Introduction to Transgender Equality


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  • 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
  • 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
  • NB- Truly embracing diversity -
  • Introduction to Transgender Equality

    1. 1. Introduction to Transgender Equality Facilitated by Equality South West
    2. 2. Personal Identity  Sex – determined by physical examination at birth  Gender – a social construct  Sexuality – how we express our physical desires
    3. 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. 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. 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. 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. 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. 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. 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. 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.
    11. 11. Vulnerability       Social exclusion and bullying and abuse Isolation Loss of family and home Potential loss of place of employment High anxiety states Paranoia
    12. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 oppres e s y to h very ea xample, on t t is “I re ess ority, fo ingly harml min eem ga sis of s r and allowin ba ante ople office b of bigoted pe y minorit to express m freedo ews obic vi h homop ged.” le n unchal “The people who most need to change are the media.” “I do feel restricted in what form of voluntary work I seek to undertake particularly where it involves children, older people or religious groups” “Educat ion of health a nd care professi onals in Trans is sues.” Menta l is I do no sues conce rn me t point o want to get to the f depe nd withou t a qua ence li Alzhei mer's” ty of life - e. g.
    23. 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. 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
    25. 25. Break
    26. 26. My Personal Journey
    27. 27. Round Up
    28. 28. Some useful links  The Beaumont trust:  GIRES - Information for trans people, their families and the professionals who care for them:  Press for Change:  NHS website: An Introduction to working with Transgender people: 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:  Transgender Information: Text: 0781 609 3291
    29. 29. Thank you for listening