Ct-Tg-community · Eastern Connecticut Transgender Support
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Ct-Tg-community North Eastern Connecticut Transgender Support is about the special health concerns of transsexual people.
Those who want to change their bodies to be like the other sex. The process
of changing the body, through hormones, surgeries, and other means, is commonly
referred to as "transitioning." Transgendered people are a diverse group,
including people who feel a strong identification with the other gender;
people who cross-dress occasionally or regularly; and people who actually
change their bodies to look and feel more like the other sex. People whose
genes, genitals, or reproductive organs aren't clearly male or female are
intersexual. To learn more about intersexuality, visit the Intersex Society
of North America website. What does transsexual mean? Why do transsexual
people have special health concerns? Emotional issues for transgendered and
transsexual people Frequency of mental health problems in transgendered people
Medical issues for transsexual people Gender identity and youth What does
transsexual mean? Transsexuals are persons who identify so strongly with
the other sex or gender (biologic females who identify as men and vice versa)
that they change their bodies, through hormones and sometimes surgery, to
look and feel more like the other sex. Following transition, transsexual
people often function quite normally in society in their sex of reassignment,
and often those around them do not know that they were born the other sex.
They may be straight, lesbian, gay, or bisexual -- gender identity is neither
the same as, nor is it necessarily related to, sexual orientation. Biologic
females who transition to live as men are also called transgendered (transsexual)
men or FTM (female to male). Biologic males who live as women are called
transgendered (or transsexual) women or MTF (male to female). Why do transsexual
people have special health concerns? Transsexual people face a unique set
of emotional health issues. Living in a body that feels foreign, and being
perceived widely as a gender that feels wrong and unnatural is enormously
challenging. In addition, the process of transitioning to the other sex brings
up a myriad of specific challenges, some anticipated and others harder to
predict. Transsexual people typically take cross-sex hormones throughout
their lives and they may also undergo surgeries to change their bodies. Both
the hormones and the surgeries can have specific health effects that need
to be acknowledged and monitored to maintain the good health of a transsexual
person. Emotional issues for transgendered and transsexual people Persons
who are contemplating the process of transitioning from male-to-female (MTF)
or female-to-male (FTM) may encounter a range of emotional reactions both
in themselves and among those around them. Some of these reactions may be
anticipated and prepared for; others may be unanticipated and difficult to
manage. From a very early age, our culture makes a large and specific set
of assumptions about individuals based on perceptions of gender. Sex role
socialization is a powerful force that our culture uses to define "appropriate"
and "inappropriate" boundaries and activities for each gender. Transgender
individuals often experience anxiety and stress as they attempt to fit into
a gender role that may match the outward appearance of their physical body
but not their emotions or their more internal sense of their gender. Relief
The decision to transition is often the result of a long and difficult process.
Many transgendered individuals identify a sense of great relief that comes
with finally being able to acknowledge their true selves and live in the
body and gender role that is most natural for them. Transgendered people
often feel enormous satisfaction at watching their bodies change with hormone
treatments and surgeries, and at being seen by others as they feel themselves
to be inside. Although societal acceptance of transsexual and transgendered
people is far from complete, there is a growing and active community of transgendered
people, both MTF and FTM, particularly in the coastal areas of the United
States. There are also increasing numbers of books and online information
and support for people transgendered people. Difficulties The transitioning
process can also bring with it a new set of difficulties (and sometimes dangers)
that result from the reactions of acquaintances, loved ones and the larger
society to the transitioning process. New problems that may arise include:
* Employers and colleagues who are not prepared for, understanding of or
sympathetic to the issues of transgendered individuals. Many individuals
find themselves either fired from their jobs or facing workplace hostilities
that force them out of employment. The risk that individuals will experience
acts of hostility and even violence directed against them is real. * Family
members and friends who are not able to understand or accommodate the change
process. Many transgendered persons begin the transition process long after
they have married and raised their own families. Spouses, domestic partners,
parents, children and close friends may be confused by the transition that
is occurring and will need education and support to help them deal with what
is happening. Some relationships end; others are able to survive the transtioning
