性别认同与出生时的性别不一致的任何人都是跨性别者，无论他们是否已采取任何社会上或医学上性别过渡的步骤。变性男人是男人，即使他的身体看起来仍然是女性，性别表达上也是女性，就和一个历经睾丸切除术或穿着裙子的顺性男人仍然是男人一样。性别认同不取决于您的衣着或您所有的身体部位。

虽然跨性别人士本有大幅度自杀的风险（2011年的一项调查发现，美国41％的跨性别人士曾尝试自杀，而全国平均水平为1.6％），过渡大大降低了这风险。它不会导致它。

误解的主要来源是一项2011年的瑞典研究，该研究发现1989年之前进行过性重新分配手术（SRS）的人的自杀率是普通人群的20倍。

但是，这并未考虑未经历过性别重置手术的跨性别者。该研究本身澄清说：“本研究的结果不应该被解释为性别重置手术本身会增加发病率和死亡率。如果没有经过性别重置手术，情况可能会更糟。”

值得注意的是，他们发现1989年后接受性别重置手术的跨性别者的自杀率与其余人口相似，并将其归因于更大的社会支持和接受度。他们还发现，即使在1989年之前，跨性别男人中的风险也没有升高，这从跨性别女性如何受到社会更多虐待的角度来看是有道理的。

该研究的主要作者塞西莉亚•德涅（Cecelia Dhejne）谴责了人们对其作品的普遍误解。她说，她大力支持跨性别者过渡，并引用了众多过渡给予跨性别人福利的资料。

跨性别者的自杀率预计比常人高。这既是由于性别焦虑症造成的内部困扰，也因为受别人虐待。多数的跨性别者报告曾因变性而遭受口头，身体或性侵犯，若是青年与不支持他的家人所过的家庭生活中，这是会持续下去的情况。许多跨性别者也被家人舍弃，被解雇，从而失业，无家可归，从中导致贫穷，精神疾病及吸毒等的风险增加，所有这些因素均与自杀风险密切相关。

上面链接的2011年调查包括增加跨性别者自杀风险的因素：由于偏见而失业（55％），在学校中的骚扰和霸凌（51％），人身攻击（61％）和性侵犯（64％）。

另一个被误解的研究是加州大学洛杉矶分校威廉姆斯学院的2014年报告。他们发现，经历过医学过渡的人终生自杀未遂率要比那些不想进行医学过渡的人高。

有人再次认为这是过渡使他们自杀。但是，这些都是终身尝试自杀的次数。它没有考虑这些尝试自杀的次数是在过渡之前或是之后。与较轻度或几乎没性别不安的人相比，性别不安最严重的跨性别者更容易自杀，并且更可能追求医学过渡。

根据这种解释，研究发现，想要但尚未进行医学过渡的跨性别者在这三组中拥有最高的终生自杀未遂率。

当我们直接测量跨性别人群自身内部过渡的影响时，发现过渡是抵抗自杀的主要保护因素。 （为强调起见，添加了粗体）：

• 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。”

（注：尽管一些研究提到其数据质量低下，这与自杀念头或企图的报告的内在主观性以及缺乏对照组有关，因为要求推迟治疗并等待观察哪些受试者自杀是不道德的。然而，迄今为止，有关最大跨性别人群终生自杀未遂率的最大研究表明，其自杀率约为40％。因此，这些受医疗过渡的全性别人士在研究中自杀率少过40％（以上都没有）代表过渡给予正面的影响。）

家庭的支持也给予很大的帮助。在2012年共有433名跨性别青年的研究中，那些拥有支持其身份和过渡的父母的人所报告的自杀率仅为4％，而没有父母支持的人的自杀率为57％。

实际上，与未跨性别的同龄人相比，在青春期接受医学干预的跨性别青年在心理健康方面的得分相似或更好（deVries等人，2010）。

简而言之，虽然跨性别者的自杀率要比非跨性别者高得多，降低这自杀率的最有效方法是让他们过渡。

反之亦然。实际上，性别焦虑症得不到治疗的时间越长，人患精神疾病的可能性就随着时间的流逝越大。

康奈尔大学对1991年至2017年6月间发表的所有52篇经同行评审的研究进行了元审查，关于过渡对跨性别者幸福感的影响。他们发现93％的研究表明过渡是有益的，其余7％尚无定论。

