Transsexual Medicine

ABSTRACT
This research, situated at the junction of feminist, trans and disability studies, examines the limits of intersectional feminist analyses and the difficulties faced in their consideration of gender identity and ability through an analysis of two types of body modification: transsexuality and transability (voluntary disability acquisition). In response to the question “what are the limits of intersectional analyses and how can they be addressed?”, three objectives are proposed: 1) participate in the critical examination of specific limits of intersectional feminist analyses in order to diversify their axes through the consideration of gender identity and ability; 2) question the conceptual assumptions and cisgenderist and (cis)ableist privileges informing negative discourses around these body modifications and highlight points of convergence among feminist, transactivist and anti-ableist movements in order to encourage dialogue and solidarities among them; 3) provide feminist, trans and disability studies with an enriched model of intersectionality capable of addressing new claims for justice from oppressed groups, such as those of transsexual and transabled individuals. The negative discourses of certain feminists and other scientists regarding these body modifications are mapped and critiqued through a methodology combining archeological, genealogical and critical discourse analysis. The reflections presented here, inspired by poststructuralist and queer approaches, explore neither the “origins” of transsexuality and transability nor their motivations; this is a study of the negative discourses about these phenomena and the normative systems from which they originate. The result is an important contribution to theoretical, normative and political fields of knowledge: the examination of two “extreme” cases of body modification reveals the bodily normativities of dominant regimes, specifically cisgenderism and (cis)ableism, that remain as unrecognized in our societies as in our social movements. 


KEYWORDS
Intersectionality; feminist theories; trans theories; queer theories; disability theories; social movements; body modifications; bodies; transsexuality; transability; voluntary amputation; BIID; disability; mutilation; pathologization; normality/abnormality; stigmatization; discourse; critical discourse analysis; norms; oppression; autonomy; bioethics.


RÉSUMÉ
Cette recherche se situe à la jonction des études féministes, trans et sur la production du handicap. Elle s’intéresse aux limites des analyses féministes intersectionnelles et leurs difficultés à considérer certains axes identitaires, telles l’identité de genre et les capacités, à travers l’analyse de deux cas de figure de modifications corporelles, soit la transsexualité et la transcapacité (transformation visant à acquérir un handicap). Cette thèse s’articule autour de la question suivante : quels sont les angles morts des analyses intersectionnelles et comment pouvons-nous y remédier? Pour répondre à cette question, cette thèse propose trois objectifs : 1) Participer aux questionnements critiques entourant certaines limites des analyses féministes intersectionnelles pour en diversifier les axes à partir de l’identité de genre et des capacités; 2) Remettre en question les présupposés conceptuels et les privilèges cisgenristes et (cis)capacitistes qui sous-tendent les discours négatifs entourant ces modifications corporelles et mettre en valeur les points de convergence entre les mouvements féministes, transactivistes et anticapacitistes pour instaurer des dialogues et des solidarités entre eux; 3) Fournir un modèle enrichi de l’intersectionnalité pouvant être déployé en études féministes, trans et sur la production du (trans)handicap, apte à répondre aux nouvelles revendications de justice de groupes opprimés, comme celles des personnes transsexuelles et transcapacitaires. À l’aide d’une méthodologie alliant l’analyse critique de discours, l’analyse archéologique et généalogique, les discours négatifs de certaines féministes et d’autres scientifiques sur ces transformations corporelles sont cartographiés et critiqués. Les réflexions présentées ici, s’inscrivant dans une approche poststructuraliste et queer, ne proposent pas une recherche des « origines » et des motivations de la transsexualité et de la transcapacité, mais plutôt une étude des discours négatifs vis-à-vis ces phénomènes et des systèmes normatifs qui sous-tendent ces discours. C’est sous cet angle que cette recherche constitue un apport important aux champs des savoirs, tant sur le plan théorique, normatif que politique : en se penchant sur deux cas de figure « extrêmes », elle met en lumière les normativités corporelles des régimes dominants, notamment cisgenriste et (cis)capacitiste, occultées tant dans nos sociétés que dans nos mouvements sociaux.


