried to suggest above, she’s got the classic surgeon’s personality (hard-charging cowgirl, very self-confident), although she’s got significantly better people skills. And that’s a personality type that’s much more acceptable in men than in women.

  8. Emma on 13 Dec 2010 at 1:20 pm #

    Or maybe they just don’t want to offer SRS anymore. After all, there is little real medical or psychological oversight of the procedure and the follow up studies that have been done have provided evidence that it’s not as successful as its most vocal and visible advocates would like to say.

    It is an unregulated medical procedure which doesn’t do what its patients mostly hope it will do.

    Or maybe the hospital figures it can offer the care it needs to offer without the circus hoopla. One should seriously ask WHY there is such a circus at this hospital around this particular surgical procedure. Surely Bowers could find a less disruptive and intrusive way to “educate” people.

  9. Historiann on 13 Dec 2010 at 2:18 pm #

    I used to be down on sex reassignment surgery for feminist reasons, but now I’m much more about everyone following hir own bliss. It appears to bring some satisfaction to people, and they’re adults, so why not?

    I also think it’s perfectly OK for Bowers to promote herself heavily. I think she needed to do this for her business model, esp. when located in rural Southern Colorado. I can understand that having cameras following her around would have been a major interruption, but it’s not like she proposed hosting a reality TV show. There are all kinds of medical and verternary hospitals that now participate in those shows–and I don’t hear about them being overly disruptive for those hospitals or their patients.

    From what I’ve seen and read, no one gets sex reassignment surgery on a whim. Most people who get it have struggled for years with their bodies and emotions. If it brings them some peace and acceptance–then I’m all for it.

  10. Digger on 13 Dec 2010 at 3:19 pm #

    I don’t see a problem with Dr. Bowers self-promoting herself; though re: Historiann’s point about her classic surgeon’s personality, I suspect that the self-promotion also is a trait that would have been perfectly acceptable had she been a man.

    I also seriously doubt that Dr. Bowers constantly had cameras and reporters trailing after her like some sort of wired entourage. If there was that much circus, she’d never have gotten any surgery done.

  11. Historiann on 13 Dec 2010 at 3:20 pm #

    At least not 100 surgeries a year!

  12. koshem Bos on 13 Dec 2010 at 5:09 pm #

    There are sex changes in a banana republic.

  13. Emma on 13 Dec 2010 at 5:11 pm #

    I used to be down on sex reassignment surgery for feminist reasons, but now I’m much more about everyone following hir own bliss.

    Which sets me up as the illiberal bigot. Thanks.

    It appears to bring some satisfaction to people, and they’re adults, so why not?

    It appears to bring no satisfaction for very many people, who continue with the same mental illnesses and dysfunction they presented with prior to surgery.

    I also think it’s perfectly OK for Bowers to promote herself heavily.

    And it’s perfectly ok for her employer to not be on board with the manner in which she promoted herself heavily. Especially as that manner appears to have been disruptive and intrusive to the care and treatment of people who were not her patients and thus had not signed on for the disruption and intrusion into their hospital stay.

    <I think she needed to do this for her business model,

    And, again, her business model is selling unregulated and, for many people, unhelpful cosmetic surgery. Hmmmm, I wonder what the analysis would be if Bowers’ business model was selling liposuction and labiaplasty?

    There are all kinds of medical and verternary hospitals that now participate in those shows–and I don’t hear about them being overly disruptive for those hospitals or their patients.

    a) animals don’t have the same issues with disruption of treatment and invasion of privacy that humans do and b) the only people-medical shows that I’ve seen are done in private offices, not hospital settings.

    From what I’ve seen and read, no one gets sex reassignment surgery on a whim. Most people who get it have struggled for years with their bodies and emotions. If it brings them some peace and acceptance–then I’m all for it.

    Again, neatly making me the illiberal bigot and ignoring the point that for MOST people it doesn’t do what you’re trying to say it does. There are plenty of people who get it reversed because it didn’t provide the outcome they hoped for. See, for one example, Piny over at Feministing who went all the way through with it, to the point of her family calling her him, and then “reversed” it — to the extent one can reverse a double mastectomy and hysterectomy.

    The problem isn’t that people get the surgery. The problem is that it is largely unregulated, the “treatment” that leads to the surgery is farcical, there is little effort to track outcomes, and the trans political movement is doing everything it can to make SRS a wholly elective procedure.

    One does not have to be illiberal, a bigot, or down on trans persons to see problems with this.

