1493 The quotation from Kelly Winters (“Behaviors that would be ordinary or even exemplary . . .”) comes from her essay “Issues of GID diagnosis for transsexual women and men” (2007).
1494 Gerald Mallon and Teresa DeCrescenzo refer to “the sports corrective” and “the etiquette corrective” on page 58 of Social Services with Transgendered Youth (1999); and on page 230 of their article “Transgender children and youth: A child welfare practice perspective,” Child Welfare 85, no. 2 (March–April 2006). In full: “Gender variant boys may be mercilessly teased for not being rough-and-tumble, they may be frequently assumed to be gay by those adults who are ill-informed, and some are moved toward what the authors term, ‘the sports corrective.’ They are pushed into organized sports teams as if participation in such activities will correct their gender nonconformity.
“Gender variant girls are also verbally harassed for being too much like a boy and not enough like a girl. Although other girls seldom wear dresses nowadays, gender variant girls always are confronted by both peers and adults who try to enroll them in what the authors term, “the etiquette corrective.” Turn them from tomboys into ladies and everything will be all right. It seldom, if ever, works for them, and only adds to the pain and the self-blame.”
1495 The quotation from Diane Ehrensaft (“The mental health profession has been consistently doing harm . . .”) comes from Lois Wingerson, “Gender identity disorder: Has accepted practice caused harm?,” Psychiatric Times, May 19, 2009.
1496 Deborah Rudacille’s observation about GID (“The diagnosis legitimizes the range of hormonal and surgical interventions . . .”) occurs on page 216 of The Riddle of Gender (2005).
1497 The quotation from William Narrow (“The harm of retention is stigma . . .”) comes from Susan Jeffrey, “APA 2009: DSM-V on track for 2019, but difficult decisions lie ahead,” Medscape Medical News, May 26, 2009.
1498 Although gender reassignment surgery generally remains ineligible for insurance reimbursement, in November 2011 the Internal Revenue Service dropped its opposition to a 2010 Tax Court ruling allowing a federal tax deduction; see Jonathan Berr, “Sex change surgery is now tax deductible,” Time, November 10, 2011.
1499 All quotations from Michele Angello come from my interview with her in 2009 and subsequent communications.
1500 See “AMA policy regarding sexual orientation” (2007), http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/ama-policy-regarding-sexual-orientation.page.
1501 The quotation from Edgardo Menvielle (“The goal is for the child to be well adjusted . . .”) comes from Patricia Leigh Brown, “Supporting boys or girls when the line isn’t clear,” New York Times, December 2, 2006. Menvielle is author of “Parents struggling with their child’s gender issues,” Brown University’s Child & Adolescent Behavior Letter 20, no. 7 (July 2004); and coauthor with Ellen Perrin and Catherine Tuerk of “To the beat of a different drummer: The gender-variant child,” Contemporary Pediatrics 22, no.2 (May 2005).
1502 The characterization of Peggy Cohen-Kettenis’s work occurs on page 29 of Alice Dreger, “Gender identity disorder in childhood: Inconclusive advice to parents,” Hastings Center Report 39, no. 1 (January–February 2009).
1503 The quotations from Aristotle (“the single cause” as to “why the man is man or the musician musical” is simply “because each thing is inseparable from itself”) occur in Metaphysics, Book VII, pt. 17, on page 311 of A New Aristotle Reader (1987). In full: “Let us state what, i.e. what kind of thing, substance should be said to be, taking once more another starting-point; for perhaps from this we shall get a clear view also of that substance which exists apart from sensible substances. Since, then, substance is a principle and a cause, let us pursue it from this starting-point. The ’why’ is always sought in this form—’why does one thing attach to some other?’ For to inquire why the musical man is a musical man, is either to inquire—as we have said why the man is musical, or it is something else. Now ’why a thing is itself’ is a meaningless inquiry (for [to give meaning to the question ’why’] the fact or the existence of the thing must already be evident—e.g. that the moon is eclipsed—but the fact that a thing is itself is the single reason and the single cause to be given in answer to all such questions as ‘why the man is man, or the musician musical,’ unless one were to answer ’because each thing is inseparable from itself, and its being one just meant this’; this, however, is common to all things and is a short and easy way with the question). But we can inquire why man is an animal of such and such a nature. This, then, is plain, that we are not inquiring why he who is a man is a man. We are inquiring, then, why something is predicable of something (that it is predicable must be clear; for if not, the inquiry is an inquiry into nothing). E.g. why does it thunder? This is the same as ’why is sound produced in the clouds?’ Thus the inquiry is about the predication of one thing of another. And why are these things, i.e. bricks and stones, a house? Plainly we are seeking the cause. And this is the essence (to speak abstractly), which in some cases is the end, e.g. perhaps in the case of a house or a bed, and in some cases is the first mover; for this also is a cause. But while the efficient cause is sought in the case of genesis and destruction, the final cause is sought in the case of being also.”
