The rights of transgender and gender-nonconforming people have been in the news constantly, mostly due to an increase in anti-trans legislation throughout the country.
Out of the 470-plus anti-LGBTQ+ bills introduced in the 2023 legislative session, more than 40 have targeted transgender people specifically. Many of these bills impact trans and nonbinary youth and what types of gender-affirming care they can legally receive.
Unfortunately, most of these bills are based on misinformation and myths that don’t reflect scientific evidence or the reality of living as a trans or nonbinary person.
Debunking myths about trans and nonbinary people is important to help protect their rights and access to what is often lifesaving healthcare.
Myth #1: Being transgender is a mental illness
Gender dysphoria is in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the book psychologists and psychiatrists use to diagnose the conditions that affect people. Gender dysphoria is a condition some transgender people experience; it is not the same thing as being trans.
“The language in the DSM is that gender dysphoria results from incongruence between someone’s experienced gender and their sex assigned at birth,” says Dr. Corinne Heinen, a family medicine doctor at UW Medicine and clinical director of the UW Medicine Transgender and Gender Non-Binary Health Program. “Though it is a psychiatric diagnosis, it resolves when you treat it by helping people have their experienced gender.”
As the American Psychiatric Association notes, trying to force someone not to be trans or nonbinary is harmful and results in poor mental health outcomes. Therefore, treatment for gender dysphoria is about affirming, not trying to change, someone’s gender identity.
“I’ve been doing this care for more than 30 years. A colleague described it best to me: doing gender-affirming care is like obstetrics because patients have a new life,” Heinen says.
Myth #2: Many people regret transitioning and will detransition
There are not many studies following transgender people throughout their lives, but those studies that exist show that a majority of trans people do not change their minds about being trans.
“In my practice, I have only had three people who chose to stop hormonal therapy. They were individuals who were assigned male at birth who sought feminizing care and stopped it within three years — these cases all occurred in the 1990s. Two of the three sought to become fathers thereafter and were able to. I have not had anyone do this since,” Heinen, who regularly treats trans and nonbinary patients, says.
Additionally, she adds, research has shown that out of the small percentage of people who choose to detransition, many do so because they do not feel socially safe or supported to continue pursuing gender-affirming care.
Myth #3: Kids are too young to know they’re trans or nonbinary
Research has shown that children can understand their own gender identity by as early as age 3 and are confident about how they identify by age 5 or 6.
Kids will often use play to explore their gender. Sometimes they will pretend to be a different gender just for fun, but other times it will be more meaningful. If a kid is consistently identifying as a different gender and regularly shows signs of gender dysphoria, that means they are likely trans or nonbinary.
Myth #4: Social pressure can make kids trans or nonbinary
Given the harassment, threats, denial of rights, inaccessibility of healthcare and more that gender-diverse people face, the likelihood of someone saying they are trans or nonbinary due to social pressure or because they think it’s “trendy” is extremely low.
In fact, there is considerable social pressure to be straight and cisgender, which is what keeps so many people from coming out in the first place, says Dr. Mariebeth Velasquez, clinical assistant professor in the Department of Family Medicine at the UW School of Medicine and a faculty advisor for the Qmedicine student organization.
“Understanding that you’re trans, nonbinary or queer often involves needing to unlearn what we’ve been socialized to learn with Western civilization, where we have all these labels and binaries,” she says.
Myth #5: Doctors regularly perform gender-affirming surgery on kids
“It’s extremely rare to perform gender-affirming genital surgery on kids and teens. When it does happen, it’s typically chest, not genital, surgery and is in older teenagers,” says Heinen.
The reality is that even if surgery is deemed medically necessary (the way any other surgery would be, by weighing health benefits versus health risks) it doesn’t happen right away. Young people must have gender dysphoria for at least six months before receiving a diagnosis, and the process of getting any type of gender-affirming care takes time.
“None of this happens quickly, even in places like Seattle with the most resources,” Heinen adds.
Puberty blockers and hormone replacement therapies are more common types of gender-affirming care in young people.
