GD is supposed to be placed in a chapter of its own, no longer linked with sexual dysfunctions and paraphilias (which will also have chapters of their own)

This reclassification, along with the change in title from Gender Identity Disorder to Gender Dysphoria, is a significant improvement in the diagnostic coding used for access to medical transition care, for trans and transsexual people who need it. Preceding diagnoses of Transsexualism/Gender Identity Disorders were grouped with "psychosexual" disorders in the DSM-III.

They were briefly moved to the class of Disorders Usually First Evident in Infancy, Childhood or Adolescence in the DSM-III-R in 1987 but were returned to the sexual disorders chapter in the DSM-IV, and DSM-IV-TR. Community advocates and supportive medical providers have long raised concern that this placement was clinically misleading and reinforced false stereotypes about gender diversity.

Gender identity is not specifically related to sexuality, sexual orientation or sexual dysfunction. Political and religious extremists have long exploited the sexual disorder grouping in the DSM to sexualize gender diversity and defame trans people as deviant. Trans and transsexual individuals have consequently lost their jobs, homes, families, children, and civil justice.

Unfortunately, the DSM-5 Task Force and APA Board of Trustees retained the Transvestic Disorder category in the sexual disorders chapter. Previous known as Transvestic Fetishism, it is grouped with paraphilic disorders such as pedophilia and exhibitionism and authored by Dr. Raymond Blanchard of the Toronto Centre for Addiction and Mental Health (formerly called the Clarke Institute of Psychiatry).

This punitive and scientifically capricious category maligns many gender variant people, including transsexual women and men, as mentally ill and sexually deviant, purely on the basis of nonconforming gender expression. It is written to promote Blanchard's unfounded theories of "autogynephilia" and "autoandrophilia" that conflate social and medical gender transition with fetishism.

More than 7000 people have signed an online petition, sponsored by the International Foundation for Gender Equality (IFGE), calling for the removal of this harmful diagnosis from the DSM.

(An expanded version of this post may be found at the GID Reform Blog)

Now don't be sad
'Cause two out of three ain't bad

- Meat Loaf, 1977

On May 18, 2009, about 150 trans community members and allies gathered outside the Annual Meeting of the American Psychiatric Association in San Francisco to protest diagnostic policies that psychopathologize gender diversity. Bull horn in hand, I and others called upon the APA leadership to issue three public position statements in support of the dignity and health of trans and gender variant people.

The response from APA officials was silence - three years of it.

Then last week, on August 16, the APA announced two of these position statements, authored by Drs. Jack Drescher and Ellen Haller and approved by votes of the Assembly and Board of Trustees.

Position Statement on Access to Care for Transgender and Gender Variant Individuals

Therefore, the American Psychiatric Association:

1. Recognizes that appropriately evaluated transgender and gender variant individuals can benefit greatly from medical and surgical gender transition treatments.
2. Advocates for removal of barriers to care and supports both public and private health insurance coverage for gender transition treatment.
3. Opposes categorical exclusions of coverage for such medically necessary treatment when prescribed by a physician.

The second statement [pdf] acknowledges harassment and discrimination that trans and gender variant people face in employment, education, parental rights and civil justice. It notes that trans people are frequently victimized in violent hate crimes and inappropriately assigned in gender-segregated facilities . Similar nondiscrimination statements were issued by the National Association of Social Workers in 1999, the American Psychological Association in 2008, and WPATH in 2010.

Position Statement on Discrimination Against Transgender and Gender Variant Individuals

Therefore, the American Psychiatric Association:

1. Supports laws that protect the civil rights of transgender and gender variant individuals
2. Urges the repeal of laws and policies that discriminate against transgender and gender variant individuals.
3. Opposes all public and private discrimination against transgender and gender variant individuals in such areas as health care, employment, housing, public accommodation, education, and licensing.
4. Declares that no burden of proof of such judgment, capacity, or reliability shall be placed upon these individuals greater than that imposed on any other persons.

Although the APA lags years behind other leading medical and mental health associations in speaking out, these position statements represent an unprecedented shift in acceptance of human gender diversity by their leadership and membership. Given the APA's unique position in setting diagnostic policy that has been historically used to limit civil justice and transition care access for trans people, these statements come far better late than never.

However, the APA statements fall short of debunking the false stereotype that gender difference is inherently pathological. This is troublesome, because the proposed diagnostic criteria for the Gender Dysphoria category in the pending Fifth Edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) continue to mischaracterize gender identities and expressions that do not conform to birth-assigned gender stereotypes as symptomatic of mental illness.

By describing social and medical transition itself, or the desire for transition, as pathological, the new Gender Dysphoria diagnosis, like its controversial predecessor Gender Identity Disorder (GID), contradicts rather than supports the medical necessity of transition care that is affirmed in the new APA position statement. Even worse, the Transvestic Disorder category in the DSM-5 ascribes nonconforming gender expression and medical transition for many transsexual women and men to a defamatory false stereotype of sexual deviance and paraphilia.

Ironically, the Medical Care statement acknowledges these contradictions in the DSM.

...the presence of the GID diagnosis in the DSM has not served its intended purpose of creating greater access to care-one of the major arguments for diagnostic retention.

Thankfully, there is evidence of change in attitudes toward gender diversity at the American Psychiatric Association. In 2010, the DSM-5 Task Force proposed to rename the widely despised Gender Identity Disorder title (intended to imply "disordered" gender identity) to Gender Incongruence and a further change in 2011 to Gender Dysphoria (from a Greek root for distress). The new Position Statement on Discrimination [pdf] contains the APA's strongest statement to date that gender difference is not disease:

Being transgender gender or variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities;

Though long overdue, these position statements on Discrimination and Access to Care for Transgender and Gender Variant Individuals represent a historic step forward in reducing barriers to civil justice and transition care access. But they do not go far enough in deconstructing false stereotypes that equate gender diversity with mental sickness and sexual deviance. In the context of the proposed gender diagnoses in the DSM-5 and the recent treatment task force report, they represent a mixed message.

Please join me in thanking Drs. Drescher and Haller and the American Psychiatric Association leadership for these policy statements that acknowledge the worth and dignity of trans and transsexual individuals. In addition, I urge the APA to issue a position statement that gender identity and expression which differ from assigned birth sex do not, in themselves, constitute mental disorder; to correct diagnostic criteria in the proposed Gender Dysphoria category that malign gender nonconforming expression and transition itself as pathological; and to delete the punitive and scientifically capricious Transvestic Disorder diagnosis from the DSM-5.

An expanded version of this article with linked citations is posted on the GID Reform Blog. One two three graphic via Bigstock.

step one in what we're now going to see as a real change, a real reckoning, in antigay politics

Sadly, Maddow only told half of the story. For four decades, Robert Spitzer has played pivotal roles in mental health policies - not only on sexual orientation, but on gender diversity as well. Rachel Maddow and other journalists turned a blind eye to Dr. Spitzer's failure to retract a lifetime of trans psychopathologization, stereotyping gender identities and expression that differ from assigned birth roles as mental disease. This omission speaks to the marginal status of trans people within the GLbt rights movement and progressive media, as much as Spitzer's omission speaks to trans marginalization by mental health policymakers.

Shifting stigma from one oppressed class to a more oppressed class is not real change.

