INTRODUCTION TO THE LGBTQ POPULATION FOR CLINICIANS

INTRODUCTION TO THE LGBTQ POPULATION FOR CLINICIANS 1

Kathleen Anne OBrien

Alcoholism & Drug Abuse Council of Orange County

Goshen, NY


Abstract

This paper is an expository on LGBTQ individuals. It contains separate sections of each of the

sets of people defined by the LGBTQ acronym. The LGBTQ population is defined with the

personal, psychological, and social issues they face. Further, the issues of hatred and bigotry in

society but also in their families are mentioned. Clinical snippets of cases are noted. A

summary section is included listing the risk and protective factors affecting these populations for

Substance Abuse issues. Without recognition of the LGBTQ individual as a unique and valuable

person, effective treatment cannot take place. It is only with a better understanding of the

LGBTQ individual by the Substance Abuse Counselor, can more effective treatment be

accomplished. Suggestions for clinics are cited and noted so that treatment facilities can provide

better treatment for LGBTQ individuals throughout the entire process of assessment, intake, and

individual and family treatment.

Keywords: LGBTQ Population; LGBTQ Issues; LGBTQ Treatment Issues; CASAC

treatment issues for LGBTQ Clients


Contents

Abstract .............................................................................................................................................................................. 2

The LGBTQ Population ................................................................................................................................................. 5

LGBTQ Defined ............................................................................................................................................................ 5

LGBTQ Definitions ................................................................................................................................................. 7

LGBTQ determined in utero. .............................................................................................................................. 7

Attributes Common to All People .................................................................................................................... 8

Myths and Stereotypes about the LGBT population .......................................................................................... 11

The Lesbian Population ......................................................................................................................................... 13

Latina Lesbians ..................................................................................................................................................... 16

The Gay Population ................................................................................................................................................... 17

The AIDS Epidemic ............................................................................................................................................. 22

The Bisexual Population ........................................................................................................................................ 25

The Transgender Population .................................................................................................................................... 29

Gender Dysphoria .................................................................................................................................................. 30

The Transsexual ................................................................................................................................................... 30

Cross-dressers a Transgender Subset ................................................................................................................ 34

Transgender case examples ................................................................................................................................. 37

Use of pronouns with Transgender Clients ...................................................................................................... 38

Queer/Genderqueer Clients ............................................................................................................................... 40

LGBTQ Youth Kicked Out of Their Homes ..................................................................................................... 42

Risk and Protective Factors in the LGBTQ Population .................................................................................... 43

Risk Factors of the LGBTQ Population ........................................................................................................... 44

Protective Factors of LGBTQ Population ........................................................................................................ 44

What Substance Abuse Agencies Need to Do ................................................................................................... 45

APPENDIX A ................................................................................................................................................................. 47

Further Gender/Sexuality Terms and Definitions ............................................................................................... 48

Bibliography ................................................................................................................................................................... 54


The LGBTQ population even after the beginnings of the Gay Civil Rights movement

arising as a result of the Stonewall Riots in 19691, is still misunderstood, hated, and

discriminated against on a social, societal and personal level. Without an understanding of the

individuals in the LGBTQ population, effective treatment by the substance abuse counselor and

the clinic they work in cannot be done effectively.

As a part of the training for CASAC counselors (Orange County CASAC training,

Goshen, NY, spring 2014), the movie “Thirteen”2 was shown. It depicts a thirteen year old

female (Tracy) with high risk factors becoming a “friend” of a poplar girl in school who

introduced to self-mutilation, alcohol, sex, and drugs. As observed, the class had some verbal

and non-verbal reactions to the use of alcohol, drugs, cutting, and sex by a thirteen year old girl

who had been a shy but good student. However when the girlfriends were “hanging out” in

Tracy’s bedroom, the “friend” tried to kiss her and a majority of the class expressed some loud

cries of repulsion and/or disgust. This type of stigma that Lesbians go through is just the tip of

the iceberg of derision and unacceptance that the LGBTQ community is faced with even today in

the year 2014.3

1 The Stonewall Inn in 1969 at 53 Christopher Street is a gay bar, one of only a few in New York City at the time. It

was owned by the Mafia and raided by the police of the 6th precinct at least once a month and sometimes more

frequently. There were some of the police in that precinct that were taking payoffs from the bar. Raids on bars by

the police resulted in the confiscation of the alcohol in the bar, harassment and debasement of the patrons, beating of

the patrons with Billy clubs (for no reason other than they were Gay, just didn’t look right, or for the pleasure of the

officers). At 1:20 am on June 28th 1969 the Stonewall Inn was raided. The police called in a paddy wagon which

was an indication that this was not going to be a normal raid. There are mixed thoughts on how much the influence

of the funeral of Judy Garland on the 27th affected attitudes. People were despondent and did not want to be hassled.

They wanted to be left alone. The riots that followed this confrontation with the police were a part of the beginning

of the modern Gay Rights Movement. 2 (Holly Hunter, 2004)


The LGBTQ Population

The people in the LGBTQ population are still today stigmatized and subject to acts of

violence and murder. In 2013 a Gay man was shot and killed on the streets of New York City

for being Gay.4 In Texas, a father killed his daughter and her friend for being Lesbian.5 In

another case a transgender woman, “…had been brutally beaten about the head and ears, then

strangled, and finally stabbed deeply in her chest and breast area between 15 and 2 dozen times.”

Prior to fleeing the scene, her assailant set fire to the apartment only a few feet from her prostrate

body, apparently in an attempt to destroy evidence. Her body had been so savagely assaulted that

some friends at first believed she had been deliberately mutilated.”6

The LGBTQ populations are described here for the sake of counselor education.

Counselors need to know the mental and social environment of the LGBTQ person to help them

effectively understand their clients. “Some teachers, school counselors, and even therapists are

uncomfortable in discussing LGBTQ issues and refuse to talk to a child who comes to them with

LGBTQ concerns.” (OBrien, LGBT Issues, 2007-2014)

LGBTQ Defined

The definitions listed in Table 1: “LGBTQI definitions” are a short definition of each of the

letters in the LGBTQI acronym. Note that each definition of a classification is complex and that

an individual is composed of many traits. A full understanding of where each individual is in

the congregation of any of the separate categories is not possible except on a personal basis.

“LGBTQI” is an acronym that stands for Lesbian, Gay, Bisexual, Transgender, Queer

(sometimes referred to as GenderQueer), and Intersexed individuals. It is interesting to note that

even some physicians do not know what LGBT stands for and what implication it might have for

their treatment of the clients they see.7 However, there are MANY more terms that describe the

individuals in this population and many are not understood outside the subculture they exist in.

These complex and perhaps unfamiliar terms and definitions can be seen in

4 (New York Man Fatally Shot In Alleged Anti-Gay Hate Crime, 2013) 5 (Texas, 2014) 6 http://gayhistory.wikidot.com/christian-paige 7 For example, in the Hispanic population a Dr. may ask a client if he were Gay and that client could reply “No.”

even if he was engaging in MtM (Male to Male) sex. In that population if a male is the penetrated, they are Gay. If

the male is the penetrator, they do not consider themselves Gay.


APPENDIX A. Note

That even the terms given there (45 in number) are not all inclusive. The clinician that enters

into discussion with their client will find there are many terms used and these terms may not be

clear to their client as well.

8 There is a general misconception about Bisexuality and bisexual behavior. A Bisexual can be attracted to a male

partner or a female partner. However, this does not mean that they alternate with a great deal of frequency between

the sexes. Some bisexuals choose either a male or a female and can remain a faithful partner to them for life. 9 Cross-dressers (formerly called Transvestites) are one sub-classification of transgendered people. It is estimated

that up to 85% of men have cross-dressed to some extent and it is to be noted that 95% of cross-dressers are

married heterosexual men with families.

Table 1

Definitions of components of the acronym LGBTQI

Lesbian Used to describe women who are sexually and emotionally attracted to

women.

Gay Used to describe men who are sexually and emotionally attracted to men.

However this term is now being used to describe both men and women.

Bisexual Used to describe a person who is attracted to both men and women.8

Transgender A generic term that is an umbrella for those people who express their

gender in a manner that is different that the “bi-gender” norm of male and

female. There are many classifications that fall under this broad term

ranging from cross-dressers to transsexuals.9

Queer or

GenderQueer

Is a broad category for gender identities other than man and woman, thus

outside of the gender binary that is always assumed in our society.

Intersexed Is a term for those persons born with ambiguous genitalia either internal,

external, or both. There are MANY variations on this condition.

MTF A transsexual that has the biological sex of Male has the gender identity

of a female and may have surgery to change their body from Male To

Female.

FTM A transsexual that has the biological sex of Female has the gender identity

of a Male and may have surgery to change their body from Female To

Male.


LGBTQ Definitions

Who are these individuals? They are your friends, your neighbors, your co-workers, and

your children. LGBTQ children are not only harassed and bullied but beaten and raped for who

they are. LGBTQ youth are sometimes homeless. “…LGBTQ youth may be at greater risk for

experiencing homelessness and, if they become homeless, more likely than their heterosexual

counterparts to experience victimization, engage in high-risk sexual behaviors, and have poor

mental health.”10 (Burwick, 2014) Up to 20% of the general population are LGBTQ individuals.

Negative attitudes toward these individuals can hurt and even kill. One interesting

exercise to do is an imagination exercise. Imagine your home life, work life, and/or social life as

a life in which you had to continually cover up who you are as a person. Imagine a life in which

you constantly were fearful of someone “discovering” who you really were. Imagine lying about

the sex of the person is that you went out with last night. Imagine if you were lesbian and

someone asked you why you didn’t have a picture of your husband on your desk like all the other

girls in the office – after all, you do have a wedding ring on your finger. Gay people do this

every day.11

LGBTQ determined in utero.

