Understanding Your Transgender Employee

Presented By: Jennette L. Caden Jacqueline M. Phillips

Overview
Definitions, Terms, and Slang What Is Transgender? Types of Transgender People. A Transgender FAQ. Transgender @ Work Question and Answer session Credits
Some of the clipart used here is from TG Forum and is used by permission. Some material courtesy Dr. Mary Ann Horton and Professor Lynn Conway.

Definitions
Transgender (TG) Someone with a gender identity conflict. The two most common types are:
Transsexual (TS) A person whose birth sex and gender are in conflict. Crossdresser (CD) Someone who dresses in clothing of the opposite sex. Sometimes known as a transvestite, but that term is now viewed as pejorative; crossdresser is the preferred term.

Terms and Slang

Terms
MtF Male to Female FtM Female to Male SRS/GRS Sex Reassignment Surgery; also known as Gender Reassignment Surgery or (more accurately) Genital Reassignment Surgery. Pre-op TS A TS who has not had GRS Post-op TS A TS who has had GRS.

Slang

Pass To pass means you are accepted for what you appear to be; for an MtF, as a woman. Read The opposite of pass; to be read means you have been recognized as what you really are; for an MtF, being read = guy in dress.

So What IS Transgender?
Transgender is the T in GLBT.
There is an alliance between the Gay, Lesbian, and Bisexual community and the TG community because both have similar goals.
Nondiscrimination. Civil & Human Rights. Acceptance.

GLBT

But wait - arent Sex and Gender the same thing?

Sex, Gender, & Orientation

Three totally separate issues:
Your sex is your biological or physical sex. A male or female body. Your gender is what is in your mind; your Brain Sex How you see yourself socially and mentally.
Male, female, androgynous, etc.

Your sexual orientation is what sex you are attracted to for physical and relationship partnering Basically unrelated to sex or gender per se.

Transgender Behavior
Everyone has behaviors that exhibit characteristics, traits, and even body chemistry pertinent to the opposite sex. Transgender behaviors are a form of personality expression.
A TG person happens to exhibit and be aware of such characteristics, etc. to a higher degree than others. Such behavior is not rare or unusual.

Causes of Transgenderism
No conclusive cause found to date. Strongest current TG hypothesis:
We all start life as a female; natures default setting. Three washes of androgens (male hormones) are needed to turn the female zygote into a male.
The timing and amount of these androgen washes is extremely critical.

The theory is that one or more of these androgen washes is either the wrong amount (), or is incorrectly timed.

Cures for Transgenderism

None of the cures tried to date have proven to be permanent.
These have been tried, but have only been temporary:
Hormones. Drugs. Behavior modification. Other psychotherapies

As a general rule, most TG people do not want a cure.

Types of Transgender People

Transgender people generally fit under one of following categories:
Crossdresser (CD). Transsexual (TS). Drag Queen/King. Other (or none of the above).

Crossdressers (CD)
Crossdressers comprise the more than 75% of the Transgendered community members.
90% or more of all CDs are heterosexual males who dress as females.
Most are married and have families.

The remaining 10 % are comprised of gay males, bisexual males/females, and some femaleto-males. For this presentation, we will refer only to Male-to-Female

More About Crossdressers

A CD dresses part-time.
On average, once a month to several times a week. The feminine aspect of their personality does not require fulltime expression.

Important:
A CD rarely wants or desires to have permanent body modification (i.e., via surgery, hormones, etc.). (Crossdressing) is an identity issue, not a sexual issue. Randi Ettner, PhD.

Transsexuals (TS)
A Transsexual is someone whose sex and gender are in opposition.
They feel trapped in the wrong body and know this in their soul.
Most TSs are Male-to-Female, but there are Female-to-Male TSs.

Important points:
A TS wants to live full-time in their preferred gender. They are willing to permanently modify their body to do this. Transsexuals are often suicidal unless their bodies can be brought into conformity with their gender identity.

More About Transsexuals

A transsexuals desire for a permanent solution includes one or more of the following:
Psychological Therapy. Cross-Gender Hormone Replacement Therapy treatment. Cosmetic/Surgical Changes
Breast Augmentation/Reduction Facial Surgery (if warranted) Facial hair removal via electrolysis or laser or both

Genital Reassignment Surgery

Avg. USA cost: Male-to-Female = $20,000+; Female-to-Male = $50,000+

Significant lifestyle changes.

A TS Standard Of Care
The Harry Benjamin International Gender Dysphoria Association, Inc.
Publishes a Standard of Care; currently 6th ed.
This is a guideline, not a requirement.

Transsexual Procedure Review:

Start with psychotherapy. After a minimum 6 months psychotherapy, may begin hormone therapy. Min. 1 year hormone therapy + psychotherapy = may live full time 24x7. Min. 1 year living 24x7 = eligible for genital reassignment surgery (need letter from therapist + 2nd letter from PhD therapist or psychiatrist).

