nickgorton

chapstick and hand grenades

2006-08-25T15:24:40Z

I was looking up to make sure the the prescription I wrote for myself for chapstick so I could take it on the plane with me would work next weekend. (Yes, that would be entitlement... but I can't go 3 hours w/o it....its my heroin... layoff.)

So I was perusing the TSA's website and found this: http://www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-items.shtm

The list of prohibited items includes of course.... chapstick (without a prescription,) toothpaste, deodorant, aerosolized cheese products... you know the dangerous stuff... but would you believe they also exclude you from taking on in your carry-on: hand grenades, tear gas, TNT, gas torches, blasting caps, flares (in any form), stun guns, billy clubs, and hatchets?

Really.

What kind of mental deficient would think.... "gee... they don't say I can't take my blasting caps and and grenades.... lemme take it to the airport with me and see if I can get through security?"

a reference

2006-07-19T05:40:30Z

A reference for someone - just ignore.... move along.... move along.....

THE SECRETARY OF EDUCATION
WASHINGTON, D.C. 20202

In the Matter of

THE COUNCIL ON NATUROPATHIC MEDICAL EDUCATION

Docket No. 00-06-O
Accrediting Agency
Recognition Proceeding

Appellant.

_________________________________________

DECISION OF THE SECRETARY

The National Advisory Committee on Institutional Quality and Integrity ("National Advisory Committee") has recommended that I not renew recognition of the Council on Naturopathic Medical Education ("CNME") as a nationally recognized accrediting agency under Section 496 of the Higher Education Act of 1965, as amended ("HEA"), 20 U.S.C. § 1099b (m). CNME has appealed this recommendation, I deny CNME's appeal and adopt the recommendation of the National Advisory Committee to deny CNME's petition for continued recognition.

CNME is an accrediting agency initially recognized by the Secretary in 1987. CNME has accredited and preaccredited only educational programs that lead to the degree of Doctor of Naturopathy or Doctor of Naturopathic Medicine. Currently, CNME's accreditation or preaccreditation forms the basis of eligibility to participate in federal programs for only one institution, Southwest College of Naturopathic Medicine ("Southwest"). In total, CNME accredits or preaccredits two programs and two institutions. By statute, the Secretary can recognize accrediting agencies only when their accreditation enables an institution or program to participate in a federal program. Section 496 (m) of the HEA, 20 U.S.C.§ 1099b(m). Therefore, it is CNME's preaccreditation of Southwest that enables it to seek recognition by the Secretary.

In order to be recognized by the Secretary, an accreditor must have standards for accreditation that assess, among other things, an institution's "curricula," "faculty," and "fiscal and administrative capacity." Section 496(a)(5) of the HEA, 20 U.S.C § 1099b (a)(5). Further, the accreditor must be one that "consistently applies and enforces standards that ensure that the course or programs . . . are of sufficient quality to achieve . . . the stated objective for which the courses or the programs are offered." Section 496 (a)(4) of the HEA, 20 U.S.C. § 1099b (a)(4). As well, the Secretary recognizes an accrediting agency only after determining that it is a "reliable authority as to the quality of the education or training offered." Section 101(c) of the HEA, 20 U.S.C. § 1001(c).

The governing regulations allow an accreditor to grant an institution preaccreditation status for a limited period of time of no more than five years. 34 C.F.R. §§602.2, 602.23 (b)(2). Accordingly, CNME's accreditation standards allow for a grant of preaccreditation of "candidate" status when an institution has met CNME's eligibility requirements and is progressing toward accreditation. Exhibit 1 to CNME Petition for Recognition, CNME Handbook of Accreditation for Naturopathic Medical Colleges and Programs ("Handbook of Accreditation") at p.7. At the same time, CNME's Handbook of Accreditation provides that the following circumstances "will lead" CNME to issue a show-cause letter as to the withdrawal of candidacy status: an institution's failure to maintain compliance with CNME's eligibility requirements or policies; unsatisfactory progress in meeting the general goals for the development of the college; inadequate financial support and control; and inadequacies in the number or professional competence of the faculty, administrators or support staff. Handbook of Accreditation at p.12.

