Transgender 102 for NMNPC

Who is the person in the front of the room?

Definitions: TRANSGENDER Transgender: A term for people whose gender, gender expression and/or behavior is different from those behaviors typically associated with their assigned sex at birth. Transgender is a broad term and is good for non-transgender people to use. "Trans" is shorthand for "transgender." (Note: Transgender is correctly used as an adjective, not a noun, thus "transgender people" is appropriate but "transgenders" is often viewed as disrespectful.) Transgender Man: A term for a transgender individual who was assigned female at birth and currently identifies as a man (sometimes called FTM). Transgender Woman: A term for a transgender individual who was assigned male at birth and currently identifies as a woman (sometimes called MTF).

Definitions: CISGENDER Cisgender: denoting or relating to a person whose self- identity conforms with their sex assigned at birth; i.e. not transgender.

What is sex?

Basic Concepts: SEX Sex (assigned at birth) For transgender people, it’s often important to not use phrases like “biological sex” or “born a boy/girl.” Male Female Intersex (Formerly hermaphrodite)

Basic Concepts: SEX Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex is an umbrella term used to describe a wide range of natural bodily variations. In some cases, intersex traits are visible at birth while in others, they are not apparent until puberty. Some chromosomal intersex variations may not be physically apparent at all. According to experts, between 0.05% and 1.7% of the population is born with intersex traits – the upper estimate is similar to the number of red haired people. "Free & Equal Campaign Fact Sheet: Intersex" United Nations Office of the High Commissioner for Human Rights. 2015.

What is gender?

Basic Concepts: GENDER Gender (internal) Gender Expression

Basic Concepts: GENDER Fluidity: Being Transgender does not mean that you are assigned a label or category or that you wish to conform to the gender binary. Many people, especially younger urban transgender people, are embracing identity terms like genderqueer, gender fluid, bi-gender, tri-gender, etc.

What is sexual orientation?

Basic Concepts: SEXUAL ORIENTATION Gay Lesbian Straight Bisexual Asexual Pansexual

Where do I fit?

My Gender My Sexual Orientation Both Both Gender Expression Gender Sex Assigned @ Birth Male Female Gender Expression Male Female Neither Neither

2015 U.S. Transgender Survey: Facts: THE REALITY National Center for Transgender Equality 2015 U.S. Transgender Survey: Disproportionate discrimination and violence in all areas 30% reported experiencing homelessness at some point 12% within prior year - because of transgender status 3x the unemployment of the general population 4x unemployment for people of color Trans people of color experience the most violence and discrimination (http://www.ustranssurvey.org)

What does this mean to me as a Nurse Practitioner?

Health Disparities One in four (25%) respondents experienced a problem with their insurance in the past year related to being transgender, such as being denied coverage for care related to gender transition. One-quarter (25%) of those who sought coverage for hormones in the past year were denied, and 55% of those who sought coverage for transition-related surgery in the past year were denied. One-third (33%) of respondents reported having at least one negative experience with a health care provider in the past year related to being transgender, such as verbal harassment, refusal of treatment, or having to teach the health care provider about transgender people to receive appropriate care. In the past year, 23% of respondents did not see a doctor when they needed to because of fear of being mistreated as a transgender person, and 33% did not see a doctor because of cost. While more than three-quarters (78%) of respondents wanted hormone therapy related to gender transition, only 49% had ever received it.

Suicide attempt rate for general population vs. transgender population Lifetime suicide attempt rate for general population vs. transgender population 0.6% vs 7% Suicide attempt rate for general population vs. transgender population in the past year (http://www.ustranssurvey.org)

Data Collection Are EMRs and intake forms tracking trans patients? Best Practices on data collection: Two-part gender question Preferred name prominent and respected Pronoun recorded/respected

Data Collection Current practice at Fenway Health: Gender, sex, and transgender identity What is your gender? Female Male Genderqueer or not exclusively male or female What was your sex at birth? Do you identify as transgender or transsexual? Yes No Don’t know

Trans Friendly Enviroments Signs and health-related materials Display photos/ads reflecting gender diversity LGBTQ newspapers, magazines, etc. Single occupancy or gender neutral bathroom Call people by preferred name/pronoun Post non-discrimination policy Include ‘gender identity and expression’ Ensure safety in lobby and parking areas Human Resources forms

Clinical Concerns If you have it, check it Hormone therapy Affirmed woman will still have a prostate gland? Does an affirmed man still have his uterus and ovaries? Hormone therapy Mental health Substance Use/Abuse Suicidality

Important Resources Fenway Institute “Meeting the Health Care Needs of Transgender People” http://www.lgbthealtheducation.org/wp-content/uploads/Sari-slides_final1.pdf Center of Excellence for Transgender Health http://transhealth.ucsf.edu Fenway’s LGBT Health Education Center https://www.lgbthealtheducation.org/topic/transgender-health/ US Transgender Survey 2015 http://www.ustranssurvey.org/report Transgender Health Journal http://www.liebertpub.com/overview/transgender-health/634/

Questions?

Thanks! Contact us: TGRCNM 149 Jackson Dr NE Albuquerque, NM 87108 505-440-3402 adrien@tgrcnm.org