Sex and gender diversity

Sex, Gender & Sexuality

I am a member of the Australian Professional Association for Transgender Health (AusPATH) and the World Professional Association for Transgender Health (WPATH).

My Approach to Therapy

transIntersex and Transgender persons are distinct groups, facing different issues and should not be thought of as one.

However, due to the invisibility and discrimination both Intersex and Transgender individuals may similarly struggle with the ramifications of living within a rigidly gendered culture, or face medical or social discrimination due to rigid definition of gender.

My counselling philosophy is based on 3 notions:

  1. Everyone has the right to his/her/their own sex and gender expression.
  2. Everyone has the right to make informed and educated decisions about his/her/their own body and sex and gender expression.
  3. Strength based empowerment and advocacy treatment models are best to support client’s authentic sexual and gender identity development.

You may also find my document, Sex, Gender and Sexuality informative.

Goals of therapy are dependent on the individual and may include:

  • Provision of a safe environment with accurate information on sex and gender diversity, in which the client can question his/her/their gender identity or intersexuality without having to make decisions.
  • Assistance with greater self-knowledge so he/she/they can make informed decisions about his/her/their gender expression and self-identity.
  • Assistance with disclosures and ‘coming out’ for those who are experiencing transgender emergence, want to vary their gender expression, or who are transitioning to another gender.
  • Assisting with family and relationship stability pre and post disclosure of gender and sex variance.
  • Exploring ideas, choices and consequences of body configuration and modification.
  • Making connections with transgendered or intersex communities if desired.
  • Helping clients understand, articulate and have comfort with their gender identity, sex, sexual identity/orientation, self labelling, and or navigate sexual and gender fluidity.
  • Understanding the impact of Intersex conditions and hormone therapy on reproduction and family planning.
  • Provision of treatment for mental health problems, if present.
  • Provision of treatment for sexual function and improved sexual satisfaction if required.
  • Assistance with couple sexuality and possible challenges to partner’s sexual orientation and sexual identity.
  • Finally, validation of the diversity of choices in sex and gender expression.
gender diversity

Assessment for Medical Interventions for Gender Alignment for Individuals Over 18 years

Some people do not require or want therapeutic support, but require a letter from a specialist mental health provider to proceed with their desired medical intervention.

I meet criteria to write letters of support for hormone treatment and surgery as per WPATH-7 Guidelines. The WPATH guidelines suggest a that a person have 1 year of hormone therapy and 1 year of lived experience as desired gender prior to sex alignment surgery. Not all GPs require a letter to commence hormone therapy, as they follow the Equinox Consent model.

See TransHub below for a list of gender specialist doctors.

The purpose of ‘the letter’ is to ensure that you have adequate understanding of treatment implications, have good psychological care (if required) and adequate social supports. Often surgeons and medical doctors do not have the in-depth training to do psychosocial assessments or sufficient time to have a lengthy discussion about your psychosocial needs.

The process involves 1-2 sessions (two maybe required where if you have a more complex mental health history) and involves discussing your:

1. Gender history: gender identity experience and impacts
2. Psychosocial history: how life is going, who you live with, where you work, friends, partner(s) strengths, etc.
3. Mental health and medical history: clarify any areas in which you may benefit from additional mental health support, and develop a plan if there is a risk for relapse of mental or medical conditions.
4. Treatment implications: Understanding of desired treatment and possible side effects, including family planning decisions and developing an after-care plan (for surgery).

TransHub is  a great place for resources on social, medical, legal, affirmation and health including Gender Affirming medical doctors.

Dichotomous notions of sex and gender have led us to believe that there are only 2 biological sexes, male and female, and only 2 genders, man and women. However, there is and has always been existence of people with a mixture of both male and female biological sex characteristics, which is termed intersex and people who show inconsistency between their biological sex and gender identity, which is termed transgender. Statistics

https://www.acon.org.au/who-we-are-here-for/tgd-people/

Gender terminology explained

Intersex is a general term to refer to a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male. Intersex people have reproductive organs, chromosomes, hormones or other physical sex characteristics that are neither typical female nor typical male. Intersex is a description of biological diversity and may or may not be the identity used by an intersex person. Intersex persons are usually identified after discovery of a medical issue with sexual or reproductive organs at birth, puberty or upon discovery of infertility as an adult. The vast majority of Intersex persons identify as either male or female rather than transgender and do not have dysphoria around gender identity. Click here for historical information on Intersex persons.

