That's all it is. It is not the arbiter of what is or is not real. It does not prescribe anything; that is, it does not tell us things are a certain way, and thus compel them to become so. It is a means of description in which accuracy and alignment with reliably provable fact are paramount. This is why it evolves. It is our best collective understanding of everything, and as we evaluate everything with the benefit of our current understanding of it, we can arrive at newer, better understanding of it. We achieve this primarily by hypothesizing as to how or why a thing is, and then testing that hypothesis as narrowly and specifically as possible.
For a very long time, in western culture, trans women were regarded by science as men who had a disorder. But as that description did not feel right to any actual trans women, the study of whom necessarily included interview, the description had to evolve. With new data, such as strikingly similar experiences of gender and body described by a wide variety of otherwise disparate and unrelated people, it became clear that trans women are in fact women, and we find new evidence to support that constantly. The pace of accepting this as fact is picking up, because we have started asking the right questions. Trans women, and the people who study us, are over the question of what we are, and have moved on to other questions, built off of the foundation of understanding that we are women.
One common refrain from cis people who do not understand what being trans really means, especially when it comes to this kerfuffle about bathrooms and locker rooms, is that girls like me "should just get the surgery" if we want to be in the women's room, with other women, since we claim to be women (a claim we make because, as women, we're women). This is said without any awareness of what is involved in these processes, by people who still fundamentally believe we are delusional men with a psychological disorder, and that gender lives in genitals.
But getting The Surgery is not as simple as going to Wal-Mart and hitting the Genitalia aisle and seeing what's in stock, picking up an affordable, American-made vagina, taking it home, and following the installation instructions. It's not as simple as stopping off at the local Genital Reconstructive Surgery shop after work and getting it taken care of. And it's not even as simple as getting other surgeries that require a multi-step insurance authorization process.
One challenge is dealing with multiple medical professional bodies who have been incrementally catching up to the reality of our existence. For example, nearly all trans health providers rely upon the WPATH Standards of Care for guidance. Most, if not all, insurers require adherence to them when they cover transgender services. The first edition of the WPATH SoC was released in 1979. Even though the version 7 standards are available, many insurance carriers are still referring to the version 6 standards, despite their outdated and inaccurate information about trans people. But even when version 7 was released, DSM-IV was the current DSM for mental health professionals, and it still referred to the condition of being transgender as a disordered one: Gender Identity Disorder.
When DSM-V was released in May, 2013, one of its changes was to formally de-pathologize the transgender existence. Like homosexuality before it, being transgender was finally recognized, through years of the application of rigorous scientific examination, for what it always was: not a disorder, but a natural variation. Something less common than most developmental tracks, but not actually wrong in any sense.There is no longer any diagnosis in the DSM for being transgender because, as science has advanced, we've collectively learned that it is not a mental illness. Instead, the DSM-V recognizes Gender Dysphoria, a type of stress that only trans people experience, and one that underlines many trans experiences. It's the stress of knowing you are one thing, and being told by everything around you, from your culture to your body, that you are something else. Interestingly, a "diagnosis" of this non-problem, for lack of a better word, is required in order to access services. This is the first step of many on the road to Genital Reconstructive Surgery (GRS, sometimes called "SRS," Sex Reassignment Surgery). As many of these steps are built around the now-outmoded pathologized model, they are regarded by a number of trans people, myself included, as unnecessary and draconian. Ironically, the "just go get the surgery" crowd and I agree on this. I should be able to just go get The Surgery. But I can't. Nobody can.
There's a more sinister problem around class and economics when it comes to figuring out who is "really trans," as many (understandably confused) cis people demand. Sometimes, even other trans people demand that. I was extremely lucky to be where and when I was when I realized I was female. I had no romantic relationship or job to worry about offending. I had reliable income, though it was an extremely tight stream. And I had access to some pretty comprehensive gender-affirming services through the VA. This meant I was able to "prove" I was trans by seeing a psychologist, who agreed, during our first-ever meeting, that I had been incorrectly designated male at birth. I didn't wheedle and beg, I just told him about my experiences, and he said I hit more than enough criteria for the diagnosis. It also meant I was able to afford the fees associated with legally changing my name and gender. People can change their legal names, for a fee, to whatever they like, whenever they like, generally speaking. But the gender marker can't be changed without the diagnosis, and in Washington, requires the use of a specific form.
