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Transgender

gender identity different to the gender assigned at birth
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Transgender people have a gender identity that differs from their biological sex. Such individuals have either have been medically diagnosed as suffering from Gender dysphoria, and may be in the process of transitioning to the other sex, or self-identify as the other gender.

While some cisgender people refuse to take our experiences seriously, the fact of the matter is that transgender people can be found in virtually every culture and throughout history; current estimates suggest that we make up 0.2 – 0.3% of the population [or possibly more]. [...] In other words, we simply exist. —Julia Serano
Every day you're seeing our existence debated. Transgender people are so very real. ~ Elliot Page
For me, it's always important to support other transgender people, to love and support each other. There's enough spotlight, there are enough resources to go around, so for me it's always about loving and supporting my trans siblings. —Laverne Cox
Do we have a theory on why people are gay? No. They just are. The only reason we even feel like we need a theory about trans people is that society is so unaccepting of us that it’s constantly demanding we justify our own reality. —Natalie Wynn
The narrative on trans issues has been controlled by people who have no understanding of them. Social media is about us grabbing the narrative back and telling our own stories – this is our reality, this is what we go through and this is what matters to us. We're here, we're in your face, we definitely exist. —Paris Lees


Arranged alphabetically by author or source:
A · B · C · D · E · F · G · H · I · J · K · L · M · N · O · P · Q · R · S · T · U · V · W · X · Y · Z · See also · External links

A

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  • “The AMA opposes the dangerous intrusion of government into the practice of medicine and the criminalization of health care decision-making,” said AMA Board Member Michael Suk, MD, JD, MPH, MBA. “Gender-affirming care is medically-necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people.”
    Most recently in April 2021, the AMA delivered a letter (PDF) to the National Governors Association urging its members to oppose legislative dictates that inappropriately limit the range of options physicians and families may consider when making decisions for gender-diverse pediatric patients. The letter cited evidence demonstrating that forgoing gender-affirming care can have tragic consequences for transgender individuals who face increased risk of anxiety, stress, substance use disorder and suicide. The majority of transgender and diverse-gender patients report improved mental health and lower rates of suicide after receipt of gender-affirming care.

B

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  • Evidence suggests that less than 1% of transgender people who undergo gender-affirming surgery report regret. That proportion is even more striking when compared to the fact that 14.4% of the broader population reports regret after similar surgeries.
    For example, studies have found that between 5% and 14% of all women who receive mastectomies to reduce the risk of developing breast cancer say they regretted doing so. However, less than 1% of transgender men who receive the same procedure report regret.
    These statistics are based on reviews of existing studies that investigated regret among 7,928 transgender individuals who received gender-affirming surgeries. Although some of this prior research has been criticized for overlooking the fact that regret can sometimes take years to develop, it aligns with the growing body of studies that show positive health outcomes among transgender people who receive gender-affirming care.
  • About 1.6 million people in the U.S. identify as transgender. While only about 25% of these individuals have obtained gender-affirming surgeries, these procedures have become more commonplace. From 2016 to 2020, roughly 48,000 trans people in the U.S. received gender-affirming surgeries.
    These procedures provide transgender people with the opportunity to align their physical bodies with their gender identity, which could positively impact mental health. Research shows that access to gender-affirming surgeries may reduce levels of depression, anxiety and suicidal ideation among transgender people.
    The mental health benefits may explain the low levels of regret. Transgender people have far higher rates of mental health concerns than cisgender people, or people whose gender identity aligns with their sex at birth. This is largely because transgender people have a more difficult time living authentically without experiencing discrimination, harassment and violence.
  • Gender-affirming surgery often involves going through a number of hoops: waiting periods, hormone therapy and learning about the potential risks and benefits of the procedures. Although most surgeries are reserved for adults, the leading guidelines recommend that patients be at least 15 years old.
    This thorough process that trans people go through before receiving surgery may also explain the lower levels of regret.
    In addition, many cisgender people get surgeries that, in their ideal world, they wouldn’t receive. But they go through with the surgery in order to prevent a health problem.
  • Purpose of review
    Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research.
    Recent findings 
    Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking.
    Summary
    Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.
  • Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.

C

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  • The preoccupation with transition and surgery objectifies trans people. And then we don't get to really deal with the real lived experiences. The reality of trans people's lives is that so often we are targets of violence. We experience discrimination disproportionately to the rest of the community. Our unemployment rate is twice the national average; if you are a trans person of color, that rate is four times the national average. The homicide rate is highest among trans women. If we focus on transition, we don't actually get to talk about those things.

D

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Hence sprang the fable of Tiresias,
That he the pleasure of both sexes tryde;
For in a daunce he man and woman was
By often chaunge of place from side to side;
But for the woman easily did slide
  And smoothly swim with cunning hidden art,
  He tooke more pleasure in a woman’s part.
—John Davies
  • And how was Caeneus made at first a man,
    And then a woman, then a man againe,
    But in a daunce? which when he first began
    Hee the man’s part in measure did sustaine:
    But when he chang’d into a second straine,
      He daunc’d the woman’s part another space,
      And then return’d into his former place.
    Hence sprang the fable of Tiresias,
    That he the pleasure of both sexes tryde;
    For in a daunce he man and woman was
    By often chaunge of place from side to side;
    But for the woman easily did slide
      And smoothly swim with cunning hidden art,
      He tooke more pleasure in a woman’s part.

F

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The liberation of trans people would improve the lives of everyone in our society. I say 'liberation' because I believe that the humbler goals of 'trans rights' or 'trans equality' are insufficient. Trans people should not aspire to be equals in a world that remains both capitalist and patriarchal and which exploits and degrades those who live in it. Rather, we ought to seek justice – for ourselves and others alike. —Shon Faye
  • The liberation of trans people would improve the lives of everyone in our society. I say 'liberation' because I believe that the humbler goals of 'trans rights' or 'trans equality' are insufficient. Trans people should not aspire to be equals in a world that remains both capitalist and patriarchal and which exploits and degrades those who live in it. Rather, we ought to seek justice – for ourselves and others alike. Trans people have endured over a century of injustice. We have been discriminated against, pathologized and victimized. Our full emancipation will only be achieved if we can imagine a society that is completely transformed from the one in which we live.
  • The demand for true trans liberation echoes and overlaps with the demands of workers, socialists, feminists, anti-racists and queer people. They are radical demands, in that they go to the root of what our society is and what it could be. For this reason, the existence of trans people is a source of constant anxiety for many who are either invested in the status quo or fearful about what would replace it. In order to neutralize the potential threat to social norms posed by trans people's existence, the establishment has always sought to confine and curtail their freedom. In twenty-first-century Britain, this has been achieved in large part by belittling our political needs and turning them into a culture war 'issue'. Typically, trans people are lumped together as 'the transgender issue', dismissing and erasing the complexity of trans lives, reducing them to a set of stereotypes on which various social anxieties can be brought to bear. By and large, the transgender issue is seen as a 'toxic debate', a 'difficult topic' chewed over (usually by people who are not trans themselves) on television shows, in newspaper opinion pieces and in university philosophy departments. Actual trans people are rarely to be seen.
  • ‘Trans’ [...] is an umbrella term that describes people whose gender identity (their personal sense of their own gender) varies from, does not sit comfortably with, or is different from, the biological sex recorded on their birth certificate based on the appearance of their external genitalia. The standard view of how sex and gender manifest in the world is as follows. Babies born with observable penises are recorded as male, referred to and raised as boys, and as adults are men; babies born with observable vulvas are recorded as female, referred to and raised as girls, and as adults are women. To be trans is, on some level, to feel that this standardized relationship between one’s genitalia at birth and the assignment of one of two fixed gender identities that are supposed to accurately reflect your feelings about your own body has been interrupted. How the person who experiences this interruption reacts to it can vary hugely – which is why ‘trans’ is a catch-all word for a diverse range of identities and experiences.
  • When we talk about trans people, we’re usually referring to individuals who were either recorded as male at birth but who understand themselves to be women (trans women) or, vice versa, were recorded as female at birth but who understand themselves to be men (trans men). Not all trans people, however, find simply moving between the pre-existing categories of man and woman satisfactory, accurate or desirable. Such trans people, who are less well understood, generally unsettle mainstream society more than trans men and women, because they challenge not only the prevailing idea that birth genitals and gender are inseparable, but also the idea that there are just two gender categories. Often, these people are accused of making up their experience out of a need for attention or a desire to feel special – though in reality the political, economic and social costs for such ‘non-binary’ trans people (who don’t straightforwardly see themselves as men or women) can be immense.
  • Suicide attempts occur at a higher rate among trans people than the general population. Indeed, the statistics are truly alarming: research by the UK charity Stonewall published in 2017 found that 45 per cent of trans young people had attempted suicide at least once. Yet, behind the statistics are individuals, suffering in private and leading complex human lives: there is rarely one simple explanation for such a tragedy.
  • In the final months of her life, when she must have been experiencing a degree of mental anguish, Lucy Meadows was bullied, harassed, ridiculed and demonized by the British media. Her death remains one of the darkest chapters in the British trans community’s history, and one of the most shameful episodes in the long and shameful history of the British tabloid press. [...] By the end of the 2010s, trans people weren’t the occasional freak show in the pages of a red-top tabloid. Rather, we were in the headlines of almost every major newspaper every single day. We were no longer portrayed as the ridiculous but unthreatening provincial mechanic who was having a ‘sex swap’; now, we were depicted as the proponents of a powerful new ‘ideology’ that was capturing institutions and dominating public life. No longer something to be jeered at, we were instead something to be feared. Soon after the Lucy Meadows inquest, that fleeting opportunity to shed light on the bullying of trans people evaporated. In the intervening years, the press flipped the narrative: it was trans people who were the bullies.
  • The media agenda with respect to ‘the transgender issue’ is often cynical and unhelpful to the cause of trans justice and liberation. Media coverage of the trans community rarely seems to be driven by a desire to inform and educate the public about the actual issues and challenges facing a group who – as all evidence indicates – are likely to experience severe discrimination throughout their lives. Today, the typical news item on trans people features a debate between a trans advocate on one side and a person with ‘concerns’ on the other – as if both parties were equally affected by the discussion. As trans people face a broken healthcare system – which in turn leaves them with a desperate lack of support both with their gender and the mental health impacts of the all-too-commonly associated problems of family rejection, bullying, homelessness and unemployment – trans people with any kind of platform or access have tried to focus media reporting on these issues, to no avail. Instead, we are invited on television to debate whether trans people should be allowed to use public toilets. Trans people have been dehumanized, reduced to a talking point or conceptual problem: an ‘issue’ to be discussed and debated endlessly. It turns out that when the media want to talk about trans issues, it means they want to talk about their issues with us, not the challenges facing us.
  • Human beings rely on familiarity to understand and empathize with others, and we find it easier to extend compassion to those we can relate to. Given that, like any minority, trans people are unfamiliar to the average person, we rely more heavily on media representation, on political solidarity from people who aren’t trans and vocal, and ongoing support from public institutions to create the right conditions for understanding and compassion from the rest of society. By the same token, we’re especially vulnerable to the spread of misinformation, harmful stereotypes and repeated prejudicial tropes. And the latter, unfortunately, are widespread in public culture, just as they have been throughout history. Trans people are discriminated against, harassed and subjected to violence around the world because of deep prejudices that have been embedded into the fabric of our culture, poisoning our capacity to empathize, and even to accept trans people as fully human.
  • Family rejection and estrangement have devastating long-term health implications. They also have a material impact. For some kids, the only option is leaving home. Others have no option at all: their parents kick them out. As a result, trans teenagers and young adults in Britain are much more likely to experience homelessness than their cisgender peers. [...] A minority within a minority, trans young people are disproportionately over-represented in the homeless population: one in four trans people have experienced homelessness.
  • In general, trans people are more likely to have lower incomes and to experience poverty than the wider population. [...] Prejudice persists. It is not just a personal affront, but an economic reality that shapes and limits trans lives.
  • The experience of being trans is shaped by social class. While there are middle-class trans people, the vast majority are working class – just as the vast majority of the total population is working class. Trans workers are often employed in lower paid and more precarious jobs, with a high risk of discrimination and bullying in the workplace. As a result, trans political struggle is part of a wider class struggle. Despite this, trans politics is commonly misrepresented as coddled, bourgeois and anti-working class.
  • A key tenet of the drive by trans people towards ‘visibility’ in mainstream media in the past decade has been the belief that, the greater amount of more accurate media coverage, the more chance trans people have of encouraging empathy in the wider population. This, it is hoped, will make people want to treat trans individuals better both in daily life and in policy. This strategy hasn’t worked – or, at least, it hasn’t worked sufficiently to materially improve the lives of the majority of trans people. The problem is that it involves a rose-tinted view of the media, which is imagined as some kind of benevolent megaphone, which amplifies our voices, uncovers truth and educates. This is an apolitical understanding of the raison d’être of the media in a capitalist society, which – as for any other industry – is first and foremost to make money.
  • To this end, much of the mainstream media exists to entertain people, for which purposes it clings to tried and tested formulas and conventions, to avoid any risk to its revenue streams. In the case of trans people, it tends to focus less on what wider society might recognize as familiar about our experience, instead foregrounding what makes us different, peculiar, titillating, aggravating or freakish. Cisgender people, media bosses conclude, do not want to watch a news item about a trans call-centre worker talking about his poor pay and how his shift patterns make medical appointments difficult – because it is depressing and, arguably, familiar to many low-paid non-trans people with medical conditions of their own. [...] Trans bodies when objectified are entertainment; trans bodies when at work in the service of profit are not.
  • Generally, trans people remain confined to lower-paid, more precarious roles even in the organizations that campaign for our welfare. In particular, Black and Asian trans communities in Britain remain completely under-represented in LGBTQ+ sector organizations; these are the same communities experiencing the brunt of systemic anti-LGBTQ+ oppression in the UK.
  • Trans people are emblematic of wider, conceptual concerns about the autonomy of the individual in society. Their rejection of dominant, ancient and deep-seated ideas about the connection between biological characteristics and identity causes a dilemma for the nation state: whether to acknowledge and give credence to the individual’s assertion of their own identity in law and in culture; or to mandate that it, the state, is the final authority on identity, and to assert its power over the individual – by force if necessary. Attacking the very concept of trans people by imposing rigid and immutable definitions of sex and gender, as Orbán’s Fidesz party has done, is the latest iteration of the way national governments embrace totalitarian ideology. After all, attacking trans people has been a part of fascist practice since the destruction of Magnus Hirschfeld’s Berlin Institute of Sexology back in 1933 by Nazi youth brigades.
  • Being trans, of course, is not a consciously adopted political position, just as claiming a trans identity is not, usually, an expression of a consciously held ideology. A trans person is just a person. We see our daily lives through the same everyday lens as most human beings; after all, we are simply trying to live. However, as with all stigmatized social identities, the very ability to articulate being trans, or to work, seek healthcare, or participate in civic life while trans, is political.
  • Hope is part of the human condition and trans people’s hope is our proof that we are fully human. We are not an ‘issue’ to be debated and derided. We are symbols of hope for many non-trans people, too, who see in our lives the possibility of living more fully and freely. That is why some people hate us: they are frightened by the gleaming opulence of our freedom. Our existence enriches this world.

