The national outcry over the suicide of transgender teen Leelah Alcorn, along with the rise of hit TV shows Orange is the New Black and Transparent, has brought more awareness to the unique challenges facing transgender Americans — a segment of the population that’s widely marginalized and misunderstood.
The recent speculation by media outlets about whether Bruce Jenner, the patriarch of the Kardashian family and former Olympian, is transitioning has only inflamed misconceptions about gender identity.
People who identify as transgender — or trans, for short — relate to a gender different than the one assigned to them at birth. In 2011, nearly 700,000 people in the US identified as transgender, according to a study from the Williams Institute at UCLA.
Over the past few weeks, I’ve spoken with dozens of transgender individuals, their friends and family, and LGBT advocates about issues facing trans communities, including widespread ignorance about their lives. Here are 11 common myths they cited as most pervasive.
Myth #1: Transgender people are confused
Trans people aren’t misleading others or unsure about their gender. They’re certain about their gender identity and firmly reject the gender designated to them at birth.
This misconception is “baffling to a lot of trans people,” Mara Keisling, a trans woman and executive director of the National Center for Transgender Equality, said. “We realize we’re among the few people who are really approaching things with full integrity and full transparency. We’re saying, ‘This is who I really am.'”
Myth #2: Transgender people are alike
Trans communities are as diverse as any other group, filled with people of various socioeconomic, racial, and ethnic backgrounds, with varied personal challenges and life experiences. Although trans people face similar societal pressures and forms of discrimination, how they handle and respond to these issues varies from person to person. But Keisling says the view that trans people are homogeneous is something she hears far too often as an advocate for transgender equality.
Myth #3: All trans people medically transition
Not everyone who is transgender prioritizes or desires procedures, such as hormone therapy and sex-reassignment surgeries, required for a full medical transition. While some undergo medical transitions for cosmetic, psychological, or health reasons, many won’t because they can’t afford it, face some other obstacle, or simply don’t want to.
Myth #4: Children aren’t old enough to know their gender identity
A recent study from the TransYouth Project found that transgender children as young as five years old respond to psychological gender-association tests, which evaluate how people view themselves within gender roles, as quickly and consistently as those who don’t identify as trans.
“I always knew,” said Jordan Geddes, a 26-year-old trans man in Columbia, Maryland. “But I grew up and had the whole world telling me I’m wrong. At that point [as a child in the 1990s], there was no visibility whatsoever about trans issues. My parents just assumed I’m a very butch lesbian.”
Myth #5: Transitioning is as simple as one surgery
Transitioning is a long, complicated process that involves far more than medical procedures. Trans people also have to go through personal, legal, and social changes — and some may go through some of these changes but forgo medical transition.
Trans people individually decide how they’ll express their gender identity in different public and private settings. They may decide to be fully open with some people but cautious with others. Some trans people will also undertake legal changes, such as changing a name or switching a gender marker on a driver’s license. And those who are willing and can afford it will go through medical procedures, including hormone therapies, multiple types of physical surgeries, or only some of the medical options.
Kortney Ziegler, a 34-year-old trans man in Oakland, California, described his transition as a journey. “I use that word — journey — because it contrasts from a definitive time stamp,” he said. “It’s not that simple for a lot of people.”
Myth #6: Transgender people are mentally ill
“Gender dysphoria,” as defined by the Diagnostic and Statistical Manual of Mental Disorders, is a state of emotional distress experienced by people dissatisfied with the gender designated to them at birth. This is a temporary, treatable condition — not a permanent mental disorder that all trans people struggle with for their entire lives.
“I used to have a horrible relationship with my mother,” said Katherine, a 34-year-old trans woman in Charlotte, North Carolina. “Since I started transitioning, it’s been very positive, because she’s seeing I’m happy now for the first time in my life. Because she’s seeing the happiness in me, I guess we now have a closer bond.”
Myth #7: Transitioning is cosmetic, not medically necessary
Transitioning can help treat severe gender dysphoria, which can contribute to mental health issues common in trans communities.
“Just the gender dysphoria led to some very serious depression,” said Leah Roukema, a 19-year-old trans woman in London, Canada. “Talking to a lot of trans people in my community, I’ve realized it’s a very common thing both pre- and post-transition. Just about everyone has had some sort of run-in with depression.”
Medically transitioning can be a lifesaving treatment for trans people coping with these types of mental health issues. A 2014 study by the Williams Institute and American Foundation for Suicide Prevention found that 46 percent of trans men and 42 percent of trans women have attempted suicide at some point in their lives, compared to 4.6 percent of the general US population.
Myth #8: All trans people make up a third gender
Some people don’t identify as male or female, falling outside of conventional gender roles. People who associate with non-binary gender roles might identify as trans, gender non-conforming, genderqueer, something else entirely, or some or all of the above.
But many trans people explicitly identify as either male or female.
Emily Prince, a 30-year-old trans woman in Alexandria, Virginia, recently struggled with the misconception about trans people’s gender identity while signing up for a therapy program. “The first line of the form asked for sex with three options: male, female, and transgender,” she said. “Right there, we already have an issue. I’m a woman. I’m not some third sex. There are some non-binary people who don’t fit into male or female, but you don’t describe all trans people in that way.”
Myth #9: Sexual orientation is linked to gender identity
Sometimes trans people retain their sexual orientation through the medical or social transition: they are attracted to men, women, or both before and after the process. Others experiment with sexual partners of different genders. Some begin to identify with a different sexual orientation altogether. It varies.
“Before I transitioned, I was a straight male. Now, I’m a woman and still prefer women,” said Lily Carollo, a 22-year-old trans woman in Burbank, California. “But people assume I’m attracted to men. People ask if I have a boyfriend and what I look for in a man. It’s a really uncomfortable position to put me in.”
Myth #10: Drag queens are transgender
Drag shows have little to do with gender identity. LGBT group GLAAD explains that “transgender women are not cross-dressers or drag queens. Drag queens are men, typically gay men, who dress like women for the purpose of entertainment. Be aware of the differences between transgender women, cross-dressers, and drag queens. Use the term preferred by the individual.”
Myth #11: Trans-inclusive health benefits are expensive
The cost of health plans doesn’t increase much, if at all, if they include trans-inclusive health benefits.
The Human Rights Campaign, an LGBT advocacy group, estimates that trans-specific treatments can cost between $25,000 to $75,000, which is minimal compared to other health-care needs. And very few patients require these treatments, since trans people make up less than 1 percent of the population, making the one-time cost relatively small for major health providers.
These treatments can also save health insurers money in other areas, since some trans people may be less likely to struggle with gender dysphoria, depression, and other mental health issues after medically transitioning.
When San Francisco began to offer trans-inclusive health coverage to its employees in 2001, the city applied a small surcharge to all employers enrolled in its health plan. But the city ended up using just $386,000 of the $5.6 million raised by the surcharge — a cost so low that it eventually dropped the additional charge altogether.
“[D]espite actuarial fears of over-utilization and a potentially expensive benefit,” San Francisco’s Human Rights Commission noted, “the Transgender Health Benefit Program has proven to be appropriately accessed and undeniably more affordable than other, often routinely covered, procedures.”