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  • Writer's pictureJulie Love

Gender-Affirming Treatment

From the Archive: February 2022

In a nutshell:There are many aspects of treatment for people whose lived experience is different from the gender they were assigned at birth.

Let’s start with the basics: Even the specifics of biological sex (chromosomes, hormones, genitalia) fall on a spectrum and are far more complicated than you’d expect. When a baby is born, the adults look at it and take their best guess about its gender. This is the “gender assigned at birth.” Sometimes they get it wrong, and the child grows up feeling forced into an identity that doesn’t fit. Many people try to imagine what it would be like to feel like the other gender, and can’t do it – but that’s not the trans experience. If you’re a woman, imagine instead that you feel exactly like yourself – but everyone around you keeps insisting you’re a man. I’m a cis woman (woman, AFAB (assigned female at birth)), and can’t imagine being trans, or non binary. Or a man. Or another woman, actually – I often hear sweeping generalizations about “women’s experience” and can’t relate. I really only understand my own gender experience. That’s fine – it’s the only one I need to.

When one’s gender identity differs from the one assigned at birth, it causes distress. This distress can be greatly alleviated by giving the child support as they figure out who they are, and what they need to be healthy and happy. Gender expectations are a societal thing, so it is complicated to tease out the source of the distress. A five-year old AFAB child who says she wants to be a boy because she hates wearing dresses might grow up to be a woman who doesn’t wear dresses. Or a woman who does. Or a man who, when young, didn’t have any other words to express his internal experience. Or non-binary, or something else. All children could benefit from having fewer rigid gender stereotypes.

If a child has issues around gender, the first thing to do is to connect them with a therapist who understands the issue and is able to facilitate the child’s exploration without applying any pressure on the outcome. Once the child is focused on their own experience and identity rather than reacting to the expectations of others, it is common for their gender expression to fluctuate. To allow enough time for them to come to a solid, secure sense of their identity, they might be given medicine to block hormones and delay puberty. Once they are certain of themselves, the hormone blockers are stopped, and puberty proceeds. If their body does not produce adequate hormones for their development to align with their identity, they might choose to have supplemental hormones prescribed.

The child should be supported in living in the gender aligned with their identity, and not pressured to accommodate others’ expectations. No one should be forced to use a name they are uncomfortable with, or tolerate being referred to with pronouns reflecting a gender that is not theirs. Staff should ask children whether they prefer to use a bathroom aligned with the gender identity, or a gender-neutral bathroom, and then ensure they have access to it. Many people have strong feelings about this issue, myself included. I highly recommend watching this TED talk by Ivan Coyote.

If a person’s body conflicts with their sense of self, it is common for them to take steps to alter their physical appearance – shaving, hair style, clothing style, and wearing undergarments to affect the shape of their body are all common practices. For some, the difference between their body and their identity is significant enough for them to seek surgical interventions. This is not a practice limited to transgender people, and not all transgender people pursue this option. Don’t ask. It's rude. Think how appropriate it would be to ask a colleague or student if he is circumcised; then remind yourself that this taboo against asking people about their genitals also applies to trans folks.

Change is hard, and for many it is a significant challenge to keep up with change in an area they assumed was immutable, like gender. Do your best. If you make a mistake, thank the person correcting you – after all, they are helping you towards your goal of doing your best. Remember that the world can be a very hostile, threatening, and terrifying place for LGBTQ people; if they are upset with you it is because they think you are among those who would hurt them. Be clear that you are not. It helps when they know they have people who care about them offering them a safe space to be themselves. You may or may not understand them; you can still care about them.

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