gender reassignment story

John Money Gender Experiment: Reimer Twins

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The John Money Experiment involved David Reimer, a twin boy raised as a girl following a botched circumcision. Money asserted gender was primarily learned, not innate.

However, David struggled with his female identity and transitioned back to male in adolescence. The case challenged Money’s theory, highlighting the influence of biological sex on gender identity.

• David Reimer was born in 1965; he had a MZ twin brother. When he was 8 months old his penis was accidentally cut off during surgery.
• His parents contacted John Money, a psychologist who was developing a theory of gender neutrality. His theory claimed that a child would take the gender identity he/she was raised with rather than the gender identity corresponding to the biological sex.
• David’s parents brought him up as a girl and Money wrote extensively about this case claiming it supported his theory. However, Brenda as he was named was suffering from severe psychological and emotional difficulties and in her teens, when she found out what had happened, she reverted back to being a boy.
• This case study supports the influence of testosterone on gender development as it shows that David’s brain development was influenced by the presence of this hormone and its effects on gender identity was stronger that the influence of social factors.

What Did John Money Do To The Twins

David Reimer was an identical twin boy born in Canada in 1965. When he was 8 months old, his penis was irreparably damaged during a botched circumcision.

John Money, a psychologist from Johns Hopkins University, had a prominent reputation in the field of sexual development and gender identity.

David’s parents took David to see Dr. Money at Johns Hopkins Hospital in Baltimore, where he advised that David be “sex reassigned” as a girl through surgical, hormonal, and psychological treatments.

John Money believed that gender identity is primarily learned through one’s upbringing (nurture) as opposed to one’s inborn traits (nature).

He proposed that gender identity could be changed through behavioral interventions, and he advocated that gender reassignment was the solution for treating any child with intersex traits or atypical sex anatomies.

Dr. John Money argued that it’s possible to habilitate a baby with a defective penis more effectively as a girl than a boy.

At the age of 22 months, David underwent extensive surgery in which his testes and penis were surgically removed and rudimentary female genitals were constructed.

David’s parents raised him as a female and gave him the name Brenda (this name was chosen to be similar to his birth name, Bruce). David was given estrogen during adolescence to promote the development of breasts.

He was forced to wear dresses and was directed to engage in typical female norms, such as playing with dolls and mingling with other girls.

Throughout his childhood, David was never informed that he was biologically male and that he was an experimental subject in a controversial investigation to bolster Money’s belief in the theory of gender neutrality – that nurture, not nature, determines gender identity and sexual orientation.

David’s twin brother, Brian, served as the ideal control because the brothers had the same genetic makeup, but one was raised as a girl and the other as a boy. Money continued to see David and Brian for consultations and checkups annually.

During these check-ups, Money would force the twins to rehearse sexual acts and inspect one another’s genitals. On some occasions, Money would even photograph the twins doing these exercises. Money claimed that childhood sexual rehearsal play was important for healthy childhood sexual exploration.

David also recalls receiving anger and verbal abuse from Money if they resisted participation.

Money (1972) reported on Reimer’s progress as the “John/Joan case” to keep the identity of David anonymous. Money described David’s transition as successful.

He claimed that David behaved like a little girl and did not demonstrate any of the boyish mannerisms of his twin brother Brian. Money would publish this data to reinforce his theories on gender fluidity and to justify that gender identity is primarily learned.

In reality, though, David was never happy as a girl. He rejected his female identity and experienced severe gender dysphoria . He would complain to his parents and teachers that he felt like a boy and would refuse to wear dresses or play with dolls.

He was severely bullied in school and experienced suicidal depression throughout adolescence. Upon learning about the truth about his birth and sex of rearing from his father at the age of 15, David assumed a male gender identity, calling himself David.

David Reimer underwent treatments to reverse the assignment such as testosterone injections and surgeries to remove his breasts and reconstruct a penis.

David married a woman named Jane at 22 years and adopted three children.

Dr. Milton Diamond, a psychologist and sexologist at the University of Hawaii and a longtime academic rival of John Money, met with David to discuss his story in the mid-1990s.

Diamond (1997) brought David’s experiences to international attention by reporting the true outcome of David’s case to prevent physicians from making similar decisions when treating other infants. Diamond helped debunk Money’s theory that gender identity could be completely learned through intervention.

David continued to suffer from psychological trauma throughout adulthood due to Money’s experiments and his harrowing childhood experiences. David endured unemployment, the death of his twin brother Brian, and marital difficulties.

At the age of thirty-eight, David committed suicide.

David’s case became the subject of multiple books, magazine articles, and documentaries. He brought to attention to the complications of gender identity and called into question the ethicality of sex reassignment of infants and children.

Originally, Money’s view of gender malleability dominated the field as his initial report on David was that the reassignment had been a success. However, this view was disproved once the truth about David came to light.

His case led to a decline in the number of sex reassignment surgeries for unambiguous XY male infants with a micropenis and other congenital malformations and brought into question the malleability of gender and sex.

At present, however, the clinical literature is still deeply divided on the best way to manage cases of intersex infants.

Colapinto, J. (2000). As nature made him: The boy who was raised as a girl. New York, NY: Harper Collins.

Colapinto, J. (2018). As nature made him: The boy who was raised as a girl. Langara College.

Diamond, M., & Sigmundson, H. K. (1997). Sex reassignment at birth: Long-term review and clinical implications . Archives of pediatrics & adolescent medicine, 151(3), 298-304.

Money, J., & Ehrhardt, A. A. (1972). Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Money, J. (1994). The concept of gender identity disorder in childhood and adolescence after 39 years . Journal of sex & marital therapy, 20(3), 163-177.

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David Reimer and John Money Gender Reassignment Controversy: The John/Joan Case

In the mid-1960s, psychologist John Money encouraged the gender reassignment of David Reimer, who was born a biological male but suffered irreparable damage to his penis as an infant. Born in 1965 as Bruce Reimer, his penis was irreparably damaged during infancy due to a failed circumcision. After encouragement from Money, Reimer’s parents decided to raise Reimer as a girl. Reimer underwent surgery as an infant to construct rudimentary female genitals, and was given female hormones during puberty. During childhood, Reimer was never told he was biologically male and regularly visited Money, who tracked the progress of his gender reassignment. Reimer unknowingly acted as an experimental subject in Money’s controversial investigation, which he called the John/Joan case. The case provided results that were used to justify thousands of sex reassignment surgeries for cases of children with reproductive abnormalities. Despite his upbringing, Reimer rejected the female identity as a young teenager and began living as a male. He suffered severe depression throughout his life, which culminated in his suicide at thirty-eight years old. Reimer, and his public statements about the trauma of his transition, brought attention to gender identity and called into question the sex reassignment of infants and children.

Bruce Peter Reimer was born on 22 August 1965 in Winnipeg, Ontario, to Janet and Ron Reimer. At six months of age, both Reimer and his identical twin, Brian, were diagnosed with phimosis, a condition in which the foreskin of the penis cannot retract, inhibiting regular urination. On 27 April 1966, Reimer underwent circumcision, a common procedure in which a physician surgically removes the foreskin of the penis. Usually, physicians performing circumcisions use a scalpel or other sharp instrument to remove foreskin. However, Reimer’s physician used the unconventional technique of cauterization, or burning to cause tissue death. Reimer’s circumcision failed. Reimer’s brother did not undergo circumcision and his phimosis healed naturally. While the true extent of Reimer’s penile damage was unclear, the overwhelming majority of biographers and journalists maintained that it was either totally severed or otherwise damaged beyond the possibility of function.

In 1967, Reimer’s parents sought the help of John Money, a psychologist and sexologist who worked at the Johns Hopkins Hospital in Baltimore, Maryland. In the mid twentieth century, Money helped establish the views on the psychology of gender identities and roles. In his academic work, Money argued in favor of the increasingly mainstream idea that gender was a societal construct, malleable from an early age. He stated that being raised as a female was in Reimer’s interest, and recommended sexual reassignment surgery. At the time, infants born with abnormal or intersex genitalia commonly received such interventions.

Following their consultation with Money, Reimer’s parents decided to raise Reimer as a girl. Physicians at the Johns Hopkins Hospital removed Reimer’s testes and damaged penis, and constructed a vestigial vulvae and a vaginal canal in their place. The physicians also opened a small hole in Reimer’s lower abdomen for urination. Following his gender reassignment surgery, Reimer was given the first name Brenda, and his parents raised him as a girl. He received estrogen during adolescence to promote the development of breasts. Throughout his childhood, Reimer was not informed about his male biology.

Throughout his childhood, Reimer received annual checkups from Money. His twin brother was also part of Money’s research on sexual development and gender in children. As identical twins growing up in the same family, the Reimer brothers were what Money considered ideal case subjects for a psychology study on gender. Reimer was the first documented case of sex reassignment of a child born developmentally normal, while Reimer’s brother was a control subject who shared Reimer’s genetic makeup, intrauterine space, and household.

During the twin’s psychiatric visits with Money, and as part of his research, Reimer and his twin brother were directed to inspect one another’s genitals and engage in behavior resembling sexual intercourse. Reimer claimed that much of Money’s treatment involved the forced reenactment of sexual positions and motions with his brother. In some exercises, the brothers rehearsed missionary positions with thrusting motions, which Money justified as the rehearsal of healthy childhood sexual exploration. In his Rolling Stone interview, Reimer recalled that at least once, Money photographed those exercises. Money also made the brothers inspect one another’s pubic areas. Reimer stated that Money observed those exercises both alone and with as many as six colleagues. Reimer recounted anger and verbal abuse from Money if he or his brother resisted orders, in contrast to the calm and scientific demeanor Money presented to their parents. Reimer and his brother underwent Money’s treatments at preschool and grade school age. Money described Reimer’s transition as successful, and claimed that Reimer’s girlish behavior stood in stark contrast to his brother’s boyishness. Money reported on Reimer’s case as the John/Joan case, leaving out Reimer’s real name. For over a decade, Reimer and his brother unknowingly provided data that, according to biographers and the Intersex Society of North America, was used to reinforce Money’s theories on gender fluidity and provided justification for thousands of sex reassignment surgeries for children with abnormal genitals.

Contrary to Money’s notes, Reimer reports that as a child he experienced severe gender dysphoria, a condition in which someone experiences distress as a result of their assigned gender. Reimer reported that he did not identify as a girl and resented Money’s visits for treatment. At the age of thirteen, Reimer threatened to commit suicide if his parents took him to Money on the next annual visit. Bullied by peers in school for his masculine traits, Reimer claimed that despite receiving female hormones, wearing dresses, and having his interests directed toward typically female norms, he always felt that he was a boy. In 1980, at the age of fifteen, Reimer’s father told him the truth about his birth and the subsequent procedures. Following that revelation, Reimer assumed a male identity, taking the first name David. By age twenty-one, Reimer had received testosterone therapy and surgeries to remove his breasts and reconstruct a penis. He married Jane Fontaine, a single mother of three, on 22 September 1990.

In adulthood, Reimer reported that he suffered psychological trauma due to Money’s experiments, which Money had used to justify sexual reassignment surgery for children with intersex or damaged genitals since the 1970s. In the mid-1990s, Reimer met Milton Diamond, a psychologist at the University of Hawaii, in Honolulu, Hawaii, and academic rival of Money. Reimer participated in a follow-up study conducted by Diamond, in which Diamond cataloged the failures of Reimer’s transition.

In 1997, Reimer began speaking publicly about his experiences, beginning with his participation in Diamond’s study. Reimer’s first interview appeared in the December 1997 issue of Rolling Stone magazine. In interviews, and a later book about his experience, Reimer described his interactions with Money as torturous and abusive. Accordingly, Reimer claimed he developed a lifelong distrust of hospitals and medical professionals.

With those reports, Reimer caused a multifaceted controversy over Money’s methods, honesty in data reporting, and the general ethics of sex reassignment surgeries on infants and children. Reimer’s description of his childhood conflicted with the scientific consensus about sex reassignment at the time. According to NOVA, Money led scientists to believe that the John/Joan case demonstrated an unreservedly successful sex transition. Reimer’s parents later blamed Money’s methods and alleged surreptitiousness for the psychological illnesses of their sons, although the notes of a former graduate student in Money’s lab indicated that Reimer’s parents dishonestly represented the transition’s success to Money and his coworkers. Reimer was further alleged by supporters of Money to have incorrectly recalled the details of his treatment. On Reimer’s case, Money publicly dismissed his criticism as antifeminist and anti-trans bias, but, according to his colleagues, was personally ashamed of the failure.

In his early twenties, Reimer attempted to commit suicide twice. According to Reimer, his adult family life was strained by marital problems and employment difficulty. Reimer’s brother, who suffered from depression and schizophrenia, died from an antidepressant drug overdose in July of 2002. On 2 May 2004, Reimer’s wife told him that she wanted a divorce. Two days later, at the age of thirty-eight, Reimer committed suicide by firearm.

Reimer, Money, and the case became subjects of numerous books and documentaries following the exposé. Reimer also became somewhat iconic in popular culture, being directly referenced or alluded to in the television shows Chicago Hope , Law & Order , and Mental . The BBC series Horizon covered his story in two episodes, “The Boy Who Was Turned into a Girl” (2000) and “Dr. Money and the Boy with No Penis” (2004). Canadian rock group The Weakerthans wrote “Hymn of the Medical Oddity” about Reimer, and the New York-based Ensemble Studio Theatre production Boy was based on Reimer’s life.

• Carey, Benedict. “John William Money, 84, Sexual Identity Researcher, Dies.” New York Times , 11 July 2016.
• Colapinto, John. "The True Story of John/Joan." Rolling Stone 11 (1997): 54–73.
• Colapinto, John. As Nature Made Him: The Boy who was Raised as a Girl . New York: HarperCollins Publishers, 2000.
• Colapinto, John. "Gender Gap—What were the Real Reasons behind David Reimer’s Suicide." Slate (2004).
• Dr. Money and the Boy with No Penis , documentary, written by Sanjida O’Connell (BBC, 2004), Film.
• The Boy Who Was Turned Into a Girl , documentary, directed by Andrew Cohen (BBC, 2000.), Film.
• “Who was David Reimer (also, sadly, known as John/Joan)?” Intersex Society of North America . http://www.isna.org/faq/reimer (Accessed October 31, 2017).

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Theater | ‘boy’ based on true story of gender reassignment gone wrong.

Money, meanwhile, had used the case as evidence for his conviction that gender identity was, primarily, learned.

“Boy,” a 2016 play by Anna Ziegler that now is at TimeLine Theatre, is a fictionalized version of Reimer’s case: a horrific example of what well-intentioned but naive parents can allow to be done to us when we we are too young to scream “stop!” and have someone actually listen. Ziegler’s 90-minute drama imagines Adam Turner (Theo Germaine), as a young male adult, falling in love for the first time with a young woman, Jenny (Emily Marso), the both trying to navigate what this relationship means. As you watch that journey, Adam’s past is revealed in flashback scenes, featuring both his traumatized parents (played by Mechelle Moe and Stef Tovar) and his creepy doctor, here known as Dr. Wendell Barnes and played, in oily fashion, by David Parkes.

Since Reimer’s life and death were real, part of the experience of watching “Boy” involves the nauseating realization that this unethical act was perpetrated, not in the distant past but as recently as the late 1960s, and that the medical professional involved continued to practice (Money died in 2006). Money’s legacy is arguably complicated: He wrote early and extensively about the fluidity of gender, and argued that Reimer’s problems flowed from interference by “the anti-feminist movement” and by those who argued for gender immutability. Whatever. If there is one thing we have finally learned about gender and humanity at this point in our evolution, it is the crucial role of choice. For ourselves. Only we know who we are.

As a show at TimeLine, “Boy” functions as an overly efficient melodrama. As soon as you hear Barnes say the line “and you can never tell her,” you hear the cue for creepiness, which is the way director Damon Kiely and Parkes approach the character, which makes it yet harder to believe the parents would have been so duped. The script has a rigorously symmetrical structure: I found myself resisting some of that and wanting the central character of Adam, the only person who really matters here, to have more time to be, to breathe, and for the script to be willing to rip away some of this impositional neatness. Although carefully wrought and visually rich (the set is by Arnel Sancianco), the emotionally restrained production follows the same path: Whenever the actors are beginning to approach a deep place, and both Germaine and Marso do at times, we’re whisked elsewhere to a scene that could wait.

“Boy” certainly has value as a dramatic work. It’s just hard to contain this explosively experiential narrative in a very cautious off-Broadway play that feels somehow removed. You keep wanting Adam to be given more of a chance to self-actualize, to go further, to love as he has the innate human right to live.

Chris Jones is a Tribune critic.

[email protected]

Review: “Boy” (2.5 stars)

When : Through March 18

Where : TimeLine Theatre, 615 W. Wellington Ave.

Running time : 1 hour, 30 minutes

Tickets : $40-$54 at 773-283-8463 and www.timelinetheatre.com

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‘This is me, as I am’: A photographer documents her own gender transition

In 2015, Allison Lippy realized who she had always been—and turned her camera on herself to understand her journey as a transgender woman.

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I should start at the beginning.

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I moved to New York City in 2011. Keeping my mind and body occupied by working in the photo industry distracted me from introspection. In 2015, I was sitting in my therapist’s office when she casually mentioned a person—a celebrity—who had come out as trans. I don’t remember what the context of that conversation was. I don’t think I was even paying particular attention to what she was saying. But I remember thinking, ‘Oh, that’s interesting.’

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All the confusion I’d felt made sense; all the puzzle pieces fit for the first time. Everything just fell right into place. Confident and excited, I started moving quickly to make up for lost time.

I came out to my therapist first, just to test the waters, and then to my mother, who gladly was my rock throughout my transition. I’m fortunate that everybody in my life—including my parents, brother and friends—was really accepting.

Fundamentally, I owe my very existence to my trans elders, especially queer Indigenous, Black, Asian, Latinx, and POC people. They were in the streets and in our communities doing the hard work,paving the way for the rest of us to discover and live authentically as ourselves. Trailblazers, like Marsha   P. Johnson, Sylvia Rivera, and countless others , stood up and fought for our community in a time when visibility and representation were next to none.

Within a few months of coming out, I started taking hormones—and I began making self-portraits. Turning the camera on myself was a way to understand where I started and where I would end up. As a photographer and someone who didn’t encounter positive images of trans people as a kid, I felt I had a responsibility to tell my story through my own queer perspective.

I don’t intend to be representative of all trans people. Just as there isn’t one way to be human—there isn’t one right way or one wrong way to transition. We each have our own path.

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Challenging Gender Boundaries: A Trans Biography Project by Students of Catherine Jacquet

A collection of biographies written by the students in Catherine Jacquet's Fall 2012 class at the University of Illinois, Chicago. The class was titled "Gender Non-Conformity in Historical Perspective." 

Christine Jorgensen

By Stephanie Barajas

During the 1950’s, Christine Jorgensen’s story brought the matter of sex change to the center stage of American public consciousness. With the revelation of her transition from male to female, Christine Jorgensen educated the public on the subject of transsexuality. Her story forced doctors and scientists to revisit the terms of sexuality and reveal the distinctions between homosexuality and transsexuality. Christine Jorgensen managed to take her personal story and turn it into a tale of inspiration and awareness.

Christine Jorgensen was born as George Jorgensen Jr. on May 30, 1926 to parents George Jorgensen and Florence Davis Hansen Jorgensen in the Bronx. She was born into a Danish-American family and was raised with the help of a close-knit extended family (Meyerowitz, 53). Her father was the primary bread earner and her mother was a devoted stay at home wife, who looked after her husband and children (Moore). In essence, Christine enjoyed a pleasant childhood. The family lived in a nice neighborhood, where both Christine and her sister were enrolled in public school, attended summer camp and went on family vacations (Meyerowitz, 53). Hers was a typical, white, middle-class upbringing.

From an early age, Christine noticed that something was wrong and she felt that she was different from other boys her age (Shuman). As a young child, Christine hated everything associated with boys. She hated short hair, hated boys clothing and did not enjoy things such as fighting or participating in sports, like many of the boys her age did. Instead of sports and fighting, toy trucks and cars, Christine dreamed of playing with girls and baby dolls (Moore). She also found herself becoming envious of her sister Dorothy and her beautiful long hair, and resented the fact that she and Dorothy were not alike (Moore). Christine would later state that the feelings concerning her identity made her feel extremely unhappy and hopeless as a child. She knew something was wrong, but could not do anything about it (Moore). As Christine progressed through her childhood, the people surrounding her also began to notice that she was in fact different from other boys but summed it up as Christine exhibiting female tendencies (Moore).

