Bioethics in Practice: Ethical Issues in the Care of Transgender Patients.

"Either/Or" and "Both/Neither": Discursive Tensions in Transgender Politics -- TEST

In recent times, the interrelationship between policing and sexuality has been reworked in significant ways. No longer solely a site for the reproduction of queer deviancy, pathology and criminality, policing now serves as a method for the production of respectable and innocent sexual and gender identities that are seen as deserving of visibility, recognition and protection. Through an investigation of lesbian, gay, bisexual, and transgender (LGBT)-police relations in the Australian state of Victoria from 1994 until the present, this research documents the incorporation of limited formations of sexual and gender diversity into regimes of policing and punishment. I conceptualise this as a process of bringing LGBT rights ‘into the fold of the state’ (Agathangelou, Bassichis & Spira 2008: 122). This thesis forwards the claim that modes of inclusion are always connected to forms of exclusion. Moving away from the idea of inclusion as inherently positive and desirable, I critically interrogate some of the possible costs, compromises, risks and benefits associated with the incorporation of LGBT rights into criminal justice frameworks. This study provokes concerns over the renewed legitimation and justification for regimes of policing and punishment that are gained on the backs of claims to LGBT protection. Using a qualitative methodology, informed by critical discourse analysis and genealogical methods, I examine a variety of texts in the archive that are generated by mainstream and LGBT media, government agencies, LGBT organisations, activist campaigns and other individuals. I provide three case studies to illustrate some of the different ways in which sexual and gender non-conformity are policed: the Tasty nightclub raid (1994); the participation of the Chief Commissioner of Victoria Police in Pride March (2002); and hate crime sentencing reform (2009). In each case study I highlight dominant articulations of queerness used to garner popular support for anti-homophobic causes that, as I show, are imbricated in the politics of respectability, victimhood, consumption, and self-responsibility, whether resisting or affirming these categories (or sometimes both or neither). I investigate how police legitimacy may be enabled or constrained in their dealings with LGBT people by unpacking some of the techniques used to reproduce and fortify institutional legitimacy and create a positive police image within the LGBT community. I suggest that for police, their legitimacy has become increasingly bound up with appearing responsive to LGBT concerns.

Research shows that the LGBTQ population is disproportionately affected by hate crimes and those against transgender individuals are especially violent. Given the considerable underreporting of these crimes, better insight into the victimization experiences and reasons for underreporting is necessary to improve the safety of the transgender community and secure necessary services for these victims. The current study takes a community-based participatory research (CBPR) approach by creating and utilizing an Advisory Board made up of service providers in the transgender community in Los Angeles, to assist in the development of a survey instrument and focus group questions and provide venues for the focus groups. The study examines results from a short survey and five focus groups with transgender individuals on their experiences of hate crimes and reporting activities. Results indicate nearly all participants experienced some type of hate incident or crime based on their gender identity and/or expression. Almost half of the respondents did not report these crimes to the police because they did not think police would do anything, were afraid of being arrested, or were afraid of being victimized by the police. Narrative accounts describe mostly, though not entirely, negative encounters with the police and how participants take preventative measures to reduce their potential for hate-based victimization. Based on our findings several recommendations have been made to help improve relations between transgender communities and law enforcement with the goal of creating a safer environment for transgender individuals and increasing the reporting of hate crimes.

Unveiling Koovagam

Purpose: Voice–gender incongruence has predominantly been investigated in the past through the perspective of feminine-identifying individuals seeking feminine-sounding voices. The purpose of this study was to determine the prevalence of self-reported voice–gender incongruence in the transgender, nonbinary, and gender-nonconforming (TNG) community and to describe health information–seeking behaviors exhibited when individuals attempt to address their voice and communication challenges.Method: An online survey was designed with questions targeting the self-reported prevalence of voice–gender incongruence, characteristics of this complaint, and health information–seeking behaviors. Valid standardized measures, including the Voice Handicap Index and the Barriers to Help-Seeking Scale, were also included.Results: Four hundred five participants were sorted into three groups based on gender identity (feminine, masculine, gender-neutral) to facilitate comparative analysis. Ninety-six percent of participants reported the experience of voice–gender incongruence in the past, and 88% reported that they currently experience voice–gender incongruence. There were no significant differences in reported voice–gender incongruence between groups. Voice Handicap Index scores were significantly higher for those who currently experience voice–gender incongruence (p < .0001) and reflected differences in how much this concern bothers participants, as rated on a Likert scale, ranging from no problem to a very big problem (p < .0001). Barriers to Help-Seeking Scale scores indicated that the masculine group perceived greater barriers to seeking help as compared to the feminine group.Discussion: We present foundational evidence for the prevalence of voice–gender incongruence within the TNG community and barriers encountered when individuals attempt to access care. Future work should investigate the specific needs of subgroups within the TNG community and whether those who desire feminine-, masculine-, and/or androgynous-sounding voices experience voice–gender incongruence and access to services differently.Supplemental Material S1. Participant survey. Kennedy, E., & Thibeault, S. L. (2020). Voice–gender incongruence and voice health information–seeking behaviors in the transgender community. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2020_AJSLP-19-00188

