Agree or disagree: Transgender should be a medical condition

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Transgenderism should be a medical diagnosis and not a mental diagnosis.

I am not advocating that transgenderism should be held separate from mental illness because I feel that mental illness is something to be ashamed of. My reasoning is how you treat transgenderism is totally different than how you would treat mental illness.

It is different from a mental illness. It is a conflict between the body and the mind, and it is easier to change the body to resolve this conflict than the mind (thus physical intervention such as surgery and hormones).

I am aware that some transgender people don't get any physical intervention, but the same thing applies. No one can give you a 'pill' or counseling to truly change your feelings. Mental professionals can give you coping skills but nothing they do can truly change your feelings.

Thoughts?

So if I suffer from depression or anxiety or schizophrenia I should be ashamed? Silly boy. These conditions cannot be helped.

Firstly, I feel I should declare my bias, I am transgendered (so theoretically my bias should be in fair of people who are transgendered, but bias is more complex than it appears).

I feel that it should be a mental condition, because gender is in your brain, not your body. Physical intervention is implemented for a variety of conditions, especially body dysmorphic conditions (such as when one feels the intense desire to amputate a limb).

That's the exact opposite of what I was saying. Although I could understand how you interpreted that sentence in that way. My sentence was poorly written. Let me explain in a more clear way:

Some transgender people feel that the mental illness label further stigmatizes them and thus feel mental illness is shameful. I don't feel that way. I don't advocate the change like other people who "metal illness is sometime to be ashamed of or distance oneself from". A condition is a condition.

I have bipolar disorder and autism in addition the transgenderism. The treatment for transgenderism is nothing like the treatment for bipolar disorder or autism; not even close. I believe that labeling it as a mental disorder gives people the excuse to think that "seeing a psychiatrist" or "taking a pill" will treat transgenderism. It gives people the excuse to guilt transgender people from getting the treatment they need or making necessary body modifications or changing their gender.

Example:

Father: I read that transgenderism is a mental disorder.

Me: What source?

Father: The DSM.

Me: Okay, what's your point?

Father: It means that you can go see a therapist, psychiatrist, or something. Maybe take some anti-psychotics? Then you'll be cured for sure and you can always stay the same.

Me: But that's not the cause of-

Father: That's what it says!

*sighs*

I don't see it as a medical condition. I view it as how some people are bi sexual or homosexual and those aren't medical conditions. Homosexuality used to be but not anymore. I don't think transgender should be either. What's next? Making people who don't want to have kids a medical condition too? Some are born without the desire to have kids.

Disagree.
Its a choice, not a necessity. I suppose that it could cause mental anguish though. But then again, thats mental, not physical, so....

I disagree that it's all that much of a choice. It's not like I woke and thought, hey I shall transition today and endure much abuse and misunderstanding! That will be aces, love win times.

For myself, and my partner who is also FtM, it's transition or be suicidally depressed forever (however long that would last). When I started my period at 13 I was so devastated I tried to kill myself. I couldn't even identify why I was so upset. But everything female related about me just makes me so upset. Everytime someone calls me she, love, whenever my mum calls me her daughter, it hurts.

I am more depressed and just fundamentally upset about my female appearance and physical characteristics than anything in my life. And I can see that if I don't get away from where I am soon (I'm living with my mother, who is very transphobic and says she wouldn't 'allow' her child to be 'like that') then I don't see how I could go on.

The worse thing also is that the pain of being bullied, the pain of falling out with a friend, or an argument with a parent is understood. People get it, and understand your upset when you're talking about it. Talk to a cisgendered person about how fracking horrible gender dysphoria and at best you're get somewhat sympathetic but mostly blank stares (in my experience anyway). It's lonely.

Sorry for the rant, which isn't really adding to the discussion, but I dislike it when people say that things that I have had no choice in are a choice. Yes you have choices within reason (will you medically transition? Bottom surgery or no bottom surgery? Metoidioplasty or a phalloplasty?).

Back to the debate at hand, I still think it should be considered a mental problem that is treated physically. Much like body integrity identity disorder.

I feel that the gender difference is in my brain, but changing my body is just following the path of least resistance.

I think the question really should be whether the DSM is correct in drawing an artificial distinction between "mental disorders" and "general medical condition."

For classification and therapeutic purposes, it may have value--but at the end of the day, I take the view that mental disorders form a subset of a larger classification of "medical disorders."

As for whether transgenderism or gender dysphoria should be classified as a mental disorder, my medical view is an unqualified, "yes." The majority of these conditions are presented as a disjunction between an inidividual's physiological sex and the individual's awareness of their own sex. Since the ambigious physiology would be properly classified as an intersex condition, rather than transgenderism, it follows that the disorder lies in the inconsistency in the individual's self-awareness. Note, though, that just because the disorder is rooted in perception, does not mean that treatment must necessarily alter that self-perception. If a person's sexual identity is egosyntonic, then it is perfectly proper to surgically alter the person's physiology to match their sexual identity. On the other hand, if the person's sexual identity is egodystonic, then there may be better therapeutic options short of surgery.

All of this is distinct from intersexed conditions, where sexual classification is ambiguous or impossible because of a genetic or physiological cause. In these cases, mental disorders accompanying intersexed conditions are more often comorbid, secondary disorders, rather than being primary.

