Health for Gender Variant Youth

Healthcare for Gender-Variant Youth
Challenges and Successes
in Approaches and Access
YTH SF 04.25.2016

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Introduction
Steph Nagoski @informationchef
Gwen Smith @gwenners
• Transgender Language and
Terminology:
• Gender Identity vs Sexual Identity
• Trans Woman, Trans Man
• Non Binary, Genderqueer
• Two Spirit, Agender
• Supportive Pronouns:
• He/Him, She/Her, They/Them,
others

Outline
• The Dire Need – Why is this important?
• History of Approach & key problems
• Current Standards of Care
• Key challenges with unaware providers

The Dire Need – Harassment at School
• LGBT Teens at School - 2007
• 86% verbally harassed
• 44% physically harassed
• 22% physically attacked
• 60% attacked say they did not report the incidents because they
believed no one would care.
• 31% students who report incidents of harassment and violence at
school to staff only to receive no response.
• Two times: How much less likely gay and transgender students
are to finish high school or pursue a college education compared
to the national average.

The Dire Need - Homelessness
• 1.6 million to 2.8 million: Est # of homeless
youth in the US.
• 20%- 40% of the homeless youth population
are gay or trans, compared to only 5%-10% of
the overall youth population.
• 320,000 to 400,000: A conservative estimate
of the number of gay and transgender youth
facing homelessness each year.
• 14.4: Avg age that lesbian and gay youth in
New York become homeless.
• 13.5: Avg age that transgender youth in New
York become homeless.

The Dire Need
Assault, Sex Work, Alcohol
• Homeless LGBT Youth
• 58%: have been sexually
assaulted, compared to 33 percent
of homeless heterosexual youth.
• 44%: asked by someone on the
street to exchange sex for money,
food, drugs, shelter, or clothes,
compared to 26 percent of straight
homeless youth.
• 42%: abuse alcohol, compared to
27 percent of heterosexual youth.

The Dire Need – The Impact
• 62% of homeless gay and transgender youth attempt suicide,
compared to 29% of their heterosexual homeless peers.
• Gay and trans youth are 8.4 times as likely to attempt suicide if
they are rejected by their families in adolescence compared to if
they are not rejected by their family. They are also 5.9 times as
likely to have experienced depression, 3.4 times as likely to have
used illicit drugs, and 3.4 times as likely to have had unprotected
sex.

Outline

History of Healthcare for Trans Youth & Adults
• Reparative Therapy
• Gender Identity Disorder
• Harry Benjamin Standards of Care
• Heavy Gatekeeping
• Autogynephilia
• We will be dealing with the effects of
these harmful practices for many, many
years.

Changing the Standards
• After massive press expose by Truth Wins Out & national media
• Illegal, Immoral, and Unethical treatment of Youth
• Exodus, Int’l org collapses
• June 2013 - Alan Chambers, former CEO apologizes
• 9 States have outlawed Reparative Therapy for Youth
• “Conversion therapy is a hateful and fundamentally flawed
practice that is counter to everything this state stands for,” said
Governor Cuomo. “New York has been at the forefront of
acceptance and equality for the LGBT community for decades –
and today we are continuing that legacy and leading by example.
We will not allow the misguided and the intolerant to punish
LGBT young people for simply being who they are.”

Effects of Gatekeeping
• “No LGB in T” – lying to providers,
hiding relationships (back in the
closet), and Divorce from perfectly
supportive partners
• “2 Yrs” rule endangered us
• Lack of trust in providers
• Fear and stigma from existing
transfolks who transitioned through
the worst of HBSOC

Outline

New Standards
• May, 2013: DSM-V
• Gender Dysphoria
• WPATH Standards of Care
• http://www.wpath.org
• Informed Consent

Puberty Blockers
• GnRH analogues
• Netherlands Study 2000-2008
• All but one of these adolescents socially transitioned during the
assessment process (e.g., change in pronouns and name across
settings), and
• All 70 adolescents continued with cross-sex hormone therapy.
Between these time points, general functioning improved
while depression, behavioral, and emotional difficulties
decreased
• http://www.impactprogram.org/wp-
content/uploads/2014/12/Kuper-2014-Puberty-Blockers-Clinical-
Research-Review.pdf

Breaking the Myths
• Some modern, progressive Providers still clinging to outdated
guidelines: Dr Zucker & CAMH
• Still strong resistance against our Civil Rights in many states
• NC: HB2, MS: HB1253, TN: Several, 10 other states (at least)
• Still strong pushback to our social awareness in the form of:
• The Bathroom Myth

• Informed Consent means HRT
now possible for people
transitioning to embrace
GenderQueer, or other “Enby”
identities
• Respecting and trusting the
patient’s perspective of identity
• Lots more info from Micah
• http://Neutrois.me
Support for Non Binary Identities

Outline

Even the most well-intentioned…

Avoid Language issues

Fears and Concerns

Be an Ally. Be a part of the Remedy.

Health for Gender Variant Youth

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