A de­tailed re­port on the re­cent de­vel­op­ments in the trans­gen­der world.

On April 24 of this year, Kar­dashian fam­ily pa­tri­arch and all-Amer­i­can, gold-win­ning Olympic de­cath­lete, Bruce Jen­ner, sat across from US news an­chor Diane Sawyer and an­nounced that the pre­vi­ous 65 years of his life had been spent liv­ing a lie. “I am a woman,” he told Sawyer and the 17 mil­lion peo­ple who tuned in to watch the broad­cast. “That’s who I am.” And there she was, Cait­lyn Jen­ner, a beau­ti­ful, stylish lady in­tro­duced to the world through the glam­our of a Van­ity Fair cover. Within four hours of join­ing Twit­ter, she’d amassed more than a mil­lion fol­low­ers – Jen­ner’s sec­ond world record, af­ter a tri­umphant per­for­mance at the 1976 Mon­treal Olympics – and with an an­tic­i­pated re­al­ity TV show I Am Cait also un­veiled, just like that, with­out any sense of overem­pha­sis, the trans­gen­der com­mu­nity had its most prom­i­nent am­bas­sador. But she’s far from alone. Eleven months ear­lier, trans­gen­der ac­tress Laverne Cox, star of Net­fix’s award-win­ning prison drama Or­ange is the New Black, ap­peared on the cover of Time mag­a­zine along­side the head­line, ‘The Trans­gen­der Tip­ping Point’. Then in April this year Aus­tralian An­dreja Pe­jic be­came the world’s frst openly trans­gen­der fash­ion model to be profled in US Vogue, and in May, Mas­sachusetts­born Hari Nef signed with global pow­er­house IMG Mod­els. “She’s a force,” is how pres­i­dent of IMG Mod­els, Ivan Bart, de­scribes Nef, speak­ing down the phone from his New York base. “As a leader in the in­dus­try, we have the abil­ity to break down bar­ri­ers; this is an op­por­tu­nity to ex­plore what beauty means in 2015 – and di­ver­sity is key.” Sev­eral other cul­tural touch points re­lat­ing to gen­der iden­tity sug­gest grow­ing mo­men­tum for greater in­clu­sion within the West. In TV se­ries Trans­par­ent, Jeffrey Tam­bor plays trans­gen­der woman Maura Pf­ef­fer­man, who strug­gles to come out to her fam­ily. Said to be inspired by ru­mours of Jen­ner’s se­cret strug­gles, it saw the Ar­rested De­vel­op­ment ac­tor win a 2015 Golden Globe, which he ded­i­cated to the trans­gen­der com­mu­nity. “Thank you for your courage, thank you for your in­spi­ra­tion,” said Tam­bour in his ac­cep­tance speech. “Thank you for let­ting us be part of the change.” Set for re­lease later this year, Os­car win­ner Ed­die Red­mayne leads the drama, and love story, in The Dan­ish Girl. The flm is an ex­plo­ration of the life of Lili Elbe, who in the 1930s be­came the frst known per­son to un­dergo gen­der re­as­sign­ment. And just last month, Google en­tered the trans con­ver­sa­tion with a touch­ing video de­tail­ing the poignant story of a young Amer­i­can trans­gen­der man and the lo­cal gym­na­sium that as­sisted his tran­si­tion. With ev­ery tale – real or imag­ined – comes recog­ni­tion, a push to­wards ac­knowl­edg­ment and a seal of so­ci­etal ap­proval. Or does it? While the gen­eral mood re­gard­ing trans­gen­der is­sues may be pos­i­tive, a few high-profle trans­gen­der peo­ple (and char­ac­ters) does not a civil rights move­ment make.

“Gen­der non­con­form­ing be­hav­iour in child­hood is very com­mon. The av­er­age age of our pa­tients is 12, but al­most all of those have a history go­ing back to the age of three or four, where they were aware of gen­der con­cerns.”

“It’s great to stim­u­late a dis­cus­sion,” says for­mer Syd­ney Univer­sity gen­der stud­ies lec­turer, Dr Jen­nifer Ger­mon. “But one doesn’t know where those dis­cus­sions will go.” Agree­ing that Jen­ner’s tran­si­tion has made a sud­den, no­tice­able im­pact, Ger­mon is quick to point out that a real, deep-seated change in at­ti­tude is only just be­ing built – and that blan­ket ac­cep­tance still sits far off on the hori­zon. “While it looks good on the sur­face, there’s still a long way to go. And you need to tem­per [any] en­thu­si­asm be­cause it doesn’t mean life is bet­ter for the ma­jor­ity of trans peo­ple. “The big mile­stones will come in re­la­tion to so­cial disad­van­tage, but whether what’s go­ing on in pop­u­lar cul­ture at the mo­ment will help fa­cil­i­tate change is the mil­lion­dol­lar ques­tion.”

