BDS & the New York State Freedom to Boycott Coalition
by Pauline Park

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Pauline Park, Ph.D.

On a beautifully sunny day in April 2004, I joined half a dozen members of the Gay Asian & Pacific Islander Men of New York (GAPIMNY) at the Manhattan offices of “Details,” a men’s magazine that had published an offensive feature entitled “Gay or Asian?” that mocked gay Asian men as effeminate and undesirable.  After a successful meeting with the editor and publisher, we went to the Manhattan Mall nearby on Sixth Ave. at 33rd Street for lunch; we were delighted to have gotten an apology from them and a promise that “Details” would run a formal apology in the next issue of the magazine. While my colleagues were having lunch in the food court in the basement, I went to the women’s room; when I came out, I was surrounded by security guards who stood around me in a menacing stance, demanded to know if I was a man or a woman; the five men were big and menacing; the one woman among them seemed to have some authority, and when I suggested to them that they were risking a discrimination lawsuit, she had the others return to their station behind a one-way window just down the hall from the women’s restroom. While a bit shaken, I demanded to see her supervisor, who came out a few minutes later. After reconnoitering with my colleagues in the food hall, who were curious as to why I had disappeared for such a long time, we left the Manhattan Mall. When I got home, I called my colleague, Michael Silverman, then the executive director of the Transgender Legal Defense & Education Fund (TLDEF) to enlist his support.

My experience of discrimination in the Manhattan mall on that day in April 2004 was not that different in character from countless such incidents of discrimination based on gender identity and expression that transgendered and gender-variant people have had over many decades in the United States and throughout the world; what was different was that I was a transgender activist who had led the campaign for the transgender rights law enacted only two years earlier in April 2002 and at the time of the incident in April 2004 was a member of the working group meeting at the New York City Commission on Human Rights engaged in drafting guidelines for implementation of that transgender rights law. Having written the statement of legislative findings and intent, I knew the new law as well as anyone; and given my participation in the working group at the Commission, I also knew that status of the guidelines at that moment.

The working group was actually at an impasse over the language to use to describe possible situations involving discrimination in sex-segregated facilities requiring nudity such as gyms and locker rooms. Michael Silverman represented me in legal action against Advantage Security, the private firm that provided security for the Manhattan Mall; at the same time, I filed a complaint on my own with the Commission, meeting with a staff attorney who did not know about my participation in the working group working to draft the implementation guidelines for the transgender rights law. After some discussion between TLDEF and Advantage Security, they agreed to settle, making a donation to the New York Association for Gender Rights Advocacy (NYAGRA) at my request as well as having their security guards undergo transgender sensitivity training. Ironically, the language that Michael Silverman and I worked out for the Advantage Security settlement helped us resolve the impasse within the working group and the Commission on Human Rights incorporated that language into the draft of the guidelines adopted by the Commission in December 2004.

TLDEF announced the settlement of my case as well as that of Justine Nicholas on 31 March 2005 and the  New York Times reported on our settlement, Nicholas Confessore writing,

When Pauline Park watched Mayor Michael R. Bloomberg sign an amendment toughening the city’s anti-discrimination laws two years ago, she never expected to become one of its first beneficiaries. But yesterday, a complaint filed by Ms. Park – a co-chairwoman of the New York Association for Gender Rights Advocacy, which helped lobby for the amendment to the New York City Human Rights Law – became part of the first settlement issued under it… (Nicholas Confessore, “Transgender Group Reaches Agreement on Restrooms,” New York Times, 2 April 2005).

A New York Times story tends to attract attention from both friends and foes, and so it was with this one. Among the most influential of the organizations on the religious right is the Traditional Values Coalition. TVC attacked the settlement that I reached in April 2005 in my discrimination case, not in the least bit impressed by the fact that I was the first (along with Justine Nicholas) to successfully pursue a discrimination claim under the transgender rights law enacted by the New York City Council in 2002. In response to the report by the e Traditional Values Coalition declared on April 7 of 2005,

“The New York Association of Gender Rights Advocacy has won a victory over restroom use by individuals who believe they are a member of the opposite sex… The victory involves a settlement from a security guard company that allegedly discriminated against transgender activist Pauline Park when he [sic] used a woman’s restroom in a Manhattan mall in April, 2004. Park wears women’s clothing and identifies as a woman but has not had a sex change operation. Park is still anatomically a male but calls himself [sic] a ‘male-bodied woman’… This decision means that men who think they are women and are still anatomically males can use women’s restrooms in New York City…”

The April 7 TVC news report is entitled, “Ladies Restrooms: Who is That Male-Bodied Woman In the Next Stall?” That report concludes, “In a society where rational thought still existed, Pauline Park would be institutionalized for insanity or be given intense therapy to overcome his [sic] serious gender identity disorder. Instead, he has imposed his own mental illness upon the city of New York — and Michael Bloomberg has been a willing accomplice…”

That TVC ‘news report’ (if one could call such an absurd expression of prejudice a ‘news report’) brought home to me the profound significance of the continuing pathologization of transgender identity of gender variance and transgender identity. The ‘gateway’ diagnosis required to access to hormone replacement therapy (HRT) and SRS from 1974 until 2013 was gender identity disorder (GID), introduced into the fourth edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM IV), published by the American Psychiatric Association (APA). While GID is usually thought of as the diagnosis by which adult transsexual and transgendered people gain access to HRT and SRS, the true significance of GID is much larger. First, a change of legal sex designation  the ‘gender marker’ on identification documents that assigns us to either male or female sex in most jurisdictions requires at the very least documentation of an intent to go for SRS, if not actually proof of completion of surgery (as is the case in New York City).

While there is no necessary connection between a change of legal sex designation and a change of legal name, in many if not most cases, transitioning transsexuals pursue these two changes simultaneously. The truth is that most transgendered people frequently or even consistently present in a gender that does not match their ID, which causes problems in a multitude of situations. Since 911, most large buildings in New York City require photo ID even to enter the building. And so the apparent discrepancy between ID and either ‘gender marker’ and/or gendered name and/or gender presentation in a photocan constitute a barrier to employment, housing, and public accommodations as well as to accessing health care and social services.

But if the apparent ’solution’ is to go for a change of legal sex designation as well as name, and if the former change – and in some cases, effectively, the latter – requires a diagnosis by a psychiatrist; then in effect, the ability to access health care as well as employment, housing, and public accommodations requires such a diagnosis as well. I personally find it outrageous that transgendered people in the United States and elsewhere have to have themselves declared mentally ill in order to access health care or to get or to keep a job. We must commit to finding means by which transgendered people can access forms of medical intervention such as HRT and SRS without having to subject themselves to the degradation of being declared mentally ill simply by virtue of their gender identity.

GID not only undergirds the Harry Benjamin Standards of Care (SOC) and the protocols for gender transition in this society, this diagnosis – what I call the GID ‘regime’ – constitutes the very basis for American society’s understanding of transgender. Even in relatively more sympathetic portrayals of transgendered characters such as those in “TransAmerica” and on “All My Children” and “Ugly Betty,” the discourse through which those characters are understood is a medical model of transsexuality based fundamentally on the concept of gender dysphoria. My own work as a transgender activist is informed by a feminist conception of gender and a commitment to challenging and dismantling the sex/gender binary that is at the root of our oppression as women and as men as well as transgendered men and women or for that matter, genderqueers who resist binary categorization. Our goal as a movement must therefore be nothing less than the transformation of society’s understanding of gender. And if we are committed to that goal, we must also be committed to dismantling the ‘GID regime’ that undergirds this system of gender regulation and control.

In 2013, the APA published the DSM V, which replaced ‘gender identity disorder’ with ‘gender dysphoria’ (American Psychiatric Association, “Gender Dysphoria in Adolescents and Adults,” Supplement to the Diagnostic and Statistical Manual of Mental Disorders,” fifth edition (Sept. 2016), p. 19.: DSM-5 classificaion, gender dysphoria, gender dysphoria in adolescents and adults, p. xxiv (Desk Reference, p. xxv): change F64.1 to F64.0).

I fully understand the practical implications of GID for accessing hormones and surgery, but I think we need to question the notion that we must accept the pathologizing of all gender variance as mental illness in exchange for the ostensible benefits that flow from the diagnosis. The reality is that many and perhaps even most of those who have gotten SRS paid for by private insurance in the United States in the last decade have been able to do so under the auspices of the Affordable Care Act, legislation whose future is extremely insecure given the public commitment of Barack Obama’s successor Donald Trump and the Republican majorities in both houses of Congress to repeal the ACA. One might also point out parenthetically that there was no provision in ‘Obamacare’ (as the ACA is popularly known) that explicitly prohibited discrimination in the provision of health care on the basis of gender identity or expression (or sexual orientation, for that matter), nor was there any provision that explicitly required health insurance companies from covering HRT or SRS for transitioning transsexuals. The very fact that insurance payment for HRT and SRS appear to be dependent on the fate of controversial legislation opposed by the majority party in the United States itself would seem to be a compelling argument to re-examine the very notion of retaining a pathologizing diagnosis in the DSM simply to secure continued insurance payment for those medical interventions. And it must also be pointed out that, despite the ACA, many transgendered people continue to have no health insurance at all, and those who do have either Medicaid, whose budget is more precariously perched than that of any other major federal entitlement program.

If Republicans in Congress are successful in ‘repealing and replacing’ the ACA, then the reversion to the status quo ante could well mean that those who get health insurance through health maintenance organizations (HMOs), most of which had explicit clauses written into their policies excluding coverage of any service related to gender transition, could well find themselves unable to access insurance coverage for HRT and SRS as in the era before Obamacare.

What is striking to me is the narrow parameters of the debate within the transgender community and even within the larger LGBT community over the role of the diagnosis of GID and its successor, gender dysphoria, in accessing HRT and SRS; there has been virtually no discussion in LGBT contexts of the fact that the United States is the only industrialized democracy in the world without universal health care. It seems to me that rather than fighting for private insurance coverage for medical interventions related to gender transition, we in the transgender community and the larger LGBT community should instead be demanding universal health care and statute laws that explicitly prohibit discrimination in the provision of health care based on gender identity and expression as well as sexual orientation; doing so would enable us to connect the struggle for transgender access to health care to the larger national debate over universal health care; doing so would also enable the transgender community to forge real relationships and alliances with other communities fighting for health care rather than characterizing the issue of transgender health care narrowly as a fight for HRT and SRS through a pathologizing definition of transgender identity under the rubric of disability.

It is important at this point to talk about the impact of pathologization and to recognize the fact that the pernicious effects of GID extend far beyond simply the instrumental necessity for adult transsexuals to obtain the diagnosis in order to access hormones and surgery. According to one report, three quarters of all those diagnosed with GID are diagnosed with GID in childhood and adolescence. These are for the most part gender variant children whose parents take them to a psychiatrist because Johnny is playing too often with dolls or Janie is climbing too many trees. The parents conflate homosexuality with transgender and hope that the psychiatrist can ‘cure’ or at least ‘prevent’ homosexuality in their chil dren. There may well be a significant segment of the psychiatric profession that uses the diagnosis in precisely this fashion  to try to ‘cure’ or ‘prevent’ homosexuality in children and youth – this, despite the removal of homosexuality from the DSM in 1974.

Many of these psychiatrists, such as Charles Socarides and George Rekers, are associated with the religious right and in fact advocate re introduction of homosexuality in the DSM. Rekers, who is on the faculty of the School of Medicine at the University of South Carolina, has in fact received over half a million dollars from the National Institute of Mental Health (NIMN) to study ways to ‘treat’ and ‘cure’ such ‘deviant’ behavior, including ‘at ypical gender identity,’ ‘atypical sex roles,’ and ‘pre transsexual behavior.’

One of the leading organizations advocating re introduction of homosexuality in the DSM is the National Association for Research & Therapy of Homosexuality. NARTH and their co conspirators in homophobia see removal of GID as having the potential to eliminate the ability of psychiatry and homophobic and transgenderphobic parents to police and enforce the gender boundaries that they wish to impose on their children as well as on adults to the extent possible.

I have an Asian American lesbian friend in Queens whose nephew is transgendered. When he told his parents that he felt himself to be a girl, his mother and stepfather had him institutionalized, on the basis of a diagnosis of GID. He is currently at Cinnamon Hills, which despite its charming name, is in effect a prison for youth located in the middle of the desert in southern Utah. Perhaps the most famous such case of institutionalization of a youth with GID is that of Daphne (now Dylan) Scholinski, who now identifies as a transman. At fifteen years old, Scholinski identified as a butch lesbian and was committedto a mental institution by parents who were determined to ‘cure’ her ofthe mental illness with which she was diagnosed. The Last Time I Wore A Dress is only the most famous account of a gender-variant youth subjected to behavior modification therapy for a gender identity that is no disorder and that cannot be cured.

What many people evenwithin the transgender community do not realize is that legal minors can be committed to a mental institution and subjected to behavior modification therapy up to and including electroshock therapy. In fact, even adults can be institutionalized against their will if they are diagnosed with GID, which is precisely what happened to the renowned economist Deirdre McCloskey, when family members decided that she was ‘insane’ after she told them of her intention to transition (as she writes in Crossing: a Memoir, University of Chicago Press, 1999). It seems to me that what is ‘insane’ is forcibly institutionalizing a brilliant economist simply because she has informed her family that she wishes to live her life consistent with her internal sense of gender identity. What is insane is the diagnosis of GID itself.

The pernicious effects of GID extend by implication indirectly to the intersexed as well. Intersex genital mutilation (IGM) certainly requires no diagnosis of GID, and in fact, the intersex ‘condition’ is explicitly excluded as a criterion for GID, but the rigid insistence on the sex/gender binary articulated by the GID diagnosis that is officially recognized by the psychiatric profession through its inclusion in the DSM gives implicit support to the practice of IGM.

The influence of GID also extends into the sphere of public policy as well, impeding the fight for transgender rights. We have made enormous progress as a community and as a movement over the course of the last two decades, but while 95 jurisdictions  including nine states and the District of Columbia – now have enacted legislation explicitly prohibiting discrimination based on gender identity or expression, it is a sad fact that 41 states have no such protection in their state laws. However, every state has included disability in its human rights law, and it is that rubric that litigators are using to obtain legal redress for transgendered plaintiffs across the country, and they often win on that basis. But the argument that such litigators proffer usually follows along these lines: my client is mentally ill by virtue of his/her gender identity disorder and therefore is protected under state disability law. I should make clear that I have nothing but admiration for the hard  working lawyers who represent transgendered clients – often pro bono – with limited time and resources. And in those 41 states without explicit inclusion of gender identity and expression in state human rights law, appeal to disability by way of GID may well be the only practical way of obtaining legal redress for discrimination against a transgendered client. But I think we need to recognize how sharp the horns of that dilemma may be.

As a non lawyer who works on legislation, I can tell you that the genuine happiness that I feel for the transgendered client who wins such a case is diminished by the realization that the victory for that individual undercuts the very arguments that we need to make in the legislative arena. Because it is precisely GID that gives the religious right and other opponents of transgender rights legislation their most powerful ammunition.

