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Transgender Access to Health Care

I want to start off by just apologizing for being a little haphazard in my posting here. I am hoping to get on a more regular posting schedule. I have had a lot of different things going on, and I have had a lot that I have wanted to write about but little time to do it. I do appreciate those who have stopped by to see what is going on here, and I look forward to writing more and engaging in some discussions of the topics and issues.

I just got off the Town-Hall conference call with Donna Rose, Jamison Green, and Becky Allison. I thought it was a good start, and I hope there can be more opportunities for our community to come together like this. I think one of the major benefits of calls like this is the breaking down of economic barriers. Today’s topic was essentially health care, and underlying the need for coverage is the need to break down economic barriers. Far too many in our community are unemployed or underemployed. For many, making the journey to a conference may not be possible for economic reasons. Calls such as this will help those members of the community to be able to reach out and interact with the Transgender community at large. I think this will also be of value to those who may live where there is no trans community to speak of. 

Now on to the topic. I think most of us have heard about the AMA resolution in June and the WPATH statement in July. These were both significant statements. I would like to start with the AMA statement, which was actually three statements related to removing barriers to careremoving insurance barriers, and removing financial barriers. The one thing that struck me was the repeated use of GID throughout the statements. They did, however, reference GID as a medical condition, and referenced not only the DSM but also the ICD. Now, I was not familiar with the ICD until this evening. I would appreciate information about it if anyone knows a little more about it, and how GID is treated in the ICD. I think that it is positive that the AMA referred to GID as a medical condition as opposed to a mental disorder. I am curious about how this statement in conjunction with the WPATH statement and other papers could serve to help legitimize our need for treatment if GID were removed from the DSM.

I am behind Kelley Winters’ efforts, my only concern being that we have another avenue by which can can continue to gain the medical treatments necessary to transition. I know some have argued that they do not want to be medicalized. To those I would argue, how can one justify medical treatment in the absence of a medical condition. I want to be medicalized, I just don’t want to be pathologized. I believe that part of our process towards equal health coverage is strengthening the medical need and the recognition of GID in the medical community as a medical condition.

I rather liked the fact the the WPATH statement included things such as chest reconstruction and FFS. As Jamison mentioned, chest reconstruction is the only surgery that many FTM’s want at this time, and for many of them, this surgery is very validating for their gender presentation. The WPATH statement acknowledges that the path to transition is about more than GRS. There are other surgeries and procedures, which some consider cosmetic, that go a long way towards helping to affirm ones gender identity and help make a transition more successful and less emotionally painful (I think anyone who has been through laser or electrolysis knows these don’t reduce physical pain!). 

I think one of the most powerful things in this statement was the AMA’s statement of dispelling the myth that treatments, procedures, and surgeries for trans people are cosmetic or experimental. For us, these procedures are necessary for us to be able to live a life that is more genuine and more true to who we really are. These procedures reduce the emotional stress that can cause so many other health problems. When it comes to insurance companies arguing about cost, I have a few examples of my own situation. Prior to coming out and beginning transition, I smoked almost a pack of cigarettes a day and I was borderline high cholesterol. Within days of coming out, I quit smoking. I stopped cold turkey, now that I was on the road to being me, I didn’t need that crutch. I also changed my eating habits and reduced my stress levels significantly. I was no longer eating the bad foods we eat when we stress eat, fast food, high fat foods, high cholesterol food, you know that stuff that tastes so good but is horrible for you. Since then, my cholesterol is half of what it was before. Not smoking and reduced stress are also significant. Essentially, I likely saved my insurance company easily hundreds of thousands of dollars by transitioning. I greatly reduced my risk of heart attack and stroke, reduced my need for cholesterol and blood pressure reducing medications, slashed my cancer risk each year that goes by, and greatly reduced the potential costs if depression were to lead to suicide or suicide attempts and the related hospitalizations. You tell me, which is better. I think I would take the road of paying for therapy for a few years, GRS and a few other procedures, and HRT. Over my lifetime I bet that it will cost them a lot less then the bypasses and other procedures I was headed towards! 

Another thing I did take away from this was the need for education. Educating our employers, the insurance companies, and the insurance brokers that our companies deal with. There were several stories of brokers discouraging Trans benefits, or pricing them too high to be affordable. I worked in the insurance industry for a brief period of time, and when you are a smaller company, you have little or no ground to negotiate when it comes to benefits. It all comes down to what can I and my employees afford, and what do we have to give up this year. The education has to start with the insurance companies and the larger companies that have the negotiating power. If every company listed in the Fortune 500 index said we want full coverage for out trans employees, I am sure that the insurance companies would take notice.

