Guest Blogger

Misguided Policy for Transgender Residents in NYC

Filed By Guest Blogger | June 17, 2011 4:30 PM | comments

Filed in: Living, Transgender & Intersex
Tags: birth certificates, Jen Pula, names, NYC, transgender issues

Editors' Note: Guest blogger Jen Pula, MD is a psychiatrist and member of the LGBT Committee of the Group for Advancement of Psychiatry

NY-State-Seal.jpgTwo transgender citizens, Sam Berkely and Joann Prinzivalli, are suing New York City's Department of Health and Mental Hygiene. Why? Ms. Prinzivalli felt humiliated when she went to the DMV to apply for a new license and a clerk kept calling her "sir" because her legal birth certificate listed her as "male." Mr. Berkely, whose birth certificate says "female," applied for new health insurance and endured a disapproving, shaming gaze from the company's employee.

Why are they suing New York City over these incidents? Because its 40-year old health code requires individuals to have genital surgery before changing their legal gender on their birth certificates. Yet today, many people like Prinzivalli and Berkely transition without undergoing genital surgery, and an absence of legal documentation can create situations that are often embarrassing, discriminatory and possibly even dangerous.

Calling a trans woman "sir" in public may expose her to potential harassment and possibly even violence. Possible denial of health insurance for being trans is discriminatory. When a trans person transitions to a new gender, they need new legal documents that accurately reflect their lived gender.

Policies regulating the change of gender on legal documents vary by state, locality, and country. Many states continue to stipulate a requirement of surgery, though most, including New Jersey allow for non-genital surgery (eg.-chest surgery in female-to-male transition). Washington State does not require proof of surgery and neither does the federal government to anyone born abroad to US parents. The ACLU has recently filed suit against the state of Illinois for requiring genital surgery. The UK, Spain, Uruguay, Hungary, and Finland require no surgery. German courts have struck down as unconstitutional a law that required genital surgery to obtain corrected birth certificates.

New York City's requirement for genital surgery is misguided and behind the times. Today, transgender people have a myriad of medical and social options available to transition. Some will avail themselves of hormones and surgery. Some will choose to have genital surgery. However, genital surgery is not always available, is not always affordable, is not always medically indicated, is not always desired, and it is not always effective. In New York City, only 5% of trans men and 20% of trans women undergo genital surgery.

Clinical experience has shown that one can undergo a successful gender transition without genital surgery and many people comfortably take this route. Being able to change legal documents is a vital step in completing a successful transition. According to the "Standards of Care" issued by the World Professional Association for Transgender Health (WPATH), "genital reconstruction is not required for social gender recognition, and such surgery should not be a prerequisite for document or record changes." Furthermore, WPATH cautions that the "delay of document changes may have a deleterious impact on a patient's social integration and personal safety."
Across the country, reform is needed so that requirements are consistent with the medical definition of gender transition, which does not require genital surgery. New York City's Department of Health and Mental Hygiene needs to revise its policy so that transgender citizens can safely and productively move on. Their lives depend upon it.

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I don't disagree but I would ask you what policy you would replace it with. I would think the state needs at least some sort of policy.

The post lists many places that do not have a surgery requirement, so presumably NYC could adopt any of those policies. The federal government, for example, requires a letter from a doctor saying the person has undergone appropriate clinical treatment.

The city can have a policy, but it's not really their business to determine what someone's sex is. That is a medical issue best left to doctors to determine. It was a doctor who incorrectly assigned the sex in the first place, so let's let doctors correct the error.

A couple of points:

Calling a trans woman "sir" in public does not *maybe* expose her to *potential harassment*, it IS harassment. Period.

As far as this statement goes:

"most, including New Jersey allow for non-genital surgery (eg.-chest surgery in female-to-male transition)."

I think that should be 'i.e.', not 'e.g.'; I may be wrong, but my understanding is that in many places where genital surgery is required for trans women to change their sex assignment on records, for trans men, chest reconstruction surgery is accepted as sufficient. Are there places that perhaps will accept only face surgery or something in trans women?

And finally, my understanding was that in Germany, trans women at least (I don't know about trans men) had to certify that they were sterile, and that was a big part of the surgery requirement.

