Introduction to Transgender Equality Facilitated by Equality South West

Personal Identity  Sex – determined by physical examination at birth  Gender – a social construct  Sexuality – how we express our physical desires

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 gender 1 and develops whilst still in the womb. 1 Atypical Gender Development – A Review International Journal of Transgenderism

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

Britain today  Approximately 21 in every 100,000 people in the UK is transsexual (GIRES)  Only 20% felt they encountered no problems 2  34.4% said they thought about or attempted suicide or self harm 2 2 Engendered Penalties – Whittle, Turner and Al-Alami – The Equalities Review, Feb 2007

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.

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)

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.

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

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.

Vulnerability  Social exclusion and bullying and abuse  Isolation  Loss of family and home  Potential loss of place of employment  High anxiety states  Paranoia

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

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

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

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.

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!”

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 surgery- based 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

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.”

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”.

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.”

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)

“Education of health and care professionals in Trans issues.” “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.” “The people who most need to change are the media.” “It is very easy to oppress a minority, for example, on the basis of seemingly harmless office banter and allowing a minority of bigoted people freedom to express homophobic views unchallenged.” Mental issues concern me - I do not want to get to the point of dependence without a quality of life - e.g. Alzheimer's” “I do feel restricted in what form of voluntary work I seek to undertake particularly where it involves children, older people or religious groups”

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.

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

Break

My Personal Journey

Round Up

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:  SW Transgender Equality Network – to get involved and find out more, including local groups, research and general information:  Transgender Information: Text:

Thank you for listening