TransGenderCare.com : Guidance/Transition : Transgender Magazine interview with Dr. Carl Bushong

Transgender Magazine interview with Dr. Carl Bushong
Transgender Magazine, Issue 85

Dr. Carl W. Bushong, known as "Dr. B." to many, is the originator of a new style of long-distance transsexual and transgender services having helped hundreds fully transition. Since the early 1990's, his pioneering efforts broke the mold of the few remaining gatekeeper-style gender clinics by establishing the progressive Tampa Gender Identity Program which allowed access to a variety of transition services including hormone therapies, electrolysis and guidance to be readily available under one roof. Dr. B. continues to innovate by removing the need to travel great distances for many transition services such as guidance, hormone therapy, laboratory review and recommendation through his web site, doctorbushong.com.

TRANSGENDER TAPESTRY INITIATES A SERIES OF ARTICLES DESIGNED TO FAMILIARIZE YOU WITH GENDER CLINICS IN THE UNITED STATES AND ABROAD. IT IS OUR BELIEF THAT MAKING THE PHILOSOPHY AND METHODOLOGY OF THESE CLINICS PUBLIC KNOWLEDGE WILL INCREASE THE COMPETENCE AND ACCOUNTABILITY OF ALL CLINICS, AND ALLOW THOSE SEEKING HEALTH SERVICES TO FIND, WITH GREATER EASE, A PROGRAM WHICH PARALLELS THEIR OWN IDEOLOGY.

OUR ARTICLE IS AN INTERVIEW WITH DR. CARL BUSHONG OF THE TAMPA GENDER IDENTITY PROGRAM.

DR. BUSHONG, DR. RICHARD MARTIN , AND MS. KIMBERLY WESTWOOD HAVE FOUND SUCCESS IN DELIVERING A WIDE RANGE OF TRANSGENDER SERVICES TO A BROAD GEOGRAPHIC AREA. IT IS THIS CHARACTERISTIC THAT FIRST BROUGHT TGIP TO OUR ATTENTION.

Transgender: Could you please tell us a bit about the philosophy which forms the Tampa Gender Identity Program (TGIP) and the services you offer?

Dr. Carl Bushong: While we perform a number of services here, our real emphasis is quality. By the way, when I say ‘we’ I’m referring to myself, Dr. Richard Martin, our staff physician, and Kimberly Westwood, who performs electrology and make-up consultation.

We’re different because we try to be cutting edge, both in our philosophy and the services we offer: We’re not gatekeepers, I can’t begin to tell you how much I dislike the thought of psychological and medical professionals requiring transgendered gals and guys to prove themselves. One’s gender identity is really immeasurable. I can’t measure, nor can anyone, one’s feeling of maleness or femaleness.

Our internal awareness of gender is subjective. When a transgendered person comes to me, I take that person’s word at face value. And I can’t see any reason why not. For example, when someone has a headache, we don’t say, "Prove it, then I’ll give you an aspirin." The headache is real-and so is the emotional discomfort that comes from not being in sync with one’s gender role. I see that pain, and I see the happiness that comes when things are put right.

The only person who truly knows where and how far to go is the transgendered person, themselves. But even they cannot do it alone-when one has spent decades fooling everyone, including oneself, it is difficult to tell what is true and what is smoke and mirrors. As we need a reflection to see our own face, we need a knowledgeable, experienced helper to see our true self.

In my opinion, a psychotherapist’s role is to be a helper, a teacher, and a guide. To help the transgendered with those areas and conflicts resulting from a lifetime of living a double life, one inside or hidden from others, one out in public. The therapist needs to be a teacher in making available all the accumulated knowledge, skills and choices one has as well as clearing away the myths, lies and misinformation. And as a guide, the therapist aids the client through the social, legal, medical and emotional mine fields toward one’s true self.

It’s hard finding transgender based services, harder finding good providers, and almost impossible finding the gamut all under one roof that’s not a university-based bureaucracy. And that’s where TGIP comes in. We strive to bring together the best, all under one roof, but in a family style setting.

Dr. B: I’d say that on average patients travel about 700 miles to seek services at the Center. But we have patients as close as Tampa and as far as California.

Transgender: What enables you to provide quality care over such a wide area?

Dr. B: While our physical roof is far away for many, we’ve designed a program that gives the maximum in individual care with the minimum of face-to-face contact. Most counseling can be done via telephone and hormonal management is mainly conducted via the mail (lab orders and results, prescriptions, etc.).

And most patients prefer receiving intensive treatment while visiting the Center. There’s just so much involved with successful transition. Providing treatment in drips and drabs is very inefficient, and just takes too long. So, we make a point of providing services in an intensive way As an example, a patient might come here and receive ten to fifteen hours of electrolysis, receive a medical work-up, start/continue hormone therapy and receive counseling from me... all in a period of a couple of days.

This approach to treatment works very well. We realize we have a job to do-and we just do it.

