What gay trans guys wish their doctors knew

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Vancouver study peers into the lives and troubles of trans MSM

Sam Larkham organizes sexual health clinics across Metro Vancouver with the Health Initiative for Men (HIM). He says he was once referred by his doctor to a trans health care clinic that had been closed for years.

By Niko Bell

Speaking to gay and bisexual trans men, the word “invisibility” comes up a lot. Invisibility in the bathhouse and on dating apps, invisibility among cisgender people, straight people, trans people and gay people. And, too often, invisibility in the doctor’s office.

“I have tried just going to walk-in clinics and stuff like that to ask questions or request tests,” one trans man recently told researchers in Vancouver. “And I just found the doctors were generally confused about me and my body. And I had to go into great detail. That made me not so comfortable talking to them about it because they were just kind of sitting there confused.”

“People have tried to talk me out of testing . . . saying I was low-risk behaviour,” another man told the researchers. “They didn’t understand my behaviour really. . . I’ve had practitioners as well say they don’t know what to do; they don’t know what to look for.”

Both men were speaking to researchers for a new study on the sexual health of trans men who have sex with men — a group social scientists know remarkably little about. Many of the men spoke about being on the margins of mainstream culture, gay culture and of the healthcare system.

It should be no surprise, then, that the study happened almost by accident. When PhD student Ashleigh Rich started work with the Momentum Health Study — a five-year, in-depth research project on the sexual health of men who have sex with men (MSM) conducted out of the BC Centre for Excellence in HIV/AIDS — she never intended to write a paper about trans MSM.

But a small group of trans men volunteered for the study, some pointing out ways the Momentum researchers could change their surveys to be more inclusive.

There were too few for quantitative research — only 14 — but Rich asked if they would sit down for an hour and talk about their experiences. Eleven agreed.

The result is a slim, 11-page paper that hints at a world of things we don’t yet know about transgender gay and bisexual men. We do know they form a large part of the trans population; nearly two thirds of trans men say they are not straight. We also know trans MSM participate in the same rich world of sexuality as other men who have sex with men — from dating apps to anonymous sex to sex work and a broad range of sexual behaviour.

We don’t know much about trans MSM risk for HIV; estimates range from much less than cisgender gay and bi men to somewhat more. We also don’t know much about how a combination of stigma, invisibility and limited healthcare options may be affecting trans men’s health.

Rich is cautious about drawing any broad conclusions from her study. Not only is it a tiny sample, but the men she spoke to are also mostly urban, white and educated. This study was less about answering questions, and more about figuring out which questions to ask.

A few themes, though, emerge clearly. One is that trans MSM often find themselves falling through the cracks when it comes to sexual health. Doctors are increasingly aware of how to talk to gay men, but don’t always see trans gay men as “real” MSM. They assume trans men are heterosexual, or fail to bring up sexual health altogether.

Some doctors give trans men information on PrEP — a preventative anti-HIV medication that can drastically reduce the risk of contracting HIV if taken every day — based on studies on cisgender men, without checking to see if different anatomy requires different doses. When trans men come in for HIV tests, they are sometimes urged to get pap smears instead.

“We come in with specific issues we want to talk about in a health care consult, and sometimes once people discover we’re trans they’ll want to do a pregnancy test or something,” says Kai Scott, a trans inclusivity consultant who collaborated on the study with Rich. “And we’re not there for that. They’re giving us things we don’t want, and not telling us the things we do need to know.”

Sam Larkham, a trans man who organizes sexual health clinics across Metro Vancouver with the Health Initiative for Men (HIM), says he was once referred by his doctor to a trans health care clinic that had been closed for years. Experiences like that make him think the best path for trans MSM is to rely on queer-focused health care providers like HIM.

“It would be ideal if it were the whole medical system, but that’s impossible,” Larkham says. “I think we have to look at what we can do, and that’s have specific places where we have nurses who are well trained to handle trans MSM. I think that’s the more doable thing. I would love to have every clinic be culturally competent, but that’s not the reality and never will be.”

