Hi friend, this factsheet contains everything you need to know about a variety of issues ranging from gender dysphoria to hormone treatments, along with a fact-based perspective on the medical and sociological legitimacy of trans people.

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Medical Consensus

An incomplete list of the reputable scientific & social organizations which affirm the validity of transgender people (that transness is not an illness, that trans people are deserving of respect and equal rights, etc). This also serves as a list of the institutions which recognize the difference between sex and gender.

  • American Psychological Association
  • American Medical Association
  • American Psychoanalytic Association
  • Human Rights Campaign
  • American Academy of Pediatrics
  • American College of Osteopathic Pediatricians
  • Royal College of Psychiatrists
  • United Nations
  • United Kingdom’s National Health Service

The following organizations have also made public statements expressing support for transgender people, the details and citations of which are compiled by Transcsend Legal

  • American Academy of Child and Adolescent Psychiatry
  • American Academy of Family Physicians
  • American Academy of Nursing
  • American College of Nurse-Midwives
  • American College of Obstetricians and Gynecologists
  • American College of Physicians
  • American Counseling Association
  • American Osteopathic Association
  • American Psychiatric Association
  • American Public Health Association
  • Endocrine Society
  • National Association of Social Workers
  • National Commission on Correctional Health Care
  • World Medical Association

READ MORE:

Medical Transition

Medical transition (including sex reassignment surgery) decreases dysphoria, suicide attempts, and improves depression and anxiety

  • ENORMOUS meta-analysis on transgender people and the effect gender transition has on their mental health
  • Of 56 studies, 52 indicated transitioning has a positive effect on the mental health of transgender people and 4 indicated it had mixed or no results.
  • ZERO studies indicated gender transitioning has negative results
  • ANOTHER meta-analysis of 28 studies on transition and hormones
  • Sex reassignment/hormonal improvements:
  • 80% of individuals reported significant improvement in dysphoria
  • 78% of individuals reported significant improvement in psychological symptoms
  • 72% of individuals reported significant improvement in sexual function
  • overall quality of life was found to have increased significantly
  • Lower quality evidence, see methodology. Still significant and helpful findings regardless.
  • Longitudinal study on the effectiveness of puberty suppression, hormones, and later sex reassignment surgery on trans individuals in improving mental outcomes
  • Unambiguously positive results - results indicate puberty suppression, support of medical professionals & SRS have markedly beneficial outcomes to trans individuals’ mental health and productivity.
  • These indicators were “similar to or better than same-age young adults from the general population”
  • “A new study has confirmed that transgender youth often have mental health problems and that their depression and anxiety improve greatly with recognition and treatment of gender dysphoria”
  • Longitudinal meta-analysis which indicates transgender people have a lower quality of life than the general population.
  • However, that quality of life raises dramatically with ‘Gender Affirming Treatment’, the nature of which is detailed extensively in-text.

Long-term Follow-ups:

  • In long-term follow-ups, trans women "function well on a physical, emotional, psychological and social level"
  • However, they have problems when it comes to arousal, lubrication, and pain - a minor trade-off for the previously mentioned well-being measures
  • Small sample size but still useful
  • Trans people reported being just fine in long-term follow-up, as well as having reduced gender dysphoria

Social Transition

Social transition improves depression, anxiety, and psychological function

  • Analyzes consensus on the effectiveness of social transition
  • “Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents.”
  • Socially transitioned transgender children who are supported in their gender identity have:
  • Normative levels of depression
  • Minimal elevations in anxiety
  • Lower rates of internalizing psychopathology (a spectrum of conditions characterized by negative emotion) then non-socially transitioned people

  • Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population.

  • Children who socially transition report levels of depression and anxiety which closely match levels reported by cisgender children, indicating social transition massively decreases the risk factor of both.

Puberty Blockers

Puberty blockers are safe, well-studied, completely reversible, endorsed by credible medical and endocrinological associations, and effective at reducing dysphoria, anxiety, and depression.

  • Everything you need to know about puberty blockers 
  • Full-blown puberty is irreversible
  • Taking a gonadotropin-releasing hormone (GnRH) agonist, secretion of the sex hormones can be stopped and the onset of puberty suppressed so that the body does not develop secondary sex characteristics
  • This has been done safely for decades to suppress sex hormones in children who develop too early, a condition known as precocious puberty. Suppressors have also been used to treat endometriosis, uterine fibroids, and prostate cancer.
  • It was only in 2008 that the Endocrine Society approved puberty suppressors as a treatment for transgender adolescents as young as 12 years old. The Society, with members in more than 100 countries, has since declared that the intervention appears to be safe and effective.  In 2011 the World Professional Association for Transgender Health (WPATH), also issued Standards of Care for the treatment of patients with gender dysphoria, which include puberty suppression.

  • Smaller Dutch study on puberty blockers
  • All 55 participants were on par with or better than others their age when it came to things like anxiety, depression and body image, and none of them expressed regret as adults about their transitions or the choice to delay puberty.
  • Since puberty suppression is a fully reversible medical intervention, it provides adolescents and their families with time to explore their gender dysphoric feelings, and [to] make a more definite decision regarding the first steps of actual gender reassignment treatment at a later age

  • BIG report on trans youth and transition
  • Endorsed by the Human Rights Campaign, American Academy of Pediatrics & the American College of Osteopathic Pediatricians which affirms the validity of transgender youth, encourages appropriate care and respect for their transness and provides resources on how to do so.
  • Outlines TYPES OF TRANSITION: hormone blockers are the ONLY treatment used on adolescents and are COMPLETELY reversible.

