Megan Milano

December 14, 2009

Women and Media

Professor Dacoilo

“Gender is Between Your Ears, Not Your Legs”

A Look at the Social and Financial aspects of Transgender Healthcare in America
and How the Trans Community is Portrayed on Screen

I come from a small island of people, Staten Island. It is one of the five boroughs of
bustling New York City, yet it is has the same small-town feel of any mid west suburb in the US.
Many people reside there know each other, they know each other‘s families, more importantly;
they know each other‘s business. News travels fast within the communities so if you want to
make a statement or make waves in any fashion, it is not relatively hard to spread the news.
Bottom line; in Staten Island it is easy to stand out. I have always had an interest in the LGBT
community; many of my friends and co workers are either openly gay or lesbian. Most say they
always knew they were ―different.‖ I tend to gravitate towards people who are comfortable with
themselves and are boisterous in nature, because I like to think myself as being the same. My
friends and I are not like the Staten Island norm; we are not avid clubbers with too much self tan
and hair gel as shows such as Jersey Shore* will have you believe. No, we are different but not
in the way that would be noticeable to the average eye.

Back in 2003, two of my closest buddies revealed themselves to be gay to our group of
friends. They are both male, aged 15 at the time. The LGB community in Staten Island is a large
community but a close knit one; if you know one, then by association, you know them all. I met
my first openly Transgender person in 2005, at my high school graduation party. My friend
Mark‘s boyfriend at the time brought his sister Angelina**. A lovely girl indeed, Angelina was
25 at the time and had the prettiest brown eyes I have ever made contact with and long wavy hair
that flowed past her shoulders. Angelina possessed a delicate demeanor that seemed clashing to
her deep vocal tone, and her peep-toe black pumps added four inches to her already six foot
frame. What I noticed most about her was her indifference to her difference. She was truly a
beautiful enigma, and we became fast friends.

It was obvious to see what Angelina was upon first meeting her; but it was the
nonchalance to her presence which was most perplexing. Does she choose to ignore the faint
stubble across her cheeks? I am sure she either forgot or didn‘t have the time to correct that that

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particular morning. Questions such as these plagued me upon meeting her; you certainly did not
see someone like Angelina often in Staten Island, especially one with as much confidence and
charisma as she had. Angelina, Mark and his boyfriend Alejandro would introduce to some of
the most interesting characters I would ever come across. I would come to learn a lot from this
community; they were older by a couple of years and therefore more experienced in love, life
and hardship, all with diverse perspectives. I was granted a glimpse into another world where
*Recently debuted MTV show depicting an embarrassingly bad side of obnoxious young adults from the Tri-state area

** Name has been changed

lessons in love, money and family where not at all typical. I would say having met such
wonderful people in the queer population of S.I. was definitely the pre cursor to my increased
interest in the greater LGBT community, and the basis for this paper.

Having met people like my friend Angelina, I wondered, how would someone else like
her go about completing the journey into the other sex? I could imagine the cosmetic bills alone
as being astronomical (Angelina herself paid a whopping $3,500 for a pair of breasts, but they
are the best I‘ve ever seen!). I wondered besides the aesthetic expenses, what about the rest of
their upkeep; what kind of internal health issues would be addressed differently between a
naturally born male/female and a transgender? Is there a difference? I imagine for people like
Angelina, Hispanic, living transsexual, that her concerns not easily seen on the surface; I assume
her problems would be dissimilar to problems of mine, a heterosexual female; therefore her
ailments are unique to diagnose and require sensitivity to treat. How does the American
Healthcare system aids in such matters when the institutionalized ―binary system‖ works to
exclude the Transgender community? I wonder, in regards to healthcare, what it would be like to
live and be treated as a Transgender…

The background on the term Transgender is one in perpetual flux; it is an ―umbrella

term‖ that‘s constantly expanding to fit a more diverse group of people. A transgender individual
is a person with a gender identity which is inconsistent with his or her biological anatomy.
Researcher Susan Stryker writes on Transgender, that it ―refers to all identities and practices
that cut across, move between, or otherwise queer socially constructed sex gender boundaries.”
(Transgender Rights pg.4) This quotes means that this term includes incredible variation; the
Transgender category embraces a number of sub-groups, including transsexual, transvestite,
cross-dressing and androgynous. Originally, the term transgender was coined in the 1970s by
Virginia Prince; Cisgender (not coined by Prince) is its antonym, meaning a complete connection
and satisfaction with one‘s own gender. Prince was the first to use the term transgender, which
she used to describe a person who lives full time in a gender other than the one assigned at birth
but without body or anatomy modification. Prince was infamous for her disbelief that SRS (sex
reassignment surgery) was a suitable approach for Gender Identity disorder (GID), a disorder
commonly associated with transgender discussion (Transgender Rights pg. 4).
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 The term Transgender is often used as a synonym for transsexual, which incurs many
negative implications as the two terms have many differences. ―Transsexual‖ refers to an
individual who seriously acts on the sense of having a body of the wrong gender, often but not
always culminating in sexual reassignment surgery. ―Transvestites‖ are those who cross-dress
but do not consider themselves to be members of the opposite gender or see SRS as essential to
their well being and personal happiness. ―Transgender‖ refers to people who for various reasons
identify with a gender identity that differs from their original physiological and psychological
condition (i.e., as male or female, man or woman).

