Alice, great to see you here! I must admit that I haven't read the actual decision, I imagine it probably does talk about GID as a disease a lot. But it should be possible to put forward a legal argument that recognizes transition related medical care as medically necessary without qualifying being trans as a disease.

I mean for example, plenty of health care is considered medically necessary but not a disease, such as pre-natal care. I'm certain if a cis person required genital reconstructive surgery and their doctor signed off on it as medically necessary then the IRS wouldn't have given it a second thought.

As for the "holy grail," it's a reality in a growing number of cases. City governments, university systems, Ontario, Cuba, I got my own insurance policy to cover it after just one year working with my union on it.

Trans health coverage is a matter of equality. Insurance companies regularly cover hormones and genital reconstructive surgery for cis folks. Before my insurance became inclusive, I was flat out told that they'd cover my HRT, just like any other woman, if I could prove to their satisfaction that I was female, but so long as they considered me male they'd only approve me for testosterone therapy. When cis men can get testosterone and cis women can get estrogen, but trans folks are denied the same treatment, that's clearly a matter of discrimination.

"After just half an hour of speaking with me, Ms. Ellaborn said she could diagnose me with GID and get me any US surgeon I liked within six months"

That gave me a laugh. Good luck shaking that tree until a letter falls out of it.

I guess the only question left to ask is this: "What would you rather have happen?"

I don't like feeling diseased any more than the next trans person, but I do recognize that treating my mind-body disparity costs a significant chunk of change. On an entirely practical level this tax change means that these gender-affirming measures are recognized as any other medical procedure: necessary, as well as tax deductible. Disease-model or no, this means we get a tax break. Money that previously went to the government now goes to your pocket.

Whether or not we have the GID model of mental disorder, the idea that transgender conditions are diseases or conditions, or which gatekeepers we have to go through to get our treatment, some portion of the financial burden will still be on our heads. This decision puts money back into the pockets of transitioners. I don't see where that translates to making transgender issues more or less palatable in the eyes of the public.

I lied: i do have one more question to ask. "Why is the affirmation of our equality as taxable citizens an admonishment of our identity?" I think you tried to attack that question here, but I don't yet feel convinced of the thesis. Sorry.

When one says "treating GID" that doesn't mean that you will permanently have GID, rather that, for people who have issues about the gendered sexual characteristics of their bodies, this surgery has been proven helpful/even essential for many. It's treating the distress which comes from a particular physical state in some people. I don't see anything which says "if you experienced this and had to have surgery, therefore you will permanently be branded with the scarlet letters GID".

I paid out of pocket for my SRS (and paid a lot more than you did) and I think this is a very positive legal decision. What I do see (and sorry to bring up this issue yet again) is non-ops (and long term pre-ops) are still left with being stigmatized with GID, and I agree that's wrong. But quite honestly, in the practical world, this decision doesn't change that one iota.

I do have huge issues with ANYONE, transgender activists included, making a political issue against having SRS available to those who need it to further a specifically queer/LGBT agenda. This decision greatly helps many people who need it in being able to swing funding their SRS and that is what's important.

Btw, it's nothing new... trans people were able to itemize their surgeries for years until the GW Bush administration. This is restoring a right which was taken away. Of all the oppression trans people need to be concerned about, this decision wouldn't even be on my list.

I am re-evaluating my reaction to whether being trans should be classified as a disease or a mental illness.

Some years ago when I began transitioning, I thought "of course it's not a mental illness - I'm fine!!"

But having that attitude puts down people who are diagnosed with mental illnesses. In effect, I am saying "I don't have a mental illness, not like those OTHER people."

There shouldn't be anything wrong with having a mental illness. Lots of people are diagnosed with a mental illness, and none should be stigmatized because of it.

And what is a mental illness? One way of looking at it is that when you have a mental illness, it is difficult for you to make your way in the world. Being who you are is difficult. Things that other people find easy are difficult for you. This is a reality for trans people as well as people with other mental illnesses -- the world isn't set up to be friendly to us.

Also, just as anyone who is determined enough can get a GID diagnosis, so can anyone who is determined enough get a prescription for anti-depressives.

It seems to me that mental illness is the label that is put on people who don't fit into the way society is structured. And the fact that more and more people are labeled this way says a lot about our society and its values.

From the ruling:

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In the crash course on transsexualism that this case has forced on us, there are at least four approaches that those who’ve studied the phenomenon of such feelings have had. One response, curtly dismissed by the majority, is that this is a form of delusion:

It is not obvious how this patient’s feeling that he is a woman trapped in a man’s body differs from the feeling of a patient with anorexia nervosa that she is obese despite her emaciated, cachectic state. We don’t do liposuction on anorexics. Why amputate the genitals of these poor men? Surely, the fault is in the mind and not the member. - McHugh, “Psychiatric Misadventures”, Am. Scholar 497, 503 (1992)

For such psychiatrists, gender follows sex, is a fundamental part of human nature, and is not easily amenable to change. Those who take this view look at transsexual persons to uncover what they suspect are comorbidities--other things wrong with their patients that might explain the undoubtedly powerful feeling that they are wrongly sexed and whose treatment might alleviate the stress that it causes them.

