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  1. Tobysgirl · ·

    I have become very confused about what the term radical feminist means. I am a child of the sixties and seventies, and have always identified as a radical feminist. I believe in a fierce and critical analysis of patriarchal culture, including the state and religion. I believe in advancing the values of nurturing and connection, which are totally devalued in the society around me. Then I read a radical feminist writing that rapists and pornographers should get the death penalty. Is this what radical feminism now means, accepting the power of the state to murder people? I am very confused.

  2. Toby, “radical feminism” is a set of ideas about the world. By some standards I am a “radical feminist,” by others I am not. The way that some of the most strident “radfems” use the word is simply identity politics, in my opinion. I’m not particularly interested in labeling myself; the *substance* of my ideas is what I care about.

  3. Tobysgirl · ·

    Please explain identity politics to me; I hear the term frequently and have a pretty good idea, but would like someone to define the phrase as precisely as possible. Certainly in the era in which I grew up, radical feminism cut a fairly broad swath but all of us, I think, opposed the brutality of the patriarchal state. Guess that’s not true now! Thank you for your help; I agree that substance trumps labels.

  4. You have made some progress here in helping trans people understand the viewpoint of some radical feminists toward their adopted behavior.
    Please bear in mind that it’s very difficult even for trans people to grasp the nature of the phenomenon they experience. It does feel as though it has biological roots however.

    I would suggest that gender identity is not the correct term for the source of the incongruity trans people feel. Rather, I would describe it as body sex incongruity, that is being experienced by all trans people. This is what sets us apart as a distinct group.

    In my view, the body itself feels wrong due to some sort of mapping within the brain, set before birth, that is adapted for one body or another. If the body and the brain map don’t match there is a problem not that unlike the sense of incongruity seen with intersex where an attempt has been made to alter the body without the knowledge or consent of the patient. This is entirely possible from a neuro-biological perspective and could be found in the brains of non transitioned trans people if there were a way and we actually knew what to look for.

    While male to female (mtf) transition alleviates the incongruity experienced with the body, I truly don’t think it does anything to solve a “gender identity” issue which as I think Elizabeth, you might agree doesn’t even exist, correct?

    So perhaps the manifestation of the patriarchal culture within the scientific community, has created a fiction of gender identity to explain trans people, without really listening to the people experiencing the phenomena for clues to the real issue? that’s just male experimenter bias. I have heard sex researchers instantly refer to the concept I describe as a possible ” third type” in conversation, which immediately reveals an effort to conceal the bias in the derivation of the published analysis.

    Unfortunately this bias has also worked against all women, but I don’t think it should be a source of conflict between trans women and women. As the title of this blog implies: sex matters! I would extend this to say the cultural perception of what body sex implies matters.

    The male human responds to what he sees without questioning that much. Trans women and women do experience many of the same forms of discrimination and other negative consequences, due to what the culturally trained male mind deduces about “gender identity” at an instinctive level when he sees a body that appears female.

    It hurts very much that some radical feminists, have such a poor perception of trans women, on the basis of claims about the existence of a female gender identity. I believe the term stuck and was embraced by many trans people reaching out for much needed support from broader society because it “sounds” as though it describes the phenomena they experience and can, because of the existing cultural constructs, be most easily comprehended by others who already appear to believe it exists.

    The nuances of the impact of being a trans woman are not fully appreciated before they become candidates for transition. Getting help in this is the first concern.

    They are forced into the “real life experience” of being a woman by psychiatrists who insist they must internalize all the cultural perception of “female identity”, and are able to “pass” prior to being given body altering treatments.

    At a deep down level, I don’t think female gender identity exists outside the reflection of the construct existing in the male mind and manifested by many women just trying to fit in and be liked by men. At least not any more than I believe a male gender identity exists outside the puppet show a constructed culture puts on.

  5. Tobysgirl, sorry for missing your question. Identity politics is when people rely on their IDENTITY, rather than the substance of their arguments, to demand credibility in a political debate.

    “Identity politics” is also the idea that someone can be something just because they say they are– “I am a woman” “I am a lesbian” “I am a radfem”– without meeting the core criteria for membership in that group.

    Here is something I have written about it:

  6. Thanks for your comment, JC. Yes, I agree, “gender identity” does not have a biological basis! There is no inner “gender” compass directing us all towards the culturally-bound concepts of “man” and “woman.”

