Being Trans Is Not a Mental Disorder
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Forty-five years ago, members of the American Psychiatric Association decided, by a slim 58 percent majority, to remove “homosexuality” from the list of mental disorders in its Diagnostic and Statistical Manual of Mental Disorders. In his old age, the great gay rights activist Frank Kameny recalled Dec. 15, 1973, as the day “when we were cured en masse by the psychiatrists.”
In a single stroke, the A.P.A. helped transform homosexuality from a medical condition to a social identity.
It would take another 27 years for the World Health Organization to eliminate homosexuality from its own classification of mental disorders in the International Classification of Diseases, the comprehensive manual of some 55,000 diagnostic codes that doctors everywhere use for diagnosis and insurance reimbursement. But this summer, the W.H.O. beat the A.P.A. to the punch on another issue — transgender rights — by moving “gender incongruence” from its chapter on mental health to its chapter on sexual health. On its website, under the heading “Small Code, Big Impact,” the W.H.O. says that gender incongruence is a sexual health condition for which people may seek medical services, but that “the evidence is now clear that it is not a mental disorder.”
The A.P.A. should now do the same by eliminating its category of gender dysphoria, a technical term for people unhappy because of their gender incongruence. It would be an important step in advancing transgender rights and reducing the stigma and prejudice that people experience when, because of nothing they or anyone else did wrong, they cannot abide the sex they were assigned at birth.
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The 1973 decision on homosexuality taught us that we shouldn’t expect too much too quickly. Indeed, Frank Kameny overstated the A.P.A.’s power for sarcastic effect.
Most of the 42 percent who objected clung to the psychoanalytic view articulated by Sigmund Freud in 1914 that homosexuality was a developmental problem. Nor did the A.P.A. immediately excise homosexuality from the D.S.M.
As a compromise, the organization retained diagnoses in subsequent editions to denote people unhappy about being homosexual — ego dystonic homosexuality, for example — and eliminated homosexuality completely only in the 1987 revision.
History is now repeating itself. Echoing the compromise on homosexuality, the A.P.A. decided in 2013 not to remove gender incongruence entirely from the D.S.M.
but to change “gender identity disorder” to “gender dysphoria,” just a slight tweak of the equivalent word “ego-dystonic” that had been paired with homosexuality in the 1980s. The worthy aim of coining this new diagnosis was to lessen the stigma of gender incongruence.
But as was the case with the short-lived “ego-dystonic homosexuality,” the A.P.A. is just delaying the inevitable.
Jack Drescher, who was a member of the A.P.A.’s work group on sexual and gender identity disorders, cautions that there is one crucial difference.
“Un homosexuality,” he told me, “we wanted to retain a gender category so that people could get access to services, and insurance coverage for hormone therapy and gender-affirming surgeries.” However, that goal could be achieved by following the W.H.O.
’s pragmatic approach, which says that gender incongruence is not a mental illness. For the W.H.O. it is a physical health concern with a billable insurance code. For trans people who want mental health care, psychiatrists can still bill for whatever mental illness category is most appropriate.
After all, being transgender does not immunize someone from anxiety, depression or any other mental illness. Why should the transgender person who is sad, tired and losing weight have “gender dysphoria” while a straight or gay person with the same symptoms has “depression?”
Being trans should be a personal or social identity, not a psychiatric one.
Indeed, for many transgender rights advocates, a category of gender dysphoria makes no more sense than having a category of mobility dysphoria for someone distressed by a lifelong need for a wheelchair, or African-American dysphoria for people who experience emotional distress associated with discrimination against them as minorities.
“Gender dysphoria” also puts the responsibility on trans people for their suffering, and not on the social and moral environment that stigmatizes them.
According to the National Center for Transgender Equality, about half of all people who identified as, or were perceived to be, transgender while still in school (K-12) report being verbally harassed, and nearly a quarter report being physically assaulted because they were transgender.
More than a third of all transgender individuals have attempted suicide at least once. Civil rights protections for trans people will be at even greater risk if, as has been widely reported, the Trump administration seeks to define sex under Title IX as either male or female and as unchangeable.
