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(Mis)understanding transgender health

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(Mis)understanding transgender health
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In an age of increasing transgender awareness, why is it that transgender health remains a subject of great controversy between doctors and patients? How can the Internet help us understand and address this problem?
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today but sadly I don't have I just have me walking talking not even many pictures accept this beautiful snake and and 1 of the interesting things about the snake is we've got this idea of the symbol of health being a staff with 2 snakes and essentially the symbol of commerce and so today I'm not going the symbol of commerce going with the the single Greek snake of health data then going to be talking about trends health I gonna talk a little bit about what I mean by trends I'm going to talk about why there are problems with trends health and specifically drawing upon research that I've been doing in the United Kingdom which a large-scale research project over 6 years it's
a qualitative projects dealing with data such as people's conversations and stories narratives rather than numbers and I drew upon websites Eiger upon the documentation from various official organizations and upon social media platforms conversations happening in places like Facebook and Twitter to be talking a little bit about some data from a number of large European surveys to give a little bit of context I it talk about why the Internet is important what the Internet is important for trans people understanding themselves and also why the Internet is important for understanding how trans people understanding themselves in coming to terms with maybe bridging some of the happening between the ways that trans people understand themselves and the ways that perhaps trans people or understood differently by doctors so I and I'm going to begin by looking at a number of key concepts because a lot of this is quite contested terrain so I'm going to say what all I mean of where I'm coming from for the purposes of this talk uh so you can understand that and also I realize that there might be different knowledge is in the room and different people might have different understanding so hopefully we can start in roughly the same place and use some fairly complex ideas but it's something that you know if you lose the complexity sometimes you lose some other kind of the real bite from this so what is trends strands is quite a new idea of the term uh goes back only to the late nineties when it was based upon the idea of transgender this got roots that go back a long way from as as a contemporary Western concept that can be traced to anything from 19th-century sexology to the gay liberation movement but I'm looking at what's happening now and so trends it's kind of often associated with the idea of trans sectionalism and so a really easy example to sharing coming from all use myself but I'm a trans woman or a transsexual woman and what that means is I was assigned a male gender at birth and some doctors and my parents looked at me and said hey look that looks like a boy will bring it up as a boy and I grew up in society in that way and then I grew older as like a actually makes more sense to understand myself as a girl and I underwent what's called transition which is a social but it can also be a medical process of moving physically from 1 gender to another but that's not the only way to be trends of the terms transvestites and cross dresser but interestingly at the idea of transvestitism comes from Berlin where it's going by uh Magnus Hirschfeld if you ever see that really famous picture of the Nazis burning books that was Hutch Feltz and sexological institute which is a really interesting piece of history that's lost and something that was forged in Berlin it was actually really the place where early ideas about more liberated ideas of treating trans patients 1st came about but transvestites and cross dresser are often associated with someone who you know is is wearing different clothes presenting themselves presenting their gender differently and by presenting their gender differently I mean and that the way they might the mannerisms although and all the way they dress and and the way they interact with the world and transgender was originally coined is an umbrella term for these and also the people who don't fit what happens if you have a transsexual who doesn't have a physical transition what if they just transition socially but as it turns out this doesn't entirely described people's experiences and so this language such as gender Quæro non-binary which is going to explain the experience of people like hey I don't feel like my gender is either female or male and that's gender in terms of social there's also an idea of intersects which is about people's bodies and as as they're born but I'm not gonna talk about that today and what we've seen since this is this proliferation of terms people go hey I think I want to understand myself better and these are just a few of the terms and they're all from an angle from context so if you look outside the English language is even more always was even more complexity in ways that people can understand gender beyond the binary of female and male perhaps and also in terms of an you know ways of interacting with the gendered world and so and this is quotes um I really like from Stephen Whittle in the introduction to The Transgender Studies Reader and he says a translate density is now accessible almost anywhere to anyone who does not feel comfortable in the gender role they were assigned at the so that sending it really whites we've gone from these individual identities and experiences to his overarching idea that's what transit strands is almost an alliance so at the same time as we're breaking down individual experience into these ready specific terms we've got these overarching idea people come together and say hey we're Roger gender diverse and perhaps you've shared interests around that the another term is useful to point right now is 6 so since like trends comes from the Latin root and where trans means on the other side of and in terms of what I'm talking about today I would say it's on and of a side of rather than the other side is not just 2 sides not