We’ll be posting the contents of his presentation over the next few weeks, in tasty bite sized morsels, and the full paper (with all its references intact) will be available to download as soon as its been confirmed complete.

The story so far:

1 Introduction and Terms

2 What does sex and gender diversity have to do with Men’s Health?

3 Medical Professionals involvement in Making Men

4 Issues with Primary Health Care

5 Specific Health Issues

Todays post, and the final post in the series is beyond the cut

Funding Community-Specific Health Services

There is almost no national or state based funding for services responding to sex and gender diverse people’s health needs. One reason for the lack of funding is that sex and gender diverse people are rarely identified in government strategy or policy. This absence or invisibility at the strategy level means that those in positions to make funding decisions do not include sex and gender diverse people, as there is no requirement for them to do so and/or they fear they will not be supported in their funding decisions by those above.

Organisations anchored in the LGBT community have historically often provided the only services addressing the health of sex and gender diverse people. Many of these organisations struggle to obtain competitive funding for health programs and/or are forced to invest significant resources into fundraising and grant applications. In addition, many are not entirely comfortable with the inclusion of sex and gender diversity within a target group more actively focused around sexuality. This is reflected by the fact that many such organisations have ceased the inclusion of intersex people in their official target groups. This feeling is also reflected from many within the sex and gender diverse community – those who themselves identify as fiercely heterosexual, those who identiy as neither intersex nor transsexual and also those who are not comfortable with a further division of their community along the lines of intersex vs transsexual.

It is clear that sex and gender diverse communities have enough specific health needs to warrant specifically targeted and focused health services. The importance of such specific targeting has been recognized in other population groups as evidenced by the prevalence of womens health centres and indigenous health centres.

Given the high degree of specific knowledge required it is clearly more practical to train staff at specific gender centres of excellence than it is to provide all health services with the level of training required to bring them up to this level of expertise.

To be effective, it is critical that such services operate using Standards of Care based on informed consent and mutual respect models. There are currently no such services in Australia.

What you can do in your own service:
Sex and Gender specific health services are an essential but not the complete solution.

It is also critical that sex and gender diverse people are able to access adequate and appropriate health care from mainstream service providers.

On a practical level some things you can easily and quickly implement in your own services are:

• Review your intake/client form – do you currently ask “what is your sex?”. Do you really need to know the answer to that question? What difference does it make to your service delivery if someone ticks M as opposed to F? If you really do need to ask a question like this, change the way it is asked and encourage alternative answers (for example ask “How do you identify (male/female/other)?”
• Don’t make assumptions that someone is intersex/trans/neither/both based on their appearance/voice – instead, ask clients how they identify. If it is not appropriate to ask clients directly, the sex you indicate on data collection forms should be “unsure” unless the person has specifically aligned themselves as being male or female. Ask clients what their preferred pronouns are and respect their choice. If it is not appropriate to ask clients for their preferred pronouns, avoid using a pronoun until you hear the person use a pronoun themselves.
• Where a client identifies as sex/gender diverse respect their confidentiality.
• Ensure your resources don’t assume a necessary alignment between gender identity, legal sex, biological sex, genitals, sexuality or sexual practices
• Remember it is generally inappropriate to ask someone about the shape or functionality of their genitals – do not ask someone for medical diagnosis or surgical status merely out of curiosity.
• Seek out and provide training for staff on the basics of sex and gender diversity issues (such as the information included in this session).

We’ll be posting the contents of his presentation over the next few weeks, in tasty bite sized morsels, and the full presentation (with all its references intact) will be available to download at the end of the series.

The story so far:
1 Introduction and Terms

2 What does sex and gender diversity have to do with Men’s Health?

3 Medical Professionals involvement in Making Men

Todays post, is beyond the jump:

Quality and Effectiveness of Primary Health Care

Despite the high interaction between health services and sex and gender diverse people, there is a remarkable lack of any research in relation to the quality or effectiveness of these interactions. Consistent with many findings within the Tranznation report, A Gender Agenda has also observed the following issues are commonplace:

Sex and gender diverse people tend to:

• have a general perspective of health providers as ‘gate-keepers’. This sense of a power imbalance leads to distrust and many sex and gender diverse people report that they are  not always comfortable being honest with their health service providers.
• have multiple GP’s most of whom are unaware of their sex/gender status
• are often treated inappropriately in public waiting rooms and/or are subjected to humiliating and unnecessary physical examinations
• are provided with inaccurate or misleading information including being provided with  pharmaceutical or surgical services without being informed of specific risks
• feel that they are often required to educate their health providers about sex/gender diversity before being able to receive health services
• have to travel interstate for common procedures because they are refused services by local doctors (this is true even from a capital city such as Canberra)
• avoid health services wherever possible because they are concerned about these issues
• be provided with inadequate and/or inappropriate health cover by Medicare and/or private health insurance (for example, Medicare will provide Testosterone under PBS for men but not women, and it will provide pap smear related rebates to women and not men. So, a person who has a cervix, but is legally male, is unable to obtain coverage to meet their needs.)