process. Sometimes children remain emotionally close to the transitioning
parent; at other times children have taken years to reconcile with the transitioned
parent, if they ever come to terms with the issue at all. Most importantly,
the person who is in the midst of transition her or himself may be surprised
at the feelings that emerge during the process. Being able to identify and
work with a counselor or therapist who has expertise in transgender issues
is critically important as the individual begins to explore the realities
of becoming more fully themselves. Individuals socialized and seen their
whole lives as male may experience significant difficulties as they begin
to live and function as female, and visa versa. The journey across the gender
divide is rarely an easy one. The combination of physical and emotional issues
that can emerge can make the transitioning process a time of increased stress
and risk for symptoms of depression, substance abuse, and anxiety. Despite
this reality, most transgender individuals report that the joy they experience
in becoming more fully themselves makes the journey worthwhile. Frequency
of mental health problems in transgendered people While research is scant,
transgendered persons appear to be at similar risk for mental health problems
as other persons who experience major life changes, relationship difficulties,
chronic medical conditions, or significant discrimination on the basis of
minority status. * Depression There is some evidence that transgendered persons
may be less likely to seek treatment for depression-fearing that their gender
issues will be assumed to be the cause of their symptoms, and that they will
be judged negatively. Because of these and other factors, depression associated
with gender transition may be underdiagnosed. * Victimization and Post Traumatic
Stress Syndrome (PTSD) Many transgendered persons experience some form of
victimization as a direct result of their transgender identity or presentation.
This victimization ranges from subtle forms of harassment and discrimination
to blatant verbal, physical, and sexual assault, including beatings, rape
and even homicide. The majority of assaults against transgender persons are
never reported the police. A link between these experiences and mental health
disorders such as Post Traumatic Stress Disorder (PTSD) is widely suspected,
but has not been adequately documented. * Suicide and self-harm Both suicide
attempts and completed suicides are common in transgendered persons. Studies
generally report a pre-transition suicide attempt rate of 20% or more, with
MTFs relatively more likely to attempt suicide than FTMs. There is some evidence
that transsexual people are less likely to attempt suicide once they have
completed the transition to the other sex. Another form of self-harm in transgendered
persons is genital mutilation. This is most common among transsexuals, although
cross-dressers have done this as well. A 1984 study of a cohort of transgendered
individuals who applied for services at gender identity clinics reported
genital mutilation by 9% of the biologic males and breast mutilation was
attempted by 2% of the biologic females. ..........................................
Depression and Transgender Issues Persons experiencing gender dysphoria do
not necessarily experience depression; however, my experience is that transgender
people highly conflicted about making a fulltime gender transition or who
have started a fulltime transition are at a greater risk of becoming depressed
then the average person. The complex problems associated with gender transition,
coming out, fears and anxiety, and uncertainty about the future all place
a tremendous strain on a person's coping ability. When problems such as social
intolerance, discrimination, under-employment and unemployment, and rejection
by loved ones occur, coping skills often are overwhelmed. Social support
from a transgender support group, friends and family can help to prevent
an emotional collapse; however, transgender persons are sometimes isolated
or isolate themselves from potential sources of support. The result can be
loneliness, depression, alcohol and drug abuse. Suicidal thinking can occur
when the emotional suffering is intolerable, when the suffering and the problems
do not seem to have any resolution, and the person feels hopeless about the
future. Suicide risk is often greater when suicide is viewed in a positive
light, and when the person does not believe there are any significant reasons
to continue living. What are the symptoms of depression? Depression is a
disorder of mood where one feels sadness or irritability, a loss of interest
and pleasure in activities in life, a loss of energy, and disturbed sleep.
Symptoms last for at least two weeks more days than not, and cause some degree
of disturbance in normal ability to function. Additional symptoms often include:
feeling tired and lethargic. poor attention and concentration. inability
to sleep normally or sleeping too much of the time. a loss of appetite or
eating more than normal. hopelessness. negative self-esteem. loss of sexual
libido. thoughts of death or suicide. How do I know if I am depressed? If
you have 4 or more of the above symptoms for two weeks or more, and this
cluster of symptoms is disturbing your ability to function to some degree,
then you may have a depression that needs treatment. Do not assume that depression
is a normal reaction to gender dysphoria or gender transition. It is not.
