Transition: Difference between revisions

Historically, eligibility criteria for medical treatment has presented a barrier for nonbinary individuals, specifically the 'real life test' (RLT) component which was later renamed the 'real life experience' (RLE). The website of the London NHS gender identity clinic states, ''"There is a two year Real Life Experience (RLE) of living in the reassigned gender role at the GIC for people who want to have genital reconstruction surgery (GRS). This is dated from the start of full-time gender role transition after which they can be assessed for referral for GRS. The RLE includes at least a year in some form of agreed occupational activities."'' [http://www.wlmht.nhs.uk/gi/gender-identity-clinic/frequently-asked-questions/]. Nonbinary individuals requesting genital reconstruction surgery (GRS) are generally unable to satisfy clinicians in relation to the RLE criteria as there is little [http://nonbinary.org/wiki/Recognition_%28UK%29 social] or [http://nonbinary.org/wiki/Legal_gender#UK legal recognition] of the nonbinary demographic. On the 1st December 2010, the University of Cambridge Centre for Gender Studies hosted the final public forum in its series on gender and radical biomedical advances, ''“Transitioning gender: the challenges of radical technologies”'', in association with the Guardian and supported by Cambridge University Press [http://www.guardian.co.uk/commentisfree/audio/2010/dec/07/transitioning-gender-radical-technologies-debate]. One of the speakers was Dr Richard Green, former research director and consultant psychiatrist of the London NHS gender identity clinic, who referenced ''“third gender or no-gender person(s)”'' seeking surgery to ''“remove breasts or male genitalia”'' and calls this a ''“medical '''dilemma for physicians because there’s no real life experience'''. Its either surgery, or not”''.

''“...Young people are eligible for treatment in the adult NHS clinics (once they are 18 years old) or by private practitioners (from 16 years old)”'' <ref>http://www.gires.org.uk/assets/DOH-Assets/pdf/doh-children-and-adolescents.pdf</ref>.

Changing one's name within an everyday social context can be as simple as informing others of one's choice. However, in societies with a complex legal system (or equivalent), there can be conditions that place limitations on the individual's right to self determination, which can be especially problematic for [[nonbinary]] individuals. For example, in Germany the Standesamt (Office of Vital Statistics) <ref>http://standesamtauskunft.de/Default2.aspx</ref> typically refuses to recognise in German civil registration law names that are gender-ambiguous; a given name must indicate that the owner is either 'male' or 'female'.

: ''Main article: [http://nonbinary.org/wiki/Nonbinary#Nonbinary_presentation_and_expression Nonbinary presentation and expression]''

Puberty blockers are drugs that postpone or temporarily suspend puberty in children and teenagers. They are used for [[transgender]] children, including those who identify as [[nonbinary]], to stop the development of features that they consider to mark the wrong sex,<ref name=":0">{{Cite journal|last=Stevens|first=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free}}</ref><ref>{{cite web |url=http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |title=Looking at suppressing puberty for transgender kids |publisher=Associated Press |date=March 12, 2016}}</ref><ref>{{cite web |url=https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |title=Transgender Youth Using Puberty Blockers |publisher=[[KQED]] |date=August 19, 2016}}</ref> with the intent to provide transgender youth more time to explore their identity.<ref name=":1">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|issn=2327-6924}}</ref> the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals.<ref name="lancet_pubertyblockers">{{cite journal | last=Mahfouda | first=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 | ref=harv|quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref>{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> In 2019, a study in the journal ''Pediatrics'' found that access to pubertal suppression during adolescence was associated with a lower odds of lifetime suicidality among transgender people.<ref>{{cite journal |last1=Turban |first1=Jack |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |journal=Pediatrics |date=February 2020 |volume=145 |issue=2 |page=e2019172 |doi=10.1542/peds.2019-1725 |pmid=31974216 |url=https://pediatrics.aappublications.org/content/145/2/e20191725 |accessdate=11 February 2020|pmc=7073269 }}</ref>

Periods are often a source of distressing [[gender dysphoria]] for nonbinary people who were [[sexes#assigned female at birth|assigned female at birth]]. There are several ways of preventing periods:<ref>{{Cite journal|last=Carswell|first=Jeremi M.|last2=Roberts|first2=Stephanie A.|date=December 2017|title=Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents|url=http://www.liebertpub.com/doi/10.1089/trgh.2017.0021|journal=Transgender Health|language=en|volume=2|issue=1|pages=195–201|doi=10.1089/trgh.2017.0021|issn=2380-193X|pmc=PMC5684657|pmid=29142910}}</ref>

Some nonbinary people want to look and sound in such a way that most people can't categorize them as a man or a woman. There is no one widely recognized hormone therapy for this. Possible options for people who want to suppress both masculinizing and femininizing hormones at the same time are described in the [https://madgenderscience.miraheze.org/wiki/Experimental_non-binary_HRT#Sex-hormone_antagonists_alone Mad Gender Science Wiki].  

* [http://openmindedhealth.com/transgender-101-trans-people Trans 101 for Trans People] has a nearly comprehensive list of physical transition options for trans people of all kinds, with lots of information about each.