• What Being a Trans Person is All About

• What Makes a Trans Man a Man & a Trans Woman a Woman?

• Statements by Medical & Psychological Organizations

• About Trans People and Notable Definitions

• Neurological and Biological Research on Gender Identity

• Gender Identity is Not Chosen

• The Age When Trans People First Realize Their Gender Identity

• Gender Dysphoria

• The High Suicide Rate with Trans Adolescents

• Gender-Affirming Care Significantly Decreases Suicide Ideation

• What is Gender-Affirming Care?

• Research Shows Conversion Therapy is Associated With Suicide

• The Rate of Regret and Detransition is Extremely Low

• The Reason Why Few People Detransition

• Discrimination Faced by Trans People

• Gender Identity & Expression is Not Based on Stereotypes

• Statistics Show Trans People Are Less Likely to Offend

• Trans People Are More Likely to be Assualted

• How We Can Address Sex & Gender in Spaces

• Bathrooms

• Prisons

• Being Trans is Not a Mental Illness

• Do Trans Women Have Cis Male Privilege?

Transcending the Binary: What Being a Trans Person is All About

Hi, this site explains what it means to be born trans based on the scientific perspective and why every medical organization finds that gender-affirming care to be life saving care. Also from the perspective of a trans woman, Christie Elsy. I’ve studied this topic for decades as someone who personally experienced what it’s like to grow up as a trans woman.

It will be a very large collection of studies and professional organization statements, which I’ll keep updating, but it probably will not be all of them.

What makes a trans man a man and a trans woman a woman?

Medical and psychological associations give the words sex and gender different definitions based on what we know through scientific studies about human sexuality. [What are Sex & Gender? By The National Institutes of Health]

Sex refers mostly to biological characteristics such as chromosomes, hormones, organs, etc.

For gender, there’s gender identity and gender expression.

Gender identity is similar to how most people don't choose the gender they're attracted to. We also found that we don't choose the sex we identify with. It's a core aspect of a person’s deep sense of self and how they perceive themselves in relation to the world around them and others. Most people have a gender identity, but for trans individuals, their gender identity does not align with the sex they were assigned at birth.

We partly know gender identity isn’t a choice from decades of research on unsuccessful conversion therapies. There’s also decades of research that shows extremely low regret rates after trans people transition. There is the substantial increase in mental health when trans people can live in sync with their gender identity. There is also what trans people will tell you from their personal experience, and more. Many of these studies are further down this page, including [Gender Identity is Not Chosen] It's a part of us, much like something that is biologically a part of the brain, just like sexual orientation. We found that it is rooted in biology. [Neurological and Biological Research on Gender Identity] The brain influences many behaviors, like how we also don't choose right or left handedness.

Sex and gender are not completely separate from one another. Gender is more of a subcategory of sex. Sex and gender describe different parts of us, but they are interconnected with each other, because gender identity is rooted in biology.

What about the saying that gender is a social construct?

Gender identity includes identifying with non-societal aspects of a sex, like anatomy, which is why transitioning is vital to the mental health of many trans people.

However, as we grow up in a society where one sex expresses themselves differently from another, since we identify with a certain sex, we eventually attach those expressions to our identity, even subconsciously, and this is Gender Expression. Gender expression has varied differently throughout history. It is a social construct, while gender identity is an innate part of gender.

Gender expression is parts of our individuality that are shaped by what we find inspiring, happy, or exhilarating through life. It's what makes us feel content with ourselves from observing diverse expressions from people who we feel match our gender identity.

It’s also important to note how gender expression is not necessarily gender stereotypes or views about gender roles. It’s what we like to associate with ourselves, rather than how we view the majority of a certain sex, including stereotypes or roles. [Gender Identity & Expression is Not Based on Stereotypes]

Gender identity has more influence to someone’s life than chromosomes. What matters the most when it comes to daily life is gender identity and people’s ability to live in sync with it. Reproductive organs are important for having a baby (trans people who have transitioned can have children through artificial insemination or adoption), however those things aren’t a part of regular daily life. This makes gender identity the most influential part of a person’s sex. What makes up a person is more than their chromosomes, and that’s a good thing, because it’s a part of an intelligent mind.

Referring to trans women as men because of their chromosomes is like calling a wood chair a tree. There are many other important aspects to people other than their chromosomes or gametes.

Rather than making the incorrect claim that those who support trans rights are in denial of sex when they use pronouns that reflect a person’s gender identity, they are recognizing the scientific reality of both sex and gender. Language is made by us, and we change it based on new scientific knowledge and perspectives. How we choose to use it is reflection of our views or knowledge. So, misgendering trans people says more about the person misgendering than the person being misgendered. [About Trans People & Scientific Sex and Gender Definitions]

When referring to non-trans women as biological women, it’s inaccurate because gender identity is rooted in biology. Trans women’s anatomy is biological, and trans women are also women. Calling trans women males is also still misgendering.

However, there’s a better way. It’s the words Cis and Trans. So, male and female refer to sex, and when we say trans female, doctors know it means their biology is different from cis females. Just like the intersex condition known as the XX Male, when people are born intersexually in other ways, doctors need to distinguish that they have a unique anatomy in a certain way.

It’s vital for many trans people to transition because a large part of gender identity is identifying with the anatomy of a certain sex. It’s also why puberty is incredibly difficult for trans people to go through, because the body starts to change away from the gender identity in the brain. As a result, we experience gender dysphoria the most during our teen years.

Transgender = Transcendent Gender Identity

Instead of "transforming" or "transitioning" gender, transgender people, or trans people, are those whose gender transcends the ordinary. They are people whose gender is different from the sex assigned to them at birth. [Understanding Transgender People, by the American Psychological Association] Some of them may experience Gender Dysphoria, a condition characterized by a persistent sense of discomfort or distress due to the incongruence between their gender identity and their assigned sex. It can lead to severe depression, anxiety, and even suicidal thoughts. [Gender Dysphoria] This compels them to eventually transition so their bodies are in sync with their gender identity, which is recommended as a vital treatment by every leading medical organization. It may include social transition, puberty blockers, hormone therapy, or gender affirmation surgeries. However, not all trans people desire or are able to access these treatments.

Likewise, cisgender people or cis people refers to people whose gender identity matches the sex they were assigned at birth. As a shorthand, it can be used as cis man or cis woman. It’s also not intended to be used in every situation when we refer to cisgender men and women. Just as in every day conversation, trans women mostly prefer to be referred to just as women. However, these terms are helpful when we’re talking about topics related to gender.

The word "cis" comes from Latin, where it means "on the same side." Although, the relationship between the words "cis" and "trans" in the context of gender identity actually comes from chemistry. In organic chemistry, the terms "cis" and "trans" are used to describe the spatial arrangement of atoms or functional groups in a molecule. If two groups are on the same side of a carbon-carbon double bond, the molecule is referred to as "cis." If they are on opposite sides, the molecule is referred to as "trans." The use of these terms was then adopted by biologists studying the structure of DNA, where they were used to describe the orientation of the bases on either side of a double helix. [The Word Cisgender Has Scientific Roots]

The word transgender is a term that encompasses a wide range of identities. Along with trans men and trans women, it may also include individuals who identify as non-binary. [The American Academy of Pediatrics] Transgender can also refer to those who identify as a third gender. In many cases, these are people from different cultures that have recognized more than two genders for more than a millennium. [Third Gender] Many people who go by Two-Spirit also consider themselves to be transgender. Two-spirit people are from Native American traditions that originated long before European colonization.[Two-Spirit People]

Transgender people have been documented all throughout human history and in societies all over the world. However, the words they used to describe them have greatly varied with each society. [Transgender History]

Sexual orientation is a person’s emotional or sexual attraction to people of a certain gender or sex. Some names of sexual orientations are heterosexual or straight, homosexual or gay, bisexual or bi, and so on. However, gender identity and sexual orientation are two distinct aspects of a person. Transgender individuals can have any sexual orientation, just like cisgender individuals, who can be straight, gay, or bi. [Transgender Persons, by the CDC]

Studies show gender identity is formed in everyone, both trans and non-trans people, as young as 3 years old.

Around age two: Children become conscious of the physical differences between boys and girls.

Before their third birthday: Most children can easily label themselves as either a boy or a girl.

By age four: Most children have a stable sense of their gender identity.

During this same time of life, children learn gender role behavior—that is, doing "things that boys do" or "things that girls do." However, cross-gender preferences and play are a normal part of gender development and exploration regardless of their future gender identity.

[The American Academy of Pediatrics, Gender Identity Development in Children]

Trans people usually realize at a very young age that they identify with a different sex than they were assigned at birth, and that it’s not a choice. [The Age When Trans People First Realize Their Gender Identity]

This is why teaching children age-appropriate education about LGBTQ+ people is important in fostering a safe and accepting environment for students and child care by displaying values of kindness and respect towards those who are different from themselves, including as children who will grow up in a diverse society. Providing information about LGBTQ+ people can help children who may have similar feelings so that they don’t feel ostracized from the other children for something they don’t choose, which can be very harmful to their mental health.

Puberty is especially harrowing for trans people because the body changes away from the brain’s sense of self, which leads to severe gender dysphoria. There are many studies showing a much higher rate of suicidality in trans adolescents. [The High Suicide Rate with Trans Adolescents] Many other studies have shown that gender-affirming care significantly prevents them from becoming suicidal.

Trans people like me know that trans kids exist, because we were trans kids. For many of us, it was before we knew what the word transgender was, and it was obvious at that time that it’s something we don’t choose, especially during puberty.

It’s important to know that every leading psychological and medical association has asserted many times that gender-affirming care is life saving care. [Statements by Medical & Psychological Organizations] They’ve repeatedly condemned legislation that blocks teen and adult trans people from receiving gender-affirming care. These organizations represent hundreds of thousands of mental health and medical professionals who have been professionally trained to study this subject without bias and in detail. The peer review and empirical scientific process are designed to prevent bias from entering studies. They are independently performed studies done by different people all over the world. Then they are reviewed by many other professionals in their field.

What is Gender-Affirming Care?

Gender-affirming care is considered by every major medical organization to be life saving care for trans children and adults. [Gender-Affirming Care Significantly Decreases Suicide Ideation] It’s a healthcare approach that aims to support individuals in expressing and living in alignment with their gender identity.

The decision for parents to seek gender-affirming care for their child who is questioning their gender identity is made after they have expressed significant distress related to the incongruence between their gender identity and their assigned sex.

A key component of gender-affirming care for transgender children is to allow them to explore and express their gender identity in a safe and supportive environment without suggesting gender expectations or roles one way or the other. This involves taking a child and family-centered approach, where the child’s preferences, needs, and comfort level are prioritized.

When healthcare providers begin gender-affirming care for trans children, they typically conduct a thorough assessment of the child’s gender identity development and provide the child and their family with education and support. This may involve discussions with the child and their parents or guardians, as well as various physical and psychological evaluations.

This typically involves a multidisciplinary approach that may include various healthcare providers, such as a pediatric endocrinologist, a mental health provider, and a pediatrician.

As the child reaches 13 years old, if they say they have feelings that are associated with gender dysphoria and they plan on transitioning as an adult, medical professionals may recommend interventions such as puberty blockers, which are gonadotrophin-releasing hormones that have been used to delay puberty in cisgendered children with central precocious puberty since the 1980s. They can temporarily halt the onset of puberty and provide more time for the child to explore their gender identity without the development of physical characteristics that may cause severe mental harm, such as severe depression, anxiety, or even suicidal thoughts.

Hormone therapy or surgical interventions may be considered when they reach adulthood, depending on the individual’s needs and goals.

