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On the News: Defining gender identity

The concerns of transgender Americans have become increasingly visible and recognized in recent years. Notable milestones include the new edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 2013, which removed an entry for a disorder that classified transgender individuals as having a psychiatric illness. With regard to medical care, language was added to the Affordable Care Act in 2015 to protect transgender individuals from discrimination in healthcare settings. And in 2016, the Pentagon announced plans to lift the ban on transgender Americans serving in the military.

According to a report published last month by The New York Times, President Donald Trump and his administration are working to codify a definition of gender that would eliminate or diminish recently created protections for transgender Americans. According to a leaked memo, Trump’s Health and Human Services department plans to amend Title IX to include language that defined gender identity as “the sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence.”

In response to this policy proposal, three faculty members from the College of Public Health shared their professional experiences working with transgender populations in research, clinical and policy settings.

"Our responsibility as researchers"

Omar Martinez, assistant professor in the School of Social Work

"Access to health services is especially important for transgender populations, since they have a unique set of medical needs. For instance, HIV prevention and treatment initiatives are crucial to addressing the growing disparities in HIV/AIDS affecting transgender populations in the U.S. (Recent CDC estimates suggest that about a quarter of transgender women are living with HIV.) And in addition to medical procedures themselves, being treated in a manner that affirms a transgender person’s gender identity is vital. One participant in my team’s current research study told us: “When I changed my name, a nurse insisted on calling me ‘he.’ It made me feel uncomfortable. I consider myself a woman.”

"The administration’s proposal to define gender as “male or female” based on genitalia at birth is against the established evidence-based practices and clinical approaches in public health. My team’s previous research (both quantitative and qualitative) has documented how draconian, exclusionary policies like this one, jeopardize vulnerable populations’ wellbeing and access to care while worsening stigma. Moving forward, it is our responsibility as researchers to continue documenting these disparities, challenging the structural barriers to care, including discrimination, and developing and testing innovative prevention and treatment interventions that involve community-based participatory action research approaches."

'...A failure in national health policy'

Ann Addis, clinical instructor and supervisor in the Department of Communication Sciences and Disorders

"In our voice clinic located within the Speech-Language-Hearing Center at Temple University, we use evidence-based treatments to assist clients in various stages of their transition from their assigned gender. The strongest support for our intervention services has come from the clients themselves, who report consistent satisfaction with voice outcomes and much improved participation in vocational and social interactions. We administer a questionnaire pre and post treatment and consistently see clients rating their voices as much improved following the course of individual treatment sessions. Once a client has self-identified and begins the process of transition, voice therapy is often the final piece of the transition puzzle, allowing the person to “be read” as the gender they identify with.

"According to recent estimates, one of every approximately 12,000 males and one of every 30,000 females experiences gender dysphoria—severe distress over a mismatch in an individual's gender identity and physical appearance. These estimates may be lower than actual numbers since gender dysphoria can often go undiagnosed because of co-occurring disorders like depression and anxiety. Eliminating protections for transgender Americans and failing to recognize their unique, real medical needs would be a failure in national health policy."

'Right now is the time to act'

Kimberly McKay, assistant professor in the School of Social Work, and graduate students in her Gender & Sexuality Through the Lifespan course

"The wide variety of gender identities and expressions in the human experience are beautiful and to be celebrated. Two years ago I was part of a group of volunteers who trained the Philadelphia School District on Policy 252, a local policy designed to protect trans and nonbinary students. While Policy 252 is a significant shift in the ways trans and gender nonconforming students are supported and affirmed in Philadelphia public schools, much work remains. We must broaden our understanding of the cultural and social scope of oppression and marginalization that trans and gender nonconforming populations face in our countries, communities, and at Temple University. The federal protections put into place in May 2016, that gave platforms for policies like Policy 252, are currently vulnerable given a recently leaked White House memo filled with misinformation. As a cisgender white woman I must acknowledge the prioritization of cisgender people that has led to these potential policy changes that target and harm individuals and communities we care about. As social work and public health academic communities, we must call out hate when we see it. Right now is the time to act.

"In our classes, we discuss the importance of advocacy in social work. Our students—including those who are cisgender, transgender, and nonbinary—compiled a list of action steps that can help combat the harmful attitudes presented in the leaked memo and, hopefully, make a difference in ensuring that this policy change does not come to pass."

Read more about the college's efforts to improve health outcomes for people who are transgender. 

— Tara W. Merrigan
Illustrations by: Abby Musial

Posted:  November 8, 2018