An Introduction to Trans Care

I am a disabled, 60-year-old non-binary transgender woman. Like many of my trans siblings, I have no children. I am married, but my wife is older than I am and has her own health issues.  What would happen to me if I were to be placed into a care setting with nobody to make decisions for me?

Suppose I did have children, and they were available. Then the situation would be like that of other “sandwich generation” people, but of course with added complications due to my gender identity.

Or, I might be like many trans siblings and have a family but be out of contact with them. They may have divorced me when I came out and vowed to have nothing to do with me. If my community is unable to reach them, how would you proceed?

You are a friend, or a member of the community to which I belong, or maybe even a leader of my congregation, perhaps a board member or clergy person. What will you do if I’m in a facility?  I have an advanced-directive. But what if it is inadequate for some reason? How do you proceed with trans care?

There are resources out there on trans elder care. My colleague Jude Patton  is an expert on this topic, and he has written extensively on it, but perhaps there is not time to consult with him, or he is unavailable.

Over the next several articles, we will explore some topics needed to understand how best to care for Jewish elder trans folks in the event they are in a hospital or care facility. This series will be helpful for family, friends, community, hospital workers, and congregational members and staff – lay and professional alike.

Related to but separate from the transgender community is the Intersex/Inter-Gender (IS/IG) community. Many people who are transgender are also IS/IG, but there are people who are IS/IG who do not identify as trans.

So first off, what does it mean to be transgender/trans?  The basic definition is any person whose gender identity or expression does not match their assigned sex at birth.

But then one would ask, gender and sex? Aren’t they the same?  No, they are quite different.

Assigned sex at birth is determined by visual inspection by the provider on delivery. If there are external labia, the baby is assigned the sex: girl. Note that this has nothing to do with a vaginal canal, cervix or uterus, fallopian tubes, etc., as no internal exam is done.  If penis and scrotum are visualized, the assigned sex: boy. This may or may not attest to the condition or presence of two healthy testicles.  For any other condition at birth the baby is IS/IG.

Far too often, doctors convince parents that an IS/IG patient should be surgically “corrected” to a specific sex, but this is often disastrous, when the person later finds out. Many suicides have resulted from this.

Gender identity, on the other hand is an innate sense of self, that includes assigned sex, but may not match it, and includes many other factors, including socialization, roles desired and many factors not known.

It is not clearly known why someone’s gender identity does not match their assigned sex. What is known, however, is that allowing a person to live in their correct gender is healthy, and preventing them from doing so is disastrous.

It is so dangerous to do this, that I published a scholarly work prohibiting obstructing gender transition, based on the principle that Pikuah nefesh dokheh et haShabbat v’et kol haMitzvot – saving a life transcends the Shabbat and all other Torah obligations.  You can download this article here (PDF).

In the next article we will explore assigned sex and gender identity starting with Torah and Rabbinics, and moving to modern gender theory. We will attempt to remove some of the common misconceptions, so that you, the family member or friend, will better understand your trans loved one, and be better prepared to care for them as they age.