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Prisoners, Doctors and the Struggle for Trans Medical Care

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It was Stephen Levine Born in 1942 in Pittsburgh. He wanted to be a doctor since he was a little boy; he saw how much his parents and the people in his community respected the profession. She decided to enroll in psychiatry at Case Western Reserve University School of Medicine, attracted by how the field explored human stories and biology. In 1973, as he was finishing his residency, Levin heard that his alma mater wanted to hire someone to develop a medical school curriculum in human sexuality. Levin got the job. In the years that followed, he helped create several clinics that focused on sexual disorders in college. In 1974 he founded Case Western’s Gender Identity Clinic to treat people who were unable or unwilling to live as a gender assigned at birth.

When Levine entered the field in the 1970s, scientists and doctors have spent years debating what caused transness and, therefore, how to treat it. As Joanne Meyerowitz describes in her 2002 book How sex changedFrom the middle of the twentieth century, two schools of thought competed for priority. The first was the desire to change one’s body through a psychoanalytic lens as a symptom of unresolved first-life trauma or sexual difficulties. Initially, most psychiatrists belonged to this group because they believed that doctors who helped their patients make the physical transition only allowed their deceptions. The attitude was summed up in the words of renowned sexologist David Cauldwell, who wrote in 1949: “It would be a crime for any surgeon to mutilate a couple of healthy breasts.”

The second camp emphasized biological factors. Although their adherence generally agreed that the patient’s education and environment could influence their gender identity, they found the chromosomal or hormonal composition of a person to be more important. Famous people, including endocrinologist Harry Benjamin, noted that the “cure” of trance through conversation therapy was almost unsuccessful, in which case he advocated another intervention: is to consider the reverse procedure “.

As these camps were set up, some trans people constantly backed down from their views that transness was not a medical disorder and that access to hormones and surgery should not be preached the most, with the approval of cis and male doctors. In the late 60s and early 70s, some trans people tried to organize their own treatment clinics, offering peer advice and support and referrals for surgery.

However, these clinics did not survive, and the first medical model remained in force. In his research and academic work, Levine relied on a psychoanalytic approach, theorizing that the desire for transition was a way for his patients to “avoid painful intrapsychic problems”. She examined what she considered to be the possible causes of these feelings, including the “too long, too symbiotic” relationship between the mother. When a person called himself a transgender, he liked to say that the mind was an attempt to offer him a solution. In psychotherapy, patients could question and resolve the problem that created these feelings. As in other clinics across the country at the time, Case Western offered surgery to some transgender patients – about 10 percent in 1981. A lot of trans people were disappointed with this view, but at least clinics like Levine found a level of sympathy and understanding. Instead of deviating, they were seen as people who needed treatment.

During the 70s and 80s, Levin’s height continued to increase. His clinic attracted patients and he published articles in famous magazines. In the early 1990s, however, scientific consensus among trans health care providers and researchers began to move away from psychoanalytic theory. More people were seeing evidence of innate biological factors. An increasing proportion of providers argued — they have more and more quantitative data to prove their claim — that medical interventions were more effective than therapy than therapy to alleviate gender dysphoria. An area of ​​the human brain associated with sexual behavior is larger in men than in women. In 1995, a landmark study published in Nature they found that this area was the same size as trans-female counterparts, regardless of whether they took their sexual orientation or hormones. According to the finding, “gender identity develops as a result of the interaction between the developing brain and sex hormones.”

Two years later Nature This study came out when Levine was named chairman of the board of the Harry Benjamin International Gender Dysphoria Association, the first national organization for medical providers to treat trans nationals. The most important task of the organization was to develop and publish a regularly updated document that includes good practices for diagnosing and treating trans people, called the Rules of Care. Levine was invited to lead the team that produced the next update, SOC 5.

Reviewing the rules was a long process. In 1997 the organization held a biennial conference in Vancouver, British Columbia. Jamison Green, a trans man and health activist living in San Francisco, attended the event as one of the few trans people in attendance. “It wasn’t a nice atmosphere,” he told me. “They weren’t happy when they saw you.” Levine was scheduled to lead the Saturday afternoon session about the draft rules. Green was sitting in the auditorium, waiting for the event to begin, when he heard a commotion outside. Technically, the meeting was open to the public, but there was a high cost of registration. Many other trans activists, especially those who lived locally, were outraged because of the high price and were basically leaving out a meeting that would directly affect their attention. Green says “they started knocking on doors and asking them to let them in.”

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