Transgender 101

BY: E VE LYN B AB ARO UD I, S YD N E Y C AR N E VAL E , AN N IE

GUIL IAN O, K E L SE Y P U LIAFI C O, B RIAN N A P U P P ,
CYN T H IA S AN C H E Z, M IC H E L L E VE R STE N , & M IC H E L LE
W IL SON

Activity
Break into 9 groups of three
Scenario 1: You are going to your five year old cousins birthday. She
is in kindergarten and likes to play outside. You need to pick up a gift
for the party.
Scenario 2: You are attending your nephews bar mitzvah later this
week and need to find a gift for him. Hes a very good student.
Scenario 3: You are attending a coworkers birthday. They enjoy
attending yoga class on the weekends. They do not need any more
yoga equipment.

Go to your favorite online store and find a gift for each

person (no gift certificates!)

How Do You Know What

Gender You Are?
Physical anatomy?
Testosterone level?
Menstruation?
Given birth to child?
Clothing choices?
Transgender Identity. (2015). Retrieved from
http://www.nzingaharrisonmd.com/blog/caitlyn-jenner-may-just-save-a-teens-life-43of-transgendered-teens-have-attempted-suicide/

Definitions
Transgender
Transsexual
Cross-dressers
Genderqueer
Gender variant or gender
nonconforming
**Remember that these definitions
may mean something different to
the person who claims them!

Pronouns. (2014).Retrieved from http://www.gayrva.com/newsviews/style-weekly-examines-local-trans-youth-support-group/

(Teich, 2012)

The Gender Binary

Gender and sex
Gender identity and
gender expression

Gender Binary. (2016).Retrieved from

https://fysopgenderfocus.wordpress.com/gender-binary/

We can no longer limit

persons to the binary,
rather we must imagine
gender, sexual
orientation, and sexual
identity as a spectrum

(Teich, 2012)

Sexual Orientation
|----------------------------------|------------------------------------|
0
1
2
3
4
5
6
Heterosexual

Bisexual

Homosexual

(Teich, 2012)

Sexual Orientation
Gender ID

Non-Trans
Man

Non-Trans
Woman

Transman

Transwoman

Sexual Orientation:
Straight

Gay/Lesbian

Bisexual

(Teich, 2012)

Transitioning
Counseling sessions: ~$50-200/month
Hormone therapy: ~$100/month
Surgeries
Female to Male
Chest Reconstruction: ~$6,000
Hysterectomy: ~$10,000
Scrotoplasty: ~$11,500
Metoidioplasty: ~$5,200
Male to Female
Orchiectomy: ~$4,600
Vaginoplasty: ~$20,000
Breast Augmentation: ~$8,200
Facial Feminization: ~$70,000

Outness of Respondents. (2010).Retrieved from

http://www.thetaskforce.org/static_html/downloads/repo
rts/reports/ntds_full.pdf

People Whom can Tell. (2010).Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/
reports/ntds_full.pdf

(Center of Excellence for Transgender Health, 2016; The Philadelphia Center for

Statistics Regarding
Transitioning
Transitioning is not limited to physical changes,
may encompass changes in dress, hobbies, and
other social constructs
Injustice at Every Turn
55% live full-time in a gender different from their
birth sex
27% are not living full-time in their desired gender
yet, but want to someday
18% do not want to live full-time in a gender other
than that assigned at birth

Medical transition vs surgical transition

Transition Status. (2010). Retrieved from
http://www.thetaskforce.org/static_html/downloads/reports/reports/nt
ds_full.pdf

61% have medically transitioned

33% have surgically transitioned

(Grant et al., 2011

Transgender Transition
Ages
The age of transition varies for every person
Injustice at Every Turn found that most individuals transitioned
between the ages of 18 and 44
Generally it was found that transgender men transitioned at an
earlier age than transgender women

Hormone Therapy. (2010). Retrieved from (2010).

Retrieved from
http://www.thetaskforce.org/static_html/downloads/repor

Age of Transition. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/rep
orts/reports/ntds_full.pdf

(Grant et al., 2011

Can You Tell?

