The Sorry State of Transgender Health Care

From The Huffington Post:

Reposted with the permission of Joanne Herman

The Sorry State of Transgender Health Care

Joanne Herman

Transgender advocate and author of “Transgender Explained For Those Who Are Not”

Posted: July 7, 2010 04:27 PM

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 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?

Copyright © 2010, Inc.

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Gay Marriage Foes: ‘Til Disclosure Do Us Part?

From Mother Jones Magazine:

The National Organization for Marriage was on a roll—until it wedded its campaign to a multistate legal effort to keep its donors secret.

— By Stephanie Mencimer

Thu Jul. 1, 2010 3:00 AM PDT

When the National Organization for Marriage succeeded in banning gay marriage in California in 2008 through the ballot measure known as Proposition 8, it looked like the movement was on a roll. That same day, similar measures passed in Arizona and Florida. Anti-gay-marriage activists seized on these victories, bragging that they had delivered a crushing blow to nationwide efforts to legalize same-sex marriage.

Those activists don’t seem quite so smug these days. That’s because they’ve been on a losing streak: In the past month alone, the National Organization for Marriage (NOM) and its allies have suffered a series of significant legal setbacks, culminating with last week’s nearly unanimous Supreme Court ruling in a case arising from a Washington State ballot measure. Collectively, these defeats, in states from California to Maine, could make it much harder for these activists to wage war on gay marriage. For this, New Jersey-based NOM really has no one to blame but itself. That’s largely because in its quest to fend off gay marriage, it has engaged in a host of potentially illegal stealth campaign tactics and waged legal battles to shield its supporters from public exposure.

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Federal Court Strikes Down DOMA Section 3

From Glad (Gay and Lesbian Advocates and Defenders)

July 08, 2010

Today, U.S. District Court Judge Joseph L. Tauro ruled that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional with respect to claims brought by seven married same-sex couples and three widowers from Massachusetts. Under the ruling, the plaintiffs are entitled to the same federal spousal benefits and protections as every other married couple.

The ruling stems from GLAD’s lawsuit Gill et al v. Office of Personnel Management et al, filed in March 2009.

“Today the Court simply affirmed that our country won’t tolerate second-class marriages,” says Mary Bonauto, GLAD’s Civil Rights Project Director, who argued the case. “I’m pleased that Judge Tauro recognized that married same-sex couples and surviving spouses have been seriously harmed by DOMA and that the plaintiffs deserve the same opportunities to care and provide for each other and for their children that other families enjoy. This ruling will make a real difference for countless families in Massachusetts.”

Read the decision.

Read GLAD’s press release.

Hate can wear a famous face

Today Leonard Pitts column was on the infamous anti-Semite, racist and well known misogynist, Mel Gibson.

I read it in the Dallas Morning News but I am linking you to the source.

Read it at:

When I read it the most important part wasn’t about the sado-masochistic Gibson who displays his sick paraphilia  in every film he makes or stars in.  He has become one of those people whose products I will neither buy nor watch.

More important was a passage in Mr. Pitts’ column:

People tend to have this naive notion about hate. They think it’s something you can see at 20 paces, something obvious and over-the-top, like the Nazis Jack Kirby drew for Marvel Comics; you always knew they were evil from their craggy teeth and bad skin.

But hate looks like a grandmother baking cookies, a teacher standing in front of the class, a preacher opening his Bible. It looks like you or me, like anybody anywhere.

The philosopher Hannah Arendt famously wrote of what she called the “banality of evil.” Well, there is a banality to hatred, too. We are conditioned to expect a grand, operatic malevolence, but there is nothing grand about it. Hatred is ordinary, hatred is insipid, hatred is small and mean. It is a series of compromises made with conscience, an expedience that bypasses thought and compassion.

A funny thing happens in our struggles for freedom, social justice, equality, human rights and dignity.
Too often I hear the most hateful things thrown about by people who make up the great masses of oppressed people at the bottom of the social order.  Seems like some people seem to think they can gain the acceptance of the bigots if they act like them.  In some cases they succeed.  Look at “Wide-Stance Larry Craig”  Or Ted Haggard…
I am extremely saddened when I hear sisters espousing the values of right wing conservatives and Christo-Fascists.  I want to say to them that sleeping with the enemy will not only not save you from oppression but that it is both un-ethical and soul destroying.
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Who is More Conservative: Ronald Reagan or Barack Obama?

