Sex, gender, etc...

This all boils down to the idea, or rather, the fact, that gender is a social construct. By this I mean that gender is not innate or immutable, it is something that differs from culture to culture and even within societies as the times change. For example, wearing makeup, high heels, wigs, and frilly clothing used to be considered masculine during the American Revolution, but today it’s seen as feminine. Ideas about gender are taught and reinforced by the hegemonic ideas of what a specific gender is and isn't. The idea that gender isn't innate but taught is something that even conservatives acknowledge, accidentally of course. For example, there's this tweet from Ben Shapiro where he states "boys are taught to be more masculine," and there's a part in a popular conservative podcast where one of the guests says "my 2nd grader has no idea what her body parts mean at all" (skip to 44:44 in the video). Granted, the second example confuses gender with sex, but both are admitting that children have to be taught how to act "their" gender correctly and made aware of what's expected of them by others.  

Of course, gender is not just limited to how people present themselves - it also includes behaviors, roles, traits, attitudes, and more. To think that at birth you already know what combination of all these things a baby will exemplify is absurd. Furthermore, to think that there are only two “acceptable” combinations of all of these qualities is simplistic and facile. It would be like saying there are only two positions in the game of football - offense and defense.

While there is a relationship between gender and sex, or more broadly, biology, this correlation does not mean causation. The XY chromosomes and testosterone in a baby do not make that baby gravitate towards the color blue over pink. That baby is taught that blue is a boy color and pink is a girl color by society. The baby is also taught that they should act a certain way and show interest in certain things, and their behaviors are either rewarded and encouraged or punished and discouraged based upon whether or not they conform. This is further reinforced by what they observe in real life and what they see depicted in media.

In addition to what I’ve outlined above, I support the idea that gender is something people choose for three other reasons:

• If we truly live in a free country and have free will that can be exercised, then people should be able to identify as they please.

• I believe that what a person chooses in life is more important than the things they didn't choose, and a person's choices tell you more about who they are as a person than the things they didn't choose or inherited. For example, the career field a person chooses to work in tells you more about them than the hair color they were born with. The media a person chooses to consume tells you more about them than their height. In other words, if the choices we make define who we are, then the gender a person identifies with, or "chooses," defines them more than their genitals or hormones. This is not to say that things a person doesn't choose are irrelevant, just that the things they do choose are more relevant. 

• Modern society is built on the idea that the circumstances of one’s birth shouldn't define the entirety of a person's life. We recognize that being born poor doesn’t mean a person should have to live the rest of their lives poor and being born a citizen of one country doesn’t mean a person must call that place home their entire lives, among other things, so we should also recognize that being born and assigned a certain gender doesn’t mean one has to be that gender the rest of their lives.

While there is a relationship between gender and sex, they are not the same thing. Many idiots believe that gender and sex are the same thing or that sex is gender or some other nonsense but this would be like saying your height is your shoe size. There is a relationship between the two things - taller people tend to have larger shoe sizes - but they are not the same thing. Similarly, there is a relationship between sex and gender - people born with penises tend to identify as male, people born with vaginas tend to identify as female - but they are not the same thing. 

The National Institute of Health, a part of the US Department of Health and Human Services (a government entity) also recognizes this difference: "'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."

The American Psychological Association offers this definition of sex and gender from their Dictionary of Psychology, second edition: "sex refers especially to physical and biological traits, whereas GENDER refers especially to social or cultural traits." They also offer this statement on the matter: "Sexual orientation refers to an individual’s enduring physical, romantic, and/or emotional attraction to another person, whereas gender identity refers to one’s internal sense of being male, female, or something else. Transgender people may be straight, lesbian, gay, bisexual, or asexual, just as nontransgender people can be."

• Also: "Gender refers to the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex. Behavior that is compatible with cultural expectations is referred to as gender-normative; behaviors that are viewed as incompatible with these expectations constitute gender non-conformity."

• More from the APA: "Gender identity is defined as a person’s deeply felt, inherent sense of being a girl, woman, or female; a boy, a man, or male; a blend of male or female; or an alternative gender. In many cultures and religious traditions, gender has been perceived as a binary construct, with mutually exclusive categories of male or female, boy or girl, man or woman. These mutually exclusive categories include an assumption that gender identity is always in alignment with sex assigned at birth...Gender as a nonbinary construct has been described and studied for decades. There is historical evidence of recognition, societal acceptance, and sometimes reverence of diversity in gender identity and gender expression in several different cultures...However, people may experience distress associated with discordance between their gender identity and their body or sex assigned at birth, as well as societal stigma and discrimination."

The American Academy of Pediatrics defines sex as "an assignment that is made at birth, usually male or female, typically on the basis of external genital anatomy but sometimes on the basis of internal gonads, chromosomes, or hormone levels," and gender identity as "a person’s deep internal sense of being female, male, a combination of both, somewhere in between, or neither, resulting from a multifaceted interaction of biological traits, environmental factors, self-understanding, and cultural expectations."

The American College of Physicians states, "Gender identity may or may not correspond to a person's anatomical sex assigned at birth. The term "transgender" is now widely used to refer to a diverse group of persons who depart significantly from traditional gender norms."

Gender is an identity and refers to masculine and feminine characteristics which are largely socially created. As the World Health Organization identifies, "this includes norms, behaviors and roles associated with being a woman, man, girl or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time."

• The WHO recognizes confusion between these two concepts, stating that "these terms are often mistakenly used interchangeably," but it really shouldn't be hard to recognize the differences: sex is biological and gender is expression. 

The American College of Obstetricians and Gynecologists states, "Gender identity is a person’s fundamental and innate sense of being male, female, or somewhere in between. For transgender individuals, their gender identity differs from their natal gender (the gender they were assigned at birth)."

A Human Rights Campaign document published with the American Academy of Pediatrics & the American College of Osteopathic Pediatricians states, "Whether talking about children or adults, it is helpful to think of gender in three parts: 1. Sex, the combinations of physical characteristics (including but not limited to genitals, chromosomes, and sex hormone levels) typical of males or females. 2. Gender identity, a person’s internal sense of being male, female, or, for some people, a blend of both or neither. 3. Gender expression, the many ways people show their gender to others, such as the clothing and haircuts they wear or the roles and activities they choose."

Interesting fact: Up until the late 1880s, dresses would be worn by little boys and girls. Even eventual US president Franklin D. Roosevelt is pictured in one. This illustrates how gender is socially constructed and ideas as to what determines a certain gender can change overtime. Nowadays, it's a commonly held belief that boys wear pants and girls wear dresses, yet back ~140 years ago both boys and girls wore dresses and it was a normal thing.

Trans, cis, non binary

Scientific American has a great infographic which helps not only identify the ambiguous and bimodal nature of sex, but also helps explain prefixes like trans and cis as well as nonbinary. A transgender person is someone who was assigned a certain gender at birth based on their anatomy (chromosomes, hormones, and reproductive organs) but identifies as a different gender. For example, a transgender woman is someone who was assigned male at birth but identifies as a woman and a transgender man is someone who was assigned female at birth but identifies as a man. A cisgender person is a person whose gender identity and gender expression align with sex assigned at birth . For example, a cisgender woman is someone who was assigned female at birth and identifies as a woman. A cisgender man is someone who was assigned male at birth and identifies as a man. Lastly, nonbinary refers to someone who identifies neither as completely male or female. They could identify with both masculine and feminine characteristics or neither. 

Gender Dysphoria 

Gender dysphoria is another term that comes up quite often when looking at transgender issues. The American Public Health Association defines gender dysphoria as a term "used to describe transgender and gender-nonconforming people’s symptomatic experiences." 

Gender dysphoria essentially s form of stress of discomfort. The American Psychological Organization states, "people may experience distress associated with discordance between their gender identity and their body or sex assigned at birth, as well as societal stigma and discrimination." The World Health Association identifies gender dysphoria as discomfort and distress often felt by transgender individuals: "The WMA asserts that gender incongruence is not in itself a mental disorder; however it can lead to discomfort or distress, which is referred to as gender dysphoria (DSM-5). "

The Diagnostic and Statistical Manual of Mental Disorders, Firth Edition (DSM-5) states that, "With the publication of DSM–5 in 2013, “gender identity disorder” was eliminated and replaced with “gender dysphoria.” This change further focused the diagnosis on the gender identity-related distress that some transgender people experience (and for which they may seek psychiatric, medical, and surgical treatments) rather than on transgender individuals or identities themselves." Key word - some. The DSM–5 articulates explicitly that “gender non-conformity is not in itself a mental disorder.” In layman's terms, being transgender or having a gender identity that differs from what is assigned at birth is not a mental illness, but some of the certain stress related to gender identity can be considered an illness in need of treatment. The American Psychiatric Association even states that "Some people who are transgender will experience “gender dysphoria,” which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity," key word - some. Furthermore, gender dysphoria refers to discomfort and stress associated with one's sex and/or gender NOT the desire to identify as a specific gender. Medical News Today states "A person with gender dysphoria may experience conflict with their sex assigned at birth and their gender identity. It is not the same as being transgender or gender-nonconforming."