Injustice at Every Turn posed the
question to survey participants:
Can people tell you are
transgender even if you dont tell
them?
Results found that most
transgender individuals only felt
others could tell they were
transgender sometimes or
occasionally

Visual Non-Conformity. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/
reports/ntds_full.pdf

(Grant et al., 2011

Transgender Youth
Age 2: conscious of physical differences between
boys and girls
Age 3: easily able to label as boy or girl
Age 4-6: stable sense of gender identity
Just a phase
No way to predict what child will identify as when they
grow up
Important for children to feel loved for who they are

Transitions

Transgender Rights. (2015). Retrieved from

http://www.speakingofsuicide.com/2015/01/02/transgender-suicide/

Puberty inhibiting medication

Surgery: 18 years, or older
Can be younger if they have parental permission

(American Academy of Pediatrics, 2015;

Community Values and Beliefs

[Skybluepink-baphomet]:
There is no transgender community, it does not exist as a single
entity. Try to think of it as a large collection of individuals and
also numerous small localised communities of trans people and
associated queers. What beliefs and values you encounter will
vary an awful lot between people. Trans people run the
spectrum of politics, religions, hobbies, professions etc. so by
and large there isn't a homogenous trans community, although
a lot of us know each other at least in passing.

Beliefs
Should transgenderism be included in the DSM V?
Some believe transgenderism should be classified as a mental health diagnosis, others believe it
is demoralizing and should be a medical diagnosis rather than psychiatric
DSM IV: gender identity disorder
Mental health diagnosis

DSM V: gender dysphoria

Identification Beliefs
...Because I am not on hormones, I feel like I have to include transgender with how I identify in
order for people to not mis-gender me. I think that once I am fully transitioned I wont use the
word transgender or trans when I identify myself and I will just say male. I am not ashamed that I
am transgender, I just think that its not the only or most important thing about me.
-Bob

What should insurance companies provide?

I think insurance companies should cover these surgeries, hormones however are cheap and
affordable for individuals and should not necessarily be covered by insurance.
- Michael

Values
Advocating for the transgender community
Living stealthily, some feel they should not have to out themselves or
identify as transgender
Its
funnyand
in my
office,
literally
like talk sh*t about transgender people,
Equality
respect
forpeople
their true
identity
and yeah sometimes I feel bad not like I guess standing up because I mean
thats
Open-communication
in health
care who I am, but at the other time, its nice,
who I am I cant deny
that thats
kinda
If a mistake
is made
apologize!
its
nice, ya
know, regarding
this is the identification,
first place in my
life where people dont know
where I came from dont know how I grew up, so its nice not really having to
deal with that.
- Michael
(Grant et al., 2011; Human Rights Campaign,
2016; National Center for Transgender Equality,

Roles
Differ for every individual
May relate to socially constructed gender roles of the gender(s)
transgender individuals identify, however not always the case
Michael
No role has changed, filled the male role all throughout growing up. Never
conformed to gender roles too much. Played baseball when identified as female,
continued to play baseball until high school
As male, he receives more respect. Customer service...people more urgent to
help at restaurant or store. Easier to get bartenders attention because they
know guys will most likely buy the drinks and thats where theyre going to get
their tip

Discrimination Workplace
26% lost a job due to bias
78% reported at least one form of harassment at work
47% discriminated against in hiring, promotion, or job
retention
16% reported they felt compelled to work in the underground
economy (i.e., sex work, selling drugs)
Transgender individuals of color face higher rates of
discrimination
Only 18 states currently prohibit discrimination based on
gender identity
4x more likely to live in extreme poverty (i.e., less that

Discrimination Workplace
Injustice at Every Turn:
I was a very respected lawyer before all of this, but lost my practice
and clients, and have not been able to attract any new clients or get
referrals or even get a job in my field for the past 8 years. Very
frustrating because I dont feel any less intelligent or less qualified,
but others, both the public and lawyers, perceive me that way.

Promotion Denial. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downlo
ads/reports/reports/ntds_full.pdf

Employment Discrimination. (2010). Retrieved

from
http://www.thetaskforce.org/static_html/download
s/reports/reports/ntds_full.pdf

(Grant et al., 2011

Discrimination Education
59% report harassment or bullying in school at any level
15% left school because the harassment was so bad
23% reported experiencing physical assault at school
8% reported sexually assaulted at school in any level
11% lost or could not get financial aid or scholarships because they
were transgender
Prior to being out at school, I received about $18,000 in financial aid,
several awards, and scholarships. The year that I decided to be out
on my applications, I received one scholarship out of 18 that I applied
for despite having a 4.0 and an excellent application package.
Alarming relationship between mistreatment in school and had to
leave, nearly 48% were currently or formerly homeless

