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In the action plan the term is primarily used to describe people whose gender identity does not match their biological sex. However, it is important to note that not everybody identifies exclusively with one sex or the other. Some people may identify as male in one setting and female in another. This suggests a gender continuum, rather than simply an opposition between one gender (male) and another (female).0+Definitions continued0Large variation in preference amongst transgender groups Boston study concludes  Older adult group dislike for term transgender..... Younger groups preferred term transgender over transsexual.. may reflect differences in both social and physical attributes amongst individuals, or may indeed reflect changing cultural norms around language over time. Starting point to study the use of meanings of language. The Ancients`The surgical methods and effects of castration were first known to Ancient cultures through their experience of domestication of animals. It became known that castration of human male s testes at a young enough age would prevent his masculinisation. Slaves were castrated and became known as  eunuchs .The Ancient Greeks and RomansRIn these cultures men were completely emasculated by the removal of the testes, penis and scrotum. In addition the external pubic area was often sculptured to look feminine. After undergoing these procedures men went through religious ceremonies and then took their place as  women in society.$Transsexuals in India and BangladeshYoung transsexuals in India and Bangladesh join the Hijra caste. To become hijra these teens undergo full emasculation surgeries under primitive conditions only with opium as an anaesthetic. "Hijra - The Third Gender in India" F%`# Other cultures8Native American folklore includes reference to cross dressing and cross gender behaviour. The explorers called such individuals berdache. The tradition still exists in various parts of the world including: Central and southern Asia, Amazon regions, Australia, Tahiti (where they are called the mahu) and India.!Modern accounts of transsexualityLKrafft-Ebling publishes  Psychopathia Sexualis in 1894. He was an Austrian psychiatrist whose work under  Metamorphis Sexualis Paranoica or  Psychic Hermaphrodism gives the clinical picture of transsexualism. He saw this condition as he did homosexuality as a delusion and a mental illness Havelock Ellis`In his second Volume of  Studies in the Psychology of Sex in 1920, Ellis coins the name  Eonism and  Sex-aesthetic inversion Magnus Hirschfeld expands on Ellis s work, coins the term transsexual in 1923 and opened the  Institute for Sexual Science from 1919 until it was closed by the Nazis in 1933. Sex reassignment surgeryThe first complete male to female SRS was reported in 1931, it was performed based on Hirschfeld s recommendations by two co-workers in the institute, Dr Levy-Lenz and Dr Felix Abraham. Hirschfeld viewed transsexuality as a form of intersex. WWII developmentsClinics in Denmark and Norway resume some of the work begun in Berlin WWII advancements in flap surgery promoted knowledge in SRS as did the advent of hormone therapy with estrogens being discovered and utilised.  Public awareness of transsexuals Scientific investigations,Cauldwell 1949 Psychopathia Transsexualis 1953 Dr Harry Benjamin authored articles and begun treating transsexuals with hormone therapy in 1949. He wrote his seminal work the - Transsexual Phenomenon in 1966 SRS grew dramatically- Burou late 1950 s pioneered a new form of SRSSurgery in the USA\Wealthy FTM Reid Erickson formed the Erickson Education Foundation to promote the study of transsexualism. 1965 John Hopkins Gender Clinic in the next couple of years clinics opened at Stanford, Northwestern and the University of Minnesosta. Biber opened the first private clinic in 1969 an alternative to gender clinic with less strict criteria.