Consider Vermont, where activists are trying to get the state legislature to pass a transgender rights bill against the opposition of right -wing organizations such as Vermont Renewal, which describes itself as “a grassroots organization with the primary goal of promoting and defending traditional family and moral values based on the Judeo- Christian worldview that Vermont and the entire United States were founded upon” (www.vermontrenewal.org). In an op-ed in the Burlington Free Press for Vermont Renewal, Stephen Cable writes,

“Under the banner of equality, the Vermont Legislature seeks to protect transgender behavior (i.e. transvestite and transsexual) from discrimination (bills S.51 and H.228)… Despite good intent, there are major problems with this legislation. First, such behavior is associated with a treatable mental disorder. However, we question efforts which, under the pretext of equality, actually favor one mental disorder for protections to the exclusion of all others, such as depression, anorexia, kleptomania, etc. The Common Benefits Clause of the Vermont Constitution forbids such preferential treatment…”

Cable continues,

“There are, of course, serious pitfalls associated with efforts to protect behavior associated with mental disorders. Perhaps the largest would be inadvertently sending a message that such illness is healthy, or even desirable, rather than encouraging treatment and recovery – thereby trapping people within this disorder. Equally important, however, is the danger that, by affording too much protection to the sufferer, government may actually become the oppressor, creating unforeseen hardship and complexity for businesses, schools, and the common person…” Now, there are certainly many responses to Cable’s uninformed and bigoted screed, including a critique of the way in which he misconstrues disability law and how it works. And one can also respond to Cable by pointing out that there is no evidence that the GID diagnosis was intended to be used as an argument against non-discrimination legislation. But we simply cannot ignore the fact that the religious right not only in Vermont but across the country has latched onto GID as the core of its argument against transgender rights legislation at the local, state and national levels; to that extent, the removal of GID from the DSM would disable their core argument (pun intended). And any student of LGBT history would be conscious of how the removal of homosexuality from the DSM in 1974 advanced the gay and lesbian movement from that point onwards.

What I would say to the Traditional Values Coalition is this: I do not have a gender identity disorder; it is society that has a gender identitydisorder. I must admit it was a bit of a shock to be subjected to personal attack by one of the largest religious right organizations in the country, but I have taken the advice of a friend of mine who encouraged me to wear it as a badge of honor. Now that I’ve been declared a public enemy by the likes of TVC that I have ‘arrived.’

But the point I would like to make here is not so much about the TVC bull’s eye on my forehead; it is the ammunition that the discourse of mental pathology gives to opponents of transgender rights. In TVC’s report, “A Gender Identity Disorder Goes Mainstream” (also issued in April 2005), the organization declares, “These are deeply troubled individuals who need professional help, not societal approval or affirmation.”

Elsewhere in its ‘report,’ TVC describes “this mental illness and how it is being normalized in our culture.” In fact, the very title of the TVC ’special report’ is “A Gender Identity Disorder Goes Mainstream,” followed by the sub head, “Cross dressers, transvestites, and transgenders become militants in the homosexual revolution.” And TVC is not the only such organization pursuing this line of argument, however specious. The religious right is now so panicked about the growing acceptance of gay men and lesbians in this societythat they are increasingly focusing on the diagnosis of GID not only to oppose transgender rights legislation, but also non discrimination andhate crimes legislation that includes sexual orientation as well.

And that is why I say that every victory for a transgendered plaintiff whose lawyer uses disability to win a discrimination case compromises our ability to work in the legislative arena – hence my profound ambivalence about the GID-based arguments being used in such cases. A few years ago, I had a conversation with a transgender activist from another state for whom I have great respect. She insisted that the way forward for the transgender movement was the disability route. I insisted with equal vehemence that the ‘disability track’ was the wrong path to pursue. I cited the clause in the Americans with Disabilities Act that explicitly excludes ‘transvestism and transsexualism’ from coverage under the terms of the 1990 federal disability rights law, thanks to Jesse Helms. The notoriously bigoted senator from North Carolina made certain that the path to transgender rights through federal disability law would be closed, and there is little if any chance that that path will be opened anytime soon.

But the issue of federal disability law aside, the larger strategic question for our community and for our movement must be this: is our goal only litigation and legislation or are we pursuing something bigger? The whole critique of the queer left of the mainstream gay and lesbian movement is that it has for far too long focused narrowly on juridical rights. Now, I happen to believe that we should pursue non-discrimination legislation and that we must ensure that all transgendered and gender variant people – indeed, all LGBT people – gain equal rights under federal as well as state and local law in every area of activity, including marriage. But I also believe that our movement must have at its core a vision of social justice and social change. And that vision must be premised on the goal I articulated earlier. Our objective must be nothing less than the transformation of society’s understanding of gender. And so the removal of GID from the DSM must be a goal of our movement; it simply cannot be otherwise. We must discard a medical model of transsexuality that is a disease model of mental illness; we must reject any suggestion that our goal as a community and as a movement is simply to find a place within a normalizing discourse of the existing sex/gender binary, expanded ever so slightly to accommodate us – or at least those of us who can comfortably fit within a governing regime of heteronormativity. In its stead, we must embrace a vision in which all forms of transgender are seen simply as natural variants in gender identity and expression and in which all transgendered and gender variant people will be accepted as fully equal to their conventionally gendered family members, friends, colleagues, and neighbors.

It is important at this point to address the misunderstandings that have arisen when I have discussed the need for the depathologization of transgender identity and gender variance in speeches that I have given since 2007, when I called for the abolition of GID in my keynote address at the Philadelphia  Trans-Health Conference (“Transgender Health: reconceptualizing Pathology as Wellness,” 7 April 2007) and in a talk at Harvard University’s School of Public Health in Boston in 2011 (“Transgender Health, Pathology and Human Rights,” 20 April 2011). When I spoke at Harvard, one graduate student in the audience asked me if I was advocating that the transgender community disassociate itself from the disability community; this student misinterpreted my comments as suggesting that transgendered people should distance themselves from people with disabilities because of the stigmatization of people with disabilities (mental as well as physical) in American society. In fact, I think we should work to end the stigmatization of all forms of disability, whether mental or physical; and I think an alliance between transgender activists and disability rights activists would be a very good thing indeed; but that relationship cannot be based on a false pathologization of transgender and gender variance. The real basis for an effective working relationship between the transgender community and other communities, including the disability community, would be precisely the rejection of the false notion that transgender is a psychopathology, the objective of ending the stigmatization of all forms of disability.

What I would like to suggest as an alternative is to put a concept of wellness at the center of transgender health. I am arguing here for the removal of transgender identity from the DSM altogether and a comprehensive rejection of the pathologizing of transgender and gender variance. Just as homosexuality is now viewed by mainstream psychiatrists and psychologists as simply a natural variance in sexual orientation, so transgender would be viewed simply as a natural variance in gender identity and expression – no more or less natural than conventional gender identities.

The objection to such a conception coming from certain quarters no doubt would be that it would render hormone replacement therapy and sex reassignment surgery as ‘elective’ procedures, thus making it impossible to get insurance payment for HRT and SRS as ‘medically necessary.’ But I would argue that we must challenge the very notion that as transgendered people we should view ourselves as having been born with a ‘birth defect’ and instead see ourselves as being fully natural and fully human just as in fact we are.

In this conception, the various technologies that some of us use to modify our anatomy and biology would be viewed as technologies of self-determination, used to configure our bodies to conform to our internal sense of gender identity. In other words, HRT and SRS, breast reduction and breast augmentation, metoidioplasty, tracheal shaves, and other forms of plastic surgery would be technologies we can use to make ourselves feel more comfortable in our own skin – technologies that we can use to enhance our sense of well-being. In such a conception, would hormones, surgery and the like be elective? Yes, and by reconceptualizing such technologies as elective, we would reclaim our sense of self determination. The truth is that the argument for SRS as currently conceived makes no sense whatsoever. For what mental illness is surgery on a part of the body other than the brain indicated or prescribed? I know of none. The usual objection to SRS is that it involves the removal (in most cases) of perfectly healthy tissue, and that is in fact usually the case. There is nothing diseased in the sex organs of most transsexual or transgendered people who seek SRS. But surgery will enhance the well-being of those who elect it. And by reconceptualizing surgery – including and above all SRS – as elective, we reclaim our sense of agency. The notion that SRS is medically necessary cannot be advanced except by way of an argument that pathologizes our bodies and our minds – that pathologizes our very identities.

The truth is that SRS is rafely if ever medically necessary in the conventional sense of the term. Rather, SRS can be a very effective way of enhancing the well-being of those who elect it, and as such, should be readily available without any psychiatric evaluation or diagnosis to those who choose to elect it. And just as private insurance pays for hormone replacement therapy for post menopausal non transgendered women, it should pay for HRT for transgendered women and men as well as for SRS for both. The crucial point is that we as transgendered individuals have to move towards acceptance of ourselves. And we as a transgender community have to reject the idea that the body of a transgendered person is a diseased body. Even more importantly, we must reject the notion that the mind of a transgendered person is a diseased mind. The ‘problem’ of ‘gender dysphoria’ is not to be found in the mind of a transgendered person. Rather, the problem is to be found in the society that is too rigid to allow for those born male to identify as women or those born female to identify as men – or to allow those born male, female, or intersexed to identify as something other than men or women.

And so I say that what we need to do is to reconceptualize pathology as the problem and not the solution to our problems. The solution is, instead, a (w)holistic concept of wellness informed by feminist consciousness that locates the problem at the level of society and not the individual who resists the dictates of an overly gender-rigid society. As I see it, my work as a transgender activist is not about helping a small number of post-operative transsexuals to fit more easily into existing boxes but rather about helping all of us to break out of all of the boxes so that we can all be whoever and whatever we feel ourselves to be. In my view, the task facing us as a community is not to shore up regressive notions of mental pathology but rather to challenge and dismantle the GID regime and the larger sex/gender binary of which it is a part and which is the source of our oppression as transgendered and gender variant people. We must set as our objective nothing less than the transformation of society’s understanding of gender, as part of a movement for social justice for all.

Reconceptualizing the struggle for transgender health care access in progressive feminist terms is part and parcel of engaging in the struggle for universal health care, which can only be based on a ‘single-payer’ system administered by the federal government. The question of the precise form of that system of health care lies well beyond the parameters of this chapter but could certainly involve ‘Medicare for all,’ to cite just one possible option. But what is crucial is that we move from the limiting conceptualization of our work as transgender activists as being about securing access to HRT and SRS through use of the Americans with Disabilities Act (ADA) on the basis of transgender identity as a mental illness and instead recast our struggle as part of the larger struggle for universal health care with guarantees prohibiting discrimination in its provision on the basis of gender identity and expression as well as sexual orientation; by doing so, we can make common cause with other groups and communities.

I urge you to join me in that struggle. Thank you.

In 2004, I named and co-founded the Transgender Health Initiative (THINY), a joint project of the New York Association for Gender Rights Advocacy (NYAGRA) and the Transgender Legal Defense & Education Fund (TLDEF) whose mission was to enhance access to health care for transgendered and gender-variant people. When we began a series of monthly membership meetings that continued for a few years, we expected that THINY members would want to begin by working with hospitals that were part of the Health & Hospitals Corporation of the City of New York, which were and still are underfunded and desperately in need of transgender sensitivity training; we were  surprised to discover that THINY members actually wanted to address issues of transgender sensitivity — or lack thereof — at the Callen-Lorde Community Health Center; we were surprised because Callen-Lorde is the lesbian, gay, bisexual and transgender (LGBT) community health care provider in New York and may well have more transgendered clients than any other health care provider in the city.

But our transgendered members had many complaints about Callen-Lorde and their experiences there, and so we launched a project collaborating with management at Callen-Lorde to survey transgendered patients and clients on their experiences there; we designed the survey, which was made available on-line and in paper form at the front desk, and we got a significant rate of return. As a result of the very candid feedback from the survey, we were able to make recommendations to the administration, which in turn created a transgender community advisory committee as well as hiring for a new position of transgender services coordinator. Following our work with Callen-Lorde, we then began to work with senior management at HHC, though it was the inability to get a commitment to a budget for training that prevented us with moving forward on training for HHC personnel. (At the same time, Gouverneur, one of the HHC hospitals, was moving forward with a small LGBT health clinic.)

In 2009, I worked with NYAGRA’s summer intern, Kelly White, to put together the first directory of transgender-sensitive health care providers in New York City and the metropolitan area (which is now available on-line at  transgenderrights.org). Published in July of that year, this was the first directory of transgender-sensitive health care providers for New York City and the metropolitan area ever published, and to my knowledge, it was the first such directory for any city published in a print edition anywhere in the United States.

In 2006, I did a series of trainings with Michael Silverman (then executive director of TLDEF) for St. Vincent’s Hospital, which was one of the largest hospitals in New York City, and a hospital with one of the largest transgender patient populations; these were the first transgender sensitivity trainings at any major hospital in the city. Sadly enough, St. Vincent’s went bankrupt in 2010 and closed after failing to resolve a situation in which the hospital had accumulated over a billion dollars in debt. These transgender sensitivity trainings were as much of an eye opener for us as they were for the nurses, techs, and other health care professionals we trained. Participants ranged from hostile to indifferent to open-minded to genuinely supportive  in short, a microcosm of society and its attitudes towards the transgendered. Only a few of the nurses were openly hostile and even (in at least two cases) somewhat disruptive. But most of the nurses and other providers we did trainings for at the very least listened politely.

The real problem was the lack of both knowledge of the challenges facing transgendered people as they try to access health care as well as the lack of sensitivity on the part of some of these providers. With regard to the former  lack of knowledge  one of the big problems facing our community is that among those who think about transgender access to health care and there are far too few who think about this issue at all  most imagine that the main challenge we face is accessing hormones and sex reassignment surgery (SRS). While that is a challenge, the biggest challenge for transgendered people really is accessing healthcare for all of those medical issues unrelated to gender transition.

And that leads me to the central theme of this chapter. The work that I have done in New York on health care access for members of the transgender community has made very concrete the many paradoxes and dilemmas of advocating simultaneously for health care access and for human rights in the face of the pathologization

(photo courtesy Anh Ðao Kolbe)

Pauline Park is chair of the New York Association for Gender Rights Advocacy (NYAGRA), the first statewide transgender advocacy organization in New York (www.nyagra.com), which she co-founded in June 1998. She also serves as vice-president of the board of directors of the Transgender Legal Defense & Education Fund (TLDEF). Park led the campaign for the transgender rights law enacted by the New York City Council (Int. No. 24, enacted as Local Law 3 of 2002). She served on the working group that helped to draft guidelines – adopted by the Commission on Human Rights in December 2004 – for implementation of the new statute.

Park negotiated inclusion of gender identity and expression in the Dignity for All Students Act (DASA), a safe schools bill currently pending in the New York state legislature, and the first fully transgender-inclusive legislation introduced in that body. She also serves on the steering committee of the coalition that secured enactment of the Dignity in All Schools Act by the New York City Council in September 2004. Park has written widely on LGBT issues and has conducted transgender sensitivity training sessions for a wide range of social service providers and community-based organizations. She has a Ph.D. in political science from the University of Illinois at Urbana-Champaign.

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ESPA goes out with a whimper not the bang of having passed GENDA
by Pauline Park

On Dec. 12, the Empire State Pride Agenda abruptly announced it would be shutting down the Pride Agenda — which so many people over the years have called ‘ESPA’ — and its Foundation, though its political action committee will apparently remain active.

