TransKit Module Four: Social

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ON VISIBILTIY - UNDERSTANDING THE OUT EXPERIENCE

ARE YOU IN OR OUT | OR?

For transgender persons, being out is a complex exploration into safety, status, identification, relationships and community dynamics.
Out does not imply any stage of gender identification or transition status.
Consider: A transwoman who has completed gender confirming procedures, is she out? Or back in? Or?
An individual’s ability to socially pass (passing privilege) as their identified gender is a contributing factor in determining if there is a need to disclose gender status.
For transgender patients seeking initial assessment or treatment, considerable time should be spent understanding the patient’s experience of self-disclosure to others as well as the various identity labels, names and/or pronouns the patient has adopted based on setting (work, school, social, religious, etc.).

VISBILTIY & ISOLATION

Seeing others openly discussing their gender experience on social-media can bring up feelings of isolation.
Exploring understanding and experience with personal or community visibility allows uncovering or better understanding barriers to affirming care.
Many transgender people in early stages of exploration find a sense of community and connection to others using pseudonyms which allow open communication while mitigating fears of social retribution.

VISIBILTIY | CLINICAL CONSIDERATIONS

Identity development for transgender people often occurs in secrecy/isolation.
The first several times (or years) going out in public presenting as their identified can be a harrowing experience.
Peoples stories about their awareness and acceptance of a transgender identity are remarkably similar. Enabling a transgender patient to share their story and hear from others provides a healthy normalizing effect and can help to reduce feelings of anxiety and shame.

COMMUNITY EXPOSURE

Meeting other members of the community results in developing relationships that improve every aspect of mental health.
Getting to know other gender-diverse people lets people develop a greater understanding of themselves, and the recognition of the massive gender spectrum.
Transgender meet-up groups or support meetings are common in larger cities. Contact the nearest LGBTQIA+ center to learn more about these resources.
For transgender adults, initial contact with other in similar circumstance often occurs in bars catering to LGBTQIA+ communities.
The effects of meeting others are the same, improving mental health and developing wider support systems.
Bars and club catering to our community can often invoke feelings of shame, stigma or anxiety. Many of your older patients may be resistant to venturing into these settings.
Affirming spaces are targeted by individuals wishing to harm the LGBTQIA+ community. While shootings like the Pulse nightclub in Orlando are rare, targeting and the physical assault of transgender people is commonplace.

VISIBILITY COMPLICATIONS

Due to the current news and media stores which sensationalize the transgender experience, visibility is on the rise.
The increased awareness and visibility of the transgender community has been shown to be met with greater levels of risk and exposure to violence.
For the first time, public support for the LGBTQIA+ community has declined; as awareness builds, so does resistance and violence against our community.

SOCIAL STRUGGLE

Transmen, transwomen, and nonbinary individuals face similar social struggles but also experience struggles unique to their gender identity experience.
Transfeminine individuals who don’t pass are more likely to face violence and harassment (including transwomen and AMAB nonbinary femmes).
Transmasculine individuals face invisibility within their struggles as the social focus largely revolves around the transfeminine experience.
Nonbinary individuals face struggles based on their assigned gender and their presented gender such as existing in binary and gendered public spaces, limited social use of gender neutral pronouns, safety concerns based on not fitting either male or female social expectations, gendered documentation (ID cards, passports, forms that require either male or female gender), etc.

PROGRESSIVE STATES & MUNICIPALITIES

Significantly higher percentages of transgender people in states with laws providing greater discrimination protections.
Progressive states are beginning to provide education about gender diversity in primary education.
Is this access to education allowing youth to more quickly recognize their status and spend less time suppressing their identity?
Percentages of transgender people should be consistent regardless of geography; especially between the various US states. Perhaps transgender people are moving to more
accepting communities?
Perhaps those in more rural areas are still in hiding, fearful to disclose or respond to surveys about their status.
The dissonance fueled by community safety, acceptance and protections can be crippling, with long-term mental health complications.