Throughout this process, healthcare providers work closely with the child and their family to ensure that they have access to supportive resources and that the child’s preferences and well-being are prioritized. This may involve providing counseling or therapy to help the child and their family cope with the social and emotional aspects of gender identity development.

Top surgery is one of the gender-affirming surgeries trans people may choose to receive, and it involves the surgical removal of breast tissue to create a more masculine chest contour. It’s otherwise known as a mastectomy.

In general, top surgery is not recommended for transgender people until they have completed puberty. However, in some cases, top surgery may be recommended for transgender boys when they are 16 years old because breast development during puberty for transgender boys can cause significant distress and discomfort. They are at greater risk than the rest of the transgender population of developing suicidality. Puberty blockers can cause the development of breast tissue to slow or stop, but it may not be sufficient to completely eliminate breast tissue that has already developed. So, the decision to undergo top surgery is based on the child’s gender identity, physical development, and overall well-being.

In summary, gender-affirming care for trans children involves a collaborative and individualized approach that prioritizes the child’s preferences, needs, and comfort level. Healthcare providers work closely with the child and their family to support their exploration of their gender identity and provide access to safe and supportive resources. [What is Gender-Affirming Care?]

Studies Show The Regret Rates and Detransition Rates Are Extremely Low

Scientific studies have consistently shown that the regret rate for transgender people who undergo gender-affirming medical interventions is extremely low. [The Rate of Regret and Detransition is Extremely Low] For those who did detransition, most say it was due to social pressure or external factors that were not related to their gender identity. [The Reason Why Few People Detransition]

Conversion Therapy

Conversion therapy, also known as reparative therapy or sexual orientation change efforts (SOCE), refers to a range of practices that attempt to change an individual’s sexual orientation or gender identity to align with heterosexual or cisgender norms. There is no scientific evidence to support the effectiveness of conversion therapy for trans people, and it is widely considered to be unethical and harmful. There’s unfortunately a long and death filled history showing it causes significant mental health problems and makes trans people suicidal.

Gender identity is a core aspect of a person’s identity and cannot be changed through therapy or other interventions. Trans people often describe their gender identity as a fundamental part of who they are, and attempting to change it can lead to feelings of shame, guilt, and self-hatred.

Conversion therapy often fails to address the underlying issues that may contribute to a person’s distress about their gender identity, such as discrimination, stigma, and a lack of access to supportive resources. Addressing these issues through affirmative and inclusive therapy can be much more effective in helping trans people achieve better mental health outcomes. [Conversion Therapy Causes Suicide]

Conclusion

In light of all of this, instead of reacting hastily and negatively towards people because they seem unfamiliar, which leads us to live in fear and in denial of what is innately a part of ourselves, we can have enlightening conversations about the possibilities and capabilities this shows about human nature and intelligence. It is a good thing that we’re not just chromosomes or gametes. Human gender and sex is more advanced than that because we are capable of more. As we recognize the intricacy and multifaceted nature of gender and sex, we can gain new insights into the ways in which humans develop and express their identities over the course of their lives. This, in turn, leads to a more vibrant and diverse society, where individuals are valued for who they are rather than being constrained by rigid gender norms and expectations. Loving one another for who we are is the way. With it, we can create a more harmonious, inclusive, and equitable society. When we accept and celebrate the diversity of human experience, we create a culture of empathy, understanding, and respect that values individuals for their unique perspectives. This, in turn, fosters greater social cohesion, resilience, and reduces the prejudices and biases that often lead to discrimination and exclusion.

It is also a valuable asset in fields such as science, technology, and the arts, where innovation often arises from the intersection of different disciplines and perspectives.

In addition, a culture of love and acceptance will lead to improved mental and physical health outcomes, as individuals are better able to express their true identities and find support from others who share their experiences. A positive ripple effect will happen throughout society, as individuals who feel valued and supported are more likely to contribute positively to their communities and to society as a whole.

Overall, loving one another for who we are will foster a more just and flourishing society, where individuals are valued for their unique gifts and talents, and where everyone has the opportunity to thrive and reach their full potential.

Statements by Medical & Psychological Organizations

The American Academy of Child and Adolescent Psychiatry

AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth

“The American Academy of Child and Adolescent Psychiatry (AACAP) supports the use of current evidence-based clinical care with minors. AACAP strongly opposes any efforts – legal, legislative, and otherwise – to block access to these recognized interventions. Blocking access to timely care has been shown to increase youths’ risk for suicidal ideation and other negative mental health outcomes. Consistent with AACAP’s policy against conversion therapy, AACAP recommends that youth and their families formulate an individualized treatment plan with their clinician that addresses the youth’s unique mental health needs under the premise that all gender identities and expressions are not inherently pathological.”

“Research consistently demonstrates that gender diverse youth who are supported to live and/or explore the gender role that is consistent with their gender identity have better mental health outcomes than those who are not.”

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The American Academy of Pediatrics

What Is Gender-Affirming Care?

“Proper gender-affirming care can mitigate a patient’s clinical distress and lead to significant improvements in the overall well-being of youth and adolescents who are at risk of or have been diagnosed … studies show that transgender adults who received appropriate treatment during adolescence had a lower incidence of lifetime suicidal ideation than those who wanted but could not obtain such treatment.”

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As Organizations Dedicated to Ensuring Physical, Mental, and Social Health and Well-being for All Americans

“Medical care for transgender youth is evidence-based and has proven effectiveness. Guidelines for appropriate treatment have been carefully developed and endorsed by American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the Endocrine Society and Pediatric Endocrine Society, the American College of Physicians, World Professional Association for Transgender Health, and the American Psychological Association.

The international consensus among health care professionals regarding treatment for gender dysphoria is to assist the patient to live in accordance their gender identity. In a gender-affirmative care model, providers offer developmentally appropriate care that is oriented toward understanding and appreciating a person’s gender experience. Treatment may include counseling, social transition, hormone therapy and/or gender confirming surgeries. Before puberty, there is no medical or surgical treatment that is used at all; guidelines emphasize supporting children as they express themselves. Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population. The treatment for gender dysphoria is highly effective in reducing or eliminating the incongruence and associated distress between a person’s gender identity and assigned sex at birth. Receipt of gender-affirming care has been linked to dramatically reduced rates of suicide attempts, decreased rates of depression and anxiety, decreased substance use, improved HIV medication adherence, and reduced rates of harmful self-prescribed hormone use.”

Sincerely,

National Organizations

ACA Consumer Advocacy

Academic Pediatric Association

American Academy of Family Physicians

American Academy of Hospice and Palliative Medicine

American Academy of Pediatrics

American Association of Clinical Endocrinology

American College of Obstetricians and Gynecologists

American College of Physicians

American Geriatrics Society

American Medical Association

American Medical Student Association

American Pediatric Society

American Physical Therapy Association

American Psychological Association

American Public Health Association

American Society of Nephrology

Association of Medical School Pediatric Department Chairs

Center for Parental Leave Leadership

Children’s Defense Fund

Coalition of Labor Union Women

Common Threads

Eating Disorders Coalition for Research, Policy & Action

Endocrine Society

Families USA

First Focus Campaign for Children

Futures Without Violence

Health Resources in Action

HIV Medicine Association

League of Women Voters of the United States

MomsRising

NASTAD

National Association for Children’s Behavioral Health

National Association of Councils on Developmental Disabilities

National Association of Social Workers

National Consumers League

National Crittenton

National Employment Law Project

National Family Planning & Reproductive Health Association

National League for Nursing

National Organization for Women

National Partnership for Women & Families

National Patient Advocate Foundation

Pediatric Endocrine Society

Pediatric Policy Council

Physicians for Reproductive Health

Public Advocacy for Kids (PAK)

Society for Adolescent Health and Medicine

Society for Pediatric Research

The National Alliance to Advance Adolescent Health

Trust for America’s Health

Union for Reform Judaism

Young Invincibles

State Organizations

PFlag of Jacksonville

South Dakota Chapter of AAP

AAP Colorado

American Academy of Pediatrics Vermont Chapter

American Academy of Pediatrics, Alaska Chapter

American Academy of Pediatrics, CA Chapter 3

American Academy of Pediatrics, California Chapter 2

American Academy of Pediatrics, DC Chapter

American Academy of Pediatrics, Hawaii Chapter

American Academy of Pediatrics, Utah Chapter

Arizona Chapter of the American Academy of Pediatrics

Arkansas Chapter of the American Academy of Pediatrics

California Academy of Family Physicians

California Chapter 1, American Academy of Pediatrics

Colorado Academy of Family Physicians

Consumers for Affordable Health Care

Every Texan

Florida Chapter of the American Academy of Pediatrics

Florida Health Justice Project

Georgia Academy of Family Physicians

Georgia Chapter-American Academy of Pediatrics

Georgians for a Healthy Future

Health Care For All

Illinois Academy of Family Physicians

Illinois Chapter, American Academy of Pediatrics

Immunize Nevada

Iowa Academy of Family Physicians

Iowa Chapter of the American Academy of Pediatrics

Kentucky Chapter of the AAP

Maine Chapter, American Academy of Pediatrics

Maryland Chapter, American Academy of Pediatrics

Michigan Academy of Family Physicians

Minnesota Chapter of the American Academy of Pediatrics

Missouri Chapter, American Academy of Pediatrics

Montana Chapter of the American Academy of Pediatrics

NC Pediatric Society

Nebraska Chapter AAP

New Jersey Chapter, American Academy of Pediatrics

New Mexico Pediatric Society

NYS American Academy of Pediatrics, Chapters 1, 2 & 3

Office of the Health Care Advocate, Vermont Legal Aid

Ohio Academy of Family Physicians

Oklahoma Chapter - American Academy of Pediatrics

Public Justice Center

Rhode Island Chapter of the American Academy of Pediatrics

SC Chapter of the AAP

South Carolina Appleseed Legal Justice Center

TakeAction Minnesota

Tennessee Health Care Campaign

Tennessee Justice Center

Texas Parent to Parent

Texas Pediatric Society, the Texas Chapter of the American Academy of Pediatrics

Virginia Chapter, American Academy of Pediatrics

Voices for Utah Children

Washington Academy of Family Physicians

Washington Chapter of the American Academy of Pediatrics

West Virginians for Affordable Health Care

Wisconsin Academy of Family Physicians

Wisconsin Chapter of the American Academy of Pediatrics

Women Employed

Healthcare Facilities and Systems

Advocate Aurora Health

Ann & Robert H. Lurie Children’s Hospital of Chicago

Atlantic Health System

Baptist Health of Northeast Florida

BJC HealthCare

Callen-Lorde Community Health Center

Children’s Hospital of Philadelphia

Children’s Hospital Colorado

CrescentCare

DAP Health

Desert AIDS Project d/b/a DAP Health

Family Tree Clinic

Hospital Damas. Inc

Inova Health System

JASMYN

John Muir Health

Managed Access to Child Health, dba, Partnership for Child Health

Mel Leaman Free Clinic

Nemours Children’s Health System

NYC Health + Hospitals

Ochsner LSU Health

Oregon Health & Science University

Redstone Global Center for Prevention and Wellness

Saint Francis Memorial Hospital

Sequoia Hospital

Stanford Health Care

UPMC Children’s Hospital of Pittsburgh

Wolfson Children’s Hospital

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As Organizations Committed to Serving the Best Interests of All Youth

“Research has shown that when transgender youth have access to gender-affirming services, competent care and affirmation, their risk of depression, anxiety and other negative mental health outcomes is greatly reduced.”

“We stand in opposition to proposals that harm transgender youth, including limiting access to medically-necessary, best practice care, forbidding students from using the restroom at school consistent with their gender identity, and preventing transgender youth from playing sports alongside their peers. On behalf of our members and communities, we call on legislators across the country to reject these harmful measures.”