  • Key finding is “that provision of puberty delaying medications

to adolescents with gender dysphoria is not experimental,

  • Hormone blockers are not new
  • “Since the mid 1990s, puberty delaying medications have been prescribed to some adolescents (not prepubertal children) with severe and persistent gender dysphoria, in cases in which such distress was aggravated by pubertal development.”
  • “The Royal College of Psychiatrists, in 1998, recommended delaying puberty in young adolescents who experienced  strong and persistent ‘cross-sex  identification’ and distress around the physical body that intensifies with the onset of puberty.”
  • “Puberty blockers are not ‘novel' treatment. They were recommended by prominent bodies of medical opinion in the UK and internationally over two decades ago, and have thus been part of standard medical treatment for many years.”
  • “GnRHa has been used in the treatment of gender dysphoria since the mid 1990s, and their efficacy in delaying puberty in adolescents is documented by numerous studies and scientific publications” (21 scientific studies are then listed)

  • Study on the cognitive side-effects of puberty blockers
  • “Current evidence does not support an adverse impact of gender-affirming hormone therapy on cognitive performance in birth-assigned either male or female transgender individuals”
  • “An enhanced effect on visuospatial ability following post-pubertal hormone therapy was shown in assigned females”
  • “Pooling data from cross-sectional studies showed a higher performance in verbal working memory in treated assigned males”

  • A clinical practice guideline for puberty blockers
  • “Puberty suppression typically relives distress for trans adolescents by halting progression of physical changes such as breast growth in trans males and voice deepening in trans females and is reversible in its effects”
  • “Puberty suppression medication is reversible”
  • Compares psychological function before and after treatment with puberty blockers
  • “Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression”
  • Longer term study -- looked at kids in 2000 and followed up in 2008
  • Analyzed the effect of puberty suppression in conjunction with SRS and hormone treatment later in life
  • 55 trans youth (22 transfem and 33 transmasc) were followed over an 8 year period from before starting blockers (mean aged 13.6 years)
  • While many studies like this compare those after treatment to those before treatment, this study also made comparisons to the general population and still found that psychological function was on par or better.
  • “After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Wellbeing was similar to or better than same-age young adults from the general population.”
  • Article on why puberty blockers are prescribed and whether or not they are experimental.
  • “Puberty delaying medications are currently provided off label to adolescents affected by gender dysphoria and this particular use cannot be investigated by a RCT. We have shown that this does not mean they are experimental drugs or are provided experimentally. Whether or not these (or even approved drugs) are ethically prescribed depends on whether they are likely to serve the patient’s health interests based on the evidence available at the time of prescription.”
  • Study on the long-term outcomes of puberty suppression
  • “Pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.”
  • “Those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation”
  • “Growing evidence base suggesting that gender-affirming medical care for transgender youth is associated with superior mental health outcomes in adulthood.”
  • Study of 201 kids between the ages of 12-17 with gender dysphoria
  • Subjects were assessed for psychosocial functioning utilizing the Children’s Global Assessment Scale (CGAS), which indicated positive mental health outcomes after puberty suppression
  • “The CGAS is one of the most widely used rating scales designed to measure how children and adolescents function psychosocially in daily life”
  • “Results from this study indicate that psychological support is associated with a better psychosocial functioning in GD adolescents, especially if presenting psychological/psychiatric problems. Moreover, puberty suppression was associated with a further improvement in global functioning. Finally, global functioning improved steadily over time in GD adolescents receiving both psychological support and GnRHa [blockers]”
  • Results also showed slightly higher CGAS scores for the sample group that was “immediately eligible” for puberty blockers compared to the “delayed eligible” group that only received psychological support, although with such a small sample size the researchers ultimately consider this difference negligible.
  • A combination of these two approaches enabled subjects to reach levels of psychosocial functioning comparable to peers.
  • Some guidelines towards gender dysphoria treatment, focusing on trans adolescents
  • “physical treatment outcome following interventions in adulthood is far less satisfactory than when treatment is started at an age at which secondary sex characteristics have not yet been (fully) developed”
  • “Often have difficulties in connecting socially and romantically with peers while still in the undesired gender role, or the physical developments create an anxiety that limits their capacities to concentrate on other issues”
  • “Suffering from gender dysphoria without being able to present socially in the desired social role, and/or to stop the development of secondary sex characteristics usually leads to problems in these areas”
  • Also found no notable differences in bone density, but since data from only nine individuals was considered, this finding is not particularly significant
  • Paper focused strictly on the ethicality of puberty blockers
  • Argues that the general improved quality of life, including substantially reduced risk of suicide, justifies the ofen challenged ethics of pubertal suppression.
  • Dutch trans man who started on puberty blockers at age 13 in 1988. His health and well being was monitored regularly for over 22 years
  • he was well-functioning with no clinical signs of a negative impact of earlier puberty suppression on brain development, metabolic and endocrine parameters, or bone mineral density
  • Focuses on one person’s case in which puberty blockers were used at a young age to relieve pressure from them, give them more time to go through proper psychotherapy, and get a more reliable diagnosis of the situation
  • Demonstrates that puberty blockers can be used to more to help more accurately diagnose gender dysphoria
  • This should make puberty blockers an appealing option even to people who accept the science around being transgender but still believe that it’s mostly a trend
  • Note: this paper is based on an anecdote, so it shouldn’t be used as hard evidence, only to make a point
  • Found that medical intervention in transgender adolescents appears to be safe and effective and that hormone treatment to halt puberty in adolescents with gender identity disorder does not cause lasting harm to their bones.
  • Study on some commonly cited side effects of puberty blockers
  • “Puberty was recovered within 1 year after GnRHa treatment discontinuation, and there were no abnormalities in reproductive function”
  • “Bone mineral density decreases during GnRHa treatment but recovers to normal afterwards, and peak bone mass formation through bone mineral accretion during puberty is not affected”

