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A Comprehensive Defense of Trans People

2018.06.23 02:55 musicotic A Comprehensive Defense of Trans People

Credit to for some sources and inspiration for the title. I scoured hundreds of reddit posts, blog posts and news articles to get all this information.
I've been collecting dozens of scientific research and news articles on trans people for some time now, but I just realized that it was selfish to not share this research with others. All credit to the scientists!
I'm going to be using the terminology GCS (gender confirming surgery) for the post. Common synonyms are SRS, GRS. A warning that many of the studies use the terminology 'transsexual'.

Why Trans People Are Suicidal/Depressed: Society

  1. Being validated with the correct name, pronouns and documentation is associated with drops in suicide/depression [1] [2] [17] and delegitimization is associated with rises in suicide [9]
  2. Friend, social and familial support is associated with drastic reductions in suicidal ideation and depression [2] [3] [4] [5] [6] [17] [18]
  3. Gender-based violence is a factor that contributes to suicide [7] [10] [11]
  4. Internalized transphobia is sometimes a factor that contributes or leads to suicide [12]
  5. And seeking religious treatment is not effective, and actually increases the rate of suicide [13]
  6. Discrimination is generally linked with higher suicide rates [8] [17] [18], and can cause mental disorders [14], which are further connected to suicide [15]
  7. The kicker: After controlling for minority stress (discrimination) and access to healthcare (a proxy for poverty, and a measure of the ability to transition), trans people have a mental health quality of life similar to that of the general population [16]
[1] When trans youth are allowed to use their actual name, depression and suicide drops [2] Having a supportive family reduced suicide rates by 57% and access to legal documentation reflecting ones gender reduces suicide rate by 44% [3] Parental support is associated with a 93% reduction in suicide attempts [4] The ability to transition, along with family and social acceptance, are the largest factors reducing suicide risk among trans people. [5] Social support is a suicide protective factor [6] Familial support is associated with a better psychological and overall quality of life, and support from friends is associated with ab better quality of life in all other aspects [7] Individuals targeted on the basis gender have the highest risk for attempting suicide, Being physically attacked is associated with suicidal ideation and behavior. [8] Homelessness, lower income, discrimination, violence, lack of treatment (all of which have higher prevelancy among trans ppl) are contributing factors to suicide [9] Restricing teens to the bathroom of their assigned sex increases suicide rates [10] Gender-based victimization of transgender individuals is associated with suicide [11] Gender-related abuse is a significant psychiatric health problem that affects the suicide rate [12] Internalized transphobia is a factor in some suicides [13] Seeking religious/spiritual treatment increases likelihood of committing suicide [14] Discrimination as a cause of PTSD [15] The connection between PTSD and suicide [16] After controlling for minority stress and medical care, trans people have similar QOL (including mental health) [17] Social support, reduced transphobia & discrimination, having personal identification with the correct name and pronouns, and transitioning all significantly reduce suicide rates [18] A literature review that finds considerable support for the idea that social support reduces suicide and discrimination increases it among trans individuals

