Category Archives: DSD and Intersex

Seeking Interventions for Transgender Sex Workers at Risk of HIV

A key population at risk for HIV within the worldwide epidemic response has been overlooked, according to a new study: transgender sex workers, along with their clients, have been missing from HIV national surveillance and program interventions. One reason could be that their gender is often misclassified.

The study “HIV risk and preventive interventions in transgender women sex workers,” published in July in The Lancet, took a look at the knowledge gaps regarding transgender women and prevention interventions.

According to the study, when a legally authorized gender or gender appropriate identification is absent, it can heighten the discrimination a transgender person may face, restricting their access to adequate healthcare, education, employment, and voting rights. The combination of discrimination and stigma restricts their economic opportunities. Some transgender women have turned to sex work as a result to fund a livelihood that includes fees for gender-affirming hormones, injections, and surgeries so they appear more feminine and can increase their earning power. Transgender sex workers also receive community support from their peers and gender validation from their male clients.

Seeking Interventions for Transgender Sex Workers at Risk of HIV Sex work puts them in greater harm. The study indicates:

  • These women face an increased exposure to violence, reduced rates of condom use and increased risk of sexual transmitted infection.
  • Transgender women detained or imprisoned in connection with sex work are often placed in male facilities which places them at sexual risk and drug injection.
  • They are reported to participate in high levels of drug use and the use is often associated with sex with their partners and clients.
  • Many transgender women have faced stigma and discrimination in medical settings. Also, their costly surgical interventions are not always covered. As a result, some transgender women will needle-share or use contaminated needles for hormone or silicone injections.
  • When achieving feminization, erectile dysfunction can occur and interfere with correct condom use.
  • The new vaginal lining of transgender women can be subject to micro tears due to mechanical and physiological factors.

HIV is primarily transmitted in transgender women through condomless intercourse with male partners, the study says. It also shows that these women might be more likely to engage in condomless receptive anal intercourse with stable partners than with clients as a way of expressing intimacy. However, this sexual activity has been linked to higher rates of substance misuse, low self-esteem and self-efficacy. Few transgender women ask about the sexual status of their stable partners.


The Online Sexual Education of LGBT Youth

Today’s youth gravitate toward the Internet to find information and what they find can alter their sexual development — this especially has a powerful effect among LGBT youth. Many of them come out online and explore their sexual attraction through this medium.

According to the study “Sexual Health Information Seeking Online: A Mixed-Methods Study Among Lesbian, Gay, Bisexual and Transgender Young People,” LGBT youth face challenges with the development of their sexual health when compared to their peers. They often lack the sexual health information they need because many school-based sex education programs seldom discuss LGBT health concerns and issues. Some parents still grapple with their child’s sexual identity, and that’s if they even know their child’s sexuality. The lack of awareness or unwillingness to discuss their child’s sexuality makes it difficult to aid their child’s sexual development. LGBT youth may turn to their peers for information, but they may face peer victimization. The limited availability of sexual partners also plays a role because it interferes their availability to properly explore romantic relationships in an appropriate context.

Gathering information online about sexual health has its pros and cons for the LGBT youth. For instance, the information may conflict, the quality may be poor and they may feel overwhelmed. However, they can find information when they need it, they have privacy, and it can lead them to offline resources.

Talk About It: Gay Men That Discuss HIV Less Likely to Develop It!

Researchers in the study decided to examine the positive and negative aspects of Internet use for sexual health information among LGBT young people. Ethnically diverse participants ranging between 16 and 24 years old completed interviews that asked how, where, and when they used the Internet for social, romantic, sexual, and informational purposes and whether the information helped or harmed their sexual health.

The researchers learned many of the participants were motivated by a fear of becoming infected with sexually transmitted infections and HIV. Some who avoided accessing sexual health information online were worried about stigma, or they didn’t think the information was relevant to them.

The researchers believe that their results suggests the Internet is having a largely positive effect on LGBT youth, and the Internet provides unmet opportunities for online interventions that improve the youth’s sexual health development.

Should Gay Men and Lesbians be Lumped Together?

