- M. J. GilbertM. J. GilbertUniversity of Minnesota
In this entry, transgender is defined in the context of ethnomethodology and social construction of gender. A history of the role of transgender people in the gay, lesbian, and bisexual rights movement is presented, including tensions concerning the role of transgender people in this movement. Issues regarding social work practice related to transgender issues on the micro, mezzo, macro, and meta levels are discussed.
- Clinical and Direct Practice
- Gender and Sexuality
- Human Behavior
- Populations and Practice Settings
- Social Justice and Human Rights
Definitions and Meanings
Transgender is an evolving term used to describe people whose gender identity does not conform to that assigned at birth. Transgender people have existed throughout history and across cultures, with varying levels of acceptance from the societies in which they have lived (Feinberg, 1996).
Transgender can best be understood within the larger context of gender—one of the fundamental bases on which we organize our social relations. We attribute gender (“male” or “female”) to every person we encounter, assuming that these are natural, rather than constructed, distinctions. Kessler and McKenna (1978) discussed how we create the social reality of a binary sexual dichotomy, ignoring or disregarding data that do not fit with it. Garfinkel (1967) posited the following as the “natural attitude” or social reality of gender. There are two, and only two, genders (male and female).
One's gender is invariant.
Genitals are the essential sign of gender.
Any exceptions to two genders are not to be taken seriously.
There are no transfers from one gender to another except ceremonial ones (for example, masquerades).
Everyone must be classified as a member of one gender or another.
The female and male dichotomy is a “natural” one (existing independently of anyone's criteria for maleness or femaleness).
Membership in one gender or another is “natural” (independent on anyone deciding what you are).
Transgender people transgress these fundamental assumptions (Meyerowitz, 2006). This explains why the emergence of transgender people has been controversial, and why they, like gay and lesbian people, have struggled to gain civil rights and public acceptance.
Using this framework as context, gender can thus be defined as follows:
… a determination of maleness, femaleness or ‘otherness', initially assigned at birth and then continuing throughout life. This assignment may be made according to genital or genetic type (often described as “sex”) or according to hormonal balance, secondary characteristics, dress, behavior or other culturally specific signals (Gilbert & Zemsky, 1999).
Transgender can be defined as follows:
… an umbrella term used to describe people who in some major way defy the “natural attitude” concerning gender, or whose gender identity or presentation does not match that assigned to them at birth. For some, this nonconformity may be transient or intended to reveal the performative nature of gender. For others, it may take the form of a decision to change their actual assignment through legal records, appearance, pronoun usage or medical intervention (Gilbert & Zemsky, 1999).
Transsexuals is an inclusive term made up of diverse subgroups: those who may or may not pursue hormonal or surgical intervention to make their presentation more closely match their gender identity; cross-dressers who may have a gender identity in keeping with their assignment, but who express aspects of their personalities by wearing clothing not associated with their gender; drag kings and queens who cross gender boundaries for purposes of performance (highlighting the performative nature of gender itself); genderqueer people, who actively seek to transcend the system of binary gender in which “male” and “female” are the only, and mutually exclusive options (Nestle, Howell, & Wilkins, 2002, p. 15).
Not included in this category are intersex people who are born with physiological or hormonal attributes that do not conform to a binary system. They expose the limitations of the natural attitude toward gender. Babies born with healthy and well-functioning genitals that do not conform to male or female anatomy are routinely subjected to surgical interventions to force their bodies into conformity, often resulting in chronic pain or inability to experience sexual pleasure. In recent years, there has been activism on the part of these people to change this practice (Intersex Initiative, 2007).
Transgender and the Gay, Lesbian, Bisexual Movement
Transgender people have played a major role in the gay rights movement, and yet have struggled for recognition within it. Transgender people initiated the seminal event in the modern gay rights history, the Stonewall riot in 1969. They were active in organizing early gay rights organizations. The early gay and lesbian movements rejected transgender people, however, seeing them as a threat to wider acceptance (Brown, 1999). Transgender issues were seen as irrelevant to gay and lesbian people. In radical lesbian feminist circles, transgender people were sometimes castigated as reinforcing sexist stereotypes and threatening women's identity, having not been raised and socialized as women, and through the way in which the requirement that transsexuals seeking medical intervention were required to “live in the social role” of their desired sex, a role that was seen as defined and constrained by the view of a patriarchal society (Raymond, 1979). This view still persists in some feminist thought (Ruby, 2000). Transgender people were excluded from the historic 1993 march in Washington. Not until 2001 did the Human Rights Campaign, the largest gay and lesbian rights organization in the country, amend its mission to include transgender people, affirm that it will only support federal Employment Non-Discrimination Act legislation that is inclusive of transgender people. They also launched a number of initiatives related to transgender rights (National Gay and Lesbian Task Force, 2007). Uninformed health professionals may associate transgender with psychopathology, which can result in poor care, inappropriate referrals to mental health treatment, and medical records issues that can be damaging (Lev, 2004).
Transgender and Social Work
An understanding of transgender people and issues is critical for social work on the micro, mezzo, macro, and meta levels. On the direct practice level, social workers work with transgender people across the life span. Transgender youth are at significant risk for harassment in school (Kosciw & Diaz, 2005), abuse, self-destructive behavior, and suicide (Brooks, 2005) as well as verbal and physical abuse in their families (Grossman, D'Augelli, Howell, & Hubbard, 2005). As adults, transgender people may require advocacy in getting their needs met with respect to health, mental health, and other social services. Aging transgender people have complex needs that have not been adequately studied (Witten, 2005). Social workers need to serve transgender people and their families in a manner that is informed, competent, empowering, and in keeping with the code of ethics.
