"Conformity is the jailer of
freedom and the enemy of growth."
TS Prevalence in the UK
Problems and Implications within The Gender Recognition Act 2004 (GRA 2004)
From: Kathy Noble
Sent: 16 March 2007 21:14
Subject: FW: TS Prevalence in the UK
I find these figures fascinating, as I have always thought that Lynne Conway's way of approach was more in line with how it should be done.
I have questioned how the Act 2004 now impacts on your figures as I have stated.
I do hope that you will reply, as we are very interested out here in Australasia
I find this very interesting, as it comes very much into line with Lynne Conway's figures. Of course from the point of view that it is Post-Op figures for the 5000, it does not address those born in UK, but now residing abroad.
How many of the estimated 1,800 GRCs issued up to the end of 2006 were for those abroad. As we felt that we were really excluded from being able to attain these dizzy heights due to the way the legislation was put together.
Now we have the "Case by Case Basis" to work with, what impact would that have on the numbers applying? These figures of course have been very much altered, due to the fact of "Non-Surgery" being part of the Act!
This indicates that the figures if taken for those who are applying for a GRC/BC under the Act 2004 are to include Non-surgery, then what is the real figure for GID/Tsism, as the figures here would need to be drastically altered to include those people, whether they are pre-op, or just do not intend, for one reason or another, to have SRS.
Love and Peace, Kathy Anne Noble
Sent: Saturday, March 17, 2007 12:56 PM
To: 'Kathy Noble'
Subject: RE: TS Prevalence in the UK
Thanks for your kind words. I appreciate your comments very much.
I think the "Act 2004" you mention is the UK Gender Recognition Act? I do have a few thoughts on that. In general, it's a good thing, but with two serious flaws. The first is the requirement for married couples to divorce before Gender Recognition can be granted. Now, it's true that only about one in a hundred marriages survive transition, but I think it's cruel that those few that do are required to be dissolved. I wrote to my MP when this was being debated, and he promised that he would support that position (couples could stay married). In the event, the liar voted the other way.
The second flaw is the ability for non-op people to gain Gender Recognition.
Absolutely everywhere else has a simple rule. Op and ok to change official sex. No op, no change. Makes perfect sense to me: imagine a 'legal' female in the ladies' changing rooms . . . but 'she' has a penis! They would be hell to pay, and it would impact fully transitioned women very badly indeed. It will happen one day, I believe.
Regarding the first flaw, I think the Canadian way is best. Instead of introducing 'civil partnerships' for same-sex couples, they changed the Marriage Act to define marriage as the union of two /persons/. They said essentially that they would not tolerate second-class status for some people because of their sexual orientation.
Regarding the second flaw, this came about because of the political activism of Press for Change (PfC: you may have heard of them). There are some F>M people in it who believe that 'bottom' surgery is unnecessary (because of the difficulty of constructing a penis) and therefore no one should need to get their bits done. There is also a strong 'transgender' strand in that group. Gee, but I *hate* that word. Transsexualism is a recognised serious medical condition. Transgenderism is a US-derived political movement to justify and legitimise transvestism as being 'just like' transsexualism, and which therefore should have the same legal rights. I've written some pretty harsh polemics on this topic.
You ask how it impacts on figures. Well, I don't really know, but I do have the numbers for UK National Health Service surgeries last year. There were a little over 100 Genital Reconstruction Surgeries (GRS) done. About 100 of those were M>F, and 4 GRS were F>M. Some were in their 60s, and 1 was in their 70s. I also know two people who were offered free NHS GRS, but elected to pay for it with Suporn instead. So I would guess that at least 200 (probably more like 300) people completed transition last year. Given a transitioning cohort with a typical age span between 35 to 60 (i.e. 25 years) then that would imply a cumulative increase of 25*200 = 5000 /additional/ formerly transsexual people into the general population over that timespan. BTW, that original 5000 in the figures is now 6000 i.e. +20% in 5 years. Adding the +5000, and we are heading into the 11,000+ range, or starting to converge on the originally speculated prevalence numbers. They simply get stronger as more evidence is added each year. I remember getting a letter from a PfC brass when I was originally researching the numbers (this was pre-GRA, remember). It said: Shh! We know there are “lots” more than 5000, but it's a nice, round, *low* number that won't scare the politicians. That was one of the reasons I used that low-ball estimate! :-)
Technically speaking, that means transsexualism is not a 'rare illness'.
