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Transgender 101: An introduction

Getting Started

This article is a sampling of definitions which are informed by my experiences and viewpoint. I have spoken to many at length about these subjects to broaden my understanding and I hope to offer a culturally informed and competent analysis of the terms; but know that, like everything on my blog, what I write is from my perspective and I still have a great deal to learn. My definitions may not ring true for all.

I encourage discussion of the terms described below to take place, so we may learn more from each other.

Definitions are a tricky thing to discuss.

For one thing, everyone has their own set of definitions they use to navigate through the world, and these definitions are incredibly difficult for some people to change. For another, dictionary definitions are often used as ultimate, impartial truths. The problem with this is that language is incredibly fluid. Definitions can differ between cultures, geographical regions; what's more, they evolve and change over time.

Take the word 'literally', for example. For the longest time, the word 'literally' was primarily used to mean "in a precise or strictly realistic manner". Over time, in a subculture in our society, the word 'literally' evolved a secondary meaning to convey a strong emphasis. As the popularity of this new usage flourished and permeated, it was met with opposition by those who operated under the first definition and refused to update their lexicon. English professors ground their teeth in frustration as, from their perspective, they saw their students using the word completely incorrectly. People angrily rifled through dictionaries, triumphantly pointing to single-definition versions of the word, as if that nullifies the other usage.

The truth is that there isn't a single dictionary that can encapsulate all the various definitions a word one may have.

Language and culture are evolving faster than ever before, and as the transgender culture grows in prominence and numbers, a clash of culturally different versions of terminology is once again occurring. For many, a simple grade school understanding of sex and gender has gotten them through life up to this point, and it's on this foundation that they have built their worldview. However, as is the case with many aspects of our society, grade school knowledge is hardly encapsulating of all the required knowledge for navigating adulthood.

The topics of sex and gender are much more interesting and complicated than this simple view could ever encapsulate (and, speaking as a product of North Carolina's public school system, many health/sex education programs do a shoddy job of teaching even the basics of anatomy and contraception).

Sex 101

The combination of physical characteristics that affect the development of one's genitalia (external sex organs), gonads (internal sex organs), and secondary sex characteristics (body hair growth/density, fat distribution, muscle development. These factors include hormone levels, chromosome presence/organization, and prenatal development.

Intersex

For countless years, the dominant scientific theory of sex development was that the absence of a Y chromosome results in the development of a uterus and ovaries, and a Y chromosome presence results in testis and penis development. However, thanks to developments in genetic and cellular analysis, our understanding has evolved to understand that sex is rarely so easily determined.

Many people in our society are born with a mix of sex characteristics that don't fit into the traditional, simplistic definitions of sex. These people, if they so choose, can identify as intersex, and as science continues to evolve, so does our understanding of the prevalence of intersex combinations of sex characteristics. A study in 2014 states that so many as 1 in 100 people could have these traits. Intersex is not a cultural identifier under the transgender umbrella. There are people who are intersex and trans, there are people who are intersex and not trans; they are separate concepts.

Assigning Sex at Birth

In Western culture, upon birth, a doctor examines a baby's genitalia, and from this, assigns a baby the label of 'male' or 'female' for their sex and their gender. Children who are born with a penis and testes are assigned-male-at-birth, or AMAB; Those born with a uterus and ovaries are assigned-female-at-birth or AFAB. From this designation at birth onward, many aspects of the child's development and life are predetermined due to societal and parental pressures: the toys they can play with; the permittable interactions with other children of the same and different genders; how to behave; what activities to be interested in; the list goes on and on. These expectations and societal pressures are often detrimental to children's development.

If intersex gonads or genitalia are present, it is not uncommon for doctors to perform genital mutilation upon intersex infants for cultural or religious reasons. These surgeries, more often than not, are unnecessary and harmful to the children. Thanks to the efforts of intersex activists, this practice has received a lot of backlash in recent years. This past June, former US Surgeon Generals Drs. Joycelyn Elders, David Satcher and Richard Carmona have released a statement calling for an end to intersex genital mutilation.

