Transgender patients sidelined by attitudes and labelling.

In spite of an enlightened constitution and enabling legislation, South Africa's small transgender population continues to battle medical prejudice and ignorance in addition to huge societal pressure to conform to socially constructed sexual stereotypes. An Izindaba investigation showed that transgender people need precise information and deep pockets to access hormone treatment and/or gender-reassignment surgery, be it in the public or private sector. Attempts to access care in the public sector where facilities, staff and protocols exist, often result in humiliation, up to 6 years waiting on surgical lists and sometimes being routed via the private sector at major expense, with no guarantee of an outcome. This emerged late last year at a pioneering inaugural conference held in Hout Bay where transgender men and women, health care providers and the national Department of Health met to establish a long-awaited research and policy agenda. A transgender person may have a male body but feel inside that they are female, or vice versa. They experience a deep incongruence between their physiological gender and their basic internal sense of gender self (or core gender identity). They may choose hormone treatment and/or surgery to address this or simply live their lives according to their internal sense of their 'gender'. Research in the USA has shown that transgender children whose parents pressure them to conform, when compared with accepting, supportive parents, have a four times higher suicide and drug abuse rate, twice the risk of contracting HIV/AIDS and a five times greater chance of suffering depression. 1 The best available evidence points to transgender children being born that way, but society (and science to a lesser extent) tend to view the incongruence as a 'disorder' , attributing it to more esoteric reasons, like divorce, parental neglect, parents wishing they had given birth to the other sex, using fertility drugs to conceive, encouraging children to play sports too often or not enough or a range of other parental thoughts, behaviours or influences. While supporting a child's transgender behaviour is challenging, research shows that loving and accepting children 'as they are' helps them lead happier, healthier lives, reduces risk and, in many cases, literally saves their lives. In some parts of Europe and the USA puberty is delayed by means of hormone blockers, enabling the person to transition at 17 or 18 years old when surgery is generally more successful because the patient is not 'masculinised or feminised'. …