Welcome to the first podcast of October 2018. This is our month on topics around the theme of Gender Identity, the Gender Spectrum, and Gender Transitions. We have a really packed month - with 5 amazing Monday Mumblings, 5 podcasts, 5 blogs, and 4 nuggets. Make sure you stay tuned in to all of our episodes!
In This Episode:
Today Monkey and the Professor got to chat with Dr. Raj Purohit. Dr. Raj was born in Rajasthan, India (https://en.wikipedia.org/wiki/Rajasthan) but grew up in the midwest - he is a Michigander at heart. He left Michigan to study history and political theory in college - at Williams. He believes that background certainly informs many of his decisions and things he is very passionate about - he grew up in a family of artists and doctors. In medical school, he took a year off to apprentice with a painter in Rajasthan. He attributes his apprenticeship and painting to have a significant impact on how he views surgery.
He came back to the US, finished his medical training at Columbia, went on to UCSF for his internship in surgery and residency in urology. He did a Fellowship in pelvic reconstructive surgery - this is where he developed an interest in cis gendered patients originally - in reconstructing the urethra from trauma and complications, and ultimately shifted his focus to developing the Gender Affirmation Surgery program at Mount Sinai a year ago.
Dr. Raj made the decision to go into medicine because of his strong family background in medicine, where many of his family members are also doctors. His wife and sister-in-law are both doctors as well. You could consider medicine to be a family business. Even with that, something sparked within him when he entered the operating room for the first time - it was a sense of belonging and home and passion. He sees the surgical suite as a controlled environment, whereas a surgeon, he is an artist - painting the body and bringing out the beauty from within the canvas. Surgery is where he finds his balance in both art and medicine.
We started off with a very high-level overview of what is involved in Gender Reassignment. To begin with, the preferred term is Gender Affirmation - because what is really happening is helping the person become externally what they are already internally - it merely affirms their gender identity. At no point are they really assigning a gender to the patient - that patient is already the gender they are on the path to appearing as. We really love that terminology and phrasing. As Dr. Raj states - the doctors are not assigning or giving the patient a new gender - they are only uncovering what is already there, the gender the person already feels exists.
So - Gender Affirmation Surgery typically involves some level of reconstruction on the body so that the body will fit the gender that the person already identifies as. Patients have already gone through hormonal therapy and have had changes in their bodies to reflect the correct gender profile.
These surgeries are broadly split into two groupings - Top Surgery and Bottom Surgery (https://www.plasticsurgery.org/reconstructive-procedures/gender-confirmation-surgeries).
For transwomen (assigned male at birth, but identify as female) the surgery may entail:
For transmen (assigned female at birth but identify as a male) the surgery may entail: (https://www.ftmsurgery.net/)
Dr. Raj stressed that this is really a continuum of options - not every trans individual will have all of these surgeries or go through hormones or have implants - it is a very individual decision as to what a person wants to do and go through. They may do one or two of these options, none of them or all of them. As a surgeon, he believes his job is the help the patient achieve a body that they are comfortable with, and who they want to be.
Pre-Surgical Requirements:
We spoke with Dr. Raj on counseling for gender affirmation procedures - what is involved, what is required. Keep in mind that different locations (states, countries) have different requirements on counseling and other things that must be completed prior to gender affirmation surgery can occur. All patients do require a psychiatric evaluation before being approved to move forward with surgery - this is very much the case when it comes to some of the more involved surgeries like phalloplasty and vaginoplasty. Most centers require that patients live in that gender identity for at least a year and that they are additionally on hormone therapy for at least one year prior to surgery.
The delays before surgery are not really about ensuring people do not change their minds. Really, by living in the gender identity they relate to, it provides them with experience with the varied receptions within society, their jobs, etc. That may impact the medical care that is then available to them post-surgery. It is important that access to proper medical attention post surgery is readily available for the patient's well being in the long term. Unfortunately many during this year of living in their gender find themselves ostracized, or being terminated for their place of employment - both scenarios having significant impacts on their lives overall.
Hormone Therapy:
The therapy treatments with transmen and transwomen are obviously different. The aim of hormone therapy is to make transgender people feel more at ease within their bodies, both physically and psychologically. Hormone therapy is usually the first treatment that trans people want to have and, for some, it may be the only treatment they need. Some people find that they get sufficient relief from taking hormones so that they do not need to change their gender role or have surgery.
Transmen (FTM)
For trans men (FTM) who have been born into "typically female bodies" (i.e., bodies that have functional ovaries), as well as trans men who were born into intersex bodies, the goal of testosterone therapy is to induce and maintain the presence of masculine secondary sex characteristics. Addition of testosterone is the therapy - this is a very dominant hormone making it an easier treatment for transmen. There are many changes that occur almost immediately with the administration of testosterone.
