There are at least 10 times more trans people than psychiatrists say, probably more

Great Debates
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I hesitate to start a new thread when I’m leaving tonight to go to Quebec City for the NDP convention and only coming back on Sunday, but what the hell. I just came across a very interesting paper by computer scientist Prof. Lynn Conway in which she estimates that the frequently quoted (including by the DSM-IV) prevalence figures of 1:30,000 among male-bodied people and 1:100,000 among female-bodied people, which were calculated decades ago, are fantastically too low.

She goes on to discuss in detail the pressures that may exist to retain the old number, which is widely quoted in the press, as well as the effects of quoting it and the possible effects of coming to accept a larger proportion.

Thoughts?

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Your link needs to be fixed, I had to edit it to follow.

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and here it is.

:smack:

I don’t know what I was thinking…

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Although I’ve read some anthropological articles which suggest the rate is 1 in 600, I can see some glaring problems with her “study.”

First, there is the assumption that all those who get SRS are really transsexual. I suppose it depends on how you define transsexuals and who you include under that umbrella, but since there are people who reverse transition it can’t simply be ignored. If we ignore the people who get SRS back to their default sex, then we would be counting people twice if we include ftms in the study.

Secondly, her estimate of 1/4 people who identify as transsexual get SRS seems to be arbituary. Based on what I have observed, I would argue that most transsexuals do undergo SRS at some point in their lives. Non-ops are not very common and a good percentage of them change their mind as they get older (most non-ops tend to be young). It’s impossible to say how many transsexuals are in total denial of who they are, but I bet a detailed anthropological study could examine transsexuals in cultures where it is accepted and figure out average rates there rather than just guessing.

Thirdly, her estimates of how many women underwent SRS are just that, estimates. She could have forgotten to factor in the fact that someone might need to go for SRS twice if their first operation was screwed up. Where are the cites for the numbers she does claim?

As you can see, this is a “study” based on estimates, not on facts. I will continue to believe the ““psychiatric authorities” who write untruths in obscure “scientific journals”” since their work is based on, you know, actual science.

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[QUOTE=kimera]

As you can see, this is a “study” based on estimates, not on facts. I will continue to believe the ““psychiatric authorities” who write untruths in obscure “scientific journals”” since their work is based on, you know, actual science.
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Still… two orders of magnitude is a whopper. Someone is way, way off and if it’s nigh unbelievable that the incidence of transsexualism only 1-30,000 or 1 in 100,000 given that the not altogether unrelated biological aspect of being gay is around 3-5% or so. Not that gay men are actually hetero women, or gay women are hetero men, but the prevalence of homosexuality does speak (in a statistical sense) to the frequency with which innate biological orientations can be switched around.

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[QUOTE=kimera]
As you can see, this is a “study” based on estimates, not on facts. I will continue to believe the ““psychiatric authorities” who write untruths in obscure “scientific journals”” since their work is based on, you know, actual science.
[/QUOTE]

I believe many of your objections are discussed in the article, which I commend to your readership. (Thank you to DaddyTimesTwo for the link.) In particular:

  1. I believe she acknowledges the estimates that she makes as being estimates; what she takes issue with are those figures that are unbelievable by an order of magnitude or more. There are almost certainly more or fewer trans people than she estimates; her figures are wrong, but her point is the figures she impugns are very wrong.

  2. You refer to all those transsexuals who do not get SRS as “non-ops,” suggesting that they do not desire SRS, or else are in denial. But there are also those who do not have access to SRS, which is extremely expensive, or who cannot get SRS for medical reasons.

  3. You mention detransition. However, this study suggests that a vanishingly small number of trans people retransition following SRS; indeed, only “1 to 2 percent of those treated express regret about the SRS, be it for different reasons.” I do not believe this to be significant as we are, as pointed out above, discussing a difference of an order of magnitude.

  4. I believe she acknowledges she is only dealing with MtF trans people, and only counting MtF SRS procedures.

  5. You describe the standard figures expressing great rarity as “facts.” In the article, she discusses some problems with how those figures were gathered.

