Dr Michelle Telfer, who represented Australia in gymnastics at the 1992 Olympic Games, has described how she “made herself a big target” by becoming a global leader in caring for trans kids.
In a short documentary for ABC News In-depth, Telfer explained that after the end of her gymnastics career at the age of 18, she was inspired to become a doctor by those who had treated her various sports injuries.
She said: “I was trying to decide between doing paediatrics or doing psychiatry. And then in paediatrics, I found adolescent medicine, which is that perfect combination of paediatrics and mental health… I’d found the place I wanted to be.”
In 2012, after returning from maternity leave, Telfer took a job as the head of adolescent medicine at the Royal Children’s Hospital in Melbourne.
She oversaw various services for young people, but her life changed forever when she was asked to lead the hospital’s gender clinic for children.
“I was asked to take over this group of trans children in their care, and I jumped at it,” she said. “I’d never met a trans child before I started this job.”
One of the first children she met with, she was, was named Oliver.
She continued: “I said to Oliver, ‘How do you know that you’re a boy? When did you start thinking about yourself as a boy?
“He was 10 at the time, and he told me his story… It was such a beautiful story.
“And I thought, ‘I can help this child have a boy’s body. How many people can do that?”
Oliver went on to receive hormone treatment when he was 15, with the consent of both of his parents. Now 18, he told ABC News: “I’m in my final year of high school. I’m hoping one day to study medicine, cardiothoracic surgery or something similar.
“I’m really optimistic about my future. I’ve huge ambitions I want to do a lot of good in this world. And I think that, you know, I wouldn’t be in that place, I wouldn’t be able to have those dreams, if I didn’t receive support from Michelle.”
Another of the kids in Telfer’s care, a trans teenager named Isabelle, also appeared in the film. She said: “I don’t know where I’d be if I didn’t have Michelle and the Royal Children’s Hospital with me. I think I’d equate a large part of my being alive at the moment to them.”
Right-wing newspaper The Australian has written “nearly 50” articles about Michelle Telfer.
But, despite the huge satisfaction she gets from helping kids to be their true selves, as the “debate” over trans people’s right to exist gets louder, Michelle Telfer has has become a “target”.
“There have always been critics,” she said.
“You don’t go into this area of medicine without being warned about becoming a target. And I’ve certainly made myself a very big target.”
“From August, 2019, to the current time, The Australian newspaper has written nearly 50 articles about me and my work,” said Telfer
“The newspaper is inferring that clinicians like me are harming children, that it’s experimental, that the care is novel, and that they’re potentially mentally ill and they’re not really trans.”
In 2020, following fierce lobbying by right-wing media and anti-trans campaigners for a “national inquiry” into health care for trans kids, Australia’s health minister Greg Hunt referred the issue to the Royal Australasian College of Physicians.
The college shot down the idea of an “inquiry”, instead calling for greater access to gender-affirming services for trans kids.
However, even after the statement in support of her work, Telfer said the articles in The Australian continued and she began to struggle with anxiety.
Finally at the end of her tether, last year Telfer submitted a 42-page complaint to the Press Council over The Australian‘s coverage.
Despite everything, Telfer remains “absolutely optimistic about the future”.
“I know that what we’re doing is the right thing,” she said.
“Society has for hundreds and hundreds of years tried to ignore and dismiss trans people. But now that we’re affirming them, look at what they can do.”
Before the coronavirus pandemic tore through the U.S., resulting in nearly 600,000deaths and a slew of collateral damage, transgender people across the Southeast were participating in self-defense classes catered specifically to them. The courses, organized by LGBTQ advocacy group Campaign for Southern Equality, had one goal: to teach trans people to protect themselves should they be the target of an attack.
The campaign saw the classes as a necessity, with trans Americans facing disproportionate levels of violence — including record levels of reported fatal violence against the community.
“When folks are being attacked and murdered, helping with a name change doesn’t really do much good if we can’t keep our people alive,” Ivy Hill, the community health program director for the Campaign for Southern Equality, told NBC News.
Now, as it seems the worst of the pandemic may be in the rearview mirror for the U.S., Hill hopes these classes will resume — either through their own organization or local grassroots groups. While the damage spawned by Covid-19 is slowing down, the violence faced by transgender Americans — particularly trans women of color in the South — appears to be accelerating.
This year is on track to be the deadliest on record for transgender Americans, with at least 28 trans and gender-nonconforming people fatally shot or violently killed so far, according to the Human Rights Campaign, which has been tracking trans deaths since 2013.
2021 is outpacing 2020, when the group recorded a record 44 trans people killed due to violence. By this time last year, the group had tracked 13 trans deaths. Of this year’s 28 known transgender victims, 20 were trans women of color (16 of them Black trans women), and 14 were killed in the South. https://iframe.nbcnews.com/UdlwyyS?app=1
The disproportionate violence trans Americans face in the South, and more specifically the Southeast, is due to a combination of issues, according to advocates. These factors, they say, include a lack of discrimination protections, a flurry of recently introduced anti-LGBTQ state bills, high rates of poverty and a host of cultural factors. To combat this dangerous brew, local and regional advocacy groups, like the Campaign for Southern Equality, say they are working to fill the void left by their states to ensure trans people have some form of protection where they live.
‘Institutional violence’
The Southeast in general is a hostile region for the transgender community due, in part, to “institutional violence,” according to Austin Johnson, an assistant professor of sociology at Ohio’s Kenyon College, who studies the trans community. Trans people face high barriers to health care and housing in the region, and state legislatures in recent years have put forward “persistent attacks” against the community with bills that seek to limit the everyday rights of trans people, he explained.
Add in the high rates of poverty in the region, along with religiosity that promotes a very conservative view of gender roles and sexuality, he said, and there is a combination of factors that contribute to the violence. https://iframe.nbcnews.com/YGXPfXs?app=1
“I think those kinds of norms, all of those intersect with the kind of economic deprivation, educational deprivation, we have in the South, and so when you have all of this deprivation, in terms of the different institutions, it’s going to affect every group,” Johnson said. “When there are some groups that are more disadvantaged, it’s going to affect them. So I think that’s why we’re seeing these really drastic rates of negative outcomes for LGBTQ people and trans people in particular in the South.”
Although there is a disproportionate number of reported killings of transgender people in the South, it does not mean the region is inherently more deadly, according to Eric A. Stanley, an assistant professor of gender and women’s studies at the University of California, Berkeley.
The true number of trans people lost to violence each year is unknown, due in part to the lack of a national database to track anti-trans violence, police misgendering victims in official reports and some victims’ closeted status. Absent that, Stanley said, it is impossible to truly judge the regionality of anti-trans violence in proportion to other areas of the country.
“I don’t think anywhere is necessarily safer, as the kinds of anti-trans antagonism that propels so much of the harm is any and everywhere,” Stanley said.
