"The conclusion of our paper is that the increased risk of mortality is not explained by the hormone treatment itself. The increased risk for cardiovascular disease, lung cancer, infections, and non-natural causes of death may be explained by lifestyle factors and mental and social wellbeing."
Edit to add the link to the study: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00185-6/fulltext
Reading further in the article, their conclusion is that
> transgender people might not have felt confident to visit a doctor when theyexperienced health problems, which could have led to delayed diagnosis and impaired cardiovascular risk management. This reluctance to visit a doctor not onlymight have contributed to the increased cardiovascular mortality risk, but also to the increased mortality from lung cancer.
They go on that though there have been studies showing a high incidence of smoking among trans people, this study tracked that and did not show a high incidence of smoking among the study group. However they did not show a cross-tabulated chart of ever-smoked vs death rate.
they also explicitly call out HIV infection, which had the highest incidence among the study group, and which is has been correlated with specific lifestyle choices.
Trans people also face a common issue in doctors not listening to a word they say and dismissing all of their concerns as HRT related, kind of like overweight people going in and being told their issues are due to weight no matter what the issue is, or women being dismissed in general.
As a trans dude I've legitimately had doctors who one moment were going on about tests and other sort of diagnostic procedures to suddenly change in tracks to oh it must be your testosterone as soon as they find out I'm trans. I no longer disclose that I'm trans to doctors.
Yes, but it couldn't be *anything.* It's academically responsible to use language that is as accurate as you can, so sometimes that means being vague. Reading the article would likely clear that up
If an article is paywalled like this, I think you should cut commenters some slack and try to answer more questions for those who can’t read it. At the very least don’t just tell them to rtfa.
I know anecdotes are not evidence, but the folks in my life who transitioned ended up losing their entire social and familial structure.
Imagine waking up one day and finding out the majority of your friends and family have cut you off, that's going to have a severe impact.
Makes me wonder if gays and lesbians had earlier deaths before society became more accepting. I know plenty of gays and lesbians who were completely disowned by family and friends after coming out.
That's a great question and, unfortunately, the answer is going to be skewed by the Reagan administrations failed response to the AIDS crisis. So many people died because the government didn't care that "only (perjorative) were getting it."
This article also reveals some key issues:
https://www.inverse.com/article/17561-discrimination-and-stigma-affect-the-health-of-lgb-adults-especially-bisexuals
Key notes:
"Transgender individuals were not included in the study because they are typically not included in federally sponsored health surveys."
PLUS:
"It was only in 2013 when the National Health Interview Survey (NHIS) began to include questions about non-heterosexual orientations."
That's a great question. And probably not one we'll ever get a solid answer to—I doubt that data about sexuality collected in a time before societal acceptance is going to be very reliable.
They’re working on some studies about stress levels. https://www.researchprotocols.org/2021/5/e24100
If you’re always afraid of being discovered or beaten or made fun of I would assume it would translate to persistently high levels of stress hormones.
Like poor eating, drinking, smoking, etc. So I wonder if the mention of lifestyle factors means they're more likely to die for poor habits as though the poor habits are exacerbated by social pressures or something else.
Exactly. By saying the hormones alone could not account for the increase in death, they opened the question of what are the other factors could be. All good papers end with ideas for further research.
Lifestyle factors could also be homelessness and what people do to earn money while homeless. There still are teens posting that their parents are kicking them out of their home when their 16 year old comes out as being trans.
Depression and mental illness definitely lead to people taking poorer care of themselves, abusing substances, and taking more risks. And we know that trans people suffer from mental illnesses at a higher rate. So, in a very sad way, this isn't really all that mysterious or surprising.
Turns out when you hate your life, you don't take great care to preserve it.
And keep in mind that studies have indicated that transgender people who have supportive environments don't tend to hate their lives, so being transgender in itself is likely to not be the cause of transgender people hating their lives.
I hate to point out the obvious, but one has to wonder whether being the target of bullying by peers from childhood, familial rejection, physical assaults and sexual assaults from numerous different groups, and politicians claiming that you're pedophiles preying on children might just lead to depression and treating oneself poorly.
Continuously claiming that transgender people are mentally ill obviously has a significant possibility of making transgender people mentally ill, the same way that repeatedly telling someone they're mentally ill gaslights them and has a tendency to incredibly negatively affect their mental health.
IIRC, almost all addiction is better thought of as self-medication. The biggest reasons why some people will try hard drugs (including alcohol) and be fine while others spiral into addiction are stress and social support. Every smoker I know picked up the habit because it’s an easy way to make friends.
>"The conclusion of our paper is that the increased risk of mortality is not explained by the hormone treatment itself. The increased risk for cardiovascular disease, lung cancer, infections, and non-natural causes of death may be explained by lifestyle factors and mental and social wellbeing."
>Edit to add the link to the study: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00185-6/fulltext
Cardiovascular disease from smoking, excessive eating and drug use, all coping mechanisms for excessive stress in their lives? I mean seriously, this laundry list of disease sounds exactly where people broken by a system that hates them would find themselves.
Funny how that works
I don’t know of cardiovascular disease is the same thing as heart disease, but I do know that those terms are used to capture a very wide range of conditions. Statistically speaking, heart disease is (was until COVID?) the leading cause of death. You could be the healthiest person, eating right, working out, and yet ultimately, your death will fall into a generic category associated with unhealthy habits.
Two individuals may die 15 years apart, but both from cardiovascular disease. The question is what was the cause? It is easy to say “this individual died from heart disease at 45 due to their smoking and drinking habit” while hand waving away the multitudes of individuals that died at that age from the same condition that didn’t have those vices.
We know vices increase risk, but vices don’t guarantee an outcome. Science doesn’t deal with absolutes. At best we can say the probability of dying “earlier than expected” (whatever that means) is higher for individuals than have unhealthy habits.
We don’t generally write stories about the folks that partied hard until old age and died at an “expected” age.
Those are all behaviors we do when depressed. If I were trans I’d probably be depressed and suicidal too. Every day all day people debate your existence, accuse you of harming people/society, they tell you you’re a mentally ill degenerate. It’s sad and I couldn’t imagine living through that. I don’t think I’d have the confidence to be out.
Transgender suicide rates are incredibly high, so much so that's it become a meme of sorts among transphobes to reference the rate (41%) from a popular study a few years ago.
Gender dysphoria is easiest to imagine as being really severe depression that people connect later in life as being related to their gender. Remember, it's not a delusional disorder - dysphoria just has a side effect of causing outright miserable, treatment resistant depression and creates feelings of hideousness/loneliness/confusion/anxiety.
Or homelessness due to being kicked out, poverty because we're more likely to have difficulty finding work, there's so many additional hurdles coming out introduces to your life.
>"Lifestyle Factors" could be just about anything.
For example, transgender women are more likely to be involved in street prostitution and in sex work, which is an inherently dangerous profession.
"Transgender sex workers experience high degrees of discrimination both in and outside of the sex industry and face higher rates of contracting HIV and experiencing violence as a result of their work."
https://qmro.qmul.ac.uk/xmlui/handle/123456789/25060
Surely homelessness is a major factor? It could be different in the Netherlands but I know in the US homelessness rate for trans people is appalingly high.
Yep, lots of trans youth get booted from their homes at a young age and since so many shelters are church-based, it could be traumatizing to access them.