What has not been said about the people in the LGBTQ community is that being LGBTQ

is NOT a choice. There is medical evidence from the American Medical Association that being

LGBT is caused by hormonal balances in utero (in the womb) (O'Hanlan, 2011). Being LGBTQ

is at least in part caused by hormonal imbalances in the womb.

10 (Burwick, 2014) p. viii 11 The author of this paper once was employed by a major utility in New York City. When walking on the street,

another employee came up and said: “You have a lot of strength to come out like you did. I really appreciated your

disclosure. I’m a lesbian and I am so very afraid that if I came out at work, I would be fired.”


Attributes Common to All People

The following table lists four basic attributes common to all people.12 They can be

viewed as a template of which we are all derived from.

Common Attributes

Biological Sex or Natal Sex Sex is the physiological makeup of a human being, referred to as

the biological or natal sex. Sex is a complex relationship of

genetic, hormonal, morphological, chromosomal, gonadal,

biochemical, and anatomical determinants that impact the

physiology of the body and the sexual differentiation of the brain.

Although everyone is assigned a sex at birth, approximately 2

percent of the population are intersexed and do not easily fit into a

dimorphic division of two sexes that are “opposite.”

Gender Identity Gender is a social construct that divides people into “natural”

categories of men and women that are assumed to derive from

their physiological male and female bodies. Most people's gender

identity is congruent with their assigned sex, but many people

experience their gender identity to be discordant with their natal

sex. Gender identity is considered a core identity. A person's self-

concept of his or her gender (regardless of their biological sex) is

called his or her gender identity.

Gender-Role Expression Gender role is the expression of masculinity and femininity and

has often been referred to as “sex role.” Gender roles are thought

to be reflections of one's gender identity and are socially dictated

and reinforced. It is through gender roles that gender is enacted or

“performed” (consciously or unconsciously) and may or may not

be related to gender identity or natal sex.

Sexual Orientation

Sexual orientation is the self-perception of one's sexual

preference and emotional attraction. Sexual orientation can be

directed toward members of the same sex (homosexual), the

opposite sex (heterosexual), both sexes (bisexual), or neither sex

(nonsexual). Sexuality is experienced through the person's gender

identity (regardless of his or her biology).

Attributes Common To All People 1

These attributes are also shown graphically in the figure “Error! Reference source not

ound.”Error! Reference source not found.13. Examining this figure, the ovals in the portion

12 (Lev, 2004) pp. 81-85


Biological/Assigned Sex of the diagram representing Male and Intersexed overlap as well as the

ovals representing Female and Intersexed. In looking at all other clusters of ovals (Gender

Identity, Gender Expression, and Sexual Orientation) other ovals overlap AND it is to be noted

that there is part of the graphic in each of these clusters that represent a circular path between the

attributes expressed by each of the ovals. In the cluster that represents Gender Identity, there are

four ovals: Woman, Man,

A Chart of Common Attributes 1

13 (OBrien, LGBT Issues, 2007-2014)


Ambivalent, and BiGender.14 The circular reference between Man and Ambivalent means that a

person’s gender can change between those attributes. In a similar manner in the Sexual

Orientation Group a Male (upper left pink oval can be sexually attracted to Female (lower right

blue oval in that group and be considered “Straight” or heterosexual. If that same Male were to

be sexually attracted to a Male (lower blue oval in that group) then he would be considered

“Gay”. Note that there is an overlap between both the Male, Female and Bisexual ovals. This

indicates that both males and females can also be attracted to persons that consider themselves

Bisexual.15 It also indicates that a bisexual can be attracted to either a male or a female. The

final grouping is that of Gender Expression. It too is composed of four ovals. From this

grouping a gender expression can be masculine, feminine, androgynous, or undifferentiated.

An interesting exercise for the reader is to place themselves in each grouping throughout

the timeline of their lives. These attributes can and do vary as a person goes through life based

on their social, personal, and cultural experiences. A person may start life and sexuality thinking

they are heterosexual or “straight” yet perhaps in college or later in life finds that they are really

gay or lesbian. Sexual attraction is not necessarily a static given in anyone’s life.

14 Bi-Gender; Bigender or bi-gender: describes a person who feels they exhibit two genders. The two genders may

include any particular gender on or outside of the gender spectrum. Some bigender individuals switch genders

(Gender Switching), sometimes using different personas for either gender to feel comfortable in at any given time. It

is recognized by the American Psychological Association (APA) as a subset of the transgender group. 15 At times people say they are Bisexual when they may not really what the term means. Bisexuality is a complex

subject. In the pop culture, the term is taken that a person may “jump” between partners “willy-nilly”and feels that

these sexual escapades define them as bisexual. Bisexuals can do this and some do, but this but the activity is really

in the range of normal human sexuality.


Myths and Stereotypes about the LGBT population

LGBTQ people (as do all people in our society) exist along a spectrum of possibilities.

There can be no “pigeonhole” to put an individual. Myths and Stereotypes about the LGBTQ

population abound and contribute to unfair treatment of those in that group. In the table entitled

“Myths and Stereotypes about the LGBT population, a set of myths or stereotypes are listed for

each of the populations. Read each and see if you agree that each statement in the table is TRUE

or FALSE.

What is the problem? Myths and stereotypes can create an atmosphere in which you

operate that will stop you from really seeing the people in front of you – your daughter, son,

neighbor, co-worker, your client, etc., and this will result in your judgment to be distorted as to

who these people really are. The people in a particular group do NOT possess all the myths and

Myths and Stereotypes about the LGBT population

Gay Lesbian Bisexuals Transgender

It’s just a phase. All Lesbians Hate

Men

Like Men and Women

Equally

Transgender people

are confused

Can be taught not to

be Gay

Butch Lesbians want

to be men

Can choose to be

straight

Being transgender is a

choice.

All Gay Men Will Die

of AIDS

Lesbians are attracted

to all women

Are denying they are

gay.

Transgender people

are really gay

Are only concerned

with sex

Being a Lesbian is a

choice and can be

changed

Bisexuals are

Promiscuous

Transgender people

can’t have families

Someone Made Him

Gay

You Can Tell a

Lesbian by how she

looks

Bisexuals will Never

Settle with one Person

Transgender people

can be cured

All Gay Men Are

Feminine

Lesbians Can't be

Spiritual

Bisexual Women are

Really Lesbians

All transgender

people have surgery.

Will have quickies

with any other Gay

man

Lesbian women

recruit others into

their lifestyle.

Bisexual Women are

Really Straight

Psychotherapy can

cure Transsexuals

Myths and Stereotypes 1


stereotypes of that group. Not knowing a person inhibits us from developing a great working

environment with that person or client. [The Answers to EVERY myth and stereotype in the

table are FALSE.]


The Lesbian Population

When the author of this paper lectures, she asks the audience: “What is the first thing you

think about when you think of Lesbians (Gays). This is uncomfortable for the audience. If

pressed, they will usually say: “Sex.”16 The question is then asked: “Why?” People usually

cannot answer this question or they give a multiple or conflicting responses. They general do

NOT think of Lesbians (or Gays) as a wonderful loving couple who care for each other deeply.

Nor do they think that Lesbians can be wonderful parents to both male and female children.

“Even if they know that some lesbians do have children, the homophobic element in our society

often asserts that lesbians should not have them, or be allowed near them. … A significant aspect

of the prejudice has to do with the fear that the child of the lesbian will not grow up to play the

appropriate heterosexual sex role.”17 There is the thought in the homophobic world that “gay”

can be taught and a learned behavior. Sometimes people who do not have the knowledge about

the Gay population will ask: “When did you decide to be Gay?” A good answer is: “When did

you decide to be straight?” It will be said again in this paper but being gay cannot be taught nor

is it a conscious decision that is made.

Who are Lesbians? They are the women around you every day. They could be your

sister, and could be your daughter. There is no “standard” Lesbian population (nor is there a

“standard” Gay population either female or male). The aversion to the “Lesbian Stereotype” is

taught in our culture and society. “The overt and covert fear of lesbians in our society is

conveyed to all of us at an early age.”18 “… the mere existence of lesbians—women who

16 It is interesting to note that heterosexual men usually find it much easier to watch a movie with two women

having sex rather than two men having sex, witch disgusts the heterosexual male population. 17 (Boston Lesbian Psychologies Collective, 1987) p. 7. 18 (Boston Lesbian Psychologies Collective, 1987) p. 9.


succeed in living relatively apart from men—is too threatening to the patriarchy and to

heterosexual women.”19

This negativity is something faced by lesbian women of all ages every second of their

lives. Many people have the stereotype that lesbians are “man-haters” that are hostile toward

males and have been that way their entire life. This is NOT true! In fact some lesbians are

women that have been married and have had natural children, been divorced, and now choose a

female partner and to live a lesbian life. Going back to the section in this paper of Attributes

Common To All People 1, it is found that: “For women, sexuality may be an aspect of identity

that is fluid and dynamic as opposed to fixed and invariant.”20 As with all populations

lesbianism may be thought of as existing on a continuum. It is not a binary switch in which you

either “are” or “are not”. Society does not recognize continuums very well.

In a conference in New Paltz, NY at SUNY New Paltz about six or more “Lesbian”

student organizations combined their efforts to bring in speakers and promote public awareness

and activism concerning Gay-Trans cooperation and rights. What was striking at the conference

was the infighting among each of the organizations. Each organization tried to define

themselves as the “real” and “true” group that represented Lesbianism. “ …there was the belief

“…that women who choose to be lesbians are somehow less real, or legitimate, than those who

felt they had a choice about it.”21 Lesbians as groups take several stands on who a “real

lesbian” is and who is not. One group who may be termed “primary lesbians” have had from an

early age have had a “…conscious sense of difference based on sexual attraction toward

members of the same sex, and do not perceive this difference to be based on any kind of

19 (Boston Lesbian Psychologies Collective, 1987) p.12. 20 (Boston Lesbian Psychologies Collective, 1987) p. 19. 21 (Boston Lesbian Psychologies Collective, 1987) p. 28


conscious choice.”22 There is a group of lesbians termed “elective lesbians” as they have

consciously made the choice to whom they are sexually attracted.

