tag:theconversation.com,2011:/us/topics/gender-affirming-healthcare-96371/articlesGender-affirming healthcare – The Conversation2024-03-13T20:59:46Ztag:theconversation.com,2011:article/2234122024-03-13T20:59:46Z2024-03-13T20:59:46ZWhat is gender-affirming care? A social worker and therapist working with trans people explains<figure><img src="https://images.theconversation.com/files/581460/original/file-20240313-20-z1u6um.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C4466%2C2991&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although medical doctors may be the first point of contact for children exploring their gender identity, many other professions can provide gender-affirming care, such as psychologists, social workers, teachers, counsellors and recreational coaches.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In late January, Alberta Premier Danielle Smith unveiled <a href="https://globalnews.ca/video/10264944/danielle-smith-unveils-albertas-proposed-guidelines-on-parental-consent-gender-affirming-care-rules">policies on gender-affirming care and parental rights</a>. These policies want to change access to medical treatments, participation in athletics, and whether transgender children can use preferred pronouns and names in school.</p>
<p>Meanwhile, <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html?smid=nytcore-ios-share&referringSource=articleShare">op-eds in newspapers</a> have brought attention to how professionals are supporting transgender children and the long-term effects of medical interventions. <a href="https://edmontonjournal.com/opinion/columnists/david-staples-alberta-danielle-smith-europe-gender-transition-policy">And suggested</a> that “adults can live with the consequences, but inexperienced children can’t”. </p>
<p>This suggests medical professionals are not assessing maturity and readiness in transgender children, and also that children should not be transitioning prior to adulthood. </p>
<p>As a registered clinical social worker and registered marriage and family therapist who works primarily with the 2SLGBTQIA+ population, I want to explain gender-affirming care and how professionals use it. I also want to discuss detransition, because too many people misunderstand and misuse the term. </p>
<p>There are several important assessments that must be considered prior to addressing maturity. For gender-affirming care, a child has to be assessed as a mature minor, which is a rigorous assessment completed by a professional such as a <a href="https://www.cap.ab.ca/Portals/0/pdfs/CAPPA-MatureMinors.pdf">psychologist</a> or <a href="https://acsw.in1touch.org/document/2024/SUM_MinorsAndConsentIssues_20150326.pdf">social worker</a>.</p>
<h2>Gender-affirming care</h2>
<p>According to the <a href="https://cps.ca/en/documents/position/an-affirming-approach-to-caring-for-transgender-and-gender-diverse-youth">Canadian Paediatric Society</a>, gender-affirming care assesses psychological, social, medical and surgical options for gender-diverse people. These assessments explore an individual’s personal, familial and environmental histories, as well as their mental health and physical health. Practitioners use this knowledge to best understand one’s functioning and strengths, and to give people the kind of support they need. </p>
<p>Although medical doctors may be the first point of contact for children exploring their gender identity, many other professions can provide gender-affirming care, such as psychologists, social workers, teachers, counsellors and recreational coaches. </p>
<p>Allowing children to express gender creatively is one of the first steps explored by mental health experts when working with transgender children, youth and their families. <a href="https://www.psychologytoday.com/ca/blog/lifetime-connections/202311/gender-creative-parenting-lets-kids-be-kids#:%7E:text=Gender%2Dcreative%20parenting%20is%20a,the%20world%20and%20varied%20interests.">Gender creativity</a> is a term used to identify the fluidity of gender; how one’s identity is not set in stone and can change as we learn more about ourselves. </p>
<p>Allowing a child to express independent thought and creativity with gender expression will not lead children to assume they are in need of medical interventions. On the contrary, as a professional, these interventions are used to support a child’s understanding of their options through improving self confidence and self-esteem. </p>
<p><a href="https://jeunesidentitescreatives.com/upload/ressources/files/Barbies_and_Beer.pdf">Methods</a> can include social play, such as learning more about their own likes, forms of expression and ultimately exploring what makes them happy. The intention behind this is to help children build confidence and self worth, allowing them to engage in social settings authentically without fearing social consequence. </p>
<h2>Importance of support</h2>
<p>It is normal for us to compare ourselves to others, or to what we understand of social customs and rules. These social customs suggest our assigned sex at birth must match socially regulated forms of gender expression. </p>
<p><a href="https://www.plannedparenthood.org/learn/gender-identity/transgender/what-do-i-need-know-about-transitioning">Transitioning</a> begins the moment one confirms to themselves that their identity is different from these social rules. This doesn’t mean everyone who feels this way will go on to socially or medically transition. </p>
<p>Once a child can identify that they feel a certain way, it is vital for them to receive support from parents, caregivers, teachers and their broader community. Gender non-conforming young people are at risk for <a href="https://doi.org/10.1016%2Fj.jadohealth.2016.09.014">mental health struggles</a> such as anxiety, depression, self-harm and attempted suicide.</p>
<p>One possible explanation for this could be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846479/#:%7E:text=Minority%20stress%20theory%20posits%20that,physical%20and%20mental%20health%20outcomes.">minority stress</a>, which is the distinct, chronic stressors minorities experience related to their identity, including victimization, prejudice and discrimination. </p>
<p>It is important to think critically about the social and political contexts that limit gender expression, because it impacts everyone, and can directly harm gender-diverse children. Considering this and minority stress, this is why it is important to allow children the space and freedom to freely express themselves, so that they can understand gender expression has more than two options: conform to social expectations or medically transition. </p>
<p>When children are provided gender-affirming care, mental health professionals support them in better understanding their emotions. This involves identifying feelings and learning how to emotionally regulate. This also includes addressing negative beliefs about their feelings, normalizing emotional responses and supporting children to become more self-compassionate. </p>
<p>Some believe mental health professionals focus on <a href="https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=abs2270">gender dysphoria</a> when providing such care to children and youth. This is the feeling of uneasiness or distress because your gender identity does not match your assigned sex at birth. </p>
<p>However, children and youth are provided with various forms of support prior to medical interventions being used. Medical interventions are oftentimes the last method a child is provided, and when it is provided, <a href="https://doi.org/10.1080%2F26895269.2021.1915223">some have described it as life-saving</a>.</p>
<p>Practitioners use gender-affirming care to promote <a href="https://www.healthline.com/health/transgender/gender-euphoria">gender euphoria</a> — the joy of aligning gender identity with gender expression. This is done by supporting children in finding confidence and self-worth by promoting their social and psychological well-being.</p>
<h2>What is detransitioning?</h2>
<p>Some gender-diverse children will need medical interventions but that doesn’t mean they have to persist for a lifetime. By providing children and youth access to medical interventions, professionals are addressing the <a href="http://www.phsa.ca/transcarebc/child-youth/affirmation-transition/medical-affirmation-transition/puberty-blockers-for-youth#:%7E:text=The%20changes%20to%20your%20body,that%20can't%20be%20reversed.">severity of dysfunction caused by gender dysphoria</a> </p>
<p>“Detransition” is a term used to describe those who have undergone medical and/or surgical interventions, and then reverted back. There is <a href="https://fenwayhealth.org/new-study-shows-discrimination-stigma-and-family-pressure-drive-detransition-among-transgender-people/">evidence</a> showing people undergo corrective approaches after medical or surgical interventions due to <a href="https://doi.org/10.1089%2Flgbt.2020.0437">discrimination, stigma and family pressure</a>. </p>
<p>It is crucial to understand that transgender individuals who use medical and surgical means for a period of time and stop, may not be detransitioning.</p>
<p>There are individuals who identify as <a href="https://doi.org/10.3390/jcm9061609">non-binary</a> who begin medical interventions, at a limited dose or for a duration of time, instead of committing life long. In my practice, I have seen many individuals begin hormone treatment and with the support of their doctor change the dosage as they continue to explore their gender identity. </p>
<p>There is a need for further research exploring detransition, especially in terms of how therapists can best support individuals who decide to stop or change their medical intervention plans with their doctors. </p>
<p>Ultimately, gender-affirming care is about providing people with the support they need. To help them see themselves in ways that promote joy, confidence and happiness. It is not about pathologizing gender expression. </p>
<p>Gender transition is not about fitting into preset ideals, but rather, finding joy in day to day experiences that is cultivated by our happiness, confidence and sense of belonging.</p><img src="https://counter.theconversation.com/content/223412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gio Dolcecore does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gender-affirming care assesses psychological, social, medical and surgical options for gender-diverse people.Gio Dolcecore, Assistant Professor, Social Work, Mount Royal UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2255432024-03-12T21:27:08Z2024-03-12T21:27:08ZDetransition and gender fluidity: Deeper understanding can improve care and acceptance<figure><img src="https://images.theconversation.com/files/581420/original/file-20240312-16-b238nw.jpg?ixlib=rb-1.1.0&rect=143%2C377%2C5748%2C3727&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The increasing visibility of gender transitioning and detransitioning has come with a helping of sensationalization and polarization.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>If you have been following recent coverage about gender-affirming health care, <a href="https://ici.radio-canada.ca/tele/enquete/site/episodes/864008/episode-du-jeudi-29-fevrier-2024">detransition will not be an unfamiliar topic</a>. From <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html">mainstream</a> <a href="https://nationalpost.com/news/canada/wpath-files-transgender-care-children">journalists</a> to transgender <a href="https://www.rollingstone.com/culture/culture-features/detransition-baby-book-torrey-peters-1193653/">authors</a>, many have taken an interest in people who underwent a medical gender transition and chose to return to their former identity.</p>
<p>The <a href="https://nationalpost.com/news/canada/wpath-files-transgender-care-children">increasing visibility</a> of gender transitioning and detransitioning has also come with a helping of sensationalization and <a href="https://theconversation.com/the-real-threat-to-gender-diverse-children-is-the-politicization-of-care-issues-like-puberty-blockers-and-detransition-223170">polarization</a>. But a divided media landscape that presents detransitioners as either “<a href="https://www.them.us/story/new-york-times-detransition-youth-op-ed-pamela-paul-chase-strangio">misinformation</a>” or victims of “<a href="https://www.heritage.org/gender/commentary/how-big-tech-turns-kids-trans">gender ideology</a>” hurts all gender-diverse people, including those who are detransitioning.</p>
<p>We are <a href="https://scholar.google.com/citations?user=BH8jEdkAAAAJ&hl=en">transgender</a> and <a href="https://scholar.google.com/citations?user=0mJq6LQAAAAJ&hl=en">cisgender</a> <a href="https://scholar.google.com/citations?user=9qiUwT0AAAAJ&hl=es">researchers</a> who study gender-affirming health care, and we are among a <a href="https://doi.org/10.1080/0092623x.2020.1869126">few in the world</a> who are <a href="https://www.thedarestudy.com/">currently investigating detransition</a> (detrans, for short — a label adopted by some with this lived experience). We also know many people who have detransitioned personally, whose first-hand perspectives have helped us to improve how we approach this topic.</p>
<h2>Detransition is not new, but we are seeing new gender-diverse experiences</h2>
<p>Detransition is not new. Providers of gender-affirming medicine have long been aware of adults who medically transitioned and later returned to live in their former “gender role” or showed signs of regret. </p>
<p>Dr. Harry Benjamin, the endocrinologist who was among the first to offer gender-affirming medical interventions in the United States, wrote about one such case in his 1966 book, <a href="https://www.goodreads.com/en/book/show/1229462"><em>The Transsexual Phenomenon</em></a>.</p>
<p>In 1992, German clinicians Friedemann Pfäfflin and Astrid Junge published a <a href="https://web.archive.org/web/20070812100135/http:/www.symposion.com/ijt/pfaefflin/6002-6.htm#Treatment%2520Results">comprehensive review</a> of followup studies published over the previous 30 years, reporting 25 cases of “role reversal” or regret among adults who had undergone surgery. Later, in 1998, Dutch clinicians Abraham Kuiper and Peggy Cohen-Kettenis published a <a href="https://www.researchgate.net/publication/270273121_Gender_Role_Reversal_among_Postoperative_Transsexuals">qualitative study</a> of 10 adults who returned to their original “gender role” or expressed feelings of regret after surgery.</p>
<p>Pioneers of gender medicine were interested in understanding these stories because regret, along with suicide, was considered an outcome <a href="https://doi.org/10.1300/J056v05n04_05">that should be prevented</a> at all costs. </p>
<p>The logic of <a href="https://pubmed.ncbi.nlm.nih.gov/34666278/">preventing regret</a> was part of what inspired <a href="https://nyupress.org/9781479899371/trans-medicine/">doctors’ strict gatekeeping</a> practices and the requirement that <a href="https://doi.org/10.1215/23289252-9311060">gender transitions be binary</a>: male-to-female or female-to-male. Using strict measurement criteria, they estimated that detransition was rare: <a href="https://doi.org/10.1097%2FGOX.0000000000003477">around one</a> to <a href="https://doi.org/10.1007/s10508-014-0300-8">two per cent</a>.</p>
<p>But today, gender is no longer thought of as binary. And while there is evidence that <a href="https://doi.org/10.1089/lgbt.2020.0437">detransition</a> has <a href="https://doi.org/10.1136/archdischild-2022-324302">increased</a> in <a href="https://doi.org/10.3390/healthcare10010121">recent years</a>, debates about numbers can distract from a more delicate conversation about the real need for LGBTQ+ communities, organizations and gender-affirming care providers to develop a <a href="https://doi.org/10.1080/26895269.2023.2279272">nuanced understanding of gender fluidity and detransition</a>.</p>
<p>Although detransition may not be new, what is new is a small but emerging gender-diverse population in our society who <a href="https://doi.org/10.1542%2Fpeds.2021-056082">transitioned socially</a> and/or medically as <a href="https://doi.org/10.1080/26895269.2022.2085224">children, youth</a> or <a href="https://doi.org/10.1007/s10508-023-02716-1">young adults</a> who are now <a href="https://doi.org/10.1001/jamapediatrics.2024.0077">re-identifying</a> with their <a href="https://doi.org/10.1002/icd.2402">birth-assigned sex/gender</a>, or moving from a binary trans identity (trans man or woman) <a href="https://doi.org/10.1037/sgd0000678">to non-binary</a>.</p>
<h2>Understanding detransition can help us to enrich gender care</h2>
<p>We have long known that <a href="https://doi.org/10.1007/s11930-016-0092-z">sexuality can be fluid</a> for some LGBTQ+ people. New <a href="https://doi.org/10.1080/00224499.2023.2244926">research</a> shows that it is not uncommon for trans and <a href="https://doi.org/10.1371/journal.pone.0293868">gender-diverse</a> young people to report <a href="https://doi.org/10.1177/00333549231223922">shifts in gender identity</a> over time — dynamically moving between binary trans girls or trans boys, to non-binary, or to <a href="https://www.jahonline.org/article/S1054-139X(22)00832-1/pdf">cisgender</a>. In some cases, these identity-shift patterns can influence <a href="https://doi.org/10.1016/j.jadohealth.2022.10.020">changes in desires for gender-affirming interventions</a>. </p>
<figure class="align-center ">
<img alt="Painted stripes in the colours of the rainbow pride flag" src="https://images.theconversation.com/files/581421/original/file-20240312-28-x8knjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581421/original/file-20240312-28-x8knjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581421/original/file-20240312-28-x8knjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581421/original/file-20240312-28-x8knjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581421/original/file-20240312-28-x8knjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581421/original/file-20240312-28-x8knjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581421/original/file-20240312-28-x8knjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rigorously studying detransition can help build a more robust understanding of gender identity development, and improve gender care.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>However, when a person’s gender identity or their desire for how they want to express their gender changes after already completing medical or surgical interventions, this may contribute to feelings of decisional regret. This poses <a href="https://actaspsiquiatria.es/index.php/actas/article/view/36">important dilemmas</a> for providers of gender-affirming medical interventions.</p>
<p>Many people who detransition are <a href="https://doi.org/10.1136/bmj-2022-073584">LGBTQ+</a>. But because detransition and regret are being <a href="https://www.nytimes.com/2023/05/16/us/politics/transgender-care-detransitioners.html">instrumentalized in debates</a> about trans people and gender-affirming health care, organizations and care providers serving sexual minorities and gender-diverse communities may feel that offering outward support for detransitioners is politically risky.</p>
<p>But if organizations and care systems fail to offer formal recognition and support, where can detransitioners turn to for help?</p>
<p>Discussion of anything but positive outcomes from gender-affirming hormonal or <a href="https://www.nytimes.com/2018/11/24/opinion/sunday/vaginoplasty-transgender-medicine.html">surgical treatments</a> was long <a href="https://www.reuters.com/investigates/special-report/usa-transyouth-outcomes/">considered unspeakable</a> in mainstream culture and in the trans community. As a result, regret went underground, to online social media networks and <a href="http://doi.org/10.1001/jamanetworkopen.2022.24717">detrans peer support networks</a>. Apart from a small number of therapists working privately with this population, there are few support services.</p>
<h2>Detransitioners’ voices</h2>
<p>Some detrans people have decided to go public and tell their <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html">stories in the media</a>, to <a href="https://www.washingtonpost.com/nation/2023/12/06/detransitioners-transgender-care-laws/">testify in state legislatures</a> and to <a href="https://www.nysun.com/article/lawsuits-by-regretful-detransitioners-take-aim-at-medical-establishments-support-for-gender-transition-treatments-for-minors">take legal action</a>. As social scientists who study gender-affirming health care, we understand what motivates these pursuits: a desire to be understood, and to seek validation and justice.</p>
<p>Detransitioners’ voices, though, may be strategically positioned toward <a href="https://thehill.com/opinion/4284777-matthews-here-come-the-gender-detransitioner-lawsuits/">gender-affirming care restrictions</a>, rather than to improve research or to develop comprehensive detransition-related care services. This positioning may further contribute to stigma and division between trans and detrans people.</p>
<p>It is our view that detransition should be rigorously studied to build a more robust understanding of gender identity development, and to improve gender care — so that nobody’s needs or lived experiences are neglected.</p>
<p>We wrote about some of these ideas and recommendations in the medical journal <a href="https://doi.org/10.1136/bmj-2022-073584"><em>BMJ</em></a>, including what we know about detransition so far. We <a href="https://www.yorku.ca/laps/2023/10/31/laps-professor-kinnon-mackinnon-and-team-launches-a-research-website/">also developed</a> an <a href="https://detransinfo.com/">online support resource</a> to communicate the most up-to-date research and care guidance.</p>
<h2>Identity evolution and detransition are LGBTQ+ experiences</h2>
<p>In our own emerging research with detransitioning people, we have observed that these experiences <a href="https://rjs.inrs.ca/index.php/rjs/article/view/294/182">can often overlap with trans people’s</a> and the broader LGBTQ+ community. Indeed, some who understand themselves as detrans may also identify as <a href="https://doi.org/10.1002/icd.2402">non-binary, gender-fluid</a>, bisexual, queer, butch, gay, <a href="https://doi.org/10.1080/00918369.2021.1919479">lesbian and/or gender nonconforming</a>; and many continue to experience <a href="https://doi.org/10.1080/26895269.2023.2279272">gender minority stress and homophobia</a>. </p>
<p>Some might only <a href="https://doi.org/10.1089/lgbt.2020.0437">detransition temporarily</a> due to <a href="https://doi.org/10.1001/jamanetworkopen.2022.24717">lack of support</a>, external pressures and transphobia, and re-affirm a trans identity in the future.</p>
<p>Regardless, detransition can bring about <a href="https://doi.org/10.57814/8nd4-6a89">loss of community supports, stigma</a>, <a href="https://doi.org/10.1001/jamanetworkopen.2022.24717">shame and health care avoidance</a>. <a href="https://doi.org/10.1080/00918369.2021.1919479">Many</a> — <a href="https://doi.org/10.1371/journal.pone.0293868">but not all</a> — detransitioners experience regret over past medical interventions. Other feelings may be present as well, including <a href="https://doi.org/10.1002/icd.2402">satisfaction, ambivalence, grief and self-discovery</a>.</p>
<p>Identity shifts can be hard to predict. However, in hindsight, some detransitioners do feel that they were influenced by their cultural environment to <a href="https://doi.org/10.1007/s10508-023-02556-z">interpret their feelings</a> and behaviours through the <a href="https://doi.org/10.1002/icd.2402">lens of gender dysphoria</a> or to <a href="https://doi.org/10.1037/sgd0000678">adopt a trans identity</a> without considering alternatives. At the same time, some detrans people recount that environments that suppressed or <a href="https://doi.org/10.57814/8nd4-6a89">doubted their initial trans identity</a> only meant that later on, in detransition, it was hard to disclose to loved ones and care providers that their identity had changed.</p>
<p>In any case, gender fluidity does not negate the reality of detrans people’s authenticity in their own gender-diversity. While we understand that some of this information is new and may be uncomfortable to embrace, a gender-affirmative stance must hold space for the full breadth of gender diversity being reflected in our society today.</p>
<p>Rigorous, on-going research that is inclusive of these experiences is fundamental to being gender-affirming. Gender fluidity and detransition deserve further understanding and formal care services, not controversy.</p><img src="https://counter.theconversation.com/content/225543/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kinnon R. MacKinnon receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Annie Pullen Sansfaçon receives funding from the Social Sciences and Humanities Research Council of Canada and the Canada Research Chair Program.</span></em></p><p class="fine-print"><em><span>Pablo Expósito-Campos receives funding from the Predoctoral Research Fellowship Program of the Government of the Basque Country, Spain. He is a student member of the World Professional Association for Transgender Health (WPATH) and a member of the "Gonad, identity, and sexual differentiation" Working Group of the Spanish Society of Endocrinology and Nutrition (GT-GIDSEEN).</span></em></p>Gender fluidity and detransition deserve nuanced understanding. Polarization that presents detransitioners as either ‘misinformation’ or victims of ‘gender ideology’ hurts all gender-diverse people.Kinnon R. MacKinnon, Assistant Professor, School of Social Work, York University, CanadaAnnie Pullen Sansfaçon, Professor of Social Work, Université de MontréalPablo Expósito-Campos, Predoctoral researcher in Psychology, Universidad del País Vasco / Euskal Herriko UnibertsitateaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231702024-02-13T16:22:48Z2024-02-13T16:22:48ZThe real threat to gender-diverse children is the politicization of care issues like puberty blockers and detransition<p>Under the pretext of protecting children, Pierre Poilievre, leader of the Conservative Party of Canada, has <a href="https://www.cbc.ca/news/politics/poilievre-transgender-puberty-blockers-1.7107486">said he is opposed</a> to the use of puberty blockers for gender-diverse children.</p>
<p>“I think that we should protect children and their ability to make adult decisions when they’re adults,” Poilievre said.</p>
