Male-to-Eunuch Standards of Care

[Jesus]

The next article based on the second Eunuch Archive survey was finally published today. Copies are available in PDF format for any Eunuch Archive member who sends me a <Private Message> requesting it and who includes an email address which will accept PDF attachments.

The Development of Standards of Care for Individuals with a Male-to-Eunuch Gender Identity Disorder

International Journal of Transgenderism, 12:40–51, 2010

ABSTRACT: Currently, the WPATH Standards of Care (SOC) provide guidelines for the treatment of male-to-female (MtF) transsexuals suffering from a gender identity disorder (GID). However, a large number of men with gender dysphoria who desire to be emasculated do not fit the classical pattern of MtF transsexualism. They loathe their manhood, but do not identify as, nor wish to be, female. Instead, they seek castration to become something outside the binary sexes. The formal term for such an individual is “eunuch,” which we here refer to as an MtE transgendered individual. The WPATH SOC, as currently written, are not applicable to these individuals. Indeed, neither the Diagnostic and Statistical Manual IV (DSM-IV) nor the International Classification of Diseases 10 (ICD-10) currently recognizes MtE transgenderism as a specific GID. The closest category into which MtE transgenderism fits in the DSM-IV is “GID Not Otherwise Specified” (GIDNOS). This vague diagnostic category has been a barrier for MtE individuals to receive treatment. An online survey posted at www.eunuch.org provided data on more than 300 individuals who have had voluntary genital ablations (as well as approximately 1,300 self-identified “eunuch wannabes”). More than half of the men who had surgery either did it themselves or resorted to medically unqualified underground “cutters.” This article offers a draft MtE SOC that outlines the criteria that we believe should be satisfied prior to surgical treatment.

This draft MtE SOC is designed to initiate discussion of an unserved population of individuals with gender dysphoria, who are currently at risk of serious injury or death from the lack of medical care.


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[mrt]

I've never quite resolved how I think about this but for at least DonFL (A guy who died trying to do this himself) I think its an idea that truly need to be thought about!

[bobbie]

Great effort on trying to change the medical world and thoughts. Hope it will make it more easy to find a willing doctor.

I do find the phrasing of some parts very offensive. .... suffering from a gender identity disorder (GID). Why is I, that has the disorder. Why can it not be "ME" that is normal and the rest of the world be the 'Gender Identy Disorder'. I was born like this, just like all the rest are different.

This is a little jesting, but the feeling of me being the one that is not normal is difficult to handle for I have no choice.

[Jesus]

I’d like to thank both MRT and Bobbie for introducing a couple of very important topics.

I have added another item to the Bibliography this morning. Dick Swaab is an important neuroanatomist at the Netherlands Institute for Neuroscience. His article is a survey of the literature on both physical and brain development of sex and gender and how these can be out of sync. The article is aimed at medical practitioners, not fellow researchers (who ought to already understand the literature, but probably don’t). The key sentence reads, “As sexual differentiation of the genitals takes places in the first 2 months of pregnancy, and sexual differentiation of the brain starts during the second half of pregnancy, these two processes may be influenced independently of each other, resulting in transsexuality” Swaab discusses mechanisms by which there can be more than a binary “male” vs. “female” for the body and implies that the same is true for the brain. One can be born with genitals that are “male” and a brain that is “not-male,” but which is not necessarily “female.”

Bobbie raises the important issue of the power of words. Unfortunately, we are stuck with the phrasing that is already a part of the medical literature – though we are also trying to change that. The term “Gender Identity Disorder” has been in use for far too long. It was a major issue at the 2009 meeting of the World Professional Association for Transgender Health in Oslo, where there was consensus that a more neutral term needed to be found for the next edition of the Standards of Care. “Gender Dysphoria” seemed to be the consensus, at that point. The draft for the next edition of the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) suggests “Gender Incongruence,” which I much prefer. The body and mind are out of sync, with no mental illness implied! Until one or the other term is formally adopted, however, we are stuck with the current term for publication.



