Task Force on Gender Identity and Gender Variance — Comprehensive Notes (APA, 2009)
Task Force on Gender Identity and Gender Variance — Comprehensive Notes (APA, 2009)
Source: Report of the APA Task Force on Gender Identity and Gender Variance (APA, 2009). The report documents the Task Force’s charge, methodology, stakeholder consultations, policy and practice implications, research synthesis, and recommendations.
Scope: Distinguishes transgender/gender-variant issues from intersex/DSD issues for this report; focuses on education, training, research, policy, practice, and advocacy for psychologists and the broader public.
Core aim: Strengthen psychologists’ competence to address gender identity and gender variance; improve APA policies and advocacy; foster collaboration with other organizations and communities; support transgender psychologists and students within APA; and outline guidelines for care and research.
Ethical and social justice framing: Emphasizes human rights, reduction of discrimination, and social justice as central to APA activities in this area.
Key outputs include: a) policy recommendations and a nondiscrimination resolution; b) education and training recommendations (basic, intermediate, advanced levels); c) collaboration with external organizations; d) research priorities; e) guidelines for care and practice; f) creation of organizational homes within APA to coordinate transgender-related activities.
Major organizational shifts: Recommends establishing designated “homes” for transgender issues within APA (ultimately aligning with Committee on Lesbian, Gay, Bisexual, and Transgender Concerns [CLGBTC, now CLGBTC] and Division 44) to sustain leadership and action.
Public-facing materials: APA educational brochure for the public; language guidance for the Publication Manual; and other dissemination efforts to improve cultural competence.
Central tension in scope: debated whether to address transgender issues and intersex (DSD) issues together; ultimately omitted DSDs from the main report while acknowledging potential cross-cutting relevance for a subset of individuals with DSDs.
Core deliverables: a detailed set of conclusions and recommendations across education/training, research, policy, and practice; and a formal Resolution on Transgender, Gender Identity, and Gender Expression Nondiscrimination (pp. 65–69 in the report).
Key caveats: APA policy statements do not constitute APA policy unless adopted; the report’s recommendations are proposals to guide action and further study.
Executive Summary (Highlights)
Adopted in Feb 2005; Task Force created to review APA policies and develop education, training, and research recommendations; and to propose collaboration with other organizations.
Concluded from early discussions that addressing both gender identity/gender variance and intersex (DSD) issues in one document would be impractical; recommended separating the topics for a more thorough treatment.
Found a shift in the research landscape from pathology-focused to more holistic, life-span, public-health, and sociopolitical approaches; advocate for broader methodological approaches and a life-span perspective.
Emphasized that gender variance intersects with social justice issues (safety, human rights, discrimination) and recommended APA actions to advance social justice through advocacy, research, education, and professional development.
Identified a need for a formal APA “home” for transgender issues (within CLGBTC and Division 44) to coordinate policy, training, and outreach.
Proposed collaboration with six core organizations and several others to leverage expertise (HBIGDA/WPATH, SSSS, APA, CWSE, IASWR, APHA) and to engage transgender community-based organizations.
Recommends a broad, staged approach to education and training, including development of a public-facing brochure, internal guidelines, and proposed language for the Publication Manual.
Introduces a comprehensive Resolution on nondiscrimination (pp. 65–69) to advance civil rights and legal protections for transgender and gender-variant people.
Introduction
Historical trajectory: APA began sustained consideration of gender identity issues in 1996–1998 via CLGBC (now CLGBTC), CYF, and CWP examining DSM-IV GID concerns; later shifts included broader consultations with divisions and external organizations.
Contextual drivers: Increasing public visibility of transgender issues, decentralization of assessment and treatment, and rising community activism by transgender people and organizations influencing care practices and policy.
Service-delivery trends: Decentralization to community mental health settings; growth of transgender-led advocacy; reliance on multidisciplinary teams; ongoing debates about standards of care and gatekeeping roles for clinicians.
Core concerns for clinicians: Gender identity and dysphoria; cross-gender expression; medical interventions (hormones, surgery); discrimination and safety; access to health care; and the broader social justice implications tied to human rights.
