A review of non-pathologizing psychology research that expands our understanding of trans identity, experience, and mental health. Maintained by Sebastian Mitchell Barr.
I’m a transgender man and psychology researcher looking for trans people to take an online research survey on mental health and adverse experiences
My name is Sebastian Barr – I am a transgender man and a doctoral candidate in Counseling Psychology at the University of Louisville. I used to write the blog xxboy and for Autostraddle, and am now primarily researching and educating on transgender mental health and psychology. I am currently seeking participants for my dissertation research, which I am conducting under the supervision of Drs. Kate Snyder and Mark Leach.
To qualify for the study, participants must identify as having a gender that is different from the sex they were assigned at birth and must be over the age of 18. Participation involves completing an anonymous online questionnaire that will take approximately 15-20 minutes to complete. After you finish the survey you will have the option of providing your contact information in order to be entered to win a $100 gift card. This study has been approved by University of Louisville’s IRB.
The information collected will not necessarily benefit you directly but may be helpful to others. As you are likely aware, gender diverse people are at increased risk of having adverse experiences and poor mental health. The information you provide will help us better understand the experiences of transgender and gender non-conforming people and may help us communicate these experiences to the scientific community and the general public. This could lead to important applications in therapy and counseling that might improve access to effective mental health care.
It is important to us that the research reflects the wide range of identities and experiences of transgender and gender non-conforming people, so we strongly encourage the participation of individuals who are often left out of other trans-focused studies, e.g., those who live stealth and people with nonbinary identities. For this reason, we also encourage individuals with marginalized intersecting identities (e.g., trans people of color, trans people with disabilities) to participate.
If you are interested in being a part of this study, you can complete the questionnaire here: http://bit.ly/BarrTransSurvey
If you have any questions, please contact Sebastian Barr at [email protected].
Thank you,
Sebastian Mitchell Barr
Doctoral Candidate, Counseling Psychology
University of Louisville
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Reflections on the murder of yet another trans person
Every trans person murdered is a reminder to me of three things:
The unacceptable lack of safety, support, resources, and rights trans people have access to, particularly trans people of color and trans people in poverty (which aforementioned lack of safety, support, resources, and rights makes more likely for trans people in general).
The near-constant pain the trans community is in, suffering blow after blow, being dealt a steady mix of personal and political losses and rejection.
The strength, power, and beauty of my trans siblings who live their truths (privately and/or publicly) and fight to live authentically in whatever ways are accessible to them; who survive and thrive in the face of obstacles; who find and create beauty in the face of pain.
I have so much love for my community. There is still so much need for change.
A note about correlations, risk factors, and aggregate quantitative research
I recently posted a review of the quantitative research on trans suicide (8 Things the Statistics Actually Say About Trans Suicide), which has gone slightly-viral (at least compared to other nerdy research things I've written in the past, haha).
(TL;DR here)
On Correlational vs. Causational Research
A lot of the quantitative (or numbers-based) research in the social sciences is correlational. A correlation is a way of measuring how much two variables are related or associated. A variable is anything that we measure that might change between time points or individuals. For example, whether someone has considered suicide is a variable; so is height, happiness, test performance, etc., etc. When two variables are associated, it means that the average value of one changes as the average value of the other changes. We then say that those variables are correlated.
An example of a correlation from the post: "Research has found that both of these experiences (internalized transphobia and body shame) are associated with increased suicide risk.5,6,7" Let's look at the specific finding that internalized transphobia is associated with increased suicidality. This means that researchers measured a lot of trans people's internalized transphobia as well as their suicidality. And they found that, on average, people with higher levels of internalized transphobia also had higher levels of suicidality.
This type of research cannot evaluate whether internalized transphobia causes suicidality. To figure out causality, you would have to be able to change people's levels of internalized transphobia, and measure whether, on average, levels of suicidality changed in response to the changes in internalized transphobia. Like I said, most social science research isn't causational - and that's mostly because variables like internalized transphobia are really difficult for researchers to change.
Correlational research is still incredibly important and valuable. Understanding how different variables are associated offers insight into patterns and allows us to hypothesize about causality.
What does "increased risk" mean?