Signed,

American Academy of Child and Adolescent Psychiatry

American Academy of Pediatrics

American Association of Colleges for Teacher Education

American Association of School Librarians

American Counseling Association

American Federation of Teachers

American Psychological Association

American Public Health Association

American School Counselor Association

American School Health Association

BOOST Collaborative

The Council of Administrators of Special Education

Child Welfare League of America

Mental Health America

National Association for College Admission Counseling

National Association of School Nurses

National Association of Secondary School Principals

National Association of Social Workers

National Education Association

National Parent Teacher Association

Society of Pediatric Nurses

The School Social Work Association of America

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The American Psychiatric Association

Position Statement on Treatment of Transgender and Gender Diverse Youth

Worsening dysphoria may manifest as depression, anxiety, poor relationships with family and peers, self-harm and suicide. Racism, misogyny, economic disadvantage and neurodiversity can compound the risk of negative outcomes. Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses. Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth.

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American Medical Association

The American Medical Association fights to protect health care for transgender patients

"Proponents of these disturbing bills often falsely assert that transgender care for minors is extreme or experimental. In fact, clinical guidelines established by professional medical organizations for the care of minors promote supportive interventions based on the current evidence and that enable young people to explore and live as the gender that they choose. Every major medical association in the United States, including the AMA, recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people. Unfortunately, if enacted, legislation of this kind could have tragic consequences. Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5% reporting at least one diagnosis of a mental health or substance use disorder. Transgender minors also face a significantly heightened risk of suicide. But research has demonstrated that improved body satisfaction and self-esteem following the receipt of gender-affirming care is protective against poorer mental health and supports healthy relationships with parents and peers. Studies also demonstrate dramatic reductions in suicide attempts, as well as decreased rates of depression and anxiety."

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The American Medical Association to States: Stop Interfering in Health Care of Transgender Children

"Empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression. For gender diverse individuals, standards of care and accepted medically necessary services that affirm gender or treat gender dysphoria may include mental health counseling, non-medical social transition, gender-affirming hormone therapy, and/or gender-affirming surgeries. Clinical guidelines established by professional medical organizations for the care of minors promote these supportive interventions based on the current evidence and that enable young people to explore and live the gender that they choose. Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people.

[...]

In addition, evidence has demonstrated that forgoing gender-affirming care can have tragic consequences. Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5 percent reporting at least one diagnosis of a mental health or substance use disorder. 1 The increased prevalence of these mental health conditions is widely thought to be a consequence of minority stress, the chronic stress from coping with societal stigma, and discrimination because of one’s gender identity and expression. Because of this stress, transgender minors also face a significantly heightened risk of suicide.

Transgender children, like all children, have the best chance to thrive when they are supported and can obtain the health care they need. Studies suggest that improved body satisfaction and self-esteem following the receipt of gender-affirming care is protective against poorer mental health and supports healthy relationships with parents and peers. 2 Studies also demonstrate dramatic reductions in suicide attempts, as well as decreased rates of depression and anxiety. 3 Other studies show that a majority of patients report improved mental health and function after receipt of gender-affirming care. Medically supervised care can also reduce rates of harmful self-prescribed hormones, use of construction-grade silicone injections, and other interventions that have potential to cause adverse events. 4"

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The Pediatric Endocrine Society Opposes Bills that Harm Transgender Youth

“We caution legislators and the public that the support and implementation of these bills will worsen mental health, increase the risk of suicide, and contribute to poorer overall health in our TGD patients.”

“The Pediatric Endocrine Society recommends an affirmative model of care that supports one’s gender identity, and follows a multidisciplinary approach that includes involvement of mental health professionals, patients and their families. Puberty suppression and/or gender-affirming hormone therapy is recommended within this evidence-based approach on a case-by-case basis as medically necessary and is potentially lifesaving. The implementation of these recommendations has been demonstrated to improve the psychological health and well-being of TGD youth.”

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The Texas Counseling Association: Joint Statement Supporting and Care of Transgender Children

“Supporting and providing access to gender-affirming care for transgender children promotes health and well-being. It is not child abuse. This approach is recommended by the prevailing standards of care, best practices, and guidelines endorsed by national and international professional organizations including the World Professional Association of Transgender Health, the American Psychological Association, the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, the National Association of Social Workers, and the Australian Professional Association for Transgender Health and is associated with improved mental and physical health outcomes.”

“This gender-affirming model of care is based on the latest scientific evidence which demonstrates that family acceptance of a child’s gender identity and providing gender-affirming care are associated with improved well-being and mental health including reductions in symptoms of depression, anxiety, and suicidality. Children who experience negative family and caregiver responses of indifference, rejection, and/or attempts to change their gender identity or expression are more likely to experience negative psychological and social outcomes including depression, anxiety, suicidality, substance abuse, as well as heightened risk of lower educational attainment and homelessness.”

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The Pediatric Endocrine Society and The Endocrine Society, Transgender Health

“Transgender individuals who have been denied care show an increased likelihood of dying by suicide and engaging in self-harm. [7] Transgender/gender incongruent youth who had access to pubertal suppression, a treatment which is fully reversible and prevents development of secondary sex characteristics not in alignment with their gender identity, have lower lifetime odds of suicidal ideation compared to those youth who desired pubertal suppression but did not have access to such treatment. [9] Youth who are able to access gender-affirming care, including pubertal suppression, hormones and surgery based on conservative medical guidelines and consultation from medical and mental health experts, experience significantly improved mental health outcomes over time, similar to their cis-gender peers. [10-12] Pre-pubertal youth who are supported and affirmed in their social transitions long before medical interventions are indicated, experience no elevation in depression compared to their cis-gender peers. [12] It is critical that transgender individuals have access to the appropriate treatment and care to ensure their health and well-being.”

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Child Welfare League of America Opposes Redefining Child Abuse to Include Gender-Affirming Care

“The Child Welfare League of America (CWLA) stands with national and local organizations in opposition to any attempt to redefine child abuse to include gender-affirming care for youth who are transgender or nonbinary.”

“Providing appropriate, compassionate medical care for your child is not child abuse. We know that youth who identify as LGBTQ are at greater risk of homelessness, substance use disorders, mental illness, suicide ideation and attempts, trauma, and other negative outcomes than their peers; the right to receive individualized, evidence-based, identity-affirming care from their doctors and other medical providers saves lives. With nearly 30,000 children in care in 2021, Texas DFPS needs to focus its limited resources protecting children from actual abuse and neglect, not investigating children and families who are vulnerable.”

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National Association of Social Workers: NASW Condemns Efforts to Redefine Child Abuse to Include Gender-Affirming Care

“The National Association of Social Workers (NASW) condemns Texas Governor Greg Abbott’s direction to the state’s Department of Family and Protective Services (DFPS) to implement Texas Attorney General Ken Paxton’s opinion to treat age-appropriate, medically necessary, gender-affirming treatment as child abuse.

Although these cruel, politically motivated actions are non-binding, they perpetuate transphobia, and further harm the mental health and well-being of transgender and gender expansive youth by attempting to eliminate life-saving access to essential health services. These actions are taking place at a pivotal time: rates of suicide and compromised mental health for transgender youth are at an all-time high due to the persistent threats posed by transphobic laws and institutional policies.”

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The National Association of School Nurses, LGBTQ Students

“It is the position of the National Association of School Nurses (NASN) that, to provide culturally competent care, school staff and communities should institute affirming policies that support lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth. These include bullying, health risk behaviors, and rejection from family and friends. Such challenges can cause adverse mental and physical health effects such as depression and suicidal ideation. Registered professional nurses (hereinafter referred to as school nurses) are uniquely positioned to help LGBTQ youth by creating LGBTQ-affirming spaces, guiding youth towards resources, advocating for school-wide protections, and assuring youth that their identities and feelings are normal and appropriate.”

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The National Association of School Nurses, Transgender Students

“Transgender individuals are disproportionately affected by negative mental and sexual health outcomes. School nurses have prime opportunities to combat these outcomes through affirming nursing care, especially when transgender students are socially transitioning. Examples of affirming practice include recognizing students’ gender-affirming names, using their pronouns, ensuring safe locker rooms, advocating for student’s clothing choices, stopping bullying and harassment, and refraining from making assumptions about their transgender students’ sexual orientation. Through inclusive care directly provided to transgender children, school nurses can also be instrumental in ushering an affirming environment for all.”

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American Academy of Nursing

Health care services for transgender individuals: Position statement

“It is critical to provide TI (transgender individuals) with appropriate and quality health care services […], and nurses must become educated about the health care needs and barriers faced by TI.”

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National Association of School Psychologists & The American Psychological Association

The APA Resolution on Supporting Sexual/Gender Diverse Children and Adolescents in Schools

“WHEREAS transgender and gender diverse children and adolescents disproportionately experience elevated rates of depression, anxiety, self-harm, suicide, and other health risk behaviors (American Psychological Association, 2009; Coleman et al., 2011; Grossman, Park, & Russell, 2016; McGuire, Anderson, Toomey, & Russell, 2010; Veale, Watson, Peter, & Saewyc, 2017);”

“WHEREAS it may be medically and therapeutically indicated for some transgender and other gender diverse children and adolescents to transition from one gender to another using any of the following: change of name, pronouns, hairstyle, clothing, pubertal suppression, cross-sex hormone treatment, and surgical treatment (Coleman et al., 2011; Forcier & Johnson, 2012; Olson, Forbes, & Belzer, 2011);”

“WHEREAS invasive medical procedures that are not medically necessary in nature (e.g., genital surgery for purposes of ‘normalization’) continue to be recommended to parents of intersex/DSD children, often proceed without the affected individual’s assent, and lack research evidence on long-term quality of life, reproductive functioning, and body satisfaction (Wiesemann et al., 2010);”

“BE IT FURTHER RESOLVED that the American Psychological Association and the National Association of School Psychologists affirm that diverse gender expressions and presentations, regardless of gender identity, and diverse gender identities, beyond a binary classification, are normal and positive variations of the human experience;”

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National Association of Nurse Practitioners

Amicus Brief in Support of Transgender Health Care in Texas

“Following its Feb. 25 official statement in response to the Texas governor and attorney general’s actions Feb. 18-22 that threaten the health and well-being of transgender youth, the National Association of Pediatric Nurse Practitioners joined more than 20 health care organizations in an amicus brief on March 10 in the Doe v. Abbott litigation.”

“NAPNAP strongly believes that providing evidence-based health care to improve physical and mental health outcomes for transgender youth does not equate to child abuse and pediatric experts should not be persecuted and punished for taking care of their patients.”

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The National Association of Pediatric Nurse Practitioners Strongly Opposes Actions by Texas Leaders

“The National Association of Pediatric Nurse Practitioners strongly opposes the actions this week by Texas Governor Greg Abbott and Texas Attorney General Ken Paxton that threaten the health and well-being of transgender youth by falsely vilifying the dedicated pediatric health care providers who care for this vulnerable group of young people with unique health needs.”

“Pediatric-focused nurse practitioners and our fellow pediatric clinicians provide transgender health care based on the Endocrine Society’s Clinical Practice Guideline for Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons (CPG) which was developed following extensive inter-professional collaboration with nationally regarded experts,” said NAPNAP President Dr. Andrea Kline-Tilford. “This is the gold standard of peer-reviewed, evidence-based gender-affirming care and supported by leading organizations including NAPNAP, the American Academy of Pediatrics, the Endocrine Society and the American Psychological Association.”

