Shirah Vollmer MD

The Musings of Dr. Vollmer

Gender Health?

Posted by Dr. Vollmer on January 11, 2018

https://www.uclahealth.org/med-peds-care/gender-health-program

 

Image result for ucla gender health program

 

With deep respect for UCLA as an institution, and with deep respect for my training which has entirely occurred at UCLA, and with deep respect for the many departments within UCLA that I have been affiliated, I am quite curious and, dare I say, skeptical, about a “gender health program”. Reflecting back on my training in the 1980s (yea, I am getting old, I know), UCLA was doing transgender surgery, mostly in the department of urology. Mostly they were turning male genitalia into female genitalia. Other tertiary care medical centers were doing this too, and so this was a “standard of care” a phrase which has now been replaced by “evidenced-based medicine”. In the early 90s they stopped doing this surgery and so patients seeking a change in genitalia sought private practice doctors, both here in LA and around the world. Medical tourism was a popular notion among male-female transgender folks as they could pay out of pocket a fraction of the cost in another country, and that would include their airfare, a fancy hotel, and an American trained physician working in another country (usually their birth country). Somewhere around 2010, the “medicalization” of transgender patients took off, with the example being in LA, that children’s hospital started a clinic…

http://www.chla.org/the-center-transyouth-health-and-development and then pediatricians throughout LA, when faced with a patient who expressed discomfort with their gender, would be sent to Children’s Hospital. The assumption is that CHLA is a good hospital and so, therefore, they must appropriately deal with transgender issues, since most pediatricians have no training in this area. Somehow, UCLA seems to want to join the party, and so the Gender Health Program is born. I say this, with the complete disclosure that I am not aware of the politics, or the motivation behind opening this clinic, but I do enjoy speculating publicly (to my 50 or so readers), as to how transgender issues seem to come and go within the medical profession. Having Gender Dysphoria..as opposed to Gender Identity Disorder (GID)..see below

 

GID was reclassified to gender dysphoria by the DSM5. … The American Psychiatric Association, publisher of the DSM5, states that “gender nonconformity is not in itself a mental disorder. The critical element ofgender dysphoria is the presence of clinically significant distress associated with the condition.

 

…is a mental disorder. I am not sure that I agree that those who have distress over their gender are mentally ill. Sure, they need a prescription for hormones, and possibly surgery, to change their gender, so they do need medical care, but whether they need mental health care has more to do with individual preference. A patient, for example, might have extreme distress over the size of their nose, but they don’t need to see a psychiatrist if they opt for rhinoplasty to attempt to minimize their distress. I know this statement is very controversial when it comes to gender, but I think this argument is worth consideration. If the patient is curious as to why their nose distresses them so much, then mental health intervention makes sense, but if there is no curiosity, then mental health care is harder to execute. In the 70s being gay meant you had a mental illness. That quickly got fixed when psychiatrists realized the absurdity of that notion. Being bisexual, or uncertain of your sexuality, is also not a mental illness. So, I would say that being uncertain about your gender is not a diagnosis, but only a nodal point, which suggests thinking about how to proceed. As with all big decisions, we, as psychiatrists, can help people through them, but it is also true that people make big decisions without our help and do just fine.

Returning to the Gender Health Program, I can see the advantage of pooling patient populations in order to develop an expertise. I can also see the marketing advantage that the program makes people feel like they will have a place of understanding. My issue is that Gender Health is a made-up term. I wish they would call it a Gender Program. I am not sure what Health has to do with it, as the patient may not be sick to begin with.

 

 

4 Responses to “Gender Health?”

  1. Shelly said

    I enjoyed this piece as I think it’s really the first time I heard your uncertainty about transsexual issues and Gender Health. I’m not sure I agree with you that UCLA is jumping on the bandwagon here. I think that it does have its place right where it belongs and it is justified. Calling it “Gender Health,” in my opinion, makes sense, because there are very particular needs to those who are transitioning, are thinking about it, want to transition, have transitioned, face discrimination, etc., and you psychiatrists are just the people who can help them. At least, this is my belief.

    • I think “gender health” is a marketing term, and there is so much we don’t know about transitioning, but we are afraid to articulate that, as patients look to us like we should know. I am glad you enjoyed this post. I hope uncertainty in many fields of medicine can be embraced for what it is, but sadly, that is often not the case. Thanks, as always.

  2. TransCulturalCritic said

    Yes, thank you!

