Nikki Cairns, Bako Orionzi, Jennifer Janssen, Madia Ampey LGBTQ Terminology Nikki Cairns, Bako Orionzi, Jennifer Janssen, Madia Ampey

The Basics People will self-identify, so no matter how many terms we define there are more identities than we can teach

The Basics Terms change and not all terms mean the same thing to everyone Absolutely ask: “what does that term mean to you?” You will make mistakes, it’s okay Apologize briefly and move on Ex Gender and sexual minorities

Within the next twenty minutes you should understand this diagram and see how it applies to you and your future patients.

The Basics Sex = Anatomy (i.e. reproductive organs) and Biology (i.e. hormones and genetics) assigned at birth Bako at birth, doctor looks at external genitalia and “assigns” or states what the sex of the neonate is http://issuu.com/carlysoos/docs/lets_talk_about_sexuality_and_gender

Beyond the Basics Sex is not binary (male or female) Intersex: variation of sex characteristics (including chromosomes, gonads, and genitals) such that they do not align with the typical male or female designation Intersex can be controversial. Let them self-identify (DSD, VSD) DSD is the clinical term Bako

Beyond the Basics Intersex: Many identified at birth, some later (i.e. puberty) Many do NOT identify with LGBT community Disorder of Sex Development(DSD)is a clinical term Try: Variation of Sex Development (VSD) Avoid: “hermaphrodite” Many genetic conditions- Klinefelter’s, Turner’s, hypospadias, gonadal dysgenesis, etc. People born with a VSD have unique medical concerns different from LGBT patients. However, they do share some of the stigma and discrimination experienced by LGBT people within society and the healthcare system. Some VSD people identify as transgender or a gender minority but not all. Bako

Beyond the Basics Instead of biological sex, try using sex assigned at birth Using this term will not isolate any of your patients. This is mainly to ascertain the hormones, genetics and reproductive organs Bako

The Basics Gender = traditional or stereotypical roles, behaviors, activities and attributes that a given society consider appropriate for men and women (and non-binary genders) Many cultures have more than two genders, such as the two-spirit gender in many Native American cultures Jen - Many cultures, especially native populations have many genders, and not a binary male and female gender. In fact in many of these cultures such as in Hawaii transitioning throughout life is considered a growth process and moving closer to god. In these cultures transgender is not really even a term because transitioning across genders is not stigmatized. http://www.pbs.org/independentlens/two-spirits/map.html

The Basics Gender is Socially constructed More than anatomy and hormones Typically binary in the U.S. EVERYWHERE especially language Jen

Here are some examples of very gendered language. Jen

Exercise Try to tell the person next to you about the most recent tv show or movie you’ve seen without using any gendered language Jen

Beyond the Basics Gender is not binary for everyone A Gender Non-Conforming Person: someone who does not identify exclusively with the stereotypical masculine or feminine gender. They do not fit into the binary of male and female. Nikki http://www.transstudent.org/graphics

Beyond the Basics Types of Gender Non-Conforming Identities Androgynous (both masculine and feminine) Intergender (between male and female) Multiple gender identities (ex. bigender) Genderfluid (gender identity changes with time) Demigender (partial or weak connection to a specific gender) Cultural gender from a culture with more than two genders And many more...

The Basics Gender Identity = innate, deeply-felt psychological identification as a man, woman, or non-binary gender http://www.thetrevorproject.org/pages/spectrum

The Basics The pronouns and names that people use in reference to themselves are often informed by their gender identity NOT their sex assigned at birth.

The Basics Gender expression = how someone chooses to express themselves, which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine (or a non-binary gender) http://www.thetrevorproject.org/pages/spectrum

The Basics Gender expression: May or may not align with gender identity Does not have to conform to masculine or feminine stereotype EVERYONE expresses themselves in a gendered way

Beyond the Basics Gender expression may not equate with gender presentation http://www.thetrevorproject.org/pages/spectrum

Exercise Talk to the person next to you about three decisions you made this morning that express yourself in a gendered way. Give examples? Nikki

The Basics Sexual Orientation madia http://www.thetrevorproject.org/pages/spectrum

Sexual Orientation Components Attraction: Behavior: Identity: the gender(s) of the people whom you are attracted to, physically and romantically Behavior: who you have sex with Identity: how you self-identify madia Do not align predictably: • ~ 1/2 of women who report sex with women identify as straight ~ 3/4 of men who report sex with men identify as straight ~ 1/2 of older lesbian women reported past marriage to a man

http://lacigreen.tumblr.com/image/82437012695 madia examples, not all inclusive Heteronormativity…. http://lacigreen.tumblr.com/image/82437012695

