Ab Ovo - The Psychology Podcast

PRIDE month special: Transsexual, transgender, transition.

In this episode, I discuss issues related to gender incongruence.

You can catch me on:
🐦 Twitter at https://x.com/abovotherapy
📸 Instagram at @kkoz_official
💼 LinkedIn at https://www.linkedin.com/in/k-koziara/
📚 ResearchGate at https://www.researchgate.net/profile/Karolina_Koziara

Duration:: 26m
Broadcast on:: 24 Jun 2024
Audio Format:: mp3

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If you listen to this on YouTube or Spotify or Apple, you are more than welcome to comment and write questions you have or write what kind of issues are interesting for you. And I will do my best to find sources and publications to talk about it. And now, let's go to the episode. In this episode, I want to continue the Pride Special series and tackle the issue of trans people. So I will discuss who transgender people are and who they are. Not as well as the most common misunderstanding regarding transgender people. To get a glimpse of what I'm talking about, I will start with a very broad definition of the term transgender. This is often referred as an umbrella term, meaning that this is a very general notion that covers many smaller terms. Transgender in a broad understanding includes all the people whose gender identity, so the way they feel, and/or gender expression, so the way they look and behave is somewhat different from their assigned sex. And assigned sex or assigned gender is what is listed on our ID. And usually, in a vast majority of countries, we use binary identification. So when a child is born, they are assigned male or female based on their genitals. However, as we can imagine and as we probably know, the body is not always congruent with the mind. This broad definition is sometimes subject to criticism because it combines transgender people, transsexual people, sometimes transvestite people, drag queens, drag kings, and so on and so forth. And this gives the impression that all those expressions and identities can be unified, which is actually not true. By definition, I agree with the idea of treating transgender and transsexual people as completely different identities and queer people as different from the latter, etc. However, to make it easier to describe, we sometimes have to compromise and use simpler definitions to explain the basic concepts. So that's why I'm using transgender term and not introduce, at least right now, I'm not introducing much more complicated identities. And one of the most common pieces of misinformation I come across is the idea that transgender people are a recent phenomenon or kind of fashion, implying that there weren't any transgender people in the past. However, well, surprise, transgender people have been around as long as people themselves. Even in ancient civilizations, there were individuals who would be considered transgender today. Although, they were not called that because the term transgender has been in use for a little more than 100 years. But this doesn't mean that people displaying incongruence between their gender expression and assigned sex at birth did not exist before then. For instance, it is believed that Hatshepsut, I know you heard about Hatshepsut, but this is a far out of Egypt, who was born female, but served as a king and presented as male. And while this is not 100% confirmed, but after 3,000 years, Egyptology suggests it might be the case. What else? In Native American cultures, there are two-spirit people, male, female or intersex individuals who took on roles and activities traditionally associated with either men or women. Another example is the Bakan-sworn virgins, women who lived as men in places like Kosovo, Albania or Montenegro. And these people were not identified as transgender because this term is primarily used in Western societies. However, I mentioned them to illustrate that diverse gender expressions and roles have always existed and did not just emerge 20. Or 30 years ago. And I've spent several years working with transgender people, also with their parents, their partners, their friends, and the question that often comes out during the first session is, since this is a disorder, can this and should this be cured? Well, this is a kind of disorder that is not really a disorder, but first things first. It is true, DSM, the American manual for psychiatrists, previously included transsexuality. Now the names and diagnostic criteria have slightly changed and it recognizes gender dysphoria. However, yes, gender dysphoria is still in DSM. And gender dysphoria is also included in the ICD, the international classification of disorders and diseases used in Europe and in general in the majority of the world. However, there has been controversy surrounding its classification from the very, very beginning. I don't want to delve too deeply into the history, although it is fascinating and I recommend reading more about it. But what is important to know is that more than 100 years ago in Berlin, the guy named Magnus Hirschfeld founded the Institute for Sexual Science. This Institute provided medical and professional help to transgender people and allowed them what is quite interesting. More than almost 150 years ago, this institution allowed transgender and transsexual people to work there and to build a local community with complete affirmation from the doctors. Hirschfeld believed that an affirmative approach was necessary to guarantee proper and healthy mental and physical functioning for his patients and it was clear to everybody that this was the only way transgender people should be treated. But unfortunately, societal changes, world wars and pressure from the medical community, which was happening over the years, Hirschfeld and other progressive doctors to shift from this liberal approach to a more rigid and less affirmative one. And they developed criteria to distinguish true transsexual patients from cross dressers and other phony transgenders, which sounds brutal and humiliating. But even today some people and doctors still hold