Depression should be targeted for treatment in addition to any counseling
you may be receiving for gender identity issues. There is no medical test
for depression. Depression can usually be easily diagnosed by an experienced
psychotherapist, psychologist, or physician. .............................................
http://www.gendercentre.org.au/58article9.htm Health Report - Depression
& Transgender by Gianna E. Israel Depression is the leading mental health
issue faced by transgender persons. However, unless a client or reader’s
depression has progressed to crisis proportions it is the subject I am least
likely to receive questions about. Depression is also the leading mental
health issue faced by those who do not have a transgender identity. With
this knowledge it should be clearly understood that when transgender persons
are depressed, it does not mean that having a transgender identity or fulfilling
one’s crossdressing needs is pathological, mentally disordered or medically
diseased. Both transgender and non-transgender populations are equally unlikely
to receive treatment for depression. This is tragic, because depression is
one of the best understood mental illnesses, with recognizable symptoms and
effective interventions. People do not seek treatment for a variety of reasons.
Some individuals allow themselves to suffer tremendous pain, believing that
obtaining help is shameful or a sign of weakness. Typically these persons
have bought into the notion that mental health issues are stigmatizing or
less important than medical conditions. In other words, people are more likely
to seek treatment after contracting a painful, sexually-transmitted disease
than get help for depression. It does not seem to matter how much emotional
turmoil the person is suffering. Within both populations, there also exist
numerous persons who recognize that they are moderately to severely depressed.
Some of these individuals do not seek treatment because they believe it will
be ineffective or they are suspicious of the medical and mental health professions.
Because transgender persons continue to be discounted, misdiagnosed or characterized
as pathological, particularly by professionals unfamiliar with gender identity
issues, it is understandable that some will feel hesitant in seeking support
for depression. This concern is an important dynamic in supporting transgender
persons. I will address it after providing basic information about depression
itself and how it is identified. Depression is a mood disorder characterized
by extended feelings of sadness, loss, restlessness, discouragement, hopelessness,
self-doubt and guilt. These feelings are often accompanied by noticeable
changes in a depressed individual’s regular sleeping, eating and sexual habits.
They are also likely to have changes in self-perception, think negative thoughts
on an on-going basis, have difficulty making decisions, and sometimes, contemplate
self-destructive acts. Their emotions typically swing sharply between feeling
angry, sad, melancholic or moody. Depression is not about having one or
several isolated bad or low-energy days; its about feeling badly and having
an emotionally poor quality of life, day after day, with no hope of relief
in sight. The preceding description reflects the state of mind that characterizes
depression and lends understanding to why people do not seek treatment.
The more severe the depression the more limited an individual’s ability
to think realistically or recognize options which might improve their quality
of life. Simply stated, most depressed persons routinely discount treatment
options until everything else has failed. This type of “clouded” judgment
also frequently slows the resolution of gender issues. Depressed transgender
persons frequently feel compelled to move ahead in their transition without
seeking adequate support. Also, in order to gain acceptance and reduce emotional
turmoil, they may disclose their transgender issues without having taken
into account potential consequences or its effect upon others. It is well
documented within professional literature that depression can be caused by
either one or a combination of medical, psychological or circumstantial factors.
As a result there are a variety of treatment approaches which are designed
to address this disorder. Therefore, while it is a positive step for people
to acknowledge they are depressed, deciding ones’ own course of treatment
or self-medicating is irresponsible and dangerous. A professional familiar
with the treatment of depression should be consulted. In some circumstances
anti-depressant medications may be useful, particularly when an individual
is in crisis or experiencing debilitating emotional pain. Most anti-depressants
are designed to take the edge off of the extreme lows or sharp mood swings
which accompany severe depression. They provide temporary emotional relief
allowing the individual an opportunity to build coping skills. Anti-depressants
vary in their recommended length of use and several also address depression-related
anxiety or manic-depression. Education within individual psychotherapy also
plays an important treatment role and may be coupled with medication.. In
learning about depression, people frequently feel that the tremendous pain
they are suffering will never end. Being reassured that despondent feelings
do resolve and that positive change is possible is an important part of
treatment. It is also helpful for people to find out that they are not alone,
and that there are numerous instances of successful treatment. Because depression
exacerbates social isolation, peer support or group therapy can provide
individuals with positive social contacts and an opportunity to hear how
others combat depression. It should be noted that in providing depression
treatment to transgender persons, there exist several dynamics which frequently
prevent persons from seeking help. As previously mentioned, transgender
persons routinely have been characterized as mentally disordered because
their crossdressing and gender identity issues seem unusual to non-transgender
persons. Regrettably such attitudes still exist today within the medical
and mental health professions, particularly in locations that do not have
access to up-to-date professional literature on gender identity issues.