The Benefits of Transition - Debunking Some Myths

The scientific consensus is clear. Transitioning is the only scientifically-supported method of ameliorating gender dysphoria. (I'll be lumping together HRT, SRS and other treatments for this, but if anyone has any problems or wants me to, I can attempt to separate them). This is not to say that any one surgery is going to solve all of your problems, because as shown above, society has a significant impact on the well-being of transgender individuals.
I'll go into detail about the misinterpreted studies in a minute.
  1. Transition is associated with lower suicide ideation, attempts and rates [1] [2] [3] [4] [5] [6]
  2. Transition is associated with a lower rate of depression [7] [8] [9] [10]
  3. Transition is associated with improved anxiety, stress and distress levels [8] [9] [10] [11] [12] [13] [14]
  4. Transition is associated with a higher quality of life [9] [15] [16] [17] [18]
  5. Individuals undergoing transition are satisfied with their results
  6. The regret rate of various transition procedures is very low [20] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [37], ranging from 0% [24] to 0.6% [25] [26] to 2.2% [23], and has been decreasing with time [23] and are similar to that of other common surgeries [35]
  7. Undergoing transition increases sex satisfaction [37] [38] [39] [40] [41]
  8. Transition increases general mental health, reduces psychopathology and psychiatric disorders and symptoms [10] [13] [16] [21] [32] [36]
  9. Transition is safe and has little long-term side effects [42] [43] [44] [45] [46] This review summarizes the benefits of transition from the research
[1] Transition vastly reduces risks of suicide attempts, and the farther along in transition someone is the lower that risk gets. [2] Survey found that 70% were more satisfied after transition, 74% had better mental health, 63% had decreased self harming, and 63% had less suicidal ideation [3] Rate of suicide attempts dropped dramatically from 29.3 percent to 5.1 percent after receiving medical and surgical treatment among Dutch patients treated from 1986-2001. [4] “In a cross-sectional study of 141 transgender patients, Kuiper and Cohen-Kittenis found that after medical intervention and treatments, suicide fell from 19 percent to zero percent in transgender men and from 24 percent to 6 percent in transgender women.” Additionally, none of the patients regretted their decision to undergo GCS [5] A 2013 study of 433 trans people in Canada found that 27% of those who hadn’t begun transitioning had attempted suicide in the past year, but this dropped to 1% for those who were finished transitioning. [6] Studies show that there is ...a little more than 1% of suicides among operated subjects. The empirical research does not confirm the opinion that suicide is strongly associated with surgical transformation [7] Hormone treatment decreases depression by 10x [8] Most individuals had average scores on mood, satisfaction, depression and anxiety tests in a hostile environment after SRS [9] The research shows that hormone therapy reduces depression and anxiety to normal ranges, and is associated with a significant increase in the quality of life [10] Treated patients have less stress, anxiety, depression, psychological symptoms, etc [11] CHT decreases anxiety, depression and distress [12] CHT is an effective treatment for anxiety problems [13] SCL-90 scores (a test that measures anxiety, distress and hostility) resembled that of the general population after the initiation of hormone therapy [14] Transition is associated with a drop in stress levels, reaching stress levels within normal values [15] Hormonal therapy was significantly associated with a higher quality of life [16] Gender-affirming hormone therapy is a safe and effective way to improve quality of life and mental health outcomes for transgender adolescents [17] Undergoing CHT increased quality of life for all transgender people [18] Transition is associated with an increased quality of life and a high satisfaction rate [19] Satisfaction is 97% among trans men and 87% among trans women for gender confirming surgery in the 1990s before the advancement of the procedure [20] Trans individuals were overwhelmingly happy with their GCS results, said that GCS greatly improved the quality of their lives. None reported outright regret, and only a few expressed occasional regret [21] Patients had fewer psychological problems and interpersonal difficulties and a increased life satisfaction [22] Transition is successful at increasing body satisfaction and improving body image, which may alleviate eating disorders [23] Regret was about 2.2% and there was a significant decline of regrets over the time period. [24] More than 90% were satisfied, and no one reported regret after GCS [25] Only 0.6% of transwomen and 0.3% of transmen who underwent gonadectomy were identified as experiencing regret. [26] Out of 162 trans adults, only one reported that she would choose not to transition again, and another had some regrets but would choose to transition again, which yields a 0.6% regret rate [27] Out of 62 trans people who had undergone surgery, one woman said she occasionally regretted it, and continued to live as a woman [28] A study of 50 trans women who had received genital reconstruction found that only two felt regret sometimes [29] None were consistently regretful, and 6% felt regret sometimes [30] Studies show that there is less than 1% of regrets [31] None of the patients regretted their surgery [32] 1.6% of patients regretted their surgery and patients improved on 13 out of 14 mental health indicators [33] None of the patients experienced doubts about undergoing surgery [34] Among female-to-male transsexuals after SRS, i.e., in men, no regrets were reported in the author's sample, and in the literature they amount to less than 1%. Among male-to- female transsexuals after SRS, i.e., in women, regrets are reported in 1-1.5% [35] Regret rates are similar to/better than that of gastric bypass/banding surgery [36] A review of the literature: levels of psychopathology and psychiatric disorders improve with medical intervention and often reach normative values. Schizophrenia and bipolar have prevalences equal to that of the general population. [37] Trans men experience a better sex life after SRS and do not regret the surgery [38] Seventy-five percent had a more satisfactory sex life after SRS, with main complications being pain during intercourse and lack of lubrication. [39] "Sexual experience was considered to have improved by 83.3% of the patients, and became more frequent for 64.7% of the patients." [40] 80% report improvement in sexuality [41] "Based on the available literature, transsexuals appear to have adequate sexual functioning and/or high rates of sexual satisfaction following SRS" [42] Finds that there are little to no long-term side effects of transitioning [43] Transgender men did not experience important side effects such as cardiovascular events, hormone-related cancers, or osteoporosis [44] Hormone therapy is safe with medical supervision. There was no increase in mortality or cancer prevalance [45] The only side effect of hormone therapy is current ethinyl estradiol use (which is not commonly used anymore), causing an increase in cardiovascular risk of death [46] Mortality was not different from the general population and observed mortality was not linked with hormone therapy

