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The Spectrum of Gender

The Spectrum of Gender. Tory Clark. Special Thanks to the Fenway Institute in Boston, MA for their contributions to this slide presentation. www.fenwayhealth.org

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The Spectrum of Gender

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  1. The Spectrum of Gender Tory Clark

  2. Special Thanks to the Fenway Institute in Boston, MA for their contributions to this slide presentation. www.fenwayhealth.org • Mary Minten LMFT, DAACS, LCADC Marriage and Family Therapist, Diplomate of American Academy of Clinical Sexologists, Alcohol and Drug Counselor • Transgender Allies Group

  3. The sense of who you are in regards to your sexuality, behavior and social roles does not always correspond to your genitalia or reproductive organs.

  4. What is this person’s: • Sex? • Gender? • Gender identity? • Gender expression? • Sexual orientation?

  5. Gender Assumptions: • Assumptions about how people are likely to behave based on their maleness or femaleness

  6. Are Sex and Gender Synonymous?… “Gender and gender role refers to society's idea of how boys or girls or men and women are expected to behave and should be treated. It can be said that one is a sex and one does gender; that sex typically, but not always, represents what is between one's legs while gender represents what is between one's ears.” ~ Dr. Milton Diamond

  7. Gender Identity: How one psychologically perceives oneself as either male or female • Gender Role: A collection of attitudes and behaviors that a specific culture considers normal and appropriate for people of a particular sex (social script)

  8. 2:20

  9. Noah is your son…. • How would you raise Noah? • How would you handle your other family members regarding Noah’s feminine expression? • Would you allow Noah to express his femininity at school? Why or why not? • If the school would not allow Noah to express his femininity, what would you do? • Noah is now approaching puberty and has not changed one bit. Would you allow Noah to go on puberty delaying medications?

  10. Transgender

  11. Transgender • A person whose gender identity is not in agreement with her/his biological sex. Many diverse identities and expressions – no one way to be trans. • Transgender woman or Trans woman – Male-to-female (MTF), assigned male at birth, lives female/feminine/affirmed woman, transfeminine spectrum • Transgender Man or Trans man–Female-to-male (FTM), assigned female at birth, lives as male/masculine/affirmed man, transmasculine spectrum • Transsexual? Transvestite?

  12. Terminology Varies! How people define their transgender identity varies by individual and changes over time. Terminology related to transgender is evolving, and some terms may be less popular or accepted by the community at different points in time. For example, some gender variant people do not like being called transgender. It is always best to ask clients how they define or would describe themselves.

  13. Transgender cont’ • Many (but not all) seek some degree of medical or surgical intervention to align their minds and bodies • Transition: The emotional and/or physical process of actively moving away from the gender you were assigned at birth and toward whatever makes you feel more comfortable. • This looks different for EVERY individual. • This process may or may not involve a new name, new clothes, new pronouns. Hormone Replacement Therapy (HRT), surgery, etc.

  14. Gonadotropin-Releasing Hormone Analogs(Hormone Blockers) • Reversible and allows an adolescent to have more time to decide • 2013 study followed 127 adolescents- no negative bone density or metabolic effects • “Hormonal interventions to block the pubertal development of children with gender dysphoria are effective and sufficiently safe to alleviate the stress of gender dysphoria,” said the study’s lead author, Henriette Delemarre-van de Waal, MD, PhD, a professor of pediatric endocrinology at Leiden University Medical Center, Leiden, The Netherlands. • “These patients often harm themselves if they are not treated because they are clearly in the wrong body….the younger generation of endocrinologists who have grown up with gender-variant people see this as a disregard for a human right.”-Dr. Norman Spack

  15. Gender Dysphoria (greek-emotional distress): a marked incongruence between one’s experienced/expressed gender and assigned gender.

  16. Gender Dysphoria Cont’ • 2008 AMA position paper affirms the medical necessity of surgical and hormonal interventions (Avery, 2008) • APA Council of Representatives supports full equality and ‘the legal and social recognition of transgender individuals consistent with their gender identity and expression’ (Glicksman, 2013, p. 1).

  17. Problems Trans People Face • Depression • Prejudice & discrimination • Difficulty finding housing • Difficulty obtaining health care • Loss of family / significant other • Loss of employment • Substance abuse • Self mutilation • Suicide

  18. Unsettling Statistics • Between January 1, 2008 and October 31, 2013, 1,374 transgender people in 60 countries worldwide were murdered (68 in the U.S.). (Transrespect versus Transphobia Worldwide, 2013). • The National Center for Transgender Equality and the National Gay and Lesbian Task Force (2011) surveyed 6,450 transgender and gender non-conforming people and found that 41% have attempted suicide (25 times higher than the general population) • The American Journal of Public Health (2013) reported that of the 1,093 transgender individuals surveyed, 44.1% struggle with clinical depression, 33.2% with anxiety • 57% experience rejection from their family (Grant et al., 2011).

  19. Table 6.Fears and concerns about accessing health care. Reprinted from “When Healthcare Isn’t Caring: LambdaLegal’s Survey on Discrimination Again LGBT People and People Living with HIV” by LambdaLegal, 2010, p. 12, LambdaLegal: New York. Available at www.lambdalegal.org/health-care-report .

  20. “Is schizophrenia always a sick response to a healthy society? Or, can schizophrenia be seen as a healthy response to a sick society?” ~ R.D. Lang Being transgender is not a disorder; however, living in a culture that does not yet really understand, support, or outright rejects transgender people can lead to mental health issues. Note, however, that not all transgender individuals struggle with their gender identity.