Should Gay Men and Lesbians be Lumped Together? They’ve been put together for years by government agencies and advocacy groups alike. But lesbians and gay men often say that they have few things, if anything in common besides discrimination, prejudice, and the other things that come from societal marginalization and varying from the norm. Should we lump gay men and lesbians together?

We are now comfortable using the term LGBT. But some say even this term is out of step with the complex reality, the spectrum of human sexuality, as psychologist Erik Erikson classified it. We also have questioning, queer and intersex, making the new acronym LGBTQQI. These groups have their own culture, goals, values, and indeed different needs when it comes to healthcare. Gay journalist Anthony Lorenzo makes fun of the newest acronym saying, “We’ve had to start using Sanskrit because we’ve run out of letters.”

Canada has gone the extra mile, recently holding an event which it termed as its “annual festival of LGBTTIQQ2SA culture and human rights.” LGBTTIQQ2SA and festival attendees were defined as, “a broad array of identities such as, but not limited to, lesbian, gay, bisexual, transsexual, transgender, intersex, queer, questioning, two-spirited, and allies.” Two-spirited is a Native American term meaning “having more than one gender identity.”

LGBT finalIn terms of healthcare, there are cross overs. For instance, though the data is limited, most LGBT have a higher suicide rate, higher substance abuse rate, and suffer from elevated depression, anxiety and stress. Much of this is due to discrimination, harassment, prejudice, not being accepted by family, friends and their community, and trouble in relationships. But different aspects of the LGBT community are affected by different healthcare issues. For instance, the HIV epidemic is mainly a men who have sex with men (MSM) issue. Although anyone can catch HIV, this group has the highest propensity, along with transsexual women, and so should be more targeted in campaigns. Sexual reassignment surgery and hormone therapy affects transsexuals, but few others in the LGBT community.

As awareness grows, our language has to change, to become logical and still inclusive. Gay rights activist Paul Burston suggested to the BBC the acronym NQBHTHOWTB (Not Queer But Happy To Help Out When They’re Busy). Burston also offers the far more concise GLW (Gay, Lesbian or Whatever). Though humorous, Burston may not be far off, as the extended acronym alphabet soup is sure to drive people crazy and stir up controversy within and outside the community for quite some time to come.

Supporting a Partner going through Gender Transition

lgbt-health-wordleGender transition can be equally as stressful on relationships as it can before the individual. Recognizing and caring for the difficulty of this process can help maintain a strong relationship with a partner.

Immediately, understand they are going to feel a lot of stress. They may be questioning their decision, which can bring up issues from the past and other complex identity questions. It’s important for anyone whose partner is going through gender transition to be supportive and to show their support in a way that will help the partner feel soothed and loved.

Before your partner starts hormone replacement therapy, if you so have the option, research what side effects they may encounter. There are some myths even in the transgender community of how taking hormones will affect a person. For instance, some believe that taking testosterone will make one become aggressive or more libidinous. But in fact, they will mostly be the same person. Read up on reliable, medical websites, go to the doctor with your partner, do some deep research in the library and get all the facts. Make sure you know what’s true, and what is just a myth, because misunderstandings can cause communication problems. This is a time when you want to be supportive of your partner, not arguing with them.

Understanding TransgenderismSome worry that they won’t be accepted by friends, or the community, or won’t be able to related to self-representations in media because no community, characters or personalities will fit. Instead, make sure that your partner has the opportunity and support to reach out to the people that are closest to them. Invite them over. Have a party. Show support and love. Let them see and feel that it’s not the community they identify with but the people who are closest to them that will really matter, and who will really support them.

Be okay with your partner’s new identity. The transition is not instantaneous or full. But come to be okay with how they will be, intend to be, knowing the essential core components of who they are will always be there. Practice referring to your lover in the pronoun they prefer, and have them say it for themselves as well. Understand their family situation and be sympathetic. Be available to help them with any caregiving they need, including their injections.

If you really love your partner, embrace this phase of their life. Be sure to find out who your supportive people are and take of yourself as well.

Should Intersex Children be “Normalized”?

Should Intersex Children be “Normalized”? When a child is born with genitalia that is unclear, it’s standard medical practice to “normalize” the infant, but should intersex children have this operation before they can choose for themselves what gender they feel comfortable with? Disorders of sex development (DSDs) or being born without being clearly either gender specifically affects one in 2,000 newborn infants per year. The practice of assigning a gender to children, however, isn’t regulated.