  14. Historiann on 13 Dec 2010 at 6:11 pm #

    Hey–I never used the terms “illiberal” or “bigot.” I was just explaining my position.

    I don’t know for sure, but I’m pretty sure that Bowers was not a hospital employee but rather a private clinician who had privileges at that hospital. (That’s the way it works for most docs, although more are becoming hospital employees in the trend toward mini-empire building among hospitals.) If she were, I agree with you that the hospital could fire her if they wanted to. But I’m pretty sure she ran her own clinic.

    I’m sorry to hear that anyone went through the trauma of sex reassignment only to want to change it back. However, what’s the solution? Make it illegal? Will that make it safer? (Kind of like abortion, perhaps?)

    So, that’s why I’m agnostic/libertarian about sex reassignment.

  15. Anon for Now on 14 Dec 2010 at 5:25 am #

    Emma and others who question the lack of regulation around trans-related surgery:

    The fact that some people change their bodies and regret it later– however many there may be– isn’t a reason for all surgeons who help with such changes to be stigmatized or regulated out of business. Moreover, we can’t separate individuals’ decisions about their sexed/gendered bodies from the wider culture. When trans people, regardless of their medical decisions, end up mentally broken and suicidal, it’s always reasonable to consider the impact of transphobia, misogyny, and (often) poverty first.

    The lack of regulation in transgender medicine, historically, is also a face of institutionalized transphobia and misogyny. Outcomes research, standardized treatments for recognized diagnoses, and regulation are a sign (to put it bluntly) that some group of doctors gives a rat’s ass whether an affected population lives or dies. Dr. Bowers and others like her have been important for stepping into that gap.

    In recent years, the World Professional Association for Transgender Health has been an important forum for professionalizing transgender medicine and for bringing trans people ourselves into the professional conversations about our medical care. They do good work— much of it focused on bringing “off-label” medical treatment into well-designed research studies, so that the efficacy of various treatments can be determined.

    (The comparisons here with nontrans women’s health issues aren’t insignificant. For as few conclusive studies as we have on, say, the connections between hormonal birth control and breast/cervical/ovarian cancer, we have even fewer on the connections between trans people’s uses of hormones and their subsequent cancer risks. Neither of those research areas is, shall we say, a likely profit center for Big Pharma.)

  16. Z on 14 Dec 2010 at 7:39 am #

    Well, I think I’ve got perimenopause and they won’t give me hormones, they don’t think I’m feeling bad enough … but elsewhere in town people are pumping themselves full of hormones to transgender, and if I can find out who is presecribing that I will see if I can get them to prescribe what I allege would be good for me. I actually favor more information and fewer barriers to all sorts of things, because I think a lot of people DO know what is good for them. It took me forever to convince the medical establishment, for instance, that I was clinically depressed and treatment would help, but not psychoactive drugs. Point: a lot of people really do know what they need, or would see it given enough information.

    On the gender thing, I am informed that there are five sexes: Male, Male Tendency, Hermaphrodite, Female Tendency, and Female; I don’t know if these are the right names. I theorize that if this is true, and we recognized it, then there might be a lot less gender dysphoria. (Note: I know the difference between sex and gender theoretically but I do not always use the words correctly.)

  17. Emma on 14 Dec 2010 at 10:10 am #

    I’m sorry to hear that anyone went through the trauma of sex reassignment only to want to change it back. However, what’s the solution? Make it illegal? Will that make it safer? (Kind of like abortion, perhaps?)

    Not illegal. Why go there? SRS is a *medical procedure* and medical procedures are standardized and regulated by medical protocols. Why go to “make it illegal”? Again, it just implicitly portrays me as a bigot, particulary given the reference to abortion.

    Create fair, non-transphobic, standard protocols, just as there are for other types of surgery. And those protocols MUST recognize that there is no single root cause for wanting SRS. The reality is that SRS can be, and is, sought as a response to trauma, sexual or otherwise, mental illness unrelated to gender, or sexual fetishism. And it MUST recognize the SRS is not a treatment or a cure for gender dysphoria, it is a palliative.

    I don’t “question” the lack of standard protocols and professional regulation, I decry it. It doesn’t serve anybody well and, IMO, is tantamount to malpractice.

    When people seek MTF SRS because they want to “think more like a man”, i.e. more rationally, and the medical professionals who are the gatekeepers to the procedure a) acknowledge that SRS isn’t going to provide that but b) approve people for SRS anyway, that’s a real problem.

