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Gender Dysphoria, But Not Trans?


emeraldmountain2

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16 hours ago, MaeBe said:

In this study they chose interesting questions to determine "euphoria":

 

The questions asked participants to indicate the response that best described their experience in the past two weeks: “I am happy that I have the gender identity that I do” and “I have accepted my gender identity”.

 

These seem to hint at quality of life over euphoria as I've seen it described. I know I've felt euphoria and NOT "strongly agree" with either question.

 

Taken alone, I agree it does not seem to be a strong metric for gender euphoria. But, the study participants were surveyed every two weeks for 2 1/2 years and the other survey questions asked about sociodemographics, medical gender affirmation, gender dysphoria, psychological distress, substance use, and resilience. So, there is longitudinal value in the study as they aimed to measure the intersections between items such as gender euphoria and trans-affirming healthcare; or gender dysphoria and substance abuse, etc.

 

To contrast note survey questions about gender dysphoria: “I feel strongly that my gender identity is different than my assigned sex at birth” and “I feel unhappy every time someone treats me as my assigned sex at birth.”

 

From a mathematical point of view (I am a mathematician) in order to conduct such a high multivariable statistical analysis, survey items for each variable need to be kept as concise and optimal as possible. Check out their Venn diagram!

 

image.thumb.png.7bf3b72a31647d8fd25aaa34e73a839d.png

 

Of note:

"high gender euphoria was associated with a statistically significant lower odds of gender dysphoria (Model 2: aOR = 0.58; 95 % CI = 0.47–0.72), lower odds of alcohol misuse (Model 4: aOR = 0.75; 95 % CI = 0.60–0.95), and higher odds of resilience (Model 5: aOR = 1.31; 95 % CI = 1.07–1.61). High gender euphoria was not significantly associated with psychological distress though the association was in the expected inverse direction (Model 3: aOR = 0.82; 95 % CI = 0.64–1.05; p = 0.12).

 

Additionally, other secondary effects were observed. Gender dysphoria was significantly associated with an increased odds of psychological distress (Model 3: aOR = 2.01; 95 % CI = 1.57–2.59) and reduced odds of resilience (Model 5: aOR = 0.65; 95 % CI = 0.53–0.80). Resilience was associated with decreased odds of psychological distress (Model 3: aOR = 0.30; 95 % CI = 0.24–0.39). Alcohol misuse was not associated with any other mental health variables besides gender euphoria."

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5 minutes ago, Vidanjali said:

From a mathematical point of view (I am a mathematician) in order to conduct such a high multivariable statistical analysis, survey items for each variable need to be kept as concise and optimal as possible.

I agree that the study is quite comprehensive, even with suboptimal association of euphoria via questioning, there is a positive link. I think with a better question, one that could be balanced with an equally telling question regarding dysphoria, would have shown a marked increase in correlation with euphoria. 

 

The question about feeling unhappy being misgendered is a better question for dysphoria than either of the euphoria questions IMO, because it is instance-based. Had they countered that question with a question of euphoria in a similar vein, I think they would have collected better euphoria data. “I have felt positively about myself when expressing my gender identity”, removing the holistic aspect of needing to “accept” or being happy “being the gender”. Essentially those questions exclude, or depreciate, euphoria in all cases one does not hit the maxim. It really suppresses transitionary stages of transness where a person is less likely going to select higher confidence levels of agreement.

 

That said, I am not a data scientist nor do I play one on TV. I do love that you are a mathematician! I always found more joy in words than numbers, but I do appreciate when they tell us things.

 

💜Mae

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16 hours ago, Betty K said:

Gender, at least partly, is something that is done to us — bestowed on us from outside. I would say it is de facto “assigned” to us at birth along with our sex

 

I agree. This is why in my initial post here, to distinguish from one's internal gender identity, I used the phrase "gender associated with sex assigned at birth", where that gender association depends on the culture of society, family, heritage, tribe, religion, moment in history, etc.