If we define a man and woman based on their chromosomes - XY for males and XX for females - then it should be noted that chromosomes were "discovered" in 1842 by Karl Wilhelm von Nageli and in 1888 the term chromosome was coined by by German anatomist Wilhelm von Waldeyer-Hartz. By 1917, scientists were using X and Y to identify human sex chromosomes. Thus, society had an understanding of what a man and woman were prior to the "discovery" of chromosomes. The idea than men and women are defined by these chromosomes is a very modern one, exemplifying how the definitions for what a man is and what a woman is have changed over time (just like the definitions for most words wow). Prior to the 20th century there had to some other definition for man and woman that was not related to chromosomes considering no one had any idea what a chromosome was at the time. Thus, the recent "movement" you could call it I guess to redefine what a man or woman is is just the last in a long line of amendments and changes to our understanding of what a man or woman is, continuing that trend.

Furthermore, this idea that a man is someone with XY chromosomes and a women is someone with XX chromosomes does not account for the existence of intersex people. Intersex refers to a group of conditions where there is a discrepancy between the external genitals and the internal genitals, an older term for this condition being hermaphroditism. There are four different categories of intersex: 

• 46 XX intersex - an individual with the chromosomes of a woman, the ovaries of a woman, but external genitals that appear male.

• 46 XY intersex - an individual with  the chromosomes of a man but the external genitals are incompletely formed, ambiguous, or clearly female. Internally, testes may be normal, malformed, or absent. 

• True gonadal intersex - an individual with both ovarian and testicular tissue. This may be in the same gonad (an ovotestis), or the person might have 1 ovary and 1 testis. The person may have XX chromosomes, XY chromosomes, or both.

• Complex or undetermined intersex - an individual with many different chromosome configurations other than simple 46, XX or 46, XY. These include 45, XO (only one X chromosome), and 47, XXY, 47, XXX - both cases have an extra sex chromosome, either an X or a Y.

  • The XO chromosome condition is called Turner Syndrome,  XXY chromosome condition is called the Klinefelter syndrome and the XXX chromosome condition does not have a name like that for some reason. 

In addition to intersex there are people born with conditions like 5-alpha reductase deficiency, a condition which affects male sexual development in which a person is born with XY chromosomes has testicles but their sexual development is stunted, the body does not produce enough of a specific hormone, and this shortage prevents the formation of external sex organs at birth. Many people with this condition are born with female appearing external genitalia. 

So the idea that sex is purely determined by whether someone has XY or XX chromosomes (which science does not agree with, by the way) simply doesn't account for the intersex condition. I say that science does not agree with purely chromosomes determining sex because, as stated in a 2018 scholarly article describing modern scientific attitudes towards human sex published in the Gender and Genome journal, "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 World Health Organization also recognizes that sex is not binary, as research suggests "that in a few births per thousand some individuals will be born with a single sex chromosome (45X or 45Y) (sex monosomies) and some with three or more sex chromosomes (47XXX, 47XYY or 47XXY, etc.) (sex polysomies). In addition, some males are born 46XX due to the translocation of a tiny section of the sex determining region of the Y chromosome. Similarly some females are also born 46XY due to mutations in the Y chromosome. Clearly, there are not only females who are XX and males who are XY, but rather, there is a range of chromosome complements, hormone balances, and phenotypic variations that determine sex." The Intersex Society of North America also identifies that roughly 1 in every 1,500 - 2,000 births are an intersex baby nd the United Nations identifies that "According to experts, between 0.05% and 1.7% of the population is born with intersex traits – the upper estimate is similar to the number of red haired people." So we can’t say there’s only two sexes. We have to deal with at least 3 (clumping all the abnormalities into one sex category).

In the section above - Chromosomes and Their Relation to Sex - I eluded to how we can't say there are only two sexes due to the number of "abnormalities" like intersex and I will explore that more here. 

The idea that sex is binary suggests that sex is two and only two possibilities: XY chromosomes = male or XX chromosomes = female. This is a popular idea among conservatives considering their proneness to view the world in only extremes where things are either this or that and there is no in-between. Unsurpsingly, it's wrong. The idea that sex is bimodal suggests that sex is a range of possibilities with two of those possibilities - XX chromosomes and XY chromosomes - occurring most often. Sex as bimodal means that most (but not all) humans are either males with XY chromosomes or females with XX chromosomes but there are a slew of other humans with genetic and biological variations like folks with XXX chromosomes, XXY chromosomes, XO chromosomes, and more. The Intersex Society of America estimates that roughly 1 in 1,500 - 2,000 births are an intersex baby and the United Nations identifies that "According to experts, between 0.05% and 1.7% of the population is born with intersex traits – the upper estimate is similar to the number of red haired people." Considering intersex people exist sex being bimodal is an accurate reality. 

Saying that sex is binary would be like saying there are only two kinds of animals: animals with two legs or animals with four legs. Both do not explain or account for the existence of less frequently occurring instances - animals with no legs (snakes), 8 legs (spiders), 10 legs (crabs), hundreds of legs (centipedes and millipedes), and more, and humans with XXX chromosomes, XXY chromosomes, XO chromosomes, and more.

For sex to be binary - humans are either males with XY chromosomes or females with XX chromosomes - there then must be definitive definitions for each that exclude the other. A definition like this is impossible (thanks to those humans with XXX chromosomes, XXY chromosomes, XO chromosomes, and more). It would be like asking for the definition of a chair that includes everything that is a chair while also excluding everything that isn't a chair. You could say a chair is "something with four legs that people sit on" but that then includes horses, elephants, camels, donkeys, and more animals and some couches with four legs as a chair and excludes bean bags and school chairs and minimalist modern chairs with less than four legs. So that doesn't work. While most people recognize the quality of having four legs is part of what a chair is, they can also recognize that there are things with four legs that are not chairs like horses, bedframes, dogs, cats, etc... and there are things with less than two legs that are chairs like school chairs and minimalist, modern chairs.

The too long, didn't read version

So essentially being transgender is not a mental illness for the same reason that feeling stress or anxiety in of itself is not a disorder. Obviously. all people experience stress or anxiety in their lives but simply feeling that does not mean one has a stress or anxiety disorder. It is when the distress resulting from the stress or anxiety that causes disability - inability to hold down a job, clean and feed oneself, clean one's living environment, have a social life, et cetera - that then results in the diagnosis of a stress or anxiety disorder. Similarly, just being transgender or feeling/identifying with a different gender than assigned at birth is not a mental illness, but when one experiences significant distress and disability as a result of this feeling/identity then there is an illness. That is called gender dysphoria. Simply being transgender does not constitute a mental illness, rather when someone experiences their gender as significant distress and/or disorder that it becomes an illness, just like feeling stress or anxiety is not a disorder but significant distress and/or disorder as a result of that stress or anxiety constitutes a disorder or illness.

Changing one's gender or sex is actually quite natural (in the sense that it occurs in nature). Many animals are known to change their sex, notably: snails (apparently all snails are born male. and when in close proximity to each other the larger male will begin to change into a female according to a study), bearded dragons, frogs (even in regular, pollution-free conditions), clownfish (all are born male, they change sex to become the dominant female of the group), a type of fish called the wrasses (it can change sex in just 20 days - quite speedy), another type of fish called the rusty angelfish (all are born female and the larger ones will change to male like all other Centropyge fish), and more. 

A list of organizations that have made statements publicly validating and supporting transgender people and/or opposing discrimination of transgender individuals:

American Academy of Dermatology 

• "Recognizes and affirms the identity and dignity of LGBTQ/SGM (lesbian, gay, bisexual, transgender, queer / sexual and gender minority) individuals and recognizes their unique health needs."

• "Recognizes that transgender and gender diverse individuals can benefit greatly from medical and surgical gender-affirming treatments."

