Sunday, November 04, 2007
AAP: Androgen Insensitivity Does Not Mean Immediate Surgery
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
November 02, 2007
SAN FRANCISCO, Nov. 2 -- Many patients with the intersex syndrome of complete androgen insensitivity can safely delay gonadectomy and vaginal reconstruction at least until late adolescence, suggests a long-term study.
- Explain to interested patients that this study found that people with the intersex syndrome of complete androgen insensitivity can safely delay decisions about orchiectomy and vaginal reconstruction.
- This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.
Of 27 patients who underwent gonadectomy, 20 had the procedure in late adolescence or early adulthood, and seven had surgery in childhood, Todd Purves, M.D., of Johns Hopkins reported at the American Academy of Pediatrics meeting here. None of the surgical specimens demonstrated evidence of malignancy.
Additionally, 11 patients have had vaginal reconstruction, 10 procedures performed after puberty. Seven of the 10 postpubertal patients who had vaginoplasty are sexually active, as are 12 of 15 who decided not to have the surgery.
"A woman who has a vaginal depth of two or four centimeters won't be able to have sexual intercourse, but that finding and that decision [about surgery] can be made at age 19," Dr. Purves said in an interview. "The decision can't be made at age two or three or four."
"One of the bottom-line findings of this study is that if a physician sees a two- or three-year-old child with this condition, it would be inaccurate, inappropriate, and wrong to tell the parents 'Your child is going to need vaginal surgery,'" he added. "That is incorrect. Not all of these patients need surgery."
Much of the debate about caring for patients with complete androgen insensitivity syndrome centers on the need for, and the timing, of gonadectomy and vaginal reconstruction or dilation, Dr. Purves noted. For patients who have surgery, the principal issue becomes timing: Should the surgery be done before or after puberty?
The testes are not necessary for development after puberty, but patients with the syndrome face a risk of malignant transformation of 2% to 5% per year after age 25. Additionally, some patients and parents are advised that surgery will be required for normal sexual functioning.
Complete androgen insensitivity syndrome occurs in two to five of every 100,000 live male births, according to the National Institutes of Health. Those with the condition have XY sex-determination chromosomes of males, but because their body does not respond to androgen, they may develop female characteristics, including sexual characteristics. . . .
The travails of the third gender
Karachi
Bindiya, a member of the Hijra (Eunich) community, won the hearts of a jam-packed audience at The Second Floor on Saturday night with her witty responses during the question-answer session after the screening of a documentary on her life entitled, ëBindiya Chamki Gií.
The 24-minute documentary was a short narrative on the lifestyle and challenges encountered by the Hijra community [also known as Khwaja Siras] in Karachi and Pakistan in general. Through the documentary, Bindiya highlighted the harassment they face at every step. ìBe it public buses or
public toilets, we are harassed by both men and women. We donít even know where to stand in public queues; the women say we should be with men, when we join the menís queue they tease us and ask us to join the women,î shared Bindiya during her interview with Ragini Kidvai, Director/Producer of the documentary.
Ragini, through her documentary, tried to draw peopleís attention towards this important segment of the population, whose rights are conveniently being ignored by the government. From the issuance of NICs to the provision of jobs, the presence of a third gender has still not been acknowledged by the state, she complained. Ragini informed that the Hijras can be classified
into three types - transsexuals, transgenders and crossgenders - and that most of the doctors are unable to determine the right gender at the time of birth.
In the documentary, Bindiya disclosed that her parents could not determine that she belonged to the third gender until she was old enough. “I had other brothers and sisters but could not relate to either of them. When I found out about Hijras I starting hanging out with them and realised this is where I belong and then abandoned my family to stay with other Hijras. However, I am still in touch with my family,” she said.
Bindiya said that the Khwaja Siras, would willingly accept jobs if offered by the government or the private sector. ìWe deserve as much respect and recognition as any other citizen of the country,î said Bindiya. . . .
Japan sex-change parents can't change records: court
TOKYO (Reuters) - Japan's Supreme Court has denied pleas from two people with gender identity disorders to change their sex in government household records, their legal adviser said on Monday.
Masami Osako, 51, and Sayaka Morimura, 47, had wanted to have their registered sex switched to female from male after undergoing sex-change operations.
But both were denied the move under a law that says people who have children cannot change their sex on the household registry. Osako and Morimura each have a child with wives they had divorced before their sex changes.
Lawyer Toshiyuki Oshima, who advised the two separate cases, said he now planned to urge politicians to change the conditions under which transsexuals can change their records.
"Now that the Supreme Court has denied the change, we now have grounds to ask lawmakers to revise the law so that people with children can also have their registry changed," Oshima said by telephone.
Under a law in place since 2004, people diagnosed with gender identity disorder can change their sex in Japan's detailed household registry system, but under several conditions, including that they are unmarried and have no children.
More than 570 people succeeded in changing their registered sex under the law up until the end of 2006, Oshima said. Eight have been denied the change, all because they had children.
The Supreme Court ruled that allowing a registry change for someone with a child would "add confusion to family discipline and would possibly cause problems for the child's welfare." . . .