The conservative reaction to gender nonconformity is that it is a violation of nature, but many biologists and anthropologists disagree. While reproduction occurs between males and females, there is nothing natural about limiting all sexual behavior to male-female pairs or all gender identities to male and female.
Between 1 percent and 2 percent of all human births qualify as intersex and, in fact, many societies have multiple genders and do not presume they are psychiatric or physical disorders at all. The hijras in India are neither male nor female — though most were born with male genitalia — and are generally revered. In Indonesia, on the island of Sulawesi, there are three sexes and five genders.
In Polynesia, the mahu are also neither male nor female, and traditionally they engage in sex with both men and women, without any sort of sexual stigma. In North America, the Navajo believed that intersex people were divinely blessed and essential to society. Without them, as a Navajo interviewee told the early anthropologist W.W. Hill in 1935, it “will be the end of the Navajo.
” Our sexual lives and identities are determined not by our genes but by our cultures.
The D.S.M. is also a product of culture that reflects the values of its authors. If the American Psychiatric Association truly believes that gender nonconformity is not a mental illness, it should follow the W.H.O.
Psychiatrists will still have all the billable insurance codes they need to provide care, and transgender people will be able to carry on with their lives, suffering if they must from the same things that everyone else suffers from, but at least with one fewer burden.
Roy Richard Grinker is a professor of anthropology at George Washington University. His book about stigma and mental illness is forthcoming.
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Overview of Stroke – Brain, Spinal Cord, and Nerve Disorders – Merck Manuals Consumer Version
- If needed, measures to support vital functions such as breathing
- Various drugs, angiography, or surgery
- Treatment of problems after a stroke
Anyone with symptoms of a stroke should seek medical attention immediately. The earlier the treatment, the better the chances for recovery. Thus, emergency medical services and hospitals are continuously developing new and better ways to treat people who have had a stroke as soon as possible after symptoms begin.
Doctors check the person’s vital functions, such as heart rate, breathing, temperature, and blood pressure, to make sure they are adequate. If they are not, measures to correct them are taken immediately.
For example, if people are in a coma or unresponsive (as may result from brain herniation), mechanical ventilation (with a breathing tube inserted through the mouth or nose) may be needed to help them breathe.
If symptoms suggest that pressure within the skull is high, drugs may be given to reduce swelling in the brain, and a monitor may be put in the brain to periodically measure the pressure.
Other treatments used during the first hours and first days depend on the type of stroke.
Treatment of ischemic strokes may include the following:
- Drugs (such as antiplatelet drugs, anticoagulants, drugs to break up clots, and drugs to control high blood pressure)
- Insertion of a thin, flexible tube (catheter) into an artery, usually in the groin, and then through the aorta to an artery in the neck
- Injection of a drug through the catheter to dissolve a clot (intra-arterial thrombolysis)
- Surgery (endarterectomy) to remove fatty deposits blocking blood flow in an artery in the neck
Treatment of hemorrhagic stroke may include the following:
- If needed, treatments that help blood clot (such as vitamin K and transfusions of fresh frozen plasma or platelets)
- If blood pressure is very high, drugs to control it
- Occasionally, surgery to remove large areas of accumulated blood or to place a shunt to relieve the increased pressure within the skull
- Insertion of small coils or stents through a catheter to the affected area to treat a ruptured brain aneurysm (the most common cause of a subarachnoid hemorrhage—a type of hemorrhagic stroke)
Later and ongoing treatments focus on
- Preventing subsequent strokes
- Treating and preventing problems that strokes can cause
- Helping people regain as much function as possible (rehabilitation)
|To prevent blood clots, doctors may give anticoagulants, such as heparin or low molecular weight heparin, put elastic or air-filled support stockings on the person’s legs to improve blood circulation, or both.Moving the legs, which improves blood flow, can also help. People, if able, are encouraged to walk or simply move their legs (for example, extending and flexing their ankles). If people cannot move their legs, a therapist or other staff member moves their legs for them (called passive exercise).|
|Nurses, other staff members, or caregivers should frequently turn or reposition people who are confined to a bed or wheelchair. Areas ly to develop pressure sores should be inspected every day.|