Almost all of the findings discussed in the blog post on trans suicide research conclude that certain experiences or characteristics (for example, internalizd transphobia) increase trans people's risk of suicidality. In quantitative research, risk factors are variables that are known to be associated with negative outcomes. So, for example, my statement that "Suicide risk increases when trans people experience discrimination," means that research has found that experiences of discrimination are correlated with suicidality in trans people. If you read the above section, you know that this means that on average, people who experience higher levels of discrimination experience higher levels of suicidality. Other ways of talking about risk and risk factors include statements about likelihood. So, when for example, I write "Trans people who survive trans-related violence and abuse are substantially more likely to attempt suicide," this means that there was a significant trend in the data that showed that for trans people, the presence of a history of abuse was associated with a presence of suicidality.
"But I've experienced that and I'm not suicidal": The value and limitations of aggregate data analysis
The research I referenced in the post is based on taking values from a lot of trans people and identifying trends in the data (we call this aggregate data analysis). This means using advanced and scientifically/mathematically rigorous methods for finding patterns in people's experiences and characteristics. This is incredibly important, because it allows us to draw conclusions about risk factors and get a sense for how different variables usually relate to each other. For example, we know from decades of research that smoking cigarettes usually goes along with cardio-vascular problems. This does not mean that every person who smokes cigarettes will have cardio-vascular problems, but it is still an important thing to know and understand.
Aggregate correlations that allow us to say things like "Trans people who are easily identifiable as trans are at greater risk of attempting suicide" do NOT in any way mean that every person who is easily identifiable as trans is going to attempt suicide. In fact, it's even more complicated than that, because each person has a lot of individual variables (like age, income, other psychological variables) that increase and decrease their risk for any given outcome, such as suicidality. So the statement that "Trans people who are easily identifiable as trans are at greater risk of attempting suicide" also does not mean that every person who is identifiable trans has an increased risk of attempting suicide. It means, on average trans people who are identifiable as trans have an increased risk. On the individual level, you can imagine how protective factors, such as family acceptance, low levels of depression, pride, community belongingness, etc., could offset the risk for a person who is identifiably trans. However, this finding does mean that a person with any combination of risk and protective factors who is identifiably trans is more likely to have experienced suicidality than a person with the exact same combination of risk and protective factors who is not identifiably trans.
So again, these individual differences do not make the conclusion about the overall trend invalid or unimportant. Let's consider the smoking example again. On average, cigarette smoking is associated with an increased risk of cardio-vascular problems. On average, a healthy family history and exercise are associated with decreased risk of cardio-vascular problems. An individual who smokes cigarettes may also work out and have no family history of cardio-vascular problems. His protective factors offset the risk from cigarette-smoking so he may actually have low or regular level of cardio-vascular risk when compared to non-smokers. Importantly, his risk of having cardio-vascular problems is higher than a non-smoker who works out and has no family history of cardio-vascular problems.
In conclusion (AKA TL;DR)
Increased risk means an increased likelihood of an outcome or a likelihood of an increase in an outcome. Understanding how experiences and characteristics are associated with specific outcomes, like suicidality, are incredibly important for us to hypothesize about what contributes to those outcomes and how we can intervene to reduce the likelihood of those outcomes. Correlational data cannot prove that an experience or characteristic contributes to or causes something, just that, on average, people who have that experience or characteristic also have that outcome - or people who have higher levels of that experience/characteristic also have higher levels of the outcome. Risk factors also identify general trends, which means there will be people who have a risk factor but do not have higher levels of the outcome.
8 Things the Statistics Actually Say About Trans Suicide
Author's note 1: If you are thinking about hurting yourself or ending your life, please reach out and get help. We want you to stay alive. National Suicide Hotline: 1 (800) 273-8255; National Crisis Textline: Text “GO” to 741-741; Trans Lifeline: 877-565-8860; Trevor Helpline for LGBT Youth: 1-866-7386.
