Gender Dysphoria and the Persecution of Transgender People

The morality of sex has been given wide attention because it is a principle to differentiate between proper sexual behavior and improper sexual behaviour. Since the sexual act is connected with the giving birth to children (human reproduction),it despite being a very private and intimate matter. People normally born with only one sex either male or female. There are people who unsatisfied with their own sex which most probably happen in man,they undergo gender reassignment therapy to make themselves a real woman. In 20th century, issue regarding sex exchange is still a rare and unprecedented case. Einar Mogens Wegener make an outstanding decision that he want to undergoes sex exchange,he is one of the first identifiable recipients of male to female sex reassignment therapy which after that named himself as Lili Elbe. In 1930,the medical technology is still not advanced enough to make sure the sex exchange operation can be successfully done but he still determined with his own decision. He went through a series of five operations over a period of two years. However, three months after her last operation, he died. His cause of death is believed to have transplant rejection. He is a pioneer to the history of sex exchange. In the aspect of psychology,the cause of human being who unsatisfied with their own sex and strong willing to undergo sex exchange is due to ‘gender dysphoria’ but the cause of gender dysphoria is still an unknown. Recently, scientific evidence suggests that there are biological influences before birth. This imply that gender identity, along with other physical characteristics, is established long before environmental factors influence individual socialisation. A recent experiment suggests that both biology and some environment influences may play a role in determining gender identity. In the medical model, transsexual men and women are diagnosed with gender dysphoria and gender identity disorder. In the DSM IV the American Psychiatric Association presents several components of what it calls ‘gender identity disorder’: * a strong and persistent cross-gender identification, which is the desire to be, or the insistence that one is, of the other sex * not merely a desire for any perceived cultural advantages of being the other sex but evidence of a persistent discomfort about one’s biologically assigned sex * clinically significant distress or impairment in social, occupational or other important areas of functioning.
While some forms of gender identity dysphoria may be temporary and thus transsexualism is immutable. However, the costs of sex reassignment surgery vary. According to the data collected through internet,Female to male surgery in Toronto costs approximately $10,000 to $12,000.In the UK, where the Gender Identity clinic of the Clark Institute of Psychiatry used to sent its clients, male to female surgery costs approximately £9,000 (approximately $18,000 Canadian). The information that is available on costs of sex reassignment surgery indicates that in the United States male to female surgery can cost between $10,000 and $28,000 (U.S.). According to the 1996 British Columbia law reform project on human rights and the transgendered community, male to female sex reassignment surgery ranges from between $5,000 and $10,000. Female to male sex reassignment surgery costs considerably more, ranging from $20,000 to more than $60,000. Under legal and medical issues,the authors note that the legal system and the medical system have engaged in the ‘medicalisation of identity’. For example, the courts ask whether, medically speaking, a person is a woman or a man. In Ontario, the government interpretation of the Vital Statistics Act requires a medical letter and sex reassignment surgery before allowing a change in the birth certificate. Government policies for other documentation vary, but many ask for medical proof that the individual is transsexual instead of accept self-identification. Consultees reported instances of court cases such as custody disputes where the transsexual parent was required to undergo medical assessment to confirm the person's gender identity. Next,transgendered person must receive legal recognition from a gender identity clinic, which is not always accessible, in order to receive appropriate service or treatment from the health care system and other organizations that they may come in contact with. General practitioners often do not have suffivcient resources or expertise that provide appropriate services to transgendered patients. As a result, there are many transgendered individuals who self-medicate and self-treat with hormone therapy, which subsequently puts their health at risk. Many individuals in this situation reported that they felt they have no other option due to expensive operation cost and lack of expertise in this aspect. There are some case that a pre-operative transsexual woman and one intersexed woman should always bring along the letters written by their doctors because the letter recommend the individual and advised that the individual had been diagnosed as having ‘gender identity disorder’ so that the people address the individual as a woman. These two individuals indicated that they carried this letter at all times in the event that they were stopped by the police, stopped when using women’s change rooms or washroom facilities, questioned at government agencies or in any other official setting. It is a recent trend that a growing number of people who are transgendered no longer consider sex reassignment surgery as a suitable option for them either due to cost, medical risks, medical barriers or even on principle. Many of them do not wish to assimilate into a society with rigid bifurcated standards of sex and gender congruence, but rather ask that society accepts and adapts to transgendered people. Nevertheless, a large number of transsexuals in Ontario seek sex reassignment surgery but due to a recent change in government policy, economic and medical barriers, they cannot access it. These factors also effectively preclude transgendered people from accessing hormone therapy. Sex change is a term often used for sex change in humans, that is all medical procedures transgender people may pursue, or specifically to sex reassignment surgery, which usually refers to genital surgery only. It is also sometimes used for the medical procedures intersex people undergo or more often are subjected to as children. "Sex change" is sometimes also used for the whole process of changing gender role and the medical procedures associated with it. Actually,to them, changing of gender role such as living as a woman instead of living as a man, or living as a man instead of living as a woman, is much more important than any medical procedures.
