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American Doctors Report Lacking Training in Transgender-Specific Care.

Most primary care physicians in the U.S. are willing to provide routine care to transgender individuals, but that doesn’t mean they are well prepared to do so, a small study suggests.

Overall, 86 percent of doctors who responded were willing to provide routine care to transgender patients and 79 percent were willing to give Pap tests to transgender men to screen for cervical cancer, according to the results reported in Annals of Family Medicine.

Many physicians, however, reported a lack of familiarity with transgender transition care guidelines, lack of training in transgender-specific care, lack of exposure to transgender patients, and lack of knowledge about transgender patients among office staff, medical assistants or nursing staff.

These barriers suggest that willingness is not necessarily equivalent to competence, study leader Deirdre Shires of Michigan State University in East Lansing told Reuters Health by email.

“A number of studies have shown that transgender people often have negative experiences when they try to access healthcare services, including experiencing bias, harassment and even being denied care altogether,” Shires said. “What we realized is that no one had really gotten the perspective of providers to find out why this was happening.

Shires’ team sent surveys to 308 internal medicine and family practice doctors in a large Midwest health system and had evaluable responses from 140 of them. Doctors who had met transgender people were more willing to provide Pap tests to transgender men, the researchers found. And older doctors in the survey were less willing than their younger peers to provide routine care to transgender patients.

“Medical knowledge and clinical experience may be less important than personally feeling comfortable with transgender people,” Shires said. “Therefore, it is important for medical education to address not only clinical knowledge but also personal biases and attitudes as well.”

John Ayers, a public health researcher at the University of California, San Diego, agrees. “A lack of training was not associated with a willingness to provide care, instead the more important factor is having experience with transgender people,” said Ayers, who was not involved in the study.

“During the 80’s and early 90’s some doctors were unwilling to care for AIDS patients, but as familiarity with HIV grew this problem abated.” The study was restricted to only one medical system, so the findings might not be widely applicable, the researchers point out.

Another limitation, notes Dr. Janelle Downing of the University of South Carolina in Columbia, who was not involved in the study, is that so many of the doctors invited to participate declined to do so.

For that reason, the responses are “likely an overreport of willingness to provide care,” because clinicians who felt uncomfortable with transgender populations may have declined to respond to the survey, Downing said.

“As more individuals are identifying as a gender other than that assigned to them at birth, younger providers are more likely to know transgender individuals and therefore more comfortable providing care for them,” Dr. Carl Streed, Jr. of the Center for Transgender Medicine and Surgery at the Boston Medical Center, suggested in an email. Streed, who was not involved in the study, said, “Given the significant lack of training in sexual and gender minority health in medical schools, it is no surprise that providers are unfamiliar with transgender health issues and primary care needs.”

“This is also rooted historically in the shuttering of transgender clinics across the United States in the late 1970’s and 1980’s,” Streed added. A 2016 study by The Williams Institute at the UCLA School of Law estimated that 0.6 percent of American adults, or 1.4 million individuals, identify as transgender.

A lot of people wonder what makes people transgender, the same way we ask what makes people gay, or what causes autism.

The consensus scientific answer on all three is unsatisfyingly vague; there is no single reason, and what we can see appears to be a combination of multiple factors involving genetics, epigenetics, oligogenetics, and potentially some environmental factors.

There is broad consensus that it’s not caused by bad parenting, or what your mom ate when she was pregnant, or not going to church enough.

However, this isn’t enough for random (and not so random) cranks to propose absolutely bonkers reasons for why people are transgender. Because the public and the media knows so little about transgender people in general, some of these are getting more play than they deserve.

Related: Feminists are blaming trans women for ‘forcibly transing’ crocodiles

So, in no particular order, here are 15 of the nuttiest suggested reasons for why people are transgender, and why they deserve to be laughed at rather than taken seriously for a nanosecond.

Stupid Idea #1: The internet makes you transgender

Remember how in the 80’s and 90’s homophobes thought that being around gay people would turn you gay? Same thing… except now it’s virtual! Because the internet is full of transgender predators recruiting and grooming children to become one of us. This got popular after one “study” showed that trans youth interacted with other trans youth online.  Shocking!

Stupid Idea #2:  Seeing Chaz Bono on TV makes people transgender

Remember Chaz being on “Dancing with the Stars” a few years back? It seemed like all the crazies crawled out of the woodwork to bemoan how Chaz would normalize being transgender and make people think being transgender was “cool” and give it a try because Chaz. And dancing.

