Issues around gender

I am reading the World Professional Association for Transgender Health standards of care. There are overlapping issues around transgender.

First, there is the cultural concept of how a man should be, and the character of the person who does not fit that concept. Then, there is the enforcement on the person of the cultural concept, by family and peers. Then, there is the amount to which that person tries to hide difference, even from themselves, and the distress arising from the difference. Some people will not be bothered that others apparently object to their gender presentation, some will take it to heart. Transitioning is one solution to problems arising from these issues.

WPATH say Being Transsexual, Transgender, or Gender Nonconforming Is a Matter of Diversity, Not Pathology. Well, yes. Doctors might get involved because of the distress, or because the person wanted medical help with transition, but not to make the person conform to gendered expectations. We suffer stigma, so abuse and neglect from family and society, which can cause anxiety and depression.

WPATH say Treatment is available to assist people with such distress to explore their gender identity and find a gender role that is comfortable for them …What helps one person alleviate gender dysphoria might be very different from what helps another person. I feel treatment should also be available for the person who does not present with distress, because they have decided to transition. Aversion is an emotional response- “I find my genitals unpleasant”- but people might show dignity, and not wish to express that emotion as distress. However the diagnosis in DSM is gender dysphoria, or distress.

Find a role comfortable for the patient- transition is only one of several possibilities.

The standards of care are based on European and North American experience, and there is a wide diversity in cultural construction of gender around the world. Doctors elsewhere should apply the principles of the SOC being sensitive to the local culture and to patients’ needs. These principles include the following: Exhibit respect for patients with nonconforming gender identities (do not pathologize differences in gender identity or expression); provide care (or refer to knowledgeable colleagues) that affirms patients’ gender identities and reduces the distress of gender dysphoria, when present; become knowledgeable about the health care needs of transsexual, transgender, and gender nonconforming people, including the benefits and risks of treatment options for gender dysphoria; match the treatment approach to the specific needs of patients, particularly their goals for gender expression and need for relief from gender dysphoria; facilitate access to appropriate care; seek patients’ informed consent before providing treatment; offer continuity of care; and be prepared to support and advocate for patients within their families and communities (schools, workplaces, and other settings).


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