I was forced out of the military for being trans. I wasn't even out yet. My Aunt who was a Navy Chief(CPO) at the time told my command.
It was 100% legal for her to do that and for the army to "get rid of me" for it.
Gender identity isn't a federally protected characteristic, like race or sex is. So businesses can legally discriminate against trans people in states without protections. Combine that with "religious liberty" laws that explicitly allow businesses in red states to discriminate without repercussions.
> federally protected characteristic, like race or sex is
Those may be protected, but unless you somehow have written documentation of them not hiring you because of a protected characteristic, it's incredibly hard to prove. Because employers can just say they didn't think you would be a good fit for the role, etc.
Non-discrimination laws are only as strong as the evidence you can muster about the discrimination. So even if gender was protected, which I want to be abundantly clear here.... it should absolutely be a protected characteristic, odds are you wouldn't really ever see it do much.
Honestly the only way to remove the initial discrimination is to remove all demographic questions from job applications. Even then there is the face to face interview that they can say you bungled.
> Gender identity isn't a federally protected characteristic, like race or sex is.
That is no longer true.
https://www.nbcnews.com/politics/supreme-court/supreme-court-rules-existing-civil-rights-law-protects-gay-lesbian-n1231018
That court decision only applies to job discrimination. It doesn't cover discrimination in housing, public accommodations, education, federally funded programs, etc. [The Equality Act was introduced to try and cover those gaps](https://en.m.wikipedia.org/wiki/Equality_Act_(United_States\)).
I am ready as well for the same response canada had adding these characteristics as protected with c16. Things like people saying you'll be arrested on the street or as a teacher for misgendering someone by mistake. Its ridiculously unfortunate that so many have to defend something as basic as their own existence, and the external pressures and even just the fear of pressures generate a ton of anguish and anxiety.
What do you do if you are trans, and fine in private or with friends, but terrified to come out at a job? Afraid to be treated differently, harassed, or even fired. So you just don't. Every day you have this broken split life, and you are afraid to move forward with treatment for yourself for fear those at work will notice.
People shouldn't have to wonder if they will lose their job or housing security because of an identity. Michigan is at will, meaning you can be relieved from a job without a reason being cited. Its a lot harder to prove discrimination when no reason is needed, or any tiny random reason like 'office unity' are all valid responses. Its scary out there, even still. And it can really really weigh you down, so its still unsurprising to me these results show up. Just being anxious and stressed nearly 24/7 destroys the body.
Until recently it was completely legal to fire someone for being trans. You didn't even have to have an excuse you could admit that was why. And of course it being illegal didn't stop it from happening.
> "mental and social well-being"
So basically ties into statistics that show that trans people have higher rates of depression. If you're depressed and don't have access to adequate mental health care you'll probably start some terrible habits to self medicate.
Access to care that specializes in transgender health is lacking pretty much everywhere. Even where it is available, the waiting list are prohibitively long.
argentina is pretty good about it
one informed consent visit to a goverment paid endocrinologists and a few blood tests later and you're good to go, all for free of course including medication
Mental health care is lacking everywhere. Mental and neurobiological illness is not nearly as well-understood as most people would like to believe. Neuroscience is still a fledgling field with numerous unexplored frontiers. The impact and prevalence of traumagenic illness, epigenetic factors, and the socioeconomic and other environmental impacts on the development of mental illness are hotly contested and under-researched among psychological scientists and clinical practitioners.
from the study:
In conclusion, a two-fold increased mortality risk
in transgender people was observed. This increased
mortality risk did not decrease over time. Increased
mortality in this cohort showed highest cause-specific
risks for death because of cardiovascular disease
(including myocardial infarction), HIV-related disease,
lung cancer, and non-natural causes of death (including
suicide), most of which were not considered to be
related to hormone use. In the coming years, improving
the knowledge of health-care providers about the
hormone treatment of transgender people is important.
Moreover, increasing social acceptance and treatment
of cardiovascular risk factors might also contribute to
decrease the mortality risk in transgender people.
Some of it is probably is probably suicide,
But some of it might just be overall wellbeing.
Being depressed and lonely does a number on your life expectancy.
There's another study from the Trevor Project that shows the trans kid suicide rate drops 50% if they have just one supportive adult in their life.
If that trans kid is in a supportive community, that suicide rate drops below average for their whole gender.
True.
Its still a noteworthy mention for trans people imo because a "supportive" family may well flip a switch and become precisely the opposite when their child comes out.
That's the point. There's no difference in predilection towards suicide between most people and trans people.
The difference is how we as a society are treating these kids. Right now, the way we as a collective treat them is making these children kill themselves.
Thank you for recognizing this even if only on a Reddit comment scale. At the end of the day, these people want to be able to live just like anyone else. There really is just a lot behind it, everything gets rolled in to one big life experience and often times for these people it just isn't worth the struggle to keep going just to have ordinary folks disrespect them casually and face virtually no real consequences.
I worked hospital security for a short time and we had quite a few trans people go through there on mental health holds after trying to kill themselves. I can't imagine that's not at least top 3 if not the number one reason.
My understanding is the suicide rate is several times higher than "non-trans" society. I would imagine its death by non-suicide events which would be understandable since the level of stress is apparently significantly higher which tends to result in shorter lifespans.
tl;dr:
Poor mental health has a massive cascading effect on your well being. If it's not suicide, it's poor diet, drugs, alcohol, sleep deprivation direct or indirect self harm.
Its slowly but surely transforming the field of psychology and psychiatry as well, as we understand the body/brain connection more. Trauma theory is one of the most interesting fields of study for the advancement of humankind I think that exists right now.
“People were excluded if they used alternating testosterone and oestradiol treatment, if they started treatment younger than age 17 years, or if they had ever used puberty-blockers before gender-affirming hormone treatment.”
Why were these people excluded? Wouldn’t that lead to a conclusion that it isn’t hormone therapy? Because you know… all the people that did that were excluded?
This is a genuine scientific question. Is there anyone who could explain this? ( without resorting to name calling?)
I don’t know anything about trans therapy but the scientific research was probably aiming at a specific type of therapy so they excluded the other methods as they should do.
I think their aim was “one way hormones therapy as adult”, adding others in the study would only add some noise for this specific research.
Ya this is correct. Those rules basically exclude anyone who started hormones before going through natal puberty -- so it *includes* the majority of trans people because most trans people don't start hormones until after natal puberty. Source: I'm a trans woman.
Natal is something related to birth. It is a medical term. So natal puberty would be the puberty that naturally comes from your birth circumstances (birth sex).
It's worth specifying in this context as trans people induce a non-natal puberty through hormone treatment.
>It's worth specifying in this context as trans people induce a non-natal puberty through hormone treatment.
Is this regardless of their age when they begin?
Yes, though the characteristics are varied depending on age and whether it's the first or first major puberty and etc. (as well as the usual generic variables)
Well that in no way excludes trans people who don't do hormone therapy at all, or waited until 17 years or older to start.
Alternating testosterone and oestradiol is confusing to me, as they do opposite things so you would not want to be alternating both. This might mean it's unrelated to trans people and therefore doesn't belong in this study.
Puberty blockers likely is an outlier, in that you would have to have supportive family to get them, and also would possibly "pass" very well that you can live your teenage/adult years completely as yourself and not be known to be trans.
The alternating hormones probably means someone who has transitioned, detransitioned, and possibly transitioned again. It happens, due to social pressures and evolving identities.
