Transgender

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

"Evidence suggests that less than 1% of transgender people who undergo gender-affirming surgery report regret. That proportion is even more striking when compared to the fact that 14.4% of the broader population reports regret after similar surgeries. For example, studies have found that between 5% and 14% of all women who receive mastectomies to reduce the risk of developing breast cancer say they regretted doing so. However, less than 1% of transgender men who receive the same procedure report regret. These statistics are based on reviews of existing studies that investigated regret among 7,928 transgender individuals who received gender-affirming surgeries. Although some of this prior research has been criticized for overlooking the fact that regret can sometimes take years to develop, it aligns with the growing body of studies that show positive health outcomes among transgender people who receive gender-affirming care."

"About 1.6 million people in the U.S. identify as transgender. While only about 25% of these individuals have obtained gender-affirming surgeries, these procedures have become more commonplace. From 2016 to 2020, roughly 48,000 trans people in the U.S. received gender-affirming surgeries. These procedures provide transgender people with the opportunity to align their physical bodies with their gender identity, which could positively impact mental health. Research shows that access to gender-affirming surgeries may reduce levels of depression, anxiety and suicidal ideation among transgender people. The mental health benefits may explain the low levels of regret. Transgender people have far higher rates of mental health concerns than cisgender people, or people whose gender identity aligns with their sex at birth. This is largely because transgender people have a more difficult time living authentically without experiencing discrimination, harassment and violence."

"Gender-affirming surgery often involves going through a number of hoops: waiting periods, hormone therapy and learning about the potential risks and benefits of the procedures. Although most surgeries are reserved for adults, the leading guidelines recommend that patients be at least 15 years old. This thorough process that trans people go through before receiving surgery may also explain the lower levels of regret. In addition, many cisgender people get surgeries that, in their ideal world, they wouldn’t receive. But they go through with the surgery in order to prevent a health problem."

"Purpose of review Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research. Recent findings Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking. Summary Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted."

"Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population."

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

"For me, it's always important to support other transgender people, to love and support each other. There's enough spotlight, there are enough resources to go around, so for me it's always about loving and supporting my trans siblings."

"Being uncomfortable does not mean that you are unsafe. Right? [...] For several years, it was all about bathrooms. Banning trans people from bathrooms, right? In the segregated South, white folks were not comfortable with black people in the bathroom with them. But did that mean that they were unsafe?"

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

"The liberation of trans people would improve the lives of everyone in our society. I say 'liberation' because I believe that the humbler goals of 'trans rights' or 'trans equality' are insufficient. Trans people should not aspire to be equals in a world that remains both capitalist and patriarchal and which exploits and degrades those who live in it. Rather, we ought to seek justice – for ourselves and others alike. Trans people have endured over a century of injustice. We have been discriminated against, pathologized and victimized. Our full emancipation will only be achieved if we can imagine a society that is completely transformed from the one in which we live."

"The demand for true trans liberation echoes and overlaps with the demands of workers, socialists, feminists, anti-racists and queer people. They are radical demands, in that they go to the root of what our society is and what it could be. For this reason, the existence of trans people is a source of constant anxiety for many who are either invested in the status quo or fearful about what would replace it. In order to neutralize the potential threat to social norms posed by trans people's existence, the establishment has always sought to confine and curtail their freedom. In twenty-first-century Britain, this has been achieved in large part by belittling our political needs and turning them into a culture war 'issue'. Typically, trans people are lumped together as 'the transgender issue', dismissing and erasing the complexity of trans lives, reducing them to a set of stereotypes on which various social anxieties can be brought to bear. By and large, the transgender issue is seen as a 'toxic debate', a 'difficult topic' chewed over (usually by people who are not trans themselves) on television shows, in newspaper opinion pieces and in university philosophy departments. Actual trans people are rarely to be seen."

"‘Trans’ [...] is an umbrella term that describes people whose gender identity (their personal sense of their own gender) varies from, does not sit comfortably with, or is different from, the biological sex recorded on their birth certificate based on the appearance of their external genitalia. The standard view of how sex and gender manifest in the world is as follows. Babies born with observable penises are recorded as male, referred to and raised as boys, and as adults are men; babies born with observable vulvas are recorded as female, referred to and raised as girls, and as adults are women. To be trans is, on some level, to feel that this standardized relationship between one’s genitalia at birth and the assignment of one of two fixed gender identities that are supposed to accurately reflect your feelings about your own body has been interrupted. How the person who experiences this interruption reacts to it can vary hugely – which is why ‘trans’ is a catch-all word for a diverse range of identities and experiences."

"When we talk about trans people, we’re usually referring to individuals who were either recorded as male at birth but who understand themselves to be women (trans women) or, vice versa, were recorded as female at birth but who understand themselves to be men (trans men). Not all trans people, however, find simply moving between the pre-existing categories of man and woman satisfactory, accurate or desirable. Such trans people, who are less well understood, generally unsettle mainstream society more than trans men and women, because they challenge not only the prevailing idea that birth genitals and gender are inseparable, but also the idea that there are just two gender categories. Often, these people are accused of making up their experience out of a need for attention or a desire to feel special – though in reality the political, economic and social costs for such ‘non-binary’ trans people (who don’t straightforwardly see themselves as men or women) can be immense."

"Suicide attempts occur at a higher rate among trans people than the general population. Indeed, the statistics are truly alarming: research by the UK charity Stonewall published in 2017 found that 45 per cent of trans young people had attempted suicide at least once. Yet, behind the statistics are individuals, suffering in private and leading complex human lives: there is rarely one simple explanation for such a tragedy."

"In the final months of her life, when she must have been experiencing a degree of mental anguish, Lucy Meadows was bullied, harassed, ridiculed and demonized by the British media. Her death remains one of the darkest chapters in the British trans community’s history, and one of the most shameful episodes in the long and shameful history of the British tabloid press. [...] By the end of the 2010s, trans people weren’t the occasional freak show in the pages of a red-top tabloid. Rather, we were in the headlines of almost every major newspaper every single day. We were no longer portrayed as the ridiculous but unthreatening provincial mechanic who was having a ‘sex swap’; now, we were depicted as the proponents of a powerful new ‘ideology’ that was capturing institutions and dominating public life. No longer something to be jeered at, we were instead something to be feared. Soon after the Lucy Meadows inquest, that fleeting opportunity to shed light on the bullying of trans people evaporated. In the intervening years, the press flipped the narrative: it was trans people who were the bullies."

"The media agenda with respect to ‘the transgender issue’ is often cynical and unhelpful to the cause of trans justice and liberation. Media coverage of the trans community rarely seems to be driven by a desire to inform and educate the public about the actual issues and challenges facing a group who – as all evidence indicates – are likely to experience severe discrimination throughout their lives. Today, the typical news item on trans people features a debate between a trans advocate on one side and a person with ‘concerns’ on the other – as if both parties were equally affected by the discussion. As trans people face a broken healthcare system – which in turn leaves them with a desperate lack of support both with their gender and the mental health impacts of the all-too-commonly associated problems of family rejection, bullying, homelessness and unemployment – trans people with any kind of platform or access have tried to focus media reporting on these issues, to no avail. Instead, we are invited on television to debate whether trans people should be allowed to use public toilets. Trans people have been dehumanized, reduced to a talking point or conceptual problem: an ‘issue’ to be discussed and debated endlessly. It turns out that when the media want to talk about trans issues, it means they want to talk about their issues with us, not the challenges facing us."

"Human beings rely on familiarity to understand and empathize with others, and we find it easier to extend compassion to those we can relate to. Given that, like any minority, trans people are unfamiliar to the average person, we rely more heavily on media representation, on political solidarity from people who aren’t trans and vocal, and ongoing support from public institutions to create the right conditions for understanding and compassion from the rest of society. By the same token, we’re especially vulnerable to the spread of misinformation, harmful stereotypes and repeated prejudicial tropes. And the latter, unfortunately, are widespread in public culture, just as they have been throughout history. Trans people are discriminated against, harassed and subjected to violence around the world because of deep prejudices that have been embedded into the fabric of our culture, poisoning our capacity to empathize, and even to accept trans people as fully human."

"Family rejection and estrangement have devastating long-term health implications. They also have a material impact. For some kids, the only option is leaving home. Others have no option at all: their parents kick them out. As a result, trans teenagers and young adults in Britain are much more likely to experience homelessness than their cisgender peers. [...] A minority within a minority, trans young people are disproportionately over-represented in the homeless population: one in four trans people have experienced homelessness."

"In general, trans people are more likely to have lower incomes and to experience poverty than the wider population. [...] Prejudice persists. It is not just a personal affront, but an economic reality that shapes and limits trans lives."

"The experience of being trans is shaped by social class. While there are trans people, the vast majority are working class – just as the vast majority of the total population is working class. Trans workers are often employed in lower paid and more precarious jobs, with a high risk of discrimination and bullying in the workplace. As a result, trans political struggle is part of a wider class struggle. Despite this, trans politics is commonly misrepresented as coddled, bourgeois and anti-working class."

"To be trans is an experience bound up with economic struggle. There cannot be one without the other."

"A key tenet of the drive by trans people towards ‘visibility’ in mainstream media in the past decade has been the belief that, the greater amount of more accurate media coverage, the more chance trans people have of encouraging empathy in the wider population. This, it is hoped, will make people want to treat trans individuals better both in daily life and in policy. This strategy hasn’t worked – or, at least, it hasn’t worked sufficiently to materially improve the lives of the majority of trans people. The problem is that it involves a rose-tinted view of the media, which is imagined as some kind of benevolent megaphone, which amplifies our voices, uncovers truth and educates. This is an apolitical understanding of the raison d’être of the media in a capitalist society, which – as for any other industry – is first and foremost to make money."

"To this end, much of the mainstream media exists to entertain people, for which purposes it clings to tried and tested formulas and conventions, to avoid any risk to its revenue streams. In the case of trans people, it tends to focus less on what wider society might recognize as familiar about our experience, instead foregrounding what makes us different, peculiar, titillating, aggravating or freakish. Cisgender people, media bosses conclude, do not want to watch a news item about a trans call-centre worker talking about his poor pay and how his shift patterns make medical appointments difficult – because it is depressing and, arguably, familiar to many low-paid non-trans people with medical conditions of their own. [...] Trans bodies when objectified are entertainment; trans bodies when at work in the service of profit are not."

"Generally, trans people remain confined to lower-paid, more precarious roles even in the organizations that campaign for our welfare. In particular, Black and Asian trans communities in Britain remain completely under-represented in LGBTQ+ sector organizations; these are the same communities experiencing the brunt of systemic anti-LGBTQ+ oppression in the UK."

"Trans people are emblematic of wider, conceptual concerns about the autonomy of the individual in society. Their rejection of dominant, ancient and deep-seated ideas about the connection between biological characteristics and identity causes a dilemma for the nation state: whether to acknowledge and give credence to the individual’s assertion of their own identity in law and in culture; or to mandate that it, the state, is the final authority on identity, and to assert its power over the individual – by force if necessary. Attacking the very concept of trans people by imposing rigid and immutable definitions of sex and gender, as Orbán’s party has done, is the latest iteration of the way national governments embrace totalitarian ideology. After all, attacking trans people has been a part of fascist practice since the destruction of ’s Berlin back in 1933 by Nazi youth brigades."

"Being trans, of course, is not a consciously adopted political position, just as claiming a trans identity is not, usually, an expression of a consciously held ideology. A trans person is just a person. We see our daily lives through the same everyday lens as most human beings; after all, we are simply trying to live. However, as with all stigmatized social identities, the very ability to articulate being trans, or to work, seek healthcare, or participate in civic life while trans, is political."

"Hope is part of the human condition and trans people’s hope is our proof that we are fully human. We are not an ‘issue’ to be debated and derided. We are symbols of hope for many non-trans people, too, who see in our lives the possibility of living more fully and freely. That is why some people hate us: they are frightened by the gleaming opulence of our freedom. Our existence enriches this world."

