Transphobes are denying basic science

**Being trans is not classified as a mental illness:**

Being trans is not classified as a mental illness by either the [**American Psychological Association**](http://www.apa.org/topics/lgbt/transgender.aspx) or the [**World Health Organization**](https://www.usatoday.com/story/news/2018/06/20/transgender-not-mental-illness-world-health-organization/717758002/). Gender dysphoria or incongruence is recognized by both as a medical condition, and transition is the only treatment recognized as effective and appropriate medical response to this condition. A trans person who has completed transition, and who no longer experiences distress because the conditions previously causing it have been corrected, is no longer diagnosed as having dypshoria or incongruence.

**On claims that the "Swedish Study" shows that transition does not reduce suicide risk:**

That is a reference to [**this study**](http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0016885) by Dr. Dhejne. The claim that her study shows that transition does not reduce risk of suicide attempts while improving mental health and quality of life is a deliberate misrepresentation popularized by Paul McHugh, a religious extremist and [**leading member**](https://thinkprogress.org/hate-group-masquerading-as-pediatricians-attacks-transgender-youth-544e755c6a20) of an anti-gay and anti-trans [**hate group**](http://www.snopes.com/americas-pediatricians-gender-kids/), who presents himself as a reputable source but publishes work without peer review. His claim to fame is having shut down the Johns Hopkins trans health program in the 70's, which he did not based on medical evidence but on his personal ideological opposition to transition. Johns Hopkins has [**resumed offering transition related medical care**](http://transadvocate.com/johns-hopkins-resumes-trans-care_n_19077.htm), including reconstructive surgery, and their faculty are finally [**disavowing**](http://www.baltimoresun.com/news/opinion/oped/bs-ed-lgbtq-hopkins-20160928-story.html) him for his irresponsible and ideologically motivated misrepresentation of the current science of sex and gender.

That study's lead author Dr. Dhejne had [**emphatically denounced**](http://www.transadvocate.com/fact-check-study-shows-transition-makes-trans-people-suicidal_n_15483.htm) McHugh and his misuse of her work. If for those who don't trust the TransAdvocate article, she did so again in her [**r/Science AMA last year**](https://www.reddit.com/r/science/comments/6q3e8v/science_ama_series_im_cecilia_dhejne_a_fellow_of/).

**Edit:** Details on Dr. Dhejne's often misrepresented study - it found only that trans people who transitioned *prior to 1989* had slightly higher risk of suicide attempts than the *general public.* The author attributed this higher risk to the vicious anti-trans discrimination people who transitioned 29+ years ago experienced. The study found no difference in the risk of suicide attempts among trans people who transitioned after 1989, vs the general public.

She is also the primary author the other study I posted below, *An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets*, which found a "regret" rate of 2.2%




**Citations on the congenital, neurological basis of gender identity:**

* An overview from [**New Scientist**](https://www.newscientist.com/article/dn20032-transsexual-differences-caught-on-brain-scan)

* An overview from [**MedScape**](http://www.medscape.com/viewarticle/840538_3)

* [**Sexual differentiation of the human brain: relevance for gender identity, transsexualism & sexual orientation**](http://postcog.ucd.ie/files/Schwaab.pdf) - D. F. Swaab, Netherlands Institute for Brain Research, Amsterdam

* [**Sex difference in the human brain and its relation to transsexuality**](https://www.ncbi.nlm.nih.gov/pubmed/7477289) - Zhou JN, 1995

* [**White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study**](http://www.journalofpsychiatricresearch.com/article/S0022-3956%2810%2900158-5/abstract)

* [**Prenatal testosterone & gender-related behaviour**](http://courses.biology.utah.edu/carrier/3320/sexual%20diff.%20papers/Prenatal%20testosterone.pdf) - Melissa Hines, Department of Psychology, City University, Northampton Square, London

* [**Prenatal & postnatal hormone effects
on the human brain and cognition**](http://docs.autismresearchcentre.com/papers/2013_Auyeung_Prenatal%20and%20postnatal%20hormone%20effects_EuJPhysio.pdf) - Bonnie Auyeung, Michael V. Lombardo, & Simon Baron-Cohen, Dept. of Psychiatry, University of Cambridge

* A [**spreadsheet**](https://docs.google.com/spreadsheets/d/1d9KKqP9IHa5ZxU84a_Jf0vIoAh7e8nj_lCW27KbYBh0/edit?pli=1#gid=0) with links to *many* articles about gender identity and the brain.