 

9 hours ago, Betty K said:


“stereotypical behaviours that might be considered male, female, or some variation”. Isn’t this just another way of saying what I said above about gender having a social aspect? (The Oxford Dictionary definition.) In any case, it certainly refers to more than just “the way we see ourselves”.

 

I also agree with this. The definition I gave for gender I garnered from several sources to try to provide nuance when writing a transgender awareness newsletter a few years ago. Forgive me, I would struggle to recall all the sources I used.

 

Gender relates to your personal sense of who you are (your identity), how you experience inhabiting your own body, how the society in which you live interacts with your body, how you present yourself in the world given societal expectations and norms, and your relative level of harmony or disharmony with all these factors. 

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5 minutes ago, MaeBe said:

Had they countered that question with a question of euphoria in a similar vein, I think they would have collected better euphoria data. “I have felt positively about myself when expressing my gender identity”, removing the holistic aspect of needing to “accept” or being happy “being the gender”. Essentially those questions exclude, or depreciate, euphoria in all cases one does not hit the maxim. It really suppresses transitionary stages of transness where a person is less likely going to select higher confidence levels of agreement.

 

I agree. The euphoria survey items could have been better phrased if the transitory preface "within the last two weeks" were logically embedded. The questions as they are err on the side of absoluteness, as if euphoria were a fixed destination.

 

They do specify that "([g]ender euphoria was assessed with two survey items, drawn from a previously validated scale of gender congruence (Kozee et al., 2012), that reflected experiences of happiness and acceptance as proxy measures for gender euphoria." You can click in the article to read the abstract of the Kozee et al. article, but there's a paywall to read it. Playing the academics' advocate (and I am in no way implying academics are devils!!), I imagine they were striving for continuity in the research, by measuring happiness and acceptance. Still, it is a mystery why they did not tailor those survey items to not sound so absolute.

 

5 minutes ago, MaeBe said:

That said, I am not a data scientist nor do I play one on TV. I do love that you are a mathematician! I always found more joy in words than numbers, but I do appreciate when they tell us things.

 

Lol, why, thank you :) At an advanced level of mathematics, you find almost no numbers! It becomes rather artistic and poetic, believe it or not. However, one would need to understand syntax to some degree to be able to appreciate it, so it's not always entirely accessible. Statistics on the other hand is certainly data-driven, but the results - significant or insignificant - speak for themselves! I was a professor for 17 years and I loved to help students understand things they may have initially perceived as impossible.

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Thank you for chiming in, @Vidanjali. It makes sense that you’re a maths whiz; your posts are always so logical. That is balm to my brain. 

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1 hour ago, Betty K said:

Thank you for chiming in, @Vidanjali. It makes sense that you’re a maths whiz; your posts are always so logical. That is balm to my brain. 

 

😁

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@Vidanjali Interesting Venn diagram... I've never seen one as complex as that.  I recall seeing diagrams with two or maybe three circles when I was in high school, but I never really got the point.  I always sucked at math, and it just got worse the older I got.  Especially in algebra, when the teacher was young and cute and I think all I did was stare for a year. 🤣 I only learned how to understand long division as an adult 🙄. After all, weren't calculators meant to spare me from that?

 

My horrible math skills aside, one thing I wonder is how accurately we can measure things like euphoria, dysphoria, and happiness.  It reminds me of going to the hospital and a nurse asking me, "Rate your pain on a scale of 1 to 10."  Like, how the heck do I do that?  And is my 5 the same as someone else's?

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33 minutes ago, awkward-yet-sweet said:

@Vidanjali Interesting Venn diagram... I've never seen one as complex as that.  I recall seeing diagrams with two or maybe three circles when I was in high school, but I never really got the point.

 

Take just this part, for example. (Not my finest artwork, I just scribbled it on my phone.)

