Keeping the Transgender Community Safe: The Misinformation Epidemic

Good intentions do not always yield good results. In an attempt to make the world a more accepting place, a part of social activism has latched onto the idea that everyone’s identity is valid, and that anyone who says otherwise is simply bigoted. This crosses over into the LGBT community especially, specifically the trans community. These activists aim to be as inclusive as possible, and so they claim that the only thing making a person transgender is simply labelling his/herself as transgender. Some even go as far as spreading misinformation, intentionally or otherwise, about the medical condition gender dysphoria, and whether or not it is required. But all of this comes at a price. Spreading misinformation and telling people they can be transgender without gender dysphoria harms everyone involved; it can make things worse for real trans people and expose non-transgender people to violent transphobia that they could have avoided.

With many misconceptions about the condition, gender dysphoria can be explained as such: “The term gender dysphoria describes a heterogeneous group of individuals who express varying degrees of discomfort with or diassociation from their anatomic gender” (Schechter). Included in this is the desire to possess the secondary sex characteristics of the opposite sex, in addition to primary sex characteristics (Schechter). Put in simpler terms, gender dysphoria is the discomfort/disconnect between one’s birth sex and gender. Gender dysphoria, therefore, seems to be what differentiates trans people from other people. Cisgender people don’t have dysphoria; transgender people do. This is only one side of the debate, however.

The other side of this debate claims that you do not need dysphoria to be transgender, and that gatekeeping identities is harmful to the trans community. Both sides aim to tackle rampant transphobia in daily culture and protect the community. Both have the intention of keeping trans people safe and promoting acceptance. That’s what fuels the debate the most: both sides have the same goal, but cannot agree on what really makes a person ‘transgender’. While the other side does not have the intention of harming the community, misconceptions and misplaced good intentions fuel this argument and create a dangerous atmosphere.

One large issue facing the transgender community is stigma. Anti-transgender stigma can start from an early age and can harm them in virtually every part of life (“Violence Against the Transgender Community” 40). “Moreover, anti-transgender stigma can have long-term impacts on mental health and economic and housing stability, especially if individuals experience familial rejection and isolation from social support systems” (“Violence Against the Transgender Community” 40). Anti-trans stigma can range from offensive pop culture characters to severe violence and discrimination. It can damage trans people’s already fragile sense of self and can even compromise their safety. This is an issue that cannot be ignored and action needs to be taken.

In 2013, the DSM-5 replaced gender identity disorder (GID) with gender dysphoria due to public pressure and to make it clear that gender dysphoria diagnosis pertains to distress, not identity (“...gender-affirming health care?”). This was a large-scale attempt to remove some of the stigma and misconceptions about trans people and gender dysphoria itself. Activists and clinicians fought to remove terms such as transsexualism and gender identity disorder, citing the inclusion of homosexuality in the DSM until 1973. They claimed that it fostered the idea that being gay could be treated and cured (“...gender-affirming health care?”). Going by this train of thought, including transgenderism in any way in the DSM would imply that being transgender could be cured, so it should similarly be removed. The idea that homosexuality and transgenderism can be cured also falls in line with the idea behind conversion therapy, aka abusing a person until they are traumatized enough that they avoid things pertaining to homosexuality and transgenderism. This is definitely a logical conclusion.

However, that isn’t quite the way this needs to be approached. Just because something is stigmatized doesn’t mean that it suddenly isn’t a mental illness/condition anymore. Mental health issues such as depression and schizophrenia are deeply stigmatized, but the solution to that stigma isn’t demedicalization either. The DSM-5 attempted to find a sort of middle ground, but didn’t entirely get the reception it had hoped. “The new diagnosis was intended to clear hurdles to gender-affirming treatment, including surgical procedures. But some contend that it inappropriately pathologizes transgender identity by requiring a mental health diagnosis to access care” (“...gender-affirming health care?”). The only way that stigma can be alleviated is by promoting tolerance and spreading awareness about a condition. It is a slow road, but it is one worthwhile. Saying that gender dysphoria is a mental illness doesn’t contribute to the stigma by existing as a mental illness; the stigma comes from a misunderstanding of the condition that is warped by activists and the general media. Plus, needing a mental health diagnosis to access hormone therapies and surgeries that are completely life changing is also for the safety of the patient, not just to ‘add to the anti-trans stigma’.

While both are severely stigmatized, homosexuality and transgenderism also are nothing alike. “In its broadest sense ‘sexuality’ describes the whole way a person goes about expressing themself as a sexual being” (“Sexuality”). Homosexuality just refers to the sexual and romantic attraction to the same sex and any subsequent relationships that follow. Sexuality as a whole has a few general parts. The four major components of sexuality include sexual health, sensuality, gender/sexual identity, and intimacy & relationships (“Sexuality”). Nothing about homosexuality, as it is described here, meets the criteria to be a mental illness. The only reason it was referred to as such was because of prejudices at the time. Furthermore, the only way homosexuality typically causes distress is in response to homophobia, whether external or internal. Going back to the definition of gender dysphoria, comparing the two shows that the two are nothing alike. Therefore, the same rules can’t be applied. Just because being gay isn’t a mental illness doesn’t mean that transgenderism isn’t one either.