MOTS CLÉS
Intersectionnalité; théories féministes; théories trans; théories queers; théories sur le handicap; mouvements sociaux; modifications corporelles; corps; transsexualité; transcapacité; amputations volontaires; BIID; handicap; mutilations; pathologisation; normalité/anormalité; stigmatisation; discours; analyses critiques de discours; normes; oppressions; autonomie; bioéthique.

Source: Baril, A. (2020). “La Condizione Trans Come Debilità: Ripensare le intersezioni tra le incarnazioni disabili e quelle trans” (“Transness as Debility: Rethinking intersections between trans and disabled embodiments”), KABUL Magazine (Torino), 5, 3: 1-23. URL: https://www.kabulmagazine.com/la-condizione-trans-come-debilita/

Original publication: Baril, A. (2015). “Transness as Debility: Rethinking intersections between trans and disabled embodiments,” Feminist Review, 111: 59-74.

Purpose
The purpose of this research project was to obtain a global picture of osteopathic dysfunctions found in transmen who have undergone surgical gender reassignment, by studying more specifically the repercussions of mastectomy, genital reconstruction and testosterone.

Methodology
Thirty-seven participants were recruited, aged 21 to 54 years old, then divided in three groups of 12 transgender men, 12 cisgender women and 13 cisgender men. Data collection was done through a one-on-one interview with each participant, using a general health survey, as well as questions regarding the medical aspects of transition for the trans* participants. A series of 43 osteopathic tests and evaluations were performed on each of the 37 participants.

Results
Our study shows a significant number of repercussions on the superior cervical spine, cervicothoracic area, soft tissue of the neck and thorax. The pelvic mobility is also affected, whether through the bone structure or musculotendinuous elements. Visceral testing revealed changes in the mobility and motility of organs, and cranial tests showed a disturbance felt throughout the entire craniosacral axis.

Conclusion
Mastectomy, hysterectomy, testosterone and high levels of stress bring a tremendous amount of disruption in trans* subject’s homeostasis. With its holistic approach, osteopathy allows the practitioner to bring harmony between the body and soul, to care for the person while respecting their authenticity, and accompany them toward global wellness, and is therefore a treatment of choice to support trans* folks in their transition process.

WPATH Board confirming that sex (gender) reassignment, properly indicated and performed as provided by the Standards of Care, has proven to be beneficial and effective in the treatment of individuals with transsexualism, gender identity disorder, and/or gender dysphoria.

Übersicht: Das Modell der Informierten Zustimmung bietet Trans*-Men-schen einen alternativen Zugang zur gegengeschlechtlichen Hormonbehandlung. Um die gegengeschlechtliche Hormonbehandlung beginnen zu können, muss nach Maßgabe dieses Modells keine Psychotherapie durchgeführt werden. In der Folge reduzieren sich – je nach Gesundheitssystem – finanzielle Belastungen sowie Verzögerungen beim Zugang zu geschlechtsangleichenden Behandlungsmaßnahmen. Statt einer Fachkraft für psychische Gesundheit ist die primäre Gesundheitsfachkraft für das erste Erfassen der psychischen Gesundheit verantwortlich, und stellt fest, ob der_die Klient_in eine informierte Zustimmung zur angestrebten Behandlung geben kann. Das Modell der Informierten Zustimmung wird im Callen-Lorde Community Health Center seit mehr als zwanzig Jahren angewandt. Das Modell integriert die Trans*-Gesundheitsversorgung in die allgemeinmedizinische Grundversorgung und betont auf diese Weise deren ganzheitlichen Charakter. Das Modell der Informierten Zustimmung steht im Einklang mit der 7. Version der Versorgungsempfehlungen der World Professional Association for Transgender Health. Eine Überprüfung der Daten von N = 1714 Patienten für einen Zeitraum von zwei Jahren ergab weder ein Bedauern der Entscheidung noch eine Umkehr geschlechtsangleichender Operationen.

