On March 12th, we gathered at the Statehouse in Montpelier to counter an attempt to spread lies about our trans and nonbinary community. We came together in the spirit of joyful liberation. We came to dance, to celebrate community, and to show our resistance to a harmful narrative that seeks to erase us from public view and deny us access to healthcare.
Those who want to erase transgender and nonbinary people do so from a place of bigoted intent wrapped up in the guise of concern for the children. The term ‘bigot’ may sound harsh, but it is appropriate for those who are seeking to cut us off from care and community. We know this story; we’ve heard it levied against us for generations. We know what happens when people prey on fear to target a vulnerable population. How do we counteract this narrative? First, with the truth.
Every major medical association supports gender-affirming care and recognizes it as a way to prevent harm (1). Gender-affirming care is a treatment that follows a diagnosis of gender dysphoria. The treatment for dysphoria follows established, evidence-based standards of care for all ages. These standards have been in place for decades. Like all medical decisions, the choice to undergo medical treatment involves consultation with doctors, the patient, and, in the case of minors, their parents.
Gender-affirming care is not one-size-fits-all. The treatment typically includes therapy and may or may not include puberty blockers, hormone therapy, and surgery. It’s important to note that surgery for transgender youth is exceedingly rare (2) and usually involves a reduction in breast tissue.
The process involves a patient (and their parents, in the case of minors) beginning gender-affirming care by visiting a specialty clinic or provider with expertise in the treatment protocols for gender dysphoria. Sometimes, this is after a referral from a PCP or therapist, but not always. Patients then receive extensive counseling. If further treatment is deemed necessary, such as puberty blockers or hormone treatment, they are only prescribed after additional assessments to determine whether the patient meets the prescribing criteria. These criteria include at a minimum, letters of referral, documentation, ongoing mental health support, education, informed consent of the patient, and, for minors, parental consent. At every stage of gender-affirming care for minors, parents are informed and must give consent for further treatment.
For teens experiencing gender dysphoria, puberty blockers may be part of the treatment plan. Puberty blockers prevent the intense distress that some teenagers with gender dysphoria experience as their bodies begin to change. Blockers will temporarily pause puberty and are reversible. Blockers have been in use for over thirty years (3) in both cisgender and transgender youth. The patient’s medical care team monitors the use of puberty blockers to watch for any side effects or complications, which are rare and treatable(5). When a teen stops taking puberty blockers, puberty resumes (4). Studies have demonstrated that patients can experience normal fertility and reproductive function when they stop taking blockers (6).
The next step in gender-affirming care may involve gender-affirming hormone therapy (GHAT), which is a synthetic version of estrogen or testosterone. This treatment is similar to hormone replacement therapy (HRT) used to treat a variety of medical conditions used by millions of people across the world and is safe (7). A patient’s medical team supervises the use of these prescriptions. The effects of GAHT may be partially or fully reversible, depending on the length of the treatment (8). Any patient undergoing this therapy receives an education on all side effects and benefits, including discussions about the impact on fertility before treatment. Typically, minors do not receive hormone therapy. However, in cases where the patient has been on puberty blockers and socially transitioned for a significant length of time, has physician approval and parental consent, and fully understands all of the risks and benefits of this type of therapy, some older teens may receive GHAT.
Gender-affirming surgery for minors is rare and limited (9). Surgery includes a variety of potential procedures. Surgical options may include facial surgeries, “top” surgery to change the chest or surgery, or “bottom surgery” to make changes to the genitals – all with the intended effect of shifting the patient’s appearance to mimic the socially assumed appearance of their gender. Cisgender and intersex people regularly receive all of these types of surgeries with significantly fewer barriers to access safely and effectively.
Gender-affirming surgeries are safe and positively received by patients. Complications after surgery are low – for both cisgender and transgender patients (10,11) – and potentially lower for transgender patients (12). Satisfaction is high for all forms of gender-affirming surgery (13, 14, 15).
Cherry-picked data and individuals propped up on large platforms do not a consensus make. No matter how poorly done the research nor how genuinely isolated from the experience of being transgender their examples are, they cling to those justifications and deny the overwhelming majority of experiences and data because it doesn’t conform with their feeling that we do not belong.
The people who are behind these movements to strip our healthcare, rights, and visibility within our communities cannot face their discomfort with our existence, so they dismiss the consensus of the experts, both within the medical and mental health community and within the lived experience of the majority of the transgender and nonbinary community. We can choose to meet their disgust with disgust. Meet hate with hate. Instead, we meet hatred with irrepressible joy in our liberation from the chains of conformity to outdated societal expectations.
These bigots seek platforms where they can convince others to share their disgust by wrapping it in language designed to prey upon the fears and confusion of worried parents. To those who have never met a transgender or nonbinary person before, learning that their child doesn’t feel comfortable with the gender they were assumed to be at birth can be bewildering. It can be alarming.
Those who oppose our existence seek to capture that confusion and transform it into terror that will stop parents from seeking the gender-affirming care that can be transformational for their child’s long-term wellbeing. They shake their fingers and warn their parents of the dangers of seeking that care. That it will harm their child, leave them miserable and isolated, mutilated and unhappy. So, we dance to demonstrate our collective joy at the beauty we find in the journey of coming into ourselves.
These bigots use the language of division to try to reflect the label they’ve earned back to us. They claim we oppose a pathway to detransitioning. The truth is that we support bodily autonomy. We support everyone getting access to the care they need to be whole and healthy. For some, that means de-transitioning. There are a myriad of reasons people might choose to do so. They may be among those who discover they are among the unfortunate few who experience adverse reactions to treatment, a risk associated with every type of medical intervention. They may not feel safe in the current divisive political climate in which gender-nonconforming people are targets of increasingly violent rhetoric and behavior. They may also determine that their attachment to their gender has evolved. We do not believe it is our business to police the bodies and choices of others, which extends to those who seek to end or alter their gender-affirming treatment.
What we cannot abide are the handful of people who changed their minds about their own bodies wanting to dictate the choices of a whole population. Our issue isn’t with any person who chooses to detransition. Our problem is with their attacks on our collective access to healthcare and our right to exist openly within our communities without risk to our safety and wellbeing.
I’ve had the opportunity to witness firsthand the transformation that can occur when people with no exposure to our community start to see us as human, not as an alarming statistic. I welcome concerned parents to reach out to us to learn more. Please do not allow a vocal minority to persuade you that our community is dangerous with misconstrued data and outright lies.
We are part of your community. We are your neighbors and the volunteers who show up to help muck out a basement or serve a hot meal to a family in need. We are parents, caregivers, and medical providers. We are veterans and first responders. We are teachers and librarians. We are artists, farmers, and mechanics. We have interests and experiences as broad as any other community. Some of us are modest and reserved, and some of us are playful and bright. We care about our families, enjoy a good meal, and usually can fix the thing or know someone who can help. We are your neighbors. Our only collective agenda is to have the same inalienable rights all humans are entitled to.
Sources:
(3) https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020263s042lbl.pdf
(4) https://academic.oup.com/jcem/article/102/11/3869/4157558?login=false
(6) https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020263s042lbl.pdf
(7) https://pmc.ncbi.nlm.nih.gov/articles/PMC5226129/
(10) https://www.sciencedirect.com/science/article/abs/pii/S1701216319304141
(11) https://pmc.ncbi.nlm.nih.gov/articles/PMC6846310/
(12) https://pmc.ncbi.nlm.nih.gov/articles/PMC6635198/
(13) https://pmc.ncbi.nlm.nih.gov/articles/PMC11554349/
