Transgender awareness growing in society, but science has yet to make more strides

It has been a tremendous month for transgender people across North America. On June 4th, just days after Caitlyn Jenner became the first transwoman to ever grace the cover of Vanity Fair magazine, here in Canada the revolutionary Bill 77 received unanimous support from every party in the legislative assembly. The bill, introduced by New Democrat Party MPP Cheri DiNovo in March, bans conversion therapy, a practice aimed at changing the orientations of LGBT (an umbrella term for sexual and gender minorities) individuals. It is the first law of its kind in North America to address gender conversion specifically.

This comes hot on the heels of controversy at the Centre for Addiction and Mental Health in Toronto, responsible for the care and treatment of gender-nonconforming youth in Ontario and several other provinces as well. In February, CAMH responded to allegations of conversion therapy tactics being used in their own clinic, shutting down intake for new patients and announcing an in-depth six-month review on their practices.

According to CAMH spokesperson Kate Richards, “the review will look at our current therapeutic approaches for children and youth with gender identity issues," focusing on "emerging treatment modalities and international best practice standards.” The review itself predates the introduction of Bill 77 by a little more than a month, and resulted from action by the Rainbow Health Organization and other community organizers. Richards maintains that CAMH is dedicated to helping gender-nonconforming children as best they can.

“Children and youth who are experiencing gender identity issues are a very vulnerable group,” she said in an email exchange. “We welcome the unanimous support for Bill 77 because it’s advancing the effort for a much-needed conversation on how best to support these children and their families.”

Both the CAMH review andPrivate Members Bill 77 were goals for LGBT activists. Susan Gapka, a community organizer and founding chair of Canada’s Trans Lobby Group, says that “this piece of legislation, Bill 77,will significantly direct the outcomes of [CAMH's] review.” This may be just a beginning, but it's a big beginning. “We’ve always suffered a great deal of hardship, of trauma at the hands of psychiatrists and the medical community,” Susan says. “So Bill 77 was a remarkable and significant paradigm shift in that relationship, where trans people themselves were part of the process, directing policy at a provincial level.”

Traditionally transgender people in Canada have been at the whim of social institutions that barely recognize their rights, let alone understand their needs. Even now, theories on gender identity and related disorders are evolving so quickly that many institutions can't keep up. The Canadian Psychological Association (CPA) has removed the links to "gender dysphoria" information from their main webpage, but documents relating to the diagnoses are still available on the site.

While our understanding of gender and mental health is in flux, most professionals in the field stand by the current American medical definitions. The CPA makes it clear that, “Gender dysphoria is not a diagnosis. It is one of the symptoms of gender identity disorder,” defined by specific characteristics in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR; American Psychiatric Association, 2000).

The criteria for a diagnosis of gender identity disorder are:

(a) a strong and persistent desire to be of the other sex;
(b) a persistent discomfort with one’s assigned sex or a sense of inappropriateness in the gender role of that sex;
(c) the person does not have an intersex condition; and
(d) the person experiences clear distress or impairment in their social, work, or other areas of their life as a result of their gender dysphoria.

The American Psychological Association (APA) points out that many professionals believe the medicalization of gender dysphoria “inappropriately pathologizes gender noncongruence and should be eliminated. Others argue it is essential to retain the diagnosis to ensure access to care.” Sill others have concerns about the sincerity of children expressing gender nonconformity, responding to studies suggesting the majority of children who act out against prescribed gender roles will not be transgender adults.

Nonetheless, there are many reasons why support for gender-nonconforming youth is incredibly important.The TransPULSE survey, a social survey of health markers among Ontario transfolk completed in 2010, points out that “while they may not have had language for it at the time, 59% knew that their gender identity did not match their body before the age of 10, and 80% had this knowledge by the age of 14.”

It is a difficult position to be in. On one hand, there is a worry that children with access to body-changing hormones and surgeries could make decisions they may later regret. But for trans youth, the difference between accessing medical transition therapy before and after puberty can be staggering, both in the effort and costs involved, and the likelihood of successful results.

Further, these issues don't even begin to touch on the support needed by adult transfolk who have suffered at the hands of medical and social institutions for decades.