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Society of Pediatric Nurses

“The SPN Healthcare Policy and Advocacy Committee (HPAC) and Board have been following legislation in several states that have threatened or impacted access to gender-affirming care for children. SPN supports a parent’s ability to access specially trained clinicians to address the healthcare needs of their children including gender dysphoria. In summer 2021, in response to the state of Arkansas passing legislation that would prohibit a physician or other healthcare provider from providing or referring transgender young people for medically necessary health care, SPN signed onto an amicus brief with other professional healthcare organizations, including the American Medical Association, American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners.”

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American College of Obstetricians and Gynecologists

Health Care for Transgender and Gender Diverse Individuals

“The American College of Obstetricians and Gynecologists opposes discrimination on the basis of gender identity, urges public and private health insurance plans to cover necessary services for individuals, and advocates for inclusive, thoughtful, and affirming care for transgender individuals.”

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World Association for Sexual Health

“Every trans person should have full access to health services and trans-specific care, which includes, for example, social and therapeutic support starting from early childhood, treatment of gender dysphoria and all necessary medical treatments in puberty and adulthood”

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The World Health Organization, Moving One Step Closer to Better Health and Rights for Transgender People

“It is crucially important that transgender individuals have equal access to health services, including HIV prevention and care, and this requires health systems to be responsive to their needs. The adoption of ICD-11 by more and more countries is a vital first step towards removing legal barriers to care. That will help stop stigma and discrimination and accelerate progress towards true universal health coverage.”

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The World Health Organization, Gender Incongruence of Adolescence or Adulthood

“Gender Incongruence of Adolescence and Adulthood is characterised by a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender. The diagnosis cannot be assigned prior the onset of puberty. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.”

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Association of American Medical Colleges

“In medical decision making, the doctor-patient relationship must be paramount, and the needs of the patient must be given precedence. Efforts to restrict the provision of gender-affirming health care for transgender individuals will reduce health care access for transgender Americans, promote discrimination, and widen already significant health inequities.”

“In addition to harming some of the most vulnerable patients, efforts to restrict care undermine the doctor-patient relationship and the principle that doctors are best equipped to work with patients and their families to arrive at shared decision-making.”

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The World Medical Association

“The WMA urges that every effort be made to make individualised, multi-professional, interdisciplinary and affordable transgender healthcare (including speech therapy, hormonal treatment, surgical interventions and mental healthcare) available to all people who experience gender incongruence in order to reduce or to prevent pronounced gender dysphoria.”

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About Trans People & Scientific Sex and Gender Definitions

What are Sex & Gender? By The National Institutes of Health

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The Word “Cisgender” Has Scientific Roots

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LGBTQ+ Definitions from The American Academy of Pediatrics

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LGBTQ+ Definitions from The CDC

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Understanding Transgender People, Gender Identity and Gender Expression, by The American Psychological Association

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The American Academy of Pediatrics & The American College of Osteopathic Pediatricians, Supporting & Caring for Transgender Children

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Third gender, Non-Binary Wiki

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Two-Spirit People

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Transgender History

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Transgender Persons, by The CDC

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Neurological and Biological Research on Gender Identity

The Endocrine Society, Transgender Health

“There is a durable biological underpinning to gender identity that should be considered in policy determinations.”

“Attempts to change gender identity in intersex patients to match external genitalia or chromosomes are typically unsuccessful 1. 2.“

“identical twins (who share the exact same genetic background) are more likely to both experience transgender identity as compared to fraternal (non-identical) twins 3.”

“Among individuals with female chromosomes (XX), rates of male gender identity are higher for those exposed to higher levels of androgens *in utero* relative to those without such exposure, and male (XY)-chromosome individuals with complete androgen insensitivity syndrome typically have female gender identity. 4.”

“There are associations of certain brain scan or staining patterns with gender identity rather than external genitalia or chromosomes. 1. 2.”

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1. Evidence supporting the biologic nature of gender identity

Results: Evidence that there is a biologic basis for gender identity primarily involves data on gender identity in patients with disorders of sex development (DSDs, also known as differences of sex development) along with neuroanatomical differences associated with gender identity.

Conclusions: Although the mechanisms remain to be determined, there is strong support in the literature for a biologic basis of gender identity.

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2. Approach to the patient: transgender youth: endocrine considerations

Compelling studies have demonstrated that "gender identity"--a person’s inner sense of self as male, female, or occasionally a category other than male or female--is not simply a psychosocial construct, but likely reflects a complex interplay of biological, environmental, and cultural factors.

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3. Gender Identity In Twins: A Review Of The Case Report Literature

Aim: To review the current literature on case studies of twins concordant or discordant for GID.

Methods: A systematic, comprehensive literature review.

Results: Of 23 monozygotic female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same-sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P=0.005). Of the seven opposite-sex twins, all were discordant for GID.

Conclusions: These findings suggest a role for genetic factors in the development of GID.

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4. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia

Females with XX chromosomes, but born intersex with congenital adrenal hyperplasia (CAH) are sometimes raised male before doctors or parents know their gender identity. This study examined them and found, “The large majority (94.8%) of the patients raised female (N= 250) later developed a gender identity as girls and women and did not feel gender dysphoric. But 13 (5.2%) patients had serious problems with their gender identity. This percentage is higher than the prevalence of female-to-male transsexuals in the general population of chromosomal females. Among patients raised male, serious gender identity problems were reported in 4 (12.1%) out of 33 patients. From these observations, we conclude that the assignment to the female gender as a general policy for 46,XX patients with CAH appears justified, even in severely masculinized 46,XX newborns with CAH (Prader stage IV or V).”

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White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study

“Our results show that the white matter microstructure pattern in untreated FtM transsexuals is closer to the pattern of subjects who share their gender identity (males) than those who share their biological sex (females). Our results provide evidence for an inherent difference in the brain structure of FtM transsexuals.”

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The Use of Whole Exome Sequencing in a Cohort of Transgender Individuals to Identify Rare Genetic Variants

“We performed whole exome sequencing on the genomic DNA of 13 transgender males and 17 transgender females. Whole exome sequencing revealed 120,582 genetic variants. After filtering, 441 variants in 421 genes remained for further consideration, including 21 nonsense, 28 frameshift, 13 splice-region, and 225 missense variants. Of these, 21 variants in 19 genes were found to have associations with previously described estrogen receptor activated pathways of sexually dimorphic brain development. These variants were confirmed by Sanger Sequencing. Our findings suggest a new avenue for investigation of genes involved in estrogen signaling pathways related to sexually dimorphic brain development and their relationship to gender dysphoria.”

”Overall, the above evidence suggests that, in many species and by proxy of estrogen, testosterone’s presence or absence during the perinatal period drives diverging pathways of permanent sex-specific neurodevelopment, which later result in sex-specific behavior.”

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Callosal Shapes at the Midsagittal Plane: MRI Differences of Normal Males, Normal Females, and GID

Japanese researchers Yokata, Kawamura and Kameya have investigated shape differences in the brain’s corpus callosum (CC) in cisgendered and transgendered individuals. Their findings show significant differences in the CC shape of typical male and female brains and the corpus callosum of transsexuals. They report that the CC of transsexuals “more strongly reflects their mental sex, i.e., gender, than their physical sex.”

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Androgen Receptor Repeat Length Polymorphism Associated with Male-to-Female Transsexualism

“A significant association was identified between transsexualism and the *AR* allele, with transsexuals having longer *AR* repeat lengths than non-transsexual male control subjects (*p* = .04).”

“This study provides evidence that male gender identity might be partly mediated through the androgen receptor.”

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Genetic Link Between Gender Dysphoria and Sex Hormone Signaling

“A significant association was identified between gender dysphoria and ERα, SRD5A2, and STS alleles, as well as ERα and SULT2A1 genotypes. Several allele combinations were also overrepresented in transgender women, most involving AR (namely, AR-ERβ, AR-PGR, AR-COMT, CYP17-SRD5A2). Overrepresented alleles and genotypes are proposed to undermasculinize / feminize on the basis of their reported effects in other disease contexts.”

“Gender dysphoria may have an oligogenic component, with several genes involved in sex hormone–signaling contributing.”

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A polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism

“These data support CYP17 as a candidate gene of FtM transsexualism and indicate that loss of a female-specific CYP17 T -34C allele distribution pattern is associated with FtM transsexualism.”

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Effects of male sex hormones on gender identity, sexual behavior, and cognitive function

“Androgens, the male sex hormones, play an essential role in male sexual differentiation and development. However, the influence of these sex hormones extends beyond their roles in sexual differentiation and development. In many animal species, sex hormones have been shown to be essential for sexual differentiation of the brain during development and for maintaining sexually dimorphic behavior throughout life.”

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Male-to-female transsexuals have female neuron numbers in a limbic nucleus

“The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.”

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A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity

“We propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early atypical sexual differentiation of the brain and that the changes in INAH3 and the BSTc may belong to a complex network that may structurally and functionally be related to gender identity.”

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Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure

“The findings suggest that treatment of MFs with estrogens and anti-androgens decreases the male brain size towards female proportions, whereas treatment of FMs with androgens (not substantially affecting circulating estrogen levels) increases the female brain size towards male proportions. The magnitude of this change (i.e. 31 ml over a 4-month period) is striking, since it signifies a decrease in brain volume, which is at least ten times the average decrease of around 2.5 ml per year in healthy adults.”

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The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study

“Diffusion tensor imaging (DTI) has been shown to be sensitive in detecting white matter differences between sexes. Before cross-sex hormone treatment female to male transsexuals (FtM) differ from females but not from males in several brain fibers.”

“Our results show that the white matter microstructure pattern in untreated MtF transsexuals falls halfway between the pattern of male and female controls. The nature of these differences suggests that some fasciculi do not complete the masculinization process in MtF transsexuals during brain development.”

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The (CA)n polymorphism of ERβ gene is associated with FtM transsexualism

“There is an association between the ERβ gene and FtM transsexualism. Our data support the finding that ERβ function is directly proportional to the size of the analyzed polymorphism, so a greater number of repeats implies greater transcription activation, possibly by increasing the function of the complex hormone ERβ receptor and thereby encouraging less feminization or a defeminization of the female brain and behavior.”

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Analysis of Four Polymorphisms Located at the Promoter of the Estrogen Receptor Alpha ESR1 Gene in a Population With Gender Incongruence

An association between polymorphisms in the estrogen receptor alpha gene promoter and a transgender male identity was found.

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Genotypes and Haplotypes of the Estrogen Receptor α Gene (ESR1) Are Associated With Female-to-Male Gender Dysphoria

XbaI-rs9340799 is involved in FtM gender dysphoria in adults. Our findings suggest different genetic programs for gender dysphoria in men and women. Cortés-Cortés J, Fernández R, Teijeiro N, et al. Genotypes and Haplotypes of the Estrogen Receptor α Gene (ESR1) Are Associated With Female-to-Male Gender Dysphoria. J Sex Med 2017;14:464-472.

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Dichotic Listening, Handedness, Brain Organization, and Transsexuality

Auditory response of the brain was tested with trans people and the response by trans women resembled the results from cis women, which were significantly different from cis men’s. While the response of trans men didn’t resemble cis men’s results.

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Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids

Olfactory (sense of smell) response was tested with trans women, specifically who were also only attracted to women, to rule out the possibility that if their olfactory response was similar to cis women’s it wasn’t the result of past sexual encounters. What they found is that the olfactory response still resembled cis women’s, which were also distinct from cis men’s olfactory response. They use out-of-date language for trans people in this study though.