|Permanent shortening of muscles that limits movement (contractures)||Moving the limbs can prevent contractures. People, if able, are encouraged to move and change positions regularly. Or a therapist or other staff member moves their limbs for them and makes sure the limbs are placed in appropriate resting positions. Sometimes splints are used to keep the limbs in place.|
|People are evaluated for difficulty swallowing. If they have difficulty, care is taken to provide them with enough fluids and nourishment. Sometimes learning simple techniques (for example, how to position the head or how to breathe when swallowing) can help the person swallow safely. Tube feeding may be necessary until the ability to swallow returns. The feeding tube may be inserted directly into the stomach through a small incision in the abdomen.|
|If people smoke, they are encouraged to stop.Therapists also teach them to do deep breathing exercises and to cough to clear the airways. Therapists may provide a handheld breathing device.If needed, oxygen is provided through a face mask or a tube inserted in the nose or in the mouth.|
|Health care practitioners regularly check for signs of urinary problems.If possible, a urinary catheter, which can cause urinary infections, is not used. If a catheter is needed, it is removed as soon as possible.|
|Discouragement and depression||Doctors discuss the effects of the stroke with affected people and their family members or other caregivers. The discussion includes the type of recovery that can be expected and ways to cope with limitations of function. People and their caregivers are put in contact with stroke support groups. Formal counseling or drugs may be necessary to treat depression.|
Intensive rehabilitation after a stroke can help many people overcome disabilities. The exercises and training of rehabilitation encourage unaffected areas of the brain to learn to perform functions that were done by the damaged area. Also, people are taught new ways to use muscles unaffected by the stroke to compensate for losses in function.
The goals of rehabilitation are the following:
- To regain as much normal function in doing daily activities as possible
- To maintain and improve physical condition and to improve walking
- To help people relearn old skills and learn new ones as needed
Success depends on the area of the brain damaged and the person’s general physical condition, functional and cognitive abilities before the stroke, social situation, learning ability, and attitude. Patience and perseverance are crucial. Participating actively in the rehabilitation program can help people avoid or lessen depression.
Rehabilitation is started in the hospital as soon as people are physically able—usually within 1 or 2 days of admission. Moving the affected limbs is an important part of rehabilitation.
Regularly moving the limbs helps prevent muscles from shortening and becoming tight. It also helps maintain muscle tone and strength. If people cannot move their muscles themselves, a therapist moves their limbs for them.
People are encouraged to practice other activities, such as moving in bed, turning, changing position, and sitting up.
Some problems due to stroke require specific therapies—for example, to help with walking (gait or ambulation training), to improve coordination and balance, to reduce spasticity (involuntary tightening of muscles), or to compensate for vision or speech problems.
After discharge from the hospital, rehabilitation can be continued on an outpatient basis, in a nursing home, in a rehabilitation center, or at home. Occupational and physical therapists can suggest ways to make life easier and the home safer for people with disabilities.
Family members and friends can contribute to a person’s rehabilitation by keeping in mind what effects a stroke can have, so that they can better understand and support the person. Support groups can provide emotional encouragement and practical advice for people who have had a stroke and for those who care for them.
What a Stroke Taught Me About Being Transgender
I once had a stroke caused by an arterial dissection. It was a big one. It was in my left hemisphere…the side that you use for language. When I woke up in the hospital, I could only say “Yes” or “No”.
I couldn’t even say “yeah” or “nope” even though I wanted to. I was told that those were the first words I learned as a baby, and that was why I could only remember those words.
During my recovery, I became increasingly aware that recovery from a stroke is a sequential process that starts with your first memories and works its way up.
At least I was young when I had the stroke…in my 30’s…so I could recover a lot. It was also a time when I was unhappy with my gender. I had been born with a female body, and I was told that was what makes me a girl.
But I didn’t feel a girl. I remember thinking that I was a boy when I was 5, but that was a long time ago and my memories from that age are sparse. But I didn’t feel totally a boy either.
I felt a “space alien”… I didn’t belong to humanity.
Actual MRI of my brain | Source
So, after the stroke, they immediately put me in speech therapy. I had to learn every one of the other words in the English language. But I learned them quickly, and began to realize that I wasn’t learning all over again so much as “re-remembering” how I’d learned them in the first place.