    Genital or sex-based dysphoria (aka trans) may be a particular *kind* of the larger BDD condition, yup, I can work with that. :) It makes sense! And does not offend me as a woman.

  7. It is really warming to see that you are willing to work with a medical model. And yes, the mainstream medical model is not the same as “identity libertarianism”. It presumes that not all persons who say they are trans are transsexual, and insists on a lengthy diagnostic procedure. It insists on therapy in most cases (whether transition is prescribed or not).

    This IS, generally, the current medical consensus – with APA and WPATH only differing in details. Medical opposition to the consensus is limited to a group very similar to NARTH (and linked to NARTH); of that group only Paul McHugh has some sort of legitimate credentials. Others – Zucker, Bradley, Fitzgibbons – are, as far as I am aware, “doctors” accredited by sectarian institutions and practicing the sort of treatment recently prohibited in California. Every single radfem criticism of the consensus ends up quoting one or more of the four I listed – your own blog is no exception.

    Unfortunately, you have some posts where you call for no access (via no insurance coverage) to this diagnostic procedure, and also the procedures that are prescribed by medical consensus in case, *and only in case*, the diagnosis is made. But in the absence of medical support and diagnosis, people can only rely on their own feelings – and often substitute street drugs for supervised medical treatment. At that point, identity libertarianism will kick in whether you like it or not – unless you actually police it, and that, in the public sphere, can turn very nasty very quickly. Other things, like people turning to prostitution to try and finance relief of their distress, also kick in.

    Medical access is not capitulation to identity libertarianism, it is the only viable antidote (at least one that would work in a Western country, where strict policing is not an option). And once the problem of access is solved, it is rather easy to limit legal protections of gender identity to diagnosed cases (for American law, one could simply stop excluding transsexualism from the ADA – one small amendment of a federal law instead of endless GENDA acts for the states). Such protection would then stop overriding sex, being a subset of disability protection. But without access to diagnosis, this limitation becomes discrimination based on income.

  8. Mikhail Ramendik, I think you misunderstand my support for a medical model. Body Dysmorphic Disorder (BDD) is a psychiatric diagnosis. It requires psychiatric treatment. That is the full extent of my support for a medical model.

    I said that BDD focused on the genitals or sexed appearance of one’s body might be a particular kind of the larger diagnosis because of its specificity. But under no other circumstances is surgery an accepted medical treatment for BDD. I see no reason to make an exception for radical body modifications in the case of transsexualism– especially when rates of depression, suicide and hospitalizations is not significantly decreased by dangerous and expensive hormonal and surgical treatments.^^

    In regard to the “ccess” issue of economic discrimination, it is no more an injustice for transsexuals not to have insurance coverage for hormones and surgery than it is an injustice for people with anorexia to be denied liposuction. Cosmetic surgery on perfectly healthy and well-functioning body parts is not *medically necessary.* Medical necessity is everything.^^

    About the ADA, a psychiatric condition must somehow inhibit an individual’s functioning for it to be disability. BDD can be disabling, but transsexualism ITSELF is not disabling. The exception in the ADA should stay The way we think about transsexualism should change: the symptoms of BDD can be treated in the same way and/or under other diagnostic codes such as depression and anxiety– the same way homosexuals are treated. There’s your precedent.

    Yes, I quote McHugh. No, I don’t support everything he says. I don’t support everything ANYONE says. A doctor’s analysis in regard to one kind of treatment does not require me to be in perfect agreement with him/her on every other treatment opinion or decision s/he has ever made. Come on, that’s a ridiculous demand.

    But I do have a nice chart from a Blanchard/Fedoroff article that is relevant here. Let me upload it for you! It’s from the pdf:

    ^^“The increased mortality in MtF in the 25–39 years of age group (SMR 4.47; 95% CI: 4.04–4.92) was mainly due to the relatively high numbers of suicides (in six), drugs-related death (in four), and death due to AIDS (in 13 subjects).”

    A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Henk Asscheman, Erik J Giltay, Jos A J Megens, W (Pim) de Ronde, Michael A A van Trotsenburg and Louis J G Gooren. European Journal of Endocrinology 164 635–642.

