JULY 2015
Volume 7 Issue 11
LGB AND THE SILENT T
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4 COVER LGB and the Silent T 8 SHANE ORTEGA Has Decided to Take On the U.S. Army
14 Kaleo ramos
An Emperor’s Kuleana
20 laila villanueva
Boy’s Club
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24 Dr. Samuel Hawk
Possibilities
28 family
In-Vitro Fertilization and Spousal Sperm
eXpression808.com to
and have our current issue mailed to you
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spectra By: Mickey Weems
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On June 24, Laila Villanueva and her fiancé Logan Ireland went to the White House at the invitation of the President of the United States for his LGBT Pride reception. Ireland, who is in the Air Force, wore his dress blues. Villanueva, who is in the Army, wore a blue midi with blue lace bodice. They made a beautiful couple, and no doubt won the admiration of Barack Obama when he posed with them for a photo. They were also setting a new trend for trans service members. Regulations dictate that Logan should have been in women’s dress blues (he wore the men’s) and Villanueva in men’s clothing. But there was one catch: Villanueva could not wear her women’s Army dress blues - she is not even allowed to own them.
Their situation reflects the current state of flux concerning public attitudes on trans identities. The transgender community is in transition to full acceptance as legitimate citizens. Anti-discrimination laws extended to the LGB do not quite reach the T, not yet. In this issue, we interviewed Shane Ortega, Kaleo Ramos, Dr. Samuel Hawk, and Laila Villanueva on issues that affect transpeople. The focus of the media recently has been on transwomen but not transmen. To address this imbalance, three of the four interviews for the July issue of eXpression! are with transmen. The gay community’s most visible symbol is the rainbow, the color spectrum from red to violet. But humans actually have at least three
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spectra (plural of “spectrum”): heterosexual to homosexual, feminine to masculine, and female to male. Transpeople cover the three spectra of orientation, gender, and sexual physiology in ways that the LGB does not. In the LGB community, orientation and gender cover identity and self-expression. The T community blows that framework out of the water by including physiology, which is not simply female or male bodies, but everything in between, with the full range of gender expressions and orientations. Many of us still cannot comprehend the idea that someone born with an apparently female physiology might be classified as a straight man. Even more confusing for them is the notion of that same transman being attracted to men (“So why did they change?”), or that somebody who keeps his functioning female reproductive organs could still be considered male. There is also the public’s obsession with bodies that plagued the very first transman, Michael Dillon. In 1958, the press found out about his transition, tracked him down in Baltimore, and threatened to tear his clothes off to see if he had a penis and testicles. That obsession with body parts is still with us in 2015. In the future, it will become increasingly difficult to identify who is trans, whether clothed or not. Doctor Hawk describes hormonal therapies, surgeries, and techniques for growing organs with one’s own genetic material that will allow transpeople to have bodies with typical female/male physiologies. But conforming to the female/male binary is not the goal of every transperson, and there are those who intend to keep the genitalia they had at birth so that they can produce their
own children. This leads to even more variety within the human family: Ortega knows of gay male trans couples in which one partner is pregnant. Regardless of where we situate ourselves in the three fluid spectra of orientation, gender, and sexual physiology, none of us deserves mistreatment on that basis. In his article, Ramos said, “The trans community used to always say ‘LGB silent T’ instead of ‘LGBT’ because they always felt like second-class citizens, as if their issues did not matter.” It is up to all of us to make sure that our trans siblings are rendered silent no more. In the majority opinion of the Supreme Court when it ruled on marriage equality, Justice Kennedy said, “The Constitution promises liberty to all within its reach, a liberty that includes certain specific rights that allow persons, within a lawful realm, to define and express their identity.” Time to extend that same promise to the myriad trans identities as well.
Laila Villanueva and her fiancé Logan Ireland at the White House.
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NO
Stealth
separation
compromise
By: mickey weems | Photos: JTL
Shane Ortega decided to take on the U.S. Army. When his identity as a transman became an issue, the military moved to have him separated, which is code for “dismissed from active duty.” Ortega brought in the American Civil Liberties Union (ACLU) to bring legal action against his separation. He has also became a media spokesman for the trans community, and has been featured in The Advocate, The Washington Post, The New York Times, CNN, the RX Muscle Show, and Outfield on Sirus XM. Even though the armed forces had already accepted out lesbians and gay men into their ranks, there is still a rule against transpeople based on outdated theories that trans identities are psychologically deviant. By this time, the military should realize those theories are wrong, and Ortega was just the man to let them know.