A second approach focuses on the notion of “feeling female.” What does this mean? The answer adopted by the majority and urged by O’Donnabhain is that this is a shorthand way of saying that a transsexual person’s gender (i.e., characteristic way of feeling or behaving, and conventionally labeled either masculine or feminine) is strongly perceived by her as mismatched to her sex (i.e., biological characteristics). This, too, is highly contested territory--gender being thought by many, particularly feminists, to be entirely something society imposes on individuals. To such theorists, transsexualism is likewise a social construct:

The medical profession need not direct the gender dissatisfied to surgery. Counselling is possible to encourage clients to take a more political approach to their situation and to realize that they can rebel against the constraints of a prescribed gender role, and relate to their own sex in their native bodies.
-- Jeffreys, “Transgender Activism: A Lesbian Feminist Perspective,” 1 J. Lesbian Stud. 55, 70 (1997) (suggesting SRS be proscribed as “crime against humanity”); see also id. at 56 (citing Raymond, The Transsexual Empire (Teachers College Press 1994)).

Yet a third school of thought is that the origins of at least many (but not all) transsexual feelings--particularly those with extensive histories of secret transvestism--is that it’s not about gender, but about a particular kind of erotic attachment.
See, e.g., Blanchard, “Typology of Male-to-Female Transsexualism,” 14 Archives Sexual Behav. 247 (1985); Cohen-Kettenis & Gooren, “Transsexualism: A Review of Etiology, Diagnosis and Treatment,” 46 J. Psychosomatic Res. 315, 321-22 (1999) (summarizing research); Lawrence, “Clinical and Theoretical Parallels Between Desire for Limb Amputation and Gender Identity Disorder,” 35 Archives Sexual Behav. 263 (2006).

Scholars of this school regard SRS as justified--not so much to cure a disease, but because SRS relieves suffering from an intense, innate, fixed, but otherwise unobtainable desire.
See, e.g., Dreger, “The Controversy Surrounding The Man Who Would Be Queen: A Case History of the Politics of Science, Identity, and Sex in the Internet Age,” 37 Archives Sexual Behav. 366, 383-84 (2008).

These are all intensely contested viewpoints. The fourth and currently predominant view among those professionally involved in the field is the one urged by O’Donnabhain, and not effectively contested by the Commissioner: that the reason a transsexual person seeks SRS is to correct a particular type of birth defect--a mismatch between the person’s body and her gender identity. That mismatch has a name--GID--if not yet any clinically verifiable origin, and SRS (plus hormone therapy) is simply the correct treatment of the disorder.

I profess no expertise in weighing the merits of biodeterminism, feminism, or any of the competing theories on this question. But the majority’s decision to devote significant analysis to the importance of characterizing GID as a disease, and SRS as its medically necessary treatment, pulls me into such matters to give context to the majority’s analysis.

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That's about it for the other theories. We're insane, evil, or perverts.

And to treat us so we don't actually die would be to co-operate with a mental illness (because there HAS to be a "talking cure" according to their ideology, they've only been looking for it for 80 years, after all), or to commit a "crime against humanity" (again, because that's what their ideology says it is), or is justified because sexual deviants are people too. That plays real well with the voting public and legislature.

Notice a certain common thread that binds these three very contradictory views together? All three have been used as reasons to deny us basic human rights in the past - and will no doubt continue to be used in the future.

I guess we're lucky. Because those prejudiced against us can't agree on exactly why we're a Bad Thing(tm). Just that we are. And that rather undercuts their case, and strengthens our contention that the animus against us has no rational basis. I don't think even the Jews have been accused by Anti-Semites of being Evil, Psychotic, and Deviant.

It's been 8 years since Ms O’Donnabhain put in her 2001 Tax Return. It's taken 8 years, and untold expense, to claim the huge sum of.... $5,679. Actually less, the amount for breast augmentation was disallowed as having its necessity insufficiently evidenced in this particular case. So her refund will be less than $5,000.

Other TS people will now be rushing to file amended returns. Too bad the cut-off date is 3 years, so if they had treatment before 2007, they're out of luck.

For the rest - Many Happy Returns.

Ok, the mis-information, mis-conceptions and out and out deliberate slight of hand here compels me to respond.

Transsexuality is a prenatally developed birth condition. Period. That's what all the actual science to date supports. There is not a shred of scientifically valid evidence that it is "mental" beyond the fact it is primarily seen by it's effect on "mental" understanding of one's self.

Dysphoric Imperative is the primary indicator of this medical condition. That means the absolute need to put the body and mind in congruence. If that is absent, one is not transsexual. This medical condition has a cure that is nearly 100% effective, surgical alteration of the body to match the internal sense of sex case membership.

SRS is a surgical medical treatment, but as such, it can be an actual treatment or it can be misused as cosmetic proceedure by those who do not have the condition it is a treatment for.

WPATH, as HBIGDA was originally set up to aid those with the medical condition in gaining access to medical treatment. That was the original purpose. Quickly the psychs turned it to promote their own agendas of gender as a social construct. Then it was further expanded to transgender rather than transsexual...at this point it essentially made itself meaningless, which is the place it's at today.

Classic transsexuals are basically trying to claim back a medical term for a medical conditon from identity politics where the medical meaning is basically erased. None of these positions here are possible if you understand the basics in place here.

Let me state this as clearly as I can: The original SOC was to assure you were NOT mentally ill when you presented for SRS. It was gradually subverted to a specific mental illness, GID. That model is discredited among actual medical practitioners.

Whenever I read American commentary on this subject, I am always amazed by the hysteria that is present in the backround. Not that things are perfect in Canada, but, as pointed out earlier, most of the single-payer provincial health insurance programs cover it. And when it didn't, a tax refund, as for any other physician service is available on a no questions asked basis. The politically driven tax system, so apparent in America, is not seen here.

Yes, for many years, I simply did not want to think of myself as a transsexual, though I knew, in the absolute core of my being that I wanted to be/was a woman, not the man I appeared to be.

I don't really understand the ideological fervour that propels the struggle to remove, I hate the term GID, but any reference to transsexuality from a medical diagnosis. There must be some alternative that isn't an artifact of bad theory that anything to do with gender identity--a conflation of both gender and sex--and that recognizes the medical need for us to conform our physical anatomy to our certain knowledge of our sex.

I believe too many comparisons to the struggles of gay and lesbian people, even to feminists, just distract us from our own necessary, principled and legitimate struggles.

But then, I don't know, in any part of my struggle, the moral panic that pervades American society and certainly encourages, if not drives, some of those marginalized by the need for conforming their physicality to identify with the struggle of others.

The simply question is, why must transsexual people become more than allies, but submit our struggles to the whims of others?

Why cannot the simple justice of our struggle, just as the simple justice of the struggles of gay and lesbian people on the one hand, and that of feminists on the other, be recognized as necessary and good and worthy of support on its own?

I am ambivalent about this ruling. We should think carefully before embracing it. I'm glad for Rhiannon, but I'm not sure whether I'm glad for the whole LGBT community. I also assume that the case may be reviewed by higher courts, and that may change the calculus significantly.

Thanks for writing about this. This is an important post, and I'll have to come back and read it again a few times to help sort out my thoughts.

as a trans woman and an attorney, I tend to agree with Austen's comments and with vivian's, as well. These kinds of decisions have little bearing on the general public's view of transsexualism. But as to that, on the margin, if they help folks think - hey, this is the condition they have, this is the treatment, shouldn't be a bigger deal than a person having heart surgery if they need it - then that is a help to us as trans people making our way in the world of people who know precious little of us and don't really know what to make of us.

If some of us find it easier to afford SRS, then that is a real help. I believe it will help me, if the decision holds. I think it may help many of us. If it helps with insurance coverage, that is huge.

And I think vivian's view is well stated also. I think we as trans people ought to think carefully before we rush to distance ourselves from "those people", where "those people" are the mentally ill or the disabled. The issue really concerns the stigmatization and marginalization of, and an explicit or implicit disapprobation of, what is different.

So I changed my sex. Big deal. I don't get why that needs scientific studies, pyschiatric evaluations, or brain scan research.

I don't have a "condition," a birth defect, or a mental illness. I don't need to justify myself by blaming it on a prenatal condition, or a female brain, or any of the myriad of excuses people use to say "I know it's shameful, but it's not my fault!"

I paid for everything myself. No, it wasn't easy, but it was important enough for me to find a way. I don't want any handouts. This was all my doing from beginning to end.

And I did everything possible to assimilate socially AND physically as a female. I'm not playing around with gender stereotypes or mixing male and female body parts. I make no claim to "being a woman inside" or being a classic trannsexual or any of the identity politics people justify their actions with.

My reasons really don't matter. What DOES matter is that I did what was required to assimilate, and by consequence (not demand, not assertion, not "presentation") I'm considered female.

So I don't want other people, be they the government or a "community," to project their own unresolved shame upon my motives and actions, stripping me of the responsibility for my choices.