just the binary syst means all on the same side as the so if you were assigned a female gender and you're like K I quite like dressing like a woman whatever that means in the way that you feel comfortable with that and you're like AIC feel comfortable as a woman that I don't really want to change my body and I don't really want to change how do things socially although I might want to oppose traditional gender norms you might be 6 the so it's an antonym it's 2 transistors to translate and straight or Hector sexual to gay or homosexual so how did all these strands language happen the answer is on the internet which played a really important role because you've got these invisible trans communities prior to the nineties lots of trans people want immediately obvious to other trans people and because I'm we either try and pass this test I'm all because people are too afraid to be openly trends if they don't pass and you've also got very small communities sometimes in big cities you can't connect the Internet changes that's and this great quote from again from Stephen Whittle from the brilliantly titled the Trans-Siberian male way traffic is a great pie tie for an academic paper and it's really nineties you know it's all like the virtual self in cyberspace but he still got really important point he says that the it is the virtual self the node of communication inside space that has allowed an actual self to be recognized so in this way people you might be visible you might be like hey don't look at me I'm a bit scared and say to each other hey look at you know look into I am declare themselves to be on the internet and in this way the technology of
the home home-PC back in the day before mobile phones and tablets and the internet has been a catalyst for enabling trans people to come together and build community the and this has developed so now of course you've got people could talk strategically about things like health so this quotes and is from a report by the EU an Agency for Fundamental Rights and a Polish psychiatrist says in the virtual world today patients the longest seen anonymous doctor their research and read reviews so trans people talking about health and is gone beyond who are way and it's going to what do we do how do we live our lives this to more ideas and entrenched right at the beginning now what is transphobia and transphobia is prejudice or a rational dislike or hatred or fear it's an individual interaction between people the trans phobic interaction can be an interaction where it's like a I don't like you you know an active hatred or discrimination and then you have sensors spaces comparible too many ideas of sexism or homophobia but there's also an idea called cisgender and Syst gender rhizome if we're going back to see it's idea that the world is built forces people is the assumption that everyone is system should be set the and there's a quote from the attach Kennedy here that's a really like and and she says assist gender rhizome represents a systemic erasure and problematizing of trans people by assuming everyone and essentializing of gender as binary biologically determined fix the birth mutable natural and externally imposed upon the individual the the the so what does this have to do with health well effectively transphobia insist gender is a pretty common and go look at some statistics from European Union surveys in a minute to show how that works out that these some quotes from my own research and I'm not going to read for everyone because is quite a lot and this is a tiny minority I went and spent about 2 minutes going care all interested quite so his loads yeah of the situation is in the UK historically and in in recent history the national health services very popular it's very well trusted there's a lot of faith in it on so so it it it's a it's a health system that inspires confidence in many ways has been there's nothing quite often my head a few surveys done on this if you look at the NHS satisfaction you'll find quite a lot whereas I found the trans patients overwhelmingly did not trust that they would be treated well by the doctors so an example of this can be found in the top quotes out where a patient says I'm hiding my anxiety and self harm from clinic doctors because I don't feel safe in telling them about this the so why is this 1 reason is that transphobia is common in health settings discrimination and I look at that in a moment but it never is that the patients can't necessarily trust the doctors to and understand them and to understand what it means to be trans to understand what the patient experience is and I'm going to come back to that after the you bets with a look a bit more so my own research examples the so looking at the European context of of got some quotes to begin with a from a 2013 piece of research in this is the paper published on in 2014 and it found that over half of and trends people reported being discriminated or harassed against because there were trends and the really important thing to bear in mind here is this differs this number differs quite a lot so the moment you look at people who were visibly trans or people who out 2 strands the number rises if you look at particularly at risk groups like transgender men and transgender women as opposed to cross dressers and actually the uh going to point out quickly here the terms a could test you could say well maybe across stressor can be a transgender a so let's say transaction management sexual women if you look at particular groups again be the prevalence of harassment and discrimination rises and so on I over 1 in 5 reported being discriminated against in health settings In the past year so you can see is is common this is not real life time just of in the last year that experience this and this raised to 30 % of out trans people showing how is it increased the moment trans people visible but it's not just about this level of you know discrimination arrestments there's also an issue with health professionals who want to help the lack the necessary information to do so and as you can see from this study conducted in 2008 and 30 % of respondents to the survey said that they encountered help health profession who wants to help but lacked information the so and so 1 element of facts is that there's this binary idea of what gender race the the and this can either be well you either a man or a woman and that's the way you always are all