Some common myths

  1. CLAIM: “Young people wouldn’t want to take puberty blockers if they knew the risks”

Vrouenraets et al. 16 found that the few negative effects of puberty blockers do not change children’s minds and most adolescents stated that the lack of long-term data did not and would not stop them from wanting puberty suppression. They said that being happy in life was more important for them than any possible negative long-term consequence of puberty suppression.

  1. CLAIM: “Puberty blockers will give trans kids osteoporosis and make them sterile”

Heger et al. 99 found that long term puberty blocker treatment of precocious puberty girls preserved genetic height potential and improved FH significantly combined with normal body proportions. No negative effect on bone mineral density and reproductive function was seen.

  1. CLAIM: “Children are too young to know they are trans and are pushed to take blockers by parents / social media / peer pressure”

There are multiple accounts by parents and older trans people who observe that they/their child knew that they were transgender from a young age – Here is one such account and another article explaining how transgender kids aren’t rushed into transitioning

  1. CLAIM: “It is not ethical to give puberty blockers to transgender children”

Focusing strictly on the ethicality of puberty blockers, Giordano argues that the general improved quality of life, including substantially reduced risk of suicide, outweighs the ethical considerations of disrupting puberty. Puberty blockers can be used to relieve stress from a patient and give them more time to get an accurate diagnosis of the situation, as was the case here - certainly more ethical to go forward with an accurate diagnosis than without one.

Bullying & Suicide

Suicidality is heavily influenced by bullying, discrimination, and poor treatment. Suicide attempt rates are also far higher among individuals who experience substantial discrimination or harassment.

  • 41% of respondents reported attempting suicide compared to 1.6% of the general population
  • these rates rising for those who:
  • lost a job due to bias (55%)
  • were harassed/bullied in school (51%)
  • had low household income
  • were the victim of physical assault (61%)
  • were the victim or sexual assault (64%)
  • THE 40% STATISTIC IS AN ATTEMPT RATE despite conservatives claiming it is simply a “suicide rate.” 40-41% of trans people DO NOT DIE FROM SUICIDE.
  • Broad meta-analysis of 21 studies on the trans suicide rate (it’s quite high).
  • The suicide attempt rate ranges from 32% to 50% across countries
  • The following were found to have an impact on the suicide attempt rate
  • Gender-based victimization
  • Discrimination
  • Bullying
  • Violence
  • being rejected by the family, friends, and community
  • harassment by an intimate partner, family members, police and public
  • discrimination and ill-treatment in healthcare
  • Swedish study on trans suicide prevention
  • 37% of respondents reported that they have seriously considered suicide during the past 12 months and 32% had ever attempted a suicide
  • Suicide ideation is associated with:
  • Offensive treatment
  • lifetime exposure to trans-related violence
  • less satisfaction with contacts with friends and acquaintances and with one's own psychological wellbeing
  • lack of practical support
  • Massive demographic analysis which codifies the many social & institutional factors which contribute to trans suicide rates
  • Prevalence of suicide attempts is elevated among those who:
  • disclose to everyone that they are transgender or gender-non-conforming (50%)
  • among those that report others can tell always (42%) or most of the time (45%) that they are transgender or gender non-conforming
  • The suicide attempt rate was associated with mental health factors and experiences of:
  • Harassment
  • Discrimination
  • Violence
  • Rejection
  • LGBT folks’ self-reported perceptions of discrimination
  • Regarding trans people, finds high levels of perceived discrimination across the board, including:
  • 46% felt discriminated against or harassed within the past year for being trans
  • 29% felt discriminated against when it came to looking for employment
  • 70% hid being trans during schooling before becoming 18 years old
  • 55% had an incident of violence within the past year in part or whole because of them being trans
  • Uses data from 872 respondents in the UK, which is a large number of respondents compared to most studies on trans people (pg 26)
  • To date, the most comprehensive study on discrimination of trans people (pg 17)
  • There are a number of ‘trigger points’ at which trans people start being discriminated against during their transition, the most common of which is once they come out at work (pg 25-6)
  • Aside from that, there’s a wide variety of ways and places in which trans people are discriminated against

Family Support

Family support decreases suicide attempts and drug usage

  • Family rejection linked to suicide, drug use, and overall detriments to health
  •  To cope with transgender-related discrimination:
  • 42.3% of the sample reported a suicide attempt 
  • 26.3% reported misusing drugs or alcohol
  • “After controlling for age, race/ethnicity, sex assigned at birth, binary gender identity, income, education, and employment status, family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection.”
  • A META-ANALYSIS of 42 peer-reviewed studies that analyzed the links between family support and the health and well-being of LGBT youth
  • 25 studies found that accepting behavior by parents toward their children’s sexual orientation or gender identity is linked to the health and well-being of LGBT youth.
  • The other 17 studies found that family support in general (i.e. not necessarily in response to children’s sexual orientation or gender identity) is linked to the health and well-being of LGBT youth.
  • From Ontario (not international scope) but academically credible and VERY widely cited
  • Analysis of the ways in which parental support affects elements of disadvantage experienced by transgender youth.
  • Strong parental support decreases the likelihood of a suicide attempt within the past year from 57% to just 4%.

