Out On The Couch
By Rachel Jones, MA
NOTE: Throughout this article, I will refer to different gender identities including non-transgender women and transgender women. Every person has a gender identity, which is separate from the sex assigned at birth. Non-transgender or non-trans describes a person whose gender identity is the same as the sex assigned at birth–for example, someone who identifies as female and was assigned female at birth (GLAAD, 2019). Cisgender is another term used in replacement of non-trans, but it will not be used in this article for the sake of centering on transness and to avoid centering cisgender as the “norm” (GLAAD, 2019). Transgender or trans describes a person whose gender identity is different from the sex assigned at birth–for example, someone who identifies as female and was assigned male at birth (GLAAD, 2019). Distinguishing non-transgender women and transgender women throughout the article is solely for the purpose of pointing out perceived differences in a clear manner, and NOT to suggest that either term makes someone more of a woman than the other.
Women’s Equality Day
In the United States, August 26, 2019, will mark the 46th annual Women’s Equality Day. In the 1970s, President Nixon and the US Congress appointed August 26 to be Women’s Equality Day to commemorate the nineteenth amendment (Greenspan, 2018). In 1920, the United States government allowed women the right to vote, ratifying the nineteenth amendment that declared voting rights would not be denied on the basis of sex or gender (U.S. Const. amend. XIX). Today, millions of people across the country continue to advocate for women’s equality. However, a major aspect of mainstream feminism seems to be forgetting something pretty important. The battle for women’s equality has not been won if the only winners are white, non-transgender women. Mainstream feminism’s definition of a woman must be inclusive of transgender women, women of color, queer women, and other women in marginalized groups – otherwise, it is simply not feminism. In recent years, major feminist-driven events such as the Women’s March more explicitly and affirmatively include women of color and queer women in their mission, but transgender women continue to be blatantly left out of the major feminist discourse (Anti-Defamation League, 2017).
Similar to the experiences of non-transgender women vying for equal rights, transgender women experience dramatic disparities in civil liberties, legal protections, and cultural equity (Grant et al., 2011). Unlike non-transgender women, transgender women don’t have millions of privileged people fighting alongside them with the goal of equality. Instead, trans women are banned from women’s locker rooms, unprotected in public restrooms, left out of feminist manifestos, mocked by government representatives, and robbed of basic human rights to safety and respect. Many self-proclaimed feminists gleefully join their peers at Pride parades, yet express outrage when a trans woman hopes to share safe spaces.
A women-only space cannot be labeled safe if trans women are not allowed in that space–or are at risk of harassment or other hurts in that space. Equal pay for women has not been achieved if non-trans women receive higher wages than their transgender sisters. The quality of women’s healthcare has not been enhanced if clinicians are only trained to care for non-transgender women and their bodies. Misogyny has not been defeated if trans women are still being misgendered and pronouns are not respected or affirmed. Refusing to acknowledge trans women in the rulebooks of feminism makes it difficult to apply the narratives we work so hard to rewrite. Is the team really winning if half the players have been benched or disqualified?
Transphobia and Feminism
Transphobia is a driving force attempting to keep trans women out of feminism. While transphobia is often seen as a politically far-right driven attitude against transgender people, a popular subgroup of modern feminism has been loudly promoting transphobia across the country. This subgroup of radical feminism is often referred to as trans-exclusionary radical feminism or TERF and is considered a hate-group by many since its mission seems to promote transphobia and transmisogyny (Lewis, 2019). TERF ideology argues misogyny can only affect people with ovaries, uteruses, and vaginas, claiming trans women cannot be targets of misogyny (Dembroff, 2019). Furthermore, this group of radical feminists states trans women “by definition” are not “adult human females” and therefore “no trans woman is correctly categorised (sic) as a woman” (Stock, 2019). Other group members have acknowledged the decision to purposely misgender trans women, stating that using she/her pronouns for trans women is a “courtesy” they rarely extend (Bindel, 2019). Radical feminists have gone so far as to argue transgender women identify as female in order to “infiltrate women’s spaces” and assault or harass non-trans women (Kacere, 2014).
