The Riddle of Gender - Deborah Rudacille [127]
In her plenary lecture at the 2001 True Spirit Conference, Rachlin focused on the mistrust many transpeople feel toward scientists and physicians, and the need to overcome that suspicion and participate in research studies. She noted that the two questions transgender people heard most often were “ ‘how many of you are there’ and ‘why would you do this?’” With regard to prevalence, Rachlin says, “we’re never going to get good numbers,” owing to the nature of the condition. Most cross-dressers, for example, remain deeply closeted. “So it’s the ‘why would you do this’ question that’s the most important.” If gender variance were proved to be “unchangeable and physical,” she says, it would have a very big impact, not only on public perceptions but also on the availability of insurance benefits for those who require surgical and hormonal intervention, and legal decisions regarding marriage, child custody, and discrimination on the basis of gender identity.
“What you need when you go to court is persuasive data showing that this is a sane thing to do, it’s a necessary thing to do, there’s nothing antisocial about it, that it doesn’t make you an unstable person,” Rachlin says. “We saw recently with the Kanteras trial, all those accusations and how hard they are to refute. And then you need to be able—especially men—to justify physical choices, which Michael Kanteras had to do at the trial when they asked him, ‘Why didn’t you have genital surgery?’” Solid data would give Michael Kanteras and all the men like him the opportunity to say, “I am a man and I should be given all the rights and privileges of men no matter what my genital status is,” she says.
Rachlin also sees a great need for outcome studies, particularly those comparing outcomes for people who do not follow the Standards of Care drafted by the Harry Benjamin International Gender Dyspho-ria Association, which are considered the gold standard. “I think that anyone who is doing anything medically should know the outcome,” Rachlin says. “The Standards evolved at a time when people were going from one gender to another. They were following a sequence, fairly structured; and using that system, they had incredibly low levels of regret. We don’t know why, because there are no controlled studies. All that we know is that using the SOC, people had low levels of regret. We don’t know whether the SOC contributed to that; we don’t know what the relationship is. Maybe the SOC didn’t have anything to do with it, maybe it was just a small piece of the SOC, maybe it was just that they got the medical care they needed. And someone else might say that the SOC had nothing to do with it, but my reply is that all the data was gathered from people who were treated using the SOC. What we need now is research that looks at people using medical and social interventions to suit their own unique gender identity or unique ways of expressing their gender identity, which shows that their way of using medical interventions produces just as good results as the traditional model.”
Such research might help alleviate one of the major problems encountered by transgendered people, the lack of insurance coverage for medical and surgical interventions. Rachlin points out that the failure of most insurance companies to provide benefits covering SRS or hormone therapy is due to the lack of research establishing that this is a legitimate medical problem with treatments that have been proved effective. “If somebody approached an insurance company with a large current sample done well it should be taken seriously. But people think that insurance companies are discriminating against transgendered people