一些结果如下：

• Ainsworth＆Spiegel，2010年：发现接受过相关手术的变性女性的心理健康得分与一般女性相当，而那些无法获得医疗服务的女性在心理健康方面的得分要低得多。
• Asscheman，2014年：跨性别女性的抑郁症从24.9％降低到2.4％，而跨性别男性的抑郁症从13.6％降低到1.4％。
• Heylans等人，2014年：荷尔蒙治疗开始后，观察到的困扰，焦虑和压力量度下降最为明显，其后的得分与普通人群相似。
• Colizzi等人，2013年：注册时，受试者的CAR水平（皮质醇唤醒反应–压力的生理指标）高度升高，并且感知的压力水平更高。激素治疗开始的一年后，CAR水平和感知的压力报告均降至正常范围以内。
• Gomez-Gil等人，2012年：与未进行跨性别激素治疗的患者相比，未经治疗的患者的抑郁和焦虑得分显着更高；未经治疗的患者中焦虑和抑郁症状的比例明显高于接受治疗的患者（分别为61％比33％和31％比8％）。”

目前，有超过100项类似的研究报告说，由于跨性别者的医疗过渡，其心理健康和福祉方面得到了改善。这里收集了更多这些信息：

• 激素治疗的效果
• 性别再分配手术的效果

尽管对同性恋排斥的社会态度导致其中许多人压抑自己的性倾向，但这种恐惧或自恨会促使他们迈向过渡的没有一个能够确定的原因，因为社会往往对跨性别者怀有更大的敌意。

这也不能解释为何许多跨性别者在过渡后被视为同性恋，而之前他们会被视为“异性恋”。从统计上讲，跨性别人士在其过渡后身份中更可能身为同性或者双性恋者。

换句话说，同性恋恐惧症不可能迫使大量的男同性恋者过渡为异性恋的女性来过着更轻松的生活，而最初被视为异性恋的女性的人正在过渡为同性恋的男性，这相同的社交同性恋恐惧症显然并不令人畏惧。

这是不正确的。最新的研究表明，进行性交手术的遗憾率约为0-2％。

（相比之下，在英国的整容手术遗憾率徘徊在65％左右。）

• 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％。
• Dhejne，2014年：在瑞典从1960年至2010年过渡的767名跨性别者中，进行性别重置手术的总体遗憾率是2.2％。随着医疗技术的改善（导致更少的并发症）及社会认可度的提升，多年来该数字稳步下降。作者还指出，有些后悔案例是由于患者感到被迫接受不必要的手术以能够改变其合法性别，而其后悔动手术的人并不一定后悔过渡。
• 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。
• Michel，2002年：在法国的跨性别者中，性别重置手术的遗憾率不到1％。
• Smith，2005年：一项针对162位接受性别重置手术的跨性别者的研究有2位患者表示遗憾（1.2％）。两位都是跨性别女性，她们并没被男人吸引，患有心理健康问题，并且有较低的身体满意度，这阻碍了她们融入社会的能力。

那些对手术或过渡感到遗憾的人以及去性别转换的人，通常提及的原因包括：

• 无法应对因过渡而遭受的家人，朋友和社会的虐待；遭受无家可归，贫穷，失业，殴打，孤独感，尤其是在发展浪漫关系上的困难
• 关于性别的政治或宗教观点有所改变，尤其是关于跨性别者的身份是否有应用性或是道德上的问题，以及过渡
• 误诊，由于精神疾病混淆了结果，或者是由于不符合性别角色被误认为跨性别身份的一个情况
• 意识到自己的性别不安是由于过去的创伤（尤其是性虐待或对此类行为的恐惧）或内在的厌女症，而不是真正认同或渴望成为另一种性别；在某些情况下，创伤咨询解决了烦躁不安
• 内在的跨性别恐惧症（例如“我永远不会成为真正的女人”），认为过着对于自己的身体焦虑不安的生活反而比较诚实
• 将不愿作为自己生理性别的欲望误认为自己是异性
• 意识到他们实际上是性别酷儿的，并且/或者对于拥有典型的异性的身体感到不舒服
• 感到迫于压力要过渡或采取他们不希望的过渡步骤，尤其是手术。有些人从一开始就不希望进性别重置手术（可能是由于成本，对当前技术的不满，对生殖器并不感到焦虑或烦躁，希望保留生育能力等原因），但医生给予压力，性别观念理想或浪漫/性伴侣，或改变合法性别的需求（目前在新加坡就是这种情况）
• 由于想要自己的亲生子女而对于失去生育能力那方面感到悲伤
• 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％）
• 外表无法像顺性人一样，从而导致生活质量下降和对自身安全的担忧

