| THE TRANSITION
THREE MONTHS AGO, CAITLYN JENNER PULLED THE TRANSGENDER COMMUNITY FROM THE SHADOWS AND INTO THE GLARE OF GLOBAL NEWS BULLETINS. SO DOES THIS MARK THE BEGINNING OF A NEW CIVIL RIGHTS MOVEMENT? OR IS IT SIMPLY A PASSING FAD FOR THE MEDIA TO SALIVATE AFRESH?
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.”
CLOCKWISE: JENNER IN 1976; ON THE COVER OF VANITY FAIR; WITH DIANE SAWYER; A STILL FROM I AM CAIT.
FROM TOP: EDDIE REDMAYNE AS LILI ELBE; TIME MAGAZINE’S LAVERNE COX COVER; COX IN ORANGE IS THE NEW BLACK.
FROM TOP: JEFFERY TAMBOR (RIGHT) IN TRANSPARENT; AUSTRALIAN MILITARY LEADER CATHERINE MCGREGOR.
CLOCKWISE: MODEL ANDREJA PEJIC (FAR LEFT) ON DAYTIME TV; LIZ DUCK-CHONG; FORMER SURFER PETER DROUYN; WESTERLY WINDINA.