• "Recognizes that gender-affirming procedures and treatments are not 'cosmetic' or 'elective' or for the mere convenience of the patient. These procedures are not optional in any meaningful sense, but are understood to be medically necessary for the health and well-being of the individual."

• "Supports the ability of transgender and gender-diverse persons to utilize public facilities of the gender with which they identify and opposes any legislation or policy that would infringe upon that ability."

• Defines gender identity as "the personal sense or perception of one’s own gender. Gender identity may correlate with assigned sex at birth or can differ from it."

American Academy of Pediatrics

• "transgender identities and diverse gender expressions do not constitute a mental disorder"

• "there is no evidence that risk for mental illness is inherently attributable to one’s identity of TGD (transgender and gender diverse)"

  • Identify that this idea was affirmed by the American Psychological Association in 2008 and the American Psychiatric Association, which made the following statement in 2012: "being transgender or gender variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression.… [Such] discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals." (See Figure 1 below, because it is a PDF the link doesn't want to work on here).

• "variations in gender identity and expression are normal aspects of human diversity, and binary definitions of gender do not always reflect emerging gender identities"

• "gender identity evolves as an interplay of biology, development, socialization, and culture; and if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child."

• "The Substance Abuse and Mental Health Services Administration has concluded that any therapeutic intervention with the goal of changing a youth’s gender expression or identity is inappropriate. Reparative approaches have been proven to be not only unsuccessful but also deleterious and are considered outside the mainstream of traditional medical practice."

American College Health Association

• "As a society, we have made significant strides in removing barriers and improving health care and outcomes for transgender and gender diverse patients. Individuals feel more comfortable disclosing their authentic gender and are doing so at younger ages. Health care services should be made universal to all and should not discriminate in any way, whether this be on age; race/ethnicity, sex; sexual orientation; gender (including gender identity); marital status; physical size; religious, spiritual or cultural identity; psychological/physical/learning disability; socioeconomic status; or veteran status."

American College of Obstetricians and Gynecologists

• "Gender identity is a person’s fundamental and innate sense of being male, female, or somewhere in between. For transgender individuals, their gender identity differs from their natal gender (the gender they were assigned at birth). In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, transgender identity is not considered a pathologic diagnosis;"

American College of Physicians

• "The American College of Physicians recommends that public and private health benefit plans include comprehensive transgender health care services and provide all covered services to transgender persons as they would all other beneficiaries."

• "Research shows that when transgender persons receive individual, medically appropriate care, they have improved mental health, reduction in suicide rates, and lower health care costs overall because of fewer mental health–related and substance abuse–related costs."

• "Many professional medical organizations, including the American Medical Association, American Psychological Association, American Psychiatric Association, American Congress of Obstetricians and Gynecologists, and American Academy of Family Physicians, consider gender transition–related medical services medically necessary."

American Counseling Association

• the ACA states that competent counselors will, "Affirm that all persons have the potential to live full functioning and emotionally healthy lives throughout their lifespan while embracing the full spectrum of gender identity expression, gender presentation, and gender diversity beyond the male-female binary," and, "Affirm transgender mental and medical health care (e.g., hormone therapies, sexual reassignment surgery, safe and trans-positive general medical services) through the entire lifespan, not just during the initial assessment process or during transition."

American Nurses Association

• "ANA is committed to the elimination of health disparities and discrimination based on sexual orientation, gender identity, and/or expression within health care. LGBTQ+ populations face significant obstacles accessing care such as stigma, discrimination, inequity in health insurance, and denial of care because of an individual’s sexual orientation or gender identity."

American Public Health Association

• "Policies and practices that exclude transgender and gender-nonconforming people have a negative impact on gender minority health by permitting discrimination and reinforcing stigma. APHA advocates for the adoption and application of inclusive policies and practices that recognize and address the needs of people and communities identifying as transgender or gender nonconforming. Inclusive policies and practices are those that recognize transgender and gender-nonconforming identities as valid and deserving of equal consideration and treatment."

• "APHA urges Congress, state legislatures, and other public and private entities to ensure that policies and practices across all sectors are explicitly inclusive of transgender and gender-nonconforming people."

• "Policies and practices that exclude transgender and gender-nonconforming populations have a negative impact on transgender and gender minority health by permitting discrimination and reinforcing stigma."

• "Discrimination against transgender and gender-nonconforming people increases the likelihood of social alienation, homelessness, financial instability, substance use (as a coping mechanism for transphobic discrimination and mistreatment), HIV vulnerability, incarceration, psychological distress, suicidal ideation, suicide attempts, suicide, and homicide."

• "Several studies have demonstrated strong correlations between exposure to discrimination and psychological distress (particularly depression) among transgender people. An Internet-based study of more than 1,000 transgender men and women revealed significant rates of psychological distress, including clinical depression (44.1%), anxiety (33.2%), and somatization."

• "GID (Gender Identity Disorder) diagnoses have been used against transgender people in court cases, as the diagnosis legally establishes “severe and chronic mental illness.” The medical community has begun to recognize the biological basis of gender identity and the errors of incorrectly classifying the transgender population as “deviant” and “mentally ill.” Instead, the term “gender dysphoria” is now used to describe transgender and gender-nonconforming people’s symptomatic experiences."

In collaboration with the American Medical Society, the Gay and Lesbian Medical Association (GLMA) published a document which expresses these views:

• "Therapeutic treatment, including hormone therapy, mental health therapy and gender affirming surgeries, are medically necessary for the treatment of gender dysphoria. These gender-affirming medical and surgical treatments should be covered by all public and private insurance plans."

• "GLMA: Health Professionals Advancing LGBTQ Equality recognizes  recognizes that mental healthcare, hormone replacement therapy, and/or gender-affirming surgery are medically necessary for the treatment of transgender people who meet the criteria for gender dysphoria and advocates that these services not be excluded from any public or private insurance programs. In addition, other medical associations, including the American Academy of Family Physicians, American College of Obstetricians and Gynecologists and American Psychiatric Association have stated that medically necessary transition-related care should be covered by insurance."

World Medical Association

• "Although being transgender does not in itself imply any mental impairment, transgender people may require counseling to help them understand their gender and to address the complex social and relational issues that are affected by it."

• "The WMA emphasises that everyone has the right to determine one’s own gender and recognises the diversity of possibilities in this respect. The WMA calls for physicians to uphold each individual’s right to self-identification with regards to gender."

• "The WMA asserts that gender incongruence is not in itself a mental disorder; however it can lead to discomfort or distress, which is referred to as gender dysphoria (DSM-5)."

Other statements and research on "transness" and transgender individuals

The Diagnostic and Statistical Manual of Mental Disorders, Firth Edition (DSM-5) states that, "With the publication of DSM–5 in 2013, “gender identity disorder” was eliminated and replaced with “gender dysphoria.” This change further focused the diagnosis on the gender identity-related distress that some transgender people experience (and for which they may seek psychiatric, medical, and surgical treatments) rather than on transgender individuals or identities themselves." Key word - some. The DSM–5 articulates explicitly that “gender non-conformity is not in itself a mental disorder.” In layman's terms, being transgender or having a gender identity that differs from what is assigned at birth is not a mental illness, but some of the certain stress related to gender identity can be considered an illness in need of treatment. The American Psychiatric Association even states that "Some people who are transgender will experience “gender dysphoria,” which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity," key word - some. Furthermore, gender dysphoria refers to discomfort and stress associated with one's sex and/or gender NOT the desire to identify as a specific gender. Medical News Today states "A person with gender dysphoria may experience conflict with their sex assigned at birth and their gender identity. It is not the same as being transgender or gender-nonconforming."

The World Health Organization recognizes that being transgender is no longer considered a mental illness. WHO officials voted to remove it from the mental disorders chapter to its sexual health chapter in the 11th revision of its International Statistical Classification of Diseases and Related Health Problems in 2019. One of these officials said it "was taken out from the mental health disorders because we had a better understanding that this wasn't actually a mental health condition."

The American Psychological Association (quotes below come from this link if not otherwise specified) recognizes that that transgender people are valid, have existed throughout history, are subject to discrimination, and that "transness" is not a mental disorder. The APA also supports total equality for transgender people, as evident from a 2019 resolution titled "APA RESOLUTION on Transgender, Gender Identity, and Gender Expression Non-Discrimination." More from the APA on all LGBT things can be found here.

• "A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder."