由于社会上常见的同性恋恐惧症的影响，异性恋者通常报告的结果要比那些在过渡后要过同性或双性恋生活的人要好得多。

在被误诊的病例中，最引人注目的是沃尔特•海耶尔（Walt Heyer），他因儿童时期的创伤而遭受未确诊的分离性身份障碍。他的多重性格中有一位是女人。他被错误地诊断为跨性别者，于是医生鼓励他去做他实际上不想要的变性手术。他接受了手术，但觉得手术极具创伤性。他起诉治疗他的医生有不当行为，并坚信因为他自身的情况进行过渡手术是错误的，所以不应允许任何跨性别者过渡。现在，他积极倡导反对过渡，一再将自己定位为遗憾的榜样，尽管他本生不是一个典型的跨性别者。

另一个著名的案例是富有的地产大亨山姆•哈希米（Sam Hashimi）的故事，他与妻子分手后精神崩溃。在随后的中年危机中，他觉得由于女性过上更轻松的生活，他想成为一名女性。他的财富和人脉使他避开了许多通常阻碍人们过渡的枷锁，获得了自己想要的东西，却发现自己对激素疗法的反应很差，并且在女性生活中变得越来越沮丧和烦躁。因此，他去性别转换沦为男性。他的故事也远非跨性别人们的代表，他们出于想表达自身的性别所感到认同感而过渡，过渡后的烦躁和不安等感觉多数会下降。

在某些情况下，那些去性别转换的人发现情况并没有好转，或者发现自己的性别焦虑症再次出现-有时导致他们再次重新过渡。他们中的一些人愿意容忍这一点，特别是如果去性别转换是由于政治或宗教信仰而导致的，他们认为过渡是虎头蛇尾，或是罪恶。

其他人则因为认为自己顺着原来的性别生活更舒适而去性别转换。并非所有人都认为这种转变是去性别转换，而是使他们的身体与自我形象保持一致的一个步骤。其中有一些人仍然认为自己是跨性别人，而另一些人则对自己的身体感到满意，并已返回他们的指定性别身份。

我们提倡每个正在考虑过渡的人都先询问一个合格的辅导员，并仔细考虑您希望进行过渡的动机。>这些是您可能要问自己的问题。

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。

此后约翰•霍普金斯远离了他的观点，并提出反对意见。他们并且继续提供变性医疗和手术的服务。

许多人错误地认为性别认同是性行为的副产品。有时这还导致人们断言，任何表现出跨性别身份的孩子都一定是受到性虐待的孩子。这是错误的。性别认同的存在和性倾向毫无关系。孩子们不需要知道性行为或者性倾向是什么就可以告诉您他们是男孩还是女孩，并且通常能够在18岁之前。
跨性别儿童也是如此。唯一的不同的是，他们表达的性别认同可能与典型的体型不同，因此他们可能因为他们的身体感觉到焦虑不安。

人类的性别认同在3岁左右就形成了。许多跨性别成年人从幼儿时代就意识到本身具有非典型的性别认同，即使他们可能没办法表达出这样的感觉。

一项2015年研究儿童潜意识性别认同的研究发现，跨性别儿童以与非跨性别同龄人无异的方式体验其性别认同。换句话说，跨性别女孩“感觉”像一个女孩，就和其他女孩一样。

其他跨性别儿童可能没有严重的性别不安，或者不敢说任何话，或者没有意识到能够作为身体的性别以外的可能性。他们可能过了一段很长的时间才意识到自己是跨性别者，但这不是他们改变性别身份的结果，而是花费更长的时间来发觉自己的性别认同。

无论如何，即使跨性别的孩子可能不知道作为一个性别意味着什么的复杂细微的差别，他们也能够分辨出什么时候感到不对劲或使他们感到痛苦。采取措施减轻这种痛苦是没有害处的，特别是当这种痛苦长期持续发生时；拒绝采取行动通常会导致更糟糕的结果。

但是，这些统计数据的研究来自对80年代和90年代被诊断出患有性别认同障碍（GID）的儿童的小样本研究。当时，诊断标准主要将性别认同障碍的儿童定义为那些表现出强烈的性别非典型游戏和兴趣模式的儿童，而并非要求孩子声称自己是或渴望成为异性。在这些研究中，许多孩子是女性化的男孩和男性化的女孩，他们对性别认同所表示的不满是因为别人因性别而对他们拥有的错误的期望。

这是经常被引用为证据的研究之一。该研究追踪了25名女孩，其中只有15名符合性别认同障碍的诊断标准。其余10个被视为“亚阈值”案例。在14年后的随访中，发现15个人中只有3个人是跨性别者。但是，大多数（如果不是全部）的这些女孩子们最初都是根据《精神疾病诊断与统计手册》III或IV诊断的，前者描述的是女孩的性别认同障碍如下：

