Gender Diversity Guide

Part 1: INTRODUCTORY SECTION

Resources:

AVMA & VMAE Journey For Teams
“Gender Identity” – Journey for Teams Module 13

Part 2A: GENDER IDENTITY RIGHTS, INTRODUCTION

Introduction- What is Identity?

The Oxford English Dictionary (2022) defines identity as either a)”who or what somebody is”; or b) “the characteristics, feelings or beliefs that make people different from others”. We know that there are a myriad of aspects to gender identity as a concept. But what about personal gender identity? How can this be understood? As human beings we are familiar both with the struggle to understand what is going on in other people’s heads and lives, but also to try to figure out categories to put ourselves and others in to better understand them. It is no surprise that people struggle when faced with the concept that they might not be able to understand someone else’s categories; and that there are unknowns which they must educate themselves about to understand. Even harder sometimes is the concept that their understanding and acceptance are not ultimately important to someone else’s choices.

Gender Expression

In trying to understand gender identity, outside perspectives frequently confuse this topic with gender expression. Gender expression (PFLAG, 2020) is the outward appearances and behaviors that telegraph gender to others. Gender expression can be stereotyped for members of the gender binary, but most stereotypes based on appearance and activities break down when examined more closely and may ultimately be performative (Butler, 1990). The reality is that the things that anyone thinks they know about gender expression are not universal for everyone. This is true for both gender diverse (Halberstam, 2017; Wilchins, 2019) and cisgender people (Halberstam, 2002).

Gender Identity

Transgender, non-binary and gender non-conforming people are placed in a paradox. Most have lived a life wearing an ill-fitting, poorly conceived identity that has been largely created by others and society and does not represent who they have always been. To break this mismatched reflection in the mirror requires an act fundamentally of sublime vulnerability and significant effort. The remaining question to answer by the individual for themselves is then what does ‘transition’ (Gallagher, 2021; Walker et al. 2022 ) look like (if they choose to go through with transition then or ever)? Transition is extremely important and joyful for so many because of the act of inhabiting ones’ true self- in whatever form that takes. Transition from the outside observer’s standpoint is an act of relativity in which the observer’s view shifts, but the perspective of a transgender, non-binary or gender non-conforming person is in many ways the same as it was when they first put together thoughts.

Gender identity (Barker et al., 2019) is often seen as falling inside or outside of the ‘trans umbrella’ although some groups may not agree with this. Transgender can be a binary gender term as there are transmen and transwomen, but people can be trans and also have other gender diverse identities. Non-binary consists of multiple genders all of which do not fall within a gender binary. Non-binary does not mean androgynous or gender ambiguous. Non-binary gender can have masc and femme aspects, have no gender, two or multiple genders or have other more cultural role variations. Genderfluid implies that gender identity for individuals can shift so that they oscillate between genders. This should be differentiated from gender fluid gender expression. Genderqueer (Barker et al., 2019; Kobabe, 2020) can overlap with non-binary or be considered its own identity blurring the margin of gender norms. Pronouns are chosen by the individual to reflect what they feel is correct, and certainly may change independently or along with gender identity category.

The gender baseline is non binary

The common understanding of transition presupposes that the ordinary state is binary. In many societies that has never been the norm. Even though globalized religions have told multiple indigenous cultures to shed a model of multiple genders, these cultures still exist. India has a catch all category of hijra (Singh et al., 2020) that captures multiple variations in sex and gender. Thailand has a third distinct gender class that is often mistakenly conflated with gayness (Käng et al., 2012). In Oaxaca, the muxe (Mirandé, 2014) exist as a third gender in Zapotec culture. Pasifika cultures in New Zealand, Samoa, Hawaii and other Polynesian countries have long established accepted transgender identities (Besnier, 2015). Native North American communities have adopted ‘two-spirit’ (Wilson, 1996), a term already in use for transgender people, non-binary and gender non-conforming people in some of these societies, as a general transgender identity term which encompasses other gender identity categories from many cultures.

Unseen Obstacles to Gender Identity

When you meet a transgender, non-binary and gender non-conforming person it is important to understand what potential barriers (e.g. Cicero et al. 2019; Brooks, S., 2020) to existing as gender diverse they may have experience with. These are often invisible to anyone else. (see Table 1).