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[bobbie]

Thank you Jesus. I wanted to look up just what "congruence" full deification was. I can upon this article.


http://genderkid.wordpress.com/2010/...-incongruence/



“Gender Incongruence”

February 11, 2010

tags: APA, DSM, DSM-5, gender identity disorder, gender incongruence, GID
by genderkid

I just found that the APA –the US-based psychiatric organization– published its list of proposed revisions for the next edition of the DSM (Diagnostic and Statistic Manual of Mental Disorders). Of course, what interested me the most was this:

It is proposed that the name gender identity disorder (GID) be replaced by “Gender Incongruence” (GI) because the latter is a descriptive term that better reflects the core of the problem: an incongruence between, on the one hand, what identity one experiences and/or expresses and, on the other hand, how one is expected to live based on one’s assigned gender (usually at birth).

This is a big improvement: the revision authors are stating that the problem is between a person’s identity and societal pressures, rather than within said person’s identity. I don’t know how they’ll manage to keep this diagnosis within a manual of mental disorders once they’ve recognized that it’s a larger societal issue, as well as a physical one. I guess they don’t know where to put trans people, yet they feel like they have to put us somewhere to maintain a sense of order. We’re just a reminder that human beings are a whole rather than distinct bits –bodies, minds, social beings– to be dealt with separately.
I’ll leave my thoughts on the larger picture –the whole idea of having a diagnosis for trans identities– for a later post. For now, let’s look at more of the actual text. These are the new criteria:

Gender Incongruence (in Adolescents or Adults) [1]
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2* or more of the following indicators: [2, 3, 4]
1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]
2. a strong desire to be rid of one’s primary and/or secondary sex characteristicsbecause of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]
3. a strong desire for the primary and/or secondary sex characteristics of the other gender
4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
5. a strong desire to be treated as the othergender (or some alternative gender different from one’s assigned gender)
6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

Look, they’re acknowledging the existence of non-binary genders! In Endnote 16 they even point out their “avoidance of male-female dichotomies”. And, no mentions of stereotypical masculinity or femininity.
There are lots of surprises in the endnotes. For instance, Endnote 15 states that trans people are now allowed to be happy, and the revision authors have acknowledged that transphobia is to blame for much unhappiness: they took out the requirement of suffering “significant distress or impairment” in part because “increased psychiatric problems in transsexuals appear to be preceded by increased experiences of stigma”. “Postulating ‘inherent distress’ in case one desires to be rid of body parts that do not fit one’s identity is, in the absence of data, also questionable.”
There’s a whole endnote –number 16– that discusses the problem of limiting diagnosis and treatment to “true transsexuals” (they used quotation marks!) which tends to exclude other gender-nonconforming people. And in Endnote 18, they mention that they removed the question of sexual orientation entirely, not only because it’s irrelevant but also because non-straight people might lie if they’re afraid of being denied treatment. So, the authors are acknowledging the problem with normative trans stories, and the perpetuation of those stories to get by the gate-keepers.
Another interesting point –at the end of Endnote 2– is the treatment of post-transition regret. It states that these people would also be considered to have Gender Incongruence, although happily transitioned people would not (which makes sense). Extra points for recognizing the existence of regret, while not stigmatizing it.
Now for the criticism. Item 1 speaks of an (allegedly objective) incongruence between someone’s sex and gender. As I see it, no body type is necessarily bound to a certain gender identity — my manhood is not at odds with my body, even if doctors choose to label it as female. There is an incongruence between my body and my mind, but that has to do with my subjectivity (item 2) rather than a universal truth about which genders are “congruent” with which bodies. And point 4, seriously, what do you mean, desire to be of another gender? I’m already a guy.
Point 5 and 6 present might be more complicated than they seem: is “desire to be treated as the other gender”only about pronouns? If it isn’t, then it touches on a sensitive point of discussion: by wanting to be treated as men (or women), we have to recognize that men and women are treated differently. I like it when I’m treated as a boy, but that pleasure comes with a twinge of guilt — am I validating a differential treatment of differently-gendered people? But then, the item only describes a desire; whatever my opinion, I can’t deny that some of us have this desire. This is closely tied to item 6: I don’t think that feelings and reactions should be limited to one gender, except for maybe the feeling of belonging to that gender. But again, my opinion has no place in other people’s convictions.
So there’s a lot of food for thought in these items, but it’s a huge leap from Gender Identity Disorder (except they’re still diagnosing people’s identities — oh wait, I promised to leave that for later). I bet many people are going to post their own analyses soon; I look forward to reading other opinions on these proposed revisions. This is an important discussion to be had, because –for better or for worse– the DSM affects the medical and legal treatment of trans people around the world.
Thanks to Micah for the hat-tip!


