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