European Union definition of 'rare' is prevalence lower than 1:2000.
How it has impacted socially is more interesting. Transsexualism has just dropped off the radar screen completely. Can't remember when it was last in the news. You occasionally see (being crude) some really rough-looking women who are clearly transitioning and no-one blinks. Like behind the check-out at Marks & Spencer the other day. I would say that either Canada or England are the best places in the world to transition, at the moment. 'Course, there's still the 'woman with a dick' time-bomb waiting in the wings, here in the UK. Canada has the op=girl, no-op=boy rule, which as I said, I believe to be much smarter. Canada on the other hand, is a bit of a patchwork when it comes to funding GRS, as it is provincially based.
Ontario is no go, but Alberta (redneck country, where I'm from) is cool.
Incidentally, that means I'm bisexual. Literally. As far as the UK is concerned, I'm a bloke. I did send off a GRA application about eighteen months ago, but they turned it down on the grounds that I had not documented it sufficiently (I did include my GRS letter from 2000). Canada, on the other hand, said op? Yes. Ok, you're a girl. Not that the UK status means anything much, as both my passports state F, and I'm one of those lucky ones who really don't have worries about 'passing' (yucky word).
http://www.mtftransition.com/t-girl.htm This is so absolutely true! And the 'tornado' it refers to is a solid reflection of my own personal journey.
p.s. How's the weather in Brisbane? It's rotten here at the moment.
From: Kathy Noble
Sent: Saturday, March 17, 2007 2:15 PM
Subject: RE: TS Prevalence in the UK
Thank you for getting back to me, it is very much appreciated.
Please have a look at our web site, which should be on our heading. I am president, and the activist, lobby person, lecturer and general factotum!
I have dealt with PfC over the last couple of years when trying to get us outside of UK, but born there, a way of getting our GRC/BC. This I finally achieved after 20 months and you can find out about how it was done in Advocacy, under History of Case by Case Basis, how to apply using this route and some other items that are there to do with the Act!
We were black balled because we asked too many questions and you will see that all there. I have, and am covering all of OZ and NZ in trying to help people get their GRC/BC if born in UK. I am also trying to get a GRC in Queensland for those born abroad, and this has been ongoing since 2004. I work with Anti-Discrimination, give lectures at TAFE and UNI, am a Board member for one of the groups that I work with and am also TS advisor for a group that deals with kids questioning their sexuality.
I, like you, hate the term "TRANSGENDER" as it conveys nothing. It was coined by Victoria Prince, as she did not like TS people around. Since then it has been used as an umbrella term, which in itself has done us great harm, I believe. I still cannot see how they can change gender, as to my knowledge there is no brain surgery available to do this.
Please look at our web site, and you will find the Brisbane weather listed, along with current radar, as we wait and pray for rain.
I am off to NZ at the end of May for the Agender NZ conference, but more importantly to meet old and new friends.
I do hope that we can keep in touch. May we use anything from you and list it on our web site? Also feel free to use anything of ours that you wish.
Love and Peace, Kathy
NHS to scrap care for Transsexual people.
Are trans campaigners Press for Change to blame?
Oxfordshire PCT are latest to scrap Gender Reassignment Surgical (GRS) procedures
In recent years the un-elected 'trans' campaign group Press for Change has deliberately devalued the status of Transsexuality as a medical condition. They have attempted to portray transsexual people as simply having a sexual orientation or a crossdressing fetish, similar to being gay or lesbian or even transvestite.
This notion is completely incorrect. A gay man's sexual orientation is towards another man, and a lesbian is attracted to other women. So by PfC's reasoning, if correct, a transsexual person would be attracted to another transsexual person. That is clearly not the case.
Transsexual people are attracted to sexual partners the same way as everyone else is. Some may be straight, homosexual or bisexual, dependent on their own sexual orientation, and irrespective of their born condition of transsexuality.
And, If transsexuality was simply a sexual fetish there would be no desire to embark on a life long hormone regime and generally turn their lives, and those of their families, upside down, and most importantly obtain genital reconstruction surgery - just for the sexual thrill of it. The truth is, and it has been recognised for decades, that transsexuality is not sexual or indeed sexy. It is a painful, debilitating medical from birth defect that can best be described as an intersex condition.