CNME's eligibility requirements require that a candidate college must have a chief executive officer whose full-time or major responsibility is to the college or program; can document a funding base, financial resources, and plans for financial development adequate to carry out the college's mission and objectives within a balanced budget and a safe level of debt; and must disclose to CNME all information required to carry out its evaluation and accrediting functions. Handbook of Accreditation at pp. 8-9. In accordance with the regulations, CNME also requires that a candidate college progresses towards full accreditation within 5 years; and CNME emphasizes that "sound financial management and planning are of critical importance" for a candidate college. Handbook of Accreditation at p. 12, 34.

Since Southwest is the only institution accredited or preaccredited by CNME, it is CNME's handling of Southwest's preaccreditation that forms the basis of the National Advisory Committee's recommendation and my decision. CNME initially preaccredited Southwest in 1994. In 1996, CNME's site evaluation team stated its concerns about Southwest's financial circumstances by noting the expense involved in opening a new campus in Tempe, Arizona, and underscoring the need for fundraising to support the school's educational program. Exhibit (3) to the Petition for Recognition, July 1996, Evaluation Team Report at pp. 4-5. Soon thereafter in September of 1996, CNME voted to reaffirm Southwest's candidacy status. A scheduled mid-1997 site visit was postponed at Southwest's request to November of 1997. November 1997 Evaluation Team Report (Exhibit 3 to CNME Petition for Recognition) ("November 1997 Report") at p.8.

The November 1997 Report revealed that Southwest was in serious trouble. Between July 1996 and November 1997, its "entire financial structure had become unstable"; the college had "a large accumulated debt." November 1997 Report at 1. Southwest had no President, Senior Vice President/Chief Operation Officer, or Dean of Students, primarily because of financial constraints. November 1997 Report at p.6. The school's tuition income could not cover its general operating budget, much less deal with its debt burden. November 1997 Report at p. 11. The school's administrative problems made it impossible for the evaluation team to review monthly income and expense statements, November 1997 Report at p. 10, and, understandably, the team concluded that the school's employees, students, and board members believed that the school "was operating under crisis management." November 1997 Report at p.6. Not surprisingly, the team also found that the school had not adequately addressed the recommendations that the 1996 site evaluation team had made. November 1997 Report at p.11.

Under CNME's own standards, these facts certainly called for CNME to issue a show cause letter why Southwest's candidacy status should not be terminated. However, CNME did not issue a show cause letter and did not undertake to withdraw Southwest's candidacy or preaccreditation status. Instead, CNME scheduled another visit for the spring of 1998, made additional recommendations, and asked for further information. November 1997 Report at p. 35-37.

The April 1998 site team visit did not reveal significant improvement. The school had not addressed CNME's concerns. April 1998 Evaluation Team Report (Exhibit 3 to CNME's Petition for Recognition) at pp. 1-2. Once more, CNME did not issue a show cause letter or withdraw Southwest's candidacy status. Instead it reaffirmed Sourthwest's candidacy status. CNME Minutes of May 22, 1998 (Tab A to CNME Petition for Recognition) at p.5. CNME did ask Southwest for a progress report, and subsequently scheduled a site visit for November of 1998. CNME Minutes of August 24, 1998 (Tab A to CNME Petition for Recognition).

In March of 1999, near the end of Southwest's five-year candidacy period, CNME recognized that there were sufficient reasons to justify a show cause order, but CNME refrained from sending a show cause letter. Instead, it sent Southwest a letter outlining what it considered critical issues facing Southwest, including Southwest's serious financial problems. CNME March 17, 1999 Letter Southwest (attached to CNME's response to the Staff Analysis of the U.S. Department of Education, November 12, 1999)("CNME's Response"). Subsequently, on July 27, 1999, the school's leadership announced a decision to close the school, in the end classes were suspended for two weeks, and the then-president and board chair resigned. CNME August 3, 1999 Letter (attached to CNME's Response). Thereafter on July 30, 1999, CNME finally issued a show cause letter to Southwest; CNME amended its show cause letter on August 20, 1999, giving Southwest until September 10, 1999, to demonstrate that its candidacy should be continued. CNME July 30 and August 20, 1999 Letters (attached to CNME's Response).

