Jul 172013

Gender Spectrum

Gender Spectrum has a yearly Family Conference and Professionals Workshop in Berkeley, California. This year was the 7th conference, and my 3rd time attending (2nd year as a volunteer). Gender Spectrum is an organization supporting, educating and advocating for transgender and gender non-conforming youth and their families.

I’ll start by talking about the Professional’s Workshop, which was Friday. It was roughly split into four tracks: medical, mental health, legal, and educational. There was a lot of overlap. One panel I particularly enjoyed was the “Working With Caregivers” panel. It was a series of cases and discussion of those cases between a family practice physician and a social worker. The varying concerns in each case , the individuality, and the back-and-forth between professional fields really helped bring the case reports to life. For someone like me with limited clinical experience it was a real treat. Another panel I really appreciated was on research relevant for trans youth. The summary? As usual, not much… but I do have a few more citations to track down and read.

I also want to give a shout out to Jeanne Nollman (and, by extension, the AIS-DSD Support Group) for coming and giving an Intersex 101 talk and sharing her story. This was the first year Gender Spectrum addressed intersex/DSD issues and it’s sorely needed. As much as trans issues are hidden from the public eye, intersex issues are even more hidden… often by medical professionals and families themselves. Thank you Jeanne for stepping into the light and talking with us. Let’s create some change there too!

The last panel I attended in the professionals workshop was on fertility. It was repeated for the family conference. Many many families are concerned that, by allowing their children to start hormone therapy or have surgery, that they will forever lose their ability to have biological children. I see two aspects to this: the (often complex) biology of fertility and fertility preservation, and the emotional aspects of family and family building. Before the conference began, I coordinated with several of the presenters to help make a flow chart to simplify explaining the fertility biology.

The family question is, in a way, a lot harder. What is family? Who is family? For many, biological grandparentage is important. For others, they simply don’t want to sterilize their child. I was more emotionally involved in the conversation than I expected to be. I believe very strongly that family is chosen, not just biological. I have more than two parents. I accept them all whole heartedly, and I don’t make a distinction based on genes. But I admit that the dominant culture I see in California doesn’t accept that… and we lack language that truly supports that. Worse, much of my family is not legally recognized. So it’s a bit of a tangle of an issue. As far as I know this was the first year fertility was addressed in a panel. It went very well, and I hope to see it repeated and expanded next year.

As for the family conference? I heard rumor that some 150-200 youths were there. It was huge this year! My volunteering this year was primarily focused on the medical consult sessions. Every year the conference offers one-on-one sessions with various professionals. This year it included medical, mental health, spiritual, and legal professionals. It was pretty busy. I didn’t get to as many panels as I might have liked, but that’s nothing strange. As always at a conference, one wants to be in five different places all at the same time. So unlike previous years, I didn’t come home with a folder full of notes and citations to look up. Instead, I sat and talked with people.

It was a surprisingly intense and emotional conference for me. I really came out of the world of statistics and risk factors and into the world of emotions and realities. It was… well, I’m still looking for the right words. I appreciate all the people who sat and talked with me. I hope you’re all well. Know that someone in the world is thinking of you and hoping everything’s going to come out OK in the end. Another shout-out, this time to Micah of Neutrois Nonsense. Good to see you again!

One theme stands out for me this year particularly strongly: self-determination. The goal of Gender Spectrum, and of the parents there raising trans and gender non-conforming youth, is to let their children be themselves. Whatever that is at that particular moment. Let them explore and play and decide what’s right for themselves in the end. It’s like Maslow’s Hierarchy of Needs: provide the safety, security and love and let the child self-actualize and be happy.

At the closing plenary for the conference, we were asked “What’s the one thing you’ll do with this experience when you leave here?” For me? I need to revise my Gender and Sexual Minorities 101 lecture. I may accept the gender binary for myself (I identify as a woman), but that doesn’t mean I should assume others do. I think I emphasized the binary too much in my previous lectures. So when I record those lectures, it’ll be a revised version that’s more open to gender fluidity, and that provides more information on trans and gender non-conforming youth.

…also, I so need to bring business cards next year! Augh! Oh well. Hope everyone I gave contact info to is able to find me. 🙂

In summary? Great experience, as it is every year. If you are a family with a trans/gender non-conforming youth, or work with those youths, or do trans care of any flavor, or are just curious…. please try to come for next year! I hope to see you all there again soon.

May 192013

I got back from the 2013 National Transgender Health Summit (NTHS) in Oakland last night. What a fabulous conference! I’m still processing a lot of my notes, but wanted to give a quick report on it before I flood the blog with new resources.