(Grant et al., 2011

Discrimination
Healthcare
19% of transmen and 22% of
transwomen have been refused
treatment
28% reported verbal harassment in a
doctors office, emergency room, or
other medical setting
28% reported postponing medical care
when sick or injured due to
discrimination
Health Care Disparities. (2016). Retrieved from
www.imgur.com

50% reported their medical provider

lacked knowledge in transgender care

(Grant et al., 2011

Discrimination LGBTQ
Community
Transphobia
Some gay men and lesbians denounced those who felt
themselves to be of the opposite sex, criticizing them for acting
like "freaks," bringing disrepute to those gays and lesbians
trying to live quietly within heterosexual society. (Meyerowitz,
2002)
In reference to a man that identified as a transwoman, "As far
as the public knows," Winters wrote, "you were merely another
unhappy homosexual who decided to get drastic about it."

(Weiss, 2004)

Occupational Engagement
Activities of Daily Living
Dressing
Toileting
[deleted]: When I was a kid the bathroom
was a source of anxiety for me, just
stepping into the room filled me with
dread but I've learned to cope with it as an
adult.

Gender-Neutral Bathroom. (2014). Retrieved from

http://chicago.cbslocal.com/2014/07/17/northwesterngetting-two-new-gender-neutral-bathrooms/

[deleted]: If I wasn't comfortable in my

#wejustneedtope
appearance, it wasn't worth the risk of
e
someone freaking out in the bathroom and
causing a huge scene.
We Just Need to Pee. (2009).
Retrieved from;

Occupational
Engagement, Cont.
Activities of Daily Living
Occupational Safety and Health
Administrations take on toileting
Companies have implemented written
policies to ensure all employees have
prompt access to appropriate sanitary
facilities

Sanitation Standard. (n.d.). Retrieved from

https://www.osha.gov/Publications/OSHA3795.pdf

Best policy:
Offer single-occupancy gender-neutral
(unisex) facilities
Use of multiple-occupant, gender-neutral
restroom facilities with lockable single
stalls

(Occupational Safety and Health Administration, 20

Occupational
Engagement, Cont.
Activities of Daily Living
Personal hygiene and grooming
[glasswings]: Actually, that [grooming activities] is a problem.
I went through a long period of not liking being naked. Now,
shaving. Shaving makes me so sad. Not shaving does too.
Sexual activity
[missk11]: Many of my trans friends have a history of
substance abuse, self harm, suicide, and other mental illnesses.
Some do sex work or have done it in the past, either to obtain
income or to help fund surgeries or procedures.

Occupational Engagement,
Cont.
Instrumental Activities of Daily Living
Religious and Spiritual Activities
For some, participation in religious or
spiritual activities is significantly limited
due to the oppression of others.
The acceptance of ones religious/spiritual
community varies significantly depending
on the religion itself, the location of the
community, the values of the community,
and the values of the individual
If someone is gay and searches for the Lord
and has good will, who am I to Judge?
-Pope Francis

Pope Francis. (2015). retrieved from

blog.cleanenergy.org

(Hale,

Occupational
Engagement, Cont.
Instrumental Activities of Daily
Living
Shopping
[deleted]: ..For me, I feel like my
ability to pass has a direct link to my
ability to go out in public. If i feel like I
will be negatively judged by the
population (ie. If I feel like I'm going to
look like a crossdresser), I generally
will be more avoidant to go anywhere
public (to the extent of just skipping
meals so I don't have to go to the

Mistreatment of Retail Stores. (2010). Retrieved from

http://www.thetaskforce.org/static_html/downloads/reports/reports/
ntds_full.pdf

Health Management
[Quirkyqueer]:

The problem I run into most often when I go to the doctors

office is issues with my pronouns...It would be helpful to
have a gender field aside from that with the option to writein gender, and a space to write-in are pronouns.

[thecarolinekid]:
Something that healthcare professionals, particularly
therapists of any kind, should be aware of is the correlation
between autism spectrum disorders and being transgender.