    The fact that some people change their bodies and regret it later– however many there may be– isn’t a reason for all surgeons who help with such changes to be stigmatized or regulated out of business.

    The cavalier tone towards people who have gotten major surgical procedures that have permanently altered their bodies based on misinformation and/or misrepresentations about what SRS will provide them grates, to say the least. As is the tagging me with the position that “all” of a certain class of people should be “stigmatized” and “regulated” out of business when I’ve said no such thing.

    Nonetheless, I think it’s fair to say that I believe doctors who use their patients as a soapbox to advance their own personal and political interests should be regulated out of business. Particularly when that soapbox involves showing photos of their patients’ genitals to a general lay audience in a fit of self promotion and “showmanship”.

  18. Emma on 14 Dec 2010 at 10:12 am #

    Typo above, it should read “The reality is that SRS can be, and sometimes is, sought”

  19. Historiann on 14 Dec 2010 at 10:39 am #

    Emma, I think your call for regulation in the service of safety makes sense. But of course, I would assume that as medicine and surgery it’s already regulated. Is it documented that SRS is unsafe and/or underregulated? (I’m asking–I don’t know. I would imagine that it’s difficult to find truly nonpartisan/non-agenda-driven research on these surgeries.)

    I’m sure Dr. Bowers got all of the the permission she needed from her patients to take photos and use them professionally. They obviously didn’t include faces or other identifying information–and FWIW it’s quite typical for physicians to publish or display publicly photos of patients/conditions in medical journals as well as in public and professional talks. So her use of the slides was typical, and moreover uncontroversial among the 200+ audience members at her talk.

    Speaking of photographic invasions of privacy: I don’t know about the newspapers where you live, but the Denver Post is filled with all kinds of photos of people’s pre- and post-op bodies, boobs, faces, teeth etc. That seems to be the standard way plastic surgeons and dentists who do dental implants advertise their work. (The teeth/dental implant ads creep me out more than the plastic surgery ads, actually. It’s disturbing to have someone’s nasty maw on display as I’m trying to choke down my museli.)

  20. Emma on 14 Dec 2010 at 12:51 pm #

    It’s not that the surgical procedure is any more unsafe than any other surgical procedure. It’s that the standards for prescribing the surgery and hormones are not standardized and are pretty much absent. Really, when people can get major surgical and hormonal medical intervention in part because they want to think “like a man” there’s a problem.

    SRS is a surgical/hormonal intervention meant to address/alleviate a psychiatric issue. But there are few, if any, real and enforced standards about what it takes to qualify for prescription of hormones and surgery. Generally, what’s going on is people say “I want it” and they can get it, if not here then in Thailand. Here they’ll have to jump through more hoops, but not enough to ensure that a mistake isn’t made. And that’s a pretty big mistake.

    Getting written consent to use the slides isn’t the issue. Undoubtedly, Bowers does have consents and I can postulate a number of reasons why that’s true. But other than SRS, I don’t know of any doctors who give general public talks, including slides, about their surgical results in an effort to drum up business. When was the last time you went to a public speech, with surgical slides, about heart bypass surgeries? Or a public speech, with surgical slides, about breast reconstrution techniques for women who have had mastectomies? Or a public speech about any new, cutting edge, or transformative surgical procedure? Why THIS procedure?

    And, yes, I know about and have seen the ads for elective plastic surgery, teething whitening, laser fat removal, etc. Is SRS on that level, i.e., elective cosmetic surgery that should be no harder to get than writing a check? I’m arguing against that particular outcome. But I’m at odds with the trans political movement including, apparently, Dr. Bowers.

  21. Comrade Svilova on 14 Dec 2010 at 4:55 pm #

    Emma, I am not trying to deny that you have encountered people who have had a very easy time getting SRS and a hard time afterward, but I’d ask you not to ignore the many people who have had every barrier possible thrown in their way by a medical establishment that consistently marginalizes trans people. In fact, until reading your posts here, the only narrative I’ve encountered among my trans friends is of decades-long battles to be granted the right to do what they want with their own bodies. Like anything, SRS is treated differently in different situations. Although in some, like those you describe, perhaps it is under-regulated, in many many areas it is over-regulated by people who are heavily invested in preventing people from changing their gender. The right to bodily autonomy is so fundamental a right, and for many people, their experience with SRS and the medical establishment is that it is still almost illegal in practice if not in statute.