Screenshot_20240114-140336.thumb.png.0631702c2c4bea106bb64d90665c88b4.png

 

The yellow oval contains data on participants who reported gender euphoria above the average response score. So, 35% of participants reported high gender euphoria. In the blue circle, 49% of participants reported gender dysphoria. Yellow and blue make green. That's where the two shapes overlap. 14% of participants had overlapping experience of dysphoria and high euphoria. Looking at the complex diagram (before I scribbled on it), you can see which qualities were more prevalent with euphoria or dysphoria or both by looking at the overlapping bits or intersections. These sorts of results can help to substantiate the need for gender affirming care for better health and quality of life.

 

Briefly, mathematically speaking, understanding whether you're dealing with an "and" or an "or" statement determines which operations can be applied. "I experience euphoria and dysphoria" versus "I experience euphoria or dysphoria or both." 

 

 

33 minutes ago, awkward-yet-sweet said:

how accurately we can measure things like euphoria, dysphoria, and happiness.  It reminds me of going to the hospital and a nurse asking me, "Rate your pain on a scale of 1 to 10."  Like, how the heck do I do that?  And is my 5 the same as someone else's?

 

Each individual's experience is entirely subjective. Pain is subjective. It's almost literally always "in your head", which is not to invalidate it, but to say it's a function of the brain and nervous system. Pain is not well understood by the medical community. I'm told there have been studies which show you cannot quantify sensorial experiences in a hierarchy. But each individual's subjective experience is valid for them. So, with statistics its vital to have a reasonable sample size of participants so that you can well substantiate average responses. There's a statistical measure called standard deviation by which we can measure how rare a data point is compared to the average. For a numerical ranking scale, there are standards for how often we see respondents answering close to the average. Naturally, it becomes increasingly more rare to encounter a response farther and farther from the average response. 

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50 minutes ago, Vidanjali said:

Briefly, mathematically speaking, understanding whether you're dealing with an "and" or an "or" statement determines which operations can be applied. "I experience euphoria and dysphoria" versus "I experience euphoria or dysphoria or both." 

 

Each individual's experience is entirely subjective. Pain is subjective. It's almost literally always "in your head", which is not to invalidate it, but to say it's a function of the brain and nervous system. Pain is not well understood by the medical community. I'm told there have been studies which show you cannot quantify sensorial experiences in a hierarchy. But each individual's subjective experience is valid for them. So, with statistics its vital to have a reasonable sample size of participants so that you can well substantiate average responses. There's a statistical measure called standard deviation by which we can measure how rare a data point is compared to the average. For a numerical ranking scale, there are standards for how often we see respondents answering close to the average. Naturally, it becomes increasingly more rare to encounter a response farther and farther from the average response. 

 

Definitely tough for my brain to comprehend this stuff.  I'm confused by the "and" vs "or" part.  I would think that it would always be "or" because why would people be experiencing euphoria and dysphoria simultaneously?  And while I guess it is possible for one person to experience dysphoria exclusively and another to experience euphoria exclusively, isn't life usually a mixture?  And measuring that has the same issues as measuring pain.

 

Perhaps it is more rare to encounter a response father from the average, but might some of that be due to the personality of the respondent?  For example, on surveys where people are asked to rate things on a scale, there are some people who naturally put in "middle" responses, not as a description of their experience but more because they have trouble with choices.  And others naturally respond with one extreme or the other, more as an expression of personality than experience. 

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1 hour ago, awkward-yet-sweet said:

because why would people be experiencing euphoria and dysphoria simultaneously? 


“I experience euphoria and dysphoria” does not mean the subject experiences both simultaneously. It means that, at various points in time, the subject habitually experiences one or the other. That is because the statement uses the *present simple* tense, which does not just describe action happening now, in the present, but action that happens regularly. 

 

1 hour ago, awkward-yet-sweet said:

And while I guess it is possible for one person to experience dysphoria exclusively and another to experience euphoria exclusively, isn't life usually a mixture? 


I agree that most trans folks probably experience both, but I have heard some say they only experience dysphoria. 

 


 

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22 minutes ago, Betty K said:

I have heard some say they only experience dysphoria. 


