The field of research into gender identity and intersex issues can be divided into three sectors: Causality, Treatment, Environment
Weighing the relative needs
Although GIRES' first priority is to help those who are already experiencing some form of disadvantage, the charity intends to monitor very closely developments in the science relating to gender identity. GIRES recognises that identifying the biological determinants of gender identity and intersex conditions helps society generally to understand and accept that those they affect are naturally transgendered. The understanding that gender dysphoria is not a fantasy is especially important. However, the cost of research in this field is far too high for the charity to have a realistic possibility itself of obtaining the necessary funds. It therefore intends to keep abreast of the extensive research that other organisations are conducting in this field and produce papers that summarise and interpret the findings.
GIRES recognises the risk that research into causality may lead on to searches for ways to prevent the conditions pre-natally rather than to make life better for those they have already affected. However, it is powerless to curb the intellectual curiosity of the scientists working in this field.
Within the transgendered community there is widespread dissatisfaction with the quality of medical treatment. This is especially the case within the NHS where quantity is meagre too. The authors of "Transsexualism: The Current Medical Viewpoint" stated that "there is a paucity of research into the long-term outcomes of treatment for transsexualism". To improve quality, comparative research is needed into the success of alternative treatment models and the performance of the different treatment centres. Policy makers within the NHS may also be persuaded to increase quantity if research demonstrates conclusively that the availability of prompt treatment is cost effective in reducing the burden on its psychiatric services and the risk of suicide.
Such studies will require working closely with the medical profession. It will not be possible to make worthwhile comparisons and publish the results without the profession's wholehearted acceptance that this may reveal significant shortcomings in the service it now provides. Charing Cross Hospital wishes to collaborate with us in obtaining funds for a retrospective study of all its former patients. We are not currently able to participate in that project due to its very high cost, estimated to be £250,000. Also, we are conscious that a survey of only one treatment centre may have limited value.
Medical treatment is not the only area of concern. Research is also needed into the way other public services respond to the needs of those affected by gender identity and intersex issues, for example in the retraining and employment help provided to those undergoing gender reassignment; the way the courts and justice system including the police and prisons deal with them; the responses of the social services in child custody and access disputes and in dealing with rehousing in the event of a breakdown in relationships. We have had a very preliminary discussion with Charing Cross Hospital on augmenting earlier research into the effects on the child of having a transsexual parent. We see that the outcome of such research might be a valuable consideration in issues of child access and custody. The provisional cost estimate for this project is £50,000.
A major influence on the quality of life for those affected by gender identity and intersex issues is the way they are treated by those with whom they are in daily contact at home, in the workplace and when mingling with other members of society. Policy makers at all levels need to be aware of the extent of transphobia, its causes, the suffering that results and what should be done to prevent discrimination. In view of recent changes in employment law, GIRES immediate concern has been with discrimination in the workplace.
How to proceed
Our first step was to offer a prize for the most influential piece of research published annually, with special emphasis on work that affected the UK.
We also carried out a survey of employees who undergo gender confirmation. This is the type of small-scale project which GIRES can undertake itself rather than place with an external research organisation.
In due course, we need to develop a prioritised list of research project. Although PFC has already helped us with a number of suggestions (see accompanying list), this task will not be completed rapidly. What we lack is a good knowledge of what research has already been completed or is already under way. Entries for our research prize should over the years give us some indications about what is going on in the UK but is unlikely to keep us adequately informed about research conducted overseas.
In assessing our priorities, we can refer to the expert panels that we have established to provide advice covering the medical and social fields.
Eventually, the list of proposed research projects should show for each one its objectives, timescale, cost and priority. For each high priority project that will certainly be too costly in terms of financial and human resources for GIRES to fund out of its own resources, appropriate donors should then be identified and a fully documented grant application should be prepared.
For each top priority small scale project, i.e. those which GIRES intends to fund itself, a detailed research methodology, workplan and cost estimate should be prepared. The trustees would not, however, commence any project until they were certain that GIRES' own income would be sufficient to cover the necessary expenditure.
Research projects favoured by GIRES' trustees
A large-scale research project to evaluate the relative efficacy and cost of the alternative treatment methods now provided in various centres.
A medium-scale project dealing with the issues that particularly affect those making the transition from female to male gender identities. The general public and policy makers are largely unaware of this group and its needs.
Research projects suggested by Press For Change
Review of current sources of advice, assessment, hormone therapy, surgery and other treatments related to gender reassignment, including Charing Cross and other clinics, but also looking at alternative avenues used including local resources, going private etc. Assessment of the quality, speed and accessibility of treatment at different venues and the satisfaction expressed by clients of the services. Recommendations on preferred method(s) for provision of treatment. In particular considering the possible benefit of locally based (e.g. per region) multi-disciplinary services.
Review of the success of gender reassignment as a resolution for severe gender issues, involving the follow up of people who have been "changed over" for various periods including issues such as social adjustment, relationships, family, employment, mental health etc.
Interviews of FIM transsexual people which cover a range of issues including their experiences, needs, medical and social issues, sexuality etc.
Study of employers' equal opportunities policies and practices following the P v S case to see how/whether they have been amended to take account of the change in the law.
Follow up study of the experiences of trans people in the courts and justice systems (both criminal and civil), looking at their experiences and making recommendations for good practice.
Follow up study of trans people who have been in prison.
Study of the housing needs of trans people, identifying what special needs they have as a result of their status and its social, physical or other effects and identifying good practice by local authorities, RSL's and other landlords. This would include obvious issues like harassment and social integration, but also look at other things like tenancy rights and privacy.
Study of the cost of gender reassignment including advice, assessment, hormone therapy, surgery and other treatments over the lifetime of transsexual people (this varies enormously depending on how and where purchased) and comparison with the costs of non-treatment e.g. long term crisis intervention by psychiatric/social services; institutionalisation in hospitals, supported housing, prison, non-employment or employability, personal loss e.g. inability to form relationships or use potential abilities. Do the latter types of cost also arise for people post gender reassignment and if so to what extent comparatively?
Study of the children of trans parents (both those cared for by people who subsequently undergo gender reassignment, and those cared for by people who had previously undergone gender reassignment). Looking at what effects it has, both positive and negative, and looking longer term at adults/older children as well as those who have recent experience.
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