18 Apr 2012

Report Shows Trans Worst Off

By Annelise Roberts
A new report confirms that transgendered Australians suffer the worst rates of general and mental health - but where can they go for help? The women's sector needs to step up, argues Annelise Roberts

Last week La Trobe Uni quietly launched the second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender Australians. Private Lives 2 provides us with some of the most comprehensive data yet about these population groups, putting flesh on the skeleton of existing research — which is very scant.

PL2 is very welcome and much needed, but it was no surprise to read that transgender Australians consistently report the lowest levels of general and mental health. This is very much in accordance with other available data. It was also no shock to read that discrimination continues to have a tangible impact on the lives of trans people, paving the way to high rates of drug and alcohol use, heightened exposure to violence and harassment (including sexual violence) and social and economic marginalisation.

The needs of trans folk continue to be overlooked or poorly understood by policy-makers and service deliverers; little population data is available that could help to inform decision-makers about this group, given that more brawny data-collection mechanisms like the ABS or the National Health Survey do not collect information about transgender status.

Essentially, PL2 confirms that trans people are in real, urgent need of support and have very little access to it. So where can they turn to?

Probably not to the women's sector. Unfortunately, the second-wave feminist ethos — "by women, for women" — that still informs the women's sector doesn't mix well with concepts of gender diversity.

After my involvement in Canberra's Reclaim the Night event last year, for example, a transgender woman confided in me that she didn't attend because she had understood that "people like her" wouldn't be welcome to march. And I continue to hear stories about female only organisations that manage their transgender clients with clumsy, restrictive policies or exclude them altogether — domestic violence refuges that only allow "post-op" trans women to seek shelter, for example, and which flatly discount trans men as legitimate clients.

Lorene Hannelore Gottschalk of the University of Ballarat has argued that including transgender people in women's spaces "compromises the rights of women to seek support in a context where they are with ... people with whom they have shared experiences": "The inclusion of ... MTFs [male-to-female transgender people] results in the elimination of women-only space and re-assimilation into male dominated institutions," she writes.

Of course, it's well recognised that there are both pragmatic and political reasons to provide women's-only services. The women's sector is necessary to meet the particular needs of women. It is also a feminist project that is about correcting a long-standing power imbalance, and creating a space for something that has previously been pushed to the margins. This makes sense.

What continues to unsettle me is the fact that the women's sector, a sector that prides itself on having special insight into the social mechanics of gender, has struggled to cope with scenarios that challenge traditional ways of thinking about gender. It's one thing to talk about empowering this group of people we have defined as women, but third wave feminism and queer theory have long been more interested in tracing the cracks and inconsistencies in the actual framework we use to describe gender (that organises people into the categories man/woman, male/female, masculine/feminine), with the idea that it is actually this kind of binary thinking that creates the power inequalities that underlie sexism.

This level of critical reflexivity, I would argue, has yet to reach the women's sector. We have failed to be reflective about the way we use binary gender frameworks in defining the population group we speak for — and we have for the most part failed to recognise the inadequacy of this system to represent the everyday lived experience of sex and gender for many, many people.

Peter Hyndal, founding member of Canberra's gender rights organisation A Gender Agenda, notes that feminist responses to trans inclusion have "historically been based on a range of assumptions" about the legitimacy of trans people's experiences of gender. But bound up in that are all kinds of assumptions about women more generally — "what a woman is, how she is defined and by whom".

"On one level, I really don't understand why women's services have struggled so much with the issue of trans inclusion," Hyndal told New Matilda.

"Feminism has consistently argued that women should not be reduced to their biology, that there is no 'right way' for a woman to be — that gendered social norms are oppressive and that women should question and challenge those stereotypes and assumptions that seek to constrain them... Trans people are, by their existence, questioning and challenging the gendered stereotypes that constrain us all. As trans people, we live this experience every day of our lives. It seems to me that this is a real point of commonality."

Like Hyndal, I believe that the women's sector should be in the business of dealing with gender diversity. Because some trans people are approaching women's services and are in real need of support; because I have yet to hear a convincing argument in favour of excluding trans women (or, at least in some cases, trans men) from accessing women's services; because as advocates we claim to represent women in all their diversity, and this should extend to the diverse experiences and expressions of the gender.

But most importantly of all, because it's becoming clear that we in the women's sector need to find a way to reconcile the need to provide specialist services to women with the need to maintain a critical approach to the way we think about gender — an approach that leads us beyond a gender framework that only leaves room for "real women" and "real men". An approach that can cope with the beauty, subtlety and diversity of people's real, private lives. Without having the conversation about gender diversity, the women's sector risks becoming irrelevant.