Some Trans people take hormones or go through surgeries to feel more comfortable with their
bodies; others do not. Whether someone has had these treatments or not, and whether they desire to, does
not affect their identity as trans. The titles male to female (MTF) and female to male (FTM) are often
used to describe trans people; these terms assert the chosen identity. "Transitioning" to another gender
may involve dressing and living as a different gender, but can be done without surgery ( The
need for … pg 484 ). Some are gay, effeminate males who are FTM, or masculine, lesbian
women who are MTF. It cannot be understated how the term Transgender encompasses many
persons; the term is defined by fluidity. This includes the previously mentioned transvestites and
cross-dressers. I myself rather use the word ―transgender‖ rather than ―transsexual‖ because
gender implies that transition is not purely about biological sex and has a strong social element.
We must not forget the gender is a social construct, not a biological assumption. The rest of this
piece will refer to Trans, FTM/ MTF and SRS as shortened versions.

Intersexuality is frequently associated with Trans discussions; intersexuality is a set of

medical conditions that feature innate abnormalcy of persons reproductive parts. That is, intersex
people are born with "sex chromosomes," external sex organs, or internal reproductive systems
are not considered typical for either male or female. The existence of the intersexual shows that
there are more than two sexes and trying to force everyone to fit into either the male or female
category is socially constructed concept, not biological. Technically, intersex is defined as
"congenital anomaly of the reproductive and sexual system." (TransHealth 2009) Intersex people
are born with external genitalia, internal reproductive organs, and/or endocrine system that are
different from most other people. What makes intersex people different is that it is not an identity
category. While some intersex people do reclaim "intersex" as part of their identity, most regard
it as a medical condition, or just a unique physical state. Most intersex people identify and live as
ordinary men and women, and are gay, lesbian, bisexual, or straight. Intersex conditions are also
known as "disorders of sex development" (DSD) in the medical community (Why …Public
Health? Pg.865). People with intersex conditions have anatomy that is not considered typically
male or female. Most people with intersex conditions come to medical attention because doctors
or parents notice something unusual about their bodies.

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 In contrast, people who are transgender have an internal experience of gender identity
that is different from most people. Many people confuse transgender and transsexual people with
people with intersex conditions because they see two groups of people who would like to choose
their own gender identity and sometimes those choices require hormonal treatments and/or
surgery. These are similarities and the truth is that the vast majority of people with intersex
conditions identify as male or female rather than transgender or transsexual. People who identify
as transgender/transsexual experience problems with their gender identity, Trans and intersex
person should not be thought of as one (Information needs of gay, lesbian…2002). With all this
said, the difference between transgender and transsexual and intersex, it is a common theme
throughout the three groups; a feeling from a very young age that their exterior does not match
their interior.

Transgender also refers to those who are transitioning between two sexes by taking sex
hormones or surgically removing or modifying genitals and reproductive organs. Transgender
people may identify strongly as gay, lesbian, bisexual, or transsexual. They may identify as being
male or female, or they may not identify with any of these. People who identify as transgender or
transsexual are usually people who are born with typical male or female anatomies but feel as
though they‘ve been born into the ―wrong body.‖ Many transgender people claim to be
uncomfortable with their biological sex and entailing assigned gender role and may be diagnosed
with gender identity disorder (GID) as defined by the American Psychiatric Association (APA).
For these people, gender reassignment surgery, hormone therapy, and gender role changing
allows them to feel "right," or "natural." The DSM the standard for mental healthcare
professionals and is regarded as the medical and social definition of mental disorder throughout
North America. GID literally implies a "disordered" gender identity. The terms "gender
dysphoria" and "gender identity disorder" are used in the medical community to explain these
tendencies as a psychological condition and the reaction to its social consequences. Strictly
speaking, gender dysphoria and gender identity disorder are considered to be mental illnesses
according to the DSM (TransHealth 2009).

The question remains though, why is it so important to present viable topics for the
LGBT community in Public health? What makes their concerns a distinctive from any other
concerns? The American Journal of Public Health debuted its first volume dedicated to LGBT
health topics in June 2001. The article detailed the LGBT community as being so diverse both
culturally and economically, that it is impossible to properly give attention to every facet of the
community ( pg 859) Unlike other public health concerns, this group is not characterized by race
or religious creed, it include all races and all beliefs, and social classes, either gay straight or
lesbian. The only common ground this diverse group has is shared feeling so discrimination and
rejection. The LGBT community is at increased risk for unique exposures regarding sexual
health and practices (i.e. unprotected anal intercourse). The Trans community (in regards to the
greater LGBT) includes many in disguisable personalities. Prejudices felt by both groups about

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same-sex orientation or gender roles can lead to alienation of public health involvement and
prevention programs that fail to respect the needs of the vast LBG and Trans community
(Guidelines for Transgender Care 2009).

Like any other definable group, transgender people have particular health disparities as
compared to the overall population. It is important to understand these disparities, but not to
assume that all transgender people have the same risks. Transgender people are believed to be
victims of violence more often than others. Suicidal tendencies are increased in transgender
people, and may be up to 64% Significant substance abuse is also noted in transgender people,
and current treatment programs are thought to lack the needed cultural sensitivity to effectively
help this population. Lack of health insurance or health care coverage is a problem for many
transgender people. There are high rates of unemployment and poverty in this population, partly
because of the difficulty navigating the working world as a gender-nonconforming person (HIV
Prevention and Health…1997).Trans persons are also at risk for health factors that are not
exclusionary to the rest of the population; problem that are not directly relates to sexual
orientation or gender identity such a alcoholism, obesity, drug use. All the aforementioned are
not unique to the LGBT but have a higher prevalence and requires special approached and
understanding from medical professionals.