Stanley did note, however, that the Southeast is “less resourced” when it comes to combating violence against the transgender community — and the LGBTQ community more broadly — due to the relatively high poverty in the region and the lack of a social safety net.
Alabama, Louisiana and Mississippi — three Southeastern states — are also home to the highest homicide rates in the country, further adding to the climate of violence that trans people face in everyday life.
‘Dehumanized’ by state legislatures
Outside of housing and basic needs, transgender Americans only recently received federal protection from being fired for their gender identity, thanks to the Supreme Court’s 2020 ruling in Bostock v. Clayton County, Georgia. Besides that, there are no federal discrimination protections in other areas of life for trans people, according to the Movement Advancement Project, an LGBTQ think tank.
Hill said trans people’s inability to safely access public spaces without fear of discrimination — and the issues being debated in state legislatures aimed at rolling back the rights of trans people — have created a climate that has “dehumanized” the trans community. That combined with a lack of legal protections such as nondiscrimination ordinances leaves trans people vulnerable and easy targets of violence.
Twenty-two states do not have public accommodation nondiscrimination laws protecting LGBTQ people from being discriminated against in public places due to their sexual orientation or gender identity, and 20 do not have such protections when it comes to housing, according to the Movement Advancement Project. Many of these states are clustered around the Southeast.
In addition, only 15 states — none in the Southeast — have laws that make it illegal for a defendant to claim the victim’s sexual orientation or gender identity contributed to their violent actions, known as the “gay/trans panic” defense.
“I think for a lot of us, what people kind of miss is just how dangerous or scary it can be just to move through public space, which is something that other folks who are cisgender generally don’t even have to think about,” Hill, who lives in South Carolina, said of being trans in the South.
A number of Southeastern states have recently passed bills that restrict the rights of transgender Americans. Alabama, Florida, Mississippi and Tennessee all passed bills that bar trans student athletes from competing on sports teams that match their gender identity.
Tennessee enacted an additional law that compels businesses to display signs that read, “This facility maintains a policy of allowing the use of restrooms by either biological sex, regardless of the designation on the restroom,” if transgender people are allowed to use bathrooms that match their gender identity. The state also enacted a law that restricts access to gender-affirming care for trans minors.
State bills targeting transgender people that did not pass in 2021 will likely be introduced next year, advocates warn. Advocacy groups, including the Human Rights Campaign, say serious political change must happen on the federal level to help stem the tide of rising anti-trans violence.
HRC President Alphonso David said one of the most important things that can be done to help protect trans Americans is for Congress to pass the Equality Act. The federal legislation would explicitly create LGBTQ nondiscrimination protections in housing, credit, education, public spaces and services, federally funded programs and jury service.
“It is heartbreaking to see violence against transgender and gender-nonconforming people across our country,” David said in a statement. “The Equality Act that will provide legal recourse to incidents of discrimination, discourage discrimination, and work to reduce stigma against transgender and nonbinary people nationwide.”
In addition, HRC cited actions the Biden administration took — such as reinstating the Equal Access Rule that allows people to access Department of Housing and Urban Development-funded housing without discrimination based on their gender identity and encouraging the Education Department to enforce Title IX with protections based on gender identity — as tangible solutions to help the trans community.
Some advocates, however, are not optimistic about additional national actions, especially given the slim majority Democrats hold in Congress. That’s why groups like the Campaign for Southern Equality continue to focus on lobbying state legislatures and supporting more local, grassroots efforts.
‘Robust community of grassroots work’
A number of queer advocacy groups in the Southeast say they are filling in the gaps left by the federal, state and local governments.
Organizations like Atlanta-based Southerners on New Ground are dedicated to keeping reports of anti-transgender violence in the news to ensure the public is aware of this ongoing issue.
“Those folks are amplifying their voices and amplifying their stories,” Johnson said of advocates sharing the stories of trans people lost to violence. “I wonder if we didn’t have this robust community of grassroots work, that we wouldn’t even know many of their names.”
In Charlotte, North Carolina, the trans community has been racked by violence. Two Black women, Jaida Peterson and Remy Fennell, were killed in the span of two weeks in April. Ash Williams, an organizer with Charlotte Uprising and the House of Kanautica, which both support the local Black trans community, said the groups’ main goal has been to get money in the hands of struggling trans people so they can find stable housing. After Peterson’s death, the groups raised over $20,000 for trans people of color. Williams said if they had this kind of funding year-round, it may have saved Peterson’s life.
“We believe that how we are organizing is certainly in the spirit of what we understand to be happening across the country, which is, we hope, some kind of cultural awakening that says trans people matter and Black lives matter,” Williams said.
Thousands march during a Transgender Resistance Vigil + March in Boston on June 13, 2020. Barry Chin / Boston Globe via Getty Images file
However, he added, distributing funds so the community members can take care of each other only goes so far when there is limited access to health care and other necessary services.
“Because of the way that power structures are, regular people have to show up,” Williams said. “And one of the things that we hope to be able to do is to get people mobilized and to show up for the trans folks where they live.”
Several groups in the Southeast are organizing to provide vulnerable trans communities with essential needs, such as housing, where they say state institutions have failed to provide a path to safety.
“A big portion of the folks that we serve participate in survival sex or sex work. Therefore, they don’t have verifiable income,” Kayla Gore, co-founder of My Sistah’s House, told NBC News last year. “So that’s the reason that they can’t get housing or they’re underemployed, in a sense that they don’t necessarily have access to equitable jobs that will provide them an income that is enough to obtain stable housing.”
My Sistah’s House also provides emergency housing in an effort to keep the local trans population safe in the immediate term.
House of Tulip in New Orleansis renovating a multifamily home in hopes of creating a pilot program to house 10 transgender people facing housing insecurity. The group, according to its website, also plans to establish a “separate space that can serve as a community center” where transgender people have a safe space to visit, access resources and get a hot meal or shower. H
House of Tulip said 1 of every 3 trans people in Louisiana faces homelessness, emphasizing the need for immediate housing as well as investment to help trans people find long-term housing arrangements.
Trans United Leading Intersectional Progress, or TULIP, is a nonprofit collective creating housing solutions for trans and gender-nonconforming people in Louisiana.House of Tulip
Johnson said local grassroots groups in the Southeast have come to realize in the absence of institutional help, they have to rely on each other for survival.
“When you have that kind of community building, it’s empowering, and people are not going to just roll over and expect this treatment that they’re getting,” Johnson said. “Also, they’re going to honor those who they’ve lost in their community, because they have people to rely on.”
Every year it gets better and worse for the transgender community. March 31 is International Transgender Day of Visibility and the first in four years we’re celebrating under political leadership championing queer and transgender rights.
Politics plays a critical role when it comes to including and empowering transgender people. At the highest level, inclusive laws and protections must be enforced to create equal access to basic human needs like healthcare, housing, and employment.
