Breakthrough in Transsexual Brain Studies

The New Scientist reports a potentially groundbreaking study for the early identification of transsexuals. The  new study, about to be published in the Journal of Psychiatric Research, identifies a new method for identifying transsexuals before puberty and before hormone treatment by a newly discovered brain scan technique.

Antonio Guillamon‘s team at the National University of Distance Education in Madrid, Spain, think they have found a better way to spot a transsexual brain. In a study due to be published next month, the team ran MRI scans on the brains of 18 female-to-male transsexual people who’d had no treatment and compared them with those of 24 males and 19 females.

They found significant differences between male and female brains in four regions of white matter – and the female-to-male transsexual people had white matter in these regions that resembled a male brain (Journal of Psychiatric Research, DOI: 10.1016/j.jpsychires.2010.05.006). “It’s the first time it has been shown that the brains of female-to-male transsexual people are masculinised,” Guillamon says.

While it’s far too early to blow this out of proportion, the potential clinical implications are significant.

If the new technique is verified the identification of transsexualism would no longer need to remain solely in the variable hands of psychologists, who currently take from months to years to arrive at such diagnoses, and even then allow great latitude for their own individual interpretations. Quicker diagnosis means quicker access to treatment which means much greater overall health – mental and physical – for affected patients.

What’s more this study may prove the tip of the iceberg, allowing clinical identification of a host of related (or perhaps even unrelated) conditions. However it wouldn’t be wise to see this as a panacea, as the lead researcher notes:

Guillamon thinks such scans may not help in all cases. “Research has shown that white matter matures during the first 20 to 30 years of life,” he says. “People may experience early or late onset of transsexuality and we don’t know what causes this difference.”

In other words don’t look at this as a “catch all,” or “litmus test,” but rather one more tool by which science is building toward better understanding and treatment of this previously mysterious condition. Even if some of us (I’m looking at myself here) are pretty excited by the potential of this particular tool.

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Trans Health Coverage – Looking Ahead

Yesterday at the Huffington Post, Joanne Herman offered an interesting article: More Employers To Cover Transgender Surgery, But New Hurdles Expected

(Let’s not  derail over the use of the words “transgender surgery” here. Note that this is the language called for by the AP Stylebook, which is widely adhered to by U.S. journalists. They don’t use the word “transsexual.” It’s not technically accurate, but that’s a topic for another time.)

The article speculates about the impact of the upcoming change to Human Rights Campaign’s Corporate Equality Index, which has been updated for 2012 to require employers to offer extensive trans related medical care as a condition of achieving a perfect score.

The required changes are summarized by the HRC as…

• transgender exclusions must be removed or substantially modified to ensure coverage for transgender-specific treatment
• either directly in the contract or in clinical guidelines referenced by the contract, the insurance plan must acknowledge the WPATH Standards of Care to determine what treatment will be considered medically necessary and not cosmetic.

It’s not certain at this point what impact the updated CEI requirements will have. After all, most companies don’t ask for a CEI rating in the first place.

But quite a few companies not only care about getting a perfect CEI rating, they have gotten into the habit of boasting about it annually. One would assume these companies have some motivation to take action to keep their rating. And if they do so, that’s good news for trans health.

Another interesting item from Herman’s article comes near the end.

Regardless of the hurdles, the new coverage is timely. The recently-released U.S. Department of Health and Human Services’ Healthy People objectives for the next 10 years include, for the first time, a specific objective of recognizing transgender health needs as medically necessary. The change in attitude brought by the new surgery coverage will go a long way toward achieving this objective.

A departmental objective isn’t exactly a law, but it’s a heck of a lot more than I would have expected at this point. If all it does is raises awareness and gets people to better examine the evidence, I’d see that as making solid progress.

I may be reading too much into this, but it seems to me like transsexualism is coming to be recognized by a much broader audience as a medical condition responsive to medical intervention, just like the evidence has long shown.

I personally hope that this recognition spreads bottom-up throughout the minds of the general public who then respond accordingly (and I see the voluntary nature of the CEI to be a good step in this direction), rather than being mandated top down at some point. I don’t want trans health to become a political football. I’d prefer lasting recognition of trans health needs based on good science and sound medical evidence, making it about as political as treating a cleft palate.

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The Burning Monk

In 1963 a Buddhist Monk in Saigon, South Vietnam wanted world attention to understand the persecution of Buddhists under South Vietnam’s Ngô Đình Diệm administration. So this monk, Thích Quảng Đức, went to a busy intersection in the heart of Saigon. Once there, with much buildup so that the cameras of reporters around the world could witness the event, he performed ritual suicide by setting himself on fire. The action was a success. The world turned its attention to Vietnam. Photographs of the self-immolating monk resonate to this day.

Much more recently, a trans woman embarked upon a mission at least as shocking, trying to call attention to the plight of trans women facing barriers to obtaining basic transition related medical procedures. She didn’t succeed at winning the world’s attention to the extent of the Buddist monk. But her attempt to do so was no less courageous or outrageous.

Jadis Illiana Argiope recently attempted to perform a self-orchiectomy (a.k.a. castration) while broadcasting the event on web-cam and publicizing it on Twitter.