The most common type of puberty blocker, gonadotropin releasing hormone (GnRH) analogues, are given via injection or a small arm implant. These medications are used to help cisgender children who enter puberty too soon as well as to treat conditions like endometriosis.
GnRH analogues are safe and put puberty on hold so kids who don’t identify with their sex assigned at birth don’t experience puberty changes like voice deepening, menstrual periods or facial hair growth that could be distressing.
Myth #6: Science has proven that transgender athletes have an unfair advantage
The House of Representatives recently passed a bill banning trans females from being on women’s and girls’ sports teams. The bill is unlikely to pass the Senate and be enacted into law, but similar bills have already passed in 20 other states.
The idea behind these bills is that people who were assigned male at birth have unfair advantages against people who were assigned female at birth due to higher testosterone levels, XY chromones, muscle mass and other physical differences.
The truth is, researchers simply don’t know if this is the case, says Dr. Bradley Anawalt, an endocrinologist and chief of Medicine at UW Medical Center.
“We have relatively little firm scientific data to determine whether there is a biological advantage for the person who is born with XY chromosomes consistent with being assigned male at birth and exposed to testosterone,” he explains. “We don’t have studies with large numbers of trans individuals, and we don’t have studies that extend beyond one to three years.”
It’s true that an advantage could exist if a trans woman went through puberty before transitioning. Currently, many rules around trans athlete participation stipulate an athlete must be on testosterone suppression for at least a year before competing.
“Today, a number of physicians and patients agree that we should start hormonal therapy before an individual completes puberty,” Anawalt says.
Of course, bans on gender-affirming care would make this difficult if not impossible for many people.
Myth #7: There are only two biological sexes
Bans on trans athletes also overlook another complicating factor: not everyone is born female or male in the way we currently define these sexes — female as having XX chromosomes, more estrogen, and a vagina, and male as having XY chromosomes, more testosterone, and a penis.
Intersex people are born with differences in chromosomes, hormones, internal sex organs or genitalia — or a combination of those things. There are many ways to be intersex. Population data are hard to get because intersex births are not tracked, but estimates suggest that around one person out of every 4,500 people is intersex, Heinen says.
People are now recognizing that trying to “fix” intersex people by performing surgery during infancy is not always helpful and can be harmful. Instead, advocates recommend letting a child grow up a little and make their own decisions after consulting with a doctor.
“There is a lot of invisibility of intersex and people with sex trait variance. They’ve been left out of research and data, but they need to be recognized,” Velasquez says.
And, while it is not the same thing as being intersex, there are many common hormonal disorders such as primary ovarian insufficiency and low T that prove biological sex is not as binary or fixed as many people believe.
Myth #8: Only gender-nonconforming people need gender-affirming care
Many types of medical care that cisgender people receive are also gender-affirming, such as a woman who had a mastectomy to treat cancer getting a breast reconstruction or a man who has low T getting testosterone therapy.
Breast augmentation and reduction, hysterectomy, mastectomy, reconstructive genital surgery, facial plastic surgery, fertility preservation, hormone therapy — these are all types of care that cisgender people receive. They also happen to be types of gender-affirming care for trans and nonbinary people.
Many of these procedures were originally created for cis people, Heinen says.
“Phalloplasty, for example, was created for people who lost their penis in an injury. Modifications have been made to the procedures, but they have all been around for 30 to 40 years, and hormones have been prescribed for the past 80 years at least. None of this is new,” she says.
Why separate fact from fiction about gender-nonconforming people
Gender-nonconforming people have always been here and aren’t going anywhere. Denying them rights doesn’t deny their existence. Surveys have shown that transgender adults make up about 1% of the U.S. population — so more than 3,300,000 people, and that doesn’t include trans youth.
Compared to many other states and places throughout the world, Washington is generally a safer place for trans and nonbinary people, though a few anti-trans bills have been proposed here, too.
Earlier this year, a shield law was passed that protects gender-affirming care in Washington state, including for people who travel here from other states, and protects doctors who provide this care.
Ultimately, the truth is that most trans and gender-nonconforming people, like most people, don’t have some nefarious agenda — they just want to be themselves and live their lives.