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Moving towards de-psychopathologisation: a global chorus

The National Board of Health and Welfare in Sweden has removed gender identity disorder of childhood, dual-role transvestism, and several other diagnoses relating to sexual and gender diversity from its version of the ICD-10. France has removed transsexualism from the list of psychiatric disorders. The Government of Iran has taken steps to terminate the classification of transgender people as mentally disordered. The pressure grows for psychiatric depathologisation of gender and gender identity variance.

As at July 2010 (thanks for information to Justus Eisfeld, Co-Director, GATE - Global Action for Trans* Equality) we can report that there is a proposal in Germany for a new name/gender change law, introduced by Volker Beck MP of the German Green party. Justus believes that this proposal for a new law should be used as a best practice example for laws on name/gender changes. The proposed law provides for name and gender change based on self-idenficiation only, without evidence from mental health (or any other) professionals. It also avoids long court procedures and wait times, and leaves open the possibility to revert to earlier gender if needed. Official English translation.

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See also the following voices (in rough contra-chronological order) on the issue of de-psychopathologisation

1. The De-psychopathologisation Statement issued by the Board of Directors of the WPATH (World Professional Association for Transgender Health, formerly HBIGDA (Harry Benjamin International Gender Dysphoria Association) (issued May 26th 2010)

Statement reads (in full) : The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide. The expression of gender characteristics, including identities, that are not stereotypically associated with one's assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative. The psychopathologlization of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalization and exclusion, and increasing risks to mental and physical well-being. WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people. A commentary.

Thai translation: “คณะกรรมการอำนวยการ WPATH เรียกร้องให้ทั่วโลกยกเลิกการจัดความแตกต่างทางเพศสภาพเป็นความเจ็บป่วยทางจิต. การแสดงออกถึงลักษณะทางเพศสภาพรวมถึงอัตลักษณ์ทางเพศสภาพที่อาจไม่สัมพันธ์กับเพศสรีระแต่กำเนิด เป็นปรากฏการณ์ที่พบได้ทั่วไปในวัฒนธรรมที่หลากหลาย ซึ่งไม่ควรถูกตัดสินว่าเป็นความเจ็บป่วยหรือแง่ลบ การจัดลักษณะและอัตลักษณ์ทางเพศสภาพเป็นความเจ็บป่วยทางจิตนั้นเป็นการตอกย้ำหรืออาจทำให้เกิดการตีตรา ทำให้มีโอกาสเพิ่มขึ้นที่จะเกิดอคติและการเลือกปฏิบัติ ทำให้ TG สุ่มเสี่ยงมากขึ้นต่อการถูกกีดกันและแบ่งแยกทั้งทางสังคมและกฎหมาย และเพิ่มความเสี่ยงต่ออันตรายทั้งทางสุขภาวะร่างกายและจิตใจ. WPATH ขอเรียกร้องให้องค์กรภาครัฐและองค์กรวิชาชีพทางการแพทย์ได้ทบทวนนโยบายและแนวทางการปฏิบัติงานของตนเพื่อขจัดการตีตราต่อบุคคลที่มีเพศสภาพแตกต่าง” A Thai commentary

2. Cuban Multidisciplinary Society for Sexuality Studies, Statement on Depathologisation of Transsexualism, 2010

3. The Letter from Asia-Pacific Transgender Network to the American Psychiatric Association, 2010

4. The Call for De-psychopathologisation made by MSM-GF (The Global Fund for MSM and HIV), 2010

Extract: ' A psychiatric diagnosis of Gender Identity Disorder fosters stigma and discrimination, escalating vulnerability of transgender persons to social exclusion and disease'

5. TransgenderASIA's call for removal of gender identity variance from the psychiatric manuals, 2009 . English and Spanish versions (posted on Transgender Day of Remembrance, 20th November)

6. Issue Paper 'Human Rights and Gender Identity' (Thomas Hammarberg, Commissioner for Human Rights, Council of Europe), 2009.

