Module 10 Clinical Issues with Transgender Individuals

1. Module 10Clinical Issues with Transgender Individuals A Provider’s Introduction to Substance Abuse for Lesbian, Gay, Bisexual, and Transgender Individuals First Edition

2. Clinical Issues With Transgender Individuals Learning Objectives • Understand “transgender” • Be familiar with research & data • Be aware of clinical issues • Understand treatment implications Power Point Slide # 10-1, n36 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

3. Review of Terms • Gender:femaleness or femininity and maleness or masculinity • Gender Role:masculine or femininebehaviors • Gender Identity: inner senseof oneself, a person’s self-concept, in terms of gender • Sexual Orientation: distinct from gender identity, describes one's attraction to, sexual desire for, lust for, romantic attachments to others; lesbian, gay, bisexual, heterosexual. Power Point Slide # 10-2, n37 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

4. Definition of Transgender An umbrella term that came from the transgender communities in the 1990s and includes the spectrum and continuumof gender identities, expressions, and roles that challenge or expand the current dominant cultural values of what it means to be male or female. Power Point Slide # 10-3, n38 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

5. Transgender Spectrum • Transsexuals • Cross-dressers • Drag Queens and Drag Kings • Bigender, Androgyny, Nongendered, Gender-Queer Power Point Slide # 10-4, n39 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

6. In a recent (1999, 2000) San Francisco study by Dr. Kristin Clements at the San Francisco Department of PublicHealth AIDS Office: HIV prevalence among MTF persons was 35% and 65% among African-American MTFs. Injection drug use was 34% among MTF transgender individualsand18% among FTM transgender individuals. 55% ofMTF individuals reported they had been in alcohol or drug treatment sometime during their lifetimes. . Research and Data Power Point Slide # 10-5, n40 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

7. A study from Hollywood, California, (Reback and Lombardi1999) reported that the drugs most commonly used by MTF transgender individuals were alcohol, cocaine/crack, and methamphetamine Other recent studies of transgender health risks in urban areas around the country , including Boston, New York City, Washington D.C., Chicago, Los Angeles and Houston, show similar results with higher rates of substance abuse in general and higher rates of substance abuse with HIV prevalence, particularly among transgender sex workers. . Research Power Point Slide # 10-6, n41 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

8. Issues about appearance, "passing" and body image History of hiding or suppressing gender identity Lack of family and social support Isolation and lack of connection to positive, proactive transgender community resources Hormone therapy and use or injection history Stigma and discrimination Employment problems Relationship/child custody issues Clinical Issues and Implications for Treatment Power Point Slide # 10-7, n42 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

9. TREATMENT DO'S AND DON'TS DO’S • Use the proper pronouns based on client’s self-identity when talking to/about transgender individuals. • Get clinical supervision if they have issues or feelings about working with transgender individuals. • Allow transgender clients to continue the use of hormones when they are prescribed. Advocate that the transgender client using “street” hormones get immediate medical care and legally prescribed hormones. • Take required training on transgender issues. Power Point Slide # 10-8, n43 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

10. TREATMENT DO'S AND DON'TS DO’S • Find out the sexual orientation of all clients. • Allow transgender clients to use bathrooms and showers based on their gender self-identities and gender roles. • Require all clients and staff members to create and maintain a safe environment for all transgender clients. Post a nondiscrimination policy in the waiting room that explicitly includes sexual orientation and gender identity. Power Point Slide # 10-9, n44 A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide

11. TREATMENT DO'S AND DON'TS DON’TS • Don’t call someone who identifies as a female “he or him” or call someone who identifies as male “she or her”. • Don’t project transphobia onto the transgender client or share transphobic comments with other staff members or clients. • Never make the transgender client choose between hormones and treatment and recovery. • Don’t make the transgender client educate the staff. • Don’t assume transgender women or men are gay. • Don’t make transgender individuals living as females use male facilities or transgender individuals living as males use female facilities. • Never allow staff members or clients to make transphobic comments or put transgender clients at risk for physical or sexual abuse or harassment. Power Point Slide # 10-10, n45 Prairelands ATTC Toolbox Training Module 5 – 12 Clinician’s Overview