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The role of neonatal NMDA receptor activation in defeminization and masculinization of sex behavior in the rat

“In a series of animal model studies confirming these pathways, researchers exposed developing rodents to substrates that would either induce ER activated pathways in females (i.e. exposure to testosterone or estradiol) or disrupt those pathways in males. In each of these models, investigators were able to induce cross-sex neurodevelopment and resulting cross-sex behavior in rodents, scored by examination of lordosis and proceptive behavior in males and by mounting and thrusting events in females”

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Sexually dimorphic gene expression in mouse brain precedes gonadal differentiation

“Using microarrays and RT-PCR, we have detected over 50 candidate genes for differential sex expression, and confirmed at least seven murine genes which show differential expression between the developing brains of male and female mice at stage 10.5 days post coitum (dpc), before any gonadal hormone influence. The identification of genes differentially expressed between male and female brains prior to gonadal formation suggests that genetic factors may have roles in influencing brain sexual differentiation.”

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Twin Studies

The Heritability of Gender Identity Disorder in a Child and Adolescent Twin Sample

Results of testing for GID among the large twin data set of Australia found, “The model that best described the data included a significant additive genetic component accounting for 62% of the variance and a non-shared environmental component accounting for the remaining 38% of the variance (...) Overall, the results support the hypothesis that there is a strong heritable component to GID. The findings may also imply that gender identity may be much less a matter of choice and much more a matter of biology.

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Gender Identity Disorder in Twins: A Review of the Case Report Literature

“A 2012 review of the literature found that of the reported cases of identical twins where at least one was gender dysphoric, 39.1% of twin pairs were concordant for gender dysphoria (Heylens et al., 2012). However, out of all the reported cases of fraternal twins where at least one was gender dysphoric, none were concordant for gender dysphoria. In other words, genetically identical twins were vastly more likely to be concordant for gender dysphoria than those who were not genetically identical. That is not a negligible biological contribution to gender identity – it is a significant one.”

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Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation

”If you’ve read about it, you know that identical twins are much more likely to both be trans than fraternal twins.”

“The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing”

”Combining data from our independent findings with those from past research, 13 of 39 male MZ twin pairs (33.3%) were found to be concordant for transsexual identity and eight of 25 (22.8%) female MZ twins were found concordant. In comparison, concordance between either male or female DZ twins was low or zero (1/38 = 2.6%; Table 5).”

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Identical Reared Apart Twins Concordant for Transsexuality

This study was a situation where twins were separated at birth from adoption agencies and grew up without knowing each other. However, when they reunited they both found they had a long history of defying their parents to live by their gender, which was different than the gender assigned to them at birth. One twin (Abbreviated to be, “AT”) tragically took their life when they were 35 years old from how they grow up with societal prejudice.

“Genetic effects on transsexuality are strongly indicated by this unique case study. The nature and extent of family support also affect the behavioral adjustment of transsexual individuals, as evidenced by LT’s more favorable outcome and AT’s tragic outcome.”

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The Biological Contributions to Gender Identity and Gender Diversity: Bringing Data to the Table

“This review of existing family and twin studies summarizes significant and consistent evidence for the role of innate genetic factors in the development of both cisgender and transgender identities, a negligible role for shared environmental factors, and a small potential role for unique environmental factors.”

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Gender Identity is Not Chosen

The DSM By The American Psychiatric Publishing Textbook of Psychiatry

"Gender identity appears to develop in the early years of life and generally is established by age 3 years." - The DSM By The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition 2013, page 682.

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The American Psychological Association - Gender Diversity and Transgender Identity in Adolescents

"(Transgender)..youth’s sense of their internal gender is not caused by anything a family member did or did not do. Importantly, by adolescence, one’s gender identity is very resistant, if not immutable, to any type of environmental intervention."

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American Academy of Pediatrics, Gender Identity Development in Children

Around age two: Children become conscious of the physical differences between boys and girls.

Before their third birthday: Most children can easily label themselves as either a boy or a girl.

By age four: Most children have a stable sense of their gender identity.

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Similarity in transgender and cisgender children’s gender development

A study, published Nov. 18 in the Proceedings of the National Academy of Sciences, followed more than 300 transgender children from across the United States, as well as nearly 200 of their cisgender siblings and about 300 unrelated cisgender children as a control group. It is the first study to report on all of the participants in the TransYouth Project, launched in 2013 by UW professor of psychology Kristina Olson.

“Four primary findings emerged. First, transgender children strongly identify as members of their current gender group and show gender-typed preferences and behaviors that are strongly associated with their current gender, not the gender typically associated with their sex assigned at birth. Second, transgender children’s gender identity (i.e., the gender they feel they are) and gender-typed preferences generally did not differ from 2 comparison groups: cisgender siblings (n = 189) and cisgender controls (n = 316). Third, transgender and cisgender children’s patterns of gender development showed coherence across measures. Finally, we observed minimal or no differences in gender identity or preferences as a function of how long transgender children had lived as their current gender. Our findings suggest that early sex assignment and parental rearing based on that sex assignment do not always define how a child identifies or expresses gender later.”

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Gender Identity 5 Years After Social Transition

317 socially transitioned transgender children joined this longitudinal study between July 2013 and December 2017.

“The overall rate of retransition (back to a cisgender identity) was 7.3%. An average of 5.37 years after their initial binary social transition, most participants were living as binary transgender youth (94.0%).”

For inclusion in the study, children had to be between 3 and 12 years of age and had to have made a complete social transition, including changing their pronouns to the pronouns that differed from those assigned at their birth. They made sure the participants were equally from every region of the United States and Canada.

“Based on data collected at their initial visit, these participants showed signs of gender identification and gender-typed preferences commonly associated with their gender, not their sex assigned at birth. Further, parent report using the Gender Identity Questionnaire for Children indicated that youth showed significant “cross-sex” identification and preferences (when scored based on sex at birth)”

“Only 1 classification was debatable; this participant was classified by pronouns (and in this paper) as nonbinary but could have been classified as binary transgender (and not retransitioned).”

”This study has been approved by the University of Washington and Princeton University institutional review boards.”

Youth who initially socially transitioned before age 6 (124 children), were more likely to be living as cisgender (7 children, which was 5.6% of the participants) than youth who transitioned at age 6 or later (1 child out of 193, which is 0.5%), although low rates of retransition were seen in both groups.

“Other clinicians argue that early social transitions can be beneficial for some gender-diverse youth. Some clinicians and scholars who support early childhood social transitions encourage families to remain open to later retransitions, which are seen by some as part of a youth’s exploration of their gender.”

“Past work has suggested that the ages 10 to 13 years are an especially critical time for retransition. In our sample, many of the youth who retransitioned did so before that time frame, particularly the cisgender youth. In the nonbinary group, however, 6 of 11 retransitioned between ages 10 and 13 years, with the remainder retransitioning before age 10. Importantly, our sample differed from the past work on which this age range was determined in several key ways, including that our participants socially transitioned at earlier ages (perhaps pushing retransitions earlier, too), had undergone complete social transitions including pronouns and names (not just hairstyle and clothing changes as in most cases in previous studies ), and are living at a different historic time in a different country. Any, or all, of these may turn out to be key differences related to age of retransition.”

“Our key finding, that there was a relatively low rate of retransition about 5 years after initial social transition, may, on the surface, appear contradictory with past clinic-based research on what is sometimes called persistence and desistence of childhood gender dysphoria. Several large studies attempted to recontact adolescents and adults who had previously been evaluated for gender dysphoria in childhood. Many of those were formally diagnosed with what was, at the time, called gender identity disorder. Those studies reported that a minority of youth later identified in a way that might indicate a transgender identity by today’s definition.

Interpretation of those results, and especially comparison with the present work, is difficult for several reasons. First, in past studies, when asked “are you a boy or a girl?” about 90% of the children supplied answers that aligned with their sex at birth,18 leading some to question whether the majority of those children were the equivalent of transgender children today or not. Second, participants in those studies were children between the 1960s and the 1990s, and many features of society have changed since then, including greater rates of acceptance and acknowledgment of transgender identities. Third, the parents of the youth in the current study support their children’s identities, as indicated by their approval of their social transitions, whereas many of the parents of youth in past studies explicitly discouraged gender nonconformity or “cross-gender” identification. In addition, it would have been exceedingly rare for youth in those studies to socially transition, especially completely. Finally, there were substantial drop-out rates in all of the previous studies, making the true estimates of persistence or desistence difficult to obtain. Because there are so many possible contributors to differences in rates of persistence (in past work) and retransition in the current work, we urge caution about overinterpreting differences, or overconfidence about which contributing factors explain the differences.

There are also some reasons why we might have had such a low retransition rate. First, on average, participants had socially transitioned 1.6 years before joining our study. It is possible that some youth initially try socially transitioning and then change their minds quickly. Such youth would be unlikely to be enrolled in this study because their eligibility period would have been quite short and therefore the odds of finding the study and completing it would have been low. This means the children in our study may have been especially unlikely, compared with all children who transition, to retransition because they had already lived and presumably been fairly content with that initial transition for more than a year. Second, it is possible that families who failed to participate in the past 2 years of our study (n = 26) were disproportionately those whose children retransitioned and who were therefore hesitant to participate again. If true, their exclusion could have reduced our retransition rate. We are skeptical of this possibility for a few reasons. First, 4 of these participants did retransition and had told us about that outcome, so it does not appear that hesitancy in telling us was widespread in this group. Second, many of these families continue to be in touch with our research team and only missed participation because of ongoing personal issues (eg, COVID-19, emergency family circumstances). We anticipate that most of these families will be able to participate as we continue to follow these youth. Finally, from the beginning of the study, the research team has been clear in discussing with the families that we are open to any outcome in their youth.”

They are also planning to do follows-ups with the participants into adulthood.

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The Age When Trans People First Realize Their Gender Identity

How Early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System

This study found that most adult transgender patients who transitioned knew at 3-7 years old. 78% of the transgender men and 73% of transgender women. Also, that it can persist for years before they receive treatment. It’s also found that untreated gender dysphoria can result in poor quality of life for transgender people.

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Gender Dysphoria

What is Gender Dysphoria? By the American Psychiatric Association

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The High Suicide Rate with Trans Adolescents

Prevalence and Correlates of Suicidal Ideation Among Transgender Youth in California: Findings From a Representative, Population-Based Sample of High School Students

First, we found significant gender identity-related disparities in past-year suicidal ideation: nearly 35% of transgender youth in

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Transgender Adolescent Suicide Behavior

“Nearly 14% of adolescents (overall; cis and trans adolescents) reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%).” Also keep in mind these are suicide attempts, which means suicidality would be a much higher percentage.

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National Survey on LGBTQ Youth Mental Health 2020

48% of LGBTQ youth reported engaging in self-harm in the past twelve months, including over 60% of transgender and nonbinary youth

10% of LGBTQ youth reported undergoing conversion therapy, with 78% reporting it occurred when they were under age 18

Transgender and nonbinary youth who reported having pronouns respected by all or most people in their lives attempted suicide at half the rate of those who did not have their pronouns respected

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Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada

We included 6800 adolescents aged 15–17 years, including 1130 (16.5%) who indicated some degree of same-gender attraction, 265 (4.3%) who were unsure of their attraction and 50 (0.6%) who reported a transgender identity. Compared with cisgender, heterosexual adolescents, transgender adolescents showed 5 times the risk of suicidal ideation (95% confidence interval [CI] 3.63 to 6.75; 58% v. 10%) and 7.6 times the risk of suicide attempt (95% CI 4.76 to 12.10; 40% v. 5%).

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Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers

For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4–82) to 144 (95% CI 36–1248). The corresponding range for suicidal ideation was 25 (95% CI 14–45) to 54 (95% CI 18–218).

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Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers

“Conclusions: Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression.”

