1. Transgender 101
Dr. Jay A. Irwin

2. Outline Learning the Alphabet (LGBTQQIA, etc.)
Examining Transgender Terms
Transgender Identity Development
Transition Steps of Transgender Persons
Transgender Experiences & Struggles
Transgender Supports and Resource Suggestions

3. Language and identity

4. Technical Language Sex Gender Gender Identity Gender Expression
Sexual Attraction
Sexual Orientation
Sexual Behavior

5. Learning the Alphabet LGBTQQIA: Sexual Minority Populations
L = Lesbian
G = Gay
B = Bisexual
T = Transgender
Q = Questioning
Q = Queer
Intersex
Ally or sometimes Asexual
Sexual Minority
Populations

6. The Importance of Language
Language for LGBT individuals is constantly changing
Addition and reclaiming of the term Queer
Especially among youth, new and creative identity terms
Language as a mode of maintaining some power over one’s own life

7. Continuum of Identity
Biological Sex (anatomy, chromosomes, hormones) female intersex male Gender Identity (psychological sense of self) woman two spirit/third gender man Gender Expression (communication of gender) feminine androgynous masculine Sexual Orientation (romantic/erotic response) attracted to women bisexual attracted to men asexual

8. Trans specific terms

9. From http://www.ontoscopy.net/on-my-way-to-the-marketplace

10. Medical Terms Gender Identity Disorder Gender Dysphoria
Old term used by the DSM IV-TR
Problematic term for many trans people
Gender Dysphoria
New term used by the DSM V
Still a lot of disagreement within the community
Mostly these terms are used by MDs and mental health professionals and are largely medical coding mechanisms
Most insurance companies will not pay for things associated with these codes

11. Transgender Terms
Transgender – an umbrella term for people who identify as something other than their birth sex
Transsexual – someone who seeks medical intervention to change their bodies to match their internal sense of gender
Male to female (MTF)/Male Assigned At Birth (MAAB) – a person classified as male at birth, but now identifies as something other than male
Female to male (FTM)/Female Assigned At Birth (FAAB) – a person classified as female at birth, but now identifies as something other than female

12. Transgender Terms
Others include genderqueer, bigender, agender, genderf*ck, etc.
Cisgender – someone who is not trans; someone who identifies with the sex they were assigned at birth; non-transgender persons

13. Transgender Terms Pronouns
Someone who presents as female = feminine pronouns
Someone who presents as male = male pronouns
Could be more complicated:
Someone who presents as female within the housing facility or on their off time, but due to employment needs they work as their birth gender
It is ok to ask someone what pronouns they would like to be called

14. Transgender Terms Gender Neutral Terms
Source:

15. Transgender Identity Development

16. Transgender Development
Transgender individuals often report feeling different at a young age (4-5 yrs old)
“I thought I was a girl, and when we lined up in kindergarten I went to the girls line. I was told ‘go to the other line, you’re a boy.’ That’s how I learned I was a boy.”
“Playing” with gender
Puberty as a time of particular hard realities
Some trans people do not realize their identities until later in life due to social expectations, fear of coming out, and lack of language to explain their internal feelings

17. Prevalence How many trans people are there in the U.S.?
“Official” estimates are 1:30,000 (MtF) and 1:100,000 (FtM)
American Psychiatric Association – DSM-IV-TR 2000
Dutch studies 1:10,000 (MtF) and 1:30,400 (FtM)
van Kesteren et al. 1996
Broader categorization 1:4,500 (MtF) and 1:8,000 (FtM)
Conway 2002
Most recent estimate is around 700,000 trans people in the U.S. (0.3% of the population)
Gates 2011

18. Transition as a process

19. Typical Steps
All persons experience a unique transition experience, but there are some common steps:
Social transition
Psychological care
Hormonal transition
Surgical transition
There are guidelines put out by many organizations
Best known is WPATH – World Professional Association for Transgender Health
Used to be Harry Benjamin International Gender Dysphoria Association
Others include The Endocrine Society, Vancouver Coastal Health, Fenway Health, and American Medical Studies Association

21. Social Transition
Coming out both to one’s self and to friends, family, and co-workers
Can take years for someone to come out to themselves
Typically involves a lot of stress and uncertainty
Will my significant other still love me?
Will my family abandon me or kick me out of the house?
One of the most common reasons for LGBT youth homelessness
Will I be fired?
Coming out is a brave and well thought out step

22. Psychological Steps
Most trans people see a mental health specialist early on in transition
Can happen before coming out to friends and family, or after
Mental health as a “gateway” for other transition steps
Typically at least 3 months of mental health visits
Therapist typically role is to evaluate persistence of identity and to ensure that the person understands the transition process before moving forward, evaluate for co-occurring mental health conditions
Letter of recommendation for further trans-related services and care to a medical provider or surgeon
Care is often out of pocket ($50-$200 per visit)
Not all locations have knowledgeable mental health infrastructures

23. Hormonal Transition
Often trans people want to alter their physical body to match their internal gender
Hormone options:
Testosterone for transmen to masculinize the body
Estrogen and androgen blockers for transwomen to feminize the body
Hormones are the #1 most common medical intervention for trans people
Costly and out of pocket
Black market options available for individuals unable to access hormones safely and legally

24. Hormonal Transition

25. Surgical Transition There is no such thing as “the surgery”
Numerous surgical opportunities depending on many factors
What part of the body
Transwoman versus transman
Availability
Cost

