Transgender people make up a small percentage of active-duty U.S. military personnel, but their experience in the service may yield long-term, positive effects on their mental health and quality of life.
A study from the University of Washington finds that among transgender older adults, those who had served in the military reported fewer symptoms of depression and greater mental health-related quality of life. The findings were published in a February special supplement of The Gerontologist.
The paper is part of a national, groundbreaking longitudinal study of LGBT older adults, known as “Aging with Pride: National Health, Aging, Sexuality/Gender Study,” which focuses on how a range of demographic factors, life events and medical conditions are associated with health and quality of life.
Estimated numbers of U.S. military personnel who are transgender vary widely, but range between one-tenth and three-quarters of 1 percent of the roughly 2 million active-duty and reserve forces. A study from UCLA estimates about 134,000 transgender veterans in the United States.
The new paper, by researchers from the UW School of Social Work, explores how military service affects transgender people because previous data indicated that, among LGBT people over age 50, those who identified as transgender were more likely to be veterans than lesbians, gay men or bisexuals.
Reports have indicated that transgender individuals serve in the military at higher rates than people in the general population. In the 2015 U.S. Transgender Survey of 28,000 individuals, 15 percent said they had served, compared to about 9 percent of the U.S. population overall. And yet, little is known about how military service influences the well-being of transgender veterans later in life.
Other studies have shown that transgender veterans suffer higher rates of depression than other veterans. UW researchers were somewhat surprised, then, to learn that the transgender veterans they surveyed tended to have better mental health than transgender people who hadn’t served, said lead author Charles Hoy-Ellis, a former UW doctoral student who is now an assistant professor at the University of Utah College of Social Work.
The traditionally masculine culture of the U.S. military would seem to be a potentially difficult environment for someone who doesn’t identify with the gender they were assigned at birth, he said.
But military service creates its own kind of identity, the authors said, because it presents often dangerous and traumatic challenges; overcoming those challenges builds resilience. And that’s where the identity as a transgender person enters the picture.
“Many people develop an identity as a military person — that it’s not just something they did but something that they are,” said Hoy-Ellis. “If transgender people, who are among the most marginalized, can successfully navigate a military career, with so many of the dynamics around gender in the general population and in the military, then that experience can contribute to a type of identity cohesiveness.”
The internalizing of negative stereotypes, such as those around sexual orientation, is considered a risk factor for poor mental health, added co-author Hyun-Jun Kim, a UW research scientist in the School of Social Work. Military service could be the opposite — a protective factor.
“Often when people think of the transgender population, they focus on the risk factors, but it’s equally important to focus on the protective factors and nourish those resources. In this case, what aspects of military service contribute to being a protective factor?” Kim said.
Researchers said they were somewhat limited by the size of their study sample: Out of the 2,450 people ages 50 to 100 who were surveyed for Aging with Pride, 183 identified as transgender. Of those nearly one-fourth, or 43, had served in the military. Of those who had served, 57 percent identified as female. People of color made up 29 percent of the transgender veterans in the study.
But as awareness grows about gender-identity issues, there is an opportunity to address support services for transgender veterans at the federal level and in the community, Hoy-Ellis said.
“This is a population that has served the country very proudly, and it’s important that we recognize that service,” he said. “Learning what we can about transgender older adults with military service may help us develop and implement policies and programs for people who are serving today.”
Other co-authors were Chengshi Shiu, Kathleen Sullivan, Allison Sturges and Karen Fredriksen-Goldsen, all in the UW School of Social Work. Funding was provided by the National Institutes of Health’s National Institute on Aging.
Sexual Education & Disability: Why it Should Matter to Social Workers
What do you get when you mix the taboo nature of discussing sexual intimacy with the social stigma surrounding intellectual and developmental disabilities? The answer: a heck of a lot more problems than you might think. Sexual education in the school setting is already a hot-button issue for non-disabled students. But when students with intellectual and developmental disabilities are introduced into the mix, so too are the ableist stigmas we all hold.
