Andrew Forshée

Most people take their gender for granted. Often this is reduced to two variables: (1) vagina = female/girl/woman or (2) penis = male/boy/man. A combination of both is considered socially noncompliant, and is often “made right,” via the mysteries of medical technology and the pressure of public codes of conduct. Adherence to the male/female binary is typically upheld, maintaining society’s comfort with expressions of femininity and masculinity. Yet, for many individuals, the nonchalant experience of gender as a “birthright” isn’t as clear-cut.

Definition of Terms

• The term “transgender” (trans) is often used to describe a wide range of individuals who transit socially and culturally defined categories of sex and gender, including, but not limited to, drag queens, drag kings, cross-dressers, and female-to-male (FTM) and male-to-female (MTF) transsexuals (Siragusa, 2001). 
• More specifically, “transsexual” (T or TS) refers to those individuals who feel that their physical bodies do not represent their authentic gendered self (Lev, 2004). While many transsexuals desire sex reassignment surgery (SRS) to actualize their identities, others choose to live their lives in their trans identities without surgical intervention (Lev, 2004; Vanderburgh, 2002).

Limitations of the Literature
The literature on transgender individuals is narrow. The literature on female-born male-identified men, or “transmen,” is nearly nonexistent. From personal rights to public accommodations, transpeople face tremendous discrimination in all areas of their lives. Recent studies indicate that transpeople are particularly vulnerable to high-risk behaviors, including homelessness and HIV/AIDS transmission. 

Service Availability
The availability of culturally responsive health and human service programming for transgender people is far from adequate. More specifically, there is a strong need for professionals to address the needs and treatment of transgender men: “Some transgender men still need to receive gynecological services or other health services because parts of their bodies remain subject to diseases” (Mottet & Ohle, 2003, p. 22). 

Avoidance of Services
Often, transgender men avoid obtaining needed human and health services. This caution is due to the fear of inadequate care, undereducated professionals, and the social stigma attached to accessing specific needs-based care (e.g., guys seeking pelvic exams and mammograms). Hence, providers should become increasingly sensitive to the broad range of clients, bodies, and experiences they may encounter, including those of transmen.

At Issue
Agencies that have clear policies and staff members who have an understanding of trans-related issues from academic, theoretical, and practical vantages contribute to a positive and culturally responsive setting for transpeople. However, health and human service providers must be willing to review and respond to their current policies and procedures, staff qualifications, and educational expertise regarding the treatment and care of transgender people.

Exploring the Needs
In an attempt to expand the literature, elucidate the perceptions of transmen, and avoid turning transpeople “into cardboard cutouts” (Devor, 2004, p. ix), I recently interviewed seven transmen about their experiences with human service professionals. 

Recommendations
Based on the outcomes of these interviews, I propose the following actions for social service agencies:

1. Review existing policies and procedures for trans-inclusive language, including anti-discrimination language based on gender identity and expression. If there are gaps in policy and procedure, take steps toward inclusion of transgender issues. 
   
   Remember, there is a distinct difference between “sex discrimination” (i.e., discrimination based on biological body parts) and “gender discrimination” (i.e., discrimination based on an individual’s perceived gender expression or identity).
   
   
2. Urge university and college health and human service departments to include trans-related topics into the standard curricula.
   
   Due to the tendency to “tokenize” differences, a one-day lecture or “tourist” approach to transgender-related issues should be avoided. Educate academic programs on the importance of trans inclusion in the development of courses and field experiences for students. 
   
   
3. Educate agency and program leaders, supervisors, line staff, and clients on transgender issues, including the differences in FTM, MTF, and intersex needs. 
   
   Each specific group has a distinct history, as well as a unique set of needs. Generalizing “transgender” as one grouping of people misses the point of culturally responsive human service practice.
   
   
4. Educate direct service workers on the unique histories, needs, and experiences of transgender people, including the difference in sexual orientation and gender identity. 
   
   Important to note is that transgender people actually have sexual orientations. However, don’t assume all FTMs or MTFs are heterosexual.
   
