Saturday, August 24, 2013

Question to ZJempTV on the issue of hormone therapy

ZJempTV was on CNN arguing for the rights of inmates such as Chelsea Manning to gain access to hormone therapy to assist them in their transition from one sex to another.  Below is the interview.

I will admit, at first I was against the idea of tax payers funding this until it was revealed that the cost would be less than $100 per month.  ZJ herself claimed to pay for this out of her own pocket at the rate of $25 per month.  This surprised me.  When a typical hospital visit can cost thousands of dollars I had no idea this type of treatment was so inexpensive.

However there are a few questions I was hoping ZJ might address.  She can do so via twitter, or perhaps on her blog, or on her FreeThoughtsBlog, or perhaps even video.  However she decides to respond, I will update this blog accordingly.

You cite hormone therapy as a standard of care based on the recommendations from the American Psychological Association, the American Psychiatric Association and the American Medical Association and cite this as "medically necessary."  I am inclined to give the benefit of the doubt to ZJ on this one however at the time of this blog post I find no such claims.  What I do find is the following.

While there is no “right” way to transition genders, there are some common social hanges transgender people experience that may involve one or more of the following: adopting the appearance of the desired sex through changes in clothing and grooming, adopting a new name, changing sex designation on identity documents (if possible), using hormone therapy treatment, and/or undergoing medical procedures that modify their body to conform with their gender identity.Every transgender person’s process or transition differs. Because of this, many factors may determine how the individual wishes to live and express their gender identity. Finding a qualified mental health professional who is experienced in providing affirmative care for transgender people is an important first step. A qualified professional can provide guidance and referrals to other helping professionals. Connecting with other transgender people through peer support groups and transgender community organizations is also helpful. 
The American Psychiatric Association likewise does not state that hormone therapy is "medically necessary" and instead simply lists it as one of many options that the patient can persue.  You can read their report HERE.  The American Medical Association was a little harder to find.  Essentially all I could find was that they recently reclassified Gender Identity Disorder as Gender Disphoria in an effort to destigmatize transgender people.  You can read their report HERE. which does include the words, "We decided the access-to-care issue was very important," Dr. Drescher told Psychiatric News. "If you take out the diagnosis, you don't have a code for treatment."

If ZJ provides sources for hormone therapy being "medically necessary" I will update the blog here.  For now I will assume she meant to say access to treatment leading up to hormone therapy is medically necessary, and if that is the case then we agree.  I would also agree that in some cases treatment leading up to surgery is medically necessary.  A civilized society does not deprive inmates of medical care.  However, I have to admit I would be more on Chelsea's side had she begun her hormone therapy before she was locked up.  If it were an issue of continuing treatment I don't think this would be much of an issue, but as it stands we have someone who is wanting to begin treatment.

Now of course Chelsea comes from the military and the days of Don't Ask Don't Tell.  So obviously it wasn't easy for her to put on lipstick and a wig.  I will admit there wasn't really an opportunity for her to start hormone therapy.  However, I can not ignore the fact that she is wanting to begin her transition and not merely continue it.

At 1:41 ZJ cites a statistic.  41 percent of trans people have attempted suicide.  At first glance this statistic is very precise, so she is obviously quoting it from somewhere.  My gut reaction might place blame for this suicide rate on discrimination not lack of medical care.  However as it turns out ZJ is quoting from a survey of 7000 transgender people conducted in 2010.  You can read the PDF HERE.  While this survey is essentially about health care and transgender people it did say this about the suicide rate.

The National Institute for Mental Health (NIMH) reports that most suicide attempts are signs of extreme distress, with risk factors including precipitating events such as job loss, economic crises, and loss of functioning.  Given that respondents in this study reported loss in nearly every major life area, from employment to housing to family life, the suicide statistics reported here cry out for further research on the connection between the consequences of bias in the lives of transgender and gender non-conforming people and suicide attempts.
They do not cite access to medical care as being a primary reason for suicide.   Essentially they suggest discrimination but ultimately state that more research is needed.

Towards the end of the video ZJ and CNN discuss the cost of hormone therapy which as it turns out is less than $100 per month.  Now on to the questions.

Question 1:
Regarding your TWEET that is embedded below saying that hormone therapy is a civil right, do you imply or believe that this is equal to other civil rights that LGBT people are fighting for.  Such as the right to marry, not be discriminated against in the workplace or in housing, ect?  The reason why I ask this is because I still perceive hormone therapy as optional, whereas a person has to work and a person has to live somewhere, and the desire to love is intricate to our nature.  Perhaps my question is based on ignorance, as I am not trans, but I don't see hormone therapy to be equal to the other civil rights.

Question 2:
As I have previously laid out by citing the various medical boards, hormone therapy is only one of the options that should be medically available to those who wish to transition from one sex to another.  If this treatment is optional, should tax payers be responsible?  Would it be a fair comparison to view this as someone who wanted to get laser surgery on their eyes to rid the need for glasses.  Essentially both are a medical procedure.  Both can make the lives of the person better.  Both are an elective procedure.

Question 3:
Hormone therapy is relatively inexpensive.  However gender reassignment surgery is not.  If Chelsea Manning wanted tax payers to fund her surgery, would you support that?  If you do would, can you lay out the justification?

Question 4:  Bonus Question.
I believe Chelsea Manning was tried and convicted not for what she did, but for others in her position who are thinking about blowing the whistle as she did.  Her punishment was intended to deter any other whistleblowers.  Agree or disagree?

You can also check out ZJ on Twitter

Here is MY twitter

ZJ is on FreeThoughtBlogs

Any response she makes to this article I will update below here.

UPDATE:  ZJ has responded via twitter with two tweets.

The first one is a a tweet linking to a statement released by WPATH the World Professional Association for Transgender Health.

While WPATH only lists hormone therapy and surgery as one of many options that should be available to transgender people it does say this about surgery.

The medical procedures attendant to sex reassignment are not "cosmetic" or "elective" or for the mere convenience of the patient. These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of the diagnosed condition.

The second tweet from ZJ is a PDF article from LAMBDA Legal which contains links to statements from various medical associations which you can read for yourself via excepts or click on the links in the document as I have and verify this PDF is factual.  In a nutshell, these medical associations do identify treatment as medically necessary but they don't limit it to just hormone therapy.  Hormone therapy is just one of the treatments that they advocate should be available to all.  For others it could be simple counseling and others surgery.

So it would appear that ZJ has answered Question 2.  Treatment leading up to hormone therapy and even surgery is medically necessary for trans people according to the respected medical community.  I will accept this answer and thank ZJ for responding.