The reason behind this aberration of the truth promoted by self serving PfC is because it suits their aims, that of latching on to the LGB movement to gain a louder political voice from riding on their coat tails. In this regard they have been very successful. It also seems, to many transsexual people, that personal pursuit of power for the individual members of PfC was also a very real driving force. The individuals concerned have certainly not been adverse to collecting Government honours and accepting highly paid Government positions for themselves in return for their sell out of transsexual people, particularly the part they played in the disgraceful Gender Recognition Act 2004.
Meanwhile, self styled 'trans' leaders, PfC, not content with forcibly including thousands of transsexual people into a 'homosexual' category that they may be adverse to, have also encouraged the inclusion of transvestite, transgender and even drag queens in to the same category. This unwilling and incongruent alliance is designated collectively by a 'T' and tacked on the end of the LGB anachronism to form LGBT. It's clear what PfC have got from this union, but many LGB people are beginning to wake up to the fact their own political movement has been highjacked for PfC's own purposes. LGB have been suckered!
For PfC It is not a new strategy to use others for their own gain. They have been doing this with genuine transsexual people for years while having absolutely no mandate to do so.
But getting back to LGB & 'T.' There has been a huge cost to genuine transsexual people for this erroneous amalgamation. It has resulted in the NHS and the Government happily conniving in the myth that transsexual people are simply gay, which of course is not a medical condition that requires a medical solution. That saves money! Which of course pleases the Government and NHS.
NHS Primary Care Trusts are increasingly deciding to opt out of providing GRS (Gender Reassignment Surgery) and that is sadly the logical outcome of 'trans' campaigning group PfC's actions.
NHS Commissioning Boards are also attempting to justify the removal of not just surgical intervention in the treatment of transsexual patients, but any treatment at all, because non-op 'trans' people are now given legal gender recognition.
The (non surgical requirement) legal gender recognition came about due to PfC insistence, particularly from Stephen Whittle (who's support comes from the transmen that make up a tiny but very vocal part of the transsexual population). He persuaded the Government that this is fairer to those transsexual people who cannot have surgery due to dangerous pre existing medical problems.
As we know this unfortunate group is minuscule. It seems illogical to pass legislation that helps a tiny part of the transsexual population to the detriment of the rest. What similar example of legislation exists? But, the legislation does conveniently suits transmen in particular because many do not want the painful and expensive surgery required to create a penis.
It is suspected by some that actually a lot of transmen are simply lesbians who wish to legally present as men simply for the benefits that can bring, while keeping themselves physically female and thus able to switch back and forth as the mood and circumstances takes them.
This having your cake, eating it, and not even paying for it, approach, is not surprisingly popular with non transsexual 'trans' people. A lot of transvestite men have also cottoned on to this wheeze that legitimises their crossdressing, while allowing them to keep their sexual organs intact to enjoy their fetish. This in turn provides more 'trans' supporters to PfC, and so on. Unfortunately, It also unfairly leads to alienation of genuine transsexual people who have no wish to switch back and forth between the sexes. The legislation intended for transsexual people is in fact anti transsexual, and brings shame and confusion to the transsexual condition. The UK is now the only country in the world where a legally recognised man can give birth. And a legally recognised woman can commit rape with 'her' penis.
This all makes a mockery of transsexual people who have a genuine medical need. GRS is the most important (and most expensive) fundamental part of treatment for transsexual people. There are very few genuine transsexual people who would not wish to have their bodies surgically corrected to match their brains and perception of themselves. Those who claim to be transsexual but choose not to have surgery really cannot be genuine and are much more likely to be transvestites or the indeterminate 'trans' people with a sexual enjoyment of their fetish. With the benefit of modern surgical techniques it is extremely disingenuous for anyone who claims to be transsexual to choose to be non op. In fact the stated wish to have surgery should be an obvious core requirement of a transsexual diagnosis
Press for Change have handed the NHS the excuses they needed.
The preferred treatment for diagnosed transsexual people, ever since the condition was scientifically identified in the 1950's by Harry Benjamin has always been sex change surgery combined with a life long (opposite birth sex) hormone regime. This straightforward treatment has been proven to be 97% effective. Very few other medical solutions to a condition can claim that kind of success rate.