Beyond the Basics LGB identities are often used in mainstream white Western culture Some people may prefer Same Gender Loving (SGL) or two spirit (in reference to their gender or sexual orientation) madia sometimes used homosexual and gay have negative connotations (usually in reference to masculinity) -- seen in black community native american; refer to bisexual or pansexual usually can be seen with gay or lesbian; non-binary

Beyond the Basics MSM (Men who have sex with men), WSW, TMSM(Trans men who have sex with men),TWSM, etc. can be considered problematic MSM was coined in HIV research and is established in research and education. These terms supposedly eliminate the issues with seuxal identity, however they are obscure definitions that may have little impact on identity groups madia Public health terms, not how people identify

Birth Assigned Nikki

Key Take Aways Sex assigned at birth is NOT always the same as gender identity Someone’s gender expression does NOT tell you what their gender identity is Gender identity and expression are NOT the same as sexual orientation Don’t assume, ask! Nikki

Exercise Take a few moments to think about your sex, gender identity, gender expression, and sexual orientation. If you have questions about any the terms or definitions we can help! Break Nikki

Beyond the Basics-Intersectionality Sexual orientation, gender identity and gender expression are all influenced by cultural norms, environmental factors, societal and/or familial pressures Bako This also includes race, socioeconomic status others, as well. How a person living in Brainerd, MN will have different factors influencing their identity compared to a person living in Atlanta, GA.

Beyond the Basics-Fluidity Gender identity, gender expression, and sexual orientation can be fluid People’s understanding of these aspects of themselves can change as they learn more about terminology and themselves Bako It can change over time as it fits their mindset and understanding of themselves. Caveat, if someone’s relationship status changes, only the person they are attracted to and having a relationship has changed, not necessarily their gender identity, expression or sexual orientation.

Beyond the Basics Fluidity does not mean that people’s current gender identity, gender expression, or sexual orientation is not valid. Respect people where they are. Trust people to know who they are. Youth especially. Not a phase, not experimental.

Transgender Is an umbrella term for people whose gender identity or expression is different from those typically associated with their sex assigned at birth Is an adjective not a noun: a transgender person not a transgender DON’T use transsexual this is an outdated term madia Transsexual is sometimes used for trans individuals who decide to use medical interventions

Transgender Not everyone with non-stereotypical gender expression will identify as transgender Is NOT the same as intersex Transgender people can have any sexual orientation, just like cisgender people madia Maybe instead of the word Intersex, use VSD? I think intersex is becoming a non preferred term now

Transgender Transition= the process of changing one’s sex characteristics, gender expression and/or lifestyle in order to better align with one’s gender identity including social, legal, and medical transitions madia

Transgender Social transition when a person makes others aware of their gender identity. It can include: Telling people their gender identity Changing the name they use in social interactions Asking others to use different pronouns, titles and other gendered language Changing gender expression Jen Emphasize that these transitions do not occur at the same time Socially, someone may express their gender differently at work versus in social life until they are ready to transition

Transgender Legal transition refers to changing one’s gender as recognized in legal contexts in one’s country of residence. This can include changing one’s name and/or gender on forms of identification including driver’s licenses and passports. Jen can change gender marker on birth certificate legally (not in all states but you can in MN) can change SS # but if you live in a state that does not allow for gender marker change, this can result in mismatch of license and SS#

Transgender Medical transition refers to the use of hormones and/or gender-affirming surgery to better align with one’s gender identity. NOT all trans folks want medical and/or surgical interventions and many insurance companies do not cover these services Jen 88% of LGBTQ respondents have health insurance, compared to 95% of the general population of Minnesota Most people in the US DO NOT have surgical transition (bottom surgery especially is not common)

Queer Is an umbrella term for people who want to identify as queer and/or who feel outside of societal norms in regards to gender or sexuality Nikki

Queer Was used as a derogatory term Has been reappropriated by the LGBT community Is an offensive term to some people Do NOT call someone queer unless they told you that you can

Queer People may identify as queer if they reject conventional identity categories in addition to L,G,B, and/or T even if they are heterosexual and embrace non-normative sexual practices

When Communicating with Patients People may use different pronouns in different contexts Do NOT assume what pronouns someone uses Ask what name and pronouns a patient would like you to use in reference to them

When Communicating with Patients: Use open ended questions and allow patients to self identify: What would you like me to call you? What pronouns would you like me to use? What words would you like me to use to describe your body parts? Tell me about your family. Just to make sure I understand what you mean, could you tell me how you define ___? More to come, 3rd question especially during sensitive exams even with cis people Nikki

References Trans Student Education Resources. Retrieved 8/26/2015 from http://www.transstudent.org/graphics The Trevor Project. Coming Out as You: The Spectrum. Retrieved 8/26/2015 from http://www.thetrevorproject.org/pages/spectrum