The Trials and Travails of Transness: My Body, My Choice

by Shaker Alexmac, a transgender woman studying at the University of Florida.

[Part 7 in an ongoing series: Part 1; Part 2; Part 3; Part 4; Part 5; Part 6.]

While transgender people have a large historical and cultural connection to the Cis LGB community, Transgender people (especially transsexuals) also have a lot in common with the feminist movement. Specifically, the reproductive rights movement. Just the most recent example is in health care reform, with Rep. Stupak and his merry band of anti-choice democrats attacking insurance coverage of abortion (apparently successfully...sigh) and a right-wing group attacking potential coverage for transition treatment costs. In fact they are using the same logic to attack it. They don't want to potentially pay to help the "trannies" or the "dirty sluts" who want access to legal medical procedures. Medical access is extremely important for trans people, especially because any transsexual who desires to be recognized by officials as their target sex must interact with the medical establishment and follow the legal procedures.

Let's first explore the actual process of medical transition as set forth by the World Professional Association for Transgender Health (WPATH), the organization of therapists and doctors which set up the current rules for transition. The rules can be found in the its 6^th edition Standards of Care (pdf), hereafter SOC.

The first step for people wishing to transition is a visit to your friendly local gender therapist who must be convinced that hir patient is a "real" transexual. This is a major hurdle for many trans-people, who must bear not only the cost of an indefinite number of therapy sessions, but also the burden of proving to their therapists that they are trans. Depending on the therapist you find, it can be as simple as meeting hir and explaining how you feel, or as complicated as having to attend sessions presenting as the gender to which you want to transition without regard for any potential threats to personal safety, personal comfort with dressing as one's target gender before any physical alterations have begun, or any other considerations. In the latter case, you also often have to present in a very stereotypical way (for your target gender) or you aren't "serious" about transition.

An anecdote of this treatment can be seen Viviane Namaste's book Invisible Lives (via Whipping Girl).

One woman explained that she was initially denied hormones by her therapist when she showed up wearing 'male' clothes. She recounts: "I just went back, and this time I did all my makeup, inside and outside my eyes, wore my little fake fur jacket and my tight black plants. And she said 'you've come a long way since I saw you first. And now I am convinced that you're a transsexual.'"

Once this first hurdle is passed, the next one is hormones. If your therapist thinks you are sufficiently trans for their approval, they will write you a letter to see a doctor who can prescribe the hormones. Once you see the doctor (another big expense), you are then branded by the insurance company with a pre-existing condition, and more than likely none of your treatment costs from here on out will be covered.

You can then begin hormones, which won't be covered unless you have an experienced doctor to cook up a story for your medicine (I am being treated for a urinary condition. *wink*wink*)

The next step is up to you. You can continue to pass as your assigned gender while the hormones begin to change your body, or you can start the real-life experience at this point. The real-life experience is when a person lives full time as hir desired gender. Trans people must live full-time for at least 12 months and then they can be considered for surgery. During this time, they continue to see their therapists and, once the waiting period is over, they need to get a letter from two therapists before they can be approved for surgery. If all these conditions are met, then the trans person can have gender reassignment surgery (GRS).

Now, the SOC does allow some flexibility, but this is the process for the most part. It is set up as a gatekeeper model to test how badly trans people want to transition and is not set up to focus on actually improving the mental health of trans people. Up until last month, Thailand did not follow the SOC and that allowed many people to avoid at least some of the hoops, but looks like that loop is closed. For those who are too poor to see a therapist and doctor, there are black market hormones, silicone injections and even back-alley butchers to perform surgery for them. (For more insight on how the SOCs are inherently abusive economically, physically, and emotionally, due to the power therapists and doctors are given over trans people, read here.)

Is any of this sounding familiar? Trans people, like fertile cis-women, are not allowed to choose for themselves to have access to a legal medical procedure which can seriously affect their quality of life. We are both paternalistically denied treatment with the excuse that some may regret their decisions. Likewise, the poor among us are unable to access treatment due to cost, and are in danger of harm when forced to seek unregulated treatment. We face the same enemies, with right-wingers depicting GRS as mutilation and abortion as murder.

Unfortunately, some of those who are fighting for reproductive rights turn around and attack trans people with the same sort of attacks used against reproductive rights, undermining their message. With feminists such as Janice Raymond claiming that transsexuals should be "morally mandated out of existence," functionally saying "my body, my choice" and then turning around and telling trans people, "your body, my choice."

Transsexual people who want to medically transition should be trusted to make decisions about their own bodies. We should also fight for those who do not want to medically transition to be respected. Feminists and transsexual people are natural allies in the fight for access to medical treatment and make sure the motto "my body, my choice" applies to everyone.