What Does All This Trans Stuff Mean?

Honest Answers for Honest Concerns

Are you the family member, friend, or coworker of a transgender person? Maybe you’re curious and/or confused, seeing all of this trans stuff popping up everywhere and don’t know quite what to make of it. Maybe you’re worried for your child’s well-being. Maybe a coworker just announced their transition. Maybe you’ve just heard a lot of weird and scary things lately, and you’re not sure who or what to trust.

This is the article for you.

A lot of people are saying a lot of things about trans people right now, and they all seem to conflict with each other, don’t they? Well, I’m going to try and answer the most common concerns and questions people have about our community. I promise, I’m going to be non-judgmental everywhere, and I’ll only give hard answers when we’ve got a lot of science to back it up, and I’ll show it to you too—and anywhere we don’t have good science, I’ll tell you that too.

Promise.

Who are you, anyway, and why should I trust you?

My name is Zoe, and I’m a transgender professor of Technical Writing. I’ve got several areas of specialization, but one of them is biomedical communications—in other words, explaining complicated health ideas in plain English. To be able to do that, I have to be able to read and understand complicated scholarly and medical English. And, because I’m a pretty big nerd, when I started my transition, I read everything I could get my hands on about the science of being trans. Now, I like to explain what I’ve found to people. That’s kind of what this whole Substack is about—but that’s another story.

We actually know a whole lot about the science of being trans… and there are some pretty important gaps where we don’t know very much.

Bet you didn’t expect a trans person to admit that, huh? It’s true, though.

You’re really going to tell the whole truth?

Yep. I don’t believe there’s anything to hide. But just as importantly, I believe you deserve the whole truth. It’s the only way any of us can make good decisions.

Guess that’s the technical writer in me. Always give the user the information they need to do the task.

I’m also going to keep things as simple as I can for you. Keep in mind that that’s going to mean I’ll be glossing over some details that are important to a lot of transgender people, but which don’t change or affect the answers I’m giving, especially when it comes to the science. So, in a nutshell: everything here is as completely true as I can find quality evidence for but there are also shades of gray when it comes to trans identities and what our transitions involve that I’m not getting into.

I don’t want to overwhelm you, and even just covering the basics is already an awful lot.

So… what does it mean when someone says they’re transgender?

There are a couple of different ways to answer that question, but let’s start off with the simplest.

Being transgender means that a person has something called gender incongruence, which is a medical way of saying that their internal sense of gender and the gender the doctor said they were when they’re born doesn’t match. In other words, who they feel they are inside and who people think or thought they were don’t match.

That’s it. That’s really all it is.

If that’s all it is, why is it such a big deal?

It doesn’t really have to be. Mostly, it’s a big deal because people make a big deal out of it.

And yes, trans people are as much the cause of this as everyone else.

There’s basically two reasons someone transitioning gets made into a Big Deal: the trans person excitedly making it a big deal, and someone who doesn’t believe trans people should exist gets upset about it.

Trans people usually make a big deal out of our transitions because a lot of us have suppressed this part of ourselves for a long time, and it feels really good to let that part of ourselves out for everyone else to see. Some of us might have known we were trans for most of our lives. Some of us, like me, might not have known until recently. Either way, we had to hold that part of ourselves in, essentially telling ourselves a lie about who we thought we were, or were trying with all our heart to be.

And living like that? Wow, it sucks.

Maybe we hid ourselves to stay safe, because we were afraid we’d be hurt. Maybe we were afraid our families would leave us. Maybe we were afraid we’d be fired. Maybe we just didn’t believe we could ever really be the person we wished we were.

But eventually, living that life of self-deception becomes unsustainable.

I thought there was a thing called gender dysphoria…?

There is! That’s the more complicated way to answer your first question.

Gender dysphoria is a feeling of intense sadness that comes from living that self-deception for a long time. It takes time to develop, and the longer you go without living as yourself, the worse it gets.