Section from page 24 (Section on Access to Health Care), and referring to psychopathological di9agnoses in ICD-10 and DSM-IV) : These classifications are in turn problematic and increasingly questioned by civil society actors and health care professionals. Such classifications may become an obstacle to the full enjoyment of human rights by transgender people, especially when they are applied in a way to restrict the legal capacity or choice for medical treatment. It needs to be noted though that this question is a significant dividing line within the transgender movement itself.Many transgender people feel threatened by a possible change in the classification systems, since they fear it could result in further restrictions in accessing transgender health care. They consider that because health care systems require a diagnosis to ‘justify’ medical or psychological treatment, it is essential to retain a diagnosis to ensure access to care. Others, however, argue that being diagnosed as having a mental disorder stigmatises individuals in society and makes them objects of medicine, rather than subjects who are responsible for expressing their own health needs. Alternative classifications should be explored in close consultation with transgender persons and their organisations.From a human rights and health care perspective no mental disorder needs to be diagnosed in order to give access to treatment for a condition in need of medical care. (my emphasis, SJW)

7. The 'Stop Trans-Pathologisation' Equadorian Manifesto, 2009

8. The Malta Trans-Rights Declaration, 2009

9. The Report ('Moving from Intentions to Action') of the Second International Experts Meeting on HIV Prevention for MSM, WSW and Transgenders, in Amsterdam, November 5-6, 2009. Available by way of pdf link at http://www.schorer.nl/76/schorer-internationaal/expert-meeting-2009/.

On page 19, the report issues the following call for action: Gender identity variance (“transgenderism”) should be reclassified from its current classification as a mental health disorder in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual (DSM) and the World Health Organisation’s (WHO) International Classification Of Diseases (ICD). Instead it should be classified as a medical condition. This would provide a diagnostic category in the ICD that would accommodate the needs of those gender identity variant people who require medical care for their condition, but without the stigma attached to mental disorder.
It is noteworthy that this report is issued in the context of a meeting on HIV prevention

10. Principles Regarding Health Care for Transpeople (here called Gender-Variant people). ILGA World Conference, (Transgender Pre-Conference Meeting. Health Care Sub-group)Geneva, 2006. (, Published as an endnote to a journal article )

Principles 1 and 2: All people have the right to freedom of gender identity and expression (the right to gender-variance).All should have the freedom to exercise that right without psychiatric pathologisation or imposition of other people’s moral judgments (without being judged as either mad or bad).

11. The International Bill of Gender Rights (1995).

Right No. 7 (The Right To Freedom From Psychiatric Diagnosis Or Treatment) states: Given the right to define one's own gender identity, individuals should not be subject to psychiatric diagnosis or treatment solely on the basis of their gender identity or role. Therefore, individuals shall not be subject to psychiatric diagnosis or treatment as mentally disordered or diseased solely on the basis of a self-defined gender identity or the expression thereof.

12. The Health Law Standards of Care for Transsexualism, from the International Conference on Transgender Law and Employment Policy.(1993).

Principle 1 states: Transsexualism is an ancient and persistent part of the human experience and is not in itself a medical illness or mental disorder.

....... and ......

Professionals Concerned with Gender Diagnoses in the DSM

GID Reform Advocates

STP2012: The Stop Transpathologisation 2012 Campaign

SASS ROGANDO-SASOT'S SPEECH AT THE UNITED NATIONS (10th December 2009) YouTube video link (Total viewing time = 10mins 47 secs) Transcript

An highly eloquent and moving affirmation of the right to gender variance, and a denunciation of the prejudice, discrimination, harassment and violence which gender variant persons suffer worldwide. Delivered, at the United Nations in New York, by a leading activist transpinay (a Filipina woman of transgender experience).

Welcome to the Transgender ASIA Research Centre. The Centre seeks to bring together psychologists, sociologists, anthropologists, as well as medical and legal experts who share a desire to better understand the phenomenon of transgenderism, as well as the circumstances in which transpeople (transgendered people) live, in Asia. This website aims to promote and disseminate research and understanding of, as well as contributing towards efforts to effect social change in regard to, transgenderism in Asia.

Disclaimer: We make efforts to avoid linking to any sites carrying material that might, for any reason, be considered offensive. However, the nature of websites is that they can be very extensive and can change on a daily basis. We cannot therefore be held responsible for any links that turn out to lead to offensive material. In the event that such material is found please inform us so that we can examine whether we need to take the link down.

