Transgender and Gender Diverse Persons

A Handbook for Service Providers, Educators, and Families

Alfred F. Carlozzi, Kurt T. Choate, Alfred F. Carlozzi, Kurt T. Choate

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780815382966
• eBook ISBN: 9781351207096
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Transgender and Gender Diverse Persons offers mental health professionals and other caregivers information and best practices for working with transgender and gender diverse persons and their families. In each chapter, experts from a variety of fields provide an accessible introduction to medical, legal, educational, and spiritual care for transgender and gender diverse adults and youth within a range of contexts, including communities and schools in urban and non-urban settings. Appendices include helpful suggestions for online resources, as well as additional reading for practitioners, clients, and their families. With rich examples and personal narratives woven throughout, this is an essential reference for mental health professionals, as well as other service providers, educators, and family members seeking to address the needs of transgender and gender diverse persons in an up-to-date, inclusive manner.

CHAPTER ONE

What We Know About Transgender and Gender Diverse Persons

Kurt T. Choate

I write this chapter with a sense of hope that readers will augment their understanding of the beauty of this awesome and diverse world around us. This introductory chapter is meant for a variety of people and professionals seeking information about transgender and gender diverse persons. Furthermore, I have tried to write this chapter in a conversational tone so that the reader does not feel intimidated wading through too many scientific terms and psychological jargon. I attempt to unravel some of the questions readers may have concerning transgender and gender diverse persons. Perhaps you, or a child, sibling, spouse, client, patient, or student, has “come out” as being transgender or gender diverse, and you are looking to disentangle the mysteries surrounding these individuals within our world population.

This chapter reviews the differences between biological sex and gender, the development of gender identity, terms that are frequently used by transgender and gender diverse individuals, some important historical events specific to the transgender and gender diversity community, and the multicultural aspects that overlay transgender or gender diverse identities.

BIOLOGICAL SEX AND GENDER

“Is it a boy or a girl?” This is one of the first questions many expectant parents are asked when their friends and family find out they are having a baby. Although this is a seemingly innocuous question, it bears deeper thought into why individuals would start with this question. Perhaps the question is asked so that the person will use the correct pronouns with the baby (he or she), or perhaps it is asked so that the person will know what color of clothes to buy the baby once it is born. This answer to a very simple question will follow a person from birth onwards in their development. Birth certificates will need to be completed. Forms will need to be filled out at healthcare offices, and schools will require a single check mark in either the “Male” box or the “Female” box. On these forms, most of us know which box to check simply because our outer body and genitalia match how we feel inside. However, for some individuals, being forced to check one of these boxes can be an excruciating task because they may have an outer body and genitalia that do not match how they feel inside. Within this section, I hope to clarify the differences between biological sex and gender.

BOX 1.1

“Is it a boy or a girl?” This is one of the first questions many expectant parents are asked when their friends or family find out they are having a baby? Although this is a seemingly innocuous question, it will follow a person from birth onwards in their development.

Biological sex, very simply, refers to the genetic markers that are present at conception. That is, as the father determines the genetic sex of the child, if he passes along an X chromosome, the child will be biologically female. If he passes along a Y chromosome, the child will be biologically male. These genetic markers are immutable; they cannot be changed. They are within every cell of our body. Once the genetics are in place, fetal growth occurs that activates certain genes within the cells. However, simply because the genetic markers are present inside the child’s cells, a host of interactions with the environment will change or modify how the genes activate to express themselves in development. In fetal development, the genetic markers will determine whether undifferentiated gonads will develop into ovaries or testes. It is due to gonadal growth that hormones will flood the placenta and have a profound and lasting effect on the body and the brain of the child. By 12 weeks of prenatal growth, the external genitalia are developing into either a vulva or a penis. Before 12 weeks, the tissue that makes up the vulva and penis is undifferentiated. Due to genetics, gonadal growth, and the hormones that are present, this undifferentiated tissue will begin to change. Although this book does not go into the aspects of the intersex condition, some babies will be born with external genitalia that have both male (penis) characteristics and female (vulva) characteristics due to many prenatal factors that do not allow this undifferentiated tissue to develop fully. Furthermore, it is estimated that approximately one in 100 births has some degree of ambiguity in genitalia and that one in 2000 births has so much ambiguity of genitalia that the biological sex of the baby is uncertain (Blackless et al., 2000). For more information about the intersex condition, the Intersex Society of America (www.isna.org) provides excellent information and many resources for those who are interested.