Scott is more sanguine. He points to Trans Care BC, a provincial health program that has pushed for more education for doctors. Education needs to happen on both fronts, Scott says, among MSM organizations and in the health care system at large.

Lauren Goldman is a nurse educator for Trans Care BC. Since she was hired last fall, she’s been giving workshops to healthcare providers on how to treat trans patients. For now, though, the workshops are aimed at small groups of sexual health professionals, such as at the BC Centre for Disease Control or HIM. Goldman wants the program to expand to include everyone.

“We know trans patients are accessing care through a number of places all across the province,” she says. “We want everyone to have access to this information as soon as possible.”

Goldman says Trans Care is designing an online course that could bring trans cultural competency to primary care doctors everywhere as part of mandatory continuing education. Trans Care has also designed a primary care “toolkit” for doctors, and is in talks with UBC’s medical school about including trans-focused sexual health education for doctors in training.

Without specialized knowledge, Goldman says, there’s a lot doctors can miss. Testosterone can make vaginal tissue more sensitive and inflexible, for example, meaning trans men might have special difficulties with genital sex. Bacterial vaginosis is more common, and the usual antibiotics given to cis women may not solve the problem. Vaginal and rectal tissue may need different doses of PrEP to be effective.

And, most importantly, doctors need trans patients to know they will be heard.

“We need to be providing really obvious cues that show people that our services are trans inclusive,” Goldman says. “Including how we design our services, how we market our services, how we educate our clinicians, what signs we hang up, letting people know that our clinicians have a greater understanding of gender diversity.”

While Goldman is educating doctors, the trans men Rich studied were already very well educated about their own sexual health. They told Rich about careful risk assessments they make around sex, sharing information with other men, and advocating for STI screening to their reluctant doctors.

One man described slipping in HIV tests while getting regular testosterone-level screening: “Yeah, oh, I’m already getting blood drawn. I probably need to get tested, let’s just draw two more vials for HIV and syphilis.”

It’s not surprising that many trans men are so health-conscious, Scott says. “We’ve had to be champions of our own bodies for a while, and so that ethos carries through when it comes to health information.”

But it would be a mistake to overstate how safe trans MSM are, he adds. For one, the urban, white and well-educated men in Rich’s study may be more likely to have access to resources and care than less wealthy or more rural trans people. Also, the very reason trans MSM seem so safe might be because they aren’t getting the opportunities for sex they want.

“To some extent, we’re still on the sidelines,” Scott says. “I don’t think that systemic rejection should be the means of HIV prevention for trans and nonbinary people. We’re dealing with a lot of rejection, and so I don’t think we’ve really had the opportunity to be exposed to that risk.”

The theme of rejection is echoed frequently by the study subjects.

“I remember meeting this one guy at a friend’s party and we were flirting the whole time,” one participant recounted. “He was like, ‘Oh we should totally go for a beer’ and so we connected and then I told him I was trans and he was like, ‘Oh I’m not looking for anything.’”

“Cis men often shut down immediately, out of a sort of fear of the unknown, and being unaware of what can and can’t happen,” Scott says. “They can assume all trans guys are bottoms, which isn’t true.”

Constant rejection can wear trans men down, Larkham says. Not only does it damage mental health, but constant rejection can weaken trans men’s resolve to negotiate sexual safety.

Many trans men, the study notes, rely on online hookup sites, where they can be upfront about being trans, and avoid rejection by anyone who isn’t interested.

The burden of rejection is one reason trans MSM need better mental health services too, Larkham says. Too many men show up to sexual health clinics after being exposed to sexual risks. Mental health support, he thinks, could reach people earlier.

But again, Scott strikes a positive note. “It’s a source of celebration to me that despite huge barriers we’re still having the sex that we want,” he says.

In the end, the clearest message to emerge from Rich’s study is that there’s a lot more to learn. She hopes to get more answers from the next stage of the Momentum study, which will recruit a larger sample of MSM from across Canada. That study, she hopes, will be large enough to deliver the kind of precise, quantitative answers that this one couldn’t.

