Understanding Stigmas and Barriers for the Trans Community

With the increasing discrimination of the trans community, I find it important to educate and advocate for equality. Through grad school research, I hope to provide a deeper understanding of the stigma and barriers faced by the trans community by covering the difference of gender and sexual orientation, take a deeper dive into stigmas and barriers to healthcare, and we will close with covering the importance of inclusion and allyship and provide resources to continue your education.

First, let us discuss the difference between gender and sex. While many think these things are the same or even interchangeable, they are not. Your sex assigned at birth is defined as male, female, or intersex terminology that a doctor uses to describe a child at birth based on their external anatomy (HRC, 2021). This is simply the reproductive organs you are born with. An important distinction here is the third sex of intersex; it is estimated approximately 1.7% of the population is born with intersex traits (Amnesty, 2018).

Gender Identity is the concept of oneself as male, female, a blend of both or neither. It is how individuals perceive themselves and what they call themselves. Sexual orientation is an inherit or immutable emotional, romantic, or sexual attraction to other people. And transgender is an umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth (HRC, 2021). You can find a full glossary of terms on the Human Rights Campaign website.

The gender binary system assumes that one's gender is determined biologically at birth, stable over time, meaningful to the individual, and a predictor of psychological variables (Hyde et al, 2019). However, there are distinct differences between biological sex and the spectrum of gender. Gender is a social construct introduced in the 1950s during a time of conformity, when both men and women observed strict gender roles and complied with society's expectations.

The Gender Continuum pictured (Northcentral University, 2021) depicts the various spectrums in which one identifies themselves. Sex, gender identify, expression, and sexual orientation are not tied to one another and can vary with each person and be fluid over time.

As the gender spectrum becomes more understood, today’s youth find connection to the gender spectrum and their identity journey. The percentage of youth in the United States who identify as transgender is estimated to be between 1.3% and 3.2%. Of those that identify as transgender, 41% have also identified with a nonbinary identity (Chavanduka et al, 2021).

Transgender individuals face pervasive, systemic stigma and discrimination and are subsequently at heightened risk for inequitable hiring practices, wrongful terminations, economic disadvantages, social isolation, physical violence. In a study of over 400 transgenders people in the U.S., 56% reported verbal harassment, 37% reported employment discrimination, nearly 20% reported physical violence. Trans individuals are reported to be a greater risk with 41% reporting to have attempted suicide in their lifetime (Schvey et al, 2020).

The stigmas faced by the trans community based on their gender identity can cause distress and mental health issues. Positive reframing is associated with lower negative affect and greater satisfaction (Schvey et al, 2020). The issues that face the Trans community are more complicated that many thinks as seen by this illustration from Pink News. The ability for trans people to serve openly in the Armed Forces has been a topic covered quite a bit in the last few years. It is estimated that up to 8,000 trans people are serving in the U.S. Military.

With the 2011 repeal of the Don’t Ask Don’t Tell legislation, U.S. lawmakers allowed gay and lesbian individuals to serve openly in the armed forces, however, it did not make provisions for transgender service members. In 2016, announcement was made by then Secretary of Defense that a new policy would go into affect for the retention of transgender servicemembers and allow them to finally serve openly. However, an announcement was made in 2017 over social medial that reversed this decision (Schvey et al, 2020). This ban was finally lifted in 2021 with announcement from President Biden allowing transgender service members to, once again, serve publicly and authentically.

Healthcare plans have historically excluded provisions for the treatment of gender dysphoria or any gender affirming surgeries. With the 2020 U.S. Supreme Court decision, employers will finally need to review their benefits offerings and ensure they comply with offered for treatment of gender dysphoria and that reasonable access is available. Employers should also review short-term and long-term disability plans to ensure the same reasonable access is available (Bokert & Hahn, 2021).

We have also seen an unjust lashing out against transgender youth recently with thirty-three states introducing more than one hundred bills that would strip the rights of transgender people from access to bathrooms to sports to restrictions to medical care (Krishnakumar, 2021).

The root cause of system-level barriers are all attributed to social-structural factors that work to exclude and erase LGBT people from the institutions that shape the healthcare and mental health systems (Romanelli & Hudson, 2017). Access is defined as identifying “healthcare needs to obtain or use health care services, and to actually be offered services appropriate to the needs of care”. A comprehensive review of the barriers to healthcare for trans community found a pattern of five main barriers: discrimination and rejection from services, poor treatment and provider insensitivity, problems with physical environment and climate of services, issues with the availability and appropriateness of services, and the lack of competence in transgender care (Romanelli & Hudson, 2017).

Lack of resources and access to care complicates mental and physical health issues for the trans community. A prevalence of substance abuse has been reported with 65% abusing alcohol, 71% abusing marijuana, and 23% reporting abuse of other illicit drugs (Chavanduka et al, 2021).

