American Attitudes Towards Trans People Are Not Great

Americans seem to have the impression that LGBT people in the U.S. have more rights and get more respect than in most places. In particular, I've run into many Americans who think that trans rights have been advancing here at mach speed. If they're transphobic, of course, they frame this as some horrible threat to society that must be undone. But I've encountered a lot of cisgender Americans who understand themselves as generally supportive of the LGBT community who still say that the pace of change when it comes to trans issues has been so fast it's hard for them to keep up, so let's just slow down. The U.S. may be the most socially advanced country, but we don't need to get crazy.

Well, this fall an international study was conducted in 27 countries on attitudes towards trans people. And what it shows is that rather than being the most "advanced" in its acceptance of trans people, the U.S. population has a much more negative attitude towards trans people than the norm.

Consider these findings:

1. Americans are the most likely to say they would intentionally misgender trans people (call a trans woman "he," a trans man "she," and refuse to use any gender-neutral pronoun). For example, there are almost twice as many Americans who say they would intentionally misgender trans people than there are Australians or Canadians who say this.

2. Americans are three times more likely to say being trans is a mental illness than are citizens of Italy, Spain, Argentina or France.

3. Americans are more likely than study participants in any of the other surveyed countries to frame being trans as "sinful."

4. "Americans are the most likely to say that society has gone too far in allowing people to dress and live as one sex even though they were born another (36%), while people in Japan are least likely to agree with this sentiment (9%)."

So, you may hear people telling you that America is "way out there" when it comes to trans rights, and needs to slow down. In fact, the U.S. is dragging way behind the international community when it comes to accepting and supporting trans people.
Americans need to know that, step up, and do better.

A Red State is "Detransitioning" State Employees--Like Me

It's been close to a decade since I legally gender transitioned.

While it was a great relief to finally live authentically in the gender I knew myself to be, transitioning was a process both challenging and tedious. I needed to have my name and gender marker changed in so many databases. This meant awkward interpersonal interactions. (For example, when I went to get a driver's license issued with my new name and gender marker, the person staffing the front desk at the DMV, apparently seeing me as insufficiently manly looking after just a few months on testosterone, responded by exclaiming in front of the crowd waiting in line, "What are you, some kind of pre-op?!").  It meant educating and cajoling and placating administrators of multiple bureaucracies who had never personally changed anyone's gender marker in whatever system they administrated, and were disconcerted to be asked to do so. It meant presenting my court order of name change and state ID showing my "M" marker over and over again.

Running the gauntlet of getting my gender transition acknowledged and implemented took months. It was tiresome. But I managed it, and moved on with my life. As my appearance shifted under the influence of hormone therapy and most people got used to addressing me as "he," the levels of stress involved in just living my life as myself slowly dropped. There were ongoing battles that remained, like my fight against the ban on insurance coverage for transition-related care in the policies offered to Wisconsin state employees, but the legal hassles seemed mostly behind me. I could mostly breathe free and just go about my business.

And for a brief moment, things really started to look up. After eight years of fighting with no success for insurance coverage for the trans care my wife and I required, policy directives under Obamacare forced my state to say it would lift the ban on transition care. The exclusion was to be lifted on January 1, 2017. But in November of 2016, Donald Trump won the presidential election, promising to repeal Obamacare and produce a total change in federal regulations. Now, my Republican governor and state legislature felt empowered to enact transpohobic policies. In December, the "Employee Trust Fund" or ETF--the agency administering all benefits programs for Wisconsin state employees--directed all insurers providing coverage to state employees to reinstate the ban on coverage for trans care.

For a family like mine, with two gender transitioners who had been waiting for many years to access additional care and get coverage for our HRT, that was more than depressing. But at least we saw it coming.

What came like a bolt from the blue was the notice I got a week ago.

It was a Friday afternoon. I'd just given a colloquium talk in my department. The week was winding down, and so was I, sitting in my office going through the day's pile of email--the usual questions from students about assignments and discussions about programming with instructors in the LGBT+ studies program I direct. Then I came across an email from my university human resource specialist, opening with a cheerful "Hello!" It informed me that ETF had changed their policy on gender transitioning in their system (which covers not only health insurance but all benefits, like disability, retirement plans, etc.). It stated that in order to "maintain a gender change," I had to provide additional documentation for myself and for my wife.

