Category Archives: Terms Defined
A look at some of the different Identities
Sex Reassignment Surgery SRS When things go wrong
Filed By:
Amy Hunter
Sometimes, things go wrong with the surgery.
It has many names and many acronyms, SRS, GRS, GCS-Sex Reassignment Surgery. Whatever you call it, it is an irrevocable commitment and irreversible step should you choose to take it.
Male to female (MtF) transpeople talk about it a lot. You know: Are you, or aren’t you? Is she pre-op, or post-op? Who did yours? Whom are you going to have do yours? We talk about it a lot, except…when things go wrong. Then–we don’t say much at all. In fact, we won’t talk about it publicly, but it happens. We cover it up as if we should be ashamed. We feel damaged.
Something odd ensues, much like forty or fifty years ago. Back then, people spoke in hushed tones, if at all about the family member, colleague, or friend who had certain illnesses-the “C word”-only whispered. Many times this lack of openness about such matters led directly to preventable consequences–even deaths.
We need to talk about healthcare for the transgender individual and I want to talk–openly about my experience–about what can happen when things go wrong with SRS.
After the jump– a story.
I Knew There Were Risks
While death is an unlikely result of complications from sex reassignment surgery, things can and do go wrong with the procedure. Even the most skilled of surgeons are, after all, human and as with any surgery, there are risks.
The information packet sent to me from my surgeon’s office listed the possible things that could go wrong. I had read extensively about what my body would have done to it after Propofol sent me to a dreamless sleep. Everything I found on the internet listed possible complications. One was a worst-case scenario, but the websites always mentioned it last and even then, it happened so seldom, most said, that it was a risk hardly worth mentioning.
My pre-operative appointment, a scant two hours before I signed the waiver, was brief. The surgeon asked a few questions, looked me over, pronounced me suitable for surgery and added that I had enough tissue for good depth. Almost as an afterthought, she said we needed to go over “this stuff”. We got to that last, not worth mentioning but still possible, worst-case scenario thing. Of course, it needed to be brought up but in almost four hundred surgeries “it had only happened just once, so we don’t worry about it”. I didn’t.
Just before I walked into the surgical suite, I signed the waiver.
I slumped to the floor of the shower that morning in Trinidad Colorado, water and reality raining down on me. Bewilderment and terror replaced hope, which swirled toward the drain along with the feces and the blood. Emergency surgeries there, four more at home in Kalamazoo and another in Denver have all failed.
Chronic pain, heavy narcotics addiction, and bouts of deep depression are the hushed legacies I have battled. Left with a possibly permanent colostomy and a painful, fibrous lump between my legs where a vagina should be, it is nearly impossible not to revisit the devastation daily. It is now two and a half years later.
The infrastructure of a natal male body is not the same as a natal female. The male pubic bone is lower and in my body, tipped somewhat, making it hard for my surgeon to get the geometry just right. In my case, there probably wasn’t really quite enough space to allow for the proper thickness of septum between the new vaginal wall and the rectal wall.
A slight tear in my colon from a retractor, was all that was necessary to compromise an otherwise flawless procedure. I had developed a rectal-vaginal fistula. This problem happens to natal women too, often as a complication from difficult childbirth or certain cancers. Frankly, the success rate for repairing the defect in natal women is not good either. It often takes multiple surgeries for them too. What makes it even harder for the transwoman?
The Endemic Problems In Transsexual Healthcare
My story–and my surgeon’s– illuminate important problems endemic to healthcare for the transgender and specifically, the transsexual person.
- Lack of access– Discrimination by doctors and hospitals and inability to get insurance or pay outright makes it difficult, if not impossible, for many transgender people to access care – primary or specialized.
- Lack of knowledge– Documentation of protocols for care of patients undergoing transition is severely limited. Additionally, techniques for remedial care of complications are not well developed; instead, procedures designed for amelioration of fistulae in natal females are used.
- Lack of training– There exist no specialized courses of study or teaching hospitals for SRS surgeons.
- Lack of experience– While some surgeons learn techniques from other doctors already performing SRS, there are no residencies for those wishing to become SRS surgeons.
- Lack of inter-disciplinary collaboration– Ignorance, discrimination and arrogance on the part of specialists often block those needing specialized post-SRS care.
In 2008 both the American Medical Association and the American Psychological Association issued white papers – policy statements calling for equal and fair access to healthcare for the transgender community. Both organizations recognized lack of access to health care as a growing crisis among transgender people.
Significantly, however, while both bodies asked the insurance industry to remove discriminatory blocks for transpeople, neither the APA nor the AMA asked for better training and documentation of skills. Neither organization called for unilateral coverage of transition related care and procedures. The APA resolution reads thus (emphasis mine):
THEREFORE, BE IT FURTHER RESOLVED THAT APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments;
And the AMA:
RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician.)
Ok, pretty strong statements, right? Look again and in particular, consider the italics. The APA resolution makes one BIG assumption-that you will be able to be “appropriately evaluated” , this requires you to have found and be able to pay for a psychologist, assuming of course, that you want to be evaluated. The AMA resolution assumes much the same thing; that you have a physician and that he or she is willing to make such recommendations, if, in fact, they are so qualified.
Whom Should I Go See When No One Will See Me?
I am associated with a LGBT resource center so, I get calls for things like, “Who is a trans-friendly electrologist” but the most frequent call I get is “My family doctor won’t prescribe me hormones. Whom should I see?”
To my knowledge, there are only two therapists in this area who take transgender clients, neither is a clinical psychologist who can render a surgical readiness opinion for SRS. There are one or two primary care physicians in the area who will prescribe hormones but, after hearing stories of one of them prescribing the exact same regimen for every patient, I am more than reluctant to send people to him. The nearest endocrinologist who takes transgender patients is ninety minutes from here. My own primary care doctor, admittedly, has no knowledge of how to dose a transwoman either pre-operatively or, post-operatively. He has left it up to me to tell him.
There is no curriculum, no specialization, no residency, and no board certification for SRS surgeons. No medical texts detail the procedures. Most SRS surgeons have followed in the footsteps of pioneers.
In my doctor’s case, the pioneer was legendary Colorado surgeon, Stanley Biber M.D. whose compassion for a social worker led him to develop the most celebrated sex reassignment practice in the States. The surgeon who did my SRS learned from him and took over his practice when he retired. Soon, she began refining his technique and developing and teaching her own. Today, she routinely performs SRS as many as two hundred times a year.
There are surgeons who want to do SRS-who have trained under doctors as mine did, but find it difficult, if not impossible, to find a facility that will grant privileges for SRS. Often, these surgeons may have the technical skills for SRS-urology, gynecological and plastic surgery, but hospitals will not grant access because there is no accredited course of specialization or board certification.
This may not be all bad. While there are a few new surgeons doing SRS every year, are they really getting the training necessary to accomplish not just the surgery itself but, adequate follow-up care too? Again, no curriculum, no specialized course of study, no board certification, but perhaps more significantly, certainly for the patient, there is no roadmap for what to do when things go wrong.
My Surgeon Doesn’t Know How to Fix It
Then, seemingly, neither does anyone else. My SRS surgeon attempted to fix the two-inch tear in my colon while I was still there, the repair failed in less than twelve hours. Next, a colon-rectal surgeon was found in the nearest large city and brought in to look at me. He aborted his attempt to repair the defect and instead, performed a full colostomy.
I flew home to Michigan with a bag attached to my abdomen and thick pads between my legs to soak up the blood.
A local colon-rectal surgeon, persuaded to see me by my primary care physician, was upbeat. Each time I went into surgery with him he would encourage me, saying “this time we’ll get it”. Coming out of surgery, my spouse Cindy would hear from him how well it went and that he was “optimistic this time” the closure would take and a new defect would not open up.
Another surgeon who has had some success with other fistula patients seemed promising, but eight months later, under the pressure of a barium test, that repair too, failed.
I have had stitch-overs, mucosal flap advancements, and pelvic floor muscle mobilization; each new approach diminishes what viable tissue I have for another attempt. I have tried to go into every surgery with a realistic outlook; multiple failures however, become difficult to bear.
Still, I am one of the fortunate ones with this complication; I stand a chance, albeit small, for an eventually favorable outcome. Many transwoman are not able to find a colon-rectal surgeon who is willing to work on a transperson, much less “someone else’s problem”, nor do all of us have the means.
Even if you are fortunate enough to locate a doctor–and in my case, privileged to have insurance and financial means to cover remedial procedures, then there is still only a slim chance for alleviation of this humiliating and debilitating condition. One surgeon, out of frustration no doubt, finally washed his hands of me saying, “well, you did this to yourself”.
Losing the Patient
I am not writing this to slam the physician who did my SRS. Far from it, she is a dear friend. We have shared much together, laughing, and holding each other; the two of us have grappled for footing. We have cried together, and yes, yelled at each other. She is an icon in the transgender community and heroine to many transsexuals. She is also perhaps the most accomplished of the few surgeons doing primary SRS in the United States.
However, even a surgeon as accomplished as mine cannot overcome obstacles that she has no training for and little experience resolving. There are unseen and unsaid barriers that come into play when someone with complications from SRS must seek treatment aside from their original surgeon.
As I mentioned before, most surgeons just do not want to deal with what they may perceive to be another doctor’s mistakes, if they are willing to look at you at all. A person would be hard pressed to get a doctor to admit that they are closed-minded, yet there are many doctors who simply will not work on-or treat a transsexual.
My surgeon has told me, and has repeated often, that she would see me through this. I believe she has tried, but somewhere in the mix of discrimination, ego, and fear, the patient has been lost.
First Transgender Presidential Appointee Fears Being Labeled ‘Token’
For Amanda Simpson, believed to be America’s first openly transgenderpresidential appointee, the job she starts Tuesday in the U.S. Commerce Department is an honor and the culmination of a career dedicated to understanding military technology.
