hderstanding and counseling

transgender clients
James Kirk
Robert Belovics
Because transgender individuals experience widespread employment discrimin
a-
tion, counselors need to understand and be able to work with members of the gay
,
lesbian, bisexual, and transgender communities. The aim of this article i
s to help
counselors become more transgender literate by (a) defining gender dysp
horic
disorder and related terms; (b) discussing the causes, diagnosis, and treatment
of
gender dysphoria; (c) highlighting career realities faced by transgender employe
es;
(d) touching upon legal issues pertaining to transgender workers; and (e) o
ffering
a few suggestions to counselors working with transgender clients.
According to Merissa Sherrill Lynn, founder of the International Founda
tion of
Gender Education,
crossdressing and transsexual phenomena have been an integral part of hum
an experience as long
as there has been a human experience. These phenomena have manifested
themselves in every
society and in every walic of life throughout history, and continue to affect
the lives of vast numbers
of people. (International Foundation of Gender Education, n.d., 1 2)
Today, transgender individuals are employed in every industry and profe
ssion
throughout the world. As a community, however, transgender people face
enormous
amounts of employment discrimination, leading to high rates of unemploym
ent and
underemployment. Irwin (2002) held that it is of the highest importance that co
unsel-
ors recognize such conditions exist and that gay, lesbian, bisexual, an
d transgender
(GLBT) employees are in need of understanding and guidance in order to progress
in
their chosen careers.
There are varying estimates regarding the number of transsexual persons worldwid
e
(i.e., individuals with gender dysphoria). For example, the American Ps
ychiatric
Association (APA; 2000) has estimated that 1 in 30,000 males and 1 in
100,000
females rank high on the Benjamin scale, the scale that is used for the ident
ification
of persons experiencing gender dysphoria or transsexualism. Transgender at
Work
(2001) has held that the rate of female-to-male transsexual persons is
equal to or
less than the rate of male-to-female transsexual persons (f 14). However
, extreme
caution should be exercised when discussing these and other estimates
regarding
transsexual persons. The shame and social stigmas transgender individuals frequ
ently

James Kirk, Human Resources Program, Western Carolina University; Robert Belov
ics, Office of
Institutional Research and Assessment, Coastal Carolina University. Correspond
ence concerning
this article should be addressed to James Kirk, Human Resources Program, Wester
n Carolina
University, Cullowhee, NC28723 (e-mail: klrk@email.wcu.edu).
2008 by the American Counseling Assoeiation. All rights reserved.
journal of employment counseling March 2008 Volume 45 29
experience often prevent them from fully identifying themselves to ther
apists, re-
searchers, society, and professional organizations. (Throughout this article, th
e terms
transsexual and transgender are used interchangeably.)
GENDER DYSPHORIC DISORDER: WHAT IS IT?
To begin to understand transgender workers, it is best to become familiar
with two key
terms: gender identity and gender dysphoric disorder. To grasp the concept of ge
nder identity,
one must begin with the distinction between the terms gender identity, biologica
l sex, and
sexual orientation. In its most recent version of the Diagnostic and Statistic
al Manual of
Mental Disorders (4th ed., text rev.; APA, 2000), APA has explained that "gender
identity
refers to an individual's self-perception as male or female" (p. 535). This stat
ement is not to
be confused with biological or genetic sex, which can be generally defined as t
he physical
sex (male or female) of the individual at the time of birth. APA has further cl
arified these
important distinctions by providing an operational definition of "sexual orienta
tion," which
they defined as the "erotic attraction to males, females, or both" (p. 535).
APA (2000) classified gender dysphoria as a component of the overall di
agnosis
of a condition termed gender identity disorder., which is defined as being "c
haracter-
ized by strong and persistent eross-gender identification accompanied by pe
rsistent
discomfort with one's assigned sex" (p. 535). APA clearly defined gender dys
phoria,
stating that it "denotes strong and persistent feelings of discomfort with one's
assigned
sex, the desire to possess the body of the other sex, and the desire to be regar
ded by
others as a member of the other sex" (p. 535). For individuals to be diagnosed
with
gender identity disorder, APA indicated that the discomfort individuals e
xperience
with their gender identity must result in "clinically significant distr
ess or impair-
ment in social, occupational, or other important areas of functioning" (p.
576). See
Appendix A for a listing of transgender-related terms and definitions.
APA (2000) has held that individuals experiencing schizophrenia or obsessive-com
pulsive
disorder (e.g., skoptic syndrome), in which those conditions mimic symptoms of g
ender
identity disorder or gender dysphoria (e.g., being uncomfortable with t
heir gender
identity), should not be diagnosed with gender identity disorder. APA has a
lso made
a clear distinction between the diagnosis of intersex conditions, such as K
linefelter's
syndrome, and a diagnosis of gender identity disorder. The distinction is that
intersex
conditions cannot be diagnosed as gender identity disorder, but gender identity
disorder
can be a comorbid condition that exists with a diagnosis of an inherited chr
omosomal
or developmental intersex condition (Levy, Crown, & Reid, 2003). See Appe
ndix B
for APA's diagnostic criteria for gender identity disorder.
GENDER DYSPHORIC DISORDER:
ITS CAUSES, DIAGNOSIS, AND TREATMENT
The causes of gender dysphoria and gender identity disorder remain a mystery. O
ne
of the widely held causal theories has to do with exposure to unnatu
ral levels of
male or female hormones. Levy et al. (2003) suggested that individuals who dev
elop
30 journal of employment counseling Marcii 2008 Volume 45
this sexual identity-related condition may have been exposed to unnatural le
vels of
male or female hormones in utero or during the childhood phases of dev
elopment.