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

"The report of the 2015 USTS provides a detailed look at the experiences of transgender people across a wide range of categories, such as education, employment, family life, health, housing, and interactions with the criminal justice system. The findings reveal disturbing patterns of mistreatment and discrimination and startling disparities between transgender people in the survey and the U.S. population when it comes to the most basic elements of life, such as finding a job, having a place to live, accessing medical care, and enjoying the support of family and community. Survey respondents also experienced harassment and violence at alarmingly high rates."

"Respondents reported high levels of mistreatment, harassment, and violence in every aspect of life. One in ten (10%) of those who were out to their immediate family reported that a family member was violent towards them because they were transgender, and 8% were kicked out of the house because they were transgender. The majority of respondents who were out or perceived as transgender while in school (K–12) experienced some form of mistreatment, including being verbally harassed (54%), physically attacked (24%), and sexually assaulted (13%) because they were transgender. Further, 17% experienced such severe mistreatment that they left a school as a result. In the year prior to completing the survey, 30% of respondents who had a job reported being fired, denied a promotion, or experiencing some other form of mistreatment in the workplace due to their gender identity or expression, such as being verbally harassed or physically or sexually assaulted at work. In the year prior to completing the survey, 46% of respondents were verbally harassed and 9% were physically attacked because of being transgender. During that same time period, 10% of respondents were sexually assaulted, and nearly half (47%) were sexually assaulted at some point in their lifetime."

"The findings show large economic disparities between transgender people in the survey and the U.S. population. Nearly one-third (29%) of respondents were living in poverty, compared to 12% in the U.S. population. A major contributor to the high rate of poverty is likely respondents’ 15% unemployment rate—three times higher than the unemployment rate in the U.S. population at the time of the survey (5%). Respondents were also far less likely to own a home, with only 16% of respondents reporting homeownership, compared to 63% of the U.S. population. Even more concerning, nearly one-third (30%) of respondents have experienced homelessness at some point in their lifetime, and 12% reported experiencing homelessness in the year prior to completing the survey because they were transgender."

"The findings paint a troubling picture of the impact of stigma and discrimination on the health of many transgender people. A staggering 39% of respondents experienced serious psychological distress in the month prior to completing the survey, compared with only 5% of the U.S. population. Among the starkest findings is that 40% of respondents have attempted suicide in their lifetime—nearly nine times the attempted suicide rate in the U.S. population (4.6%). Respondents also encountered high levels of mistreatment when seeking health care. In the year prior to completing the survey, one-third (33%) of those who saw a health care provider had at least one negative experience related to being transgender, such as being verbally harassed or refused treatment because of their gender identity. Additionally, nearly one-quarter (23%) of respondents reported that they did not seek the health care they needed in the year prior to completing the survey due to fear of being mistreated as a transgender person, and 33% did not go to a health care provider when needed because they could not afford it."

"When respondents’ experiences are examined by race and ethnicity, a clear and disturbing pattern is revealed: transgender people of color experience deeper and broader patterns of discrimination than white respondents and the U.S. population. While respondents in the USTS sample overall were more than twice as likely as the U.S. population to be living in poverty, people of color, including Latino/a (43%), American Indian (41%), multiracial (40%), and Black (38%) respondents, were more than three times as likely as the U.S. population (12%) to be living in poverty. The unemployment rate among transgender people of color (20%) was four times higher than the U.S. unemployment rate (5%). People of color also experienced greater health disparities. While 1.4% of all respondents were living with HIV— nearly five times the rate in the U.S. population (0.3%)—the rate among Black respondents (6.7%) was substantially higher, and the rate for Black transgender women was a staggering 19%. Undocumented respondents were also more likely to face severe economic hardship and violence than other respondents. In the year prior to completing the survey, nearly one quarter (24%) of undocumented respondents were physically attacked. Additionally, one half (50%) of undocumented respondents have experienced homelessness in their lifetime, and 68% have faced intimate partner violence. Respondents with disabilities also faced higher rates of economic instability and mistreatment. Nearly one-quarter (24%) were unemployed, and 45% were living in poverty. Transgender people with disabilities were more likely to be currently experiencing serious psychological distress (59%) and more likely to have attempted suicide in their lifetime (54%). They also reported higher rates of mistreatment by health care providers (42%)."

"Detransitioners speak of trauma from experimental drugs and surgeries, of having been manipulated and deceived by adults, and of being abandoned by friends when they detransitioned. I have seen them abused and defamed on social media, accused of being transphobes and liars, and of trying to stop genuine trans people getting the treatments they need. In fact, most are simply urging caution, and have no desire to stop others living as they wish. Their most obvious wounds are physical: mastectomies; castration; bodies shaped by cross-sex hormones. But the mental wounds go deeper. They bought into an ideology that is incoherent and constantly shifting, and where the slightest deviation is ferociously punished. They were led to believe that parents who expressed concern about the impact of powerful drugs on developing minds and bodies were hateful bigots, and that the only conceivable alternative to transition was suicide."

"Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. T"

"Gender-affirming treatment remains a topic of controversy, with many calling for greater access to gender affirming treatments to foster psychological well-being for transgender, nonbinary, and intersex individuals. There is accumulating literature that suggests transgender individuals suffer worse mental health outcomes than their cisgender peers; of particular concern is increased suicidality. The literature to date reveals concerning trends regarding suicidality in transgender individuals. A high prevalence of suicide attempts and thoughts of suicide occur in transgender youth compared to their cisgender peers. Transgender US military veterans have more than 20 times higher rates of suicide-related events than cisgender veterans. The prevalence of suicidal ideation and attempts varies by sample, with the prevalence of suicidal ideation sometimes as high as 50-75%. Rates of attempted suicide can reach peaks of 30% and above. One longitudinal study of over 6,000 transgender individuals in the US indicates that the highest risk of suicide is among those under 18 years of age. Transgender individuals are also at increased susceptibility for various suicide risk-enhancing factors, as a growing body of literature suggests that transgender individuals face a high burden of chronic health conditions, psychiatric illnesses and their comorbidities, substance use], trauma and victimization, and housing and employment discrimination. In light of this high prevalence of suicidality and the proliferation of gender-affirming treatments, a common argument by advocates of gender-affirming treatments is that such treatments are needed to reduce suicidality."

"Clinical judgment, rather than an indiscriminatory tabulation of risk-enhancing factors for suicide, will ultimately be needed, as “no study has identified one specific risk factor or set of risk factors as specifically predictive of suicide or other suicidal behavior”. Risk-enhancing factors for suicide may act in a synergistic manner, with mood disorders, substance use, physical and sexual abuse, minority sexual orientation, disturbed family relationships, parental psychopathology, and various precipitating stress events leading to near-infinite permutations of suicide risk that is ultimately expressed and unique on an individual level. This is especially the case for TGD individuals, for they constitute “heterogeneous groups of individuals with multiple intersecting identities” that may contribute to different levels of risk for suicide."

"The most frequent sexual dysfunctions experienced by trans women and trans men were difficulties initiating and seeking sexual contact (26% and 32%, respectively) and difficulties achieving an orgasm (29% and 15%, respectively). Compared with trans women after hormone treatment and non-genital surgery, trans women after vaginoplasty less often experienced arousal difficulties, sexual aversion, and low sexual desire. Compared with trans men without medical treatment, trans men after a phalloplasty experienced sexual aversion and low sexual desire less often."

"Sexual dysfunctions among trans men and women were very common among the various treatment groups and were unrelated to intentions to have further genital treatment. Although medical treatment may be helpful or even essential to developing good sexual health, a significant group of trans persons experienced sexual dysfunctions after genital surgery."

"Transgender and gender non-conforming people know things about gender that most cisgender folks are light years away from realising. To survive unequal realities, marginalised folks often cultivate deep knowledge of how these realities actually function."

"People have been taking the piss out of trans people for 60 years. The narrative on trans issues has been controlled by people who have no understanding of them. Social media is about us grabbing the narrative back and telling our own stories – this is our reality, this is what we go through and this is what matters to us. We're here, we're in your face, we definitely exist. That's the most important thing – realising we exist."

"Trans persons appear to report generally lower levels of sexual health, according to several studies, though it should be noted that the field of trans medicine is advancing quickly. Trans men appear more likely to report orgasms and sexual arousal post-transition compared to trans women, though it is unknown whether this is related to the fact that most trans men do not go through "bottom surgery" and retain their clitoris and vagina. In addition, trans women historically demonstrate higher levels of discomfort with their genitals and sexual arousal, compared to trans men. Trans women are much more likely to report sexual arousal without orgasm, and lower levels of sexual desire in general. Studies with trans women in particular find a wide variance in ability to experience orgasm post vaginoplasty surgery, ranging from 17-100% across 140 different studies. However, these studies are focused mostly on adults who transitioned in adulthood. At this time, there do not appear to be any studies which examine sexual health or orgasmic experience in trans individuals who initiated affirmative treatment prior to adulthood or the onset of puberty."

"The AMA has sent a strong message to America’s governors cautioning that interfering in the medical care of transgender minors would be detrimental to the health of transgender youth. AMA Executive Vice President and CEO James L. Madara, MD, warned that these measures would “insert the government into clinical decision-making and force physicians to disregard clinical guidelines.”"

"We’re not fighting for equality [...] None of these conflicts against systems of oppression are fights for equality. They are fights for accurate regard of supremacy. We're better at sex than y'all. We're better at art. We're better at warfare. These are things carried in the old understandings of so-called, whatever-you-want-to-call-it: non-binary, queer, genderqueer, trans, gay, lesbian. Just like the neurodiverse peoples, these people are all sacred beings, superior to other beings."

"Research on the sexual experiences of transgender persons has thus far focused predominantly on the impact of gender-confirming treatment (i.e., hormonal treatment or genital surgery to change one’s sex characteristics; hereafter referred to as “GCT”) on several aspects of sexuality. This is not surprising given that sexual experiences, such as masturbation frequency and the ability to reach an orgasm, are seen as indicators of treatment success (De Cuypere et al., 2005). There has been great variability in studies on sexual experiences in transgender people following GCT, both in terms of the outcomes under study and the study findings, which hinder comparisons across studies (for reviews, see Klein & Gorzalka, 2009; Murad et al., 2010). Nevertheless, some general observations can be made. Concerning sexual behavior, empirical research has typically focused on frequency of sex and masturbation. For transwomen (male-assigned at birth), studies have generally shown increased frequency of sex after GCT, but either decreased, increased, or unchanged frequency of masturbation (Klein & Gorzalka, 2009). Studies among trans men (female-assigned at birth) have shown either unchanged or increased frequency of sex and masturbation (Costantino et al., 2013; Klein & Gorzalka, 2009; Wierckx et al., 2011). Studies on sexual feelings after GCT have mainly focused on general measures of sexual satisfaction, as opposed to more specific measures like sexual pleasure and esteem. In general, studies have indicated increased sexual satisfaction in the majority of both trans women and trans men following GCT (Murad et al., 2010; Weigert, Frison, Sessiecq, Mutairi, & Casoli, 2013)."

"Most of the existing studies on the impact of GCT have been retrospective in nature (Klein & Gorza-lka, 2009; Murad et al., 2010) and may therefore suffer from recall bias. Further, these studies may suffer from a cognitive dissonance effect, whereby respondents may evaluate the effect of the treatments as more positive. A pre- and post-measure of a behavior (e.g., masturbation frequency) may have given a more realistic representation. Few studies have assessed the sexual experiences of transgender persons who wish to, but did not yet receive treatment (for some exceptions, see Cerwenka, Nieder, Briken, et al., 2014;Cerwenka, Nieder, Cohen-Kettenis, et al., 2014). This group of transgender persons may have particular negative sexual experiences due to their yet unfulfilled desire for treatment (Cerwenka, Nieder, Brikenet al., 2014). Similarly, little research has focused on transgender persons who do not wish to undergo GCT (for a similar observation, see Bauer & Hammond, 2015), thereby ignoring a substantial subgroup of transgender people."