I find it interesting that many insurance companies offer full benefits to their trans employees, and yet make it difficult and expensive for other companies to provide the same benefits. I wonder about the concept of creating an index that would measure and rate insurance companies not only on the benefits they provide their own employees, but also on how they make the same benefits available to subscribers. Imagine being self employed and having to shop for health insurance with trans benefits, I am sure that is impossible, and if possible prohibitively expensive. 

We need insurance companies to recognize trans benefits as a fundamental part of any group or individual plan. Spread over a sizable group, the costs are negligible. I believe one study showed that it was pennies per premium. I will find that presentation and post it later, I think it was from an Out & Equal conference. If this is part of every policy, cost would not be an issue, and we would finally have equal access to health insurance and the procedures that we need. 

I look forward to future calls, and the discussions and actions that they will generate. There are a few things out there that are dividing some of us, we need to concentrate on many of the things that bring us together. We will always have differing opinions on how to tackle a particular issue, but I think we need to respect the diversity of opinions in this community. We are an educated community, and we need to realize that there is more than one way to approach an issue. Good night to everyone, and hope to talk about some of this more.

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My new blog on wordpress

Just a quick note to let you know that I now have a blog on WordPress.  It’s Amber’s ramblings under amberdarlene.  Rather than posting my various adventures here, I thought I’d post them there.

Amber

Will the proposed amendment to Arizona’s Constitution to ban same-sex marriage change the treatment of existing marriages in which one partner transitions?

Recently, on one of the Arizona trans-related Yahoo groups that I belong to, one member stated her belief that the proposed constitutional amendment to ban same-sex marriages in Arizona, known as Prop 102, would change the law so that “[e]xisting marriages involving a transsexual could easily be nullified.” (The proposed amendment states, “Only a union of one man and one woman shall be valid or recognized as a marriage in this state.”) Here is my response:

I disagree. Prop 102 will have no more, and no less, effect on marriages in which one partner transitions after marriage than the existing statute.

That statute (ARS 25-101(C)) states, “Marriage between persons of the same sex is void and prohibited.” There is no material difference, from a legal standpoint, between a statute, or constitutional amendment, one of which says same-sex marriages are void and the other of which says that only marriages between a man and a woman are valid. Both have the same potential to invalidate existing marriages in which one partner legally changes her or his sex, if the courts choose to recognize that change for purposes of marriage, thus rendering the marriage an illegal same-sex marriage. (Note that, this is not the approach the courts in Kansas and Texas took. Those courts refused to recognize a legal change of sex for purposes of marriage. Under those rulings, a marriage in which one partner legally changes sex after marriage would continue to be valid. As noted below, however, I know of no cases in which that holding has been extended to pre-existing marriages, rather than marriages in which the partner transitions prior to marriage as were involved in those cases.)

In either case, any attempt to declare an existing marriage that was legal at the time it was first entered into, void because one partner transitions would face significant problems under the due process and equal protection clauses of the federal constitution, which always trump state law. There is a long line of cases saying that, as long as a marriage was legal when and where it was entered into, then it remains valid until and unless the partners legally divorce. That’s why people did, and still do, go to Las Vegas to get married instantly and can go back to their home states and have their marriages treated as valid, even though their home state would have imposed additional requirements, such as a waiting period or a blood test. It’s also why first cousins from Arizona can travel to a state where such marriages are legal, get married, and return to Arizona and have their marriage recognized as valid, even though Arizona law says that marriages between first cousins are “void and prohibited” (ARS 25-101(A)), which is the same language used in the ban on same-sex marriages.

The validity of existing marriages in which one partner transitions after marriage hasn’t been resolved anywhere in the U.S., at least, as far as I know, but there is no reason to think that such marriages are any more, or any less, at risk under Prop 102 than they are under existing Arizona law. Nonetheless, I think that anyone in such a marriage needs to be aware of the risk that their marriage might be challenged at some point, and take precautions, e.g., mutual wills and medical directives, to ensure that, if that happens, they will not lose all of the rights and benefits they expected to receive from being married.

Cross-posted from my personal blog.

Children and Transition

This is a blog entry from my personal blog.  Lori had suggested I cross post this entry here. I am glad that she suggested that, it has been some time since I posted here. Thanks for the suggestion Lori, and the wonderful comments. 