Reputable US/Canada GRS surgeons will

Drag Queens and Kings

Drag Queen is a term for a male performer who occasionally dresses as a woman for entertainment purposes. Drag King is the term for a female performer dressing as a male. More information:
The effect is an exaggerated (campy) image of a female with little or no emphasis on "passing (intentionally). Drag Queen is frequently misused to mean any male in female clothing. Most, but not all, Drag Queens & Kings are gay.

Other Transgender Folk

Other types of Transgender folks may include:
Androgynous persons that identify as neither male or female. Intersexed persons; i.e., someone born with both male and female genitalia. Any person who is unsure of their own gender identity.

Further discussion is outside the scope of this presentation.

Transgender FAQ
How many transgender people are there? Why must a crossdresser dress? Does a crossdresser become a transsexual? Is a transgender person considered mentally ill? Are transgender persons considered sexual deviants?

How Many TGs Are There?

Male-to-Female TGs
Post-op 0.017 Full Time 0.8 Part-time 0.9 Holidays 3

Answer: Approximately 6% of all men and 3% of all women are considered to be transgendered.
An accurate number will be nearly impossible because most are heavily closeted. Half or more only dress on holidays like Halloween.

Partial CD 2

Female-to-Male TGs
Full Time 0.01 Post-op 0.009

Part-time 0.9

In a crowd of 5,000 people:

1 will have Muscular Dystrophy 2 will have undergone MtF GRS As many as 75 will be TG

Partial CD 0 Holidays 2

Why Must a CD Dress?

Answer: Crossdresser could express their feminine side in ordinary ways, but this does not satisfy their need to express themselves. Therefore, they must dress the part to fully express their feminine gender.
Their exterior (appearance) must match their interior (gender). Passing may not be the goal of all CDs, but most try to blend in. The few that dont frequently end up on television, on shows like Jerry Springer - and stigmatize the rest.

Does a CD Become a TS?

Answer: Generally, crossdressers do not "graduate" into transsexuality.
The gender psyche between them is quite different. Discerning between the two, plus consideration of the possibility of being a transgenderist, is usually quite difficult even for a genderaware mental health professional. Therapy may help, if the person is willing to accept it.

Is a TG Mentally Ill?
Answer: No.
Transgenderism is a behavior. It is not an illness, mental or otherwise. Transgender behavior is simply an expression of who that person is; it is as intrinsically harmless as having blue eyes.
Cross-dressing per se is not a disorder. Merck Manual, 2001 edition

A transgender person is not suffering from a Multiple Personality illness, Manic/Depressive or Bi-Polar disease, or Schizophrenia.
The transsexual needs to rule this out prior to any permanent body modifications, per Standard of Care guidelines.

Are TGs Sexual Deviants?

Answer: No.
Society largely views any conduct that is not mainstream to be "deviant. Deviant versus Harmful
Coercive sexual practices such as exhibitionism, voyeurism, molestation, and rape are harmful and create victims with their behavior. Non-coercive sexual behaviors such as crossdressing and fetishism are benign activities that do not create victims and are not harmful.

Transgenderism is not related to any harmful sexual behaviors.

Transgender @ Work
Why Would I Want To Allow This? Why Would An Employee Want To Do This? Business Issues. Creating A Genderfriendly Workplace. Restroom Issues.

Why Would I Want To Allow An Employee To Do This?

It is to the companys long-term benefit to attract and keep the best and brightest employees
Decreased turnover due to increased employee loyalty.

Increased Productivity
Employee does not waste energy hiding part of themselves.

Recruiting benefit to be inclusive in a competitive job market. Increasing diversity in a global marketplace.

Why Would An Employee Want To Do This?

It is an expression of self.
Who we are and what we are.

The inevitable rumors and gossip will end up hurting the person, their co-workers, the company; in short, everyone. Prejudice will fade over time
Everyone will eventually see the person underneath remains the same.

Business Issues
Customers Problems
If the employee presents in a professional manner, there should be no problem. Stricter Dress Code may be needed if customer interaction is required.
Applied uniformly to everyone.

Religious Boycotts
Little or no impact to date.

Feeling Safe @ Work

Understand the concept of a hostile workplace environment.
Sexual harassment.

Affect on the workplace

I cannot leave who I am at home. Pictures & personal items in cubicles/personal workspaces. What people talk about is different, too. To not feel threatened at work just because I am who I am.

The TG world/experience.

What do we need?

A TG-Friendly Workplace
Step 1 Amend EEO Policy
Amend corporate nondiscrimination policy, covering on and OFF the job!

Step 2 Education!
Posters Formal Training (Workshops, etc.) Media (Films, videos, books, etc.)

Step 3 Address Restroom Concerns and Medical Issues.

Will be covered in next two slides.

The Restroom @ Work

Probably the most sensitive issue at work. Work with everyone to cooperatively establish an appropriate policy.
Education knowledge is power over fear.
Stress that any TG person has no illicit reasons for being in there. Our visit is purely for taking care of bodily functions. Any behavior other than that by an average person is inappropriate and should be dealt with accordingly with company disciplinary or legal action, or both.

