In Colorado, lots of trans teenagers think of suicide

The Colorado Department of Public Health and Environment conducted a Healthy Kids Colorado Survey in 2015. Ann Schimke of Chalkbeat reports that the survey shows that transgender teenagers in the state are more likely to plan or attempt suicide than their non-trans classmates.

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Unlike some surveys, this is based on an actual sample of 15,970 high school students in Colorado, with a 46% response rate. 2.2% of the kids (162) said they were trans, and 1.6% (118) said they were questioning their gender. 35% (57) of the trans kids said they had attempted suicide, and 14% (16) of the questioning kids said they had.

The reported rate of attempted suicide for the other kids is 7%. That’s 53 more high school kids in Colorado who say they’ve attempted suicide than would have if they hadn’t been trans.

I’ve got more thoughts on suicide, but the biggest thing is that we need to work on accepting kids who are trans. That doesn’t necessarily mean any body modifications. Just accepting would make a huge difference. I say that from experience.

The Power of Glamour and transgender feelings

Seven years ago I talked about the notion of glamour as described by Virginia Postrel. Virginia has been working on a book about glamour, and it was published on Monday. Here’s the definition from the book (as of last year):

Glamour is not the same as beauty, stylishness, luxury, sex appeal, or celebrity. Glamour is, rather, a form of nonverbal rhetoric, which moves and persuades not through words but through images. Glamour takes our inchoate longings and focuses them. By binding image and desire, glamour gives us pleasure, even as it heightens our yearning. It makes us feel that the life we dream of exists, and to desire it even more. We recognize glamour by its emotional effect—a sense of projection and longing—and by the elements from which that effect arises: mystery, grace, and the promise of escape and transformation. The effect and the elements together define what glamour is.

The Power of GlamourYou can probably see why I was immediately struck by the connection to transgender feelings. My strongest trans feeling is that longing to escape from my male reality, with its career obligations and social frustrations, where I’m expected to go out and get what I want, into a dream world where all I have to do is put on the right clothes and everyone will pay attention to me, desire me, and give me what I want. (Yeah, right!)

To me, glamour explains the connection between gender dysphoria, my feeling of unhappiness with being a man, and gender desire, my desire to be a woman, to be seen as a woman. There are lots of men who are unhappy being men, but only some of us want to be women. Glamour helps us understand why we do.

As Virginia has pointed out, this is compatible with the Official Trans Narrative: if you have an innate sense of gender that doesn’t match your physical sex, then you’re likely to be unhappy and thus feel a desire to escape your birth gender classification. But for those of us not convinced by the innatist narrative, glamour opens the door to other explanations.

Since then I’ve followed Virginia on her blogs and on Twitter, and in June she mentioned that she visited my blog while checking footnotes. On Monday night I had the pleasure of meeting her in person at the book launch party, and found that I’m quoted on Page 63, connecting glamour with despair:

I came to the idea of despair based on Virginia’s characterization of glamour as a means of escape. If you’re trying to escape through a fantasy you have to be pretty desperate, right? That’s the sense of “despair” that I mean – a feeling of being trapped and having no options left.

To Angus/Andrea with thanks & best wishes - Virginia

That’s from a comment I left on an article Virginia wrote in 2008, expanding on the connection Salman Rushdie made between terror and glamour. In the book, she expands on my connection to despair by noting the glamour elements highlighted in the documentary Paris Is Burning.

The glamour response is powerful. It can move us to approach strangers, to buy houses, and to blow up buses full of people. It can also move us to cross-dress, to get surgery to change our bodies, and to declare gender transitions.

What I’ve read of the book so far has been great. I encourage anyone who’s interested in transgender feelings to get a copy. I’ll be posting more about it in the future.

Good research: Three trans communities in New York City

In November I was annoyed with a couple of statements by Sel Hwahng, but after re-reading this article he co-authored with Larry Nuttbrock, I’ve decided that it’s really solid research and should be read by anyone who’s interested in public health – or trans politics in general.

