Gender Identity, sexual orientation & disclosures in healthcare - PowerPoint Presentation

Gender Identity, sexual orientation & disclosures in healthcare Terrell Foster ThD /PhD & Jon Haley

Learning outcomes Upon the successful completion of this discussion, you will be; able to distinguish the difference between gender and gender identity; able to distinguish the difference between gender identity and sexual orientation; be able to explain how gender roles dictate everyday life; Be familiar with basic terminology surrounding gender theory ; Understand why LGBT individuals don’t disclose to healthcare providers .

What is gender? ”Gender is a language, a system of meanings and symbols, along with the rules, privileges and punishments pertaining to their use—for power and sexuality.” 1 1 Wilchins , R. A. ( n.d. ). Derrida and the Politics of Meaning. In Queer theory, gender theory: An instant primer (pp. 38-52).

Gender Binary A social system that requires that everyone be raised as a boy or girl (dependent on what sex you are assigned at birth ) Forms the basis for how:You are educated what jobs you can do (or are expected to do)How you are expected to behaveWhat you are expected to wearwhat your gender and gender presentation should bewho you should be attracted to/love/marry, etc.

The social construction of gender The building blocks of gender are socially constructed statuses. Western societies have only two genders; “Man” and ”Women.” p3 We assume gender is a “built-in” feature of society The meanings we give to gender depends on people actually ”doing gender” Individuals are born sexed but not gendered Gender is a learned idea that begins at birth from observation Acceptable gender identities are standards set by ones one society Gender identity varies in the world “Gender is a process of creating distinguishable social statuses for the assignments of rights and responsibilities”

Terms to Know Assigned Gender The gender a baby is given upon birth, usually based on the child’s birth sex. Gender Identity How we feel about our gender in our hearts and minds. Gender Expression/Gender PresentationHow we show our gender to the world through external choices (e.g. dress, behavior, hairstyle). Cisgender Describes a person whose birth sex and gender identity align. B irth Sex/Biological Sex A specific set of genetic, chemical and anatomical characteristics that we are either born with or that develop as we mature.

Terms Cont. Binary Gender The faulty concept that there are only two genders: male and female. Genderqueer A broad descriptor many people use to indicate a person does not identify as either male or female. Transgender Describes anyone whose gender identity and birth sex do not align. The word should be used as, “transgender,” not “transgendered.” For example, “My brother Sam is transgender. His birth name was Samantha.” Preferred Personal Pronouns In addition to the traditional pronouns (he/him, she/her, they), some people prefer to use gender-neutral pronouns, such as ne, ve , ze/zie and xe. If you don’t know an individuals preferred personal pronoun, it’s always best to ask.

Explanation of the above image On the top we have “woman” and on the bottom we have “man”—two terms you are likely already familiar with Your gender identity is your own combination of “Masculinity and Femininity.” There are four different identities (of infinite possibilities), each presented as a sliding scale Please note the “NO” symbol located to the left of “Woman-ness & Man-ness” This indicates a “lack of,” meaning not having feelings of Woman-ness or Man-ness Gender identity is about how you think about yourself; and internally interpret the chemistry that composes you (e.g., hormone levels). Do you think you fit better into the societal role of “woman,” or “man,” or do neither ring particularly true for you? It has been accepted that we form our gender identities around the age of three, and after that age it is incredibly difficult to change them 

  Explanation of the above image On the top we have “feminine” and on the bottom we have “masculine”—the two expressive terms related to “woman” and “man.” To the left, we again see the “NO” symbol. Again, the idea of expression is presented as a sliding scale, your own combination In the bottom left chart, you will see, “androgynous,” which describes an ambiguous or mixed form of expressing gender Gender expression is all about how you demonstrate your gender through the ways you act, dress, behave, and interact—whether that is intentional or unintended; interpreted by others perceiving your gender based on traditional gender roles (e.g., men wear pants, women wear dresses); and something that often changes from day to day, outfit to outfit, event or setting to event or setting—It’s about how the way you express yourself aligns or doesn’t with traditional ways of gendered expression.