Tell us about the struggle to keep from being separated. Shane Ortega: I first have to pay respects to the transgender military advocates who came before me, especially Monica Helms, who also created the transgender pride flag, 8 | ju ly 2015 - E X P R E SSI O N808.C OM
and my dear friend, retired Navy Seal Kristin Beck. Thanks for coming out and speaking loudly about your experiences.
up at the Pentagon level. These are some of the key actions that took place before the repeal of Don’t Ask, Don’t Tell (DADT).
When I was first informed of possible discharge, I called my lawyer at the ACLU, Joshua Block. He, my military JAG [legal advisor], and I decided to send up a “Hail Mary” [attempting to get something done against all odds] in order to not be separated from the Army. I sent up the letter to the Office of the Surgeon General with the ACLU - the first thing it did was elevate the discharge decision from the company commanders in the Army up to Debra Wada, the Assistant Secretary of the Army.
So what made you enter the media spotlight?
Later on, the Air Force followed suit, and soon the Navy did too. That elevation protects service members from being discharged immediately, just for being transgender. It puts that decision
It was a decision that I weighed heavily. I discussed it with my command, with public affairs, with the ACLU, and my girlfriend beforehand. I wanted to make sure I knew the risk and that it was for the absolutely right reasons. I also wanted to do so with respect for the Army and my chain of command, making sure that what I did was not only professionally done, but did not shine negative light on future transgender people who serve in the military. Many times, marginalized groups are judged by the perceptions of the first of their kind to become popularized. Whatever
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actions I took not only set precedents, but also would educate, proving that there is no “transgender boogeyman” out there to be afraid of. I have no motivations for fame or popularity. I knew that I was in a position to make change happen, so I took it.
I don’t see how you can avoid fame, Shane. You got the look. How much have things changed for the better since you’ve been in the service? The military has made some forward progress, though it is not rapid. The Air Force elevated its separations to their civilian in charge of manpower and reserve, just like the Army did after my letter to the Office of the Surgeon General with the ACLU. The Air Force also allowed Logan Ireland to wear male attire and have male standards, which is a great step forward. [See article in this issue on Leila Villanueva where she talks about her future husband, Logan Ireland.]
But there are no changes across the board yet. The Army has not given any exemptions to those standards for myself or any other service member. However, Major Henry was able to change her gender marker in the DEERS system. [Defense Enrollment Eligibility Reporting System: DEERS is a database of military-related personnel who are entitled under the law to TRICARE benefits.] I too have filed paperwork for that same change.
Is a change in DEERS status enough? If allowed to change my gender marker in DEERS, I could potentially still be separated from the military if found not medically fit for duty due to the lack of male genitalia - the same goes for female genitalia for transwomen.
These regulations apply to cisgender people too, even if they can still do their jobs? Those regulations can be applied to troops who have lost or injured their genitalia in combat. They are usually medically retired regardless of ability to continue serving. Knowing this part about the medical regulations, I make sure to educate for the whole transgender community spectrum in the military. There are many different types of people who could be fit EX P R ESSION808.COM - j u ly 2015 | 11
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for service and they may or may not be binary identified [as female/male]. When I advocate for transgender issues in the military, I make sure not to give a binary hyper-masculine narrative. For example, I was talking to a group of medical professionals about my experience with a military endocrinologist. During the appointment, the doctor was very curious and respectfully asked about my goals for my body. I told him I didn’t want to have a hysterectomy or have sexual reassignment surgery. That would limit my ability to have my own children with my girlfriend who is also a transgender woman.
to include non-binary people. There are some folks out there profiting off of the community, which rubs me the wrong way when most transgender folks are not economically well off. I also highly dislike the embraced term of “stealth” in the transgender community.
What is “stealth?”
For my flight status, I have to have my hormones in the average male range for my age group.