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The Silver Swan, a popular hangout for “White cross-dressers” in the mid-00s.

As I discussed in my earlier post, several years ago I participated in a study where I went to a storefront every month or so, gave a blood sample, and talked with a researcher for a while. Usually it was a fairly repetitive series of short-answer or Likert questions, but there were a few discussions that were more open-ended. Larry Nuttbrock was the principal investigator on the study, and I’m one of the “White cross-dressers” that he and Hwahng are talking about.

Re-reading the article, I see that it was really only two lines that bothered me:

These cross-dressers explained that because of their desire to maintain a traditional masculine gender role and hide their transgender status, they often did not undergo transition, hormonal supplementation, or surgery until well into their 40s or 50s. Transition often occurred after a domestic breakup, when they could be more out as transgender.

It was definitely true that some of us really wanted to transition but felt trapped by commitments to work and family, but not all of us by any means. I personally decided that I didn’t want to transition years before I got married and had a child, and I haven’t changed my mind about it. Most of the other people I met in that scene showed no interest in transitioning. But this is relatively minor.

Judging from media reports and health research, you might think that the trans population is either all HIV-infected prostitutes or all sexy young transitioners. I schlepped down to Avenue A every month and got pricked with a needle so that people could see another way to be trans. Hwahng and Nuttbrock show that here in New York there are at least three ways to be trans. They found that life was very different for us White cross-dressers than for Asian sex workers and members of the House Ball community.

According to Hwahng and Nuttbrock, House Ball members, almost all from Black and Latin American backgrounds, were more likely to engage in survival sex work and to have little power to refuse sex or to insist on condoms. Members of my White cross-dresser community were largely able to avoid sex work if we chose, so “when White cross-dressers did engage in sex work, it was almost always for recreational purposes.” The Asian sex workers in the study had an intermediate level of power, often being able to insist on condoms and working in hotels and apartments instead of on the street.

Given these different circumstances, it’s sadly not surprising that our risks of HIV infection are vastly different. In another paper co-authored by the entire study team, they didn’t have enough data about the Asian sex workers, but they reported that “HIV was 3.5% among Caucasian Americans compared to 49.6% and 48.1% among the Hispanics and African Americans.”

It’s important to note here the limitations of the study. Nuttbrock and his colleagues were able to investigate these three trans communities, but they were aware of others:

The study also identified additional groups, including the following: low-income, immigrant Latina(o) sex workers of Central and South American origin who solicited in Queens; low income, immigrant Latina(o) sex workers who solicited in Manhattan; and low-income, immigrant South Asian transvestites in Manhattan, Queens, and New Jersey. Not enough data had been gathered at this writing, however, for detailed analyses of these other populations. Some study participants did not fit any of these ethnocultural contexts but did not constitute large numbers and were thus considered outlier data.

This is really key. We don’t know what we don’t know. There could be some population of wealthy South Asian transvestites that completely swamps all three of the other groups numerically, but that was invisible to Hwahng and Nuttbrock because they meet in secret in luxury condo towers. Not that likely, but nobody really knows. I’ll close with a great quote from the report:

To understand the complex, interlocking behavioral and sociostructural determinants of health that often remain hidden within the geographic location of the New York City metropolitan area, it is thus imperative to examine as many divergent ethnocultural transgender communities as possible.

Good research of the month: “coming out” in trans communities

As you could probably tell, I feel bad describing research like the Trans Mental Health Study in such strong negative terms. I know that the authors wanted to do something to help the trans community, and they thought that was what they were doing. I want to balance that out by highlighting examples of transgender research done right.

I recently had the pleasure of meeting Lal Zimman, a fellow linguist who studies transgender language. In 2009, Zimman published a paper (PDF) summarizing his research into the concept of “coming out” in transgender communities.

