Virtual Journal Club – Gender queer: Politics is killing us — GLMA Nursing

One thing we’ve decided to try is to have a virtual journal club in which we discuss an article related to LGBTQ health, and for our first article, it seemed like a good idea to start with this article by Laura C. Hein and Mary F. Cox. The topic is timely, and the lead author […]

via Virtual Journal Club – Gender queer: Politics is killing us — GLMA Nursing

The first of what will hopefully be a biweekly series of journal article discussions.

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Useful Sources for Conversations on Transgender Assault

These days, the folks starting conversations on the subject seem to all be watching Fox News, at least the ones talking to me. Here’s an example from last night when my spouse and I were out to dinner.

Spouse: There was no soap in the unisex bathroom or the men’s room, so I had to grab some from the women’s room once I knocked and no one was in there.
Friend: Wow, you should be careful! These days, you might be asked to prove something!
Me: Thankfully, not in this state.
Friend: ?
Me: Connecticut is actually pretty good about equal access, unlike North Carolina, which is the one that’s been in the news recently. And anyway, it’s a completely different situation.
Friend: ???
Me: *facepalm*

Seriously, how is someone who knocks and makes sure they’re not going to startle someone in order to grab some soap even part of the same conversation as access to appropriate public bathrooms for transgender people? My answer is, obviously, that the two situations have nothing to do with one another besides the fact that, in North Carolina, whether he knocked to be sure no one was in there or not, Spouse could’ve (at least theoretically) been hauled off to jail.

I’ve found myself in several of these conversations over the last couple of days (well, weeks, really, but quite a few very recently). I’m sure that once my Gender and Sexual Minority Healthcare Issues classes start, there will be more. Last year, Caitlyn Jenner and Jazz Jennings came up frequently. This year, I expect it will be bathroom bills. So, I’m going to park some references to back up the assertion that the person at risk for assault when a transgender person accesses a public bathroom is the transgender person. Because, to borrow from the UHart Center for Reading and Writing

Credible Hulk

Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman,
and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender
Discrimination Survey. Washington: National Center for Transgender Equality
and National Gay and Lesbian Task Force, 2011. Retrieved May 17, 2016, from http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf
(Okay, it’s not APA-formatted, but it is the recommended citation, so I’m rolling with it.)
This report deals with discrimination overall. The segment on discrimination in public accommodations begins on page 124, and does not specifically address access to public restrooms. It is possible that access to restrooms and/or access to changing rooms are one of the reasons that retail outlets scored so high, but this survey does not appear to have captured that information.

Herman, J. L. (2013). Gendered restrooms and minority stress: The public regulation of gender and its impact on transgender people’s lives. Journal of Public Management & Social Policy (Spring 2013) p. 65-80. Retrieved May 17, 2016, from http://williamsinstitute.law.ucla.edu/wp-content/uploads/Herman-Gendered-Restrooms-and-Minority-Stress-June-2013.pdf
While this was a fairly small study (n=93), the following finding is still significant: “Eight respondents (9 percent) reported experiencing at least one instance of physical assault in gender-segregated public restrooms” (p. 73).

National Coalition of Anti-Violence Programs. (2014). Lesbian, gay, bisexual, transgender, queer, and HIV-affected hate violence in 2013. Retrieved May 17, 2016, from http://avp.org/storage/documents/2013_ncavp_hvreport_final.pdf
This report shows that transgender women are at extremely elevated risk for violence. In particular, “[t]ransgender women were 4 times more likely to experience police violence compared to overall survivors. Transgender women were 6 times more likely to experience physical violence when interacting with the police compared to overall survivors. Additionally, transgender women were 2 times as likely to experience discrimination, 1.8 times more likely to experience harassment, and 1.5 times as likely to experience threats and intimidation compared to overall survivors. Transgender women were 1.8 times more likely to experience sexual violence when compared with other survivors. In addition, transgender survivors were 1.5 times more likely to experience hate violence in public areas and 1.4 times
more likely to experience hate violence in shelters.”

It should also go without saying (but apparently not) that the people who might theoretically pretend to be transgender in order to commit various acts of assault are breaking the law regardless of whether there are laws in place preventing people who are transgender from accessing the bathroom congruent with their gender identity. Assault remains against the law in any case. Cisgender men who assault other cisgender men in a men’s room are guilty of assault, as are cisgender women who assault other cisgender women.

