Archive | March 2014

The HR followup

Mar25

I really didn’t learn much in my HR meeting on Monday, the 24th. The benefits coordinator was out and unable to give me an answer to questions about trans surgeries and health care. We did cover my tentative legal transition schedule and that I was planning to go full time at work after that, so in the second half of this year.

It sounds like the surgery situation is somewhat ambiguous. I did point out that I would have letters of medical necessity when that time came, and that she should mention it to the CIGNA rep.

I also have permission to come out to my team mates. I need to coordinate that with my boss.

An amazing week in Memphis

Mar25

From March 15th to March 23rd, I was in Memphis, Tennessee, visiting two wonderful, supportive and close friends, and in turn making nearly a dozen more friends. It was a 10 hour drive from Texas but quite doable and as a side note, that old Z-28 that I drive managed to get 24, 26, 25, and 27 mpg on the four tanks of gas to and from Memphis. Of course, that car loves to cruise at about 75-80 mph, so letting it flex its muscles was the perfect opportunity for it to stretch out and run, like a thoroughbred horse.

I arrived in Memphis late Saturday evening, gave friends a couple text messages, then got unpacked for the evening. Now to put things in perspective, back home in Texas, I’ve been living a more and more female/androgynous mode but hadn’t gone all out yet and wasn’t presenting fully female full time. Memphis was going to be a week where I didn’t have to soothe anyone else’s discomforts and could just be myself.

Sunday came and we went thrift shop hopping for several hours. I picked up several new items, all of which I loved and we did dinner together and spent time chatting. Monday was more shopping and more clothes to take home. Tuesday was various activities with friends as well as a visit to one friend’s Pagan temple. The wonderful woman there who was the priestess did a tarot card reading for me that seemed, to me, to be very positive about the future, and especially about the question I asked (which she did not know until after, when I told her). That question was rather simple – will I always be alone? And her answer suggested no, I would not. I hit it off well with her and we’re going to keep in touch via Facebook.

Wednesday was a rest day, in which we got together a bit in the evening but mostly we took the day off to catch up. We’re not that young anymore! Thursday was the zoo, with lots of walking, seeing exhibits, admiring the expansion of the zoo, which the friend from Memphis was more than willing to explain to us. The Memphis Zoo has come a long ways, with many larger open enclosures versus the small cages of years ago. That evening we did barbeque and Central BBQ and then I chose to retire, being rather worn out from the long day. Several others went to another friend’s house and played board games. I wish I’d felt up to doing so but it didn’t work out that way with me falling asleep a bit after I got back to the hotel.

Friday was more running around getting eyebrows waxes, manicures, and then followed by a ceremony at the temple specifically for me. I was taken into the women’s circle, embraced as one of them, and really felt some overwhelming care and love from those there. I cried a lot, which I fully expected, hence avoided eye makeup that evening, else I’d have been a racoony mess!

On Saturday, my friend from Wisconsin had to depart with her family. We all had lunch together, chatted a bit, exchanged hugs, wished each other well, exchanged hugs again, and then they were off on the first leg of their drive home. On Saturday evening there was a large gathering at the temple but I skipped that, given my hearing problems when among large numbers of people, and because I needed to pack for the drive home Sunday.

On Sunday, I checked out of the hotel, had lunch with the friend who was local to Memphis, then finally got back on the road. This time I took I-55 south to I-10 west (with a few dog legs along the way). This trip was also about 10 hours overall.

One thing I was not aware of until one of my friends told me was that different men had asked to be sure I was going to be safe going to and from my hotel alone. As she noted, that question isn’t asked for men but it is for women.

It was an amazing week for me, and one which completely reaffirmed my own belief in my transition. I’ve never been that completely comfortable with myself anywhere and I was not misgendered once the entire week there. Below is one of my favorite pictures from the trip.

