Transgender Problems in Healthcare

While not all cultures view agender incongruence as abnormal, it is generally considered atypical in Western cultures, particularly in America. Third gender is widely accepted around the world, yet America has been slow in providing tolerance, much less acceptance towards those that fall outside male/female classifications, or those that wish to change from one sex to another.

Recently, more teenagers have been identifying outside the gender norm, preferring to classify as gender-fluid, non-binary, or transgender. Of Minnesota teenagers alone, 3% consider themselves gender non-conforming, a 2.3% increase in the last year. They also reported poorer mental health yet were less likely to seek treatment or therapy. This fact shows that gender-nonconforming people feel misunderstood and that their concerns are ignored. Understanding and listening, especially by doctors, can help make non-binary people feel more comfortable, raising mental stability and reducing situational depression. Normalizing atypical gender identity is important to the health of America as a whole.

Health insurance is a contributing factor towards transgender persons unwillingness to seek health care. Not only are many health-care providers not familiar with transgender or alternate gender issues, many insurance providers do not cover hormones, treatments or surgeries needed. Culturally relevant propaganda, resources and research materials are limited, resulting in higher STI rates for transgender women, especially HIV. Risky sexual behaviors contribute to this statistic but sharing of needles for hormones and even buying black market hormones also contribute. STI rates could be significantly lowered if providers were trained on transgender issues and appropriate resources were provided for transgender individuals.

In addition to unavailable resources, the stigma of being classified with a mental disorder also adds to transgender unwillingness to seek medical treatment. While the process has been slow, earlier this year the World Health Organization declared gender incongruence no longer a mental disorder. This new classification will induce more in-depth research on gender identity and the effects it has on health, both mental and physical. These studies have already begun, and the continuance of this research as well as acceptance by more healthcare providers will propagate a healthier transgender community, leading to a healthier society overall.

In order to understand the issues presented with gender incongruence it is important to understand how history has shaped humanity’s view of gender. The concept of gender identity was first hypothesized by Robert Stoller in 1968, who also viewed gender and sex as separate. Before that, gender norms were much different than today. Before the eighteenth century, there was only one recognized gender – male. Women were considered simply an incomplete and lesser version of a man. During the Renaissance, the idea of two separate genders began to emerge but was not substantiated until the early nineteenth century when Charles Darwin emphasized the psychological and physiological differences between male and female animals. The main basis for differences revolved around reproductive organs and gender became based on sex. These events shaped the social norms in Western culture.

Many other cultures acknowledge a third “nonbinary” gender. Polynesians refer to the third gender as Māhū, a cultural term for “someone in the middle”, or Raerae, which extends into transsexual individuals as well as non-binary. Māhū are given a special cultural status and most often revered. In India, the third gender is referred to as hijra. Though hijra have been culturally accepted for many years, though not with as high status as the Māhū, they have only recently been accepted by the Indian government as of 2017.

Although individual cultures may or may not accept more than two genders, science no longer supports the existence of only two genders. It has shown that not only is gender identity determined after sex organs begin to develop, but many other genetic markers play a role in gender determination as well. Studies indicate that gender identity may be partially shaped by prenatal hormones. Fetuses exposed to androgens such as testosterone have been shown to masculinize gender identity, whereas lack of exposure to androgens feminizes gender identity.

Maternal immune responses possibly shape male gender identity and sexual orientation as well. The fraternal birth order effect (FBO) is a finding that shows how men with multiple older brothers are more likely to be homosexual as well as display more classically feminine traits, raising the likelihood of opposing gender identity to that of biological sex. This research consequently also provides evidence of a physical link between gender identity and sexual orientation. Each older brother increases the likelihood of homosexuality by 33%. While the exact cause has not been pinpointed, studies show that mothers of gay sons have a higher concentration of antibodies to neurolignin 4, a protein that participates in synaptic functions, that has been linked to fetal brain development. This has led to a hypothesis specifically regarding the effect of antibodies on brain development of male offspring.

This research leads to other studies that show how gender identity is inherited. However, gender identity is polygenic, or linked to multiple genes, and even more that have yet to be distinguished, making it more difficult to determine exactly how it is inherited. Hundreds of genome sequences are hypothesized to be responsible for gender identity, and only a handful have currently been studied. Studies using monozygotic and dizygotic twins showed that at least one-third of variations in masculinity and femininity can be explained through genetic factors, meaning that up to two-thirds of variations can be explained through environmental factors. Things as simple as boys wearing pants and girls wearing dresses, or boys having short hair and girls having long hair are social norms that can be environmental factors that lay a foundation for which gender is expected to do what. But environmental factors are only part of what shapes gender identity. At approximately 50%, heritable traits of gender identity show similarity to those of behavioral and personality traits, which fall between 30 and 60%. While genetic research is still being performed, these heritable traits show significant evidence towards gender identity being innate rather than simply a choice.

Abnormal gender identities are simply another part of what makes the human race unique. So many cultures that Americans view as backward or “third-world” have accepted multiple genders beyond simply male or female, and yet America, the melting pot that accepts anyone has a hard time recognizing three or more genders or simply tolerates them. Acceptance of various genders is imperative to not only the mental health of society, but the physical health as well. Science has given reasons for more than two genders, and history has shown that various gender identities are not new. It is natural to be wary of things that one does not understand but lack of knowledge is not a good excuse for intolerance and stigma. Just like any other part of the human body, gender identity is a part of what makes humans unique. If people have spent the entirety of human existence evolving and learning about what makes them “them”, they shouldn’t stop at gender identity.