Transgender 101

B Y: E VE LYN B A B A R O U D I, S Y D NE Y CA R NE VA L E, A NNI E
G U IL IA NO, K E L S E Y P U L I AF I CO, B R I A NNA P U P P, CY NT HI A
S A NCHE Z , MICHE LLE VE R S T E N, & MI CHE LL E W I L S O N

Activity
Break into 9 groups of three
Scenario 1: You are going to your five year old cousins birthday. She is in
kindergarten and likes to play outside. You need to pick up a gift for the party.

Scenario 2: You are attending your nephews bar mitzvah later this week and
need to find a gift for him. Hes a very good student.
Scenario 3: You are attending a coworkers birthday. They enjoy attending
yoga class on the weekends. They do not need any more yoga equipment.

Go to your favorite online store and find a gift for each person (no
gift certificates!)

How Do You Know What Gender

You Are?
Physical anatomy?
Testosterone level?
Menstruation?
Given birth to child?

Clothing choices?
Transgender Identity. (2015). Retrieved from http://www.nzingaharrisonmd.com/blog/caitlyn-jennermay-just-save-a-teens-life-43-of-transgendered-teens-have-attempted-suicide/

Definitions
Transgender
Transsexual

Cross-dressers
Genderqueer
Gender variant or gender
nonconforming
**Remember that these definitions may
mean something different to the person
who claims them!

Pronouns. (2014).Retrieved from http://www.gayrva.com/news-views/styleweekly-examines-local-trans-youth-support-group/

(Teich, 2012)

The Gender Binary

Gender and sex
Gender identity and gender
expression
We can no longer limit persons
to the binary, rather we must
imagine gender, sexual
orientation, and sexual identity
as a spectrum
Gender Binary. (2016).Retrieved from https://fysopgenderfocus.wordpress.com/gender-binary/

(Teich, 2012)

Sexual Orientation

|----------------------------------|-------------------------------------|
0
1
2
3
4
5
6
Heterosexual

Bisexual

Homosexual

(Teich, 2012)

Sexual Orientation
Non-Trans Man

Non-Trans
Woman

Transman

Transwoman

Straight

Gay/Lesbian

Bisexual

Gender ID
Sexual Orientation:

(Teich, 2012)

Transitioning
Counseling sessions: ~$50-200/month
Hormone therapy: ~$100/month
Surgeries
Female to Male
Chest Reconstruction: ~$6,000
Hysterectomy: ~$10,000
Scrotoplasty: ~$11,500
Metoidioplasty: ~$5,200
Male to Female
Orchiectomy: ~$4,600
Vaginoplasty: ~$20,000
Breast Augmentation: ~$8,200
Facial Feminization: ~$70,000

Outness of Respondents. (2010).Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/reports/
ntds_full.pdf

People Whom can Tell. (2010).Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/reports/ntd
s_full.pdf

(Center of Excellence for Transgender Health, 2016; The Philadelphia Center for Transgender Surgery, n.d.)

Statistics Regarding Transitioning

Transitioning is not limited to physical changes,
may encompass changes in dress, hobbies, and
other social constructs

Injustice at Every Turn

55% live full-time in a gender different from their birth sex
27% are not living full-time in their desired gender yet,
but want to someday
18% do not want to live full-time in a gender other than
that assigned at birth

Medical transition vs surgical transition

Transition Status. (2010). Retrieved from
http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf

61% have medically transitioned

33% have surgically transitioned
(Grant et al., 2011)

Transgender Transition Ages

The age of transition varies for every person
Injustice at Every Turn found that most individuals transitioned between the
ages of 18 and 44
Generally it was found that transgender men transitioned at an earlier age than
transgender women

Hormone Therapy. (2010). Retrieved from (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/reports/
ntds_full.pdf

Age of Transition. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/report
s/ntds_full.pdf

(Grant et al., 2011)

Can You Tell?

