Scottish Government Equality Outcomes: Lesbian, Gay, Bisexual and Transgender (LGBT) Evidence Review

4 Transgender

4.1 It is important to note the severe limitations on Transgender data. The EHRC Transgender Research Review^[62] presents a wealth of methodological material concerning definitions, research and data on Transgender people. It observes that, although there is a considerable amount of literature produced for campaigning or lobbying purposes, commentary on the legal position of Transgender people and anecdotal discussion of experiences, there is only a small number of robust studies. Where primary research has been conducted, difficulties associated with identifying Transgender people mean that samples were often too small to make robust generalisations from the data, or that reliance on convenience sampling meant that it was not possible to be sure that the studies had mapped sufficient diversity within the Transgender community to draw substantive conclusions. The Review specifically points out the methodological difficulties of conducting international comparative research, due to broad variations in administration, finance and ethics in different countries, in addition to the small amounts of Transgender research being undertaken in any country.

School education

4.2 The evidence reviewed for Transgender people and school education focuses on harassment and discrimination.

4.3 The EHRC Transgender Research Review brings together a number of UK studies, all sharing a focus on harassment - the data are not specific to Scotland. In an LGBT study in London that included 24 Transgender respondents and 430 LGB respondents^[63], experiencing problems in school was more widely reported by Transgender respondents (75%) than LGB respondents (21%). The authors report that Transgender people face problems similar to those they may encounter within the workplace: respondents "felt isolated and needed to stay 'in the closet' ", or were harassed by teachers and other students.

4.4 Whittle et al (2007)^[64] report similar problems in schools from their much larger sample of 872 Transgender people (of all ages). 64% of young Transgender men and 44% of young Transgender women experienced harassment or bullying at school, not just from their fellow pupils but also from school staff including teachers. The authors report that these are higher rates than shown in many studies on young lesbians and gay men at school. The research also counters the commonly held belief that there is less tolerance of gender variant boys than girls, finding that females who became Transgender men later in life faced the most harassment and bullying at school.

4.5 Despite the apparently high incidence of discrimination against Transgender people in schools, Whittle et al (2007) report that their respondents were on average better educated than the national average. To explain the higher achievers, Whittle et al (2007) note that - for those of their respondents who had undergone gender reassignment - the gender reassignment process itself is so complex that the better educated may find it easier to progress. The EHRC Transgender Review also suggests that the methodology Whittle et al used may have favoured the better-educated: the 30-minute online self-completion questionnaire may have favoured those Transgender people with IT knowledge and better education.

4.6 An online survey of Transgender people in the UK in April 2011^[65] sought adults' points of view regarding children's experiences in school:

• Almost half of respondents (44%) thought that the behaviour of other children presented the most challenges to gender variant children;
• Nearly two-thirds of respondents (47%) thought that intervention, such as guidance or training, would be best focussed in secondary school;
• Nearly half of respondents (45%) thought that teachers did not have the tools to tackle the bullying of gender variant children in schools.

Employment

4.7 This section begins with a summary of issues in employment from the Scottish Transgender Alliance, followed by a number of UK-based studies drawn from the EHRC Transgender Review.

4.8 The Scottish Transgender Alliance^[66] observes that the workplace is one of the most likely locations for transphobic discrimination and harassment to occur, and as a result many Transgender people are unemployed, under-employed or self-employed - Morton (2008)^[67] found that 19.7% of the respondents to his survey in Scotland were self-employed, although no comparison should be made from this sample to a national average.

4.9 The three key issues identified by the Scottish Transgender Alliance for Transgender people in employment are:

• the risk of transphobic workplace gossip, bullying and harassment occurring if their work colleagues or managers find out they are Transgender;
• discrimination during the recruitment process, especially at interview; and
• for employees undergoing gender reassignment, arranging with their employer to get the necessary time off for medical appointments and any surgery.

4.10 Whittle et al (2007)^[68] surveyed respondents on their experiences of discrimination at work. They report that "nearly 29% of respondents experienced verbal harassment (comments) at work and some also experienced verbal abuse (name calling) and threatening behaviour or physical abuse" (p. 37).

4.11 Keogh et al (2006)^[69] found that Transgender respondents were more likely than LGB respondents to experience problems at work, at 33% versus 13%.

4.12 a:gender^[70] report on research by Transgender campaigning groups which suggested that over 50% of transsexual people suffer discrimination and harassment at their place of work. One in four felt obliged to move to another job as a consequence of bullying and harassment and 42% of those who identified as having an unfulfilled need for gender transition, cited the workplace as the reason for their not living in that gender.

