Terry reed gender identity research and education society


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Terry reed gender identity research and education society

  1. 1. University of Birmingham inner worlds – outer worlds gender identity research & education society www.gires.org.uk November 2011GIRES 2011
  2. 2. NMC Nursing & Midwifery Council defrα Surrey and Borders CISCO PartnershipPearson PLC General Medical Council KENT Home Office; Dept of Health; DCLG GIRES 2011
  3. 3. How many gender variant people in the UK have sought medical help? (data from government sources & surveys)14000 Number of 16 year olds12000 and over, who have sought help up to10000 2010, is 12,500 =8000 prevalence ~25 per 100,00060004000 The number is growing at 11% per annum2000 0 Reservoir of 40 gender 1998 2000 2003 2007 2010 variant people for every one that is currently countable. Roughly 8 will transitionGIRES 2011
  4. 4. gender identities ? man woman WOMAN gender dysphoria MAN transsexual person pan-gender, poly-gender, bi-gender, gender queer, non-gendered, transvestiteGIRES 2011
  5. 5. gender identities ? man woman Trans/transgender WOMAN gender dysphoria gender variant MAN transsexual person pan-gender, poly-gender, bi-gender, gender queer, non-gendered, transvestiteGIRES 2011
  6. 6. trans girl treated with hormone-blockers to suspend puberty (Finally introduced in UK 2011) De Vries et al (2011) prospective study, 2000-2008 (n=70) None withdrew. Psychological functioning improved better social integration, higher achievementGIRES 2011
  7. 7. April Ashley married and separated in 1963 Corbett v Corbett Ormerod, 1970, even the most extreme degree of transsexualism…or the most severe hormonal imbalance…in a person with male chromosomes, male gonads and male genitalia cannot produce a person who is naturally capable of performing the essential role of a woman in marriageGIRES 2011
  8. 8. What you see is what you get IDENTIFICATION IDENTIFICATION MAN WOMAN beard, body hair breasts deep voice menstruation testes ovaries (testosterone) (oestrogen) BOY GIRL penis, testicles clitoris, labia XY XX© - GIRES 2011
  9. 9. Whose boots?© - GIRES 2011
  10. 10. Gender stereotyping© - GIRES 2011
  11. 11. BOY or GIRL? Social question Expectation of match with sex Sex and gender identity conflatedGIRES 2011
  12. 12. Intersex (DSD) congenital adrenal hyperplasia• n = 283 XX CAH,• 250 raised girls(many having had phallus reducedsurgically in infancy)•13 of them (5.2%) identified asboys• 33 raised as boys• 4 of them (12%) identified asgirls)• 29+13 = 42 identified as boys Virilised XX fetusGIRES 2011
  13. 13. Intersex (DSD) partial androgen insensitivity syndrome Cells of fetus do not Some identify respond to as boys, some testosterone as girlsGIRES 2011 Under-virilised XY fetus
  14. 14. Intersex (DSD) complete androgen insensitivity syndrome Completely female appearance; usually identify as women Under-virilised XY fetusGIRES 2011
  15. 15. John/Joan: (mid 60s) twin boy, lost penis in circumcision. Re-assigned surgically as girl, Joan. triumph of nurture over nature ? Never comfortable as a girl; refused to continue hormones and transitioned to live as John in adolescence brain sex (nature) triumphed over (artificially created) phenotype plus gender of rearing (nurture)© - GIRES 2010
  16. 16. Ethical medicine• The way an infant looks, and the gender role in which the child is raised doesn‟t guarantee a consistent gender identity• So, is it ethical to assign sex surgically, and enforce a consistent gender role?• What would you do if this were your child?