This article explores different conceptualizations of, and debates about, Body Integrity Identity Disorder and Gender Identity Disorder to first examine how these “identity disorders” have been both linked to and distinguished from, the “sexual disorders” of apotemnophilia (the de- sire to amputate healthy limbs) and autogynephilia (the desire to per- ceive oneself as a woman). We argue that distinctions between identity disorders and sexual disorders or paraphilias reflect a troubling hier- archy in medical, social and political discourses between “legitimate” desires to transition or modify bodies (those based in identity claims) and “illegitimate” desires (those based in sexual desire or sexuality). This article secondly and more broadly explores how this hierarchy between “identity troubles” and paraphilias is rooted in a sex-negative, ableist, and cisnormative society, that makes it extremely difficult for activists, individuals, medical professionals, ethicists and anyone else, to conceptualize or understand the desires that some people express around transforming their bodies—whether the transformation relates to sex, gender or ability. We argue that instead of seeking to “explain” these desires in ways that further pathologize the people articulating them, we need to challenge the ableism and cisnormativity that require explanations for some bodies, subjectivities and desires while leaving dominant normative bodies and subjectivities intact. We thus end the article by exploring possibilities for forging connections between trans studies and critical disability studies that would open up options for listening and responding to the claims of transabled people.

Link: https://thediscourseunit.files.wordpress.com/2016/05/22-exploring.pdf

Pregnancy is considered a feminine experience in mainstream Canadian culture. Babies identified as female at birth are expected to grow up to become feminine heterosexual mothers. This research considers the desires, choices, and experiences of individuals who were identified as female at birth, but who do not identify as feminine heterosexual women; this dissertation focuses on the reproductive desires, choices, and experiences of butch lesbians, transmen, and genderqueer individuals in British Columbia. Three methods and two distinct populations formed this research. Participant observation was conducted in 21 cities across southern BC. Questionnaires were completed by 28 health care professionals (HCPs), and by 46 butch lesbian, transmen, and genderqueer (BTQ) individuals. Face-to-face interviews were conducted with 10 HCPs, 8 BTQ individuals who had experienced at least one successful pregnancy, and 4 BTQ individuals who had either experienced or been diagnosed with a condition linked to infertility. What I found, is that for many BTQ individuals, reproduction associated with the female body (ie: pregnancy and breastfeeding) is not exclusively considered a feminine desire or experience. In fact, what I discovered is that BTQ individuals who experience pregnancy and breastfeeding explicitly challenge the cultural fetish associating femininity with reproduction (including pregnancy, breastfeeding, mothering, and fertility). Thus, I highlight not only the typically ignored desire and achievement of pregnancy of BTQ individuals, but also how BTQ individuals have experienced breastfeeding, how some BTQ parents raise queerlings, and how some BTQ individuals have negotiated diagnoses and experiences of infertility. Overall, I highlight the unique and various expectations and experiences that butch lesbians, transmen, and genderqueer individuals have regarding their ‘female’ (and potential) biological reproduction. In the end, I hope that by presenting the diverse reproductive experiences, desires, and choices of BTQ individuals, that I can foster more of an understanding of these experiences, desires, choices, and individuals, and thus challenge the cultural fetish that links femininity with ‘female’-associated reproduction. Moreover, I offer recommendations for health care professionals in an effort to foster more understanding in BTQ health care, as well as help to facilitate more queer competent health care professionals.

Transition for a transsexual person is essentially the process of changing one’s sex and this process may include any number of procedures which may not necessarily be medical ones (Serano 2016, p. 30). The process of transition is central to the transsexual experience because it defines the operative arena of transsexuality – it is what transsexuals do. In 1998, Jay Prosser, a female –to-male (FTM) transsexual author published his first book called Second Skins: The Body Narratives of Transsexuality in which he emphasized on the importance of transsexual narratives. In this book, Prosser looks at how transition is made sense of in transsexual narratives. He categorized five meanings of transition as they are inscribed in the narratives i.e. conceptual, ontological, narratological, historic-discursive and political. Using this same framework, one can read into other narratives of transsexuality. This paper utilizes Prosser’s theoretical scaffold to read into the transsexual narratives of the television series ‘Pose’. The series is created and produced by numerous talented individuals among who are transsexual producers like Janet Mock and Our Lady J. The cast is also primarily constituted of transsexual actors. Therefore, the series may be considered as an important and credible narrative text. ‘Pose’ follows the lives of its protagonists (many of who are transsexual women) as they navigate their lives within and outside of the ‘ball culture’ of 1980s New York. The narratives of the transsexual characters affirm Prosser’s arguments and conceptualization of transition as being a route to the transsexual subject’s identity and bodily integrity; that narratives on trans embodiment are important for shaping medical practices and discourse; that transsexual narratives on embodiment, accounts of transsexual experiences and transsexual identity patterns precede the construction of the transsexual subject through technology; that somatic transition is initiated by active transsexual subjectivity rather than by the medical establishment; and that transition is a complex open-ended process.