4.13 In an online survey of Transgender people in the UK in April 2011^[71], employment was identified as being the second top area of concern for the Transgender community, with around a third (31%) of respondents selecting it as their priority. Difficulty in gaining and retaining employment was considered the most important challenge that Transgender people face, with two-thirds of respondents (66%) identifying it as the most important challenge. In the third phase of this survey in August 2011, six broad areas were addressed:

4.14 (A) Awareness of Transgender issues:

• A majority of respondents (88%) said ignorance was the biggest challenge Transgender people faced in employment.
• Over a third of respondents (37%) said ignorance was the biggest problem amongst colleagues and other employees in their organisation.
• A majority of respondents (86%) cited employers fearful of possible customer/client reaction towards a Transgender employee as an additional barrier in employment.

4.15 (B) Discrimination and harassment

• Half of respondents (50%) said they had been harassed or discriminated against because of their gender identity in their previous or current job.
• Around a third of respondents (32%) said the main source of discrimination or harassment came from their colleagues.

4.16 (C) Challenging discrimination and harassment

• Nearly two thirds of respondents (63%) raised the discrimination and/or harassment they experienced within their organisation, with most going to their senior manager.
• Nearly a third of respondents (30%) said their complaint was handled poorly.

4.17 (D) Employers' Transgender policy

• Over half of respondents (57%) said their current or last employer did not have an employment policy to support Transgender employees.
• Most respondents (93%) said their employer had never asked to see a Gender Recognition Certificate, regardless of whether the respondent had one.

4.18 (E) Job seeking

• Most respondents (96%) said they had never been given any support because of their gender identity in finding a job.

4.19 (F) Privacy and Identity

• Approximately a third of respondents (31%) said that gossip, as a threat to their privacy, had the greatest impact on their life.
• Nearly three-quarters of respondents (72%) did not feel their current identity was secure from disclosure.
• Nearly half of respondents (46%) said they did not have any difficulty living in their current gender identity in their local community.

4.20 A UK survey of 208 transsexual people^[72] found that pre-transition, 28% of respondents worked in the public sector, but this rose to 42% post-transition.

Poverty

4.21 The EHRC Triennial Review^[73] cites two studies, but warns of their small sample sizes:

4.22 Research conducted for the Scottish Transgender Alliance^[74] suggests that Transgender people's income is low. For example, a 2007 survey of 71 Transgender people in Scotland found that 30% of respondents had an income of over £20,000, and 48% of respondents had an income under £10,001.

4.23 According to a questionnaire and focus-group based survey of 819 lesbian, gay, bisexual and Transgender people in Brighton and Hove^[75], the Transgender people in the sample were over three times as likely as LGB people to have an income under £10,000, and 11 times less likely than LGB people to earn over £30,000 a year, although it should be noted that only five percent of the sample in question identified themselves as Transgender.

4.24 Regarding welfare reform, the Department for Work and Pensions has published an Equality Impact Assessment for the Universal Credit^[76]. This explains that the Department for Work and Pensions does not hold information on its administrative systems on gender reassignment, but also that it does not envisage any adverse impacts on these grounds.

Housing

4.25 This section addresses tenure, homelessness, and service provision.

Tenure

4.26 A Scottish Transgender Alliance survey in 2012^[77] addressed tenure and homelessness. It reported that 22% of 526 respondents owned their own property, with 11% renting privately as a joint tenant and nine percent renting privately as a single tenant. Most respondents lived in a city - 53% of the 545 answering this question - with a further 20% living in a town near a city; only 23% lived in an area that they described as rural.

Homelessness

4.27 In the Scottish Transgender Alliance survey cited above, 19% of the 542 respondents reported having been homeless at some point, with 11% having been homeless more than once. 171 respondents provided information about having to leave housing:

• "7% stated that they had left their parental home due to people's reactions upon finding out that they were trans or had a trans history,
• 6% had left a home shared with a partner,
• 4% had left a home that was shared with other people,
• 3% had had to leave their own home which they lived in alone due to other people's reactions to their trans status".

4.28 In an earlier Scottish Transgender Alliance survey, Transgender experience in Scotland (2008)^[78], four percent of the 71 respondents were currently homeless, and 25% stated that they had previously had to move out of their home (often ending up homeless) due to the transphobic reactions of their families, flat-mates or neighbours.