The technology we bring to transgender care. Our electrology facility is a great example. We use state-of-the-art computerized equipment and Kim’s [Westwood] technique is excellent. She’s had more than a decade’s experience strictly with beard removal, and holds both national electrology certifications. Patient comfort along with quick beard removal is her trademark. Kim’s treatment room uses very comfortable hydraulically controlled seating (as compared to the typical flatbed treatment tables), fixed-beam surgical-type lighting (eliminates the ring-light in the patient’s face), and topical pain-control that’s about five to seven times more effective than Emla cream.

But our latest innovation in electrolysis treatment involves the use of nitrous oxide anesthesia. Based on this type of anesthesia, we’ve developed a very comprehensive system that provides virtually painless electrolysis.

Nitrous oxide is the same anesthetic used during surgery. But our equipment is a scaled-down version of what you would find in an operating room. In our setting, the anesthesia machine is comparable to a plastic surgery office or a dental office. And the great thing about nitrous oxide is that it offers much more than just pain control. Psychologically, it’s tough to go through several hours of electrology in one sitting, I know I’d get very antsy sitting in the chair for four, five hours straight. But nitrous takes care of that. It produces a sense of euphoria and time slips by before you know it.

In this type of setting, beard removal is a snap. We are able to provide extensive treatment and permanently clear the face of facial hair in only a few extended sessions-with the patient feeling very comfortable and sedate.

Transgender: You mention plastic surgery. Is feminizing, masculinizing, or sex reassignment surgery performed at TGIP?

Dr. B: We do not have a gender re-assignment surgeon on staff, but instead have affiliations with several surgical providers around the U.S. and abroad who perform a variety of transgender and aesthetic surgeries. I act as a liaison between surgeons and patients, and as a consumer’s advocate.

Dr. B: I help my patients understand the risks and benefits of one type of surgery over another; the results that others have experienced, along with avoiding the hidden hazards.

The hazards usually take the form of undergoing surgery prematurely, or before exhausting other options. As an example, a patient might undergo a surgery when a better solution may be achieved by a drug therapy. A patient who suffers from some male pattern baldness may see their scalp hair return fully as a result of our hormone regimen. Undergoing hair transplants or worse, a scalp reduction prematurely could be disastrous. I help patients look at the overall picture to avoid these types of mistakes.

What can now be done with hormones and various anti-androgens is remarkable. Not only can we now re-grow some scalp hair and retard most, if not all, chest and arm hair, we can give the majority of physical males a true female shape through the loss of muscle mass and the redistribution of body fat. Hips and shoulders change as additional fat forms on the hips, buttocks and thighs, and as a good deal of muscle mass is lost in the upper body. The general appearance of hands and feet become softer, but the underlying bone structure will not change.

Transgender: As the counselor, what do you see as your most important job in helping the community?

Dr. B: My main job is to help each person to first "be themselves," not just the product of society’s or others’ expectations. I call this shift in thinking "finding the natural you," as compared to the normal you (what you are supposed to be or do).

Keep in mind that normal is only the state of being what others expect you to be. And seeking a normal existence instead of a natural one can be a big mistake. Those of us who try to meet other peoples’ expectations instead of our own needs may miss out on true happiness. Submitting oneself to pre-defined roles, for example, may cause a young girl to eventually become a sales clerk instead of, let’s say a professional racecar driver. Or a transgendered person who never really "goes for it" and remains unfulfilled, instead of living in their natural gender role. My second main concern is helping people discover for themselves just how much change is right for them-what to change and what to keep. A self-identified CD individual may make only conservative changes while a TS person may likely go through a complete transformation.

Transgender: I understand from your writings that you do not categorize trans-people as CD, TG, or TS. Why is this?

Dr. B: As I went into great detail in my article, "The Multidimensionality of Gender;" each of us is made up of at least five semi-independent aspects of gender (physical, genetic, brain sex, sexual orientation, and gender identity). Each aspect may be male or female independent of the others. All gender folk begin life with their physical gender and their gender identity of a differing sex regardless of their expression in the other three aspects. But, how and how well an individual handles this condition determines their attitudes and expression. Most people try to be normal (like everybody else) and hide their natural self and later express themselves as CD, TG or TS. Only a minority have the determination along with the right circumstance to say "no, this isn’t me-whatever you see on the outside." Some people call these individuals Primary Transsexuals.

But our gender or sex is an array of many male-female aspects, which mix together to give each of us our own individual "flavor." If we had to give a name to each member of this array we would end up with as many terms as we have individuals. We are, each of us, a matrix of male and female aspects and traits, not a single gender.

Our society’s view of sex or gender sets our gender role to be either exclusively male or female, based on genitals. No variations and certainly no changes are allowed. But while this viewpoint may prevail, it is unrealistic.

And it’s not hard to see that society’s no variation gender mold is unrealistic. Whether we realize it or not, we expect great variations amongst individuals: size, skin color, eye color, general disposition, etc. So variations in gender, too, fit into the scheme of our lives. Not an off/on, black or white expression, but a complicated, individual expression. From my viewpoint, transition is the journey from normal to natural - from what we should be to who we are.

