Trans Day of Visibility

Why the work I do as an affirming provider matters so much.

March 31 is International Transgender day of Visibility. Visibility is important so that people who may be questioning their identity, or wondering why they don't feel "right" in their body, can see what is possible. It's hard to imagine something if you can't see examples of it.

However, visibility is not enough. Trans people in general, and trans youth in particular are under attack at both the state and national level. I live and work in New York, one of the "safer" states for transgender rights. That has unfortunately not stopped multiple large healthcare organizations from scaling back or stopping gender-affirming care for minors, and some have stopped gender affirming care for everyone. The threats to Medicaid and Medicare funding have led to hospital systems complying in advance. Journalist Erin Reed has excellent reporting on all of this.

I am a cisgender queer woman in my 40s. My therapy career has focused on teens and young adults. Over time, I have come to focus on queer youth, and specifically trans youth and those questioning their identity. I often write letters of support for puberty blockers, hormone treatment, and gender affirming surgery. I also defer to trans writers, activists and friends as experts in their lived experience, and am always learning, because I cannot actually experience what they do.

There is so much rhetoric, misinformation and outright lying about trans kids, transition in general and the risks involved that I spend much of my first few sessions with younger trans folks explaining the steps, and hurdles that are in place to ensure appropriate care. For the trans kids who want to transition immediately, this is frustrating. For the grownups, it's often a relief that it's a slow process.

Here's a crash-course in steps of gender affirming care:

Social Transition: can happen at any age. Usually change in clothing, hair style, name and pronouns. Nothing is permanent, and usually does shift and change over time. Figuring out a new identity is tricky! Therapy is usually a part of the process for folks, but not always. For pre-adolescent folks, this is the extent of transition. For post-adolescent folks, social transition can happen before, or alongside medical transition.

Medical Transition: this rarely starts before puberty, unless a child has been loud and firm in their trans identity for multiple years and has socially transitioned. Therapy is almost always required for medical transition, as letters of support are necessary to access care. Puberty blockers are often the first step for youth under 18. After about 6 months, if the client still wants to pursue hormone therapy, then they can start that. Surgeons who perform gender-affirming surgeries often require a period of hormone treatment before a consultation for surgery. It's a lot of steps, and a lot of waiting. There are multiple chances to stop, consider, and change your mind.

Anti-trans Myths

-Social Contagion: the idea that seeing/hearing/knowing about trans folks will make someone transgender. It's patently false. If someone is transgender, seeing someone who looks like them can help them realize their gender. But cisgender folks will remain cisgender, even if they have questioned their identity.

-"Rapid onset gender dysphoria": ie the idea that someone comes out as trans abruptly with "no warning". Which is baloney. In my experience, it's usually one or two things: someone has been debating and exploring their gender privately for months to years before they come out, and/or they were ok-ish until puberty hit and the post-puberty body they have is distinctly wrong for how they see themselves. (There's a big gap between "my new body is weird" and "I'm not supposed to have breasts!")

-"They'll regret it!" The rate of regret for gender affirming care is lower than that of knee surgery. Trans healthcare is held to a higher standard than any other. Yes, some people detransition, but there are multiple reasons for why folks do that, including pressure from others and safety.

-"They're to young to know what they want/who they are!" The attempts to ban trans healthcare below the age of 19 are absurd and infantilizing. We allow people to get married at age 16 (or younger!) At 18 you can join the military, work dangerous jobs, get a tattoo or piercing, get plastic surgery, sign contracts, and borrow money, and nobody panics about those things. While identity as a whole changes across the lifespan, gender tends to be pretty stable after puberty.

-Medical and mental health professionals are pushing transition: Nope, nope, not even close! As someone who does assessments, and writes letters of support, I've seen some youth who "try on" an identity to see if it fits. These teens often don't pursue medical transition because it's not ultimately right for them, and they realize they're cisgender. If someone isn't 100% on whether they want to pursue social or medical transition, it's unethical to push them into doing so. My job as a therapist is to give them a space to explore their emotions and experiences and to provide resources for next steps. Many people delay, pause, and restart their medical transition multiple times. I just walk alongside them.

Providing the gender-affirming mental health care that I do helps to reduce suicidal ideation and self-harm. I have seen the positive impact it makes on my clients. I'm proud to assist my clients in their gender journey. I am sometimes the first person that they come out to, and to really see them. So on this Trans Day of Visibility: I see you, thank you for letting me help you.