As Christine reached her teenage years it became more obvious to her and others that she was different from all the other boys. One thing in particular that made Christine realize that she was different from those around her were the feelings of attraction which she began to develop for other males, specifically male friends (Moore). Although Christine developed strong feelings for some of her male friends, she later recalled that she never received any of the same feelings from them in return (Moore). At this point, Christine felt extremely confused and torn about her sexuality and her attraction to men. Despite the fact that she had developed feelings and was attracted to other men, she refused to admit or accept the fact that she might be gay (Shuman). Instead, Christine felt that she was a woman who had somehow ended up in the wrong body, essentially feeling trapped inside the body of a man (Shuman).

After Christine graduated from high school in 1945, she unsuccessfully tried to enlist in the army twice but was rejected because of her small stature (Moore). After being denied entrance into the U.S. army, less than six months later she was drafted. However, her small boyish stature prevented her from earning anything more than a desk job (Moore). Even though Christine had tried her best to fulfill the male gender role, especially by enlisting in the army, she still did not fit in among other men. Serving in the army for a little over a year, Christine remained isolated from the other soldiers and rarely interacted with them (Shuman). Not long after enlisting, Christine was honorably discharged following an illness.

Christine then moved to Hollywood in hopes of finding a job as a photographer but soon after discovered this was not as simple as she thought it would be (Moore). Christine’s move to Hollywood, however, was not a complete failure. While in California, Christine spoke about her personal confusion and turmoil for the first time, confiding in two of her closest friends that she felt that “she had the emotions of a girl” (Meyerowitz, 54).

In 1948, Christine Jorgensen returned to the East Coast and enrolled in photography classes at the Progressive School of Photography in New Haven, Connecticut. At the same time, she still continued to look for answers concerning her feelings and turmoil in her life as a man (Moore). While in Connecticut, Christine read about an endocrinologist who was performing experiments with hormones on animals (Meyerowitz, 54). Christine wondered if hormonal treatment could possibly be the answer she had always searched for. After her discovery, Christine contacted a noted endocrinologist, Dr. Harold Grayson, who immediately rejected Jorgensen’s wish to possibly undergo hormonal treatment in order to fix what she felt was wrong. Grayson instead referred her to a psychiatrist where she could get help in getting rid of her female inclinations (Moore). Jorgensen knew this was not what she needed and refused psychiatric treatment that attempted to “fix” her, still believing that there had to be a biological reason for the way that she felt (Moore). Finally in May 1950, Jorgensen traveled to Denmark after learning from a friend that medical research was being performed on transsexuals (Shuman). Christine met with Dr. Christian Hamburger, a specialist on transsexuality (Shuman), and he told her that she was not a homosexual but most likely a transsexual (Shuman). Finally, Christine had answers that confirmed what she had always felt.

On September 24, 1951, Dr. Hamburger began Christine’s sex reassignment surgery free of charge as part of his experiment. He completed the series of procedures in October of 1952. In June, 1952, Christine shared the news of her sex change with her family in a letter where she wrote, “I have changed, changed very much, as my photos will show, but I want you to know that I am an extremely happy person and the real me, not the physical me, has not changed. I am still the same old “Brud.” But nature made a mistake, which I have had corrected, and I am now your daughter” (Moore). Her family was very open and welcoming and declared that their love for their daughter was still the same as it had been before (Moore).

Although it is disputed how Christine’s story was leaked to the press, some suggest Christine leaked it herself. Christine claims she was betrayed by a family friend, others claim it was a lab technician who revealed the story. Nevertheless, the New York Daily News broke the story of Christine’s transformation on December 1, 1952 with the headline “Ex-G.I. Becomes Blonde Bombshell” (Meyerowitz, 62). After this first newspaper revelation, more and more reporters wanted in on the sensational story and immediately Christine became a media sensation. The media was obsessed with Christine’s physical presentation (Meyerowitz, 63), and they picked at every detail of her appearance. The newspapers buzzed about how feminine she looked, how graceful she was and how she appeared to have successfully turned into a woman. The media wanted to know everything about her. Did she have a boyfriend? Did she want to marry in the future? (Meyerowitz, 63). Jorgensen used all the media attention to her advantage. After returning to New York, she began to make appearances where she shared her story, even using the spotlight to promote her night club act (Meyerowitz, 74).

The significance of Jorgensen’s story lies in the fact that she took control of her own story (Theophano). Although it was first reported as a sensational story of sex reassignment, she took advantage of the media coverage and used it to educate the public on transsexualism and its distinction apart from homosexuality (Theophano). Jorgensen’s story pushed doctors to redefine their terms on transsexuality and encouraged scientific research on surgical intervention (Meyerowitz, 97). Furthermore, just as significant was the fact that Christine’s story encouraged other transsexuals who might be feeling the same way she had her entire life, to seek help. She represented a symbol of hope.

The following are links to videos of Christine Jorgensen:

http://www.youtube.com/watch?v=M9Q50y5IsJU http://www.youtube.com/watch?v=lDlGUeF1Bg0

• Meyerowitz, Joanne J. How Sex Changed: A History of Transsexuality in the United States. Cambridge, MA: Harvard UP, 2002. Print.
• Moore, Michelle. "Heaven's Oldest Gift Christine Jorgensen's Story." Transgender Community News (2004): 21-36. LGBT Life with Full Text. Web. 24 Oct. 2012.
• Shuman, R. Baird. "George Jorgensen Becomes Christine Jorgensen." LGBT History, 1855-1955 (2005): 35-38. LGBT Life with Full Text. Web. 25 Oct. 2012.
• Theophano, Teresa. "Jorgensen, Christine (1926-1989)." GLBTQ Arts (2006): 1-3. LGBT Life with Full Text. Web. 24 Oct. 2012.

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From gi joe to gi jane: christine jorgensen’s story.

WWII veteran Christine Jorgensen became the first American transgender woman to attain fame for having sex reassignment surgery. Her story has influenced many others and helped redefine gender identity.

Top Image: Photo of Christine Jorgensen taken by Maurice Seymour in January 1954. Courtesy of Wikicommons.

One day while flipping through my dad's collection of vintage Life magazines, the headline “Ex-GI Becomes Blonde Beauty” caught my eye. What followed was the fascinating story of Christine Jorgensen. Jorgensen, who served in the US Army during and after World War II, became the first American transgender woman to attain fame for having sex reassignment surgery. The article celebrated her heroism during the war and embraced her feminine qualities, such as her hair and fashionable clothes. Interestingly, the article was published in 1952, a time when gay and lesbian WWII veterans were often stripped of their medals and fired from their jobs because of who they loved. But why was Jorgensen celebrated when other members of the LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer) community were not?

Christine was born George William Jorgensen, Jr. on May 30, 1926 in the Bronx, New York City. As a child, Jorgensen felt very different from other little boys and remained secluded and shy. The boys poked fun at Jorgensen’s feminine tendencies and even her own sister would chime in now and then. She seemed to gravitate toward dolls and dreamed of having the elegant feminine qualities that a woman possessed. In one of Jorgensen’s early memories, she recalled questioning her identity to her mother: “‘Mom,' I asked, 'why didn’t God make us alike? My mother gently explained that the world needed both men and women and there was no way of knowing before a baby was born whether it would be a boy or girl.” Jorgensen’s family was very close, and her grandmother became Jorgensen’s biggest champion and supported Jorgensen expressing her identity. In high school, Jorgensen developed an attraction to her male friends, but she knew at the time, she was not gay. Instead, she realized that she was a woman trapped inside a man’s body.

 After Jorgensen graduated high school during World War II, she tried to enlist in the Army, but she was denied because of her dainty size and weight. However, a couple of months later she was drafted into the Army and stationed at Fort Dix, New Jersey. During Jorgensen’s service, she kept mostly to herself and concealed her attraction to men. At the time, many service members feared being exposed or labeled as a homosexual, which could get a soldier prison time, a dishonorable discharge, or court-martialed. Jorgensen explained that, “I wanted to be accepted by the army for two reasons. Foremost was my great desire to belong, to be needed, and to join the stream of activities around me. Second, I wanted my parents to be proud of me.” She labored as a clerical worker, managing thousands of discharged soldiers after VE Day for 14 months until she herself was honorably discharged in December 1946.

Jorgensen’s Army registration card courtesy of Fold3.com.

After Jorgensen’s military service, she went to photography school in New Haven, Connecticut, and dental assistant school in New York City. Jorgensen was still unhappy with her life, however, and she began to look for answers in books, hoping she might find answers. One book called The Male Hormone piqued her interest and helped explain her problems, which led her to start taking estrogen. Then, she consulted with doctors about surgeons in Europe who had already performed sex reassignment surgery. Jorgensen was determined to be transformed into a woman, and in 1950, she traveled to Denmark to pursue her dreams.

When Jorgensen arrived in Denmark, she met endocrinologist Dr. Christian Hamburger, who agreed to do the experimental procedure for free. He was the first person to diagnose Jorgensen as transsexual and not homosexual. For the next two years, Jorgensen underwent hormone treatment, psychiatric evaluations, and finally surgery to remove her male genitalia. Unfortunately, she did not receive a surgically created vagina until years later when she was back in the United States. Before she returned to the United States, she had one last alteration to make in order to complete her transformation. She changed her name to Christine in honor of Dr. Hamburger’s work of making her dreams come true.

Jorgensen's arrival in the United States from Denmark. Image courtesy of TransasCity.org.

 Telegram of Jorgensen's story. Image courtesy of TransasCity.org.

Upon Jorgensen’s arrival home, her story reached the newspapers and on December 1, 1952, she made the front page of the New York Daily News under the headline “Ex-GI Becomes Blonde Beauty: Operations Transform Bronx Youth.” In the following months, hundreds of newspapers featured her story, and she became an overnight sensation. The press and public’s reaction came as a great shock to Jorgensen: “I was surprised that everyone seemed very interested in my life… time went on and I realized this was an important step in the eyes of the world.”

Soon after she arrived, she was given a very prestigious award by the Scandinavian Societies of Greater New York, where she was made “Woman of the Year.” Image courtesy of TransasCity.org.

Headlines emphasized her GI background and embraced her as an American beauty by describing her long legs, blonde hair, and high fashion clothes. Jorgensen’s patriotism as a WWII veteran and beautiful feminine attributes embodied American values and structure, which captivated the public and press. Her transition from a man to a woman also showed the world the advancement of technology and medical science. These qualities help explain why the press and American society celebrated Jorgenson’s story. Although not everyone was so kind.

Like most members of the LGBTQ community, Jorgensen experienced her share of hate and discrimination. Six months after the media released her story, reporters reached out to surgeons who transformed Jorgensen from one gender to the other on the steps of the surgery. The surgeons released information that although Jorgensen removed her male genitalia, she did not have a vagina. Before this incident, the press assumed Jorgensen had a vagina. Her former supporters felt betrayed at the discovery and claimed she could not be a woman without ovaries and women’s other reproductive organs. Previously, Jorgensen avoided questions relating to her anatomy by focusing on her war background and physical appearance. The media soon shunned her and, according to author David Serlin, “they exposed her as an ‘altered male’-and, later, a ‘morbid’ transvestite… Jorgensen was seen as nothing more than a limp wristed queer who indulged in activities culturally identified as female and therefore effeminate.” She felt incomplete without a vagina until the day finally came, in May 1954, when Jorgensen underwent a vaginoplasty performed by Dr. Joseph Angelo and Dr. Harry Benjamin.

Jorgensen went on to be an entertainer and performed in many nightclubs. She wanted to be a Hollywood star but never made it big. She had several romantic relationships and was engaged twice, but unfortunately, she was denied a marriage license because her birth certificate identified her as a male. To compound her struggles, one of Jorgensen’s fiancés also lost his job when their engagement became known. However, she remained confident and optimistic about life, and in 1967, Jorgensen wrote an autobiography titled  Christine Jorgensen: A Personal Autobiography. Throughout her life, she received thousands of letters, both positive and negative, but the majority of the letters were from others with the same problems asking for help and guidance. She only wished that she could help all the individuals who reached out to her, but in a way she did by staying true to her identity and being a role model for others. Jorgensen went on to use her story to lecture at colleges across the United States on gender identity. Her life captivated and influenced so many that, in 1970, Hollywood created a film based on Jorgensen’s life called, The Christine Jorgensen Story.

Christine on the set during the filming of The Christine Jorgensen Story, meeting with actor John Hansen (who is portraying the “male” Jorgensen.) Image courtesy of TransasCity.org.

On May 3, 1989, Jorgensen died from bladder and lung cancer. Although gone, her incredible story still resonates and offers hope for transgender veterans as they pursue self-fulfillment. Jorgensen concluded that “The answer to the problem must not lie in sleeping pills and suicides that look like accidents, or in jail sentences, but rather in life and freedom to live it.”

Suggested Further Readings:   

Christine Jorgensen, Christine Jorgensen: A Personal Autobiography (New York: A Bantam Book/ published by arrangement with Paul S. Eriksson, Inc., 1967).  

David Serlin, Replaceable You: Engineering the Body in Postwar America (Chicago: University of Chicago Press, 2004).

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Opinion What I wish I’d known when I was 19 and had sex reassignment surgery

Corinna Cohn, a software developer in Indianapolis, is an officer in the Gender Care Consumer Advocacy Network.

When I was 19, I had surgery for sex reassignment , or what is now called gender affirmation surgery. The callow young man who was obsessed with transitioning to womanhood could not have imagined reaching middle age. But now I’m closer to 50, keeping a watchful eye on my 401(k), and dieting and exercising in the hope that I’ll have a healthy retirement.

In terms of my priorities and interests today, that younger incarnation of myself might as well have been a different person — yet that was the person who committed me to a lifetime set apart from my peers.

There is much debate today about transgender treatment, especially for young people. Others might feel differently about their choices, but I know now that I wasn’t old enough to make that decision. Given the strong cultural forces today casting a benign light on these matters, I thought it might be helpful for young people, and their parents, to hear what I wish I had known.

I once believed that I would be more successful finding love as a woman than as a man, but in truth, few straight men are interested in having a physical relationship with a person who was born the same sex as them. In high school, when I experienced crushes on my male classmates, I believed that the only way those feelings could be requited was if I altered my body.

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It turned out that several of those crushes were also gay. If I had confessed my interest, what might have developed? Alas, the rampant homophobia in my school during the AIDS crisis smothered any such notions. Today, I have resigned myself to never finding a partner. That’s tough to admit, but it’s the healthiest thing I can do.

As a teenager, I was repelled by the thought of having biological children, but in my vision of the adult future, I imagined marrying a man and adopting a child. It was easy to sacrifice my ability to reproduce in pursuit of fulfilling my dream. Years later, I was surprised by the pangs I felt as my friends and younger sister started families of their own.

The sacrifices I made seemed irrelevant to the teenager I was: someone with gender dysphoria, yes, but also anxiety and depression. The most severe cause of dread came from my own body. I was not prepared for puberty, nor for the strong sexual drive typical for my age and sex.

Surgery unshackled me from my body’s urges, but the destruction of my gonads introduced a different type of bondage. From the day of my surgery, I became a medical patient and will remain one for the rest of my life. I must choose between the risks of taking exogenous estrogen, which include venous thromboembolism and stroke, or the risks of taking nothing, which includes degeneration of bone health. In either case, my risk of dementia is higher, a side effect of eschewing testosterone.

What was I seeking for my sacrifice? A feeling of wholeness and perfection. I was still a virgin when I went in for surgery. I mistakenly believed that this made my choice more serious and authentic. I chose an irreversible change before I’d even begun to understand my sexuality. The surgeon deemed my operation a good outcome, but intercourse never became pleasurable. When I tell friends, they’re saddened by the loss, but it’s abstract to me — I cannot grieve the absence of a thing I’ve never had.

Where were my parents in all this? They were aware of what I was doing, but by that point, I had pushed them out of my life. I didn’t need parents questioning me or establishing realistic expectations — especially when I found all I needed online. In the early 1990s, something called Internet Relay Chat, a rudimentary online forum, allowed me to meet like-minded strangers who offered an inexhaustible source of validation and acceptance.

I shudder to think of how distorting today’s social media is for confused teenagers. I’m also alarmed by how readily authority figures facilitate transition. I had to persuade two therapists, an endocrinologist and a surgeon to give me what I wanted. None of them were under crushing professional pressure, as they now would be, to “affirm” my choice.

I may well have transitioned even after waiting a few years. If I hadn’t transitioned, I likely would have suffered from the world in other ways. In other words, I’m still working out how much regret to feel, but I’m comfortable with the ambiguity.

What advice would I pass on to young people seeking transition? Learning to fit in your body is a common struggle. Fad diets, body-shaping clothing and cosmetic surgery are all signs that countless millions of people at some point have a hard time accepting their own reflection. The prospect of sex can be intimidating. But sex is essential in healthy relationships. Give it a chance before permanently altering your body.

Most of all, slow down. You may yet decide to make the change. But if you explore the world by inhabiting your body as it is, perhaps you’ll find that you love it more than you thought possible.

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Single mom Bri was visiting the pediatrician’s office with her 15-year-old, a child struggling with anxiety, when the doctor said: “If you don’t affirm your daughter’s gender identity, or get her the help she needs, and she kills herself, you’re going to feel awfully guilty.”

Bri, who asked The Post to publish only her nickname for fear of being branded a bigot and doxxed by transgender-rights activists, was horrified — not only by the insinuation her teen would commit suicide if she didn’t transition, but also the fact that the general practitioner issued the warning in front of them both.

Activists are increasingly pushing for laws that allow children to make their own decisions to transition without parental approval, insisting that going through puberty is traumatic for those who feel misgendered. 

But some experts now question the threat that they say is commonly used by medical professionals. They believe many doctors are so scared of the label “transphobe” that they automatically present skeptical parents with a doomsday scenario: “Would you rather have a dead son or a living daughter?” or vice versa.

Critics of the blunt proposition include pediatric endocrinologist Dr. Paul Hruz, of the Washington University School of Medicine in St Louis. He told The Post: “In these circumstances, I would advise parents to ask, ‘On what evidence are you making this claim?'”

His concerns focus on the widely accepted belief that sex-reassignment treatment prevents emotionally damaged kids from ending their lives. He questions the theory, pointing out that its supporting studies are variously limited or skewed. According to the physician, fundamental problems with the research include large numbers of self-selected subjects, a lack of control groups and inadequate reviews by peers.

By contrast, a 2011 study spanning three decades by the respected Karolinska Institute in Sweden found that people who underwent sex reassignment were 19 times more likely to die by suicide than the general population . In the US, a yearlong survey by the National Center for Transgender Equality concluded that those who had transitioned were more likely to have attempted suicide than trans people who had not had medical or surgical treatments.

Hruz’s views are also backed by a study published in 2019 in the American Journal of Psychiatry, which concludes that when it comes to the mental health of those diagnosed with gender dysphoria, there is “no advantage of [reassignment] surgery.”

His take on the issue is explored in the newly released film “Trans Mission: What’s the Rush To Reassign Gender? ” Produced by the Center for Bioethics and Culture Network , the documentary is streaming on YouTube and Vimeo, and arrived a month after a similar investigation by “60 Minutes. “

Lesley Stahl’s exposé highlighted the surge in unregulated, money-spinning transgender clinics serving kids and young adults in the US. The Human Rights Campaign currently lists more than 40 “clinical care programs for transgender and gender-expansive youth” on its Web site.

Only one such institution existed in America in 2007.

In the “60 Minutes” segment, chronically depressed young woman Grace Lidinsky-Smith describes how, in her early 20s, she believed transitioning would make her feel “free.” She tells Stahl that a gender therapist she found on the Internet “didn’t go into what my gender dysphoria might have been stemming from.”

She was hastily prescribed testosterone and, just four months later, was approved for so-called top surgery, trans speak for a double mastectomy. But, instead of experiencing relief after the drastic operation, she felt traumatized. “I started to have a disturbing sense that a part of my life was missing — almost a ghost-limb feeling,” Lidinsky-Smith, now 27, reveals on camera. She de-transitioned by coming off testosterone, and says she complained to the unnamed clinic about its agenda-driven methods.

Meanwhile, according to 39-year-old Bri, her daughter, who aims to become a boy, has comorbid psychological issues because of a traumatic childhood, partly caused by the difficult divorce of her parents. The Baltimore-based mom remains convinced her child has been duped by peer pressure, social media — which seems to champion transgenderism among young people without question — and the “grass is greener” trope that men have an “easier” lot in life.

“It has to be a safe and careful process for both parents and kids to move forward wherever their gender exploration goes. It doesn’t work that a child says, ‘I’m trans, give me hormones,’ and then gets a shot.” Dr. Michelle Forcier, a professor of pediatrics who supports early “gender care” that “helps kids express their authentic identity”

“There was no indication between her birth and the age of 13 that she felt she was in the wrong body,” said Bri, who sadly believes the catalyst was her girl being lusted after and shamed by boys. “As they started taking an interest in her — she told me how a classmate had repeatedly touched her inappropriately — she began to bind her breasts and became introverted and round-shouldered, as if she was trying to disguise the fact she was a woman.”