H

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  • Among countries that expressly forbid expression of transgender identities, at least two, Brunei and Oman, have national laws that criminalize “posing as” or “imitating” a person of a different sex. Saudi Arabia has no codified law, but police routinely arrest people based on their gender expression. Malaysia also criminalizes “posing as” a different sex, not in its federal criminal code but in the Sharia codes of each of its states and its federal territory. Nigeria criminalizes transgender and gender nonconforming people in its northern states under Sharia.
    In South Sudan, such laws only apply to men who “dress as women” and in Malawi, men who wear their hair long. Tonga prohibits any “male person” from presenting as a female while “soliciting for an immoral purpose, in a public place with intent to deceive any other person as to his true sex.”
    In the United Arab Emirates, laws prohibit men “posing as” women in order to enter women-only spaces. The UAE has used this law to prosecute gay and transgender people even in mixed-gender spaces. Other countries with similar laws on “women-only” spaces have not done so, to our knowledge, and are not included in these maps.

"How Many Adults and Youth Identify as Transgender in the United States?" (June 2022)

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Jody L. Herman, Andrew R. Flores, Kathryn K. O’Neill; “How Many Adults and Youth Identify as Transgender in the United States?", Williams Institute, (June 2022)

  • The report of the 2015 USTS provides a detailed look at the experiences of transgender people across a wide range of categories, such as education, employment, family life, health, housing, and interactions with the criminal justice system. The findings reveal disturbing patterns of mistreatment and discrimination and startling disparities between transgender people in the survey and the U.S. population when it comes to the most basic elements of life, such as finding a job, having a place to live, accessing medical care, and enjoying the support of family and community. Survey respondents also experienced harassment and violence at alarmingly high rates.
    • p.4
  • Respondents reported high levels of mistreatment, harassment, and violence in every aspect of life. One in ten (10%) of those who were out to their immediate family reported that a family member was violent towards them because they were transgender, and 8% were kicked out of the house because they were transgender.
    The majority of respondents who were out or perceived as transgender while in school (K–12) experienced some form of mistreatment, including being verbally harassed (54%), physically attacked (24%), and sexually assaulted (13%) because they were transgender. Further, 17% experienced such severe mistreatment that they left a school as a result.
    In the year prior to completing the survey, 30% of respondents who had a job reported being fired, denied a promotion, or experiencing some other form of mistreatment in the workplace due to their gender identity or expression, such as being verbally harassed or physically or sexually assaulted at work.
    In the year prior to completing the survey, 46% of respondents were verbally harassed and 9% were physically attacked because of being transgender. During that same time period, 10% of respondents were sexually assaulted, and nearly half (47%) were sexually assaulted at some point in their lifetime.
    • p.4
  • The findings show large economic disparities between transgender people in the survey and the U.S. population. Nearly one-third (29%) of respondents were living in poverty, compared to 12% in the U.S. population. A major contributor to the high rate of poverty is likely respondents’ 15% unemployment rate—three times higher than the unemployment rate in the U.S. population at the time of the survey (5%).
    Respondents were also far less likely to own a home, with only 16% of respondents reporting homeownership, compared to 63% of the U.S. population. Even more concerning, nearly one-third (30%) of respondents have experienced homelessness at some point in their lifetime, and 12% reported experiencing homelessness in the year prior to completing the survey because they were transgender.
    • p.5
  • The findings paint a troubling picture of the impact of stigma and discrimination on the health of many transgender people. A staggering 39% of respondents experienced serious psychological distress in the month prior to completing the survey, compared with only 5% of the U.S. population. Among the starkest findings is that 40% of respondents have attempted suicide in their lifetime—nearly nine times the attempted suicide rate in the U.S. population (4.6%).
    Respondents also encountered high levels of mistreatment when seeking health care. In the year prior to completing the survey, one-third (33%) of those who saw a health care provider had at least one negative experience related to being transgender, such as being verbally harassed or refused treatment because of their gender identity. Additionally, nearly one-quarter (23%) of respondents reported that they did not seek the health care they needed in the year prior to completing the survey due to fear of being mistreated as a transgender person, and 33% did not go to a health care provider when needed because they could not afford it.
    • p.5
  • When respondents’ experiences are examined by race and ethnicity, a clear and disturbing pattern is revealed: transgender people of color experience deeper and broader patterns of discrimination than white respondents and the U.S. population. While respondents in the USTS sample overall were more than twice as likely as the U.S. population to be living in poverty, people of color, including Latino/a (43%), American Indian (41%), multiracial (40%), and Black (38%) respondents, were more than three times as likely as the U.S. population (12%) to be living in poverty. The unemployment rate among transgender people of color (20%) was four times higher than the U.S. unemployment rate (5%). People of color also experienced greater health disparities. While 1.4% of all respondents were living with HIV— nearly five times the rate in the U.S. population (0.3%)—the rate among Black respondents (6.7%) was substantially higher, and the rate for Black transgender women was a staggering 19%.
    Undocumented respondents were also more likely to face severe economic hardship and violence than other respondents. In the year prior to completing the survey, nearly one quarter (24%) of undocumented respondents were physically attacked. Additionally, one half (50%) of undocumented respondents have experienced homelessness in their lifetime, and 68% have faced intimate partner violence.
    Respondents with disabilities also faced higher rates of economic instability and mistreatment. Nearly one-quarter (24%) were unemployed, and 45% were living in poverty. Transgender people with disabilities were more likely to be currently experiencing serious psychological distress (59%) and more likely to have attempted suicide in their lifetime (54%). They also reported higher rates of mistreatment by health care providers (42%).
    • p.6

