Healthcare Training in Gender Diversity

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Gender affirming for trans and gender diverse people consists of different domains that can affect one from a psychological, medical, social and legal perspective.

In partnership with Same Love Toti and TransHope, UKZN’s College of Health Sciences hosted a Gender Affirming Healthcare Training Day at the Nelson R Mandela School of Medicine.

The training aimed to provide an opportunity for trans and gender diverse people, their family members and health professionals (social workers, nurses, psychologists, speech therapists and doctors) to learn more. Dr Christine McLachlan, a clinical psychologist based at Edendale Hospital noted that a recent research study indicated that three million South Africans present themselves in gender non-conforming ways. Despite this, gender different individuals need to be diagnosed with gender dysphoria (the distress a person feels due to a mismatch between their gender identity and the sex assigned at birth) in order to access healthcare.

Being gender fluid refers to non-binary gender which is a spectrum of gender identities that are not exclusively masculine or feminine?. These identities are outside the gender binary since most non-binary people identify with a gender that’s different from their assigned sex. Within this classification are a number of other genders including bi-gender, trans-gender, cross-sexed, trans man, trans women, cisgender, androgyne, etc.

Ms Sazi (Sassie) Jali, founder and Director of TransHope, an organisation dedicated to increasing knowledge about gender identity and sexual orientation and providing a safe environment for gender diverse individuals, recounted her journey of transitioning. Sazi was born male but at a very early age, her mother, Mrs Tamara Jali, realised that Sazi was different. ‘He would always cry for dolls and not want to play with toy cars or footballs,’ she said.

In 2016, Sazi, who grew up in Umlazi, began her transition by seeking help from a psychologist at a public hospital. Six months after her sessions, she started on hormone therapy. ‘In 2017 I started advocating for the rights of transgender people. After I had thoroughly done my research and found out what the law said about changing my gender marker, I immediately applied to change it. The process took two months due to the knowledge I had gathered and by actively assisting Home Affairs officials.’ Sazi is the first transgender person on the African continent to graduate and receive her qualification in shipping logistics, under her new and correct assigned gender marker.

South Africa’s Alteration of Sex Description and Sex Status Act (Act No. 49 of 2003) provides for individuals to change their gender marker. It states that, ‘Gender reassignment means a process which is undertaken for the purpose of reassigning a person’s sex by changing physiological or other sexual characteristics, and includes any part of such a process.’ In order to change one’s gender marker or name, one does not need to have had surgery. Gender reassignment is seen as a process of transitioning.

Professor Mershen Pillay from the Discipline of Speech Language Therapy presented a speech therapists’ skills base to help develop Transvoice and communication. He noted that it is vital to match one’s voice to enact one’s gender. This would include working on one’s tone, pitch, resonance and rate. Non-verbal communication and articulation are also key. ‘How your voice is helping you express yourself is part of your identity. Hence, voice training is essential,’ said Pillay

Hormone therapy (HT) is a major part of transitioning. Dr Elma de Vries from the University of Cape Town’s Division of Family Medicine presented on gender affirming surgery and hormone therapy. ‘Prior to starting on HT, it is important to note that the effects are irreversible and future reproductive options must be considered. Medical doctors must also take note of any family history of risk factors including cancer, liver disease, heart conditions, high cholesterol, HIV, syphilis, and others,’ said de Vries.

The hormones usually used include oestrogen and anti-androgens. De Vries and others are advocating for the hormone Estrofem to be added to the Essential Medicines list, making it easily accessible. HT also has many side effects including Deep Vein Thrombosis, Pulmonary Embolism, stroke, headaches, depression, hypertension, and amenorrhea and others.

As part of her doctoral study, Dr Zamasomi Luvuno from the Discipline of Public Health is looking at re-engineering primary healthcare and the care of transgender people. ‘Transgender people have unique health risks and needs. It is important to look at the establishment of transgender friendly primary healthcare clinics and to educate nursing staff and other healthcare professionals,’ said Luvuno. She added that, it is important to note that, in hospitals and clinics, physical examinations and treatment will be provided to the anatomy that is present.

Words: MaryAnn Francis

Photographs: Supplied