But what gnaws at her, she says, is the fear of being labeled a token who was hired because of her sexual identity rather than on her merits.
“Being the first sucks,” she told ABC News.com. “I’d rather not be the first but someone has to be first, or among the first. I think I’m experienced and very well qualified to deal with anything that might show up because I’ve broken barriers at lots of other places and I always win people over with who I am and what I can do.”
Simpson has been named senior technical adviser in the Commerce Department’s Bureau of Industry and Security, a job in which she will monitor the exports of U.S. weapons technology.
She has 30 years in the industry but can’t escape the feeling that some will see her appointment as a political maneuver.
“[There will be] questions like: Is this a token? Are you here to do a job or just to fill a quota or appease other people? In that regard it makes it a bit more difficult,” she said. “I’m sure I will have to do and intend to do a far superior job than any other person. But I’m sure I will always be second guessed.”
“The Human Rights Campaign believes this appointment represents meaningful progress for the LGBT community, in particular, transgender Americans who have faced significant and well documented discrimination in the workplace. As the first transgender person appointed by the president, Amanda is not only eminently qualified for her new position in the Department of Commerce, but she is also a trailblazer for equality,” spokesman Trevor Thompson said in a statement.
Obama’s appointment of Simpson is being hailed by groups such as the Human Rights Campaign — which endorsed Obama but condemned his support of the Defense of Marriage Act while other gay rights groups are taking a more measured approach.
Though careful to say Simpson’s appointment was not merely a bone thrown to the gay and transgender community, Mara Keisling, executive director of the National Center for Transgender Equality, said the administration needed to do more to protect the rights of transgender people.
“There is certainly not enough being done by either the administration or Congress,” said Keisling. “It is frustrating as hell things work as they work, and more needs to get done.
“This was not an appointment because they have to fill a transgender spot. This is a real serious technical policy position and the job matches her resume. Her being transgender had nothing to do with getting that job,” said Keisling.
Simpson sat on the NCTE board of directors for three years.
Though transgender advocates believe Simpson’s gender identity had no role in her hiring, conservative groups claim it was a political move.
“Simpson’s nomination was forwarded through to President Obama by a gay activist group, making it appear that this appointment of a male-to-female ‘transgender’ activist to a high level Commerce Department position to be payback to his far-left base for their political support,” Monica Schleicher, spokeswoman for Christian group Focus on the Family, said in statement.
“Efforts to promote ‘transgenderism’ in public policy deconstruct one of the most fundamental concepts known to mankind. It renders gender, the most basic organization of social systems, completely meaningless. In doing so, activists like Simpson are asking the rest of society to radically reorder the ways in which the culture makes reasonable and rational accommodation for the two genders,” she said.
A former test pilot, Simpson worked in the aerospace and defense industries for 30 years, mostly at Raytheon Missile Systems in Tucson, Ariz. She holds degrees in physics, engineering, and business.
Simpson told ABCNews.com that much of her work will involve “licensing and enforcement for exports” of military technology.
In 2004, she was named by the YWCA as one of their “Women on the Move,” and in the same year, she won the Democratic nomination to the Arizona state House of Representatives. She lost in the general election.
Employment Non-Discrimination Act (ENDA)
The Employment Non-Discrimination Act (ENDA) is a proposed bill in the United States Congress that would prohibit discrimination against employees on the basis of sexual orientation or gender identity by civilian, nonreligious employers with at least 15 employees.
ENDA has been introduced in every Congress, except the 109th, since 1994, albeit without gender identity protections, but gained its best chance at passing after the Democratic Party broke twelve years of Republican Congressional rule in the 2006 midterm elections. However, some sponsors believed that even with a Democratic majority, ENDA did not have enough votes to pass the House of Representatives with transgender inclusion, and dropped it from the bill, which passed and subsequently died in the Senate. LGBT advocacy organizations were divided over support of the changed bill.
In 2009, on the heels of the 2008 elections that strengthened the Democratic majority, and after the debacle of the 2007 ENDA divisions, only a transgender-inclusive ENDA was introduced by House representative Barney Frank. Frank reintroduced the bill in 2011. Shortly thereafter, the bill was introduced in the Senate by Jeff Merkley.
President Barack Obama supports the bill’s passage; former President George W. Bush threatened to veto the measure.
Evidence Discrimination based on sexual orientation occurs at a similar rate as sex and race at 4.7 per 10,000, as compared to discrimination based on sex at 5.4 and race at 6.5. In states that have discrimination policies in place, LGB complaints are equivalent to the number of complaints filed based on sex and less than the number of complaints filed based on race.
Evidence of Employment Discrimination on the Basis of Sexual Orientation and Gender Identity
The Williams Institute estimates the number of LGBT employees as follows: 7 million private sector employees, 1 million state and local employees, and 200,000 employees of the federal government. Thirty percent of state and local LGBT employees live in California and New York. In comparison, LGB people make up only one half of one percent of state and local employees in Montana, North Dakota and Wyoming combined. This suggests that the need for policy to address discrimination may vary across the country. Surveys which seek to document discrimination on the basis of perceived sexual orientation and/or gender identity are often conducted with a pool of self identified LGBT people, making it difficult to ascertain the impact of this type of discrimination on non-LGBT individuals.
Transgender people may experience higher rates of discrimination that the LGB population. A survey of transgender and gender non-conforming people Conducted by the National Center for Transgender Equality found 90 percent of respondents experienced harassment, mistreatment or discrimination on the job or took actions like hiding who they are to avoid it. In comparison, a review of studies conducted by the Williams Institute in 2007 found that transgender people experienced employment discrimination at a rate 15 to 57 percent.
It is unclear whether LGBT individuals earn more or less than the general population. In a survey conducted by Harris Interactive, 38 percent of LGBT people report incomes less than $35,000,compared to 33 of all US adults over age 18. Some organizations believe that no such gap exists, and that LGBT people may in fact have higher incomes than non-LGBT families. The American Family Association (AFA) argues that homosexuals as a class enjoy privileged, rather than disadvantaged economic and cultural positions in society and that their household income is above average.
Existing law
State law
Current U.S. LGBT employment discrimination laws.
All employment:
State employment:
Animation showing the evolution of US LGBT civil rights policies
Wisconsin was the first state to ban employment discrimination based on sexual orientation, in 1982, while Minnesota was the first state to ban employment discrimination based on both sexual orientation and gender identity when it passed the Human Rights Act in 1993. Currently, 13 states and the District of Columbia have policies that protect against both sexual orientation and gender identity discrimination in employment: California, Colorado, Hawaii, Illinois, Iowa, Maine, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington in the public and private sector. An additional eight states — Connecticut, Delaware, Maryland, Massachusetts, Nevada, New Hampshire, New York, and Wisconsin — have state laws that protect against discrimination based on sexual orientation only.
Five states have an executive order, administrative order, or personnel regulation prohibiting discrimination against public employees based on sexual orientation and gender identity: Indiana, Kansas, Kentucky, Michigan, and Pennsylvania. Delaware,Maryland, Massachusetts, and New York prohibit discrimination based on gender identity in public employment only. An additional five states prohibit discrimination against public employees based on sexual orientation only: Alaska, Arizona, Missouri , Montana and Ohio. Ohio previously included gender identity, Governor Kasich let this executive order expire in January 2011.
Fifteen other states have laws that have been interpreted to protect transgender persons.
Local law
A number of cities and counties have implemented non-discrimination laws. As of April 27, 2011, at least 137 cities and counties prohibit discrimination on the basis of gender identity for both public and private employees. By and large, these city and county laws exist in states that already have a statewide non-discrimination policy for sexual orientation and/or gender identity. However, this is not true in all cases. The following localities have local laws prohibiting discrimination on the basis of gender identity in the absence of a comparable state law:
- Florida: County of Broward, City of Dunedin, City of Gainesville, City of Gulfport, City of Key West, City of Lake Worth, County of Leon, City of Miami Beach, City of Oakland Park, County of Palm Beach, City of Tampa, and City of West Palm Beach
- Georgia: City of Atlanta and City of Decatur
- Indiana: City of Bloomington, City of Indianapolis, County of Marion and County of Monroe
- Louisiana: City of New Orleans
- South Carolina: City of Charleston and City of Columbia
- Texas: City of Austin, City of Dallas, County of Dallas, City of El Paso and City of Fort Worth
- Utah: City of Logan, City of Park City, City of Salt Lake, County of Salt Lake, County of Summit and City of West Valley
Federal employees
As with other employers in most states, there is no federal statute addressing employment discrimination based on sexual orientation or gender identity in the federal government. However, in 1998, the administration of President Bill Clinton interpreted the Civil Service Reform Act of 1978, prohibiting federal government workplace discrimination “on the basis of conduct not related to job performance”, as meaning sexual orientation [as a factor not related to job performance], and issued an executive order to more strongly cover the executive branch, over which the President has more control. In 2009 Barack Obama did the same for gender identity. However, remedies pursued under this law are limited.
Existing workplace policies
Many large companies already provide equal rights and benefits to their lesbian, gay, bisexual and transgender employees, as measured by the Human Rights Campaign (HRC) through their Corporate Equality Index. The 2011 report found that 337 large companies received a 100% rating. These businesses employ a total of over 8.3 million full-time U.S. workers. When the Rights Campaign’s Corporate Equality Index was first utilized in 2002, 13 companies were rated 100 percent. Additionally, each year, corporations send thousands of employees to the Out & Equal Regional Summit, a conference that intends to create a more inclusive work environment for lesbian, gay, bisexual and transgender employees. Furthermore, there are workplace resources for how allies can create a more inclusive work environment, including programs available through PFLAG and the Out & Equal publication, Allies at Work, by David M. Hall.
Widespread adoption of private workplace policies may be motivated by good business sense, the Williams Institute suggests. It’s conclusion is based on a set of studies that show that lesbians and gay men who have come out at work report lower levels of anxiety, less conflict between work and personal life, greater job satisfaction, more sharing of employers’ goals, higher levels of satisfaction with their co-workers, more self-esteem, and better physical health.
Current version provisions
The current version of the bill under consideration in Congress would prohibit private employers with more than 15 employees from discriminating on the basis of sexual orientation or gender identity.
Religious organizations are provided a special exception to this protection, similar to the principles of the Civil Rights Act. Non-profit membership-only clubs (except labor unions) are likewise not bound to this rule.
The bill defines that service in the military is not “employment” and thus it does not affect the don’t ask, don’t tell (DADT) policy of the United States military. DADT was repealed by the Don’t Ask, Don’t Tell Act of 2010, signed by President Barack Obama on December 22, 2010. DADT will remain in place until President Obama, the Secretary of Defense, and the Chairman of the Joint Chiefs of Staff can certify that repeal will not harm military readiness, followed by a 60-day waiting period. On April 8, 2011, Adm. Gary Roughead, chief of naval operations reported to the House Armed Services Committee that “Our training is going very well.” “In those areas that we detected that there may be some areas of moderate risk…it is not at the level that we had originally forecasted.” The training may be completed as early as June 2011.
Legislative progress
103rd through 108th Congresses
While the first bill on the subject of sexual orientation discrimination was introduced in Congress in 1974, the first bill using the current title of “Employment Non-Discrimination Act” was introduced in 1994. It failed in 1994 and 1995, though by 1996, missed passage in the Senate by a 49-50 vote. Versions of ENDA introduced in the 103rd through 108th Congresses did not include provisions that protect transgender people from discrimination.
109th Congress
ENDA was not introduced in the 109th Congress.
110th Congress
In the 110th United States Congress there were two versions of the bill:
- H.R. 2015, introduced on April 24, 2007 by Representatives Barney Frank, Chris Shays, Tammy Baldwin, and Deborah Pryce, does include gender identity within its protections; and
- H.R. 3685, introduced by Representative Frank on September 27, 2007 and passed by the Education and Labor Committee on October 18, does not include gender identity within its scope. On November 7, 2007, H.R. 3685 was passed by the House of Representatives by a vote of 235 to 184 (14 members did not vote).
Under both versions, the bill provided employment protections similar to those of the Civil Rights Act of 1964 (the employment section is also known as “Title VII”), but specifically directed to gay, lesbian, bisexual (and under HR 2015, transgender) employees. The bills were different from Title VII in that they contained exemptions concerning employer dress codes.
H.R. 2015 does contain provisions that protect transgender people from discrimination, including a specific definition of gender identity, as well as exemptions for employer dress codes and locker rooms . The bill defines gender identity as “gender-related identity, appearance, or mannerisms or other gender-related characteristics of an individual, with or without regard to the individual’s designated sex at birth.” The bill also specifically allowed employers to require adherence “to the same dress or grooming standards for the gender to which the employee has transitioned or is transitioning.”
After H.R. 2015 died in committee, Frank proposed a new bill, H.R. 3685, that contained only prohibitions on sexual orientation discrimination, excluding gender identity. Some LGBT activist organizations responded by refusing to support H.R. 3685. This version was protested against by many LGBT rights organizations in the United States, with the exception of theHuman Rights Campaign.
Many have claimed that excluding transgender people would undermine the underlying principle of ENDA, which is that fairness is a fundamental American principle. In addition, failure to include gender identity/expression will weaken the protection for the portion of the gay population that needs it most: gender non-conforming gays, who are discriminated against in greater numbers than their gender-conforming compatriots[citation needed]. The courts would narrowly interpret a sexual-orientation-only ENDA as not covering anti-gay discrimination that stems from gender expression. Those favoring exclusion counter that it will ease the process of passing some changes in civil rights.
111th Congress
House
The Washington Blade reported on June 17, 2009 that Rep. Barney Frank (D-MA) had announced plans to introduce an ENDA bill (H.R. 2981) that includes gender identity in June 2009, with original cosponsors slated to include 4 Republicans. The lead Republican cosponsor is Rep. Ileana Ros-Lehtinen (R-FL).
On June 24, 2009, Rep. Barney Frank introduced H.R. 3017 to ban workplace discrimination based on sexual orientation and gender identity. The Advocate reported that “the 2009 Employment Nondiscrimination Act (ENDA) has 114 original cosponsors, up from 62 cosponsors for the trans-inclusive bill of 2007.” Republican Main Street Partnership members Mark Kirk (R-IL), Mike Castle (R-DE), Todd Russell Platts (R-PA), Judy Biggert (R-IL), and Leonard Lance (R-NJ) were among the original cosponsors. Earlier in June Frank had introducedH.R. 2981 for the same purpose. H.R. 3017 was referred to the House Education and Labor Committee; a hearing was held before the committee on September 23, 2009 but no further action was taken.
At the end of the 111th Congress, H.R. 3017 had 203 cosponsors in the House.
Senate
The Washington Blade reported on August 5, 2009 that Sen. Jeff Merkley introduced an ENDA bill (S. 1584) that included gender identity, with 38 original cosponsors including Sens. Ted Kennedy (D-MA), Susan Collins (R-ME), Olympia Snowe (R-ME) and Chris Dodd (D-CT), according to a statement released by Merkley’s office. Sen. Merkley was quoted by The Advocateas noting that while he has yet to consult with others, “[i]t’s certainly possible that this could be passed by year’s end, though the [congressional] schedule is very crowded.”
Blue Oregon, a progressive Oregon blog, commented on the suitability of Sen. Merkley to be lead sponsor of ENDA, noting that as Speaker of the Oregon House of Representatives Merkley had successfully guided Oregon’s state version of ENDA, the Oregon Equality Act, to become law.
As of March 13, 2010, S. 1584 had 45 co-sponsors and was pending before the Health, Education, Labor, and Pensions (HELP) Committee. A hearing was held before the committee on November 5, 2009.
112th Congress
On April 6, 2011, Rep. Barney Frank introduced an ENDA bill (H.R. 1397) to the 112th Congress House of Representatives to ban workplace discrimination based on sexual orientation and gender identity. The bill had 111 original cosponsors, compared to 203 cosponsors at the conclusion of the 111th Congress.
On April 14, 2011, Sen. Jeff Merkley introduced an ENDA bill (S. 811) to the 112th Congress Senate. The bill had 39 original cosponsors.
Arguments in favor of ENDA
Most proponents of the law[who?] intend it to address cases where gay, lesbian, bisexual, and transgender employees have been discriminated against by their employers because of their sexual orientation or gender identity. Currently, these employees are unable to find protection in the courts because sexual orientation is not considered to be a suspect class by the federal courts and by many U.S. states. Proponents argue that such a law is appropriate in light of the United States Constitution‘s guarantees of equal protection and due process to all. Advocates argue that homosexuality is not a “choice” but a personal identity, a claim supported by the American Psychology Association (APA), and that all working people have a right to be judged by the quality of their work performance and not by completely unrelated factors. According to a study published in 2001 by the Williams Institute at the UCLA School of Law, reports of discrimination based on sexual orientation are roughly equal to those on race or gender. The APA also states that there is significant discrimination against homosexuals in the workforce. There are also studies showing that local anti-discrimination laws are ineffective, and federal law is needed.
Cost estimates from the Congressional Budget Office from 2002 show that the EEOC estimated that their complaint caseload would rise by only 5 to 7%. Assessments of the impact of comparable state policies also show a minimal impact on caseload. Regarding constitutionality, the act incorporates language similar to that of Title VII of the Civil Rights Act of 1964, which has consistently been upheld by the courts.
Arguments in opposition of ENDA
Gay people as a “protected class”
Opponents of ENDA sometimes argue that gay people should not be considered a “protected class of employees” by law. However, ENDA would not protect “homosexuals” as a class; rather, the law would ban discrimination in employment based on any sexual orientation (including heterosexual orientation). Consumer surveys show that self-identified gay individuals likely have higher incomes than the average US household, and ENDA opponents argue that many gay people hold positions of cultural influence as well. The conservative Christian organization American Family Association‘s (AFA) Journal concluded in 2007 that there was “no real problem of discrimination against homosexuals.” Additionally, AFA is concerned about how non-discrimination laws impact religious organizations. The organization cites a lack of clarity around whether the narrow exemption would apply to support staff and lay employees in addition to churches and clergy.
Transgender protection
The Traditional Values Coalition bases its argument against additional legal protections for gender identity on fears that it will have a negative impact on school children, claiming that ENDA would threaten a stable and supportive learning environment. A non-discrimination policy would eliminate schools’ ability to discriminate against transgender teachers. Likewise, the Traditional Values Coalition is concerned that parents are not being adequately informed of the presence of transgender teachers in their children’s classrooms. It argues that children should not be “subjected to [a transgendered] man’s [sic] bizarre sexual transformation,” as it claims transgender individuals are “seriously mentally disturbed.” The Traditional Values Coalition argues that individuals cannot change their sex, even with surgery, and do not believe it is possible to successfully transition from one sex to another.
History
The “United ENDA” coalition protests the removal of gender identity from the 2007 bill at San Francisco City Hall.
On May 14, 1974, the fifth anniversary of the Stonewall Rebellion, Representatives Bella Abzug and Ed Koch introduced H.R. 14752, the “Gay Rights Bill.” The bill would have added “sexual orientation” to the Civil Rights Act of 1964.
