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DR. WALTER BOCKTING: I’ll be sharing from both a scientific perspective as well as from
my over 20 years of experience working clinically as a psychologist with the transgender population.
A little bit about what we know about gender identity development and about mental health.
Next slide. I will be addressing the developments. I will be talking about some original research
we did here in Minnesota using the Internet to reach a national sample of the transgender
community and examine how stigma affects people’s mental health, and what some of the factors
are of resilience in coping with that stigma. And then I’ll briefly answer some recommendations.
Next slide, please. One very important thing to realize is that sex is not a simple construct;
that there are many different aspects of sex. And most of the time when a baby is born we
just look at the external genitalia, and based on that we assign a sex and raise the child
as a boy or a girl. But we know from working with children who are born with ambiguous
genitalia there are many different components, and you see them listed here.
And, I just want to point out the gender identity role, particularly relative to transgender
people as it differs from the sex they were assigned at birth, it is probably the most
important component, because this is how people end up identifying, this is how they basically
feel in terms of their gender identity. So when a child is born with ambiguous genitalia
we always want to make sure that we assign a sex that most likely corresponds with the
gender identity and role that really develops over time. At birth we are not sure about
that, but several years later that will then emerge.
But most transgender people are born with genitalia that were not ambiguous. We just
find out later that the gender identity differs from the sex that was assigned at birth.
The next slide, please. In this national study that we did, we asked people -- transgender
identified people -- to describe their transgender identity, and then we get a point of analysis
of that, and basically classify them in two different categories. One is people who really
describe their gender identity in a dichotomous way. So male to female transgender people
who described their gender identity as female; transgender man who identified their gender
identity as male. Also terms that were used were “formerly ***,” “a survivor
of transsexuality.” So these are people who very much identify with the other sex
and simply feel that an error was made somehow along the way.
Now, on the right side you see a number of different descriptions that really challenges
dichotomous thinking where people defined their gender identity outside of this dichotomous
understanding. So, for example, one person said: “I was born with female body, but
I am on the male end of the gender spectrum, but I am more than just male.” Or, one said:
“I identify as gender ***,” which is a term becoming more and more popular among
the younger generation, “I am female bodied, but not necessarily female in gender, and
possibly not male either.”
So we see that as we learn more and as the transgender community becomes more visible,
that gender is a spectrum. And where some people feel that they’re very much on one
or the other side of that spectrum -- male or female -- there are also a growing number
of people who put themselves somewhere in the middle of that spectrum, or who at least
recognize that being transgender is its own identity, and comes with a unique experience;
that it forms who they are and how they stand in the world.
The next slide, please. Oftentimes, the concept of gender role behavioral and gender identity
are conflated, so if there is a child, a boy, who likes to play with dolls, or a girl that
likes to play with cars and trucks, we’re not immediately talking about transgender
identity; no, we’re just simply talking about a boy who happens to also like dolls
or a girl who likes trucks. So that really operates on another level. But our characteristics
in terms of masculinity and femininity, first, is on a deeper level -- how we feel about
ourselves in terms of our basic gender identity as male, female or other.
We know from research that nonconformity in gender role is more common than nonconformity
in gender identity. And from children we know that about 4.8 versus 1 percent for boys,
to the smaller number for people who have gender identity that really differs from the
sex assigned at birth. And for girls those figures are 10.6 versus 3.5 percent. So many
more children are gender role nonconforming than children who really have a transgender
identity.
We also note that from the children that are gender role nonconforming that the majority
grows up to be lesbian or gay, and only a minority grows up to be transgender. And then
to make matters even more complicated, we know from working with adults that not every
transgender man or transgender woman reports that they were a feminine boy or masculine
girl at childhood. About half of the adult transgender people report that they were gender
role nonconforming at childhood. The other half was able to fit in, but over time they
realized that they cannot continue to live in the sex they were assigned at birth and
may need to express their transgender identity.
And you could say that there are, as a result, two different developmental paths. One is
a child who at a very early age has to deal with people’s reactions, noticing that his
or her gender is different. Whereas there are others who fit in perfectly, who oftentimes
hide and live in isolation until they bring this out at a later age. And this may have
different implications for how they cope with stigma and for their mental health.
Next slide, please. In terms of etiology, we basically do not know how gender identity
develops. There certainly is some research. There has been some research on environmental
influences, and there was some support found for separation anxiety among gender nonconforming
boys, and greater incidence of psychopathology among mothers of gender nonconforming boys.
But these results could not be replicated.
And in terms of the concerns that the mothers reported, it is also a question perhaps that
was in response to being concerned and the stress of having a child who was struggling
with their gender identity.
We know from research that prenatal hormonal influences affect gender role behavior, so
they affect masculinity and femininity. But they do not have a direct influence on gender
identity in the basic sense of being a man, woman or other gender. There is some research
that suggests that genetic factors may play a role, and there is more and more research
that focuses on the *** differentiation of the brain. And there are some people who
really liken gender identity as essentially as the sex of the brain. And some structural
brain differences have been found in the hypothalamus where the brains in that particular area of
transgender women were much more similar than those of non transgender women than they were
of non transgender men. So there is some preliminary evidence that this is in part about ***
differentiation of the brain.
Now, my own perspective is that gender is not binary. I think for most people the genderancy
lines up perfectly well with the sex we were assigned at birth, but then there are some
people who are in between. So you can think of this as an inverted bell curve, and I just
think it’s an expression of diversity that we see in most areas in life. And I think
the question to study how genderancy develops for all of us is a legitimate one. But really
to approach it as what went wrong for a transgender person, I think, is not the right approach
to take to this line of research in trying to understand the development.