(Grant et al., 2011

Health Management
Injustice at Every Turn
I was forced to have a pelvic
exam by a doctor when I went
in for a sore throat. The doctor
invited others to look at me
while he examined me and
talked to them about my
genitals.
Refusal to Provide Care. (2010). Retrieved from
http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf

(Grant et al.,

#Transhealthfail
Social media provides outlets for transgender individuals
to share their #transhealthfail

Occupational Engagement,
Cont.
Education
Laws that inhibit or allow transgender persons to utilize certain facilities
...My old high school district was just in the news for denying a
transgender student access to the womens locker room. While title 9
helps, there are loopholes that board members are finding to exclude
transgender students
Bob
[deleted]: It also affected my ability to go to classes last year when I
was uncertain of my ability to present confidently...it's just one of those
things where I very strongly do not want to be misjudged or harassed
Injustice at Every Turn:
I have chosen to attend college online to avoid harassment.
I ... have been censured by the faculty for coming out ...I have been
denied classes...One male psychologist verbally attacked me in class
and used transphobic and misogynist language.

Occupational
Engagement, Cont.
Work
For many trans individuals, there is a constant balance between
achieving in the workplace and outing oneself
Some may be concerned that transitioning or coming out as
transgender may affect their career mobility and reputation
According to a survey in 2014, 33% of Fortune 500 companies
now have policies regarding gender identity protection as
compared to the 3% in 2002
If your services are related to your clients work experience, ask
yourself:
Does their gender impact their occupational performance?
Do coworkers, peers, or management need to know the client's
gender in order to accommodate the needs of the client?

(Elejalde-Ruiz, 2016)

Occupational
Engagement,
Cont.
Work
Injustice at Every Turn
The obstacles currently facing trans people in regards to employment
are the most insidious. Without an income, one has absolutely NO
voice, politically, economically or socially. Elimination of employment
discrimination, above all else, is the keystone to fundamental
transgender equality in America.
I was fired from my job after 18 years of loyal employment after a
fellow employee saw me dressed while attending counseling and
reported me to the boss...
When I started my transition, the place that I was working was very
supportive. My boss had a family member who is transgender. I was
treated with respect by everyone. I had worked there for many years
and everyone assumed that I was gay until then and they knew my
partner. I guess they just figured I would still be me. Except for growing
facial hair and going bald, I am the same, only better and more free.

(Grant et al., 2011

Occupational Engagement,
Cont.
Social Participation
Social participation can be difficult as a result of the individuals
fears of being ostracized or as a result of the judgements of others
[deleted]:...When I was a kid I was invited to a birthday party at a
lake and I sat on the dock for about 4 hours straight by myself
watching the other kids have fun because I hated swimming because
of the bathing suit thing...I didn't go swimming for close to 15 years,
I never did things I wanted like...going to school dances or anything
that required gendered clothing, so I missed out on a lot in my life.
[deleted]: A lot of lay people have this impression that transpeople
are bombastic and gregarious, some are I guess, but many have
quite severe social anxiety and general anxiety issues.

Occupational Engagement,
Cont.
Change Desired in the Community by the Community
Protecting transgender/gender non-conforming people from
discrimination in hiring and at work: 70%
Getting transgender-related health care covered by insurance:
64%
Access to transgender-sensitive health care: 43%
Passing anti-bullying laws that make schools safer: 21%
The right of transgender/gender non-conforming people to
parent, including adoption: 14%

(Grant et al., 2011

Changes in Media Over

Time

Women in Revolt. (2015). Retrieved from

http://www.bfi.org.uk/news-opinion/newsbfi/lists/10-great-transgender-films

To Wong Foo. (1995). Retrieved from

http://www.austinchronicle.com/calen
dar/film/1995-09-08/142658/

Buffalo-Bill. (2014). Retrieved from

http://www.bilerico.com/2014/05/stealing_t
he_sisterhood_terf_ideology_in_the_movie.
php

Boys Dont Cry. (2015).

Retrieved from
http://www.bfi.org.uk/newsopinion/news-bfi/lists/10great-transgender-films

Transgender Persons in the

Media

Laverne Cox. (2014). Retrieved

from http://mashable.com/2

Andreja Pejic. (2016). Retrieved from

https://www.yahoo.com/celebrity/news/excl
usive-andreja-pejic-sees-marie205000928.html?ref=gs

Jazz Jennings. (2016). Retrieved from

https://twitter.com/jazzjennings__

Eddie Izzard. (2014). Retrieved from

http://www.interviewmagazine.com/

Competence in Occupational
Therapy
Despite increased awareness of the need for comprehensive, clientcentered care for transgender persons, few health care professionals
feel confident in providing care to the transgender population (Vance,
Halpern-Felsher, & Rosenthal, 2015)
Establishing a well-rounded occupational profile is a key component to
developing a treatment plan that best suits any clients needs
Challenge yourself to seek out continuing education opportunities that
focus on how to provide the highest level of care for marginalized
groups