1504 John Locke’s statement “a man is a man” occurs in “Mr. Locke’s reply to the Bishop of Worcester,” in The Works of John Locke, Esq., in Three Volumes, vol. 1 (1727), page 419.
1505 This passage is based on my interviews with Bettina and Greg Verdi in 2009 and subsequent communications. All names in this passage are pseudonyms.
1506 The quotations in these two paragraphs from the two parents of trans people and the trans son of one of them come from personal interviews conducted between 2007 and 2010.
1507 See Richard Green and John Money, Transsexualism and Sex Reassignment (1969). Money first publicly referred to the “John/Joan” case in Man and Woman, Boy and Girl (1972).
1508 David Reimer told his story to John Colapinto, who published it first as “The true story of John/Joan,” Rolling Stone, December 11, 1997; and three years later in As Nature Made Him: The Boy Who Was Raised as a Girl (2000). Colapinto commented on Reimer’s death in “Gender gap: What were the real reasons behind David Reimer’s suicide?,” Slate, June 3, 2004.
1509 For reports of the Johns Hopkins study, see William G. Reiner and John P. Gearhart, “Discordant sexual identity in some genetic males with cloacal exstrophy assigned to female sex at birth,” New England Journal of Medicine 350, no. 4 (January 22, 2004); and William G. Reiner, “Gender identity and sex-of-rearing in children with disorders of sexual differentiation,” Journal of Pediatric Endocrinology & Metabolism 18, no. 6 (June 2005).
1510 The quotation from William G. Reiner (“These children demonstrate . . .”) comes from a Johns Hopkins University press release, “Hopkins research shows nature, not nurture, determines gender,” May 12, 2000.
1511 For the UCLA study of effeminate boys, see George Rekers, O. Ivar Lovaas, and B. Low, “Behavioral treatment of deviant sex role behaviors in a male child,” Journal of Applied Behavioral Analysis 7 (1974); and Richard Green, The “Sissy Boy Syndrome” and the Development of Homosexuality (1987).
1512 The incident that ended George Rekers’s public career as an academic standard-bearer against homosexuality was first reported by Penn Bullock and Brandon K. Thorp in “Christian right leader George Rekers takes vacation with ‘rent boy,’” Miami New Times, May 4, 2010.
1513 The quotation from Kirk Murphy’s sister comes from Scott Bronstein and Jesse Joseph’s report for Cable News Network, “Therapy to change ‘feminine’ boy created a troubled man, family says,” broadcast June 10, 2011.
1514 See Phyllis Burke, Gender Shock: Exploding the Myths of Male and Female (1996).
1515 This passage is based on my interview with Tony Ferraiolo and Anne Ferraiolo in 2008 and subsequent communications.
1516 Jim
Collins Foundation website: http://jimcollinsfoundation.org.
