In recent years, the national conversation regarding identity and rights has brought a number of old myths about transgender individuals back to the forefront. From bathrooms to the military to high school proms, these myths continue to haunt the discussion, turning those who don’t fit a profile into fodder for debate. Misperceptions about health, motivation and day-to-day life have pervaded initiatives to deny equitable opportunities to those who identify as transgender.
Over the 44 years I’ve been practicing medicine, we’ve seen a great deal of progress in policies that affect transgender people due to a cultural shift in understanding and empathy. But it has been shocking to see such a quick reversal that erroneously and harmfully singles out the transgender community. There is little to no evidence supporting arguments about an increase in violence committed by transgender individuals or the undue burden on our military. In fact, by perpetuating negative myths, the environment has grown more dangerous for transgender people, with more than two dozen individuals killed in each of the last two years (almost all of whom were people of color).
In my experience, there are at least five myths that have contributed to negative perceptions about transgender people:
Myth No. 1: Transgender people are mentally ill. The American Medical Association and the American Psychiatric Association have recognized gender dysphoria as a medical condition, but not a disorder. Further, the degree of dysphoria varies, meaning the psychological distress varies as well. Yet because gender dysphoria can lead to severe health issues like depression, anxiety and suicidal ideation, the recommended course of treatment is living as transgender including the use of mental health support and the options of hormone therapy and surgery.
Myth No. 2: Transgender people are dangerous. Advocates of recent bathroom bills and the military ban have claimed them necessary to protect cis people from a transgender person waiting to harm them. But the data does not support this. The language of these policies also speaks to a deeper issue, with transgender individuals allowed to still serve in the military and use gendered bathrooms according to their birth gender, thus denying their identity.
Myth No. 3: Gender identity and sexual orientation are linked. The definitions of gender identity and sexual orientation often get muddled, but the former is how one self-identifies and the latter who they are attracted to. Both gender and orientation exist on their own spectrum, meaning they are not necessarily related.
Myth No. 4: All transgender people medically transition. The desire and ability to transition differs across individuals. While some pursue hormone therapy and gender reassignment surgeries, others lack access to them or are barred by discrimination. Others have no interest in full genital surgery. The medical treatment for someone with gender dysphoria seeks to help people live as their true gender but it does not prescribe a particular course of action.
Myth No. 5: Transitioning is as simple as one surgery. For those who do opt to undergo gender reassignment surgery, the process is more involved than simply electing to proceed. Many will go through facial, chest and other procedures. Furthermore, in my practice, before moving forward with gender reassignment surgery, we require three steps from our patients to assess their readiness:
• Certification by two mental health specialists to confirm the diagnosis of gender dysphoria and to ensure the patient is emotionally stable
• Hormonal therapy for a minimum of one year prior to surgery
• Live and present full-time as their desired gender
Those who perpetuate these myths lose something by closing themselves off to others’ life experiences. Understanding the hurdles and victories of the transgender community has helped me to be a more compassionate physician. I’ve been able to help an incredible number of transgender people feel more wholly themselves through surgical and nonsurgical procedures. We’re all stronger when everyone can reach their potential and participate, regardless of how they identify.
Rather than limiting a community, we should work toward ensuring rights and equity across the board. Mistaken beliefs are increasingly used to attack people’s humanity when most are seeking nothing more than to quietly go about their lives. Therefore, it falls to those of us who are able to help remove barriers so that cis and transgender people can live their lives to the fullest. JN
Dr. Sherman Leis, D.O., is a pioneer in transgender surgery and the founder of The Philadelphia Center for Transgender Surgery in Bala Cynwyd, Pennsylvania.