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face social, economic, legal, health, and health care–related disparities amid evolving threats to sociopolitical advances made in the last decade ([1][1],[2][2]). In response, organizations, including the National Institutes of

TITLE: SOCIAL PREDICTORS OF HEALTH STATUS AMONG TRANSGENDER AND GENDER NON-CONFORMING YOUTH PURPOSE: Transgender and gender non-conforming (TGNC) individuals experience significant health disparities compared to their cisgender counterparts. TGNC youth in particular may face distinct challenges when it comes to improving and maintaining health. There is limited research regarding TGNC youth and the mediating factors that may influence health status. The purpose of this study was to explore the association between various predictors, including gender identity, substance use, bullying, and …

transgender, discrimination: Caitlyn Jenner, formerly Bruce Jenner, brought the limelight to transgender issues last year during her transition.FigureFigureFigureFigure“Whatever affects one directly, affects all indirectly.” — Martin Luther King, Jr., letter from a Birmingham Jail, AL, 1963 Transgender patients, because they are more likely to lack adequate health insurance and access to basic medical care, are also more likely to need emergency medical services, but their fear of discrimination and prior negative experiences also make them more likely to avoid seeking care. One study reported these poor experiences as high as 21 percent for all emergency department encounters for the transgender community in Ontario, Canada. (Ann Emerg Med 2014;63[6]:713.) The authors attributed bad encounters to health providers' lack of experience with transgender patients and insulting behavior. These issues place transgender patients at risk from inadequate emergency care, and merits the need for emergency departments to place heavier emphasis on improving the experience of transgender patients. Transgender individuals, those whose gender identity differs from their sex, is a subgroup of the gender nonconforming community, individuals who do not follow other people's ideas or stereotypes about their looks and behaviors based on their sex. Transgender topics have been covered more in the news and on social media in recent years, and efforts to destigmatize the transgender community have been supported by research suggesting that genetic variations, hormones, and brain structures were causes of disharmony between gender identity and phenotypic sex. (Gynecol Endocrinol 2004;19[6]:301.) This research also suggests that gender identity is not a dichotomous male or female designation, and argues that it may be a trait that lies along a spectrum. Society's use of physical characteristics to define gender identity can lead to emotional distress for those who disagree with this definition. For some individuals, this distress leads to gender dysphoria, a new DSM-V term aimed at eliminating the stigma attached to the former term, gender identity disorder. The psychiatric and medical conditions associated with the transgender community are just as important to understand as the conditions associated with other minority populations. This population also has a higher rate of suicide, potentially related to their higher rate of anxiety and depression. Unfortunately, these patients are also more likely to be victims of hate crimes, sexual/physical assault, and intimate partner violence. (Ann Emerg Med 2015;66[4]:417.) All of this information means transgender patients are more likely to need emergency medical services. Building Trust The first step toward improving the transgender patient's experience is to educate emergency physicians and staff on issues pertaining to their health. Studies have shown that a barrier to providing adequate care is physicians' lack of knowledge on specific gender nonconforming medical issues. That study from Ontario, Canada, reported that 54 percent of transgender patients had to educate their physicians on transgender issues. This void in knowledge can dismantle the patient's trust in health care. Emergency departments can remedy this by including gender nonconforming topics in their cultural competency curriculum, such as paying attention to laws surrounding single-sex bathrooms, health insurance, and spousal rights and how they may influence patient encounters. Emergency departments can also consider recruiting and hiring physicians and staff from the lesbian, gay, bisexual, transgender, and queer (LGTBQ) community to show the gender nonconforming population their commitment to diversity and inclusion. These efforts should also address prehospital care and be supported by the greater hospital administration, working toward creating a safe space to treat transgender individuals and discuss social and medical issues affecting these patients. Improving the emergency department encounter for the transgender community will not be an easy task. Some embrace the conversations and changes, but others may not fully engage in the movement due to personal beliefs. There will also be resistance because the rights of the transgender community are wrapped up in national and state legislation, which may limit the changes an emergency department can make. Regardless of the personal convictions of emergency physicians and government regulations, emergency departments must address the factors that lead to poor patient experiences among transgender patients. Ignoring the deficits in emergency health care delivery to transgender patients will only set a precedent to ignore deficits in care for other at-risk minority groups. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