Being stealth, or having to be stealthy about being transgender, means that people have to hide or assimilate due to negative connotations of the transgender experience in their society or community. This may also mean that there is violence or discrimination for people of transgender experience. I understand discretion and privacy. Even I use that. But when we promote stealth as acceptable, we say it’s okay for someone to live in an unsafe and unhealthy environment.
How do things stand right now?
Tell us about Trans4Trans.
I am still working on policies with the ACLU, and Military Freedom Coalition in the Department of the Navy and the Marines for some steps forward on transgender inclusions. One large victory will be the July 1 passing of equal opportunity protections for sexual orientation.
I created a group on Facebook called Trans4Trans to provide a resource for transgender people to meet and establish healthy romantic relationships. My group also caters to LGB and heterosexualidentified members. We have 700 binary and nonbinary members from 12 different nations, and we support existing trans/trans partners and their families. My girlfriend Pina Newman and I actually met via my group on Facebook and have been together for eight months.
In your own situation, what kinds of things are you required to do to fit the Army’s standards?
Could you name some relevant issues you feel should be addressed concerning transpeople? The transgender narrative from the media is of the glamorous lifestyle and attractive gender binary norms. More than 1/3 of transgender people live on less than $10,000 a year. Four out of 10 are unemployed. Most do not have healthcare or insurance. The discrimination against and lack of employment for transgender people, especially transwomen, leads to sex work. There is lack of resources and safe spaces for transgender youth. The epidemic of murders against transgender women of color and definitely the lack of perspective when we are speaking about the trans community. When I say “lack,” I mean that we forget
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I made the group because I am aware of the difficulty of transgender people who have trouble finding a partner that not only doesn’t objectify them, but accepts them as their authentic gender. I’ve heard such things from gay men and transwomen like, “I was attracted, until I found out you were transgender,” or “I don’t like vaginas,” basically reducing me to just genitals. So instead of getting down about it, I created the group for the community that focuses on topics that are relevant to the transgender community such as marriage rights, communication skills, childbearing, et cetera. We do not focus on the prescription of the person such as their medical transition history or whether they are post-op or not.
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An Emperor’s Silent T and the
By: Mickey Weems | Photos: JTL
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Transpeople have been in the news like never before. Caitlyn Jenner came out on television and on the cover of Vogue. Hawai‘i’s own Janet Mock made statements about the movie Aloha, and the drama of transgender rights is unfolding before our eyes.
Kuleana
What better person to ask on these issues than Kaleo Ramos, a man who currently sits on the board of the Legacy Foundation, has worked with several LGBT organizations, is on the forefront for pro-trans and anti-bullying legislation, and who earned the title of emperor?
The Road to Imperial Status
In 2009, Kaleo Ramos became the 28th Emperor of the Imperial Court of Hawai‘i, a charitable organization whose members appreciate royal pageantry, brilliant costume jewelry, camp, and the LGBT community. Becoming emperor was a dream come true for a man who, while growing up, prayed that he would magically wake up in a male body. Ramos never forgot the trauma of those years:
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Starting at about nine years old, I would lay in bed and prayed to God to change me into a boy while I slept so that in the morning when I woke, I would be in the correct body and no one would know the difference. I would never utter my prayers or wishes to be a boy out loud fearing someone would hear me and I would have to face humiliation, so these prayers and wishes were silent. As each day came to an end and night approached, I wished on every first star, picked up every penny as I walked across the surface of the earth, looked under bridges and caves for genie lamps hoping for three wishes, chased rainbows to find the pot of gold, and every other thing that might give me hope for what I really wanted. Ramos married and gave birth to a son, then left that marriage in order to transition. Three years later, he became emperor. This was a crucial moment for him as he transitioned from a private life to becoming an advocate for LGBT causes. When I was first introduced to the community back in 2006, I really had no idea what to expect. I’ve heard many horror stories from others about being part of the LGBT community. Most stories included drugs, alcohol, and partying. I had no idea of my role within this community until I became emperor and discovered that I felt validated and happy in helping others of my community. As Emperor of Hawai’i, I was able to create and implement fundraisers to raise money for others in need, such as people living with HIV/AIDS.