Efforts to 'cure' gays draw protests
29 October 2007
29 October 2007
The long-raging debate over efforts by some religious and psychological groups to "cure" homosexuals is flaring anew this weekend on two battlegrounds: at a conference in Irving and at a Barack Obama campaign concert in South Carolina.
Several dozen people demonstrated Saturday outside the DFW Airport Marriott, where the National Association for Research & Therapy of Homosexuality is holding its annual conference. Members are discussing research in conversion therapy: therapy to suppress homosexual desires.
Protesters are also expected to stage a vigil today in Columbia, S.C., where a gospel outreach concert is being held to help Obama's efforts to reach out to black voters in the pivotal South Carolina primary. At issue is one of the event's featured stars: Grammy-winning gospel singer Donnie McClurkin, who has said he believes that homosexuality is a choice, one he was able to break loose from with the power of prayer.
The message from the gay, lesbian, bisexual and transgender groups protesting at both events is that homosexuality needs no cure because it is not an illness and that attempts to convert gays to a straight lifestyle are based on quack science.
The views of the therapy association and McClurkin "are patently absurd, unscientific and have no basis in fact," said Wayne Besen, an author and political organizer who helped arrange Saturday's protest.
Besen also helped spark the national controversy over Obama's concert by publicly challenging the Illinois senator to disavow McClurkin. . . .
Born Again
October 31, 2007
Clinton Edwards’ journey to womanhood.
It’s her hands that will always give her away.
Strong and broad and coarse with wide nail beds, they’re folded daintily across her lap, fidgeting and smoothing the fabric of her tan skirt. She doesn’t try to hide her hands. Doesn’t dress them up. No nail polish. No French manicure.
Just hands.
They are Clinton Edwards’ hands. They are also Nova Edwards’ hands.
Those hands had been used to hide things. They helped Clinton hide Nova. Tried to cover up all the little things that might have given her away. That might have revealed her true nature to the world, to her family, to the people that both she — and he — love.
Now they’re a reminder of Clinton and his sometimes painful past, but they’re nothing that Nova needs to hide from any more.
“My first memories of my life are of me identifying as a little girl,” says Nova, who stopped hiding from herself about three years ago. That’s when she began the rocky transition from a full-grown man — with a life and a woman who loves him — to the woman that she hopes soon to be.
She says she’s a much happier person than she was living Clinton’s lie, but there are some things from Clinton’s life that Nova doesn’t want to lose. Such as “Elizabeth,” Clinton’s girlfriend of 17 years, the woman who might have been his wife if life had turned out differently. The woman Nova still hopes might have a change of heart.
“I don’t want to say goodbye, because when I do, she’s not going to want to see me and she’ll consider me dead,” Nova says softly while sipping coffee in a booth at Perly’s on Franklin Street near her apartment.
Clinton and Elizabeth got together in 1990, when both of them were students at Virginia Commonwealth University. Clinton was 22 and had discovered only four years earlier as a freshman with unfettered access to a university library that there was a name for the way he’d felt all his life.
He told Elizabeth everything about his secret. He told her that at 19, he’d nearly begun the process of gender reassignment, but had held back for the sake of his mother.
Elizabeth didn’t like the truth, but she accepted him. Although Clinton wanted to be a woman, he was still sexually attracted to women — and to Elizabeth. They could make it work.
Now, their solid friendship is months — maybe days — away from the end.
While Nova gets closer and closer to the day that her transition from male to female will be complete, Elizabeth can no longer accept Nova as part of her relationship with Clinton.
And Nova can no longer accept Clinton.
Once bottled up inside Clinton, Nova is as honest as can be about who she is. She is a transgender woman — a T-girl, a TG woman — who as a man came to the decision to accept her true nature as a woman lost in a man’s body.
She’s not unique, but whether her condition is part of the natural range of human sexuality or the manifestation of perverted thoughts or a personality defect remains a public debate.
While the debate continues, so does the social stigma. It’s much more complicated, and less accepted, than being gay in today’s society. To want to change your sex is something else. Jobs are lost. Families are lost. Friends are lost. Few can — or want — to understand. Psychiatry still views transgenderism as a disease, classifying it as an aberration and recommending treatments in its official literature.
People like Nova often gather the courage to make the transition to living as women late in their lives, long after their duties and social ties have become well-established. It’s ironic that courage comes only with time, when an earlier transition might have made for a simpler reintegration into society as a woman. Hormones can do a lot for a teenager not yet fully endowed with the masculine traits of a middle-age man.
Often the decision to risk losing girlfriends, wives, children and extended families is one of desperation. Living for decades in a body they feel is not theirs and trying to play the role in society assigned by their gender, the transgendered desperately seek a way out. Years of depression — of contemplating or attempting suicide, or sometimes just the simple inability to continue in a lie — eventually take a toll.
Some transgender women commit suicide; various medical community statistics put suicide rates among TG women as high as 25 percent. That’s regardless of whether they are still living as men, are beginning a new life as something between man and woman, or have made the full transition to surgically achieved womanhood. . . .