Where I'm concerned, "proving" I'm a woman has already been done. But not everyone has access to that kind of healthcare, and even if they do, they don't always have the money to take legal steps to correct their gender or update their name. And since trans people are routinely denied housing, healthcare, and employment on the basis of their being trans, many of us find ourselves crushed under the weight of overlapping systems that each individually say they don't want to deal with the fact of our existence.
As a trans woman, I have to constantly prove that my gender is real. Not only that, I have to constantly prove that it's not what a lot of people insist it must be. I have the benefit of a lot of documentation from very well-qualified people behind me. But I was female well before any doctor said I was female. In fact, I was female before the doctor who took me out of my mother said I was male. That realization is why I can't support a requirement for trans people to have medical documentation supporting the validity of their gender unless it's in the context of a single-payer, guaranteed-as-a-right healthcare system with robust and modern transgender services.
It's been suggested that the changes to the DSM between the fourth and fifth editions were achieved through political means. This suggestion tends to come from people who view our existence as a political problem. It also tends to come from organized religious groups. The idea is that trans people, a number of whom, like me, did not really know that being trans was even an actual thing until they realized it applied to them, somehow are all connected and organized in the same way as the churches that come up with ideas like this. And that we've used that powerful (haha!), unified (are you serious?) community to lobby for these kinds of updates. It's the idea that trans women, for example, are a bunch of men who are essentially playing a dirty prank on the entire world. It's the idea that being transgender is not the singular trait, like eye color, that it actually is, but rather is one that is coupled necessarily with some kind of predatory sexual nature.And yet before I knew I was trans, I did not know any trans people, personally. I had, to my knowledge, directly met and interacted with all of three trans people. Two were trans guys I met peripherally, and barely interacted with, and the third was a trans woman with whom I went on one spectacularly uninteresting date. I was not part of some massive secret society, bent on dismantling "traditional" marriage or gender roles. I was just a girl who didn't know she was a girl, and I mostly spent my time wishing I was dead, for a reason I did not know or understand. And ironically, I was doing my best to uphold "traditional" marriage and gender roles, when it came to my own life.
When I did see those trans guys, I thought something to the effect of "that's kinda weird, but whatever," and did my best to treat them as they asked to be treated. I used their pronouns, I used the names they gave me, and the idea of either or both of them in a public restroom with me meant nothing to me at all. I treated the one trans girl with the same kind of acceptance, with the exception of expecting that she'd use a women's restroom, and not be in a restroom with me, since I was still under the impression that I was a guy.This is largely what I'm after from other people now. I don't expect them to understand the how or why of my womanhood. I don't honestly even care if they do. Reading up on all this shit is a big commitment that a lot of people don't have time for, because none of it applies directly to them. What I need is acceptance of the fact that I'm a woman. What I need is for other people to accept that reality, even though it seems incomprehensible to them, in the same way that (most) people accept that the earth is more or less spherical, and not flat, though that idea, too, was once the height of radical thinking, and widely rejected.
The rejection of facts does not nullify them.
It makes sense to me that groups that are organized around ideas or beliefs might also automatically perceive other groups as being similarly organized. But we're not a group. We're a demographic. Just like people with heterochromia, or mid-digital hair. And for trans people like me, the ones who knew something was wrong, but not what, for decades before realizing that the problem was an incorrectly designated gender at birth, that demographic was Them for a long time before it was Us.
When children who do not know each other, around the world, in multiple languages, are clearly declaring their gender as something other than what it was designated at birth, that is just natural variation. There is no cult leader. Because there is no cult.
Today, I completed my application for vaginoplasty with Dr. Marci Bowers. Dr. Bowers is the only surgeon contracted by Washington Health Care Authority (Medicaid) to perform this procedure. Her clinic is in California. It would not surprise me to learn that she is not just the only GRS surgeon for WA HCA, but for other states' HCAs, as well, in addition to California. In any case, there is a long, long line for GRS through WA state Medicaid.