These infuriating and inflammatory messages spew misinformation and hate, and can lead to dangerous misunderstandings. No transgender woman casually goes through the costly and trying physiological, social, professional, and emotional transitions.Transitioning often is motivated by wanting to feel affirmed in one’s gender identity, avoiding repression, combating suicidal ideation or dysphoria. In fact, research shows approximately three-quarters of trans women who transition experience an increase in psychosocial well-being and quality of life (Hess et al., 2018). Transgender people do not transition for the sake of harming or harassing others, and it is upsetting that such a statement needs to be spelled out. Non-trans women experience blatant inequality in the United States, and there are many ways to address those inequalities while involving trans women. In fact, it is almost impossible to effectively approach feminist issues if the female population is being separated into trans and non-trans women.
Feminism Must Include All Women
Equal Pay. Although the nineteenth amendment was a major feat in the fight for equal rights, it was by no means the end of inequality for women in the United States. In 2018, women in the US earned on average 81.1 percent of their male colleagues’ weekly earnings (Hegewisch & Hartmann, 2019). When broken down by race and ethnicity, this gap became even bleaker. White women, Black women, Hispanic (sic) women, and Asian women earned 81.5 percent, 65.3 percent, 61.6 percent, and 93.5 percent respectively of their white male colleagues’ earnings (Hegewisch & Hartmann, 2019). Objectively, these disparities are alarming.
Workplace Discrimination. While precise numbers on transgender wage earnings are lacking, research findings on the experiences of transgender women in the workplace are nothing short of disturbing. More than one in three transgender women have lost a job due to gender identity or expression, and over half have been denied employment due to being transgender (Grant, et al., 2011). Furthermore, 32 percent of transgender people have been “forced to present in the wrong gender” to keep their job (Grant et al., 2011). Because of the lack of legislature protecting gender identity and expression in the workplace, transgender people experience unemployment and insufficient income at rates three times the national average (Grant et al., 2011). As feminists fight for equality in the workplace, it is vital to be aware of these experiences of transgender women in addition to the more widely publicized inequities of working non-transgender women. Due to the intertwined intricacies, we cannot fix one issue without facing the other. The fight for women’s rights and equality have been going on in the United States since its conception, and all women deserve advocacy.
School. 21 percent of school-age transgender girls are sexually assaulted at school because of their gender identity, and 22 percent had to change schools due to mistreatment (James et al., 2016). Over 20 percent of non-trans girls experience some form of harassment or bullying in school, and eight percent avoid attending school due to feeling unsafe (Hess et al., 2015).
Homelessness and Poverty. Over 20 percent of trans women of color reported homelessness in the past year due to gender identity, and many were denied access to shelters due to being transgender (James et al., 2016). For trans women of color, the rates of homelessness rise to around 50 percent (Human Rights Campaign, 2018). Non-trans women have higher poverty rates than men, and non-trans women of color have higher poverty rates of approximately 25 percent (Hess et al., 2015).
Sexual Violence. Five percent of all transgender people have been attacked by strangers and almost 40 percent of transgender women have been sexually assaulted at least once in their lifetime (James et al., 2016). Furthermore, trans women of color make up 80 percent of all anti-transgender homicides (Human Rights Campaign, 2018). Approximately one-fifth of non-trans women experience sexual violence or rape in their lifetime (Hess et al., 2015). For Native American and multiracial women, those numbers jump to one-third (Hess et al., 2015).
Hate Crimes. In addition to widespread transphobia and the disturbing inequities in many other areas, transgender women experience inequality, misogyny, and oppression perpetuated by an obscene lack of civil protections. Almost two-thirds of states have laws protecting non-transgender women against hate crimes, while less than half include biases against gender identity and transgender people in their legislature (Human Rights Campaign, 2018). In the United States, there are on average five hate crimes against transgender people for every single hate crime targeting non-transgender women (Federal Bureau of Investigation, 2017).
These statistics are not for the sake of creating a “who has it worse” narrative. Rather, they are presented to point out that transgender women need feminism and feminist support, too. There are intrapersonal and community-level implications for empowerment that come from having a strong network of peers who support and understand each other’s experience (Labonté & Laverack, 2008). In order to boost this empowerment through trans inclusionary feminism, non-transgender women must be willing to share some of the power they already have (Labonté & Laverack, 2008). If we create a hierarchy of women and ban certain women from safe spaces, the meaning of feminism becomes lost entirely.