It’s also what psychologists use to diagnose their transgender patients. Here’s the official language American psychologists use, for instance:

The DSM-5-TR defines gender dysphoria in adolescents and adults as a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, as manifested by at least two of the following:

1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)

2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

3. A strong desire for the primary and/or secondary sex characteristics of the other gender

4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

In order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Phew, that’s wordy! And what the heck is “strong” supposed to mean, anyway? Don’t worry, I’ve got you.

You can be diagnosed with gender dysphoria if you have experienced any two of the six bulleted things for at least six months and if feeling it upsets you in a way you can’t resolve on your own. The six points are:

1. The body you have doesn’t have physical features that fit your sense of gender.

2. You want to get rid of some physical features, like wide hips or facial hair, you do have because they don’t match your sense of gender.

3. You want the physical features another sex or gender typically has.

4. You want to be a gender that isn’t the one people think you are.

5. You want people to treat you like you’re a gender that isn’t the one other people think you are.

6. You have the feelings and emotional state of a gender that isn’t the one other people think you are.

You probably noticed that gender incongruence got put in there for #4, and that wanting people to do something about it is #5. That’s intentional! American health insurance is weird, and insurance companies need an official diagnosis before they’ll cover things like therapy, so psychologists took the things that actually make up gender dysphoria (numbers 1, 2, 3, & 6) and added in gender incongruence (numbers 4 & 5), so trans people can get medical and psychological help when we need it.

So some trans people have gender dysphoria, but all trans people have gender incongruence?

That’s it exactly!

But I thought trans people had a mental disorder, or a delusion.

That’s really understandable! Being trans—having gender dysphoria, specifically—used to be thought of that way. When I was born, back in 1985, gender dysphoria was thought to be a form of psychotic delusion. Trans women, for example, were thought to be a form of gay man who was so bad both at being a man and at being gay that she’d transition to get a bigger dating pool.

Thing is… not all trans women are attracted to men. Quite a lot of us, actually. I should know. I’m one of them. Same thing for trans men—not all of them like women.

What changed is that we did science. We made a theory, tested the theory, and when the theory didn’t hold up, we threw it out and went looking for a better explanation. I mean, that’s how it’s supposed to work, right? Isaac Newton discovered gravity, and then Albert Einstein came and said “no, that’s not quite how it works,” and then we went with that until Stephen Hawking came along and said “no, that’s not quite how it works.”

The more psychologists researched trans people—and they’ve been at it since the early 1900’s—the more it turned out that we’re a lot like any other member of our gender. And when they stacked up all the evidence they’d found, psychologists concluded that there was no possible definition of mental disorder which fits what it means to be trans.

But here’s the thing: most trans people see therapists regularly as part of our transitions. It’s not required, for sure, but it’s really common.

But I’m sure from science class that there’s only two sexes: male and female!

For humans, yeah, more or less—there are intersex people, who make that a little fuzzy—but sex and gender aren’t the same thing. And what's more, sex is a more loosey-goosey concept than you probably think. There's a species of mushroom, for instance, that has over 23,000 sexes! And some fish can change their whole sex as an adult! And the REALLY weird thing is that humans actually have one of the genes that lets fish do that! It's called DMRT-1. We just don't have the gene that lets us toggle it during our adulthood.

Yeah. Biology is pretty wild.

In general, trans people aren’t disputing what our sex is, even though taking HRT could pretty fairly be said to be changing our sex characteristics. It’s our gender that’s a mismatch. And gender’s a lot more complicated than sex, even with all that weird and wild stuff I just mentioned!

What do you mean gender’s more complicated than sex?

I actually wrote a whole article on it! Go have a read if you want the details. There’s even really good biological grounds for why it’s so weird and complicated.

The simple version is this: gender is an insanely complicated "thing" that we don't quite even have language specific enough to talk about easily—I put finger quotes there because gender isn't actually a thing, it's an action, a constant becoming. Thing is, English doesn't really even have a good word to describe that outside of scholarly language. So, just to start off, that's why so many people have so much confusion about what we're even talking about--the only language that accurately describes it is super scholarly, and almost nobody understands what it really means.

