The Tampa Tribune from Tampa, Florida • 21

i TAMPA TRIBUNE-TIMES, Saiday, Sept. 1976 jV i Fear Of Breast Rays Said To Be Unfounded conditions, should continue yearly mammograms. And so certainly should women over age 50, the guide- linnc env Some 80 per cent of the women under 50 are at higher risk than others because of family history, on mother's or father's side, or in sisters; because they have never been pregnant; because they have children after age 30; have a history of breast cancer themselves; have chronic cystitis with or without pain; have nipple Transsexual Teacher Arrested Steve Dain, right, stood by his lawyer, Larry Sleizer, as Police Lt. Dave Reno served him with a citation that he was making a "willful disturbance" at a public school or school meeting, a misdemeanor. Snperintendent Lewis Stommel (background) made a citizens arrest in the hallway of the school.

Dain, who was Doris Richards, a tenured Emery Hich School teacher before undergoing a sexual identity, change, was arrested by the superintendent when he appeared for a teacher's orientation meeting at the Emeryville, i 1 Sexual Reassignment Of Transsexuals Make Change To New Life discharge or other abnormalities; have lumps or thickening in the breast, and had begun menstruating early, about age 11, Holleb says. SOME BREAST CANCER detection centers are refusing to go along with the guidelines. Most report a sharp drop in women keeping appointments for mammography. One center director said 45 per cent of cancers detected there had been found in women 50 and younger, and "92 per cent of these were not palpable," meaning they could not be felt. Another physician declared, "I sincerely believe a number of women are going to lose their lives because of the rather extensive publicity" given the guidelines.

The medical debate began after the NCI and ACS had set up 27 breast cancer detection centers. The question rose as to how beneficial mammography had been when it was added to a breast screening program conducted by the Health Insurance Plan of Greater New York, starting in the early 1960s. DR. LESTER BRESLOW, dean of the School of Public Health, University of California at Los Angeles, headed a study on that program. He and associates concluded that study showed no real benefit among women under 50 who had no symptoms, but said there was or could be a hazard from radiation.

Results were good in BY ALTON BLAKESLEE NEW YORK (AP) "There is no reason for women to be frightened about having breast rays," says the medical director of the American Cancer Society. And he cites reasons why they shouldn't be. But a scare over the rays, known as mammography, did follow the recent issuance of official guidelines saying some women aged 35 to 50 shouldn't have routine mammography, meaning once a year, because the radiation might cause as many or more cancers than it detected. "There has been a Women have been staying away in droves from breast cancer detection clinics," says Dr. Arthur Holleb of the ACS.

"Radiologists tell us women are also refusing to have rays to detect possible diseases of the stomach, intestines or chest." THE THINGS WRONG behind the scare, says Dr. Holleb, are: "Radiation" is a panicky word itself. Many women misunderstood what was said after a scientific debate on the risk-versus-benefit from mammography. Many missed the point on how low the risk really is. One of 14 American women develops breast cancer.

This means a woman's risk in her lifetime is 0.07 per cent (when 1.0 equals 100). By one theoretical estimate, an exposure to one rad (a unit of radiation dosage) from a single mammogram would increase this risk by 1 per cent, making her risk 0.0707. It would take 100 mammograms to double the natural risk to 14 per cent, says Holleb. Some scientific ignorance is involved. For no one really knows how much of a dose of X-ray radiation it might take to cause a human cancer.

Some specialists think there is no "threshold," no minimum dose that would be totally safe. Others, say there's no proof of that assumption; that there might be a safe low dose. A reply to them is that they can't prove their point either. THE DEBATE ENDED on the side of prudence not to expose some healthy women to routine mammography, even at risk of missing some silent cancers in their breasts. Thus came the interim guidelines, issued by the National Cancer Institute (NCI) and Cancer Society, interim until other studies are complet centage of applicants and are usually rejected, as are publicity seekers, and people with a collection of psychological problems that they blame entirely on their gender difficulty.

"OUR BEST PATIENTS are people who have led reasonably functional lives despite being very unhappy," said Fisk. He said only 10 to 15 per cent are accepted at first, though some of the others manage to rehabilitate themselves enough to be permitted in later. What about those rejected? Some, said Fisk, find others have less strict standards. Some go abroad, where some surgeons do a brisk business in operations on those who couldn't obtain it in their own countries. Fisk warns that "there are a lot of charlatans in picking up breast cancers among women over 50.

Other studies suggest X-ray doses greater than 100 rad may induce breast cancer in women 10 to 15 patients have been examined by gynecologists who noticed nothing out of the ordinary.) About 40 per cent of the patients willingly reveal their great secret, said Fisk; the others manage to conceal it. This would seem very unlikely in the case of newly made males, but Fisk said they sometimes say' their sex organs are not normal because of some accident; furthermore, the women who marry such men may often be sexually naive, according to Miss Norberg. BREAKING THE NEWS is difficult, and is not best handled as one patient Miss Norberg mentioned: "She told him over the telephone, 'There's something I have to tell He freaked out. It has to be done more subtly than that." By the time they have surgery, many patients have already vanished from their old lives, and afterward Surface elsewhere with a new name, new wardrobe, identification credentials changed to reflect the new gender. The transition often requires help from a lawyer.

