ADDENDA Feb. 27, 2004

7. A concerned prospective blood donor, who is not a professional in blood banking, has submitted the following response:

"There is a great deal of confusion, it seems, with your reporting medical professionals on just what transsexuality is and whether this is a cause for concern for blood banks. I would encourage you to first of all discover that transsexuality is, like inter-sexuality, a biological condition. So, a transsexual woman is not a "man who wants to be a woman." A transsexual woman is a woman in a neurologically phenotypic sense, and vice versa. Gender-wise, only "late onset" transsexual women have interacted much in an imposed masculine gender role and few would have sexually interacted with men as "men", and hence would be a concern for the (in my opinion bigoted) blood donation injunction against those who have had "homosexual male" sex.

Most transsexual women, both pre- and post-op have sexual histories not too different from women at large. In fact, as lesbianism is, both anecdotally and by study (Anne Bolin, 1988) a disposition of a large minority of transsexual women, there should be less concern for exposure to HIV in this population. As most transsexual women have no sexual contact with the gay male community, this assessment of risk in the sector is proportionally small and hence invalid (not to mention spurious to begin with). In other words, the comments of some of your members to the effect of limiting access of donations to transsexual women are based entirely on false and bigoted impressions. Once identified as women (socially as well as internally) in the feminine role, transsexual women usually date men, or often women, in monogamous situations according to societal "norms". As such, heterosexual non-transgendered women provide a higher risk for HIV and STD transmission.

Regarding the effects of exogenous estrogens on blood, it is very well established that these conjugated estrogens are of healthy benefit to transsexual women. Taken in large doses pre-op over time periods exceeding 3 years, there is risk to the liver of such patients, but this is due to metabolism of oral estrogens over long periods of time. Post-operatively, transsexual women take hormone replacement therapy (HRT) in line with that of post-ovariectomy women. These estrogens are metabolized in practically similar ways to endogenous estrogens. Such hormone therapy can hardly be called "experimental", having been prescribed by thousands of doctors for 50 years. As the Red Cross itself does not restrict women on HRT from donation, this "risk" seems to be quite invalid, and probably fascetious.

Respondent number 4 would do well to use proper clinical nomenclature in his search parameters - it is "sex reassignment surgery", not "sex reversal". Try looking for "transsexuality" or "Gender Dysphoria" or "Gender Identity Disorder" and one might have more winnings.

Any reasonable analysis would find the effect of a very few transsexual women donating to be on the balance a good, adding to the total blood supply, which your organizations continually trumpet to be in crisis. An analysis based on subjective impressions of risk is unprofessional, unethical, and counterproductive to the needful work of finding able volunteers for blood donation. Any cursory examination of mainstream literature on transsexuality provides a contrast to such undeserved bigotries. As such donation is widely pushed as an act of civic virtue, such biases maintain illiberal constraints upon a phenotypically (and quite probably) genetically predisposed sexual minority. (As an aside, just how does one define "male" and "female" biology? Intersexual conditions are fairly common, both phenotypically and genotypically. Transsexuality is sometimes viewed by sympathetic, educated professionals as a highly dichotomous variant of intersex. Are you willing to write off entire sectors of the populace because they aren't "textbook"? Even though their blood may save lives?) I hope your members revisit and reappraise this discussion, hopefully with more consideration and educated opinions.

The psychologies of transsexual (TS) women reflect very much those of women in general for their societies, despite your ill-informed and medically unlearned impressions of them as "cross-dressed men." I can personally guarantee that many blood banks receive massive amounts of blood from TS women every year (as well as TS men, who you seem strangely unconcerned about as a vector). They do not take kindly to unscientific and patronizing dismissals of their persons as displayed on your website, any more than anyone else. Transsexuality is not an "at risk behavior," but rather a complex physiological condition which, thankfully for you, poses no reasonable threat to blood donation.

On a personal note I would ask you to consider that, at the very least, social gender should be respected in presentation (which is usually contrasted with "natal sex", not "biological gender" as you malapropically presume.) That is, your constant referral to transsexual women as "he" and "him" shows no science, only moralistic bias, and reveals you as completely disrespectful. It would behoove you to change such uses to be in line with a volunteer's presentation, at the very least from a self-interested perspective of good public relations. As your "colleagues" show little understanding of transsexuality as a condition, this may be a futile request, but a needful one. Some of the anonymous addenda in your article relate unethical and arbitrarily discriminatory behavior which could open up such blood banks to litigation. Transsexuals do, believe it or not, at times hold positions of power. Some are even doctors and healthcare professionals. Some even read your own journals. It's obvious to this transsexual woman that some reform is necessary in the blood banking world."

ADDENDA Mar. 10, 2004

8. A medical director at a blood collection center in the Pacific Time Zone of the United States reports that they had a similar situation with a prospective blood donor and consulted CBER for the FDA's interpretation. The blood center was told that if the donor was legally accepted as a specific gender then that is the gender they should use for the sake of donor eligibility screening. It was emphasized that there is no reason to consider the history given by a transsexual or a "cross-dresser" to be any less reliable than that of any other donor. It appeared to the Medical Director that this was not a medical issue, but rather a regulatory one, and CBER dealt with the regulatory aspects, as stated above.

ADDENDA April 28, 2007

9. A director of donor collections wonders if her donor center should accept or defer a prospective blood donor who is a biological male, but in the initial stages of a transgender process. The donor presented to the donor center dressed as a female; the 'high risk history' and 'health history' were otherwise essentially unremarkable. The prospective blood donor will begin hormone therapy and psychological counseling shortly. The donor has been married twice and has several children.

ADDENDA May 22, 2007

10. A transfusion medicine physician at an academic center on the East Coast reports that when she was the Medical Director of a blood center in the late 80s, a member of her donor room staff became suspicious upon noticing a prominent Adam's apple on a well dressed, attractive female who was donating a unit of whole blood. Upon further investigation it was disclosed that the donor had undergone a sex change surgery and hormone therapy. Before the sex change surgery, the individual had been a frequent, extremely devoted male donor with no risk factors including denial of male/male sex. Upon being informed about the aforementioned situation, the East Coast physician decided to discard the donated unit and to place the donor on an indefinite deferral. Now, two decades later, the East Coast physician wonders if there is enough knowledge and reliable testing to take a fresh look at the risks of collecting blood from an individual who has undergone (or who is in the process of undergoing) a sex change, if there are no other risk factors.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator