Gender reassignment surgery case decided
by Linda Beale
(Rdan here…I thought this case represents another aspect of the complexities of insurance coverage, approved procedures versus experimental, proper diagnosis, and how our medical and societal expectations interact. Many are aware of the topic but many probably have little personal experience with a transgender person. I believe it is jarring enough for many to create discussion.)
Gender reassignment surgery case decided
Back in 2005 when the IRS released CCA 200603025 stating that gender reassignment surgery is not a deductible medical expense, I objected. Gender identity disorder had been recognized by the medical profession, I argued, so why should the IRS rely on a Catholic Church authority who had fought against such surgery for its decision. Read the post from 2006 here.
The Tax Court ruled on the issue today, in O’Donnabhain v. Comm’r, 134 T.C. No. 4 (Feb. 2, 2010). As Caron notes on TaxProf (hat tip), the majority recognized gender identity disorder as a disease and gender reassignment surgery as treatment for a disease (though they thought breast augmentation surgery was merely cosmetic).
Good decision, except maybe for that bit about breast augmentation being merely cosmetic. If we were talking about “Hot Lips” on Mash I’d agree. Or even about any woman who just wants bigger breasts. But when the subject is a male with gender identity disorder who is undergoing genital and breast surgery to make himself into the female she believes herself to be, then breast augmentation is a critical part of the picture, which the medical standards quoted in the case make clear. I couldn’t read the court’s discussion of this topic without thinking–but, if you had undergone that surgery, wouldn’t it be pretty important to have really good breasts? The court essentially said there wasn’t enough substantiation that the breast surgery was because of the gender identity disorder.
One of the examining physicians who concluded that the petitioners were a “good candidate” for the surgery also noted that she already appeared to have developed decent breasts (B cup) under hormone therapy. Yet the surgery is described as “designed to make petitioner’s breasts, which had experienced some development as a result of feminizing hormones, more closely resemble the breasts of a genetic female.” An expert testified how important it is for persons with this disorder to “pass’ convincingly in public as female.” That does not sound like elective, purely cosmetic surgery to me, but something that is a singificant part of the change in the gender appearance of the individual– something that “prevents or treats illness or disease”–i.e., a medically deductible expense. The court concluded that the petitioner hadn’t shown that the breast surgery “treated” the gender disorder. It seems there was some lack of substantiation, since the recommending physician had not specifically discussed presurgical breast condition. But I suspect the court is giving more weight to an examining physician’s statement of “significant breast development” than it should–that could merely mean “compared to a man without hormone treatment” but nowhere near normal female breasts. In fact, the physician that had noted presurgical “nice shape” also testified that he meant–compared to other males on hormones and not compared to ordinary female breasts. That didn’t sway the court that there was enough substantiation to support that breast surgery was because of the gender disorder.
By the way, reading this from the context of a “battle of the experts” is interesting. One government “expert”, Dr. Schmidt, was one who has not had a very important role in the matter since the 1980s (not a listed author on articles, not an author of a chapter in a medical reference text on the subject, but had “participated in evaluation” of about 12 gender disorder patients a year). He tried to have it both ways–unconvinced about the validity of the gender identity disorder diagnosis at this trial, yet testying regularly in other trials (recently) about the diagnosis and admitting that it is taught at medical schools and is something doctors are required to learn about. The summary of his testimony reads like what one would expect a creationist to say on a stand to defend the teaching of creationism–hedging and more hedging around the fundamental admission of the disorder, the medical consensus around it, and the real basis for it. The other government expert was a forensic psychiatrist–odd choice. He claimed that gender identity disorder is a mental disorder but not a disease because it isn’t clear that it arises from a pathological process within the body (in spite of the fact that others have suggested at least three different conditions for disease–either discomfort, or dysfunction or pathology). So bulimia, to Dr. Dietz, is not a disease, and obsessive-compulsive disorder wouldn’t have been one til it was discovered that it has a pathological cause about 20 years ago. The tax court concluded that the government’s position against treating gender identity disorder as a disease was “meritless”, with no authority whatsoever other than the one expert’s interpretation, which “is flatly contradicted by nearly a half century of caselaw.” Id. at 37. Further Dr. Schmidt’s claims that the disorder is subject to some debate was found unconvincing, since the court was persuaded by “the widespread recognition of the condition in medical literature” showing that recognition of the disorder “is the prevailing view.” Even these government witnesses undermined the government’s claim that the disorder was merely a “social construction” since they agreed that it is a serious condition “sometimes associated with autocastration, autopenectomy and suicide.” Id. at 43.
February 03, 2010
crossposted with ataxingmatter
Good Morning Linda:
A problem with many of these cases, such as the one you detailed, is the lack of knowledge on the part of the jury and/or the judge to understand the diagnosis or the treatment to the illness or the disorder muchless the illness or the disorder. Instead we see each side trot out its forensic (trained to testify legally) experts in a public hearing to debate the merits of the diagnosis or treatment, or whether the defendant was actually ill or suffered from a disorder, in front of an unknowing audience who have to decide based upon the interrupts of a prosecutor and a defense attorney. If perchance there was a juror(s) who could decipher the magnitude of what was being presented by an expert, the chain of testimony is broken so many times by dialogue other than what is pertinent to the trial, that little could be ascertained in which to decide upon. I am a big proponent of medical review boards rather the court room spectacles testing whether the jury can wade through the morass of baloney being dispensed by those who wish just to gain the win at any cost in place of the truth.
