March 31 is International Transgender Day of Visibility
While trans folks have been extremely visible as of late, it’s probably not for the reasons they’d like.
The day was started 15 years ago as an opportunity to combat the seemingly exclusively negative portrayals of trans people in the media, which are many Americans’ only points of reference.
Its purpose feels more relevant than ever today, as our country’s fixation on gender identity continues to grow.
To really understand this topic, we of course have to dive into some basics and terminology.
We’re starting with sex, the label that’s given to an individual at birth based on the outward appearance of their genitals: male or female.
While it seems like that would be a simple binary (one or the other), it’s really not.
For any rule one might want to use to define someone’s “sex,” be it chromosomes, hormones, or reproductive organs, there are always exceptions.
Some people with XY chromosomes (which are typically associated with males) fail to develop the corresponding external genital as an embryo and are marked as “girl” on their birth certificate.
Some people with XX chromosomes, historically associated with females, can have high levels of testosterone which cause them to grow excess facial hair like a man.
And if biological sex isn’t really a binary, then why should we expect gender to be?
Gender is a construct.
What that means is that it’s largely our society and culture that shape what it means to be a man or a woman.
The way each gender should look, or act, or sound, or the things they should be interested in are all just sort of…made up by the culture in which they live.
What it means to be a man in one country might be different from what it means in another.
Sometimes people have a hard time understanding this. They get very set in their ideas of how things “should be.” Perhaps it makes them uncomfortable to not be able to easily label strangers they meet. But we see these conflicts play out constantly, even when trans people aren’t involved.
Think of the people you know who insist that women shouldn’t have short hair or that men shouldn’t wear jewelry.
The “metrosexual” craze of the early 2000s was literally just national confusion over heterosexual men who cared about personal hygiene, because that’s “for girls.”
Gender identity is the gender that they feel aligns with who they are as a person.
So someone’s gender identity is their intrinsic sense of self.
People whose gender identity matches the sex they were assigned at birth are known as “cisgender.”
Despite the claims by some people that cisgender is a slur, it’s actually just a word derived from the Latin prefix “cis,” which means “on the side of,” indicating that someone’s sex assigned at birth and their gender identity have always been aligned.
Many people are cisgender …over 97% of the population.
Less than 1% of the U.S. population identifies as trans (the rest identify as non-binary, intersex, or gender non-conforming, also known as “gender diverse”).
This less-than-1% of people who have a sex assigned at birth and gender identity at odds are often, but not always, known as transgender, from the Latin prefix “across.”
The process of a transgender person getting their gender identity to align with the sex they were assigned at birth is known as “transition,” and it can take many forms.
Social transition is the act of changing aspects of one's identity that don’t require medical interventions and are easily reversible.
It could be things like asking people to call you by a different name or use different pronouns and changing your clothing style or personal grooming.
These changes can have a huge impact. One study found that being called by a preferred name in just one area of someone’s life reduced their risk of suicide by 56%.
Legal transition similarly does not require medical intervention and includes things like legal name changes or updating gender markers on official documents like driver’s licenses or passports.
The options for medical transition can vary. For trans adults it might include things like hormone therapies, which can influence the sound of their voice and facial or body structures.
Or it could include things like top surgery to remove breast tissue or to add breast implants, bottom surgery to align external genitalia with their gender identity, or surgeries like facial feminization.
Hormone therapy and surgeries are known as “gender-affirming care.” But they aren’t exclusive to trans people.
For example, cisgendered women who get breast implants are also receiving gender-affirming care—a surgery to make their bodies feel more representative of themselves.
But what about the children?
A lot of the trans panic is around the idea that more and more children are undergoing irreversible surgeries or taking dangerous medications that they could later regret—but the data doesn't support this.
One study looked at youth aged 8-17 with private insurance who identify as transgender or gender diverse to see how common puberty blockers or hormone therapies were.
It found that less than 0.1% of transgender teens receive medications as part of their transitions. Most just socially transition, which is entirely reversible.
Over the five-year period that the study included, there were fewer than 1000 kids total who accessed puberty blockers and fewer than 2000 kids who accessed hormones.
And this was a study that was conducted prior to many states making it illegal for doctors to prescribe hormones or puberty blockers to transgender children.
So even at a time when access wasn’t legally restricted, there was still an extremely small number of prescriptions.
Puberty blockers also only seem to be an issue now that they are being used to help children explore their gender identity.
For decades, puberty blockers have been used to suppress the hormones that trigger puberty in cisgendered kids experiencing what’s known as “precocious puberty,” or puberty that starts at an extremely young age, and studies following those kid’s outcomes indicate they’ve beenfine.
These medications can be started during the first stages of puberty to prevent it progressing, so a child who is questioning their gender has more time to figure things out without developing physical features of a body they feel doesn’t match their identity and could cause them undo stress.
And unlike puberty itself, puberty blockers are reversible—stop taking the drugs and puberty begins.
There’s some evidence that prolonged use of puberty blockers can impact bone mineralization, but it’s not completely clear why. Other factors like lack of exercise might be contributing.
The argument for restricting their use has centered around potential medication safety concerns, but none of the legislation has applied to its use in cisgender kids, only trans.
Despite what some may falsely claim about gender-affirming surgeries happening in schools, rates of surgical interventions in transgender youth are also incredibly low.
One study that looked at rates of gender-affirming surgeries among people with transgender and gender diverse diagnoses in 2019 found that for every 100k trans youth between 15 and 17 years old, two were receiving gender-affirming surgeries, and zero gender-affirming surgeries were happening in kids under 12 years old.
Of the surgeries that did happen on minors, 96% were chest-related, but the vast majority of those were happening on cisgendered males.
That’s because of a condition called gynecomastia, in which men produce higher than normal levels of estrogen which results in the growth of breast tissue.
Ninety-seven percent of the breast reductions included in this study that were performed on minors were performed on people who were assigned male at birth, continue to identify as men, and wanted to affirm their male identity by having breast tissue removed.
Gender-affirming care has extremely positive outcomes for everyone.
Transgender youth who receive puberty blockers are at a lower risk of suicide than those who do not.
Transgender youth (under 24 years old) who receive gender-affirming hormone therapy are less likely to experience depression or suicidal ideation.
Both transgender youth and adults have extremely low levels of regret when it comes to medical interventions for transition.
A systematic review found the regret rate for gender-affirming surgery was less than 1%.
For comparison, it’s estimated that around 7% of all parents regret having children.
In the largest-ever survey of trans Americans, 97% of those who received gender-affirming surgery and 98% of those receiving hormone therapy said they were more satisfied with their lives.
It’s because of this satisfaction with getting care and risk of suicide if care is denied that every major medical association and leading world health organizations support health care for transgender youth and adults.
The fact of the matter is that transgender people have always existed.
Ancient Sumerian priests who were assigned male at birth were noted to cross gender boundaries in their worship.
There are accounts of female-born Civil War veterans who disguised themselves as males to fight and then continued to live their rest of their days as men.
The first American to publicly undergo gender-affirming surgeries was a WWII veteran.
The first clinic for gender-affirming care was opened in Berlin in 1919 and provided both surgeries and hormone therapies, as well sexual and mental health counseling.
And if you’re surprised to learn the history of transgender people goes back so far, it’s probably because part of that history is that governments have tried to erase it.
That Berlin Institute for Sexual Research that was opened in 1919 had an extensive library of over 20,000 books on gender-non-conforming history and medical studies.
Those volumes, many irreplaceable, were destroyed in one of the first book burnings by the Nazi Party in May of 1933.
And, per usual, history repeats itself.
Shortly after being sworn in, the Trump administration released an executive order stating that there are only two genders, which are assigned at birth based on reproductive cells, and that any mention of “gender ideology” beyond this will be removed from all agency websites.
As a result, the CDC mandated all papers by its employees that were under review for publication be withdrawn to have terms like “transgender,” “non-binary,” or “gender” removed.
The administration has also released a number of official and unofficial guidance on words that agencies caution could trigger additional review if used in grant applications or contracts, or that should be removed immediately from government websites.
It includes words or phrases like “transgender,” “they/them,” “non-binary,” “LGBTQ,” and “pregnant people.”
Even the website for the Stonewall National Monument, which was established under the Obama administration to commemorate the uprising that is viewed as the start of the gay rights movement, has had the T (for “transgender”) removed from any mention of the history of the LGBT movement on their
This is despite the fact that Marsha P. Johnson and Sylvia Rivera, two transgender women and activists, were instrumental in the uprising, along with other gay, lesbian, queer, and non-conforming people.
The current attacks on trans or gender-non-conforming people aren’t just limited to erasure from history, they also include legislation set to limit both their access to medical care and the ability to participate in daily life.