Based on these facts, CNME failed to "consistently apply and enforce standards that ensure that the course or programs . . . are of sufficient quality to achieve . . . the stated objective for which the courses or the programs are offered." Section 496(a)(4) of the HEA, 20 U.S.C. § 1099b(a)(4). See also Section 101(c) of the HEA, 20 U.S.C. § 1001(c). As of November 1997, the conditions at Southwest clearly were those that, under CNME's Handbook of Accreditation, "will lead" to a show cause letter. From that point on, the conditions at Southwest continued to deteriorate significantly, yet CNME did not issue a show cause letter until July of 1999, after the school's president and board chair attempted to close the school and classes were suspended. Faced with the serious condition of Southwest in 1997, CNME did not follow its requirements. Likewise, CNME did not, as required by the regulations, either take prompt adverse action or require Southwest to bring itself into compliance with CNME's standards within a period not exceeding two years. 34 C.F.R. § 602.26(C)(2) AND (3). See also 34 C.R.F. § 602.24 (setting out requirements for accreditation processes, including the requirement that accreditors evaluate whether an institution complies with the accreditor's criteria).

In its appeal, CNME contends that it has been "completely impartial and objective" toward Southwest. The basis of the National Advisory Committee's recommendation and the basis of my decision is not a conclusion that CNME has acted in bad faith or with partiality. Instead, CNME is denied recognition because it did not follow its own standards and did not take appropriate action when faced with a school in candidacy status that was in a financial and management crisis.

CNME also raises concerns about a third party organization that opposed CNME's recognition before the National Advisory Committee and argues that CNME has served a useful purpose for the naturopathic profession. However, the views of this third party organization have played no part in my decision, and the National Advisory Committee and I do not express any view concerning any issues regarding the naturopathic profession. Our only role is to determine whether CNME satisfies the statutory and regulatory requirements for an accreditor to be recognized under the Higher Education Act, so that the accreditor can accredit institutions for participation in various federal programs, including the Title IV student financial assistance programs. As explained above, both the National Advisory Committee and I have concluded that it does not.

For these reasons, I deny CNME's appeal, adopt the recommendation of the National Advisory committee, and deny CNME's petition for continued recognition.

So ordered the 16th day of January 2001.

Washington, D.C.

________/S/________
Richard W. Riley

Irony

2006-06-24T19:28:16Z

I need a low irony diet. The only problem is that I don't think I will ever get one in the trans-community.

I was at the TransMarch in San Francisco yesterday, and it was really amazing.

But... yes there has to be a but....

I was struck by the contradictory messages that were voiced. Certainly they were by different speakers, but the striking thing was that the audience responded with wild approval to messages that were not even just subtly contradictory, but amazingly so.

For a good example: Leslie Feinberg was discussing the Bush administration's travesty of a policy in the Middle East. One of the ways in which he illustrated this was by describing the culture in Iran as a thousand years old and one which was more enlightened in its treatment of transgender people since the government in Iran sanctioned transgender treatments and had paid for surgery for some transgender people. What he failed to mention was that this is because the leaders in Iran see transition as a 'cure' for homosexuality - which is routinely punished by death in that society. It was less than a year ago that Iran publicly hanged two teen-aged boys for no other real crime than being gay.

Now, don't get me wrong... I think that the Bush administration's 'policy' in the Middle East is entirely fucked. However, I don't think its necessary to laud a nation as sensitive to the needs of transgender people when the real motivation for this 'understanding' is profound and violent homophobia. There are better arguments to be made that demonstrate that Bush has his head up his ass without using this one. But the crowd went wild in approval of Leslie's comments.

So the irony comes in a little later. Once the parade ended at the Civic Center, there were more speakers. Bevin Dufty was one of the first. He is a gay man who is on the SF board of supervisors. He's probably one of the best advocates that we have in city government for transgender people in SF. He's gone to bat for the clinic in which I work (Lyon-Martin.) He's advocating for funding of the Transgender Law Center for an employment initiative for SF transpeople. However, a few speaker's later, Alex Lee (who I love and who is the founder of the TGI-Justice Project) started haranguing Bevin (by name) because he hasn't done enough for the entire transgender community. Alex condemned him for not advocating for changes in the sentencing and policing of transgender people who are doing survival sex, non-violent property crimes, and drug related crimes in SF. While I certainly agree that people doing these types of crimes need social services rather than jail, I don't see how calling out a persistent and vocal ally like this does to help us. Nudging is one thing, but Alex was flat out insulting. Repeatedly. Vitriolicly.

