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Health and Intersex, Trans and Gender Diversity

Diverse Sex and Gender (DSG)

Overview:

Most LGBTI Australians live healthy, happy lives; however, disproportionate numbers experience worse health outcomes than their non-LGBTI peers in a range of areas, particularly mental health and suicidality (Rosenstreich 2011).  The acronym ‘LGBTI’ is often used but some people perhaps don’t give much thought to the  ‘T’ (Transgender/Transsexual/Trans*) and ‘I’ (Intersex).

The Alliance will be using Intersex, Trans and Gender Diversity instead of the term ‘Diverse Sexes and Genders’ (DSG) to describe intersex, trans/transgender and non-binary gender people. This shift has been made because members of media, government and the public used this term to describe trans/transgender people only. To ensure more consistent inclusion of intersex people and of people who do not identify as women or men, we will henceforth use Intersex, Trans and Gender Diversity (without an acronym).

Please click here to download our 'Inclusive Language Guide: Respecting People of Intersex, Trans and Gender Diverse Experience'

This page is currently in progress. Please check back for future additions.

 

 

 

 

 

 

 

Sex, Sexuality and Gender
Some key terms:
  • Sex is a biological term relating to reproduction; sexual reproduction requires input from two members of the same species, which have come to be referred to as ‘female’ and ‘male’.
  • Gender refers more to social roles and the attributes and behaviours that any particular society designates as ‘feminine’ or ‘masculine’.  For example, the hair, make-up, fabrics, jewellery, and high heels seen here on King Charles II of England would all be associated with femininity today.
  • The term cisgender refers to individuals who have a match between the gender they were assigned at birth, their bodies, and their personal identity, complementing "transgender".
  • Cissexual is an adjective used to describe "people who are not transsexual, who feel that their gender identity matches their body/sex, and who have only ever experienced their mental and physical sexes as being aligned".y particular society designates as ‘feminine’ or ‘masculine’.  For example, the hair, make-up, fabrics, jewellery, and high heels seen here on King Charles II of England would all be associated with femininity today.

Sex and gender are quite different categories to sexuality.

Sexuality has three aspects: sexual attraction (who a person is attracted to; eg same sex, other sex, both sexes, all or many sexes), sexual behaviour (what kind of sexual practices a person has experienced and prefers), and sexual identity (eg lesbian, gay, bisexual, straight, queer).
So, for example, a man who has sex with men on a casual basis (attraction and behaviour) but is married to a woman and has children, may still see himself as heterosexual (identity).  [The Alliance believes that how a person chooses to identify should be respected; none of us have the right to tell someone what their identity is.]

There is currently a wide range of sexed bodies and gender expressions amongst non-cisgendered or non-cissexual Australians. As well as Intersex people, there are a number of people who have undergone medical and/or surgical treatments that have rendered their bodies neither conventionally female nor male.

 

Sex and gender, however, are not primarily concerned with sexuality, but with biological characteristics of femaleness or maleness (e.g. chromosomes, reproductive organs, and secondary sex characteristics such as body hair, musculature, pitch of voice, etc.) and social characteristics of femininity and masculinity (such as clothing, hairstyles, mannerisms, cosmetics, jewelry, occupations, and sports).

 

Contemporary Western society has come to see these things strictly in terms of the ‘Two-and-only-Two’: female and male, feminine and masculine.  Biologically however, there are many bodies that are not clearly female or male; some people are born that way (known as Intersex), and some undergo hormonal and/or surgical procedures that mean their bodies are not exclusively male or female.  For example, a person assigned male at birth, who takes hormones and has breast augmentation surgery, but retains their male genitals; their gender identity may be ‘female’ but their sexed body is neither clearly female or male.  There are also many people who do not experience or express their gender in a way that corresponds to commonly held beliefs about how female and male bodies should behave.

 

The Alliance has adopted the terminology ‘Diverse Sex and Gender’ (DSG) to cover all such people.  Other current terminology includes Transgender and Intersex (T&I), and ISGD (Intersex, Sex and/or Gender Diverse).