Some published papers authored by researchers connected with the TransgenderASIA Centre

Male, female and transgender: stereotypes and self in Thailand. (Sam Winter and Nuttawut Udomsak). The paper was originally published in the International Journal of Transgenderism (Vol 6, No 1, 2002) and is also available on the website of the World Professional Association for Transgender Health (WPATH) at http://www.wpath.org/journal/www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/ijtvo06no01_04.htm. .

Abstract: Two hundred and four Thai Male-to-Female (MtF) transgenders (mean age 23.0 years) completed questionnaires designed to examine self-concept (actual and ideal) and gender-trait stereotypes held towards men and women.Findings indicated that (a) participants' gender-trait stereotypes were similar to those of non-transgenders examined in other studies (both in their own country and internationally), (b) their actual and ideal self-concepts each displayed much more consensus about traits not possessed than about those possessed, (c) their actual and ideal self-concepts were commonly discrepant, and (d) while they commonly held a stereotypically female view of themselves, they often aspired towards a broad range of traits that were less stereotyped. Indeed, (e) they commonly disowned stereotypically female traits.These last two findings suggest that transgenders have personal growth goals that transcend, or even run counter to, gender-stereotype. They may instead conform to more fundamental ideas about favourable human qualities.

Gender,stereotype and self among transgenders: underlying elements. (Sam Winter and Nuttawut Udomsak). The paper was originally published in the International Journal of Transgenderism (Vol 6, No 1, 2002), and is also available on the website of the World Professional Association for Transgender Health (WPATH) at http://www.wpath.org/journal/www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/ijtvo06no02_02.htm

Abstract: In an article published earlier in The International Journal of Transgenderism (Winter and Udomsak, 2002) showed that while Thai MtF transgenders displayed actual self-concepts that were strongly female-stereotyped (that is, consistent with their own beliefs about femaleness) their ideal self concepts, and aspirations for change were distinctly less female-stereotyped.This finding raised the following question: what underlying considerations, if not the simple pursuit of stereotyped femaleness, governed their ideal self and aspirations for personal growth? To answer this question, the Adjective Checklist (ACL) data from the original study (Winter and Udomsak, 2002) were further analysed in a three-step procedure.Firstly, an attempt was made to identify the underlying essence of the traits we employed in the ACL. Using findings from earlier ACL research by Williams and co-workers (Williams and Best, 1990; Williams et al., 1998, 1999), we ascribed to each ACL trait-item a set of 14 scores, each of which reflected the degree to which that trait reflected an important psychological feature. These features represented (a) affective meaning (three scores: favourability, strength and activity), (b) ego-state (five scores: critical parent, nurturing parent, adult, free child and adapted child), (c) higher-order personality factors (five scores: extraversion, agreeableness, conscientiousness, emotional stability and openness), and (d) psychological importance (one score: indicating the degree to which the trait is a ‘core’ element of personality).Secondly, in order to reduce the data somewhat, these scores were factor analysed. The 14 scores were loaded onto four factors. On the basis of the loadings, these factors were labelled: ‘resourceful / dependable’ (factor I), ‘intrusive / controlling’ (factor II), ‘risk-taking / stimulation-seeking’ (factor III), and ‘caring / harmonious’ (factor IV).Thirdly, multiple regression analyses were employed to identify which if any of these factors appeared to underlie participants’ (i) gender-trait stereotypes, (ii) actual-self, (iii) ideal-self, (iv) aspirations to acquire traits (traits desired but not possessed) and (v) aspirations to lose traits (traits possessed but not desired).The analysis revealed that gender-trait stereotypes were predicted by factors I, II and III (all underlying male-stereotyped traits) as well as by IV (underlying those that were female-stereotyped). Factors I, II and III could therefore be considered ‘male’ factors, while factor IV was ‘female’. As one might expect, factor IV (the ‘female’ factor) predicted those traits endorsed for actual self, while factor II (a ‘male’ factor) acted in a counter-predictive way.Our main interest focused on finding factors that might shed light on our earlier findings on ideal self and aspirations for change. We found that ideal self was predicted by a gender-inconsistent mix of factor IV (the ‘female’ factor) and factor I (a ‘male’ factor). Factor I was also important in predicting those traits which participants aspired to acquire, and in counter-predicting those (unwanted) traits, which they aspired to lose. Beyond this, factor IV (the ‘female’ factor?) somewhat paradoxically predicted aspirations to lose traits.In short, participants’ ideals for self seemed to embody qualities of care and harmony (‘female’ qualities), but also resourcefulness and dependability (‘male’ qualities). Indeed, participants wished not only to retain whatever ‘male’ qualities of resourcefulness and dependability they had, but also to acquire more of these qualities. Furthermore, while they valued many ‘female’ qualities like care and harmony, they also aspired to lose some of these qualities.These findings, which are, at face value, gender-anomalous, attest to personal growth goals that transcend (or indeed run counter to) gender stereotype; instead they conform to notions of maturity and personal efficacy.