Our assumption is that most mainstream service providers want to be inclusive of sex and gender diverse people, but do not have the knowledge, skills, resources and leadership support to do so. Certainly we know that Sex and gender diversity are not usually covered in undergraduate training courses for health professionals, nor included in in-service training programs. There is little other professional development opportunities in the areas of sex and gender diversity. Organisational policies tend not to include issues for sex and gender diverse people, and there are few centres of excellence with the capacity to provide consultancy advice and support.

We’ll be posting the contents of his presentation over the next few weeks, in tasty bite sized morsels, and the full presentation (with all its references intact) will be available to download at the end of the series.

First post: Introduction and Terms

Second Post: What does sex and gender diversity have to do with Men’s Health?

Todays post, is beyond the jump:

The involvement of the medical profession in “creating men”

The starting premise in talking about mens health is that men “pre-exist” their interaction with health services. But I really want to challenge this position – because in my view, the medical profession plays an active and critical role in “making men” and in maintaining the illusion of binary sexes.

In the first few minutes of each of our lives, a doctor physically examined our genitals and ticked a box on a form – decalring to the world that we were either male or female. Why? Who was the patient? The mother? The newly born child? And what health need was being met by performing the examination? The answer is that there was no medical purpose at all – the only purpose was a legal one. And the examination itself was not performed on behalf of the patient, but on behalf of the state.

Many intersex infants with visibly atypical genitals have been subjected to surgery to more clearly ‘align’ them to a male or female physicality. Often this has occurred soon after birth – without the individuals express consent – and where there is no health related reason to perform the surgery1. Here the medical profession actively perpetuates the myth that all people are unquestionably either male or female, in this case, by surgically removing those body parts that prove that there is variation in human biology.

Some, but by no means all trans people have medical interventions to align their physicality with their gender identity . This may include hormones, and/or surgery such as mastectomy or genital reconstruction. Health services are necessarily involved in these interventions where they occur, and again, the role of those health care providers is fraught. Medical professionals here play the role of ‘gatekeeper’ – determining who can have surgery, under what conditions, what kind of surgery, and when access to that surgery will be permitted.

Many people in Australia are unable to change their legal sex from that assigned at birth. But for those who are able to apply for such a change (whether on the grounds of an intersex condition, or on the grounds of transsexuality), the new legal sex will only be recognised upon producing ‘medical proof’. Here the medical profession plays the role of ‘gatekeeper’ not just to the medical services provided to sex and gender diverse individuals, but also as to what legal rights their patients will have recognised by the state.

With the medical profession concurrently filling so many conflicting roles, they simply are not currently in a position that allows good health care provision to sex and gender diverse individuals.

We need to move from a medicalisation of identity, and acknowledge people as who they are without requiring state sanctioned medical intervention to ‘normalise’ their bodies.

We also need to adopt nationally consistent Standards of Care based on an informed consent model to assist health services to provide appropriate levels of care to sex and gender diverse communities.

We’ll be posting the contents of his presentation over the next few weeks, in tasty bite sized morsels, and the full presentation (with all its references intact) will be available to download at the end of the series.

The first post is First post: Introduction and Terms and todays post, is beyond the jump:

What does any of this have to do with men’s health?

When we use the term men’s health we deploy a range of assumptions about the biology, appearance, gender identity, lifestyle and health risks of the individuals we are talking about. But there are many people who do not meet some or all of these assumptions. Some men’s bodies do not conform to many assumptions of masculinity, some women have physicalities and face health issues that are commonly regarded as male-specific and some people simply can’t or won’t identify as either male or female.
In a national context where the development and assessment of future of health policy seems to be already framed in terms of “men’s health” and “women’s health” it is of significant importance that health services are cognicent of these issues.

