Treatment Alternatives In Gender Identity Disorder

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Artist-Philosopher Chriss L. Pagani, statement and biography
Artist's Statement & Bio


 This information is provided in order to help persons who feel they were born the wrong gender make informed decisions regarding their feelings of cross-gender identity. For starters: If you are gender dysphoric (unhappy with your birth gender) to the point of considering transition and/or surgery, and/or hormones, it is absolutely imperative that you contact a qualified therapist as soon as possible. Even if you have to go to a government mental health clinic, don't do anything before taking this step! Unless you've already unalterably decided the course of action you are taking, you might want to consider seeing someone other than a "gender therapist," however, because in my opinion many of these professionals are to predisposed to going down the transition road - at least in my experience. It is my personal opinion that you should at least consider treating other symptoms you have, such as depression or obsessive compulsive disorder with medication FIRST, and then get to the gender stuff. G.I.D. professionals often want to jump ahead to the gender issues, believing that the other ones will resolve themselves once you get on the road to transition -- and this may actually be the case in the short term, but long-term experience tells us that all those old issues will come back.

    I am not qualified to give you medical advice and I will NOT give you medical advice. I am passing-on some collected wisdom here and you have to make your own decisions about it. Some of this information is highly controversial, I know, but I think everyone should make well-informed decisions so here it is...

    For the sake of clarity, this treatment section is divided into sub-categories. I strongly suggest that you read these pages in order, rather than jumping ahead to a particular topic. Unless you are familiar with all the terms used in these pages, you should also read the list of definitions at the end of this page before proceeding.

I also want to add that if you are crossdressing part time, having fun and it is NOT causing a problem in your life then maybe you should stop worrying about it. The variation in the gender spectrum, both behaviorally and physically, is wide - and few humans fit one hundred percent into classic rigid gender role expectations. It's okay.

  1. Overview of crossdressing and gender dysphoria
  2. The Therapy Process -Getting Started with Therapy
  3. The Therapy Process II - Ready for Transition
  4. Transitional Processes - What you will need to do.
  5. Alternative Therapy - A Warning. You must read this first.
  6. Alternative Therapy II - A Further Disclaimer
  7. Alternative Therapy III - The Current State of Affairs
  8. Alternative Therapy IV - The OCD/Depression Connection
  9. Alternative Therapy V - The Practical Application
  10. Alternative Therapy VI - The FAQ. This is important information and should not be overlooked.

TERMS USED IN THIS DOCUMENT:

  • Bipolar Mood Disorder. An organic condition which causes the mood of the sufferer to change radically from elation to depression. This condition was formerly called Manic-Depression, and is organic rather than behavioral in nature.
  • Birth Gender. The gender which one appears to be based on physical and psychological characteristics. This can sometimes be ambiguous, of course, so for reading purposes think of the gender your parents thought you were.
  • Birth Sex. One's genetic sex. (See definition of genetic sex).
  • Cross-gender Identification. The belief that one possesses characteristics which are most identified with stereotypical beliefs about one's non-birth gender. A strong cross-gender identification may be indicative of Gender Identity Disorder, or it may merely indicate that the individual has internalized false and unrealistic stereotypes regarding gender roles.
  • Crossdressing. Wearing the clothing of the non-birth gender for the purpose of simulating that gender. Also known has transvestitism, which means the same thing. In shorthand, CDing .. to crossdress; a CDer ..one who crossdresses.
  • Cyclic depressive disorders. Bipolar Depressive Disorder, Mono-polar Depressive Disorder, Depression. These are all organic conditions stemming from a defect in brain chemistry.
  • Dysphoria. Literally, a "bad feeling." A discomfort or difficult feeling, or an unhappiness. As used in these documents, a reference to gender dysphoria - a discomfort with one's birth gender or a general unhappiness with the role which one's birth gender imposes.
  • Gender. One's apparent sex based on physical and psychological features. It is not, as some have tried to claim, exclusively a mental issue, but a combination of the above factors.
  • Gender Identity Disorder. The medical term for transsexualism, as defined by the Diagnostic & Statistical Manual of Mental Disorders. This is a condition probably caused by a combination of biological and environmental factors. When I say "environmental" I mean in-utero environment; that is, the hormones and chemicals one was exposed to before one was born. The symptoms include: A lifelong belief that one was born the wrong sex or that one actually is a member of the non-birth sex. Discomfort with one's birth-gender sufficiently strong to cause significant social impairment. A desire to live as the opposite sex (A late addition to the definition of G.I.D., put in, apparently, to allow those with transient gender dysphoria to be diagnosed with this condition).
  • Gender Dysphoria. A discomfort with one's birth gender. Gender dysphoria is a component of Gender Identity Disorder, but it is not in and of itself transsexualism.
  • Gender Reassignment Surgery. Often referred to as sex reassignment surgery, or a "sex change." Gender Reassignment Surgery is a cosmetic procedure whereby plastic surgery procedures are used to give a person the appearance of having the genitalia of the non-birth sex.
  • Gender Roles. The social expectations and limitations which society tends to assign to individuals according to their gender. Gender role issues tend to overlap each other to a great degree, unlike gender stereotypes. In the most advanced societies, there are few roles that are broadly assigned to only one gender.
  • Gender Stereotypes. A stereotype is a broad generalization made about a group of people based primarily on myth. Stereotypes tend to cover subjects as broad as intelligence and personal abilities. Gender stereotypes are sweeping generalizations made about men and women. "Women are more emotional" is an example of a stereotype common in our society. Stereotypes can be positive ("Men are our protectors", "Women are nurturing") or negative ("Men are pigs", "Women are manipulative"). The most important thing to remember about stereotypes is that while some of them may have a slight basis in reality, in the absolute sense they are false. I have yet to meet a person who fits all the male or all the female stereotypes, even considering the fact that many people try very hard to do so.
  • Genetic Sex. The sex one is actually born. This is based on a pair of sex chromosomes: XY for a male, XX for a female. There is currently no medical procedure by which one can change one's birth sex. You need to realize, though, that many people have a genetic sex that differs from their apparent sex, even though they may be unaware of it. There are several medical conditions that cause this and they are collectively referred to as Inter-Sex conditions.
  • GRS. Gender Reassignment Surgery.
  • Hormone Replacement Therapy. A treatment in which one is given large doses of estrogen (for men) or testosterone (for women) in order to produce the secondary sex characteristics of the non-birth gender. Hormone Replacement Therapy takes months to start having effects and years to reach maximum effect. For the Male-to-Female transsexual, it is important to know that hormones will not make the voice higher or reduce facial or body hair, nor will hormones change bone structure. They will, however, grow small breasts, soften the skin and eventually after several years redistribute fat to give a slightly more curvaceous appearance.
  • HRT. Hormone Replacement Therapy. See above.
  • Non-birth Sex, Non-birth Gender. The sex other than the one which is indicated by the chromosomal pattern (in the case of sex) or the physical appearance (in the case of gender).
  • Obsessive Compulsive Disorder. A defect in the brain which causes one to compulsively perform certain actions, or obsessively think about certain subjects. Until recently, there were no effective treatments available for this disorder. New medications, however, have been proven to be helpful in many cases.
  • OCD. Obsessive Compulsive Disorder.
  • Pass. "To Pass" ..to look sufficiently female (or male, for Female to male transsexuals) to be accepted in general society as such, without anyone looking at you and wondering what you are. The term comes from early American culture in which some light-skinned black people would try to "pass" as white - a practice which, if successful, gave the person many social advantages.
  • Purging. "To purge.." To get rid of all cross-gender related items such as clothing and makeup in the belief that one is giving up the cross-gender identity. Purging is a strong indicator that a person is suffering from a cyclic depression disorder and/or Obsessive-Compulsive Disorder.
  • Read. "To get read." Failing to pass. To be suspected of being a crossdresser or transsexual based on appearance. From the phrase, "He read me like a book."
  • Real Life Test. (or ":Real Life Experience") The required period of one to two years in which one lives as their preferred gender without actually getting cosmetic surgery. This is an important time which, if done properly, will give the patient a true idea about whether they can "make it" as their preferred gender - or not. Some therapists will help you subvert this requirement. In fact, such subversion has become very common. However, if you cannot live comfortably as your chosen gender NOW, it's not going to be all that much easier after surgery. Many a suicide has come from such subversion.
  • RLT. Real Life Test. See above. Also called "Real Life Experience," or RLE.
  • Sex. As used in these documents, a reference to one's genetic sex. The generally accepted idea in the world is that there are only two sexes. There are some very genetic variations (XXY and other chromosomal abnormalities) but most of us are either XX (Female) or XY (Male). Some of us may have been born with male equipment and yet have a female XX chromosome pattern (estrogen-insensitivity) but that's another story.
  • Sex Change. A cosmetic surgical procedure. See Gender Reassignment Surgery.
  • Sex Change Industry. A group of therapists and plastic surgeons who make their living primarily from treating people with gender dysphoria through the use of hormones and cosmetic surgery. We need these people, but sometimes I think they get carried away with their business. Although transsexualism is a relatively rare condition (1 in 30,000 births or so), there are also many people who are not transsexuals but who suffer from some form of gender dysphoria such as autogynephilia, and they actively seek medical help too. I don't think that gender professionals do anywhere near enough to separate out these groups.
  • SOC. Shorthand for the "Standards of Care" of the Harry Benjamin institute.
  • Standards of Care. A set of guidelines first developed by Doctor Harry Benjamin intended to determine who is and who is not a good candidate for Gender Reassignment Surgery. The original guidelines specified that one must have several months of therapy before contemplating transition, followed by at least a year of living as one's chosen gender - before medical intervention could be contemplated. The intent was to separate persons with true Gender Identity Disorder from those with other conditions which caused gender dysphoria. Today, these standards have been watered down to the point that anyone who is willing to jump through a the bureaucratic hoops can receive hormones and/or surgery. Now it is also my experience that many of the non-GID persons with gender dysphoria can be helped with hormones, but therapy is mostly in an all or nothing mode at the moment so sufferers aren't given a lot of options.
  • SRS. Sex Reassignment Surgery - a so-called "sex change" operation. See Gender Reassignment Surgery.
  • Transgender, Transgendered, Transgenderism. A generalized term covering the full range of gender identity issues from crossdressing to full-blown Gender Identity Disorder. The term is often also used to refer to persons who live full-time or a majority of time as their non-birth gender, but who are not seeking to have surgery.
  • Transition. The process by which one comes to live full-time in their preferred gender rather than their birth gender. This is the primary core element of the Real Life Test.
  • Transsexual. A person suffering from Gender Identity Disorder. A person who is in the process of changing their apparent gender, or who has already done so. This group is generally divided into "Preops" - transsexuals who have not yet had surgery, and "Postops," - persons who already had "Gender Reassignment Surgery."
  • Transsexualism. The old name for Gender Identity Disorder.
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