Policy Statement Adopted by the Governing Council
of the American Public Health Association, November 10, 1999
9933: The Need for Acknowledging Transgendered Individuals within Research and Clinical Practice The American Public Health Association,
Realizing that transgender refers to a population of individuals who do not and/or
cannot conform to traditional norms of gender,for example:
Transgender: Transgender is an umbrella term used to describe the full range of individuals
who do not necessarily conform to society’s standards of gender and sex; and
incorporate one or more aspects, traits, social roles or characteristics of the other gender.
FTM: Common abbreviation denoting a female-to-male transgendered/transsexual. This term can cover many forms of gender expression of the individual.
MTF: Common abbreviation denoting a male-to-female transgendered/transsexual. This term can cover many forms of gender expressions of the individual.
Transsexual: An individual who actively seeks to change or has changed his/her body
through hormonal reassignment and/or various surgical procedures.
Transvestite/Cross-dresser: One who wears the clothing and cultivates the appearance
of the other gender. This word has a few different meanings. In its purest form, transvestitism
Intersexed: Anatomic sex differentiation occurs on a male/female continuum, and there
are several dimensions. Genetic sex, or the organization of the sex chromosomes, is
commonly thought to be isomorphic to some idea of true sex. The sex chromosomes
determine the differentiation of the gonads into ovaries, testes, ovo-testes, or non functioning
streaks. The hormones produced by the fetal gonads determine the differentiation
of the external genitalia into male, female, or intermediate (intersexual) morphology; * and
Understanding that transgendered individuals vary by age, race, culture, income,
education, residence, sexual orientation, marital status, religion, ability/disability, immigration status, and interest in medical interventions; and
Noting that studies generally either do not identify the existence of transgendered
individuals, or combine them into a single transgender category and/or misconceptualized
under other labels; and
Acknowledging that little is known about the long term health risks associated with the
hormonal and/or surgical reassignment, some of which is conducted without a health care
provider’s participation, and that studies that do exist have small sample sizes and little
Noting that medical procedures are conducted upon many children and adolescents
with little understanding of their long-term outcome often resulting in pain and distress,
and examples of this are that
(a) Gender Identity Disorder within the DSM-IV is misused by some health care professionals to treat pre-homosexual and pre-transsexual childrenand adolescents so as to promote their
development into nontranssexual, heterosexual adults, and
(b) genital surgery or sex reassignment surgery are sometimes conducted upon intersexed infants so that their external genitalia resembles that of normal infants; and
Noting a growing body of literature that finds many transgendered individuals within
the United States are at risk of experiencing violence, HIV infections, and many sexually
transmitted diseases; and
Concluding that transgendered individualsare not receiving adequate health care,
information, or inclusion within researchstudies because of discrimination by and/or
lack of training of health care providers and researchers; therefore
1. Urges the National Institutes of Health and the Centers for Disease Control
and Prevention (as well as individuals researchers and health care workers) to categorize
MtF and FtM transgendered individuals as such and not conflate them with gay
men or lesbians (unless as appropriate to an individual’s sexual orientation in their preferred
gender) as well as acknowledging the variation that exists among transgendered
2. Urges researchers and health care workers to be sensitive to the lives of trans-gendered
individuals and treat them with dignity and respect, and not to force them to fit
within rigid gender norms. This includes referring to them as the gender with which
3. Urges researchers, health care workers, the National Institutes of Health, and
the Centers for Disease Control and Prevention to be aware of the distinct health care
needs of transgendered individuals; and
4. Urges the National Institutes of Health and the Centers for Disease Control
and Prevention to make available resources, including funding for research, that will
enable a better understanding of the health risks of transgendered individuals, especially
the barriers they experience within health care settings.
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* The Intersex Society of North America
(ISNA) is a peer support, education, and
advocacy group founded and operated by
and for intersexuals: individuals born
with anatomy or physiology which dif-fers
from cultural ideals of male and