The only purpose of specifically targeting mens health is to more correctly target health care services. But by doing this without acknowegdeing the diversity of men and of male identities we run the risk of further marginalising sex and gender diverse people who already suffer significantly worse health outcomes than most. I’m not arguing here against the targeting of mens health services – but rather that, in targeting “men’s health” services we need to challenge our everyday assumptions of sex and gender and be aware of not excluding services to sex and gender diverse individuals.

Why does it matter to men’s health?

Firstly it is worth noting that the prevalence of sex and gender diversity is far higher than usually acknowledged and that these issues therefore affect a far greater number of people than previously thought.

It matters to sex and gender diverse people because despite the fact that health studies erase our existence, and that only a very small number of studies focus on our needs, it is clear that the health risks and needs of the sex and gender iverse community are in urgent need of attention.

It matters to men’s health services more broadly because services that are able to recognise and respond effectively to issues of sex and gender diversity will as a necessary result provide more inclusive health services to all men.

We’ll be posting the contents of his presentation over the next few weeks, in tasty bite sized morsels, and the full presentation (with all its references intact) will be available to download at the end of the series.

Todays post, is beyond the jump:

Introduction
It’s been very interesting for me to have spent the last two days at a “mens’ health” conference – where I’ve heard lots of discussion and debate about the definition of “health”. But I’ve heard no discussion or debate around the definition of “men”. The reason for this, of course, is that most of us tend to assume that the definition of “man” is completely self evident and unproblematic.

That’s not the only thing we assume. We assume, when we say the word “man” that all people are, categorically, either male or female. We assume that the attributes that make a man a man are clear, definable, biological, fixed, and that they are categorically different from those characteristics that make somebody a woman. We believe these things to be true to such an extent that we assume that every time we meet someone, no matter how briefly, we will instantly “know” whether they are a man or a woman. And having just met a complete stranger and decided that they are a man, we assume that they identify as a man, that they are happy with this identity, that they always have been a man, that they always will be a man. We assume things about the chromosomes in every cell of their body; about the hormones that are inside their body; and about what their very body looks like underneath their clothes.

None of these assumptions are true all of the time, and this is what I’ll be talking about in this series.

Terminology and Prevalence

Intersex people can be defined as people for whom the development of chromosomal, gonadal, or anatomic sex is not aligned with our notions of a sexually binary biology. That is, there are biological physical differences that “can be seen as both male and female at once, not wholly male or female, neither male or female, or other ways of being that are not captured by current sex binary”. Estimates of the number of intersex people commonly vary from 1:100 to 1:2000 depending on the types of conditions included.

Gender identity is an individual’s internal sense of being a man, a woman, or another gender. Trans people can be defined as people whose gender identity is outside or crosses the social norms of ‘man’ or ‘woman’. I use the term “trans” here to explicitly include people identifying as transsexual, transgender, or genderqueer. Accurate estimates of the number of trans people are also difficult to obtain – most research uses a far narrower definition of “trans” and suggests the prevalence as somewhere between 1:4,500 and 1:8,000. A Gender Agenda’s membership in Canberra suggests that even this figure is an underestimate, and that estimates of 1:500 is probably more accurate.

Virtually no data is captured for trans people who do not seek medical treatment for gender affirmation. The growing number of people who identify as gender queer are essentially unacknowledged in any prevalence statistics. Due to the intense level of stigma associated with sex and gender variance, many intersex and trans people are often invisible to the general population and service providers for fear of discrimination and ridicule.

Terminology is hotly contested and culturally variable. For the sake of brevity and clarity I will be using the term “Sex and Gender Diverse”. This term is used with the specific intent of being inclusive not only of intersex and trans people but also of anyone who ‘falls through the gaps” of our binary sex model.

There is a common misconception that sex and gender diverse people can be identified “by the way they look”. This is generally untrue, and paradoxically, much of the inappropriate health care offered to sex and gender diverse people comes about because they are not visibly identifiable.

Some specific examples health services need to be aware of are that:

Someone presenting as male, who you identify as being unquestionably male may:

• have functioning female reproductive capacity
• require regular pap smears and/or be at risk of ovarian cancer
• identify as a woman

Someone presenting as female, who you identify as being unquestionably female may:

• be at risk of prostate cancer
• be at high risk levels for other ‘mens health” issues
• want to be perceived as male

That logic is flawed right from the beginning, after all, the native Aboriginal people of Australia have the poorest health of any minority group in the country, but one can hardly claim it is a sin to be born black. (For more information about Indigenous Health, see Health Info Net)

The part of that argument that I most want to address today though, is the incorrect notion that LGB people are suffering from poor health *because* they are LGB. A recent study has shown that there is a clear link between a young lesbian, gay or bisexual identified persons health, and their relationship with their family. That would imply that these people have poorer health, not because they are LGB, but because their family has a negative attitude to a large part of their identity.