Gender Euphoria

Much of the dialogue around gender identity in gender diverse people used to be framed by cisgender psychologists attempting to understand and frame the trans experience. They focused on concepts of gender dysphoria and body dysmorphia as key ingredients that define needs like social and medical transition. This presupposed, as had been done before with sexuality, that being gender diverse was a disorder. Those days are now past, although not long ago. The APA delisted ‘gender identity disorder’ in 2013 (Wiggins, 2020), and the WHO declassified it in 2019 (WHO ICD-11, 2019). Despite this, it is difficult to find providers who will prescribe hormones and do the associated blood test monitoring (Cicero, 2019). The price of hormones is also variable and not covered to the point where they are easily accessible to all socioeconomic groups globally (Koch et al., 2020). There are also ongoing rules that require doctor approval to go forward with gender affirmation surgery in order to have insurance coverage despite the median age of self-identification being 7 years old (Zaliznyak et al.,2020). Self-identification of gender (Gilleri, 2022) is also not a reality for the majority of global citizens and some individuals need court appearances with doctors letters to legally change gender markers. Exceptions include non-binary markers (Katri, 2022) on driver’s licenses and passports although rules vary highly based on location.

As opposed to gender dysphoria, gender euphoria (Jacobsen, 2022) is a gender diverse centered perspective. This is an experience of joy, radiance and wholeness that occurs when an individual has mental, sensory or physical alignment with their true self (Austin et al, 2022). Because human beings are complex and different, the ingredients necessary to feel at one with gender identity vary. Gender euphoria is something that cisgender people also feel (Beischel, 2022), sometimes for themselves and sometimes vicariously about others masculine or feminine nature. Although it is true that it is incredibly difficult to continue to occupy and be seen as the wrong gender, gender affirmation is driven by cumulative positive outcomes of correct lived experience (Tacit, 2020). As an aside, such limited effort has been placed on understanding gender euphoria over dysphoria that citations are limited. This is a sad statement on the pathologizing of gender diverse identity.

Conclusion

The most comprehensive lesson to be learned about gender identity is that it is as broad as human existence so not all aspects will make sense to everyone. With 20-40% of Gen Z identifying as LGBTQIA+ (Gallup Poll, 2021; Bond, 2021) of which ¼ are non-binary, the future will include many interactions with gender diverse people in the veterinary profession. Transgender, non-binary and gender non-conforming veterinary professionals are driven by the same dedication to animal health as everyone else.

