health lab by dr. joel
T
r
ansgender 101
HHomosexuality may not be easy for some people to accept, but at least it’s
fairly easy to explain. When one of my male friends said “How can you be gay?” I’d
respond “You know how you feel when you see Angelina Jolie? That’s how I feel
when I see Ryan Reynolds.” For female friends, it was even easier: “You know how
you feel when you see Ryan Reynolds? That’s how I feel when I see Ryan Reynolds.”
Almost everyone has felt lust, infatuation and love, even if they don’t want to ac-
cept that they can be stimulated by someone of the same sex.
Explaining what it means to be transgender is tougher. How do you describe
what it feels like to know that your gender is different than the physical body you
were born with? What can you liken it to for someone else?
Like many things that are hard to understand, transgender health issues are
often swept under the rug. Gay and lesbian health issues may not get enough
attention, but transgender issues rarely even get into the discussion. So here’s
your primer.
Let’s start with some definitions. In this case, they don’t clear things up; rather,
they nicely demonstrate the confusion.
Transgender:
-having personal characteristics (as transsexuality or transvestism) that tran-
scend traditional gender boundaries and corresponding sexual norms [Merriam
Webster]-is an umbrella term used to describe people whose gender identity
(sense of themselves as male or female) or gender expression differs from that
usually associated with their birth sex [American Psychological Association].
The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-
IV) is the current bible of psychiatry, and it doesn’t really define “transgender.”
Instead, it discusses “Gender Identity Disorder” as a male or female who feels a
strong identification with the opposite sex and experiences considerable distress
because of their actual sex.
Most of the transgender people I know prefer something closer to the second
definition, and understandably consider the DSM-IV a slap in the face. For the
record, homosexuality has not been considered a “disorder” since a revision of
the DSM-II in 1973.
Some members of the transgender community choose to TRANSITION to the
sex consistent with their gender identity. This can involve a number of medical
interventions. They range from simple devices to complex surgeries, and all of
The act of honestly filling out an employee health information form may put one’s
them can have side effects. A female-to-male (FTM) transgender friend of mine
job on the line.
overheated at a sporting event in part from a breast compression device. Some
Perhaps the most important thing we can all do to advance transgender health
male-to-female (MTF) transgender people take medications that block their male
care is to create a more open and caring environment. A 2006 study estimated
hormones. These medications can cause problems with blood pressure, sodium,
the suicide attempt rate in the transgender community at 32 percent. The suicide
potassium and even liver failure.
rate for transgender youth is even higher, estimated by many to be 50 percent.
The most difficult and confusing problems often come after gender re-assign-
These data are tragic, but I often use them effectively on the doubters. Suicide
ment surgery, and are complicated by the health care system. MTF individuals
rates this high don’t suggest a “choice,” rather they point to a difficult and painful
may still need screening for prostate cancer, and FTM individuals may need to
internal struggle. It is one that needs empathy, not judgment.
be checked for breast or ovarian cancer, especially if it runs in the family. Finding
Feeling that you are a different gender than your body is still hard to explain.
a doctor sensitive to these needs can be hard, and getting tests done and insur-
But here’s a way to start that I learned recently. Did your parents ever make you
ance companies to cover them can be impossible. Most have no mechanism to
put a doll away because it was too “girly?” Make you change clothes because you
authorize a prostate specific antigen (PSA) test for a woman, and refuse to cover
looked “like a boy?” Imagine having those judgments made about you every mo-
it even if ordered.
ment of every day. No one should be forced to be something they’re not. It’s just
Any chance of effective health coverage presumes the transgender person has
not healthy.
been able to keep a job and have insurance, no easy task since most states don’t
protect people from hate crimes or job discrimination based on gender identity.
Special thanks go to Connor Maddocks for his help with this article.
82 RAGE monthly | APRIL 2009
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