"Aside from differences in treatment desire, two factors that are likely to be associated with sexual experiences of transgender people are their psychological well-being and body satisfaction. There are several indications that dissatisfaction with one’s appearance or feelings of gender dysphoria can make it more difficult to enjoy or to be satisfied with sexual experiences (Doorduin & Van Berlo, 2014). Further, although in general transgender people reported improved sexual satisfaction after GCT (De Cuypereet al., 2005; Klein, & Gorzalka, 2009), findings also indicate that satisfaction with one’s genitals plays an important role in sexual satisfaction following GCT (De Cuypere et al., 2005)."

"[A]fter gender-confirming interventions, trans women reported low levels of sexual desire and trans men high levels of sexual desire (Elaut et al.,2008; Wierckx et al., 2011; Wierckx et al., 2014). Higher levels of sexual desire will result in more motivation to engage in sexual activities like masturbation and partner sex."

"Body incongruence, a key element of gender identity problems, hinders sex and enjoyment of sex (Door-duin & Van Berlo, 2014). Also, gender incongruence is often accompanied by body dissatisfaction thatis not confined only to the genitals (van de Grift, Cohen-Kettenis et al., 2016). In both samples, bodysatisfaction was positively related to almost all of our indicators of sexual behaviors and feelings, under-lining the importance that body satisfaction plays in sexual experiences in transgender people. This is in line with a previous study that showed that MtF transgender persons who indicated a higher degreeof satisfaction with their appearance also reported a better sexual functioning (Weyers et al., 2009). Psychological well-being played a role in the sexual feelings of FtM transgender persons only, with higher psychological well-being being related to higher sexual satisfaction, agency, and esteem. Secondary analyses (not shown here) showed that psychological well-being was positively related to these indicators of sexual feelings in MtF transgender persons as well, but this relationship disappeared after including body satisfaction in the analyses. This suggests that psychological well-being and body dissatisfaction in MtFtransgender persons are highly related and that sexual feelings are mainly affected by body dissatisfaction."

"Every day you're seeing our existence debated. Transgender people are so very real."

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

"Approximately 1 in 250 adults or almost 1 million adults in the United States identify as transgender. The frequency of adults, and especially younger adults, reporting a gender diverse identity has increased over time. Some persons who identify as transgender or gender-diverse (TGD) will seek treatment with gender-affirming hormones to align their bodies more closely with their gender identity. Medical treatment of people who identify as transgender improves body satisfaction, quality of life, and mental health. However, many of these treatments are not entirely reversible."

"Some adolescents or adults who take gender-affirming hormones subsequently elect to stop treatment. Most adults who stop gender-affirming hormones report doing so for reasons unrelated to a change in gender identity, such as pressure from family, difficulty obtaining employment, or discrimination. Also, discontinuation of gender-affirming hormones does not necessarily represent a failure in treatment or initial decision-making. Some TGD adolescents and adults who start and then discontinue gender-affirming hormones experience use of hormones as an important part of consolidating their gender identity and experience no regret over the use of hormones despite some permanent effects. However, a portion of TGD individuals who pursue gender-affirming medical or surgical affirmation do express regret over the permanent effects of treatment. In a metanalysis of 7928 TGD individuals who had gender confirmation surgery, 1% expressed regret after surgery. The most prevalent reason for regret was psychosocial circumstances, particularly from a lack of social support or negative reactions from family and employers."

"Clinical guidelines for medical affirmation of persons who identify as TGD suggest that the rate of “de-transition” among postpubertal adolescents and adults is rare, but few studies have assessed the actual rate of treatment discontinuation."

"Our study documented higher gender-affirming hormone continuation rates among transfeminine individuals and by patients who started hormones before reaching the age of legal majority in a population with universal insurance and access to low or no-cost medical and pharmaceutical care. Family socioeconomic status, family member type, and the official status of gender-affirming care as a TRICARE-covered benefit at the time the patient began taking gender-affirming hormones had no influence on continuation of gender-affirming hormones. We noted a higher hormone continuation rate among TGD individuals who were younger than 18 years old at the time of first use of gender-affirming hormones compared with those who were aged 18 years and older when starting hormones. This has not been documented in previous studies"

"This is probably one of the reasons why they are so successful in the discourse. It’s really easy to succeed when your point is simple and a lot harder when your point is complex. When you see someone like Ben Shapiro confront a college student and say, “Well, if I say I’m a moose, does that make me a moose?” or “biology is reality,” there is a very simple “logic” to what he says. But reality is complicated. It takes 10 seconds to say something that is wrong, but simple. And then it takes two minutes to explain something more complicated."

"One of the funniest things to me, the thing I cannot help laughing about really, is that people who look at the world and see women and men, when they’re going through that world, often they correctly gender trans people, and they can’t, in fact, carry out their ideological program. There’s this great clip of Ben Shapiro talking about Laverne Cox, and he correctly genders her by accident because he sees a world of men and women and he’s got fixed psychological categories. But Laverne Cox is in the “female” box in his head, and he has to try to forcibly pull her out of the female box in his head because he can’t help himself. A lot of these people can’t actually carry out their scheme because as you have mentioned in your writing, we don’t see people’s chromosomes. People suddenly say, “Oh, chromosomes are the end all, be all.” But that’s not, in fact, how the classifications operate. They are social categories."

"Sexual function and satisfaction in the transgender community is a nascent field with a paucity of data due to the fast paced nature of improving upon surgical technique and variety of patient experiences."

"Several factors, both mental and physical, must be considered when assessing for sexual dysfunction in TGDI prior to medical or surgical intervention as these factors contribute to one’s gender dysphoria. A systematic review of 44 studies analyzed data on sexual satisfaction, desire, arousal, orgasm, and pain. Generally, studies found that a healthy and positive relationship can have a positive impact on general sexual function, orgasm frequency and associated pleasure."

"Distress surrounding sexual activity or one’s own sexual health, which may or may not include individual anatomy, may impact general sexual satisfaction. Thus, those experiencing high levels of gender dysphoria may have lower levels of sexual satisfaction. Dissatisfaction with one’s body, or body dysmorphia can heavily contribute to sexual dysfunction and plays a large role in gender dysphoria. Specifically, one study of 141 trans men demonstrated a connection between body dysmorphia and difficulty with sexual arousal in 91% of participants."

"While there is not much data on sexual pain in trans men, one study found that 12% of 211 participants reported pain at the same frequency before and after genital reconstruction surgery."

"General sexual satisfaction has been shown to improve after initiation of gender affirming care, both medical and surgical. Several studies have shown a decrease in sexual distress after a combination of hormone therapy and gender affirming surgery. Interestingly some studies discussed a difference in sexual satisfaction based on the type of genital reconstruction that was performed, with one study showing an increase in sexual satisfaction for those who received a metoidioplasty compared to those who received a phalloplasty. Gender affirming surgery has shown to increase sexual satisfaction, even when solely analyzing body self image as demonstrated in several studies despite surgical complications."

"Most survey studies demonstrated an increase in ability to attain orgasm and an increase in intensity of the orgasm after medical and surgical transition. Data from these studies showed a 30% increase in ability to orgasm during sexual intercourse or masturbation after genital reconstruction surgery, not differentiating between metoidioplasty and phalloplasty."

"Several studies demonstrate a decrease in sexual desire after initiation of estrogen and antiandrogen medications. Prevalence of low sexual desire ranged from 32% to 73%, but the percentage of those experiencing distress from low sexual desire or hypoactive sexual desire disorder (HSDD) was 22% in a study of 214 trans women after medical and surgical affirmation. This distress associated with low sexual desire is a key marker for HSDD, a diagnosis often paired with depression."

"With regards to gender affirming surgery and its effect on sexual desire, most studies demonstrated an overall increase in desire compared to preoperative levels."

"Multiple studies have compared sexual arousal levels of trans women post-operatively with sexual arousal in cisgender women. In these studies, 90–100% of trans women reported experiencing sexual arousal post-operatively, but when level of sexual arousal was assessed using the Female Sexual Function Index (FSFI), sexual arousal scores were overall lower in trans women than in their cisgender counterparts."

"In trans women who have initiated hormone therapy, but who have not undergone genital reconstruction surgery, difficulty in achieving orgasm was seen to decrease. In one study, the prevalence of orgasmic dysfunction decreased to 29.2% from 46.7% after the initiation of hormone therapy. Whether this finding can be attributed to the simultaneous decrease in gender dysphoria and body dysmorphia associated with the initiation of hormone therapy still needs to be investigated. Ability to orgasm in trans women post-vaginoplasty has also been studied. Due to the unique anatomy of trans women post-operatively, it must be noted that orgasms can occur at multiple locations including the clitoris and prostate via masturbation or vaginal penetration, for example. There is variability in the rates of orgasm post-operatively with studies citing percentages between 40–100%. These studies used the FSFI to assess orgasmic scores and demonstrated ranges of 2.82 to 4.0 out of 6 in comparison to cisgender women without sexual dysfunction who scored an average of 5.1. When analyzing the correlation between sexual activity and achieving orgasm, one study found that direct stimulation of the clitoris had a higher frequency of orgasm when compared to intercourse. In assessing frequency and quality of orgasms post-operatively, studies are inconsistent. While one study reported an increase in orgasm frequency with sexual activity post-operatively, another study of 91 trans women postoperatively found orgasms to occur less frequently in 52.6% of participants and more frequently in 20.5% of participants. Quality of orgasms, when investigated, was found to be more pleasurable postoperatively in 51% of a 218 person study and with no changes in 62.5% of a 31 person study."

"Both medical and surgical affirmation care is improving with the overall goal of reducing gender dysphoria. Nevertheless, there are multiple areas for growth. Trans men and women undergo medical and surgical transitions in ways that affect sexual function and satisfaction. These sexual experiences can be directly correlated to gender affirming medical and surgical interventions. Overall, despite medical and specifically surgical complications, satisfaction with transition and sexual health is high."

"In January 2019, the Wall Street Journal ran my piece, "When Your Daughter Defies Biology." It provoked nearly a thousand comments, and hundreds of responses to those comments. A transgender writer, Jennifer Finney Boylan, quickly wrote a rebuttal in an op-ed that appeared two days later in the New York Times. Her op-ed garnered hundreds of comments and hundreds more reactions to those comments. All of a sudden, I was flooded with emails from readers who had experienced with their own children the phenomenon I had described or had witnessed its occurrence in their kids' schools - clusters of adolescents in a single grade, suddenly discovering transgender identities together, begging for hormones, desperate for surgery. . . . This is a story America needs to hear. Whether or not you have an adolescent daughter, whether or not your child has fallen for this transgender craze, America has become fertile ground for this mass enthusiasm for reasons that have everything to do with our cultural frailty: parents are undermined; experts are over-relied upon; dissenters in science and medicine are intimidated; free speech truckles under renewed attack; government healthcare laws harbor hidden consequences; and an intersectional era has arisen in which the desire to escape a dominant identity encourages individuals to take cover in victim groups."

"While some cisgender people refuse to take our experiences seriously, the fact of the matter is that transgender people can be found in virtually every culture and throughout history; current estimates suggest that we make up 0.2 – 0.3% of the population [or possibly more]. [...] In other words, we simply exist."

"Accusations that IP is inherently “narcissistic” and “divisive” have become quite prevalent among EC-centric leftists lately. [...] In addition to disregarding all forms of non-EC marginalization, accusations that IP activism is inherently “narcissistic” or "divisive" severely confuse cause and effect. After all, I’m not the one who is “obsessed” with my identity. [...] It’s the people who harbor anti-trans attitudes who are obsessed with my identity, not the other way around! While I would absolutely love to live in a world where my trans identity was not especially notable or worth calling attention to, these people insist on making an issue out of it. Furthermore, by making a distinction between transgender people (who they single out for discrimination) and non-transgender people (whose identities and experiences they respect), it is they (not us) who are the ones being divisive. Once we acknowledge this causality, it becomes clear that IP is not an expression of navel-gazing or narcissism, but rather a form of organized resistance against those who are actively trying to delegitimize and disenfranchise us."

