Trans News/ Issues

[theoddz]

Originally Posted by Toughy

I don't know about SRS at SFVA (in the past) but I'll see what I can find out cuz I am now curious........I know they are not doing it now. I know transwomen are getting their healthcare in the Women's Clinic......a friend of mine gets her care there....and trust me she would be vocal if she was not happy....laughin.... I'm not sure about transmen.

I'm not sure what the format will be for the program, but I am sure there will be a Q&A after the lectures....it is a teaching hospital.....so it should be very interesting.

I'll come back and give y'all my impressions if you like.........

Toughy, that would be really great if you could do that!!! That's so kind of you to take your time to do that for us. I'd love to hear more about it.

There are, indeed, some very wonderful perks in living in the Bay area/GLBTQ "Mecca"!!!

~Theo~

[Toughy]

Originally Posted by theoddz

Toughy, that would be really great if you could do that!!! That's so kind of you to take your time to do that for us. I'd love to hear more about it.

There are, indeed, some very wonderful perks in living in the Bay area/GLBTQ "Mecca"!!!

~Theo~

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....

[theoddz]

Wow, Toughy, that sounds like it was quite a presentation. I'd have loved to have attended, just to hear what was said. Thank you so much for sharing that with us!!!

I'm so happy that the VA is having these presenters and these kinds of presentations. I think that the time is quickly approaching when the VA system and other private insurance carriers will have to provide surgical services and coverage to transgendered and transsexual patients. That would certainly be great. If they do get into this in a full scale way, I'm sure it will go a long way into advancing the reasearch and subsequent quality of genital reconstructive surgery for FTMs, too. I've heard several plastic/reconstructive surgeons say that FTM genital surgery (namely, phalloplasty) is much more difficult that MTF genital reconstruction, simply because "it is easier to take away than it is to add".

Thanks again, Toughy, for sharing that.

~Theo~

[Toughy]

The MtF surgery is easier because we all start life as a female.......in the second trimester sex differentiation occurs and in males there is room in the pelvic cavity for a vagina. The other thing is because you are using viable sex organ tissue (the penis) most if not all MtF are capable of orgasm of the clitoral and vaginal varieties. She also said transwomen have a G-spot....

Dr Bowers seemed to think the awful skin grafts needed to make a penis is a HUGE drawback and that yes there are intact nerves in the new phallus, however they are not nerves of the sexual stimulation variety. So no orgasm and you need a rod in the new phallus for penetration.

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The two women in the first presentation are at the SFVA and are more than happy to talk to any and all VA folks around the country about trans issues. They really are dedicated to quality service delivered in a respectful way.

[Jess]

not "news"... but, WOW!!!

[Nadeest]

That poem definitely expresses things, in a way that helps people to understand, I think and hope.

[Nadeest]

I hope and pray that the VA starts doing our surgeries soon. I would really, really appreciate it if they did, especially if they started doing it in the area where I am living, as I will certainly take advantage of it.

[theoddz]

Nadeest, as you know, I work for the VA, and have worked in 2 different VA Health Care systems (Sacramento, CA, and here in Las Vegas, NV). When the VA decides to offer these services, and I believe that they eventually will, in time, I look for it to happen this way:

There are 22 VISN's (Veterans Integrated Service Networks) in this country and its territories. A VISN is similar to a "region", so to speak, and encompasses several, if not quite a few, individual health care systems, or facilities, with a VAMC and its collection of affiliated outpatient clinics. The big VAMC's are usually, but not always, sitting right beside and are directly affiliated with a state University medical school complex. The VAMC usually takes advantage of the teaching environment and its huge pool of medical residents, students and attending physicians, in addition to facilities and resources. By and large, the care in these VAMC's is usually only as good as the medical school that it is associated/affiliated with. Here in Nevada, for example, the state medical school is located in Reno, which is in northern Nevada, and only has a limited "satellite" type presence here in Las Vegas. The University of Nevada Medical School is not usually considered to be one of "the best" medical schools in this country, and that fact, combined with the fact that the school is not here in Las Vegas, has (IMHO) resulted in a "not so good" quality of care here at the Las Vegas VA. Because of this, I would not want to have any kind of surgery performed on me in this particular VA system. Now, when I worked at the VAMC in Sacramento, CA, we were affiliated with the University of California (Davis) School of Medicine. The care in our VAMC was second to none and the Veterans at the VAMC Sacramento had top-notch care. I would have gladly had surgery at that VAMC. Now, that being said.......

When gastric bypass surgery became popular in the private sector, the VA began offering it to veterans through the VA system, but it wasn't something that every VAMC offered. For the most part, a certain medical center in the VISN was chosen to perform that surgery and when a Veteran chose to undergo it, they were referred and sent to that VAMC for the procedure. The followup was then continued in the Veteran's local facility. The reason for this has to do with the financial resources. I think the VA is still managing these services this way and it's the same for all VISNs nationwide. When the VA begins offering SRS to transgendered Veterans, I look for them to handle it in the same way, but it may turn out to be so limited that it may only be offered in one VA facility, nationwide. I wouldn't be at all surprised if it was only offered at the San Francisco VAMC. Remember, the VA health care system is a teaching institution, relying on medical teaching systems for a large part of its provider base. Any kind of lucrative surgical procedure or service will be taught to surgical residents and trainees who want to be able to make money off of it in the private sector. What the VA will do is offer it to Veterans in a teaching scenario for these student doctors at state medical schools. As with other procedures, the quality of that care will be largely dependent on how good the training program and its instructors are.

I wouldn't be one bit surprised if it turns out that the San Francisco VA will be the only facility participating in this kind of a training program and that it will be the referral center for transgendered Veterans seeking SRS, nationwide. Even though that would be inconvenient for many Vets, it would still be a wonderful thing if the VA would offer it. I certainly hope that it does come to pass and that we transgendered Veterans could take advantage of it.

~Theo~

[Soft*Silver]

just ran across this on yahoo. Not totally relevant, but interesting nonetheless

http://news.yahoo.com/photos/sworn-v...166559097.html

[Soft*Silver]

sorry...but that link seems to no longer work...

Originally Posted by Miss_Tia

just ran across this on yahoo. Not totally relevant, but interesting nonetheless

http://news.yahoo.com/photos/sworn-v...166559097.html

[Nadeest]

Isn't it interesting, the way that different cultures have chosen to deal with this?