This paper investigates how deploying neoliberal discourses of equal rights, anti-discrimination laws, and hate crime legislation limits the advancement of equality and protection for trans persons under the law. The push for the legal recognition of trans persons, through the addition of "gender identity" and "gender expression" to
anti-discrimination and hate crime laws relies on neoliberal discourses of biological determinism and medicalization. This approach ultimately pathologizes trans persons and precludes their self-determination. As the trans community continues to gain rights in Canada and the United States, a backlash of anti-trans “bathroom bills” threaten to restrict trans persons from sex-segregated spaces that align with their gender identity. Moreover, hate crime legislation focuses on individual perpetrators, reinforcing systemic forms of transphobia and state-sanctioned violence against trans persons. In order to guarantee that trans persons have equal access to state services and are protected from discrimination and violence, systems of power must be dismantled and reimagined.

This article is available in Western Journal of Legal Studies: http://ir.lib.uwo.ca/uwojls/vol6/iss1/3

Some authors in disability studies have identified limits of both the medical and social models of disability. They have developped an alternative model, which I call the ‘composite model of disability’, to theorise societies’ ableist norms and structures along with the subjective/phenomenological experience of disability. This model maintains that ableist oppression is not the only source of suffering for disabled people: impairment can be as well. From a feminist, queer, trans activist, anti-ableist perspective and using an intersectional, autoethnographic methodology, I apply this composite model of disability to trans identities to consider the potentially ‘debilitating’ aspects of transness. I argue that transness, like disability, has too often been perceived from two perspectives, medical or social, without the benefit of a third option. From a medical perspective, transness is reduced to an individual pathology curable with hormonal/surgical treatments, a conceptualisation that erases structural oppression. From a social point of view, transness is conceptualised as a neutral condition and variation in sex/gender identity. In this model, structural oppression (transphobia/cisgenderism) is seen as the only cause of ‘trans suffering’. I argue that, just as the medical and social models of disability provide limited opportunities for reflection on the complex experience of disability, medical and social understandings of transness, respectively, are insufficient to describe the complexity of trans experience. I explore the possibilities presented by the application of a composite model of disability in trans studies. By problematising both cisgenderist oppression and acknowledging trans people’s subjective experiences of suffering through some of the debilitating aspects of transness, this composite model avoids the pitfalls of the medical and social models. The application of tools from disability studies to trans issues uncovers cisnormativity in disability movements and denounces ableism in trans movements. This will, I hope, solidify alliances between these communities and fields of study.

Link: http://link.springer.com/article/10.1057%2Ffr.2015.21

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Volume 3, Number 3, July - September 1999



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Factors Which Influence Individual’s Decisions When Considering Female-To-Male Genital Reconstructive Surgery

by Katherine Rachlin

Citation: Rachlin, Katherine (1999) Factors Which Influence Individual’s Decisions When Considering Female-To-Male Genital Reconstructive Surgery. International Journal of Transgenderism, Vol. 3(3).  Currently availablle at http://www.wpath.org/journal/www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/index-2.htm

Abstract

This research examined the factors, which influenced the decisions of people who had considered female-to-male genital reconstructive surgery. The sample consisted of 27 people who had been born as female and had male gender identities. Subjects were recruited from a support group for female-to-male transsexuals (FTMs) in New York City and from participants at a conference for female-to-male transsexuals in San Francisco. A questionnaire was designed to explore subject demographics and surgical decision-making. Respondents rated contact with other FTMs and information from within the FTM community as the most important sources influencing their decision. Lack of money and inadequate medical technology were the most frequent obstacles to implementing their choice. Results illustrate the growing influence of community and peer support services. Results also challenge the expectation that FTMs will request genital reconstructive surgery (phalloplasty in particular) and identify some of the numerous reasons why FTMs may not undergo such surgery.

