Transgender

"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."

"“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."