Wednesday, April 30, 2014

I've written before that I believe most transgender people share the same basic feelings: gender dysphoria, transgender desire and gender fog. Whether you are transsexual, transvestite, drag queen, drag king, butch lesbian, genderqueer, non-binary or something else, you almost certainly experience one of those feelings, and probably all three. Whatever neurological claims you may have read about essential differences between one group and another, the fact remains that almost none of the trans people you will meet have been found to have a "female brain," neurologically. People cross those subcategory boundaries all the time, and the only evidence currently accepted for membership is personal declaration.

We are the same, and yet we can be divided into two subgroups that are very different, with an essential conflict of interest between us that is impossible to erase. This difference is not based on biology or neurology, it is based on a simple difference of goals. Trans people who transition - who take a goal of becoming or being seen as a different gender - are often at odds with trans people whose goals do not include transitioning.

There are multiple conflicts between transitioners and non-transitioners, but the most common, the most salient, conflict is over destiny. Transitioners tend to believe that it is their destiny to transition, and to interpret facts as evidence for that destiny. Non-transitioners may believe that it is our destiny not to transition, or we may be agnostic on that issue.

For example, one time I was out with a friend, presenting as a woman. My friend remarked to me, "You're not very feminine, are you?" At first I was hurt, but then I saw he had a point, and I thought to myself, "Actually, I'm getting tired of being a woman, and I'll be glad when I can take this bra off and use my regular voice. Good thing I didn't transition!" In contrast, Lal Zimman interviewed trans men who reported feeling devastated by the idea that they were failing as men. They couldn't say, "good thing I didn't transition," because they did. Instead, they said things like, "I must just be a feminine man."

And you know what? I completely understand the value of the destiny argument. Transition is hard. I've known transitioners for whom it was pretty obvious to everyone that they were on the right path, but still they encountered some very daunting challenges. There are many people who are politically and philosophically opposed to transition, and who will fight you on it, possibly including parents, employers and medical professionals. It's hard to go through that constantly wondering if you're doing the right thing.

The psychologist Dan Gilbert talks about an experiment where people who felt that they were stuck with a possession (an artistic print) decided that they liked it better than people who thought they could exchange it. When we're stuck with something - and it's something we can live with - we make peace with it. When we can change it at any time, the grass is always greener. Marriage works in similar ways. If you're committed to a person it helps to believe that you're destined for them, and if you're committed to transitioning it's helpful to believe that you're destined to transition.

The conflict comes in when people start making universal destiny arguments, like the idea that "trans women are women," not just when presenting as women, but essentially, eternally, from birth through death, whether we transition or not. Transition then is portrayed as not a change of gender, but as revealing the "real you," or your "authentic self." That implies that someone like me who chooses not to transition is hiding the real me, or denying my authentic self. And that is true for people who stay in the closet, but it's not true for the rest of us.

If we are not denying our authentic selves, but we are still not transitioning, many conclude, we must not have that essence of womanhood (or manhood) that makes transition such a necessity. And that leads to bizarre twists of logic, where someone can be a "man who likes to wear dresses" one day, and be seen as essentially and forever male, and the next day declare a transition and be seen as essentially and forever female.

This essentialist view of non-transitioners leads people to declare that we are not truly trans, and therefore not part of LGBT. It leads them to deny the very real feelings of gender dysphoria, transgender desire and gender fog that we continue to feel, and to deny us any need for support or services. It leads them to speak on behalf of all transgender people, setting priorities and making declarations about terminology without any regard to our very real needs.

Transgender essentialism also leads people to marginalize and ignore non-transitioners. Because the choice not to transition results in people tending to become less passable over time, non-transitioners are caricatured as embarrassing, and negative characteristics that are found across the transgender spectrum are pushed into caricatures of cross-dressers and drag queens as big clumsy insensitive objectifying men in short skirts, and of transmasculine genderqueer people as childish "transtrenders" who claim gender variance only to attract attention.

Detransitioners are usually kicked right out of the transgender club. The fact that they weren't happy with their transition leads many people (including many detransitioners themselves) to declare that they were "never really trans" in the first place. But of course the feelings of dysphoria and desire and fog don't vanish, and the detransitioners are left to cope with them with very little support.