Carol, the laws are all over the place. Most states allow trans men to change legal sex using top surgery only... but not all. A few require hysterectomy as well. There are no states which will change a trans woman's legal sex by virtue of her getting FFS and all require SRS to do so. I believe this to be hugely unfair and 'phallo-paranoid'. In the 90s, some states used to casually accept orchiectomy as a criteria for change of sex... I don't know of any state which does now. And you're right, in a lot of countries like Germany, Sweden and Japan, being sterilized is a prerequisite to changing your legal sex.

Gina, that's not true. I'm legally a woman in NJ. I've got an F on my driver's license and I've had no surgery at all. Granted, I had to jump through a zillion hoops in order to get it done, but I did. On the other hand my birth cert still says male because I was born in Brooklyn and haven't been able to change it yet because of NYC's antiquated laws.

Driver's license isn't legal change of gender. Yes, it and a passport are certainly important legal identification but they have nothing to do with your birth certificate.

Rebecca I'm sorry to bust your bubble but having an "F" on your drivers license does Not legally make you a women,it may make you feel like one but what determines your legal status is your birth certificate. Think I'm wrong go ask the attorney general of NJ see what he tells you. A Birth Certificate is the Primary document that is attached to us at birth and determines the rest of our life, from what roles we are to play as well as whats expected from us in society, or how we'll be treated concerning legalities or the law.

Gina, it's frustrating to see this misinformation being asserted when trans people are making great strides in this area.

The federal government, Washington state, Vermont have and will change birth certificates without any proof of surgery at all.

Re: Germany's sterilization requirement, like it said in the post, the The German Federal Constitutional Court struck down all surgery requirements earlier this year.

Adam, you're right about Vermont... but you have to have been born in that state. The others... I still believe you're wrong (we've had this argument before). In Washington State trans women still need to have SRS to effect legal change of gender. If you have actual proof to the contrary then let's see it.

In Germany it states:
The change of name can and almost certainly will be revoked if the person marries and then fathers or gives birth to a child that was conceived after the name change became valid.[citation needed]

For the change of legal gender, it is also required that the person

* is permanently infertile, and
* "has had surgery through which their outer sexual characteristics are changed to a significant approximation to the appearance of the other sex/gender".

Btw, Even though I've had SRS, I'm in no way a supporter of having required surgeries in order for legal change of sex and am not a member of "Elitist club Brandi and Lisa."

I don't agree with the assumption that someone MTF or FTM should be allowed to change their birth certificate without at the very least some form of sterilization preferably sex reasignment surgery. Changing gender is not the same as changing sex. I see both cases as pretty weak Joann Prinzivalli because you don't need an F or an M on your drivers license to drive. The case of Sam Berkely is also troubling Doctors and insurers should have a right to know what liabilities or health issues a potential customer might have. Should the Insurance company employee given Sam a disapproving look no but they still doesn't justify a birth certificate change or the accompanying falsification of information the company bases it rates and risk assessment of a customer on.

Why sterilization?

I don't believe that someone should be able to claim to be the opposite of their birth sex in a legal sense if they are still fully functioning as that sex.Its easy to claim to be something but unless your willing to take concrete steps to prove it I don't see it as anything more than wishful thinking or screwing with the system.

Justine-Paula | June 18, 2011 1:59 AM

Hi Lisa, wow, I am saddened by this idea that you have to have gender surgery in order to transition, ok, how many times have you been asked to strip naked in public to prove your gender? I would guess zero times.. what is our private parts remain, for the record which part of the ID is used for photographs? The face or the the private parts?

Now that should close the argument on that...

Nobody is claiming you have to have surgery to live as the opposite sex. But if you want to claim you really are the opposite sex then you have to do more then simply claim you are it. Taking permanent steps would help to weed out those who are out to simply make fools out of all us. I also believe there should be laws put in place that make it difficult for those who have taken illegal steps or violated the SOC from gaining legal recognition of their transition.The NCTE survey shows that there are serious issues with those who are transgender identified with suicide both pre-op and post-op.

Justine-Paula | June 18, 2011 3:19 AM

Gee, and surgery would weed the true TS from the fake TS? If only that was possible, but as far as I know there is no direct flight to Utopia..

It seems to me that you are saying you want the full rights to a sex but you are unwilling to take the steps necessary to become that sex. Square pegs don't in round wholes.