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"This study surveyed 134 female--to--male transgendered individuals (FTMs) in order to obtain information about their experience of hysterectomy and oophorectomy. The survey was designed to explore motivation for undergoing surgery, access to care, surgical complications, post--operative changes, and use of standards of care.  The survey was distributed at transgender conferences and online via transgender e--mail lists and websites. Results demonstrated a wide range of postoperative experiences.  Common motives for the surgery were to remove organs that were incongruent with the individual’s identity (58%) and also concern about the potential for future medical problems associated with masculinizing hormone therapy (60%) Many sources advocate lowering testosterone post--oophorectomy, yet our data reveal that virtually equal numbers of individuals increased (23%) or decreased (25%) testosterone levels post--operatively, and nearly twice as many maintained the same dose (44%).  For many respondents hysterectomy and oophorectomy came before a year of living full--time in their preferred gender role (34%), before a full year on hormones (41%), or chest reconstruction (54%). This not only reflects the diversity of experience in this population, but also has implications for the relevance and implementation of the Standards of Care for Gender Identity Disorders. 

KEY WORDS: female--to--male; hysterectomy; standards of care; transgender; transsexual, testosterone, FTM, gender identity, transman, sex reassignment surgery
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This research examined transgender and transsexual individuals’ experiences in psychotherapy in a range of treatment settings. Participants completed a survey that asked why they had sought mental health services and what their experience of treatment had been. The sample consists of 93 participants (70 Female-to-Male and 23 Male-to-Female) who reported on 150 contacts with various psychotherapists. Results indicate that it was common to have seen a psychotherapist for general personal growth issues earlier in life and to later seek out a therapist who had experience in transgender work in order to focus on gender issues. Provider experience in working with the gender issues was associated with a higher number of positive changes, higher patient satisfaction with progress in both general personal growth, and gender related issues. Individuals consistently expressed appreciation for therapists who were flexible in their treatment approach and demonstrated respect for the patient’s gender identity.

Employee voice has largely been examined as a universal concept in unionized and non-unionized settings, with insufficient attention to diversity of workers (Rank, 2009). As invisible minorities, gay, lesbian, bisexual, and transgender employees provide a valuable focal point from which to examine employee voice mechanisms. Positing that gay, lesbian, bisexual, and transgender (GLBT) employees are often silenced by what is perceived as “normal” in work organizations, this paper considers some of the negative consequences of this silencing, and proposes ways in which voices of GLBT employees and other invisible minorities may be heard. With its relevance to policies and practices in other organizations, the “don’t ask, don’t tell” policy of the U.S. military is used as a lens through which to analyze voice, silence, and GLBT employees. Specific recommendations are provided for HR managers to facilitate the expression of voice for GLBT employees in today’s increasingly diverse organizations.

Many comparative studies have evaluated the behavioral and functional differences between the male and female sexes. Fewer studies have evaluated the gender identity in addition to these findings. This literature review attempts to provide an outline of the most commonly referenced behavioral differences between the male and female sex as well as explain the neural mechanisms associated with the behaviors. Special attention will be allotted to studies with conflicting methodologies and results as a tool to illustrate the gaps in knowledge required for simple diagnostic methods of empirical evaluation required for concrete evidential support for transitioning transsexual patients. Furthermore, regardless of differences in participant size, or conflicting results of behavioral, and neuroimaging studies, the role of hormones in the formation and regulation of the brain does establish unchanging gender identity prevalent throughout a lifetime. The role of hormones as a prevalent factor in the establishment, maintenance, and possible modification of brain structure and corresponding behavior is imperative in the identification for the early transition of transsexual youth.