They hypothesized, based on the conclusions of prior research, that thi
s hormonal
exposure may have resulted in sexually dimorphic brain characteristics, esp
ecially
among male-to-female transsexual persons (Levy et al., 2003).
According to APA (2000), the first behavior that leads to the diagnosis o
f gender
identity disorder or gender dysphoria can be seen in individuals in childhood or
early
adolescence, but individual behaviors may also be dependent on the developmenta
l
level of the person. APA, comparing the behavior between boys and girls with ea
rly
symptoms of gender identity disorder, stated the following:
In boys, the cross-gender identification is manifested by a marked preoccupa
tion with traditionally
feminine activities. They may have a preference for dressing in girls' o
r women's clothing or may
improvise such items from available materials when genuine articles are un
available. . . . There is
a strong attraction for the stereotypical games and pastimes of girls [e.g., p
laying house or watching
videos of their favorite female characters] . . . Girls with Gender Identi
ty Disorder display intense
negative reactions to parental expeetations or attempts to have them wear dresse
s or other feminine
attire. Some may refuse to attend school or social activities where such
clothes may be required.
They prefer boys' clothing and short hair, are often misidentified by
strangers as boys, and may
ask to be called by a boy's name. Their fantasy heroes are most often po
werful male figures, such
as Batman or Superman, (pp. 576-577)
Girls exhibiting this type of sexual identity crisis may also refuse to co
nform to so-
cially accepted behaviors for their sex, such as urinating in the seated positi
on, and
make claims that they will grow a penis and will grow up to become a
man, hence
experiencing severe discomfort with adolescence breast development and the
onset
of monthly menstruation (see APA, 2000, p. 577).
As it pertains to adults with gender identity disorder, APA (2000) has stat
ed, they
"are preoccupied with their wish to live as a member of the opposite sex" (p.
577):
This preoccupation may be manifested as an intense desire to adopt th
e social role of the other
sex or to aequire the physical appearance of the other sex through hormonal
or surgical manipula-
tion. Adults with this disorder are uncomfortable being regarded by ot
hers as, or functioning in
society as, a member of their [biologieal] sex. To varying degrees, they a
dopt the behavior, dress,
and mannerisms of the other sex. In private, these individuals may spend mueh
time cross-dressed
and working on the appearance of being the other sex. Many attempt to pass i
n public as the other
sex. (p. 577; also, see Appendix B)
Regardless of the stage of life in which individuals with gender identity disord
er find
themselves, the key root of their cross-identification behavior is the conflict
over their
biological sex role and their perceived sexual identity. The acting out of cross
-dressing;
cross-identification; and active pursuit of hormonal, social, and medical appro
aches to
alter their appearance are all conducted by these individuals in order to
ensure that
their biological characteristics or appearance corresponds to their mental socia
l identity,
thereby providing relief for the internal conflict over their sex role (APA, 2
000).
As it relates to transsexual individuals' sexual orientation, persons should
not be
assumed to be homosexual, heterosexual, bisexual, or asexual because of the nat
ure
journal of employment counseling March 2008 Volume 45 31
of their gender identity disorder. Schilderet al. (2001) indicated that gender
identity
is different and distinct from sexual orientation, where the transsexual
individual's
sexual preference can indicate heterosexuality, homosexuality, bisexuality, or
asexu-
ality. Although APA (2000) has included sexual orientation as part of the diagn
ostic
criteria for the identification of gender identity disorder, the sexual prefere
nce of the
individual is not a contributing factor to the overall diagnosis.
There are generally three widely accepted methods of treating gender i
dentity
disorder. These methods include hormone treatment, psychotherapy/counselin
g,
and/or sexual reassignment surgery. In many cases, the effective treatment of g
ender
identity disorder is a combination of all the aforementioned treatment
options in
a custom treatment option suited for the individual's specific needs a
s opposed to
the general condition of gender identity disorder or gender dysphoria (A
PA, 2000;
McDonald, 2004).
Levy et al. (2003) claimed that gender identity disorder is an incurable co
ndition
whose symptoms can be alleviated through hormonal and surgical treatmen
ts. The
authors pointed out that even these treatments options may result in
an increased
chance for social isolation, mental anguish, physical discomfort, and infertil
ity. The
authors went on to explain that the social and psychological aspects of the tra
nsition
or treatment process can be very difficult because these individuals may expe
rience
ridicule or discrimination as a result of their choice of transition
or treatment for
gender identity disorder. The fear and/or stress of social lack of acc
eptance make
many individuals reluctant to identify themselves to pursue treatment o
ptions as
transsexual individuals. According to Levy et al., individuals experiencing untr
eated
gender dysphoria may be at an increased risk for variations of mental
depression
and attempts at suicide.
TRANSGENDER CAREER REALITIES
Publicly acknowledging one's sexual identity and/or preference, or "comi
ng out,"
is often very difficult for members of the GLBT communities. This difficulty
is due
in part to the fact that coming out in the workplace can result in undesira
ble career
consequences for transgender or gay employees. For the sake of professional sur
vival
and to avoid workplace discriminationin the form of unfair treatment from layo
ffs,
terminations, hiring, and promotionsmany GLBT employees choose to keep th
eir
private and professional lives far removed from one another (Swain, 1997
).