However, the cis-heteronormative powers that sit in the decision-making chairs have deliberately chosen to exclude and dehumanize transgender and nonbinary folks. This creates inequality that waterfalls into their involvement in society. Just recently, the Arkansas legislature passed HB 1570, which, if signed by the governor, would prevent doctors from providing gender-affirming care to minors.
The challenge of visibility for transgender people is that once seen, they can be targeted. That’s exactly what’s happening to this community, especially people of color. Since the Human Rights Campaign started keeping records in 2013, at least 200 transgender and gender-expansive people have been killed in the United States. This is at minimum considering that many of these violent attacks and homicides go unreported.
Then what does visibility mean if it comes at the cost of potentially losing one’s life? And what does it mean to move beyond visibility?
Last Friday, five transgender activists came together to answer these questions in an event called “Beyond Visibility” hosted by FOLX Health, Trans Guy Supply, and HER app.
The event took place on Zoom, naturally. Chris Mosier, the first transgender athlete to represent the U.S. at the Olympics, moderated the event along with four panelists, all people of color.
Over 60 attendees were in the digital room at one point. Despite my acquired Zoom fatigue over the past year, this event felt different. Unlike a corporate-sponsored justice and equity workshop or an all-access Instagram live, this semi-private Zoom room was the closest to a safe and large queer space we could have in these times.
Mosier, wearing a red and blue flannel, bikes hanging on the wall behind him, opened the discussion with what each panelist thought of visibility.
Rej Joo, an activist, self-defense teacher, and 1.5 generation Korean-American started. His challenge with the question was that it touched on his Asian American identity. “Culturally, a lot of information is encouraged to be private,” he said. Intersecting his ethnic background is his trans experience of being a man, he continued.
Ultimately, he hopes to see a future where we’re not even talking about visibility because “being trans and non-binary is boring.”
This is a loaded question for these panelists. Race and ethnic background add multiple layers of complexity to the simple act of being seen.
Dr. Kameryn Lee, vice president of medical affairs and equity at FOLX Health, added that visibility works both ways. It’s not about just being seen, but also how well others can see you, she said in her yellow tee with “Protect Black Trans Women” written across the front. A transgender flag hung on the wall behind her.
“For most people, their visibility will improve if they are willing to turn on a light, and open their eyes a little wider,” she said.
Marquise Vilsón Balenciaga, activist and actor, nods his heads in agreement.
“I love that response,” Vilsón said. An activist, actor, and member of the House of Balenciaga, he knows a thing or two about being seen. He famously said, “To be both Black and Trans is to be hunted in this country”.
Visibility’s proximity to violence is why this is still an issue for the transgender community. Living life as their authentic selves costs them their lives. While mainstream representation through television shows like Pose and the movie Disclosure added new transgender narratives to the screen, the problem isn’t solved.
The United States has seen a skyrocketing of anti-trans bills in 2021. Already, there have been 65 anti-trans bills targeted at youth. In 2020 there were 41. The main focus of the bills this year has been on regulating school sports, a topic close to Mosier’s heart.
“In sports, 30 states have laws that prevent trans folks from competing from elementary to college,” said Mosier. “That’s a huge loss to young people.”
Transgender people have been invited to the table for media, entertainment, and glossy magazine covers, but they’re still discriminated against politically. This ripples into bigger society and creates more dangerous waves as it travels out.
“I myself am a survivor of multiple ways of violence both on the streets and in person. Violence specifically towards trans women has always been present,” said Bamby Salcedo through tears. She is the president and CEO of TransLatin@ Coalition, an organization that specifically helps immigrant transgender women.
On March 17, Rayanna Pardo, a 26-year old transgender woman, was hit and killed by a car in Los Angeles. TransLatin@ Coalition along with Pardo’s friends and family held a candlelight vigil on March 20. This marks at least 12 transgender or non-binary people killed in 2021.
“There’s a seductive narrative to visibility,” added Joo. “But it depends on the various intersectional identities.”
Visibility isn’t as dangerous for someone of privilege like Caitlin Jenner as it is to an immigrant transgender sex worker, said Joo. This is proven by the cold, lifeless numbers of who’s getting killed.
Even then, people like Dr. Lee are willing to be visible.
“I’m not going to be invisible because of fear,” she said. It’s the same thing with her Blackness. By being more visible, others can be inspired to do the same, she added. For her, multiplying visibility is more important than moving beyond it.
Salcedo disagreed and argued that the community needed to move beyond visibility.
“Many people think our social issues have been addressed. That is a lie,” she said in regards to increased media representation.
After visibility comes education, and after that comes acceptance. Eventually, the utopia is a place where these things don’t matter at all.
“We’re so visible that we’re invisible,” added Joo. “I hope all the colors existing in society is not a big deal.”
At the end of the event, audience members submitted their questions. One person was experiencing difficulty in explaining their transition to others. Salcedo swiftly responded that, “You don’t need to explain anything to anybody,” and the rest of the panelists nodded in agreement.
Another was looking for mental health help and Dr. Lee recommended Violet and Euphoria as apps she had tried with success. Joo recommended community Facebook groups.
It’s clear that the community is great at taking care of each other, and now the work must come from outside. It’s up to the rest of the LGBTQ+ community and allies to keep fighting for transgender people until they’re treated fairly. Donating to BIPOC organizations, calling senators, and redistributing wealth all go a long way in protecting these trailblazers of history and culture. Although Transgender Day of Visibility is one day, every day is Transgender Day of Pride.
If the traditional gender categories of “male” and “female” feel too restrictive to you, there’s a chance you could be genderfluid or genderqueer.
Gender is a spectrum, not a binary, and the words we use to describe it are constantly changing as our language evolves to encompass identities that have always existed, but were previously hidden under the burden of shame.
We now have a wider range of gender expression than ever before, which is great! But it’s OK to ask questions. Here’s a breakdown of what it means to be genderqueer and genderfluid, and how the two are different.
What is genderqueer?
Genderqueer is an umbrella term to describe someone whose gender identity doesn’t fit within socially constructed norms, whether that’s in terms of their thoughts, feelings, behaviours or presentation.
According to a history of the term published in them, “genderqueer” originated in activist circles in the 1990s and grew in commonality over the last three decades.
Every genderqueer person experiences their gender in a way that is unique to them and the label can mean different things to different people.
For example, some genderqueer people fall under the banner of non-binary, and these two categories can sometimes overlap. Others may feel that they don’t identify with any gender at all, and this is called agender.
“To me, ‘genderqueer’ represents a queering of gender, so to speak,” Laura A Jacobs, a psychotherapist who specialises in trans and gender non-binary issues, told Vice.
“It’s a deliberate playing with gender in a very political sense, and being provocative around gender norms to highlight the gender stereotypes of our culture. It is also how I identify.”
Many genderqueer people will use gender-neutral pronouns such as the singular “they”, while others are comfortable using “she/her/hers” or “he/him/his”. It’s important to ask someone what pronouns they use if you’re not sure.
What is genderfluid?
