The Disorder Nobody Wants To Talk About

Imagine, for a moment, a disease that affects 1 in 10,000 people. That is a fairly common disorder; about the same number of people that are affected by glaucoma or deafness, and three times more frequent than brain cancer. Add to that image a mortality rate of 41%. That's a pretty serious disease, isn't it?

Let's add a bit to that picture. The treatment for this health problem is not terribly expensive, nor difficult. It requires some common, inexpensive drugs. It also requires some surgery, in the price range of $12,000. None of this treatment is particularly unmanageable or experimental, though as with any medical procedure, research would no doubt find room for improvement, and it does take a certain level of specialization.

What would you say if you found out that there is no insurance coverage for the treatment of this common, deadly disorder? And despite the fact that you may pay thousands of dollars per year for your insurance coverage, if you or a loved one had it, not a single dime will go toward the payment of life saving treatment.

That disorder exists. It's called Gender Identity Disorder, and though we don't know the cause of it, we do know how to help people with it. Through the use of hormones such as estrogen and testosterone, and surgery to help people's bodies reflect their self-identity, we can not only vastly improve someone's health and quality of life, we can also save their lives. Untreated gender identity disorder is associated with high suicide rates, and very high levels of substance abuse, as people try to self-medicate their pain.

All too often, GID (also known as gender dysphoria) is tossed off as a problem of morals, as if it were rectifiable by the application of religion, or as a manipulative version of homophobia. Even in the psychological community, there have been attempts made to reclassify gender dysphoria as an oddball variant of homosexuality.

In particular, there is the claim that male-to-female transsexuals are simply gay men who cannot admit their attraction for other men; or, alternatively, that this same group is  sexually aroused by the image of themselves as females, and thus turn to drugs and surgery to fulfill their autoeroticism. Not only do these half-baked theories fail to explain those seeking to transition from female to male, it also fails to take into account the full range of sexual expression, as transgender people may be gay, straight, bi or uninterested, just like everybody else.

The more likely explanation -- and the one that has objective research supporting it -- is that the vast majority of people who would prefer living as the opposite gender are simply responding to the way their brain is wired.

That's right. The preponderance of the evidence these days points to the idea that for some people, during fetal development, their brain growth follows one gender track while their bodies follow another. The mismatch may be noted as early as mid-childhood, though for others the problem does not become evident until puberty, as the genders further differentiate, and as one transsexual person said, "it was all wrong!"

Even so, many people will continue to live with this precarious disconnect between their bodies and their brains because they feel they have no alternative. Afraid of the discrimination and out-and-out violence that is directed toward transgender people, even within the medical community, they suffer quietly. And their suffering takes its toll, in very high rates of depression and its end result, suicide; in drug abuse and alcoholism, as they try to manage their anguish by becoming oblivious; in unemployment and poverty, as their depression and anxiety makes it difficult to hold a job, or even worse, being fired after their condition becomes known to their employer.

The argument that transgenderism is "just" a boy who likes girls' clothing or a tomboy gone too far is like calling a melanoma "just" a skin blemish. Gender identity disorder is serious, often deadly, and levies an awful toll on both the individual and society.

Which makes the denial of coverage for this disorder little short of heinous, particularly because the solutions we have at hand are relatively successful and not particularly experimental. Unfortunately, even for those people with health insurance, denial of coverage for surgical transition is the norm, via a “Transsexual Exclusion Clause” which excludes all medical procedures related to a person’s transgender status.

With the combination of hormones and surgery, medical doctors can create an internal and external state where one's body more closely parallels one's gender self-identity. No, it's not a perfect answer; few medical responses to chronic conditions are perfect. Nor is surgery the right answer for all transgender people. But for many, the surgical answer is literally life-saving. Enter the Jim Collins Foundation:

The mission of the Jim Collins Foundation is to provide financial assistance to transgender people for gender-confirming surgeries. The Jim Collins Foundation recognizes that not every transgender person needs or wants surgery to achieve a healthy transition. But for those who do, gender-confirming surgeries are an important step in their transition to being their true selves.

Last week, the Foundation awarded its first grant to Drew Lodi. “The Jim Collins Foundation for me is a miracle," Drew said. "They helped me to stay motivated to live each day purposefully…I improved my life, mind, body, relationships, and faith. To know that people are out there who do NOT have to be helping–but are–makes me motivated to do everything I can…”

The Foundation awards grants based on a combination of financial need and preparedness. And it aims to be more than just deep pockets for people in need. The Foundation strives to empower people to find creative means of financing surgery for themselves, at least partially. Drew, for example, began funding his surgery by collecting bottles and cans for their deposits.

Having firsthand seen the results of the life-saving surgeries which the Jim Collins Foundation funds, I cannot think of a more worthy, or necessary organization deserving of your support and donations.

I know that money is tight for everyone, as this country slowly claws its way out of the Great Recession. But to the extent that you can consider a charity at all, I hope you will consider making a donation to the Jim Collins Foundation.

Gender dysphoria is the disorder that nobody wants to talk about, but that affects millions of Americans just the same.  The cost of treating every person who needs the life-transforming surgery amounts to 5 cents per American citizen. Do you think you could spare a dime to save a life?