“Thus, it seems that for some members of the lesbian community the

critical issue in determining the “legitimacy of a woman’s claim to lesbian

identity is not whether or not she is sleeping with women, but whether she is

sleeping with men. This kind of thinking is problematic because women’s

relations to men are given greater weight than are women’s own self-conscious

voices.” (Boston Lesbian Psychologies Collective, 1987) p.21

One problem is that these feelings of who one is attracted to, either by choice or by

nature, by training, and society may not at all times be congruent within the individual.

Therefore emotional distress may manifest itself at times. This could cause Alcohol and

Substance use but does not necessarily have to. This is a problem sometimes not

recognized in the counseling population.

“For many lesbians, entering a relationship is the event that signals the choice of a

lesbian life. The lesbian couple relationship is probably the most intense of all

romantic relationships and the most egalitarian.” 23 “... Margaret Nichols and Beverly

Burch, suggest that the joy and happiness in bodily contact with another woman springs

from a buried primal experience.”24 What is not fully understood, or felt, by males is that

there is a bonding that can take place among women that is not in the experience of the

male. There is a sisterhood of and in women. Women understand women. Women bond

with other women no matter what the sexual orientation of the women.

22 (Boston Lesbian Psychologies Collective, 1987) p. 25. 23 (Schwartz, 1983) 24 (Boston Lesbian Psychologies Collective, 1987) p. 5. (bold by the author of this document).


All LGBTQ people have the choice of being “closeted” or of “coming out” of the closet.

In (Boston Lesbian Psychologies Collective, 1987) it is said: “We should begin to question not

only whether there is a “right” way to come out, but also whether there is some static end point at

all.”25 There are problems associated with coming out. If the lesbian chooses to be out, her

family’s initial reaction may be to ignore her statement, or to banish her from the family.26 (Also

see: LGBTQ Youth Kicked Out of Their Homes in this document. With the alienation of family

“Lesbians often choose friendship groups that function in many of the same ways as families do

for heterosexuals.”27 This choice of a surrogate family and support group is sometimes a

“protective factor” in the use of drugs in this population.

Latina Lesbians

Other cultures treat Lesbianism differently than the Anglo culture. “Although emotional

and physical closeness among women is encouraged by Latin culture, overt acknowledgement of

lesbianism is even more restricted than in mainstream American society…most members of the

Puerto Rican community strongly reject lesbianism.” “Latin families tend to treat their lesbian

daughters or sisters with silent tolerance…”28 Note this when counseling Latina lesbians. One

Latina stated in a questionnaire: “…their lesbianism was a “trial” sent by God…”29

25 (Boston Lesbian Psychologies Collective, 1987) p. 32. 26 (Boston Lesbian Psychologies Collective, 1987) p. 7 27 (Boston Lesbian Psychologies Collective, 1987) p. 6 28 (Boston Lesbian Psychologies Collective, 1987) p. 40. 29 (Boston Lesbian Psychologies Collective, 1987) p.42.


The Gay Population

“Gay” is now applied to both Lesbians and to Gay men. Here the word Gay will refer to

homosexual men. Much of what is said in this paper about the other populations in the LGBTQ

populations also applies to the Gay population. A lot of the descriptions of the emotional

attraction of men to men will not be referenced here. It is for the reader to accept that Gay men

have feelings toward other Gay men just as Lesbians have feelings toward other Lesbian women.

When asked what people think of when they think of Gay men (as for the Lesbian population),

when pressed they say: “Sex.” In almost every case they do not think of the Gay couple that

adopt children and are raising their adopted child (or biological child through a surrogate mother)

in a loving and caring family that is far and above the touted “healthy” family of some

heterosexuals. People do not generally think of the Gay lawyer that is very intelligent and caring

about other groups of people in both the heterosexual and Gay world. The general public

sometimes expresses concerns that Gay marriage will destroy the sanctity of marriage when they

have just obtained their second, third, or fourth divorce.

What will be noted are a few vignettes of gay life, history, and persecution to show the

environment that Gays in our current society have lived under and that Gays are now living

under. All across the United States today there is state after state trying to pass “freedom of

religion” laws which are intended to allow businesses, organizations, churches, and the general

public to not serve anyone Gay or expected of being Gay. If you even look Gay to someone

they could deny you service, including medical service if you are injured. These laws are in fact

discrimination laws and are made with the intent to discriminate. These laws discriminate just as

the laws on the books did in the Civil Rights movement in this country. Courts have again and

again ruled that these laws are discriminatory and have struck them down, but this does not stop

some individual states from enacting them. If one state fails, then they may re-group, rewrite


and try again. In another snapshot of Gay events currently taking place in the United States,

some states have passed laws to NOT recognize nor allow any Gay marriage. Again and again,

when these laws have been brought to court, they have been stricken down. These laws are

falling like dominoes and their falling is rejoiced by the Gay Rights movement. This is the

current environment Gays have to live in, and it can affect them deeply.

In the early 20th century “homosexuality, transvestitism, and cross-gendered self-

identification were regularly collapsed together in the medical literature.” (OBrien, LGBT Issues,

2007-2014). People tried to define why there were homosexuals and “blame” it on something or

someone. There had to be someone at fault. Blame had to be found. In psychotherapy it was

once thought that Gay men were “made” by having a strong mother and an ineffectual father.

“There are a lot of conditions that go into making any person who they are

including their early family environment BUT someone who is LGBT has the

same kind of environment in growing up that everyone else has. There is NO

indication that homosexuality is “caused” by a particular type of mother,

father, or family environment.” (OBrien, LGBT Issues, 2007-2014)

The Gay population is constantly being examined. There seems a need to explain why

people are Gay rather than to simply accept it as a natural part of life. Sometimes the money

spent on research is interesting. “Researchers in China and at the University of Minnesota

published a study on May 1st, where they found that humans produce chemical cues that

communicate gender to members of the opposite sex. While knowledge of pheromones has been

around for a long time, the new and intriguing finding shows that homosexual males responded

to gender pheromones more like heterosexual females did.” (Rosswood, 2014)


People do know that they are Gay from an early age, often in childhood. It is something

that they cannot change. There are therapists that state they can change sexual orientation but

“Reparative Therapy” as it is called does NOT work. In fact, it can kill. Gay men usually know

by the time they are in their teens that they are attracted to other Gay men. This can be a source

of confusion especially if they have no one to talk to about their feelings.

Gays too have issues in coming out. There is societal prejudice and hatred toward Gays.

Gay men can be murdered for who they are. Gay men get beaten for who they are. Gay men

have families that disown them. The same risk factors that exist as for all other groups under the

LGBTQ classification also apply to Gays.

Gay men are attracted to other gay men. Just as lesbians are NOT attracted to all women,

Gay men are NOT attracted to all men. One reason for the extreme hostility toward Gay men is

that heterosexual men have a fear that they could be the interest of a Gay male. This fear is also

present in heterosexual men and women toward transsexuals. When the heterosexual male finds

that his gender identity or sexuality is threatened, he can become hostile.

Homosexuality has been present since before recorded history. It has in the past been

ignored, accepted, considered a mental defect and placed in the Diagnostic and Statistical

Manual as a mental illness.

“In 1973, the weight of empirical data, coupled with changing social norms and

the development of a politically active gay community in the United States, led

the Board of Directors of the American Psychiatric Association to remove

homosexuality from the Diagnostic and Statistical Manual of Mental Disorders

(DSM).

http://www.healthyminds.org/More-Info-For/GayLesbianBisexuals.aspx


Some psychiatrists who fiercely opposed their action subsequently circulated a

petition calling for a vote on the issue by the Association's membership. That vote

was held in 1974, and the Board's decision was ratified.” (OBrien, LGBT Issues,

2007-2014)

In the past, homosexuality has been accepted until religion became involved.

“Modern attitudes toward homosexuality have religious, legal, and medical

underpinnings. Before the High Middle Ages, homosexual acts appear to

have been tolerated or ignored by the Christian church throughout Europe.

Beginning in the latter twelfth century, however, hostility toward

homosexuality began to take root, and eventually spread throughout

European religious and secular institutions. Condemnation of homosexual

acts (and other nonprocreative sexual behavior) as "unnatural," which

received official expression in the writings of Thomas Aquinas and others,

became widespread and has continued through the present day (Boswell,

1980).”

Religion often enters into the discussion of homosexuality and will often be quoted in

justification against anyone homosexual. Gays are told every day they are immoral and

going to Hell, they are God rejecting hell-bound beasts. The counselor’s role is to think

about what happens to the individual who is bombarded with constant hatred and

condemnation every day. As a counselor your job is NOT to argue or use these passages,

religion should never be used to convince a client of the truth of his or her sexuality.

There are seven main verses in the bible that are predominately quoted as passages

against homosexuality. The Video “Fish Out of Water” (Fawzia Mirza, 2010) is a

documentary that “explores the impassioned relationship between homosexuality and the

Bible.” Those passages are:


1. Genesis 1:1-31

2. Genesis chapters 2-3

3. Genesis 19:1-29

4. Leviticus 18:22 & 20:13

5. Romans 1:26-27

6. 1 Corinthians 6:9

7. Timothy 1:9-10

Each of these verses is used to hate and to spread hate. The humanness of Gays is

forgotten to be replaced by an object of hate. For the counselor good book that discusses

these verses is: “What The Bible Really Says About Homosexuality”. (Helminiak, 2000)

Working with one client who was strongly religious coming out as a member of the

LGBTQ community, a therapist saw this client figuratively “load the cannons of his

battleship with scriptural quotations, pull alongside other people who were strongly

religious, and let forth a salvo. Of course some of the other people loaded up the canons

of their battleships up with scriptural verses pulled their battleship up broadside and let

forth their salvo.” This type of justification of behavior is something a counselor should

be aware of and how that war of justification affects clients.