Professional Opinions on Transgender Individuals and Transitioning

Master list from Lambda Legal: https://www.lambdalegal.org/sites/default/files/publications/downloads/ll_trans_professional_statements_17.pdf. This list includes the American Psychiatric Association, American Psychologist Association, AMA, The American Academy of Child and Adolescent Psychiatry, AAFP, AAPA, American College of Nurse Midwives, American College of Obstetricians and Gynecologists, APHA, NASW, National Commission on Correctional Health Care, WPATH
Another list: https://transcendlegal.org/medical-organization-statements
Royal College of Psychiatrists: http://www.teni.ie/attachments/14767e01-a8de-4b90-9a19-8c2c50edf4e1.PDF
Endocrine Society: https://www.endocrine.org/advocacy/priorities-and-positions/transgender-health
American Academy of Pediatrics: https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Statement-in-Support-of-Transgender-Children-Adolescent-and-Young-Adults.aspx
American Association of Clinic Endocrinologists: https://www.ncbi.nlm.nih.gov/pubmed/29320643
American College of Physicians: https://www.acponline.org/acp-newsroom/american-college-of-physicians-publishes-second-edition-of-the-fenway-guide-to-lgbt-health, https://www.acponline.org/acp-newsroom/acp-says-transgender-individuals-should-not-be-barred-from-military, http://annals.org/aim/fullarticle/2292051/lesbian-gay-bisexual-transgender-health-disparities-executive-summary-policy-position
American College of Surgeons: https://www.facs.org/find-a-session/session/13221, https://www.facs.org/member-services/ras/webinars/archive/transcare
American Academy of Neurology: https://journals.lww.com/neurotodayonline/fulltext/2017/04060/Medical_Societies,_Including_the_AAN,_Move_to.10.aspx
CDC: https://www.cdc.gov/lgbthealth/index.htm, https://www.cdc.gov/nchhstp/sexual-id-orientation.htm
National Association of School Psychologists: https://www.nasponline.org/assets/Documents/Research%20and%20Policy/Position%20Statements/Transgender_PositionStatement.pdf
Canadian Psychiatric Association: https://www.cpa-apc.org/wp-content/uploads/LGBTQ-2014-55-web-FIN-EN.pdf
American Geriatric Society: https://geriatricscareonline.org/ProductAbstract/american-geriatrics-society-care-of-lesbian-gay-bisexual-and-transgender-older-adults-position-statement/CL019
World Psychiatric Association: http://www.wpanet.org/detail.php?section_id=7&content_id=1807, http://www.hrc.org/blog/world-psychiatric-association-condemns-conversion-therapy-denounces-anti-lg
Royal Austrian & New Zealand College of Psychiatrists: https://www.ranzcp.org/Files/Resources/College_Statements/Position_Statements/PS-83-LGBTI-mental-health-2016.aspx
ICAPAP: http://iacapap.org/wp-content/uploads/H.3-GENDER-IDENTITY-Edition-2018.pdf This one is a bit of a stretch, but they mention "• Ethics and Access to Treatment for Transgender and Transsexual Issues" as one of their topics: https://www.escap.eu/bestanden/call_for_abstracts_2015_english_final.pdf
A session from the American Association for Geriatric Psychiatry: https://www.ajgponline.org/article/S1064-7481(18)30223-9/abstract?code=amgp-site
This guideline (https://www.endocrine.org/news-room/current-press-releases/experts-issue-recommendations-for-gender-affirmation-treatment-for-transgender-individuals) was co-sponsored by the American Association of Clinical Endocrinologists, American Society of Andrology, European Society for Paediatric Endocrinology, European Society of Endocrinology, Pediatric Endocrine Society and the World Professional Association for Transgender Health.