"I would love to live in a world where the word “transgender” serves the same simple purpose — a mere sharing of information about my life experiences — but unfortunately, it doesn’t. On top of being a descriptor, the word “transgender” is also politically loaded. But that is not my, nor other trans people’s, fault. As discussed in the last section, there’s a long history of people hating, ostracizing, and criminalizing us, and much of this history took place before words like “transgender,” “transphobia,” and analogous terms even existed. In fact, those terms were created in response to that marginalization, not the other way around. And even if I were to relinquish my trans identity, those people would still exist and continue to discriminate against me for supposedly being a sinner, or freak, or deviant, or for being delusional, or whatever other rationales they might concoct in order to justify their bigotry."

"The most infuriating assertion regularly made by the "trans women are biologically male" camp is that trans people are somehow "denying" or "erasing" biological sex differences, and that this hurts cisgender women/“biological females.” This is patently untrue. I can assure you that trans people are highly aware of biological sex differences — the fact that many of us physically transition demonstrates that we acknowledge that sexually dimorphic traits exist and may be important to some people! I would reframe things this way: Transgender people often have a more complicated relationship with our sex-related traits (as they may be discordant with our identified and lived genders), and thus the language that we use to describe or discuss these traits may seem arcane, or nonsensical, or unnecessary to the average cisgender person. And because they are unfamiliar with this language (and/or flat-out antagonistic toward us), some cisgender people will subsequently misinterpret this language and differing perspective as some sort of "denial.""

"Experiences may vary. But again, humans are these overlapping bell curves. We, as trans people, have experience being members of both the male and female persuasions, and that relates to both physical and social aspects of gender. Having moved through the world as male and as female, we have very interesting experiences. And we have moved through the world as non-binary and have been read different ways and have experienced very real double standards."

"One of the things that really struck me during my transition—a lot of trans people have shared similar stories, but let me speak in “I” statements—one of the most startling things that I totally did not expect was that people who knew me before I transitioned were so invested in my being a he/him. Versus after I transitioned, and people started reading me as female, I would get the reverse situation—where people, upon finding out I was trans, were shocked. They were just as shocked to find out that I was trans, when I presented as a woman, as the people who knew me as male were shocked when I came out to them as trans. And so it’s very weird to be in a world where people just accept me as like she/her and nobody thinks about it. But then I’ll still have people from my past, who I don’t see all that often, who slip up and call me the wrong pronouns. And I think this is exactly what you’re saying. I think we have these boxes—I sometimes describe them as filing cabinets. Not like literal spaces in your brain, but basically, we organize people, or we’re taught to organize people, according to the man box or the woman box. And it creates difficulty for all of us, including myself."

"I think most trans people would say the same thing, which is that once you learn more about gender, about trans people’s experiences, when you learn about non-binary people, there are these hurdles or obstacles you have to get over. You have to think about the world in a slightly different way to accommodate people who exist, people you didn’t know existed in the world before. And I think all of us do it to some degree, even if it’s not about gender. Almost all of us grow up in a very straight world. We think there are men and women and husbands and wives, and those are the only relationships. And then as you get older, you realize that there are same sex relationships. And that’s a hurdle that a lot of us get over at a certain point in time. We realize that there’s more diversity here. And so it’s not any different with trans people. It’s just that as a society, most of society has moved on. Not all, obviously. I don’t know specifically what Ben Shapiro’s opinion is on same sex relationships. [Editor’s note: Shapiro has claimed homosexuality is a mental illness and a sin.] But I think most people have accepted same sex relationships. And trans is a new thing to them, even though trans people have been around forever."

"I would love to be at a point where—and obviously, we’ve taken this kind of backlash turn—we realize that trans people provide a lot of insight for everyday people about gender. People will debate the differences between the sexes, and it’s like, trans people have written about our experiences with, say, hormonal transitioning. And the answer is that yeah, there are very real differences. Experiences may vary. But again, humans are these overlapping bell curves. We, as trans people, have experience being members of both the male and female persuasions, and that relates to both physical and social aspects of gender. Having moved through the world as male and as female, we have very interesting experiences. And we have moved through the world as non-binary and have been read different ways and have experienced very real double standards. A lot of these anti-trans people purport to be feminists. I’m not going to say they aren’t feminists, but their feminism seems a bit off to me. We can talk at great length about how sexist double standards are very real things—if you would stop fighting us. There are a lot of feminists who appreciate trans people’s insights and perspectives into these issues. But this particular group of people, some of whom consider themselves to be feminists, just really don’t want to have that conversation. They only want to have one conversation, and it’s one where trans people don’t get to speak and where it ends with us being shown the door."

"So going back to the question of trans women are women or a woman trapped inside a man’s body, these statements from a transgender perspective very clearly are attempts to explain something really complicated in a very simple way to people who might not get it. I came up against the whole thing when I was first transitioning. What does it mean to be a woman trapped inside a man’s body?—which is never how I saw myself, but it was what I had to answer for the statement that other people would make. Growing up, I had no idea what other girls felt or what other boys felt. I had no idea; I only knew what I was experiencing. And so when I say I’m a trans woman, it’s not because I aspire to be a woman or have stereotyped notions of being a woman or that I’m making a crass assumption about what women really feel. I’ve no idea what anybody feels on the inside except me. There are some people who have really strong feelings. And you can say feelings—I would say it’s a little more complicated than that. I often describe it as being similar to cognitive dissonance, a kind of understanding that your body should be a particular way that it isn’t, and trying to sort that out."

"Matt Sharp, a top lawyer at ADF who drafts model legislation on the group’s behalf, said he expects issues dealing with transgender athletes and medical care to reach the Supreme Court. In an interview, Sharp compared judges ruling in favor of allowing gender-affirming care for transgender minors to courts upholding forced sterilization for disabled individuals a century ago. “I think it’s always worth stepping back and remembering the courts get it wrong sometimes,” Sharp said. “It was about 100 years ago that the Supreme Court upheld forced sterilization for individuals with mental disabilities. It was a wrong decision. And thankfully, both the courts and the medical community recognized the damage that they were doing to a vulnerable population and corrected that mistake. Similar here, these are courts that are struggling now.”"

"Paul Smith, who successfully argued the 2003 landmark Supreme Court case Lawrence v. Texas, which found the U.S.’s remaining sodomy laws unconstitutional, said the repeated victories for LGBTQ people and advocates are “a sign that these laws are mostly being thought up based on their appeal to a certain frenzied group of people in the country who were very excited about picking on LGBTQ people right now, not based on their legal merits and sustainability. “Take a law that says, you can’t have a drag show. It’s hard to imagine an easier First Amendment case to win, because it’s just plain content censorship,” he said. “And there’s not going to be any evidence that is harmful to somebody.” Smith, a professor at Georgetown Law, said the cases regarding restrictions on transition-related care are more complicated, but the wins still make sense, because in those cases the care is supported by the adolescents, their parents and doctors, and by expert testimony."

"It is difficult to generate a counterdiscourse if one is programmed to disappear. The highest purpose of the [medically defined] transsexual is to erase h/erself, to fade into the "normal" population as soon as possible. Part of this process is known as constructing a plausible history--learning to lie effectively about one's past. What is gained is acceptability in society. ... In the transsexual's erased history we can find a story disruptive to the accepted discourses of gender."

"To attempt to occupy a place as speaking subject within the traditional gender frame is to become complicit in the discourse which one wishes to deconstruct."

"Transsexuals for whom gender identity is something different from and perhaps irrelevant to physical genitalia are occulted by those for whom the power of the medical/psychological establishments, and their ability to act as gatekeepers for cultural norms, is the final authority for what counts as a culturally intelligible body."

"Fifty-three studies were included. Findings indicate reduced rates of suicide attempts, anxiety, depression, and symptoms of gender dysphoria along with higher levels of life satisfaction, happiness and QoL after gender-affirming surgery. Some studies reported that initial QoL improvements post gender-affirming surgery were not always enduring."

"There is a paucity of data regarding transgender and gender diverse (TGD) people who ‘‘detransition,’’ or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States."

"Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future."

"Of all respondents who reported a history of detransition, 82.5% cited at least one external factor. A total of 15.9% of respondents cited at least one internal factor. Of all participants who ever pursued gender affirmation, 10.8% reported lifetime history of detransition due to an external factor and 2.1% reported a lifetime history of detransition due to an internal factor."

"Older age cohorts were more likely to report a history of detransition due to caregiving responsibilities, or pressure from a spouse or partner. Younger age cohorts were more likely to report a history of detransition due to pressure from a parent, pressure from the community or societal stigma, and pressure from friends or roommates."

"In this national study, 13.1% of TGD respondents who had ever pursued gender affirmation reported a history of detransition. To our knowledge, this is the first study to systematically examine reasons for detransition in a large national sample of TGD adults. The vast majority of participants reported detransition due at least in part to external factors, such as pressure from family, nonaffirming school environments, and sexual assault. External pressures such as family rejection, school-based harassment, lack of government affirmation, and sexual violence have previously been associated with increased suicide attempts in TGD populations. Our findings thus extend prior studies, and suggest that external pressures should be understood not only as risk factors for poor mental health but also as obstacles to safely living in one’s gender identity and expression."

"A history of detransition was significantly associated with male sex assigned at birth, consistent with prior research, indicating that TGD people assigned male sex at birth experience less societal acceptance. Detransition was also significantly more common among participants with a nonbinary gender identity or bisexual sexual orientation. These findings are congruent with past studies, indicating that TGD people who identify beyond traditional binary and heteronormative societal expectations are less likely to access gender-affirming services."

"Lack of family support was also associated with a history of detransition, which is of particular concern, given the strong association between familial nonacceptance and suicidality."

"[G]ender affirmation is a highly personal and individualized process, and not all TGD people will desire all domains of gender affirmation at all times, as has been highlighted in case literature regarding people who desire medical but not social affirmation."

"It is important to highlight that detransition is not synonymous with regret. Although we found that a history of detransition was prevalent in our sample, this does not indicate that regret was prevalent. All existing data suggest that regret following gender affirmation is rare. For example, in a large cohort study of TGD people who underwent medical and surgical gender affirmation, rates of surgical regret among those who underwent gonadectomy were 0.6% for transgender women and 0.3% for transgender men. Many of those identified as having ‘‘surgical regret’’ noted that they did not regret the physical effects of the surgery itself but rather the stigma they faced from their families and communities as a result of their surgical affirmation. Such findings mirror the qualitative responses in this study of TGD people who detransitioned due to family and community rejection."

"Although there have been published guidelines for gender affirmation, case studies regarding detransition, and published data on the uncommon experience of regret following gender affirmation, there has been little rigorous study with large TGD community samples regarding detransition."

"“The laws do so much damage when they’re passed that I think it’s difficult to see even the court victories as a good thing on balance,” said Ryan Thoreson, a University of Cincinnati law professor and former researcher for Human Rights Watch. “The sheer number of these laws has been significantly disruptive to the care that transgender children are receiving. They’ve had a chilling effect on providers who are now much more cautious about providing some of these services to kids and their families.”"

"In this prospective clinical cohort study of TNB youths, we observed high rates of moderate to severe depression and anxiety, as well as suicidal thoughts. Receipt of gender-affirming interventions, specifically PBs or GAHs, was associated with 60% lower odds of moderate to severe depressive symptoms and 73% lower odds of self-harm or suicidal thoughts during the first year of multidisciplinary gender care. Among youths who did not initiate PBs or GAHs, we observed that depressive symptoms and suicidality were 2-fold to 3-fold higher than baseline levels at 3 and 6 months of follow-up, respectively. Our study results suggest that risks of depression and suicidality may be mitigated with receipt of gender-affirming medications in the context of a multidisciplinary care clinic over the relatively short time frame of 1 year. Our findings are consistent with those of prior studies finding that TNB adolescents are at increased risk of depression, anxiety, and suicidality and studies finding long-term and short-term improvements in mental health outcomes among TNB individuals who receive gender-affirming medical interventions. Surprisingly, we observed no association with anxiety scores. A recent cohort study of TNB youths in Dallas, Texas, found that total anxiety symptoms improved over a longer follow-up of 11 to 18 months; however, similar to our study, the authors did not observe statistically significant improvements in generalized anxiety. This suggests that anxiety symptoms may take longer to improve after the initiation of gender-affirming care. In addition, Olson et al found that prepubertal TNB children who socially transitioned did not have increased rates of depression symptoms but did have increased rates of anxiety symptoms compared with children who were cisgender. Although social transition and access to gender-affirming medical care do not always go hand in hand, it is noteworthy that access to gender-affirming medical care and supported social transition appear to be associated with decreased depression and suicidality more than anxiety symptoms."