The announcement was reported by media outlets from the New York Times (“Empire State Pride Agenda to Disband, Citing Fulfillment of Mission,” 12.12.15) to Gay City News to PlanetTransgender.com. This is big news for the lesbian, gay, bisexual and transgender community, because ESPA is the only statewide LGBT advocacy organization in New York and widely viewed as its voice, especially by members of the state legislature. In its Dec. 12 press release, ESPA declared,

The Boards’ decision comes on the heels of securing the Pride Agenda’s top remaining policy priority — protecting transgender New Yorkers from discrimination in housing, employment, credit, education and public accommodations — in the form of new regulations announced in partnership with Governor Andrew M. Cuomo at the organization’s Fall Dinner on October 22…

Of course, an executive order and even a state Division of Human Rights regulation can be rescinded by any of Cuomo’s successors as governor, so it does not have the force of an enacted statute law, and many saw this as a George W. Bush ‘mission accomplished’ moment, in particular because the Pride Agenda is closing shop without having gotten the Gender Expression Non-Discrimination Act (GENDA) through the state Senate and signed into law.

But Norman C. Simon, chair of the Pride Agenda board and co-chair of the Foundation, responded to criticism of the decision and the announcement of it by telling Gay City News,

We did not and are not declaring mission accomplished on LGBT equality. What we are saying is that our top priorities have been completed, and that the remaining work that needs to be done we will transition to other organizations in the coming months in an orderly process (Paul Schindler, “ESPA Leadership Pushes Back on Charge They’ve Declared ‘Mission Accomplished’,” Gay City News, 12.13.15).

In his story for Gay City News, Paul Schindler wrote, “Matt Foreman focused his criticism both on the way the Pride Agenda reached its decision and on the message the announcement of that decision sent,” quoting the former executive director as saying,

There was zero consultation with folks who spent their lives building the Pride Agenda. If they are going to make a decision of that magnitude, there has to be a consultative function. They need to talk to the stakeholders, to the communities around the state… This is an abrogation of a fundamental obligation that an organization has to its constituency… And, it plays into the national narrative that the job is done.

But the same could be said of ESPA’s decision to endorse Cuomo’s executive order without any consultation even with the coalition attempting to advance GENDA in the state Senate. I have been involved with what originally was called the GENDA Coalition from the beginning, far longer than all of the current ESPA staff, and I represented the New York Association for Gender Rights Advocacy (NYAGRA) in that coalition from its formation, and at no time was there even a conference call to discuss the executive order, which will have the effect of undermining any remaining efforts to push GENDA through the Senate. Why would the Republican majority in the Senate feel pressured to pass GENDA when ESPA and the governor are both touting the executive order/regulation as providing sweeping protections for transgendered people in the state? And the lack of even the most rudimentary consultation on the decision to endorse the governor’s executive action is why it feels to me like a backroom deal cut between ESPA and the governor rather than a genuinely community-driven policy victory. Hence the decision to settle for an executive order rather than to demand that the governor use his power and influence to push GENDA through the Senate — in which Republicans maintain a majority in large part due to Cuomo’s efforts to keep the Senate in Republican hands — is not only substantively questionable but really represents a betrayal of the transgender community and the process through which the GENDA coalition was working to achieve a legislative remedy to the lack of protection from discrimination based on gender identity or expression in state law.

The most negative reactions to the news of the shutdown of the two most important parts of the Empire State Pride Agenda empire have focused on the organization’s abandonment of its transgender legislative agenda, Kelli Anne Busey writing,

Realizing the trans community’s worst fears, the New York Empire State Pride Agenda announced the shocking news Saturday that they are ceasing operations after 25 years of operations…  [executive director Nathan] Schaefer just said the job isn’t finished without saying transgender and every fucking person in the room knows that’s what he’s eluding to. (it’s their little secret) They’ll just walk. So gay New Yorkers will spend money on making sure the laws protecting them aren’t eroded but will throw the T under the bus. Nice. (Kelli Anne Busey, Empire State Pride Agenda Disbands, Screwing NY Transgender People,” Planet Transgender, 12.13.15)

On Twitter, a number of people ‘tweeted’ critical comments:

This is what superficial justice looks like: “Empire State Pride Agenda to Disband, Citing Fulfillment Mission” (Jen Jack Gieseking @jgieseking, 12.13.15)

“We got marriage equality our work is done.” “What about trans equality, we aren’t done?” “Well we are!” (Mia Marie Macy @Miamariemacy, 12.13.15)

The closure of NYC’s @prideagenda is a sad indictment of legal activism. Marriage equality does not heal all wounds. (Senthorun Raj @senthorun, 12.13.15)

I have worked with every executive director and deputy director of the Pride Agenda from 1998 onwards as well as every transgender community organizer and every coordinator of the New York State LGBT Health & Human Services Network, which Tim Sweeney founded when he was deputy director of the Pride Agenda and in which I represented Queens Pride House (the only LGBT community center in the borough of Queens), so I actually know ESPA’s history better than the current members of the board and staff. And . So my perspective is the long view, informed by my experience leading the campaign for the transgender rights law enacted by the New York City Council in 2002, in partnership with Tim Sweeney and Matt Foreman and other ESPA staff; it is also informed by my participation in the steering committee of the coalition that led the campaign for the New York State Dignity for All Students Act (DASA), enacted in 2011.

And so what I would like to do is offer an assessment of the Pride Agenda’s record from 1998 to 2015 as informed by 17 years of working with the organization. That relationship goes back to the founding of NYAGRA in 1998 and our very first meeting with another organization; several co-founding members went to the Pride Agenda’s old office on Hudson Street. In the cramped office in the West Village, we met with Tim Sweeney, then deputy director, to seek ESPA’s support for inclusion of gender identity and expression in the Sexual Orientation Non-Discrimination Act (SONDA) then pending in the Republican-controlled state Senate after having already passed the Democrat-controlled Assembly; we also sought Pride Agenda support for transgender inclusion in the hate crimes bill, which had also passed the Assembly and was also stalled in the Senate. Tim Sweeney told us that NYAGRA should join the state hate crimes bill coalition if we wanted to have gender identity and expression added to the hate crimes bill; he also told us that ESPA was not prepared to add gender identity and expression to SONDA but that the Pride Agenda would be willing to work with us on a local transgender rights bill. As a result of that collaboration, we launched the campaign for the bill that would eventually pass the City Council in April 2002 and be signed into law later that month.

It is important to recognize that the Empire State Pride Agenda was a self-defined ‘lesbian and gay’ organization when we met with ESPA staff in November 1998; transgender simply was not a part of the organization’s mission and there was no indication that they had even considered including transgendered people in their work. NYAGRA was the first transgender advocacy organization in the city or the state, and its formation and our pressing ESPA on transgender inclusion in pending state legislation is what prompted the Pride Agenda to move toward transgender inclusion in its work.

Any assessment of the Empire State Pride Agenda has to focus primarily on legislation, because that is where the organization has made its mark, along with the founding of the Network and the funding that it was able to garner for the over 60 LGBT-specific social service providers in the state. The major legislation that ESPA played a role in getting enacted since 2000 have included the state hate crimes law (2000), SONDA (2002), DASA (2011), and marriage equality. ESPA also helped with the campaign for the New York City Dignity in All Schools Act (NYC DASA), enacted by the City Council in 2004 over Mayor Michael R. Bloomberg’s veto, though the organization didn’t play the leading role with that legislative campaign as it did with the aforementioned state bills.

The first and best-known charge of transgender exclusion leveled against ESPA is also the most misunderstood; it is often thought that the Pride Agenda stripped gender identity and expression from SONDA so that it could be pushed through the Senate in December 2002; but in fact, transgender-specific terms were never in SONDA; the more mundane truth is that ESPA simply refused to bow to pressure from various parties to add gender and expression to the bill when it became viable in June 2001 when Gov. George Pataki first expressed openness to supporting it. As executive director of the Pride Agenda, Matt Foreman cut the deal that secured passage of SONDA: in exchange for ESPA’s endorsement of Pataki for a third term as governor, Senate majority leader Joe Bruno allowed a floor vote on SONDA in December, with the bill passing with a majority of Democrats and a minority of Republicans before being signed into law by Pataki.

GENDA was introduce the next year and has since passed the Assembly several times but never the Senate, where it was even defeated in a vote in committee in 2011. The bill that did finally pass the Senate in that year was the Dignity for All Students Act, the first and so far only explicitly transgender-inclusive legislation enacted by the state legislature and signed into law. But the history of DASA does not reflect unqualified support for transgender inclusion on ESPA’s part. When Moonhawk River Stone was co-chair of NYAGRA with me, we were twice approached by Alan Van Capelle, then executive director of the Pride Agenda, about a possible compromise that could satisfy the Republican Senate leadership sufficiently to allow the bill to come up for a vote in the Senate. The first was an overture from the Senate leadership that entailed stripping gender identity and expression from the bill altogether; the second a proposal by Kevin Jennings, then executive director of the Gay Lesbian & Straight Education Network (GLSEN) to water down the language of the Dignity bill to remove the definition of gender, which included identity and expression, and instead put ‘identity and expression of’ in front of the list of characteristics in the bill; the dubious language had never been tested in any court or even enacted by any state language. Alan Van Capelle convened a small group of transgender activists, hoping I am quite certain that we would all go along with the dubious proposal; but Hawk Stone and I stood firm and refused to put NYAGRA’s imprimatur on it. After these two overtures were deflected, the coalition continued to work on the bill, even after the lead sponsor in the Senate, openly gay Sen. Thomas K. Duane, completely lost interest in his own bill; Dignity did eventually pass the Senate in June 2010, ironically enough as a kind of consolation prize to the LGBT community for the Senate’s rejection of the marriage equality bill that would eventually pass a year later, in June 2011.

As for the marriage equality legislation itself, on the one hand, it is certainly true that it ultimately redounded to the benefit of transgendered New Yorkers as well as non-transgendered gay and lesbian New Yorkers; but many felt that those who would be the most immediate beneficiaries of same-sex marriage recognition in New York would be the relatively more privileged members of the LGBT community, including wealthy gay white Manhattan professionals who — just as Andrew Cuomo no doubt calculated they would — opened up their checkbooks to make donations not only to ESPA but also to Cuomo for his 2014 re-election campaign. The most deleterious effect of the drive for marriage legislation by ESPA and Cuomo as well as marriage organizations such as Freedom to Marry and Marriage Equality-New York was that marriage came to dominate discussions of LGBT issues in the state legislature and coverage of the LGBT community in the media for most of the decade that preceded passage of the marriage equality bill, to the detriment of discussion of virtually anything else. I can remember one media interview in which I attempted to discuss GENDA and DASA with a reporter who seemed to insist that marriage was the most important issue facing the LGBT community and misquoted me to that effect in her write-up, despite my having said the opposite. Because of the enormous media attention on marriage, even Tom Duane, the lead sponsor of both GENDA and DASA, lost interest in those bills and let them languish. Nor did ESPA do anything effective to pressure the Democrats when they were briefly in control of the Senate from January through mid-June 2011 to bring GENDA to the floor for a vote, when it would almost certainly have passed.

The Empire State Pride Agenda Foundation honored Christine Quinn and Louis Bradbury at its annual fall dinner in October 2012, which was a disgraceful political act intended to ingratiate the organization with the Council Speaker when she was preparing to run for mayor; the press release announcing the honorees declared, as Council Speaker, “she was at the helm of some of our community’s most historic victories, including ensuring dignity and protections against bullying for all students, and New York’s momentous marriage victory in 2011.”  Chris Quinn had little if anything to do with the marriage bill passing — the Speaker of the New York City Council has no authority in the state Senate — and she did nothing but sign her name to the New York City Dignity in All Schools (NYC DASA) bill as a co-sponsor; I was on the NYC DASA Coalition steering committee and Chris Quinn didn’t lift a finger to help us get the bill passed, which actually passed during Gifford Miller’s speakership, not Quinn’s; in fact, after NYC DASA was enacted, she conspired with Mayor Bloomberg to block its implementation by the NYC Department of Education (NYC DoE); so to give her credit for NYC DASA’s enactment is doubly false. The same ESPA release asserted of Bradbury, “As Chair of the Board of the Empire State Pride Agenda, which under his leadership helped to secure passage of The Dignity for All Students Act.” I was on the steering committee of the New York State DASA Coalition and Louis Bradbury had zero involvement with that effort; the bill finally passed the New York State Senate when he was chair of the ESPA board, but enactment had nothing to do with him, and it was clear to me that he was just using his position as chair for yet further self-aggrandizement after he fired Ross Levi — ESPA’s best executive director, in my view — back in March 2012 in a sordid power struggle initiated by Bradbury that significantly undermined the organization’s credibility. Truth does not come from falsity and honoring the dishonorable only dishonors the LGBT community that the Pride Agenda claimed to represent; honoring Chris Quinn and Louis Bradbury by making false claims about their achievements was a disgraceful act.

The manner of one’s passing says a great deal about an individual and I think the same is true of an organization. Organizations die just like individuals, and the rather abrupt, almost hasty manner of ESPA’s passing is telling. Just as the Pride Agenda consulted with no one — not even the coalition working to advance GENDA — when it cut a deal with Gov. Cuomo to endorse his executive order on transgender discrimination and give him a platform at its annual fall dinner in October 2015, so the boards of the Pride Agenda and its Foundation consulted with no one, not even former board and staff members, on the decision to close their doors. Norman Simon’s talk about an ‘orderly process’ of winding down and collaboration with other organizations to try to parcel out its current work seems to mask something quite disorderly. Because of the secretive nature of ESPA deliberations, it would likely be impossible to get confirmation of my suspicions, but I suspect that the board voted to shut down operations for the very mundane reason that ESPA and even its Foundation were no longer financially viable operations. As Gay City News reported,

Pauline Park is chair of the New York Association for Gender Rights Advocacy (NYAGRA) and served as executive director of Queens Pride House from 2012-15; she led the campaign for the transgender rights law enacted by the New York City Council in 2002 and served on the steering committee of the coalition that led the campaign for the New York State Dignity for All Students Act that was enacted in 2011.

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“Would You Still Love Me If…”
thoughts on a transgender-themed play

by Pauline Park

As an openly transgendered woman and a transgender activist, I was delighted to hear that a transgender-themed play had come to an ‘Off Broadway’ theater in New York. But after seeing “Would You Still Love Me If…” with a friend, I’m tempted to suggest that the piece should be renamed, “”Would You Still Love This Play After You’d Seen It…”

Goddess knows we need more transgender-themed plays, but is it too much to ask that they also be good? Unfortunately, this dog of a play won’t hunt. There are two basic problems with “Would You Still Love Me If…”: first, it peddles in tired old tropes about transgender identity; and second, it’s just not a very good play. I say this as someone who has written a play herself and studied theater and drama since junior high school as well as a transgender activist who has conducted hundreds of transgender sensitivity trainings and written extensively on gender identity and expression. The two problems are not at all unrelated, as the material of the drama often seems like a thinly disguised pretext for a rather misguided lecture on transgender identity and transition, while the revelations about Danya’s transition seem to be thrown out as pretexts to generate dramatic sparks on stage.