In FTM testosterone therapy, testosterone (often called "T" for short) can be administered into the body in a number of ways. The most common method is intramuscular injection with a syringe. Other delivery methods include transdermal application through gel, cream, or patch applied to the skin; orally by swallowing tablets (this method is uncommon as it has been shown to have negative effects on the liver); sublingually/buccally by dissolving a tablet under the tongue or against the gums; or by a pellet inserted under the skin. The T-delivery method used will depend on the type of medication available in the country of treatment, the health risks/benefits for the patient, personal preference, and cost.
Testosterone is not stored by the body for future use, so in order to maintain healthy levels, it must be administered in timed intervals and in appropriate dosages. Injectable and subcutaneous T pellets remain active in the body the longest. Injectable T is typically administered between once a week to once every three weeks, and subcutaneous T pellets are replaced every 3-4 months. Transdermal T (patch, gel, or cream) is typically applied to the skin in smaller daily doses; oral and sublingual/buccal T are also typically taken daily.
Transwomen (MTF):
Transwomen have a more complicated approach to hormone therapy. It tends to be a combination of adding feminine hormones while simultaneously blocking male hormones. The goal of feminizing hormone therapy is the development of female secondary sex characteristics and suppression/minimization of male secondary sex characteristics.
Estrogen is not a very dominant hormone - treatment with estrogen is combined with a testosterone blocker like spironolactone (this blocks the production of testosterone at a cellular level). There are many formulations of both estrogen and the testosterone blockers that can be provided to the person going through therapy - pills, injections, etc.
With the combination treatment, increased fat levels in the body can be seen, reduced testes sizes and the growth of breasts, among many other physical changes.
The transformation of the physical bodies with hormone therapy can start within a few weeks to months but will continue over time. The effects in a couple months may not give a complete indication of where things will continue to progress.
The Challenges of Surgery for Transmen:
Transmen do not typically go forward with the bottom surgeries - phalloplasty - at the time of this recording - the general opinion is that those surgeries are not very optimal. Constructing a new penis is a very difficult challenge - and functional penis creation is difficult and dangerous. The idea would be a penis that can experience erections, that can be urinated through (so peeing standing up is possible), and that can provide pleasurable sensations through touch.
Broadly speaking there are two ways that a penis can be constructed. The first is clitoral enlargement (3 to 8 times) that occurs from the taking of testosterone. A new penis can be created from the enlarged clitoris. Additional skin flaps can be used to create a new urinary tube. This provides sensation and urination. The downside is that erections are not possible because the anatomy involved in erections cannot be created within this structure. Obviously, there is a small amount of fullness through stimulation but it is not really an erection. The second downside is that the clitoris can only enlarge so much - a couple inches at most, so you are left with a fairly small penis - and many are not satisfied with that size. The significant benefit is that the surgery is easy and has a high rate of success with low risk of complications.
The second methodology for bottom surgery is the phalloplasty. This is where some tissues from another part of the body is used to create a brand new penis. You can create a tube within a tube - the first time is a penis, the second is the urethra. You can implant as well a penile prosthesis to enable an erection. You can have a penis with quite a good size. The downside is that sensation is very limited and not the same as the clitoris. The additional downside is a very high complication rate - scar tissue, infection, etc. At this point, the best way to avoid these is not figured out. Much debate and research is still ongoing.
Dr. Raj believes a future possibility might be penile transplants. A number of transwomen are removing their penis - that might be one source for the transmen. That may provide a penis with all three criteria. There is, however, a very long way to go to get the immunology, sensation, and functions correctly. There is precedent in penile transplants - a Massachusetts General trauma patient had their pelvis blown off. The surgery was successful there so that leads to possibilities in the future for transmen.
Surgery for Transwomen:
Vaginoplasty is a far more common procedure than phalloplasty. The complication rates are significantly lower than other surgeries - it is truly a technique that appears to have been optimized for success.
These surgeries come in a few different flavors - the most common is the penile inversion surgery. The penis is inverted back into the cavity and the outer skin becomes the vagina inner walls. Sometimes skin grafts are added from the scrotum to deepen the cavity. The benefit here is that you have sensation. The former head of the penis becomes tailored into the clitoris. It is a functional and sensational surgery - providing transwomen with the benefits they would seek from a bottom surgery. The vagina must then be dilated for the rest of their life to avoid a long-term complication of scarring down but essentially this is a fairly optimal procedure. Additionally cosmetically this surgery looks amazing.
What Dr. Raj finds most fascinating is that each center who performed these bottom surgeries historically had developed their own techniques but it is only in the last few years that there has been a sharing of the information so that the group knowledge can work together for better ways to treat patients, with fewer complications and more successes. It is also moving the industry towards a standardization in procedures that include what works.