References

‘Identity’ 2022. Oxford English Dictionary. Oxford University Press.
‘Gender Expression’ Dec 2020. PFLAG National Glossary of Terms. PFLAG.
Butler, J. (1990). b: Performative Acts and Gender Constitution: An Essay in Phenomenology and Feminist Theory. I Case Sue-Ellen (ed): Performing Feminisms: Feminist Critical Theory and Theatre.
Halberstam, J. (2017). Trans: A quick and quirky account of gender variability (Vol. 3). Univ of California Press.
Wilchins, R. (2019). Gender norms and intersectionality: connecting race, class and gender. Rowman & Littlefield.
Halberstam, J. (2002). An Introduction to Female Masculinity: Masculinity without Men’. Rachel Adams and David Savran, eds. The Masculinity Reader.
Gallagher, S. (2021). Affirmed: An Inclusive Guide to Medical and Surgical Transition.
Walker, M. & McGrath, M. (2022). ‘Gender Identity Emergence and Affirmation in Adults: Alex S. Keuroghlian, Jennifer Potter, Sari L. Reisner, eds. Transgender and Gender Diverse Healthcare.
Barker, M-J & Scheele, J. (2019). Gender, A Graphic Guide.Icon Books.
Kobabe, M. (2020). Genderqueer, A Memoir. Oni Press.
Singh, H., & Kumar, P. (2020). Hijra: An understanding. Journal of Psychosocial Research, 15(1), 79-89.
Käng, D. B. C. (2012). Kathoey “In trend”: emergent genderscapes, national anxieties and the re-signification of male-bodied effeminacy in Thailand. Asian Studies Review, 36(4), 475-494.
Mirandé, A. (2014). Transgender identity and acceptance in a global era: The Muxes of Juchitán. Masculinities in a global era, 247-263.
Besnier, N. (2015). Transgender in Polynesia. The International Encyclopedia of Human Sexuality, 1355-1404.
Wilson, A. (1996). How we find ourselves: Identity development and two spirit people. Harvard Educational Review, 66(2), 303-318.
Cicero, E. C., Reisner, S. L., Silva, S. G., Merwin, E. I., & Humphreys, J. C. (2019). Healthcare experiences of transgender adults: An integrated mixed research literature review. ANS. Advances in nursing science, 42(2), 123.
Brooks, S. (2020). Everyday Violence against Black and Latinx LGBT Communities. Lexington Books.
Wiggins, T. B. (2020). A perverse solution to misplaced distress: Trans subjects and clinical disavowal. Transgender Studies Quarterly, 7(1), 56-76.
Gender Incongruence. 2019. International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD-11; World Health Organization, 2019).
Koch, J. M., McLachlan, C. T., Victor, C. J., Westcott, J., & Yager, C. (2020). The cost of being transgender: where socio-economic status, global health care systems, and gender identity intersect. Psychology & Sexuality, 11(1-2), 103-119.
Zaliznyak, M., Bresee, C., & Garcia, M. M. (2020). Age at first experience of gender dysphoria among transgender adults seeking gender-affirming surgery. JAMA Network Open, 3(3), e201236-e201236. Chicago
Gilleri, G. (2022). Abandoning Gender” Identity”. AJIL Unbound, 116, 27.
Katri, I. (2022). Transitions in Sex Reclassification Law. UCLA Law Review (Forthcoming).
Jacobsen, K., & Devor, A. (2022). Moving from Gender Dysphoria to Gender Euphoria: Trans Experiences of Positive Gender-Related Emotions. Bulletin of Applied Transgender Studies, 1(1-2), 119-143.
Austin, A., Papciak, R., & Lovins, L. (2022). Gender euphoria: A grounded theory exploration of experiencing gender affirmation. Psychology & Sexuality, 13(5), 1406-1426.
Beischel, W. (2022). Gender Pleasure: The Positive Affective Component of Gender/Sex (Doctoral dissertation). Michigan State University.
Tacit, S. (2020). Joyful bodies, joyful minds: gender euphoria among transgender adults living in Canada (Doctoral dissertation, Memorial University of Newfoundland).
Bond, P. (2021). Nearly 40 Percent of Gen Zs, 30 Percent of Young Christians Identify as LGBTQ, Poll Finds. Newsweek 10/20/21. https://www.newsweek.com/nearly-40-percent-us-gen-zs-30-percent-christians-identify-lgbtq-poll-shows-1641085
Trevor Project. (2021). Trevor Project Research Brief: Diversity of Non-binary Youth.https://www.thetrevorproject.org/wp-content/uploads/2021/07/Diversity-of-Nonbinary-Youth_-July-Research-Brief.pdf

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Table 1- Potential Unseen Stressors on Gender Diverse Individuals

Race

Access to gender affirmation care
Inequality in quality of care provided
Increased risk of violent crime and murder, in particular for BIPOC transwomen
Increased risk of mistreatment and harm from law enforcement
Generational socioeconomic factors
Additional burden of discrimination, bias, microaggressions and stereotyping
Additional burden of job access and wage disparity
Additional burden of residual colonialism on gender identity

Home

Loss of shelter and family
Attempts at conversion therapy
Homophobia and transphobia
Internalized homophobia, transphobia and resultant self-loathing
Violence, including sexual violence
Psychological abuse
Forced outing
Detransition
Misgendering and incorrect pronoun use
Losing partners/children due to transition

Medical Settings

Denial of care for ‘medical conscience’, or ‘inadequate training’
Severely reduced access to providers
Inept medical management due to decreased training/experience
Physical and psychological abuse
Forced outing
Misgendering and incorrect pronoun use
Decreased access to routine preventative care
Lack of insurance coverage for procedures that provide increased safety
Limited hormone coverage

Public Settings

Worrying about safety with common settings like stores, restaurants, gas stations
Difficulty safely accessing clothing and accessories
Difficulty safely accessing cosmetics
Worrying about safety in changing rooms, bathrooms, pools
Worrying about having an emergency and people finding out gender identity
Worrying about chasers and those who seek to harm trans, non-binary and gender non conforming people in social settings

School Settings