obstacles to medical information and care obstacles to medical information and care for transgender populations for transgender populations

John OttoJohn OttoLIS 528LIS 528

March 9, 2006March 9, 2006

trans terminologytrans terminology

transsexualism defined…transsexualism defined… Up to DateUp to Date

“ “Transsexualism is the condition in which a person with Transsexualism is the condition in which a person with apparently normal somatic sexual differentiation of one apparently normal somatic sexual differentiation of one gender is convinced that he or she is actually a member of gender is convinced that he or she is actually a member of the opposite gender. It is associated with an irresistible urge the opposite gender. It is associated with an irresistible urge to be that gender hormonally, anatomically and to be that gender hormonally, anatomically and psychosocially.”psychosocially.”

Stedman's Online Dictionary Stedman's Online Dictionary “ “the desire to change anatomic sexual characteristics to the desire to change anatomic sexual characteristics to conform physically with one's perception of oneself as a conform physically with one's perception of oneself as a member of the opposite sex” member of the opposite sex”

trans terminologytrans terminology

Transgender as umbrella termTransgender as umbrella term TranssexualTranssexual TransgenderistTransgenderist Cross dresserCross dresser TransvestiteTransvestite Drag queen / drag kingDrag queen / drag king Gender queerGender queer transpersontransperson

Transgender as Transgender as nonnon-umbrella term -umbrella term original meaningoriginal meaning

Gender vocabulary is highly inconsistent and evolvingGender vocabulary is highly inconsistent and evolving

trans terminologytrans terminology

trans terminologytrans terminology

Sexual orientation vs. gender identitySexual orientation vs. gender identity Two different thingsTwo different things Transpeople may or may not come from gay/lesbian backgroundTranspeople may or may not come from gay/lesbian background Gay/lesbian/bisexual people do not need medical treatment to Gay/lesbian/bisexual people do not need medical treatment to

be GLBbe GLB Transsexuals dependent on medical systemTranssexuals dependent on medical system

M to F = transwoman, female pronounsM to F = transwoman, female pronouns

F to M = transman, male pronounsF to M = transman, male pronouns

DSM-IVDSM-IV

Diagnostic and Statistical Manual IVDiagnostic and Statistical Manual IV

Gender identity disorderGender identity disorderGender 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 JorgensenChristine Jorgensen

Prevalence of transsexualismPrevalence of transsexualism

1 in 11,900 for MTF1 in 11,900 for MTF

1 in 30,400 for FTM1 in 30,400 for FTM

Trans advocatesTrans advocates numbers are offnumbers are off likely FTM and MTF are roughly even in numberslikely FTM and MTF are roughly even in numbers

FTMS less likely to be visibleFTMS less likely to be visible

Health care and research focus on MTFsHealth care and research focus on MTFs

HBIGDAHBIGDA

Harry Benjamin International Gender Dysphoria Harry Benjamin International Gender Dysphoria AssociationAssociation

professional organization devoted to the understanding and treatment of professional organization devoted to the understanding and treatment of gender identity disorders gender identity disorders

350 members - medicine, psychology, law, social work, counseling, 350 members - medicine, psychology, law, social work, counseling, psychotherapy, family studies, sociology, anthropology, and sexologypsychotherapy, family studies, sociology, anthropology, and sexology

Standards of CareStandards of Care

HBIGDAHBIGDA

Standards of CareStandards of Care

Treatment guidelinesTreatment guidelines guidelinesguidelines

sometimes applied rigidlysometimes applied rigidly

only 9 of 19 clinics adhere completely to the SOConly 9 of 19 clinics adhere completely to the SOC

International influenceInternational influence

Offers protections to health care providerOffers protections to health care provider

Obstacles to medical treatmentObstacles to medical treatment

Lack of health provider knowledgeLack of health provider knowledge patients usually must educate providerspatients usually must educate providers Small groups of “experts” in urban areasSmall groups of “experts” in urban areas Rural areas – often no treatment optionsRural areas – often no treatment options

Transpeople lumped in with LGBTranspeople lumped in with LGB minority within a minorityminority within a minority rejected by larger LGB minorityrejected by larger LGB minority different issues than LGB different issues than LGB

Health research, policies, and materials usually do not mention Health research, policies, and materials usually do not mention transpeopletranspeople

Fixation on SOC and DSM-IVFixation on SOC and DSM-IV

Obstacles to medical treatmentObstacles to medical treatment

discrimination & bias toward transpeoplediscrimination & bias toward transpeople Health care discrepanciesHealth care discrepancies

Recurring theme in literatureRecurring theme in literature

Social marginalization Social marginalization 60% - harassment or violence60% - harassment or violenceDiscrimination & insensitivity in treatment settingDiscrimination & insensitivity in treatment setting

Economic marginalizationEconomic marginalizationEmployment discriminationEmployment discrimination37% - economic discrimination37% - economic discriminationLack of insuranceLack of insuranceHigh proportion of MTFs turn to survival sex workHigh proportion of MTFs turn to survival sex work

Lack of insurance coverageLack of insurance coverage

Medicalizing lives Medicalizing lives institutional negative attitudes institutional negative attitudes

Obstacles to quality researchObstacles to quality research

methodologicalmethodological Hidden populationHidden population ExpensiveExpensive

homophobiahomophobia too sensitivetoo sensitive too “exotic”too “exotic” High proportion of MTFs turn to survival sex workHigh proportion of MTFs turn to survival sex work

Patient information needsPatient information needs

Grassroots self educationGrassroots self education

Web-based resourcesWeb-based resourcesTrans organizationsTrans organizations

Yahoo email groupsYahoo email groups

Individual’s websitesIndividual’s websites Hudson’s FTM Resource GuideHudson’s FTM Resource Guide

Transactivists acquiring professional credentialsTransactivists acquiring professional credentialsNick Gorton, MD – www.nickgorton.orgNick Gorton, MD – www.nickgorton.org

Jamison GreenJamison Green

Web resourcesWeb resources

King County Public Health websiteKing County Public Health website http://www.metrokc.gov/health/glbt/ http://www.metrokc.gov/health/glbt/transgender.htm

LGBT Health Channel Transgender Health webpageLGBT Health Channel Transgender Health webpage http://www.lgbthealthchannel.com/transgender

National Coalition for LGBT Health websiteNational Coalition for LGBT Health website http://lgbthealth.net

HBIGDAHBIGDA http://www.hbigda.org