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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IntroductionSteph Nagoski @informationchefGwen 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

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Outline

• The Dire Need – Why is this important?• History of Approach & key problems

• Current Standards of Care

• Key challenges with unaware providers

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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.

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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.

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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.

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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.

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• The Dire Need – Why is this important?

• History of Approach & key problems

• Current Standards of Care

• Key challenges with unaware providers

Outline

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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.

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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.”

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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

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• The Dire Need – Why is this important?

• History of Approach & key problems

• Current Standards of Care

• Key challenges with unaware providers

Outline

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New Standards

• May, 2013: DSM-V

• Gender Dysphoria

• WPATH Standards of Care

• http://www.wpath.org

• Informed Consent

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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

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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

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• 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

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• The Dire Need – Why is this important?

• History of Approach & key problems

• Current Standards of Care

• Key challenges with unaware providers

Outline

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Even the most well-intentioned…

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Avoid Language issues

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Fears and Concerns

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Be an Ally. Be a part of the Remedy.

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Thanks!

Q&A time