Biological sex refers to the objectively measurable organs, hormones, and chromosomes you possess  Being female means having a vagina, ovaries, two X chromosomes, predominant estrogen, and you can grow a baby in your stomach area Being male means having testes, a penis, an XY chromosome configuration, predominant testosterone, and you can put a baby in a female’s stomach area Being intersex can be any combination of what is described above For example, someone can be born with the appearance of being male (penis, scrotum, etc.), but have a functional female reproductive system inside.   Explanation of the above image On the top we have “female” and on the bottom we have “male,” the two biological sexes we all grew up knowing about In the bottom left, we have a new term “intersex,” which describes someone whose sexual organs are not strictly male or female. Note the “NO” symbol again, to the left of Female & Male. The term “hermaphrodite,” which you’ve likely heard used to describe an intersex individual, is frowned upon as “hermaphrodite” is a stigmatizing word that means someone who is entirely male and  female, a biological impossibility

Intersex Conditions

Explanation of the above image On the left we have “sexually attracted to,” meaning your desires based upon the other individual being women/female or men/males. On the right we have “romantically,” meaning, who you feel drawn to romantically, spiritually. or emotionally. It is the combination of “Sexually attraction” and “Romantic Attraction” that make up an individual’s sexual orientation. Note: The phrase “nobody” is listed to the left of each graphic. This lack of sexual or romantic attraction is known as “ asexuality ,” which is the lack of sexual attraction to others . Sexual orientation is all about who you are attracted to, physically, spiritually, and emotionally If you are male and you’re attracted to females, you’re straight.  If you’re a male who is attracted to males and females, you’re bisexual.  And if you’re a male who is attracted to males, you’re gay.   This is the one most of us know the most about. We hear the most about it, it’s salient in our lives, and we understand where we stand best.  It’s pretty cut and dry, right?  Maybe not as much as one would think.

What is the definition of transgender? “Transgender is an umbrella term for persons whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth .” “Gender identity refers to a person’s internal sense of being male, female or something else; gender expression refers to the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice or body characteristics.”— American Psychological Association Answers to your Questions About Transgender People, Gender Identity, and Gender Expression. (n.d.). Retrieved December 11, 2014, from http://www.apa.org/topics/lgbt/transgender.aspx

What is the definition of transgender? “A term for people whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth. Transgender is a broad term and is good for non-transgender people to use. “Trans” is shorthand for “transgender. ”— National Center for Transgender Equality. TRANSGENDER TERMINOLOGY. (2014, January 1). Retrieved December 7, 2014, from http://transequality.org/Resources/TransTerminology_2014.pdf

Communication WHAT TO ASK A TRANS PERSON IF IT’S OK TO ASK QUESTIONS!! PREFERED PRONOUNS HOW THEIR DAY IS. WHAT NOT TO ASK/SAY to A TRANS PERSON WHAT THEY “REALLY” ARE HOW THEY HAVE SEX HAVE YOU HAD SURGERYBATHROOM USAGE“YOU PASS REALLY WELL”“IF YOU DID _____ , YOU’D LOOK MORE ______”THEIR “REAL” NAMEWHAT TRANS IS

Terms that are offensive “TRANNY” “SHIM” “SHEMALE” “HE-SHE” “NOT A REAL ____” “I LOVE TRANS GUYS/GIRLS – THEY’RE SO HOT” NOTE--“You should always Refer to a transgender person by their preferred pronoun ”

How many people identify as transgender? Gates, G. (2011, April 1). How many people are lesbian, gay, bisexual, and transgender? Retrieved December 8, 2014, from http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf

Changing of Birth Certificates Nevada Administrative Code: Nev. Admin. Code. Ch. 440, § 130 (2006). Text: 1. The state registrar may prepare a new certificate of birth for a person having a sexual transformation only upon order of a court of competent jurisdiction. 2. The court order must specify those facts to be changed on the new certificate. All other items must remain as on the original certificate. Summary: Nevada will issue a birth certificate reflecting the proper sex. See : http://www.lambdalegal.org/publications/changing-birth-certificate-sex-designations-state-by-state-guidelines#N

Suicide rates “Transgender people experience an unemployment rate at twice the national average” “47% of respondents said that they had been fired, not hired, or denied a promotion due to their gender non-conformity”

Famous Transgender People Chaz Bono , the son of Cher and Sonny Bono, was already a gay rights figure but in 2009 revealed he is a transgender man. Kye Allums the first publicly transgender person to play NCAA Division I college basketball for George Washington University. Laverne Cox competed on Vh1’s I Wanna Work For Diddy , making her the first African-American transgender woman to be on a mainstream reality TV series . OITNB Isis King made history as the first transgender model to compete on the 11 th  cycle of America’s Next Top Model .