Transgender: You’ve dedicated a lot of your professional career to studying gender and working with the community. How did you develop on interest in gender studies?

Dr. B: I went through a traditional graduate program in psychology at Bradley University in Illinois, followed by an internship at Peoria State Hospital. But shortly afterwards, my life took a very untraditional course. I had been given an opportunity to pursue another internship in child and adolescent psychotherapy in Chipstead, Surrey, England, which is just outside of London.

My second internship is unremarkable in the context of transgender issues. But afterwards I continued to live in London for about the next ten years, beginning in the mid-sixties. During much of this period, London was a remarkable place, setting fire to a lot of the cultural change that later spread worldwide. It was during this period that I became acquainted with several transsexual women. Back then the terms we commonly use today hadn’t been established yet, and transsexualism was poorly understood. But it was clear to me then that there was much more substance behind their motivations than what was documented by the scientific community. I tried to offer as much support as I could. There was little in the way of an infrastructure at the time.

Years later I settled in Tampa, Florida, and began a private practice called Tampa Stress Center, which initially focused on stress management, and individual and couple counseling. Soon after starting my practice, I began focusing on gender issues and differences, and several of my patient-clientele were gay and lesbian individuals and couples. Later I began counseling several gals who worked as female impersonators at a couple of the local gay clubs and began working with physicians to further help my transgendered patients. As the years passed, crossdressing and crossliving issues became a central focus of my practice, as well as my professional interest.

Transgender: I see Tampa Gender Identity Program listed on the web, on your written materials, etc. But why is Tampa Stress Center listed on your signage instead of Tampa Gender Identity Program?

Dr. B: Most people find a comfort zone with our original name, Tampa Stress Center, and appreciate walking through an entrance door that isn't marked Tampa Gender Identity Program. Who needs an additional obstacle in seeking help? Tampa Stress Center is Tampa Gender Identity Program, and people know that.

Transgender: You've had a long-term association with Kimberly Westwood and collaborated on a number of projects. Tell us some of your favorite projects that you two have worked on over the years.

Dr. B: First, besides her involvement with TGIP, Kim manages her own company, Nu-Woman, which is a transgender-based business providing videos, her own specialized line of formulated cosmetics for the TG community, and related products. She also has a web site called Nu-Woman Transgender Cabaret located at www.nu-woman.com. It's a great online resource for the community.

Our first project was the Splendor of Gender Conference, which drew nationwide attendance by both transgendered individuals and treating professionals alike. The Splendor Conference focused on the gamut of available treatment. We were lucky to have Dr. Schrang discuss his surgical techniques, along with other providers discussing hormones, psychology, electrology, and related treatment methods.

In preparation for the conference, Kim and I coordinated with our state's psychological services board so we could provide continuing education credit to mental health providers in attendance. Since the Splendor Conference offered continuing education credit, many mental health providers who may not have attended otherwise took the time to learn more about transgender care.

We are very proud of the Splendor Conference. It was the first of its kind to educate so many mental health professionals towards the needs of the transgendered patient. Splendor also provided the trans-community with a great opportunity to learn more about themselves as well as to become informed health care consumers in the process.

Kim and I also collaborated on three videos produced by Nu-Woman. Our first video project was The Operation, which featured the sex reassignment surgical procedures of Eugene Schrang, M.D. We released the video in 1995, and immediately it received a great response. It has been, literally, distributed worldwide. And like Splendor, The Operation was a first of its kind, providing true professional production quality, digital editing, digitally mastered audio, and the list goes on. Not only was there nothing available on the subject up until this point, but I believe The Operation set a higher standard for transgender-based productions.

We then worked on Making Up Is Not Hard To Do!, which features Kim showing makeup techniques. Kim is well-trained in makeup and skin care techniques. She gives the viewer a makeup lesson that takes into account the special needs of the transgendered gal.

Our final effort was a video called Electrolysis…Permanent Beard & Body Hair Removal. It provides an in-depth look at electrolysis treatment, and shows how to avoid poor methods that can produce effects like pitted scarring. This video met a real need. Did you know that training and professional licensure for electrologists is only required in about half of our fifty states? And many electrologist's practice techniques, that while acceptable for a genetic woman, may produce very bad results on the coarse facial hair of a transgendered patient. Nothing like it was available before, and to my knowledge no one else has produced anything since. Some treating electrologists have gone as far as showing the video to their transgender patients as an educational aid.

Dr. B: We’re currently designing a new web site exclusively for TGIP. It can be reached at www.transgendercare.com or www.tgcare.com. We hope to have a good deal of treatment-based Information at this site, including a TG Consumer Reports styled area. Kim is also looking into producing a CD version of some of our work. The CD is in the early planning stages, so I can’t tell you more.

Transgender: We look forward to seeing your new offerings, and thank you for your help inaugurating this new series.