Visit msnbc.com for breaking news, world news, and news about the economy

Robert Spitzer played a central role in the declassification of same-sex orientation as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) between 1973 and 1987. The DSM is published by the American Psychiatric Association and remains the medical and cultural definition of mental disorder in North America. As Chairman of the DSM-III and DSM-III-R Task Forces and chief editor of the diagnostic manual, Spitzer oversaw removal of the last major vestige of gay diagnosis, "Ego-dystonic Homosexuality," from version III-R.

However, while depathologizing same-sex orientation, Dr. Spitzer simultaneously directed a massive expansion of trans-pathology diagnoses in the DSM. In 1980, a new category of Gender Identity Disorders (GID), including a Transsexualism (TS) diagnosis, was added to the class of Psychosexual Disorders in the DSM-III. The TS coding was paradoxical and controversial for many trans people.

Many community advocates and medical providers agreed (and do today) that some kind of diagnostic coding was necessary to facilitate access to medical and/or surgical transition care for those trans and transsexual people who needed it. On the other hand, defining a medical transition coding as a mental illness, rather than a treatable medical condition, contradicted access to hormonal and/or surgical transition care and encouraged gender conversion, or gender-reparative, psychotherapies- unsubstantiated treatments attempting to change gender identity and shame trans and TS people into the closets of their assigned birth roles. Vulnerable trans and gender nonconforming youth were targeted and institutionalized as a consequence of diagnostic criteria based on nonconformity to birth-assigned stereotypes.

In the DSM III-R, Dr. Spitzer's Task Force expanded the diagnostic criteria for children to emphasize gender role nonconformity for birth-assigned girls, including "persistent marked aversion to normative feminine clothing" (whatever that means). Even more damaging, a new category was added, Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type (GIDAANT), to psychopathologize for the first time the gender identities of trans people who did not need access to medical transition care.

The punitive category of Transvestism in the DSM-III was renamed "Transvestic Fetishism" in the DSM-III-R, to further stigmatize crossdressing or gender nonconformity by birth-assigned males as sexual obsession. This change served to sexualize a diagnosis that did not clearly require a sexual context in its diagnostic criteria. The DSM-IV Casebook, edited by Dr. Spitzer in 1994, went even further in pathologizing gender nonconformity, recommending a Transvestic Fetishism diagnosis for a self-accepting bigender male, whose crossdressing was not necessarily erotically motivated and whose primary distress was his spouse's intolerance.

Sexual and Gender Identity Disorders symposium from the 2003 APA Annual Meeting. From the left, Drs. Karasic (speaking), Hill, Winters, Moser, Drescher, Spitzer (front), and Fink.

In May, 2003, Dr. Spitzer and I presented papers to a symposium entitled, "Sexual and Gender Identity Disorders: Questions for the DSM-V" at the Annual Meeting of the American Psychiatric Association. The only trans person and non-clinical scholar in the session, I sat on the left side of the stage table with presenters advocating reform of the Gender Identity Disorder (GID) and paraphilia diagnoses in the DSM-5. At the far right end of the table, Spitzer joined former APA President Dr. Paul Fink in defending the status quo. Spitzer wasted no time in invoking the worn stereotype of disordered gender identity:

Children normally develop a sense of gender identity. It is not taught - it just happens. I would argue that by itself, the failure to develop a gender identity that is congruent with biological gender is a dysfunction.

In the May, 2006, issue of Congressional Quarterly Researcher, Robert Spitzer debated UC San Francisco psychiatrist Dan Karasic on the question of GID as a mental illness. Spitzer used his most defamatory language to date to argue that well adjusted post-transition adults should continue to be regarded as mentally ill, so long as they deviate from their birth-assigned sex roles:

Granted that hormone therapy or surgery may now be the only treatment that we can now offer the adult with GID... But surely something remains profoundly wrong psychologically with individuals who are uncomfortable with their biological sex and insist that their biological sex is of the opposite sex. The only diagnosis that is appropriate for such cases is GID.

In issues of social discrimination, historic context matters. Cisgender GLB people had every right to their outrage at Spitzer's 2001 attack on their dignity. This week, they had cause to celebrate his retraction. Wayne Besen noted that,

Spitzer just kicked out the final leg from the stool on which the proponents of 'ex-gay' therapy based their already shaky claims of success.

Perhaps, but trans and especially transsexual people are not celebrating. Dr. Spitzer and like-minded policymakers in American psychiatry have long kicked the the legs from under our human legitimacy, and the rush to his redemption in progressive media has cast our issues aside once again.

We too have been injured by Robert Spitzer's role in perpetuating defamatory stereotypes of mental "dysfunction" and deviance. Trans people continue to lose our jobs, homes, children, families, dignity and civil justice because of these stereotypes and continue to face predatory gender conversion psychotherapies.

These stereotypes lie behind every extremist political campaign that demeans our most basic civil rights as "bathroom bills." These stereotypes lie behind military discrimination and government policies that still malign us as "mentally unfit." These stereotypes convince parents and school officials to dismiss trans youth as "confused" or going through "a phase."

Trans communities have waited more than two decades for a retraction or an apology from Dr. Spitzer. and we are still waiting.

An expanded version of this post can be found on the GID Reform Advocates Blog

Overall, this newest SOC represents significant forward progress in respecting trans people and affirming the necessity of medical transition care for trans and transsexual individuals who need it. Although controversies and issues of transition care access remain in the SOC7, WPATH has announced a more frequent update process that will hopefully be more responsive to emerging evidence and clinical experience in the future.

First published in 1979, the SOC has provided clinical guidance to medical and mental health providers serving trans people, with an emphasis on transsexual individuals seeking hormonal and/or surgical transition care. In many parts of the world, particularly North America and Europe, the SOC has played a role in enabling access to medical transition care and in enabling medical and surgical practitioners to provide it. However, the SOC has been controversial among trans communities and supportive care providers.

Prior versions have been critized for unreasonable barriers to medical transition care, pathologizing language of "disordered" gender identities and "gender-disturbed children," maligning pronouns and terms for transitioned individuals, and compulsory psychotherapy requirements. Fortunately, successive revisions of the SOC have trended toward greater respect for trans and transsexual people and fewer unjustified barriers to transition care. For example, mandatory urological examinations were dropped from the 4^th Version in 1990, and mandatory psychotherapy requirements for those needing access to hormonal or surgical transition care were dropped from the 5^th SOC in 1998.

A run-down of the changes are after the break.

Perhaps the most historic change in the SOC7 appears in the section of ethical guidelines:

Treatment aimed at trying to change a person's gender identity and lived gender expression to become more congruent with sex assigned at birth has been attempted in the past (Gelder & Marks, 1969; Greenson, 1964), yet without success, particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical.

Though long overdue, this condemnation of gender-conversion or gender-reparative psychotherapies sets a new ethical standard for the mental health professions. Sexual orientation conversion therapies have been rejected by the American Psychiatric Organization, the American Psychological Association, the American Medical Association, the National Association of Social Workers and many other professional associations for over a decade. Yet the mental health and medical professions have maintained a double standard for trans, transsexual and gender nonconforming people victimized by analogous gender-reparative therapies that are equally harmful.

I commend the WPATH leadership and the SOC committees for taking this historic step and call upon the American Psychiatric Association and other professional associations to follow WPATH's leadership on this important issue.