  6. You suggest studies of other cultures. She mentions such figures in the article.

I don’t regard it as a fatal flaw that she does not deal in exact figures. She admits this; her aim is not to definitively establish prevalence rates for transsexuality, but to analyze the prevalence rates that are usually quoted. As she says:

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astro, I do believe that transsexuality occurs at a higher rate than is currently accepted based on anthroplogical evidence. I would love to see a real study on numbers of transsexuals that looked at actual statistics of transsexuals in the US and compared them to other societies where transsexuality is more accepted. I believe a detailed study would show that transsexuality occurs higher than the rates currently accepted because of the anthropological evidence.

matt_mcl, I did read the article. I just don’t believe that you should fight bad science with bad science. If she wants to present this scientifically, then she should make it scientific. It wouldn’t be hard to do by showing cites for her figures and explaining the math she used to make her estimates. We could then figure out the margin of error and adjust the estimates.

I was not trying to imply that all transsexuals who do not get SRS are non-ops. I was mentioning various reasons which might result in most transsexuals not getting SRS. I am certainly well aware that there are those who can not afford SRS or are in denial. However, it would be very easy to factor out those who can’t afford SRS by looking at numbers in countries where it is covered under health plans. SRS isn’t “extremely expensive” in my view (but I guess that would depend on your personal costs, 8k isn’t a lot for me). There are very few who can not get SRS due to medical reasons. They would raise the numbers, but not nearly as much as she thinks they should be raised. My point was, of those who are “out,” most seek SRS and are able to get it. Although the number who seek to reverse their SRS are small, they still should be counted. Not all who are disatisfied with their SRS seek to reverse it, so that means that there are people being listed as transsexual who really aren’t. Since we can not reasonably estimate how many are in denial/confused, we should compare rates of transsexualism with countries where it is accepted after figuring out how many transitioned in the US. She sort of does that near the end, but doesn’t present any cites for her claims.

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I just thought of something else, we should first clarify who we define as transsexuals. Some people only consider those with GID to be transsexuals. Intersexed individuals will not be considered transsexual under that definition even if they get SRS. Some intersexed individuals hate being lumped with trans, others consider themselves both intersexed and trans, and others consider the two synomyms. I have a friend who is going to thailand for SRS early next year who considers herself intersexed instead of transsexual. She has two X chromosomes, but one of the X chromosomes had the SRY on it, giving her male genitals. She needed hormonal help either way, and chose to become female because that’s what she identified as and she didn’t like how the testosterone shots made her feel. Although she identifies as intersexed, not trans, she would be included as trans by the definition presented by this “study.”

I wonder if transsexuality were less stigmitized, more intersexed people would identify as trans.

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[QUOTE=kimera]
I was mentioning various reasons which might result in most transsexuals not getting SRS. I am certainly well aware that there are those who can not afford SRS or are in denial. However, it would be very easy to factor out those who can’t afford SRS by looking at numbers in countries where it is covered under health plans. SRS isn’t “extremely expensive” in my view (but I guess that would depend on your personal costs, 8k isn’t a lot for me).
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Unfortunately, money still is a huge hurdle. It was $18,000-$20,000 20-some years ago (MtF) and many times that FtM; I imagine it’s a lot more now. Plus there is the hormone treatment and “additionals” (breast reduction, plastic surgery, beard removal). And the damned insurance companies refuse to cover any of this, calling it “uneccessary elective surgery.”

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http://www.chet-plasticsurgery.com/price.html

Do ANY insurance companies pay for reassignment surgery?

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The Canadian Government pays for gender reassignment for convicts. It probably doesn’t answer the spirit of your question, but it’s 2 cents of info you never wanted to know.

Kavanagh won a landmark ruling in 2001 when the Federal Court of Canada ordered Corrections Canada to remove her from a men’s prison, house her in a women’s facility and pay for her sex reassignment surgery. NSFW but then again this thread probably isn’t either.

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Well, it depends who you go to and where you go. Marci Bowers is pretty famous among Americans and she does charge ~18k but most of the girls I know prefer to go to Thailand and where the SRS itself runs about 8k. I have two friends looking to go to Suporn, who is one of the best doctors, in Thailand next year and they were planning on spending an average of 13k between them. You can get package deals where you get BAS, FSS, etc while you are there for SRS that can save you a lot in the long run. Of course, BAS isn’t necessary and I don’t think that should be covered by insurance. How much extra stuff is needed/wanted varies for each individual person and in some cases, aren’t necessary at all.

As for hormones, a lot of places cover them now. Canada is extremely generous and they cover everything but the SRS (they covered it for a while) although I know plenty of people who are working to get SRS covered as well. There is even a person in Canada who claims to recieve disability for being transsexual. Here in the US, the UC system covers psychological counseling, hormonal treatments, and endo visits for students and faculty. I’ve heard that SRS is covered for faculty (although I haven’t been able to confirm it) and I’ve been working with my friend to get it covered for students. The doctors there are very good and understanding, my friend was able to bypass the psych visits and she visited the best endro in LA on her school’s insurance. She has since switched carriers and her work place covers her HRT as well. It would be cool if SRS was covered by more insurance companies because the ones that do cover it are very limited.