Gender 101

As stated in the DSM-5, gender “refers to an individual’s identification as male, female, or… some category other than male or female” (2013). Everyone’s relationship with their gender (how they identify, why they identify that way, what traits they have that they identify with their gender) is varied and highly personal. How one person relates to their gender (and others' genders) can be completely different than the way another person feels about it, and neither person is more or less valid than the other. For instance, one person might see using makeup to be a very feminine thing; another may find a great connection to their masculinity through makeup.

Of course, our society has very rigid expectations when it comes to expressing gender; those who express their gender unconventionally are often treated with disrespect and violence by members of mainstream Western culture. Men who wear makeup are harassed; women who present with masculine traits are mocked; non-binary people are not acknowledged at all. These are all aspects of the societal construct that is the gender binary.

The Gender Binary

Male and female. In Western society, for the longest time, male and female were the only accepted gender identities. Currently, this is still the framework the majority works under; however, this is changing thanks to activists' efforts. Identifying as male or female affects a lot in our society, from what behaviors are considered socially acceptable, to what jobs one is expected to fill, to what people one expects you to be attracted to. These expectations for men and women highly restrict the ability of those who do not fit these models to flourish.

Western Non-Binary Identities

Non-binary people have existed for centuries, both in Western society and beyond. In this section, we will discuss non-binary identities in Western culture. The number of nonbinary identities is vast, for numerous reasons. For one, as I stated earlier, everyone's relationship with their gender is unique to them, and as nonbinary identities largely aren't acknowledged by society (and thus, there are no societal rules containing them), individuals are left on their own to explore their identity and create the words to describe that identity, the pronouns to use when referring to themselves, and so on. There are nonbinary people who identify as partially male or female, who identify as no gender, who identify as multiple genders and their association with these genders fluctuates over time and so much more.

Non-Western Non-Binary Identities

Many cultures of the world do not adhere to the gender binary. There are less now than there were pre-colonization, as the English, Dutch, Spanish, and other Western cultures sought to exterminate these indigenous cultures and install their own ideals, including the gender binary. Ideally, I want to make my own resource describing all of these beautiful cultures, how they survived colonization, and how their lives today are shaped by this history. As a placeholder until that time, here is an article provided by the unexpected hero of 2017, Teen Vogue.

Transgender 101

When one's gender is different from the sex and gender they were assigned at birth, they have access to the cultural identifier 'transgender'. The Latin prefix trans means 'across from', to indicate the relationship between sex-assigned-at-birth and gender. When a transgender person begins to identify differently than the sex/gender they were assigned at birth, this is the beginning of their transition.

Transition

Transition can be a very difficult time for a transgender person; however, it can also be filled with euphoria and a heightening of self-esteem; truly, no one's transition is the same. Transition is shaped by internal forces and external forces: gender dysphoria; societal expectations of gender; how others treat the person in transition; and so many other factors affect what aspects a person chooses to change.

Some people change physical aspects of their person/presentation by taking hormones, or by undergoing any of a number of surgeries, or by simply wearing different clothes that they feel expresses their gender identity better. Some undergo trans vocal training to change deeply-ingrained patterns of communication and producing speech. Some change their names and gender markers in government paperwork. Others only transition socially by asking others to use a different name/set of pronouns. Some do not transition at all due to familial or social pressures, or because their bodies would not react well to transition, or because they simply do not want to.

All of these people are valid and are welcome in the transgender community.

Gender Dysphoria

As defined by the DSM-5, "refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender... not all individuals will experience distress as a result of such incongruence" (2013). As they stated, gender dysphoria is not a requirement for being transgender; it is, however, not uncommon for a transgender person to experience dysphoria at some point in their lives. Dysphoria is often thought of to be comprised of two possible components: body dysphoria, which is centered around a feeling of disconnect with one's physical features; and social dysphoria, which refers to the distress that accompanies others' mistreatment of a trans person due to their identity/presentation.

Our society instills a lot of pressure to conform to cisgender-centric standards of expression, and harshly judges/hurts individuals who do not meet these standards. The psychological anguish that results from this judgment is dysphoria.

