The Politics of Transgender Health

1. The Politics ofTransgender Health Bobbi Williams, Ph.D. This presentation is available at http://members.tgforum.com/bobbiwilliams

2. Cancer Nutrition Aging Violence & Hate Crimes Mental Health Alcohol and Other Drug Abuse Sexually Transmitted Diseases HIV / AIDS [Unless otherwise indicated, all quotes are from the LGBT Health Companion Document] The Health Issues

3. “TS hormone therapy over an extended period of time might be expected to increase the risk of certain hormone-related cancers.” (p. 104) “Estrogen is a risk factor for cancer of the breast…and it has been suggested that testosterone therapy may be a risk factor for such cancers in FtoM transsexuals.” (p. 107) CANCER The Health Issues

4. NUTRITION The Health Issues • “No empirical studies on the nutritional and weight management practices of transgender persons have been conducted.” (p. 246) • “…it is reasonable to expect individuals who are transitioning…(to) modify their diet, eating behaviors, or perception of weight to appear more like the desired gender.”(p. 264)

5. “Little research on health promotion or special health concerns for older transgender individuals.” (p. 135) As the ‘boomers’ grow older so do we No research on long-term hormone use No research on the interactions of hormones with other medications Effects of decreases or elimination of hormones. “Polycythemia Vera” AGING The Health Issues

6. Majority of assaults against TG’s are never reported TG’s likely to experience victimization as a direct result of TG identity or gender expression. Link between TG experience and mental health disorders (e.g. post-traumatic stress disorder) widely suspected, but not documented. Violence & Hate Crimes The Health Issues

7. DSM-IV: being transgendered does not in itself constitute a mental disorder GID is generally applied to transsexuals “Transvestic Fetishism” is applied to crossdressers Depression Suicide Mental Health The Health Issues

8. Alcohol & Other Drug Abuse The Health Issues • Lack of data • Substance use programs not sensitive to the needs of TG’s • Few programs address the realities faced by the TG population.

9. Chlamydia Genital warts Hepatitis B Genital herpes Pubic lice (crabs) Scabies Trichomoniasis ("trich") Sexually Transmitted Diseases The Health Issues

10. HIV / AIDS The Health Issues • HIV infection estimates among TG ‘s range from 14% - 69% • HIV/AIDS risk behaviors reportedly high among TGs, but many self- identify as having low risk • Few TG-sensitive HIV/AIDS prevention activities

11. The Political Issues • Activism • Needs • Government Agencies • Insurance • Education

12. 1992 - Transgender Nation 1993 - Annual meeting of the APA calls attention to the pathologization of TG 1994 - Transexual Menace 1994 – It’s Time America 1995 – GenderPAC 1996 – First National Conference on Gender Activism 1999 - National Transgender Advocacy Coalition 2001 – National Coalition for LGBT Health 2003 - National Center for Transgender Equality (NCTE) The Political Issues • Activism

13. GenderPAC’s 2004 Budget 22% Public Education & Advocacy 22% Conference & Outreach 15% Children & Youth Advocacy 14% Workplace Fairness 14% Member Education & Support 13% Fundraising & Development The Political Issues • Activism

14. Transgender Needs Assessments The Political Issues • Needs • 1999 – Minnesota • 1999 – San Francisco • 1999 – New York City • 2001 – Philadelphia • 2002 – Chicago • 2003 – Washington, D.C. The focus of these has been on social services and health, primarily HIV/AIDS

15. The Political Issues • Needs

16. Federal law does not protect employees from workplace discrimination based on their gender identity or expression. A number of states and localities have enacted laws prohibiting discrimination based on sexual orientation. Today, three-quarters of Fortune 500 companies include sexual orientation in their written non-discrimination policies. [Human Rights Campaign Foundation] The Political Issues • Insurance

17. More than 50 percent of transgender people did not have any form of health insurance [San Francisco Dept. of Public Health, 1999 ] Health insurance companies and medical providers have denied coverage to transgender people [Transgender Law Center] More than 30 percent of TG’s indicate they were discriminated against while trying to access health care. [National Center for Lesbian Rights and the Transgender Law Center] The Political Issues • Insurance

18. Even when a TG has insurance most plans exclude procedures medically necessary for transsexuals. Disqualified treatments include: psychological counseling hormone replacement therapy doctor’s office visits SRS The Political Issues • Insurance

19. Social Security Administration (SSA) runs periodic audits of company records to match gender markers Washington, D.C., Boston, New York, Chicago and Los Angeles have offices or senior officials designated to address LGBT health Motor Vehicle Department of New Jersey: if a transperson has legally changed their name through the courts, and presents a letter from their therapist affirming that the transperson is a pre-operative transsexual, all New Jersey Motor Vehicle agencies must allow that person to choose their preferred gender for their driver's license The Political Issues • Government Agencies

20. The Political Issues • Education • The lack of training in professional schools on issues related to transgender health has further marginalized transgendered people and places them in situations of greater health risk • Professional associations are insensitive to the alienation felt by transgendered people with regards to their health care system and providers,

21. The Political Issues • Education • Social service organizations are insensitive to the fact that transgendered people have varying levels of unease when accessing services. • Transgendered people presume that they must hide, or camouflage their gender identity in their interactions with health care and social service institutions and providers in order to receive adequate and equitable care.

22. A Comprehensive Approach to the Problem Members of the Transgendered Community Members of the Health & Human Services Community A TWO-PRONGED APPROACH http://www.rainbowaccess.org

23. A Comprehensive Approach to the Problem THE CURRICULUM • Module 1: • Barriers to Quality Health Care Services • Module 2: • Gender & Identity • Understanding Cross-Gender Expression • Module 3: • Domestic Violence • Sexual Abuse • Sexual Assault • Bias-Related Violence • Other Trauma Issues

24. A Comprehensive Approach to the Problem THE CURRICULUM • Module 4: • Relationships and Parenting • Module 5: • Substance Abuse • Addictions • Recovery Issues • Module 6: • Sexual and Gender Development • Children and Youth Issues

25. RAI’s Funding • New York State Department of Health • - Two-Year Grant • New York State Health & Human Services Network • Development Grants • Memberships & Donations

26. Funding • “At Risk” • LGBT (as opposed to ‘T’) • Faith-based Initiatives • 501(c) Non-Profit Status • Partnerships and Co-op Arrangements • Appeals to Corporate “Missions”