Dr Michelle Telfer is the clin­i­cal lead of ado­les­cent medicine at Mel­bourne’s Royal Chil­dren’s Hos­pi­tal (RCH). As the head of Aus­tralia’s only ded­i­cated mul­ti­dis­ci­plinary team for gen­der dyspho­ria – when a child’s felt gen­der is dif­fer­ent to his or her bi­o­log­i­cal sex – Telfer deals, daily, with young pa­tients ex­pe­ri­enc­ing gen­der iden­tity is­sues. “Gen­der non­con­form­ing be­hav­iour in child­hood is very com­mon,” she ex­plains. “The av­er­age age of our pa­tients is 12, but al­most all of those have a history go­ing back to the age of three or four, where they were aware of gen­der con­cerns. “Peo­ple of­ten say, ‘How does a three­year-old know about their gen­der?’ and I fnd that fas­ci­nat­ing be­cause if you have a bi­o­log­i­cal boy who fts with our stereo­type of what is ‘nor­mal’, we ac­cept that they can be cer­tain about it. But if they say they’re a girl, sud­denly we don’t trust them.” Gen­der con­fu­sion in chil­dren is more com­mon than you might think. Last year a study of more than 8000 New Zealand school stu­dents, pub­lished in the Jour­nal of Ado­les­cent Health, re­vealed 1.2 per cent iden­ti­fed as trans­gen­der, while a fur­ther 2.5 per cent said they were un­sure about their gen­der. That’s po­ten­tial for a lot of kids who feel they were born in the wrong body. While RCH had just three chil­dren present with gen­der iden­tity is­sues be­tween 2005 and 2007, in re­cent years the num­bers have spiked. “In 2012, we had 18 pa­tients, in 2013 we had 40, and last year it rose to 105 re­fer­rals,” says Telfer. “This year we’ll easily have in ex­cess of 150.” In­creased ac­cess to the in­ter­net and so­cial media means trans­gen­der youths no longer feel iso­la­tion as be­fore. “We of­ten hear sto­ries of young ado­les­cents who are de­pressed, anx­ious or feel some­thing is wrong, and who come across a story online about some­one who’s gen­der di­verse or trans­gen­der, and iden­tify with it,” says Telfer. “Sud­denly they have a lan­guage they can use to ex­press them­selves, and will then iden­tify as trans­gen­der.” Dr El­iz­a­beth Ri­ley, one of the coun­try’s most re­spected ex­perts on gen­der iden­tity is­sues, op­er­ates a pri­vate coun­selling ser­vice from her home in Syd­ney’s north­west. She too no­ticed an in­crease in cases from 2012, though that also has to do with her doc­tor­ate ‘The Needs of Gen­der­Vari­ant Chil­dren and Their Par­ents’ gain­ing wide­spread media at­ten­tion. “That rock­eted my prac­tice up,” re­calls Ri­ley. “Be­fore that, there re­ally hadn’t been chil­dren com­ing for­ward.” Ri­ley’s frst task, es­sen­tially, is to lis­ten to both pa­tients and par­ents and un­der­stand their con­cerns. Of­ten if the chil­dren are very young, she’ll ask the par­ents to come alone. “It’s the fu­ture that wor­ries them – how their child is go­ing to be treated, but also what about surgery, what about work, whether they’re go­ing to have a part­ner.

