Cultural Competency in the LGBTQ Community Cultural Competency in LGBTQ Healthcare
Focus on Transgender Cultural Competency in LGBTQ Healthcare
Definitions: Biologic sex = sex assigned @ birth Gender identity Gender expression Transgender Cis-gender Cultural Competency in LGBTQ Healthcare
Definitions: Biologic sex What’s between your legs Never unclear ? UNLESS Disorder of Sexual Development
CONGENITAL ADREAL HYPERPLASIA ANDROGEN INSENSITIVITY GONADAL DYSGENESIS 5-Α-REDUCTASE ANORCHIA MOSAICISM HYPOSPADIAS UNUSUAL CHROMOSOMAL SEX PERSISTANT MÜLARIAN DUCT SYNDROME MICROPENIS CRYPTORCHIDISM Cultural Competecny in LGBTQ Healthcare
Differences of Sexual Development Chromosomes Hormones production or action Genitalia are ambiguous Gonads (ovaries or testies) may be different Cultural Competency in LGBTQ Healthcare
Definitions: Biologic sex = sex assigned @ birth Gender identity Gender expression Transgender Cultural Competency in LGBTQ Healthcare
Gender identity What your brain knows Identify as male or female? In between states
Cultural Competency in LGBTQ Healthcare
Definitions: Biologic sex = sex assigned @ birth Gender identity Gender expression Transgender Cultural Competency in LGBTQ Healthcare Definitions: Gender expression – what you show on the outside Dress – clothes, hair, makeup Mannerisms – gestures, walking, Traits Speech Play Traits Cultrual Competence in LGBTQ Healthcare
GENDER EXPRESSION: STARTS AT A YOUNG AGE
PLAY:
BOYS GIRLS PLAY WITH TRUCKS PLAY WITH DOLLS ROUGH AND TUMBLE GENTLE AND QUIET PLAY ARMY AND WRESTLE PLAY SCHOOL AND TEA PARTY Cultural Competency in LGBTQ Healthcare
TRAITS
Masculine traits: Purposefulness, independence, self-confidence, self- reliance, adventurous, assertiveness, self-discipline, determination, endurance, leadership skills, courage, loyalty, persistence, decisiveness, rationality, inventiveness, ambitious, dependability, provider, worldly view. Cultural Competency in LGBTQ Healthcare
TRAITS
Feminine traits: Compassion, empathy, intuitiveness, cooperation, communication, kindness, calmness, thoughtfulness, graciousness, warm-heartedness, emotionally expressive, able to be happy for others, sustainer, peacemaker, gentleness, patience, nurturing, helpfulness, open mindedness, empathetic, neatness, attentive to detail, creativeness, life giving, sexual fidelity. Cultural Competency in LGBTQ Healthcare
Definitions: Biologic sex = sex assigned @ birth Gender identity Gender expression Transgender Cultural Competency in LGBTQ Healthcare
Transgender – denoting or relating to a person whose self-identity does not conform unambiguously to the gender assigned to them at birth. Cultural Competency in LGBTQ Healthcare
Gender Gender Transgender non-binary Congruent
act Prevelance Estamited to be about 0.5% or one in 200 based on a recent study by the Williams Institute That makes 1,400,00 in the USA Somewhere between the size of Charlotte and Phoenix ?Etiology? . Cultural Revered in Native American . Genetics Family clusters Autistic children . Hormones in utero Prenatal androgen/estrogen . Biological Brain differences . Environmental No evidence for relation to parenting Cultural Competency in LGBTQ Healthcare
Why does this happen only in humans? Cultural Competency in LGBTQ Healthcare
It Doesn’t! Cultural Competency in LGBTQ Healthcare
What transgender is not Cultural Competency in LGBTQ Healthcare What transgender is not Sexuality • Transgender people are like everyone else • A trans-male attracted to females if heterosexual • Can be hetero sexual, gay/lesbian, bisexual or asexual A disease: you can’t catch transgender! A choice Cultural Competency in LGBTQ Healthcare
Ways to express your gender identity when it’s trans? Only you (or close loved ones) know Dress in the gender with which you identify Take hormones Have surgery Cultural Competency in LGBTQ Healthcare World Professional Association of Transgender Healthcare WPATH Standards of Care Cultural Competency in LGBTQ Healthcare DSM V: Gender Dysphoria in Children: o Consistent, Insistent and Persistent o Simulating or wearing attire of other gender o Cross gender roles in fantasy or make believe play o Toys, games and stereotypic other gender activity o Preference for playmates of other gender o Rejection of gender typical games, toys or clothes o Strong dislike of genitalia o Strong desire of other secondary sexual characteristics Impairment of school, social or other function Cultural Competency in LGBTQ Healthcare Supporting children and families • No medical intervention • Therapy to help children and parents • Social transition Reversible No one has been harmed by allowing this Better outcomes Cultural Competency in LGBTQ Healthcare Gender Dysphoria in Adolescents and Adults 302.85 (F64.1 ) A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following: 1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics). 2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics). Cultural Competency in LGBTQ Healthcare