What am I saying? I have also heard of trans folk who only experience gender euphoria, but I have not met any of them. 

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2 hours ago, awkward-yet-sweet said:

I would think that it would always be "or" because why would people be experiencing euphoria and dysphoria simultaneously?

 

23 minutes ago, Betty K said:

“I experience euphoria and dysphoria” does not mean the subject experiences both simultaneously. It means that, at various points in time, the subject habitually experiences one or the other. That is because the statement uses the *present simple* tense, which does not just describe action happening now, in the present, but action that happens regularly. 

 

Exactly. Nice grammar @Betty K 😊@awkward-yet-sweet in particular, participants were surveyed every two weeks for 2 1/2 years. Try giving the article a read. You'll see how the participants were chosen and perhaps feel uplifted learning about what motivated the researchers to do this work. Give it a chance, you'll probably understand more than you suspect. Just skip over the number crunching parts and you'll be able to understand the gist of the research. 

 

2 minutes ago, Betty K said:

I have also heard of trans folk who only experience gender euphoria, but I have not met any of them. 

 

I recall seeing at least a couple folks who have posted intros here who reported only positive experience being trans. I can't remember who exactly and maybe they didn't stick around. But it is certainly remarkable and made me hopeful that that would some day be much more common. 

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12 minutes ago, Vidanjali said:

I recall seeing at least a couple folks who have posted intros here who reported only positive experience being trans. I can't remember who exactly and maybe they didn't stick around. But it is certainly remarkable and made me hopeful that that would some day be much more common. 


I must have missed those folks, but I know they’re out there somewhere.
 

I vividly recall my first conscious experience of what I would now call gender dysphoria: it happened in response to a group of six-year old school children standing in a circle around me, the new kid, and demanding to know if I was a girl or a boy. I know for other kids it can happen when they are first told — usually by some cheeky classmate who is judging them for their gender presentation — that they can’t be a certain gender because they have the wrong genitalia. If society could be more accepting, I feel as if much dysphoria could be avoided. Also, if those trans folk who require gender-affirming care are able to access it early enough, I suspect dysphoria can likewise be largely avoided. Though then we get to the problem of disclosure in a dating context, which could trigger it all over again. But that brings me back to societal acceptance.

 

Related to this, imo it is unfortunate that a diagnosis of dysphoria is often necessary to access gender-affirming care. It’s a typical western-medicine approach: it’s not about prevention but about cure. That said, I recognise the need to play the medical game in order to access insurance, etc, so I am not about to try and undermine the diagnosis. But imo gender euphoria is at least as good an indicator that someone could benefit from gender affirmation. Not only that, but many of the symptoms of gender dysphoria as currently defined (ie, gender incongruence, a marked desire for the secondary sex characteristics of “the other gender”, a marked desire to be treated like “the other gender”) are not necessarily dysphoric at all. It’s quite easy to feel euphoric about any one of those things. “Gender dysphoria” is just a frame through which the medical profession sees gender incongruence. I would say there is still, despite the advances that have been made, something pathologising about that frame in itself. 

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1 hour ago, Betty K said:

“I experience euphoria and dysphoria” does not mean the subject experiences both simultaneously. It means that, at various points in time, the subject habitually experiences one or the other. That is because the statement uses the *present simple* tense, which does not just describe action happening now, in the present, but action that happens regularly.

 

Ok, that makes sense....except when "or" is a separate choice.  Wouldn't saying "I experience euphoria or dysphoria" also mean experiencing both, at various points in time?  Then again, I sucked at grammar too 😒

 

53 minutes ago, Vidanjali said:

In particular, participants were surveyed every two weeks for 2 1/2 years. Try giving the article a read. You'll see how the participants were chosen and perhaps feel uplifted learning about what motivated the researchers to do this work. Give it a chance, you'll probably understand more than you suspect. Just skip over the number crunching parts and you'll be able to understand the gist of the research.

 

Well, it certainly is interesting information.  I might try having my husband explain it to me... he can usually put it in words I can understand. 

