Ethnicity, Sexuality

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Ethnicity, Sexuality Transgenderism

• Vernon A. Rosario, MD, PhD
• Semel Institute for Neuroscience and
• Human Behavior at UCLA

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Objectives

• The medical history of transsexualism is slanted
  towards white, middle-class subjects
• DSM criteria for Gender Identity Disorder (GID)
  fail to capture the diversity of gender atypical
  behavior and identity
• Cultural, socioeconomic and experiential factors
  significantly shape gender role, gender identity,
  and sexuality
• Making a diagnosis of GID is particularly
  challenging with Latino teens

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Medical History of Transsexualism

• Earliest documented SRS in 1931 Germany
  (Genitalumwandlung)
• Psychopathia transsexualis -- David Cauldwell
  (1949)
• 1952 Christine Jorgensen brings sex change to
  international public attention
• 1960s Dr. Harry Benjamin and the International
  Gender Dysphoria Association legitimize
  transsexualism

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GID in the DSM

• DSM-III (1980) Transsexualism--Homosexual or
  Heterosexual Type. Classified as psychosexual
  disorder alongside paraphilias
• DSM-III-R (1987) GID classified under Disorders
  first evident in infancy, childhood, or
  adolescence
• DSM-IV (1994) Gender Identity Disorder--in
  Children, or in Adolescents and
  Adults--Attracted to Males, Females, Both, or
  Neither
• Criteria
• Strong and persistent cross-gender identification
  and behavior
• Persistent discomfort with ones sex or gender
  role (gender dysphoria)
• No concurrent intersex condition
• Significant impairment

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Christine Jorgensen GID

• GI George Jorgensen fixed female identity,
  uneasy about homosexuality, experimented with
  estrogen
• 1952 DenmarkDx genuine transvestitism, Rx
  hormones, orchiectomy penectomy, vaginoplasty
  1954
• Lifelong self-publicist and role-model for
  countless TS

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Jorgensen and GID

• First Standards of Care of Gender Dysphoric
  Persons (1979) shaped by Jorgensen model of
  persistent or life-long cross-gendered
  identification, and desire to become
  conventionally gendered and heterosexual
• Persistent desire for SRS and full transitioning
• FTMs not recognized till 1980s (Lothstein (1983)

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Childhood GID or Sissy Boys

• Green (1987)--only long term study of GID boys
  (n66, 75 homosexual or bisexual, 1 TS,
  remainder heterosexual)
• Sex ratio (referred children) boysgirls 51
• Cross-gendered behavior often starts age 3,
  present for treatment in KG or 1st grade
• CBCL referred children (ae. 4-5) GA behavior
  16.3 boys 18.6 girls gender dysphoria
  15.5 boys 6.5 girls
• Childhood GID TS or homosexuality?

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Two Categories of GID?

• Green, Blanchard, Bailey identify two main types
  of GID
• Non-homosexual GID (hetero-, bi-, and asexual)
  with onset in adolescence or young adulthood,
  associated with autogynephilia
• Homosexual GID with childhood
  gender-atypicality and homosexual attraction,
  etiologically related to homosexuality

9
Prevalence

• Netherlands hormone treatment in adult gender
  identity clinic 111,000 MTF 130,400 FTM
  (Bakker, van Kestern, Gooren, Bezemer 1993)
• Sex ratio of transsexualism in adults--varied
  greatly historically from 101 MF in the 1970,
  to now 41, or even parity

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TG Cross Culturally

• Focus on white, middle class, adult MTFs forces
  conformity to GID model
• Ethnocentric235 publications on TG (1992-2002)
  41 European 48 North American (Winter 2002)

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Asian/Pacific Island TG

• Malaysia est. 10,000 MTF TG, Mak Nyah, pondan
  bapok (effeminate men)
• Thailand Kathoey , 10-30,000 or 6/1000 FTF TG
• Indonesia Waria (Boellstorff, 2004)
• Phillipines bakla tomboy (Garcia 1996)
• Oceania mahu, fa-a-fa-fine
• India Hijra est. 1 mill.

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Gender Sexuality in Latin America

• Mexico Vestidas, locas, jotos, mayates (Prieur
  1998)
• Brazil Bicha (Green 1999)
• Macho culture
• Religious values

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Mexican sexuality codes
Fifi (a vestida) A mayate is a man who does it
with jotos. A tortilla is a man who likes to
fuck a joto, and also likes to have the joto fuck
him. Bugas are those who say they dont do it
with a joto--only with women. Then there are the
heterosexuales, who like to fuck men--which means
jotas who like to fuck men. And bisexuales are
those who fuck men, and the men who fuck jotos.
They are the bisexuales mayates. ... My
experience is that most men that I have been with
are mayates. And some rare times bisexuales.
And bugas--the truth is that I dont think they
exist anymore. Because now any man will be with
a joto or a with a woman (Prieur 1998, 24-25)
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• Rigidly gendered code of sexual behavior
  maleactiveinsertive femalepassivereceptive
  