* Here are [**more**](http://aebrain.blogspot.co.uk/p/transsexual-and-intersex-gender-identity.html)

----

**Citations on transition as medically necessary and the only effective treatment for dysphoria, as recognized by every major US and world medical authority:**

* Here is the [**American Psychiatric Association's policy statement**](http://www.apa.org/about/policy/transgender.aspx) regarding the necessity and efficacy of transition as the appropriate treatment for gender dysphoria. More information from the APA [**here**](http://www.apa.org/pi/lgbt/programs/transgender/?tab=1).

* Here is a [**resolution from the American Medical Association**](http://www.tgender.net/taw/ama_resolutions.pdf) on the efficacy and necessity of transition as appropriate treatment for gender dysphoria, and call for an end to insurance companies categorically excluding transition-related care from coverage.

* Here is a similar policy statement from the [**American College of Physicians**](http://annals.org/aim/article/2292051/lesbian-gay-bisexual-transgender-health-disparities-executive-summary-policy-position)

* [**Here**](https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf) are the guidelines from the American Academy of Pediatrics.

* [**Here**](http://www.aafp.org/dam/AAFP/documents/about_us/special_constituencies/2012RCAR_Advocacy.pdf) is a similar resolution from the American Academy of Family Physicians.

* [**Here**](http://www.socialworkers.org/da/da2008/finalvoting/documents/Transgender%202nd%20round%20-%20Clean.pdf ) is one from the National Association of Social Workers.

* [**Here**](http://www.teni.ie/attachments/14767e01-a8de-4b90-9a19-8c2c50edf4e1.PDF) are the treatment guidelines from the Royal College of Psychiatrists, and [**here**](http://www.wlmht.nhs.uk/wp-content/uploads/2013/05/Gender-dysphoria-guide-for-GPs-and-other-healthcare-staff.pdf) are guidelines from the NHS. More from the NHS [**here**](http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx).

----
**Citations on the transition's dramatic reduction of suicide risk while improving mental health and quality of life, with trans people able to transition young and spared abuse and discrimination having mental health and suicide risk on par with the general public:**

* [**Bauer, et al., 2015**](http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2): Transition vastly reduces risks of suicide attempts, and the farther along in transition someone is the lower that risk gets.

* [**Moody, et al., 2013**](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722435/): The ability to transition, along with family and social acceptance, are the largest factors reducing suicide risk among trans people.

* [**Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment**](http://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958). A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides trans youth the opportunity to develop into well-functioning young adults. All showed significant improvement in their psychological health, and they had notably lower rates of internalizing psychopathology than previously reported among trans children living as their natal sex. **Well-being was similar to or better than same-age young adults from the general population.**

* The only disorders more common among trans people are those associated with abuse and discrimination - mainly anxiety and depression. Early transition [**virtually eliminates these higher rates of depression and low self-worth**](http://www.jaacap.com/article/S0890-8567%2816%2931941-4/fulltext), and [**dramatically improves trans youth's mental health**](https://thinkprogress.org/allowing-transgender-youth-to-transition-improves-their-mental-health-study-finds-dd6096523375#.pqspdcee0). Trans kids who socially transition early and not subjected to abuse are comparable to cisgender children in measures of mental health.

* [**Dr. Ryan Gorton**](https://www.ncbi.nlm.nih.gov/pubmed/3219066): “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.)”

* [**Murad, et al., 2010**](https://www.ncbi.nlm.nih.gov/pubmed/19473181): "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**](http://www.sciencedirect.com/science/article/pii/S1158136006000491): 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**](http://www.gires.org.uk/assets/Medpro-Assets/trans_mh_study.pdf): "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.

* [**Smith Y, 2005**](https://www.ncbi.nlm.nih.gov/pubmed/15842032): Participants improved on 13 out of 14 mental health measures after receiving treatments.

* [**Lawrence, 2003**](http://link.springer.com/article/10.1023/A:1024086814364): Surveyed post-op trans folk: "Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives

There are a [***lot***](http://www.ncbi.nlm.nih.gov/pubmed/24344788) of [**studies**](http://link.springer.com/article/10.1007%2Fs10508-009-9551-1) showing that [**transition**](https://mayoclinic.pure.elsevier.com/en/publications/hormonal-therapy-and-sex-reassignment-a-systematic-review-and-met) [**improves**](https://www.hindawi.com/journals/tswj/2014/960745/) [**mental health**](http://europepmc.org/abstract/med/25690443) and [**quality of life**](http://link.springer.com/article/10.1007/s10508-014-0453-5) while [**reducing dysphoria**](https://www.researchgate.net/publication/23553588_Long-term_Assessment_of_the_Physical_Mental_and_Sexual_Health_among_Transsexual_Women).