 

14 minutes ago, Betty K said:

I vividly recall my first conscious experience of what I would now call gender dysphoria: it happened in response to a group of six-year old school children standing in a circle around me, the new kid, and demanding to know if I was a girl or a boy. I know for other kids it can happen when they are first told — usually by some cheeky classmate who is judging them for their gender presentation — that they can’t be a certain gender because they have the wrong genitalia. If society could be more accepting, I feel as if much dysphoria could be avoided. Also, if those trans folk who require gender-affirming care are able to access it early enough, I suspect dysphoria can likewise be largely avoided. Though then we get to the problem of disclosure in a dating context, which could trigger it all over again. But that brings me back to societal acceptance.

 

Interesting experiences you describe.  I wonder how common it is to have dysphoria instigated by social interaction with one's peers? 

 

For me, it was a combination of feelings.  I wasn't able to identify them as gender issues until adulthood, because I ignored them before puberty and during/after puberty I focused more on the sexual desire and orientation aspects of it.  Looking back now, I can see the issues showed up early.  I distinctly recall watching the girls around me get hips and breasts and having mixed feelings of fear that I wouldn't get those features to be like others, and also fear that I would.  And never feeling like my body was acceptable, or even that it really belonged to me. 

 

While I wasn't out, I don't think anybody would have been surprised to find out that I liked girls, and there were girls in my peer group who were lesbian or bisexual as teenagers.  I sometimes think that if I'd had the confidence to express my interest in girls, if I might have been more accepted and less lonely.  I also wonder if I had been identified as intersex or trans back then, if it would have changed things socially?  Or did everybody see it back then but me?  All hypothetical stuff, of course. 

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1 hour ago, awkward-yet-sweet said:

Well, it certainly is interesting information.

The summary does a good job of stating that euphoria is a good marker of positive experience: resilience, etc., while dysphoria is closer aligned with negative experience, including substance abuse. Effectively, they posit more research must be done from the euphoric standpoint, where traditional focus for trans people has been purely on dysphoria. 
 

Cliff’s: if you have positive response to your gender identity, it may be a better indicator of transness than if you have a negative one. 

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2 hours ago, Betty K said:

imo it is unfortunate that a diagnosis of dysphoria is often necessary to access gender-affirming care... imo gender euphoria is at least as good an indicator that someone could benefit from gender affirmation... “Gender dysphoria” is just a frame through which the medical profession sees gender incongruence. I would say there is still, despite the advances that have been made, something pathologising about that frame in itself. 

 

What I found neat about the study is that it was the trans patient community who asked for such research to be undertaken with hope to go beyond a "deficits-based framing" of trans healthcare which focuses on mitigating distress rather than assisting the individual to become more fully realized. 

 

"...an overemphasis on gender dysphoria, medicalized narratives of distress, and related constructs such as incongruence may be harmful for TGD people by reinforcing stigma and associations with mental health disorders."

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5 minutes ago, Vidanjali said:

What I found neat about the study is that it was the trans patient community who asked for such research to be undertaken with hope to go beyond a "deficits-based framing" of trans healthcare which focuses on mitigating distress rather than assisting the individual to become more fully realized. 


Brilliant. I wholeheartedly support this. But I suspect in most cases a “deficits-based framing” is necessary to obtain insurance? I have no firsthand experience of this as I don’t have medical insurance, so I may be wrong. But it seems to me the trans community is caught in a bit of a bind: if we finally convince the world that gender incongruence is not intrinsically pathological then we may argue ourselves out of medical benefits.

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6 minutes ago, Betty K said:

if we finally convince the world that gender incongruence is not intrinsically pathological then we may argue ourselves out of medical benefits.

 

It's an interesting point. I suspect this type of research has not gone so far as to develop remedies to the current trans healthcare paradigm, but that will necessarily need to be part of the research else it would render itself moot!

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6 minutes ago, Vidanjali said:

 

It's an interesting point. I suspect this type of research has not gone so far as to develop remedies to the current trans healthcare paradigm, but that will necessarily need to be part of the research else it would render itself moot!


I suspect this has been an issue since the dawn of trans-specific healthcare. Historically, trans folk have often been required to perform pathology in order to receive care. I think in this respect the search for truth w/r/t trans identity is sometimes at odds with the search for medical help. 

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1 hour ago, Vidanjali said:

"...an overemphasis on gender dysphoria, medicalized narratives of distress, and related constructs such as incongruence may be harmful for TGD people by reinforcing stigma and associations with mental health disorders."

I relate to this. When my egg broke three years ago, I knew I needed mental health care but I didn't feel sick from disgust with my own body so much as disgust with society's stigma against the gender diversity I carried in my own mind and body. Transphobia and trans-hatred are the diseases that affected me most. My recovery involves realizing how sick it makes me to face the hatred in this world. I'm afraid it also includes sexism and racism which are all part of the same thing and that makes it difficult to fight. Trying to limit the truth by blaming the victim does not solve the problem—evil lives in ignorance, the maintenance of an elite system of status, and a lack of love for others.

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9 minutes ago, Davie said:

Transphobia and trans-hatred are the diseases that affected me most.

 

In other words, it's society that's sick, not trans people.

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7 hours ago, awkward-yet-sweet said:

Ok, that makes sense....except when "or" is a separate choice.  Wouldn't saying "I experience euphoria or dysphoria" also mean experiencing both, at various points in time?  Then again, I sucked at grammar too

 

I haven't looked closely at the passage you're quoting but I imagine they mean "I experience either euphoria or dysphoria".

 

7 hours ago, awkward-yet-sweet said:

Interesting experiences you describe.  I wonder how common it is to have dysphoria instigated by social interaction with one's peers? 

 

I have always suffered more from social dysphoria far than physical dysphoria. My experience of having my gender (and sexuality) constantly policed caused me much shame and alienation. On the other hand, it was gender euphoria that made me want to physically present as a girl. I know there are others who share this experience but I can't guess how many.

 

 

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@awkward-yet-sweet, another way of saying this is that I was completely happy being myself until I hit a particular age and went to a particular school at which a certain gender presentation was expected of me. After that, my self-perception kind of split in two: the feminine part went underground while I tried to play the role expected of me above-ground. I think this is a very common experience among those who experience gender incongruity in childhood.

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44 minutes ago, Betty K said:

@awkward-yet-sweet, another way of saying this is that I was completely happy being myself until I hit a particular age and went to a particular school at which a certain gender presentation was expected of me. After that, my self-perception kind of split in two: the feminine part went underground while I tried to play the role expected of me above-ground. I think this is a very common experience among those who experience gender incongruity in childhood.

I was being raised similar to a 'little girl' by my grandmother (AMAB/intersex). I was quite content sewing, knitting, baking/cooking, and catering weddings. I was just another tomboyish little girl. 

 

Then what you described happened at home!

 

My father took over my upbringings and ballet, piano lessons, and time with grandma all disappeared. I was signed up for every sport available and later on two years of testosterone treatments to 'fix' my low levels. Needless to say none was a good fit. I longed to go back to being who I was, but that became increasingly distant. 

 

Grandma's passing just confirmed that I seemed to have no return. 

 

I lived in boy-mode because it was beat into me. It was expected of me, and it didn't matter if my body didn't fit the profile (wide hips and large breasts). 

 

45 years of gender dysphoria later I finally found myself again. My feminine side didn't need to go underground anymore. 

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8 hours ago, Betty K said:


Brilliant. I wholeheartedly support this. But I suspect in most cases a “deficits-based framing” is necessary to obtain insurance? I have no firsthand experience of this as I don’t have medical insurance, so I may be wrong. But it seems to me the trans community is caught in a bit of a bind: if we finally convince the world that gender incongruence is not intrinsically pathological then we may argue ourselves out of medical benefits.