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Suicidality Disparities Between Transgender and Cisgender Adolescents

“Adolescents aged 14 to 18 completed a cross-sectional online survey (*N* = 2020, including 1148 TGAs).”

“TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt.”

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The impact of discrimination on the mental health of trans*female youth and the protective effect of parental support

We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16–24 years.

High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95% CI, 1.4–5.0), depression (AOR, 2.6; 95% CI, 1.2–5.9), and stress related to suicidal thoughts (AOR 7.7, 95% CI 2.3–35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95% CI 1.2–10.8), PTSD (AOR 2.1; 95% CI 1.1–4.2) and stress related to suicidal thoughts (AOR 4.3, 95% CI 1.5–13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts.

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Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study

Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all *p* < .05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.

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CDC, Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students — 19 States and Large Urban School Districts, 2017

“The results of this study validate findings from smaller clinical and web-based studies that, at a population level, transgender students are at disproportionately higher risk than are cisgender students for violence victimization, substance use, and suicide risk”

“…suicide risk (e.g., 34.6% attempting suicide in the last 12 months) are concerning…”

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Gender-Affirming Care Significantly Decreases Suicide Ideation

Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults

“Conclusion: Access to GAH during adolescence and adulthood is associated with favorable mental health outcomes compared to desiring but not accessing GAH.”

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Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation

“There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.”

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Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth

“Findings support a relationship between access to GAHT and lower rates of depression and suicidality among transgender and nonbinary youth.”

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Association of Gender Identity Acceptance with Fewer Suicide Attempts Among Transgender and Nonbinary Youth

“Conclusion: Interventions aimed at suicide prevention for TGNB youth should include efforts aimed at leveraging gender identity acceptance from supportive adults and peers in their lives.”

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Gender Affirmation Is Associated with Transgender and Gender Nonbinary Youth Mental Health Improvement

“Conclusion: Enabling transgender and gender nonbinary youth to access gender affirmation processes more easily should be considered as a strategy to reduce depression and anxiety symptoms, as well as to improve gender positivity.”

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Psychosocial Functioning in Transgender Youth after 2 Years of Hormones

“Conclusions: In this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning.”

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What does the scholarly research say about the effect of gender transition on transgender well-being?

“We conducted a systematic literature review of all peer-reviewed articles published in English between 1991 and June 2017 that assess the effect of gender transition on transgender well-being. We identified 55 studies that consist of primary research on this topic, of which 51 (93%) found that gender transition improves the overall well-being of transgender people, while 4 (7%) report mixed or null findings. We found no studies concluding that gender transition causes overall harm. As an added resource, we separately include 17 additional studies that consist of literature reviews and practitioner guidelines.”

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Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study

In this study they examined 70 children between the age of 12 and 16 between 2000 and 2008. Psychological functioning and gender dysphoria were assessed twice. Before starting puberty blockers and just before they made the decision to progress to Hormone Replacement Therapy, which is the first step of fully transitioning. Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger didn’t change, which is expected. This is mainly about preventing the suicidal depression that comes along. Transitioning in itself can be stressful, but it improves mental health over time. Gender Dysphoria didn’t decrease, but that’s because with puberty blockers they haven’t transitioned yet.

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Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents

“Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents.”

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Psychosocial Characteristics of Transgender Youth Seeking Gender-Affirming Medical Treatment: Baseline Findings From the Trans Youth Care Study

“GnRHa cohort youth appear to be functioning better from a psychosocial standpoint than GAH cohort youth, pointing to possible benefits of accessing gender-affirming treatment earlier in life.”

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Young adult psychological outcome after puberty suppression and gender reassignment

“Conclusions: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.”

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Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK

A majority of the trans young people on puberty blockers had a positive experience of the treatment, the study, which was published in journal PLOS One, found.

“Participant experience of treatment as reported in interviews was positive for the majority, particularly relating to feeling happier, feeling more comfortable, better relationships with family and peers and positive changes in gender role,” the conclusion states.

“Smaller numbers reported having mixed positive and negative changes. A minority (12 per cent at 6-15 months and 17 per cent at 15-24 months) reported only negative changes, which were largely related to anticipated side effects. None wanted to stop treatment due to side effects or negative changes.”

The study found that 98 per cent of the young people continued on to hormone replacement therapy (HRT) once puberty blocking treatment stopped at the age of 16 – as had been predicted, given the severity and persistence of their gender dysphoria.

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Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults

“Conclusion: Access to GAH during adolescence and adulthood is associated with favorable mental health outcomes compared to desiring but not accessing GAH.”

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Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results

“Conclusion: Endocrine intervention may improve mental health in transgender youths in the US. This effect was observed in both male-to-female and female-to-male youths, but appears stronger in the former.”

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Effectiveness of Puberty Suppression with Gonadotropin-Releasing Hormone Agonists in Transgender Youth

“2015 U.S. Transgender Survey”

“Conclusions: GnRHa are effective in suppressing the HPG axis in transgender youth, similar to that observed in children with CPP.”

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Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents

“Conclusion: Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents.”

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Care for Transgender Young People

“Gender-affirming care has been associated with improved mental health outcomes in TGD young people [13, 15, 71]. Medical interventions specifically are associated with decreases in depression and anxiety [13, 35, 36]. Modifiable lifestyle factors that can mitigate cardiovascular and bone health risk should be discussed prior to initiating and during gender-affirming therapy. Clinicians providing medical gender-affirming therapies should counsel TGD young people and their families on the expected changes as well as the known and unknown outcomes. More research regarding the long-term effects of GnRHa and GAH treatment is needed, especially for TGD young people.”

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Psychosocial assessment in transgender adolescents

“The rates of anxiety, emotional and behaviour distress, depressive symptomatology, as well as the feeling of gender dysphoria of these transgender patients were similar to those of non-transsexual population of the same age after one year of CHT initiated at ages between 14 and 18 years old.”

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Well-being and suicidality among transgender youth after gender-affirming hormones.

“Conclusion: These findings suggest that gender-affirming hormones are a valuable medical intervention with promising psychosocial outcomes for transgender youth.”

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Association Between Gender-Affirming Surgeries and Mental Health Outcomes

“In this article, we present the largest study to our knowledge to date on associations between gender-affirming surgeries and mental health outcomes. Our results demonstrate that undergoing gender-affirming surgery is associated with improved past-month severe psychological distress, past-year smoking, and past-year suicidal ideation. Our findings offer empirical evidence to support provision of gender-affirming surgical care for TGD people who seek it. Furthermore, this study provides evidence to support policies that expand and protect access to gender-affirming surgical care for TGD communities.”

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Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt

“The study found that trans people are most at risk prior to social and/or medical transition and that, in many cases, trans people who require access to hormones and surgery can be left unsupported for dangerously long periods of time. The paper highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritize timely intervention and support.”

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Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care

“In this prospective cohort of 104 TNB youths aged 13 to 20 years, receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.”

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What is Gender-Affirming Care?

American Academy of Pediatrics

"What is most important is for a parent to listen, respect and support their child’s self-expressed identity. This encourages open conversations that may be difficult but key to the child’s mental health and the family’s resilience and wellbeing.” “The gender-affirming model strengthens family resiliency and takes the emphasis off heightened concerns over gender while allowing children the freedom to focus on academics, relationship-building and other typical developmental tasks.”

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American Medical Association

“As with all medical interventions, physicians are guided by their ethical duty to act in the best interest of their patients and must tailor recommendations about specific interventions and the timing of those interventions to each patient’s unique circumstances. Such decisions must be sensitive to the child’s clinical situation, nurture the child’s short and long-term development, and balance the need to preserve the child’s opportunity to make important life choices autonomously in the future. We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients.”

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The American Academy of Pediatrics, Ensuring Comprehensive Care

"In a gender-affirmative care model (GACM), pediatric providers offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. A strong, nonjudgmental partnership with youth and their families can facilitate exploration of complicated emotions and gender-diverse expressions while allowing questions and concerns to be raised in a supportive environment."

See the sub section, "Gender-Affirmative Care" They go into detail about what it is, including "Developmental Considerations", "Medical Management", "Clinical Setting", and "Pubertal Suppression".

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Standards of Care for the Health of Transgender and Gender Diverse People, by WPATH

The WPATH Standards of Care are considered the gold standard for providing Gender-Affirming Care to transgender and gender diverse individuals, and they are widely recognized and used by healthcare providers around the world.

Many medical organizations and institutions have adopted the WPATH Standards of Care as the basis for their policies and procedures related to the care of transgender and gender diverse individuals. For example, in the United States, the WPATH Standards of Care are often referenced in the guidelines and policies of professional organizations such as the American Medical Association and the American Psychological Association, as well as in the policies of hospitals and healthcare systems.

The description of the Gender-Affirming Care procedures begins in Chapter 5, "Assessment of Adults", page 31, of their guidelines.

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USPATH and WPATH Confirm Gender-Affirming Health Care is Not Experimental

“The WPATH Standards of Care for the Health of Transgender and Gender Diverse People, now in its 8th version (SOC8), is the foremost evidence-based guideline for the provision of transgender and gender diverse healthcare. SOC8 is based on the best available science with input from over 100 global medical professionals and experts and represents best-practice guidelines for the provision of gender-affirming healthcare. Gender-affirming interventions are based on decades of clinical experience and research and are not considered experimental. Gender affirming hormone therapy (GAHT) is a component of widely accepted medically necessary care for transgender and gender diverse people.”

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Long-term effects of gonadotropin-releasing hormone analogs in girls with central precocious puberty

This study found puberty blockers are safe medication for cisgender children to take for precocious puberty.

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Research Shows Conversion Therapy is Associated With Suicide

The American Academy of Child & Adolescent Psychiatry, Conversion Therapy

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American Psychological Association, Resolution on Gender Identity Change Efforts

“Whereas GICE (Gender Identity Change Efforts) are associated with harmful social and emotional effects for many individuals, including but not limited to, the onset or increase of depression, anxiety, suicidality, loss of sexual feeling, impotence, deteriorated family relationships, a range of post-traumatic responses, and substance abuse”

The experiences of transgender survivors of trauma who undergo social and medical transition.

“Transgender individuals have frequent experiences of trauma, often related to societal prejudice, hatred, or intolerance, because of their gender identity.”

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Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018

“Relative to young people who had not experienced SOGICE (Sexual Orientation & Gender Identity Change Efforts), those who reported undergoing SOGICE were more than twice as likely to report having attempted suicide and having multiple suicide attempts.”

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Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults

“In a cross-sectional study of 27,715 US transgender adults, recalled exposure to gender identity conversion efforts was significantly associated with increased odds of severe psychological distress during the previous month and lifetime suicide attempts compared with transgender adults who had discussed gender identity with a professional but who were not exposed to conversion efforts. For transgender adults who recalled gender identity conversion efforts before age 10 years, exposure was significantly associated with an increase in the lifetime odds of suicide attempts.”

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The American Psychological Association’s Resolution on Gender Identity Change Efforts

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Statement on conversion therapy by The Independent Forensic Group

“The opinions expressed in this statement are based on international standards and the experiences of members of the Independent Forensic Expert Group (IFEG) in documenting the physical and psychological effects of torture and other cruel, inhuman, or degrading treatment or punishment (also ill-treatment). Consisting of 39 preeminent independent medico-legal specialists from 23 countries”

“Conversion therapy has no medical or scientific validity. The practice is ineffective, inherently repressive, and is likely to cause individuals significant or severe physical and mental pain and suffering with long-term harmful effects. It is our opinion that conversion therapy constitutes cruel, inhuman, or degrading treatment when it is conducted forcibly or without an individual’s consent and may amount to torture depending on the circumstances”

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Conversion Therapy and LGBT Youth

“Only 8% of respondents to a 2014 national poll said they thought conversion therapy could change a person\’s sexual orientation.”

