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(Chinese translation by Xavier Chua)
- Murad等，2010：“……治疗后自杀未遂率显着下降。平均减少量从治疗前的30％降至治疗后的8％。 …对28项研究的荟萃分析显示，有78％的跨性别者经过治疗后心理功能得到改善。”
- De Cuypere等，2006年：在1986年至2001年间接受治疗的荷兰患者中，自杀未遂率从29.3％大幅度下降至5.1％。
- 英国研究：“过渡后，自杀念头和实际尝试次数减少了，有63％的人在过渡前更多地考虑或尝试自杀，而只有3％的人在过渡后更多地考虑或尝试自杀。有7％的人发现过渡期间时考虑或尝试自杀，这意味着要给予经历这些过程的人支持（N = 316）。”
- Kuiper，1988年：Ryan Gorton博士：“在对141名跨性别患者的横断面研究中，Kuiper和Cohen-Kittenis发现，经过医学干预和治疗，跨性别男人的自杀率从19％下降到零，而在跨性别女人当中，自杀率从24％下降到6％。）…在整个LGBT群众中，自杀驱动因素中有很大部分是少数民族所受的压力。”
- 美国医学学生协会（American Medical Student Association），2010年：对所有可用研究的荟萃审查发现，接受性别重置手术的总体遗憾率<1％。
- de Cuypere，2006年：1986年至2001年在比利时接受性别重置手术的107名跨性别者中，他们发现没有人感到遗憾。
- 手术结果差或不令人满意（随着技术的不断进步，这种情况变得越来越不普遍； MTF生殖器手术并发症的风险现在降至1％）
约翰•霍普金斯（Johns Hopkins）确实曾经暂时停止为跨性别者提供与过渡相关的医疗保健，但这是由于他们当时的董事保罗•麦克休（Paul McHugh）博士，一位原教旨主义天主教徒，因宗教信仰而不是因为医学上的原因反对过渡。他提出来支持他的观点的许多观点在本页上都被揭穿了，例如，允许跨性别者过渡可能会增加自杀风险并恶化心理健康等的误解。
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Myth: People only become transgender when they transition
Anyone with a gender identity that’s at odds with their birth-identified sex is transgender, regardless of whether they have taken any steps to socially or medically transition. A transgender man is a man even if his body still looks female and he lives as a woman, just like how a cisgender man who gets castrated or who puts on a dress is still a man. Gender identity is not defined by how you dress or what body parts you have.
Myth: Transitioning makes people suicidal
While transgender people have a vastly elevated risk of suicide (a 2011 survey found that 41% of trans people in the US had attempted suicide, vs. national average of 1.6%), transitioning significantly reduces this risk. It does not cause it.
The main source of the myth is a 2011 Swedish study which found that people who had undergone sex reassignment surgery (SRS) before 1989 had a suicide rate 20 times that of the general population.
However, this did not consider trans people who had not undergone SRS. The study itself clarifies: ”The results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment.”
Notably, they found that trans people who had SRS after 1989 had similar rates of suicide as the rest of the population, and attributed this to greater social support and acceptance. They also found no elevated risk among transgender men even before 1989, which would make sense in light of how it is trans women who receive greater abuse from society.
The study’s lead author, Ceceilia Dhejne, denounced the popular misinterpretation of her work. She said that she strongly supports transition for trans people, citing the numerous sources supporting its benefits.
It is expected that transgender people would have a higher suicide rate. This is due both to the internal distress from gender dysphoria as well as external abuse. A majority report having experienced verbal, physical or sexual assault for being transgender, where this may be on-going in case of youth living with unsupportive family. Many also get disowned, fired from jobs and made homeless, resulting often in poverty, elevated risk of mental illness and drug abuse, all of which are factors strongly correlated with suicide risk.
The 2011 survey linked above included factors that raised the suicide risk for trans people: losing a job due to bias (55%), harassment and bullying in school (51%), physical assault (61%) and sexual assault (64%).
Another misinterpreted study is a 2014 report by the Williams Institute at UCLA. They found that those who had undergone medical transition had a higher lifetime suicide attempt rate than those who had no desire to pursue medical transition.