Chosen Name Usage

The use of trans people’s chosen name decreases suicide ideation, severe depression, and suicide attempts

  • Compared to those without chosen name usage, trans people with chosen name usage experienced:
  • 71% drop in severe depression
  • 34% drop suicidal ideation
  • 65% drop in suicide attempts

Bathrooms

Evidence for the public safety argument in regards to bathroom bills is unsubstantiated in data.

  • Analysis of crime & privacy violations as they relate to concerns raised by those who advocate for ‘trans bathroom bills’
  • Analysis indicates there is no empirical evidence to support these concerns; such crimes & privacy violations are exceedingly rare.
  • Calls for trans bathroom bills are fearmongering, plain and simple.
  • Regardless of baseless fear mongering, most people in the UK are fine with transitioned transgenders using the restroom of their gender - "Women tend to be more comfortable with this than men, with 72% of women saying they are “very” or “quite comfortable” with a transgender woman using a female toilet, compared with 64% of men saying they are comfortable with a transgender man using male toilets. Around 1 in 6 (14% of women, and 15% of men) say they are not comfortable with this." (pg 14)
  • This one excludes the "Neither comfortable nor uncomfortable" answer which was another 14% from the 2017 survey
  • Regardless of baseless fear mongering, most women are comfortable or

"72% of women said that they were “very” or “quite comfortable” with a transgender woman using a female toilet"

  • This one excludes the "Neither comfortable nor uncomfortable" answer which was another 14% from the 2017 survey
  • Specific Debunks:
  • Debunk - an interview with the school’s superintendent confirms that this never happened
  • Joey Salads experiment - Salads dresses up how he thinks a trans woman would, and goes into a women’s restroom, receiving negative responses from others in the scene
  • [Video] Debunk - Salads misrepresented the behaviour of trans women and used a single-person restroom, so his whole experiment was probably staged. A replication of the experiment got no negative responses from others in the scene
  • Dallas incident - Trans women allegedly taking photos of children in women’s restrooms
  • Debunk - the website’s about page says “And here we are today, to bring you nothing but pure horse shit... This should go without saying, but everything on this website is purely for entertainment purposes. We are in no way affiliated, or trying to look like we are affiliated with any local news station.”
  • This actually did happen, but this one incident can’t be extrapolated onto the greater trans population, especially not with the existing empirical evidence regarding bathroom bills
  • Most of the stories they cite do NOT involve or even MENTION trans people; this is by-and-large a compilation of CIS men harrassing women
  • Even if every single incident involved a trans man, this does nothing to disprove existing statistics regarding the non-issue of bathroom bills. 25 instances over the course of more than a decade is barely anything demonstrative of a larger problem in need of being addressed at a large scale.
  • Most of those incidents would be illegal even without a trans bathroom bill being in effect, so introducing such a law isn’t really the solution here.

Some other notes on bathroom bill arguments:

  • If an AMAB person wanted to use the bathroom as an excuse to rape women, he doesn't have to fake being a woman to go in there. The law won't physically prevent him from going in there.
  • Rape and sexual harassment are already illegal, so if your primary concern is women being sexually harassed or raped by men in the bathroom, then there's already laws to address your concerns.
  • Even from a conservative perspective, bathroom bills give an unnecessary amount of power to big government and aren't necessarily effective; as most trans people don't look like their birth sex, it's much easier for a cis man to enter a woman's bathroom and claim to be trans. The cis man won't present as a woman, just as a trans man wouldn't present as a woman.
  • Even by citing one specific incident or several specific incidents of trans people harrassing cis people in bathrooms, that doesn’t demonstrate anything about the broader trans population. Someone could find several instances of cis people harrassing trans people in bathrooms (which is far more common anyway) but that doesn’t demonstrate any broader tendency among all cis people.

Prisons

  • 59 percent of transgender women housed in men’s prisons had been sexually abused while incarcerated, as compared to 4 percent of non-transgender inmates in men’s prisons

Depiction in Media

Trans people are generally depicted negatively.

  • Interesting (and long) qualitative analysis on the depiction of transgender people in Sports Illustrated over past decades.
  • Finds disproportionately negative depictions (of course).
  • Finds that LGBT folk are usually depicted in media in stereotypical ways, which could limit their perception of their possible future

Sterilization

Forced sterilization is an obstacle faced by trans people internationally

  • 16 countries in Europe & Central Asia still require sterilization before transgender peoples’ gender identity can be legally recognized

Trans Athletes

Trans athletes are at no significant advantage in athletics, especially since hormones reverse any strength discrepancies, yet face substantial discrimination in athletics.

