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May 26

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WPATH Releases De-Psychopathologisation Statement on Gender Variance

This is the statement from WPATH:

“FOR IMMEDIATE RELEASE

May 26, 2010

The World Professional Association for Transgender Health has prepared and released a statement urging the de-psychopathologisation of gender variance worldwide.  The statement can be found on the WPATH website www.wpath.org and is as follows:

The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide.  The expression of gender characteristics, including identities, that are not stereotypically associated with one’s assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative.  The psychopathologlisation of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalisation and exclusion, and increasing risks to mental and physical well-being.  WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people.”

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.


Mar 31

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The Prevalence of Transgenderism

Someone asked me recently “what is the prevalence of transgenderism”, so I thought I’d take a stab at finding out.

An article on questions of prevalence and epidemiology of GID appears in the International Journal of Transgenderism in its special issue: “Toward Version 7 of the World Professional Association for Transgender Health’s Standards of Care” (Volume 11, number 1, 2009).  The article was written by Kenneth Zucker and Anne Lawrence, and was summarized by Eli Coleman in his introduction to the special issue:

“Formal epidemiological studies on gender identity disorder in children, adolescents, and adults are still lacking and no strong conclusion about its prevalence or incidence can be drawn. The current prevalence estimates that are cited in the DSM-IV and the WPATH SOC(1) are based upon data over 20 years old.  They [Zucker and Lawrence] note, however, that between the 1960’s and 1990’s, there appears to be at least a threefold increase (and as high as eightfold increase) in patients presenting to clinics in Western Europe.  This could be due to increased awareness and seeking of transgender services.  There is also the problem of whom to count.  Individuals who undergo surgical sex reassignment are only an extreme end-point of a continuum of cross-gender identification. We are more and more aware of the myriad of individuals who identify as transgender or gender queer and who represent individuals along the broad spectrum of cross-gender identification.”(p. 5)

This is from the Zucker, Lawrence article itself:

“As is the case with children and adolescents, there are also no formal epidemiological studies on GID in adults. The most common indirect method that has been used to gauge the prevalence of GID in adults has been to rely on the number of persons who attend specialty hospital and university-based clinics serving as gateways for surgical and hormonal sex reassignment.”  (p. 13)

They then present a table of data from 25 such clinics and try and estimate prevalence.   I’m listing 7 lines from their table (of 25) where the period reported falls somewhere between the year 1990 and the present and where prevalence estimates where made:

Author Period Reported Country Incusion Criteria N MtF :  FtM Prevalence
Weitze & Osburg (1996) 1981-1990 Germany Granted legal change of name or gender status 1047 2.3  :1 MtF:1 : 42,000 FtM:1 : 104,000
De Cuypere et al. (2007) 1985-2003 Belgium Completed sex reassignment surgery 412 2.4  :1 MtF:1  : 12,900 FtM:1  : 33,800
Bakker, van Kesteren, Gooren, & Bezemer (1993) 1986-1990 Netherlands Receiving hormone therapy 713 2.5  :1 MtF:1 : 11,900 FtM:1 : 30,400
Gomez Gil et al. (2006) 1996-2004 Spain Diagnosis of Transsexualsism 161 2.6  :1 MtF:  1 : 21,000 FtM:  1:  48,100
Wilson, Sharp, & Carr (1999) circa 1998 Scotland Gender Dysphoria 273 4  :  1 MtF:1  :  7,400 FtM:1  :  31,200
Wilson, Sharp, & Carr (1999) circa 1998 Scotland Receiving Hormone therapy or post-surgery 160 3.8  :1 MtF:1  :  12,800 FtM:1  :  52,100

To summarize

  • There are some estimates based on indirect methods and counting those seeking treatment specifically some form of surgery & we know that this is a small percentage of overall people with gender variance.
  • no direct studies on prevalence of GID have been done
  • doing an accurate count is complicated by the fact that those counted are those who are “out” as being transgender and seeking some form of treatment, and also those who have transitioned may not wish to be counted.

Also – this is a subject very much on the minds of researches in the field now (its been a lively topic of conversation on the WPATH email list for several months).

(1)    – prevalence cited in DSM-IV:  “Data from smaller countries in Europe with access to total population statistics and referrals suggest that roughly 1 per 30,000 adult males and 1 per  100,000 adult females seek sex-reassignment surgery.” (p. 535).  This data was probably drawn from Hoenig and Kenna (1974) “The prevalence of transsexualism in England and Wales, British Journal of Psychiatry, 124, 181-190.  And we know that only a fraction of transgendered individuals actually seek sexual reassignment surgery.”
 

an update to this post can be found here
Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.

Mar 7

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Subtle Discrimination – How do transgender individuals cope with it?

This incident of subtle (and not trans related) discrimination really stuck with me from a book I read recently called My Freshman Year: What a professor learned by becoming a student (Nathan, R. 2005. Cornell University Press).  The professor is interviewing ‘Pat’, a student of color in a largely white university campus:

When I asked Pat, a Hispanic-Native American woman, whether she had ever considered rushing a sorority, she told me that she had in her freshman year, but “I could see that it wasn’t really right for me, because I’d pass by all the sorority tables – you know how they call out to girls to come over and take a look – well, I saw they called out to other girls but not me.  They kinda ignored me, not hostile or anything, but not interested either”. (p. 61)

This type of discrimination is undoubtedly a common occurrence for transgender individuals, particularly those who are in-transition or who are “read” as transgender.  They are at times (perhaps unconsciously) not-included, not invited to participate and ignored when in a “mainstream” environment.  This can be particularly jarring for one who has presented in the past in such a way as to not incur any discrimination (like those who have presented as ‘straight white men’).

When it’s unnoticed

I think it’s likely that a lot of this discrimination goes unnoticed by a transitioning individual in part because of their satisfaction and happiness with transitioning (and thereby being less concerned with how others are reacting to them), and in part because it is indeed subtle.  This not knowing you are being discriminated against can at times be an advantage, because one just proceeds as usual, and perhaps overcomes barriers by their non-acknowledgement of any prejudice coming their way.

When it is noticed

When you recognized that you are being discriminated against in some way it is extremely frustrating and upsetting.

I think one way for the trans person to deal with this is to proceed as if no discrimination is happening, even if you know it is.  I think letting oneself get angry or defensive can only be counter-productive, even when one has a genuine beef.  An unfortunate  consequence of the transitioning process is that one becomes more visible at a time when most people would prefer to be less visible.  Developing coping mechanisms around discrimination are essential to making it through.

I’d like to turn the question out to all of you to find how people have dealt with this and to discover what has worked well when you do want to engage with the people who are discriminating against you.  What do you do when you want to be accepted by a school group or any other group.

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.


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