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By Root 2036 0

that Congress allocate funds to the National Institutes of Health for new and expanded efforts in the collection of medical and demographic information on transgendered and gender-variant people. “The transgendered community, including transsexuals, cross-dressers, and the intersexual, is believed to represent as much as 2 percent of the American populace and has specific needs regarding mental and physical health,” Maverick and NTAC point out in their request for research funding. “They have the highest suicide rate for any demographic group, a very high incidence of depression and other mental health problems and a very high incidence of substance abuse. They have unique medical needs associated with hormonal therapy (breast cancer in genetic males, for example), sexual reassignment surgery and misdiagnosis of ailments (like ovarian cancer in female to male transsexuals).” Transgendered sex workers are also a “critical vector” for the transmission of HIV, as the request notes. Surveys carried out in Washington, D.C., San Francisco, Los Angeles, New York, and Philadelphia found high rates of HIV infection among trans sex workers in those cities.

Despite the serious health problems confronted by transgendered people, they remain a largely invisible and untreated population for a number of reasons. Some fear exposure, many lack health insurance, and more than a few have encountered hostility, ridicule, and rejection from health care providers when they have sought treatment. “Trans-gendered people commonly receive substandard or inadequate medical treatment due to discrimination, ignorance, confusion and loss of health insurance due to job loss,” the NTAC request for funding notes. To a certain extent, the difficulties that transgendered people encounter are shared by other members of the LGBT community. “Most physicians get no training at all” with respect to treating transgendered patients, says Dr. Ben Barres, but “this is related to an even bigger problem, because let’s face it, transgendered people are very rare, but homosexuals are very common, a couple percent of the population, and there’s no training in medical school about that. For example, most physicians are very insensitive to that issue when they do a history and physical. They’ll ask a person if they use birth control before they’ve even ascertained whether they are gay or not.”

Speakers at the American Medical Students Association’s 2001 conference concluded that “LGBT patients face many barriers to adequate health care. These problems range from poor physician access to a lack of awareness in the medical community about the health concerns of LGBT patients, not to mention the failure to address these health issues in most medical school curricula.” The failure of medical schools to train future physicians to treat LGBT patients is yet another consequence of the lack of research on the specific health care needs of these populations. Research on LGBT issues typically begins and ends with AIDS research. AIDS remains a significant problem, to be sure— rates of HIV infection among male-to-female transsexuals in cities remain shockingly high. But the circumstances that drive those high rates of infection—needle-sharing among users of black-market hormones, sex work, substance abuse, and possibly depression—remain understudied, and therefore largely invisible. This lack of research has very large consequences for the transgender community, even beyond the basic but somewhat esoteric question of the etiology (cause) of gender variance.

“In this culture, and in most of the civilized world today, research data is used to determine public policy, to determine legislation, making cases in court, is used in determining protocols in medicine and psychiatry. Virtually every place you touch, people are coming up against this system where research data would be helpful,” says Kit Rachlin, a psychotherapist with a doctorate in applied research who has worked with transgendered clients since 1990. “Everything from the quality of the medical care I get to whether I can