Everything you've always wanted to know about trans issues (but were afraid to ask)

Writing for NS Trans Issues Week, Jennie Kermode outlines the facts about trans issues and language - an area where prejudice and confusion so often get in the way.

1. What is the difference between a transvestite and a transsexual person?

A transsexual person needs a permanent change of gender role, often accompanied by bodily changes, in order to feel comfortable. A transvestite, also called a cross dresser, is a man who dresses in a way usually associated with women, or vice versa. For some transvestites this is just a bit of fun or a way of challenging gender norms; for others it reflects a deep seated need. Some people go through a stage of cross dressing on the way to coming out as transsexual.

2. I've seen people talking about trans* issues. What is the asterisk for?

The asterisk shows that "trans" is being used as an umbrella term, covering not just transsexual people but also transvestites and people who don't identify as male or female.

3. Why do some people in the trans* community find "tranny" problematic?

It's a word that has strong associations wth pornography and it's often shouted at people in the street in an abusive way. This can be accompanied by a threat of violence — sadly not uncommon — so people are reminded of that fear when they encounter the word elsewhere.

4. What happens when a person transitions from one gender to another - what's the process?

There's no one-size-fits-all procedure. The primary process is psychological and social — learning to fit into a different social role and hoping loved ones can adjust to that. Most people take hormones, which can make them feel more mentally relaxed even before starting to change their bodies. Many go on to have surgery.

5. Do all trans people have surgery?

No. Some people are not able to, for medical reasons. For others, intimate changes don't feel necessary as long as their gender is generally accepted — after all, when we meet strangers, we don't usually need to see their genitals to decide what gender we think they are. Many trans men have breasts removed but don't have genital surgery because it carries a risk of urological problems. This means that the notion of "pre-op" and "post-op" trans people is misleading. For many, changing social role is a much bigger deal anyway.

6. What does being genderqueer mean?

This is one of several terms that people use to describe not feeling either male or female. This is different from just not having much sense of gender. For some people, it's a very strong feeling and may lead to them seeking medical assistance to align their bodies with their identities. For others, it's about creating a space in which to escape from the usual expectations of gendered behaviour.

7. I've seen some people call themselves "queer". Is that an OK word for straight people to use?

Because it has a history of being used as a term of abuse, it's best to avoid it in generral discourse. In smaller social circles you may find that people don't mind, but it never hurts to ask.

8. What inaccurate clichés about trans people do you see in the media?

Most transsexual people don't think of themselves as changing sex — they have a consistent sense of gender identity. Rather, they feel that bodily changes are about feeling more comfortable in their own skins and having their gender more easily recognised by others, confirming their existing identities. By and large, they are no more concerned about being manly men or beautiful women than the average person. Some know they will never "pass" very well but passing isn't the point — they hope people will respect the clear signals that they're sending about their gender. The media tends to find these concepts difficult. Likewise, it tends to present people without male or female gender identities as confused (much like the clichés that exist about bisexual people) whereas most have a very clear sense of their gender, it just isn't one that onforms with society's expectations. Finally, there's the notion that all trans people are attention-seekers. In fact, most just want to get on with their lives.

9. Are there more M2F transgendered people than F2M? And if so, why?

We used to think so but gender clinics now tell us they have about equal numbers coming forward to seek help. It's sometimes easier for trans men to stay in the closet because masculine behaviour in women is more socially acceptable than feminine behaviour in men.

10. What does "cis" mean?

It's simply a catch-all term referring to people who are not trans.

11. What kind of problems and challenges do trans people face in everyday life, and in getting treatment?

They are often rejected by family and friends, they can find it difficult to secure employment (especially before getting medical support) and they face high rates of stress-related mental health problems. It is estimated that around 45 per cent of trans people attempt suicide at least once — nine times the rate for the wider population. Trans people are often subjected to verbal abuse and threats from strangers and face a higher than average risk of being assaulted, with this being worse in some areas than others. Getting medical support is a bit of a lottery. There's a new system in Scotland which is very good, but not enough specialist doctors yet to make it work. In England, many people struggle to get taken seriously, face obnoxious treatment from medical profesionals (as exemplified in the recent #transdocfail Twitter thread) and face long waiting lists, while genderqueer people have to pretend to be transsexual if they want to get any treatment at all. This is particularly tough for people who can't afford to go private.

12. What proportion of the population is transgender?

This really depends on how widely you want to cast your net. Around one in five people try cross dressing, even if it's just for fun, and lots of people feel uncomfortable with the roles set out for them as men or women. The number of people who feel a strong need to change roles is much smaller, probably around 0.8 per cent of the population. Of course, that's still a lot of people overall, and the problems they face also affect their friends and families.

