World Professional Assoc. for Transgender Health Symposium 2018

Buenos Aires

So, what about science at the WPATH conference? Aside from the gala, the tango and the politicking was there any interesting science talked about. There was.

Vulvoplasty

For the first time, there were several papers and much discussion about vulvoplasty as an alternative to vaginoplasty. For those who do not want the worry and work of caring for a neovagina or for those who do not intend to have vaginal intercourse, there is a cosmetically correct alternative. The vulva, for those who do not know (and many at the meeting did not exactly know) is what you see from the outside. Although many people call that the vagina, it is not. The vagina is the opening into the inside that goes from the vulva to the cervix. Probably MTYEWTK. In the operation, they do all the things that are involved in vaginoplasty but just create a female-looking vulva from the outside.

I asked my friends about vulvoplasty and, after I explained what it was, they all said “Well what’s the fun of that?” Evidently there are a lot of transwomen who do not expect to have vaginal sex in the future, either because they are asexual or already get their kicks in other ways. Taking care of a vagina is a lot of work, from what people tell me, and a neovagina runs the risk of infection and other unmentionable problems. I have not figured out exactly why people opt for a vulvoplasty but it is now a standard option with many doctors. It comes with a benefit—that it only requires a BMI of 35 as opposed to 30 which brings me to my next topic.

Body Mass Index

For us large-size TGPS-eligible gals, there were two papers challenging BMI (body mass index) requirements for transgender genital plastic surgery. These requirements have prevented transgender people from even getting into the operating room without losing large amounts of weight. Body mass index is measurement of body fat based on height and weight. It means for me at 5 ‘ 11” that I have to weigh 215 pounds to get a vaginoplasty which was my football playing weight in college 50 years ago. There is no way. But for a vulvoplasty, I can weigh 250 pounds and still get the op.

It turns out that these previous BMI requirements had no scientific evidence to back them up. Once they studied the possible negative after effects of TGPS, the BMI requirements were shown to be bogus. There was no correlation with BMI. If you watched Jazz’s reality program, she was faced with this problem by none other than Marci Bowers (who holds the record for most TGPS ops). Bowers fessed up at the WPATH meeting that that was all contrived reality TV drama to maintain suspense of whether Jazz was going to get TGPS. So, the question is, in light of this evidence will doctors back off on this requirement? Stay tuned.

Liberalization of WPATH HT Guidelines

The other big thing that happened is a liberalization of WPATH guidelines for HT. You can now get hormone therapy (HT) from any medical doctor who has taken their CEU course with your informed consent. The story is that now any medical doctor can prescribe hormones, given that they ask a few questions one of which is that you understand the risks. No letter from a medical health professional is required. It has actually been this way for some time but it is now a point of emphasis because the system is swamped with new applications for HT. From my point of view, it would be good for the doctor to have at least a little training as to what to monitor in blood tests. Many students can now get that in med school and the others can get the knowledge from CEU courses.

That is one way to handle the demand for HT treatment. The other is not so good. There was a paper on the backlog of cases for the UK Health Service. They are running many months behind on just initial intake of transgender people because they underestimated the demand. That is a problem with centralized control. Well, about 23% of people on the waiting list have already started their do-it-yourself hormone therapy. This is dangerous. If you are taking hormones, you need to get regular blood test monitoring, particularly at the beginning.

Communications Therapy

Voice therapy has been a staple of transgender transition for some time and now has expanded to “communications therapy” which includes not just voice but also gesture and posture. Right now, they are doing research to figure out which gestures are feminine and which are masculine, although that may seem obvious. They are doing some sophisticated experiments to understand which gestures have the most effect in gender expression.

Transgender and Autism?

There were a couple of papers that debunked previous reports of a linkage between being transgender and autism. Seems like previous studies used screening checklists for each phenomena but the tests are both invalid. There may be an overlap in hospital gender clinics because they tend to get the complicated cases. I remember one paper that said that 40% of patients in such clinics had multiple phenomena going on. There was one paper that tried to support the connection but it was not believable to me. They provided quotes, ostensibly from pre-teenagers and teenagers about their experiences but their grammar was too perfect and they included words and phrases that only psychiatrists would use.

The Southern Hemisphere Speaks Up

A bit of a dust up came from some of the WPATH members down under in the Southern hemisphere. They would like more input into WPATH, which to them seems to be dominated by the U.S. and Europe. They are probably right. Looks like Brazil will have its own WPATH subsidiary — BRPATH, which may help. With their obscene transgender murder rate, Brazil needs something. I was surprised to learn that Argentina is the leader in South America with transgender rights. Uruguay has followed them and awards $7000 in reparations per trans person. Uruguay is just across the river, the Rio de la Plata, from Buenos Aires where we were. At the rate things are going in the U.S., there was tongue-in-cheek talk among the U.S. trans people at the meeting that they should swim for it, and ask for asylum and the seven grand.

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Tags: featured, neovagina, Transgender, vulvoplasty, WPATH

Category: Transgender Body & Soul, Transgender Community News