患有这种疾病的女孩经常有男性同龄人群体，对运动和粗鲁的玩耍非常感兴趣，对玩洋娃娃或玩“房子”的兴趣不足。

《精神疾病诊断与统计手册III》（和《精神疾病诊断与统计手册IV》不一样）要求儿童也表达强烈的，持久的成为异性的愿望，很多假小子都会表示愿意成为男孩，这并不奇怪，因为当时的性别刻板印象比较刻板。此文详细介绍了一个年轻女孩的案例研究（第6页），该女孩坚持要成为男孩，并且符合所有《精神疾病诊断与统计手册》IV的性别认同障碍诊断标准。但是当被问到为什么要成为男孩时，她说那是因为她喜欢男孩的内衣。她说女孩不能穿男孩的内裤，所以她想成为男孩。

同样，一个男孩被告知不能玩洋娃娃，因为只有女孩这样做，他可能会做出反应：“那么我想成为女孩！”但是，他在这里的实际愿望是玩洋娃娃，而不是因为本身实际上是女孩，而诊断标准并未区分两者。

其他研究也遵循类似的模式。同时，许多跨性别儿童并不符合诊断条件，因为他们被认为不够男性化或女性化。

为了滤除这些误报，部分诊断标准随后被修订了，以不再强调性别非典型性特征，而将重点放在患者坚持自己是另一个或是想要成为另一个性别上。这是跨性别者身份的决定性特征，尤其是在伴随着持续数月或数年之久的明显困扰的情况下。如果一个女童表现出强烈的想成为男性的愿望，而当被允许与“男孩”玩具一起玩并穿上更多阳刚的衣服时，这种痛苦和欲望减轻了，那么她很可能只是个假小子；但是，如果所有这些行动仍然无法解决困扰，那么她很有可能这是一个变性男孩。

（您可以在这里阅读更多有关此内容的信息。）

父母通常会自责或在得知自己的孩子是变性者后感到内疚。他们可能会尝试弄清楚自己做错了什么，让孩子有这种结果。但是，父母教养方式和性别认同之间没有已知的关联，目前的证据强烈指向产前的生物学影响，尤其是激素影响。

一些父母担心他们在执行性别角色时过于严格，导致孩子觉得自己必须成为另一种性别才能自由地作为为自己。相反的，其他父母担心他们在执行性别角色方面不够严格，导致一个孩子在发展成为跨性别身份之前并未消除其性别非典型行为。对于每种育儿方式，有些父母做的完全相反，但最终还是有了变性孩子。跨性别人士来自各个阶层，种族和文化，家境保守派的也有和自由派也有，宗教派和非宗教派，富人和穷人，充满爱的家庭和从满虐待倾向的家庭都有。

有一些微弱的证据表明，跨性别者在家庭中遗传。不止一个兄弟姐妹成为跨性别人，或者父母在孩子表达自己是跨性别后也声称自己也是跨性别人，并承认他们多年来一直压制它，这些并不少见。一个大家庭的多个成员可能是跨性别者，即使那些不知道其他人存在的人也是如此。跨性别和非异性恋倾向也有联系，跨性别者更可能拥有同性或双性恋的家庭成员。一名跨性别女人发现她先前婚姻中的三个儿子都是同性恋。

听起来很正式的美国儿科学会（ACPeds）的一份声明驳斥了跨性别者身份的合法性，并宣布让变性儿童过渡是虐待儿童。

但是，与拥有64,000多名儿科医生的美国儿科学会不同，ACPeds不是官方的医疗机构。这是一个由大约60-200人组成的小团体，其明确目标是追求反LGBT议程。

您可以在此文中逐点阅读反驳他们的点数。斯诺普斯（Snopes）也对他们的主张进行了揭穿，以及来自实际的美国儿科学会的演讲，支持对性别不符合儿童采取肯定的方法。他们建议父母为孩子提供一个可以被接受的，支持性的环境，无论他们最终是否跨性别，都让他们蓬勃发展。

对于那些仍然坚持跨性别身份并表达过渡愿望的人，美国儿科学会注意到允许跨性别儿童社交上过渡的积极成果：

总而言之，我们提供了新的证据，表明在性别认同上受到支持的年轻跨性别儿童中，他们的心理病内部化率低。这些数据至少表明跨性别的可能性与儿童期的心理病理学不是同义词，也不是其直接的结果。相反的，这些结果提供了明确的证据，表明变性儿童的焦虑和抑郁水平与非变性兄弟姐妹和同龄人没有什么不同。