There is a fairly good overview with FAQs on this subject that you can download http://www.teni.ie/attachments/9ea50d6e-1148-4c26-be0d-9def980047db.PDF
The Cost of Transition:
This is a question that comes up all the time. Unfortunately, there is no simple answer and it will often depend on insurance coverage and such. Many insurances will not cover all or any of the procedures, hormones, etc. Many will.
In general terms, Dr. Raj suggested most insurances will cover hormones. Blue states tend to cover some or all of the surgeries - whereas many red states do not cover these at all. For patients that do not have insurance, cannot get Medicaid, or some from states where the insurance will not cover the procedures the surgical costs can range anywhere from $20,000 - $50,000 dollars. The cumulative costs of hormones can be expensive over the course of a lifetime but are not crazy on a monthly basis.
The great thing about today's world versus a few years ago is there is more and more of a push to include and cover these surgeries than ever before. Dr. Raj does not believe gender affirmation surgery as a choice - he believes it is a necessity to someone's health and well being. This follows the way the medical and insurance industries are moving - these surgeries are no longer considered simply to be a vanity. Being in the wrong body has significant physical effects on health and well being. Doing the surgery results in a reduction of mental health issues that can also then lead to less physical health issues.
"This is something as doctors we can fix, so why should we not fix it?"
The Impact of Age on Transition:
Currently, in society, there are seeing more children (pre-pubescent) and young teens moving towards gender transition. This is often done through postponing puberty through the use of drugs to suppress hormones. This is a very controversial topic - both in society and within the medical community. There is not great data on this topic and on the long-term effects of postponing puberty.
What is known - many children under the age of 12 (puberty) may identify as a gender that they were not assigned to at birth. The majority of those kids will identify as the gender they were born with later in life. There is no real debate for these kids and doing hormone therapy - they are unlikely to continue on with the transition as they get older. The real debate is what to do about those kids who are 12 years and entering adolescence and entering puberty. There are studies that have shown that once puberty is hit and after, the gender is fairly fixed and is unlikely to change as they get older. That means that they are not likely to change their gender identity back to what it was assigned at birth - it is established in their identity. This is where the question comes into play - should puberty be stopped and/or should hormone therapy be initiated so that those secondary sex characteristics of the assigned birth gender do not develop. Questions around early surgery are also being debated. A lack of data makes outcomes uncertain - would they provide better outcomes with earlier surgeries or would there be additional challenges because of coming growth.
For risks and things to be aware of for children, Dr. Raj suggested that parents should speak to an endocrinologist. This is their area of expertise and they can advise if there are and are not things to keep in mind.
Resources for Parents:
There are a lot of websites - but the best in Dr. Raj's mind is the World Professional Association for Transgender Health (https://www.wpath.org/). This site is used by medical professions as well and contains accurate well-vetted information. Many other sites out there may be full of misinformation. It includes standards of care, risks, questions, and so much more.
Other resources include Lambda Legal (https://www.lambdalegal.org/). This organization is geared toward LGBT issues and has a lot of amazing references present for parents.
Transitions in Older Generations:
The older generations - considered geriatric, are making a lot more of a splash in transitions. There are more articles out in the world about people in their 70's, 80's and 90's going through gender affirmations and transitions. Dr. Raj notes he is seeing an uptake of people across all age ranges, but he is highly impressed by the older people who come in. They have lived with the social ostracization through their years. Now as the world is becoming more supportive, they seem to be able to feel safe in moving forward. The courage the older generations have lived with their entire lives, to now come forward with the transition is a true inspiration to Dr. Raj.
Later transitions have different risks than those done at a younger age. One the one hand there are social risks for gender transitions - groups of friends and peers may not support the transition and it may result in a loss of companions and loved ones in their social network. This can result in feelings of loneliness and feelings of isolation. There are also risks of hormonal therapy in older transmen versus younger men. Testosterone can increase blood count and the risk of high blood pressure and sleep apnea and cholesterol. This means these are things that need to be monitored more deeply. There are also concerns of prostate cancer for transwomen who are then put onto hormones. It is unknown if there need to be more screening, testing, and treatment around the prostate.
Surgeries for gender affirmation are all serious lengthy surgeries with risks. Older patients may not be great candidates depending on their health - but as always, Dr. Raj does what he can to help his patients, young and old, do as much as they can to become the physical body they identify with. The patients often have to assess the risks for themselves as well.