26. Surgical Transition - Transwomen
Many procedures are available:
Breast Augmentation/Top Surgery ($3,000 - $8,000)
Facial Feminization Surgery ($5,000 - $15,000)
Various liposuction procedures ($2,000 - $10,000)
Sex Reassignment Surgery (SRS)/Bottom Surgery ($20,000 +)
Transwomen have to travel to another state or country to get these procedures typically
Virtually no health insurance companies cover these procedures, so costs are out of pocket, thus having a surgical standard for entry into a facility is a heavy burden that many can not meet

27. Surgical transition - Transmen
Multiple procedures available
Double Mastectomy/Top Surgery ($6,000 - $8,000)
Hysterectomy ($15,000 - $25,000)
Sex Reassignment Surgery (SRS)/Bottom Surgery ($5,000 - $21,000)
Transmen have to travel to another state or country to get these procedures typically
Virtually no health insurance companies cover these procedures, so costs are out of pocket, thus having a surgical standard for entry into a facility is a heavy burden that many can not meet

28. Transgender experiences and struggles

29. Identity Documents First step is a court ordered name change
Therapist or other doctor must write a letter stating the person is living “full-time” as their identified gender
Must be notarized
Must be filed with the courts ($15 fee)

30. Identity Documents
Numerous identity documents that have various rules for changing gender markers
Drivers License
AL DL – Doctor’s letter stating SRS surgery has been performed before gender marker can be changed
Birth Certificate
Totally dependent upon which state you were born as some states will never change gender marker
Social Security
Changed birth certificate of letter from physician stating SRS
Health Insurance
More complicated due to various surgeries that could be completed and potential needs of patient
Many trans people have mismatching documents because of the difficulties in obtaining some of the above

31. Violence
Transgender people experience more violence of all kinds than cisgender (non-transgender) persons
Violence from police
Domestic violence
Homicide rates
Estimated 50% higher among trans people than LGB people
Even higher among transwomen of color
Transgender Day of Remembrance
Yearly events held nationwide/internationally to memorize and remember victims of anti-transgender violence

32. Economic Struggles
Due to employment discrimination and anti-trans bias, many trans people experience difficulty obtaining stable employment
Lack of matching identity documents often contribute
Some trans people need to work as their gender assigned at birth, but prefer to live as their affirmed gender when not at work
Transwomen in particular have been found to turn to survival sex work to make ends meet
Lack of support from family/being kicked out of the house for youths
Discrimination by landlords, housing providers, etc.

33. Economic Struggles and Housing
Washington (D.C.) Transgender Needs Assessment Study (2002)
1/3 of trans people earned $10,000 or less per year
29% of respondents unemployed
1 in 4 were satisfied with housing situation
Transgender study in San Francisco (2002)
64% reported a salary of $25,000 or less a year
Over 40% did not have health insurance
1 in 5 did not have stable housing

34. Healthcare Equity
Transgender persons face significant hurdles to accessing competent health care
Refusal of care
19% of persons surveyed by the National Center for Transgender Equality reported being refused care due to their transgender status
Harassment and violence
28% of survey respondents were harassed in medical settings due to their gender presentation, and 2% were actually assaulted in doctor’s offices
Lack of provider knowledge
Most trans people have to educate their providers about their health care needs
Lack of coverage of health care needs
Even things not related to transition often get denied by health insurance companies

35. Marriage and Family
Many trans people come out within the context of a relationship where the partner may not know about the persons gender identity
Stress of potentially loosing a spouse or children
Many families disown transgender family members when they come out
Lack of social support important in face of economic and social struggles

36. Health Disparities
HIV infection higher, especially among unemployed transwomen who have engaged in sex work
Higher rates of smoking, abusing alcohol, or drugs as coping mechanisms to deal with discrimination
High rates of considering or attempting suicide
41% of the sample collected by the National Center for Transgender Equality had attempted suicide, compared to 1.6% of the general population
Delay in seeking care due to concerns about discrimination or ability to pay
Lack of any health care coverage

37. Youth Specific Issues High proportion of homeless youth are LGBT
20-40% estimated
High rates of sexual assault among LGBT homeless youth
High rates of survival sex work among LGBT homeless youth
High rates of suicide behaviors among LGBT homeless youth (one study based in New York City sites 62% for suicide attempts)
High rates of alcohol abuse among LGBT homeless youth

38. Transgender support and resources

39. National Groups World Professional Association for Transgender Health
National Center for Transgender Equality
Trevor Project – 24 hour LGBTQ suicide prevention hotline
National Gay and Lesbian Task Force
Human Rights Campaign

40. Local Support Groups
Alabama Gender Alliance -
Local college based programs/clubs

41. Transgender Homeless Resources
Transitioning Our Shelters: A Guide to Making Homeless Shelters Safe for Transgender People National Gay and Lesbian Task Force Policy Institute and National Coalition for the Homeless
Housing and Homelessness National Center for Transgender Equality.
LGBTQ Homelessness Fact Sheet National Coalition for the Homeless.
– Toronto LGBTQ Services, including homeless outreach

42. Transgender Homeless Resources
National Coalition for the Homeless Resolution, October 2003
“…. Whereas, those people living without housing have the right to decent, safe, affordable and appropriate housing and services, without regard to race, ethnicity, national origin, age, gender identity or expression, sexual orientation, belief, health, disability, or family composition…”
“The national Coalition for the Homeless does affirm and resolve that shelters, transitional housing, group homes or any public and/or private housing must be made available to persons requesting such housing as they present themselves, without discrimination…”
“Note: Abiding by this non-discrimination resolution means that housing, shelter and services are to be made available to individuals according to the gender that the person self identifies as.

43. Questions? Troubleshooting? Ideas for policy?