<p>Poilievre is one among many politicians to wade into debates surrounding gender-affirming health care in recent years. Alberta Premier Danielle Smith has <a href="https://www.cbc.ca/news/canada/edmonton/danielle-smith-unveils-sweeping-changes-to-alberta-s-student-gender-identity-sports-and-surgery-policies-1.7101053">proposed controversial policies that would affect gender-diverse youth</a>, including prohibiting puberty blockers for children aged 15 and under.</p>
<p>But the growth of politicization and misinformation on this issue — on top of already <a href="https://nyupress.org/9781479899371/trans-medicine/">longstanding ideological battles</a> over the <a href="https://www.thestar.com/news/gta/closing-of-camh-clinic-fans-controversy-over-gender-questioning-children/article_ba7595a8-f367-53bc-bc8e-f19555880bf4.html">care of minors</a> — probably pose a bigger threat to gender-diverse people than puberty blockers.</p>
<p><a href="https://www.researchgate.net/profile/Pablo-Exposito-Campos">We are researchers</a> who study the <a href="https://scholar.google.com/citations?user=BH8jEdkAAAAJ&hl=en">experiences of transgender</a> and gender-diverse people who have accessed gender-affirming health care. <a href="https://www.advocate.com/politics/transgender/2014/09/17/photos-meet-first-trans-man-win-gay-games-gold-powerlifting#:%7E:text=Last%2520month%252C%2520Kinnon,before%2520the%2520competition.">One of us is transgender</a> and also a parent. And <a href="https://scholar.google.com/citations?user=9qiUwT0AAAAJ&hl=es">we are among a few</a> who also research <a href="https://doi.org/10.1136/bmj-2022-073584">detransitioning</a> — the process of discontinuing or reversing a gender transition. </p>
<p>We both personally know countless people who have been helped by transitioning, as well as others who were <a href="https://doi.org/10.1371/journal.pone.0293868">let down by the promises of gender-related treatments</a> that can have <a href="https://globalnews.ca/news/10281751/alberta-says-it-consulted-widely-in-drafting-controversial-transgender-rights-policy/">life-altering consequences</a>.</p>
<p>We have noticed that what is presented as “fact” in these debates has distorted real complexities of gender-affirming health care, creating a rift between conservative and progressive information outlets. The result has left many in the dark about what is really at stake.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GmzDMeLLPPA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Conservative leader Pierre Poilievre speaks to the media about puberty blockers and trans children.</span></figcaption>
</figure>
<h2>Fertility and gender-affirming medicine</h2>
<p>Take the <em>New York Times</em> as an example. Two opinion columnists recently wrote about gender-affirming care for minors, making drastically different remarks about the fertility implications of this care. </p>
<p>Opinion columnist <a href="https://www.nytimes.com/2023/12/01/opinion/politics/life-without-regret.html#:%7E:text=Most%2520chilling%2520to,become%2520biological%2520parents.">Lydia Polgreen</a> asserted that it is a “mistaken belief” that infertility routinely results from treatments for gender-diverse children, while <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html#:%7E:text=hormone%2520therapy%2520discontinue%2520its%2520use%2520within%2520four%2520years%252C%2520though%2520the%2520effects%252C%2520including%2520infertility%252C%2520are%2520often%2520irreversible.">Pamela Paul</a>, writing about detransition, claimed that hormonal therapy causes “often irreversible” infertility.</p>
<p>But the reality of fertility and gender-affirming treatments is in the details. Research on fertility outcomes is lackluster to begin with, but outcomes are highly sensitive to whether <a href="https://doi.org/10.1215/23289252-8553202">puberty blockers were taken prior to starting cross-sex hormones and the stage of puberty</a>.</p>
<p>For children who start puberty blockers followed by cross-sex hormones without ever undergoing natal puberty, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979264/#:%7E:text=The%20Endocrine%20Society,cross%2Dsex%20hormones.">infertility is presumed</a> because reproductive maturity is not achieved, and saving sperm or eggs for the future is <a href="https://transcare.ucsf.edu/guidelines/fertility#:%7E:text=Currently%2520it%2520is,undergoing%2520natal%2520puberty.">not possible</a> with current assisted reproductive technologies. However, for transgender people who begin cross-sex hormones after undergoing at least some natal puberty, fertility does not seem to be permanently affected. </p>
<p><a href="https://doi.org/10.1016%2Fj.xcrm.2022.100858">Early</a> <a href="https://doi.org/10.1089/trgh.2022.0023">research</a> indicates that for those who went through natal puberty, taking cross-sex hormones alone is <a href="https://www.huffpost.com/archive/ca/entry/fertility-treatment-trans_ca_5ddeebdce4b00149f728e7c0#:%7E:text=The%2520actual%2520egg,whenever%2520we%2520are.">unlikely to cause permanent sterility</a>.</p>
<h2>Puberty blockers</h2>
<p>The history of transgender medicine and reproductive rights has been fraught with injustice. When puberty blockers <a href="https://doi.org/10.1007/s10508-011-9758-9">were first tested for use with gender dysphoric youth</a>, transgender adults were being coercively sterilized. In 2014, the Netherlands struck down a policy requiring <a href="https://www.hrw.org/news/2020/12/01/netherlands-apologizes-transgender-sterilizations#:%7E:text=The%20Dutch%20government%20has%20apologized%20to%20transgender%20people%20for%20previously%20mandating%20surgeries%2C%20including%20sterilization%2C%20as%20a%20prerequisite%20for%20legal%20gender%20recognition.%20During%20a%20Cabinet%20meeting%20this%20week%2C%20government%20officials%20also%20announced%20plans%20to%20compensate%20people%20who%20underwent%20the%20operations.">sterilizing surgeries to legally change genders and paid out financial reparations as an apology</a>.</p>
<p>Pediatric gender medicine is a <a href="https://www.psychiatrictimes.com/view/gender-affirming-care-for-adolescents-separating-political-polarization-from-medicine">relatively new field</a>, and while the <a href="https://doi.org/10.1146/annurev-med-043021-032007">evidence base is growing steadily</a> it also <a href="https://doi.org/10.1111/apa.16791">shows its novelty</a>. </p>
<p>In fact, fertility is not the only issue at stake with puberty blockers. There are uncertain <a href="https://doi.org/10.1080/15265161.2018.1557284">impacts on bone health, neurodevelopment and social development</a>, as well as <a href="https://www.nytimes.com/2022/06/15/magazine/gender-therapy.html#:%7E:text=Shrier%2520also%2520quoted,stage%2520of%2520development.">sexual function</a> — issues clinicians and researchers are paying close attention to. </p>
<figure class="align-center ">
<img alt="A mother and child and a doctor seen from behind" src="https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Poilievre gives the wrong impression by saying that ‘we should protect the rights of parents to make their own decision with regards to their children,’ because, given the age of the child, parents are typically involved in the decision to start puberty blockers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A team of Dutch clinicians who were among the first to offer transgender children puberty blockers <a href="https://doi.org/10.1093/jsxmed/qdac029">recently acknowledged</a> that these drugs may not be just a “pause button” to explore identity, as originally intended. Instead, they should be thought of as the first step of a medical gender transition, because a <a href="https://doi.org/10.1093/jsxmed/qdac029">majority eventually go on to take hormonal treatments</a>.</p>
<p>But there are also major <a href="https://doi.org/10.1093/oso/9780192895400.003.0008">consequences involved in delaying or withholding treatment with puberty blockers</a>, which could hurt transgender girls more than boys. Testosterone’s effects on the body can be difficult to reverse, so undergoing a masculinizing puberty could render transfeminine kids more <a href="https://doi.org/10.1186/s12939-022-01632-5">vulnerable to future anti-trans discrimination</a>. Irreversible body changes from puberty can not only heighten distress and reduce social acceptance, but also contribute to a need for future surgeries.</p>
<p>Given that puberty may occur as early as <a href="https://www.nytimes.com/2022/05/19/science/early-puberty-medical-reason.html#:%7E:text=But%2520the%2520study,observed%2520in%2520boys.">eight or nine years old</a> for some children, this is a high-stakes medical decision never taken lightly by families or clinicians. <a href="https://www.cbc.ca/news/politics/poilievre-transgender-puberty-blockers-1.7107486">Poilievre gives the wrong impression</a> by saying that “we should protect the rights of parents to make their own decision with regards to their children,” because, given the age of the child, parents are typically involved in the decision to start puberty blockers.</p>
<p>However, there is <a href="https://psycnet.apa.org/record/2024-16010-001">always some risk of getting it wrong</a> — in either direction.</p>
<h2>Detransition debate</h2>
<p>Puberty-blocking drugs are not the only politicized topic in gender-affirming health care. <a href="https://doi.org/10.1136/bmj-2022-073584">Detransition also tops the list</a>. </p>
<p>On one side, opponents of gender-affirming care distort studies to argue detransition has <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html#:%7E:text=Studies%2520show%2520that%2520around%2520eight%2520in%252010%2520cases%2520of%2520childhood%2520gender%2520dysphoria%2520resolve%2520themselves%2520by%2520puberty%2520and%252030%2520percent%2520of%2520people%2520on%2520hormone%2520therapy%2520discontinue%2520its%2520use%2520within%2520four%2520years%252C">reached epidemic proportions</a> and draw from testimonies of regretful detransitioners as a “<a href="https://www.foxnews.com/opinion/stop-mutilation-girls-gender-affirming-care#:%7E:text=Yet%2520the%2520harrowing%2520stories%2520of%2520former%2520trans%252Didentified%2520individuals%2520serve%2520as%2520a%2520cautionary%2520tale%2520against%2520medical%2520transitioning">cautionary tale against medical transitioning</a>.” </p>
<p>Proponents retort by dismissing detransition either by alluding to its <a href="https://www.cbc.ca/kidsnews/post/gender-affirming-care-what-it-means-and-why-its-in-the-news#:%7E:text=However%252C%2520research%2520says,of%2520family%2520support">“rarity,” using outdated</a> and <a href="https://slate.com/technology/2024/02/transgender-youth-health-care-regret-pamela-paul-nyt-data.html">flawed studies</a>, or by <a href="https://www.cbc.ca/kidsnews/post/gender-affirming-care-what-it-means-and-why-its-in-the-news#:%7E:text=Detransitioning%2520or%2520reversing,related%2520care%2520needs.">decoupling the experience from regret</a>.</p>
<p>As a result, the public is exposed to two different sets of “facts,” none of which reflect the heterogeneity that we and others have encountered in <a href="https://slate.com/technology/2023/12/trans-health-care-detransition-research-studies-new.html">researching detransition</a> — different <a href="https://actaspsiquiatria.es/index.php/actas/article/view/36">psychological, medical and social motives</a> for detransitioning; a range of emotions including <a href="https://doi.org/10.1002/icd.2402">regret, resilience, and satisfaction</a>; expansive patterns of <a href="https://www.tandfonline.com/doi/abs/10.1080/00224499.2023.2244926">identity discovery and fluidity</a>. All of it must be studied for gender-related medical care to continue being evidence-informed.</p>
<p>But threats, or outright restrictions, from politicians will not advance this care. What is badly needed from governments is investments in higher quality research and systems of care so treatments can be accessed in the safest possible terms. There are currently gaps in the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0293868#:%7E:text=We%20found%20that,accessing%2C%20care%20services.">Canadian gender-affirming care system</a> affecting access, quality, and safety.</p>
<h2>Guidelines, dilemmas and the need for high-quality research</h2>
<figure class="align-center ">
<img alt="A stethoscope and a transgender flag in the shape of a heart" src="https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=264&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=264&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=264&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=331&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=331&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=331&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Debate should not centre on whether to ban treatments or not, but how to build an accessible and high-quality health and social care system that can support all gender-diverse people.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This area of health care already <a href="https://doi.org/10.1080/26895269.2022.2100644">has guidelines</a> developed through a review of the evidence and <a href="https://www.psychiatrictimes.com/view/gender-affirming-care-for-adolescents-separating-political-polarization-from-medicine#:%7E:text=In%2520September%25202022,in%2520the%2520process.">international expert consensus</a>. But that does not mean the science is settled or that the medicine has no room for improvement.</p>
<p>Gender-affirming care is riddled <a href="https://doi.org/10.1007%2Fs10508-018-1287-3">with ethical</a> <a href="https://doi.org/10.1007/s10508-020-01762-3">dilemmas</a> that have <a href="https://nymag.com/intelligencer/article/bell-v-tavistock-transgender-health-care.html#:%7E:text=There%2520are%2520signs,after%2520anguishing%2520month.">spilled over into an explosive political situation</a>. The changing landscape of transgender health care, <a href="https://doi.org/10.1111/apa.16791">debates about puberty blockers</a> and <a href="https://www.nysun.com/article/lawsuits-by-regretful-detransitioners-take-aim-at-medical-establishments-support-for-gender-transition-treatments-for-minors">detransition</a> are all low-hanging fruit for opportunistic politicians like Poilievre.</p>
<p>On the polarization of these topics, anthropologist and medical doctor <a href="https://doi.org/10.1215/23289252-8553202">Sahar Sadjadi</a> — who <a href="https://doi.org/10.14506/ca34.1.10">studied in-depth some of the first American pediatric gender clinics</a> — wrote:</p>
<blockquote>
<p>“It is tempting to take the opposite position of one’s enemy, by defending all medical interventions currently associated with gender transition in children and insisting that they are safe and save children’s lives.” </p>
</blockquote>
<p>But by not being able to tolerate some of the unknowns, or banning treatments outright, we miss a crucial opportunity to advance knowledge that is needed to help gender-diverse children and their families.</p>
<p>Debate should not centre on whether to ban blockers, but on how to build a high-quality health and social care system that can support all gender-diverse people. Doing so depends on our collective ability to tolerate complexity.</p><img src="https://counter.theconversation.com/content/223170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kinnon R. MacKinnon receives funding from the Social Sciences and Humanities Research Council of Canada.
He is a member of the World Professional Association for Transgender Health (WPATH).</span></em></p><p class="fine-print"><em><span>Pablo Expósito-Campos receives funding from the Predoctoral Research Fellowship Program of the Government of the Basque Country, Spain. He is a student member of the World Professional Association for Transgender Health (WPATH) and a member of the "Gonad, identity, and sexual differentiation" Working Group of the Spanish Society of Endocrinology and Nutrition (GT-GIDSEEN).</span></em></p>On both sides of the transgender care debate, what is presented as ‘fact’ distorts real complexities of gender-affirming health care, leaving many in the dark about what is really at stake.Kinnon R. MacKinnon, Assistant Professor, School of Social Work, York University, CanadaPablo Expósito-Campos, Predoctoral researcher in Psychology, Universidad del País Vasco / Euskal Herriko UnibertsitateaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225792024-02-02T18:51:32Z2024-02-02T18:51:32ZAlberta’s new policies are not only anti-trans, they are anti-evidence<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/albertas-new-policies-are-not-only-anti-trans-they-are-anti-evidence" width="100%" height="400"></iframe>
<p>What did Alberta Premier Danielle Smith get wrong in her new anti-trans policies? Spoiler alert — everything. </p>
<p>Let’s spend some time fact-checking Smith. </p>
<p>She recently promised a <a href="https://globalnews.ca/news/10255444/alberta-parental-rights-legislation-introduction/">new “parental rights” policy</a> would be introduced by her United Conservative Party government.</p>
<p>Like other experts, <a href="https://edmontonjournal.com/opinion/columnists/opinion-parental-rights-legislation-increases-risk-of-harm-for-alberta-students">we worried these policies would mimic the parental rights legislation</a> recently introduced in Saskatchewan and New Brunswick.</p>
<p>But we grossly underestimated the breadth of the Alberta measures.</p>
<p>Smith <a href="https://globalnews.ca/video/10264944/danielle-smith-unveils-albertas-proposed-guidelines-on-parental-consent-gender-affirming-care-rules">has unveiled a suite of policies</a> that directly attack trans and gender-diverse children and youth in Alberta. Spanning health care, education and sports, these policies extend well beyond the expected changes to the use of chosen names and pronouns in schools.</p>
<p>Smith intends to implement the most <a href="https://egale.ca/egale-in-action/egale-canada-and-skipping-stone-foundation-condemn-albertas-attack-on-2slgbtqi-people-and-promise-legal-action/">extensive, draconian and unbalanced proposals</a> of any conservative province to date, all under the guise of “preserving choice” for kids. </p>
<p>As we explain below, these policies are at odds with research about gender-affirming care, curriculum and sports. </p>
<p>As a result of ignoring the evidence, these policies could cause significant harm to the <a href="https://www.cbc.ca/news/canada/edmonton/alberta-2021-census-gender-age-dwelling-1.6432469">many transgender and non-binary youth</a> who live in Alberta or access gender-affirming care in the province (like youth from the Northwest Territories, for example).</p>
<h2>Evidence on trans-affirming care</h2>
<p>Smith’s new policy will forbid access to puberty blockers and hormone therapy for the purpose of gender reassignment or affirmation for youth 15 years of age and under, except for those who have already started those treatments. For youth 17 years and under, top and bottom gender reassignment surgeries are not permitted. </p>
<p>This particular policy deliberately spreads disinformation — <a href="https://www.centreforsexuality.ca/learning-centre/transitioning/">parents are already required to give consent</a> for their pubescent children to receive puberty blockers and for teenagers to access hormone replacement therapy. Bottom surgeries are <a href="https://www.grsmontreal.com/en/frequently-asked-questions.html">already restricted to adults</a>. </p>
<p>Puberty blockers slow down the onset of puberty and are often prescribed for <a href="https://www.mayoclinic.org/diseases-conditions/precocious-puberty/diagnosis-treatment/drc-20351817#:%7E:text=This%20usually%20involves%20medicine%20called,be%20given%20at%20longer%20intervals.">cisgender girls who experience puberty before 10 years old</a>. </p>
<p>According to <em>Scientific American</em>, puberty blockers have been <a href="https://www.scientificamerican.com/article/what-are-puberty-blockers-and-how-do-they-work/">studied extensively</a> and have been used safely since the 1980s. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979264/">Any risks</a> associated with puberty blockers are already included in <a href="https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.210064">Standards of Care</a> for transgender patients, and are not being prescribed to pubescent youth <a href="https://cps.ca/en/documents/position/an-affirming-approach-to-caring-for-transgender-and-gender-diverse-youth">without careful consultation</a>. </p>
<p>Like all medicines, side effects are a risk but <a href="https://read.dukeupress.edu/tsq/article-abstract/7/3/508/166964/The-Vulnerable-Child-Protection-Act-and">researchers caution</a> against <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/joim.13441">fear-mongering</a> in response to gender-affirming care. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1653775493550813184"}"></div></p>
<p>The <a href="https://doi.org/10.1016/j.jadohealth.2016.06.012">evidence about trans-affirming health care</a> for youth is clear — it saves lives. Evidence suggests that puberty blockers lead to <a href="https://doi.org/10.1542%2Fpeds.2019-1725">positive mental health outcomes</a> and that the <a href="https://doi.org/10.1186/s13633-020-00078-2">biggest benefits</a> of gender-affirming hormone therapy (HRT) are realized when <a href="https://www.umass.edu/news/article/gender-affirming-care-can-save-lives-transgender-youth#:%7E:text=Nguyen%20was%20part%20of%20the,at%20age%2014%20or%2015.">HRT is started at age 14 or 15</a>. </p>
<p>Rather than restrict life-saving medical care, <a href="https://www.sciencedirect.com/science/article/pii/S0015028221000820">experts in fertility medicine</a> call for increased accessibility for trans people to fertility services.</p>
<h2>Sex education evidence</h2>
<p>Paralleling <a href="https://www.cbc.ca/news/canada/saskatchewan/sask-parental-rights-law-1.7002088">Saskatchewan</a> and <a href="https://www.cbc.ca/news/canada/new-brunswick/gender-identity-policy-713-pronouns-school-1.6954807">New Brunswick</a>, Alberta youth 15 and under now require parental consent to use chosen names and pronouns at school. Notification is required for 16- and 17-year-olds to do so. </p>
<p>Classroom instruction on gender, sexuality and sexual orientation also now requires parental notification and opt-in. Finally, third-party resource materials on gender, sexuality and sexual orientation in schools need to be pre-approved by the ministry to make sure they’re “age-appropriate.”</p>
<p>Education experts agree that what is needed to <a href="https://www.actioncanadashr.org/resources/sexual-health-hub/sex-ed/sex-ed-preventing-violence-and-increasing-safety">protect youth — including cisgender and heterosexual kids — from potential abuse</a> is robust and consent-based sexual health education. Youth have the right to knowledge and skills about their bodies, consent, safe/unsafe touch and healthy relationships. </p>
<p>By creating conditions that could result in youth receiving no or limited information, <a href="https://content.c3p.ca/pdfs/C2K_SportEdition_ParentsGuide_eng.pdf">Smith has put children and youth at greater risk of violence and harm</a>. </p>
<h2>Risk of parental, peer rejection</h2>
<p>Requiring parental consent for youth to use their chosen name and pronouns at school could <a href="https://www.cp24.com/world/saskatchewan-pronoun-policy-doesn-t-do-enough-to-mitigate-harms-say-legal-professors-1.6602093">cause irreparable harm</a>. This process essentially requires schools to “out” youth to their parents, who may reject their children. </p>
<p>Smith incorrectly suggests that <a href="https://www.cpac.ca/headline-politics/episode/alberta-premier-danielle-smith-discusses-gender-identity-policies?id=5b8e0a28-da27-4f0e-afe4-d771e34fbed1">parental rejection of 2SLGBTQIA+ kids is rare</a>. </p>
<p>According to a Canadian study by The Family Acceptance Project, 30 per cent of families reject their child when they come out, and <a href="https://familyproject.sfsu.edu/sites/default/files/documents/Family%20Acceptance%20Project-rr%20Overview.pdf">many are removed from their homes</a>. Among youth who are homeless, 20 per cent identify as 2SLGBTQIA+. </p>
<p>For those who experience family rejection, the rates of suicide are incredibly high. According to the <a href="https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf">2015 U.S. Transgender Survey</a>, <a href="https://doi.org/10.1080/27703371.2023.2192177">79 per cent of those rejected by their families experienced suicidal ideation and 43 per cent have made a suicide attempt</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1193023154630754309"}"></div></p>
<h2>Trans athletes evidence</h2>
<p>Smith’s policy will also ban trans girls and women athletes from participating in competitive women’s sports. They will be forced to play in gender-neutral or co-ed divisions.</p>
<p>Yet again, Smith hasn’t listened to the experts. <a href="https://www.cces.ca/sites/default/files/content/docs/pdf/transgenderwomenathletesandelitesport-ascientificreview-e-final.pdf">Some scientists maintain</a> that trans women and girls have no <a href="https://www.cces.ca/transgender-women-athletes-and-elite-sport-scientific-review">“biological advantage”</a> over cisgender girls and women. </p>
<p>A <a href="https://www.hup.harvard.edu/books/9780674725324">book on the topic</a> that reviewed evidence on testosterone determined there is no direct relation between the hormone and athletic performance. It found that while testosterone can be linked to muscle mass and muscle memory, there’s no connection to other capacities like endurance and flexibility.</p>
<p>High levels of athleticism are actually correlated with <a href="https://pubmed.ncbi.nlm.nih.gov/24616603/#:%7E:text=In%20addition%2C%20the%20possession%20of,as%20determinants%20of%20sport%20expertise">coaching and specialized training</a> — including access to competitive leagues — not to “biological sex.” </p>
<p>Trans sports participation is vital for health and well-being. That’s why the Canadian Centre for Ethics in Sport recommends “<a href="https://cces.ca/sites/default/files/content/docs/pdf/cces-transinclusionpolicyguidance-e.pdf">policies governing the participation of trans athletes should be evidence-based</a>.” According to a <a href="http://doi.org/10.1001/jamapediatrics.2023.3266">study published by the <em>Journal of the American Medical Association</em></a>, youth participation in sport is associated with positive physical, mental and emotional well-being.</p>
<p><a href="https://indd.adobe.com/view/publication/40b5fe5b-48b2-48a3-81b2-8ed970144e66/1/publication-web-resources/pdf/Working_Towards_a_Sport_for_Them.pdf">Inclusive sports environments</a> — not segregated leagues — are associated with greater self-esteem and school retention.</p>
<h2>What’s the truth?</h2>
<p>In <a href="https://transpulsecanada.ca/results/report-health-and-well-being-among-trans-and-non-binary-youth/">survey data collected from 2,873 non-binary and trans people in Canada</a>, youth reported high levels of harassment (72 per cent), rejection from family (25 per cent) and suicide ideation (40 per cent). </p>
<p>In contrast, trans youth who are <a href="https://www.glsen.org/activity/inclusive-curriculum-guide">affirmed in schools</a>, <a href="https://www.wpath.org/publications/soc">health care</a> and in <a href="https://www.psychiatry.org/news-room/apa-blogs/lgbtq-participation-in-sports">sports</a> have better <a href="https://doi.org/10.1080/09589236.2023.2285984">self-confidence and relationships with their parents</a>.</p>
<p>Smith has <a href="https://www.cpac.ca/headline-politics/episode/alberta-premier-danielle-smith-discusses-gender-identity-policies?id=5b8e0a28-da27-4f0e-afe4-d771e34fbed1">incorrectly warned</a> there are risks associated with affirmation and inclusion in schools for trans kids.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-the-alberta-election-the-stakes-are-high-for-2slgbtq-youth-205966">In the Alberta election, the stakes are high for 2SLGBTQ+ youth</a>
</strong>
</em>
</p>
<hr>
<p>What the evidence actually demonstrates is what truly puts trans kids at risk are <a href="https://doi.org/10.1111/cdep.12405">transphobic, misguided and ill-informed policies and practices</a> that deny them the right to live authentically and to express themselves fully without fear. </p>
<p><a href="https://www.ctvnews.ca/politics/federal-ministers-accuse-alberta-premier-danielle-smith-of-putting-trans-youth-at-risk-1.6751597">Federal cabinet ministers</a> are speaking out against Smith’s proposed restrictions. Ottawa may oppose the policies in court.</p>
<p>In Alberta, Skipping Stone Foundation in Calgary and Egale Canada — advocacy groups for 2SLGBTQI people — have <a href="https://egale.ca/egale-in-action/egale-canada-and-skipping-stone-foundation-condemn-albertas-attack-on-2slgbtqi-people-and-promise-legal-action/">publicly condemned Smith’s policies</a> and have partnered to file a court injunction. </p>
<p>These policies are clearly meant to satisfy Smith’s electoral base, but her government is now going to have to go head-to-head with the experts — and the evidence — in future legal battles. </p>
<p><em>This is an updated version of a story originally published on Friday, Feb. 2. It includes more information on clinical guidelines for the prescription of puberty blockers for the purposes of gender-affirming care.</em></p><img src="https://counter.theconversation.com/content/222579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Corinne L. Mason receives funding from SSHRC.</span></em></p><p class="fine-print"><em><span>Leah Hamilton receives funding from SSHRC.</span></em></p>Alberta Premier Danielle Smith’s anti-trans policies are likely meant to satisfy her base, but her government will now have to go head-to-head with the evidence in future legal battles.Corinne L. Mason, Associate Professor, Women's and Gender Studies, Mount Royal UniversityLeah Hamilton, Professor in the Faculty of Business & Communication Studies, Mount Royal UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2208312024-01-30T13:35:29Z2024-01-30T13:35:29ZBacklash to transgender health care isn’t new − but the faulty science used to justify it has changed to meet the times<figure><img src="https://images.theconversation.com/files/571543/original/file-20240125-15-cirbso.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5778%2C3252&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anti-trans legislation adjudicates the bodily autonomy of those who do not conform to gender norms.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransgenderRights/5105bf799bb64a7b88d180c1a410463a">Carolyn Kaster/AP Photo</a></span></figcaption></figure><p>In the past century, there have been three waves of opposition to transgender health care. </p>
<p>In 1933, when the Nazis rose to power, they <a href="https://daily.jstor.org/90-years-on-the-destruction-of-the-institute-of-sexual-science/">cracked down on</a> transgender medical research and clinical practice in Europe. In 1979, a research report critical of transgender medicine <a href="https://doi.org/10.7326/M22-1480">led to the closure</a> of the most well-respected clinics in the United States. And since 2021, when <a href="https://www.npr.org/2023/06/20/1183344228/arkansas-2021-gender-affirming-care-ban-transgender-blocked">Arkansas became the first U.S. state</a> among now <a href="https://www.lgbtmap.org/equality-maps/healthcare_youth_medical_care_bans">at least 21 other states</a> banning gender-affirming care for minors, we have been living in a third wave.</p>
<p>In my work as a <a href="https://gsrosenthal.com">scholar of transgender history</a>, I study the <a href="https://theconversation.com/gender-affirming-care-has-a-long-history-in-the-us-and-not-just-for-transgender-people-201752">long history of gender-affirming care</a> in the U.S., which has been practiced since at least the 1940s. Puberty blockers, hormone therapies and anatomical surgeries are <a href="https://www.latimes.com/opinion/story/2023-03-28/opinion-gender-affirming-care-is-not-new-or-experimental">neither experimental nor untested</a> and have been safely administered to cisgender, transgender and intersex adults and children for decades.</p>
<p>On the other hand, the archives of transgender medicine demonstrate that backlash against these practices has historically been rooted in pseudoscience. And today, an anti-science movement that aims to <a href="https://www.scientificamerican.com/article/the-antiscience-movement-is-escalating-going-global-and-killing-thousands/">discredit science altogether</a> is fueling the fire of the current wave of anti-trans panic.</p>
<h2>The 1930s − eugenics and sexology collide</h2>
<p>In the 1920s, the new science of hormones was just reaching maturation and <a href="https://uncpress.org/book/9781469674858/wondrous-transformations/">entering mainstream consciousness</a>. In the field of sexology – the study of human sexuality, founded in 19th century Europe – scientists were excited about research on animals demonstrating that removing or transplanting gonads could effectively change an organism’s sex.</p>
<p>In 1919, the German sexologist <a href="https://theconversation.com/the-early-20th-century-german-trans-rights-activist-who-transformed-the-worlds-view-of-gender-and-sexuality-106278">Magnus Hirschfeld</a> founded the <a href="https://www.scientificamerican.com/article/the-forgotten-history-of-the-worlds-first-trans-clinic/">Institut für Sexualwissenschaft</a> in Berlin, which became the world’s leading center for queer and transgender research and clinical practice. Hirschfeld worked closely with trans women as co-researchers throughout the 1920s. Several trans women also received care at the institute, including <a href="https://doi.org/10.1080%2F26895269.2020.1749921">orchiectomies</a> that halted the production of testosterone in their bodies.</p>
<p>Within months of Hitler’s rise to power in early 1933, a <a href="https://www.hmd.org.uk/resource/6-may-1933-looting-of-the-institute-of-sexology/">mob of far-right students</a> broke into and shuttered the institute for being “<a href="https://daily.jstor.org/90-years-on-the-destruction-of-the-institute-of-sexual-science/">un-German</a>.” Some of the <a href="https://collections.ushmm.org/search/catalog/pa26364">most famous images</a> of Nazi book burning show the institute’s library set ablaze in an outdoor plaza.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white photo of person in uniform throwing books into a bonfire" src="https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=478&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=478&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=478&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=600&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=600&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=600&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Members of the Nazi party confiscated and burned ‘un-German’ books, including those from the Institut für Sexualwissenschaft.</span>
<span class="attribution"><a class="source" href="https://collections.ushmm.org/search/catalog/pa26364">United States Holocaust Memorial Museum, courtesy of National Archives and Records Administration, College Park</a></span>
</figcaption>
</figure>
<p>Nazi ideology was based on another prominent field of science of that time: <a href="https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism">eugenics</a>, the belief that certain superior populations should survive while inferior populations must be exterminated. In fact, Hirschfeld’s sexology and Nazi race science had common roots in the Enlightenment-era effort to <a href="https://doi.org/10.1080/17496977.2020.1794161">classify and categorize</a> the world’s life forms. </p>
<p>But in the late 19th century, many scientists went a step further and <a href="https://theconversation.com/proposed-1920s-orphanage-study-just-one-example-in-history-of-scientific-racism-37015">developed a hierarchy of human types</a> based on race, gender and sexuality. They were inspired by <a href="https://www.britannica.com/topic/social-Darwinism">social Darwinism</a>, a set of pseudoscientific beliefs applying the theory of survival of the fittest to human differences. As race scientists imagined a fixed number of human races of varying intelligence, sexologists simultaneously sought to classify sexual behaviors as innate, inherited states of being: <a href="https://www.beacon.org/A-Queer-History-of-the-United-States-P1426.aspx">the “homosexual”</a> in the 1860s and <a href="https://www.digitaltransgenderarchive.net/news/2016-08-die-transvestiten-sexology-and-pivotal-moments-in-trans-history">the “transvestite,”</a> a term coined by Hirschfeld himself, in 1910.</p>
<p>But where Hirschfeld and other sexologists saw the classification of queer and trans people as justifications for legal emancipation, eugenicists of the early 20th century <a href="https://encyclopediavirginia.org/entries/eugenic-sterilization-in-virginia/">in the U.S.</a> and <a href="https://encyclopedia.ushmm.org/content/en/article/eugenics">Europe</a> believed sexually transgressive people <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">should be sterilized</a> and ultimately eradicated.</p>
<p>Based on this premise, the Nazis <a href="https://www.cornellpress.cornell.edu/book/9781501765155/pink-triangle-legacies/">murdered thousands of LGBTQ people</a> in the Holocaust.</p>
<h2>The 1970s − making model citizens</h2>
<p>In the 1950s and 1960s, transgender medicine bounced back in the U.S. Scientists and clinicians at several universities began experimenting with new <a href="https://press.uchicago.edu/ucp/books/book/chicago/H/bo156724705.html">hormonal and surgical interventions</a>. In 1966, Johns Hopkins became the <a href="https://soundcloud.com/hopkins-medical-archives/gender-identity-clinic-press-conference-1966">first university hospital in the world</a> to offer trans health care. </p>
<p>By the 1970s, trans medicine went mainstream. <a href="https://www.hup.harvard.edu/books/9780674013797">Nearly two dozen university hospitals</a> were operating gender identity clinics and treating thousands of transgender Americans. Several trans women and men wrote <a href="https://www.theparisreview.org/blog/2021/01/29/the-conundrum-of-conundrum/">popular autobiographical accounts</a> of their transitions. Trans people were even <a href="https://americanarchive.org/catalog/cpb-aacip_507-cc0tq5s22t">on television</a>, talking about their bodies and fighting for their rights. </p>
<p>Yet trouble was brewing behind the scenes. Jon Meyer, a psychiatrist at Johns Hopkins, was skeptical of whether medical interventions really helped transgender people. In 1979, Meyer, along with his secretary Donna Reter, published a <a href="https://doi.org/10.1001/archpsyc.1979.01780090096010">short academic paper</a> that ushered in the second wave of historic backlash to trans medicine.</p>
<p>In their study, Meyer and Reter contacted previous patients of the Johns Hopkins Gender Identity Clinic. To understand whether surgery had improved patients’ lives, the authors developed an “adjustment scoring system.” They assigned points to patients who were in heterosexual marriages and had achieved economic security since their operations, while deducting points from those who continued to engage in gender nonconformity, homosexuality, criminality, or sought mental health care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white image of transgender artist Coccinelle smiling beside her husband Francis Paul Bonnet" src="https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some researchers defined a successful medical transition as one that resulted in visible conformity to gender norms and heterosexuality.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/artiste-transgenre-coccinelle-et-son-mari-francis-paul-news-photo/1505597233">Reporters Associes/Gamma-Rapho via Getty Images</a></span>
</figcaption>
</figure>
<p>Meyer and Reter believed that gender-affirming surgeries were successful only if they made model citizens out of transgender people: straight, married and law-abiding.</p>
<p>In their results, the authors found no negative effects from surgery, and no patients expressed regret. They concluded that “sex reassignment surgery confers no objective advantage in terms of social rehabilitation,” but it is “subjectively satisfying” to the patients themselves. This was not a damning conclusion. </p>
<p>Yet, within two months, Johns Hopkins had <a href="https://doi.org/10.7326/M22-1480">shuttered its clinic</a>. <a href="https://www.nytimes.com/1979/10/02/archives/benefits-of-transsexual-surgery-disputed-as-leading-hospital-halts.html">The New York Times</a> reported that universities would feel pressure to similarly “curtail their operations and discourage others from starting to do them.” Indeed, only a <a href="https://doi.org/10.7326/M22-1480">handful of clinics remained</a> by the 1990s. Transgender medicine did not return to Johns Hopkins <a href="https://www.washingtonpost.com/national/health-science/long-shadow-cast-by-psychiatrist-on-transgender-issues-finally-recedes-at-johns-hopkins/2017/04/05/e851e56e-0d85-11e7-ab07-07d9f521f6b5_story.html">until 2017</a>.</p>
<p>In requiring trans patients to enter straight marriages and hold gender-appropriate jobs to be considered successful, Meyer and Reter’s study was <a href="https://doi.org/10.1007/BF02115944">homophobic and classist in design</a>. The study exemplified the <a href="https://nyupress.org/9781479899371/trans-medicine/">pseudoscientific beliefs</a> at the heart of transgender medicine in the 1960s through the 1980s, that patients had to conform to societal norms – including heterosexuality, gender conformity, domesticity and marriage – in order to receive care. This was not an ideology rooted in science but in bigotry.</p>
<h2>The 2020s − distrust in science</h2>
<p>As in the 1930s, opposition to trans medicine today is part of a broad reactionary movement against what some far-right groups consider the “<a href="https://www.theguardian.com/world/2023/sep/15/project-2025-policy-manifesto-lgbtq-rights">toxic normalization</a>” of LGBTQ people. </p>
<p>Legislators have <a href="https://theconversation.com/penguin-random-house-pen-america-authors-and-parents-sue-florida-county-for-removing-books-on-race-and-lgbtq-themes-205945">removed books with LGBTQ content</a> from libraries and <a href="https://www.newsobserver.com/news/politics-government/article254903187.html">disparaged them as “filth</a>.” A recent law in Florida <a href="https://www.them.us/story/florida-trans-bathroom-law">threatens trans people with arrest</a> for using public restrooms. Both Florida and Texas have pursued efforts to <a href="https://www.them.us/story/texas-attorney-general-ken-paxton-state-data-on-trans-texans">compile data on their trans citizens</a>. Donald Trump’s <a href="https://www.theatlantic.com/magazine/archive/2024/01/trump-lgbtq-transgender-community-protections/676139/">campaign platform</a> calls for a nationwide ban on trans health care for minors and severe restrictions for adults.</p>
<p>And similar to the 1970s, opponents of trans medicine today frame gender-affirming care as a “debate,” even though <a href="https://glaad.org/medical-association-statements-supporting-trans-youth-healthcare-and-against-discriminatory/">all major U.S. medical associations</a> support these practices <a href="https://www.ama-assn.org/press-center/press-releases/ama-states-stop-interfering-health-care-transgender-children">as medically necessary</a> and lifesaving. </p>
<p>But widespread <a href="https://www.bostonreview.net/articles/andrew-jewett-science-under-fire/">distrust in science and medicine</a> in the <a href="https://www.thenation.com/article/society/anti-science-is-a-systematic-issueand-its-not-going-away/">wake of the COVID-19 pandemic</a> has affected how Americans perceive trans health care. Prohibitions on gender-affirming care have occurred simultaneously with the relaxing of pandemic restrictions, and some scholars argue that the movement against trans health care is part of a <a href="https://blogs.lse.ac.uk/gender/2022/04/11/what-anti-gender-and-anti-vaccines-politics-have-in-common-the-construction-of-gender-and-the-covid-19-pandemic-in-right-wing-discourses/">broader movement</a> aimed at discrediting scientific consensus.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Back of person wearing trans flag at the back of a legislative hearing room with a rotunda" src="https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A rash of legislation restricting access to gender-affirming care claims to protect the health of children, despite lack of support from major U.S. medical associations.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransgenderHealthMissouri/442b19097c7f44a0a0864c4046aa5acb">Charlie Riedel/AP Photo</a></span>
</figcaption>
</figure>
<p>Yet the adage “<a href="https://www.nsta.org/journal-college-science-teaching/journal-college-science-teaching-mayjune-2022/why-do-people-say-i">believe in science</a>” is not an effective rejoinder to these anti-trans policies. Instead, many trans activists today call for diminishing the role of medical authority altogether in <a href="https://www.americanscientist.org/blog/macroscope/its-time-to-stop-gatekeeping-medical-transition">gatekeeping access to trans health care</a>. Medical gatekeeping occurs <a href="https://doi.org/10.1080/26895269.2022.2100644">through stringent guidelines</a> that govern access to trans health care, including mandated psychiatric evaluations and extended waiting periods that limit and control patient choice. </p>
<p>Trans activists have <a href="https://filtermag.org/wpath-trans-nonbinary-health-care/">fought with the World Professional Association for Transgender Health</a>, the organization that maintains these standards of care, by demanding greater bodily autonomy and depathologizing transsexuality. This includes pivoting to an <a href="https://doi.org/10.1093/jsxmed/qdad019">informed consent model</a> where patients make decisions about their own bodies after discussing the pros and cons with their doctors. Trans activists have been rallying against medical authority since the early 1970s, including calling for <a href="https://www.digitaltransgenderarchive.net/downloads/th83kz57z">access to hormones and surgeries on demand</a>.</p>
<p>It is not clear how the current third wave of backlash to transgender medicine will end. For now, trans health care remains a question dominated by medical experts on one hand and people who question science on the other.</p><img src="https://counter.theconversation.com/content/220831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>G. Samantha Rosenthal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For as long as trans medicine has been around, so has its opposition. The tactics of prior waves of anti-trans policies are still in play today.G. Samantha Rosenthal, Associate Professor of History, Roanoke CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2075922023-07-31T12:22:14Z2023-07-31T12:22:14ZTrans youth are significantly more likely to attempt suicide when gender dysphoria is met with conversion therapy than with hormone treatment<figure><img src="https://images.theconversation.com/files/539103/original/file-20230724-15-9fs65h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trans teens living in a supportive family environment have a lower risk of attempting suicide or running away from home.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/gender-symbols-royalty-free-image/1314046616">Eoneren/E+ via Getty Images</a></span></figcaption></figure><p>As states continue to <a href="https://translegislation.com/">introduce laws</a> that restrict access to gender-affirming care or limit protections against conversion therapy, questions have arisen about the effectiveness of interventions intended to help transgender youth. In this political climate, gold-standard evidence is more important than ever.</p>
<p>Prior research has been unable to tease out cause and effect between health outcomes and gender-affirming care like hormone therapy or gender-denying interventions like conversion therapy, largely because of a lack of longitudinal data or an appropriate control group. To establish whether something causes an outcome, researchers typically rely on <a href="https://doi.org/10.1111%2F1471-0528.15199">randomized control trials</a> – experiments that randomly assign people to a treatment or a placebo. Random assignment is a trusted way to create two equal groups to compare. However, because it is unethical to withhold treatment or administer potential harmful interventions, randomized controls trials are off the table in this case.</p>
<p>In lieu of randomized control trials, researchers often retrospectively compare people who have received an intervention with those who did not. Studies using this approach have linked hormone therapy with <a href="https://doi.org/10.1371/journal.pone.0261039">positive mental health outcomes</a> for trans teens. However, because this treatment requires parental approval, teens who receive hormone therapy may have more supportive families than those who do not. The mental health improvement they experienced may partially be due to <a href="https://doi.org/10.1089/trgh.2020.0094">living in a gender-affirming family environment</a> rather than the effects of hormone therapy alone.</p>
<p>Our research team was able to address these study design issues directly. Along with our colleagues <a href="https://www.umass.edu/economics/graduate/current-graduate-student/nguyen">Duc Hien Nguyen</a> and <a href="https://scholar.google.com/citations?user=6VtcuWMAAAAJ&hl=en">Yana Rodgers</a>, <a href="https://www.researchgate.net/profile/Travis_Campbell3">we are</a> <a href="https://scholar.google.co.uk/citations?user=7qADvu8AAAAJ&hl=en">economics and</a> <a href="https://scholar.google.com/citations?user=Di1AiloAAAAJ&hl=en">health policy</a> researchers who study the health and economic outcomes of marginalized populations, including LGBTQ+ communities. To assess cause and effect, we used a method commonly used in economics, policy analysis and health policy research called an <a href="https://doi.org/10.1146/annurev-publhealth-040617-013507">event study</a>. We analyzed data from the 2015 <a href="https://www.ustranssurvey.org/reports">U.S. Transgender Survey</a>, which includes responses from over 27,000 trans adults across the nation. We compare people who initiate an intervention with those who initiate the same intervention one year later. The group that has not yet started treatment acts as a control group, providing credible estimates of the effect of treatment.</p>
<p>We found that supportive family environments and <a href="http://dx.doi.org/10.1257/pandp.20231057">hormone replacement therapy</a> that affirms a transgender child’s gender identity decrease their risk of suicide or running away from home, whereas unsupportive family environments and <a href="https://doi.org/10.1016/j.jhealeco.2023.102750">conversion therapy</a> that denies their gender identity increase these risks.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7gGQxP-KTFM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Trans youths and their parents struggle to navigate the wave of anti-trans bills in the U.S.</span></figcaption>
</figure>
<h2>Treating gender dysphoria</h2>
<p>Many transgender people experience <a href="https://www.psychiatry.org/psychiatrists/diversity/education/transgender-and-gender-nonconforming-patients/gender-dysphoria-diagnosis">gender dysphoria</a>, which is psychological distress arising from a mismatch between how a person expresses their gender identity and the social norms of their sex assigned at birth. To treat gender dysphoria, health professionals typically use gender-affirming interventions such as hormone therapy to align gender expression with identity. Some, however, use gender-denying interventions such as conversion therapy to align gender identity with sex. </p>
<p>Gender affirmation includes processes that help a person feel socially and physically aligned with their gender identity. Affirmation could include social changes, such as going by a gender-affirming name and pronouns, using gender-aligned bathrooms, or wearing gender-affirming clothing. Affirmation could also include medical interventions, such as medications to delay the onset of puberty, hormones that help align physical characteristics with gender identity, or, for trans adults, gender-affirming surgeries. Some trans adults also legally change their names and gender markers on their ID. Research has shown that these forms of gender affirmation may <a href="https://doi.org/10.1089/trgh.2020.0038">alleviate gender dysphoria</a>.</p>
<p>Conversely, <a href="https://doi.org/10.1002/hast.365">gender-denying interventions</a> like conversion therapy attempt to change the sexual orientation or gender identity of youth. These interventions assume that gender identity is malleable before puberty. Although it is presumably intended to alleviate gender dysphoria and social stigma of being trans, studies have found that it can prolong and intensify those issues and lead to <a href="https://doi.org/10.1001/jamapsychiatry.2019.2285">psychological distress in adulthood</a>. </p>