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Posted Friday, April 20, 2012 - 13:48

Thank you Anneliese for an enlightened opinion piece on what is far from the noisy lobbying claimed by Iain Hall. Gender Dysphoria is not a mental illness, far from it. It is a physical condition from birth, and only if there is no recognition or treatment do the unconscionable mental stresses take their toll. There is little understanding in the health profession generally. I speak as a mother who found the whole concept extremely confronting yet I could not find a counsellor who had the slightest idea how to help me.

Posted Friday, April 20, 2012 - 22:39

The functional problem is in the brain.

Iain you seem very loud mouthed, for someone with little knowledge of a topic.
Your binary cissexism is so obvious it leaks from your every word, you are the crude facsimile of a humane being.

I'd end this comments about where you can go to get further information about this topic you seem so concerned about, but your mind closed awhile ago didn't it Honey.

Much love


Posted Saturday, April 21, 2012 - 09:05

Ok Iain, do you understand the difference between your physical sex and your gender identity?, this is critical if we are to have an intelligent discussion on this topic. poeple like yourself are trapped in old forms of thinking.

Your DNA contributes to your physical sex, if you think that your DNA and physical sex are the only contributing factors to human sexuality and gender expression, then you fail in your arguement.

Also your arguement is littered with negative words that genuinely express your disgust at transgendered people.

You use very base and loosely logical arguments to back up your flimsy paradigm eg a spade is a spade, how 1950's of you Iain.

The human species has more diversity in it then the social constructed sex binary that you have brought into.

Pick up your intelllectual game and then come back to discuss this, you seem intelligent, but extremely ignorant of facts, either that our you have some real issues to deal with with respect to yourself.

Posted Saturday, April 21, 2012 - 09:35

To use your spade analogy.

There is great diversity in human foods, for some you require a spoon, for others a fork, but to deny the rightfull place of the spork as valid, is simply to deny that there are other ways to eat.

Here's a clue for you re: research hormone influences on fetuses in the 2nd to 3rd trimester and also the importance of the hormonal spikes after birth and in the early childhood years before puberty.

Posted Saturday, April 21, 2012 - 09:37

Iain Hall

If i had a dollar everytime i had to justify ourselves to someone like you i would have enough money to fund my surgery.

FACT: Growing up as a Transsexual is not a choice and cause a lot of discomfort and distress, a mood condition known as Gender Dysphoria, which results in severe anxiety, depression and sometimes leads to self harm, mutilation and suicide.

Sex Reassignment Surgery is much more than just being cosmetic surgery and has more of impact on a transsexual person's life. SRS is highly regarded as life saving surgery by medical professional’s right around the world including surgeons who perform these revolutionary surgical procedures. Some Transsexual people can’t find the financial means to pay for SRS and become deeply depressed and dysfunctional affecting their everyday lives. Transsexuals also face vilification, discrimination and abuse which can make it very difficult to find gainful employment. It should not be the case that in Australia, in 2012, people are driven to attempt to perform necessary surgery on themselve’s because they can't afford it. The degree of desperation shown illustrates the scope of the problem. Suicide is, of course, the more usual consequence. We need equality within healthcare provisions as i do not understand why we are so behind the rest of the world in this field, So many states and countries around the world fund Sex Reassignment Surgery as it is for health and legal reasons. As it states below SRS Reassignment Surgery is required by law to be done to have ones Birth certificate changed plus other documents once checked out by the required doctors. Why "Sex Change" Surgery is Medically Necessary


"The degree of legal recognition provided to transsexualism varies widely throughout the world. Many countries now extend legal recognition of sex reassignment by permitting a change of legal gender on the individual's birth certificate. Many transsexual people have their bodies permanently changed by surgical means or semi-permanently changed by hormonal means (see sex reassignment therapy). In many countries, some of these modifications are required for legal recognition. In a few, the legal aspects are directly tied to health care; i.e. the same bodies or doctors decide whether a person can move forward in their treatment, and the subsequent processes automatically incorporate both matters.

