2. Personal Identity
Sex – determined by physical
examination at birth
Gender – a social construct
Sexuality – how we express our
physical desires
3. Gender Dysphoria
Means ‘discomfort’ with your assigned gender
Trans people identify with or wish to be considered as
the opposite gender. There is a spectrum of identity that
is not necessarily static – gender variance
Transsexual people wish to change their gender
completely and seek medical interventions to confirm
that need
Emerging evidence that the brain anatomy and
physiology in transsexual people is similar to that of the
desired gender1 and develops whilst still in the womb.
1
Atypical Gender Development – A Review
International Journal of Transgenderism
4. Trans People
Appear in every culture – not just a Western thing
Have existed through recorded history
Cross all economic and social boundaries
Are both ‘women’ and ‘men’
Are not “sick” or “defective”
Are simply part of natural variation
Want no more than to be themselves, in peace
May need the assistance of medicine to reach that goal
Need to be treated with respect
5. Britain today
Approximately 21 in every 100,000
people in the UK is transsexual (GIRES)
Only 20% felt they encountered no
problems2
34.4% said they thought about or
attempted suicide or self harm2
2
Engendered Penalties – Whittle, Turner and Al-Alami –
The Equalities Review, Feb 2007
6. Legislation
Human Rights Act 1998
Gender Recognition Act 2004
• Gender Recognition Certificate
Equality Act 2010
• Gender reassignment – no longer need to be
under medical supervision.
7. Early years
80% of those who go on to transition knew by
the time they were 8 years old that their gender
identity was at odds with society’s perception.
(SWTEN report)
“I have felt like a gay boy trapped in a girl’s body since I
was five and don't understand why… My head is messed
up over this stuff and there doesn't seem to be anybody
who understands or who I can talk to. It affects me
everyday.”
(PP&T contributor)
8. Pressing the pause
button
Changes at puberty “can be terrifying and repulsive to a
transgendered person”.
"People are always afraid that (puberty blocking) will be
harmful for the children. But what they never take into
account is that it is also harmful to not give them this
treatment.”
Some clinics in Australia, Canada, Germany, the U.S.,
and the UK have started to offer treatment to
transgendered teens in order to prevent their onset of
puberty.
9. Transition
Can be extremely stressful
It’s the one of the biggest changes anyone can make
to their lives
Many lose friends, jobs, family and homes, often all in
one go and trans people need support
Many years of male/female socialisation may need to
be unlearnt and new behaviours to be acquired
Hormone therapy and gender confirmation surgery
works well, but is not widely available in the UK for
people under 18
10. Ruth’s Story
Ruth was born in a male body but knew from
the age of 16 that she wanted to be a woman.
Learn about her hormone treatment and
surgery, and how she feels now.
12. Supporting mental
health and well being
Gender Dysphoria is not a mental health problem,
although it is treated as one by most of the medical
profession
The stresses of coming to terms GD and going through
transition can trigger mental health issues
Physical health can be affected too
Loss of confidence and self esteem
Can lead to isolation, self harm and suicide
13. The NHS Experience
1
16% of trans respondents think that the quality
of care delivered by their current GP is poor or
very poor, while 62% think it is good or very
good
Many trans people experience difficulties finding
a trans-friendly (or non-transphobic) GP and the
process of finding such a GP is subject to pure
chance
1
Count Me In Too Trans People Report
Browne & Lim – Dec 2008
14. Sexual health
Over half 56% of trans people do not know
where to find help around sex and relationships
Trans people are more likely than non-trans
people to not know where to find help around
sex and relationships
Trans people are more likely than non-trans
people to say they have never had a sexual
health check up
1
Count Me In Too Trans People Report
Browne & Lim – Dec 2008
15. From NHS gate keeping
to transition pathway...
Trans people “frequently experience barriers in health
service provision ... policies and access to adequate and
safe treatment ... inconsistent and generally
unsatisfactory.”
Wasteful emphasis (in some cases) on repeated
involvement of mental health assessment.
Important for people to know what lies ahead...
Need to move from GP discretion and inconsistencies to
a recognised gender reassignment pathway.
