For most of us who are true transsexuals  and of whom have had Gender Reassignment Surgery (GRS), there are several terms, people, or phrases that are burned into our memory.  Dr. Harry Benjamin, The Transsexual Phenomenon, HBIGDA (Harry Benjamin International Gender Dysphoria Association now known as WPATH , the World Professional Association for Transgender Health, Inc.), and the Standards of Care (SOC) are a few of them.  Most of us remember these people, terms, phrases or acronyms because they represented the people and organizations that in one way or the other guided us out of the living hell we experienced prior to transitioning and surgery.  For me personally the light shown most brightly when I stumbled upon a copy of The Transsexual Phenomenon  in early 1968 and instantly realized exactly where I fit in with the scheme of things; it was a lot like blindly bouncing off the walls of a fully enclosed concrete maze for seventeen years and then quite unexpectedly finding oneself handed a key to escape it. 

The young, aggressive and transitioning transsexuals of today can’t fathom the days of no liberal television documentaries on transsexualism, no TS Roadmap or Transsexual Women’s Resources  much less high speed internet.  There were no blogs, no support groups, and no therapists around every corner.  Finding information of any  kind on the issue was a quest one had to pursue with vigor; and even then the information was scarce and often riddled with inaccurate facts.  A review of the histories of those who transitioned and had surgery during the 1960’s invariably indicates they hailed from the larger, more metropolitan cities and yet, even then, access to qualified therapists and medical supervision was almost an underground like connection.  I was lucky.  I lived in Louisiana and quickly tapped into the Erickson Educational Foundation, one of the earliest gender resource foundations in the nation.  I am in unequivocal awe of those who successfully transitioned during the 60’s.

The WPATH (HBIGDA) Standards of Care is the ethical and medical guide for those physicians who supervise our transition.  It is a fairly lengthy document that covers a lot of ground, but for most of us this document defines what is necessary to change our sex.  And the eligibility requirements for gender reassignment surgery are quite simply, emphasis mine:

1.  Legal age of majority in the patient’s nation.

2.  Usually twelve (12) months of continuous hormonal therapy.

3.  Twelve (12) months of successful continuous full time real-life experience.

4.  Psychotherapy, though psychotherapy per se is not an absolute eligibility criterion for surgery.

5.  Demonstrable knowledge of the GRS procedure, its cost, complications, aftercare, etc.

6.  Awareness of different competent surgeons.

7. Two letters of recommendation are generally required for genital surgery.  If the first letter is from a person with a master’s degree, the second letter should be from a psychiatrist or a Ph.D. clinical psychologist, who can be expected to adequately evaluate co-morbid psychiatric conditions. If the first letter is from the patient’s psychotherapist, the second letter should be from a person who has only played an evaluative role for the patient. 

I paraphrased the SOC in the interest of brevity, but item #4 is of note because though psychotherapy per se is not required, Item #7 dictates that two letters of recommendation from psychotherapist are required for GRS, one of which must be from either a psychiatrist (of whom is a medical doctor) or a therapist with a Ph.D. is clinical psychology, neither of which are simply going to take one’s word for it that they are GRS material.  Suffice to say, if one is on the road to GRS, they will be spending a significant amount of time in front of a psychotherapist before the letters will be forthcoming.  Reputable gender surgeons will insist on the two letters which, among other things, are meant to validate that the other six requirements have been fulfilled. 

So, the reality, when the boiler plate is removed, is that if one follows the WPATH (HBIGDA) Standards of Care, in order to have gender reassignment surgery one must: 

1.  Be on hormones for twelve continuous months.

2.  Undergo twelve months of a continuous full time real-life experience.

3.  Undergo psychotherapy long enough to ascertain one is actually transsexual.

4.  Have two letters of recommendations for GRS from two qualified psychotherapists. 

Three of the above requirements are pretty straight forward:  hormonal therapy, psychotherapy, and the letters of recommendation.  However, what exactly is the real-life experience?  What is the purpose of it? 

The real-life test  is living full time in one’s target gender.  One definition of the RLT  and its purpose is this, emphasis mine:

Real life experience (RLE), sometimes called real life test (RLT), is a process where transsexual and transgender people live in their preferred gender role for a period of time, in order to demonstrate that they can function in the preferred role. Historically, this process was a prerequisite to receive permission for hormonal treatment and sex reassignment surgery.  However, clinical practice in many places may be more or less stringent. In the United Kingdom most National Health Service trusts will require 24 months, whereas in Thailand the Benjamin SOC is not usually followed and RLE may not be required.

