sillyolme

Why Does Typology Matter to Medical Professionals?

(Somewhat related post & another)

Or, does typology have any medical bearing on treatment? It seems the answer is a resounding no according to a litany of research on the topic.

A 2016 study of Chinese trans individuals (Yang et. al) found that sexuality has essentially no correlation with PCS (physical component summary) and MCS (mental component summary) of the measured quality of life. Table 3 indicates that the associations between orientation and PCS ranged from -0.005 to 0.098, all of which were far below statistical significance. It was the same for MCS; a range from -0.012 to -.121 that did not achieve statistical significance (the most accurate model has a correlation of -0.066). Now of course we could attribute this result to sample bias, statistical error, or using faulty statistical models, but luckily there are a host of other studies that replicate the finding.

Meier et. al 2013 found no differences in mental health variables between FtM individuals, other than a minor difference in anxiety (the only difference was between androphilic and ambiphilic individuals, all other comparisons were statistically insignificant). We should also note the interesting change in sexual orientation reported by FtM individuals during the process of transition (which I’ll eventually get around to a post on).

Nieder et. al reviewed the entire literature and found just 10 studies (which is sufficient for a literature review in the field) reporting on the association between sexuality and transition-related outcomes. Just one of these studies reported a difference;

Given the intense debate surrounding the predictive, outcome-related value of sexual orientation after transition-related interventions (Lawrence, 2014; Veale, 2014, 2015), it seems remarkable that out of 10 follow-up studies (Table 1), only one reported or found a significant association according to the outcome measures between groups based on sexual orientation at all (Wierckx et al., 2014). They found that trans women who are attracted to men (unfortunately mostly referred to as ‘homosexual male-to-females’, which pertains to the sexual orientation according to the sex assigned at birth) had higher sexual desire compared with trans women who are attracted to women

and

Further, sexual orientation was not associated with the prevalence of hypoactive sexual desire disorder (HSDD) (Wierckx et al., 2014). However, quality of life was not
assessed within this study.

Given the literature’s confirmation that sexual orientation is not related with transition-related outcomes, it is necessary for medical professionals to ask for sexual orientation? Perhaps, in scenarios that are directly relevant; STD prevention, sex therapy, relationship counseling/therapy. But to the majority of the health professionals that trans individuals will encounter, it seems entirely unnecessary for them to ask and inquire as to the deeply personal nature of their sexual orientation.

Even more, this casts doubt on the diagnostic value of the purported ‘autogynephilia’. If we can classify ‘autogynephilic transsexuals’ and ‘homosexual transsexuals’ into two different categories, but the outcomes don’t differ, is there any value in differentiation?

Some Other Readings

A description of historical gatekeeping which importantly mentions the factor of sexual orientation

The Harry Benjamin Society standards

His book depicting the prototypical classification scale (page 19)

Experiences of gatekeeping in Thailand, Czech Republic, Germany

Assumptions about sexuality in the trans community

All of this goes to show the gatekeeping that arose from sexual orientation classification

Update – 11/16/18

Given that I choose a poor title for this piece, I’ll clarify what I had intended to communicate with the wording & the thought process I went through went writing & publishing this piece at midnight.

I was searching for more research for another piece when I came across the Chinese study (Yang et. al), recalled the existence of Nieder et. al (the literature review) and thought that the two could work together to make a coherent article on how it isn’t necessary for one’s medical professionals to inquire about sexual orientation (and thus the false ‘typology’) in order to impact decisions on providing treatment to patients. The articles linked in the Some Other Readings section articulate the issues with medical professionals asking about sexuality and using that to deny or delay treatment, which was is my primary criticism of the use of sexuality in medicine in trans-specific contexts (which is not to say that I oppose it). The existence of gatekeeping was intended to be a theme throughout the piece (and is something that I am eventually going to get around to writing on). Even more, the piece’s even larger overarching goal (as is the blog’s) is to criticize Blanchardianist ideology & criticize autogynephilia typology.

The “re”formulation of the title as “Or, does typology have any medical bearing on treatment?” helps contextualize the original purpose of the piece (as do the links to Kay Brown’s articles), but the chosen title then influenced the irrelevant and poorly worded content of the piece.

But the language I used obscured all of this; Medical professionals is far too broad of a term to refer to the individuals I intended to refer to: psychiatrists, psychologists and therapists – those who very often make diagnoses of trans individuals; the people who’ve been reported denying letters, recommendations and treatment because of sexual orientation; the paradigmatic gatekeepers. There are plenty of valid instances to ask for sexual orientation (although there may be more prudent and sensitive methods of obtaining the necessary information): for risk assessments for STD prevention, some therapeutic contexts, and so on as commenters on the Reddit thread insightfully pointed out. Even more, my crude estimation of the makeup of medical professionals trans people encounter could be false in many instances: it could be, for instance, that a trans individual is post-transition and encounters their primary physician far more than their psychiatrist (if they even have one).

A longwinded way of saying I’m sorry for choosing such a poor title.