De-psychopathologisation of Gender Difference

The 7^th Version of the SOC goes further than prevous versions in employing respectful language and dispelling false myths that equate nonconformity to birth-assigned sex and gender roles with mental illness. A section entitled, "Being Transsexual, Transgender, or Gender Nonconforming Is a Matter of Diversity, Not Pathology," prominently notes:

WPATH released a statement in May 2010 urging the de-psychopathologization of gender nonconformity worldwide (WPATH Board of Directors, 2010). This statement noted that "the expression of gender characteristics, including identities, that are not stereotypically associated with one's assigned sex at birth is a common and culturally-diverse human phenomenon [that] should not be judged as inherently pathological or negative."

We can only hope that the American Psychiatric Association and World Health Organizations will take guidance from this principle in future revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD).

The de-psychopathologization principle  is underscored by statements that, "Psychotherapy is not an absolute requirement for hormone therapy and surgery," first introduced in Versions 5 and 6--

A mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy - although highly recommended - is not a requirement.

The new standard clarifies gender dysphoria, from a greek root for distress, as the focus of treatment, replacing pathologizing language of "disordered" gender identity. Gender dysphoria is painful distress with one's current physical sex characteristics or assigned or ascribed social gender role. Social role transition to a congruent, affirmed gender role and hormonal and/or surgical transition treatments (for those who need them) are well proven in relieving this distress. The SOC7 notes,

...transsexual, transgender, and gender nonconforming individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available.

The American Psychiatric Association has already proposed to replace the defamatory diagnostic title of "gender identity disorder" with Gender Dysphoria in the pending 5^th Edition of the DSM.

Other Positive Changes

The tone and language of the SOC7 are more positive than in previous versions, with more emphasis on care and less emphasis on barriers to care. Some highlights include:

• Relaxation of the age 18 restriction for access to hormonal transition care.
• Removal of the three month requirement for either "real life experience" (living in a congruent gender role) or psychotherapy before access to hormonal care.
• Clarification that "the presence of co-existing mental health concerns does not necessarily preclude access to feminizing/masculinizing hormones."
• Removal of barriers to surgical care because of family intolerance or interpersonal issues.
• An expanded role for medical health professionals in granting access to hormonal therapies.
• Acknowledgement of informed consent model protocols, developed at community health centers worldwide for hormonal transition care.
• Emphasis of cultural competence and sensitivity for care providers.
• Expanded and clarified information on puberty delaying treatment for gender dysphoric adolescents.
• Graduated requirements for different kinds of surgical transition care.
• Recognition of diverse non-binary gender identities and expressions.
• Clarification on the role of the SOC as flexible clinical guidelines that may be tailored for individual needs and local cultures.

Issues for Future Revisions

Although the 7^th Version of the SOC is significantly improved over previous versions, there remain issues of concern to trans communities and their allies. One issue is promotion of a widely held myth that gender dysphoria in children will persist in only a small minority by adolescence, in other words, that gender identity in children is malleable and impersistent. These statements in the SOC are based on studies that conflated mere nonconformity of gender expression in children with the distress of gender dysphoria: painful distress with born sex characteristics or assigned gender roles. Among a new generation of gender dysphoric children from supportive families, children who have actually transitioned to affirmed roles congruent with their gender identities, there is so far very little evidence of impersistence. Hopefully, future revisions of the Standards of Care will quickly incorporate research findings on these new populations of affirmed youth, as they become available.

(Crossposted at GID Reform Advocates)

The Sexual and Gender Identity Disorders Workgroup of the APA's DSM-5 Task Force has partially responded to concerns about the GID diagnosis in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders. For example, the derogatory title of "Gender Identity Disorder" (intended to imply "disordered" gender identity) has been replaced with "Gender Dysphoria," from a Greek root for distress. DSM-5 authors have expressed a desire to focus on distress with incongruent physical characteristics and assigned gender roles rather than on difference.

Moreover, the workgroup has articulated a historic shift in diagnostic focus away from the stereotype of "disordered" gender identity:

We have proposed a change in conceptualization of the defining features by emphasizing the phenomenon of "gender incongruence" in contrast to cross-gender identification per sé.

However, the workgroup has not reflected these principles in the diagnostic criteria for gender dysphoria. They retain much of the flawed language from the DSM-IV, casting differences from birth-assigned roles and desires for medical transition treatment as symptoms of mental disorder. Worse yet, post-transition people who are happy with their bodies and affirmed roles remain entrapped by the diagnostic criteria and specifiers - they are permanently labeled as mentally and sexually disordered. The proposed diagnostic criteria and categorical placement in the DSM-5 continue to contradict transition and describe transition itself as pathological.

An international group of mental health and medical clinicians, researchers, and scholars, Professionals Concerned With Gender Diagnoses in the DSM, has proposed alternative diagnostic nomenclature based on distress rather than nonconformity. These include anatomic dysphoria (painful distress with current physical sex characteristics) as well as social role dysphoria (distress with ascribed or enforced social gender roles that are incongruent with one's inner-experienced gender identity).

For children and adolescents, these alternative criteria include distress with anticipated physical sex characteristics that would result if the youth were forced to endure pubertal development associated with natal sex. For those who require a post-transition diagnostic coding for continued access to hormonal therapy, the criteria include sex hormone status. Based on prior work by psychologist Anne Vitale, this distress may also be described as deprivation of physical characteristics or social gender expression that are congruent with inner experienced gender identity.

The resulting four-cornered definition of gender dysphoria, encompassing direct distress and deprivation distress around anatomic sex and ascribed/assigned gender, provides a cogent definition of the problem to be treated with medical transition care. It addresses prior false-positive and false-negative diagnostic concerns and does not contradict the treatment.

These alternative criteria acknowledge that experienced gender identity may include elements of masculinity, femininity, both, or neither and are not limited to binary Western stereotypes. They also define clinically significant distress and impairment to include barriers to functioning in one's experienced congruent gender role and exclude victimization by social prejudice and discrimination.

Suggested Diagnostic Criteria for Gender Dysphoria in the DSM-5

I would like to suggest that the APA adopt new diagnostic criteria for the gender dysphoria categories for children and adults/adolescents that are based on the following summary of work from the Concerned Professionals group:

A. A distressing sense of incongruence between persistent experienced or expressed gender and current physical sex characteristics or ascribed gender role in adults, or in adolescents who have reached the age 13 or Tanner Stage II of pubertal development. Incongruence, for this purpose, does not mean gender expression that is nonconforming to social stereotypes of assigned gender role or natal sex. The incongruence should be manifested by at least one of the following indicators for a duration of at least three months:

1. A distress or discomfort with living in the present gender or being perceived by others as the present gender, which is distinct from the experiences of discrimination or the societal expectations associated with that gender.

2. A distress or discomfort caused by deprivation of gender expression congruent with persistent experienced gender. Experienced gender may include alternative gender identities beyond binary stereotypes.

3. A distress or discomfort with one's current primary or secondary sex characteristics, including sex hormone status, that are incongruent with persistent experienced gender, or with anticipated pubertal development associated with natal sex.

4. A distress or discomfort caused by deprivation of primary or secondary sex characteristics, including sex hormone status, that are congruent with persistent experienced gender.

B. Distress or discomfort is clinically significant or represents impairment in major life functions in a role congruent with experienced gender identity. Distress or impairment due to external prejudice or discrimination is not a basis for diagnosis.

Regardless of the wording chosen for the DSM-5, these alternative criteria for Gender Dysphoria may be used in clinical practice today to inform treatment by clarifying the problem being treated. These alternative criteria may serve to facilitate clearer communication between primary care, medical specialty, and mental health providers, and they can enable patients and families of transitioning youth to make more informed decisions on treatment options.