For example, when I learned my numbers the first time I remember always getting tripped up on the number 13. And here I was at 30 doing the same thing… getting tripped up on 13. I’ve heard it said that your brain is a filing cabinet, and when you have a stroke all the files get locked shut and you literally have to open them up one by one to get all the old memories back.
That was what I was doing: not making new memories but remembering the old ones.
It was really weird when they ask me to write my name for the first time. When I woke from the stroke I knew exactly what reality was. I knew the date, what had happened to me, and who my spouse and child were.
I also new my name, and the fact that six years ago I had married and changed my name. Writing my married name was old hat. But when they asked me to write my name, my maiden name came spilling out. I didn’t understand it.
But they told me that that was because that was the first way I was taught to write my name. My old memories were coming to the forefront of my brain.
Another lady who I chatted with said the same thing about her father who had a stroke:
”When my dad was first in the hospital it did seem he was going year to year, even with his personality, every morning he'd wake up in another decade or time in his life. He still has pretty serious memory problems, but it’s more he's disorganized in his brain then not remembering.
he can look at me, know I'm his 30-year-old daughter and say its 1985, then when I say, “Dad how old would I be in 1985”, then he says, ”Oh” and laughs. Or he will know he's married to his current wife, but thinks he works at his job he had 30 years ago (long before he met her).
That’s exactly how it was… I’d know the reality of here and now, but I was acting my younger self. It was I was living two time-lines at the same time. It was sci-fi-esque.
But it seems to support what memory researchers are finding out: that some memories, even if we don’t remember them, could still be in our brains… it’s just a matter of accessing them.
1,2 And although I wouldn’t recommend having a stroke to access them, that’s what it seems to do.
It was I was living two time-lines at the same time.
While recovering from the stoke, I realized that you can recover a past memory that you don’t remember now. I did. It seemed to be a memory of a feeling or a personality I once had. A few days after the stroke…
I knew that I was a boy.
I didn’t THINK that I was a boy; I KNEW it. I knew it I knew the grass is green and the sky is blue. someone who never questioned their gender, I simply accepted it.
During the time that I had this feeling, I couldn’t talk about it because my vocabulary was still a two-year-old’s. I’m sure the nurse was confused by me saying, “I a man.”, and having no other words to explain. I knew about my body, and therefore I knew that I was a trans man, but that was too complicated to say.
Even today I don’t have the words to express how freeing that feeling was. To simply be, and not think. To feel I should have felt… cis people feel. To instinctively know as if no one had told you you were wrong.
If you knew something the grass was green, how many people saying something contrary would it take for YOU to doubt it?
There was a “peer pressure” experiment performed in 1951 by Solomon Asch where 8 men were asked a visual question that was so easy that everyone could get it right.
3 But unbeknownst to the 8th man, the 7 before him were in on it and gave the wrong answer. On average, 32% of the 50 tested men gave the wrong answer, mimicking the 7 men.
But It turned out to be more than just a peer pressure experiment. Saul McLeod from SimplyPsychology writes,
“When they were interviewed after the experiment, most of them said that they did not really believe their conforming answers, but had gone along with the group for fear of being ridiculed or thought “peculiar.” A few of them said that they really did believe the group's answers were correct.”
That means that a few grown men 50 were essentially gaslighted into doubting what they saw with their own two eyes… by only 7 people!
How much easier would it be to convince a child who knows he’s a boy that he was really a girl if everyone he’d ever met since birth called him a girl.
As my recovery from the stroke progressed, this feeling of simply knowing that I was a boy didn’t last long. It was supplanted by how I felt later on in life.
Now I realize I am a boy… just a particular kind of boy: I’m exactly any boy (cis or trans) who was somehow convinced that he had to be a girl, be segregated from boys and have life experiences with girls instead of boys. That kind of boy wouldn’t know much about male culture, and wouldn’t know how to act in some cases. And that kind of boy would have doubts and shame about his gender baked into his brain by years of being raised in the wrong gender.
What I learned from my stroke is that I was NOT born to have confusion about my gender.