Scott is also eager to move forward.

“There’s so much you want to pack in and so much you want to report on,” he says. “There’s such a dire need to research these issues. People are really hurting, and I really feel that. But you’ve got to take it one step at a time.”

Complete Article HERE!

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LGBTQ definitions every good ally should know

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By Alia E. Dastagir

Millions of Americans identify as LGBTQ, and like any group, they have their own language to talk about both who they are and the challenges they face in a society that doesn’t fully accept or protect them.

If you want to be an ally, these terms might help — but be aware that many have been used derogatorily by straight, white, cisgender (defined below!) people, and were reclaimed over time by the LGBTQ community.

This list is by no means exhaustive, and some of these terms — because they are so personal — likely mean slightly different things to different people. If you’re puzzled by a term and feel like you can ask someone you love in the LGBTQ community to help you make sense of it, do it. But also be careful not to put the burden of your education on other people when there’s a whole wide world of resources out there.

Let’s get started

LGBTQ: The acronym for “lesbian, gay, bisexual, transgender and queer.” Some people also use the Q to stand for “questioning,” meaning people who are figuring out their sexual orientation or gender identity. You may also see LGBT+, LGBT*, LGBTx, or LGBTQIA. I stands for intersex and A for asexual/aromantic/agender. The “A” has also been used by some to refer to “ally.”

Speaking of intersex: Born with sex characteristics such as genitals or chromosomes that do not fit the typical definitions of male or female. About 1.7% of the population is intersex, according to the United Nations.

Sex: The biological differences between male and female.

Gender: The societal constructions we assign to male and female. When you hear someone say “gender stereotypes,” they’re referring to the ways we expect men/boys and women/girls to act and behave.

Queer: Originally used as a pejorative slur, queer has now become an umbrella term to describe the myriad ways people reject binary categories of gender and sexual orientation to express who they are. People who identify as queer embrace identities and sexual orientations outside of mainstream heterosexual and gender norms.

Sexual orientation

Sexual orientation: How a person characterizes their sexuality. “There are three distinct components of sexual orientation,” said Ryan Watson, a professor of Human Development & Family Studies at the University of Connecticut. “It’s comprised of identity (I’m gay), behavior (I have sex with the same gender) and attraction (I’m sexually attracted to the same gender), and all three might not line up for all people.” (Don’t say “sexual preference,” which implies it’s a choice and easily changed.)

Gay: A sexual orientation that describes a person who is emotionally or sexually attracted to people of their own gender; commonly used to describe men.

Lesbian: A woman who is emotionally or sexually attracted to other women.

Bisexual: A person who is emotionally or sexually attracted to more than one sex or gender.

Pansexual: A person who can be attracted to all different kinds of people, regardless of their biological sex or gender identity. Miley Cyrus opened up last year about identifying as pansexual.

Asexual: A person who experiences no sexual attraction to other people.

​Demisexual: Someone who doesn’t develop sexual attraction to anyone until they have a strong emotional connection.

Same-gender loving: A term some in the African-American community use instead of lesbian, gay or bisexual to express sexual attraction to people of the same gender.

Aromantic: A person who experiences little or no romantic attraction to others.

Gender identity and expression

Gender identity: One’s concept of self as male, female or neither (see “genderqueer”). A person’s gender identity may not align with their sex at birth; not the same as sexual orientation.

Gender role: The social behaviors that culture assigns to each sex. Examples: Girls play with dolls, boys play with trucks; women are nurturing, men are stoic.

Gender expression: How we express our gender identity. It can refer to our hair, the clothes we wear, the way we speak. It’s all the ways we do and don’t conform to the socially defined behaviors of masculine or feminine.​

Transgender: A person whose gender identity differs from the sex they were assigned at birth.

Cisgender: A person whose gender identity aligns with the sex they were assigned at birth.

Binary: The concept of dividing sex or gender into two clear categories. Sex is male or female, gender is masculine or feminine.

Non-binary: Someone who doesn’t identify exclusively as female/male.