Unlike genderqueer people, those who identify as genderfluid have a gender that is not fixed, and their gender identity may shift over long or short periods of time.
Some people might identify strongly with a particular gender one day, and another gender the next – it all depends on how they’re feeling in the moment.
“I would be equally comfortable with a male or female body. My male personality is more outgoing than my female one. It’s like having both male and female energies and some days a mix of both,” explained Daniela Esquivel Asturias in the Guardian.
Genderfluidity is often tied into personal expression and presentation. For some it may be a way to explore gender before landing on a more stable gender expression or identity, while others may fluctuate all their lives.
Some genderfluid people are transgender, but not everyone who experiences changes in their gender expression or identity identifies as genderfluid. Nor does everyone want gender-affirming medical treatment to change their body to better align with their gender identity.
As with people who identify as genderqueer, it’s important to ask what pronouns they use rather than assuming.
Genderfluid and genderqueer celebrities
A growing number of celebrities are embracing gender non-conformity and fluidity in their lives.
The stand-up comedian Eddie Izzard, who’s long identified as trans, recently announced she is genderfluid and now uses she/her pronouns.
Australian model and actor Ruby Rose has long been open about her identity, alternately describing herself as “genderfluid” and “gender neutral”. The Walking Dead‘s Nico Tortorella is also genderfluid, as is their spouse Bethany C Meyers.
JD Samson of the lesbian synthpop group Le Tigre uses a range of different labels. “I think my identity, or the words that I choose, vary a bit – but I would identify as a woman, as a lesbian and as a queer person, and also as genderqueer,” she told Archer magazine in 2016.
Game of Thrones star Maisie Williams is also exploring genderfluidity while retaining feminine pronouns. “I like that I don’t need to label that, I guess, and can just express myself that way and still feel, and identify, as female,” she said.
And Queer Eye‘s Jonathan Van Ness described his experience with gender in a 2019 interview with Out. “The older I get, the more I think that I’m non-binary — I’m gender non-conforming. Like, some days I feel like a man, but then other days I feel like a woman,” he said.
“I think my energies are really all over the place. Any opportunity I have to break down stereotypes of the binary, I am down for it, I’m here for it.”
How to be a genderqueer ally
Listen to genderqueer youth and validate their experience of their gender. Don’t make assumptions or project expectations based on their gender – just have patience and allow them to explore without fear of judgement.
If a genderqueer person is struggling with their identity, offer to connect them to appropriate resources so they can talk to others with similar experiences. Gender Spectrum is a great resource for both gender-fluid youth and the adults in their lives.
Use their correct pronouns, but don’t worry if you mess up every now and then, just apologise and move forward.
Finally, don’t pressure them to identify with any particular label. Many people try out a label for a while to see if it fits, and if they change their mind later on that’s fine! Everyone is the expert on their own gender, so let them choose the descriptors that suit them.
Intersex people have been around for as long as humans have, yet they’ve been shrouded in secrecy and ignorance for much of our history.
The truth is that these traits are perfectly natural and far more common than many people realise. Up to 1.7 percent of the world population is born intersex, a figure roughly equivalent to the number of redheads.
Nowadays, growing numbers of intersex people are casting aside the historical stigma and proudly embracing their identity as members of the community. Here’s a breakdown on what it means to be born outside the gender binary.
What is intersex?
Intersex people are born with a particular set of sex characteristics — such as chromosomes, genitalia, reproductive anatomy and hormones — that don’t fit neatly into typical binary categories of male or female.
Some of these traits are visible while others are not. Some are obvious at birth, some become apparent during puberty or later in life, and some are never discovered at all. Most traits are random, although some do run in families.
These biological variances occur naturally in humans and there are over 40 medical terms under the intersex umbrella for the different ways sex anatomy might develop.
That means there is no one way to “look” intersex. An intersex person may have female chromosomes but ambiguous to male-appearing genitals, or male chromosomes but ambiguous to female-appearing genitals.
They could have what’s called “true gonadal intersex”, which means they have both ovarian and testicular organs, or they could have a complex or undetermined form of sexual development that doesn’t fit neatly into any of these categories.
As the Intersex Society of North America wrote over 20 years ago: “Nature doesn’t decide where the category of ‘male’ ends and the category of ‘intersex’ begins, or where the category of ‘intersex’ ends and the category of ‘female’ begins. Humans decide.”
How common are intersex people?
According to campaigners, annually around one in 2,000 live births have these characteristics, and one in 200 of these babies are born with visibly variant genitalia which don’t fit typical binary definitions of male or female.
This amounts to roughly 1.7 per cent of the world population, which makes intersex people about as common as those with red hair.
But the true figure is hard to ascertain since most intersex people don’t have characteristics that are externally visible. Others have their genitalia altered at birth, so some may never know they are a part of this community.
Between 1930 and 1960, various forms of genital reconstructive surgery were pioneered by doctors whose understanding of these conditions was relatively primitive, and whose main motivation was to make the child’s appearance more “typical” of the gender binary.
These invasive procedures include clitoroplasty, vaginoplasty, phalloplasty and gonadectomy, and they are frequently performed on intersex babies to this day.
While some are done to reduce the likelihood of future problems, surgical intervention is usually only necessary in the rare case that an infant is unable to urinate. Often it is the surgeries themselves that cause health issues.
Many adults are left with scarring, incontinence or loss of sexual feeling, while the removal of testes and ovaries results in involuntary sterilisation which may require lifelong hormone replacement therapy.
The community has long called for an end to these operations, pointing out that they have high complication rates and can lead to painful physical and psychological problems in later life.
It looks like we could be on the cusp of a watershed moment for intersex rights as a growing number of medical bodies opt not to perform the procedures, but there is still a long way to go.
Is intersex is different from transgender?
Yes! The two terms are often confused but they are not the same and shouldn’t be used interchangeably.
The key difference is that a trans person has a gender identity that differs from the one they were assigned at birth, whereas an intersex person was born with physical variations to their sexual or reproductive anatomy which mean they don’t fit typical definitions of “male” or “female”.
Intersex people can have any sexual orientation or gender identity. Both intersex and transgender people can identify as men, women, gender-fluid, non-binary, or in a multitude of different ways.
How can I be an ally to intersex people?
For starters, don’t reinforce the belief that they need to be fixed. Instead of pushing “normalising” surgeries, parents and doctors should give intersex children the autonomy to decide when they’re older.
“The most important thing would be to advocate for people to make their own choices about their bodies. The person having that intervention has to have some agency in the decision,” said Dr Arlene Baratz of the Androgen Insensitivity Syndrome-Disorder of Sex Development Support Group, speaking to Health.
Be careful about the terminology you use when referring to intersex people. Historically the term “hermaphrodite” was often used, but many intersex people now find this word insulting and an inaccurate description of intersex bodies.
And finally, don’t ask invasive questions about their bodies – you wouldn’t normally strike up a conversation about a person’s genitals, and intersex people are no different!
