By Laura Erickson-Schroth and Laura A. Jacobs

Photo credit: Daydreamerboy

Notice how certain pleas to “protect the children” don’t actually consider the well-being of children? Especially if children and teens are trans? 2021’s latest rash of anti-trans bills aims to restrict their access to gender-affirming healthcare and make it illegal, restrict transgender students’ right to fully participate in school and sports, and bar them from using bathrooms aligned with their gender identity. Cis-gendered folks need to show up for trans youth! These points from Laura Erickson-Schroth and Laura A. Jacobs’s “You’re in the Wrong Bathroom!”: And 20 Other Myths and Misconceptions About Transgender and Gender Noncomforming People explain why support and acceptance is so important for their mental health and development. Erickson-Schroth and Jacobs also debunk the myths fueling these anti-trans bills.

***

Bullying from Peers and Teachers

Many transgender people have been marginalized from a young age. Children and adolescents who demonstrate gender variance can be harassed by their peers simply for dressing in the “wrong” garment or for having a hairstyle that more closely matches norms for the “other” gender. Teachers often refuse to acknowledge students’ trans identities and insist on referring to individuals by their birth names and pronouns, something most transgender and gender-nonconforming people find to be an aching nullification of their identity. Very frequently, youth who do not conform are subject to ostracization, jeers, bullying, physical violence, and sexual assault. Many youth also face similarly unsupportive or hostile families.

These explicit and implicit attacks can become a chronic trauma individuals face daily. Lack of physical and emotional safety can lead to poor school performance, less access to higher education, fewer opportunities for stable and lucrative employment, and less safe living conditions.

Because Bathrooms . . . Again

There have been numerous attempts to legislate trans people’s restroom use based on allegations that we are sexually exploitative. These laws are framed not as infringements on the rights of transgender people but as “protection” for women, children, and others. Those in favor of “bathroom bills” argue that trans people are more likely than others to perpetrate physical or sexual violence, or to spy on their neighbors while using the restroom. There is little discussion of the burden imposed on transgender and gender-nonconforming people when they are forced to use bathrooms inconsistent with their genders.

In fact, as of 2015, there had been no recorded incidents of anyone trans or gender nonconforming being arrested for sexual misconduct in a bathroom within the United States ever, and trans people are far more likely to be the victim in such settings. Up to 70% of transgender people report having been denied access to restrooms, harassed while using restrooms, or even physically assaulted.

Hormones and Gender-Affirming Healthcare

Even with the numerous steps that trans people are required to take in order to gain access to hormones and surgeries, critics of current practices still argue that they are too easy to obtain. One of the biggest concerns is that those seeking hormones or surgery will regret the decision later on, but decades-long follow-up studies conducted by researchers around the world demonstrate extremely low regret rates (0–3 percent).

Many are concerned about these health-care interventions being applied to children, unaware that children do not physically transition with hormones or surgeries. Instead, children who express gender-nonconforming behaviors or thoughts and have supportive parents often work with therapists to explore their feelings, and some socially transition, adopting clothes, hairstyles, names, and pronouns that they feel fit them. There are times when children socially transition and then later decide that the gender they were assigned at birth actually fits more comfortably, and these individuals, in supportive environments, still thrive. The distress often experienced is more commonly due to an intolerant social atmosphere; it is more harmful to prevent children from exploring their gender identities than to follow them on their journeys, wherever they may lead.

Some adolescents are prescribed hormone blockers, which can be offered in the early stages of puberty to halt the development of secondary sex characteristics, or even later in puberty to prevent ongoing body changes and menstrual cycles, or to provide time for an individual to make decisions. However, hormone blockers are extremely expensive and financially prohibitive for most families. Teenagers with supportive families may have the option to start adult hormones like estrogen or testosterone if they are mature enough to understand their decisions.

Our current approaches to care for transgender people seeking hormones or surgeries are less restrictive than they were in the past, but far from making it too easy to obtain hormones and surgeries, these systems continue to put up numerous barriers. Unfounded fears related to regret rates, which are actually quite low, continued to drive opposition to efforts to increase access and make it harder for trans people to live as their authentic selves.

The Importance of Trans Visibility for Trans Youth

In a 2015 Marie Claire article, activist and writer Janet Mock wrote that the cultural acceptance of multiple genders in her native Hawaii “served as a backdrop for my best friend and me as we embodied our womanhood, enabling us to transition through the halls of our high school and become who we knew ourselves to be.” A 2016 study in the journal Pediatrics demonstrated that transgender children with supportive families have no more anxiety or depression than children who don’t identify as trans.

Rather than being threatening to others, the visibility of trans and gender-nonconforming people contributes to the well-being of youth, both trans and cis, and to a safer, more civil society. Exposure to trans and gender-nonconforming individuals benefits our society both directly and indirectly. Normalizing transgender and gender-nonconforming lives through visibility on television, in movies, and in daily life offers role models people can identify with, especially during the agonizing process of coming out. Additionally, these representations help our allies address their own fears by seeing us in everyday settings, and they help everyone, trans or cis, explore the rich diversity of gender and sexuality by offering a vision of a broad range of possibilities for how we might live our lives.

Family Support

In addition to formal mental health care, there are other strategies that have been shown to promote resilience in transgender people. Helping parents with gender-nonconforming children learn to be supportive can have a significant impact. In a 2010 study by the Family Acceptance Project, LGBTQ+ young adults with high levels of family acceptance showed greater levels of self-esteem and general health and lower levels of depression, substance abuse, and suicidal ideation and attempts. A 2016 study on the mental health of transgender children clearly demonstrated that “out” trans youth living in supportive environments with supportive families, schools, and friends have no greater rates of depression and anxiety than youth in similar environments who do not identify as trans. In addition to environmental changes that can be made to assist trans people in building resilience from a young age, trans people often engage in behaviors that build their capacity to thrive in difficult situations. Studies of transgender people’s strategies for coping and resilience show that they often use techniques like positive reframing and self-talk, and turn to hobbies, humor, and spirituality to deal with transphobia in society. They also find ways to act as mentors to younger people, boosting their own and their mentees’ sense of agency.

Fighting anti-trans legislation in schools and other public spaces is important. But there are a number of smaller changes we can make as individuals or as members of organizations or companies to improve bathroom access for transgender people. Single-stall, gender-neutral restrooms can be beneficial not only for trans and gender-nonconforming people but also for families and people with disabilities. In larger, multi-stall restrooms that cannot currently be converted to single bathrooms, urinals can be removed and stalls upgraded for complete door and side coverage, so that people of all genders can be invited in. Work can also be done to change the language of bathroom access, acknowledging that many people, including trans people, require more access rather than less.

About the Authors

Laura Erickson-Schroth, MD, MA (New York, NY), is a psychiatrist working with LGBTQ people in New York City. She is the editor of Trans Bodies, Trans Selves, a resource guide written by and for transgender people.

Laura A. Jacobs, LCSW-R is a psychotherapist, activist, author, and public speaker in the NYC area.  She is co-author of “You’re In The Wrong Bathroom!” and 20 Other Myths and Misconceptions about Transgender and Gender-Nonconforming People, and Chair of the Board of Directors of the Callen-Lorde Community Health Center, one of the largest LGBTQ+ health centers in the nation. Follow her on Twitter at @LauraAJacobsNYC and visit her website.