Heterogeneity in Transgender: a cluster analysis of a Thai sample. (Sam Winter). An electronic postprint version (i.e. author version, not final publisher pdf) of an article published in the International Journal of Transgenderism, 8, 1, 31-42, 2005. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/103164_794049447_903382742.pdf

Abstract: An analysis was performed of data from an Adjective Checklist (ACL) study of identity and gender-trait stereotype in Thai MtF transgenders (Winter and Udomsak, 2002a, 2002b). Contrary to previous analyses, the current analysis employed the participants (rather than the ACL traits) as the unit of analysis. For each participant a calculation was made of the extent to which traits endorsed for actual self were also those endorsed as stereotypically male (masculine) or stereotypically female (feminine) traits. In this way gender-in-self scores (indices of masculinity, femininity and non-differentiation) in actual self-concept (MASC, FASC and NASC respectively) were calculated. A similar matching procedure involving ideal self led to the calculation of indices for masculinity, femininity and non-differentiation in ideal self-concept (MISC, FISC and NISC respectively). A cluster analysis was then performed, using these six gender-in-self scores in order to identify any groups within our sample. Participants clustered into three substantial groups, together accounting for 98% of the data. The largest (69.9% of the sample) endorsed stereotypically male and female as well as undifferentiated traits. It could therefore be described as an androgynous group. The next, accounting for 21.4% of the sample, endorsed overwhelmingly undifferentiated traits. It was accordingly labelled the undifferentiated group. The last, accounting for 6.6% of the sample, endorsed overwhelmingly female-stereotyped traits and, in view of the fact that they had constructed for themselves such a highly stereotypically female self-concept, was labelled the feminine group. All six gender-in-self scores played a part in distinguishing the groups from each other.For all three groups discrepancies between actual and ideal self were found, suggesting personal growth goals that led away from female stereotype. Traits endorsed for actual self were further examined for any sign of group differences in terms of scores for 14 underlying features, as well as loadings on four higher-order factors, as employed in the Winter and Udomsak (2002b) analysis. Traits endorsed for ideal self and for gender-trait stereotyping were examined in the same way and for the same purpose. For actual self no significant group differences were found. In contrast, several differences were found for ideal self. Traits endorsed by the undifferentiated group stood out from the others by being higher on adult ego state, conscientiousness and emotional stability, and lower on adapted child ego state. All this was reflected in stronger loadings on resourcefulness / dependability.Numerous group differences were identified for gender-trait stereotyping. The feminine group (compared to the other two groups) considered stereotypically female traits to be ( a ) higher on strength, favourability, adult and free child ego states, extraversion, agreeableness, conscientiousness, emotional stability, openness, and psychological important, and ( b ) lower on adapted child ego state. All this was reflected in a stereotypical view of the female as both more caring / harmonious (a stereotypically ‘female’ factor), as well as more resourceful / dependable (usually a stereotypically ‘male’ factor) than how she was viewed by the other groups. The undifferentiated group’s view of the female was at the other extreme, providing a mirror image effect.In conclusion, three groups of MtF transgenders were identified, differing from each other in terms of the degree of gender stereotypy evident in their actual and ideal self-concepts. The three groups also differed in terms of the underlying elements of the traits that they had endorsed for ideal self, as well as for gender-trait stereotypes.

