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SUNDAY, DECEMBER 25, 2011 PAGE 13B
QUESTIONS AND ANSWERS
TRANSGENDER
Q: How many transgender people are there? A: It’s not a question asked on the U.S. census, and even if it were, many in the transgender community are hesitant to open up about their gender identity. The National Center for Transgender Equality estimates that 0.25 percent to 1 percent of the population is transgender, a range in line with estimates from sex researchers.
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PETE G. WILCOX/THE TIMES LEADER
RJ, 6, Swoyersville, wrestles with his younger brother, Billy, 3.
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the brain tumors behave differently than any other tumor in the body. They don’t tend to spread into the rest of the body. It’s already kind of a contained cancer within the central nervous system.” And now, RJ is free from the disease. When it began to manifest itself more than two years ago, his parents were bewildered by his symptoms. On a family vacation to North Carolina in September 2009, RJ began vomiting profusely. He also had difficulty walking. Could this be a severe stomach virus? Did the little boy, one week into preschool, have a problem with his hip? “It took a good six weeks for diagnosis,” Lori Bell said, recalling blood tests and urine tests and, finally, a visit to an orthopedic surgeon at Geisinger Medical Center in Danville who quickly referred them to the neurological department. “He sent us downstairs immediately.” Then came the surgeries and all the anxious waiting. “I’m not a good waiter,” Lori Bell said, adding the medicalcenter personnel, from pastoral staff to Kershenovich, helped calm her fears. “For the parents, you just tell
them the truth completely,” the doctor said. “You can comfort them with your experience, with the knowledge most of the outcomes are successful. You have to be honest and tell them the risks and complications, too. You don’t always give complete comfort to families. The job is to do the surgery right.” Because of RJ’s illness, his parents wanted to be closer to medical care and to extended family members, so they moved from Sweet Valley to Swoyersville, where they live in a former rectory with a large, fenced-in yard, big enough for two boys and two large dogs. On a recent Saturday, it was also big enough for RJ’s sixth birthday party. “He wanted to invite all the boys in his class,” Lori Bell said. As a surprise to the boys, Santa made an appearance, too. “They’re a lovely family,” said Kershenovich, who expects to see RJ for follow-up visits, at least until he’s an adolescent. There’s a good chance now that RJ will enjoy a long and healthy life. He has no residual effects, other than a permanent shunt that removes excess cerebrospinal fluid from his brain. And if kindergarten classmates at Dana Street Elementary Center or T-ball teammates from the local Red Sox ever ask about it, he has a ready answer: “That’s where the doctors fixed my legs.”
tinue to fight for marriage and other rights, the next significant wave of legal action will involve transgender people. On Dec. 6 in Georgia, the 11th U.S. Circuit Court of Appeals ruled in favor of a transgender woman who was fired from her state job in 2007 after telling her boss she planned to transition from male to female. In the court’s ruling, Judge Rosemary Barkett wrote: “An individual cannot be punished because of his or her perceived gender non-conformity.” In October, the Illinois Department of Public Health, pressed by a lawsuit from the American Civil Liberties Union, said transgender Illinoisans could change the gender on their birth certificates without undergoing genital-reformation surgery. Also this year: the 7th U.S. Circuit Court of Appeals in Wisconsin ruled it unconstitutional to deny transgender prison inmates hormone therapy; Connecticut became the 15th state to protect transgender people from discrimination; and Wal-Mart made changes to its employee nondiscrimination policy to protect workers based on both gender identity and gender expression. “I think it has been a good year,” said M. Dru Levasseur, transgender rights attorney for the national gay, lesbian, bisexual and transgender legal rights group Lambda Legal. “I think the key thing — and it’s very similar to the change that happened in the movement with gay and lesbian people — is that many people thought, ‘Oh that’s a choice, that’s a lifestyle.’ When people come to understand that this is who someone is, I think that’s when they can really take it into their hearts.” Despite progress with civil rights, transgender people still face considerable discrimination in public and in the workplace. The impact of that is crystallized in a national study released this year by the National Gay and Lesbian Task Force and the National Center for Transgender Equality. The survey of more than 6,000
MCT PHOTO
Andre Perez is shown at the Gender and Sexuality Center at UIC in Chicago, Ill.
transgender and gender nonconforming people found that 41 percent of respondents had attempted suicide, compared with less than 2 percent in the general population. One of the primary psychiatric terms linked to transgender people is “gender identity disorder,” although it has been proposed that the term be changed to “gender dysphoria” in the upcoming fifth edition of the Diagnostic and Statistical Manual. “People with severe gender dysphoria, there’s a very high incidence of suicide if it’s not addressed,” said Randi Ettner, an Evanston, Ill.-based psychologist who specializes in gender conditions and wrote the book “Gender Loving Care.” Whether it’s Joan of Arc — executed in part for routinely wearing male clothing — or the Native American “berdache” — gendervariant people revered in certain tribes as “twin spirits” — the world has a long history of gender roles being blurred. Some cultures accept people whose gender identity doesn’t match their anatomical sex. A tribe in Samoa, for example, has a third gender made up of men who perform tasks otherwise reserved for women. But in America and most parts of the world, the binary system of gender identification is not friendly to those who don’t fit in. Experts like Ettner agree that the term “transgender” means, in essence: people who want to spend all or part of the time pre-
senting themselves in a gender other than the one they were assigned at birth. That said, sex researchers have found that there is tremendous diversity in the transgender community, so much so that many now view gender identity not simply as “male” or “female,” but as points on a spectrum between masculine and feminine. For Carmichael, who was serving as a woman in the Army National Guard, the time to think about gender identity came during the Iraq War. When a close friend was badly injured, the thin line between living and dying prompted him to address the confusing feelings that had plagued him since childhood: “I had hard questions to ask myself. And I did it.” While still in Iraq, Carmichael began, in his head, referring to himself using male pronouns. It felt right. After the war, he spent time reading extensively about what it meant to be transgender. He considered his lifelong journey — being a young girl who felt awkward in traditionally feminine roles; coming out in high school as a lesbian, hoping the disconnect he felt was a matter of sexuality; then recognizing that the problem was actually one of gender identity. When he decided to transition and began living his life fully as a man, Carmichael, at last, felt right. “I’m very comfortable being a trans man,” he said. “I’m sort of reveling in the idea of finally being content.”
Q: Is being transgender a mental illness? A: Gender identity disorder is a psychiatric condition listed in the Diagnostic and Statistical Manual. However, most transgender people bristle at the thought of having their identity pathologized. There is a push in the transgender community to have gender identity disorder removed from the DSM, much as homosexuality was removed decades ago. Many researchers say gender identity disorder is not a psychiatric illness that can be cured with treatment, but is a rarely occurring medical condition that has a strong psychological component. For most transgender people, a psychiatric or medical diagnosis is the only way insurance plans will deem hormone therapy and surgical procedures medically necessary. The World Professional Association for Transgender Health issued a statement in 2010 saying: “the expression of gender characteristics, including identities, that are not stereotypically associated with one’s assigned sex at birth ... should not be judged as inherently pathological or negative.” Q: What is a transvestite? A: The term “transvestite” is now considered offensive as it implies that a person wears opposite-sex clothing as a sexual fetish. The term “crossdresser” is more appropriate. Crossdressers are people who wear clothing associated with the opposite gender not for sexual arousal but because it gives them a sense of fulfillment and allows them to express a part of their identity. Though they dress in opposite-sex clothing, crossdressers may identify with the gender they were assigned at birth. Q: How do I know what pronoun to use with a transgender person? A: Never make assumptions. If you aren’t sure, ask the person which pronoun he or she prefers you use.
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