Following several rounds of counseling — which, Bri claims, only accelerated her desire to transition — she contemplated top surgery at only 14. This operation is frequently followed by bottom surgery, a k a an elective hysterectomy.

Bri said, “I felt the need to safeguard my daughter before she allowed her body to be harmed.” By then, without the mom’s knowledge or consent, teachers at the eighth-grader’s school were exclusively calling their student by her boy name.

“I felt completely marginalized — like the odd one out,” said Bri, whose state does not require parental permission for anyone 16 and older to either take cross-sex hormones or fully transition.

Hruz has become increasingly worried about the way kids are allowed to make these life-changing decisions on their own. In the state of Washington, for example, a child as young as 13 can defy the wishes of their parents by transitioning via medical treatments. Moreover, that same seventh-grader is legally entitled to use their family’s health insurance to cover gender-affirming procedures such as tracheal shaves, or Adam’s apple reductions.

“There’s well-established literature on the inherent tendency of adolescents to be impulsive and not fully able to appreciate long-term consequences,” Hruz said. “It’s the whole basis for society limiting their autonomy on things like drinking alcohol, purchasing cigarettes and even voting until a certain age.

“The concept that gender reassignment is an exception needs to be challenged.”

Concerned about enduring health effects of medical and surgical interventions such as puberty blockers, sustained hormone therapy and the removal of intimate body parts, he added: “These issues are so under researched. We don’t have the long-term data on the relative risks and benefits of this approach.”

Californian Abigail Shrier, who wrote the 2020 book “Irreversible Damage: The Transgender Craze Seducing Our Daughters,” is horrified by the way children — particularly girls — have easier access to hormones and surgeries.

“Most of these girls seeking interventions don’t have typical gender dysphoria at all, and there is no evidence they will be helped by any of the treatments they are getting with almost no medical oversight,” Shrier told The Post. “It’s a crisis in the making.”

She’s argued that “peer contagion” may play a part, an idea that’s supported by a 2019 study from Brown University that found that parents of children experiencing gender dysphoria observed their teens feeling pressure to fit in with their friend group.

Brenton Netz, 49, of Marquette, Mich., feels his parental concerns over the medical treatment of his child, Miles Gewirtz, have been ignored. Appearing in “Trans Mission,” he expresses his opposition to his 11-year-old, who has autism, taking puberty blockers. He fears the boy will be considered for gender-reassignment surgery when he reaches his mid to late teens.

“Miles is very impressionable,” Netz told The Post. Netz has joint custody with Miles’ mother, Sarah Gewirtz, and feels the tween has been unduly influenced by “overzealous” clinicians who diagnosed him with gender dysphoria at age 8.

“My son has said he’s going to drink a magic potion to keep him young forever,” he said. “It demonstrates his limited capacity to understand his feelings about something as important as gender.”

Netz, who launched an online campaign called Save Miles to generate publicity for his cause, recently won a significant victory in a lengthy legal battle. The judge’s ruling prevents Miles’ mother from pursuing medical interventions at a gender and sexuality clinic in St. Cloud, Minn.

“Miles’ autism makes him particularly vulnerable,” said Netz, explaining that the disorder has already made his son feel lonely and isolated, leaving him with an overwhelming “need to please and fit in.”

Not everyone is so distrusting. Dr. Michelle Forcier, professor of pediatrics at Brown’s Warren Alpert Medical School, who is featured in “Trans Mission” as a supporter of early “gender care,” describes the practice of gender intervention at a young age as “beautiful and inclusive,” since it “helps kids express their authentic identity.”

She says in the film, “We’re telling parents to love your child, no matter their gender trajectory, because every kid is better if they are loved for who they are and feels safe, respected and valued at home.”

Forcier insists that the process is not rushed; consideration and balance are employed before puberty blockers and other hormone treatments are administered to children.

“It has to be a safe and careful process for both parents and kids to move forward wherever their gender exploration goes,” adds the doctor. “It doesn’t work that a child says, ‘I’m trans, give me hormones,’ and then gets a shot of testosterone.”

However, she stressed that the practice of “watchful waiting” — where parents and clinicians resolve to delay intervention until the child gets older — can be harmful, since they may miss the “window” when treatments are most effective.

Addressing the prevalence of autistic children such as Miles who are diagnosed with gender dysphoria — the Tavistock Centre , the only gender identity clinic in the UK for under-18s, has reported some 35 percent of its referrals are kids on the spectrum — Forcier offers a controversial explanation.

“They are neuro diverse, and might also be gender diverse,” she says. “With their wiring and their hormones, they are not necessarily going to fit in this square hole. They’re going to need a different fit.”

She adds: “If you are not super attentive to social cues — and you’re not, ‘Oh, God, what will people think of me?’ — you may be more willing to think, ‘My gender isn’t this clear cut.’ ”

As for Bri, the staunch feminist hopes to persuade her daughter to first tackle her mental-health issues before making an informed choice about a possible transition. As she says in the documentary: “It’s because I love her so much [that] I’m willing to take on this whole ideology just to protect her.”

Nonetheless, she told The Post she would never turn her back on her child, whichever road she eventually chooses.

The mom concluded: “I’ve said that — even though I don’t agree with it — if you feel lousy after hormonal treatments or surgical interventions, I will still make chicken soup for you.”

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A Reuters Special Report

Why detransitioners are crucial to the science of gender care.

UNDONE: Max Lazzara lived as a transgender man for eight years before detransitioning in 2020. She says she now realizes that gender-affirming medical treatment was not appropriate for her and that it took a toll on her physical and mental health. REUTERS/Matt Mills McKnight

USA-TRANSYOUTH/OUTCOMES

Understanding the reasons some transgender people quit treatment is key to improving it, especially for the rising number of minors seeking to medically transition, experts say. But for many researchers, detransitioning and regret have long been untouchable subjects.

By ROBIN RESPAUT , CHAD TERHUNE and MICHELLE CONLIN

Filed Dec. 22, 2022, noon GMT

For years, Dr Kinnon MacKinnon, like many people in the transgender community, considered the word “regret” to be taboo.

MacKinnon, a 37-year-old transgender man and assistant professor of social work at York University here, thought it was offensive to talk about people who transitioned, later regretted their decision, and detransitioned. They were too few in number, he figured, and any attention they got reinforced to the public the false impression that transgender people were incapable of making sound decisions about their treatment.

“This doesn’t even really happen,” MacKinnon recalled thinking as he listened to an academic presentation on detransitioners in 2017. “We’re not supposed to be talking about this.”

MacKinnon, whose academic career has focused on sexual and gender minority health, assumed that nearly everyone who detransitioned did so because they lacked family support or couldn’t bear the discrimination and hostility they encountered – nothing to do with their own regret. To learn more about this group for a new study, he started interviewing people.

In the past year, MacKinnon and his team of researchers have talked to 40 detransitioners in the United States, Canada and Europe, many of them having first received gender-affirming medical treatment in their 20s or younger. Their stories have upended his assumptions.

Many have said their gender identity remained fluid well after the start of treatment, and a third of them expressed regret about their decision to transition from the gender they were assigned at birth. Some said they avoided telling their doctors about detransitioning out of embarrassment or shame. Others said their doctors were ill-equipped to help them with the process. Most often, they talked about how transitioning did not address their mental health problems.

In his continuing search for detransitioners, MacKinnon spent hours scrolling through TikTok and sifting through online forums where people shared their experiences and found comfort from each other. These forays opened his eyes to the online abuse detransitioners receive – not just the usual anti-transgender attacks, but members of the transgender community telling them to “shut up” and even sending death threats.

“I can’t think of any other examples where you’re not allowed to speak about your own healthcare experiences if you didn’t have a good outcome,” MacKinnon told Reuters.

The stories he heard convinced him that doctors need to provide detransitioners the same supportive care they give to young people to transition, and that they need to inform their patients, especially minors, that detransitioning can occur because gender identity may change. A few months ago, he decided to organize a symposium to share his findings and new perspective with other researchers, clinicians, and patients and their families.

Not everyone was willing to join the discussion. A Canadian health provider said it couldn’t participate, citing recent threats to hospitals offering youth gender care. An LGBTQ advocacy group refused to promote the event. MacKinnon declined to identify either, telling Reuters he didn’t want to single them out. Later, after he shared his findings on Twitter, a transgender person denounced his work as “transphobia.”

He expected his research would be a hard sell even to many of the 100 or so people from Canada, the United States and elsewhere who accepted his invitation. “I need your help,” he told the crowd that assembled in November in a York University conference room for the daylong session. “My perspectives have changed significantly. But I recognize that for many of you, you may find yourselves feeling much like I did back in 2017 – challenged, apprehensive, maybe fearful.”

Fighting words

In the world of gender-affirming care, as well as in the broader transgender community, few words cause more discomfort and outright anger than “detransition” and “regret.” That’s particularly true among medical practitioners in the United States and other countries who provide treatment to rising numbers of minors seeking to transition.

They insist, as MacKinnon once did, that detransitioning is too rare to warrant much attention, citing their own experiences with patients and extant research to support their view. When someone does detransition, they say, it’s almost never because of regret, but rather, a response to the hardship of living in a society where transphobia still runs rampant.

“These patients are not returning in droves” to detransition, said Dr Marci Bowers, a transgender woman, gender surgeon and president of the World Professional Association for Transgender Health (WPATH), an international group that sets guidelines for transgender care. Patients with regret “are very rare,” she told Reuters. “Highest you’ll find is 1% or 1.5% of any kind of regret.”

Doctors and many transgender people say that focusing on isolated cases of detransitioning and regret endangers hard-won gains for broader recognition of transgender identity and a rapid increase in the availability of gender care that has helped thousands of minors. They argue that as youth gender care has become highly politicized in the United States and other countries, opponents of that care are able to weaponize rare cases of detransition in their efforts to limit or end it altogether, even though major medical groups deem it safe and potentially life-saving.

“Stories with people who have a lot of anger and regret” about transitioning are over-represented in the media, and they don’t reflect “what we are seeing in the clinics,” said Dr Jason Rafferty, a pediatrician and child psychiatrist at Hasbro Children’s Hospital in Providence, Rhode Island. He also helped write the American Academy of Pediatrics’ policy statement in support of gender-affirming care. Detransitioning is a “very invalidating term for a lot of people who are trans and gender-diverse,” Rafferty said.

Some people do detransition, however, and some do so because of regret. The incidence of regret could be as low as clinicians like Bowers say, or it could be much higher. But as Reuters found, hard evidence on long-term outcomes for the rising numbers of people who received gender treatment as minors is very weak.

Dr Laura Edwards-Leeper, a clinical psychologist in Oregon who treats transgender youths and a co-author of WPATH’s new Standards of Care for adolescents and children, said MacKinnon’s work represents some of the most extensive research to date on the reasons for detransitioning and the obstacles patients face. She said the vitriol he has encountered illustrates one reason so few clinicians and researchers are willing to broach the subject.

“People are terrified to do this research,” she said.

For this article, Reuters spoke to 17 people who began medical transition as minors and said they now regretted some or all of their transition. Many said they realized only after transitioning that they were homosexual, or they always knew they were lesbian or gay but felt, as adolescents, that it was safer or more desirable to transition to a gender that made them heterosexual. Others said sexual abuse or assault made them want to leave the gender associated with that trauma. Many also said they had autism or mental health issues such as bipolar disorder that complicated their search for identity as teenagers.

Echoing what MacKinnon has found in his work, nearly all of these young people told Reuters that they wished their doctors or therapists had more fully discussed these complicating factors before allowing them to medically transition.

No large-scale studies have tracked people who received gender care as adolescents to determine how many remained satisfied with their treatment as they aged and how many eventually regretted transitioning. The studies that have been done have yielded a wide range of findings, and even the most rigorous of them have severe limitations. Some focus on people who began treatment as adults, not adolescents. Some follow patients for only a short period of time, while others lose track of a significant number of patients.

“There’s a real need for more long-term studies that track patients for five years or longer,” MacKinnon said. “Many detransitioners talk about feeling good during the first few years of their transition. After that, they may experience regret.”

In October, Dutch researchers reported results of what they billed as the largest study to date of continuation of care among transgender youths. In a review of prescription drug records, they found that 704, or 98%, of 720 adolescents who started on puberty blockers before taking hormones had continued with treatment after four years on average. The researchers couldn’t tell from the records why the 16 had discontinued treatment.

Gender-care professionals and transgender-rights advocates hailed the 98% figure as evidence that regret is rare. However, the authors cautioned that the result may not be replicated elsewhere because the adolescents studied had undergone comprehensive assessments, lasting a year on average, before being recommended for treatment. This slower, methodical approach is uncommon at many U.S. gender clinics, where patient evaluations are typically done much faster and any delay in treatment, or “gatekeeping,” is often believed to put youth at risk of self-harm because of their distress from gender dysphoria.

Dr Marianne van der Loos, the Dutch study’s lead author, is a physician at Amsterdam University Medical Center’s Center for Expertise on Gender Dysphoria, a pioneer in gender care for adolescents. “It’s important to have evidence-based medicine instead of expert opinion or just opinion at all,” van der Loos said.

Reliable evidence of the frequency of detransition and regret is important because, as MacKinnon, van der Loos and other researchers say, it could be used to help ensure that adolescent patients receive the best possible care.

“We cannot carry on in this field that involves permanently changing young people’s bodies if we don’t fully understand what we’re doing and learn from those we fail.” Dr Laura Edwards-Leeper, clinical psychologist and co-author of WPATH treatment guidelines for adolescents

A basic tenet of modern medical science is to examine outcomes, identify potential mistakes, and, when deemed necessary, adjust treatment protocols to improve results for patients. For example, only after large international studies analyzing outcomes for thousands of patients did researchers establish that implanted coronary artery stents were no better than medication for treating most cases of heart disease.

Stronger data on outcomes, including the circumstances that make regret more likely, would also help transgender teens and their parents make better-informed decisions as they weigh the benefits and risks of treatments with potentially irreversible effects.

“We cannot carry on in this field that involves permanently changing young people’s bodies if we don’t fully understand what we’re doing and learn from those we fail,” said Edwards-Leeper, the clinical psychologist and WPATH member. “We need to take responsibility as a medical and mental-health community to see all the outcomes,” she said in an interview.

As Reuters reported in October , thousands of families in the U.S. have been weighing these difficult choices amid soaring numbers of children diagnosed with gender dysphoria, the distress experienced when a person’s gender identity doesn’t align with their gender assigned at birth. They have had to do so based on scant scientific evidence of the long-term safety and efficacy of gender-affirming treatment for minors.

Concern about how to cope with the growing waiting lists at gender clinics that treat minors has divided experts. Some urge caution to ensure that only adolescents deemed well-suited to treatment after thorough evaluation receive it. Others argue that any delay in treatment prolongs a child’s distress and puts them at risk of self-harm.

Detransition defined

Detransitioning can mean many things. For those who transitioned socially, it may entail another change in name, preferred pronouns, and dress and other forms of identity expression. For those who also received medical treatment, detransitioning typically includes halting the hormone therapy they otherwise would receive for years.

Nor do all people who stop treatment regret transitioning, according to interviews with detransitioners, doctors and researchers. Some end hormone therapy when they have achieved physical changes with which they are comfortable. Some are unhappy with the side effects of hormones, such as male pattern baldness, acne or weight gain. And some are unable to cope with the longstanding social stigma and discrimination of being transgender.

Doctors and detransitioners also described the challenging physical and emotional consequences of the process. For example, patients who had their ovaries or testes removed no longer produce the hormones that match their gender assigned at birth, risking bone-density loss and other effects unless they take those hormones the rest of their lives. Some may undergo years of painful and expensive procedures to undo changes to their bodies caused by the hormones they took to transition. Those who had mastectomies may later undergo breast reconstruction surgery. As parents, they may regret losing the ability to lactate. Detransitioners also may need counseling to cope with the process and any lingering regret.

The impact can be social, too. In a study published last year in the Journal of Homosexuality, a researcher in Germany surveyed 237 people who had socially or medically transitioned and later detransitioned, half of them having transitioned as minors. Many respondents reported a loss of support from the LGBTQ community and friends, negative experiences with medical professionals, difficulty in finding a therapist familiar with detransition and the overall isolation after detransition.

“Many respondents described experiences of outright rejection from LGBT+ spaces due to their decision to detransition,” wrote Elie Vandenbussche, the study’s author, a detransitioner and at the time a student at Rhine-Waal University of Applied Sciences. “It seems reasonable to suspect that this loss of support experienced by detransitioners must have serious implications on their psychological well-being.”

In its new Standards of Care, released in September, WPATH cited Vandenbussche’s paper and a few others on detransitioning and continuation of care among younger patients. “Some adolescents may regret the steps they have taken,” the WPATH guidelines say. “Therefore, it is important to present the full range of possible outcomes when assisting transgender adolescents.”

However, Bowers, WPATH’s president, is among several gender-care specialists who say patients are ultimately responsible for choices they make about treatment, even as minors. They should not be “blaming the clinician or the people who helped guide them,” she said. “They need to own that final step.”

WPATH’s guidelines acknowledge the lack of research on long-term outcomes for youth who didn’t undergo comprehensive assessments, saying that the “emerging evidence base indicates a general improvement in the lives of transgender adolescents” who receive treatment after careful evaluation. “Further, rates of reported regret during the study monitoring periods are low,” the guidelines say.

Specific treatment protocols for detransitioning are hard to find. WPATH’s guidelines don’t provide detailed advice to clinicians on treating patients who detransition. The Endocrine Society’s guidelines for gender-affirming care, published in 2017, don’t address the issue, either. The “question of discontinuing hormone treatment is beyond the scope covered by the current guideline,” an Endocrine Society spokeswoman said.

Some doctors think they – and patients – would benefit from more guidance. “We have guidelines to guide us in providing transition-related care, initiating hormones and managing them long-term. Equally as important would be having guidelines in deprescribing hormones in the safest way possible,” said Dr Mari-Lynne Sinnott, a doctor who attended MacKinnon’s symposium. She runs one of the only family medical practices in Newfoundland focused on gender-diverse people, who make up about half of her 1,500 patients.

“Sure of my identity”

Max Lazzara’s childhood in Minneapolis, Minnesota, was chaotic, with divorce, “moving around a lot, some emotionally abusive stuff at home,” she said. Her mother worked full-time, so Lazzara did most of the cooking, cleaning and caring for her little brother. She began to cut and burn herself as a means of coping and had tried to commit suicide three times before she entered high school, according to Lazzara and her medical records, which cite a history of bipolar disorder.

“The life of a woman was bleak to me,” Lazzara told Reuters. “I worried that I would have to get married to a man someday and have a baby. I wanted to run far away from that.”

In early 2011, when Lazzara was 14, she started questioning her gender identity. After discovering forums on Tumblr where young people described their transitions, she felt like something snapped into place. “I thought, ‘Wow, this could explain why my whole life felt wrong.’”

During the summer of that year, Lazzara changed her name and began experimenting with presenting as more masculine. It felt good to cut her hair and wear gender-neutral or men’s clothing. She took medications and received therapy to treat bipolar disorder. But it wasn’t enough to alleviate her distress. In April 2012, Lazzara was admitted to the hospital at the University of Minnesota after a fourth suicide attempt.

“I felt so strongly. I thought nothing would change my mind.” Max Lazzara, on her decision to medically transition at age 16

Three weeks later, she sought care at the university’s Center for Sexual Health, where she was diagnosed with gender identity disorder. Lazzara told the clinic she was “sure of my identity,” according to her medical records. She wanted hormones and surgeries, the records show, including a mastectomy, a hysterectomy, and liposuction to slim her legs and hips. She was horrified at her body, could not look down in the shower and felt “absolute dread at the time of menstrual cycle,” the records note.

“I felt so strongly. I thought nothing would change my mind,” Lazzara told Reuters.

Clinicians at the university warned families that their children were suicidal “because they are born in the wrong bodies,” Lazzara’s mother, Lisa Lind, told Reuters. “I thought, ‘I’ll do whatever it takes, so she doesn’t kill herself.’”

Lazzara started taking testosterone in the fall of 2012, at age 16. She was still binding her breasts – so tightly, she said, that her ribs deformed. After a man groped her on the street, she decided to have breast-removal surgery, tapping the college fund her grandmother had left for her to cover the nearly $10,000 cost.

Initially, Lazzara was happy with her transition. She liked the changes from taking testosterone – the redistribution of fat away from her hips, the lower voice, the facial hair – and she was spared the sexist cat-calling that her female friends endured. “I felt like I was growing into something I wanted to be,” Lazzara said.

But her mental health continued to deteriorate. She attempted suicide twice more, at ages 17 and 20, landing in the hospital both times. Her depression worsened after a friend sexually abused her. She became dependent on prescription anti-anxiety medication and developed a severe eating disorder.