“For the first time, research has established a predictive link between specific, negative family reactions to their child’s sexual orientation and serious health problems for these adolescents in young adulthood such as depression, illegal drug use, risk for HIV infection, and suicide attempts,” said Caitlin Ryan, who is the lead author of the paper.

So, if you are the parent it would seem that the greatest gift you can give your child, the best way that you can help ensure them a happy, healthy future, is not by trying to ’stamp out the gay’ in them… but to love and accept them for who they are, whether they are same-sex loving, or have a gender identity at odds with how you perceive them.

In it he discusses how queer youth are faced with the problem of finding and then reproducing queer culture often without the benefit of mentorship by the previous generations of queer people.

Because of the highly lateral dispersion of queer people in our society, (being that there are few indicators showing that queer people are more likely to come from one part of our society than the other), from our entrance into the world, the queer nation is constantly a nation in diaspora. With each successive generation, the new queer generation is mustered together by a collective sense of “otheredness,” and introduced to a radically new culture to which we may choose to cleave to.

However this process is highly individualized and extremely informal, with very few opportunities for mentorship or leadership. What often occurs is learning through mimicry and trial and error. Queer youth learn to copy examples of queerness that they see in television, in film, the older queers they might see on misadventures into queer life. But most importantly, queer youth learn about being queer mostly from each other.

This process of recreating queer culture is not without its benefits. It means that we are a highly adaptive culture, and although there is a massive ‘generation gap’, I think that young queers are moving in the right direction, particularly when it comes to accepting gender variance and making cultural space for all kinds of trans people and new sexual orientations.

However, there are also problems. For example, we forget our history so quickly. The history of the LGBT movement is not taught in school. When I came out, I had no idea what ‘Stonewall’ was and was quite alarmed when I saw a documentary about the first Australian Mardi Gras. (Police brutality!? IN AUSTRALIA? What a shock!) Then on the trans side… who knew that the first medical transitions occurred only a few decades ago? Amazing!

Another notable issue for young people, is that even today, and particularly sex and gender diverse children and teens, we are still often rejected by our families, leaving us alone, and somewhat vulnerable. We create new queer families, and tribes, but we miss the mentorship from the older generation. Sometimes we wonder what on earth will become of us… we wonder if we’ll ever grow up, what we’ll look like when we are 40, 60, or 80. We wonder how other, older people coped with transition, with being genderqueer, whether they lost their family and friends too, or maybe they patched things up? If so, how? How hard is it to have kids? How do you go about having kids? What about negotiating the legal minefield surrounding marriage?

There are so many questions, and its often hard for young sex and gender diverse people to find older mentors who can help them with their unique gender journey.

There are ways to combat these problems. There are websites about our history that celebrate successful trans people. Organisations like AGA have members who range in age, providing a valuable source of mentorship. As individuals we can all do our bit, helping out young people, and people who are newly awakening in their identity as gender diverse.

Its very important that older people understand how important they are to the next generation of gender diverse people, and that young people have access to safe mentors and leaders.

Sex and Gender Diversity Community Survey
The survey closed early in January, and we’re currently in the process of analysing the data. Once we’ve looked at the info, and pulled out some interesting factoids we’ll publish our findings to the AGA Website. We hope that our data will be instrumental in convincing the ACT Government that people undergoing medical transition are of a significant enough number in the ACT to have services and funding provided to us.

T-Boy Get-Togethers
Most of the trans guys in Canberra have at some point thought that they are the only FTM in the area, but we actually have a pretty healthy population! We hold regular informal get togethers for FTM Spectrum folk (not everyone there identifies as a man… I for example, identify as a genderqueer), and so if you’ve been looking for a laid back and chillaxed group to hang out with, shoot me an email at webmaster@agenderagenda.org.au and I’ll add you to our email list. This year we hope to be able to hold bi-monthly events, a dinner or coffee night on a weekday evening after work, and a Saturday lunch event – picnics, and bbq’s etc.