Injustice at Every Turn posed the question to
survey participants:
Can people tell you are transgender even if
you dont tell them?
Results found that most transgender
individuals only felt others could tell they
were transgender sometimes or
occasionally
Visual Non-Conformity. (2010). Retrieved from
http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds
_full.pdf

(Grant et al., 2011)

Transgender Youth
Age 2: conscious of physical differences between
boys and girls

Age 3: easily able to label as boy or girl

Age 4-6: stable sense of gender identity
Just a phase
No way to predict what child will identify as when they grow
up
Important for children to feel loved for who they are

Transitions

Transgender Rights. (2015). Retrieved from http://www.speakingofsuicide.com/2015/01/02/transgender-suicide/

Puberty inhibiting medication

Surgery: 18 years, or older
Can be younger if they have parental permission
(American Academy of Pediatrics, 2015; Teich, 2012)

Community Values and Beliefs

[Skybluepink-baphomet]:
There is no transgender community, it does not exist as a single entity. Try to
think of it as a large collection of individuals and also numerous small localised
communities of trans people and associated queers. What beliefs and values
you encounter will vary an awful lot between people. Trans people run the
spectrum of politics, religions, hobbies, professions etc. so by and large there
isn't a homogenous trans community, although a lot of us know each other at
least in passing.

Beliefs
Should transgenderism be included in the DSM V?
Some believe transgenderism should be classified as a mental health diagnosis, others believe it is
demoralizing and should be a medical diagnosis rather than psychiatric
DSM IV: gender identity disorder
Mental health diagnosis

DSM V: gender dysphoria

Identification Beliefs

...Because I am not on hormones, I feel like I have to include transgender with how I identify in
order for people to not mis-gender me. I think that once I am fully transitioned I wont use the word
transgender or trans when I identify myself and I will just say male. I am not ashamed that I am
transgender, I just think that its not the only or most important thing about me.
-Bob

What should insurance companies provide?

I think insurance companies should cover these surgeries, hormones however are cheap and
affordable for individuals and should not necessarily be covered by insurance.
- Michael

Values
Advocating for the transgender community
Living stealthily, some feel they should not have to out themselves or identify as transgender
Equality and respect for their true identity
Open-communication in health care
If a mistake is made regarding identification, apologize!
Its funny in my office, people literally like talk sh*t about transgender people, and yeah
sometimes I feel bad not like I guess standing up because I mean thats who I am I cant deny that
thats who I am, but at the other time, its nice, its kinda nice, ya know, this is the first place in my
life where people dont know where I came from dont know how I grew up, so its nice not really
having to deal with that.
- Michael

(Grant et al., 2011; Human Rights Campaign, 2016; National

Center for Transgender Equality, 2015; Sears & Mallory, 2011)

Roles
Differ for every individual
May relate to socially constructed gender roles of the gender(s) transgender
individuals identify, however not always the case
Michael
No role has changed, filled the male role all throughout growing up. Never conformed to gender
roles too much. Played baseball when identified as female, continued to play baseball until high
school

As male, he receives more respect. Customer service...people more urgent to help at restaurant or
store. Easier to get bartenders attention because they know guys will most likely buy the drinks and
thats where theyre going to get their tip

Discrimination Workplace
26% lost a job due to bias
78% reported at least one form of harassment at work
47% discriminated against in hiring, promotion, or job retention
16% reported they felt compelled to work in the underground economy
(i.e., sex work, selling drugs)
Transgender individuals of color face higher rates of discrimination
Only 18 states currently prohibit discrimination based on gender identity
4x more likely to live in extreme poverty (i.e., less that $10k/year) when
compared to the general population

Discrimination Workplace
Injustice at Every Turn:
I was a very respected lawyer before all of this, but lost my practice and clients, and
have not been able to attract any new clients or get referrals or even get a job in my
field for the past 8 years. Very frustrating because I dont feel any less intelligent or
less qualified, but others, both the public and lawyers, perceive me that way.

Promotion Denial. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/repor
ts/reports/ntds_full.pdf

Employment Discrimination. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/
reports/ntds_full.pdf

(Grant et al., 2011)

Discrimination Education
59% report harassment or bullying in school at any level
15% left school because the harassment was so bad
23% reported experiencing physical assault at school
8% reported sexually assaulted at school in any level
11% lost or could not get financial aid or scholarships because they were
transgender
Prior to being out at school, I received about $18,000 in financial aid, several
awards, and scholarships. The year that I decided to be out on my applications, I
received one scholarship out of 18 that I applied for despite having a 4.0 and an
excellent application package.
Alarming relationship between mistreatment in school and had to leave, nearly 48%
were currently or formerly homeless
(Grant et al., 2011)