J

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  • Detransitioners speak of trauma from experimental drugs and surgeries, of having been manipulated and deceived by adults, and of being abandoned by friends when they detransitioned. I have seen them abused and defamed on social media, accused of being transphobes and liars, and of trying to stop genuine trans people getting the treatments they need. In fact, most are simply urging caution, and have no desire to stop others living as they wish. Their most obvious wounds are physical: mastectomies; castration; bodies shaped by cross-sex hormones. But the mental wounds go deeper. They bought into an ideology that is incoherent and constantly shifting, and where the slightest deviation is ferociously punished. They were led to believe that parents who expressed concern about the impact of powerful drugs on developing minds and bodies were hateful bigots, and that the only conceivable alternative to transition was suicide.
    • Helen Joyce, Trans - When Ideology Meets Reality, p. 10
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  • Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. T
    • p.1
  • Gender-affirming treatment remains a topic of controversy, with many calling for greater access to gender affirming treatments to foster psychological well-being for transgender, nonbinary, and intersex individuals. There is accumulating literature that suggests transgender individuals suffer worse mental health outcomes than their cisgender peers; of particular concern is increased suicidality.
    The literature to date reveals concerning trends regarding suicidality in transgender individuals. A high prevalence of suicide attempts and thoughts of suicide occur in transgender youth compared to their cisgender peers. Transgender US military veterans have more than 20 times higher rates of suicide-related events than cisgender veterans. The prevalence of suicidal ideation and attempts varies by sample, with the prevalence of suicidal ideation sometimes as high as 50-75%. Rates of attempted suicide can reach peaks of 30% and above. One longitudinal study of over 6,000 transgender individuals in the US indicates that the highest risk of suicide is among those under 18 years of age.
    Transgender individuals are also at increased susceptibility for various suicide risk-enhancing factors, as a growing body of literature suggests that transgender individuals face a high burden of chronic health conditions, psychiatric illnesses and their comorbidities, substance use], trauma and victimization, and housing and employment discrimination.
    In light of this high prevalence of suicidality and the proliferation of gender-affirming treatments, a common argument by advocates of gender-affirming treatments is that such treatments are needed to reduce suicidality.
    • p.1
  • Clinical judgment, rather than an indiscriminatory tabulation of risk-enhancing factors for suicide, will ultimately be needed, as “no study has identified one specific risk factor or set of risk factors as specifically predictive of suicide or other suicidal behavior”. Risk-enhancing factors for suicide may act in a synergistic manner, with mood disorders, substance use, physical and sexual abuse, minority sexual orientation, disturbed family relationships, parental psychopathology, and various precipitating stress events leading to near-infinite permutations of suicide risk that is ultimately expressed and unique on an individual level. This is especially the case for TGD individuals, for they constitute “heterogeneous groups of individuals with multiple intersecting identities” that may contribute to different levels of risk for suicide.
    • pp.12-13

K

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  • The most frequent sexual dysfunctions experienced by trans women and trans men were difficulties initiating and seeking sexual contact (26% and 32%, respectively) and difficulties achieving an orgasm (29% and 15%, respectively). Compared with trans women after hormone treatment and non-genital surgery, trans women after vaginoplasty less often experienced arousal difficulties, sexual aversion, and low sexual desire. Compared with trans men without medical treatment, trans men after a phalloplasty experienced sexual aversion and low sexual desire less often.
  • Sexual dysfunctions among trans men and women were very common among the various treatment groups and were unrelated to intentions to have further genital treatment. Although medical treatment may be helpful or even essential to developing good sexual health, a significant group of trans persons experienced sexual dysfunctions after genital surgery.

L

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  • People have been taking the piss out of trans people for 60 years. The narrative on trans issues has been controlled by people who have no understanding of them. Social media is about us grabbing the narrative back and telling our own stories – this is our reality, this is what we go through and this is what matters to us. We're here, we're in your face, we definitely exist. That's the most important thing – realising we exist.
  • Trans persons appear to report generally lower levels of sexual health, according to several studies, though it should be noted that the field of trans medicine is advancing quickly. Trans men appear more likely to report orgasms and sexual arousal post-transition compared to trans women, though it is unknown whether this is related to the fact that most trans men do not go through "bottom surgery" and retain their clitoris and vagina. In addition, trans women historically demonstrate higher levels of discomfort with their genitals and sexual arousal, compared to trans men. Trans women are much more likely to report sexual arousal without orgasm, and lower levels of sexual desire in general. Studies with trans women in particular find a wide variance in ability to experience orgasm post vaginoplasty surgery, ranging from 17-100% across 140 different studies. However, these studies are focused mostly on adults who transitioned in adulthood. At this time, there do not appear to be any studies which examine sexual health or orgasmic experience in trans individuals who initiated affirmative treatment prior to adulthood or the onset of puberty.

M

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  • The AMA has sent a strong message to America’s governors cautioning that interfering in the medical care of transgender minors would be detrimental to the health of transgender youth. AMA Executive Vice President and CEO James L. Madara, MD, warned that these measures would “insert the government into clinical decision-making and force physicians to disregard clinical guidelines.”
  • We’re not fighting for equality [...] None of these conflicts against systems of oppression are fights for equality. They are fights for accurate regard of supremacy. We're better at sex than y'all. We're better at art. We're better at warfare. These are things carried in the old understandings of so-called, whatever-you-want-to-call-it: non-binary, queer, genderqueer, trans, gay, lesbian. Just like the neurodiverse peoples, these people are all sacred beings, superior to other beings.

N

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“Sexual Experiences in Transgender People: The Role of Desire for Gender-Confirming Interventions, Psychological Well-Being, and Body Satisfaction”

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Sanne W. C. Nikkelen, Baudewijntje P. C. Kreukels; “Sexual Experiences in Transgender People: The Role of Desire for Gender-Confirming Interventions, Psychological Well-Being, and Body Satisfaction”, volume 44, issue 4, pp.370-381.

  • Research on the sexual experiences of transgender persons has thus far focused predominantly on the impact of gender-confirming treatment (i.e., hormonal treatment or genital surgery to change one’s sex characteristics; hereafter referred to as “GCT”) on several aspects of sexuality. This is not surprising given that sexual experiences, such as masturbation frequency and the ability to reach an orgasm, are seen as indicators of treatment success (De Cuypere et al., 2005). There has been great variability in studies on sexual experiences in transgender people following GCT, both in terms of the outcomes under study and the study findings, which hinder comparisons across studies (for reviews, see Klein & Gorzalka, 2009; Murad et al., 2010). Nevertheless, some general observations can be made. Concerning sexual behavior, empirical research has typically focused on frequency of sex and masturbation. For transwomen (male-assigned at birth), studies have generally shown increased frequency of sex after GCT, but either decreased, increased, or unchanged frequency of masturbation (Klein & Gorzalka, 2009). Studies among trans men (female-assigned at birth) have shown either unchanged or increased frequency of sex and masturbation (Costantino et al., 2013; Klein & Gorzalka, 2009; Wierckx et al., 2011). Studies on sexual feelings after GCT have mainly focused on general measures of sexual satisfaction, as opposed to more specific measures like sexual pleasure and esteem. In general, studies have indicated increased sexual satisfaction in the majority of both trans women and trans men following GCT (Murad et al., 2010; Weigert, Frison, Sessiecq, Mutairi, & Casoli, 2013).
    • pp.370-371
  • Most of the existing studies on the impact of GCT have been retrospective in nature (Klein & Gorza-lka, 2009; Murad et al., 2010) and may therefore suffer from recall bias. Further, these studies may suffer from a cognitive dissonance effect, whereby respondents may evaluate the effect of the treatments as more positive. A pre- and post-measure of a behavior (e.g., masturbation frequency) may have given a more realistic representation. Few studies have assessed the sexual experiences of transgender persons who wish to, but did not yet receive treatment (for some exceptions, see Cerwenka, Nieder, Briken, et al., 2014;Cerwenka, Nieder, Cohen-Kettenis, et al., 2014). This group of transgender persons may have particular negative sexual experiences due to their yet unfulfilled desire for treatment (Cerwenka, Nieder, Brikenet al., 2014). Similarly, little research has focused on transgender persons who do not wish to undergo GCT (for a similar observation, see Bauer & Hammond, 2015), thereby ignoring a substantial subgroup of transgender people.
    • p.372
  • Aside from differences in treatment desire, two factors that are likely to be associated with sexual experiences of transgender people are their psychological well-being and body satisfaction. There are several indications that dissatisfaction with one’s appearance or feelings of gender dysphoria can make it more difficult to enjoy or to be satisfied with sexual experiences (Doorduin & Van Berlo, 2014). Further, although in general transgender people reported improved sexual satisfaction after GCT (De Cuypereet al., 2005; Klein, & Gorzalka, 2009), findings also indicate that satisfaction with one’s genitals plays an important role in sexual satisfaction following GCT (De Cuypere et al., 2005).
    • p.372
  • [A]fter gender-confirming interventions, trans women reported low levels of sexual desire and trans men high levels of sexual desire (Elaut et al.,2008; Wierckx et al., 2011; Wierckx et al., 2014). Higher levels of sexual desire will result in more motivation to engage in sexual activities like masturbation and partner sex.
    • pp.377-378
  • Body incongruence, a key element of gender identity problems, hinders sex and enjoyment of sex (Door-duin & Van Berlo, 2014). Also, gender incongruence is often accompanied by body dissatisfaction thatis not confined only to the genitals (van de Grift, Cohen-Kettenis et al., 2016). In both samples, bodysatisfaction was positively related to almost all of our indicators of sexual behaviors and feelings, under-lining the importance that body satisfaction plays in sexual experiences in transgender people. This is in line with a previous study that showed that MtF transgender persons who indicated a higher degreeof satisfaction with their appearance also reported a better sexual functioning (Weyers et al., 2009). Psychological well-being played a role in the sexual feelings of FtM transgender persons only, with higher psychological well-being being related to higher sexual satisfaction, agency, and esteem. Secondary analyses (not shown here) showed that psychological well-being was positively related to these indicators of sexual feelings in MtF transgender persons as well, but this relationship disappeared after including body satisfaction in the analyses. This suggests that psychological well-being and body dissatisfaction in MtFtransgender persons are highly related and that sexual feelings are mainly affected by body dissatisfaction.
    • pp.378-379