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But he couldn’t afford the crown he wanted. Initially, I wanted a big crown, but I later discovered that my primary role to the community was not to prance around with a crown on my head, but to do as much as I can by working with my hands turned down, working directly with the people. Who knew that, in wanting a big crown, it would lead to me fulfilling my entire reign known as the “Emperor Without a Crown?” Following my reign as emperor, I continued to serve my LGBT community, mainly youth and the trans community.
Recognizing Privilege
Ramos lives to fulfill his kuleana, his responsibilities that have come his way due to the privilege he has gained as a man, as a trans activist, and as emperor. Most people don’t even recognize all the privileges they carry in their daily lives. Privilege come in many forms: race, gender, sexuality, religion, skin color, education, knowledge, height, weight, looks, eye color, upbringing, location, social status, economic status, and the list goes on. Have you ever stopped to recognize all your privileges? Ramos is of Hawaiian and Puerto Rican ancestry. He recognizes the kuleana he carries as Kanaka Maoli (Native Hawaiian), so he is concerned with a statement on the movie Aloha that Janet Mock (who is also trans and Hawaiian) had made from her privileged position as a media personality. Mock weighed in about the movie, criticizing Aloha for appropriating Hawaiian culture and language: “If you are not Kanaka Maoli, you do not get to spread the message of aloha because it is not yours.” Ramos, however, takes a different stance than Mock on kuleana and who gets to use the word “aloha.” In Janet Mock’s statement, the privilege is in being Kanaka Maoli because the word “aloha” is of the Native Hawaiian EX P R ESSION808.COM - j u ly 2015 | 17
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language. It is the responsibility of Native Hawaiians to teach through example and by sharing aloha with others. At that point, the word “aloha” should not be restricted to only Kanaka Maoli, but for everyone to use after understanding its meaning. The spectacular presentation of Caitlyn Jenner (formerly world-class athlete Bruce Jenner) to the world has generated tremendous drama, which Ramos sees as both positive and problematic. I’m generally happy for Ms. Jenner and applaud her courage for coming out to share her authentic self with the public. However, I believe her coming out to the world as transgender was carefully calculated as a means to generate money, ratings, and promote her upcoming reality show. I’m amazed at how much publicity encompassed her coming out while at least 10 transwomen of color were murdered since January of 2015 and received little to no media attention. However, a rich, white, famous woman comes out and the world is captivated and talking about her. I think as a person of her status, it’s almost like an assigned responsibility for her to use this privilege as a platform for speaking on trans issues. The world is watching. Ms. Jenner had a beautiful transition, yet this is not realistic for majority of the population of transpeople. Most transpersons are not able to afford transition-related surgeries to become their authentic selves.
Call of Duty
For his part, Ramos has used his imperially generated superpowers for the good of humankind, especially for the helpless. The introduction of two legislative bills [the birth certificate bill for transpeople and the anti-bullying bill] and learning the key components to how bills move through the legislature was a crash course on the legislative process. Of the two bills, the birth certificate bill passed all the way through to the governor’s desk, while the anti-bullying bill made it all the way until the final committee meeting just before it would go to the floor for the final vote. The anti-bullying bill did not make it through due to budget, however, we are lucky to be in an odd year and able to introduce the same bill this 2016 legislative session. This
upcoming legislative session, I will work with a committee to ensure passage of the antibullying bill and hopefully introduce a trans health care bill to the 2016 session. Ramos talked about meeting with young people of color on what it means to be a man. In addition to working with the youth, he wants to make sure the aunties, older transwomen since the days of the Glades era in Chinatown are given the respect they deserve. I was recently part of a program called the Brown Boi Project based out of the Bay Area in California. Brown bois [young people who identify as masculine] from across the nation, Canada, and Paris met up in Las Vegas in March of 2015 for the biannual Brown Boi Retreat. While at the retreat, we learned about masculinity and how to live as a masculine person of color in a white-dominated society. I left the retreat learning so much more about myself and felt empowered to make big changes in my life. I hope to work very hard on helping our trans youth and “the aunties” correct their birth certificates. The aunties have been waiting long enough to correct their birth certificates and I would like them to progress in age knowing that their birth certificate finally matches their authentic selves. As far as youth, the birth certificate bill will allow youth to register for school as their correct gender, which will ease the confusion that comes with providing services to trans youth.