Cenk Uygur

Host of The Young Turks

From The Huffington Post

Posted: July 8, 2010 01:55 AM

Who is more conservative – Ronald Reagan or Barack Obama?

If you think that’s an absurd question, you’re not alone. We had this discussion on The Dylan Ratigan Show when I was filling in for him on MSNBC and both of my guests thought it was absurd. A conservative website led with the headline that it was absurd (though they did not present one single fact to back up their claim). Except as it turns out, based on the facts, it is a really hard question to answer. And it would be absurd to claim otherwise.

Ronald Reagan:

-Gave Amnesty to Illegal Immigrants
-Negotiated with Terrorists (Traded Arms for Hostages with Iran)
-Raised Taxes on a Large Scale Four Times (After Initially Lowering Them)
-Negotiated with the “Evil Empire” without Pre-conditions
-Made a Decision to “Cut and Run” From Lebanon After Our Troops Were Attacked

In fact, as you look at the Reagan list, it seems he is the exact opposite of what conservatives now claim they want. It looks like the caricature of what they think liberals do. There is no way that even Dennis Kucinich would be able to do all of those things; he certainly wouldn’t negotiate with terrorists the way Reagan did.

Of course, Reagan also took the country further right in many ways but our political spectrum has moved so far to the right that he looks left behind by comparison. So, let’s go to Obama and see what that “socialist” is up to.

Barack Obama:

-Escalated the Afghanistan War (Added 30,000 More Troops)
-Has Ordered Drone Strikes (Assassinations) on US Citizens Outside the Country
-Gave Drug Companies Near Monopoly Power by Barring Imports, Extending Patents and Not Allowing the Government to Negotiate Better Prices
-Funneled Billions into the Biggest Banks in the Country After They Crashed the Economy
Stacked Deficit Commission with Fiscal Conservatives
-Lowered Taxes Significantly (Stimulus Bill)
-Ordered Increased Offshore Drilling Before BP Spill

The Obama team would argue that they did a lot of this because the Republicans made them do it. First, that’s entirely untrue because the Republicans didn’t make them pass any bills. The GOP also didn’t give most of this legislation a single yes vote, so they could have been entirely ignored if Obama had the courage to do that. And many of the items on the list are executive actions, which the Republicans have no control over.

Second, conservative is as conservative does. If you implement this many conservative positions, are you really sure you’re not one?

Now, people will cry and scream that we had the most historic health care reform and will soon have the most historic financial reform ever. Isn’t that progressive enough?! No, that’s nonsense. They are called historic only because the White House called them that. Financial reform is a joke that still leaves the big banks in charge and has failed to end “too big to fail.” And yes, health care reform actually covers more people if they ever get it (maybe in 2014) and if they can afford it (depends on what private insurance decides to charge them), but it still leaves the health care system exactly as it was before. This is the progressive change people voted for?

The bottom line is that, no matter what the reason, Obama seems to be in some important ways significantly to the right of Reagan on the political spectrum. If Reagan ordered the execution of US citizens abroad, he might have been impeached. If Obama tried to give undocumented immigrants blanket amnesty the way Reagan did, he might be impeached.

I don’t think Obama is a hard right-winger. It’s just that the political establishment in this country has moved so far to the right (though not the public, according to polls on specific issues) that as a natural politician when he goes to appease them, he is solidly center-right on the spectrum.

And the political line has moved so far that if Reagan tried to run as a Republican now he would be the laughing stock of the party. Rush Limbaugh would tear him to shreds and Bill Kristol would say he is Neville Chamberlain. He would be run out of town as a tax-raising, amnesty giving, terrorist negotiating, cut and run no-good lib who hates the troops.

And anyone who claims otherwise is being absurd. As Reagan once said, “Facts are stubborn things.”

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