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68 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 7 UN • DER • STAND THE GENDER SPECTRUM Biologists now recognize that both sex and gender exist on a spectrum. 2 Many people are accustomed to the idea that sex and gender fi t comfortably into one of two boxes, but that doesn't make it true. The best current estimate of the adult transgender population is, on average, about 0.6 percent of the US population. 3 The number of intersex people (see Terminology on page 69) is about 1.7 percent of the population. 4 While that may not sound like a lot, think of it this way: the population of the United States is about 319 million— that means there are almost 2 million transgender and over 5.4 million intersex members of our national population. Those are not small numbers! People under 24 are the most likely to identify themselves as transgender, and so the numbers may climb as acceptance becomes more commonplace. Many of us (especially those of us over 30) were never exposed to the idea of the gender spectrum at any point in our education; fortunately, that is changing as science improves and younger generations are embracing the diversity of the human species. It is still up to us as health-care professionals, however, to continue to study and learn about the great variety of humanity so that we may knowledgeably lay our hands on our clients with compassion and openheartedness. In general, there is still a lot of misinformation and fear surrounding the transgender community, even though there has been a lot more openness and visibility in the last few years. As is typical when social changes are in process, strong backlash occurs even as progress is made. Anti-trans legislation at local, state, and national levels has made day- to-day living as a transgender person more challenging, to say the least. While "reality" television depicts well-supported people like Caitlyn Jenner or Jazz Jennings, the on-the-ground reality is usually quite different. Transgender and gender- nonconforming people report the highest rates of discrimination and barriers to health care, and have the highest rates of suicide, substance abuse, and homelessness. The majority of transgender and gender- nonconforming people have suffered from touch-related trauma, sex abuse, bullying, or harassment, all of which make it more diffi cult to accept nurturing touch even in a therapeutic setting. Transgender women in particular suffer such high rates of discrimination and harassment that 20 percent turn to sex work for survival. 5 A person in survival mode is not going to be comfortable with touch—to expose would be so uncomfortable as to be unthinkable. If they have experienced abuse or harassment, the negative feelings are only going to be amplifi ed. The mental and emotional cost, not to mention the physical risks, of coming out to yet another professional presents a real barrier to accessing bodywork for the transgender community. BE • COME INFORMED Different gender identities and differences of gender expression are not pathologies. First, they are normal, they are real, and they aren't going to disappear just because some people are uncomfortable with them. Second, sexuality and gender are not the same. Sexual orientation is whom you are attracted to; gender is who you know yourself to be. The words lesbian, gay, bisexual, and asexual indicate sexual orientations. The words transgender and intersex are gender related and are medical terms. Third, not all transgender people identify as being part of the LGBTQ community. Once a person has come to a level of comfort with their body by bringing it and their mind into closer alignment, they may simply identify themselves as male or female, without the trans identifi er. Most importantly, transgender patients and clients should not be placed in the position of training their providers about their physical health-care needs. It is our responsibility to get informed. Often, cisgender people (those whose gender identity corresponds to their biological sex) have many questions about working with transgender clients, but it is not the client's responsibility to speak for all transgender people, so do your research and get current. You should never tell a trans person they were "born in the wrong body." To do so devalues the humanity of their soul. Their bodies are unique and valuable and their own to do with as they want. PHYS • I • CAL ISSUES YOU NEED TO UNDERSTAND It's important to remember that a transgender person may elect not to do anything as far as making changes to the way they dress or act, and especially not to elect for medical treatments, which are expensive, often not covered by medical insurance, and may be contraindicated for the particular person. This does not mean they aren't "really" transgender. Everyone's experience is unique to themselves; everyone has their own comfort level with change, especially visible changes. Particularly with a person transitioning in later adulthood, after years or decades of living, working, and building within their cisgender persona, it is often emotionally and socially costly to give up the life, perks, family, etc., that one has built up. According to the Center of Excellence for Transgender Health, "… (N)ot all transgender people seek all interventions, and some may seek none. In contrast to past practices in which a set pathway involved a requirement of psychological assessment, hormones, [and] genital surgery, the current standard of care is to allow each transgender person to seek only those interventions which they desire to affi rm their own gender identity." 6 According to Renee Baker, a counselor and massage therapist based in Texas, "It's about taking power back if they have given it away to cisgender people, valuing transgender as equally as cisgender, and not comparing and judging. It's OK to have a unique 'queer' body. It's OK to change it, too; but honor it and talk to it like a friend."