Non-Trans Kuleana
Ramos feels that the privilege of non-trans people is such that public opinion can seriously affect the lives of trans folks. The kuleana of trans allies is to listen, especially those allies in the gay (male), lesbian, and bisexual communities. The biggest thing is [for allies] to educate themselves on the issues of the trans community so they become better supporters. So often trans issues become second to issues that affect the LGB community because trans folk are the minority population. The trans community used to always say “LGB silent T” instead of “LGBT” because they always felt like second-class citizens, as if their issues did not matter. EX P R ESSION808.COM - j u ly 2015 | 19
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Boy’s C lub By: Mickey Weems | Photos: JTL
Laila Villanueva and Logan Ireland are proud members of the U.S. Armed Forces and the LGBT community. They are also in love with each other. Since Don’t Ask, Don’t Tell was abolished, one might assume that Villanueva and Ireland can be just another military couple and can serve without harassment or fear of losing their jobs. Not yet. Although the situation for transgender service members has improved, there is still no official policy that allows them to serve openly. There is more: The strong machismo of military life tends to be easier on transmen like Ireland than it is for transwomen like Villanueva. Of Hawaiian-Puerto RicanChamorra descent and raised in Hawai‘i, Villanueva is currently stationed at Tripler Army Medical Center. She joined the military to travel the world and for its college benefits. What she did not sign up for was the double standard in the armed services, the country’s biggest Boy’s Club.
Laila, you also joined the Army so you could “butch up?”
Yes. Being an effeminate male 20 | j uly 201 5 - E X P R E SSI ON808.C OM
in my family was frowned upon. I thought that by joining the military I could rid myself of the desire to be a female. I quickly learned that this option was not a wise choice. During my first few years in the military, I found myself on a quest to better understand myself. Identifying as homosexual did not resonate with me, but it was the closest term that I could find. I explored gender binaries by dressing up and impersonating women.
When was this?
I started performing in drag shows in 2008. For the time being, I was satisfied with that and identified as a gay male. But it wasn’t enough. During the summer of 2013, I began hormone replacement therapy. I was well on my way to experiencing womanhood.
Is the military worse for transwomen than it is for transmen?
Absolutely. It is much easier for transmen because masculine lesbians were accepted into the culture years ago, so the likeliness of a transman being caught transitioning would be very minimal. On the other hand, transwomen face scrutiny. Can you take a 6’2” burly, hairy man and change him into
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a woman without anyone noticing? Absolutely, if you come from wealth. But, like most common people, that is a luxury that most transwomen cannot afford.
So the root problem is the culture of hyper-masculinity?
I would agree. The constant stereotyping that certain jobs are for men only and certain jobs are for women only is also a contributing factor. What society needs to understand is that if a person can apply themselves and accomplish a mission, that is the only thing that should matter.
As transpeople in the military, what is the situation that you and Logan find yourselves?
Logan and I have very similar but very different work situations. His unit is completely supportive of him and his transition. My unit is the opposite.
How is your relationship with your superiors different from Logan’s?
Logan’s chain of command is willing to work with him. They acknowledge him and the transition. I was afraid to notify my command of transition in fear that I would be immediately discharged from the military. Even if by some chance I was not discharged, I was afraid that my unit would make it extremely difficult for me. Several friends of mine were discharged for saying that they identified as transgender. I opted to keep quiet and transition silently, hoping that it would not bring much attention to me. I was absolutely wrong.
Regulations forbid males to wear makeup or women’s clothing on base, correct?
Partially correct. AR 670-1 Wear and Appearance of Army Uniforms and Insignia does not specifically state that each gender is prohibited to wear the clothing of the opposite sex. However, the interpretation varies from person to person, unit to unit, and leadership to leadership. In addition, it does state that males are not allowed to wear make up unless authorized for medical treatment. I was walking on eggshells everywhere I went, constantly worrying that someone might see me off-base. I own no male civilian clothes so it’s quite hard to go home EX P R ESSION808.COM - j u ly 2015 | 21
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“I was asked on
multiple occasions to wipe my face with a tissue to prove it. I cannot emphasize how embarrassing the whole experience was, each and every time it happened.�
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and live my life freely when you think someone is watching your every move. And I couldn’t bring the concern to my unit leadership because I felt that it would create an even bigger problem than it already was.