Transgender Statistics

Due to the intense societal discrimination against transgender people, it is difficult to obtain accurate statistics on how prevalent the transgender population. The US Census was considering adding LGBT-specific data to the census in 2020; however, this has since been changed. In 2015, the National Center for Transgender Equality released the findings of a massive survey of American transgender people; the results are publically available here, and provide a great deal of insight into the hardships the community faces.

Cisgender 101

When one's gender is identical to the sex and gender they were assigned at birth, they have access to the cultural identifier 'cisgender'. The Latin prefix cis means 'on the same side of', to indicate the consistency between sex/gender assigned at birth and current gender.

Cisgender people make up the vast majority of our society; as such, their presentation, their ideas of what it means to be male or female, are heavily centered in our society. This happens to the point where transgender people have to fight for visibility at every turn, as we are so very rarely seen in media or culture. Transgender people are inundated with cisgender-centric standards of beauty and presentation.

It's standards like these which fuel many transgender people's gender dysphoria, and desire to physically transition.

In Conclusion

I think that's more than enough terms for one post. I am definitely planning on making more posts regarding transgender terminology in the future. I hope this was useful as an introduction to this terminology!

As always, please let me know what you think, and feel free to email me if you have concerns.

Kevin Dorman, MS, CCC-SLP

Owner and Speech-Language Pathologist
(336) 609-6258
kevin@prismaticspeech.com
A watercolor abstraction of the lungs

LCR: Relax, Take A Breath

Good evening!

There are so many topics I cannot wait to address! Before we get too deep into complex discussions of speech and hearing sciences, however, we need to establish a common base of knowledge to draw from later on. Therefore, several upcoming posts will address the basics of speech sound production!

Speech production is something many of us do every day. Whether it’s for one’s job or socialization, so much of our society is built around the voice. But how many of us can say we understand how the production of speech works beyond the basics? Why do we breathe in before we talk? What happens in the throat that makes the air vibrate? How does the passage through the mouth and nose shape and change the sound? And how does the human brain coordinate and execute the complex sequence of muscle contractions that results in the movement of teeth, tongue, lips and much more, to articulate speech?

For most, these questions don’t even occur as they rely on this intricate interplay of systems every day of their lives. For those curious, however, look no further! Prismatic Speech Services is here to unveil the mysteries of the voice in:

Lights, Camera, Refraction!


The beginning step of producing the voice is respiration, or the act of breathing. Breathing in is referred to as inhalation or inspiration; breathing out is known as exhalation or expiration. This takes place in the lungs. The lungs reside in the thoracic cavity, along with the heart, esophagus, trachea, bronchi, and other important structures. The thoracic cavity is protected by the ribs and the surrounding musculature.

Respiration Simulation

Major Muscles of Inhalation

Diaphragm
Intercostal Muscles

During inhalation, the diaphragm contracts, expanding the thoracic cavity by pushing our abdominal cavity organs down and out. The lungs expand to fill the empty space, which results in a pressure drop in our lungs. Due to the pressure difference between our lungs and our surrounding environment, air rushes in to fill the space (this is known as Boyle’s Law). The air travels into the lungs and reaches the alveoli, which transfer the oxygen to the blood in exchange for carbon dioxide. 

Thanks to the heat our bodies produce, the air in our lungs begins to increase in temperature. As the air heats up, it expands and the pressure in our lungs increases (this is known as Charles’ Law. The lungs also begin to decrease in size due to wanting to return to a resting position (or elasticity), which increases the pressure as well. At this point, the air in our lungs is at a greater pressure than the pressure in our environment. Thanks again to Boyle’s Law, the air rushes back out of the body and out into the environment.

Folks, DO Try This At Home!

 

Tidal Breathing: Breathe in and out as calmly as you do when you're at rest, feeling the muscles activate when you breathe in, and how no force is needed to breathe out. Time how long it takes you to breathe in, and how long it takes to breathe out. The rates of inhalation and exhalation should be roughly the same (with maybe a nod towards longer exhalation).

Speech Breathing: The next time you speak to someone, pay attention to how different the inhalation and exhalation feel when compared to life breathing.