Unlike most minority groups, Trans individuals are not instantly recognizable by physical
features as any other sub group would be. This is the case with health care providers; most of
which will tend to have no idea of their patient‘s sexual orientation. This is so for many reasons.
First off there is a fear of stigmatization that prevents many from identifying themselves as
lesbian, gay, bisexual, or transgender; especially to their doctor. Some doctors might not even
ask the patients sexual orientation or wrongly assume that they are heterosexual. General
healthcare for transgender patients is much the same as it is for others. However, there are certain
guidelines that may be helpful to physicians as they approach primary care for transgender
patients. One important rule is to remember that medical care should focus on the body parts a
person has, whether those are matching with the gender identity or not. For example, an acting
male may still have a cervix, in which case he should be followed with PAP smears. An FTM
who most likely still has a prostate, in which case she should be screened for prostate cancer at
the appropriate age.

This combines to formulate the assumption that Trans people face more health care risks
then the average (heterosexual) person. It is mainly due to lack of knowledge of the patient's
sexual orientation and ignorance of specific health care issues that I feel this way. These are the
assumptions that I would like to prove true in my paper. Researching the topic further would
prove so as I only came to find a limited amount of sources is available on health care risks
within the lesbian, gay, bisexual, OR transgender community. Most studies do not address sexual
orientation, at least none that I have seen. In addition, many do not seek health care at all (and
are therefore excluded from health studies) because of possible prior negative experience.

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 There are many risks related to the mal treatment or lack of proper treatment to
transgender, all of which are attributed to both nature and nature. Most of us have used alcohol
or drugs as a coping mechanism at one point or another. Sometimes life is painful, drugs and
alcohol provides a short-term solution; but, there can be long-term costs. Alcoholism and long-
term drinking increase risks for pancreatitis, hepatitis and fibrosis. . Medical risks associated
with shared needles for intravenous drug use as well as hormones. Trans people do not usually
have the cash to buy the hormones and without health care coverage to pay for hormones, or the
needles, or the place to properly store them. That leads to needle and disease sharing. Many
transgender persons resort to sex work for a living, the high pay helps for purchase of hormones
too. The lack of applicable sexual health information can lead to higher risk behaviors, resulting
in higher cases of HIV and Hepatitis. Very few doctors in North America have experience
treating Trans patients at all, never mind those who are HIV positive. They might not be certain
about how anti-retroviral meds will interact in conjunction with a trans-woman‘s anti-androgens
and estrogen pills, or how that large cocktail combination will impact on her liver when she
already has Hepatitis A, B or C (American …Public Health pg. 856).

Many Trans people, especially teenagers, do not receive support at home and seek refuge
in the streets. Trans people do not end up shelters because they're refused access to those
gendered oriented facilities. Shelters and hostels are normally divided up into women's floors,
men's rooms, women's hours, etc. Trans people who are on the streets haven't generally had the
cash to get the surgical procedures which will allow them to change their legal ID. This can leave
many Trans people with no other options but to stay on the streets, leaving them at risk for a
whole laundry list of diseases. Foot problems, ringworm, nail infections, frostbite are just a
sample of what can occur to the homeless population regardless of gender status. Just imagine
how much more difficult it would be having the binary system work against in this scenario too.
Having no money for transportation, and leg ulcers are frequent problems since homeless and
street-involved people tend to walk everywhere (American …Public Health pg. 916).

The signs and symptoms of gender identity disorder differ somewhat in children and
adults. Children may: the desire to be the opposite sex, have disgust with their own
genitals, believe that they will grow up to become the opposite sex, show a strong preference for
playmates of the opposite sex, and want to play the stereotypical games of the opposite sex. As
adult the clues are similar; one may openly dress like the opposite sex (transsexual/cross gender)
show signs much like those of depression, low self esteem and isolation.

There are no concrete ways to diagnose GID. Typically, a physical exam should be done
to see if the person has any other any other condition that could be causing a sex identity
problem, i.e. hermaphrodite. The diagnosis of gender identity disorder is made only if the person
is distressed or has problems in social, interpersonal, or occupational functioning. Unfortunately,
many mental healthcare providers know little about transgender life, and persons seeking help
from these professionals often end up educating the professional rather than receiving help.
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Among those therapists, psychologists, etc. who do know about transgender issues, many believe
that transitioning from one sex to another "the standard transsexual model" is the best or only
solution. This usually works well for those who are transsexual, but often far less well for those
cross-gender people who do not identify as plainly male or female. Transvestic Fetishism (TF
people who gain erotic pleasure from dressing as the opposite sex) is another DSM diagnostic
category that labels cross-dressing by heterosexual males that fetishize female clothing.

Thirty-six years after the APA voted to delete homosexuality as a mental disorder
(Transgender Health: Findings…) the diagnostic categories of "gender identity disorder" and
transvestic fetishism (Deletion or reform of the TF diagnosis is also the focus of GID Reform
Advocates) in the Diagnostic and Statistical Manual of Mental Disorders continue to raise
questions of consistency, validity, and equality. Advocates insist the diagnosis reinforces
detrimental stereotypes whilst failing to legitimize the medical necessity of SRS whose Trans
men and women so desperately need. The result is that a larger amount of people who are
submitted by the medical community as ―diagnosis of psychosexual disorder,‖ risk disastrous
effects of stigma and loss of civil liberties.

Present day there is an increasing desire among GID advocates to limit the influence of
the GID diagnosis. It is integral to these arguments to specify that GID reform is not a question
of fewer stigmas versus improved SRS access; it is a question of less stigma and improved SRS
access. The question of the validity of the GID diagnosis is a topic worth a paper to itself. At the
moment, transgender people often receive medical care under the diagnosis of Gender Identity Disorder
in the DSM. Many people, such as the GID Reform Advocates believe that transgender identity is not a
mental disorder and should be a medical, rather than psychiatric, diagnosis. Most people recognize that
even if transgender identity is a medical issue, the social stigma associated with the identity can create a
difficult situation for those with transgender feelings.