    “Inpatient care for psychiatric disorders was significantly more common among sex-reassigned persons than among matched controls, both before and after sex reassignment.” Dhejne C, Lichtenstein P, Boman M, Johansson ALV, Långström N, et al. (2011) Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 6(2): e16885. doi:10.1371/journal.pone.0016885

  9. Once you accept the medical model in principle, what I don’t understand is why political ideology should be a deciding factor in clinical treatment. The fact remains that modern clinical opinion sans one group, based on clinical outcome, supports surgical treatment. If you support a medical model and then state what you do state, you actually become a medical revisionist opposing the mainstream based on limited research. A notable example of such revisionism is the anti-vaccination movement.

    You are right that “medically necessary” is everything, but who should decide what is “medically necessary”, mainstream medical opinion, or lawyers and politicians based on ideologies? Note that I am not even raising the question of which ideology is right in which issue. Let us assume, for the sake of discussion, that your analysis of gender is fully correct. Does it mean that majority medical opinion should be disregarded just because the treatment results can have unfortunate implications for the philosophical definition of “woman”? Is it acceptable to deny medical treatment to people based on the fact that other people won’t like it?

    To return to the area where you do have valid credentials and where decisions should be guided by politics and perhaps ideologies: in a liberal society where you can’t have gender police, medical opinion is the only workable alternative to the “identity libertarianism” that you deplore. There are gatekeepers or there is free flow; you can’t lock that gate.

    The Swedish study explicitly states that it does NOT prove sex reassignment being the cause of the comorbidity and suicide increase. It also cites a number of other studies that show SRS does measurably improve quality of life (note: it is a medical term in this context) in properly diagnosed patients. Its conclusions have to do with the necessity to improve post-SRS care, and that is by this time a part of the consensus, at least in theory.

    The chart you have posted is not by Blanchard. As Blanchard’s theories are well respected in trans-critical circles, it might be funny to note that in this article he argues *for* public funding of surgical treatment. But you do present a name not in my list – John Paul Fedoroff. I admit I was *not* able to link him to sectarian institutions immediately – as is true for the others (McHugh is a very active Roman Catholic, and the specific RC view of ethics obviously informs his position on the issue). This really is a first. Fedoroff is a well known medical activist against surgical treatment, and while his name indicates he was likely born RC, I can’t find any evidence of his connection to the institution.

    However, Blanchard does a very good job at responding to most of Fedoroff’s arguments. And he also does cite follow-up studies, which some surmise do not exist. The one thing that, I think, he fails to confront sufficiently is the extreme West-centricity, even US-centricity, of Fedoroff. He does call Fedoroff out on ignoring non-Western examples in the hijra. But he does not call out the absurdity of Fedoroff’s claim that surgery “diverts resources” from “finding a cure”. The world is big and there are a lot of psychiatrists in a lot of conservative places that do not have and will not have public funding for surgery. Yet the kind of psychiatric treatment that Fedoroff would advocate is no closer 13 years later.

  10. While I’m happy to hear that my view on what it means to be transsexual doesn’t offend you Elizabeth, I don’t believe there is good evidence supporting the view that this is a “type of BDD”. That, I think is an impossible overextension of the scope of the definition for that condition and makes a psychiatric condition out of something that is actually completely physical in nature and a natural occurrence.

    What I am trying to say is that in my view, a biological root of transsexualism produces a conscious experience of crossed physical characteristics when the physical body does not fit the brains model for the body. This might also extend to incongruous internal “qualia” related to the hormonal environment.

    This biological root makes both the combined conscious experience AND the physical reality part of who I am. An identity yes but “gender identity” no. I have heard plenty of women say they don’t “feel” female or male they just are what the brain and body makes them and so are transsexuals.

    Medical use of psychiatric chemistry could not address the underlying physical incongruity. An anti depressant might alleviate any depression that might exist but wouldn’t touch the sense of incongruity which would continue to cause discomfort.

    Since I am not aware of any pronouncements from the physics or philosophy communities that the nature of consciousness and perception (what creates blue? or C# ?) has been solved, I think it would be unwise and unethical for the psychiatric profession to presume they “know” otherwise on the basis of weak and contested empirical evidence.