  17. 17. XY – XXY, male appearance XYY, XX, raised as boy XXYY, XXX, XXYYY identifies as woman mosaicism trans woman or woman of transsexual history© - GIRES 2010
  18. 18. female appearance XX raised as girl identifies as a man trans man, or man of transsexual history© - GIRES 2010
  19. 19. the organ that appears critical to psychological development and adaptation is not the external genitalia but the brain Reiner, 1999GIRES 2011 Cloacal extrophy
  20. 20. BSTc in trans women in female range. BSTc of trans man in male range 35 FtM 30 25 20 15 10 5 0 9 hom M 12 het men 7 trans W 13 W Small but statistically robust study: 1 in 1,000 chance of being random. Further studies on uncinate nucleusGIRES 2011
  21. 21. Scans: white matter in living, untreated subjectsTrans women significantly different from both male and femalecontrols in A,B,C and DTrans men consistent with male controls in A,B,C, not D
  22. 22. Dichotic listening – hard wired Men have Women have Right Ear Left Ear Advantage Advantage, but more balanced hearing between the R and L ears Trans women have LEA, so hearing is like other women’s – not like men’s. NOT diagnostic© - GIRES 2011
  23. 23. Hare et al, 2008 • Study on testosterone receptor gene • Conclusion: • trans women – unusual repeats this gene compared with Unusual gene – non-transsexual male control formation subjects Repeat polymorphisms© - GIRES 2011
  24. 24. Physiologically: trans women‟s hearing is hard-wired like women‟s, not like men‟s Brain: white and grey it isn‟t a mental matter is cross-sex illness or a differentiated in trans lifestyle choice people hormones: correlation it isn‟t about between high pre- NATURE LOVES sexual natal testosterone in female children VARIETY orientation (HLGBA) who identify as boys SOCIETY HATES IT hormones: gender identity correlation between doesn‟t depend on low pre-natal sex appearance testosterone in male children who identify as girls it doesn‟t depend on genes: there may be a how you are raised© - GIRES 2011 genetic trigger in people
  25. 25. It‟s not catching© - GIRES 2011
  26. 26. Discuss • “Humans form their social structures around gender because males and females have different and biologically influenced behavioral predispositions. • Gendered social structure is a universal accommodation to this biological fact” (Udry, 2000)© - GIRES 2011
  27. 27. transition visible sex gender role invisible sex core gender identity invisible sex core gender identity transition visible sex & gender role the core gender identity remains UNCHANGED© - GIRES 2011
  28. 28. Choice v stereotyping – Less emphasis on binary gender identities; wider remit including non-gendered people (not just full GR) – International WPATH guidelines allow hormone therapy to be initiated without change of gender role (RLE) or insistence on psychotherapy – Will UK continue to insist on full compliance with RLE?• “the principle of Respect for Patient Autonomy, reminds us that the imposition of a scientifically unfounded RLE may be a disrespectful abrogation of allowing for patient self-
  29. 29. ‘transition’ offers ‘light at the end of the tunnel’: • it is not about being „happy‟ • it is about being authentic • life before transition = a charade • continuing the charade is not possible • for many = life or death situation • suicidal feelings are almost universal; 34% have attempted suicide at least once; rates are especially high before treatment is started – aggravated where access impededGIRES 2011
  30. 30. Life experiences before transition • “as far back as I can remember” • no particular childhood trauma, except the struggle to conform to societal & cultural norms • adopt gender stereotypical jobs/hobbies (especially MtF) • marry, have families • parallels with LGB people? • http://readingroom.skillsfundingagency.bis.gov.uk/sfa/Sexual_Orientation_a nd_Gender_Identity_Equality_in_Adult_Learning- _Published_August_2011.pdf© GIRES 2011
  31. 31. negative family responses • Rejection of trans person (50% rejected or not allowed to attend family events • Trans parents not permitted contact with children (unless returned to previous gender presentation) • gender variant children/drop out of school/ in care • Homelessness • Social isolation • Loss of employment • Financial hardship© GIRES 2011
  32. 32. 4 in 10 trans people who wished to transition did not feel able to do so at work:© GIRES 2011
  33. 33. Families of trans people GIRES has run 13 workshops and seen 400 family members;© GIRES 2011
  34. 34. Possible emotions of family members:  Shock  Guilt  Pain and grief  Loss of control  Anger  Stigma Isolation  Fear for self and loved one  Desire to distance oneself from trans person  Awkwardness/ embarrassment  Sometimes religious concerns  Perhaps relief that a mystery is solved© GIRES 2011
