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January 27, 2013

Unhappy with their bodies

Reuel S. Amdur

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Ayatollah Ruhollah Khomeini made history in providing the leadership to the movement that drove the Shah from power in Iran. He made his mark in the domain of sexuality as well. Fereydoon Molkara barged into his presence and brought his tear-filled problem, that he was, as he experienced it, a woman trapped in a male body. After due consideration, Khomeini decided that there was nothing in Islamic religious texts to forbid sex change operations, and so they are available in Iran, even though transgendered individuals there in fact are apt to face persecution.

Often trans experience the feeling of “really” belonging to the other sex very early in life.  Jenna Talackova, the trans who crashed the Miss Universe Canada pageant, experienced the desire to be male as early as age four.  For another male-to-female trans, Michelle Lascelle, it was at age five.  While there are also female-to-male trans, they are far fewer.  Both Lascelle and Talackova are Aboriginal, and in fact Talackova’s band, the Lake Babine Nation in British Columbia, helped her cover the admission fee for participation in the pageant.

While the residential school experience has had a devastating impact on First Nation cultures, it may be that something of the old cultures has managed to survive, in relation to sexuality.  Just about all North American aboriginal societies had a role for non-heterosexual males.  Many also had a role for non-heterosexual women.  These roles did not distinguish between homosexuals and transgendered persons, and of course back in pre-colonial times there was no surgical procedure for trans.  Anthropologists called men taking a female role berdaches, while they prefer the term Two-Spirit.  Algonquins saw Two-Spirit people as having a special relationship to the supernatural, and for good measure they expanded the term to include other people who were different and thought to have these same special relationships—cross dressers and people who had visions, for example. 

Algonquin attitudes today toward trans are not the same from one place to another and not always the way they were prior to colonization.  Some bands are more accepting than others.  Lascelle has a strong First Nations identity, expressed in dance and hand-drumming.  The Algonquins of Golden Lake, Ontario, accepted her in the female role, but those of the Kitigan-zibi band near Maniwaki, Quebec, did not, with a shift in tolerance over three years.  “The first year I danced with the women.  My regalia is all female.  The second year, I could not dance with the women.  I had to dance by myself.  The next year they told me to dance with the men.”

Some years ago, I had a trans male as a client, someone who had not had the operation.  His father explained his orientation.  “He is attracted to men, but only to straight men, not to homosexuals.”  It used to be said that trans were psychologically maladjusted, but that view has changed.  Dr. Louis Gooren, writing in the New England Journal of Medicine, found that the surgery benefits trans, provided that they do not have some other psychiatric diagnosis.  Now, question is being raised about the justification for having a psychiatric label on the condition at all and about the involvement of psychiatry in dealing with the treatment. 

In Ontario, the Gender Identity Clinic is part of the Centre for Addiction and Mental Health, and it is headed by a half-time psychiatrist.  There is a psychologist at the clinic full-time.  A person engaged in the sex change process begins with hormone treatments.  Before the actual surgery, a person must demonstrate ability to function as a person of the other sex.  Fairly recently, this procedure, called a “real life experience”, lasted for two years.  Now the procedure has been reduced to one year.  Dr. Nicola Brown, the psychologist, told us that the clinic is also considering eliminating what has been a three-month real life experience requirement before beginning hormone treatment.

Kaitlin Riordan, a California trans, is not impressed by the change in the Ontario procedures.  “One year is the international standard,” she said.  And as for hormone treatment, “I didn’t have to go through any real life experience ahead of that.” 

In order to get surgery, he needed letters from two different specialists in gender identity, while in Ontario the clinic provides the selection process.  The one way in which Ontario impresses Riordan is in the public health insurance coverage.  “I had to pay out of my own pocket,” she said.  “In the US, unless you have private insurance, that’s what you have to do, and private insurance provides very limited coverage.”  In Ontario, even people on welfare are accepted for the procedure. 

Riordan’s autobiography is planned to come out in 2013.

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