Stupid Idea #3:  Anime makes people decide to be transgender

Dr. Ray Blanchard has a spent a lifetime peddling weird ideas about the transgender community that never really caught on, except with other people who really hate transgender people as well.  Now that he’s no longer a practicing clinician or researcher the primary outlet for his theories is… Twitter. Just like our President, he’s another very stable genius.

Blanchard’s latest hypothesis is that watching anime somehow makes people transgender. Because some transgender people like anime, and people who are treated like outsiders are never drawn to cultural touchstones for outsiders. By this logic, Star Trek: The Next Generation probably made all the Gen-Xers trans people.

Stupid Idea #4: Goth culture disappeared because they all turned transgender

Another one of Blanchard’s Twitter ramblings claims that Goth culture disappeared because they all turned trans…and certainly not because they got jobs, got married, had kids, and basically did all the things that people do when they get older.

Stupid Idea #5: A world that accepts transgender people is worse than one run by Mike Pence

It takes a rather special sort of feminist to align yourself with the religious right, because you’re more afraid of the consequences of transgender people being accepted than you are of people like Mike Pence being in a position to do what they want with women’s bodies and to enforce gender norms via religious opprobrium.

But, TERFs (Trans-Exclusionary Radical Feminists) are so very special: they are absolutely convinced transgender people will end humanity, and that after finishing transgender people off, the religious right definitely won’t have enough power or desire to do anything that bad to women or LGB people. Basically, in their minds, it’s worth the risk of turning the US into the Republic of Gilead just to have the peace of mind that there are no transgender people sharing a bathroom with you.

What the !@#$ kind of feminism is that?

Stupid Idea #6: People transition to access female privilege

The icky little world of Men’s Rights Advocates, Incels, and Jordan Peterson fans produces some bizarre, irrational, and dangerous ideas. Among the more bizarre is that transgender women are just “beta males” who transition in order to gain access to “female privilege.”

After the Brett Kavanaugh hearings, it should be obvious to everyone how much “privilege” that entails.

Stupid Idea #7: Demons make people transgender

Back in the day in 2017, blaming “transgenderism” on Satan and demons was the province of snake handling churches in Arkansas, preachers who say God commanded them to get another private jet, and Trump administration judicial nominees. We can thank Dr. Ray Blanchard for expanding the audience a bit by tweeting that exorcisms and detransition sound like pretty much the same thing to him.

Stupid Idea #8: Peer pressure makes you transgender

Worst sales pitch ever: “Hey, since I came out as trans I’ve been forced to hold my pee until I get life threatening bladder infections, beaten, sexually assaulted, insulted by teachers and the administration, and banned from participating in school athletics. The Secretary of Education is working hard to ensure that everyone has a religious right to discriminate against me as well. You should definitely try experimenting with gender too!”

This is why 75% of transgender students feel unsafe at school.

Next dumb idea please.

Stupid Idea #9: Jewish billionaires turn you transgender

The next idiotic supposition combines anti-Semitism with globalist conspiracy theories. Namely, that there is a secret plot to destroy the world with gender ideology using Jewish lucre from billionaires George Soros, Jennifer Pritzker, and Martine Rothblatt. Their evidence? Um… some of them give to Planned Parenthood, liberal universities, and the ACLU.

Yeah. It’s just that stupid and offensive.

Stupid Idea #10: “Big pharma” is making everyone transgender

Normally, people who engage in “Big Pharma” conspiracy theories (e.g. they’re hiding the cure for cancer!) aren’t allowed in the building, much less given the microphone in a debate over public health policy. Yet… here we are.

This is dumb on so many levels. First, in the US, how do you make money off a tiny sliver of the population that doesn’t have any money to begin with? Second, estrogen is generic and ridiculously cheap already. Finally, in everywhere else in the world but the US, national health services already provide care and profits are relatively low.

These are corporations. Why would they put so much money into something with so little profit in it?

Stupid idea #11: Tofu will turn you transgender

Another one brought to you by the Jordan Peterson crowd that spends their days navel gazing about where “beta males” come from and how women ruin everything.  The logic (if you could call it that): soybeans have minute amounts of phyto-estrogens, and therefore eating food with soy in it feminizes you through the magic of super science.

Stupid Idea #12: Vaccines make people transgender

Here’s one from the anti-vaxxer crowd (because you just knew it was coming).  Their hypothesis is that because vaccines contain DNA and RNA, they mutate human sex chromosomes, replacing X’s with Y’s and vice versa. In terms of plausible origin stories, this is on a par with being bitten by a radioactive spider (or transgender person).

Stupid Idea #13: Chemtrails are a government plot to make people transgender

Because everything eventually devolves into chemtrails. It’s like the Godwin’s Law of conspiracy theories.

