In 2012 and 2013 Dr Clemence Due and I conducted two surveys, the first focusing on the health care experiences of Australian people who were female assigned at birth (FAAB) but who now identify with a different gender identity, and the second focusing on the healthcare experiences of Australian transgender women. Our analyses so far have adopted a comparative approach, primarily because most previous studies of transgender, transsexual or genderqueer people’s experiences of healthcare have not disaggregated findings by assigned sex. We thought that a comparative approach might thus be useful given that research suggests that transphobia is highly correlated with both homophobia and sexism amongst heterosexual, cisgender people (see Riggs, Webber & Fell 2009). These three forms of discrimination are related by the fact that the first two are about attitudes towards gender non-conformity, and the third measures how much an individual subscribes to social norms about (nominally cisgender) gender role conformity. Previous research suggests that transphobia (and cisgenderism more broadly) is gendered, not only in the sense that cisgender men are more likely to be transphobic than are cisgender women, but that people FAAB will experience transphobia or cisgenderism differently than will people male assigned at birth (MAAB). In undertaking a comparative approach, then, our hypothesis was that such differential discrimination would result in different experiences with healthcare providers between the two surveys.
In order to test if it was appropriate to group all responses from people MAAB together as one group, and to compare this with all responses from people FAAB, we first checked to see if there were any significant differences within each group in terms of current gender identity. In each study participants were asked to name their current gender identity. The three main categories used by participants within both of the studies were:
1. Affirmed gender (i.e., simply ‘male’ – used by people FAAB – or ‘female’ – used by people MAAB)
2. Transgender (this included terms such as trans woman, trans girl, trans boi, transgender man)
Statistical testing indicated that both within the surveys, as well as when combining the two samples into a whole, there were no significant differences in between those people who identified themselves using either their affirmed gender, the term ‘transgender’, or the term ‘genderqueer’.
In order to further ensure that focusing on differences between people MAAB and people FAAB was a valid approach, we also looked at whether there were other notable differences across the two samples. We found that:
1. Participants who were older were more likely to have undertaken sex-affirming surgery than participants who were younger,
2. Participants who were older reported more positive levels of mental health than did participants who were younger, and
3. Participants who had undertaken sex-affirming surgery reported more positive levels of mental health than did participants who had not undertaken surgery (as we had already found when looking solely at the first study, see Riggs & Due, 2013).
These initial findings suggested to us that it was possible that the main issue at stake across the samples was age. What we did, then, was control for age in our subsequent statistical testing. This enabled us to examine whether assigned sex (MAAB or FAAB) was a significant predictor of experiences. The answer was yes:
• Participants who were MAAB were more satisfied overall with the support they received from counselors, psychologists and psychiatrists than were participants who were FAAB,
• Participants who were FAAB reported more positive levels of mental health than did participants who were MAAB,
• Participants who were MAAB reported more positive experiences of gender-affirming surgery than did participants who were FAAB,
In addition to differences between participants MAAB and participants FAAB, there were other interesting findings. Some of these highlight areas in need of improvement by (nominally, though not in all cases) cisgender mental and physical health care professionals:
• Participants who reported higher levels of discrimination from health care professionals reported less positive levels of mental health,
• Participants who reported feeling that they frequently had to educate health care professionals about issues related to their current gender identity reported higher levels of discrimination,
• Participants who reported feeling that they frequently had to educate health care professionals about issues related to their current gender identity reported that they felt less respected by the professionals.
So what do all of these findings suggest to us? We of course acknowledge that this was a modest sample (78 people FAAB and 100 people MAAB), though these numbers are similar to those of the pioneering TranZnation report (2007), and they include participants from all Australian states and territories. The findings suggest the importance of taking into account both age and natally assigned sex. These demographics may impact upon people’s experiences due to differing:
• Diagnosis rates of ‘gender dsyphoria’ between people MAAB (0.005% to 0.014% of the population) and people FAAB (0.002% to 0.003% of the population),
• Societal gender norms and expectations of people FAAB and people MAAB, such that experiences of discrimination from the general population, from transgender communities, and from health care professionals will likely differ according to cisgender (and transgender) people’s assumptions about gender norms,
• Degrees of availability and successful outcomes of surgery as perceived by people MAAB when compared to people FAAB (though this is slowly changing, see Cotten, 2012),
• Understandings of gender identity within non-gender normative communities.
The report documenting the full findings is available at: http://www.genderidentityaustralia.com/?p=262
Cotten, T.T. (Ed.). (2012). Hung jury: Testimonies of genital surgery by transsexual men. Transgress Press.
Couch, M., Pitts, M., Mulcare, H., Croy, S., Mitchell, A., & Patel, S. (2007). TranZnation: A report on the health and wellbeing of transgender people in Australia and New Zealand. Melbourne: Australian Research Centre in Sex Health and Society.
Riggs, D.W. & Due, C. (2013). Mapping the health experiences of Australians who were female assigned at birth but who now identify with a different gender identity. Lambda Nordica, 5.
Riggs, D.W., Webber, K., & Fell, G.R. (2012). Australian undergraduate psychology students’ attitudes towards trans people. Gay and Lesbian Issues and Psychology Review, 8, 52-62.
Dr Damien Riggs
GPO Box 2100