   
5. Stay open to hearing feedback from trans community members regarding their specific program/service needs.
   
   This recommendation may entail the improvement of some program areas or the creation of others. Sometimes this feedback may feel uncomfortable. Change often feels uneasy.
   
   

Programs taking time to consider the needs of transgender individuals from all aspects of their service delivery systems are more likely to gain trust and positive rapport from trans clients.

As with any clientele, when transpeople feel safe, welcome, and responded to, the likelihood that they will access much-needed services will increase. Similar suggestions are also supported by the Washington Transgender Needs Assessment Survey (WTNAS) (Xavier, 2000) and the Gay and Lesbian Medical Association (Dean, et al., 2000).

Most importantly, it is vital that health and human service workers understand that FTMs are “real men,” with unique and contextual histories, who happen to have female genitalia. It’s vital for professionals to have the important conversation about their inexperience or lack of knowledge regarding trans-specific needs.

Responding to a question about what human service workers need to know about trans clients, one interviewee stated:

Recognize that they need to have the conversation. And that it’s not transpeople’s fault that they need to have the conversation. It’s not my fault that you’ve gendered this situation unnecessarily. Or, if you’re uncomfortable with it. Don’t put that on me.

In essence, professionals must “do their own work” around biases, stereotypes, and misinformation regarding transsexual and transgender issues.

As Bornstein (1994) stated: “Gender identity seems to be an unspeakable thing in our culture, just as names are considered unspeakable in some other cultures. When it comes to work, we can ask. When it comes to sex and gender, we’re supposed to observe discreetly and draw our own conclusions” (p. 10).

Conclusions
Therefore, the best way to begin incorporating transgender perspectives into human service work is to ask. 

• Begin by accessing regional gay, lesbian, bisexual, transgender, queer, and intersex (GLBTQI) community organizations like Parents, Families, and Friends of Lesbians and Gays (PFLAG)) and local GLBTQI community centers.
• Read literature relevant to transgender topics, including current events on issues that impact transpeople. 
• Attend local GLBTQI events, such as a Pride Parade. Allies are usually welcome. 
• Ask for help, advice, training, and anything else that will dissolve the stereotypes, encourage meaningful connections, and allow the important conversations to begin.

Web Resources
Female-to-Male International (FTMI): http://www.ftmi.org/
Gender Education and Advocacy: http://www.gender.org/
Gender Public Advocacy Coalition: http://www.gpac.org/
National Gay and Lesbian Task Force: http://www.thetaskforce.org/
Parents, Families and Friends of Lesbians and Gays: http://www.pflag.org/
The Transitional Male: http://www.thetransitionalmale.com/

References
Bornstein, K. (1994). Gender outlaw: On men, women, and the rest of us. New York: Vintage Books.

Dean, L., Meyer, I. H., Robinson, K., Sell, R. L., Sember, R., Silenzio, V. M. B, et al. (2000). Lesbian, gay, bisexual, and transgender health: Findings and concerns. Journal of the Gay and Lesbian Medical Association, 4(3), 101–151.

Devor, A. (2004). Foreword. In J. Green, Becoming a visible man (pp. ix–x). Nashville, TN: Vanderbilt University Press.

Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. New York: The Haworth Press.

Mottet, L., & Ohle, J. (2003). Transitioning our shelters: A guide to making homeless shelters safe for transgender people. Washington, DC: National Gay and Lesbian Task Force Policy Institute/National Coalition for the Homeless.

Siragusa, N. (2001). The language of gender: A discussion and vocabulary list for educators on gender identity. [Brochure]. New York: Gay Lesbian Straight Education Network (GLSEN).

Vanderburgh, R. (2002). But isn’t it just cosmetic surgery? Retrieved October 10, 2003, from http://www.transtherapist.com/

Xavier, J. M. (2000). The Washington, DC transgender needs assessment survey: Final report for phase two: Tabulation of the survey questionnaires, presentation of the findings and analysis of the survey results, and recommendations. Washington, DC: Us Helping Us, People into Living, Inc.