The takeaway: Tidal breathing (usually) feels different than breathing for speech. Tidal breathing is a cycle of roughly 40% inhalation and 60% exhalation, and the exhalation is passive, meaning no muscles are activated to do it. However, when breathing for speech, the cycle is roughly 10% inhalation and 90% exhalation!

By gently activating the muscles of inhalation alongside other muscles, such as the inner layers of intercostal muscles, one slows down how quickly air exits the lungs to a rate we can use for speech. This slower air travels up the trachea and through the larynx. It is here that the next stage of speech production occurs: phonation! We'll talk more about this next step in a later post. For now, let me know if you have any questions about breathing that were not answered in this post!

Take care,

Kevin Dorman, MS, CCC-SLP

Recap: The Voice Foundation 2017 Symposium (03)

06/12/17 UPDATE:
I was able to gain the perspective of one of the presenters in the afternoon. With their permission, I will share a section of their statement:

“…I completely agree that we missed a really important moment there and I’m sorry. I will confess, before the opening day I was feeling confident about our workshop and had clear intentions. After the morning sessions, I felt like I had been hit by a bus–like we had all collectively been hit by a bus. I had to sit in a quiet place and try to sort out what had just happened, and rethink my section of the presentation because the audience I was hoping to speak to was so clearly not this audience. I honestly didn’t feel safe introducing myself with my pronouns… [and] if it wasn’t safe for ME, how could it be safe for my friends?”

I thank this presenter for sharing their perspective with us, for feeling unsafe in spaces centered around our experiences is a grave concern and is very difficult for many to talk about openly. And this presenter is not alone, as their feelings of insecurity have been echoed in multiple other transgender audience members we have spoken to since the event.

If The Voice Foundation and other similar organizations wish to truly serve the transgender population in the future, the security and safety of trans attendants must be prioritized. If they feel unsafe because of actions of the presenters, the quality of information presented becomes very suspect of holding prejudice and transphobia. If the medical community ever wishes to gain the trust of the transgender population, they must work to improve their own cultural competency, particularly when they think no (or few) trans ears are present. It is not enough to treat a client with respect when they are present; true, authentic respect for the culture must be achieved.

***

This past weekend, I was fortunate enough to be able to attend The Voice Foundation’s 46th Annual Symposium. Every year, voice professionals from across multiple disciplines come together to hear about the latest in voice-related research, intervention and teaching techniques. This year, there was an entire day of resources dedicated to transgender voice! It was an incredibly enriching experience to attend: I learned a great deal from the top endocrinologists, surgeons, speech-language pathologists, and vocal performance specialists; I reconnected with several old friends in my field; and made many new friends and connections! I was also able to purchase several resources for my practice that will be incredibly useful in the future.

During many of the sessions, presenters emphasized how important it is to be culturally competent when working with the transgender population. This was good to see, particularly when the history of transgender medical intervention is steeped in discriminatory language and practice. In the spirit of pursuing cultural competency, there are several issues that must be raised with this year’s Symposium. As always, there were multiple moments of clumsy misusage of terminology or usage of outdated problematic terms such as “natal female” or “biological male” by members of the audience as well as the experts they’d invited to present. Additionally, none of the presenters introduced themselves with their pronouns. This lack of awareness of preferred terminology is frustrating to me, particularly if these individuals are considered experts of working with trans people in their field. Another element I would like to address is the lack of diversity in the presenters. Almost all of the presenters were white and cisgender, which was disappointing to see. The moderator of the panel lamented the fact that, despite their efforts, there was a lack of transgender voices on that panel. My trans and non-binary speech-language pathologist friends glanced at each other in confusion; we certainly hadn’t been reached out to, nor had several of the other trans practitioners in the audience.

Even among the heads of their fields, the need for transgender cultural competency training is clear. The presenters were certainly well-intentioned, but that alone is not enough. I approached the panel during their Q & A and asked the question that I felt most people needed to be answered:

Kevin: How can clinicians and researchers respectfully engage with the transgender community without invading safe spaces, such as support groups? What are effective methods you’ve had success with?