First some basic information. NTHS is cosponsored by UCSF’s Center of Excellence for Transgender Health and the World Professional Association for Transgender Health. It’s designed for medical professionals, mental health professionals, advocates, health administrators, students, and others. I can’t speak for previous years, but this year it was a two-day event. Sessions were broken into various tracks: research, medical, mental health, policy, and special topics. And boy, did we cover quite a lot! And, as always, I wanted to be in five different places all at once.

Aside from the official session topics, though, there were some themes that stood out to me…

  • There’s a very strong need for cross-cultural trans care. Trans care, like lots of medicine, has been focused on white people. I admit to being guilty of this too! I don’t know how being trans is handled in, for example, an urban latino/a community, and I don’t know how I can best respond to those needs as a future health care provider. I met some folks who were involved in the Trans People of Color Coalition, and I hope to not only educate myself but bring more awareness to my posts here.
  • There’s a disconnect in some areas between cultural knowledge about medical treatments in trans communities and medical knowledge. I want to give a shout out to Trystan Cotten, author of Hung Jury, for bringing attention to this within trans male communities. One of his examples? Something new for me, certainly: there are anecdotal reports that some trans men can have penetrative sex after metoidioplasty. Sounds like there needs to be a community-level conversation.
  • It sounds so far like the ICD-11 system will handle both the transgender/transsexual diagnoses and the paraphilia diagnoses much better than the previous ICDs and certainly better than the DSM system. More details when the preliminary criteria are out for comment.
  • Insurance coverages for trans-related care may improve with the Affordable Care Act. Again, more on this as information becomes more available.
  • There is a lot of research going on! Yay! I’ll try to link to some of the studies I heard about in a follow up.

Plus so much more! It was really exciting. I hope to post again with more information, links to lots of new resources and shout outs for on-going studies and organizations.

Aug 012011

I spent this weekend at the Gender Spectrum Family Conference and Professional’s Conference. Gender Spectrum is an organization in the San Francisco Bay Area (Berkeley) which helps families with transgender or gender non-conforming children. I really enjoyed my time, both attending workshops and chatting with families and professionals, so I thought I’d share a bit of what I learned and experienced. My mind is still swimming with new knowledge and perspectives, so please excuse the scattered-ness. I am not going to go through Trans 101 or Transition 101 here – I’ll be covering that in another post fairly shortly.

Some quick things I learned:

  • In California, gender identity is a protected class.
  • The most common intersex condition is congenital adrenal hyperplasia. If unrecognized, this can lead to death very quickly in newborns. Females with CAH end up producing too much testosterone as fetuses. This alters aspects of their physical sex, but not their gender – nearly all of them identify as women.
  • Some physicians have had luck suppressing testosterone in their pre-op trans women patients by just using estrogen and progesterone with no androgen blocker. The work will be presented at this year’s WPATH meeting and is slated for publication. I will cover it more thoroughly when it does get published.
  • Some professionals are thinking that the ratio of MtF:FtM is actually closer to 1:1. The numbers I’d previously heard varied, but with more MtF in Western countries and more FtM in Japan.

GnRH analogues were discussed a lot. These are so-called “hormone blockers” that can delay puberty. They’re considered safe to use, and have been used for children with very early (“precocious”) puberty for a while. GnRH analogues can also “buy” valuable time for trans children, delaying puberty to allow for decision-making, resource finding or family-convincing. For trans boys, it means they have more time to grow (the hormonal changes in puberty for both sexes stop height growth – this is why women are shorter than men). Unfortunately, they are also rather expensive.

There are trans children now who have the opportunity to go through hormone treatment instead of their natal puberty. That is, for a trans girl, instead of going through male puberty, she can be put on estrogen and progesterone so she goes through puberty just like any other girl her age. I am really excited about this. This reduces the painful and expensive procedures they might have had to go through otherwise, and helps them truly be in the right body for them. There’s only one medical conundrum… if they want to change their genitals then surgery is still the best option. Surgery for trans men is getting better all the time (Yay!). For trans women, though, not going through their natal puberty presents a potential problem. One of the things that happens in male puberty is that the penis gets bigger. The penis then gets used in surgery to create a vagina. The bigger the penis, potentially the deeper the vagina. Now, other tissue can be used instead (skin grafts from places like the forearm, thigh, or tummy), but they’re not as sensitive. I do believe that people are working on a solution to this, though. We’ll see what they come up with.

The consensus at the conference was that transgenderism is a biological condition. I was impressed with the strength of the evidence I heard. I want to look at the original articles before I discuss it in detail. Stay tuned, though – I definitely will be posting about it!

Part of the joy of the conference was getting to hear about children exploring their gender with support from parents or others. That was awesome. Most of the stories I’ve heard have been from people who transitioned as adults, where they had to fight every step along the way alone. There’s still a struggle in these families, but it’s wonderful to see how they support each other.

I also have a long list of new local resources to check out. I’ll add those as I parse through them.

All in all, it was a great experience. I’m really glad I went. 🙂