In short, the essentialist way of thinking about trans issues is a big problem for non-transitioners and detransitioners. I used to think that it was just confined to a particular subgroup, and I had friends, many of them non-transitioning trans people, who were skeptical of it. But then a funny thing happened. Many of these friends transitioned, and as each one began to commit to building new lives in a new gender they and their families started repeating essentialist claims. Each time I heard one of these claims I objected, but the result was that over time they began to think of me as a combative stickler. This pattern is repeated in most of my interactions with transitioners.

I used to take some of this personally, but now I realize that the transitioners are just protecting their interests. They don't seem to be capable of realizing how much their actions threaten my interests (this kind of egotism is a hallmark of gender fog), and thus they tend to dismiss my complaints as cranky contrarianism.

It is not cranky contrarianism. It is the one essential difference between trans people who transition and those who don't: transitioners have an interest in justifying transition, and non-transitioners often have an interest in justifying not transitioning. It is not biology, it is simple psychology.

Can we still be friends? Yes, despite this difference, we have many of the same feelings, and many of the same needs. We face many of the same dangers, and we inhabit many of the same spaces. I have friends who have transitioned or are transitioning, and I respect their choices about what path to follow. (That is all I can do; I cannot accept that they have no choice. I think this is clear.)

There is room for us to form alliances of common interest, and alliances of the hearth. But there will always come a Yalta, a time when that essential conflict of interests will manifest itself, when the alliances will break down. Some people - Righteous Ones - will be able to put things in perspective and sacrifice their own interests for someone with a greater need.

It will not always be obvious whose need is greater, and we may take actions that are at odds with each other's interests. But what is absolutely critical is to acknowledge and respect them. If a transitioner tells me that something I do or say affects her interests, I may keep doing it, but I will try to accept that the conflict exists and respect her interests. I ask the same from transitioners. If we all do that, there's a chance we may be able to stay friends and keep the door open to future alliances.

Thursday, December 05, 2013

In my family, when we celebrate Passover we often have non-Jewish friends join us for dinner. Enjoying their company in an overtly Jewish context helps to defuse potential prejudice, and the specific activity of the night, the retelling of the story of slavery in Egypt and our exodus from it, gives them the opportunity to condemn the slavery and in turn reaffirm their tolerance for us and our different practices.

I should point out here that I'm actually not that different from our guests, being half-Scottish and pretty well assimilated. Like most American Jews, I don't do much outside of Passover and Hanukah. My Jewishness is much more a matter of cultural heritage than religious belief. I checked online and this inviting non-Jews is apparently a relatively new tradition: there are some people who believe that non-Jews should never participate in a Seder, because it involves sacrificial lamb meat. The rabbinical consensus seems to be that since the Romans destroyed the Temple there's been no such thing as true sacrificial lamb, and Paschal lamb is just a tasty symbol.

The reason I'm telling you about our tradition of sharing Passover is to note that we do not challenge the separate identities of our non-Jewish friends. We do not ask them to believe in our god or pray to him. We do not ask them to believe the plagues and miracles. We don't give them a hard time if they fail to use the proper forms of addressing our god, including capitalization.

We simply ask our friends to accept the historical aspects of the story, and to reassure us that they do not approve of enslaving minority populations. We give them the opportunity to reaffirm their acceptance of us as friends and neighbors, deserving of respect and equal treatment.

I propose that we as trans people do the same with the annual Transgender Day of Remembrance. This is a day (November 20), when we talk about those of us who have been killed, for being trans and presenting as women, and often for being poor at the same time, for not being white, for being immigrants, for loving men and having sex with men.

We trans people are diverse, but we have a lot in common with each other and with lesbians, gay men and bisexuals. Among our family, friends, spouses and lovers, there are many people who share goals with us. Those are the people we want to have by our sides when we are fighting for our goals, celebrating our lives, or supporting each other. Like most trans people I know, there are times when I want to be treated like my target gender (a woman), with the appropriate pronouns and facilities. These are the people who are most likely to treat me this way.

The problem is that a lot of trans people treat alliances like they're black and white. You're with us or you're against us. You believe in essentialism and determinism, and you support our entire agenda, or you're worthless. I understand why people use these ideological tests to screen allies: someone who doesn't believe that we're even provisionally women (or men) is likely to bargain away some of our rights. You don't want to depend on people who don't really share your goals.