In the early 1990s, a new strategy emerged. Rather than trying to obtain all of the rights in the Civil Rights Act, the legislative efforts focused on employment rights, and the “Equality Act” was renamed the “Employment Non-Discrimination Act,” (H.R. 4636/S.2238) and introduced by Rep.Gerry Studds on June 23, 1994. [Congressional Record, 103rd Congress, 2d Session, 140 Cong. Rec. E 1311; Vol. 140 No. 81 (June 23, 1994).] The legislation failed in 1994 and 1995. In 1996, the bill came within one vote passage in the Senate and was not voted on in the House, its success perhaps spurred by backlash from the recently passed DOMA, the “Defense of Marriage Act” that permitted the states and mandated the federal government to ignore same sex marriages from other states. HRC sets out the timeline of ENDA introductions.
Transgender inclusion in ENDA
The inclusion of transgender employees in ENDA has long been debated in the LGBT community. One argument is that transgender individuals are already covered under existing laws prohibiting employment based on gender stereotypes.
In 1999, the National Gay and Lesbian Task Force became the first LGBT civil rights organization to stop work on ENDA because of its lack of transgender-inclusion. From 1999 to 2007, it has worked to build a LGBT community consensus to only support a trans-inclusive bill, and participated in redrafting the fully trans-inclusive version for the 110th Congress. ENDA now enjoys the unequivocal support of a large coalition of civil rights, labor and religious organizations. In August 2004, the Human Rights Campaign – anLGBT organization that is among the primary lobbyists for the bill – announced that it will only support passage of ENDA if it included gender identity protections as well. However, in November 2007, it reneged on its stance and supported a non-inclusive ENDA instead. A 2004 article by Matt Foreman, the executive director of the National Gay and Lesbian Task Force discusses this.
Legislative history
| Congress | Short title | Bill number(s) | Gender identity included? | Date introduced | Sponsor(s) | # of cosponsors | Latest status |
|---|---|---|---|---|---|---|---|
| 112th Congress | Employment Non-Discrimination Act | H.R. 1397 | Yes | April 6, 2011 | Rep. Barney Frank (D-MA) | 133 | Referred to the Education and the Workforce, House Administration, Oversight and Government Reform, and Judiciary committees. |
| S. 811 | Yes | April 14, 2011 | Sen. Jeff Merkley (D-OR) | 39 | Referred to the Health, Education, Labor, and Pensions committee. | ||
| 111th Congress | Employment Non-Discrimination Act of 2009 | H.R. 3017 | Yes | June 24, 2009 | Rep. Barney Frank (D-MA) | 203 | Referred to the Judiciary, House Administration, Education and Labor, and Oversight and Government Reform committees. Hearings held September 23, 2009 in Education and Labor committee. |
| H.R. 2981 | Yes | June 19, 2009 | Rep. Barney Frank (D-MA) | 12 | Referred to the House Judiciary Committee | ||
| S. 1584 | Yes | August 5, 2009 | Sen. Jeff Merkley (D-OR) | 45 | Referred to the Senate Health, Education, Labor, and Pensions Committee Hearings held November 5, 2009. | ||
| 110th Congress | Employment Non-Discrimination Act of 2007 | H.R. 2015 | Yes | April 24, 2007 | Rep. Barney Frank (D-MA) | 184 | Died in the House Subcommittee on the Constitution, Civil Rights and Civil Liberties |
| H.R. 3681 | No | September 27, 2007 | Rep. Barney Frank (D-MA) | 9 | Passed the House (235-184), died in the Senate | ||
| 108th Congress | Employment Non-Discrimination Act of 2003 | H.R. 3285 | No | October 8, 2003 | Rep.Christopher Shays (R-CT) | 180 | Died in the House Subcommittee on Employer-Employee Relations |
| S. 1705 | No | October 2, 2003 | Sen. Ted Kennedy (D-MA) | 43 | Died in the Senate Committee on Health, Education, Labor, and Pensions | ||
| 107th Congress | Employment Non-Discrimination Act of 2001 | H.R. 2692 | No | July 31, 2001 | Rep.Christopher Shays (R-CT) | 193 | Died in the House Subcommittee on Employer-Employee Relations |
| S. 1284 | No | July 31, 2001 | Sen. Ted Kennedy (D-MA) | 44 | Died in the Senate | ||
| 106th Congress | Employment Non-Discrimination Act of 1999 | H.R. 2355 | No | June 24, 1999 | Rep.Christopher Shays (R-CT) | 173 | Died in the House Subcommittee on Employer-Employee Relations |
| S. 1276 | No | June 24, 1999 | Sen. Jim Jeffords (R-VT) | 36 | Died in the Senate Committee on Health, Education, Labor, and Pensions | ||
| 105th Congress | Employment Non-Discrimination Act of 1997 | H.R. 1858 | No | June 10, 1997 | Rep.Christopher Shays (R-CT) | 140 | Died in the House Subcommittee on Employer-Employee Relations |
| S. 869 | No | June 10, 1997 | Sen. Jim Jeffords (R-VT) | 34 | Died in the Senate Committee on Labor and Human Resources | ||
| 104th Congress | Employment Non-Discrimination Act of 1995 | H.R. 1863 | No | June 15, 1995 | Rep. Gerry Studds (D-MA) | 142 | Died in the House Subcommittee on the Constitution |
| S. 932 | No | June 15, 1995 | Sen. Jim Jeffords (R-VT) | 30 | Died in the Senate Committee on Labor and Human Resources | ||
| S. 2056 | No | September 5, 1996 | Sen. Ted Kennedy (D-MA) | 3 | Failed in Senate (49-50) | ||
| 103rd Congress | Employment Non-Discrimination Act of 1994 | H.R. 4636 | No | June 23, 1994 | Rep. Gerry Studds (D-MA) | 137 | Died in the House Subcommittee on Select Education and Civil Rights |
| S. 2238 | No | July 29, 1994 | Sen. Ted Kennedy (D-MA) | 30 | Died in the Senate Committee on Labor and Human Resources |
Changing your Birth Certificate (State by State)
| For persons who are U.S. Citizens but were born outside the United States: You can change your name and gender on your U.S. Department of State issued birth certificates. One must obtain a legal name change (original or certified copy) from the court of the county for which they reside, the original birth certificate, plus an original letter of SRS from the surgeon and forward such information to: U.S. Dept of State The State Department will then re-issue a new birth certificate (not amended) and the process takes approximately 6-8 weeks. As of 1999, the fee was $40, but one should call them to obtain the current fee for this process. Alabama Alabama will issue an “amended” birth certificate noting change of name and sex, but will not issue a new birth certificate replacing the original. The fee to prepare an amended birth certificate is $15.00, which includes one certified copy. Additional copies of the same record ordered at the same time are $4.00 each. You will need an original or certified copy of the court order for your name change, as well as an original or certified copy of a COURT ORDER for change of sex (not just the surgeon’s letter). This enters another step into the procedure and is best handled through an attorney, although at extra cost. You must file a “petition to amend a vital record,” state what you want to amend, provide documentation of the reason for your petition, and name the Center for Health Statistics as defendant. This is the actual portion from the Alabama Vital Statistics Law which deals with gender reassignment:
On the positive side, if you live in another state they will accept the court order from that state, if issued from “a court of competent jurisdiction” (court with authority to issue such orders in that particular county or state). The fee for the court order is a separate fee, and varies from one court to another. Contact information: State Board of Health Ms. Dorothy S. Harshbarger Alaska Alaska will issue an amended birth certificate noting change of name and sex. You will need an original or certified copy of the court order for the name change, and an original or certified copy of the letter from your SRS surgeon. Mr. Alfred G. Zangri Alberta Please refer to the Alberta government Web pages regarding vital records. Vital Statistics requires statutory declarations signed by two doctors before a notary public, plus a statutory declaration by the applicant signed before a commissioner of oaths or a notary public. Fees to amend a birth certificate are $20. Name change to a gender-appropriate name does not require SRS or the alteration of the legal sex. Arizona Arizona will change both name and sex, and will issue a new birth certificate rather than amend the old one. The original certificate is “closed” to further inspection. As of 2011, the fee for the change process is $301.00. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. IMPORTANT: The court order must specifically state “the name may be changed on the Arizona birth certificate.” Contact information: Office of Vital Records Ms. Renee Gaudino Arkansas Arkansas will change both name and sex, and will issue a new birth certificate if the court order so specifies. The request for the court order must include medical documentation (letter from SRS surgeon). Arkansas Department of Health British Columbia Sex on a birth certificate issued in BC can be altered if 1) the sex was recorded in error at the time of birth, or 2) the person has undergone SRS. The applicant must provide a certificate from the physician who performed the SRS; evidence that the physician is licensed in the jurisdiction where the surgery was performed; and a certificate from a physician licensed to practise in the jurisdiction where the applicant resides, stating that the person has completed SRS. (The government does not require a specific type of surgery to be performed, but that the physicians certify that the sex has been reassigned according to accepted medical standards.) Formerly, the applicant had to be unmarried; now that same-sex marriage is legal in British Columbia, this requirement is no longer enforced. The fee to amend the birth certificate is $27; if a new certificate is to be issued, there is a fee of $27 for that service as well. A person may change their name to one appropriate to their gender of identification without undergoing SRS or changing their legal sex assignment. Please see the BC Vital Statistics Agency for details. California (Update 2009) See this pamphlet: California will change both name and sex, and will issue a new birth certificate rather than amend the old one. California Health and Safety Code, Section 103425-103445, states: “A petition for the issuance of a new birth certificate in those cases shall be filed with the superior court of the county where the petitioner resides.” The State Office of Vital Records has made a Web link with a PDF document detailing the procedure for obtaining a new birth certificate after “gender reassignment”. The link is: There is also a phone number for information on this procedure: You will need an original letter from your SRS surgeon, and acertified copy [not the original!] of the court order for your name change. If you do not have a court order for your name change, you may petition the court for change of name at the same time you petition for the new birth certificate. You will need a complete VS-24 form, which can be obtained from the State Office of Vital Records. A photocopy of this form is not sufficient. A fee of $20 includes one copy of the new Birth Certificate; additional copies are $14 each. Michael Rodrian Colorado Colorado will change both name and sex, and will issue a new birth certificate rather than amend the old one. In order to change the name and gender for a person born in Colorado, we need a certified copy of a legal name change and the judge ordering us to change the birth certificate because of gender reassignment. Once the surgery has been completed and you have the court order, we need a notarized letter or our correction form (website-www.cdphe.state.co.us) and $20.00 to correct the certificate, $15.00 for one copy of the birth certificate and $6.00 for each additional copies. Jake J. Salazar Connecticut (updated 2007) Connecticut will change both name and sex. To change your name you need to get a Probate Court order for the name change and take it to to the town clerk of the town where you were born. They will AMEND your Birth Certificate. To change your gender you must contact the Vital Records office in the State Department of Health in Hartford. You can contact Maria Colon at: They will send you two affidavits you must have completed and NOTARIZED. One affidavit is for a therapist to confirm your female identity and the other is for the SRS surgeon to confirm you had SRS. If you had SRS outside the United States, you’ll have to get an affidavit from a US Doctor confirming that SRS was done. Delaware Delaware will change both name and sex, and will issue a new birth certificate rather than amend the old one. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. Mr. Michael L. Richards District of Columbia The District of Columbia will NOT issue a new birth certificate, but will amend the original birth certificate upon receipt of certified copies of the court order for name change and the letter from the surgeon who performed SRS. Mr. Carl W. Wilson, M.P.H. Florida WILL change name and sex on the birth certificate. Information as of 2008 indicates that the old name remains “on the bottom of the new birth certificate”. I do not know if the same applies to the old gender marker. If anyone has an update of how that looks, please let me know. To process a request for birth certificate amendment as a result of gender reassignment surgery: · The registrant must present a court order entered pursuant to Section 68.07, Florida Statutes OR if the order is from another state, there must be evidence that the proceeding for name change is substantially similar to that outlined in Section 68.07, Florida Statutes. The registrant may submit a copy of the petition for change of name or the applicable state statute that indicates what procedures the foreign court utilized. · The existing birth record must be amended to reflect the name change prior to processing for gender reassignment surgery. · Once the name change is recorded, the registrant must file a notarized affidavit, i.e., DH 430, Affidavit of Amendment to Certificate of Live Birth. Additionally, pursuant to Section 382.003, the applicant must submit medical records indicating that the patient has completed sexual reassignment in accordance with appropriate medical procedures and that they are now considered to be of (male/female) gender) for all medical purposes . The medical records must be signed by the physician who performed the reassignment surgery. The physician must include his/her medical license number. · The required amendment fee must be submitted and the record will be amended as outlined in Florida Administrative Code Rule. 64-V.1.003 (1)(f) to correct the gender, which conflicts with the given name as recorded. Here are the details: (1) the court order for a name change must be effected first – and the person should choose a clearly female name, e.g., don’t change your name to Pat, Dana, Frances/Francis, Meredith or any other name that could be construed as a male name. (2) the birth certificate must be amended to reflect the new, clearly female name. (3) After the birth certificate has been amended to reflect the new “clearly female” name, then you can apply to change the gender based on the fact that the gender is clearly in conflict with the name. You should include an affidavit from the physician who performed operation and who will state that you are female. Office of Vital Statistics Georgia Georgia will change both name and sex, and will issue a new birth certificate rather than amend the old one. Contact Information: Vital Records Service Mr. Michael R. Lavoie Please contact the Legal Section of the Vital Records office (404-656-4901) and ask for instructions for correcting a vital record. Hawaii Hawaii will change both name and sex, and will issue a new birth certificate rather than amend the old one. You will need an original or certified copy of the letter from your SRS surgeon. A court order is not required. Alvin T. Onaka, Ph.D. Idaho Idaho does NOT change sex on the birth certificate. A bill to permit the changes was rejected by the Idaho legislature. Idaho will, however, change the name on the birth certificate. Details on how to accomplish this can be found at the state site: http://www2.state.id.us/dhw/vital_stats/appmenu.html Illinois Illinois will change both name and sex, and will issue a new birth certificate rather than amend the old one. There’s a new revision of the form, out in 2005, which requires either a letter from a surgeon licensed to practice in the United States, or an examination post op by a physician licensed to practice in the United States. * As of 2006, unfortunately, Illinois is refusing applications from persons whose surgery was outside the US, even with a post op exam by a US physician. Now, however, Dr. Brassard has obtained a US license, so his Montreal patients can proceed with the Illinois requirements. Stay tuned. First you should follow the instructions on their website: http://www.idph.state.il.us/vitalrecords/gender.htm This definitely appears to be the easiest way to start the process. Or you may write to the following address: Department of Public Health Ask them to fax you what you need to get signed by the doctor and notarized, top and bottom (see below). Make sure you specify name and sex aka gender change form. They can also mail it to you snail mail; but it is easier to get it faxed then signed, notarized, and send in your fifteen dollars for one copy, two dollars for each one after that. A third alternative is to call 217.782.6554 and ask for Vital Records, then ask for the birth certificate change department. My correspondents don’t recommend the telephone contact because some persons in the office have been less than helpful on the phone. and ask for a “request for change of name and sex form.” This form has two parts. The top is “affidavit by physician as to change of sex designation.” If you get the form before SRS, you can ask your surgeon to fill it out and get it notarized. Otherwise you can send a separate notarized letter from the surgeon as usual. The bottom part is “affidavit by parent, guardian, or applicant, if of legal age.” That part is obvious except for the line: “THAT the following were the personal particulars at the time of birth of_____________ ” Complete this line using “John Doe, now Jane Doe” or the opposite as indicated. Complete this form and return it to this address: Department of Public Health IMPORTANT: Send it by Priority Mail! Include the original letter from your SRS surgeon (unless the surgeon complete the top part of the form as above) and a certified copy of the name change order, and a check for $15.00 made out to “Vital Records”. Additional copies are $2.00 each. Indiana (update 2009) Send a check for $10 made out to ISDH for new birth certificate. Mary Keltner (Mary K) Iowa From Lambda Legal and the Sylvia Rivera Law Project, 2006:
Iowa will change both name and sex, and will issue a new birth certificate rather than amend the old one. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. Ms. Jill France Kansas (updated 2010) Kansas will issue an amended birth certificate. The following information is required: Affidavit from applicant documenting dressing and living as new gender; documentation of hormone treatment and surgery (“physiological and hormonal change”). Note: taking hormones without surgery does not qualify. Breast surgery (mastectomy) does not qualify; genital surgery is required. The cost is $15 for amending the certificate and another $15 for each certified copy. Elizabeth W. Saadi, Ph.D. See the Web site: http://www.kdheks.gov/vital/amend_birth_adults.html Kentucky Kentucky will change both name and sex, and will issue a new birth certificate rather than amend the old one. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. Please note that current interpretation (2005) of Kentucky law requires a notarized letter from your SRS surgeon, which can be difficult if your surgery was performed in the past or in another country. Ms. Barbara F. White Louisiana (updated 2009) Louisiana will change both name and sex, and will issue a new birth certificate rather than amend the old one. According to the Louisiana Department of Public Health/Vital Records Registry, a person born in Louisiana may change their name and gender on their birth certificate pursuant to Louisian Revised Statute (RS) 40:62, which can be found here: The statute allows a person to change their gender if they have “sustained sex reassignment or corrective surgery which has changed the anatomical structure of the sex of the individual to that of a sex other than that which appears on the original birth certificate.” RS 40:62(A) It is unclear what types of surgery constitute “sex reassignment of corrective surgery.” However, in determining whether a person has had such surgery, the court “shall require such proof as it deems necessary to be convinced that the petitioner was properly diagnosed as a transsexual or pseudo-hermaphrodite, that sex reassignment or corrective surgery has been properly performed upon the petitioner, and that as a result of such surgery and subsequent medical treatment the anatomical structure of the sex of the petitioner has been changed to a sex other than that which is stated on the original birth certificate of the petitioner.” RS 40:62(C). To change name and gender on a Louisiana birth certificate, a person must first submit a legal petition and include a surgeon’s letter and any other supporting materials detailing how the person has met the requirements of the statute. A person will likely have to get a Louisiana attorney to write the petition. The petition has to be submitted to the court in the parish where a person was born, or to Orleans parish (where the Vital records registry is located). Louisiana does not accept name and gender change orders from any other jurisdiction, so even if a person has obtained these orders in another state, Louisiana still has the discretion to refuse to change a birth certificate. Nevertheless, a person should include these (if they have already obtained them) with their petition. The court will hear the petition, and if granted, will issue an order to change name and gender. The person will then submit the order, with a fee, to the Louisiana Vital Records Registry, and it will issue a new birth certificate. If a person has questions about the process, they can email the Vital Records registry at dhh-vitalweb@la.gov or contact them at (540) 219-4500. The state of Louisiana maintains this page telling how to change the sex and name on the driver’s license. Maine (update 2011) Maine will change name and sex. The details are listed under ‘department rules’ for the Department of Health and Human Services, Specifically Chapter 2 can be downloaded as a Word document here:http://www.maine.gov/sos/cec/rules/10/146/146c002.doc . LEGAL CHANGE OF NAME When a person born in this State acquires a new name by judicial decree from a court of competent jurisdiction, the clerk of the court shall file the appropriate notification form (VS-14) with the Office of Vital Statistics upon the written request of the registrant (aged 18 or older), his or her parents, guardian, or legal representative if under the age of 18. If the applicant wishes to amend items on his or her birth certificate in addition to the change in name, it must be done in accordance with sections 5 and 6 of this chapter. A line shall be drawn through the name(s) to be changed and the new name(s) entered above or to the side thereof. Entries shall be typewritten whenever possible or clearly printed in black ink. An asterisk shall be placed next to the name. A notation of the date of the court action, the name and location of the court, and the date the record was amended shall be entered on the certificate, placed so that it will become part of any copy issued. Certificates altered under this section shall be regarded as amended and be labeled accordingly. Certified copies of records with legal name changes finalized from January 1, 1982 through the effective date of this chapter, January 1, 1993, may not be issued by photocopying. Certified copies shall be typed and shall show only the name acquired by judicial decree. The copies shall have a marginal notation that the name was changed by judicial decree and shall show the name and location of the court. The fee for processing each court ordered legal name change shall be paid at the time that the request and court order are presented to the Office of Vital Statistics. It includes a complimentary certified copy of the record after amendment. If other amendments, in addition to the legal name change, are requested at the same time, the additional fee may be waived by the state registrar. LEGAL CHANGE OF SEX Any person born in the State whose sex has been changed by surgical procedure and whose name has been changed by judicial decree from a court of competent jurisdiction may present a certified copy of the