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  • If cisgender people, who are 99.5 percent of the population, are accused of transphobia for simply existing, failing to use the correct terminology, allowing genitals to influence their dating preferences, or even having non-queer Theory beliefs about gender, this is likely to result in much unfair antagonism against trans people (most of whom do not believe in this either).

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  • Approximately 1 in 250 adults or almost 1 million adults in the United States identify as transgender. The frequency of adults, and especially younger adults, reporting a gender diverse identity has increased over time. Some persons who identify as transgender or gender-diverse (TGD) will seek treatment with gender-affirming hormones to align their bodies more closely with their gender identity. Medical treatment of people who identify as transgender improves body satisfaction, quality of life, and mental health. However, many of these treatments are not entirely reversible.
  • Some adolescents or adults who take gender-affirming hormones subsequently elect to stop treatment. Most adults who stop gender-affirming hormones report doing so for reasons unrelated to a change in gender identity, such as pressure from family, difficulty obtaining employment, or discrimination. Also, discontinuation of gender-affirming hormones does not necessarily represent a failure in treatment or initial decision-making. Some TGD adolescents and adults who start and then discontinue gender-affirming hormones experience use of hormones as an important part of consolidating their gender identity and experience no regret over the use of hormones despite some permanent effects. However, a portion of TGD individuals who pursue gender-affirming medical or surgical affirmation do express regret over the permanent effects of treatment. In a metanalysis of 7928 TGD individuals who had gender confirmation surgery, 1% expressed regret after

surgery. The most prevalent reason for regret was psychosocial circumstances, particularly from a lack of social support or negative reactions from family and employers.

    • pp.3937-3938
  • Clinical guidelines for medical affirmation of persons who identify as TGD suggest that the rate of “de-transition” among postpubertal adolescents and adults is rare, but few studies have assessed the actual rate of treatment discontinuation.
    • p.3938
  • Our study documented higher gender-affirming hormone continuation rates among transfeminine individuals and by patients who started hormones before reaching the age of legal majority in a population with universal insurance and access to low or no-cost medical and pharmaceutical care. Family socioeconomic status, family member type, and the official status of gender-affirming care as a TRICARE-covered benefit at the time the patient began taking gender-affirming hormones had no influence on continuation of gender-affirming hormones.
    We noted a higher hormone continuation rate among TGD individuals who were younger than 18 years old at the time of first use of gender-affirming hormones compared with those who were aged 18 years and older when starting hormones. This has not been documented in previous studies
    • p.3941

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“Sexual Function After Gender Affirming Surgery” (09 May 2024)

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Amine Sahmoud, Alicia R. Castellanos, Jessica Abou Zeki, Rachel Pope; “Sexual Function After Gender Affirming Surgery”, (09 May 2024), Volume 13, pages 128–135