Her description of the event (which she dubbed Operation Tranny Freedom) is NOT for the faint of heart. And yeah, this strikes me as insanely risky. And yeah, the parent in me would have caused me to try to stop her by any means at my disposal had I been aware at the time. And no, I’m not going to be cool with this if any of my friends or readers tries to repeat the procedure. But still.

I don’t want to read too much into Jadis’ motivation. Clearly most of it was about her personal trans anguish over being in the wrong body. But she was just as clearly ALSO motivated by trying to send a message to the medical establishment. Here’s an exerpt making it plain:

I didn’t get into any of this out of ego, I got into this out of desperation. I had to remember my mission, my purpose. I had to collect my bearing. Back to business then. I explained, how, where, and why I did all of this. I even made sure to mention that I was attempting this live on stickam, while tweeting, and talking to people on the phone, just to show how important this public service announcement of mine really was! T-Girls simply can’t get the help they need without sacrifising a great amount of their quality of life.

It’s a message the medical establishment needs to hear. Just like some women are going to have abortions even if you make them illegal, some trans people are going to take medical matters into their own hands if their medical providers play keep-away with their medical needs. Many of them will fare worse than Jadis and die as a result.

Transsexualism is not a medical condition that solely afflicts the wealthy. People of all ages and income levels are equally afflicted. Yet the current situation in the U. S. is to price access to trans surgery like a luxury commodity. It’s considered “cosmetic surgery,” akin to that sought by wealthy women in  Beverly Hills who turn themselves into living Barbie dolls by paying buckets of cash. That is the medical model applied to treating transsexuals with one exception… Transsexuals ALSO need to spend months in therapy to get “official” permission before they’re allowed to spend buckets of cash out of pocket on their medical procedures. That’s kind of funny if it’s only “cosmetic” surgery, eh?

I think what Jadis did was foolish, reckless, crazy, ill-advised, and horrifying. I also think it was brave, self-sacrificing, and understandable once you understand what transsexualism really is. And if you can’t understand it you clearly don’t know what transsexualism is.

No one should have to resort to this. But people will continue to do so until this condition is treated responsibly by the medical community at large.

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Why?

A big question the trans world struggles to address with the non-trans world is about why we do what we do. Why do we feel like we’re the opposite sex from that of our external bodies? Why do we transition? Why do we make such a big deal out of gender in the first place? Why? Why? Why?

This came up again as I was reading Juliet’s latest article on her transgender journey. Near the end of the piece (which is about the invasive and personal questions people routinely ask transsexuals) she writes:

Most questions came down to the single word (which drives parents of small children mad): “Why?”

The very first comment posted after the article states:

I guess, despite reading all your columns, I still don’t understand “why?”.

So you see, we’re not dealing with a simple problem of ignorant or hostile people. We’re dealing with a fundamental lack of comprehension. It feels like one of those problems that initially seems too obvious to require an explanation. But then when you try to explain it you realize it’s not obvious at all. Despite the volumes upon volumes of first person narratives from trans people attempting to address our motivation, the general public remains largely stumped. Yet I don’t think they need to remain stumped forever. We need to do a better job explaining our “whys” in terms non-trans people understand, and they need to do a better job listening to our actual words without presuming they already know.

There’s an old joke about a man who goes to a doctor and says, “Doctor it hurts when I lift my hand over my head.” The doctor replies, “Then don’t lift your hand over your head.”

That joke  is eerily akin to the transsexual experience.

If you went to your doctor explaining that something was causing you pain just by going about your daily life, they’d try to figure out what was causing the pain and then try to cure it. That’s not what it’s like for us. We go to our doctors explaining that we hurt because we feel like we should be the opposite sex. In many cases now (and virtually all cases in the recent past) our doctors then respond as if the problem is all about our “wanting” to be the opposite sex, rather than being about our pain. “Don’t lift your hand over your head.”

But if you spend time listening to the voices of transsexuals you find that there is very little talk about wanting to be the opposite sex, and a whole lot of talk about the pain and isolation caused by being stuck in a sex that feels wrong. That is not the way most people think about “wanting” something, and so I would suggest that anyone trying to figure out why we want to transition our sex is already off track. Or at least they’re putting the cart before the horse.

What we actually want is a way to make the pain go away. It’s a kind of pain that non-trans people have a hard time understanding because it’s a kind of pain they have never experienced, and there isn’t really anything like it in the common experience one could use for comparison. But surely it can’t be hard to understand why someone might want a lingering pain that occurs every day and intensifies over time to stop. There should be no mystery to the “why” there.

I once quipped that I had a hard time understanding how non-trans people thought about gender, because for so long I experienced gender as pain. Lofty discussions about gender roles within society, and all the talk about patriarchy and privilege seemed like utter garbage to me. It seemed like all such discussions were based upon blithely ignoring what gender really was.