Gender comes from an innate, internal sense, a lot like your sense of balance. Nobody can tell you whether you're balanced or unbalanced, you just are. When you're balanced, it's like you can't even notice that sense, right? But when you're off balance, there's this panic reaction until you get things stable again. A person's sense of gender works in the same way: when things are in harmony, you can't even notice it. That’s how dysphoria feels. That’s why all of this feels so weird and hard to understand. You feel balanced.

A lot of non-trans people have a hard time imagining why anyone would "want to be trans." If you’re reading this and you’re a woman, you’re trying to imagine wanting to be a boy, and that probably sounds pretty terrible to you, right? Instead, imagine everyone around you kept insisting you were a boy, treated you like one, and were shitty to you if you didn't act boyish enough for them. What would you do--how far would you go--to get them to see that you're a girl? If you’re reading this and you’re a guy, try to do the opposite. That's much closer to what it's like to be trans.

Now, gender itself is different from gender roles, which is what society tells people to do, and from gender performance, which is the things we do outside to signal in a sort of shorthand way to everyone else what our gender is and how we want to be treated.

Here’s a good way to think about it: Society tells us what gender roles we’re supposed to do based on what gender it thinks we are. They’re pushed onto us by the outside. Gender is our sense of self on the inside—imagine it like a bright light, shining outward. Gender performance is like passing figurines or cardboard cutouts in front of that shining light so that people outside of us can understand what the light inside means more easily.

This is important, because if we jam those three things together, we'll get misunderstandings, and that's what we're trying to solve!

Why can't there just be feminine men and masculine women?

There can be!

Here's something a lot of cis people don't realize: there a lot of transgender women who are tomboys. Like, softball, doc martens, basketball shorts, no makeup, the whole nine yards. Some trans women will transition and keep on wearing the same clothes they'd been wearing for years in boy-mode! And if you pop over to /r/ftmfemininity, you can see a whole boatload of trans men—guys who've been on testosterone, who have often had their breasts removed--rejoicing in makeup and skirts and dresses.

But that’s not gender, it's gender performance. It doesn't matter if you look right—if people don't treat you as the you inside, it feels off. And over years, that feeling grows, and often becomes intolerable. Again, that’s gender dysphoria.

But why transition, then?

It's about living authentically, and it's the same reason bisexual or pansexual people come out when they’ve been in a stable, long-term relationship that looks heterosexual from the outside. Even if it doesn't change anything in their day-to-day life, people knowing this important part about them means that they know and love them as their whole selves.

Living a lie is corrosive to the soul. I wouldn't wish it on my worst enemy.

I’ve heard some stuff about nonbinary people, and that just doesn’t make any sense to me. What’s the deal?

Imagine gender was like color for a minute. Men are blue, women are red. That’s pretty easy, right?

What about purple? What about green? What about gray?

Now, my favorite color is red (both literally and metaphorically!). I love red. And I haaaaate that really bright shade of lime green. You know the one—the neon lime green that was really popular in the 1980’s, right? It feels fundamentally gross to me. I don’t like it.

But someone out there does. A lot. After all, it was kinda everywhere in the ‘80’s.

It makes absolutely no sense whatsoever to me why anyone would like that color. I think it’s absolutely horrible. But the thing is, I don’t need to understand why they like it. They just do, and them liking it doesn’t hurt anyone. It makes sense to them. I just have to believe them when they say that they love it.

After all, I know myself better than anyone else in the world, so it logically follows that they know more about themselves than anyone else in the world.

Now, if you wanted to understand more about why they liked that color—or being nonbinary—the right person to ask (respectfully!) would be a nonbinary person. For better or worse, I’m just another woman, so I can’t speak with any more authority than this.

We’ve gotten off the point. How is gender dysphoria different from any other form of dysmorphia?

Common misconception—dysphoria isn’t a kind of dysmorphia.

Gender dysphoria is a type of dysphoria that stems from your sense of gender. And dysphoria, as a category, exists as a separate thing from dysmorphia because it is the polar opposite of dysmorphia.