• "Transgender persons have been documented in many indigenous, Western, and Eastern cultures and societies from antiquity until the present day. However, the meaning of gender nonconformity may vary from culture to culture."

• "transgender people in most cities and states face discrimination in nearly every aspect of their lives."

• In a 2019 resolution titled "APA RESOLUTION on Transgender, Gender Identity, and Gender Expression Non-Discrimination" the APA states that, "that APA encourages legal and social recognition of transgender individuals consistent with their gender identity and expression, including access to identity documents consistent with their gender identity and expression which do not involuntarily disclose their status as transgender for transgender people who permanently socially transition to another gender role," and that "that APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments."

• In a 2018 statement titled "Position Statement on Discrimination Against Transgender and Gender Diverse Individuals" the APA states that, "Being transgender or gender variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression.… [Such] discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals." Use this link to download a copy of the statement, or refer to it in in Figure 1 below.

• In a 2018 statement titled "Position Statement on Access to Care for Transgender and Gender Diverse Individuals" the APA states that, "Significant and long-standing medical and psychiatric literature exists that demonstrates clear benefits of medical and surgical interventions to assist gender diverse individuals seeking transition," and "Access to medical care (both medical and surgical) positively impacts the mental health of transgender and gender diverse individuals." Use this link to download a copy of the statement, or refer to it in in Figure 2 below.

• In a 2020 statement titled "Position Statement on Issues Related to Sexual Orientation and Gender Minority Status" the APA states that, "Diverse sexual orientations and gender identities exist as part of the human condition. Ongoing, widespread stigma against those with diverse sexual orientations and gender identities are present in mainstream society and contribute to higher rates of psychiatric illness in those populations. Inclusive and supportive environments for those individuals identifying with diverse gender and sexual orientations are associated with favorable mental health outcomes." Use this link to download a copy of the statement, or refer to it in in Figure 6 below.

A different APA, this time the American Psychoanalytic Association, also affirms that transgender people are valid and that they "affirms the right of all people to their sexual orientation, gender identity and gender expression without interference or coercive interventions attempting to change sexual orientation, gender identity or gender expression." 

A Human Rights Campaign document published with the 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.

The United Kingdom National Health Service writes that "gender dysphoria is not a mental illness."

This interactive map from PBS looks at transgender people throughout different cultures in history, affirming that transgender people have always existed. 

General info

Puberty blockers, commonly referred to as GnRH for gonadotropin-releasing hormone, are among the the first medical step most transgender or gender nonconforming individuals take in their "transition." There are two types of puberty blocking medicines: a shot given every three months (Lupron) or a implant placed under the skin in the upper arm (Histerline). Fun fact, GnRH drugs have been used to treat children since the 1980s for slowing down puberty which occurred to quickly or too early (the medical term for this is precocious puberty). As the name implies, puberty blockers delay the effects of puberty which gives the individual taking them more time to explore and assess their gender identity, potentially preventing them going through a male or female puberty they do not wish to go through.

Puberty generally begins between 9 or 10 in girls and 10 or 11 in boys and since obviously a kid can't just decide to go through a medical procedure their parents and medical professionals are involved. Parents who notice signs of gender nonconformity in their children consult a doctor and, according to Mayo Clinic, a child must show long lasting and intense patterns of gender nonconformity or gender dysphoria, have gender dysphoria that began or worsened at the onset of puberty, and be provided informed consent prior to any treatment. Additionally, all other psychological, medical, or social problems that could interfere with treatment must be addressed. This is a process that usually takes years. The Provincial Health Services Authority offers similar criteria. Puberty blockers are prescribed and administered by a pediatric endocrinologist who also monitors the well-being of the recipient. Administering puberty blockers to a child isn't as simple as "hey doctor my son wore a dress and likes the color pink can he go on puberty blockers now?" as some idiots may believe it to be. Additionally, the earliest puberty blockers can be administered are at the onset of puberty, as Mayo Clinic and MDEdge reports, so no six year old is getting on puberty blockers or anything like that. The American Medical Association Journal of Ethics argues that this is entirely ethical, asserting that if allowing puberty to progress appears likely to harm a child, puberty blockers should be administered: "It would be unethical to allow a patient to suffer through the distress of pubertal development when we have a way of preventing the distress it causes."

So what exactly do puberty blockers do? In layman's terms, they suppresses the body's release of sex hormones - testosterone or estrogen - and generally result in limiting breast development and delaying the menstrual cycle in those assigned female at birth and limit the growth of body and facial hair and prevent voice deepening in those assigned male at birth. In more scientific terms, puberty blockers will actually stop the GnRH receptors (located in the pituitary gland) from producing sex hormones. 

Puberty blockers are reversible, or, as MDEdge puts it "Puberty blockers are like a pause button that gives everyone – patient, clinicians, therapists – time to process, explore, and ensure transition is the right path." One can stop taking puberty blockers if they realize that this route is not for them, their gender dysphoria is otherwise alleviated, they just don't like it - whatever - and then the puberty they would have gone through essentially hits them like a truck. 

GnRH info

In layman's terms, Gonadotropin-releasing hormones (GnRH) are drugs which result in changes to biological activity. There are several different types available for clinical use but they all act through the same mechanism: "first to stimulate and then to inhibit gonadotropin and gonadal steroid secretion by downregulating the pituitary Gn-RN receptors." This info comes curtsey of a paper from the CAMJ Journal, which identifies that GN-RN drugs have been used as treatment for a variety of conditions including endometriosis, uterine leiomyoma, precocious puberty, prostate and breast cancers, and polycystic ovarian disease. GnRH drugs have been used to treat women with endometriosis for over 20 years, their use in the treatment of women with symptomatic leiomyoma is "well established" and effective and has been considered "the most effective presurgical therapy for symptomatic leiomyoma," and they have been used since the late 70s to treat precocious puberty and has "been the gold standard therapy for CPP for more than 30 years." GnRH drugs have also been used in in-vitro fertilization. 

Long-term effects of GnRH

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342775/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233750/

https://www.karger.com/Article/FullText/501336

While medical transitions do come with their fair share of risks (like pretty much all surgeries do), medical transitions can improve mental health, reduce or completely alleviate gender dysphoria, and are generally helpful to transgender individuals who pursue this path.

Research from a study published in Dovepress - "The effect of cross-sex hormonal treatment on gender dysphoria individuals' mental health: a systematic review"

• The study aimed to "systematically review all studies examining the effect of cross-sex hormonal treatment on mental health and well-being in gender dysphoria."

• All but one of the reviewed studies suggest that cross-sex hormone treatment is effective in reducing depression: "Apart from a study, which reported no significant differences in terms of depression (it only investigated MtFs), the remaining studies reported lower depressive symptoms in gender dysphoria individuals receiving hormonal treatment. Two of these studies also assessed self-esteem, reporting higher levels of self-esteem due to the hormonal treatment intervention."

• All of the reviewed studies suggest that cross-sex hormone treatment helps reduce anxiety: "All these three investigations (two cross-sectional studies and one longitudinal one) have consistently reported a reduction in symptoms of anxiety among individuals receiving hormone therapy." The study notes that there have only been three other works which investigate anxiety in the last five years, hence the small sample size.

• Two of the three reviewed studies which looked at the overall mental health of individuals that had gone through cross-sex hormone treatment "described a significant decrease in global psychopathology occurring after the initiation of hormone therapy," and the results of the third, which "did not find any difference between hormone-treated and nonhormone-treated individuals," may be the result of "the restricted range and low levels of psychopathology observed in their sample."

• This review suggests that cross-sex hormone treatment had a positive effect on overall wellbeing, citing one study which "reported higher emotional, social, and mental quality of life in hormone-treated FtM adults, with hormonal treatment duration associated with higher emotional quality of life," and three other studies which "confirmed a better psychosocial and mental quality of life in both MtFs and FtMs receiving hormone therapy."

• This review suggests that social distress, perceived stress, and body uneasiness were reduced in individuals who had undergone cross-sex hormone treatment: "Using a cross-sectional design, Gómez-Gil et al reported that gender dysphoria individuals who have not received hormonal treatment show higher levels of social distress than those receiving cross-sex hormones. Consistent with these findings, in a second study, hormone-treated gender dysphoria individuals showed lower perceived stress, which overlapped with that found in the normative sample."

• Ultimately, this review concluded that "when treated with hormone therapy, gender dysphoria individuals reported less anxiety, dissociation, perceived stress, social distress, and higher mental health-related quality of life and self-esteem," and that recent studies "suggested reduced depressive symptoms in hormone-treated gender dysphoria individuals."