According to WPATH (HBIGDA) it is defined as this, emphasis mine:

The act of fully adopting a new or evolving gender role or gender presentation in everyday lifeis known as the real-life experience. The real-life experience is essential to the transition to the gender role that is congruent with the patient’s gender identity. Since changing one’s gender presentation has immediate profound personal and social consequences, the decision to do so should be preceded by an awareness of what the familial, vocational, interpersonal, educational, economic, and legal consequences are likely to be.  Professionals have a responsibility to discuss these predictable consequences with their patients.  Change of gender role and presentation can be an important factor in employment discrimination, divorce, marital problems, and the restriction or loss of visitation rights with children.  These represent external reality issues that must be confronted for success in the new gender presentation. These consequences may be quite different from what the patient imagined prior to undertaking the real-life experiences. However, not all changes are negative. 

The Stardards of Care  go on to say, emphasis mine: 

The real-life experience tests the person’s resolve, the capacity to function in the preferred gender, and the adequacy of social, economic, and psychological supports. 

What satisfies the real-life experience requirement?  Again, we turn to the WPATH Standards of Care, which says, emphasis mine: 

Parameters of the Real-Life Experience:  When clinicians assess the quality of a person’s real-life experience in the desired gender, the following abilities are reviewed:

1. To maintain full or part-time employment;

2. To function as a student;

3. To function in community-based volunteer activity;

4. To undertake some combination of items 1-3;

5. To acquire a (legal) gender-identity-appropriate first name;

6. To provide documentation that persons other than the therapist know that the patient functions in the desired gender role. 

Most transitioning true transsexuals should be able to understand the Standards of Care, and adhere to them.  For us to have GRS, it is important that we be able to function in society  before we have surgery.  Sadly, many of the transgendered, when they speak of it at all, only do so with disdain.  When I transitioned I followed the SOC to the letter.  Most assuredly I knew how I felt.  When I reflected on the issue of my transsexuality I could not see things any differently than I felt I had known them to be for my entire life.  Still, I was smart enough to know that if  there was some psychological reason for me feeling as I did I would not be able to isolate it for I wouldn’t know what I didn’t know …only a trained psychotherapist could make that determination.  One doesn’t need to look very far to see a transgender make a statement along the lines of, “I don’t need some damned therapist to tell me I’m a girl.”   And, if one digs a little deeper, they will see another TG say that they have been thwarted in their quest for either hormones or surgery because they were diagnosed as a transvestite…still they moan, “I’m a girl and I know it.” …when actually they are not  and don’t  know it.

The real-life test is the transgender’s real  Waterloo.  How many times do we see the transgender whine about how they are discriminated against?  How often do we hear if there was only an inclusive ENDA, the employment concerns of their masses will disappear?  Over 80 jurisdictions now have such employment anti-discrimination statues, including some states and many of the larger cities, yet it appears these folks still can’t get jobs.  Why they think the Employment Non Discrimination Act  is going to do away with their woes is beyond me.  The fact of the matter is simply when they present to a perspective employer they are either not qualified or are unable to present as a legitimate female, or person.  They are unable either because of their qualifications  or their presentation  to sell themselves to the hiring manager sitting across the table from them and legislation is not  going to change that.  Yep, the real-life test is a wicked pill to swallow and if the transgender, or transsexual for that matter, can’t overcome it, the fact is that they might simply want to reconsider rather than expecting some future legislative help to miraculously come to their aid. 

The real-life test (RLT) has one overwhelming theme:  it determines whether the person can cut it in their target gender role.  That’s it.  Very plain and very  simple.  It tests the person resolve to persevere until they are capable of presenting and functioning  in society in their target gender role.  The SOC says that transitioning presents, emphasis mine: 

“…immediate profound personal and social consequences, the decision to do so should be preceded by an awareness of what the familial, vocational, interpersonal, educational, economic, and legal consequences are likely to be.” 