Unfortunately, the response I received was rather vague. The panel of six was silent until one woman spoke that she was usually invited to support group meetings and that generally made it more acceptable for her to attend. Which I can see; if the support group is okay with one visiting, then visiting the group is acceptable. However, this did not really answer my question, and we ran out of time to discuss further. I hope the panelists have engaged with transgender culture more than could be discussed at that time. Seeing as none of the panelists were transgender, and the many cultural blunders that were exhibited, it’s given me more drive to complete cultural competency training courses for practitioners who want to learn more.

ResonaTe

With all the above problems, the Symposium was still very informative, and a great success! In the afternoon, the Symposium arranged a fantastic demonstration by four members of ResonaTe, an all-transgender choir in Chicago which eschews conventional Western choral traditions in favor of a more flexible structure. The five representatives of ResonaTe who were presenting explained that traditional choirs’ usage of very gendered language such as soprano, alto, tenor, bass, etc, do not allow much wiggle room, both in terms of the gender makeup of the parts and in terms of very limited acceptable presentation. The ideal soprano is a very specific type of woman with a very specific sound. Instead, ResonaTe uses a numeric system to identify different vocal parts, and members of the choir learn every vocal part. Then, they are free to choose voice parts for themselves and are free to change voice parts as meetings go on. This self-selection also removes some of the authoritarian power of the conductor, who typically assigns members to their voice parts.

It was inspiring to hear these singers performing so beautifully. I feel driven to begin a similar program in Greensboro someday! But I cannot do this alone, as I do not have experience conducting or leading a choir. If you know of any transgender people in the Triad area that have experience leading a choir, please send them my way! I would love to discuss the feasibility of beginning this project.

-Kevin Dorman, MS, CCC-SLP

LCR – What’s In A Name? (02)

The term ‘speech-language pathology’ is an unwieldy one. When I introduce myself as a speech-language pathologist, very few people in the general public have even heard of the profession. This is hardly their fault; speech-language pathologists use a variety of different titles and job descriptions when referring to themselves. Speech teacher; speech therapist; speech teacher; speech pathologist; voice therapist; voice coach; accent coach; the list goes on and on. When there are so many informal variations, it’s no wonder that people are unsure of what our profession is!

Prismatic Speech Services is here to fill in the gaps between the professional and the public in our educational series:

Lights, Camera, Refraction!
(logo pending)

Let’s begin our discussion by defining the term ‘speech-language pathology’.

Speech-language pathology: the field of study involving the detection, evaluation, diagnosis, and treatment of speech, language, voice, swallowing, fluency, and cognition-related disorders.

Wow, what a long list of words! Put in more reader-friendly terms: speech-language pathologists work with those who are unsatisfied with their communicative abilities. In graduate school, burgeoning speech-language pathologists are given in-depth instruction in all subjects listed and beyond in order to prepare them for employment possibilities in a wide variety of settings. The primary employers of SLPs are hospitals; outpatient clinics; school districts; skilled nursing facilities; and ear, nose, and throat clinics. We use our diverse skill set to work with clients whose quality of life is currently lower than average due to difficulties with any of the domains listed in the base definition above.
The ‘quality of life’ component is an important one, as not everyone who has a communication disorder, delay or difference feels negatively impacted by their atypical communication style. If someone doesn’t feel that their communication style hurts their quality of life, then seeing a speech-language pathologist may not be necessary.

With so many areas of communication (and swallowing) and populations to work with and specialize in, it’s no surprise the branding of the field is so vague. Another contributing factor to this difficulty is the lack of public knowledge regarding just how complicated communication (and swallowing) is! Do you know the difference between speech and voice? Language and fluency? Let’s address these terms before we proceed. The following is a basic overview of each of these concepts:

Voice
Definition
Resonance
Video
Speech
Definition
The Articulators
Video
(Verbal) Language
Definition
The Sub-Domains of Language
Non-Verbal Language
Fluency
Definition
Disfluencies
Secondary Behaviors
Swallowing
Definition
Cognition
Definition

There is so much more to say about all of these areas; unfortunately, I am out of time. I must begin packing for my adventure to Philadelphia for the 47th Annual Voice Foundation Symposium! Next week, I’ll discuss my time at the symposium and everything I learned there. I hope you enjoyed my brief overview of what speech-language pathology is and who we work with! As always, leave any questions or comments and I will do my best to respond in a timely fashion. Thank you for reading!
Have a great night,
Kevin Dorman, MS, CCC-SLP

Kevin at their wedding, April 1st, 2017

An Introduction (01)

Hello!