I completely agree Lisa their should be stricter requirements for hormones ,surgeries and changing of ANY documents including drivers lic as it's the first one that most of the transgender horde changes and then they seem to think wa-la they're women. * NOTE wearing of women's clothes, changing gender on ones drivers license or taking Internet hormones does not make one a women if one doesn't have the brain gender of a female and documentation to prove one has said brain gender then they are only playing dress up ! ie: living "AS" a women is not the same as "BEING" a women.

Justine-Paula | June 18, 2011 2:01 AM

Hi Lisa, wow, I am saddened by this idea that you have to have gender surgery in order to transition, ok, how many times have you been asked to strip naked in public to prove your gender? I would guess zero times.. what is our private parts remain, for the record which part of the ID is used for photographs? The face or the the private parts?

Now that should close the argument on that...

Oh, ok. So, if you have had a vasectomy, or had your tubes tied, or are sterile for some other reason (such as cancer treatment), you are already set! Cool!

Gotta love you and your logic Carol :)

So you're arguing for eugenics for trans people? Forced sterilization?

Lisa, it's doesn't matter whether or not there needs to be an M or F on a driver's license because currently they do contain sex designations and people have to deal with that fact. You also have to show a birth certificate to get a driver's license these days.

Maybe that's not an issue for you because you have the privilege of being assigned female at birth. But for women who don't have that luxury, it's a serious issue. Until you have some understanding of issues facing trans people, you might want to educate yourself some more rather than perpetuate transphobia.

How is proving that your really trans anything eugenics? If your claiming to be the opposite sex and your wanting to be recognized as the opposite sex then you should be willing to take a permanent step towards proving it.Otherwise all your going to accomplish by pushing stuff like this is getting post-op transsexuals marriage rights taken away in all the States that ban gay marriage.We're supposed to be working towards moving forward all crap like this does is hurt us.Stuff like this is why Republicans want to ban Transgender Marriage. Remember we are listed in the DSM keep pushing crap like this and we could all be banned from being or getting married gay or straight.

Lisa... new sign in name... same old elitist garbage. :(

Gina how is requiring someone to take the same steps as those who came before them elitist garbage. Seriously its people like you pushing the elitist garbage and separation-ism by claiming to be better than everyone else. The days of bullying are coming to end just like the word Transgender is better hurry up and get over it.

Because not everyone can afford surgery even if they desperately want it, and the situation is getting worse for them the more the economy collapses. Because getting a job to help you afford that surgery is more difficult if your background check outs you as a transsexual. Because even if you are living like a nun and saving every penny for your surgery, you don't deserve to lose your legal rights just because you're not there yet. Because many true transsexuals are less privileged than you and will have to work much harder just to get to the same place you are.

That's why it's elitist garbage, because you're advocating a system whereby money is what determines who's a real transsexual and who isn't. You're advocating that people have to pay money to have rights, and that's not what rights ARE.

Not bingo I call foul. If surgery is getting more expensive and its getting harder to get insurance you don't just roll over and play dead. Lets fix the real problem to many people to include some of us that claim to represent us view surgery as a choice and are using peoples lack of funds as an argument to justify that belief.They are killing us politically and literally and they have blood on their hands and a black heart.Surgery is not cosmetic and we have enough dead brothers and sisters to prove it. Instead of fighting for a band aid that isn't going to stop the patient from bleeding to death lets go for the needed full on surgery. Lets work to make access to the necessary treatment and surgery more easily accessible for all. We need to be lobbying to get people in office and in the general public to understand that SRS isn't cosmetic instead of continuing to give them reasons to take rights away from us.

Uh huh. We can't even get affordable health care for any ailments in the US, but instead we're just supposed to let transsexual people suffer abuse because we're holding out for a pie in the sky solution of affordable transition care somewhere, somehow, somewhen. Still elitist, sorry.

Sorry SAS but I see your argument as just as much a strawman argument as Brandi's. I see both of you doing your best to argue that Surgery is a choice so if you believe surgery is a choice then there is no need for anyone to change their birth certificate. Everyone according to you to might as well just choose not to transition since all we are is just glorified transvestites in your opinion. Your excuses are just as lame as your accusations of elitism.