A NEW COMMUNITY

The reality of living a life congruent with gender identity is now available for an exponentially larger group than ever before.
The adoption of standards by the AMA, The Endocrine Society, and the AAP have normalized the experience that sex, and gender do not always align.
Younger parents, less likely to be steeped in religious dogma or dated cultural traditions, are providing access to affirming treatment for their children, and are also becoming community advocates.

INFORMATION DISPARITIES

Historically, information about gender-diversity has been extremely limited, or heavily biased.
Numerous states are crafting and passing laws which prevent the education of youth on the realities of gender-diversity.
Many states still prohibit curriculum which speaks of the positive contributions of LGBTQIA+ in US history. Youth in conservative states are growing up without access to LGBTQIA+ history
Sex-education, critical and exclusive to the LGBTQIA+ community, is not being taught even in progressive states despite laws requiring such. Schools fear public backlash.

A HIDDEN COMMUNITY

The LGBTQIA+ community has won many battles for equal treatment in employment, marriage, law enforcement, education, and access to health care.
By denying youth access to information about these gains, our history is quickly being forgotten or rewritten by groups oppositional to LGBTQIA+ acceptance.
We’re not preparing the next generation to pick up where we left off. This is one reason were seeing countless institutions coming down on transgender individuals.
Patients who explore LGBTQIA+ history report increased feelings of connection to the community, and empowerment in activism.

SOCIAL CONNECTION - VITAL TO THRIVING

Social support reduces anxiety, depression and suicidal ideation common in the gender-diverse community.
Social interaction provides the external validation necessary in identity development for transgender patients.
The threat of social retribution for transgender people just starting in their gender journey is real. People have lost families, jobs, and lives due to simply existing as a genderdiverse human.

SCHOOL SUPPORT

Mental health support of transition is increasingly common amongst school-aged youth.
Coming out in school can occur before coming out to family, recognizing school as a safer venue to explore identity.
An increasing number of schools are developing affirming practices of recognizing name, pronouns, and access to facilities congruent with gender identity.
Schools are maintaining confidentiality from parents.
Many schools have LGBTQIA+ affirming clubs or affirming policies that all school-sponsored groups must be LGBTQIA+ affirming.
Schools are permitting access to gender segregated programs including sports. These sports programs bring the benefit not only of active participation, but in developing social supports
Public accommodations are increasingly being understood and legally protected for use by gender identity.

SPORTS & COMPETITION

Transgender athletes are competing as their identified gender with increasing frequency and acceptance.
Complaints of trans athletes are inherently advantaged in competition over cisgender women are also increasing.
These arguments operate on the the assumption that any transwoman is somehow biologically advantaged over every ciswoman.
These arguments are becoming more pervasive in treatment with youth who want to be recognized as their gender identity and deserve the same access to sports programs as there peers.

EMPLOYMENT

Transgender inclusive employers are becoming more common. Household names like Apple, Disney, Nike, Best Buy, Coke, Starbucks, and Ford have all adopted strong antidiscriminatory hiring practices of gender-diverse applicants.
Unfortunately, the positions available are either corporate positions requiring higher-level education, or retail part-time positions, limiting access to health-care or a living wage.
As a provider you will notice a lot of transgender elders starting to transition following their retirement from their lifelong profession.

TRANSGENDER EMPLOYMENT DISCRIMINATION

Though illegal to fire a transgender worker in many states, there remains numerous methods for employers to discriminate against gender-diverse employees.

Workplace conditions, microaggressions, changes in job duties, unfair/inconsistent disciplinary action are ways in which an employer create numerous scenarios wherein a gender-diverse employee will quit or be fired for a reason unrelated to their gender identity.

ON PASSING PRIVELEGE

Passing privilege is the ability for a transgender person to be recognized in public settings as their gender identity.

Many (if not all) of the negative social aspects of being transgender are bypassed for the transwoman or man with passing privilege.