McDonald (2004) spoke of the exclusion of employees from certain jobs based o
n
bona fide occupational qualifications. He believed that occupations such as elem
entary
school teachers and child day care workers may fall into this category
(McDonald,
2004, p. 95). Irwin (2002) specifically addressed the collaborative workplace e
xperi-
ences of 900 GLBT employees in the field of education and academia. As it relate
s to
these employees, Irwin's research concluded that homophobic harassment, behavio
r,
and treatment were widespread in these particular fields and were perp
etrated by
colleagues and clients. The most common of these behaviors involved phys
ical as-
sault, verbal harassment and abuse, destruction of property, ridicule, h
omophobic
32 journal of employment counseling March 2008 Volume 45
jokes, unfair work schedules, workplace sabotage, and restrictions to the car
eers of
these individuals.
The choice to work at a given job can revolve around many factors, but th
e com-
pensation package and the individual's value of that package is one o
f the most
prominent factors. This is particularly true for transgender or gay em
ployees as
it pertains to the coverage and use of the medical insurance benefits
. The issue
GLBT employees often encounter is that organizational medical insurance w
ill not
recognize domestic partners or spouses of GLBT employees. This fact of
ten puts
added financial pressure on employees, and, in cases where employees m
ight be
in transition between the birth sex and the preferred sex, the medica
l costs of the
nonrecognized sexual reassignment surgery can be quite costly to employees an
d/or
their families (Edwards & Hempel, 2003).
The effects of workplace discrimination and unfair treatment can have
a serious
impact on the individual GLBT employee's mental state. Irwin (2002) indicated th
at the
most common psychological conditions resulting from this treatment revolved aro
und
increasing levels of anxiety/stress; depression; loss of confidence; and, in som
e cases,
alcohol or drug dependency. Results from the Irwin study concluded that approxim
ately
49% of those interviewed decided on a change in career. Irwin believed
that career
counselors should be prepared to help transgender clients cope with their experi
ences,
resolve their occupational grief, and plan toward future career steps.
Most transsexual individuals change their names when they make the transition. T
hey
may go through court to do so legally, or they may adopt a new name through the
usage
method, which permits legal recognition of a new name simply through the fact th
at it is
the name the person uses. Transsexual individuals change their names on their ch
ecking
accounts, credit cards, business accounts, memberships, driver's licenses
, and social
security cards. They must also change their name on company records so that the
payroll
department can begin issuing checks in the new name. According to Chilan
d (2005),
documentation changes pose problems for many transgender workers in transition.
For
a period of time, the papers no longer reflect the worker's actual appe
arance (p. 33).
Chiland indicated that documentation issues, especially for the mcJe-to-f
emale trans-
sexual persons in transition, cause many transsexual individuals to leave thei
r regular
employment as they begin the process of changing their sexual or social status.
In recent years, companies have begun developing internal organizational policie
s
that govern the treatment of GLBT employees. Edwards and Hempel (2003) discussed
some unique steps being made as organizations attempt to develop a ga
y-friendly
workplace. They discussed the development of diversity- and sensitivity-
training
courses for various levels of employees and specifically highlighted th
e efforts of
Eastman Kodak and the pioneer of the gay-friendly workplace movement in corpora
te
America, Lucent Technologies (Edwards & Hempel, 2003). In addition, Edwa
rds
and Hempel mentioned institutions of higher education, such as the Univ
ersity of
California at Los Angeles, that have developed and offer weeklong training
courses
for executives on gay issues and management.
Furthermore, Edwards and Hempel (2003) highlighted the efforts of compa
nies,
such as Raytheon and Lockheed Martin Corporation, that have built upon the polic
y
journal of employment counseling March 2008 Volume 45 33
development guidelines provided in McNaught (1993). McNaught offered spe
cific
guidelines on how to develop organizational policies toward the equitable trea
tment
of GLBT employees in the workplace. The guidelines include the following:
A specific employment policy that prohibits discrimination based on sex
ual
orientation or identity
Creation of a safe work environment that is free of heterosexist, homoph
obic,
and AIDS-phobic behaviors
Company-wide education about gay issues in the workplace and about AIDS
An equitable benefits program that recognizes the domestic partners of
gay,
lesbian, and bisexual employees
Support of a GLBT employee support group
Freedom for all employees to participate fully in all aspects of corpor
ate life
Public support for gay issues
LEGAL ISSUES
Legal protections are a concern for transsexual employees and employing organiza
tions
alike. Although federal and state laws often differ on how they treat these em
ployees,
there remains no federal statute that conclusively protects transgender
workers.
Title VII of the Civil Rights Act of 1964 protects employees from employ
ment and
workplace discrimination based on an individual's gender. However, federal
courts
have ruled against the extension of this protection to include an individua
l's sexual
identity, thereby excluding transsexual individuals from equal protection
under
this act (Cadrain, 2004; Levi, 2003). In discussing federal law and the
protection
of transsexual employees, Cadrain and Levi explained that the Americans
With
Disabilities Act of 1990 specifically excludes the legal protection of
transsexual
individuals and individuals with gender identity disorders in all cases
but those
where the condition was caused by physical impairment.
