What would we like to change in the SOC?

[mounds_dont]

I am trying to get more involved in my state's politics. One of the things that I have found, is that statements with lots of words and little content abound. It is almost a requisite. Nobody wants to be the person seen taking "sides". They leave that for other people, while they remain quietly "neutral". After all, a politician's main focus is to keep their seat.

Having said that, we here at the NEA (New Eunuch Archive) have taken sides just by being here supporting the community. So, we have a vested interest in the SOC 8, and how it applies to us. How well do we understand the SOC 8? What are our "hot button" issues, and how are those (not) covered in SOC 8? How would we want to alter the SOC 8? What did they get right? What can be changed to benefit everyone, not just our niche? How can we make or propose the changes without alienating WPATH? How do we work within their organization?

I saw some discussion about getting a seat at WPATH's table. I don't know how to do that, yet. I don't even know if that is what we want. I would be happy to get an invite to their general meetings, so I can network. There is so much I need to learn about how WPATH is organized, before I can even think about membership or participation. What I do know, from my experience in politics, is it takes persistence, patience, and adaptability. Nothing will happen fast and there is no direct route. In the political arena, there is a fair amount of "Credentialism", or a dependence on "experts" with framed diplomas filling office walls. It is possible to earn credentials, by gaining credibility. Notice the same root etymology?

Shall we begin?

As I see it, Chapters:
Chapter 4—Education
Chapter 5—Assessment of Adults
Chapter 6—Adolescents
Chapter 7—Children
Chapter 8—Nonbinary
Chapter 9—Eunuchs
Chapter 12—Hormone Therapy
Chapter 13—Surgery and Postoperative Care
Chapter 15—Primary Care
Chapter 17—Sexual Health
Chapter 18—Mental Health

All impact the Physical and Mental health of Eunuchs. Understanding these chapters and how they affect us, will go a long way toward how we can give voice to our position on SOC - 8 as a whole. That understanding may answer some of our questions or may spur us on to ask other questions.

[WheelyFixed]

In the recent thread about the WPATH response to the Executive Order about gender care for minors, WPATH Statement Regarding Executive Order viewtopic.php?t=187, mounds_dont made an excellent post about the question of what sort of changes we might like to see in future revisions of the SOCv8, and how to work towards making them...

I feel that this is a very important question and is only slightly relevant to the WPATH statement, so I'm using my "Magic Moderator Powers" to start up this topic and move his post to it so we can have a separate discussion about it...

WheelyFixed

[NaturalEunuch]

Regarding the Eunuch section, SOC-8 makes four main statements.

Statement 9.1.
We recommend health care professionals and other users of the Standards of Care, Version 8 guidelines should apply the recommendations in ways that meet the needs of eunuch individuals.

This section is fine but needs updating.

Statement 9.2.
We recommend health care professionals consider medical intervention, surgical intervention, or both for eunuch individuals when there is a high risk that withholding treatment will cause individuals harm through self-surgery, surgery by unqualified practitioners, or unsupervised use of medications that affect hormones.

This section is also pretty much fine.

As far as our new Eunuch Archive is concerned, I think we should be able to freely discuss cutters and various genital ablation techniques. These methods are dangerous should be discouraged but since this is one of the main reasons doctors will agree to do castration procedures safely, having threads on these issues makes sense to me.

Statement 9.3.
We recommend health care professionals who are assessing eunuch individuals for treatment have demonstrated competency in assessing them.

How are health care professionals supposed to gain competency in assessing and treating eunuchs? Having a eunuch as a patient is pretty rare and there are no books on eunuch health that I know of. WPATH needs to create specialized educational materials addressing this.

Statement 9.4.
We suggest health care professionals providing care to eunuch individuals include sexuality education and counseling.

To me, this is not that important. People will figure it out.

[mounds_dont]

Regarding the Eunuch section, SOC-8 makes four main statements.

Statement 9.1.
We recommend health care professionals and other users of the Standards of Care, Version 8 guidelines should apply the recommendations in ways that meet the needs of eunuch individuals.

This section is fine but needs updating.

I agree, NE. I think this statement could be made stronger through thorough definitions. Explaining what eunuch's basic needs are as examples, but not a complete enumerated list would be a good start.

Statement 9.2.
We recommend health care professionals consider medical intervention, surgical intervention, or both for eunuch individuals when there is a high risk that withholding treatment will cause individuals harm through self-surgery, surgery by unqualified practitioners, or unsupervised use of medications that affect hormones.

This section is also pretty much fine.

As far as our new Eunuch Archive is concerned, I think we should be able to freely discuss cutters and various genital ablation techniques. These methods are dangerous should be discouraged but since this is one of the main reasons doctors will agree to do castration procedures safely, having threads on these issues makes sense to me.

To that end, they need to establish a solid reliable pathway to an end result that will satisfy patients' needs. This includes MtF, FtM, as well as eunuch and Female eunuch patients. By including the entire community, we can make a stronger argument than if we present ourselves as a small subset of a small subset of people. I like where your head is at on this issue, NE.

To address the larger community, and alarming number of people choose suicide as a viable option. A solid reliable pathway where patients' needs are addressed, would help the entire community.

As long as we keep our discussions about cutters grounded in reality, I have no problem with talking about them. I will NEVER recommend someone go to a cutter... EVER. We all hear about the ones that are butchers. I am sure there are good ones out there, but to be honest, I would like to put them out of business by mainstreaming Orchiectomies to the same degree we have gender reassignment surgery. With the same insurance benefits as well.

Statement 9.3.
We recommend health care professionals who are assessing eunuch individuals for treatment have demonstrated competency in assessing them.