Once the gonads form into either ovaries or testes and the associated hormones are released, they influence the developing brain in many ways that are not well understood. Recent research suggests that the release of testosterone at a particular point in fetal development might account for the development of a gender identity that is inconsistent with sex assigned at birth. A more detailed explanation of the impact of hormones on the brain in fetal development and how it contributes to the etiology of transgender is provided in Chapter 4 of this book. Throughout this book and the chapters that follow, authors are intentional about the separation of the terms “sex” and “gender.” As already discussed, sex refers to the genetic factors and physical anatomy of the person. However, the process of sexual differentiation, of becoming male or female, does not end with the formation of the genitalia. The brain also undergoes a differentiation into male or female, specifically areas of the brain associated with memory, basic motivational drives such as hunger, thirst, and sexual behavior, and emotional regulation. It is hypothesized that the hormones that flood the placenta during fetal gestation play a significant role creating groundwork for various aspects of future gender development (e.g., McFadden, 2002). Therefore, gender is a developmental process that begins in infancy and follows a person throughout their life. In essence, gender can be described as the characteristics within a person that may include masculine feelings, feminine feelings, a mixture of both, or even some other characteristics not common within the culture in which the person lives. These feelings are very subjective and individual to the person; yet, they exert a powerful force on various other qualities throughout their lives. Gender identity refers to this subjective sense of one’s gender as male, female, or somewhere in between or beyond the binary of male and female.

Gender identity and gender expression are necessary parts of our lives. Throughout our lives, society and culture have a profound influence over how we should act. Many cultures are built on the notion that gender comes in a binary form, that is, male or female. From this binary viewpoint, society has certain expectations, or defined roles, for how males and females should act or behave. For example, some cultures have expectations that women behave in a more submissive way toward men, provide the caregiving for their offspring, and tend to the needs of others. These social aspects of gender are called gender roles. Similar to parts in a movie or a stage play, men and women in society are expected by others to act in certain ways. Any significant deviation might elicit fear in those who adhere to the gender roles considered appropriate by their culture. Society and culture do not change overnight. However, in recent years, more visibility and open discussions about gender have led to greater acceptance of those whose gender expressions and roles do not follow society’s prescribed rules.

BOX 1.2

Gender identity refers to this subjective sense of one’s gender as male, female, or somewhere in between or beyond the binary of male and female. Depending on the culture in which the person lives, it may be unacceptable for the individual, whose gender identity is inconsistent with society’s expectations of males and females, to live, dress, and act, namely express their true gender self.

There are many factors that interact to create the sense of gender within an individual. Through treating a child as a “boy” or a “girl,” parents provide the catalyst for developing an understanding of the cultural norms and the expectations for the way a boy or girl “should” act. The biological factors that occur in the brain interact with parents’ caregiving treatment to influence their sense of gender. If the feelings of gender on the inside of the individual are incongruent with their body appearance or the expectations society places on them, significant psychological distress can occur. People whose gender identity and/or expression is incongruent with societal/cultural expectations for the appearance and behavior associated with the sex assigned to them at birth may be ridiculed, rejected, hated, and bullied by others. To avoid such derision and harsh treatment, gender diverse persons may suppress this desire to express whom they really are in terms of their gender identity. Over time, this constant suppression can become untenable, and can contribute to psychological distress, depression, and suicidal ideation. Although psychologists and other mental health practitioners have named this gender dysphoria, it is important to note that it describes the distress a person experiences, not the gender incongruence itself. This is an important distinction and the mindset of the medical and psychological community in western society has evolved significantly, as evidenced by the shift from the diagnosis of Gender Identity Disorder in the former DSM-IV-TR (Diagnostic and statistical manual for mental disorders, 4^th edn., text revision: American Psychiatric Association [APA], 2000) to the diagnosis of Gender Dysphoria in the DSM-5 (APA, 2013).

It is important to remember that the internal sense of gender or gender identity is not a conscious decision or choice. For many, however, their sense of gender identity is consistent with their assigned sex at birth and with their genitalia. The term typically used for these individuals is cisgender. The terms used for individuals whose assigned sex at birth does not match their gender identity are varied, such as transgender, gender nonconforming, gender nonbinary, gender fluid, gender queer, or gender diverse, among others. The overarching or umbrella terms that many of this book’s authors will use to group these various identities together are transgender and gender diverse. However, it is important for you to allow individuals to tell you the term they would prefer to be used when referring to them. If you are unsure, simply ask the person how they would like to be identified. It has been my experience that individuals are not insulted by this question; rather, they appreciate the willingness, effort, and time taken to acknowledge their genuine gender self.

Another aspect that often gets confusing is the sexual orientation of a transgender individual. Up until the year 2000, sexual orientation and transgenderism were believed to highly related to each other. However, the DSM-IV-TR (APA, 2000) explicitly stated that sexual orientation was a separate construct from gender identity. Transgender and gender diverse persons may be straight, gay, bisexual, or pansexual, just like cisgender persons. Therefore, it is important to allow the transgender or gender diverse person to express their sexual orientation to you, if they so choose, without confusing their sexual orientation with their gender identity. It is important to remember this frequently stated distinction between sexual orientation and gender identity: Sexual orientation refers to whom someone wants to sleep with, whereas gender identity refers to whom someone wants to sleep as, namely as male, female, nonbinary, or any other gender identity that they feel best describes them. Asking the transgender or gender diverse person who has chosen to reveal their sexual orientation to describe their gender identity can open up a deeper line of communication, help cultivate a sense of trust, and instill confidence that you understand that sexual orientation and gender identity are not the same thing.