How Clinicians Can Help Fight Transmisogyny
Therapists and doctors are not immune to transmisogyny; and following clear guidelines to affirm all patients can help prevent it. When running support groups for women, it is imperative to explicitly include transgender women. If trans women are not allowed in a women’s group, it promotes the warped narrative that trans women are not “real” women. The same goes for asking for a patient’s “real” name, the name the patient uses to introduce herself, the name she chose to affirm her gender identity, is her real name. The name on the patient’s original birth certificate does not automatically become her “real” name. Prioritizing what a piece of paper says over the patient herself is a perfect example of transmisogyny, and it is completely avoidable. Being a trans-affirming clinician requires an agreement that trans women did not “become” or “turn into” or “choose to be” women, but truly are women. When in doubt, trust the patient’s first-hand account, and affirm her identity as she defines it. Listen to women.
Including trans women in feminism is not a dramatic shift and requires nothing more of non-trans feminists than the ideals they fight to uphold: respect, equality, and reciprocal support. Trans women are women––it’s that simple.
Anti-Defamation League. (2017). What the women’s march teaches us about intersectionality. ADL Blog. Retrieved from https://www.adl.org/blog/what-the-womens-march-teaches-us-about-intersectionality
Bindel, J. (2019). It’s time for progressives to protect women instead of pronouns. Quillette. Retrieved from https://quillette.com/2019/06/14/its-time-for-progressives-to-protect-women-instead-of-pronouns/
Dembroff, R. (2019). Trans women are victims of misogyny, too–and all feminists must recognize this. The Guardian. Retrieved from https://www.theguardian.com/commentisfree/2019/may/19/valerie-jackson-trans-women-misogyny-feminism
Federal Bureau of Investigation. (2017). Hate crime statistics: Incidents, offenses, victims, and known offenders by bias motivation. U.S. Department of Justice. Retrieved from https://ucr.fbi.gov/hate-crime/2017/topic-pages/tables/table-1.xls
GLAAD. (2019). Glossary of terms–transgender. GLAAD Media Reference Guide.
Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. National LGBTQ Task Force. Washington, DC: National Center for Transgender Equality.
Greenspan, R. (2018). On Women’s Equality Day, here are 3 things to know about the suffrage moment. Time. Retrieved from https://time.com/5372770/womens-equality-day-2018-facts/
Hegewisch, A., & Hartmann, H. (2019). The gender wage gap: 2018 earnings differences by race and ethnicity. Institute for Women’s Policy Research. Retrieved from https://iwpr.org/publications/gender-wage-gap-2018/
Hess, C., Milli, J., Hayes, J., Hegewisch, A., Mayayeva, Y., Roman, S., Anderson, J., & Augeri, J. (2015). The status of women in the states: 2015. Washington, DC: Institute for Women’s Policy Research.
Hess, J., Breidenstein, A., Henkel, A., Tschirdewahn, S., Rehme, C., Teufel, M., Tagay, S., & Hadaschik, B. (2018). Satisfaction, quality of life and psychosocial resources of male to female transgender after gender reassignment surgery. European Urology Supplements, 17(2), e1748. https://doi.org/10.1016/S1569-9056(18)32062-1
Human Rights Campaign Foundation. (2018). A national epidemic: Fatal anti-transgender violence in America in 2018. Washington, DC: Human Rights Campaign Foundation, Public Education & Research Program.
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
Kacere, L. (2014). Why the feminist movement must be trans-inclusive. Everyday Feminism. Retrieved from https://everydayfeminism.com/2014/02/trans-inclusive-feminist-movement/
Labonté, R., & Laverak, G. (2008). Health promotion in action: From local to global empowerment. New York, NY: Palgrave Macmillan.
Lewis, S. (2019). How British feminism became anti-trans. The New York Times. Retrieved from https://www.nytimes.com/2019/02/07/opinion/terf-trans-women-britain.html
Stock, K. (2019). Doing better in arguments about sex, gender, and trans rights. Medium. Retrieved from https://medium.com/@kathleenstock/doing-better-in-arguments-about-sex-and-gender-3bec3fc4bdb6
U.S. Const. amend. XIX.