The physician who generally “normalizes” the child decides by performing a surgery that intersex advocates, some doctors and advocates feel, is assigning an arbitrary gender which may or may not match the gender the person will feel inside as they mature. The patient may also endure physical problems like scarring, reduced sexual sensitivity, natural hormone removal, and possible sterilization from torn genital tissue.

Now the couple of an intersex child they adopted, the Crawfords, are suing the South Carolina Department of Social Services and the federal government for arbitrarily assigning their child the wrong sex while the child was in foster care. Though their adoptee was assigned to be a girl, it has always recognized itself as a boy and this duality has given the child and the family undue hardship.

The state suit officially claims negligence and malpractice on the part of both the SCDSS and the hospitals which performed the operation. The federal lawsuit states that the Social Services employees and the doctors violated their child’s 4th amendment right not to “deprive any person of life, liberty, or property without due process of law.” Advocates for Informed Choice an intersex civil rights group and the Southern Poverty Law Center support the Crawford’s suit.

Should Intersex Children be “Normalized”? The goal is to ultimately stop this from happening to more children, to get the medical establishment to create a protocol and oversight to protect intersex children from this horrific surgery.

There is a precedent that these suits are resting on; adults who endured sexual assignment surgery as infants spoke out as adults feeling as though they had been mutilated. In that same time period, a Johns Hopkins study found that reassignment of gender through “surgical reinforcement” proved disastrous. This was based on an earlier study in 1967 when psychologist John Money supposedly taught a little boy to be a girl after his penis had been destroyed and so was assigned to be a girl.

Today, fertility is one thing doctors take into account when assigning gender. But accidents do happen, ruining lives and hurting parents deeply. Hopefully this case will raise awareness on this issue and get the medical community to make it’s protocol on the issue uniform and clear.

Federal Health Plans now Cover Sexual Reassignment Surgery

Federal Health Plans now Cover Sexual Reassignment Surgery
Federal Health Plans now Cover Sexual Reassignment Surgery

One of the most important healthcare issues in the transgender population is sexual reassignment; this is when the person believes he or she was assigned the wrong gender at birth, or their internal gender doesn’t match their external one. Sexual reassignment surgery helps convert them to the proper gender. The procedure is expensive, especially if it isn’t covered by insurance. Today we see a new era where Medicare and federal health plans cover sexual reassignment for those in the transgendered community.

This plan begins in 2015. Office of Personnel Management spokesman Edmund Byrnes wrote in an email that the change regarding the federal healthcare plan was due to medical science and new evidence that has been uncovered. Transgendered was thought to be an incurable medical condition before the 1990s. Gender dysphoria, the medical term used for those who don’t believe they are the proper gender, can be treated with sexual reassignment surgery and hormone therapy according to the American Psychiatric Association.

Though the federal government has changed its stance, the issue is still more complicated when put into practice.This doesn’t mean that all federal employees will receive coverage. It simply clears the federal government as a hurdle, but the final decision will be up to the carriers. They are not mandated to cover sexual reassignment surgery, which can cost tens of thousands of dollars.. Still, activists and advocates hailed the decision by the federal government as one step closer to equality.

David Stacy, director of HRC Government Affairs, said in a statement, “Today’s welcome decision by the Office of Personnel Management to remove this discriminatory and harmful exclusion is an important step towards closing the gap in access to quality health care for transgender workers.” He went on to say, “HRC urges FEHB insurance carriers to include this essential coverage in their plans so that federal workers have access to medically necessary transition-related care.”

According to HRC, transitional related care is offered by 25% of fortune 500 companies. Still, one has to wonder exactly how many federal employees are transgender? Though more of a symbolic victory, this will help spread awareness and lead to concrete changes that affect more people. Still more must be done to address how expensive this procedure is and to give the transgender community more access to surgery so everyone in our society can feel comfortable within their own skin.