  • The review also identifies that the longitudinal studies it reviewed all "were consistent in indicating an association between hormonal treatment and better mental health."

Research from the Journal of Clinical Endocrinology & Metabolism - "Long-Term Treatment of Transsexuals with Cross-Sex Hormones: Extensive Personal Experience"

• This study ultimately concludes that "sex reassignment of transsexuals benefits their well-being, although suicide rates remain high." The high suicide rate could potentially be explained by the high level of discrimination transgender and transsexual people face.

Research from a scholarly article from the Journal of Clinical Endocrinology & Metabolism - "Cross-Sex Hormone Treatment and Psychobiological Changes in Transsexual Persons: Two-Year Follow-Up Data"

• Found that transgender individuals who had gone through cross-sex hormone treatment (CHT) "reported significantly lower levels of subjective GD, body uneasiness, and depressive symptoms as compared with those without." GD obviously refers to gender dysphoria.

• The study also found that "CHT-induced body modifications were significantly associated with a better psychological adjustment," and "during CHT, patients reported a significant reduction of general psychopathology, depressive symptoms, and subjective GD"

• Ultimately, the study concluded that the "results support the efficacy of CHT intervention in improving subjective perception of one’s own body, which was partially associated with objective changes."

Research from the Health and Quality of Life Outcomes journal - "Quality of life in people with transsexuality after surgery: a systematic review and meta-analysis"

• Reviewed 497 total studies on the subject of medical transition and subsequently selected eight of those articles for meta-analysis - "In this study, out of 497 articles extracted from the initial investigation, 8 articles with 1099 patients were ultimately selected for meta-analysis," - and the findings ultimately suggest that sex reassignment and hormone therapy are beneficial to transgender people and improve their quality of life. 

• Although it was noted that this study did not account for quality of life (QoL) prior to sex reassignment surgery, it found that "the weighted mean of QoL was better in transsexual individuals after surgery," and concluded that "The main finding of this study may support the approaches to transsexuality that facilitate sex reassignment."

  •  Quality of life was based upon "World Health Organization Quality of Life (WHOQoL-BREF) and The 36-item short form of the Medical Outcomes Study questionnaire (SF36)"

Research published in the American Journal of Psychiatry - "Transgender Research in the 21st Century: A Selective Critical Review From a Neurocognitive Perspective"

• As the title would suggest, the paper looked at findings in current transgender research and in regards to mental health, it identifies that "emergent longitudinal research has begun to document the positive change in mental health associated with successful transition. This research shows significant reductions in psychopathology after transition, down to a level resembling normative data."

  • "In sum, while being trans may be associated with increased mental health problems, predominantly affective disorders, promising findings are emerging that indicate a reduction of mental health–related psychopathology, including depression and body dissatisfaction, with time and hormonal treatment."

• Among the paper's key findings are that "gender affirming surgery and/or cross-sex hormone treatment decrease mental health problems, body uneasiness, and gender dysphoria but not necessarily suicidality." This suicidality could potentially be explained by the high amounts of discrimination transgender individuals face, which this paper confirms: "a high rate of trans persons find discrimination in both personal and professional lives."

Research from a study published in the Pediatrics Journal - "Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment"

• The study looked at the mental health and overall wellbeing of transgender youth who received puberty suppression found that "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. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being." 

  • "Psychological functioning improved steadily over time, resulting in rates of clinical problems that are indistinguishable from general population samples (eg, percent in the clinical range dropped from 30% to 7% on the YSR/ASR30) and quality of life, satisfaction with life, and subjective happiness comparable to same-age peers."

• It should be noted that while gender dysphoria was alleviated and physiological functioning had improved, depression had increased. This could potentially be a result of the high amounts of discrimination faced by transgender individuals rather than a result of the treatment since the study identifies that "all young adults in this study were generally satisfied with their physical appearance and none regretted treatment," and, "None of the participants reported regret during puberty suppression, CSH (cross-sex hormone) treatment, or after GRS (gender reassignment surgery)."

Research from the Archives of Sexual Behavior Journal - "Long-Term Follow-Up of Adults with Gender Identity Disorder"

• This study aimed to examine and re-examine transgender individuals over as along a time as possible and in total examined 71 transgender individuals over 10-24 years, with a mean of 13.8 years. The study ultimately found that "Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation."

• Please note that I cite only from the abstract of the study, as I cannot find a version that is free to view.

Research from the Archives of Sexual Behavior Journal - "A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder"

• This study looked at the outcomes of sex reassignment as viewed by both patients and clinicians. It found that none of 42 transgender individuals which completed a five year follow up regretted their reassignment decision, that few were dissatisfied with the treatment - "more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5–15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health" - and that "almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning."

• Please note that I cite only from the abstract of the study, as I cannot find a version that is free to view.

Research from the Psychoneuroendocrinology journal - "Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: Results from a longitudinal study"

• "Psychiatric distress and functional impairment were present in a significantly higher percentage of patients before starting the hormonal treatment than after 12 months (50% vs. 17% for anxiety; 42% vs. 23% for depression; 24% vs. 11% for psychological symptoms; 23% vs. 10% for functional impairment)." Thus, it is evident that hormone treatment reduces anxiety, depression and improves the mental health and well being of transgender individuals. 

• "hormonal treatment seemed to have a positive effect on transsexual patients' mental health."

• Please note that I cite only from the abstract of the study, as I cannot find a version that is free to view.

Research from the Journal of Sexual Medicine - "Hormonal Treatment Reduces Psychobiological Distress in Gender Identity Disorder, Independently of the Attachment Style"

• "Our results suggested that untreated patients suffer from a higher degree of stress and that attachment insecurity negatively impacts the stress management. Initiating the hormonal treatment seemed to have a positive effect in reducing stress levels, whatever the attachment style may be."

• Please note that I cite only from the abstract of the study, as I cannot find a version that is free to view.

How Many Genders Are There?

The short answer: Gender identity is qualitative - meaning it's a combination of qualities - so the answer to how many genders there are is how many combinations of qualities one is willing to accept. Asking "how many genders are there" would be like asking "how many personalities are there?" It depends

Gender norms have obviously varied between cultures throughout human history but they even change within the same culture given time. In 1700/1800s America, men wore wigs, makeup, and shoes with heels but now all those things are associated with women, not men. As societies and cultures change, the thoughts and ideas on certain things change along with them. this is not uncommon. As society advances and becomes more complex these ideas about things should also become more complex since a better understanding is gained but that hasn't really been the case for gender (it should be). In the beginning, human society was pretty simple - you either went out and hunted down food or you stayed in the cave and tended to the fire and the young - but human society has become so much more advanced and complex since then. In today's human society there is more to do than hunt food and tend to the fire and the young. There are more and more ways to express oneself and truly become an individual (your job, the media you consume, the media you like, the way you dress, the way you wear your hair, your interests, what you're attracted to, what type of attraction you experience etc...), not to mention the bevy of genetic differences that have always existed between humans, that it seems stupid to think there are only two genders a human can identify with. Human society has changed so much - there are so many advancements, discoveries, inventions, et cetera - that it's very stupid to think gender is as binary as it was back before the wheel was invented. 

I get that this can be hard to understand so I will try and explain it by using the same arguments/logic towards concepts people are likely more familiar with - football and colors - below. 