Stupid Idea #14: Liberal activist therapists railroad people into being transgender

I’m not sure what sort of therapist tells their clients to do things that will make their lives exponentially more difficult and complicated.

Stupid Idea #15: People are transitioning because it’s a fad or a social contagion

If you hadn’t noticed, the Trump administration is running the show. This theory makes as much sense as converting to Judaism in 1930’s Germany because you saw a lot about it in the news. (Plus, the one study purporting to show this is a hot anti-transgender mess of deliberately biased samples, deceptive questions, and unsupported conclusions.)

Two decades ago, a black trans woman by the name of Rita Hester was stabbed multiple times in her first-floor apartment in Boston, Massachusetts. The police arrived at her apartment to find her in cardiac arrest. She was pronounced dead after she was transported to a local hospital.

Two decades later, Rita Hester’s death has yet to be solved.

At the time, I was operating an online forum for transgender people on America Online. The web was only starting to gain popularity, and many people on the internet still used commercial services like AOL and CompuServe.

Talking with others in the forum’s chat room, The Gazebo, I brought up the Rita Hester murder. As we discussed the death, I noted how similar Hester’s death was to another anti-transgender murder that took place three years prior, that of Chanelle Pickett.

It’s not to say that these two deaths were actually linked, as the murderer of Pickett, William Palmer, was in jail at the time of Hester’s murder. Nevertheless, I noted that both were trans women of color, both had gone out to a bar before heading home, both were in Boston, and both were killed near the end of November.

The others in the room — including two members from Boston — had never heard of Channel Pickett.

This shocked me: while it had been three years since Pickett’s murder, the trial had only wrapped up less than a year and a half prior, and had received a fair amount of local media coverage.

George Santayana, a philosopher and writer, once said, “Those who cannot remember the past are condemned to repeat it.”

In that moment, my own community was living that quote: we were forgetting the people we had lost due to anti-transgender violence, and opening the door for future death.

A week or so later, I released a website called Remembering Our Dead. The original site chronicled roughly 30 cases of anti-transgender violence over roughly a decade.

This site led myself and Penni Ashe Matz, a Boston-based trans activist, to hold an event in our cities one year after Hester’s murder. That was the first Transgender Day of Remembrance.

The project started because our deaths were forgotten. Today, it is a time to remember those we’ve lost, and bring attention to the issue of anti-transgender violence.

It is a time to reflect and mourn. It’s a sacred day for those we have lost, and for the resilience of a community that no longer forgets.

On Sunday morning, the New York Times published a report detailing a memo from the Trump administration that would effectively erase federal recognition of trans and nonbinary gender identities. The Department of Health and Human Services would make changes to Title IX definitions of gender, only recognizing male and female sex, which could be DNA tested to determine. It would also define gender as “unchangeable.”>>

The effects of such a policy would be devastating to over 1 million Americans — access to health care, housing, and other public services would be limited or withheld completely. This is not the Trump’s administration first attack on transgender Americans. Trump himself once tweeted out a proposal to not allow trans Americans to serve in the military.>>

In response to the latest proposal, trans and nonbinary people began to share photos of themselves under the hashtag #WontBeErased, as part of the larger response to Trump’s devastating policy proposal. Below are words and photos shared by the transgender and nonbinary community, and organizations who advocate for their human rights.>>

Since Trump took office, his administration has systematically eroded legal protections for transgender Americans.>>

Despite the fact that transgender people make up just three percent of the population, according to a 2017 GLAAD study, there is a concerted effort across the United States to limit our access to health care and civic spaces—an effort that has been fomenting prejudice on the state level for years, and is now being undertaken by the top levels of American government.>>

The New York Times recently exposed the Trump administration’s secret initiative that, if enacted, would definitively exclude trans protections from existent Constitutional civil rights statutes. The plan, according to the Times, is spearheaded by the Department of Health and Human Services and seeks to collaborate with the departments of Education, Justice, and Labor in a joint definition of gender as “a person’s status as male or female based on immutable biological traits identifiable by or before birth.”>>

This is essentially the bizarro inverse of what the Obama administration did in 2016, when the U.S. Department of Justice and the U.S. Department of Education issued an order clarifying that the term “sex” in constitutional anti-discrimination laws covers transgender people. Obama’s decision to formally recognize trans people’s rights was based on court precedent that had already ruled in this manner. Though Obama’s directives didn’t change the law, they clarified how it had been interpreted, and thus sent a message across the nation that trans people are a constitutionally protected minority.>>

That action enraged the right, which, in some states, levied lawsuits against school districts that have allowed trans students to use properly gendered school facilities, and launched multi-state-backed national lawsuits on behalf of state-funded religious health care professionals who objected to providing transgender care to patients.

