What does it mean to be a trans person? How included do they feel in society, and why are some of us afraid of people who are different?
What does it mean to be a trans person? How included do they feel in society, and why are some of us afraid of people who are different?
In this episode Sarah is joined by Associate Professor Sam Winter, who shares their insight into what it means to be a trans person, how society can be more inclusive of people who are gender diverse and where traditional notions of gender may still be relevant.
Associate Professor Sam Winter, Curtin School of Population Health.
Associate Professor Winter is a researcher and teacher working in the field of trans health, wellbeing and rights. Much of his research experience has been in Asia and the Pacific.
Since 2000 her work has focused on trans-related issues, in which time she has led or been an investigator on around 20 funded research projects and has published around 60 works on the health, rights and wellbeing of trans people.
They were a member of the WHO Working Group that initiated the 2019 removal of the ‘gender identity disorder’ diagnoses from the mental disorders chapter of the WHO’s International Classification of Diseases manual.
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Speaker 1: 00:00
This is The Future Of, where experts share their vision of the future and how their work is helping shape it for the better.
Sarah Taillier: 00:09 I'm Sarah Taillier. Gender is becoming a more fluid concept and practice in many Western countries, but this fluidity is often at odds with a country's laws and social and cultural norms. For trans people, this can make them vulnerable to discrimination and ostracised from society. In this episode, I chat to Sam Winter from Curtin's School of Population Health, about being trans in Australia, how society can be more inclusive of trans people, and how we can create inclusive spaces in the future.
Sarah Taillier: 00:44 Sam was a member of the World Health Organization's Working Group, which successfully advocated for the WHO to stop categorising transgender people has having a mental disorder in its global diagnostic manual from 2019. If you’d like to find out more about this research you can visit the links provided in the shownotes.
Sarah Taillier: 01:06 Sam, we hear a lot about transgender and gender diverse people. How is being transgender different from being gender diverse?
Sam Winter: 01:15 Well, it's not. One of the irritating, at times, aspects of being in Australia, though there be so many nice aspects of living in Australia, is that we constantly come across this term, trans and gender diverse, transgender and gender diverse. Transgender people are people who identify in a gender other than the one that was presumed for them at birth, other than the one that we would expect to match their sex assigned at birth. That's what transgender people are.
Sam Winter: 01:55 What are gender diverse people? Well, the vast majority of the time people are using it to mean exactly the same thing, but to refer to people who choose, for whatever reason, not to identify as transgender. And there are a number of identities that transgender people live with authentically, trans women, trans men, men with transgender experience, women with a transgender history, non-binary people, gender queer people, agender people, transsexual people -- there are still people alive who identify in that way within the trans community -- and there are people who identify as gender diverse, but the vast majority of the time, those people are simply referring to a transgender identity.
Sam Winter: 02:57 And so to use the term trans and gender diverse is a bit of a nonsense. It's rather like constantly, constantly repeating the phrase Australians and Sydneysiders, Australians and Perthlings, you see what I mean? So in this conversation today, I will just refer to trans people and you can understand that I am referring to a range of identities, all of them, if you like, unified in this one objective feature, that is that they identify and very much want to live and be accepted and recognised in a gender other than the one that was presumed for them at birth.
Sarah Taillier: 03:54 What's life like right now for Australian trans people, particularly when it comes to accessing things like education, sports, employment, healthcare?
Sam Winter: 04:07 I think a really short answer would be that it's a lot better in Australia than in much of the world, even most of the world, certainly most of the world in this region of Asia and the Pacific, but of course, that doesn't mean that things are fine and dandy. Trans people do experience challenges here in pretty much all aspects of their lives. I would say that two key areas are employment. You would like to think that there is protection within the workplace for trans people. Some of the law is federal, some of it is state, but you'd like to think that there's protection.