    I hope this helps your understanding of this concept and still does not offend you as a woman. I am just hoping to help others recognize my claim to the right to define my own identity rather than let someone else define it for me. I also hope that eventually transsexuals and all feminists can stop working at cross purposes.

  11. Mikail Ramendik: First, I disagree that “majority” medical opinion is in favor of surgical solutions to mental disorders, especially on otherwise healthy & functioning body parts. I think the trans lobby has made it seem that medical opinion is in their favor by bullying doctors with threats of self-harm and smear campaigns against anyone who disagrees with them (see Andrea James; They even went after Alice Dreger– it’s fucking crazy! This clearly CHILLS THE SPEECH of professionals whose reputations and careers are more important than challenging some delusional fringe group.

    Secondly, as McHugh discusses in “Psychiatric Misadventures,” at several times throughout history “majority medical opinion” has been DEAD WRONG. No, lobotomies are not an accepted medical practice anymore! I will not worship the opinions of medical “authorities” when there is so little clinical basis to support their opinions. I don’t worship authority in my own field either and frequently disagree with legal scholars and Supreme Court judges alike. I’m just that kind of intellectual rebel. I know, I know, it scares some people. Very un-feminine.

    Next, about the Swedish studieS, yeah, they show that psychiatric problems continue to be GREATER in transsexuals than in the control group. They show that suicide, psych hospitalizations, and drug use remain high even AFTER treatment. This indicates 1> that the treatment does NOT resolve many of the functional limitations attributed to GID, and 2> that psychiatric problems are more common among transsexuals than control groups.
    The cause of this might be social (as with homosexual oppression resulting in unhappy homosexuals) or biological. If the cause of discontent is social, well, let’s work on relaxing rigid gender roles such that gender variance is normalized and becomes less stigmatized– that’s MY argument. On the other hand, if the cause of discontent is a biological, we are still looking at a neurological or psychiatric disorder which could be intrinsic to transsexualism itself. Either way, why are we stil indulging the fantasies of “born in the wrong body?” The emotional pain of transsexuals is not caused by mis-functioning or otherwise malformed genitals for which surgery and hormone replacement are medically *necessary.*

    And lastly, I know the chart is not by Blanchard, excuse me for misspeaking! I still think it’s interesting. And yes, I’d like to know more about Fedoroff too, but not about his religious affiliation because that isn’t directly relevant. Yes, McHugh is in the pope’s pants. It’s upsetting. I’m an atheist. We all have different ideas. About one of your other concerns: treating the symptoms most certainly DOES divert resources from finding the source of the problem. Just like pink ribbon products and cancer treatment– so many new drugs, so LITTLE discussion of carcinogens in our environment and digestibles. We discuss these matters in the context of capitalism, scientific studies do not get done unless there is financial incentive on the part of those funding them. Profit is the primary motivation; not the Truth and goodness of human hearts. I laugh at the idea that Truth will prevail. Hahahahaa. If only. Then there would be no injustice in the world. Wouldn’t that be wonderful!

  12. JC, let’s review the diagnostic criteria for BODY. DYSMORPHIC. DISORDER.

    Per DSM-5 criteria, body dysmorphic disorder is defined by the following:

    A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

    B. At some point during the course of the disorder, the individual has performed repetitive behaviors (eg, mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (eg, comparing his or her appearance with that of others) in response to the appearance concerns.

    C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

    D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

    Specify if:

    With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.

    Specify if:

    Indicate degree of insight regarding body dysmorphic disorder beliefs (eg, “I look ugly” or “I look deformed”).

    With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.

    With poor insight: The individual thinks that the body dysmorphic beliefs are probably true.

    With absent insight/delusional beliefs: The individual is completely convinced that the body dysmorphic beliefs are true.

    BDD usually appears during early adolescence, and, when left untreated, is often a chronic condition. Social values and mass media greatly influence body image and, in turn, self-image. Most people have concerns related to appearance; however, this concern is considered pathologic when it causes distress that interferes with social or occupational functioning.

    I see no reason why transsexualism does not fit this framework. There is CLEARLY nothing biologically wrong with a fully functioning reproductive system that *medically necessitates* surgery. Such a need/demand is delusional. I called transsexualism a TYPE of BDD because as you can see, eating disorders are excepted from qualification for the diagnois. Possibly transsexualism should be it’s own disorder as well? I don’t care.