notification form (VS-14), a notarized affidavit by the physician who performed the surgical procedure to the Office of Vital Statistics and a form VS-7 requesting that his or her birth certificate be amended accordingly. A new birth certificate shall be prepared in accordance with section 6, subsection C of this chapter. A notation shall be entered on the certificate indicating that the name of the registrant has been changed pursuant to court order. The date of the court action, the name and location of the court, the date surgical procedures were completed, and the day the record was amended shall also be entered on the certificate, in such a way as not to become a part of any copy issued. Certificates established under this section shall not be regarded as amended. The fee for processing a legal sex change shall be paid at the time that the request and the surgeon’s affidavit are presented to the Office of Vital Statistics. It includes a complimentary certified copy of the new record after amendment. Call: 1 (888) 664-9491 or (in Maine) 1 (207) 287-3181 and ask for Form VS-7: “Correcting a Vital Record in Maine.” The completed form must be notarized. Mail the notarized, completed form, along with an original letter from your SRS surgeon, an original or certified copy of the court order for your name change, and a check for $25.00 (made out to State of Maine Dept. of Health and Human Services) to: State of Maine Dept. of Health & Human Services Manitoba In order for a person’s legal gender to be reassigned, an application is required accompanied by two medical certificates: one from a doctor who performed sex reassignment surgery, and a second from a doctor who assisted at the surgery. Both certificates must attest that the sex of the applicant was changed through the surgery. There is a $25.00 fee to amend the record, and $25.00 for each new birth certificate requested. Application forms may be requested from the Vital Statistics Agency. Names may be changed using the normal procedure, and do not require legal gender reassignment in order to proceed. Maryland – updated information needed 2009 – address below not working Information direct from Kathryn Morris, Birth Section Chief, DVR: In order for the Division of Vital Records to change your sex and name on your birth certificate, we require a Court Order indicating that both your name and sex are to be changed. You can most likely obtain an amended Court Order to indicate the correct sex along with your new name. We cannot change the sex on a birth certificate with just a Physicians letter. [The amended birth certificate does not retain any reference to the original.] Once you obtain this information, send True Test Copy or Original Court Order to my attention at the Division of Vital Records, P.O. Box 68760, Baltimore, Md. 21215-0020 c/o Birth Section Chief. (410)764-3145. For the State of Maryland there is a Fee of $12.00 for any change made on a birth certificate if the person is over one year of age/ for an adoption/ paternity name change/ court order name change or gender change. Checks or money orders should be made payable to the Division of Vital Records. Massachusetts Massachusetts will issue an amended birth certificate. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. The letter from the surgeon must use the word “completed,” not just “performed.” Denise O’Gara http://www.state.ma.us/dph/bhsre/rvr/vramend.htm Note: in Massachusetts, people can change names free of charge if they are “indigent.” One is considered indigent if one is accessing government programs such as MassHealth, food stamps, SSI, SSDI, Section 8 housing, etc. One can also submit a form demonstrating inability to pay. The Commonwealth waves fees for these folks. This is a legal name change, not a birth certificate change. Michigan (Update 2010) Michigan will change both name and sex, and will issue a new birth certificate rather than amend the old one. Michigan law also provides for “sealing” of the old record. For further information, see Michigan Compiled Law 333.2831. UPDATE 2010: To alter a birth record, Michigan requires a standard form available on the website: Click to access over6_6643_7.pdf as well as the following document: UPDATE 2008: You will need an original letter from your SRS surgeon [SEE UPDATE BELOW], and an original or certified copy of the court order for your name change. The fee is $26.00. Update 2008 from a Michigan correspondent:
Contact information: Michigan Department of Community Health Ms. Connie Sopocy Minnesota As of August 2000 the following information applies: There are essentially 2 ways to amend a birth record. Method one is to provide 2 documents per item being amended that were established at least 7 years ago or more which show the information the way your want it to appear on the birth record. Method two is to provide a court order which specifically directs the birth record be amended for the specific items that are desired to be changed. For either the cost is $20 to amend the record. Contact: Mississippi Mississippi will NOT issue a new birth certificate. If a court order is received, Mississippi will issue an amended birth certificate with the new name and gender typed in the margin, but the old name and gender remain unchanged. Contact information: Vital Records Missouri (update 2010) Missouri will issue an amended birth certificate. You will need an original or certified copy of the court order for the name change “if the name is ‘typically’ used for the opposite sex.” There is a $15 charge for the change and another $15 for each copy. Updated 2006: Update 2010: Montana Montana will issue an amended birth certificate, but the item(s) amended are not designated. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. Debra M. Fulton Nebraska (update 2009) Nebraska will change both name and sex, and will issue a new birth certificate rather than amend the old one. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. Also this form will need to be printed and completed, to send in with your documents: Stanley S. Cooper, M.S., Ph.D. Nevada Nevada will change both name and sex, and will issue a new birth certificate rather than amend the old one. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. Emil DeJan New Brunswick/Nova Scotia The following information is current as of March 2002, according to my sources: I live in New Brunswick, Canada, I was born in Nova Scotia, Canada. First I had to visit the Vital Statistics New Brunswick office on-line to change my name: http://www.gnb.ca/0379/en/change.htm They have all the info and you can order the ‘kit’ on-line. I was asked to provide a letter from a therapist as to verify the nature of my request. I also had to provide an original ‘long-form’ birth certificate, because I was born out of province. I ordered that on-line from this site: http://www.gov.ns.ca/snsmr/onlineservices.stm It cost $25 and was delivered promptly. After all that, and $100 later to PNB, I got my ‘Change of Name’ certificate. Then you go back to the PNS (Province of Nova Scotia) site. In order to change name and sex, you will need to supply this Change of Name certificate, a letter from your SRS surgeon, and a letter from another physician who has examined you post op. New Hampshire New Hampshire will change both name and sex, and will issue a new birth certificate rather than amend the old one. New Hampshire now requires a document of a court-ordered legal sex change….just a surgeon’s letter is not enough. They made this change in Nov 2001. NH State Vital Records Code 7007.03(e) You will also need an original or certified copy of the court order for your name change. Ms. Karen Grady New Jersey New Jersey will change both name and sex, and will issue a new birth certificate rather than amend the old one. Updated New Jersey information as of June 2005:
Updated New Jersey information as of November 2002:
Contact information: State of New Jersey Attention: Corrections Unit Mr. Don Lipira New Mexico (update 2010) New Mexico will change both name and sex, and will issue a new birth certificate rather than amend the old one. The old information will be “sealed” and cannot be opened without a court order. You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. You will also need this Birth Search Application form completed :http://www.vitalrecordsnm.org/Forms/birthsearchapp.pdf The fees are $10.00 for changing the information, and another $10.00 for a new certificate. Contact information: Vital Records and Health Statistics Bureau Phone: (505) 827 – 0121 or 827 – 2338 New York City (update 2010) New York City has its own separate Bureau of Vital Statistics. New York City will issue a new birth certificate rather than amend the old one. From a 2010 correspondent:
New York State See the 2006 update on the Transsexual Road Map site: www.tsroadmap.com/reality/name/new-york-birth-certificate.html New York State will change both name and sex, and will issue a new birth certificate. New York requires more documentation than most states. You must first complete an application which can be obtained from the following address: State of New York Return the completed application, with fees as indicated on the application, and the following documents (all “original or certified copy”): Once these documents are received, a “medical review” will be performed, and your new certificate issued. Processing takes approximately three months. One certified copy will be provided following the amendment; any additional copies are $15.00 each. Mr. Peter Carucci Updated information June 2002 for New York State: It turns out that NYS has two different forms of birth certificate: (i) a regular “Certificate of Birth” that contains your name, sex, date of birth, time of birth, county/city/town of birth, parent’s names, ages and social security numbers, mother’s maiden name and address at the date of birth, whether this was a twin birth, etc. (ii) a much shorter “Certification of Birth” that the Dept of Vital Stats internally calls the “short form”, which only contains your name, sex, county/city/town of birth, and date of birth. The “short form” isn’t mentioned anywhere in the paperwork, but is available by simply asking for the “short form” (it costs the same $15 as the long form) when ordering. The short form carries an impressed seal and serves as a legally valid birth certificate just as well as the long form. The New York State short form can be very useful in cases where both first and last name were legally changed – because it eliminates the incongruity of the child on the certificate having a different last name from the parents (it is also useful in cases where the “father is unknown”, etc). Quite a few postops face this problem, which causes unwanted outings if they ever need to use a regular birth certificate. North Carolina North Carolina will change both name and sex, and will issue a new birth certificate rather than amend the old one. You will need an original notarized letter from your SRS surgeon, and a certified copy of the court order for your name change. The processing fee for the preparation of a new birth certificate is $15.00. There is an additional $15.00 to obtain one certified copy of the new record. Each additional copy is $5.00. See Statute 130A-118: Ms. Vickie Pearce North Dakota North Dakota will issue an amended birth certificate. You will need an original or certified copy of the court order for the name change, and an original letter from your SRS surgeon. Mrs. Beverly R. Wittman Nova Scotia: see New Brunswick Ohio Ohio will NOT change sex on the birth certificate. There was some question whether Ohio will even change the name, but latest information tells me that name change can be done through the Division of Vital Records with a court order. This, however, does not amend the original birth certificate. An “abstract copy” will be created with a court order, and if you request by name this “abstract copy” you will receive an attached statement with your new name. You may, however, be able to have the sex designation on your Ohio driver’s license changed by showing a letter from your SRS surgeon. It depends on whether you catch the clerk at the DMV on a good day… Oklahoma (update 2011) We have conflicting information from Oklahoma. Please read this message recently (March 2011) received and compare it with the information below it. I am not sure if this depends on the person you come in contact with or if it has recently changed