During the summer of 2020, Lazzara was spiraling. She realized she no longer believed in her gender identity, but “I didn’t see a way forward.”

That October, Lazzara was working as a janitor in an office building in the Seattle area when she caught her reflection in a bathroom mirror. For the first time, she said, she saw herself as a woman. “I had not allowed myself to have that thought before,” she said. It was shocking but also clarifying, she said, and “a peaceful feeling came over me.”

Then she began to ponder her sexuality. In middle school, she had crushes on girls. After her transition, she identified as a transgender man who was bisexual. Now, she realized, she was a lesbian.

Lazzara stopped taking testosterone. She later asked her doctor in the Seattle area for advice, but he seemed unsure about how to proceed. She found a new doctor and recently sought laser hair removal on her face.

Lazzara told Reuters she now realizes that gender treatment was not appropriate for her and that it took a toll on her physical and mental health. “I do wish my doctors had said to me, ‘It’s OK to feel disconnected from your body. It’s OK to like girls. It’s OK to be gender non-conforming.’”

Since Max Lazzara detransitioned, many in the online transgender community who embraced her a decade ago have distanced themselves from her, and she has received hateful messages on social media.

Her original gender-care providers at the University of Minnesota declined to comment. In a statement, the university’s medical school said “gender-affirming care involves a carefully thought-out care plan between a patient and their multidisciplinary team of providers.”

Lazzara recently found the before-and-after pictures of her torso on the website of the surgeon who performed her mastectomy in 2013. She had given him permission to post the images because he was proud of the outcome. Seeing her body as it once was stunned her. “I saw my breasts before I got them removed. That’s my 16-year-old body,” she said. “I had no ability at that age to be in my own body in my own way.”

Since revealing she detransitioned, Lazzara said, many in the online transgender community who embraced her a decade ago have distanced themselves from her, and she has received hateful messages on social media. Now, when she sees someone come out online as detransitioned, she sends them a private message of support. “I know how lonely and alienating it can be,” she said.

“Shut up,” detransitioner

Transgender people are frequently subjected to harassment, abuse and threats online. And as Lazzara’s experience shows, so are detransitioners. In recent posts on TikTok, users took turns telling detransitioners to “shut up,” and mocked, attacked and blamed them for perpetuating harm on the transgender community.

Diana Salameh, a transgender woman, film director and comedian from Mississippi, posted a TikTok video on Oct. 1 to “all the so-called transgender detransitioners out there.” Detransitioners “are just giving fuel to the fire to the people who think that no trans person should exist,” she said in the video. “You people who jumped the gun, made wrong decisions that you should actually feel embarrassed for, but you want to blame somebody else.” In closing, she said, “I think you all need to sit down and shut the fuck up!”

Salameh told Reuters she posted the video because detransitioners spread the false idea “that nobody can be happy after transition,” and right-wing opponents of youth gender care are using their stories “to fuel their agendas.”

Earlier this year, K.C. Miller, a 22-year-old in Pennsylvania who was assigned female at birth, began wrestling with how she felt about her medical transition.

Miller initially sought treatment for gender dysphoria when she was 16 from the adolescent gender clinic at Children’s Hospital of Philadelphia. In September 2017, Miller met with Dr Linda Hawkins, a counselor and co-founder of the hospital’s gender clinic, for the first of two 90-minute visits. During that session, Miller told Hawkins she had wanted to be a Boy Scout as a kid and “always felt like a tomboy,” according to Hawkins’ notes in Miller’s medical records, reviewed by Reuters. Miller also told Reuters that as a young girl she was attracted to other girls, but didn’t feel she could pursue those relationships because her family’s church didn’t accept homosexuality.

Miller’s case had further complications. Hawkins noted that Miller had an extensive history of sexual abuse by a family member starting at age 4, and that as a result, Miller had already been diagnosed with anxiety and post-traumatic stress disorder. Miller had been admitted to a psychiatric hospital for 10 days because of suicidal thoughts in late 2016.

While in the hospital, Miller told her mother she wished she wasn’t a girl “because then the abuse would not have happened,” Hawkins wrote. Elsewhere in the records, Hawkins noted that “Mom expresses concern that the desire to be male and not female may be a trauma response.”

Miller, her mother and Hawkins met again seven weeks later. Miller had continued to have suicidal thoughts. She had taken medication for depression and anxiety and was working with a therapist, Hawkins noted. By the end of that second visit, Hawkins concluded that, “in spite of” Miller’s trauma from abuse, the 16-year-old “has been insistent, persistent and consistent” in thinking of herself as male.

Hawkins referred Miller to a local gender clinic to receive testosterone. Miller got a mastectomy about six months later.

But medical treatment didn’t offer the relief she sought. Her body started to change due to the hormones, yet Miller didn’t feel better. Instead, she cycled through bouts of depression. She passed as a young man, but “something felt off. It felt like I was putting on an act.”

Then Miller began reading the stories posted online by young detransitioners. Parts of their experiences resonated with her. “I absolutely would not have done this if I could go back and do it again,” Miller told Reuters. “I would have worked through therapy and would be living my life as a lesbian.”

Miller said Hawkins should have done a more thorough evaluation of all of Miller’s mental health issues and shouldn’t have recommended treatment so quickly.

Her mother, who asked not to be identified to protect her privacy, told Reuters that providers assured her that Miller’s distress was related to her gender identity and that gender-affirming care would reduce the risk of suicide.

A spokesman for Children’s Hospital of Philadelphia declined to comment, citing patient privacy.

Sitting in her car in early October, Miller let out years of frustration in a video posted on Twitter. She told viewers she felt she looked too masculine to detransition. She described how testosterone thinned her hair. “I don’t see me personally being able to come back from what’s happened,” she said in the video.

The video went viral, registering nearly four million views within days and igniting an avalanche of comments. Two days after Miller’s post, Alejandra Caraballo, a transgender woman, LGBTQ-rights advocate and clinical instructor at Harvard Law School’s Cyberlaw Clinic, wrote on Twitter: “The detransition grift where you complain about transitioning not making you look like a greek god but you also aren’t actually detransitioning yet because you don’t feel like your birth gender and you follow a bunch of anti-trans reactionaries that want all trans people gone.”

Caraballo told Reuters she reacted to Miller’s video because those types of detransition stories are “outlier examples being used by many on the anti-trans side to undermine access to gender-affirming care. They aren’t representative of detransitioners on the whole.”

In other posts and direct messages, some transgender people Miller had once idolized made fun of her appearance and criticized her decisions. One person made a death threat.

A few weeks later, Miller said she stopped taking testosterone, began to feel suicidal and sought psychiatric care. She uses female pronouns among friends, but still presents as a man in public.

In its Standards of Care, WPATH says many detransitioners “expressed difficulties finding help during their detransition process and reported their detransition was an isolating experience during which they did not receive either sufficient or appropriate support.”

In May, Dr Jamison Green, a transgender man, author and former president of WPATH, said he was encouraged when about 30 medical professionals attended an online WPATH seminar he and other gender-care specialists helped lead. The session was intended to help providers better serve detransitioners and other patients with an evolving gender identity.

“I wish people in the transgender community would be less judgmental about people who change their mind,” Green said. “Transgender people, especially when they are newer to the community, can be really brutal to people for not conforming. I really think it’s harmful for everybody.”

Word search pitfalls

Ever since the first clinic to offer gender care to minors in the United States opened in Boston 15 years ago, none of the leading providers have published any systematic, long-term studies tracking outcomes for all patients.

In 2015, the National Institutes of Health funded a study to examine outcomes for about 400 transgender youth treated at four U.S. children’s hospitals, including the gender clinic at Boston Children’s Hospital. Researchers have said they are looking at “continuation of care.” However, long-term results are years away.

That has left a small assortment of studies to guide clinicians in this emerging field of medicine. The results of these studies suggest a wide range of possibilities for rates of detransitioning, from less than 1% to 25%. The research provides even less certainty about the incidence of regret among patients who received medical treatment as minors. And the studies have serious drawbacks.

Two of the largest ones, which found that 2% or less of people who transitioned experienced regret, focused on Europeans who primarily initiated treatment as adults. Experts caution that the results, because of the differences in maturity and life experiences between adults and adolescents, may have limited relevance as an indicator of outcomes for minors.

Researchers acknowledge that studies that follow patients for only a short time may underestimate detransition and regret because evidence indicates some people may not reach that point until as long as a decade after treatment began. Some studies also lose track of patients – a recurring challenge as minors age out of pediatric clinics and have to seek care elsewhere.

Even the choice of search terms can trip up researchers, as apparently happened in a study published in May by Kaiser Permanente, a large integrated health system based in Oakland, California.

That study examined 209 patients who underwent gender-affirming mastectomies as minors between 2013 and 2020 in Kaiser’s northern California region. Its authors searched the patients’ medical records for words such as “regret,” “dissatisfaction,” “unsatisfied” and “unhappy” as indicators of regret. They didn’t look for the term “detransition,” according to the study.

Their search yielded two patients who had expressed regret, or less than 1% of the group studied. The two patients, identified as nonbinary, had top surgery at age 16, and expressed regret within a year and a half.

Reuters found two other patients in the region covered by the study who don’t match those characteristics and whom the Kaiser researchers apparently missed. Both have been outspoken about their detransitions.

One is Max Robinson, who was 16 when she sought gender care at Kaiser in 2012. Her pediatric endocrinologist prescribed a puberty blocker and later testosterone.

The doctor monitored Robinson’s hormone levels, wrote numerous letters to help Robinson change her legal gender from female to male, and recommended a plastic surgeon in San Francisco, Robinson’s medical records show. “I have no reservations recommending Max as a well adjusted candidate for breast reduction,” the Kaiser endocrinologist wrote to the surgeon in May 2013. Max had the surgery six weeks later, when she was 17.

After the surgery, Robinson felt better. But within a year, her mental health issues, including anxiety and depression, had escalated, medical records show.

In November 2015, three years after starting testosterone and two years after her surgery, Robinson told the Kaiser physician she was now seeing that she wasn’t interested in taking hormones any longer. “I’m no longer going to be using testosterone, so I don’t need further appointments or for those prescriptions to be active,” she wrote to the doctor. Two months later, she asked Kaiser to provide a letter confirming her detransition so she could change her legal records back to female. Kaiser obliged.

“The whole experience alienated me from my doctors,” she told Reuters.

Robinson began to speak publicly about her decision to detransition and in 2021 published “Detransition: Beyond Before and After,” a book in which she details her own process of medical transition and detransition.

The other patient was Chloe Cole. According to a letter of intent to sue that her lawyers sent to Kaiser in November, Cole was 13 when a Kaiser doctor in 2018 put her on a puberty blocker, followed a few weeks later by testosterone, for her gender-affirming treatment.

At 15, Cole told Reuters, she also wanted top surgery. In an interview, she and her father said the doctors at Kaiser readily agreed, though he wanted to wait until she was older.

“They were so adamant,” he said. He recalled the doctors telling him: “‘At this age, they definitely know what their gender is.’” The father asked not to be named out of concern that speaking publicly might jeopardize his employment. Detransition, he said, “wasn’t really discussed as a possibility.”

In June 2020, a Kaiser surgeon performed a mastectomy on Cole, according to the letter of intent to sue. That was a month before her 16th birthday. Less than a year later, Cole said, she began to realize she regretted her surgery and medically transitioning in general after a discussion in school about breastfeeding and pregnancy.

Cole said that when she discussed her decision to detransition with her gender-care specialist at Kaiser, “I could tell that I made her upset that I was so regretful,” Cole said in an interview. Eventually, the doctor offered to recommend a surgeon for breast reconstruction, Cole said, “but that’s something I’ve decided to not go through with.”

Cole has begun speaking out publicly in support of measures to end gender-affirming care for minors, appearing often on conservative media and with politicians who back such bans.

In the letter of intent, Cole’s lawyers said Kaiser’s treatment “represents gross negligence and an egregious breach of the standard of care.”

Steve Shivinsky, a spokesman for Kaiser Permanente, declined to comment on the care provided to Cole and Robinson or whether they were included in the study, citing patient privacy.

In a statement, he said Kaiser’s “clinicians are deeply interested in the outcomes of the care we provide and the individual’s state of health and wellbeing before, during and beyond their gender transition.” For adolescents seeking gender-affirming care, he said, “the decision always rests with the patient and their parents and, in every case, we respect the patients’ and their families’ informed decision to choose one form of care over another.”

The Kaiser researchers followed up with patients in their study an average of 2.1 years after surgery. “The time to develop postoperative regret and/or dissatisfaction remains unknown and may be difficult to discern given that regret is quite rare,” the researchers wrote.

A change of perspective

MacKinnon, the assistant professor of social work, grew up as what he calls “a gender-nonconforming tomboy” in a small Nova Scotia town. After getting his degree in social work, he medically transitioned at 24 when he started taking testosterone. “It was a very slow build,” MacKinnon said of his transition. He didn’t identify as transgender as a child.

As a young researcher in Toronto, MacKinnon was drawn to work that exposed the barriers transgender people face in getting medical care and navigating daily life, interviewing clinicians and patients about their experiences. More recently, he turned his attention to detransition and regret.

In August 2021, MacKinnon published a paper in which he and his co-authors wrote that there was “scant evidence that detransition is a negative phenomenon” for patients that would justify limiting access to gender-affirming treatment. That conclusion angered many of the detransitioners he would later need to win over.

Michelle Alleva, a 34-year-old detransitioner in Canada, criticized MacKinnon’s study in a blog post as another effort by gender-care supporters to whitewash the pain of regret and assuage clinicians’ fears of malpractice lawsuits. Another detransitioner complained on Twitter that the word “regret” was put in quotes in the paper, undermining its legitimacy in her opinion.

Still skeptical that regret was a significant issue, MacKinnon in the autumn of 2021 embarked on his latest study and began talking to more people about their decisions to detransition. In July, he published a paper based on formal interviews with 28 of the more than 200 detransitioners he and his colleagues have found.

A third expressed either strong or partial regret about their transition. Some said their transitions should have proceeded more slowly, with more therapy. Others expressed regret about the lasting impact on their bodies. Some said their mental health needs weren’t adequately addressed before transitioning. “They felt like their consent wasn’t informed because they didn’t initially understand what was going on that might have explained their feelings and suffering,” MacKinnon told Reuters.

The patients’ stories brought MacKinnon round to the view that the gender-care community needs to address regret, adjust treatment to reduce its incidence, and provide better support for detransitioners. “Some of what I’ve learned about detransitioners is identifying cracks in the gender-affirming care system, particularly for young people,” he said.

In September, MacKinnon presented his findings to a small but attentive crowd at WPATH’s annual conference in Montreal. A few weeks later, he shared his research more widely on Twitter. “We need to listen to and learn from the experiences of detransitioners, not silence them,” he wrote.

Some people applauded his work. Others criticized it. Robyn D., who identified as “quietly trans,” replied on Twitter: “Transphobia disguised as academic opinion is the most poisonous of them all.” She didn’t respond to requests for comment from Reuters.

At his November symposium, MacKinnon didn’t encounter the blowback from clinicians that he had expected. In fact, he accepted an invitation from one to speak about detransition at her medical practice.

Alleva, who had criticized MacKinnon’s earlier study, was also there, one of the scores of detransitioners MacKinnon and his colleagues have talked to. She medically transitioned 12 years ago and then detransitioned in 2020 after a mastectomy, a hysterectomy and years of testosterone. She had refused to participate in his research because she didn’t trust MacKinnon, but over the summer, they began talking.

“He reminded me of my old trans friends who I don’t speak with anymore,” Alleva said. “He actually listened to me.”

Few answers: A survey of the science on gender-care outcomes for youths

No large-scale, long-term studies have tracked the incidence of detransition and regret among patients who received gender-affirming treatment as minors. Studies that are available yield a wide range of results for various definitions of detransition, regret or continuation of care. Due to their limitations, the studies lack definitive answers. Here is an overview of frequently cited research:

Research institutions

Karolinska Institute, Karolinska University Hospital, Sahlgrenska University Hospital

The study’s authors said they found a 2.2% regret rate  among patients who had gender reassignment surgeries in Sweden from 1960 to 2010. The researchers found 681 people who filed a government application for a legal change in gender and received surgery, which was available only to patients 18 and older. Among that group, 15 people later reversed their decisions and filed a “regret application” with a national health board.

Limitations

The authors said the regret rate for patients in the last decade reviewed, from 2001 to 2010, may have increased over time. “The last period is still undecided since the median time lag until applying for a reversal was 8 years,” according to the study.

Far fewer adolescents received gender-affirming medical care prior to 2010. Also, the assessment phase for patients in the study was much longer than what Reuters found most youth gender clinics in the U.S. offer today. The gender-care specialists in Sweden did approximately one year of evaluation before recommending any treatment, according to the study.

10.1007/s10508-014-0300-8

Netherlands

Research institution

Amsterdam University Medical Center

February 2018

This study found a rate of regret of less than 1%  among transgender men and women “who underwent gonadectomy,” or removal of the testes or ovaries, from 1972 to 2015 in the Netherlands.

The authors found 14 cases of regret out of 2,627 patient cases reviewed. The earliest any of the 14 started hormone treatment was 25. Until 2014, transgender people in the Netherlands had to undergo gonadectomy to change the gender on their birth certificate. For surgery, patients were required to be at least 18 and on hormone therapy for at least a year.

The study didn’t report regret among patients who didn’t undergo surgery. Thirty-six percent of patients overall didn’t return to the clinic after several years of treatment and were lost to follow-up.

People treated in the last decade of the study may report regret later. “In our population the average time to regret was 130 months, so it might be too early to examine regret rates in people who started with (hormone therapy) in the past 10 years,” the authors wrote.

https://www.jsm.jsexmed.org/article/S1743-6095(18)30057-2/fulltext

October 2022

Researchers found that 98% of 720 adolescents who started on puberty blockers before taking hormones had continued with treatment after four years on average. The authors used a nationwide prescription drug registry in the Netherlands to track whether patients were still taking hormones.

The researchers didn’t identify the reasons why 2% of patients had stopped treatment . The adolescents in the Netherlands also went through a lengthy assessment process, a year on average, before being recommended for medical treatment. For that reason, the Dutch researchers say, their results may not be applicable more broadly.

“There might be a difference because of that diagnostic phase,” said Dr Marianne van der Loos, the study’s lead author and a physician at Amsterdam University Medical Center’s Center for Expertise on Gender Dysphoria. “If you don’t have that, maybe more people will start treatment and reconsider it later on because they didn’t get help during that phase by a mental health professional.”

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/fulltext

United States

Children’s Mercy Kansas City, Uniformed Services University, U.S. Department of Defense

The authors said that more than a quarter of patients  who started gender-affirming hormones before age 18 stopped getting refills  for their medication within four years. The study examined 372 children of active duty and retired service members in the U.S. military insurance system, known as TRICARE.

It’s unclear why patients stopped their medication because the study only examined pharmacy records. The researchers said the number of patients who stopped hormones is likely an overestimate because they couldn’t rule out that some patients got hormones outside of the military system, perhaps at college or with different health insurance.

The follow-up period for many patients was relatively short. The researchers examined patients enrolled from 2009 to 2018, but 58% of the patients started hormones in the last 22 months of the study.

https://doi.org/10.1210/clinem/dgac251

United Kingdom

University College London Hospitals, Leeds Teaching Hospitals, Tavistock and Portman clinic – National Health Service Trust

Researchers found that 90 patients, or 8.3% , of 1,089 adolescents referred for gender-affirming care at endocrinology clinics no longer identified as gender-diverse , either before or after starting on puberty blockers or hormones. The review spanned patients who were treated from 2008 through 2021.

The authors noted the 8.3% figure may be an underestimate because 62 additional patients, or 5.4% of all participants, moved away or didn’t follow up with the clinics.

https://adc.bmj.com/content/107/11/1018

Fenway Institute, Massachusetts General Hospital

Drawing on the 2015 U.S. Transgender Survey, the authors found that 13.1%  of 17,151 respondents had detransitioned  for some period of time.

Some of the common reasons respondents provided were pressure from a parent (35.6%), pressure from their community or societal stigma (32.5%), or difficulty finding a job (26.9%). Nearly 16% of respondents cited at least one “internal driving factor, including fluctuations in or uncertainty regarding gender identity,” according to the study. Half of the people who reported detransitioning had taken gender-affirming hormones.

By design, the authors said, all respondents identified as transgender at the time of survey completion, and the survey wasn’t intended to capture people who detransitioned and no longer identified as transgender.

https://www.liebertpub.com/doi/10.1089/lgbt.2020.0437

Youth in Transition

By Robin Respaut, Chad Terhune and Michelle Conlin

Photo editing: Corinne Perkins

Art direction: John Emerson

Edited by Michele Gershberg and John Blanton

• Follow Reuters Investigates

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I Had Gender Confirmation Surgery. Here's What Happened Before, During And After.