By Megan Tucker, PsyD
I am a fat, queer, able-bodied, neurotypical, white, and cisgender femme person (note: cisgender = my gender is congruent with the gender I was socially assigned). I’m well aware of societal expectations for the way my body should look, to express my gender consistent with white womanhood, and to engage in romantic and sexual relationships in a certain way. I also know that the bar for being seen, respected, and accepted for who I am would be sky high if I was a fat, autistic, disabled, polyamorous, transgender feminine person of color.
Most of the research conducted with people who are fat and/or trans has been with white, able-bodied humans, so any negative impact I discuss related to fat trans folks is likely even more detrimental for people of color and for those with chronic illness and/or disabilities. I write this as a person with privilege who aims to learn more, and educate others about systems of oppression and power, while also advocating for human rights and dignity. I am personally familiar with experiences of fatphobia and sexism, and I have a specialty in counseling trans and gender nonbinary (TGNB) people.
Weight Stigma, Fatphobia, & Microaggressions:
When you see a slim person jogging down the road, do you think, “good for them!?” When a slim person walks along the beach in a bikini, do you think, “ugh, they shouldn’t be wearing that!?” When you notice that a slim friend has gained weight, do you say, “oh wow, you’ve gained weight? What are you doing?” I’m guessing most of us don’t, so why would it be OK for us to judge or comment on fat bodies? The short answer: it’s not OK. Basically never. Just like it’s never OK for us to comment on trans and gender non-conforming bodies.
The National Eating Disorders Association (NEDA, 2018) defines weight stigma as discrimination or stereotyping based on a person’s weight (also referred to as sizeism). Weight stigma is known to increase body dissatisfaction, which is a leading risk factor for disordered eating. NEDA clearly states, “the best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness.” Many people who struggle with body image and disordered eating got messages along the way that shamed their bodies and/or food choices, suggesting they weren’t good enough just the way they were.
Fatphobia, the fear and/or hatred of fat bodies, is an extension of sizeism. Many of us have learned not only that thin is the ideal, but that being fat is to be avoided like the plague. We are constantly exposed to messages that thin = good and fat = bad (e.g., TV and movies, comments from our parents, health & wellness marketing, conversations with our friends, and health insurance companies offering wellness discounts). Brené Brown’s research found that a) appearance and body image and b) being stereotyped and labeled are two of the 12 most common triggers for shame (Brown, 2007). This hatred and fear of fatness becomes internalized and spreads like wildfire in the ways we talk about ourselves, evaluate ourselves compared to others, and judge others’ bodies and food choices. Three questions you might ask yourself to examine your weight bias are: 1) Do I engage in negative body talk? 2) How do I feel about bodies of different sizes? and 3) How do I feel about the concept of weight gain for myself? (Chastain, 2018).
We can’t talk about stigma and fatphobia without also talking about microaggressions, which Sue (2010) defined as “commonplace verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative insults to a target person or group.” The very nature of microaggressions is that they are often unintentional and unacknowledged slights, leaving the recipient to process those thousands of tiny moments that invalidate that person’s very existence.
For example, when someone says to a friend who has lost weight, “wow, you look great,” it is thinly veiled as a compliment that covers up the deeper diet culture judgment, “your body is more desirable now that it is thinner.” When someone watching you eat X food says, “I don’t eat X – it’s bad for you,” what it really suggests is, “be careful eating that food – you wouldn’t want to become fat and/or unhealthy. In fact, the conflation of weight with health and “concern for health” is one of the more common ways that people (especially health providers) justify weight-related microaggressions. Sadly, what often gets in the way of health for fat folks is the very structural oppression they face by those who believe people are unhealthy because they are fat (Lee & Pausé, 2016).
At the Intersection of Fat & Trans
When we talk about the above concepts in relation to fatness, they also hold true for other identities that experience oppression, e.g., race, gender, ability, sexuality, etc. TGNB folks experience transphobia, cissexism, cis-heteronormative expectations, and pressures to fit into (white) binary understandings of gender, i.e., what it supposedly means to be a man or a woman. Because TGNB people are often valued based on how well their bodies “fit in” to these expectations, it follows that they would also be held to standards of body size, shape, and weight. Adding weight stigma to the other pressures that a TGNB person experiences along with their own struggles with their body is like a shaken soda bottle of oppression waiting to explode.