or it can be well OK someone can be translated they can transition but they've got to end up as a man or woman it's a binary idea of gender i and the 2016 Fundamental Rights Agency reports on an LGBT health care in the European Union noted that the majority of health care professionals including specialists gender specialists appeared categories gender sexuality in a binary system including assuming the trends or transgender just means sexual but doesn't include gender Quæro non-binary possibilities the so in this way we can see how it's in in some ways assist genderist understanding is binary and and some other professionals who might be OK trans people exist and you might say well at the same time you know your genders is defined at birth so that's going to define for the rest your life what you do OK so in this way we see this isn't just about transphobia it can be very well-meaning practitioners but as the cis genderist idea which crosses culture which affects the implementation of health care provision and excuse me a moment I've got cold it's the worst thing thank you feels so terrible model with stage sorry offering to that would be lovely very slick and professional important and this is Republican we have to be slick and professional it's going to be on the Internet regard OK controller digital selves right I'm so 1 thing I particularly found out in my data was that there were these different understandings between practitioners and patients about what it means to be trends and this 1 of the key things affected health care provision so I'm going to look at 3 examples and I've got a loan to these just free what is missed gendering rights and this gendering
is a failure to recognize trends densities is real through not referring to a trans persons with the correct gender so I found many instances of this and in a sense what it's saying when when the trans patient sees a medical professional and and they want to be perceived in a certain way in the medical profession is like no you're man and they're like are few terrible about this and then you the you have a problem and whereby this this this knocks a a an understanding patterns so I've got caught here from my field work diary of not the original quite from the participant because it was in a private Facebook group on the what happened is the individual said that they wouldn't it's gender history available to them so in this case the the the dodo was actively ignoring their gender and imposing any binary cis genderist idea of what it means to be human upon these patients in a way that made them feel uncomfortable and and and you know like all maybe I should go to hospital again bad things will happen I'll feel bad and so that's 1 example of how it there's a radically different understanding of gender between doctors and patients however you can get problems when trans patients are recognized as trends so and trans broken arm syndrome it's not it's not a real medical thing it's a term coined by trans communities in the UK on that is best illustrated by a really bad joke really unfunny joke based it's not a very funny situation but also ways for consumers help people get through difficult problems and so I suppose if you got 2 people on 1 says Dr. Dr. uh broken my arm and the doctor says so tell me about your gender the really of broken my no no really tell me about your gender on what they see is is it's this understanding of trans justice transition and boiling down and someone's entire being to this idea that maybe they're transitioning from 1 gender to another and this can influence health negatively and so got examples of actual broken arms being a problem when someone's like no please talk about my broken arm a doctor's like but I really want to know about your genital surgery and on the reasons why you you might want to do that actually to talk about and for instance you might wish to ask about OK how's the hormone regime affecting your bone density but there so many examples where this is inappropriate he brought up the even when is a real reason for the doctor to ask about it the patient doesn't trust them so an example of got here and of course it doesn't just apply to broken arms is is a patient who has a mental health issue and they're like please help me and then the clinics is no we can't do that I'm afraid you've got your trans that's a mental health problem and so we'd like you to see the gender clinic about that and agenda clinics as well know where a specialist gender clinic we don't deal and with bipolar you're going to have to go to someone else and this means people don't get treatment because of trends broken arms injury matters of regarding of trans just transition I'm and the final example I'm going to use here is medical keeping for individuals who want specialist services for physical transition um and so what we've got here is a conflict between medical expertise medical definitions and trans language and experience and this is a bit more of a complicated quote because it's from Twitter and inevitably there's a Twitter forms the convention of speaking so you assume everyone knows we're talking about and so I'm just gonna talk for a little bit so you've got a patient she's going to a psychiatrist and she's hoping the psychologists were offered for gender click in gender clinic can assess her and your translation not trans and she can have treatments the gatekeeper in this instance the psychiatrist say is well you're not actually a trend sexual you or a dual role transvestites and what this means is you like dressing is a man summertime and 1 some of the time and you don't need a physical intervention and the individual says on non-binary and the psychiatrist as well of got the uh World Health Organization International Classification of Diseases here and that saves your over Duro transactional you're a sorry a juror transvestites or you're a fetishistic transvestites or your transaction the person says on non-binary but please I really need this and then you know they have to have a long argument in order to get the referral and so we have this these very rigid ideas about how treatment operates how treatment is experienced and also what is the basis for appropriate treatment such as the guidance and this comes into conflict with the individual's understanding of themselves through gate-keeping so what do we do about this I've got a number of suggestions there's a lot