The war between prisoners, doctors and transgender healthcare

Stephen Levine is Born in Pittsburgh in 1942. He wanted to be a doctor since he was a child; he saw how much his parents and people in the community respect this profession. At Case Western Reserve University School of Medicine, he decided to enter psychiatry and was attracted by how the field explored human stories and biology. In 1973, when he completed his residency internship, Levine heard that his maternal correction was looking for hiring people to develop medical school courses on human sexuality. Levine got the job. Over the next few years, he helped establish several clinics at the university that focused on sexual disorders. In 1974, he co-founded Case Western’s Gender Identity Clinic to treat people who are unable or unwilling to live according to the gender assigned at birth.

In the 1970s, when Levine entered the field, scientists and doctors had been arguing for years what “caused” degeneration—and how to treat it.As Joanne Meyerowitz described in her 2002 book How does gender changeBeginning in the mid-20th century, two schools of thought competed for primacy. The first to think that the desire to change one’s body through psychoanalytic lenses is a symptom of unresolved early trauma or sexual difficulties. Initially, most psychiatrists belonged to this group, and they believed that doctors who helped patients make physical transformations would only make them delusional. In 1949, the famous sexologist David Cauldwell wrote: “Any surgeon who cuts a pair of healthy breasts is a crime.”

The second camp emphasizes biological factors. Although its supporters generally agree that the patient’s growth experience and environment will affect their gender identity, they believe that a person’s chromosome or hormone composition is more important. Well-known personalities including endocrinologist Harry Benjamin pointed out that it is almost always unsuccessful to “cure” transgender disease through talk therapy. In this case, he tends to take different interventions: Only then must the opposite procedure be considered. “

With the emergence of these camps, some transgender people continue to refute their views, insisting that transgender is not a medical barrier, and that hormones and surgeries should not be obtained on the premise of the approval of most cis-style doctors and male doctors. In the late 1960s and early 1970s, some transgender people tried to organize their own treatment clinics by providing peer counseling, support, and surgical referrals.

However, these clinics did not survive, and the main part of the medical model continues to dominate. In his research and academic work, Levin tends to use psychoanalytic methods. In theory, the desire to change is a way for his patients to “avoid painful inner problems.” He explored the underlying reasons that he believed to produce these feelings, including the “too long, excessive symbiosis” maternal relationship. When a person claims to be transgender, he likes to say that this is the brain trying to provide them with a solution. In psychotherapy, patients can ask and solve the problems that produce these feelings. Like other clinics across the country at the time, Case Western only provided surgery for a small number of transgender patients—as of 1981, this proportion was about 10%. Many transgender people are frustrated with this practice, but at least they are in clinics like Levine. They are seen as people in need of treatment, not deviants.

In the 1970s and 1980s, Levine’s status continued to improve. His clinic attracted patients, and he published articles in prestigious journals. However, by the early 1990s, the scientific consensus between transgender healthcare providers and researchers began to shift away from psychoanalytic theories. More and more people are seeing evidence of innate biological factors. An increasing number of providers believe that—with ever-increasing quantitative data to confirm their claims—medical interventions are more effective than treatments in alleviating gender anxiety. An area of ​​the human brain related to sexual behavior is larger in men than in women. In 1995, a Landmark research Published on natural It was found that this area of ​​transgender women was as large as their cisgender peers, regardless of their sexual orientation, and regardless of whether they had taken hormones. The findings indicate that “gender identity is the result of the interaction between the developing brain and sex hormones.”

Two years later natural After the research was completed, Levin was appointed as the chairman of the Harry Benjamin International Gender Dysphoria Association Committee, which is the main organization of medical providers for the treatment of transgender people in the United States. The most important role of the organization is to develop and publish a regularly updated document that outlines best practices for diagnosing and treating transgender people, called standards of care. Levine was invited to lead the team to produce the next updated version of SOC 5.

Revision of standards is a process that takes several years. In 1997, the organization held a biennial meeting in Vancouver, British Columbia. When Jamison Green, a transgender and health activist living in San Francisco at the time, arrived at the event, he found that he was one of the few transgender people who participated in the event. He told me that this is “not a welcome environment”. “They are not happy to see you.” Levine was originally scheduled to chair a meeting on the draft standard on Saturday afternoon. Green was sitting in the auditorium, waiting for the activity to begin, when he heard a commotion outside. Technically speaking, the conference is open to the public, but requires expensive registration fees. Many other transgender activists, especially those who live there, are angry that because of the high price, they are basically excluded from meetings that directly affect their care. They “started knocking on the door and asked for them to come in,” Green said.