So if treatment is so effective why is there a problem? There are several reasons, not least the critical role in who does the diagnosis. Transsexual people claim their brains are opposite sex to their physical body, this can be proven as correct, and has been shown in clinical studies carried out in Holland. Unfortunately the research can only be performed once the transsexual person is dead and the brain dissected. Traditionally, transsexual people have diagnosed themselves. Self diagnosis is fraught with danger so there has to be a further confirmation of diagnosis before referral to surgery to protect those non transsexual people who claim to be suffering the condition bu are in fact sexually motivated or suffering a mental disorder. For that reason the most successful method of diagnosis confirmation has been to use short term cross sex hormone treatment as a diagnostic tool. A transvestite man or someone suffering from a psychosexual disorder soon loses the attraction to living and dressing as a woman, for example, when they lose the ability to have an erection and reach orgasm during crossdressing masturbation. While a genuine male to fem transsexual will feel great benefit from the suppression of testosterone and male sex drive. This kind of short term hormone treatment can be carried out for up to 3 months without any physical long lasting ill effects to the body.
So, that seems simple enough? Except simple inexpensive solutions do not suit the commercially driven psychiatric profession. Psychiatrists want clients, whether in the NHS or private, it's their daily bread, what pays the mortgage. Shrinks have been getting an ever decreasing portion of the population to 'work with' since the 1960's. At that time they could rely on the homosexuals and the unmarried mothers as part of their caseloads, but now those people are not deemed mentally ill. Just different. The atheists and pacifist s have gone to! But fortunately for the shrinks there is still the 'trans' population.
Although no transsexual person has ever in the history of psychiatric health ever been cure of transsexualism through psychiatric treatment. Why? Because the only cure is surgery and hormones. Despite this, all NHS treatment for transsexualism is only available through Mental Health Departments. The reason the mental health professionals were initially involved was to weed out the non transsexual people and provide the help those people needed. Most transsexuali people, if not all, wish to be disassociated with mental health altogether. They have no need for it, theirs has always been a physical problem with a physical solution
PfC, as usual have undermined this basic argument. By aligning themselves so closely to 'trans' people and pretending that includes transsexuals, they have persuaded the Gov. and the rest of the UK NHS medical profession (neither of whom needed much persuasion) that transsexuality (being part of 'trans') is indeed a mental disorder rather than a physical problem that can be cured through surgery. Yet again they fail the transsexual people of the UK by misrepresenting them for their own ends.
This latest decision by Oxfordshire PCT comes hot on the heels of Hounslow PCT and Camden PCT who are also reported to be attempting to remove GRS from their core treatment service provision. Unofficially there are many more PCT's who simply ignore transsexual people or hide them on vague mental health waiting lists not covered by the Governments official time limits. These PCT's will be greatly encouraged by PfC's actions. For decades the NHS have been trying to include TS people in sexual orientation or mentally ill categories, thereby justifying offering no treatment for the former and relatively inexpensive and useless psychiatric treatment for the later. The PCT's do not want to spend money on expensive surgery that is politically unpopular. Press for Change have handed the NHS the excuses they needed.
NB. It is little known outside the transsexual community that PfC is in fact a tiny organisation consisting of a small group of friends (approx. six or seven individuals). PfC is also completely undemocratic and has absolutely no mandate to speak for transsexual people or anyone else for that matter. They have managed to hide these facts from the various Government bodies, the NHS and other campaign groups like Liberty and even the LGB factions they rely on for support. It is a scandal that PFC has given the impression to such organisation that they have widespread support from transsexual people. They do not.
PFC is also less than transparent when they say they campaign for TRANS people, what exactly that means. PfC includes not just transsexual people, but transvestites with a sexual fetish, cross dressers & drag queens. This is damaging, many of the public, while supportive of transsexual people with a medical need, are not so comfortable about whether the other groups, particularly the sexual fetishists, actually need Gov. legislative help. (Incidentally, none of the other groups: transvestite or drag queens, etc. asked PFC to campaign for them either, so they have no mandate to do so.)
PfC, as well as being a completely undemocratic organisation is secretive. They have no elective process of membership, and they allow no open forum for policy contribution ideas from outside their tiny group. These facts, though known to some informed transsexual people are not known to the Government, the wider public, most LGB campaign and the religious organisations they confront in debate.
