Beyond Binaries:

1
Beyond Binaries
Addressing the Health Service Provision Needs of
People with Fluid Non-Binary Gender Identities
and Sexualities
JAMES MORTON james_at_equality-network.org SCOTTISH
TRANSGENDER ALLIANCE www.scottishtrans.org
2
Presentation Structure

• Quick overview of binary thinking
• Basic binary model
• Jigsaw binary model
• Whos beyond binaries?
• STA research findings
• Non-Binary Gender identities
• Non-Binary Sexualities
• Addressing health service provision needs
• General Practitioners
• Sexual Reproductive Health
• Gender Identity Clinics

3
Quick Overview of Binary Thinking
4
Beyond Basics?

• First Steps
• Challenge health service provider assumptions
  that all service users are straight /
  heterosexual.
• Challenge health service provider assumptions
  that all service users are gender typical /
  cisgender.
• The extent to which health service providers have
  grasped the basics and stopped making these
  assumptions varies widely.

5
Beyond BasicsJigsaw Binary Thinking?
WOMAN
MAN
OR
Male Physical Body Male Gender
Identity Masculine Behaviour Attracted to Women
Female Physical Body Female Gender
Identity Feminine Behaviour Attracted to Men
6
Jigsaw Binary Thinking?Gay/Lesbian People
WOMAN
MAN
OR
Male Physical Body Male Gender
Identity Masculine Behaviour Attracted to Men
Female Physical Body Female Gender
Identity Feminine Behaviour Attracted to Women
7
Jigsaw Binary Thinking?Transsexual People
WOMAN
MAN
OR
Male Physical Body Female Gender
Identity Feminine Behaviour Attracted to Men
Female Physical Body Male Gender
Identity Masculine Behaviour Attracted to Women
8
Subtle Binary Thinking

• Assumptions that everyone will self-identify
  simply either as straight or gay/lesbian.
• Assumptions that all past, present and future
  sexual behaviour will match either straight or
  gay/lesbian stereotypical expectations.
• Assumptions that everyone will self-identify
  simply as either men or women.
• Assumptions that all trans people will feel they
  are either a man trapped in a female body or a
  woman trapped in a male body.

9
Whos Beyond Binaries?

• Some LGBT people will fit reasonably comfortably
  within a jigsaw binary understanding of sexual
  orientation and gender identity.
• However, many LGBT people are more complex and
  diverse in their identities and experiences than
  the binary jigsaw pieces can represent.

10
Whos Beyond Binaries?

• A non-binary model is needed to accurately
  represent
• People who are attracted to more than one gender
  or who are attracted to people on the basis of
  characteristics other than gender. (May perhaps
  identify as Bisexual / Queer / Pansexual)
• People who experience their own gender identity
  as not being clearly male or female. (May perhaps
  identify as Androgyne / Genderqueer / Polygender)

11
STA Research

• Online and paper survey designed to collect data
  on
• Gender identity and gender expression
• Experiences of transphobic harassment
• Experiences using various public services
• Distributed across Scotland via trans support
  groups, trans email lists and Scottish gender
  specialists between July 2007 and September 2007.
  71 valid, non-duplicate responses received from
  trans people living in Scotland. Survey findings
  highlighted diversity of non-binary gender
  identities and sexualities.
• Follow up meetings with Polygender Scotland group
  to explore in greater detail the health service
  provision needs of people with non-binary gender
  identities and sexualities.

12
STA Findings Gender Identities

• Of the 71 survey respondents, 48 (34/71) are
  male-to-female transitioned women, 28 (20/71)
  are female-to-male transitioned men, and the
  remaining 24 (17/71) are non-transitioned
  transgender people.
• Of the 17 non-transitioned transgender
  respondents, 18 (3/17) intend to transition in
  the future, 29 (5/17) are undecided about
  whether or not to transition, and 53 (9/17) do
  not intend to transition.
• 8 (6/71) of respondents stated they are intersex.

13
Types of answer to open question "How do you
describe your gender?"
left blank
FOR ALL 71 RESPONDENTS
just female
just male
transgender and female
transgender and male
transgender only
14
Types of answer to open question "How do you
describe your gender?"
FTM TRANSITIONEDRESPONDENTS
just male
transgender and male
left blank
transgender only
15
Types of answer to open question "How do you
describe your gender?"
left blank
MTF TRANSITIONED RESPONDENTS
just female
transgender only
transgender and female
16
Types of answer to open question "How do you
describe your gender?"
Transgender and female
NON-TRANSITIONED RESPONDENTS
just female
just male
transgender and male
transgender only
17
Non-Binary Gender Identity Self-Descriptions

• From trying to conform as male when I was
  younger, I now have a much more fluid gender
  identity. I move between genders depending on
  how I need to express myself at different times.
• I have progressed from presenting as male,
  through presenting as female, to finally
  presenting as androgyne.
• In my childhood and early teens I made
  alternating attempts to present as strictly male
  or strictly female, but ultimately I didn't feel
  comfortable with either.