So I disagree with both of what Leslie and Alex said in a significant way, but what struck me as profoundly ironic is that the crowd responded wildly to each of these two speakers... so its great that Iran provides SRS to a few straight transpeople while at the same time executing gay children. However Bevin should be drawn and quartered because he is only trying to get several hundred thousand dollars to support a trans-employment initiative, is advocating for the city to include transgender benefits in Gavin Newsome's 'universal coverage' for the uninsured in SF, advocates for the funding of clinics that serve poor and homeless transgender people in SF, etc.

Am I the only one who sees the irony in that? GAAAAAAHHHHHHH! I mean... I really like Alex and I think that TGIJP is extremely important.... but don't effing shoot us in the foot, Dude! And, Leslie... I will be impressed that Iran is evolving into a tolerant culture when my partner and I can safely visit the country without risking execution for being gay.

Nick

nickgorton @ 2006-06-09T20:34:00

2006-06-10T03:43:34Z

Is GID a disease?

Nick Gorton, MD, DABEM
June 6, 2006

The term disease, while having many common connotations, is used in medicine to denote a specific classification.

Stedman's Medical Dictionary defines a disease as: "An interruption, cessation, or disorder of body function, system, or organ," "A morbid entity characterized usually by at least two of these criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations," and "Literally, dis-ease, the opposite of ease, when something is wrong with a bodily function."

Dorland's Medical Dictionary defines disease as: "any deviation from or interruption of the normal structure or function of a part, organ, or system of the body as manifested by characteristic symptoms and signs; the etiology, pathology, and prognosis may be known or unknown."

In addition, the US Government (via the EPA Terminology Reference System) gives a similar definition: "A definite pathological process having a characteristic set of signs and symptoms which are detrimental to the well-being of the individual."

So in medicine, a disease is characterized by the following traits:

1) It has an identifiable set of signs and symptoms that are characteristic.
2) It represents a deviation from the normal state of the organism.
3) It results in negative consequences for the organism through pain or discomfort, inability to perform normal functions of all or part of the organism, or in some circumstances death of the organism.

In addition to the strict scientific definition of disease, there are other functional attributes that suggest that a condition is recognized by the fields of science and human medicine as a disease. These include:

1) Inclusion of the disease and its diagnostic criteria in established disease classification schemes such as the World Health Organizations International Statistical Classification of Diseases (the "ICD-9" and "ICD-10" that are used for all medical coding in the United States and other countries world wide.)
2) Inclusion of the disease and research about it in the established medical literature.
3) Inclusion of the disease and its management in established and recognized medical texts.
4) Existence of health care professionals, and in some cases professional organizations of such professionals who focus their professional practice on diagnosing and treating patients with the disease.

That GID is a disease is supported by the fact that GID meets all three of the commonly recognized characteristics of a disease, as well as the four listed attributes above. The following sections describe how GID fulfills all of these criteria in greater detail.

1) It has an identifiable set of signs and symptoms that are characteristic of the disease.

Both the American Psychiatric Association, in the DSM-IV-TR (1) and the ICD-9 and ICD-10 list specific signs and symptoms that are characteristic of GID. These criteria are established by the APA and the WHO in order to ensure that patients with the illness are properly diagnosed, and that patients without GID are not mis-diagnosed. These criteria have existed for several decades as objective determinants of whether a patient has GID.

As an example, the DSM diagnostic criteria for GID of Adolescence and Adulthood (302.85) are:

1.A strong and persistent cross-gender identification.
2.Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one's birth sex.
3.The disturbance is not concurrent with a physical intersex condition, such as hermaphroditism in which a person is born with the genitalia of both male and female.
4.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

2) It represents a deviation from the normal state of the organism.

It is certainly quite obvious from individual experience that the normal state for human beings is to have one's gender identity match one's physical body and gender assigned at birth. In particular, the DSM quotes an incidence of 1:30,000 for transgender women, and 1:100,000 for transgender men.

3) It results in negative consequences for the organism through pain or discomfort, inability to perform normal functions of all or part of the organism, or in some circumstances death of the organism.

