Transgender Awareness Week is a time to educate ourselves and our community about the issues faced by transgender individuals. It is a week to remember those who have faced violence and death due to prejudice and to celebrate the lives and contributions of transgender people in every community. This is the third in a five-part educational series for Transgender Awareness Week.
Transgender Awareness Week Part 3
Transitioning
Coming Out as Transgender
Every transperson’s experience is different in terms of how, if, when and why they choose to come out as transgender. Some may choose to come out publicly, whereas others may only feel safe and comfortable sharing their identity with a few trusted people. Though many out transgender individuals live happy and healthy lives, for many coming out and transitioning can be a dangerous and intimidating endeavor.
Choosing to Transition
Transitioning is a process, not an event, that can take months to years. The overall goal of transitioning is to achieve comfort with one’s gendered self, allowing maximal psychological well-being and self-fulfillment. An individual’s transition may involve a number of interventions such as legal (and social) name/pronoun change, wardrobe adjustments, removal of certain body hair through electrolysis or waxing, breast-binding, wearing prosthesis, vocal training, hormone therapy, and surgical interventions. Each individual finds a unique path through transitioning-- not all individuals pursue any given intervention (ex: many trans identified individuals do not take hormones or have surgery). Some people who transition aim to “pass” in the general public as a member of their desired sex, whereas others do not (ex: gender-queer individuals may not identify as entirely male or female, and may not seek to pass as either a man or woman).
Guidelines for the health care provider assistance of transitioning are outlined by the Standards of Care (SOC) set by the World Professional Association for Transgender Health. Although the SOC are changing, these steps traditionally included counseling with a mental health professional, learning about available options and medical treatments, conducting a trial period of “real life experience” (during which one lives as their desired gender, often about one year), and medical recommendations regarding the administration hormone treatment.
Gender Identity Disorder (GID) Diagnosis
In the medical community transgender individuals are diagnosed as having Gender Identity Disorder (GID). The GID diagnosis and nomenclature is fraught with controversy and stigma. The American Psychiatric Association defines GID as long-standing “discomfort with one’s assigned sex or a sense of inappropriateness in the gender role of that sex.”
Given theories of the social construction of gender and the continuum of gender, many reject the GID diagnosis as incorrectly labeling transgender individuals as having a psychopathology or a “disorder.” Gender diversity is normal and not a psychiatric illness; it has been suggested that the distress or psychopathology associated with gender dysphoria may largely result from oppression and intolerance, rather than distress inherent to being transgender. Many queer activists are now working to remove transgender identity from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in much the same way that homosexuality was removed from the DSM decades ago. Conversely, some argue that the diagnosis is an important tool to obtain health insurance coverage for the procedures and medications used in transitioning.
Ultimately, beyond the controversy over the DSM diagnosis, the medical profession still regards transitioning differently than other medical treatments. The current standard of care requires that any person seeking to transition must be first cleared by a psychiatrist to prove that they are of sound mind and are able to comprehend the decision that they are making. No other operation or treatment in medicine (including plastic surgery, experimental drug trials, or forgoing CPR/life-saving treatment) requires this prior approval universally.
Health and Transitioning
Though research is sparse data suggests that the mental health of trans-people improves after transitioning; pre-transition suicide attempt rates are estimated to be has high as 41% compared to suicide rates below <1% following sex reassignment surgery. However, depression and anxiety rates are higher among transgender individuals than the general population both pre- and post-transitioning, likely relating to the societal stigma and barriers faced by transgender individuals. There are also important physical health considerations, that influence one's experience of transitioning. For example, hormones are not considered medically safe for all individuals (for example estrogen replacement is contraindicated for people that smoke or have high blood pressure). Individuals must weigh the risks and benefits of any given medical transitioning intervention. For example, estrogen may help a male-to-female transperson develop breasts and redistribute body fat, but may increase the risk of blood clotting, impact liver function and worsen high blood pressure. Similarly, testosterone may help female-to-male trans-individuals grow facial hair, deepen their voices, and build muscle, but it may also cause mood shifts and negatively affect one's liver.
Barriers to Transitioning
Transphobia exists in families, workplaces and communities. Many transphobic sentiments are not intentionally malicious, but are instead the result of ignorance; regardless of their origin it is important that we as allies acknowledge and work to address transphobia and the many barriers it creates for transitioning.
- Ostracism and Violence: Some trans-people are ostracized from their families or support circle, some lose their jobs and even their houses for coming out as transgender. Transgender individuals also face alarmingly high rates of violence and may be the target of hate crimes; according to one national study 26% of transpeople have faced physical violence because of their transgender identity.
- Discrimination: In most states, including Michigan, their are no state laws banning discrimination based on gender identity and gender expression, putting people transitioning in the workplace in a particularly vulnerable situation. Job discrimination due to gender expression contributes to the high poverty rate among transgender individuals; it is estimated that transgender individuals are four times more likely to be in poverty than non-transpeople. Some cities and institutions, including Ann Arbor and the University of Michigan, have adopted internal anti-discrimination policies.
- Legal: There are a number of legal hurdles to consider when transitioning, including the process of changing one’s name and gender on important documents. (see Part 2: Legal Barriers).
- Access: An estimated 50% of transgender people lack any form of insurance. As a result, many transgender people miss out on important routine screening for heart disease, cancers, STIs, and other illnesses. In the United States, transgender people with insurance often cannot access medically necessary care because most public and private insurance policies exclude coverage for transgender-related services (notably, Medicaid does cover hormone therapy). In contrast, in Great Britain, the Netherlands and Australia procedures such as sex reassignment are accepted as the standard of care and are paid for by national health insurance. If they can access medical services, transgender people may have a hard time finding a doctor they trust or a doctor knowledgeable about interventions such as hormone therapy. These barriers lead some transgendered individuals to take potentially dangerous action such as seeking black-market hormones to facilitate their transition.
Profile of a Public Transition: Chaz Bono
Chaz Bono is a spokesperson for transgender rights, having transitioned from female to male in the public eye between 2008 and 2010. He was born Chastity Bono to entertainers Sonny and Cher. Chaz is a writer for the Advocate, a national LGBT magazine. He has written three books about his life as a trans-man, including “Transition” and portrayed his experiences in a documentary called “Becoming Chaz.” Most recently, Chaz appeared as a competitor on Dancing with the Stars.
Compiled with information from the National Center for Transgender Equality, National Gay and Lesbian Task Force, and World Professional Association for Transgender Health
Brought to you by OUTbreak and BGLAM
Additional Sources:
-American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders I-V. Washington, DC, 1994.
-Dean et al. 2000. Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns. Journal of the Gay and Lesbian Medical Association. 4(3): 102-151. (DOI: 10.1023/A:1009573800168)