GENDER PANIC
In the last couple of years it has become increasingly impossible to avoid antagonistic discourse around gender identity. Debates about whether or not gender is a binary, who gets to define it, how it manifests, and what rights people have to transgress the culture’s perceived norms around it, loom large in headlines and Twitter threads across the political spectrum.
Folded into this discussion (often clunkily) is a very public focus on gender transition and the specificities of what it means to each person whose identity conflicts with the sex they were assigned at birth.
Human bodies are (and in one way or another always have been) legislated at almost every level, but recently it seems as though the court of public opinion is having an outsized impact on policies that materially impact people’s lives. Nowhere is that more obvious than in the rights people have to transition. Most recently, elected officials in a wave of states across the US have successfully sought to ban gender-affirming care for under-18s, dragging doctors into a fight that resembles the familiarly bitter battles of abortion providers. Today, to the extent that we’re able to quantify it, data suggests that 45.4% of transgender youth in the US currently live in states that prevent them from accessing medical care or a region in which they are at risk of losing existing options.
This figure is all the more sombering when contextualized with what we know about the higher rates of depression, anxiety, suicidal ideation and self-harm that trans and non-binary youth experience compared to their cisgender peers. Much ink has been spilled about how many young people are seeking medical interventions to affirm their gender, but remarkably little in the media about the impact doing so has on mental health and survivability.
For that we have to turn to quantitative data. From the figures, it seems positive. In a recent study, individuals were 60% less likely to experience depression and 73% less likely to experience suicidality when compared to youths who did not receive gender-affirming interventions. Many more such studies have come to similar conclusions .
If, as is often spouted in debates fanning the flames of the culture war, “facts don’t care about your feelings”, the facts seem to suggest that affirming health care such as hormone therapy and top surgery are medical necessities. Why then are the feelings behind this particular body issue so contentious?
In my desire for fresh perspectives and a deeper understanding of the heft behind the headlines, I spoke with “A”, about their experience as a young person choosing to undergo top surgery and what they think about the rising rates of others seeking the same.
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S: Tell us a bit about your story and how you came to be the person you are today.
A: I got top surgery in June 2021. This was after identifying as transgender/nonbinary for a few years and having been on testosterone since March 2020.
S: How has your relationship to gender changed over time?
A: I’ve gone “full trans” in that I’m just a passing he/him man at this point. It was baby steps to get there for sure.
S: Talk us through the process of how you chose the right medical team once you decided that you wanted top surgery. What was most important to you? What questions did you ask? What were you most nervous about?
A: There are a few known doctors in New York City and the country at large who are considered the big names. Looking at pictures of their work (knowing who to attribute the right styles to, e.g., Hazen = curved lines, Bluebond = straight lines) was a big one…I liked Bluebond and knew she was #1. I asked all the predictable questions and wasn’t fearful at all. Even though it’s a major surgery, technically, so many people do it and are fine. I had paid time off of work that made it practically luxurious.
S: What would you say to someone who suggested you might regret the decision eventually? Is this something you experienced?
A: A resounding absolutely not from me.
S: What do people get wrong about the relationship between “medicalization” and gender identity, in your opinion?
A: People love to say that there’s no necessary relationship between the two. That’s correct in that you can totally be trans without medical intervention, but the medical intervention is a big step. Someone said to me that someone who was cis wouldn’t be thinking about these types of things all the time. It’s true– obsessing over having a different body (not just a perfected one) is not a cis thing.
S: What do you most want cis people to understand about what it’s like to get top surgery?
A: That it’s no biggie. If you don’t want tits you shouldn’t have to have them. But also that it’s deeply emotional outside of the gender stuff. It becomes this big before/after, and a moment for the people in your life to show up for you when you need care. It’s hard to unsee the people who fail to show up for you during that critical time and especially meaningful to think back on the people who do. My friend brought me a Juice Press green smoothie while I was in the hospital for a night post-op. Every time I get that smoothie now I think back to being on drugs in the hospital and feeling cared for– it’s something about the mixture of the emotional intensity, trauma to the physical body, and all the drugs they feed you that just makes me think about it and smile. Another friend watched the Scripps Annual Spelling Bee with me in the hospital. It was all just so sweet.
S: What advice would you give a young trans person just starting to figure themselves out?
A: That it all gets done eventually. Make a to-do list and try to tackle one step at a time. Also, it’s not always easy to predict how you’ll feel– it was hard to imagine the ways in which life would change post-top surgery, but it’s truly one of the best decisions I’ve ever made. I think transness includes a massive onus of being the one to push the button– decide you want surgery, have to communicate pronouns, etc. It’s a lot of decision making power and overthinking it, trying to make the “right” decision is a lot of cognitive power. So just trying not to overthink it is cool.
S: Why do you think top surgery, and other forms of gender-affirming care, are “on the rise” in the last few years?
A: The idea that it’s “trending” is such a false framing. Yes it’s more available than ever, yes it’s more normal than ever. I can understand why that makes it feel trendy. If people 100 years ago could have gotten it earlier, maybe they would have. Maybe consider why people feel uncomfortable in their sex at birth, why the enforcement of gender is oppressive.
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Reflecting on A’s answers, I’m struck by the mutually-constitutive roles of agency and care. The “onus of being the one to push the button” can be stressful and depleting, but it’s also unavoidable when making a powerful decision about your own body. Having people in your life “who show up for you when you need care” (an evergreen human need if ever there was one) can counteract some of that depletion and make painful, boring, or complicated times in your life a little bit less so.
What seems to be missing from the narrative around young people seeking medical intervention related to gender identity is a good faith attempt to accept this truth about agency and care. Young people are rarely trusted to lead decisions about their own body, which is replicated in issues around consent, reproductive health, and data privacy. Without the agency to explore potential paths, it’s impossible to know what someone questioning their gender identity truly needs and, vitally, how we can meaningfully care for them.
I’m compelled too by A’s simple point that what’s happening here is actually normalization, rather than a “trend”. In the dataset of human existence, we’re zoomed right in on an acutely specific part of the time series; the moment when instances of people (young and old alike) seeking to reduce or eliminate the discomfort they feel with an assigned gender identity are increasing, at the same time as supportive services, well respected doctors, and health insurance coverage for these procedures have also become more widely available.
What if, instead of panicking about this, we saw reflected in this statistical increase an example of society’s very best impulse to keep as many humans alive and as happy as possible? What if we take time to get to know the people making these decisions and believe them when they say it’s no big deal? What else might be revealed about the fuzzy stuff between bodily autonomy and mutual responsibility? What other forms of care and self-actualization might we make room for in a heavy world? What then?
-Sophie Peck