    Now, if you would like to discuss insurance coverage for ALL forms of cosmetic surgery, that’s quite another story and some people support that. But I do not. I think BDD is very serious, making superficial changes to healthy body parts is absolutely not necessary. It is dangerous (yes, phsycial complications up to and including death have been documented), it is expensive, and it diverts resources from more life-threatening physically necessary procedures. As discussed below with Mikhail, SRS and hormones don’t necessarily relieve a transsexual’s psychiatric problems. So no, I don’t support surgery without a functional problem or for removal malignant tumor (Medicare takes exception for *reconstruction* of an unintentionally lost body part, which I discuss here).

  13. Here is a well-written, well-researched article about BDD from the year 2000.

  14. Nicola Cowie · ·

    I would argue that one difference between SRS and BDD is that whereas the BDD sufferer wishes (for whatever reason) the simple removal of a body part. A transsexual seeks the reconstruction of of their primary and secondary physical sex characteristics. It is a common element in ‘critique’ of trans peoples quest for bodily autonomy, that it almost always concentrates on the “mutilation” or “removal” of tissue. It never acknowledges that there is an element of recreation that is I think, missing in BDD cases.

  15. If you choose to ignore mainstream medical opinion in favour of an opinion held by a Roman Catholic clique, it is your intellectual choice, but it is weak evidence in a political matter. And, yes, I insist that McHugh’s religion has direct relevance in the matter, because he is loyal to a political-religious body which has an open and dogmatic opinion on it.

    I stress that mainstream medical opinion does NOT equate to “every self-described trans person should be treated all the way”. In fact, it is sometimes derisively described as “gatekeeping”. It is not a free-for-all – and, in fact, the *only alternative* in a liberal society would be a free-for-all. Like it or not, freely crushing a group of suffering people just won’t happen anymore – and you can either have medical gatekeeping (with proper access to it) or self-determination which is free. Attempting to gauge resources by controlling access could work in a highly authoritarian state where street drugs, cheaper foreign treatment and similar things could be effectively blocked.

    The Bailey-Blanchard school, while inspired by McHugh, does *not* oppose surgery, and indeed your own reference shows Blanchard defending it. So in the context of access to treatment a reference to that debate is a red herring. The reference to a particular loose cannon (Andrea James) is a red herring within a red herring; even your very link has a clear statement that her behaviour doe snot represent all trans women. For an example of a proper trans activist who played a major part in opposing that school, one can look at Lynn Conway. (Or should one routinely describe trans-critical radfems by those routinely dispensing insults all round?)

    Moreover, in the American context, a lower standard of medical necessity is routinely applied to insurance coverage. I am speaking of coverage for birth control. I did not remember it earlier because it is not the case in Ireland, where birth control as such is not normally covered (though prescribing and possibly – not sure – installing it can be partly covered as “outpatient treatment”, available on some plans only).

    Birth control’s sole aim is to prevent healthy functioning of some parts of the human body (these days the female body, though a male pill might be developed eventually). It is done to enable a lifestyle choice, engaging in non-reproductive “PIV”. Just as with transsexuality, conservative Roman Catholics and some radical feminists find non-reproductive “PIV” problematic. There is, however, much less evidence that abstaining from non-reproductive “PIV” would lead to dramatic consequences.

    I see no (sex-neutral) standard by which birth control could be covered but properly prescribed transsexual treatment could not.

  16. Tobysgirl · ·

    Just to let you know I appreciate the rational tone of this website and the comments. I’ve never had much patience with women putting other women down, and I find my patience has not increased with age.

  17. Mikhail Ramendik, I know what “gate keeping” is ffs. Triggers me to think about Dean Spade’s awful arguments. Yuck. The characters I referenced just became a derail for you. Many doctors agree that surgical solutions to psychiatric distress is dangerous and unecessary, but they aren’t famous and they’re afraid to say it because the tyranny of the trans lobby will destroy their careers. There can be no honesty under these conditions. Reality has been warped. 1984.

    And no, medicine should not be a free-for-all, especially not under commercial and governmentally funded health insurance frameworks in which the risk of loss is shared among large groups of people whose premiums will go up when the pool of funds is tapped for unecessary procedures and related medical complications. When nose jobs, breast enlargements, and other cosmetic surgery are covered by commercial insurance plans, you’ll have a better argument. But since they aren’t, you don’t.