On the mezzo level, schools, agencies, and social service organizations need to adopt policies and procedures that are sensitive to the needs of transgender people, including staff training, school dress codes, bathroom and other access issues. Risks include physical violence in schools (Kosciw & Diaz 2005), inability to access health-care services (Kenagy, 2005), and death, as in the case of Tyra Hunter, who died in 1995 from wounds suffered in a car accident when paramedics ceased treatment upon discovering she was a transwoman (Wright, 2001). On the macro level, transgender people are affected by a variety of legislative and policy issues. Six states currently have nondiscrimination statutes that explicitly protect transgender people (http://www.hrc.org). Beyond civil rights and employment protection, the ability to change birth certificates, driver's licenses, and school records can have a significant impact on quality of life and ability to obtain employment. Whether and how these changes can be made differs from state to state, and is often dependent on surgical status (Mottet, 2004). This can penalize individuals for whom surgery is not an option or a choice. There is also a significant risk of discrimination against transgender people in parenting and custody issues (Funatake, 2004). Serious barriers to health-care access among transgender people result in a number of risks, including the pursuit of black market hormones (Mottet, 2004), inability to meet basic needs, HIV infection, violence, and suicide (Kenagy, 2005). Transgender people in poverty face particular obstacles (Wright, 2001).
The inclusion of gender identity disorder in the DSM is seen by many transgender people as pathologizing, and the Harry Benjamin International Gender Dysphoria Association Standards of Care (Harry Benjamin International Gender Dysphoria Association, 2001), which are used by most professionals treating transsexuals, are seen by many as overly restrictive and paternalistic. (Lev, 2004, p. 49). The International Conference on Transgender Law and Employment Policy has proposed an alternative set of standards that emphasize self-determination of transgender people (International Conference on Transgender Law and Employment Policy, 2003).
Challenges and Future Trends
Transgender people challenge social work theory related to group membership and identity politics (McPhail, 2004). The presence of transgender people in the culture and the questions they raise call into question other socially constructed categories such as race and ethnicity. This postmodern perspective can conflict with notions of social justice founded on collective action to address oppression based on group identification (McPhail, 2004). Social work is thus challenged to recognize the role of identity in both oppression and liberation, and to consider alternative paradigms of empowerment. In the future, social workers will have a major role to play on every systems level, standing with transgender people as they work to change the ways that they are viewed and treated in clinical, health-care, schools, and other institutional settings, and advocating for policy and legal changes that impact the civil rights and quality of life for transgender people. Social work as a profession should come to acknowledge how the struggle of transgender people for dignity and acceptance is part of the mandate to work for social justice.
- Brooks, F. L. (2005). Transgender behavior in boys: The social work response. Doctoral dissertation, Simmons College School of Social Work.
- Brown, K. (1999). 20th Century transgender history and experience. Retrieved October 10, 2006, from http://jenelrose.com.
- Feinberg, L. (1996). Transgender warriors. Boston, MA: Beacon Press.
- Funatake, P. (2004). Transgender parents and custody. Retrieved April 19, 2007, from TransParentcy, http://transparentcy.org.
- Garfinkel, H. (1967). Studies in ethnomethodology. Englewood Cliffs, NJ: Prentice Hall.
- Gilbert, M. J., & Zemsky, B. (1999, October). Transgender. Training presented to Hennepin county social services, Minneapolis, MN.
- Grossman, A. H., D'Augelli, A. R., Howell, T. J., & Hubbard, S. (2005). Parent's reactions to transgender youth's gender nonconforming expression and identity. Journal of Gay and Lesbian Social Services, 18(1), 3–16.
- Harry Benjamin International Gender Dysphoria Association. (2001). Standards of care (6th version). Minneapolis, MN: World Professional Association for Transgender Health.
- International Conference on Transgender Law and Employment Policy. (2003). Health law standards of care for transsexualism. Washington, DC: ICTCEP.
- Intersex Initiative. (2007). Intersex Frequently asked questions. Retrieved April 19, 2007, from http://www.intersexinitiative.org/articles/intersex-faq.html.
- Kenagy, G. P. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health and Social Work, 30(1), 19–26.
- Kessler, S. J., & McKenna, W. (1978). Gender: An ethnomethodological approach. Chicago, IL: University of Chicago Press.
- Kosciw, J. G., & Diaz, E. M. (2005). The 2005 National School Climate Survey. New York: Gay Lesbian and Straight Education Network.
- Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. Binghampton, NY: Haworth Press.
- McPhail, B. A. (2004). Questioning gender and sexuality binaries: What queer theorists, transgendered individuals, and sex researchers can teach social work. Journal of Gay and Lesbian Social Services, 17(1), 3–21.
- Meyerowitz, J. (2006). Transforming sex: Christine Jorgensen in the postwar U.S. OAH Magazine of History, 20(2), 16–20.
- Mottet, L. (2004). Education and policy needs of transgender individuals. SIECUS Report, 32(4), 35–39.
- National Gay and Lesbian Task Force. (2007). Transgender issues. Retrieved April 19, 2007, from http://thetaskforce.org/issues/transgender.
- Nestle, J., Howell, C., & Wilkins, R. (Eds.). (2002). Genderqueer. Los Angeles, CA: Alyson Books.
- Raymond, J. (1979). The transsexual empire. Boston: Beacon Press.
- Ruby, J. (2000). Men in ewes' clothing: The stealth politics of the transgender movement. Off Our Backs, 30(4), 5–9.
- Witten, T. M. (2005). Aging and gender diversity. Social Work Today, 4(4), 28–32.
- Wright, K. (2001). To be poor and transgender—Treatment and problems faced by transgender persons. The Progressive, 65(10), 21–25.