    I would agree with you that SRS should be honestly presented and fairly regulated, but given the experience of many trans people, Dr. Bowers’ openness and advocacy is far from being a step too far in terms of how the medical establishment treats SRS and transsexual people. For many people, who wait years being marginalized, side-lined, and denied bodily autonomy, it is an amazing experience to see a capable, respected, skilled, and articulate trans woman advocate for their shared cause.

  22. Emma on 14 Dec 2010 at 10:36 pm #

    the many people who have had every barrier possible thrown in their way by a medical establishment that consistently marginalizes trans people.

    See where I talked about standard practices that are non-transphobic. I’m not denying that people have to jump hurdles to get SRS. I see where what I said looks like I think it’s “easy” to get SRS. That was badly stated on my part and not what I think.

    I’m saying that the hurdles which are in place do a piss-poor job. There is an obstacle course, yes, but all that means is that whoever can stick with it the longest, or avoid it by going to Thailand, “wins”. It makes SRS the prize on which people — including medical treaters — focus to the exclusion of all else, including psychiatric or psychological treatment.

    You see, the protocols don’t even try to determine whether people need SRS, they simply are there to determine people’s level of determination to get SRS. The more determined somebody is, the more likely they are to get it. Unfortunately, the more determined they are to get SRS, the less likely they are to think of or seek out other explanations or treatments for their pain. Because the nature of an obstacle course is to get to the end without thinking much about the process or why you’re even on the course to begin with.

    I don’t think a gateway, controlled by fair, consistent procedures and protocols which are more than “I think I need it and I’m going to stick with it until you give it to me” is a problem given the magnitude of the surgery sought, the magnitude of a possible mistake, and the problems of diagnosing a condition that is solely manifested through the subjective reports of people who come into the medical system already actively seeking SRS.

    The only reason SRS exists at all is the advocacy of the trans community. SRS was created in response to people’s subjectively stated need for it. Also consider the perspective of a trans political movement that wants SRS and hormones to be no more difficult to obtain than elective cosmetic surgery but have it paid for as a necessary medical procedure under health insurance plans.

    You can’t really have it both ways: either it’s medically indicated, which requires protocols and prescriptions, or it isn’t in which case insurance shouldn’t pay for it. Hey, if people really want no more control on SRS then there is on liposuction, no skin off my nose, I guess. But then insurance should pay for SRS just like it pays for liposuction, which is to say not at all. But if people think SRS is a medical treatment and should be treated as such, there should be protocols to ensure it actually is medically indicated.

    Regarding Dr. Bowers, the Hospital need not provide Dr. Bowers a free, public platform to advocate for her own political cause under the guise of providing medical care. The hospital need not even provide Dr. Bowers a place to practice medicine. Is the hospital losing money? Sure. That’s their choice. And since I don’t think much of for-profit medicine in the first place, I don’t much care that Dr. Bowers has to drive her Porsche Boxster to a new for-profit hospital to make googobs of money.

    Dr. Bowers also does not stand in as everywoman victim of sex discrimination for me. Dr. Mark Bowers built his career in a male dominated profession (surgery, even) as a male with a wife who raised his kids. Given that, Dr. Marci Bowers actually misrepresents women’s chances and status within the medical profession.

  23. Zoe Brain on 15 Dec 2010 at 8:45 am #

    From the Standards of Care:

    Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not “experimental,” “investigational,” “elective,” “cosmetic,” or optional in any meaningful sense.

    Not “elective”. Not “cosmetic”. Not “optional”. This is a position affirmed by the AMA, the APA and in fact all medical professional organisations.

    Why isn’t it covered by Medicare etc? Because of a report Janice Raymond, author of “The Transsexual Empire” wrote in 1981 for the Federal Government, stating that Transsexuals were by definition rapists out to colonise women’s identities and sap their spiritual essence, and recommending that they be “mandated out of existence” as they are a part of the Global Patriarchal Conspiracy against women.

    Such ideas were very popular at the time. Today… not so much. Feminism has moved on, and those obsolete views from forty years ago are now regarded with some embarrassment.

  24. Emma on 15 Dec 2010 at 9:27 am #

    Right — it says it’s a “therapeutic regimen”, but doesn’t talk about the standards for getting that regimen or what it means to be diagnosed with transsexualism or profound GID or what makes the therapeutic regimen medically indicated or medically necessary. Which is what *I’m* talking about, in part.

    In fact, the prevailing medical opinion seems to be that SRS is not, in fact, “treatment” as it doesn’t cure or treat the underlying psychiatric illnes of transsexualism and/or GID. It is merely palliative care meant to alleviate the discomfort of the underlying illness.