-Other countries also developed Gender clinics1967 the Charing Cross Hospital in England and other programs in Germany and Paris. Australia - In the 1960 s Professor Ball came to Australia from England where he did a doctoral thesis on gender dysphoria he coordinated the transsexual clinic at Parkville and at the Royal Melbourne hospital which diagnosed and operated on a number of patients.A1975 Dr Bower establishes the GDC at the Queen Elizabeth HospitalBA$In 1975 Dr Bower approached Prof Carl Wood and A/Prof Walters at the Queen Victoria Hospital to start a clinic The first operation was performed in 1976 The team wrote a textbook in 1986 In the late 1980 s Professor Walters goes to Newcastle, Dr Kennedy becames coordinator and the clinic transfers to Monash medical Centre.  TreatmentsCounselling, superficial and in-depth psychotherapy, psychoanalytic treatment even exorcism were used in the management but with few exceptions were unsuccessful. Behaviour modification, hormone therapy (enhancing the biological gender) and even ECT all were tried and abandoned. Late 1960 s  Worldwide medical opinion endorsed surgical sex reassignment as the only available treatment of this gender disorder Benjamin standards now in the 6th revision Feb, 2001 are used as clinical guidelines by many clinicians - 1979, 1980, 1981, 1990, & 1998.  !Psychiatric classification of GIDADiagnosis of transsexualism was introduced in DSM-III in 1980 for gender dysphoric individuals who demonstrated at least two years of continuous interest in removing their sexual anatomy and transforming their bodies and social roles. Also classifications of GID of Adolescence or Adulthood Nontranssexual Tpe or GIDNOS.DSM-IVIn 1994 DSM-IV replaced the diagnosis of transsexualism with gender identity disorder. (Many in the transsexual community do not like the psychiatric classification of GID as they do not see they have a disorder).(Incidence rates of M-F& F-M transsexuals>Walinder , 1967 Sweden 1: 37 000 (2.8:1) Pauly, 1968, USA, 1: 100 000 Hoenig & Kenna, 1974, England 1: 34 000 Ross et al, 1981, Australia, 1: 24 000 (6:1:1) Tsoi, 1988, Singapore, 1: 9000 Gooren et al, 1992, Netherlands, 1: 11900 Osburg & Weitze, 1993, West Germany, 1: 36 000- 1: 42 000. Green, 2000 1 in 10 000 men.Perception by patients When I first heard of the GDC, horror stories abounded of girls leaving in tears and cherished dreams being ridiculed by  gatekeepers from hell. Needless to say& what I found was rather different than my fears .7Perception of a staff member - Dr Hunter-Smith surgeon cThere appears to be enormous misunderstanding among the medical profession as well as the general public, about the needs and desires of transsexuals. The overall impression I got when speaking with even the most highly educated people, was that all transsexuals must be nuts and that I must be equally mad to be even slightly interested in helping them. Dr Hunter Smith continuedWhen asked for a comment by a reputable  journalist I spent two hours outlining the MMC team and the need for the surgery, however, what appeared in the paper was  Surgeons make penis for women . This sort of comment he states does nothing for the confidence of mainstream doctors and really works against common goals.Recent influential StudiesDean et al. Lesbian, Gay, Bisexual and Transgender Health: Findings and Concerns. Journal of Gay and Lesbian Medical Association, Vol 4, No 3, 2000.  /Sources investigating health concerns for GLBIT{ GLMA. Healthy People 2010 - Companion Document for LGBT Health. April 2001 http://www.glma.org/policy/hp2010/index.html >z`";:5BAmerican Public Health Journal June, 2001 (Devoted to GLBT health)CB$Despite many differences that separate them LGBT people share remarkably similar experiences related to stigma, discrimination, rejection, and violence across cultures and locales. Special need to focus on health concerns.;6.Increased risks in transgender communities of:oDepression Suicide ideation Drug and alcohol problems Risk of sexual transmitted diseases Delayed health care 50%Possible risks of Hormone Therapy M-FBenign pituitary tumours Gallbladder disease Hypertension Hypothyroidism Liver Disease Migraine headache Tendency for blood to clot - Aneurysm, deep vein thrombosis, pulmonary embolism, weight gain worsening of depression if present61%Possible risks of hormone therapy f-mBreast cancer Cancer of endometrium Diabetes High cholesterol Hypertension Liver Disease (Tobaco use can worsen the