obstacles to medical information and care for transgender populations John Otto LIS 528 March 9, 2006

trans terminology transsexualism defined… Up to Date Up to Date “Transsexualism is the condition in which a person with apparently normal somatic sexual differentiation of one gender is convinced that he or she is actually a member of the opposite gender. It is associated with an irresistible urge to be that gender hormonally, anatomically and psychosocially.” “Transsexualism is the condition in which a person with apparently normal somatic sexual differentiation of one gender is convinced that he or she is actually a member of the opposite gender. It is associated with an irresistible urge to be that gender hormonally, anatomically and psychosocially.” Stedman's Online Dictionary Stedman's Online Dictionary “the desire to change anatomic sexual characteristics to conform physically with one's perception of oneself as a member of the opposite sex” “the desire to change anatomic sexual characteristics to conform physically with one's perception of oneself as a member of the opposite sex”

trans terminology Transgender as umbrella term Transsexual Transsexual Transgenderist Transgenderist Cross dresser Cross dresser Transvestite Transvestite Drag queen / drag king Drag queen / drag king Gender queer Gender queer transperson transperson Transgender as non-umbrella term original meaning Gender vocabulary is highly inconsistent and evolving

trans terminology

Sexual orientation vs. gender identity Two different things Two different things Transpeople may or may not come from gay/lesbian background Transpeople may or may not come from gay/lesbian background Gay/lesbian/bisexual people do not need medical treatment to be GLB Gay/lesbian/bisexual people do not need medical treatment to be GLB Transsexuals dependent on medical system Transsexuals dependent on medical system M to F = transwoman, female pronouns F to M = transman, male pronouns

DSM-IV Diagnostic and Statistical Manual IV Gender identity disorder Gender identity disorder Gender Identity Disorder (GID) in adolescents and adults (302.85) Gender Identity Disorder (GID) in children (302.6) Gender Identity Disorder Not Otherwise Specified (GIDNOS; 302.6) Transvestic Fetishism (302.3) Controversy over GID inclusion in DSM

Christine Jorgensen

Prevalence of transsexualism 1 in 11,900 for MTF 1 in 30,400 for FTM Trans advocates numbers are off numbers are off likely FTM and MTF are roughly even in numbers likely FTM and MTF are roughly even in numbers FTMS less likely to be visible Health care and research focus on MTFs

HBIGDA Harry Benjamin International Gender Dysphoria Association professional organization devoted to the understanding and treatment of gender identity disorders professional organization devoted to the understanding and treatment of gender identity disorders 350 members - medicine, psychology, law, social work, counseling, psychotherapy, family studies, sociology, anthropology, and sexology 350 members - medicine, psychology, law, social work, counseling, psychotherapy, family studies, sociology, anthropology, and sexology Standards of Care Standards of Care

HBIGDA Standards of Care Treatment guidelines Treatment guidelines guidelines guidelines sometimes applied rigidly sometimes applied rigidly only 9 of 19 clinics adhere completely to the SOC only 9 of 19 clinics adhere completely to the SOC International influence International influence Offers protections to health care provider Offers protections to health care provider

Obstacles to medical treatment Lack of health provider knowledge Lack of health provider knowledge patients usually must educate providers patients usually must educate providers Small groups of “experts” in urban areas Small groups of “experts” in urban areas Rural areas – often no treatment options Rural areas – often no treatment options Transpeople lumped in with LGB minority within a minority minority within a minority rejected by larger LGB minority rejected by larger LGB minority different issues than LGB different issues than LGB Health research, policies, and materials usually do not mention transpeople Fixation on SOC and DSM-IV

Obstacles to medical treatment discrimination & bias toward transpeople discrimination & bias toward transpeople Health care discrepancies Health care discrepancies Recurring theme in literature Social marginalization Social marginalization 60% - harassment or violence Discrimination & insensitivity in treatment setting Economic marginalization Economic marginalization Employment discrimination 37% - economic discrimination Lack of insurance High proportion of MTFs turn to survival sex work Lack of insurance coverage Lack of insurance coverage Medicalizing lives  institutional negative attitudes

Obstacles to quality research methodological methodological Hidden population Hidden population Expensive Expensivehomophobia too sensitive too sensitive too “exotic” too “exotic” High proportion of MTFs turn to survival sex work High proportion of MTFs turn to survival sex work

Patient information needs Grassroots self education Web-based resources Web-based resources Trans organizations Yahoo groups Individual’s websites Hudson’s FTM Resource Guide Hudson’s FTM Resource Guide Transactivists acquiring professional credentials Transactivists acquiring professional credentials Nick Gorton, MD – Jamison Green

Web resources King County Public Health website LGBT Health Channel Transgender Health webpage National Coalition for LGBT Health website HBIGDA