At the state level, legal progress has been made to protect transsexual individ
uals
and those experiencing gender identity disorder from workplace and empl
oyment
discrimination. Such states as Minnesota, Rhode Island, New Mexico, and Califor
nia
have amended state legislation to protect individuals from employment discrimina
tion
based on gender identity and/or expression (Cadrain, 2004). Levi (2003) called a
ttention
to the fact that cases have been won at the state level, where persons
experiencing
gender dysphoria proved their mental condition to be a legitimate disability. Le
tellier
(2003) provided a list of municipalities that have implemented laws to pr
ohibit the
discrimination of transgender individuals, including cities such as Baltimore, B
oston,
Chicago, Key West, San Jose, San Francisco, and West Hollywood.
A very emotional legal topic within the GLBT communities is the issue of restro
om
use by transgender or gay employees. McDonald (2004) highlighted a variety of
legal
cases from various states, where non-GLBT employees have brought suit
against
organizations that have allowed transgender employees to use the restroom of
prefer-
ence and thereby offended employees of the opposite sex. Hence, the legal q
uestion
34 journal of employment counseling March 2008 Volume 45
becomes. Which restroom can these employees use to avoid making other employees
uncomfortable and to protect the right of privacy by all employees? There are a
variety
of solutions regarding this issue: Transgender employees can use the restroom ap
propri-
ate to their biological sex, use the restroom of the preferred sex only after
completing
the sexual reassignment surgery, and use a unisex restroom if the employer add
s this
addition to accommodate the specific needs of GLBT employees.
The development of internal organizational policies to protect the empl
oyment
rights of transgender employees has become increasingly more prevalent in the p
ast
10 years, as noted in a study conducted by the Gender Public Advocacy
Coalition
(GPAC; 2006). The study reported that more than 100 major U.S. organi
zations
have developed employment and antidiscrimination policies to protect the ri
ghts of
GLBT employees. At this level of policy development, employers are not only bein
g
proactive toward the treatment of GLBT employees but also realizing the competit
ive
advantage of the recruitment, retention, and equitable treatment of these empl
oyees
toward efforts to cultivate a diverse, strategic workforce.
WORKING WITH TRANSGENDER PERSONS
Letellier (2003) cited a report prepared by the San Francisco Human Righ
ts Com-
mission that indicated that "nearly seventy percent of transgender indi
viduals are
unemployed or under employed" (p. 24). According to Letellier, the commission hi
gh-
lighted the importance for employment counselors to address the needs of transge
nder
workers as they stated, "So prevalent is transgender employment discrimination
that
even cross-dressing off duty can cost people their jobs" (p. 24). Furthe
rmore, Levi
(2003) stated, "Many transgender employees routinely face demotions, unfav
orable
conditions of employment, and even discriminatory terminationsdue not to
job
related problems but to employers' discomfort with and animus against transg
ender
people" (p. 12).
In working with transgender clients, it is important for the counselor to make s
ure
her or his office has transgender-friendly policies. Intake forms shoul
d encourage
or allow people to identify their sex based on their current gender
identity. Rest-
rooms should be accessible to people based on their gender identity (as opp
osed to
their birth sex or genital anatomy). When possible, it is always a good id
ea to have
a gender-neutral option available. However, the use of a gender-neutral
bathroom
should be optional for anyone who wishes to use it; a transgender employee
should
not be forced to use a gender-neutral bathroom, and forcing the perso
n to do so
may be unlawful. Furthermore, coworkers should be trained in basic tra
nsgender
cultural competencies.
Transgender clients are not fundamentally different from nontransgender cli
ents.
They have the same need for resolution, respect, effective representati
on, and re-
turned phone calls. Most often, the unique challenges these clients fa
ce originate
from discomfort or disinterest on the part of others. For some transgender indi
viduals,
past experience with this discomfort or disinterest may lead them to be
wary about
opening up to new people. This barrier may be something a counselor may nee
d to
journal of employment counseling March 2008 Volume 45 35
overcome in order to provide effective counseling. The counselor should rem
ember
to keep the focus on care rather than indulging in questions out of curio
sity and to
never disclose a person's transgender status to anyone who does not explicitly
need
the information.
It is best to refer to transgender persons by the name and pronoun that corresp
ond
with their gender identity. Use "she" for transgender women and "he" for transge
nder
men, even when not in the client's presence. If a counselor is unsure about a pe
rson's
gender identity, or how the individual wishes to be addressed, she or he sho
uld ask
the client for clarification. It can be an uncomfortable feeling to be c
onfused about
someone's gender. It can also feel awkward to ask individuals what th
eir gender
is. However, if a counselor lets the client know that she or he is
only trying to be
respectful toward the client, the question will usually be appreciated.
Depending on the size of the counselor's employing organization or com
munity,
she or he may wish to consider organizing a support group for transgender wo
rkers.
As with McNaught's (1993) recommendations. Swain (1997) indicated that for thos
e
who are willing to come out in the public arena or for transgender
employees, in
general, support groups can serve as a mechanism to discuss GLBT issues and
find
support from others. Swain contended that, with upper management encouragemen
t,
the establishment and use of support groups can deter feelings of homophobia am
ong
employees, which can adversely affect employee motivation, organizational commi
t-
ment, and employee retention.
In working with transgender clients, it is important to determine the nature o
f their
employment needs. In some respects, the process is no different from working wit
h other
clients. For example, clients may be out of work, underemployed, mismat
ched with
their current career, working in a hostile work environment, seeking new employm
ent
in a different geographical location, contemplating a career change, and/or se
eking a
job with a higher salary and better benefits package. Hence, transgender clie
nts may
need help with self-assessment, career exploration, career decision maki
ng, career
planning, changing careers or positions, job searching, and salary negotiatio
ns. They
may also need relocation assistance and referrals to therapists and legal
counsel.