Take anorexia, for example, a tragically common dysmorphia. A person sees an inaccurate version of what their body looks like—the classic example is a skinny person seeing a large body—and that inaccurate perception causes distress. No matter what we do to the body, that distress will remain. As a result, we have to treat the misperception.

Dysphoria, by contrast, happens when the body is seen accurately, as it truly is, and that correct and accurate perception causes distress. So, when a pre-transition trans woman looks at herself in the mirror, it’s not that she sees a woman, it’s that she sees a man—and that hurts very badly. A good non-trans example of this is when a woman loses her breasts to cancer treatments. She sees that her breasts are gone, know they should be there, and the absence makes her sad.

The thing is, you can't treat dysphoria by working on someone's body-image, because the more you do, the more they see and focus on what their body is really like. When that happens, it makes their distress worse, not better! So, if you try to find ways to make a trans person who’s experiencing gender dysphoria appreciate their body as it is, you’re actually making their pain worse. This is the exact reason why insurance is required by law to cover breast implants for breast cancer survivors—you can't make the pain go away with therapy, so the only way to fix the pain is to change a dysphoric person’s body.

That's why trans people generally transition: because it's the only thing that treats gender dysphoria. Everything else we've tried as treatment for dysphoria in over a century of research has only made it worse.

So you think people should just get the surgery if they don’t like their body?

Whoa, hold up! Believe it or not, the overwhelming majority of trans people don’t get genital surgery.

Ever.

And contrary to what you’ve probably heard, American kids never get genital surgery. Some other countries have an age of consent at 16, and teens there can get genital surgery before they’re 18. In the US? It’s virtually impossible for a minor to get genital surgery. How impossible? Well, not only does the trans teen need to want surgery, and be persistent about it, but they have to have been on HRT for a couple of years, have some really extensive and time-consuming preparation called elecrolysis done, their surgery has to be signed off on by both parents, a pair of psychologists with specialties in developmental psychology and gender-affirming care, usually at least one social worker to make sure that the teen isn’t being coerced in any way, a surgeon able and willing to do the surgery, and then the whole case gets sent to a review board to make sure that everybody’s acting in the kid’s best interest.

Yeah. It’s a heck of a lot.

There’s only one recent source I’ve been able to find that talks about this stuff with numbers, but it’s a good one, because it pulled data from insurance billing. That means that it only counted cases where someone submitted an actual, completed procedure that was done on an actual, under-18-at-the-time-of-surgery minor—it’s less rare for someone to start the ramp-up to surgery when they’re a teen, but not actually get it until they’re 18 or 19—and the grand total?

About twenty cases a year. For the entire United States.

Where at least 5.3 million transgender people live.

It’s rarer than hen’s teeth.

So… minors never get transgender surgeries?

I didn’t say that.

There’s really only one surgery that doctors perform on minors: a double mastectomy for trans guys. Most doctors who do this surgery won’t do it for minors, no matter what. The few who do usually require that the teenager have been on hormones for at least a year or two, be old enough to understand the long-term effects of their decisions, and have their parents’ approval. That last bit is actually required in all cases around the world unless the teen’s parents are overtly abusive.

This is just about the only surgery that teens get for a pretty simple reason: it can be reversed. Just like the cancer survivor earlier, in the extremely rare cases where the teen changes their mind later, they can have breasts back with a completely normal breast augmentation surgery. The same study I linked a moment ago says that between 90-95% of all gender-affirming surgeries that get performed on teens are mastectomies for trans guys.

I heard about that! Don’t like 80% of kids who think they’re trans grow out of it?

No.

The opposite, in fact—five years after telling their parents they’re trans, 97.5% of all trans kids still say they’re trans. And that 2.5%? Almost all of them changed their minds before they were 10, which means they never did anything other than wear some different clothes and try out a different name.

Only about a half of a percent of all trans people ever detransition, and most of those who do retransition later. It’s important to note here that the science on retransition, specifically, is thin on the ground. There’s nothing malicious here—it’s just a pretty new area of research, so we don’t have good data yet. We’re working on it, though!

But I’d heard some things about like a 40% suicide rate or something…?