In recent Gay history the treatment of Gays is remarkable. The Stonewall Riots

were a major event that precipitated the modern Gay Rights movement. (Duberman,

1994)30 In the book “Stonewall” descriptions are given of Gay life in New York City.

The climate against homosexuality is illustrated in the following example:

“President Eisenhower signed a 1953 executive order that established

“sexual perversion” as grounds for being fired from government jobs. And

since employment records were shared with private industry, exposure or

suspicion of homosexuality could render a person unemployable and

30 The Stonewall Riots that began in the wee hours of June 28, 1969, lasted six nights and catapulted the issue of sexual liberation out of the Dark Ages and into a new era. (Wolf, 2009)


destitute. “Loitering in a public toilet” was an offense that could blacklist a

man from work and social networks, as lists of arrestees were often printed

in newspapers and other public records. Most states had laws barring

homosexuals from receiving professional licenses, which could also be

revoked upon discovery. Sex between consenting adults of the same sex,

even in a private home, could be punishable for up to life in prison,

confinement in a mental institution, or even castration.” (Wolf, 2009)

In New York City, the police often raided and arrested people at The Stonewall

Inn. Many were routinely clubbed and arrested for little or no reason. “New York’s

penal code called for the arrest of anyone in public wearing fewer than three items of

clothing “appropriate” to their gender.” (Wolf, 2009) To get around this law sometimes

Gays who wanted to dance with each other would choose one partner to be the “female”,

and that partner would dress in female clothing. By doing this if the cops were walking

by and looked through the window of the bar or club, they would apparently see a

heterosexual couple dancing together and not go in to make an arrest. The atmosphere

of the time was intensely that of hatred toward Gays. Please see footnote 1 of this paper

for a short description of the Stonewall Riots. In short, the Stonewall riots marked the

beginning of the modern Gay rights movement.

The AIDS Epidemic

The AIDS epidemic was first noted in 1981 although it was not recognized by this name

at that time.

“On June 5, the U.S. Centers for Disease Control and Prevention (CDC) publish

a Morbidity and Mortality Weekly Report (MMWR), describing cases of a rare

lung infection, Pneumocystis carinii pneumonia (PCP), in five young,

previously healthy, gay men in Los Angeles. All the men have other unusual

infections as well, indicating that their immune systems are not working; two

http://www.cdc.gov/

http://www.cdc.gov/mmwr/about.html


have already died by the time the report is published. This edition of the MMWR

marks the first official reporting of what will become known as the AIDS

epidemic.” ( U.S. Department of Health and Human Services )

“On September 24, CDC uses the term “AIDS” (acquired immune deficiency

syndrome) for the first time…” ( U.S. Department of Health and Human

Services )

The complete history of AIDS is inappropriate here. But, the Gay population was blamed

for the disease. It was known as the “Gay Disease”. It is a disease the counselor should

know about for client treatment in issues affecting them. When the disease started

spreading, the general public had another reason to hate Gay men. Some of those in the

heterosexual population at the time either openly or privately rejoiced at the news that a

disease was killing Gay men. AIDS at this time started to be transmitted to female

partners of men who had sex with other men (MSM). Portions of the population even in

the medical community did not want to treat Gays with AIDS. In de facto they were left

to die. Up until this time the Gay community and the Lesbian community did not have

common interests in general. At the time of the AIDS crisis, Lesbian women started to

take care of the AIDS infected. Lesbians were the women that as a grouping came to

help these Gay males. This was one of the incidents that started the Lesbian and Gay

community to come together more, each seeing commonalities of their community with

the other.

Men Having Sex With Men (MSM)

It should be noted here that there are men that have sex with other men (MSM)

that do not consider themselves Gay. (On the Down Low: A Journey into the Lives of

'Straight' Black Men Who Sleep with Men, 2004) Generally this term is used by the


black population (or against them). The problem is that some of these men do not

consider themselves Gay and clinicians, therapists, and doctors may not think to ask

appropriate questions in intake interviews so that physical and mental problems can be

addressed. MSM also applies to other ethnic groups as well. In the Hispanic population,

a doctor could ask a Hispanic male if he were Gay and that man could say “No.” even if

her were having sex with other men. In Hispanic culture, if a male is the “penetrator”

then he is not Gay. If the man is the “penetrated” then he is considered Gay.

MSM does not only affect men but their families and wives as well. A MSM may

be married and if he contracts hepatitis or AIDS he could bring it home and transmit that

disease to his female partner. She in turn could pass it on to her baby if pregnant. The

counselor must be aware of these possibilities in effective counseling.


The Bisexual Population

In the definition section of this paper bisexual was defined as a term “Used to describe a

person who is attracted to both men and women.” That is true yes, but it is more complex than

that. “The Myth is that Bisexuals are Promiscuous. Bisexuals do have a single partner and

family for years if not a lifetime, have a normal home life, and are NOT promiscuous. Some

people are promiscuous in their sexual experimentation but may be cisgendered people. But

being Bi does not mean you are promiscuous.” (OBrien, LGBT Issues, 2007-2014) Even

bisexuals have a hard time trying to define themselves. “Becoming bisexual involves the

rejection of not one but two recognized categories of sexual identity: heterosexual and

homosexual.”31 This inability for some people to really define their own sexuality does in itself

cause a dysphoria. “Alfred Kinsey’s pioneering studies of sexual behavior found that nearly half

of all men and about a quarter of all women are not exclusively heterosexual or homosexual.”

(Martin S. Weinberg, 1995) As with other populations, the society today generally expect

people must express a preference and be attracted to either one sex or another. Some other

attractions are not understandable to them. This is true even in the Lesbian and in the Gay

community.32

“Some people who behave bisexually are confused and think that they may be in the

process of becoming homosexual. Others simply deny their same-sex feelings and behaviors in

order to preserve their image as heterosexuals.”33 For one person bi-sexuality may be having

different partners of different sexes. Another person may have a preference in a partner of one

sex but is very open to choosing a partner of either sex. To them, it is not the physical sex of the

person that matters, for there are many ways to pleasure one sexually, but the person that

31 (Martin S. Weinberg, 1995) p. 26. 32 From trainings by Kathleen OBrien given to Lambda Peer Support Services at White Plains, NY March and

October 2012. 33 (Martin S. Weinberg, 1995) p. 6.


matters. The person is seen as an individual either caring or not, loving or not, cruel or not,

spiritual and religious, or not. For the bisexual choosing a partner it is these other attributes that

a person has that matter. One therapist had quite a different definition of bisexuality. She stated

that she truly considered herself bisexual because no matter how attracted she was to a sex

partner, of either sex, when in the process of having physical sex she thought of having physical

sex with a sexual partner of the opposite sex. For some bisexuals: “For men, it was easier to

have sex with other men than to fall in love with them. For women it was easier to fall in love

with women than to have sex with them.”34 The conclusion is that sexual preference is much

less rigid and defined as society thinks or that we know.

Bisexuals are often in the middle of choices and hostility even from other Lesbians and

Gays. Some Lesbians state that bisexuals are really Lesbians that are afraid to admit that fact to

themselves or to announce it to the world. Heterosexual women express that when a woman

states they are bisexual it is only because they can’t really admit to not being Lesbian. (Gays

express the same thing switching genders and sexual orientation.) Thus the bisexual is hit from

both sides of the sexual identity issue. When in the straight community, the bisexual may never

feel at ease. A heterosexual man may not trust the bisexual woman because he may feel that if

he were to commit to a relationship he would be “thrown overboard” for a woman. A

heterosexual woman may likewise feel that if she were to have a relationship with a bisexual

man she could get “thrown overboard” for a Gay man. Thus the bisexual can find themselves in

a position where they are not completely accepted in either the heterosexual or gay worlds. One

bisexual stated: “I feel that I can only be a half person in the straight community. And there’s a

subtle message in the gay community not to talk about my heterosexual relationships.” (Martin

S. Weinberg, 1995)

34 (Martin S. Weinberg, 1995) p. 7.


Bi women and Lesbians share the same type of prejudice if their choice of a sexual

partner is female. Similarly, Bi men and Gays face the same type of prejudice if their choice of a

sexual partner is male.

There are also Transsexual Bisexuals. In the section of this paper


The Transgender Population, the transsexual is defined. In the case of a MtF (Male to

Female), how is the sexual attraction of the person defined, that was once male and sexually

active with females, but now is female? If that person who was once a male were to choose a

male partner, is that person a homosexual or heterosexual? They could be married and be in a

heterosexual marriage. However if they choose a female as a sex partner, are they now in a

Lesbian relationship whereas just before Gender Reassignment Surgery they would have been

considered in a heterosexual relationship. This topic is not only for the mind but has been the

subject of court cases where a transsexual MtF was married to a male for years and after her

partner’s death upon settlement of the estate, the estate was left to her but taken away from her

because the family of her husband through the courts had the state declare the long marriage

invalid based on the original sex of the wife.

Bisexuals as with all other groups in the LGBT population can be the target of hate which

is termed “biphobia”. Noting that laws are being changed every day, looking at the Human

Rights Campaign Statewide Employment Laws and Policies map of the United States only four

states have laws that prohibit discrimination based on sexual orientation only.” (Human Rights

Campaign) Bisexuals have also been blamed for the transmission of AIDS and the start of the

AIDS epidemic to the heterosexual public.

In summary for this section, the answers are not easy for a bisexual either in terms of

understanding their own sexuality, in relationships, or in hatred and biphobia expressed by the

heterosexual community, the lesbian community, and the gay community. All these factors

come into play with the counselor working with this population.


The Transgender Population

Of the people in the LGBTQ population, transgendered people are sometimes understood

the least. People comprising the Gay and Lesbian population sometimes are really confused

about transgender people. As stated in the definitions section, Transgender covers a broad range

of individuals that “express their gender in a manner that is different that the “bi-gender” norm of

male and female.” The people in this group range from the heterosexual male that dresses in the

clothes that are traditionally female (known as cross-dressers, formerly transvestites) to the

transsexual who suffers Gender Dysphoria.35 Transgender is an umbrella term that is placed

over the spectrum of people whose gender identities are not the gender binary of male or female.