    Free-for-all if you can afford it. That’s capitalism. I have to save my pennies for teeth implants too.

  18. Nicola, I appreciate the distinction but I dont think it works because some BDD is focused on the nose or the breasts and “reconstruction” or inflation happens– creating the appearance of healthy body tissue or organs where there was none at birth. See the BDD criteria below. “perceived defects or flaws in physical appearance”

  19. Why then should (non-health-related) birth control. which is not even a risk but a routine procedure for women selecting a certain lifestyle, be covered? Or are you against its coverage?

    On whether medicine should be a “free-for-all” we might not be able agree since I fundamentally support an NHS-like system while you probably don’t. One of the reasons I don’t want to live in the USA. Different sides of the Atlantic here.

    However, with gatekeeping medicine not being a “free for all”, there is no escaping the fact that your very own limitation of trans protection to medically proven cases would be, in effect, discrimination by income. And that just won’t wash in a liberal society.

  20. Ramendik, you wrote: “Just as with transsexuality, conservative Roman Catholics and some radical feminists find non-reproductive “PIV” problematic.”

    Actually as someone raised (but no longer) Roman Catholic, I can tell you that non-reproductive “PIV” is not an issue in Catholicism. Catholics are taught the old “rhythm method,” as well as temperature charting and examining bodily secretions to determine (and avoid) times of peak fertility. It is birth control, hormonal or barrier based (including condoms) that the Church has a problem with.

    So your analogy of “PIV” as a lifestyle choice is flawed. Sorry.

    And your definition of contraception as “prevent(ing) healthy functioning of the reproductive system” not only ignores many non-hormonal contraceptives that are out there, but your use of the word “healthy” suggests that preventing ovulation/barring or killing sperm is somehow unhealthy. How’s that, exactly? Are condoms medically dangerous now? Is every man or whom who has sex meant to have children? Why? And what if they fail? Will they fall ill? Is a woman’s reproductive system only “healthy” when she is producing eggs, or do the other 27 days of her cycle mean something, too?

  21. I was commenting specifically on insurance coverage of birth control. And what is covered is, as far as I am aware, not condoms, but hormonal pills intended to alter the healthy functioning of a female reproductive system.

    I am not saying that the new state is unhealthy – only that the original cycle is healthy. All the time, *including* the time when one can conceive. Moreover, when a woman (of fertile age) is unable to conceive without the use of contraception, it can indeed be considered a disease. So what contraception does is *similar* to a disease, while not in fact being a disease solely because of the will of the woman.

    And the sole reason it is being done is to support the choice of having “PIV”. I do not see where the analogy is flawed.

    Therefore, *even if* one states that transition treatment of GID is also a choice, this does not automatically exclude insurance cover. Supporting the choice of having “PIV” is a part of insurance and there were lawsuits against those not including it, because for some people not having “PIV” significantly lowers their quality of life. For a much smaller number of people, lack of access to transition significantly lowers their quality of life. There is an established medical protocol to ensure that is indeed the case.

  22. Mikhail/Ramendik,

    I notice that you completely ignored my comments about Catholicism. I guess that means you accept that part of your argument is without support. ;)

    Re the rest:

    Your wrote, “I am not saying that the new state is unhealthy– only that the original cycle is healthy. All the time, *including* the time when one can conceive.”

    But, obviously, a “healthy” state of being able to ovulate often leads to pregnancy, when contraception is not used. To ignore this in your argument suggests that you believe that conception and pregnancy is also a healthy thing, when in many cases it is not. A woman may not want to risk an ectopic pregnancy, a prolapsed uterus, pre-eclampsia or any of the many other complications of pregnancy. In 1900, before many birth control technologies and modern medical techniques were implemented, pregnancy related deaths were 100 times higher than they are now. At times the death rate was even higher.

    Additionally, If a woman has miscarried or has given birth to a child with a genetic defect, she may not want to risk another pregnancy. Is insurance-covered birth control really a choice in these cases, any less than being treated for any other medical issue? Or are you saying she should give up on sex as pregnancy is “naturally” inevitable?