What You Can Do Now

1. Ask the APA to reject diagnostic criteria and categorical placement for the Gender Dysphoria diagnosis that contradict transition or depict transition as symptomatic of mental disorder. Ask them to clarify that nonconformity to birth-assigned roles and being victims of societal prejudice do not alone constitute mental pathology. Go to the APA DSM-5 Gender Dysphoria pages for children and adults/adolescents, click on "Register Now," create a user account, and enter your statement in the box. The deadline for this second period of public comment is June 15.

2. Ask your local, national, and international GLBTQ non-profit organizations to issue public statements to clarify that nonconformity to birth-assigned roles and being victims of societal prejudice do not alone constitute mental pathology.

3. Ask mental health and medical professionals who work with the trans community to voice their concerns to the APA.

4. Spread the word to your network of friends and allies.

(Cross-posted at the GID Reform Advocates Blog)

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While GID has received a great deal of attention in the press and from GLBTQ advocates, the second transvestic category is too often overlooked. This is unfortunate, because a diagnosis of Transvestic Disorder is designed to punish social and sexual gender nonconformity and to enforce binary stereotypes of assigned birth sex. It plays no role in enabling access to medical transition care for those who need it, and it is frequently cited when care is denied.

I urge all trans community members, friends, care providers, and allies to call for the removal of this punitive and scientifically unfounded diagnosis from the DSM-5. The current period for public comment to the APA ends June 15.

Worse yet, Blanchard has broadly expanded the diagnosis to implicate gender-nonconforming people of all sexes and all sexual orientations, even inventing an autoandrophilia specifier to smear transsexual men. Most recently, he has added an "In Remission" specifier to preclude the possibility of exit from diagnosis. Like a roach motel, there may be no way out of the Transvestic Disorder diagnosis once ensnared.

What You Can Do Now

1. Go to the APA DSM-5 website, click on "Register Now," create a user account, and enter your statement in the box. The deadline for this second period of public comment is June 15.

2. Sign the Petition to Remove Transvestic Disorder from the DSM-5, sponsored by the International Foundation for Gender Education.

3. Demand that your local, national, and international GLBTQ nonprofit organizations issue public statements calling for the removal of this defamatory Transvestic Disorder category from the DSM-5. So far, very few have.

4. Spread the word to your networks, friends, and allies.

More Information

Cross-posted with additional comments at the GID Reform Advocates Blog.

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The Gold Rush is sponsored by the Gender Identity Center of Colorado, providing support, outreach, and advocacy for all forms of gender identity and expression since 1978. Please join us in Denver for an extraordinary transcommunity conference and incredible skiing/riding in the Rockies nearby.

Co-Directed by Carol Christenson and Gus Spheeris
Bravo Video, Boulder, Colorado
Executive Producer, Jean Hodges

You will want to see this uplifting documentary about the Joy of Authenticity. Trans children, adults and families share their touching stories of journeys from despair and loss to the joy of claiming and becoming who they were meant to be. This film was produced by PFLAG Boulder County to introduce the public to transpeople and gender diversity and to inspire dialogue about the issues faced by trans and transitioning individuals. The filmmakers and panelists interviewed in the film will answer questions and share their insights with the audience. Thursday, Feb 24, 1:30-3PM more information

Film Preview and Panel Discussion: Photos of Angie

Produced and directed by Alan Dominguez
Coproducers, David Dominguez and Jennifer Warren
Loco Lane Filmworks, Denver, Colorado
Executive Producers, John Huggins and Monica Martinez
Music by Ozomatli and The Flobots

Join us for a sneak preview of scenes from this documentary film about the remarkable life and tragic death of Angie Zapata, a teen transwoman brutally murdered in her Greeley home in 2008. Angie's story is presented in five acts that recount the five days of her killer's trial in Weld County, Colorado. This case is believed to be the first prosecution under a hate crime statute for the murder of a transperson. The film features interviews with Angie's loving family, local authorities and media, and community advocates. A panel of interviewees from the film and the filmmakers will lead a discussion and answer questions after the screening. This is a unique opportunity to preview one of the most important documentaries of 2011 and speak with the producers before its release. Thursday, Feb 24, 3:00-4:30PM more information

Nonviolence is a powerful and just weapon. Indeed, it is a weapon unique in history, which cuts without wounding and ennobles the man [or woman] who wields it. I believe in this method because I think it is the only way to reestablish a broken community.
--Martin Luther King, Jr., December 11, 1964

Forty-seven years after Dr. King's acceptance of the Nobel Peace Prize, these words remain as inspiring and urgent to us today as they were then. Against a backdrop of national dialogue on hate speech and gun violence, I have been heartbroken this month at escalating personal attacks online among transsexual women and deepening division between communities of gender diversity.

When we stereotype, scapegoat, or misgender others who have suffered the same discrimination as ourselves, we stereotype, scapegoat and misgender ourselves as well. As President Obama reminded us last week in Tuscon:

It's important for us to pause for a moment and make sure that we're talking with each other in a way that -- that heals, not in a way that wounds.

I consider all people whose gender identities or gender expression transcend the boundaries and stereotypes of assigned birth sex to be my brothers and sisters. I consider gender identities and expressions in all of the countless combinations of masculinity, femininity, both or neither to be equally valid, equally precious and equally deserving of equality and dignity. I strive to be a better ally for those whose gender identities, social identities and personal challenges differ from my own and to not impose my own narrative upon others. I strive for unity among those who share common barriers of prejudice, intolerance and false stereotypes of mental deficiency and sexual deviance. I invite all gender transcendent people and people of conscience to join me.

Tonight, we gather once again on this Twelfth International Transgender Day of Remembrance to honor those who lost their lives to hatred and violence. We remember, we mourn, those who were murdered this past year, because their gender identities or expression were judged to differ from stereotypes of their assigned birth sex. This annual Day of Remembrance was founded by Gwendolyn Smith in 1998 and is observed each November 20. Tonight, more than 200 communities around the world are joining us in observing this solemn anniversary.

We are also gathered tonight to honor the living, to celebrate the tenacity and courage of all who have overcome barriers of intolerance to live authentic lives, to simply be ourselves in the face of such adversity and danger.

I use transgender or trans as a term of social identity in the most inclusive context: masculine, feminine, nonconforming, crossdresser, bigender, dual gender, genderqueer, gender surfer, androgynous, transitioned, transsexual and many more. All human beings possess a unique blend of the masculine, the feminine, or both or neither, and in my view all are equally valid and equally precious. I also acknowledge and respect those of our community who choose not to socially identify as transgender. However, regardless of physical characteristics or surgical status or class or privilege of passing, all of us who transcend the bounds of our assigned birth sex are subject to anti-trans prejudice. We are here tonight to honor all of us and our affirming families, friends and allies.

On the International Transgender Day of Remembrance web site, Mr. Ethan St. Pierre reports more than 30 thirty people murdered worldwide since last November 20 out of hatred of gender diversity. This is down from 163 reported last year, and that is cause for hope. However, these known tragedies are likely a tip of a much larger iceberg of murders that were not reported, investigated, prosecuted or recognized as trans-related. All except one of the victims this year, a toddler, were trans women or presenting as female at the time of their deaths-- our sisters died in Istanbul, Indonesia, the Dominican Republic, Honduras, Malaysia, Brazil, Italy, Mexico, Pakistan, Turkey, and Thailand. Many died in circumstances too horrific to describe here. We know from years past that transmen are at risk as well.