Some people again took this to mean that it was transitioning that made them suicidal. However, these were lifetime suicide attempts. It did not take into account whether those attempts were before or after transition. It would be expected that trans people with the most severe gender dysphoria would have both been more suicidal as well as more likely to have pursued medical transition, compared to those with milder or negligible dysphoria who saw no need for that.
In line with that interpretation, the study found that trans people who wanted but had yet to pursue medical transition had the highest lifetime suicide attempt rates of the three groups.
When we directly measure the effects of transition within the transgender population itself, transition is found to be a major protective factor against suicide. (Bolds added for emphasis):
- Murad, et al., 2010: “…significant decrease in suicidality post-treatment. The average reduction was from 30 percent pretreatment to 8 percent post treatment. … A meta-analysis of 28 studies showed that 78 percent of transgender people had improved psychological functioning after treatment.”
- De Cuypere, et al., 2006: 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.
- UK study: “Suicidal ideation and actual attempts reduced after transition, with 63% thinking about or attempting suicide more before they transitioned and only 3% thinking about or attempting suicide more post-transition. 7% found that this increased during transition, which has implications for the support provided to those undergoing these processes (N=316).”
- Kuiper, 1988: Dr. Ryan Gorton: “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.) … a significant proportion of the drivers of suicide in the LGBT population as a whole is minority stress.”
(Note: While some of the studies mention that their data is of low quality, this has to do with the inherently subjective nature of reports of suicidal thoughts or attempts, as well as the lack of controls, which would be unethical as it would require deferring treatment and waiting to see which subjects kill themselves. However, the largest study to date on the lifetime suicide attempt rate of the general trans population places it at around 40%. The fact that these studies of medically transitioned trans people show rates significantly under 40% (and none above) thus indicate the positive impact of transition.)
Supportive family also makes a big difference. In a 2012 study of 433 transgender youth, those who had parents who were supportive of their identities and transition reported only a 4% attempted suicide rate, vs. 57% for those with unsupportive parents.
In fact, transgender youth who underwent medical intervention at puberty were found to score similar or better on measures of mental well-being, compared to their non-trans peers (deVries et. al, 2010).
In short, while transgender people have a significantly higher rate of suicide than people who aren’t trans, the most effective way to lower this rate is to allow them to transition.
Myth: Transitioning doesn’t treat the root of the problem and worsens mental health
The opposite is true. In fact, the longer gender dysphoria goes untreated, the more likely the person is to develop mental illnesses with time.
Cornell University produced a meta review of all 52 peer-reviewed studies published between 1991 and June 2017 concerning the effects of transition on the well-being of transgender people. They found that 93% of studies showed that transition was beneficial, with the remaining 7% being inconclusive.
Some results are as follows:
- Ainsworth & Spiegel, 2010: Transgender women who had undergone relevant surgeries were found to have mental health scores comparable to women in general, while those who were not able to access care scored much lower on mental health measures.
- Asscheman, 2014: Reduction in depression from 24.9% to 2.4% for trans women, and 13.6% to 1.4% for trans men.
- Heylans et al., 2014: The most prominent decrease in measures of distress, anxiety and stress was observed upon the initiation of hormone therapy, after which scores resembled that of the general population.
- Colizzi et al., 2013: At enrollment, subjects experienced highly elevated levels of CAR (cortisol awakening response – a physiological measure of stress) as well as higher levels of perceived stress. One year after hormone therapy was initiated, CAR levels and reports of perceived stress had both fallen to within normal range.
- Gomez-Gil et al., 2012: Scores of depression and anxiety were significantly higher on untreated patients compared to those who had begun cross-sex hormone treatment; symptoms of anxiety and depression were present in a significantly higher percentage of untreated patients than in treated patients (61% vs. 33%, and 31% vs. 8% respectively).”
Right now, there are over 100 similar studies reporting improvements in various aspects of mental health and well-being as a result of medical transition for transgender people. More of those are collected here:
Myth: Transgender people are just self-hating gays
While hostile social attitudes towards gay people lead many of them to repress their attractions, it is uncertain why this fear or self-hatred would push them towards transitioning – because society tends to be even more hostile towards transgender people.