I learned to curse from the kids down the road. I don’t know where they learned it. Maybe they snuck into the living room late one night and watched Cinemax. Or maybe someone let them listen to that George Carlin bit (Carlin, of course, has become my cursing idol – what an appreciation for language that man has).
They knew all the basics and a few interesting combinations. I didn’t know what “fuck” meant but understood it to be foul and taboo, so the combination “buttfuckers” struck me as joyously obscene.
We were the kind of kids who integrated new words into our vocabulary by shouting them while jumping on the trampoline, leaping off the bed or bounding from one piece of furniture to another trying not to touch the floor — lava, obviously.
If you had first encountered cursing in such a magnificent, joyful, wild atmosphere, you would love it, too. Few things entertain me more than the thought of my eight-year-old self in mid-air shouting “buttfuckers” with glee.
I love cursing the way I love beer. It is a guilty love, one that cannot possibly be good for me, one that concerns my mother a little. In high school, she heard me singing along with Ani DiFranco: “I may not be able to save the whole fucking world, but I can be the million that you never made.” Mom sighed.
“I guess you and your friends all talk that, don’t you?” I recently sent an invitation to a small sampling of my rather large Catholic family — only to the ones who already know i don’t go to church — inviting them to read my blog.
It was another tentative step into the online world of self-promotion in which the line between enthusiasm and shamelessness is thinning by the day.
The invitation included a suggestion that my family members could share the blog with anyone they know who might be interested, but it also came with a warning: “If you know anyone with a strong aversion to four-letter words, this may not be the kind of thing they’ll want to read.”
This e-mail lead to a conversation with my Mom in which I explained how I really do need to improve my vocabulary and she said how she loved Julie and Julia except for all the cursing, which she found not so much offensive as simply unnecessary and distracting. I could relate. I’m always talking about how writers have annoying and distracting habits that they seem to have been trying out for effect, but the effect just didn’t come out so well.
But I also believe cursing can be used to great effect, the time my brother talked our mom and sister into a staged argument in the mall parking lot. My sister Katie, generally recognized as the polite one in the family, called shotgun as we all went to get in the car. My mother, more commonly known as the nicest lady ever born, voiced her objection.
Mom: No, I want to ride in the front.
Katie: But you always get to ride in front.
Mom: Fuck you, Katie.
Seriously, it was priceless. Just the briefest moment of shock passed until we all realized our mom would never use that word. John, who had orchestrated the scene, couldn’t contain his smile. Mom has probably blocked it out, but to me it was completely unforgettable.
Cursing does a lot for me, actually. There are those who call it cheap, low class, anti-intellectual, a sign of a weak mind, a foul temper and a lacking vocabulary. All these things are true, of course. But sometimes, my mind is weak, my temper foul, and my vocabulary lacking — there’s no getting around it — I run words sometimes.
In college, I took a women’s self-defense class for credit. I was OK at sparring. I learned the moves and did the exercises, even lost a couple pounds. Found out I could hit pretty hard, too.
For the final exam, we had to fend off an attacker (a former cop or something, a man paid to show up in padding and a cup and threaten us). I was terrified. I had stage fright, for one thing.
I knew I could hold my own against a classmate; I’d even given my friend a bloody lip by accident one time. But I was afraid of the pressure of not getting mugged (or raped or killed) in front of the whole class. I was afraid I couldn’t let fly witht he fists on a total stranger.
Our teacher had instructed us to keep shouting “no” at the attacker as we fought him, and being raised in the polite tradition of “yes,” I was afraid I couldn’t raise my voice against him.
When my turn came, we stood in the center of the room, encircled by my classmates, acting convincingly total strangers until he said, “Hey lady, can I play with your titties?” No kidding. Fucker gets paid to say this shit. I was shocked, but the adrenaline rushed in a title wave as I shouted, “Fuck no!”
My classmates laughed a little. We were all surprised by my voice, considering I’d been labeled as “the nice one” by our teacher. The attacker grabbed my arm, and then I fought him. I fought him hell, and I didn’t care anymore if he had a cup on. My classmates were chanting, “No! No! No!” with every punch, and I was going to ruin his day. Ruin his life. Ruin his family tree.