  • Sexual function and satisfaction in the transgender community is a nascent field with a paucity of data due to the fast paced nature of improving upon surgical technique and variety of patient experiences.
    • p.128
  • Several factors, both mental and physical, must be considered when assessing for sexual dysfunction in TGDI prior to medical or surgical intervention as these factors contribute to one’s gender dysphoria. A systematic review of 44 studies analyzed data on sexual satisfaction, desire, arousal, orgasm, and pain. Generally, studies found that a healthy and positive relationship can have a positive impact on general sexual function, orgasm frequency and associated pleasure.
    • p.129
  • Distress surrounding sexual activity or one’s own sexual health, which may or may not include individual anatomy, may impact general sexual satisfaction. Thus, those experiencing high levels of gender dysphoria may have lower levels of sexual satisfaction. Dissatisfaction with one’s body, or body dysmorphia can heavily contribute to sexual dysfunction and plays a large role in gender dysphoria. Specifically, one study of 141 trans men demonstrated a connection between body dysmorphia and difficulty with sexual arousal in 91% of participants.
    • p.129
  • While there is not much data on sexual pain in trans men, one study found that 12% of 211 participants reported pain at the same frequency before and after genital reconstruction surgery.
    • p.129
  • General sexual satisfaction has been shown to improve after initiation of gender affirming care, both medical and surgical. Several studies have shown a decrease in sexual distress after a combination of hormone therapy and gender affirming surgery. Interestingly some studies discussed a difference in sexual satisfaction based on the type of genital reconstruction that was performed, with one study showing an increase in sexual satisfaction for those who received a metoidioplasty compared to those who received a phalloplasty. Gender affirming surgery has shown to increase sexual satisfaction, even when solely analyzing body self image as demonstrated in several studies despite surgical complications.
    • p.130
  • Most survey studies demonstrated an increase in ability to attain orgasm and an increase in intensity of the orgasm after medical and surgical transition. Data from these studies showed a 30% increase in ability to orgasm during sexual intercourse or masturbation after genital reconstruction surgery, not differentiating between metoidioplasty and phalloplasty.
    • p.130
  • Several studies demonstrate a decrease in sexual desire after initiation of estrogen and antiandrogen medications. Prevalence of low sexual desire ranged from 32% to 73%, but the percentage of those experiencing distress from low sexual desire or hypoactive sexual desire disorder (HSDD) was 22% in a study of 214 trans women after medical and surgical affirmation. This distress associated with low sexual desire is a key marker for HSDD, a diagnosis often paired with depression.
    • p.131
  • With regards to gender affirming surgery and its effect on sexual desire, most studies demonstrated an overall increase in desire compared to preoperative levels.
    • p.131
  • Multiple studies have compared sexual arousal levels of trans women post-operatively with sexual arousal in cisgender women. In these studies, 90–100% of trans women reported experiencing sexual arousal post-operatively, but when level of sexual arousal was assessed using the Female Sexual Function Index (FSFI), sexual arousal scores were overall lower in trans women than in their cisgender counterparts.
    • p.131
  • In trans women who have initiated hormone therapy, but who have not undergone genital reconstruction surgery, difficulty in achieving orgasm was seen to decrease. In one study, the prevalence of orgasmic dysfunction decreased to 29.2% from 46.7% after the initiation of hormone therapy. Whether this finding can be attributed to the simultaneous decrease in gender dysphoria and body dysmorphia associated with the initiation of hormone therapy still needs to be investigated.
    Ability to orgasm in trans women post-vaginoplasty has also been studied. Due to the unique anatomy of trans women post-operatively, it must be noted that orgasms can occur at multiple locations including the clitoris and prostate via masturbation or vaginal penetration, for example. There is variability in the rates of orgasm post-operatively with studies citing percentages between 40–100%. These studies used the FSFI to assess orgasmic scores and demonstrated ranges of 2.82 to 4.0 out of 6 in comparison to cisgender women without sexual dysfunction who scored an average of 5.1. When analyzing the correlation between sexual activity and achieving orgasm, one study found that direct stimulation of the clitoris had a higher frequency of orgasm when compared to intercourse. In assessing frequency and quality of orgasms post-operatively, studies are inconsistent. While one study reported an increase in orgasm frequency with sexual activity post-operatively, another study of 91 trans women postoperatively found orgasms to occur less frequently in 52.6% of participants and more frequently in 20.5% of participants. Quality of orgasms, when investigated, was found to be more pleasurable postoperatively in 51% of a 218 person study and with no changes in 62.5% of a 31 person study.
    • p.132
  • Both medical and surgical affirmation care is improving with the overall goal of reducing gender dysphoria. Nevertheless, there are multiple areas for growth. Trans men and women undergo medical and surgical transitions in ways that affect sexual function and satisfaction. These sexual experiences can be directly correlated to gender affirming medical and surgical interventions. Overall, despite medical and specifically surgical complications, satisfaction with transition and sexual health is high.
    • p.133
  • In January 2019, the Wall Street Journal ran my piece, "When Your Daughter Defies Biology." It provoked nearly a thousand comments, and hundreds of responses to those comments. A transgender writer, Jennifer Finney Boylan, quickly wrote a rebuttal in an op-ed that appeared two days later in the New York Times. Her op-ed garnered hundreds of comments and hundreds more reactions to those comments. All of a sudden, I was flooded with emails from readers who had experienced with their own children the phenomenon I had described or had witnessed its occurrence in their kids' schools - clusters of adolescents in a single grade, suddenly discovering transgender identities together, begging for hormones, desperate for surgery. . . . This is a story America needs to hear. Whether or not you have an adolescent daughter, whether or not your child has fallen for this transgender craze, America has become fertile ground for this mass enthusiasm for reasons that have everything to do with our cultural frailty: parents are undermined; experts are over-relied upon; dissenters in science and medicine are intimidated; free speech truckles under renewed attack; government healthcare laws harbor hidden consequences; and an intersectional era has arisen in which the desire to escape a dominant identity encourages individuals to take cover in victim groups.
  • While some cisgender people refuse to take our experiences seriously, the fact of the matter is that transgender people can be found in virtually every culture and throughout history; current estimates suggest that we make up 0.2 – 0.3% of the population [or possibly more]. [...] In other words, we simply exist.
  • Accusations that IP is inherently “narcissistic” and “divisive” have become quite prevalent among EC-centric leftists lately. [...] In addition to disregarding all forms of non-EC marginalization, accusations that IP activism is inherently “narcissistic” or "divisive" severely confuse cause and effect. After all, I’m not the one who is “obsessed” with my identity. [...] It’s the people who harbor anti-trans attitudes who are obsessed with my identity, not the other way around! While I would absolutely love to live in a world where my trans identity was not especially notable or worth calling attention to, these people insist on making an issue out of it. Furthermore, by making a distinction between transgender people (who they single out for discrimination) and non-transgender people (whose identities and experiences they respect), it is they (not us) who are the ones being divisive. Once we acknowledge this causality, it becomes clear that IP is not an expression of navel-gazing or narcissism, but rather a form of organized resistance against those who are actively trying to delegitimize and disenfranchise us.
  • I would love to live in a world where the word “transgender” serves the same simple purpose — a mere sharing of information about my life experiences — but unfortunately, it doesn’t. On top of being a descriptor, the word “transgender” is also politically loaded. But that is not my, nor other trans people’s, fault. As discussed in the last section, there’s a long history of people hating, ostracizing, and criminalizing us, and much of this history took place before words like “transgender,” “transphobia,” and analogous terms even existed. In fact, those terms were created in response to that marginalization, not the other way around. And even if I were to relinquish my trans identity, those people would still exist and continue to discriminate against me for supposedly being a sinner, or freak, or deviant, or for being delusional, or whatever other rationales they might concoct in order to justify their bigotry.
  • The most infuriating assertion regularly made by the "trans women are biologically male" camp is that trans people are somehow "denying" or "erasing" biological sex differences, and that this hurts cisgender women/“biological females.” This is patently untrue. I can assure you that trans people are highly aware of biological sex differences — the fact that many of us physically transition demonstrates that we acknowledge that sexually dimorphic traits exist and may be important to some people! I would reframe things this way: Transgender people often have a more complicated relationship with our sex-related traits (as they may be discordant with our identified and lived genders), and thus the language that we use to describe or discuss these traits may seem arcane, or nonsensical, or unnecessary to the average cisgender person. And because they are unfamiliar with this language (and/or flat-out antagonistic toward us), some cisgender people will subsequently misinterpret this language and differing perspective as some sort of "denial."
  • Matt Sharp, a top lawyer at ADF who drafts model legislation on the group’s behalf, said he expects issues dealing with transgender athletes and medical care to reach the Supreme Court. In an interview, Sharp compared judges ruling in favor of allowing gender-affirming care for transgender minors to courts upholding forced sterilization for disabled individuals a century ago.
    “I think it’s always worth stepping back and remembering the courts get it wrong sometimes,” Sharp said. “It was about 100 years ago that the Supreme Court upheld forced sterilization for individuals with mental disabilities. It was a wrong decision. And thankfully, both the courts and the medical community recognized the damage that they were doing to a vulnerable population and corrected that mistake. Similar here, these are courts that are struggling now.”
  • Paul Smith, who successfully argued the 2003 landmark Supreme Court case Lawrence v. Texas, which found the U.S.’s remaining sodomy laws unconstitutional, said the repeated victories for LGBTQ people and advocates are “a sign that these laws are mostly being thought up based on their appeal to a certain frenzied group of people in the country who were very excited about picking on LGBTQ people right now, not based on their legal merits and sustainability.
    “Take a law that says, you can’t have a drag show. It’s hard to imagine an easier First Amendment case to win, because it’s just plain content censorship,” he said. “And there’s not going to be any evidence that is harmful to somebody.”
    Smith, a professor at Georgetown Law, said the cases regarding restrictions on transition-related care are more complicated, but the wins still make sense, because in those cases the care is supported by the adolescents, their parents and doctors, and by expert testimony.
  • It is difficult to generate a counterdiscourse if one is programmed to disappear. The highest purpose of the [medically defined] transsexual is to erase h/erself, to fade into the "normal" population as soon as possible. Part of this process is known as constructing a plausible history--learning to lie effectively about one's past. What is gained is acceptability in society. ... In the transsexual's erased history we can find a story disruptive to the accepted discourses of gender.
    • Sandy Stone, “The Empire Strikes Back: A Posttranssexual Manifesto,” in Body Politics: The Cultural Politics of Gender Ambiguity, edited by Julia Epstein and Kristina Straub (1991), pp. 280–304.
  • To attempt to occupy a place as speaking subject within the traditional gender frame is to become complicit in the discourse which one wishes to deconstruct.
    • Sandy Stone, “The Empire Strikes Back: A Posttranssexual Manifesto,” in Body Politics: The Cultural Politics of Gender Ambiguity, edited by Julia Epstein and Kristina Straub (1991), pp. 280–304.
  • Transsexuals for whom gender identity is something different from and perhaps irrelevant to physical genitalia are occulted by those for whom the power of the medical/psychological establishments, and their ability to act as gatekeepers for cultural norms, is the final authority for what counts as a culturally intelligible body.
    • Sandy Stone, “The Empire Strikes Back: A Posttranssexual Manifesto,” in Body Politics: The Cultural Politics of Gender Ambiguity, edited by Julia Epstein and Kristina Straub (1991), pp. 280–304.
  • Fifty-three studies were included. Findings indicate reduced rates of suicide attempts, anxiety, depression, and symptoms of gender dysphoria along with higher levels of life satisfaction, happiness and QoL after gender-affirming surgery. Some studies reported that initial QoL improvements post gender-affirming surgery were not always enduring.