Many in the trans-advocacy community argue that “passing” should not be an intended goal, playing into stereotypes of what define a woman’s or man’s appearance.

Passing provides increased safety for transgender individuals in public spaces; the ability to conform to social norms of appearance lessens the risk for targeted violence or discrimination.

PUBLIC ACCOMODATIONS

Access to public accommodations is hotly debated with transgender people being referred to as pedophiles, voyeurs and instigators of sexual assault.
Attacks on transgender women are commonplace with multiple reports of physical or sexual assault each week.
It’s actually about locker rooms.
Laws are being written in some states which would consider a transgender person changing in such a place an act of lewdness and requiring a registered sex-offender status.

NORMALIZING PUBLIC ACCOMODATIONS FOR GENDER EXPANSIVE PEOPLE

Many states have (or are passing) laws which would make any single-stall restroom required to be all-gender inclusive.
Progressive institutions have been experimenting with all gender locker rooms and restrooms. No incidents of illegal behavior has been reported.
Multi-stall all-gender restrooms with shared sink/mirror areas are typical in many countries.
Despite protections, anxiety related to restroom use is a very real experience, even for transgender women or men with passing privilege.
Numerous cases have been reports of transgender people dying from bladder infections, related to holding urine far longer than typical in order to reach a safe facility.

RELATIONSHIPS - MAKING FRIENDS & RELATIONSHIPS

LOSING FRIENDS

Coming out and beginning the transition process often reveals the strength of existing friendships. Some of these relationships deteriorate instantly and some fade away.
Grieving the loss of friends is a common element in transition related treatment.
Many transgender patients will come to realize many of their friendships were based on shared interests; often recognizing the interests were those of the façade identity, and not necessarily representative of their true interests.

MAKING FRIENDS

Developing friendships with other LGBTQIA+ individuals, while potentially beneficial to exploration and validation, can be limited due to accessibility.
The most common methods of meeting other LGBTQIA+ individuals are often on dating apps or clubs/bars.
Finding local meet-up groups or support groups at affirming spaces is a good way to develop LGBTQIA+ friends.
More resilient trans individuals living in more liberal/progressive areas may consider meetup type activities engaged in by progressive or younger people (i.e. Pokémon groups, yoga, dance, environmental cleanup, etc.)

INTIMATE RELATIONSHIPS

If a person is transitioning and is currently in a relationship wherein their partner was not initially aware of the transgender status or identity, it would be a safe, data-supported assumption that the relationship will dissolve due to concerns of violating deceit.
The change in gender status, including following confirming procedures is not the typical reason for separation. Emerging research highlights the fluidity of sexual attraction of partners in emotionally committed relationships.
Anonymous sexual encounters are becoming increasingly commonplace and with it the rise in STD transmission.
Helping the patient develop realistic dating expectations will be critical as they adjust to a transition/post-transition life.
Physical safety is massive issue with dating as a transgender person.
10% of transgender respondents (USTS) reporting physical or sexual assault within the past year.

ADDITIONAL CONSIDERATIONS

Develop a deep understanding the patient’s current status of disclosure, including what has been disclosed and to whom. Consider the weight of maintaining various identities and narratives during the period of starting to come out publicly.

While the LGBTQIA+ community can be an affirming place and good starting point for a person to develop new relationships, many do not feel welcomed, and may allow personal bias and phobias o prevent an authentic connection. Community identification should be discussed in treatment for the resilience factors it provides, even if connections with others in the community do not exist.

Public laws and support for transgender people facilitate safe identity exploration and develop in public. These laws are fragile, and with increased awareness of transgender concerns, those opposed to trans-equality protections are actively seeking to subvert these accomplishments.'

Friendships and intimate relationships are an often-overlooked element of the transgender coming out process. Many transmen and transwomen are surprised at how dramatically social ties are altered or severed by those who they once considered close. In the long run, having potentially harmful relationships expose themselves quickly can aide the grieving and healing process.