If I were an out-of-pocket patient, I could get processed and into the queue right now, with a non-refundable deposit of $1,000. Without that, I am told it's an average of four to five months before the clinic receives pre-authorization from Medicaid. And that's when I get on the list. Not when I get the surgery done. When I get in line.
That line is two years and four months long.
I was told that, for patients who don't mind rescheduling their surgery date, cancellation openings can shift the queue a bit, and shave up to about six months off of the wait time. But there are some requirements before one can even submit an application. They include:
- Usually 12 months of continuous hormonal therapy for those without a medical contraindication.
- 12 months of successful continuous full time real-life experience.
- Demonstrable progress in consolidating one’s gender identity;
- Receive a diagnosis of Gender Dysphoria from a therapist
- Begin Hormone Replacement Therapy (requires referral from psychology)
- Be consistently on HRT for at least one full contiguous calendar year
- Live publicly and privately, 100% of the time, in gender expression coinciding with declared gender for at least one full contiguous calendar year
I was able to be seen by a psychologist about my gender dysphoria before the end of August, 2014, just a few weeks after I first realized it was a thing. That's very fast. I was diagnosed on the first visit. That's atypical. I legally changed my name and was "out" as a woman in all aspects of my life, full-time, within one month of realizing I actually was a woman, and had always been female. I was started on HRT by the end of October, 2014. As a veteran, I have access to these medications, and they are provided to me with no out-of-pocket cost. This is also not the norm.
Because HRT was the last of those to start, it is effectively the only start point that matters, when it comes to the one-year requirement. This means that the soonest I could have possibly applied for this service with Dr. Bowers was October 24, 2015, about four months ago. That date, itself, was barely a month after GRS was even covered by WA Medicaid. The earliest possible surgery date for me would have been around two years from now, and with the best possible cancellations scenario, I'd have been looking at late summer or early fall 2017. Instead, I'm looking at late summer or early fall 2018.
But consider that phrase: "12 months of successful continuous full time real-life experience." This means that to get the surgery that people who insist I don't belong in the women's room say I must get in order to be there, I have to use those kinds of spaces for at least a full year before I can even get in line to get that surgery in the first place. If trans women are legislated out of women's facilities, we cannot ever meet the requirements for vaginoplasty, requirements which have been developed to confirm as absolutely as possible that we are really women in the first place.This massive network of requirements and dependencies, both medical and legal, was not sketched out on a bar napkin and put into place worldwide a couple days ago by irreverent, free-wheeling doctors and legislators who were drunk when they wrote it. This has been developing for decades, as the science on what people like me really are has come to better describe us. The fact is, we have always been here. And we always will be. Even if you managed to somehow eradicate every transgender person alive today, another one would be born tomorrow, because that is how natural variation works. I chose my gender no more than I chose my skin color, my genetic risks for cancer, or my height. There is an uproar around our existence because it's not just new data on a thing that was previously considered solved by most people, but because it's about something fundamental to all of us.
When people say that penis = male and vagina = female, they tend to cite "basic science," and that is part of the problem. They will sometimes even say that they've known that this is how things are since some early grade, say, second, or maybe fifth. Maybe they'll talk about XX and XY chromosomes, and refer to their high school biology class.
What else did you learn back then, whenever "then" was, that turned out to be false, or at least overly simplified?
Someone who has earned a PhD is very far removed from a fifth-grade understanding of their area of study and expertise. They're well past high school biology, and they're relatively far beyond even a Bachelor's level of understanding. They have devoted years of their lives to understanding their subjects, and if they are currently licensed professionals, they are generally required to participate in continuing education. To make sure their knowledge continues to evolve with the rest of the scientific community. And those are the people who, through constant and continuous application of the scientific method — that process underlying all valid science, by which people like McHugh have been proven overwhelmingly biased and wrong — have concluded that trans women are women, that gender is a function of mind and not body.
Highly focused, dedicated and well-educated people are studying sex and gender, and they are the ones laying out these guidelines. The furor that people raise in objection to them is rooted in ignorance, and nothing else. It would be akin to me launching a massive political campaign against Tesla Motors demanding that they stop trying to trick us by calling their products "cars," because I learned that cars run on internal combustion engines when I was a kid, and I once took an engine apart in a shop class in middle school.
Transgender people are not a new phenomenon. What's new is that science is finally starting to understand us.