Interpreting Our Change / Our Charge
Task Force charge: Develop recommendations about how APA should address transgender issues in training, education, research, and policy; address needs of APA members and students who identify as transgender; and identify entities with relevant expertise for ongoing dialogue and sensitivity training.
Charge challenges: Assessing whether to cover transgender and intersex issues together; recognizing that concerns of transgender individuals are primarily about identity and stigma, whereas intersex/DSD concerns center on medical procedures and patient/family education.
Decision rationale: After consults, it was deemed inseparable to attempt to unify these populations in a single report; thus, DSD/Intersex content was omitted from the main document (though some topics may still be relevant to a subset of DSD individuals).
Outcome: A clear rationale for creating a long-term APA leadership role on transgender issues, with targeted recommendations for education, training, and policy development; emphasis on collaboration with other professional organizations.
The Cultural Context Surrounding Transgender Issues
Public awareness surge: Media portrayals, award-winning portrayals (e.g., Boys Don’t Cry, Transamerica), high-profile media features (Oprah, 20/20, Dr. Phil, Newsweek), and Internet resources increased awareness.
Decentralization in care: Movement away from university-centered clinics to community-based care; variability in standards of care; ongoing debates about gatekeeping and access to hormones/surgery; disparities in third-party coverage.
Transgender activism and visibility: Activism by transgender communities and allies influenced care providers to engage more competently and sensitively; ongoing tensions between communities and health care providers.
Cross-cultural context: Recognition that gender categories and variance exist across cultures, and that gender binaries are not universal; non-Western gender diverse roles (e.g., hijras, Two-Spirit, etc.) illustrate varied social integration and acceptance.
Implications for psychology: Cultural context shapes identity formation, stigma, access to care, and human rights advocacy; psychologists should understand the sociocultural landscape in which clients operate.
Interpreting Our Constituency
Nominal constituency: APA members (psychologists and students) who identify as transgender or gender-variant; broader aim to improve services for transgender clients generally.
Expanded constituency: A social justice framing that includes transgender people generally and recognizes psychological science as a basis for advocacy and policy.
Community expectations: Transgender activists and organizations may view the task force as advocacy; the report emphasizes the need to balance advocacy with the evidence-based remit of APA.
Resolution development: Led to the Resolution on Transgender, Gender Identity, and Gender Expression Nondiscrimination (pp. 65–69), framed within APA’s commitment to minority rights and equal protection under the law.
Framing for policy: The Task Force sought to position APA to advocate for civil rights and health care access while maintaining methodological rigor and ethical practice.
Questions of Terminology
Terminology challenges: Difficulty balancing internal consistency, established terms of art in transgender care, usage in related fields, and respect for diverse identities.
Core definitions provided in the report (summarized):
Sex: Biological maleness/femaleness; genes, gonads, hormones, internal/external anatomy.
Gender: Psychological, behavioral, or cultural attributes associated with masculinity/femininity.
Gender identity: A person’s basic sense of being male, female, or indeterminate.
Gender role: Societal expectations for masculine/feminine behavior.
Gender expression: How a person communicates gender through behavior, dress, etc.
Sexual orientation: Attraction to others (same, opposite, both, or neither).
Transgender/Gender variant: Behavior/appearance/identity that crosses or does not conform to cultural norms for one’s biological sex.
Gender dysphoria: Distress or impairment associated with incongruence between gender identity and assigned sex.
GID: DSM diagnosis (historical; replaced in many settings by gender dysphoria terminology in DSM-5).
Transsexualism: Desire to live as the opposite sex, often with hormone therapy and sex reassignment surgery.
Diagnostic and clinical terminology debates: Ongoing discussion about GID vs. gender dysphoria; debates about pathologizing gender variance; variability in diagnostic criteria across ages; differential diagnoses for children, adolescents, and adults.
Cross-cultural considerations: Terminology evolves with cultural context and patient preferences; emphasize person-centered language and avoid pejorative terms (e.g., transvestite; hermaphrodite).
Consultation and Fact Finding
Methods used: literature review, APA member survey (Appendix A), consultations with APA divisions and committees, consultations with external professional organizations, and input from transgender community organizations and individuals.