Genderqueer: People who reject static, conventional categories of gender and embrace fluid ideas of gender (and often sexual orientation). They are people whose gender identity can be both male and female, neither male nor female, or a combination of male and female.

Agender: Someone who doesn’t identify as any particular gender.

Gender-expansive: An umbrella term used to refer to people, often times youth, who don’t identify with traditional gender roles.

Gender fluid: Not identifying with a single, fixed gender. A person whose gender identity may shift.

*(Note: While the previous six terms may sound similar, subtle differences between them mean they can’t always be used interchangeably).*

Gender non-conforming: People who don’t conform to traditional expectations of their gender.

Transsexual: A person whose gender identity does not align with the sex they were assigned at birth, and who takes medical steps such as sex reassignment surgery or hormone therapy to change their body to match their gender.

Transvestite: A person who dresses in clothing generally identified with the opposite gender/sex.

Trans: The overarching umbrella term for various kinds of gender identifies in the trans community.

Drag kings & drag queens: People, some who are straight and cisgender, who perform either masculinity or femininity as a form of art. It’s not about gender identity.

Bottom surgery: A colloquial way of referring to gender affirming genital surgery.

Top surgery: Colloquial way of describing gender affirming surgery on the chest.

Binding: Flattening your breasts, sometimes to appear more masculine.

Androgynous: A person who has both masculine and feminine characteristics, which sometimes means you can’t easily distinguish that person’s gender. It can also refer to someone who appears female — like Orange is the New Black’s Ruby Rose, for example — but who adopts a style that is generally considered masculine.

‘Out’ vs. ‘closeted’

Coming out: The complicated, multi-layered, ongoing process by which one discovers and accepts one’s own sexuality and gender identity. One of the most famous coming outs was Ellen DeGeneres, with “Yep, I’m gay” on the cover of Time magazine 20 years ago. Former President Obama awarded DeGeneres a Presidential Medal of Freedom in 2016, saying that her coming out in 1997 was an important step for the country.

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Outing: Publicly revealing a person’s sexual orientation or gender identity when they’ve personally chosen to keep it private.

Living openly: An LGBTQ people who is comfortable being out about their sexual orientation or gender identity.

Closeted: An LGBTQ person who will not or cannot disclose their sex, sexual orientation or gender identity to the wider world.

Passing: A person who is recognized as the gender they identify with.

Down low: A term often used by African American men to refer to men who identify as heterosexual but have sex with men.

Attitudes

Ally: A person who is not LGBTQ but uses their privilege to support LGBTQ people and promote equality. Allies “stand up and speak out even when the people they’re allying for aren’t there,” said Robin McHaelen, founder and executive director of True Colors, a non-profit that provides support for LGBTQ youth and their families. In other words, not just at pride parades.

Sex positive: An attitude that views sexual expression and sexual pleasure, if it’s healthy and consensual, as a good thing.

Heterosexual privilege: Refers to the societal advantages that heterosexuals get which LGBTQ people don’t. If you’re a straight family that moves to a new neighborhood, for example, you probably don’t have to worry about whether your neighbors will accept you.

Heteronormativity: A cultural bias that considers heterosexuality (being straight) the norm. When you first meet someone, do you automatically assume they’re straight? That’s heteronormativity.

Heterosexism: A system of oppression that considers heterosexuality the norm and discriminates against people who display non-heterosexual behaviors and identities.

Cissexism: A system of oppression that says there are only two genders, which are considered the norm, and that everyone’s gender aligns with their sex at birth.

Homophobia: Discrimination, prejudice, fear or hatred toward people who are attracted to members of the same sex.

Biphobia: Discrimination, prejudice, fear or hatred toward bisexual people.

Transphobia: Prejudice toward trans people.

Transmisogyny: A blend of transphobia and misogyny, which manifests as discrimination against “trans women and trans and gender non-conforming people on the feminine end of the gender spectrum.”

TERF: The acronym for “trans exclusionary radical feminists,” referring to feminists who are transphobic.