I would like to start this piece with a brief exercise one of the health teachers at my high school conducted at the beginning of sex ed. Repeat after me: Penis. Vagina. Penis. Vagina. Why do you think she would make a room of teenagers yell these words in school? Isn’t that inappropriate? If you think it is, you proved my point from earlier. Sexual intimacy and anything loosely related to sex are currently incredibly taboo topics. To help break down the air of discomfort surrounding such topics, that health teacher did something many are afraid to do: she spoke openly and encouraged others to follow suit.
One could argue these topics are not to be spoken about simply because we are taught to not speak about them. A child can ask why their anatomy is different from their siblings, but they will often be met with shushes or roundabout answers. In many cases, there is no reason for this reaction other than traditional values. Those same values are often times what causes conflict in regard to sexual education in public schools.
My sex ed experience at a public school was mediocre at best. Genitalia, STIs, and contraceptive methods were discussed. Consent was not taught nor were the proper ways to actually engage in sex, just that if we did it we should do it safely. This was not the most educational experience. And if this is what I received, what is the experience of children and adolescents with intellectual and developmental disabilities?
The Institutional Deficit
Working in a behavioral school for boys with emotional, developmental, and intellectual disabilities yields an interesting perspective. These students are taught the same subjects most other students in the country are taught just with more academic and therapeutic support. However, they are not always provided with a health class.
I worry greatly about this institutional deficit, partly due to my own ableism. These students are receiving very little, if any, sexual education during the school year from our faculty and who knows what they see on the Internet and what their families and friends are telling them. As they get older and begin to develop their curiosity, I am worried that they might not always have a reliable source of sexual education. With that, the concept of consent is often discussed but not in the context of intimacy. I don’t know if the connection between consent and sexual activities has been made or if it ever will be in this school setting. I don’t know if some of these students would understand the magnitude of these topics. I’d like to think these kids can do anything, but from what I’ve seen I don’t know if I would feel confident in their understanding. I wish I could feel otherwise.
Individuals with an intellectual or developmental disability are seven times more likely to experience sexual assault than non-disabled people. In many cases, the perpetrator is another individual with an intellectual or developmental disability. Ableism likely prevents people from thinking this to be possible. Common stereotypes around this population convince the non-disabled community that these individuals can do no wrong and are by default sweet and innocent. Of course, this is not realistic. Another ableist stereotype, as seen above, is the incapability of this population to understand topics related to sexual education and sexual intimacy. Like the non-disabled community, however, individuals with an intellectual or developmental disability prove that idea wrong.
Why This Matters to Social Workers
So, if people with intellectual and developmental disabilities are able to learn about sexual education, and learning about sexual education dramatically decreases instances of sexual assault, then what is the reason for this population to not receive sexual education? The signs point towards ableism held by those in helping professions, with social workers being a perfect example. While the social work community prides itself on how educated and accepting they are of different identities, very rarely do social workers take the time to reflect upon identities they may not be as familiar with. Race and sexual orientation are examples of identities social workers study extensively, but disability as an identity and the depths of disability culture are rarely examined. To combat this, social workers need to begin the process of confronting personal ableism.
Confronting personal ableism is difficult, but doing so will only benefit social workers and others who choose to do so. It is important and necessary to challenge internal biases. Critically examining personal ableist ideas pushes social workers to gain a different perspective. Through this difficult process, one gains clarity in the issues they may not even know they wrestle with. Understanding how ableism impacts perceptions allows social workers to get a firm grasp on the disability community. They may begin to feel empowered to advocate for a change they never once considered, such as a stronger sexual education program for people with an intellectual or developmental disability. The importance of critically examining personal biases should be emphasized throughout the entirety of the social work community and by every social worker.
The Causes, Risks, and Solutions for LGBTQ+ Youth Homelessness
In 2020, the population of homeless people grew for the fourth year in a row, and a single night count in January of that year revealed 580,000 people were experiencing homelessness. But while the homelessness crisis is widely acknowledged, a problem that is less recognized is how (and why) LGBTQ+ youth are disproportionately represented among the homeless. Moreover, the problem is not only the overly high representation of LGBTQ+ youth without homes but the increased risks and challenges they face while they are living homeless. And if they are also Black, Indigenous and People of Color (BIPOC), then there are even further risks yet. Mitigating the problem will therefore require a broad, multifaceted, and holistic approach that addresses the multiplicity and intersectionality of these challenges, some of which have been exacerbated by the pandemic.
