I'm doing it for me too Theo......I like to keep up.......so here it is:
It was a great mini-conference. I would say about 50 folks were there with large majority social workers and they got CME/CEU credit for it.
There were 3 presentations from 4 presenters.
Sira Maguen, PhD and Angela Waldrop, PhD MD Working with Transgender Individuals: Mental Health Highlights
Covered definitions (transgender, transexual, sexual orientation) along with issues of violence, barriers to care, HIV, substance abuse risks and what the VA does. Only 29% used VA hospitals and then all the abysmal civilian care issues we all know about such as denial of care, discrimination. I did not know this, but there is a "Transgender American Veterans Association" and they did a study that is the first empirical data on trans vets with 827 trans vets answering questions. link to their website:
http://www.tavausa.org/
They then talked about VA Care and the directive of June 2011. They covered pronouns, WPATH Standards of Care, issues with GID diagnosis (they don't like it), and the VA will provide pre-op and post-op care, HRT, mental health counseling (if needed and not everyone needs it), etc. The VA will not provide SRS surgery. The interesting thing pointed out by a later presenter is this exact quote from the directive which is titled '
Providing Health Care for Transgender and Intersex Veterans'. The Directive number is 2011-024 June 9,2011
Section 2b VA does not provide sex reassignment surgery or plastic reconstructive surgery for strictly cosmetic purposes.
That presenter felt this was a very smart little statement since no SRS including chest reconstruction is 'strictly cosmetic'. He thought this was a way to actually get the VA to do the surgeries. It will take time but it certainly could be an advocacy path......
I thought it was interesting that intersex folks are recognized by the VA.
Next Presenter was
Marci Bowers, MD.
She is a warm, dynamic, funny as hell woman who has a tendency to ramble when she talks. The best and most interesting thing I heard from her had to do with female genital mutilation/female circumcision. It seems the damage can be repaired with a normal looking and functioning female genitalia as the result. Yes it can be fixed with what she called 'a simple surgery'. She is the only surgeon (she knows about) in the US that is doing this surgery and she does every one of them pro bono. There are surgeons who Europe who do it and she went to Paris and trained. I was stunned and so were the rest of the audience.
She talked about intersex folks as well MtF and FtM. She was clear that more work needs to be done to stop any surgery being done on an intersex persons until they decide what their gender is.
She does metoidioplasty and will create a scrotum with implants if individual wants it. She does not do chest reconstruction, but will also do hysterectomy. She is a board certified OB/GYN. She is not too impressed with available phalloplasty options.
She talked a bit about the history of trans folks and I mean way back history. She seems to think all those eunchs in the Bible were probably MtF folks who were castrated. It seems there was an FtM Pope....Pope John VIII 855AD was the reason that there is now a genital check for all those who are elected Pope. The Pope sits in a chair with a hole in it and one of the Bishops goes below the chair and looks for the necessary dangling bits....this is done in a special room and the Pope does not know who does it......
Another interesting thing she said was this idea of trans folks having 'regret' later is entirely un-supported by data (and in her practice) and is most likely transference on the part of the provider who may or may not have experience with trans folks.
Nick Gorton, MD (and an FtM) was the last presenter. He covered all the HRT stuff as well as some of the legal issues around documents and Medicaid/Medicare/Social Security issues. He does some work with the Transgender Law Center.
He pointed out the very large majority of health care for a trans person has nothing to do with the 'trans' part and everything to do with the human part. He says you already know 90% of what you need to know. 100% of the medical treatments and most of the surgeries are used in cisgender patients. He also does not do much in the way of labs for MTF/FtM.....at baseline, 2 months, 6 months and then yearly.
There is no data to suggest FtM on T will have more heart trouble, more bone fracture problems, and for MtF the big issue when on E is Embolism (blood clots).
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I have a handout with all the slides from the 3 presentations. I figure we can work something out if anyone wants a copy of them. PM if you are interested.
If you have questions you can ask me and I will see if I can answer it based on what I heard today.
edited to add: Dr Bowers showed a 6 minute video (at high speed because the operation is about 3 hours long) of the MtF vaginoplasty...damn is all I will say....