Care to ask me if I have an opinion?
Linda and run,
So would this kind of surgery be covered by the Senate of Congress HCR bills? How much does it cost? Why should the tax-payers cover purely elective surgery?
Again, what will you NOT cover?
Islam will change
. . . pre-existing condition.
Furthermore, you will spend far more on innovation from pharma, devices, and procedures that have a low benefit to cost return instead of treating a disorder such as this outlier mega-times over. Attack the number one problem of rising healthcare cost.
While off on your obvious tangent from the top post and my reply, you have appeared to lose the thrust of my dialogue with Linda which had nothing to do with either the Dem healthcare bill in the senate or the house or the one proposed by the Repubs. Oops, I was mistaken, the Repubs proposed nothing or nothing of substance. I was discussing a way in which to handle all disorders and illnesses afflicting defendants and plaintiffs arriving in court for a judgement which more than likely would have a lower cost outcome. The courts do not appear to be able to handle medical questions easily and outside of the adversarial court atmosphere.
Only reply to you buff as you are off-topic again and as usual.
I think the best treatment for gender identity disorder, especially early in life, is to help the person function in his or her biologic sex role the best they can. There is no such thing as a sex change operation. A man can’t become a woman and a woman can’t become a man. Any procedure that mutilates someone should be made illegal and the doctors that perform these operations should be put away. Some people have severe problems but you don’t fix them by castrating them and pumping them up with hormones.
Some people are doomed but it does not make the rest of us better people by participating in a freak show. Also, I don’t want to be in an insurance pool that underwrites these obcense procedures. And what is it about liberals where they have to abandon all concepts of right and wrong and pursue some mindless notion or progressivism.
Um, if we decide that women don’t get to pay for their choice of (apparent) breast size with insurance, and some women have breast when not pregnant that are not all that, um, evident, why does a sex-change that is medically necessary come with a choice of breast size. Why should a man who becomes a women get to be happier about bra size than women who are born women?
One argument that many participants in this debate have used, for high-minded and low-minded reasons alike, is that we should not have an insurance system that gets in the way of the practice of medicine. When the medical profession says something is necessary, then it is and insurance should pay. That is the GOP argument against “bureaucratic” interference as well as an argument that was used against HMOs and today’s insurance plans.
If this is the standard, then the answer to buffy’s question is obvious. We will not cover what doctors define as other than medically necessary. Boob-jobs. Nose jobs. Leg-bone jobs to get taller. Tummy tucks. Experimental treatment, apparently. Sharlatanism and shamanism.
Oh, and don’t let the use of “purely elective” lead you astray. In modern society, we don’t limit “necessary” medical practice to those things that keep one alive and fit to work. We include amelioration of suffering. That is what the medical profession has decided is involved in sex-change operations.
So we don’t really care whether the buffys of the world think something is seemly or un, worthy or not, necessary of frivolous. We only care what the medical profession thinks. What a relief.
Medical costs are exploding – Society is in debt up to its eyeballs, yet you want to add to the tax payers yoke the costs of a perverts body mutilation?
Worse still you atempt to legitamize a radical procedure. If a confused young guy were to tell me he was having a gender crises, I would tell him “no you really don’t want to chop your d**k off, because sometimes they come in real handy”.
Why is it whenever a woman comes to a position of power they want to emasculate men? Do you have a dog in this fight? Do you have penis envy?
You emphisise the importance “for persons with this disorder to “pass’ convincingly in public as female”, yet I’m sure you don’t give a rats *ss about the poor schmuck who initially falls for the deception and later finds out the ugly truth. Most guys get upset, when a mutant intitiats the launch sequence.
I was talking just last night to an ex gf back in Utah who is horrified that her husband is having a gender crises. She found out he started wearing panties. Her position is she is not folding anybodies panties other then her own. So should she be sent at taxpayers expense to a re-education camp to dispell her of her outdated Catholic views?
In closing if you have a d**k enjoy it. If your to dumb to play with it, don’t expect me to pay to have it chopped off.
hard to tell what your opinion is here, but i think i’d be a little careful about letting the doctor decide what is “medically necessary.” not all doctors are saints.
I was afraid this might happen.
Transgender, cursed, is not remotely connected to cross dressing. It is not a ‘gender crisis’, which reminds one of a mid-life crisis. The genetic or gender was set, we are finding, well before we think of kids as one or another aside from color of clothes and paint on the walls. Ex-gf can keep her point of view…who is trying to change her mind?? Also, it can sort of go the other way…woman to man…just not the way your imagination might go.
Buff, this has nothing to do with liberals and the health care bill….it is included already as a treatment under very rigorous guidelines with private health insurance in many states. Maybe even Texas.
kharris, man boobs ain’t the same with hormonal treatment. You would notice mostly I bet.
cantab, you are simply wrong about sex-change operations in terms of sexual function (not reproductive). Therapy doesn’t change the persons mind or sense of wrongness for many transgender persons. Reproductive function was not discussed in the decision. Mutilation is the reflection of your emotional response, not the procedure. Check your insurance..BC/BS or Tufts??? Better change your insurance today before the week end.