There are many different opinion of people nowadays toward the transgender issue. Some people thought that people who really decide to change their gender must be a brave and ambitious people. They give people some positive effect that we must not let our fear to outweigh our desire to make our dreams come true.Thus,they feel that people who undergoes transgender without care on other people’s view is so courageous as the ready to suffer of the pain in operation and in the cold-shoulder of society.However,there are some people who think that people who not appreciate just will unsatisfired with their own gender,we should appreciate what we had as a gift of God.Therefore,there are some family members who not agree with them and feel that it is a shame toward the reputation of a family thus this causes some of the thransgender persons homeless.This is because transsexual youth who are open about their identity face extreme abuse and rejection from families and peers. Many are forced to leave their home communities and survive on the streets. During the consultation, some individuals indicated that they were not in conflict with the diagnosis of gender dysphoria. Indeed, the diagnosis facilitated their ability to identify in their felt gender and allowed them to access sex reassignment surgery. One group involved with transgendered individuals who are homeless, street workers or living with HIV/AIDS stated that the medical diagnosis is especially important for lower income transsexuals who cannot afford private medical care or who are employed during the transition from the birth assigned sex to their felt gender. Others were, at the very least, concerned with the negative stereotyping attached to a diagnosis of a psychiatric disability. Most community members stated that access to medical services for sex reassignment should not be barred even if the psychiatric diagnosis is removed. One group made an analogy between the accommodation of medical needs related to aligning one’s physical appearance to one's gender identity on the one hand and the medical care that is required during pregnancy on the other. For instane,The Supreme Court of Canada in Brooks recognized pregnancy as a health issue rather than a disability and required that accommodation be provided on the former basis. Similarly, it is argued that transgendered persons should be able to obtain accommodation without being ‘pigeon-holed’ as persons with disabilities. According to the data,transgender person actually face a lot of morality problems.For example the transgender students face severe discrimination and harassment in schools. 89.5% of transgender students report feeling unsafe in schools. Transgender students are at higher risk of dropping out of school and of suicide.Next, many transgender and gender non-conforming students have no access to bathrooms. Some are told to use the bathroom that does not correspond to their gender identity. Many are expelled from school because the school does not know where the person should use the bathrooms.Then, more than one quarter of them said they had lost a job due to being transgender or gender non-conforming and half were harassed. Many Americans have a profound lack of understanding of what it means to be transgender. Consequently, transgender people commonly face a wide variety of discriminatory barriers to full equality. They sometimes face difficulties meeting their basic needs such as getting a job, housing and health care or in having their gender identity respected too like in the simple act of going to a public restroom.As a conclude,the transgendered community has to deal with discrimination, physical violence and undue stereotypes in reality.
Those are eight main problems face by transgender people:
(a) HIV/AIDS
HIV/AIDS is a significant health consideration for transgendered individuals who engage in high-risk behaviors such as unprotected sexual activity or intravenous drug use. This issue is highlighted by a research report done in Vancouver, which indicated that 70 to 80 per cent of transgendered sex trade workers are HIV positive.
(b) Transgendered Youth
Transgendered youth have limited access to professionals who understand the nature of gender identity and how to support a transgendered individual. Continued homophobia and transphobia in the social services directed to gay, lesbian and bisexual and transgendered youth compound this. This was stated several times in the consultations. One woman related the story of her incarceration in youth group homes before her sex reassignment surgery. She was told to act like a man, disciplined for not doing so, and survived the process simply by denying her transgendered status.
Further, consultees stated that the educational system does not understand transgendered issues. Transgendered youth and transgendered parents both face barriers dealing with the school system. Some social service agencies are beginning to recognize the need to address these issues. For example, the Catholic Children’s Aid of Metropolitan Toronto has developed a policy that includes transgendered youth in its intervention policy. The policy states that all staff care providers and volunteers must undergo training with regard to the needs, concerns, language, symbols and culture of gay, lesbian, bisexual and transgendered youth and families. Issues concerning sexuality that arise in service delivery to transgendered youth should be treated with the same respect, concern, sensitivity, and confidentiality accorded to heterosexual youth and families.