Still, there are medical organizations that still disagree, saying that being transgender isn’t a mental illness/isn’t required to be transgender. One of these organizations is the American Psychiatric Association, aka the APA. According to one of their articles, it isn’t required at all. “Not all transgender people suffer from gender dysphoria and that distinction is important to keep in mind…” (Drescher and Pula). While it is more so implied, this means that the APA believes that dysphoria isn’t necessary to be trans. Furthermore, they also address the issue of gender dysphoria being a mental illness: “A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder” (“Answers to Questions About Trans People”). This is the tricky part about this debate: if you believe that dysphoria isn’t necessary to be trans, then you also probably believe that being trans isn’t a mental illness. It hinges on the idea that not all trans people have dysphoria.

The reliability of the APA, however, is a bit questionable. The APA also categorizes crossdressers and drag queens/kings as transgender, when this isn’t necessarily true. Furthermore, they believe that neopronouns, aka non-conventional pronouns such as zie and hir, are valid pronouns (“Answers to Questions About Trans People”). Neopronouns are not grammatically correct and are hard to say and conjugate. There is no need for new pronouns; he, she, and they all work fine. One is masculine, one is feminine, and one is neutral. Plus, because they’re unconventional and near impossible to use in spoken conversation, it is difficult to take neopronouns seriously. Saying that these grammatically incorrect, unnecessary, and made up pronouns are valid is a statement that has nothing to truly back it up. This means that the APA is making statements it cannot back up, meaning that their reliability is not very stable. They rely on the reader to take their word for it, rather than presenting facts as to why neopronouns are valid.

Going back to the categorization the APA uses for transgender people, including crossdressers and drag kings/queens under the ‘trans umbrella’ causes confusion and is not completely sound. While some transgender people do choose to do drag, not all drag kings/queens are transgender. The same can be said about crossdressing. Including these people as transgender shows that the APA does not necessarily know enough about transgenderism to give a completely factual say in the matter.

However, the APA has company. The World Health Organization (WHO) strays even further from the actual meaning of transgender. The WHO says that gender “refers to the socially constructed characteristics of men and women-- such as norms, roles and relationships between groups of women and men. It varies from society to society and can be changed” (“Gender”). Besides being wildly different from the actual definition of gender, the WHO also contradicts itself. Their definitions of gender norms, gender stereotypes, and gender roles are near exactly the same to the definition given for gender (“Glossary”). The problem with these definitions being this similar is that it isn’t correct in practice; a butch lesbian rejects female gender roles but is still a woman. If gender roles determine gender, then this would not be possible.

Spreading these incorrect definitions of gender and transgenderism carry risks on their own, but is much deeper than just spreading false information. Going back to the debate with the DSM-5, some activists claim that requiring a gender dysphoria diagnosis to access care is harmful (“...gender-affirming health care?”). However, this prerequisite is not just to ‘medically gatekeep’; it is also to protect people from the negative consequences of medical transition.

Physically transitioning carries risks for dysphoric people and non-dysphoric people alike. Starting HRT, or Hormone Replacement Therapy, is not something to be taken lightly. “Masculinizing hormone therapy is used to induce the physical changes in your body caused by male hormones during puberty...to promote the matching of your gender identity and body…” (“Masculinizing hormone therapy”). HRT completely changes how the body looks and functions; for people with gender dysphoria, this is an amazing thing. It can make gender dysphoria less severe, improve quality of life, improve psychological & social functioning, and reduce psychological & emotional distress (“Masculinizing hormone therapy”). The way HRT for transgender men works: “...you’ll be given the male hormone testosterone, which suppresses your menstrual cycles and decreases the production of estrogen from your ovaries…” (“Masculinizing hormone therapy”). However, it comes at a price.

HRT will begin producing changes in the body within weeks to months (“Masculinizing hormone therapy”). Complications include weight gain, producing too many red blood cells, sleep apnea, abnormal amounts of lipids in the blood, high blood pressure, type 2 diabetes (when risk factors are present), and cardiovascular disease (“Masculinizing hormone therapy”). There are also some less talked about side effects such as clitoral enlargement and vaginal atrophy (“Masculinizing hormone therapy”). In short, this means that the clitoris will grow longer, to an extent, and the vagina will lose its ability to self-lubricate. Since this is not often talked about, some people may start HRT and not know about those changes and may not be happy with those changes.