◦ 698,000 LGBT adults (ages 18-59)5 in the U.S. have received conversion therapy, including about 350,000 LGBT adults who were subjected to the practice as adolescents.

◦ 16,000 LGBT youth (ages 13-17) will receive conversion therapy from a licensed health care professional before they reach the age of 18 in the 32 states that currently do not ban the practice.

◦ 10,000 LGBT youth (ages 13-17) live in states that ban conversion therapy and have been protected from receiving conversion therapy from a licensed health care professional before age 18.

◦ An estimated 57,000 youth (ages 13-17) across all states will receive conversion therapy from religious or spiritual advisors before they reach the age of 18.

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Sexual orientation and gender identity change efforts (so-called “conversion therapy”)

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The Rate of Regret and Detransition is Extremely Low

Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence

A total of 27 studies, pooling 7,928 transgender patients who underwent any type of GAS, were included. The pooled prevalence of regret after GAS was 1%

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The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets

One of the most thorough longitudinal studies from 1972-2015 (6,793 patients with 548 kids under 12) found that, while the number of trans patients increased, regret stayed the same, ~.5%.

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The Report of the U.S. Transgender Survey

In 2015 a survey of 28,000 transgender respondents, it found that just 8% of respondents reported “some kind” of detransition, and of the 8% 62% said they did it just temporarily because of society, family, or financial pressure. (2015 U.S. Transgender Survey)

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Inside Matters. On Law, Ethics and Religion

In the United Kingdom a survey with 3,398 transgender attendees who have transitioned found just 0.47% transition have experienced regret about transitioning. Even fewer went on to detransition.

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An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960-2010: Prevalence, Incidence, and Regrets

A 50-year longitudinal study in Sweden that found of 767 trans people, just two per cent expressed regret following gender-affirming surgery. Studies in Britain and the Netherlands found similar rates of 0.47 per cent and 1.9 per cent respectively.

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Gender Identity 5 Years After Social Transition

Researchers completed the a large longitudinal study on trans children this year. They found an overwhelming number (97.5%) of trans kids continued to identify as trans. Those that desisted did so for various reasons including the violence faced as trans people.

I meant to put an “overwhelming” 97.5% of trans kids continue to identify as trans. This is a higher satisfaction rate than appendectomies, knee replacements, or laser eye surgery.

If you asked most surgeons if they would like their procedures to have a 97.5% success rate they would jump at the chance.

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Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands

Groundbreaking new study shows that 98% of trans youth that take puberty blockers and start HRT continue to take hormones into adulthood. Trans kids know who they are and they don’t just "grow out of it.

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A Survey Study of Surgeons’ Experience with Regret and/or Reversal of Gender-Confirmation Surgeries

46 surgeons (30%) responded to the survery. 67% of providers have been in practice for greater than 10 years and most surgeons practice in the United States (69%) followed by Europe (22%). In total they have had 22,725 patients. 49% of respondents had never encountered a patient who regretted their gender transition or were seeking detransition care. 12 providers encountered 1 patient with regret and the rest encountered more than one patient.

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The Reason Why Few People Detransition

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

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Study Showing Negative Mental Health Outcomes After Gender-Affirming Care Go Away After Accounting For Social Harassment Based on Gender Identity

Timing of Social Transition for Transgender and Gender Diverse Youth, K-12 Harassment, and Adult Mental Health Outcomes

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Discrimination Faced by Trans People

Transgender people confront many forms of discrimination in the western world and violence in various aspects of life, such as in employment, housing, health care, education, and public spaces. • Political demagogues with a lot of money and some people, who want to push a closed minded definition of sex and gender that doesn’t fit millions of people in reality on society, constantly lie to demonize trans people. Being trans is just being born differently and it’s not a choice for us. We’re not trans to hurt anyone or play toxic political games. We have been dragged into this political circus by people who don’t want us to exist.

• Trans people are sexually and violently assualted at four times the rate of cisgender people, including rape.

• The Williams Institute at UCLA School of Law “Transgender people over four times more likely than cisgender people to be victims of violent crime”

• 66% of trans people have reported being victims of sexual assault.

• U.S. Department of Justice, Office for Victims of Crime "Responding to Transgender Victims of Sexual Assault”

• The [2015 U.S. Transgender Survey] found that 47% of transgender people are sexually assaulted at some point in their lifetime.

• Nearly half (46%) of respondents in a national survey of trans people were verbally harassed in the past year because of being transgender. Nearly one in ten (9%) respondents were physically attacked in the past year because of being transgender.

• Trans or non-binary students in grades K-12 reported significant rates of harassment, physical assault, and sexual violence. Of the respondents who were harassed or physically/sexually assaulted due to their gender expression, over half have attempted suicide.

• The right to access gender-affirming health care, especially, which every scientific organization who has studied this professionally for decades has adamantly asserted in different ways is vital care for many trans children and adults. Some states have passed or proposed laws that would ban or restrict medical treatments, such as needed support by a psychiatrist and sometimes puberty blockers under the careful eye of a medical professional if it’s vitally needed. These laws could harm the physical and mental health of trans people, who already face extremely high rates of depression, anxiety, and suicide.

• The right to update their identification documents to reflect their gender identity. Some states require proof of gender-affirming surgery or prohibit updating the gender marker altogether for birth certificates and driver’s licenses. This exposes trans people to harassment, discrimination, and violence when they present their IDs in various situations, such as applying for jobs, traveling, or voting. Some states legally recognize non-binary citizens, and offer an "X" marker on identification documents.

• The right to be free from conversion therapy. Conversion therapy is a harmful practice that attempts to change a person’s sexual orientation or gender identity. Has been unilaterally condemned by every scientific organization that studies this after decades of research, because it only made people’s health much worse and increased suicide ideation. This is one of many things that show gender identity and sexual orientation are not a choice for most people. Conversion therapy is based on the false and stigmatizing belief that being LGBTQ+ is a mental disorder that can be cured. Conversion therapy can cause serious psychological harm, such as depression, anxiety, low self-esteem, and suicidal thoughts. Some states have banned conversion therapy for minors, but it is still legal in most states for adults and minors.

These are some of the major issues that affect trans rights in the U.S. many countries in the western world, but there are many more challenges and barriers that trans people face every day. In some parts of the world trans people have to hide it just to stay alive. Trans rights are human rights, and they deserve respect, dignity, and equality as much as everyone else.

Statistics Show Trans People Are Less Likely to Offend

Offending rates for trans people are hard to come by, but we have statistics from the Ministry of Justice in the United Kindom [1] that showed the total amount of trans women sex offenders in jail on September 30 2021, and there were only 56 in England and Wales. This is in a population of 59 million. Most estimates of the trans population is around 1% of the total population, which is 590,000 people in England & Wales. We can half that to match trans women, which is 295,000 people, that would make 56 people 0.02% of trans population. Even though that’s a rough estimate, this reveals there is no a prevalence of offences in the total population by any means.

We still see, even though trans offenses literally happen less often, they had a higher rate of offending per capita. However, there’s several things at play here.

• These likely aren’t offences that happened in women’s spaces. Statistics show most offences happen at home with someone they know. [2]

• The amount in prison also isn’t how many happened annually, because the time to spend in prison for a sex offence in the UK is 4-19 years. [3] So, the range of time they possibly offended is much larger.

• We also don’t even know what happened because the MOJ simply vaguely said they’re sex offences.

• External factors are also capable of influencing groups when they’re smaller, like 56 people out of 295,000. Like growing up in a society with discrimination, prejudice, being constantly stigmatized, treated like terribly by employers, and more. [4] Marginalized groups also have higher conviction rates, because people accusing them of crimes lie out of bigotry. Judges and jury can also have prejudice. [5]

• The only risk with per capita rates are the fictional situation where the trans population is much larger than it is, but they wouldn’t grow up in the social stigma that they do. The rate wouldn’t be as easily influenced by external factors due to a small population. That means the rate would be much lower.

There are images floating around from anti-trans groups misrepresenting this exact data with big letters that say, "Rates of Sexual Offending" and a bunch of little people vastly misrepresenting the amount of sex offenders in prison. They mixed up higher rates per capita with higher amount of people, which is misleading. The Freedom of Information Request to the Ministry of Justice itself was most likely requested by an anti-trans person, since they are intentionally misgendering trans women in the request, but the MOJ gave unbiased data.

References

1. The Data | Freedom of Information Request to the Ministry of Justice

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2. Scope of the Problem: Statistics | RAINN.org

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3. Criminal Justice Statistics quarterly: March 2021

“On average, a defendant will be sentenced to between 4-19 years’ custody for rape.”

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4. National Transgender Discrimination Survey: Full Report

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5. Ethnicity and the criminal justice system: What does recent data say on over-representation? | Published in the UK Parliment Library | Authored by Baber Yasin and Georgina Sturge

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Trans People Are More Likely to be Assualted

Trans people are 4 times more like to be victims of sexual and violent crime than cis people, including rape. [1]

66% of trans people have reported being victims of sexual assault. [2]

The 2015 U.S. Transgender Survey found that 47% of transgender people are sexually assaulted at some point in their lifetime. [3]

Bullying and harassment at school and online. A 2019 survey by the Human Rights Campaign found that 85% of transgender youth reported being verbally harassed, 63% reported being physically harassed, and 23% reported being physically assaulted at school because of their gender identity. [4]

Dating violence and sexual assault. A 2015 survey by the U.S. Transgender Survey found that 54% of transgender youth reported being sexually assaulted in their lifetime, and 13% reported being sexually assaulted in the past year. [3] A 2019 study by the Centers for Disease Control and Prevention found that LGBTQ+ youth were more likely to experience physical and sexual dating violence than their heterosexual peers. [5]

Homelessness and involvement in sex work. A 2015 survey by the U.S. Transgender Survey found that 30% of transgender youth reported experiencing homelessness at some point in their lives, and 12% reported engaging in sex work for income. [3] These factors can expose them to further violence, exploitation, and health risks.

Suicidality and depression. A 2019 survey by the Trevor Project found that 35% of transgender youth reported attempting suicide in the past year, and 71% reported feeling sad or hopeless for at least two weeks in the past year. [6] A 2015 survey by the U.S. Transgender Survey found that 40% of transgender youth reported attempting suicide in their lifetime, compared to 4.6% of the general U.S. population. [3]

References

1. Transgender people are over four times more likely than cisgender people to be victims of violent crime | The Williams Institute at UCLA School of Law

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2. Responding to Transgender Victims of Sexual Assault | U.S. Department of Justice, Office for Victims of Crime

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3. 2015 U.S. Transgender Survey

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4. Sexual Assault and the LGBTQ Community - Human Rights Campaign

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5. LGBTQ+ Youth: Addressing Health Disparities with a School-Based Approach | Centers for Disease Control and Prevention

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6. Data on Transgender Youth | The Trevor Project

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How We Can Address Sex & Gender in Spaces

Topics about trans people that have been raised, such as restrooms, locker rooms, and other spaces, are contested by voices varying in degrees of bigotry and honesty.

But let me point out one important distinction: these are not issues of people; they are issues of design; how we arrange our spaces, how we structure our societies. And where there are design challenges, there are also opportunities for innovation, for progress, and for inclusivity.

Trans women do not pose a statistical threat. [Trans People Are Less Likely to Offend] And when we encounter challenges, we can solve them with logic and creativity.

Stalls in locker rooms are just one way we can make this change.