“And par­ents of­ten want to know for sure – they want a di­ag­no­sis. I tell them a child needs per­mis­sion to be dif­fer­ent, and not be locked into some­thing,” she says. “If they can speak about it, the chil­dren feel freed from a lot of shame and em­bar­rass­ment. Just in the frst ses­sion, there’s of­ten a vis­i­ble change in their de­meanour – some­times there will be tears of re­lief. It can be very emo­tional.” This in­ten­sifes once a child hits pu­berty. “That’s when there’s a lot more dis­tress. I get re­fer­rals of young peo­ple al­ready in pu­berty and who are sui­ci­dal or cut­ting them­selves, and their par­ents have taken them to a psy­chi­a­trist who’s said it’s gen­der-re­lated.” While gen­der in early child­hood is of­ten fuid – and not all gen­der vari­ant chil­dren will later iden­tify as trans­gen­der – Telfer agrees that pu­berty is a turn­ing point. “99.5 per cent of peo­ple who iden­tify as trans­gen­der at, or af­ter, pu­berty go on to re­main with that iden­tity.” And that’s when med­i­cal in­ter­ven­tion can be con­sid­ered. “At that point we can start some­one on pu­berty block­ers,” says Telfer. “They don’t stop growth gen­er­ally, or your brain from ma­tur­ing emo­tion­ally and cog­ni­tively, they just stop the sex­ual char­ac­ter­is­tics from de­vel­op­ing.” These so-called ‘stage one’ treat­ments are ad­min­is­tered as an in­jec­tion, ev­ery three months, at a cost of about $5000 per pa­tient, per year (which RCH cov­ers for its pa­tients). Given pu­berty block­ers are re­versible should a pa­tient stop treat­ment, they ef­fec­tively ‘buy’ a per­son time to con­frm they’re on the right track, be­fore con­sid­er­ing more per­ma­nent mea­sures. The next step, ‘stage two’ treat­ment, is cross-sex hor­mone ther­apy – daily oe­stro­gen pills for those who iden­tify as fe­male, or reg­u­lar testos­terone in­jec­tions for male-iden­ti­fy­ing pa­tients. “Those med­i­ca­tions cause per­ma­nent changes to your body, so it’s a big de­ci­sion,” says Telfer. These are typ­i­cally ad­min­is­tered around 15 or 16 years of age and, in the vast ma­jor­ity of cases, will need to be taken for the en­tirety of a pa­tient’s life. But there’s a catch. Un­der cur­rent Aus­tralian law, no one un­der the age of 18 can re­ceive cross-hor­mone treat­ment with­out tak­ing the mat­ter to court. Un­der 18-year-olds must prove what is known as ‘Gil­lick Com­pe­tence’ – a le­gal term named af­ter ac­tivist Vic­to­ria Gil­lick who won a land­mark 1985 rul­ing in the UK’S House of Lords to re­strict the pre­scrip­tion of the con­tra­cep­tive pill to mi­nors. Since the de­ci­sion also ap­plies to Aus­tralian cases, it means fam­i­lies of trans­gen­der chil­dren must ap­peal to the Fam­ily Court. “It’s still a ma­jor prob­lem that needs to be changed,” states Telfer. “The court process is ex­tremely dis­tress­ing for the fam­i­lies, it can take a long time, and it’s also ex­pen­sive. For par­ents who can’t fnd a pro-bono lawyer to rep­re­sent them, the costs are some­where be­tween $20,000-$30,000.” Iron­i­cally, the Fam­ily Court’s judg­ment re­lies solely on the ad­vice of the hos­pi­tal’s med­i­cal team – the same peo­ple at­tempt­ing to get their pa­tients ac­cess to treat­ment. So far, ev­ery case brought be­fore the Fam­ily Court has been suc­cess­ful. Pre­vi­ously, mi­nors seek­ing ac­cess to pu­berty block­ers also had to take the mat­ter to the Fam­ily Court, though this was over­turned af­ter a suc­cess­ful le­gal ap­peal in 2013. It puts par­ents and doc­tors in yet another tricky po­si­tion – where a child’s pu­berty can be de­layed with­out the cer­tainty of ac­cess to stage-two treat­ment at the ideal time. “If you’re stop­ping some­one’s pu­berty at 11 or 12, un­til they’re an adult, that’s go­ing to cause psy­cho­log­i­cal harm,” says Telfer. “We need to change the le­gal sit­u­a­tion, which will take ei­ther a High Court chal­lenge, or a change to fed­eral leg­is­la­tion.” This predica­ment is more than sim­ply in­con­ve­nient. Re­search shows trans­gen­der ado­les­cents who do not have ac­cess to treat­ment – for le­gal rea­sons or due to parental re­fusal – have a 50 per cent chance of self-harm­ing, with those at risk of sui­cide as high as 30 per cent. On the other hand, a study of pa­tients at the Dutch VU Univer­sity Med­i­cal Cen­tre’s gen­der dyspho­ria clinic – on which RCH ser­vices are based – re­vealed chil­dren who re­ceived the stan­dard course of stage one and stage two treat­ments, at op­ti­mal ages, were said to have men­tal health out­comes com­pa­ra­ble to that of the gen­eral pop­u­la­tion. Ri­ley says it’s for this rea­son that ed­u­cat­ing par­ents is cru­cial. “If there’s a great re­sis­tance to ac­cept­ing [their trans­gen­der chil­dren], some­times you have to say, ‘You might end up with a dead child.’ That’s the bot­tom line.” Late last year, 17-year-old Lee­lah Al­corn wrote a well-pub­li­cised ac­count of her ex­pe­ri­ence liv­ing as a trans­gen­der girl in small town Ohio, USA. She spoke about the joy she felt on dis­cov­er­ing that she wasn’t alone – that there were oth­ers out there who felt the same way. She then out­lined how her par­ents re­fused her to tran­si­tion med­i­cally, stat­ing that God didn’t make mis­takes.