To better serve their GLBT clients, it is recommended that employment counselors
become knowledgeable about trarisgender-friendly companies. Many companies, suc
h
as American Airlines, have implemented equal employment opportunity statements
to include gender identity; these companies actively assist transitioning trans
gender
employees with medical issues and have developed protective policies in
areas of
employee harassment, discipline, compensation, benefits, and training (McD
onald,
2004). According to the GPAG (2006), since 1997, more than 166 major U.S. cor
po-
rations have included various amendments to their Equal Employment Opportunit
y
Gommission policies to include and protect the rights of GLBT applicants a
nd em-
ployees. See Appendix G for a complete listing of major U.S. organizations recog
nized
by the GPAG for their GLBT-friendly equal employment opportunity policies
.
It is important for counselors of transgender clients to be familiar with the v
ariety
of high-quality, transgender-related resources available online. These materi
als are
useful sources of information for making one's own organization transgender f
riendly
36 journal of employment counseling March 2008 Volume 45
as well as assisting clients. See Appendix D for quality online resources
for trans-
gender workers and Appendix E for quality online resources for employers
.
CONCLUSION
Due to no fault of their own, transgender workers encounter many personal, c
areer,
and legal challenges. We applaud the progress that many companies, cities, and s
tates
have made in creating a more GLBT-friendly workplace. We believe that employmen
t
counselors can contribute to this ongoing progress by becoming more tra
nsgender
literate, promoting transgender-friendly policies within their own employ
ing orga-
nization, and effectively meeting the needs of their transgender clients.
I^ote. James Kirk, the first author of this article, is the father of a trans
gender adult
child and is personally aware of the aforementioned challenges.
REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manua
l of mental disorders (4th
ed., text rev.). Washington, DC: Author.
Americans With Disabilities Act of t990, Pub. L. No. 101-336, 2, 104 Sta
t. 328 (1991).
Cadrain, D. (2004). Transgender issues in the workplace. HR Wire, 8(6).
Chiland, C. (2005). Exploring transsexualism. London: Karnac.
Coleman, E., & Cesnik, J. (1990). Skoptic syndrome: The treatment of an obse
ssional gender dysphoria
with lithium carbonate and psychotherapy. American Journal of Psychotherapy,
44, 204216.
Edwards, C, & Hempel, J. (2003, December 15). Coming out in corporate
America. Business Week,
3862, 64-72.
Gender Public Advocacy Coalition. (2006). Corporations banning gender-based disc
rimination. Retrieved
September 4, 2006, from http://www.gpac.org/newweb/workplace/corps.html
Inner Discovery Network. (1998). The treatment of gender identity issues. Retr
ieved September 4, 2006,
from http://innerdiscovery.survivorart.com/gender/treatment.htm
International Foundation of Gender Education, (n.d.). Transgender tapestry & the
International Foundation
for Gender Education FAQs (frequently-asked questions). Retrieved August 27,20
06, from http://www.
ifge.org/FAQ-id_cal-2.phtml
Intersex Society of North America, (n.d.). What is intersex? Retrieved August
27, 2006, from http://www.
isna.org/faq/what_is_intersex
trwin, J. (2002). Discrimination against gay men, lesbians, and transgender pe
ople working in education.
Journal of Gay & Lesbian Social Services, 14, 65-77.
Letetlier, P. (2003, April). Beyond he and she: A transgender news update.
Lesbian News, 28, 24.
Levi, J. (2003). Protections for transgender employees. Human Rights: Journal of
the Section of Individual
Rights & Responsibilities, 30, 12-13.
Levy, A., Crown, A., & Reid, R. (2003). Endocrine intervention for tra
nssexuals. Clinical Endocrinol-
ogy, 59, 409^18.
McDonald, J. J., Jr. (2004). The tranvestites' bill of rights. Employe
e Relations Law Journal, 29,
92-101.
McNaught B. (1993). Gay issues in the workplace. New York: St. Martin's Pre
ss.
Nietzel, M. T, Spettz, M. L., McCauley, E. A., & Bernstein, D. A. (1998). Abnorm
al psychology Needham
Heights, MA: AUyn & Baeon.
Schilder, A. J., Kennedy, C, Goldstone, I. L., Ogden, R. D., Hogg, R. S., & O'
Shaughnessy, M. V. (2001).
Being dealt with as a whole person: Care seeking and adherence. The benefits of
culturally competent
care. Society of Science Medicine, 52, 1643-1659.
journal of employment counseling March 2008 Volume 45 37
Swain, W. K. (Eds.). (1997). GayAesbian/bisexual/transgender public policy issue
s: A citizen's and admin-
istrators guide to the new cultural struggle. Binghamton, NY: Harrington Park
Press.
Title Vtt of the Civil Rights Aet of 1964, 42 U.S.C., 2000e (1964).
Transgender at Work. (2001). Transgender background information. Retrieved Se
ptember 6, 2006, from
http://www.tgender.net/taw/background.html
University of California at Riverside LGBT Resource Center. (2007). Transgender
101. Retrieved January
25, 2008, from http://out.ucr.edu/pdf/Transl01.pdf
APPENDIX A
Terms and Conditions Related to Sexual Orientation
and Gender Identity
Androgen insensitivity: An intersex condition typical of males with damage to t
he Y chromosome
where the individuals cannot absorb testosterone at the cellular level. These ma
les are born with
female genitalia, develop female breasts during puberty, but do not contain the
internal reproductive
organs (ovaries and uterus) of a genetic female (American Psychiatric Associat
ion [APA], 2000;
Nietzel, Speltz, McCauley, & Bernstein, 1998, p. 489).