Thai transgenders in focus: demographics, transitions and identities. (Sam Winter). An electronic postprint version (i.e. author version, not final publisher pdf) of an article published in the International Journal of Transgenderism, 9, 1, 15-27, 2006. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/278634_794049447_904340235.pdf

Abstract: Data was analysed for a sample of 195 Thai transgendered females (i.e. male-to-female (MtF) transgenders) who had completed a questionnaire covering, inter alia, demographics, transition histories and sexual/gender identities. Mean age was 25.4 years.For demographic data, we found that our participants were often among the youngest in their family, that females played a prominent role in their lives (often rearing them without any male help), and that around one in five brothers (natural or step) were also transgendered. With regard to transition histories, we found that many participants had transitioned very early in life, beginning to feel different to other males, and identifying as non-male by middle childhood. By adolescence many were living a transgendered life. Many took hormones, beginning to do so by a mean age of 16.3 years, and several from as early as 10 years. Many underwent surgeries of various kinds, on average in the twenties, with one undergoing SRS as early as 15 years.As to identity, most of our participants thought of themselves simply as phuying (women), with a smaller number thinking of themselves as phuying praphet song (a ‘second kind of woman’). A small number thought of themselves as kathoey (a more general Thai term embracing a variety of gender non-conformities) While most participants would prefer to be a woman, there were a few who seemed comfortable being transgendered. A few foresaw that they would not be living a transgendered life into old age. The vast majority expressed a sexual attraction to men.

Thai transgenders in focus: their beliefs about attitudes towards and origins of transgender. (Sam Winter). An electronic postprint version (i.e. author version, not final publisher pdf) of an article published in the International Journal of Transgenderism, 9, 2, 47-62, 2006. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/900579_794049447_904281571.pdf

Abstract: One hundred and ninety five transgendered females (i.e. male-to-female transgenders (or MtF TGs)), with a mean age of 25.4 years, completed a questionnaire examining, inter alia, their beliefs about ( a ) attitudes (of parents and society) towards them (and to MtF TGs in general); and ( b ) origins of their own MTF TG status. According to our participants, 62.9% of mothers and 40.6% of fathers accepted or encouraged their child’s transgender from its first expression. Many with misgivings became more positive as time went on. According to 40.7% of our participants, Thai people overall held similarly favourable attitudes towards MtF TGs. Many of our participants cited multiple origins for their transgender. Nearly 84% believed inborn biology had played a role. Friends and karma were also commonly endorsed as explanatory factors (50% and 48.4% respectively). Parents, siblings, and other relatives were less commonly cited (30.3%, 24.1% and 22.2% respectively). Cluster analysis revealed that, based on their beliefs, 97.1% of the sample could be divided into three groups. Most (61.2%) fell into a ‘biogenic’ group, emphasising the role played by inborn biology, while 29.4% believed took a ‘peer psychogenic’ view, emphasising the role played by friends in the development of their transgender. A small ‘eclectic’ group (6.5%) believed that biology, karma and parents combined to account for their transgender

Transgendered Women of the Philippines. (Sam Winter, Sass Rogando-Sasot and Mark King) An electronic postprint version (i.e. author version, not final publisher pdf) of an article published in the International Journal of Transgenderism, 10, 2, 79-90, 2007. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/510050_794049447_904203098.pdf

Abstract: A convenience sample of 147 transgendered females (i.e. male-to-female (MtF) transgenders, or transwomen, transgendered members of a community often called bakla in the Philippines) was studied. Participants (mean 23.6 years) completed a questionnaire covering, inter alia, demographics, transition histories, sexual preferences, sexual and gender identities, experience of social attitudes towards transgenderism, as well as beliefs about the origins of their own transgenderism. Despite a level of education that was high in relation to the national average, the level of unemployment in our sample was comparatively high. Participants’ family backgrounds revealed a significantly higher frequency of older sisters than younger ones. Participants differed in the ways in which they self-identified, but overwhelmingly reported early feelings of gender incongruity (i.e. in early or middle childhood) and initial transition in adolescence. Though most were at the time of the study using hormones, surgery was relatively uncommon, and sex reassignment surgery rare. While none of the participants aspired to a male identity, many anticipated that they would nevertheless be presenting as male later in their lives. An overwhelming majority reported a sexual attraction to men, the vast majority of these exclusively so. Participants commonly reported that Filipino society was unfavourably disposed towards the transgendered. Many reported rejection by their parents, though this was more common ( a ) by fathers, and ( b ) when they had earlier begun to transition. Participants most commonly cited inborn biology or God’s Will as a factor underlying their own transgenderism. Very few cited social influences.