Here are several ways that a TGNB person might experience the cumulative and harmful effects of sizeism and fatphobia in the context of their transness:
- A trans masculine person eats as little as possible to shrink his body and appear more androgynous by reducing the width of his hips & the size of his chest
- A nonbinary person hesitates to go to the gynecologist for worsening pelvic pain, because when they initially brought it up, the doctor said the pain was weight-related.
- A transfeminine person fears going out on a date, because she can’t blend enough with her large belly.
- An agender person has to search endlessly for affordable clothing that both fits their large body and also feels congruent with their gender.
- A genderqueer person wants to fly without drawing attention to themself, but they face ridicule when going through the security body scanners and then are looked at with disgust while walking down the airplane aisle due to their body size.
- A trans woman’s doctor does not refer her to get treatment for her Anorexia, because he reasons that restriction might help her to lose weight.
- A trans adolescent is extremely uncomfortable in their body due to the compounded effects of going through puberty as a fat person.
- A pregnant trans man gets mistaken for being fat and doesn’t get the emergency medical care he needs (note: an article was recently published about this exact situation at usatoday.com).
- A trans person arrives for their consultation appointment for gender affirming surgery, but the armchairs in the waiting room are too small for them to fit, the exam room table cannot hold their weight, and they soon find out that the surgeon has a maximum BMI requirement.
- A trans college student gets the courage to go to the gym and build muscle for his upcoming top surgery, but then is fat shamed by other students at the fitness center.
It is so crucial to be mindful of the ways in which weight stigma and fatphobia intersect with the policing of trans and nonbinary bodies. Don’t trans folks already have enough to worry about with their internal struggles to find peace and affirmation with their bodies? Why do we pile on societal constructions of what they should and shouldn’t look like, that they should and shouldn’t eat, and pressures to modify their bodies to be more feminine (i.e., thin and curvy in the “right” places) or masculine (i.e., thin and muscular)? Why do we expect TBNB people to not only modify their bodies to societal standards, but to do it without developing an eating disorder or increasing hatred toward themselves? We need to do better in making space for TGNB folks of ALL sizes, shapes, expressions, and food preferences. Everybody and every body is worthy of respect and human dignity.
The Greater Impact
The impact of sizeism and fatphobia are pervasive and insidious. For example, adolescents who are teased for their weight are 2-3x more likely to consider and attempt suicide (Eisenburg et al. 2003). TGNB folks, especially transfeminine people and people of color, are significantly impacted by the pressure to fit into gender appearance ideals (i.e., white, light skinned, thin, & young with straight hair; Patton, 2006) that reflect the binary norms of femininity or masculinity.
Here are some ways that TGNB people are impacted by these pressures compared to cisgender people:
- Increased body dissatisfaction and frequent body checking
- Risk of dissociation from or hatred of certain parts of their bodies
- Increase in disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use
- Weight loss to suppress secondary sex characteristics and/or
- For transfeminine people, to achieve the thin ideal
- For transmasculine people, to slow or stop the menstrual cycle
- For TGNB people with a high BMI, even greater rates of body dissatisfaction and disordered eating
- For transfeminine people, increased experiences of sexual objectification
- Greater risk of mental health struggles due to the stigma of being trans and/or fat
- e.g., desire for weight change increases reported history of suicide attempts and self-injury
- Risk of negative social consequences, stigma, and safety concerns when physical features are not in line with societal expectations for their gender
(Algers et al., 2010, Algars et al., 2012; Diemer et al., 2015, Gordon et al., 2016, Hepp & Milos, 2002; Jones et al., 2016; McGuire et al., 2016, Peterson et al., 2017; Sevelius, 2013; Vocks et al., 2009; & Witcomb et al., 2015)
It’s not surprising that trans folks are afraid to seek medical care from providers who often invalidate them while also imposing guidelines and hoops for them to jump through in order to seek some semblance of gender affirmation/congruence. When you’re fat, that fear increases. And don’t get me started on providers who recommend weight loss as a treatment for anything, regardless of gender. Would you pay to participate in a treatment program that had a 95-98% failure rate and led to most people going back to pre-treatment symptoms within 3-5 years? I hate to be the bearer of bad news, but if you have ever joined a weight loss program or gone on a fancy diet to lose weight, that’s exactly what you’ve done.