The results of untreated GID have been documented in numerous places in the medical literature. For example, in research spanning two decades, pre-treatment suicidality of transgender patients is approximately 20-30%, while post treatment suicidality is generally less than 5%.(2,3,4,5) In addition to suicide, however, increased rates of substance abuse, depression are noted in untreated patients with GID, while improved social functioning, decreased clinical depression, decreased need for psychotherapy, decreased substance abuse, and improved quality of life is demonstrated in patients who are treated for GID.(6,7,8,9,10)

1) Inclusion of the disease and its diagnostic criteria in established disease classification schemes such as the World Health Organizations International Statistical Classification of Diseases (the "ICD-9" and "ICD-10" that are used for all medical coding in the United States and other countries world wide.)

Transsexualism is included in both the current ICD version, 10 as well as the version now used for medical coding in the US for all Medicaid and Medicare, and most private insurance policies. In addition, it is included in the current and prior versions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. These two classification schemes are the most recognized and widely used methods by which mental diseases (in the case of the DSM) and both medical and mental diseases (in the case of the ICD) are classified in the US and world wide. Transsexualism has been included in these two documents for several decades. (Note: the current nomenclature used in the DSM uses the name "Gender Identity Disorder" and the ICD uses "transsexualism". It is generally recognized that these diseases are the same entity, much like 'juvenile diabetes', 'type 1 diabetes,' and 'insulin dependent diabetes' all refer to the same disease. Historically transsexualism was thought of as the more severe end of the spectrum of GID, however the terms are used synonymously by most providers now. In addition, in the past few years, the term transgender or transgenderism has sometimes been used in the place of transsexualism in the medical literature and in common parlayance in much the same way that 'gay and lesbian' is often used instead of 'homosexual' because 'transgender' is more often used by the community it describes similarly to gay and lesbian communities.)

2) Inclusion of the disease and research about it in the established medical literature.

There are numerous studies and review articles in the medical literature and in medical reference texts concerning GID. In addition to the ones referenced above, the following are some illustrative examples.

Gender Related Disorders. Wylie, K. British Medical Journal. 329: 615-617. 2004.

This clinical review article for primary care providers in one of the 'big four' international medical journals (NEJM, JAMA, Lancet, and BMJ) is indicative of the level of acceptance that SRT has gained among medical practitioners as a valid, non-experimental therapy. The author states: “Transpeople should be counseled about the range of treatment options and implications, and if necessary, should be encouraged to have psychotherapy. The professional should ascertain eligibility and readiness for for progression to hormonal and surgical therapy. Whenever possible this should be done within the context of a multidisciplinary team and should take into account the needs of the individual patient rather than enforcing a rigid package of care.”

Medical Advances in Transsexualism and the Legal Implications. Harish, D and Sharma, B. American Journal of Forensic Medicine and Pathology. 24(1): 100-105. 2003.

“[N]o true transsexual has yet been persuaded, bullied, drugged, analyzed, shamed, ridiculed, or electrically shocked into an acceptance of his or her physique. It is an immutable state. Even though for years in the future many may argue about the causes and nature of transsexualism, no one can deny that this is an identifiable, severe, and incapacitating disease, a pathologic condition which is undesirable for both the patients and for the society.” The review summarizes that “the general belief now among behavioral scientists and physicians is that it is an identifiable and incapacitating disease, which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients.”

A Psycho-Endocrinological Overview of Transsexualism. Mormont, A and Legros, J. European Journal of Endocrinology. 145: 365-376. 2001.

Summary of the current best practice and research on the epidemiology, etiology, diagnosis and appropriate treatment of transsexual patients. Accepts the HBIGDA guidelines as the international minimum standard that is followed by most practitioners who treat transsexual patients. “In light of the various studies mentioned earlier, it is quite clear that surgical anatomical transformation results in largely positive effects. Based on this and where treatment is carried out correctly from the diagnostic phase to the operation, there is no empirical reason why a sex-change request should be refused.”

Gender Reassignment Surgery and the Gynecologic Patient. Fugate, S, et al. Primary Care Update OB/Gyns. 8(1): 22-24. 2001.

Review article detailing the appropriate treatment and care of post-operative MTF transsexual women for primary care obstetricians and gynecologists. The article concludes: “it is important that the experienced gynecologist be familiar with transsexualism, the reconstructive surgery involved, the surgical complications, and the transgender support groups available. As part of their new gender, they will be presenting for their annual gynecologic examination. Transsexuals should be treated, to the extent possible, like other female gynecologic patients, while care is taken not to overlook underlying or preexisting medical conditions, including conditions unique to their prior gender.”