We were being detransitioned by the state, though I'd legally transitioned nearly a decade ago, and my wife started her transition in the 1990s. And we did not have the additional documentation demanded.

Reading this email caused an immediate feeling of shock at the attack on our identities. But let me note that reverting our gender markers to what they were years ago does more than emotional or psychological damage. And it impacts more than how others view our genders. For example, I have developed a neurological problem with my arm leading to partial loss of the use of one hand. I'll be seeing a neurologist in a few days--and a mismatch in my identification can mean denial of insurance coverage. That could be very costly to my family--but delaying needed medical care is costly in other ways.

Between a Rock and a Hard Place

Before I get to discussing the additional demands ETF is making, let me point out a very broad problem, and that is the idea that agents of the state can change one's legal status retroactively at any time. Imagine, for example, if the state decided that it wished to make it harder for people to get married, and so it imposed a new requirement--that in order to have a marriage recognized, residents would have to provide DNA evidence proving they and their spouse are not related (an expensive prospect). Then imagine that all married state employees were informed that their status had been reverted to single in employment databases and systems, because they had not complied with the DNA test requirement when documenting their marriages. That's not the way regulatory changes, mundane or shocking, operate--they are applied going forward, but not retroactively.

Now, as for the new procedures for gender transitioning, there are three requirements listed by ETF. The first is that the employee must notify ETF directly, providing their old and new names, old and new gender markers, ETF ID number, and a declaration that they are gender transitioning. Previously, employees notified HR at their place of employment, and employer HR staff changed the gender marker directly in the benefits system. But now ETF will centralize control over implementing transitions, and maintain a database of gender transitioners. In essence, we are being required to register with the state. As a Jewish person who lost extended family in the Holocaust, I find this extremely creepy.

The second thing trans people are required to do is provide "proof of identity," such as a driver's license or military ID showing the new name and gender marker. That's what we had to do in the past, and my wife and I can easily produce our Wisconsin driver's licenses showing our names and most correct binary gender markers. But now ETF is demanding more.

We are now being required to produce a third item, "proof of gender." This is very strange, because a driver's license already provides state-recognized proof of one's gender. Requiring more serves no purpose other than to make it harder for people to get their identified genders recognized. And the new "proof of gender" items are difficult and intrusive items to get.

Let's look at the options. One is a court order of gender change. To get one of these is difficult, expensive, and in many states, like Wisconsin, requires a doctor to testify that one has had surgical sex reassignment. Now, some people cannot have such surgery for medical reasons. Others do not want it--they desire social recognition of their identified genders, not a program of body modifications. And nonbinary gender transitioners often find they are denied access to surgeries. But let me underline that in any case, the very surgeries that ETF is making necessary in order to have one's transition recognized it has also categorically excluded from insurance coverage. My wife and I have been waiting for years to access some surgical interventions that would make our lives easier on many levels, one of which is being able to access things like a court order of gender change. But we can't afford them without insurance coverage. It's a Catch-22, and seems deliberately cruel.

Well. Instead of presenting a court order of name change, another "proof of gender" is a US birth certificate showing the identified gender. Now, in bluer states than mine, amending one's birth certificate sex requires just a letter from a doctor or therapist attesting that a person under their care is gender transitioning. A few states with reactionary policies, like Ohio and Idaho, do not allow birth certificate sex to be changed for gender transitioners at all. But most states, like Wisconsin, will do it for people who have had sex reassignment surgery which is documented in some particular way--in Wisconsin, it's by a court order of gender change. So we're back to square one, for my family and for so many gender transitioners.

What else will ETF accept as proof of gender? Another option is a US passport showing the identified gender. My wife and I have been trying for months to get the documentation we need to get passports issued in our lived genders, but have run into difficulties trying to get certified copies of legal documents. Hopefully these problems will be resolved in time and the rules for gender transition and passports won't shift under us before then. But even if we had them, this option as provided by ETF is highly problematic. Their policy requires that for a passport to "count" as proof of gender, the original passport must be mailed to an ETF P.O. box to be examined. It's crazy to demand that someone hand over their passport, via ordinary mail, with no specified procedure for ensuring its safety, no description of how long it will be held, no contact information given for an employee to inquire about the location of their passport should they not receive it back in a timely fashion, and most of all no explanation as to why the original document has been demanded, rather than just shown to the employee's HR office. So, even if we did have passports, we wouldn't want to mail them off to ETF as required.