Memphis_20140321-1

It wasn’t supposed to happen this way

Mar11

On Monday, we completed our usual planning session for the next two weeks of work and afterwards I stopped in to talk to my boss. Along the way, he informed me that the person I know best and trusted in HR just retired. Uh-oh. That threw a spanner into my coming out plans with HR. I had planned to talk to that exact person in early April since I’ve had contact with her before but not openly about this specific issue. My boss saw this bothered me so asked why. Given that I do trust him and have no reason not to talk to him, I said, “Let me close the door. We probably need to chat.”

So out it came. He now knows. And his reaction? “I don’t see this impacting your place in this organization in the least. In fact, if it does, I will be very disappointed in whomever tries to make it an issue.” He also said with my HR contact having left the company last week, he will find out who is best for me to talk to in HR so I’ll either have an HR appointment later this week or probably the first week or second week after I get back from vacation. I did explain that I am aiming to complete the legal aspects of transition in the second half of this year with a soft target date of September. Once that is done, I can really be full time and start the clock towards GCS.

That also means it’s all in play and live. And my boss? He congratulated me on tackling something that must be very difficult to face. He also said that I probably have enough stress from this outside the office (which is true) but he wanted to make sure the office was zero stress on this specific issue.

I work with great people, for a great company. I hope I can continue to say that going forward.

Addendum: Today I received an email from our new contact in HR. She wants to see me the first day I am back from vacation, which is Monday, the 23rd.

My boss also reiterated that if I need to speak to him at any time, his door is always open.

Medical Information about Transwomen in Sports

Mar9

The following was put together by Transadvocate, a trans advocacy website, on their Facebook page. In order to not lose track of it, I am putting it here. This is not my work! I am copying it for ease of reference! Thank you Transadvocate and Rehan! If I find another link to this, I will add it here for completeness as well.

In regards to the Crossift HQ refusal of Chloie Jonnson’s participation at the games here are some facts that should be considered before any sensationalistic claims are made without proper knowledge.

First of all the XY vs XX argument is invalid and not sufficient. There are well documented cases of XX males and XY females. The SRY gene region is normally found on the Y chromosome but is not a reliable method of testing since not only is not always found on the Y chromosome it also triggers a gene cascade not well understood by scientists yet that in turn affect other tissues during development which may lead to altered sexually dimoprhic traits in individuals, such as brain structure.

This is evidenced by scientific literature cited

Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus
http://press.endocrine.org/doi/abs/10.1210/jcem.85.5.6564

and

Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation

Read More: http://informahealthcare.com/doi/abs/10.1080/09513590400018231
http://informahealthcare.com/doi/abs/10.1080/09513590400018231

and

Sexual Differentiation of the Bed Nucleus of the Stria Terminalis in Humans May Extend into Adulthood
http://www.jneurosci.org/content/22/3/1027.short

and

A sex difference in the human brain and it’s relation to transsexuality.
http://depot.knaw.nl/821/1/15106_285_swaab.pdf

with subsequent study by Dr.Swaab et al. And Kruijver et al. showing differences in the Bed Nucleus of the Stria Terminalis, SDN, Hypothalamus and gray matter volume underlining the importance of brain physiology.

http://www.sciencedirect.com/science/article/pii/0165380688902313

http://www.sciencedirect.com/science/article/pii/S1053811909003176

http://www.tandfonline.com/doi/abs/10.1300/J082v28n03_07#.UxoCwRbPPFI

http://books.google.ca/books?hl=en&lr&id=JFpq6hYQRhQC&oi=fnd&pg=PA41&dq=brain+dissection+transgender+Dr.+Swaab&ots=FjtewJ28wz&sig=8F-QOG1Q5QCEIMe1oQwqlWNb9ko#v=onepage&q&f=false

http://www.hawaii.edu/PCSS/biblio/articles/2005to2009/2006-atypical-gender-development.html

Also studies showing it to be irreversible

http://aace.metapress.com/content/nm510264636815vk/

There is also an article linking hormone related genes to the atypical sexual dimoprhism. Genes CYP19 (Aromatase responsible for testosterone to estrogen conversion), AR (androgen receptor, the “key” hole for the cell that the testosterone “key” acts on to elicit it’s effects) and ESRB (Estrogen Receptor Beta which is responsible for the initiation of differentiating gene cascades in the fetal brain during fetal hormonal “washes”)

here

http://www.sciencedirect.com/science/article/pii/S0306453005000454

Continuing on the topic of performance and gender testing the IOC released a statement before the 2012 summer Olympics.