Depathologization

https://youtu.be/kyCgz0z05Ik and https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f411470068 - gender incongruence is being moved out of the mental health category in the next version of the ICD (from the WHO - World Health Organization - which is a body of the UN). It will also be declassified as a behavioral health disorder, and is no longer considered an 'illness' of any sort. There is no gender dysphoria in the ICD, and gender incongruence is the ICD's version of that (if you doubt that, it's implied in table 2 in this study)
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00022-X/fulltext, https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2816%2930165-1/fulltext - two studies going over the importance of and scientific behind depathologization
http://www.cnn.com/2012/12/02/health/new-mental-health-diagnoses/, https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf The DSM-V removed 'gender identity disorder' and replaced it with gender dysphoria & promoted destigmatization of being transgender, which can be compared to what the DSM did before depathologizing being gay.
https://www.scientificamerican.com/article/where-transgender-is-no-longer-a-diagnosis/ - Denmark declassifies it, and a summary of declassification in general

Sports

https://theestablishment.co/no-female-trans-athletes-do-not-have-unfair-advantages-14b8e249f93c - Trans women don't have an advantage in sports
http://www.upworthy.com/the-next-time-someone-says-trans-people-shouldn-t-get-to-play-sports-send-them-this - Trans people do not have an advantage
http://www.sportsci.org/2016/WCPASabstracts/ID-1699.pdf - analysis of race times
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357259/ - Review of the literature on sports and transgender people that concludes there is no evidence that transgender women and men have an advantage in sports

Curative Therapy

There isn't much research on curative/conversion therapy for trans individuals, but the evidence for LGB+ people is very strong. https://www.susans.org/wiki/Conversion_therapy and http://www.nclrights.org/bornperfect-the-facts-about-conversion-therapy/ sum it up very well
http://www.wpath.org/uploaded_files/140/files/IJT%20SOC,%20V7.pdf - "Treatment aimed at trying to change a person's gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical."
http://www.apsa.org/content/2012-position-statement-attempts-change-sexual-orientation-gender-identity-or-gender - "Psychoanalytic technique does not encompass purposeful attempts to "convert," "repair," change or shift an individual's sexual orientation, gender identity or gender expression. Such directed efforts are against fundamental principles of psychoanalytic treatment and often result in substantial psychological pain by reinforcing damaging internalized attitudes."

Trans Youth

Myth #1: Kids Will Change Their Minds / The Desistance Myth

The desistance myth is one of the most frustrating arguments made against transgender children. It's all based off of some research that has some significant methodological flaws. Many of the individuals included in the studies did not identify as transgender (two studies had 90% of the participants identify as their assigned sex), some studies concluded that a respondent had desisted if they did not follow up (Steensma 2011 and Steensma 2013), and many included very small sample sizes. (All from this book and this study). There is more recent research indicating that more than 96% of children diagnosed with gender dysphoria continue to identify as transgender as adults. Even the flawed research indicates something far lower than the commonly repeated trope of 80-85%: Steensma 2013 (critiqued above) reports 16%. Wallien and Cohen-Kettenis 2008 and Ristori and Steensma 2016 have multiple weaknesses that render their conclusions useless, and Steensma 2010 is also flawed
There are specific criteria to be diagnosed with gender dysphoria as a child.
The American Psychological Association's guidelines state:
The gender affirmative model supports identity exploration and development without an a priori goal of any particular gender identity or expression. Practitioners of the gender affirmative model do not push children in any direction, rather, they listen to children and, with the help of parents, translate what the child is communicating about their gender identity and expression. They work toward improving gender health, where a child is able to live in the gender that feels most authentic to the child and can express gender without fear of rejection.
There is a large body of researching indicating that gender identity is formed by the age of 3-5, possibly as early as 18 months, and that transgender children know what gender is, what they are identifying as and think of themselves as their gender identity:
Gender identity of transgender youth is deeply held and not the result of confusion. Transgender children view themselves as their expressed gender and are similar to cisgender children of their gender identity. (A more readable article). Transgender children develop similarly
Transgender teens that undergo gender reassignment do not experience regret. And all transgender children that underwent puberty suppression continued on to undergo hormone therapy
Transgender children endorse gender stereotypes less and see violations of gender stereotypes as more acceptable (Take THAT TERFs)