• Football: Gender can be regarded as similar to positions on a football field. While biological components (size, weight, height, arm length, hand size) often influence a person to play a certain position this doesn’t hold true for everyone, and not every person at a position has the same biological makeup (i.e. Derrick Henry has the build of a defensive lineman or edge rusher but plays running back, Kyler Murray has the build of a running back but plays quarterback). The roles they play in the field define them more than their biological build (Derrick Henry isn’t playing on the d-line rushing the passer and playing the run, he’s being handed the ball on offense). There are even players that play multiple positions like Cordarrelle Patterson and Patrick Ricard. Additionally, the traits and roles associated with positions have changed over time as the game evolves and the understanding of the game changes and evolves. New positions like edge are even created as the game evolves and recognizes that certain traits and roles can be considered their own position/specialty. The 1880 Michigan football roster lists just four positions - quarterback, halfback, fullback, and forward. Ten years later in 1890 the Michigan football roster lists seven positions - end, tackle, guard, center, quarterback, fullback, and halfback. so was the coaching staff mentally ill for thinking there were 7 positions and not 4 positions? No - they just added new positions to align with how the game had changed and certain aspects of the game became specialized. keep in mind the positions we know in football today like wide receiver, tight end, linebacker, cornerback, safety, edge, kicker, and punter are not on these rosters. The 1920 Chicago Cardinals (now Arizona Cardinals) roster does not list the wide receiver position and it was not until 1965 that the roster includes the wide receiver position. Keep in mind the NFL's began in 1920 and the first Super Bowl took place in 1967. The first Super Bowl champions Green Bay Packers did not even have the wide receiver position listed on their roster. So are all of today's wide receivers mentally ill and is every football fan or analyst who thinks wide receiver is a football position also mentally ill? No, because despite the position not existing when the game was first conceptualized and wasn't for much of its history, the game changed and became more complex which brought with it new positions, one of which was the wide receiver.  It was not until the game evolved and passing became more common that receiver became its own position. So were the people back then mentally ill for "inventing" a new position to add to the football roster ("inventing" a new gender to add to society)? No, they just added a new category to align with how the game had changed.  So asking how many genders there are is like asking how many football positions there are. The number changes depending on the time. In the beginning. there were only four positions but in today's game of football, there are 20+ positions. As the sport grew, evolved, and changed the number of positions changed - new ones were added, others were combined, and some got renamed. The lines between these positions are arbitrary. Tight ends and wide receivers both run routes, catch the ball, and block but they're thought of as two different positions. Offensive tackles and guards both open up lanes for the running back and protect the quarterback but both are thought of as different and individual positions. In short, the number of different positions changed as the game of football evolved and changed, so too should the number of genders as human society and culture evolve and change. 

• Color: Gender can be thought of as similar to how we view the color spectrum in the sense that the lines we draw to differentiate between colors (gender in this analogy) are relatively arbitrary and malleable. We created those categories, after all. Saying that there only are two genders- male and female - and only ever were would be a lot like saying there only are three colors - red yellow and blue. New colors, or names to differentiate colors humans have felt differ enough from other colors to the point that they can be thought of as their own unique one deserving of their own name (thus becoming its own color), have been added to the color spectrum throughout human history. For example, it wasn’t until the 1500s that orange got a name and was thought of as its own, distinct color. Prior to that, it had been referred to as some variation of red-yellow but it became its own color in the Renaissance era, thus adding to the number of colors. Are we all mentally ill to think that orange is its own color? No, we just made a distinction between things after gaining a different understanding and perspective. I posit that gender can be thought of in the same way - as a spectrum with arbitrary lines being drawn to create specific genders that can change over time. 

How Does Someone Change Their Gender?

A person stops being a man/woman and starts being a woman/man. This concept of a person being one thing at one point in time and another thing at another point in time should be pretty easy to understand for people who are familiar with the concept of change, but sadly rarely is. 

This is another question that I think is best answered in the form of some analogies. 

• Citizenship analogy: Is it possible for someone who is born a Canadian to become an American? The answer to this is obviously yes, as one can renounce their Canadian citizenship (WBM link) and apply for American citizenship (WBM link) by submitting a certain form - the N-400, Application for Naturalization (WBM link). You can use Melania Trump and Yugoslavia as an example too. She was born in Novo Mesto, Slovenia (WBM link) in 1970 at a time when it was a part of Yugoslavia, making her a Yugoslavian. Despite being born Yugoslavian she is now an American, having completed the naturalization process in 2006 (WBM link). "But how can Yugoslavian be an American????" Through a transition process in which you renounce your former citizenship and apply for your new citizenship, much like a transgender person "renounces" their gender assigned at birth and goes through a transition process to become the gender they identify with. 

• Sports analogy: Is it possible for a football player who is a quarterback to become a wide receiver? The answer is obviously yes, as positions on a football field are just made up of things (social constructs) comprised of numerous qualities (similar to gender!) and this has been done numerous times before by NFL players like Terrelle Pryor, Julian Edelman, Jakobi Meyers, Antwaan Randle-El, and so on. 

But How Does X Know What It's Like to Be Y?

How does anyone know they want to be something or do something without ever having been it or done it before? 

How does someone applying for a job they've never had know they want to have that job? Take me for example, one of my first jobs was as an opinion columnist for a local newspaper. I had never been an opinion columnist before and I had never been employed as a writer, so how did I know I wanted to be an opinion columnist? Does my desire to be something I previously wasn't mean I have a mental illness or something? Obviously, no. Despite not being an opinion columnist before, I was able to understand what it meant to be an opinion columnist by asking other opinion columnists about it, researching the qualifications, responsibilities, and expectations opinion columnists generally have, gaining a historical understanding of opinion columnists, observing how opinion columnists were treated and portrayed in media, et cetera.

You can apply this to really any other job out there. Say for example someone who just graduated high school wants to be a mechanic. They've never been a mechanic before, does this mean they cannot be one and can never understand what it's like to be a mechanic? No, they've likely already understood what it's like to be a mechanic through speaking to mechanics, researching mechanics, looking at the history of mechanics, observing how mechanics are treated and portrayed in media, et cetera. 

The same logic here can be applied to gender. Someone can understand what it's like to be a different gender by talking to people who identify as a different gender and asking them about their experiences (it's not outside the realm of possibility for two people of different genders to speak to one another), observing how people of different genders are treated in society, what society expects of different genders, what roles different genders are assigned, how different genders are portrayed in media, et cetera. 

Let's apply this to sports as well. The first sport I played was soccer. I had never played soccer before but I expressed interest in playing soccer and joined a soccer team when I was younger. Does this interest in being something I had never been before - a soccer player - mean I have a mental illness or something? No, I just had an interest in it and it was appealing to me. Today, I'm a big fan of football, yet I was not raised as a football fan. I discovered on my own that I had a passion for the sport. So, despite the fact that I was not raised as a football fan and was not a football fan until my early 20s I can still identify as a fan of the NFL. There's nobody out here saying I'm a "fake" football fan because I wasn't raised as a football fan or because I didn't attend NFL games growing up. 

So, basically, transgender people are really no different from people who change their career field, job, favorite sport, or favorite sports team. It's obviously a more complicated process than those examples but the premise - understanding you want to be something you previously weren't through research, conversations with people that currently are that thing, and observing coverage and portrayals of that thing in media - remains the same. 

Do People Choose Their Gender?

Eeeehhh, not really. Do people choose their personality? No they just act in a way that is natural and athentic to them and then society places labels on these actioins and groups som etogether. 

As transgender people become increasingly more accepted and less discriminated against, their place in sports has been a point of contention. Considering the "new-ness" of this issue there is still a lot of research to be done and arguments to consider and I certainly don't have all the answers at the moment (no one does) but I still want to offer a perspective on the issue.

The idea that transwomen ("biological men") should compete against men is a popular one among conservatives and other people who all of a sudden care about women's sports, arguing that if transwomen were allowed to compete against other women they'd blow them out of the water since they were born male. I don't agree with this logic. Firstly, while the majority of transwomen were likely born with a penis and balls and assigned male at birth, they likely took puberty blockers which inhibited male puberty and underwent hormone therapy that allowed them to undergo female puberty. So you have two people who both underwent female puberty and have high levels of estrogen, but because one was assigned male at birth that should stop them from competing against women and force them to compete against people (cismen) who underwent male puberty and have high levels of testosterone? That doesn't make much sense to me. You could point to a transwoman like Jane Marie Kroc as an outlier, but it is important to remember that she transitioned much later in life, meaning she didn't take puberty blockers or do the whole female puberty thing. This Conservative logic would also suggest that transmen, people who went through male puberty and have high levels of testosterone, should compete against ciswomen. Again, this is quite dumb. Wrestler Mack Beggs is a good example of this. Beggs, a transman, was forced to compete against ciswomen in high school because the Texas University Interscholastic League rules stated that Beggs had to wrestle on the team maligning with his gender assigned at birth, meaning he had to wrestle against women. He would go on to win two straight girls' state wrestling championships in Texas. Beggs has since had his birth certificate changed so he competes against other men now (yay). Beggs can be seen pictured below in Figure 7. Also, check out the documentary Mack Wrestles from ESPN. Another good example of a transman who could be forced to compete against ciswomen under this Conservative logic is boxer Patricio Manuel, seen below in Figure 8.

Now where conservatives and other people skeptical of transpeople competing in sports do have a point is regarding biological advantages. Yes, a transwoman who transitioned well after experiencing male puberty would have an advantage over ciswomen and that's a very tricky area to navigate. However, it's also important to note that there is no such thing as fairness when it comes to biology and sports even amongst men and women. Many sports boil down to genetics, as Doug Stanhope pointed out, Michael Phelps is genetically built to swim better than other people if he trains the same way. Fairness in sports does not come down to equal biology - there is no equal biology - it comes from people adhering to the same rules. 

One of the highest profile transwomen who competed in a women's sporting event is Laurel Hubbard, a transwoman from New Zealand who competed as a weightlifter in the 2020 Tokyo Olympics. She failed on all three attempts and didn't even qualify for anything. So there were ciswomen who lifted more weight than a transwoman? How can this be? This terrible performance shows that transwomen don't have this enormous advantage or anything. 

The NCAA has recently released a statement in support of tranSgender athletes, stating "The NCAA Board of Governors firmly and unequivocally supports the opportunity for transgender student-athletes to compete in college sports. This commitment is grounded in our values of inclusion and fair competition." The statement also goes on to say "When determining where championships are held, NCAA policy directs that only locations where hosts can commit to providing an environment that is safe, healthy and free of discrimination should be selected. We will continue to closely monitor these situations to determine whether NCAA championships can be conducted in ways that are welcoming and respectful of all participants."

I do not think children should be transitioning. By that I mean a six year old should not be given hormone therapy or gender reassignment surgery. I do think that if parents notice a pattern of gender nonconforming behavior they should consult a psychologist and work with the child to understand things better. If this behavior continues through the age the child would go through puberty they should be given the option of going on puberty blockers (with approval from the parents, psychologists, and doctors and informed consent of course). From there, assuming the kid still expresses gender nonconforming behavior and wants to start transitioning, they should be able to, assuming parents, psychologists, and doctors agree. Obviously once they reach 18 it's their choice. 

Much of this is reflected in reality as I describe under the "Puberty Blockers and the Current Trans Process" section above, and most children who grow up to be trans adults go through this very same process. But of course, there are transphobes out there who cherry pick fringe cases of parents putting their young children going on puberty blockers 

A common theme amongst transphobes, TERFs, and people who are critical of trans people is this fear that transwomen are trans in order to gain access to a woman's restroom and assault women. This is not a fear backed by reality or any data. A 2017 research brief from The Police Foundation examined official police reports of sexual assault from as far back as 2012 in four US locations - Atlanta, GA, Dallas, TX, Miami Beach and Miami Gardens in Miami-Dade county, and Tucson, AZ - and found no evidence of any assault taking place wherein a man dressed as a woman or any trans person entered a woman's restroom and committed sexual assault: "Based on our review of sexual assault complaints in Atlanta, Dallas, Miami Beach, Miami Gardens and Tucson, before and after an official amendment to the human rights ordinance in that locality, we did not find evidence of sexual assaults taking place in which men, under the guise of being women or transgender, entered women’s bathrooms to commit a sexual assault or otherwise victimize women." In case the link to the PDF is broken, here is this link to the Police Foundation website which has its own link to the brief.

Furthermore, why does who is using a toilet even matter? Apparently to some people it does and they're so scared or fragile that they need businesses to hang signs letting them know if they let trans people use their bathrooms or not (*Jim Crow south has entered the chat*). What is the big deal though, really? Women’s restrooms have stalls, so no one would be seeing anything and transmen would use stalls in the men’s room (unless they’ve had bottom surgery) so again, no one is seeing anything. 

Also, if someone is intent on raping a person how is an unlocked door and stall door which can easily be kicked in, climbed over, or crawled under, going to stop them?

Saying we should ban transwomen from using women's restrooms and transmen from using men's restrooms because they'll go in there to rape a kid or something would be like banning the library from letting people rent DVDs and Blu Ray discs because they may use the disc's sharp edge as a weapon and commit murder. Both are very far-fetched scenarios, and perfect examples of the slippery slope logical fallacy, and have never happened ever, or enough, to warrant restrictive laws.

Some of the studies included in the above "Medical Transitions" section noted that suicidality is still an issue in transgender individuals after cross-sex hormone treatment or sex reassignment surgery. I think it's pretty clear that this high suicide rate is mostly due to the large amount of discrimination and oppression transgender people face.

Research from the Human Rights Campaign - "2018 Youth Report"

• This study aims to identify the difficulties LGBTQ individuals face and finds that most LGBTQ youth face discrimination within their own families, and trans individuals are 2x more likely to be mocked and taunted by their family.

  • 78% of of LGBTQ youth who are not "out" to their parents "hear their families make negative comments about LGBTQ people."

  • 67% of LGBTQ youth "hear their families make negative comments about LGBTQ people."

  • 48% of LGBTQ youth "out to their parents say that their families make them feel bad for being LGBTQ."

  • "Trans youth are over 2x more likely to be taunted or mocked by family for their LGBTQ identity than cisgender LGBQ." Meaning transgender people are 2x more likely to be taunted or mocked than those who are just lesbian or gay or bisexual.

• The study identifies that "LGBTQ youth continue to experience bullying because of their actual or perceived LGBTQ identity." Specifically, "73% of LGBTQ youth have experienced verbal threats because of their actual or perceived LGBTQ identity."

  • "3 in 10 have received physical threats due to their LGBTQ identity."

  • "50% of transgender girls have been physically threatened."

  • "70% have been bullied at school because of their sexual orientation."

• LGBTQ youth can experience things that are far worse than bullying

  • "11% of LGBTQ youth report that they have been sexually attacked or raped because of their actual or assumed LGBTQ identity"

Report from the Williams Institute - "Suicide Thoughts and Attempts Among Transgender Adults"

• This report goes into detail about the many risk factors transgender individuals face and provides some statistics which show the more discrimination faced by a transgender individual, the more likely they are to consider suicide. Overall, 13.4% of transgender individuals who experienced discrimination or mistreatment in education, employment, housing, healthcare, in places of public accommodation, or from law enforcement tried to commit suicide whereas 6.3% who had no experienced this tried to commit suicide and 10.5% of transgender individuals who were rejected by their family tried to commit suicide whereas 5.1% of transgender individuals who did not experience this tried to commit suicide. 

  • Basically, the more risk factors a person faces the more likely they are to attempt suicide. And since transgender individuals face a host of risk factors, it makes sense that they have a high suicide rate.

• "In addition to general risk factors, transgender people have additional risk factors, such as experiences of discrimination, stigma, family rejection, and lack of access to gender-affirming health care. Findings regarding these unique factors include the following...

  • "Experiencing discrimination or mistreatment in education, employment, housing, health care, in places of public accommodations, or from law enforcement is associated with a higher prevalence of suicide thoughts and attempts. For example, the prevalence of past-year suicide attempts by those who reported that they had been denied equal treatment in the past year because they are transgender was more than double that of those who had not experienced such treatment (13.4% compared to 6.3%).

  • "Those who reported that their spouses, partners, or children rejected them because they are transgender reported a higher prevalence of lifetime and past-year suicide attempts. Those who reported rejection by their family of origin, for example, reported twice the prevalence of past-year suicide attempts compared to those who had not experienced such rejection (10.5%compared to 5.1%).

  • Respondents who had been rejected by their religious communities or had undergone conversion therapy were more likely to report suicide thoughts and attempts. For instance, 13.1 percent of those who had experienced religious rejection in the past year had attempted suicide in the past year; by contrast, 6.3 percent of respondents who had experienced religious acceptance in the past year attempted suicide in the past year."

• Overall, the report concludes that "it’s clear that minority stress experiences, such as family rejection, discrimination experiences, and lack of access to gender-affirming health care, create added risks for transgender people." So because transgender individuals face experience more stress and discrimination as a result of them being trans, it would make sense that their suicide rate is higher than cisgender people who do not experience such amounts of stress and discrimination.

Research from the Trans Pulse project - "Impacts of Strong Parental Support for Trans Youth"

• Finds that parental support signifgantly reduces the risk of suicide in transgender individuals (Figure 3 below).

  • 75% of transgender individuals without very supportive parents had depressive symptoms, as opposed to just 23% when they had supportive parents.

  • 57% of transgender individuals without very supportive parents attempted suicide, as opposed to just 4% when they have supportive parents. 

• "For parents and caregivers, our data have many implications. Our earlier results (not shown) revealed that having a “somewhat supportive” parent did not have a significantly more positive effect on youth than if their parents were not at all supportive of their gender expression and identity. This indicates that anything less than strong support may have deleterious effects on a child’s well-being."