The key is that alliances are never permanent, and if you act like they are it'll get you into all kinds of trouble. An alliance is not absolute trust, it's just a recognition of shared goals. When you're dealing with goals that aren't shared, the alliance is meaningless.

As I wrote before, there is a large number of people who believe that we shouldn't be killed for being trans. Not killing us is an idea with broad appeal. A lot of those people will not be on board with free surgery on demand, or birth certificate changes, bathroom rights or even using our preferred pronouns. But they are on board with not killing trans people. If we don't let them show it, that's our loss.

We should follow Incohate Erica's principle of nihil de nobis sine nobis: feminine spectrum trans people who are poor, nonwhite, immigrants and sex workers should be at the center of any Day of Remembrance activities. They, not me, not other bloggers and authors, and not the leaders of mainstream service and advocacy organizations, are the ones most at risk, and they should be doing most of the talking. And their loved ones, who also suffer greatly, should share center stage.

We trans people who are not most at risk should participate too, out of solidarity and because every once in a while one of us gets killed too. Our dependable allies should be there too. But on this day, and on this day most of all, we should reach out beyond our normal alliances and build new alliances around the shared principle of not killing us.

This year Queens Pride House observed the Day of Remembrance a day late, on November 21. I attended, and I invited a friend who is not trans or LGB, but who has a good heart. If you're trans, I hope you will consider doing the same next year. If you're not trans, check with your local Day of Remembrance organizers to see if you'd be welcome. And consider writing a blog post or an editorial that will reach people who might not normally think about this issue, making it clear that you don't think anyone should be killing us. They need to hear that.

Thursday, March 21, 2013

Kate Bornstein is fighting cancer. Help her kick its ass by donating something to help her pay her bills and for her treatment.
I can say for one thing: I don't know that I'd be around without her. Please let's keep her alive. She blew the roof off this trans thing for so many of us; she continues to do amazing work year in and year out, and her heart is about as big as they come. I know that every time I see her, or talk with her, I have a renewed sense of my own dedication to this movement.
So give until it hurts. Masochist that she is, she'll love that.

Thursday, February 07, 2013

There's an ugly bit of misinformation going around the Internet, that feelings of gender discomfort always get worse with age. I discovered it the other day in the comments to a New York Tines "Ethicist"column responding to an older trans person. The first comment was by a post-transition woman named Zoe Brain: "Gender Dysphoria varies in intensity, and is also progressive."

It was echoed by another woman, Julie C. from Bala Cynwyd: "Trans is progressive, getting worse as the trans person gets older."

The gist of this argument is that even if you're not one of the "transition or die" trans people, if you don't transition now you'll eventually find yourself in that category. There's also an idea (which I generally agree with) that if you're going to transition the earlier the better. Put the two together, and you get an argument that every trans person should transition as soon as possible.

(I’m still not sure how you get from there to “anyone who doesn’t want to transition must not be trans,” but we can deal with that at some other point.)

For some people, feelings of gender discomfort and the desire to be the other gender definitely do get stronger over time. I've heard this from many trans people, and I don't want to discount their experiences. But it's not necessarily true, and it's not automatically true.

Again we come back to the principle that no one really knows what's going on with trans people, and no one will know until we get some kind of representative sample. Generalizations with "all" and "always" are simply not appropriate.

I personally find that my discomfort with being a man, and my desire to be a woman, are not even perfectly correlated with each other, much less constant over time. They both have their ups and downs, and I can connect some of those ups and downs to particular circumstances in my life, but not all of them. Brain and "Julie C." are right in that both feelings keep coming back, even after thirty years or so, but she's wrong in that on average they haven't gotten more intense or more frequent.

This is again the problem of negative evidence: we can see that for some trans people it gets harder over time, but we don't necessarily notice that for other people it doesn't get harder. For every person who transitions or commits suicide, or even hangs on in quiet desperation, there may be one, or many, who lead relatively happy lives without transitioning, until they die. We just don't know.

What we do know is that there are some people like me, for whom it hasn't gotten harder. And that's the thing about generalizations: they can be invalidated by even one counterexample.