Long-Term Health Risks that May Result from Gender Affirmation Surgery:
Unfortunately, there is not a lot of really good data on the long-term risks associated with gender transitions. A few things that are known however are the risks associated with the hormone therapy. Patients taking testosterone to run higher risks of increased blood count, high blood pressure, sleep apnea, and high cholesterol. They also tend to gain weight and may develop acne. For estrogen, there is a higher risk of gallstones, clots, cholesterol issues, cardiac disease, and high blood pressure. The things that are debated but there is no immediate proof is the increase in breast cancer for those on estrogen and progesterone. There is no data, yet, that testosterone can increase the risks of uterine and breast and ovarian cancer in transmen.
Ultimately all these questions require more research and research dollars to look into.
Pregnancy and Hormone Therapy:
Following some of the conversations we had this month, we were curious as to known complications from stopping hormone therapy as a transman to get pregnant. Dr. Raj suggested a few things to consider - normalizing hormones to that of a gender female before getting pregnant and possible concerns for the baby from the additional testosterone in the system. These are also situations that do not have a lot of real research to understand what the possibilities are.
Resources at Mount Sinai:
Mount Sinai has one of the best online resources available to people. They have spent time and commitment in developing one of the best transition centers in the world. They have created a multidisciplinary team to ensure that they can work strongly in a coordinated care method on the patients' behalf. They have also developed two Fellowship programs within the gender affirmation field. In Dr. Raj's opinion, Mount Sinai is moving the field forward through training and procedure development. The research there is also pulling data together for long-term understanding and improvement.
Parting Words:
Dr. Raj likes to think about what appeals to him about the transgender community and the work he does. Some of the patients he has come from very supportive environments and can make the transitions easily. However too many others face ostracization, employment loss and os much more He inquires of each of our listeners - what are you willing to give up absolutely everything so that you can be true to yourself?
Dr. Raj joins our barnyard today - he identifies as a pig in our barnyard. He does not mind to get dirty and to spent time flopping around in the mud. Pigs are also very intelligent animals and he believes that also indicates a part of his personality.
About Our Guest:
Dr. Rajveer Purohit is the Director of Voiding Dysfunction and Reconstructive Urology and Associate Professor of Urology at The Mount Sinai Hospital. He has performed over 400 complex reconstructive surgical procedures including urethroplasty for urethral strictures with grafts and flaps, surgery for complications of radiation therapy, treatment of mesh complications and complications of pelvic surgery such as incontinence and maintains a particular interest in transgender surgery. In addition, Dr. Purohit has continued to maintain an interest in general urology including surveillance for cancer, vasectomy, urinary problems, sexual dysfunction, and work-up for hematuria and elevated PSA.
Dr. Purohit graduated Magna Cum Laude from Williams College and earned his medical degree (MD) and Masters in Public Health (MPH) from Columbia University before completing his surgical internship and urology residency at the University of California in San Francisco. While there he trained with one of the pioneers of male urethral reconstruction and then completed a fellowship with Dr. Jerry Blaivas in pelvic reconstruction and voiding dysfunction and was on the clinical faculty at New York Presbyterian for over 10 years before joining Mount Sinai.
He has been listed in New York Magazine's Best Doctors in New York City. He has been awarded the Pfizer Scholars in Urology, AUA/Praecis Gerald P. Murphy Scholar, Society of Medicine and Reproductive Urology Travel Scholar award, a California Urology Foundation Grant and an Arnold P. Gold Fellowship and multiple Patient Choice and Compassionate Doctor awards.
Finding Dr. Raj!
Mount Sinai Department of Urology: https://www.mountsinai.org/profiles/rajveer-s-purohit
Twitter: @DrUroRecon
Additional Resources and Links:
https://www.pinknews.co.uk/2018/06/26/starbucks-to-pay-for-all-transgender-staffs-surgeries/
https://nypost.com/2017/03/29/transgender-wwii-veteran-comes-out-as-a-woman-at-90/
https://www.plasticsurgery.org/reconstructive-procedures/gender-confirmation-surgeries
https://www.youtube.com/watch?v=EWdtByPm9a4
https://www.youtube.com/watch?v=zGkiC3Y8kk0
https://health.howstuffworks.com/medicine/surgeries-procedures/transgender-voice-surgery.htm
https://www.webmd.com/women/guide/vaginoplasty-and-labiaplasty-procedures#1
http://www.teni.ie/attachments/9ea50d6e-1148-4c26-be0d-9def980047db.PDF
http://transhealth.ucsf.edu/trans?page=guidelines-feminizing-therapy
https://www.cosmopolitan.com/sex-love/news/a52196/what-its-like-to-transition-transgender-man/
https://www.healthline.com/health/transgender/bottom-surgery
Welcome to our last Podcast for our month of October on Gender Identities, the Gender Spectrum, and Gender Transitions. We have had an amazing month, where we have spoken with experts on gender and transitions, and to several people about their personal journeys. Tomorrow we have our final Behind the Scenes blog for the year - so do not forget to check that out. But today is the final discussion on Gender.