GID diagnosis is integral when the patient requests SRS. Some transgender people decide to
have surgery so that their bodies fully match their identities, while others do not desire or cannot afford
surgery. Procedures range from altering secondary sex characteristics as well as their reproductive organs.
Surgeries for FTM persons may include a hysterectomy (removal of the uterus), ring metoidioplasty
(rearrangement of the urethra so that standing urination is possible through a small phallus), testicular
implants, and phalloplasty (creation of a penis from skin on another part of the body, such as the
forearm).Surgeries for MTF persons may include breast augmentation, genital surgery (creation of a
vagina, labia and clitoris), and tracheal shave (reduction of the thyroid cartilage to minimize the ―adam‘s
apple‖). Trans persons may want all or none of these surgeries and may still identity as Trans person, as
mentioned by harry Benjamin. Benjamin was a famous German endocrinologist mostly known for
his clinical work with transsexualism. HE founded the Harry Benjamin International Gender
Dysphoria Association, Inc. (HBIGDA) and help establish a clear real-life test, though it is usually on
referenced and not often used (Transsexualism and Transvestitism … pg223).

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 There is surprisingly little empirical evidence that a one year real-life experience-- or indeed that
any real-life experience-- is either a necessary or a sufficient condition for achieving favorable outcomes
after SRS. I recognize the necessity of a trial period. The reasons given for the real-life test are to allow
you to overcome awkwardness and to establish new gender-specific behavior patterns. Then the moment
will have arrived for surgery to confirm the changes which you have so well prepared. A review of the
literature on post-operative regret suggests that incidence of such regret are relatively low; around 1-1.5%
of post-operative transsexuals show signs of emotional remorse (Transsexualism and Transvestitism …
pg229). There is, however, a necessity to research whether either of these significantly benefits clients
seeking hormones and SRS. I feel that that is lacking in the subject.

Members of the Trans community who wish to transition must figure out how they feel
about submitting themselves to the medical community as ―disordered,‖ against those that feel
being diagnosed it overall beneficial to the gender- altering process. Acclaimed Transgender and
feminist write Judith Butler discussed the above double bind in her book ―Undoing Gender.‖
Butler speaks on the positives and negative of diagnosing people with GID. Butler describes GID
as both a curse and a blessing as society encloses gender in norms dictated by conventional
traditions, the ―male‖ and ―female‖ binary. The diagnosis is necessary to increase the chances of
better treatment. Is it worth social stigma to be able to attain an economical feasible way to
transition? Butler depict that you may very well welcome the diagnosis and sees it as enabling
themselves to financial help and entitlement, and that in itself is a means of sovereignty.
Furthermore, Trans and GID advocators are extremely divisive on the subject of SRS. This is
due to fear of loss of health care for sex reassignment surgery if it were to be changed. Both
parties have long been polarized by fear that access to SRS (and the health insurance to cover it)
would be lost if the GID classification were revised or omitted. From my research I found that
this division over issues of psychological stigma versus access to SRS has greatly hindered
progress on GID reform the past two decades. In truth, however, trans individuals are poorly
served by a diagnosis that both stigmatizes them unconditionally as mentally deficient and
undermines the legitimacy of sex reassignment procedures that have been easily dismissed as
"elective" and "cosmetic" by insurers, governments and employers. As we can see below, access
to information on SRS is one of many priority to the Trans community (credit:Transheath.com).

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 It was only 36 years and still to this day, to be diagnosed with GID it to be stigmatized as
in need of correction, incomplete. It was not that long ago. The diagnosis can also be seen as a
predictor of sexual orientation, though Butler laments that this shouldn‘t be thought as so. The
patient must submit themselves to labels and engage in levels of normalcy, (what is normal, what
about you aren‘t normal) and pass the ―GID test.‖ I GID test in quotes because there is no clear
cut way to determine one has GID. There are guidelines stipulated by by Harry Benjamin and the
Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA). Typically, it is a process
of doctor visits, medical recommendations and therapist referrals to make your insurance
company believe that SRS is necessary. With this GID diagnosis, it is understood that the patient
is ―disordered,‖ therefore we (as a society) are continuing to pathologises a disorder that (Butler)
believes isn‘t a disorder at all (Butler pg.76).

Most rely on healthcare insurance to pick up the cost of this essential surgery. Due to the
way that most health insurance contracts are written, transgender people can be denied health
insurance coverage, often irrespective of whether those needs are related to transitioning. Not all
transgender people have the same medical needs — some may request financial assistance for
surgery, some may only need for therapist/psychiatric coverage. Most transgender people who
apply for private health insurance on their own (not through a group plan with their work or
school) have been denied coverage if the insurance company is aware of their transgender status.
Without health insurance, many transgender people have no access to health care. Transgender
people, who develop health problems such as the flu, pneumonia, broken bones et cetera, have
nowhere to turn unless they pay for the services themselves. Health care in the United States is
extremely expensive. For instance, I went for a checkup with my PCP recently. The visit cost me
a $25 co pay due to my insurance through work. Without it, the visit would be a cool $ 255. I
was shocked when the nurse told me that. How could a part time working college student afford
that? More importantly, how could a jobless, homeless transgender teen afford it wither? It
should be illegal to deny health insurance coverage to transgender people, solely because they

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are transgender. Some would say an even better solution for this problem would be universal
health insurance coverage; comparable to the one President Obama is currently pushing.