How about we normalize the idea that assaulting anyone is never okay, and being around people who are getting changed or going to the bathroom is not some sort of free pass for assault? Because really, that is what would make everyone safer.

The “C” Word

Probably not the one you’re thinking of.

I got into a conversation of Facebook about the use of the term “cis.”  Some page that I follow had posted a comic strip illustrating how things said by well-meaning non-transgender allies often sound to transgender people.  Normally, I avoid the comments.  (Actually, normally, I avoid Facebook, but my niece was in labor and Facebook was the means she and her fiance would be using to tell as many of us as possible when the wee one arrived*, so there I was.)  So anyway, yes, I read the comments, and sure enough, someone was very upset over the word (or rather, prefix) “cis.”

Here’s the thing.   Coming from a scientific background as a nurse, I found that it took about two seconds from the first time I heard the term used to figure it out.  Just like with molecules, where some are described as “trans” if certain parts are not in alignment and some are described as “cis” if all of those parts are in alignment, people whose gender identity and sex assigned at birth are not aligned (note: not necessarily in opposition to one another, but not aligned in some manner that is significant to that person) are described as “trans,” so therefore it is logical to refer to people who do have these things in alignment as “cis.”  Of course, it’s true in chemistry that often “cis” is dropped because alignment is the expected outcome.  Nobody talks about cis fatty acids, for example, though they would be the logical opposite of trans fatty acids.  So, too, this prefix is rarely used in regards to people except in the context of discussing transgender issues.  But I’ve always been relatively mystified why it seemed to actually be controversial.  Unfamiliar, sure, but why controversial?

In my relatively limited experience, most people I’ve encountered who object (often loudly) to the term “cis” have argued that it is irrelevant as they are just “normal,” whatever that means.  So, when somebody jumped in with how we need to stop using the “cis slur,” I may possibly have gone into lecture mode.  See the preceding paragraph for a rough example of what that looked like.  This went over about as well as might be expected.  But another commenter brought in a point that made me sit down, shut up, and put myself in a time out.

Used by itself rather than as a prefix (e.g. “cisgender”), “cis” is a homophone for “siss” which at least this particular gay man reported he experiences as triggering, due to the common experience of being called a “sissy.”  He stated that other gay men share this experience.

Oh.

Now, that, I can see.  And because I am neither transgender nor a gay man, I’m not really clear on where my lane is here.  So I’m trying to shut up and listen, at least in the context of that conversation.  Being me, I also need to try to work it through a bit though, so I figured I’d do that here while I’m in my Facebook time out. Continue reading

Sex And Gender Are Actually The Same Thing (but bear with me…)

I’ve certainly relied on the sex =/= gender model, most recently right here. I’d actually really like to learn a better and more useful way to discuss and teach this stuff. Any thoughts?

Androgyneity

As you read the title, you may be overcome with indignation that this article is going to be a gender-essentialist rant. You’ll be relieved to know that it’s quite the opposite. My intent in writing this is to point out some serious misconceptions perpetuated in ‘trans 101’ and cisgender allyship resources, which end up doing much more harm than good for transgender people.

Anyone with an entry-level understanding of trans issues is probably familiar with the phrase “gender and sex are different things.”

While the idea of treating sex and gender as unrelated factors may result from an attempt to validate and support transgender identities, it actually perpetuates harmful cultural beliefs about the validity of sex assignment and the static nature of biological sex, which remove agency from trans and intersex people to define their own bodies and experiences. This way of thinking does nothing to combat (and in fact…

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Sampling, definitions, and heart attacks

So, back in October, I had an entry with some discussion of sampling for research purposes.  That topic covered two weeks in the course, actually, but since we had a paper due that week, there was no reading response due, and this is me just finally coming back to it.

The paper involved exploring various types of sampling used on the population we’d identified an interest in, selecting one specifically, and critiquing it.  During some of the early class discussions, somehow I’d honed in on the question of whether the symptoms of acute coronary events (aka heart attacks) experienced by transgender women were more like those we think of for cisgender men (crushing chest pain) or those associated more with cisgender women (back pain, indigestion) (Barouch, n.d.) and what that might tell us about the reasons for those differences (estrogen exposure, center of gravity, psychosocial factors, who knows?).  So, my “target population” became transgender women.

Of course, I’ve subsequently learned that this idea of gendered differences in acute coronary symptoms is losing traction, though I can’t find the article I read on that at the moment.  So maybe the bottom line in terms of patient education is to make sure everyone of every gender knows what the range of possible symptoms are.