“So many of us older adults have experienced great trauma,” says Gapka. “At first around, conversion therapy, when we were younger, or being misdiagnosed. Diagnosis had a horrendous impact, resulting in experience around alcohol and substance use, self harm, a number of negative outcomes.And it can take us a lifetime,sometimes, of trying to overcome those negative impacts.”

But it isn't just medical industry that has caused trans people grief. In the fifties and sixties, as gender clinics started to pop up in North America, both the RCMP and the FBI maintained criminal databases listing all people known to belongto sexual and gender minority groups. As Gapka puts it, “The stigma that gay and lesbian people, trans people and bi people have had with medical and legal systems has been one of criminality, one of disdain.”

So how did we get here in the first place?

Filmmaker and trans ally Dr. Annalise Ophelian explains that when the gender clinics first emerged, there was no special schooling for those specializing in the treatment of gender disorders. “The folks that were involved in these clinics became self-appointed experts,” and this self-appointment continues today. “There’s still no training, there’s no particular reason why therapists are able to say 'yes you’re ready for this', 'no you’re not.'”

These clinicians and so-called experts were heavily focused on perfecting medical transition and identifying an ideal transsexual experience. This is an interesting case of confirmation bias,which Ophelian exposed in her filmDiagnosis Difference. In their idealism, doctors “ended up creating a situation which put therapists in a position of signing off on whether or not a person is ready to be able to access hormonal care or any kind of surgical intervention." The took the patient's voice right out of the equation and measured each case not on its own merits, but against some imagined clinical standard. "Endocrinologists and psychiatrists will be responsible for judging whether or not you are worthy at every step along the way.”

In Diagnosis Difference, trans activist and community organizer Miss Major describes how the first transwomen to medically transition came out of treatment with stories about what worked to convince doctors of the legitimacy of their need. In response, the trans community developed a narrative to match the prevailing theories – what to say, and how to be trans just right to be deemed ready for treatment.

But Ophelian and others like her are trying to change things for transfolk and those who offer them support. “What it really comes down to is being quiet and listening. We’re in a really amazing moment right now, where trans folks are getting to speak for themselves. I see, particularly in this media moment, a lot of cis folks wanting to jump up and be experts on the trans experience, and the only experts on trans experience are trans folks themselves.”

Because transgender people have plenty to say.

Just take a look at some results from the TransPULSE survey about the ways trans people have experienced harassment, assault, objectification, embarrassment, police misconduct, fear, isolation and poverty.

Bill 77 is just the first step towards a future where it doesn't have to be this way. The joy and hope in Gapka's voice isunmistakable. “This is to send hope, and ripples of hope, to all the younger people, and all the people across Canada and across North America, that there is hope, and we’re sending ripples of hope with this bill. I just think that’s a really beautiful thing.”

You help spread those ripples of beauty too, by supporting transfolk in your community. The APA recommends the following six basic steps that cis allies can take to make a difference in the lives of trans people today.

Read, listen and learn about the issues facing transgender people. Remember that not everyone who appears not to conform to gender roles identifies as trans. Talk to trans people and hear their stories.

• Be aware of the attitude you take and the judgments you make about people who don't meet your expectations of gender conformity.

• Remember that there is no one, universal way for a person to express trans identity. Not every trans person wants to medically transition and not everyone who falls outside the umbrella of cisgender wants to “pass” as a binary gender person.

• Don't make assumptions about a person's names, pronouns, sexual orientation, desire for medical intervention, or any other aspects of their personal identity. If you have a reason to know beyond personal curiosity, be polite and ask.

• Get support for dealing with your reactions and feelings. If someone you care about is transitioning, or you need help understanding, seek out support groups for family and friends of transfolk. Don't make it a trans person's responsibility to deal with your struggle. Find support in other cis allies.

• Get familiar with the laws and legislation relevant to transgender people in your area. Advocate for increasing transgender rights, and help transfolk share their stories.

The biggest issues facing most transgender people today are about fear and hate. The best thing you can do to help is to put your foot down. Don't sit idly by when you witness transphobia in your own life. Take a stand. Little by little we can make a difference.