“The new rules state that a panel of independent medical experts will examine through a blood test the testosterone levels in a woman and will then make a recommendation about whether she could be eligible to compete.”

The IOC and NCAA have decided after extensive research (independently) that Hormone profile is the primary determining factor for gender qualification in sport.

The Olympics requires 2 years post surgery before being allowed to compete at an INTERNATIONAL event.

The NCAA requires only one year of HRT.

This was determined the minimum to not have any unfair advantage as evidenced by the quotes from respective authorities below.
“Requiring sex reassignment surgery before allowing participation for the high school or collegiate student athlete is medically unnecessary and not linked to competitive equity IOC regulations requiring surgery for Olympic transgender athletes have been controversial and it would be unreasonable to”make this requirement for high school and college students”
ERIC VILAIN M.D., PH.D., PROFESSOR, DIRECTOR OF THE CENTER FOR GENDER-BASED BIOLOGY AND CHIEF MEDICAL GENETICS DEPARTMENT OF PEDIATRICS, UCLA
“Research suggests that androgen deprivation and cross sex hormone treatment in male-to-female transsexuals reduces muscle mass; accordingly, one year of hormone therapy is an appropriate transitional time before a male-to- female student athlete competes on a women’s team
ERIC VILAIN: M.D., PH.D., PROFESSOR, DIRECTOR OF THE CENTER FOR GENDER-BASED BIOLOGY AND CHIEF MEDICAL GENETICS DEPARTMENT OF PEDIATRICS, UCLA
“Transgender student athletes fall within the spectrum of physical traits found in athletes of their transitioned gender, allowing them to compete fairly and equitably”
DR. NICK GORTON
AMERICAN BOARD OF EMERGENCY MEDICINE, MEDICAL LEGAL CONSULTANT, TRANS HEALTH CARE

Further more, the difference need to be put into perspective when transgender women are compared with cisgender women they fall within a female range after the required time period (1 year NCAA, 2 years post-op IOC).
“Differences within the sexes are considerable and often times larger than differences between the sexes ”
DR. WALTER BOCKTING, PH.D.
PRESIDENT OF WPATH, ASSOCIATE PROFESSOR, UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

These facts are presented based on scientific literature as cited
here
Elbers JM, Asscheman H, Seidell JC, et al. Effects of sex steroid hormones on regional fat depots as assessed.
here
Australian Sports Commission. Transgender in sport.www.ausport.gov.au/fulltext/2001/ascpub/women_transgender.asp (accessed 22 Mar 2005).

here
as contrasted between these two
↵ Stamm R, Veldre G, Stamm M, et al. Dependence of young female volleyballers’ performance on their body build, physical abilities, and psycho-physiological properties. J Sports Med Phys Fitness 2003;43:291–9. [Medline][Web of Science]
↵ Viitasalo JT. Anthropometric and physical performance characteristics of male volleyball players. Can J Appl Sport Sci1982;7:182–8. [Medline]
and here
Pilgrim J, Martin D, Binder W. Far from the finish line: transsexualism and athletic competition. Fordham Intellectual Property Media & Entertainment Law Journal2003;13:495–549.
And the rest of these studies