This would also not account for the many transgender people who become seen as gay after transition, when they would have been previously seen as ‘straight’. Statistically, transgender people are much more likely to be LGB in their post-transition identities.
In other words, one cannot argue that homophobia is pressuring masses of feminine gay men to transition to supposedly easier lives as feminine straight women, when masses of people originally perceived as feminine straight women are transitioning to live as feminine gay men, apparently undaunted by that very same social homophobia.
Myth: Most people regret transitioning / surgery
This is untrue. The regret rate for sexual reassignment surgery ranges from about 0-2%, as reported by most recent studies on the subject.
(As a comparison, the regret rate for cosmetic surgery hovers at around 65% in the UK.)
- American Medical Student Association, 2010: A meta review of all available studies found an overall <1% regret rate for SRS.
- Dhejne, 2014: Among the 767 transgender people in Sweden who transitioned from 1960-2010, the overall regret rate for sex reassignment surgery was 2.2%. This figure was observed to steadily decrease over the years as medical techniques improved (leading to fewer health complications) and social acceptance grew. The author also notes that some regret cases were due to patients feeling pressured into unwanted surgery so as to be able to change their legal sex, and that those who regretted surgery did not necessarily regret transition.
- de Cuypere, 2006: Among 107 trans people who underwent SRS in Belgium from 1986-2001, they found zero regrets.
- Michel, 2002: Among trans people in France, the regret rate for SRS was under 1%.
- Smith, 2005: A study of 162 trans people who underwent SRS had 2 patients who cited regrets (1.2%). Both were transgender women who were not attracted to men, and who suffered mental health problems and low levels of body satisfaction – all of which impeded their ability to blend into society.
Among those who did regret surgery or transition, as well as those who detransitioned, commonly cited reasons include:
- Inability to cope with the abuse from family, friends and society that they experienced as a result of transitioning; being subject to homelessness, poverty, unemployment, assault; loneliness, especially the difficulty in developing romantic relationships
- Changing political or religious views on gender, particularly regarding the validity/morality of transgender identities and transitioning
- Misdiagnosis – either due to a mental illness which confounded the results, or a case where gender non-conformity was mistaken for a transgender identity
- Realising their gender dysphoria was due to past trauma (especially sexual abuse or the fear of such) or internalised misogyny, rather than a genuine identification with or desire to be another sex; in some cases, trauma counselling solved the dysphoria
- Internalised transphobia (e.g “I’ll never be a real woman”) and finding it preferable or more honest to struggle with dysphoria than live as a transitioned transgender person
- Mistaking the desire not to be their assigned sex for a desire to be the other sex
- Realising they were actually non-binary, and/or just as uncomfortable with a body more typical of the ‘other’ sex
- Having felt pressured into transition or into taking transition steps they did not want, especially surgery. Some had not desired sex reassignment surgery in the first place (perhaps due to cost, dissatisfaction with current technology, lack of genital dysphoria, a desire to retain fertility, etc) but were pressured into doing so by doctors, gendered body ideals or romantic/sexual partners, or as a requirement to change legal sex (as is currently the case in Singapore)
- Sadness at loss of fertility, due to wanting to have their own biological children
- Poor or dissatisfactory surgical outcomes (which is becoming less common as technology continues to improve; the risk of complications for MTF genital surgery is now down to 1%)
- Inability to ‘pass’ as cisgender, leading to diminished quality of life and fears for safety
Straight transgender people frequently report much better outcomes than those who have to navigate life as an LGB person after transitioning, due to the impact of social homophobia.
Among misdiagnosed cases, the most notable is Walt Heyer, who suffered from undiagnosed Dissociative Identity Disorder due to childhood trauma. One of his multiple personalities was that of a woman. He was wrongly diagnosed as transgender, whereupon he was encouraged to pursue sex reassignment surgery he did not actually want. He underwent the surgery but found it extremely traumatic. He sued the doctors who treated him for malpractice, and is convinced that because they were wrong in his case, no transgender person should be allowed to transition. He now actively advocates against transitioning, repeatedly positioning himself as an example of regret, despite not being anywhere near representative of a typical transgender person.