from → Activism, Politics and Mass Media, Links

[Jesus]

An earlier thread about the draft for the next edition of the DSM can be found at: DSM-5 Proposals.

I was one of the many who were asked to draft position papers for the committee to read as they prepared their draft. I also wrote a long commentary on the draft, which the committee will use during the revision process. While I would like to see all of the issues resolved at once, I know that it is a long (and slow) process with far too many dinosaurs needing to be brought on board. The direction is right….



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[datyiasp]

For any number of good reasons, some males are unable to tolerate testosterone and it's effects.

Testosterone Poisoning might define this syndrome. Maybe it is time for this malady to be recognized. Afflicted males should be allowed treatment if they desire.

Efforts men are takng for relief are akin to the back alley abortions women were forced before Roe/Wade.

[nullorchis]

Personally, I prefer the term "aberration".
1. (n.) A deviation from the proper or expected course.
2. (n.) A departure from the normal or typical

#1 represents what society in general expects because "normal" or "typical" behavior is to deal with the cards that you were dealt and don't go beyond certain society established boundaries.

Whatever causes someone to depart from the normal or typical can be different from one person to another.

Society's expectations (and impositions, punishments etc.) can cause an individual to live in conflict with their personal needs and what society expects of them.

If one could live in a society where differences, aberrations, incongruences were simply noted, accepted, and everyone just went on their merry way, there seems to me to be reason to believe that individuals who have mental and emotional gender needs that are different than their physical realities might not ensure such personal and social conflicts.

Kind of like: physically you are a male but you want to dress and act in a female style...........; in a non-judgemental society - ok....no problem........go for it. We have accomplished this to a certain degree: There are ample cases of females (hetro and lesbian) who dress like a man (levis, flannel shirt, boots, etc) and few make a big deal of it. Carrying it one step further beyond dress and behavior is physical modifications so that body matches self image. If society didn't place such importance on considering this unacceptable, but instead said, ok, no problem, go for it, people just might not be in such personal conflict.

The problem is with society in general; it's expectations and what it does to people who fall outside of average and "normal" behavior. The universal "we" establish what is common and that becomes acceptable behavior and "we" then judge, berate, punish, adversely impact anyone who deviates from the "norm".

Individuals who fall outside of the norm are not the problem, it is society's insistence that everyone exist within the norm.
Individuals who fall outside of the norm generally only experience conflict because society is conflicted.

Religion of course has a large role in all of this.
Which brings us back to power, authority, domination.
These are the people who are establishing the baseline of how society should act, and how society should treat those who drift from the norm.
As soon as those in power decide to "live and let live" we might then become a better society. But until then, even psychology will continue to treat people who live beyond the "norm" as variants who are more to be studied than pitied.

[datyiasp]

An earlier thread about the draft for the next edition of the DSM can be found at: DSM-5 Proposals.

I was one of the many who were asked to draft position papers for the committee to read as they prepared their draft. I also wrote a long commentary on the draft, which the committee will use during the revision process. While I would like to see all of the issues resolved at once, I know that it is a long (and slow) process with far too many dinosaurs needing to be brought on board. The direction is right….