Regardless the level of medical help requested there are many ways in which
institutionalized discrimination in health insurance may occur. Examples of such discrimination
generally take one of the following forms: Denial of health insurance coverage, where someone
is denied any health insurance on the basis of gender identity. The Transgender Law Center
online has documented cases in which health insurance companies and medical providers have
denied coverage to transgender people when they became aware of an applicant's transgender
status or prior treatment and medical history related to gender transition. Denial of coverage for
claims related to gender transition, including claims arising from complications from medical
treatment for gender transition; denial of coverage for claims for gender-specific care based on
the person's gender marker on insurance. We see examples of this in cases such as a MTF person
who develops prostate cancer, or a female-to-male person who develops ovarian cancer.

Health care plans themselves may include language that diminishes help for Trans
persons that are insured, but do not have their needs covered. Transgender people who have
managed to acquire health insurance cannot get coverage for any services that are related to
being transsexual or transgender. The vast majority of commercial health insurance plans in the
United States exclude all or most coverage for treatment related to gender transition. This Trans
denial of health coverage includes claims for treatments such as psychological counseling for
initial diagnosis and ongoing transition assistance, hormone replacement therapy, doctor's office
visits to monitor hormone replacement therapy and surgeries related to sex reassignment. Their
language may be direct as in ―Those for or related to sex change surgery or to any treatment of
gender identity disorders" (Transgender Law and Policy Institute). Sometimes the exclusionary
language is broad enough to deny coverage to a transgender person for treatments unrelated to
transitioning; this language is generally referred to as the ―transgender exclusion.‖ There is also
rampant denial of coverage for claims unrelated to gender transition. For example, an insurer
argues that a medical concern is the direct or indirect result of transgender-related treatment such
as hormone therapy. Even those transgender people who do have health insurance will most
likely have to pay for their hormones, therapy, and surgery. For the Trans members of society
that wish to embark on the journey of transitioning, SRS is the best way to go to completeness.

Let‘s play with some numbers. Hormones are $100 per month. Therapy is $75-$100 per
session. Surgeries can run $7000- $50,000; According to the graphs below from
Transhealth.com, roughly 16% can afford these costs. Most (32%) only have a little college to
their credit. The lack of proper health care coverage results in many transgender‘s to go without
medically necessary treatments because they simply cannot afford them. This can result in stress,
depression, suicide attempts, and poor work performance. To avoid costs, some transgender
people will resort to the black market to get their hormones. Some hate the bodies biologically

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given to them that they may even attempt doing the surgery themselves, (cutting off their
genitalia) – resulting in fatal consequences.

Let‘s say for the sake of the argument, you are a transgender person who managed to get
decent medical coverage despite all the liabilities previously mentioned above; you got passed
the ―transgender exclusionary‖ language, now you must overcome the institutionalized ―binary‖
system. The medical community recognizes the existence of males and females- that‘s about it.
This creates problems for many transgender people whose bodies do not fit the standard
male/female model. For instance, health insurance companies require that everyone identify
themselves as either male or female; problems ensue dealing with the paper work alone.

While some providers have come to an understanding in the last several years that not all
transgender people are alike; the vast majority still only recognize the existence of males and
females. For instance, many doctors (as well as insurance companies) before prescribing
hormones, will require that the transgender person identify as 100% male or female, going
against their nature (Guidelines for Transgender Care) This is another instance of the dreaded
―binary system‖ dilemma. This creates problems for many transgender people whose bodies do
not fit the traditional male/female mold. There are many FTMs who take testosterone but have
not had a hysterectomy, and therefore have secondary male characteristics as well as uteruses. If
a transgender man checks the ‗male‘ box on his insurance form, he may be able to get his
testosterone treatment covered, as hypo-gonadism (when the testes do not produce enough
testosterone) is a recognized disorder for men who are not transgender. But, if he checks the
‗male‘ box, he cannot get coverage for any gynecological care. This creates many problems.
Private health insurance companies will not pay for services that they understand stand only to
be necessary for ―females‖ if they are already paying for services that they understand are only
necessary for ―males‖, or vice versa One FTM checked the ‗male‘ box and later developed breast
cancer in one of her breasts. His insurance policy would not pay for a double mastectomy
because there was only cancer in one breast, and they viewed that‘s paying for both would be
allowing a cosmetic or gender stipulated surgery. Basically, the patient who was battling cancer
has to either fork over the money for the other breast to be removed, or pray to God to get cancer

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in the other breast; A atrocious thought to have to consider. (Butler, pg84). Many transgender
people who have insurance cannot get all their health care needs met and have to choose whether
or not they want to have coverage for the female aspects of their bodies or the male aspects of
their bodies. This is especially true for MTF‘s who do not receive prostate cancer screenings and
FTM‘s who do not receive gynecological care.

We know now the incredible costs of transitioning and living life as a transgender, but
what about the social aspects; how do health care professionals treat the sensitive subject of
treating a Transgender? Too often Trans persons experience discrimination from their health care
providers due to the professionals having little to no understanding of the medical effects or risks
of transgender related treatments. Therefore many transgender people are not fully informed
about the medical decisions they are making for themselves. In order to avoid this type of
institutional discrimination, many transgender people stop going to the doctor altogether. Others
decide not to inform their health care provider of their transgender status. These are options that
many Trans person cannot afford to take lightly. It would greatly enhance patient to doctor
relationship if professional were educated while still medical students (while they are still in
training) therefore they are already familiar with how to address the sometimes awkward
situation. Even those who are already practicing, health care providers should have information
given to them by their employer about transgender sensitivity and appropriate protocols of
treatment for transgender people.