BOX 1.3

All of us have our own unique way of expressing our gender identity; in fact, gender variance is a normal expression of human diversity. Looking at the variety of animal species across the planet, it makes sense that biology loves variation and differences. Therefore, acceptance of the variety of gender identities should be no different from accepting a person with blue eyes or brown hair.

FREQUENTLY USED TERMS ASSOCIATED WITH GENDER DIVERSITY

Many terms are used when discussing the transgender and gender diverse community. It may be daunting at first to try to understand and adapt to these frequently evolving terms and meanings. However, by seeking guidance from the gender diverse individual, educating yourself in current terminology, and a little patience, a person can integrate these terms into their vocabulary to provide affirming communication with those who identify as gender diverse.

Many individuals, once they have “come out” as transgender or gender diverse, may tell others what personal names and pronouns they prefer to be used when addressing them or referring to them. For example, a person who was assigned the sex of male at birth and is transgender may ask others to use the pronoun “she” instead of “he” while communicating with “her.” Other gender diverse individuals may prefer more androgynous terminology, such as “ze,” “hir,” “they,” or “them.” Whatever pronouns a transgender or gender diverse person chooses, mistakes in pronoun use are going to be made during communication. It is difficult to shift your mindset regarding personal pronouns used with a person you may have known for years; however, it is the effort extended to at least attempt to make this mental and behavioral shift that demonstrates acceptance and can build trust with a gender diverse individual.

Some gender diverse individuals are comfortable with a more nonbinary gender expression, whereas others seek medical interventions to reshape their physical body to more closely match the gender they internally experience. Transgender persons may feel sufficiently uncomfortable with the mismatch between their body and their identity to seek physical changes. They may seek hormonal and surgical interventions that bring their body and identity into better alignment. Transitioning is a common term used to describe a process of changing from one’s assigned sex to one that is more congruent with one’s gender identity. Various medical treatments help with this reshaping or transition.

Hormone therapy is a tool that rebalances hormones within the body which lead to biological changes consistent with one’s gender identity. Surgical reshaping of the body has many names, some of which may be more acceptable to the person than others. Older terms, such as a sex change operation, are no longer used in the current vernacular. Terms such as “gender affirmation surgery” and “gender confirmation surgery” better describe the outcomes expected from such procedures.

Once a person has undergone the medical procedures to align their body to match their gender identity, they may describe themselves as a FTM (female-to-male), a MTF (male-to-female), a trans male, a trans female, or simply male or female. However, some transgender individuals may struggle with exhibiting enough outward features to look like, or pass as, the gender with which they identify. Passing, as used by transgender individuals, is the ability to live congruent with one’s gender identity and blend into society without being detected as a transgender person. Furthermore, many individuals prefer to remain undetected as a transgender person and may choose to reveal that they transitioned only to those with whom they are close. By going stealth, they do not reveal that their sex assigned at birth is anything other than who they are now. In essence, some who are transgender or gender diverse may simply want to live as their authentic gender selves without having to explain their history of transition to anyone with whom they interact on a day-to-day basis. Others choose to be more open about their transition and their history. Although being transgender or gender diverse is not a choice, how and with whom to be open about it are choices that can be daunting for transgender and gender diverse persons.

Finally, many trans individuals desire to formally change various legal documents, such as birth certificates, driver’s licenses, and passports, to match their true gender identity. Changing gender markers on legal documents can be a time-consuming and so...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Editor Biographies
• Notes on Contributors
• Acknowledgments
• INTRODUCTION
• CHAPTER 1 WHAT WE KNOW ABOUT TRANSGENDER AND GENDER DIVERSE PERSONS
• CHAPTER 2 EXPERIENCES OF TRANSGENDER AND GENDER DIVERSE PERSONS
• CHAPTER 3 GENDER DIVERSITY IN NON-URBAN SETTINGS
• CHAPTER 4 AN INTRODUCTION TO THE MEDICAL AND SURGICAL CARE OF TRANSGENDER PERSONS
• CHAPTER 5 TRANSGENDER POLITICS: THE CIVIL RIGHTS OF TRANSGENDER PERSONS
• CHAPTER 6 INTEGRATIVE AND ETHICAL MENTAL HEALTH CARE OF TRANSGENDER AND GENDER DIVERSE ADULTS
• CHAPTER 7 HELPING TRANSGENDER AND GENDER DIVERSE YOUTH
• CHAPTER 8 FAMILIES OF TRANSGENDER AND GENDER DIVERSE PERSONS
• CHAPTER 9 CULTIVATING A SUPPORTIVE SCHOOL CLIMATE FOR TRANSGENDER AND GENDER DIVERSE STUDENTS
• CHAPTER 10 MATTERS OF RELIGION AND SPIRITUALITY FOR TRANSGENDER AND GENDER DIVERSE PERSONS
• APPENDIX A FURTHER READING
• APPENDIX B ADDITIONAL WEBSITES
• Index