    And the prevailing opinion in the trans political movement seems to be that the medical standards and protocols that do exist should be dismantled because transsexuality/GID is not an illness in the same way that homosexuality is not an illness and both were similiarly misclassified as such by the DSM.

    Leaving aside unsourced allegations about Medicare and Janice Raymond, that is. For a more contemporary legal take on transsexuality and GID, one might more profitably read the text of the ADA, which clearly contemplates that transsexuality is a sexual behavior disorder separate from transgenderism with a biological basis. IIRC. It’s an interesting take, though it is unclear how much it might draw from Janice Raymond’s much mythologized views and their mythologized effect on lawmakers then or now. /sarcasm

    The assumption that I don’t know what’s happening in this area, that I’m somehow uninformed about trans rights, the trans political movement, SRS, and/or discrimination on the basis of transsexuality is a false assumption. I would wager I’m better informed than any person who’s posted here thus far. So, if you want to have that argument — that I’m an ill informed bigot who ought to be “embarassed” by my oh-so-out-of-date views — forget it.

    If you want to talk about what it means to try and get SRS, what Bowers’ situation means, what it means to have a medical condition that’s entirely diagnosed based on your subjective feedback to the dr., whether GID or transsexuality is, in fact, a condition or mental illness at all, or anything other than clumsy, off-point attempts to “educate” me about trans persons and SRS, that’s great. I’m all for it. Otherwise, piss off.

  25. Historiann on 15 Dec 2010 at 11:14 am #

    Emma–this is my blog, not yours. I’ll tell people to pi$$ off (or not.) Seems like Zoe was just responding to you in kind, and not out of bounds at all.

  26. Zoe Brain on 15 Dec 2010 at 5:08 pm #

    The ADA amendments to preclude coverage of Transsexuality were introduced by the late Strom Thurmond, against the advice of the medical profession, and on the basis of ideological belief.

    If you read the link I embedded in my reply, you will see that it goes into great detail in giving the requirements for treatment to be authorised.

    First, the patient is given a psychological evaluation by a mental health professional, over a course of at least three months, often longer, to preclude the possibility of mental illness.

    The patient may then be authorised to take hormones, providing the treating endocrinologist concurs in the diagnosis. This requires a formal letter of approval, where the mental health professional puts their professional reputation “on the line” as it were.

    Some time after that, the patient must undergo the “Real Life Test” or “Real Life Experience”, changing their documentation and living full-time in the target gender role. There is considerable scope for abuse here, some mental health professionals will consider the “test” to be failed if the patient does not wear makeup, heels, and a dress rather than a pants suit.

    This period must be at last 12 months long, 2 years in some jurisdictions, and in Canada, often is required even before body-altering hormonal treatment is authorised. The idea is to test the patient’s resolve: can they function despite being an obvious “man in a dress” and subject to societal abuse and violence for two years, before treatment is authorised?

    12 months is a minimum; some mental health professionals require 5 or even 10 years before authorising surgery by yet another formal letter.

    But that’s not all. Because a second opinion, this time from a post-doctoral specialist reviewing the case history de novo is also required. This specialist must also put his or her professional reputation on the line by writing another formal letter.

    Finally… the surgeon takes both formal letters, and if they also agree with the diagnosis – they may not – will perform the surgery.

    All of this is described in the Standards of Care, though as I said, some jurisdictions have laws in place that require more extensive waiting periods. These are minimums.

  27. Zoe Brain on 15 Dec 2010 at 5:17 pm #

    As regards Janice Raymond and “The Transsexual Empire” – it’s still in print, so you can see where she recommends that Transsexuals be mandated out of existence.

    The book is not the most damaging writing that Raymond has penned. Far worse is a United States federal government commissioned study in the early 1980’s on the topic of federal aid for transsexual people seeking rehabilitation and health services. This paper, not well publicized, effectively eliminated federal and some states aid for indigent and imprisoned transsexuals. It had a further impact on private health insurance which followed the federal government’s lead in disallowing services to transsexual patients for any treatment remotely related to being transsexual, including breast cancer or genital cancer, as that was deemed to be a consequence of treatment for transsexuality.

    - Source. This report is a matter of public record.

  28. Zoe Brain on 15 Dec 2010 at 5:27 pm #

    To see what Transsexuality is…. some light reading.

    Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. by Berglund et al Cerebral Cortex 2008 18(8):1900-1908;

    …the data implicate that transsexuality may be associated with sex-atypical physiological responses in specific hypothalamic circuits, possibly as a consequence of a variant neuronal differentiation.