Wednesday, September 19, 2012

You've all heard the Trans 101 definition: "irrational or persistent fears or non-acceptance towards people whose gender identity or expression differs from the gender they were assigned at birth. Transphobia can lead to direct or indirect discrimination or harassment in a variety of forms; the common theme is a misunderstanding of, or failure to respect, gender diversity."

Are you ready for something more advanced - say, Trans 201? It's all very well to declare that someone's fears are irrational, and many of them sure are, but that doesn't really tell us much about where they come from, so it doesn't help us to stop it. We can only get true understanding through empathy and compassion. I count at least six distinct reasons for someone to feel afraid of or hostile towards a transgender person. They all have different sources, and they all call for different responses. Some are more rational than others. Lump them together at your peril.

Entitlement policing: the fear that someone is getting away with something they don't deserve. This is behind bathroom anxiety and so much more. It's even more intense if the self-appointed border guard believes that the transgender person in question needs to be made an example of, or else "they'll all want one."

Moral condemnation: the belief that transgender behavior is immoral and must be punished. Usually there is no reason given for this condemnation, it's just written in a book somewhere.

Sissy discipline: the belief that "men" (particularly young ones) who refuse to accept male roles must be punished for shirking their duties.

Deception rage: anger based on a belief that someone has deceived you to gain something valuable from you, including but not limited to sexual gratification. This is a factor in many murders of transgender people.

Fear of unintended consequences: fear based on the belief that someone may be unintentionally putting themselves in danger, or making a choice they may regret.

Fear of shaming or retribution by association: the fear of being attacked for having loved, cared for or been intimate with a transgender person. This is a legitimate fear based on events such as the murder of Barry Winchell, Calpernia Addams's boyfriend, in 1999. It is also a factor in murders of transgender people.

Fear of self-hatred: some people who are intimate with transgender people criticize themselves for it, especially if they believe that it means they are "gay." They may further believe that killing their lover will somehow absolve them of "gayness" or demonstrate their rejection of it.

Fear of shaming or shunning of a transgender loved one, by others or even by oneself. Yes, some people attack their loved ones because they don't want to feel obligated to attack them in the future. How messed up is that?

Wednesday, June 13, 2012

WASHINGTON, June 8 — Trans United for Obama, a national volunteer effort, has launched a campaign to rally transgender people, their allies, families, and supporters in the re-election campaign of President Barack Obama.

The campaign, organized by a group of transgender advocates, educators, bloggers, authors, and their families and allies, aims to educate people about the historic changes that the Obama Administration has accomplished in the past three and a half years to secure equal rights and protections for all Americans, including transgender people.

Among the victories achieved during President Obama’s first term is the removal of onerous and outdated requirements to change gender markers on legal documents such as passports, immigration documents, federal employee records, Veterans’ Administration records, and birth certificates for American citizens born outside of the US. In addition, discrimination based on gender identity is now banned in areas like federal employment and public housing programs, and President Obama signed the first federal law aimed at addressing the rampant violence that transgender people face.

Trans United for Obama (TU4O) will work closely with the president’s campaign and will hold regular national calls to coordinate and boost trans and allied people’s participation in the re-election campaign. One of its goals is to register new trans voters and support others who may be prevented or discouraged from voting by new and discriminatory voter ID laws in several states. Supporters can register at the website to volunteer, donate money to the campaign through the grassroots fundraising site, and express their support for the re-election of President Obama and for his ongoing efforts to secure equal rights for transgender Americans.

Sunday, December 18, 2011

Today I got an email from the Human Rights Campaign saying, "Tell ABC: Your new comedy is no laughing matter." It's about this new television show called "Work It." HRC says,

As part of their winter line-up, ABC is releasing a new comedy called "Work It," featuring two men who dress as women in order to get jobs. The problem is that the premise reinforces false, hurtful stereotypes about transgender people. This kind of programming only mocks those who don't adhere to society's gender norms. Tell ABC's president to can "Work It" now.

The link in HRC's email goes to a petition asking ABC "not to air a show that reinforces negative and damaging stereotypes about transgender people." On their website, HRC says that their president Joe Solomonese "contacted ABC Entertainment Group President Paul Lee today to request a meeting to discuss the very real challenges transgender Americans face in the work place – with the goal of ensuring “Work It” can be a light-hearted comedy that doesn’t belittle or mock these obstacles; or reinforce negative and potentially damaging stereotypes."