Finally, there's the alternative of mailing a letter from a care provider as "proof of gender." At first, this seems the go-to option. Letters from medical practitioners and therapists are employed in many transition contexts. But there are two problems with ETF's letter option. First, ETF will only accept a letter from someone with a doctoral-level credential. The clinic where my wife and I get our medical care is staffed solely by (very competent!) nurse practitioners, with masters-degree-level credentials. So our care provider isn't allowed to write a letter for us.

But there's something more insidious, and that is the content required in the letter. Transition letters are commonplace, and they follow a standard format intended to protect the private medical information of the gender transitioner. The care provider writing the letter makes only a general statement that "appropriate clinical treatment" has been provided. But ETF demands that the letter writer explain what that treatment was. This is none of their business! Moreover, ETF is staffed by bureaucrats and accountants, not medical personnel qualified to review such information.

There's no justification given for the letter to disclose such highly personal information. But given what we've just experienced in terms of retroactive de-recognition of our gender transitions, there's reason to fear. It may be that if certain medical procedures are not listed in the letter, even if the letter is accepted now, at some time in the future employees might find their gender transitions reversed in state records yet again.

Ugh.

So, I've been trying to mobilize my university HR to push back against the detransitioning of me and my wife in the benefits system, and against the imposition of onerous and atypical requirements future gender transitioners. A conference call is planned between ETF and HR administrators. We'll see what the outcome is, but one piece of information I have been given so far by the head HR administrator at my university is that apparently my wife and I are the only people to whom ETF directed a notice be sent that our gender transitions would be reversed unless we produced additional documentation, at least as far as he could determine.

There are two interpretations I can give this disconcerting bit of information. Both turn on the fact that I am quite open about being trans, run an LGBT+ studies program, and as an academic who researches intersex and trans issues, have been interviewed by the media numerous times to provide commentary on related news stories. The first interpretation is that some ETF staffmember has been tasked with identifying trans state employees to receive detransitioning notices, and as I'm simply particularly visible as a trans employee of the state, I and my wife were the first identified. And the other is that because I am a critic of transphobic policy initiatives, my family has been personally targeted in retaliation--which is a pretty unsettling possibility. I suppose there's a third scenario--that every other trans person who is a state employee or receives benefits as family member of a state employee presented their HR office with a court order of gender change or amended birth certificate when they gender transitioned. But given that there are almost 300,000 state employees, how hard it is to get those documents, and the fact that they were not considered necessary until now, this seems extremely unlikely. It's an anxiety-inducing situation to find oneself in under any interpretation.

In any case, the short story is this: around the US and the world, as trans rights have advanced, insurance coverage for transition care has become commonplace, while changing gender markers has shifted to being based upon gender identity, not any particular physical sex characteristic or its modification. States like Wisconsin were lagging behind the curve, but progress was being made. Yes, there were backlashes, like the flurry of so-called "bathroom bills," but under the Obama administration, these were federally identified as discriminatory.

But like so many things, a lot has changed fast. And trans people are among those finding themselves besieged.

And that's how I find myself facing detransition by an agency of the state.

Dear U.N. Ambassador: Gender Identity is Not a Sexuality

All around the world, people are being maltreated because they are born intersex, or they are trans, or they have a sexual orientation or identity that is in the minority. And LGBTI+ rights have become a battleground in international law. Representatives of nations including the influential Russia have been fighting at the U.N. against the idea that gender and sexual minorities should be protected, and continue to criminalize same-sex activity, gender transgression, and attempts to gender transition. It's important that the U.S. fight for the rights of sex, gender and sexual minorities.

So I was glad to hear today that the U.S. delegation to the U.N. is going to do this. Deputy U.S. ambassador to the U.N. Richard Erdman announced U.S."support for the rights and dignity of all individuals regardless of their sex, sexual orientation, or gender identity," even where those rights have not been recognized in international law. (Bans on "sodomy" are now against international law, but international law doesn't protect gender identity, nor does it recognize a right to same-gender marriage.)