Sam Winter: 04:58 There is a degree of protection, I think in most, if not all of Australia, but it's quite clear that trans people in Australia do experience problems. Getting a job, keeping a job and progressing through some sort of career ladder. They experience problems in all of these areas, but there is another area that I would like to signal, and that is access to healthcare, particularly, not exclusively, access to gender affirming healthcare. That is the type of healthcare that can enable trans people who are distressed or uncomfortable about the body that they have, to get a body that is more closely matched to what they would wish for their gender and what society would expect for their gender.
Sam Winter: 05:58 I think there are problems of accessibility, but availability. Sometimes the healthcare's just not there. Accessibility, sometimes you have to go a long, long way and wait a long, long time to get that healthcare. Cost and quality, which is rather patchy, I think across Australia viewed as a whole. So those are the two things that I would want to spotlight. Employment and access to healthcare. Maybe there's one other area. Can I? And that is access to birth certificates that are consistent with gender identity.
Sam Winter: 06:52 Now this is a bit of a controversial issue, but the question is under what sort of circumstances and with what sort of preconditions should a person be able to change their birth certificate? Now, there are people in Australia who would say, "Well, under no conditions, under no circumstances at all. Your birth certificate should always reflect your assigned sex at birth."
Sam Winter: 07:21 But at the other end of the spectrum, there are people, and I've argued this along with many other people that trans people should actually be able to change their birth certificate, that change their birth certificate as simply by making a statutory declaration. That is no preconditions, no medical preconditions at all. Now that's rather a radical position to take. I think there are maybe... I'm not up to date on this, but there might be about 15, 20, maybe 25 jurisdictions in the world, sometimes countries, sometimes city jurisdictions or state jurisdictions across the world that actually do allow this self-determination model of gender recognition. I'm talking birth certificates here, birth certificates. In Western Australia, you do have to undergo some medical procedures in order to change your birth certificate. In New South Wales, you have to have full-scale genital surgery to be able to change your birth certificate.
Sam Winter: 08:33 So there's a lot of... And in Victoria is pretty much a self-declaration model, Tasmania pretty much a self-declaration model, I think. So there's a lot of variation across Australia, each state, each territory, having its own legislation in regard to birth certificates. I think what I would say is this, that there needs to be some very careful thought about the sort of barriers that are put up in some jurisdictions within Australia, that do actually prevent many trans people from having the birth certificate that would actually reflect what they consider to be, and I think what I would consider to be, their authentic self.
Sarah Taillier: 09:18 Sam, what are some of the key changes that you think need to happen to ensure trans people in Australia have equitable access to things like employment and education?
Sam Winter: 09:29 I think at a very basic level, I think there needs to be more understanding of trans people and who they are, and what the experience of being a trans person is, although many working in the field are cisgender. And so in that sort of situation, one has to accept a degree of humility on that. Trans people know best what their experiences are, but I think trans people and many of their allies have the responsibility, I think, to provide more information on the trans experience and the challenges that trans people face so that we have a more informed society.
Sam Winter: 10:21 There are a lot of consequences of misinformation and lack of information. Consequences in terms of stigmatising beliefs, myths. Maybe we'll talk about this later on. I think the trans community and those who support the trans community have a responsibility, I think to shed a little bit of light on the trans population. The result would be a more informed and understanding society, a more inclusive society, I think.
Sam Winter: 11:04 Legislation plays a role, I think. I think legislation can reflect the culture in which we live, the society in which we live, but legislation can also change the culture in which we live. I think you saw that with equal marriage legislation a few years ago in Australia. The legislation itself reflected a change, but contributed to future change. People actually saw, some for the first time, that the sky would not fall in if gay men and lesbian women were allowed to marry each other, to marry the people that they loved.
Sam Winter: 11:51 So legislation, I'm talking about legislation as education, and I think that is something that we always have to bear in mind, that laws do also have an educational function. So laws against discrimination, laws on legal gender recognition, and so on.
Sarah Taillier: 12:21 Sometimes a very notion of being trans or gender diverse seems to upset a lot of people. Why do you think some people find trans people threatening or the idea of itself threatening?