A TS in transition will have needs to be

Medical Insurance Costs

Many health care insurance plans specifically exclude anything to do with the treatment of gender identity issues. Employers worry that removing this exclusion will significantly drive up health care insurance costs. Medically necessary procedures versus Cosmetic procedures.
Which procedures should and should NOT be covered?

What IS Medically Necessary?

Medically Necessary Procedures: Cosmetic Procedures:
Mental Health (Therapy) Hormones (Pharmaceuticals) and associated physician visits Surgery MTF: Surgery FTM:
Orchidectomy, Penectomy, Vaginaplasty, Labiaplasty Mastectomy, Hysterectomy, Metoidioplasty, Phalloplasty

Electrolysis Speech therapy Breast augmentation surgery Facial surgery Voice surgery

The Bottom Line

If you amortize the cost of GRS over all US residents who have insurance, what is the annual cost per insured?
Answer: $0.06 per insured! Add in hormone medicines, associated physician visits, plus therapy: $0.39. A 'worst case maximum estimate: $3.64. Domestic partner benefits add approx. $40.00.

Actual cost to the employer to cover TGs is less, as the cost is shared between the employer and employee/patient.
Maintenance hormones probably already covered under existing prescription plan.

A Real-world Rx Comparison
Brand Name Synthroid Diovan Prozac Viagra Premarin Estrace Aldactone Aygestin

Comparison of prescription drug per dose costs, based on a quantity of 90 tablets (100% self-pay): Usage Generic Name Dose Cost/tablet
levothyroxine valsartan fluoxetine sildenafil conjugated estrogen estradiol (synthetic estrogen) spironolactone norethindrone ace 100 mcg. 160 mg. 10 mg. 50 mg. 1.25 mg. 2 mg. 50 mg. 5 mg. Low thyroid High blood pressure (HBP) Anti-depressant (SSRI) Erectile dysfunction Estrogen replacement therapy Estrogen replacement therapy HBP and Anti-androgen Progestin, used w/estrogen $0.44/$0.20 $1.81 $4.34/$0.56 $9.96 $1.13 $1.35/$0.24 $1.27/$0.51 $2.12/$1.64

Note: Costs from www.drugstore.com and rounded to the nearest cent. Cost per pill indicates name brand and generic prices, if

TS Health Care Costs over 5 years

Cost/month for a MtF TS in 2006 to transition:
One TG-related doctor visit per month: $50/visit, Generic prescription costs: $100/month, Two sessions per month with a psychologist: $250 ($125/session), and A one-time surgical cost of $24,000 (GRS + breast enhancement) amortized over a 5-year period for a cost of $400/month. Total cost of transsexual health care amortized over 5-years: $800/month.

Cost to care for a person with diabetes: $1100/month.

Source: American Diabetic Association, 2002

LEAGUE@NCR
About LEAGUE@NCR More about LEAGUE@NCR The Safe Space Program

About LEAGUE@NCR
LEAGUE@NCR is one of six active Business Resource Groups (BRGs) within NCR Our Purpose:
The primary purpose of LEAGUE@NCR is to promote an inclusive work environment that supports employees of all sexual orientations, and gender identities and expressions, so that these employees can perform freely to their fullest potentials. We commit ourselves to advancing changes that will help people to respect and value differences, thus allowing gay, lesbian, bisexual and transgender employees to further NCRs quest for excellence.

More about LEAGUE

In addition:
LEAGUE@NCR also provides educational resources and informational support to NCR in attaining workplace diversity goals by retaining and recruiting gay, lesbian, bisexual and transgender employees. Despite gains, there is really no legal protection for LGBT persons in the workplace. LEAGUE@NCR keeps LGBT issues in front of NCR leaders. The closet is an unproductive place to work.

Why LEAGUE?

The Safe Space Program

NCR wants its gay, lesbian, bisexual, and transgender employees to feel comfortable in the workplace so that they can perform at their best. NCR's equal opportunity employment policy states that a person's sexual orientation, or gender identity and expression cannot be used as a criterion for personnel decisions. Sexual orientation is also a major element of NCR's diversity management program. The Safe Space program is designed to provide a non-threatening way to send the message that homophobia and hostility will not be tolerated in the NCR workplace. By displaying this free magnet, employees show that their desk or office is a "safe space" for gay, lesbian, bisexual, and transgender The Safe Space name and logo are trademarks of EQUAL! at Lucent employees. Technologies

Summary
Sex is between your legs; Gender is between your ears. A transgender person:
Is expressing their personality, Is not suffering from any disease or mental illness.

A crossdresser:
Dresses part-time. Rarely wants permanent body modification.

A transsexual:
Wants his/her sex & gender to match 24x7

Question and Answer Session

A Final Word
Fear always springs from ignorance.
Ralph Waldo Emerson

Hopefully today we have:

Corrected a few myths about TGs. Allowed you to put your fears to rest. Imparted some wisdom.

Be who you are and let the future work itself out around you.
From No Half Measures by Jenny Walker.

Thank you for your attendance!