possible effects)72 Cancer risksNeed for more research no data on actual risk however need to inform: M to Fs still need prevention urological care and prostate examinations, as well as mammograms F to Ms may remain at risk for cervical cancer require regular Pap tests and mammograms for remaining breast tissue830 Lesser Health Concerns Non-disclosure Allergies Eye infections  If the clinician is not aware of a patient s gender identity, he or she may fail to accurately diagnose, treat, or recommend appropriate preventative measures for a range of conditions .!RecommendationstMedical Boards and other groups that license or certify health care professionals should ensure that their examinations include questions on health care for the transgendered. Academic departments of health should encourage, if not require, an internship or a rotation at a community center or health center that includes service to LGBT people. Home care agencies should be trained to be culturally sensitive and respectful of transgendered elders. Medical Boards and other groups that license or certify health care professionals should ensure that their examinations include questions on health care for the transgendered. (us"Recommendations Cont;Health care providers of all disciplines should be provided with education and training on how to communicate with transgendered consumers and families in a culturally competent way and how to reduce barriers to effective communication. Health insurance companies should extend coverage to include transgender issues and remove barriers to the transgendered obtaining coverage. Workers in alcohol and drug abuse programs should be trained in understanding the needs of their transgendered clients and made aware of the relationship between gender issues and addiction. 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˸keE%eE@%!)-/ s5q]I5o7e<CrS(   hhttp://www.advocate.com/html/books/834_jorgensen.asphhttp://www.advocate.com/html/books/834_jorgensen.aspD/ 0Oh+'0HU hp$ @L l x 7The Gender Dysphoria Clinic past and current practicesFrank SamuhelphRC:\Program Files\Microsoft Office\Templates\Presentation Designs\high voltage.potrann maree nobeliusc19 Microsoft PowerPointoso@^F@e%@`[)XGSg  )'    """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___wwwP4'A x(xKʦ """)))UUUMMMBBB999|PP3f3333f333ff3fffff3f3f̙f3333f3333333333f3333333f3f33ff3f3f3f3333f3333333f3̙33333f333ff3ffffff3f33f3ff3f3f3ffff3fffffffff3fffffff3f̙ffff3ff333f3ff33fff33f3ff̙3f3f3333f333ff3fffff̙̙3̙f̙̙̙3f̙3f3f3333f333ff3fffff3f3f̙3ffffffffff!___wwwݵݵݵݵݵݵݵݵݼݵݵmݵݮݼmݼݵݮݵݵݵݵݵݵݵݵݵݵݵݵݵݵݵݒmݒݮݼmݼݵݮݮݵݵݵݵݵݵݵݵݵݵݼݵݵݵݵmݼݮݵmݼݵݵݵݵݵݵݵݵݵݼݵݵݵݵmݼݵݮmݼݵݮݵݵݵݵݵݵݵݵݵݵݵݵݵݵݒݵݮmݼݵݮmݵݵݵݵݵ___ݵݵ______________________________________________________ݵݵݵm_________________________________________ݵ______________________________________ݵݵ_______________________________________________ݮ________________________________________ݵm_______________________________________________________________________ݵ______________ݮmݮݵݵݵݵݼݵݵݵݵݵݵݵݼݵݵݮmݮݵmݼݵݵݵݼݵݵݵݵݵݵݵݼݵ՜.+,D՜.+,@    On-screen Show -sOD% +Times New RomanImpactMonotype Sorts Arial NarrowSymbolhigh voltage.potGender Dyshoria and Health+Health Issues in the Transgender Community[Definitions -Victorian Gay, Lesbian, Bisexual, Transgender and Intersex Health Action PlanDefinitions continued The AncientsThe Ancient Greeks and Romans%Transsexuals in India and BangladeshOther cultures"Modern accounts of transsexualityHavelock EllisSex reassignment surgeryWWII developments!Public awareness of transsexualsScientific investigationsSurgery in the USA.Other countries also developed Gender clinicsB1975 Dr Bower establishes the GDC at the Queen Elizabeth Hospital Treatments Late 1960s "Psychiatric classification of GIDDSM-IV)Incidence rates of M-F& F-M transsexualsPerception by patients8Perception of a staff member - Dr Hunter-Smith surgeon Dr Hunter Smith continuedRecent influential Studies0Sources investigating health concerns for GLBITCAmerican Public Health Journal June, 2001 (Devoted to GLBT health)/Increased risks in transgender communities of:&Possible risks of Hormone Therapy M-F&Possible risks of hormone therapy f-m Cancer risksLesser Health ConcernsRecommendationsRecommendations Cont$American Public Health Association What the future holds  Fonts UsedDesign Template Slide Titles% 8@ _PID_HLINKSA5http://www.advocate.com/html/books/834_jorgensen.asp*_}ann maree nobeliusann maree nobelius  !"