By Aimee Beardslee Spring 2012

1. FROM A BLACK AND WHITE TO A TECHNICOLOR VIEW OF GENDER:A DISCUSSION ON GENDER IDENTITY AND GENDER VARIANCE By Aimee Beardslee Spring 2012

2. TOPICS OF DISCUSSION • Let’s talk about sex…versus gender • What does “Intersex” mean? (It’s more common than you think!) • What does “Transgender” mean? • Hormone Therapy & Sex Reassignment Surgery • Gender Development Theories • Gender Variance Across Cultures • Gender identity development in childhood and adolescence • DSM-IV Diagnostic Criteria for Gender Identity Disorder & Proposed Criteria for DSM-V • Why is studying gender identity and gender variance important?

3. SEX VS. GENDER…SOME BASICS: • SEX: a term that typically describes an individual’s anatomical structure. “Biology” • GENDER: a term that describes an imposed or adopted social and psychological condition. “Culture/Society” • GENDER ROLE: a term that describes the patterns of behavior that are learned or “acted” based on one’s gender identification. (Diamond, 2002) *Gender role scripts, rules, and expectations vary across cultures…but more on that later!

5. GENDER, AND EVEN SEX, ARE NOT DICHOTOMOUS CATEGORIES • Not everyone is born either “male” or “female”. • Although one’s sex and gender are expected to be congruent, not everyone grows up feeling that the two “match”. • Historically, the concepts of masculinity and femininity have changed, and how they are defined varies across cultures. • There are many cultures that accept the existence of more than two genders-and have for centuries! • Gender and sexual orientation are NOT the same. Gender variance should not be conflated with homosexuality.

6. WHAT DOES “INTERSEX” MEAN? • An intersex person is “born with external genitalia, chromosomes, or internal reproductive systems that are not traditionally associated with either a ‘standard’ male or female” (NCTE, 2009). • Medical experts state that 1 in 1,500 to 1 in 2,000 infants are born with “noticeably atypical” genitalia (ISNA, 2008). • However, the actual number is likely to be significantly higher, because many variations do not show up until later in life (and some may never be noticed! ISNA, 2008).

7. HOW COMMON IS INTERSEX? (from isna)

8. HOW COMMON IS INTERSEX? (cont’d)

9. WHAT DOES “TRANSGENDER” MEAN? • “An umbrella term for people whose gender identity, expression, or behavior is different from those typically associated with their assigned sex at birth, including but not limited to transexuals, cross-dressers, androgynous people, genderqueers, and gender non-conforming people. Transgender is a broad term and is good for non-transgender people to use. ‘Trans’ is shorthand for ‘transgender’” (NCTE). • Prevalence of transgenderism varies widely, from 1 in 30,000…to 1 in 5,000…to 1 in 500 (Pleak, 2009).

10. TRANSGENDER TERMINOLOGY • Transgender man or “transman”: individual born biologically female who identifies as male. Also referred to as “FTM” (female-to-male) • Transgender woman or “transwoman”: individual born biologically male who identifies as female. Also referred to as “MTF” (male-to-female)

11. TRANSGENDER HORMONE THERAPY • Many transgender individuals undergo hormone therapy to develop secondary sexual characteristics. Transwomen receive estrogen, and transmen receive testosterone. • Some effects of testosterone on secondary sex characteristics include deepening of the voice, cessation of ovulation/menstruation, growth of facial and body hair, enlargement of the clitoris. • Some effects of estrogen on secondary sex characteristics include breast growth, redistribution of body fat (hourglass shape), reduction of musculature, softening of facial contour.

12. SEX REASSIGNMENT SURGERY • SRS may also be called gender reassignment surgery, genital reconstruction surgery, sex affirmation surgery, sex realignment surgery, or a sex-change operation. • “Surgery” can include hysterectomy, mastectomy (“top surgery”), removal of the ovaries, removal of testicles, breast augmentation, genital reconstruction, and facial plastic surgery. • “Pre-op”: indicates individuals who have yet to undergo SRS but desire it. • “Post-op”: indicates individuals who have undergone SRS. • “Non-op”: indicates individuals who do not desire to undergo SRS.

13. GENDER DEVELOPMENT THEORIES: AN OVERVIEW • Biological theories: posit that gender differences are “ancestrally programmed” or that hormonal influences are the basis of gender differences in social behavior. • Psychoanalytic theories: posit that identification with a certain gender is a result of child adopting characteristics and qualities of the same-sex parent.