The APA member survey (Appendix A) aimed to assess experiences and needs of TGTSGV (transgender, transsexual, gender-variant) individuals in education and practice.
Key survey results (from pages 22–23 in the transcript):
294 APA/APAGS respondents; of them, 205 were psychologists and 80 were graduate students; 211 had doctoral degrees; 56 master’s, 56 bachelor’s degrees.
Demographics: 84% White/Caucasian; 6% Hispanic/Latino; 3% Asian/Pacific Islander; 2% Native American/Alaskan; 1% Black; 6% other.
TGTSGV experiences: 71% knew at least one TGTSGV student as a student; 52% learned about TGTSGV issues in school or professionally; only 27% felt sufficiently familiar with TGTSGV issues in general.
Workplace experiences: 29% had worked with at least one TGTSGV colleague; 4% had worked with a colleague who transitioned on the job; 2% had a TGTSGV supervisor; 10% had supervised TGTSGV students in academia.
General tone: While there is notable interest and some access to education, there is a clear need for more information, training, and institutional support for TGTSGV issues.
Consultation Within APA; Consultations With Other Organizations; Community Input
Within-APA consultations: Included committees/divisions with potential interest in TGTSGV issues (e.g., CLGBC/CLGBTC, Division 44). The Division 44 engagement highlighted longstanding involvement in transgender issues and potential for formal inclusion, though membership diversity of opinion exists.
Other professional organizations consulted (examples):
World Professional Association for Transgender Health (WPATH) – Standards of Care; expressed support for the Task Force and interest in implementation.
Society for the Scientific Study of Sexuality (SSSS) – frequent transgender-related research; potential for collaboration.
American Psychiatric Association (APA) – diagnostic issues; includes transgender issues in conferences; potential for collaboration around diagnostic categories and policy implications.
Council on Social Work Education (CWSE) – transgender issues within education and policy;
American Public Health Association (APHA) – policy statements on transgender health and inclusion.
Transgender community-based organizations and individuals: A formal consultation process began in 2005; the Task Force received input from ~25 community respondents and 1997 onwards; focus areas included destigmatization, civil rights, healthcare access, coming-out processes, and policy language.
Community feedback highlights: Emphasized removal of gender identity disorder (GID) from DSM; advocated for civil rights and anti-discrimination protections; highlighted need for healthcare access, including hormone therapy and sex reassignment surgery; called for better practitioner training and public education.
Notable community organizations discussed as potential partners: Sylvia Rivera Legal Project (legal/human rights and policy; housing, prisons, discrimination), Transgender Law and Policy Institute (policy and identity documentation), PFLAG (parents/families network), Parents, Families and Friends of Lesbians and Gays (PFLAG) network; and other advocacy groups.
Community feedback informed the report’s framing of policy and advocacy actions, and reinforced the need for a formal APA home for transgender issues to coordinate education, research, and policy work.
Review of Existing APA Policy (Policy Landscape)
APA policy is broad, including bylaws, rules, codes, practice guidelines, continuing education criteria, accreditation standards, and nondiscrimination language.
Current policies touching transgender issues include: Resolution on Child Custody/Placement; Ethical Principles and Code of Conduct; Guidelines and Principles for Accreditation; Members’ Rights; Hate Crimes Resolution; and the Resolution on Prejudice, Stereotypes, and Discrimination.
The Task Force notes that certain internal policies (e.g., equal employment opportunity) had not yet been explicitly updated to include gender identity and gender expression; the report recommends adding both to internal non-discrimination policies.
Publication language: The Publication Manual (5th edition then current) lacked explicit guidance on gender identity terminology; the Task Force called for addenda to reduce bias in language, and recommended publishing language changes for broad dissemination.
Recommendations emphasize updating both internal policies and public-facing language to explicitly include gender identity and gender expression to ensure comprehensive protection and inclusion.
Review of policy also highlighted the potential need to re-examine the GID diagnosis in DSM in collaboration with other stakeholders; the Task Force did not mandate a policy take on DSM changes but recommended ongoing monitoring and dialogue.