My name is Kevin Dorman (they/them/their) and I’m the owner and sole practitioner of Prismatic Speech Services. I am a state licensed speech-language pathologist, and a member of both the American Speech-Language-Hearing Association (ASHA) and the World Professional Association for Transgender Health (WPATH). On this page, I’ll be posting informational articles on a variety of subjects, including the mechanics of speech production, child speech and language development, transgender vocal training, Greensboro events, and LGBTQ+ advocacy, as well as answering questions sent in by guests and clients who want my opinion on a certain subject.

For this first post, however, I wanted to give you a small introduction to who I am, so you know whose perspective it is you’re reading. I’m not a fan of “emotionless fact listing” as a blogging format, as emotion and empathy are vast components of the work we do here at Prismatic Speech Services. Too often, I feel speech-language pathologists and other healthcare professionals can come across as impersonal and withdrawn from discussing themselves, which only undermines the pursuit of building a trusting, equal relationship between clinician and client. Receiving speech/language intervention (trans vocal training in particular) can be such a vulnerable position to be in. If I ask that of my clients in our sessions the least I can do is return the favor, and during a session is hardly the time to do so!

Ever since I can remember, I’ve had a passion for voice, and this passion has changed and evolved over time as much as I have. When my brother and I were younger, we both worked endlessly on developing an ear for unique voices and replicating them ourselves. My vocal flexibility and range improved as I got older and began stage acting in school and voice acting for animated shorts made by burgeoning animators. I joined an auditioned choir as well as an a capella group as a beatboxing and auxiliary specialist. I figured out that I was bisexual during my senior year, which helped answer a lot of unasked questions I had.

During my undergraduate years at the University of North Carolina at Greensboro, I began seeking a more practical application for my vocal prowess. It was my high school theater teacher who encouraged me to investigate speech-language pathology. Upon taking an introductory course, I was head over heels for the field! I had never experienced a science that gripped me as speech-language pathology had – I knew I had to pursue it.

It was at this time that my gender identity began to manifest. I conferred with a close friend of mine, and eventually emerged as the proud non-binary bisexual person you can meet today. This friend would in time become my boyfriend, and more recently, my husband (April 1st, 2017!) Through my Deaf Studies classes and new friendships, I began learning about oppression and intersectional feminism, which greatly influence my approach to life and my career. I left UNCG in May of 2013 with a Bachelor of Science in Speech-Language Pathology and a Minor in American Sign Language/Deaf Studies.

In my graduate study of Communication Sciences & Disorders at Western Carolina University, I began learning about transgender vocal training, and pursued a specialization in the niche area by seeking experience in voice disorders. I attended conferences, seminars, and workshops centered around the voice. In my clinical practicum (and post-graduate clinical fellowship), I gained experience in a diverse range of speech-language pathology settings, including interning and working in elementary schools, skilled nursing facilities, outpatient rehabilitation clinics, and hospitals. I worked with many clients with voice disorders and motor speech disorders, such as apraxia of speech, myasthenia gravis, and multiple presentations of dysarthria, to name a few. This implanted in me a multiplicity of skilled intervention techniques and a love of working with a variety of clients. 

In April 2016, I began planning the launch of my private practice to serve the underserved in North Carolina. A full year later, I am proud to say that my efforts have paid off and Prismatic Speech Services is open for business! This does not mean that my learning is finished; speech-language pathology is a field of constant evolution as new research is published and applied to my clinical practice. I am constantly working to improve my clinical skills and bag of tricks, and view every client as a unique opportunity to learn.

If you are interested in receiving services yourself or procuring them for your child or other dependent, do not hesitate to book a free consultation or an assessment! If you are a professional interested in adding me to your referral network, please call Prismatic Speech Services.

 

I hope to hear from you soon,

Kevin Dorman
MS, CCC-SLP