Transfeminism: Defined as “a movement by and for trans women who view their liberation to be intrinsically linked to the liberation of all women and beyond.” It’s a form of feminism that includes all self-identified women, regardless of assigned sex, and challenges cisgender privilege. A central tenet is that individuals have the right to define who they are.

Intersectionality: The understanding of how a person’s overlapping identities — including race, class, ethnicity, religion, sexual orientation and disability status — impact the way they experience oppression and discrimination.

Complete Article HERE!

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Explaining Transgender to Our Kids

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A month or so ago, my family had the awesome opportunity to meet Youtube vlogger, Miles McKenna. It was during this meeting that we filmed a cool episode for Miles’ new show Hella Gay on Fullscreen.

However, before Miles showed up at our house for the taping of the show, we had to sit down our kids and have a conversation because Miles is transgender. We explained to our kids as best we could about what transgender means and how Miles is trans. We then showed them wonderful Youtube videos of Miles coming out as trans and explaining his feelings and experience with his identity. From there, we let our kids watch silly videos that Miles has done to allow them to get to know Miles.

The results were fantastic. Our kids loved Miles and there was no question about Miles’ gender after that. As kids, they accepted who Miles is.

We live in a very diverse world these days, and it’s becoming increasingly clear as parents that we have a duty to prepare our kids and educate them on different things such as what each letter in the LGBTQ+ umbrella stands for. You don’t have to do it all at once and it doesn’t have to be anything extremely serious. Just take a look at our video below to see how great and easy the conversation was about “transgender” and feel free to copy it with your own kids.

And don’t forget to check us out on the newest episode of Hella Gay, here.

Complete Article HERE!

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The story of Magnus Hirschfeld, the ‘Einstein of sex’

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Decades before Alfred Kinsey developed his scale for human sexuality, there was Magnus Hirschfeld — a doctor who dedicated his career to proving that homosexuality was natural.


A party at the Institute for Sexual Science is shown here. Magnus Hirschfeld (second from right) is the one with the moustache and glasses. His partner Karl Giese is holding his hand.

By Julia Franz

Hirschfeld’s reasoning was simple: In turn of the 20th century Germany, where he lived, a law called Paragraph 175 made so-called “unnatural fornication” between men punishable by prison time.

“Magnus was gay himself,” says Undiscovered podcast co-host Elah Feder. “He was both a scientist and an activist, and he was really hoping that his science would lead to greater acceptance of gay and lesbian people.”

Hirschfeld founded what’s considered to be the first gay rights organization and established the Institute for Sexual Science in Berlin. He also gained international renown for his radical research on the biology of sexual orientation. “He was, in the 1930s, touring the world lecturing about sexuality in China and India,” says co-host Annie Minoff. “The American press actually called him the ‘Einstein of sex.’”

But as Minoff and Feder explore in a recent episode of Undiscovered, Hirschfeld’s legacy didn’t turn out quite as he’d hoped.

“Magnus was using the science at his disposal, right?” Minoff says. “So now, we might talk about genetics or even epigenetics, but back in his day, scientists could see chromosomes under the microscope, but they still weren’t sure if they had anything to do with heredity.”

“So, Magnus was really all about documenting and recording things like physical traits or behavioral traits, trying to see what gays and lesbians might have in common or might be different than the rest of the population.”

Today, some of Hirschfeld’s research comes across as antiquated, even a bit zany. In one excerpt from his book, “The Homosexuality of Men and Women,” Hirschfeld debunks an apparently long-held stereotype that gay men can’t whistle.

“This does not agree with the results of our statistics,” he wrote, explaining that in a sample of 500 gay men, 77 percent could whistle, although “only a few could truly whistle well.”

“But he found that among lesbians, the whistling arts were very strong, which was nice to hear,” Feder adds.

Other aspects of Hirschfeld’s science have better weathered the tests of time. “So, for example, he was interested in whether homosexuality ran in families,” Feder says. “You know — was it a heritable trait?”

“Or, you might remember a few years ago, there were a bunch of studies looking at the correlation between finger length ratios and sexual orientation. They seemed to find a connection in women. And he did stuff like that. He was looking at hip-to-shoulder ratios — pretty pioneering sex research.”

