Originally appeared in Transgender Tapestry #097, Spring 2002.
I?ve long been a supporter of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association. I felt they made great sense in a time when transsexual and other transgendered people were typically confused, frightened, and ignorant of their life options. In this postmodern age in which more and more of us are strong and sure of ourselves, I?m no longer certain about the appropriateness of the Standards of Care, and I?m becoming more and more convinced that it?s unethical to apply constraints to a class of people without solid evidence that they are needed.
Just as I?m an opponent of seat belt and motorcycle helmet laws which eliminate freedom in the name of the greater good, I?ve decided to come down in opposition to Standards of Care which give therapists gatekeeping powers over other human beings. I routinely use my seat belt, and I wouldn?t ride a motorcycle without a helmet, and I didn?t have sex reassignment surgery without having lived 24/7 for more than a year, but I assert my right and the rights of others to live free without such constraints.
Do transgendered and transsexual people have mental characteristics which render them less capable than others of making important decisions? That was once believed to be the case, but it certainly isn?t the predominant view nowadays, and the scientific data do not support such a notion. Why then, does access to medical care require therapy letters, and why is this the case only for transsexual and other transgendered people?
Although the Standards of Care are more than 20 years old, they have not generated data to support their effectiveness. Even though many therapists and for that matter many transsexuals believe it to be true, no studies show a period of real-life experience leads to a better outcome than surgery on demand, no studies show transsexuals are better off for having to wait for hormones. We do, on the other hand, have a considerable literature showing that when one human being holds thrall over another, mistreatment is prone to occur. The power given therapists by the Standards of Care sets up a dangerous differential that can, has, and will continue to lead to exploitation and other abuse.
I speak not only as a transsexual, but as a formerly licensed mental health professional (I retired my license to practice psychology in year 2000, after 20 years). I have many friends who are therapists, and I think highly of therapists in general, but when they and transsexuals interact under the auspices of the Standards of Care, they must play out respective roles which make effective therapy difficult or impossible. Their interactions become a careful dance in which transsexuals do whatever is required to get their permission letters and therapists do whatever is required to make sure transsexuals don?t get the letters unless and if. And then, when the letters are supplied, the transsexual is more often than not outta there, to the frustration and chagrin of the therapist.
I submit that the Standards of Care have outlived their usefulness?or, rather, I should say that the parts of the Standards of Care which set up gatekeeping functions for therapists are obsolete and should be expunged. Certainly, Standards of Care for the treatment of transsexuals and other transgendered persons are needed, but they should concern themselves with broad ethical issues and not with hormones and surgery policing business. Sadly, in their concentration on issues of access, recent revisions of the Standards of Care have dropped important constraints of care providers?for instance, they no longer address the issue of overcharging.
I?m no longer a member of HBIGDA; I refused to renew my membership when the Standards of Care began to allow therapists to require transsexuals to crosslive in order to receive hormones.I consider this a horrible abuse of power and will not rejoin until l the Standards expressly forbid such meddling in the lives of transsexuals. Here?s hoping that change comes soon.
At the time this issue went to layout, we had received but two short letters. Letters from our readers will appear in Transgender Tapestry #98, provided you send them?Ed.