I see no one running to research. If interested, I can point people in the right direction.
buff is hardly off topic.
you may not agree with where he draws the line, but if you are asking “society” to pay for something “society” has a right to decide what it is willing to pay for.
perhaps the case for gender surgery can be made… i don’t know. but you have to make it. just expecting “society” to pay because you feel sorry for the poor confused individual is not sufficient.
unfortunately i know too many people who get too much medical care. so i am not happy to pay for unlimited society-pays medical care. i am however willing to pay for real treatments of real illnesses that would be crippling expenses for the sufferer. the problem is how to tell what is which.
i suspect that in most cases the answer is fairly obvious. for the other cases an individualized review process might be less expensive that just giving doctors and their hypochondriacs carte blanche.
I think you’re wrong to refer to the patients as transgender persons. We don’t call people with Cancer, Cancers, or call people with infections, disease people, so I think is outlandish to call someone with gender identity disorder a transgender person. The condition is a disorder and one where therapy, especially for the young, is the prescribed way to treat this disorder. Some people don’t respond and get better. This is not the point in time to pump them up with hormones or to perform cosmetic surgery. Like I said some people are doomed, but this is not a legitimate reason for doctors to become sex change Frankenstein’s.
cantab, you are simply wrong about sex-change operations in terms of sexual function
Well then, that’s one sorry woman.
“since they agreed that it is a serious condition “sometimes associated with autocastration, autopenectomy and suicide.” Id. at 43.
“The genetic or gender was set, we are finding”
I disagree. I have observed that more and more guys are deciding that chicks are so screwed up that it is simpler to just find sexual relief from a guy.
I run into convicts who were forced to submit to sexual demands in prison and learned to like it. Check out craigs list. There are more men who want to be used as a receptical then there are Men who just want to get off.
Our societies elite have promoted the gay aggenda. Young kids are encouraged to accept homosexuality from the earliest age, and when you got a gazzillion harmons and no taboos you are going to have lord of the flies type behavior. Societies who proclaim “Thou shalt not corn hole” have less cornhollers.
It is becoming increasingly trendy for youngsters to become bi-sexual. Not all of them were born with confused x and y genes. They are just young misguided hedonists.
no need to be afraid. this is what blogs are for.
but i think it’s sad that liberals are such idiots when it comes to tactics and strategy. you haven’t even been able to get “society pays” health care for the illnesses that are generally recognized by society as serious and financially crippling, but you need to go ahead and stick society in the eye with cases that are sure to offend most people…. whatever their actual merit.
my doctor, jumo jumorama is willing to sell me his treatment for brain enhancement. just a few secret herbs that he will provide me at a cost of about a thousand dollars a week. there is no doubt that being smarter would enhance my quality of life. so there can be no reason you would refuse to pay for this treatment for me. except that jumo is black, so it is clearly a case of racism.
and it turns out that my ex wife knows a lady doctor who is willing to give her hormone treatment that will make her more aggressive, just like a man, so she can smash through that glass ceiling. The cost is only 200,000 dollars. there is no doubt that being more aggressive just like a man is very important to the success and well being of women. and strictly equitable. so there can be no reason you would refuse to pay for this treatment. except sexism.
and of course my poor old mother has not been feeling well for decades and yet the doctors are baffled. she goes to the doctor every week, and this only costs a hundred dollars a visit, so it is really quite cheap for society to pay for this. only reason society would refuse to pay for it would be a callous insensitivity to the needs of an older woman. sexism and ageism.
oh, where will it all end?
Let me clarify. buffy asks, in what seems a fairly confrontational way, where to draw the line. It’s in the text: “…the majority recognized gender identity disorder as a disease and gender reassignment surgery as treatment for a disease…”
That standard has apparently come up with a result that buffy doesn’t like. Well, those of us who are not absolute monarchs do occassionally have to live with decisison we don’t like. So sad. But there is a standard. I see no reason to let buffy’s state of mind have weight in the discussion.
Now, in further answer to your question, I just want to say, my opinion of paying for sex-change surgery through medical insurance shouldn’t carry any more weight than buffy’s. (Except to the extent that I am less driven by a self-aggrandizing sense of personal rightness. In the absence of a self-aggrandizing sense of my own rightness, I am more likely to examine a situation before drawing a conclusion than buffy is, so maybe in that sense, I should get a better listen. But unless I have some special expertise, I don’t belong on the panel calling the shots.) I don’t care if the result bothers buffy for his own personal reasons, including his unwillingness to be part of an insurance pool that pays for things he doesn’t think he might someday need.
If we aren’t going to allow doctors to decide what is medically necessary, then who? That is not a rhetorical question. We don’t live in a perfect world. Doctors have vested interests, just like everybody else. But they certainly are the people we want assessing the treatment side of things. Do we need actuaries in the discussion? Fine. Statisticians? OK. Religious leaders? Not a chance. But we need a standard, so that smug, sneering jerks don’t have a louder voice in how we live than thoughtful, educated people have.
Now, you may have been confused by the fact that I am happy with a standard that says sex-change is OK, but that a boob-job is not. If you expect me to take a stand with the interests of the trans-gender crowd, you are mistaken. I don’t care whose dog is in the fight. Carrying about whose dog is in the fight takes us back to buffy’s notion that if he doesn’t like it, it shouldn’t be insurable. And you haven’t been listing all these years. If people who have reason to know these things say that some people suffer without a sex-change to an extend similar to others for whom we do provide treatment through insurance, I think we should listen. If, at the end of the process, some sex-changers are dissatisfied with their equipment, well that seems more or less a part of the human condition. If a boob-job is cosmetic for Jill, then it is cosmetic for Jack-cum-Jill. Clear?