Author's note 2: As this is getting shared, many people have been asking questions about how to interpret the findings I describe. For example, "Does this mean that this causes that?" I penned a post briefly explaining some concepts*, like correlations and risk, which should help if, like most folks, you've never had the pleasure of a course on statistics or research methods.*
I have seen a growing number of people citing statistics about increased suicide risk as evidence that therapists/psychologists/counselors/society should not support trans people's identities and transitions. Gina Loudon told Fox News that those who supported trans people's right to transition were "science deniers," claiming that research has found that trans people's suicide risk increases 20-fold when they transition (spoiler: that statistic is inaccurate). Michael Cook recently penned a blog post titled "What do the statistics say about transgender mental health?", in which he concluded that the idea that trans people's psychological stress will be relieved through transitioning is pure deception that runs counter to the evidence. Heath Lambert, professor of biblical counseling who counsels trans people to avoid transition, defends his position by stating that trans people who have transitioned still have higher rates than the general population.
(Note: this list is based on a more comprehensive post here.)
1. Rejection and lack of support increase risk of suicidality.
Researchers who conducted the National Transgender Discrimination Survey found that trans people who were rejected by their families were twice as likely to have attempted suicide as trans people who were not rejected.1 Studies have also found that the less social support a transgender person experiences and the more lonely they feel, the more likely they are to seriously consider suicide.2 Family and peer acceptance and support, on the other hand, have been found to be associated with decreases in suicidality, depression and anxiety.3,6 This fits with Dr. Thomas Joiner's evidence-based Interpersonal Theory of Suicide, which suggests that suicidality emerges when people simultaneously feel that they are a burden to others and lack a sense of belonging.
2. Suicide risk increases when trans people experience discrimination.
Discrimination greatly contributes to suicide risk.4 For example, in one study, trans people who had lost a job for being trans were more than 50% more likely to have attempted suicide than trans people who had not experienced employment discrimination.1 This actually extends to the policy level and general political climate, too. A study published this year in Behavioral Medicine found that trans people have increased suicide risk if they live in states that lack legal protections for LGBT people.5
3. Trans people who experience shame about being trans or about their bodies are more likely to be suicidal.
Trans people may internalize the negative messages about trans people that are perpetuated by media, society, and bigots. They are internalized as negative beliefs about transgender people or negative gender-related beliefs about themselves, and are often experienced as shame about being transgender. This is called internalized transphobia. A piece of this can also be the shame that some trans people feel about the way their body looks and/or is perceived by others. Research has found that both of these experiences (internalized transphobia and body shame) are associated with increased suicide risk.5,6,7
4. Trans people who are easily identifiable as trans are at greater risk of attempting suicide.
Research shows that suicide risk increases as a trans person's visibility increases. That is, when a trans person is consistently open about being trans or is regularly perceived as trans by others, they are more likely to seriously consider or attempt suicide. This increase is due in part to increased experiences of gender-related discrimination, harassment, and violence.1,8 This likely also explains the mixed findings about medical transitions and suicide risk.
5. Undergoing an affirming medical transition does not make trans people more suicidal. In fact, it reduces suicide risk.
This is a big one. A lot of people who argue against supporting/affirming a person's transition try to make the case that transitioning makes trans people more suicidal. They often cite a thoroughly debunked study from the 1970s or a gross misrepresentation of recent research. This argument might also come from a misunderstanding of a more recent study, which found that transgender people who have had some form of gender affirmation surgery were slightly more likely to have attempted suicide in their lives than those who who had not (43% vs. 39%). This difference was more pronounced when looking at people who had taken any medical transition steps (e.g., hormone replacement therapy).1 This doesn't mean trans people who have transitioned are more likely to attempt suicide than trans people who don't transition - it means they are more likely to have attempted at one point in their life. These are very different statements, and the former is not supported by other research. The only published longitudinal studies which have reliably measured mental health of transgender people before transitioning and again after beginning that transition found that medical transitions significantly reduce psychological distress.9 A recent study out of Canada further clarified these findings by evaluating differences in current suicidal thinking and past-year suicide attempts at various stages of transition. Trans people who were on hormones were half as likely to have seriously considered suicide in the past year. Trans people who reported that their medical transition was complete were 62% less likely to have seriously considered suicide. They were also significantly less likely to have recently attempted suicide. Of trans people who had seriously considered suicide in the past year, those who said they were in the process of transitioning were more likely to have attempted suicide than those who had completed a transition and those who wanted to transition but hadn't started.6 The finding that trans people who are seriously considering suicide may experience an increased risk of attempting when they are "in the process of" a medical transition is not surprising. It is a safe assumption that this increase in risk is due to initial increases in visibility (e.g., coming out, being more visibly non-conforming) that, in the beginning, offset the reduction of psychological distress transition has been found to have. So in sum, existing evidence overwhelmingly shows that medical transitions, when desired, are linked to improved mental health and suicide risk reduction, though the difficulties of beginning a transition may increase suicidality of those already considering suicide. It is important to also note that despite the reduction in risk, trans people who have transitioned are still at greater risk of attempting suicide than non-transgender people.10 The rest of this post should help explain why the risk persists.