  35. 35. stress inhibits communication trans person family • waited years - it‟s my • unaware of trans person’s turn inner conflict, not ready • followed the for change expectations of: • initially hard to convince, think person should slow – family down, reconsider, think of – peer groups effect on relationships, – society education and • has often over- employment compensated • feel trans person not listening to family’s needs mutual accusations of selfishness: “neither can leave their own heartache to hear each other’s pain”© GIRES 2011
  36. 36. NOBODY IS TO BLAME© GIRES 2011
  37. 37. • Margaret, senior tutor, explains that a student, Ben, is going to return next term as Helen. Margaret says she will not accept any discrimination, bullying or harassment; she wants her colleagues to monitor this.• Alan, a tutor says that although he would never bully or harass the individual, he can‟t personally teach „him‟ (sic) as he is a devout Christian •Is Alan right to assume that he need not teach Helen? Do his rights a Christian – a protected characteristic under the Equality Act - allow him to do this? •What should Margaret do? •See similar example at: section 7 http://dev.bdpstaging.co.uk/trans_equality/index. php?i=50 GIRES 2011
  38. 38. Conflict between religion/culture and LGB & T • Alan is wrong. He must leave his religious views at the gate • Provide further training and if his religious views remain incompatible with his job, he will have to leave • See section 10 at: http://dev.bdpstaging.co.uk/trans_equality/index.php?i=53© GIRES 2011
  39. 39. Student discloses plan to transition • Listen, accept, support • Ask “how can we help?” • Explain “Memorandum of understanding” (see next slide) and the help that is available; • but don‟t make assumptions • take it at the pace of the student • Ask if student already has support from family, friends, groups. • See how not to do it, in section 4, at: http://dev.bdpstaging.co.uk/trans_equality/index.php?i=58 • See how to do better in sections 9,10, 12, at: http://dev.bdpstaging.co.uk/trans_equality/index.php?i=63© GIRES 2011
  40. 40. memorandum of understanding • Confidential document; access restricted – protects the trans person and – clarifies the university‟s obligations • important changes may be scheduled – Name change – Document changes – Timing of transition; possibly treatment, however, in the NHS, it is not always possible to choose the dates of treatments; early treatment is likely to be hormone therapy for trans women. No time off needed; however, trans men may have chest surgery – University medical support (possibly depot injections of hormones for trans men) – Use of facilities • Disclosure: who, when, how, and to whom: small group, entire year, all staff? • Complete confidentiality until wider disclosure • Offer to involve Student Union? Outside Support groups? See sections 12,13, 14, atGIRES 2011 http://dev.bdpstaging.co.uk/trans_equality/index.php?i=66
  41. 41. Trans Equality Code and Support • Publicise, and display in all public areas, the Code of Conduct in respect of „protected characteristics‟ • Robust approach to breaches of Code • Ensure all staff (not just academic) are trained in trans awareness, and understand their responsibility to operate zero tolerance to breaches; don‟t ignore small stuff • Rolling programme for all incoming students and staff • Appoint a trans champion • Liaise with student and staff unions to ensure they are supportive of trans people, engage local trans support groups if necessary. See: http://gires.org.uk/tranzwiki/index.php/Main_Page© GIRES 2011
  42. 42. BIRMINGHAM UNIVERSITY CODE We are proud of our university We believe that everyone is equal and must be treated with respect We do not allow anyone to discriminate against others because of their: age disability; gender identity; pregnancy/maternity race/ethnicity; religion or belief; sex; sexual orientation; We challenge those who breach the code Identifying with one protected characteristic does not give you the right to discriminate against, harass or bully someone because they have a different protected characteristic Whatever your religion or belief, you must respect other people’s religions and beliefs; and whatever religion you follow, you must respect other people’s identification as gay, lesbian, bisexual or trans If you are being harassed or bullied in, or outside, the premises, report it. If you see someone else being bullied, report it. We are all responsible for each other’s wellbeing WE RESPECT EACH OTHER’S DIFFERENCESGIRES 2011