  21. Transgender Statistics • No reliable data on the number of tans people • 1 in 1000 to 1 in 2000 (Joan Roughgarden) • This # pertains to postoperative trans • Closer to 1 in 500? • Approximately 800 – 1,000 SRS/yr in the U.S. • Map of gender diverse cultures

  22. Intersex HBO Middle Sexes

  23. How do we come to think of ourselves as either male or female?? Biological Process (Nature) Social-Learning (Nurture) Social and cultural models and influences during early development Interaction model – both nature & nurture • Chromosomal sex differences • Development of gonads • Production of hormones • Development of internal & external reproductive structures • Sex differentiation of the brain

  24. Social-Learning Influences on Gender Identity • In contrast to the biological material, social-learning theory says that gender identity results primarily from social and cultural influences during early development • Boys and girls are treated differently from the moment of birth or before • By 18 months, most children have developed a firm sense of gender identity, and usually insist in behaving in a way consistent with that gender identity • Long-term case studies by John Money of intersex individuals with atypical gender development were interpreted as supporting the importance of gender of assignment and rearing • Reimer twins - As Nature Made Him: The Boy Who Was Raised As A Girl by John Colapinto • Follow-up of Money’s cases by Diamond, however, suggested that biological factors during development do affect gender identity • “If we as physicians or scientists want to know about a person’s sexual identity we have to ask them.” (Dreifus, 2005)

  25. Gender identity as a Biological Process—Prenatal Differentiation

  26. Prenatal Variations There are two major types of variations in development: • Sex Chromosome Variations – patterns other than XX or XY - more than 70 variations. • Prenatal Hormone Variations – presence or absence of the usual prenatal hormones changes the development of the internal and/or external genitals, and probably the brain as well Endocrine disrupters • Diethylstilbestrol (DES) – Acts as a potent synthetic estrogen, no longer used in the US • Dioxin – mimics the effects of estrogen at low levels • Bispenol A (BPA) – estrogenic effects

  27. Intersex • A term applied to people who possess biological attributes of both sexes. • Hermaphrodite (outdated term): have both ovarian and testicular tissue. Genitals are a mixture of male & female – incidence of true hermaphroditism is about 1 in a million • Intersex: 1 in 1500 to 1 in 2000 births • Genital surgery sometimes performed on infants • Ideally, rather than surgery, should be up to the individual when they are old enough to make an informed decision • http://www.thevisualmd.com/visualizations/result/healthy_nerve_supply_of_clitoris_and_labia

  28. Summary of Biological Variations

  29. Language Tips • Words that are offensive to transgender people • She-male • He-she • It • Trannie or tranny • “Real” woman or “real” man • Unhelpful questions or comments • “When did you decide to be a man/woman?” • “You look so real. I never would have known.” • “Have you had/do you want THE surgery?” • “How do you have sex?” • “What is your real name?” • “You’re so attractive, why would you want to…?” • "Meet my friend _____; he's a transgender!"

  30. Local Changes • Employment discrimination and housing discrimination based on gender identity & expression now against the law in Nevada • Nevada hate crime laws now include gender identity and expression language • Referral list for therapists, doctors, salons, shopping, electrolysis, and more has grown from one-page document Mary Minten created in 2006, to a multiple page booklet now printed and hosted online at NNHOPES and UNR • NNHOPES - Now offers transgender care - medical, mental health, prescriptions and more. Transgender concerns are part of staff training and standards of care are utilized. • UNR - Now has a working policy for transgender athletes, assisted by Dr. Carol Scott • Two screenings of the documentary Trans in 2012 sponsored by early TAG members, AASECT, Unitarian Universalist Church, select UNR departments, and others. Another screening sponsored by Carson City’s PLFAG chapter in 2013 • Trainings done by clinicians, advocates, and transgender people throughout medical, law enforcement, therapy, and other fields. • And more.... being done for awareness and education

  31. Allies in Clinics, Schools, and Other Settings: Creating a Friendly and Welcoming Environment • 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; If you slip up, apologize! Individuals often appreciate sincerity and good intentions. • Post non-discrimination policy • Include ‘gender identity and expression’ in the language • Ensure safety in lobby and parking areas

  32. Allies in Clinics, Schools, and Other Settings: Training Front-Line Staff and Setting Office Policies • Intake forms • Assigned sex at birth • Current gender identity • Create and follow a protocol for noting preferred names, pronouns, mail, voice message instructions • Have clear lines of referral for questions • Appoint a staff person responsible for providing guidance, assisting with procedures, offering referrals, fielding complaints • Ongoing training and retraining of staff • Annual transgender competency trainings and boundary trainings (e.g., know what/what not to ask about) • Train new staff on protocols within one month of hire • Accountability for transphobic responses • Advanced training for staff involved in direct care with expectations of continuing education on transgender issues

  33. Tips for Best Practices • Throughout the client’s transition it is important to have open communication with them regarding things like: name, pronoun, disclosure, interventions and the treatment pathway • AFFIRMATION builds resilience, hope, trust and confidence with the authentic self.

  34. Common Questions/Concerns Cont’ • Do all transgender people need counseling to come to an understanding and acceptance of their gender identity? • Not requisite for understanding or accepting gender identity • Making it mandatory reinforces the idea that trans are unable to make healthy, educated choices • Therapy is expensive & some fear going

  35. Common Questions/Concerns Cont’ • My patient says he is transgender but he often shows up at my office using his female birth name and looking like a girl. Is it possible that he is not really transgender? • Trans identity is not necessarily related to their public presentation • Risks of being harassed for not “passing” • Mentally ready • Fear of losing job, family

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