Population Estimates

There are no reliable estimates at this time for the numbers of sex and/or gender diverse people in Australia, and attempting to do so raises two main problems (Kentlyn 2012).    First is the challenge of mapping the ‘messiness’ of people’s lived experience with narrowly defined identity labels.  A trans* person may be pre-operative, post-operative, or non-operative (i.e. not intending to have surgery at all), and may identify as a Trans woman or Trans man, simply as a woman or man, as Genderqueer, or some other term for being neither, both, or alternating.  The second problem is the issue of self-report, especially when it involves stigmatised and criminalised identities and/or behaviours.  People may not be willing to report these identities and/or behaviours to researchers, especially if they are not convinced their confidentiality will be protected.  Particularly Seniors, who have lived through periods when gender non-conforming behaviours could result in enforced psychiatric treatment, loss of access to children, loss of employment, and other negative consequences, may still experience profound reluctance to reveal these aspects of their lives.

 

The US Transgender Law and Policy Institute estimates between 2 and 5% of the population experience some degree of gender dysphoria [sic], but the number who identify as transgender or transsexual and who go on to seek medical treatment is considerably lower (date unknown).  Van Kesteren et al. (1996) in the Netherlands report that approximately 1 in 12,000 natal males and 1 in 34,000 natal females undergo sex reassignment, and that the gap between the two is closing.  Olyslager and Conway (2007) review recent reports from Thailand, the UK and the US and estimate the prevalence of male-to-female transgenderism as at least 1:100 (i.e. 1% of the total population).  They offer no estimates for female-to-male prevalence.

 

The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, identifies 116 biological variations under the term ‘Intersex’; only twenty appear on Australian lists of reportable birth defects.  Wilson, President of Organisation Intersex International Australia, reports that her review of the most common kinds of Intersex variations listed in the New South Wales, Victorian and West Australian birth defects registers range between 13 in 1000 and 18.3 in 1000 live births; i.e. 1.3-1.8% of live births (pers. comm).    Blackless et al. (2000) reviewing the international medical literature from 1955 to 2000 conclude the frequency may be 2% of live births; Fausto-Sterling points out that incidence is not uniform throughout the world, and may be increasing (2000: 51-54).

 

 

Sex and Gender Diversity as Social Determinants of Health

A person’s experience of health and wellbeing is affected by more than just their genetic predisposition to certain health conditions, their exposure to pathogens, and their health and hygiene practices.  In many respects, social factors such as income, education, and belonging to stigmatised minorities are just as important.  Such factors are known as the social determinants of health.

According to the World Health Organisation, the social determinants of health are the conditions in which people are born, grow, live, work, and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries(WHO 2012).

People of diverse sex and gender have in the past experienced, and continue to experience, prejudice and discrimination in society in general and in their access to health services and in the way they are treated by health services.  Members of any stigmatised minority group are subject to minority stress, which is the excess stress individuals experience as a result of their social position (Meyer 2003, p. 675).  This concept helps to explain the consistently poorer health that studies of sex and gender diverse people reveals.

Health and Wellbeing

Health and Wellbeing of People of Diverse Sex and Gender

Most general Australian health research has not looked specifically at people of diverse sex and gender, which makes it difficult to obtain accurate information about their health and wellbeing.  The 2010 National Drug Strategy Household Survey included sexual orientation, but not diverse sex and gender (AIHW 2010).  The National Health Data Dictionary lists permissible values for Intersex or indeterminate, but specifies that this term is normally used for babies whose sex has not been determined, and should generally not be used on data collection forms completed by the respondent  (AIHW 2010, p. 1465-1466).  It acknowledges that a person’s sex may change during their lifetime due to sex or gender reassignment, and that this process may take place over a considerable period of time.  However it envisages the person’s sex would still be recorded as male or female (AIHW 2010, p. 1466).  The Alliance is working proactively to have diverse sex and gender included in all routine data collections.

 

The first study to comprehensively include people of diverse sex and gender was the Private Lives study.  Carried out in early 2005, it aimed to document aspects of the health and wellbeing of a large sample of Gay, Lesbian, Bisexual, Transgender and Intersex (GLBTI) people in Australia, to explore the impact of factors such as homophobia, discrimination, family and community connection on health and wellbeing, and to investigate aspects of health service use. In all, 5476 people between 16 and 92 years of age (mean age 34) with a broadly representational spread of participants from all states and territories, completed the on-line survey (Pitts et al. 2006, p. 8).  There were 100 transgender and 18 intersex participants; the initial forced choice of a male/female gender caused some people not to participate (p. 18).  Some data was analysed by categories which included Trans males, Trans females, Intersex males, and Intersex females.  In terms of general health, trans people scored slightly below average, and intersex people scored substantially lower (p. 28).  Other results can be seen in the report, which recommended more targeted research with transgender and intersex people (p.65).