Betty,

 

You raise an excellent point. If there is no distressful condition, why is further treatment required. It is a funny slope in that regard. I worried as I was going through counseling leading up to my constellation of surgical procedures, would there be a point where it was deemed that I was no longer dysphoric. One of the more common psychiatric screens is the PHQ-9 scale. We use this in our assessments both in primary care, as well as the emergency department. You go to your counselor, and you mention you have thought about killing yourself, well, you may get tagged with suicidal thought. Not something you want to be tagged with because of the stigma. Let's face it, a vast number of us probably have thought about ending everything.

 

This is a fine line. One may be dysphoric, but at what point is it successfully treated. It is also a miserable mess dealing with the insurance companies and their incessant games. Some of the insurance companies have great coverage for trans individuals and some just play games. 

 

While I believe there are points during which we may feel euphoric about our progress, there are still battles to fight. Even with the procedures I have, I still dysphoria over a life spent in hiding, feeling sullen, withdrawn, and pissed off. It takes time to resolve much of that. There are great days and not-so-great days. Another aspect of dysphoria all unto itself is whether the procedures went as we thought they would. Then we face being labeled as dysmorphic instead of dysphoric. Let's be honest. Not all surgeries have great results. The talent varies from surgeon to surgeon.

 

While I think that the idea of dysphoria vs euphoria is an interesting discussion, how does it translate to the real world. Most folks do not seek medical care or psychiatric care when things are rosy. The other aspect of gender transition and combating the dysphoria that we face is that transition does not magically make everything better. While one may feel that boost in finally being on the pathway they want to make them whole, the truth is that most of us face some real struggles in beginning transition, and during transition. This can add additional stress to all of the other negative things going on. We may still have many of the same stressors throughout and after successful transition.

 

The biggest take away for me, especially considering the vast number of us who have so many similar thoughts, is that we are not alone in this world. We exist. We get a lot of negativity, but regardless, we are worthwhile human beings who are as good as anybody else. We have our inherent strengths, and our inherent flaws, but we are more than the sum of being transgender. The sad reality is that nobody can truly understand where we are in the universe unless they are like us, or are close to us. Many of us have tried to wall ourselves off from the hurt inflicted on us. That isolates us more, and because of the way society has been marginalizing us more over the past four years, I am afraid it will only get worse for a while.

 

I think we could all use some euphoria!