  43. 43. Toilets and changing facilities • Helen is now living full-time as a young woman. Her name has been changed on the register, and staff and students are getting used to her altered gender expression • Helen uses the „ladies‟ toilets • A student challenges her and tries to get her to leave the toilets • See example at: section 9, http://dev.bdpstaging.co.uk/trans_equality/index.php?i=42 • Helen refuses, so the student complains to a tutor that where she comes from, they would not be able to share facilities with such a person • how should the tutor/university respond?© GIRES 2011
  44. 44. Toilets and changing • facilities issue Point to Code; provide further training; warning about bullying and harassment; insist that the student apologises to Helen. • a person who has transitioned full time may immediately use gender-appropriate facilities. • those who don’t wish to share facilities with a trans person must use alternative facilities • check toilet and changing facilities can accommodate a person who wishes to use unisex (not disabled); • ensure cubicle sides and doors extend down to floor, and up to ceiling for additional privacy • See example at sections 10 and 11(click submit to access text): http://dev.bdpstaging.co.uk/trans_equality/index.php?i=43© GIRES 2011
  45. 45. Name change • Ensure all staff are aware of the change in name and pronouns. This should happen immediately upon change of role. • Names can be changed in the UK without any legal process. Statutory Declaration or Deed Poll is not a legal name change, but these do provide evidence of the intention of the student to continue in that role and may make educational establishments more comfortable about altering or reissuing documents. • Documentation and certificates that show previous names and titles should be stored separately in sealed envelopes, clearly marked with the one or two named people who may have access.© GIRES 2011
  46. 46. • Make sports as inclusive as possible • Help young person to access medical treatment if necessary • If time missed from studies, allow extra time, and assist the student to catch up with work© GIRES 2011
  47. 47. Guidance on monitoring • Monitoring by counting heads should only be undertaken when your environment is safe for trans people. Monitoring attitudes among staff can give an indication about how trans friendly your environment is. • “How comfortable are you, or would you be, teaching, or working alongside, a trans person?” • (Or “How confident are you…?‟‟) • 1) very comfortable • 2) comfortable • 3) not sure • 4) uncomfortable • 5) very uncomfortable • 6) would refuse to teach or work with a trans person© GIRES 2011
  48. 48. Guidance on monitoring• Before you start, clearly identify a legitimate aim for collecting data on gender identities, and guarantee anonymity• Heading:• Gender Identities (optional section) Do you identify as: > a man? > a woman? > both? > neither? The following question is also optional, but you may answer it IN ADDITION TO the above or, if you prefer, INSTEAD OF the above questions: Is your gender identity inconsistent with (different from) the sex you were assigned at birth? > yes > no The following question is also optional: How would you describe your gender identity?© GIRES 2011
  49. 49. legal protections• Human Rights Act 1998 (Articles 3, 8, 14) – 3: prohibition of degrading treatment – 8: right to privacy of family life and correspondence – 14: right to „enjoy‟ other Article rights without discrimination – (it is not necessary to have a „comparator‟)• Gender Recognition Act 2004 – Affirmed gender status for all purposes (BC) – Strong privacy provisions (criminal offence for anyone acquiring information in an official capacity to disclose information indicating gender history – Marriage/ Civil Partnership implications (annulment/ dissolution before GRC awarded - conflict with Artivle12, HR)GIRES 2011
  50. 50. legal protections • Equality Act 2010 Public Sector general duty applies to public bodies or those exercising a public function (and those procured/commissioned) • It protects trans people (who propose to undergo, are undergoing or have undergone gender reassignment) against direct and indirect discrimination in employment and in provision of goods, facilities, services, and premises – N.b. indirect discrimination is where a policy or protocol that is neutral in it application to the majority of people, has a disproportionately discriminatory effect on trans people. Where indirect discrimination cannot be avoided, it must be proportionate to a legitimate aim • The Act protects trans people and those „perceived‟ as trans or associated with trans people from discrimination, harassment and victimisation • removes medical supervision from definition of gender reassignmentGIRES 2011
  51. 51. A Celebration of Diversity LGBT Health Summit 2010© GIRES 2011