In recent years it appears their (PfC) search for personal glory, Gov. advisory jobs and titles from the discredited parliamentary honours system has been more important than any real interest in seeking equality, justice and access to medical provision for transsexual people. In fact their actions have probably set back the case for TS people by 30 years at least, back to when Dr's simply assumed transsexuality to be another form of homosexuality or a sexual cross dressing fetish. Now we are beginning to see the results of the PfC's campaign, and it's the genuine transsexual people of Camden, Hounslow and Oxfordshire who are among the first to suffer, but they will not be the last unless the Government opens its eyes to who they have been dealing with.
No one should be under any illusions that PfC represents anyone except themselves!
Problems and Implications within The Gender Recognition Act 2004 (GRA 2004)
At present there appears to be many problems within the National Health system (NHS) in UK, with regard to service provided for Trans People. Most of these stem from people’s perceptions of what the GRA 2004 should or should not be doing for them. (Add BC and Rights)
As the GRA 2004 is predicated on “NON SURGERY”, many who are Transsexual (TS) are now questioning why Transgender (TG) and Transvestites (TV & CD) should be able to apply for and receive a Gender Recognition Certificate (GRC) and an amended Birth Certificate (BC), even though the GRA 2004 allows for this!
We can understand the situation that Female to Males (FtM), find themselves in, in regard to bottom surgery, as it is costly and invasive and really does not work too well after phalloplasty. Here in Australia, they only have to have a double mastectomy, hysterectomy and be on Testosterone to be able to change their BC! To make it legal for those who are Male to Female (MtF) and do not wish to have Sexual Re-assignment Surgery (SRS), or have no intention of doing so, is flying in the face of fate! In this circumstance what happens if they are incarcerated, or more to the point if they wish to travel abroad and encounter the new X-Ray machines. These machines are able to see through clothing to see if any illegal items are secreted on the body. They are being installed in the USA at airports, and you can be sure that other Countries will follow that lead!
We can understand those unable to have SRS due to it being life threatening, and are sympathetic to their need to be allowed to apply for a GRC/BC, as we in Australia are asking for this, but have been told “Not at this point in time” In Queensland, we are currently unable to even obtain a GRC for those born abroad, but residing here.
It would appear that 3 National Health Committees are considering cutting, or ceasing funding for TS people. ( Oxfordshire Paper ) This will no doubt impinge on many who cannot afford to go off shore for SRS. (Just how many have gone offshore for SRS is really unknown) This leads to the disputed figure of 5000 in UK (As per Donna)
I have worked on figures for Australia and they seem to come pretty well into line with Donna’s figures and also the way of arriving at these figure as used by her and Lynne Conway. (My figures, Still checking)
At present, there are many who are questioning Press for Change (PfC) figures and their approach to TS people, as the feeling is that they are more concerned with the outcome for TGs (Used here as the umbrella term)
We here in Australia have experienced some problems in our dealings with PfC when trying to find a workable solution to our problems in regard to obtaining our GRC/BC. This was for people born in UK, but now residing abroad. In the end, we believe that they were on the same learning curve as us, but had little time or resources to spend on our problems. We suppose that you have to take this into account and it was up to us to pursue, and find a solution to these problems, which we did towards the end of 2006, after 20 months of attempting to find a solution (See History of Case by Case Basis. In Advocacy)
We like them, are volunteers! We do not receive any Government support, but have to rely on subscriptions and donations in order to fund our work.
As you will see from the ( Oxfordshire Paper ) there exists some angst, which, if looked at in this context, is very understandable.
For many in the TS community, “Time is of the essence”, as we know that long waiting periods for a diagnosis, or SRS (If one can afford it. We have to pay for SRS and all other surgical and medical needs in Australia). (There is no Government assistance here, apart from rebates from Medicare and Private Health Cover!) Because of this, as we well know, these can exacerbate the poor feelings within the TS person, to such an extent that frustration at the system can and does lead to depression, or in some instances, self harm, or even suicide!
One very big area of concern for us, is the fact that all of the so called “Specialists” have had no formal training in Gender Identity Disorder (GID) or Transsexualism. They have gleaned their knowledge by default! They have learnt as they go and especially when one of us asks for help. They then see this as an adjunct to their practice. We asked very early on, after we had seen the “Approved List of Psychiatrists” “What constitutes a Specialist? The answer we received was ‘A specialist is a person who has read about GID/TSism, written papers on the condition and has met with those suffering form these conditions’”
It appears to us, that until these conditions are recognised by being part of the core curriculum at University, we will still be being dealt with by unqualified “Specialists” in this field! Even if GID/TSism were to become a recognisable part of the curriculum, there would be few who would take it up full time, as they would have to resort to the more mundane to survive.