"Our study provides quantitative evidence that access to PBs or GAHs in a multidisciplinary gender-affirming setting was associated with mental health improvements among TNB youths over a relatively short time frame of 1 year. The associations with the highest aORs were with decreased suicidality, which is important given the mental health disparities experienced by this population, particularly the high levels of self-harm and suicide. Our findings have important policy implications, suggesting that the recent wave of legislation restricting access to gender-affirming care may have significant negative outcomes in the well-being of TNB youths. Beyond the need to address antitransgender legislation, there is an additional need for medical systems and insurance providers to decrease barriers and expand access to gender-affirming care."

"Testosterone use among transgender people likely impacts their experience of sexual function and vulvovaginal pain via several complex pathways. Testosterone use is associated with decreased estrogen in the vagina and atrophic vaginal tissue, which may be associated with decreased vaginal lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function."

"Testosterone use among transgender men and gender diverse people was associated with an increased interest in sexual activity and the ability to orgasm, as well as with vaginal pain or discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (eg, testosterone-associated vaginal atrophy) and psychological factors (eg, gender affirmation)."

"At least 1.6 million transgender adults and adolescents live in the United States,1 among whom an estimated 70% of transgender men have used testosterone as gender-affirming hormone therapy (GAHT). A vaginectomy is rare (<3%) in this population, and the majority of transgender men and gender diverse people retain their vagina. Testosterone GAHT likely impacts sexual function via several complex pathways. Testosterone GAHT is associated with vaginal atrophy, which may be associated with decreased lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function."

"There is limited research on the sexual function of transgender men and gender diverse people assigned female at birth (AFAB). The evidence that exists suggests that, although testosterone GAHT is associated with increased desire and arousal, a high proportion of transgender men also reported dyspareunia (painful sex), a common symptom of vaginal atrophy. The prevalence of dyspareunia may be as high as 60% to 62% among transgender men, markedly higher than the prevalence reported among cisgender women (3%–48%)."

"In our study, testosterone use among transgender men and gender diverse people AFAB was associated with some domains of positive sexual function (such as a higher interest in sexual activity and ability to orgasm) and pain or discomfort during sexual activity. Specifically, we observed a strong, consistent association between current testosterone use and higher interest in sex, as well as vaginal or FGO pain during sexual activity."

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

"Caeneus, a woman once, and once a man, But ending in the sex she first began."

"Research suggests that trans people compared to cisgender people self-report significantly lower sexual pleasure, with researchers in one study finding that being younger in age, having higher genital satisfaction, and being happier in general predicting more sexual pleasure in trans people (Gieles et al., 2023). Trans people often experience elevated rates of shame, genital dissatisfaction, and body image distortion, which researchers have found to be associated with reduced sexual functioning, alongside the complexities of how medical transition might impact sexual functioning and one’s experience of sex (Barcelos et al., 2022)."

"Staples et al. (2020) found that time since medical transition was associated with increased body satisfaction which reduced sexual distress, rather than gender-affirming surgeries alone. Furthermore, while HT is recognized to impact some trans people’s sexualities, a review of HT and trans sexuality argues that hormones alone are unlikely to change sexual attraction, rather, they impact how trans people interact with the world (Burns et al., 2024)."

"What is known suggests that trans people may experience both changing gendered embodiment and sexual habitus (one’s psychological, physical, and emotional repertoire of sex acts, fantasies, and attractions) in tandem around transition, leading to unique experiences (Schilt & Windsor, 2014). They may also face navigating normative gender scripts within sexual and romantic encounters, which offers both opportunities and challenges around affirmation (Lindley et al., 2020). Further, trans people may use a range of labels to identify their sexual orientation, which may also shift over time and intersect with generational, cultural, and personal meanings (Doorduin & van Berlo, 2014; Galupo et al., 2016). Research suggests that unique labeling and othering processes may occur as a result of this, as trans people navigate their identity within cisgenderist norms, which can also influence how one perceives oneself, one’s relationships, and how partners perceive them (Pollock & Eyre, 2012; Thurston & Allan, 2018; Yerke & Mitchell, 2011). For some, this offers opportunities and access to communities, while for others, this is constraining (Pipkin et al., 2023)."

"Because the transgender population is growing, a larger availability of transgender health care is needed. Other health care providers should familiarize themselves with transgender health care, because HT can influence diseases and interact with medication. Because not all people apply for the classic treatment approach, special attention should be given to those who choose less common forms of treatment."

"The number of people with gender identity issues seeking professional help increased dramatically in recent decades. The percentage of people who regretted gonadectomy remained small and did not show a tendency to increase."

"A total of 48 019 patients who underwent GAS were identified, including 25 099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27 187 patients (56.6%), followed by genital reconstruction (16 872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13 011 in 2019 and then declined slightly to 12 818 in 2020. Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients."

"While numerous surgical interventions can be considered GAS, the procedures have been broadly classified as breast and chest surgical procedures, facial and cosmetic interventions, and genital reconstructive surgery. Prior studies have shown that GAS is associated with improved quality of life, high rates of satisfaction, and a reduction in gender dysphoria. Furthermore, some studies have reported that GAS is associated with decreased depression and anxiety.8 Lastly, the procedures appear to be associated with acceptable morbidity and reasonable rates of perioperative complications."

"These findings suggest that the number of GAS procedures performed in the US has increased dramatically, nearly tripling from 2016 to 2019. Breast and chest surgery is the most common class of procedure performed while patients are most likely to undergo surgery between the ages of 19 and 30 years. The number of genital surgical procedures performed increased with increasing age."

"Do we have a theory on why people are gay? No. They just are. The only reason we even feel like we need a theory about trans people is that society is so unaccepting of us that it’s constantly demanding we justify our own reality."

"I feel like trans culture is just so obsessed with reassuring ourselves that we’re valid, that we sometimes forget that the end goal of a political movement is not validity, it’s equality."

"The most frequent sexual dysfunctions experienced by trans women and trans men were difficulties initiating and seeking sexual contact (26% and 32%, respectively) and difficulties achieving an orgasm (29% and 15%, respectively). Compared with trans women after hormone treatment and non-genital surgery, trans women after vaginoplasty less often experienced arousal difficulties, sexual aversion, and low sexual desire. Compared with trans men without medical treatment, trans men after a phalloplasty experienced sexual aversion and low sexual desire less often."

"Trans women are much more likely to report sexual arousal without orgasm, and lower levels of sexual desire in general. Studies with trans women in particular find a wide variance in ability to experience orgasm post vaginoplasty surgery, ranging from 17-100% across 140 different studies. However, these studies are focused mostly on adults who transitioned in adulthood. At this time, there do not appear to be any studies which examine sexual health or orgasmic experience in trans individuals who initiated affirmative treatment prior to adulthood or the onset of puberty."

"Multiple studies have compared sexual arousal levels of trans women post-operatively with sexual arousal in cisgender women. In these studies, 90–100% of trans women reported experiencing sexual arousal post-operatively, but when level of sexual arousal was assessed using the Female Sexual Function Index (FSFI), sexual arousal scores were overall lower in trans women than in their cisgender counterparts."

"In trans women who have initiated hormone therapy, but who have not undergone genital reconstruction surgery, difficulty in achieving orgasm was seen to decrease. In one study, the prevalence of orgasmic dysfunction decreased to 29.2% from 46.7% after the initiation of hormone therapy. Whether this finding can be attributed to the simultaneous decrease in gender dysphoria and body dysmorphia associated with the initiation of hormone therapy still needs to be investigated. Ability to orgasm in trans women post-vaginoplasty has also been studied. Due to the unique anatomy of trans women post-operatively, it must be noted that orgasms can occur at multiple locations including the clitoris and prostate via masturbation or vaginal penetration, for example. There is variability in the rates of orgasm post-operatively with studies citing percentages between 40–100%. These studies used the FSFI to assess orgasmic scores and demonstrated ranges of 2.82 to 4.0 out of 6 in comparison to cisgender women without sexual dysfunction who scored an average of 5.1. When analyzing the correlation between sexual activity and achieving orgasm, one study found that direct stimulation of the clitoris had a higher frequency of orgasm when compared to intercourse. In assessing frequency and quality of orgasms post-operatively, studies are inconsistent. While one study reported an increase in orgasm frequency with sexual activity post-operatively, another study of 91 trans women postoperatively found orgasms to occur less frequently in 52.6% of participants and more frequently in 20.5% of participants. Quality of orgasms, when investigated, was found to be more pleasurable postoperatively in 51% of a 218 person study and with no changes in 62.5% of a 31 person study."

"Research exploring the lived experience of sexuality for trans women is limited, with conceptualizations focusing largely on exploring deficits or the impact of gender-affirming medical care, such as hormone therapy (HT) and/or surgeries."

"A further study highlights that as many as 26% of a sample of 307 trans women reported difficulties initiating sexual contact, 29% reported difficulties achieving orgasm, and that vaginoplasty was associated with a reduction in difficulties with sexual arousal and sexual aversion (Kerckhof et al., 2019)."

"Research into the impact of transition on sexuality reports that, following the commencement of HT, some trans women experience a temporary change in sexual desire (Defreyne et al., 2020). Research has found that trans women are less likely to engage in sexual activities before accessing gender-affirming care (Scheim & Bauer, 2019), and some experience a reduction in sexual activities after starting HT (Knezevich et al., 2012). Rosenberg et al. (2019) also found a difference in orgasm experience after commencing HT in trans women. One clinic-based study further found that as many as 32% of trans women may experience a change in sexual orientation during medical transition (Auer et al., 2014). Barcelos et al. (2022) conducted a systematic review of the available literature concerning trans women’s sexual functioning. They found that, of the 17 available studies, there was a large divergence in how sexual functioning was measured, and overall, there was limited evidence that gender-affirming surgery improved sexual functioning overall."

"Women who insist that trans women are not women often object to being called “cis women” under the false assumption that it somehow undermines their femaleness — this is not at all the purpose of this language. The sole purpose of cis terminology is to name the unmarked majority (similar to how one might refer to white women, or heterosexual women, or able-bodied women, etc.). In other words, referring to someone as “cisgender” simply means that they have not had a transgender experience."

"Trans women differ greatly from one another. Perhaps the only thing that we share in common is a self-understanding that there was something wrong with our being assigned a male sex at birth and/or that we should be female instead. While some cisgender people refuse to take our experiences seriously, the fact of the matter is that transgender people can be found in virtually every culture and throughout history; current estimates suggest that we make up 0.2 – 0.3% of the population [or possibly more]. [...] In other words, we simply exist."

"Like women more generally, many trans women are feminists. Feminism and transgender activism are not in any way incompatible or mutually exclusive. As feminists who acknowledge intersectionality, we believe that we should be fighting to end all forms of sexism and marginalization — this includes both traditional sexism and transphobia. Forcing trans women into a separate group that is distinct from cis women does not in any way help achieve feminism’s central goal of ending sexism."

"Claims that trans women are not women often rely on essentialist (and therefore incorrect) assumptions about biology. For instance, people might argue that trans women are not “genetically female,” despite the fact that we cannot readily ascertain anybody’s sex chromosomes. Indeed, most people have never even had their sex chromosomes examined, and those that do are sometimes surprised by the results. Other common appeals to biology center on reproduction — e.g., stating that trans women have not experienced menstruation, or cannot become pregnant. This ignores the fact that some cisgender women never menstruate and/or are unable to become pregnant. Claims about genitals are similarly problematic: Women’s genitals vary greatly, and as with chromosomes and reproductive capabilities, we cannot readily see other people’s genitals in everyday encounters. If you and I were to meet, should I refuse to recognize or refer to you as a woman unless you show me your genitals? And frankly, what could possibly be more sexist than reducing a woman to what’s between her legs? Isn’t that precisely what sexist men have been doing to women for centuries on end?"