16. Awareness and respect
in the NHS - Voices
Need for Transgender champions in the
NHS?
“Sorry, I can't really help you - you're rather Uncharted
Territory,”
“What have they sent you here for? We only deal with life
threatening illness here”
“Unnecessary surgery, that in there, and we're supposed
to look after him!”
17. Health and well-being:
Key Messages from
PPT research
• All providers – including voluntary sector: publicise Trans
inclusiveness
• All staff and volunteers: awareness training and respect in
practice
• GPs: attitudes and clinical knowledge key - Trans surgerybased specialists?
• Health and social care, and supported housing providers:
need to understand complexities of LGB and Trans ageing
• All providers: monitor sexual/gender identities
• Mental health services: more counselling, more timely
and more LGB and Trans aware
18. Ageing as a Trans
person
Long term impact of treatments: “a paucity of research
into the long-term outcomes of treatment for
transsexualism” (SWTEN report)
“I am over 65 and a transwoman - I am concerned at almost the
complete lack of information that will inform my GP and myself re
my hormone treatment, its long term effects on my body and on
other treatment e.g. heart etc.”
19. Ageing as a Trans
person
Entering the care system (PP&T contributors)
“The realisation that it will not be too long before I will
need residential/ similar care I do not think the
providers are geared up to this.”
“Worry that I will suffer from dementia or similar as I get
older and will get confused about my identity which
will cause problems with the respect and dignity that I
will require as a human right”.
20. Awareness and Respect:
Voices
“Being trans can attract unwanted attention and
make your life more difficult. You can be seen as
a threat ... or simply mocked.”
“They just could not imagine or really deal with
how I could be feeling (following an assault) as
they were uneducated in Trans issues. I felt
unheard, pacified and patronised.”
21. Awareness and Respect:
Voices
“There is an overarching need for health and social care
professionals to receive appropriate training in relation to
gender dysphoria and the kinds of interventions and care
required, this should be refreshed as the knowledge
base grows, and trans people should be invited to
contribute actively to this learning process.”
(SWTEN report)
“A more informed, respectful and genuinely caring
attitude would be preferable to an ignorant, disrespectful,
humiliating and often very frightening one.” (PP&T
contributor)
22. “Health care providers
need to realise that there
is more than one way to
live and love. As soon as
they’ve got that down,
we’ll be fine.”
sa
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“The people who most need
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“I do feel restricted
in what form of
voluntary work I
seek to undertake
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23. What Trans People
Want
Over 65% of trans respondents would like a
specialist local support service
51% cite the need for a specialist GP
53% say that psychotherapy could have improved
their experience of transition
47% of trans people said that their transition would
have been improved by better information
To be a visible part of society
To be consulted and involved.
24. How Can You Help?
Having anti-discriminatory and anti-bullying
policies
Being informed and understanding – training for
staff and awareness raising with service users
Providing a mentor who can help a trans person
– good pastoral care
Embracing diversity – staff and service users
alike
28. Some useful links
The Beaumont trust:
http://www.beaumontsociety.org.uk/help_and_advice.html
GIRES - Information for trans people, their families and the
professionals who care for them: http://www.gires.org.uk/
Press for Change: http://www.pfc.org.uk/
NHS website: An Introduction to working with Transgender people:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@d
h/@en/documents/digitalasset/dh_074254.pdf
SW Transgender Equality Network – to get involved and find out
more, including local groups, research and general information:
http://www.equalitysouthwest.org.uk/transgender
Transgender Information: transgender.information@yahoo.co.uk
Text: 0781 609 3291
Important to remember that when we talk about Transgender we are not discussing sexual orientation, trans people can be straight, gay, lesbian or bisexual, same as everyone.
NB - Don’t forget intersex!
Explain what social construct is i.e. that it varies from the eastern and western hemisphere, various countries, so is never the same.
Transgender is an umbrella term, that is meant to be all encompassing. Some people start their journey living as a transvestite or in certain situations in a gender role, some feel they need to go further and take hormones and have surgery. To be covered by Equality Law there is no legal requirement for you to be under any form of medical supervision.
They may be aware of “being different” from peers from a very early age. And if there is an intention to reassign then they may start to be come cross gender behaviour i.e. cross-dressing.