  • Meta-analysis covering prior research on trans individuals’ performance in sports and preexisting sports policies concerning trans people
  • “There is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition
  • (includes cross-sex hormones, gender-confirming surgery)
  • competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.
  • Additional findings show most sports policies are not evidence-based and trans individuals experience substantial discrimination from sports institutions.
  • “Any athletic advantages a transgender girl or woman arguably may have as a result of her prior testosterone levels dissipate after about one year of estrogen therapy”
  • “According to medical experts on this issue, the assumption that a transgender girl or woman competing on a women’s team would have a competitive advantage outside the range of performance and competitive advantage or disadvantage that already exists among female athletes is not supported by evidence.”
  • Study that notes how all earlier studies did not check trans women who have been prescribed testosterone blockers which is now a common practice; indicates that the results of such studies cannot be used as proof that trans women have an advantage
  • “The athletic advantage transgender athletes are perceived to have appears to have been overinterpreted by many sport organisations around the world, which has had a negative effect on the experiences of this population.”
  • “It is primarily the lack of public understanding regarding transgender people that remains the greatest cause of their exclusion”, not some perceived advantage among athletes.”
  • The study found interconnecting themes among all its participants to substantiate the prominence of public exclusion:
  • k/lra.le.ac.uk/bitstream/2381/38576/6/Trathe impact of alienating sports experiences at school
  • the intimidating nature of the changing room environment
  • the fear of public space and how this drastically constrained their ability to engage in sport and physical activity
  • the overall impact of their exclusion in terms of being denied the social, health and well-being aspects of sport

Gendered Behavior

At a young age, children learn and copy perceived gendered behavior, which in many cases leads to the limiting of children’s expression.

  • Evaluation of a childcare facility suggests that gender role development is socially constructed and learned from birth.
  • Gendered stereotypes were found to affect children’s perception of gender and appropriate behavior and proliferate through certain influences:
  • Consumer products
  • The Media
  • Early childhood education
  • Relationships with parents
  • A study of Korean immigrant girls and gender stereotypes
  • Korean immigrant girls admired princesses based on beauty or singing voice while boys admired princes based on chivalry, courage, or actions. Combined with a tradition of female subservience in Korean culture, these young girls appeared to accept their disenfranchisement.
  • Korean immigrant girls perceived that a woman could not be President of the United States because a classroom poster depicted all-male presidents.
  • Observed children between the ages of 3-5
  • Children predicted parents would consistently apply these stereotypes as reflected by their approval or disapproval of children’s choices to play with gender stereotyped or cross-gender toys.
  • As early as 3-5 years, children recognize stereotypes about gendered play and subconsciously account for social disapproval
  • One paper which details how children, from a young age, are subject to stereotyping and perceived gender differences, and the poststructuralist outlook

They/Them Pronouns

Singular “they” is grammatically correct

  • They/Them Pronouns are academically approved
  • As of 2019, most big style guides—including the Associated Press, the Chicago Manual of Style, the MLA style manual, and the APA style manual—accept the usage of the singular they.
  • Traces singular they back to 1375, demonstrating a large historical precedent.
  • “They” is grammatically similar to “You,” which “was a plural pronoun that had become singular as well.”

Sex is Not Binary

Modern science endorses a bimodal model in its understanding of sex

  • Graphic describing the many characteristics which factor into one's sexual identity.
  • Helpful in indicating the ambiguous and bimodal nature of sex/responding to people who believe it’s as simple as XX/XY
  • NY Times Op-Ed from a professor of biology & gender studies
  • Explains the biological complexity of sex and the ways in which the Trump Administration’s attempts to legislate that complexity of existence is both immoral and unscientific.
  • Description of modern scientific attitudes towards human sex.
  • “The view that the world’s population can be separated into a clearly defined dyadic unit of male and female is defunct; not only clinical observations, but molecular biology has established that sexual identity is on a continuum, with an enormous potential for variance”
  • “The X and Y chromosomes determine a person’s sex.”
  • However, XX and XY are not the only arrangements that those chromosomes can come in, meaning that there’s not a binary but bimodal range of options to choose from. WHO goes over a number of documented abnormalities when it comes to chromosomes, including but not limited to:
  • Turner syndrome (one X, phenotypically female)
  • XXX Females
  • Klinefelter syndrome (XXY males)
  • XYY Males

Gender and Sex are Different

Modern science also recognizes an important distinction between gender and sex

  • “"Sex" refers to biological differences between females and males, including chromosomes, sex organs, and endogenous hormonal profiles. "Gender" refers to socially constructed and enacted roles and behaviors which occur in a historical and cultural context and vary across societies and over time.”
  • “Sex refers especially to physical and biological traits, whereas GENDER refers especially to social or cultural traits”
  •  “Gender refers to sociocultural attitudes and behaviors that shape behaviors, products, technologies, environments, and knowledges... Gender may not match sex.”
  • “‘Gender’ describes those characteristics of women and men that are largely socially created, while ‘sex’ encompasses those that are biologically determined”

Detransitioners

While detransitioning is rare in the first place, it is overwhelmingly driven by various forms of descrimination, not uncertainty with regards to identity.