Guest Writer

The day after I turned 19, I underwent gender confirmation surgery, or GCS, in Bangkok. An announcement like this is usually followed by a slew of questions, often from total strangers, including, “Do you have a vagina now? If so, does it ... you know ... work? Did it hurt?” and many others.

Actually, when people find out you’re transgender ― whether you’ve surgically transitioned or not ― the questions start almost immediately and they pretty much never stop. They’re often deeply personal questions ― ones you would never dream of asking a cisgender (non-trans) person, but because society typically treats trans bodies as public property, we don’t receive the privacy or dignity that everyone else receives.

Even if these inquiries come from a place of genuine compassion or curiosity, being trans can be an incredibly painful and traumatic experience, and when trans people are asked invasive, often quite rude questions by people who have no right to the answers, it only exacerbates that pain and trauma.

That said, I understand the curiosity that drives these questions. I really do. I understand why it can all seem a bit confusing at first. And because I believe that if there’s a silver bullet for prejudice, ignorance and hate, it’s education, I’ve decided to set the record straight, once and for all, from start to finish. No holds barred. No punches pulled. I will be completely honest about what I went through and how things changed when I came out the other side.

I’m going to do my best to answer these questions so that maybe people will stop asking them. Of course, everyone’s transition is different, and every experience of GCS is unique. Everyone has their own story. This is mine.

“If you’ve ever been through puberty or menopause, you know how awful sudden hormonal shifts can be. By the end of it all, I was physically and emotionally exhausted, and the hardest part hadn’t even begun yet.”

GCS is not something you do on a whim. In Australia, where I live, I needed to have lived full-time as my true gender and be on hormone replacement therapy or HRT, for one full year before I was even allowed to apply for surgery, and it is never legally performed on minors. After that, both a psychologist and a psychiatrist had to sign documents certifying that this procedure was not only very much desired but medically necessary for me.

I also had to choose a surgeon. After an exhaustive search, I chose Dr. Chettawut Tulayaphanich, who specializes in treating gender dysphoric patients and who came highly recommended by my endocrinologist. While there are surgeons in Australia who offer GCS, surgeons overseas, particularly in Thailand, tend to be more affordable and have more experience with the procedure.

After that, all my travel documents had to be lined up — no mean feat when you’re halfway through legally changing your name. I had to undergo a battery of physical, blood and STD tests. My results were then emailed to the clinic overseas. Around this time, I also had to stop taking my HRT until after the surgery. If you’ve ever been through puberty or menopause, you know how awful sudden hormonal shifts can be. By the end of it all, I was physically and emotionally exhausted, and the hardest part hadn’t even begun yet.

My surgery was scheduled for Friday, May 25, 2018. Between the flights, the hotel and the surgery itself, the bill came to about $20,000 AUD. I landed in Bangkok at 2:00 a.m. on the Sunday before my surgery. The following week was a barrage of more tests, consultations and preparation for what was to come. On Tuesday, I was ordered to fast until Friday.

On Wednesday, I had my big consultation with the surgeon himself. I had to take off my clothes in front of a room full of strangers (and my mother) and have the most intimate parts of my body examined, probed and photographed. Dr. Chettawut explained to me the exact process of the operation using multiple, very detailed, very realistic diagrams. You can read more about this process and see one of those diagrams here .

The most common method for creating a neo-vagina is a “penile inversion” technique where the genitals are, just as the name implies, inverted. In my case, the procedure was a little more complicated. Rather than being inverted outright, the genitals are removed and then reutilized to create different parts of the neo-vagina. The vaginal lining is made up of scrotal tissue and groin skin grafts. Because of this, unlike many other post-op trans women, my vagina can self-lubricate thanks to the preservation of certain secretory glands around the urethral and vaginal opening. Penile and prepuce skin was used to construct an anatomically accurate labia minora. The result is a vagina that looks and functions, sans periods and childbirth, more or less identically to that of a cis woman.

On the day of the operation, a car picked me up from my hotel and took me to the clinic. I surrendered my clothes and my phone and lay down on a gurney and waited to be wheeled into the operating theater. You may not believe me, but at that moment, I wasn’t scared ― not even a little bit. Maybe I was too exhausted to be afraid. Or maybe it was because I would rather have died on that operating table than go on living in the body into which I’d been born.

At 2:58 p.m., the nurses wheeled me into the operating theater, and the anesthesiologist placed a breathing mask on my face. I remember making a bad joke about the taste of the gas in my mouth as the lights went dim and I drifted into unconsciousness.

When I woke up, everything was a blur. The voices I heard sounded like they were far away, and I could feel the hands of the nurses on my body as they moved me from the operating table to a gurney. I felt absolutely nothing between my legs. I couldn’t move or speak.

They wheeled me to a small room outside the operating theater, and someone said something about checking on me later. Then I was left alone in the dark. I remember feeling thirsty, and I found myself struggling to breathe. Every breath felt too shallow, like I couldn’t get enough air into my lungs. I drifted in and out of sleep, content to simply lie still in the dark. At that point, there was no pain ― that came later.

The next day, I was moved to my own room and finally given water to drink. After that, I was gradually allowed to start eating again. Soon, the pain started. At first, it was a dull ache, but within 24 hours, it had become an unbearable agony that radiated out from the surgery site up through my entire abdomen.

I spent three or four days at the clinic before being moved back to my hotel. My daily routine consisted of taking several different kinds of painkillers and antibiotics at breakfast, lunch, dinner and bedtime, and watching a lot of Netflix to ease the boredom in between my doses. The idea was to medicate me enough so that I would be comfortable during the day and sleep through the night, but the painkillers always wore off too quickly. Each night became a grueling marathon of agony, and I would wait, desperate for the morning ― and my next set of pills ― to arrive.

I slept in stops and starts during the day, when the pills softened my excruciating pain into a strong but bearable ache. I cried at least once a day when I was alone, sometimes from the pain, sometimes from missing my partner, who was waiting for me back home in Sydney. Often, I found myself crying for no reason at all.

Each day, I was visited by nurses from the clinic. After about a week, I was told it was time for me to start dilation. For the uninitiated, when a seven-inch hole is created in your body, your body treats it like a wound and tries to close it up. Obviously, that would defeat the purpose of GCS, so the vagina is kept open using glass cylinders called dilators. I was given five of them, numbered zero to four, all about eight inches long, ranging from one and a half centimeters to about one and a half inches in width. Thanks to the technique my surgeon used, my vagina was able to accommodate a little more than seven inches in depth. Many trans women get five inches, sometimes even less. It all comes down to the skill of the surgeon, how diligent you are about sticking to your dilation schedule, and luck.

“After about a week, I was told it was time for me to start dilation. For the uninitiated, when a seven-inch hole is created in your body, your body treats it like a wound and tries to close it up.”

The process began with the nurses performing the dilation, and after that, it would be up to me. That first time, when the gauze packing was taken out of my vagina and that first, narrow glass rod (about the width of a large pen) was placed inside me, I lay back on the bed and caught my breath as I stared at the ceiling. It hurt a little, but not as much as I’d expected.

The sensation of something being inside my new vagina was beyond description. The novelty, the strangeness of it, the sudden sense of my mind and body being in harmony with one another after so many years of dissonance ... I can only imagine it might compare to how Dorothy felt stepping into Oz and seeing her sepia world turn to color. For the first time, I felt the reality of my new body set in, and despite everything, at that moment, I felt utterly breathless with joy.

One thing I expected after the surgery, but which nothing could have prepared me for, was the bleeding that I experienced after the gauze was removed. The amount of blood I lost over the next several months was almost unimaginable. When someone tells me I’ve never had a period and therefore I can’t possibly imagine what it must be like to be a “real” woman, I like to joke that I did have periods, I just got all of them at once. Every time I limped to the bathroom, a trail of blood followed me there and back. I changed my pads twice a day for a month, and every morning, the hotel staff would come and change my sheets which, despite the extra-absorptive pads I wore overnight, were soaked through with a massive pool of blood.

Two weeks later, a week before I was set to return home to Australia, the nurses noticed something off about how I was healing and I had to go back under the knife.

The first time I was operated on, I received general anesthesia. This time, I was awake and the anesthesia was local. It took three separate needles in my new vagina to administer the numbing agent, and even with it, over the next hour and a half, I felt everything, and I mean everything , as my new vagina was cut apart, rearranged and stitched back together. It was and remains the single most painful experience of my life.

By some miracle, I was still able to go home the following week. The second surgery had gone well, and I was starting to heal properly. I could now walk short distances with the aid of a walking stick but I still needed a wheelchair at the airport to make it to the plane. It took another two months before I was even close to being fully healed.

I’ve since read many accounts by other trans women about what dilation was like for them. Some of them almost never have to dilate after seven or eight months. A lot of them say the pain was negligible as they continued to dilate to keep their vagina open. I wasn’t so lucky. The best way I can describe dilating after I left Thailand is to liken it to inserting a serrated knife seven inches deep into an open wound and then holding it there for two and a half hours. Even now, four years later, I still need to dilate for one hour a day to maintain my depth and elasticity. The pain started to taper off after about three months, and I barely think about it now. It’s as much a part of my day as brushing my teeth and taking a shower. It seems strange now to think that this isn’t the body I was born into.

A lot of people have made headlines ― not just recently, but for years now ― talking about GCS and transgender people more broadly. Almost all of them have one thing in common: They’ve never actually been through it. I’d be willing to bet they’ve never even spoken to someone who has. I have been through it ― and it was harder than words could ever describe. It was terrifying. It was expensive. And it was the best thing I have ever done for myself.

I say this to all readers, but especially to any who might be thinking about undergoing GCS themselves: It doesn’t fix everything. When you’re finally healed and you go back to your day-to-day life, you’re still, at your core, the same person you were before GCS. You don’t live the rest of your life in a state of perpetual bliss. But what did change for me is that now, when I look in the mirror or when I look down at my body, I see my body, not someone else’s. When someone touches me, I don’t flinch or feel ashamed and disgusted. When I feel the right parts between my legs, most of the time I don’t feel euphoric, but I feel OK, and after a lifetime of agonizing incongruity between my body and brain, just feeling OK is absolutely priceless.

So there you have it. Now, let’s quickly get a few of the other more common questions out of the way: Yes, it looks like a vagina; yes, I can have vaginal sex and orgasm; no, I can’t give birth; yes, it was absolutely, beyond a shadow of a doubt worth it.

Lastly, it’s important to note that not every trans person wants or needs to undergo GCS. Some trans people only go on HRT, and some only transition socially. Gender originates not in the body but in the brain. Studies have shown that the brains of trans people are structurally closer to those of the gender they identify with than that of the gender they were presumed to have at birth .

To say I was born with a female brain in a male body is not just an expression, it’s a material and scientific fact. Wanting to express yourself and live as your true gender is not, as Bill Maher so crassly put it , analogous to wanting to be a “pirate.”

There is no one right way to be trans, any more than there is one right way to be a cis man or woman. I needed GCS just to feel comfortable in my own body, but not everyone feels that way, and many people that do need it can’t access it.

It can cost $50,000 or more to undergo GCS in Australia, and for plenty of trans people — for whom rates of poverty and unemployment are significantly higher than the national average — even the $20,000 I paid (half of which my parents covered) is out of reach. It doesn’t mean their gender is any less valid or that they should be treated any differently.

“There is no one right way to be trans, any more than there is one right way to be a cis man or woman. I needed GCS just to feel comfortable in my own body, but not everyone feels that way, and many people that do need it can’t access it.”

I’m incredibly grateful to have been able to undergo GCS. It’s no exaggeration to say it saved my life, and the fact that it remains inaccessible to so many people who need it is heartbreaking.

Gender dysphoria can be painful, and for some of us, myself included, it’s unbearable without medical intervention. I’m also grateful to have a family that supported me both during and after the procedure. Too many trans people (some of whom I know personally) have been either shunned or abandoned outright by unsupportive families after coming out.

Everyone’s experience is different, but for me and many other people, being trans is hard, even without factoring in the stigma and hate that is still so rampant in our society. But that does not mean that trans people are broken. It doesn’t mean they’re oddities or freaks. We’re different, and different can be confusing. Different can be scary. It seems written into our DNA to be scared of what we don’t understand. But the more we know, the less confusing and scary these identities and experiences become. That’s why I wrote this. And there are resources available online, at your local bookstore and at LGBT community centers.

Ignorance isn’t a virtue. If you don’t understand something, educate yourself. Research, read, and if you know a trans person and if they’re comfortable with talking about their life, ask (politely). But be OK if they don’t want to answer your questions. Many trans people don’t, and the obligation shouldn’t be on us. We’re human beings and deserve to be treated as such. We deserve to be treated with respect and dignity, just like you.

Elizabeth Walker is a 23-year-old trans woman living in Sydney. She studies animation and works part-time as a freelance writer. She started transitioning at the age of 15 and hasn’t looked back. Her hobbies include photography, ice skating and trail hiking. She has a loving partner of four years and two fur babies that she loves with all her heart.

Do you have a compelling personal story you’d like to see published on HuffPost? Find out what we’re looking for here and send us a pitch .

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From our partner, more in huffpost personal.

• The Moving Image

A Perfect Daughter: Gender Reassignment by Gillian Laub

N ikki was born Niko. A biological boy at birth, she began at the age of 10 the complicated transition to becoming girl. With the utmost support of her family and friends, two years later, she is living happily as the person she always knew herself to be — singing, acting and dancing, often draped in pink.

Earlier this summer, PEOPLE magazine commissioned photographer Gillian Laub to spend several days with Nikki’s family in California, documenting her life after the transition through video and photographic stills. Her portrait shows what it was like for Nikki coming out with her gender identity, finding solace in puberty-blocking medication and looking to the gender reassignment surgery on the horizon for her teenage years.

“It’s always an honor when someone is open and wants to share their life in such an intimate way under the gaze of a camera,” Laub tells TIME, “so the minute the editor told me about Nikki, I said of course I would love to do it.”

To gain their trust and to make them feel comfortable, Laub spent the first day just talking with the family without her cameras.

“Nikki told me she spent the first ten years of her life feeling like she was in the wrong body, almost betrayed by it,” she says. “After the transition, she finally felt happy, safe and proud in her body. I wanted to convey the new feeling of freedom and liberation.”

What stood out to Laub most and what she aimed to capture in the video above was how immensely loving Nikki’s family was. With the knowledge that 50% of transgender youth will attempt to commit suicide by the age of 20, they strove to provide all the support they could for their child to lead the life she wanted.

“Although this story ultimately is a very happy ending,” Laub says, “the family went through years of heartache and stress. They lived with a secret that they all struggled with for very long. The reason they were sharing their story publicly is because they wished they had known sooner that this was actually something many families deal with; they wouldn’t have had so many years of worry and confusion.”

Gillian Laub is a photographer based in New York and a frequent contributor to TIME. See more of her work here .

Eugene Reznik is a Brooklyn-based photographer and writer. Follow him on Twitter @eugene_reznik .

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The Gender Reassignment Controversy

When people opt for surgery, are they satisfied with the outcome.

Posted March 16, 2018 | Reviewed by Ekua Hagan

In an age of increasing gender fluidity, it is surprising that so many find it difficult to accept the gender of their birth and take the drastic step of changing it through surgery. What are their motives? Are they satisfied with the outcome?

Gender may be the most important dimension of human variation, whether that is either desirable, or inevitable. In every society, male and female children are raised differently and acquire different expectations, and aspirations, for their work lives, emotional experiences, and leisure pursuits.

These differences may be shaped by how children are raised but gender reassignment, even early in life, is difficult, and problematic. Reassignment in adulthood is even more difficult.

Such efforts are of interest not just for medical reasons but also for the light they shed on gender differences.

The first effort at reassignment, by John Money, involved David Reimer whose penis was accidentally damaged at eight months due to a botched circumcision.

The Money Perspective

Money believed that while children are mostly born with unambiguous genitalia, their gender identity is neutral. He felt that which gender a child identifies with is determined primarily by how parents treat it and that parental views are shaped by the appearance of the genitals.

Accordingly, Money advised the parents to have the child surgically altered to resemble a female and raise it as “Brenda.” For many years, Money claimed that the reassignment had been a complete success. Such was his influence as a well-known Johns Hopkins gender researcher that his views came to be widely accepted by scholars and the general public.

Unfortunately for Brenda, the outcome was far from happy. When he was 14, Reimer began the process of reassignment to being a male. As an adult, he married a woman but depression and drug abuse ensued, culminating in suicide at the age of 38 (1).

Money's ideas about gender identity were forcefully challenged by Paul McHugh (2), a leading psychiatrist at the same institution as Money. The brunt of this challenge came from an analysis of gender reassignment cases in terms of both motivation and outcomes.

Adult Reassignment Surgery Motivation

Why do people (predominantly men) seek surgical reassignment (as a woman)? In a controversial take, McHugh argued that there are two main motives.

In one category fall homosexual men who are morally uncomfortable about their orientation and see reassignment as a way of solving the problem. If they are actually women, sexual interactions with men get redefined as heterosexual.

McHugh argued that many of the others seeking reassignment are cross-dressers. These are heterosexual men who derive sexual pleasure from wearing women's clothing. According to McHugh, surgery is the logical extreme of identifying with a female identity through cross-dressing.

If his thesis is correct, McHugh denies that reassignment surgery is ever either medically necessary or ethically defensible. He feels that the surgeon is merely cooperating with delusional thinking. It is analogous to providing liposuction treatment for an anorexic who is extremely slender but believes themselves to be overweight.

To bolster his case, McHugh looked at the clinical outcomes for gender reassignment surgeries.

Adult Reassignment Results

Anecdotally, the first hurdle for reassignment is how the result is perceived by others. This problem is familiar to anyone who looked at Dustin Hoffman's depiction of a woman ( Tootsie ). Diligent as the actor was in his preparation, his character looked masculine.

For male-to-female transsexuals, the toughest audience to convince is women. As McHugh reported, one of his female colleagues said: “Gals know gals, and that's a guy.”

According to McHugh, although transsexuals did not regret their surgery, there were little or no psychological benefits:

“They had much the same problems with relationships, work, and emotions, as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled (2)”.

Thanks to McHugh's influence, gender reassignment surgeries were halted at Johns Hopkins. The surgeries were resumed, however, and are now carried out in many hospitals here and around the world.

What changed? One likely influence was the rise of the gay rights movement that now includes transgender people under its umbrella and has made many political strides in work and family.

McHugh's views are associated with the religious right-wing that has lost ground in this area.

Transgender surgery is now covered by medical insurance reflecting more positive views of the psychological benefits.

Aspirational Surgery

Why do people who are born as males want to be women? Why do females want to be men? There seems to be no easy biological explanation for the transgender phenomenon (2).

Transgender people commonly report a lifelong sense that they feel different from their biological category and express satisfaction after surgery (now called gender affirmation) that permits them to be who they really are.

The motivation for surgical change is thus aspirational rather than medical, as is true of most cosmetic surgery also. Following surgery, patients report lower gender dysphoria and improved sexual relationships (3).

All surgeries have potential costs, however. According to a Swedish study of 324 patients (3, 41 percent of whom were born female) surgery was associated with “considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.”

1 Blumberg, M. S. (2005). Basic instinct: The genesis of behavior. New York: Thunder's Mouth Press.

2 McHugh, P. R. (1995). Witches, multiple personalities, and other psychiatric artifacts. Nature Medicine, 1, 110-114.

3 Dhejne, S., Lichtenstein, P., Boman, M., et al. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study of Sweden . Plos One.

Nigel Barber, Ph.D., is an evolutionary psychologist as well as the author of Why Parents Matter and The Science of Romance , among other books.

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Hormones, surgery, regret: I was a transgender woman for 8 years — time I can't get back

At first i was giddy for the fresh start. but hormones and sex change genital surgery couldn't solve the underlying issues driving my gender dysphoria..

I started my transgender journey as a 4-year-old boy when my grandmother repeatedly, over several years, cross-dressed me in a full-length purple dress she made especially for me and told me how pretty I was as a girl. This planted the seed of gender confusion and led to my transitioning at age 42 to transgender female.

I lived as “Laura” for eight years, but, as I now know, transitioning doesn’t fix the underlying ailments.

Studies show that most people who want to live as the opposite sex have other psychological issues , such as depression or anxiety. In my case, I was diagnosed at age 40 with gender dysphoria and at age 50 with psychological issues due to childhood trauma.

Eventually, my parents found out, and my unsupervised visits to Grandma’s house ended. I thought my secret was safe, but my teenage uncle heard about it and felt I was fair game for taunting and sexual abuse. I wasn’t even 10 years old. If not for the purple dress, I believe I would not have been abused by my uncle.