Health care providers and insurance companies have often refused to treat transgender
people, solely because they are transgender. For instance, Robert Eads, a female to male trans
person who developed ovarian cancer, was denied treatment by over twenty doctors who did not
approve of him and his trans body. He eventually died, untreated. Transgender people have also
died because emergency response teams have stopped treatment when they realized that the
person they were treating did not have the genitals that they expected or have entirely refused
treatment because of the gender androgyny of their patient. Providers also often do not treat
transgender people respectfully or appropriately. The Transgender Law Center has taken many
complaints from transgender people who have been harassed and mistreated by medical
providers. Ill informed providers will tell their patients that they find them disgusting or
inappropriately insist on seeing their patients‘ genitals. Providers will not ask medically
necessary questions or will tell their patients that they deserve the illness that they are
experiencing.

People (unless you live in one of the major cites) do not encounter on a regular basis a
person of a Trans lifestyle. The media is the only outlet for people (for example) in Omaha and
Ohio can ever see a transgender human being. The media‘s role in how American sees this
relatively unknown population is crucial. So how do the American media partake in the portrayal
of transgender life? This is relatively young topic (roughly 36 plus years in America) and has
had minor coverage in American media, some of which does not tend to convey a positive view.
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Many themes are represented of illness, rejections and shame; which are all quite often
incorporated regularly in a life faced with adversity. Let‘s take a look at some examples of how
directors and screenwriters took a jab at how the other half lives. Two films that I saw recently
really captured the real severity of a Trans person life. They are actually two of the few that ever
document the lives of transgender. Paris Is Burning – a documentary representing poor, black
and Hispanic, gay male and transsexual ball walkers – and Boys Don’t Cry – the story of a
young, white female-to-male transsexual named Brandon Teena. Both are base o real life, the
former a documentary and the latter a re- creations. These films are notable for the way in which
they give their otherwise marginalized subjects a voice to express their anxieties, values, and
struggles. Both of these films raise the Trans awareness to the viewer, as they give the audience
opportunities to identify with people whose race, sexuality, and gender are very different from
their own.

Paris is Burning depicts the ball culture of 1980‘s Harlem, an otherwise invisible sub
culture to the white masses. Director Jennie Livingston (a white woman) puts the viewer in the
cross-dressing hot seat; one many Americans have not been in before. To a degree, we become
entrenched by the grandiosity of the characters such as Venus Xtravaganza, the teenaged
transsexual who longed to be a ―spoiled white rich girl.‖ It is the interviewees of Paris are
portrayed as wanting the white, rich dream; while giving minimal attention to their hopelessly
eminent poverty. Also the movie only mentions the prevalence of AIDS within the community
(even it has killed a number of the interviewees since the documentary debuted), or the
oppression that drives them to have the balls in the first place.

Boys Don’t Cry that the film deliberately opens up multiple sites of potential
identification for the audience: the transsexual Brandon, whom women adore as ―the best
boyfriend they ever had,‖ is both a woman playing a man‘s role and an idealized heterosexual
man; Lana is a heterosexual woman whose desire transcends gender; John is a heterosexual man
who identifies with and mentors Brandon, then violently repudiates that identification lest he
recognize himself in Brandon‘s female body. The audience gets to see the main character as a
woman named Brandon who s truly a female lesbian, is just a lesbian who happens to put a sock
in her pants. The shower scene is a typical one for film, lingering on Brandon‘s hairless legs and
curves; when John and Tom forcibly remove Brandon‘s pants, the camera responds with an
unusually long zoom-in shot on his female genitalia.

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 As they demonstrate the fluidity of gender, these films open up opportunities for audience
members to question and explore the potential deeper understanding of gender in their own lives.
Nothing about this movie is mainstream. Gender, the film implies, is ultimately about the body,
not about social roles; those who tries to hide their true body makes will inevitably have their
―true‖ selves forcibly revealed. The movie plays on social roles even in the toughest of scenes.
Even in the midst of Brandon‘s rape, however, there is ambiguity in their treatment of Brandon
afterward calling him ―little buddy‖ as they simultaneously threaten to kill him if he tells anyone.
The movie conveys the notion of ―rape‖ as much a punishment handed down for the façade of
Brandan Teena. Brandon‘s masculine status is affirmed by the fact that even his rapists continue
to somewhat identify him as male. Confusing to say the least; it would be thoughtless to not
mention the increasing emphasis on Brandon‘s female body as the film approaches its height, the
changing nature of his romance with Lana, sends the message that Brandon is not just a girl in
men‘s clothing, but a woman and a lesbian; also the mentioning of Brendan period and the
problem it ensues as an active male buying tampon (he eventually steals them as opposed to
buying them). Throughout the film though his breasts are bound by athletic cloth, his pants
stuffed and his hair cut short. As he successfully passes amongst his new friends, these examples
in the movie helps indicate the many roles a Trans person can have.

These characters Brandon and the ball walkers are normally disparaged by society. In
situations where straight men sexually proposition transgender women, the reality of the
situation when the man realizes that the woman really isn’t, physical danger may very well
ensue. For transgender women, the possibility of date rape carries the added risk of attempted
murder, as the example of Venus Xtravaganza in Paris is burning demonstrates. Studies show
that 27% of participants were victims of violence. 60% have experience some form of physical
harassment (HIV Prevention and Health…1997). Violence against transgender individuals is a
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serious concern in the GLBT community. Even those who are accepting towards transgender
individuals who are to transition, they often display a curious fascination about the status of their
friend‘s sex organs. A common complaint among my transgender friends is that, when first
telling a new friend about their transgender status, the first question they‘re asked is inevitably
what they have ―down there.‖ Much too popular disbelief, gender is socially constructed. The
success that many transgender individuals have lies in passing as the opposite gender. Upon
finding out your gender is not what it seem, it may invoke a whole spectrums of reactions. As we
see in Boys don’t cry where there are horrible consequences to learning the truth of Brandon.
Gender transgression is believes to justify violations in social norms, whether this is displayed
itself in an inappropriate question about the body or a vicious attack on an individual who refuses
to fit into normal societal gender standards.