<p>Because there is <a href="https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-whether-conversion-therapy-can-alter-sexual-orientation-without-causing-harm/">no credible evidence</a> supporting the efficacy of conversion therapy, <a href="https://doi.org/10.1542/peds.2018-2162">many professional</a> <a href="https://www.psychiatry.org/about-apa/policy-finder/position-statement-on-treatment-of-transgender-%28tr">health organizations</a> <a href="https://www.apa.org/news/press/op-eds/science-gender-affirmation">have recommended</a> <a href="https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence">gender-affirming care</a> to alleviate gender dysphoria in trans people. </p>
<p>There has been limited evidence, however, on the health effects of both hormone therapy and conversion therapy for trans people, which is why the Centers for Medicare and Medicaid Services has not provided a <a href="https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=368">national coverage determination regarding hormone replacement therapy</a>. This means HRT isn’t uniformly covered by state or federal health insurance.</p>
<h2>Effects of gender affirmation or denial</h2>
<p>So what are the effects of affirming or denying a child’s gender identity? </p>
<p>First, we found that <a href="https://dx.doi.org/10.2139/ssrn.4503648">over 40% of trans adolescents</a> living in family environments that are unsupportive of their gender identity attempted suicide by the age of 18, a rate approximately eight times as high as that of cisgender adolescents.</p>
<p><iframe id="sMN1O" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/sMN1O/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>We also found that <a href="http://dx.doi.org/10.1257/pandp.20231057">hormone replacement therapy significantly improves</a> the mental health of trans youths. In comparing differences in suicide attempts between trans youths who started HRT a year apart from each other, we found that both groups experienced similar increases in suicide attempts over the five years before initiating treatment but experience a significant drop the year they start treatment. Overall, initiating hormone therapy led to a 14.4% reduction in attempting suicide for trans youths.</p>
<p><iframe id="IBo1u" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/IBo1u/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Our research on the effects of <a href="https://doi.org/10.1016/j.jhealeco.2023.102750">conversion therapy</a> on the mental health of transgender youths had dismal findings. We found a 13.8% increase in attempted suicide within the first year of conversation therapy, and a 47.5% increase in running away from home.</p>
<p><iframe id="yebCU" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/yebCU/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>We also analyzed the effects of social transitions on risk of attempting suicide or running away from home. These social transitions include realizing their gender differed from their sex assigned at birth, self-identification as trans, starting to tell others they are trans, and living full time as their gender identity.</p>
<p>We found that for trans youths living with unsupportive families, social transitions <a href="https://dx.doi.org/10.2139/ssrn.4503648">increase their risk of attempting suicide and running away from home</a>. For those living in supportive family environments, that risk is reduced and in some cases virtually eliminated. Some of the increased risk of suicide and running away from home for trans youths living in unsupportive family environments can likely be attributed to higher incidences of conversion therapy and limited access to hormone therapy.</p>
<h2>Public policy and transgender well-being</h2>
<p>Transgender people face <a href="https://theconversation.com/health-rights-for-trans-people-vary-widely-around-the-globe-achieving-trans-bliss-and-joy-will-require-equity-social-respect-and-legal-protections-194237">widespread stigma, discrimination and violence</a>. In June 2023, the Human Rights Campaign declared a <a href="https://www.hrc.org/press-releases/for-the-first-time-ever-human-rights-campaign-officially-declares-state-of-emergency-for-lgbtq-americans-issues-national-warning-and-guidebook-to-ensure-safety-for-lgbtq-residents-and-travelers">national state of emergency for LGBTQ+ Americans</a>, the first in the LGBTQ civil rights organization’s over 40-year history. This was prompted by the <a href="https://translegislation.com/">more than 560 anti-transgender bills</a> that have been introduced in the U.S. through July 2023, 80 of which have passed.</p>
<p>More anti-trans bills have been on the docket in 2023 than any prior year in U.S. history. Our research suggests that policies restricting access to gender-affirming care and limiting protections against conversion therapy will have significant negative effects on the lives of transgender youths.</p>
<p>As newer and larger data sets on the health, economic and social outcomes of trans people <a href="https://www.ustranssurvey.org/">become available</a>, researchers will be able to quantify the effects of anti-trans policies and provide richer insights into the lives of transgender Americans. Whether these findings will help change the tide of restrictive policies on trans health care and protections in the U.S. remains to be seen, but for now, our research suggests that family support will be key.</p>
<p><em>If you are struggling or having suicidal thoughts, help is available. Call or text the 988 Suicide & Crisis Lifeline or chat at <a href="https://988lifeline.org/chat/">988lifeline.org</a>. The Trans Lifeline (1-877-565-8860) and The Trevor Project (phone 1-866-488-7386, text 678-678, or chat <a href="https://www.thetrevorproject.org/get-help/">thetrevorproject.org</a>) also offer crisis support.</em></p><img src="https://counter.theconversation.com/content/207592/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathaniel Tran receives funding from the National Institute on Aging. </span></em></p><p class="fine-print"><em><span>Samuel Mann receives funding from the Nuffield Foundation. </span></em></p><p class="fine-print"><em><span>Travis Campbell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Because of ethical considerations, there are no clinical trials comparing the effects of hormone therapy to conversion therapy on trans youths. But a set of recent studies tease out cause and effect.Travis Campbell, Assistant Professor of Economics, Southern Oregon UniversityNathaniel Tran, Ph.D. Candidate in Health Policy, Vanderbilt UniversitySamuel Mann, Postdoctoral fellow, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2071402023-06-14T12:28:41Z2023-06-14T12:28:41ZTrans and gender-diverse people in Saskatchewan need better access to primary care<figure><img src="https://images.theconversation.com/files/531890/original/file-20230614-17-ritl1a.jpg?ixlib=rb-1.1.0&rect=1116%2C41%2C5030%2C3016&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trans and gender-diverse people in Saskatchewan face challenges accessing primary care.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Research has demonstrated time and again that the social marginalization and exclusion experienced by many people who are trans and gender diverse are <a href="https://doi.org/10.1001%2Fjamanetworkopen.2020.15036">closely tied to having poorer health, including higher rates of chronic illness</a>. </p>
<p>This may be because many trans and gender-diverse people have had negative experiences with health-care providers, or feel that the health-care system is ill-equipped to handle their needs, or are on long waiting lists for care.</p>
<p>In a <a href="https://www.schoolofpublicpolicy.sk.ca/research-ideas/publications-and-policy-insight/policy-brief/access-to-quality-healthcare-for-people-who-are-trans-and-gender-diverse-in-saskatchewan.php">new policy brief</a>, we outline our concerns about access to health care for people who are trans and gender diverse in Saskatchewan. </p>
<p>This work is part of a broader initiative — <a href="https://research-groups.usask.ca/transnavigator/the-project.php">the Trans Research and Navigation Saskatchewan</a> (TRANS) project — that explores the effectiveness of peer navigation for improving the health-care experiences of trans and gender-diverse people in the province. </p>
<figure class="align-center ">
<img alt="A person in a purple T-shirt outdoors, looking at the camera," src="https://images.theconversation.com/files/531891/original/file-20230614-22-aaakle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531891/original/file-20230614-22-aaakle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531891/original/file-20230614-22-aaakle.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531891/original/file-20230614-22-aaakle.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531891/original/file-20230614-22-aaakle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531891/original/file-20230614-22-aaakle.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531891/original/file-20230614-22-aaakle.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The challenges facing people who are trans and gender-diverse begin from the moment they enter their doctor’s office.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Peer navigators are members of a community — in this case, trans and gender-diverse people — who draw on their own experiences with the medical system to help others overcome barriers to care. </p>
<p>The brief draws on the preliminary research from the project as well as existing research on the experiences of people who are trans and gender diverse in Saskatchewan and elsewhere. It focuses on barriers to primary care, barriers to specialist care and other socio-legal concerns. </p>
<h2>Challenges for trans, gender-diverse patients</h2>
<p>The challenges facing people who are trans and gender diverse begin from the moment they enter their doctor’s office. </p>
<p>In addition to concerns about the use of the right name and pronouns, some people who participated in the focus groups and interviews held by the TRANS project shared accounts of physicians refusing to provide any type of care to trans and gender-diverse people and/or refusing to refer them to another physician. </p>
<p>Given the <a href="https://globalnews.ca/news/9175996/saskatoon-clinics-close-patients/">lack of family physicians with openings for new patients in Saskatchewan</a>, this leaves some trans and gender-diverse people without a doctor. Furthermore, people whose doctors aren’t willing to provide hormone therapy may feel that the same doctor is unlikely to provide supportive knowledgeable care in other areas.</p>
<figure class="align-center ">
<img alt="stock photo of a transgender person looking at camera with blurred light background" src="https://images.theconversation.com/files/531892/original/file-20230614-20-bb9fjr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531892/original/file-20230614-20-bb9fjr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531892/original/file-20230614-20-bb9fjr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531892/original/file-20230614-20-bb9fjr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531892/original/file-20230614-20-bb9fjr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531892/original/file-20230614-20-bb9fjr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531892/original/file-20230614-20-bb9fjr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People who are trans and gender diverse may face long wait lists for appointments with doctors who are comfortable providing gender-affirming care.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In other instances, people who are trans and gender diverse reported that their family doctors are generally supportive, but not comfortable — at least not yet — with providing gender-affirming care including prescribing hormone therapy. </p>
<p>Yet hormone therapies are relatively straightforward prescriptions, <a href="https://theconversation.com/gender-affirming-care-has-a-long-history-in-the-us-and-not-just-for-transgender-people-201752">and similar medications</a> are often prescribed for cis-gender men with low testosterone or cis-gender women experiencing menopause. But many family doctors do not feel comfortable providing them to people who are trans and gender diverse, though the reasons for this are unclear.</p>
<p>This leaves people who are trans and gender diverse hoping that their family doctor will refer them to someone else who is comfortable providing hormone therapy. For people in rural areas — <a href="https://saisia.ca/wp-content/uploads/2022/07/Final-version-EN-Benefits-of-living-in-Rural-SK-with-crop-marks.pdf">35 per cent of the people in Saskatchewan</a> — these challenges can be compounded by the need to travel for care. </p>
<p>Given that there are very <a href="https://doi.org/10.1089/trgh.2020.0181">few family doctors who report that they <em>are</em> comfortable providing hormone therapy in Saskatchewan</a>, there are long wait lists for appointments, and people who are trans and gender diverse are left in the lurch. </p>
<h2>Solutions for improving care</h2>
<p>The solution to this problem is relatively simple: ensuring that more and more family doctors in Saskatchewan are comfortable providing gender-affirming care, including hormone therapy. </p>
<figure class="align-center ">
<img alt="A person with a beard and glasses wearing a striped shirt smiling and a second person out of focus" src="https://images.theconversation.com/files/531893/original/file-20230614-31-dbn8gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531893/original/file-20230614-31-dbn8gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531893/original/file-20230614-31-dbn8gn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531893/original/file-20230614-31-dbn8gn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531893/original/file-20230614-31-dbn8gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531893/original/file-20230614-31-dbn8gn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531893/original/file-20230614-31-dbn8gn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Reducing bottlenecks in primary care is a critical part of improving the health of people who are trans and gender-diverse.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>There are many ways to make this happen. The simplest and most cost-effective approach is for willing family doctors to educate themselves <a href="https://www.rainbowhealthontario.ca/TransHealthGuide/">using relevant guidelines</a> carefully developed in other provinces (or <a href="https://bmc1.utm.utoronto.ca/%7Ekelly/transprimarycare/resources.html">other training resources</a>). </p>
<p>Other options, as we outline in the policy brief, could involve family doctors connecting with others who are more experienced in providing gender-affirming care, or receiving support from the peer navigation program initially established by the TRANS research team. </p>
<p>Those involved in medical education — at the University of Saskatchewan and elsewhere — could continue to support <a href="https://www.sma.sk.ca/?tribe_events=trans-inclusive-healthcare-series">medical education opportunities</a> for family doctors and other primary-care providers to become more comfortable in providing gender-affirming care. </p>
<p>There are other straightforward and important interventions that could improve access to care. These include, among others: </p>
<ul>
<li>Continued support for the peer navigation program, </li>
<li>Changing requirements for access to surgical care, </li>
<li>Increasing the availability of mental health supports, </li>
<li>Making it easier to make changes to legal documents and identification, and </li>
<li>Establishing a multidisciplinary network or health centre dedicated to care for people who are trans and gender diverse. </li>
</ul>
<p>Improving access to family doctors who are <a href="https://doi.org/10.3390/healthcare9080967">supportive, competent and confident</a> in providing access to hormone therapy — reducing bottlenecks in primary care — is a critical part of improving the health of people who are trans and gender diverse.</p><img src="https://counter.theconversation.com/content/207140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alana Cattapan receives funding from the Social Sciences and Humanities Research Council of Canada and the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Gwen Rose does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Improving the health of people who are trans and gender diverse means improving access to family doctors who are supportive, competent and confident in providing access to gender-affirming care.Alana Cattapan, Assistant Professor, Department of Political Science, University of WaterlooGwen Rose, PhD candidate in English and research assistant with the Trans Research and Navigation Saskatchewan (TRANS) project, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1998592023-06-12T12:26:37Z2023-06-12T12:26:37ZAnti-trans bills and political climates are taking a significant mental health toll on trans and nonbinary people – even during Pride<figure><img src="https://images.theconversation.com/files/530671/original/file-20230607-26-5c1g24.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8256%2C5475&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">States and schools with more inclusive policies and protections help LGBTQ youth and their families feel safer.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/SilencedTransgenderLawmakerTown/da92dab06dde4edc80a9ea94ce7c6d37">AP Photo/Tommy Martino</a></span></figcaption></figure><p>Pride month is a time of celebration for the LGBTQ+ community, with parades and events that bring people together in joyful moments of connection. In 2023, as the LGBTQ+ community is facing <a href="https://www.cnn.com/2023/04/06/politics/anti-lgbtq-plus-state-bill-rights-dg/index.html">unprecedented legislative attacks</a>, I am especially reminded of the <a href="https://theconversation.com/stonewall-riots-global-legacy-shows-theres-no-simple-story-of-progress-for-gay-rights-119257">history of protest and activism</a> that is inherently a part of Pride and its origins. </p>
<p>There have been <a href="https://www.aclu.org/legislative-attacks-on-lgbtq-rights">almost 500 bills</a> proposed this legislative cycle seeking to limit the rights of LGBTQ+ people and their access to essential resources like medical care, <a href="https://www.cnn.com/2023/04/06/politics/anti-lgbtq-plus-state-bill-rights-dg/index.html">nearly 12 times</a> as many as there were in 2018. Many of these bills target transgender and nonbinary people, particularly youth access to gender-affirming medical care, falsely claiming that they are <a href="https://www.washingtonpost.com/outlook/2021/07/06/false-claims-protecting-children-are-fueling-anti-trans-legislation/">protecting children from abuse</a>.</p>
<p>I am a <a href="https://psychology.msu.edu/directory/puckett-jae.html">psychologist, researcher</a> and director of <a href="https://www.trans-ilience.com/">Trans-ilience</a>, a community-engaged research team studying how stigma and oppression influence mental health for trans and nonbinary communities. We also study how trans and nonbinary people stay resilient in the face of such challenges. Whether or not these bills pass, the research is clear that the political climate itself can have <a href="https://doi.org/10.1080%2F26895269.2021.1937437">significant negative effects</a> on the lives of trans and nonbinary people, especially on their mental health and well-being. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/osrBHXCvHok?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">State lawmakers know very well the effects that anti-trans bills will have on trans people.</span></figcaption>
</figure>
<h2>Mental health burden of anti-trans legislation</h2>
<p>When trans and nonbinary people see their rights broadly targeted <a href="https://www.aclu.org/legislative-attacks-on-lgbtq-rights">across the country</a>, many affected individuals feel the weight of the sociopolitical climate. </p>
<p>In a 2023 report from The Trevor Project, a suicide prevention nonprofit focusing on LGBTQ+ youth, <a href="https://www.thetrevorproject.org/blog/new-poll-emphasizes-negative-impacts-of-anti-lgbtq-policies-on-lgbtq-youth/">86% of trans and nonbinary youth</a> across the U.S. reported that debates around state laws restricting LGBTQ+ rights negatively influenced their mental health. This political climate can leave trans and nonbinary people feeling <a href="https://doi.org/10.1080/26895269.2021.1937437">on edge about their safety</a>, <a href="https://doi.org/10.1037/ort0000636">concerned about their future</a> and <a href="https://doi.org/10.1037/fam0000987">heighten feelings of distress</a> like anxiety and depression. Families of trans and nonbinary youth also report <a href="https://doi.org/10.1037/fam0000987">fearing for their safety</a> and <a href="https://doi.org/10.1037/sgd0000495">fleeing areas</a> where these bills are being passed. These bills are especially likely to <a href="https://doi.org/10.1037/cou0000558">elicit feelings of fear</a> in trans and nonbinary people who have been victims of violence in the past, creating a cycle of distress in response to interpersonal acts of violence and the political climate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Crowd of protesters holding signs in a legislative building" src="https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530675/original/file-20230607-21-7ib25t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In May 2023, hundreds of people gathered in the Nebraska Capitol to protest a proposal to fold an abortion ban into a bill banning gender-affirming care for trans youth.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransHealthAbortionNebraska/0fd1175c15ae4ed6ab18f34d0ae09ae8">AP Photo/Margery Beck</a></span>
</figcaption>
</figure>
<p>On the other hand, research shows that trans and nonbinary people who live in areas with more inclusive policies and greater protections have overall better mental health. For instance, trans and nonbinary people who live in states with nondiscrimination protections are <a href="https://doi.org/10.2105/AJPH.2015.302981">less likely to experience mood disorders</a> or <a href="https://doi.org/10.1089/lgbt.2022.0247">report symptoms of depression</a> than those living in states without those protections. In addition, trans and nonbinary people living in areas with protective policies not only have <a href="https://doi.org/10.1111/1468-0009.12467">less trouble accessing gender-affirming medical care</a> but also may be <a href="https://doi.org/10.1016/j.amepre.2020.01.030">less likely to avoid seeking health services</a> in general because of fears of being mistreated. </p>
<p>Research also shows that medical providers who care for trans and nonbinary youth are likely to <a href="https://doi.org/10.1016/j.jadohealth.2021.08.020">oppose legislation</a> banning gender-affirming medical care because it is likely to cause harm to those patients, such as by increasing distress or heightening discrimination. Parents also <a href="https://doi.org/10.1016/j.jadohealth.2020.09.010">fear the negative effects</a> on their children of bans on gender-affirming care.</p>
<p>Anti-trans bills also seek to take away access to other important resources beyond gender-affirming medical care. </p>
<p>Book bans and bills banning any discussion of LGBTQ+-related topics in classrooms are likely to significantly affect the ability of trans and nonbinary youth to participate in school. For instance, research has shown that having <a href="https://doi.org/10.1111/jora.12487">gay-straight alliances and LGBTQ+-affirming policies</a> in school systems is linked to a lower likelihood of experiencing bullying and higher levels of support from classmates and teachers. LGBTQ+ youth also report having <a href="https://doi.org/10.1016/j.jsp.2019.05.007">more positive experiences at and perceptions of school</a> when there are inclusive policies. These affirming and trans-inclusive spaces may become less accessible or cease to exist with bills that restrict discussion of LGBTQ+-related content in schools. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Demonstrators wave or wear trans flags outside a building" src="https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530679/original/file-20230607-29-xjif84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pride month arose from a history of protest and activism.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ProblemsforPrideMonth/f5257c7118bd49e5b3edd444e66f8133">AP Photo/Eric Gay</a></span>
</figcaption>
</figure>
<h2>Shifting the political climate</h2>
<p>Trans and nonbinary communities face ongoing struggles at unprecedented rates. The onslaught of anti-trans bills across the country has the ability to negatively affect nearly every facet of trans and nonbinary people’s lives, from free speech to health care access to protections against discrimination, to name just a few. </p>
<p>Everyone can play a role in shifting the sociopolitical context so that there are more protections for trans and nonbinary people and fewer attacks on that community’s rights and access to resources. <a href="https://www.hrc.org/campaigns/the-state-legislative-attack-on-lgbtq-people">Contacting legislators</a>, <a href="https://allenneighborhoodcenter.networkforgood.com/projects/189505-gender-affirmation-name-change-fund">organizing in your local community</a> and raising awareness can help <a href="https://doi.org/10.1037/cpp0000456">make a difference</a>. Along with celebrating the LGBTQ+ community, such actions can help create a world in which trans and nonbinary people feel safe and respected and have access to the same resources and rights as others.</p>
<p>Don’t let the rainbows fool you – this fight isn’t over.</p><img src="https://counter.theconversation.com/content/199859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jae A. Puckett and their research team, Trans-ilience, co-organize the Gender Affirmation Project with the Allen Neighborhood Center. This is a community organizing effort to improve trans and nonbinary people's access to legal name and/or gender marker changes in the Lansing, MI area. The views represented in this article are those of the author and do not necessarily represent their institution.</span></em></p>The rainbow Pride flags flying this month obscure the ongoing legislative attacks threatening the health and well-being of transgender and nonbinary people and their families.Jae A. Puckett, Assistant Professor of Psychology, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2062592023-06-01T15:37:24Z2023-06-01T15:37:24ZListen: Trans scholar and activist explains why trans rights are under attack<iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/e2ecabe1-cf01-433c-bd7e-7aac7f1d241a?dark=true"></iframe>
<p>This year we’ve seen an aggressive push to implement anti-trans legislation across the United States. There are currently more than <a href="https://translegislation.com/">400 active anti-trans</a> bills across the country. </p>
<p>Some of the legislation <a href="https://time.com/6265755/gender-affirm-care-bans-u-s/">denies gender-affirming care to youth</a> – and criminalizes those health-care providers that attempt to do so. Other bills <a href="https://apnews.com/article/transgender-nonbinary-hormone-puberty-missouri-lawmakers-5a8922430ffab9e43cf9b7ce254bff9f#:%7E:text=Charlie%20Riedel%2C%20File">block trans students from participating in sports</a> and still others have banned books with trans content. </p>
<p>These bills have at least two things in common. They all aim to make being trans harder in an already hostile society and they are being spearheaded by the far-right. </p>
<p>Where does anti-trans sentiment come from? </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/529186/original/file-20230530-23-atrb5u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529186/original/file-20230530-23-atrb5u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529186/original/file-20230530-23-atrb5u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529186/original/file-20230530-23-atrb5u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529186/original/file-20230530-23-atrb5u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529186/original/file-20230530-23-atrb5u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529186/original/file-20230530-23-atrb5u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Black Lives Matter activists organize a sit-in at Yonge Street and College Street during the Trans Pride March, in Toronto, 2016. (THE CANADIAN PRESS/Eduardo Lima)</span>
</figcaption>
</figure>
<p>The <a href="https://www.thenation.com/article/society/transphobia-white-supremacy/">enforcement of a gender binary</a> likely has much to do with the preservation of white power. And, <a href="https://www.advocate.com/commentary/2022/5/20/through-line-critical-race-dont-say-gay-great-replacement">violence</a> against trans people continues as a result. </p>
<h2>Is Canada better?</h2>
<p>What do things look like in Canada? Are we a safe haven or are we following some of the same trends?</p>
<p>Recently, a <a href="https://www.cbc.ca/news/canada/us-transgender-asylum-petition-1.6779692">petition</a> signed by <a href="https://petitions.ourcommons.ca/en/Petition/Details?Petition=e-4268">over 160,000 people</a> asked the Canadian government to extend asylum to trans and gender non-conforming people from nations in the West, previously considered safe. </p>
<p>To get a better understanding of trans histories in Canada, <a href="https://dont-call-me-resilient.simplecast.com/episodes/listen-to-an-american-canadian-trans-scholar-and-activist-explain-why-trans-rights-are-under-attack">we are joined by Syrus Marcus Ware</a>, an artist, activist and assistant professor at the School of the Arts at McMaster University. He is a co-curator of Blockorama/Blackness Yes! and a co-editor of <a href="https://uofrpress.ca/Books/U/Until-We-Are-Free"><em>Until We Are Free: Reflections on Black Lives Matter in Canada</em></a>.</p>
<p>We discuss the history of anti-trans and queer actions in Canada. We also speak about backlash and ways to move forward.</p>
<h2>Listen and Follow</h2>
<p>You can listen to or follow <em><a href="https://dont-call-me-resilient.simplecast.com/episodes/listen-to-an-american-canadian-trans-scholar-and-activist-explain-why-trans-rights-are-under-attack">Don’t Call Me Resilient</a></em> on <a href="https://podcasts.apple.com/ca/podcast/dont-call-me-resilient/id1549798876">Apple Podcasts</a>, <a href="https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9qZFg0Ql9DOA">Google Podcasts</a>, <a href="https://open.spotify.com/show/37tK4zmjWvq2Sh6jLIpzp7">Spotify</a> or <a href="https://dont-call-me-resilient.simplecast.com">wherever you listen to your favourite podcasts</a>. </p>
<p><a href="mailto:DCMR@theconversation.com">We’d love to hear from you</a>, including any ideas for future episodes. Join The Conversation on <a href="https://twitter.com/ConversationCA">Twitter</a>, <a href="https://www.facebook.com/TheConversationCanada">Facebook</a>, <a href="https://www.instagram.com/theconversationdotcom/">Instagram</a> and <a href="https://www.tiktok.com/@theconversation">TikTok</a> and use #DontCallMeResilient.</p>
<figure class="align-center ">
<img alt="A person with a rainbow on their shirt holds up a hand with a pointed finger and a sign in the other hand. They appear to be yelling." src="https://images.theconversation.com/files/529465/original/file-20230531-24-q99it2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529465/original/file-20230531-24-q99it2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529465/original/file-20230531-24-q99it2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529465/original/file-20230531-24-q99it2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529465/original/file-20230531-24-q99it2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529465/original/file-20230531-24-q99it2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529465/original/file-20230531-24-q99it2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Brenna Thompson protests this month against an abortion ban and restrictions on gender-affirming care for children in Lincoln, Neb.</span>
<span class="attribution"><span class="source">Justin Wan/Lincoln Journal Star via AP/KOLN-TV OUT</span></span>
</figcaption>
</figure>
<h2>Resources</h2>
<p><a href="https://doi.org/10.1215/23289252-3814961">All Power to All People? Black LGBTTI2QQ Activism, Remembrance, and Archiving in Toronto</a> (<em>Transgender Studies Quarterly</em>) by Syrus Marcus Ware </p>
<p><a href="https://www.thestar.com/news/gta/2023/05/30/pride-flag-wont-fly-at-york-catholic-schools-after-board-votes-against-the-motion.html">‘A travesty’: Outrage swells over York Catholic board’s rejection of Pride flag</a> (<em>Toronto Star</em>) </p>
<p><a href="https://www.thestar.com/opinion/contributors/2022/10/05/supreme-court-cant-ignore-equality-rights-claims-of-refugees.html">Supreme Court can’t ignore equality rights claims of refugees</a> (<em>Toronto Star</em>) </p>
<p><a href="https://xtramagazine.com/power/toronto-bathhouse-raids-40-years-194590">Everything you need to know about the Toronto bathhouse raids</a> (<em>Xtra</em>) </p>
<p><a href="https://xtramagazine.com/power/what-the-national-inquiry-into-missing-and-murdered-indigenous-women-and-girls-means-for-two-spirit-canadians-158992">What the National Inquiry into Missing and Murdered Indigenous Women and Girls means for Two-Spirit people</a> (<em>Xtra</em>) </p>
<p><a href="https://doi.org/10.1215/10642684-2009-015">Settler Homonationalism: Theorizing Settler Colonialism within Queer Modernities</a> (<em>Journal of Lesbian and Gay Studies</em>) by Scott Lauria Morgensen </p>
<p><a href="https://blockorama.ca/">Blockorama/Blackness Yes!</a></p>
<h2>From the archives - in The Conversation</h2>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/transgender-hate-crimes-are-on-the-rise-even-in-canada-121541">Transgender hate crimes are on the rise even in Canada</a>
</strong>
</em>
</p>
<hr>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cuts-to-telehealth-in-ontario-mean-fewer-trans-and-non-binary-people-will-have-access-to-life-saving-health-care-198502">Cuts to telehealth in Ontario mean fewer trans and non-binary people will have access to life-saving health care</a>
</strong>
</em>
</p>
<hr>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-went-to-cpac-to-take-maga-supporters-pulse-china-and-transgender-people-are-among-the-top-demons-they-say-are-ruining-the-country-201442">I went to CPAC to take MAGA supporters' pulse – China and transgender people are among the top 'demons' they say are ruining the country</a>
</strong>
</em>
</p>
<hr>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/right-to-party-20-years-of-black-queer-love-and-resilience-80040">Right to party: 20 years of Black Queer love and resilience</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/206259/count.gif" alt="The Conversation" width="1" height="1" />
This year, there are more than 400 active anti-trans bills across the U.S. What do things look like in Canada? Are we a safe haven or are we following those same trends?Vinita Srivastava, Host + Producer, Don't Call Me ResilientBoké Saisi, Associate Producer, Don't Call Me ResilientLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2039972023-05-22T12:28:07Z2023-05-22T12:28:07ZTrans joy and family bonds are big parts of the transgender experience lost in media coverage and anti-trans legislation<figure><img src="https://images.theconversation.com/files/526881/original/file-20230517-29-eund6e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some trans people find gender euphoria in being mothers and being with family.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/family-having-fun-at-home-royalty-free-image/1388504287">rparobe/E+ via Getty Images</a></span></figcaption></figure><p>Since the beginning of 2023, 49 U.S. state legislatures have introduced <a href="https://translegislation.com/">over 500 anti-trans bills</a>. While mainstream media increasingly <a href="https://time.com/6131444/2021-anti-trans-violence/">cover violence</a> and <a href="https://www.vice.com/en/article/5d383z/anti-trans-violence-2022">legislative attacks</a> against trans people, many scholars and activists worry that focusing just on violence and discrimination <a href="https://doi.org/10.1093/socpro/spac034">fails to capture the full experience</a> of being trans.</p>
<p>Drawing on the success of movements like the <a href="https://kleavercruz.com/the-black-joy-project">Black Joy Project</a>, which uses art to promote Black healing and community-building, trans activists are challenging one-dimensional depictions of their community by highlighting the <a href="https://www.advocate.com/voices/trans-joy-challenging-times">unique joys of being transgender</a>. </p>
<p><a href="https://scholar.google.com/citations?user=LzPI-r8AAAAJ&hl=en">My research</a> <a href="https://www.umass.edu/sociology/users/dpsiegel">on trans parents</a> affirms the reality of trans joy. From 2019 to 2021, I interviewed 54 transgender women – both current and prospective parents – from diverse racial and class backgrounds across the country. I found that while many have navigated discrimination in their parenting journeys, they also have fulfilling parent-child relationships, often with the support of partners, families of origin and their communities.</p>
<h2>Gender euphoria</h2>
<p>Scholars and community members use the term <a href="https://doi.org/10.1080/26895269.2021.1915223">gender euphoria</a> to describe a “joyful feeling of rightness in one’s gender/sex.” It diverges from the diagnosis of <a href="https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria">gender dysphoria</a>, or a sense of conflict between assigned sex and gender identity typically associated with feelings of distress and discomfort. </p>
<p>While gender dysphoria reflects some trans people’s experiences, physicians have historically used this concept to <a href="http://dx.doi.org/10.1136/medethics-2018-105293">restrict access to gender-affirming care</a>. For example, doctors may prescribe hormones only to people who obtain a letter from a therapist attesting that they fit a narrow understanding of transness that includes expressing hatred for their body.</p>
<p>Gender euphoria celebrates feeling comfortable with who you are and how you are perceived by the world. Some people transition with a specific set of goals, while others discover new sources of joy and new facets of their identity over time. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Parents kissing child on either cheek" src="https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526888/original/file-20230517-19-42g2za.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some trans women find euphoria in their role as mothers.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/happy-lgbtqia-couple-kissing-daughter-at-home-royalty-free-image/1421318476">Maskot/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<p>Many of the trans women I interviewed expressed their gender euphoria in relation to their role as mothers. A Black trans woman in her 20s, whom I will call Gloria, experiences joy in being recognized as a mother. “I love being called Mom. That’s the greatest thing,” she told me. “I love waking up every morning to see [my child’s] beautiful face. It keeps me motivated.”</p>
<p>Other people experience euphoria in how they express their gender. Naomi, a white trans woman in her 40s, experienced her first spark of gender euphoria at the nail salon. “It was the only gender-affirming thing I could express [at the time],” she said. “When the nail tech took the polish off and I saw how long my fingernails had gotten, my heart skipped a beat.”</p>
<p>For many trans people, transitioning opens up a new set of possibilities. When I asked Adriana, a trans Latina in her 30s, what it was like to come out as trans, she told me, “I’ve never been happier. The happiest day of my life was when my daughter was born, and the second happiest day of my life was when I [started transitioning].” </p>
<h2>Family and community connections</h2>
<p>While some trans people do experience rejection from their families of origin, that is not true for the majority of the community. In a 2015 national survey of over 27,700 trans adults, the U.S. Trans Survey, 60% of respondents reported having families who are <a href="https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf">supportive of their trans identity</a>.</p>
<p>Liza, a white trans woman in her 20s, has a close relationship with her brothers. “We are still a little triad. Yes, things change, but ultimately, I’m the same person just using a different name,” she said. “I can see myself as part of this family going forward. There’s no break. I’m not breaking anything by coming out.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Family and friends in a room celebrating" src="https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526889/original/file-20230517-25-oyufc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many trans people are supported by their families of origin and their chosen families.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/family-and-friends-coming-together-for-a-birthday-royalty-free-image/1398118272">Flashpop/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<p>Trans women also form <a href="https://www.familyequality.org/resources/finding-and-forming-a-chosen-family/">chosen families</a> with friends, co-workers and other community members. Relationships with other trans people can have particularly positive effects on <a href="https://doi.org/10.1089/lgbt.2019.0014">identity development and overall well-being</a>, including emotional resilience, self-acceptance and a sense of connection. </p>
<p>Jane, a Black trans woman in her 20s, has a tight-knit group of first-time parents she can call “whenever [she’s] freaking out,” no matter the scope of the emergency. While she laments her father’s lack of support, Jane’s friends are always there for her. “[T]hey come to visit, they bond with my son, [and] we get to spend time together like a big family, you know?” </p>
<h2>Trans community care</h2>
<p>In addition to caring for their biological and adopted children, the trans women I interviewed felt a responsibility to take care of their community. </p>
<p>Sometimes this care manifested as parent-child relationships, in which respondents provide financial or emotional support to LGBTQ+ youth. Maggie, a white woman in her 50s, didn’t know she was a parental figure for her “queer kids” until they tagged her on Instagram to celebrate Mother’s Day. </p>
<p>“Someone might go, ‘Hey, can I stay on your sofa tonight? I’m having a hard time.’ Well, yeah, of course,” she said. “Or they might hang around the shop [I work at], and only later it dawns on me, ‘Oh, this was the only place they could come and get affirmed and not feel weird.’”</p>
<p>Many also provide care outside their family units. Whitney, a Black trans woman in her 20s, reaches out to and tells local teachers they can refer parents of trans kids to her if they have any questions about how to support their children on their gender journeys or if their kids need someone to talk to.</p>
<p>Respondents like Whitney, who began questioning her gender identity in her early teens, also mentor trans women who are older than they. “Why not,” she told me, “if I have relevant experiences and can help make their lives easier?” </p>
<p>Miriam, a white trans woman in her 60s, agreed that she has a lot to learn from younger trans people. “A lot of my community today, people who I count as family and my beloveds, are not of my generation,” she said. ‘Beloveds’ is the term she uses to describe her platonic loved ones. “I learn a lot from my beloveds in their 20s and 30s, who don’t have the same baggage I [dealt with] about how I could be and who I could be.”</p>
<h2>Anti-trans hate as a self-fulfilling prophecy</h2>
<p>Anti-trans politicians deploy a variety of tactics to stigmatize transgender communities, from describing gender-affirming care <a href="https://www.cnn.com/2023/02/11/politics/gender-affirming-care-bans-transgender-rights/index.html">as mutilation</a> to falsely accusing trans people of <a href="https://www.hrc.org/press-releases/new-report-anti-lgbtq-grooming-narrative-surged-more-than-400-on-social-media-following-floridas-dont-say-gay-or-trans-law-as-social-platforms-enabled-extremist-politicians-and-their-allies-to-peddle-inflamatory-discriminatory-rhetoric">predatory behavior</a>. </p>
<p>While these politicians <a href="https://www.aclu.org/podcast/protecting-women-and-children-is-a-shield-for-transphobia">claim to be protecting children</a> by restricting access to gender-affirming care, a 2021 Trevor Project survey found that recent political events have <a href="https://www.thetrevorproject.org/survey-2021/?section=Introduction">harmed the mental health</a> of 94% of LGTBQ youth in the U.S. A study based on data from the 2015 U.S. Trans Survey found that harassment based on gender identity at school <a href="https://doi.org/10.1016/j.jadohealth.2021.06.001">also harms transgender youths</a>, resulting in higher rates of suicide attempts and suicidal thoughts.</p>
<p>In contrast, research has shown that starting hormone replacement therapy <a href="https://theconversation.com/transgender-youth-on-puberty-blockers-and-gender-affirming-hormones-have-lower-rates-of-depression-and-suicidal-thoughts-a-new-study-finds-177812">reduces the risk of suicide</a> by 73% for trans youth, <a href="https://news.cornell.edu/stories/2018/04/analysis-finds-strong-consensus-effectiveness-gender-transition-treatment">among other mental health benefits</a>. Another study found that trans people who start hormones as adolescents report <a href="https://doi.org/10.1371/journal.pone.0261039">lower levels of binge drinking, drug use and suicidality</a> than those who desired gender-affirming hormones but could not access them. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Trans youth holding signs reading 'PROTECT TRANS KIDS'" src="https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526907/original/file-20230517-17-80m0ex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Legislation targeting trans youths has significantly harmed the children they intend to protect.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/GenderAffirmingCareBanKentucky/8766283f5ccc4352848130aca6a2b0fa">Timothy D. Easley/AP Photo</a></span>
</figcaption>
</figure>
<p>For Adriana, who described beginning transition as the second happiest day of her life, after the day her daughter was born, fear of rejection kept her in denial of her trans identity. She used alcohol and made “reckless decisions” to cope with her gender dysphoria. Transitioning, meanwhile, brought her closer to her daughter. “I was never myself around her, not completely, which my daughter noticed,” she said. “We’ve always been close, but now that I’m genuinely happy with myself, we’re even closer.”</p>
<p>Amid efforts to <a href="https://rewirenewsgroup.com/2022/10/24/idaho-conservatives-want-to-ban-drag-performances/">criminalize drag shows</a> and <a href="https://www.technologyreview.com/2022/07/15/1055959/book-bans-social-media-harassment/">ban LGBTQ topics</a> from public schools, highlighting the joy of trans motherhood directly rejects myths that <a href="https://rewirenewsgroup.com/2023/03/14/we-are-not-groomers-how-anti-lgbtq-stereotypes-inhibit-reproductive-justice/">portray trans women as “groomers”</a> or otherwise dangerous to children. Extensive research shows that <a href="https://williamsinstitute.law.ucla.edu/publications/transgender-parenting/">having a transgender parent</a> does not affect children’s gender identity, sexual orientation or other developmental markers. Yet trans people experience discrimination in both <a href="https://doi.org/10.1111/fcre.12354">adoption</a> and <a href="https://doi.org/10.1093/swr/svz005">custody disputes</a> based on these pervasive myths. </p>
<p>Trans motherhood showcases the resilience of trans people who work diligently to take care of each other, even when they are failed by their communities and other institutions. Maria, an Indigenous Latina trans woman in her 30s, finds beauty in serving as a mother for the young queer and trans activists she works with. “I find it an honor that someone holds you in such high esteem that they want to call you their mom. … Because motherhood is a beautiful thing,” she said. “I think it’s a beautiful thing to help them in their journey to become the best versions of themselves.”</p><img src="https://counter.theconversation.com/content/203997/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Derek P. Siegel receives funding from the American Sociological Association. </span></em></p>Trans motherhood showcases the unique joys of being transgender, be it through developing a deeper connection with one’s own child or caring for others in one’s community.Derek P. Siegel, Ph.D. Candidate, Sociology, UMass AmherstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2017522023-03-27T12:25:04Z2023-03-27T12:25:04ZGender-affirming care has a long history in the US – and not just for transgender people<figure><img src="https://images.theconversation.com/files/516795/original/file-20230321-2376-1glr1q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2953%2C1971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Enforcement of binary gender norms has led to unwanted medical interventions on intersex and cisgender children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-carrying-newborn-baby-girl-at-hospital-royalty-free-image/668808357">Javier Valenzuela/EyeEm via Getty Images</a></span></figcaption></figure><p>In 1976, a <a href="http://lgbthistory.pages.roanoke.edu/wp-content/uploads/sites/40/2020/02/Long-Road-from-Man-to-Woman.pdf">woman from Roanoke, Virginia, named Rhoda</a> received a prescription for two drugs: estrogen and progestin. Twelve months later, a local reporter noted Rhoda’s surprisingly soft skin and visible breasts. He wrote that the drugs had made her “so completely female.” </p>
<p>Indeed, that was the point. The University of Virginia Medical Center in nearby Charlottesville had a clinic specifically for women like Rhoda. In fact, doctors there had been prescribing hormones and performing surgeries – what today we would call gender-affirming care – for years.</p>
<p>The founder of that clinic, <a href="https://www.washingtonpost.com/local/obituaries/milton-edgerton-trailblazing-plastic-surgeon-for-children-and-transgender-patients-dies-at-96/2018/07/16/28bcae0a-8836-11e8-8aea-86e88ae760d8_story.html">Dr. Milton Edgerton</a>, had cut his teeth caring for transgender people at Johns Hopkins University in the 1960s. There, he was part of a team that established the nation’s first university-based Gender Identity Clinic in 1966.</p>
<p>When politicians today refer to gender-affirming care as new, “<a href="https://www.advocate.com/health-care/mississippi-governor-ban-transgender-care">untested</a>” or “<a href="https://www.desmoinesregister.com/story/news/politics/2023/03/07/iowa-lawmakers-approve-gender-affirming-care-ban-for-transgender-youth/69980950007/">experimental</a>,” they ignore the long history of transgender medicine in the United States. </p>
<p>It’s been nearly 60 years since the first transgender medical clinic <a href="https://www.scientificamerican.com/article/the-forgotten-history-of-the-worlds-first-trans-clinic/">opened in the U.S.</a>, and 47 years since Rhoda started her hormone therapy. Understanding the history of these treatments in the U.S. can be a helpful guide for citizens and legislators in a year when <a href="https://www.vice.com/en/article/5d378d/anti-trans-bills-2023">a record number of bills</a> in statehouses target the rights of transgender people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Christine Jorgensen standing before a set of microphones at a press conference" src="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=488&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=488&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=488&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=613&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=613&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=613&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Christine Jorgensen, who received gender-affirming treatments in the 1950s, was one of the first trans celebrities in the U.S.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/new-york-new-york-christine-jorgensen-arriving-at-idlewild-news-photo/515992248">Bettmann/Getty Images</a></span>
</figcaption>
</figure>
<h2>Treating gender in every population</h2>
<p>As a trans woman and a <a href="https://gsrosenthal.com">scholar of transgender history</a>, I have spent much of the past decade <a href="https://uncpress.org/book/9781469665801/living-queer-history/">studying these issues</a>. I also take several pills each morning to maintain the proper hormonal balance in my body: spironolactone to suppress testosterone and estradiol to increase estrogen.</p>
<p>When I began HRT, or hormone replacement therapy, like many Americans I wasn’t aware that this treatment had been around for generations. What I was even more surprised to learn was that HRT is often prescribed to cisgender women – women who were assigned female at birth and raised their whole lives as women. In fact, many providers in my region already had a <a href="https://uncpress.org/book/9781469665801/living-queer-history/">long record of prescribing hormones to cis women</a>, primarily women experiencing menopause.</p>
<p>I also learned that gender-affirming hormone therapies have been prescribed to cisgender youths for generations – despite what contemporary politicians may think. Disability scholar Eli Clare has written of the history and continued practice of <a href="https://www.dukeupress.edu/brilliant-imperfection">prescribing hormones</a> to boys who are too short and girls who are too tall for what is considered a “normal” range for their gender. Because of binary gender norms that celebrate height in men and smallness in women, doctors, parents and ethicists have approved the use of hormonal therapies to make children conform to these gender stereotypes <a href="https://www.penguinrandomhouse.com/books/292342/normal-at-any-cost-by-susan-cohen/">since at least the 1940s</a>.</p>
<p>Clare describes a severely disabled young woman whose parents – with the approval of doctors and ethicists from their local children’s hospital – administered puberty blockers so that she would never grow into an adult. They deemed her mentally incapable of becoming a “real” woman. </p>
<p>The history of these treatments demonstrates that hormone therapies and puberty blockers have been used on cisgender children in this country – for better or for worse – with the goal of regulating the passage from girlhood to womanhood and from boyhood to manhood. Gender stereotypes concerning the presence or absence of secondary sex characteristics – too tall, too short, too much body hair – have all led parents and doctors to perform gender-affirming care on cisgender children.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5dJduGC3HyQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Enforcement of binary gender norms has led to unwanted medical interventions on intersex children.</span></figcaption>
</figure>
<p>For over half a century, legal and medical authorities in the U.S. have also approved and administered surgeries and hormone therapies to force the bodies of intersex children to conform to binary gender stereotypes. I myself had genital surgery in infancy to bring my anatomy into alignment with expectations for what a “male” body should look like. In most cases, intersex surgeries are <a href="https://doi.org/10.1001/amajethics.2021.550">unnecessary for the</a> <a href="https://www.wgbh.org/news/science-and-technology/2019/10/24/medically-necessary-or-cruel-inside-the-battle-over-surgery-on-intersex-babies">health or well-being</a> of a child.</p>
<p>Historians such as Jules Gill-Peterson have shown that <a href="https://www.upress.umn.edu/book-division/books/histories-of-the-transgender-child">early advances in transgender medicine</a> in this country are deeply interwoven with the <a href="https://theconversation.com/trans-kids-in-the-us-were-seeking-treatment-decades-before-todays-political-battles-over-access-to-health-care-157481">nonconsensual treatment of intersex children</a>. Doctors at Johns Hopkins and the University of Virginia practiced reconstructing the genitalia of intersex people before applying those same treatments on transgender patients.</p>
<p>Given these intertwined histories, I contend that the current political focus on prohibiting gender-affirming care for transgender people is evidence that opposition to these treatments is not about the safety of any specific medications or procedures, but rather their use specifically by transgender people.</p>
<h2>How transgender people access care</h2>
<p>Many transgender people in the U.S. have deeply complicated feelings about gender-affirming care. This complexity is a result of over half a century of transgender medicine and patient experiences in the U.S.</p>
<p>In Rhoda’s time, medical gatekeeping meant that she had to live “full time” as a woman and prove her suitability for gender-affirming care to a team of primarily white, cis male doctors before they would give her treatment. She had to mimic language about being “<a href="https://doi.org/10.1177/1363460717740258">born in the wrong body</a>” – language invented by cis doctors studying trans people, not by trans people themselves. She <a href="https://ojs.stanford.edu/ojs/index.php/intersect/article/view/2056">had to affirm</a> she would be heterosexual and seek marriage and monogamy with a man. She could not be a lesbian or bisexual or promiscuous. </p>
<p>Many trans people still need to jump through similar hoops today to receive gender-affirming care. For example, a diagnosis of “<a href="https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria">gender dysphoria</a>,” a designated mental disorder, is sometimes required before treatment. Many trans people argue that these preconditions for access to care should be removed because being trans is an identity and a lived experience, not a disorder.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KomI-XiiJw0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Transgender people undergo more evaluations to obtain gender-affirming care than do cisgender people.</span></figcaption>
</figure>
<p>Feminist activists in the 1970s also critiqued the role of medical authority in gender-affirming care. Writer Janice Raymond decried “<a href="https://www.worldcat.org/title/transsexual-empire-the-making-of-the-she-male/oclc/29548586">the transsexual empire</a>,” her term for the physicians, psychologists and other professionals who practice transgender medicine. Raymond argued that cis male doctors were making an army of trans women to satisfy the male gaze: promoting iterations of womanhood that reinforced sexist gender stereotypes, ultimately ushering in the displacement and eradication of the world’s “biological” women. The origins of today’s gender-critical, or <a href="https://theconversation.com/why-the-words-we-use-matter-when-describing-anti-trans-activists-130990">trans-exclusionary radical feminist</a>, movement are visible in Raymond’s words. But as trans scholar Sandy Stone wrote in her <a href="https://doi.org/10.1215/02705346-10-2_29-150">famous reply to Raymond</a>, it’s not that trans women are unwilling dupes of cis male medical authority, but rather that we have to strategically perform our womanhood in certain ways to access the care and treatments we need.</p>
<h2>The future of gender-affirming care</h2>
<p>In many states, especially in the South, where I live, governors and legislatures are introducing bills to ban gender-affirming care – <a href="https://www.washingtonpost.com/nation/2023/02/28/anti-trans-bills-gender-affirming-care-adults/">even for adults</a> – in ignorance of history. The consequences of hurried legislation extend beyond trans people, because access to hormones and surgeries is a basic medical service many people may need to feel better in their body.</p>
<p>Prohibitions on hormone therapy and gender-related surgeries for minors could mean ending the same treatment options <a href="https://www.nbcnews.com/think/opinion/gender-affirming-care-isnt-just-for-trans-people-rcna54651">for cisgender children</a>. The <a href="https://www.courier-journal.com/story/opinion/2023/03/06/kentucky-anti-trans-bill-impacts-intersex-kids-forces-gender-choice/69965192007/">legal implications for intersex children</a> may directly clash with <a href="http://www.kslegislature.org/li/b2023_24/measures/documents/sb180_00_0000.pdf">proposed legislation</a> in several states that aims to codify “male” and “female” as discrete biological sexes with certain anatomical features. </p>
<p>Prohibitions on hormone replacement therapy for adults could affect access to the same treatments for menopausal women or limit access to hormonal birth control. Prohibitions of gender-affirming surgeries could affect anyone’s ability to <a href="https://www.cbsnews.com/news/texas-bill-ban-gender-affirming-care-transgender-adults/">access a hysterectomy or a mastectomy</a>. So-called cosmetic surgeries such as breast implants or reductions, and even facial feminization procedures such as lip fillers or Botox, could also come under question. </p>
<p>These are all different types of gender-affirming procedures. Are most Americans willing to live with this level of government intrusion into their bodily autonomy? </p>
<p>Almost every <a href="https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-26-Bill-McBride-opposing-anti-trans-bills-Final.pdf">major medical organization</a> in the U.S. has come out against new government restrictions on gender-affirming care because, as doctors and professionals, they know that these treatments are <a href="https://doi.org/10.1016%2Fj.xcrm.2022.100719">time-tested and safe</a>. These treatments have histories reaching back over 50 years.</p>
<p>Trans and intersex people are important voices in this debate, because our bodies are the ones politicians opposing gender-affirming care most frequently <a href="https://www.nbcnews.com/nbc-out/out-politics-and-policy/arkansas-lawmaker-hearing-asks-transgender-woman-penis-rcna70787">treat as objects of ridicule and disgust</a>. Legislators are developing policies about us despite the fact that most Americans say they <a href="https://www.pewresearch.org/fact-tank/2021/07/27/rising-shares-of-u-s-adults-know-someone-who-is-transgender-or-goes-by-gender-neutral-pronouns/">do not even know a trans person</a>. </p>
<p>But trans and intersex people <a href="https://www.washingtonpost.com/dc-md-va/2023/03/23/transgender-adults-transitioning-poll/">know what it is like</a> to have to fight to access the care and treatment we need. And we know the joy of finally feeling comfortable in our own skin and being able to affirm our gender on our own terms.</p><img src="https://counter.theconversation.com/content/201752/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>G. Samantha Rosenthal is co-founder of the Southwest Virginia LGBTQ+ History Project</span></em></p>The first transgender medical clinic opened in the US in the 1960s. But cisgender and intersex children began receiving similar treatments even earlier – often without their consent.G. Samantha Rosenthal, Associate Professor of History, Roanoke CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1985022023-02-02T18:50:12Z2023-02-02T18:50:12ZCuts to telehealth in Ontario mean fewer trans and non-binary people will have access to life-saving health care<figure><img src="https://images.theconversation.com/files/507193/original/file-20230130-20-owp5y.jpg?ixlib=rb-1.1.0&rect=24%2C20%2C2707%2C1798&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exemptions from funding cuts are needed to ensure trans and non-binary people can get medical care.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/cuts-to-telehealth-in-ontario-mean-fewer-trans-and-non-binary-people-will-have-access-to-life-saving-health-care" width="100%" height="400"></iframe>
<p>Amid a <a href="https://www.ctvnews.ca/health/i-thought-i-might-die-at-home-canada-s-health-care-system-is-crumbling-experts-say-1.6036628">crumbling</a> health-care system and <a href="https://www.cbc.ca/news/canada/canada-us-transgender-hate-1.6503087">rising transphobia</a>, trans and non-binary people in Ontario are facing a new challenge: reduced access to gender-affirming care. Changes to how the Ontario government funds virtual health-care services have led to the closure of a key resource, <a href="https://www.connect-clinic.com/">the Connect-Clinic</a>. </p>
<p>The clinic provides vital health-care services, and its closure means fewer trans and non-binary people will get the life-saving medical care they need. Gender-affirming care providers should be exempt from these rate cuts to maintain trans and non-binary people’s access to health-care services.</p>
<h2>Connect-Clinic closes</h2>
<p>The Connect-Clinic is a specialized virtual clinic that provides <a href="https://transcare.ucsf.edu/guidelines/overview">gender-affirming care</a> to trans and non-binary people across Ontario. The clinic provides hormone therapy and surgery referrals that many trans and non-binary people describe as <a href="https://www.cbc.ca/radio/day6/gender-affirming-care-1.6664121">life-saving</a>. But the Connect-Clinic is now unable to provide virtual consultations because of recent changes to how doctors are paid for virtual appointments.</p>
<p>When the COVID-19 pandemic began, doctors were paid the same amount for an appointment by video or phone call as they were for an in-person appointment. This allowed for <a href="https://doi.org/10.1186/s12875-022-01902-9">greatly expanded access to virtual care</a> across Ontario. </p>
<p>But <a href="https://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/redux/bul220901.aspx">as of Dec. 1, 2022,</a> the Connect-Clinic can only bill $20 for a video appointment and $15 for a phone appointment. Previously, <a href="https://torontolife.com/city/my-clinic-saves-lives-the-ford-governments-funding-cuts-to-virtual-health-care-will-shut-us-down/">the Connect-Clinic could receive $67 or more per appointment</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A doctor speaking with a person on a laptop screen." src="https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507444/original/file-20230131-10300-p8sct7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Reduced billing rates for telehealth appointments mean fewer trans and non-binary people will be able to access medical services.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The new reduced rates aren’t enough to cover the specialized care that the Connect-Clinic provides. As a result, the clinic has <a href="https://www.connect-clinic.com/virtualhealthcare">paused appointments</a> for their 1,500 patients and closed their waitlist of over 2,000 trans and non-binary individuals.</p>
<h2>Gender-affirming care saves lives</h2>
<p>Gender-affirming care is essential to trans and non-binary people’s health and well-being. Research has consistently found that gender-affirming medical care significantly improves the <a href="https://doi.org/10.1080/19359705.2021.2016537">mental health</a> and <a href="https://doi.org/10.1210/jendso/bvab011">quality of life</a> of trans and non-binary people.</p>
<p>Based on a large survey of trans and non-binary people in Ontario, members of our <a href="https://transpulsecanada.ca/">Trans PULSE Canada</a> research team found that having access to all desired gender-affirming medical care <a href="https://doi.org/10.1186/s12889-015-1867-2">reduced suicidal ideation by 62 per cent</a>.</p>
<p>Unfortunately, accessing gender-affirming care is difficult in Ontario. Services are provided through a patchwork of community health centres, hospital-based clinics and individual family physicians. Many clinics are dealing with <a href="https://ottawacitizen.com/opinion/johnstone-time-to-act-on-gender-affirming-health-care-in-ontario">long waitlists</a> and demand that far exceeds capacity. Our <a href="https://doi.org/10.9778/cmajo.20210061">own research</a> found that one-third of trans and non-binary people who need gender-affirming medical care were on a waitlist.</p>
<h2>The importance of virtual care</h2>
<p>Virtual care can help bridge this gap. In 2020, our research team surveyed 820 trans and non-binary people in Canada. <a href="https://doi.org/10.2196/40989">We found that 33 per cent of participants</a> would prefer to access health care virtually rather than in-person once the COVID-19 pandemic was over. </p>
<p>Participants living with anxiety or chronic health conditions were even more likely to prefer virtual care. Our participants emphasized the importance of flexibility in access to both in-person and virtual care. </p>
<p>The Connect-Clinic has helped thousands of trans and non-binary people across Ontario access gender-affirming care through virtual appointments. Their services are especially important for people living in rural and remote areas who do not have any gender-affirming care providers in their area.</p>
<p>The closure of the Connect-Clinic has added even more stress to a health-care system facing already <a href="https://www.cihi.ca/en/news/ongoing-pandemic-driven-pressures-impact-activities-and-workload-of-health-care-workers-across">severe worker shortages</a> and <a href="https://globalnews.ca/news/9329715/ontario-long-waiters-pandemic-surgery/">long wait times</a>. Trans and non-binary people will suffer as a result.</p>
<figure class="align-center ">
<img alt="A man in a dark suit speaking at a podium with a sign that reads: Your heath, Votre sante." src="https://images.theconversation.com/files/507192/original/file-20230130-15020-h2qs7p.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507192/original/file-20230130-15020-h2qs7p.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507192/original/file-20230130-15020-h2qs7p.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507192/original/file-20230130-15020-h2qs7p.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507192/original/file-20230130-15020-h2qs7p.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507192/original/file-20230130-15020-h2qs7p.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507192/original/file-20230130-15020-h2qs7p.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ontario Premier Doug Ford makes an announcement on health care in the province with Health Minister Sylvia Jones in Toronto on Jan. 16, 2023.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
</figcaption>
</figure>
<h2>Compounding barriers to access</h2>
<p>Even before the closure of the Connect-Clinic, trans and non-binary people in Ontario had a much harder time accessing health care than their cisgender (non-trans) peers. </p>
<p>While all primary care providers are able to prescribe hormone therapy and refer patients to surgeons, gender-affirming care is <a href="https://doi.org/10.1089/trgh.2016.0010">rarely covered in medical education</a>, and many family doctors <a href="https://doi.org/10.1186/1472-6963-12-110">do not feel confident or experienced enough</a> to provide gender-affirming care. As a result, many trans and non-binary people turn to specialized clinics, such as the Connect-Clinic. </p>
<p>In 2019, we surveyed nearly 3,000 trans and non-binary people from across Canada. <a href="https://doi.org/10.9778/cmajo.20210061">We found that only 55 per cent of participants</a> from Ontario had a primary care provider with whom they were comfortable discussing their gender. Furthermore, 42 per cent of Ontario participants had at least one unmet health care need in the past year. </p>
<p>In comparison, <a href="https://doi.org/10.25318/1310083601-eng">less than seven per cent of the general population</a> said the same in 2019. The closure of the Connect-Clinic is likely to make accessing health care even harder for trans and non-binary people.</p>
<h2>The need for an exemption to rate cuts</h2>
<p>Other medical providers, such as those providing <a href="https://globalnews.ca/news/9180526/addiction-doctors-ontario-government-deal-virtual-care/">addiction medicine</a>, were given an exemption from the physician services agreement. That exemption allows them to continue to be paid the same amount for virtual and in-person appointments. </p>
<p>Considering the unique needs of trans and non-binary patients, gender-affirming care must be provided the same exemption. Addiction medicine and gender-affirming care both require specialized expertise and non-stigmatizing providers that are not always available to patients locally.</p>
<p>Maintaining the previous billing rates for virtual visits is essential to enable the Connect-Clinic and other clinics to continue providing vital gender-affirming care for trans and non-binary people in Ontario.</p><img src="https://counter.theconversation.com/content/198502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Greta Bauer receives funding from the Canadian Institutes of Health Research for trans health research and for work on research methods. She is a Principal Investigator of Trans PULSE Canada and Trans Youth CAN! Studies, funded by the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Ayden Scheim receives funding from the National Institutes of Health for research unrelated to this article. He is Co-Principal Investigator of Trans PULSE Canada, funded by the Canadian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Kai Jacobsen receives funding from the Social Sciences and Humanities Research Council for their Masters thesis about access to gender-affirming care. Trans PULSE Canada is funded by the Canadian Institutes for Health Research.</span></em></p><p class="fine-print"><em><span>Leo Rutherford receives funding from the Canadian Institutes of Health Research Strategy for Patient Oriented Research Transition to Leadership award for his dissertation project about experiences of gender-affirming care. </span></em></p><p class="fine-print"><em><span>Jose Navarro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The closure of the virtual Connect-Clinic means fewer trans and non-binary people will get the vital health-care services they need.Greta Bauer, Adjunct Professor of Epidemiology and Biostatistics, Western UniversityAyden Scheim, Assistant Professor of Epidemiology, Drexel UniversityJose Navarro, Medical Student, Queen's University, OntarioKai Jacobsen, MA Sociology Student, Carleton UniversityLeo Rutherford, PhD Candidate, Social Dimensions of Health, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1942372022-11-16T13:29:14Z2022-11-16T13:29:14ZHealth rights for trans people vary widely around the globe – achieving trans bliss and joy will require equity, social respect and legal protections<figure><img src="https://images.theconversation.com/files/495180/original/file-20221114-18-ruhqzj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2189%2C1369&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Achieving equity in global health requires addressing the root sources of inequity.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/happy-young-multiracial-people-having-fun-together-royalty-free-image/1398829422">Sabrina Bracher/iStock via Getty Images Plus</a></span></figcaption></figure><p>While transgender people might be more <a href="https://time.com/135480/transgender-tipping-point/">culturally recognized in the U.S.</a> than ever, visibility is <a href="https://www.alokvmenon.com/blog/2017/3/12/trans-visibility-isnt-trans-justice">not the same as justice</a>.</p>
<p>Transgender is an <a href="https://www.dukeupress.edu/Imagining-Transgender">umbrella category</a> that emerged in the U.S. in the 1990s to encompass diverse gender identities that don’t fully correspond with an individual’s assigned sex at birth. Although local communities worldwide have adopted this term, it can also <a href="https://doi.org/10.1215/23289252-2685615">erase and collapse</a> other diverse gender identities people have used across time, location and culture. </p>
<p>People who are today called trans, nonbinary and intersex have existed for centuries throughout the world. The rights of trans people <a href="https://www.penguinrandomhouse.com/books/203953/transgender-warriors-by-leslie-feinberg/">have not always</a> been up for debate in mainstream society, and nonnormative sex and gender categories appear in <a href="http://buddhism.lib.ntu.edu.tw/museum/TAIWAN/md/md08-52.htm">ancient Buddhist texts</a>, as well as <a href="https://www.ucpress.edu/book/9780520382053/trans-talmud">Jewish rabbinic literature</a>. Yet <a href="https://doi.org/10.1215/10642684-2009-022">colonial conquests</a> have violently stamped out sexual and gender diversity globally.</p>
<p>Trans people’s right to exist <a href="https://doi.org/10.4324/9781003206255-33">has been challenged</a> throughout time and across the world in multiple ways. Worldwide, trans people face <a href="https://doi.org/10.1080/14461242.2020.1868899">disparities across many areas</a>, including access to health care, legal support and economic security. Governments, global organizations and the legacies of colonialism also enact high levels of <a href="https://www.sup.org/books/title/?id=32715">violence and stigma</a> against them. </p>
<p>At the same time, <a href="https://globalhealth5050.org/2019-report/">95% of global health-related organizations</a> do not recognize or mention the needs of gender-diverse people in their work, resulting in the “<a href="http://doi.org/10.1089/trgh.2020.0026">near-universal exclusion</a>” of trans people from health practices and policies. There is also a <a href="https://doi.org/10.1111/1467-9566.13563">lack of holistic trans-inclusive research</a> around the world. For instance, searching for the word “transgender” on the website for the <a href="https://www.healthdata.org/search?search_terms=transgender">Institute for Health Metrics and Evaluation</a>, the global health metrics giant of the Bill and Melinda Gates Foundation that <a href="https://www.healthdata.org/news-release/who-and-ihme-collaborate-improve-health-data-globally">collaborates with the World Health Organization</a> to improve global health data, currently returns zero results.</p>
<p><a href="https://scholar.google.com/citations?user=N3VopfkAAAAJ&hl=en&oi=ao">As a sociologist</a>, I study how health outcomes are affected by various social conditions, including global economic policies, institutions and cultural values. In particular, I analyzed how government-endorsed medical tourism, or health-related travel, has affected <a href="https://doi.org/10.1016/j.socscimed.2022.114950">Thai transgender women</a>. Broadly, I seek to understand how the body acts as what French philosopher Michel Foucault calls an “<a href="https://www.penguinrandomhouse.com/books/55035/the-foucault-reader-by-michel-foucault/">inscribed surface of events</a>,” imprinted upon by an ever-changing social context that can afford or withhold resources, rights, recognition and power. </p>
<p>With their health and well-being shaped by the social context worldwide, the bodies of transgender people are no exception.</p>
<h2>History of gender-affirming care</h2>
<p>Medical institutions and authorities are a major pathway to health and how one lives in one’s body. They <a href="https://www.jstor.org/stable/2083452">define, classify and pathologize</a> a range of human conditions, from <a href="https://doi.org/10.1016/j.socscimed.2010.02.019">male pattern baldness</a> to <a href="https://doi.org/10.1111/j.1475-682X.2008.00271.x">fatness</a>. </p>
<p>The German physician <a href="https://theconversation.com/the-early-20th-century-german-trans-rights-activist-who-transformed-the-worlds-view-of-gender-and-sexuality-106278">Magnus Hirschfeld</a> coined the now antiquated term “transvestite” in 1910 to define those who desired to express themselves in opposition to their sex assigned at birth. At his Institute for Sexual Science, Hirschfeld offered people hormone therapy and performed the first documented genital transformation surgery. Adolf Hitler deemed Hirschfeld “<a href="https://www.sealpress.com/titles/susan-stryker/transgender-history-second-edition/9781580056908/">the most dangerous Jew in Germany</a>,” and the Nazis burned his research center after he fled for his life. </p>
<p>Despite this violence toward trans medicine, endocrinology in the U.S. and Europe advanced in the 1930s with the use of synthetic testosterone and estrogen for medical transitioning. <a href="https://doi.org/10.1210/en.2018-00529">Estrogen</a> was first purified in 1923 and used for hot flashes, bone loss prevention and other reproductive health issues. <a href="https://www.jstor.org/stable/24980239">Testosterone</a> was isolated and synthesized in 1935 and first used to treat <a href="https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881">hypogonadism</a> in men as well as tumor growth in women. </p>
<p>Puberty blockers, or gonadotropin-releasing hormone agonists, were <a href="https://www.ohsu.edu/sites/default/files/2020-12/Gender-Clinic-Puberty-Blockers-Handout.pdf">first approved by the U.S. FDA in 1993</a> for children undergoing puberty too early. For trans adolescents experiencing <a href="https://doi.org/10.1080/26895269.2022.2100644">gender dysphoria</a>, or distress from a mismatch between their gender identity and sex assigned at birth, these medications can be <a href="https://doi.org/10.1177/07435584221100591">critically important</a> for their well-being. Far from being experimental, the medications have <a href="https://doi.org/10.1080/26895269.2020.1747768">strong evidence</a> for their overall beneficial effects for trans youths.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KomI-XiiJw0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">There is debate about whether trans youths are able to determine whether they are ready for gender-affirming care.</span></figcaption>
</figure>
<p>Christine Jorgensen was the first American to undergo what was then called “sex change” surgery, in Denmark in 1952, <a href="https://www.sealpress.com/titles/susan-stryker/transgender-history-second-edition/9781580056908/">making headline news</a>. Doctors in other parts of the world also started to gain clinical expertise in <a href="https://transcare.ucsf.edu/guidelines/vaginoplasty">vaginoplasty</a>, sparking global networks of transgender health care. For instance, <a href="https://doi.org/10.1155/2014/182981">surgeons in Thailand</a> developed their own techniques in the 1970s for Thai trans women. </p>
<p>Soon, trans people from other countries learned of Thai surgical techniques and began to travel to Thailand for care. With strong government support, Thailand has become a <a href="https://www.dukeupress.edu/mobile-subjects">global hub for gender-affirming services</a>. Subsequently, foreign travelers “<a href="https://doi.org/10.1016/j.socscimed.2022.114950">crowded out</a>” some Thai trans people from quality care as the market shifted to accommodate medical tourists.</p>
<p>For some health travelers, <a href="http://doi.org/10.1017/S1745855207005765">services are more affordable</a> in Thailand than in their home country. Traveling for health services can also <a href="https://www.oecd.org/health/health-systems/48723982.pdf">provide greater anonymity</a>. For those in the U.K. seeking gender-affirming care, traveling abroad is an alternative to <a href="https://cass.independent-review.uk/publications/interim-report/">long wait times</a>.</p>
<p>Medical tourism is more dire for those living in countries where <a href="https://ilga.org/trans-legal-mapping-report">trans people face criminalization</a>, such as Brunei, Lebanon and Malawi, or where gender-affirming surgeries are <a href="https://pubmed.ncbi.nlm.nih.gov/34194279/">religiously prohibited</a>, such as Saudi Arabia.</p>
<h2>What does global health equity mean?</h2>
<p>Globally, trans people experience issues accessing <a href="http://doi.org/10.1016/S0140-6736(16)30653-5">culturally competent and equitable health care services</a>, both <a href="https://theconversation.com/doctors-often-arent-trained-on-the-preventive-health-care-needs-of-gender-diverse-people-as-a-result-many-patients-dont-get-the-care-they-need-191933">generally</a> and for gender-affirming services. Trans and gender-diverse people experience greater mental distress and <a href="https://doi.org/10.1016/S0140-6736(16)00684-X">everyday violence and discrimination</a> than their cisgender peers. </p>
<p>A <a href="http://doi.org/10.1089/trgh.2020.0026">2019 report</a> of nearly 200 health organizations around the world found that 93% do not recognize trans people in their work on gender equality, and 92% do not mention trans health in their programmatic services. <a href="http://doi.org/10.1136/bmjgh-2020-003394">Decolonizing global health</a> means including marginalized people in decisions and knowledge production around global health. It also includes and addresses the needs of trans and gender-diverse people worldwide.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patient and doctor in exam room" src="https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495182/original/file-20221114-19-pmhw1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Including trans people in health care policies and practices can help reduce disparities.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-talking-to-patient-at-hospital-room-with-royalty-free-image/1236342725">FG Trade/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Global trans health equity means providing resources to <a href="http://doi.org/10.1089/trgh.2020.0026">target the root causes</a> of gender-based health disparities. <a href="http://doi.org/10.1016/S0140-6736(16)30653-5">This involves</a> legal gender recognition, government support and anti-discrimination laws. While medical and public health support is necessary for trans women, who are <a href="https://www.aidsmap.com/news/mar-2022/trans-women-66-times-more-likely-have-hiv-trans-men-nearly-7-times-more-likely-global">disproportionately affected by HIV</a> worldwide, global trans health equity also means addressing other areas that contribute to this disparity, such as <a href="https://doi.org/10.1080/14461242.2020.1868899">poverty</a>, economic exclusion and <a href="https://www.undp.org/asia-pacific/publications/denied-work-%E2%80%93-audit-employment-discrimination-basis-gender-identity-south-east-asia">workplace discrimination</a>. </p>
<p>For countries with universal health coverage, medical and public health researchers recommend that gender-affirming services be included as <a href="https://doi.org/10.1016/S0140-6736(16)00684-X">essential services</a>. They are not cosmetic, but are necessary for those who want them. </p>
<h2>Better alternatives for all</h2>
<p>Amid everyday injustices, violence and <a href="https://doi.org/10.1016/S0140-6736(16)00684-X">vulnerabilities</a> are countless forms of trans <a href="https://doi.org/10.1080/17441692.2020.1856397">resilience and resistance</a>, <a href="https://doi.org/10.1016/j.socscimed.2020.112808">activism</a>, <a href="https://doi.org/10.1215/01642472-7971139">collective care</a> and <a href="https://doi.org/10.1332/policypress/9781447342335.001.0001">knowledge sharing</a>. There are even some “<a href="https://doi.org/10.1080/14461242.2020.1855999">bubble[s] of utopia</a>,” or clinics and health care settings where trans people can access services with reduced delay. These alternatives open the possibility for <a href="https://doi.org/10.4324/9781003034063-9">transgender bliss</a>, or liberation from restrictive colonial gender constructs, and <a href="https://doi.org/10.1093/socpro/spac034">transgender joy</a>, or improving one’s quality of life and forming meaningful connections by embracing a marginalized identity. </p>
<p>How can policies, institutions and society cultivate trans bliss and joy worldwide?</p>
<p>All human bodies are “<a href="https://doi.org/10.4324/9780203976531">sociocultural artifacts</a>.” How they are expressed and lived in is determined by social contexts and shaped by available resources. Sex and gender are points in a vast “<a href="http://doi.org/10.1002/j.2326-1951.2000.tb03504.x">multi-dimensional space</a>” of anatomy, hormones, chromosomes, environment and culture. Global health equity for trans people holds accountable the institutions and decision-makers responsible for the health and safety of all human beings. It is oriented toward the freedom to flourish in a world that celebrates sex and gender diversity as a <a href="https://blogs.scientificamerican.com/voices/stop-using-phony-science-to-justify-transphobia/">natural fact of life</a>.</p><img src="https://counter.theconversation.com/content/194237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Reya Farber received funding from a National Science Foundation Graduate Research Fellowship under Grant No. DGE-1247312, Boston University Graduate School, Boston University Sociology Department Morris Funds, and William & Mary Summer Research Grant.</span></em></p>While gender-affirming health care is essential to the well-being of trans people, access to quality services varies significantly by geographic region and social context.Reya Farber, Assistant Professor of Sociology, William & MaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1795152022-03-31T13:38:31Z2022-03-31T13:38:31ZTransgender people of color face unique challenges as gender discrimination and racism intersect<figure><img src="https://images.theconversation.com/files/455275/original/file-20220330-5562-172vy7p.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Transgender people of color face more than their share of discrimination and violence.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-four-friends-embracing-royalty-free-image/1164940484">We Are/DigitalVision via Getty Images</a></span></figcaption></figure><p>Throughout history, <a href="https://www.hrc.org/resources/glossary-of-terms">transgender</a> people of color have had a <a href="https://www.pbs.org/independentlens/content/two-spirits_map-html/">place of honor</a> in many indigenous cultures around the world. </p>
<p>This changed in many places, however, as <a href="https://jps.library.utoronto.ca/index.php/des/article/view/18630">European colonizers</a> began forcing indigenous people to follow white social norms. These include <a href="https://www.dukeupress.edu/otherwise-worlds">anti-Blackness</a>, Christianity and a <a href="https://doi.org/10.1007/978-1-137-38273-3_2">gender binary</a> that reduced gender to just man and woman. Colonizers presumed that being <a href="https://www.health.com/mind-body/lgbtq-health/what-is-cisgender">cisgender</a>, or having a gender identity that is congruent with gender assigned at birth, was the only acceptable norm.</p>
<p>For trans people who refused or were unable to conform, colonial societies often used racism and <a href="https://www.healthline.com/health/transgender/cissexist">cissexism</a>, or behaviors and beliefs that assume the inferiority of trans people, to invalidate their existence, limit their access to resources and threaten their well-being. For example, colonizers in some cases deemed people who expressed their gender outside the binary <a href="https://www.them.us/story/colonialism-black-and-indigenous-people-gender-identity">as sinful and deviant</a>, and punished them with <a href="https://doi.org/10.33972/jhs.47">emotional and physical violence</a>.</p>
<p>The reverberations of these colonial beliefs are still felt today. In just the first three months of 2022, there were <a href="https://www.nbcnews.com/nbc-out/out-politics-and-policy/nearly-240-anti-lgbtq-bills-filed-2022-far-targeting-trans-people-rcna20418">over 154 anti-trans state bills</a> proposed across the U.S. seeking to limit the rights of trans kids and <a href="http://dx.doi.org/10.1037/sgd0000495">their parents</a>.</p>
<p>And for trans people of color, the challenges they face because of gender discrimination are exacerbated by struggles they deal with because of racism.</p>
<p><a href="https://people.clas.ufl.edu/rabreu26/">We</a> <a href="https://www.researchgate.net/profile/Jules-Sostre">are</a> <a href="https://www.researchgate.net/profile/Gabriel-Lockett">researchers</a> who study how LGBTQ people of color <a href="https://cheverelab.com">build resilience, resist oppression and promote wellness</a> within their communities. We look at how having multiple identities like being trans and a person of color <a href="https://www.feministsof.com/post/what-is-intersectionality">intersect</a> and interact with each other in ways that affect how someone navigates their life. </p>
<p>Trans people of color who have multiple marginalized identities face higher levels of <a href="https://doi.org/10.1080/19359705.2017.1320739">stress from being a minority</a> compared to those with fewer marginalized identities. While there has been a <a href="https://doi.org/10.1037/amp0000562">lack of research</a> on the experiences of trans people of color, <a href="https://doi.org/10.1111/soin.12341">many</a> <a href="https://doi.apa.org/doi/10.1037/a0023244">studies</a> <a href="https://doi.org/10.1007/978-3-030-82250-7_4">suggest</a> that many of the challenges they face arise from the intersection of racism, xenophobia and cisnormativity. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/qRJJR6bGyL4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Transgender people have existed for thousands of years.</span></figcaption>
</figure>
<h2>Common challenges and barriers</h2>
<p>The health care system has historically been a fraught with danger for trans people of color.</p>
<p>Over the years, people of color have been <a href="https://www.mcgill.ca/oss/article/history/40-years-human-experimentation-america-tuskegee-study">experimented upon without consent</a>, <a href="https://journalofethics.ama-assn.org/article/genetic-research-among-havasupai-cautionary-tale/2011-02">denied ownership</a> over their own test results and bodies and <a href="https://doi.org/10.1080/15313204.2016.1242102">denied access to care</a>. Some have played <a href="https://www.npr.org/2010/02/02/123232331/henrietta-lacks-a-donors-immortal-legacy">critical roles</a> in transforming medical research and science without any knowledge of doing so.</p>
<p>Mistrust is <a href="https://doi.org/10.1080/15532739.2015.1064336">magnified</a> for trans people of color, who may get <a href="https://www.healthline.com/health/transgender/deadnaming">deadnamed</a> (called by the birth name they no longer go by), misgendered and be racially discriminated against all in one medical appointment. </p>
<p>Medical professionals and lawmakers have also mandated <a href="https://www.transhub.org.au/gatekeeping">gatekeeping measures</a> that require extra steps to qualify for gender-affirming care such as hormones and surgery. Trans people are asked to prove that they have a persistent experience of <a href="https://doi.org/10.1177%2F1745691619872987">dysphoria</a>, defined as an incongruence between one’s gender assigned at birth and one’s gender identity. This treats being transgender <a href="https://dx.doi.org/10.3390%2Fijerph16060978">as an illness</a> to be cured based on what cisgender people believe bodies should look like. It erases <a href="https://doi.org/10.1080/26895269.2021.1915223">gender euphoria</a>, or a feeling of joy or satisfaction associated with a gender separate from what was assigned at birth, as a reason for pursuing transition.</p>
<p>With only a <a href="https://www.npr.org/sections/health-shots/2019/01/20/683216767/medical-students-push-for-more-lgbt-health-training-to-address-disparities">limited number of providers</a> who can <a href="https://doi.org/10.1007/s11606-019-05179-0">competently and respectfully</a> help them navigate these life-changing services, trans people of color are often left to fend for themselves. With <a href="https://www.cnn.com/2022/03/24/politics/arizona-transgender-health-care-ban-sports-ban/index.html">ongoing legislation</a> that outlaws gender-affirming treatment for trans kids, they and their families are forced to travel long distances to obtain care, or not have access to care at all.</p>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2020035">Continuous exposure</a> to stressors resulting from this discrimination have negative physical and mental health consequences for trans people of color. And these challenges are compounded by other common barriers, including <a href="https://doi.org/10.1080/26895269.2020.1830222">homelessness</a>, <a href="https://doi.org/10.1177%2F08948453211062951">employment discrimination</a> and <a href="https://doi.org/10.1037/cou0000546">restricted access to legal documentation</a>, among <a href="https://www.ustranssurvey.org/reports#USTS">others</a>.</p>
<h2>Targets of violence</h2>
<p>Trans people of color face <a href="https://reports.hrc.org/dismantling-a-culture-of-violence">disproportionate rates of violence</a> as a result of racism and transphobia. Compared to their cis peers, trans people are <a href="https://williamsinstitute.law.ucla.edu/press/ncvs-trans-press-release/">four times more likely</a> to be a victim of a violent crime. </p>
<p>And trans people of color have been the overwhelming targets of this violence. The Human Rights Campaign has recorded <a href="https://reports.hrc.org/an-epidemic-of-violence-fatal-violence-against-transgender-and-gender-non-confirming-people-in-the-united-states-in-2021">over 256 cases of fatal violence</a> against trans people since 2013 in the U.S., 84% of whom were people of color. In 2021 alone, <a href="https://time.com/6131444/2021-anti-trans-violence/">57 trans people were killed</a>, and over half were Black trans women. Black trans women continue to have the highest risk for violence due to how their experiences of anti-Black racism, cissexism and sexism intersect (also known as <a href="https://www.harpersbazaar.com/culture/features/a33614214/ashlee-marie-preston-transmisogynoir-essay/">transmisogynoir</a>).</p>
<p>The true numbers are likely to be much higher. Many hate crimes go unreported, due to both fear that one’s <a href="https://doi.org/10.1186/s12889-021-11107-x">identity will be questioned</a> and <a href="https://publicintegrity.org/politics/lack-of-trust-in-law-enforcement-hinders-reporting-of-lbgtq-crimes/">lack of trust in law enforcement</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/9_bre2DPD1A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Trans women of color face an epidemic of violence in the U.S.</span></figcaption>
</figure>
<p>Additionally, trans people of color often experience violence from police and other law enforcement officials. A <a href="https://www.ustranssurvey.org/reports#USTS">2015 report</a> by the National Center for Transgender Equality in the U.S. found that 58% of trans people reported being harassed, abused or mistreated during their interactions with police. It also noted that police frequently assume that trans women of color are sex workers. A <a href="https://www.tandfonline.com/doi/full/10.1080/26895269.2021.1938779">2021 study</a> showed that trans Latinx immigrants and asylum-seekers who enter the U.S. often experience torture and are denied basic medical care in detention facilities.</p>
<h2>Resilience and strength</h2>
<p>Trans people of color have found many different strategies to help them navigate and overcome these challenges. </p>
<p>One is to <a href="https://doi.org/10.1177%2F0011000018787261">build resilience</a>, or coping with and adapting to stressors and adversities. Many trans people of color draw strength from supportive role models and members of their community. Being a positive role model themselves and having a strong sense of their own self-worth are also key factors to building resilience.</p>
<p>For example, one trans person of color who survived a traumatic event <a href="https://doi.org/10.1177%2F1534765610369261">shared in a study</a> that resilience for them meant having pride in their gender and racial and ethnic identity, while also recognizing and negotiating the challenges they face because of systemic oppression. They also built resilience by engaging in activism, advocating for themselves and connecting with trans communities of color. </p>
<p>Trans people of color continue to find strength in collective action. Trans women of color have been at the <a href="https://www.thenation.com/article/archive/trans-women-color-lgbtq-stonewall/">forefront of social justice movements</a>, and Black trans women have been a central <a href="https://www.nytimes.com/2020/06/27/us/politics/black-trans-lives-matter.html">driving force</a> in the fight for LGBTQ rights.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black trans woman of color holding flower at a Pride March event." src="https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455276/original/file-20220330-23-1tzgona.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Trans people of color have historically met the societal challenges they face through community engagement and collective action.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/portrait-of-an-unidentified-participant-dressed-in-a-blue-news-photo/1250531142">Mariette Pathy Allen/Archive Photos via Getty Images</a></span>
</figcaption>
</figure>
<h2>Toward liberation</h2>
<p>There are countless ways to support trans people of color working toward liberation.</p>
<p>One way is self-education. This includes <a href="https://psycnet.apa.org/doi/10.1037/cou0000430">learning about privilege</a> and how it gives select groups power over others in ways that range from <a href="https://results.org/wp-content/uploads/Microaggressions_Learning-About-Power-Privilege-and-Oppression.pdf">microaggressions</a> to physical violence. It is important to note that self-education is a continuous journey that requires humility.</p>
<p>Another way is to keep up with attacks against marginalized communities and be a <a href="https://aninjusticemag.com/the-differences-between-allies-accomplices-co-conspirators-may-surprise-you-d3fc7fe29c">co-conspirator</a>. Instead of just being a passive ally, ask how you can leverage your privilege to support trans people of color. This could be working to provide inclusive and safe work environments, schools and medical systems, among others. It could also be <a href="https://www.mckinsey.com/featured-insights/diversity-and-inclusion/being-transgender-at-work">fairly and equitably compensating</a> trans people of color for their labor. </p>
<p>Finally, <a href="https://results.org/wp-content/uploads/Call-in_Call-Out_Resource_Guide.pdf">call in and call out</a>. Speak up when someone is being harmful to a trans person of color. Listen and take responsibility if you are called out.</p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/179515/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Being both trans and a person of color comes with a unique set of challenges. Collectively working toward overcoming these barriers is one way this community fights for survival.Gabriel Lockett, PhD Candidate in Counseling Psychology, University of FloridaJules Sostre, PhD Candidate in Counseling Psychology, University of FloridaRoberto L. Abreu, Assistant Professor of Counseling Psychology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1778122022-02-25T16:02:58Z2022-02-25T16:02:58ZTransgender youth on puberty blockers and gender-affirming hormones have lower rates of depression and suicidal thoughts, a new study finds<figure><img src="https://images.theconversation.com/files/448469/original/file-20220225-27-1fsqygc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2091%2C1433&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gender-affirming care and social support can help trans youth thrive.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/transgender-teenager-portrait-royalty-free-image/679618077">Jonathan Kirn/The Image Bank via Getty Images</a></span></figcaption></figure><p>Recent studies estimate that <a href="http://dx.doi.org/10.15585/mmwr.mm6803a3">1.8%</a> to <a href="https://doi.org/10.1016/j.jadohealth.2017.04.014">2.7%</a> – or approximately 750,000 to 1.1 million – adolescents in the U.S. identify as transgender or nonbinary. Many of these trans youth experience high levels of negative mental health symptoms due to anti-transgender stigma, discrimination and lack of family or peer support. A <a href="https://doi.org/10.1016/j.jadohealth.2021.10.036">2021 study</a> found that as much as 72% of trans youth were depressed, and half had seriously considered suicide.</p>
<p>We are an <a href="http://www.dianatordoff.com">epidemiologist</a> and fourth-year medical student who study ways to make clinical care more inclusive for trans and nonbinary people. We conducted a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789423">study</a> in collaboration with the <a href="https://www.seattlechildrens.org/clinics/gender-clinic/">Seattle Children’s Hospital Gender Clinic</a> that found that transgender youth on puberty blockers and gender-affirming hormone therapy are less likely to report depression and suicidal thoughts.</p>
<h2>Safe and proven treatments</h2>
<p><a href="https://health.clevelandclinic.org/what-are-puberty-blockers/">Puberty blockers</a> are medications that delay puberty. By temporarily stopping the body from making the hormones that lead to puberty-related changes, young people and their families are given time to pause and make health decisions. These medications have been used for <a href="http://dx.doi.org/10.3345/kjp.2015.58.1.1">over 30 years</a> to treat young people with puberty that starts too early, also called <a href="https://www.mayoclinic.org/diseases-conditions/precocious-puberty/symptoms-causes/syc-20351811">precocious puberty</a>. </p>
<p>Gender-affirming hormone therapy, like <a href="https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy">testosterone</a> or <a href="https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy">estrogen</a>, are medications that allow trans youth to experience a puberty appropriately aligned with their gender.</p>
<p>There is no shortage of scientific and clinical societies that have found these medications to be both safe and effective for transgender people. <a href="https://www.aap.org/en/news-room/news-releases/aap/2021/frontline-physicians-oppose-legislation-that-interferes-in-or-penalizes-patient-care/">Numerous medical and professional societies</a>, including the <a href="https://doi.org/10.1542/peds.2018-2162">American Academy of Pediatrics</a>, the <a href="https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx">American Academy of Child and Adolescent Psychiatry</a> and the <a href="https://www.ama-assn.org/press-center/press-releases/ama-states-stop-interfering-health-care-transgender-children">American Medical Association</a>, endorse access to gender-affirming care specifically for trans youth.</p>
<p><a href="https://doi.org/10.1542/peds.2015-3223">Social support</a>, as well as access to <a href="https://www.psychologytoday.com/us/blog/political-minds/202201/the-evidence-trans-youth-gender-affirming-medical-care">gender-affirming care</a>, is known to significantly reduce poor mental health in trans youth. In addition, several recent studies have suggested that early access to <a href="https://doi.org/10.1542/peds.2019-1725">puberty blockers</a> and <a href="https://doi.org/10.1371/journal.pone.0261039">hormones</a> during adolescence can have long-term positive effects that last into adulthood. Despite these benefits, many young people face significant barriers in accessing gender-affirming care. Only <a href="https://doi.org/10.1016/j.jadohealth.2021.10.036">1 in 5 youth</a> who need hormones have been able to access them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Parents and children wearing masks and holding signs protesting anti-transgender legislation" src="https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=357&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=357&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=357&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=448&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=448&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448434/original/file-20220224-23-uagw5m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=448&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents and trans youth protest Texas Governor Greg Abbott’s recent attempt to outlaw gender-affirming care for trans youth.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransgenderLegislationTexas/81151a206a9a48e79275cff2cd7a1746">AP Photo/Eric Gay</a></span>
</figcaption>
</figure>
<p>To further examine the mental health effects of puberty blockers and hormone therapy, we followed 104 trans and nonbinary youth ages 13 to 20 during their first year of gender-affirming care. After one year, we found that young people who began puberty blockers or gender-affirming hormones were 60% less likely to be depressed and 73% less likely to have thoughts about self-harm or suicide compared to youth who hadn’t started these medications. </p>
<p>In addition, young people who were unable to start these medications within three to six months of their first appointment with a medical provider had a two- to threefold increase in depression and suicidal thoughts. Our findings suggest that delays in prescribing hormones and puberty blockers may worsen mental health symptoms for trans youth.</p>
<h2>What this means for anti-transgender legislation</h2>
<p>2021 and 2022 have been record-breaking years for <a href="https://doi.org/10.1001/jama.2021.7764">anti-transgender legislation</a>, including attempts to <a href="https://twitter.com/ErinInTheMorn/status/1496511215719399431">criminalize gender-affirming care</a> for trans youth.</p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>Banning gender-affirming care will have immediate and long-term negative effects on the well-being of trans youth and their families, both by increasing the stigma and discrimination these young people face and by denying them access to critical life-saving and evidence-based health care. Our study builds on existing scientific evidence and underscores that timely access to gender-affirming care saves trans youth lives.</p><img src="https://counter.theconversation.com/content/177812/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diana Tordoff receives funding from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, the American Sexually Transmitted Diseases Association (ASTDA), and the Northwest Center for Public Health Practice at the University of Washington’s School of Public Health.</span></em></p><p class="fine-print"><em><span>Arin Collin does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A wealth of evidence supports the protective mental health effects of gender-affirming care, despite ongoing legislation that asserts otherwise.Diana Tordoff, PhD Candidate in Epidemiology, University of WashingtonArin Collin, Medical Student, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1498162020-11-19T22:48:51Z2020-11-19T22:48:51ZWhy the way we approach transgender and non-binary healthcare needs to change<p>Demand for healthcare for transgender people is <a href="https://www.nzma.org.nz/journal-articles/increasing-rates-of-people-identifying-as-transgender-presenting-to-endocrine-services-in-the-wellington-region">on the rise</a> in New Zealand but training for health professionals to develop basic competencies is lagging behind. </p>
<p>There is little teaching on gender and sexuality at either of <a href="https://www.nzma.org.nz/journal-articles/sexuality-and-gender-identity-teaching-within-preclinical-medical-training-in-new-zealand-content-attitudes-and-barriers">New Zealand’s medical schools</a>. It’s partly due to lack of time, but also lack of <a href="https://www.nzma.org.nz/journal-articles/advancing-transgender-healthcare-teaching-in-aotearoa-new-zealand">confidence and knowledge</a> to teach the topic. </p>
<p>Medical education needs to change urgently to prepare doctors to adequately care for their transgender and non-binary patients.</p>
<h2>Transgender and non-binary health</h2>
<p>We use the term transgender (or trans) to refer to people who identify with a gender different to that assigned to them at birth. The term non-binary describes people who don’t identify with the male/female gender binary. </p>
<p>There are other gender identities such as <a href="https://takatapui.nz/#home">takatāpui</a>, a traditional Māori term which has been reclaimed to embrace all Māori who identify with diverse genders and sexualities. Not everyone will identify with these umbrella descriptors. </p>
<p>Transgender identities are not an illness or a mental health problem. They are a variation of human experience. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/supporting-trans-people-3-simple-things-teachers-and-researchers-can-do-149832">Supporting trans people: 3 simple things teachers and researchers can do</a>
</strong>
</em>
</p>
<hr>
<p>Problems arise because of negative societal attitudes. Trans and non-binary people still face <a href="https://www.hrc.co.nz/news/human-rights-commission-issues-report-rainbow-human-rights-aotearoa-new-zealand/">discrimination, stigmatisation and marginalisation</a>. These experiences can lead to <a href="https://www.liebertpub.com/doi/full/10.1089/trgh.2016.0012">psychological distress</a>.</p>
<p>In the <a href="https://www.fmhs.auckland.ac.nz/assets/fmhs/faculty/ahrg/docs/Youth12-transgender-young-people-fact-sheet.pdf">Youth’12</a> survey of 8,500 high school students carried out in 2012, almost half of the transgender students reported experiencing depressive symptoms. One in five had attempted suicide in the year prior to the survey. </p>
<p>The <a href="https://countingourselves.nz/">Counting Ourselves</a> survey in 2018 also showed high rates of mental health problems and a higher risk of suicide and substance abuse. </p>
<p>It highlighted the difficulty many transgender and non-binary people face in accessing gender-affirming healthcare. Many already had negative experiences and said they avoided seeing a doctor because they were worried about being disrespected. </p>
<p>Not all trans people will require access to hormone therapy or surgery, but many do. Removing barriers to healthcare is essential. Trans and non-binary people have specific health needs to affirm their gender identity and to reduce <a href="https://www.healthnavigator.org.nz/health-a-z/g/gender-dysphoria/">gender dysphoria</a> — the distress that can occur when someone’s gender identity differs from the sex assigned to them at birth. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/informed-consent-individual-care-vital-to-ensure-reproductive-rights-of-transgender-australians-99589">Informed consent, individual care vital to ensure reproductive rights of transgender Australians</a>
</strong>
</em>
</p>
<hr>
<h2>Changing medical education and training</h2>
<p>Case studies used to teach medical students rarely show diversity of sexuality or gender identity. When you don’t see yourself or the population reflected in your learning, it can send a message that this isn’t important or relevant to future practice. </p>
<p>Just as we want our <a href="https://www.otago.ac.nz/healthsciences/students/professional/otago686979.html#:%7E:text=The%20Mirror%20on%20Society%20Selection,have%20applied%20via%20the%20application">future doctors</a> to reflect the population they will treat, the <a href="https://www.bmj.com/content/364/bmj.l300.full">medical curriculum</a> should evolve to do so, too.</p>
<p>Transgender healthcare teaching needs to be part of all medical speciality, nursing and allied health training, so that trans and non-binary patients can expect some basic cultural competence in all areas of our health service. Care and sensitivity are required in certain specialities — including endocrinology, obstetrics, gynaecology, sexual health, mental health, urology and breast surgery. But it is most important in general practice where we receive most of our healthcare.</p>
<h2>From dysphoria to celebration</h2>
<p>While some care requires hospital specialists, general practitioners (GPs) can provide much gender-affirming care. </p>
<p>GPs are experts in supporting people with normal life issues, as well as addressing physical and psychological needs in a holistic manner. </p>
<p>GPs who wish to provide gender-affirming care based on an <a href="https://www.transhub.org.au/clinicians/informed-consent">informed consent</a> model, should be supported and encouraged to do so. This aligns with <a href="https://www.nzma.org.nz/journal-articles/guidelines-for-gender-affirming-healthcare-for-gender-diverse-and-transgender-children-young-people-and-adults-in-aotearoa-new-zealand">best practice models</a> that view the patient as the expert in their identity and recognise them as a competent adult who can make choices about their own healthcare. </p>
<p>A multidisciplinary approach with the GP at the centre, supported by other specialists where necessary, is an ideal model. Financial and educational support for primary care to take the lead in this area would increase patients’ access to care and reduce the need for referrals to secondary care, freeing up appointments for people who need them. </p>
<p>There are simple steps health providers can take to make transgender and non-binary patients feel more welcome and respected, including:</p>
<ul>
<li>Outward signs of acceptance in the practice environment, such as a rainbow flag, relevant posters and pamphlets</li>
<li>gender-neutral toilets</li>
<li>enrolment forms with appropriate questions around gender identity, names and pronouns.</li>
</ul>
<p>These things in themselves can make a difference, but need to be backed up by staff who use people’s correct names and pronouns and do not make assumptions around gender or sexuality. </p>
<p>Healthcare providers who treat their transgender and non-binary patients with respect and support them to affirm their individual gender identity contribute to making them comfortable attending appointments. The result is improved health and well-being.</p>
<p>Better medical training and practice also require changes in societal attitudes, and that’s where we all have a role to play.</p><img src="https://counter.theconversation.com/content/149816/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Rona Carroll is a general practitioner affiliated with PATHA (Professional Association for Transgender Health Aotearoa).</span></em></p>Trans and non-binary people often avoid seeing a doctor because they fear discrimination. Health professionals need better training to provide gender-affirming care.Rona Carroll, Senior Lecturer, Department of Primary Health Care and General Practice, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/927422018-03-22T22:17:55Z2018-03-22T22:17:55ZWhy ‘rapid-onset gender dysphoria’ is bad science<figure><img src="https://images.theconversation.com/files/211135/original/file-20180320-31596-r6jdth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A commonly cited statistic that 60 to 90 percent of gender dysphoric children grow up not to be transgender is based on studies that are deeply flawed.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>A few decades ago, sexologist Ray Blanchard suggested that trans lesbians — trans women who are solely attracted to other women — were in fact men whose misguided heterosexuality led them to be aroused by the thought of being women. </p>
<p>Blanchard’s theory has since been <a href="http://www.juliaserano.com/av/Serano-CaseAgainstAutogynephilia.pdf">put to rest by careful analyses</a> and <a href="https://www.researchgate.net/publication/26660017_Autogynephilia_in_Women">scientific studies</a>. Despite being discredited, the theory remains popular among opponents of transgender rights.</p>
<p>Another idea is now making the rounds in anti-trans circles: “Rapid-onset gender dysphoria.” The theory suggests that youngsters are being misled into claiming a trans identity before they truly understand what that means. They are supposedly influenced by the internet, social media and peers. </p>
<p>It is presented as a critique of the <a href="https://www.huffingtonpost.com/entry/six-facts-about-affirming-therapy-for-youth_us_588639e0e4b08f5134b62325">gender-affirmative model</a> of therapy, which encourages supporting the child through their journey of exploration and affirmation of their gender identities, without expectations as to the result. </p>
<p>Debra Soh and Barbara Kay’s recent pieces in <a href="https://www.theglobeandmail.com/opinion/dont-treat-all-cases-of-gender-dysphoria-the-same-way/article37711831/"><em>The Globe and Mail</em></a> and <a href="http://nationalpost.com/opinion/barbara-kay-parents-victimized-in-the-identity-vs-mental-health-battle-over-transgendered-children"><em>National Post</em></a> bring this previously underground notion into the mainstream. They claim that rapid-onset gender dysphoria contradicts gender-affirmative care, which they misleadingly portray as pushing children to transition.</p>
<p>This idea shares much in common with that of Blanchard’s earlier theory. </p>
<p>It conveniently pulls on heartstrings by calling us to defend our children, much as Blanchard’s work appealed to our sexual puritanism. It distinguishes “good,” true transgender people from “bad,” fake trans people, allowing proponents to claim that they have nothing against trans people — well, at least the real ones. </p>
<p>Theories which rely on the idea of “contagion” in order to invalidate marginalised identities are not new. The same has happened with other marginalised groups, such as gay, lesbian and bisexual people. Young people were thought to be misled by the “gay agenda” into mistakenly and rashly claiming a queer identity.</p>
<p>The idea of rapid-onset gender dysphoria gives ammunition to those who are eager to oppose gender-affirmative policies. Best explained by transphobia and research study biases, it does not withstand scrutiny.</p>
<p>Those who push the idea of rapid-onset gender dysphoria misrepresent the quality and extent of available science and the structure of gender-affirmative therapies. </p>
<p>They say that 60 to 90 per cent of transgender children grow up not to be transgender. This is false.</p>
<h2>Flawed research</h2>
<p>The statistic that 60 to 90 per cent of gender dysphoric children grow up not to be transgender is <a href="https://gidreform.wordpress.com/2017/02/10/revisiting-flawed-research-behind-the-80-childhood-gender-dysphoria-desistance-myth/">based on studies that are deeply flawed</a>. </p>
<p>This body of research is known as “desistance research.” Children who have met diagnostic criteria for gender dysphoria are enrolled in a study. After a number of years, they are reassessed to see if they are still trans. If they are, they are said to have persisted with their transgender identity. If they aren’t, they are said to have “desisted” from that identity. </p>
<p>The aim of the research is to estimate the number of transgender children who will grow up to be transgender adults.</p>
<p>Desistance research uses outdated diagnostic criteria crafted in the 1980s and ‘90s that don’t reflect current science. It has included many children who aren’t trans at all in research studies. In some studies, as many as <a href="https://www.ncbi.nlm.nih.gov/pubmed/18981931">25 per cent</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/18194003">40 per cent</a> of children didn’t meet the criteria for diagnosis but were nonetheless included and later counted as not growing up to be trans. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/211133/original/file-20180320-31599-11kzbvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211133/original/file-20180320-31599-11kzbvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211133/original/file-20180320-31599-11kzbvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211133/original/file-20180320-31599-11kzbvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211133/original/file-20180320-31599-11kzbvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211133/original/file-20180320-31599-11kzbvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211133/original/file-20180320-31599-11kzbvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents march in the Pride Parade in Stockholm, Sweden, July 2016.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>According to <a href="http://www.jaacap.com/article/S0890-8567(15)00794-7/abstract">Dr. Kristina Olson</a>, who offers careful criticisms of the studies, as many as 90 per cent of these children probably would have shown themselves not to be trans had researchers simply asked them: “Are you a boy/girl?” This is one of the indicators used today to tell whether a child is trans or simply gender non-conforming.</p>
<p>And the 40 per cent of children who simply refused to participate were assumed by the researchers to no longer to be trans. The statistic is simply out of sync with the current state of scientific knowledge on trans children. </p>
<p>As the mental health director of the University of California at San Francisco Child and Adolescent Gender Center, <a href="http://www.dianeehrensaft.com/">Diane Ehrensaft</a>, points out in a peer-reviewed article, <a href="http://www.tandfonline.com/doi/abs/10.1080/00107530.2014.942591">experienced therapists are typically capable of telling whether a young child is transgender — though perhaps not at first glance</a>.</p>
<h2>Rapid-onset gender dysphoria</h2>
<p>There is <a href="https://www.sciencedirect.com/science/article/pii/S1054139X16307650?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb">one research study</a> that seeks to document the existence of rapid-onset gender dysphoria. This too is <a href="https://genderanalysis.net/2017/07/fresh-trans-myths-of-2017-rapid-onset-gender-dysphoria/">riddled with flaws</a>. </p>
<p>The study was based on parental reporting and the participants came from websites where reports of rapid-onset gender dysphoria had cropped up. It was heavily biased towards specific groups and in no way can be said to be representative of the general population. Ultimately, the study tells us less about trans teenagers than it does about the parents being surveyed. </p>
<p>The fact that there are more children who were assigned female at birth in the pool of children said to have rapid-onset gender dysphoria is used as evidence that it is not a natural phenomenon, but rather reveals that young girls are fleeing their womanhood under the pressure of misogyny or peer pressure.</p>
<p>That most of the children surveyed were said to be girls can, however, be explained by other facts — including the fact that gender non-conformity among men is more likely to prompt consultation at a gender identity clinic. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/211215/original/file-20180320-31611-wp8wmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211215/original/file-20180320-31611-wp8wmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211215/original/file-20180320-31611-wp8wmo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211215/original/file-20180320-31611-wp8wmo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211215/original/file-20180320-31611-wp8wmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211215/original/file-20180320-31611-wp8wmo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211215/original/file-20180320-31611-wp8wmo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The goal of gender-affirmative therapy is to listen to, and follow, the child on gender identity and gender expression.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Furthermore, gender non-conforming girls have been historically underrepresented in clinics despite the ratio of trans men to trans women being roughly 50-50 in adulthood. Changes in referral patterns could just be a regression toward the mean.</p>
<p>More and more teenagers are coming out. This is neither a surprise nor is it bad. Coming out, almost universally, carries not only some degree of personal stress but requires one to openly confront societal prejudices. </p>
<p>As trans realities become more and more widely known, it becomes easier for trans people to understand their internal turmoil and open up about the fact that they are, indeed, trans. </p>
<p>As we make friends who are trans, they help us understand ourselves and support us through the coming-out process. We should rejoice in the fact that trans visibility is helping more people realize they are trans — ourselves included, a few years ago.</p>
<h2>Gender-affirmative therapy</h2>
<p>The goal of gender-affirmative therapy is not transition, contrary to what proponents of rapid-onset gender dysphoria claim. The goal is to <a href="https://www.karger.com/Article/Fulltext/355235">“listen to the child and decipher with the help of parents or caregivers what the child is communicating about both gender identity and gender expression.”</a></p>
<p>Instead of encouraging the child not to be transgender and risking pushing them back into the closet, therapists seek to support the child and their parents throughout the process of exploring gender. They remain neutral with regards to whether the child should be trans or not.</p>
<p>And as for gender non-conforming behaviour like cross-dressing which some therapists seek to discourage, why not just let the child express themselves freely? </p>
<p>Maybe they are not trans. Maybe they <a href="https://www.vox.com/2016/6/6/11853060/transgender-children-parents">just want to wear those clothes and play with those toys.</a> Often you can tell just by listening to the child, though they may not say it in easy-to-understand terms.</p>
<h2>Follow the child</h2>
<p>Gender non-conforming children aren’t all being treated alike, contrary to what <a href="https://www.theglobeandmail.com/opinion/dont-treat-all-cases-of-gender-dysphoria-the-same-way/article37711831/">Debra Soh’s op-ed</a> claims. </p>
<p>Transgender children aren’t treated the same as cisgender (non-transgender) children by gender-affirmative therapists. And transgender children aren’t all being treated alike either, because each has different desires and different needs.</p>
<p>Gender-affirmative therapy’s motto is: “Follow the child.” If that means following them to social transition and, in due time, <a href="https://www.healio.com/endocrinology/pediatric-endocrinology/news/print/endocrine-today/%7B69c4c36a-37c3-4053-a856-22a27f8df62c%7D/pubertal-blockade-safe-for-pediatric-patients-with-gender-identity-disorder">medical transition</a>, then so be it. But only if that’s what they truly want.</p>
<p>Transgender children are in good hands. Therapists aren’t acting hastily in ignorance of scientific evidence. On the contrary, their approach is one that’s been built over decades of research and of following trans children. </p>
<p>The unfounded idea of rapid-onset gender dysphoria is a poor attempt at manufacturing a new moral panic — based on the same old idea of “contagion” — over children who couldn’t be in safer hands.</p>
<p><em>Another version of this article, with signatories, is <a href="https://medium.com/p/f8d25ac40a96/">published on Medium</a>.</em></p><img src="https://counter.theconversation.com/content/92742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Florence Ashley is a recipient of the Bourse Dorais-Ryan in LGBT research. They are affiliated with the Trans Legal Clinic at McGill University and the Conseil québécois LGBT.</span></em></p><p class="fine-print"><em><span>Alexandre Baril does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Rapid-onset gender dysphoria’ suggests children are being persuaded into transgender identities before they know what that means. This theory is best explained by transphobia and research study biases.Florence Ashley, LL.M. Candidate in Law and Bioethics, McGill UniversityAlexandre Baril, Assistant Professor of Social Work, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.