Sam Winter: 12:34 Because of what they believe about trans people and there are a lot of stigmatising beliefs out there. It goes to that issue of education, information, shedding light on the subject. Beliefs like trans people in some way conflict with nature. Trans people contradict God's will, trans people in some way go against this or that culture, our culture. Trans people are sexual deviants, trans people are pretenders and deceivers. They live as they do for whatever reason, perhaps so that they can more easily get sexual partners, and the trans people are mentally ill.
Sam Winter: 13:32 All of these beliefs are stigmatising beliefs. All of them contribute to this... tend to lead to this notion that trans people are less than you and me, and perhaps we shouldn't have anything to do with them. I would reject all of those beliefs, of course. All of them are based on misinformation or myth. I would want to say, particularly about that last stigmatising belief I talked about, that is that trans people are mentally ill, well, that just ain't so! And to its credit, the World Health Organization in 2019 reclassified the diagnoses that trans people employ to access the healthcare that some of them need, the healthcare that can transform some trans people's lives, the healthcare that can actually save some trans people's lives.
Sam Winter: 14:47 WHO re-designated those diagnoses as conditions related to sexual health. Previously, those diagnoses had been in the mental disorders section of the World Health Organization diagnostic manual, the International Classification of Diseases. That's not the case now. So that's a big move and I'm really pleased to say that I had a sort of foundational role in working for that change, but a lot of people worked on this. A lot of people worked on this. I had a small role in that.
Sam Winter: 15:34 That's a big move. That's a very big move and I think it's one that will, down the years, have an impact on the way that people do regard trans people. One should see a withering of that belief that trans people are mentally ill. And I think there'll be other consequences too, in terms of access to healthcare but that's another discussion for another day.
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Sarah Taillier: 16:37 Sam, what are some of the ways that you think we can increase acceptance of the trans community?
Sam Winter: 16:45 Information, education, legislation as education. I think trans people have a really important role to play. One of the consistent findings in the literature is that contact with the prejudiced group can, doesn't always, but can actually lead to more positive attitudes towards that marginalised, sometimes suppressed group. Certainly some research that we did a few... a long time ago actually now, show that that was the case for trans people, that is contact with trans people promotes more positive attitudes towards trans people and towards their rights as human beings.
Sarah Taillier: 17:32 Gender is becoming increasingly fluid. We've touched on that a little earlier as well, in some Western countries. How do we decide who to regard as a man and who to regard as a woman, and why is that distinction or is that distinction important?
Sam Winter: 17:49 Well, distinction's important because society really runs on the lines of gender. I think after we identify ourselves as human beings, I think gender is probably right up there as amongst the most important aspects of our identity. That's true for all of us, whether it be cisgender or transgender. Essentially you've asked what is a woman? I think, and we do tend to think in terms of cisgender women when we answer that. And so I think the easy answer to that is, and I would subscribe to this, my views have changed a little bit over the years, I think, perhaps over the last year, but my view on what is a woman is that a woman, and that's a social category, is an adult female, and that's a biological category. Woman is gender, female is sex. Woman is social, female is biological. A woman is an adult female.
Sam Winter: 19:03 Well, I do think we have to accept that there are many people who were assigned male at birth based on what could be seen of their biology the day that they were born, who also identify as a woman. They deeply, deeply want to live as a woman and be accepted as a woman. To do so is for them authentic. It is who they are. And I know very well that many such people can experience great distress, great discomfort when they encounter barriers to being able to live and be accepted and recognised as women, trans women, we're talking about trans women.
Sam Winter: 20:10 And my view is that in a civilised society, we should be prepared to regard them as women, treat them as women, accept them as women, recognise them as women, including legally. I think that's the sort of thing one should do in a society that has any pretensions to be inclusive and, I used that word already, civilised.
Sarah Taillier: 20:56 In the future, what's one space where you think traditional notions of male and female will matter less or not at all?