14. GENDER DEVELOPMENT THEORIES (cont’d) • Kohlberg’s Cognitive Developmental Theory: When children achieve “gender consistency” they place value on their own gender and seek to act in ways that are consistent with their gender. • Kohlberg’s stages of Gender Development: Gender Identity: Ability to label oneself a boy or girl and others as boys or girls (usually by age 2). Gender Stability: Ability to recognize gender remains constant over time. “I was born a boy and will grow up to be a boy” (usually by age 4). Gender Consistency: Understanding that gender is invariant despite outward changes. “That woman has short hair and is wearing shorts but is still a woman” (usually by age 6 or 7).

15. GENDER DEVELOPMENT THEORIES (cont’d) • Gender Schema Theory: similar to cognitive-developmental theory. However, this theory posits that as soon as a child masters gender identity (“I am a boy” or “I am a girl”), gender schemas begin to develop. These schemas expand and grow to include “knowledge of activities and interests, personality and social attributes, and scripts about gender-linked activities” (Bussey & Bandura, 1999, p. 5).

16. GENDER DEVELOPMENT THEORIES(cont’d) • Social Cognitive Theory: In this theory, “gender conceptions and roles are the product of a broad network of social influences operating interdependently in a variety of societal subsystems. Human evolution provides bodily structures and biological potentialities that permit a range of possibilities rather than dictate a fixed type of gender differentiation” (Bussey & Bandura, 1999, p. 676). • Basically, biology is not destiny, and multiple factors (parents, peers, educational institutions, the media, culture, etc.) interact to determine gender identity.

17. TRANSGENDER DEVELOPMENT MODELS: ARE THERE ANY? • Transgender experiences do not readily fit into stage models, because they do not fit into the traditional gender binary construction (Bilodeau & Renn, 2005). • “Mallon argued that it is inappropriate for social service practitioners to use traditional human development models, including those of Erikson and Marcia, because these theorists posit concepts of gender role identification in traditionally gendered, biologically based constructions” (Bilodeau & Renn, 2005, p. 33). • D’Augelli’s model has been used to understand transgender development, but there is a need for the creation of new models.

18. GENDER VARIANCE ACROSS CULTURES • Many North American Indian tribes have a “third gender”. Called “two-spirit” (formerly “berdache”), these cross-gender individuals have been documented in over 150 groups. (Newman, 2002). • In the Dominican Republic (guevedoche), Papua New Guinea, and the South Pacific, children with enzymatic deficiency (who have ambiguous genitalia) are often raised female, but if virilization occurs at puberty, the child is allowed to adopt a male identity and this change is socially accepted (Newman, 2002).

19. GENDER VARIANCE ACROSS CULTURES (cont’d) • “There is no consensus across world cultures regarding the appropriate traits, characteristics, and patterns of behavior that males and females should have” (Langer & Martin, 2004, p. 13). • Even within the same country, different cultures and subcultures have different roles and expectations for men and women. • For example, there may be more gender role equality among African Americans but more rigid gender roles for Latin American families (Langer & Martin, 2004).

20. GENDER IDENTITY DEVELOPMENT IN CHILDHOOD • Some children express feelings of wanting to be the other sex as young as 1 and a half to 2 years old and pretend to be the other sex when playing “pretend”. • Parents may be tolerant of such behavior up until the child enters school; this is commonly when parents take children to see psychiatrists. • Gender variant children may be quite isolated in early school years. At age 8-10, teasing worsens and they may be targets of bullying and violence. • Only a small number of gender variant children will remain gender variant into adolescence and adulthood. • Outcomes for gender atypical children: most become gender typical gay and lesbian adults, some become gender typical straight adults, and a few will become transgender adults. (Pleak, 2009)

21. GENDER IDENTITY DEVELOPMENT IN ADOLESCENCE • Around age 11 to 13, gender atypicality or gender variance does not change much going forward. • Considerable consensus that these young people will continue to be transgender or transexual as they mature. (Pleak, 2009) • Note: individuals may “transition” later in life, which may be due to the necessity of suppressing their gender variance until more freedom (or safety) is attained in adulthood. • Angie, transgender teen, 17 years old, NYC, trans

22. THE GENDER INTENSIFICATION HYPOTHESIS • “Hill and Lynch proposed that puberty plays a role in the differentiation of masculine and feminine characteristics by serving as a signal to socializing others (parents, teachers, peers) that the adolescent is beginning the approach to adulthood and should begin to act accordingly, that is, in ways that resemble the stereotypical male or female adult” (Lerner & Steinberg, 2004, p. 240). • "Straightlaced (a documentary) unearths how popular pressures around gender and sexuality are confining American teens."