For those who are non-dysphoric and start HRT, there is another negative side effect. Because HRT will induce male puberty, the body will start to resemble a biological male. If one does not have dysphoria, this will make the body more male than the brain, inducing dysphoria. Induced dysphoria is similar to typical gender dysphoria except that induced dysphoria can be avoided. Spreading misinformation about HRT and its seriousness can inflict dysphoria on people who otherwise would not have had it, and dysphoria is not an easy thing to deal with.

Besides the physical risks that come with transitioning, there are also economic consequences and risks via misinformation. Many transgender people can only receive the medical help they need in their transition through insurance. This is because on a decent number of insurance plans, surgical procedures such as top surgery and sex reassignment surgery are considered a medical necessity to alleviate a mental health condition. “‘Medically Necessity’ means health care services and supplies provided by a health care provider appropriate to the evaluation and treatment of disease, condition, illness or injury…” (“Illinois Insurance Facts”). Because gender dysphoria is a diagnosable mental health condition, any procedures meant to alleviate it fall under this category. It needs to stay this way.

If gender dysphoria is demedicalized, as per what many activists want, this will no longer be the case. Insurance companies will be open to decide that surgeries such as sex reassignment surgery are cosmetic procedures, and therefore will not necessarily cover them. Cosmetic surgeries typically are not considered ‘medically necessary’ (“Illinois Insurance Facts”). Surgeries meant to alleviate gender dysphoria are different than cosmetic procedures in a distinct way. Cosmetic procedures and surgeries change, restore, or enhance one’s appearance; elective cosmetic surgery is normally chosen because one is unhappy with features such as nose, breasts, or wrinkles (“Cosmetic Surgery and Procedures”). In contrast, medical transition is pursued to alleviate a condition. Transitional surgeries are not always aesthetically pleasing, nor do they necessarily make the patient more attractive. Also, dysphoria is more severe than just a general dislike of one’s appearance. This means that these surgeries are more than just cosmetic and are much more important in the long term.

The demedicalization of gender dysphoria will take these resources away from people who cannot afford it otherwise. This could potentially increase a risk already present in the transgender community: suicide. In 2015, “A staggering 39% of respondents [transgender people] experienced serious psychological distress in the month prior to completing the survey, compared with the only 5% of the US population” (James et al. 5). Adding onto this, the same survey also found that 40% of the transgender people surveyed had attempted suicide at some point in their life. The attempted suicide rate of the general US population was 4.6% (2015). This goes back to the anti-transgender stigma that both sides of this argument are trying to combat, but it also factors in dysphoria. Dysphoria can become so severe that one may consider taking their own life. If activists want to lower, or at least not increase, the suicide rate, then the demedicalization of gender dysphoria cannot happen. Doing so would be taking valuable resources from already vulnerable patients.

Another plight affecting these already vulnerable people is hate crimes. According to a report from the Human Rights Campaign: “At least 22 transgender people have been killed in the United States since the beginning of 2018” (“Violence Against the Transgender Community” 4). Furthermore, this report also found that 82% of those killed were women of color, 55% lived in the South, and 64% were under the age of 35, though this is likely undercounted due to some deaths being unreported or getting misgendered by family after death. That is in the United States alone. “Over 2,300 transgender people are known to have been killed in the last decade in dozens of countries, according to figures released by Transrespect versus Transphobia Worldwide, a global project combining the efforts of advocates in more than 100 countries” (“Violence Against the Transgender Community” 50). Outside of murder, there are other types of hate crimes to worry about. For example: “LGBTQ people are 97x more likely to report being sexually abused in immigration detention” (“Violence Against the Transgender Community” 49). The world is still currently a very dangerous place for transgender people.

Misinformation about being transgender can open up innocent non-trans people to hate crimes and increase their risk of murder, assault, homelessness, and various other negative social consequences. In this situation, misinformation can be fatal. The best way to protect these people from consequences they don’t have to bear is by telling them the truth. If they do not have gender dysphoria, they are not trans. Real trans people have it hard enough; dragging even more innocent people into it just adds to the harm and destruction these crimes have on people’s lives.

In an age of shining activism, promoting acceptance of all people is a noble goal. But there is a fine line between innocent acceptance and something much more harmful. Blind, uneducated acceptance can have devastating consequences down the road. All people involved are put at risk. As a member of this community, the trans community wouldn’t wish these things on anyone. Misinformation kills. While people’s feelings may be hurt, the best way to care for these people is to inform them truthfully and hopefully avoid some of these negative consequences. It may not feel moral or right, but it is the right thing to do. Hurt feelings are are much less lethal than the long-term damage that can be caused. Good intentions do not always yield good results. But if these good intentions are redirected in a productive manner, these risks can be lessened for everyone involved, transgender and non-transgender alike.