Aphailiaifvn intersex condition that consists of being born without a penis, in
a patient with othenwise
typical male anatomy (Intersex Society of North America, n.d.).
Congenital adrenal hyperpiasia: An intersex genetic condition that leaves the bo
dy's adrenal glands
unable to synthesize cortisone. This condition affects females during fetal deve
lopment by over-
stimulating the hormone growth of external genitalia (clitoris), where, upon bir
th, the clitoris could
be mistaken for a male penis (APA, 2000; Nietzel et al., 1998, p. 489).
Drag king: Male-emulating woman (University of California at Riverside LGBT [Les
bian, Gay, Bisexual,
and Transgender] Resource Center, 2007).
Drag queen: Female-emulating male (not always homosexual; University of Californ
ia at Riverside
LGBT Resource Center, 2007).
Fetishism: A condition in which the sexual arousal or focus involves the use
of nonliving objects
(APA, 2000, p. 569).
FTM transsexuais: Abbreviation for female-to-male transsexual individuals. The
se individuals are
born genetically female but possess the gender Identity and desire to be male.
Gender dysphoria: A component of gender identity disorder that denotes strong or
persistent feelings
of discomfort with one's assigned sex, the desire to possess the body of the oth
er sex, and the
desire to be regarded by others as a member of the opposite sex (APA, 2000, p. 5
35).
Gender identity: Refers to an individual's self-perception as male or female (AP
A, 2000, p. 535).
Gender identity disorder (transsexualism): C\r\a:ac\enzed by strong and persiste
nt cross-gender iden-
tification accompanied by persistent discomfort with one's assigned sex (APA, 20
00, p. 535).
Gender reassignment surgery: Often referred to as sex reassignment surgery, o
r a "sex change."
Gender reassignment surgery is a cosmetic procedure whereby plastic surgery pr
ocedures are
used to give a person the appearance of having the genitalia of the nonbirth sex
(Inner Discovery
Network, 1998,14).
Gender/sex role: Refers to the patterns of behaviors typically expected of m
ales or females in a
particular culture (Nietzel et al., 1998, p. 488).
Gender transition: The process by which individuals come to live full time in th
eir preferred gender
rather than their birth gender (Inner Discovery Network, 1998).
GLBT: A common abbreviation used to represent the inclusive gay, lesbian, bisexu
al, and transgender
individuals and/or communities.
Hermaphrodites: Individuals who possess both female and male sexual orga
ns (Nietzel et al.,
1998, p. 499).
Hormone replacement therapy: A treatment in which one is given huge doses of est
rogen (for men)
or testosterone (for women) in order to eventually produce some of the secondary
sex character-
istics of the nonbirth gender (Inner Discovery Network, 1998, H 4).
(Continued on next page)
38 journal of employment counseling March 2008 Volume 45
APPENDIX A (Continued)
Terms and Conditions Related to Sexual Orientation
and Gender Identity
Intersex conditions: A broad category to describe a variety of conditions, genet
ic and/or hormonal
in nature, that consist of atypical reproductive anatomies and disorders of sex
development that
occur during fetal development (Intersex Society of North America, n.d.).
Klinefeiter's syndrome: A genetic intersex condition that affects males, which a
re genetically described
by an XXY combination of chromosomes. The condition results in physical males
who typically
become infertile during adolescence; grow little or no body hair; and develop s
econdary female
sexual characteristics, such as breasts. This condition can result in the males
exhibiting female
gender identities (Intersex Society of North America, n.d.).
MTF transsexuais: Abbreviation for male-to-female transsexual individuals. The
se individuals are
born genetically male but possess the gender identity of and desire to be female
.
Paraphiilias (fetish): Characterized by recurrent, intense sexual urges, fantasi
es, or behaviors that
involve unusual objects, activities, or situations and cause clinically signific
ant distress or impair-
ment in social, occupational, or other important areas of functioning (APA, 2000
, p. 535).
Postoperative transsexual: A transsexual individual who has completed the gender
transition process,
related sexual reassignment surgery, and testosterone or estrogen hormone therap
y
Preoperative transsexuai: A transsexual individual who may have or may not have
begun hormone
or group therapy treatment but has not completed the sexual reassignment surgery
aspect of the
transition process.
Sexuai dysfunctions: CowiMons characterized by disturbance in sexual desire and
in psychophysi-
ological changes that characterize the sexual response cycle and cause
marked distress and
interpersonal difficulty (APA, 2000, p. 535).
Skoptic syndrome: Nn unusual and rare form of obsessive-compulsive disorder that
is characterized
by an annoyance with one's body image. Untreated individuals may exhibit behav
iors of sexual
avoidance/indifference and self-mutilation of primary or secondary sexual
organs (Coleman &
Cesnik, 1990).
Transsexua/s. A term often used to refer to adults who experience gender identit
y disorder (Nietzel
etal., 1998, p. 498).
Transvestic fetishism: Fetishism that specifically involves the wearing of wome
n's clothing by het-
erosexual males for the purpose of sexual arousal or gratification (APA, 2000).
journal of employment counseling March 2008 Volume 45 39
APPENDIX B
Diagnostic Criteria for Gender Identity Disorder
A. A Strong and persistent cross-gender identification (not merely a desire fo
r any perceived
cultural advantages of being the other sex).
