XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Social Inequalities: Demographic Characteristics of Patients Treated at the First Gender Identity Disorder Unit in Spain

ESTEVA, I. Spain
Co-authors: T. Bergero, I. Gornemann, G. Cano & F. Giraldo (Spain)
E-mail: isolde@hch.sas.cica.es

Introduction: There is little information regarding presentation and evolution of Gender Identity Disorders in Spain. Until the Regional Government of Andalusia approved the inclusion of Gender Identity Disorder’s treatment through the National Health Service, the majority of patients were seen either in private practices or had to travel to other European countries to receive treatment. Most patients could not afford this alternative and resorted to self-medication or no treatment at all, which increased their suffering, sense of isolation and lack of adequate care. At the end of 1999, the First Gender Identity Disorder Unit (GIDU), with a multidisciplinary team, was set up at the Hospital Carlos Haya in Malaga (Andalusia), south of Spain, for the care of people with gender identity disorders under the Andalusian Health Services, free of charge. Since then, we have seen more than 150 patients from all over the country.

Aims: The aim of this work is to present preliminary results on a longitudinal study to identify factors associated with the evolution of the disorder and, to evaluate treatment interventions directed to improve patients’ quality of life.

Setting: Clinical setting. Patients who come for treatment at the Gender Identity Disorder Unit (GIDU) at the Hospital Carlos Haya, Malaga, Spain.

Measurements: Several questionnaires were developed specifically for the study to include information on demographic variables, psychological events of interest, family history, personal history of health services utilization, use of medication, suicide attempts, attempts to harm their genitalia, personal history of abuse, violence, substance use, sexuality, natural history of the disorder, stressful events, psychiatric comorbidity, expectations regarding treatment, social support throughout the process, satisfaction with services and quality of life.

Results: We present preliminary results on demographic characteristics of the first 100 patients seen at the GIDU. Two thirds (60.6%) are biological men, and 94.1% were born in Spain. The majority (76.5%) were never married and 20.6% live with a partner. Those living with a partner were mostly biological women (68%). Ages range between 16 and 55 (M 28,66+8,29). Educational attainment is low, 59.4% did not finish high school, 29% had a high school education and, only 11.6% had some college education. Occupation and employment status in this population are indicators of the social exclusion most of these patients suffer, only 34.6% hold a full time job of which at least a third had had the job for less than a year, and 53.6% were unemployed. Most occupations were blue collar or non-qualified workers. More than half (55.9%) declared having been discriminated in the job or when looking for a job because of their sexual status and 17.2% declared having to get involved in dangerous or illegal activities to survive. The most common and evident discrimination was being denied access to a job due to discrepancies between personal appearance and the information on their identification card regarding their biological gender. A third declared being afraid at discrimination when looking for certain jobs that are traditionally assigned either to men or to women.

Conclusions: The majority of patients seen at our GIDU suffer from social inequalities associated with their gender identification status compared to the population in Spain; low educational attainment, lack of professional opportunities, discrimination and isolation are some of the consequences these men and women have to face.