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I have a nephew with Lime disease. Various doctors here in Florida panhandle diagnosed it as; lupus, ALS, MS, colitis and etc. A smart doc finally diagnosed Lime, even though he doesn't go Lime infested areas. She somehow correlated all those disparate symptoms into a single disease treatable by simple Tetracycline.

I now believe so many of these wildly divergent complaints and desires from posters desiring some sort of castration for cure may possibly be suffering because their bodies and/or minds are more sensitive and affected by Testerone than average person.

Castration for men suffering from excessive sensitivity to T is as reasonable as hysterectomy to alleviate women's suffering.

Perhaps some women's health groups may understand many men are as aided by castration as women by hysterectomy. We could sure use their advice and support!

No person would deny a woman her right to better her health by hysterectomy. Why prevent a male castration for HIS health improvement and abatement of his suffering?

[datyiasp]

A man can't urinate all of Sunday. Bright and early Monday he presents to a doctor. He quickly learns what a "Foley" does. Many tests. "Appointment at noon tomorrow, bring the wife" says doctor. Next day doc says that your surgery is tomorrow at 6AM. They go after cancer, continence and sexual function in that order. You awaken after surgery to learn prostate and testicles have been removed but recovery looks good.

A soldier steps on a Claymore mine and awakens in a hospital, nullo.

Many M to E scenarios!

[devi]

I was thinking that GID used to stand for "gender identity dysphoria" which was lengthened from the simple "gender dysphoria" which it was first called, -but then somewhere along the line the "dysphoria" in GID somehow had been changed to "disorder". I also think that there should be some distinction made for biologically induced gender incongruence and psychological induced with an obvious significant overlap between the two.

[doneunuch]

Comments are closed on existing diagnoses (such as Gender Incongruence), so I commented on the proposal to include Male-to-Eunuch Gender Identity Disorder ( http://www.dsm5.org/ProposedRevision...deSources.aspx ), giving my history as someone who wanted to be a eunuch from the age of 12, and who found what I wanted when I was castrated at age 48. Now, it looks to me like the proposed definition of Gender Incongruence is broad enough to encompass those of us who want to be eunuchs, so maybe it's taken care of. We'll see.

[nullorchis]

Gender Incongruence ?

I had to laugh. At first glance I thought this was Gender Incontinence, then I thought it was Gender Incompetence. It's early and I didn't get much sleep last night.

If congruence is:
Corresponding in character or kind; appropriate or harmonious, then incongruence is NOT corresponding in character or kind; not appropriate or not harmonious.

At first glance the word incongruence seems possibly offensive, but I can see how this can be interpreted to mean that one's physical body is not in harmony with one's self image, self identity, in situations where a person wants to trans-gender M to F or F to M. Society does not have a category other than M or F. There is no E for eunuch or "none of the above" choices when it comes to physical sexual classification.

I understand a male wanting to go from M to E. I don't understand why, even though I am one such person who wants to go from M to E.
Thus my body parts are incongruent with my self image. Truly so out of the ordinary as to be abnormal.

Is there a similar incongruence for females such as wanting to have their breasts removed, but in all other ways remaining a female. If a woman does this are they considered to have transitioned from F to E, a female version of E ?

I am not talking about people who have testes or breasts removed for necessary medical reasons such as cancer but about people who have a personal desire to modify their body so that it matches how they want their body to actually be.

[JessJames1968]

If I'm reading this correctly, if these changes to the Standards of Care are accepted, then each MtF, MtE and those males wanting GRS but not full transition would each have an individual set of steps required to achieve the desired physical changes. Correct?

[Conscientious]

The guidelines or steps would be similar to the current treatment of transsexuals. It would require a person to be first diagnosed as MtE (ie mental disorder), then, more than likely, a test with chemical castration for 12 months. After this stage if the psychiatrist is satisfied the patient's only recourse is surgery he will write an approval letter to take to a surgeon of the patient's choosing.

In some countries that will mean the treatment, from the doctor's appointment (psyche, endocrinologist) and hrt to the surgery, will all be free or rebated by the government.