Service provision

4.29 Stonewall Scotland's project report, Safe and secure? LGBT experiences of social housing in Scotland, February 2007^[79] has a short section specifically on Transgender people's experiences of housing access and service provision (p21). These include concern as to how they will be treated by housing officers, and the need for privacy within B&B or hostel accommodation.

4.30 The UK-wide views from the EHRC Transgender Review^[80] conclude that abuse or exclusion by neighbours or family may trigger a housing crisis, potentially leading to homelessness. Whittle et al. (2007)^[81] recommend that Transgender status be taken into account in assessing prioritisation of need for social housing. The EHRC Transgender Review states that there are no examples of Transgender-only housing initiatives designed to meet their specific needs, placing Transgender people at great risk of housing vulnerability and crisis; however, the Review concludes that the value of housing dedicated to the needs of Transgender people requires exploration.

Transport

4.31 Regarding air travel and hence airport security checks, the American Transportation Security Administration^[82] specifies that "Pat-downs are conducted by an officer of the same gender as presented by the individual at the checkpoint" (emphasis added). The National Center for Transgender Equality^[83] (NCTE), also in the USA, observes that "Obviously, this could lead to difficulties or challenges for many Transgender people. NCTE recommends that you decide at the time what you believe to be the safest and most comfortable options [sic] for you".

Hate crime and good relations

4.32 Hate crime is generally understood to be a crime motivated by malice and ill-will towards a social group^[84]. The Offences (Aggravation by Prejudice) (Scotland) Act 2009 provides for statutory aggravations for crimes motivated by malice and ill-will towards an individual based on their gender identity.

4.33 This section reviews the levels of abuse against Transgender people, and a reported disinclination to involve the police. This section closes with a review of attitudes towards Transgender people.

Levels of abuse, and reporting

4.34 Summary figures are available from the Hate Crime in Scotland report^[85]. This reports that in 2011-12, 16 charges were reported with an aggravation of prejudice relating to Transgender identity, compared with 14 charges the previous year.

4.35 Detailed survey data of 71 respondents from Transgender experience in Scotland^[86] show that:

• 46% of respondents stated they had previously experienced transphobic abuse in domestic relationships: mostly this took the form of verbal abuse but 17% experienced threatening behaviour; 11% experienced physical abuse and six percent experienced sexual abuse.
• 62% of respondents stated that they had experienced transphobic harassment from strangers in public places who perceived them to be Transgender: mostly this took the form of verbal abuse but 31% experienced threatening behaviour, 17% experienced physical assault and four percent experienced sexual assault.
• Although 38% did not describe experiencing transphobic harassment from strangers, it must be taken into account that 23% of respondents stated they have never been perceived to be Transgender by any strangers. Therefore, just 15% of respondents had been perceived as Transgender by strangers on one or more occasion but never experienced any transphobic harassment.
• Only 15% of respondents had ever reported any transphobic harassment to the police. Of those 11 respondents, only five stated they were satisfied with the response they received from the police.

4.36 The EHRC Review of Research^[87] reports a UK study in 2007 (N.B. not specific to Scotland) on Transgender and transsexual people^[88] that highlighted evidence of high levels of verbal, physical and sexual abuse occurring when in public places, with 73% of people stating they had experienced some form of abuse. Far fewer (37%) of those who chose to present their acquired gender permanently reported experiencing negative comments about their gender when out socially. The authors suggest that some may have 'disappeared'; that is, in day-to-day activities they may pass well enough to be treated as 'ordinary' men or women. For others, however, it is thought to be more likely that there is under-reporting as a result of not seeing incidents of violence or harassment as relating to their Transgender status.

4.37 In an online survey of 1,275 Transgender people in the UK in April 2011^[89], respondents' most widely-reported fear was for their safety on the streets and when using public transport, whilst just under half of respondents (47%) said their greatest worry was being a victim of a violent crime or harassment. Around three-quarters of respondents (76%) had never brought a complaint to the police, and nearly half of respondents (47%) cited the police's lack of understanding/sensitivity as being the greatest challenge in bringing about a complaint.

Attitudes towards Transgender people

4.38 The Scottish Social Attitudes Survey (2010)^[90] asked people how they would feel if a close relative married or formed a long-term relationship with someone of a different race or religion, or:

• someone who has had a sex change operation
• someone who cross-dresses in public.