Thank you. My point exactly…I don’t mind Bill Gates spending his Billions anyway he wants. But at some point we, as a society, have to say we will not pay for some medical procedure for anyone reguardless of the fact the Gates can just write a check.
We keep coming back to that question. And if you want to turn the cost curve down your going to have to be fairly restrictive.
I have no problem with anyone paying for this procedure out of their own pocket. But the taxpayers shouldn’t be paying a dime. My brother-in-law’s partner flew to the Phillipines and got some very expensive experimental stem-cell therapy for his heart. Still going strong 4 years later when the US docs were telling him he had 6 months or less. Probably cost him north of $500K. He wrote a check. No insurer or medicare/medicaid would have paid and we would have buried him years ago if he had been poor.
So is this acceptable to you guys or not? At some point you have to draw the line.
So, what procedures will poor grandma die from that rich grandma gets to live becuase she can pay?
Islam will change
Don’t care about same or different. We are not in the business of guaranteeing happiness at the end of medical intervention. A bunch of qualified people have decided that sex-change surgery is a treatment for a disorder. Has anyone made the same argument for boob-jobs? If not, then one fits the standard, the other does not. We only confuse ourselves if we assume that some particular quality of flesh is the necessary goal of treatment. Going from living as a man to living as a woman seems pretty profound. Going from a less satisfatory to a more satisfactory figure? Not sure that’s the same. We have some women and some men who have become women, wishing for different breasts. How is the argument made that one is insurable and the other not?
I just love it when you talk so tuff.
As I read Linda’s post she had a mild objection to not including it. I do not think it central at all.
But just the wrong crowd again.
Ah well, it is the private market here that has chosen.
NPR did story on two kids with gender identity disorder. If there was every an Olympic competition for being lousy parents the two in this story would win the gold medal. In one family there is a crazy mother with an attitute and in the other its a couple of Californian ultra liberal flakes. Another annoying aspect of the story is they did substantial interviews with the kids so we got to hear very normal sounding children given that both girls and boys have high voices. The producer seemed to be pulling a fast one. Try doing the inverviews in 10 years and the take away will be a whole new impression.
This is the crowd that you’ve inherited. Live with it. If you’re saying that the topic is one of serious importance I’ll agree to that for those effected it is certainly so. It is just too difficult for the average guy to get his head around. That is the concept of the transexual is difficult enough to understand or at least to empathize with. It is more difficult still to understand the antecedents to such an identity crisis. Is it plausible that gender identity has an innate basis? While I think that most people would recognize the almost certainty of that, it is less likely that many will be able to understand the dichotomy of one’s biological sexuality being one thing and their perceived self identity be contradictory to that biology. In other words, can we have a biological basis for the hardware and at the same time have a biological basis for the conflicting identity? It’s even confusing to write about the conflict and still make some sense.
What about ugly person disorder? Only a matter of time before that is recognized. I would not call higher pay, easier hiring, better esteem, just cosmetic by a long shot.
Maybe we can have an operation for priests turning them into 11-year-olds (or just pretend that they’re 11 — and gay).
Go back and read my initial answer to Linda and what I was saying and then reread Linda’s post without Dan’s initial statement. . Since buff addressed a reply to me some 40 minutes after my reply to Linda, buff is off topic to my reply to Linda and to Linda’s post (if you again read Linda’s post, look for the word insurance within it). There is no mention of the word insurance in it and it is only introduced by Dan’s preliminary statement. I answered Linda’s post and ignored Dan’s preliminary statement because they are two separate topics.
coberly, I deliberately ignored the issue of insurance as it is not germaine to Linda’s topic and the ruling of the tax court. As far as experts, I accept you as an expert on Social Security because you have demonstrated a knowledge of it far superior to those upon this board or elsewhere and I accepted your expertise without knowing what credentials you may possess to support your views. The problem of real illness and real treatments should not be determined by non-experts as real or not because of the bias over whether either are real and the lack of knowledge. I will state the same as what I explained initially; the same as the court or the jury, YOU lack the expertise in this case to make an informed decision. It is your bias coming to bear and your lack of knowledge in this case, which happens to plague most of us here on other issues as well. If you want bias or conjecture on illness and/or treatments, then get a “witch doctor” or a group of 12 to vote on what should be done.
While Dan’s intentions are good, I see we have the usual collection of males gathered here to discuss the topic of female anatomy. How ludricrious does this appear? Not one woman present to discuss the issue and then look at some of the comments:
– “real” illnesses
A rather interesting dialogue coming from a bunch of men who lack the knowledge on a woman’s psychology and anatomy much less their breasts other than to leer at them from time to time.
Cantab, You do kniow how to turn a phrase and with such an insightful perspective. You remind me of the story of Oz. Dorothy wanted to get back to Kansas and the Lion dreamed of having courage. The Tin Man wanted a heart in order to feel his humanity.
You have so much more in common with the Scare Crow.
It looks like you never understood the message of the story since the lion, tin man, and scarecrow all had inside what they went looking for.