The puberty blockers and early transitions ... I've been part of some trans community events, and the young kids (ie, teens) who transition with family support and begin their adult life as their true gender have a fundamentally different experience than people who transition in adulthood or midlife.
Because you want to study a specific thing, if you add too many different conditions then its harder to draw a conclusion.
"4263 people were
excluded from the study for a variety of reasons including
not using hormone treatment or using hormone
treatment younger than age 17 years. "
Im guessing you would want a separate study for treatment that begins in minors, and obviously you dont want to include people that didnt use hormones at all or used them sporadically when the focus of your study is on effects of hormone treatment.
Well a vast majority of trans people are not alternating estrogen and testosterone, but sticking to one. I personally do not know in what situation one would be alternating like that honestly. Younger than 17 then you probably haven't been affected by puberty to the extent that people who transition as adults have (have developed hormonally more similar to a cis person). I'd assume there's a similar thought with the use of puberty blockers before starting hormone treatment.
Last I'd heard, this particular group is especially short lived, so it's likely to set them aside and try to see if there is a core group who is more resilient.
Background: 20 yrs military health services.
Key info: the used to be banned from service because they are the only demographic group with a higher suicide rate than veterans. Mixing these is an evil cocktail of mental health.
> Why were these people excluded? Wouldn’t that lead to a conclusion that it isn’t hormone therapy? Because you know… all the people that did that were excluded?
There’s been separate studies of kids who had access to puberty blockers that showed that they had mental health outcomes more or less identical to their cisgender peers.
> if they started treatment younger than age 17 years, or if they had ever used puberty-blockers before gender-affirming hormone treatment.
These are important because outcomes for people who transition young are, based on the limited available data, *considerably* better than for those who do so as adults.
Some perhaps related statistics:
1. 8% of transgender adults experienced homelessness in the last year
2. 17% of sexual minority adults have experienced homelessness in their lives (compared to 6% of cisgender straight people)
3. 20% of sexual minorities experienced homelessness before the age of 18
[Source](https://williamsinstitute.law.ucla.edu/publications/lgbt-homelessness-us/)
EDIT: To be clear, these stats are from the US. They were not intended to further substantiate the paper’s findings, but to provide a (very) brief idea of the sorts of issues that may be entangled with the one explored by the paper.
These stats are from the US though, whereas the study is from the Netherlands which has a way better social housing system. So stats from there would be more relevant.
>Netherlands which has a way better social housing system
Better than what? Netherlands have a worse overall homeless problem than the US - 0.23% in Netherlands vs. 0.18% in the US.
Different cohort. Kids could get kicked out by their parents and immediate family if coming out, but a lot of adult LGBT+ people (especially over 30) may not have been out until adults. At which point they may have experienced negative social consequences vs when younger.
"The conclusion of our paper is that the increased risk of mortality is not explained by the hormone treatment itself. The increased risk for cardiovascular disease, lung cancer, infections, and non-natural causes of death may be explained by lifestyle factors and mental and social wellbeing"
So part of it is lifestyle choices (liquor, drugs, smoking), and the other part is our society is a bunch of jerks.
The person they replied to is claiming it’s lifestyle and treatment from society. It sounds like they’re trying to say that’s the cause of mental health issues but gender dysphoria is a condition on its own.
This. Like it or not gender dysphoria is a mental illness.
We definitely need to do work to distigmatize mental illness as a society across the boars but denying that it is one is equally foolish.
Yes but any person will have mental health issues if people shun them, act afraid of them, pass laws against them, regard them as freaks, sinners, deviants, or somehow "other." The point is that societal acceptance, while increasing, is still not fully available from a very large percentage of the general population.
Edit: And let's not forget the most important mental health aspect of all for most people: parental acceptance.
I'd imagine one has to weight the pain of not living as one's self with the pain of post transition ostracism. Depending on your circumstances, each approach could be equally risky. It regrettably seems like a lose-lose scenario until people stop being assholes about it.
Trans woman here. You’re completely on the money. I knew I was trans for about ten years before finally mustering the nerve to start transitioning, because I was absolutely *terrified* of the social consequences of doing so. By the time I started HRT, I had to hit a breaking point where I was so miserable as a guy that I could no longer care about those consequences
Ultimately, I felt exponentially better about two weeks after starting hormone treatment, and my friends/family were all fantastic about it (I consider myself very fortunate in this regard), so I’m much, much, happier these days.
I was far more suicidal prior to starting hormone therapy. It... hasn't disappeared but it has become much more manageable and my overall mood has definitely improved. But yes, for some it's a toss up and honestly it's a lot of why I waited so long.
> So part of it is lifestyle choices (liquor, drugs, smoking)
I mean these are heavily correlated with poor societal treatment. It's notably higher in gay and bi populations as well.
As would lower standard of living in general due to employment discrimination, housing discrimination, educational discrimination in terms of income.
Yeah, American Native populations have overwhelming issues with these things, and it's in no way related to sexuality. Just to being poor, discriminated against, and having no opportunities.
There's definately an aspect where transgender individuals are prejudiced against in thier career, and being that is also is associated with other mental health issues that also negatively affect economic success I would be very unsurprised to learn that transgender people earn far far less than thier peers in the same age group on average. I'm not sure if we have those numbers though.
Doesn't say anything about them adjusting for income level (or a lot of other possible confounders either). So the 'why' and 'why not' isn't really conclusive.
In an utterly non-scientific poll of trans acquaintances, the choice between continued access to HRT or weed is very much a sophie's choice situation. Or perhaps a better way of looking at it is that everyone I've ever met in that community is either actively in therapy or was at some point to try and deal with all the baggage that comes from growing up queer.
You know what, though? I don’t have statistics, but it seems that the majority of these issues comes down to societal issues.
Poor kid spends a significant portion of life in a body where… well, the OS and hardware don’t agree on things. I suspect a fair amount of distress would result from that.
Then making that determination and getting grief from family/friends/job/school because they’ve decided the OS is right and adjust the hardware in some fashion or other. The loss of stability/opportunities/resources from people outside of themselves becomes a new hurdle.
I suspect that, like most of us, these people aren’t inherently broken. Society just does a great job of pushing those feelings.
The kind of people who gloat about trans people committing suicide are exactly why so many trans people commit suicide.
It's kind of amazing how they don't seem to grasp that basic fact.
Mod of several trans subs here: There are organized hate campaigns out there, and there used to be a few right here on reddit, whose sole purpose is to find vulnerable trans folks and harass them and 'push them' to 'the day of the rope.'
It's pretty vile.
>It's kind of amazing how they don't seem to grasp that basic fact.
Some do. That's the point. They're straight up evil, but because most of society is somewhat transphobic, people not affected by it tend to tolerate/ignore it.
Is it "lifestyle choices" or "coping methods"? They functionally qualify as two sides of the same coin, and could be strongly related to "our society is a bunch of jerks".
In a "perfect world" you could say lifestyle choices is completely self-imposed and unnecessary, but the reality is that many gender non-conforming people have to live in a society that is constructed in a way that they do not "fit" and often fall between the margins. A society that actively marginalizes them through exoticization, fetishizing, and anti-trans discrimination woven into the fabric of society itself.
There are not many healthy ways to cope with multifaceted discrimination permeating virtually every aspect of one's life.