It fascinates me when someone can use a term like "strawman argument" and then turn around and do that exact thing. I didn't say surgery was a choice, I said it was something that many people are prevented from accessing. Since I never said that surgery was just a choice I have no idea where you're getting that from. Unlike Brandi, I think everyone who needs SRS should have it. The standards of care are supposed to be standards of CARE, not a gauntlet you have to run to "prove" you're transsexual enough.

These are your words SAS because we're holding out for a pie in the sky solution of affordable transition care somewhere, somehow, somewhen. Still elitist, sorry.
You might as well have said I don't think poor Transsexuals deserve people lobbying and working to get them the help they need sorry but I see that as saying hey we'll get whatever you want accept the one thing you really can't live without Transition related healthcare and surgery. To me that all adds up to an elitist attitude and surgery is a choice. How many bodies do we have to stack up before people will figure out SRS isn't cosmetic? and also how many bodies do we have to stack up because of pumping parties, black market hormone use, and suicide? I know your not the cause of all that but do you realize that I'm not either?

@ SAS Being able to afford surgery should not and has never been a consideration as to whether one meets the diagnosis requirements of GID. The Expense involved in transitioning from one gender to the other are well known before the process is ever begun by everyone. All this whining about its not fair its not fair I'm poor I can't afford surgery so therefore I should be allowed to skip that part is B/S F^%#$# Grow up !

I disagree with you Brandi there is a legitimate problem with cost and access to care. Just because someone can't afford access to treatment doesn't mean they should be denied it. I think this also points to the other elephant in the room people self medicating and performing genital mutilation on themselves because they can't get access or even worse killing themselves. Call me radical but if all else fails I can't see any good reason why tax payers can't pay for SRS but can pick up the tab for a heart transplant.

Also Brandi using your same argument that if someone can't afford the process they shouldn't even start it one could argue that your saying being Transsexual is a choice. I can tell you in my experience that isn't the case. Did you choose to become Transsexual?

Lisa I have to disagree Access isn't an issue if you got money theres plenty of access, however I do feel that ALL transition expense should be covered for those Individuals who have a GID diagnosis and that Insurance companies should require a diagnosis before being Obligated to cover anything. I also most certainly DON'T feel that being born as GID is a choice, that said know ning one has a condition and being able to afford correcting it are two different things. One may known one has cancer but being able to afford the treatment may be Impossible in which case some people have no choice but to live the best life they can for whatever time they have left. It's the same with those who get a diagnosis and have the transitional cost explain to them they may have no Idea how they'll paid for it, but they knew going in what the cost were.

Ha, I'm being told to grow up by someone who uses cartoon symbol swearing.

Justine-Paula | June 18, 2011 1:20 AM

Changing the birth description is a huge problem, and I think that we as the TS community should fight harder for this, it makes no sense to issue documents changed from birth gender to chosen gender and not change the birth description, this idea that sex and gender are the same is old, outdated irrelevant.

Gender is important, if we know all our documents are reflecting the correct gender as "we" want, then we can relax and be more productive, but the truth is that governments will always be trans and homophobic and make life difficult to impossible for the non gender conformists of the population, which I am sure could vote for a Trans party would have a majority.. Yet we allow ourselves to be governed by a minority...


So far the government lets you change your birth certificate in 47 states if you get SRS or its FTM equivalent. You can technically get married in all fifty states if you've gotten SRS and changed your birth certificate. That isn't transphobic. Whats Transphobic is people trying their damndest to screw up all the hard work those who came before them did. You want to do something worth doing get those last three states fixed so they change post-op birth certificates. Then you work to get it fixed for those who are non-op for legitimate medical reasons so they can change their birth certificates. As for those who choose to be non-op or are gender deconstructionist fight for gay marriage for them.

While I agree on your prioritisation of three different categories in theory, in practice it doesn't work.

Marriages where one partner is trans can be voided, Birth Certificates ignored, in many states. Possibly in all, though it hasn't happened in some, and there's caselaw to show that it shouldn't in some of those.

But no marriage involving a trans person, regardless of birth certificate status, has survived legal challenge in the USA in last 35 years. Being fair, there's less than a dozen such cases.