These are the type of things that should be publicly funded. When we embrace these design principles, we create environments where safety and fairness thrive. Where, who people really are, is not just acknowledged but celebrated.

It isn’t the fault of trans people that some things were designed in a way that do not recognize the real diversity in humans. It’s that we’re in a transitional stage in society. These issues are not an excuse to be hateful towards people who never chose who they are. These are just regular people trying to live their life with what they’re born with.

And in a truly civilized society, we create safe and fair spaces where every person can flourish, where every soul can find solace in being themselves, rather than pointlessly taking away the rights of a group for their differences. It’s like someone standing in a flowing river trying to make it go the other way by pushing it in the other direction. It will just keep flowing in the way it naturally goes even if ripples are made. We will just keep being ourselves, because it’s just a natural part of who we, as humans, are.

Bathrooms

These are important points this issue.

• There is no statistical prevalence of trans women doing anything but answering the call of nature in restrooms. [Trans People Are Less Likely to Offend]

• Research shows transgender people are over four times more likely than cisgender people to be assaulted, including rape, sexual assault, simple assault, aggravated assault. This will put them at a lot more risk, especially if they’re forced to go in the men’s restroom. [Trans People Are More Likely to be Assualted]

• Statistically, predators almost never go in public restrooms, and it’s because random people go in and out of it all the time. Studies show most rapes happen in the home with someone they know. [3] In the rare cases this has happened they didn’t feel the need to pretend to be trans to do it. They just barged in as a cis man. However, if no one is around the restroom, then it has risk no matter what sign is on the door.

• Since the population of trans people is so small, what will happen more often is cis women being assaulted if they don’t fit into someone’s view of gender roles. [4][5][6][7][8][9][10][11][12][13][14][15][16] Gender diverse people will always exist. We will never be able to fit everyone into two categories.

• There’s more risk with a woman and a man being alone in any room at all.

• Many trans men are big burly men who would be forced to go in the women’s restroom. They have and will be mistaken for cis men. When they have in the past there are reports of them being assaulted. [17] Since the trans man population is much smaller than cis women this happens less often.

• The same argument, that predators can pretend to be trans women, would work the opposite way if bathrooms were inaccurately named, “single sex spaces” The predators could then pretend to be trans men. That argument isn’t realistic though because of every other reason listed here.

• Trans people have used the restrooms that matches their gender identity since there have been restrooms. The few laws limiting restroom use in certain areas are very recent because of politicians who wish to fear monger to exploit a disenfranchised minority for votes.

• If you want to make restrooms safer we can add tall stall doors with locks and emergency buttons in stalls that alert staff of the building. Much like there already is in most handicap toilets. There could even be an app that alerts the staff. All of this can be government funded. We can also make single occupancy restrooms where it’s possible.

References

1. Transgender people over four times more likely than cisgender people to be victims of violent crime | The Williams Institute at UCLA School of Law

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2. Responding to Transgender Victims of Sexual Assault | U.S. Department of Justice, Office for Victims of Crime

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3. Scope of the Problem: Statistics | RAINN.org

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4. “This Woman Shows ‘Bathroom Safety’ Isn’t Only a Trans Concern: A lesbian mistaken for a man was followed into a hospital restroom and thought to be a danger to other occupants.” 2016.

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5. Women are getting harassed in bathrooms because of anti-transgender hysteria. 2016

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6. Savage Love Letter of the Day: Cis Woman Mistaken For Trans. 2017

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7. Lesbian couple kicked out of women’s toilet at cinema because security thought they were men. 2015

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8. Lesbian teen asked to prove gender, ejected from McDonald’s for using women’s toilet. 2016

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9. Lesbian kicked out of bowling alley because she used the women’s restroom. 2018

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10. Self-Appointed Bathroom Cop Catches Dallas Woman Using Women’s Restroom. 2016

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11. Cancer survivor hits out at ‘bathroom bill’ after she is mistaken for trans woman following mastectomy. 2016

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12. SNP MP Mhairi Black: “I’ve been challenged going into female toilets. I’m not leaving transgender people behind” 2019

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13. This lawmaker thought he was in the presence of a transgender woman. So he “threatened to wave his p***s” at her. 2016

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14. Woman Sues Restaurant That Ejected Her From Bathroom for Looking “Like a Man” 2015

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15. Woman mistaken for transgender harassed in Walmart bathroom. 2016

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16. “It gets me chucked out of toilets,” she says, referring to the furore surrounding trans women’s use of women’s lavatories that has resulted in many butch lesbians being hounded out of public bathrooms, in the UK and the US. “It happens all the time.” Especially, she says, when she’s with her partner, Caroline.

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16. “It gets me chucked out of toilets,” she says, referring to the furore surrounding trans women’s use of women’s lavatories that has resulted in many butch lesbians being hounded out of public bathrooms, in the UK and the US. “It happens all the time.” Especially, she says, when she’s with her partner, Caroline.

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17. The Advocate, “Trans Man Brutally Assaulted For Using Women’s Restroom at Campground”

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Prisons

For prisons, we can place any trans women that have committed a violent and sex offense in a seperate area away from cis women in a women’s prison. This will ensure the safety of everyone while also not misgendering. They need to receive HRT as well. A benefit of that is it drastically decreases the libido for most trans women. Some have told me they don’t care if the person committed such an offense, and yes, I understand that. However, we wouldn’t make a prisoner of another minority group go through racism or sexism because of what they did. There’s definitely more humane ways for them to be punished that does not hinder our integrity. Also, the reason they committed the crime to begin with likely has to do with the prejudice they’ve faced in society. Making them go through more transphobia will just add fuel to the fire and won’t be productive.

Being Trans is Not a Mental Illness

Mental illness typically involves significant distress or impairment, rather than something that’s just out of the ordinary. We only go through mental harm when our lives are out of sync with our gender identity, which causes us significant distress, a condition known as gender dysphoria.

Decades of research and the consensus of psychological and medical organizations affirm that being transgender is not a mental illness but rather a variation of human experience. These experts, with over a century of professional study on gender identity, emphasize the importance of recognizing and respecting this diversity.

It’s crucial to dispel misconceptions, such as the notion that transgender individuals are delusional about their gender. Trans women don’t think they’re cis women. If they did they obviously wouldn’t need to transition. We simply recognize the real diversity in sex and gender in humans, which is what the scientific organizations also recognize. We use language that reflects that.

• The American Psychiatric Association (APA) replaced "gender identity disorder" with "gender dysphoria" in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, recognizing it as a condition of distress rather than a disorder. The APA explained that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition." Source

The American Psychological Association (APA) issued a resolution in 2021 stating that:

“BE IT FURTHER RESOLVED that Transgender and gender nonbinary identities, as well as other gender identities that transcend culturally prescriptive binary notions of gender, represent normal variations in human expression of gender.

BE IT FURTHER RESOLVED that neither transgender or gender nonbinary identities nor the pursuit of gender-affirming medical care constitutes evidence of a mental disorder.

BE IT FURTHER RESOLVED that APA opposes portrayals of transgender and gender nonbinary people as mentally ill because of their gender identities and expressions.

BE IT FURTHER RESOLVED that evidence supports psychologists in their professional roles to use affirming and culturally relevant approaches with individuals of diverse gender expressions and identities.” Source

• The American Academy of Pediatrics (AAP) has stated that, “But variation in gender identity is a normal part of human diversity, the American Academy of Pediatrics, or AAP, stresses in a new policy that outlines how to provide supportive medical care for transgender youth.” Source

• The World Health Organization (WHO) explained why they reached their conclusion of the diagnosis of gender incongruence, “This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.” Source

• The British Psychological Society (BPS) has issued guidelines for psychologists working with gender, sexuality, and relationship diversity. These guidelines state that being transgender is not a mental illness and that gender identity is not inherently pathological:

[LGBTQ+ people, including transgender people] "are not in themselves pathological, and are part of human diversity." Source

• Australian Psychological Society has said that, "It is important to remember that being transgender or gender diverse is not a mental health issue. However, mental health issues may arise for TGD children due to societal and cultural ideas about gender. Children can feel confused, scared marginalised and sad, and often experience a lack of support.” Source

• The Canadian Mental Health Association "Having a gender-diverse or sexual-minority identity is not a mental health concern. These identities do not result from parents’ actions or a traumatic event. Variation in gender and sexual identities is part of what defines us as human beings. Youth tend to do well when they are allowed to express their gender or sexuality identity freely and when they are supported by their caregivers." Source

Gender Identity and Expression Isn’t Based on Stereotypes

Gender identity and expression aren’t rooted in stereotypes. Gender Identity is biologically based in the brain. It’s much like how we don’t choose the gender or sex we’re attracted to. Firstly, the core of gender identity lies in identifying with a specific sex. So, a large part of gender identity has nothing to do with gender expression. It’s about identifying with the anatomy of a certain sex, which is why we have an overwhelming need to transition or we go through different types of severe mental distress, especially during our teen years when puberty changes the body.

As we grow up in a society with gender expression we may eventually attach some of those things to our gender identity, and rather than it being about a fixed gender stereotype, it’s what we’re able to observe about some people while growing up, and yes, that include social norms, which have had different characteristics in different societies all throughout history. However, at the same time, we can observe people of a certain sex can express themselves in any way, and that’s capable of being considered when the gender identity of people are developed. If our gender expression was how we saw everyone of a certain sex, or even the majority, we’d be many different things at once, which would be really difficult. So, that’s not how that works.

Rather than thinking everyone of a certain sex is a certain way, our gender identity and expression is a reflection of how we see ourselves. This development is shaped by what we find inspiring through life, what makes us feel happy, and what makes us feel content with ourselves from observing diverse expressions from people we’ve seen of the sex that matches our gender identity.

Problems only arise in society when individuals insist on rigid roles or beliefs about how everyone of a certain sex behaves. Instead, gender identity and expression encompasses the freedom to be oneself, embracing the variety of ways individuals can authentically exist, unbound by limiting stereotypes.

Trans people are those who have gone directly against how a patriarchal society has pushed them to be their entire life. When trans women express themselves in ways that may seem typically feminine it doesn’t mean we’re trying to fit into a box or impose it on others. We’re celebrating how this is something we were not able to experience before, because of the constraints of a patriarchal society. It’s what we love about our identity, rather than how we view others. We are exploring and expressing our individuality, our personality, and our joy. It means that this is our gender euphoria and our gender liberation, and at the same time, we are capable of supporting the self expression and liberation of everyone. Most trans people do, since most of us have socially progressive views.

So, instead of thinking because a woman expresses themselves in a certain way, that she absolutely has to do it representing all women, we can recognize we’re all individuals, no matter our gender or sex, with our own unique backgrounds, experiences, and traits. We can focus on people who actually stereotype, rather than policing how other people live, which is the entire point of being against stereotypes.

Do Trans Women Have Cis Male Privilege?

Since our gender identity is innate and never was a choice, our whole lives, we’re faced with pressure and expectations to conform to cis male roles by a patriarchal society, when we don’t identify with them, and we don’t agree with them. The views of most trans people I’ve seen have been somewhere on the progressive spectrum and are for equality for all.

When we transition or come out as trans, we change some aspects of our sex and live differently from our assigned gender at birth. So, society then responds to that, and we experience sexism from every direction. We’re objectified through how men objectify cis women, by saying we can’t look like how they want cis women to look. We are subjected to gender roles by people who have sexist views and who demand that we act in certain ways to prove our womanhood. If we do not, they say we are not real women. If we do, they say we are just pretending to push gender roles. So, we’re basically trapped in a lose-lose situation. We’re prejudged that we can’t be caring, empathetic, or nurturing, because they mistakenly associate us with men, and believe men can’t be those things, which is sexist views about men.