I often write about how transgender people who need to access hormone therapy and/or surgery (not all do) must go through one of the most rigorous pre-qualification processes of any medical procedure. But while medical and mental health professionals have focused much attention on setting the hurdles of qualification, relatively little has been focused on either the reality of the qualification process or what comes after it.
One of the foundations of the process is that a therapist must determine who is qualified. Surprisingly, there is no process to certify therapists to do this. In fact, it's rarely covered in university social work curriculums.
One attendee of a recent training at the Massachusetts Department of Public Health expressed disbelief to have never been exposed to the qualification process, or any transgender issues for that matter, in her studies. My younger stepdaughter, a recent grad of another masters program in social work, had the same experience.
Therapists who do develop a specialty in gender have generally done so on the job, but there are few of them in the United States. For transgender folks not lucky enough to have a gender specialist nearby, some can afford to travel the long distance to see one. Many others will end up educating a nearby therapist who has never worked with transgender people on how to qualify the very person doing the educating.
And some transgender people will shun the process altogether, obtaining hormones over the Internet, administering them without medical supervision in doses that can be unhealthy, possibly sharing needles in the process.
And then there's transgender genital reconstruction surgery, also called sex reassignment surgery (SRS). Only a few surgeons in this country specialize in it. Those who do may have started with a brief period observing another doctor before opening up shop, and all perfect their procedures on the job. They rarely talk to each other to compare notes.
Of course, SRS and most other transgender health care is generally not covered by medical insurance. This means that many of us are forced to spend our life savings on surgery, and when a problem develops, no funds remain to travel back to the specialist for treatment. We are stuck going to a local doctor who is virtually guaranteed to not know what to do to fix the problem.
My surgeon tells his patients that his procedure rarely has complications. I learned early on that he really means "complications that he can't handle." In my case I had two -- the need for a urinary catheter for three weeks post-surgery due to swelling, and the need for a subsequent procedure to remove excess tissue that became evident when my swelling went down. But those problems are long gone and I'm ecstatic about the result.
Yet my SRS complications pale in comparison to the rare fistula that Amy Hunter is dealing with. She has since undergone several additional procedures near her home and is still hopeful for a resolution. Yet her doctors are flying by the seats of their pants because the only existing guidance is for dealing with fistulae in natal females.
Hunter detailed what she has learned about the medical community in her recent Bilerico.com post:
There is no curriculum, no specialization, no residency and no board certification for SRS surgeons. No medical texts detail the procedures. Techniques for remedial care of complications are not well developed. Ignorance, discrimination and arrogance on the part of specialists often block those needing specialized post-SRS care.
This is not surprising when you consider the bias against transgender people in the undergraduate psychology text Understanding Abnormal Behavior by Sue, Sue and Sue. The current edition from 2008 cites outdated prevalence numbers that are severely understated. The text says that most research shows that people regret their surgeries (the vast majority do not), and discounts surgery in favor of highly controversial reparative therapy, which claims to "cure" a person of being transgender. How many other textbooks are like this?
With bias like this as the norm in the medical community, is it any wonder that college faculty have difficulty justifying inclusion of anything other than a brief mention of transgender health issues in curriculums?
Perhaps consequentially, little research is done on transgender health. It's rare for an article to appear in the mainstream New England Journal of Medicine, with much of the little research that is done being published in the much lesser known International Journal of Transgenderism.
What to do? So much energy goes into setting high hurdles of qualification, hurdles which some believe are unnecessarily strident. Why not refocus some of that energy on educating the providers of transgender care, and on providing follow-up care?
Follow Joanne Herman on Twitter: www.twitter.com/joanneherman
Rev. Meg Riley: After Transgender Remembrance Day, Giving Thanks for the Living
http://www.thescavenger.net/isgd/more-problems-with-trans-healthcare-28679.html
This is not surprising when you consider the bias against transgender people in the undergraduate psychology text Understanding Abnormal Behavior by Sue, Sue and Sue. ... How many other textbooks are like this?
Joanne, I wonder what that book says about intersex people? I dread to think.
Storm4u writes:
I went to a Doctor in Kings Cross Sydney who had 35 yrs experience in dealing with TS and had seen TS try lots of things. He knew what worked and what didnt. ...
Storm4u, I would love to know the name and contact details of that doctor. At OII Australia - google "intersex" and "australia" - we are still looking for doctors who are at least openminded about prescribing for intersex people.
It is at least as bad for intersex people as it is for people with transsexualism. I would hope that a doctor with 35 years experience prescribing for TS would make an effort with intersex people too.
Would you mind sending us a note about this doctor via the OII Australia Contact page please?
I've done guest lectures in front of thousands of college students, and every time they're amazed at both the cost, the fact that *everything* comes out of pocket, only a few if any insurance companies cover transition, and the fact that Medicaid and Medicare are *purposefully* prohibited from treating transfolk in regards to their transition!
There needs to be a strong call around the world from the medical profession to the pharmacutecal companies for trial based information on the treatment of Transsexuals. I have yet to see anywhere one pharmacuetical recommendation of hormones for Transsexuals. Heaven forbide this stopping Doctors prescribing hormones for TS but basically the medical profession is negligent in prescribing hormones for MtF Transsexuals and they should be yelling long and hard for this information.
We are just people and should have the rights of all. The right to be treated equally and with care and respect by the medical profession.
We need better access to counselling and surgeries. The medical profession needs to recognise us and stop patronising us.
When I needed hormones, I researched them on the net and worked out myself what I needed, what would happen, what the dangers were etc and I presented the Doctors with the information and told them what I needed. I was lucky as I choose Doctors who were perpared to listen to my aguments and not just dismiss me as they knew better.
I went to a Doctor in Kings Cross Sydney who had 35 yrs experience in dealing with TS and had seen TS try lots of things. He knew what worked and what didnt. He told me of a high dose rate course over 12 weeks. What it would do and he was right in everyone of them. I have told other Doctors of this and they throw up their hands in horror but can’t say why.
The thing is that there is little actual trial work done anywhere in the world done on pre op TS. We are prescribed hormones based on the effects on natal woman. And the dangers.
I stay away (far, far away) from anything sharp that might rearrange my body.
Plus, it costs money. Forget that.
Its also kind of a slap in the face to the very few community clinics, which offer critical support to transgender patients on a sliding scale/low income basis, being mostly sidelined by a law which essentially is guaranteed to hand over millions of dollars to the ugly private insurers who've only ripped off the american people over and over.
If anyone deserves money for their commitment and effort to communities it is clinics like these, which don't need to waste millions of dollars on expensive ad campaigns convincing everyone they care about the community. They are too busy doing it.