Female-To-Male (FTM) transgender individuals were
approached at a conference and several peer support groups in the United States and asked to complete a short questionnaire regarding their medical care. Results from the 122 completed questionnaires indicated that a high number of respondents were taking testosterone (n = 106) and had some gender-confirming surgery (n = 68). Seventy percent of respondents rated their overall quality of health care “good” or “excellent.” A surprising finding was the low number (7%) reporting diagnoses of polycystic ovarian syndrome–the incidence of which has been reported elsewhere as high as 50%. Also notable were the high levels of employment,
insurance, knowledge of standards of care, and access to providers, contrasting with reports from studies involving predominantly Male-To-Female (MTF) individuals. Finally, FTM’s usage of transition-related medical resources can vary, but many within this study are foregoing genital surgery.

This research examined Transgender and Transsexual individuals' experiences in psychotherapy across a range of treatment settings. Participants completed a survey that asked why they had sought mental health services and what their experience of treatment had been. The sample consisted of 93 participants (70 Female-to-Male and 23 Male-to-Female) who reported on 150 contacts with various psychotherapists. Results indicated that it was common to have seen a psychotherapist for general personal growth issues earlier in life and to later seek out a therapist who had experience in transgender work in order to focus on gender issues. Provider experience in working with gender issues was associated with a higher number of positive changes, higher patient satisfaction with progress in both general personal growth, and gender related issues. Individuals consistently expressed appreciation for therapists who were flexible in their treatment approach and demonstrated respect for the patient's gender identity.

ABSTRACT
The DSM IV-TR diagnosis Gender Identity Disorder Not Otherwise Specified (GID NOS) is used to describe individuals who have gender issues but do not meet the current criteria for GID. As part of a consensus process conducted by the World Professional Association for Transgender Health, the authors make the following recommendations for DSM-V: removal from the chapter on sexual disorders; more specific diagnostic criteria; retention of clinical significance criteria; and removal of exclusionary criteria of Intersex /Disorders of Sex Development. Changes to the existing clinical examples were also recommended, suggesting additional clinical examples which encompass a broader range of gender-variance and more commonly found transgender presentations. The diagnosis must reflect the severity of the clinical issues which represent legitimate identity experiences and possible need for gender-confirming treatments.

KEYWORDS: Transgender, transsexual, Gender Identity Disorder (GID), Gender Identity Disorder Not Otherwise Specified (GIDNOS), gender dysphoria, crossdressing, castration, intersex, Disorders of Sex Development, DSM, DSM-V, gender variance, genderqueer

The Trump administration is considering defining gender as a binary biological, immutable condition determined “biologically” at birth. According to this proposed policy, one is either “male” or “female.” No other categories would be allowed. This policy change is apparently directed at transgender citizens who would be classified according to their chromosomal “identity” at birth, rather than their pre-or post-operative gender re-assignment.