Never mind the reassign
>> For Toronto’s the Cliks, queer and
transgender politics take a backseat to rock
CROSSOVER POTENTIAL: The Cliks
by ANDREA ZANIN
Toronto-based rockers the Cliks have attracted quite a lot of attention this year. Their music has been compared to the White Stripes and David Bowie, and their major-label debut album, Snakehouse, was released in April by Warner in Canada and Tommy Boy in the U.S. This summer, the Cliks played several cities with Cyndi Lauper’s True Colors tour, and now they’re making a few stops in Canada before heading off to open on the Cult’s U.S. tour.
It should come as no surprise that an all-queer band with a female-to-male transgender frontman, the charismatic Lucas Silveira, would have a distinctly queer fan base. But the labels are betting that the foursome (with bassist Jen Benton, drummer Morgan Doctor and guitarist Nina Martinez) has crossover potential, and Silveira has high hopes as well.
“All I know is that we’re creating music,” he says. “To be good, it should be universal. The kind of stuff I write about is particular to the human spirit as opposed to a community or a politic of people.”
Silveira is happy to embrace his pop roots. “I’m not underground. I grew up listening to pop rock and mainstream rock music, so of course the music I create would be of that genre.”
Much has been made of Silveira’s transgender status—the Toronto Star described him as “on the verge of becoming the first transgendered pop heartthrob ever to register on mainstream radar,” and he’s been told he’s the first trans male to be signed to a major label.
“Everyone has a story,” he says. “This just happens to be my story and I happen to be a songwriter. I’m visible because it’s important to talk about these things. But I walk around thinking about music, not gender.”
Musically speaking, however, a gender change is more than an interesting factoid. A typical female-to-male transition involves using testosterone to help develop masculine physical traits—including a deeper voice, which can take several years to mature. For a singer, that’s no small consideration, especially since Silveira’s transition began just as the band was embarking on the upward spiral of success.
As with everything else, though, Silveira has made some unusual choices—he’s opted out of taking hormones. “I decided right at the beginning about the effects it would have on my voice, and I just couldn’t take the risk,” he explains. “Having a moustache would have been nice but it’s not worth losing my voice. It’s carried me throughout my life. I felt sorry for myself at first but because of this, I was sort of forced to start thinking about gender a little differently.”
He did have a double mastectomy—top surgery—“so that’s made me feel a lot more comfortable with my body. But I don’t necessarily need to have a beard or a deep voice to consider myself a transgender male.”
Silveira wrote the album while going through an intense period in his life, and that certainly comes through in the music. “It’s a strong album not just musically but because it’s about going to the deepest, darkest places inside yourself and coming out and finding hope and strength that you never thought you had,” he says. “But if people just want to dance around and say, ‘Yeah, it’s hot, that’s a great song’—well, that’s fine too.” . . .
Thailand's secret history
About 2,000 books, magazines, photo albums, video tapes, movie and audio CDs relating to homosexuals fill the small room that is the country's only library dedicated to documenting the local gay community. Called the Thai Queer Resource Centre (TQRC), it was founded by Australian scholar Assoc Prof Peter Jackson with the aim of preventing the history and voice of the Thai GLBT (gay, lesbian, bisexual and transgender) community from erosion by the state.
''No official library in Thailand is collecting this material. Also, the police are out to destroy them. It's therefore essential that the Thai GLBT community, and researchers such as myself work together to save these important records of Thai queer history,'' explained Jackson, senior fellow in Thai history at the Australian National University's Research School of Pacific and Asian Studies.
There is a lot of interest among Thai university students in conducting research on Thailand's gay, lesbian and transgendered community, he said, but the authorities view material that reflects the lives of the Thai GLBT community as immoral and illegal, which must be destroyed. So there is no place where students or researchers can find such historical records.
Hence his effort to set up the Thai Queer Resources Centre to collect as many publications as possible before the police and ill-informed government policies lead to them being destroyed.
The Thaksin administration's social order campaigns, for example, severely affected gay publishing in Thailand, with police raiding magazine and book shops, even second-hand bookshops, to confiscate gay magazines.
''If private citizens, academics and Thai gay organisations do not work together now, then the negative attitudes of Thai bureaucrats and the police may mean that vital historical records will disappear forever in this country,'' he pointed out.
''To understand the real lives and situations of the Thai gay, lesbian and transgendered communities, it is necessary to read what they say about themselves and their own lives,'' he said.
''This material forms an excellent record of how Thai gays, lesbians and transgendered people have lived their lives in Thailand over the past few decades amid so many negative and misinformed stereotypes of gays, lesbians and transgender people in the Thai press and media.''
Thai GLBT magazines have been written and published by people from these communities, for readers who are gay, lesbian and transgendered. They include short stories and novels, biographies and autobiographies and movie reviews.
Jackson himself has his own academic collection in Australia, now kept at the Australian National University. It will eventually be transferred to the National Library of Australia. To him, it is important that a similar collection also be established in Thailand.
He started collecting Thai magazines and books on gay, lesbian and transgender issues in Thailand on his first research visit to Thailand in 1982.
''I now have about 300 Thai-language books, and about 2,000 Thai gay magazines, which have been published since the early 1980s. I think I probably have the largest collection of Thai-language publications on gay, lesbian and transgender issues in the world,'' he said proudly. . . .