With a little googling, I found a trailer for the new series, and articles at The Wrap and the Hollywood Reporter. These both said that not only HRC, but the Gay and Lesbian Alliance Against Discrimination were up in arms about the new show.

On GLAAD's website, I found a blog post attempting to explain "Why ABC's New Sitcom Work It Hurts the Transgender Community." That blog post linked to a Huffington Post article by Mark Daniel Snyder of the Transgender Law Center saying, "We owe it to our constituents to speak out anywhere we see an injustice, no matter how big or how small."

I don't particularly feel that this show is harmful to transgender people. I'll explain my reaction in more detail later, but for now I want to focus on the advocacy messages.

Note that in the HRC website and email, and the statements in the media, we do not hear from a single trans person. HRC president Joe Solomonese is not transgender, and I'm pretty sure that neither is GLAAD Acting President Mike Thompson or Matt Kane, their Associate Director of Entertainment Media. The transgender Huffington Post bloggers who've discussed this issue, Emerson Whitney and Mark Daniel Snyder, are both female-to-male, as is Transgender Law Center Executive Director Masen Davis, quoted in the Advocate.

It took a lot of digging to find any public statements by male-to-female transgender people, and there was a negative one by Kelli Busey and one withholding judgment by Jillian Page. The only expert on transgender workplace diversity I know of, Jillian Weiss, has produced a single tweet, "@kellibusey I like your guest post on care2."

What I find a lot more disturbing than yet another crappy sitcom is reading pronouncements by a bunch of gay men and FTMs about what MTF transgender people feel and think and want, at best referencing yet another problematic convenience-sample survey, without a single MTF voice to be heard. Do Joe Solomonese and Matt Kane and Mark Daniel Snyder know any MTFs? Emerson Whitney at least quoted Kelli Busey; why couldn't Mike Thompson or Mason Davis?

I'll tell you what hurts the transgender community. It's the pretense that we are united by anything other than the hatred we get from outside. It's the idea that we all care about the same things, feel the same way, react the same way. It's the constant stream of shoddy convenience-sample survey reports that allow some gay guy who read The Celluloid Closet or some FTM who read Marjorie Garber to set themselves up as authorities about What Hurts the Community. It's the idea that this is a problem ABC can solve by meeting with Joe Solomonese instead of, say, an actual transgender person, maybe even an actor or producer.

Tuesday, September 20, 2011

History is being made today for the lesbian, gay, bi, and respective non-heterosexual communities the US Military policy Don't Ask, Don't Tell (DADT) officially is repealed. Everyone is celebrating, and I'm celebrating too, but I have to admit I'm more jaded than joyful. Today as the LGB military is coming out, trans* military is being left out.

As an activist rooted in the anti-war/anti-military movement, even I recognize the significance of the USA's largest employer (the federal government) removing a grossly discriminatory policy that theoretically places sexually queer people on equal footing with non-queer people. That's a big deal. And I think it is an even bigger deal that this momentously important event for the "LGBT" community completely leaves off the T. One would like to believe that if high schools can create gender identity and expression inclusive policies then congress can too, but apparently not. An early Department of Defense report on DADT, referenced by several blogs and articles, stated: “Transgender and transsexual individuals are not permitted to join the Military Services.The repeal of Don’t Ask, Don’t Tell has no effect on these policies.” After media attention the report was removed from the government's website. According to the US Military, trans* people are "unfit to serve" primarily (categorically) because of our good friend, Gender Identity Disorder. As mentally ill people, trans* communities are not medically fit to serve.

A common thought about DADT, or now in this case with trans* people in the military, is that the "military problem" isn't really a problem because it is better if our people don't join up - it's better to protect our precious queers. I can't help but think this sometimes... or most of the time... but I force myself to remember that there are people out there who actually like the military - (like a pre-teen Midwest GenderQueer who associated fighter pilots with a desirable yet (continually) unobtainable masculinity - thank you Top Gun). My freshman year of college I met a guy who was determined to have a military career; he said it was his calling. He was also gay. This was years before I came out but even a "straight girl" could see how problematic the situation was. I remember asking him why he wanted a job where he would have to hide who he was his entire life. He looked very sad, yet very determined and said "It's not ideal, but I can do it." Now he doesn't have to, but no such luck if it were me.