TransAction! Day – Feb 27
A Gender Agenda are looking forward to the first ever TransAction! Day. TransAction! Day is eventually intended to be a day of education in schools, and as such has already stirred up some controversy in the USA. The Illinois Family Institute is calling it ‘Deviant Transgender Day‘ which I think is a very amusing, and catchy name for it.
We don’t have the resources to plan anything really spectacular for this year, but will probably hold a BBQ on the weekend following, and send out press releases in the weeks prior.

Mardi Gras Gaggle – March 7
A Gender Agenda are marching with Tranny Panic for Trans Rights in the Australian Mardi Gras Parade. We’ve got a group of about 16 takers so far, but the more the merrier! I hope you’ll consider coming along. For more information or to register your interest, contact our Mardi Gras organiser Robyn Grafkin at baglieg@gmail.com ASAP.

Butch Auction Fundraiser
We hope to run a Fundraising party at the end of June. We’re aiming to coincide with New York Cities annual Trans Day of Action. The night should be loads of fun, with performances from local musicians and Drag Kings and Drag Queens. Tranny Panic will also be running an interactive performance to raise awareness about trans people and our constant battle over toilets.
If you are interested in performing at the Butch Auction, or you are some-kind-of-masculine identified man, woman or genderqueer and wish to be Auctioned off to raise money for A Gender Agenda’s work, please shoot me an email at webmaster@agenderagenda.org.au.

Workshops and Education
Later in the year, perhaps September and/or October (dates to be announced), we plan on holding a series of workshops about issues facing the sex and gender diverse community. We want to cover a variety of topics, from dating and sexuality, raising children outside of traditional gender roles, the intersection of trans and intersex needs, and how to deal with trans people within your organisation. The workshops will cost money, so that we can afford to fly presenters in from other cities, and so that we can book a nice venue and so on. We will be offering subsidies and free places to sex and gender diverse identified individuals who would like to attend, but cannot afford it.

Possible Film Festival
Pending news about sponsorship of the event, we may be holding a “Breaking the Binary” film festival, for talented young film makers who want to say something about being sex and gender diverse. More news about this will be published to the AGA website if we can get sponsorship.

Well! Its going to be a busy year! I hope that something there appeals to you!

We had lots of new members join, including yours truly. We also made friends with the New Canberra Transgender Network, which means that we shall be more aware of trans women’s issues, and they shall be more aware of trans men. We held a combined Christmas party in December that saw record numbers of the Canberra sex and gender diverse community get together and socialise. We all had an awesome time, at a very pleasant restaurant. We even had visitors from Sydney and Wollongong come all the way down to hang out with us.

We made a submission to HREOC’s Sex and Gender Diversity project, and participated in their community consultation. Although we were disappointed in the decided focus of HREOC’s project, we look forward to seeing the recommendations that are made to the Federal government. We will be continuing to lobby the ACT Government to improve things in the ACT for the sex and gender diverse community.

A small delegation of our members attended a workshop in Sydney called “Gender Dysphoria to Gender Euphoria: Working Towards Gender Belonging”. (Leaflet can be downloaded from here). The workshop was held at the AIDS Council of New South Wales, and was conducted by Esben Esther Pirelli Benestad & Elsa Almas from Norway. The workshop was extremely inspiring, and we hope to hold something similar here in Canberra later this year.

In November we participated in SpringOut, the Canberra LGBTIQ Community Pride Festival. We had a stall next to NewCTN at the Fair Day, and held several events during the festival, including a film night, a Picnic/BBQ and a candle lit ceremony for Transgender Day of Remembrance. At the end of the festival, our Co-ordinator Peter Hyndal won an ACT Pride Award for his work with AGA, and contribution to forwarding trans rights and building a vibrant gender diverse community.

November also saw us launch a community survey in an attempt to learn more about the face of the ACT Sex and Gender Diverse community. We had 93 responses, which was far more than we expected, especially since we know that not all members of AGA or NewCTN actually filled in the survey. This has increased our estimate of the number of sex and gender diverse people in Canberra and the surrounding region to several hundred. It is clear that medical and other services are not nearly adequate, and we hope to be able to use the data we gathered to apply for a Health Pact grant to allow us investigate further how services in the ACT can be improved for the Sex and Gender Diverse community.

2009 looks to be an even bigger year, and I hope to see new faces at our events. If you would like to get involved in A Gender Agenda, or be notified of our events, don’t forget to subscribe to the Blogs RSS feed, or send an email to events-subscribe@agenderagenda.org.au to our join our email list.