Each life lost is to anti-trans violence is a loss too many. Each is precious; each is irreplaceable.

Of these more than 30 lives, nearly half, 14, were taken in the United States and its territories, 6 in Puerto Rico alone. They died in San Francisco, New York, Charlotte, Milwaukee, Chicago, Philadelphia, Houston, and in small towns with names like Maplewood and Southampton. There occurred the most tragic and senseless loss, Roy Antonio Jones III of the Shinnecock Nation, just 16 months old. On August 1st, he was savagely beaten to death by his mother's boyfriend, who later said he was "trying to make him act like a boy instead of a little girl."

At a candlelight vigil in honor of Baby Roy, Shinnecock spiritual leaders spoke of the message brought by his short life, "We must put the unity back in our community and rekindle how our people once lived as one." Perhaps this was Baby Roy's message to our transcommunity as well.

Here in Colorado, anti-trans violence has taken a toll close to home and close to our hearts in recent years. In 2001, 16 year old Fred, F.C., Martinez, who lived in the Navajo Two-Spirit or Nadleehi tradition, was brutally murdered near home in Cortez. On July 17, 2008, Miss Angie Zapata was savagely murdered in her home in Greeley, just before her 19th birthday. To their families, we offer our our love, thoughts and prayers.

I also wish to remember our sisters, brothers and queer sibs lost to a different kind of violence, perhaps even more deadly. Each year, uncounted scores of trans, queer and gender variant youth and adults are lost to suicide, to the consequences of shame and guilt that were never, ever, deserved.

In recent weeks, we have seen unprecedented media coverage of GLBTQ teen suicides linked to societal intolerance and bullying. One of them was Chloe Lacey, a 19 year old transwoman in Eureka, California, who took her life in despair on September 24. How many of us were at risk when we were young, alone, ashamed or hopeless that we could ever fit in to our own skin, let alone the world around us? How many of us are fortunate to have survived those vulnerable years?

Please support and be aware of the trans and GLBTQ suicide prevention resources that are available to those at risk: the Trevor Project, the Ian Benson Project at TransYouth Family Allies, and here in Denver, the Sent(a)Mental Project, a memorial to GLBTIQA suicides, founded by artist and author Dylan Scholinski, to name just a few.

In the midst of these tragedies, there is hope with the heartbreak-- hope inspired by stories of courage and resilience in the face of terrible adversity. We have one remarkable Colorado story very recently reported in the Denver Post. Ms. Alexandra Reyes was born in a traditional Mayan family in Cenotillo, Mexico in 1976. She transitioned to her affirmed female role at age 8 and endured terrible persecution and violence until she escaped to the U.S. Just this month, the Board of Immigration Appeals granted Ms. Reyes asylum status in the United States, based on the persecution and denial of protection that she would receive in her home country. Hers is a narrative of survival, perseverance and hope.

Angie's and F.C.'s deaths, and so many of these murders fueled by hate and marked by such extreme cruelty and violence, represent much more than crimes against individual victims. These murders are acts of terrorism against all trans, queer and gender nonconforming people. They are meant to threaten all of us who might dare step out of the closet or socially transition. In this war against gender diversity, our fallen sisters, brothers and queer sibs are heroes, not because of how they died but because of how they lived-- Affirmed and authentic lives that transcended the bounds of their assigned birth sex and defied the barriers and dangers of hate.

In this war, we often feel helpless, but our most powerful defense lies in the examples of our fallen. When we emerge from dark closets of despair, when we live our lives authentically and honestly, when we take our place at the table of humanity, we send our own powerful message-- each and every one of us. We gather tonight not just in remembrance of our sisters' and brothers' deaths but to stand in solidarity, with them and with each other, for dignity and against hate and violence. You, my brothers, sisters, families and allies are my heroes tonight. Thank you for standing here with me.

This diagnosis perpetuates false stereotypes of sexual deviance that are used to deny human dignity and civil justice to gender variant and transgender people. It punishes feminine gender expression that does not conform to masculine conventions. It pathologizes harmless consensual sexual expression and sexualizes gender expression that is not necessarily sexually motivated.

The Transvestic Disorder category is not limited to crossdressers or male-identified people. It also targets transsexual women with a specifier of "autogynephilia," a deeply offensive label to many transwomen, implying that all transsexual women transition for sexual reasons rather than harmony with gender identity.

Please ask the the American Psychiatric Association DSM-5 Task Force, Board of Trustees and elected leadership to reject the proposed Transvestic Disorder category and remove this gender nonconformity diagnosis from the DSM-5.

The publication date for the DSM-5 is now scheduled for May, 2013.

The proposed list of gender related diagnoses in the DSM-V are after the jump.

Please check the GID Reform Advocates site for updates and views on these draft diagnoses.

Petitioner has shown that her hormone therapy and sex reassignment surgery treated disease within the meaning of section 213 and were therefore not cosmetic surgery. Thus petitioner's expenditures for these procedures were for "medical care" as defined in section 213(d)(1)(A), for which a deduction is allowed under section 213(a).

However, this recognition of the legitimacy of medical transition came at a cost to the dignity of transsexual women and men. It relied on the flawed diagnostic nomenclature of Gender Identity Disorder (GID) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its implication of mentally "disordered" gender identity. Paradoxically, this case fueled opposition to medical transition access, based on the current wording of the very same GID classification and its more virulent companion diagnosis of Transvestic Fetishism. While the Tax Court decision underscored the utility of some kind of diagnostic coding for those who need access to hormonal or surgical transition care, it also illustrated the urgency of reforming the GID diagnosis and removing the Transvestic Fetishism category in the next revision of the DSM, published by the American Psychiatric Association (APA).

Ms. Rhiannon O'Donnabhain underwent corrective genital surgery in 2001 and claimed a tax deduction for surgical and hormonal treatment expenses as well as the cost of a breast augmentation procedure. Her courageous nine year battle with the IRS to affirm the medical legitimacy of her transition care took a tortuous off-again, on-again path among the potholes of politics and prejudice.

Any notion that medical treatment for a transgender person is purely cosmetic is based on misunderstanding and prejudice, not medical science.

In November, 2004, the IRS reversed the examiner's decision and allowed Rhiannon to deduct her surgical expenses as medically necessary and professionally prescribed. However, political extremist groups responded by pressuring the Bush Administration to deny tax deductions for all medical transition care. They based their arguments on the same psychiatric classification of GID that GLAD cited to win the appeal. The following month, Rev. Louis Sheldon, chairman of the Traditional Values Coalition (TVC), wrote IRS Commissioner Mark Everson:

[B]y giving this tax deduction, your agency will be encouraging other mentally disturbed individuals to consider such surgery as an unneeded surgical procedure for what is a troubled mind--not a troubled body.

The IRS caved to political pressure in October, 2005. IRS Branch Chief Thomas Moffitt issued a Memorandum of Chief Counsel Advice that reversed the decision of the appeals officer and once again denied Rhiannon's deduction of medical transition expenses. Moffitt demeaned Rhiannon with maligning pronouns of her assigned birth sex and concluded,

In light of the Congressional emphasis on denying a deduction for procedures relating to appearance in all but a few circumstances and the controversy surrounding whether GRS is a treatment for an illness or disease, the materials submitted do not support a deduction.