of conversations about education within trends groups but also Buttiglione engineers were trying to help trans people and this idea yes I will do some education will tell people about that but often there's this kind of basic trends 101 idea you know that the the absolute basics which ignores complexity and often ignores non-binary gender and another problem with it is often it's like I know we're going to educate everybody about the diagnostic and statistical manual of this is that of psychiatric problems or about the International Classification of Diseases so I'm just saying trans people exist or here's how we understand them isn't good enough instead practitioners need to recognize the diversity of translate identities and experiences and this needs to happen in medical school that's just beginning to happen in the UK beneath the haploid lot faster as well as kind of also talking to existing practitioners and it's not just amongst you know and general practitioners in my counter trans people also specialists need to take a step back and say maybe on not be up to the experts on this and that was the said yes this is complicated sometimes it can be a simple as asking asking a trans patients pay how do you understand yourself what your feelings how do you relate to ideas of gender and also there needs to be more conversations between policy and trans organizations who are absolutely willing to talk about these issues a lot of the time and finally I would say um trends against the experience but it's got to be recognized as this part of the real world part of the social world it's not just a problem someone has it's it's a way someone might happen to be and it might require medical assistance or it might not and so this is less about hey we need to completely change everything more about how about we talk to each other more constructively and listen to each animal constructively and so that's it's and I would love any questions you have feel free to contact me on twitter if you want to ask anything else thanks a lot
for a very much and a questions so we have a mike here Patricia and the like the yes please it so is said yeah how
proactive an hour practitioners supposed to be in terms of diagnosis when not us is it different did it is this is the perceived as being different than it takes someone who's In the binary self-identifies as binary it's talking to a practitioner by the at the boundaries of different somehow I so I
think there is there's there's 2 ways of looking at that are going to try and keep dividing alter have a sensible answer so on 1 hand there needs to be I think this
understanding that if a transpose and comes to a doctor they're not just there about the trends because it's seen as a medical problem a lot of friends people will go and see a practitioner the practitioner be all that good a medical problem that help with that and I think as a result trans people become defined by his medical issues which is really inappropriate because often we want to go to the doctor go ahead of but a really bad cold and sniffling of Republican but you know it's been here for days on end so that's 1 problem that needs to be this moving away and maybe a trusting patients to say OK I quite like to see you about a problem today it's about it being trans and the lot of patients what it's hard to do that and you know there we usually have to say I want help now as the difference between binary and nonbinary so as suppose it's an aspect of this gender is in that so it's easier for binary trans people to be recognized because to a certain extent we fits within societies model of what it means to be gendered it's like OK if own medicine women well you have transmitted trans women as well whereas because and on viruses talked about much as much which party we're talking about today released into the public discourse the bombarded people become more visible which means it's nonbinary person please I would like to refer to gender clinic and because you know I'm I'm where and the practitioners as what does that even mean on which is why it's so important to have this on for instance medical school curricula as well as through and you know kind of like active groups talking to each other and outreach programs no 1
will question the have a high and I'm Sarah and I'm most talking only about sex and gender medicine and I
always have the child within to address the trends community because as some in the medical field you have to rely on the sources of lying genes are and how your body is years influenced by that as well as hormones you all also in taking by transitioning and and I'm always struggling with how to address is like saying the the the the genes without using the binary Male Female cold to try and make it understandable to people can you help me and that I couldn't try so I really wish
should come to talk of afraid it was it was my very brief quiet by during the day so I'm sorry I missed it I 1 1 of the ways forward is
perhaps the gender last but we can still talk about sex at tributes of what I mean by that is gender is this artificial set categories and got a male and female and they had been entirely consistent OK so so women wear makeup but sometimes men wake-up that women have long had you know sometimes Mandarin into heavy metals so they have long hair and so the categories a kind of artificial bodies also tiny makes sense because there are a lot of people who intersects and and so for instance there might be people who have an X chromosome in the Y chromosome but they've you know they they also developed female so-called secondary sexual characteristics so what are the ways forward to this might be medical records saying OK is a genital configuration here is and the whole Marie-Jeanne and here is you know a chromosome regime for instances where it's relevance on and this is you know you it's very hard to do this because there's also instances of trans people often it's a relevance and if it if it's on the radical record than someone ago harvest thestatus trends and treat them poorly so it's really difficult issue I think we need to have conversations around but in the long term I think we need to be maybe just stepping away from gender it's saying here are the characteristics of a person the
OK thank you very much thank you very much Thank you Hi inside and this very specific topic uh and your flight is going and how how fast uh so you know many