Transgender people in government Stacie Laughton — New Hampshire House of Representatives Althea Garrison— Massachusetts lawmaker Stu Rasmussen— Mayor Silverton, OR. Michelle Bruce—Councilwoman Riverdale, GA Jessica Orsini—Alderwoman Centralia, MO Victoria Kolakowski — superior court judge Alameda County, CA Amanda Simpson— America's first openly transgender presidential appointee, by Obama in 2010 There are currently only 7 (known) people who are transgender in government in the United States! Broverman , N. (2012, November 14). Meet the Shockingly Small Pool of Trans Elected Officials. Retrieved December 7, 2014, from http://www.advocate.com/politics/transgender/2012/11/14/meet-shockingly-small-pool-trans-elected-officials?page=full

LGBT Disclosures to healthcare providers

Why don’t lgbt individuals disclose to their provider? Fear of stigmatization Fear of judgment Historical treatment of the LGBT community Implicit biases Shame Sodomy laws– SCOTUS Lawrence v. Texas (2003)

Historical treatment of trans identified peoples the Diagnostic and Statistical Manual of Mental Disorders (the DSM )--- from the American Psychiatric Association 1973 the DSM eliminated homosexuality from it’s list of disorders Gender Identity Disorder first described in DSM 3 (1980) Being Transgender was considered a mental disorder until 2013! In 2013 “gender identity disorder” was removed from the DSMDSM 5 released in 2013 eliminated this diagnosis renaming it to “Gender Dysphoria”“This shift reflects recognition that the disagreement between birth gender and identity may not necessarily be pathological if it does not cause the individual distress. Chan, A. (2013, June 6). Gender Dysphoria : DSM-5 Reflects Shift In Perspective On Gender Identity. Retrieved December 10, 2014, from http:// www.huffingtonpost.com /2013/06/04/gender-dysphoria-dsm-5_n_3385287.html

LGBT History timeline 1935 --“Successful ” electric shock therapy treatment of homosexuality reported at American Psychological Association meeting 1941 - -Transsexuality” first used in reference to homosexuality and bisexuality 1945--First known female-to-male sex change surgery, on Michael Dillon in Britain 1952 --American Psychiatric Association includes homosexuality under “sociopathic personality disturbance” in its first official list of mental disorders1966--First transgender public uprising at San Francisco’s Compton’s Cafeteria

LGBT History Cont. 1968 --The American Psychiatric Association moves homosexuality from “sociopathic” category to “sexual deviation ” 1973 --American Psychiatric Association removes homosexuality from its list of mental illnesses 1993 --“Don’t Ask, Don’t Tell” U.S. military policy adopted (repealed in 2010) 1996 --Congress passes Defense of Marriage Act (DOMA), forbidding federal recognition of (and benefits for) married same-sex couples ( repealed in 2013) 2015 --Obergefell v. Hodges, SCOTUS passes marriage equality 5-4

APA Resolution C alls on APA to: Support legal and social recognition of transgender individuals consistent with their gender identity and expression; Support the provision of adequate and medically necessary treatment for transgender and gender-variant people;Recognize the benefit and necessity of gender transition treatments for appropriately evaluated individuals. Adopted by the American Psychological Association Council of Representatives August, 2008 The Resolution on Transgender, Gender Identity and Gender Expression Nondiscrimination

disclosures in healthcare? “A 2008 survey of 452 New York City men who had had sex with other men within the past year found that 39 percent had not disclosed their sexual orientation to their doctors.”1 http:// www.nyc.gov /html/ doh /html/pr2008/pr052-08.shtml “These findings show that the stigma of homosexuality can be harmful to people’s health…because of the fear and discrimination that still surround coming out.” -Dr. Monica Sweeney, Assistant Commissioner NYC.

Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men 1 METHODS The study examined attitudes toward heterosexual people versus lesbian and gay people in Implicit Association Test 2,338 medical doctors 5,379 nurses8,531 mental health providers,2,735 other treatment providers, 214,110 non-providers 2015 study published in the American Journal for Public Health 1 Janice A. Sabin, Rachel G. Riskind , and Brian A. Nosek . Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. American Journal of Public Health: September 2015, Vol. 105, No. 9, pp. 1831-1841. doi : 10.2105/AJPH.2015.302631

Implicit bias test The IAT measures the strength of associations between concepts (e.g., black people, gay people) and evaluations (e.g., good, bad) or stereotypes (e.g., athletic, clumsy). The main idea is that making a response is easier when closely related items share the same response key. https:// implicit.harvard.edu

Study Cont. RESULTS Heterosexual men were found to have more implicit biases than heterosexual women Heterosexual nurses “held the strongest implicit preference for heterosexual men over gay men.” CONCLUSION Implicit preferences for heterosexual people versus lesbian and gay people are pervasive among heterosexual health care providers. Future research should investigate how implicit sexual prejudice affects care.

What’s next? Take the test! https :// implicit.harvard.edu Be aware of our own personal biases You don’t have to change your mind, just your attitude Create a safe space for clients/patients for them to be open and comfortable Attend a Safe Zone training READ: A Living Memory LGBT History Timeline (included in handout) Pay attention to the resources and credits

Thank you Terrell Foster ThD /PhD myuncleterry@att.net Jon Haley MSW Student jonathonhaley@unr.edu