I have mostly ignored this current round of the health-care debate. Not to sound wiser than I am,( I am mostly just old ), but I first argued for socialized medicine about 35 years ago, and this thread may be the first interesting health-care related conversation I’ve been privy to in decades. But, like I said, I have been mostly out of the loop.
A good way to frame a debate is to pretend that a pill exists that will extend life by one day. But the pill costs $1000.. This allows the wealthy to buy ‘time’ itself, but of course the poor must die when their time is up. This of course exposes how much the health-care debate is, increasingly, part of the wealth distribution issue, and this evokes questions of a citizen’s contribution to society. Using an extreme to give a sense of how far we have to go on the issue of contributions, incarcerated mass murderers receive medical care — but many who contribute in critical roles do not receive care, or they must accept subsidized, or, ‘charity’ care . Yet our national debate about health-care mostly circumvents the issue of wealth distribution — and, if anything at all has been said about contributions — I have missed it.
There are of course some government transfers involved, and some wealth may transfer from the rich to the poor, although, historically, substantial wealth shifts only occur when unions have support from the body politic. But the current political mandate has instead an agenda that requires medical care for some contributors to be a form of charity; while others, who in some cases contribute less, are able to afford the precious pills. So, I suspect that the contribution issue must be confronted before any serious progress might occur regarding health-care.
What so many seem unwilling to understand, is that respect, is as important — as wages or money etc.., and charity is for the unfortunate. So if some poor soul is so unfortunate as to be trapped in a gender that is admittedly mis-fortunate, then, that person should be allowed to choose, and the public cost is small and inconsequential. But the public must also recognize that contributors should not be put in positions that require charity, or subsidies, in the absence of misfortune. The simple truth is — that we must learn to respect all of the roles first, then, if enough wealth can be generated to afford conspicuous consumption, well, that is a problem for some other time.
For now, the only way to provide medical care for all, without subsidizing for some, while allowing waste-full care for others, is to nationalize the entire industry. Sacrifices will most certainly be necessary, but we may well be facing a choice between conspicuous consumption, and a functional society.
not as clear as you might suppose. i agree with much of what you say, but i am not so sure your smugness is any less than you think buff’s is.
if we were being strictly rational, i’d have to agree with you and with run that buff is a little off topic. but we are not strictly rational (seems i heard that somewhere) and buff poses an objection which is very on-topic to the “real” debate… who pays for what health care.
in this case i gather that a panel of doctors and a judge decided the operation was “deductible.” well and good. you would hear no complaint from me. but if i were just an ordinary tax payer and i heard that i was paying for sex-change operations i have to admit i’d be unhappy.
i tried to offer my reasons in another comment.
i think if you read my comments you will see that i was careful to say not that i opposed the decision or favored it. and kharris above even got me to admit that buff was off topic… “if we were being strictly rational.”
i am sorry if i joined buff in missing your point. but you can’t exactly cry fire in a crowed theater and have people ask who is being fired.
so let me try again. in this blog, in the context of a rather emotional debate about “healt care” in the recent news, your and linda’s quiet talk was bound to raise some questions. i sided with buff that the questions would have to be answered. i did not say how i thought they ought to be answered.
for what it’s worth, i agree about juries. unfortunately i have exactly no more respect for doctors or judges.
glad i could help out for a change.
but it seems to me that by the end of your 10:16 comment you have changed sides. ?
“A rather interesting dialogue coming from a bunch of men who lack the knowledge on a woman’s psychology and anatomy.”
I have niether interest or knowledge concerning a womans psycholoy, but it has been my lifes work to study there anatomy
And you demonstrated clearly that you’re still searching for something that is out of your reach.
When did the discussion of the medical neccesity and appropriateness of gender change surgery become a discussion health care financing? Granted that issues of financing such surgery may emerge at some point, but that does not seem to be the focus of Linda’s post and it certainly confounds the effort to answer the ethical issue concerning necessary and appropriate.
As to “when”, beginning with the first sentence: “(Rdan here…I thought this case represents another aspect of the complexities of insurance coverage, approved procedures versus experimental, proper diagnosis, and how our medical and societal expectations interact.”
But perhaps it was simply on an emotional level for some. The first couple of paragraphs may have been confusing for those ‘readers’. And some of the thread may have seemed less than arousing for them too.
One poke in the eye to some…but we did wake up!
I recall when I wrote on PTSD here a few years ago, and some of the confusions of diagnosis and treatment that were common as well as ‘what it was’.
So we have societal conflicts of belief, medical definitions defined as disorders (there are other approaches) to some of these questions especially in mental health, and I asked in such a delicate way, suggesting ‘aspect’ of…good thread to get out reactions to deal with.
Another aspect of records and medical opinions is the fact that eventhough the original doctor clarified a previous statement made on his opinion of breast size due to hormones only (it sounded as if it was within the context of his procedures and not a more general statement), he was unable to correct the medical record in practice. Yet medical record on a routine basis always contain some error.
I didn’t yell “fire,” I addressed the case in question and made reference to how little expertise the court has in discerning illness, disorders, mental capacitity, etc. A completely different topic outside of healthcare, healthcare insurance, and healthcare insurance coverage.