4.39 2010 was the first time the Survey included a question about people who cross-dress in public. This question was added to find out whether people who cross-dress attract more prejudiced responses than people who have had sex change operations. It was suggested that people who cross-dress might attract more prejudice because they are seen as more challenging of the male/female dichotomy, while people who have had sex change operations may be more likely to be accepted in their self identified gender. The findings suggest that this is indeed the case - 55% said they would be unhappy if a close relative married or formed a relationship with someone who cross-dresses in public. This was the highest level of unhappiness expressed for any of the 10 groups the survey asked about, although at 49% the proportion that would be unhappy if a close relative married someone who has had a sex change operation was not far behind. The proportion that was unhappy with the idea of a person who has had a sex change joining their family circle was 12 percentage points higher than the proportion that was unhappy with a Gypsy/Traveller doing so (37%). It appears then that Transgender people are particularly likely to attract prejudiced attitudes in the context of personal relationships. The report concludes that, while it is true that for the most part only a minority express discriminatory views, that minority is not always a small one. Some groups - particularly Gypsies/Travellers and Transgender people - appear to be the subjects of fairly widespread discriminatory attitudes.

Justice

4.40 This section looks at confidence in the justice system, the composition of the legal profession, and legal recognition of the acquired gender.

4.41 The EHRC Triennial Review^[91] reports a survey of attitudes and experiences among 872 Transgender people in 2007^[92]. This found that two-thirds felt confident that they would be treated appropriately by members of the police service as their acquired gender. However, around 1 in 5 of those who had had contact with the police felt that they were treated inappropriately, with attacks against them not being taken seriously and inappropriate searches being carried out.

4.42 A 2006 survey of the legal profession in Scotland^[93] found that:

• Six percent did not state whether they consider themselves to be Transgender.
• Less than one percent considered themselves to be Transgender.

4.43 Regarding access to justice and legal aid, no information has yet been found on the gender identity of applicants for civil or criminal legal aid.

4.44 The Gender Recognition Act 2004 provides a mechanism for Transgender people to apply for legal recognition of their acquired gender^[94]. The Act came into force across the UK on April 4, 2005. Under the Divorce (Scotland) Act 1976, a ground for divorce and for dissolution of civil partnership is the granting of an interim gender recognition certificate to one of the parties to the relationship. Under the current law, a marriage must be between a man and a woman. A civil partnership must be between two people of the same sex. Therefore if a Transgender person wants to be legally recognised in his or her acquired gender, he or she cannot remain in a marriage or civil partnership. It is open to the couple to form a new legal relationship. But the couple's responsibilities and rights may be affected - for example, survivors' pension benefits. It can also affect rights to "matrimonial property", as defined in the Family Law (Scotland) Act 1985, in the event that the couple divorce or dissolve their civil partnership. This means that Transgender people may face a choice between staying in their marriage or civil partnership, or obtaining full legal recognition in their acquired gender.

Health

4.45 This section addresses the health of Transgender people, and their concerns with the provision of health care.

Transgender people's health issues

4.46 It is recognised by the Scottish Government and the EHRC that there is limited evidence into the health of Transgender people in Scotland^[95]. Currently, there is no fully tested recommended question with which to collect information on gender identity in surveys or other data sources.

4.47 In an online survey of Transgender people in the UK in April 2011^[96], the top area of concern for Transgender people was their health, with nearly half of respondents (49%) selecting this as their priority.

4.48 In addition to care during gender reassignment, the EHRC Transgender Research Review^[97] considers that Transgender healthcare needs "may relate to experiences of isolation, discrimination and transphobia… these experiences place many Transgender people at risk of alcohol abuse, depression, suicide, self-harm, violence, substance abuse and HIV" (p55).

4.49 Regarding Transgender people's mental health, the Scottish Transgender Alliance describes its 2012 survey^[98] as the largest survey of its kind in Europe, providing vital data on Transgender people's mental health needs and experiences, explored in the context of daily life, social/support mechanisms and when accessing healthcare and mental health services. It explores how the process of transitioning (social and/or medical) impacts on mental health and wellbeing, in both positive and negative terms. Its findings include:

• 74% of respondents felt that their mental health had improved as a result of transitioning. The five percent who reported a decline in their mental health since transitioning felt that their issues related to a lack of appropriate support, losing family and loved ones, or for reasons which respondents felt were unrelated or 'not directly related' to the transition, such as employment or cultural/environmental issues.
• Rates of current and previously diagnosed mental ill health were high, with many participants additionally feeling that they might have experienced issues which remained undiagnosed. Depression was the most prevalent issue with 88% feeling that they were currently or had previously experienced it. Stress was the next most prevalent issue at 80%, followed by anxiety at 75%.