Astonishingly, Moffit based his ruling, not on respected medical literature, but on a political magazine called First Things, published by the Institute on Religion and Public Life. He cited an article by psychiatrist Paul McHugh, known for employing false stereotypes of mental pathology to terminate gender confirming surgeries at John Hopkins Hospital in the 1970s . McHugh mocked post-operative transsexual women as "caricatures" and invoked the current classification of mental disorder to discredit medical transition care:

Once again I concluded that to provide a surgical alteration to the body of these unfortunate people was to collaborate with a mental disorder rather than to treat it.

Finally, Chief Moffit erected an addition political barrier, unprecedented for other minorities, to transsexual citizens seeking equal treatment under the tax code:

Only an unequivocal expression of Congressional intent that expenses of this type qualify under section 213 would justify the allowance of the deduction in this case.

Civil justice advocates were outraged at such tactics by the Bush Administration. Professor Lynn Conway noted,

To deny such people medical deductions for the medical correction of their bodies - people who often face extreme financial and employment difficulties during their transitions - is unfair and inhumane. The claim that such people require a special "act of Congress" before being treated fairly exudes not only ignorance and intolerance, but also open Executive Branch hostility towards gender variant people.

Berkeley tax attorney Donald Read commented in the San Francisco Chronicle

The IRS should not allow religious views to impact the administration of our tax laws... We all should be concerned about the politicization of the IRS, not only against gay and transgender people, but in all its forms.

Rhiannon's suit was heard by the U.S. Tax Court in July, 2007. She was again represented by the GLAD legal staff as well as co-counsel from the Boston firm of Sullivan & Worcester.

Senior IRS attorney John Mikalchus repeated the party line from the TVC and Paul McHugh that transition in itself represents psychopathology, citing the current GID diagnosis. He stated that surgery, hormones and other transition treatments do not cure cross-gender identification but "reinforce" it.

Mikalchus also invoked the second gender diagnosis of Transvestic Fetishism, speculating that many transsexual women seeking corrective transition surgeries are afflicted with a paraphilic sexual preoccupation with dressing as women. The APA fueled this false stereotype with publication of the DSM-IV in 1994, where TF was expanded to specifically include transsexual women who are attracted to other women. Mikalchus further belittled Rhiannon with the term, "autogynephilia," an unsupported derogatory theory promoted by Toronto sexologist Raymond Blanchard, associating male-to-female transition with a narcissistic sexual arousal at "the thought or image of oneself as a woman." Dr. Blanchard was largely responsible for the current Transvestic Fetishism diagnosis in the DSM-IV. As chairman of the APA's Paraphilias Subcommittee for the pending DSM edition, he has recently proposed
expanding the TF diagnosis with the title, Transvestic Disorder, and adding "Autogynephilia" as a diagnostic specifier.

Despite these barriers, the Tax Court ultimately rejected the IRS portrayal of transition as pathological and its associated medical care as "cosmetic." On February 2, 2010, the Court ruled that Rhiannon's hormonal and surgical transition treatments --

were for the treatment of disease within the meaning of § 213(d)(1)(A) & (9)(B), I.R.C. and thus not "cosmetic surgery" excluded from the definition of deductible "medical care" by § 213(d)(9)(A), I.R.C. [paraphrased]

A 69 page majority opinion, authored by Judge Joseph Gale, once again reversed the IRS denial and allowed Rhiannon to deduct her expenses for hormonal medications and corrective genital surgery (although it denied a deduction for her breast augmentation expenses). Their decision rested upon an interpretation of the GID diagnosis as "a serious, psychologically debilitating condition," rather than a demeaning indictment of "disordered" gender identity. Although political extremists and the IRS attempted to exploit conflicting and ambiguous language in the current GID nomenclature, the GLAD legal team and expert witness Dr. George Brown successfully clarified that severe persistent distress with current physical sex characteristics (often termed anatomical dysphoria.) is the true focus of medical transition treatment. In spite of the shortcomings of the current Gender Identity Disorder and Transvestic Fetishism diagnoses, they persuaded the Court that the necessity and efficacy of these treatments in relieving this debilitating distress is well established. Jennifer Levi, Director of GLAD's Transgender Rights Project, noted,

In this landmark ruling, the Tax Court affirmed the consensus position of the medical establishment that transition-related medical care is essential for many transgender people.

However, the political fragility of this ruling and the contradictory role of the GID and TF diagnoses in establishing the medical necessity of transition treatments are underscored by the dissenting opinion (p. 119-139) of Judge David Gustafson. Joined by four other judges, he opposed allowing a deduction for transition surgeries, stating:

One could analyze the GID patient's problem in one of two ways: (1) His anatomical maleness is normative, and his perceived femaleness is the problem. Or (2) his perceived femaleness is normative, and his anatomical maleness is the problem. If one assumes option 2, then one could say that SRS does "treat" his GID by bringing his problematic male body into simulated conformity (as much as is possible) with his authentic female mind.

However, the medical consensus as described in the record of this case is in stark opposition to the latter characterization and can be reconciled only with option 1: Petitioner's male body was healthy, and his mind was disordered in its female self-
perception.

In its present form, the diagnostic criteria and supporting text of the GID diagnosis can all too easily be inferred in Gustafson's second context of "disordered" gender identity, in contradiction to the medical necessity of hormonal and surgical transition treatments. If the intention of the Internal Revenue Service was to punish transsexual people for nonconformity to their assigned birth roles, the American Psychiatric Association, inadvertently or not, handed them blunt instruments of oppression with the current GID and TF diagnoses. Rhiannon herself said it best,

It's a Catch-22. I have to accept the stigma of being labeled as having a disorder [or] a mental condition ... in order to get benefits. I haven't liked this diagnosis from the very beginning. But I've got to play the game.

This week, on February 10, the American Psychiatric Association is scheduled to release draft diagnostic criteria for the Fifth Edition of the DSM for public review. In the DSM-V, the APA has an opportunity to correct the shortcomings and ambiguities of the GID diagnosis that pose barriers to civil justice and access to medical care: (1) clarifying distress as the diagnostic focus rather than nonconformity to assigned birth sex roles; (2) excluding from diagnosis those who suffer no distress or impairment with their bodies or ascribed social gender; (3) clarifying that transition is therapeutic and not pathological; and (4) removing maligning pronouns and terms that disrespect the affirmed identities of transitioned individuals. The APA also has an opportunity to remove the Transvestic Fetishism category that is purely punitive and defamatory to many transwomen.

An American hero in the struggle for dignity and equality, Rhiannon O'Donnabhain deserves better from mental health policymakers. We all do.

This essay is also posted at GID Reform Advocates.

Tonight, on this eleventh International Transgender Day of Remembrance, we come together once again to honor those who lost their lives to anti-transgender hatred or prejudice. Our annual Day of Remembrance was founded by Gwendolyn Smith in 1998 and is observed each November 20 in communities around the world today. Attorney and advocate Lisa Gilinger has called this tradition our holy day in the trans community.

Thank you for joining us this evening, for sharing your sorrow, your grief, your fear, your outrage and your support.

We trans people are a diverse community. For me, transgender or trans is a term of social identity in the most inclusive context: masculine, feminine, nonconforming, crossdresser, bigender, dual gender, genderqueer, gender surfer, androgynous, transitioned, transsexual, pre-op, post-op, non-op, never-op -- we all transcend the bounds of our assigned birth sex. We are all subject to prejudice. We are all at risk. We are all honored here tonight.