It would be interesting to compare Canadian SRS rates with American. I think that way, you’d be able to get a pretty good estimate for the number of transsexuals who don’t transsition beause of cost. I’ve often heard that the biggest cost isn’t SRS but the combination of electo/laser, court fees, psych fees, etc. However, it probably varies widely.

I can’t believe that Stalky. They won’t cover it for regular citizens, but they will pay for convicts? BS

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[QUOTE=Canadian Human Rights Tribunal ]

[187] Assuming that an inmate meets the eligibility requirements for sex reassignment surgery, and obtains the necessary approvals to proceed with such surgery, the question remains as to who will pay for it. As noted previously, sex reassignment surgery is a legitimate medical treatment for a recognized medical condition. It should be treated like any other medical procedure, for the purposes of CSC’s Health Services policy.

[188] Under the policy, essential medical services are paid for by CSC, whereas elective procedures are paid for by the inmate. Dr. Dickey, Dr. Hucker and Ms. Petersen all testified that sex reassignment surgery is an elective procedure, within the meaning of CSC’s policy. Although Dr. Watson did not address the issue directly, her description of the distress suffered by those she describes as having ‘high intensity’ Gender Identity Disorder certainly suggests that there are those for whom sex reassignment surgery might well be essential for their well-being.

[189] We have some concerns about Dr. Dickey’s testimony in this regard. Dr. Dickey was very concerned about public monies possibly being expended to provide surgery to inmates, when law-abiding citizens in the community at large may be unable to access surgery at public expense. With the greatest of respect, this appears to be a moral judgment, and not a medical one. Although Dr. Dickey was clearly a knowledgeable witness, we were left with the impression that his concern with respect to the funding issue may have influenced his characterization of sex reassignment surgery as a non-essential procedure.

[190] We have no such concerns with respect to the testimony of Dr. Hucker and Ms. Petersen. Nevertheless, we are concerned about their categorical assertion that sex reassignment surgery was not [and presumably could never be] an essential medical service, in light of the clear statement to the contrary in the Harry Benjamin Standard. It is apparent that different individuals experience varying degrees of distress in relation to their Transsexualism. It may very well be that there are some individuals for whom sex reassignment surgery is an essential procedure, and others for whom it is elective. It seems to us that this is a determination best made, on a case by case basis, by the physicians from a recognized Gender Identity Disorder Clinic, who are supervising the inmate’s transition, and are familiar with his or her situation.

…Snip…

C. Conclusion on Liability

[192] We have found that CSC’s policy with respect to the placement of pre-operative transsexual inmates has a discriminatory effect on transsexual inmates. While we agree with CSC that pre-operative transsexuals should not be placed in target gender facilities, CSC has failed to establish that it cannot not accommodate persons with the characteristics of the complainant, within the male prison population, without incurring undue hardship.

[193] We have also found that CSC’s blanket prohibition on sex reassignment surgery has a discriminatory effect on transsexual inmates because of their sex and their disability, and that CSC has been unable to justify such a blanket policy.

[194] For these reasons, Ms. Kavanagh’s complaints are sustained.
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The full case

Pertinent details regarding the decision are toward the bottom.

Believe it.

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[QUOTE=Kalhoun]
http://www.chet-plasticsurgery.com/price.html

Do ANY insurance companies pay for reassignment surgery?
[/QUOTE]

Yes, the Spanish government. Oh, you mean in the States? Think not.

The only time I’ve heard an MtF say that she was thinking it may not have been such a good idea, the reason was the ridiculous problems she’d had with finding a job. This was in a TV program and the audience and some of the other MtF guests informed her that those problems happen to a lot of Spanish women, not just those who’ve needed SRS. She was mighty stuned, having never considered that there could be any kind of discrimination behind “his” being in charge of teams of equally-or-better qualified people who all happened to be female. Gender discrimination is illegal here, but that doesn’t mean it’s nonexistant.

15

[QUOTE=Kalhoun]
http://www.chet-plasticsurgery.com/price.html

Do ANY insurance companies pay for reassignment surgery?
[/QUOTE]

Yes, some insurance companies do pay for reassignment. However, most surgeons want the money up front, so even if you eventually will get the money back, you often need to come up with it to begin with.