Read more commentary:

Trump's anti-transgender memo would hurt teens like me. I'm hoping my state protects me.

My high school's transgender bathroom policies violate the privacy of the rest of us

High school could have been hell for my transgender son. Don't make it hell for the next kid.

That abuse caused me to not want to be male any longer. Cross-dressing gave me an escape. I lay awake at night, secretly begging God to change me into a girl. In my childlike thinking, if I could only be a girl, then I would be accepted and affirmed by the adults in my life. I would be safe. 

Making the decision to transition

Gender dysphoria is about identity, not sexual orientation. I was never homosexual; I was interested in dating girls. In my early 20s and engaged to be married, I confided to my fiancée about my cross-dressing. She figured we could work it out. We got married and had two children.

In my work life  I was successful, but the girl persona still occupied my thoughts. With weekly travel away from home, I easily indulged in cross-dressing, fueling the desire to be a woman.

By the time I was 40, I couldn’t take the pressure of living two separate lives. I felt torn apart, wanting to be a good husband and father, but in severe torment about needing to be a woman.

I sought out the top gender specialist at the time, Dr. Paul Walker, who had co-authored  the 1979 standards of care for transgender health. He diagnosed me with gender identity disorder (now gender dysphoria ) and recommended cross-sex hormones and sex change genital surgery. He told me that the childhood events were not related to my current gender distress, and that sex change was the only solution. I started taking female hormones and scheduled the surgery for April 1983 in Trinidad, Colorado. I was 42.

My marriage ended shortly before surgery. In addition to genital reconfiguration, I had breast implants and other feminizing procedures and changed my birth certificate to Laura Jensen, female. My childhood dream was realized, and my life as a woman began.

A fresh start, then a harder fall

At first, I was giddy with excitement. It seemed like a fresh start. I could sever ties with my former life as Walt and my painful past. But reality soon hit. My children and former wife were devastated. When I told my employer, my career was over.

As Laura, I decided to pursue being a counselor and started courses at the University of California-Santa Cruz in the late 1980s. There, a crack in my carefully crafted female persona opened, and I began to question my transition. The reprieve I experienced through surgery was only temporary. Hidden underneath the makeup and female clothing was the little boy hurt by childhood trauma. I was once again experiencing gender dysphoria, but this time I felt like a male inside a body refashioned to look like a woman. I was living my dream, but still I was deeply suicidal.

A gender specialist told me to give it more time. Eight years seemed like an awfully long time to me. Nothing made sense. Why hadn’t the recommended hormones and surgery worked? Why was I still distressed about my gender identity? Why wasn’t I happy being Laura? Why did I have strong desires to be Walt again?

Emotionally, I was a mess. But with grit and determination, and the love and support of several families and counselors, I pursued healing on a psychological level. With expert guidance, I dared to revisit the emotional trauma of my youth. It wasn’t easy, but it was the only way to address the underlying conditions driving my gender dysphoria.

I was 50 when I had the breast implants removed, but the next few years were spent in confusion and counseling. In 1996, at the age of 55, I was finally free from the desire to live as a woman and changed my legal documents back to Walt, my biologically correct male sex. I still have scars on my chest, reminders of the gender detour that cost me 13 years of my life. I am on a hormone regimen to try to regulate a system that is permanently altered.

Regret is real

Eventually, I met a wonderful woman who didn’t care about the changes to my body, and we’ve been married for 21 years. Now we help others whose lives have been derailed by sex change. Measured by the human benefit to a hurting population, it’s a priceless way to spend our time.

Had I not been misled by media stories of sex change “success” and by medical practitioners who said transitioning was the answer to my problems, I wouldn’t have suffered as I have. Genetics can’t be changed. Feelings, however, can and do change. Underlying issues often drive the desire to escape one’s life into another, and they need to be addressed before taking the radical step of transition.

You will hear the media say, “Regret is rare.” But they are not reading my inbox, which is full of messages from transgender individuals who want the life and body back that was taken from them by cross-sex hormones, surgery and living under a new identity.

After de-transitioning, I know the truth: Hormones and surgery may alter appearances, but nothing changes the immutable fact of your sex. Walt Heyer is a former transgender woman who provides support to others who regret gender change at SexChangeRegret.com . He is the author of " Trans Life Survivors ."  

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• 28 May 2024

Heed lessons from past studies involving transgender people: first, do no harm

• Mathilde Kennis 0 ,
• Robin Staicu 1 ,
• Marieke Dewitte 2 ,
• Guy T’Sjoen 3 ,
• Alexander T. Sack 4 &
• Felix Duecker 5

Mathilde Kennis is a researcher in cognitive neuroscience and clinical psychological science at Maastricht University, the Netherlands.

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Robin Staicu is a neuroscientist and specialist in diversity, equity and inclusion at Maastricht University, the Netherlands.

Marieke Dewitte is a sexologist and assistant professor in clinical psychological science at Maastricht University, the Netherlands.

Guy T’Sjoen is a clinical endocrinologist and professor in endocrinology at Ghent University Hospital, Belgium, the medical coordinator of the Centre for Sexology and Gender at Ghent University Hospital, and one of the founders of the European Professional Association for Transgender Health.

Alexander T. Sack is a professor in cognitive neuroscience at Maastricht University, the Netherlands.

Felix Duecker is an assistant professor in cognitive neuroscience at Maastricht University, the Netherlands.

You have full access to this article via your institution.

Over the past few decades, neuroscientists, endocrinologists, geneticists and social scientists have conducted numerous studies involving transgender people, meaning those whose gender identity does not conform to that typically associated with the sex to which they were assigned at birth. Justifications for doing such research have shifted over the years and, today, investigators are increasingly focused on assessments of transgender people’s mental health or the impact of hormone therapies.

But such work raises challenges. Despite researchers’ best intentions, these studies can perpetuate stigmas and make it even harder for transgender people to access appropriate medical care.

Here we focus on neuroscientific approaches to the study of transgender identity to explore how investigators might navigate these concerns.

Brain scanning

In 1995, neuroscientists at the Netherlands Institute for Brain Research in Amsterdam published findings from a post-mortem study, which included six transgender individuals 1 . They found that the volume of part of the brain’s hypothalamus — called the bed nucleus of the stria terminalis, which tends to be larger in men than in women — corresponded to the gender identity of the transgender individuals, not to their sex assigned at birth. Although the data were only correlative, the researchers suggested that people identify as transgender because of changes in the brain that happen before birth — in other words, that someone can be born with a male-typical body and brain characteristics more typical of a female brain, and vice versa.

Sex and gender in science

Since it was published, the paper has been cited more than 1,000 times, and at least a dozen researchers have probed this theory and related ones using tools such as structural and functional magnetic resonance imaging (MRI).

Although the results of these analyses have been inconsistent, several ideas have nonetheless arisen about a neurobiological basis for gender dysphoria — the distress associated with a person’s gender identity not aligning with the sex they were assigned at birth. These include the ‘own-body perception’ theory 2 , which proposes that a reduced structural and functional connectivity between certain brain networks is responsible. (Previous work has associated these networks with brain regions thought to be involved in people’s ability to link their own body to their sense of self 3 .)

As analytical tools and methods advance, brain research is becoming more sophisticated. The number of neuroscientific studies that include transgender participants has increased considerably since 1991 (see ‘On the rise’).

Some neuroscientists are using functional MRI to study the effects of hormone therapy on brain structure 4 and to examine cognitive processes such as face perception 5 . Others are applying machine-learning techniques to establish whether features in brain scans of cis- and transgender people correlate with their gender identity 6 . Researchers are also trying to assess whether particular features identified in brain scans make it more likely that transgender individuals will benefit from gender-affirming hormone therapy 7 . And some are conducting ‘mega-analyses’ — pooling the brain scans of hundreds of participants — to identify brain characteristics that are specific to transgender people 8 .

Help or harm?

One concern arising from such studies is that neuroscientific findings related to transgender identity could make it even harder for some people to access medical treatment that could help them.

In countries or regions where gender-affirming medical treatment is available, individuals often need a diagnosis of ‘gender dysphoria’ or ‘gender incongruence’ to be eligible for hormone therapy or gender-affirming surgery, and to be reimbursed for such treatments. Results from brain scans could be included in the suite of measurements used to assess whether someone is experiencing gender dysphoria or incongruence.

Those in favour of such requirements argue that it is necessary to prevent people taking irreversible steps that they might regret. Hormonal therapy can have adverse effects on fertility, for instance 9 . However, many transgender people argue that whether someone can receive gender-affirming hormone therapy or other treatment shouldn’t depend on a health-care practitioner deciding that they experience ‘enough’ gender dysphoria to be eligible 10 . The current approach, combined with a shortage of specialists qualified to make such diagnoses, has been linked to long waiting lists. In the Netherlands, waiting times can be more than two years .

A second possibility is that neuroscientific findings related to transgender identity will fuel transphobic narratives 11 .

Take the debate on social media and other platforms about gendered public spaces in countries such as the United States , the United Kingdom and Brazil 12 . Some people argue that allowing transgender women to access infrastructure, such as public toilets or women’s prisons, threatens the safety of “real women” . Neuroscientific research is sometimes misused to bolster flawed claims about what ‘real’ means.

Moreover, such studies could exacerbate tensions between scientific and transgender communities.

Scientists are aiming to identify brain characteristics that are specific to transgender people. Credit: Alain Jocard/AFP/Getty

Although cis- and transgender researchers have taken steps to improve people’s understanding, there is a history of tension between the scientific and transgender communities 13 . In the late 1980s, for instance, a sexologist argued that trans women who are mainly attracted to women experience sexual arousal from their own expression of femininity. He described their feelings of gender dysphoria as resulting from paraphilia — a sexual interest in objects, situations or individuals that are atypical 14 . This theory has not held up under broader scientific scrutiny 15 , but it has become notorious in the transgender community and, from our discussions with transgender people and discussions by other groups 16 , it is clear that such studies have reduced transgender people’s trust in science.

How four transgender researchers are improving the health of their communities

In 2021, for example, a neuroimaging study with transgender participants was suspended in the United States after backlash from the transgender community. The study would have involved showing participants images of themselves wearing tight clothes, with the intention of triggering gender dysphoria — an experience that is associated with depression, anxiety, social isolation and an increased risk of suicide. The study’s researchers had acquired ethical approval from their research institute and obtained informed consent from the participants. Yet they had failed to anticipate how the transgender community would perceive their experimental procedure.

In 2022, to learn more about how transgender people view current neuroscientific approaches to the study of transgender identity, we conducted focus-group interviews that lasted for three hours with eight transgender participants — all of whom had differing levels of knowledge about the topic.

The group expressed concern that studies that look for a neurological basis to transgender identities could have a pathologizing effect. “I think questions of aetiology are just inherently wrong,” one participant said. “We don’t ask ‘Why is someone’s favourite colour blue?’. These are questions that come from wanting to pathologize.” Participants also agreed that a biological-determinist approach does not do justice to the complex and layered experience of identifying as transgender.

Decades of work aimed at establishing how science can benefit minority groups 17 suggest that neuroscientists and other scholars could take several steps to ensure they help rather than harm transgender, non-binary and intersex individuals and other people who don’t conform to narrow definitions around sex and gender. Indeed, the four actions that we lay out here are broadly applicable to any studies involving marginalized groups.

Establish an advisory board. Researchers who work with transgender participants should collaborate with an advisory board that ideally consists of transgender people and members of other groups with relevant perspectives, including those who have some understanding of the science in question. Funding agencies should support such initiatives, to help prevent further distrust being sown because of how studies are designed.

Set up multidisciplinary teams. Researchers trained in neuroscience will view phenomena such as transgender identity through a different lens from, say, those trained in psychology. To prevent the outcomes of neuroscientific and other studies being described and published in an overly deterministic and simplistic way 18 , research teams should include social scientists. Ideally, such collaborations would also include transgender researchers or others with diverse gender identities, because their input would help to prevent a cis-normative bias in study design and in the interpretation of results. Indeed, our own group has benefited from this diversity (one of us is transgender).

Prioritize research that is likely to improve people’s lives. Neuroscientists and others engaged in research involving transgender participants, non-binary people or individuals with diverse gender identities should prioritize research questions that are likely to enhance the health of these groups. Although the applications of basic research can be hard to predict, investigations into the neurobiological impacts of hormone treatment on the brain, for instance, could be more directly informative to health-care practitioners and transgender individuals than might investigations into the underlying bases of transgender identity.

Rethink how ethical approval is obtained. Ethical boards at universities typically consist of scientists with diverse backgrounds. But it is unrealistic to expect them to be educated on the sensitivities of every minority group, whether in relation to gender, religion, ethnicity or anything else. One way to address this problem is for ethical boards to require researchers to state what feedback and other information they have gathered through community engagement. A university’s ethical review committee could then evaluate whether the researchers have done enough to understand and address people’s concerns and sensitivities.

Our aim is not to halt scientific enquiry. But when it comes to transgender identity, knowledge cannot be pursued in isolation from the many societal factors that shape how that knowledge is received and acted on.

Nature 629 , 998-1000 (2024)

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The idea of getting stuck in the wrong body sounds like the premise for a movie in "Freaky Friday," a mother and a daughter swap bodies, and in "Big" and "13 Going on 30," teenagers experience life in an adult's body. These movies derive their humor from the ways in which the person's attitude and thoughts don't match their appearance. A teenager trapped in her mother's body, for example, revels in breaking curfew and playing air guitar, while a teenager trapped in an adult's body is astounded by the trappings of wealth that come with a full-time job. We laugh because the dialogue and actions are so contrary to what we'd expect from someone who is a mother, or from someone who is an employed adult.

But for some people, living as an incongruous gender is anything but a joke. A transgender person is someone who has a different gender identity than their birth sex would indicate. We interchange the words sex, sexuality and gender all the time, but they don't actually refer to the same thing. Sex refers to the parts we were born with; boys, we assume, have a penis, while girls come equipped with a vagina. Sexuality generally refers to sexual orientation , or who we're attracted to in a sexual and/or romantic sense. Gender expression refers to the behavior used to communicate gender in a given culture. Little girls in the U.S., for example, would be expected express their feminine gender by playing with dolls and wearing dresses, and little boys would be assumed to express their masculinity with penchants for roughhousing and monster trucks. Another term is g ender identity, the private sense or feeling of being either a man or woman, some combination of both or neither [source: American Psychological Association ].

Sometimes, a young boy may want to wear dresses and have tea parties, yet it's nothing more than a phase that eventually subsides. Other times, however, there is a longing to identify with another gender or no gender at all that becomes so intense that the person experiencing it can't function anymore. Transgender is an umbrella term for people who identify outside of the gender they were assigned at birth and for some gender reassignment surgeries are crucial to leading a healthy, happy life.

Gender Dysphoria: Diagnosis and Psychotherapy

Real-life experience, hormone replacement therapy, surgical options: transgender women, surgical options: transgender men, gender reassignment: regrets.

Transgender people may begin identifying with a different gender, rather than the one assigned at birth, in early childhood, which means they can't remember a time they didn't feel shame or distress about their bodies. For other people, that dissatisfaction with their biological sex begins later, perhaps around puberty or early adulthood, though it can occur later in life as well.

It's estimated that about 0.3 percent of the U.S. population self-identify as transgender, but not all who are transgender will choose to undergo a gender transition [source: Gates ]. Some may choose to affirm their new gender through physically transforming their bodies from the top down, while others may prefer to make only certain cosmetic changes, such as surgeries to soften facial features or hair removal procedures, for example.

Not all who identify with a gender different than their birth sex suffer from gender dysphoria or go on to seek surgery. Transgender people who do want gender reassignment surgery, however, must follow the standards of care for gender affirmation as defined by the World Professional Association for Transgender Health (WPATH).

In 1980, when gender identity disorder (GID) was first recognized, it was considered a psychiatric disorder. In 2013, though, GID was, in part, reconsidered as biological in nature, and renamed gender dysphoria . It was reclassified as a medical condition in the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a common language and standards protocol manual for the classification of mental disorders. With this classification, transgender people must be diagnosed prior to any treatment [source: International Foundation for Gender Education ].

Gender dysphoria is diagnosed when a person has a persistent desire to become a different gender. The desire may manifest itself as disgust for one's reproductive organs, hatred for the clothing and other outward signs of one's given gender, and/or a desire to act and be recognized as another gender. This desire must be continuously present for six months in order to be recognized as a disorder [source: WPATH].

In addition to receiving the diagnosis from a mental health professional, a person seeking reassignment must also take part in psychotherapy. The point of therapy isn't to ignite a change, begin a conversion or otherwise convince a transgender person that it's wrong to want to be of a different gender (or of no specific gender at all) . Rather, counseling is required to ensure that the person is realistic about the process of gender affirmation and understands the ramifications of not only going through with social and legal changes but with permanent options such as surgery. And because feeling incongruous with your body can be traumatizing and frustrating, the mental health professional will also work to identify any underlying issues such as anxiety, depression, substance abuse or borderline personality disorder.

The mental health professional can also help to guide the person seeking gender reassignment through the next step of the process: real-life experience.

WPATH requires transgender people desiring gender reassignment surgery to live full-time as the gender that they wish to be before pursuing any permanent options as part of their gender transition. This period is a known as real-life experience (RLE) .

It's during the RLE that the transgender person often chooses a new name appropriate for the desired gender, and begins the legal name-change process. That new name often comes with a set of newly appropriate pronouns, too; for example, when Chastity Bono, biologically born as Sonny and Cher's daughter in 1969, began her transition in 2008 she renamed herself as Chaz and instructed people to use "he" rather than "she" [source: Donaldson James ].

In addition to a new name and pronouns, during this time gender-affirming men and women are expected to also adopt the clothing of their desired gender while maintaining their employment, attending school or volunteering in the community. Trans women might begin undergoing cosmetic procedures to rid themselves of body hair; trans men might take voice coaching in attempt to speak in a lower pitch. The goal of real-life experience is to expose social issues that might arise if the individual were to continue gender reassignment. How, for example, will a boss react if a male employee comes to work as a female? What about family? Or your significant other? Sometimes, during RLE people realize that living as the other gender doesn't bring the happiness they thought it would, and they may not continue to transition. Other times, a social transition is enough, and gender reassignment surgery isn't pursued. And sometimes, this test run is the confirmation people need to pursue physical changes in order to fully become another gender.

In addition to the year-long real-life experience requirement before surgical options may be pursued, WPATH recommends hormonal therapy as a critical component to transitioning before surgery. Candidates for hormone therapy may choose to complete a year-long RLE and counseling or complete six months of a RLE or three-months of a RLE/three months of psychotherapy before moving ahead with hormone therapy.

Upon successfully completing a RLE by demonstrating stable mental health and a healthy lifestyle, the transitioning individual becomes eligible for genital reconstructive surgery — but it can't begin until a mental health professional submits a letter (or letters) of recommendation indicating that the individual is ready to move forward [source: WPATH].

Hormone replacement therapy (HRT) , also called cross-sex hormones, is a way for transgender individuals to feel and look more like the gender they identify with, and so it's a major step in gender reassignment. In order to be eligible for hormone therapy, participants must be at least 18 years old (though sometimes, younger adolescents are allowed to take hormone blockers to prohibit their naturally occurring puberty) and demonstrate to a mental health professional that they have realistic expectations of what the hormones will and won't do to their bodies. A letter from that mental health professional is required, per the standards of care established by WPATH.

Hormone therapy is used to balance a person's gender identity with their body's endocrine system. Male-to-female candidates begin by taking testosterone-blocking agents (or anti-androgens ) along with female hormones such as estrogen and progesterone . This combination of hormones is designed to lead to breast growth, softer skin, less body hair and fewer erections. These hormones also change the body by redistributing body fat to areas where women tend to carry extra weight (such as around the hips) and by decreasing upper body strength. Female-to-male candidates begin taking testosterone , which will deepen the voice and may cause some hair loss or baldness. Testosterone will also cause the clitoris to enlarge and the person's sex drive to increase. Breasts may slightly shrink, while upper body strength will increase [source: WPATH].

It usually takes two continuous years of treatment to see the full results of hormone therapy. If a person were to stop taking the hormones, then some of these changes would reverse themselves. Hormone therapy is not without side effects — both men and women may experience an increased risk for cardiovascular disease, and they are also at risk for fertility problems. Some transgender people may choose to bank sperm or eggs if they wish to have children in the future.

Sometimes hormonal therapy is enough to make a person feel he or she belongs to the desired gender, so treatment stops here. Others may pursue surgical means as part of gender reassignment.