Without giving too much away, I think (plot spoiler alert for those who want to remain entirely in the dark before seeing it), I will sketch out the broad outline of  the action. Danya (Sofia Jean Gomez) and Addison (Rebecca Brooksher) are a lesbian couple who seem deeply in love with each other, but each has a secret. Addison’s deep dark secret propels her to arrange an adoption behind Danya’s back. But Danya is seeing a sex reassignment surgeon (Roya Shanks) behind Addison’s back; because the surgeon requires one responsible adult other than Danya to sign off on the surgery, she asks her mother, Victoria (Kathleen Turner) to do so.  Among the most absurd plot devices, it’s Dr. Gerard (Roya Shanks) who actually pushes Danya into what some call the ‘real life test’ as well as insisting that she pursue hormone replacement therapy (HRT) before being approved for sex reassignment surgery (SRS).

Watching this play, I got the sense that John S. Anastasi was a well-meaning liberal, possibly a gay man (just a guess; I don’t actually know what his sexual orientation is) who has suddenly discovered that transgender is the hot topic of the day and wants to simultaneously boost his playwrighting career and advance the cause of transgender rights through a play about a transman’s transition. But the characterization of Danya’s transition and Dr. Gerard’s role in it is so far-fetched that Anastasi is unlike to be successful with either objective. I know thousands of transgendered people, and I have yet to meet a single transman who has tried to go for phalloplasty (‘bottom surgery’) or even chest reconstruction (‘top surgery’) before first going on ‘T’ (testosterone, which is the basis for HRT for female-t0=male transsexuals). And the idea that someone who desperately desires surgery would flounce about in a revealing dress and heels pushes this play into a theater of the absurd without any of the significance of signification of Beckett and early twentieth century drama. Honestly, what transman is so clueless about and disconnected from the gender he identifies with that he has to be told by his own surgeon to stop wearing cleavage-revealing dresses and high-heeled pumps and start wearing more masculine attire?

And that’s where the rubber dildo hits the road. The completely unrealistic and frankly preposterous plot devices that jerk the audience forward for an hour and-a-half are based in good part on sensationalistic ‘reveals’ that contribute little to the audience’s understanding of transgender identity, despite well-meaning didacticism. And so what starts out as a potentially promising concept — the genuine tension that results from the announcement by one partner in a relationship (same-sex or opposite-sex) that s/he intends to transition to the other sex and gender — ends up trading on tired old tropes about sex change and selfishness. I have no idea how many real transgendered people he knows, but the playwright could have benefitted from even a half hour chat with me or observation at a meeting of the transgender support group that I run.

None of the actors struggling to make this ‘ungainly new play’ (as the New York Times critic called it in her review) work really succeed, not even the great Kathleen Turner, who is also the director of this sad and frankly embarrassing little affair; the material defeats them every time. “More plays about transgender experience will follow, and with them, perhaps, more poetry,” wrote Laura Collins-Hughes. I would be happy with halfway decent prose~!

Pauline Park, Ph.D. is a writer and an activist based on New York.

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TRANSGENDER
Tragic Trans? Nope!

The American series “Transparent” makes the subject gender identity now also popular in Germany. In America, the debate is far more. A visit to the transgender center in Queens, New York.
By Claudia Steinberg
Die Zeit
9 April 2015

A rainbow flag between Isabel’s Hair Salon and the mini supermarket shows the way to Pride House: the center for queers and transsexuals on 37th Avenue in Jackson Heights, Queens. There sits on voluminous sofas and office chairs a group of transsexuals, lesbians and bisexuals. The atmosphere is relaxed. Until a woman of indeterminate age dressed in black with a glamorous Chinese shawl draped around her shoulders, takes her place. Pauline Park is the founder and director of Pride House. The group discussion includes dramatic tales of family disputes and unease with their assigned gender identity that feels wrong.

Everyone has known for a long time about Laura’s attempted suicide. Gene reported on the visit of his beloved grandmother from China and how she did not understand the transformation of her granddaughter into a boy and the difficulty she was having accepting his new gender identity. Dylan is computer programmer and longs for acceptance from his ex-wife and his children as he contemplates his transition. June wants to find a new job as a woman, but her doctorate and all her excellent work experience is under her male name.

Since the debates of the 1970s, gays have been able to integrate into the mainstream, leaving transgendered  individuals as an exotic community of outsiders. Their stories of redemption still have entertainment value in a way that the story of a gay couple with a dog and a house in the suburbs has lost. Meanwhile transgender has become the new hot topic, even among the general public, as a civil rights issue, as glamor factor, as a television series. In universities, transgender is challenging gender boundaries under the flag of queer studies. In October of last year, New York Mayor Bill de Blasio called for the ability to change one’s gender on birth certificates without sex reassignment surgery. New York Governor Andrew Cuomo has demanded that health insurance companies pay for sex change operations. The New York City jail, Rikers Island, one of the largest prisons in the world, set up a special department for transsexual inmates because prisons are dangerous places where they often have to endure violence and sexual attacks. Ten years ago a film like “TransAmerica” – in which heroine Bree transitions from man to woman – was still exceptional. Beginning this week, you can go to Amazon.com to find a German-language version of the series “Transparent” (as in, a parent who is transsexual); it has already won a Golden Globe award and has a good chance of attaining cult status.

The writer and director of “Transparent,” Jill Soloway, was inspired by the gender metamorphosis of her own father to create a funny and empathetic call for gender freedom: As Mort’s three daughters are grown up, he risks his coming-out and suddenly comes through the door as a woman with a long hair, in high heels and in a pretty dress. The astonishment is great, especially since Papa Mort surprises his daughter in an intimate embrace with her girlfriend. The series celebrates not just “the birth of a new mother from the female I of the Father,” but also “boygirl, girlboy, macho princess and officer slutty sweet bear,” encouraging them to affirm the identity of their choice. With this anti-dualistic conception, Soloway has wiped away the stereotype of the tragic tranny, the audience of millions demonstrating the possibilities of bold self-determination.

Pauline Park has situated her Pride House in one of the most ethnically diverse places in the world: In the school kitty corner, 84 languages are spoken. At Pride House, there are clients from Colombia, Ecuador, Mexico, China, India, Pakistan, Bangladesh and the Philippines. Each year, the site provides approximately 6,000 interactions with residents from throughout Queens, New York’s second largest borough in population. Pride House has a database of lawyers and doctors accumulated over the course of two decades from whom transsexuals can hope for respectful behavior, working with psychotherapists or psychiatrists together. Immigration and health care are the most important issues. Pride House provides HIV tests, distributes 50,000 condoms a month, and helps homeless clients to find accommodation. “Transsexual teens often end up on the street,” says Park.

Pauline Park’s compassion for people like Laura or Gene is based on her own complicated biography. In 1960, American adoptive parents took two malnourished twins from Seoul. The boys were only eight months old and were the only non-white children in their elementary school. They found themselves in a Christian fundamentalist Republican family. In the first semester of her philosophy degree at the University of Wisconsin, to Park came out as gay. But that was only half the story. The other half came to light when Park took a scholarship to London and there increasingly appeared as a woman. She calls it the most liberating experience of her lives: “For the first time, I presented myself as I saw myself.” Finally, there was her reading of Michel Foucault, through which Park freed herself from the burden of supposedly inauthentic Korean identity and the sex/gender binary, unmasked as a social construct. “I started to accept me as” a male-bodied woman “and as Korean adoptee.”

At home in the sexual and cultural ambiguity, Pauline Park makes a radical theorist and activist who is at loggerheads with the “transgender establishment” in America and the “classic transsexual transition narrative.”

Page 2/2: The gender identity disorder still has the status of a mental illness

After conducting hundreds of training sessions and workshops at universities, hospitals, government agencies and companies Pauline Park is very familiar with all the prejudices that circulate about transsexuals. “Most participants expect me to tell them something about hormones and surgery. But while I begin by talking about that, I focus on trying to explain how many barriers a transsexual must overcome in a hospital visit.” Since 9/11, almost every public building has required showing an identity card. If one’s ID is in a male name, but the person appears as a woman, she will not be able to get beyond the guards. The next hurdle is the form on which you have to check ‘male’ or ‘female.’ If the patient Joanna is sitting in the waiting room, but the name John is called, it can expose her to astonished glances.

The linear transformation from male to female and vice versa is presented to the public on countless talk shows, from Oprah Winfrey to Barbara Walters – with guests who talk about being trapped in the wrong body and want to corrected that state of affairs through hormones and surgery. A change in legal sex designation can actually reinforce the sex/gender binary if it is based on the disease model of transsexuality. In 1974, homosexuality was removed from the diagnostic manual of mental disorders, which instantly ‘cured’ millions of gays. At the same time, the American Psychiatric Association introduced the diagnosis of gender identity disorder, which was recently changed to gender dysphoria, but which retains its status as a mental illness. Consequently, all transgendered individuals are still considered mentally ill.

Park conceded that the dissonance between the assigned gender identity and internal feeling, especially coupled with transgenderphobia, can lead to depression. But that would implicate a diseased society rather than the individual. She wants more than a few crumbs from the table at the Department of Health and isn’t willing to accept them at the cost of pathologizing the community. She regards transgender identity rather like left-handedness, with transsexualism as a natural variant of the dominant gender identity, not a form of deviance. Whoever would like sex reassignment surgery should have the opportunity to get it, says Park. But in contrast to the traditional transgender discourse only a tiny minority would undergo these serious interventions. The majority is situated on some point in the wide spectrum between masculine and feminine. A subversive concept that can result in open conflict in the choice of a public toilet in New York as elsewhere.

NB: This article appeared in the 9 April 2015 issue of Die Zeit under the title, “Tragische Transe? Nö!.” The original German text is below. The above English translation is mine. ~Pauline Park

TRANSGENDER
Tragische Transe? Nö!

Die amerikanische Serie “Transparent” macht das Thema Geschlechtsidentität jetzt auch in Deutschland populär. In Amerika ist die Diskussion längst weiter. Ein Besuch im Transgender-Zentrum in Queens, New York.

Von Claudia Steinberg
Die Zeit
9 April 2015

Eine Regenbogenflagge zwischen Isabels Haarsalon und dem Minisupermarkt zeigt den Weg nach Pride House: ins Zentrum für Queers und Transsexuelle auf der 37th Avenue in Jackson Heights, Queens. Dort sitzt auf voluminösen Sofas und Bürostühlen eine Gruppe von Transsexuellen, Lesben und Bisexuellen. Die Atmosphäre ist ausgelassen. Bis eine schwarz gekleidete Dame unbestimmten Alters, glamourös einen chinesischen Schal um die Schultern drapiert, Platz nimmt. Pauline Park ist die Gründerin und Direktorin von Pride House. Sie weiß, gleich wird die Stimmung abstürzen, mit dramatischen Erzählungen von Familienstreit, dem Aufflammen von Unbehagen an der zugewiesenen Geschlechtsidentität, die sich falsch anfühlt.

Alle wissen längst um Lauras Selbstmordabsichten. Gene berichtet vom Besuch seiner geliebten Oma aus China, die über die Verwandlung ihrer Enkelin in einen Jungen so verzweifelt war wie er über ihre Unfähigkeit, seine neue Identität zu akzeptieren. Dylan ist Computerprogrammiererin und sehnt sich nach einer “Rückwärtskompatibilität” mit der Ehefrau und den Kindern aus ihrem früheren Leben als Mann. Ihre Kollegin June sollte sich bei der Suche nach einem neuen Job einfach als Frau vorstellen, findet Dylan – doch Junes Doktortitel und ihre ganze exzellente Berufserfahrung laufen unter ihrem Männernamen.

Seit sich die Schwulen nach den Debatten der siebziger Jahre in den Mainstream eingliedern konnten, sind Transgender-Individuen als exotischer Rest der Außenseitergemeinde übrig geblieben. Ihre Erlösungsgeschichten besitzen noch immer jenen Unterhaltungsfaktor, den ein schwules Paar mit Hund und Haus in der Vorstadt längst verloren hat. Inzwischen ist Transgender das neue heiße Thema, es ist sogar in der breiten Öffentlichkeit angekommen, als Bürgerrechtsproblematik, als Glamour-Faktor, als Fernsehserie. An den Universitäten rüttelt es unter der Flagge von Queer Studies an den Geschlechtergrenzen. Im Oktober des vergangenen Jahres plädierte der New Yorker Bürgermeister Bill de Blasio für die Möglichkeit, das Geschlecht auf Geburtsurkunden ohne operative Umwandlung ändern zu können. Der New Yorker Gouverneur Andrew Cuomo hat verlangt, dass Krankenversicherungen für Geschlechtsumwandlungen aufkommen. Das New Yorker Gefängnis Rikers Island, eine der größten Strafanstalten der Welt, richtet eine Sonderabteilung für transsexuelle Häftlinge ein, weil Gefängnisse für sie zu den gefährlichsten Orten zählen, wo sie oft Gewalttätigkeit und sexuelle Attacken erdulden müssen. Vor zehn Jahren war ein Film wie Transamerika mit seiner vom Mann zur Frau transformierten Heldin Bree noch eine Ausnahme. Von dieser Woche an kann man über Amazon auch auf Deutsch die Serie Transparent sehen (parent wie Eltern und trans wie transsexuell), sie ist schon ausgezeichnet mit dem Golden Globe und hat beste Aussichten auf einen Kultstatus.

Die Autorin und Regisseurin von Transparent, Jill Soloway, hat sich von der Gendermetamorphose ihres eigenen Vaters zu einem witzigen und empathischen Aufruf für die Geschlechterfreiheit inspirieren lassen: Als Morts drei Töchter erwachsen sind, wagt er sein Coming-out und kommt plötzlich als Frau mit langer Haarmähne, auf Stöckelschuhen und im hübschen Kleid durch die Tür. Das Erstaunen ist groß, zumal Papa Mort dabei seine Tochter in inniger Umarmung mit ihrer Freundin überrascht. Die Serie soll nicht nur “die Geburt einer neuen Mutter aus dem weiblichen Ich des Vaters” feiern, sondern auch “boygirl, girlboy, macho princess and officer sweet slutty bear” zur Identität ihrer Wahl ermutigen. Mit dieser antidualistischen Auffassung hat Soloway das Klischee der tragischen Transe mit Schwung hinweggewischt und einem Millionenpublikum die Möglichkeiten kühner Selbstbestimmung vorgeführt.

Dieser Artikel stammt aus der ZEIT Nr. 15 vom 9.4.2015.

Dieser Artikel stammt aus der ZEIT Nr. 15 vom 9.4.2015.  |  Die aktuelle ZEIT können Sie am Kiosk oder hier erwerben.

Pauline Park hat ihr Pride House an einem der ethnisch vielfältigsten Orte der Welt angesiedelt: In der Schule schräg gegenüber werden 84 Sprachen gesprochen. Im Pride House erscheinen Klienten aus Kolumbien, Ecuador, Mexiko, China, Indien, Pakistan, Bangladesch oder von den Philippinen. Die Einrichtung verzeichnet jedes Jahr rund 6000 Interaktionen mit Bewohnern aus ganz Queens, New Yorks zweitgrößtem Stadtteil. Pride House hat in zwei Jahrzehnten einen Katalog von Rechtsanwälten und Medizinern angesammelt, bei denen Transsexuelle auf respektvollen Umgang hoffen können, man arbeitet mit Psychotherapeuten oder Psychiatern zusammen. Immigration und medizinische Versorgung sind die wichtigsten Themen. Pride House vermittelt HIV-Tests, verteilt pro Monat 50.000 Kondome oder hilft obdachlosen Klienten, eine Unterkunft zu finden. “Gerade transsexuelle Teenager enden oft auf der Straße”, sagt Park.