Barouch, L. (n.d.) Heart disease: Differences in men and women. Retrieved December 30, 2015 from http://bit.ly/1fU0K1S *

Herbst, J.H., Jacobs, E.D., Finlayson, T.J., McKleroy, V.S., Neumann, M.S., and Crepaz, N. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS & Behavior 12(1), 1-17.
So, as a systematic review, this article looks at a number of articles and reports over a long period of time.  In this instance, the time frame is 1988-2006 and what they’re looking at are reports of incidence and prevalence of HIV infection among transgender persons, risk behaviors around HIV for transgender persons, and contextual factors associated with risk behaviors. That makes this something of a must-read for anyone looking at HIV and the transgender population, both for the analysis of what they found and for the extensive reference list.

Keatley, J, Deutsch, M, Sevelius, J, and Gutierrez-Mock, L. (2015). Creating a foundation for improving trans health: Understanding trans identities and healthcare needs. In Makadon, H., Mayer, K., Potter, J., & Goldhammer, H. (2015). The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health (2nd ed.). Philadelphia, PA: American College of Physicians.
The main reason I ended up referencing this chapter in this paper is for some definitions, as I needed to talk about distinctions along the transgender spectrum, including terms like genderqueer and genderfluid.  That said, there is far more to this chapter than just the definitions it provides.  This book is one of the most important in this field, in my opinion, and this chapter provides exactly what it says: a solid foundation for understanding the needs of trans-identified people.

Nuttbrock, L., Bockting, W., Rosenblum, A., Hwahng, S., Mason, M., Macri, M., & Becker, J. (2014). Gender abuse, depressive symptoms, and substance use among transgender women: A 3-year prospective study. American Journal of Public Health, 104(11), 2199-206.
This is the study whose approach I chose to critique.  They actually did a great job exploring this topic, and the limitations I noted around the definition of transgender women and sampling methods chosen were imposed on these researchers by the larger study from which they drew their sample.  Also, for all the apparent limitations, they do note that transgender or gender-variant persons were involved in all stages of this study.  So, if transgender women and other gender-variant persons were involved in deciding that “assigned male at birth but not identifying as male in all roles or situations” was a valid working definition, who am I as a ciswoman to say it isn’t? 

Sell, R.L. and Petrulio, C. (1996). Sampling homosexuals, bisexuals, gays and lesbians for public health research: A review of the literature from 1990-1992. Journal of Homosexuality 30(4), 31-47.
This seems like a really limited time-frame for a lit review, but considering the timing, it makes a lot of sense.  The study of queer health was shifting gears as a result of the AIDS epidemic, so looking at how these early studies conceptually defined and then sampled LGB people was necessary.  It’s unfortunate that it took until 1996 to be published (I presume it was done in 1993-4 or so, one of the drawbacks of academic publishing schedules is you do see this type of a lag) but made some important critiques that one hopes others took note of.

*Note: I would not normally use a bit.ly URL in a bibliography, but the first several attempts at pasting in the full URL ranged from annoying (only part of it pasted in) to disastrous (the rest of this post got erased). So I caved.  Also, seriously, Johns Hopkins, no date?  At least give me a “last updated” date somewhere on the page. *pouts*

Gender is Gender and Sex is Sex, and while the twain may meet sometimes, that doesn’t make them the same thing

So, attempt #1 at starting to build this annotated bibliography with vloggy bits.

First: the vloggy bit.  Clearly, I need to work on little things like camera (aka phone) angle and lighting.

And now for the articles and written commentary.  I realize that the entries should have hanging indents, but I haven’t a clue how to make that happen on WordPress.  That is on the to-learn list also.

Johnson JL, Greaves L, and Repta R. (2009). Better science with sex and gender: Facilitating the use of a sex and gender-based analysis in health research. Int J Equity Health 8(14) 1-11*.
Does a good job laying the foundation for defining sex and gender appropriately for research purposes.  Particularly like the way the authors start with the biological and complicate the idea of a binary at that level before diving into the complexities of gender identity.  The strategies they identify for improving research are 1. revisit an old study and reanalyze or perform a secondary analysis of the data with regard to sex and/or gender, 2. augment an existing research plan with sex and gender-based analysis, and 3. incorporate sex and gender-based analysis from the outset. The case-study used, however, deals strictly with biological sex within the typical gender binary, which is frustrating after such a nuanced beginning.