Another well-known case is that of Sam Hashimi, a rich property tycoon who suffered a mental breakdown after he broke up with his wife. In his mid-life crisis that followed, he decided that women had it easier in life and he wanted to be one. His wealth and connections allowed him to bypass a lot of the usual obstacles to transitioning and get what he wanted, only to find himself responding badly to hormone therapy and growing increasingly depressed and dysphoric at living as a woman. He thus detransitioned back to living as male. His story is also far from representative of transgender people who transition out of rather than into gender dysphoria, and who are motivated by the need to express their gender identity.
There are a few cases where those who detransitioned found that things were not much better, or to find their gender dysphoria returning – sometimes resulting in them re-transitioning all over again. Some of them were willing to tolerate this, especially if the detransition was due to political or religious beliefs that considered transitioning a cop-out or a sin.
Others detransitioned because they decided that they were more comfortable as their original assigned sex. Not all of them consider this detransition, but rather a further step in aligning their bodies with their self-image. Some still identify as transgender, while others are happy with their bodies and have returned to identifying as their assigned sex.
We advocate that everyone who is considering transition first see a qualified counsellor and carefully consider your motivations for desiring transition. Here are some questions you may wish to ask yourself.
Myth: Johns Hopkins doctors discovered that medical transition harmed rather than helped transgender people and thus stopped providing such services
While it is true that Johns Hopkins temporarily stopped providing transition-related healthcare to transgender people, this was due to their director at the time, Dr. Paul McHugh – a fundamentalist Catholic with religious rather than medical objections to transition. Many of the points he raised to support his view are debunked on this page – for instance, that allowing transgender people to transition increases suicide risk and worsens mental health.
Johns Hopkins has since distanced themselves from his views and spoken out against them. They have also resumed providing transgender healthcare and surgeries.
Myth: Transgender people cannot know for sure what gender they are until they hit puberty / 18 years old
Many people wrongly assume gender identity is a by-product of sexuality. This also sometimes leads to accusations that any child who expresses a transgender identity must have been sexually abused. This is not true. Gender identity exists independent of sexuality. Children do not need to know what sex or sexual attraction is in order to tell you if they’re a boy or a girl, and are typically able to do so long before they turn 18.
The same is true for transgender children. The only difference is that their expressed gender identity may differ from what’s typical for their body type, and they may find their bodies distressing as a result.
Gender identity in humans forms around the age of 3. Many transgender adults were aware of having an atypical gender identity from early childhood, even if they may not have had the words for it.
A 2015 study exploring subconscious gender identity in children found that transgender children experienced their gender identities in ways indistinguishable from their non-trans peers. In other words, a transgender girl ‘feels’ like a girl in the exact same way other girls do.
Other transgender children may not experience as severe gender dysphoria, or be afraid to say anything, or be unaware that it is possible to be a gender other than what their bodies suggest. They may not understand themselves to be transgender until much later in life, but that is not a result of them changing their gender identity so much as taking a longer time to discover it.
Regardless, even if a transgender child may be unaware of the complex nuances of what being a particular gender means, they are able to tell when something feels wrong or causes them distress. There is no harm in taking steps to alleviate that distress, especially when it is prolonged and consistent; refusing to take action often leads to worse outcomes.
Myth: The vast majority of transgender children cease to be transgender in adulthood
In discussions of transgender children, particularly those who are transitioning, people often bring up the claim that 75/80/90/98/99.8% of transgender children will not remain transgender as adults. Many people are hence are against letting them transition in childhood for fear of setting them onto a path that could otherwise be avoided.
However, the studies that these statistics came from studied small sample sizes of children who had been diagnosed with Gender Identity Disorder (GID) in the 80s and 90s. At that time, the diagnostic criteria primarily defined GID children as those who expressed a strong pattern of gender-atypical play and interests. It did not always require children to claim to be or desire to be the other sex. Many children in those studies were feminine boys and masculine girls, whose expressed unhappiness with their gender had more to do with the ill-fitting expectations placed on them because of it.