There are many groups of people under this umbrella term. Transsexuals are those people that

sometimes undergo Gender Reassignment Surgery to physically change their body to people who

have an inner sense of their Gender Identity that is opposite that of their natal or biological sex.36

When one parent was told his child was transgender, he said he could accept the child being a

lesbian and that he could accept his child being Gay, but then buried his faces in his hands and

cried: “Anything but transgender.”37 The fear of transgender people is great at times and many

are murdered each year.38 It is not only Gays and Lesbians that “come out” but transgender

people “come out” as well. Similar reactions occur with the transgender family when someone

comes out as in families that have a Gay family member.

35 Gender Dysphoria refers to the distress that may accompany the incongruence between one’s experienced or

expressed gender and one’s assigned gender. (Association, 2013) p. 451. In the DSM IV TR the classification for

transgender individuals was “Gender Identity Disorder”. This was objected to by transgender advocates who stated

that to get the help they needed they had to be diagnosed with a mental disorder. In the DSM V Gender Identity

Disorder was changed to Gender Dysphoria. 36 The estimated frequency of the population of males that are transsexual is: 1:11,900. For females around 1 in

30,000 BUT because females who are transitioning may not get GRS some estimates of the frequency in the US

between males and females is the same. 37 (Lev, 2004) 38 (Gender Org) Remembering Our Dead


Gender Dysphoria

The feeling of Gender Dysphoria is often very hard for some to understand. One of the

usual comments heard is: “You’re such a good looking man and are attractive to women, why do

you want to destroy your body? You could have any girl you want.” A thought exercise to

answer this question and explain the feelings of dysphoria to a natal female would be to ask that

person to reflect on how wonderful they feel in their femininity, and to reflect on how very

wonderful they feel as a woman. Then to reflect on how utterly wonderful it feels to have sex

with a male partner. Then when they are in this state of reflection, to imagine that society has

appointed someone who has an absolute power position over her and that this person were to tell

her that it did not matter how she felt that it had been decided she would be forced to have and

operation and that via that operation she would no longer have a vagina but would have a penis

for the rest of her life, additionally her beautiful complexion would become coarse and, she

would be forced to wear a beard. Something not very appealing to women.

The Transsexual

The process of “transitioning” is the process the transsexual person goes through when

assuming the gender identity of the gender they feel inside of themselves. It is often assumed

that a transsexual person will have surgery on their bodies to change their body to the gender

they are transitioning to. This is not always the case. For many reasons there can be “pre-op”,

“post-op”, or “non-op” transsexuals. In looking at family dynamics one important matter to note

is that when a transgender person “transitions” they do not do so alone. Every member of their

family, their extended family, their neighbors, their co-workers, and their friends, undergo a

transition as well. Everyone associated with the person transitions. For some the change is

accepted and worked through. For others, the change is rejected with sometimes quite severe

consequences. Even though, there is a lot of information on the subject, some severe reactions


lead to casting the transgender person, out of the house, family, job, church, circle of friends, co-

workers, etc. Sometimes people are murdered, beaten, ostracized, literally kicked out of their

home, and forgotten. One description of a “coming out” and a transition can be found in a paper

by Kathleen Obrien entitled A Transsexual Wonder Woman Finally Beginning Life. (OBrien, A

Transsexual Wonder Woman Finally Beginning Life, 2009)

There is an involved process for a transsexual to transition from one gender to another if

the process involves surgical procedures to achieve the transition. Because of surgical outcomes

the process is different for males who are MtF and females who are FtM. It should be noted here

that some women living the lesbian lifestyle decide to transition FtM. Some lesbians feel that

they identify more as a male. They may choose to transition. This transition may involve:

Mammoplasty

Chest reconstruction

Hysterectomy

Oophorectomy

Genital (bottom) surgery

However, because genital surgery is not as advanced for females (loss of orgasmic ability and the

presence of a penis that does not have any sensitivity for the sex act and cannot achieve erection

without implants, most FtM people do not elect to have genital surgery.

WPATH the World Professional Association for Transgender Health (formerly HBIGDA

the Harry Benjamin International Gender Dysphoria Association) has published the “Standards

of Care” that clinicians and surgeons follow for the transsexual who desires surgery. (Health,

2012) This publication is “the bible” for therapists, physicians, and transsexuals. It lists the

steps to be followed for a transsexual transition. A transsexual cannot “just go” to a surgeon and

ask for GRS (Gender Reassignment Surgery). Steps have to be followed. Generally this is


called the triadic steps for transition (there are more steps in the complete process and are the

initial assessment and the final surgical therapy (making five steps). However when viewed in

three steps those steps are:

1. Psychotherapy

2. Hormonal Therapy

3. Real-Life Experience

Psychotherapy usually involves seeing a therapist for a year or a year and a half plus a

psychiatrist for a year. All Co-Morbid mental issues must be eliminated before the client is

ready for transition and the gender issue examined in detail. Hormonal therapy may take place

within the time frame of the psychotherapy or toward the end of it. Hormonal therapy before

surgery involves the suppression of the natal hormones and the introduction of the hormones of

the gender to be transitioned to. Real-life experience is working and living 24 hours a day for at

least a year in the gender that is the desired goal. Thus when someone states that the transsexual

is “out of their mind” or “doesn’t know what they are doing” are usually completely wrong. The

properly prepared transsexual is usually a very mentally healthy individual. After the triadic

steps are taken the transsexual is then given a letter from the therapists involved for surgery.

There have been relatively few individuals that have regretted their decision to transition. Those

that have cannot “go back” to the way things were. The individuals that have regrets have been

those who have had or probably have had insufficient therapeutic preparation. A case example

follows.

One individual after surgery was beaming from ear to ear with happiness now that she

was “a woman”. Her family was supportive and she had a friend with her in the hospital. After

going home, she called another person who had been in the hospital for the same surgery a week


before and reported “things were great”. The first week a lot of friends had come to wish her

well and to see her. The second week, there were not at all as many people that came. The third

week, there were only a few, and the fourth week perhaps two people came to see her. She

called the person who also had the surgery and told her: “Maybe I’ve made a mistake.” She was

not properly prepared psychologically for what had happened. The expectation from some

people who are not properly prepared is that their complete life will change that figuratively

speaking they are Cinderella and a White Knight will charge in and give complete fulfillment to

their life.

This therapist believes figuratively that your life is like a tightrope you walk along. At

some point on the rope there is a thin cloud that you walk through. Then, you pass to the other

side and you have that event behind you. That event to a transsexual should be the surgery. You

should walk through the surgery psychologically being a woman and appear after the surgery a

woman. The surgery itself does not change you. Nor will it change your life into something

fantastically beautiful. You still have your life to lead.39

The “Trans” Phenomena

AS an LGBT subject matter expert, Kathleen OBrien has seen transgender youth and

adults; the prevalence of the “trans” phenomena seems to be increasing in the last decade.

Treating youth as “trans” people can be confusing at times. In the exuberance of youth and in

the normal development of human development, teenagers may want to go forth into the world

and correct its faults as Don Quixote believing that they will not be harassed, encounter any

problems with their transition (after all the GSA (Gay-Straight Alliance) in school is accepting,

finding a job, or in life. All in the face of the facts that many other people have had difficulty


over a period of years in simply acquiring a name change from New York courts.40 These

people are the clients the CASAC counselor may be working with. A hypothesis that needs

researched is: Does the rise in transgender identified youth represent an actual classification of

transgender or is it grasping at an assumed “identity” for a means of being unique or special?”

Cross-dressers a Transgender Subset

There is a subset of the male population that is called “cross-dressers”.41 Although this

term could technically be applied to some females it is generally applied to males and associated

with males in our current American society.42 There is a unique psychology among cross-

dressers. Generally almost all state that they too have gender dysphoria and would transition if

they could. There are also men who cross-dress primarily for masturbatory purposes. A large

majority of cross-dressers state they dress for this purpose or started dressing for this purpose. A

search on the internet will lead to articles by cross-dressing individuals that openly state this and

proclaim it to the world as a valid reason to display themselves in public to become sexually

excited. This is one of the main differences between cross-dressing males and transsexuals.

Transsexual males find that clothes do not arouse them sexually and they do not dress in female

attire for that purpose. The purpose that transsexuals dress in female attire is because it

accurately reflects their gender.

40 The ability to change one’s name varies from judge to judge and from county to county. Some judges will grant

them with proper paperwork especially if that paperwork includes a letter from a therapist or psychiatrist. Others

will not grant a name change unless the filing comes through an attorney. Judges often say “No.”, and are NOT

required to give any reason for declining the name change. 41 It is estimated that up to 85% of men have cross-dressed to some extent AND it is to be noted that 95% of cross-

dressers are married heterosexual men with families. (OBrien, LGBT Issues, 2007-2014). 42 When lecturing audiences the author of this paper asks who in the audience might want to identify as in the

audience cross-dressed. Usually none of the women raise their hands even when wearing jeans or slacks. What is

pointed out that in some cultures of the world today, there are some societies that would lock them in confinement

for that behavior and not let them out until they decided to wear a skirt or dress. Then if they did not change their

mind, they could be stoned to death.


Since 95% of cross-dressers are married heterosexual men with families, the presentation

of the cross-dresser in feminine attire is of course, a major psychological impact to themselves,

their wives, their families, and to society. This can of course lead to substance abuse of Alcohol

and other Drugs. Many have to hide their cross-dressing from their wives, children, and

families. They then lead a life that is full of secrets and deceit. This can and does cause a lot of

conflict in a marriage.

Psychologically, cross-dressers sometimes have a unique perspective on who they are.