I felt compelled to write about a topic that is rather close to my heart, children and transition. I was reading a blog on Yahoo 360 by a friend from the 360 community, Stephanie, see it here. I must admit that I had a very defensive reaction to this posting when I first read it. I hold nothing against Stephanie, I just feel the need to assert my view on this topic. In her blog, she basically questions the decision to withhold information from children during transition, stating that,”There should be no secrets in a family.” 

   Before going much further, I feel that I should give a little background on myself. I came out almost five months ago to my spouse, and I have two young children, both under the age of 6. When I came out, I knew that it was only going to lead to one place for me, and that was transition. For me there is no middle ground. I cannot live part time in one role and work in the other. I have lived my whole life knowing where I was supposed to be, and, since figuring out that transition was possible, I have known that transition was something I needed to do. Yes, I tried to avoid it, through love and other means, but those paths led me to the place I am at now. 

    Now that I am beginning my transition, I have to manage the flow of information about my transition to avoid it getting to the wrong people at the wrong time. Only a very few people know right now, and those are the people who I trust, and who I know will absolutely keep my confidence about what I am going through. There are others who I feel similarly about, but I am still working up the courage to tell them. Others, I feel, will spread the information faster the Paul Revere on a midnight horse-ride. 

     Now for children and the blog post I am referring to. Stephanie is right that children are extremely perceptive. They can sense when something isn’t right or when someone is keeping a secret. I have witnessed the power of children’s perceptions and how they can sense emotions and feelings. One of the most powerful ways I experienced this was on Sept. 11, 2001. I went to my sister-in-laws house that morning on my way to work. My niece, who had just turned one, came up to me right away, and instead of just giving me a quick hug and going about playing, she gave me a long tight hug. This was not just a happy to see you hug, this was one where I could feel that she knew I was upset, and she just held on until I thanked her and told her I felt better now. I was not crying at the time, but I was upset, and she sensed this and did the only thing she knew she could do to try and help. 

    When transitioning with children, we have the added burden of trying to determine the right time to tell our children. Depending on our family situation, their ages, spousal situations, and a myriad of other factors, the “right time” or “best time” to tell your children carry vary greatly from one person to the next. For many of us, if our personal and professional lives intertwine to some extent. Children tend to be pretty honest, and trying to get children, especially young children, to keep secrets can be extremely difficult if not utterly impossible. If information gets out to the wrong people at the wrong time, it can damage personal relationship, work environments, family relations, or other sensitive areas of transition. 

   Do I think that it is good to keep secrets in a family? No, I don’t. I love my children dearly, and I am very honest with them. However, I have not yet begun to tell them about who I really am. My clothes hang in my closet right along side my boy clothes, but they don’t question it. I have also seen no negative effects from my “hiding” the fact that I am transitioning and going out in girl mode once a week. In fact, since I came out and began my transition, my children have become more loving, more affectionate, and more confident. It seems that my being happier and more content has carried over to their own personal sense of well being. Because I am more confident with myself, they are no longer affected by my hiding my true self and the struggle that accompanied it. 

    I think that this brings me to a point that has come up a few times for me recently. That point being about what is the right way to approach any part of transition. Simply put, there is no right way. There is no right time frame, no right hormone regimen, no right surgeon, no right path to transition. There is only your path towards becoming your true self. I appreciate hearing from others about what has worked for them, why they liked a particular physician, why they chose to do things the way they did it, or their general philosophy on transition, but we must remember that we all have to do what is comfortable and right for ourselves. The journey of transition is about discovering yourself through your own personal journey. We are fortunate to have a diverse community with many stories of transition, let’s continue to share those stories, and not judge those who take a different path. I could never spend the rest of my life living as Kathryn but working as a male, yet there are those who can. I do not judge them. We have a community because we need support in a society that judges us and does not understand us, let us not judge each other and let us continue to give each other the support we all need to make what ever transition we choose to make.

I must be crazy!

That’s what keeps cycling through my thoughts as I get deeper into the “trans land of no return”. In the last few weeks there’s been a series of small but significant things that I’ve done for, or with, my transition progress that I can’t “take back”. Things like telling my boss about my GID and that I’m taking certain drugs to deal with it, or showing Amber to my daughter (finally), or this morning, telling my boss that I’m going to have to tell my co-workers about me pretty soon because my changes are starting to get more noticable.

Scandalizing the neighbors with my “dual appearance” out in the yard seems to be a non-issue for me now. The first couple times I went outside as Amber had me thinking I was nuts, but, “I got better”

I had some serious “I must be completely crazy!” thoughts after my last laser treatment, it was really painful!