In Georgia in the early 2010s, what was available to me as a LGBTQ person during my high school sex education class was… inadequate, to say the least. Now, my heart weighs heavy as GOP-led state governments are making LGBTQ* sex education even more inaccessible in public schools across the country.
The latest wave of anti-LGBTQ legislation comes only two years after Arizona lawmakers retracted their efforts to ban HIV/AIDS curriculum that “promotes a homosexual lifestyle” after facing massive public outlash and a lawsuit. However, this state’s legislature has made a second attempt in the spring of 2021, now framing the issue as a parents’ rights issue–stating that parents must provide consent for their child to participate in discussions about gender identity, sexual orientation, or HIV/AIDS in sex education classes. Parents must even sign off on teaching historical material, including the 1969 Stonewall Riots and the gay rights movement.
Following Arizona’s lead, Tennessee and Missouri lawmakers are drafting similar measures which would require parents to be notified before instruction on sexual orientation or gender identity (but would exclude historical references). Idaho legislation, which has already passed the House and now awaits Senate action, also requires notifications and opt-ins, including for discussion of sexual orientation outside of sex education classes.
Despite these efforts by state legislatures, public support for LGBTQ youth continues to grow, and as LGBTQ youth mature into adulthood, they’ll need to have a sex education that prepares them for a healthy life. Because of the failures of my own high school education system, I had to bumble through life learning how to protect myself from self-study on the internet and through podcasts, TV, and friends. Even today, I meet LGBTQ adults who are still largely unaware of important aspects of queer sexual health. So, whether you’re young, old, a thoughtful person, or just a GOP state lawmaker, these are important topics to know.
PrEP, a drug that has prevented the transmission of HIV with a 99% efficacy, has been out on the market ever since I’ve been in high school. I had been sexually active for five years before discovering this once-a-day medication, which ensures that I stay HIV-free. Most individuals experience no side effects, and despite rumors of it being “too expensive,” it can be free with most insurances and because there are numerous cost assistance programs for the uninsured. And for those who have already been exposed to the virus, but aren’t on PrEP (also known by its brand names Truvada or Descovy), there’s an alternative (sort of like the Plan B of HIV), called PEP. PEP, when taken up to 72 hours after exposure can significantly lower the chances of HIV transmission. Thanks to increasingly effective treatments, so many people living with HIV have what’s known as an Undetectable=Untransmittable status. Their viral loads are so low, the CDC says there is “effectively no risk” of transmission when engaging in oral, anal, or vaginal sex.
2. STIs don’t make you dirty. Most are curable.
Upon moving to San Francisco, I contracted my first STI–gonorrhea. It was asymptomatic, and identified quickly. Because I was on my daily prescription for PrEP, I was seeking sexual health care at San Francisco AIDS Foundation’s sexual health clinic Magnet, and was therefore receiving regular testing. The treatment was quick and easy and seven days later, I could get back to hanky panky. The reality of contraction and treatment was far less painful than I had imagined. My high school education in Georgia had me believe that if I so much as undressed in front of another person, Sebastian and every critter from The Little Mermaid’s deep blue sea would be knapping at my pubes.
3. How to douche.
If you’re queer, I seriously hope that Sex Education was a part of your early pandemic Netlfix binge. If not, Season 2, Episode 6 is where my beloved characters deal with numerous dramas, one of them concerning the topic of anal douching. Heartthrob Rahim teaches us the mechanics to ensure shit doesn’t happen. In short, the sigmoid colon, where our bodies are designed to hold our poop, is located well above the rectum, which means that it lies farther inside our bodies than a penis, dildo, or fingers can reach during penetrative anal sex. For those of us that eat high fiber diets and evacuate regularly, douching may not be necessary. And for those of that do require cleaning, San Francisco AIDS Foundation’s anal douching safety tips are extremely helpful.
4. The HPV vaccine is for everyone.
The HPV vaccine, which prevents the transmission of the strain of the virus that develops cancer and genital warts, was originally recommended only for people with vaginas by the CDC. As scientific evidence grew, the CDC amended it’s guidelines to include everyone in their preteens through 26 years old, too. Adding to the confusion, my primary care doctor explained to my dad that the vaccine was specifically for sex between a man and a woman. His narrowly defined definition didn’t consider that men could pass it between each other and that those men could then pass it to others if either of them engaged in vaginal sex. This lack of clarity led my father to decline me getting the vaccine, since he assumed it was not for gay men. It wasn’t until I began visiting my college’s LGBTQ Center that I realized that the HPV vaccine is for everyone, regardless of sexual orientation, and chose to take the necessary precautions.
In What I Didn’t Learn In Sex Ed (Part 2), I’ll expand on these topics, adding four more, including, pleasure can come in multiple forms, how to give consent & how to say no, mental health is sexual health, and you get to decide what sex means to you.
Survivor’s guilt and trauma from surviving the early days of the AIDS epidemic are oftentimes cited as the reasons why HIV long-term survivors experience depression and other mental health symptoms. Now, the experience of living through a second devastating pandemic–COVID-19–is compounding the anxiety, sense of loss, and social isolation faced by some long-term survivors.
“COVID-19 has really brought up a lot of memories of friends dying from AIDS,” said Vince Crisostomo, a long-term survivor and director of aging services at San Francisco AIDS Foundation. “The images of hospitals being overrun–they’re similar to the images we saw in the early years of the AIDS epidemic. The scale of how many people have died is really scary. You just think, ‘Will I make it? Will I survive?”
Activists are calling for additional support to address the evolving mental health care needs of a growing population aging with HIV. This need is specifically called out in the San Francisco Principles, a call for resources and treatment specifically addressing the unmet needs of long-term survivors published by a group of activists including Crisostomo, and a 2021 San Francisco budget request to fund mental health care services for long-term survivors.
The budget request, for $300,000, would fund mental health coordination efforts in order to decrease barriers to accessing culturally competent mental health services.
“We have suffered through isolation and loneliness, the expense of medications and health care visits, declining physical health, untreated substance use and mental health problems, and the damage done to us by early HIV medications. We have been virtually forgotten, shoved to the sidelines by AIDS researchers and service providers, and by physicians who have not been trained to treat the unique problems of surviving with HIV,” said long-time survivor and activist Hank Trout, in an article describing the Principles.
“Many long-term survivors who lived through the early years of AIDS didn’t know whether they were going to live this long,” said Angel Vazquez, health educator with aging services. “Now they’re still here–but have lost relationships, friends, and families. They need to be able to regain a sense of resilience in order to integrate again into the community after COVID-19.”
“You have to keep in mind that people who have been living with HIV for many years also often experience comorbidities from HIV or the early HIV drugs,” said Dusty Araujo, manager of aging services at SFAF. “These additional health problems can really affect someone’s mental health when experiencing yet another pandemic. Especially if they’re more isolated because of COVID-19 and don’t have strong support from family or other loved ones nearby.”
