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Quoted Intersex Activist Responds

Dear Editor of,

On your web site, I found the following reference to my presentation, Intersexed Adults’ Access to Care.

The keynote speaker at Transcending Boundaries, Emi Koyama, brought up a barrier to care that intersex and trans people both experience: access to SRS. According to Koyama, after age 16, intersex people typically can’t gain access to SRS without going through the same gatekeepers as transsexuals. After that age, insurance companies are also far less likely to cover the costs for intersex people who want genital surgery. This is particularly significant, according to Koyama, because the procedure for vaginoplasty has a 90 percent failure rate as it’s performed on intersex people, typically around age 2, and “the procedure used to be done this way on trans people and it didn’t work on them, but they still do it this way on us.”

While most of the information contained in this paragraph is technically true, I feel that this description distorts the main message of my presentation. I did state in the question-and-answer period that intersex adults who want to have SRS do indeed face the same problem that other people who want the same procedure do, but I am offended that this comment was the only thing you chose to report about my presentation, especially since the main point of my presentation was that we need to move beyond commonalities or common needs if we were to build a true alliance.

As an intersex activist, my main concern is the concealment of intersex existence through secrecy and shame. Surgeries are important part of this picture because they epitomize the society’s desire to keep intersex bodies invisible and shameful, what we are dealing with is much, much deeper than this. Notions of self-determination, while important, doesn’t even begin to address this depth.

What do you feel if you gave a presentation about trans issues, and the only thing gay and lesbian press reported about it was that some trans people are also gay and therefore domestic partnership is a common issue facing gay and trans activists, while completely ignoring your main points about issues specific to trans people? That is exactly what you are doing to the topic of intersexuality in how you summarized my presentation. I am hurt, although not surprised, by such minimalization of our needs and priorities, which I have experienced from other trans activists on a daily basis.

The text of my presentation can be read on my web site. I hope that you will read it again and think about what it really means for intersex and trans people to work in coalition.


Emi Koyama
Program Assistant
Intersex Society of North America

Dear Emi,

Thank you for bringing your concerns about Accessing Health Care, an article I wrote for the Winter 2001 issue of Trans-Health, to my attention. In your letter, you seem to be saying that because I did not write about the main thrusts of your speech— single-issue politics and how they stand in the way of true GLBTI alliance— that I did not have a right to quote you on facts and your opinions on SRS as it’s applied to intersexed and transgendered people.

While I appreciate the points you raised in your keynote speech and agree that continually segmenting the movement divides our efforts and places the greatest workload on those activists who have multiple communities of identity, those points were not related to my article, which was about access to care, nor did they fall within the scope of Trans-Health’s mission, which is to provide information on the health and fitness of transgendered people. I don’t think that focusing on these issues for the purposes of an article is a segmentation of the movement, and I don’t believe that by choosing to focus on what you said about SRS, that I have distorted your message or its context.

Justin Cascio

Editor’s Note: After this email exchange, it came to my attention that Emi Koyama was dissatisfied with my response and felt that I was compounding the problem of trans-intersex alliance. After discussing the issue with the other members of the Trans-Health editorial staff, I would like to add the following remarks.

My original article mentions a point of commonality between transgendered and intersexed people regarding access to care, and this should be evident in the portion Koyama quotes in her email. Clearly, there are enormous differences between the needs of intersexed and transgendered people. In Koyama’s speech, the full text of which is available at the link quoted in her letter, she addresses many of the ways in which the GLBT communities do not meet the needs of marginalized members, including people of color being ignored by largely white organizations, and GLBT communities objectifying intersexed people for the purposes of creating arguments about the non-binary nature of sexual orientation, displaying ignorance about intersex conditions, or conflating intersexed people with transgendered people. What she doesn’t provide, and can’t be expected to have as one individual in a movement, are ways in which these groups could correct their excluding behaviors. By printing Koyama’s letter and my response, as well as providing the link to the full text of her prepared speech (which by necessity does not include the question-and-answer period which followed), I believed I’d done enough to balance the inequity Koyama perceived in my use of her quote about access to SRS.

Trans-Health is a magazine for transgendered people. It seems, based on Koyama’s speech, that we would be in agreement that an organization should not include a group of people in name without following that up with genuine inclusion of the people within that group, and their issues and history. We support and encourage intersexed people who want and need a similar forum for their health and fitness issues to create one. Trans-Health is not intersex-inclusive by design: the issues of trans and intersexed people have some overlap, but the differences are also enormous, and both groups of people deserve forums dedicated to their own needs for health education. Trans-Health does not want to become yet another watered-down GLBTI magazine.

Upon re-reading Koyama’s speech, it appears that she is drawing a parallel between my inclusion of only the portion of her speech that relates to transgendered people and the objectification and false inclusivity of other organizations. I’ve given hours of thought to the matter of whether Accessing Health Care objectifies intersexed people for the purposes of making a point about transgendered people. Although Koyama has made a decision not to discuss this issue further with me, she raises a point worth thinking about.

At this point, I’m not convinced that I have objectified or falsely included intersexed people through writing Accessing Health Care. I hope to retain an open mind on the matter, and to use this opportunity to continue to educate myself on intersex conditions, the treatment of intersexed infants, children, adolescents, and adults, the social, political, and medical requirements of intersexed people, and the intersections of trans and intersexed people’s identities and needs. -Justin Cascio, Ed.

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