Both care providers and transgender persons should understand that having
a transgender identity or individual crossdressing needs does not cause
depression; rather they are caused by experiencing seemingly unresolvable
social and circumstantial pressures. Learning effective coping skills which
concurrently resolve these pressures while preserving a person’s gender
identification is the correct approach in these situations. Transgender persons
also avoid treatment for depression because it is widely believed that in
order for treatment to be effective, both gender identity and depression
issues must be addressed at the same time. This is not always the case.
In some situations it is possible to provide symptom relief without having
to immediately deal with gender identity issues. Individuals may seek support
for their depression, stressing that they are not interested in discussing
gender identity issues until they feel safe doing so, if it should it become
necessary. Those who feel that disclosing their gender issues may prove
compromising or be met with negativity, may choose not to. Rather, they
can utilize the break from emotional anguish which is available through
traditional depressive-symptom relief to seek gender-specialized resources
for their crossdressing or gender identity issues. Having two care providers,
one who dispenses depression treatment and the other who offers gender-specialized
support is useful in many circumstances. This is particularly so when a transgender
person does not yet have a sufficient level of communication skills and knowledge
about gender identity issues to disclose to a helping professional unfamiliar
with gender identity issues. The interpersonal difficulties and social hostilities
which transgender persons experience can play a large role in causing or
aggravating depression. This is particularly true for individuals who are
coming to terms with gender issues without the assistance or awareness of
gender specialized resources. “Coming-out,” disclosure concerns, balancing
transition costs, social isolation, family rejection, and being single or
unable to find acceptance from a significant other, are some of the recognizable
sources of depression in transgender persons. Less frequently acknowledged
contributors to depression include; unresolved gender identity conflicts
in pre and post-operative persons, pre and post-surgical emotional adjustment,
poor body image and low self-esteem. Transgender hormone administration also
may play a causal role in depression. Because hormones are powerful chemicals,
an increase or decrease in dosage can bring on changes in mood. Transgender
persons and their physicians need to recognize that routine laboratory testing
of blood-based hormone levels helps insure that dosages are effective, yet
not so high as to create debilitating mood swings or dangerous medical complications.
Gradual changes in hormone dosages are a sensible precaution that provide
an opportunity for physical and emotional adjustment. Also, individuals who
are initiating hormone administration frequently are poorly prepared for
the emotional changes that go with it. These persons are encouraged to adjust
their thinking and seek support for their needs much as women do during menopause.
This is particularly so for transgender women who choose to cycle their hormones
so as to mimic the biological rhythms genetic women experience. Lastly, care
providers need to be aware that a lack of access to hormones also produces
high rates of depression, emotional mood swings, and occasionally suicidal
feelings. This is particularly so when public institutions, and medical or
mental health providers deny transgender persons access to hormones because
it is against policy or care provider staff are unfamiliar with gender identity
issues. Transgender persons should not be denied access to hormones or cut-off
from pre-existing prescriptions solely because a care provider is uninterested
in or unfamiliar with supporting transgender persons. Transgender hormone
administration is a routine medical procedure and transgender persons are
no less entitled to informed medical care than other patients. Transgender
persons can suffer depression caused by situations or disorders that are
in no way related to gender issues. Transgender persons need to recognize
this, and research treatment options before things reaching a crisis. It
is senseless for individuals to suffer from depression when successful treatment
options exist. In many circumstances severe and long-term depression can
be halted with early intervention. If you are a person suffering from depression,
start searching for help now and do not give up until you find it. Most gender-specializing
care providers are familiar with treatment and available resources. If you
do not have a gender specialist in your area, traditional mental health counseling
and psychiatric resources are listed in your local telephone directory. Lastly,
if you would like to read more about combating depression, most bookstores
and libraries have numerous professional and self-help titles available.
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