It is time the gender-based community articulate this stand in words that clearly define what gender rights are.

It is time to stand alongside other minority rights movements to declare these gender rights as follows:

I.                     The Right to Assume and Express a Gender Identity and Gender Role

Every human being has within themselves an idea of who they are and what they are capable of achieving.  That identity and capability shall not be limited by a person’s physical or genetic sex, nor by what any society may deem as “masculine” or “feminine” behavior.  It is fundamental, then, that each individual has the right to assume gender roles congruent with their self-perceived identity and capabilities, regardless of biological sex, gender identity, or gender role.

Therefore, no person shall be denied their human or civil rights on the basis that their gender identity, gender role or perceived gender role is not congruent with their biological sex.

II.                  The Right to Freely Express Gender Identity and Gender Roles

Every individual has the right to freely express gender identity and gender roles in any manner that does not infringe on the freedom of another individual.

Therefore, no person shall be denied their human or civil rights on the basis that a private or public expression of a gender identity or gender role or perceived gender role is not congruent with their biological sex.

III.                The Right to Make One’s Body Congruent with Gender Identity or Gender Role

Every individual has the right to change his or her body or alter its physiology so it better fits a gender identity or gender role.  These changes may be cosmetically, chemically or surgically induced, provided these changes are supervised by an appropriately licensed professional, and the individual accepts sole responsibility for his or her actions.

Therefore, no person shall be denied their human or civil rights on the basis that they changed or wish to change their body, cosmetically, chemically, surgically or any combination of these, to better fit a gender identity or gender role.

Adapted from “Bill of Gender Rights” – JoAnn Roberts, Ph.D., 1990

The psychoanalytic model was the lens through which it was originally viewed in the United States and Europe. Psychoanalysts maintained  that the female-to-male transsexual demonstrated “serious object relations disturbances, notably an inability to separate on the part of both mother and child… led to an attempt to incorporate a female person” (Macvicar 1978).  When it was shown that talk therapy did nothing to ameliorate the symptoms of transsexualism, psychoanalysis was abandoned as a legitimate way to describe and treat the condition.

Biological explanations have enjoyed popularity since the 1970s.  Early versions included the H-Yantigen, temporal EEG abnormality, and shape and size of the selenium of the corpus callosum hypotheses.  These were all disappointingly refuted.

Recent biological theories include gender transposition which describes hormonal changes at a critical gestational stage and neuronal pruning.  There is an active pruning of the right hemisphere in the majority of individuals, but it appears that the alternative pruning of the left hemisphere may result in left-handedness, dyslexia, and transsexualism.  One tantalizing theory purports that there are differences in the brains of male-to-female transsexuals compared to both homosexual and heterosexual males in an area of the hypothalamus known as the bed nucleus of the stria terminalis or BSTc.

Genetic markers for transsexualism are currently under scrutiny. Diamond and Hawk (2003) established a 48 percent concordance for transsexual identity in identical twins, and concluded that there may be a genetic contribution to gender identity disorder.

There is a current dispute among those who study the origins of transsexualism.  Some believe that if a gene or genes for transsexualism is uncovered, that gene could be destroyed or fetuses aborted.  The complexity of genetic expression renders this fear baseless; it is known irrefutably that “the impact on most human characteristics is a result of multiple effects of multiple genes.” (Ridley 2000).

The etiology of transsexualism is, at this point, unknown.  Behavior in humans is complex and largely inexplicable.  We do know, however, that treatment must be provided for those who seek medical intervention.  Current treatment comprises changing the body to align with the internal sense of gender identity.  White (1977) maintains that no matter the pathway, gender identity, “once crystallized…becomes as difficult to change as forgetting one’s mother tongue.” 

References
Ettner, R., Monstrey, S., Eyler, 2007, Principles of Transgender Medicine and Surgery, Binghamton, NY: The Haworth Press.

