Law school hosts discussion about transgender health

Students, faculty and staff discussed the intersection of the law and global health specifically for transgender populations at “Maximizing Sexual Health & Rights of Transgender Populations: The Changing Role of the International Classification of Diseases” Tuesday in the Musick Law Building. The USC Gould School of Law and Global Health sponsored the event.

Doe Mayer from the USC School of Cinematic Arts moderated while Sofia Gruskin, the Director of the Program on Global Health & Human Rights in the Keck School of Medicine and Gould School of Law, gave the presentation.

The discussion centered around the fate of the International Classification of Diseases, the standard tool in assessing health management. The ICD was last updated in 1990 and is set to be revised in 2018.

The current ICD, according to Gruskin, classifies transgender populations as people with a mental and behavioral disorder. Much of the conversation regarding transgender populations and the ICD is whether they should be included or ejected from the document altogether.

“Based on lots of discussions among advocacy groups, it’s clear that there is consensus that transgender populations need to be in the new ICD, but it needs to not be in the mental behavioral disorder section,” Gruskin said.

The larger implication of its inclusion is the access to medical care.

“The reason it needs to be included is so people can access hormones and silicone and so any issues they have with healthcare can be recognized by health professionals,” Gruskin said.

The presentation highlighted Argentina’s 2012 progressive gender identity law. The law legally acknowledges the right to self-assigned gender identity. Moreover, it allows a change to gender identity without requirement of psychiatric evaluation and a right to appropriate gender health services. By the end of 2013, over 3,000 individuals had adopted a new gender identification because of the law.

“The people who were most empowered were those to first take advantage of this right,” Gruskin said. “A change of institutional mechanisms had to be in place for people to have such a different experience than what they had before. The law made a positive difference for people’s lives.”

Similar work is being done in the United States to be presented at the World Health Assembly in 2018. Both Gruskin and Mayer mentioned the importance of including the transgender population in the conversation about ICD definition revision.

The current working definition is “gender incongruence of adolescence and adulthood.” The definition requires transgender individuals to have persistent incongruence between an individual’s experienced gender and the assigned sex. Furthermore, the inconsistency of the word “trans” between different versions of the ICD introduces the possibility of discarding it in the 2018 ICD.

“The word ‘trans’ implies movement, so is that still the right word that should be used for those people who change their gender?” Mayer said. “We’ve seen changes in the language throughout the years, so we see the possibility of changes in the future.”

Gruskin emphasized how the definitions in the ICD are not human rights definitions.

“The definitions are meant to give people access to medical services like hormones and silicone,” Gruskin said. “In 2018, you’ll need two-thirds of countries of the world to agree to this definition for the ICD to change.”

The USC Law and Global Health Collaboration’s next event will be a conversation on transgender immigrant and refugee populations. It will be on Nov. 8 in Musick Hall 118/120.

1 reply
  1. M___Townsend
    M___Townsend says:

    I ran across this account in the Daily Trojan only incidentally, but noticed a detail given in this account that bears clarification: the use of silicone for body modification in the transgender community.

    Body modification is one of several options available to the transgender community, as it is for cisgender individuals who wish to achieve some aesthetic change in the look of their bodies. Transgender people often choose modify their bodies with additional plastic surgery to supplement the changes brought by hormone therapy, as there are limits to what hormone therapy can do; for transgender women, this often will mean breast implants, which use medical-grade, FDA-approved, silicone.

    What is not clear in the account of this presentation is whether medical-grade or industrial-grade silicone is being referred to. This is an opportunity to explain to readers why it is important to distinguish between them.

    Industrial-grade silicone is also used, illegally, for use in body contouring and filling. Used primarily by poor and unknowing transgender women, this practice is not sanctioned by medical professionals, is highly dangerous, can result in a lifetime of medical problems, and can even be fatal. I refer readers to news accounts of ‘Injection Parties’ and arrests of predatory individuals who take cash for injecting transgender women in home settings.

    In both instances we see an underlying problem: the Transgender community, which continues to be highly stigmatized and marginalized, often cannot get access to appropriate medical care, much less afford it; in desperation, transgender individuals might resort to use of industrial-grade silicone, which is far cheaper, to achieve the brain/body match they feel comfortable with. Because the current ICD treats gender variance as a mental illness rather than a medical problem, insurance companies will not fund therapies that get a the root of gender dysphoria.

    I sincerely hope the upcoming proposed revisions to ICD-11 will include de-pathologizing gender variance. I am deeply grateful to Professor Gruskin for making the larger connection of how healthcare and legal systems can embody cultural biases. As with other marginalized populations that have also been medically pathologized, legal bias can sometimes be scaffolded upon medical bias, which, in turn, absorbs the cultural biases of the day; they reinforce and depend on each other to claim legitimacy. This is why we need institutional changes to best achieve successful health outcomes.

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