again. ————– At the present time, the Oklahoma State Department of Health does not have the statutory authority to amend a birth certificate to modify the gender. A bill was introduced in the Oklahoma State Legislature in 2011 to give the Oklahoma State Department of Health the authority to amend a birth certificate to modify gender, but that provision in the bill was defeated. ————— Oklahoma will issue an amended birth certificate. You will need an original letter from your SRS surgeon. Information as of 2007 is that Oklahoma issues a two page certificate, with the “amendment” page on top, and the original page unamended on the bottom. What you need to send: 1. Notarized statement from the SRS physician who completed the SRS surgery Send to: If you have questions, contact: Lucinda (405) 271-5615 at the Oklahoma Office of Vital Records. Ontario Ontario will issue an amended certificate, changing either name or sex, and the certificate will not reveal which items were changed. The change of the sex designation on the birth registry is a separate process from the change of name. A copy of the long form of the certificate will list the original name and sex, along with the new name and new sex, plus annotations describing the changes made. Change of Name: Contact the Registrar General’s office and request an “Application to change an adult’s name”. You will need original copy of your birth certificate, a signature of a guarantor, and a signature of a commissioner. Present cost is C$137. Change of Sex Designation: Contact the Registrar General’s office and request an “Application for Change of Sex Designation on Birth Registry” package. There are three forms to be filled in. You fill in the “Application for Change of Sex Designation on Birth Registry” form. The surgeon who conducted the transsexual surgery the “Medical Certificate of Transsexual Surgery”. And another physician completes the “Medical Certificate to Substantiate Transsexual Surgery was Performed” form. The cost to have the change performed is C$37. Cost of the short form (certificate) is $C15 while the cost of the long form is C$22. Office of the Registrar General Oregon Oregon will change both name and sex, and will issue an amended birth certificate, without any designation of what has been amended. Updated information as of January 2010: Contact Oregon Vital Records at this link. The telephone contact is (971) 673-1137. Send a copy of the name change court order and the court order for gender change (these will not be returned to you) along with $50 to: Oregon Vital Records I would suggest that anyone planning on doing this call for the correct person as the job does move around. A good referral is the department manager, (971) 673-1178. Pennsylvania Pennsylvania will change both name and sex, and will issue a new birth certificate with no mention of being amended. The original birth certificate is amended and “sealed” so that it is unavailable to the public. Web site: You will need an original letter from your SRS surgeon, and an original or certified copy of the court order for your name change. The fee is $10.00, but there is no fee for military veterans. Mail to this address: Vital Records, Corrections Unit With your materials, include your date and county of birth. “Please send the certified court order change of name as well as your incorrect birth certificate. We also need a letter from your doctor stating sex reassignment surgery has occurred and you are now functioning in the newly assigned gender.” Please note that some respondents report that Pennsylvania kept their original letter from the SRS surgeon and would not return it. Québec In order for a person’s legal gender to be reassigned, the person must be of age, unmarried, and a Canadian citizen, and have resided in Quebec for at least a year. Sex reassignment surgery must be completed. A form from theDirecteur de l’état civil must be submitted along with: * a medical certificate from the physician who performed the surgery; Fees are $125 for amending the record, and $10 for extra copies of the certificate of gender reassignment. The fee is not refundable if the request is refused. Formerly, a change of name to one of the opposite gender required a legal gender reassignment. This was successfully challenged in court and now a person can change their name to one of the other gender by the normal name change procedure, without needing a gender reassignment. See the provincial government site (in French). Rhode Island (update 2010) December 2010: While the information below may be correct, the staff at the Department of Vital Records recommend that you contact them directly at www.health.ri.gov for updated information. You will need a notarized statement from the physician that performed the complete surgery. The statement must be on the official letterhead of the hospital or clinic, and must declare that the “complete” surgery was performed and state the correct sex of the patient. The statement must also include the date and place of birth of the patient. Once I receive this document, I will send you an affidavit to be signed in the presence of a notary public. You would then return the signed affidavit, along with the $30.00 fee and a photocopy of your picture ID. If there is also a legal name change involved, you would have to send us a certified copy of the court order for the legal name change. Office open to public: Monday through Friday State of RHODE ISLAND There is a $20 fee for a certified copy of existing birth certificate and a $30 fee for a certified copy of new birth certificate showing a change of sex (as of 9/15/10). Saskatchewan The relevant legislation is the Saskatchewan Vital Statistics Act. It requires a medical certificate of completed SRS from a physician licensed in the jurisdiction where the surgery took place (or, if this cannot be obtained, other documentation as required by the director of vital statistics); a certificate signed by a second licensed physician attesting that the person was examined and found to be of the target sex; and “any other evidence the director may require.” With this, the sex on a birth certificate issued in Saskatchewan may be altered. The fee is $20. SeeSaskatchewan Health — Vital Statistics. A person may change their name to one appropriate to their gender of identification without undergoing SRS or changing their legal sex assignment. South Carolina South Carolina will NOT issue a new birth certificate. They will send a “card” that can be attached to the old birth certificate, indicating change of name and sex. They require an original court order for the name change and a letter from the SRS surgeon. The fee is $39.00. Contact Information: Bureau of Vital Statistics Mr. Murray B. Hudson, M.P.H. South Dakota (update 2006) Contact: Vonda Abbott, Secretary, Office of Data, Statistics, and Vital Records According to ARSD 44:09:05:02 any amendment of a surname, first and middle name when affidavit already has been filed or any information on a deceased persons vital record requires an order from a court of competent jurisdiction. When such an order has been obtained, please send a certified copy of it to this office. The following are the requirements regarding a court order name change. 1. The court order must order the South Dakota Department of Health or Vital Statistics to prepare the birth record to reflect the change. 2. There must be enough informaiton in the court order to identify the birth record as it is now such as: Name on the birth record, date of birth, mother’s maiden name 3. The court order must list the incorrect data as it is listed on the record. Name, Gender 4. The court order must have the correct data, as it should appear. Name, Gender 5. The court order must be certified. If you are a member of a tribe: (If applicable) If the court order does not state parent or child is a member of a tribe, the following is the requirement: The Attorney General’s Office has advised that tribal court orders for name changes are acceptable if the tribal court has jurisdiction. Tribal membership will determine jurisdiction in these cases. * A notarized document that proves membership of parent or child to a tribe. You may want to seek legal counsel: the following is the State Bar of South Dakota attorney referral number 1-800-952-2333. The fee to prepare the birth record is $8.00 for the amendment. In addition, if you wish to obtain a certified copy of the birth certificate you must complete the SD application form wiht the statutory fee of $10.00. If you have previously purchased a certified copy of the birth certificate we will exchange for no additional charge, but you must complete the application form for all orders. Tennessee Tennessee will NOT change the sex designation on the birth certificate. Tennessee will issue an amended birth certificate with the old name visibly struck over and the new name typed above it. You will need an original or certified copy of the court order for your name change. Texas (updated 2011) Direct from the Amendment Specialists at the Department of Vital Statistics Go to: and open Form VS-2318.1A. Print it out and fill it out. The fees to file an amendment to a birth certificate are $15.00. The cost of a certified copy of the birth certificate is $22.00 for each certificate. The fees were raised in December of 2005. There are two styles of the birth certificate, a short form or abstract and a long form. The short form is printed from the computer system and will only show the new name, date of birth, place of birth, sex, and parent’s names. The long form is a photocopy of the original birth record filed with our office at the time of birth onto our certified paper that will show the amendment underneath. On the long form you will be able to see the old information and the new information and how it was changed. It is up to you which style of birth certificate you want. We will automatically issue the short form or abstract unless you specifically request the long form. Along with your Application and fees you will need to submit a certified copy of the court order granting the name and gender change. The court order must have the original stamp or seal and signature of the clerk of the court. We can accept court orders from any state within the US. The court order does not have to come from a Texas Court if you do not live in the state of Texas. We do not need a copy of the SRS letter or a photocopy of your driver’s license because the court will have verified all the information. If you send us the Application, correct fees, and CERTIFIED COPY of the court order, your request will NOT be denied. The Vital Statistics Office in Austin, Texas is the only office that has the authority to make any changes or corrections to a birth certificate for a person born in the state of Texas. The normal processing time for requests sent by regular mail is 6-8 weeks. Send your money, court order and application to: Vital Statistics Unit MC 2096, Tx Dept of State Health Services, PO Box 149347, Austin, Texas 78714-9347. If you would like expedited services an additional fee of $13.00 is required. $5.00 expedite fee and $8.00 for our office to overnight the birth certificate to your address once the birth certificate is amended. Please use an overnight service such as Fed-Ex, UPS, DHL, ect… Do NOT use the Post Office. They do not hand deliver the package to our office and your request will only be delayed because it will come to our office as regular mail. If you use our expedite service, send your money, court order and application to: Vital Statistics Unit MC 2096, Tx Dept of State Health Services, 1100 W. 49th Street, Austin, Texas 78756. The processing time for the expedite service is 10-15 business days. You can make one check or money order out for the total fees. One check or money order of $37.00 for the amendment filing fee and one certified copy of the birth certificate OR $50.00 for the amendment filing fee, one certified copy of the birth certificate and the expedited fees. Utah (update 2011) Utah will issue an amended certificate, changing both name and sex, and the certificate will not reveal which items were changed. You will need original or certified copy of a court order for your name change and a court order for your change of sex designation. These court orders can be from any U.S. State or from Canada. Mr. Barry E. Nangle Update 2007: The Utah statute involved is 26-2-11 of the Utah Vital Statistics Act.