Having a mental or physical illness would also cause mental distress. So that means that illness is a choice? Sorry, I'm not following your logic.

I think when people are about to kill themselves due to the gender dysphoria, the treatment immediately moves from being a "choice" to necessity.



I also agree that transgenderism isn't a choice. It isn't anymore of a choice than having bipolar disorder or some other mental condition. If you tell any transgender person that their condition is a choice most, if not all, will vehemently deny it.

It isn't a choice to be transgender, but it is a choice to get the "controversial" treatment for it. Then again, it also is a choice to get treatment for a broken leg, cancer, and various mental illnesses.

That's the problem with having transgenderism. Hell if you transition and hell if you don't. That's why so many people with transgenderism commit or attempt suicide. They can't have a happy life going either direction.



I am so sorry about your living situation. It reminds me when I lived with my dad. He constantly tried to convince me that I was mentally ill, and I needed to be hospitalized. Thankfully, I never listened to him, and I moved out on my own.



That contributed a lot to the debate. It actually makes sense.

All mental diagnoses are medical diagnoses.

Psychiatry is the study of both. All psychiatrists are MDs first.

I only wish it was for the sake of health insurance purposes in the US of A... Other than that, I don't feel like it falls into a mental or a physical condition, per se. It's a question of gender identity, which lays between both areas. Risky.

Absolutely. Heck, ASD is in the DSM and it's very different from conditions like depression and bipolar, particularly in that (like transgender) it's ingrained (whereas depression may pop up in the middle of life and lessen or go away after antidepressants). There is no pill that makes autism (or transgender) go away. You can take pills to mitigate secondary conditions (like self-injury or depression), but it doesn't make a dent in the underlying condition. Behavioral therapy may help the person function better, but it doesn't take away autism (or transgender). There is certainly a qualitative difference between things like mood disorders and things like transgender conditions or autism, but they are all of the mind, regardless of what treatments are indicated or effective.

I'm not sure that I see any distinction between what you call "ingrained" condictions and other disorders.

You are absolutely correct that there is no therapy that will directly alter the atypical state of the autistic brain. But neither is there a therapy that will regrow a missing limb or a mitral valve. That does not make these conditions any less medical disorders.

It is important to distinguish between preventions, cures, treatments and supports. Some conditions cannot be cured, but they can be treated.

I think it's important to distinguish gender identity issues from actual transgenderism. Certain people transition with surgery, hormones, etc, only to realize at some point that they've made a terrible mistake and detransition. This people felt dysphoric about their genders at some point and that's why they transitioned in the first place, but they weren't truely transgender.
If transgenderism is to be treated as a medical condition, then the diagnosis should be set because of physical things in the brain and not only because someone feels dysphoric.

I am absolutely against this.

The problem is that it isn't a perfect science nor is it a really defined science. What if you don't have the "physical things" they are looking for in your brain but still feel the same way for years upon years and desperately need to transition? That would be a nightmare to automatically be disqualified because you don't fit narrow standards. Transgender study is still in its infancy.

I sort of agree with how things are done according to the Transgender Guidelines of Care; the old ones. Before any surgery or hormones get aggressive therapy sessions. These sessions weed out people who are simply experiencing a gender crisis based on societal expectations and who wouldn't benefit from surgery.

People just don't walk in to get a surgery or hormones. They need to go through a process and the process is even more tedious if you have insurance.



Out of the hundreds of transgendered people I met or got to know closely; I know one person who detransitioned. She was originally a transman like me, but she was seeing this ultra-masculine lesbian therapist who only took hormones to make her "more menacing" and "taken seriously". She rushed my friend to take them despite her hesitation to do so. Very atypical.

Thank god she decided not to get pushed into surgery. She then saw a real gender therapist who specializes in transgender issues; she told my friend what was really bothering her. And, with that, she decided to detransition.

Detransitioning is extremely rare and can be avoided.

It was my current gender therapist who made her realize she probably wasn't transgender.

As far as people regretting transitioning, I get the feeling that idea comes from people who have no idea what the standard protocol's requirements are (called WPATH now, and "The Harry Benjamin Standard of Care" in the past).

1) A person is required to do at least 1-2 years of therapy. If they don't they can't get hormones or surgery.

2) Before transitioning, people have to do a "real life test," where they have to live as their target gender/sex for at least a year (or two), regularly attend therapy, and prove that they can work, function socially (have friends, relationships), and psychologically not fall apart. If they fail the test they cannot get surgery. That separates the people who are serious from those who aren't, and is intended to reduce the rate of people having regrets after transitioning.

Nowadays, people are allowed hormones after 3 months, but in the past you had to do your real life test purely by cross-dressing. The idea was to make it brutally psychologically punishing, in order to, again, sort out the people who really needed to transition from those who might end up with regrets.

IMO, there are enough checks to make this idea of lots of people regretting transitioning seem dubious to me. I can't remember the source (may have been from Lynn Conway's site) that overall there is a 90% are satisfaction rate (non-de-transition rate).

I recall a case of a guy who was rich and bipolar circumventing WPATH with money and ending up with huge regrets. He apparently was having some sort of hypomanic episode at the time. If he'd seen a shrink they probably would've caught that.