The much anticipated 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the renown American Psychiatric Association (APA) continues its misguided tradition of pathologizing gender variance. And they have newly expanded the patient base by including intersex individuals who reject their sex of rearing. Mounting evidence continues to demonstrate that gender is hardwired into our brains at a very early age. Indeed most children know their gender identity by age three and adamantly attest to it; no amount of social pressure, environmental factors or psychiatric persuasion can alter this. For individuals whose bodies do not match their gender identities, the only “cure” (normal variation is not disordered and thus does not necessitate cure) is gender reassignment either by physical presentation alone or aided by hormones and/or surgical modification.

According to the APA, “For a mental or psychiatric condition to be considered a psychiatric disorder, it must either regularly cause subjective distress, or regularly be associated with some generalized impairment in social effectiveness or functioning.” Thus in 1973 the APA concluded that “Clearly homosexuality, per se, does not meet the requirements for a psychiatric disorder since, as noted above, many homosexuals are quite satisfied with their sexual orientation and demonstrate no generalized impairment in social effectiveness or functioning.” It is baffling to me how these same conclusions do not apply to gender variance. Both the homosexual and the gender variant are capable of living full rich lives; only they who deny their inner truth and they who are socially tormented for revealing it are so impaired.

And why include the intersexed? After being surgically modified as infants and subsequently forced into living within the socially imposed system of binary gender roles these individuals are somehow disordered for rejecting this suppression? Apparently the medical community who altered them and inaccurately chose their sex of rearing cannot be at fault. What a travesty it is that the medical community continues to rubber stamp society’s aversion to gender minorities by pronouncing them disordered and thus justifying their mistreatment.

Good news for individuals paying for gender reassignment surgery — it’s tax deductible! So while many still have to pay out of pocket for these procedures, at least the Feds won’t be adding to the costs.

Scott Moore and his husband, Thomas, have decided to follow in the footsteps of Thomas Beatie and Ruben Coronado by going public about Scott’s very much wanted pregnancy and impending delivery in order to raise awareness.

While pregnancy among trans men actually occurs with some frequency it has only recently been brought to public attention. And unfortunately the medical community is often just as startled, befuddled and prejudiced as everyone else.

In the article linked above Scott speaks to the difficulty he had obtaining appropriate prenatal care: “We didn’t want everyone to be shocked when a man turns up to give birth. We found it very difficult to get a doctor and midwife at first. It was hard when people didn’t want to treat me… No pregnant person should be denied healthcare just because they are a man.”

Now granted, a portion of the hesitation Scott encountered in finding a provider was likely related to the lack of established treatment guidelines for pregnant trans men, the inherently increased risks to both father and fetus and the medical-legal liability to be assumed by the would-be provider. Even the standards of care published by the renown World Professional Association for Transgender Health (WPATH) are silent on this issue. But the fact remains that few providers make the effort to educate themselves regarding the medical needs of individuals with atypical gender experience and there has yet to be published even one case report in the Medline (Ovid) primary literature database regarding trans men and pregnancy. Clearly medical providers have a long way to go in meeting the needs of this neglected population.

So what should a trans man considering pregnancy do? First of all, do your research early on and find a provider before you get pregnant. Second, testosterone should be discontinued at least 6 weeks prior to pregnancy in order to prevent its deleterious effects on a potentially female fetus. Elevated levels of androgens like testosterone can masculinize external female genitalia as well as brains with potential social, sexual and gender identity consequences. In the event that an inadvertent pregnancy occurs, testosterone should be discontinued immediately if termination is not desired.