Letter to Texas Medicine (1995)
©1995, 2013 by Dallas Denny
Source: Dallas Denny. (1995, 16 February). Letter to Texas Medicine (Texas Medical Association).
When I read Collier Cole et al.’s article in the journal Texas Medicine I felt obliged to respond.
16 February, 1995
I was only recently able to obtain a copy of the article “Treatment of gender dysphoria (transsexualism)” by Cole, et al., which was published in Texas Medicine, 90(5), May, 1994.
It’s commendable that Dr. Cole and his colleagues have been so dedicated to working with individuals with gender identity disorders. However, I would like to address several issues on which our opinions differ.
First, it is not true that all transsexual persons are sexually attracted to members of the same natal sex. Clinicians have begun to waken to the fact that sexual orientation is relatively independent of gender identity (cf the recent work of Ira Pauly, and especially Pauly, 1992), but do not seem to yet realize the extent to which post-transition transsexual people identify as gay men and lesbians. Bolin (1988) reported data on the sexual orientation of seventeen male-to-female subjects: one reported being exclusively attracted to women; one preferred men, but was open to bisexuality; one was bisexual but preferred males; six were bisexual; six were exclusively attracted to women; one reported a preference for women, but was open to bisexuality; and one did not know her preference. In five years of work with a support group in the Southeastern United States, I have noted a similar mix.
Second, the practice of Dr. Cole and his colleagues of requiring their clients to live full time in the new gender role before receiving hormonal therapy is not engaged in by the majority of clinicians; in fact, the American Educational Gender Information Service has published a position statement on this issue, pointing out that the social changes which are necessitated by living cross-gender are much more disruptive and long-lasting than any physical changes which are caused by a short period on counter-sex hormones, and that it is much easier to survive an aborted attempt to change gender after a short period on hormones than after the disclosure and severing of relationships which are necessary in order to begin the cross-living period. This statement was released with the unanimous approval of a 27-member advisory board which features prominent professionals and consumers, and which included psychiatrists, plastic surgeons, endocrinologists, and other physicians. Cole et al.’s article is likely to lead readers to believe that a global requirement that the individual cross-live before hormonal therapy is common practice, and is even endorsed by the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, Inc. In fact, it is not. In our experience, it can be psychologically and socially devastating, and should never be a global requirement, although it can be useful (rarely) in individual cases. Certainly, it is important that individual cross-live for a minimum of one year before surgery to alter genitalia, but requiring a cross-living period before administration of hormones strikes me as excessive gatekeeping. I am distressed to learn that Dr. Cole and his colleagues are continuing this harmful practice even after our correspondence about the issue, and even after we sent them our position statement.
Third, it is not true that all transsexual persons show an absence of erotic arousal to crossdressing. Certainly many do, but others do not. It is true that many transsexual people learn to lie about this to clinicians in order to obtain a diagnosis of transsexualism and access to medical procedures to change their body. Sandy Stone has written eloquently of this (Stone, 1991; see also Denny, 1992).
Finally, I would like to point out that the interdisciplinary team approach to transsexualism has given clinicians forty years to study the outcome of the treatment of transsexualism, and most of what has been written is not particularly impressive (Denny, 1994). Forty more years will not lead to much enlightenment unless clinicians begin to listen to what anthropologists, sociologists, and transsexual persons themselves are saying about this remarkable condition. Viewing a desire to change one’s body and social role as pathological flies in the face of historical and cross-cultural evidence which indicates that the cross-gender wish has an ancient and honorable tradition. Articles such as Cole’s et al. are a mark of the medical colonization of transsexual persons. They merely rehash previous such articles, missing entirely the exciting social revolution which is occurring as transsexual persons begin to demand their independence from psychiatric diagnosis and to exert the power of self-definition.
Dallas Denny, M.A.
Licensed Psychological Examiner
American Educational Gender Information Service, Inc.
cc Dr. Collier Cole, Help Me… Accept Me Support Group
Bolin, A. (1988). In search of Eve: Transsexual rites of passage. South Hadley, MA: Bergin & Garvey Publishers, Inc.
Cole, C., et al. (1994). Treatment of gender dysphoria (transsexualism). Texas Medicine, 90(5).
Denny, D. (1992). The politics of diagnosis and a diagnosis of politics: The university-affiliated gender clinics, and how they failed to meet the needs of transsexual people. Chrysalis Quarterly, 1(3), 9-20.
Denny, D. (1994). Gender dysphoria: A guide to research. New York: Garland Publishing.
Pauly, I.B. (1992). Review of L. Sullivan, From female to male: The life of Jack Bee Garland. Archives of Sexual Behavior, 21(2), 201-204.
Stone, S. (1991). The empire strikes back: A posttranssexual manifesto. In J. Epstein & K. Straub (Eds.), Body guards: The cultural politics of gender ambiguity, pp. 280-304. New York: Routledge.