Sam Winter: 21:06 It already matters less in terms of marriage in Australia, and I think something like 20, or is it 30 other countries in the world? I believe it should matter less in toilets and changing rooms. I think the area in which I have the most misgivings is sport. I think that's because I know that the evidence is out there that the male hormone testosterone can have a tremendous impact on the human body during male puberty. I have seen research which shows that trans women who are taking feminising hormones do experience changes to their body. I see evidence to suggest that muscle mass can deteriorate over time, that in terms of muscle strength, the effects of testosterone during male puberty can dissipate. I'm not sure about whether the impact on lung capacity on the cardiovascular system dissipate. I don't know, I'm not sure about that, but one thing's for sure, the effect of testosterone on the male skeleton is permanent. Well, I've never seen any evidence to suggest otherwise. And common sense, I think and observation suggests that testosterone has permanent effects on the male skeleton.
Sam Winter: 23:04 So in something like swimming, for example, if you've gone through male puberty, I'm not mentioning any names here, but clearly swimming has been in the news lately, if you've gone through male puberty, you might on average have shoulders that are about five centimetres broader. You might have upper arms that are a few centimetres longer. You might have upper legs that are a few centimetres longer.
Sam Winter: 23:39 Now, never mind the lung capacity or muscles, whatever. Don't worry about that. You're dealing with a skeleton that... Well, actually I don't know enough about swimming, but I can see that there might be a debate there. I can see that there might be reason to be cautious there in allowing trans women to compete at the highest levels where people's lives and where people's careers are at stake, including the careers of the female competitors, that is the cisgender female competitors that one might be competing against.
Sam Winter: 24:16 So look, all I'm saying is that I think there are real issues for debate out there. Now, do you continue to have an entirely inclusive policy towards trans women in sport until the hard evidence is in, or do you remain cautious at the highest levels of support whilst you do the research? Is the advantage that a trans woman might have in this sport or that sport, and obviously it will vary between sports, is it an unfair advantage? That's another question too. That's a separate question. That's a separate question.
Sam Winter: 25:06 I would argue that in the world of highly competitive sport, particularly at the international level, there is no fairness. Ian Thorpe had size 17 feet. Did any anybody question his right to swim against other men with smaller feet? Eliud Kipchoge, I think I'm pronouncing the name correctly, a Kenyan marathon runner was born and grew up at 3,000 metres. Do we prevent him from competing against people who've grown up in the Netherlands, a few metres above sea level, because of an advantage that he might have had throughout his entire life living at a higher altitude?
Sam Winter: 25:57 I've got some figures here. The unfairness happens at a national level. Can I just quote some figures to you? All right. So the Commonwealth Games have, as we speak here, just ended in Birmingham. Australia with a population of 25 million, England, a population of 56 million, Canada, a population of 38 million. Small countries but they together got a total of 446 medals as compared with, say, India has 1.38 billion people, got 61 medals. Now, is there something inherently un-athletic about the population of India?
Sam Winter: 26:47 Well, no. What is the advantage that Canada, Australia, and England have? They're wealthy countries. They can fund sport, they can fund training, they can fund an entire infrastructure, sort of pyramid infrastructure that leads people up, that sucks people up to the elite levels of sport, where they can compete internationally and win medals internationally. Where's fairness in the Commonwealth Games for a country like Nigeria? Well, see what I mean? You can argue, there is no fairness at the highest levels, particularly the international levels of sport. So really, the question about whether trans women might have an unfair advantage, I think has to be set within that context.
Sam Winter: 27:49 But finally, I know I've gone on a lot about this. Finally, what I want to say is this, that everything I've said about my misgivings, my worries, my anxieties about the impact of testosterone, long-lasting impact of testosterone in some cases, in some aspects, those anxieties are in regard to competitive sport where people's careers are on the line. I do think that at the lower levels where we're doing sport for fun, I think the emphasis does need to be on inclusiveness.