In children, the disturbance is manifested by four (or more) of the follo
wing:
1. repeatedly stated desire to be, or insistence that he or she is, the
other sex
2. in boys, preference for cross-dressing or simulating female attire; in gir
ls, insistence
on wearing only stereotypical masculine clothing
3. strong and persistent preferences for cross-sex roles in make-believe play o
r persistent
fantasies of being the other sex
4. intense desire to participate in the stereotypical games and pastimes of the
other sex
5. strong preference for playmates of the other sex
In adolescents and adults, the disturbance is manifested by symptoms s
uch as a
stated desire to be the other sex, frequent passing as the other sex, de
sire to live or be
treated as the other sex, or the conviction that he or she has the
typical feelings and
reactions of the other sex.
B. Persistent discomfort with his or her sex or sense of inappropriateness in
the gender role
of that sex.
In children, the disturbance is manifested by any of the following: in boys,
assertion
that his penis or testes are disgusting or will disappear or assertion that
it would be bet-
ter not to have a penis, or aversion toward rough-and-tumble play and re
jection of male
stereotypical toys, games, and activities; in girls, rejection of urinating in a
sitting position,
assertion that she has or will grow a penis, or assertion that she does
not want to grow
breasts or menstruate, or marked aversion toward normative feminine cloth
ing.
In adolescents and adults, the disturbance is manifested by symptoms such as
pre-
occupation with getting rid of primary and secondary sex characteristic
s (e.g., request
for hormones, surgery, or other procedures to physically alter sexual
characteristics to
simulate the other sex) or belief that he or she was born the wrong sex
.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in soci
al, occupational,
or other important areas of functioning.
Code based on current age:
302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults
Specify \i (for sexually mature individuals):
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both
Sexually Attracted to Neither
Note. From Diagnostic and Statisticai Manual of Mental Disorders (4th
ed., text rev., pp.
581-582), by American Psychiatric Association, 2000, Washington, DC: Auth
or. Copyright
2000 by the American Psychiatric Association. Reprinted with permission.
40 journal of employment counseling March 2008 Volume 45
APPENDIX C
Corporations With Gender Identity/Expression Equal Employment
Opportunity Policies
1997
Lucent Technologies
1998
Apple
2000
Avaya
Lexmark
2001
Aetna
Agere
American Airlines
National Cash Register
Nike
Xerox Corporation
2002
Capital One
Intel
JPMorgan Chase
Kodak
Public Gas & Electric
2003
Advanced Fibre
Communications
Bank One
Bausch & Lomb
Best Buy
ChoicePoint
Chubb
Deutsche Bank
Hewlett Packard
IBM
Lehman Brothers
Levi
MetLife
Miller
Motorola
New York Times
Prudential
Sandia Nationai
Laboratories
SO Johnson & Son
2004
Agilent
Air Products &
Chemicals
American Express
American Telephone
& Telegraph
Borders Group
Cargili
Charles Schwab
Cisco
Citigroup
Coors
Deil
Electronic Arts
Ford
Goldman Sachs
HarperCollins
Publishers, Inc.
Keyspan
Kraft Foods, Inc.
Miller Brewing Co.
Nationwide
Owens Corning
PepsiCo, inc.
Rizer
Southern Caiifornia
Edison Company
Sprint
Sun Microsystems
Tech Data Corp.
US Airways Group
USBAG
Weils Fargo
Whirlpool
2005
Adobe
British Petroleum
America
Chevron
Cooper Tire & Rubber
Corning, Inc.
Credit Suisse First
Boston
Cummins, Inc.
Daimler Chrysler
Dominion Resources,
Inc.
Dow Chemical
Ernst & Young
Estee Lauder
Companies
Freescale
Semiconductor, Inc.
Gap, Inc.
General Mills
GlaxoSmithKline
Hyatt
Illinois Tooi Works
Intuit
John Hancock
Financial Services
Johnson & Johnson
Kaiser Permanente
KPMG
Lincoln National Corp.
Liz Claiborne
Mattel
Mellon Financiai Corp.
Merrill Lynch & Co.
Microsoft Corp.
Nordstrom, Inc.
Northern Trust Corp.
PacifiCare Heaith
Systems
Pathmark
Providian
Raytheon Co.
SBC Communications
Sears, Roebuck & Co.
Staples, Inc.
Sun Trust Banks, Inc.
T-Mobile
Toyota Motor Sales
Toys "R" Us
UBS AG
Unisys
Viacom
Walgreens Co.
Washington Mutual,
Inc.
Whole Foods
Wyndham
International
2006
Advanced Micro
Devices
A. G. Edwards
Alliant Techsystems
Anheuser-Busch
Companies
Aon Corp.
Aquila
Bank of America
BellSouth Corp.
Boeing
Bristol-Myers Squibb
Co.
Carlson Companies
CIGNA
Clear Channel
Clorox
Coca-Cola Company
Consolidated Edison
Costco
Countrywide
Cox Communications
DuPont
Eli Lilly & Co.
GenCorp
General Dynamics
General Motors Corp.
Harrah's
Entertainment
Health Net
Hewitt Associates
Hilton
Honeywell
Hospira
IDEXX Laboratories,
Inc.
ITT Industries
Massachusetts
Mutual
McKinsey & Co.
Merck
Morgan Stanley
New York Life
Northrop Grummon
Owens & Minor
Pitney Bowes, Inc.