“COVID-19 has affected so many people, from the disabled, to the working class, to people who all of a sudden have found themselves job insecure,” said Michael Rouppet, an activist and long-term HIV survivor. “Everything devolved into chaos. I think COVID-19 really took the mask off and showed how vulnerable we really are–especially for people who are at risk of losing their housing and being evicted. Housing really is healthcare, and it is a component of mental health. Even though we have an eviction moratorium at the moment, what happens once rent becomes due? These issues are all inter-related. Many long-term survivors are experiencing the overlapping effects of COVID-19, housing insecurity, isolation, substance use, and mental health issues.”
Rouppet said that this is one reason why the San Francisco Principles specifically call out the need for on-demand, reasonably-priced (or free) access to mental health care for long-term survivors.
“There’s so much unmet need right now,” said Rouppet. “A lot of people are in crisis. We’re just not meeting the need, and we’re not moving quickly enough to meet the needs of an aging population of people living with HIV. Here I am in my 50s, and I’m looking 20 years ahead to how many of us will still be here that will need these types of services.”
A component of holistic care includes connection to community–one focus of the Elizabeth Taylor 50-Plus Network and aging services at SFAF. Although the group is not specifically a therapy or mental health group, services focus on building the resilience of the aging community.
“Our focus is really on socializing and making sure that people have a positive community they can connect with,” said Crisostomo. “Being happy with your life–because of your social connections–is so important to aging, and living longer. You have to stay connected and get involved, so you don’t become isolated.”
“When people are going through mental health issues and crisis, they might turn to drugs and alcohol,” said Rouppet. “But we need harm reduction resources, to lessen the risk of overdose. We need ways for people to get community support. The opposite of isolation is connection. And that has to be instrumental in getting people back connected to the community.”
Britton Hamilton said, as a trans man, he wanted to become a police officer to help promote change from the inside.
He applied to the New Orleans Police Department in June 2020, and after several exams and a panel interview, he received a conditional job offer in December.
“It was like a dream job,” Hamilton said. “I want to be able to help the community and help people to view police officers differently than how they are feeling now.”
The offer was conditional on him passing a routine medical and psychological evaluation, during which he said the psychologist asked him questions about his transition.
On Jan. 26, he received an email from the police department rescinding the conditional offer “based on a psychological assessment” of his “emotional and behavioral” characteristics.
“It was super, super disappointing, because I prepared myself physically, emotionally for this job,” Hamilton said. “This is the foundation for me and my family.”
Britton Hamilton.Britton Hamilton
In May, Hamilton filed a federal complaint with the Equal Employment Opportunity Commission alleging hiring discrimination. His attorney, Chelsea Cusimano, said the EEOC has since opened an investigation.
The New Orleans Police Department issued a statement in May.
“The decision not to move forward with the applicant in question did not involve any discrimination against the individual as a member of a protected group,” the statement read in full.
The department declined additional comment.
Hamilton’s experience isn’t unique, said Julie Callahan, a former law enforcement officer in San Jose, California, and the founder of the Transgender Community of Police and Sheriffs, a peer support group for trans law enforcement officers. Trans people face disproportionate employment discrimination generally, and she said law enforcement, which she described as a relatively conservative field, is no exception.
TCOPS is trying to do its part by providing training and policy templates to departments in the hopes that this educational material can help address the biases and misinformation that lead to discrimination. But outside of that, it’s incredibly difficult for trans people to prove they’ve faced hiring discrimination. Even if they can, many can’t afford to take legal action.
Complicating matters is the historically fraught relationship between law enforcement and the LGBTQ community. This has caused some transgender officers — many of whom are trying to address inequities from within — to face pressure from both sides.
“It’s an ongoing issue that we have to address as a society,” Callahan said of the hiring discrimination trans law enforcement officers face. “We’re starting to see agencies that are developing transgender interaction policies with the public, but they’re not developing policies like this for their employees, and we find that ridiculous. You should be doing both, because you’re going to have people from the community working or at least trying to get jobs at your agency.”
‘That’s not equal protection of the law’
Hamilton alleged that the psychologist who did his evaluation asked him questions like, “What were the names of your doctors that performed your surgery? How does your family feel about you being transgender? How does your wife feel about you being transgender?”
“I felt like it was kind of weird because … it doesn’t pertain to the duties of being a police officer at all,” Hamilton said. The psychologist, who is named in Hamilton’s complaint, has not returned a request for comment.
As part of standard procedure, the department asked Hamilton for information about his employment over the last 10 years.
After the psychological evaluation, Hamilton said the department asked for documentation outside of the standard 10-year window related to his honorable discharge from the Army 12 years ago due to medical issues, according to his EEOC complaint. Hamilton provided part of the medical discharge records signed by himself, his commanding officer and a physician stating why he was discharged. The department asked for his complete Army medical record, which Hamilton requested from the National Personnel Records Center for military personnel, according to his complaint. The documents were delayed due to the Covid-19 pandemic, so Hamilton also provided the department with the tracking number for his request.
The department rescinded the conditional offer the day after it requested additional documentation related to his honorable discharge, according to Hamilton’s complaint.
After the department rescinded the offer, Hamilton said he contacted his uncle, who has been a police officer for more than 30 years in Chicago.
“The first thing he said was, ‘That doesn’t even sound right; something definitely is up,’” Hamilton recalled.
After hearing Hamilton’s story, Cusimano said the questions that the psychologist allegedly asked him were red flags.
“I just don’t see, at the end of the day, under any reasonable standard, how you get to ask these questions of protected class members when you’re not asking them of members of the straight community applying for the same positions,” Cusimano said. “That’s not equal protection of the law.”
She also noted that Hamilton applied for the job just a few days after the Supreme Court ruled in June 2020 that LGBTQ people are protected from employment discrimination under federal law. Hamilton’s case, she said, is an evolution of that Supreme Court decision.
“Now that the LGBTQ community is a protected class, what are those protections?” she said. “Acting reasonably, should an employer have understood — and I say, certainly — that those protections extend to the equal hiring process, as well as all processes related to employment?”
‘The phone call never came’
Patrick Callahan, Julie Callahan’s husband, a member of TCOPS and a criminology consultant for the federal government and political groups in Washington, D.C., said he had a similar experience to Hamilton’s.
In 2006, he had a promising interview with an agency outside of Boston. The person he interviewed with “was thrilled” and said he’d call him back that Monday, Patrick Callahan recalled.
“Well, the phone call never came,” he said. “So Tuesday I gave him a call. He wouldn’t take my call. In fact, I was never able to get in contact with him again.”
He said he found out through a friend who knew officers who worked for the department that he wasn’t hired because he’s trans.
“As soon as they got my background check back and saw those female names,” they changed their minds, he said. His friend told him it was “a joke around the department, that some ‘it thing’ wanted to work there.”