Revisiting the "military problem," in my experience people think that it is easy to fix: If you don't like the military, then don't join. This is the number one pillar upholding the classist, global mirage that choosing to join the military is always a choice. Speaking strictly for America, our economic system promotes dependency and servitude towards positions in power. We tell our people to succeed, but don't enable them to do it. With jobs disappearing and public funds being non-existent, we're left with a mass population of the under-educated, unsupported, and unemployed. Our trans* community is especially vulnerable because, like other oppressed groups, we are more likely to be poor, unemployed/underemployed, and more likely to lack personal and/or societal support and resources. In other words, we are a population in need and in comes the secure, sturdy military to solve all our problems. I have personally known several young trans* folks who can't pay for groceries let alone for college; who may struggle to get a job because they are gender non-conforming; sometimes they are trying to escape an unaccepting home; maybe they are desperate to get money to transition; they are people willing to give up everything to get a better life, and that's exactly what they do by joining up. It was not a choice for them. They felt they had no other options, and perhaps they didn't. Being trans* in the military has it's own unique issues that no one talks about. A fascinating 2008 study by Transgender American Veterans Association (TAVA) showed that all military branches have trans* people, the Army being highest at 38%. If you're trans* in the military you live in fear of being outed (resulting in losing your job, your home, and/or friends and chosen family). You can't transition in any form, medical or otherwise, and rigidly sexist uniform codes forbid expressing your actual gender (you can even be court-martialed for "cross-dressing"). If you've taken hormones or had surgery before enlisting but don't report it (which you wouldn't because it would keep you from being admitted) you will be discharged when it was inevitably found out in your records. The military has no protections against harassment over gender expression or perceived gender and if you went to complain to a higher up (that is, if it wasn't the higher up who was harassing you) their solution is to tell you that "if you aren't trans, you have nothing to worry about." You also can not confide in religious or medical personnel because, as military employees, they are not required to practice confidentiality on the subject. Quiet the opposite. In the TAVA survey, 40% of the trans*military personnel stated they were unhappy with their lives.

I also believe that repealing DADT won't change much for your average LGB (or perceived to be LGB) military employee. It's against military law to harass, beat, and rape people, but it still happens; and like everywhere in society it is extremely under-reported and often left without any reprisal. Rules changing doesn't mean that people change, and people are who you see every day. Just like any place of business (and it is a business) without an aggressive campaign of combined education and no-tolerance policies the military will never be a safe place for anyone, "gay" or not. We must continue to address the military industrial complex for what it is, as an institutional system of oppression that preys upon our poor, our young, our disenfranchised, and our communities of color. It is a presence that manipulates the global society in order to serve a small percentage, and that is the top 1% of the US elite.

What bothers me more than the issues within the military is the greater "LGB" community's reaction, or lack their of, to the exclusion of trans* communities. I'm so glad today is here so I won't be invited to another "Yay DADT! All Our Problems are Over!" facebook event; after months of it I'm fed up. Yes, we should be celebrating, but its downright lousy to rub it in trans people's faces saying "we don't have to worry anymore" and "problem solved." If you're going to go that far you might as well just call today what it is, yet another "We Forgot You, Again" day, or "We Matter More" day. And yes, I do have to remind people that our problems are not over. I'm not a downer, I'm an activist. I'm not bitter, I'm fucking furious. The LGB community knows what it's like to be ignored, passed over, discriminated against, but that doesn't mean they aren't capable of taking their rights and privileges for granted. The LGB community makes strides with the help of the trans* community, the trans* community is booted out, and what should be our joy becomes a part of our pain. But in of every disappointment there is room for action. It holds me together when people do speak out and recognize that we are not done yet. We must continue to work, continue to fight, and never be satisfied until we all are equal.

I've heard today described as "the light at the end of the tunnel." If this is your truth, I celebrate joyously for you. And as you reach that light at the end of the tunnel, I hope you remember that some of us have been left behind and we are still working in the dark.