Then there's the issue of Intersex. Currently, it appears from the latest ruling in Texas, that some Intersex people are counted as neither men nor women, so may not marry anyone of either sex. While that's not binding, it is caselaw, and also the policy of the Iowa GOP. It is likely that every state whose constitution has been amended to define marriage as between a man and a woman would follow that ruling.

"But no marriage involving a trans person, regardless of birth certificate status, has survived legal challenge in the USA in last 35 years."

Well...not exactly. For instance here --->

Post ops marry and get divorced all the time. The truth is that there are only a handful of states in which the issue has ever been contested in court.

What "latest ruling in Texas" are you referring to? Hopefully, not the Araguz case. To my knowledge, no evidence of her being intersex has been presented in her court case to date.

Zoe everything you said isn't exactly true and what has been causing difficulties for Post-ops that are in heterosexual marriages is they are being confused as gay men because of a lot of the stuff being pushed by those who support the Transgender umbrella and gender deconstruction. Even WPATH is guilty to some point in causing the belief that Transsexuals aren't really their corrected sex because they are calling them more like bi- gendered or transgender. WPATH is selling the Transgender label and LGBT attachment. One good look at its board and you can easily come to the concluson that it is suffering from an LGBT bias.

Again Lisa I agree completely I'm sick and tired of the social deconstructionist trying to force their Transgender meme onto society. I for one won't stand for it any longer. I will take every opportunity to educate anyone and everyone I meet as to the differences between the transgender horde and a true diagnosis transsexual even at the cost of me coming out of stealth to do so. I believe there is a right way to transition and a wrong way and the wrong way involves the do-it-yourselfers wannabes thinking they can do whatever the HELL they want and then Demanding society accept them and grant them the same rights as everyone else. IMO do-it-yourselfers do not deserve legal protections and I will not advocate for them. I believe ONLY those who follow the SOC to the Letter deserve legal protections as they seek to fit "INTO" society and are not trying to force a new and third gender upon society

It's interesting that in 60 years, I think I needed to show my birth certificate 3 times, getting a drivers license for the first time in AZ, joining the Navy, and getting a Georgia drivers license, which I could have substituted other documents. If I get a passport, I would need it for that. I didn't need it to get married in 1980, or for any other things in all those years.

Yes, 47 states will allow you to change your birth certificate, but others, like South Carolina will just amend it, leaving the old information still on it. What good would that birth certificate be to show anyone? It seems to me that no one is asking people on a regular basis to produce their birth certificate at a moment's notice. A drivers license? That's another story.

I completing and strongly disagree ! Likewise I think this suit is a complete waste of time and is sure to be lost ! This is simple another scapegoat tactic by the transgender Inc in an attempt to force they're third gender upon society. The SOC also says that GRS is the cure for Gender Dysphoria and it is expected that it's going to say that those who complete transition (Including complete GRS) are consider cured and No longer suffering from GID if the preposed language is accepted. WE are a two sexes society and society is NOT going to accept a third gender forced down their throats,nor are business going to hire or promote those who do not meet the requirements of society. I happen to agree with Donna Rose who is also against changing of birth certificates without surgery and posted so in her blog recently. Changing of a birth Certificate should ONLY be done when an event of equal proportion takes place. Someone deciding on their own they are really a man or a women and undertaking a "do-it-yourself transition" to differing degrees does not qualify in my opinion.

The latest SOC or the original SOC? You have to remember that the SOC has changed over the years to become accepting of those that were not the true Harry Benjamin standard.

And what about people that cannot transition because of medical issues such as blood clots, etc.?

What about botched circumcissions? Or Intersex where the doctor got it wrong at birth?

Following the SOC is not an End All. Assuming it is, requiring others to follow it exactly, even if it leads to death, is just plain selfish.

But then, much of the wars and battles of the world are due to selfishness. We need to love and help each other, even if our feelings get hurt now and again.

Seems that nothing has changed here on Bilerico. Threadjacking by Classic Coke transsexual elitists is still happening unabated. Bilerico should be ashamed of themselves on how they treat trans people in allowing this crap to go on. I left for awhile, and it seems I have no reason to come back. I can also add to the fact that you posted nothing on the historical VA directive on the improved care for transgender and intersex veterans, but you continue to post fluff crap about gay men. Goodbye.