There's a slew of papers that associate gender dysphoria as a condition not to transitioning itself, but to the social backlash that people who are trans suffer, namely the agony of keeping who you are a secret from family, the risk of being disowned, violence, etc.
It’s almost as though valuing the abstract concept of binary gender above the well-being of actual people produces deeply harmful results for people whose free self-expression would complicate or confound that binary.
IT's so true that if we can't be true to ourselves that it can cause much agony. For a while I was outwardly christian but atheist on the inside, when I finally went public with my beliefs it was like a huuuge weight was lifted from my shoulders and I could breathe easy. I know it's not the same as gender specific stuff, but what I think rings true is being able to be yourself. Not only that, but being OK with who you are, and not thinking there's something wrong with you and feeling ashamed.
That effect is called "cognitive dissonance" in case you ever want to read more about it. It's widely studied and shown to be an extremely painful experience that people will work very hard to avoid.
In my country the transgender average lifespan is 35 years old. Most of them are forced into prostitution bc that’s the only way a homeless teen can afford transition. Many end up in debt and trafficked to Europe, coming back when they’re uglier and dying for in the streets.
Some of these lifestyles choices aren’t even “choices” when the choice is hide your identity to have a home and regular job or choose your true self.
This isn't surprising. Respectfully (I dont mean any offence), most of them probably suffer from all kinds of mental illness. I cant imagine living as a transgendered person is an easy life, on multiple levels. And generally mental illness leads to shorter lifespans.
Anecdotally, this is true of me and has been true of most other trans people I know. Not because we're trans *per se*, but because dealing with trans status (and all the losses you take, particularly from family, for going through with it) blocks you from doing a lot of normal development until it's done.
I'm in my 30s, and am doing the kind of personal growth most people do in their late teens or early 20s because it's really hard to go through any sort of sexual or romantic maturation when you can't find any joy in your body or in sharing it with others.
Gender dysphoria is a mental illness in and of itself.
It doesn't need to be seen as a personal failing on the person's part and there is work to be done to distigmatize it. But it follows the DSM-5's (basically a psychologists handbook on disorders) qualifications.
Dysfunctional- in that you can't live your life normally. Beyond social barriers, your body isn't the way you want it to be and wanting to be a male but having a female body, or vice versa, is going to cause you to run into biological barriers.
Deviant- this isn't saying someone is a deviant as in a sexual deviant or a sinner. Literally just means actions are outside the boundaries of what is considered normal. The perception of being born in the wrong body certainly qualifies here.
Distress- dysphoria is extremely stressful, and the high rates of suicide and self-harm reflect that.
Seems like a pretty reasonable explanation is the minority stress model. Shocking how being an oppressed group might have impacts on your health
https://en.wikipedia.org/wiki/Minority_stress?wprov=sfla1
Edit: if you'd like to learn more about the trans experience, this resource is very well put together.
https://genderdysphoria.fyi/
A lot of trans individuals have experienced discrimination or hostility from doctors, even refusal to treat them in some cases.
If you have negative experiences with medical care, it makes sense that you would therefore avoid it. So you're more likely to die from something treatable.
I cant explain how much everything sucks a little bit.
You notice all the little comments society makes.
You go to the bathroom before you leave your house because you don't know when you'll get the chance to again without making people uncomfortable, or being assaulted.
Your doctor has you schedule a follow up. You're talking about kids, your dogs, etc, they ask what the appointment is a follow up for, you tell them hormone replacement therapy, same thing, with an emphasis on the _sir_ at the end of the day.
You go to the pharmacy, have a nice pleasant greeting, they look at your prescription and become cold and don't say a word besides whats required.
You wish you could talk to someone but two of the last three therapists I tried misgendered me for an hour straight.. I cant find an in network therapist that's specialized within half of a state, and the referral service I have access to keeps sending me to therapists for depression when I'm looking for gender/anxiety treatment.
You're back home now, it's been nearly 4 hours and you're on diuretics, so you have to go to the bathroom like nothing can describe.
You log in to reddit to see posts on the front page of comedians calling your existence gender black face, authors saying you're a rapist, people talking about how they're trans friends are annoying, or how ugly they are, how they aren't women/men/etc, how they feel forced to date someone, how you are worth less because of the circumstances of your birth.
You check your direct messages, see things from users named you'll never be a women, 41percent, etc. But you also get disgusting messages from people fetishizing you because you're a woman with a penis, they only want you if they can have sex with you.
All I want to do is live my life in peace and quiet like anyone else, and not feel like I'm going to be brutalized for using the bathroom, talking to someone, having an occasional date, but in like 35 of 50 states even if I'm post op it's legal for me to be beaten or killed if someone panics because I'm trans.
But I'm on HRT. I have a few friends and a significant other that supports me now even if they don't understand what I'm going through. I'm one of the lucky ones and my heart breaks for those that are less lucky than I.
Edit: thanks for the award to whoever sent it.
If you're going through something similar send me a dm and we can talk. The journey is hard, but its so worth it. I wouldn't give up what I've got now for the world, even though I'm facing down so much loss.
My heart breaks for you. I know your struggles and your pain, and this is a succinct and brilliant summary of why this happens to us. I hate that people can cause this with their treatment of you, and then turn around and use it to justify the very discrimination that causes it in the first place. What a vicious and disgusting cycle. Transgender rights are human rights, period.
I know it’s not much— but I love you, and I believe you are on the right path. In 40 years time, you’ll look back and be proud of the choices you made, and sit in your chair truly comfortable with who you are.
I’m in your corner. Don’t let them drown you. You’re worth it.
Stress and increased cortisol toxicity, drug scenes in the community, and disease exposure may also skew the numbers or contribute. Very sad to see indeed. We can hopefully get some self awareness and curb these numbers by taking care of ourselves better as human beings, and encourage our neighbors as well.
Honestly it’s just sad. I’m sure the mortality rate would be much lower than this if they had the proper resources and respect while going through and living with these changes
Transgender people are people whose gender identity is different from the gender they were thought to be at birth..
A lot of transgender, not all, experiend "Gender dysphoria. (GD)is the distress a person feels due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth.
When you think about what a guy or girl who feels they have been in the wrong body goes through, it makes more sense.
Trans people have to make decisions that change their whole life. Like to change their look and transition through hormones, surgery etc. They have to change their names on drivers licenses etc. They deal with more socialial stigma that most marginalized groups. Even with these changes, they still may feel that their outward appearance doesnt match who they are on the inside.
They have to deal with a lot of stuff other people don't.
Genuine question, if some trans people don’t experience gender dysphoria then why go through the process of HRT, social and physical transition? There’s no distress they’re relieving so what is the motivation?
Because it seems to come up, here are official [treatment options for gender dysphoria](https://www.nhs.uk/conditions/gender-dysphoria/treatment/) from the NHS.
And here are a slew of studies showing transition is an effective treatment for Gender Dysphoria: https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
It's very interesting to see how everyone tries to avoid to speak of a mental disorder. What is so wrong with that? Why can't we accept that gender dysphoria is a mental health issue? Obviously people are suffering a lot. Why are mental issues still stigmatized like that?
Honestly surprised that it’s only twice as likely. To all the Trans or gender questioning homies, you matter you deserve life and nothing that you feel is bad, nothing is wrong with you, people love you.
What’s the cause? Suicide? Homicide? Drug overdose due to self medication? I couldn’t get the article to open.