Thursday, July 28, 2011

I've noticed that transgender health researchers tend to focus on people with health problems, and that makes sense. Consequently, I've often felt a bit guilty talking about transgender health issues. I don't have a sexually transmitted disease, the worst thing I'm addicted to is sugar, I've never been bashed, and I'm not depressed or suicidal. So why should I talk about my health? Why would any researcher want to study someone like me?

Gregory ( Scotland Yard detective): "Is there any other point to which youwould wish to draw my attention?"Holmes: "To the curious incident of the dog in the night-time ."Gregory: "The dog did nothing in the night-time ."Holmes: "That was the curious incident."

There's a fancy word for this: negative evidence. Often, the absence of a salient event can tell you more about the causes of a problem than a hundred events.

I see this all the time in my computer consulting business. If a customer is not getting an image on their computer monitor, it could be caused by a fault in the motherboard, the video card, the video cable, or the monitor. I can turn on the computer and get a blank screen a hundred times, but that doesn't help me figure out which component is causing the problem.

If I can get a picture even once, however, I can isolate the problem. If I hook the computer up to a different monitor and the display comes on, I know that the monitor is the problem. If I put in a different video card, I know the customer needs a new video card.

This method can work with transgender health as well. We are a diverse group, and there may be something in family background or upbringing that can make the difference between health and sickness.

There are many choices that we make in our lives, and those choices may affect our health. We need to know the consequences of those choices. Even if that knowledge doesn't ultimately change our decisions, it can prepare us and allow us to plan better.

That is why we need to hear about a whole range of transgender people, not just those that the researchers were able to track down.

Saturday, July 16, 2011

I wanted to go into a bit more detail about something I've mentioned before: that the use of non-representative samples can cause problems down the line. To illustrate this, I want to examine the claims of health disparities that Emilia Dunham lists in her Bay Windows article.

Transgender people take more hormones and have have more surgeries than average.

Transgender people smoke at a 30% prevalence rate, and use other substances to cope with the stress from discrimination.

We’re more likely to suffer from depression and anxiety, and more likely to live with HIV.

61 - 64% of transgender people have been physically or sexually assaulted.

41% of transgender people have attempted suicide.

All these percentages skyrocket for transgender people of color and low-income folks.

A startling 1 in 5 transgender people have experienced complete refusal of services from healthcare providers.

If transgender people aren’t referred to with correct names or pronouns or are treated with coldness, they may avoid the office.

Of these statements, only the last one is an existential statement. All the others are statements of prevalence or likelihood that are not generalizable without a representative sample. In my impression, some of them are more likely to be true of the entire transgender population than others. There are chains of causation from transgender actions to these disparities, and the chains are not all the same. Here are some possible causal chains. They are not the only possible ones, but they are the ones that seem likely to me.

First there are the inherent consequences of transgender actions: more hormones and surgery. If you're only concerned with transpeople who choose to take hormones and undergo surgery, then of course this is true. But if you believe that not all transpeople choose hormones or surgery, and you don't know how many do, then you have no way of knowing how great these disparities are.

Then there is harassment based on perceptible differences: physical and sexual assault. A lot of this has to do with passing - as one gender or another, not necessarily the one you prefer. The passing does not have to be total: a transperson can avoid a lot of harassment simply by avoiding being noticed. However, note that there is a feedback loop here regarding socioeconomic status: wealthier transpeople can afford higher quality hormones, surgery, hair removal or attachment, clothes, padding, cosmetics and training that can give them (us) a better chance of passing as the target gender.

There is also discrimination based on records or perceptible differences: refusal of healthcare service. There can also be housing, consumer and job discrimination, which can affect some of the factors below.

A transgender person has a number of potential reactions to the harassment or discrimination described above, including: avoidance of healthcare providers, depression, anxiety, substance abuse, suicide attempts. Out of fear of discovery, many transpeople engage in hidden sexual activities, where there is a greater risk of HIV infection.

Completing the vicious cycle I described above are the consequences of poverty, which may in turn result from discrimination: there is greater likelihood of harassment and discrimination (and the consequences that follow from that harassment and discrimination) and sex work (which increases the likelihood of HIV infection).

