Nerd Na­tion

Jenny Ni­cholls ex­plores the dif­fer­ence be­tween sex and gen­der.

North & South - - North & South -

“I MEAN, my body is some­times this thing I look at and think, ‘What strange, alien thing grew around my con­scious­ness?’” US model Rain Dove told The Guardian in a re­cent in­ter­view. “It’s like this weird fun­gus that’s just there.”

Dove was born fe­male, but “passed” as a male firefighter in Colorado for 11 months be­fore be­com­ing a model. She has quite the back­story, and daz­zling looks – but it is, per­haps, her in­sights and in­tel­li­gence trans­fix­ing the press.

Al­though her Wikipedia en­try uses the gen­der-neu­tral pro­noun “they”, Dove told The Guardian to “use she, he, it, one, they. You could call me mow mow and I hon­estly don’t care. A pro­noun is just a sound. All I’m lis­ten­ing for in that sound is pos­i­tiv­ity.”

Her tran­quil wit – “I went to what­ever bath­room was the short­est line" – sets jour­nal­ists to fu­ri­ous scrib­bling and sug­gests it’s all been a dod­dle. In fact, as she ad­mit­ted to one writer, she has been pep­per sprayed by some­one who thought she was in the wrong bath­room.

Dove’s mod­el­ling de­but was cer­tainly a mem­o­rable one for her booker: “They handed me some un­der­wear and said, ‘Go put on your out­fit.’ I said, ‘Okay, but where do I get the out­fit?’ and they were, like, ‘That’s it.’ Just the un­der­wear. It was a men’s un­der­wear show!”

The new­bie had been booked by an agent who hadn’t re­alised the 1.9m (6ft 2in) Dove came with breasts at­tached. “I could [ have said], ‘ Hey, there are some things in my body that don’t align with the par­tic­u­lar mar­ket­ing scheme you have in mind for this gar­ment.’” But she didn’t. “I walked out top­less. The cast­ing di­rec­tor looked like he was go­ing to shit him­self.”

Brave, but not ca­reer- end­ing. Dove now ap­pears in women’s and men’s fash­ion shows – she says she wears an “an­gry face” when mod­el­ling menswear – has shot ads for the likes of Chanel, mod­els for Vogue, and is dat­ing #Metoo ac­tivist Rose Mc­gowan. She is one of a num­ber of gen­der-fluid pop-cul­ture stars whose suc­cess might lull us into think­ing their life is easy, or all about cloth­ing. But this is not re­motely true. “Pub­lic health re­searchers are be­com­ing aware that trans per­sons rep­re­sent one of the most marginalised and un­der-served pop­u­la­tions in medicine,” warned US re­searchers Tif­fany Roberts and Corinne Fantz in 2014 in the Clin­i­cal Bio­chem­istry Jour­nal. They felt the need to ex­plain the dif­fer­ence be­tween sex and gen­der on their pa­per’s sec­ond page.

“It is im­por­tant to un­der­stand that the terms ‘sex’ and ‘gen­der’, while of­ten used in­ter­change­ably, have spe­cific med­i­cal and psy­cho­log­i­cal mean­ings. ‘Sex’ com­monly refers to phys­i­cal char­ac­ter­is­tics whereas ‘gen­der’ rep­re­sents iden­tity and self-im­age.” As Dr Jaimie

Veale, a lec­turer in psy­chol­ogy at the Univer­sity of Waikato, ex­plains, “Gen­der is what's in your brain and sex is what's be­tween your legs.”

Bi­ol­ogy 101 tells us hu­man men and women have dif­fer­ent chro­mo­somes: XY for men and XX for women. But bi­ol­ogy 101 over­sim­pli­fies. Sex can be as­signed by a bl­iz­zard of bod­ily forces – anatomy, hor­mones, chimeric cells and chro­mo­somes – and these can clash.

“Na­ture loves di­ver­sity,” says Veale, “but so­ci­ety doesn't, al­ways.”

Bi­ol­o­gists versed in hu­man gen­der now see hu­man sex as a spec­trum. As an ar­ti­cle in Na­ture pro­claimed in 2015, “The idea of two [hu­man] sexes is sim­plis­tic.” A fun Twit­ter ac­count to fol­low is “gen­der of the day”. Sam­ple tweet: “To­day's gen­der is the sound of thun­der in the dis­tance” (73 retweets, 166 likes).

AND SO THE old gen­der cer­tain­ties are shrugged off, al­though it's re­ally no laugh­ing mat­ter. There are plenty of in­ter­na­tional stud­ies on what we do to those born into a sex they don't want or un­der­stand.

A 2013 Cana­dian study, Re­ported Emer­gency Depart­ment Avoid­ance, Use, and Ex­pe­ri­ences of Trans­gen­der Per­sons in On­tario, Canada, re­vealed that deal­ing with medics leaves many trans peo­ple with a dis­like of hos­pi­tals so in­tense they avoid emer­gency de­part­ments.

Surely this wouldn't hap­pen here? North & South can tes­tify that it does. A trans per­son we know was in­volved in an se­ri­ous ac­ci­dent. The thought of go­ing to hospi­tal was so scary she lay at home for days without seek­ing care. When ad­mit­ted to hospi­tal, she was ini­tially too zonked to re­alise that while painkillers were be­ing gen­er­ously sup­plied, the hor­mones pre­scribed by her GP a year ear­lier were not. When she was able to raise this with the nurs­ing staff, she told them an ear­lier at­tempt to go off them had re­sulted in her hav­ing sui­ci­dal feel­ings. How­ever, no hor­mones were sup­plied and she was un­able to con­tinue her treat­ment un­til she went home af­ter be­ing dis­charged.