"While gender socialization is quite real, all of us are capable of overcoming or transcending the socialization that we experienced as children. And gender socialization doesn’t simply stop when one reaches adulthood: All of us are constantly facing gender-related social pressures, expectations, and obstacles throughout our lives. If you believe that these statements are true for cis women, then they also must be true for trans women."

"Trans women do not transition out of a desire to be feminine; we transition out of a self-understanding that we are or should be female (commonly referred to as gender identity)."

"Trans women who are conventionally feminine are not in any way asserting or insinuating that all women should be conventionally feminine, or that femininity is all there is to being a woman. Like cis women, trans women dress the way we do in order to express ourselves, not to critique or caricature other women."

"As a trans woman, I will be the first to admit that I cannot possibly know what any other woman experiences or feels on the inside. But the thing is, the trans-women-aren’t-women crowd cannot possibly know what any other woman experiences or feels either! Every woman is different. We share some overlapping experiences, but we also differ in every possible way. Every trans woman I know acknowledges this diversity. In contrast, it’s the cis women who attempt to exclude us who seem to have a singular superficial stereotypical notion of what constitutes a woman, or of what women experience."

"Trans women are women. We may not be “exactly like” cis women, but then again, cis women are not all “exactly like” one another either. But what we do share is that we all identify and move through the world as women. And because of this, we all regularly face sexism. That is what we should be focusing on and working together to challenge. And as I said at the outset, forcing trans women into a separate group that is distinct from cis women does not in any way help achieve feminism’s central goal of ending sexism. In fact, it only serves to undermine our collective cause."

"To talk about the "rights" of someone who has chosen to rebel against responsible living is nonsense. It is simply not true that all human beings have the same rights."

"There is an effort in some countries to manipulate the Church by gaining the often well-intentioned support of her pastors with a view to changing civil-statutes and laws. This is done in order to conform to these pressure groups' concept that homosexuality is at least a completely harmless, if not an entirely good, thing. Even when the practice of homosexuality may seriously threaten the lives and well-being of a large number of people, its advocates remain undeterred and refuse to consider the magnitude of the risks involved.The Church can never be so callous. It is true that her clear position cannot be revised by pressure from civil legislation or the trend of the moment. But she is really concerned about the many who are not represented by the pro-homosexual movement and about those who may have been tempted to believe its deceitful propaganda. She is also aware that the view that homosexual activity is equivalent to, or as acceptable as, the sexual expression of conjugal love has a direct impact on society's understanding of the nature and rights of the family and puts them in jeopardy."

"It is legitimate and necessary to ask oneself if this is not perhaps part of a new ideology of evil, more subtle and hidden, perhaps, intent upon exploiting human rights themselves against man and against the family."

"[Social Justice Campaigners] decided instead to push vigorously on trans: to pick up the hardest part of the whole question ('I am who I say I am and you can't prove otherwise') and run with it: 'Trans lives matter'; 'Some people are trans. Get over it'. Everywhere, with a wearying predictability, the people who always complain about every aspect of the patriarchal, hegemonic, cis-supremacist, homophobic, institutionally racist, sexist state, decided to run with the trans issue. They specifically claimed that yes, if a man said he was a woman and didn't do anything about it, then yes he was a woman and it was transphobic to suggest otherwise."

"[L]esbians and radical feminists who object to the idea that identification should grant biological men an all-access pass to women’s rights and safe spaces are openly derided as “TERFs” all over social media."

"Transgender activism purports that biological sex and "gender" are non-binary fluid constructs."

"Some trans activists are just as creative as their rejection of reality. Two popular YouTube trans activists (Riley J. Dennis and Zinnia Jones) have proclaimed that it is "cisgender" for people to restrict their mating preferences to "cisnormative" individuals; or in other words, heterosexuality is bigoted. It would seem that my my marriage is transphobic because I never considered a transgendered individual as a prospective wife."

"One of the primary objectives of trans sports activists is to normalize their theory of gender fluidity as settled fact. They sometimes resort to ruthless tactics in order to chill discourse that pushes back against their dogmas. They have de-platformed speakers, such as outspoken feminist Meghan Murphy. They have mobbed opponents on social media and, often successfully, demanded that their accounts be blocked (it helps that platforms like Twitter and Facebook are sympathetic to gender ideology). They have organized campaigns to cripple or end the careers of pre-eminent sexologists, including Dr. Kenneth Zucker, former director of the Gender Identity Clinic at Toronto's Centre for Addiction and Mental Health. And they have ensure that trans activists constitute an influential presence on committees tasked with providing gender identity guidelines in education, jurisprudence, social services, and yes, sport. They label anyone in the media who opposes their claims as "transphobic." Observant readers will have noticed that, in the last few years, the mainstream media have lost heart for engagement on this front and have largely ceded the field to the gender theorists."

"This powerful new [transactivist] lobby far outnumbers the trans people it claims to speak for. And it serves their interests very poorly. Its ideological focus means it seeks to silence anyone who does not support gender self-identification – which includes many post operative transsexuals, who are under no illusion as to how much bodies matter. It also ignores other possible solutions to problems faced by trans people – research into the causes and treatment of gender dysphoria, for instance, or adding unisex facilities alongside single sex ones. Its overreach is likely to provoke a backlash that will harm ordinary trans people, who simply want safety and social acceptance. When the general public finally realises what is being demanded, the blame may not land with the activists, where it belongs."

"[...] as gender clinics have come under activists' sway, the treatment they offer has taken an ideological turn. Instead of advising parents to watch and wait with sympathy and kindness, they now work on the assumption that childhood gender dysphoria destines someone to trans adulthood. They recommend immediate 'social transition' – a change of name, pronouns and presentation – followed successively by drugs to block puberty, cross-sex hormones and surgery, often while the patient is still in their teens. This treatment pathway is a fast track to sexual dysfunction and sterility in adulthood."

"No one is transgender ... To use names and pronouns that contradict the person’s God-given identity is to speak falsely."

"Girls deserve equal opportunity to compete and achieve in sports. The Biden administration's reinterpretation of Title IX is a slap in the face to young women and girls, telling them their hard work, on-field achievements, and athletic futures do not matter. Title IX was designed to stop discrimination and ensure equal athletic opportunities for women. By allowing biological males to compete in girls' sports the Biden administration will be reversing 50 years of progress for women. H.R. 734, the Protection of Women and Girls in Sports Act of 2023 strengthens the law's existing protections for women, ensures a level playing field for female athletes, and protects the law from the Biden administration's radical regulatory scheme."

"Call me old-fashioned, but if your activism permits men to hit women, and to deprive women of medals, and to humiliate women who’ve trained hard for sporting glory, then it’s not ‘progressive’ – it’s misogyny in woke drag."

"Trans people are emblematic of wider, conceptual concerns about the autonomy of the individual in society. Their rejection of dominant, ancient and deep-seated ideas about the connection between biological characteristics and identity causes a dilemma for the nation state: whether to acknowledge and give credence to the individual’s assertion of their own identity in law and in culture; or to mandate that it, the state, is the final authority on identity, and to assert its power over the individual – by force if necessary. Attacking the very concept of trans people by imposing rigid and immutable definitions of sex and gender, as Orbán’s party has done, is the latest iteration of the way national governments embrace totalitarian ideology. After all, attacking trans people has been a part of fascist practice since the destruction of ’s Berlin back in 1933 by Nazi youth brigades."

"In an era of growing right-wing populism in the United States and the UK alike, accompanied by an alarming rise in visible street fascism, there is more need than ever for unity across the four different letters (as well as queer, asexual, intersex and other groups). It is in the interests of those who hate us all for us to be at war with one another."

"Moral panics rely on an inherent paradox: that the rights of a small minority of the population wielding little institutional power are in fact a risk to the majority. This is achieved by inciting in the population a mixture of moral disgust and anxiety about contagion. The problem group may be small now, but they will grow. They will grow by encouraging confused young people to join. For sexual minorities, this narrative of recruitment lends itself to the language of seduction and abuse, which helps direct the moral disgust society feels at paedophilia on to an innocent group. It is a shameful but highly effective propaganda tool. Despite the obvious parallels and analogous struggles that trans people have had with the wider queer movement’s struggle for sexual liberation, the claim that trans people are not only actively different but substantially harmful to the LGB movement has been readily embraced and promoted by extreme political conservatives. This includes even politicians who would themselves traditionally oppose lesbian, gay and bisexual rights."

"Even if a tiny proportion of LGB people are willing to team up with right-wing homophobes to oppose trans civil rights, it only takes a handful of committed LGB people wilfully perpetuating these negative narratives for them to become normalized. Such narratives are then taken up by political conservatives and far-right voices, whose ultimate goal is the dismantling of all LGBTQ+ rights because of their profound disgust for us all."

"The simple moral case for resisting transphobia as a form of cruelty should be enough for anyone who has been similarly victimized by society (as cisgender lesbians, gay men and bisexual people have all been in one way or another) to stand with us in solidarity. Yet it should also be a matter of self-interest. The world in which trans people’s rights are restricted relies on narratives of dehumanization and myths of sexual predation. Restricting trans people’s rights relies on policing other people’s gendered appearance in toilets and changing rooms by arbitrating on who looks male or female enough, and by punishing deviation from rigid norms with intimidation and violence. It involves kids following the examples of adults and harassing their peers in the playground for being different. It relies on parents either beating into submission the child asserting their identity, or psychologically breaking them with conversion therapy. These traumatic experiences affect all ‘queers’, whether trans or cis. Advocating for them in any form for any letter will inevitably normalize their use against everyone judged queer. Politically, it is a gift to fascists at a time of growing far-right sentiment in Europe and North America alike."

"Together, an LGBTQ+ coalition with class consciousness and anti-racism at its core must recover its radicalism and reaffirm its opposition to capitalism and patriarchy. Infighting and division are in the interests of our right-wing oppressors. Gay people and trans people have had to battle similar arguments about being ‘unnatural’: homophobia still often rests on the prejudice that the worthiest form of sexuality is that which is capable of reproduction. Transphobia, too, emanates from a prejudice that a person’s stated identity is more trustworthy if it reflects their ‘natural’ role in human reproduction. Similarly, cisgender women’s reproductive freedom is the first thing to be curbed by conservative regimes. Misogyny, homophobia and transphobia share much of the same DNA. To the patriarchy, we all do gender wrong."

"The recent drive for religious exemptions is not born of a neutral concern with religious liberty, but is largely the product of resistance to recent gains in LGBT equality across the United States. The public and legislative debate around these bills has focused on LGBT people exercising their rights, and objections to same-sex marriage, same-sex parenting, same-sex relationships, and recognizing the gender identity of transgender individuals. Proponents of these exemptions have not incorporated protections that would ensure they are not used to discriminate against LGBT people at risk of discrimination."

"One of the primary objectives of trans sports activists is to normalize their theory of gender fluidity as settled fact. They sometimes resort to ruthless tactics in order to chill discourse that pushes back against their dogmas. They have de-platformed speakers, such as outspoken feminist Meghan Murphy. They have mobbed opponents on social media and, often successfully, demanded that their accounts be blocked (it helps that platforms like Twitter and Facebook are sympathetic to gender ideology). They have organized campaigns to cripple or end the careers of pre-eminent sexologists, including Dr. Kenneth Zucker, former director of the Gender Identity Clinic at Toronto's Centre for Addiction and Mental Health. And they have ensure that trans activists constitute an influential presence on committees tasked with providing gender identity guidelines in education, jurisprudence, social services, and yes, sport. They label anyone in the media who opposes their claims as "transphobic." Observant readers will have noticed that, in the last few years, the mainstream media have lost heart for engagement on this front and have largely ceded the field to the gender theorists."

"The reality is that tens of thousands of transgender and non-binary students have been playing sports for years without any unfair advantages or problems. In fact, the Associated Press asked lawmakers who were seeking to pass these discriminatory bills to cite problem cases in their states and not a single lawmaker could identify a case. That’s why “more than 500 college athletes signed a letter to the NCAA board of governors asking the organization to refuse to schedule championships in states that have banned transgender participation in sports.” All female athletes — transgender and non-transgender — have different shapes and sizes, have different strengths and weaknesses. The research shows there’s no scientific reason to exclude transgender young people. Doing so can lead to immense harm in overall well-being by interrupting an activity crucial to identity and development."