Gender Reassignment and Assisted Reproduction: Present and Future Reproductive Options for Transsexual People. De Sutter, P. Human Reproduction. 16(4): 612-614. 2001.

Review summarizing the currently available techniques for preserving the reproductive capacity of transsexual patients after hormonal and surgical therapy. The author states, “Transsexualism is now generally recognized to be a condition that needs to be treated by state-of-the-art hormonal and surgical therapy to obtain reassignment to the desired gender,” and “The overall well-being of transsexual people after gender reassignment therapy has been well documented in recent studies.” Now, due to improved understanding of transsexualism as well as acceptance of standard medical and surgical treatments, the debate has expanded to the importance of preservation of reproductive capacity through sperm or ovarian tissue banking. The author states that, “transsexual people should be offered the same options as any person at risk of losing their germ cells because of treatment for a malignant disease.”

3) Inclusion of the disease and its management in established and recognized medical texts.

In addition to the DSM which was referenced previously, GID is included in numerous medical and psychiatric texts. Below are a sample of such references.

Treatments of Psychiatric Disorders. Edited by Glen O. Gabbard, M.D. American Psychiatric Press; 3rd Ed. May 2001. (First Edition published as: Treatments of Psychiatric Disorders: A Task Force Report of the American Psychiatric Association. Washington, DC.)

“Cross-sex hormonal treatments play an important role in the psychological and anatomic gender transition process for properly selected adult patients with GID. Internationally recognized Standards of Care indicate that such treatments are 'medically necessary' for rehabilitation in the new gender and that they improve quality of life and limit psychiatric comorbidities which may accompany lack of treatment.”

The text notes that medical treatments for GID “should no longer be considered experimental and are now a component of acceptable medical practice for GID” and “have been used for more than three decades and appear to be generally safe when administered to carefully evaluated and monitored patients.”

The text also notes the possible adverse outcomes if GID is not appropriately treated: “But the therapist must also stress the danger of choosing to do nothing about their gender condition, because such an approach generally has disastrous consequence. Suppression and repression often lead to depression and substance abuse, sometimes accompanied by suicidality.”

Sexual and Gender Identity Disorders. Levey, R, et al. eMedicine online medical textbook. 2004. (accessed 6/06/06)

“Existing case reports do not indicate that psychotherapy produces complete and long-term reversal of cross-gender identity. Transsexuals are not a homogeneous group. Some transsexuals do not show severe psychopathology. SRS may be a viable treatment solution for some. Satisfactory results are reported in 87% of male-to-female and 97% of female-to-male SRS patients.”

“Negative attitudes toward SRS appear to be changing among professionals, and scientific interest is increasing. Nevertheless, SRS does not promote a trouble-free life. Psychotherapy post-SRS may substantially improve overall outcome.”

“Controversy exists over whether adolescents should be allowed to pursue SRS. Many countries deny SRS to adolescents; however, early treatment may be beneficial in adolescents whose secondary sex characteristics have not yet fully developed (eg, facial hair, lowered voice, breast development).”

Oxford Textbook of Psychiatry, Fourth Ed. Gelder, M. Oxford University Press. 2001. pps 608-613.

“Treatment generally follows the guidelines of the Harry Benjamin International Gender Dysphoria Association.”

“Transsexual people are unlikely to seek treatment to reduce their conviction about their gender, nor is there any evidence that psychological treatment can bring about this change.”

Review of General Psychiatry, Fifth Edition. Foltin, J et al. Appleton and Lange. 2000. pps 367-371.

“Gender dysphoria is the pathological state of dissatisfaction and subjective incongruity between the sex phenotype (genital anatomy and secondary sexual characteristics) and the gender identity and role. Gender dysphoria is expressed as a body image disorder, for which the treatment has been a combination of psychotherapy and the alteration of the body through medical and surgical procedures.”

“Once diagnosed, gender identity disorders of adolescence and adulthood are usually chronic until the individual is rehabilitated in the desired gender identity and role.”

“Psychotherapy alone has not been effective in alleviating profound gender dysphoria... Psychotherapy as part of sex reassignment rehabilitation helps ensure that those individuals who undergo sex reassignment will benefit from the procedures and be satisfied with the outcome.”