A.C. Liang (1997) and Kathleen Wood (1997) reported on “coming out” stories of gay men and lesbians. In these stories, the term “coming out” is used to refer to the sharing of a sexual orientation. Because this orientation may not be visible, Zimman says, “Liang argues that reference to the ‘processual’ nature of coming out – in other words, the fact that coming out is not a single event but is rather reenacted time and again throughout an individual’s lifetime – is a crucial component of the coming out narrative.”

Zimman interviewed nine individuals who had completed a gender transition and found a pattern that will probably be familiar to a lot of you. They used “coming out” to share a transgender identity, but in one of two specific ways that were very different from those reported for gay men and lesbians. Those who hadn’t transitioned to their target gender used “coming out” to mean a declaration (in Zimman’s terms) of their desire or plans to transition to a different gender. Those who had transitioned used “coming out” to mean a disclosure of their history of gender transition.

This is the right way to do research on an unrepresentative sample. Ask relatively open-ended questions and listen to the answers. Note common threads among the answers. Use the stories to make existential arguments – ones that highlight the existence of something that may not have been acknowledged by the academic community. This is particularly valuable to show exceptions to generalizations that others have made. In this case, Zimman identifies exceptions to the generalizations that Liang and Wood made about coming out narratives.

Even though I think Zimman’s research is exemplary here, I want to note that I have a verbal hygiene argument with what he found. I don’t like these uses of the term “coming out,” and I think they’re bad for both the trans community and the wider LGBT community. But that’s a topic for another post. In the meantime, keep studying trans communities!

My life as a data point

I came across this quote in the abstract of a conference presentation by Sel J. Hwahng (on Page 7 of this PDF):

It is well known among public health researchers that in the U.S. the majority of male-to-female transgender (transfeminine) people are low-income people of color, while the majority of female-to-male transgender people (specifically those that identify as transmen, FTM, or genderqueer) are white and economically/educationally privileged.

I was floored by this statement, since I’ve been very adamant about the fact that we just don’t know what the majority of anything trans is, and about the need for caution when making any kind of statement involving proportions. The statement goes against my own perceptions, but I deliberately avoid reading too much into my own perceptions, because I know how much I don’t know. If this non-fact is “well known among public health researchers,” then my opinion of public health researchers just dropped quite a bit.

I was further intrigued to discover that I’m in those numbers. Me personally, I’ve been counted! Several years ago I volunteered for a multi-year study of male to female transgender people in the greater New York area. Every few months I’d go in, answer a bunch of questions, and get a blood test and a few bucks for my trouble. I didn’t do it for the money, which was well below my hourly rate for computer work. I was contributing my data, in part to provide a counterpoint to the idea that all transfeminine people are low-income people of color. I guess it only goes so far.

It turns out that Sel Hwahng was one of the researchers. I might have talked to him once or twice, but I mostly dealt with Mona Rae Mason and Monica Macri. And yes, non-Hispanic white people counted for only 27% of study participants and people making more than $30,000 a year were only 26%, so us well-off white people are certainly a minority of the study participants. No, you can’t generalize from that, but then again I didn’t really talk sampling with anybody while I was there.

Reading that abstract got me looking up the results that have come out of the study. Sel Hwahng used some of the qualitative data in this report from 2007, showing how the MTF trans population in New York is segregated into distinct communities based on ethnicity: black/latin, asian and white. It’s got a lot of interesting existential observations, but I could do without the implication that all of us “middle-class White cross-dressers” are just waiting to break up with our wives to transition. Some of us plan to die as men.

In 2009 the whole group published a report using the quantitative data to argue that life for transgender people is more complicated than Ray Blanchard’s simplistic “homosexual” and “autogynephilic” dichotomy. They then got into a thing with Anne Lawrence about it. What I find most interesting is that among the study participants were 221 people who reported that at some time in our lives, wearing feminine attire was “sexually arousing,” including 90 who reported not being attracted to non-transgender females, and 58 who reported not being attracted to non-transgender males. One of those 58 is me.