    I am a transsexual man. I was born intersex but raised as a female. This was the mid 1970s. Decades later I learned that my parents were told that once I hit puberty I might need female hormones and androgen blockers to make me “more feminine”, I would certainly eventually need genital surgery to render me penetrable without severe pain and urinary leading to kidney infections, and multiple interventions for a “regular cycle” in the hope that someday with medical “help” I could maybe be impregnable. The doctors encouraged my parents to have the genital surgery done ASAP.

    Let that sink in for a few seconds. As a baby, the doctors already assumed that I would grow up to desire being desired by men, that I would want men to penetrate me, and I would want to have a baby, and that these desires would be so strong that I should have my genitals cut as an infant. They also told my parents that I should never be told about any treatments and that “girls like me” often displayed early-childhood dislike for feminine activities and a “strange aversion to motherhood” and my parents should encourage me to be as feminine as possible. They said that despite my “potential abnormality”, parental guidance, peer groups, and modern medical technology could make me grow into a “normal young woman”.

    All that occurred was that I was alienated and hurt, by peers and my parents, because I was unable to pretend to be anything other than me. I always think about what would have happened had I been born male, and then every one of my preferences would be considered “normal”, I would have had no problem with my body, and indeed my capacity for empathy would have been considered a plus rather than seen as oversensitivity. I have been diagnosed with Asperger Syndrome and Gender Identity “Disorder” (as they were called then), and presently my three diagnoses are ASD, ADHD, and Gender Dysphoria (the latter is crippling).

    It says a lot that my first psychologist (in 1994) told my parents (without even meeting me) that I automatically had Borderline Personality Disorder because my going online as a male (as I felt I truly should have been), becoming morose at puberty (because of the unwanted physical changes), lack of involvement in activities important to teenage girls (which he considered “a typical manipulative Borderline ‘cry for help’), and very vocal dislike of the idea of heterosexual sex, childbearing, and a disidentification and hatred towards my primary and secondary sex characteristics indicated “a lack of identity” and “excessive emotions”.

    Another professional, whom I met during some more difficulties socially in my first and only year at the very gender/sexuality normative Duke University actually admitted that if I were male, his diagnosis would be ADHD and Asperger due to my account of my childhood years (I did not mention my gender/sex/sexuality issues in this environment), but “young ladies don’t have these disorders”. He recommended “prettying [myself] up”, and then I’d find it easier to “let loose and find a boyfriend”, “stop taking things so seriously”. If I did so and was still “unhappy”, then I should come back and be evaluated for “anxiety issues” which were apparently “common in perfectionist college girls”.

    I transferred to a top notch but more liberal university the next year but it took a while until I once again sought help, due to the fact that my gender dysphoria could no longer be ignored for even the hours I spent going to class. I am thankful I found someone in those early days of trans awareness who not only recognized my gender dysphoria (even if they didn’t really understand intersex conditions or how my transness overlaps; I have yet to meet someone who does) but also did not use one’s sex to eliminate possible diagnoses, and also didn’t slap an unfitting BPD label on anyone born female who was noncompliant with gender/sexual norms and emotionally distressed by his others treated them as a result. I am very grateful for this.

    My dysphoria is a problem of my primary and secondary sex characteristics (largely) maturing contrary to my neurological connections AND my ego/superego/id. If I could trade bodies with a natal male who felt opposite to me, we both would have no further problems in that area. My “gender health” (I don’t think such a thing exists) has nothing to do with society’s acceptance of “men with different genitals”. No, I don’t want that genital accepted on me or to do the acts it is known to do. I want to have the penis and testicles I should have–the same feeling a non-trans man would have if he woke up one day without them, and with equipment–and what it’s normatively used for-horrifying if it is attached to his body.

    This is the opposite of how I see my autistic qualities. They are me, my personality, my ways of interacting even if they cause me struggle in a world that doesn’t get me. My body is not-me and I would do anything to have my consciousness reside in a congruent (male) body.

    My ADHD is an impairment that causes me trouble, but nowhere near to the trouble my incorrect body does. It also is a part of me in the way my incorrect body isnt and should not be, but not as part of me as much as my autism. I am grateful to how well medication helps. Unlike some positive things about autism, my autistic “special interests”, for example, my ADHD often seems like an impairment that I am glad to correct. So it is a part of me (unlike my incorrect body but like my autism) but at the same time I desire its amelioration.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

 
%d bloggers like this: