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Here's a case you won't read about every day.

On or about January 18, 2006, the New York County Family Court granted a Law Guardian's motion for an order directing the Commissioner of Social Services for the City of New York (CSS) to pay for sex reassignment surgery for a 20-year-old male -- Brian L., also known as "Mariah L." -- who is in foster care.  While the Appellate Division, First Department, did not dispute the legitimacy of the surgical procedure, it objected to CSS's failure to delineate its grounds for withholding consent.

Certainly, the appellate court was free to view the agency's conclusory and unsubstantiated denial as "arbitrary or capricious" and a form of acquiescence to the central relief sought. Instead, it opted to question the dispute's "ripeness" and remanded the case back to CSS for further consideration. In its decision, the AD observed as follows:

While the record contains evidence that the operation is the generally recognized successful treatment for gender identity disorder, the record is incomplete, and, therefore, this issue is not yet ripe for determination.

The Commissioner should have provided the Family Court with a clear statement of the reasons for denial of this surgery ... and, consequently, we remand for that purpose ... The appellate arguments supporting the Commissioner's denial are speculative as the record is silent as to any basis or rationale for such denial. Furthermore, the Family Court should determine whether a fact-finding hearing is warranted once the Commissioner articulates the reasons for denying petitioner's request.

According to the "Diagnostic and Statistical Manual of Mental Disorders" or "DSM-IV," published by the American Psychiatric Association, before a patient may be diagnosed with a Gender Identity Disorder, the following elements must exist:

a strong and persistent cross-gender identification, which must exceed the desire for any perceived cultural advantages of being the other sex;

a persistent discomfort about one's assigned sex or a sense of inappropriateness in that gender's role;

the absence of a physical intersex condition (such as an "androgen insensitivity syndrome" or "congenital adrenal hyperplasia"); and

a clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Although the underlying statistics are elusive, anecdotal evidence suggests that thousands of these surgical procedures are being performed each year in the United States.  While the procedure's high cost (reportedly $10,000-20,000) and risks are certainly of concern, researchers suggest that a variety of factors will ultimately determine whether the procedure will achieve the desired end-result. These factors include: the patient's support network (family, friends and employers), psychiatric care, and hormone therapy.

Hopefully, CSS will seriously examine these and other considerations of pertinence and issue recommendations that are consistent with Mariah's best interests.

For a copy of the Appellate Division's decision in Matter of Brian L. v. Administration for Children's Servs., please click on the following link: http://www.nycourts.gov/reporter/3dseries/2006/2006_06302.htm

For a research paper on "Gender Identify Disorders," authored by Professor George A. Rekers of the University of South Carolina School of Medicine, please click on the following link: