Stephen Whittle

Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

ABSTRACT The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.

Transgender people: health at the margins of society

In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.

The Trans-Cyberian Mail Way

Certain features of cyberspace have allowed new forms of minority activism in many spheres of influence. This paper looks at how those features have been particularly appropriate to the life experiences of the transsexual and cross-dressing communities. They have enabled a new community identification category, transgender. This new category has enabled transgender people to acknowledge the transgender self as having an experience outside of the conventional binary dichotomies of sex and gender. Through the experience of the virtual self in cyberspace they have been able to acknowledge an experiential self - an actual self, and become aware of the inade quacies of the self they experience in the real world. This has changed the transgender communitys understanding of the legal problems they face and their use of law to tackle those problems. This paper looks at two particular areas in which this new understanding has enabled new forms of activism, and considers how the under standing of the actual self has arisen.

''Sex Changes'? Paradigm Shifts in 'Sex' and 'Gender' Following the Gender Recognition Act?'

Gender transformations are normatively understood as somatic, based on surgical reassignment, where the sexed body is aligned with the gender identity of the individual through genital surgery – hence the common lexicon ‘sex change surgery’. We suggest that the UK Gender Recognition Act 2004 challenges what constitutes a ‘sex change’ through the Acts definitions and also the conditions within which legal ‘recognition’ is permitted. The sex/gender distinction, (where sex normatively refers to the sexed body, and gender, to social identity) is demobilised both literally and legally. This paper discusses the history of medico-socio-legal definitions of sex have been developed through decision making processes when courts have been faced with people with gender variance and, in particular, the implications of the Gender Recognition Act for our contemporary legal understanding of sex. We ask, and attempt to answer, has ‘sex’ changed?

Recommendations from the WPATH Consensus Process for Revision of the DSM Diagnosis of Gender Identity Disorders: Implications for Human Rights

ABSTRACT Categorizing certain gender identities as mental illness or disorder undermines human rights. The diagnosis of Gender Identity Disorder has contributed to stigma and bias against gender-variant people and to the restriction of their human and civil rights; however, in some cases, it has also facilitated validation and availability of necessary treatment. Although there was some disagreement within the work group about the underlying rationale, the Human Rights Work Group of the consensus process held by the World Professional Association for Transgender Health recommends a medical diagnosis for those who seek sex affirmation treatment without experiencing confusion about their gender identity, the continued availability of mental health support for those who require it, and the creation of a pathway enabling gender-variant people to be migrated from a mental health diagnosis to a medical one as life circumstances change. It is essential to ensure that Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, does not pathologize conditions of diversity in sex/gender identity formation and expression.

Working With Transgendered And Transsexual People As Offenders In The Probation Service

Many organisations over recent years have recognised that the litmus test of diversity policies is how equipped staff feel to work with a person from any ‘minority’ group, whether this group forms part of the regular case load or if their needs are so unique that their experiences are exceptional. In work with offenders, thinking about diversity has quite rightly focussed on systematic discrimination and challenging why some groups receive a less favourable treatment in the criminal justice system than others. Less consideration has been given to people who may form part of a very small minority, even though they often experience extreme levels of discrimination and bigotry. Transgender people are such a group, a small proportion of the general population who experience discrimination and lack of understanding on a daily basis and who are over represented in the criminal justice system.

Listen carefully: transgender voices in the workplace

Abstract We find that only 17% of FTSE 100 company websites refer directly to transgender (‘trans’) individuals, illustrating the extent to which trans voices are unheard in the workplace. We propose that these voices are missing for a number of reasons: voluntary silence to protect oneself from adverse circumstances; the subsumption of trans voices within the larger ‘LGBT’ community; assimilation, wherein many trans voices become affiliated with those of their post-transition gender; multiple trans voices arising from diversity within the transgender community; and limited access to voice mechanisms for transgender employees. We identify the negative implications of being unheard for individual trans employees, for organizational outcomes, and for business and management scholarship, and propose ways in which organizations can listen more carefully to trans voices. Finally, we introduce an agenda for future research that tests the applicability of the theoretical framework of invisible stigma disclosure to transgender individuals, and calls for new theoretical and empirical developments to identify HRM challenges and best practices for respecting trans employees and their choices to remain silent or be heard.

Queer Europe: New Normative Values for Global LGBT Law

This article reviews the jurisprudence of sex and gender in medieval Europe; a time in history when a Judeo-Christian-based legal framework allowed for the persecution and judicial killing of lesbian, gay, bisexual, and transgender (LGBT) people. The chapter then considers how the new ‘Europes’ of the European Union (EU) and the Council of Europe, in their response to a Europe in which the Nazi genocide was able to flourish, have also responded to this traditional jurisprudence. It outlines the development of a new moral sensibility—a new ‘rule of law’, which has created a social and legal framework in which LGBT people’s rights have not just been increasingly recognized but are also now, increasingly, being protected. The chapter contrasts this with the history of national persecutions of LGBT people, and discusses how the new versions of Europe have led to a process of creating normative and ethical law in which LGBT rights are natural and given.

Teorizando el cambio. La historia y desarrollo de una Europa queer

Este articulo considera como la influencia de la temprana iglesia cristiana en Europa llevo al marco legal en el que las personas LGBT pudieran ser perseguidas. Luego, aborda la respuesta de las naciones europeas al genocidio nazi de la Segunda Guerra Mundial, y como esto llevo al desarrollo de dos jurisdicciones paralelas en Europa, una economica y otra basada en los derechos humanos. El articulo considera despues como las caracteristicas de estas dos jurisdicciones han contribuido al desarrollo de un marco legal en el que los derechosde las personas LGBT pueden ser crecientemente reconocidos dentro del derecho, y se pregunta si esto lleva a un proceso normativo y etico legal en el que los derechos LGBT sean naturalmente reconocidos y otorgados.