Not to mention [**this 2010 meta-analysis**](http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2009.03625.x/abstract) of 28 different studies, which found that transition is extremely effective at reducing dysphoria and improving quality of life.

---
**Condemnation of "conversion therapy" attempting to change the gender identities of trans people:**

* **Edit: missed this one:** [**From the APA**](http://www.apa.org/about/policy/orientation-diversity.aspx)

* From the [**American College of Physicians**](http://annals.org/aim/article/2292051/lesbian-gay-bisexual-transgender-health-disparities-executive-summary-policy-position)

* Included in the [**AAP Guidelines**](http://hrc-assets.s3-website-us-east-1.amazonaws.com//files/documents/SupportingCaringforTransChildren.pdf) previously mentioned - see coverage on this "therapy" starting p.12

* From the [**American Psychoanalytic Association**](http://www.apsa.org/content/2012-position-statement-attempts-change-sexual-orientation-gender-identity-or-gender)

* A joint statement from the [**UK Council for Psychotherapy, British Association for Counselling and Psychotherapy, British Psychoanalytic Council, British Association for Behavioural and Cognitive Psychotherapies, The British Psychological Society, College of Sexual and Relationship Therapists, The Association of LGBT Doctors and Dentists, The National Counselling Society, NHS Scotland, Pink Therapy, Royal College of General Practitioners, the Scottish Government and Stonewall.**](http://www.pinknews.co.uk/2017/01/16/health-experts-condemn-attempts-to-cure-trans-people-in-wake-of-controversial-bbc-documentary/)

* The [**AAP Guidelines**](http://hrc-assets.s3-website-us-east-1.amazonaws.com//files/documents/SupportingCaringforTransChildren.pdf) also have a pretty emphatic and detailed condemnation of "conversion therapy", starting on p. 13.








**For when people try to claim puberty blockers are harmful:**

There is *extensive* research about long term use of puberty blockers, and they have overwhelmingly been shown to be very gentle and safe.

This treatment isn't just used for trans youth - it has been the standard treatment for kids with precocious puberty for decades. Most kids with precocious puberty don't have any underlying medical condition, their early development is just an extreme variation of normal development, but it would still cause serious psychological damage to start puberty at the age of, say, 6. This treatment has no long term side effects; it just puts puberty on hold. Stop treatment, and puberty picks up where it left off.

* [**Treatment of central precocious puberty by GnRH analogs: long-term outcome in men**](http://www.ncbi.nlm.nih.gov/pubmed/18478155)
* [**Long-term effects of gonadotropin-releasing hormone analogs in girls with central precocious puberty**](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342775/)

And for the *lots of people regret transition* bullshit:

**Persistent regret among trans surgical patients is about 1% and falling:**

This 1% "regret" rate also includes a lot of people who are very happy they transitioned, and continue to live as a gender other than the one they were assigned at birth, but regret that medical error or shitty luck led to low quality surgical results.

This is a risk in any reconstructive surgery, and a success rate of about 99% is astonishingly good for any medical treatment. And "regret" rates have been going down for decades, as surgical methods improve.

* [**Care of the Patient Undergoing Sex Reassignment Surgery (SRS)**](http://www.amsa.org/wp-content/uploads/2015/04/CareOfThePatientUndergoingSRS.pdf) \- *Persistent regret among post-operative transsexuals has been studied since the early 1960s. The most comprehensive meta-review done to date analyzed 74 follow-up studies and 8 reviews of outcome studies published between 1961 and 1991 (1000-1600 MTF and 400-550 FTM patients). The authors concluded that in this 30 year period, <1\% of female-to-males (FTMs) and 1-1.5\% of male-to-females (MTFs) experienced persistent regret following SRS. Studies published since 1991 have reported a decrease in the incidence of regret for both MTFs and FTMs that is likely due to improved quality of psychological and surgical care for individuals undergoing sex reassignment.*
* [**Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals**](http://www.ncbi.nlm.nih.gov/pubmed/15842032) \- regret rate of <1&#37;
* [**An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets.**](http://www.ncbi.nlm.nih.gov/pubmed/24872188) \- regret rate of 2.2&#37;