It's great that the U.S. delegation to the U.N. is taking some action. What's not great at all is the language that has been chosen. The "U.S. government says it will begin using the term 'sexual rights' in discussions of human rights and global development" to refer to the rights of sex, gender and sexually marginalized people, and to the right to protection of "sexual and reproductive health."

I have to say, as an intersex trans person, this is highly problematic. Being trans is not about sexuality. (Neither is being intersex; unfortunately the U.S. government hasn't gotten around to considering the idea that intersex people have a right to physical autonomy.) 

I'm all for sexual and reproductive health. Sexual orientation should be protected. These issues can certainly be linked together under the banner of sexual rights. But sticking trans people in there as a sort of afterthought actually does us damage. It winds up further entrenching damaging beliefs about us: that people gender transition due to some sort of sexual kink, and that how we have sex and thus the status of our genitalia is what defines who we "really are."

We've been explaining for years that gender identity is not a sexuality, but even people who are trying to act as allies seem only to half-hear us. It's good to hear our U.N. deputy ambassador use the phrase "sex, sexual orientation, or gender identity". . . but then that gets collapsed into "sexual rights," which is not good to hear at all.

One more time, people: gender identity and sexuality are different things.

On Trans Gender Identity and the "Intersex Brain"

Once upon a time, in the fairly recent past, people often asked what made a person gay or lesbian—taking the perspective that homosexuality was a pathology that needed explanation. Various theories were proposed: psychological (could a domineering mother and passive father be the cause?); moral (was it a failure to embrace “traditional Christian family values”?); and biological (was there some hormone imbalance or brain abnormality at fault?).

Today, when someone comes out as lesbian, gay, or bisexual, the question of etiology is rarely raised. Lesbian, gay and bisexual rights advocates are much less likely to spend their time tossing back at the homophobic the questions, “What made you straight? When did you realize you were straight? Could you do something to change your heterosexuality if you tried?” Sexual orientation is generally treated as a fact, something that is not pathological and that requires no etiological explanation.

Back in the 20^th century, however, many advocates for “gay rights” sought to find a physical cause for homosexuality. They hoped that finding proof that there was some immutable, biological reason for homosexuality, beyond the individual's control, would lead to greater social acceptance. In fact, it was political activism, not scientific discoveries, that led to the social shift to viewing LGB people as a minority deserving of protection from bigotry. But for a while, many “gay rights” activists were focused on finding proof that there was such a thing as the “gay brain,” and research on the topic persists today. The size of the hypothalamus of gay men has been argued to be more similar to straight women's than straight men's. It's been posited that straight men and lesbians have brains with a right hemisphere slightly larger than the left, while straight women and gay men have balanced brains.

Implicit behind these arguments is a belief that gay men are in some way effeminate, and lesbians masculine. But LGB activists scoff at this belief today—the idea that gender expression relates to sexual orientation now seems offensive and ridiculous. So while scientific research continues to look for ways in which gay male brains are “feminine” and lesbian brains are “mannish,” LGB rights advocates no longer pay much attention.

We've not come to this point, however, in the struggle for trans gender rights. Trans people today are making strides, but we're now in the position LGB people were decades ago. We face a great deal of discrimination and disgust from the cis gender population, and we are constantly asked, “What made you trans? Was it psychological trauma, is it that you don't respect traditional Christian family values, or is there something wrong with you medically?”

And just like lesbian, gay and bisexual people in the 20^th century, trans people today face such virulent bigotry that many trans people hope finding scientific proof that there is some immutable, physical reason for trans gender identity, beyond the individual's control, will lead to greater social acceptance. Today many trans activists are eager to trumpet neurological studies that purport to show that the brains of trans men are more like the brains of cis men than of cis women, or that the brains of trans women are more like those of cis women than cis men.

It was the philosopher Descartes who first argued that the brain contains localized areas that control the body. He declared that the soul occupied the pineal gland—a theory sounds ridiculous today, when we know that the pineal glad is more prosaically the structure that secretes melatonin. But today, many trans people (it must be clear by now that I am not one of them) are looking for a brain structure housing gender identity. They argue that people are born with a “brain sex,” and that if this “brain sex” differs from the individual's genital sex, they suffer from an intersex condition that must be treated via gender transition.

