Transgender: A Diverse Group of Individuals

With the recent spotlight on people who identify as transgender, it’s important to keep in mind that transgender people are as diverse as the general population and express themselves in a number of ways.

On a very basic level, a transgender person is born as male or female, but identifies as either the opposite gender, both genders, or no gender at all.  Some who are labeled as transgender may also decide not to even use that term. There is plenty of evidence that transgender people have existed as long as there has been a concept of male and female. Only recently have they received enough support from society to express themselves in a more open way.  This new recognition and support has opened the door for transgender people to pursue life in a body that feels on the outside the way they have always felt inside.

People who identify as transgender usually start to notice their differences early in life. However people can identify and come to understand themselves to be transgender at any point during their life.  Along the lines of discovering one’s sexual orientation, there are no clear “rules,” and identifying as a transgender individual is a very personal and unique process.  This means that those who identify as transgender may decide to dress as the opposite gender, take hormones to change their bodies, and even have surgical procedures to change their appearance to fit how they feel on the inside. There are also many transgender people who decide that these options are not right for them and express themselves in other ways.

Because society has traditionally been unaccepting to those who identify as transgender, they are at higher risk of depression, anxiety, substance abuse and even suicide. Symptoms can generally improve once the person is in a more supportive and accepting environment. Being supportive can be as simple as using the person’s preferred name and pronoun. Traditionally, even this level of support has not been reached in the health care industry because lack of education and training. It’s important that health care providers become more educated about this diverse group of individuals so that all transgender people can receive appropriate health care for their minds and bodies.

For more information on the historical and psychological evolution of transgender Individuals, please see Association for Gay and Lesbian Psychiatrists (AGLP).
More information and medical guidelines can be found at World Professional Association for Transgender Health (WPATH), www.wpath.org/

By Eric Yarbrough, M.D.
President, Association of Gay and Lesbian Psychiatrists
Director of Psychiatric Services, Callen-Lorde Community Health Center
New York City

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.

From Secrets and Shame to an Authentic Self: How Caitlyn Jenner Could Reduce Stigma for Transgender People

When Caitlyn (formerly Bruce) Jenner revealed her new identity as a transgender woman this week, it sparked many news articles and conversations about what it means to be transgender.

“For many people, it is difficult to understand how you can feel like a different person in your own body,” said Marshall Forstein, M.D., chair of the American Psychiatric Association’s LGBT Caucus, Associate Professor of Psychiatry at Harvard Medical School and Director of Adult Psychiatry Residency Training at the Cambridge Health Alliance. 

As celebrities like Jenner and Laverne Cox share their personal stories, they help reduce the stigma around being transgender, Forstein said. “The more that people get to know people who are living their authentic lives, the easier it is to understand.”

“I think any time there’s a sudden revelation of secrets there are different ways people metabolize that information,” said Forstein said. “Some people will say: ‘Wow, how brave.’ Others will doubt that someone could know they are transgender from such an early age.” Although research on transgender is limited, evidence shows that changes in the brain may occur even before people are born—leading to a disconnect between their outward appearance and how they feel.

Despite the limited research on transgender individuals, Forstein said: “One of the things we know is that, by and large, people who do transition begin to feel happier about this consistency of the internal and external experience.”

While many people who are transgender experience anxiety and depression, Forstein said that this is usually a result of keeping their authentic identity hidden: “It’s the pressure of stigma and shame from being other than what society wants you to be.” As defined by the DSM-5, gender dysphoria ends once an individual has transitioned to their authentic gender. “Put yourself in a situation where you’re not allowed to be you—like when left-handed children were forced to write with their right hands—what would that do to your mental health?”

As Jenner shared with more than a million Twitter followers on Monday: “I'm so happy after such a long struggle to be living my true self. Welcome to the world Caitlyn. Can’t wait for you to get to know her/me.”

By Amanda Davis, Deputy Director of Corporate Communications and Public Affairs, APA

THE DIVIDE: Transgender Mental Health Disparities - why they exist & what we can do…

By Anthony Dobner, Medical Student
Reviewed by Claudia Reardon, M.D.

The Basics…

A transgender individual is someone with the desire to live and be accepted as a member of the opposite sex. This can be accompanied by the wish to make his or her body as congruent as possible with the preferred sex. A transsexual individual is someone who has taken measures, through surgery or hormone therapy, to achieve their desire of living and being accepted as a member of the opposite sex. In general, transgender individuals prefer to be addressed using pronouns and other culture norms that are congruent with their preferred gender identity.

Mental Health Issues Affecting Transgender Individuals…

Lesbian, gay, bisexual, and transgender individuals (LGBT) in general are 2-3 times more likely than the general population to suffer from anxiety and depression. This is probably because anyone who experiences discrimination is more likely to have anxiety or depression.

Almost half of transgender individuals report having attempted suicide. Transgender individuals are also more likely to suffer from substance abuse compared to the general population. Interestingly, transgender individuals who are accepted by their families are less likely to abuse substances. Also, transgender individuals who undertake hormone therapy are less likely to report depressed mood.

Barriers…

Many LGBT individuals experience unintentional discrimination from health care professionals. This may be because they use behavior and language that make assumptions about sexuality. Examples of this include assuming a lesbian or transgender woman does not need to receive education on condoms because she will “never have to worry about getting pregnant.” Research indicates that other barriers include:

• Homophobia
• Assumptions of heterosexuality (or homosexuality in transgender individuals)
• Real or perceived lack of confidentiality
• Lack of training
• Insurance policies and laws that create loopholes for employers that do not provide coverage to domestic partners.

5 Tips for Overcoming Disparities & Receiving Quality Health Care...

SEEK friends and allies who love and accept you for who you are no matter what. Research shows that having a strong support system decreases depression and suicidal ideation.

ASK friends and allies what resources are available in your community. Some communities have LGBT-specific clinics. Smaller communities may not have these services, but there may be individual clinicians who have experience working with LGBT patients.

TALK to your doctor! He or she should care about you and want you to be happy and healthy but may not know the best way to address your unique needs. Don’t be afraid to bring up the issue if they don’t. Refer them to this excellent resource for clinicians who want to improve the accessibility of their clinics for transgender individuals.

ENCOURAGE your doctor to use gender neutral language during your visit, and on surveys, signs, and intake forms.

SUPPORT efforts in your community to pass laws that change language in insurance policies that make it difficult for LGBT individuals to receive quality care.

For more information, check out this great resource for transgender individuals on a variety of health care issues.

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