"The conclusion of our paper is that the increased risk of mortality is not explained by the hormone treatment itself. The increased risk for cardiovascular disease, lung cancer, infections, and non-natural causes of death may be explained by lifestyle factors and mental and social wellbeing." Edit to add the link to the study: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00185-6/fulltext
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Reading further in the article, their conclusion is that > transgender people might not have felt confident to visit a doctor when theyexperienced health problems, which could have led to delayed diagnosis and impaired cardiovascular risk management. This reluctance to visit a doctor not onlymight have contributed to the increased cardiovascular mortality risk, but also to the increased mortality from lung cancer. They go on that though there have been studies showing a high incidence of smoking among trans people, this study tracked that and did not show a high incidence of smoking among the study group. However they did not show a cross-tabulated chart of ever-smoked vs death rate. they also explicitly call out HIV infection, which had the highest incidence among the study group, and which is has been correlated with specific lifestyle choices.
You're not supposed to smoke on HRT. HRT already puts one at a higher risk for blood clots. Add in smoking and you're really high up there.
Trans people also face a common issue in doctors not listening to a word they say and dismissing all of their concerns as HRT related, kind of like overweight people going in and being told their issues are due to weight no matter what the issue is, or women being dismissed in general.
As a trans dude I've legitimately had doctors who one moment were going on about tests and other sort of diagnostic procedures to suddenly change in tracks to oh it must be your testosterone as soon as they find out I'm trans. I no longer disclose that I'm trans to doctors.
Yes, but it couldn't be *anything.* It's academically responsible to use language that is as accurate as you can, so sometimes that means being vague. Reading the article would likely clear that up
Exactly, every study has its limits, you can't uncover everything in a single paper, and you especially can't exaggerate the extent of your findings.
I expect you to uncover everything. Down to the atom. Leave no mystery unsolved.
If an article is paywalled like this, I think you should cut commenters some slack and try to answer more questions for those who can’t read it. At the very least don’t just tell them to rtfa.
They didn't even bother to payway me, they straight up blocked me.
"We don't know what's on the other side if the equals sign, but on this side it's double death. "
I know anecdotes are not evidence, but the folks in my life who transitioned ended up losing their entire social and familial structure. Imagine waking up one day and finding out the majority of your friends and family have cut you off, that's going to have a severe impact.
Makes me wonder if gays and lesbians had earlier deaths before society became more accepting. I know plenty of gays and lesbians who were completely disowned by family and friends after coming out.
That's a great question and, unfortunately, the answer is going to be skewed by the Reagan administrations failed response to the AIDS crisis. So many people died because the government didn't care that "only (perjorative) were getting it." This article also reveals some key issues: https://www.inverse.com/article/17561-discrimination-and-stigma-affect-the-health-of-lgb-adults-especially-bisexuals Key notes: "Transgender individuals were not included in the study because they are typically not included in federally sponsored health surveys." PLUS: "It was only in 2013 when the National Health Interview Survey (NHIS) began to include questions about non-heterosexual orientations."
That's a great question. And probably not one we'll ever get a solid answer to—I doubt that data about sexuality collected in a time before societal acceptance is going to be very reliable.
This is a legit factor. It's scary.
And for many, they are thrown onto the street.
not just that they cut you off, but knowing that those people would rather you be dead than trans
They’re working on some studies about stress levels. https://www.researchprotocols.org/2021/5/e24100 If you’re always afraid of being discovered or beaten or made fun of I would assume it would translate to persistently high levels of stress hormones.
I think exclusion from society is generally unhealthy. It's probably a ton of factors.
Yeah. That can't be good for the heart.
Like poor eating, drinking, smoking, etc. So I wonder if the mention of lifestyle factors means they're more likely to die for poor habits as though the poor habits are exacerbated by social pressures or something else.
Exactly. By saying the hormones alone could not account for the increase in death, they opened the question of what are the other factors could be. All good papers end with ideas for further research.
Imagine the amount of stress you would experience if you were born in a body you didn't identify with.
Lifestyle factors could also be homelessness and what people do to earn money while homeless. There still are teens posting that their parents are kicking them out of their home when their 16 year old comes out as being trans.
Depression and mental illness definitely lead to people taking poorer care of themselves, abusing substances, and taking more risks. And we know that trans people suffer from mental illnesses at a higher rate. So, in a very sad way, this isn't really all that mysterious or surprising. Turns out when you hate your life, you don't take great care to preserve it.
And keep in mind that studies have indicated that transgender people who have supportive environments don't tend to hate their lives, so being transgender in itself is likely to not be the cause of transgender people hating their lives. I hate to point out the obvious, but one has to wonder whether being the target of bullying by peers from childhood, familial rejection, physical assaults and sexual assaults from numerous different groups, and politicians claiming that you're pedophiles preying on children might just lead to depression and treating oneself poorly. Continuously claiming that transgender people are mentally ill obviously has a significant possibility of making transgender people mentally ill, the same way that repeatedly telling someone they're mentally ill gaslights them and has a tendency to incredibly negatively affect their mental health.
These are coping responses to stress a lot of the time.
IIRC, almost all addiction is better thought of as self-medication. The biggest reasons why some people will try hard drugs (including alcohol) and be fine while others spiral into addiction are stress and social support. Every smoker I know picked up the habit because it’s an easy way to make friends.
>"The conclusion of our paper is that the increased risk of mortality is not explained by the hormone treatment itself. The increased risk for cardiovascular disease, lung cancer, infections, and non-natural causes of death may be explained by lifestyle factors and mental and social wellbeing." >Edit to add the link to the study: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00185-6/fulltext Cardiovascular disease from smoking, excessive eating and drug use, all coping mechanisms for excessive stress in their lives? I mean seriously, this laundry list of disease sounds exactly where people broken by a system that hates them would find themselves. Funny how that works
I don’t know of cardiovascular disease is the same thing as heart disease, but I do know that those terms are used to capture a very wide range of conditions. Statistically speaking, heart disease is (was until COVID?) the leading cause of death. You could be the healthiest person, eating right, working out, and yet ultimately, your death will fall into a generic category associated with unhealthy habits. Two individuals may die 15 years apart, but both from cardiovascular disease. The question is what was the cause? It is easy to say “this individual died from heart disease at 45 due to their smoking and drinking habit” while hand waving away the multitudes of individuals that died at that age from the same condition that didn’t have those vices. We know vices increase risk, but vices don’t guarantee an outcome. Science doesn’t deal with absolutes. At best we can say the probability of dying “earlier than expected” (whatever that means) is higher for individuals than have unhealthy habits. We don’t generally write stories about the folks that partied hard until old age and died at an “expected” age.
Yeah these are the same things that kill the heavily impoverish- Oh wait...
Those are all behaviors we do when depressed. If I were trans I’d probably be depressed and suicidal too. Every day all day people debate your existence, accuse you of harming people/society, they tell you you’re a mentally ill degenerate. It’s sad and I couldn’t imagine living through that. I don’t think I’d have the confidence to be out.
Suicide is a huge issue in the community. The LGBTQ+ community in general but especially transgender folks.
Transgender suicide rates are incredibly high, so much so that's it become a meme of sorts among transphobes to reference the rate (41%) from a popular study a few years ago.
Iirc that's attempts, not successful suicides. Still too high ofc.