Getting birth certificates and drivers' licenses changed is difficult in some states, California being one of them. The Erickson Foundation, which aids transsexuals, said 33 states are now willing to change birth certificates; in some cases the gender is completely revised, while in others the old gender is marked out and the new one added. The Social Security Administration will change its records with a letter of authorization from a doctor, said a lawyer; one patient got a brand new number. The lawyer, who asked not to be identified, helps transsexuals with such problems as well as difficulties with insurers and employers. Many employers, including agencies of the government, have been accommodating to workers who change their sex.

Some have not, and the lawyer said that an employer who fires a worker simply because he or she is a transsexual "can probably get away with it" bejcausQ(4lis not discrimination that is covered by federal Iawii years later, rnis nas neen confirmed, says the NCI, by recent studies of patients treated many years ago with high doses of radiation for mastitis and IB. "The levels of radiation in the detection program are 100 to 500 fold lower than those reported to have caused cancer in the studies cited," the NCI says. Mammography, used with other techniques such as physical examination and thermography detecting cancer through differences in temper- ature compared with normal tissues has been picking up cancers at the detection centers. By RICHARD SALTUS PALO ALTO, Calif. (AP) It is a long and lonely journey across the border of sex, but thousands among us feel they must make the trip.

They are transsexuals, people with the mind of one sex imprisoned in the body of the other. This tragic mismatch can produce a state of misery that drives such people to drastic action: sex change through surgery and a reversal of life styles. Perhaps 3,000 persons in the United States have been sexually reassigned, as doctors call it, mainly in the last 10 years as the surgery has become widely available. At Stanford University Medical Center, one of the most active institutions in sexual reassignment, more than 150 persons have under-gone the hormone therapy and plastic surgery. i' DOCTORS HAVE A hard time evaluating how much transsexuals are helped by the switch, because so many disappear and cut all their old ties.

Nevertheless, the Stanford specialists feel that their patients carefully selected from thousands of applicants have generally been helped. Some feel whole and happy for the first time in their lives, showing "major improvements" in sexual function and psychological adjustment, said Dr. Norman Fi6k. Vocationally there also is some improvement, said Fisk, a Palo Alto psychiatrist and co-director of the Stanford program. Few if any regret what they did, he said, though two patients later reverted to their pre-surgical sex roles.

One did so after an overwhelming religious experience; the other found so much discrimination against her as a woman she went back to living as Z'i man. "Sexual reassignment," as it's called, is currently performed at some 20 centers in 17 states. One of the pioneering institutions was Johns Hopkins Medical School, where sex-change surgery began in 1966. In an evaluation two years ago, doctors were more qualified in their enthusiasm than are their counterparts. ALTHOUGH SOME of the patients did "extraor- dinarily well" after surgery, said a Hopkins report, others did "extraordinarily poorly," falling into self- destructive relationships, drug abuse, suicide attempts.

Drs. Jon K. Meyer and John E. Hoopes said a post-surgical euphoria in many patients drained away two to five years later, as they realized the switch was not a cure-all for personal troubles. "Sex reassignment surgery seems to temporarily palliate an unfortunate emotional state, rather than really cure the problem of gender dysphoria," they wrote.

Gender dysphoria is a term that means of an intense and overriding degree about one's sex. In some persons estimated at one in 10,000 to one in 100,000 births this dissatisfaction is tso strong that there is a feeling of revulsion at pone's own sexual organs and a compelling wish to be of the other sex. These people are called transsexuals. Dr. Renee Richards, the male-to-female eye doctor who stirred up controversy in the tennis world by daring to compete as a woman, expressed the transsexual dilemma: "EMOTIONALLY THE desire to be a woman a girl had been a most overwhelming drive ever since I can remember." ed: Women aged 35 to 50 shouldn't have yearly mammograms if they have no symptoms, such as lumps, discharges or other conditions and no family history of breast cancer.

For them there might be more risk than benefit in detecting early cancer. But women of this same age who have symptoms, or history, or other MORE THAN 250,000 women had been screened at the centers as of late March, about half of them aged 35 to 50. In these younger women, 233 breast cancers were detected. Paid Political Advertisement 1 he transition often requires help from a lawyer, bet on Ivans will make a great legislator!" ting birth certificates and drivers' licenses changed is dinicult in some states. Don Evans grew up in Tampa and now he and his wife, Amy, are bringing up their three children in this community.

They want their children to enjoy the quality 'jk I'fe in Florida that they have enjoyed. That's one of the reasons why Don Evans Unnlc 4a torua in tlA tr'iAr Uir a aI DanMrAHlKti'iiArt this business" but he does not imply that private physicians outside the medical centers are generally unqualified. Hormone therapy and living in the opposite sex role usually begin a year or more before the operation. Dr. Richards, in fact, said her hormone treatments began 12 years before surgery.

IN MALES, THE female hormones help to soften the skin and redistribute the body's fat in a womanly way. At the same time, many patients have facial hair removed by electrolysis. This can take 150 to 200 hours and run into thousands of dollars. Male hormones given to women deepen the voice and bring facial hairs sprouting into mustaches and beards. This is the crucial time when the patient must learn the behavior of the opposite sex and not the stereotypes of the sex.

''We do not want people to become caricatures, but to have naturally masculine or feminine behavior," said Fisk. IT'S ALL PART of a requirement called "pas-sability." Males-to-females have to be able to wear makeup convincingly, walk and act in a feminine way. Sometimes Stanford brings in charm or modeling school teachers to give workshops in social behavior. "It they are not convincing, it's a nightmare," said Fisk. Of course, many women who make the switch are on the short side as men, and males who become women are unusually tall.

If the transition would be ludicrous, the patient is strongly discouraged, as one doctor reportedly did when a 6-foot-7, 250-pound man applied to try the feminine life. Age is not a bar in most cases: Stanford has converted patients as young as 21 and as old as 65. If tendencies toward transsexualism are noticed in children, they are usually treated with psychotherapy, which may be able to reverse the condition in the early years, By the time for surgery, the transition has been largely carried out. "IT IS THE cross-living, and not the surgery, that really causes the transformation," said Marti Norberg, coordinator of Stanford's Gender Dysphoria Program. "The surgery merely confirms what has already happened and the promise of the operation is what motivates the patient to do well in the cross-living." Sex-change operations have come to be accepted by the medical profession in general as a valid procedure, but insurance companies are often reluctant to cover the costs, which may range as high as $7,000 or $8,000.

Some policies exclude such surgery specifically, or label it as an "experimental" procedure that is not covered. The male-to-female procedure is easier and more likely to be cosmetically successful. Briefly, the testicles are removed, the penis is amputated and its skin inverted to line the new vagina, which is created by cutting into the area between the rectum and prostate. Often the vaginal lining produced this way is sensitive enough to allow orgasm. Breast implants of silicone are sometimes added.

THE FEMALE-TO-MALE operation is more difficult, and several methods have been tried. Sometimes the clitoris is inlarged by hormone therapy and freed of its connective tissue to form a small penis. i Another approach is to cut a flap of skin from the abdomen and shape it into a tube. Artificial testicles are implanted. Not all patients can have satisfactory sexual relationships, though Miss Norberg said "orgasm is reported by both male and female" sex change recipients.

Marriage is common after the transformation, with female-to-male patients generally having better, more stable relationships, Miss Norberg said. TO SOME PATIENTS, sex and marriage is not as important as the relief from conflict over identity. "In all our lives, we have to give up some pre' tvuiii IV IIC III IIIC IIUIIUU IIUU9C VI Don Evans is well-equipped to serve as a legislator! He earned a B.S. degree in Business Administration, his Juris Doctorate in law, and worked for 2 years as a supervisor with the Florida Probation and Parole Commission. For the past 10 years he has worked as an attorney, including 2 years as an Assistant Public Defender.

Don will work just as hard for you as he has worked for himself and his family. He has no obligations or commitments to any special interest group. He will always vote in terms of the best interests of Florida and its citizens. Isn't this what makes a great legislator? Think about it and vote for Don Evans on September 7th! Specialists feel their patients have generally been helped and some feel whole and happy for the first time in their lives. ii fi VS" wvv if Is lvW The causes of the disorder are not known, though Fisk believes the answer is to be found in the development of the brain before birth.

"My feeling is that it is a biological abnormali-ty; in animals, there's no question it's biological," tie said. Injections of male hormones into female fetuses have produced masculine behavior Jn the offspring, for example. ii In some cases, an affected child develops cross-Sfgender characteristics. Steve Dain, an Emeryville, high school teacher who became a man through reassignment and is the center of con-' troversy over his attempt to retain a teaching job is an illustration. As Doris Richards, she was woman in most But she had the muscles of a male athlete and enough facial hair to require shaving.

HES PERSONALITY was aggressive and dominating: "I always had to keep it in check and behave more femininely than my real self." i For her, as for Dr. Richards (no relation) and thousands of persons in similar circumstances, the only salvation seems to be to completely live out the sex role that feels natural. There are far more applicants to centers like Stanford than are accepted. Dr. Fisk is one of the specialists who help evaluate and screen out poor surgical candidates.

Psychotics, for instance, make up a small per- The causes of the disorder are not known, but it is believed the answer is to be found in the development of the brain before birth. Marriage is com mon after the trans formation, with female-to-male patients generally ing better, more stable relationships. thing," said Steve Dain, the Emeryville school teacher. "I made a decision that if (living ma-teless) had to be my existence, I'd still rather be male than female." After the change, many patients are so convincingly living their new roles that they can keep their history a secret. This is especially true in male-to-female changes, because the plastic surgery-makes a better resmblance.

(In some cases, such (D) Florida House of Representatives Paid for by the Campaign Fund foi Dsn vans. Richard Chapman. Campaign Treasurer District 67.