Pauline Parks Mitgefühl für Menschen wie Laura oder Gene ist in ihrer eigenen komplizierten Biografie begründet. Im Jahr 1960 nahmen amerikanische Adoptiveltern zwei unterernährte Zwillingsbrüder aus Seoul in Empfang. Die Jungen waren erst acht Monate alt und wuchsen nun auf als die einzigen nicht weißen Kinder der Umgebung. Sie waren in einer christlich fundamentalistischen, republikanischen Familie gelandet. Im ersten Semester ihres Philosophiestudiums an der University of Wisconsin offenbarte sich Park als schwul. Doch das war nur die halbe Wahrheit. Die andere Hälfte kam zum Vorschein, als Park mit einem Stipendium nach London zog und dort immer häufiger als Frau auftrat. Sie nennt es die befreiendste Erfahrung ihres Lebens: “Zum ersten Mal präsentierte ich mich so, wie ich mich sah.” Schließlich war es die Lektüre von Michel Foucault, die Park von dem vermeintlichen Fluch einer inauthentischen koreanischen Identität befreite und die binäre Geschlechtsbestimmung als gesellschaftliches Konstrukt entlarvte. “Ich begann, mich als ›körperlich männliche Frau‹ und als koreanisches Adoptivkind zu akzeptieren.”

Dass sie sich in der geschlechtlichen und kulturellen Ambiguität so beheimatet fühlt, macht Pauline Park zu einer radikalen Theoretikerin und Aktivistin, die mit dem “Transgender-Establishment” Amerikas und seiner “klassischen Version der Geschlechtsumwandlung” auf Kriegsfuß steht.

Seite 2/2: Die Geschlechtsidentitätsstörung hat immer noch den Status einer Geisteskrankheit

Nach Hunderten von Schulungen und Workshops an Universitäten, in Kliniken, Regierungsstellen und Unternehmen ist Pauline Park bestens mit allen Vorurteilen vertraut, die über Transsexuelle kursieren. “Die meisten Teilnehmer erwarten, dass ich ihnen etwas über Hormone und Operationen erzähle. Aber das Thema berühre ich kaum. Ich versuche zu erklären, wie viele Barrieren ein Transsexueller etwa bei einem Krankenhausbesuch überwinden muss”. Seit dem 11. September verlangt nahezu jedes öffentliche Gebäude das Vorzeigen eines Ausweises. Wenn der auf einen männlichen Namen lautet, die Person jedoch als Frau erscheint, wird sie möglicherweise nicht über den Wachtposten hinauskommen. Die nächste Hürde ist das Formular, auf dem man “männlich” oder “weiblich” ankreuzen muss. Wenn die Patientin Joanna im Warteraum sitzt, aber als John aufgerufen wird, ist sie verwunderten Blicken ausgesetzt.

Die lineare Transformation vom Mann zur Frau und umgekehrt wurde der Öffentlichkeit in zahllosen Talkshows von Oprah Winfrey bis Barbara Walters nahegebracht – mit Gästen, die sich im falschen Körper eingesperrt fühlten und diesen Missstand mit Hormonen und Operationen behoben. Mit der Umkehrung der genitalen Vorzeichen bleibt aber nicht nur die Weltordnung der polaren Geschlechtsidentität erhalten, sondern die Transsexualität weiterhin dem Krankheitsmodell verhaftet. 1974 wurde die Homosexualität aus dem diagnostischen Handbuch psychischer Störungen gestrichen, das führte mit einem Streich zur “Heilung” von Millionen von Schwulen. Gleichzeitig definierte aber die American Psychiatric Association eine gender identity disorder, Geschlechtsidentitätsstörung, die zur gender dysphoria abgemildert wurde, ohne jedoch ihren Status als Geisteskrankheit zu verlieren. Demzufolge wären alle Transgender-Individuen geisteskrank.

Park konzediert, dass die Dissonanz zwischen der zugewiesenen Geschlechtsidentität und der eigenen Empfindung, vor allem aber Transgender-Phobie zu Depressionen führen kann. Das wäre allerdings eher eine Krankheit der Gesellschaft als eine des Individuums. Sie will mehr als ein paar Brotkrumen vom Bankett des Gesundheitsministeriums um den Preis der Pathologisierung eines Zustands, den sie als so natürlich betrachtet wie Linkshändigkeit. Transsexualität ist für sie eine Varianz der dominanten Geschlechtsidentität, keine Devianz. Wer eine operative Geschlechtsumwandlung wünsche, sollte die Gelegenheit dazu haben, meint Park. Doch im Unterschied zum klassischen Transgender-Diskurs wolle sich nur eine winzige Minorität diesen gravierenden Eingriffen unterziehen. Die Mehrheit siedele sich einfach an irgendeinem Punkt auf dem breiten Spektrum zwischen maskulin und feminin an. Ein subversives Konzept, das bekanntlich schon bei der Wahl einer öffentlichen Toilette Konflikte eröffnen kann, in New York wie überall.

In der Serie “Transparent” wählen “MaPa” (Jeffrey Tambor” und seine Töchter die Damentoilette.

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Wal-Mart Pride in the Cincinnati Pride Parade

I’m reading through the 2014 New York City Pride March ‘order of march’ list and noticing all of the large corporations in this year’s parade, including: AT&T, Bank of America, Best Buy, Chipotle, Citibank, Delta, Facebook, Google NY, JP Morgan Chase, Logo TV, Macy’s, Marriott, MasterCard, NBC, Netflix, New York Life Insurance Co., Nielsen, Penguin/Random House, The Ritz, Satori Laser, Shutterstock, Spotify NYC, TD Bank, United Airlines, Vitamin Water, Wal-Mart, Wells Fargo Bank, Wyndham Worldwide and Yahoo. That’s nearly 30 corporations, about 10% of all of the groups in the parade.

I don’t mean to denigrate the hard-working people who organize these LGBT affinity groups to march in the NYC Pride March and other pride parades in the city and around the country; many of them are doing pioneering work in opening up corporations to LGBT employees. That work is especially important for transgendered people seeking to transition on the job, particularly for those seeking coverage for gender transition-related procedures. And the fact that the Fortune 500 are ahead of most state and local governments can be useful in prodding legislatures and executives to move forward with LGBT non-discrimination legislation.

That being said, I have to wonder if our community is simply becoming more and more of a market segment to be marketed to and less and less of a movement for social justice. When I was honored to be named grand marshal of the NYC Pride March in 2005 — the first openly transgendered person to be grand marshal of the country’s oldest and largest pride parade — I don’t remember nearly this number of corporate groups marching in the parade. Far more disturbing, to my mind, is the number of corporations that have become sponsors of pride parades around the country. While parades are expensive to mount and organizing committees need funds to put on ever-larger events, the increasing corporate largesse means that our community is becoming ever more dependent on such corporations, with implications for the independence of our community and the ability of community leaders to speak out against corporate power (see, for example, “Corporate sponsorship of pride parades on the rise,”, by Brady McCombs, Associated Press, 27 June 2014).

Wal-Mart is the largest and most powerful corporation in the country and along with Amazon is emblematic of the worst labor abuses in the system. I’m sure there are good people working at Wal-Mart and I think having an LGBT affinity group at Wal-Mart is a good thing. But seeing Wal-Mart marching in the parade cheek-by-jowl with community-based groups such as the Gay Asian & Pacific Islander Men of new York (GAPIMNY) and Q-Wave (for lesbian, bisexual and queer women and trans people) is more than a little jarring. Did the participants in the Stonewall Riots in June 1969 pick up paving stones in order to get more gay market share for Citibank and Wal-Mart? I hardly think so~!

Baltimore Pride 2011

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ISSUES OF TRANSGENDERED ASIAN AMERICANS AND PACIFIC ISLANDERS
By Pauline Park, co-founder, New York Association for Gender Rights Advocacy and John Manzon-Santos, Executive Director, Asian & Pacific Islander Wellness Center

Testimony submitted to the President’s Advisory Commission on Asian Americans and Pacific Islanders

Transgendered and gender-variant people are among the most invisible and marginalized of all Asian Americans and Pacific Islanders, and it is important that our issues be addressed in any attempt to discuss the needs and concerns of the larger lesbian, gay, bisexual, and transgendered (LGBT) Asian Pacific Islander community.

What we today would call ‘homosexuality’ and ‘transgender’ have existed throughout human history, present in some form in every pre-modern society, though they have been socially constructed in very different ways across different cultures and time periods. Most often, the two phenomena have been conflated and have been constituted through notions of a ‘third sex’ or ‘third gender’ role. In fact, in pre-modern Asian and Pacific Islander cultures, individuals whom today we would identify as lesbian, gay, bisexual, transgender, or intersexual, might have identified themselves as bakla (in Tagalog), shamakhami (in Bengali), waria (in Javanese), paksu mudang (in Korean), or mahu (in Hawaiian).

Mythological narratives involving sexual transformation appear throughout the oral storytelling tradition and written literature of Asian and Pacific Islander cultures, as for example, with the Chinese story of the male deity Kuan-yin, who changed sex to become the goddess of mercy. There are many popular tales of Kuan-yin’s adventures, and traditionally, she is the most popular deity in the Taoist pantheon. It is fitting that mercy should be the province of transgendered people, because the power of the transformation teaches compassion to the transformed.

Unfortunately, European colonialism had a deleterious effect on many traditions of transgender in Asia and the Pacific. For example, the Hijra of India, male temple priestesses of the mother goddess Bahuchara Mata, were turned into social pariahs during the British occupation. And the Babain culture of transgendered priests and priestesses that was revered in traditional Filipino society was destroyed by Catholic missionaries in the nineteenth century.

In Korea, there are three distinct transgenderal traditions. Under the Silla dynasty, which unified the peninsula in the 7th century, the Hwarang warrior elite included many boys who dressed as women, wearing long gowns and make-up when they were not practicing archery or preparing for battle. In addition to the Flower Boys of Silla, there were the boy actors who played women’s roles in the Namsadang theatrical troupes that toured the villages of Korea until the end of the 19th century, often taken as lovers by the older males who played the men’s roles in those same companies. Finally, there was the tradition of the mudang, always a woman, but not always female. The paksu mudang was a male shaman who performed sacred rituals as a woman (and may have lived as a woman as well), and who was not only respected but also revered. However, the mudang culture has slowly died out, under the impact of Communism in the North (where the paksu mudang were particularly popular before World War II) and capitalism and conservative Christianity in the South. Ironically enough, the mudang tradition is in fact rooted in the Altaic origins of Korean culture having its origins in the Siberian homeland from which the Korean people migrated, and it long predates the introduction of Confucianism, Taoism, and Buddhism to the peninsula under Chinese influence after the unification of Korea under the Silla.

The term ‘transgender’ is of relatively recent origin, having come into general use only in the last ten years or so; it is an ‘umbrella’ term used to identify a diverse community of individuals who are similar only in transgressing conventional gender norms. The term is usually meant to include everyone from casual crossdressers and transvestites to post-operative transsexuals, as well as many individuals who are not consciously transgender-identified. There has been no comprehensive study of the transgender community, and so an estimate of the population is speculative at best. While Kinsey estimated the lesbian and gay proportion of the general population to be approximately ten percent, the percentage of Americans – and by extension, Asian Americans and Pacific Islanders – who are transgendered in some sense depends to a large extent on how one defines that population.

The smallest proportion of the transgender population may well be those who are transsexual-identified – both male-to-female (MTF) and female-to-male (FTM) – ‘transsexual’ traditionally being used to describe someone seeking or having undergone sex reassignment surgery (SRS). But in addition to pre-operative and post-operative transsexuals, a growing number of individuals identify as non-operative transsexuals, those who do not seek SRS; some ‘non-op’ transsexuals may undergo hormone therapy, while others do not.

A much larger category, in which would be included transsexuals, would be those whom we could term ‘transgendered,’ whether they use that term as a self-descriptor or not. This category includes transvestites and crossdressers, the former term now considered by many to be somewhat old-fashioned or overly clinical and giving way to the latter term as a self-identifier. In that category, one could also include those who identify as or who are labeled by others as drag queens and drag kings, stone butches, etc. Non-transsexual transgendered people are those who choose to spend a significant portion of their lives in the gender opposite their sex assigned at birth without SRS.

A still larger category would be the gender-variant: individuals who transgress conventional gender norms but who do not (for the most part) ‘crossdress’; this category would include feminine men (some gay, others bisexual or heterosexual-identified) and masculine women (some lesbians, others bisexual or heterosexual-identified), as well as transgendered and transsexual people. In contrast to the gender-variant are the conventionally gendered – masculine males and feminine females who at most times and in most places conform to societal standards of gender. One important point must be made here: the lesbian, gay, and bisexual (LGB) population and the transgender population are not mutually exclusive, nor are they coterminous. At some point in their lives, many transgendered people identify as LGB: e.g., an individual may ‘come out first as a gay male and then later come to identify as a transgendered woman; or a heterosexual-identified male may, as a post-operative transsexual woman, identify as a transsexual lesbian.

It is widely assumed that there are only two sexes – male and female – and that these form the basis of masculinity and femininity; this is what social theorists call the ‘sex/gender binary.’ Even many of those who recognize gender as being ‘socially constructed’ – i.e., in a very profound sense, ‘invented’ by human beings, just as we invent different styles of clothing – do not fully realize the extent to which sex is also socially constructed. Pioneering work by Dr. Anne Fausto-Sterling, a leading biologist, is leading to a re-evaluation of our notions of sex as well as of gender. The phenomenon of intersexuality represents one of the most significant challenges to the sex/gender binary. Intersexuals (traditionally known as ‘hermaphrodites’) are those whose genitalia are neither entirely male nor female. Because of the ‘ambiguity’ of their genitals at birth, intersexed people are subject to intersex genital mutilation (IGM), usually performed between birth and age six, in which their genitals are surgically altered to conform to socially sanctioned notions of maleness or femaleness. Many intersexuals suffer lifelong sexual dysfunction and physiological problems as a result of the brutal physical mutilation to which they are subjected, almost always in infancy or childhood, when they have neither the legal standing nor the cognitive maturity to give informed consent, much less to object, to IGM.

Intersexed people have existed in all societies and epochs, and were thought in many Asian and Pacific Islander cultures to have special spiritual powers. Therefore, a renewed respect for intersexuals would represent a rearticulation of traditional Asian and Pacific Islander cultural values as well as empowering those intersexed Asian Americans and Pacific Islanders who suffer so much shame and stigmatization. We therefore urge the Commission to make a public statement in support of an amendment to the recently passed federal law banning female genital mutilation (FGM) that would explicitly include intersex genital mutilation in its provisions. It is striking the extent to which Americans, outraged by the practice of FGM in the Middle East and Africa, are largely unaware of the equally disfiguring practice of IGM that the medical establishment condones here in the United States.