Surgical options are usually considered after at least two years of hormonal therapy, and require two letters of approval by therapists or physicians. These surgeries may or may not be covered by health insurance in the U.S. — often only those that are considered medically necessary to treat gender dysphoria are covered, and they can be expensive. Gender reassignment costs vary based on each person's needs and desires; expenses often range between $7,000 and $50,000 (in 2014), although costs may be much greater depending upon the type (gender reconstructive surgeries versus cosmetic procedures) and number of surgeries as well as where in the world they are performed [source: AP ].

Gender affirmation is done with an interdisciplinary team, which includes mental health professionals, endocrinologists, gynecologists, urologists and reconstructive cosmetic surgeons.

One of the first surgeries male-to-female candidates pursue is breast augmentation, if HRT doesn't enlarge their breasts to their satisfaction. Though breast augmentations are a common procedure for cisgender women (those who identify with the gender they were assigned at birth), care must be taken when operating on a biologically male body, as there are structural differences, like body size, that may affect the outcome.

The surgical options to change male genitalia include orchiectomy (removal of the testicles), penile inversion vaginoplasty (creation of a vagina from the penis), clitoroplasty (creation of a clitoris from the glans of the penis) and labiaplasty (creation of labia from the skin of the scrotum) [source: Nguyen ]. The new vagina, clitoris and labia are typically constructed from the existing penile tissue. Essentially, after the testicles and the inner tissue of the penis is removed and the urethra is shortened, the skin of the penis is turned inside out and fashioned into the external labia and the internal vagina. A clitoris is created from excess erectile tissue, while the glans ends up at the opposite end of the vagina; these two sensitive areas usually mean that orgasm is possible once gender reassignment is complete. Male-to-female gender reconstructive surgery typically takes about four or five hours [source: University of Michigan ]. The major complication from this surgery is collapse of the new vaginal cavity, so after surgery, patients may have to use dilating devices.

Trans women may also choose to undergo cosmetic surgeries to further enhance their femininity. Procedures commonly included with feminization are: blepharoplasty (eyelid surgery); cheek augmentation; chin augmentation; facelift; forehead and brow lift with brow bone reduction and hair line advance; liposuction; rhinoplasty; chondrolargynoplasty or tracheal shave (to reduce the appearance of the Adam's apple); and upper lip shortening [source: The Philadelphia Center for Transgender Surgery]. Trans women may pursue these surgeries with any cosmetic plastic surgeon, but as with breast augmentation, a doctor experienced with this unique situation is preferred. One last surgical option is voice modification surgery , which changes the pitch of the voice (alternatively, there is speech therapy and voice training, as well as training DVDs and audio recordings that promise the same thing).

Female-to-male surgeries are pursued less often than male-to-female surgeries, mostly because when compared to male-to-female surgeries, trans men have limited options; and, historically, successful surgical outcomes haven't been considered on par with those of trans women. Still, more than 80 percent of surgically trans men report having sexual intercourse with orgasm [source: Harrison ].

As with male-to-female transition, female-to-male candidates may begin with breast surgery, although for trans men this comes in the form of a mastectomy. This may be the only surgery that trans men undergo in their reassignment, if only because the genital surgeries available are still far from perfect. Forty percent of trans men who undergo genital reconstructive surgeries experience complications including problems with urinary function, infection and fistulas [sources: Harrison , WPATH].

Female-to-male genital reconstructive surgeries include hysterectomy (removal of the uterus) and salpingo-oophorectomy (removal of the fallopian tubes and ovaries). Patients may then elect to have a metoidioplasty , which is a surgical enlargement of the clitoris so that it can serve as a sort of penis, or, more commonly, a phalloplasty . A phalloplasty includes the creation of a neo-phallus, clitoral transposition, glansplasty and scrotoplasty with prosthetic testicles inserted to complete the appearance.

There are three types of penile implants, also called penile prostheses: The most popular is a three-piece inflatable implant, used in about 75 percent of patients. There are also two-piece inflatable penile implants, used only 15 percent of the time; and non-inflatable (including semi-rigid) implants, which are used in fewer than 10 percent of surgeries. Inflatable implants are expected to last about five to 10 years, while semi-rigid options typically have a lifespan of about 20 years (and fewer complications than inflatable types) [source: Crane ].

As with trans women, trans men may elect for cosmetic surgery that will make them appear more masculine, though the options are slightly more limited; liposuction to reduce fat in areas in which cisgender women i tend to carry it is one of the most commonly performed cosmetic procedures.

As surgical techniques improve, complication rates have fallen too. For instance, long-term complication risks for male-to-female reconstructive surgeries have fallen below 1 percent. Despite any complications, though, the overwhelming majority of people who've undergone surgical reconstruction report they're satisfied with the results [source: Jarolím ]. Other researchers have noted that people who complete their transition process show a marked improvement in mental health and a substantial decrease in substance abuse and depression. Compare these results to 2010 survey findings that revealed that 41 percent of transgender people in the U.S. attempted suicide, and you'll see that finally feeling comfortable in one's own skin can be an immensely positive experience [source: Moskowitz ].

It's difficult, though, to paint a complete picture of what life is like after people transition to a new gender, as many people move to a new place for a fresh start after their transition is complete. For that reason, many researchers, doctors and therapists have lost track of former patients. For some people, that fresh start is essential to living their new lives to the fullest, while others have found that staying in the same job, the same marriage or the same city is just as rewarding and fulfilling and vital to their sense of acceptance.

In many ways, the process of gender affirmation is ongoing. Even after the surgeries and therapies are complete, people will still have to deal with these discrimination issues. Transgender people are often at high risk for hate crimes. Regular follow-ups will be necessary to maintain both physical and mental health, and many people continue to struggle with self-acceptance and self-esteem after struggling with themselves for so long. Still, as more people learn about gender reassignment, it seems possible that that these issues of stigma and discrimination won't be so prevalent.

As many as 91 percent Americans are familiar with the term "transgender" and 76 percent can correctly define it; 89 percent agree that transgender people deserve the same rights, privileges and protections as those who are cisgender [source: Public Religion Research Institute ]. But that's not to say that everything becomes completely easy once a person transitions to his or her desired gender.

Depending upon where you live, non-discrimination laws may or may not cover transgender individuals, so it's completely possible to be fired from one's job or lose one's home due to gender expression. Some people have lost custody of their children after divorces and have been unable to get courts to recognize their parental rights. Historically, some marriages were challenged — consider, for example, what happens when a man who is married to a woman decides to become a woman; after the surgery, if the two people decide to remain married, it now appears to be a same-sex marriage, which is now legalized in the U.S. Some organizations and governments refuse to recognize a person's new gender unless genital reconstructive surgery has been performed, despite the fact that some people only pursue hormone therapy or breast surgery [sources: U.S. Office of Personnel Management , Glicksman ].

Lots More Information

Author's note: stages of gender reassignment.

It's interesting how our terminology changes throughout the years, isn't it? (And in some cases for the better.) What we used to call a sex change operation is now gender realignment surgery. Transsexual is now largely replaced with transgender. And with good reason, I think. Knowing that sex, sexuality and gender aren't interchangeable terms, updating "sex change" to "gender reassignment" or "gender affirmation" and "transsexual" to "transgender" moves the focus away from what sounds like something to do with sexual orientation to one that is a more accurate designation.

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• How Gender Identity Disorder Works
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More Great Links

• DSM-5: Gender Dysphoria
• National Center for Transgender Equality
• The Williams Institute
• American Medical Student Association (AMSA). "Transgender Health Resources." 2014. (April 20, 2015) http://www.amsa.org/AMSA/Homepage/About/Committees/GenderandSexuality/TransgenderHealthCare.aspx
• American Psychological Association (APA). "Definition of Terms: Sex, Gender, Gender Identity, Sexual Orientation." 2011. (July 1, 2015) http://www.apa.org/pi/lgbt/resources/sexuality-definitions.pdf
• AP. "Medicare ban on sex reassignment surgery lifted." May 30, 2014. (April 20, 2015) http://www.usatoday.com/story/news/nation/2014/05/30/medicare-sex-reassignment/9789675/
• Belkin, Lisa. "Smoother Transitions." The New York Times. Sept. 4, 2008. (Aug. 1, 2011) http://www.nytimes.com/2008/09/04/fashion/04WORK.html
• Crane, Curtis. "The Total Guide to Penile Implants For Transsexual Men." Transhealth. May 2, 2014. (April 20, 2015) http://www.trans-health.com/2013/penile-implants-guide/
• Donaldson James, Susan. "Trans Chaz Bono Eyes Risky Surgery to Construct Penis." ABC News. Jan. 6, 2012. (April 20, 2015) http://abcnews.go.com/Health/transgender-chaz-bono-seeks-penis-genital-surgery-risky/story?id=15299871Gates, Gary J. "How many people are lesbian, gay, bisexual, and transgender?" April 2011. (July 29, 2015) http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf
• Glicksman, Eve. "Transgender today." Monitor on Psychology. Vol. 44, no. 4. Page 36. April 2013. (April 20, 2015) http://www.apa.org/monitor/2013/04/transgender.aspx
• Harrison, Laird. "Sex-Change Operations Mostly Successful." Medscape Medical News. May 20, 2013. (April 20, 2015) http://www.medscape.com/viewarticle/804432
• HealthResearchFunding.org (HRF). "14 Unique Gender Identity Disorder Statistics." July 28, 2014. (April 20, 2015) http://healthresearchfunding.org/gender-identity-disorder-statistics/
• International Foundation for Gender Education. "APA DSM-5 Sexual and Gender Identity Disorders: 302.85 Gender Identity Disorder in Adolescents or Adults." (April 20, 2015) http://www.ifge.org/302.85_Gender_Identity_Disorder_in_Adolescents_or_Adults
• Moskowitz, Clara. "High Suicide Risk, Prejudice Plague Transgender People." LiveScience. Nov. 18, 2010. (April 20, 2015) http://www.livescience.com/11208-high-suicide-risk-prejudice-plague-transgender-people.html
• Nguyen, Tuan A. "Male-To-Female Procedures." Lake Oswego Plastic Surgery. 2013. (April 20, 2015) http://www.lakeoswegoplasticsurgery.com/grs/grs_procedures_mtf.html
• Public Religion Research Institute. "Survey: Strong Majorities of Americans Favor Rights and Legal Protections for Transgender People." Nov. 3, 2011. (April 20, 2015) http://publicreligion.org/research/2011/11/american-attitudes-towards-transgender-people/#.VSmlgfnF9bw
• Steinmetz, Katy. "Board Rules That Medicare Can Cover Gender Reassignment Surgery." Time. (April 20, 2015) http://time.com/2800307/medicare-gender-reassignment/
• The Philadelphia Center for Transgender Surgery. "Phalloplasty: Frequently Asked Questions." (April 20, 2015) http://www.thetransgendercenter.com/index.php/surgical-procedures/phalloplasty-faqs.html
• U.S. Office of Personnel Management. "Guidance Regarding the Employment of Transgender Individuals in the Federal Workplace." 2015. (April 20, 2015) http://www.opm.gov/diversity/Transgender/Guidance.asp
• University of California, San Francisco - Department of Family and Community Medicine, Center of Excellence for Transgender Health. "Primary Care Protocol for Transgender Patient Care." April 2011. (April 20, 2015) http://transhealth.ucsf.edu/trans?page=protocol-hormones
• University of Miami - Miller School of Medicine, Department of Surgery, Plastic, Aesthetic and Reconstructive Surgery. "Transgender Reassignment." 2015. (April 20, 2015) http://surgery.med.miami.edu/plastic-and-reconstructive/transgender-reassignment-surgery
• University of Michigan Health System. "Gender Affirming Surgery." (April 20, 2015) http://www.uofmhealth.org/medical-services/gender-affirming-surgery
• World Professional Association for Transgender Health (WPATH). "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People." Version 7. 2012. (April 20, 2015) http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf
• World Professional Association for Transgender Health (WPATH). "WPATH Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage for Transgender and Transsexual People Worldwide." 2015. (April 20, 2015) http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947

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Q&A: These researchers examined 20 years of data same-sex marriage. Here’s what they found

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Twenty years ago this month, Marcia Kadish and Tanya McCloskey exchanged wedding vows at Cambridge City Hall in Massachusetts and became the first same-sex couple to legally marry in the United States .

The couple had been together since 1986, but their decision to wed was radical for its time. In 2004, only 31% of Americans supported same-sex marriage, while 60% were opposed , according to a Pew Research Center poll.

Much of that opposition was fueled by fears that expanding the definition of marriage beyond the traditional union of a man and a women would undermine the institution and be destabilizing to families. Researchers at the Rand Corp. decided to find out if those predictions turned out to be true.

A team from the Santa Monica-based think tank spent a year poring over the data. The result is a 186-page report that should be reassuring to supporters of marriage equality.

“If there were negative consequences in the last 20 years of the decision to legalize marriage for same-sex couples, no one has yet been able to measure them,” said Benjamin Karney , an adjunct behavioral scientist at Rand.

Karney, who is also a social psychologist at UCLA, led the report with Melanie Zaber , a labor economist and economic demographer at Rand. They spoke with The Times about what they learned.

Does marriage make people better off?

Benjamin Karney: On average, yes. People who are married experience fewer health problems , they live years longer , they make more money , and they accumulate more wealth than people who marry and divorce or who don’t marry at all. People who are married also experience more stable and positive psychological health , and they have sex more frequently than people who are not married.

All those benefits accrue primarily to people who are in happy marriages. Unhappy marriage is very, very harmful. But most people who are married are happy — that’s why they stay married.

What prompted you to examine same-sex marriage now?

BK: At the time that these policies were changing, there were a lot of arguments on both sides about whether the consequences would be positive or negative. Twenty years is a long time, and during that time, a lot of research has been conducted. It seemed like a good time to ask the question: What did happen as a consequence of legalizing marriage for same-sex couples? So that’s one reason.

The second reason is that in the Dobbs decision that overturned Roe vs. Wade , Justice Clarence Thomas in his concurring opinion said explicitly that this Supreme Court should consider reviewing and potentially overturning other decisions , and he named the 2015 Obergefell vs. Hodges decision that legalized marriage for same-sex couples by name. Given that people may be wondering about the merits of that decision, it seemed like a good time to evaluate the consequences of that decision, and that’s what we’ve done.

What did you find?

BK: We found 96 studies across a range of disciplines. Some are in economics. Some are in psychology. Some are in medicine. Some are in public health.

Melanie Zaber: We wanted it to be research that actually measured something. There were a number of more qualitative or theoretical or legal arguments that we excluded.

BK: What I found most notable is that all of the studies drew the same conclusions: There was either no effect or beneficial effects on any outcome you could look at. That’s 20 years of research, 96 studies, and no harms.

On same-sex marriage, ‘the country has caught up with California’

Gov. Gavin Newsom and Vice President Kamala Harris were at the vanguard in pushing for marriage equality, which will soon be signed into federal law.

Dec. 12, 2022

Does it seem plausible that the results could be so one-sided?

BK: I was not surprised. There’s a lot of good theory in family science and relationship science to argue that if you extend rights to a group that’s been stigmatized, that group should do better, and the majority group should not be affected. Indeed, that’s what we found.

MZ: I don’t find it particularly surprising. When we say there are no harms, that doesn’t mean everything’s coming up sunshine and roses — it means sunshine and roses or nothing. In this case, where the prediction was something negative, then nothing still feels like sunshine and roses.

What sorts of things did these studies measure?

BK: There were three general categories. The largest group was looking at outcomes for LGBT individuals and same-sex couples. The second bucket looked at the children of same-sex parents. And the third bucket was the effect on everybody else.

There was no evidence of harms anywhere.

That’s interesting because opponents of these policy changes very strongly — and very explicitly — predicted there would be harms. They predicted it in front of the Supreme Court , arguing that if we allow same-sex couples to marry, the consequences for the country will be negative and severe and unavoidable and irreversible.

Who benefits the most from legalizing same-sex marriage?

BK: Same-sex couples. Their relationships last longer when they are able to marry and cement their commitment. Their incomes go up. Their mental health improves.

That mental health improvement extends to LGBT individuals whether or not they are married. Even if you’re not married , if you’re a member of a sexual minority and live in a world that validates same-sex relationships, that relieves a stressor and has measurable benefits on physical and mental health.

What’s behind these improvements?

BK: The effects on health seem like they operate partly through employer-based health insurance being extended to spouses.

The mechanisms for mental health have been described by minority stress theory . Living in a society that is constantly sending you a message that you are less worthy of equal treatment is stressful, partly because it leads to discrimination. Being the target of discrimination is stressful , and that stress has real mental and physical consequences .

You found 96 studies about gay marriage. Why did you conduct your own research as well?

MZ: Some of those studies were conducted when only a few states had marriage for same-sex couples. A state like West Virginia or Wyoming might say, “Well that’s all well and good that you have evidence from Massachusetts or Vermont, but New England isn’t the center of the universe.”

By looking at a broader range of years, we’re better able to capture some of those states that did allow same-sex couples to marry but weren’t among the first to do so. We have reason to think those states may be very different environments. Our approach was to use each state as a quasi-experiment.

What did all that data tell you?

MZ: The headline from our new analysis is no negative impacts and some positive ones.

We see an increase in marriage, and that increase is driven not just by newly marrying same-sex couples, but also by an increase in marriage among different-sex couples. That was a bit surprising to us.

World & Nation

Hearing threat to Roe vs. Wade, I thought of my gay marriage — and Jim Obergefell’s fight

Like LGBTQ people nationwide, I can’t help but worry that the legal logic that might topple Roe will be used against my marriage.

May 16, 2022

What do you think was going on?

MZ: There are a few different mechanisms for this, none of which we can explicitly test.

One could be allyship . There are individuals who identify as cisgender straight individuals, but they want to show their allyship so they delay marriage until everyone’s able to marry.

There’s an increasing number of individuals who identify as bisexual in the United States. Even if they’re marrying a different-sex partner, they may be trying to have validation of their broader identity.

The argument we find most compelling is that having people loudly clamoring for all the great things that come along with marriage made people in the broader population say, “Oh hey, getting married means people can go visit me in the hospital, and that if I’m in an accident there’s no concern about who my property will go to, and we have more access to health insurance.” Talking about that may have made some people realize, “You know, marriage actually is pretty helpful.”

BK: If you hear about a restaurant that everyone’s trying to get into, you want to eat at that restaurant.

MZ: That is an excellent way of putting it!

Do you think this research will persuade those who were concerned that same-sex marriage would have terrible consequences?

MZ: That’s our goal — to put evidence out to the public so policymakers can make informed choices.

BK: I’d like to believe so. At the time those arguments were made, they were speculative. People were trying to predict the future. Now we don’t have to predict the future. Twenty years have passed and we have the data. We can document what has happened.

This interview has been edited for length and clarity.

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Karen Kaplan covers science and medical research for the Los Angeles Times. She has been a member of the science team since 2005, including 13 years as an editor. Her first decade at The Times was spent covering technology in the Business section as both a reporter and editor. She grew up in San Diego and is a graduate of MIT and Columbia University.

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Cannes trans actor files complaint over far-right 'sexist insult'

Agence france-presse.

The first transgender woman to be awarded Best Actress at the Cannes Film Festival on Wednesday filed a legal complaint over a "sexist insult" from a far-right politician after her win.

Karla Sofia Gascon and co-stars jointly received the accolade on Saturday for their performances in French auteur Jacques Audiard's dazzling narco musical "Emilia Perez".

In the film, the 52-year-old Spanish actor -- who lived as a man until she was 46 -- plays a Mexican drug trafficker both before and after gender reassignment surgery.

French far-right politician Marion Marechal after her win posted on X: "So a man has won Best Actress. Progress for the left means the erasure of women and mothers."

Gascon, through her lawyer, told AFP: "We need to stop such comments."

Her lawyer Etienne Deshoulieres said she had filed a legal complaint for "sexist insult on the basis of gender identity".

Gascon, who has a wife and daughter, dedicated her win in Cannes to "all the trans people who are suffering".

Earlier during the festival, she urged others to stop labelling people like her.

"Being trans is unimportant. A trans person is someone going through a transition. Once they have transitioned, that's it. They are what they are," she said.

"Emilia Perez" earned particular praise from critics for not fixating on the gender transition, but moving beyond to explore themes of family, love and the victims of Mexico's gang violence.

Stories Chosen For You

Should trump be allowed to run for office, jury starts day two of trump trial deliberations.

Jurors return Thursday to a second day of deliberations in Donald Trump's criminal trial, leaving the Republican presidential candidate and the country waiting for a decision that could upend November's election.

After weeks of testimony from more than 20 witnesses on Trump's alleged fraud in covering up a politically damaging tryst with a porn star, the spotlight is now on the 12-strong New York jury.

The jurors -- their identities kept secret for their own protection amid nationwide political tensions -- are working behind closed doors in a separate room.

The only clues to the direction they are taking come through requests for clarifications. They were due to start off Thursday by reexamining testimony from two witnesses and also hear again the judge's instructions on how to interpret the law.