If you need to talk to somebody because you think you might be trans, The Gender Trust can help. For young trans people and their parents, Mermaids provides excellent support.

Jennie Kermode is Chair of Trans Media Watch and writes at Eye For Film

A person holds a placard reading "I am the one who decide how I dress and not your standards" as he takes part in the 16th Existrans in France. Photograph: Getty Images

Jennie Kermode is Chair of Trans Media Watch and writes at Eye For Film.

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Tetris and sleep deprivation: how we can help emergency workers cope with trauma

First responders are at serious risk of developing PTSD during events like the Paris attacks. 

Some people seem able to deal with anything. They save a stranger from bleeding out in a bombed restaurant, protect passers-by from heavily armed gunmen, pull dead and dying people out of collapsed buildings, and they keep going because it is their job. These people are first responders.

When trauma goes on for days, as it has recently in Paris, however, the odds of them bouncing back from the violence, death and injury they are witnessing rapidly diminishes. They are at greater risk of developing a severe stress reaction known as post-traumatic stress disorder (PTSD). One study found that the worldwide rate of PTSD among first responders is 10 per cent, much higher than the 3.5 per cent rate among those not involved in rescue work.

Tetris to the rescue

So how best to address the problem? Research is in its infancy, but there are some promising studies. Emily Holmes’ group at the University of Cambridge has been looking at the benefits of playing Tetris, a video game, after a traumatic experience. The idea is that this could block the consolidation of traumatic memories so they don’t “flash back” later on.

For the study, her team first traumatised people by showing them distressing footage from public safety videos. The next day they invited them back into the lab to reactivate the memories with still images taken from the videos. One group then played Tetris for 12 minutes while the other sat quietly. Over the following week, the group who played Tetris had about 50 per cent fewer unwanted memories from the films compared to the group who didn’t.

The team concluded that playing Tetris helped individuals because it soaks up their visual processing capacity, making it harder for the brain to consolidate the visual parts of a traumatic memory.

Since it takes about six hours for the brain to cement a memory, the key is to play the game soon after trauma or within six hours of re-activating the traumatic memory. How long the helpful effects of playing Tetris will last and whether it will translate into helping people after real-life trauma is still unknown.

Talking it through

Other techniques, such as “updating”, taken from a highly-effective talking treatment for PTSD, may be more practical and easier to implement.

Like a detective, updating is a technique that focuses on finding new information and linking it to the case, the past memory. This is necessary because when the brain and body are in survival mode during trauma, the mind finds it difficult to encode all the relevant facts. Often key pieces of information that could make the memory less traumatic are lost. Updating links new information to someone’s memory of their trauma to make it less upsetting.

But can updating help to reduce unwanted memories after trauma?

We carried out a study, published in PLOS ONE, in which we traumatised people by showing them terrifying films of humans and animals in distress. We then divided our participants into three groups. One group watched the films again but were given new information about how long people suffered and whether or not they lived or died – essentially, they were updated. The second group watched the same films again but without the new information. And the third group watched films of humans and animals who were not in distress. The updated group had fewer traumatic memories and PTSD symptoms than the other two groups.

Updating is now being used by some UK emergency services. First responders will gather after critical incidents and update their memories of what happened before they go home.

Sleep deprivation

There are other techniques that may be helpful. One study found that depriving people of sleep may be useful in the aftermath of trauma.

But the same study found that a week after the trauma, people who had been deprived of sleep had the same number of unwanted memories as people who had slept well afterwards. Consequently, it remains unclear whether there would be any long-lasting benefits using this method. There are, however, certainly health risks linked to lack of sleep.

Still looking for a solution

To develop preventative interventions, we need to study newly-recruited emergency workers who haven’t yet suffered on-the-job trauma and follow them over time, spotting which “coping styles”, present before trauma, may predict their reactions afterwards.

For example, some people naturally react to stressful life events by dwelling on them, thinking about why they happened for hours on end. This strategy, called rumination, has been linked to PTSD in people who survived car crashes.

If rumination predicts PTSD in first responders, then preventative interventions could train people to spot when they are dwelling on an event and refocus their attention to the task at hand.

When we have identified which factors heighten emergency workers’ risk of developing PTSD, programmes can be developed to target those vulnerabilities. Only then can an intervention, directed at first responders most at risk of developing PTSD, properly protect them in their line of work.

The Conversation

Jennifer Wild is a Senior Research Fellow in Clinical Psychology at the University of Oxford

This article was originally published on The Conversation. Read the original article.