Ironically enough, while transsexuals often lack the means to obtain sex reassignment surgery, intersexuals have their sex involuntarily reassigned in a way that deprives them of autonomy in sexuality and gender expression. Sex reassignment surgery (SRS) can cost anywhere from $5,000-150,000, depending on whether the individual is MTF or FTM and the skill and reputation of the surgeon. Added to the cost of SRS itself is the cost of hormones (a lifetime expense, from the start of hormone replacement therapy), of psychotherapy, and related expenses. But the price that transsexuals pay for sex reassignment goes well beyond the costs of SRS and hormones: included in that price is lifelong stigmatization.

In order to obtain SRS, a transsexual woman or man must first undergo psychotherapy and obtain a diagnosis of ‘gender identity disorder’ (GID), a mental illness listed in the Diagnostic & Statistical Manual of Mental Disorders (DSM), compiled by the American Psychiatric Association (APA). The process of transsexual transition – including psychotherapy, hormone replacement therapy (HRT), and SRS is ostensibly governed by the Standards of Care (SOC) published by the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Together, the GID and the SOC constitute a regime for the regulation of gender, and one constructed and maintained largely by white, upper middle class, US-born, heterosexual-identified, and conventionally gendered men. One of the aims of the GID regime is to help transgendered women ¾ whom many such mental health professionals assume incorrectly to be mostly attracted to men ¾ become conventionally gendered heterosexual women, just the expectations are that transgendered men (who are incorrectly assumed to be mostly attracted to women) will become conventionally gendered heterosexual men. The fear of ‘transhomosexuality’ among such practitioners is high: they do not want to ‘create’ homosexuals (i.e., transsexual lesbians and transsexual gay men), but rather to ‘cure’ those they perceive to be homosexuals of their homosexuality.

The practical consequence of a diagnosis of ‘gender dysphoria’ or GID is that the transsexual man or woman so diagnosed is labeled mentally ill, even in those cases where he or she is perfectly mentally healthy. While there certainly are a number of transsexuals who have real mental illnesses (such as schizophrenia, bipolar disorder, etc.), most are no more mentally ill than non-transsexuals are. But the struggle to find or keep a job becomes a daunting one when, in order to obtain SRS, the otherwise mentally healthy transsexual has to accept a diagnosis of mental illness that could prompt discrimination based on prejudice against the mentally ill in addition to that against the transgendered. The logical solution is for the APA to remove GID entirely from the DSM. What further complicates the situation, however, is that SRS is still considered an ‘experimental’ practice (despite surgery for MTF transsexuals having been brought to a high level of sophistication), and so the diagnosis of GID is used to enable psychiatrists to ‘prescribe’ SRS as the ‘cure’ for a ‘mental illness’ that simply does not exist. It is important to realize that GID affects not only those who seek SRS: its presence in the DSM pathologizes not only transsexuals, but all transgendered people more and even more generally, all who are gender-variant. In fact, GID is diagnosed most often in gender-variant children and youth whose parents – once again, conflating homosexuality and transgender – are concerned that their children may grow up to be gay. Ironically, three quarters of the children and youth who are diagnosed with GID do in fact come to identify as LGB as adults, while only a quarter come to identify as transsexual or transgendered.

There is a growing consensus within the transgender community in favor of a ‘reform’ of GID to eliminate the designation of transsexuality as a mental illness but to retain some reference in the DSM to transsexuality as medical condition justifying HRT and SRS. We therefore call on the Commission to make a strong statement in favor of the GID reform to eliminate the designation of transsexuality as a mental illness.

The American Psychological Association has already taken a stand in favor of GID reform, stating quite clearly its belief that transgender is simply a naturally occurring variance in gender identity and expression. Just as the removal of homosexuality from the DSM 25 years ago helped significantly alter society’s view of lesbian and gay people as well as giving renewed impetus to their struggle for civil rights, so too, the removal of GID from the DSM will help remove the stigma of mental illness from transgender.

Given the profound transgenderphobia – reinforced by the GID diagnosis – it is not surprising that transgendered people constitute one of the most marginalized populations in American society, facing pervasive discrimination, harassment, abuse, and violence. The violence that is so commonplace in the lives of the transgendered was no more dramatically illustrated than in the case of Brandon Teena, a young female-bodied transman who was brutally raped and murdered in Nebraska several years ago, and whose story was told in the 1999 Academy Award-winning film, “Boys Don’t Cry.” Transgendered men and women face discrimination and violence not only in the United States, but in countries throughout the world, as documented by the International Gay & Lesbian Human Rights Commission (IGLHRC) based in San Francisco and by the Amnesty International OutFront Program based in New York. Unfortunately, many such human rights abuses take place in Asian countries.

In the face of such pervasive discrimination and violence, transgendered people, are beginning to organize its own civil rights movement, both here and abroad. Much of that political work is being done in alliance with LGB people. Hence, while there are distinct differences between homosexuality and transgender, the overlap in LGB and transgender populations and the common cause that these diverse communities have made justify the term ‘LGBT’ to describe a political community and movement.

In the last few years, the concerns of transgender communities have increasingly become integral to the lesbian, gay, and bisexual movement. Similarly, AAPI initiatives that include sexual orientation should also include the language of gender identity and expression. For example, the fear of persecution based on sexual orientation is now recognized as cause for political asylum; however, the term ‘sexual orientation’ does not necessarily include transgendered or gender-variant people. A statement from the Commission in favor of the addition of “gender identity or expression” to political asylum law would therefore help address the problem of pervasive discrimination and violence that our transgendered brothers and sisters face in many Asian and Pacific Islander countries.

It is a cruel irony indeed that transgendered people – who helped lead the Stonewall uprising that catalyzed the modern lesbian and gay movement – were marginalized in that movement after June 1969. Only in the last five years has a real transgender political movement emerged in the United States. In the 1990s, transgender political organizations formed at the local, state, and national level to press for transgender-inclusive and transgender-specific anti-discrimination and hate crimes legislation. Anti-discrimination laws that include transgender-specific language (such as gender identity and expression) have been adopted in 30 jurisdictions across the country, including one state (Minnesota), three counties, and 26 municipalities. Those cities range from the large and cosmopolitan (San Francisco, Minneapolis, Seattle, Atlanta) to the small and unexpected (Ypsilanti, Michigan; York, Pennsylvania).

A campaign is now underway in New York City to amend that city’s human rights ordinance which, if successful, would make New York City the largest jurisdiction in the country to protect transgendered people from discrimination in employment, housing, and public accommodations. The campaign is being led by a transgendered Asian woman and has elicited the support of leading Asian American organizations, such as the Asian American Legal Defense & Education Fund (AALDEF) and the Filipino Civil Rights Advocates (FilCRA). There is also a campaign to get the California state legislature to adopt similar legislation, and one of the key organizations involved in that campaign (California Alliance for Pride & Equality – CAPE) includes a number of LGB Asian Americans in its leadership. If successful, that campaign would make California – the largest state by population and one that includes a huge API community – a leader in transgender anti-discrimination law.

Little specific information exists on transgendered communities as a whole. To date there has been no community assessment of Asian American and Pacific Islander transgendered population in the U.S. From a behavioral health perspective, transgendered people are often subsumed under the larger category of gay, bisexual, and other Men who have Sex with Men (MSM). Few tracking systems allow for gender identification beyond male and female. One watershed effort was mounted in 1997 by the San Francisco Department of Public Health. The Transgender Community Health Project (TCHP) became the first study (qualitative focus groups and quantitative surveys) designed to assess HIV risk among male-to-female (MTF) and female-to-male (FTM) transgendered individuals. 505 anonymous surveys and HIV tests were administered, and risk behaviors inclusive of and beyond HIV were reported. Forty-nine, or 13%, were completed by AAPI participants.

Although TCHP data is limited in that its cohort resides in the City and County of San Francisco and its purpose was to assess HIV risk specifically, transgendered AAPIs are everywhere, often building visible communities in metropolitan areas across the U.S. More comprehensive studies on a national scope are urgently needed for transgendered people across races, including AAPIs. To the extent that findings from the TCHP study can be extrapolated as one example of an urban area where transgendered AAPIs live, work, and socialize, consider the alarming statistics below. Of the total sample of transgendered respondents (MTF% / FTM %):

52% / 41% had no health insurance
53% / 21% had unstable housing
65% / 29% had a history of incarceration
23% / 20% had been hospitalized for mental health
32% / 32% have attempted suicide
53% / 31% had been diagnosed with a sexually transmitted disease
35% / 2% tested HIV-positive
80% / 31% had a history of sex work
59% / 59% had a history of forced sex
91% / 57% use hormones
65% / 54% inject hormones
34% / 18% inject street drugs
63% / 91% report sharing syringes
According to the Comprehensive HIV Prevention Plan for San Francisco, transgendered respondents persons are at increased risk for HIV infection due to a combination of biological, economic, psychological, behavioral, social/situational and access-related cofactors. Primary among these are a much higher incidence of commercial sex work, substance abuse, poverty, lack of access to HIV/AIDS and medical services, and discrimination by AIDS service organizations as well as employers. In particular, commercial sex work, largely a result of employment discrimination and poverty is closely associated with: increased rates of injection drug use as well as substance abuse, increased STD rates, increased rates of rape and coerced unprotected sex, increased trauma to tissues during sex, history of child sexual abuse and abusive relationships, as well as dramatically increased numbers of sexual encounters and numbers of sexual partners of higher risk.

The Plan also suggests that a transgendered sex worker’s risk for HIV infection may be different from other groups. One study reports that transgendered sex workers are more likely to have receptive anal sex with their paying partners than their primary partners, a behavior with direct consequences for HIV and STD infection if protection is foregone. Preoperative transgendered sex workers who are trying to earn money for gender confirmation surgery or sexual reassignment may perceive a monetary incentive for unprotected sex as beneficial in the moment, despite the associated health risks. Feminization through hormone therapy, hair removal, plastic surgery, breast implants, and sexual reassignment surgery, although costly, is often a transgendered individual’s first priority.

Sharing unsterilized needles and syringes during injection drug use or hormone use is also common within the MTF transgendered community. Injection drug use, and in particular injected speed or crystal methamphetamine use in combination with commercial sex work is a common practice. Injection hormone therapy is seen as a positive component of the gender confirmation process, and therefore safe, though it poses many of the same HIV transmission risks as injection drug use.

Rejection and isolation are integral aspects of a transgendered sex worker’s life. Transgendered individuals are often marginalized from the mainstream gay and lesbian communities and many are ostracized by their families of origin. As a result, they have low self-esteem, neglect their own health, and are fatalistic about the future. Discrimination creates significant barriers for transgendered persons who want to maintain or seek regular employment. Eliminating discrimination during access to services is particularly important for disenfranchised groups such as transgendered individuals and sex workers. The provider of services is seen initially as a representative of a larger social system which is perceived as antagonistic to their well being. Based upon direct experience, many transgendered people distrust service providers, feel misunderstood by them, and believe that providers regard them as expendable, which further prevents access of services.

From the TCHP study, some AAPI-specific data can be gleaned. Consistent with a high HIV-seroprevalence among transgendered AAPI participants (27%), they reported high levels of HIV risk behavior, including unprotected anal intercourse and other sexual activities, as well as other co-factors such as sharing needles for the injection of hormones and street drugs. Among transgendered AAPI sex workers, the drugs of choice are injected and non-injected speed, such as crystal methamphetamine, which helps them to work late into the night. These individuals are often isolated from traditional support networks available in AAPI families and communities while language and cultural differences often limit access to health and human services. Finally, transgendered AAPIs engage in high-risk behavior but their perception of susceptibility is low, a reality consistent with gay, bisexual, and other MSM AAPIs. The transgendered AAPI population in San Francisco is estimated to number 2,500, or 40% of the local transgender population, and tend to be immigrants and refugees from Asian countries such as the Philippines, Thailand, Laos, Vietnam, and China where transgendered individuals have a distinct social role.

Some nonprofit organizations report anecdotal evidence that confirm the TCHP findings. Specifically, highest among the needs of transgendered AAPIs are immigrant and refugee-competent, multi-lingual programs that broker housing, employment, and health care.

Given the complex factors which place transgendered AAPIs at high risk of disease and discrimination, targeted programs and interventions should address the following barriers:

Linguistic and cultural barriers: Asian immigrants and refugees face linguistic and cultural barriers to accessing services. Since most outreach is conducted in English, limited English individuals are not reached through mainstream channels of outreach and promotion. In addition, when health services are located, limited English proficient individuals often are unable to describe their health problems to primarily English-speaking service providers. Furthermore, providers are often unaware and even insensitive to the nuances of AAPI cultures and the needs of these individuals. For example, AAPI cultures discourage the open discussion of life-threatening illnesses for fear of inviting the disease into one’s life; thus, the superstition and fatalism attached to disease undercuts the value AAPI peoples place on prevention. The fear of stigmatization is particularly important in AAPI communities. There is fear “that any disclosure will result in community-wide disclosure of a person’s most intimate, personal life. Hence many AAPIs will not disclose outwardly nor acknowledge internally behaviors that put them at risk. Out of denial, many high-risk individuals will neither acknowledge that they are at risk nor identify with a service which targets risk behavior; consequently utilization of education prevention services is low and perpetuation of risk behavior remains high.”

Lack of health providers trained in cross-cultural delivery of services: Health care systems lack culturally responsive and linguistically appropriate services. Given the diversity of AAPIs, the health service system is simply unable to reach out to many populations, especially as AAPI populations continue to grow exponentially. In addition, effective partnerships between mainstream health organizations and community-based agencies working with limited English proficient individuals are lacking. Few AAPI language interpreters are competent in sensitive issues related to work in the sex industry, gender identity among transgendered individuals, and HIV/STD services. Many lack self-advocacy skills to effectively access health services on their own.

Socioeconomic conditions which impede access to health care system: Transgendered AAPIs who engage in sex work and exchange sex for money or drugs face immediate needs which are prioritized over seeking health services. Many sex workers are immigrants and are fearful of arrest and prostitution convictions, which could hurt their chances for naturalization. Many of the transgendered MTF AAPI sex workers, being born male, often send money home to provide for their parents in fulfillment of their filial duties.

The pervasive discrimination, harassment, abuse, and violence that transgendered people face has led to the marginalization of transgendered people, and have led transgendered AAPIs in particular into sex work and other dangerous occupations.

A strong statement from the Commission on the need to accept and appreciate the fullness of the diversity of AAPI communities would do much to help ameliorate the marginalization and the stigmatization of transgendered and gender-variant AAPIs. We would also appreciate a strong statement in favor of fully inclusive hate crimes and anti-discrimination laws at the federal, state, and local levels, as well as a statement in favor of the reform of GID. And we would view as a special priority a statement from the Commission in favor of the addition of the phrase ‘gender identity or expression’ to federal asylum law and administrative guidelines.

Transgendered, intersexual, and gender-variant people were respected and even revered in many Asian and Pacific Island cultures, from the hijra in India to the paksu mudang in Korea to the mahu in Hawai’i. Contemporary AAPIs of transgender experience have much to contribute to their AAPI communities of origin, if given the chance.