 

The most comprehensive information on the health and wellbeing of transgender people comes from research sponsored by the Faculty of Health Sciences at La Trobe University, and Gay and Lesbian Health Victoria.  Called ‘TranZnation’, the report found that the ratings of general health of the 229 respondents from Australia and New Zealand were lower than the general population (Couch et al. 2007, p. 7).  The rates of depression and suicidality were much higher than for the general population, with one in four respondents reporting suicidal thoughts in the two weeks before they completed the survey (p. 27).   Most participants had experienced at least one form of stigma or discrimination on the basis of their gender; almost a quarter had been refused services, and 19% had been physically attacked (p. 60).

 

Private Lives 2, the second national survey of the health and wellbeing of GLBT Australians carried out in 2011, had 4.4% of respondents identifying as transgender (up from 1.8% in Private Lives 1) and nearly 41% of these people see their gender in non-binary terms, such as genderqueer.  The most commonly reported health conditions were in the area of mental health, with trans* people reporting much higher rates of depression, anxiety and other psychiatric disorders than non-trans people.  Rates of almost all types of physical and non-physical abuse were higher for trans people than for lesbians and gay men.  Trans* people also had significantly lower rates of screening than other respondents for cervical, breast and prostate cancers.

 

The National DSG Health Roundtable identified a list of the most important and most urgent health issues facing Australians of Diverse Sex and Gender as the basis for a national plan of action.  See the report, Health Priorities of Australians of Diverse Sex and Gender – A National Plan of Action, [coming soon].

 

The health concerns of Australians of diverse sex and gender have generally been neglected in research and policy, but have lately been receiving more attention, from governments, researchers, LGBTI organisations, and service providers.  The National LGBTI Health Alliance has made this a priority and is increasingly involved in promoting the health and wellbeing of this particularly vulnerable group.

 

Our Work

Our Work

 

Australia’s first National Diverse Sex and Gender Health Roundtable was held on 18-19 June 2012, in meeting space kindly provided by the Australian Human Rights Commission in Pitt Street, Sydney.  Intersex, Sistagirl, Trans men, Trans women and Genderqueer people, as well as others working on their behalf, from every state and territory met together to address the following questions:

 

 

  • What are the issues facing Australians of Diverse Sex and Gender?
  • Which of these issues are the most important and need to be addressed urgently?
  • What concrete outcomes do we want to see in relation to these issues?
  • What practical steps are we going to take, at a national, state/territory, and local level, to achieve these goals?

 

A program of action was developed in three broad areas: health and medical, legal and regulatory, and social services, with substantial agreement on the main priorities, which included access to appropriate health services; education, training and research; social support for people of diverse sex and gender and those around them; protection from discrimination; and issues around recognition and registration of gender identity and sex.

 

A document outlining the issues, concerns and priorities, and the concrete actions and strategies required, is now being prepared.  It is intended as a blueprint for ongoing action, as well as a comprehensive resource to inform meetings with MPs, departmental officers, the media, and other decision-makers and interested people and groups.

 

Perhaps just as important was the personal impact on those who participated.  Many were profoundly moved by the opportunity to share with others, to make connections, and the feeling of unity and collaboration in pursuit of common goals.  People were informed, encouraged, inspired, challenged, and energised.  One participant summed it up as follows:

 

"I feel so grateful to live in a time and age, as well as a country, where this group was even possible.  I am inspired and encouraged, and I return to my community excited and even more passionate."

 

 

 

 

Working Groups

The Alliance is committed to broad LGBTI representation in all of our work, across all policy areas.

The Commonwealth Department of Human Services established an LGBTI Working Group in 2011.  There are 5 Alliance representatives in the group, including an intersex woman, a trans man, and a genderqueer person.

Diverse Sex and Gender Working Group

In 2011, the Alliance formed a Diverse Sex and Gender Working Group, which is responding to immediate issues and  developing a plan for the medium term improvement in the health status of DSG people in Australia.  There will be a face-to-face meeting of the group in Canberra in June 2012.

Media Releases

 

 

Submissions

 

 

This overview has been drafted by Sujay Kentlyn (Health Policy Officer) with input from Warren Summers (Membership and Information Services Officer) National LGBTI Health Alliance. 2012