Treatment Alternatives In Gender Identity Disorder
An Overview of the Need for Therapy
Discussing therapy for Gender Identity Disorder and gender dysphoria in and of itself raises the hackles of some. First, there are sincere but misguided religious people who don't understand the difference between a medical condition and a behavioral choice. I can't help these people much: If a person wants to think a baby born blind or with cancer is punishment from God and not a victim of a medical condition, they are likely to think Gender Identity Disorder is a behavior instead of biologically based, too. They want to see the world in black & white and they aren't really interested in facts.
But they aren't the only ones who bristle at this discussion: A few of the more radical transsexual activists claim that there is no such thing as the medical condition known as G.I.D. and that they should instead be treated the same as homosexuals -- i.e., the medical diagnosis should be stricken from the Diagnostic and Statistical Manual of Mental Disorders. After all, they say, there is nothing wrong with them as transsexuals any more than there is something wrong with a person because he/she is gay. As you can see, they half-agree with the religious fundamentalists while reaching an opposite conclusion. Unfortunately, they are just as wrong as the religious extremists. Transsexualism and homosexuality are (probably) biologically-based (although not necessarily genetic) but they are very different in that homosexuals usually just want to be left alone and not abused whereas transsexuals need the help of the medical community for hormones and surgery, plus the legal community assistance, including the courts, in order to change identity information.
The final argument marshaled against the use of normal treatment methods for gender dysphoria has to do with one controlling one's own life. The thought is that if you want hormones, you should have hormones. It is nobody else's business. Perhaps if hormones and surgery were the right answer in every case and always solved the problem then I would agree, but I believe that the most recent evidence indicates that at least some cases of gender dysphoria (discomfort with one's birth gender) are cyclic in nature. This is because such dysphoria can be a side-effect of depression or Obsessive-Compulsive Disorder. Anyone who has been in "the community" long enough is familiar with the "purges" that so many go through - the throwing away of everything related to the dysphoria (clothing, makeup, etc.). People sometimes do this from a sense of hopelessness, but I suspect that at least in some cases they are doing it due to a change in brain chemistry.
It is very common to hear these people earnestly exclaim, "I can't believe I ever felt like that! I'm not a girl! That's got to be the stupidest thing I ever did." And they mean it! This strongly suggests that there is a change in brain chemistry going on, based on their complete change in perspective. Unfortunately, these cycles usually continue to repeat themselves unless medications are taken to keep brain chemistry in balance.
How, then, may we determine who can be helped by hormones and surgery, and who will be harmed? Do we give everyone a sex change who wants it, knowing that at least some of them will regret it later? Are we really willing to accept the despair and suicide of so many in order to have surgery-on-demand?
Transsexualism does indeed exist, and you - the reader - may be one of them. But it is very difficult for you to determine this entirely on your own. Perhaps you go through cycles of comfort and discomfort with your birth gender. Or maybe you use crossdressing and fantasies about being the other gender to relieve stress or depression. In any case, if you are suffering from depression or Obsessive-Compulsive Disorder, your ability to rationally think through the issues of gender change is impaired. And that is why competent, professional therapy is needed.
I support the individual's right to present themselves in the gender they choose and I believe that transition is the best route for many. Anyone who considers themselves a conservative or libertarian should agree with me: It just isn't anyone ELSE's business! I support transition, hormones, and surgery for those who can benefit from this treatment, as long as they aren't hurting themselves or others. For persons who meet all of the criteria for Gender Identity Disorder, such steps may be the only way out of a constant cycle of anxiety and depression. But it is important to realize that not all gender dysphoria is Gender Identity Disorder, and I will discuss this further in subsequent pages.