In this Episode:
Today, Monkey and the Professor sit around the table and talk to Dr. Caroline Gibbs about steps involved in gender transitions - to facilitate healthy and balanced and successful transitions or, as Dr. Raj prefers - Gender Affirmation processes.
Caroline Gibbs is the founder and director of The Transgender Institute, and is a Licensed Clinical Professional Counselor and National Certified Counselor, nationally and internationally recognized as an educator, advocate, and provider for this population.
She is also a partner in the International Center for Transgender Care.
She understands the current DSM-5 diagnosis of Gender Dysphoria and differentiates among sexual identity, gender identity, gender expression, and sexual orientation.
A Few Definitions:
We discussed a few definitions - and Caroline wanted to point out that terminology has changed - both in the phrases allowed as well as in the change of definitions. With that in mind, she believes that gender is a hardwired construct that cannot be altered - it is how people feel they are as far as male, female, or in between. That feeling is what it is - although someone's external appearance may or may not reflect those feelings.
Transgender is also a very broad term. It is an umbrella term that includes transsexual people (people whose gender identity does not match their physical selves), cross-dressers (predominantly male, heterosexual people, who enjoy dressing as women), and drag queens (crossdressers who dress as more famous women for sexual pleasure or for fun). Caroline feels that cross-dressers often have a varied transsexual identity. After time in therapy and life experience - they find themselves with a shift in their identity. There is no standard here nor has there been research. They may or may not ever move to the transgender part of the umbrella and may not transition.
Gender dysphoria has many misconceptions in the world. In general, it means, very simply, discomfort. In some cases, it may be extreme discomfort. Adding the term gender in front of that means someone who has discomfort around their gender. This involves a mismatch in gender identity from that assigned at birth, and where they may present physically - and what they feel is internally their true gender. As the Professor suggested - their insides do not match their outsides. It can be a very serious issue.
Transitioning is where someone makes a decision to journey to make the internal and external self-match. There are many different things that may happen to make that match - and many levels of matching. The goal is the removal of gender dysphoria, providing freedom and ease for the person. This is where Caroline's organization works - in helping people make the decision as to what the best choices for each individual would be. It is a goal of finding relief.
The Transgender Institute Foundation:
Caroline loves the story of how she arranged for these things to happen in her life. Around 25 years ago she met a group of transsexual individuals who were teaching clinicians on how to treat them and help them through their transitions. There were no standards or practices available at the time to facilitate their journey. This means that the people who were suffering the dysphoria were forced to create their own paths. This was done through a series of lectures and workshops.
Over time, Caroline started dating one of the people in this community - this means that she has a very very personal connection to this community. She decided at that time that it was her passion and she wanted to help this community. She went back to school and got her degrees in advanced psychology and started the Transgender Institute. At that time there were no other resources - that is changing. They have had many successes over the years. This work has become the reason to go forward with her work and life.
Her process is called Transgender Growth Therapy. People go to her group, and through her practitioners, they grow in their psychological, emotional lives - into being whole. Many of those who seek her services start off fragmented - the base goal is to help them become whole. The journey for each is personal and different. The heart of their approach is Whole and therefore holistic. It is more than simply talking about their needs - they work on all aspects of their lives to help them find that wholeness.
Everyone who approaches Caroline's group are self-selected - they have a goal to become what they want to be and who they want to be.
One of the services they include is called the Feminine Immersion Program. People come from all over and stay for a week or longer, and immerse themselves in femininity, much as you would in a foreign language. Together they work, according to individual wishes, on every aspect of feminine identity. It could be working on vocalization, movement, and more. The goal is to help them blend into society - this used to be called passing.
There are few statistics in the world of gender affirmation - though that is something that many people are focusing on more now than ever. Within Caroline's practice, they see children from the age of 3 years old up to her oldest client of 74 years old. There is no age boundary for the work she does. She believes that over time, this is a human condition, stable over time and geography.
International Center for Transgender Care:
Caroline is also the founder for the ICTC. It was founded and is the brainchild of herself and Dr. Kee Rafell? The idea is around the fact that the majority of the people that Caroline sees at her Institute often move to the path of surgery. They refer people back and forth between the organization's complementary actions. The long-term goal is to have a physical location for this in Dallas TX and it is in process.
Caroline suggests that the approach they use is holistic. Holistic means treating the whole person - not just a part. It is more than talk therapy, vocal feminization, surgery, etc. They do EVERYTHING possible that they can to address the needs of the transgender community.
While the ICTC is not the only transgender surgeons around the world, Caroline believes they are some of the best surgeons in the world. She loves the partnership the Trans Institute and the ICTC have - allowing the two organizations to work together holistically to ensure that the patients are WHOLE at the end of the process - able to blend. It is about helping those on the journey to be most successful in all aspects.