Review of Research (Scope, Evolution, Gaps, Controversies)
Research landscape evolution: From clinical/positivistic approaches to broader, holistic, life-span, public health, and sociopolitical perspectives; more work by scholars who themselves are gender-variant.
Controversies and challenges: Debates around DSM-GID/Gender Dysphoria; debates about etiology (biological vs. psychosocial factors); concerns about research language and its potential stigmatizing effects; debates about standard-care guidelines versus patient-centered approaches.
What is well established: Transgender people experience higher rates of discrimination, stigma, harassment, violence, and barriers to education, employment, housing, and healthcare; access to hormone therapy and sex reassignment has complex safety and ethical dimensions; outcomes of sex reassignment are generally favorable when appropriate care is provided (low regret rates in many cohorts); improvements in mental health and social functioning are common post-transition when well-supported.
Knowledge gaps and future directions: Need for more rigorous controlled trials where feasible; robust life-span studies including aging populations; more inclusive studies across diverse transgender populations; more research on health disparities and access to care; better understanding of coming-out processes; cross-cultural research to understand global variations; research on the effectiveness of the WPATH SOC (Standards of Care) across populations; assessment of transgender health care delivery and policy impact.
Methodological cautions: Convenience sampling in many studies; interpretive caution regarding causal inferences; the need to avoid stigma-reinforcing language; the ethical considerations in clinical trials and interventions with transgender populations.
Terminology in research: Distinctions among sex, gender identity, gender role, gender expression, sexual orientation; debates over terms like GID vs. gender dysphoria; the need for consistent operational definitions across studies while honoring participants’ self-identifications.
Cross-cultural considerations: Evidence that many cultures recognize gender diversity beyond the Western binary; research underscores the social construction of gender norms and the impact of cultural context on psychological well-being and health care access.
Conclusions and Recommendations
Overarching framework: APA should address transgender issues in training, education, research, policy, and practice; foster collaboration with other professional bodies; and provide support for transgender psychologists and students within APA.
Homes for transgender issues: Establish designated homes within APA (CLGBTC and Division 44) to provide leadership, coordinate advocacy, and sustain transgender-focused activities; ensure transparency and ongoing dialogue with transgender communities.
Policy advocacy: Use APA’s policy tools (resolutions, amicus briefs, lobbying) to push for nondiscrimination in civil rights, access to healthcare (including hormone therapy and gender-affirming care), and equitable treatment in sex-segregated facilities; advocate for legal recognition (identity documents) consistent with post-transition identity; push for civil marriage rights and anti-discrimination protections across jurisdictions.
Education and training (three levels):
Basic: Cultural competence and public information; definitions, respectful language, and awareness.
Intermediate: Clinical presentations, prevalence, etiology, lifespan development, assessment, treatment, comorbidity, and cultural competency.
Advanced: In-depth, clinician-focused materials; specialized training relevant to clinicians working intensively with TGTSGV clients; targeted resources for students with specific interests.
Information resources: Develop and disseminate brochures, articles, videos, and other media; publish language guidance in APA Publication Manual; create resource lists for psychology programs, internships, and supervision features; provide access to training sites and consultation networks.
Collaboration with other organizations: Six key groups (HBIGDA/WPATH, SSSS, CWSE, APA, IASWR, APHA) plus community organizations like SRLP and Trans Law & Policy Institute to coordinate research, policy, and service delivery.
Research priorities: Emphasize transgender health in APA funding streams; support community-based participatory research; pursue development and validation of diagnostic criteria; study stigma reduction, identity development, health care access, and the effectiveness of sex-reassignment procedures; evaluate transitions across lifespan; explore the cost-effectiveness of interventions; study custodial settings and safety; evaluate the impact of legal/institutional changes.
Specific recommendations (policy and practice):
Create separate transgender-specific practice guidelines; address ethical and clinical competencies for working with TGTSGV populations.
Reassess DSM criteria related to gender identity to balance clinical utility with minimizing stigma; involve cross-disciplinary input.
Update internal APA policies to explicitly include gender identity and gender expression; ensure equal employment opportunities, anti-harassment safeguards, and nondiscrimination measures reflect these terms.
Develop and disseminate educational resources for psychologists to improve practice, teaching, and supervision related to transgender issues.
Support access to gender-transition care by advocating for insurance coverage and reducing barriers; file amicus briefs when appropriate to defend civil rights.
Long-term vision: APA becomes a welcoming, relevant hub for transgender psychologists and students, with robust policy leadership, widespread education, and a strong research agenda that informs clinical practice and public policy.
Addressing the Needs of Transgender Psychologists and Students
Key findings from the survey and consultations identified needs in three broad areas:
Education, training, and research dedicated to transgender issues; greater protection from discrimination within training and professional settings; mentoring and ally support; recognition of TGTSGV individuals as experts on these issues.
Workplace and educational environments: Access to facilities (e.g., sex-segregated spaces); confidential documentation reflecting gender identity; access to appropriate medical care and insurance; supportive institutional climates; cross-divisional collaboration; better language and terminology guidance.
APA institutional changes: Demographic data collection on transgender status in member surveys; review/an adjustment of employment policies; ensuring insurance includes transgender-related healthcare; creating or designating a home within APA for leadership on TGTSGV issues.
Recommendations include: integrate transgender content into accredited programs; promote cross-divisional collaboration and targeted funding; ensure facilities and records policies accommodate gender changes; and designate leadership within APA to coordinate the transgender agenda.
Education and Training (Three Levels of Information)
Basic information: Widely accessible cultural competence content; glossary of terms; safe language guidance; FAQ; references and further resources.
Intermediate information: Relevant to clinicians and students who work with transgender clients; topics include prevalence, etiology, life-span development, assessment and treatment, comorbidity, and cross-cultural considerations; suggested dissemination methods include journals, chapters, videos, and convention programming.
Advanced/specialized information: In-depth materials for clinicians with intensive involvement; consider publishing special journal issues and books; identify specialized training sites; provide consultation and supervision networks.
Acknowledges a gap: Very few psychologists/students currently possess high-level, specialized transgender knowledge; emphasizes the need for targeted educational products and programs across APA channels.
Policy Issues (Advocacy and Internal Policy)
The Task Force recommends: create a formal nondiscrimination resolution (Transgender, Gender Identity, and Gender Expression Nondiscrimination); remove references to “intersex” in the Task Force name and report title; include transgender issues in the next APA Publication Manual (bias-reduction language); amend Equal Employment Opportunity and Anti-Harassment policies to include gender identity and gender expression.
Advocacy priorities: Improve access to transgender-specific health care; advocate for coverage of sex-reassignment procedures by insurers; promote anti-discrimination protections; file amicus briefs to defend civil rights; support civil marriage rights for transgender individuals; ensure access to appropriate identity documents; demand safe, non-discriminatory environments in institutions (education, housing, health care, shelters, prisons).
Public education and professional communication: Encourage educational resources, journal special issues, and cross-division collaboration to advance awareness and understanding among psychologists and the public.
Practice Issues (Guidelines and Clinical Implications)
Practice guidelines: Argues for the development of transgender-specific guidelines for psychologists; notes that existing guidelines for LGB clients are useful but not fully adequate for TGTSGV clients; recommends parallel guidelines tailored to transgender needs.
DSM considerations: The GID diagnosis (DSM framework) is controversial; APA should not take an immediate position but should monitor and engage in research to inform future DSM revisions.
Clinical competence: Emphasizes the need for clinicians to be trained in transgender issues, including appropriate language, assessment, and culturally competent interventions; healthcare providers should address hormone therapy and surgical interventions with appropriate medical guidance and ethical standards.
Custodial settings and health care: Addresses housing and safety concerns for transgender inmates, continuity of hormone therapy, and coordination with medical professionals; recognizes a need for guidelines in correctional settings.
Insurance and health care access: Highlights disparities in insurance coverage; calls for consistent coverage of transgender health services and cost-effective care; encourages health systems to adopt best practices for transgender care.
Advocacy and Research Recommendations
Advocacy: Engage in civil rights advocacy, amicus briefs, and policy statements to advance transgender rights; support legal recognition and anti-discrimination protections; advocate for health care equity and coverage.
