Lesbian

Trans Psychiatrist Answers – What the Public Needs to Know About Queer and Genderqueer People.

/ Jame A. Agapoff, MD, MS (she/they) / 2 Comments

Queer and genderqueer people have a long history of stigmatization and discrimination.

A little over 50 years ago, psychiatrist John E. Fryer had to where a disguise and use an alias at an APA conference to discuss being gay. He had to do this out of fear of being fired or worse, having his professional license attacked.

It would take almost another decade for homosexuality to be depathologized in the DSM of mental disorders. Up until then, homosexuality was considered a sexual disorder. Even after homosexuality was depathologized, pathological theories and treatments around homosexuality remained.  Queer children were forced to undergo inhumane forms of conversion therapy in the name of science. Now we know that being gay, queer, or homosexual is about WHO YOU LOVE. Queer identities are not sexual or socially appropriated, and they never were.

But social contagion is often the erroneous argument behind every don’t say gay bill and book ban. This concept is utterly preposterous and without any evidence, yet it still remains, and such unscientific and bigoted ideas continue to be legislated upon, negatively impacting the lives of queer people, and queer kids today.

Transgender and Gender Diverse People are equally misunderstood. While being queer is about who you love, being genderqueer is about WHO YOU ARE.

Gender diversity like homosexuality has also long been sexualized by the researchers and the greater medical community. This has led to largely debunked and poorly supported sexualized models of gender diversity such as autogynophilia.

It’s only been in the last decade that the DSM has depathologized gender identity and recognized gender diversity as inherent facet of human diversity. Despite this, genderqueer people are often called “groomers” and legislated against just for being themselves. It’s utterly appalling and sad, and as a society everyone needs to know that being trans, non-binary, or genderqueer is not sexual. It never has been.

The impact of being sexualized in media and in the medical literature has a significant impact on the psyches of trans people. Because they are forced to hide their exceptional gender qualities, they sometimes express their authentic gender through sexual fantasy or acts. Freud believed that dreams and sexual fantasies represented attempts by the unconscious to resolve a wish or conflict. The wish was repressed by the ego due to shame/guilt or because it represented something unaccepted by society (Freud, 1899; Schept, 2007). This is commonly seen in early transition but diminishes as individuals proceed in their transition and become their authentic selves.

As a psychiatrist, a transgender person, and a human being I implore all of you to open your hearts to queer and genderqueer people. All we want is to be ourselves free of discrimination. We can’t do this without you.

Be an ally. Be an upstander. And stand up against discrimination in all its forms.

The Fight for Civil Rights and Social Justice Never Ends

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Have you ever met someone who claims to support equality and civil rights but considers the current social justice struggles to be ‘Woke’ or somehow less meaningful than those of the past? For example, they may say they are for women’s rights, but not for the rights of transgender women.

This is absurd.

It is convenient to say one is for the hard won rights of past activists. Those battles have already been fought; the blood of them spilled. It is harder to acknowledge and face the bigotry and prejudice that exists today.

The truth is simple. If you’re not for social justice today, you would not have been for social justice in 1860 or 1920 or even 1960. The lens of bigotry and prejudice are near sighted. They always have been and they always will be.

So let’s stop pretending there is any difference between social justice then and now. The target of hatred and bigotry may change, but the struggle for civil rights and social justice never ends.

Hate and ignorance don’t smell any different with time and true heroes never put up their capes. Let us stand among the heroes of social justice so that every generation may see more freedom and opportunity than the last.

Happy Pride Month!

Military Transgender Policy is Still Trapped in the Gender Binary

/ Jame A. Agapoff, MD, MS (she/they) / 4 Comments

Gay. Non-Binary. Psychiatrist. Military Officer. Wait, military officer?

In 2015, I commissioned as an officer in the U.S. Army Reserve. Last year, I was promoted to the rank of Major. This is a part of my life I rarely share on this blog; however, I think there are a few things I need to say about my service as someone who is gay and non-binary.