Super understandable. This one’s tough.

Trans people have a lifetime, cumulative suicide attempt risk of 41%, which compares to a lifetime suicide attempt risk of around 4.6% for the general population. However, about 96% of all suicide attempts end with the person attempting suicide still alive. When you figure in the fact that one person might try to commit suicide more than once in their lifetime, 93% of everyone who attempts suicide survives long-term. As high and scary as those numbers are, that means that about 2.87% of all transgender people commit suicide. We have to use math here because some trans people commit suicide without ever telling anyone that they’re trans—and that means they can’t be counted accurately any other way.

If we compare those numbers to, for instance, major depression, the comparison is actually pretty similar: about 6% of all people with major depression eventually commit suicide, compared with 0.3% of the general population. So, depression and suicide risk are important things to keep an eye on and improve, and it means that trans people are almost ten times more likely than the general public to commit suicide, but the thing to remember here is that if you multiply a very small number by ten, the result is still a pretty small number.

And things you do can drop that number by a lot.

…By doing what? And how much does the number drop by?

By accepting a trans person for who they say they are, you can reduce the chances they commit suicide by 76%. That’s a risk of 0.688%, only about twice the risk of the general public. If a trans person is able to meet their transition goals, it drops by about another 50%, which… well, yeah. At that point, we’re at the same risk everyone else is at, aren’t we?

So it’s not being trans that makes trans people commit suicide?

Nope. It’s pretty much all either other people being jerks to us or not being able to transition.

Okay… well, what’s actually involved in transition, then?

Typically, it’s a change in name, pronouns, and usually clothes—but not always. Transition looks different for everyone. But for most people, all it is is asking other people to treat them a little differently.

Many trans people eventually go on Hormone Replacement Therapy. It’s hard to say what percentage, because the numbers have moved around a lot over the years, and because recently it’s become easier to get HRT as an adult. Being able to get on HRT without having to go through a whole rigmarole means that people who didn’t used to be able to afford six months or a year of weekly therapy—the old requirement—are able to afford it now, so the numbers are in flux. We won’t know what the rates really look like for a little while.

Somewhere between one in four and one in three trans people eventually get one type of surgery or another as part of their transition. Mostly, that’s chest surgery, with mastectomies for trans guys being by far the most common.

Isn’t HRT dangerous?

No, not really. No more than pretty much any other medicine, and much less than most. But there’s a really good reason for why you’ve heard that it’s risky!

Trans people have always used the exact same HRT medicines that other people of our genders have used—so, if you’re a man, trans men use the same testosterone that you’d use if you had low T, and if you’re a woman, trans women use the same estrogen you’d use after menopause. Now, testosterone is pretty safe—it might raise someone’s risk of a heart attack—but as long as you’re not mainlining it up to ridiculous levels, it’s nothing much to worry about. The main risk of testosterone—increased prostate cancer risk—doesn’t apply to trans guys, because they don’t have a prostate!

But! You remember back in the 1990’s, when there was that big panic over women’s HRT, when we found out they could cause blood clots? and in the 1970’s, when we found that if it was too old it could cause cancer? All of that came from a combination of drugs called Premarin and Medroxyprogesterone.

We don’t use that stuff anymore, because it is horrible.

What we use now, estradiol, is dramatically safer. It’s not the same as just having your own body make its own hormones, but it’s no riskier than other common prescription medicines, and people who are at higher risk for blood clots can take it as a cream or an injection, which reduces the risk even more. It’s so safe, in fact, that some European countries, like Spain, don’t even require a prescription to get it!

One important note here is that our safety studies for estradiol have all been done on non-transgender women, so we can’t say for certain that it’s as safe for trans women as it is for cis women. There’s no medical reason to think there would be a big difference, but it’s possible. We’ve got some studies in the works right now to check and make sure, though.

What about regrets? I’ve heard a lot of people regret transition.

Well, let’s talk numbers. Only 0.3% of everyone who gets a trans surgery of some kind have any regrets at all. And that’s been pretty consistent from study to study. But yeah, you have heard a lot of people saying they regret transitioning.