Causes, Risks, and Minority Stress
At the deepest level, generalized homophobia and transphobia are foundational causes of the high percentage of homeless LGBTQ+ youth. Both homophobia and transphobia underlie family rejection, which is a primary cause of the higher rates of LGBTQ+ youth homelessness. Among LGBTQ+ youth without housing, around 46 percent run away due to family rejection and 43 percent are forced to leave home by their parents.
Once homeless, LGBTQ+ youth also face higher risks of mental health challenges, substance use, sex trafficking, sexual assault, and becoming victims of hate crimes compared to their cisgender, heterosexual counterparts. And when we probe deeper into any one of these risks, we find them inevitably linked with numerous forms of discrimination. For example, one of the reasons unstably housed LGBTQ+ youth are at higher risk of sex trafficking is that many of them are pressured into alternative forms of making money to survive due to discrimination against sexual and gender minorities in the job market.
In addition to the job market, there is discrimination against the LGBTQ+ community when it comes to housing and accessing homeless services as well. Minority stress theory is used to describe this kind of intertwining of discrimination in multiple, overlapping dimensions in a way that compounds stress and increases risk factors for minority groups.
Racism is also a major factor. While LGBTQ+ youth in general are disproportionately represented among the homeless, so too are Black people. Because of this, there are even more risks for Black LGBTQ+ youth experiencing homelessness since they lie at the intersections of sexual, gender, and racial identities and are thus exposed to all of the discriminations these minority groups face.
Tragically, many of these preexisting disadvantages faced by homeless LGBTQ+ and Black LGBTQ+ youth were exacerbated by the pandemic, which caused numerous programs and services designed specifically for these communities to reduce hours or shut down entirely.
Minority Strengths, Resilience, and Action
A newer framework that can be seen as complementary to minority stress is minority strengths. That is, even as racial and sexual minority statuses come with increased stresses and risks, they can also be sources of strength when members of these minority groups can identify with, and experience camaraderie with, other members of their respective minority group(s). Here as well, however, there are complexities since not every minority may have equal access to social support. Even within the LGBTQ+ community, for example, there can be transphobia and/or racism. A Black trans youth may therefore experience multiple forms of discrimination from within the very community they look to for strength. Still, it is useful to consider the minority strengths model alongside minority stress so that neither the positive nor negative aspects are overemphasized.
Speaking of overemphasizing, the tendency to focus on resilience in the context of LGBTQ+ youth homelessness has become a double-edged sword. While, on one hand, resilience should certainly be acknowledged, its role as a solution should not be exaggerated. The fact of the matter is that there are many ways to reduce LGBTQ+ youth homelessness and the risks associated with it.
We can work to address homophobia, transphobia, and racism in the culture at large, for instance, and to reduce discrimination in the job and housing markets which would help reduce the rate of homelessness among LGBTQ+ youth in the first place. We can also work to implement protections for the LGBTQ+ community more widely within homeless services so that those who do end up homeless can safely access these services. Social workers and providers of social services can also be trained to better recognize and address the unique challenges that unstably housed LGBTQ+ youth face. Relying too much on resilience creates a danger of neglecting concrete actions such as these which can and should be taken as preventative measures.
Finally, a word needs to be said about research which, like resilience, is sometimes overemphasized. As a researcher myself, I know that research can certainly help play a mitigating role, but we need to be mindful of the tendency to put the onus on more research when we already know enough to get to work and make a sizable difference. Research and advocacy can complement each other. There will always be more to learn, but if we wait until we know everything we will never act. With rates of homelessness increasing, and the pandemic having amplified the causes and risks of LGBTQ+ youth homelessness, the time to act is now.
Why U.S. Government Agencies Need Comprehensive Policies For Employees With Various Gender Identities
Sex and gender identities are becoming increasingly complex in America, creating new challenges for public administrative agencies. So far, the vast majority of U.S. federal agencies lack comprehensive transgender employee policies – which are currently in place for only nine of approximately 235 federal agencies (including sub-agencies).
Yet as the workforce evolves, federal employment policy must accommodate the needs of employees who do not fit traditional sex and gender categories – and particular attention needs to be paid to formulating policies specifying the responsibilities of employers when their employees undergo transitions meant to shift their anatomy or appearance to align with their gender identity.