Challenges Working With People:
In general, Caroline's biggest challenge working within the broader community, there are co-morbid conditions that co-exist with gender dysphoria - including depression, bi-polar, etc. Unfortunately, these are not always understood so the diagnoses are often a problem with a failure to treat the whole person.
Working with transmen - it is, generally speaking, a much easier group to work with these people. They tend to have a very strong identity of being male - and they want hormone therapy fairly immediately. Her team can quickly identify these individuals very easily. Of course, there are people who are not as obvious - having a more feminine bearing initially. It is her goal to not keep people in therapy too long and putting up roadblocks. Their goal is to help people get to where they need to as quickly as possible.
Working with transwomen, it is much more difficult because, for some unknown reason, masculine socialization is very ingrained. This means it can sometimes be difficult to help MtF individuals to acquire feminine characteristics. Additionally, estrogen does nothing for modifying the voice. It means there is a lot of work and challenge around doing vocal feminization. Caroline actually started off as an opera singer many years ago - she uses her background in that to help teach people today, bodywork, movement, vocal techniques and more to help the transwomen blend. This is probably the hardest part of the entire transition process for transwomen - it is work that the women have to work at, actively, every day - to change their voices and bearing. There are a few surgeries that can aid in feminization of the voice-adjusting the pitch. Both techniques are not very effective and one of those techniques is extremely dangerous and can result in permanent damage to the voice.
Resources and Advice on Transition:
Caroline refers people out for physical modifications or appearance changes early on - hair removal, haircuts or trims. Helping people either grow their hair out or shorten it - to help them move through society in the earlier phases and steps of transition. They get to them learn styling skills and techniques that they can grow into as things shift and change.
Transus City - Website www.transuscity.com. This is a series of blogs that touches every subject around transgender individuals. Caroline feels that this is one of the best resources out there for both the people going through a transition but also their families. You cannot treat only the person - as part of the holistic approach is treating the entire family on the process.
There are also lists of books that she recommends, including books like Transgender 101.
For someone who is considering transition - Caroline, of course, suggests that they call or reach out to her organization. There are other gender therapists of course - but Caroline feels they are the best because of the holistic approach. She also recommends not doing a lot of web research - there is a lot of false and crazy information out there. Look for books recommended by some of the therapists and her group instead.
Caroline's team present workshops on a continual basis - at hospitals to educate the professionals. She has alliances with several hospitals and corporations and companies to help people be able to be better allies. She also works and provides workshops for schools. Many of the presentations they do are not open to the public - they are specific and targeted to clients and organization. Some of these are focused around people transitioning successfully on the job or while at school. Truman Medical Center is their newest ally. It is critical that anyone who comes in touch with transgender people know their stuff.
When training people, the fundamental goal they have is reducing Bias. Bias against the transgender people. It is the biggest enemy that there is. This is why they ensure that there are transmen and transwomen involved as part of their training - it is very hard to hate people up close. Demystifying and putting a face helps remove the bias.
We welcome Caroline to our barnyard. She identifies as a leopard. She believes that leopard is very sexy - she loves the fashion industry with all of the spots. Additionally, she NEVER changes her spots - she has to be strong to do the work she is doing and to stand as an advocate and that is why she is a leopard.
About Our Guest:
Caroline Gibbs, is a Licensed Clinical Professional Counselor and National Certified Counselor, nationally and internationally recognized as an educator, advocate, and provider for this population.
She understands the current DSM-5 diagnosis of Gender Dysphoria and differentiates among sexual identity, gender identity, gender expression, and sexual orientation.
Working with this clientele requires specialization, comprising in part, an awareness of the impact of stress on gender dysphoria and the non-pathologizing of stress-related symptoms, and additionally, a particular knowledge of grief and bereavement as they manifest during the transgender client's and his or her family's journey.
Caroline brings a deep respect for, and sensitivity to, the needs of families of origin, partners, children and friends, a familiarity with the diversity of gender expression and the transgender liberation movement, and an in-depth knowledge of mental health issues and psychotherapeutic techniques. She also has the ability to assess for mental illness, addictions, and trauma-related conditions.
Caroline uses a holistic approach that includes psychological counseling, hormone treatment, psychiatric referrals, and surgery guidance among numerous other services.
She follows the World Professional Association for Transgender Health (WPATH) Standards of Care (formerly the Harry Benjamin International Gender Association) and complies with the HIPAA Privacy Practices. Caroline is a member of WPATH; the International Foundation for Gender Education (IFGE); and the American Educational Gender Information Services (AEGIS).
Finding Caroline:
Introduction
Of month topic: Issues Facing Trans/Intersex/Bi
Of hosts
Date.