American Board of Obstetrics and Gynecology will Now allow the Treatment of Men

American Board of Obstetrics and Gynecology will Now allow the Treatment of Men
American Board of Obstetrics and Gynecology will Now allow the Treatment of Men

The American Board of Obstetrics and Gynecology in September of 2013 changed their policy. If a gynecologist practiced on a man, according to these changes, he or she would be denied eligibility for Board certification or recertification. There were a few exceptions to this policy, such as treating transgender people, checking couples for infertility, and circumcising babies. The Board provided no rationale for the change in policy. According to the New York Times, the “ban affected gynecologists who had developed extensive skill and experience treating male patients, and they said that it would be difficult or impossible for many of those patients to find care elsewhere.”

Protests to the policy rang out and in the following fall months of that year the board granted two additional exceptions to its policy. Men at high risk for anal cancer could be screened by an OBGYN. Still, the ban against treating most men remained. The problem is that obtaining and renewing a license is crucial to running a successful medical practice in today’s world. Still, an OBGYN may be the best option for men with certain conditions. Still the American board of Obstetrics and Gynecology will now have to treat men due to this policy being overturned. But it may have been overturned not for humanitarian reasons, but instead, capitalistic ones.

The policy was overturned due to the fact that OBGYNs that treat men would lose their licenses. Without these OBGYN’s in the system there would be less available. These rules therefore limit competition in the marketplace. As a recent court of appeals wrote, “[t]he Supreme Court has likewise made pellucid, however, that anticompetitive acts are not immune from § 1 [of the Sherman Act] because they are performed by a professional organization.” Therefore, being Board certified signifies an unfair advantage. This goes against anti-trust laws. The legal offices of Nossaman LLP served the board with a letter explaining the reasons, including this one, to justify why the policy should be lifted. The law firm mentioned this, but also that hundreds of doctors and perhaps thousands of patients would have their lives and medical care disrupted merely because the Board thought some doctors may behave unethically, which the law firm made clear was irrational.

The Board took this letter to heart, but one wonders if the law firm wasn’t eluding to a suit if the board didn’t change its tune. The board then changed their policy from only treating women to requiring that OBGYNs “must devote the majority of their practice to the specialty of Obstetrics and Gynecology.” This inherently meant that they understand that at times OBGYNs will be treating men as well, what was hailed by the law firm and others as a victory for doctors and their patients.

Differences of Sex Development (DSD) and Intersexuality

DSD and Intersex

Inarguably, the intersex community was not dealt an easy hand to play with. The secrecy, shame and social marginalization they deal with has built a kind of camaraderie that those who undergo sexual assignment surgery often face: guilt for leaving their comrades, PTSD and difficulty adjusting to their new life (

Today activists are trying to enlighten others while letting those with intersex traits and differences of sex development (DSD) know that there are people out there who are advocating for and supporting them. Activists like Jim Ambrose, Pidgeon Pagonis and Bo Laurent want them to know they are worthwhile individuals who deserve the same rights, respect and love as everyone else.

Co-founder of The Interface Project Jim Ambrose says of this, “It’s hard for people to wrap their head around what exactly is going on. It gets everywhere — it’s nothing but sprawl. It’s not limited to the bedroom.”  The Interface Project is a website that collects personal anecdotes of those with DSD or intersex conditions. These conditions are not uncommon. According to the World Health Organization (WHO), one out of every 1,500 or 2,000 infants are born with a visible difference in sex organs. For instance, in cases where women have androgen insensitivity syndrome, they will have testes and an XY chromosome. Going as far back as the 50’s, doctors would often advise surgery on a baby born with analogous genitals. Girls were generally chosen as the surgical procedure is easier to perform.

Complications arose in later times with intersexuals as Doctors began to understand that although they had assigned a sex, many of those assigned to be girls actually felt more like boys. There were whole generations of DSD and intersex people growing up in the wrong bodies. Some felt estranged from their parents. Often they hid their genitals from romantic partners. Many were filled with shame, angst, guilt and repressed anger. Sadly, they had no one to turn to.

Today the DSD and intersex population is more accepted than ever before, but they still face strong obstacles. It is important for DSD and intersex people to come to terms with who they are and learn to love themselves. That said, it’s also critical to address the particular situation as early on and as honestly as possible. More education, outreach and anti-discrimination campaigns must be enacted to protect this often silent minority. They must learn their self-esteem is not relative to other’s opinions, rather their own so they may move towards a successful and joyous life.