American Medical Association House of Delegates Resolution 121 (2008) states:

Gender Identity Disorder (GID) if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression and for some people without access to appropriate medical care and treatment, suicidality and death…delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, such as stress-related physical illnesses, depression and substance abuse problems, which further endanger patients’ health and strain the health care system.
There are many of us in this same situation in Australia and we should not have to resort to begging for funds, so please sign this petition to lobby the Federal Government to cover the costs of surgery for transsexual Australians

Posted Saturday, April 21, 2012 - 14:55

Thank you for writing this. I am looking forward to a world much more accepting of variance in gender and sexuality but I don't think I will live to see it. On second wave feminism, their philosophies have not really changed since the 70's /80's and don't look like changing ever. The world has changed, the trans community has changed, the queer community has changed but they have not. I really question their self description as being radical feminist. Ideas 30 to 40 years old are not radical if they are static, they are reactionary. Perhaps reactionary feminists might be a more accurate description lol.

Posted Saturday, April 21, 2012 - 15:19

Iain, if I take a spade and using technologies available to me, convert it to a fork, that functions as a fork and looks like a fork anwhine farmer thinks it's a fork, is it not then a fork?


Posted Saturday, April 21, 2012 - 15:22

Also Iain, there are a great deal of trans women, who do not elect to have surgery.

I'm working on a longer reply, maybe.

Posted Saturday, April 21, 2012 - 20:57

@Iaian Hall

Maybe these three papers will help understanding:

<B>Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation</b> Garcia-Falgueras A, Swaab DF <i>Endocr Dev.</i> 2010;17:22-35
<blockquote>The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in trans-sexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.</blockquote>

We've known that Transsexuals have cross-sexed neuro anatomy since the mid-90's.

<b>A sex difference in the human brain and its relation to transsexuality.</b> by Zhou et al <i>Nature</i> (1995) 378:68–70.
<blockquote>Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones</blockquote>

OK, but so what? They have cross-sexed brains, hence cross-sexed emotional responses, instincts, cognitive patterns, even senses of smell and hearing. But why is that associated with a cross-sexed "gender identity"?

<b>Biased-Interaction Theory of Psychosexual Development: “How Does One Know if One is Male or Female?”</b> M.Diamond <i>Sex Roles</i> (2006) 55:589–600
<blockquote>A theory of gender development is presented that incorporates early biological factors that organize predispositions in temperament and attitudes. With activation of these factors a person interacts in society and comes to identify as male or female. The predispositions establish preferences and aversions the growing child compares with those of others. All individuals compare themselves with others deciding who they are like (same) and with whom are they different. These experiences and interpretations can then be said to determine how one comes to identify as male or female, man or woman. In retrospect, one can say the person has a gendered brain since it is the brain that structures the individual’s basic personality; first with inherent tendencies then with interactions coming from experience. </blockquote>





Posted Saturday, April 21, 2012 - 21:46

@Iain Hall

<blockquote>It still boils down to priorities in the public heath budget and none of your argument convinces me that financing surgery for individuals like your self is the best way to bring the greatest benefit to the most people in our society.</blockquote>The same can be said for nearly any surgical procedure. OK, so time for a back-of-the-envelope financial analysis.

Let's look at "Bang for Buck" - the financial cost, and any financial benefit to the public purse, leaving aside (for now) such intangibles as "quality of life".

First, cost of <b>not</b> having surgery.
1) - Loss of Tax Revenue from productive members of society
2) - Disability benefits
3) - Palliative care, to try to keep the patient alive, with psychiatric consultations, periodic suicide watches, expensive psychotropic medications.

2) and 3) aren't as bad as it might seem at first glance; the patient is likely to die early, so these might only extend for 20 years. Moreover, there's a saving because they die before they grow old enough for an age pension, and end-of-life geriatric medical expenses.

Total cost per year:
$20,000 tax revenue lost
$15,000 disability benefits
$5,000 palliative care

Over 20 years, $800,000

Now look at cost of having surgery:
1) $20,000 once. x (1.0/0.98) as the surgery is only 98% successful.

In a health system paid for by the Government, there is over a 100% cost recovery per year.

For private health insurance, only the palliative care is a cost - $5000 a year, as opposed to a $20,000 initial outlay. At 10% accrual, break-even point is at about 5 years, so while it's a good investment, better ones may be available, with returns of over 20% per year.

I've simplified a lot - I assume no unemployment rate, that Trans people have close to average wages (tax revenue includes income tax, GST, etc), and haven't taken into account the benefits from effective euthenasia of them without surgery, nor the costs of them living to an old age with it.

The "no unemployment rate" simplification is questionable, as Trans people are discriminated against so heavily, even after surgery. It's likely that the real return is not 100% every 6 months, but more like 100% per year.