Discrimination Healthcare
19% of transmen and 22% of transwomen
have been refused treatment
28% reported verbal harassment in a
doctors office, emergency room, or other
medical setting
28% reported postponing medical care
when sick or injured due to discrimination
50% reported their medical provider
lacked knowledge in transgender care
Health Care Disparities. (2016). Retrieved from www.imgur.com

(Grant et al., 2011)

Discrimination LGBTQ Community

Transphobia
Some gay men and lesbians denounced those who felt themselves to be of the
opposite sex, criticizing them for acting like "freaks," bringing disrepute to
those gays and lesbians trying to live quietly within heterosexual society.
(Meyerowitz, 2002)
In reference to a man that identified as a transwoman, "As far as the public
knows," Winters wrote, "you were merely another unhappy homosexual who
decided to get drastic about it."

(Weiss, 2004)

Occupational Engagement
Activities of Daily Living
Dressing
Toileting
[deleted]: When I was a kid the bathroom was
a source of anxiety for me, just stepping into
the room filled me with dread but I've learned
to cope with it as an adult.
[deleted]: If I wasn't comfortable in my
appearance, it wasn't worth the risk of
someone freaking out in the bathroom and
causing a huge scene.

Gender-Neutral Bathroom. (2014). Retrieved from

http://chicago.cbslocal.com/2014/07/17/northwestern-getting-two-newgender-neutral-bathrooms/

#wejustneedtopee

We Just Need to Pee. (2009).

Retrieved from; www.funcrunch.com

Occupational Engagement, Cont.

Activities of Daily Living
Occupational Safety and Health
Administrations take on toileting
Companies have implemented written
policies to ensure all employees have prompt
access to appropriate sanitary facilities

Sanitation Standard. (n.d.). Retrieved from https://www.osha.gov/Publications/OSHA3795.pdf

Best policy:
Offer single-occupancy gender-neutral
(unisex) facilities
Use of multiple-occupant, gender-neutral
restroom facilities with lockable single stalls
(Occupational Safety and Health Administration, 2015)

Occupational Engagement, Cont.

Activities of Daily Living
Personal hygiene and grooming
[glasswings]: Actually, that [grooming activities] is a problem. I went through a
long period of not liking being naked. Now, shaving. Shaving makes me so sad.
Not shaving does too.
Sexual activity
[missk11]: Many of my trans friends have a history of substance abuse, self
harm, suicide, and other mental illnesses. Some do sex work or have done it in
the past, either to obtain income or to help fund surgeries or procedures.

Occupational Engagement, Cont.

Instrumental Activities of Daily Living
Religious and Spiritual Activities
For some, participation in religious or
spiritual activities is significantly limited due
to the oppression of others.
The acceptance of ones religious/spiritual
community varies significantly depending
on the religion itself, the location of the
community, the values of the community,
and the values of the individual
If someone is gay and searches for the Lord
and has good will, who am I to Judge?

Pope Francis. (2015). retrieved from blog.cleanenergy.org

-Pope Francis
(Hale, 2015)

Occupational Engagement, Cont.

Instrumental Activities of Daily Living

Shopping
[deleted]: ..For me, I feel like my ability to pass
has a direct link to my ability to go out in public.
If i feel like I will be negatively judged by the
population (ie. If I feel like I'm going to look like
a crossdresser), I generally will be more
avoidant to go anywhere public (to the extent
of just skipping meals so I don't have to go to
the store for groceries).

Mistreatment of Retail Stores. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf

Health Management
[Quirkyqueer]:

The problem I run into most often when I go to the doctors office is
issues with my pronouns...It would be helpful to have a gender field
aside from that with the option to write-in gender, and a space to write-in
are pronouns.

[thecarolinekid]:
Something that healthcare professionals, particularly therapists of any
kind, should be aware of is the correlation between autism spectrum
disorders and being transgender.
(Grant et al., 2011)

Health Management
Injustice at Every Turn
I was forced to have a pelvic exam by
a doctor when I went in for a sore
throat. The doctor invited others to
look at me while he examined me and
talked to them about my genitals.

Refusal to Provide Care. (2010). Retrieved from http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf

(Grant et al., 2011)

#Transhealthfail
Social media provides outlets for transgender individuals to share
their #transhealthfail

Occupational Engagement, Cont.