Sometimes, when I look in the mirror at my changing body and face, I can’t help thinking “what the hell am I doing ?” Last weekend, I was looking at Amber in the mirror and I had that ” Oh my God, I’m actually doing this, I gotta be crazy!” moment.

Last Tuesday, I filed the paperwork at the county court house for my official, legal change of name and all the way through the process I just kept thinking “I must be crazy!”

I really knew that I’m crazy when I went to get fingerprinted at the State Police post for the necessary background check required by the state of Michigan for a legal change of name. The officer was built like a linebacker and had an attitude, especially after looking at the copy of the the paperwork and reading where you have to list your reason for wanting to change your name. He was professional about it though, I’ll give him that much. This guy probably has twice as much mass as I have, and none of it was fat, from what I could see. Can you say “intimidating”? Yes, to put myself through that, I must be nuts!

Fear has a strange effect on the mind, especially fear of the unknown mixed with fear of the bad things that you do know about. It tends to make me think I’m completely crazy for starting, and more importantly, continuing transition. And yet, through all this, I keep going down the path of transition. When I get really freaked out by it, I pull myself back to reality (is this really reality?) by reminding myself that I’ve been wanting this for 30 years! Doing it IS different from wanting to do it, much more intense!

To be honest, up to this point, I really haven’t had many of those bad experiences that other people have with their family, friends, and work. My divorce was tied to this, but she had been cheating on me for 4 years. Yes, I must be crazy for putting up with that for so long. I was dumb, I kept hoping things would change. Anyway, up to this point, that’s the worst thing that’s happened because of my transition. I’m sure there’s more to come, I’m not full time yet, and going full time tends to change things, when it becomes real to everyone around you.
Yes, I’m pretty sure I’m completely crazy!

Oh ya, almost forgot, I just HAD to shave my legs this evening before I could go to the grocery store wearing shorts. How crazy is that?

“Ma’am” fallout

Earlier this week, I blogged about getting my first intentional ma’am from a sandwich maker at the local Subway.  The interesting thing is that I wasn’t trying to “pass” at the time.  If you’re interested, you could read about it on my 360 blog, including a picture of me wearing what I wore into the Subway, I had Teresa take the picture when I got home.  (We live in the same house.)

Anyway, this isn’t about that, it’s about the after-effects of it.  It was a simple thing and I got a big kick out of it, after all I was just on my way to a service call on what was supposed to be my day off.  (I gotta tell the boss that he’s cutting into my “girl” time.)   After I left the Subway, I kept looking in the mirror trying to figure out what she saw that caused her to call me ma’am.  The incident kinda freaked me out after a while, I was thinking “have I changed that much already?”

That was just one of the things going through my mind, I had an emotional surge when it occoured to me that she was looking right at me when she said it, and that I actually could be gendered as female.   That’s always been one of my fears, not being able to pass.  It held me up for a long time, and here I passed without even trying!  Very strange!

It must have hit me pretty deep, because when I was doing my service call at a multiplex cinema and had to go to the bathroom, it was a tough decision to go into the men’s room.   I actually felt like I didn’t belong there.   Now lately, I’ve been wearing a hat so no one sees the lack of hair on the top of my head, it’s not very female.

It seems like it was a defining moment for me, it’s really hard to go back to “guy” mode after that, I’m still struggling with it.  I know that my fears have kept me sitting on the “gender fence” for a while now, it’s really getting to be time to move!   The biggest problem I have with that is that I’m so unprepared, having taken a different path to get here.  I’ve never been a public “cross-dresser”, I started HRT with no “public exposure” experience.  Maybe it’s time to get out of my comfort zone.

How did your first real ma’am affect you?  Did it make you crazy and frustrated like it did me?

Notice to Commenters

As of July 10, 2008, comments posted under the name ‘Anonymous’ with obviously fake email addresses will no longer be approved on TRANScend GENDER.

There is no reason to comment anonymously. WordPress allows you to enter any name, nickname or “handle” when you comment, and the email address you enter is only visible to the blog administrators, not to the general reader or even contributors. It is far better to create an identity under which to carry on discourse – it makes the dialog far less confusing.

Making such a big deal out of being “anonymous” is trolling. We welcome a wide range of opinions as it does add to the discussion and make us all think a little deeper about these issues. However, we ask that you do so openly. We will never require that you identify yourself in such a way as to reveal your real life identity – I think we’re all too aware of how dangerous that can be to some of us in the “community”. Or even some of us who wish to remain outside such a community.

That said, carry on discussing!