6. Trans people who survive trans-related violence and abuse are substantially more likely to attempt suicide.
Transgender people who have experienced verbal, physical, or sexual abuse/assault due to their transgender identity or gender expression are substantially more likely to have attempted suicide. The more frequent/regular this abuse was, the more likely a transgender person was to have attempted suicide. Additionally, higher rates of transgender-related abuse/violence were linked with a greater number of suicide attempts, suggesting what researchers call a "dose-redose" effect: the more a person experiences transgender-related abuse/violence, the more chronic and severe their suicidality appears to be.4,7,11,12 An unfortunately, these studies and others also show that it is not uncommon for trans people to experience harassment, physical assault, and/or sexual assault due to bias. For example, 35% of trans people reported being physically assaulted in school for being trans or gender non-conforming. That percentage was higher for trans people of color and trans people who were visibly identifiable as trans or gender non-conforming.8
7. Trans people are more likely to experience general risk factors for suicide.
The experiences and characteristics that make anyone more likely to be suicidal also make trans people more likely to have seriously considered or attempted suicide. These include, but are not limited to: youth, alcohol and substance abuse, trauma, homelessness, lower education levels, depression, and severe mental health issues.3,4,5,13 Unfortunately, research suggests that (besides age), trans people are more likely than the general population to experience these risk factors.1
8. Intersecting identities matter.
Belonging to other minority and/or sitgmatized groups increases trans people's risk of seriously considering and attempting suicide. For example, studies consistently show that trans people of color have higher rates of suicide attempts than white trans people. Trans people with HIV and/or disabilitites are also at increased risk, as are low-income and homeless trans people.5,8
Edited on 11/2/2015 to include suicide prevention / crisis resources and to add reference to the Dhejne et al. (2011) article*, as well as the TransAdvocate interview with Dr. Dhejne.*
References
Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force. http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf ↩︎
Yadegarfard, M., Meinhold-Bergmann, M. E., & Ho, R. (2014). Family rejection, social isolation, and loneliness as predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among Thai male-to-female transgender adolescents. Journal of LGBT Youth, 11, 347-363. doi: 10.1080/19361653.2014.910483 ↩︎
Budge, S. L., Adelson, J. L., & Howard, K. A. S. (2013). Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping. Journal of Counseling and Clinical Psychology, 81, 545-567. doi: ↩︎
Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons. Journal of Homosexuality, 51, 53-69. doi: 10.1300/J082v51n03_04 ↩︎
Perez-Brumer, A., Hatzenbuehler, M. L., Oldenburg, C. E., & Bockting, W. (2015). Individual- and structural-level risk factors for suicide attempts among transgender adults. Behavioral Medicine, 41, 164-171. doi: 10.1080/08964289.2015.1028322 ↩︎
Bauer, G. R., Scheim. A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 15. doi: 10.1186/s12889-015-1867-2 ↩︎
Grossman, A. H., & D'Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behaviors, 37, 527-537. doi: 10.1521/suli.2007.37.5.527 ↩︎
Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). Suicide attempts among transgender and gender non-conforming adults: Findings of the National Transgender Discrimination Survey. Report published by American Foundation for Suicide Prevention and The Williams Insititute. ↩︎
Keo-Meier, C. L., Herman, L. I., Reisner, S. L., Pardo, S. T., Sharp, C., & Babcock, J. C. (2015). Testosterone treatment and MMPI-2 improvement in transgender men: A prospective controlled study. Journal of Consulting and Clinical Psychology, 83, 143-156. doi: 10.1037/a0037599 ↩︎
Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Langstrom, N., & Landen, M. (2011). Long-term follow-up for transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLOS One. doi: 10.1371/journal.pone.0016885 ↩︎
Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., & Beck, J. (2010). Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. The Journal of Sex Research, 47, 12-23. doi: 10.1080/00224490903062258 ↩︎
Goldblum, P., Testa, R. J., Hendricks, M. L., Bradford, J., & Bongar, B. (2012). The relationship between gender-based victimization and suicide attempts in transgender people. Professional Psychology: Research and Practice, 43, 468-475, doi: 10.1037/a0029605 ↩︎
Testa, R. J., Sciacca, L. M., Wang, F., Hendricks, M. L., Goldblum, P., Bradford, J., & Bongar, B. (2012). Effects of violence on transgender people. Professional Psychology: Research and Practice, 43, 452-459. doi: 10.1037/a0029604 ↩︎
I think the difficulty people have in understanding what it means to be transgender comes from the fact that in our society, we often learn about sex and gender in overly simplistic and conflated ways. The first step to understanding the concept of being transgender is to try to understand what sex and gender mean.