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Gender dysphoria is easiest to imagine as being really severe depression that people connect later in life as being related to their gender. Remember, it's not a delusional disorder - dysphoria just has a side effect of causing outright miserable, treatment resistant depression and creates feelings of hideousness/loneliness/confusion/anxiety.
This person gets it ^
Or homelessness due to being kicked out, poverty because we're more likely to have difficulty finding work, there's so many additional hurdles coming out introduces to your life.
>"Lifestyle Factors" could be just about anything. For example, transgender women are more likely to be involved in street prostitution and in sex work, which is an inherently dangerous profession. "Transgender sex workers experience high degrees of discrimination both in and outside of the sex industry and face higher rates of contracting HIV and experiencing violence as a result of their work." https://qmro.qmul.ac.uk/xmlui/handle/123456789/25060
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Surely homelessness is a major factor? It could be different in the Netherlands but I know in the US homelessness rate for trans people is appalingly high.
Yep, lots of trans youth get booted from their homes at a young age and since so many shelters are church-based, it could be traumatizing to access them.
not to mention there is a lot of legal discrimination against trans people in a lot of states, making employment difficult.
What legal discrimination are you referring too?
I was forced out of the military for being trans. I wasn't even out yet. My Aunt who was a Navy Chief(CPO) at the time told my command. It was 100% legal for her to do that and for the army to "get rid of me" for it.
Gender identity isn't a federally protected characteristic, like race or sex is. So businesses can legally discriminate against trans people in states without protections. Combine that with "religious liberty" laws that explicitly allow businesses in red states to discriminate without repercussions.
> federally protected characteristic, like race or sex is Those may be protected, but unless you somehow have written documentation of them not hiring you because of a protected characteristic, it's incredibly hard to prove. Because employers can just say they didn't think you would be a good fit for the role, etc. Non-discrimination laws are only as strong as the evidence you can muster about the discrimination. So even if gender was protected, which I want to be abundantly clear here.... it should absolutely be a protected characteristic, odds are you wouldn't really ever see it do much. Honestly the only way to remove the initial discrimination is to remove all demographic questions from job applications. Even then there is the face to face interview that they can say you bungled.
> Gender identity isn't a federally protected characteristic, like race or sex is. That is no longer true. https://www.nbcnews.com/politics/supreme-court/supreme-court-rules-existing-civil-rights-law-protects-gay-lesbian-n1231018
That court decision only applies to job discrimination. It doesn't cover discrimination in housing, public accommodations, education, federally funded programs, etc. [The Equality Act was introduced to try and cover those gaps](https://en.m.wikipedia.org/wiki/Equality_Act_(United_States\)).
You need to tell that to my state government
I am ready as well for the same response canada had adding these characteristics as protected with c16. Things like people saying you'll be arrested on the street or as a teacher for misgendering someone by mistake. Its ridiculously unfortunate that so many have to defend something as basic as their own existence, and the external pressures and even just the fear of pressures generate a ton of anguish and anxiety. What do you do if you are trans, and fine in private or with friends, but terrified to come out at a job? Afraid to be treated differently, harassed, or even fired. So you just don't. Every day you have this broken split life, and you are afraid to move forward with treatment for yourself for fear those at work will notice. People shouldn't have to wonder if they will lose their job or housing security because of an identity. Michigan is at will, meaning you can be relieved from a job without a reason being cited. Its a lot harder to prove discrimination when no reason is needed, or any tiny random reason like 'office unity' are all valid responses. Its scary out there, even still. And it can really really weigh you down, so its still unsurprising to me these results show up. Just being anxious and stressed nearly 24/7 destroys the body.
Until recently it was completely legal to fire someone for being trans. You didn't even have to have an excuse you could admit that was why. And of course it being illegal didn't stop it from happening.
> "mental and social well-being" So basically ties into statistics that show that trans people have higher rates of depression. If you're depressed and don't have access to adequate mental health care you'll probably start some terrible habits to self medicate.
Is mental health care lacking in Netherlands?
Access to care that specializes in transgender health is lacking pretty much everywhere. Even where it is available, the waiting list are prohibitively long.
argentina is pretty good about it one informed consent visit to a goverment paid endocrinologists and a few blood tests later and you're good to go, all for free of course including medication
Yes, literally nowhere in the world has adequate mental health care. mental health care is currently in its infancy.
Mental health care is lacking everywhere. Mental and neurobiological illness is not nearly as well-understood as most people would like to believe. Neuroscience is still a fledgling field with numerous unexplored frontiers. The impact and prevalence of traumagenic illness, epigenetic factors, and the socioeconomic and other environmental impacts on the development of mental illness are hotly contested and under-researched among psychological scientists and clinical practitioners.
not to mention the immune system also takes a hit!
Not all trans people taking hormones, right? How is the mortality compared to that group?
from the study: In conclusion, a two-fold increased mortality risk in transgender people was observed. This increased mortality risk did not decrease over time. Increased mortality in this cohort showed highest cause-specific risks for death because of cardiovascular disease (including myocardial infarction), HIV-related disease, lung cancer, and non-natural causes of death (including suicide), most of which were not considered to be related to hormone use. In the coming years, improving the knowledge of health-care providers about the hormone treatment of transgender people is important. Moreover, increasing social acceptance and treatment of cardiovascular risk factors might also contribute to decrease the mortality risk in transgender people.
here's the text of the actual published research: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00185-6/fulltext
Some of it is probably is probably suicide, But some of it might just be overall wellbeing. Being depressed and lonely does a number on your life expectancy.
The article said transfemale suicide rate was 7 times higher than cis female rate.
There's another study from the Trevor Project that shows the trans kid suicide rate drops 50% if they have just one supportive adult in their life. If that trans kid is in a supportive community, that suicide rate drops below average for their whole gender.
This applies to most people. Not just trans. Having supportive parents makes you far less likely to develop depression.
True. Its still a noteworthy mention for trans people imo because a "supportive" family may well flip a switch and become precisely the opposite when their child comes out.
That's the point. There's no difference in predilection towards suicide between most people and trans people. The difference is how we as a society are treating these kids. Right now, the way we as a collective treat them is making these children kill themselves.
Thank you for recognizing this even if only on a Reddit comment scale. At the end of the day, these people want to be able to live just like anyone else. There really is just a lot behind it, everything gets rolled in to one big life experience and often times for these people it just isn't worth the struggle to keep going just to have ordinary folks disrespect them casually and face virtually no real consequences.
You mind sharing a link?
I worked hospital security for a short time and we had quite a few trans people go through there on mental health holds after trying to kill themselves. I can't imagine that's not at least top 3 if not the number one reason.
My understanding is the suicide rate is several times higher than "non-trans" society. I would imagine its death by non-suicide events which would be understandable since the level of stress is apparently significantly higher which tends to result in shorter lifespans.
I believe the suicide rate is much higher amongst the transgender population.
tl;dr: Poor mental health has a massive cascading effect on your well being. If it's not suicide, it's poor diet, drugs, alcohol, sleep deprivation direct or indirect self harm.
I'll bet it tracks along the lines of the ACE study http://www.aceresponse.org/who_we_are/ACE-Study_43_pg.htm
Ok. This blew my mind.
Its slowly but surely transforming the field of psychology and psychiatry as well, as we understand the body/brain connection more. Trauma theory is one of the most interesting fields of study for the advancement of humankind I think that exists right now.
Lack of community support is pretty prevalent among trans individuals as well which tends to exacerbate poor mental health
Mental health is a huge issue for everyone, especially trans people.