(c) Services and Media
Service delivery to the transgendered community is generally reported to be poor. In consultations, individuals reported that they had been stopped by the police and told to identify who they were. Hospital workers show prejudicial attitudes in treatment once the birth assigned sex of the individual is discovered. Insurance companies give differential treatment once the transsexual identity of an individual is discovered. Transgendered women have difficulty accessing women’s shelters and other social service agencies. Families of transgendered people, including spouses, children and parents also lack the resources to obtain the support and understanding they need and to be free from discrimination.
The media generally shows a misunderstanding of the issues faced by transsexuals. There is often confusion of terminology used to describe individuals, i.e. not distinguishing between the issues of transsexuals, cross-dressers, etc. The result is that derogatory or sensationalistic language is frequently used when reporting on issues that are related, in whole or part, to transgender issues.

(d) OHIP Coverage
From 1970 to 1998, OHIP coverage had been provided for sex reassignment surgery for individuals approved by the Clarke Institute of Psychiatry. Ontario’s Ministry of Health treated most aspects of sex reassignment surgery, including out-of-province procedures, as reimbursable services under OHIP. Section 7 of the Health Insurance Act] outlines that breast enlargement, augmentation, mammoplasty or breast reconstruction in a male to female conversion is not an insured benefit unless prior authorisation is received from the Ministry of Health. In all cases, health coverage for sex reassignment surgery in Ontario was contingent upon having completed the program at the Gender Identity Clinic at the Clarke Institute of Psychiatry and having been recommended by the Clinic for sex reassignment surgery.
In October 1998, the Ontario government decided to remove sex reassignment surgery from the list of services covered by provincial health insurance. This decision was met with public outcry from the transgender community and is interpreted as a statement that the government does not consider the issues of transgendered people as valid, significant, or important. This decision has a profound impact on transgendered people who are part of a highly marginalised community and who are also often in a lower income bracket which means they lack the financial resources to pay for surgery.
The Ministry of Health has not provided any rationale behind the decision to delete health insurance coverage for sex reassignment surgery. An article in the Toronto Sun, based on information apparently provided by the government, states that the savings will be applied to cardiac surgery.However, the public funds allocated for sex reassignment surgery are insignificant when compared to the budget of the Ministry of Health. The article ignores the fact that qualified professionals have identified surgery to be a medical necessity. Moreover, the consequences of not covering surgery may include additional or increased costs in other areas such as counselling and health care. It may also result in an elevated risk of suicide in the transgendered community because individuals are unable to obtain appropriate services.
(e) Fear of discovery
Transsexuals and transgenderists fear discovery of their birth-assigned sex. Likewise, for cross-dressers, the fear of being discovered is a significant concern. The repercussions of being discovered can include termination of employment, loss of housing, loss of services, social isolation and other forms of discrimination, harassment and possibly violence.
(f) Hate Crimes and Transgendered Individuals
Crime statistics indicate that transgendered people are victims of hate crimes that may also involve violence. Furthermore, such crimes may not be taken as seriously or dealt with appropriately. As noted in a draft brief by the Canadian Task Force for Transgendered Law Reform:
(g) Poverty
There is no statistical data about the rates of poverty for transgendered people. However, it was noted during consultation that transgendered persons experience severe economic hardship. This could be due to the difficulties in accessing medical and insurance services, discrimination in the workplace, and social and economic marginalisation. Mirha-Soleil Ross, the co-ordinator of ‘Meal Trans’ a program for transgendered people in Toronto, states that 90% of those people who utilise the program earn less than $10,000 a year.

(h) International Persecution of Transgendered People
The social rejection of transgendered persons manifests itself internationally through cross-border issues of recognition of transgendered individuals as refugees and related issues of returning them to their country of origin under international law. For example, a transgendered woman who claimed refugee status in Canada was deported to Mexico although she alleged fear of persecution if returned. Public and government should give more concern toward transgender people,we must not discriminate those people but give more positive support toward them as it is not easy fot a person to decide to undergo sex exchange,the person must be tough and brave enough. In order to minimize the rate of suicide in the population of transgender people,we should pay more attention to them and thus give them an equal rights as what normal people got.We should not evade them in public but on the other hand we should respect their choice of undergo transgender. We always erroneously believe that transgender normally is AIDS carrier but in fact they too love themselves and of course will protect themselves for AIDS by having proper sex intercourse. Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and non-transgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either non-transgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.