But I now see that my own view was skewed because non-trans people don’t experience gender as pain like trans people do. An anecdote from psychologist Anne Vitale illustrates:

One of the most extreme cases I have treated was that of a 50 year old genetic male, married and the father of 3 grown children with an international reputation as a scientist who reported to me that the reason he finally sought out treatment for his gender issues was because the number of times he found himself curled up in the corner of his office in the fetal position muffling his cry was increasing. That is not dysphoria, that is pure misery.

Is it really all that mysterious why someone would not want to live like that any longer? Gender transition leads to gender congruence which in turn makes the pain of gender dysphoria go away. That’s why we do it. All the rest – the hormones, the clothes, the awkward second puberty – is just detail. Non-trans people will never understand the basic “why” by focusing upon that stuff.

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My Head Meets an Ice Pick with Bees

Yesterday I awoke already exhausted, which is not the best way to start a work day. I barely moved quickly enough to get out the door in time to get the kids to school and catch my train. I made it, but feeling very out of sorts.

I wasn’t sure if the stress level of the previous week had worn me out or if I was coming down with something, but I tried to ignore it and focus upon getting in to work. Unlike a couple of days ago I really didn’t care what anyone else on the train thought about me as I boarded. I was annoyed by the many rude people who had positioned themselves and their bags in such a way as to deny the seat next to them to anyone else. But I didn’t have the energy to make an issue of it so I just plopped down in the nearest empty seat I saw, staring straight ahead barely aware of my surroundings.

By the time I got off the train to transfer to the light rail the vision around the corners of my eyes had started swimming. This concerned me a little bit. But not nearly as much as the wind which was whipping my hair around, making it almost impossible to keep it from the front of my face. When the light rail pulled up, I was the first one into the car, grabbing a window seat and trying to use my reflection to put my hair back into some semblance of presentability. And that’s when I noticed the sparkly zig-zag lights popping up in the center of my field of vision and slowly migrating out to the edges where the world now looked as if it was made of water.

I walked from my station to my office beginning to really worry that something was wrong to me. I tried to remember the early warning signs of pulmonary thrombosis my doctor had warned me about as a potential risk of my estrogen supplements. This visual stuff didn’t seem to fit, but I wasn’t convinced. Something was definitely wrong. Between the lights and the swimming one of my eyes could now barely see at all, and the other seemed to be headed in that direction. I felt trapped by my commuting choice. Had I driven into work I would have turned around and gone home before I came to this point. But by now I realized I couldn’t trust myself to drive in any case until the vision cleared up, so it was all the same.

I made it to my desk without incident. I paused to check e-mail briefly willing my vision to clear. Slowly it started to do so. I grabbed a cup of coffee and pulled up some relevant documents in preparation for an upcoming call from our offshore testing team. In near perfect synchronization with the beginning of the call I felt the throbbing behind my right eye pulsing and growing. Before we were fifteen minutes in, I was in the full throes of a staggering migraine – the worst I’ve experienced in a long time. You know the descriptions of migraine pain as an ice pick being stabbed into your temple behind your eye? It was like that, only the ice pick was covered with bees and accompanied by waves of nausea and near blindness.

By the end of the call I wanted to curl up in a corner under my desk. I pressed my temples as if trying to shove the migraine back into some imaginary box inside my head, with all the effect of shooting a squirt gun into a raging inferno.

I tried to consult the bus schedule to find a way home. The trains wouldn’t run that direction until the evening commute, but busses ran all day. I tried to enter the address of my office as the “from” location in the metro transit website. The system couldn’t find anything close. I knew I’d done something wrong, as that address is right in the heart of downtown Minneapolis near every bus major bus stop. The problem was I couldn’t focus well enough to figure out what I’d done wrong. My brain was full of searing pain rather than coherent thoughts. I gave up and wondered what I might do.

I became torn between asking my supervisor for help – which I needed – and trying to tough it out hoping it would pass shortly. I really didn’t want to leave my first week post-transition with the impression that now I was going to be fragile and prone to illness. No, let me restate that, I was SURE that if I left that would be the general impression I’d embedded. All the good will of the first week squandered by my sudden need for a quiet, dark room and rest.

I went back and forth on this idea throughout the day, as I maxed out the daily amounts allowed without consulting a physician for over the counter pain meds. The pain did lessen ever so slightly with the meds in me. But as for the migraine going away, it never really came close.

Somehow I successfully struggled through the day, engaging in conversation only when necessary and trying my hardest NOT to seem like I was suffering. I was out the door at 4 o’clock, willing myself to fly home but settling for another round of mass transit.

At home I found stronger pain medication, a dark room, and sleep. By the time I awoke the migraine had finally passed, but I was left with a pretty strong dose of migraine-aftermath, which consists of having all my energy drained, a serious intolerance for loud noise or bright lights, and a dull, bruised feeling behind my right temple which lends my thinking a “fuzzy” feeling.

And so my first week of on the job gender transitioning was capped by a inner battle with a migraine too distracting to allow me to assess the previous days. Instead I found myself with serious medical worries.  Are these migraines going to be more frequent going forward? I know two major contributing factors – estrogen and stress – are part of my life in major doses for the foreseeable future.

I suppose it was about time to see my doctor again anyway. There are some kinds of pain transition can’t cure.

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