So you didn’t wear makeup or women’s clothing at work. But that was not enough.
As the physical changes to my body became more visible, people would approach me and ask if I had been wearing female clothing on the Tripler campus or if I were wearing makeup. When I said no, I was asked on multiple occasions to wipe my face with a tissue to prove it. I cannot emphasize how embarrassing the whole experience was, each and every time it happened. But to appease the leadership, I followed orders and proved that I was indeed not wearing makeup while in uniform.
So you were repeatedly harassed. Did your critics at least have the manners not to do so in front of others?
A patient that I was assisting referred to me using female pronouns. It was very satisfying to hear that, even in uniform, I was seen as my authentic self. One of the leaders that I worked with walked into the office, and the patient proceeded to say that “She is a good soldier,” referring to me. That leader asked the patient, “Who are you talking about?” The patient referred to me. The leader looked over at me, back at the patient, and back at me. “That’s not a she, that’s a he.” The patient was confused and insisted that I was female. He looked over at me and I apologized, saying, “No sir, I am a male.” I could tell he was still confused, but he continued to say, “Regardless, the soldier did an outstanding job.”
On to something awesome. Tell us about Logan.
Logan, he is my rock. He’s everything a woman could ever want. Such a good man with an extra kind heart. Logan and I met online years ago on OUTSERVE. But it was only at a conference in Houston in early 2014 where Logan and I met face to face. A gentleman always, he spoke eloquently and had a sweet charm about him. We will be getting married in May 2016. Wedding planning is tough, but I am confident that everything is going to turn out beautifully, or at least that’s what Logan reassures me every time I start to stress out about something. We have decided to get married here in Hawai‘i since most of our guests live here already. I seriously cannot wait. EX P R ESSION808.COM - j u ly 2015 | 23
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In a matter of years, most of the cells in our bodies are replaced with new ones. It’s as if we are constantly making ourselves a new body. The intricacy of this internal dance is breathtaking. Imagine, however, if we learned all the steps to the dance. This is exactly what is happening in medicine today, which is good news for people with lost or damaged limbs, failing internal organs, and marred features. It is also important for those of us who are trans. But we are not there yet.
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The issue today for Samuel Hawk has more to do with what transpeople feel they have to do. He awaits the day when social pressure to fit predetermined gender normal standards eventually disappears so that there are no pressures to conform physiologically.
Possibilities
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Doctor Samuel Hawk, a physician who moved to the islands four years ago, agreed to talk with eXpression! in his office at the corner of Beretania and Ke‘eaumoku about what is happening at this moment in medical history for transpeople, and what is on the horizon. The office is a new space for him, and it is still a work in progress as the interior is refurbished according to Hawk’s specifications. The space is full of possibilities: it has beautiful floors and a friendly and professional staff. The location is choice - centrally located on major bus routes and without the hassles for parking that plague downtown Honolulu.
Where We Are Today
“Transgender medical services have changed over the past 10 years,” said Hawk, who expresses himself as masculine and knows from personal experience about the trials that transpeople face. “There are more trans youth entering the picture with either being put on puberty blockers or starting hormone therapy. More clinics are starting to offer transgender hormone services and surgeries. We are only just seeing the beginning of the changes ahead.”
One big issue is hormonal therapy. Hawk is critical of the level of care given to each individual patient: “I have had many patients come to my clinic to continue hormone therapy started at other clinics. It’s very disturbing that many of these people have never had hormone labs drawn to check for the appropriateness of the dose, nor have they been explained the full effects and risks of hormone therapy. All of this can lead to poor patient compliance and poor transition outcomes.”
Hawk recommended individualized treatment, not the cookiecutter, one-size-fits-all approach that held sway in years past: “We are all different for our genetic makeup to our emotional experiences, medical conditions, and social environments. This tends to also be the failing of Western medicine - lack of individualized care. But that environment is changing.”
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All of this change hinges on the goodwill of society. “Transgender is a normal variant in the human population, and as acceptance of the transgender community grows, so will the services and medical research,” Hawk predicted, but cautioned that services “currently are still very poor.”
Surgery has also come a long way. But there are still problems for male-to-female (M2F) transpeople: “Feminizing surgeries are very good,” he said, “but cost and availability of having local surgeons continue to be barriers for all transgender surgeries. We are starting to see the medical insurance companies heading toward covering all transgender therapies, but they still have a way to go.”