In 2011 the group published another report based on questions about verbal and physical abuse, and whether such abuse was related to gender identity or presentation. They showed that MTF transpeople who experience that kind of abuse tend to be more depressed, and also to have more unprotected anal sex, and to be at greater risk for HIV infection. I’m glad to say that I didn’t have any abuse, depression or unprotected anal sex to report, and I didn’t test positive for HIV. I’m sad to read that there were 107 people who came in and told Monica or Mona that they’d been verbally or physically abused, 145 who were depressed, and 43 who had unprotected anal sex with a casual partner or a john. The point of the article is that one way to overcome AIDS is to stick up for transpeople, and of course that’s a message I support.

The 2007 report makes unsupported leaps even without explicit quantitative statements, but in the 2009 and 2011 reports, Larry Nuttbrock was very careful to include disclaimers about the limits to generalizing the results. I’m glad he did, and I think his conclusions were mostly justified. Overall, I’m satisfied with the reports that have come out of this study. It was an interesting experience to answer all those questions. I wonder what they’ll do next.

My comment on transgender data collection

Comment on Notice of Availability of Proposed Data Collection Standards for Race, Ethnicity, Primary Language, Sex, and Disability Status Required by Section 4302 of the Affordable Care Act (Document ID HHS-OMH-2011-0013-0001)

The deadline to submit your comment is Monday, August 1, 2011!

As a transgender person and a social scientist, I am excited to hear that HHS will be collecting information relating to transgender phenomena. These activities have the potential to bring us valuable information about the prevalence of transgender feelings, thoughts, beliefs and actions in the general population, beyond an often self-selected community that identifies as transgender and participates in the existing surveys. As a social scientist I have some longstanding concerns about the collection and presentation of survey data about transgender individuals, and I hope that your work will improve the situation. Here are some recommendations that I have, for the process of deciding what data to collect and how, and for the data collection itself.

In my experience, many organizations and agencies working with transgender communities repeatedly and consistently make generalizations about transgender populations that are unsupported by any data. For example, the Transgender Law Center found 194 transpeople through unrepresentative “convenience” techniques, of whom 114 reported annual incomes of less than $15,333. A cover article in the San Francisco Bay Guardian summarized it as, “In other words, more than half of local transgender people live in poverty” – an incorrect characterization that was not disputed by the study authors. As any introductory statistics textbook will tell you, prevalence in a convenience sample tells you nothing about prevalence in the general population. No one knows if the sample was representative of “local transgender people.” Presenting it as representative is misleading to the public and can lead to inappropriate funding allocations and badly targeted health initiatives, and possibly even a backlash against transgender people.

I believe that convenience samples can be very useful, for example to show the existence of job discrimination, poverty and prostitution in our community. There is a limit to their usefulness, however, and they are consistently used beyond that limit by social service providers and community advocates. The result is to spread unreliable information, and quite probably to waste taxpayer money and charitable contributions.

Reports like this are often accompanied by a disclaimer; the Bay Guardian article said, “TLC doesn’t claim the study is strictly scientific — all respondents were identified through trans organizations or outreach workers.” Unfortunately, they almost always go on to report the data as if the disclaimer were meaningless: the next sentence reads, “But the data give a fairly good picture of how hard it is for transgender people to find and keep decent jobs, even in the city that is supposed to be most accepting of them.” The reporting of percentages invites this kind of lip service to sampling procedure. Percentages are meaningless in these situations, but they are always reported, and the effect is to dismiss the disclaimer as a formality, encouraging media reporters to do the same.

On your website I see that you anticipate that the Williams Institute and the Fenway Institute will play a strong role in helping you formulate procedures for collecting information on transgender communities. I agree that they have done a lot of good work, and I support their inclusion in any round tables that you convene. However, both institutes have a history of presenting convenience samples as representative. I strongly recommend that you balance their participation with people who are knowledgeable about the appropriate use of sampling.