Note: .3-.5% of Americans = roughly 1,300,000 people
Note on the GLAAD "Understanding" reports and National Center for Transgender Equality.
Ways we'll be discussing the topic (Section Descriptions: Discrimination, Legal Challenges, Physical Safety)
Section 1 - Discrimination
Discrimination in Public Accommodations
Public accommodations are places accessible to the public, such as retail stores, restaurants, parks, hotels, libraries, movie theatres, and banks. In a 2014 study conducted in Massachusetts, 65% of transgender people reported experiencing discrimination in a place of public accommodation in the past 12 months.
Discrimination in Employment
Transgender people experience pervasive discrimination at work. Between 13% and 47% of transgender workers report being unfairly denied a job,9 and 78% report being harassed, mistreated, or discriminated against at work, as shown in
Currently, only 18 states have clear laws prohibiting employment discrimination on the basis of gender identity or expression (see Figure 3 on the next page).12 There is no federal law that explicitly prohibits discrimination against transgender employees, but there are some protections in place. Both the U.S. Attorney General and the U.S. Equal Employment Opportunity Commission (EEOC) have interpreted Title VII of the Civil Rights Act of 1964, which prohibits discrimination "because of sex," to protect transgender workers.
Discrimination in Housing.
one in five transgender people (19%) in the United States have been refused a home or apartment and more than one in ten (11%) have been evicted because of their gender identity.21 Homelessness is a critical issue for transgender people, with one in five having experienced homelessness at some time in their lives because of discrimination and family rejection
Discrimination in Education
Schools are difficult places for transgender students as they regularly face discrimination, bullying, and harassment in elementary, secondary, and post-secondary institutions. In one survey, 40% of gender non-confirming youtha reported being frequently harassed by their peers and 37% reported frequent verbal harassment and name calling.26
Across the United States, only 13 states have laws that clearly protect students against discrimination because of their gender identity and/or expression
only 18 states expressly prohibit bullying on the basis of gender identity and/or expression (see Figure 6).29
A study in Massachusetts found that 19% of transgender respondents had postponed or avoided necessary care due to mistreatment or discrimination from health care workers.
Section 2 – Legal Challenges
Inaccurate Identity Documents
Official identity documents—such as drivers' licenses, birth certificates, and passports—that do not match a transgender person's gender identity greatly complicate that person's life. Non-matching identification can obstruct employment and travel, as well as expose transgender people to harassment, violence, refusal of service, job loss, and other problems.
Only one-fifth (21%) of transgender people who have transitioned to living in accordance with their gender identity have been able to update all of their IDs and official records with the correct gender, and onethird (33%) had updated none of their IDs or records,
Marriage and Family
Transgender people can be heterosexual, gay, lesbian, or bisexual, but regardless of their sexual orientation, they can often face myriad obstacles when it comes to marriage and parenting. For example, a transgender man who wants to marry a woman may still be seen as part of a same-sex couple and denied a marriage license in states that deny marriage to same-sex couples.
Depending on state law, the couple may be seen as a same-sex couple in one state and a heterosexual couple in another state, with their marriage becoming valid or invalid depending on their state of residence.
Even when a transgender person has legal recognition of their transition and enters into a heterosexual marriage, courts have invalidated such marriages during legal disputes (for example, a transgender man dies and his employer denies benefits to his wife, arguing that the marriage was not valid).
Additionally, if a marriage or relationship dissolves, transgender parents may have their gender identity or expression used to deny them custody or visitation rights.57
Interactions with the Criminal Justice System
More than 2.4 million people are incarcerated in the United States; the country is home to 5% of the world's population and 25% of its prisoners. Latinos are incarcerated at 2.5 times the rate of whites, and African Americans are at nearly 6 times the rate of whites.61 Transgender people and gender non-conforming people, particularly low-income people and people of color, face higher levels of policing and profiling, leading to higher levels of police harassment, imprisonment, and violence.
Higher levels of interaction with law enforcement inevitably leads to higher levels of arrest and incarceration for transgender people. Nearly one in six transgender people (16% overall, including 21% of transgender women) have been incarcerated at some point in their lives—far higher than the rate for the general population. Among black transgender people, nearly half (47%) have been incarcerated at some point.63
Immigration
Transgender immigrants face many barriers to safety and economic security. Many transgender immigrants fled dangerous conditions in countries where being transgender is a crime, or where violence against transgender people is widespread and ignored or perpetrated by the government. Difficulty gaining legal status due to employment discrimination and family rejection, along with increased interactions with law enforcement, mean that transgender immigrants are more likely to be detained and/or deported.67 Once detained, transgender immigrants are especially vulnerable to sexual assault and other forms of abuse. Often held in prison-like conditions, transgender immigrants, including asylum seekers, are at high risk of sexual assault, denial of medical care, physical and mental abuse, and placement in solitary confinement
Section 3 - Physical Safety
Health
Transgender people report low insurance rates and shockingly high rates of negative health outcomes.31
Only 40% of respondents to the National Transgender Discrimination Survey reported accessing health insurance through their current or former employer,34 compared to 44.6% of Americans.3
Shockingly, 41% of respondents to the National Transgender Discrimination Survey reported ever attempting suicide.45 This compares to 1.6% of all Americans who have reported attempting suicide.