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In terms of female-to-male (F2M), Hawk found the options problematic. “Masculine surgeries continue to lag behind feminizing surgeries in outcomes. More techniques continue to be explored for bottom surgery [dealing with genitalia], but they still have high rates of poor outcomes and high complications.” For young transpeople, the earlier the hormone treatment the better. Earlier hormone therapy means more physiological changes are possible (the body is still growing, so it can be more easily shaped) as well as lessening the emotional and social impacts on youth growing up in a body with which they can identify as they mature with their gender-similar peers.
Where We Will Be Tomorrow: The Future in 3D
There have been some exciting developments in 3D technology and genetics that will allow people to grow their own organs, thus avoid problems with tissue rejection since the tissue is genetically theirs. “Medicine has started to test the viability of 3D printers for medical use in organ transplant and tissue growth, which can print organs and tissues from your own stem cells. Hopefully, this will become an option for the transgender community in the near future.” This could, for example, mean the generation of a functional penis for transmen. As per Hawk’s insistence on personalized care, new fields in medicine can help doctors determine individualized treatment for each person’s physiology, down to each body’s genetic blueprint. “With genetic profiling and proteomics [the study of proteins, the body’s building blocks], Western medicine is learning how to specifically tailor medicines and treatment based on a person’s genetic makeup and specific body chemistry environment.” It is possible that, within a couple of decades, transpeople may be able to possess a full range of selforiginating organs and tissues related to sexual physiology. Could it be that a transwoman conceive 26 | j uly 201 5 - E X P R E SSI ON808.C OM
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and carry a child to term, and a transman could father a child? Time will tell. But the issue today for Hawk has more to do with what transpeople feel they have to do. He awaits the day when social pressure to fit predetermined gender normal standards eventually disappears so that there are no pressures to conform physiologically.
What Have We Here?
So far as availability of treatment in Hawai‘i, Hawk felt that things are on the upswing. “There’s a lot on the horizon. Locally, at my clinics Hawk Health, LLC and The Lavender Clinic, we provide a lot of different services. Hawk Health provides full spectrum primary care for adults and kids, gynecological services, Prep HIV, trans-specific services, and others. We will soon be adding laser hair removal, rapid HIV testing, and HIV treatment. The nonprofit Lavender Clinic that I founded this April focuses on transgender services by providing support groups, individual and family counseling open to all communities, and education for healthcare providers.” And it’s not just Hawai‘i that concerns Hawk. “We plan to provide international transgender support to Guam, American Samoa and Tonga.”
One Gender
Hawk believes that multiplicity of identities based on gender has the potential to unite humanity, once we get over old prejudices and fears. “In the more distant future, I hope and anticipate a shift in global consciousness to embrace everyone on the spectrum of gender identity and gender expression.” With that in mind, he has created a new nonprofit called One Gender - Many Expressions. “This is a movement toward eliminating gender identity, gender bias, gender discrimination - a movement in consciousness that we are all one gender. We all do indeed start as one gender in our mother’s womb and emerge in a variety of physiological expressions. This is not the elimination of gender, but the unification of gender - like all the colors of the rainbow coming together to form one color in unity.” EX P R ESSION808.COM - j u ly 2015 | 27
family
In-Vitro Fertilization and Spousal Sperm By: Celia Dominguez, M.D. | Pacific In Vitro Fertilization Institute
There are only a few states that have insurance coverage for in-vitro fertilization (IVF), and Hawai‘i is one. The law requires that insurance plans provide coverage for IVF costs, but stipulates that one of the requirements for coverage is the use of spousal sperm: The patient’s eggs be fertilized with her spouse’s sperm. In lesbian couples, “spouse’s sperm” is nonexistent, and donor sperm is used. This may lead to denial of the IVF mandated coverage to same-sex lesbian couples. Recently, a bill in Hawai‘i is pending to remove the requirements for “spousal sperm.” IVF is an assisted reproduction procedure, which easily can run $20,000. The high cost is secondary to the weeks of coordinated medical care, including: expensive fertility medications, multiple transvaginal ultrasounds to see the development of the eggs, and finally removing the eggs from the female by a needle. To get the