↵ Federation Internationale de Volleyball. Medical regulations, ed. 2004. http://www.cev.lu/mmp/online/website/main_menu/downloads/file_28430/fivb_med_regulations_-_revised_7.pdf (accessed 23 Mar 2005).
↵ Lausanne Declaration on Doping in Sport (adopted by the World Conference on Doping in Sport). 1999.www.sportunterricht.de/lksport/Declaration_e.html (accessed 23 Mar 2005).
↵ Ritchie I. Sex tested, gender verified: controlling female sexuality in the age of containment. Sport History Review2003;34:80–98.
↵ Batterham AM, Birch KM. Allometry of anaerobic performance: a gender comparison. Can J Appl Physiol1996;21:48–62. [Medline]
Thomas JR, French KE. Gender differences across age in motor performance: a meta-analysis. Psychol Bull1985;98:260–82. [CrossRef][Medline][Web of Science]
↵ Shepard RJ. Exercise and training in women. Part I. Influence of gender on exercise and training responses. Can J Appl Physiol2000;25:19–34. [Medline][Web of Science]
↵ Dickinson BD, Genel M, Robinowitz CB, et al. Gender verification of female Olympic athletes. Med Sci Sports Exerc 2002;34:1539–42. [CrossRef][Medline][Web of Science]
↵ Simpson JL, Ljungqvist A, de la Chapelle A, et al. Gender verification in competitive sports. Sports Med 1993;16:305–15. [Medline][Web of Science]
↵ Introducing the, uh, ladies. JAMA1966;198:1117–18.
↵ Doig P, Lloyd-Smith R, Prior JC, et al. Position statement. Sex testing (gender verification) in Sport. Canadian Academy of Sports Medicine. 1997. http://www.casm-acms.org/PositionStatements/GendereVerifEng.pdf (accessed 23 Mar 2005).

There is no “residual” advantage and often times transgender athletes are at a disadvantage due to severely lowered testosterone levels in comparison to native females. Cisgender women have a higher testosterone than transgender women who have had reassignment surgery and the related information.
http://transathletes.org/hormones.php

Other issues that arise in the form of practicality

1) Her numbers pale in comparison to other female athletes

Crossfit profile comparison between her and CLB:http://games.crossfit.com/compare/161983/8404

Back Squat: 225 lb Clean & Jerk: 165 lb Snatch: 125 lb Deadlift: 275 lb

These numbers pale in comparison to the top competitors as well as compared to many other regional athletes.

2) Let her compete, if she has an unfair advantage it will be very apparent and provide evidence for these as of yet unfounded claims of unfair advantage. There are yet to be any instances of a transgender athlete dominating competitions if this were to be so likely.

3) Saying this will open the door for other males to “become” transgender and dominate is very short sighted. Firstly they would have to adhere to the strict protocol involving Hormone Replacement Therapy which would remove that advantage. Secondly transgender people face a MASSIVE amount of discrimination not to mention the amount of money and physical pain of procedures that need to be endured to complete the requirements. The transgender suicide rate is 41%, forcing someone to live as the opposite identity is devastating psychologically and would also be true of someone trying to “fake” it. (Remember once the surgery is done it is a PERMANENT change, is winning crossfit that important?)

4) Having larger bone structure and lowered muscle mass constitutes a disadvantage.

5) Furthermore there is no consistent testing policy in crossfit for PED’s. A cis-female using AA has a much larger and much more distinct advantage which could be considered universally as an “unfair advantage”.

The most shocking thing is the completely deplorable and inappropriate reply from Crossfit HQ, who seem to be the ones lacking in understanding of the human genome and biology.

Why Transition is the Overwhelming Treatment of Choice

Mar2

Recently, at a forum where I am involved, a poster asked about evidence for non-transitioning therapies for transsexuals. Now on that forum are a tiny number who consistently pound an anti-transition drum. But as I demonstrated in my reply, their position is not congruent with the position of the medical community today. Here is what I wrote, with minor edits to make it more appropriate for this blog.

__________________________________________________

The AMA is now overwhelmingly on board with fundamental brain differences being the root cause of transsexuality. And the APA (both of them) both state that the most effective therapy statistically for transsexuals is transition.