Local Resources
Advocacy
Gender Justice Nevada
American Civil Liberties Union of Nevad
a

Clothing/Hair/Nails
GC2B (binders)
Switch (clothing swap)

Shelter Support
HELP of Southern Nevada
Gender Justice Nevada

Primary Cary Physicians

Ensign Medical

Family Support
Gender Spectrum
PFLAG Las Vegas

Support Groups
Genderfolk
Rad Remedy

Spiritual
Resurrection Faith Ministries
Northwest Community Church

Youth Resources
Shannon West Homeless Youth Center
Nevada Partnership for Homeless Youth

Take Away Messages

If you have a question (as long as it is relevant), ask
respectfully
The easiest way to show sensitivity towards this population
is to use the individuals preferred pronoun
Gender identity and sexual orientation are separate
concepts
Do not generalize values, beliefs, roles, or experiences
Transitioning is not the experience of only the individual
transitioning but involves the entire social circle

Discussion Question
Transgenderism is often explained in terms of the
gender(s) with which people identify. Therefore, if
gender roles were dismissed, would transgenderism
still exist?

References
American Academy of Pediatrics. (2015). Gender non-conforming & transgender children. Retrieved from
https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Non-Conforming-TransgenderChildren.aspx
Center of Excellence for Transgender Health. (2016). Surgical options. Retrieved from
http://transhealth.ucsf.edu/trans?page=protocol-surgery
DeLine, E. (2014). Show trans: A non-fiction novel. CreateSpace Independent Publishing Company.
Durocher, E., Gibson, B. E., & Rappolt, S. (2013). Occupational justice: A conceptual review. Journal of Occupational
Science, 21(4), 418-430. doi:10.1080/14427591.2013.775692
Elejalde-Ruiz, A. (2016). How companies accommodate transgender employees - and their colleagues. Chicago
Tribune. Retrieved from

http://www.abqjournal.com/708411/biz/careers/how-companies-accommodate-transgender-

employees-and-their-colleagues.html
Grant, J. M., Mottet, L. A., Tanis, J., , Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of

References
Hale, C. J. (2015). The Pope Francis statement that changed the church on LGBT issues. Time. Retrieved from
http://time.com/3975630/pope-

francis-lgbt-issues/

Human Rights Campaign. (2016). Transgender FAQ. Retrieved from http://www.hrc.org/resources/transgender-faq#11

Levitt, H.M., & Ippolito, M.H. (2014) Being transgender: The experience of transgender identity development. Journal
of Homosexuality, 61(12),

1727-1758. doi: 10.1080/00918369.2014.951262

National Center for Transgender Equality. (2015). Non-discrimination laws. Retrieved from
http://www.transequality.org/issues/non- discrimination-laws
Occupational Safety and Health Administration. (2015). Best practices: A guide to restroom access for transgender
workers. (OSHA 3795 - 2015). Retrieved drom https://www.osha.gov/publications: Occupational Safety and Health
Administration
Sears, B., & Mallory, C. (2011). Documented evidence of employment discrimination & its effects on LGBT people.
The Williams Institute, 1-20.
Discrimination-July-20111.pdf

Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/Sears-Mallory-

References
Teich, N. M. (2012). Transgender 101: A simple guide to a complex issue. New York: Columbia University Press.
The Philadelphia Center for Transgender Surgery. (n.d.). Female to male price list. Retrieved from
http://www.thetransgendercenter.com/index.php/femaletomale1/ftm-price-list.html
The Philadelphia Center for Transgender Surgery. (n.d.). Male to female price list. Retrieved from
http://www.thetransgendercenter.com/index.php/maletofemale1/mtf-price-list.html
Vance, S. R., Jr., Halpern-Felsher, B. L., & Rosenthal, S. M. (2015). Health care providers' comfort with and barriers to
care of transgender youth.

Journal of Adolescent Health, 56(2), 251-253. doi: 10.1016/j.jadohealth.2014.11.002

Weiss, J. T. (2004). GL vs. BT: The archaeology of biphobia and transphobia within the US gay and lesbian
community. Journal of

Bisexuality, 3(3-4), 25-55. Retrieved from http://phobos.ramapo.edu/~jweiss/glvsbt.pdf