Canada has a medical review board for criminal cases involving cognitive incapacity to which cases involving mens rea, volition, etc. are referred. The review board is made up of psychiatrists, doctors, and those who understand the medical issues and how they impact a person’s ability to commit a crime knowingly. It would make sense to work to a similar model for the US justice system and remove the circus atmosphere portrayed there adversarially by lawyers, judges, and a jury in awe of both. If you dislike that arrangement then we are back to the bias of the individuals, ignorance, and bigots (the same as what has been portrayed recently by the Govenor of Virginia) and as portrayed here by some.
The same holds true for insurance and if you read some of the stuff I sent you, you would know there is the right of appeal to denial of coverage by an insurance company and outside of the insurance company. You can not deny the minority because you find it distasteful or dislike it and neither should my, or your, opinion be the deciding factor as neither are backed up by fact.
“Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not “experimental,” “investigational,” “elective,” “cosmetic,” or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID” — World Professional Association for Transgender Health – Standards of Care Section X, Surgery.
A 46,XY mother who developed as a normal woman underwent spontaneous puberty, reached menarche, menstruated regularly, experienced two unassisted pregnancies, and gave birth to a 46,XY daughter with complete gonadal dysgenesis. — J Clin Endocrinol Metab. 2008 Jan;93(1):182-9
Both Nadir and Ahmed were born with a rare birth defect called male pseudohermaphrodism.
Deficiency of the hormone 17-B-hydroxysteroid dehydrogenase (17-B-HSD) during pregnancy left their male reproductive organs deformed and buried deep within their abdomens.
At birth, doctors identified Nadir and Ahmed as girls, because they appeared to have female genitalia.
As a result, they spent the first 16 years of their lives dressing and acting like girls. It was a role that grew increasingly difficult to play, as they hit puberty and their bodies began generating testosterone, resulting in facial hair and increasingly masculine features. — From CNN: (video)
Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids by Berglund et al Cerebral Cortex 2008 18(8):1900-1908;
Male–to–female transsexuals have female neuron numbers in a limbic nucleus. Kruiver et al J Clin Endocrinol Metab (2000) 85:2034–2041
Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation. Swaab Gynecol Endocrinol (2004) 19:301–312.
A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68–70.
A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity by Garcia-Falgueras et al Brain. 2008 Dec;131(Pt 12):3132-46.
A polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism by Bentz et al Fertility and Sterility , Volume 90 , Issue 1 , Pages 56 – 59
Androgen Receptor Repeat Length Polymorphism Associated with Male-to-Female Transsexualism by Hare at al in Biol.Psych. Vol65, Issue 1, Pp 93-96
Yes, we gave our presentation to 60 plus psychiatrists from the US, AU, FR, IT, EU, UK, Holland etc.
We spoke for 2 1/2 hours on why cross gender identity was a normal inherited variation of humans. We showed how […]
Sid was referring to seminar S10 at last year’s American Psychiatric Assocn annual meeting:
S10. The Neurobiological Evidence for Transgenderism
1. Brain Gender Identity Sidney W. Ecker, M.D.
2. Transsexuality as an Intersex Condition Milton Diamond, Ph.D.
3. Novel Approaches to Endocrine Treatment of Transgender Adolescents and Adults Norman Spack, M.D.
The powerpoint presentation itself: Brain Gender Identity, which I have mirrored at http://cs.anu.edu.au/~Zoe.Brain/BGI 3.3.2.ppt
BTW… I’m technically not transsexual – I’m a female pseudohermaphrodite, born looking male till that changed from natural causes. Which was something of a relief, I was just hoping for an early death before then. Gender Dysphoria is not just uncomfortable, it’s debilitating. You can feel your mind rotting. It’s one of the more unpleasant ways to die.
Here’s a specialist psychologist on the subject:
Secondly, “Dysphoria,” defined by Marriam-Webster’s Collegiate dictionary as “a state of feeling unwell or unhappy,” or in the American College Dictionary as “a state of dissatisfaction, anxiety, restlessness, or fidgeting” is simply too soft a word to describe the angst most clinicians see on intake with this population. At best it may be an apt descriptor for individuals who, despite strong evidence to the contrary, are making an extraordinary effort to convince themselves that they are sex/gender congruent. These individuals make life decisions such as getting married and having children not only because they may find it appealing to have a spouse and have children but with the added hope that this activity will ease or erase their obsessive cross gender thoughts. Although there may be instances where these special efforts succeed, (i.e. the incongruity is mild) the more likely outcome is a realization they have actually made matters worse. Typically, at time of presentation these individuals report that either their lives are in ruin, or they are very afraid that if their gender variant condition was to become known they would loose all that they cherish and be ostracized from family, friends and the ability to support themselves. High anxiety and deep depression with concurrent suicide ideation is common. 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.
I think this is a case of crowding out….I was referring to cursed’s crowd of prison inmates, people with temporary bisexual and homosexual tendencies, experimenters, etc.
You are merely showing your lack of knowledge and willfull ignorance.
The correct term is gender identity disorder. Focus on the word disorder because that’s what it is. And it will remain so even after the Orwellian’s take over the disease classification committee.
Thanks Zoe. You pulled together a better list than I.
It happens cantab. But the medical model has room for medical science, not a pun on words, or non-examples of what we are talking about like priests.
