Patients commonly assume that a change of social gender role will require a change of occupation, particularly if their occupation is stereotypical of their birth sex. A common problem is how to inform employers and colleagues of an intention to change gender role. People with disorders of gender identity who display a talent with computers seem often to gravitate into teaching others how to work or repair computers. Occupation is important because it is a good and verifiable test of whether the patient can manage on a day-to-day basis in their acquired gender role. The reaction of children to a parent's change of gender role depends upon the ages of the child and the parent, and the quality of the relationship that existed between them prior to a change of gender role. The wider family may have knowledge of a patient's change of gender role withheld from them by closer family members.
Acknowledgments List of Abbreviations Preface Introduction 1. Aeschylus's Persians: The Messenger and Epic Narrative 2. The Literary Messenger, the Tragic Messenger 3. Euripides' Bacchae: The Spectator in the Text 4. Homer and the Art of Fiction in Sophocles' Electra 5. Rhesos and Poetic Tradition 6. Sophocles' Oedipus Tyrannus: Epistemology and Tragic Practice Appendix: Messengers in Greek Tragedy Works Cited Index
This conclusion presents some closing thoughts on the concepts covered in the preceding chapters of this book. The book suggests that an abnormality of genetic or neuroanatomical constitution or of endocrine function is compatible with a diagnosis of transsexualism. It addresses a system of clinical practice at a particular time. It should be apparent that a gender identity clinic is likely to see a very wide range of people and problems. This is somewhat at odds with public and, to some extent, psychiatric perception. Gender identity disorders were once viewed as always being serious mental illnesses. Over the years the pendulum has swung the other way, and it is now sometimes asserted that gender identity disorders have no such association. Local psychiatric services often co-operate in a definition, sometimes sincerely and sometimes because it serves as a convenient label when referring the patient to a gender identity clinic.
Carboxyhemoglobin (COHb) values were determined in mice exposed to varying amounts of marijuana and tobacco cigarette smoke utilizing a spectrophotometric technique. Mice were exposed to smoke inhalation in a modified Walton horizontal smoke exposure machine, whereby rodents can be exposed to multiples of 1-min smoke exposure cycles. Smoke exposure was intermittent; during the first 30 sec of each 1-min cycle, the subjects were exposed to smoke diluted either 1:10 or 1:5 with air. During the second half of the cycle the animals were given fresh air. There was a positive linear relationship between COHb values obtained and the number of puffs of marijuana smoke administered via either 2, 4, 6, or 8 "puffs" of marijuana smoke. COHb levels in plasma did not increase in animals given multiple 8-puff episodes of smoke daily as long as a 60-min period was interposed between smoking episodes. COHb values in mice exposed to tobacco smoke were significantly higher than those in mice receiving equal numbers of exposures to marijuana smoke. Mean COHb values of mice receiving 8 consecutive puffs of marijuana smoke were 18.6 and 22.0% saturation, but CO was rapidly cleared from the blood. This rapid clearance suggests that the binding affinity of CO for mouse hemoglobin may be be weaker than that of human hemoglobin. Mice similarly exposed to 6 or 8 puffs of tobacco smoke had mean COHb values of 24.6 and 28.5% saturation, respectively. No acute lethal effects were observed in mice receiving multiple daily episodes of 8 puffs per episode of marijuana smoke, whereas mice exposed to a single 8-puff episode of tobacco smoke suffered about 50% acute lethal effects.
In this chapter, the author argues that psychiatrists need to be more like histopathologists. This might at the very least take the form of much readier recourse to a second opinion. The management of gender identity disorders is one part of psychiatry where it seems to author that a high-quality second opinion is not just desirable, but rather is a necessity. The World Professional Association for Transgender Health, Inc. is clear that no one should be referred for gender reassignment surgery without a proper second opinion. Major difficulties are faced by small and sparsely populated countries – the Republic of Ireland or New Zealand, for example. The author suspects buying into the services of larger neighbours, either in toto or for second opinions and surgery, or perhaps teaming up with neighbouring small countries to make a joint service, might best serve countries of this sort.
Referrals to the Charing Cross Hospital Gender Identity Clinic are accepted only if they are made by a community mental health team psychiatrist or psychologist, or the child and adolescent gender identity disorder services. Before the administration around funding referrals was introduced, it used to be that general practitioner (GP) referrals were accepted. There were considerable problems with this arrangement. The first problem was that many GPs seemed unwilling to refer direct to a tertiary centre, no matter how insistent the patient or how appropriate the referral would have been. The second problem was the reverse of the first. It was that of GPs who seemed willing to refer to a tertiary service regardless of the appropriateness or otherwise of the ensuing consultation. Sometimes the patient and assessing gender identity clinic were bemused by the sorts of referrals. If direct GP referrals were reintroduced, there might be no increase in inappropriate referrals.
A real-life experience is the experience of living in a new gender role, and is very likely to last the remainder of the patient's days. Although the terms 'real-life test' and 'real life experience' are sometimes used as synonyms it would be fairer to say that for patients who want surgery, particularly genital surgery, a defined first part of a real life experience might constitute a test, while the rest will not. The real life experience should be considered to have started on the day the patient was last in their biological gender role, for whatever reason. Some patients fiercely maintain that they do not care what others think of them, and that their own conviction of their gender is what matters. The 'real-life test' is thus a period in which the patient is required successfully to live in the chosen gender role.
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