Youth, and especially trans youth, have been vulnerable during the COVID-19 pandemic in terms of mental health. Results show that trans youth are experiencing more mental health deterioration, more service disruption, and more unmet needs as they remain isolated (Hawke et al, 2021). Trans youth have reported a higher feeling of self-isolation, higher levels of family conflict, and abuse in 2020 especially when confined with less supportive family members and limited to no access to gender affirming services (Hawke et al, 2021).

In a recent national survey of LGBTQ youth mental health, the Trevor Project reported that 42% of LGBTQ youth have seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth. Nearly 60% of transgender and nonbinary youth said that COVID-19 impacted their ability to express their gender identity. And nearly half have reported wanting access to mental health support (Trevor Project, 2021).

It is important to the Trans community (as it is with all communities) to feel supported and have inclusion. Representation and support matter can contribute by being an ally and educating yourself. A few simple things you can do to be a better ally are:

Provide Space - give others space to speak and refrain from interrupting. It can take a lot for someone to speak up if they do not feel adequately represented.

Respect Pronouns - introduce yourself with your pronouns and/or display pronouns to create a safe space for others. Respect others pronouns and use them.

Educate Yourself - ask questions to better understand or research online when asking questions is not possible or appropriate. The information on allyship is out there. It takes a simple internet search and a little bit of your time to educate yourself on others' journeys and how you can be more supportive.

Stop Being Silent - help educate others and stand up when you hear discriminatory / disparaging remarks. Take the time to call out and question the discriminatory remarks, comments, and jokes of the people around you. Let them know that type of speech is not okay.

Pronouns matter!

We frequently refer to ourselves and others using pronouns. When referring to others, we often make assumptions about another's gender based on their appearance or name. While well intended, these assumptions can be offensive and harmful. Using someone's correct pronouns is a way to respect them and create an inclusive environment, just as pronouncing a person's name correctly can be a way to respect them.

Additional resources are offered below to continue your path to education and allyship These are also a great place to find answers to your questions when asking someone may not be appropriate or possible.

Human Rights Campaign (HRC) - 40+ years in fighting for equality, their goal is to ensure all LGBTQ+ people, particularly those who are trans, people of color and HIV+, are treated as full and equal citizens.

The Trevor Project - The leading national organization providing crisis intervention and suicide prevention services for LGBTQ young people under 25.

Gay & Lesbian Alliance Against Defamation (GLAAD) - Rewriting the script for LGBTQ acceptance, GLAAD tackles tough issues to shape the narrative and provoke dialogue that leads to cultural change.

PFLAG - The first and largest organization for LGBTQ+ people, parents, families, and allies.

Trans Student Educational Resource (TSER) - A youth-led organization dedicated to transforming the educational environment for trans and gender nonconforming students. Creator of the Gender Unicorn.

Openly - Part of the Thomson Reuters Foundations, Openly is a global digital platform delivering fair, accurate and impartial LGBTQ+ news to a world that isn't.

Understanding stigmas and barriers for t
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Bokert, M. E., & Hahn, A. (2021). Bostock, Section 1557, and Transgender Benefits in Self-Funded Health Plans. Employee Relations Law Journal, 47(1), 71–75.

Chavanduka, T. M. D., Gamarel, K. E., Todd, K. P., & Stephenson, R. (2021). Responses to the gender minority stress and resilience scales among transgender and nonbinary youth. Journal of LGBT Youth, 18(2), 135–154. https://doi-org.proxy1.ncu.edu/10.1080/19361653.2020.1719257

Hawke, L. D., Hayes, E., Darnay, K., & Henderson, J. (2021). Mental health among transgender and gender diverse youth: An exploration of effects during the COVID-19 pandemic. Psychology of Sexual Orientation and Gender Diversity. https://doi-org.proxy1.ncu.edu/10.1037/sgd0000467

HRC (2021). Glossary of Terms. Human Rights Campaign. https://www.hrc.org/resources/glossary-of-terms

Hyde, J. S., Bigler, R. S., Joel, D., Tate, C. C., & van Anders, S. M. (2019). The future of sex and gender in psychology: Five challenges to the gender binary. American Psychologist, 74(2), 171–193. https://doi-org.proxy1.ncu.edu/10.1037/amp0000307

Krishnakumar, P. (2021). This record-breaking year for anti-transgender legislation would affect minors the most. CNN. https://www.cnn.com/2021/04/15/politics/anti-transgender-legislation-2021/index.html

Romanelli, M., & Hudson, K. D. (2017). Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. American Journal of Orthopsychiatry, 87(6), 714–728.

Schvey, N. A., Klein, D. A., Pearlman, A. T., Kraff, R. I., & Riggs, D. S. (2020). Stigma, health, and psychosocial functioning among transgender active-duty service members in the US military. Stigma and Health, 5(2), 188–198.

Trevor Project. (2021). National Survey on LGBTQ Youth Mental Health 2021. The Trevor Project. https://www.thetrevorproject.org/survey-2021/?utm_source=Master+Contacts&utm_campaign=f15c9a66b5-EMAIL_CAMPAIGN_2021_05_20_NationalSurvey&utm_medium=email&utm_term=0_e8d7ceff05-f15c9a66b5-34018621

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