#$%&'()*+,-./013456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)`[)XPicturesZbCurrent User!VSummaryInformation(xUPowerPoint Document(2ODDocumentSummaryInformation8,|DTimes New Roman0B 0DImpactew Roman0B 0" DMonotype Sorts0B 00DArial Narrows0B 0"@DSymbolarrows0B 0@ .  @n?" dd@  @@`` A'!     #$% !"&',b$}R{Ӽߎ8>Zb 0AA@8 g4BdBd B 0ppp@ <4BdBdLpC 0tRʚ;ʚ;<4ddddL%F 080___PPT10 pp___PPT9/ 0d&? 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In the action plan the term is primarily used to describe people whose gender identity does not match their biological sex. However, it is important to note that not everybody identifies exclusively with one sex or the other. Some people may identify as male in one setting and female in another. This suggests a gender continuum, rather than simply an opposition between one gender (male) and another (female).0+Definitions continued0Large variation in preference amongst transgender groups Boston study concludes  Older adult group dislike for term transgender..... Younger groups preferred term transgender over transsexual.. may reflect differences in both social and physical attributes amongst individuals, or may indeed reflect changing cultural norms around language over time. Starting point to study the use of meanings of language. The Ancients`The surgical methods and effects of castration were first known to Ancient cultures through their experience of domestication of animals. It became known that castration of human male s testes at a young enough age would prevent his masculinisation. Slaves were castrated and became known as  eunuchs .The Ancient Greeks and RomansRIn these cultures men were completely emasculated by the removal of the testes, penis and scrotum. In addition the external pubic area was often sculptured to look feminine. After undergoing these procedures men went through religious ceremonies and then took their place as  women in society.$Transsexuals in India and BangladeshYoung transsexuals in India and Bangladesh join the Hijra caste. To become hijra these teens undergo full emasculation surgeries under primitive conditions only with opium as an anaesthetic. "Hijra - The Third Gender in India" F%`# Other cultures8Native American folklore includes reference to cross dressing and cross gender behaviour. The explorers called such individuals berdache. The tradition still exists in various parts of the world including: Central and southern Asia, Amazon regions, Australia, Tahiti (where they are called the mahu) and India.!Modern accounts of transsexualityLKrafft-Ebling publishes  Psychopathia Sexualis in 1894. He was an Austrian psychiatrist whose work under  Metamorphis Sexualis Paranoica or  Psychic Hermaphrodism gives the clinical picture of transsexualism. He saw this condition as he did homosexuality as a delusion and a mental illness Havelock Ellis`In his second Volume of  Studies in the Psychology of Sex in 1920, Ellis coins the name  Eonism and  Sex-aesthetic inversion Magnus Hirschfeld expands on Ellis s work, coins the term transsexual in 1923 and opened the  Institute for Sexual Science from 1919 until it was close     d by the Nazis in 1933. Sex reassignment surgeryThe first complete male to female SRS was reported in 1931, it was performed based on Hirschfeld s recommendations by two co-workers in the institute, Dr Levy-Lenz and Dr Felix Abraham. Hirschfeld viewed transsexuality as a form of intersex. WWII developmentsClinics in Denmark and Norway resume some of the work begun in Berlin WWII advancements in flap surgery promoted knowledge in SRS as did the advent of hormone therapy with estrogens being discovered and utilised.  Public awareness of transsexuals Scientific investigations,Cauldwell 1949 Psychopathia Transsexualis 1953 Dr Harry Benjamin authored articles and begun treating transsexuals with hormone therapy in 1949. He wrote his seminal work the - Transsexual Phenomenon in 1966 SRS grew dramatically- Burou late 1950 s pioneered a new form of SRSSurgery in the USA\Wealthy FTM Rei