Some constantly feel guilty about their behavior and suffer constantly for it. Others have hidden

“stashes” of clothes, makeup, etc. available at their disposal and ready for use either at meetings

of support groups, going out shopping when they feel they are less likely to get caught or at

conferences. Some support groups will have changing rooms available for the cross-dresser to

change clothes in before the meeting. Some cross-dressers have to put away their identity until

their spouse is literally out of town. Some cross-dressers upon wearing female attire think and

feel that they are literally female. This leads to some interesting behavior in many aspects of the

cross-dresser’s life. Some cross-dressers go to bars that are safe for them or that cater to specific

clientele. “Tranny-admirers” also frequent these bars. They are men who want to be

around/with transgender people (either cross-dressers or transsexuals). Some wish to have sex

with cross-dressers.43 Some cross-dressers and some transsexuals develop the idea that “real”

women generally across the board meet strange men in bars and have sex with them. The cross-

dresser feels that having oral (or other) sex with a man makes them “more of a woman” since

they were seen to be so attractive that a man picked them up over the choice of other women.

43 “Tranny” is a short term for a transgender person. It is now a pejorative term and should NOT be used. It is

insulting and deprecatory.


Conventions are held with transgender themes. There are national and large conventions

in many cities. Some cross-dressers go to conventions for the lectures, workgroups, classes, etc.

but others go to “hook up” with other cross-dressers. One transsexual said that transgender

conventions are the biggest hook-up events of the planet. Some cross-dressers state they are

women and sometimes psychologically bend reality to the point that when having sex with

another male believe they are women and are have had sex with another woman. When the

convention is over and the cross-dresser goes home, if he is married and his wife confronts him if

he has had sex with another woman he will say categorically that he did not. After all, the

physical body of the other person was a male body but she does not need to know that.

The immersion into the internet for many cross-dressers is interesting. There are many

internet sites catering to cross-dressing. There are chat groups for cross-dressers and there are

also fantasy sites for cross-dressers. These fantasy sites usually have a tremendous amount of

stories written by and for cross-dressers. The subject of these stories range from living a life as a

beautiful woman whose femininity is so fantastic she can win beauty pageant hands down or be a

model trophy wife, or of forced feminization where a male is kidnapped, taken hostage, etc. by

strong rough men or by their girlfriends and forced to wear female clothes and behave as a

female. Another fantasy is that a magic item such as a lantern is found and when rubbed turns

the person holding the lamp into the opposite sex. The danger seen in some cross-dressers is that

they feel compelled to spend more and more time in these fantasy sites reading and writing more

and more stories. In her book, “The Porn Trap” Wendy Maltz discusses pornography (as

usually thought of) and the problems caused by it. (Maltz, 2010) Internet Porn as general

thought of photos, videos, and live “chat” rooms can become an addiction. The author of this

paper has seen in cross-dressing clients that fantasy web sites such as described above have


become an addiction to them. The author of this paper, to the best of her knowledge is the only

person that has openly equated cross-dressing web sites to internet porn addiction.

One client, a natal male cross-dresser was so addicted to the fantasy site that he told a

therapist that he would rather read those stories than be physically with his wife (who had

planned for a romantic evening) lying beside him in bed. Quite literally the addiction counselor

may have to understand this addiction as well.

Transgender case examples

The CASAC counselor will work with individuals in the LGBTQ population and must

keep in mind that each individual is different. Some will be on masculinizing or feminizing

hormones. These hormones certainly have an effect on the body but can also have an effect on

thinking as well. Given that the introductions of hormones into a transgender youth can and will

permanently change their body, one telling question OBrien asks is of course: “Why are you

here?” One answer given is: “Because I want to be a girl.” A more meaningful response in the

clinical sense would be (for a MTF client): “Because I AM a girl.” There is a tremendous

difference in these two statements clinically. One case of a person claiming to be transsexual

follows:

One client went from therapist to therapist insisting they were transsexual and

stating that he wanted to be a girl. One therapist finally asked “Why do you want

to be a girl?” The client answered: “Because girls have it easier in society. Men

hold doors open for them, they are treated with love, and people give them gifts.”

In another case a person who had no health insurance and lacked money for mental health

and endocrinologists wanted to transition from male to female. This person thought that to be a

“woman” she had to have breasts as large as possible and as fast as possible. Lacking the funds


to see an endocrinologist she ordered hormones from offshore pharmacies. (Offshore

pharmacies will sell hormones to any individual with a credit card without a prescription.) This

person took four times the recommended maximum amount of hormones and ended up with a

blood clot in her leg.44 It was safely removed but from that point on NO endocrinologist would

treat her because of her non-compliance with medical recommendations. She fell into a deep

depression and was found hanging by her neck from a rope tied to a tree in a forested area having

committed suicide.

Regarding hormonal treatment of a young teenage transgender youth, the client walked

into a clinic demanding “T” (testosterone). When told that IF that were administered, within a

period of six months, she would be sterile. Her response was: “I don’t care.” The question that

arises is: Can a young teenager have enough life experience to state that for the rest of their life,

they are completely at ease with being sterile? If this decision was made and hormones

administered, would that person in 10 years feel they had made a mistake and turn to alcohol and

other drugs, in depression and regret?

Use of pronouns with Transgender Clients

With transgender clients the use of pronouns can at times be a sensitive issue. For the

natal male that is transitioning to a female, hearing the pronoun “he” or “his” or the word “Sir”

can be especially upsetting. In some cases depending on context, it could be considered

harassment and discrimination which could be a violation of civil rights and an actionable item

in Federal EEOC and State Human Rights Courts. When a person is in the process of transition

they can become very sensitive to the comments, remarks, slurs, insensitivity, and outright hatred

of others against them. The transgender person can seem to develop “super sensitive’ senses to

44 Hormones can lead to a 40% higher rate of thromboembolic events when taken for alteration of secondary sex

characteristics.


comments and non-verbal behavior or others. Some waiting in lines for elevators, will listen for

any laughter after they get off and the doors close on the other occupants. Some hear comments

of complete strangers passing in a street intersection saying “you’re not a man” or “you’re not a

woman”. Others have had strangers yell derisive comments at them from the opposite side of a

city street.45

There is a simple solution to all of this. Use the pronoun of the presenting gender even if

you feel that the natal gender is opposite. For a cross-dresser wearing female clothes use “she”

or “her”, etc. For the transsexual FtM presenting as a male use “he” and other masculine

pronouns. If you are not sure how to address the person, simply ask: “How would you like me to

address you?”

45 . Although transgender pronouns are being discussed for transgender clients the rule applies to other people in

this LGBTQ population as well. One Lesbian whose chosen appearance was masculine was addressed in a very

large national superstore chain by a manager yelling: “Sir, or Ma’am, or whatever the hell you are, get out of the

store!”


Queer/Genderqueer Clients

The people in this group share some attributes as the other populations in the LGBT

spectrum. Expanding the definition above: GenderQueer is defined as “a person whose gender

identity is neither man nor woman, is between or beyond genders, or is some combination of

genders. This identity is usually related to or in reaction to the social construction of gender,

gender stereotypes and the gender binary system. Some genderequeer people identify under the

transgender umbrella while others do not.” (GenderEquity Resource Center)

Kate Bornstein wrote a book titled Gender Outlaw; On Men, Women, And the Rest of Us.

In that book she said:

“In this culture, the only two sanctioned gender clubs are “men” and “women”.

If you don’t belong to one or the other, you’re told in no uncertain terms to sign

up fast.” (Bornstein, 1994)

People that are Gender Queer find themselves in this situation and find they do not “fit” into the

societal binary scheme of gender. When someone walks down the street and looks at people in

passing, usually they are automatically classified as to gender. When presented with an

androgynous individual you try very hard to classify them. This brings up a dissonant feeling

and you grasp at a definition. Some GenderQueer people dress androgynously on purpose to

play “tricks” on others trying to classify them. This is called a GenderFucking or a GenderFuck.

However, for most people that are GenderQueer, there is no game playing. They dress

androgynously or outside their natal gender because it feels “right” to them. They wear their hair

as they want and may or may not exhibit any stereotypical gender behavior. They feel happy and

not confined by living their lives in a manner that may reject the idea of a gender binary feeling


that everyone is made of multiple genders and it is a modern societal custom to demand and

absolute gender pigeonholing.

The use of pronouns with some GenderQueer people is unique. For example a

GenderQueer person may NOT want you to use the pronouns of he or she but prefer to be

addressed as “hir”, “ze”, “zir” which is generally perplexing to the public in general. In one

instance a natal female who identified as GenderQueer preferred the pronouns “they” and “them”

when being addressed as an individual.

Some of the difficulties experienced by people that are GenderQueer are just as hurtful as

other people in the LGBT umbrella population. One natal female who put herself in this

classification is a teacher working with young children. For reference in this paper her name is

Max. Max did a good job as a teacher but because of the gender presentation Max displayed,

one very angry parent came up and said: “I don’t want you to EVER work with my child again.”


LGBTQ Youth Kicked Out of Their Homes

In talking about the LGBTQ population, one thing that might shock many parents is that

LGBTQ children can be literally kicked out of their homes for coming out. One study stated that

“Additional research on the reasons LGBTQ youth become homeless would help providers

identify and address the potentially varied and distinct factors contributing to this problem.”46

The same study also states that: “…lesbian, gay, and bisexual youth and heterosexual youth who

have same-sex sexual partners are 4 to 13 times more likely than exclusively heterosexual youth

to be homeless.”47 These reasons are obvious and have been documented in many places.

Simply, some homeless LGBTQ youth are quite literally kicked out of their homes for who they

are.48 Society has and still rejects the LGBTQ individual as something that is “normal” in

society. “For gays, lesbians, and bisexuals, as well as transgendered and transsexual people,

there is, first of all, a need to come to terms with socially despised aspects of self.”49 It is not

only the LGBTQ youth that are kicked out of their homes and families. Adults are also

disowned and unwanted by their families when they “come out”.50 Families may be so ashamed

to have a Gay person in their family they are disowned and disavowed.