The psychomedical literature of transsexualism, which began after Hamburger et al.'s announcement of Christine Jorgensen's sex reassignment some 52 years ago, consists chiefly of clinical reports and studies written by presumably nontranssexual individuals. It is a literature which has been historically based on a number of unfounded assumptions: that those with gender identity disorder (as it is now called) are mentally disturbed; that their destinies are best determined by mental health professionals; that only those who are profoundly unhappy in their birth gender should be allowed access to body-changing medical technologies, and then only after passing various tests required by psychotherapists; and that body-changing medical technologies should be used only in the service of altering bodies to resemble as closely as possible those of the "other" sex, with no intermediate states allowed or even conceivable. Only in the last few years have new writings begun to challenge these assumptions.
The assumptions which have driven the literature arose from the often sexist and homophobic attitudes of researchers and clinicians [Kessler & McKenna, p. 118] and have colored both public and private perceptions of transsexuals and transsexualism and set the course for the literature itself by determining not only the research questions asked, but the ways in which the resulting data have been interpreted. The biases of researchers are often kept overtly out of their papers, but are made clear in their conversations with other professionals. [Raymond, 1979] Cautionary voices of anthropologists, feminists, occasional clinicians, and transsexual people themselves have been virtually ignored. Bolin, p. 63] Questions of experimenter bias, subject selection, and the power dynamics of the client-caregiver relationship have not been addressed. Until recently, the voices of transsexual and transgendered scholars were entirely absent from the discourse [Denny, 1993]. Consequently, the psychomedical literature of transsexualism is largely pejorative, tending to blame and otherwise stigmatize transsexuals not only for their very transsexualism, but for shortcomings in research design and treatment. When the assumptions underlying this literature are understood, the literature's failing can be seen to lie not so much in the inadequacies of transsexuals themselves as in the shortcomings of the system which arose to treat and study them, and in the disenfranchisement of transsexuals themselves, who have been considered unworthy of contributing to the literature. [Green, 1997]
Much of the existing literature, although technically accurate, addresses in detail questions which no longer seem relevant. For instance, there have been any number of studies designed to determine the ways in which transsexuals vary from controls (i.e., "normal" individuals). A great deal of effort has been expended in attempts to "manage" transsexualism and transsexuals themselves. Meanwhile, other, more important, questions remain unaddressed. We do not particularly need further studies about the relative performance of transsexuals vs. control groups on the scales of the MMPI; we need studies which will define a new literature which is less bound to the notion of the inevitability of genital surgery and Ken and Barbie stereotypes of masculinity and femininity, which empowers transsexual people rather than degrading or stigmatizing them, and which asks new questions relevant to a new century.

Objectives: We aim to provide an understanding of the psychological sequela of androgen insensitivity syndrome (AIS) in phenotypic females in order to begin to inform psychosocial health care services.

Design: Eight adult women with AIS were recruited through the Androgen Insensitivity Syndrome Support Group-United Kingdom (AISSG-UK). Data was collected via two semi-structured interviews with each woman.

Methods: Transcripts were analysed using grounded theory and a conceptual model was developed which suggests a way of understanding the AIS distress experienced by the participants.

Results: The pivotal concept is a woman's fear of devaluation. This is connected to her level of adaptation and perception of having a compromised womanhood. These, in turn, are related to her medical management and involvement with others via a support group and in talking about AIS.

Conclusions: Participants showed a clear preference for open communication about their condition throughout the process of medical management. We recommend sensitive, pacing of information to allow young women and their families to make informed decisions about treatment and a realistic adaptation to life with AIS.

This applied research project describes employment nondiscrimination policies that protect gender identity or expression in city and county governments in the United States of America. The history of transgender public policy in the United States is outlined and sets the stage for the research. Additionally, the literature review introduces relevant issues to discrimination in employment. The nondiscrimination policies are described using six descriptive categories. The categories in the content analysis include: “Source of Legal Authority,” “Scope of the Policy,” “Protected Class,” “Capability,” “Safeguards” and “Government/Demographics.” The methodology is broken down into three phases to complete the task of describing these policies by over-viewing the state-wide protections that coincide with them, the qualities of the policies themselves and the characteristics of the governments and demographics of the area. The study primarily describes characteristics and provisions of nondiscrimination policies from local governments that protect gender identity or expression. Analysis of the policies suggests that they are lacking in safeguards that protect the privacy and well-being of those that file complaints. Furthermore, four-fifths of the policies designate implementing agencies to institute policies, yet less than half delegate sufficient power to enforce them.

'Design as Cure? Treating the Male to Female Trans Body through Strategies of Design in Medical Discourse, 1890-1970'. My paper explored the main argument in my Masters dissertation, which argued that plastic surgeons treating the trans body from 1890 to 1970 saw themselves as artists and designers. It considered the consequences of treating the living body as an object to be designed, and gave an early history of trans medical treatment.

It seems naturally accepted that treating pacients with hormones, or with surgery that involves castration, mastectomy, mammoplasty, phalloplasty or vaginoplasty could and does pose a permanent health risk. This has been reported in several scientific studies, but very specifically in one conducted in the Karolinska Institute in Stockholm (the Institute that awards the Nobel prizes); the study evaluated sex reassignment in 324 transsexual persons another study is analized too to give a global idea of the problem.