After class, he took off his protective gear and we all talked for a few minutes. He was a nice guy, in his 50s, a grandfather, but still terribly fit. He was harmless after all, and he’d been there to help us learn our own strength. He helped me find my own voice, that’s for sure.
And as vulgar as anyone may think it is, I know exactly what I’ll say if a real attacker ever tries to touch me.
What I told Mom was that when you’re trying to hang with geniuses, professional journalists, people with PhDs and book contracts and all you’ve got going for yourself is a spunky attitude and a foul mouth, it leaves something to be desired. It can make you feel pretty ignorant.
And yet, there’s something satisfying about being a high school girl and using the word “cunt” to unsettle boys who’d never seen one. Truthfully, after exchanging e-mails with certain very literate friends, I do hit dictionary.
com pretty hard, but let us never underestimate the power of a well-placed “fuck.”
Natalie Egan – Hiding in Plain Sight
Chris Schembra: What were you taught as a child about gender and relationships?
Natalie Egan: The first time I recall being aware of my gender, I was doing something that girls do and I remember being corrected harshly. I had 2 older brothers that taught me everything I needed to know about being a boy. You can’t do this or that because you’re a boy and that sort of set the trajectory of my life.
From the time I was 5 onward, my gender identity was put on autopilot. It seemed to me that everything I was taught from the time I was born is part of an artificial construct. We create labels to help us identify what’s what in the world; I understand labels are helpful, but I found them to be damaging.
I was assigned male at birth and from the moment you are born, and someone announces, “it’s boy!” or “it’s a girl!”, gender becomes this habitual grooming through traditional gender roles. Its reinforced by everything from our language to what we are allowed or expected to experience.
When the child is born we don’t just announce, “it’s a soccer player” or “it’s a ballerina”. It sounds crazy to assign an entire identity to someone the observation of genitalia. Your gender expression is so much more complex than that. I lived my life expectations of what people said I should do or who I should be, and that’s unfortunate.
I was so unhealthy because I was doing what everybody wanted me to do instead of just being who I was.
Chris: From the outside, everything looked fine: you went to a prestigious college, founded a successful company, but as you put it so painfully, you were hiding in plain sight. What gave you the courage to change the narrative and start living your freedom?
Natalie: It was a total breakdown; my failure of the experience I felt I was supposed to have. I architected this narrative of a person that everybody wanted me to be. I did that well for 40 years until it eventually became unsustainable. I learned that building a sky scraper without a foundation means it’s going to come crashing down.
Despite my best efforts. I just couldn’t do it anymore. Everything was breaking apart. My entire life came crashing down so It wasn’t voluntary; it wasn’t a choice so to speak. I remember people telling how brave it was. Brave to me is choosing to jump off a diving board, a high dive or you’ve chosen to jump the plane, but I felt was pushed the plane.
Does that make me brave?
It was not about bravery for me; it was about survival. There is no other way. I had concluded that I was going to kill myself or I was going to survive the jump.
I had come within a week or two of feeling completely hopeless and had devised a plan to end my life. I didn’t want to burden the people I loved with my crisis. Luckily, I found my way through that and survived the jump after all.
Chris: You mention that you were about one or two weeks from ending your life. What saved you?
Natalie: I would to first acknowledge that I’m very privileged overall. I mean I must acknowledge my privilege to give credence to what I experienced as a trans person; a marginalized experienced I had can often times change perspective. Many trans people -specifically trans people of color do not have a support system.
My fear was that I didn’t think I would have that either. I believed that there was no way that my parents, my brothers, my then wife, my kids, my coworkers, my employees could accept what I was experiencing. For me the turning point came through a meeting with an old friend.
Some people come into our lives and completely change our trajectory a gift from the universe and that’s what he was to me.
I happened to be in New York city, waiting for coffee in a bodega in mid-town, and standing in front of me was my best friend from high school. I hadn’t seen him in years and there he was. We started chatting and he immediately recognized that something deeper was going on and I needed to talk.