46 (Burwick, 2014) p. ix 47 (Burwick, 2014) p.1 48 (Lowrey, 2010) 49 (Lev, 2004) p.232 50 The phrase “come out” means to come out of the closet. This is making a reference that if you are physically in a

closet you are hidden from view. Coming out of the closet is announcing that you are Gay and now are no longer

hidden from view.


Risk and Protective Factors in the LGBTQ Population

In the study of factors that can contribute to the use of Alcohol and Other Drugs, the

factors that can contribute to the use of AOD are termed “risk factors” they are “…’problematic

symptoms, behaviors, and associations’ that may contribute to poor outcomes…”51 Protective

factors are”…’positive skills, attitudes, behaviors, and associations’ that counteract the effects of

risk.”52 In (Burwick, 2014), several statements appear that are findings about LGBTQ youth

that are no longer living at home:

“…some types of risks—emotional distress and poor mental health, substance

abuse and sexual risk behavior, and problems with family and personal

relationships—were perceived to be particularly salient or frequent among

LGBTQ youth.”

“…LGBTQ youth may be at greater risk for experiencing homelessness and, if

they become homeless, more likely than their heterosexual counterparts to

experience victimization, engage in high-risk sexual behaviors, and have poor

mental health.” (Burwick, 2014) P. viii

“…lesbian, gay, and bisexual youth and heterosexual youth who have same-sex

sexual partners are 4 to 13 times more likely than exclusively heterosexual youth

to be homeless.” (Burwick, 2014) p.1

Given these statements, the following lists show the Risk Factors and Protective Factors

associated with runaway and homeless LGBTQ youth. Again note that these factors also

apply to adults who are homeless and have been “kicked out” in one way or another. Of

course, the risk factors are far greater than the protective factors. Look at the risk factors

51 (Burwick, 2014) p. 16. 52 (Burwick, 2014) p. 16.


and think about how great outcomes could be if they were reversed. “ LGBT youth

exhibit mental health or behavioral issues at higher rates than heterosexual youth,…”53

Risk Factors of the LGBTQ Population

Being homeless

No family support

No extended family support

No income or discrimination in obtaining employment

Constant violence or threats of violence from society, family, and partners

Human trafficking

Sexual exploitation54

Intimate partner dating violence

Low self esteem

Emotional distress

Poor mental health

Lack of counselors familiar with LGBTQ issues

Lack of access to medical help for physical health

Sexual Risk Behavior

No adequate peer support group

No positive role models in their peers

No positive role models in adults.

Forced prostitution

No adequate or constant nutrition

No adequate or safe housing

Bullying in school

Not having a counselor (at school or in a clinic) that understands LGBT problems

No access to healthcare or poor healthcare

Protective Factors of LGBTQ Population

Possible development of survival skills after experiencing stigma and rejection.

53 (Burwick, 2014) p. 16. 54 Note many LGBTQ homeless youth are forced to sex work just to survive – to buy food.


What Substance Abuse Agencies Need to Do

What follows is several suggestions to agencies with LGBTQ clients of all ages. They

range from training to intake forms.

1. Although some agencies have annual trainings in LGBTQ cultural competency,

this is not enough. Those outside the LGBTQ community may not understand the

constant rejection and harassment of those who are in the “LGBTQI” community.

What each agency needs is a competent counselor that is IN the LGBTQI

community and has no biases against any other part of the community but is

willing to serve all.

2. (Burwick, 2014) suggests that technical assistance and trainings be held regularly.

Since this might not be possible in agencies without access to local LGBTQ

resources, these trainings could be given by a subject matter expert using several

methods. One would be a seminar given in house by a traveling LGBTQ expert.

Secondly, training could be given on-line. This is also suggested by Lev: “With

the exception of some trained sexologists and a small number of medical doctors

and psychotherapists, the majority of clinicians, including social workers,

counselors, psychologists, psychiatrists, and physicians, have not received

training on the treatment of sex and gender identity or issues involving gender

dysphoria and transgenderism.”55

3. Each agency providing services should have a staff member that has more than a

passing knowledge of LGBTQ issues. “Studies in…New York City (Valentine,

1998) demonstrate a need to increase services for transgendered and transsexual

communities in areas of substance abuse…”56

4. In one study (Burwick, 2014), there was an “….absence in some agencies of

standardized protocols for gathering sexual orientation or gender identity

information.” In addition in this study,”…no agencies reported using tools that

specifically target LGBTQ youth.”57 There must be tools within the agency that

supports LGBTQ youth.

5. At times it may be difficult for an agency to collect data about homeless youth.

“Questions on sexual orientation and gender identity are likely to be particularly

sensitive for young people, who may fear harassment by peers and others, or have

concerns that information will be disclosed to their families.”58 In addition, those

clients need to feel SAFE in the agency. If they do not feel safe, then they may

not volunteer information about their sexual or gender identity.

55 (Lev, 2004) p.18 56 (Lev, 2004) p. 20. 57 (Burwick, 2014) p. viii 58 (Burwick, 2014)p. 9


6. Intake forms should allow for the expression of Gender and Sexual Orientation.

APPENDIX A of this document shows a portion of an intake form from several

agencies ( (Burwick, 2014) p.11. What is to be noted in this document is that

there are multiple Gender fields and multiple Sexual Orientation fields a client

can select. This is important in that the client now can step outside the box of

societal defined types and express themselves in a manner they feel comfortable

with.

7. AOD users are stigmatized for being so. Being LGBTQ adds to this

stigmatization. The difficulty of overcoming social stigma, especially toward

LGBTQ youth of color and transgender or gender-nonconforming youth is a

problem. Training to reduce this stigma should be provided.

8. Burwick stated “One agency employs an LGBTQ case manager who develops

individual service plans for LGBTQ-identified youth in its housing programs.

Another operates a host home program specifically for LGBTQ youth, matching

these youth with LGBTQ-supportive adults who offer youth transitional housing

in private homes.”59

9. “Staff in two agencies reported that they aim to facilitate reconciliation between

LGBTQ youth and families when possible, but that such assistance is offered only

to the extent a youth wishes to engage with her or his family.”60 However it

should be noted that some LGBTQ people DO NOT WANT their Sexual or

Gender Identity revealed to their family. In this the clinician might NOT want to

do so.

10. Adopt policies prohibiting discrimination and harassment.

11. Partner with other organizations serving the LGBTQ community.

59 (Burwick, 2014) p. viii 60 (Burwick, 2014) p. viii.


APPENDIX A

A portion of an intake form appropriate for LGBTQI clients is listed in Figure 1.

Box II.1. Sexual Orientation and Gender Identity Questions on Agency Forms and in RHYMIS

Agency A: Emergency Shelter Intake Form

Gender

Male Female Transgender male to female Transgender female to male Other Don’t Know Refused

Sexual Orientation

Heterosexual Bisexual Gay Lesbian Questioning Self-Identified Orientation

Agency B: Health Risk Assessment Form

What is your sexual orientation and/or gender identity?

Heterosexual (straight) Homosexual (gay or lesbian) Bisexual Transgender Gender confused

Agency C: Emergency Shelter and Transitional Housing Intake Forms

Gender options:

Female Male Transgendered (female to male) Transgendered (male to female) Client does not know Client refused Other

RHYMIS Basic Center and Transitional Living Entrance Reports

Gender: Choose one code indicating how the youth describes his/her gender identity.

Male Female Transgender female to male Transgender male to female Other Not known or not determined

Sexual Orientation: Choose one code indicating how the youth describes his/her sexual orientation.

Heterosexual Gay Lesbian Bisexual Questioning/Unsure Not known or not determined

Figure 1 Intake form with Sexuality and Gender Fields


Further Gender/Sexuality Terms and Definitions

AG A term used to describe a female-bodied and identified person who prefers presenting as

masculine. This term is most commonly used in urban communities of color. B

Agender A person who is internally ungendered or does not have a felt sense of gender identity.

Androgynous/androgyne: in terms of gender identity is a person who does not fit neatly into

the typical masculine and feminine gender roles of their society. Androgynes may also use the

term "ambigender" or "polygender" to describe themselves. Many androgynes identify as being

mentally between woman and man, or as entirely genderless. They may identify as "non-

gendered", "gender-neutral", "agendered", "between genders", "GenderQueer", "multigendered",

"intergendered", "pangender" or, "gender fluid".

Bear: In male bisexual and gay culture, a Bear is a large, hairy man who projects an image of

rugged masculinity.

Beast: A person or thing that looks tough, ripped, cut, or has an intimidating presence. A person

who is very good at something.

Bi-Gender: Bigender or bi-gender: describes a person who feels they exhibit two genders. The

two genders may include any particular gender on or outside of the gender spectrum. Some

bigender individuals switch genders (Gender Switching), sometimes using different personas for

either gender to feel comfortable in at any given time. It is recognized by the American

Psychological Association (APA) as a subset of the transgender group.

Bisexual: Bisexuality is romantic attraction, sexual attraction or sexual behavior toward both

males and females.

Boi: 1. in the lesbian community, a young transgendered/androgynous/masculine person who is

biologically female and presents themselves in a young, boyish way; a boidyke; often also

identifies as GenderQueer. 2. in the gay community, a young gay man; 3. In the BDSM

community, someone who presents themselves in a young, boyish way and is usually a

bottom/submissive.

Butch and Femme: are terms used to describe individual gender identities in the lesbian, gay,

bisexual, transgender and cross-dressing subcultures to ascribe or acknowledge a masculine

(butch) or feminine (femme) identity with its associated traits, behaviors, styles, self-perception

and so on.

Cross Dresser: Someone who wears clothes associated with another gender part of the time.

This term has replaced "transvestite," which is now considered outdated and offensive.

Drag King: Drag kings are mostly female performance artists who dress in masculine drag and

personify male gender stereotypes as part of their routine. A typical show may incorporate


dancing and singing, sometimes live or lip-synching to pre-recorded tracks.[2] Drag kings often

perform as exaggeratedly macho male characters, portray marginalized masculinities such as

construction workers, rappers, or "fag drag," or they will impersonate male celebrities.