This is one of the studies often cited as evidence. The study followed 25 girls, of which only 15 met the diagnostic criteria for GID; the remaining 10 were considered ‘sub-threshold’ cases. At follow up 14 years later, only 3 of the 15 were found to be transgender. However, most if not all of these girls would have been originally diagnosed under the DSM-III or IV, the former of which described GID in girls as follows:
Girls with this disorder regularly have male peer groups, an avid interest in sports and rough-and-tumble play, and a lack of interest in playing with dolls or playing “house”.
This could easily describe the average tomboy. While (unlike the DSM-IV) the DSM-III required that children also express a strong, persistent desire to be the other sex, it is not very surprising that many tomboys would have expressed a wish to be a boy, given the much more rigid gender stereotypes back then. This paper detailed a case study (page 6) of a young girl who was insistent on wanting to be a boy and had met all the DSM-IV diagnostic criteria for GID. But when asked why she wanted to be a boy, she said it was because she liked boy’s underwear. She said that girls couldn’t wear boy’s underwear, so she wanted to be a boy.
Likewise, a boy who is told that he can’t play with dolls because only girls do that might react with: “then I want to be a girl!” However, his actual desire here is to play with dolls, not to actually be a girl, and the diagnostic criteria did not distinguish between the two.
Other studies follow a similar pattern. Meanwhile, many transgender children did not qualify for a diagnosis because they weren’t deemed masculine or feminine enough.
Partly to filter out these false positives, the diagnostic criteria were later revised to de-emphasise gender-atypical traits and place the focus instead on the persistent insistence that one was or wanted to be another gender. That is the defining feature of a transgender identity, especially when accompanied by clear distress that stretches out over a long period of months or years. If a female child expresses a strong desire to be male, and this distress and desire abates when allowed to play with ‘boy’ toys and wear more masculine clothes, it’s likely that she is just a tomboy; however, if all those actions still fail to resolve the distress, chances are that this is a transgender boy.
(You can read more about this here.)
Myth: Being transgender is the result of bad parenting
It is common for parents to blame themselves or feel guilty upon learning that their child is transgender. They may try and figure out what they might have done ‘wrong’ for their child to end up this way. However, there is no known correlation between parenting styles and gender identity, where the evidence currently points strongly towards biological – particularly hormonal – influences during prenatal development.
Some parents worry that they were too strict in enforcing gender roles, resulting in a child that felt they had to be another gender in order to freely be themselves. Conversely, other parents worry that they weren’t strict enough in enforcing gender roles, resulting in a child whose gender-atypical behaviour wasn’t stamped out before it could develop into a transgender identity. For every parenting style, there are parents who did the exact opposite and still ended up with a transgender child. Trans people come from families that are conservative and liberal, religious and non-religious, rich and poor, loving and abusive, across all classes and races and cultures.
There is some weak evidence that being transgender runs genetically in families. It is not uncommon for more than one sibling to be transgender, or for a parent to eventually come out as transgender after their child does so, admitting that they had been repressing it all these years. Multiple members of an extended family may turn out to be transgender, even those who had no idea the others existed. There is also some link to non-heterosexual orientations, where trans people are more likely to have family members that are LGB; one trans woman discovered that all three of her sons from a previous marriage were gay.
Myth: Leading American pediatricians have declared letting children transition to be child abuse
A statement from the official-sounding American College of Pediatricians (ACPeds) refuted the legitimacy of transgender identities and declared that letting transgender children transition was child abuse.
However, unlike the American Academy of Pediatrics, which has a membership of over 64,000 pediatricians, the ACPeds is not an official medical institution. It is a small fringe group of about 60-200 people that was established with the explicit goal of pursuing an anti-LGBT agenda.
You can read a point-by-point debunking of their points in this article. Snopes also debunked their claims, along with a presentation from the actual American Academy of Pediatricians supporting an affirming approach to gender non-conforming children. They advise that parents provide their child with an accepting, supportive environment that will best let them thrive as they are, regardless of whether or not they turn out to be transgender.