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"Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis” (2021 Jun)

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Jack L Turban, Stephanie S Loo, Anthony N Almazan, Alex S Keuroghlian; "Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis”. LGBT Health. 2021 Jun 1;8(4):273–280.

  • There is a paucity of data regarding transgender and gender diverse (TGD) people who ‘‘detransition,’’ or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States.
    • p.273
  • Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.
    • p.273
  • Of all respondents who reported a history of detransition, 82.5% cited at least one external factor. A total of 15.9% of respondents cited at least one internal factor. Of all participants who ever pursued gender affirmation, 10.8% reported lifetime history of detransition due to an external factor and 2.1% reported a lifetime history of detransition due to an internal factor.
    • p.276
  • Older age cohorts were more likely to report a history of detransition due to caregiving responsibilities, or pressure from a spouse or partner. Younger age cohorts were more likely to report a history of detransition due to pressure from a parent, pressure from the community or societal stigma, and pressure from friends or roommates.
    • p.276
  • In this national study, 13.1% of TGD respondents who had ever pursued gender affirmation reported a history of detransition. To our knowledge, this is the first study to systematically examine reasons for detransition in a large national sample of TGD adults. The vast majority of participants reported detransition due at least in part to external factors, such as pressure from family, nonaffirming school environments, and sexual assault. External pressures such as family rejection, school-based harassment, lack of government affirmation, and sexual violence have previously been associated with increased suicide attempts in TGD populations. Our findings thus extend prior studies, and suggest that external pressures should be understood not only as risk factors for poor mental health but also as obstacles to safely living in one’s gender identity and expression.
    • pp.276-277
  • A history of detransition was significantly associated with male sex assigned at birth, consistent with prior research, indicating that TGD people assigned male sex at birth experience less societal acceptance. Detransition was also significantly more common among participants with a nonbinary gender identity or bisexual sexual orientation. These findings are congruent with past studies, indicating that TGD people who identify beyond traditional binary and heteronormative societal expectations are less likely to access gender-affirming services.
    • p.277
  • Lack of family support was also associated with a history of detransition, which is of particular concern, given the strong association between familial nonacceptance and suicidality.
    • p.277
  • [G]ender affirmation is a highly personal and individualized process, and not all TGD people will desire all domains of gender affirmation at all times, as has been highlighted in case literature regarding people who desire medical but not social affirmation.
    • pp.277-279
  • It is important to highlight that detransition is not synonymous with regret. Although we found that a history of detransition was prevalent in our sample, this does not indicate that regret was prevalent. All existing data suggest that regret following gender affirmation is rare. For example, in a large cohort study of TGD people who underwent medical and surgical gender affirmation, rates of surgical regret among those who underwent gonadectomy were 0.6% for transgender women and 0.3% for transgender men. Many of those identified as having ‘‘surgical regret’’ noted that they did not regret the physical effects of the surgery itself but rather the stigma they faced from their families and communities as a result of their surgical affirmation. Such findings mirror the qualitative responses in this study of TGD people who detransitioned due to family and community rejection.
    • p.279
  • Although there have been published guidelines for gender affirmation, case studies regarding detransition, and published data on the uncommon experience of regret following gender affirmation, there has been little rigorous study with large TGD community samples regarding detransition.
    • p.279
  • “The laws do so much damage when they’re passed that I think it’s difficult to see even the court victories as a good thing on balance,” said Ryan Thoreson, a University of Cincinnati law professor and former researcher for Human Rights Watch. “The sheer number of these laws has been significantly disruptive to the care that transgender children are receiving. They’ve had a chilling effect on providers who are now much more cautious about providing some of these services to kids and their families.”
  • In this prospective clinical cohort study of TNB youths, we observed high rates of moderate to severe depression and anxiety, as well as suicidal thoughts. Receipt of gender-affirming interventions, specifically PBs or GAHs, was associated with 60% lower odds of moderate to severe depressive symptoms and 73% lower odds of self-harm or suicidal thoughts during the first year of multidisciplinary gender care. Among youths who did not initiate PBs or GAHs, we observed that depressive symptoms and suicidality were 2-fold to 3-fold higher than baseline levels at 3 and 6 months of follow-up, respectively. Our study results suggest that risks of depression and suicidality may be mitigated with receipt of gender-affirming medications in the context of a multidisciplinary care clinic over the relatively short time frame of 1 year.
    Our findings are consistent with those of prior studies finding that TNB adolescents are at increased risk of depression, anxiety, and suicidality and studies finding long-term and short-term improvements in mental health outcomes among TNB individuals who receive gender-affirming medical interventions. Surprisingly, we observed no association with anxiety scores. A recent cohort study of TNB youths in Dallas, Texas, found that total anxiety symptoms improved over a longer follow-up of 11 to 18 months; however, similar to our study, the authors did not observe statistically significant improvements in generalized anxiety. This suggests that anxiety symptoms may take longer to improve after the initiation of gender-affirming care. In addition, Olson et al found that prepubertal TNB children who socially transitioned did not have increased rates of depression symptoms but did have increased rates of anxiety symptoms compared with children who were cisgender. Although social transition and access to gender-affirming medical care do not always go hand in hand, it is noteworthy that access to gender-affirming medical care and supported social transition appear to be associated with decreased depression and suicidality more than anxiety symptoms.
  • Our study provides quantitative evidence that access to PBs or GAHs in a multidisciplinary gender-affirming setting was associated with mental health improvements among TNB youths over a relatively short time frame of 1 year. The associations with the highest aORs were with decreased suicidality, which is important given the mental health disparities experienced by this population, particularly the high levels of self-harm and suicide. Our findings have important policy implications, suggesting that the recent wave of legislation restricting access to gender-affirming care may have significant negative outcomes in the well-being of TNB youths. Beyond the need to address antitransgender legislation, there is an additional need for medical systems and insurance providers to decrease barriers and expand access to gender-affirming care.