I suppose I'm one of those elitist Classic Coke Transsexuals that your speaking of but guess what Monica I'm a Veteran also. Your Directive is a big deal but for more reasons then your willing to let on. Sure it extends care across the United States for all TS/IS/TG vets. But it also says in that Directive that SRS is cosmetic and not only do you approve of it your promoting it as a great thing. Also since you've been around long enough you also know that not all Transsexuals like being called Transgender or being LGBT automatically associated some want nothing to do with it others want to be considered allies. but did you respect that in the policy you pushed? See Monica you disrespect a ton of Vets and Transsexuals with your elitist crap that is also really masked discrimination. Know this I've already complained to the Whitehouse about the wording. My patient advocate has known for sometime that I do not like the word Transgender and that I find it offensive when applied to me. I also complained to the Palm Center about their use of the word Transgender. Elitist are people like yourself that bully and intimidate people by thinking they have a right to pick and choose labels and associations for other people. That's pretty unAmerican and certainly conduct a Veteran should know better than for obvious reasons.So since you've chosen to label me as a coke classic Transsexual that must mean you consider yourself New Coke we all know how that worked out.

Thanks, Jen Pula, for this important piece. I hope that the outcome of the suit is favorable for trans folks in New York (and hopefully elsewhere too!). I'd never seen this stat before: "In New York City, only 5% of trans men and 20% of trans women undergo genital surgery." Can you tell me the source? Thanks in advance!

@Lisa et al

Different people seeking treatment for the same condition will often pursue treatment of different aggression. Cancer comes to mind. Some need medications, some need minor medical procedures, and some need heroic surgery.

I don't want a vaginaplasty, I don't need one to see a girl in the mirror, or to be seen as a girl by my girlfriend, and I certainly don't need to risk major sexual dysfunction, including a small chance of fistulae, colostomies, etc, to be considered a woman.

You may, but that doesn't mean that the [i]Standards of Care[/i] don't kill people, don't haze trans women and men, don't put the onus of proving sanity on us getting a few grand worth of psychological treatment, for things as simple as [i]blood-pressure medicines[/i].

I do [b]not[/b] need an arbitrary cissexist-dominated medical model to do for me what General Practitioners do for millions of cis women with hormone imbalances. I need equality in medical treatment. Surgery is not the alpha and omega of transition, it is a treatment strategy that people pursue because: They have body-map incongruence, a desire to have legal and social recognition as one's target gender, because doctors and others expect them to, or some combination of the aforementioned factors.

I know people who were triggered by the thought of their genitalia, people who said they wanted SRS so they could go to a public pool, and one person who, when waiting for surgery, met another who was clearly uncomfortable with the idea of her impending surgery and was worried about the course of treatment her psychiatrist had blithely insisted upon.

If these archetypal cases exist, then surely, these reasons exist, in varying degrees, and maybe, just maybe, the people who dominate transition medicine might suffer from selection and observer bias in drawing their conclusions.

First of all, they control access to surgery with more success than they control access to HRT and other transition medicine, such as speech therapy and hair removal, so their clients are more likely to be operative. Selection bias.

If a non-operative trans woman is asked if she wants surgery, there is pressure to say yes, because, even in our tattered umbrella, there are those who cannot stop associating genitalia with gender. If she is asked by a doctor who controls her access to other transition medicine, she is definitely under pressure. This is not an uncommon situation. My doctor did a double-take when I told him I felt no need for surgery, just for hormones... if it'd been twenty years ago, I might not have gotten hormones. This is observer bias. [i]Asking the question influences the answer.[/i]

One last time: The Standards of Care are based on poor science, there are no double-blind studies with a control group of people who did not follow the [i]Standards of Care[/i] for their transition, and they do [b]kill women[/b] by making them wait for treatment when they are in crisis situations.

Society doesn't have to accept me, but it's a pretty basic precept going back to Edmund Burke that, harming nothing but their sensibilities and having no reason to the contrary besides bigotry, that they are obligated to [i]tolerate[/i] me.

PS: [i]Standards of Care[/i] has been italicized as I have been taught to italicize short works of fiction. Your mileage may and most likely will vary on the long side. Why? Obviously you're not ready to have the major source of stress in your life treated.

I suck at html... thought it was going to let me italicize, but you get the drift.