This Utah attorney has experience with filing for court orders and is recommended: Lauren R. Barros, P.C. Vermont Vermont will issue an amended certificate, changing both name and sex. You will need original or certified copy of a court order for your name change and a court order for your change of sex designation. The court will probably require documentation from your SRS surgeon. Virginia Virginia will issue a new birth certificate as of 2005: 12 VAC. 5-550-320. Change of Sex. Except as provided in 12VAC 5-550-450-C upon presentation of acceptable Update 2008: If a notarized letter from the physician performing the surgery is presented, a court order may not be necessary. Washington Washington State will issue a new birth certificate for name and/or gender changes Here’s what they need: (1) A letter signed by the doctor performing the surgery (on his letterhead) (2) A certified copy of the Name Change Order (3) Birth info: parents names, date and place of birth; original birth (4) Address where they should send the new birth certificate (takes 2 to 3 weeks to process) (5) $20 check or money order for the fee — to Department of Health. Mail all to Kathy Devine at the Department of Health, West Virginia West Virginia will change both name and sex, and will issue an amended birth certificate with the old name struck over and the new name and sex typed in the margin. You will need an original or certified copy of the court order for your name change, and an original letter from your SRS surgeon. Wisconsin Wisconsin will change name and sex on the birth certificate. You will need a certified copy of your Court Order for Name Change as well as a certified copy of a Court Order for change of gender (two separate court orders). You will need a signed, dated, notarized letter from your surgeon confirming the date of the procedure. The surgeon should include your name, date of birth, date of surgery, type of surgery (male-to-female), and where it was performed. Finally, you will need your original birth certificate or a certified copy. Contact: Another Wisconsin correspondent gives additional information on having your old birth cdertificate “impounded”: Write a letter addressed to: Vital Records Office, 1 West Wilson Street, Box 309, Madison, WI 53701-0309. At the time of this writing, the contact person was Hal Hart. Explain that you are transsexual and seek to amend your name and sex and have the original birth record impounded. They will send you a form called: Report of Order to Change Name & Sex on Birth Certificate Due to Surgical Sex-Change Procedure (Form DOH 5035). This form can be used by any state to order information on a Wisconsin birth record to be changed. Remember, your current state of residence may have their own rules as to what they are authorized to order another state to change on a birth record. You will need to check state law yourself or contact your courthouse or legal advisor. Fill out Form DOH 5035 exactly as specified, making sure that you mark the box that orders the birth certificate be “Impounded and a new birth certificate shall be created for the registrant.” If your state of residence allows ordering the record to be impounded, you can get the order certified where you live (otherwise, you should see about returning to Wisconsin and doing it in person). Go to your county courthouse, where the Clerk of Court or Deputy can assist you in preparing the proper forms. It is very likely you will have to pay a fee, and it is also likely you will need to appear before a judge. The cost for the appearance will vary significantly: I paid $221 in my state. Appear in court. You can represent yourself in court (pro se) or have a lawyer help. You should consider having a lawyer or TS friend who has been through this help you if you are uncomfortable filling out forms yourself. You will probably have to fill out a cover sheet, a complaint, and an order. Everyone I encountered at my local courthouse, including the judge, had never done one of these before, and they process almost 20,000 cases a year. I recommend coming in with all of the necessary information. Below is the text of the Complaint and Order I wrote out on the spot, which worked fine.
Return the form imprinted with the court seal along with the appropriate fees. In 2001, the fee was $20 to create a new birth record. A certified copy was $12 for the first and $2 for each copy ordered at the same time. I recommend you not trust this document to standard U.S. Mail. If you plan to overnight any information through a service that will not deliver to a mailbox, you can send it to Processing usually take two to four weeks. RELEVANT LAW (subject to change): Wisconsin Statutes: http://folio.legis.state.wi.us/ click on the link to Statutes Wyoming Wyoming will issue an amended certificate. The certificate will specify the birth name and the birth gender, unless you can obtain a court order mandating a new certificate be created. Yukon Proof of identity is required, along with letters from two doctors attesting that the applicant’s anatomical sex has been changed. There is no fee to alter the birth record, but the old birth certificate must be surrendered and a new one ordered. A person may change their name to one appropriate to their gender of identification without undergoing SRS or changing their legal sex assignment. |
Gender Identity Disorder (GID)
Gender identity disorder
Gender identity disorder is a conflict between a person’s actual physical gender and the gender that person identifies himself or herself as. For example, a person identified as a boy may actually feel and act like a girl. The person experiences significant discomfort with the biological sex they were born.
Causes
People with gender identity disorder may act and present themselves as members of the opposite sex. The disorder may affect:
- Choice of sexual partners
- Display of feminine or masculine mannerisms, behavior, and dress
- Self-concept
Gender identity disorder is not the same as homosexuality.
Identity conflicts can occur in many situations and appear in different ways. For example, some people with normal genitalia and sexual characteristics (such as breasts) of one gender privately identify more with the other gender.
Some people may cross-dress, and some may seek sex-change surgery. Others are born with ambiguous genitalia, which can raise questions about their gender.
The cause is unknown, but hormones in the womb, genes, and environmental factors (such as parenting) may be involved. This rare disorder may occur in children or adults.
Symptoms
Symptoms can vary by age, and are affected by the person’s social environment. They may include the following:
Children:
- Are disgusted by their own genitals
- Are rejected by their peers, feel alone
- Believe that they will grow up to become the opposite sex
- Have depression or anxiety
- Say that they want to be the opposite sex
Adults:
- Dress like the opposite sex
- Feel alone
- Have depression or anxiety
- Want to live as a person of the opposite sex
- Wish to be rid of their own genitals
Either adults or children:
- Cross-dress, show habits typical of the opposite sex
- Withdraw from social interaction
Exams and Tests
The feeling of being in the body of the “wrong” gender must last for at least 2 years for this diagnosis to be made. A history and psychiatric evaluation can confirm the person’s constant desire to be the opposite sex. The person’s partner choices may be same sex or opposite sex.
Treatment
Individual and family therapy is recommended for children. Individual and, if appropriate, couples therapy is recommended for adults. Sex reassignment through surgery and hormonal therapy is an option, but identity problems may continue after this treatment.
Outlook (Prognosis)
Diagnosing and treating this disorder early can lead to a better outcome.
Possible Complications
- Depression or anxiety
- Emotional distress
- Feeling alone
- Poor self-concept
When to Contact a Medical Professional
Make an appointment with your health care provider if you have symptoms of this disorder and want help, especially with anxiety and depression.
Alternative Names
Transsexualism
Cross Dresser Defined
A cross-dresser is a person who has an apparent gender identification with one sex, and who has and certainly has been birth-designated as belonging to one sex, but who wears the clothing of the opposite sex because it is the clothing of the opposite sex.” This excludes people “who wear opposite sex clothing for other reasons”. Also, the group doesn’t include “those female impersonators who look upon dressing as solely connected to their livelihood, actors undertaking roles, individual males and females enjoying a masquerade, and so on. These individuals are cross dressing but are not cross dressers.” Cross-dressers may not identify with, or want to be the opposite gender, nor adopt the behaviors or practices of the opposite gender, and generally do not want to change their bodies medically. The majority of cross-dressers identify as heterosexual.
Cis-Gender Defined
Cisgender (or cisgendered) is an adjective used in the context of gender issues and counselling to refer to a class of gender identities formed by a match between an individual’s gender identity and the behavior or role considered appropriate for one’s sex.
Kristen Schilt and Laurel Westbrook defined “cisgender” as a label for “individuals who have a match between the gender they were assigned at birth, their bodies, and their personal identity”, complementing “transgender“. A similar adjective is “gender-normative”; Eli R. Green wrote, “The term ‘cisgendered’ is used [instead of the more popular ‘gender normative’] to refer to people who do not identify with a gender diverse experience, without enforcing existence of a ‘normative’ gender expression.” There are many derivatives of the term in use including cis male, cis female, and cissexual.
Transgender Defined
Transgender is a general term applied to a variety of individuals, behaviors, and groups involving tendencies to vary from culturally conventional gender roles.
Transgender is the state of one’s “gender identity” (self-identification as woman, man, neither or both) not matching one’s “assigned sex” (identification by others as male, female or intersex based on physical/genetic sex). “Transgender” does not imply any specific form of sexual orientation; transgender people may identify as heterosexual, homosexual, bisexual, pansexual, polysexual, or asexual; some may consider conventional sexual orientation labels inadequate or inapplicable to them. The precise definition for transgender remains in flux, but includes:
- “Of, relating to, or designating a person whose identity does not conform unambiguously to conventional notions of male or female gender roles, but combines or moves between these.”
- “People who were assigned a sex, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of themselves.”
- “Non-identification with, or non-presentation as, the sex (and assumed gender) one was assigned at birth.”
A transgender individual may have characteristics that are normally associated with a particular gender, identify elsewhere on the traditional gender continuum, or exist outside of it as “other”, “agender“, “Genderqueer“, or “third gender“. Transgender people may also identify as bigender, or along several places on either the traditional transgender continuum, or the more encompassing continuums which have been developed in response to the significantly more detailed studies done in recent years.
The Power Of Trans 