"We cannot fit a multi-gender world into a two-gender system of sports."

"Some may feel super woke to say that transgender women athletes belong in female sports, but let me tell you as a biologist, in terms of muscle mass, transgender women have similar advantages over females as male athletes do, even with testosterone suppression therapy, therefore, it is not enough to simply acknowledge transgender as a distinct gender, we must also make necessary alterations to our preexisting societal fields, such as setting up transgender category in sports, where performance is predicated on physiological attributes, so that in an attempt to vest upon the transgender population their long-overdue fundamental rights, we do not start treating other genders unfairly without even being aware of it. Remember, replacing one wrong with another is not rightness. Our purpose is to preserve the rights of everyone, not to change the shape of the violation of those rights."

"What we have is a speculative fear of something that hasn't materialized. They're acting like LeBron James is going to put on a wig and play basketball with fourth graders."

"I believe in fairness. I also believe in inclusiveness. I do not believe however that transgender women have the right to compete against me or any other gender-born women regardless of their age."

"Girls deserve equal opportunity to compete and achieve in sports. The Biden administration’s reinterpretation of Title IX is a slap in the face to young women and girls, telling them their hard work, on-field achievements, and athletic futures do not matter. Title IX was designed to stop discrimination and ensure equal athletic opportunities for women. By allowing biological males to compete in girls’ sports the Biden administration will be reversing 50 years of progress for women. H.R. 734, the Protection of Women and Girls in Sports Act of 2023 strengthens the law’s existing protections for women, ensures a level playing field for female athletes, and protects the law from the Biden administration’s radical regulatory scheme."

"The experience of being trans is shaped by social class. While there are trans people, the vast majority are working class – just as the vast majority of the total population is working class. Trans workers are often employed in lower paid and more precarious jobs, with a high risk of discrimination and bullying in the workplace. As a result, trans political struggle is part of a wider class struggle. Despite this, trans politics is commonly misrepresented as coddled, bourgeois and anti-working class."

"There can be no trans liberation under capitalism. This is a fact. Yet it’s not a popular view among liberal and centrist LGBTQ+ advocacy groups, who – as we’ve seen in the course of this book – talk about ‘trans rights’ in isolation as a range of personal freedoms and protections; and who cling to corporations and brands as potential ‘allies’ in the fight for social acceptance."

"Being transgender is not a trend and transgender people have a history that spans centuries. Over the past few years, transgender visibility has increased dramatically, a sign that our society is becoming increasingly accepting of diverse gender identities. This is a positive sign, as more and more transgender people feel that they can live openly and receive support. Like the LGBTQ community has seen time and time again, increased visibility often leads to increased attacks by those who wish to shove us back in the closet. Lesbian, gay and bi+ young people should be free to declare their sexuality without others doubting them. The same should be true for young people who have a diverse gender identity."

"Buoyed by the success of the gay and lesbian liberation movement, freed from enforced isolation by changes in the medical and psychiatric establishment, and brought together by the Internet, the transgender community has emerged in the last five years as a new voice in social activism. This voice suggests that, although gender is an identity we are born with, an identity that no amount of social influence can sway, it is too great and varied a force to shoehorn into those ubiquitous boxes marked F and M. While human desires--for love, passion, work, respect, friends, family--remain constant, the way those desires are felt and expressed cannot always be categorized at the moment of birth. Anatomy, as feminists have long argued, is not destiny."

"First, one of the most important – and, for many, confusing – questions: why do some trans people need medical intervention at all? Dysphoria, the antonym of ‘euphoria’, is the clinical term now used to describe the intense feeling of anxiety, distress or unhappiness some trans people feel in relation to their primary sex characteristics (genitals), their secondary sex characteristics (breasts, facial hair, menstruation, face shape, voice) or how these physical traits cause society to interact with them, by perceiving them as a male or female. Previously called 'gender identity disorder' and, before that, 'transsexualism', gender dysphoria is the name given to an experience many trans people struggle with, which can be helped by medical intervention. Although the term is widely used within the community, different trans people can experience dysphoria in very different ways, and so might have different clinical needs."

"Gender dysphoria is a rare experience in society as a whole, affecting about 0.4 per cent of the population, which can make it hard to explain to the vast majority of people, who have not experienced it. To get around this, we often rely on metaphors. The clumsy phrase ‘born in the wrong body’ has become the favoured soundbite in popular media. Clumsy because – and this must be stressed – many trans people do not think this describes dysphoria at all well. To my mind, the trans writer Andrea Long Chu expresses it more accurately: "Dysphoria," she says, "can feel like heartbreak." Heartbreak, its incapacitating grief and the sense of absence and loss which activate the same parts of the brain as physical pain, can be so all-consuming it interferes with your everyday life. So, too, dysphoria. For me, at least, this is a much richer way of describing how many trans people experience distress with their bodies – indeed, how I felt until I medically transitioned."

"Dysphoria, it should be said, is not a precondition of being trans. According to some research, as many as 10 per cent of those who positively identify as trans men, trans women, non-binary people and various other terms do so without any feelings of dysphoria. It is sometimes incorrectly assumed that trans men and women experience dysphoria and non-binary people do not, when in fact some non-binary people feel themselves to be in great need of medical assistance, and some trans men and women seek none at all. Nevertheless, most trans people experience dysphoria to some degree."

"It is the "battle of the beliefs": hanging on to your belief that you are who you are despite how others may define you, while also challenging yourself not to compare your insides to other people’s outsides. It's a constant effort to align yourself externally with how you feel internally."

"Gender-affirming surgery often involves going through a number of hoops: waiting periods, hormone therapy and learning about the potential risks and benefits of the procedures. Although most surgeries are reserved for adults, the leading guidelines recommend that patients be at least 15 years old. This thorough process that trans people go through before receiving surgery may also explain the lower levels of regret."

"While the media seems all too happy to focus on trans children’s right to participate in activities alongside their peers (or, indeed, on trans children’s very existence), there is little coverage of one of the most pressing problems: the fact that they are significantly more likely to experience discrimination, harassment and violence at home or at school. Sometimes, horrific stories hit local news headlines, such as the trans teenage boy whose face was slashed by a gang of teenagers in Witham, Essex, or the eleven-year-old trans girl in Manchester who, after months of bullying, was shot with a BB gun at school. To date, though, the national media has more or less completely failed to explore the ways in which such egregious incidents form part of a wider pattern of abuse of trans children."

"Family rejection and estrangement have devastating long-term health implications. They also have a material impact. For some kids, the only option is leaving home. Others have no option at all: their parents kick them out. As a result, trans teenagers and young adults in Britain are much more likely to experience homelessness than their cisgender peers. [...] A minority within a minority, trans young people are disproportionately over-represented in the homeless population: one in four trans people have experienced homelessness."

"What is already known about this topic? Convenience samples indicate that transgender youths appear to be at higher risk for violence victimization, substance use, suicide risk, and sexual risk behaviors than are cisgender youth. What is added by this report? Population-based survey data from 10 state and nine urban school districts found that an average of 1.8% of high school students identify as transgender. Transgender students were more likely than were cisgender students to report violence victimization, substance use, and suicide risk, and, although generally more likely to report sexual risk behaviors, were also more likely to report having been tested for human immunodeficiency virus."

"Almost 2% of High School students identify as transgender"

"27% feel unsafe at or going to or from school"

"35% are bullied at school"

"35% attempt suicide"

"Nearly one in five people who identify as transgender are ages 13-17."

"Research shows transgender individuals are younger on average than the U.S. population. We find that youth ages 13 to 17 are significantly more likely to identify as transgender (1.4%) than adults ages 65 or older (0.3%)."

"At the state level, our estimates range from 3.0% of youth ages 13 to 17 identifying as transgender in New York to 0.6% in Wyoming."

"The majority of respondents who were out or perceived as transgender while in school (K–12) experienced some form of mistreatment, including being verbally harassed (54%), physically attacked (24%), and sexually assaulted (13%) because they were transgender. Further, 17% experienced such severe mistreatment that they left a school as a result."

"Gender-affirming treatment remains a topic of controversy, with many calling for greater access to gender affirming treatments to foster psychological well-being for transgender, nonbinary, and intersex individuals. There is accumulating literature that suggests transgender individuals suffer worse mental health outcomes than their cisgender peers; of particular concern is increased suicidality. The literature to date reveals concerning trends regarding suicidality in transgender individuals. A high prevalence of suicide attempts and thoughts of suicide occur in transgender youth compared to their cisgender peers. Transgender US military veterans have more than 20 times higher rates of suicide-related events than cisgender veterans. The prevalence of suicidal ideation and attempts varies by sample, with the prevalence of suicidal ideation sometimes as high as 50-75%. Rates of attempted suicide can reach peaks of 30% and above. One longitudinal study of over 6,000 transgender individuals in the US indicates that the highest risk of suicide is among those under 18 years of age."

"In the Netherlands, treatment with puberty suppression is available to transgender adolescents younger than age 18 years. When gender dysphoria persists testosterone or oestradiol can be added as gender-affirming hormones in young people who go on to transition. We investigated the proportion of people who continued gender-affirming hormone treatment at follow-up after having started puberty suppression and gender-affirming hormone treatment in adolescence."

"704 (98%) people who had started gender-affirming medical treatment in adolescence continued to use gender-affirming hormones at follow-up. Age at first visit, year of first visit, age and puberty stage at start of GnRHa treatment, age at start of gender-affirming hormone treatment, year of start of gender-affirming hormone treatment, and gonadectomy were not associated with discontinuing gender-affirming hormones."

"Most participants who started gender-affirming hormones in adolescence continued this treatment into adulthood. The continuation of treatment is reassuring considering the worries that people who started treatment in adolescence might discontinue gender-affirming treatment."

"Being transgender is not a trend and transgender people have a history that spans centuries. Over the past few years, transgender visibility has increased dramatically, a sign that our society is becoming increasingly accepting of diverse gender identities. This is a positive sign, as more and more transgender people feel that they can live openly and receive support. Like the LGBTQ community has seen time and time again, increased visibility often leads to increased attacks by those who wish to shove us back in the closet. Lesbian, gay and bi+ young people should be free to declare their sexuality without others doubting them. The same should be true for young people who have a diverse gender identity."

"When a young child expresses that they are a gender other than their sex assigned at birth, their parents may support them in finding their own, unique identity. This can involve changing the child’s name, clothing or pronouns. Once a transgender youth reaches puberty, a doctor may prescribe them with reversible puberty blockers to safely delay the effects of puberty. Puberty blockers are not “experimental” treatments, but FDA-approved medications that have been used to treat precocious puberty in non-transgender children for several decades. Scientific studies demonstrate that access to puberty blockers reduces suicidal ideation and that parents’ affirmation of their child’s gender identity reduces rates of depression, anxiety and suicide to levels consistent with their cisgender peers. When kids are allowed the freedom to safely express themselves, they are happier, healthier and grow into thriving adults."

"Since 2013, HRC and other advocates have tracked over 200 cases of fatal violence against transgender and gender non-conforming people across 30 states and 113 cities nationwide. Beyond fatal violence, the transgender and non-binary community faces higher rates of harassment and physical assault — including transgender young people, with 43% of transgender youth reporting being bullied in school. Laws targeting transgender people — and the political rhetoric surrounding anti-transgender bills — send a message that transgender people are not worthy of equal treatment, contributing to dangerous stigma that drives this epidemic of violence. Bottom line: when transgender people aren’t valued — including by their own lawmakers — their lives are viewed by some as disposable, putting them at risk."

"Analysis of procedure-specific trends by age revealed a number of important findings. First, GAS procedures were most common in patients aged 19 to 30 years. This is in line with prior work that demonstrated that most patients first experience gender dysphoria at a young age, with approximately three-quarters of patients reporting gender dysphoria by age 7 years. These patients subsequently lived for a mean of 23 years for transgender men and 27 years for transgender women before beginning gender transition treatments. Our findings were also notable that GAS procedures were relatively uncommon in patients aged 18 years or younger. In our cohort, fewer than 1200 patients in this age group underwent GAS, even in the highest volume years. GAS in adolescents has been the focus of intense debate and led to legislative initiatives to limit access to these procedures in adolescents in several states."