Research from the Indian Journal of Psychological Medicine - "Suicide and Suicidal Behavior among Transgender Persons"

• The study identifies the many forms of discrimination, oppression, stress, etc... that transgender people face: "Rejection and lack of support from the families and society, gender dysphoria associated with extreme stressful experiences, child sexual abuse, early discontinuation of schooling, forced marriages, lack of livelihood opportunities, sexual and financial exploitation by the partner and police and rowdies, and lack of legal measures for protection are some of the characteristics of transgender persons."

  • The study identifies how these risk factors can contribute to suicidal actions or thoughts: "The discrimination of the transgender persons in the society has prevented them from obtaining an education, job, and housing because of which they are living in slums or street and have to resort to begging and sex work; this pitiful conditions have lead them to breakdown further and end their life in suicide."

• Ultimately finds that "Gender-based victimization, discrimination, bullying, violence, being rejected by the family, friends, and community; harassment by intimate partner, family members, police and public; discrimination and ill treatment at health-care system are the major risk factors that influence the suicidal behavior among transgender persons."

Texas essentially criminalizes trans kids

Conservatives will often talk about how they’re being hunted and oppressed for "wrong think," and expressing the "wrong" opinions" or that it’s “open season” on conservatives whenever a high profile conservative faces consequences for their actions like losing their job for saying stupid, bigoted, and/or offensive conservative talking points, but that’s hardly the case. However, this rhetoric does seem true for trans kids in Texas. The Republican governor Greg Abbot ordered the state’s child welfare agency to investigate reports of "gender-transitioning procedures" and treat it as child abuse. Gender affirming care could be treated as child abuse, as Texas’ Attorney General thinks. “Gender affirming care” even includes puberty blockers and other elective - key word there, elective - care. So, parents of trans children could be prosecuted for child abuse even for something as simple as doing what a healthcare professional recommends or calling their child the pronoun they prefer. He also added that state laws require doctors, nurses, teachers, and members of the general public to report trans children (presumably to law enforcement or child protective services) and those who fail to report them can be charged with criminal penalties. Going back to how conservatives talk about being persecuted for having "wrong" opinions, is this not persecuting people for "wrong" parenting or "wrong" expression? 

Florida almost legalized genital inspections due to prevent trans kids from competing in sports

If you can say anything nice about Florida's trans athlete bill it's this: at least they didn't include the part about inspecting kids' genitals. When initially proposed, the bill included verbiage that required trans athletes and athletes suspected to be trans to undergo genetic testing and have their genitalia examined. Considering Matt Gaetz is accused of sex trafficking a minor and some other gross stuff with kids, I guess this isn't a surprise. 

Mississippi Republican says trans people and their supporters should be killed

In a tweet that has since been removed by Twitter, Former GOP house representative Robert Foster stated that the people who supported trans people should be shot by a firing squad. While he did not specify "supporters of trans people" the verbiage he used in the tweet made it clear that he was talking about that group. He backed up what he said in a later tweet and clarified that the death penalty was fine for these kinds of people and the law should be changed for this to happen specifically. You can read more about this from the Mississippi Free Press. 

• It's worth mentioning that Foster, like so many other conservatives, links the support of trans people to the support of child grooming and sees transgender people as child groomers. By acknowledging that he is referring to trans supporters when he says, "those who want to groom our school aged children," I am not agreeing with his accusations that trans people are child groomers and people who support trans rights are supporters of child grooming. That is what he thinks these people are like so that's what he refers to them as. I obviously don't agree with this, and I can still identify that he is talking about trans people and their supporters without agreeing with the terminology he used. 

Research from the American Psychological Association - "Meta-Analyses of the Relationship Between Conformity to Masculine Norms and Mental Health-Related Outcomes"

• As the title suggests, this is a meta-analysis. In total, 78 different works which relate to the relationship between mental health and conformity to masculine norms were used for the analysis.

• Using an omnibus test - a kind of statistical test to explain variance - the authors found that conformity to masculine norms was positively correlated to negative mental health, meaning the more one conforms to masculine norms the worse their mental health gets: "conformity to masculine norms was significantly and positively related to negative mental health, as well as significantly and negatively related to positive mental health."

• In another kind of test, the predictor-centered perspective, the authors find that 81% of the "dimensions" of masculine norms they measured "were significantly and positively related to negative mental health." So, the more "dimensions" of masculine norms one engages in or conforms to, the worse their mental health gets. 

• The authors conclude that "Our meta-analytic findings reveal that conformity to masculine norms was positively associated with negative mental health as well as inversely related to positive mental health and psychological help seeking." In layman's terms: the more strongly one conforms to masculine norms the worse their mental health gets. The less one conforms to masculine norms, the better their mental health gets. 

  • The findings of the meta-analysis also suggests that conformity to masculine norms is strongly associated with negative social functioning, ever more so than negative mental health: "conformity to masculine norms was more strongly and unfavorably related to negative social functioning than to psychological indicators of negative mental health."

Study from Gallup Incorporated - "Stay-at-Home Moms Report More Depression, Sadness, Anger"

• This study finds that stay at home moms report a lot of depression, sadness, and anger. Unemployed stay at home moms reported more worry, sadness, stress, anger, and depression than employed moms and more worry, sadness, stress, anger, and depression than employed women with no children (Figure 4). Stay at home moms also were less likely to say they were "thriving" and more likely to say they were "struggling" than employed moms and employed women with no children (Figure 5). Overall, stay at home moms are less likely to report happiness than employed moms or employed women with no children. 

• "Non-employed women with young children at home are more likely than women with young children at home who are employed for pay to report experiencing sadness and anger a lot of the day 'yesterday.' Stay-at-home moms are also much more likely to report having ever been diagnosed with depression than employed moms. Employed moms are about as emotionally well-off as working women who do not have children at home."

• "Stay-at-home moms also lag behind employed moms in terms of their daily positive emotions: They are less likely to say they smiled or laughed a lot, learned something interesting, and experienced enjoyment and happiness 'yesterday.' Additionally, they are less likely than employed moms to rate their lives highly enough to be considered 'thriving.'"

• The study concludes that "Stay-at-home moms at all income levels are worse off than employed moms in terms of sadness, anger, and depression," and that employed moms "are doing as well as employed women without children at home -- possibly revealing that formal employment, or perhaps the income associated with it, has emotional benefits for mothers."

I don't necessarily understand most of this stuff but I am linking it for you to research yourself

Stop Using Phony Science to Justify Transphobia

Sex beyond genitalia: The human brain mosaic

Neuroimaging studies in people with gender incongruence

Grey and white matter volumes either in treatment-naïve or hormone-treated transgender women: a voxel-based morphometry study

A Review of the Status of Brain Structure Research in Transsexualism

From Endocrine Society

• "The medical consensus in the late 20th century was that transgender and gender incongruent individuals suffered a mental health disorder termed “gender identity disorder.” Gender identity was considered malleable and subject to external influences. Today, however, this attitude is no longer considered valid. Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity."

  • Here, the Endocrine society references a paper which found "Current data suggest a biological etiology for transgender identity. Studies of DSD (Disorders of Sex Development) patients and neuroanatomical studies provide the strongest evidence for the organic basis of transgender identity." That is to say, the data they found suggests a biological cause, or manner of causation, to transgender identity in the brain: someone can be born with male sex organs but with a "female" brain/"female" brain patterns so at birth, it is the brain that determines one's gender regardless of sex organs, hormones, etc...

    • In grey brain matter studies: "Postmortem brain studies suggest that some subcortical structures are feminized in MTF transgender individuals." A 1995 study referenced in the paper found "that the size and the number of neurons in the BSTc (Bed nucleus of stria terminalis) of 6 MTF estrogen-treated transgender individuals was typical for the size and neuron numbers found generally in control females," and that "The authors further reported that these findings could not be explained by differences in adult sex hormone levels." Another study referenced which draws on the 1995 findings found that brain tissue in male to female transgender individuals was "more similar to genetic XX female controls," meaning the brain tissue of a transgender female was closer to a cisgender woman than a cisgender man.

    • This paper also makes reference to a study done in 2008 which found "that INAH3 volume and neuron number in 11 MTF transgender persons was in the female range." 

    • It is important to note that the study also concludes "Sample sizes of the majority of studies to date on this subject are small, and conclusions must be interpreted with caution. Further research is required to assign specific biological mechanisms for gender identity," so take this all with a grain of salt.