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eggs requires anesthesia, and either a procedure room or an operating room. After the eggs are removed, they are transferred to a specialized reproductive laboratory, which uses specialized microscopes and incubators to watch the embryos’ growth while outside the body. Hawai‘i’s IVF law has been in effect since 1987. This law mandates that Hawai‘i medical insurance plans with pregnancy-related coverage must also provide a onetime only benefit for the expenses from an IVF procedure. Not only is there a “spousal sperm” clause, but there must also be a reason to conduct fertilization outside of the body. The patient and spouse must have had five years of infertility, unless the infertility is associated with the following medical conditions: endometriosis, in utero exposure to diethylstilbestrol (DES), blockage or surgical removal of one or both of the fallopian tubes, or low/abnormal sperm. Some of the Hawai‘i HMO insurance plans actually cover the simpler reproductive procedures. They include diagnosing infertility and the tests involved, and some treatments such as insemination. With the simple procedures, if covered, the plans do not have the “spousal sperm”
family
clause, and do allow the use of donor sperm for insemination. Other plans like some of the PPOs and some private insurance plans do not cover diagnosing infertility or simple treatments such as insemination, and only provide the state mandate of one lifetime in-vitro cycle. Most importantly, Hawai‘i is one of only a few states that is introducing and passing bills focused on families that otherwise would have not been able to afford these costly assisted reproductive technologies. We should all be proud, knowing that some of the Hawai‘i insurance policies have already taken the high road and eliminated a “spousal sperm” requirement. By voluntarily omitting the need of the use of spousal sperm to qualify for benefits, Hawai‘i insurance policies are at the forefront of equal reproductive rights with coverage benefits.
About IVF: With respect to IVF, a single attempt to achieve a pregnancy is called a cycle. Since women who regularly have periods only ovulate about once a month releasing one egg, the first step is the hormonal control of the woman’s menstrual cycle. Then, stimulation of the ovaries with fertility drugs follows with a goal of achieving more than one egg. The IVF cycle usually takes 4-6 weeks of synchronization, coordination, and treatment. Finally, the fertilized eggs (embryos) are transferred into the recipient’s body.
In the case of same-sex lesbian couples, reciprocal IVF can offer an interesting alternative, where one female in the relationship would provide the eggs for fertilization with donor sperm, and the other partner would be the gestational carrier where her uterus would be used for housing the embryo, carrying and delivering the baby. Only time will tell what eventually will be mandated for expanded IVF insurance coverage. It is important to call your insurance carrier to ask about your policy. Hopefully, Hawai‘i will continue to pass nondiscriminatory bills, including those that mandate insurance benefits and access of fertility treatment equally; and expanded coverage for gestational carriers for gay male couples or reciprocal IVF for lesbian couples. Call your insurance companies and know where you stand.
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VISIT SUBARUHAWAII.COM FOR CURRENT OFFERS AND INVENTORY *Applies only to specific models and only for specific model years. APR offers subject to credit approval; not all applicants will qualify. Must purchase/take delivery by 7/31/15. APR offers limited to stock on the lot and will not be applied to backorders. Vehicle selection is subject to availability. Special financing rate on the 2015 Forester available up to $35,000; $16.67 per $1,000 financed for 60 months. Down payment may be required on certain models. Not combinable with any other special financing rates, discounts, rebates, employee prices or other offers. Restrictions apply. Vehicles may not be exactly as shown. See a Subaru Hawaii dealer or visit SubaruHawaii.com for additional details. Offer ends 7/31/15. **$1,000 discount offer good with purchase and delivery of any new or demo 2015 Forester. In stock; No backorders. Not combinable with any other discounts, rebates or any other offers. All vehicles subject to prior sale. Restrictions apply. See a participating Subaru Hawaii dealer or visit SubaruHawaii.com for additional details. Offer ends 7/31/15. 1Claim based on cumulative awards won since 1997 from Car and Driver (5 Best Trucks), ALG (Residual Value Awards), and Polk (Polk Automotive Loyalty Award). 2EPA-estimated hwy fuel economy for 2015 Subaru Forester models. Actual mileage may vary.
EX P R ESSION808.COM - j u ly 2015 | 29
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