Fueled by misinformation, transgender healthcare has become a flashpoint of political controversy in recent years. Here at Charged, we’re going to debunk the myths and get down to the science to understand how transgender healthcare works, why it’s important, and what political messages are scientifically supported.
Activists from the National Center for Transgender Equality (Health Coverage Guide)
Terminology
Cisgender: “People whose gender identity is congruent with what is traditionally expected based on their sex assigned at birth” (Streed et al., 2021).
Transgender: People “whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth” (American Psychological Association, 2023).
Gender Dysphoria: “Intense, persistent gender incongruence” (American Psychological Association, 2023).
Gender Affirming Care (GAC): “Psychosocial and medical support” that allows people to live in alignment with their gender identity (Lepore, Alstott, McNamara, 2022).
How Does Transgender Healthcare Work?
Transgender healthcare involves many steps and processes, not all of which are pursued by all transgender patients. The most common form of GAC for transgender patients is exogenous hormone therapy.
During hormone therapy, transgender men use testosterone to suppress feminizing characteristics and develop masculinizing characteristics (Unger, 2016). Transgender women use anti-androgens to suppress masculinizing characteristics and use estrogen to develop feminizing characteristics (Unger, 2016).
Hormone therapy is a strongly positive force in many transgender patients’ lives. Patients that have undergone hormone therapy have shown positive physical and psychological changes, including improvements in sexual function and mood, and a reduction in stress and cortisol levels (Unger, 2016). For these reasons, hormone therapy is considered a core element of GAC.
Myth 1: Only Transgender People Seek GAC
Many arguments against the availability of GAC base themselves on the myth that only transgender people seek GAC. This is false. In fact, both cisgender and transgender individuals seek GAC, including such instances as “estrogen for menopause, breast surgery, genital surgery for sexual development disorders, etc.” (Lepore, Alstott, McNamara, 2022). Gender affirming care is not limited to transgender patients, and should be viewed as a general standard of care for patients, rather than a requirement specific to transgender people.
Myth 2: GAC is Experimental
Arguments in favor of legal bans against GAC for transgender patients state that GAC is experimental and unsafe, and thus not yet ready for use. This is another myth. GAC is used by cisgender people without legal complaints, involving the “same medications as used in [transgender] hormone therapy, like estrogen, testosterone, and spirolactone” (Lepore, Alstott, McNamara, 2022). Furthermore, puberty and androgen blockers, used by transgender patients to lower the effects of other types of hormones, are also used by cisgender people for “developmental disorders and general medical procedures” (Lepore, Alstott, McNamara, 2022). Evidently, both transgender and cisgender patients take GAC, and cisgender patients have been taking GAC without complaint. Thus, GAC cannot be experimental, and even if it was, it should not be blocked from transgender patients specifically, but from both transgender and cisgender patients, as they both benefit from GAC.
Myth 3: GAC is Entirely Irreversible
Another argument against the use of GAC for transgender patients, especially in the case of hormone replacement therapy (HRT) is the myth that GAC is entirely irreversible. While the effects of HRT are irreversible in the long term, patients are “only offered reversible treatments first,” and only take further hormonal treatments for long term symptoms of gender dysphoria (Lepore, Alstott, McNamara, 2022). Beyond treatment, transgender individuals are still able to conceive, and all individuals considering hormone therapy are recommended fertility preservation methods (Lepore, Alstott, McNamara, 2022). Furthermore, irreversible genital surgeries are only reserved for adults who have “adhered to their new identities for at least a year” (Lepore, Alstott, McNamara, 2022). Thus, it can be observed that GAC is not entirely irreversible, and all irreversible decisions are made after long-term, reversible treatment has already begun. To assuage the fears of youth taking irreversible, rash decisions, let it be known that young people seeking GAC are not capable of making irreversible medical decisions within the current guidelines.
Myth 4: GAC is Unsafe
Many argue that GAC for transgender patients is unsafe and too dangerous to be medically prescribed. However, dangerous chemicals have been removed from GAC prescriptions for many years, and the risks of cardiovascular disease, which is more prevalent among transgender people, are reviewed before any medication is prescribed (Lepore, Alstott, McNamara, 2022).
In particular, transgender patients face an excess risk to cardiovascular disease, which can be attributed to “psychological stressors” such as discrimination and structural violence, rather than lower standards of care (Streed et al., 2021). Rates of cardiovascular disease are heightened for people suffering from HIV and AIDS, which are conditions more prevalent among transgender populations for reasons outside of medically prescribed GAC (Streed et al., 2021). While GAC has been shown to increase risks of cardiovascular disease, it is by no means the sole cause of transgender patients’ increased risk, nor is it likely the major cause of it (Streed et al., 2021).
While GAC is a risk, it is by no means a risk too dangerous to be medically prescribed, and is not a prescription that distorts standards of care.
Conclusion
As transgender healthcare remains a sensitive political topic, it’s important to keep the science in mind. Gender affirming care does come with risk, but is not too dangerous to be prescribed, and is shown to be psychologically helpful and at times medically necessary for transgender patients (Unger, 2016).
Sources
Lepore C, Alstott A, McNamara M. Scientific Misinformation Is Criminalizing the Standard of Care for Transgender Youth. JAMA Pediatr. 2022;176(10):965–966. doi:10.1001/jamapediatrics.2022.2959
Streed, C. G., Beach, L. B., Caceres, B. A., Dowshen, N. L., Moreau, K. L., Mukherjee, M., Poteat, T., Radix, A., Reisner, S. L., & Singh, V. (2021). Assessing and addressing cardiovascular health in people who are transgender and gender diverse: A scientific statement from the American Heart Association. Circulation, 144(6). https://doi.org/10.1161/cir.0000000000001003
American Psychological Association. (2023, March 9). Answers to your questions about transgender people, gender identity, and gender expression. Understanding transgender people, gender identity and gender expression. https://www.apa.org/topics/lgbtq/transgender-people-gender-identity-gender-expression
Unger CA. Hormone therapy for transgender patients. Transl Androl Urol. 2016 Dec;5(6):877-884. doi: 10.21037/tau.2016.09.04. PMID: 28078219; PMCID: PMC5182227.
Health Coverage Guide, National Center for Transgender Equality, transequality.org/health-coverage-guide. Accessed 4 Dec. 2023.