I am a strong advocate of qualitative research as a means of finding out problems that exist in the world. There are several advocates from the transgender community who have done quality ethnographic and autoethnographic work. One that I know personally is Gail Kramer, who has written the books My Husband Betty and She’s Not the Man I Married under the pseudonym Helen Boyd. I urge you to include in your Roundtables at least one qualitative researcher like Helen.

To my knowledge, only one researcher has done a representative sample of any segment of the transgender community. That is Niklas Långström of the Karolinska Institutet in Sweden. I strongly recommend that Långström, or someone familiar with his survey, be part of your Roundtables. I am also willing to participate, as a transgender person interested in these issues and as a social scientist who has used representative sampling in my professional work.

A critical opportunity in transgender research

The Department of Health and Human Services has just made a big announcement: they will begin collecting data on LGBT issues, including transgender issues. The goal is to document disparities in health care, as well as plain old disparities in health, so that they can be addressed in the future. The plan is to have two roundtables on “gender identity data collection” with “key experts” this summer and fall, and then the “Data Council” will present a strategy next spring.  The department will also collect public comment in various ways, one being through a website called regulations.gov, which is currently down.

If done right, this could be a tremendous help to understanding transgender issues.  “The first step is to make sure we are asking the right questions,” HHS Secretary Kathleen Sebelius told the Washington Post. “Sound data collection takes careful planning to ensure that accurate and actionable data is being recorded.”  As I’ve written before, current research on transgender feelings and actions is severely hampered by the lack of any kind of representative sample.  Just to give you a quick sense, here are ten very basic questions that nobody knows the answer to:

  • How many transgender people are there?
  • How common are the various transgender thoughts, feelings and beliefs?
  • How common are transgender actions like cross-dressing, body modifications, and “soft mods” like shaving?
  • How common are transgender name and pronoun changes?
  • How common are part-time cross-living and full time transition?
  • How often are sexual activities part of transgender activities?
  • How common are diseases and destructive habits among transgender populations?
  • How many transgender people are in long-term relationships?
  • How often are various subgroups targeted by violence and discrimination?
  • How satisfied are transsexuals twenty, thirty or forty years post-transition?

Unfortunately, transgender research is dominated by two camps, the pathologists who make unfounded generalizations based on case studies of their own patients, and the social service providers who make unfounded generalizations based on service recipients, Internet surveys and word of mouth.  Neither of them seem to have understood the idea that while convenience samples can provide the basis for many useful existential statements, prevalence statements based on unrepresentative samples are worthless.

At this point it looks like the roundtables will be heavily influenced by social service providers who only pay lip service to the limitations of their research.  The Plan says, “While HHS is in the beginning stages of developing data collection on gender identity, many researchers (e.g., Williams Institute at the University of California Los Angeles and the Center for Population Research in LGBT Health at the Fenway Institute) have been working on such data collection for several years.”  The Williams Institute produces reports like “Bias in the Workplace” (PDF), an important summary of numerous studies investigating workplace discrimination that repeatedly acknowledges that the studies are based on convenience samples – and then goes ahead and repeats percentage results as though they meant something.

The Fenway Institute employs transgender health advocate Emilia Dunham as a Program Associate, and she also hosted a webinar on the issue.  It seems quite likely that she will be one of the experts at the roundtables.  But in an otherwise solid article for Bay Windows presenting these changes at Health and Human Services, Dunham uncritically repeated several of these unsupported percentages.

There is a very short list of Experts who I think should be on these Roundtables.  The strongest research into transgender issues has been qualitative research: listening, reading and introspection, finding existential statements but not making unsupported claims of prevalence.  I’ve said before that the best qualitative researcher in the transgender community is Helen Boyd, author of My Husband Betty.  At Helen’s recommendation I’ve also read a few things by Raven Kaldera that have been pretty good, particularly his post on female transvestites (which has somehow disappeared from his website).