    Male–to–female transsexuals have female neuron numbers in a limbic nucleus. Kruiver et al J Clin Endocrinol Metab (2000) 85:2034–2041

    The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.

    Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation. Swaab Gynecol Endocrinol (2004) 19:301–312.

    Solid evidence for the importance of postnatal social factors is lacking. In the human brain, structural diferences have been described that seem to be related to gender identity and sexual orientation.

    A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68–70.

    Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones

    A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. by Garcia-Falgueras et al Brain. 2008 Dec;131(Pt 12):3132-46.

    We propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early atypical sexual differentiation of the brain and that the changes in INAH3 and the BSTc may belong to a complex network that may structurally and functionally be related to gender identity.

    Regarding the debate about keeping GID in the diagnostic manual, even though it doesn’t meet the DSM’s criteria for a mental illness, see Seminar S6 of the 2009 American Psychiatric Association’s annual meeting:

    S6. “In or Out?”: A Discussion About Gender Identity Diagnoses and the DSM (DSM Track DM03)

    * The DSM-V Revision Process: Principles and Progress William E. Narrow, M.D.
    * Beyond Conundrum: Strategies for Diagnostic Harm Reduction Kelley Winters, Ph.D.
    * Aligning Bodies With Minds: The Case for Medical and Surgical Treatment of Gender Dysphoria Rebecca Allison, M.D.
    * The Role of Medical and Psychological Discourse in Legal and Policy Advocacy for Transgender Persons in the U.S. Shannon P. Minter, J.D.

    The conclusion was that until this congenital anatomical condition has a place in other diagnostic manuals, it should remain in the DSM so patients can access treatment.

    See also seminar S10
    S10. The Neurobiological Evidence for Transgenderism

    * Brain Gender Identity Sidney W. Ecker, M.D.
    * Transsexuality as an Intersex Condition Milton Diamond, Ph.D.
    * Novel Approaches to Endocrine Treatment of Transgender Adolescents and Adults Norman Spack, M.D.

    A good summary is in the abstract of Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

    The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in trans-sexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.

  29. Historiann on 15 Dec 2010 at 6:29 pm #

    OK, Zoe–you’ve made your point. Now this is TMI.

    I’m not a huge fan of studies that purport to bio-essentialize sex/gender identities. My support for transsexuals has more to do with my latent libertarian views than anything else. Why shouldn’t people use medicine, science, and technology to make themselves happier? (I’m also big on legalizing drugs and I think athletes and others should juice themselves to the max if that’s what they want, so long as everyone understands the risks. YMMV.)

    As a historian, I think it’s an interesting question as to where trans people were before the possibility of sex reassignment surgeries. I’m not saying they didn’t exist–we know of several cases of intersex people going back into the early modern period, for example, but I think that’s somewhat of a different issue. It’s just interesting to consider how/what trans people thought about themselves and how they constructed their lives, if they had any liberty at all to do so. I’m not sure what kinds of sources might reveal them to us now.

  30. Zoe Brain on 16 Dec 2010 at 3:10 am #

    When does History begin? 1 millisecond ago… but I’ll confine myself to pre-1500 CE.

    There are trans people and groups that only fit very broadly our modern definitions of “transgendered”, or “transsexual”, and few of those historically practiced genital surgery.

    The Galliae (Cult of Cybele) in Rome did, as did the Hajira in India.

    But there are many others: The Berdache of the Illiwinek, the Muxes of the Zapotecs and Oaxacans, the Incan Quariwarmi, the Sekhet of the Egyptian Middle Kingdom, the Ashtime of the Maale in Ethiopia, the Mashoga of the Swahili, the Maangaiko of the Ibo, the Sumerian Kugarus, the pre-vedic Tritya Prktri, and so on.

    Some used an unrefined form of the hormone Premarin – which comes from PREgnant MARe urINe. Others, such as the Kwaalu-Atmol of the Sambia in New Guinea or the Guevedoces of the Dominican Republic have “natural sex changes” due to 5-alpha-reductase-2 deficiency mutation in a significant fraction of the population.

    Some of these groups survive today, little changed: the Whakawahine/Mahu Wahine/Fa’afahine etc of Polynesia for example. The Khatoey of the Siamese, and the Hajira of course.

    Trying to shoehorn them in to western socially-constructed boxes that are less than a century old doesn’t work too well – which should tell us that those boxes, recently constructed by psychiatry don’t reflect reality very accurately. What we should do is listen to their narratives, with open minds.