There are  consequences to transitioning.  One doesn’t just transition and expect everything to be OK.  An effort is involved.  It’s a huge effort.  The RLT is a time for the transitioner to learn how to do their hair and make-up, what clothes are appropriate, to change their mannerisms, to learn how to present as a female (or male).  Society could care less about the nuances of feminism when it comes to a transitioning male-to-female transsexual and special laws are not going to change that.  If one is going to change their sex, they are going to have to learn to present, act, and behave in a way that those who interact with them will perceive them to be what they claim.  The male-to-female transitioner is going to have to evolve  from male to female.  They have to demonstrate that they are what they say they are.  And, if they can’t, they fail.  Saying one is female is just not good enough; one must demonstrate it as well.  Saying it alone and expecting society to accept it will just not fly.  No one is going to say, “close but not good enough.”   The result is one simply isn’t going to be accepted.  Thus, the transgender…thus, the whining. 

One doesn’t hear the post-operative transsexuals bitch and moan about how the world discriminates against them, for the most part.  We have passed the RLT.  We are employed.  We followed the Standards of Care.  We integrated into the mainstream.  We evolved from what we were  to what we are  and did it well enough that we relate to others in our target gender just as we did before we transitioned.  We had the resolve  to persevere in what needed to be done, not depending on some special ordinance or law to come to our rescue.  We have convincingly demonstrated  what we are presenting as.  Excuses didn’t live in our mind set.  There was no option other than success  and whatever it took to acquire our gender change was what was done.  We paid our dues…because the dues had to be paid.   And, we didn’t look to legislation to accomplish it, much less the lame GLBT.

Transgenders seem to want it given to them on a plate.  They have enlisted the GLB to speak for them as though that group have a special insight into the issue simply because they are homosexual.  The transgender fall back on feminist theory as if by some how deconstructing gender and convincing a few that theoretically there may be a reason to accept them…that acceptance will indeed be forthcoming.  BREAKING NEWS:  Society likes the gender binary!  Most classic transsexuals like the gender binary as well and in fact transitioned because of it.  The transgender and their activists can blur the lines of sex and gender until the cows come home on the homosexual and transgender blogs, but they are shouting to an ether that consists only of themselves.  No one else is buying it.  No one else accepts the premise.  No one else is listening.  And all the while, the transgenders insanely lack the ability to differentiate between tolerance and acceptance…perhaps wishing for one and willing to choke on the other. 

But the RLT issue doesn’t end there.  Many simply sidestep the Standards of Care  altogether.  More and more the transgender are becoming gender therapists themselves, essentially assuming the role of the fox in guarding the hen house.  Some are outspoken advocates of the GLBT and everything it stands for.  As well, with over 170 gender surgeons, all of which are free to set their own standards of care,  in Thailand obtaining gender reassignment  is often as easy as simply making the trip and coming up with as little as $900US.  Certainly by-passing the WPATH Standards of Care  is not a difficult thing for someone desiring to do so. 

So, to many of the transgender, the Standards of Care  is invalid.  Some, with no desire whatsoever to have GRS, complain they can’t get a job…but deserve employment, if not entitled to it.  Most can not or will not do what is required to pass the RLT, lacking the resolve to do whatever is necessary to assimilate into the mainstream…not having the “…capacity to function in the (their) preferred gender…”.   They can not function “…in the (their) desired gender role.”   They demand special legislation to accomplish this, as if that  will change society’s mind.  As often as not, they sit at the feet of the GLB assuming they are partners in an endeavor they refuse to accept the reality of.  They demand  acceptance rather than persevere in a manner that assures it.  Some claim to be transsexual, thumbing their noses at sixty years of research that most assuredly defines them as transvestites; the TG rely on what they “say they are”  rather than what society sees them as, living in a dream in which their antagonists are always  wrong…or bigoted…or phobic.  The male-to-female transgender claim it is not about dressing, though their presentation is based on it; they never see through the fetish haze to realize that aside from that variable everything about them screams male.   

No, the gender libertines flunk the real-life test in every way.  They can’t persevere.  They can’t function.  They can’t convincingly demonstrate their target gender.  They just don’t have the dues even if they were inclined to pay them.  Integration and assimilation is as far from their ability to accomplish it as Earth is to the nearest galaxy.  Many will tolerate the transgender…acceptance, however, is but a dream.

Sign THE PETITION…now!  Enough of this non-sense!