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      Oh my, here it comes...     It looks like there is a half moon out my window...  4:51am    
    • KatieSC
      While it is encouraging that they have deemed that they cannot ban the treatment, the bigger question is what treatments they will cover as a result. Speaking as a transgender female, this is a difficult definition. A fair number of insurance plans already cover the basic vaginoplasty, however, for those of us who have a rather masculine appearing face, a heavy beard, a deep voice, and other defining characteristics, attaining a passing feminine appearance is difficult without gender-affirming facial feminization surgery, genital and facial electrolysis, speech therapy and if necessary, gender affirming voice surgery, as well as other body contouring procedures. I view all of these procedures as life-saving in the sense that blending in, and thus avoiding an assault can come down to looking and sounding like you are female. I think the transgender males have a bit more ease with blending in than we do. There will be disagreements as to what constitutes enough surgery to be your truest self. We all pretty much understand that our true gender is locked in our mind. The issue is what can we do to modify our bodies enough to get the congruence between what is in our head, and how we perceive ourselves in the world. Is some of it cosmetic? That is hard to say for sure. I have had insurance companies insist that facial electrolysis is purely cosmetic. Well, most women do not have an Abraham Lincoln beard coming through. Some insurance companies have insisted that speech/voice therapy, as well as voice surgery, are purely cosmetic. I scoured the cosmetic counters for any makeup that would enhance my voice. Being feminine and passing does not mean I get to look and sound like Fred Flintstone in a dress. That kind of weirds folks out, and sets us up to be ridiculed and assaulted in my estimation.   My one insurer told me that beyond the vaginoplasty that all of this was cosmetic. In an appeal hearing, I asked the group that if they had a 14 year old daughter who was in an accident that resulted in a large facial scar, would they want the child to receive the best care to remove the scar? Of course they would. I pointed out though, that while she may have the scar, she could live with it. I asked them if the removal of the disfiguring scar in a 14-year old would be difficult for the child when the other kids made fun of her. Of course, they all nodded their head. I explained to the group that for folks like us, it is no different. While it may be cosmetic to a point, these procedures are essential to our well-being, and not something we are doing to be on a YouTube channel.   Now some who are trans, or gender fluid, may not want to opt for the procedures. There are quite a few of us that do, but the cost is prohibitive. What also clouds the issue are the surgeons who operate out of large medical centers who participate in the large insurance pools. How many of our sisters and brothers have had to pony up some major dollars to a surgeon who is out of network? Good luck trying to get the surgery paid for by your insurer. They may pay you what they pay the surgeons in network, but you won't get that much in reimbursement. A fair number of insurance companies balk at speech and voice therapy, and many will not cover voice surgery. Then there is the issue of electrolysis. A day at the "spa" for electrolysis with anesthetics will run around 3,000 bucks or so, and you may need many repeat visits. Many of the insurers fail to pay for that as well. Just about none of the insurers will cover body contouring procedures such as a panniculectomy, or liposuction. When the insurance companies will just help us become our truest selves, then we will have progress with gender identity laws.   The one good thing that this decision does is preserve the primary care for transgender individuals. I have to wonder how Florida and the rest of the states who have banned having Medicaid cover transgender healthcare are going to act. This should be an interesting fight. When we have the ability to seek care and get what we need for our true needs, without any pre-judgements, then these court orders will mean something. A court order without parameters for the insurance companies is hollow.
    • Mirrabooka
      @April MarieI just noticed that it's your birthday today! Happy Birthday to you!!!!!! 🥳🎂🎁🎉❤️
    • Mirrabooka
      Morning y'all, fingers crossed for everyone who has stuff going on.   Welcome back to reality @April Marie, enjoy your improving weather!   Why is it that we humans always take too long to acclimatize to the changing seasons, especially when it gets colder like it is here? Maybe I'm just getting soft in my old age, lol.    
    • Heather Shay
    • Heather Shay
      Speculation , worst or best case, neither.
    • Heather Shay
    • Heather Shay
    • Heather Shay
    • Heather Shay
    • Heather Shay
      @RiyaHello and welcome. I also live in Ohio and it is a challenge but I applaud you for knowing pretty early on and becoming who you really are. Congratulations!
    • Heather Shay
      Do you feel safe in the country you now live in?
    • Heather Shay
      Oooooooooooooooops, I forgot yesterday.   I was thinking of a few bands who had a member invited who said no and went right into obscurity or left before the band got big.   1) Led Zeppelin -  origially wanted Terry Reid to be lead vocalist and he decided the stay solo. 2) Crosby, Stills & Nash - invited John Sebastian to join before Neil Young, Sebastian said no. 3) Signe Anderson quit as lead vocalist with Jefferson Airplane and they replaced her with Grace Slick.    
    • April Marie
      Good morning, everyone! We're back from a short vacation with friends to the mountains of NC. It was a fun time driving the twisty mountain roads.   Now it's back to reality of cutting grass, washing windows and putting in screens and putting out the porch furniture. Coming home to warmer weather than when we left is glorious.   Happy Anniversary @Willow!    I hope your family is feeling better @KymmieL - my wife and I shared a stomach virus several weeks ago that was horrid.   Hang in there @Birdie, it will all work out!!   Have a wonderful day, everyone!
    • awkward-yet-sweet
      I think many Christians end up with a false dichotomy.  If we didn't choose to be how we are, then something in our environment did it. Is going along with it a sin?  Maybe.  But if so, its one of those times where we mess something up no matter what we do.  Part of the imperfect nature of this fallen world is that there are times where we'll sin no matter what we do.  In a no-win scenario like that, we do the wisest thing possible with our free will. 
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