For those who continue to assert a cross-sex identity and express a desire to transition, the AAP notes the positive outcomes in transgender children allowed to socially transition:
In sum, we provide novel evidence of low rates of internalizing psychopathology in young socially transitioned transgender children who are supported in their gender identity. These data suggest at least the possibility that being transgender is not synonymous with, nor the direct result of, psychopathology in childhood. Instead, these results provide clear evidence that transgender children have levels of anxiety and depression no different from their nontransgender siblings and peers.
Myth: Transgender women commit sexual assault at a similar rate as cisgender men
In the same 2011 study referenced earlier on this page, researchers found that transgender men and women in Sweden who transitioned from 1973-1988 had a similar rate of criminal convictions (including for violent crime) as cisgender male controls.
This data has been twisted to claim that transgender women rape other women at a similar rate as men, and should thus be prevented from accessing female spaces for safety reasons. This is a complete misinterpretation of the study. It also does not explain why such people are often fine with having transgender men in female spaces, given that they also exhibited the exact same crime rate.
As clarified by the study’s lead author, Cecilia Dhejne, the study did not account for different conviction types but referred to number of convictions for crime in general. There is no way to know what the statistics were for a specific crime, such as rape.
Other factors that further complicate the data include:
- Crime often correlates strongly with poverty, homelessness and unemployment, all of which disproportionately affect transgender people. It is thus expected that there would be a higher incidence of related crimes such as robbery, theft, prostitution and drug abuse, which would naturally inflate the crime rate.
- Related to the above, poorer areas are often more heavily policed, leading to a higher rate of arrests and convictions than areas with a lower police presence.
- Due to discrimination, lack of social power and increased visibility, transgender people might be more likely to get arrested and convicted for crimes, especially in corrupt law enforcement systems.
More importantly, the study states that no such elevation in crime rates was observed in transgender people who transitioned from 1989-2003. The researchers ascribe this to improved physical and mental health care, and greater social acceptance of transgender people in Sweden.
If instead it were true that transgender women were inherently more prone to crime due to being ‘really’ men, it would not explain why these elevated rates were only observed in those who transitioned before 1989 – after which they exhibited similar crime rates as cisgender female controls.
Myth: Transgender men transition to escape sexism and/or gain male privilege
Even before transition, transgender men already have some male privilege by virtue of being men and looking at the world from that perspective, although this is tempered both by transphobia and when not perceived by others as men.
In transitioning and giving up the ability to pass as cis women, transgender men also lose cis-passing privilege (and in some cases straight privilege). They additionally become subject to transphobia, which often puts them in a worse social position than before.
Even if it’s considered morally better for trans men to not transition and suffer in solidarity with women, it would be a double standard if we don’t then expect cisgender men to transition to female to do the same. That would in fact be the more logical choice if the goal is indeed to reduce cumulative male privilege, which cis men have the most of and benefit the most from. Meanwhile, nothing less than full support of trans women would make sense, which makes it inconsistent that those who subscribe to this view are also often against trans women.
Lastly, if women were indeed transitioning just to escape misogyny and sex-related trauma (such as rape), it says a lot more about society’s treatment of women that it would drive them to those extremes. The focus should then be on fixing society, not on further victimising those who are merely trying to escape; that would be addressing the symptoms of a problem, not the root.
Surely the best course of action would thus be to work to make society better for women and see if this reduces the number of trans men. If trans men are distressed at being female, sometimes to the point of suicide, but find that they can live happy, fulfilling lives as men who would be much better placed to work alongside women for equality, it would be both cruel and counterproductive to deny them transition and insist they suffer instead. It would also position womanhood as something to be meted out as punishment and manhood as freedom that is gifted solely to those born with it. Political ideologies should not be enforced at the cost of human lives, especially when doing so results in no conceivable good.
Myth: Transgender people do not want to be treated as men or women, but a separate gender
Generally speaking, transgender men wish to be treated like other men, and transgender women like other women, with the corresponding pronouns and modes of address (sir, madam, brother, sister, etc).
Another subset of transgender people are currently known as non-binary, and do not identify as men or women. Their desire to be seen as a separate gender (or a mix, or neither) is due to being non-binary, not due to being transgender.
Transgender people who actively identify themselves as trans do so in addition to rather than instead of being men, women or non-binary, much like how someone might describe themselves as both Malay and a woman.