**For the whole "trans people didn't exist until 15 years ago" shit, here's my default post/list of links:**

* [**Chevalier d'Eon**](https://en.wikipedia.org/wiki/Chevalier_d%27Eon) (1728-1810) - French diplomat, spy, freemason, and soldier who fought in the Seven Years' War, who transitioned at the age of 49 and lived the remaining 33 years of her life as a woman.
* [**Surgeon James Barry**](https://en.wikipedia.org/wiki/James_Barry_%28surgeon%29) (1789-1865) - Trans man and military surgeon in the British army.
* [**Albert Cashier**](https://en.wikipedia.org/wiki/Albert_Cashier) (1843-1915) - Trans man who served in the US Civil War.
* [**Harry Allen**](https://en.wikipedia.org/wiki/Harry_Allen_%28trans_man%29) (1882-1922) - Trans man who was the subject of sensationalistic newspaper coverage for his string of petty crimes.
* [**Lili Elbe**](https://en.wikipedia.org/wiki/Lili_Elbe) (1882-1931) - Trans woman who underwent surgery in 1930 with Dr. Magnus Hirschfeld, who ran one of the first dedicated medical facilities for trans patients.
* [**Karl M. Baer**](https://en.wikipedia.org/wiki/Karl_M._Baer) (1885-1956) - Trans man who underwent reconstructive surgery (the details of which are not known) in 1906, and was legally recognized as male in Germany in 1907.
* [**Dr. Alan Hart**](https://en.wikipedia.org/wiki/Alan_L._Hart) (1890-1962) - Groundbreaking radiologist who pioneered the use of x-ray photography in tuberculosis detection, and in 1917 he became one of the first trans men to undergo hysterectomy and gonadectomy in the US.
* [**Dr. Michael Dillon**](https://en.wikipedia.org/wiki/Michael_Dillon) (1915-1962) - British physician who updated his birth certificate to Male in the early 1940's, and in 1946 became the first trans man to undergo phalloplasty.
* [**Willmer "Little Ax" Broadnax**](https://en.wikipedia.org/wiki/Willmer_%22Little_Ax%22_Broadnax) (1916-1992) - early 20th century gospel quartet singer.
* [**Christine Jorgensen**](https://en.wikipedia.org/wiki/Christine_Jorgensen) (1926-1989) - The first widely known trans woman in the US in 1952, after her surgery attracted medical attention.

And while until recently there has been no place in modern US/European culture for people with gender identities and lives atypical to their sex at birth to exist publicly, that isn't true in other times and cultures. Throughout the middle east and Asia there have been [**Hijra**](https://en.wikipedia.org/wiki/Hijra_%28South_Asia%29) visible in public life for hundreds or even [**thousands**](https://en.wikipedia.org/wiki/Hijra_%28South_Asia%29#Hijras_in_the_Mahabharata) of years. The same is true of [**Kathoey**](https://en.wikipedia.org/wiki/Kathoey) in Thailand, [**Muxe**](https://en.wikipedia.org/wiki/Muxe) in Zapotec culture in Mexico, various [**two-spirit**](https://en.wikipedia.org/wiki/Two-Spirit) identities found in indigenous American cultures, [**Māhū**](https://en.wikipedia.org/wiki/M%C4%81h%C5%AB) in traditional Hawaiian/Tahitian/Maohi cultures, the [**Fa'afafine**](https://en.wikipedia.org/wiki/Fa%27afafine) of Samoa, Tongan [**Fakaleiti**](https://en.wikipedia.org/wiki/Fakaleiti), the [**Sworn Virgins**](https://en.wikipedia.org/wiki/Balkan_sworn_virgins) of the Balkans, the [**Galli**](https://en.wikipedia.org/wiki/Galli) of Ancient Rome, etc.

And of course, humans are not the only animals. While we can't interview animals, and gender identity is harder to identify visually in animals than something like same-gender sexual activity is, we sure as hell have observed a lot of animals displaying [**instinctive behavior typically associated with the other sex**](http://news.stanford.edu/news/2005/july13/flygene-071305.html). And there very certainly is [**evidence**](http://www.ncbi.nlm.nih.gov/pubmed/3737708) of [**congenital**](http://www.ncbi.nlm.nih.gov/pubmed/18577352), [**neurologically**](https://academic.oup.com/endo/article-abstract/65/3/369/2775439/ORGANIZING-ACTION-OF-PRENATALLY-ADMINISTERED?redirectedFrom=fulltext) based [**sexually specific behavior**](http://science.sciencemag.org/content/144/3615/185) in [**animals**](https://www.researchgate.net/publication/11467014_Effect_of_prenatal_androgen_receptor_antagonist_or_aromatase_inhibitor_on_sexual_behavior_partner_preference_and_neuronal_Fos_responses_to_estrous_female_odors_in_the_rat_accessory_olfactory_system).