I ended up confiding about what I’d been wrestling with, which was a total Hail Mary throw for me. I had no idea how he would react. This friend of mine was an Alpha male so telling him was going to be my litmus for how I expected people to react. He looked at me straight in the eye and said you have to be you.
I was absolutely shocked at how simple and straight forward he made it seem.
All this time I was so afraid and here was someone I hadn’t seen in years who embodied all the male stereotypes that I had tried to live up to and society would have me believe would be predisposed to judge me or ostracize me and instead he just accepted what I had to say and validated that I just simply had to be myself.
That moment saved my life; he saved my life. I tell that story because you never know when you’re going to be someone’s ally; you never really know what someone is going through and if you every find yourself in a chance meeting in the middle of the day, this could be the day you save someone else from the isolation of fear. He gave me courage to be able to start the journey.
Chris: That’s an incredible story. Thank you for sharing it with me…and now after all this time, you are Natalie. What has that been for you?
Natalie: I think it’s amazing; wildly liberating if I’m being honest. Although there’s a common theme I think for people suffering on the other side that it’s going to be all happiness all the time. It’s not all the time. Life is still life.
There’s no magic pill for happiness; I’m a human being just everyone else, facing challenges, overcoming obstacles and finding my way. What I can say for certain is that for the first time in my life, I am satisfied.
I’m no longer searching or rushing to fill a void with a new career goal or a new accomplishment.
Nothing ever seemed good enough because I was desperately trying to fill the void of identity with successes and achievements.
After making peace with my identity, I can look in the mirror and instead of seeing a fraud or a failure, I see who I really am. Instead of seeing that reflection with hatred, I see it with love. I get to say I honestly love myself and that’s the coolest feeling.
Chris: You mention business exposure and success. After identifying as your true self, you dedicated your work to creating a company that focuses on diversity inclusion. What can companies do to help their employees work together to overcome the things you faced?
Natalie: I think the important piece of this company, is to help others realize this is a journey; it’s a process that we all go through one way or another and having empathy for someone going through a process of their own is what it’s all about. All processes take time.
Helping each other along the way through empathy and understanding is what we strive to achieve. Having vision for who and what we could be if we operated under those terms is how we are trying to change the culture in companies throughout the country. We do this in a number of different ways.
One way is by hosting workshops that feature playbooks to help employees understand how to go through an experience of someone else’s process. An example would be how to respond if a coworker comes out as transgender and you as an employee are on the other side of reconciling that reality to yourself, your fellow co-workers, clients, etc.
There is a healthy and productive way to experience that and that’s what we want everyone to learn.
Chris: What is a piece of advice you would you give to someone who may be feeling what you felt; before you ran into your friend, when you felt alone?
Natalie: The first thing they need to know is that no matter what you think society is telling you or what your own mind is telling you, you are not alone. I lived my whole life thinking I was alone and I was the only one going through this. I grew up in a world before the internet.
There was no website, no support group, no pamphlet with encouraging information. Today we live in a world that connects us to each other constantly, through social media and the internet. It can be a double-edged sword, there’s no denying that, but the access to other people provides unprecedented relief from the isolation of fear.
Reach out to the people who may be in similar circumstances. Your circumstances don’t define you or your approach to handling your own process. It can be as simple and arbitrary as finding a hashtag you identify with that opens a whole world of people who think and feel and look just you or who you want to be.
Don’t let the lie of believing your alone prevent you from going on the journey.
Be strong and stay optimistic. Don’t go backward. I truly believe that this will lead to much better reality for all of us. Life is hard and we’re going to hurt and suffer and lose people along the way, but never ever go backward.
Chris: Wow…Natalie, thank you for all of this so much.
Natalie J. Egan (she / her / hers) is an openly transgender B2B software entrepreneur. She founded Translator in 2016 her experience coming out as a transgender woman and experiencing bias, discrimination, and hatred for the first time.
As the CEO of the company, she leads a quickly growing team into the uncharted waters of building enterprise Diversity & Inclusion software.
Natalie has over 20 years of experience driving digital change, developing high performing teams, building complex products, and selling B2B technology solutions.