In 2010, I declined a military scholarship for medical school because of the ‘Don’t Ask Don’t Tell’ policy. A year later, this policy would be lifted, opening up the path for my future commission. For me, serving with honor and upholding the military code of ethics meant being able to express my sexuality.

In 2016, when President Obama lifted the transgender ban in the military, I was overjoyed. Even though the policy focused on individuals moving from one end of the gender binary to the next, the change opened the door for other forms of gender expression.

When the ban was reinstated in 2019, it felt like a step backwards for many non-binary service members. As I note in a previous post, the term transgender defines any person who identifies a gender not listed on their birth certificate. Thus, non-binary persons are transgender, but in terms of military policy, non-binary people don’t exist.

In 2021, the ban was lifted again, but the policy remained trapped in the gender binary, focusing on individuals wishing to transition completely from one sex to another. It did not address individuals with more neutral or androgenous forms of gender expression like myself.

There is some evidence this may be changing. According to Military.com, the “Institute of Defense Analyses, at the Pentagon’s request, is researching how nonbinary troops could be allowed to serve more openly.” Some branches like the Air Force are already ahead of the curve allowing service members to list their preferred pronouns on email chains.

In my opinion, clear policies recognizing non-binary persons are necessary to support and retain fighting strength. Non-binary persons fill critical needs specialities within the military that are essential for mission success. As definitions of gender move away from the binary, the military, as an all voluntary force, must also adapt and change.

I am proud to serve in the U.S. Army Reserve as an openly gay, non-binary soldier.

Happy Pride Month!

References:

https://www.military.com/daily-news/2022/01/18/pentagon-quietly-looking-how-nonbinary-troops-could-serve-openly.html

https://www.military.com/daily-news/2022/02/11/im-pretty-much-leading-double-life-nonbinary-troops-and-pentagons-next-frontier.html

Click to access ARN32878-ARMY_DIR_2021-22-000-WEB-1.pdf

Headwinds of Intolerance

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

For many LGBTQ+ persons engaging in a gender transition, the headwinds of intolerance are a real obstacle. It can mean rejection from friends, family, and even community. All transgender persons struggle with this truth. For this reason, it takes courage to align one’s gender expression to their gender identity.

In my previous article, The LGBTQ Psychiatrist Educator (Article Available on Request), I discuss under what circumstances it may be appropriate to share one’s sexuality in the clinical learning environment. In a thoughtful follow-up Letter (also Available on Request), a “bisexual” medical student, and now doctor, noted that transgender persons who are expressing their gender identity don’t always have the luxury of selective disclosures. For this reason, transgender persons often face the greatest headwinds of intolerance.

She’s right!

Intolerance comes in many forms, both passive and active. The natural reaction to intolerance is to shirk away from it or to change one’s behavior to avoid it. For transgender persons, this could mean changing where they shop, moving to a different community, making a career shift, or even finding new friends. The most difficult choice faced by some transgender persons is whether to hide their gender expression, which could lead to significant dysphoria but protect them from threats of physical violence.

Transgender persons remain one of the most stigmatized, misunderstood, mislabeled, feared, and marginalized minority populations. As Dr. Benfield stated at the end of her letter, we “…should strive towards creating a safe, inclusive workplace for trans people, and commit to role modelling trans allyship in our professional and personal lives.”

Happy Pride Month!

References:

1. Agapoff JR. The LGBTQ psychiatrist educator. The clinical teacher. 2021;18(5):472-473. doi:10.1111/tct.13335

2. Benfield E. LGBTQ educators: an LGBTQ student’s response. The clinical teacher. 2021;18(3):314-314. doi:10.1111/tct.13349

Photo by Francesco Ungaro on Pexels.com

Be Yourself! LGBTQ+ Advocacy Through Self-Expression

/ Jame A. Agapoff, MD, MS (she/they) / 1 Comment

Be Yourself!

Sounds easy, right? It is more difficult than you think.