What Should a Transgender Policy Include?
Employee policies specifically fashioned by agencies to deal with transgender issues should, at a minimum, cover matters that arise when employees undergo transition processes; restrooms and locker rooms; dress codes; and the use of proper names and pronouns. Many benefits come from transgender-specific employee policies. Such measures can educate supervisors and coworkers about what to expect when someone transitions in the workplace and, by providing protocols to follow, help supervisors and coworkers become more comfortable with and supportive of workplace transitions.
Transgender employees also benefit and gain a sense of security when specific policies are in place. Each federal agency should create its own internal set of transgender-relevant policies, to educate all employees and help transgender employees understand their rights and know where to go for assistance. More can be said about each of the major issues a good policy needs to address.
When Employees Go through Transitions
In the absence of a comprehensive transgender policy, most agencies are left unprepared when employees change their anatomy or appearance to align with their felt gender identity. An effective way to prepare for such processes is to spell out the agency’s workplace transition protocol. Without such an explicit plan, transgender employees who want to transition do not know where to go to begin the process or where they can find answers about what a transition might entail for an agency employee. Additionally, without a standard set of practices, agencies do not know what is required to change all applicable records. Confusion can leave transgender employees scrambling to deal with many different record changes. Submitting requests and medical records to many places can be unnecessarily cumbersome and intrusive.
Plans for Restrooms and Locker Rooms
One aspect of transgender employee policy that has garnered significant attention – and sometimes controversy – is the issue of who uses which restrooms and locker-rooms. A key example comes from North Carolina’s “House Bill 2” that banned individuals from using public restrooms that do not correspond to their biological sex assigned at birth. The United States Department of Justice declared this law in violation of Title VII and Title IX of the Civil Rights Act as well as the Violence Against Women Reauthorization Act of 2013.
Openly transgender employees have, at times, been discouraged or outright or prohibited from using the restroom or locker room that correspond to their gender identities. Many federal employees use a locker room to change into their uniforms or when they enter the agency gym. Additionally, some jobs, like those in the Forest Service, necessitate the use of showers in the locker room. Existing open-shower floor plans in many facilities may not afford transgender individuals a sense of privacy and safety that everyone should have in their workplace. Inside particular workplaces, conflicts and awkward situations can often be headed off by spelling out clear guidelines for appropriate restroom and locker-room use by all employees, including transgender individuals.
Flexible Dress Codes
A comprehensive transgender policy could also resolve problems related to dress codes. Overall, transgender individuals should be allowed to wear clothing consistent with their gender identity; failure to do so could cause harm to their mental health. Obviously, this applies to employees who have gone through transitions. In addition, although dress code policies often assume that all individuals fall into a female-male binary; many individuals identify in non-binary ways. Someone who identifies as gender neutral, for example, may not fit into sex-specific dress codes.
Because it is discriminatory for employers to force transgender people to conform to gender norms, an agency-specific transgender policy should articulate dress and grooming standards that allow employees to dress and groom in ways that are consistent with varied gender identities. The policy should state that no employee will be required to dress and groom in conformance with a particular sex or gender stereotype.
Respectful Use of Proper Names and Pronouns
Another concern to be addressed is the proper use of the name and pronoun corresponding to a transgender individual’s gender identity. After a person transitions, managers and coworkers often use the wrong name and pronoun. The Equal Employment Opportunity Commission found in 2013 that the intentional and repeated misuse of a transgender employee’s new name and pronoun could harm the employee and thus substantiate a claim of sex-based discrimination and harassment. A further issue is that agencies often have no policy about pronoun use for individuals who request designations other than the traditional “he,” “she,” “him,” or “her.”
When coworkers refuse to use the correct pronoun for a transgender colleague it is disrespectful. The Office of Personnel Management should expand the definition of “transgender” to include gender non-binary employees and clearly communicate this definition to agencies. Transgender policies for each agency should include clear guidelines indicating that all employees – including transgender, non-binary, and other gender non-conforming employees – are entitled, both verbally and in writing, to be called by their preferred name and pronouns.
Read more in Nicole M. Elias, “Constructing and Implementing Transgender Policy for Public Administration” Administration and Society 49 no. 1, (2017): 20-47.
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