Prior to founding Translator in 2016 – and prior to her transition – Natalie was CEO and founder of PeopleLinx, a venture capital backed social selling technology solution that was recently acquired by a leading sales acceleration company.
In addition to her entrepreneurial pursuits, Natalie has also worked in leadership positions at LinkedIn, Autonomy, and Ecolab. Based in New York City, she spends her free time with her three children or mentoring female entrepreneurs and LGBTQ youth.
Natalie earned her undergraduate degree in business from The Hotel School at Cornell University, received her MBA from The Villanova School of Business, and is currently writing her first book about transitioning from a male to female CEO in corporate America.
Hormone therapy poses stroke risk for transgender women
(Reuters Health) – Hormones given to people to align their sex with their gender pose a significant risk of serious blood clots and stroke among transgender women, one of the largest studies of transgender patients has concluded.
The risk of a dangerous type of blood clot, called a venous thromboembolism, nearly doubles for people transitioning from male to female compared to both non-transgender men and women, researchers reported in Annals of Internal Medicine.
The risk seems to come from hormone therapy. Among transgender women who had started the therapy, the clot risk was five-fold higher after two years of follow-up compared to non-transgender men and three times higher compared to non-transgender women.
And although women have lower rates of heart disease than men, the odds of stroke and heart attack for transgender women remain the same as they would be if they had not transitioned.
For transgender men, the researchers could not confirm any health risks because number of incidents was too small.
The study did not look at specific formulations, combinations or doses of the hormones used in gender confirming therapy, so it remains possible that some regimens pose a lower risk than others and that’s where future research should focus, senior author Michael Goodman, a professor of epidemiology at the Rollins School of Public Health at Emory University in Atlanta, told Reuters Health in a telephone interview.
“These risks need to be weighed against the important benefits of treatment,” he said. “Our hope is people will understand we’re not trying to scare anybody.
We’re just saying there are some questions that need to be answered to guide the therapy. Risks comes with benefits, and benefits come with risks.
It takes a thoughtful healthcare provider and a well-educated patient to make an informed decision.”
“I don’t think this would dissuade anyone” from transitioning because the process is so important to those who feel they need it, Dr. Alice Chang, an assistant professor in the division of endocrinology, metabolism, diabetes and nutrition at the Mayo Clinic in Rochester, Minnesota, told Reuters Health by phone.
Chang, who was not involved in the research, said most doctors usually discuss such risks with patients, suggestions of an elevated risk of heart disease and stroke seen in smaller studies of people who have received hormone therapy for other reasons.
Until now, the data on whether gender confirming medical therapy treatment poses cardiovascular risks has been sparse.
The Goodman study used the cases of 2,842 transgender women and 2,118 transgender men. They were treated in California and Georgia in the Kaiser Permanente health system.
They typically had been followed for about four years and only about 23 percent had undergone gender confirmation surgery.
The records of 48,686 men and 48,775 women who had not undergone gender confirming treatment, all matched for race, ethnicity and year of birth, were used for comparison.
Clot rates were twice as high for all transgender women. But in the key subset that had begun estrogen therapy, the odds of developing a potentially-dangerous clot were 5.1 times greater after two years compared with non-transgender males.
When it came to the risk for developing a stroke caused by a blood clot, the odds for transgender women were 9.9 times higher compared to men in the control group and 4.1 times higher than for women in the control group, a follow-up period of more than six years.
Taking hormone therapy as a transgender woman did not increase the odds of a heart attack compared to non-transgender men in the control group. The risk was 2.4 times higher compared to female controls, but women are less ly to have a heart attack in that age group anyway.
It took about two years for the risks to become clear, and they increased over time.
“There were so few events because the patients tended to be young,” said Goodman.
Chang agreed with Goodman that the findings will shift the focus on the safest way to give hormone treatments. A higher risk may not have been seen in transgender males because they receive their testosterone as an injection or a patch, she speculated.
“This is the first large study that says we need to be aware of this (cardiovascular risk) and a lot of unanswered questions about duration, type and dosing of therapy have to be answered,” she said.
SOURCE: bit.ly/2MWDN2A Annals of Internal Medicine, online July 9, 2018.
Our Standards:The Thomson Reuters Trust Principles.
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