By Pauline Park & John Manzon-Santos, October 2000

Additional References / Sources
Clements, Kristen, et al; HIV Prevention & Health Service Needs of the Transgender Community in San Francisco: Results from Eleven Focus Groups; San Francisco Department of Public Health; 1997.
Clements, Kristen, et al; The Transgender Community Health Project: Descriptive Results; San Francisco Department of Public Health; 1999.
Consensus Report; San Francisco Department of Public Health; 1997.

http://www.apiwellness.org/article_tg_issues.html

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Transgender Inclusion: Transforming the Academy, Transforming Society
Pauline Park

keynote speech
Students of the American Veterinary Medical Association (SAVMA)
Diversity Forum
21 March 14

I would like to begin by thanking Shana Kitchen of the Students of the American Veterinary Medical Association (SAVMA) for being instrumental in bringing me here to speak at the Diversity Forum today and I’d like to thank Prof. Julie Gionfriddo for first suggesting me to SAVMA as a keynote speaker. This is my very first visit to Colorado State University and in Fort Collins and only my third visit to Colorado, and I’m absolutely delighted to be here and to have the opportunity to talk about transgender inclusion in academia as well as the pursuit of social change with you today.

If we start with the objective of full inclusion of transgendered and gender-variant people in academic life on campus how would we go about achieving that goal? The first step would have to be to gain a full understanding of just what ‘transgender’ means. Many in this audience will have a very good understanding of transgender identity, but for those for whom this is a relatively new topic, I would like to suggest that you imagine a diagram to illustrate the complexity of the community of which I myself am a member.

Picture  the community as a series of three concentric circles, beginning with transsexuals — those who seek or have obtained sex reassignment surgery (SRS) — often described as being either ‘pre-operative’ or ‘post-op,’ as the case may be. While the mainstream media until recently have tended to focus on those who follow what I call the classic transsexual transition, there are as many ways of being transgendered as there are transgendered people; most transgendered people don’t want SRS and most of those who do (viz., transsexuals) never get it — mainly because of the expense, but for other reasons as well. So encompassing this first circle composed of transsexuals is a much larger circle, those I will call ‘the transgendered,’ including not only transsexuals but non-transsexual transgendered people as well. In this group of non-transsexual transgendered people are those who identify as — or are identifed as — crossdressers as well as drag queens and drag kings — terms best used with reference to performance, whether professional or informal. The ‘transgendered’ in the context of this circles diagram will be used to denote those who present fully in a gender identity not associated with their sex assigned at birth — at least part of the time. A still larger category encompassing both transsexual and non-transsexual transgendered people is that which I will label the ‘gender-variant,’ a term that actually has its origins in academic circles but which has come into vogue among activists as well. The non-transgendered gender-variant would include relatively feminine males who nonetheless still identify as men or boys and relatively masculine females who still identify as women or girls. The term ‘gender-variant is particularly relevant on college campuses, as there are many who were born male and especially female who disdain the sex/gender binary and terms such as ‘man’ and ‘woman’ that they see as reflecting that binary; many such young people prefer to identify as ‘gender-queer’ and some prefer gender-neutral pronouns.

I contrast these three groups — the transsexual, transgendered and gender-variant — with another group, the conventionally gendered — those who more or less conform to the gender norms of their time and place, and who (by definition) constitute a majority in every society, as every society constructs norms of gender and imposes those norms on its members. What is crucial to grasp is that this diagram is a map of the gender universe; it does not speak to sexual orientation. As most in this audience will already understand, transgendered people are as diverse in their sexual orientation as non-transgendered people and like them, may be heterosexual or bisexual as well as gay or lesbian. And I also need to emphasize that this diagram is simply my map of the gender universe; there are as many different definitions of transgender as there are transgendered people.

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Transgender Identity, Community & Empowerment
Pauline Park, Ph.D.
Chair
New York Association for Gender Rights Advocacy (NYAGRA)

Social Sciences Open House
Marymount Manhattan College
17 October 2013

I would like to begin by thanking Prof. Manolo Guzmán for being instrumental in bringing me here to speak at the Social Sciences Open House today. This is my very first visit to Marymount Manhattan College and I’m absolutely delighted to be here and to have the opportunity to talk about transgender identity, community and empowerment with you today. And in fact, I’ve entitled my talk “Transgender Identity, Community & Empowerment” because it seems to me that those are three of the crucial elements in our task as we seek to make the social sciences fully inclusive of transgender as a topic and transgendered and gender variant people as faculty, staff and students.

My perspective is informed by work in the academy both in faculty and staff positions and of course as a student as well as work in the community, most intensively with Queens Pride House, which I co-founded in 1997, and the New York Association for Gender Rights Advocacy (NYAGRA), which I co-founded in 1998. Queens Pride House is the only LGBT community center in the borough of Queens, and we offer support groups — including a transgender support group — free mental health counseling for members of the community, and other services; we are just completing our first funded advocacy program which focused on advocating for members of the community — especially transgendered women of color — who are victims of police harassment and brutality.

In 2009, NYAGRA published the first directory of transgender-sensitive health care providers in the New York metropolitican area; and while directories of this kind have been posted on-line for cities such as Los Angeles, Boston, and Minneapolis-St. Paul, the NYAGRA directory was the first such directory in the United States ever published in a print edition; we are updating it continuously as we identify more transgender-sensitive providers in the area and it is now available on-line as well at nyagra.com.

NYAGRA is a co-founding member of the coalition seeking enactment of the Gender Expression Non-Discrimination Act (GENDA), the transgender rights bill currently pending in the New York state legislature, and I represent NYAGRA in that coalition, as I did in the coalition that secured enactment of the Dignity for All Students Act (DASA) in 2011. The Dignity Act came into effect this July and prohibits discrimination and bias-based harassment in public schools throughout the state of New York. I mention safe schools legislation in the context of this discussion because the New York State Dignity legislation includes a comprehensive list of ‘protected categories,’ including race, religion, ethnicity, and disability as well as sexual orientation and gender, defined to include gender identity and gender expression. Safe schools legislation such as DASA can help move us out of a purely ‘identitarian’ conceptual framework, which can be limiting.

It should be obvious — but may not be to everyone — that making higher education more LGBT-inclusive must also mean tackling the problem of bullying and bias-based harassment in elementary and secondary schools, since so many LGBT students drop out of school because of such bullying and never make it to college; that is especially true of transgendered students, I would essay, based on anecdotal evidence (in the absence of any comprehensive study of the problem).

In addition to the work I do on behalf of NYAGRA in the legislative arena, one other important component of my work is transgender sensitivity training; I’ve conducted sessions for a wide range of social service providers and community-based organizations, ranging from one-hour workshops to full-day trainings. A small part of my training work has been with academic institutions, focused on issues related to transgender inclusion — including, for example, gender-neutral housing, which has become a major issue on many campuses.

One of the biggest issues for transgendered people both on campus and off is access to health care, which is why I co-founded the Transgender Health Initiative of New York back in 2004. THINY (as we call it) and its members have worked tirelessly to try to open up health care to members of our community in New York, who face significant impediments to accessing quality health care, just as they do throughout the country.

In 2006, I co-facilitated a series of trainings for St. Vincent’s Hospital, which was one of the largest hospitals in New York City, and a hospital with one of the largest transgender patient populations. Sadly enough, St. Vincent’s went bankrupt last year and closed after failing to resolve a situation in which the hospital had accumulated over a billion dollars in debt. Sad, too, because these were the first transgender sensitivity trainings for any major hospital in the city and they were as much of an eye opener for us as they were for the nurses, techs, and other health care professionals we trained. Participants ranged from hostile to indifferent to open-minded to genuinely supportive  in short, a microcosm of society and its attitudes towards the transgendered. Only a few of the nurses were openly hostile and even (in at least two cases) somewhat disruptive. But most of the nurses and other providers we did trainings for at the very least listened politely.

The real problem was the lack of both knowledge of the challenges facing transgendered people as they try to access health care as well as the lack of sensitivity on the part of some of these providers. With regard to the former — lack of knowledge — one of the big problems facing our community is that among those who think about transgender access to health care —and there are far too few who think about this issue at all — most imagine that the main challenge we face is accessing hormones and surgery. While that is a challenge, the biggest challenge for transgendered people really is accessing healthcare for all of those medical issues unrelated to gender transition.

And that leads me to an important theme of my talk today. The ‘gateway’ diagnosis required to access to hormone replacement therapy (HRT) and sex reassignment surgery (SRS) since 1974 has been gender identity disorder (GID), introduced into the fourth edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM IV), published by the American Psychiatric Association (APA). While GID is usually thought of as the diagnosis by which adult transsexual and transgendered people gain access to HRT and SRS, the true significance of GID is much larger. First, a change of legal sex designation — the ‘gender marker’ on identification documents that assigns us to either male or female sex — in most jurisdictions requires at the very least documentation of an intent to go for SRS, if not actually proof of completion of surgery (as is the case in New York City).

While there is no necessary connection between a change of legal sex designation and a change of legal name, in many if not most cases, transitioning transsexuals pursue these two changes simultaneously. The truth is that most transgendered people frequently or even consistently present in a gender that does not match their ID, which causes problems in a multitude of situations. Since 911, most large buildings in New York City require photo ID even to enter the building. And so the apparent discrepancy between ID and either ‘gender marker’ and/or gendered name and/or gender presentation in a photo can constitute a barrier to employment, housing, and public accommodations as well as to accessing health care and social services.

But if the apparent ’solution’ is to go for a change of legal sex designation as well as name, and if the former change – and in some cases, effectively, the latter – requires the diagnosis of GID; then in effect, the ability to access health care as well as employment, housing, and public accommodations requires a diagnosis of GID as well. I personally find it outrageous that transgendered people in the United States and elsewhere have to have themselves declared mentally ill in order to access health care or to get or to keep a job. We must commit to finding means by which transgendered people can access forms of medical intervention such as HRT and SRS without having to subject themselves to the degradation of being declared mentally ill simply by virtue of their gender identity. As I like to say, I do not have a gender identity disorder; it is society that has a gender identity disorder.

One small step forward was taken when the APA revised the GID diagnosis and renamed it ‘gender dysphoria’ in the DSM-V published earlier this year. But while the language of the diagnosis has been softened, the diagnosis still pathologizes gender variance as a mental disorder that needs to be corrected, and that diagnosis not only undergirds the Standards of Care (SOC) published by the World Professional Association of Transgender Health (WPATH) (formerly the Harry Benjamin International Gender Dysphoria Association) and the protocols for gender transition in this society, this diagnosis – what I call the GID ‘regime’ – constitutes the very basis for American society’s understanding of transgender. Even in relatively more sympathetic portrayals of transgendered characters such as those in “TransAmerica” and on “All My Children” and “Ugly Betty,” the discourse through which those characters are understood is a medical model of transsexuality that is fundamentally model that constructs gender dysphoria as deviance from a norm rather than recognizing transgender and gender-transgressive identity and expression as simply being a natural variance in a gender identity that is no more ‘disordered’ than conventional gender identity and expression. My own work as a transgender activist is informed by a feminist conception of gender and a commitment to challenging and dismantling the sex/gender binary that is at the root of our oppressionas women and as men as well as transgendered men and women. Our goal as a movement must therefore be nothing less than the transformation of society’s understanding of gender. And if we are committed to that goal, we must also be committed to dismantling the ‘GID regime’ that undergirds this system of gender regulation and control.

The influence of GID also extends into the sphere of public policy as well, impeding the fight for transgender rights. We have made enormous progress as a community and as a movement over the course of the last two decades, but while over 150 jurisdictions — including 17 states and the District of Columbia – now have enacted legislation explicitly prohibiting discrimination based on gender identity or expression, it is a sad fact that 33 states have no such protection in their state laws. However, every state has included disability in its human rights law, and it is that rubric that litigators are using to obtain legal redress for transgendered plaintiffs across the country, and they often win on that basis. But the argument that such litigators proffer usually follows along these lines: my client is mentally ill by virtue of his/her gender identity disorder or gender dysphoria and therefore is protected under state disability law. I should make clear that I have nothing but admiration for the hard-working lawyers who represent transgendered clients – often pro bono – with limited time and resources. And in those 33 states without explicit inclusion of gender identity and expression in state human rights law, appeal to disability by way of GID may well be the only practical way of obtaining legal redress for discrimination against a transgendered client. But I think we need to recognize how sharp the horns of that dilemma may be.

As a non-lawyer who works on legislation, I can tell you that the genuine happiness that I feel for the transgendered client who wins such a case is diminished by the realization that the victory for that individual undercuts the very arguments that we need to make in the legislative arena. Because it is precisely GID that gives the religious right and other opponents of transgender rights legislation their most powerful ammunition. So I would argue that we need to move from a ‘deviance’ model to a ‘variance’ model and from a construction of transgender identity as a mental pathology to a concept of ‘wellness’ in which transgendered and gender-variant people are viewed not as vectors of mental illness and disease but rather are recognized as contributors to society, including potential contributors to a transformation of society’s understanding of gender.

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Transgender Health Care: What Hospital-Based Providers Need to Know
Pauline Park, Ph.D.
Chair, New York Association for Gender Rights Advocacy (NYAGRA)

St. Barnabas Hospital
Embrace Healthcare Equality: Introducing Our LGBTQ Initiative
11 October 2013

I’m honored by the invitation to speak here at St. Barnabas Hospital and I’m especially honored to keynote the Embrace Healthcare Equality: Introducing Our LGBTQ Initiative event today. I would like to thank the LGBT diversity subcommittee for the invitation and I would especially like to thank Dr. Rory Sweeny McGovern, who was instrumental in introducing me to this hospital. Rory and I worked together as part of a transgender health care task force at St. Vincent’s Hospital for several years and I think we and our colleagues did great things together, including organizing the first transgender sensitivity training sessions for any major hospital in this city.

Let me begin by commending you for your commitment to ensuring full access to health care here at St. Barnabas for all members of our community. But let me also add that doing so will require a very significant commitment of resources — both time and financial — to attain that objective. Since founding Queens Pride House — the only LGBT community center in the borough of Queens in 1997 and the New York Association for Gender Rights Advocacy (NYAGRA) in 1998, I have been involved with work on access to health care for members of the LGBT community in a variety of capacities; one of the most important of these has been the Transgender Health Initiative of New York, a community organizing project established to ensure that transgendered and gender non-conforming people can access health care in a safe, respectful and non-discriminatory manner.

The transgender sensitivity trainings that we did at St. Vincent’s was an important expression of that commitment, and they helped create a model for what can be done at any hospital in this city or this country. Another important part of that work was the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area and the first directory of transgender-sensitive health care providers published in print format anywhere in the United States. I continue to update that directory on nyagra.com.

Transgendered and gender-variant people face pervasive discrimination in attempting to access health care in the United States. Some of the impediments to accessing quality health care are obvious and some are not. In order to understand those impediments and how to address them, it is first necessary to understand the community that we are discussing — hence the NYAGRA ‘circles diagram’ that I created way back in 1999 when we began the campaign for the the transgender rights law bill that was ultimately enacted into law by the New York City Council in 2002. I have used this diagram to illustrate in as simple a way as possible a diverse and complex community.

