Changing Attitudes Around Transition

Sue MacGibbon Bede Stevens Gender Terms

• Transvestite: [ includes Drag Queens ] Someone who wears clothes of the opposite sex

• Takatapui, Fa’afafine, Fakaleiti: Polynesian terms for a person of male birth sex who lives as a woman

• : [once called Hermaphrodite] People born with genitals which show characteristics of both sexes

• Transgender: People who feel the gender they were assigned at birth does not correspond with their own sense of their

• : A person who decides to live permanently as the opposite of their birth sex

• Transgender Modes: ♂ → ♀ Male to female ♀ → ♂ female to male Recent data suggests 1:30,000 adult males and 1: 100,000 adult females request reassignment surgery

What Is Gender? What is normal?

. Genetic Gender – XX, XY chromosomes

. Physical Gender defined by: A) External genitalia B) Internal reproductive structures

. Brain Gender – The functional structure of the brain along gender lines [well demonstrated by MRI] and studied extensively by the Karolinska Unit of Sweden

. Gender Identity – Our subjective gender. How we feel ourselves to be: male / female or somewhere in-between

. Gender Role – Is Socially Constructed “gender defined by social upbringing”

 Worked with intersex children in the 1950’s. Found the majority (100 of 105 patients) had gender identity consistent with sex biologically assigned and rearing.

 Developed a model to guide gender assignment based on the beliefs that:

. We are psychosexually neutral at birth. . Healthy gender development is dependent on appearance of genitals. . Should not allow doubt as to gender of assignment. . Gender assignment needs to happen before 3 years.

Milton Diamond critiques Money’s schema as too simplistic. Does not account for full range of gender atypical behaviour . Biological predisposition interacts with environmental influences. Individual is not neutral at birth

. Change of gender at any time should be by informed choice

. Healthy gender development is not just related to the appearance of genitals

. Any doubts a child has about their identity should be fully discussed

. Trans-sexuality is a form of inter-sexuality.

DSMIV

Criteria for a diagnosis of Gender Variance

. A strong & persistent cross-gender identification . Persistent discomfort with his or her sex . Is not concurrent with physical intersex conditions . Causes clinically significant distress

. These criteria are criticised for not differentiating between distress that is inherent & that which is socially imposed. “Cross-gender identification may be statistically deviant, that does not make it a dysfunction” (Langer & Martin 2004) Social & Cultural factors

Feminism – gender as fluid and performed

. “It really was years, many years, before I began to realise that the women in my life – the prostitutes as well as the soft, pretty girls who giggled and teased me so much, my several wives and those of my friends – it was years before I realised that they were not women, but men……………I do not mean to say I never knew the physical difference – no one but an imbecile could make such a claim. I took it, without reflection or the slightest doubt, that this was a natural sex that emerged within the society of men, with attributes that naturally complemented masculine attributes……the attributes were feminine and so there seemed no gross misrepresentation of facts to call them (among us men) ‘women’ “. Jack Abbott, letters from prison

. Important to understand what cultural models are available for an individual to understand their experience.

Is

Gender Variance

Pathological? Psychotherapy

. Build therapeutic relationship . Gender history & impacts . Support systems . Family, spouse & children . Safety . & relationships . Triggers for increased cross-gender yearnings . Realistic expectation of changes . Informed consent – side effects . Facilitate real-life experience . Eligibility & readiness . History & management of mental health issues

Guidelines for hormone therapy Adults (Harry Benjamin standards of care)

. Age 18 yrs . Knowledge of hormones, what they can and cannot do & their social / physiological benefits & risks. . Real-life experience of at least 3 months prior to starting hormones or psychotherapy for a minimum of 3 months . Readiness criteria: . 1) Consolidation of identity . 2) Progress in mastering other identified problems (stable mental health). . 3) Likely to take hormones in a responsible manner.

Guidelines for Reassignment Surgery

. Legal age 18 . At least 12 months of hormone therapy . 12-18 months real life experience . Recommended at least 3 months psychotherapy . In NZ require letter from a Psychotherapist / Psychologist and Psychiatric Assessment What We Have Noticed

Clients

Clinicians Community Clients

• Movement toward proactive engagement with the political and medical communities – consulted with around Ministry of Health and DHB protocols. • Recent trend toward younger people presenting at our service. • Clients being better informed. • Clients having stronger social networks for support and information sharing. • Access to influential role models. • Access to the www gives access to conversations, communities and shared stories.

Clinicians

• Greater recognition of diversity within client group. • Movement from clinical rigidity toward individualisation / personalisation of treatment. • Recognition of the persons right to be treated with dignity and respect. • Ongoing conversations around standardisation of diagnosis and treatment pathways. • Increasing awareness of importance of safety [medical, social, intra and interpersonal] Community

. Despite gradually changing attitudes, still stigmatisation and discrimination - ( fear-based ? ). . Consolidation of organised social support, e.g. Genderbridge, Rainbow Youth. . Political ripple effect, e.g. Georgina Bayer, Australian immigration policy re passports. . Move away from stereotypical employment in . . Importance of www in building community and sharing resources.

Resources

. Genderbridge (transgender group) 0800 844 357 . Gender Quest ( Support for young people) www.rainbowyouth.org.nz . Agender New Zealand Inc 0800 243 6337 . Hau Ora Takatapui (NZ Aids Foundation) 09 303 3124 . Auckland Sexual Health Clinic 09 307 2885