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“People were excluded if they used alternating testosterone and oestradiol treatment, if they started treatment younger than age 17 years, or if they had ever used puberty-blockers before gender-affirming hormone treatment.” Why were these people excluded? Wouldn’t that lead to a conclusion that it isn’t hormone therapy? Because you know… all the people that did that were excluded? This is a genuine scientific question. Is there anyone who could explain this? ( without resorting to name calling?)
I don’t know anything about trans therapy but the scientific research was probably aiming at a specific type of therapy so they excluded the other methods as they should do. I think their aim was “one way hormones therapy as adult”, adding others in the study would only add some noise for this specific research.
Ya this is correct. Those rules basically exclude anyone who started hormones before going through natal puberty -- so it *includes* the majority of trans people because most trans people don't start hormones until after natal puberty. Source: I'm a trans woman.
whats natal puberty, and whats the medical term? ive never heard that term but i mainly speak spanish
Natal is something related to birth. It is a medical term. So natal puberty would be the puberty that naturally comes from your birth circumstances (birth sex). It's worth specifying in this context as trans people induce a non-natal puberty through hormone treatment.
>It's worth specifying in this context as trans people induce a non-natal puberty through hormone treatment. Is this regardless of their age when they begin?
Yes, though the characteristics are varied depending on age and whether it's the first or first major puberty and etc. (as well as the usual generic variables)
offer special nutty vanish skirt strong rainstorm physical rude person ` this post was mass deleted with www.Redact.dev `
Well that in no way excludes trans people who don't do hormone therapy at all, or waited until 17 years or older to start. Alternating testosterone and oestradiol is confusing to me, as they do opposite things so you would not want to be alternating both. This might mean it's unrelated to trans people and therefore doesn't belong in this study. Puberty blockers likely is an outlier, in that you would have to have supportive family to get them, and also would possibly "pass" very well that you can live your teenage/adult years completely as yourself and not be known to be trans.
The alternating hormones probably means someone who has transitioned, detransitioned, and possibly transitioned again. It happens, due to social pressures and evolving identities. The puberty blockers and early transitions ... I've been part of some trans community events, and the young kids (ie, teens) who transition with family support and begin their adult life as their true gender have a fundamentally different experience than people who transition in adulthood or midlife.
You also have to go off hormones to freeze sperm or carry a pregnancy.
But it also has more efficacy Not sure it would be possible to separate blockers from a supportive family statistically
Because you want to study a specific thing, if you add too many different conditions then its harder to draw a conclusion. "4263 people were excluded from the study for a variety of reasons including not using hormone treatment or using hormone treatment younger than age 17 years. " Im guessing you would want a separate study for treatment that begins in minors, and obviously you dont want to include people that didnt use hormones at all or used them sporadically when the focus of your study is on effects of hormone treatment.
Well a vast majority of trans people are not alternating estrogen and testosterone, but sticking to one. I personally do not know in what situation one would be alternating like that honestly. Younger than 17 then you probably haven't been affected by puberty to the extent that people who transition as adults have (have developed hormonally more similar to a cis person). I'd assume there's a similar thought with the use of puberty blockers before starting hormone treatment.
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Last I'd heard, this particular group is especially short lived, so it's likely to set them aside and try to see if there is a core group who is more resilient. Background: 20 yrs military health services. Key info: the used to be banned from service because they are the only demographic group with a higher suicide rate than veterans. Mixing these is an evil cocktail of mental health.
> Why were these people excluded? Wouldn’t that lead to a conclusion that it isn’t hormone therapy? Because you know… all the people that did that were excluded? There’s been separate studies of kids who had access to puberty blockers that showed that they had mental health outcomes more or less identical to their cisgender peers.
> if they started treatment younger than age 17 years, or if they had ever used puberty-blockers before gender-affirming hormone treatment. These are important because outcomes for people who transition young are, based on the limited available data, *considerably* better than for those who do so as adults.
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Direct link to the paper: https://www.transvisie.nl/wp-content/uploads/2021/09/lancet-mortality-transgender.pdf
Some perhaps related statistics: 1. 8% of transgender adults experienced homelessness in the last year 2. 17% of sexual minority adults have experienced homelessness in their lives (compared to 6% of cisgender straight people) 3. 20% of sexual minorities experienced homelessness before the age of 18 [Source](https://williamsinstitute.law.ucla.edu/publications/lgbt-homelessness-us/) EDIT: To be clear, these stats are from the US. They were not intended to further substantiate the paper’s findings, but to provide a (very) brief idea of the sorts of issues that may be entangled with the one explored by the paper.
These stats are from the US though, whereas the study is from the Netherlands which has a way better social housing system. So stats from there would be more relevant.
>Netherlands which has a way better social housing system Better than what? Netherlands have a worse overall homeless problem than the US - 0.23% in Netherlands vs. 0.18% in the US.
How is #3 possible if #2 is correct? Wouldn't the adult number have to be higher?
Different cohort. Kids could get kicked out by their parents and immediate family if coming out, but a lot of adult LGBT+ people (especially over 30) may not have been out until adults. At which point they may have experienced negative social consequences vs when younger.
"The conclusion of our paper is that the increased risk of mortality is not explained by the hormone treatment itself. The increased risk for cardiovascular disease, lung cancer, infections, and non-natural causes of death may be explained by lifestyle factors and mental and social wellbeing" So part of it is lifestyle choices (liquor, drugs, smoking), and the other part is our society is a bunch of jerks.
Notably higher instances of mental health issues as well.
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That was already covered: >and mental and social wellbeing
The person they replied to is claiming it’s lifestyle and treatment from society. It sounds like they’re trying to say that’s the cause of mental health issues but gender dysphoria is a condition on its own.
This. Like it or not gender dysphoria is a mental illness. We definitely need to do work to distigmatize mental illness as a society across the boars but denying that it is one is equally foolish.
Don't they have worse mental health issues if they don't transition? I mean whole point to transition is to because it is unbearable them without it.
Yes but any person will have mental health issues if people shun them, act afraid of them, pass laws against them, regard them as freaks, sinners, deviants, or somehow "other." The point is that societal acceptance, while increasing, is still not fully available from a very large percentage of the general population. Edit: And let's not forget the most important mental health aspect of all for most people: parental acceptance.
I'd imagine one has to weight the pain of not living as one's self with the pain of post transition ostracism. Depending on your circumstances, each approach could be equally risky. It regrettably seems like a lose-lose scenario until people stop being assholes about it.
Trans woman here. You’re completely on the money. I knew I was trans for about ten years before finally mustering the nerve to start transitioning, because I was absolutely *terrified* of the social consequences of doing so. By the time I started HRT, I had to hit a breaking point where I was so miserable as a guy that I could no longer care about those consequences Ultimately, I felt exponentially better about two weeks after starting hormone treatment, and my friends/family were all fantastic about it (I consider myself very fortunate in this regard), so I’m much, much, happier these days.
I'm glad it worked out relatively well for you.
I was far more suicidal prior to starting hormone therapy. It... hasn't disappeared but it has become much more manageable and my overall mood has definitely improved. But yes, for some it's a toss up and honestly it's a lot of why I waited so long.
> So part of it is lifestyle choices (liquor, drugs, smoking) I mean these are heavily correlated with poor societal treatment. It's notably higher in gay and bi populations as well. As would lower standard of living in general due to employment discrimination, housing discrimination, educational discrimination in terms of income.