Education
Laws that inhibit or allow transgender persons to utilize certain facilities
...My old high school district was just in the news for denying a transgender
student access to the womens locker room. While title 9 helps, there are
loopholes that board members are finding to exclude transgender students
Bob
[deleted]: It also affected my ability to go to classes last year when I was uncertain
of my ability to present confidently...it's just one of those things where I very
strongly do not want to be misjudged or harassed
Injustice at Every Turn:
I have chosen to attend college online to avoid harassment.
I ... have been censured by the faculty for coming out ...I have been denied
classes...One male psychologist verbally attacked me in class and used
transphobic and misogynist language.

Occupational Engagement, Cont.

Work
For many trans individuals, there is a constant balance between achieving in the
workplace and outing oneself
Some may be concerned that transitioning or coming out as transgender may
affect their career mobility and reputation
According to a survey in 2014, 33% of Fortune 500 companies now have policies
regarding gender identity protection as compared to the 3% in 2002
If your services are related to your clients work experience, ask yourself:
Does their gender impact their occupational performance?
Do coworkers, peers, or management need to know the client's gender in
order to accommodate the needs of the client?

(Elejalde-Ruiz, 2016)

Occupational Engagement, Cont.

Work
Injustice at Every Turn
The obstacles currently facing trans people in regards to employment are the most
insidious. Without an income, one has absolutely NO voice, politically, economically or
socially. Elimination of employment discrimination, above all else, is the keystone to
fundamental transgender equality in America.
I was fired from my job after 18 years of loyal employment after a fellow employee saw
me dressed while attending counseling and reported me to the boss...

When I started my transition, the place that I was working was very supportive. My boss
had a family member who is transgender. I was treated with respect by everyone. I had
worked there for many years and everyone assumed that I was gay until then and they
knew my partner. I guess they just figured I would still be me. Except for growing facial
hair and going bald, I am the same, only better and more free.
(Grant et al., 2011)

Occupational Engagement, Cont.

Social Participation
Social participation can be difficult as a result of the individuals fears of being
ostracized or as a result of the judgements of others

[deleted]:...When I was a kid I was invited to a birthday party at a lake and I sat on
the dock for about 4 hours straight by myself watching the other kids have fun
because I hated swimming because of the bathing suit thing...I didn't go swimming
for close to 15 years, I never did things I wanted like...going to school dances or
anything that required gendered clothing, so I missed out on a lot in my life.
[deleted]: A lot of lay people have this impression that transpeople are bombastic
and gregarious, some are I guess, but many have quite severe social anxiety and
general anxiety issues.

Occupational Engagement, Cont.

Change Desired in the Community by the Community
Protecting transgender/gender non-conforming people from discrimination
in hiring and at work: 70%

Getting transgender-related health care covered by insurance: 64%

Access to transgender-sensitive health care: 43%
Passing anti-bullying laws that make schools safer: 21%

The right of transgender/gender non-conforming people to parent, including

adoption: 14%

(Grant et al., 2011)

Changes in Media Over Time

Women in Revolt. (2015). Retrieved from

http://www.bfi.org.uk/news-opinion/news-bfi/lists/10great-transgender-films

To Wong Foo. (1995). Retrieved from

http://www.austinchronicle.com/calendar/film
/1995-09-08/142658/

Buffalo-Bill. (2014). Retrieved from

http://www.bilerico.com/2014/05/stealing_the_sister
hood_terf_ideology_in_the_movie.php

Boys Dont Cry. (2015). Retrieved

from http://www.bfi.org.uk/newsopinion/news-bfi/lists/10-greattransgender-films

Transgender Persons in the Media

Laverne Cox. (2014). Retrieved from

http://mashable.com/2

Andreja Pejic. (2016). Retrieved from

https://www.yahoo.com/celebrity/news/exclusiveandreja-pejic-sees-marie-205000928.html?ref=gs

Jazz Jennings. (2016). Retrieved from

https://twitter.com/jazzjennings__

Eddie Izzard. (2014). Retrieved from

http://www.interviewmagazine.com/

Competence in Occupational Therapy

Despite increased awareness of the need for comprehensive, client-centered care for
transgender persons, few health care professionals feel confident in providing care to
the transgender population (Vance, Halpern-Felsher, & Rosenthal, 2015)

Establishing a well-rounded occupational profile is a key component to developing a

treatment plan that best suits any clients needs
Challenge yourself to seek out continuing education opportunities that focus on how to
provide the highest level of care for marginalized groups

