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SOPA and Transition Medicine: We've Been Here Before

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There are many valid reasons to oppose the passage of SOPA. I won't dignify the bill with its Orwellian name, just as I won't call a tax on inheritances anything but an estate tax, but suffice it to say, SOPA's most well-known provision is the reverse-onus copyright provisions, the kind of assault at the heart of Web 2.0 that would erase much of the progress of the last decade when it comes to the flow of information and the ease of creation of art. It would be much like the world I grew up in, in that the Internet would effectively cease to exist, putting control back into the hands of those who hold copyrights of length and boilerplate-inviolability that was not even considered by America's Founders. In 179 the United States passed its first copyright law. The copyright lasted for 14 years, 28 if the person who created the work was still alive after the first 14 years. There was no concept of corporate ownership of copyrights, but then, it was a simpler time, much like 1983.

I was born in 1983. I don't know of what particular relevance this specific is, except to think back to what things were like then. A few things were, in my opinion, better, like the quality of vacuous pop music. I'll take Lipps Inc. over Justin Bieber any day, even if he does come with k.d. lang's stamp of approval. The ratio between pay and productivity was better, though the government of the day was doing what it could about that small equity. And we had a much cooler prime minister here in Canada. And some things were, obviously, worse, the most glaring ones to me being the Internet and tolerance. Not only did people tend to have far less understanding, decency, and tolerance toward LGBT people back then, but LGBT people were more tolerant toward one another (but we'll come back to that later). More relevant to my life than even flash games and the ability to see pretty much any piece of video or writing I could care to see near-instantaneously is my access to transition medicine.

See, in 1983, there was no way someone like me would have been able to get treatment without telling a lot of lies:

"Why, yes, Doctor, I'm solely attracted to men..."

"Why, yes, Doctor, of course I want surgery..."

"Why, yes, Doctor, I think that being required to dress high-femme for a year before milligram one of estrogen is dispensed is a completely natural restriction..."

"Why, no, Doctor, I would never be open about my history. I plan to move across the country, just as you recommend..."

It's not surprising that back then, the estimated prevalence of transition was 1 in 30,000. You needed to impress some people with some patently sexist ideas about gender. People who seemed to expect every trans woman would be straight, stealth, stunning, and snipped had no problem washing out patient after patient, denying them treatment. Of course, this attitude had been reinforced by an earlier action of the Reagan administration, the defunding of transition medicine, a change in policy from the less strident policies of previous administrations. Insurance companies were able to use this action as cover to remove transgender health care from their list of acceptable procedures. Furthermore, often (and to this day), insurers will then point to any plausibly or implausibly related condition and claim that it was a complication of transition medicine.

So the insurers point to government refusal to cover transition for eligible persons when they deny trans people health care... Who did the government point to? Susan Stryker writes in Transgender History:

As mentioned earlier, the construction of transgender identity as an official psychopathology recognized by an accredited expert medical opinion would presumably mean that medical treatment of transsexuality would be considered a fully legitimate healthcare need. This proved, however, not to be the case. Insurance companies continued to consider transsexual healthcare treatments to be "experimental," "cosmetic," or "elective" and therefore ineligible for insurance coverage or reimbursement. Transgender-access to government-funded social services, which had been more readily available during the Democratic administrations of Johnson and Carter, was drastically curtailed under Reagan -- in part, it seems, in response to antitransgender feminist arguments that dovetailed with conservative politics. When antipornography feminists in this period, such as Catherine MacKinnon and Andrea Dworkin, allied themselves with conservative government policies in order to criminalize pornography (which they considered, often with some justification, to constitute violence against women), Janice Raymond hammered home the connections with transgender issues by suggesting that the "same socialization that enables men to objectify women in rape, pornography, and 'drag' enables them to objectify their own bodies," treating a penis as a thing to "get rid of" and a vagina as something to acquire.

Operative essentialism aside, the aforementioned Raymond, currently professor emerita of women's studies and medical ethics at the University of Massachusetts in Amherst, did more than that. As a follow-up to her landmark work, Transsexual Empire: The Making of The She-Male, in which she called for transsexuality to be "morally mandated out of existence," she wrote Technology on the Social and Ethical Aspects of Transsexual Surgery, in which she recommends the following:

While there are many who feel that morality must be built into law, I believe that the elimination of transsexualism is not best achieved by legislation prohibiting transsexual treatment and surgery but rather by legislation that limits it and by other legislation that lessens the support given to sex-role stereotyping, which generated the problem to begin with. Any legislation should be aimed at the social conditions that initiate and promote the surgery as well as the growth of the medical-institutional complex that translates these stereotypes into flesh and blood. More generally, the education of children is one case in point here. Images of sex roles continue to be reinforced, at public expense, in school textbooks. Children learn to role play at an early age.