Violence
Twenty-six percent of respondents in the National Transgender Discrimination Survey had been physically assaulted on at least one occasion because of antitransgender bias.48
ransgender women and transgender people of color are much more vulnerable to violence, especially at the hands of law enforcement. In the 2013 Hate Violence Report, transgender women were four times more likely to experience police violence and six times more likely to experience physical violence when interacting with the police, compared to all respondents.50 Transgender people of color were more than two and a half times more likely to experience police violence and six times more likely to experience physical violence from the police compared to white non-transgender LGB respondents.51 In 2013, transgender women of color comprised more than half of all LGBT homicide victims.52
Transphobia:
– Believing that being transgender is a symptom of mental illness, a lie people tell, or a fad (read more: Is being transgender a mental disorder?)
– Belittling non-binary people for not fully identifying as male or female.
– Requiring transgender people to use gendered facilities such as public bathrooms that are inconsistent with their identified gender.
– Evaluating the validity of someone's gender identity based on their ability "pass" as cis.
http://queergrace.com/transphobia/
Good for definitions
GLAAD "Understanding Series"
https://www.glaad.org/publications/understanding-issues-facing-transgender-americans
http://www.lgbtmap.org/file/understanding-issues-facing-lgbt-americans.pdf
http://www.lgbtmap.org/file/understanding-issues-facing-bisexual-americans.pdf
Movement Advancement Project
GLAAD
National Center for Transgender Equality
Transgender Law Center
Welcome to the last nugget for our month of consent. Today we are excited to be speaking with Joel Baum of the Gender Spectrum organization.
The Madame got to sit down with Joel to learn about the Gender Spectrum - both as a topic of learning and as an organization. Joel's organization does some amazing work to help with education around California - so you need to check out this episode.
For more information, please visit our website and check out the show notes:
www.bcbcpodcast.com
And remember - you can like us on all the social media, subscribe to our channel, download our episodes, become a Patreon supporter and so much more!
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In this MondayMumblings Monkey and Miss Laura talk about gender reveals and what you can do to be an ally and help support people with their gender identity.
www.bcbcpodcast.com
Welcome to our third podcast of the gender spectrum, gender identity and gender transitions month. Today Miss Laura and the Madame get to sit down with an old friend, Q Wilson, to talk about what it means to be Genderqueer, his journey of gender identity, and all the good things therein!
Q is a self-identified gender independent, queer, polyamorous leather boi. His experience and background in many communities as an activist and educator allows him to bring us a unique point of view on gender and gender journeys.
For more information, please visit our website and check out the show notes:
www.bcbcpodcast.com
And remember - you can like us on all the social media, subscribe to our channel, download our episodes, become a Patreon supporter and so much more!
Website: www.bcbpodcast.com
Facebook: https://www.facebook.com/BCBCPodcast/
Twitter: https://twitter.com/BCBCPodcast
Instagram: https://twitter.com/BCBCPodcast
Patreon: https://www.patreon.com/BCBCPodcast
About Our Guest:
Q is a self-identified queer, gender independent, polyamorous leather boi. It's well known that flirting is Q's default mode of communication. He can often be found with a charming smile on his face or looking mischievous with the other bois. On rare occasions, this boi might even be found dancing on a table, for the right amount of money…for charity of course!
A social justice activist for more than 20 years, Q consistently strives to bring together the various communities to which he belongs. He continues to seek avenues to actively serve as a bridge for the leather community's kinky newcomers and it's more established members, as well as those outside of the community, whenever possible.
Welcome to the third nugget for our month of consent. Today we are excited to be speaking with Chrystal Bartlett, a gender transition coach out of North Carolina.
The Monkey got to sit down with Chrystal to understand what might be involved in gender transition coaching, resources available to people, and all of those important things.
For more information, please visit our website and check out the show notes:
www.bcbcpodcast.com
And remember - you can like us on all the social media, subscribe to our channel, download our episodes, become a Patreon supporter and so much more! We are a 501(c)3 non-profit organization so you can also make a tax deductible donation!
Website: www.bcbpodcast.com
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Monkey and Miss Laura share their thoughts about a vibrating cockring from Adam & Eve.