    You seem to be suggesting that because ovulation is natural, using medical means to avoid it is simply elective, with the same significance as bobbing the nose or pinning the ears, and ignore the real dangers that can result from sex during ovulation. Are you really suggesting that avoiding pregnancy is little more than a convenience? That’s quite a retrograde idea.

    I take issue, also, with the fact that you are choosing to compare GID with a state of being (ovulation and pregnancy) that is unique to women with no analog men. Why focus on that, when there are so many other diseases and cures out there that have the potential to affect all humans?

    As you did limit your comparison to one sex, however, how comparing the choices of treatment for GID with impotence– something that occurs “naturally” to the male human body with age? Viagra is one of the most quickly FDA approved drugs ever and was picked up immediately by many insurers, yet having sex is *not* a medical necessity. It strictly is a choice. Additionally, in the past many insurance companies have covered viagra while denying coverage of female contraception.

  23. My comparison was specifically on the issue of insurance coverage. I know of no conditions, except GID, that affect all sexes and yet coverage for medically accepted treatment is disputed. And honestly I was not aware insurers in the US ever covered Viagra. (I am in Europe and different approaches are used here).

    With THAT standard of coverage, all treatment of GID should simply be a no-brainer – it is a much lower standard that anything required for GID treatment! So if one grants coverage of Viagra as necessary, the debate appears over, but it may very well be that the owner of the blog opposes Viagra coverage as well.

    You are quite right that avoiding pregnancy is rational and in many cases quite important for health. However, there is a simple method of avoiding pregnancy that does not require contraception, which is avoiding “PIV” altogether. (Of course there is the possibility of rape, but I doubt any woman who chooses to not engage in voluntary “PIV” would resort to routine hormone treatment solely because of that possibility; emergency contraception is different, but I was not referring to it).

    Therefore, even while the *end* of avoiding pregnancy is rational, using the *means* of hormones (or IUDs etc – the routine things covered) as opposed to refusing “PIV” is a lifestyle choice. It is motivated by quality of life (for heterosexual women) and not by strict medical necessity for survival. This is where the analogy with transition treatment works, even *granted*, for the sake of the discussion, the position that it is not strictly medically necessary and that life with dysphoria is livable, perhaps with psychotherapeutic support. Surely life without “PIV” is also livable and there are loads of therapists (most of them Christian) willing to provide support for that choice!

    As for Roman Catholicism, I’ll be back with Papal quotes, but that takes time. What you described is the common practical position – I was referring to dogma. And the dogma, as far as I am aware, emphasizes “openness” to procreation because it is “natural”. NFP is tolerated because it is still “open”. Why it is supposedly easier for the Lord to alter a menstrual cycle than to engineer a torn condom if far beyond the mind of this Protestant. I need to verify that by skimming both Humanum Vitae and JP2′s work on “theology of the body”.

    P.S. Just in case this needs a statement, I support access to contraceptive services, whether routine or emergency. My references to RC ethics in this context are generally hostile.

  24. There are many, many medical treatments that are not covered by insurance but affect both sexes. Here’s an example for you: BDD affects both sexes yet NEITHER sex will be approved for surgery on healthy body parts because of psychiatric distress.

    Of course I oppose insurance coverage for Viagra! I oppose a finding of medical necessity of sexual gratification via penile erections. Do I support coverage of birth control pills for men? YES.

    Some treatments are considered PREVENTATIVE, including birth control, and insurance routinely covers these. See annual check ups, dental cleanings, etc. It is a harm-reduction thing. But guess what? Hormonal treatment and “SRS” do NOT reduce future medical costs. As we have already discussed, psych treatment and suicides are still very high for “post-transition” transsexuals. And many become *dependent* on a lifetime of hormonal treatments. It is not an effective cost-management strategy. The actuaries will measure these things. They want to see a return on their medical investment. Because, hey, this is capitalism.

    Lastly, there are also things that insurance COULD cover but generally refuses to. EYE GLASSES, for example. This is a pet peeve of mine. I am visually impaired. If I did not have corrective lenses, I could not drive or travel independently. I couldn’t read or use the computer for extended periods of time because I’d get massive headaches from massive eyestrain. In essence, I would be disabled. I could not hold down a job. Does commercial insurance cover glasses for me?? NO, or only partially. It is not mandated coverage. I have to pay at least $150 towards them in order to not wear coke-bottle, lopsided glasses because one eye is much much much much worse than the other. It’s super unfair. Lots and lots of people need glasses to function. And lots of people have to pay out of pocket for them.