Human Sexuality. The American Medical Association Committee on Human Sexuality. Chicago. 1972.

Over three decades ago the board of trustees of the American Medical Association authorized the Committee on Human Sexuality to produce and publish a text that provided guidance for physicians about medicine's current views on human sexuality. The text was published in 1972 by the AMA as the book 'Human Sexuality.' Among other topics, this text provided guidance on the treatment of transsexual patients.

The authors recognized even three decades ago that there is distinct difference between sex and gender. The text defined biological sex as, “the sum total of the chromosomal configuration (genotype), the gonads (ovary or testis), the hormonal environment and its effects on the end organs. These factors determine the internal and external reproductive structures.” Core gender is “the sense of maleness and femaleness, which develops from the sex of rearing (psychologic sex).” Gender identity is “the sense of masculinity or femininity.” Transsexuality is defined as when “the individual belongs biologically to one sex but has a strong dislike for the equipment of that gender and wants to function socially and sexually as a member of the opposite sex.” The text also notes that “'true sex' is based on many more factors than biologic sex.” The authors enumerate eight different characteristics that should be employed by physicians when determining an individual's sex: chromosomal sex, gonadal sex, hormonal milieu, internal and external sex organs, body habitus, sex of rearing, gender role and identity.

The book states that while some mild cross-gender feelings in children and adolescents may be amenable to to counseling, patients with a persistence of cross-gender identification into later adolescence and adulthood may be appropriately treated with SRS: “[If] it appears that the patient will continue to look at life through the eyes of the opposite sex, surgical reassignment may ultimately be considered.” It also notes that in adult transsexuals reparative psychotherapy is not appropriate: “Psychotherapy for adult transsexuals has been largely ineffective and surgical reassignment of the sex is frequently employed.”

4) Existence of health care professionals, and in some cases professional organizations of such professionals who focus their professional practice on diagnosing and treating patients with the disease.

There are numerous health care professionals who treat transgender patients. The primary professional association for such professionals is the Harry Benjamin International Gender Dysphoria Association. (HBIGDA.) In addition to promulgating the standards of care for the treatment of transsexual patients, HBIGDA publishes a professional journal, the International Journal of Transgenderism, and holds a biannual professional meeting for the presentation of research on transgender patients as well as providing a forum for continuing medical education by health care providers who treat patients with GID.

In addition, there are a number of well recognized clinics in the United States (and internationally) who specialize in the treatment of transgender patients.

The most well known such clinic internationally is the Amsterdam Gender Dysphoria Clinic at the Free University Hospital in Amsterdam. Additionally the Gender Identity Clinic, Charing Cross and Westminster Medical School is also well known.

Several clinics in the United States are also well known for their care of patients with GID. These include:

The University of Minnesota Family Medicine and Community Health Clinic.

The Whitman-Walker Clinic in Washington, DC.

The San Francisco Department of Public Health, Tom Waddell Clinic.

The Lyon-Martin Clinic in San Francisco.

The Callen-Lourde Clinic in New York City.

The Ingersoll Gender Center in Seattle.

The Fenway Community Health Transgender Health Program in Boston.

The Mazzoni Center Clinic in Philadelphia.

References:
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
2. Lundstrom, B, et al. "Outcome of sex reassignment surgery." Acta Psychiat. Scandinavia. 70:289-294. 1984.
3. Michel A, et al. "The transsexual: what about the future?" European Psychiatry. 17:353-362. 2002.
4. Rehman J, et al. "The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients." Archives of Sexual Behavior. 28(1):71-89. 1999.
5. Feldman J and Bockting W. "Transgender health." Minnesota Medicine. 86(7):25-32. 2003.
6. Levi B, et al. "Endocrine intervention for transsexuals." Clinical Endocrinology. 59:409-418. 2003.
7. Rehman, J, et al. "The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients." Archives of Sexual Behavior. 28(1):71-89. 1999.
8. Smith Y, et al. "Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals." Psychological Medicine. 35: 89-99. 2005.
9. Lawrence A. "Factors associated with satisfaction or regret following male to female sex reassignment surgery." Archives of Sexual Behavior. 32(4):299-315. 2003.
10. Cohen-Kettenis P and Gooren L. "Transsexualism: a review of etiology, diagnosis, and treatment." Journal of Psychosomatic Research. 46(4):315-333. 1999.