At forty, I am still striving to live openly. Even when the environment is right for transparency, there is always a risk.

In college, I had a job as a lab tech in the chemistry lab. Another technician, an older woman, quickly became a friend. At some point we were talking about relationships and I told her I was gay. I still remember the look on her face. Shock… perhaps fear as well. And, then she said, “I am a Christian.”

Rejection. I was speechless.

I remember smiling pensively and continuing about my work, but I realized then that there was a wall between us that my openness revealed. I say “revealed” because I did not create it. She did. I think this is an important point because this kind of rejection can be easily internalized and influence future openness.

Sadly, the first reaction many gay and transgender people experience when they share their sexuality and gender dysphoria with others is rejection. This is one reason why drug use, mental health problems, and suicide disproportionately impact LGBTQ+ persons.

My experience has shown me that it takes resilience to be openly gay and non-binary. Despite greater openness and acceptance in our societies, there remains significant stigma. In addition to my work as a psychiatrist, I am also a military officer. If a transgender ban were to be reinstated, I could be discharged. I accept that.

The truth is that if we aren’t open about who we are, someone else will decide for us. We owe it to ourselves and others to lead by example. Perhaps, if we do, we will live to see a time when our openness leads to opens doors rather than walls.

Happy Pride Month!

Photo by Brett Sayles on Pexels.com

Why Pronouns are Important

/ Jame A. Agapoff, MD, MS (she/they) / 9 Comments

For many transgender persons, pronouns are an important part of their gender transition and expression. As I describe in my previous post, gender expression is how a person chooses to project their gender identity, which is one’s inner perception of self such as male, female, something between, or something outside the male-female binary. Gender identity is different than sex, which is based on physiological characteristics such as genitalia as well as chromosomes.

Most of us have gotten into the habit of assuming pronouns based on a person’s gender expression. This assumes that a person’s physical appearance matches their gender identity, which is not always the case. Even people who are cis-gender (a person whose gender identity and sex align) may have many kinds of gender expression. To be more affirming, all of us should try to get out of the habit of assuming pronouns.

Often an easy way to know someone’s pronouns is to introduce yourself with yours. For example, “I am Dr. Agapoff. I use he/him/they/them pronouns. It is nice to meet you.” This creates a safe and open space for the other person to share their gender identity if they choose. Research shows that using someone’s correct pronouns has a positive impact on their mental health and wellbeing. Let’s all work together to create a more inclusive and respectful world.

Happy Pride Month!

Photo by Sharon McCutcheon on Pexels.com

A Quick Guide to Sex, Gender Identity, & Gender Expression

/ Jame A. Agapoff, MD, MS (she/they) / 2 Comments

June is LGBTQ+ pride month. Happy Pride Month! In support of LGBTQ+ persons, all blog posts this month will have an LGBTQ+ theme. Today, I’ll familiarize everyone with the differences between sex, gender identity, and gender expression.

We often conflate sex and gender, but they are different. Sex or “natal sex” is what is written on a person’s birth certificate. A person’s sex is based on physiological characteristics such as genitalia as well as chromosomes. Male, female, and intersex are examples of sex.

Gender or gender identity describe one’s inner perception of self such as male, female, something between, or something outside the male-female binary. When a person’s sex and gender align, they are considered cis-gender, when they do not align, they are transgender. Thus, non-binary persons are transgender by definition.

Gender expression is how someone chooses to express their gender identity. Examples of gender expression include names, pronouns, clothing, haircuts, behaviors, voice, body characteristics, and more. The process of aligning one’s gender expression to their gender identity is called a transition. Transgender individuals can transition using a combination of personal (name, pronouns, dress), legal (changing sex on legal documents, name change), or medical means (surgeries, hormone therapies). Transitions often help ease gender dysphoria, which is the clinically significant distress a person experiences when their natal sex does not align with their gender identity.

I hope this quick guide helps you understand the differences between sex, gender identity, and gender expression. May it help you be an ally for the transgender community!