Measuring Hong Kong undergraduates students' attitudes towards transpeople (Sam Winter, Beverley Webster and Pui Kei Eleanor Cheung). An electronic postprint version (i.e. author version, not final publisher pdf) of an article published in Sex Roles, 59, 9/10: 670-683, 2008. Displayed here with permission from the publishers (Springer)

Abstract: Hill and Willoughby’s (Sex Roles, 53:531–544, (2005) Genderism and Transphobia Scale (GTS), originally developed in Canada, was examined with a Hong Kong sample. Undergraduate students, 82 female and 121 male (total n=203), completed a Chinese version of the instrument. Overall scores and factor structure of the Hong Kong sample were compared with Hill and Willoughby’s Canadian data. Gender differences in transphobia were investigated, both in terms of the participants’ gender as well as the gender of the gender variant persons to whom GTS items referred. Transphobia was higher in Hong Kong than in Canada. The factor structure for Hong Kong differed from Canada. Five factors were identified (with a gender effect on Factors II and V). They were: I, Anti Sissy Prejudice; II, Anti Trans Violence; III, Trans Unnaturalness; IV, Trans Immorality; and V, Background Genderism. Hong Kong men were more transphobic than women. Gender variance in men was viewed less favourably than in women.

Cultural Considerations for the World Professional Association for Transgender Health's Standards of Care: the Asian perspective. (Sam Winter). We post here an electronic postprint version (i.e. author version, not final publisher pdf). Final article published in the International Journal of Transgenderism, 11: 19-41, 2009. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/669168_794049447_910819466.pdf

Abstract: This paper is about Gender Identity Variance (GIV) outside the developed West. I will consider how the non-Western experience of GIV (including healthcare experiences) may guide the Committee looking at the Seventh Edition of the WPATH Standards of Care (SOC-7). The recommendations I make later in this paper assume a genuine concern within WPATH for ‘lasting personal comfort with the gendered self’ and ‘psychological well-being and self-fulfillment’ of all GIV people everywhere, including outside the developed West. I will be making eight recommendations in all. The first four touch on fundamentals: the social context in which GIV people live, as well as the ways we describe, explain and even count GIV. They address the need to ( a ) declare transphobia as a health problem; ( b ) advocate the depathologisation of GIV; ( c ) modify the language used to refer to GIV people; and ( d ) amend the figures used for GIV prevalence. Three recommendations focus on matters of clinical management, addressing the need for ( a) health-professional involvement in family- and community-support; ( b ) more flexibility, less rigidity, in terms of RLE- and age-requirements; and ( c ) less hostile responses to autonomous medication. The final recommendation focuses on the need to consult widely within the international GIV community when drawing up SOC-7; something the old HBIGDA may not have been very good at.

Transpeople, transprejudice and pathologisation: a seven-country factor analytic study. (Sam Winter, Pornthip Chalungsooth, Yik Koon Teh, Nongnuch Rojanalert, Kulthida Maneerat, Ying Wuen Wong, Anne Beaumont, Loretta Man Wah Ho, Francis 'Chuck' Gomez, and Raymond Aquino Macapagal). We post here an electronic postprint version (i.e. author version, not final publisher pdf). Final article published in the International Journal of Sexual Health, 21: 96-118, 2009. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/476275_792506825_912333973.pdf

Abstract: Eight hundred and forty one undergraduate students in seven countries (China, Malaysia, Singapore, Thailand, Philippines, United Kingdom and United States) completed a questionnaire examining perceptions of transwomen (on a transacceptance–transprejudice continuum). The aims were to: ( a ) identify factors underlying transacceptance-transprejudice, and relationships among them; and ( b ) examine gender differences, Five factors were identified (MENTAL-ILLNESS, DENIAL-WOMEN, SOCIAL-REJECTION, PEER-REJECTION, SEXUAL-DEVIANCE). MENTAL-ILLNESS (the belief that transwomen were mentally ill) was the most powerful underlying factor, linked to other aspects of transprejudice. Gender effects (with men significantly less accepting than women) were observed in three countries; most consistently in the US (with men there markedly more prejudiced than men in other samples). We discuss implications for the US debate on depathologisation of gender variance, and for transprejudice worldwide.

