Courtesy of Zuzu, who is with us in spirit, an article from the New York Times:
Under the rule being considered by the city’s Board of Health, which is likely to be adopted soon, people born in the city would be able to change the documented sex on their birth certificates by providing affidavits from a doctor and a mental health professional laying out why their patients should be considered members of the opposite sex, and asserting that their proposed change would be permanent.
Applicants would have to have changed their name and shown that they had lived in their adopted gender for at least two years, but there would be no explicit medical requirements.
There are exceptions, but most transpeople take hormones for at least several months prior to surgery. In some places, the transsexual patient must be on hormones for a certain amount of time prior to surgery. Sometimes, that interval lasts years. Sometimes, and increasingly, transpeople are opting out of surgery or genital surgery altogether. Surgery, the when and the whether, is also dependent on class. It’s generally out of pocket. While not expensive in terms of the “That’s Outrageous!” articles that crop up whenever the media wants to frame transition as abusive, socially irrational, and at the extreme of indulgence, it’s not cheap. There are other factors that can complicate and delay or nullify, like HIV status, other health issues, substance abuse, incarceration, and other unstable circumstances.
Passing is an individual thing. Surgery usually correlates with later-transition (and therefore somewhat with the likelihood of passing), but IME does not either determine social transition or coincide with the boundary to the extent that there is a clear one. Many of us pass without any medical measures; many of us pass with hormones but not surgery; some of us don’t pass consistently with surgery. Like the man says, it’s not a good standard:
“Surgery versus nonsurgery can be arbitrary,” said Dr. Thomas R. Frieden, the city’s health commissioner. “Somebody with a beard may have had breast-implant surgery. It’s the permanence of the transition that matters most.”
I wouldn’t call it arbitrary, exactly. It’s based on beliefs about the tenacity of birth sex. Surgery is seen in magical terms, as the only act of sufficient potency to alter “natural” sex. Hormones, with their gradual changes over time, are not seen as drastic enough to wrench nature out of course. (There are exceptions to that, of course–testosterone rage, for example.) Surgery is also the site of the illegitimacy of transpeople, the place where we have to prove ourselves in order to deserve acknowledgement from the straight world. If we’re not willing to undergo surgery, we’re not real transsexuals.
For balance:
Transgender advocates consider the New York proposal an overdue bulwark against discrimination that recognizes an emerging shift away from viewing gender as simply the sum of one’s physical parts. But some psychiatrists and doctors are skeptical of the move, saying sexual self-definition should stop at rewriting medical history.
“They should not change the sex at birth, which is a factual record,” said Dr. Arthur Zitrin, a Midtown psychiatrist who was on the panel of transgender experts convened by the city. “If they wanted to change the gender for all the compelling reasons that they’ve given, it should be done perhaps with an asterisk.”
The change would lead to many intriguing questions: For example, would a man who becomes a woman be able to marry another man? (Probably.) Would an adoption agency be able to uncover the original sex of a proposed parent? (Not without a court order.) Would a woman who becomes a man be able to fight in combat, or play in the National Football League? (These areas have yet to be explored.)
An asterisk? What would the footnote look like? Zitrin’s take on it is a pretty facile one. Were transsexual status not fraught, were it not grounds for instant ejection from post-transition gender, transpeople probably would not be so concerned about revealing their history. Since, however, we face discrimination in most cases where our birth sex is known, we should have the benefit of privacy. And it’s worth pointing out that “more than the sum of one’s physical parts” would apply to a sexed body at birth as well. In one sense, an infant that later transitions was not exactly a boy or a girl; the change is retroactive based on new knowledge of the person.
All of those questions make for interesting discussion, but the only important question to answer is this: Is the surgery standard the most sensible way to delineate those borders? Would the refusal to alter a birth certificate under pre/non-op or any circumstances make the answers clearer, or obscure them on even more elementary levels?
But some psychiatrists said that eliminating identification difficulties for some transgender people also opened the door to unwelcome advances from imposters.
“I’ve already heard of a ‘transgendered’ man who claimed at work to be ‘a woman in a man’s body but a lesbian’ and who had to be expelled from the ladies’ restroom because he was propositioning women there,” Dr. Paul McHugh, a member of the President’s Council of Bioethics and chairman of the psychiatry department at Johns Hopkins University, wrote in an e-mail message on the subject. “He saw this as a great injustice in that his behavior was justified in his mind by the idea that the categories he claimed for himself were all ‘official’ and had legal rights attached to them.”
So we can’t introduce legal categories that correspond to social reality–and, as the article takes pains to point out, are controlled even as applied to transpeople–because some people will arrogate that validity in ways that are transparently disingenuous and really easy to differentiate from the honest kind? And in instances whose prohibition may be justified and enforced along separate public-safety lines? What does this have to do with the right of a transsexual to obtain identification he or she may use? This petitioner sees himself and transsexuals as virtually identical; I don’t think Dr. Paul McHugh does.