All of that was already happening under Obama; it didn’t take Trump to spark a conservative backlash to the transgender civil rights movement. The Trump administration has simply picked up this mantle and brought it to a new extreme. Since he took office, Trump has attempted to undo his predecessor's work—doing away with Obama’s pro-trans executive orders, attacking medical care, trying to ban trans people from the military, and, now, to revoke the constitutional protections of all transgender Americans. By signaling that the federal government has a trans-exclusionary interpretation of constitutional laws like Title IX and Title VII of the 1964 Civil Rights Act, the Trump administration is creating a cultural environment that may make courts feel more confident in ruling against transgender people.

To be clear: Courts have not been ruling against us. They have consistently ruled in line with the Obama-era guidances around these laws, which has created a large body of legal precedent confirming that transgender people are alreadyprotected under the law. This is an essential distinction to understand, because it is easy to assume trans people are not protected by anti-discrimination laws. We are.>>

While there are social institutions in which trans people still desperately require laws protecting against discrimination, such as housing, existent constitutional laws that protect people on the basis of sex also protect transgender individuals on the basis of sex. >>

We don’t need constitutional amendments to protect trans people from discrimination in school or at work—we already have it. Republicans simply wish to reinterpret these existing protections in a way that would exclude trans people. This seems particularly odd, since, as I said earlier, we’re such a small minority. Although there are so few of us relatively, transgender politics are an easy target for the right to label extreme, making us a useful battering ram to rally “normal” Americans behind—to the right, transgender people are more a symbol of unsettling change than they are people.>>

There are different tiers of legal precedent which guide the judiciary in interpreting law, and while the current areas of precedent for trans protections are legitimate, there has not been a ruling on this issue at the nation’s highest judiciary, the Supreme Court. That’s partially why the Trump administration’s actions are so alarming: Were a transgender discrimination case related to Title IX or Title VII to reach the Republican-majority Supreme Court, a ruling therecould create the strongest degree of precedent yet: A ruling against trans rights at the highest level would set legal precedent that would subsequently inform all future rulings about transgender people seeking protection under these laws.>>

That’s pretty fucking insane, and utterly unsurprising—with respect to trans rights and so many other issues, Trump’s election was an alarming disruption to the promise of social progress under President Obama. In 2012, Joe Biden, then the Vice President, stated that the fight for transgender equality was the “civil rights movement of our time.” Obama extended protections including an executive order on behalf of the rights and welfare of this vastly underrepresented community, and accomplished, by far, more for trans Americans than any president in history.>>

Of course, transgender people have long lived in the United States in darkness, surviving the 20th century, when it was widely illegal to cross-dress and, for most people, trans medical care was virtually a fiction. Our communities have fought to survive through the AIDs plague in the 1980s (which continues to disproportionately impact trans women of color, who are at an exponentially higher risk of HIV than other communities); extreme violence at the hands of men, with national murders that increase year after year—because we are finally looking at this problem, its true scope is being progressively unveiled; absolute erasure throughout the nation, from the home (where our families have long rejected us), to civic spaces where our presence in public restrooms is restricted, to health care, where we strive for medical treatment despite having long been castigated as mentally ill, and to the church, which has widely spread propaganda against transgender people.>>

Trump had little to say about trans people on the campaign trail, but his racist, xenophobic, sexist, ableist, and otherwise broadly discriminatory talking points at political rallies made it clear that he was a voice for id-level anxieties reflecting some Americans’ worst natures. It became clear that Trump, the odd-looking reality television host and master of none could collapse the tenuous levees of social justice that transgender people and their allies have built to prevent social forces of hatred and ignorance from flooding in and submerging us completely, again.>>

When Trump was elected in 2016, I wrote about the threat that his Presidency poses to transgender Americans. In 2017, I wrote in reflection about a year for trans people under Trump, highlighting the transgender community’s resilience and resistance against a political mad dog propelled by his own pursuit of power—a person too stupid or too self-motivated to mind playing puppet for true political masters. I know that resistance continues and grows in strength. Today, in the wake of Trump’s latest—and broadest—assault against our community, I am overwhelmed by the the inevitability of this cultural moment. It was clearly predicted from the start.>>

“Everyone needs to be alert,” said multiple security experts on multiple TV cable shows Wednesday, Oct. 24, after “live explosive devices” were sent to the Clintons, the Obamas, CNN, Rep. Maxine Waters and others repeatedly denounced as “enemies” by President Donald Trump at angry Republican rallies and on Twitter. The climate of fear throughout the country was so intense, the San Diego Union-Tribune building, which also houses offices of Sen. Kamala Harris, was evacuated after several “suspicious” packages were found at the entrance. Later, the UT tweeted: “San Diego police Lt. Kevin Wadhams said the packages contained: one shoe, two children’s books, one football, one empty bag of chips and one hat.”