Here’s the thing: we’re dealing with really big numbers now. How big? Well, according to the best data we have, about 1.6% of all Americans are trans right now (that number is probably low, by the way, but it’s hard to be certain). That means that there are, for sure, 5.3 million transgender Americans alive right now. If 0.3% of all trans people who get surgeries (so, 0.3% of 33%) regret those surgeries, that’s a little over 5,000 people who tried their best, but got it wrong.

So yeah, it’s true that an incredibly small number of trans people regret transition and it’s also true that there’s a a fair number of people who do. Really small percentages of really big numbers can do that.

How does that compare to other surgeries?

The average regret rate for all surgeries is 14.4%. That’s 48 times higher than the regret rate for transgender surgeries.

What about bathrooms and changing rooms? Isn’t there a safety issue there?

The short answer is no.

Virtually all rapists, pedophiles, and sexual predators in general are non-transgender, heterosexual men, and virtually all child predators target members of their own families to the exclusion of anyone else, and virtually all rapists target friends, acquaintances, or family members. This is because these crimes really aren’t about sex, sexuality, or anything related to bedroom-type stuff—they’re about exercising power and violence over others.

The actual rate of trans people who are sexual predators is so low that I couldn’t find concrete data on it anywhere. The literal only sources I could find were sensationalist news articles, but none of them cited anything from the Department of Justice or anything scientific.

But I read somewhere that a lot of trans women get sent to prison for sex crimes!

That’s true. The crime in question is prostitution, which many trans women are forced into as our only survival option because we’re two to three times more likely to be unemployed than average.

And that’s a huge improvement over how things used to be.

Can’t trans people just be gay instead?

Well… I am gay. I’m a trans woman who likes only women.

Gender and your sexuality are different things that really don’t have anything to do with each other. Being trans has nothing to do with sex at all.

But stop and think about the question you just asked for a minute—and I promise, I’m not judging. It’s a really common question. I see it all the time.

Doesn’t it kind of presume that being trans is… inherently a bad thing? And that being gay is also bad, just less bad? How would you think it’d feel to be asked that question from someone you loved? Getting asked if you could just not be part of who you are?

It’d hurt, wouldn’t it?

I know that’s not what you mean to do. You look at the numbers and how angry people are about trans people, and it’s scary. You don’t want those numbers to apply to your family member, your friend, or your coworker. You want them to be safe and happy and healthy, because you’re a good person.

Well, here’s the hard part: all of it applies whether the person is transitioning or not. So, even if they tried to bury that part of themselves, all of those statistics that are so scary still apply to them.

That’s why you’re hearing trans people talk about this stuff so much. We don’t want to make anyone trans. We want to make it not so scary to be trans

That’s all.

Shouldn’t we let kids be kids? If they still say they’re trans when they’re 18, they can transition then.

That’s a tough question. Nobody wants for kids to just get to be kids more than me. I’m a teacher, for goodness sakes! Explaining this is going to take a little while, so bear with me, okay?

Imagine if your kid had major depression as a teenager. Heck, maybe they do. It’s really common. You’re a good parent. You want the very best for them. You want them to be happy and healthy and strong. Because of that, you understand that 6% of people with depression commit suicide, so you take your kid seriously. You take them to a great therapist, maybe start them on antidepressants. We don’t quite know why antidepressants work, because what they do is change the levels of neurochemicals in the brain, and we know that that doesn’t cause depression (despite the fact that it’s been a scientific myth for a long time that they do), but they do seem to work. And you’re a good parent, so you’re careful once they start taking the antidepressants, because sometimes the wrong kind of antidepressant can make things much worse, so you have to change to one that works better. Maybe you change schools if your kid is getting bullied, or help them find social and support circles. Maybe you get them tested for autism or ADHD, which can cause depression when the kid isn’t able to be themselves.

In short, you’re a loving parent. You’ll do anything to help them get better. I mean, who wouldn’t, right?