Back in the 50’s and 60’s, the endocrinologist, Dr. Harry Benjamin, a clinician ahead of his time, became aware of the overwhelming obstacles that transsexuals faced in negotiating their way through transition. He became the first physician to add hormonal treatment to what had hitherto been only surgical intervention (sex reassignment surgery). In 1979 the Harry Benjamin International Gender Dysphoria Association (HBIGDA) was formed. It set up a system called the Standards of Care, still in use today, which laid out formal rules for transitioning to protect the physical and mental health of those seeking transition.

Key among the requirements HBIGDA spelled out was engagement in the process of gender therapy before referral to endocrinologists and surgeons for hormones and sex reassignment surgery. HBIGDA’s rational was to help prepare the transsexual for a process, which, by any standards, is arduous and to guide those who were not good candidates for transition towards other solutions. Note: HBIGDA is now called the World Professional Association for Transgender Health (WPATH).

As a therapist devoted to the well-being of the transgender population, I believe the clinician’s job is paramount. She or he must be highly trained and experienced in caring for those who are struggling with Gender Identity Disorder.

To illustrate the complexity of the gender therapist’s task Lev (2004) has coined the following model, which, in my view, is ideal for use by the gender therapist and is important for the transgender individual to understand.

States of Emergence

1. Awareness – In the first state, gender-variant people are often in great distress. The therapeutic task is the normalization of the experiences involved in emerging as transgender.

2. Seeking information/reaching out – In the second stage, gender-variant people seek to gain education and support about transgender. The therapeutic task is to facilitate linkages and encourage outreach.

3. Disclosure to significant others – The third stage involves the disclosure of transgender to significant others – spouses, partners, family members, and friends. The therapeutic task involves supporting the transgender person’s integration in the family system.

4. Exploration: Identity and self-labeling – The fourth stage involves the exploration of various (transgender) identities. The therapeutic task is to support the articulation and comfort with one’s gendered identity.

5. Exploration: Transition issues/possible body modification – The fifth stage involves exploring options for transition regarding identity, presentation, and body modification. The therapeutic task is the resolution of the decisions and advocacy toward their manifestation.

6. Integration: Acceptance and post-transition issues – In the sixth stage the gender-variant person is able to integrate and synthesize (transgender) identity. The therapeutic task is to support adaptation to transition-related issues.

Evaluate a therapist before hiring him or her!  The following questions from The Transsexual Roadmap (2010) are important signposts:

How many TG patients do you have?

How many individuals have you referred for surgery?

How long have you been working with TGs?

What is your educational background?

What books on TG issues most influenced you?

Have you written any books or articles on the subject?

What got you interested in working with the transgendered?

What is your basic philosophy about how to treat this condition?

What is your opinion of the Harry Benjamin Standards of Care?

What is your hourly rate?

What length of session do you usually prefer?

Is it possible to do longer or shorter sessions?

How long do you usually see patients before you might OK them for hormonal therapy? SRS?

Are you affiliated with an endocrinologist or plastic surgeons?

Are you part of my insurance network?

Do you diagnose Gender Identity Disorder?

What are your hours?

Do you have weekend or evening appointments?

Do you work from your home or from an office?

    REFERENCES
Lev, A-I. (2004)  Transgender Emergence: Therapeutic guidelines for working with gender-variant people and their families.  New York: Haworth

http://www.tsroadmap.com/mental/therapy.html

Choose to work with a gender therapist on your gender “emergence” journey and choose your therapist wisely.

 Our big news is that in April of 2012, The Transgender Institute will presents its First Annual Conference geared towards gender therapists and counselors. This two-day event will be held in Kansas City, Missouri, the beautiful city of fountains resplendent in its loveliest season. We are inviting both established gender therapists who want to update their skills and beginning clinicians and students who would like to specialize in gender therapy to attend. Gender Certification through the Transgender Institute and CEUs will be available at the event. Stay tuned for more information about presenters, topics, housing and travel.

 Once again, Welcome to the Transgender Institute!  We look forward to seeing you in the coming months.