1517 Information on the amounts of cross-sex hormones required to effect transition come from my interview with Norman Spack in 2009. For a detailed discussion of hormone treatment, see Wylie C. Hembree et al., “Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline,” Journal of Clinical Endocrinology & Metabolism 94, no. 9 (September 2009); and Louis J. Gooren, Erik J. Giltay, and Mathijs C. Bunck, “Long-term treatment of transsexuals with cross-sex hormones: Extensive personal experience,” Journal of Clinical Endocrinology & Metabolism 93, no. 1 (January 2008). From the abstract: “The optimal hormonal therapy for transsexual patients is not known. The physical and hormonal characteristics of 38 noncastrate male-to-female transsexuals and 14 noncastrate female-to-male transsexuals have been measured before and/or during therapy with various forms and dosages of hormonal therapy. All patients were hormonally and physically normal prior to therapy. Ethinyl estradiol was superior to conjugated estrogen in suppression of testosterone and gonadotropins but equal in effecting breast growth. The changes in physical and hormonal characteristics were the same for 0.1 mg/d and 0.5 mg/d of ethinyl estradiol. The female-to-male transsexuals were well managed with a dose of intramuscular testosterone cypionate of 400 mg/month, usually given 200 mg every two weeks. The maximal clitoral length reached was usually 4 cm. Higher doses of testosterone did not further increase clitoral length or suppression of gonadotropins; lower doses did not suppress the gonadotropins. Based on the information found in this study, we recommend 0.1 mg/d of ethinyl estradiol for the noncastrate male-to-female transsexual and 200 mg of intramuscular testosterone cypionate every two weeks for the noncastrate female-to-male transsexual.”
1518 See World Professional Association for Transgender Health, Harry Benjamin International Gender Dysphoria Association’s Standards of Care for Gender Identity Disorders, 6th version (2001).
1519 The various surgeries associated with gender reassignment are described in exquisite detail in the chapter “Medical and surgical options,” on pages 196–211, of Mildred L. Brown and Chloe Ann Rounsley, True Selves: Understanding Transsexualism (1996). See also TS Roadmap, http://www.tsroadmap.com/physical/hair/zapidx.html: “How Long Will Electrolysis Take? Clearing typical transsexual women’s facial hair generally takes about 100 to 400 hours of treatment time (some need even more, some less). This is spread out over approximately one to four years (some need even more, some less). Many variables affect this, and these numbers are based on anecdotal data rather than survey results.
“How Much Does Electrolysis Cost? Electrolysis usually costs about $25 to $150 an hour for treatment (some pay even more, some less). You should plan on spending $25 to $250 a week (some pay even more, some less), tapering off over time, with a total cost to clear a face between $2,000 and $20,000 (some pay even more, some less). Many variables also affect this.”
1520 For a scholarly source on hormone blockers, see Norman Spack, “An endocrine perspective on the care of transgender adolescents,” Journal of Gay & Lesbian Mental Health 13, no. 4 (October 2009). News coverage of the subject includes Lauren Smiley, “Girl/boy interrupted,” SF Weekly, July 11, 2007; and Hanna Rosin, “A boy’s life,” Atlantic Monthly, November 2008.
1521 Follow-up studies of the Dutch cohort include Peggy T. Cohen-Kettenis and Stephanie H. van Goozen, “Sex reassignment of adolescent transsexuals: A follow-up study,”Journal of the American Academy of Child & Adolescent Psychiatry 36, no. 2 (February 1997); Yolanda L. Smith, Stephanie H. van Goozen, and Peggy T. Cohen-Kettenis, “Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: A prospective follow-up study,” Journal of the American Academy of Child & Adolescent Psychiatry 40 (2001); and Yolanda L. Smith et al., “Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals,” Psychological Medicine 35 (2005). For a handy summary of this work, see Peggy Cohen-Kettenis, H. A. Delemarre–van de Waal, and L. J. Gooren, “The treatment of adolescent transsexuals: Changing insights,” Journal of Sexual Medicine 5, no. 8 (August 2008).
1522 UK policy on hormone-blocking therapy is discussed in Simona Giordano, “Lives in a chiaroscuro: Should we suspend the puberty of children with gender identity disorder?,” Journal of Medical Ethics 34, no. 8 (August 2008); Naomi Coleman, “Boys will be girls,” Guardian, August 20, 2003; and Viv Groskop, “My body is wrong,” Guardian, August 14, 2008.
1523 Domenico Di Ceglie reports that 20 percent of his patients choose not to complete gender reassignment in Lauren Smiley, “Girl/boy interrupted,” SF Weekly, July 11, 2007. Di Ceglie’s papers and books include A Stranger in My Own Body: Atypical Gender Identity Development and Mental Health (1988); Gender Identity Disorders in Children and Adolescents: Guidance for Management (1998); and “Gender identity disorder in young people,” Advances in Psychiatric Treatment 6 (2000).