Diana M. Tordoff, Mitchell R. Lunn, Bertha Chen, Annesa Flentje, Zubin Dastur, Micah E. Lubensky, Matthew Capriotti, Juno Obedin-Maliver; “Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth”, American Journal of Obstetrics and Gynecology. Volume 229, Issue 6, December 2023, Pages 669.

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  • Testosterone use among transgender people likely impacts their experience of sexual function and vulvovaginal pain via several complex pathways. Testosterone use is associated with decreased estrogen in the vagina and atrophic vaginal tissue, which may be associated with decreased vaginal lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function.
  • Testosterone use among transgender men and gender diverse people was associated with an increased interest in sexual activity and the ability to orgasm, as well as with vaginal pain or discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (eg, testosterone-associated vaginal atrophy) and psychological factors (eg, gender affirmation).
  • At least 1.6 million transgender adults and adolescents live in the United States,1 among whom an estimated 70% of transgender men have used testosterone as gender-affirming hormone therapy (GAHT). A vaginectomy is rare (<3%) in this population, and the majority of transgender men and gender diverse people retain their vagina. Testosterone GAHT likely impacts sexual function via several complex pathways. Testosterone GAHT is associated with vaginal atrophy, which may be associated with decreased lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function.
  • There is limited research on the sexual function of transgender men and gender diverse people assigned female at birth (AFAB). The evidence that exists suggests that, although testosterone GAHT is associated with increased desire and arousal, a high proportion of transgender men also reported dyspareunia (painful sex), a common symptom of vaginal atrophy. The prevalence of dyspareunia may be as high as 60% to 62% among transgender men, markedly higher than the prevalence reported among cisgender women (3%–48%).
  • In our study, testosterone use among transgender men and gender diverse people AFAB was associated with some domains of positive sexual function (such as a higher interest in sexual activity and ability to orgasm) and pain or discomfort during sexual activity. Specifically, we observed a strong, consistent association between current testosterone use and higher interest in sex, as well as vaginal or FGO pain during sexual activity.

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  • I'm non-binary, which means it's not just that I'm challenging the binary between male, female, man, woman, but between us and them. And in your statement, you said, "why don't I help them", as if this struggle is not your struggle too. The reason you don't fight for me is because you're not fighting for yourself fully. And any movement that's trying to emancipate men from the shackles of heteropatriarchy or emancipate women from traditional gender ideology has to have trans and non-binary people at the forefront, because we are actually the most honest. We're tracing the root, where did these ideas of manhood and womanhood come from? They come from a binary structure, and so that's why people like me, who are visibly gender nonconforming, who are both feminine and masculine and none of the above, we experience the brunt of all of these collective fantasies that were created that are killing other people, that are also killing us, it just looks different. And so one of the things that I try to do in my work is say, "don't show up for me because you wanna protect me, or you wanna help me. I don't need your help. I have an unshakeable and irrevocable sense of who I am, because I am divine." [...] I don't need to be legitimized, or I don't have anything to prove. What I want us to rephrase the conversation is, are you ready to heal? And I don't think the majority of people are ready to heal, and that's why they repress us as trans and gender variant people, because they've done this violence to themselves first. They've repressed their own femininity, they've repressed their own gender non-conformity, they've repressed their own ambivalence, they've repressed their own creativity. And so when they see us have the audacity to live a life without compromise, where we say there are no trade-offs, where we say we actually get to carve in a marrow of this earth and create our own goddamn beauty, instead of saying "thank you for teaching me another way to live", they try to disappear us because they did that to themselves first.

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  • Purpose of review
    Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research.
    Recent findings 
    Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking.
    Summary
    Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.
  • Research suggests that trans people compared to cisgender people self-report significantly lower sexual pleasure, with researchers in one study finding that being younger in age, having higher genital satisfaction, and being happier in general predicting more sexual pleasure in trans people (Gieles et al., 2023). Trans people often experience elevated rates of shame, genital dissatisfaction, and body image distortion, which researchers have found to be associated with reduced sexual functioning, alongside the complexities of how medical transition might impact sexual functioning and one’s experience of sex (Barcelos et al., 2022).
  • What is known suggests that trans people may experience both changing gendered embodiment and sexual habitus (one’s psychological, physical, and emotional repertoire of sex acts, fantasies, and attractions) in tandem around transition, leading to unique experiences (Schilt & Windsor, 2014). They may also face navigating normative gender scripts within sexual and romantic encounters, which offers both opportunities and challenges around affirmation (Lindley et al., 2020). Further, trans people may use a range of labels to identify their sexual orientation, which may also shift over time and intersect with generational, cultural, and personal meanings (Doorduin & van Berlo, 2014; Galupo et al., 2016). Research suggests that unique labeling and othering processes may occur as a result of this, as trans people navigate their identity within cisgenderist norms, which can also influence how one perceives oneself, one’s relationships, and how partners perceive them (Pollock & Eyre, 2012; Thurston & Allan, 2018; Yerke & Mitchell, 2011). For some, this offers opportunities and access to communities, while for others, this is constraining (Pipkin et al., 2023).
  • Because the transgender population is growing, a larger availability of transgender health care is needed. Other health care providers should familiarize themselves with transgender health care, because HT can influence diseases and interact with medication. Because not all people apply for the classic treatment approach, special attention should be given to those who choose less common forms of treatment.
  • The number of people with gender identity issues seeking professional help increased dramatically in recent decades. The percentage of people who regretted gonadectomy remained small and did not show a tendency to increase.
  • A total of 48 019 patients who underwent GAS were identified, including 25 099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27 187 patients (56.6%), followed by genital reconstruction (16 872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13 011 in 2019 and then declined slightly to 12 818 in 2020. Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients.
  • While numerous surgical interventions can be considered GAS, the procedures have been broadly classified as breast and chest surgical procedures, facial and cosmetic interventions, and genital reconstructive surgery. Prior studies have shown that GAS is associated with improved quality of life, high rates of satisfaction, and a reduction in gender dysphoria. Furthermore, some studies have reported that GAS is associated with decreased depression and anxiety.8 Lastly, the procedures appear to be associated with acceptable morbidity and reasonable rates of perioperative complications.
  • These findings suggest that the number of GAS procedures performed in the US has increased dramatically, nearly tripling from 2016 to 2019. Breast and chest surgery is the most common class of procedure performed while patients are most likely to undergo surgery between the ages of 19 and 30 years. The number of genital surgical procedures performed increased with increasing age.
  • Do we have a theory on why people are gay? No. They just are. The only reason we even feel like we need a theory about trans people is that society is so unaccepting of us that it’s constantly demanding we justify our own reality.
  • I feel like trans culture is just so obsessed with reassuring ourselves that we’re valid, that we sometimes forget that the end goal of a political movement is not validity, it’s equality.

See also

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