What are we really talking about?

Transcription

1 PROVIDING CULTURALLY COMPETENT CARE FOR TRANSGENDER PATIENTS What Providers Ought to Know Robert Oppenheimer,LCSW What are we really talking about? DEFINING TRANS-TERMINOLOGY Biological sex Gender Identity Gender Expression Cross Dressing Transvestite

2 Terminology Transsexual Transgender Transitioning DEFINITIONS Biological Sex refers to just that, the gender we are assigned based on genetic, biological markers

3 DEFINITIONS Gender Identity refers to a person s deeply felt psychological sense of Gender, which may or may not match the person s biological sex. DENFINITIONS Gender Expression refers to all of a person s external characteristics and behaviors, such as dress, mannerisms, and social interactions.

4 DEFINITIONS Cross dressing is more of a fetish, sometimes with erotic overtones, it does not necessarily represent and actual struggle with gender identification Transvestite is a term used also to refer to persons who dress as their opposite sex, but usually are not struggling with their gender identity DEFINITIONS (ARENT WE DONE YET?) Transgender is used as an umbrella term for people who experience and / or express their gender differently than the sex they were assigned at birth This is currently the term used most often to cover all designations

5 DEFINITIONS (ALMOST DONE) Transsexual is the term referring to a transgender person who has changed or is in the process of changing his or her physical and / or legal sex to better conform to his or her gender identity. This process may or may not include sexual reassignment surgery (SRS) DEFINITIONS (WILL THIS PART EVER END?) Transitioning is process of changing your gender, involving living full time as the gender of their choice at work and home and in all social interactions.

6 STATISTICS These estimates by the Transgender Law Center in San Francisco from 2007, estimate that 2 to 5 % of the population are transgender. The number who undergo SRS surgery is smaller. A study in the Netherlands indicated that 1 in 12,000 males underwent SRS and 1 in 34,000 females. DEFINITIONS Transgender is the umbrella term for people who experience and/or express their gender differently from what one might expect based on their sex assigned at birth This is the term currently most used to refer to the spectrum of possibilities that we are looking at now.

7 When and how to trans people present for Often the present simply for general medical care, but that can also present many obstacles. May present as gender variant, male or female legal name but show up as the gender they prefer. Reluctant to disclose medical history due to prior negative experiences. When and how to trans people present for Access to health care generally limited, population is underemployed and underinsured. If insured now, may not be for long, and treatment is important. Many are seeking hormone therapy to help in their transition either M2F or F2M, they may have been self treating for many years with black market hormones.

8 When and how to trans people present for Patients who present as gender variant and who have not has SRS have healthcare needs that may go unmet due to their presentation, and previous negative experiences. Example: A transgender man may still need a pap smear, a transgender woman might need a prostate exam. When and how to trans people present for Respect transgender patient s preferred name, pronoun and gender, even if different than records show. Use of correct pronouns is very very important to transgender patients If you are unsure about their gender identity, ask them politely for clarification. What name would you like to be called? Do not make assumptions.

9 When and how to trans people present for Treat transgender patients how you would want to be treated. Be mindful of facial reactions and other non verbal responses. Most transgender persons are very aware of others perceptions, this is one reason many avoid healthcare settings. Focus on necessary healthcare questions try not to indulge your own curiosity. When and how to trans people present for The presence of a transgender patient in your waiting room or treatment room is not always a teaching moment Many transgender patients report feeling like they are part of show and tell If you have an intern or resident attending, ask permission before assuming. Transgender patients are very protective of their bodies and who sees them.

10 When and how to trans people present for Establish a policy for addressing discriminatory comments or behavior in your office, clinic, or organization. Kaiser is very committed to Diversity in its workforce and in patient populations. Don t assume that you don t have transgender coworkers. You might be surprised. THE CONCEPT OF PASSING Passing is the ability for a transgender person to live and work without being identified as trans. Female to male transgender are much more successful than male to female. Passing is, for many, a crucial obstacle in transitioning. Voice Facial Features

11 THE CONCEPT OF PASSING Height, Male to Female are statistically taller than biological females Size of hands and feet When and how to trans people present for Get educated and educate your staff Remember transgender persons face discrimination in most areas of their lives and previous negative experiences in healthcare settings make many reluctant to seek care unless absolutely necessary.