• Sexuality follows code of gender
  complementarity feminine mates with masculine
  whether effeminate male with masculine/straight
  male, or fem and stud/butch.
• Homophobia co-exists with widespread practice
  (if not acceptance) of same-sex acts according to
  strict codes
• Cross-dressed men more visible and acceptable as
  sex workers and partners
• In US street culture and internet market for
  she-males

Photo Zapotec Indian drag queen ball, Oaxaca,
Mexico. www.neilkatzphoto.com.
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Gay Lesbian Adolescent Social Services (GLASS)

• 6 groups homes for 42 foster kids and juvenile
  delinquents
• Outpatient clinic for ae. 18-21
• Level 12--highly structured and restrictive
• Latino and African American
• Poor, traumatized, raised around violence, gangs,
  crime, prostitution
• Drug and alcohol abuse

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Lolo (V.C.)

• 16 yo girl, 1st gen. Mexican-American. Father
  took off when she was 4. Raised by mom.
• Reports of physical abuse by mother.
• In Juv. Justice since age 12 for delinquency,
  theft, GTA with friends.
• Fights in school since middle school.

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• Short, stocky, shaved head
• Baggy clothes, wifebeater and outer shirt,
  like any other latino gang banger boy.
• Walks with a swagger
• Self described stud.
• Highly resistant to therapy
• AWOLd for several weeks, caught, sent back to
  jail, returned to GLASS

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• Asks about stuff to make her breasts smaller and
  voice lower
• Gender ID realizes shes a girl, but always
  wanted to be a boy.
• Always a tomboy male friends role.
• Ambiguous moniker, led to indeterminate gender
  treatment.
• Passed sometimes.
• Difficult puberty--not as bad as many TS

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• Curious about hormones, wants to masculinized but
  not change sex deeper voice, breast reduction,
  stop menses, but not a penis.
• Sexually attracted to girls
• The active one, never undresses. Her pleasure is
  in pleasuring partner (stone butch)
• Does not fantasize about having a penis.
• Son ex-GF got pregnant to have a child with
  her
• Wants to become a policeman

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Martin/Jennifer (F.R.)

• 14 yo boy in foster care since age 10
• 1st generation Mexican-American
• Physical abuse by mother and step-father.
  Fathers whereabouts unknown. 3 step sisters.
• Effeminate boy played with dolls,
  cross-dressed, put on makeup at 4, theatrical and
  funny.
• Beaten and insulted because of this by parents.
  Taunted and bullied by peers till the present.
  Sexually attracted to boys from preadolescence.

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• Very inquisitive about hormones and surgery.
  Pretends to already be on estrogen. Insists on
  lifelong female identity and desire for
  sex-change.
• Petitioned to cross-dress at school--louder, more
  brash, attention seeking. Not totally convincing,
  and ego deflated. Drops it--feels not passable
  Shes dead. I just want to be a boy.

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• Small, slight boy. Funny, intelligent, quick
  witted, head-strong. Soft-spoken, but at times
  temperamental and loud. Sensitive to criticism.
• Gravitated towards passing MTFs and admired them
  for their strength, cattiness, and attitude of
  invulnerability.

Photo Miss Universo Latina USA 2004,
www.nycdivas.com
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• AWOL--turning tricks with his mother (she-male
  sex-worker), drugs, but returns in the evenings.
  Hospitalized 6 weeks.
• Conflicts with foster parents over
  cross-dressing. Jennifer came back to life.
• Æ 16--Long term foster placement finally seems to
  work
• But still runs away to do drugs, earn money with
  friends
• Gets gifts/drugs from adult, straight boyfriends

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• Confused between gender ID and sexuality. Sees
  TS as strong, vs. effeminate, gay boy as a
  victim. Cannot fulfill the macho ideal, so female
  ID is better. If I was a girl, they wouldnt
  beat me up.
• Glamorized TS teen sex workers. Yet also quite
  afraid of the street. Fantasizes that he will be
  more attractive as female than a male.
• Easier time dealing with sexuality as female than
  as homosexual male. Attracted to the most
  delinquent boys.
• Runs away, fearing termination, shaves head and
  returns to being a boy for a month.
• What will be his gender sexuality at 18?

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Gender/sexuality spectrum

• Many FTM want breasts only
• Full transitioning with hormones and genitoplasty
  not wanted or unnecessary
• Many MTFs return to male ID and role at 18
• Due to difficulty of being TS comfort with
  gay ID sex-work unappealing gay peer
  adult role models family acceptance overcoming
  traumatic associations

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Stud girls

• Unfamiliar with FTMs FTM transitioning
• Like to appear/pass as male
• Have male gender role but masculine female gender
  ID
• No interest in phallus

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Treatment Issues

• Sensitivity to socio-economics, ethnicity, gender
  roles in the culture
• SRS not for all or may only be transitional
  desire
• Gender role, gender ID, and sexuality intertwined
  and fluid

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