This was the work that allowed the Reagan administration to think, not without cause, that it could get away with neglecting trans health in the same way that they were neglecting the AIDS crisis, but this time with political cover from a significant portion of the left. As I've said in my last installment, it's hard to argue that transsexuality is a response to sex roles when greater fluidity in sex roles, fertility rates, and reproductive freedoms have made assigned sex matter less and less on a social, economic, or political level, at the same time as we see a two-orders-of-magnitude increase in the prevalence of social transition. Suffice it to say, we've come a long way since I was a baby. But Janice Raymond goes on to advocate the following:

Nonsexist counseling is another direction for change that should be explored. The kind of counseling to "pass" successfully as masculine or feminine that now reigns in gender identity clinics only reinforces the problem of transsexualism. It does nothing to develop critical awareness, and makes transsexuals dependent upon medical-technical solutions. What I am advocating is a counseling that explores the social origins of the transsexual problem and the consequences of the medicaltechnical solution. It would raise questions such as the following: is individual gender suffering relieved at the price of role conformity and the perpetuation of role stereotypes on a social level? In changing sex, does the transsexual encourage a sexist society whose continued existence depends upon the perpetuation of these roles and stereotypes? These and similar questions are seldom raised in transsexual therapy at present.

It's a pretty blatant call for reparative therapy, and, by the way, about as successful. You can no more dialectic therapy away the dysphoria than you can pray away the gay.

So what? In the early 1980s the government, under cover from special interest groups that viewed the lives of trans people as parenthetical at best, introduced policies that prevented trans people from getting access to transition medicine, and we know what happens when trans people who have expressed a need for it can't get transition medicine.

So what? Long in the past. Nobody would ever advocate something so obviously harmful to trans people today, right? Well, unless there was a more prominent issue that obscured this one.

Trans people, in doctors' offices across the country, are currently not able to enjoy the same level of reproductive freedom that cis people enjoy. If you don't believe me, get two people, one cis, one trans, who want to have their endocrine levels adjusted exogenously to bring them in line with what they would expect for their identified sex. The cis person will get a blood test, a discussion of the risks, and be back in a couple of weeks for a prescription, whereas the trans person... well, I waited 11 months, and I'm one of the lucky ones. I know people who have spent years trying to access essential medicine, as they are handed from one disinterested or simply outright transphobic medical professional to another, despite medically facing the same contraindications when it comes to exogenous hormones: an absence of a sex-steroid-driven cancer, and a functioning liver.

So where do you go if you don't live near one of the cities that have an informed consent clinic, and you simply can't get access to exogenous endocrine intervention (i.e., hormones)? Well, often, you go online, to reputable but grey-market Internet pharmacies, which source the same generic drugs that I take, and you pay out of pocket, knowing that it's about as good an outcome as you'd expect after fighting doctors for about a year for things so basic as blood-pressure medicine.

There are trans people who depend on these pharmacies when they live in places where treatment is not legally proscribed but effectively proscribed, much like access to abortion, usually in the same states. One of the provisions of SOPA would be to curtail access to those pharmacies, which would make it more difficult for many Americans to import generic drugs... but consider: not only will SOPA make prescriptions more expensive for some, but for others it will deny them their best avenue to treatment. Physicians will often only begin supervising exogenous endocrine intervention for a trans person once they have begun medication, refusing to sign off otherwise, on a diagnosis that is ultimately as reliant on self-reportage as a headache.

Ultimately, the passage of SOPA would force many trans people back into the catch-22 of requiring a prescription to get a prescription, putting the ultimate power over people's bodies back into the hands of gatekeepers who have a terrible track record on the issue.

Every civil rights struggle of the last 50 years was marked with a breakthrough in the area of reproductive freedom. Lawrence v. Texas made it illegal for the government to regulate sexual activity on the basis of legal sex. Loving v. Virginia made it illegal for the government to regulate sexual activity on the basis of ethnicity. And Roe v. Wade made it illegal for the government to restrict the rights of people to deal with unintended pregnancies. SOPA's passage would say to the nation that there lives a right to privacy and security of the person within the bill of rights...

Unless, of course, that person is trans.