This refers to a person whose gender identity, gender expression or behaviour does not align with their sex assigned at birth. In Australia, at birth children are assigned male or female. Male children are raised as boys and female children are raised as girls. A person classified as female at birth who identifies as a man may use the label trans, transman or man. Similarly, a person classified as male at birth who identifies as a woman may use the label trans, transwoman or woman.

This refers to people who do not identify as a woman or a man. In the same way that sexual orientation and gender expression are not binaries, gender identity is not a binary either. It is important to challenge our thinking beyond the binary constructs of male and female.

Some people may identify as agender (having no gender), bigender (both a woman and a man) or non-binary (neither woman nor man). There is a diverse range of non-binary gender identities such as genderqueer, gender neutral, genderfluid and third gendered. It is important to be aware that language in this space is still evolving and people may have their own preferred gender identities that are not listed here. Click here for historical information on transgendered persons.

Aboriginal and Torres Strait Islander people may use these terms to refer to transgender people. Brotherboy typically refers to masculine spirited people who are born female, and Sistergirl typically refers to feminine spirited people who are born male.

This refers to people whose gender identity is in line with the social expectations of their sex assigned at birth. It is a term used to describe people who are not transgender.

How to use inclusive language

Only use appropriate terms to refer to people’s sexual orientation or gender identity with the appropriate terms. Although terms such as ‘dyke’ and ‘fag’ may be used by LGBTI people themselves, this terminology is likely to be seen as derogatory if used by someone who is not part of the subgroup. Furthermore, “thats so gay” or using the word ‘gay’ to refer to negative situations or phenomenon unrelated to sexual orientation is offensive and unacceptable.

Handy guide to trans and gender diverse inclusive language ACON

Heteronormativity is the assumption that everyone is heterosexual (straight), and that this is the norm. Heterosexism is the belief that non-heteronormative sexual orientations or gender identities are unnatural. Avoid using language which assumes all relationships are heterosexual, as this denies the experiences of same sex couples. It is better to use the word ‘partner’ than ‘wife/husband’ where the gender, sexual orientation or relationship status of a person is unknown. When someone mentions their children, remind yourself that this doesn’t necessarily mean they are in a heterosexual relationship, and avoid making assumptions.

Misgendering is using language to refer to a person that is not aligned with how that person identifies their own gender or body. Most but not all intersex and trans people who identify as male prefer to be referred to as ‘he’. Most but not all intersex and trans people who identify as female prefer to be referred to as ‘she’. Some people prefer to be described with their first name only or a non-binary pronoun such as ‘they’ rather than a gendered pronoun. Others prefer no pronoun at all.

Other gender neutral pronouns exist, such as ‘zie’ and ‘hir’. If unsure, you can ask someone directly what their preferred pronoun is in a respectful manner. Where possible, check privately to reduce discomfort. If you do make a mistake, apologise promptly and move on, it will likely make the person feel more uncomfortable if you dwell on the mistake. Try to avoid making the same mistake again.

Most people would find it inappropriate to be asked questions about their genitals or breasts. It is therefore not appropriate to ask questions about whether a trans person has had surgery. Similarly, most people would find it inappropriate to be referred to with reference to their anatomical or medical history. In the same way trans people should not be referred to with reference to whether or not they have had surgery.

A trans or gender diverse person may refer to their gender affirmation rather than transition. They may prefer the phrase gender affirmation as it aligns with how they have always identified. Transitioning implies that they are changing from one gender to another. It is important to use respectful language in line with the person’s own experiences. Some refer to ‘aligning’ their body and gender rather than transitioning.

People who identify as LGBTI may also identify with other diversity groups such as ethnic, cultural  or disabled. Language used should not assume primacy of one dimension. The diversity within any one element of L,G,B,T or I needs to be respected.

Sex and gender-restrictive forms and databases with only ‘male’ and ‘female’ may exclude trans, intersex and gender diverse people from participating. Identify ways to change systems so they are more inclusive of non-binary people.

For the majority of people (around 98%), there is a correlation between their sex and gender (eg. their sex is female and their gender is female). The conceptual difference between the two concepts is therefore not well understood by the general public, and they are often used interchangeably in legislation and the media.

The Australian Bureau of Statistics has introduced a new Standard for Sex and Gender Variables with the following standard tick box question module for sex. The ‘Male’ response option is shown first due to tradition in the ABS and alignment with other collections.

terminology referenced Victorian Government Inclusive Language Guide.