We are also a community of diverse religious and spiritual beliefs. Many of us find comfort in traditional religious liturgy and ceremony. Others, I know, are haunted by painful memories of religious intolerance in churches, and I deeply appreciate that you have put those memories aside to be with us here. Tonight we gather across all of our differences, creating this safe space to memorialize our fallen sisters and brothers and embrace each other. From the bottom of my heart, thank you for being here.

Community advocate Ethan St. Pierre reports on the Remembering Our Dead Web Project more than fourteen people murdered in the United States this past year out of hatred and intolerance of gender diversity.

In 2008, 18 killings were reported in the U.S., including our own Colorado sister, Angie Zapata. How many more are unnoticed, unreported, uninvestigated, unprosecuted, or unacknowledged as trans? We do not know. I only know that a single human life lost is one to many, and these are only the victims that we know of.

Globally, the numbers are far more grim. Ethan reports 163 victims so far this year worldwide, more than twice the total of 2008. Thirty-five of these are from Brazil alone. Their stories are heartbreaking and horrifying. Their deaths bring the worldwide total since 1970 to well over 500 lives lost to anti-trans violence. Please know that these are but the tip of the iceberg of victims-- the few whose stories are known to us.

I can find no solace in making sense of this assault on our lives. I cannot understand the forces of hatred, ignorance and intolerance behind the killing.

Earlier this month, President Obama said this of the senseless murders of servicewomen and men at Fort Hood:

"It may be hard to comprehend the twisted logic that led to this tragedy. But this much we do know - no faith justifies these murderous and craven acts; no just and loving God looks upon them with favor."

It is no different for us or for our fallen brothers and sisters. Perhaps we will never comprehend why they were taken from us, but we can gather as a community to remember them, to honor them, to mourn their loss.

I ask that we also remember and honor our sisters and brothers lost to suicide. Some instruments of death are easy to recognize: the blade of a knife, the barrel of a gun, the clench of a fist. But there are other weapons, far more subtle, but no less deadly. To inflict undeserved shame and guilt upon someone already at risk from undeserved shame and guilt is to disregard, to discard, a human life. We have lost far too many wonderful people, who were shamed to death because their gender identities or expression differed from the demands of others.

Here in Denver we are fortunate to have artist and author Dylan Scholinski, founder of the Sent(a)Mental Project, a memorial to GLBTIQA suicides. He invites submissions of pictures, art, stories and creative works by all whose lives have been touched by suicide in our communities.

In the midst of tragedy, this year has brought signs of hope as well. Less than a month ago, President Obama signed into law the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act. I acknowledge that there is diversity of opinion within our communities on hate crimes laws and enhanced penalties, however this law is historically groundbreaking in two ways: it is specifically inclusive of actual or perceived gender identity as well as sexual orientation, and it requires the Federal Bureau of Investigation to track statistics on hate crimes against transgender people. For the first time in history, the US Government has recognized that our lives matter enough to be counted. Words cannot express my gratitude to Judy and Dennis Shepard and the Matthew Shepard Foundation for their steadfast insistence of trans-inclusion in this bill.

Here in Colorado, a bias motivated crime law was ammended in 2005 to be specifically inclusive of transgender people. Earlier this year, this law was successfully applied in the prosecution of Angie Zapata's murder. Miss Zapata, a beautiful and loving young transwoman was brutally murdered in her home in Greeley just before her 19th birthday last year. Weld County District Attorney Ken Buck noted in a Denver Post editorial,

"The defendant's conviction on the bias-motivated crime sends a message to the community at large that this type of crime should not and will not be tolerated in our society. Every human being, whether they are like us or not, is of infinite worth"

Nothing can bring back our young sister, Angie, or erase the horror suffered by her family. However, I extend my deepest appreciation to District Attorney Buck, Deputy DA Brandi Nieto, Chief Deputy DA Robb Miller, and Greeley Detective Greg Tharp for their tireless work in seeking justice for Angie's murder and respect for her dignity. Murders such as Angie's are more than crimes against individuals, they are acts of terrorism against all of us. The state of Colorado and especially Weld County have taken a stand that our lives matter, and I take comfort in that.

The past year brought increased awareness of the roles that poverty, unemployment and homelessness play in placing our people and especially our youth at risk of violence. I am encouraged by ongoing efforts toward a trans-inclusive Federal Employment Nondiscrimination Act. In Colorado, Senate Bill 200 was signed into law last year, including for the first time transgender status in prohibiting discrimination in employment, housing and public accommodation. The Colorado Civil Rights Commission has continued this work in 2009, to clarify antidiscrimination rules that implement this law. These efforts impact issues of violence and safety in addition to issues of fundamental human dignity and civil justice.

Finally, I am gratified that the world premier of the documentary film, Two Spirits, will be at the Starz Denver Film Festival tomorrow (November 21st) on the Auraria Campus. The screening is sponsored by the Matthew Shepard Foundation. Two Spirits tells the story of Fred, F.C., Martinez, a Cortez, Colorado youth who lived in the Navajo Two-Spirit or Nadleehi tradition. F.C. was savagely murdered in 2001 at only 16 years old.

"Why are people killed for being who they are?" asks F.C.'s loving mother, Pauline Mitchell, who is with us tonight. So ask we all.

Perhaps someday human beings who transcend the bounds of assigned birth sex will no longer be hated, hunted and murdered because we are different. Until then, I often feel defeated and helpless in the face of the prejudice behind these crimes. I feel anger and outrage at this violence against us. And I feel grief at such senseless waste of human life, of unique special people who lived their truth with nothing to be ashamed of. But tonight, I feel surrounded by community; I feel comforted by your presence.

Thank you for being here with us.
Thank you for being here for us.
Thank you for remembering those we have lost.

Washington Park United Church of Christ
Denver, Colorado
November 20, 2009

The current psychiatric classifications of Gender Identity Disorder (GID) and Transvestic Fetishism (TF) in the Fourth Edition Text Revision of the DSM (DSM-IV-TR) inflict great harm to gender variant, and especially transsexual, people in three ways:

* Unfair Social Stigma
* Medical Care Access
* Gender-Reparative Therapies

An in-depth look at each after the jump.

The GID and TF diagnoses falsely label identities and expressions that differ from assigned birth sex as mental illness and sexual deviance. Behaviors and emotions considered ordinary or even exemplary for other (cisgender) people are mis-characterized as madness for gender variant people.

Transwomen (those who identify as women and were birth-assigned male) are consequently maligned as crazy and sexually suspect "men" by this stereotype and vice versa for transmen.

The defamatory classification of Transvestic Fetishism particularly targets transwomen, including a great many transsexual women (whose gender identities are dramatically incongruent with born physical sex characteristics), as "paraphiliac" or sexually perverse. Across North America, these diagnoses are cited directly when gender variant people are denied human dignity, civil justice, and legal recognition in their affirmed gender roles. Gender variant people lose jobs, homes, families, access to public facilities, and even custody and visitation of children as consequences of these false stereotypes.

Medical Care Access

GID and TF pose barriers to access to medically necessary hormonal and surgical transition treatment for those who need them. The diagnostic criteria, supporting text and categorical placement of GID and TF contradict social and medical transition and mis-characterize transition itself as symptomatic of mental disorder. Transitioned individuals who are highly functional and happy with their lives are forever diagnosable as mentally disordered, according to the current diagnostic criteria.

