Transgender & Mental Health

1. Transgender & Mental Health Presenter: Kaete Walker. Registered Nurse/Case Manager, Hunter Valley Mental Health Service. Previously, Transgender Project Worker, Women’s and Girls’ Emergency Centre, Surry Hills, Sydney; Co -Convenor, Rainbow Visions Hunter Inc…

2. Previous public presentations • Walker, K. (2006) Transphobia. Key Note Speech delivered to the Transgender Day of Remembrance Seminar, NSW Parliament House, 20th November 2006. http://maenad.wordpress.com/transgender-day-of-remembrance-seminar/ • Walker, K; Wyndam, A; Walker, N. (2007) Gender and Sexuality Diversities. Workshop provided to TAFE, Newcastle students, 2007.http://kaete.org/gender-workshop/ • Walker, K. (2009) Transsexualism – latest research. Delivered at The Gallipoli Club, Hamilton, NSW. http://kaete.org/transpresoct2009/

3. Presentation Contents • What is 'transgender’? • What is the prevalence? • What are the problems, including mental health care, transgender persons may face? • Co-morbidity of transgender and mental illness? • Transgender and Suicide? • Referral options for transgendered persons?

4. Emeritus Prof. Lynn Conwayhttp://ai.eecs.umich.edu/people/conway/conway.html

5. What is ‘Transgender’ (TG)? (a) • “Transgender is an umbrella term for persons whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth.” (APA) • “Transgender persons have been documented in many indigenous, Western, and Eastern cultures and societies from antiquity until the present day. However, the meaning of gender nonconformity may vary from culture to culture.”(APA)

6. What is ‘Transgender’ (TG)? (b) • Some theorists regard TG as a form of ‘Brain Intersex’. • Some theorists, perhaps less so these days than previously, regard TG as a psychiatric illness. In DSM IV, eg, ‘Gender Identity Disorder’. (In the proposed DSMV, ‘Gender Dysphoria’). • The Jury is still out, but is more leaning the ‘Brain Intersex’ idea.

7. Transsexualism • In DSM 1V, is ”Gender Identity Disorder” • In DSM V, is soon likely to be “Gender Dysphoria”. • Is, by most, regarded part of the ‘Transgender umbrella spectrum’. • Some dissenters, however.

8. Prevalence (a) • “It is difficult to accurately estimate the number of transgender people, mostly because there are no population studies that accurately and completely account for the range of gender identity and gender expression.” (APA) • For transsexuals, per se, the incidence has been hx generally estimated at 1:10,000 to 1:50,000. However, the incidence appears to be increasing. (Zucker. 2009). • In Netherlands, 1:12000 for m2f, and 1:30000 for f2m (Campo et al, 2003).

9. Prevalence (b) But, see also: “The bottom line is that transsexualism is at least two orders of magnitude more prevalent than previously recognized by the U.S. psychiatric community…” Emeritus Prof. Lynn Conway. http://ai.eecs.umich.edu/people/conway/TS/TSprevalence.html

10. Why are some people Transgender? (a) “There is no single explanation for why some people are transgender. The diversity of transgender expression and experiences argues against any simple or unitary explanation. Many experts believe that biological factors such as genetic influences and prenatal hormone levels, early experiences, and experiences later in adolescence or adulthood may all contribute to the development of transgender identities.” (APA)

11. Why are some people Transgender? (b) • There are, however, a number of studies, albeit small at this stage, which have discovered brain differences in transsexual persons, cf, non transsexual persons. • See, eg, but not limited to, Garcia-Falgueras, A and Swaab, D.F (2008) A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. Brain 131, 3132-3146 and Luders E, Sanchez FJ, Gaser C, Toga AW, Narr KL, Hamilton LS, Vilain E (2009) Regional gray matter variation in male-to-female transsexualism. Neuroimage. 46(4):904-7, 2009 Jul 15.

12. Co-morbidity of transgender and mental illness? (a) • “Personality, mood, dissociative, and psychotic disorders were the most often reported psychiatric conditions comorbid with gender identity disorder. In about half of the cases…cross gender confusion was regarded as an epiphenomenon of other illnesses” (Campo, et al 2003 survey of 129 Dutch psychiatrists). • Other studies…

13. Tranznation Survey (2007) • 253 respondents from Aust and NZ • “..Improved mood and functioning once gender dysphoria is treated”. • 36% met criteria for current major depressive episode (cf general population= 7%) • 25% reported suicidal thoughts in the 2 wks prior the survey. (Higher rates for m2f than f2m).

14. Transgender and Suicide? • “Transgender Australians have rates of suicide at least 14 higher than the rest of the population”. http://www.lgbthealth.org.au/mental-health • “Lack of robust Australian data on suicide attempts or deaths for transgender people, however comparable nations report up to 47% have previously attempted suicide”.http://www.lgbthealth.org.au/mental-health

15. What are the problems, including mental health care, transgender persons might face? • Discrimination, intentional or unintentional? • Transphobia? • Lack of knowledge, by service providers? • Lack of knowledge, by service users? • Other?

16. Referral and/or consultative options for transgendered persons, and their clinicians? • The Gender Centre, Sydney. • ACON , Newcastle. • GLBT Counselling Service, Newtown, Sydney. • Dr Larry Brash, Psychiatrist, Warners Bay. • Other?