In terms of intangibles, one has to balance the benefit in quality of life for about 200 people per year, vs the unhappiness caused to many more than that by the existence of Trans people. Many, for ideological, political, or religious reasons, want them to just disappear, and not to fund with their tax dollars a medical procedure they deem immoral, be it because it "rebels against God", or "reinforces the Patriarchal oppression of women in a Capitalist society".

The Far Left in particular advocates the extermination of Trans people in a <em>"Final Solution"</em> (to quote radical lesbian feminist Mary Daily) and that <i>"Transsexuality should be morally mandated out of existence"</i> (to quote her protege, Professor of Ethics Janice Raymond, whose report to the Carter Administration in the USA caused the removal of existing health benefits under the US Medicare system for Trans people).

The question is really about how much Australian taxpayers are willing to shell out to ensure that Trans people suffer and die.

Posted Saturday, April 21, 2012 - 23:18

C'mon. He's a right wing troll that gets off on arguement. Don't feed the troll.

Posted Sunday, April 22, 2012 - 12:44

His points still need answering.

<blockquote>Well that is one opinion of the surgery but I think that there would be just as many doctors, if not more, who would think that yours is a psychiatric condition and should be treated as such. </blockquote>
That is his impression - had he done some research, it would be shown to be false. The AMA resolution is a bit of a giveaway, but let's look at the actual facts: the result of psychiatric treatment as an alternative, since it's been tried over the last 50+ years in tens of thousands of cases.
<blockquote>Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical.</blockquote>
It doesn't work; the patients die. The success rate is so low in fact that even attempting it is now considered as unethical as leechcraft, or treating a gangrenous wound by praying over it.

Posted Sunday, April 22, 2012 - 20:05

There are no "stories like this one".
Try to find another Charles Kane. There are a total of 5 cases recorded in the UK of regret. There must be more, the therapy is only 98% successful, but obviously there can't be many.

If there were a large number of such cases - and I've seen religious groups say 60% have regrets - then there'd be tens of thousands, not dozens, of examples. Thousands in the UK alone.

But the numbers are so small we can give individual names.

As for "not much research" - it continues to be done. What isn't being done is publication of any results. Religious groups continue to try to transmute lead onto gold, and continue to say "well, maybe <b>this</b> time....".

One such case of de-transition that I know of is a friend of mine, Josef Kirchner. His body started feminising in his teens, due to x0/XY syndrome. As he was attracted to boys, and was turning into a girl, he thought he had to be a girl.

He was ill-advised - the incompetent medics that treated him didn't even do any tests for Intersex, they just assumed he was taking hormones"on the sly".

He's since de-transitioned, and is now living as himself - a gay man.

That is a case of medical malpractice, that should never have happened.

But... if you apply the same standards to other surgical procedures, where 98% success isn't sufficient - you'd ban all surgery.

FWIW I completely agree with one of the comments on your blog post:
<i>It suggests that the following factors should be kept in mind those who get a sex-change:
* Do not get a sex-change on a whim in response to a relationship breakdown or other traumatic event;
* Be careful if what turns you on about cross-dressing is being a man dressed in women’s clothes (because being a woman dressed in woman’s clothes won’t have the same effect); and
* A loss of male libido when taking female hormones could indicate problems if a sex change is proceeded with.

It’s a complicated problem. In some ways, the problem with Kane was that he had so much money and influence that he could undertake a sex change easily – whereas for an ordinary person who had to scrimp and save, she/he would have more time to think about it and consider what they really wanted.</i>

One can go too far to the other extreme, making treatment essentially impossible. Then you get cases like the one last week, of someone attempting the surgery on themselves, as there was no way they could afford the cost.

Far more common are suicides of course.

I'll quote a typical story from the UK Mermaids website. One where there really are thousands, not dozens, of similar examples:

<i>MONDAY, 11 APRIL 2011
"I would rather have a live daughter than a dead son."

Cemeteries can be pretty bleak places, but when it is on the outskirts of a faceless Dutch suburb under a grey January sky, it feel about as about as desolate as you can possibly get. When you are visiting the grave of a child who killed herself in her early teens, the feeling of despair, especially when accompanied by her mother, gives way to an urge to weep bitterly. It is an urge which I am unable to resist as I do the maths subtracting the date of death from the day she was born. It is one thing to be told Juliaantje* was only 14, but to see it carved in marble was too much to bear. Holding her photograph her mother sobs uncontrollably as I hug her while she in turn hugs a precious photograph.