A 2015 pa­per by Dr Veale and Dr Frank Pega from the Univer­sity of Otago notes that in over­seas sur­veys of trans peo­ple, up to a third re­ported at­tempt­ing sui­cide. A US sur­vey of 6450 trans peo­ple in 2011 re­vealed that 41% re­ported at­tempt­ing sui­cide, com­pared to 1.6% of the gen­eral pop­u­la­tion.

De­spite dis­turb­ing in­ter­na­tional data like this, pub­lished re­search into trans wel­fare in New Zealand is al­most non-ex­is­tent. Our best data comes from a sin­gle sur­vey of teenagers. In the Youth'12 health and well­be­ing sur­vey of 8500 sec­ondary school stu­dents, 1.2% de­scribed them­selves as trans­gen­der. These young peo­ple were five times more likely to re­port at­tempt­ing sui­cide than other stu­dents.

What hap­pens to these kids when they grow up? A 10-year- old se­ries of in­ter­views by the Hu­man Rights Com­mis­sion gives us some clues. One trans man who re­turned from the US called it a “utopia” com­pared to New Zealand.

The com­mis­sion's re­port con­cluded that, in this coun­try, most trans peo­ple can­not ac­cess the ser­vices nec­es­sary for them to live “in their gen­der iden­tity and ap­pro­pri­ate sex”.

Since then, lit­tle has im­proved. We know this be­cause Glo­ria Fraser, a PHD stu­dent at Vic­to­ria Univer­sity, is study­ing trans health care in New Zealand. She hasn't fin­ished her anal­y­sis yet, but her work points to wide vari­a­tions in the care of­fered by dif­fer­ent DHBS.

“There are huge struc­tural bar­ri­ers to ac­cess­ing gen­der-af­firm­ing care,” she says. “My par­tic­i­pants shared with me how dif­fi­cult it is to find providers, in­clud­ing GPS, who are knowl­edge­able about trans­gen­der health. Those that are, tend to be over­whelmed with de­mand. Many ser­vices are de­pen­dent on age, so gen­der- di­verse peo­ple age out. ‘Evolve', for ex­am­ple, is a queer- and trans­gen­der-friendly ser­vice in Welling­ton, but they are only funded to sup­port peo­ple un­til the age of 24. So for lots of pa­tients, com­ing up to that age is scary. There are fewer trans­gen­der-friendly ser­vices once peo­ple get to their late 20s and older.”

Some DHBS, she says, re­port they have no ded­i­cated fund­ing for ser­vices like hor­mones or surgery, at all. The ones that do of­ten de­mand a men­tal health assess­ment be­fore a trans per­son can even chat with an en­docri­nol­o­gist (a spe­cial­ist in hor­mone-re­lated con­di­tions). While many DHBS pro­vide fund­ing for this men­tal health assess­ment, some DHBS re­quire pa­tients to ac­cess it pri­vately, of­ten at a cost of $500-$1000.

Veale's project, Count­ing Our­selves, an anony­mous sur­vey for trans and non- bi­nary peo­ple, has just closed. More than 1000 peo­ple re­sponded.

The sur­vey re­sults, out next year, are likely to show, she says, that trans peo­ple are still be­ing treated poorly by the health sys­tem, still be­ing re­fused care, and still fear be­ing mis­treated. And many are say­ing – as they did a decade ago to the Hu­man Rights Com­mis­sion – that they have to ed­u­cate ev­ery medic they in­ter­act with about the ba­sics of their care.

A new era may be dawn­ing, though, with a pi­lot Gen­der-af­fir­ma­tive Hor­mone Clinic in Welling­ton set up to side-step pon­der­ous DHB sys­tems – and promis­ing trans-led ini­tia­tives in Auck­land, too. Be­cause it just shouldn't be that hard.

GP Cathy Stephen­son is a mem­ber of the work­ing group be­hind the Welling­ton clinic. She says the vast ma­jor­ity of pa­tients need ei­ther sup­port and ad­vice, or to talk about gen­der-af­firm­ing hor­mone ther­apy. “Most won't be think­ing of surgery – pos­si­bly be­cause it has been too hard – but also be­cause they may not want that.”

For a treat­ment that is so trans­for­ma­tive ( and pos­si­bly life- sav­ing too), hor­mone ther­apy is cheap. The high­est dose of oe­stro­gen ( a fem­i­nis­ing hor­mone) costs $40 for a three-month sup­ply. Testos­terone block­ers (of­ten part of the same treat­ment) cost less than $20. With testos­terone in­jec­tions, says Stephen­son,“it de­pends on what you have, but the three-monthly op­tion is around $90”.

She believes it isn't cost that's the prob­lem in get­ting health fund­ing, “but aware­ness of the im­por­tance of this type of treat­ment for these pa­tients”. She calls her work with the clinic “one of the most re­ward­ing things I have ever done. It isn't com­plex from a med­i­cal point of view, but is life- chang­ing for pa­tients.”

Trans ex­pe­ri­ence has, surely, much to teach us, in­clud­ing in­sights into sex­ual bias. Take the fe­male-to-male Stan­ford neu­ro­sci­en­tist who, hav­ing re­cently tran­si­tioned, heard a fel­low aca­demic say, “Ben Bar­res gave a great sem­i­nar to­day, but then his work is much bet­ter than his sis­ter's.”

Dove has a brave man­i­festo. “The gen­der thing doesn't ex­ist,” she told Buz­zfeed News. “It's a so­cial con­struct you don't have to fit into.” Her im­pli­ca­tion – that gen­der is a choice, freely made – is one few of us, trans or not, might hon­estly agree with. +

Left and be­low: US model Rain Dove signed with an agency that al­lows her to ap­pear in both men’s and women’s shows. “For me, that was so im­por­tant, be­cause I didn’t feel like I was male or fe­male,” Dove said. “I just felt like I was I.”

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