The Los Angeles Times received a bundle of four suspicious envelopes that were scrutinized by a Hazmat team but did not require evacuation of The Times headquarters in El Segundo.

Reading off a teleprompter at a pre-planned event at the White House, Trump called the use of mail bombs “abhorrent” and “upsetting to everything we hold dear.” And then he uttered another stunner, as if the mail bomb targets bore no resemblance to his favorite enemy’s list: “In these times we have to unify. We have to come together and send one very clear strong unmistakable message; that acts or threats of political violence of any kind have no place in the United States of America.”

But for the transgender community in Los Angeles, the grip of terror that faced the nation Wednesday morning is a too-common experience. As the LA County Commission on Human Relations reported recently, there were a record number of anti-transgender crimes for the second consecutive year—94% of which were violent. Wednesday’s terrorism fear “gives a context, an idea of how trans people are terrorized every single day,” Bamby Salcedo, founder of TransLatin@ Coalition, told the Los Angeles Blade. “Terror manifests itself in many different ways through people’s actions. This is how terrorism comes to be. But we must not despair. It’s important that we hold each other with love and hope, understanding that evil minds and hearts will not terrorize our communities.”

This was also a theme at the massive #WeWillNotBeErased trans rally Monday night, Oct. 22, at City Hall. The rally was in reaction to a proposed memo from the Health and Human Services Department that a New York Times article suggested expressed based the Trump administration’s intention on “defining transgender out of existence.” The new regulation would require identifications to only list male or female, according to the person’s genitalia at birth. If adopted, the new definition of gender would essentially eliminate federal recognition of an estimated 2 million trans and gender non-conforming people in America, as well as numerous protections for women and some men.

When asked about the proposal to strip civil rights protections from transgender Americans, Trump, leaving the White House for a political rally in Houston, told reporters: “We have a lot of different concepts right now. They have a lot of different things happening with respect to transgender right now — you know that as well as I do — and we’re looking at it very seriously.” Trump added, walking away: “I’m protecting everybody, I want to protect our country.”

California Attorney General Xavier Becerra is among those pledged to protecting the LGBTQ community from Trump. “Time & again, the Trump Admin has attempted to rollback important protections for our #LGBTQ community. In response to these disgraceful actions, we have been here to defend patients, students, employees, foster parents & military servicemembers – we won’t stop now.#WontBeErased,” Becerra tweeted in response to The Times story.

Becerra, representing the state of California, joined Equality California as a plaintiff in Stockman v. Trump, one of four lawsuits that have so far successfully blocked the implementation of the Trump-Pence administration’s ban on transgender military service through a nationwide preliminary injunction.

“The Trump-Pence Administration’s heartless, coordinated attempts to erase the existence of transgender Americans illustrates just how low they’re willing to go for their radical political base,” Equality California Executive Director Rick Zbur said in a statement. “But rest assured, medicine, science and the law are all on our side — not the Administration’s — and so are Californians, a majority of whom want our government to do more — not less — to support and protect our transgender family members, friends, coworkers and neighbors….We are strong and resilient. And we will stand together to defeat the Trump-Pence Administration’s agenda of hate and fear.”

The Stockman v. Trump trial is tentatively scheduled to begin in July 2019. Meanwhile, on Oct. 22, the National Center for Lesbian Rights and GLAD filed a 72 page brief against the latest government attempt to enforce the transgender military ban by asking a DC appeals court to dissolve the preliminary injunction in Doe v. Trump. NCLR and GLAD challenged the Trump-Pence position that Sec. Mattis’ implementation plan is a “new” policy, arguing that it’s the same discriminatory policy Trump originally ordered by tweet. NCLR and GLAD will face the government on Dec. 10 to argue this issue before the D.C. Circuit Court of Appeals.

“This proposed policy is a heavy-handed attempt to strip federal legal protections from transgender people,” Shannon Minter, NCLR’s trans Legal Director, said in a statement. “It is part and parcel of this administration’s ongoing attempts to scapegoat vulnerable groups and to promote extremist policies rooted in stigma and stereotypes.”

Extremist policies and pronouncements that some believe lead to active domestic terrorism..


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