Indeed many people, including those who chose not to undergo surgery and/or take hormones at all, experience relief after admitting to themselves and others that they are transgendered. Accepting and integrating this new identity and seeking out a community of people who love and accept them despite their “difference,” some find their gender dysphoria transformed to gender “euphoria,” as they are released from the bonds of shame and secrecy. “Brad” described his first visit to the Tom Waddell Center, in San Francisco, to me as a kind of homecoming. “It was a wonderful situation, because it was through the city health plan and it was free and they totally understood me and supported me. Even though when I first went there, I was sitting in a hallway with all of these really ugly women, I mean really ugly, some of the freakiest fucking scary women you’ve ever seen in your life and some really strange-looking men. But I was at home. They accepted me for who I was even though I still had not transitioned yet.”
Many people who argue that GID should be removed from the DSM support a reclassification as a medical diagnosis. “Louis Gooren, one of the major Dutch researchers on transsexuality, was finally asked just in the last year to contribute a chapter to one of the major endocrinology textbooks about transsexuality, which is I think the proper place for it,” says Ben Barres. This perspective was shared by most of the trans physicans and scientists whom I interviewed for the book. “It’s not as if there is no data,” says Dr. Dana Beyer, who, like Dr. Barres, was exposed to a synthetic hormone in utero.
Many of my transsexual sources were extremely reluctant to support the deletion of GID from the DSM, however, until a formal medical reclassification had taken place—possibly in the I CD (International Statistical Classification of Diseases) produced by the World Health Organization. The ICD is used internationally to track morbidity and mortality of diseases, and unlike DSM, it is updated yearly. All of the diagnostic codes in the DSM-IV (published in 1994) and the DSM-IV TR (published in 2000) were selected to match valid ICD-9 codes. However, as the ICD is updated yearly and the DSM-V will not be published until 2010, there will be discrepancies. A reclassification of gender identity disorder from a psychiatric to an endocrinological condition in the ICD would have a major impact—but as that reclassification has not yet occurred, some argue that it is important to retain the DSM diagnosis for both medical and political reasons despite its flaws. The DSM diagnosis affirms the legitimacy of gender variance and at the same time pathologizes it—making gender variance something more than the perverse lifestyle choice that fundamentalist Christian and other critics believe it to be. More important, this diagnosis legitimizes the range of hormonal and surgical interventions developed over the years that have provided relief for thousands of transsexual and transgendered people. Activists who argue that the “medical model” of gender variance “pathologizes human diversity” tend to miss this point. Without some sort of diagnosis, sex reassignment becomes nothing more than a kind of extreme cosmetic surgery/ body enhancement, or in the view of critics like Paul McHugh, a fad, a fashion, a “craze.”
“If you talk to post-op transpeople, most are what you would call conservative on this question,” says Chelsea Goodwin of Transy House. “I’m conservative in the sense that I accept the medical model but I believe that anybody who needs to see a doctor should, and anyone who needs surgery should be able to have it reimbursed. I’m a pragmatist really. In the 1970s and 1980s the argument was that the transsexual community looked down on cross-dressers because transsexuals got legitimacy from the Benjamin medical model. Well, that legitimacy made it possible for us to exist. Nobody likes to look at the fact that Christine Jorgensen managed to do this [sex reassignment] at the height of the McCarthy era. There was still this incredible respect for scientists among the public back then. If a doctor at a time when medicine was the most respected profession in America said that this was okay, then the public believed it. That was the only way that this revolutionary act of sex change could be done at the time. To throw that legitimacy away now is crazy.”
Therapists and other professionals who work with gender-variant clients express many of the same reservations. Christine Wheeler says, “My fear is that it [the GID diagnosis] will get thrown out of the DSM because of some of the strident views coupled with malpractice issues that continue to frighten physicians. I’m afraid that we will see a time when people won’t be able to get the help they need.” Wheeler, who is on the APA task force for DSM-IV and is one of the drafters of the HBIGDA Standards of Care, says that both committees are “looking at standardizing the child and adolescent GID definitions and reexamining the protocol for intersex conditions around the world, as well as the protocols for intervention in GID.” She admits that there are problems with current definitions. “Sometimes the language is archaic, and I apologize for that,” she says. However, the essential point to remember when discussing the value or lack of value of the diagnosis, she says, is that “something has to be wrong in medicine in order [for it] to be fixed.”
Dylan Scholinski articulates this conundrum from the perspective of the trans activist, admitting that whereas “initially most people were advocating the straight-out removal of GID from the DSM,” a more nuanced position is now developing because “you don’t want to fuck with people’s access to health care, not till there’s something else in place. You can’t just leave the community with nothing.”
Not only does the GID diagnosis ensure continued access to surgery and hormones for those who require them (even if they are not covered by insurance), but it is also used as a legal tool. Those states that permit transsexual people to change their sex of record on birth certificates, driver’s licenses, and other legal documents often require letters from psychotherapists and other health care providers attesting to the medical validity of the claim. Some require proof of genital surgery; others do not. The broad definition of GID ensures that even those who have not undergone genital surgery (as most FTMs do not) qualify for such legal remedies. Attorneys Collin Vause, Shannon Minter, and Karen Doering relied heavily on the medical model in the case oiKantaras v. Kantaras, a child custody lawsuit argued in the state of Florida in 2002. In this groundbreaking case, Florida Circuit Court judge Gerard O’Brien ruled in February 2003 that Michael Kantaras, a transman, was legally male, and that his marriage to Linda Kantaras was legally valid. The court awarded custody of the two children that Michael and Linda had raised together during their marriage to Michael, who is the biological uncle of the youngest child, who was conceived through artificial insemination of Linda with sperm donated by Michael’s brother. The elder child was three months old when Linda and Michael married in 1989, and Michael adopted the child shortly afterward. Linda was aware of Michael’s history when the couple married, but neither child knew about Michael’s past until Linda revealed the details after the couple’s separation.