Health services not reaching sex and gender diverse people

The demarcation of the population into male and female effectively excludes everyone who falls outside those boundaries. Frozen Coffee/Flickr

“Sex and gender diverse” is the umbrella term for a highly disparate, largely invisible and neglected group of people. The experiences of these people challenge the popular view that all people live in the gender that correlates to their sex parts at birth, and that sex and gender are unchanging and fixed. Still, these are common perceptions and they often lead to prejudice and violence.

The “sex and gender diverse” grouping includes trans - transgender and transsexual (including Sistergirls and Brotherboys, terms with which Indigenous trans people often identify) – non-binary gendered “genderqueer” and intersex people. Sex and gender diverse people are often thought to be a small minority. But a Thai specialist attending a recent Queensland conference noted that numbers might well be as high as one in 500.

Such figures are likely to be underestimates – many trans people adopt stealth (invisibility) strategies; many misrecognise their situation and are not identifiable for much of their life; many define themselves in ways not encompassed by the male/female binary; and many may not present for medical support in ways that make them visible.

Their circumstances and experiences are sparsely documented and poorly understood. There’s relatively little research at the population level, and almost no work that explores the diversity or dynamics of sex and gender-diverse experience.

Individual experiences are diverse, but many experience gender dysphoria, which entails a deep and persistent discomfort with the sex assigned to a person at birth. This may lead to a range of other physical and mental health issues.

A recent survey by ACT-based A Gender Agenda shows unemployment rates and poverty rates are substantially higher for this group than for the population at large, even among highly educated and qualified trans people. US data indicate that sex and gender diverse people face a wide range of discrimination.

Young sex and gender diverse people experience gender-based bullying at school, and like victims of bullying more generally, frequently struggle to engage in study. This results in poorer educational outcomes. There’s little reason to think the Australian situation is significantly different. Legal protection against such discrimination is, at best, patchy.

The ‘sex and gender diverse’ grouping includes trans - transgender and transsexual – non-binary gendered ‘genderqueer’ and intersex people. Coley Cheng

Despite some recent gains (such as those in relation to passports), sex and gender diverse people face significant hurdles securing identity documents that correspond to their lived gender. Many are “outed” every time they must produce basic identification documents. This has implications for their safety and makes them vulnerable to discrimination. Large numbers of trans people are socially isolated and experience difficulties accessing a range of support services.

While these issues have clear implications for well-being and health, they extend well beyond the province of medical service provision. Nonetheless, the health professions figure significantly in sex and gender diverse people’s needs. Core services include counselling support, psychiatric assessment, general practitioner and specialist medical (such as endocrinologists and gynaecologists) and in many (but not all) cases, surgical services.

Medical service provision for sex and gender diverse people is widely acknowledged to be inadequate; many have difficulties accessing appropriate health services. There are only a handful of specialist clinics located in major urban centres. And general practitioners, the most common first port of call for health services, appear to be under-informed, especially in rural areas.

This is not surprising given trans issues are missing from, barely touched on, or even misrepresented in Australian university health courses. Many sex and gender diverse people report strongly negative experiences of those services they do access. What’s more, many services crucial to sex and gender diverse people are not covered by Medicare.

There are other issues surrounding the terms on which health services can be accessed. International (WPATH) and national (ANZPATH) organisations working to ensure quality service provision have developed standards of care. But being trans is still widely regarded as a mental disorder, and access to treatment is regulated by assessment procedures that commonly impose narrow criteria, are demeaning and disempowering.

And this cultivates mistrust between clinician and client. Indeed, many genderqueer people don’t meet the criteria for some procedures they regard as crucial to their well-being since they can’t show that they clearly identify as a different gender to the one they were assigned at birth.

Trans and genderqueer people have a right to quality health care, as well as to the more general social and legal conditions that facilitate their well-being. They’re currently denied those rights and experience unnecessarily poorer health and other quality of life outcomes than most non-Indigenous Australians. Recognition and a better understanding of these issues will provide the basis for the provision of appropriate services across key areas of health, housing, employment, education and legal aid.

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