Much of the current literature on gender-variant children and young people focuses on aetiology and developmental outcomes in adolescence, whereas their developmental experiences have been neglected. Furthermore, there is little understanding about the experiences of gender-variant youth for whom gender reassignment does not offer a straightforward solution. This qualitative study interviewed 10 gender-variant young people (Mean age = 20; range 17-27) who were not actively pursuing gender reassignment. The aim was to gain a better understanding of the developmental process of their gender identity development and how they made sense of their gender variance; the challenges that they faced; the resources that they drew upon; and what is important to them. A grounded theory methodology was adopted. The period between the approximate ages of 9 and 14 years was identified as crucial in their gender identity development and as a significant developmental challenge. A widening social gap between male and female gender roles and an emergent homosexual identity influenced how they made sense of their gender-variant expression and their bodily development, which in turn was situated within a context of widespread social exclusion. This promoted a profound lack of social belonging, which for most translated into a sense of not belonging in their bodies. A transgender identity afforded social membership, but brought with it a variety of challenges. A range of gender identities and views on gender reassignment were identified, that do not neatly fit into current conceptions of desisting and persisting gender dysphoria. Education on gender variance within the public, educational and health domain was an important priority for the participants. The findings of this study contribute to our understanding of the developmental trajectories of gender variant youth. It also intimates a number of recommendations for future research and clinical practice.

Thoughts and opinions about fertility preservation and family building from the transgender community—an interview-based approach

Gender is one of the first identities we learn and binary distinctions based on gender (e.g. girl/boy, woman/man, cisgender/transgender) are pervasive. The conceptualization of gender identity among transgender individuals is uniquely complicated by dichotomous notions of gender/sex. This is particularly true for individuals in the transgender community who are gender non-conforming or experience their gender outside the binary. The present research investigates the conceptualization of gender identity among non-binary transgender individuals by exploring the gender identity labels they choose and the descriptions they provide for their gender identity and experience. Participants included 197 adults recruited from a larger study on transgender experience who completed an online study. Participants ranged in age between 18-70 and self-identified as gender variant (n = 129) or agender (n = 68). Qualitative responses were analyzed via thematic analysis. Six themes were identified as related to the way gender non-conforming individuals describe their gender identity: 1) Gender Identity Using Binary Terms of Gender/Sex; 2) Gender Identity as Blended; 3) Gender Identity as Fluid; 4) Gender Identity as Non-Binary; 5) Transgender as Gender Identity; and 6) Agender Conceptualizations. Discussion focuses on the ways that gender non-conforming individuals’ experience of gender identity may contribute to the way we conceptualize identity flexibility.

In this Chapter, we analyse refugee status determinations (RSD) in claims brought by applicants who articulate a fear of persecution on the basis that they are transgender, broadly defined to include those who are transsexual, cross-dressing, transvestite or who identify strongly with another gender. Our study all of all publicly available decisions which concerned gender identity made by administrative tribunals and courts in Australia, New Zealand (NZ), Canada, the United Kingdom (UK) and the United States (US) indicated that, while trans claims appeared relatively successful the jurisprudence in this area is fundamentally incoherent. We argue that the specific issues raised by trans asylum claims must be examined within an overarching analysis of persecution related to gender non-conformity – a framework which allows for complex intersections between sexuality, gender identity and gender. Attending to the claimant’s experience of gender non-conformity requires a careful and flexible process of setting out the particular social group.

Mental health care among marginalized populations in the United States

Research on gender variance in childhood has for many years been limited to analyzing health issues and has therefore mostly been implemented in the medical and psychiatric field. The social and family context was generally neglected and only in recent years has it received the attention of researchers from the social sciences. Although research of this type is mostly limited to the North American context, this literature review aims to highlight the work that has been done so far. The importance of these selected studies lies on the experience of families of gender-variant children as told to us by the parents themselves. The work highlights the practical and discursive strategies implemented by parents to make sense of their children’s experience in order to guarantee their well-being and create a space where gender variance is considered a normal and legitimate life experience. Absences and limitations have been identified for future work.Keywords: transgender children, parenting, parenthood, gender identity, childhood.

ABSTRACTThe conceptualization and measurement of sexual orientation for transgender individuals is uniquely complicated by the way sexual orientation is rooted in dichotomous notions of sex and gender. The present research investigates the conceptualization of sexual orientation among transgender individuals by exploring the sexual identity labels they choose, the descriptions they provide for these labels, and their general descriptions of their sexuality. Participants included 172 adult U.S. residents, ranging in age from 18 to 65, who self-identified as transgender, transsexual, gender variant, or having a transgender history. Participants individually completed an online survey. Qualitative responses were analyzed via thematic analysis. Six themes were identified related to transgender individuals' descriptions of their sexuality: (1) trans sexuality as complex; (2) shifts in trans sexuality; (3) focus on beloved; (4) relationship style and status; (5) sexuality, bondage & discipline / domination & submission / sadism & masochism (BDSM), and kink; and (6) separating sexual and romantic attraction. Discussion focuses on the ways that transgender individuals' descriptions of sexuality fall outside the traditional research frameworks that problematize transgender experience, conflate gender identity and sexual orientation, and inherently define transgender experience in both cisnormative and heteronormative terms.