18
Non-Binary Gender Identity Self-Descriptions

• I had no idea what to grow into, or how to
  explain the point if anyone were to ask. Several
  years later I encountered transgender writing on
  the internet a revelation. It hasn't changed
  much in my personal life but it has given me a
  language. That isnt enough but its better than
  nothing. I dress my way, often wearing worn
  home-made clothes that avoid what I perceive to
  be gender extremes. Theres not much I can do
  about my body though.
• My self identity has progressed as I have
  acquired the language I needed to express it.

19
Non-Binary Gender Identity Self-Descriptions

• While the issue has always been there, for many
  years I tried to suppress it. When I did start
  to think of it I felt androgynous, that I was
  both sexes or maybe neither. Now I identify that
  the male part is stronger, but that the female or
  maybe something other is also there and part of
  who I am.
• I thought I was just a trans ally I kept very
  quiet about the genderqueer stuff now I'm seeing
  how it all fits in.

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Non-Binary Gender Identity Self-Descriptions

• I always felt intergendered but didn't know I
  was intersexed until I was 28. At 14 I thought
  seriously about transitioning to male, but
  concluded that it wouldn't suit me any better
  than being female. I use my given name, which is
  female, but talk openly and frequently about
  being intersexed on the internet. I am probably
  more relaxed and open about my gender in public
  places I know are trans-friendly than I am in
  other public placesI am a goth, so my normal
  clothing isn't really relevant to gender
  expression within my community, as most goth
  clothing etc isn't gender specific.

21
Non-Binary Gender Identity Self-Descriptions

• I was brought up almost entirely as a girl until
  age 17, so I presented as a girl and hated any
  time as a boy (thought I was being punished if I
  had to wear boy's clothes). When the truth was
  given me that I was biologically male, I
  rebelled and demanded to be returned to male
  gender - however I agonised over the change back
  for many years.

22
STA Findings Sexual Orientations

• 39 (28/71) self-identify using at least one of
  the following terms bisexual, queer or
  pansexual.
• 18 (13/71) of the survey respondents stated that
  either they are unsure how to define their sexual
  orientation or that they do not want to define
  it.
• Only 34 (24/71) of the survey respondents stated
  that they currently self-identify as
  straight/heterosexual. (3 of these respondents
  also stated that they simultaneously
  self-identify as being queer. Another 3 of these
  respondents stated that they simultaneously also
  identify as bisexual.)
• 15 (11/71) self-identify using the term lesbian.
• 7 (5/71) self-identify using the term gay.

23
Non-Binary Sexuality Self-Descriptions

• I assumed that I was female straight to about
  age 19, now I assume that I am probably bisexual,
  but find the whole issue difficult to categorise
  as gender is not important to me.
• Always attracted to only women. Part of the
  lesbian community for over twenty years so now a
  straight man with a queer history.
• Straight man ?bi man ? gay man ? hetro woman
• ? bi woman ? queer/lesbian.

24
Non-Binary Sexuality Self-Descriptions

• I identified as a heterosexual girl in my
  earlier teens, then as bisexual, then I came out
  as lesbian at 16. I started transitioning at 25
  and identified briefly as a heterosexual man and
  then I identified as a gay man. After a while I
  realised I still liked women too, so I identified
  as bisexual, then I realised I can be attracted
  to all kinds of sexes and genders and for that
  reason I find the term bisexual too limiting, so
  pansexual or just queer now seems more
  appropriate. I have a sexual preference for slim
  people and I prefer short hair, but I don't have
  a preference for a particular type of genitals,
  or a particular gender.

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Addressing Health Service Provision Needs

• General Practitioners
• More likely to know of service users transgender
  identity than any other service provider.
• Key issues identified
• Name, title and pronoun use.
• Incorrect assumptions about sexual behaviours.
• Incorrect assumptions about mental health.

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Addressing Health Service Provision Needs

• Sexual Reproductive Health
• Likely to be divided into single-sex services.
• Key issues identified
• Flexibility of single-sex service access.
• Terminology used to describe primary and
  secondary physical sex characteristics.
• Terminology used to describe sexual activities.
• Incorrect assumptions about sexual behaviours and
  parenting roles.

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Addressing Health Service Provision Needs

• Gender Identity Clinics
• Wide variation in GIC ethos and willingness to
  assist non-binary transgender people.
• Key issues identified
• Continuing mistrust of GICs in terms of
  discrimination on grounds of sexual orientation.
• Continuing mistrust of GICs in terms of need to
  be a classic transsexual textbook case to
  access transition assistance.
• Need for greater use of person-centred informed
  consent model.

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Improving Health Service Access

• Support use of persons preferred name and
  pronouns (including gender neutral pronouns)
  regardless of whether or not they are
  transitioning.
• Talk in as gender and sexual orientation neutral
  a manner as possible and provide a wide range of
  sexual health information.
• Demonstrate understanding and commitment to
  supporting diversity and non-binary identities
  dont expect people to risk revealing their
  identities before they are reassured it is safe
  to do so.
• Ensure that it is clear how people can access all
  types of services (especially single-sex
  services) if they have a non-binary gender
  identity or sexuality.

29
Beyond Binaries
Addressing the Health Service Provision Needs of
People with Fluid Non-Binary Gender Identities
and Sexualities
JAMES MORTON james_at_equality-network.org SCOTTISH
TRANSGENDER ALLIANCE www.scottishtrans.org