Officer Kathryn Winters, the LGBTQ liaison at the San Francisco Police Department, suspects she was the victim of a similar instance of anti-trans employment discrimination, though she was never able to confirm this.
In 2014, she applied to the Denton Police Department in Texas and took its written exam.
“I think I scored in like the top five on the written exam,” she said, noting that the scores are posted publicly. “And then a couple weeks later, [I] received a letter from the Denton Police Department stating that my military discharge form, my DD 214, wasn’t in my background packet. And for that reason, I was being completely disqualified for further consideration.”
She said she and her wife both double- and triple-checked to make sure everything was included in the application packet, including the DD Form 214, prior to its submission. She said “there’s nothing specific to indicate” that she was rejected because she’s trans, but she believes someone may have removed the form from her packet “and that was the reason they gave for not continuing with my consideration.”
A request for comment from the Denton Police Department has not been returned.
There have also been other high-profile cases of alleged anti-trans discrimination by law enforcement agencies. In 2012, Mia Macy, represented by the Transgender Law Center, successfully sued the Bureau of Alcohol, Tobacco, Firearms and Explosives after the agency offered her a job as a ballistics technician and then rescinded the job offer after she told them she was trans.
Clinicians ‘may lack the competency’
As lawsuits slowly accumulate and more people transition on the job, the culture within agencies is slowly changing, Julie Callahan said. Throughout its existence, TCOPS has seen more than 500 officers transition, she added. Trans officers have also made headlines over the last few years for being among the first in their agencies.
But supportive policies for current officers and applicants aren’t growing equally across the country. Agencies in bigger cities are more likely to have better policies, Julie Callahan said, meaning more conservative or rural areas might lack basic information about trans people, which can affect whether they’ll hire them at all.
There also aren’t clear, consistent standards across the country for how clinicians conduct psychological evaluations for law enforcement. Michael Roberts and Ryan Roberts, co-owners of Law Enforcement Psychological Services Inc., have evaluated many LGBTQ law enforcement applicants in San Francisco. They said the guidance, regulations and required continuing education for clinicians who conduct evaluations differs by state. California is among the most well-regulated states, they said.
“Police and public safety psychological assessment is a component of a specialty practice as recognized by the APA,” Michael Roberts said, referring to the American Psychological Association, “so this isn’t something that any clinician should be doing without training specific to this.”
There are laws interwoven into the process of doing psychological assessments for law enforcement candidates, such as the Americans With Disabilities Act, which someone could “run afoul of” while evaluating a trans candidate’s medical records, for example, he said.
“It is the case that people are out there — they’re probably not doing it correctly. They may be doing it without specialized training, which they shouldn’t be doing. They might lack the competency to perform the specialty function,” Ryan Roberts said.
A transgender applicant shouldn’t be disqualified simply for having been diagnosed in the past with gender dysphoria — a diagnosis that is often necessary to receive certain medical treatment, according to Michael Roberts.
“You cannot use just the fact that they had gender dysphoria or they attempted suicide five years ago or something like that. That wouldn’t cut it; they have to dig down deeper,” he said.
Given the allegations in Hamilton’s case, he said, it sounds like that’s what the psychologist did.
Julie Callahan said she knows of trans law enforcement candidates who were disqualified for past suicidal ideation, which 81 percent of trans adults have reported experiencing, according to the 2015 U.S. Transgender Survey.
Many therapists who are evaluating law enforcement candidates “don’t understand that once you’ve dealt with your gender issues, any kind of suicidal ideation has gone away, because you’ve removed the impetus for it,” she said.
‘We’re in an untenable position as transgender cops’
Another barrier to better policy for trans officers and prospective officers is the broader conversation about criminal justice reform, which is happening alongside recent efforts to ban law enforcement at Pride parades, Patrick Callahan said.
Trans people disproportionately face violence and mistreatment from law enforcement, leading advocates to push for reform or, in some cases, for replacing law enforcement agencies with social support services and other community-led, violence-prevention efforts.
According to a 2011 report from the National Center for Transgender Equality, nearly half of trans people reported they are uncomfortable seeking police assistance. More than one-fifth (22 percent) of trans people who had interacted with police reported police harassment, and 6 percent of trans individuals reported they experienced bias-motivated assault by officers. Those rates were higher for Black transgender people: 38 percent reported that they faced biased harassment, and 15 percent reported assault motivated by bias.
Patrick Callahan said most LGBTQ rights groups see trans officers as the “enemy,” and they “don’t speak to us at all,” even though trans officers face the same discrimination and harassment as trans people in other fields.
“They shut us out automatically, because we’ve crossed a line somewhere,” he said. “We are not trans enough anymore. We are not LGBTQ enough anymore … and we get the same from people within the law enforcement community. Right now, we’re in an untenable position as transgender cops. Actually, anybody in the LGBTQ community who is law enforcement, we’re just in a position where we can’t affect change, because we aren’t being allowed to even by the very people that we would most like to help.”
Gay and Lesbian Police Officers march during the Gay Pride Parade in New York, on June 30, 2019.Bill Tompkins / Getty Images file
For Hamilton, things are also moving slowly. Cusimano said it could take up to a year for the Louisiana EEOC to complete its investigation. But Hamilton said the experience hasn’t affected his goals.
“I still want to work in law enforcement,” he said. “At the beginning, I’m not going to lie, I was super, super disappointed, especially disappointed with NOPD. But this is still a dream of mine.”
An investigation has unearthed worrying evidence in the case of Mhelody Bruno, a trans Filipino woman who was strangled to death by a former Royal Australian Air Force corporal.
Bruno died on 21 September, 2019, in Wagga Wagga, Australia after being choked during sex
Her killer, Rian Ross Toyer, 33, initially walked free despite pleading guilty to her death due to a sentencing error.
In March 2021, after outrage from activists that Toyer was allowed to escape a prison term, the judge was forced to reopen the case and ultimately sentenced him to 22 months.
Details about the days before her death, which were not before the judge who sentenced her, reveal that Bruno, 25, was fully clothed when paramedics arrived, had made several out-of-character video calls with an unnamed man the night before she died, and that nurses saw bruises and marks on her body before she died in hospital that were not accounted for or mentioned in the coroners report.
One friend, interviewed by police after Bruno’s death, said that he received a video call from Bruno’s phone the night before she was strangled. A man was “extremely angry and yelling” and saying he would “rape Mhelody and give her AIDS”, the friend told police – but this call, and other messages sent from her phone that night, never made it to the courtroom.
The new information comes from an investigation by ABC News, an Australian media outlet, which also asked a former Supreme Court judge to review the journalists’ findings. He said that in light of the new information, “There is certainly an argument to say that a miscarriage of justice may have occurred here”.
“Unfortunately, we don’t know enough about all the detail, we’re commenting on bits and pieces as it were, but they are all pretty important bits and pieces,” said former Supreme Court Judge Anthony Whealy, who oversaw some of NSW’s most high-profile criminal trials, after reviewing the information gather by ABC.