资料来源：身份得到支持的跨性别儿童的心理健康

在本页前面引用的2011年同一项研究中，研究人员发现，1973年至1988年在瑞典过渡的跨性别男人和女人的刑事定罪（包括暴力犯罪）犯罪率与顺性别的男性控制相似。

该数据被歪曲为声称跨性别妇女以与顺性别男人相同的比率强奸其他妇女，因此出于安全理由应防止进入女性空间。这是对研究的完全误解。它也没有解释为什么这样的人通常在女性空间中拥有跨性别男人，因为他们也表现出完全相同的犯罪率。

正如该研究的主要作者塞西莉亚•德赫内（Cecilia Dhejne）所阐明的那样，该研究并未说明不同的定罪类型，而是提到了一般的犯罪定罪数量。从研究看来，没有办法知道统计数据哪部分是针对诸如强奸等特定犯的罪。

进一步使数据复杂化的其他因素包括：

• 犯罪往往与贫穷，无家可归和失业密切相关，所有这些都对跨性别者造成不成比例的影响。因此，预计抢劫，盗窃，卖淫和吸毒等相关犯罪的发生率将会增加，这自然会增加犯罪率。
• 与上述情况相关，较贫困地区的往往受到警察更严厉的管制，与警察人数较少的地区相比，逮捕和定罪的比率更高。
• 由于受到歧视，缺乏社会力量以及知名度的提高，跨性别者更有可能因犯罪而被逮捕和定罪，特别是在腐败的执法系统中。

更重要的是，该研究指出，从1989年至2003年过渡的跨性别者中未观察到犯罪率的提升。研究人员将其归因于瑞典改善了的身心保健，以及提高了的对跨性别人士的社会接受度。

如果相反，由于跨性别女性由于是“真正的”男性而天生更容易犯罪，那么这将无法解释为什么仅在1989年之前过渡的人群中观察到这些升高的比率，此后她们展现出与顺性别女性相似的犯罪率。

当他们过渡后无法被视为顺性别女性时，跨性别男人也失去了看似顺性人的特权（在某些情况下还包括看似异性恋的特权）。他们还容易遭受跨性别恐惧症的影响，这通常使他们的社会地位比以前差。

即使在道德上认为跨性别男人不要过渡并与妇女团结受苦在道德上更好，如果我们不也希望顺性别男性过渡到女性，这将是双重标准。如果目标确实是减少累积的男性特权，那么这实际上将是更合乎逻辑的选择，而这是顺性男人所能享受的最多并从中受益最多的。同时，全力支持跨性别女人才是合理的，但是不一致的是，那些拥有此想法的人通常也都反对跨性别女人。

最后，如果女性确实只是为了逃避厌女症和与性相关的创伤（例如强奸）而转型，这更加说明社会对女性使她们走向极端的待遇。然后，重点应放在纠正社会上，而不是在进一步使那些仅仅试图逃脱的人受害；那将解决问题的症状，而不是针对根本的原因。

因此，最好的做法当然是努力使社会对妇女更好，并看这是否减少了跨性别男人的数量。如果跨性别男人因为身为为女性而感到苦恼，有时甚至自杀，但发现他们可以过上幸福，充实的生活，并且身为男人更适合与女性一道为平等而工作，不让他们过渡并坚持他们受苦不只是残酷，而且是适得其反的。它将女性地位定位为一种惩罚，而将男性地位定位为一种自由，而这种特权完全是与之相伴而生的。来实施政治意识形态不应以牺牲生命为代价，尤其是当这样做根本不可能导致任何好处时。

一般而言，跨性别男人希望像其他男人受到一样的待遇，跨性别女人则希望像其他女人受到一样的对待，并带有相应的代词和称呼方式（先生，夫人，兄弟，姐妹等）。

跨性别者的另一个子集目前被称为性别酷儿，他们不认为自己是男性还是女性。他们渴望被视为独立的性别（或混合，或两者都不是）的原因是因为他们并不是男生或是女生，而不是因为他们是跨性别。

积极地将自己标识为跨性别的跨性别者们通常把自己除了是男性，女性或性别酷儿的身份以外，还具有跨性别的身份，这就像有人将自己描述为马来女人一样。

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.

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.

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:

• Effects of Hormone Therapy
• Effects of Sex Reassignment Surgery

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.

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.

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.

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.

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.)

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.

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.

Source: Mental Health of Transgender Children Who Are Supported in Their Identities

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.

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.

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.