There are four main components to sex and gender: sex assigned at birth, biological sex, gender identity, and gender expression. These are separate components and do not necessarily directly influence each other.
Sex assigned at birth is an assignment made at birth, based on doctors’ interpretation of a person’s biology – typically, via examination of external genitalia. In the United States, birth certificates must bear a “male” or “female” sex assignment. Male is assigned when a baby appears to have a penis; female is assigned when a baby appears to have a clitoris, vulva, and vagina. These assignments are not always straightforward, as it is pretty common to have genitalia that do not clearly fall into one of the above categories.1
Biological sex can refer to chromosomes, hormone levels, reproductive anatomy, secondary sex characteristics (e.g., facial hair, breasts), or a combination of all of these things. Despite the fact that we are typically taught in science about "male and female" sexes, biological sex does not fit easily into two discrete categories. Our biological sex is actually very complicated, with a great deal of diversity in chromosomal makeup, hormone levels, reproductive anatomy, and secondary sex characteristics across male-assigned and female-assigned folks. There are multitudes of chromosomal combinations; the two most common (though most of us never have our chromosomes tested) are XX and XY. Typically, people with two X chromosomes have vaginas, wombs and ovaries, are given “female” sex assignments, and have higher levels of progesterone and estrogen after puberty, which lead to menstruation and breast development. Typically people with an X chromosome and a Y chromosome have penises and testes, are given a “male” sex assignment and have higher levels of testosterone after puberty, which leads to increased body hair, lower vocal ranges, and greater muscle mass. It's important to think about biological sex as a complicated spectrum: "[Typically] male and [typically] female [sexes] form the extremes of a biological continuum that features many types of intersex conditions" -Dr. Anne Fausto-Sterling, biologist and historian.
Gender is a general term referring to social categories based on culturally-specific role expectations that are attached to sex assignments. Gender identity is a person’s internal sense of what gender and/or sex they are and/or how they fit into their society’s gender categories. A person might have an internal sense of being female/woman, male/man, a combination of both, or neither, or may have a fluid internal sense of gender, such that they identify differently at different points in time. There are lots of different possible gender identities and labels outside of man and woman, some of which include genderqueer, non-binary (referring to the fact they do not identify within the binary framework of man vs. woman), genderfluid, and two-spirited (a traditional Native American gender identity).
Gender expression is how a person communicates their gender to the world. Examples of ways we express our gender include the clothing we wear, our hairstyles, and conversation styles. When we use the words masculine and feminine, we tend to be talking about gender expression, for example. Other terms associated with gender expression include femme and butch.
None of these concepts is directly related to sexuality or sexual orientation (e.g., bisexual, lesbian, queer, gay, straight), which involve whom a person is attracted to.
Transgender People, Cisgender People, and Gender Transitions
When we learn about sex and gender, we are usually taught to think about them as a singular concept with two options, when really there are (at least) four components and an infinite possibility of combinations.
People are considered transgender when their particular sex and gender combination includes a gender identity that is different from their sex assigned at birth. For example a person who has a female sex assignment and a genderqueer gender identity is transgender; a person who was female assigned at birth and has a male gender identity is also transgender. People are considered cisgender when their particular sex and gender combination include a gender identity that is the same as their sex assigned at birth (cis is the latin root meaning same). Both cisgender and transgender people have a wide range of biological sex characteristics and gender expressions.
