What does it mean for someone to be transgender?
Gender identity is one’s innermost sense of one’s gender. This can include whether one identifies as a man (or a boy), identifies as a woman (or a girl), or identifies as nonbinary (neither simply as a man nor as a woman).
All of us are in positions of navigating a social world that is imbued with norms and expectations regarding sex and gender (Butler, 2015). While many people develop gender identities that are congruent with their assigned genders at birth, some people develop gender identities that are different from their assigned genders at birth.
The term “trans” is short for “transgender” and refers to people whose gender identities are different from their assigned genders at birth. These include trans girls and women (people who identify as girls or women but were assigned male at birth), trans boys and men (people who identify as boys or men but were assigned female at birth), and nonbinary people (people who identify neither simply as men nor as women).
Above all, it is important to trust what the young person says. One’s gender identity is an aspect of one’s subjective experience, and so whether a person is trans is ultimately determined by the person’s self-report. There is no medical or scientific test that can establish whether someone is trans. Rather, we have to respect one’s first-person authority over one’s own experience and identity (Bettcher, 2009). This means that young people know their experiences better than anyone else and ought to be trusted as the authorities over their own identities.
It is also important to accept the young person for who they are. Being trans is not a disorder, but is a healthy part of our diversity. Reassure the young person that you know that there is nothing wrong with being trans. Trans people deserve the same rights as anyone else.
Other ways of showing your trust and acceptance include referring to the young person in whatever way they prefer, being willing to change the pronouns and names you use for them, and letting them know that they will have your support no matter what their identity is. Reassure them that it is okay for them to change their mind and that it is also okay for them to identify the way they currently do more permanently. If there are people with whom the young person does not feel comfortable sharing their identity, then it is important to respect their confidentiality.
Providing this sort of support to a young person can be lifechanging. Research has shown that family support and acceptance are associated with significant benefits for trans children and adolescents, including improved mental health, improved social wellbeing, improved family relations, and decreased suicide risk (Horton, 2022).
Identifying as trans or nonbinary is within the rights of young people to express their own identities and determine their own characters (Giordano, 2019). As noted above, one’s gender identity falls within the purview of one’s first-person authority over one’s own experience (Bettcher, 2009). Young people know their own experiences better than anyone else, and so they ought to be trusted as the authorities over their own identities.
Research indicates that young people who have commenced puberty generally exhibit the relevant understandings and capacities to make decisions about their own identities and about their gender affirming healthcare (Clark and Virani, 2021). Furthermore, research also shows that the overwhelming majority of adolescents who identified as trans continued to identify as trans some years later (van der Loos et al., 2022). This evidence suggests that the gender identities of young people are not “phases” or “split-second decisions”, but are generally stable and authentic expressions of their characters.
No. There was a study in 2018 which seemed to suggest that young people who identified as trans had friendship groups where most people were trans and showed increases in social media usage after expressing gender dysphoria. The hypothesis was that these young people had a form of “rapid-onset gender dysphoria” that was caused by peer pressure. However, this study was found to be methodologically flawed, which led to a correction to the paper being issued by the journal. Specifically, the study sought the testimonies of parents but did not seek the testimonies of the young people themselves, who may have been better situated to describe their gender identities and their social circumstances (Restar, 2020). Also, the study recruited the parents from trans-exclusionary websites, which raises a serious concern about sampling bias (Ashley, 2020).
Accordingly, there is no reliable evidence that peer pressure leads children to think they are trans. The finding that young people with gender dysphoria had friendship groups where most people are trans could just indicate that young people seek friendship groups which allow them to explore and express their gender identities safely.
No. In the United Kingdom over thirty years ago, Section 28 was introduced to prevent schools from “promoting homosexuality” because there were worries that children would “turn gay” if they learned about lesbian, gay, and bi people. This has been discredited and is now considered to be grounded in bigotry. Unfortunately, we are currently seeing very similar conversations happening about teaching children about trans people.
The fact that teachers, doctors, families, and caregivers are talking more about gender is a positive thing, because it allows children to acquire the understandings and capacities to explore their identities as they grow and develop. As well as supporting their autonomy, this can help them understand and celebrate diversity and differences in others.
Every trans person’s transition is individual. For some trans people, it will involve purely social steps, such as changing their names, pronouns, appearances and clothes, and how they present in social interactions. For others, transitioning may also include medical steps, such as puberty blockade or hormone replacement therapy. These are only commenced after puberty has begun.
Gender affirming medical treatment with puberty blockers and hormones has been shown to have significant benefits for the mental health and social wellbeing of trans youth. These include decreased rates of depression and anxiety, decreased suicidality, improved social and family relationships, and improved body image (Allen et al., 2019; de Vries et al., 2014; Chen et al., 2023; Grannis et al., 2021; Green et al., 2022; Kuper et al., 2020; Tordoff et al., 2022; Turban et al., 2020; van der Meisen et al., 2020). Gender affirming medical treatment in adolescence was also associated with greater satisfaction with romantic and sexual relationships in adulthood (Bungener et al., 2020).
As with all medical treatments, there are potential risks associated with gender affirming medical treatment. An important risk to consider is the potential loss of fertility (Cheng et al., 2019). With puberty blockers on their own, the effect is reversible, and so fertility can be expected to be restored if the treatment is stopped. With hormone replacement therapy, the impact on future fertility may depend on the stage of puberty at which treatment is commenced, as trans adolescents who commence hormones early in puberty may not yet have mature gametes. Hence, it is recommended that trans youth are counselled about the potential loss of fertility, the options for fertility preservation and gamete storage, and the other options for building a family.