Credit for a lot of this goes to this doc by u/Albamc35

  • Study analyzing detransition (n=3,398) based on patient assessment reports
  • Only 16 mentioned regret or detransition. On top of that, 12 attribute this to social pressure, while only 3 de-transitioned with no intention to transition again.
  • The 3 people from a sample of 3,398 trans people, representing a mere 0.088% willing detransition rate
  • Study of 46 surgeons (which 67% have been in practice for more than 10 years) were asked to select a range representing the number of transgender patients they have surgically treated, and this amounted to a cumulative number of approximately 22,725 patients treated by the cohort.
  • 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. This amounted to a total of 62 patients
  • Overall, only 22 patients (0.1% of the sample) detransitioned because of a change in gender identity
  • A study on 232 trans women who were operated by the same surgeon 'using a consistent technique' found that none reported outright regret and only a few expressed even occasional regret.
  • An international study on people who trans related surgeries found that postoperative satisfaction was 94% to 100% 
  • depending on the type of surgery performed. Only eight (6%) of the participants reported dissatisfaction and/or regret.
  • A study of 62 trans people in Belgium, those who underwent SRS found none of the patients regretted their surgery.
  • “De-transitioned” is defined as having “gone back to living as [one’s] sex assigned at birth, at least for a while.”
  • Note that this isn’t just about people who detransition permanently, it also includes people who, socially or medically, reverted their transition temporarily.
  • Under this broad definition, only 8% of respondents reported having de-transitioned at some point.
  • Of these “detransitioners,” only 5% did it because they realized it was not for them, accounting for a mere 0.4% of the overall sample.
  • In regards to trans kids and detransitioning, it’s worth asking: how much can we expect those kids to skew the 0.4% number?
  • Other, more prominent reasons include:
  • Pressure from a parent (36%)
  • Discrimination and harassment after begining to transition (31%)
  • Trouble with getting a job (29%)
  • Pressure from other family members (26%)
  • Pressure from spouse or partner (18%)
  • Pressure from an employer (17%)
  • Pressure from friends (13%)
  • Note about the survey report: “The 2015 U.S. Transgender Survey (USTS) is the largest survey examining the experiences of transgender people in the United States, with 27,715 respondents from all fifty states, the District of Columbia, American Samoa, Guam, Puerto Rico, and U.S. military bases overseas” 
  • Research on 27,715 transgender adults living in the US, 3,869 of whom had been exposed to gender identity conversion efforts
  • They found that quote “exposure to [gender identity conversion efforts] before age 10 years was significantly associated with several measures of suicidality, including lifetime suicide attempts”.
  • They also found no significant difference when comparing religious or secular conversion attempts. So it’s not a case of finding the right way to do it, there is no right way to do it.
  • Found that only 3.8% of trans people regretted SRS
  • Keep in mind that this data was taken in 1998 during a time in which being trans was less socially accepted than they are now, so that number has evidently decreased over time

Trans Kids and Detransition

  • Several studies over a long period of time came to the conclusion children simply grow out of being trans, those studies use extremely terrible methodology
  • The methods being used were 30 years out of date
  •  The clinic assumed that all gender variant children need to be clinically “fixed” (i.e. they used coercive behavior modification on queer kids to make them act straight)
  • The clinic emphasized  tests, treatment, methods with no scientific basis in evidence based medicine
  • CAMH staff asked prepubescent children questions that were highly sexual in nature
  • Former patients, parents, and therapists of former patients described the treatment as “disturbing” and “harmful”
  • CAMH hid affirming community and medical resources from patients
  • Dr. Zucker regarded being cisgender, heterosexual, and gender conforming as the “best” outcome
  • Dr. Zucker and his team could not conclusively demonstrate that what they were doing was not reparative therapy
  • In a 2014 German study, 13 experts in treatment for gender identity were asked if CAMH’s methods were ethical. 11 said no. The two who said yes were Dr. Zucker and another CAMH staffer.
  • “close inspection of these studies suggests that most children in these studies were not transgender to begin with. In 2 studies, a large minority (40% and 25%) of the children did not meet the criteria for GID to start with”
  • When directly asked what their gender is, more than 90% of children with GID in these clinics reported an answer that aligned with their natal sex, the clearest evidence that most did not see themselves as transgender
  • Analysis found methodological, theoretical, ethical, and interpretive concerns regarding four “desistance” studies are presented.
  • “Desistance” refers to the process of a trans child no longer identifying as transgender (ie. “it’s just a phase”)
  • Cites methodological concerns in these studies such as the potential misclassification of child research participants, the lack of acknowledgement of social context for research participants, the age of participants at follow-up, the potential misclassification of adolescent and young adult participants lost to follow-up
  • Theoretical concerns include assumptions inherent in “desistance” terminology, binary gender framework, presumption of gender stability as a positive outcome
  • Ethical Concerns include intensive treatment and testing of child participants, questionable goals of treatment, lack of consideration of children’s autonomy
  • Interpretive Concerns include the assumption that unknown future adult needs should supersede known childhood needs, the underestimation of harm when attempting to delay or defer transition
  • Evidence from these studies suggests that the majority of gender nonconforming children are not gender dysphoric adolescents or adults.
  • It does not support the stereotype that most children who are actually gender dysphoric will “desist” in their gender identities before adolescence.
  • These studies do acknowledge that intense anatomic dysphoria in childhood may be associated with persistent gender dysphoria and persistent gender identity through adolescence.
  • Speculation that allowing childhood social transition traps cisgender youth in roles that are incongruent with their identities is not supported by evidence.
  • These studies fail to examine the diagnostic value of Real Life Experience in congruent gender roles for gender dysphoric children.
  • Study that examines the authenticity of trans childrens’ gender identity.
  • “Our findings refute the assumption that transgender children are simply confused by the questions at hand, delayed, pretending, or being oppositional.”
  • “Instead, transgender children show responses that look largely indistinguishable from those of cisgender children, who match transgender children’s gender expression on both more- and less-controllable measures.”
  • “Further... the data reported here should serve as evidence that transgender children do indeed exist and that their identity is a deeply held one.”
  • The largest study ever conducted on transgender children to date
  • Researchers surveyed 317 transgender kids ages 3 to 12 who had "socially transitioned," or who live as the gender they identify with. They also surveyed 189 of their siblings and 316 unrelated children who are cisgender, or whose gender identity matches the sex they were assigned at birth.
  • The researchers found no significant differences between the trans and cis kids' gender development, or how they grew to understand and formulate their gender. The findings also revealed that transgender children gravitate toward the same gendered toys, clothing items, and friends as cisgender participants, regardless of how long they had been socially transitioned.  
  • 96% of all patients who were assessed and received a diagnosis of Gender Dysphoria by the 5th intervenor (the Royal Children's Hospital) from 2003 to 2017 continued to identify as transgender or gender diverse into late adolescence. No patient who had commenced stage 2 treatment had sought to transition back to their birth assigned sex.
  • A summarisation on all people treated in Amsterdam from 1972 up to 2015, which treats more than 95% of the transgender population in the Netherlands
  • Found that out of those referred to the clinic in before the age of 18 and treated with puberty blockers, 4 out of 207 trans girls (2%) stopped puberty suppression without proceeding to HRT and 2 out of 370 trans boys (less than 1%) stopped puberty suppression without proceeding to HRT
  • A study of 143 youth receiving puberty-blocking medication in the Netherlands
  • Found that 3.5% chose to discontinue puberty blockers without seeking any further transition treatment.
  • Finds that there is no significant difference between the number of trans teens and the number of trans adults (0.7% and 0.6% respectively).
  • The slight decrease in the oldest age group could be down to rejection from peers, as older generations are much less likely to support trans rights than younger people (see additional source)
  • Finds that gender identity — the concept of knowing whether one’s self is male, female or non-binary — is as strong in trans kids as it is among those identifying as cis.
  • Finds that brain activity and structure in transgender adolescents more closely resembles the typical activation patterns of their desired gender.
  • A helpful article by pediatrician and child psychiatrist Jason Rafferty, MD.
  • Explains how by as young as age 4, most children appear to have a “stable sense of their gender identity.”
  • Even younger, children begin to perceiver “gender role behavior”
  • Paper on claims that various forms of care for trans youth are tantamount to homophobia
  • “The suggestion that gender affirmation and access to transition-related care are homophobic and tantamount to conversion therapy are groundless. There is no evidence that youth are conflating gender non-conformity and/ or normal discomfort surrounding pubertal development and unwanted sexual attention with being transgender. Nor is there evidence that they are motivated to transition by homophobia”
  • “Some critics have claimed high rates of regret regarding irreversible treatments or procedures such as reconstructive surgeries, implying that children are forced to undergo treatments they may regret. There are no studies to support these claims”

