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

4 Issues with Primary Health Care

Todays post, is beyond the jump:

Understanding Health Risks
Another ongoing issue in health care is the high prevalence of (mis)understanding of risk factors that is based around a concept of sex and/or gender:

We all know for example that “men are at greater risk of heart disease” but does this mean a trans man is at greater risk than he was when he was a woman? Or that the trans woman continues to be at greater risk even after identifying and living as a woman? What about someone who is chromosomally neither male or female?

This issue also filters down to more general health and wellbeing issues that are part of targeted community health education programs. For example, how many standard drinks should a trans or intersex person have to fit within the recommended range? What safe sex information is most relevant for a lesbian trans woman who has not undertaken any surgical procedures? Whose responsibility is it to make this information available? Or to assess the effectiveness of its dissemination?

Too often it seems that health statistics and education campaigns are framed around the use of male and female as comparators simply because that is what we have come to expect. We must acknowledge that there is no inherent value in these comparators. Used inappropriately, they can serve to erase other perhaps more significant comparators (eg indigenous/non indigenous). We also need to acknowledge that using sex as a standard default comparitor is problematic for sex and gender diverse people to the degree that sex and gender diverse people are invisible within this framework – invisible to health services as individuals, invisible from health policy as a community, and provided with health information that is completely unintelligible to their reality.

Mental Health, Depression and Suicide
Very little research has investigated any health issues and outcomes relating to sex and gender identity, which poses serious problems for the development of robust and inclusive health policy. Here I will examine some of what we know about mental health issues specifically with relation to depression and suicide.

The rate of depression identified in the Tranznation report was particularly significant with 53.4% of the sample reporting one of the criteria for a current major depressive episode. Over 1/3rd of the respondents met the criteria for a current major depressive episode compared to 6.8% of the general population.

There is a long established and universally recognised association between depression and suicide. The Australian depression incidence indicated by the Tranznation report is in line with US and UK based research and that research shows around 1 in 3 trans people have attempted suicide at least once compared to approximately 1:380 for the general population.

Despite the rate of attempted suicide being approximately 125 times greater amongst sex and gender diverse individuals than the population as a whole, sex and gender diversity is not identified as a risk factor for suicide by any mainstream suicide prevention organizations in Australia.

For example, one national Australian organisation whose mission is to prevent depression states in a downloadable fact sheet that 50-60% of transgender people report having depression. Yet a search for “transgender” on the same website brings up only two other references – a brief fact sheet primarily focused on gay and lesbian issues, and a scoping study which contains no trans or intersex content at all.

The predominate focus of suicide prevention resources are currently targeted at men – on the basis of a suicide rate four times higher than the suicide rate amongst women. Personally I think that any men’s services receiving this funding has a moral and ethical duty to target at least some of these resources towards effective prevention strategies at the sex and gender diverse community who have suicide rates 125 times higher than the general population.

Broader Health and Wellbeing Issues

Most population level research in Australia has not included questions on the sex/gender diversity of respondents. Even where respondents have specifically indicated there status as gender diverse, most research ‘erases’ their response by randomly allocating their responses to either male or female categories. So while gender diverse people will have participated in this research, there is no way of analysing their responses compared to other population groups.

The 2006/2007 the Tranznation study found that on the SF36 scale, a standard measure of health, participants had poorer health ratings than the general population in Australia.

Tranznation also identified that although trans people were significantly higher educated than the general population, the largest proportion of participants earnt less than $20,000 pa. Unemployment rates, at 9.1% were more than double the national average of 4.4%. The Sydney Gender Centre quotes unemployment rates as high as 60% within the trans community.

Perhaps most importantly, Tranznation identified a clear relationship between the experience of discrimination and depression.

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

—-

I’ve dated (proportionally) a lot of guys who were closeted homos. Now, when someone is closeted, sometimes one’s identity is really tied up in the notion of the embattled homo, who can’t have what one wants. For example, my identity was really tied up in the notion that I like girls better than boys, but I just couldn’t have them. I identified as a (closeted) lesbian instead of as a bisexual for that reason.

Now, some of these guys made it perfectly clear that they loved me in spite of my female body, not because of it. It was never verbal, it was always those little actions that tell you that someone finds part of your body too horrible to contemplate. Now, obviously having a partner who can barely have sex with me at all, and definitely can’t have sex unless I’ve put my finger up his butt, who refuses to touch my breasts, who thinks my vagina is ‘gross’, only reinforced my own body dysphoria, and my own desperate longing to have a body that my partner could desire. (For the record, I actually quite like putting my fingers up people’s butts. Its just tedious if it’s every single time, and you know your partner has to lie back and think of Tom of Finland to get it up.)

It’s a fucking horrible way to be. Being straight, or being gay is no excuse not to revere your partner’s body and the pleasure you can have together. Even if your partner is not the gender you usually desire, even if your partner is transgendered or intersex. If you can’t handle the reality of their body, you should be polite enough not to take them to bed. Express your love for them in other ways. This notion that I’ve seen in transfeminist circles, that if someone likes your body because it’s trans, rather than in spite of its transness, they must be a tranny chaser, strikes me as being full of self-loathing. I don’t want yet another gay boy to hate my body, while loving me. Or ignoring my body, while loving me. I’m a person in a body, and I want to be touched, and touched with conviction!

So anyway, imagine for a moment some heterosexual cis folk dating. They get into bed for the first time, and start to get undressed. The dude is all like “Your boobies are hot cos they are girl boobies” in his head, and he gets aroused. He doesn’t think that way about the boobies of the other footy players in the change room, even though they might be just as big and round as this girl he’s bedding (though if they are footy players, probably not as soft). She is probably enjoying the feeling of his boner pressed up against her. The knowledge that it’s a responsive, flesh and blood organ, rather than a silicone penis probably adds to that arousal. Their attraction to each others’ bodies is intrinsically linked to their understanding of the other person’s gender identity.

Now, I’m not saying that heterosexual cis women could never be attracted to a trans man, or heterosexual cis men can’t be attracted to trans women. The way we construct a lover’s body in our mind, and under our hands, is linked to how we understand their gender. So when a lover doesn’t have the strength to see a trans person naked, without starting to screw up on pronouns, or can’t touch certain body parts for fear of challenging their notion of their lovers gender, there’s a problem.

Notice that I am not saying that people should ignore trans folks’ requests not to touch certain body parts!!!

I am saying that don’t assume that just because someone’s body is trans, you aren’t allowed to touch. NEGOTIATE. For example, my breasts are fairly sensationless. I very rarely get any feeling out of them, though I do sometimes if my mind is in the right place, which tells me that there is probably no nerve damage to them, just psychological blocks. However, I am never going to get past my psychological block to enjoying my breasts if I’m the only person that ever touches them. Even when I tell partners that it’s ok to touch them, and I want them to touch them, they often don’t, because they say, when they are sleeping with a man, breast play isn’t something they usually do.

Some trans folk want to be treated exactly like a cis person of the same gender. Again, you should respect their wishes. However you can’t assume what that looks like in that trans person’s mind, and you should communicate about it and make sure everyone is on the same page. Also, for the record, don’t assume that someone’s biggest hang up in bed is their gender, just cos that’s your biggest hang up about being in bed with them.

My point is: I want a partner to love my body for what it is RIGHT NOW, not what it might be, what it could become after surgery / more hormones / more surgery. Likewise, I want to be able to appreciate a trans partner’s body for what it is right now, and enjoy my partner for being gender fucked, not for their body’s similarities to a cis body, not for my ability to block out the ‘conflicting information’, but for all of the beautiful, sexy, pleasurable body they have right now.

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.