Another potential risk is decreased bone density. Research has suggested that trans adolescents who receive puberty blockers have decreased bone density compared to cis adolescents of similar ages (Schagen et al. 2020). This is due to the lack of oestrogen and testosterone, which usually have roles in bone development. However, it is uncertain whether this is associated with any clinically significant problems for subsequent bone health. Furthermore, bone density has been shown to increase when hormone replacement therapy is commenced (Klink et al. 2015; Vlot et al. 2017). Hence, the risk to bone health can be mitigated by avoiding the delay in commencing hormone replacement therapy for trans youth who wish to proceed with medical transition, as well as by addressing other potential contributory factors such as diet, sunlight exposure, and exercise.
As with all major decisions, it is possible for people to change their minds. Some people who transition later choose to return to their assigned genders at birth, sometimes discarding their clothes, their accessories, and their hormones. Some call this detransitioning, some call it retransitioning, and some call it “trying out my birth gender again”.
However, while detransitioning does occur, it is important to understand that it is relatively rare. The overwhelming majority of trans adolescents do not regret transitioning and continue to identify as trans after several years.
Some early research seemed to suggest that many prepubertal children who display gender nonconformity later revert back to their genders assigned at birth when they reach adolescence (Zucker and Bradley, 1995). However, this research has been criticised for being methodologically inadequate, as it did not distinguish trans identity with other forms of gender nonconformity and focused on gender nonconformity in prepubertal children rather than on gender identity in peripubertal adolescents (Temple Newhook et al., 2018). Accordingly, data on gender nonconformity in prepubertal children cannot be used to draw conclusions about the outcomes of medical transition in peripubertal adolescents.
Many studies have subsequently shown that the rates of regret are very low in trans adolescents who receive gender affirming medical treatment. Over 95% of trans adolescents do not regret medical transition (Brik et al., 2020; Cohen-Kettenis and van Goozen, 1997; van der Loos et al., 2022). Furthermore, research has shown that gender identity remains stable in the overwhelming majority of trans adolescents (Olson et al., 2022).
Although detransitioning is very rare, it is important to recognise that it does sometimes happen. People detransition for many reasons and it does not necessarily mean regret. It can mean that a person no longer identifies as trans or that they feel they are now a different gender to the gender as which they previously identified. It can also mean a person has decided this moment is not the right time for them to transition and they might plan to transition when they have more support. However, the most common reason for detransition is that a person cannot cope with the family and community support they have lost and with the transphobia they have experienced since transitioning (Turban et al., 2021).
Those who detransition or report regret deserve support and care. It is also important to remember that the fact that some people detransition does not make the experiences and identities of trans people any less valid and authentic.
Gender affirming healthcare for trans youth is supported by several professional medical organisations and is grounded in robust clinical evidence.
The provision of gender affirming healthcare for trans youth is supported by international professional organisations, including the World Professional Association for Transgender Health (2022), the Endocrine Society (Hembree et al., 2017), and University of California San Francisco (Center of Excellence for Transgender Health, 2016), whose evidence-based guidelines are based on robust peer-reviewed research. Gender affirming healthcare for trans youth is also supported by the American College of Physicians and the American Academy of Pediatrics.
Research has shown that gender affirming healthcare can be lifesaving and that it results in significant improvements in the mental health and social wellbeing of transgender youth. Moreover, the withholding of gender affirming healthcare has been shown to cause very serious harms, including increased risks of depression, anxiety, and suicide (Allen et al., 2019; de Vries et al., 2014; Chen et al., 2023; Grannis et al., 2021; Green et al., 2022; Kuper et al., 2020; Tordoff et al., 2022; Turban et al., 2020; van der Meisen et al., 2020). Accordingly, leading academic legal scholars and philosophers have argued that gender affirming healthcare for trans youth is ethical (Ashley, 2022; Giordano and Holm, 2020; Maung, 2024; Murphy, 2019).
Unfortunately, policies and laws have been enacted around the world, including the United Kingdom and the United States, which have restricted access to gender affirming healthcare for trans youth. However, these policies and laws are not grounded in scientific evidence or clinical ethics. Rather, they are to a large extent ideologically motivated and reflect a wider trend of attacks on the rights of trans people by politicians, the media, and trans-exclusionary lobby groups (Hines, 2020; McLean, 2021). Several organisations have opposed these policies and laws, including the World Professional Association for Transgender Health, the American College of Physicians, and the American Academy of Pediatrics.
As noted above, trans youth are generally the people who are best informed about if and when they are ready to receive gender affirming hormone treatment. Research indicates that trans adolescents usually exhibit the relevant understandings and capacities to make decisions about their gender affirming hormone treatment (Clark and Virani, 2021). Also, regret rates for gender affirming hormone treatment are generally low in trans adolescents who have commenced puberty (Brik et al., 2020; Cohen-Kettenis and van Goozen, 1997; van der Loos et al., 2022).
Furthermore, delaying gender affirming hormone treatment until they are older can be associated with considerably more harms than benefits. Such a delay would cause one to undergo a puberty that is incongruous with one’s gender identity, which can worsen dysphoria and increase the need for more invasive interventions in adulthood. In a recent study, trans adolescents who had gender affirming hormone treatment delayed until they were older were shown to suffer from significantly higher rates of depression and suicidality than trans adolescents who received gender affirming hormone treatment promptly (Sorbara et al. 2020).