As a consequence, the medical necessity of hormonal and surgical transition treatments are not commonly recognized by care providers, insurers and government agencies. In the US, only the financially privileged have access to surgical care, with scant few exceptions.

Gender-Reparative Therapies

GID and TF implicitly promote cruel and harmful gender-reparative psychiatric "treatments" intended to enforce conformity to assigned birth sex and suppress gender variant identities and expressions into the closet.

Once diagnosed with GID or TF, the only way a transperson can be released from the current diagnostic criteria is to completely hide his or her gender identity and deny his or her authentic self. Children and adults, already at risk from undeserved guilt and shame, are subjected to more guilt, shame, torturous aversion therapies, drugs and even incarceration with these diagnoses.

The DSM-V

I urge reform and redefinition of the Gender Identity Disorder diagnosis to simultaneously address both issues of unfair social stigma and medical necessity of hormonal and surgical transition treatments.

I believe this can best be accomplished in the upcoming Fifth Edition of the DSM (DSM-V) by replacing GID with nomenclature emphasizing painful distress with born physical sex characteristics or ascribed social gender role that are incongruent with gender identity, rather than nonconformity to assigned birth-sex.

I am encouraged by a recent report from Drs. Peggy Cohen-Kettenis and Friedemann Pfafflin, of the Gender Identity Disorders Subworkgroup of the DSM-V Task Force. They acknowledge many of the GID issues described here and recommend a diagnostic focus on distress and exclusion from diagnosis of gender variant people who meet no scientific definition of mental disorder. However, I am concerned about their use of the word, "desire," in their proposed diagnostic criteria, which would ambiguously implicate desire for medical transition treatment in itself as symptomatic of mental illness.

I strongly urge elimination of the scientifically capricious and socially punitive Transvestic Fetishism diagnosis from the DSM-V. I am especially troubled by a September report from Dr. Raymond Blanchard, chairman of the Paraphilias Subworkgroup of the DSM-V Task Force. He proposes to retain the TF diagnosis, renamed "Transvestic Disorder" with its existing diagnostic criteria that ambiguously label all "behaviors involving cross-dressing" by those assigned male at birth as sexually deviant on the basis of their sexual orientation. Moreover, Dr. Blanchard proposes to add the deeply offensive and inflammatory term, "autogynephilia," as a specifier to the diagnosis. I ask the DSM-V Task Force and elected officials of the American Psychiatric Association to reject his proposal.

You can find the complete text and citations at GID Reform Advocates.

2. Like all people, you are a unique, distinctive blend of feminine and masculine.

3. Nature is diversity. Difference is not disease. Uniqueness is not illness.

4. All human beings possess a gender identity. None are disordered.

5. Hold your head high. Transcending birth-sex assignment is nothing to be ashamed of and everything to be proud of.

6. Closets kill. You bear no guilt for how you were born.

7. Try new paths that are different from those that have failed you in the past.

8. In learning the social conventions withheld from you in childhood, taste everything and try not to choke. You will discover the expressions that fit your soul.

9. You are not alone. Accept help and support when you need it. Offer help and
support when you are needed.

10 Be yourself.

On May 7, content on web sites for the show and the station were replaced a message expressing regret for these remarks but falling short of apology. The statement announced, "We will say what needs to be said this Thursday." The Thursday broadcast included community advocates Kim Pearson, Executive Director of TransYouth Family Allies and Autumn Sandeen, correspondent for the Pam's House Blend blog site, who first broke the story. Show owner Rob Williams began the broadcast stating,

We are here to make things right with the people who give us free speech, our audience
. ... I proudly and fully apologize for those comments completely.

For two and a half hours on Thursday, they were joined by Kim and Autumn in responding to listener calls in a very respectful and informative dialogue. GLAAD Senior Director of Media Programs Rashad Robinson later described the broadcast as encouraging,

"Today's episode of Rob, Arnie & Dawn in the Morning was an important opportunity to have a conversation about transgender people and lives, and we are encouraged that the hosts used their platform as a forum for education about these issues in a way that resonated with listeners,"

You can hear the entire broadcast on the KRXQ web site.

On the same day, KRXQ General Manager John Geary expressed the same sentiment on the station home page:

I know that you are probably aware of the recent comments made on the Rob, Arnie and Dawn Show, which have clearly upset, and caused pain to, many who heard them. I regret that, as those remarks do not represent my beliefs, or those of Entercom. We have always encouraged, and will continue to encourage, everyone on the Rob, Arnie and Dawn Show to exchange diverse and, at times, provocative points of view. These recent comments, however, were not just provocative; they were hurtful, and, they were unacceptable.

The show that aired today was intended to provide an open forum to candidly discuss the complex issues of sexual identity, and to be a positive and thoughtful consideration of this topic. We can't undo the hurt that may have been caused, but we can foster a greater level of tolerance and understanding by people on both sides of the issue. I believe that today's program began that process.

I would like to thank the Rob, Arnie and Dawn Show, the KRXQ FM management and station owner Entercom Communications for stepping up to do the right thing. I am grateful to everyone who raised awareness of the harm brought by verbal violence against children and especially to Kim Pearson and Autumn Sandeen for their leadership on the Thursday morning broadcast.

According to a GLAAD Blog update, McDonald's is the 10th major company so far to withdraw advertising from KRXQ.

Nine days ago, KRXQ morning hosts Rob Williams and Arnie States ridiculed and defamed a transitioned Nebraska child and her loving family, going so far as to promote shame and even violence against gender variant youth. States remarked:

"If my son, God forbid, if my son put on a pair of high heels, I would probably hit him with one of my shoes. I would throw a shoe at him. Because you know what? Boys don't wear high heels. And in my house, they definitely don't wear high heels."

Williams and States hurled hateful epithets toward transpeople and especially children throughout the thirty-minute segment, including "freaks," "abnormal," "idiot," and "dumbass."

While the bulk of the community response as been directed at the station management and its major advertisers, it is the parent corporation that should ultimately be held accountable. KRXQ FM in Sacramento is owned by Entercom Communications, Corp., based near Philadelphia, PA. According to the Entercom web site:

"Entercom is one of the five largest radio broadcasting companies in the United States, with a nationwide portfolio of 110 stations in 23 markets, including San Francisco, Boston, Seattle, Denver, Portland, Sacramento and Kansas City."

Mr. David J. Field is listed in the 2008 Annual Report as President and CEO of Entercom Communications. The principal address and contact numbers for him are:

Entercom Communications Corp.
401 City Ave., Suite 809
Bala Cynwyd, PA 19004
Tel: 610-660-5610
Fax: 610-660-5620

According to Google Finance, Entercom reported total revenues of $439 million in 2008 with 1600 employees. Its top five institutional investors listed on MSN Money Central are:

• Dimensional Fund Advisors, LP
• Barclays Global Investors, N.A.
• Goldman Sachs Asset Management
• Perkins Investment Management LLC
• AQR Capital Management LLC

To date, neither Entercom nor KRXQ have offered any apology or retraction. Instead, Arnie States fumed on May 3, "I'm not apologizing for what I said," He went so far as to threaten to quit before apologizing to the children and families harmed by his words, "If I was forced to apologize about this, I would have walked out the door."

In his responsibility to oversee the KRXQ station, CEO David Field has perhaps forgotten the principle emphasized on his own corporate web site, "The company has a long-standing commitment to responsible corporate citizenship ..." It is time for Entercom Communications to step up, to live up to this commitment.