One of the most important of these is brain differences concerns the BST in the hypothalamus. “In the hypothalamus, the bed nucleus of the stria terminalis (BST) is thought to be important for gender identity. One study showed that male-to-female transsexuals had decreased BST staining identical to that for genetic XX female subjects (8). In contrast, genetic XY male subjects had significantly increased BST staining. BST staining was not influenced by sexual orientation or sex hormone levels.”

These differences can be seen below:

MTF_Brain_Scan_differences

In addition, further brain structure differences are being identified as well that impact transsexuals.

This NIH document references the study (by van Kesteren PJ, Gooren LJ, Megens JA. An epidemio-logical and demographic study of transsexuals in The Netherlands. Arch Sex Behav. 1996;25:589–600) that sex reassignment as overwhelmingly statistically successful in addressing the needs of the transsexual community. Given the size of the TS community the size of the study is significant. If the rates of transsexuality are as high as 1 in 600 as has been suggested by various studies, and if 1 in 2500 actually undergo SRS which have been suggested by direct analysis of number of surgeries in the US per year, then the size of the study in question was almost 25% of the SRS population of the Netherlands and 3% of the overall Netherlands TS population. If the rates of transsexuality are lower, then the size of the study is even more significant because it represents an even larger cross section of the TS population!

Here is the NIH position:

Quote

__________________________________________________

Treatment options for patients with gender identity at variance with physical appearance can be evaluated in the order of extent of invasiveness. The least invasive intervention would be counseling such patients to accept the circumstance. As already noted, however, no available data support the success of such therapy. The next least invasive approach might be a targeted treatment of the underlying problem. The medical community, however, has little knowledge about the brain region associated with gender identity, and even less is known about techniques for manipulating it.
Although current transgender treatment is relatively invasive and does not address the problem completely, it is the most successful intervention available. Studies report very high transgender patient satisfaction with sexual reassignment. Thus far, the largest evaluation has been a survey of Dutch transgender patients (10). Among the 1,285 patients surveyed, 1,280 were satisfied.

__________________________________________________

As noted, “no available data support the success” of counseling patients to simply accept their circumstances. The second discussed option, manipulating the brain to become more accepting of the body, is not currently possible because the “medical community, however, has little knowledge about the brain region associated with gender identity, and even less is known about techniques for manipulating it“.

This leaves transitioning as the primary therapy for dealing with GID. As has been noted in the past here, there are people who do manage to live out their lives without transitioning to live in a new gender role. Good for them. But they are also the statistical minority among patients suffering from significant GID. For that category of patients, the number one therapy of choice today is transitioning (aside from suicide and I think we all agree that suicide is a bad option, yes?).

Therapists will assist a patient in trying to meet their personal goals but a transsexual suffering from significant GID ought to be prepared to discover that non-transitioning treatments are very likely to fail to bring them to a level of comfort with themselves that allows them to live a full and fruitful life. Certainly there will be those cases that do succeed at this, but as the NIH document notes, the medical community’s primary treatment therapy today is transition, including HRT, and optionally including surgeries to further assist the body to conform to the expectations of the mind.

Therefore, in answer to the original poster’s question – you are unlikely to find any large scale answer to your question of non-transitioning treatments that work. In almost every case where that does occur, the patient has developed their own unique regimen for coping with their GID that is specific to that patient. The single treatment option that does work and which is medically and statistically supported at this time by the medical and psychiatric and psychological communities is transition.

To the original poster, if you choose to not transition, it’s pretty much you and your therapist in uncharted waters. It’s possible you will succeed. Good luck if you choose that path. I will not dissuade you from taking whatever path you choose but I will stand by the statements in this post that transition is the proven most effective treatment for transsexuals suffering from severe GID.

P.S. This is the reason that there is so-called “cheerleading” for transition in the community – because it works. And because it is overwhelmingly statistically successful. Those are facts.

__________________________________________________

The above was the body of my response in that discussion thread.