Neurology

Some trans individuals neurologically reflect cisgender people of their desired gender, indicating a neurological component to their experiences. This suggests that gender has some biological basis, but not necessarily that gender is 100% biological. There’s obviously a sociological basis to gender and gender roles which complement its biological aspects.

  • BRAIN SCANS show that (many) transgender individuals neurologically reflect their identity, not their assigned gender at birth.
  • The study included both adolescent boys and girls with gender dysphoria and used magnetic resonance imaging (MRI) scans to assess brain activation patterns in response to a pheromone known to produce gender-specific activity.
  • The pattern of brain activation in both transgender adolescent boys and girls more closely resembled that of non-transgender boys and girls of their desired gender.
  • Out of 14 studies of brain structure (total N=307, N MtF=195, N FtM=112) with a total of 23 results: 6 results that trans people had brain structure similarities to their birth sex, 12 results that trans people had brain structure similarities to their gender identity, and 5 results that unclear results (either no significant sex differences or no significant differences between trans and cis participants, or both).
  • TLDR: 12 of 18 (66%) results with clear results suggest trans people have brain structures with similarities to their current gender identity.
  • Studies on gray matter, white matter, twins, and prenatal exposure all suggest -- albeit, with limited sample sizes and methods -- that transgender identity, like homosexuality, has a biological origin
  • “Although the mechanisms remain to be determined, there is strong support in the literature for a biologic basis of gender identity.”
  • “Current data suggest a biologic etiology for transgender identity. Studies of DSD patients and neuroanatomical studies provide the strongest evidence for the organic basis of transgender identity. Because the sample sizes of most studies on this subject were small, the conclusions must be interpreted with caution. Further research is required to assign specific biologic mechanisms for gender identity.”

History of Gendered Terms

We didn’t always hold the same attitudes or use the same terminology for genders that we do now.

  • Interesting origins of gendered terms and raising children
  • “Nor have boys always even been called boys. Until the late 15th century the word ‘girl’ simply means a child of either sex. Boys, where they had to be differentiated, were referred to as ‘knave girls’ and girls in the female sense were called ‘gay girls’. Equally a boy could be a ‘knave child’ and a girl a ‘maiden child’. The term ‘boy’ was reserved for servants or ‘churls’, the meaning ‘young man’ probably deriving from the latter as a pejorative term but not occurring before 1440.”
  • It used to be considered manly to cry - not just in one place at one time, but in multiple societies at different points in history
  • Note: Non-academic and non-expert, but still useful
  • Gendered behaviours and associated responsibilities have seen some changes even in recent times. For example:
  • Women have consistently become more involved in working for money and bringing income home (pg 11)
  • Women are now having a much greater presence in higher education, out-graduating males in college (pg 17)
  • Fathers are now more expected to take a role in childcare, though in most instances mothers do the majority of childcare work (pg 29)

Canada’s C-16 Bill

C-16 is about hate crimes, not pronoun usage. Misgendering doesn’t cross the threshold for being a hate crime in Canada.