How are health care professionals supposed to gain competency in assessing and treating eunuchs? Having a eunuch as a patient is pretty rare and there are no books on eunuch health that I know of. WPATH needs to create specialized educational materials addressing this.

That is the big catch 22. I think what they need to do, is start evaluating the current eunuch community in studies. Not questionnaires, but phone interviews or in person evaluations. Medical studies so they can understand both our physical and mental health challenges. Anything they can to figure out just how much "individual results may vary" can actually vary.

Statement 9.4.
We suggest health care professionals providing care to eunuch individuals include sexuality education and counseling.

To me, this is not that important. People will figure it out.

Both before and after procedures. What do you do with a newly minted eunuch? How many of you out there had a "normal" post op experience? Does anyone know what normal is? How long did your body take to establish the new normal? All of these questions could be answered with more than a 1 week check up with doctor XXX.

[WheelyFixed]

To start off, this is MY take, personally not as a mod... As a reminder, I was one of the early folks to get fixed entirely based on SOCv8, so have seen it from the patient end....

One of the things I'd like to see as a key change is to make a more clear distinction between those of us wanting to do M->E transitions as opposed to those wanting to do the full binary M->F switch... While there are some good medical reasons that castration is a good intermediate step on the M->F transition path, there are a lot of us that aren't on that path and have no interest in becoming female.... (I'm not discussing those on the F->M path since they don't fit into the M->E profile, even though they somewhat end up in our camp...)

I think it is reasonable to say that anyone wanting to do the full M->F switch is doing so because they aren't happy being male with male 'factory equipment', and have a desired "end state" of presenting as female...

But there are lots of reasons to want to get fixed and enter the eunuch camp, and many don't necessarily involve a dislike of being male, or having male bits (certainly some do...) Some may desire to be castrated WITHOUT necessarily assuming a "Eunuch Gender Identity". But the SOCv8 chapter 9 starts out saying it is focused ONLY on those who "identify as eunuchs" .

One can ask 'What is a Eunuch Gender Identity?" to begin with... I got asked during my psych eval. about transitioning into 'living as a eunuch' and was very puzzled about what was supposed to be different about that from living the same way I had been.... I present as male, and don't tell anyone other than my GF and medical care people, as I don't think it's anyone else's business...

I was also far from thrilled by having to let them stick me with a psych diagnosis at my first appointment as a prerequisite to getting further care.

It also seems like this limits access to only those with the "right" reasons - it should be far more open to being 'informed consent' not "must convince the shrinks". I think separating out the 'want to be castrated' from the 'want to become female' would be a good step in the right direction.

There are other changes I'd like to see, but they pretty much all involve making access easier and faster

WheelyFixed

[WheelyFixed]

As far as our new Eunuch Archive is concerned, I think we should be able to freely discuss cutters and various genital ablation techniques. These methods are dangerous should be discouraged but since this is one of the main reasons doctors will agree to do castration procedures safely, having threads on these issues makes sense to me.

A quick clarification - We do NOT prohibit discussion of cutters and other DIY techniques as such, though we most definitely don't want to sound like we are recommending or encouraging them. As stated, they are dangerous and should be discouraged...

What IS prohibited is OFFERING cutter services, or LOOKING FOR a cutter (as opposed to a qualified MD).... We don't want to be helping connect cutters and clients, but pretty much anything else is fair game.

Discussions of having used a cutter, or news stories involving cutters are mostly OK, as long as it isn't feeding the media trolls.

There were incredibly long threads on EAv2 about alcohol and calcium chloride injections, including what to use, doses, procedures, etc. I'd have no problem with those threads continuing while advising against using those techniques. There were other threads about various other techniques as well, again not a big problem. It would be tempting to want to prohibit the question of where to get supplies and equipment, but that isn't really practical given the existence of large rivers and the bay of e, among many other sources...

As long as we keep our discussions about cutters grounded in reality, I have no problem with talking about them. I will NEVER recommend someone go to a cutter... EVER. We all hear about the ones that are butchers. I am sure there are good ones out there, but to be honest, I would like to put them out of business by mainstreaming Orchiectomies to the same degree we have gender reassignment surgery. With the same insurance benefits as well.

A great summation, and I think a big part of what this thread is all about...

WheelyFixed

[wanasoso2]

I was also far from thrilled by having to let them stick me with a psych diagnosis at my first appointment as a prerequisite to getting further care.

I agree that is not a walk in the park to explain deep feelings in the process of a psych diagnosis. But I think it is an important step for many people who may actually get easily confuse with profound mixed feelings. Everything associated to sexual and gender expression and behavior is very complex and cannot be reduce to simple concepts. Years ago I felt uncomfortable with myself and having the feeling that I should do a M to F transition. Consulting a sex therapist we came to the conclusion that I was let say "built" with a fragile masculinity. It explains many things and behavior where a transition to F is not the solution. It opens my understanding on myself and now I am working on defining a new way of life where castration could be an option. Start with a 100 wanabees and for everyone you'll find different dark or secret places that could mislead their evolution. Castration is a very serious decision to manage and one should be well prepared with some support to end up in an happy journey.

[Nulloguy]

There is certainly room for improvement. However, what will be said in this forum, and what will be accepted outside of it for the purposes of SOC will be vastly different. All I'm seeing in this at the moment is a bunch of whining, if I'm blunt. It's not as if a lot of what you're saying wasn't considered, but you also need to keep in mind you have a significant headwind pushing at you.

At the moment, you all should be more concerned about getting SOC 8 more widely implemented before you start talking about editing it. But, people will do what they'll do and find out the hard way, I guess.