23. PEER RESPONSE TO GENDER NON-CONFORMITY IN ADOLESCENCE • As Smith and Leaper (2005, p. 102) assert: “Noting only the relation between gender typicality and self-worth without considering the social context might imply that gender typicality per se leads to adjustment…” However, “multiple patterns of gender identity and adjustment exist for adolescents with peer acceptance being a critical mediator. Importantly, there was no difference in the self-worth of non-conforming and conforming adolescents if they felt accepted by their peers” (emphasis in original).

24. TREATMENT OF TRANSGENDER ADOLESCENTS • Option of delaying puberty via hormone therapy: this allows a transgender adolescent to delay onset of secondary sex characteristics (Ex/breast growth and menstruation in females and facial hair growth and voice deepening in males) so that he or she may have more time to decide on a gender identity that feels right. • As mentioned, most adolescents are very aware their minds and bodies don’t “match” and have the desire to make their sex and gender congruent. However, for the few that may decide against changing their gender, the treatment can be stopped and genetic puberty will resume within 6 months. (Spack, 2009)

25. Diagnostic criteria for Gender Identity Disorder(DSM-IV-TR) • A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). • Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. • The disturbance is not concurrent with a physical intersex condition. • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

26. diagnostic criteria for gid in children (dsm-iv-tr) (Under criterion A) In children, the disturbance is manifested by four (or more) of the following: • repeatedly stated desire to be, or insistence that he or she is, the other sex • in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing • strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex • intense desire to participate in the stereotypical games and pastimes of the other sex • strong preference for playmates of the other sex In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.

27. diagnostic criteria for gid in children (dsm-iv-tr) (Under criterion B) • In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.

28. PROPOSED CRITERIA FOR DSM-V • Would change Gender Identity Disorder to Gender Incongruence • For Gender Incongruence in Children, children must meet criteria 1: "a strong desire to be of the other gender or an insistence that he or she is the other gender“ • "This will appropriately prevent children with a gender variant expression without an incongruence between gender identity and sex assigned at birth to receive the diagnosis, which was a common point of critique for DSM IV" (DeCuypere, Knudson, & Bockting, 2010). • The distress criterion is proposed to be removed, which would make the diagnostic criteria "so broad that almost any transgender person could meet criteria for a mental disorder regardless of whether or not they experience clinically significant distress and desire or need intervention" (DeCuypere, Knudson, & Bockting, 2010).

29. IS GENDER VARIANCE REALLY A “MENTAL DISORDER”? • What it means to be a “man” or a “woman” has changed over time and is still changing (ex: “stay-at-home dads”). • Gender roles vary across cultures; some cultures allow for more than two genders. Also, gender roles vary within cultures. • So-called “distress” or “dysphoria” is not inherent in being gender variant; “incongruence” is not inherently unhealthy. • There is MUCH controversy over the GID diagnosis and many argue for its removal; arguments parallel those that eventually resulted in homosexuality being removed from the DSM in 1973.

30. WHY IS STUDYING GENDER IDENTITY AND GENDER VARIANCE IMPORTANT IN OUR FIELDS? • Our conception of gender influences the questions we ask in research. • The lens through which we view gender while performing research affects the outcome of that research. • How we view gender identity influences how we treat transgender and gender variant individuals, including children.

31. AWARENESS LEADS TO ACTION! • Being aware of LGBTQI issues helps us understand struggles (across the entire lifespan) that are common among these populations. • Awareness can also teach us to respond in ways that affirm individuals with a transgender or gender variant identity, increasing their chances for healthy outcomes. We can also develop important interventions, some of which may be literally life saving. • For example, the suicide attempt rate for adolescents diagnosed with GID has been found to be as high as 50 percent (Spack, 2009). • Other areas of concern are higher incidences of bullying, suicide, drug abuse, domestic violence, rape, hate crimes, homelessness, and HIV transmission (Youth Pride, Inc., 2010)

32. GENDER DIVERSITY ACCEPTANCE IS A SOCIAL JUSTICE ISSUE! • Both the APA and ACA have ethical principles that prohibit discrimination based on gender identity (separate from gender). • Broadening our view of gender identity impacts everyone, even “gender congruent” individuals. • A respect for gender diversity gives all people more freedom to be themselves!