Currently, more and more is being learnt about our condition, but many do not want the stigma of mental illness removed from GID/TSism, as they feel that it is the only criteria that is currently in use, to enable them to arrive at an assessment in order to allow them to have SRS. However, many do realise that really it is a medical condition, that in most instances cannot be corrected other than by surgery, SRS.
So, within the TS community, we have very different schools of thought. This in itself, is most probably one of the biggest factors involved, as to why so many will not help the community by standing up to be counted. Most are in “Stealth, virtually from day one, and a large majority after SRS” This leaves only the very few who are willing to be counted, in order to make Society at large aware of us and our needs. These are the people who do manage to have legislation altered, or amended, or as in our instance, find an acceptable route to our GRC/BC.
All of this is done in the hope of making it easier for those who follow!
Love and Peace, Kathy Anne Noble
1. Potentially exceptional circumstances may be considered by the patient’s PCT where there is evidence of significant health status impairment (e.g. inability to perform activities of daily living.)
2. This policy will be reviewed in the light of new evidence or guidance from NICE.
3. The Oxfordshire Priorities Forum lavender papers can be viewed at www.oxfordshire.nhs.uk/prioritysetting.asp
Thames Valley Priorities Committees
Policy Statement 18b: Gender Dysphoria
Oxfordshire Commissioning Board decision: Approved, December 2006
Date of Issue: December 2006
Gender Dysphoria is a psychological state whereby a person demonstrates dissatisfaction with their biological sex, and requests sex reassignment. Management can be lengthy and expensive and comprises assessment, psychotherapy, real life experience, hormonal therapy and surgery.
• There is a consensus that equitable access to services for initial diagnostic assessment and hormone therapy is needed for those patients fulfilling the Harry Benjamin International Gender Dysphoria Association criteria.
• There is no professional consensus on the classification of core and non-core procedures for gender reassignment.
• There is limited evidence to suggest that gender reassignment surgery is effective. Much of the evidence in favour of or against gender reassignment surgery is of poor quality due to lack of standardised criteria for assessment and management.
• For most gender reassignment surgical (GRS) procedures, several techniques have been described with varying degrees of complications and patient satisfaction reported. In view of the heterogeneity of surgical techniques, outcomes, complications and patient choice, it is not appropriate to recommend any particular technique or procedure. There is particular concern about the clinical effectiveness of some procedures especially phalloplasty.
• There is no published evidence on cost-effectiveness of gender reassignment surgery.
GRS core surgical procedures for male to female patients (MtF) may include Penectomy, Orchidectomy, Vaginoplasty (including hair removal essential for vaginoplasty), Clitoroplasty, Labiaplasty. Core surgical procedures for female to male (FtM) patients are Mastectomy, Hysterectomy, Salpingo-oophorectomy, Metoidioplasty, Phalloplasty, Urethroplasty, Scrotoplasty and placement of testicular prostheses.
The Oxfordshire Priorities Forum recommends that:
1. Patients should be referred initially to a local NHS Consultant Psychiatrist.
2. Access to a specialist tertiary NHS commissioned Gender Identity Clinic for assessment should be via tertiary referral from the local NHS Consultant Psychiatrist.
3. Specialist psychological support and hormonal therapy will be funded provided the above criteria have been fulfilled.
4. GRS core surgical procedures are a Low Priority treatment due to the limited evidence of clinical effectiveness and are not routinely funded.
5. Cosmetic surgery and other non-core procedures such as breast augmentation, larynx reshaping, rhinoplasty, hair removal, jaw reduction and waist liposuction should not be considered as a core part of GRS. Patients who wish to be considered for these treatments should be considered in accordance with the existing policies on Cosmetic Breast Surgery and Cosmetic Procedures.
1. Paranthaman K . Cheong-Leen C. Report for TVPSU: Management of Gender Dysphoria. May 2006.
2. Standards of Care for Gender Identity Disorders. 6th version. The Harry Benjamin International Gender Dysphoria Association Inc. (( HBIGDA )-now>( WPATH )); 2001 http://www.hbigda.org/Documents2/socv6.pdf (accessed 7th February 2006)
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