I know from personal experience, from friends' anecdotes and from online reading that these disparities do not affect all transgender people. Some people do not choose hormones, some do not choose surgery. Some never take publicly visible transgender actions, and others pass well enough, so they are never harassed or discriminated against. Some are able to deal with the harassment or discrimination they experience without resorting to depression, anxiety or substance abuse, or attempting suicide (which is not a judgment against those who are unable). Some are able to avoid unprotected sex. Some are wealthy enough to avoid the consequences of poverty.

Here's the problem with sampling: Dunham and other researchers have no way of knowing for sure whether they've oversampled from those who choose hormones and/or surgery; those who take publicly visible transgender actions; those who don't pass enough of the time to avoid harassment or discrimination; those who already have tendencies towards depression, anxiety, substance abuse, suicide or casual sex, for unrelated reasons; and those who have lower incomes. After all, these are precisely the populations that public health researchers are more likely to come into contact with. Without representative samples, they can never prove that these disparities exist to the extent that they claim.

Now I want you to imagine that these researchers actually have been oversampling these higher-risk populations. On one level the consequences are minimal: if these are the populations with the greatest need, then it's just another way to spend public health dollars on the people who need them the most. But on the image level and the credibility level, there are problems.

I've seen on the Web and on television that some people have a stereotype of "tranny" that combines all these factors: a drug-addicted, unpassable, mentally ill hooker with bad plastic surgery. Some people use that stereotype to justify harassment and discrimination against transgender people, and some family members fight against accepting their relative's transgender feelings because they fear that this will be their fate. These kinds of unsupported survey results feed into those stereotypes.

What if at some point someone does succeed in doing a representative survey, and finds that the drug-addicted, cigarette-smoking sex workers are a small portion of the transgender population, and that the average transgender person is a drug- and disease-free, well-adjusted, successful computer technician making $60,000 a year? What if all the transgender health money was actually better spent on overlapping programs that would serve the needy population just as well? I think someone might feel cheated, and I think there might be a backlash.

There's also the possibility that we might be missing out on some valuable information. What if we found that there were people who had the exact same background, and the exact same transgender feelings, but one group became drug-addicted HIV-positive sex workers and the other became successful computer technicians? We could examine the populations and see what made the difference between health and sickness. It might not be the obvious solution.

This is why we need representative sampling, and this is why you need to comment on the proposal and tell that to Secretary Sebelius.

Thursday, July 07, 2011

Washington, DC – The DC Trans Coalition today released summary findings from the first phase of its ongoing Needs Assessment Project, which found that transgender, transsexual, and gender non-conforming people in the District of Columbia – regardless of race, ethnicity, or socioeconomic status – have serious concerns about their safety as they go about their everyday lives. Other findings include severe underemployment, and major difficulties accessing adequate healthcare.

“This needs assessment is the first study of its kind in DC in over a decade, and is the first trans needs study in the nation to deploy community mapping as a research technique,” said Elijah Edelman, one of the needs assessment coordinators. Over 100 trans residents in DC participated in a series of roundtable discussions where they mapped Washington, DC as a trans city, and suggested questions for the survey portion of the study. “The maps create a qualitative picture of DC that a survey simply can’t provide, and the discussion around their creation will help us craft a survey that truly investigates the community’s concerns,” Edelman said.

The mapping exercise also identified places where trans people spend their time and access resources across the city. The study found that while over half of participants mapped areas commonly referred to as sex work “strolls,” many participants mentioned these not as places where they seek income, but rather as places where they interact with their friends. “Roundtable participants overwhelmingly described the strolls as places where – despite the high chances of facing harassment or arrest – trans people go to look out for their friends, distribute resources, and support one another,” said Sadie Ryanne Vashti, a DCTC organizer. “We are concerned that some of the central places where trans people build communities are also some of the most heavily policed areas in the city, thanks to policies like the ‘Prostitution Free Zones,’” Vashti added.

The DC Trans Coalition has received a grant from the Williams Institute at the University of California, Los Angeles School of Law to conduct the survey phase of the Needs Assessment Project. DCTC is actively soliciting additional funding to support the research and economic empowerment components of this project. Donations are fully tax-deductible thanks to the fiscal sponsorship of AGREAA – The Association for Gender Research, Education, Academia and Action.

To download the summary findings from phase one of the DC Trans Needs Assessment, or to donate to the project, visit www.dctranscoalition.org.