Lost in transition: transpeople, transprejudice and pathology in Asia. (Sam Winter). We post here an electronic postprint version (i.e. author version, not final publisher pdf) Final article published in the International Journal of Human Rights, 13, 2-3: 365-390, 2009. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/188551_783567495_912654869.pdf

Abstract: In many Asian cultures transpeople are highly prevalent and socially visible members of the community. They commonly make a gender transition early in life. They often face limits on opportunity for ‘living in stealth’. The cultures often link maleness and femaleness to sexual preference and behaviour. Transpeople are preponderantly heterosexual. There are large numbers of transpeople who even in their teenage years greatly need competent and trans-friendly medical support for their gender transition, yet cannot get access to it, therefore seek alternatives outside the established health system, and in doing so put themselves at great health risk. Worse, their Governments often do not allow them to change key personal documentation, including any that designates their legal gender status. They are consequently denied a range of rights that such change in status would provide; including to privacy and to enter a heterosexual marriage appropriate to their heterosexuality. The denial of the right to marry heterosexually in turn implies denial of other rights, including the right to adopt and raise a family. Prevented from changing their legal gender status, often unable to pass even in informal social situations, transpeople often find it impossible to live in stealth. They become easy targets for the transprejudice and discrimination that pervades their societies. Among other factors which may support and encourage transprejudice, modern psychiatry may inadvertently do so by pathologising gender identity variance.

Transpeople, hormones and health risks in Southeast Asia: a Lao study. (Sam Winter and Serge Doussantousse) .We post here an electronic postprint version (i.e. author version, not final publisher pdf). Final article published in the International Journal of Sexual Health, 21: 35-48, 2009. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/218572_792506825_909391976.pdf

Abstract: Cross-sex hormones, while often effective in producing some of the bodily changes desired by transpeople, may also involve harmful side effect risks, especially when used against contraindications and precautions, and in the wrong dosages. Same-sex hormones blockers (interrupting the person’s own sex hormone production) may also have potential side effects. Yet there is evidence that Asian transpeople commonly use hormones of both types without any medical supervision, often unaware of the risks at which they put themselves. This report (employing a sample of transwomen recruited for a broader study) examines the patterns of hormone usage in developing country in South-East Asian - Laos. The results confirm that large numbers of Lao transwomen use hormones without at any time consulting a medical professional, nor being aware of many of the more major risks associated with these hormones. The implications for health services are discussed.

The Child Play Behavior and Activity Questionnaire: A Parent-Report Measure of Childhood Gender-Related Behavior in China (Lu Yu, Sam Winter and Dong Xie). An electronic postprint version (i.e. author version, not final publisher pdf) of an article published in Archives of Sexual Behavior. (DOI: 10.1007/s10508-008-9403-4). Published Online: August 22, 2008.Displayed here with permission from the publishers (Springer)

Boys and girls establish relatively stable gender stereotyped behavior patterns by middle childhood. Parent-reported questionnaires measuring children’s gender related behavior enable researchers to conduct large-scale screenings of community samples of children. For school-aged children, two parent-reported instruments, the Child Game Participation Questionnaire (CGPQ) and the Child Behavior and Attitude Questionnaire (CBAQ), have long been used for measuring children’s sex-dimorphic behaviors in Western societies, but few studies have been conducted using these measures for Chinese populations. The current study aimed to empirically examine and modify the two instruments for their applications to Chinese society. Parents of 486 Chinese boys and 417 Chinese girls (6-12 years old) completed a questionnaire comprising items from the CGPQ and CBAQ, and an additional 14 items specifically related to Chinese gender-specific games. Items revealing gender differences in a Chinese sample were identified and used to construct a Child Play Behavior and Activity Questionnaire (CPBAQ). Four new scales were generated through factor analysis: Gender Scale, Girl Typicality Scale, Boy Typicality Scale, and Cross-Gender Scale. These scales had satisfactory internal reliabilities and a large effect size for gender. The CPBAQ is believed to be a promising instrument for measuring children’s gender-related behavior in China.