Here’s something you probably didn’t know: estrogen is a neurotransmitter, and it changes how serotonin is processed and received, just like those antidepressants do. And testosterone changes the way brains work with dopamine too! Both hormones have a big impact on how the brain talks to itself.

Well, when a kid starts puberty, their hormone levels change in big, big ways. Either testosterone jumps way up or estrogen ramps up (a little more slowly), and this is throughout their entire bodies. For most teens, you get normal puberty stuff: rebellion, mood swings, that sort of thing. Just testosterone and estrogen doing what they’re supposed to—getting a teenager emotionally ready to strike out on their own.

But trans kids get all that and at the same time, those hormones act like the world’s worst dose of antidepressants. They’re stuck with impulse control problems, rebelliousness, and their neurochemistry is just screaming at them that something’s really, really wrong in a way that it didn’t used to be.

That’s why what doctors do when they’ve got a trans teen is give them puberty blockers, to push pause and give the teenager a break from all of that nastiness inside them. Usually, it only lasts a few years, after which the teen can either start HRT, if it’s right for them, or stop taking the blockers and finish their puberty as usual.

I heard there are risks with puberty blockers!

Sure. All medicines have risks.

Puberty blockers have been around for a really long time—since the 1980s—and they were invented to do the exact thing we use them for: push pause on puberty. Some little kids, for reasons we don’t understand very well, start puberty at a really young age. Like, imagine your daughter getting her first period when she was six. That’d be horrible, and something your daughter isn’t really able to deal with because, you know, she’s six.

We use the same drugs at the same doses in the same ways for trans kids. And the risks for trans kids are the same as the risks for non-trans kids—sometimes their bone density is lower than normal until they get proper estrogen or testosterone, because estrogen and testosterone help your bones get strong. It’s the same reason a lot of women take estrogen after menopause—it prevents osteoporosis. Also, once in a great while, a kid’s long-term fertility is reduced, but that’s pretty rare.

No medicine is 100% safe. Not even Tylenol or Hydrocortisone.

The reason doctors think that these risks are okay is because we’re comparing them to the risks of doing nothing. Remember those self-harm worries and impulse control problems teens have? You see, we’re not comparing the risks of giving puberty blockers to a kid to just an average, healthy, non-transgender teen. Obviously, that’d increase the risks the kid was facing; it’d be horrible to do something like that.

What we’re doing is comparing the risks of giving these drugs to a trans teen to the risks of doing nothing, and while there are risks from puberty blockers, those risks are less common and less severe than doing nothing.

Some people say the science says the risks aren’t worth it, though.

That’s true. That doesn’t mean they’re right.

Do you remember in the 1990’s and 2000’s, when some scientists kept saying that global warming wasn’t caused by humans, and not to worry about it, even though the overwhelming majority of all climate scientists said it is real, and that it is caused by people?

It’s like that. There are skeptics in every group of people, about every possible issue. I mean, you’ve hung out in big groups before. It’s basically impossible to get everyone to agree on anything, isn’t it?

The overwhelming majority of all doctors and scientists, as well as every medical organization of any size at all, agree: helping trans people, or at least getting out of their way so someone else can, is 100% the best thing to do, according to the science we have. Here’s just a few of the very biggest ones, in their own words and actions:

• The American Medical Association

• The American Academy of Pediatrics

• The Endocrine Society

• The World Professional Association for Transgender Health

• The American Nursing Association

• The American Psychological Association

• The Pediatric Endocrine Society

Like I said, it’s pretty unanimous. Almost every group that disagrees was founded for the specific purpose of opposing trans healthcare.

Why would someone care that much, if the science is so clear?

A lot of it seems to involve politics or religion.

I’m a technical writer, not a political scientist, so I can’t speak for those folks. You’d have to ask them.

I have another question that you didn’t answer here.

Ask me in the comments, and I’d be happy to answer it!

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Afterword for trans readers: I’ve simplified a lot of things as much as I possibly can—especially nonbinary identities—because a lot of the stuff we work through is kind of hard for cis people to understand at first. This guide is aimed at getting folks from very, very little knowledge to the basics, which is why I don’t use a lot of common terminology—like cis.