October 30, 2012
- Funding. In most public and private health insurance structures, a medical code is required to justify the paying out of money for surgical and non-surgical health procedures and services. So public and private health funding of sex reassignment surgery (GRS/SRS) are vulnerable. Insurers see them as “cosmetic” procedures, and switching to an elective medical model will only reinforce that perception. Mastectomies and hysterectomies for trans men might also be affected in this way (unless an alternate justification is given), and conceivably also counseling, or visits to a family doctor for HRT prescriptions and monitoring (depending on billing requirements and local regulations). And then there’s the HRT itself. Not all of these are funded in all areas, and in fact, some regions go to great lengths to deny funding for any or all of these things. But some do, and they could be compromised if GID / GD is simply declassified, with no contingency plan. Moreover, delisting would significantly hamper the potential to gain funding from insurers that don’t currently cover trans health.
- Access. Simply put, if there’s no diagnosis, a doctor doesn’t have any obligation to care. If there is a medical classification in some form, there is an obligation to provide care, or at least not stand in the way of it. This doesn’t always work this way, but the existing situation provides us some recourse when access issues occur. Further, many surgeons and doctors may not be willing to take on trans patients under a personal elective system, because of fears that we’d change our minds and sue. The existing 1-to-indefinite year of therapy process has provided a comfortable barrier against legal liability. How many medical professionals would simply walk away rather than accept that new risk to help trans people — especially with any obligation to treat removed from the equation?
- Identification correction and citizenship. Given that many regions also require a change of physical sex in order to change major identity documents, financial and access barriers to trans-related procedures also extends the time before legal and social enfranchisement is attained. It shouldn’t be that way (and has been fixed in a couple fortunate jurisdictions), but it is.
- Counseling. While it’s a problem that transition is dependent on therapists, there’s also some need for caution about taking psychiatry entirely out of the equation, at least for those who want it. Transition does bring with it some emotional upheavals, particularly related to associated stigmas (which won’t simply be gone when transsexuality is no longer considered mental illness) and challenges (unaccepting families, depression from things like job loss, etc).
- As twisted as it has been, the existence of a medical classification has provided a form of validation, even if the specific application also invalidates. It has forced people to acknowledge that we exist. The problem is that validation has focused on what’s in our heads rather than on what we’re actually bringing into alignment, which is our body. But regardless of the mistaken focus, this validation has helped to push for legal support. Just as easy as it is to find right-wingers pointing to the mental health classification as a reason to disparage, you can also throw a rock and randomly hit a reference used to justify and defend. From a statement made by 20 local and regional NGOs operating in Malaysia, responding to a ruling upholding a law making the wearing of clothes which are considered incongruent with one’s birth sex punishable with a fine of up to RM1,000 and / or up to a year in jail:
In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the American Psychiatric Association (APA) replaced the diagnostic term “Gender Identity Disorder” with the term “Gender Dysphoria”, “a marked incongruence between one’s experienced/expressed gender and assigned gender”.The APA too, in a statement urged the repeal of laws and policies that discriminate against transgender and gender variant people.This is probably a bad example, because the four women who challenged this law lost their case. They were met with a court ruling that cited Islamic texts and ordered that “religious authorities give counseling to the four and that they act prudently during enforcement.” Having a diagnosis to cite does not always help. But sometimes it does. And when it does, it can mean everything — even a person’s freedom, or their life.
Clients at many of these clinics [PDF] can acquire a prescription for hormones after basic laboratory tests, a consultation about hormonal effects, and signing a waiver stating that they know the risks of treatment.“When we’re working with clients as therapists, the goal is to help people self-realize. We want to allow space for that when it comes to people realizing themselves in the context of their gender,” Talcott Broadhead, a licensed social worker in Olympia, Wash., told Campus Progress.
“This doesn’t mean that trans people should be excluded from the health system: pregnant women are not sick, but they have medical protocols and assistance. The same should happen with trans people.”