  • “The bill is intended to protect individuals from discrimination within the sphere of federal jurisdiction and from being the targets of hate propaganda, as a consequence of their gender identity or their gender expression. The bill adds "gender identity or expression" to the list of prohibited grounds of discrimination in the Canadian Human Rights Act and the list of characteristics of identifiable groups protected from hate propaganda in the Criminal Code. It also adds that evidence that an offence was motivated by bias, prejudice or hate based on a person's gender identity or expression constitutes an aggravating circumstance for a court to consider when imposing a criminal sentence.”
  • Essentially, hate crimes against people based on gender identity/expression will be treated legally at the same level as other hate crimes, e.g. racially motivated hate crimes
  • Not once are pronouns or misgendering explicitly brought up in the bill
  • This provides some further clarity on the bill’s purpose: “The recognition of the rights of gays and lesbians has evolved in some measure through the recognition of the right to be free from discrimination based on sexual orientation. Sexual orientation does not necessarily protect those whose gender does not align with their sex assigned at birth, or who do not consider themselves to fit in with conventional conceptions of gender. Bill C-16 seeks in part to add the grounds of gender identity and gender expression to broaden the recognition of the rights of other members of sexual minority groups.”
  • This article includes a legal expert who comments on C-16 and Jordan Peterson’s takes
  • Jordan Peterson, an active critic of C-16, is likely misunderstanding or mischaracterizing the bill
  • The threshold for a hate crime in Canada is likely too high for misgendering to be considered a hate crime
  • Good brief on what C-16 actually does
  • Bill C-16 added the words “gender identity or expression” to three places:
  • Canadian Human Rights Act, joining a list of identifiable groups that are protected from discrimination. These groups include age, race, sex, religion, disability, etc.
  • A section of the Criminal Code that targets hate speech — defined as advocating genocide and the public incitement of hatred — where it joins other identifiable groups.
  • A section of the Criminal Code dealing with sentencing for hate crimes. If there’s evidence that an offence is motivated by bias, prejudice or hate, it can be taken into account by the courts during sentencing.
  • Being jailed for repeated misgendering would be very difficult to do even with C-16 in place

Specific Debunks:

  • Case was unrelated to C-16 and had far more to it than misgendering
  • The father was actively bringing his trans son’s personal issues to light in public interviews, and brought up personal details during those interviews
  • The father was also actively contributing to worsening the child’s mental health (the son had already attempted suicide in part because of his father, for example)
  • Original source in regards to this case, provides more context

  • Unrelated to C-16, dealt instead with section 7 of British Columbia’s Human Rights Code (keep in mind C-16 was national legislation, not provincial legislation)
  • Whatcott was spreading anti-trans misinformation in general, specifically targeting Oger who was running for political office at the time and lost by a small margin
  • Original source in regards to this case, provides more context — C-16 not cited in it, aside from the Canadian Human Rights Act being brought up once in 104 pages

Additional Resources

  • “Other techniques include trying to make patients’ behaviour more stereotypically feminine or masculine or teaching heterosexual dating skills. Practices aimed at changing gender identity include preventing trans young people from transitioning”
  • American Psychological Association pamphlet on transgender issues
  • Affirms psychological consensus - that transgender people are valid, have existed throughout history, are subject to discrimination, and that transness is not a mental disorder.
  • Gender Identity Resolution which expands upon the premises listed in the annotation above and supports total equality for transgender people - affirmation of the institutional legitimacy of transness in psychology.
  • Identical to the above, essentially, except pertaining to trans and gender-nonconforming youth.
  • Booklet on LGBTQ issues from the American Psychological Association, outlining their policy and attitudes towards aforementioned communities.
  • Expressly positive.
  • The UK’s National Health Service report on gender dysphoria, which affirms the validity of trans people and discusses ways in which gender dysphoria can be alleviated, the best of which is said to often be social and physical transition.
  • The American Psychoanalytic Association’s statement on gender identity, in which transness is validated, social stigma against transgender people is cited as a serious cause of harm and ‘reparative therapy’ - attempts to suppress one’s transness and force them to live as the gender they were assigned at birth - is medically invalid.
  • The World Health Organization recently stopped classifying transness as a mental disorder.
  • Multilateral condemnation of ‘conversion therapy’ from essentially every medical institution in the United Kingdom, with reasons provided.
  • Transphobia? Nah
  • Estimates a transgender population of around 0.6%, or 1.4 million people, in the United States
  • This is double the amount estimated by a 2011 study (0.3%) which had limited data to work with

Studies to Watch Out For

  • Commonly cited by transphobes to indicate sexual reassignment surgery harms trans people, increases risk of suicide.
  • This is NOT what the study says
  • A study proving that SRS harms trans people would compare the wellbeing of post-SRS trans people to pre-SRS trans people, but this one uses CIS people as a control group
  • The study merely demonstrates that trans people who have had SRS still are a vulnerable population compared to cis people, but NOT that their condition had been worsened by SRS.
  • The head author, Cecilia Dhejne, is actually very trans positive herself, and describes her intent in publishing this study in this AMA.
  • Commonly cited by transphobes to indicate transness spreads socially, that exposure to trans material might encourage youth to be trans. “Rapid Onset Gender Dysphoria” (ROGD).
  • BAD DATA. This study polled PARENTS, not the actual children, and those polls were taken online, and those sites were biased by nature - ‘4thwavenow, transgendertrend, youthtranscriticalprofessionals’.
  • Horrendously, pathetically inept data collection. Anyone who cites this should be laughed at.
  • Bad data: the study claims that hormonal therapy does not help reduce T levels to that of a cis woman’s; however, the study uses the testosterone blocker known as spiro which prevents the body from acting on the testosterone rather then remove it from the blood, making the data useless