Contact Reduces Transprejudice: A Study on Attitudes towards Transgenderism and Transgender Civil Rights in Hong Kong (Mark King, Sam Winter and Beverley Webster). We post here an electronic preprint version (i.e. author first draft sent for review), Transprejudice in Hong Kong: Associations with Contact and Demographic Variables on Attitudes towards Transgenderism and Transgender Civil Rights. Final article published in the International Journal of Sexual Health, 21: 17-34, 2009. The final published article is available online (for subscribing institutions and individuals) at http://pdfserve.informaworld.com/913727_792506825_909392359.pdf

This paper examines the construct of transprejudice and the relationship between Hong Kong Chinese people's contact with transgender/transsexual (TG/TS) people and attitudes toward transgenderism and transgender civil rights, based on Allport¹s Contact Hypothesis. Data are presented from a population-based survey with a random sample of 856 Hong Kong Chinese persons aged between 15 and 64, using the Chinese Attitudes towards Transgenderism and Transgender Civil Rights Scale (CATTCRS). Attitudes, assessed on both personal and institutional dimensions, are examined in relation to participants' gender, age, educational level, religiosity, and previous contact with TG/TS people. Results suggest that previous contact with TG/TS people was significantly associated with attitudes reflected in the scale; decreased social distance, decreased social discrimination, and decreased transprejudice, increased awareness of discrimination against TG/TS people, increased support for equal opportunities, increased support for post-operative transsexual civil rights, and increased support for anti-discrimination legislation. Our findings support the contact hypothesis, that contact has a positive effect on attitudes towards TG/TS persons. We discuss the implications of these findings for public education interventions and public policy, as well as for research.

Well and Truly Fucked: Transwomen, Stigma, Sex Work and Sexual Health in South to East Asia. (Sam Winter and Mark King). We post here, with the permission of the editor, an electronic post-print version (i.e. final copy before publication) of a chapter to appear in Dalla, R. L., Baker, L. M., DeFrain, J. & Williamson, C. (Eds.) (In Process), A Global Perspective of Prostitution with Implications for Research, Policy, Education, and Service (Vol. II: North America, Latin America, and Europe). Landham, MD: Lexington Publishers, Inc.

This chapter’s key points are as follows. First, there are large numbers of transwomen in South to East Asia, often gender-transitioning early in life. Second, in many cultures transwomen draw upon a sexology that conflates sex, gender and sexuality, and upon a rich pre-modern tradition of gender pluralism in which they played important social roles (as well as providing a sexual outlet for men). Third, transwomen have in modern times often become victims of stigma, driven out to the margins of society and unable to obtain employment except in a small range of “ghetto” occupations, which includes sex work. Fourth, a large number of men enter sexual relationships with transwomen (including TSWs, whose services involve a wide range of worker-customer relationships). Fifth, sex work offers transwomen opportunities not easily available elsewhere for earning money (including for changing their bodies to match their gender identity), for affirming their identity, and for searching for a stable partner. On the other hand it puts transwomen at heightened risk of stigma, harassment and violence, relationship distress, and HIV/AIDS and other sexually transmitted infections (STIs). It is this chain running from stigma through sex work, to more stigma, illness and death, that underlines the title of this chapter: “well and truly fucked”. We argue that the social changes which would improve the life circumstances of TSWs are broadly those that would improve the circumstances of transwomen more generally. In particular there is a need to remove stigma attached to being transgender. We argue that this stigma arises in part from the Western psychiatric view of transpeople as suffering from a mental disorder (Gender Identity Disorder or GID, and related diagnoses such as Transsexualism). TSWs, and transpeople more generally, would benefit from an end to the practice of pathologising their identities.