Sarah Taillier: 28:31 Sam, you are many things. Apart from being a well regarded researcher, you're a psychologist as well. How did you come to work in this research space and specifically in the field of trans health well-being and rights?
Sam Winter: 28:47 This is a lovely question. I can talk for hours about this. I'll give you the short version. I'm a psychologist. I had been a psychologist working with children and adolescents and their parents and their teachers for many, many years, doing research in the area, doing clinical work, came across a few gender cases and sexuality cases, and very much began to become interested in this area.
Sam Winter: 29:16 Actually, I think I was going through a sort of mid-life crisis at the University of Hong Kong. As I approached the end of the millennium, the last millennium, I think I felt that there were too many psychologists around, too many educational psychologists, child psychologists, and spending so much time and so much money on research, research that never seemed to change what happened in the classroom, much less changed children's lives. So I really wanted to move into an area where I could as a psychologist, hopefully have some sort of impact on the world to make tomorrow better, borrowing Curtin's catch phrase.
Sam Winter: 30:02 So around about 2000, actually December 2000, I decided that I would actually change my career. And I was able to do that without changing job, because I was at the University of Hong Kong on tenure, and fewer and fewer people nowadays are on something which I would call tenure, that is complete job security. I was actually able to change my career focus entirely without changing job, and I moved into gender because of some of those cases that I had dealt with that interested me. Also, I had a history of cross-dressing when I was younger and there was a time when I was a young kid, I sort of did wonder... A young man actually, I did wonder, am I transsexual?
Sam Winter: 30:57 That is when I discovered in an issue of Gentleman Quarterly, GQ, is it Gentleman Quarterly? I don't know. GQ Magazine, I discovered there were these people, transsexual people, transsexual people. That was the word used back then. I suddenly thought, "Oh my God, I've been cross-dressing. Am I one of those people?" I decided that I wasn't, but who knows? Maybe I'm deeply, deeply, deeply repressed. Who knows? Who knows? I'll go to my grave not knowing, but I did have that sort of experience.
Sam Winter: 31:28 Also, when I was in Hong Kong, about a year into being in Hong Kong in the mid 80s, I was a refugee from Margaret Thatcher. I had a girlfriend, a lovely girlfriend. Her name was Sandy. She was a troubled soul and she clearly needed to tell me something some six, eight weeks into our relationship when we were becoming a little bit intimate. It became clear that she really did need to tell me something and tell me something there and then, and I remember on a very rainy night at the top of the peak, above Hong Kong City, she told me that... She said I will remember these words, "I am not a woman."
Sam Winter: 32:24 And I was shocked, absolutely shocked. She only told me that because I had shared some of my secrets. I told her I had been a cross-dresser. It seemed to give her the courage to tell me and when she told me... We'd had a lovely relationship and she expected, I think the relationship to end there and then. It didn't. We carried on at least for several months, but during that time with her, I saw how troubled her life was because she was trans, because she was trans and the way that people responded to her, and the constraints that she operated in.
Sam Winter: 33:06 And so that experience of going out with a trans girl, trans woman for that time in the mid 80s came back, if you like, to not haunt me, but to, if you like inspire me at the end of the year, at the end of the last millennium, and I thought, "Right, I believe I can make a difference in this area. I'm going to move into this area and start." And so I started doing research in this area quietly, very quietly, publishing in this area initially, quite quietly. And then as word got around, I started getting invitations to teach. And then within another 10 years, I had the most popular course on campus! And that's my story.
Sarah Taillier: 34:01 Sam, thank you. You've since published a wealth of research. You've received many commendations for your expertise in teaching as well. Thank you for coming in today and sharing your insights and anecdotes, and understanding about what is often a really misunderstood community. Thank you.
Sam Winter: 34:22 Thank you for your patience.
Sarah Taillier: 34:24 You've been listening to The Future Of, a podcast powered by Curtin University. As always, if you've enjoyed this episode, please share it and don't forget to subscribe to The Future Of on your favourite podcast app. Bye for now.