    From a neurological perspective, a facet of a complex reality, both stereotypical “male” and “female” brains have far more in common than differenced. Studies on Intersexed people indicate that, broadly, 1/3 of people are strictly male, 1/3 female, and 1/3 could function adequately as either gender – the exact proportions depending on how well the societal construct of gender in that environment reflects real biological differences.

    In today’s society, that’s not very much. What we see as “gendered behaviour” with a supposed biological basis is (mostly) nothing of the sort, and varies between societies and times.

    Mostly. But it’s the bits that are not mere social constructs that lead to “gender identity”. Senses of smell and hearing for example are as sexually differentiated as height. That’s a good example, because there are many tall women and many short men, yet males are taller on average than females in every society.

    I’m sorry this is overly nuanced. I’m trying to tread the line between superstitious nonsense with no evidential basis about “hysterical women” who “can’t handle maths” on one hand, and the well-evidenced sexually differentiated cognitive and sensory circuitry on the other. Superstition and Junk Science about the first has been used by the Patriarchy to oppress women; Superstition and Junk Science about the non-existence of the second has been used to oppress Intersexed and Trans people, to coerce them into gender roles they can’t fit.

  31. Emma on 16 Dec 2010 at 6:42 pm #

    I’m sorry this is overly nuanced.

    Oh, but it’s not. So no need to apologize. Again, the presumption that I need “education” on what trans is, or what it takes to get surgery, is wildly off base.

    well-evidenced sexually differentiated cognitive and sensory circuitry on the other

    I think Anne Fausto Sterling might have something to say about that particular myth.

  32. Emma on 16 Dec 2010 at 7:00 pm #

    The ADA amendments to preclude coverage of Transsexuality were introduced by the late Strom Thurmond, against the advice of the medical profession, and on the basis of ideological belief.

    Again, with no citation. Unless he did it from the grave, the current ADA, which reaches much farther than the prior version, wasn’t touched by Strom Thurmond.

    I’m not a huge fan of studies that purport to bio-essentialize sex/gender identities.

    Welcome to the rathole of trans-essentialism hidden beneath the heart-tugging civil rights claims.

    My support for transsexuals has more to do with my latent libertarian views than anything else.

    In which case, trans-essentialism? The farthest thing from libertarianism, or liberation, since the invention of hysteria.

    I think Zoe’s given a pretty good demonstration of the gender essentialism that grounds trans politics. Read ENDA’s proposed language on trans protections, for one, to see how that legislation bioessentializes gender.

    Given that, it seems to me a that an imperative line of inquiry might be what the consequences are for women should trans-essentialism prevail as a lefty liberal civil rights analysis. And whether supporting Dr. Bowers without any critical analysis of what she does or his and her places in patriarchy supports an ideology of gender that requires women’s inequality. I would say yes, but undoubtedly Zoe has another “study” about the liberation of recognizing male circuitry and female circuitry.

    Also, Zoe did not respond to me “in kind”. Zoe responded to me as if I was a clueless transphobe who needed to be yanked up on a chain and shown the elementary errors of my bigoted ways with off point “information”. The same way she’s now treated everybody on this blog. Why does discernment and critical thinking go the way of the dodo anytime anybody challenges popular thinking on transsexuality and its discontents?

  33. Historiann on 16 Dec 2010 at 7:36 pm #

    Zoe–trans folk are very different from the berdache/two-spirit examples you cite above. It’s not imposing a “western socially-constructed box” on an identity to be historically and culturally specific.

    Emma, I hear where you’re coming from philosophically about the essentialism of trans identity, but what’s the realistic solution? Tell people that they can’t have SRS? Outlaw the procedure? I just don’t get your anger over the existence of SRS. (At least, I’m reading your comments here as angry. Apologies if I’m misreading you.)

    I know trans issues are kind of hot on feminist blogs (like this thread here, for example.) But off-line, I don’t see where trans issues pose a real threat to feminism.

  34. Zoe Brain on 17 Dec 2010 at 2:30 am #

    Re: the ADA – citation:
    135 Cong.Rec. S10765-01 (1989).

    Honourable mention to Jesse Helms, who did the actual arguing in 1990.