Trump , 77, is required to stay in the court building while deliberations unfold.

Although barred by Judge Juan Merchan with a gag order from attacking witnesses, he has taken out his anger daily on the judge and what he claims is a politically motivated trial.

"It's a disgrace," he said late Wednesday. "There's no crime."

There is no time limit to deliberations but an acquittal or conviction would require unanimity. If just one juror refuses to join the others, the judge would have to declare a mistrial.

Trump is accused of falsifying business records to reimburse a $130,000 payment to silence adult film star Stormy Daniels, when her account of an alleged sexual encounter could have imperiled his ultimately successful 2016 presidential campaign.

Prosecutors say the fraud was motivated by a plot to prevent voters from knowing about his behavior.

If Trump is found guilty, the political repercussions would far outweigh the seriousness of the charges as, barely five months before the November 5 presidential election, the candidate would also become a convicted criminal.

- 'Hatred for Trump' -

In closing arguments on Tuesday, Trump's defense team insisted the evidence for a conviction simply did not exist, while the prosecution countered that it was voluminous and inescapable.

"The defendant's intent to defraud could not be any clearer," said prosecutor Joshua Steinglass, urging the jurors to use their "common sense" and return a guilty verdict.

If convicted, Trump faces up to four years in prison on each of the 34 counts, but legal experts say that as a first-time offender he is unlikely to get jail time.

A conviction would not bar him from the November ballot and he would almost certainly appeal. In the case of a mistrial, prosecutors could seek a new trial.

Trump -- required to attend every day of the proceedings -- has used his trips to court and the huge media presence to spread his claim that the trial is a Democratic ploy to keep him off the campaign trail.

Polls show Trump neck and neck against President Joe Biden, and the verdict will inflame passions as the White House race intensifies.

In addition to the New York case, Trump has been indicted in Washington and Georgia on charges of conspiring to overturn the results of the 2020 election.

He also faces charges in Florida of hoarding huge quantities of classified documents after leaving the White House.

However, the New York case is the only one likely to come to trial by election day.

One-third of world still criminalizes consensual same-sex acts: report

The LGBTQ community faces "relentless opposition" across the globe despite some progress, said a report published on Thursday by an international advocacy group, with one-third of the world still criminalizing same-sex acts.

Sixty-two of the United Nations' 193 member states have laws punishing consensual same-sex relations, while the death penalty exists in some form in a dozen countries, according to the report covering the past 16 months released by the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA).

One-third of countries also have legal roadblocks to operating organizations "openly advocating the rights of LGBTI people", said ILGA. It said this gives rise to censorship, arrests, and prosecution for the "promotion" of homosexuality.

"This trend is extremely concerning," said ILGA director Julia Ehrt.

Last year, Uganda implemented one of the harshest anti-gay laws in the world, imposing penalties of up to life in prison for consensual same-sex relations and making "aggravated homosexuality" an offense punishable by death.

And between January 2023 and April 2024, Jordan, Kyrgyzstan and Uganda formally implemented legal provisions against the "promotion" of homosexuality, while Russia has categorized the "international LGBT movement" as "extremist".

"Even talking about our lives in public is becoming increasingly difficult in a growing number of states," said Ehrt.

This report comes as violence and harassment against LGBTQ people in Europe have reached a "new high" in the past few years, according to a May survey from the European Union's rights agency.

ILGA notes some progress for LGBTQ rights in the past 16 months, with four UN member states authorising same-sex marriage, bringing the total to 35 UN countries and Taiwan.

Bolivia and Latvia legalized civil unions, a move repeated in several Japanese prefectures.

And in five countries -- Germany, Ecuador, Spain, Finland and New Zealand -- individuals can now have their self-identified gender on their official documents, bringing the total number of countries to 17.

But even with these changes, ILGA said, "relentless opposition is marring the progress made in equal rights for LGBTI people" around the world.

India's onion farmers cry foul at politicians' price recipe

Almost every Indian meal requires an onion -- one of the cooking essentials along with sugar and lentils that sweet-talking politicians use to curry favour with their voters by lowering costs.

But their policies to cut prices by slapping export bans on some goods including on onions and sugar, or by allowing duty-free imports of lentils, has made the key voting demographic of farmers furious.

They say the politicians' decisions flood the markets, and that the savings shoppers make are at their expense.

"The governments talk a lot about us," said onion farmer Kanha Vishnu Gulave. "But their actions only hurt us -- to keep the easily agitated city people happy by keeping our produce cheap."

Gulave, 28, comes from India's onion-producing heartland of Nashik district in Maharashtra state, which produces some 40 percent of onions nationwide.

He felt cheated when prices crashed after a sudden export ban in December.

"We dread elections," said Bharat Dighole, onion producers' association president for Maharashtra. "The most unwise interventions come around polls."

After the ban, prices dropped to sometimes less than a third, Dighole said.

That sparked dozens of small-scale protests in Maharashtra.

- Onion barometer -

At the same time, production expenses have more than doubled since 2017, Dighole added.

But the slump in wholesale prices meant that was not passed on to the consumer -- or voter, from the politicians' viewpoint.

They paid the same for their onions as they had done for years.

"All polls are fought in the name of farmers, but the government policy clearly favours the consumers," said Dighole.

India will vote on Saturday in the seventh and final phase of a general election, stretched over six weeks to ease the logistical burden of polls in the world's most populous country.

Two-thirds of India's 1.4 billion people draw their livelihood from agriculture, accounting for nearly a fifth of the country's gross domestic product.

In India, onions can be a barometer of a government's popularity.

Runaway prices have triggered mass protests and toppled governments in the past.

In 1998, the Bharatiya Janata Party (BJP) of Narendra Modi -- at the time a local politician -- lost control of the capital Delhi in state elections.

The defeat was widely blamed on voter anger at high onion prices.

While Prime Minister Modi is expected to sweep a third term in the ongoing national elections, the BJP has been out of power in the capital's state legislature ever since.

- 'Nothing but rhetoric' -

Days before voting began in the onion belt of Nashik, Modi's government lifted the export ban.

But analysts called that a political ploy.

"The opening up of the onion market is nothing but rhetoric," said economist Ashok Gulati, from the Indian Council for Research on International Economic Relations.

Gulati said restrictions remained -- including a minimum export price and 40 percent duty -- and made exports unviable, leaving farmers teary-eyed.

"Our best hope is to not sell for a loss," 30-year-old farmer Akshay Tarle told AFP at an onion auction, where lines of trailers piled high with the vegetable waited.

"When I leave home in the morning I don't even know if I'll be able to sell my produce at the right price," added another farmer, Vikas Babaji Tushare.

"My family ask me to buy things on my way back home, but there are days I don't even have the money," the 36-year-old added.

"I don't even know what to tell my children."

- Finger on the pulse -

Gulati warned export bans and unchecked imports of other products such as lentils -- a key staple and protein source for many -- were distorting markets and hurting producers.

India's import of pulses jumped to a six-year-high of around $3.75 billion in 2023-24, according to commerce figures cited by Indian media.

"Duty-free import of pulses... would dent the progress made in domestic production," Gulati said.

But some hope for change.

"People at the top fear that if onion prices rise, governments will fall," said Jagannath Bhimaji Kute, 58, vice-president of a wholesale onion market in Nashik.

"Whoever comes to power next will have to address our issues."

Kute urged Indians to "think about the farmers", questioning why people swallowed rising prices on fuel and cooking oil, but not food.

"Why must what we produce remain cheap, when everything else is getting more expensive?" he said.

We're watching the largest and most dangerous 'cult' in American history

Cleared: cnn and donald trump dodge alleged election law violations, trump just endorsed this virginia congressional candidate whose social media isn’t so maga.

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United states sex reassignment hormone therapy research report 2024 featuring viatris, abbvie, ascend therapeutics, pfizer, eli lilly and co, novartis, endo international.

U.S. Sex Reassignment Hormone Therapy Market

Dublin, May 30, 2024 (GLOBE NEWSWIRE) -- The "United States Sex Reassignment Hormone Therapy Market, By Region, Competition, Forecast and Opportunities, 2019-2029F" report has been added to ResearchAndMarkets.com's offering. United States Sex Reassignment Hormone Therapy Market was valued at USD 1.21 billion in 2023 and is anticipated to project steady growth in the forecast period with a CAGR of 4.29% through 2029

The market encompasses a range of pharmaceutical products and medical services designed to assist transgender individuals in aligning their physical characteristics with their gender identity. This includes the administration of hormones such as estrogen and testosterone to promote secondary sex characteristics consistent with an individual's gender identity.

The United States boasts a diverse array of healthcare providers, clinics, and specialized centers that offer hormone therapy services, reflecting the nation's commitment to supporting transgender healthcare. The growth of the U.S. Sex Reassignment Hormone Therapy market is propelled by several factors, including increased societal awareness, expanded insurance coverage, and advancements in medical practices. Greater recognition of transgender rights and the elimination of discriminatory practices have paved the way for more inclusive healthcare services.

The expansion of health insurance coverage for transgender-related healthcare has made hormone therapy more accessible to a broader population. As the market continues to evolve, it is characterized by ongoing research into safer and more effective hormone therapies, improved access to care in underserved areas, and a growing community of healthcare professionals with expertise in transgender medicine. Challenges also exist, such as disparities in access to care and the need for more comprehensive insurance coverage. Key Market Drivers Increased Awareness and Acceptance Increased awareness and acceptance have become powerful catalysts in propelling the United States Sex Reassignment Hormone Therapy market to new heights. In recent years, there has been a profound societal shift, characterized by a growing understanding and acceptance of transgender individuals and their unique healthcare needs. This transformation in public perception has significantly boosted the demand for gender-affirming treatments, particularly hormone therapy. One of the most significant drivers of this change is the increased visibility of transgender individuals in mainstream media, politics, and public discourse. High-profile transgender individuals and activists have shared their personal stories, fostering empathy and understanding among the broader population. This visibility has humanized the transgender experience and created a platform for open conversations about gender identity, thereby reducing stigma and discrimination. Growing Medical Expertise Growing medical expertise is a crucial driver that is significantly boosting the United States Sex Reassignment Hormone Therapy market. In recent years, there has been a notable surge in healthcare professionals who specialize in transgender healthcare, particularly in the realm of hormone therapy. This surge in expertise is positively impacting the transgender community and the broader healthcare landscape in several key ways. The increased number of healthcare providers with specialized knowledge in transgender healthcare ensures that transgender individuals have access to more experienced and knowledgeable practitioners. These experts are well-versed in the unique healthcare needs of transgender patients and are capable of providing tailored and patient-centric care, which is essential in the context of hormone therapy. Patients can have greater confidence in the quality of care they receive, which, in turn, fosters trust and encourages more individuals to seek hormone therapy as part of their gender transition. Research and Development Research and development efforts have played a pivotal role in boosting the United States Sex Reassignment Hormone Therapy (HRT) market, fostering innovation, and enhancing the quality and safety of hormone therapy for transgender individuals. This dynamic field of healthcare has witnessed significant advancements in recent years, driven by a combination of medical research, pharmaceutical innovation, and the evolving understanding of transgender healthcare needs. One of the key contributions of research and development to the HRT market is the development of safer and more effective hormone therapy options. These advancements have reduced potential health risks associated with hormone therapy, ensuring that transgender individuals can undergo their gender-affirming treatment with greater confidence and peace of mind. The research-driven improvements in hormone regimens have led to more personalized treatment plans, better addressing the specific needs and preferences of each patient. Key Market Challenges

Cost and Insurance Barriers The United States has made significant strides in improving access to transgender healthcare, but one formidable challenge continues to hinder the progress of the Sex Reassignment Hormone Therapy (HRT) market: cost and insurance barriers. While insurance coverage for gender-affirming care has expanded, it remains far from universal, and many transgender individuals grapple with significant financial obstacles when seeking hormone therapy. Cost is a paramount concern for transgender individuals seeking hormone therapy. Hormone therapy is a medically necessary aspect of gender transition for many, helping individuals align their physical characteristics with their gender identity. However, the cost of hormone therapy can be a substantial financial burden, especially for those without insurance coverage or with high deductibles and copayments.

Limited Accessibility in Underserved Areas While significant strides have been made in improving access to transgender healthcare in the United States, a pressing challenge that continues to hinder the Sex Reassignment Hormone Therapy (HRT) market is the limited accessibility in underserved areas. Geographic disparities in healthcare infrastructure, the shortage of specialized providers, and the conservative nature of some regions have left many transgender individuals in underserved areas with inadequate access to gender-affirming hormone therapy. Key Market Trends

Mental Health Considerations Mental health considerations are playing a crucial role in boosting the United States Sex Reassignment Hormone Therapy (HRT) market. This trend underscores the importance of addressing the mental health needs of transgender individuals alongside their physical healthcare.

Telehealth Services One of the primary ways in which telehealth services benefit the HRT market is by increasing accessibility to specialized care. Transgender individuals, particularly those living in underserved or remote areas, often face geographical barriers when seeking gender-affirming care. Telehealth bridges this gap by allowing patients to consult with knowledgeable practitioners from the comfort of their own homes. Gender Transition Insights Based on the Gender Transition, Male-To-Female emerged as the dominant segment in the United States Sex Reassignment Hormone Therapy Market in 2023. Studies and data suggest that MTF transitions are more prevalent than FTM transitions. This higher prevalence contributes to a larger pool of individuals seeking MTF hormone therapy, thus increasing demand for these services. MTF individuals, often assigned male at birth, typically require estrogen and anti-androgen medications to develop secondary female sex characteristics, such as breast development and softer skin. Type Insights Based on the Type, Estrogen emerged as the fastest growing segment in the United States Sex Reassignment Hormone Therapy Market in 2023. MTF transitions are more common than Female-to-Male (FTM) transitions, contributing to the higher demand for estrogen. Individuals assigned male at birth who wish to transition to a female gender typically require estrogen therapy to develop secondary female sex characteristics, such as breast development, softer skin, and fat redistribution. For many transgender individuals seeking MTF transition, estrogen therapy is deemed medically necessary to address gender dysphoria effectively. This medical necessity is a driving factor behind the high demand for these treatments. Regional Insights Mid-West emerged as the dominant region in the United States Sex Reassignment Hormone Therapy Market in 2023, holding the largest market share. The Midwest has made significant strides in improving healthcare accessibility for transgender individuals. This includes a growing number of healthcare facilities and providers specializing in transgender healthcare, making it easier for individuals in the region to access hormone therapy. Many states in the Midwest have implemented non-discrimination laws and regulations that protect the rights of transgender individuals and emphasize the importance of providing gender-affirming care. This supportive legal framework encourages healthcare providers in the region to offer comprehensive HRT services.

Key Attributes:

Competitive Landscape Company Profiles: Detailed analysis of the major companies present in the United States Sex Reassignment Hormone Therapy Market.

Viatris Inc.

AbbVie Inc.

ASCEND Therapeutics US, LLC.

Pfizer Inc.

Eli Lilly and Company

Novartis AG

Endo International plc.

Report Scope: Gender Transition:

Male-To-Female

Female-To-Male

Puberty Blockers

Testosterone

Distribution Channel:

Hospital Pharmacy

Retail Pharmacy

Online Pharmacy

For more information about this report visit https://www.researchandmarkets.com/r/im1hyq

About ResearchAndMarkets.com ResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

South Carolina Gov. McMaster signs bill outlawing transgender care for trans youth

South Carolina Gov. Henry McMaster signed a bill banning certain medical care for transgender youth on Tuesday.

House Bill 4624, called the “Help not Harm” bill by legislators, prohibits anyone under the age of 18 from receiving gender reassignment surgery or any form of puberty-blocking or hormone therapy. The bill became effective immediately.

The bill also makes it a felony to perform gender reassignment surgery on those under the age of 18.

McMaster said a ceremonial bill signing with legislators would take place in the Upstate next week.

Under the new bill, minors can still be prescribed puberty blockers or hormone therapy to treat certain conditions like precocious puberty or endometriosis.

The new law also bans the South Carolina Medicaid program from providing coverage for gender reassignment surgery or hormone therapy to adults and minors.

The bill passed on the last day of the legislative session after the House agreed to accept the Senate’s changes to the law. The Senate's major change was an amendment requiring public school principals and vice principals to report students to parents if their child informed officials that they were identifying as a different gender from their assigned sex or using different pronouns.

More: As SC legislature winds down, bill banning transgender youth medical care returns to House

Opponents of the amendment argued the measure would be a forced outing and worried it could put a child in an uncomfortable or potentially dangerous situation if their parent or guardian were not accepting. Supporters of the amendment said parents have a right to know if their children are identifying as transgender or requesting to change their pronouns.

Dr. Elizabeth Mack, president of the South Carolina chapter of the American Academy of Pediatrics testified against the bill during a Senate medical affairs subcommittee in February, noting there are “less than 2,000 trans kids in the state.”

Still, supporters of the bill pushed for it, saying its intention was to protect children, while others say it does the opposite.

“We stand in grief and solidarity with LGBTQ South Carolinians, who are increasingly under attack by our own government,” Executive Director of ACLU South Carolina Jace Woodrum said in a statement on X, formerly known as Twitter. “We can put to rest the notion that the government cares about limited government and personal freedom. With a stroke of a pen, he (McMaster) has chosen to insert the will of politicians into healthcare decisions, trample on the liberties of trans South Carolinians, and deny the rights of the parents of trans minors.”

South Carolina joins 25 states to outlaw transgender care for minors. It was also one of the only states that did not have a ban on transgender care in the South, with Virginia now being the lone Southern state with access.

Savannah Moss covers politics for the Greenville News. Reach her at [email protected] or follow her on X @Savmoss.

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South Carolina Bans Gender Transition Care for Minors

By Adeel Hassan

South Carolina’s Republican governor, Henry McMaster, signed a bill on Tuesday that bars health professionals from performing gender-transition surgeries, prescribing puberty blocking drugs and overseeing hormone treatments for patients under 18. The state now joins about two dozen others that have passed laws restricting or banning what doctors call gender-affirming care for minors.

The law, which goes into effect immediately, also requires principals, teachers and other school staff members to tell parents when their children want to use a name other than their legal one, or pronouns that do not match their sex assigned at birth.

South Carolina lawmakers tried to pass similar legislation in 2021 and 2022 but failed to get them through the State House of Representatives. In 2022, the clock ran out on a broader bill banning transition care for minors, but lawmakers put a clause in the state budget that banned a pediatric clinic at a public hospital from using state funds on transition care for people under 16. The clinic soon went further, ending hormonal treatments to anyone under 18.

This year, House Republicans made gender-transition treatment a priority. “When God created us, he created us male and female, that’s it,” said David Hiott, the House majority leader and a co-sponsor of the bill, at the start of the legislative session in January. “All these other folks that want to change that from birth, change that through their life, we need to stand up against that.”

The measure, known as House Bill 4624, was passed by the legislature earlier this month. The new legislation not only expands the ban on care for minors to all providers statewide, but also bars adults under 26 from using Medicaid to cover the costs for such care.

In a social media post on Tuesday, Mr. McMaster said the bill “protects our state’s children from irreversible gender transition procedures” and added that he would meet with its supporters at a ceremonial signing next week.

At a House committee hearing in January, Dr. Elizabeth Mack, president of the South Carolina chapter of the American Academy of Pediatrics, criticized the measure, saying there was “no mainstream organization that doesn’t support gender-affirming care.”

“Gender-affirming care is evidence-based, suicide-prevention care,” she said at the time. She added that gender-transition surgery was currently not being performed in South Carolina, and that transition care was being done only after much deliberation between doctors, parents and children.

Why It Matters

Before Tuesday, South Carolina was one of just two states in the South without a ban on gender-transition care for minors; Virginia is now the only one.

Lawsuits have been filed in many states that have the bans, and courts have issued mixed rulings. In three states, the laws have been blocked.

The U.S. Supreme Court could agree to hear the case against Tennessee’s ban on transition care for minors, which may affect the legal challenges in other states with similar bans.

According to a recent survey , transgender and nonbinary Americans face stark rates of unemployment and harassment. The survey, which included more than 92,000 participants, also found that a vast majority of them were satisfied with their decision to transition.

“There’s clear data and medical opinion on one side,” Jace Woodrum, the executive director of the South Carolina chapter of the American Civil Liberties Union, said. “And then on the other side, an uncited science.”

What’s Next

Mr. Woodrum, who is the first transgender director of an A.C.L.U. state chapter, said that his organization was weighing a lawsuit over the South Carolina ban. Other groups that support transgender rights have said that they would immediately try to help families with grants and other financial support to travel to other states for care.

Adeel Hassan is a reporter and editor on the National Desk. He is a founding member of Race/Related , and much of his work focuses on identity and discrimination. He started the Morning Briefing for NYT Now and was its inaugural writer. He also served as an editor on the International Desk.  More about Adeel Hassan