“If you are read­ing this, par­ents, please don’t tell this to your kids. Even if you are Chris­tian or are against trans­gen­der peo­ple, that won’t do any­thing but make them hate them self,” wrote Al­corn. She posted the note to her Tum­blr page and then, in the early hours of De­cem­ber 28, walked into traffc on the In­ter­state 71 high­way and took her own life.

Liz Duck-chong’s story is a happy one. A friendly, ar­tic­u­late 22-year-old flm­maker from Syd­ney, she came out as trans­gen­der to a close friend at 16, telling her par­ents and fam­ily a year later. “It was a pos­i­tive ex­pe­ri­ence,” she re­calls, to­day. “It took [my fam­ily] a lit­tle while to get used to, but that’s just be­cause I’d been think­ing about it for two or three years be­fore, and they’d only been think­ing about it for a week.” Her high school was less ac­cept­ing. “I had ap­proached my year co­or­di­na­tor and prin­ci­pal about com­ing out, and was told I wasn’t able to do that. Look­ing back, it would have been nice to press that a bit more. It’s one of my re­grets that I didn’t come out at school, and not be­ing able to do that was quite dif­fcult.” Strug­gling with some men­tal health is­sues at the time – 60 per cent of trans­gen­der women un­der 30 have ex­pe­ri­enced a ma­jor de­pres­sive episode – Duck-chong chose not to push the mat­ter with the school. In­stead, she be­gan ther­apy, with mixed re­sults. “There are defnitely ther­a­pists who have trained in gen­der ar­eas and men­tal health,” she says, “but there are a lot of peo­ple who haven’t, and who are quite an­tag­o­nis­tic to­wards it, who don’t be­lieve it ex­ists, or have ar­chaic views. I of­ten found my­self ed­u­cat­ing ther­a­pists on what the latest re­search was. “I’ve been re­ally lucky to have a sup­port­ive fam­ily and core group of friends. All of those things are fan­tas­tic, but it’s quite rare. Lots of my trans friends don’t have fa­mil­ial sup­port and have lost a lot of friends. That’s es­pe­cially the case of peo­ple who tran­si­tion later in life, but my jour­ney has been in­cred­i­bly pos­i­tive.” Like much of the wider com­mu­nity, Duck-chong ad­mits a sense of de­light on frst see­ing Jen­ner’s Van­ity Fair cover. “I thought it was great. And one of the re­ally nice things is that most of the pos­i­tive re­ac­tion is to­wards how happy she is. But af­ter see­ing peo­ple tran­si­tion into ex­traor­di­nar­ily at­trac­tive men or women, the next step is ac­cept­ing peo­ple who don’t ft any of those la­bels. “There is some truth to it be­ing the next big so­cial jus­tice is­sue, the way gay and les­bian rights were in the ’70s and ’80s – and it’ll be in­ter­est­ing to see if it con­tin­ues or if it peters out. But for all the mag­a­zine cov­ers in the world, there is still a lot of dis­crim­i­na­tion.” De­spite the over­whelm­ingly pos­i­tive re­sponse to Jen­ner’s big re­veal, the vast ma­jor­ity of dis­cus­sion fo­cused on her looks. And it’s this pre­oc­cu­pa­tion with trans­gen­der peo­ple’s ap­pear­ance that hints at the ar­du­ous re­al­ity of many to be ac­cepted for who they are. In this re­spect, Duck-chong says she’s for­tu­nate. “I have what is termed ‘priv­i­lege’ for pass­ing as cis­gen­der,” she says – cis­gen­der es­sen­tially be­ing the op­po­site of trans­gen­der, some­one whose gen­der iden­tity and bi­o­log­i­cal sex are aligned. “Per­son­ally, I don’t face that much dis­crim­i­na­tion be­cause I have the luck of be­ing able to blend in. I’ve re­ceived the same gen­dered slurs that many women face in public, but that’s a very sep­a­rate form of dis­crim­i­na­tion.”

“There is some truth to it be­ing the next big so­cial jus­tice is­sue, the way gay and les­bian rights were in the ’70s and ’80s. But for all the mag­a­zine cov­ers in the world, there is still a lot of dis­crim­i­na­tion.”





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