Drag queen: A drag queen is a person, usually a man, who dresses, and usually acts, like a

woman often for the purpose of entertaining or performing. There are many kinds of drag artists

and they vary greatly from professionals who have starred in movies to people who just try it a

few times. Drag queens also vary by class and culture and can vary even within the same city.

Although many drag queens are presumed to be gay men or transgender people, there are drag

artists of all genders and sexualities who do drag for many reasons. Generally, drag queens dress

in a female gender role, often exaggerating certain characteristics for comic, dramatic or satirical

effect. Other drag performers include drag kings, who are women who perform in male roles,

faux queens, who are women who dress in an exaggerated style to emulate drag queens and faux

kings, who are men who dress to impersonate drag kings.

Dyke: Slang noun meaning Lesbian

Fag: Faggot, often shortened to fag, is a pejorative term used chiefly in North America

primarily to refer to a gay man. Alongside its use to refer to homosexual men in particular, it

may also be used as a pejorative term for a "repellent male" or a homosexual of either gender.

Its use has spread from the United States to varying extents elsewhere in the English-speaking

world through mass culture, including film, music, and the Internet.

Fag Hag: a person, frequently a straight woman, who enjoys hanging out with gay men.

Fish: fish--what some gay men call females; frequently derogative, sometimes joking.

Sometimes it means something is smelly down below.

FtF: Female to Femme, we can understand more what the movement of FtF means. It refers to

the deconstruction of what society expected on lesbians, particularly on femmes (lesbians with

possession of femininity who love butches).

Gender fluid: moving between genders or with a fluctuating gender identity (genderfluid).

Gender F%$k/Genderbending: A genderfuck, or gender fuck or gender-fuck, is the conscious

effort to mock or "fuck with" traditional notions of gender identity, gender roles, and gender

presentation which assume that one's identity, role and orientation is determined by one's sex

assigned at birth. This activity has also been called genderbending.

GenderQueer: A person whose gender identity is neither man nor woman, is between or

beyond genders, or is some combination of genders. This identity is usually related to or in

reaction to the social construction of gender, gender stereotypes and the gender binary system.

Some genderequeer people identify under the transgender umbrella while others do not.


Gender variance/gender nonconformity, is behavior or gender expression that does not

conform to dominant gender norms of male and female. People who exhibit gender variance may

be called gender variant, gender non-conforming, or gender atypical

Grrrl: "grrl" means lesbian OR “gyrl" means a transgendered male "transvestite"

Heterosexuality is romantic attraction, sexual attraction or sexual behavior between persons of

opposite sex or gender in the gender binary. Sexual, emotional, and/or romantic attraction to a

sex other than your own. Commonly thought of as “attraction to the opposite sex” but since there

are not only two sexes (see "Intersex" and "Transsexual"), this definition is inaccurate.

Hijra: In the culture of South Asia, hijras /eunuchs are Designated Male At Birth people who

have feminine gender identity, adopt feminine gender roles, and wear women's clothing.

Intersex: Intersex is a set of medical conditions that feature congenital anomaly of the

reproductive and sexual system. That is, intersex people are born with "sex chromosomes,"

external genitalia, or internal reproductive systems that are not considered "standard" for either

male or female. The existence of intersexuals shows that there are not just two sexes and that our

ways of thinking about sex (trying to force everyone to fit into either the male box or the female

box) is socially constructed.

Kathoey: Kathoey or katoey is a Thai term that refers to either a transgender woman or an

effeminate gay male in Thailand. While a significant number of Thais perceive kathoeys as

belonging to a third gender, including many kathoeys themselves, others see them as either a

kind of man or a kind of woman….The word kathoey is of Khmer origin. It is most often

rendered as ladyboy or lady boy in English conversation with Thais and this latter expression has

become popular across South East Asia.

Lesbian: A woman that is attracted to another woman. Usually as a sexual partner. The word

"lesbian" is derived from the name of the Greek island of Lesbos, home to the 6th-century BCE

poet Sappho. W "Lesbian" as a concept, used to differentiate women with a shared sexual

orientation, is a 20th-century construct. Throughout history, women have not had the same

freedom or independence to pursue homosexual relationships as men, but neither have they met

the same harsh punishment as homosexual men in some societies.

Lipstick Lesbian Femmes aka "lipstick lesbians" are féminine lesbians.

Metrosexual: The typical metrosexual is a young man with money to spend, living in or within

easy reach of a metropolis — because that’s where all the best shops, clubs, gyms and

hairdressers are. He might be officially gay, straight or bisexual, but this is utterly immaterial

because he has clearly taken himself as his own love object and pleasure as his sexual

preference.


MTM--Male to Male. Some female to male transsexuals dislike the term FTM, because they feel

that they were never female, and were always male, and that all this surgery is merely cosmetic,

to make it clear to everyone else that they are male.

Neutrois: “An identity used by individuals who feel they fall outside the gender binary. Many

feel Neutrois is a gender, like a third gender while others feel agendered.”

Omnigender Or: polygendered, pertaining to a person whose gender identity encompasses all

genders, not so much as combination of male and female, but rather as the greatest common

denominator of male and female. http://www.definition-of.com/omnigendered

Pillow Queen: A woman who likes to receive and not give sexually is called a "pillow queen".

Queen: In gay slang, queen is a term used to refer to flamboyant or effeminate gay men. The

term can either be pejorative or celebrated as a type of self-identification.

Shark/Carpet Shark: 1 Slang term for a lesbian 2) a lesbian who likes to go down on girls who

are on their period. When they come up for air, they have blood on their face.

Soft femme: Femme-ness expressed in pinks, pastels, pearls and bows Sissy cross dresser

Stone butch: A stone butch is a butch woman or transgender person who is apparently

masculine in character and dress, who tops their partners sexually (and sometimes emotionally),

and who is averse to sexual contact with their genitalia. .

Straight acting: Straight-acting is a term for an LGBT person who does not exhibit the

appearance or mannerisms of what's seen as typical for gay people. Although the label is used by

and reserved almost exclusively for gay and bisexual men, it may also be used to describe a

lesbian or bisexual woman exhibiting a feminine appearance and mannerisms. Because the term

invokes negative stereotypes of gay people, its application is often controversial and may cause

offense.

Third gender: The terms third gender and third sex describe individuals who are categorized (by

their will or by social consensus) as neither man nor woman, as well as the social category

present in those societies who recognize three or more genders. The term "third" is usually

understood to mean "other"; some anthropologists and sociologists have described fourth, fifth,

and even some genders. The concepts of "third", "fourth" and "some" genders can be somewhat

difficult to understand within Western conceptual categories.

Tomboi: lesbian who acts like a boy. Derivative of tomboy (16th Century).

Transgender: Transgender (sometimes shortened to trans or TG) people are those whose

psychological self ("gender identity") differs from the social expectations for the physical sex

they were born with…. An umbrella term for transsexuals, cross-dressers (transvestites),

transgenderists, gender queers, and people who identify as neither female nor male and/or as

http://www.definition-of.com/omnigendered


neither a man or as a woman. Transgender is not a sexual orientation; transgender people may

have any sexual orientation.

Transsexual: Transsexualism describes the condition in which an individual identifies with a

gender inconsistent or not culturally associated with their assigned sex, i.e. in which a person's

assigned sex at birth conflicts with their psychological gender. A medical diagnosis can be made

if a person experiences discomfort as a result of a desire to be a member of the opposite gender,

[1] or if a person experiences impaired functioning or distress as a result of that gender

identification.

Transvestite: Transvestism (also called transvestitism) is the practice of dressing and acting

in a style or manner traditionally associated with the opposite sex. Magnus Hirschfeld coined the

word transvestism (from Latin trans-, "across, over" and vestitus, "dressed") to refer to the sexual

interest in cross-dressing. He used it to describe persons who habitually and voluntarily wore

clothes of the opposite sex. Hirschfeld's group of transvestites consisted of both males and

females, with heterosexual, homosexual, bisexual, and asexual orientations.

Twink: Twink is a gay slang term describing a young or young-looking man with a slender,

ectomorph build, little or no body hair, and no facial hair. In some societies, the terms fox, plum,

chick, or chicken are preferred. The related term twinkle-toes, which implies that a man is

effeminate, tends to be used in a derogatory manner. The terms can be complimentary or

pejorative.

Two Spirit: Two-spirit people (also two spirit or twospirit) is an umbrella term sometimes used

for what was once commonly known as berdaches /bərˈdæʃɨz/, indigenous North Americans who

fulfill one of many mixed gender roles in First Nations and Native American tribes.

Unicorn: Colloquial; Synonym for hot bi babe or HBB, often derogatory, condescending, or

ironic. A bisexual person, usually though not always female, who is willing to join an existing

couple, often with the presumption that this person will date and become sexually involved with

both members of that couple, and not demand anything or do anything which might cause

problems or inconvenience to that couple.

Gender Bender: Gender bender is an informal term used to refer to a person who actively

transgresses, or "bends," expected gender roles. Gender bending is sometimes a form of social

activism undertaken in response to assumptions or over-generalisations about genders. Some

gender benders identify with the gender assigned them at birth, but challenge the norms of that

gender through androgynous behavior and atypical gender roles. Gender benders may self-

identify as transgender or genderqueer, feeling that the gender assigned to them at their birth is

an inaccurate or incomplete description of themselves; some are transsexual and desire to change

their physical sex through hormone therapy or sex reassignment surgery.


Fafafine: Fa'afafine are the gender-liminal, or third-gendered people of Samoa. A recognized

and integral part of traditional Samoan culture, fa'afafine, born biologically male, embody both

male and female gender traits. Their gendered behavior typically ranges from extravagantly

feminine to mundanely masculine.

Trans*: Write your own definition.


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INTRODUCTION TO THE LGBTQ POPULATION FOR CLINICIANS

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