Myth #2: Kids "Are Rushed" Into Transition

This myth is based off of the faulty assumption that transgender youth under the age of 12 get some or any form of gender confirming surgery or hormone therapy. This is simply untrue. Common headlines like “4 year old youngest sex change” are masked in false claims and conflate social transition with surgery and hormones. The standard age for hormone therapy is 16 (Endocrine Society, Family court lawyers indicate that hormone therapy is typically attained at age 16, and the NHS recommends starting at 16 years of age). Research into ages of teens that being hormone therapy indicated a median age of 17.9 and 17.3 ranging from 13.3 to 22.3 years at one clinic and another clinic in Holland had mean age of initation of 16.4-16.7, with minimum ages ranging from 13.9-14.9. The typical minimum for GCS is 18 years of age (WPATH page 60, Unicare, and the ICD-10) and the lowest reported case is Kim Petras at 16. For chest reconstructive surgery, the mean age of surgery was 17.2, and only 3 patients were under 16 years of age.
Kids simply aren’t being rushed into transitioning.

Myth #3: Puberty blockers are harmful

This just simply isn't supported by the evidence. They are safe and not harmful to bone growth, and don't affect greater brain function. The few negative effects of puberty blockers do not change children's minds. Puberty blockers are also easily and permanently reversible, and this has happened successfully in the past before . No clinically significant effects on physiologic parameters were noted.
Both the Endocrine Society and WPATH recommend puberty suppression for transgender children.
Important evidence to consider is the evidence of the efficacy and safety of puberty blockers to treat children with precocious puberty. GnRH is safe in children with precocious puberty. There is no negative impact on bone mineral density or reproductive function and the treatment did not cause or aggravate obesity. Two years after therapy, bone mineral density and BMD scores for bone age and chronological age were normal, and percentage body fat reached normative values one year after treatment. Menstrual pattern was normal, BMD was normal after treatment, and hormonal values, ovarian and uterine dimensions were normal after treatment.. Long-term leuprorelin treatment had no effect on reproductive function. There is little to no evidence of long-term changes resulting from GnRH agonists. Psychosocial problems are improved with puberty blockers, as well as a reduction in loneliness and behavioral problems. Treatment has no effect on BMI
There is significant evidence that puberty blockers can improve children’s quality of life and in some cases, save children’s lives

Myth #4: There is no need to transition

Gender dysphoria has been documented to harm mental health and create psychological distress. Social transition has been shown to ameliorate this distress and normalize mental health outcomes:
Well-being (of transgender children after puberty suppression) was similar to or better than same-age young adults from the general population.
Early transition virtually eliminates these higher rates of depression and low self-worth
Transition dramatically improves mental health among trans kids
Olson found that kids that transition have no elevation in depression and slight elevation in anxiety.
The younger one transitions, the fewer problems one will have
Adolescents who have gender confirmation surgery alleviate gender dysphoria and function psychologically and socially well, none having regrets
(TODO: Find Olson's new study that showed her previous research was flawed due to using parental data on child mental health)
If any links are broken, I have any typos or any incorrect statements, please notify me in the comments. If a full article is inaccessible, use outline.com and if a full study/research article is inaccessible, use sci-hub.tw. If you have studies to add or further information, feel free to chime in in the comments and I’ll add it to the post. If there are any topics you think I should cover, please ask.
Since this post is over 40,000 characters, I will have to finish it in the comments.
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