Some transgender people go through gender transitions in order to make their gender identity more visible to the outside world. This can include changes in a person’s gender expression and/or changes in their biological sex to align either or both with their gender identity. For example, a transgender man (a man who was female assigned at birth) may wear more masculine clothes and change his name to a traditionally masculine name in order to communicate his male gender identity; these would be changes in his gender expression. Changes to his biological sex may include hormone replacement or surgeries. Just like there are infinite possible combinations of gender and sex identities, there is not a singular way in which transgender people undergo a gender transition, if they choose to do so.
So, the cheat sheet version of all of this is: gender identity is an internal, psychological sense of how a person fits into gender categories; sex assigned at birth is the label a person was given at birth typically in response to their external genitalia. When these two things differ, a person is considered transgender.
How to Refer to Trans2 People
Terminology
Transgender is an adjective that describes a person, identity, experience, issue, etc. Transgendered is an outdated term that highlights medicalized/pathologized view of trans people, so it should not be used; transgender is the appropriate term. Transgender is not a noun, so a person or group of people should never be referred to as a transgender or as transgenders. Finally, transgender isn't a verb, so it is inaccurate to say a person transgendered - if you are talking about a gender transition, you can say they transitioned or went through a gender transition.
There also appropriate and inappropriate ways to discuss the categories and gender identities of transgender people. Though trans people are routinely categorized and described by the terms FTM (female-to-male), MTF (male-to-female), and non-binary-identfied, FTM and MTF are really not appropriate3, unless you are referring to a specific person who has expressly stated that they use that terminology for themselves. First and foremost, transgender people should be identified using the terminology they use for themselves (for example, a transgender woman should be referred to as a woman if she calls herself that; a genderqueer person should be referred to as genderqueer or using whatever gender label they use for themselves). When using the word transgender as a description for someone,4 include it with the person’s gender identity, not their sex assigned at birth. So a transgender woman is a person who identifies as a woman. When a person’s transgender history is important and needs to be referenced, identify them based on their gender identity and their sex assigned at birth. FAAB and MAAB are acronyms for female-assigned-at-birth and male-assigned-at-birth. For example, a transgender woman is a woman (MAAB) or a woman who was male assigned at birth. Intersex may also be appropriate if a person’s assigned sex and/or biological sex at birth were not discretely male or female. In this case, you might describe someone with a female gender identity as an intersex woman.5 An intersex person may or may not consider themselves transgender.
Pronouns
Pronouns are the words we use in place of people’s names when referring to them. In English (and many other languages), third person pronouns are gender-specific. He/him/his are typically used for people with male gender identities and she/her/hers are typically used for people with female gender identities. Because pronouns then inherently announce a person’s gender, it is important that we ask others which pronouns they want us to use for them. Many transgender men prefer he/him/his pronouns and many transgender women prefer she/her/hers pronouns, while genderqueer folks and other people with non-binary gender identities may prefer gender-neutral pronouns (e.g., they/them/theirs, ze/hir/hirs). Because we can’t tell a person’s gender identity or pronouns from looking at them, it’s most affirming to ask and use gender-neutral pronouns (or avoid pronouns) until we know which ones to use.
Further Reading
(Coming soon!)
Historically, doctors have attempted to surgically alter intersex genitalia to make them conform to more traditionally male or female anatomy. The ethics of this are highly questionable and intersex advocates have long called for different protocol in sex assignment of intersex babies, resulting in some shifts away from surgical alteration at birth. Learn more at the Intersex Society of North America. ↩︎
Trans is short for transgender and is sometimes considered to be more inclusive of different sex/gender combinations. While we’re at it, let’s note that cis is short for cisgender. ↩︎
↩︎
Please note that not everyone considers their transgender identity to be a part of their gender identity, and a transgender person may prefer to be referred to as simply a man or a woman. It is important to ask. Additionally, never disclose a person’s transgender status without their explicit permission to do so. ↩︎
In American society, and some other countries/cultures, intersex people are still assigned a male or female sex at birth. The intersex community refers to this as a coercive sex assignment, and you can use the acronyms CAFAB and CAMAB to mean coercively-assigned-female-at-birth and coercively-assigned-male-at-birth, respectively. ↩︎
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