Now priests is a whole different issue….when the sexual predator sort of theme came up in the 1990’s through research in Boston on childhood ptsd, the Archdioces squashed the research (Harvard) instead of the problem. Hmmm….it did come out and is still being felt around here.
okay, you didn’t yell fire,
instead you went quietly to your seat in the airplane and started talking in a low voice about the evils of zionism and how uncomfortable it was carrying nitroglicerine in your underpants.
dear run, try not to be so touchy. no doubt in all innocence you meant to talk about the difficulties of using jury trials to decide difficult medical questions. it is really just unfornate that you happened to bring the subject up in the middle of a huge emotional debate on “society pays” health care.
and all i did… and maybe buff, though i think he may have an actual opinion… is point out that what a jury finds difficult to decide, a hundred million americans listening to talk radio will also find difficult to decide.
and because it has come up here, and i am no better than the rest, i was led to observe that some very decent people who want nothing but the pest, have no sense of tactics and strategy when it comes to winning a political fight.
there are no “facts” here. there are only opinions. and in the long run i trust the jury more than i trust a “panel of doctors.” i have dealt with doctors and judges and i think they are no less foolish than juries. at least with a jury you have the possibility of some human judgement and actual honesty.
i suppose jurors are unjust nine tenths of the time when there is any possibility of error (fortunately that doesn’t seem to happen that often). but when you give over democracy and justice to a “panel of judges and doctors” you will get injustice 100% of the time within one generation… not even because judges and doctors are fools.. you will get that right away… but with “panels of judges and doctors” the really bad guys will move in and seize the levers of power.
a profound error. two errors actually.
their psychology is more interesting and rewarding, with the anantomy coming as a natural consequence. and when you get older you will understand the difference.
i would ammend that a bit. if the rich man can affor a thousand dollar pill that the doctor SAYS will extend his life one day, it’s his choice.
but when you are saying that society MUST buy those thousand dollar pills for everyone, you are saying something very different. and i think that is pretty much the way the debate is being framed from the left. the right, of course, would just as soon not pay for anyone but themselves. because they are too dumb to understand that when society pays for a big hospital that treats “everyone” it lowers the costs to the rich for their own treatment a thousandfold.
well and good. you have convinced me. and i think the jury and the judges were convinced. well and good. now the problem is to convince people like Cantab without having a hundred million tea partiers believe that the health care reform is all about giving neurotics sex change operations.
if i go to the doctor with a kidney disorder, he will treat the kidney, not tell me to see a priest and learn to accept my kidney-identity.
see how easy that was.
[you convinced me. you will never convince cantab. i have hopes for cursed.]
but i hope you learned something about how this looks to the masses… you know, the people who vote.
if i go to the doctor with a kidney disorder, he will treat the kidney
That’s correct, and what he does not do is pump you full of hormones so you can grow man breats, to treat your kidney.
With Zoe possibly giving new life to this thread, and because my earlier comment was seemingly misunderstood, I thought I might try to further explain myself.
Our ‘trickle-down’ era tilted the playing field, and, in a political sense, that put too much income in the hands of too many people, and, this in turn has caused our political system to become increasingly conservative, or protective. So, the health-care debate needs to be a process which explores and exposes the moral issues regarding the contributions of citizens. This because the attempt to protect the ill-gotten gains of these past few decades is weakest on that political and moral front.
But my earlier comment was an attempt to explain what is wrong with the the current debate in regards to its lack of recognition of the importance of respect for the contributions that citizens provide. A subtle shift has occurred over a period of decades and it is becoming ingrained in our culture. A common claim from the Dems for example, is that they are more educated on average. But a respectful way to put this would be to say that they have more formal education. A carpenter who spends years working in the hot sun while learning his trade is also receiving education. So by eliminating the word: formal, the implication carries a lack of respect, that, corresponds with a shift in compensation levels related to those who receive what are actually two different types of education. But whether one type of education is in fact more or less integral to a functional society or not — is largely just a matter of opinion. It is for example difficult to understand how a banker might be worth hundreds of times more than a carpenter when one can not exist without the other.
So, this is more complicated than just the economic necessity of transferring wealth to cover medical costs. It is also respect and dignity that has been usurped. Wealth transfers via taxes to provide subsidized medical care is therefore not the correct solution. Higher marginal income taxes must be used to remove wealth from where it the least efficient, especially considering that ‘bubbles’ are the result of too much of the wrong type of investment, but wealth must be shifted downward as a result of market forces as part of a respect based mandate. A significant increase in the minimum wage would be a good starting point, subsidized as needed (instead of subsidizing some health-care), but essentially the wealth shift must be a cultural change that applies pressure to the political process through a debate about respect and the rights of citizens in a wealthy and advanced society.
(anyway, I must get to work. those who wish to bash me here will have to do so with some patience if they expect me to defend myself. I have some boony chores today regarding my wife’s horse issues)
Help me out here. In the NPR story I did not here that the kids were pseudohermaphrodites, I might have missed it though. All I heard was that they were physically normal kids that had gender identity disorder. Would you give these kids homone treatment or try to get them to be comfortable living as the sex they actually are.
[you convinced me. you will never convince cantab. i have hopes for cursed.]
Convinced of what? I think leaving out the subject in a post is an indicator that the person does not really believe what he or she is saying.
LOL….that is the same chore some say I am doing by posting on this topic.
A real test then for a liberal would be to say they have problems with these procedures. It’s does not take any intelligence to figure out what the liberal toady position is.