PNM Resources
Pricewaterhouse-
Coopers
Oualcomm
Ryder System
Schering-Plough
Sempra Energy
Southwest Airlines
Stanwood Hotels &
Resorts
State Street Corp.
Valassis
Communications
Visteon
Volkswagen
Walt Disney
Wendy's
Yahoo!
Note. From Gender Public Advocacy Coalition, 2006. Corporations listed
by the year that
policies were developed.
journal of employment counseling March 2008 Volume 45
41
APPENDIX D
Quality Online Resources for Transgender Workers
FTM (Female-to-Male) International (FTMI)
http://www.ftmi.org/
Established in 1986, FTMI claims to be the longest operating organization
dedicated to
the support of female-to-male transsexual individuals.
GayJob.biz
http://www.gayjob.biz/index.cfm
A job search engine directed and marketed to the GLBT communities.
Gender Talk
http://www.gendertalk.com/
Gender Talk is the online counterpart to Gender Talk Radio, a leading radi
o program
that addresses transgender issues.
Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA)"
http://www.wpath.org/
An international organization consisting of professionals from a variety of
specialized
scientific and professional disciplines who pursue the continued study of
gender
dysphoria, transgender lifestyles, and gender issues. The HBIGDA' is also k
nown for
developing the "Standards of Care," which have come to be recognized, inter
nationally,
and have become the accepted methods of medical care and treatment of i
ndividuals
experiencing gender identity disorders.
International Journal of Transgenderism
http://www.haworthpress.com/store/product.asp?sku=J485
The Internationai Journal of Transgenderism is the professional journal pub
lished by the
HBIGDA" and examines a variety of information pertaining to gender identity
disorder
and topics of transsexuality.
National Gay and Lesbian Task Force (NGLTF)
http://www.thetaskforce.org/
Founded in 1973, the NGLTF was the first advocacy organization for the rig
hts of
members of the GLBT communities.
Texas A&M University, Allies Committee
http://allies.tamu.edu/resources/transgender101.htm
This Web site provides basic information about transsexual individuals a
nd gender
identity disorders.
Transgender Law & Policy Institute (TLPI)
http://www.transgenderlaw.org/
The TLPI is a nonprofit organization, based in San Francisco, California, de
dicated to
advocacy for the rights of members of the transgender community.
Note. GLBT = gay, lesbian, bisexual, and transgender.
Now called The World Professional Association for Transgender Health.
42 journal of employment counseling March 2008 Volume 45
APPENDIX E
Quality Online Resources for Employers
Center for Gender Sanity
http://www.gendersanity.com
An organization committed to assistance of empioyees and employers of transsexua
l
individuals who enter into the gender transition process. Visitors to the
Web site can
access information companies need to develop GLBT-friendiy organizational
policies,
provide assistance to empioyees wishing to begin the gender transition proces
s, and
offer methods human resource departments can use to support the transition
of trans-
sexual employees.
The Gender Centre, Inc.
http://www.gendercentre.org.au/human_resource_poiicy.htm
An organization committed to the education of the pubiic and employers
about gender
issues. This specific part of The Gender Centre, Inc., Web site gives g
uidelines for the
writing and use of transgender policies by human resource departments and bu
sinesses.
Gender Public Advocacy Coaiition (GPAC)
http://www.gpac.org
An advocacy organization that is dedicated to the education of employees and emp
loyers
about issues of gender-based and sexual-orientation discrimination. Visitors
to the
GPAC Web site can access information on workplace fairness, best practices
by com-
panies in employee fairness, myths about sexual stereotypes, youth-directed
education, and public education about hate crimes and national news.
Human Rights Campaign (HRC)
http://www.hrc.org
One of the largest civil rights organizations that advocates for the ri
ghts of the GLBT
communities. The HRC advocates for the equal treatment of GLBT individuals
and for
antidiscrimination laws to protect the rights of these individuals. Visitors
to the
Web site have access to federal iegisiation/laws; news; publications; GLBT
issues;
annual State of the Workplace reports; and workplace issues, which include
a tool for
managers to address issues of transition and transgender rights in the w
orkpiace.
International Foundation for Gender Education (IFGE)
http://www.ifge.org
A nonprofit organization founded in 1987 that advocates for the rights,
education, and
awareness of individuals affected by gender identity disorder, transvesti
tism, and
transsexuaiism. Visitors to the IFGE Web site have access to a variety o
f information,
inciuding books, newsletters, conferences and events, frequently asked ques
tions, and
additional information of concern to transgender individuals and employers
.
Transgender at Work
http://www.tgender.net/taw/
This Web site provides a great deal of information to employers and addre
sses many
prominent concerns in relation to the employment of transgender employees.
The Trans-
gender at Work organization provides assistance to organizations regarding
the devei-
opment of GLBT-friendly policies and various means of addressing workplace
equality
and fairness for transgender employees. Visitors to the Transgender at Work W
eb site
can access information on developing policies that address the rights o
f transgender
employees and issues of equality, organizational fairness, training, and emp
loyee heaith
care costs.
U.S. Equal Employment Opportunity Commission (EEOC)
http ://www. eeoc. gov/
A federal organization that enforces employment laws surrounding cases of discr
imination,
mistreatment, and harassment in the workplace. Visitors to the EEOC Web si
te have
access to information about legally protected classes, statistics, training, and
recommended
procedures to ensure that their organization is in compliance with federal regu
lations as it
pertains to the treatment of current and potential employees.
journal of employment counseling March 2008 Volume 45 43