There is only one person out there who has ever collected data from a representative sample of any transgender community, and that’s Niklas Långström of the Karolinska Institutet in Sweden.  He’s not focused on the transgender community, and he’s associated with the pathologist Kenneth Zucker (who is not someone we want involved), but he does know how to do a national survey, and it would be worth every penny for HHS to fly him over from Stockholm for the Roundtables.

If they can’t get Långström, then I want to be on that Roundtable.  I don’t have a degree in psychology or public health, but I did take an elementary course in statistics, and I learned what you have to do in order to make a generalization.  But what matters more than any qualification is that I care about doing this right.  If they can’t find anyone else who does, I want to be there.

Am I missing anyone? Are you doing quality quantitative research? Please let me know.

Blinding me with Neuroscience

Perusing Mark Liberman’s Language Log, I came across a post about an awesome study (PDF).  Yale psychology student Deena Skolnick Weisberg and her colleagues noticed that people seemed to like psychological explanations that contained a certain amount of neuroscience.

Weisberg and her colleagues came up with a list of interesting psychological phenomena.  For each one, they created two explanations: a “good” one corresponding to the usual explanation given, and a “bad” one, which was usually circular.  They found that their subjects (who were not particularly knowledgeable about psychology) were capable of distinguishing the bad explanations from the good ones.

The researchers changed the explanations, adding a few words of neuroscience that was consistent with the explanation.  They were very careful to ensure that it was identical to the explanation given, so that it added no new information.  The subjects who received the explanations with neuroscience were much less capable of distinguishing the bad explanations from the good ones.  Specifically, the researchers write, “the addition of such neuroscience information encouraged them to judge the explanations more favorably, particularly the bad explanations.  That is, extraneous neuroscience information makes explanations look more satisfying than they actually are, or at least more satisfying than they otherwise would be judged to be.”

The study was repeated with students taking an introductory neuroscience course; unfortunately, “a semester’s worth of instruction is not enough to dispel the effect of neuroscience information on judgments of explanations.”  It was repeated again with experts in neuroscience, who were found to be immune to this effect.

The authors conclude, “Since it is unlikely that the popularity of neuroscience findings in the public sphere will wane any time soon, we see in the current results more reasons for caution when applying neuroscientific findings to social issues.”  In other words, be skeptical and try to compensate for this effect.

Doing Transgender Research: Recognizing and Compensating for Limitations

(Thanks to the members of the My Husband Betty message boards for helpful feedback.)

Over many years of contemplating transgenderism, I’ve come up with a few principles that I’ve encountered over and over again. Principle One is “No one really knows what’s going on.” With so many closeted cross-dressers, stealth transsexuals, and people from all over the transgender spectra lying to themselves and to others, and lots of people who’d rather not hear about us, it’s very difficult to make any statements with confidence, or to believe any statements from anyone else.

Recently, there’s some good news and some bad news regarding Principle One. The good news is that there’s been an increase in funding for transgender research over the past few years. Much of this funding is in the form of locally based studies in the context of research on the transmission of AIDS. (I could write a whole article on the problems involved in that idea.) Social service organizations around the country have gotten grants to study their local transgender populations, and have gone out, found transgender people, asked them questions, and published the results. With the sometimes-generous support of the government and philanthropies, hard-working teams of investigators have collected large amounts of data, sometimes on only a small salary or even on a volunteer basis. Just do an Internet search for transgender study and you’ll find a bunch of them.

So what’s the bad news? Unfortunately, a lot of this time, effort and money have been wasted due to poor methodology. It really upsets me every time I read about one of these studies, because I want the same information that the study organizers want, and I know how caring and dedicated they are. I hate the idea that they could have taken all that money and left it in a pile for the clients of their walk-in clinic and probably done more good. (more…)