I see this issue really as a liberal loyalty test. It certainly has jack to do with economics.
“That’s correct, and what he does not do is pump you full of hormones so you can grow man breats, to treat your kidney.” The Village Idiot
Not for the kidney, but if you have any of a great many endocrinolgical disorders he will prescribe some form of hormonal treatment. Depending on the original dysfunction the treatment may produce a change to the physiological symptoms of the original disorder.
The kidneys are usually treated in some other manner depending upon the original diagnosis.
Once again cantab manages to suggest a proof by presenting an irrelevant argument.
Cantab – the evidence is that they’re not physically normal. The trouble is that with our current state of technology, to absolutely prove it would involve autopsying their brains. Bit of a problem that, if the kids are still alive.
We’d get a good indication via fMRI imaging, but that has problems as we don’t have a sufficiently large dataset of juvenile brain scans to compare with.
What would I do with these kids? Follow Spack’s protocol. The mortality rate of Zucker’s is way too high, and the sequelae of the survivors unfortunate.
The evidence is that no matter what you do, kids who don’t have an obvious Intersex condition that show cross-gendered behaviour over many years when young end up being gay, bi, or trans. If they still show signs at age 10, even Zucker gives up trying to pursuade them they’re merely gay.
Those kids not given Zucker’s treatment have a 30-35% trans rate – the rest grow out of it. Those kids given Zucker’s treatment have a 20-35% trans rate. This may be due to misdiagnosis at CAMH.
It’s complicated because you have to weed out some Intersex conditions (CAMH doesn’t). Virtually all 46XX children with CAH (Congenital Adrenal Hyperplasia) will show cross-sexed behaviour, but the parts of the neurology to do with sex identity are only masculinised one time in 10.
Conversely, those 46XY kids who have been surgically altered to look female at birth – due to parental wishes for a girl, or malformed genitalia, will show cross-sexed (compared to gender of rearing) behaviour most of the time. About 1/3 of Intersexed, and 2/3 of non-Intersexed kids will be insufficiently bigendendered to live with a feminised body. Fortunately the practice of castrating baby boys to make them into girls was never very common – these days it’s only done if circumcision goes wrong, or in case of Intersex, not just at parental whim.
Bottom line : by all means try to get the kids confortable with just being gay. Don’t press too hard though, you might damage them. Let them live as the “opposite sex” if they insist. Such insistance by them greatly increases the chances of them being trans, and if the Dutch protocols for diagnosis are followed, rather than the very loose Canadian ones of CAMH, the chance of misdiagnosis is nil. No matter what you do, it’s set in the neurology. You may be able to make changes in borderline cases. But in general, no.
Gonodotrophins at age 12 or so. This delays puberty till they reach the age of informed consent. They can let nature take its course, or continue treatment then, as the patient wishes.
Maybe another aspect of being doomed is that the people that you reach out to when you have this condition will give you bad advice, treatments that make you worse, and treatments rationalized by pseudo science. Now the doctors take a troubled man, put him in a dress, inject him with hormones and say — there now, all better.
i probably agree with you about respect and the relative value of carpenters vs bankers and horse chorse v blogging.
but i think you opponents would say “the marketplace” sets wages, and any effort to change that is doomed to fail. on the other hand, i believe that i the human economy there is a large measure of “respect” built into wages. it is only among the acquisitive classes that “what the market will bear” is consider the holy reference.
nevertheless, their’s is the view you will have to change unless you plan to overturn the entire way the world has come to do business. and yes raising the minimum wage would be a good place to start. but if you have seen what is coming out of the schools today (high schools. dont get me started on graduate schools) you would have some sympathy for the employer.
yep. it certainly takes no intelligence to understand that.
It takes intelligence. Now get lost.
Thanks for being here and for your explanation.
You seem to hold the misguided notion that labor markets are not manipulated.
“It’s does not take any intelligence to figure out what the liberal toady position is.” The Village Idiot
You’ve stated my position precisely. You are the perfect example of an individual who keeps trying as hard as possible to demonstrate how little intelligence it takes to manufacture idiotic concepts like “the liberal toady position.”
You’ve stated my position precisely.
And what is that position? Can’t figure out what it is, can you?
You are an expert? or knowldgeable? or experienced?
It is not a liberal or a conservative ideal in regards to this condition cantab. But you are playing games on this thread…to bad, you might have learned something.
No Rdan. As os usual Cantab (aka Aaron) is contributing his usual fare on this blog. Which is to say that he has nothing of value to add so he continues to spout irrelevant diatribes having to do with his own myopic view of life, but having little value to anyone else. I’ll continue to point out his ignorance/stupidity as it occurs as there is little more that one can say in respponse to same.
Look at Coberly fold, change his opinion, and agree with you. Looks like he’s playing your game. Not me though.
You’re losing you temper again.
Some one, like Cantab, having very little intelligence would come to a conclusion that there is something referred to as a liberal toady position.
In fact, Cantab/Aaron, I assume that little of what you write on this blog is of any real consequence to you. I don’t know that you are paid to waste space and be argumentative on a blog like AB, but certainly that is all you intend. You’ve had no influence on any one’s opinion, though you have wasted every one’s time and AB’s space.
No…you have no idea of my reasons.
“When the facts change, I change my mind. What do you do, sir?” – John Maynard Keynes
What fact changed?