33. Some recommendations for further learning • Books: Stone Butch Blues by Leslie Feinberg (a transgender man) Gender Outlaw: On Men, Women, and the Rest of Us by Kate Bornstein (a transgender woman) Transgender Warriors : Making History from Joan of Arc to Dennis Rodman by Leslie Feinberg Middlesex (a novel) by Jeffrey Eugenides • Films: Boys Don’t Cry (based on the true story of Brandon Teena) Ma Vie en Rose Transamerica (starring Felicity Huffman) Southern Comfort (a documentary on the life of Robert Eads, a transgender man) Hedwig and the Angry Inch (an entertaining musical/comedy/drama about a transgender German glam rocker)

34. WEBSITES: The Trevor Project: The leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth. http://www.thetrevorproject.org/ National Center for Transgender Equality: Non-profit organization dedicated to advancing the equality of transgender people through advocacy, collaboration, and empowerment. http://transequality.org/ Human Rights Campaign (HRC): The largest civil rights organization working to achieve equality for lesbian, gay, bisexual, and transgender Americans. http://www.hrc.org/ National Gay and Lesbian Task Force: Non-profit corporation that works to build the grassroots political power of the LGBT community to win complete equality. http://thetaskforce.org/

35. REFERENCES: • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. • Bilodeau, B. L., & Renn, K. A. (2005). Analysis of LGBT Identity Development Models and Implications for Practice. New Directions for Student Services (111), 25-39. • Bussey, K., & Bandura, A. (1999). Social Cognitive Theory of Gender Development and Differentiation. Psychological Review, 106, 676-713. • DeCuypere, G., Knudson, G., & Bockting, W. (2010, May 25). Response of the World Professional Association for Transgender Health to the Proposed DSM 5 Criteria for Gender Incongruence. Retrieved from World Professional Association for Transgender Health Web site: www.wpath.org/documents/WPATH Reaction to the proposed DSM - Final.pdf • Diamond, M. (2002). Sex and Gender are Different: Sexual Identity and Gender Identity are Different. Clinical Child Psychology and Psychiatry, 7 (3), 320-334.

36. REFERENCES • Intersex Society of North America. (2008). How common is intersex? Retrieved from Intersex Society of North America Web site: http://www.isna.org/faq/frequency • Langer, S. J., & Martin, J. I. (2004). How Dresses Can Make You Mentally Ill: Examining Gender Identity Disorder in Children. Child and Adolescent Social Work Journal, 21 (1), 5-23. • Lerner, R. M., & Steinberg, L. (2004). Handbook of Adolescent Psychology. Hoboken: John Wiley and Sons. • Manners, P. J. (2009). Gender Identity Disorder in Adolescence: A Review of the Literature. Child and Adolescent Mental Health, 14 (2), 62-68. • NCTE. (2009, May). Transgender Terminology. Retrieved from NCTE Web site: http://transequality.org/Resources/NCTE_TransTerminology.pdf

37. REFERENCES • Newman, L. K. (2002). Sex, Gender and Culture: Issues in the Definition, Assessment and Treatment of Gender Identity Disorder. Clinical Child Psychology and Psychiatry, 7 (3), 352-359. • Pleak, R. R. (2009). Formation of Transgender Identities. Journal of Gay & Lesbian Mental Health, 13, 282-291. • Smith, T. E., & Leaper, C. (2005). Self-Perceived Gender Typicality and the Peer Context During Adolescence. Journal of Research on Adolescence, 16 (1), 91-103. • Spack, N. P. (2009). An Endocrine Perspective on the Care of Transgender Adolescents. Journal of Gay & Lesbian Mental Health, 13, 309-319. • Youth Pride, Inc. (2010). Statistics. Retrieved from Youth Pride, Inc. Web site: http://www.youthprideri.org/Resources/Statistics/tabid/227/Default.aspx#h

38. Forest (ftm) talks with his parents about growing up trans • Talking With My Parents About Being Transgender • “This footage is the first time I have EVER talked openly about being trans with my parents. It was very hard to do, but the love was strong and I was impressed. To feel acceptance from family is very important.”