I am deeply uncomfortable with this intersex theory of gender dysphoria. While I know from personal experience that it gives some trans people great comfort, and while I worry about seeking to demolish what others feel is their life raft, I want to lay out my objections.

My first objection is a scientific one: gender identity and gendered behavior are deeply complex. They are no more located in the hypothalamic unciate nucleus than the soul is located in the pineal gland. If many of ares of the brain are involved in something as comparatively simple as speech, how many more must be involved in matters as complex as sense of self?

A second objection relates to the entire field that Cordelia Fine names “neurosexism.” Basically, the entire field of neurological study of sex differences is pervaded by sexism and flawed by a teleological approach: “We know that men are good at math, logic and sport, while women are good at nurturing and communicating, so let's pin these to some brain differences we can locate.  This will show that politically-correct resistance to the idea of eternal gender roles is pointless.” By linking claims to trans rights to this body of science, we're tying ourselves to gender stereotypes and a regressive social agenda.

A third objection is that the brain is a very “plastic” organ, meaning that it changes over time. For example, when a deaf person communicates via sign language, different areas of the brain are “recruited” to process communication than just those used for oral speech. Furthermore, early and late learners of sign have different patterns of brain activation when they observe another person signing. In other words, the brain, like other parts of the body, is affected by life experience and use--it varies greatly from individual to individual, and for one individual over time. Even if we were to find that trans men resemble cis men in their patterns of brain use, this would not mean that such a similarity is inborn. It would just mean that trans people have life experiences similar to cis people who share their identified sex, cultural norms, and gendered behavior.  This is certainly proof that we experience our gendered identities and lives in the same way cis people do.  It is not proof that trans people are born with intersex brains.

Another objection I have is to the foundational premise at hand: that trans men and cis men are uniformly masculine in their gendered behavior and style, and hence distinct from feminine trans and cis women. In fact, there are plenty of men, cis and trans, who are nurturant parents, or who like the color pink, or who are bad at sports. There are many women, cis and trans, who are dominant athletes, have bad verbal skills, are excellent at spatial relations, or who hate primping. Furthermore, plenty of trans people are genderqueer in identity, which can't be explained in the least by this dyadic, reductionist framework.

I also object as someone who is intersex by birth to the framing of trans identity as an intersex condition. The difficulties faced by intersex people can indeed relate to gender identity, since children born intersex today are forcibly assigned a dyadic sex at birth, and often subjected to sex reassignment surgery to which they cannot consent. If the child grows up not to identify with the sex to which ze was coercively assigned, gender dysphoria results. But no test has ever been developed that can determine what the eventual gender identity of an intersex person will be—not in the brain, the chromosomes, the gonads or the genitals. And the issues intersex people face center on forced sex assignment in childhood--something which advocates of the intersex brain thesis tacitly support when they argue that since trans status arises from an intersex brain, it "must" be treated medically. Like many intersex people, I boggle resentfully at the idea held by some trans people that intersex people are “lucky,” have a privileged relationship to the medical community, or are free from stigma in our lives. The belief that being categorized as intersex would lead to advantages, which causes some trans people to frame trans identity as an intersex condition, is deeply flawed.

Finally, I would argue that this entire issue is a distraction. Remember that it was not the discovery of a brain area “causing” homosexuality that led to the relative successes of the LGB community in gaining civil rights. It was activism that led to those gains. The belief that if differences could be shown to be inborn, liberation would result, seems hopelessly naïve to me. Bear in mind that for many decades, scientists argued that women should not be permitted to vote or attend college because their brains were too small. More starkly, consider the Holocaust, which was founded on a belief in inborn racial inferiority.  Some intersex conditions can be detected prenatally, but this has not led to more widespread acceptance of intersexuality.  When these conditions are detected, doctors typically offer to terminate the pregnancy.

For all these reasons, I urge people not to hitch the wagon of trans rights to the idea of inborn, dyadic, neurological differences. Brains are extraordinarily complex and shaped by culture and experience over time. Gender identities are multiple, gender roles constantly evolving, and gender expression varies widely from individual to individual. Intersex people face huge obstacles, and framing us as the lucky group to be emulated denies our suffering.

The solution to transphobia is not neurology, but political activism.