Prisoners, doctors and the battle over trans medical care

Prisoners, doctors and the battle over trans medical care


Stephen Levine was born 1942 in Pittsburgh. He wanted to become a doctor from the time he was little; he saw how much his parents and people in his community respected the profession. At the Case Western Reserve University School of Medicine, he decided to go into psychiatry, drawn to the way the field researched human histories as well as biology. In 1973, while completing his residency, Levine heard that his alma mater was looking to hire someone to develop a medical school curriculum in human sexuality. Levine got the job. Over the next few years, he helped set up several sex-focused clinic clinics at the university. In 1974, he founded the Case Western Gender Identity Clinic to treat people who were unable or unwilling to live as the gender assigned to them at birth.

By the 1970s, when Levine entered the field, scientists and doctors had spent years arguing about what “caused” transit – and so how to treat it. As described by Joanne Meyerowitz in her 2002 book How sex changed, by the middle of the 20th century, two schools of thought competed for supremacy. The first saw the desire to change one’s body through a psychoanalytic lens, as symptomatic of an unresolved early life trauma or sexual difficulty. Initially, most psychiatrists belonged to this group, believing that doctors who helped their patients physically pass only enabled scams. The attitude was summed up in the words of the eminent sexologist David Cauldwell, who wrote in 1949, “It would be criminal for any surgeon to mutilate a pair of healthy breasts.”

The second camp highlighted biological factors. While his admirers generally agreed that a patient’s education and environment could affect their gender identity, they considered a person’s chromosomal or hormonal composition as the most important. Prominent figures, including endocrinologist Harry Benjamin, noted that the “cure” of transness through speech therapy was almost always unsuccessful, in which case he favored another intervention: “If it is clear that the psyche can not behaves in sufficient harmony with the soma, then and only then is it essential to consider the opposite procedure. ”

As these camps emerged, some trans people were constantly drawn against their views, insisting that transit was not a medical disorder and that access to hormones and surgery should not be foreseen with the approval of predominantly CIS and male doctors. In the late 60s and early 70s, some trans people tried to organize their own treatment clinics, providing counseling and support to colleagues and referrals for surgery.

However, these clinics did not survive and the primary medical model continued to take over. In his research and study work, Levine relied on the psychoanalytic approach, theorizing that the desire for transition was a way for his patients to “avoid painful intrapsychic problems.” He explored what he considered to be possible causes of these feelings, including the mother’s relationship “too long, too symbiotic”. When a person declared himself transgender, he liked to say, it was the mind’s attempt to offer them a solution. In psychotherapy, patients could interrogate and resolve the problem that brought these feelings. As in other clinics across the country at the time, Case Western’s offered surgery to only a few transgender patients – about 10 percent since 1981. Many trans people were irritated by this approach, but at least they found a degree of sympathy. and understanding at clinics like that of Levine. They were seen as people in need of treatment rather than as deviants.

Through the ’70s and’ 80s, Levine’s stature grew. His clinic attracted patients and he published articles in prestigious journals. By the early 1990s, however, the scientific consensus between trans health care providers and researchers was beginning to move away from psychoanalytic theories. More people were seeing evidence of innate biological factors. An increasing number of providers argued – with ever-increasing quantitative data to substantiate their claim – that medical interventions were more effective than therapy in relieving gender dysphoria. One area of ​​the human brain associated with sexual behavior is larger in men than in women. In 1995, a historical study published in Nature found that this area was the same size in trans women as in their cisgender peers, regardless of their sexual orientation or whether they had taken hormones. The finding suggested that “gender identity develops as a result of an interaction between the developing brain and sex hormones.”

Two years later Nature the study turned out, Levine was appointed chairman of a committee of the International Association for Gender Dysphoria Harry Benjamin, the country’s main organization for medical providers treating trans people. The most important role of the organization was to develop and publish a regularly updated document outlining best practices for diagnosing and treating trans people, called the Standards of Care. Levine was invited to lead the team that produces the next update, SOC 5.

Reviewing the standards was a multi-year process. In 1997 the organization held its biennial conference in Vancouver, British Columbia. Jamison Green, a trans man and health activist then living in San Francisco, arrived at the event to find out that he was one of only a few trans people present. He “was not a welcoming environment,” he tells me. “They were not happy to see you.” Levine was expected to chair a session Saturday afternoon on the proposed draft standards. Green was sitting in the auditorium, waiting for the event to begin, when he heard a noise outside. Technically, the meeting was open to members of the public, but there was a costly registration fee. Many other trans activists, especially those living in the country, were outraged that, because of the heavy price, they were essentially being excluded from a meeting that would directly affect their care. They “started knocking on doors and trying to get inside,” Green says.


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