All About Trans People
or, Why Nobody Is Performing Surgeries On Trans Children
What Is Transgender?Trans people (from the Latin word for "on the other side of") are people whose gender identity does not match the gender they were assigned by a doctor at birth. Cis people (from the Latin word for "on the same side of") are people whose gender identity and assigned gender at birth (AGAB) match. "Cis" is not meant as an insult, nor to imply something is weird about cis people; it is simply a term used in discussions of gender identity to mean "someone who isn't trans."
When we are in the womb, fairly early on in gestation, our genitals go from a sort of in-between proto-genital shape to either a penis and scrotum or a vulva and vagina. Later in gestation, our brains develop our gender identity. Either one can be thrown off by hormones or genetic mutations, which is how we get intersex people and trans people. This means that gender identity cannot be changed by other people after birth. You cannot turn a trans person cis, nor can you turn a cis person trans.
About 1-2% of people are transgender: more than the number of natural redheads or the percentage of the world's people who happen to be from Paraguay.
How Do You Know You're Trans?Discovering that one is trans happens in a variety of ways and at any age. Here are a few common experiences.
Gender dysphoria is a feeling of discomfort or unease about performing one's AGAB. Not all trans people experience gender dysphoria, but it can be like mentally getting pricked with pins and needles every time you have to wear certain clothes, get called your deadname, or get misgendered. Being reminded that your body doesn't match your desired form can also trigger gender dysphoria, so looking in mirrors or bathing yourself can also be unpleasant.
Gender euphoria is present in nearly all trans people and is the feeling of relief and pleasure (NOT sexual pleasure) experienced when you get to dress, act, and look more like your gender identity. In the early days of a person's trans journey, gender euphoria can be triggered as easily as cutting your hair differently or wearing certain clothes.
Some people realize that they are trans when they are tiny children first learning about the differences between boys and girls. They will loudly insist, "I'm a boy!" or "I'm a girl!" in the face of parents or other adults saying otherwise. They tend to play with toys associated with their gender identity, rather than with their AGAB.
Some people realize that they are trans at puberty, when their body goes from a childish body shape to a more masculine or feminine appearance. They may talk about wishing they were a boy/girl sometimes. They may wear loose, baggy clothing to hide their changing bodies (this is where the "trans teen in a big hoodie" stereotype comes from).
Some trans people don't realize that they're trans until adulthood. Suddenly, dysphoria hits and they realize that something about their projected appearance isn't quite right. This can happen in college, or years later when the person has built a life as their AGAB. The discovery that a person is trans can impact job security, marriages, and relationships with family.
What Is Gender Transition?There are three types of transition currently: social transition, hormonal transition, and surgical transition. It can be important to make note of which kind of transition a person is talking about in a given situation, so let's look at what each kind means.
Social transition is as simple as changing your clothing, hairstyle, name, and pronouns to reflect your gender identity. This is the only form of transition performed on prepubescent children. It is 100% reversible. Some trans people are satisfied with social transition alone, but others will want to transition hormonally.
Hormonal transition takes 2 forms. In minors, temporary puberty blockers are used to delay puberty until the child is 18 and can legally consent to other treatments. This is the only form of medical transition performed on minors. It is 100% reversible, because once blockers are stopped, the child will undergo a normal puberty.
In adults, hormone replacement therapy (HRT) is performed. In trans women, this takes the form of testosterone blockers and estradiol pills, patches, or injections. In trans men, HRT takes the form of testosterone injections. Here is a full list of HRT effects and side-effects. Some effects of HRT (like breast growth or a deeper voice) are permanent. Others (like redistribution of body fat to look more masculine or feminine) stop as soon as the trans person stops taking hormones. Many trans people are satisfied with hormonal transition and do not desire surgery. These people are still trans.
Surgical transition is only ever performed on consenting adults. It takes 2 forms. "Top surgery" is surgery to either enhance or remove breasts. It is similar to breast augmentation or mastectomy in cis women. Mastectomies for trans men, however, are slightly different and can allow the trans man to keep his original nipples (as opposed to a double mastectomy performed on breast cancer patients, which generally removes the nipples). Many trans people are satisfied with only top surgery and do not seek out bottom surgery.
"Bottom surgery" is a catch-all term for surgeries performed on the internal or external reproductive organs of trans adults. These are the types of bottom surgery:
- Orchiectomy (orchidectomy in the UK) is the removal of the testicles. Other organs are not removed.
- Vaginoplasty is the creation of a vagina and vulva using the patient's own tissues. This new tissue can come from the patient's penis and scrotum, or from a skin graft.
- Hysterectomy is the removal of the uterus. Sometimes the ovaries and cervix are also removed as part of a hysterectomy.
- Vaginectomy is the removal of vaginal tissue and sealing of the vaginal opening.
- Metoidoplasty is the removal of ligaments which hold the clitoris in place, allowing it to hang loose as a sort of miniature penis.
- Phalloplasty is the building of a new penis which includes the clitoral tissue. The skin for this new penis is usually provided from a skin graft.
Which type of bottom surgeries a person has performed are their own business. Just like it's rude and invasive to ask about the genitals of your cis friends, it is deeply rude and invasive to ask about the genitals of your trans friends. Unless you are sexually active with that trans person, it really is none of your business.
Isn't This All Some New Trend?Trans people have existed for all of recorded history, in all cultures that are studied. Wikipedia has a list of people who would today be considered transgender; these people were either treated as their gender identity, or had a third gender role in their culture. It is important to remember that while the experiences of many people definitely resemble those of trans people today, the term "transgender" is a modern one. Historical people would not necessarily have thought of themselves as "transgender," regardless of their experience of gender.
Trans people are more visible today primarily because of a decrease in the social stigma behind being trans. It can be likened to how left-handed people suddenly seemed more common after it stopped being common practice to "correct" left-handed people into using their right hand.
What If You Regret Transitioning?Transphobes (people who are against trans people) often point to the existence of de-transitioned people as proof that being trans is somehow unnatural or harmful. Regret is often pushed as a reason for trans people not to transition at all, but to pretend to be cis. A variety of anti-trans organizations will tout the regret of "hundreds of people" as a reason why the millions of trans people out there shouldn't transition. "Conversion therapy" is often pushed to force cis-ness onto trans people. (Though, as I mentioned earlier, it is not actually possible to make a trans person cis, only to force them to hide their gender identity.)
Regret is actually very rare among trans people. According to Cornell University's metastudy, 93% of studies have shown that transitioning improved trans people's mental health and quality of life. It can end or prevent suicidal ideation, drug and alcohol abuse, and self-harm. (The link discusses all of this in more detail, and has links to each study that was analyzed.) This alone is a good reason to allow trans people to transition in the way that they see fit; aren't mentally healthy, happy people better than suicidal, self-destructive, or dead people?
Transphobes often focus on exactly one form of transition: bottom surgery. So let's look at studies involving specifically bottom surgery. This is the most medically invasive and permanent form of transition available; because of this, it's reasonable to assume that it has the highest regret rate of all forms of transition. And according to the Journal of Plastic and Reconstructive Surgery, approximately 2% of trans people regret having the surgery. The majority of people listed as regretting surgery had "clear regret." (This is not the majority of people studied, only the majority of people who had regret.) By contrast, the regret rate of knee replacement surgery is a whopping 17.1%. Furthermore, studies on teens who were using puberty blockers showed that ten years later, 98% of them had chosen to start HRT. This is a very high rate and would not make sense if parents or peer pressure were somehow "making kids trans."
Detransition is also mentioned a lot among transphobes. Detransition means that the trans person stops living as their gender identity and begins living as their AGAB. However, detransition doesn't mean that the person is no longer trans, nor that they have stopped experiencing gender dysphoria. Studies indicate that among people who detransition, the main reason is societal pressure against being trans and a lack of support. 82.5% of people cited this discrimination as their primary reason for detransitioning. Only 15.9% of detransitioners had a shift in gender identity or were uncertain of their gender identity. In other words, transphobes are the main cause of people detransitioning! Imagine if large numbers of wheelchair users stopped using them, not because they no longer needed a wheelchair, but because places weren't wheelchair accessible. We would consider that a failure of society, not of wheelchair users themselves. Detransition is a sign that our society is failing trans people, not that being trans is some sort of phase or trend.
So How Should I Treat Trans People Then?Trans people only want the same dignity and respect as everybody else (and possibly medical treatment). This means that you should use the name and pronouns that they ask you to use, and avoid using or asking about their "deadname" (the name they were given at birth).
Try not to say the following. They may seem to you like compliments, but they really aren't.
- "You don't look trans/I couldn't tell!" Perhaps you're implying that they weren't visibly trans. But really, the only sure-fire visible indicator that a person is trans is if they are literally holding a sign that says, "Hi, I'm trans!"
- "But you look so good as [your AGAB]!" Our AGAB is slowly destroying our mental health. Transition is our salvation and is more important to us than how attractive we look to you.
- "You're so brave!" We only have to be brave because society makes it difficult or impossible to transition. Being your correct gender shouldn't require bravery to begin with.
- Over-the-top apologies for accidental misgendering. Just say "sorry, [correct name or pronoun]" and move on. We don't want lots of attention drawn to our transition like that.
- "So are you getting The Surgery?" Whether and what kinds of surgeries we get are none of your business. And if you're going to ask us about our genitals, your penis size or whether you shave your vulva will officially become the next topic of conversation.
Be polite to us. We're just people. Treat us like any other person.