similar views about transgender patients. But anyway, the specialist experienced in working with transsexual patients created what we would now call a diagnostic criteria to allow at least some patients, those with most severe condition, with the highest level of suffering. So they wanted to allow at least those patients to undergo the transition process, including medical interventions to live as the gender they identify with. And before the last update of the diagnostic criteria, there was a long debate on whether gender dysphoria should be included. And the final decision was to keep the diagnosis in the DSM and in ICD as well, but to change and slightly losing the criteria. And the main argument for retaining gender dysphoria in the diagnostic criteria was that without it, insurance companies would not cover the cost of medical interventions, which would be detrimental to patients who would have to pay for everything themselves. And in some countries, patients must cover all interventions, cost anyway, but in others, insurance covers part or all of the expenses. And it is likely that the next update of diagnostic criteria, which will probably happen in a few, maybe 10, maybe 11 years, will eventually remove this condition. But we'll see. But the ironic and tragic aspect of this diagnosis is that you actually have to prove or at least you had to prove that gender dysphoria is not the result of another disorder. This sounds stupid as hell, but to be diagnosed as transgender person, you had to prove that you are mentally healthy. And still, this was mental condition because DSM includes only mental conditions. And this confusion adds to the misunderstandings among people unfamiliar with the history of psychiatric. Okay, so what are the current diagnostic criteria? In other words, who can be diagnosed with gender incongruence? Well, according to the ICD, gender incongruence is characterized by a marked and persistent incongruence between an individual's experienced gender and their assigned sex. And gender variant behavior and preferences alone are not a basis for this diagnosis. So this means that it's not a fleeting thought or a sudden decision, like waking up on Monday morning and deciding to change gender. Now, it doesn't work like this. There are often years of struggle. Sometimes people explicitly state that something feels off while others may spend long years feeling that something is wrong, but they don't really know exactly what is wrong. It's just the feeling that something something's not right, but it's not clear what is not right. And I remember people who came to me in their 40s, 50s or even 70s who had lived according to social norms, but never felt like they were living their true lives. So they were living, but it wasn't their life. So imagine someone who spent 30 or 40 years playing a role, they did not choose. A role which was imposed upon them. They played it because they felt it was the right thing to do, but it wasn't the right thing for them. And in therapeutic work, we often hear about suffering. We often hear about difficult situations, loss and tragic moments of people's lives. But there are also moments when we have the honor to observe people thriving. And after years of living in a closet, they can finally breathe and have the courage to be who they are. And this is kind of beautiful moments for us, as the therapy's as counselors. This is great to see that people finally come to terms with who they are. And they can finally really breathe and really leave. And additionally, it's worth noting that being a transgender person is not straightforward for many people. It's not always immediately clear and many people I know had to search for their identity. Some have a clear feeling that they were assigned male and they feel like 100% female, and that's the end of the story. But others spend years searching for answers because gender identity is quite complex. And it can take years to realize that they issue lives with the gender identity and not something else. And negating these experiences and the need to explore them causes a lot of suffering. And my job, as well as the job of other mental health specialists, is to make this process easier to support and accompany patients on their journey to find who they are. And it is extremely helpful when a patient's significant other like partners, parents, children, or siblings support and help us along the way. And another question that often comes up is whether every transgender person goes through the same process and medical interventions. In other words, do every patient want to have complete surgery including chest surgery and genital surgery? And first of all, it's not polite to ask people about their genitals unless we are medical doctors or we are genuinely interested in having sex with them. And second, the answer to the question is no, not every person who identifies as transgender wants to have all types of surgery. And according to my colleagues in my own research, some people want to undergo full transition. So it means they want to have hormone therapy, chest surgery, and genital surgery. But some people are willing to have only hormone therapy and chest surgery and others want to change their name, documents, and appearance, but they are unsure whether hormone therapy or chest surgery is necessary. So it very much depends on the needs of individual patients. But according to the diagnostic criteria, it is not necessary to undergo a complete transition process to be diagnosed with gender incongruence. So this is not the must-have anymore. So if you do not want to undergo complete surgery, still you can be diagnosed with gender incongruence. And someone might ask, doesn't this mean that people who do not want to undergo complete transition are non-binary? Well, not really, transgender identity and non-binary identity are not closely related to the medical process and surgery. And for those unfamiliar with the term, non-binary people are those who don't identify with any traditional gender, meaning they do not