Research: Promote transgender-health priorities; fund and support studies on health disparities, health services delivery, the efficacy of Standards of Care, and psychosocial outcomes; encourage community-partnered research; ensure ethical, culturally sensitive research practices; investigate the psychosocial processes of coming out and identity development across cultures and ages.
Education/Training research: Develop evaluation studies on the effectiveness of training programs; study how education translates into improved clinical practice and better client outcomes.
Appendices (What They Contain)
Appendix A: APA Survey on Gender Identity, Gender Variance, and Intersex Conditions — Methodology, sample characteristics, and results (Appendix A details: sections on TGTSGV and intersex; Section B focuses on transgender; Section C focuses on non-trans respondents; response rates, demographic breakdowns, and scales for familiarity and experience).
Appendix B: Consultation List — Detailed listing of APA committees/divisions engaged (Committee on Children, Youth, and Families; Committee on Psychology and AIDS; Committee on Women in Psychology; CLGBTC; Division 8, Division 12, Division 17, Division 37, Division 42, Division 50, Division 53, Division 51, and others); outside organizations (WPATH, SSSS, CWSE, APA, APHA, IASWR, NASW, GLMA, SRLP, Transgender Law and Policy Institute, PFLAG, etc.).
Appendix C: Answers to Your Questions About Transgender Individuals and Gender Identity — Educational FAQ with definitions, examples, and practical guidance for clinicians, families, and the public.
Appendix D: Proposed Language to Address Issues in the Publication Manual — Guidance for terminology and language usage when writing about transgender and intersex conditions; recommended terminology changes and typographic conventions; example translations for DSM-related terms; guidance on gender identity vs. gender expression; recommended usage to reduce bias in language.
Key Formulas and Numerical References (LaTeX)
Web-based prevalence estimates and epidemiology:
Dutch Netherlands GID prevalence (adult):
European annual incidence (per 100,000):
MSNBC sample prevalence (transgender-identification in general population):
(i.e., 0.2%)PlanetOut size: approximately transgender-identified U.S. adults
Survey results (sample sizes and percentages):
Respondents: APA/APAGS; plus non-APA respondents
Knew TGTSGV student when I was a student: 71 ext{ extbf{%}}
Had opportunity in school to learn about TGTSGV issues: 52 ext{ extbf{%}}
Feel sufficiently familiar with TGTSGV issues: 27 ext{ extbf{%}}
Have worked with at least one TGTSGV colleague: 29 ext{ extbf{%}}
Have worked with a TGTSGV supervisor: 2 ext{ extbf{%}}
Supervising TGTSGV students in practicum/internship: 4 ext{ extbf{%}}
Respondents identifying as TGTSGV among APA/APAGS: /n; among all: (as above)
Notes on LaTeX usage: All numerical data and equations are presented in LaTeX formatting as requested. Symbols like %, fractions, and scientific notation are shown in LaTeX-friendly forms. If you need any data reformatted (e.g., as a table instead of bullets), say the word and I’ll adapt.
How to Use These Notes for Exam Preparation
Use the top-level sections to anchor study sessions; each section maps to a major component of the Task Force’s work (policy, research, education, practice).
For policy, memorize the nondiscrimination resolution’s intent and the recommended policy updates (gender identity and gender expression across APA documents and procedures).
For education/training, remember the three levels and the rationale for creating transgender-specific guidelines separate from LGB guidelines.
For research, focus on the six priority areas highlighted in the report (e.g., health disparities, standards of care evaluations, coming-out processes, etc.).
For terminology, be comfortable with core terms and the rationale behind terminology choices in clinical and research contexts.
For consultation processes, understand why APA engaged divisions, other professional bodies, and community organizations; know the key organizations and the rationale for collaboration.
Be prepared to discuss ethical considerations, human rights implications, and the potential tension between advocacy and rigorous science when shaping policy recommendations.
If you’d like, I can format these notes into flashcards or create a condensed study sheet focused on your exam’s emphasis (policy, clinical practice, or research methods).