Whealey continued: “And putting them all together I think at the very least you could say they reveal this was a much more serious manslaughter than the judge envisaged it to be.”
He added: “Has justice been done? Well there must be a question mark over that.”
The court heard during Toyer’s trial that Bruno had not requested to be choked but also that she had not asked for the choking to stop.
oyer lost his job in the air force after Bruno’s death, which Lerve took into account when sentencing him. Toyer also received a 25 per cent discount on his sentence for pleading guilty. In the end, he was sentenced to 22 months’ imprisonment for the manslaughter of Mhelody Bruno, 25, whom he killed while engaging in an act of erotic asphyxia.
Superintendent Noble, who runs the Wagga Wagga police station, says police were interested to learn Bruno was found fully dressed but “ultimately a narrative was presented to the court that they had engaged in sex that morning”.
“Ultimately you can only prove what you can prove and you can’t prove what the evidence doesn’t substantiate,” he said.
“That is OK to do as a lay person but ultimately prosecutors and, in this case, [the judge], had to make a finding and a sentence, and inconvenient pieces of information that may be difficult to reconcile in one’s mind don’t necessarily constitute grounds for a different finding.”
Most people associate microdosing with their artist friend who chews on a minuscule amount of mushrooms before painting or the Silicon Valley tech-bro who lists their LSD-laced coffee as the key to their success. Method aside, people say that enhancing their days with a sprinkling of psychedelics lets them be themselves, just better.
Non-binary and transgender people have also adopted microdosing in pursuit of their most authentic selves. Their drug of choice: hormones.
For decades, transgender people have used gender-affirming hormone therapy (GAHT) to alleviate their gender dysphoria. The most common usage has been for transgender people of binary identity who want to transition from masculine to feminine (MTF) or feminine to masculine (FTM). Up until recently, the health care system rooted in Western binary thinking only supported medical transition from one gender to the opposite, A to B.
In more visual terms, there are as many people who disregard the gender binary as the entire population of Miami (about half a million people). And this doesn’t include the transgender people who weren’t included in the survey because of reasons like homelessness or citizenship status.
Microdosing hormones, also called low-dose GAHT, allows many non-binary-identifying people to achieve more subtle characteristics. Taking estrogen for gender feminization will increase breast growth, reduce body and facial hair growth, and soften the skin. Taking testosterone will emphasize gender masculinization in the form of increased muscle mass, deepening of the voice, and facial and body hair growth.
This slow-and-low approach is what drew 22-year old Reddit user, subspacehipster, to start low-dose testosterone GAHT.
They started researching hormone replacement therapy in middle school and familiarized themselves with the expected changes. But the idea of any sort of change scared them.
“I liked the appeal of starting more slowly so that I could better adjust to the changes,” they said. They also knew that they wouldn’t be on hormones forever, making the microdosing option all the more appealing.
Low-dose GAHT itself is not a new phenomenon. Many binary transgender people who begin their transition will start with lower doses of hormones and slowly build up to a full-dose amount that maximizes the development of secondary sex characteristics.
The doctor that subspacehipster saw knew about this type of binary transition. What she didn’t quite understand was non-binary folks transitioning.
“It was just clear that she didn’t get it,” subspacehipster said. She had worked with several binary transgender people whom subspacehipter knew. They were one of the doctor’s first non-binary trans patients.
She wasn’t able to get past equating non-binary to androgynous, which was not the explanation that subspacehipster used, but it was “close enough I didn’t correct her.”
Despite the gap in understanding, they still see the doctor because she respects the dosage that subspacehipster has chosen and hasn’t tried to change it.
It’s rare to find doctors that will support low-dose GAHT because hormone therapy in itself is built to be an all-or-nothing practice in the U.S. healthcare system. Even for providers offering gender-affirming care, the standard set out by the World Professional Association for Transgender Health (WPATH) is based on binary folks interested in fully transitioning.
But that didn’t fit the path that Reddit user Sarah Valentine wanted in their gender-affirming journey. They began considering GAHT as a way to feel more comfortable in their body and thought that low-dose would be a good place to start.
“I quickly found that the health care system in the U.S. was not amenable to that kind of experimentation, with most prescribers unwilling to follow an informed consent model,” they said.
In the U.S., those looking to start hormone replacement therapy must often obtain a letter from a licensed mental health therapist affirming the patient has gender dysphoria. In other words, that they really are transgender. With an informed consent model, the letter is not needed and the individual can seek out gender-affirming care on their terms. New transgender healthcare startups FOLX Health and Plumeemphasize this way of putting the power back into the patient’s hands. San Francisco AIDS Foundation providers with the TransCare program also prescribe hormones based on an individual’s own goals.
Finding a non-binary-affirming therapist alone was a challenge for Valentine. After numerous phone calls, they finally found the person that would write the letter.
The therapist knew how frustrating this type of medical gatekeeping was and just asked one question of Valentine, “Are you transgender?”
“Yes,” they said and the letter of support was signed, sealed, and delivered to the doctor.
In the meeting with their physician, Valentine explained that they were not a binary trans person and not interested in transitioning. Instead, they wanted to be somewhere in the middle.
“I’m more interested in the psychological changes that GAHT can provide versus the physical effects,” they mentioned.
The mental benefits of GAHT are not as discussed as the physical, given the adjacency of this treatment to gender-affirming surgeries. However, for many non-cisgender folks, hormones can relieve the inner anxiety, depression, and frustrations that constitute gender dysphoria.
The dosage for estrogen and anti-androgens that Valentine started on were low enough where there wouldn’t be much significant anatomical change. But mentally, they felt a clear difference.
“The process of thinking my thoughts felt different. I would still have the same thoughts, but the way they would form and move through my consciousness was different,” they said.
Similarly, for emotions, they found themselves experiencing a feeling more often than before. The emotions were also more ephemeral and vivid at the same time, they said. “They had more immediacy to them like they were closer to me than they were before.”
They liken taking hormones to having that first cup of coffee or tea in the morning or putting premium gasoline in their car after having run on the cheap stuff before.
“It feels right, like this is the hormone level I was always designed to run on,” said Valentine.
There’s also a feeling of empowerment that comes with making a decision to take a step in affirming your own gender. There’s risk involved and some of the changes are irreversible, but taking control of your narrative is one of the most powerful actions to support your own identity.
Ultimately, microdose/low-dose GAHT is unique to each individual and the developments they seek in their gender affirmation. One thing to note: Just because the dosage is low doesn’t mean that certain effects won’t happen.
“Low-dose T isn’t some androgynous, less manly version of T,” said subspacehipster.
Transitioning or exploring the gender binary looks different for everyone. Hormones can be part of this journey, but they shouldn’t dictate how “manly” or “womanly” a person is. Now, with increased accessibility to hormones and more transgender and non-binary-affirming providers, trying out GAHT is easier than ever.