1524 All quotations from Shannon Minter come from my interview with him in 2009 and subsequent communications.
1525 This passage is based on my interview with Jennifer Finney Boylan and Hildegarde Boylan in 2007. I have, additionally, drawn some passages from Jennifer Finney Boylan, She’s Not There: A Life in Two Genders (2003).
1526 Alice Domurat Dreger’s lament about early transition and sex-role rigidity comes from her article “Trans advocates (at least where genderqueer kids are concerned),”Stranger (The Queer Issue: You’re Doing It Wrong), June 21, 2011.
1527 The quotation from Just Evelyn (“I knew his life would be difficult and sad . . .”) occurs on page 6 of her book, Mom, I Need to Be a Girl (1998).
1528 The quotation from Aleshia Brevard (“I consciously tried to create a boy child . . .”) occurs in her 2001 essay, “The woman I was not born to be,” on pages 242–43 of Sexual Metamorphosis: An Anthology of Transsexual Memoirs, edited by Jonathan Ames (2005).
1529 Cris Beam’s account of “Ariel” occurs on page 77 of Transparent: Love, Family, and Living the T with Transgendered Teenagers (2007).
1530 This passage is based on my interview with Hendrik and Alexia Koos in 2009. All names in this passage are pseudonyms.
1531 This passage is based on my interview with Rex and Karen Butt and Cadence Case in 2009, and subsequent communications.
1532 This passage is based on my interviews with Jonah and Lily Marx in 2008 and 2009. All names in this passage are pseudonyms and some identifying details have been changed.
1533 See the American Psychiatric Association’s 2000 “Position statement on therapies focused on attempts to change sexual orientation (reparative or conversion therapies)”: “Psychotherapeutic modalities to convert or ‘repair’ homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of ‘cures’ are counterbalanced by anecdotal claims of psychological harm. In the last four decades, ‘reparative’ therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals’ sexual orientation, keeping in mind the medical dictum to First, do no harm.” See also the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation August 2009 press release, “Insufficient evidence that sexual orientation change efforts work,” which advises that mental health professionals “should avoid telling clients that they can change their sexual orientation through therapy or other treatments.” For the “heated debate” about reparative therapy for trans people, see the next note.
1534 Kenneth Zucker’s publications include: Kenneth J. Zucker and Susan J. Bradley, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents (1995); Susan J. Bradley and Kenneth J. Zucker, “Gender identity disorder: A review of the past 10 years,” Journal of the Academy of Child & Adolescent Psychiatry 36, no. 7 (July 1997); and Susan J. Bradley and Kenneth J. Zucker, “Child
ren with gender nonconformity: Drs. Bradley and Zucker reply,” Journal of the American Academy of Child & Adolescent Psychiatry 42, no. 3 (March 2003). For journalistic coverage of Zucker’s work, see Alix Spiegel, “Q&A: Therapists on gender identity issues in kids,” NPR broadcast, May 7, 2008; and Daniel Goleman, “The wrong sex: A new definition of childhood pain,”New York Times, March 22, 1994. Exemplifying criticism of Zucker’s position are Simon D. Pickstone-Taylor’s letter “Children with gender nonconformity,” Journal of the American Academy of Child & Adolescent Psychiatry 42, no. 4 (March 2003), which says in part: “What Bradley and Zucker (1997) suggest for treatment is something disturbingly close to reparative therapy for homosexuals. Parents are encouraged to discourage cross-gender behavior and stimulate same-sex identification (be this getting fathers to throw footballs at their effeminate sons, or mothers to arrange playdates with girls in frilly dresses for their tomboy daughters). At best, all these forms of therapy are done with the underlying paternalistic hope that these children need to be saved from hurt that will result from their displaying cross-gender behavior in a prejudiced society. While these children might actually thrive on the mere fact that they are getting some attention from a parent who normally shuns them because of their characteristics, the therapy does nothing to change their true predilections or interests. The 10-year review reports the failure of these traditional therapies to prevent these children from becoming homosexuals at a lower rate than ‘untreated children.’ Thus even if they become good actors, this form of therapy only helps to reinforce the message that they get from society that their instinctual gender identification is fundamentally wrong. This further erodes their self-esteem and increases the psychopathology that is normally seen in these children.”
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