Sex and gender are not the same:

Here is the World Medical Foundation's public statement[ affirming it.](https://www.wma.net/policies-post/wma-statement-on-transgender-people/)

Here is the[ American Academy of Pediatrics.](https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Statement-in-Support-of-Transgender-Children-Adolescent-and-Young-Adults.aspx)

Here is the American Psychiatric Association, the American Psychological Association, the Royal College of Psychiatrists (and the entire British Medical System), the Endocrine Society, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Child & Adolescent Psychiatry[ opinions on the matter.](https://genderanalysis.net/factsheets/professional-statements-supporting-transgender-medical-care/)

Here is the American Medical Association, the American Academy of Family Physicians, the American Academy of Physician Assistants, the American College of Nurse Midwives, American College of Obstetricians and Gynecologists, American Public Health Association, National Association of Social Work, and the National Commission on Correctional Health Care's[ thoughts.](https://www.lambdalegal.org/sites/default/files/publications/downloads/ll_trans_professional_statements_17.pdf)

These public statements are based on[ the hard science.](https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/)

>A systematic literature review of **all peer-reviewed articles published in English between 1991 and June 2017** that assess the effect of gender transition on transgender well-being. We identified 56 studies that consist of primary research on this topic, of which 52 (93%) found that gender transition improves the overall well-being of transgender people, while 4 (7%) report mixed or null findings. We found no studies concluding that gender transition causes overall harm. This search found a robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals. The literature also indicates that greater availability of medical and social support for gender transition contributes to better quality of life for those who identify as transgender.

**Citations on the congenital, neurological basis of gender identity:**

* An overview from [**New Scientist**](https://www.newscientist.com/article/dn20032-transsexual-differences-caught-on-brain-scan)
* An overview from [**MedScape**](http://www.medscape.com/viewarticle/840538_3)
* [**Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation**](http://postcog.ucd.ie/files/Schwaab.pdf) \- D. F. Swaab, Netherlands Institute for Brain Research, Amsterdam
* [**A sex difference in the human brain and its relation to transsexuality**](https://www.ncbi.nlm.nih.gov/pubmed/7477289) \- Zhou JN, 1995
* [**Prenatal testosterone and gender-related behaviour**](http://courses.biology.utah.edu/carrier/3320/sexual%20diff.%20papers/Prenatal%20testosterone.pdf) \- Melissa Hines, Department of Psychology, City University, Northampton Square, London
* [**Prenatal and postnatal hormone effects on the human brain and cognition**](https://www.ncbi.nlm.nih.gov/pubmed/17074984) \- Bonnie Auyeung, Michael V. Lombardo, & Simon Baron-Cohen, Dept. of Psychiatry, University of Cambridge
* A [**spreadsheet**](https://docs.google.com/spreadsheets/d/1d9KKqP9IHa5ZxU84a_Jf0vIoAh7e8nj_lCW27KbYBh0/edit?pli=1#gid=0) with links to *many* articles about gender identity and the brain.
* Here are [**more**](http://aebrain.blogspot.co.uk/p/transsexual-and-intersex-gender-identity.html)

TERFs are anti-science, they are basically flat earthers telling us about their backyard theories on astrophysics, anti-vaxxers trying to sell us homeopathic oils.

**In case anyone wants to push that dissonance nonsense.**

* [Summary](https://thinkprogress.org/transgender-children-desistance-a5caf61fc5c6/)
* [Rebuttal to dissonance study](https://www.tandfonline.com/doi/abs/10.1080/15532739.2018.1471767?src=recsys&journalCode=wijt20)
* [Transgender youth have consistent views on their gender over their lifetimes](https://reachmd.com/news/study-transgender-children-have-consistent-deeply-held-gender-identity/255923/)

**And anyone trying to talk suicide.**

* [Then just call them by the names they ask you too!](https://news.utexas.edu/2018/03/30/name-use-matters-for-transgender-youths-mental-health/)
* [Acceptance drops the suicide rate to baseline](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178031/)