We need to be very clear that this is not a mental illness. Because of the stress that people experience, both with physical changes, drugs, rejection by friends and family, and the loss of their support system, it does mean that Trans people often experience mental health issues, but these are not the root cause. We will come back to this later.
In any school with 1,000 pupils, 6 will experience transgenderism during their lives. There are likely to be others who have a transgender parent or relative.
It is VERY difficult to collect data amongst the Trans community as people are fiercely protective of their confidentiality
Article 8: the right to respect for your private and family life, your home and correspondence
Article 12: the right marry and found a family
Illegal to ask someone whether they have a Gender recognition certificate. This allows you to change your birth certificate, however, not all members of Trans community want to get one
You can acquire a valid UK passport in your acquired gender
Our LGB Network and Transgender Network were involved in a regional piece of work, called pride, progress and transformation which looked examined the peoples experiences in the SW and what the issues are here.
Children usually know how they fit within the gender spectrum by about age 4 or 5. Source – GIRES.
The International Endocrine Society (IES) 1 issued a draft set of guidelines in early 2008-DEC. 2 They are co-sponsored by the European Society of Endocrinology (ESE), The World Professional Association for Transgender Health (WPATH), and Lawson Wilkins Pediatric Endocrine Society (LWPES).
The guidelines recommend that some transgendered children as young as 12 years-of-age should be given medication to avoid puberty. This would greatly simplify sex reassignment surgery if they decide to undergo it later in adulthood.
The main benefit from puberty blockers would be to avoid the inevitable body changes caused by puberty. For example, a male-to-female (MTF) transexual could avoid having her voice deepen, a masculine bone structure appear, her Adam's Apple enlarge, and hair growth on her face. A female-to-male (FTM) could avoid developing breasts, feminine shaped hips, and female bone structure elsewhere. Without these bodily changes, there would be less to correct during sex reassignment surgery.
Another benefit of putting off puberty would be that the individual would be more mature and capable of making a settled decision in their mid-teens rather than their pre-teens. If, at the age of 16 or so, they decide to not proceed with sex reassignment surgery when they are adults, they can stop the puberty blocker medication and go through puberty.
Blockers are now offered, but only after very extensive counselling, in the UK.
Peggy Cohen-Kettenis of the Free University of Amsterdam Medical Center
http://www.religioustolerance.org/transsexu17.htm
Male / Female socialisation - One of the things Network members often comment on is how you have to get used to people speaking to you differently, for example the way men speak to men is very different to the ways men speak to women.
Often you have to live for 2 years before they will prescribe you hormone therapy – this also presents people with difficulties as some people feel they need to have the hormones to have the confidence to live in their desired gender.
Blockers are available earlier than this, and many transpeople who wish to permanently reassign may take hormones they have acquired off the internet
Before and during transition many people feel very vulnerable which can be increased depending on a number of factors.
PPT - Domestic violence –
19% had experienced violence from parents/ guardians
26% from intimate partners
8% from other family members
2% from own or other children in the household
Over 80% had not reported to anyone
Prevalence of long-term depression and vulnerable to strokes connected with anxiety and depression.
(SWTEN report)
The NHS often finds it Difficult to shape services that are inclusive and responsive to Trans people’s needs.
Knowledge is around – but not always in the right heads!
Scarcity of UK information about trans people’s sexual health
Sydney Sexual Health Clinic: review of cases 1990 -2006 - 40 transgender clients. 36 MtF, 4 FtM.
"Transgender clients presented infrequently at this clinic … Although half reported few risks, the other half reported multiple risk behaviors and had most [sexually transmitted infections]. These findings suggest that there needs to be improved sexual health service for transgender clients at our clinic.
Over 68% of trans people who have used NHS gender identity clinics say that the quality of care they received was poor or very poor.
NB – Have a genuine understanding of, and a commitment to Trans inclusiveness. I.e. not just ticking boxes!
Highlight “Guidance for care providers” that SWTEN developed.
Quote from Transgender report
‘Dimensions of inequality in the South West November 2009
Quote from Transgender report
‘Dimensions of inequality in the South West November 2009