Paris Is Burning and Boys Don’t Cry present a rare glimpse into the challenges of
our (too often) invisible counterparts. As we see above, the real Brandon Teen(r.) next to the left.
These films give their marginalized real-life personalities a voice; Brandon Teena, the ball
walkers, and others like them. They were on the front lines of a gender revolution, and in their
own way, their lives and deaths represented on the screen to bring their struggle closer to the
mainstream. These movies have certainly opened my eyes.

I was lucky to be researching this topic in a time where this typically invisible sub group
has finally had a face. Originally born Chastity Bono, 40, was born into pop royalty as his
parents are famed super stars of the 70‘s, Sonny and Cher. He is an author, musician and LGBT
advocate. The title to my paper was taken from an interview of a mid- transitioned Chaz on Good
Morning America, he lamented ―Gender is not between your legs, but between your ears.‖ It was
a perfect display of gender as a social ideology; and a wonderful title for my paper (CNN,2009).

While still in her original female form, Chaz had dabbled in his sexuality by coming out
as a lesbian in 1995. It was not until early 2009 that he decided to go public with his desire to
transition to the opposite sex, FTM. Before Chaz Bono, American media had only discouraging
or scandalous characters to associate with Transgender, such as Boys and Paris. Chaz Bono put a
new spin on things; he was not trying to be something he wasn‘t; all his life she was trying to
cope with being something he never felt was right for him. He was done with faking, casting
away the female facade. Chaz started his process of transitioning in 2009 and is expected to be

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complete, (SRS included) by 2010. It is Chaz‘s hopes that his broadcasting of his gender development
will bring attention to LGBT causes and help change the world‘s view of the LGBT community. People
will undoubtedly give kudos for the dual courageous decision to first transition, but to also to make it
public.

While some news outlets have respectfully referred to him by his preferred name and gender,
others still imply that his transition (use of male pronouns) is irrational and unnatural and they
tend to focus on when, how and whether or not Chaz will have surgery. Mara Keisling,
executive director of the Washington-based National Center for Transgender Equality lament in
an CNN interview that the medias illegitimate focus on Chaz‘s medical/anatomical status as
backward and misplaced. "The whole media fixation on surgery is kind of misplaced," she said.
"Almost no transgender people ever have surgery. We don't have any idea how many
do."(CNN,2009)

It seems thus far that the Medias job in handling a new news topic has been subpar, and
sensationalist. The mainstream media has failed to display the contrasting individual story of
someone transitioning who does not have access to the resources that someone of Chaz‘s
financial status may have. As we know, people who transition experience family rejection and
social stigma that makes education and employment very difficult for many of them; an issue
exacerbated when you do not have the luxury of a publicist to remind people what pronoun to
use when describing them. The media also neglects to present trans persons who experience
rejection from their families, those persons are more likely to have mental health problems later
in life, while those who experience acceptance have much better outcomes. Most are focused on
survival, not getting beat up when trying to use a public restroom or harassed in other communal
venues.

Whether the media realizes it or not, they have a big responsibility to delegate this news
story to the masses. Instead of focusing on one person‘s experience, the media should be
attentive to the larger needs of transgender people. Reporters assigned will have the tricky task of
being confronted with an issue they (most likely) have no experience with or little background
on; the media has not had an outspoken persona such as Chaz Bono making a public display of
their gender trials and tribulations before. How they react and document the following events
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will greatly help or hinder the rest to the country‘s‘ view on Transgender and transitioning. We
will have to keep a close eye to reports in the ensuing months.

In closing, it is pertinent to the Trans healthcare argument to lament the necessary

understanding needed by medical professionals to establish that ―difference‖ is not a ―disease.‖
Butler mentions in chapter four Undoing Gender, ―Insurance companies demean the notion of
liberty when they distinguish between mastectomies that are medically necessitated and those
that constitute elective surgery‖ (pg 85). Why should Trans person have to choose? You may
wonder. It is simple, when providers are not fully informed of their patient‘s medical situations,
accurate diagnosis and treatment can be compromised. In addition, if a transgender person has
complications due to their hormone treatment, providers may not recognize these systems or
misdiagnosis them. With all the higher risk health concerns, a Trans person simply cannot afford
nor play with lack of honesty in the doctors room. Insurance companies should recognize that
there exists great diversity in bodies; that insurance companies cover every person absolutely and
not require people to check ‗male‘ or ‗female‘ boxes.

As we now know, insensitivity of health care workers is one of the main reasons for lack of
treatment; instanced in which so called ―professionals‖ refuse to acknowledge the person preferred
pronouns (i.e. Referring to a transgender man as ―she‖) is a disrespect for the person‘s identity and
agency. This outright lack of empathy can be directly correlated to whether or not that Trans person will
continue to seek care.

There are a number of relatively simple things that can be done in an office to make transgender
patients more comfortable. Gender neutral bathrooms are an easy step that can really have a positive
effect. On patient intake forms, leaving a blank space after the question on gender or offering a
―transgender‖ option indicates to patients that their physician is conscious of their existence. Silence is the
worst form of ignorance because it does not deny nor allow acceptance to a Trans person, it simply does
not acknowledge it. Using gender neutral language (such as ―partner‖) when asking about a patient‘s
sexual or relationship history allows individuals to be more open about their lives.