Gender Dysphoria in Adolescents and Adults 302.85 (F64.1 ) 3. A strong desire for the primary and/or secondary sex characteristics of the other gender. 4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender). 5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender). 6. A strong conviction that one has the typical feelings and reactions of the other gender(or some alternative gender different from one’s assigned gender). B. The condition is associated with clinically significant distress or impairment in social, occupational or other important areas of functioning. Cultural Competency in LGBTQ Healthcare When children hit puberty dysphoria can worsen (or first become apparent): Puberty blockers can be offered Their effect is completely reversible Buy time for child's cognitive maturation Expensive!!! Requires frequent lab work Requires Long standing/intense pattern (expressed or not) Dysphoria emerges or worsens with puberty Parents/Guardians are on board Controll of coexisting medical, psychologicl and social problems
$27,000 !!!!!! Cultural Competency in LGBTQ Healthcare
Hormones and Puberty blockers are administered according to the Endocrine Society Guidelines on the Care of Transexual Individuals Cultural Competence in LGBTQ Healthcare
MTF Hormones: FTM Hormones: Estrogen Testosterone Spironolactone Depo-provera Progesterone Finasteride Cultural Competency in LGBTQ Healthcare
Types of surgeries: FTM MTF
Top surgery Electrolysis/Laser hair removal Salpingo-oophorectomy Breast augmentation Hysterectomy Orchiectomy Clitoral release Facial Feminization Surgery Metoidioplasty Tracheal shave Phalloplasty Labiaplasty Gender reassignment surgery Surgery is not required!!! Expensive Risky Painful Time consuming Not desired by the trans person Cultural Competency in LGBTQ Healthcare
What is the problem?
Society fears what it doesn’t understand Cultural Competency in LGBTQ Healthcare What is the problem? Society fears what it doesn’t understand This leads to bullying in school – by students, teachers and administrators 3/4 harassed,1/3 assaulted,1/10 sexually Job, home, law enforcement and medical discrimination High rates of poverty – almost 4 times more likely to make less than $10K/yr. High rates of: Anxiety and depression Drug use Sex trade STI’s including HIV Suicide attempts 41% 45% For People of color Resiliency Tied to affirmative medical and psychological services • Improved quality of life • Less dysphoria • Less psychiatric co-morbiditiy Tied to Social Support • Family acceptance • Peer support (NOT HB-2) • Religious and spiritual communities • Decreased risk of all negative outcomes Cultural Competency in LGBTQ Healthcare HOW CAN YOU BE AN ALLY?
• Don’t ask their “Real” name • Respect their pronouns • If you make a mistake, apologize and move on. Don’t make a big deal. • Don’t tell them They look good for a transgender person Cultural Competency in Transgeder Healthcare
HOW CAN YOU BE AN ALLY?
• Don’t “out” anyone • Don’t ask whats between the legs or about surgeries • Don’t ask about sexuality • Educate yourself • Be a friend How can you support your people Educate yourself This lecture does not make you an expert Advertise Rainbow sticker Start conversation with • I respect all people regardless of……. • I’m John and I use masculine pronouns Call out transphobic/homophobic remarks Documents: do you do documents? How can you support your people? Help them to empathize – “If I gave you $1,000,000 would you change your gender?” Talk about privilege – White vs Black to gay vs straight to Cis vs Trans Struggles for Chaplaincy Someone does spiritual screen Pt. agrees to talk to Chaplin Medical personnel makes referral Doesn’t interrupt patient flow Struggles of Chaplaincy Integrating science, psychology and faith/beliefs? Understand/approach scripture (Beyond literally)? How to pray about it? What does it mean to practice compassion? Keep in mind Religion has been used as a club Hypervigilance is common Homelessness is a real threat Family rejection is common equates to rejection by HP Parent’s feeling of guilt is common Universal longing for love, connection and acceptance National Center for Transgender Equality, NCTE.ORG Human Rights Campaign Parents, Family and Friends of Lesbian and Gays, PFLAG.ORG Gay and Lesbian Alliance Against Defamation, GLAAD.ORG GLSEN.ORG Advocates for youth (*.org)