    Insurance coverage is very complicated. And inconsistent. And it intersects with cultural practices. Which makes it political. When we talk about “sex changes” it’s the difference between socially-necessary and medically-necessary. If it is socially necessary (and inefficient) this is because of political conditions (sort of like birth controll pills). But “sex changes” are not medically necessary in the sense that they actually *correct* or *rebuild* non-normative body parts/functions, nor do they *prevent* future expenditures or *limit* inevitable ones.

  25. Tobysgirl · ·

    I am still trying to understand what possible connection there can be between birth control — of any type a woman chooses to use — and hormone treatments and surgery for people extraordinarily ill-at-ease in their own bodies. This analogy seems to be so far out on a limb that it’s hanging on by its ten little toes — whoops, it fell off and went splat.

  26. Birth control, unlike dental checkups, does not in itself prevent any illness. All it does (for both men and women, and I would support the male pill fully, but it is not there yet) is prevent certain consequences of certain actions. Consequences which are in themselves natural and a part of healthy functioning. Just like transition treatment, birth control does not correct or rebuild non-normative body parts or functions. (Unless you define “normative” as “supporting the qualify of life of of the person”, in which case both birth control and transition treatment do).

    You bring in the capitalist argument of cost reduction, which birth control does. However, if capitalist reasons were sufficient for birth control coverage, there would be no discussion of mandatory coverage and of denial of coverage as a human rights violation. (I’m not in the USA, and the reason I know about birth control coverage at all is that very discussion). The presence of this discussion means that some capitalists believe it does not make sense to cover birth control.

    Moreover, your claim that transition treatment does not reduce costs is not supported by actual findings. While it is true that some findings show a relatively high level of need for psychiatric support in post-operative transsexuals, it does not follow that it is the same as would be needed if they were denied treatment. Moreover, denial of transition coverage often leads not to an absence of transition but to a later transition (when the person affected by the condition has enough income to afford it); and it is undeniable that later transitions carry more cost in general welfare, some of which might fall back onto insurance even when transition itself is not covered. And then there is the cost associated with those who would be diagnosed as *not* transsexual if they were able to access specialists following proper protocol (including the real life test on hormones) but, because of lack of access to professional help, go for unsafe street options.

    Much of the cost of later transitions and of non-transsexuals on street drugs is not to insurance companies, but to society in general. And this is why mandatory coverage exists – so that cost is not shifted onto society. In fact this is one the reasons business regulation under capitalism exists at all.

    (Some people do believe that regulation for this purpose is improper, but they are generally libertarians, with whom you have denied a connection).

    Speaking of this, I have an easy test to verify or falsify my theory. I do not know where to get information on the age layout of transitions in the USA and in the UK. I would, based on my theory, predict that in the UK, the percentage of late transitions (defined as after the age of 30) has started to fall compared to the US around the year 2009 and continues to fall. The reason for that is NHS coverage of transition treatment since 1999.

  27. Ramendik/Mikhail, I find it interesting that you dismiss my 16 years of Catholic education as “the common catholic position.” Were you raised Catholic? I would guess not, as you claim that it will take you time to find the appropriate Papal quotes, but still you think you know more than someone who was forced to study that religion’s theology. As for it taking time, it took me a good 30 seconds. Of course, as I studied the document in the religion class all Catholics take if they are subjected to religious education, it wasn’t difficult. See Pope Paul VI’s encyclical “Human Vitae,” and scan down to the header “Recourse to Infertile Periods.” You’ll see that I was correct, but I won’t wait for the apology.

    As far as the US insurance system works, Hungerford has said it all better than I ever could. I also wear glasses. I can’t move about the house without them. But I get to pay for them, as well as for the exam to test my eyes for medical issues like glaucoma. In the past I’ve had to pay for the birth control needed to control endometriosis (which is not a choice), and for dentistry. I also got to pay for my son’s birth (up front) and the well baby care for the first two years of his life. But luckily, the insurance company (chosen by my employer, not me!) pays for Viagra. Because priorities.

    As for women making the “choice” to avoid PIV, you don’t seem to understand how many marriages work. I will leave it at that.

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