Kaufman R. Introduction to Transgender Identity and Health. In: Makadon H, Mayer KH, Potter J, Goldhammer H (Eds.). (2008). Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia, PA: American College of Physicians.
Intriguing approach to trans identity, leading with a discussion of Kafka’s Metamorphosis. Somewhat dated, as evidenced by relying on the DSM IV not to mention the publication dateSadly, a check of the current edition of the Fenway Guide shows that rather than being updated, this chapter was replaced.  I’d like to have seen if/how the author’s analysis changed in light of the changes in the DSM V. I’d also like to have seen if/how the author would have updated the definition of “genderqueer,” as I don’t believe it is considered exclusive to people who were assigned female at birth. First time I have seen reference to a specific time that the gender identity portion of the brain differentiating during gestation.  Will need to chase down that reference.

Krieger N. (2003). Genders, sexes, and health: What are the connections – and why does it matter? International Epi Assoc. 32, 652-7.
Really excellent and useful breakdown of how gender relations versus biological sex affect various health disparities.  Focus is on cisgender men and women.  It would be really interesting to see someone look at, say, the cardiac case example and break down further how things shake out based on gender assigned at birth versus gender identity, along with looking at what, if any, medical interventions have occurred for those whose gender assigned at birth and gender identity do not match.  That might give us some insight into why cisgender women tend to experience different acute cardiac symptoms than cisgender men.  Is it hormonal exposure?  Is it something about the presence or absence of a y chromosome?  Is it some complex mind-body interaction around living as women versus living as men?  Bit of a tangent there.  Still, very useful article on how looking at gender versus biological sex can impact how we interpret research data.

Phillips SP. (2005). Defining and measuring gender: A social determinant of health whose time has come. Int J Equity Health, 4 (11).
I find this article very frustrating in that the author quickly comes to the conclusion that while sex and gender are distinct, that “[t]here is no practical advantage to disentangling where sex ends and gender takes over as a cause of the sequelae of coronary artery disease” (p. 3*) Obviously, given my curiosity above about why the differences in presentation, which can result in very different outcomes, exist, I think it is very practically valuable to separate out gender and sex to figure out what is really going on.  I do, however, agree that we need to develop some tools with which to do epidemiological studies that study the impact of gender on health outcomes. Given that it has been 10 years since this article was published, one would hope that had happened, but so far as I am aware, it has not.

Springer KW, Stellman JM, Jordan-Young RM. (2011). Beyond a catalogue of differences: A theoretical frame and guidelines for researching sex/gender in human health. Social Science and Medicine. 1-8. doi:10.1016/j.soscimed.2011.05.033.
This article looks at how sex and gender are entangled, and how we often oversimplify differences in health as just one or the other.  For example, the authors mention that differences noted in (cisgender) male versus female glucose processing were originally thought to be related to biological sex (likely hormonal) but were, in fact, readily explained by differences in skeletal muscle mass, making it really a difference more about gender , i.e. differences in expectations around occupation choices, athletic choices, etc. impacting muscle mass (p. 8).  The proposed research methods include determining whether biological or social sex differences are worth studying in any given situation, as well as the entangled biosocial, and if so, designing control groups such that it is possible to tell whether the differences in question.  In interpreting the results, importance is also recommended to be given to within-group variation as well as between-group variation. 

*This is really just the page numbers of the PDF, not the original article, which apparently does not have page numbers of its own.  Being an online journal, I guess that makes sense.

Gender Identity and Sexual Orientation Data Gathering in Healthcare

So, I really do plan to do some research-y stuff on here.  At the moment, I’m parking this YouTube that we were required to watch for a class I’m taking in Researching Rare/Hidden Groups.  It’s a useful demo of how gender identity and sexual orientation data might be collected in a healthcare setting and some difficulties/resistance that might be encountered in the process.

https://www.youtube.com/embed/1nt34oP1kOs 

Measuring Health Equity Project

Edited to add: my classmates have raised some very valid criticisms of this video.  The patient is very stereotyped, and the nurse could stand to be more sensitive to the patient’s discomfort around discussing her gender identity.  That said, I do still like that they chose to portray the patient’s resistance (even as someone deeply invested in having this kind of data collected, as a patient who is sick or injured, I’d probably be annoyed and frustrated with all the questions too!) and the nurse sandwiching the gender identity question among other, more familiar demographic questions to normalize it as just part of the overall picture of every patient.