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

The Spectrum of Being

It's very often the first thing we ask about someone. "A baby! How wonderful -- is it a boy or a girl?" Or when we meet someone: "She's a nice-looking girl," or "He's a handsome guy." Gender identification is a core classification that everyone makes, automatically, without consciously thinking about it. Until you are confronted with just how limited that way of thinking is. I have been  fortunate to attend the past few Transgender Lives: Intersection of Health and Law conferences in Farmington CT, and from those conferences, I brought home a single, yet far-reaching fact.

Although we think of the expression of gender as binary, either boy or girl, feminine or masculine, gender is actually a spectrum of human expression in which the elements of masculine and feminine mix and combine over the entire range.

None of us are fully masculine or fully feminine. We are all a combination of gender traits to varying degrees. This mixture of yin (feminine) and yang (masculine) are what the ancient chinese philosophers had in mind in the development of the taijitu:

That small dot of the opposite color within each side represents the simultaneous, mutual existence of opposites within each other. While the taijitu is the reflection of larger universal truths, the characterization of yin and yang as feminine and masculine principles makes the meaning unmistakeable with regard to gender.

The individual intermixture of gender is also embodied in the work of the psychologist Carl Jung, who developed the concept of anima and animus, representing the female aspect within the male psyche and the male aspect within the female.

The idea that we, psychologically, embody both genders has long been accepted. But that the blending of gender would be reflected physiologically and neurologically is a concept that has fought an uphill battle to, first of all, be recognized, and secondly, to be regarded not as a psychological or moral pathology but as a normal variant.

Transgenderism is the umbrella term for the expression of gender identity that differs from the strict male/female dichotomy recognized as normal by society. Transgender people range from those who enjoy dressing as, and behaving as, a person of different gender than their birth gender; to transsexual people who, with the assistance of hormones and surgery, change their entire appearance to live their lives as a different gender; to people who are born with the physiology of both genders and choose not to identify as strictly male or female.

Because it is so basic to our patterns of classification, gender expression outside of the norm can be quite disturbing to many people. Transgender characteristics are usually lumped together with sexuality, although sexual orientation is entirely different and unrelated to gender expression.  Transgender people, like everyone else, may be straight, gay, both, or uninterested. Unfortunately, transgender people are considered by some to be morally corrupt, or predators disguising themselves to gain intimate access to the opposite gender (this is the laughable -- and indefensible -- argument used by some in Connecticut to restrict restroom access by transsexual people).

And, though once thought of as a psychological disorder, research is making it evident that transsexual people do not suffer from some sort of behavioral aberration. More and more it becomes obvious that transsexualism is the result of neurological and hormonal activity and development in the womb. Studies of the brains of male-to-female transsexuals show that their brains are much more similar to the gender they identify with (female) than the gender they were born as (male).

Unfortunately, that research goes unrecognized at many doctors' offices, where both doctor and staff have little understanding of this segment of their patient population, and transgender people may be subjected to anything from embarassment at the hands of thoughtless and poorly-trained staff to outright discrimination because of their gender preferences.

Like most doctors, I received absolutely no education on the requirements of treating transgender people, either from a clinical standpoint or from a practical standpoint. But once I became aware of my ignorance, I undertook to rectify it. From talking to people, to reading, to attending the Transgender Lives conferences, I learned.

Much of it boils down to simple things that I already know and try to practice. Things like respecting my patients. Accepting what they bring to me as people and understanding their needs and goals for their care. Recognizing people's boundaries, and not transgressing them without permission and without good reason.

That last sentence bears a little more explanation. For obvious reasons, both personal and social, a patient may not be comfortable revealing to me their gender history, though clues may be evident in the general health history with which they provide me. But the more important question is whether gender is pertinent to the problem at hand.

And, frequently, it is not. For example, most musculoskeletal issues are gender-neutral, and whether or not my  patient is a transgender person is simply not important. Why make someone uncomfortable by delving into aspects of their life that they would rather not reveal? Being a doctor gives me great latitude to explore another person's privacy in the search for clues to the nature of their problem, but that license must be used with discretion.

Much of being a transgender-friendly practice also boils down to attending to simple things that are easily overlooked. For example, the patient whose legal name on their insurance card is Jennifer Smith would rather be addressed as David. Or that gender isn't as simple as circling the M or the F on the intake form.

So I don't use M or F on the form anymore. Instead there is a blank line for the patient to provide the gender information which most suits them.  And in addition to the Last Name and First Name entries, I have a Preferred Name entry, so that we know that Jennifer should be addressed as David, the name he prefers.

These and other alterations are subtle changes, unlikely to even be noticed except by those to whom they are directed. But for that very reason they are important.

I hope that other doctors, particularly those who provide alternative medicine services, take it upon themselves to enhance their practices in this manner. It is not difficult and the rewards can be significant.

I will unfortunately not be able to attend the Transgender Lives conference this year. It will be the first time in several years that I will miss it. But I am grateful for what the conference, and my patients, have taught me.