Local Resources
Advocacy

Family Support

Gender Justice Nevada

Gender Spectrum

American Civil Liberties Union of Nevada

PFLAG Las Vegas

Clothing/Hair/Nails

Support Groups

GC2B (binders)

Genderfolk

Switch (clothing swap)

Rad Remedy

Shelter Support

Spiritual

HELP of Southern Nevada

Resurrection Faith Ministries

Gender Justice Nevada

Northwest Community Church

Primary Cary Physicians

Youth Resources

Ensign Medical

Shannon West Homeless Youth Center

Personal Medical Center

Nevada Partnership for Homeless Youth

Take Away Messages

If you have a question (as long as it is relevant), ask respectfully
The easiest way to show sensitivity towards this population is to use
the individuals preferred pronoun
Gender identity and sexual orientation are separate concepts
Do not generalize values, beliefs, roles, or experiences
Transitioning is not the experience of only the individual transitioning
but involves the entire social circle

Discussion Question
Transgenderism is often explained in terms of the gender(s) with
which people identify. Therefore, if gender roles were dismissed,
would transgenderism still exist?

References
American Academy of Pediatrics. (2015). Gender non-conforming & transgender children. Retrieved from
https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Non-Conforming-Transgender-Children.aspx
Center of Excellence for Transgender Health. (2016). Surgical options. Retrieved from http://transhealth.ucsf.edu/trans?page=protocol-surgery

DeLine, E. (2014). Show trans: A non-fiction novel. CreateSpace Independent Publishing Company.
Durocher, E., Gibson, B. E., & Rappolt, S. (2013). Occupational justice: A conceptual review. Journal of Occupational Science, 21(4), 418-430.
doi:10.1080/14427591.2013.775692

Elejalde-Ruiz, A. (2016). How companies accommodate transgender employees - and their colleagues. Chicago Tribune. Retrieved from
http://www.abqjournal.com/708411/biz/careers/how-companies-accommodate-transgender-employees-and-their-colleagues.html
Grant, J. M., Mottet, L. A., Tanis, J., , Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender
discrimination survey. National Center for Transgender Equality and National Gay and Lesbian Task Force. Retrieved from

http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf

References
Hale, C. J. (2015). The Pope Francis statement that changed the church on LGBT issues. Time. Retrieved from http://time.com/3975630/popefrancis-lgbt-issues/
Human Rights Campaign. (2016). Transgender FAQ. Retrieved from http://www.hrc.org/resources/transgender-faq#11
Levitt, H.M., & Ippolito, M.H. (2014) Being transgender: The experience of transgender identity development. Journal of Homosexuality, 61(12),
1727-1758. doi: 10.1080/00918369.2014.951262
National Center for Transgender Equality. (2015). Non-discrimination laws. Retrieved from http://www.transequality.org/issues/nondiscrimination-laws
Occupational Safety and Health Administration. (2015). Best practices: A guide to restroom access for transgender workers. (OSHA 3795 - 2015).
Retrieved drom https://www.osha.gov/publications: Occupational Safety and Health Administration
Sears, B., & Mallory, C. (2011). Documented evidence of employment discrimination & its effects on LGBT people. The Williams Institute, 1-20.

Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/Sears-Mallory-Discrimination-July-20111.pdf

References
Teich, N. M. (2012). Transgender 101: A simple guide to a complex issue. New York: Columbia University Press.
The Philadelphia Center for Transgender Surgery. (n.d.). Female to male price list. Retrieved from
http://www.thetransgendercenter.com/index.php/femaletomale1/ftm-price-list.html
The Philadelphia Center for Transgender Surgery. (n.d.). Male to female price list. Retrieved from
http://www.thetransgendercenter.com/index.php/maletofemale1/mtf-price-list.html
Vance, S. R., Jr., Halpern-Felsher, B. L., & Rosenthal, S. M. (2015). Health care providers' comfort with and barriers to care of transgender youth.

Journal of Adolescent Health, 56(2), 251-253. doi: 10.1016/j.jadohealth.2014.11.002

Weiss, J. T. (2004). GL vs. BT: The archaeology of biphobia and transphobia within the US gay and lesbian community. Journal of
Bisexuality, 3(3-4), 25-55. Retrieved from http://phobos.ramapo.edu/~jweiss/glvsbt.pdf