Issues with health care provision

4.50 The Scottish Transgender Alliance's 2012 survey of Transgender people's mental health (cited above) found that:

• Of those respondents who had attended Gender Identity Clinics, 60% were seen within a year, 32% waited 1-3 years, and less than ten percent waited over three years for an appointment. 58% of the participants felt that this wait had led to their mental health or emotional wellbeing worsening during this time.
• Once seen at a Gender Identity Clinic, 46% of the respondents felt that they had experienced difficulties obtaining the treatment or assistance that they needed. These included administrative errors, restrictive protocols, problematic attitudes, and unnecessary questions/tests.
• Within mental health services,
• • 29% of the respondents felt that their gender identity was not validated as genuine, instead being perceived as a symptom of mental ill-health.
  • 17% were also told that their mental health issues were because they were transgender.
  • 45% of respondents used mental health services more before transition than after, 18% more during, and less than one percent used mental health services more post-transition.

4.51 In the online survey of Transgender people cited above (2011):

• Nearly half of respondents (40%) thought that delays in treatment were the greatest challenge they had experienced with regard to Transgender health care.
• Just over half of respondents (53%) thought that GPs were doing an excellent or good job in addressing their health needs.
• In the second phase of this survey in June 2011, almost half of respondents (47%) thought awareness-raising of Transgender issues would be most important amongst GPs. Respondents felt that awareness-raising was most needed on the gender reassignment process itself, followed by general healthcare treatment for Transgender people.

4.52 The EHRC Transgender Research Review addresses discrimination by health care staff in the UK, citing the work of Whittle et al (2007): "21 per cent of respondents' GPs either did not want to help, or in 6 per cent of cases, actually refused to help. This is an improvement of 50 per cent compared with the experience of services over 15 years ago" (p. 16)^[99]. "Beyond gender reassignment treatment, 29 per cent of Whittle et al's (2007) respondents felt that their Transgender identity affected their experiences of healthcare in other areas" (p. 46). Through their qualitative evidence, Whittle et al (2007) cite examples of inappropriate treatment for non-Transgender-related issues from medical practitioners to whom the patient's Transgender status had been revealed.

4.53 The EHRC Transgender Research Review also looks at lack of awareness by health care staff in Scotland, citing a study from 2003^[100]: "focus groups reported experiences of GPs and psychiatrists having little or no knowledge of Transgender issues, or giving inappropriate advice." The study also describes offering inappropriate medical services, or failing to offer appropriate services, in relation to the acquired gender (p58).

4.54 In a more general Transgender survey in Scotland^[101] touching on general practice (p15): "46% of the respondents who have used an NHS General Practice as Transgender patients rated the quality of the service they received as 'Very Good' or 'Extremely Good' while 14% rated the service quality as 'Very Poor' or 'Extremely Poor'. A frequent problem reported was that General Practitioners lack knowledge about Transgender health needs, for example in regard to long-term prescription of hormones and also post-operative care and possible complications after genital surgeries. The most major problem reported was difficulty getting NHS records fully updated to correctly reflect a change in gender." This survey also identifies areas of dissatisfaction (p17): "The NHS services which the survey respondents were least satisfied with were NHS24 (which provides telephone-based medical advice and assistance out with standard GP surgery hours) and Mental Health Services…. The main problem reported with Mental Health Services was that lack of understanding and knowledge about Transgender issues by general psychiatrists often results in Transgender people being given inappropriate treatment which fails to assist them with their gender dysphoria and causes many months or even years of delay in getting access to assessment by an experienced gender specialist."

Sport

4.55 The Equality Network's research report Out for Sport^[102] discusses two major issues raised by Transgender people in Scotland: changing rooms and access to competition.

4.56 Transgender interviewees identified a number of issues around changing rooms including the fact that they might be gender specific rather than gender-neutral, or have communal areas without private cubicles. Concerns about their ability to pass as their acquired gender, issues around body scarring or body image and fears of being challenged meant that many Transgender people were anxious about entering sports facilities and taking part in sport.

4.57 The report cites the UK Department for Culture, Media and Sport's Transgender guidance for sporting bodies. This has been superseded by the Equality Act (2010), but the central point still stands^[103]: whilst Transgender people should generally be treated as belonging to the gender in which they present, exceptions should be made in sporting competition if this would give them an unfair advantage or pose a risk to the safety of other competitors - for example in some contact sports.