Though many TGNB people experience disconnect and dissatisfaction with their bodies, some reconnect with themselves and improve body satisfaction by altering their body, for example, through gender affirming surgery and hormones, body art/tattoos, and/or exercise. Gender affirming treatment, increased body satisfaction, and perceived social support from family, school, and friends help to reduce the risk of disordered eating (McGuire et al., 2016; Testa et al., 2017; Watson et al., 2017). Some find ways to reject the cultural ideals by creating their own unique gender expression, and those who have a more integrated gender identity are more likely to report social awareness, social acceptance, and body satisfaction (McGuire et al., 2017).
So What Can I Do?
Munro (2017) explains, “we live in a world that resists the notion of fatness as a facet of body diversity; as such, fat bodies are rarely represented in a positive light. Fatness is labeled as a disease and the treatment is eradication.” Social change movements for fat acceptance and body liberation are working to challenge and change this cultural mindset, but the journey is long and difficult – like transness, many are afraid of those who are different, those who do not fit the social norms, and those whose bodies challenge our internalized beliefs and fears.
Here are some ways I believe we can work to support our fat TGNB friends and fellow humans:
- Don’t comment on someone’s body parts, body size, food choices, or changes in weight. Ever. Check in when you’re thinking of complimenting someone – is there any chance that the compliment is a veiled microaggression?
- Practice empathy and compassion for others. Many TGNB and fat folks may struggle to love and accept their bodies, which can be a source of significant pain. “Empathy is the antidote to shame.” (Brown, 2007).
- While you’re at it, why not practice self-compassion and be mindful of the way you talk to yourself? “The act of giving yourself some grace is the practice of loving the you that does not like your body.” (Taylor, 2018, p. 114)
- Don’t assume that a TGNB person wants their body to be in line with binary constructions of femininity & masculinity. People have every right to exist in their bodies in whatever way works (or doesn’t work) for them.
- Dig into fat positive movements and literature (note: while there are some body positive (bopo) spaces that address fatphobia, not all bopo spaces are as fat accepting as they should be). Recommendations include:
- Ragen Chastain, https://danceswithfat.org/ blog
- Sonya Renee Taylor, The Body is Not an Apology book
- Rachel Wiley, Nothing is Okay book
- Christy Harrison, Food Psych podcast
- Alison Rachel, Recipes for Self-Love book & instagram
- Some awesome humans on social media: bodyposipanda; mynameisjessamyn; jazzmynejay; alokvmenon; ihartericka; po.rodil; ashleighthelion, and tessholliday.
- Be critical of the way that mass media portrays TGNB people, fat people, and TGNB fat people. Then, “dump the junk” (Taylor, 2018).
- Read up on intersections of transness with various identities, including size, health, race, ability, spirituality, sexuality, etc. so that your TGNB friends don’t need to teach you about their experiences.
- Check the privilege you carry in the world, whether you are cis, white, straight, able-bodied, healthy, wealthy, Christian, slim, etc. or any of the various intersections of these.
- Seek out medical and mental health providers who are fat positive and work from a Size Acceptance and Health at Every Size (HAES) perspective (Bacon, 2008; Chastain, 2012).
A Final Note
To those who are trans and fat, I see you. You are worthy, even when society doesn’t always communicate that to you. Everyone deserves to have love and compassion for the vessel that gets them through this world, even when you don’t like all parts of that vessel. You deserve to dress and express in ways that make you feel good about yourself and in clothes that fit your body, no matter what size you are. You deserve to access gender affirming care from providers who view fatness as a descriptor rather than an epidemic. You deserve to be gentle to yourself on good days, on bad days, and on in between days. There are people out there who will love and accept you at all sizes, in all gender presentations, and for all of the beautiful intersections that make up your identity. You are worthy.
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