    One case that found in favor of a transsexual as a handicapped person was Doe v. United States Postal Service [67.]. This is the same case that was discussed under the equal protection analysis. Doe advanced several different claims, among them was a claim that as a transsexual she was handicapped and was covered by the Rehabilitation Act of 1973. The court upheld the handicap claim, of Doe, against a motion by the USPS to dismiss for failure to state a claim upon which relief could be granted. The court found that, “the language of the Rehabilitation Act and of the accompanying regulations is broadly drafted, indicating a legislative intent not to limit the Act’s coverage to traditionally recognized handicaps. [68.]” The USPS counter argument was that since a transsexual’s condition may be alleviated by hormones and gender reassignment surgery the impairment was short-term and therefore not covered by the Act. However the court said that “the mere fact that treatment may be available does not automatically remove an afflicted individual from the scope of this statute.” [69.] In 1992 Congress amended the Rehabilitation Act to exclude transsexuals [70.]. To understand the reasons for the exclusion of transsexuals it is necessary to look at the legislative history of the American’s With Disabilities Act of 1990.

    In 1990 Congress passed the American’s with Disabilities Act (ADA). The ADA contains an explicit section [71.] stating that transsexualism and gender identity disorders are not, without a physical causation, considered disabilities. This section was put in at the request of Senator Jesse Helms. [72.] The exclusion clause adopted into the Rehabilitation Act is identical to the clause in the ADA. Recall that the court upheld in Doe v. United States Postal Service [73.] the equal protection argument made by Doe. Recall also that the USPS advanced no rational argument for denying Doe employment other than that she was a transsexual. The assertion by Senator Helms that the ADA would cover a transsexual is correct.

    Source.

  35. Zoe Brain on 17 Dec 2010 at 2:50 am #

    Re Anne Fausto-Sterling – as her classic book “Sexing the Body” was published in 2000, she can hardly be faulted for not being aware of papers published in 2000-2010 – that is, all the papers I mentioned, apart from Zhou’s 1995 paper in Nature.

    Obviously I didn’t give TMI after all. So here’s a few more:

    Regional cerebral blood flow changes in female to male gender identity disorder. – Tanaka et al, Psychiatry Clin Neurosci. 2010 Apr 1;64(2):157-61.

    RESULTS: GID subjects had a significant decrease in rCBF in the left anterior cingulate cortex (ACC) and a significant increase in the right insula compared to control subjects.
    CONCLUSIONS: The ACC and insula are regions that have been noted as being related to human sexual behavior and consciousness. From these findings, useful insights into the biological basis of GID were suggested.

    White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. – Rametti et al, J Psychiatr Res. 2010 Jun 8.

    CONCLUSIONS: Our results show that the white matter microstructure pattern in untreated FtM transsexuals is closer to the pattern of subjects who share their gender identity (males) than those who share their biological sex (females). Our results provide evidence for an inherent difference in the brain structure of FtM transsexuals.

    These two are particularly disliked by those whose ideology requires there be no such neural circuitry:

    “Prenatal hormones versus postnatal socialization by parents as determinants of male-typical toy play in girls with congenital adrenal hyperplasia” Pasterski VL, Geffner ME, Brain C, Hindmarsh P, Brook C, Hines M Child Dev 76(1):264-78 2005

    Data show that increased male-typical toy play by girls with CAH cannot be explained by parental encouragement of male-typical toy play. Although parents encourage sex-appropriate behavior, their encouragement appears to be insufficient to override the interest of girls with CAH in cross-sexed toys.

    Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

    Boys and girls behave in different ways and one of the stereotypical behavioral differences between them, that has often been said to be forced upon them by upbringing and social environment, is their behavior in play. Boys prefer to play with cars and balls, whereas girls prefer dolls. This sex difference in toy preference is present very early in life (3–8 months of age) [1]. The idea that it is not society that forces these choices upon children but a sex difference in the early development of their brains and behavior is also supported by monkey behavioral studies. Alexander and Hines [2], who offered dolls, toy cars and balls to green Vervet monkeys found the female monkeys consistently chose the dolls and examined these ano-genitally, whereas the male monkeys were more interested in playing with the toy cars and with the ball….

    I’d give more, but I think I’ve tried the patience of our host too much already. And besides which, would any more citations of experimental results be helpful? If a small mountain of evidence isn’t enough, would a bigger one, or two, or three, or a hundred make any difference?

    I can recommend the presentations by Dr Veronica Drantz, Biologist, Lesbian Activist, Feminist on the subject.

  36. Historiann on 17 Dec 2010 at 7:39 am #

    Zoe, please review the comments policy here. Long multiple comments are not about a conversation but about rhetorical bludgeoning.

    In any case, I don’t think you’re going to change Emma’s mind about this.

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