Briefly, the three circles include transsexuals — those who seek or have obtained sex reassignment surgery (SRS); those whom I will call ‘the transgendered’ — those who present fully in a gender not associated with their sex assigned at birth at least part of the time; and the gender-variant — including relatively feminine males who may still identify as men and boys and relatively masculine females who may still identify as women and girls. It is important to note here that this is a map of the gender universe and does not directly refer to sexual orientation; there are those in each of these circles who may identify as lesbian, gay or bisexual as well as those who may identify as heterosexual. In contrast to those in these three circles, the majority in any society are conventionally gendered — a majority of whom are undoubtedly heterosexual, but a significant minority of whom may be lesbian, gay or bisexual.

While addressing the conflation of sexual orientation with gender identity and gender expression is an important and indeed crucial part of the process of educating health care providers and the general public on transgender issues, it is also true that addressing discrimination based on gender identity and gender expression will go a long way towards addressing discrimination against LGB people because so much of that is based on the gender expression of gender-variant LGB people.

So how can we ensure full access to health care access for all members of the LGBT community here at St. Barnabas? Based on my own experience as an activist, advocate and consumer of health care, here are ten simple rules that I would like to suggest that we consider:

Rule #1: Effective health care provision requires the construction of a relationship of trust and confidence between the provider and the patient/client/’consumer.’ It is the responsibility of providers to educate themselves on issues of gender identity and gender expression in order to serve their patients, clients, and consumers sensitively and effectively. Conversely, it is also the responsibility of transgendered and gender-variant people to do what they can to educate and empower themselves and work with health care providers in order to obtain the best health care that they can.

Rule #2: Effective health care provision requires that providers take into account the diversity of the transgender community, which is extraordinarily diverse — in terms of gender identity and expression as well as race, ethnicity, religion, dis/ability, and sexual orientation. There are as many ways of being transgendered as there are transgendered people.

Rule #3: Health care providers need to understand that sex reassignment surgery (SRS) is not the end point for most gender transitions.  Most transgendered people do not want SRS and most who do never get it. There are as many ways of transitioning as there are transgendered people.

Rule #4: Transgendered and gender-variant people are denied care in many areas not directly or even indirectly related to their gender identity; any attempt to address health care provision for members of the community must address those areas not related to gender transition as well as those areas that are transition-related. Some transgendered people are denied coverage for treatments or procedures that relate to their anatomical or biological sex assigned at birth, such as prostate cancer for transgendered women or cervical or ovarian cancer for transmen. Only in a relationship of mutual trust and respect can physicians and other health care providers be sensitive and informed enough to provide effective care in such areas.

Rule #5: The impediments to health care access are both medical and non-medical and effective health care provision requires that providers take into account and address both sets of impediments. Transgender sensitivity training should focus primarily on the psychosocial aspects of the interaction between providers and consumers, and that training should extend to physicians and nurses as well as everyone in a health care facility.

Rule #6: Health care providers need to avoid pathologizing transgendered people through the false diagnosis of gender identity disorder (GID) while at the same time understanding that such diagnoses are used by some transgendered people to access hormone replacement therapy (HRT), sex reassignment surgery (SRS) and other desired medical interventions.

Rule #7: Transgender sensitivity training needs to be mandatory for all staff in hospitals and health care-providing facilities, including technical people, security guards, and intake staff as well as medical and mental health professionals; physicians should undergo psychosocial sensitivity training, regardless of participation in ‘grand rounds’ and other cognate medical trainings and discussions. Transgender sensitivity trainings should be no less than two hours in duration and ideally should be four hours long. Real training involves an intensive interaction between the trainer and the trained. Webinars and handouts may be used to supplement such trainings but can be no substitute for trainings themselves. Trainings should be conducted by those who have specific expertise in transgender issues, not merely those who do general ‘diversity’ trainings or even those who do LGBT trainings but who lack expertise on transgender issues specifically. Given staff turnover, trainings must be conducted at regular intervals.

Rule #8: All health care providers and health care-providing facilities should adopt policies and protocols that specifically prohibit discrimination based on gender identity and gender expression in the provision of health care, and such policies and protocols should be regularly and effectively communicated to all relevant constituencies.

Rule #9: Health care providers should participate in larger efforts to achieve legal and public policy change in order to provide effective and universal health care for all, including all transgendered and gender-variant people; providers need to understand that the denial of health care to transgendered and gender-variant people is part of a larger denial of health care access to and insurance coverage and payment for health care to LGBT people, low-income people, poor people, and people with disabilities in the United States.

Rule #10: There are no rules, only ‘best practices’ — or at least, better practices and worse practices; and such practices must be informed by the lived experiences of transgendered and gender-variant people.

Now, every hospital is different and every set of health care providers is unique; but these ten rules, it would seem to me, can be applied anywhere, including here at St. Barnabas. By coming here to this auditorium, you have taken the first step in  helping make this real. But as I have said, it is training that is arguably the most important and indeed crucial element in making it real and attaining an objective that I believe we all share. I congratulate you all and I especially commend the LGBT diversity subcommittee for organizing the launch of the LGBTQ Initiative today and I look forward to working with you all in helping make St. Barnabas the fully welcoming and inclusive hospital that I know it can be. That goal is within our grasp and we simply need to seize the opportunity to make it real. Carpe diem. Thank you.

Pauline Park is chair of the New York Association for Gender Rights Advocacy (NYAGRA), which she co-founded in 1998, and president of the board of directors as well as acting executive director of Queens Pride House (the LGBT community center in the borough of Queens), which she co-founded in 1997. Dr. Park led the campaign for passage of the transgender rights law enacted by the New York City Council in 2002. She served on the working group that helped to draft guidelines — adopted by the Commission on Human Rights in December 2004 — for implementation of the new statute. Park negotiated inclusion of gender identity and expression in the Dignity for All Students Act, a safe schools law enacted by the New York state legislature in 2010, and the first fully transgender-inclusive legislation enacted by that body, and she is a member of the statewide task force created to implement the statute. She also served on the steering committee of the coalition that secured enactment of the Dignity in All Schools Act by the New York City Council in September 2004. In 2004, Dr. Park named and helped create the Transgender Health Initiative of New York, a community organizing project established to ensure that transgendered and gender non-conforming people can access health care in a safe, respectful and non-discriminatory manner. And as executive editor, she oversaw the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area and the first directory of transgender-sensitive health care providers published in print format anywhere in the United States. Dr. Park did her B.A. in philosophy at the University of Wisconsin-Madison, her M.Sc. in European Studies at the London School of Economics and her Ph.D. in political science at the University of Illinois at Urbana-Champaign. She has written widely on LGBT issues and has conducted transgender sensitivity training sessions for a wide range of organizations, including the New York State Affirmative Action Advisory Council (AAAC), the Association of Vocational Rehabilitation in Alcoholism and Substance Abuse (AVRASA), the Latino Commission on AIDS, the Park Slope Safe Homes Project, and the Queer Health Task Force at Columbia University Medical School. In addition to presenting at the HIV Grand Rounds lecture series of the Bureau of HIV/AIDS Prevention and Control of the New York City Department of Health and Mental Hygiene, Dr. Park co-facilitated the first transgender sensitivity training sessions for any major hospital in New York City at St. Vincent’s Hospital Manhattan. In 2005, Dr. Park became the first openly transgendered grand marshal of the New York City Pride March. She was the subject of “Envisioning Justice: The Journey of a Transgendered Woman,” a 32-minute documentary about her life and work by documentarian Larry Tung that premiered at the New York LGBT Film Festival (NewFest) in 2008. In 2009, Dr. Park was designated ‘a leading advocate for transgender rights in New York’ on Idealist.org’s ‘New York 40’ list. In October 2012, Dr. Park was one of 54 individuals named to a list of ‘The Most Influential LGBT Asian Icons’  by the Huffington Post. In November 2012, she was named to a list of ’50 Transgender Icons’ for the Transgender Day of Remembrance 2012.

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Transgendering the Academy: Transgender Inclusion at a Women’s College
Pauline Park, Ph.D.

Chair
New York Association for Gender Rights Advocacy (NYAGRA)

address to faculty, staff and students at
Mills College
Oakland
1 April 2013

I would like to begin by thanking Prof. Julia Oparah of the department of ethnic studies for her instrumental role in bringing me to speak here at Mills College, my first time on this campus. I’d also like to thank. Rev. Laura Engelken, director of spiritual and religious life in the division of student life, who stayed up late last night to pick me up at the BART station in downtown Oakland at midnight after my flight arrived two hours late; if it weren’t for her, I would literally not be here.  And I’d like to thank Prof. Christie Chung of the department of psychology for helping to arrange my appearance here. Prof. Oparah, Prof. Chung and Rev. Engelken as well as all of their faculty, staff and student colleagues on the transgender best practices task force and the gender identity and expression subcommittee of the diversity & social justice committee have done a superb job in preparing the draft report on inclusion of transgender and gender non-conforming students, and I would like to offer my own thoughts on their assessment and recommendations.

But first, I’d like to offer what I see as a compelling argument for a women’s college like Mills to move forward with transgender inclusion.  While I never attended a women’s college myself, I have spoken at Wellesley College once and Smith College twice — as well as twice at Vassar, which was founded as a women’s college but is now fully co-educational.  And it seems to me that every women’s college in this country will face the challenge of whether to continue to define itself and its mission as focused exclusively or primarily on women and if so, how.

In 1990, the board of trustees decided to admit men to Mills College, but students led an uprising that was instrumental in persuading the board to reverse its decision under the banner of ‘better dead than co-ed.’ We are just a month away from the 22nd anniversary of that political earthquake, but as the college considers the issue of transgender inclusion, it seems to me that it is at an equally important turning point.

The difference is that 22 years ago, the choice seemed a stark one: between maintaining the college’s status as women-only or going whole hog with the admission of men. I would like to argue here that to pose the choice facing Mills today in such terms is to construct that choice in terms of a false dichotomy rooted in the sex/gender binary itself — the assumption that there are two and only two sexes and two and only two genders.

There may well be a genuine dilemma here, not only in terms of marketing and revenue from student tuition as well as alumni donations, but even in terms of core mission, because both poststructuralist theory and feminist theory have posed the question as to how we even define ‘woman’ and whether it is possible or even desirable to maintain and defend a sex/gender binary that divides the world into two and only two sexes and two and only two genders. The reality is that Mills currently enrolls students who no longer identify as women even if they may have — or conversely, those who may have been assigned to the male sex birth but who have come to identify as women. The college also has members of its current student body who may not identify with either side of the binary divide and who may instead identify as genderqueer, gender-fluid, or gender-variant in some fashion.

So I would like to suggest that the choice facing Mills today — which is the same choice facing every women’s college in this country — is not whether the college should remain a women’s college or go co-ed, but rather, if it is committed to remaining a women’s college, what kind of women’s college it intends to be. Because it would seem to me that in order to know what a women’s college is, one would first need to know who is a woman and who isn’t.

The late theorist Jacques Derrida famously asserted that there is an infinite play of signifiers and signifieds such that the relationship between any signifier and signified is arbitrary and cannot be fixed; while I myself do not identify as a Derridean and I think there is reason to doubt that that play between signifiers and signified is infinite, feminist theory of the post-structuralist variety has led many to challenge the sex/gender binary and even to identify it as the source of the oppression of women, of men, and of the transgendered and gender-variant.

Such theoretical considerations have enormous practical implications, including for women’s colleges. If the foundation stone of a women’s college is the assumption that the education of women in women-only spaces is crucial for the empowerment of female students, then any challenge to the notion of a fixity of the definition of ‘woman’ or ‘female’ would seem to threaten the very rationale for a women’s college.  I would like to argue that there is in fact a rationale for a women’s college in this post-structuralist, post-modern era, but that any such rationale must take into account the presence and active participation of those who may not easily fit into the sex/gender binary — those who identify as or are identified as transgendered or gender-variant — or if you prefer, gender-fluid, gender-non-conforming or gender-transgressive. 

The oft-quoted slogan of the women’s movement in the 1960s and 1970s was that “the personal is political,” and I would like to argue that the choice before Mills College is indeed a political one and inescapably so; if the college does not actively define itself for the 21st century, it could be defined by circumstances and by outside forces in a way that would not be flattering for its image. The committee drafting the guidelines on transgender inclusion has taken the first important steps in attempting to reconceptualize and rearticulate the college’s mission as a women’s college, and while I have a few small questions concerning details, I wholeheartedly endorse the second draft of its report as a whole; for the college to fail to take up the challenge posed by that report would be to miss a crucial opportunity to proactively redefine itself and update its mission and its profile as well as its ‘brand’ in the college market; to fail to respond substantively to that report would really be for the college to deny the reality of its own current student body. Rather like the United States military, which operated from 1993-2011 under the law known popularly as ‘don’t ask/don’t tell,’ the college has to date failed to fully recognize its own student body; the process that is now underway with the drafting of this report provides the college with an opportunity to get out ahead of a phenomenon that is affecting every women’s college in the country and even to stake out a leadership position that could bring Mills national acclaim.

So let me spell out some of the details of the process through which a vision of a transgender-inclusive academic institution could be brought about — what I will call ‘transgendering’ the academy. If our goal is to make higher education fully transgender-inclusive, how would we go about achieving that objective? The first step would have to be to gain a full understanding of just what ‘transgender’ means. Many in this audience will have a very good understanding of transgender identity, but for those for whom this is a relatively new topic, I would like to suggest that you imagine a diagram to illustrate the complexity of the community of which I myself am a member.

Pauline Park (paulinepark.com) is chair of the New York Association for Gender Rights Advocacy (NYAGRA) (nyagra.com), a statewide transgender advocacy organization that she co-founded in 1998, and president of the board of directors of Queens Pride House (queenspridehouse.org), which she co-founded in 1997. Park currently serves as vice-president of the board of directors of the Transgender Legal Defense & Education Fund  (transgenderlegal.org).

Park named and helped create the Transgender Health Initiative of New York(THINY), a community organizing project established by TLDEF and NYAGRA to ensure that transgendered and gender non-conforming people can access health care in a safe, respectful and non-discriminatory manner. And as executive editor, she oversaw the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area and the first directory of transgender-sensitive health care providers published in print format anywhere in the United States.

Park led the campaign for passage of Int. No. 24, the transgender rights ordinance enacted by the New York City Council as Local Law 3 of 2002. She served on the working group that helped to draft guidelines — adopted by the Commission on Human Rights in December 2004 — for implementation of the new statute. Park negotiated inclusion of gender identity and expression in the Dignity for All Students Act (DASA), a safe schools law enacted by the New York state legislature in 2010, and the first fully transgender-inclusive legislation enacted by that body, and she is a member of the statewide task force created to implement the statute. She also served on the steering committee of the coalition that secured enactment of the Dignity in All Schools Act by the New York City Council in September 2004.

Park did her B.A. in philosophy at the University of Wisconsin-Madison, her M.Sc. in European Studies at the London School of Economics and her Ph.D. in political science at the University of Illinois at Urbana. Park has written widely on LGBT issues and has conducted transgender sensitivity training sessions for a wide range of organizations. In 2005, Park became the first openly transgendered grand marshal of the New York City Pride March. She was the subject of “Envisioning Justice: The Journey of a Transgendered Woman,” a 32-minute documentary about her life and work by documentarian Larry Tung that premiered at the New York LGBT Film Festival (NewFest) in 2008.

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