The picture is of a sunny, smiling, apparently bubbly teenager, with long hair and a grey T-shirt. There is nothing in the picture to suggest that she was transgender, but that is the reason she took her life.

When she was 12 her mother tried to have her put onto hormone blockers to delay puberty. She didn’t want to develop body hair, a deep voice or have wet dreams. She had already self-harmed when young, trying to slice her penis off with a pair of scissors. However, in what was clearly a borderline decision, the psychologists decided to that she should not be given these drugs. She should be given counselling instead. In despair her mother, a single parent, tried to take her to the United States, but the air fare and the £200 a month cost of these drugs was way beyond her means. Her father had no money either and both sets of grandparents didn’t want to know.

Two years later the talking therapy failed. Juliaantje took a massive overdose and died, having self-harmed, abused alcohol and other substances for more than a year before that.

“She was an intelligent and lively girl.” Her mother tells me through the tears and a large glass of Genever in a nearby café, probably the only thing that can deaden the pain of losing her only child. “She had a great future ahead of her, she could have done anything, been a doctor, a lawyer her teachers said…” Her voice breaks. Her happy nature had disappeared when male puberty really hit. “Her voice broke and she started to get facial hair and hair on her chest. She wore make up and turtle-neck jumpers to hide it all, but she simply couldn’t deal with the way her body was developing…”

Did she blame the psychiatrists? No. Psychiatry is never going to be an exact science, there will always be people who don’t fit into their categories. She does however, feel that they could have given her the benefit of the doubt. “The effects of hormone blockers are easy to reverse, you just stop taking them…” There would have been no risk to her daughter if, at any time she decided that she did not want to be a girl she could simply have stopped, and male puberty would have started.

Hormone Blockers are essentially a way for young trans people and children to leave their options open. They open an extended open window of choice, which gives them time to think about their future, a time during which young people can decide whether they wish to remain the sex they were assigned at birth, whether that be male or female, or whether they need gender reassignment surgery after the age of 18. Talking to mothers of transgender children in the UK who have been prescribed hormone blockers, usually at great cost (£200 a month plus the cost of a consultation in and flight to the United States) one thing comes across loudly and clearly; “I would rather have a live daughter than a dead son.” One of them told me. One mother had remortgaged her house to pay the cost of these drugs knowing what her child was like, she realised that this would probably be the only way to keep her alive.

Another mother talked of how her young child had been prescribed a cocktail of a dozen drugs, including Ritalin, because of behaviour problems at home and at school. Yet when her child was recognised as transgender everything changed. As soon as she was treated as a girl, the tantrums, the bedwetting, the crying, the screaming, the hyperactivity, the violence, just stopped, as did the need for any of the drugs. “She became happy and contented almost overnight, just because we treated her like a girl! The psychologist who spotted this probably saved her life.”

Predictably the accusation of “child abuse” has been levelled at those who advocate prescribing hormone blockers to children between the ages of 12 and 15 (they already are prescribed to those over the age of 16) in the UK. This flies in the face of the evidence in both the United States and Holland, where these drugs have been successfully, and harmlessly prescribed for many years. It also flies in the face of the experience of parents of transgender children, who have lived a day-to-day existence, hoping that their child is still alive and in one piece. Until her daughter was prescribed hormone blockers at age 16 one mother told me of the anguish she and her husband felt when their child had gone missing for a few days when she was 14. “We really thought we would never see her again. Every time the phone rang we thought it would be the police wanting us to identify a body.”

Now that this technology has been developed, not making it available to all those children who need it is child abuse. Three years ago the trans community was shocked by the suicide of a transgender child who was only 10 years old. The allegation of “child abuse” has been levelled at parents who permit their transgender child to express the gender they prefer and who let them have hormone blockers. Yet this is effectively child abuse in reverse. Not to allow trans children to express their gender identities is actually child abuse. Those who throw accusations of child abuse around without knowing the facts are the ones who are child abusers by proxy; putting pressure on parents to force their children to conform to the gender they were assigned at birth no matter what the consequences.</i>

Too conservative - people die, in their thousands. Not conservative enough - dozens of mentally ill or really, really foolish people get mutilated.

There is no perfect solution. All we can do is try to improve our diagnostic criteria so that the number of Charles Kanes is minimised - and so is the death toll of those unable to access treatment. There's a cost in doing nothing you see, (or trying "talking cures" that have been proven ineffective, which amounts to the same thing), a cost in lives.

Rather than go by your "feelings" of what must be the case - please look at the numbers. The studies. The evidence.