In the present age, we are lucky to be at a time when congress is currently working on
reform health care; in a way that helps all Americans and addresses the needs of its specific
minorities, including LGBT Americans. Legislators can easily build on this by explicitly
defining health disparities to include disparities faced by LGBT communities and including
LGBT cultural competency training among the forms of competency that receive funding. For
congress to specifically including LGBT Americans in health reform shows that their
communities and identities are an important part of American society. LGBT is getting their
voice heard and concerned paid attention you.

It is true that it is hard to enumerate the American Trans masses and this is due to many
individual obstacles such as a person‘s reluctant to admit there Trans status. Federal health
surveys should be instructed to include LGBT identities in their demographic information as

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 means of helping expunge the issue of underreporting. Since a person‘s privacy is always at
stake, protections on such information should be enacted or made stricter; especially in cases
involving the LGBT.

It would be remiss to not mention that the change you want to see in this world starts with
you. What you as an individual can do many things to help spread acceptance and understanding.
Advocate for increased/ better access to health care, both private and public coverage. Help compile more
cohesive input from members of the Trans community; increase awareness in options and education.
Promote Trans- related groups/projects that work and research better heath care practices. Support
initiatives that work to maximize awareness on Trans issues‘ physical and psychological recourses. You
can do more concentrated outreach to Trans youth and people of color. Include and cover more
medical articles on HRT and long-term health risks of Trans people; on the mental and social
aspects of transition. It cannot be understated the notion of ―uniqueness is not an illness.‖ it is
best described my Butler in the closing of her chapter Undiagnosing Gender. After all this
research, we realize that there Trans life is a double bind. Accessing healthcare as a transgender
is not at all as easy as it is for someone like me, a young white heterosexual female. Butler
dwells on the notion that I, a hereto woman wanted a breast augmentation; I do not need a slew
of medical referrals saying so. Why should they?

One word, Transgender; it is amazing to think such a flowing term can have such
restrictive rules in terms of accessing healthcare. It does not seem to me that the real test of GID
does not happen on the offices of medical professional, or even on the streets or the room of
children who in secret wear their mommy or daddy‘s clothing. The real GID test lies in you. The
test is not whether you can successfully adapt to the gender norms of the opposite sex, but rather
if you can conform to the cultural conventions our society dictates. It is whether or not you can
comply with the psychological discourse stipulated in the DSM and the doctors that reference it.
Conforming to the language of that will allow you to be the sex will be your biggest obstacle,
unfortunately, it is one of many.

Works Cited

American Public Health Association policy statement 9933:

the need for acknowledging transgendered individuals within
research and clinical practice. Am J Public Health. 200: 90:483-484

BBBoehmer, U. (2002). Twenty Years of Public Health Research:

Inclusion of Lesbian, Gay, Bisexual, and Transgender Populations.
American Journal of Public health, 92 (7), pp. 1125-1130.

Benjamin H. Transsexualism and Tranvestiism as psychosomatic

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 somato-pyschic syndromes. Am J Psychother. 1954: 219-230
ButButler, J. (2004). Undoing Gender. Abington, Oxfordshire, Great
Britain: Routledge.

Cle Clemens-Noelle, K.. (2001, Jan. 3 ). In HIV prevalence, risk

behaviors, health care use, and mental health status of transgender
persons: implications for public health intervention. (chap. Vol 91,
Issue 6 915-921, American Journal of Public Health) Retrieved Oct.
7, 2009, from http://www.ajph.org/cgi/reprint/91/6/915
D
Currah, Paisley. Transgender Rights. University of Minnesota, 2006

Dean, L. (2000). Lesbian, Gay, Bisexual, and Transgender Health:

Findings and Concerns. Journal of the Gay and Lesbian Medical
Association, 4 (3), pp. 102-151.
FiF
Fikar, C. R. (2004, Jan. 4 ). In Information needs of gay, lesbian,
bisexual, and transgendered health care professionals: results of an
Internet survey. (chap. 92(1): 56â€―65. Journal of the Medical Library
Association) Retrieved Sep. 31, 2009, from
5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC314103/

GolGolddberg, J. M. (2006). Guidelines for Transgender Care. (Walter .

Bockting, Ed.). Binghamton, New York: Haworth Medical Press.

HIV prevention and Health Service Needs of the Transgender

Community in San Francisco: Results from Eleven Focus Groups.
San Francisco Dept. of Public Health, AIDS Office: 1997.

Israel GE, Tarver DE II. Transgender Care: Recommended

Guidelines, Practical information and Personal accounts.
Philadelphia, PA. Te,ple University Press; 1997.

Ke
Ke Kinnagy, G, and . (2005). Transgender Health: Findings from Two
Needs Assessment Studies in Philadelphia.. Journal of Health and
Social Work, 30

Lee, R. (2000, Jun. 5 ). In Health care problems of lesbian, gay,

bisexual, and transgender patients. (chap. 172(6): 403â€―408.
PubMed Central) Retrieved Oct. 5, 2009, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070935/

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M Meyer, PhD, I. H. (2001, Jun. 2 ). In Why Lesbian, Gay, Bisexual and
Transgender Public Health?. (chap. Vol. 91, No. 6American Journal
of Public Health) Retrieved Sep. 6, 2009, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446455/pdf/1139292
.pdf

Transgender Law and Policy Institute, ―Non-Discrimination Laws that

include gender identity and expression.”
http://www.transgenderlaw.org/ndlaws/index.htm

“Sonny and Cher’s Child Transitioning from female to Male.‖ CNN/entertainment (2009, Dec. 7)
http://www.cnn.com/2009/SHOWBIZ/06/11/ent.chastity.bono/index.html?iref=newssearch
Graphs: Transhealth.com; “The online magazine of health and fitness
for transsexual and transgendered people.‖ http://www.trans-health.com/displayarticle.php?aid=43

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