Intersex Resources

You Can’t Ask That: ABC Documentary

Out of the shadows: SBS Documentary

Intersex Human Rights Australia

For parents

Employers guide

Identity documents

Ambiguous_Genitalia.pdf

Intersex Society of North America

Intersex Peer Support Australia

Gender Centre Resources

gender centre logoThe Gender Centre is committed to developing and providing services and activities, which enhance the ability of people with gender issues to make informed choices. We offer a wide range of services to people with gender issues, their partners, family members and friends in New South Wales. We are an accommodation service and also act as an education, support, training and referral resource centre to other organisations and service providers. The Gender Centre is committed to educating the public and service providers about the needs of people with gender issues. We specifically aim to provide a high quality service, which acknowledges human rights and ensures respect and confidentiality.

>>Gender Centre: Support for family & Friends

Support_for_Family_and_Friends.pdf

>>Gender Centre:Employment

GenderCentre: guidelines for Employers and Service Providers

#Transgender-descrimination–guidelines-for-employers-and-service-providers.pdf

Human_Recources_Transgender_Policy_1.pdf

Concerns_For_Service_Providers.pdf

Anti-Discrimination_Law_and_Employment.pdf

Model_Document_for_Informing_Staff.pdf

Model_Policy_for_Employment_Transition.pdf

>>Gender Centre: Alignment: Gender Affirmation

F2M: Fact Kits, hysterectomy, Oopherectomy, masculine hormones, identity documents

M2F: Facial feministaion, breast augmentation, electrolysis, feminising hormones, identity documents

Trans and Non-Binary Resources

OMG I’m trans*: Trans information for youth and those interested in coming out. Resources on use of pronouns and non-binary gender.

Transgender Radio: TgR launched on-line in 1997, and has over 700 members. The aim of TgR is to foster understanding, awareness and friendship within the Australian/New Zealand gender diverse community. Online, TgR hosts resources on many aspects of transgender life and a variety of tools to facilitate communication and networking amongst its members. Offline. TgR organises or promote events for the community throughout Australia. This includes Australia’s premier transgender weekend TransFormal each May in Katoomba.

Conscious Parents Guide to Gender Identity: A mindful approach to embracing your child’s authentic self

Trans and gender diverse parents guide

Families like mine

Transcend: tips for supporting trans and gender diverse children at school

Books for parents of gender diverse children

Transgender friendly young children’s book list

Kids of Trans* resource guide: COLAGErs are people with one or more LGBTQ+ parent or caregiver—they are skilled, self-confident, and just leaders in our collective communities. Our stories are important, and so is yours.

Tips for healthy relationships between trans women and men

Sex Smart Films: Heaps of great educational videos on trans experience. $16 for 1 month unlimited viewing.

Trans PULSE is a community-based research project that was created to respond to problems identified within Ontario trans communities regarding access to health and social services.

Impact of strong parental support for trans youth

Depression in FTM

Depression in MTF

Non-binary identity

Transphobia affects parents

I’m Muslim and my gender doesn’t fit me

Starting hormones early improves mental health for transgender people

Embracing Your Sexual Identity

Sexual Identity is incredibly complex and diverse; it is not a fixed experience for many people.

When we start to consider sexual identity (how we describe ourselves), sexual orientation (who we are sexually attracted to) and sexual behaviour (what we actually do sexually) we realise that all three are rarely seamlessly aligned; nor are they static. Some people will have a more permanent and consistent sexuality i.e. I have always known I was same-sex attracted and I have no interested in heterosexual sex, for others their sexuality changes over time. This fluidity can be problematic for some people. Some times it is difficult for the individual to understand the change in the self, for others it is difficult due to the judgements or prejudice of others.

Suspicion can be cast on those whose sexual identity has changed over time, or towards those whose behaviour does not match their sexual identity. For example, society is often just as shocked when a gay man or lesbian starts a relationship with the opposite sex as it is to hear about their initial coming out. Equally society may question how a man can consider himself straight if he is having sex with men?

Judgement and confusion about sexuality can cause individuals to feel anxious, uncertain and depressed. Research findings suggest that gay, lesbians, transgendered and intersex populations are at higher risk for depression and anxiety disorders by Beyond Blue. Often discussing the internal conflict and challenging real or perceived rejection can be helpful in reducing symptoms of anxiety and depression.

I encourage all individuals to be open to the wonderfully rich spectrum of sexuality and sexual expression that we have in our communities, rather than focus on the 3 more widely acknowledged categories (heterosexual, bisexual and homosexual). Also, I encourage people to consider that there may be more possibilities of sexual expression than we could ever imagine.

See resources for support and information for individuals, parents, friends, and partners of same-sex attracted persons.

Families like mine

GLBTI Resources