identify strictly as either men or women. There are other variants of gender identity, like, for example, bi-gender, gender fluid, and so on. But let's keep it simple and focus on transgender and non-binary people this time. So there are non-binary people who are interested in medical therapy and transition, but as with transgender individuals, there is a broad variety of needs. And identity itself doesn't determine the transition process, so these can be understood as kind of two dimensions. So one is identity and the other is gender expression and appearance. And each of these dimensions should be the subject of discussion with the mental health and medical specialist who takes care of the patient. And this ensures that the decision can be made consciously with the patient at the center of the process. So this is all the subject of discussion. This must be the subject of discussion and not doctor's decision. And parents who are in the process with their children sometimes ask, what if they change their mind? What if this is a wrong decision? Well, the diagnostic process is a long one. It's not done in a single session. These are usually hours of talking, analyzing patients' lives, relationships, family situations, and so on. And sometimes patients get angry because it takes so long. But if you are a parent of transgender child or a parent of someone who just came out as transgender or maybe gender fluid, trust me. If you have a good and responsible doctor whose experience in working with transgender patients, they will diagnose the patient, terrifically, and help them find the best pace of transition to improve their health, not to deteriorate it. And if you encounter a doctor who spends 15 minutes talking to the patient and gives a ready diagnosis, this is not a good doctor. So you should find someone trustworthy because 15 minutes or even an hour is not enough time to get a reliable picture of a patient. And I'm not saying that you can't see that someone is transgender or not, because maybe you can, because maybe people come to the doctor and say, well, I'm transgender, I know what it means, I know how I feel, I am a transgender patient. But yes, it is possible. But counseling, therapy, and generally leading a patient is not only the matter of writing a diagnosis or not. It is the process of trust, and this must be trust which goes both ways, so the patient has to trust a doctor and the doctor has to trust the patient. So this is about the relationship between a patient and a doctor, and it doesn't take 15 minutes to build it. So if you are a patient and you want to speed up the process, talk to your doctor about it and ask why it takes so long and try to listen to the arguments, because some changes are reversible, some are irreversible, and sometimes it's better to wait longer and be genuinely ready than to rush the process. However, if a doctor can't give you a good reason and keeps you without the diagnosis for too long, this might be an example of a so-called gatekeeping, where doctors keep patients in the diagnostic process longer than necessary without good reason. So this is not something I support either. The diagnostic process is very individual and delicate and each case is very different, but you have to talk to your doctor about your fears, about your anxieties, about your doubts and so on. And as we are approaching the end of this episode, I want to close this discussion and I want to address another important aspect of this situation, which is the involvement of family, significant others, parents, siblings, children, and so on. All coming out as transgender person is processed that affects the whole family. The transition process involves everyone in the patient's surroundings and it cannot go unnoticed. For example, as a person transitions, their beard may start to grow and their voice may change and people will notice it. And it's understandable that transgender individuals expect support from their families, but I always say that it is also important for them to understand their family's perspectives, such as those of parents or partners. And finally, it's often try to be supportive, but this support often comes with anxiety and fear about the future, about medical interventions, about potential social rejection, about friends who may turn away, and this is all the fears that parents are coming with to therapy sessions. And parents are talking about it. And I usually ask transgender patients to expect support from their families, of course, but also try to support their families too, because they all need each other and they all need each other support. And I know it all sounds straightforward when I talk about it, but these are often difficult and extremely tough situations for everyone involved. And there is a lot to process on both an individual and family level, and it's not always possible to provide support to the whole family, unfortunately, but if it is possible, please encourage your parents, partners, friends to seek support, as they might need help at some point too. And to finish this episode, I want to tell you that I know this is a very simple presentation of transgender issue, and gender identity is generally a much more complex issue, but if we delve into details, I would need weeks to cover everything. And I promised to return to this topic in the future discussion, but this time I wanted to introduce the issue as simply as possible, knowing that many of you might be new to this topic. So if you have more questions or if you maybe you've heard something about transgender people, you're not sure whether it's true or not, so don't hesitate to write me an email or a message or a comment I will try to answer, I'll try to do my best to clarify everything that might be bothering you. And for now, thank you for listening, and until next time, take care! (Music) With the Lucky Land Sluts, you can get lucky just about anywhere. We are gathered here today. Has anyone seen the bride and groom? Sorry, sorry, we're here. 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