"We are disappointed with this latest executive order. Policies that restrict or bana ccess to necessary medical care for transgender youth are harmful to patients and their families. Transgender youth need comprehensive, individualized, family-based care from multidisciplinary teams. Healthcare decisions should be made by patients, families, and their healthcare professionals, guided by evidence-based practices, clinical guidelines, and individual needs rather than government mandates."

"Transgender youths (those whose gender identity* does not align with their sex†) experience disparities in violence victimization, substance use, suicide risk, and sexual risk compared with their cisgender peers (those whose gender identity does align with their sex). Yet few large-scale assessments of these disparities among high school students exist."

"The reported prevalence of all experiences assessing violence victimization was higher among transgender students than among both cisgender males and cisgender females, including 23.8% reporting ever being forced to have sexual intercourse and 26.4% having experienced physical dating violence. A higher percentage of transgender students also reported lifetime use of all substances except marijuana than did cisgender male and cisgender female students; marijuana use was more prevalent among transgender students than among cisgender male students only. A higher proportion of transgender students reported all suicide risk outcomes than did cisgender students. Transgender students were more likely than cisgender students to report first sexual intercourse before age 13 years, sexual intercourse with four or more persons than were cisgender students, and no method to prevent pregnancy at last sexual intercourse. Transgender students were more likely than were cisgender females to have ever had sex (43.1% versus 33.2%) and to have drunk alcohol or used drugs before their last sexual intercourse (30.0% versus 17.9%). Transgender students were more likely than were cisgender males to report no condom use during their last sexual intercourse (63.8% versus 37.6%). Transgender students were less likely than cisgender males and cisgender females to have not ever been tested for HIV (70.0% versus 87.4% and 86.9%, respectively)."

"The results of this study validate findings from smaller clinical and web-based studies that, at a population level, transgender students are at disproportionately higher risk than are cisgender students for violence victimization, substance use, and suicide risk. The prevalence of reported substance use (e.g., 27.1%, 26.1%, 24.9%, and 35.9% reporting lifetime use of cocaine, heroin, methamphetamines, and prescription opioid misuse, respectively) and suicide risk (e.g., 34.6% attempting suicide in the last 12 months) are concerning. Given that violence victimization is a documented risk factor for substance use and suicide risk, implementation of interventions focused on reducing the victimization of transgender adolescents might be a key strategy for improving overall health."

"Some examples of elevated sexual risk emerged among transgender students. More transgender than cisgender students reported first sexual intercourse before age 13 years and having had four or more sex partners, and more transgender students than cisgender female students reported ever having had sexual intercourse and use of alcohol or drugs before last sexual intercourse. Transgender students were more likely than were cisgender students to forego pregnancy prevention at last sexual intercourse and were less likely than were cisgender males to use a condom at last sexual intercourse; however, without further information about the sex and gender identities of these youths and their partners, the risk implications of these results are uncertain and should be interpreted with caution. Transgender students were more likely to have ever received an HIV test, an important protective behavior, given the known higher HIV risk experienced by this population."

"Taking steps to create safe learning environments and provide access to culturally competent physical and mental health care might be important first steps to improving the health of transgender youths. Continued research into the health of transgender youths and development of effective intervention strategies are warranted."

"Use of puberty-blocking medications and cross-sex hormone treatments for children and adolescents who experience gender dysphoria is a complex modern medical controversy. Over the past decade, clinics have seen an explosion in the number of young people seeking such treatment. At the same time, there has been a complex debate over whether these medical interventions are safe, appropriate, and effective."

"Abigail Shrier is a journalist and author of a controversial 2020 book, Irreversible Damage: The Transgender Craze Seducing Our Daughters. She recently interviewed two doctors (both trans themselves) who provide treatment to trans youth. One, Marci Bowers, is the surgeon who treated reality TV star Jazz Jennings, whose life and transition are chronicled in the show I Am Jazz. Describing her treatment of Jennings, Bowers states,“If you’ve never had an orgasm pre-surgery, and then your puberty's blocked, it's very difficult to achieve that afterwards. I consider that a big problem, actually. It's kind of an overlooked problem that in our ‘informed consent’ of children undergoing puberty blockers, we’ve in some respects overlooked that a little bit .... if they’re not able to be responsive as a lover ... how does that affect their long-term happiness?” In her show, Jennings described that she had never had an orgasm. For a sexual clinician, the concept of orgasmic naiveté and the experience of sexual pleasure and health raise fascinating questions. Unfortunately, it turns out there is relatively little data or research to explore these issues in trans youth."

"It seems quite possible that the reduced physical genital development that results from puberty suppression could inhibit the phenomenological experience and behaviors associated with sexual climax. In other words, while youth who undergo trans-affirmative treatment may have less genital tissue with which to experience sexual stimulation, their bodies and brains are likely capable of sexual climax though they may feel the experience less intensely due to reduced genital tissue. It is possible that individuals assigned as male and female at birth may experience these effects differently, as seems evident in research with people who experience transition as adults. Finally, it seems likely that learning plays a role in this process, though contrary to Bowers, it seems unlikely that it is the only factor involved. However, it seems quite important that future research examine the sexual health experiences of individuals who initiate trans affirmative treatment prior to adulthood."

"Addendum/Update: In 2023, researchers published a study of 37 transwomen and orgasm functioning. 76% were able to achieve orgasm post affirmative surgery. There were no differences between those individuals who underwent puberty suppression or not. While these data do suggest there is a significant risk - 1 in 4 were unable to orgasm - the risk certainly doesn't appear to be as universal as has been suggested."

"Introduction: Concerns about future regret and treatment discontinuation have led to restricted access to gender-affirming medical treatment for transgender and gender-diverse (TGD) minors in some jurisdictions. However, these concerns are merely speculative because few studies have examined gender-affirming hormone continuation rates among TGD individuals."

"We noted a higher hormone continuation rate among TGD individuals who were younger than 18 years old at the time of first use of gender-affirming hormones compared with those who were aged 18 years and older when starting hormones. This has not been documented in previous studies. Parental support plays an important role in the mental health of TGD youth. A prior study of adults found that lack of family support for a TGD individual’s gender was associated with a history of discontinuing social or medical gender affirmation. Higher parental support may explain the higher continuation rate among patients who start gender-affirming hormones as minors compared with people who start as adults."

"We also found that individuals who start gender-affirming hormones before reaching the age of legal majority are less likely to subsequently discontinue use when compared with individuals who start hormones after becoming a legal adult. If replicated in future studies, the improved continuation rate among patients who are not legal adults at the time of treatment should provide some reassurance to those concerned about the ability of minors to provide informed assent to use of gender-affirming hormones. A higher continuation rate among minors could also be used to inform the actions of legislators and judges who wish to prohibit gender-affirming treatment for minors to protect them from the consequences of health care decisions they make with the assistance of their parents and health care providers."

"Despite the extreme ways in which their bodies are mythologized, fetishized and denigrated by our culture, trans sex workers, compared to other kinds of trans worker, enjoy the least solidarity and have the least political attention paid to the reality of their lives. This disparity only increases when the trans sex worker is also a migrant and a person of colour."

"In a society that is both patriarchal and capitalist, men’s misogyny towards women sits comfortably alongside their desire to extract women’s sexual labour. This does not change because the woman is trans. In fact, given the political invisibility of most trans women, it may be intensified. To put it plainly, many of the men who purchase the services of trans sex workers will be the same men who argue for the oppression of all trans people and all sex workers. They will be the same men who preach hate and incite violence against them and the same men who, in some cases, personally use physical violence against them. It is no coincidence that trans sex workers are often at the forefront of LGBTQ+ community organizing and activism across the globe, particularly in countries where LGBTQ+ rights are opposed by the state. At times, the two collide."

"Globally, trans sex workers make up 62 per cent of all trans murder victims, where the victim’s profession is known. [...] Trans sex workers around the world are often at most risk from the very same men to whom they sell their services. This is not some puzzling ‘hypocrisy’, but a horrifying and sometimes deadly reality. It should also be an urgent wake-up call for society and workers’ movements to better protect and support trans sex workers. Trans people’s increased likelihood of experiencing family rejection and homelessness, combined with substantial healthcare costs and a struggle to secure other forms of employment, means that many engage in the stigmatized work of selling sex. And, as we have already seen, trans sex workers experience unique and severe forms of vulnerability and violence. Therefore, the issue of sex-worker rights and safety must be at the heart of the trans liberation movement."

"Above all, anti-prostitution feminism argues, men’s demand for the right to purchase sex should be condemned and criminalized. Given the extreme violence to which trans people, particularly trans women, who do sex work are subject worldwide, it seems tempting for trans politics to join with this condemnation of male violence and, consequently, with the condemnation of men who purchase sex. It is true that many sectors of the sex industry, from pornography to street sex work to managed brothels, rely on the exploitation of trans sex workers’ financial and social vulnerability by cisgender men for profit. Yet the converse argument – for pro-sex-worker trans politics – isn’t intended as a moral absolution of the client or unethical industry practices; it isn’t concerned with morality at all. Rather, it recognizes that trans sex workers exist in a society in which money is necessary for survival, and that sex work is one of a limited number of options available to the marginalized in this society – and so, regardless of any condemnation or criminalization of clients, trans sex workers will still need to sell sex. Accepting this reality turns the focus from ‘ending demand’ for sexual services, to harm-reduction for the worker. It is on this basis that full in all its forms must be a central tenet of the movement for trans rights."

"The murders of trans women sex workers are not rare. This is a recurring phenomenon and we regularly try to alert public opinion and the authorities to this violence. Unfortunately, as always, we find ourselves alone."

"Given the British media’s recent pained wrangling with the very idea of gender affirmation as a potential ‘slippery slope’, the fact that more straightforward access to medical transition and legal gender recognition was available during the Second World War than is often the case today is astonishing. The mainstream media’s presumption that strict ‘controls’ on transition are and have always been necessary relies on the suppression, and ignorance, of trans medical and legal history."

", then, is part of a wider political struggle for bodily autonomy that women, LGBTQ+ people, disabled people and ethnic minorities have all been fighting – a struggle that intensified during the decade of austerity that was the 2010s. This political struggle has primarily focused on trans adults, growing societal awareness of whom has allowed for more robust advocacy and rebuttal of the myths about medical transition. Even transphobes and reactionaries in the media and in politics, uneasy and disapproving though they remain, have come to begrudgingly tolerate adult medical transition as a matter of personal autonomy. After all, as trans people have successfully argued, adults are entitled to do whatever they want with their own bodies."

"The reality is that transition is an act most trans women and girls see as lifesaving, and one for which they can be punished severely: with violence, with community and familial rejection, with poverty, with mental illness, with sexual abuse, with domestic violence and, yes, with murder."

"Family rejection and estrangement have devastating long-term health implications. They also have a material impact. For some kids, the only option is leaving home. Others have no option at all: their parents kick them out. As a result, trans teenagers and young adults in Britain are much more likely to experience homelessness than their cisgender peers. [...] A minority within a minority, trans young people are disproportionately over-represented in the homeless population: one in four trans people have experienced homelessness."

"In general, trans people are more likely to have lower incomes and to experience poverty than the wider population. [...] Prejudice persists. It is not just a personal affront, but an economic reality that shapes and limits trans lives."

"The majority of trans people are working class, and the oppression of trans people is specifically rooted in capitalism. In short, capitalism across the world still relies heavily on the idea of different categories of men’s work and women’s work, in which ‘women’s work’ (such as housework, child-rearing and emotional labour) is either poorly paid or not paid at all. In order for this categorization to function, it needs to rest on a clear idea of how to divide men and women. Capitalism also requires a certain level of unemployment to function. [...] and revulsion at the existence of trans people usefully provides another class of people more likely to be left in the ranks of the unemployed (even more so if they are trans and poor, black or disabled – which is why unemployment is highest among these trans people)."