In 1919, Hirschfeld opened his Institute for Sexual Science, a big villa in Berlin’s Tiergarten. “They had medical examination rooms, they had a library, they had a sex museum that was apparently a big tourist attraction,” Feder says.

And, as Yonsei University history professor Robert Beachy explains, the institute also offered sex education to Germans who were queasy about publicly seeking advice.

“They had a little box at the edge of the property, and people could anonymously insert slips of paper with questions about sex or any sort of sexual issue that they had,” he says. “And then people were invited in, and these different slips of paper would be read out loud and then responded to.”

“There were questions about things like, I don’t know, [about] premature ejaculation and how effective it was to use condoms for preventing pregnancy. You know, just lots of relatively mundane questions. But it was supposed to be a public service.”

But if Hirschfeld hoped that greater scientific understanding could change Germany’s discriminatory law, Feder says things didn’t quite turn out that way in his lifetime. (Paragraph 175 wasn’t struck down until 1994.)

“It’s a nice idea,” she says, “but as we end up seeing in Magnus’ story, you can do science, you can hope that it’s going to be used in one way, and it can work out very differently.”

“And his story ultimately is a pretty tragic one.”

Complete Article HERE!

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The Ingredients of a Healthy, Non-Sexual Intimate Relationship

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It takes one part communication and one part vulnerability.

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Sex is everywhere these days. Unfortunately, we often let our relationships get clouded by sexual intimacy. Sometimes being physically intimate with another person blurs our vision of how we truly feel about that individual.

Believe it or not, but you can actually make your partner want you even more in a relationship by abstaining from sex. So what does a healthy, intimate relationship, without sex look like? I have just the recipe for you.

Honest conversations

Being able to have honest, open conversations, while maintaining eye contact and enjoying what the other person has to say is essential in creating and maintaining relationship intimacy. Once the beginning stages of that overpowering attractiveness dies down, you want to be able to carry on a conversation with the person you are with. Being vulnerable in your conversations will create a deeper intimacy as you learn to trust one another. Opening up and sharing your hopes, fears, and dreams helps intimacy develop and grow as both parties learn to trust one another more and more.

Enjoying each other’s company

If you can be comfortable together in sweatpants watching TV, or going to a black tie work function, you’re on the right track to a healthy, intimate relationship. It doesn’t really matter what you are doing together if you just enjoy being with one another. Focused one-on-one attention is a key ingredient in an intimate relationship and it must be fostered. Intimate moments can occur as you spend time together, having fun, talking, and building your relationship, but they do require intentionality to happen.

Both parties are themselves

Truly knowing the person you are with is one of the pillars in building intimacy in a relationship. While being able to be yourself will also be an important factor in your experiencing intimacy in your relationship. When you like the other person for who they are, and you feel loved and accepted just as you are, you are on the path to true intimacy.

Being a safe space

Being a comfort for your partner, whether they need to vent from a bad day or just want someone to talk to, is a sign of intimacy. When you are the one they seek out to provide that comfort, they know you are a safe place for them. You can increase intimacy even more by learning how to best comfort your partner in these situations. Learn how they want you to respond when they are upset, frustrated, or sad–listen, advise, console, hold …

Share what you like about one another

Providing positive affirmation and telling your partner specific things you like or love about them builds intimacy. It’s easy to assume that your partner knows why you like or love them, but sharing these specifics helps build closeness. Tell them you love their sense of humor or how much they care about family values. Through these interactions, we can grow a more secure emotional connection.

Think about your expectations about what intimacy in a healthy relationship looks like. Intimacy in a relationship means a deep closeness, affection, and acceptance. It’s essentially feeling comfortable and safe being completely vulnerable and real.

Make sure you don’t have a twisted view of intimacy as just being constant deep talks or long walks on the beach–because a healthy intimate relationship is so much more. A true healthy relationship is being with someone you care greatly for and are able to have open, honest communication about anything.

Complete Article HERE!

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