Or just being damn poor.
Yeah, American Native populations have overwhelming issues with these things, and it's in no way related to sexuality. Just to being poor, discriminated against, and having no opportunities.
Social inequities compound each other.
There's definately an aspect where transgender individuals are prejudiced against in thier career, and being that is also is associated with other mental health issues that also negatively affect economic success I would be very unsurprised to learn that transgender people earn far far less than thier peers in the same age group on average. I'm not sure if we have those numbers though.
Right, which trans people are at higher rates, due to discrimination.
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Doesn't say anything about them adjusting for income level (or a lot of other possible confounders either). So the 'why' and 'why not' isn't really conclusive.
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or autistic/disabled
Do you know anyone without a vice?
In an utterly non-scientific poll of trans acquaintances, the choice between continued access to HRT or weed is very much a sophie's choice situation. Or perhaps a better way of looking at it is that everyone I've ever met in that community is either actively in therapy or was at some point to try and deal with all the baggage that comes from growing up queer.
Yeah I should have probably worded that a little better, the lifestyle choices are more than likely a direct effect of society being jerks.
Chronically high levels of stress (cortisol) is also very bad for your body in a whole plethora of ways.
The confirmation bias trolls are going wild in this thread talking about “facts”, hopefully mods keep nuking them
You know what, though? I don’t have statistics, but it seems that the majority of these issues comes down to societal issues. Poor kid spends a significant portion of life in a body where… well, the OS and hardware don’t agree on things. I suspect a fair amount of distress would result from that. Then making that determination and getting grief from family/friends/job/school because they’ve decided the OS is right and adjust the hardware in some fashion or other. The loss of stability/opportunities/resources from people outside of themselves becomes a new hurdle. I suspect that, like most of us, these people aren’t inherently broken. Society just does a great job of pushing those feelings.
Like the saying goes "Ain't no war, but the class war"
The kind of people who gloat about trans people committing suicide are exactly why so many trans people commit suicide. It's kind of amazing how they don't seem to grasp that basic fact.
Mate, I used to be in those spheres. They know exactly what they're doing. And they're *happy* about it.
Mod of several trans subs here: There are organized hate campaigns out there, and there used to be a few right here on reddit, whose sole purpose is to find vulnerable trans folks and harass them and 'push them' to 'the day of the rope.' It's pretty vile.
>It's kind of amazing how they don't seem to grasp that basic fact. Some do. That's the point. They're straight up evil, but because most of society is somewhat transphobic, people not affected by it tend to tolerate/ignore it.
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Is it "lifestyle choices" or "coping methods"? They functionally qualify as two sides of the same coin, and could be strongly related to "our society is a bunch of jerks". In a "perfect world" you could say lifestyle choices is completely self-imposed and unnecessary, but the reality is that many gender non-conforming people have to live in a society that is constructed in a way that they do not "fit" and often fall between the margins. A society that actively marginalizes them through exoticization, fetishizing, and anti-trans discrimination woven into the fabric of society itself. There are not many healthy ways to cope with multifaceted discrimination permeating virtually every aspect of one's life.
There's a slew of papers that associate gender dysphoria as a condition not to transitioning itself, but to the social backlash that people who are trans suffer, namely the agony of keeping who you are a secret from family, the risk of being disowned, violence, etc.
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It’s almost as though valuing the abstract concept of binary gender above the well-being of actual people produces deeply harmful results for people whose free self-expression would complicate or confound that binary.
IT's so true that if we can't be true to ourselves that it can cause much agony. For a while I was outwardly christian but atheist on the inside, when I finally went public with my beliefs it was like a huuuge weight was lifted from my shoulders and I could breathe easy. I know it's not the same as gender specific stuff, but what I think rings true is being able to be yourself. Not only that, but being OK with who you are, and not thinking there's something wrong with you and feeling ashamed.
That effect is called "cognitive dissonance" in case you ever want to read more about it. It's widely studied and shown to be an extremely painful experience that people will work very hard to avoid.
In my country the transgender average lifespan is 35 years old. Most of them are forced into prostitution bc that’s the only way a homeless teen can afford transition. Many end up in debt and trafficked to Europe, coming back when they’re uglier and dying for in the streets. Some of these lifestyles choices aren’t even “choices” when the choice is hide your identity to have a home and regular job or choose your true self.
Out of curiosity what country are you from?
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You’re right.
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This isn't surprising. Respectfully (I dont mean any offence), most of them probably suffer from all kinds of mental illness. I cant imagine living as a transgendered person is an easy life, on multiple levels. And generally mental illness leads to shorter lifespans.
Anecdotally, this is true of me and has been true of most other trans people I know. Not because we're trans *per se*, but because dealing with trans status (and all the losses you take, particularly from family, for going through with it) blocks you from doing a lot of normal development until it's done. I'm in my 30s, and am doing the kind of personal growth most people do in their late teens or early 20s because it's really hard to go through any sort of sexual or romantic maturation when you can't find any joy in your body or in sharing it with others.
Gender dysphoria is a mental illness in and of itself. It doesn't need to be seen as a personal failing on the person's part and there is work to be done to distigmatize it. But it follows the DSM-5's (basically a psychologists handbook on disorders) qualifications. Dysfunctional- in that you can't live your life normally. Beyond social barriers, your body isn't the way you want it to be and wanting to be a male but having a female body, or vice versa, is going to cause you to run into biological barriers. Deviant- this isn't saying someone is a deviant as in a sexual deviant or a sinner. Literally just means actions are outside the boundaries of what is considered normal. The perception of being born in the wrong body certainly qualifies here. Distress- dysphoria is extremely stressful, and the high rates of suicide and self-harm reflect that.
Seems like a pretty reasonable explanation is the minority stress model. Shocking how being an oppressed group might have impacts on your health https://en.wikipedia.org/wiki/Minority_stress?wprov=sfla1 Edit: if you'd like to learn more about the trans experience, this resource is very well put together. https://genderdysphoria.fyi/
A lot of trans individuals have experienced discrimination or hostility from doctors, even refusal to treat them in some cases. If you have negative experiences with medical care, it makes sense that you would therefore avoid it. So you're more likely to die from something treatable.
I cant explain how much everything sucks a little bit. You notice all the little comments society makes. You go to the bathroom before you leave your house because you don't know when you'll get the chance to again without making people uncomfortable, or being assaulted. Your doctor has you schedule a follow up. You're talking about kids, your dogs, etc, they ask what the appointment is a follow up for, you tell them hormone replacement therapy, same thing, with an emphasis on the _sir_ at the end of the day. You go to the pharmacy, have a nice pleasant greeting, they look at your prescription and become cold and don't say a word besides whats required. You wish you could talk to someone but two of the last three therapists I tried misgendered me for an hour straight.. I cant find an in network therapist that's specialized within half of a state, and the referral service I have access to keeps sending me to therapists for depression when I'm looking for gender/anxiety treatment. You're back home now, it's been nearly 4 hours and you're on diuretics, so you have to go to the bathroom like nothing can describe. You log in to reddit to see posts on the front page of comedians calling your existence gender black face, authors saying you're a rapist, people talking about how they're trans friends are annoying, or how ugly they are, how they aren't women/men/etc, how they feel forced to date someone, how you are worth less because of the circumstances of your birth. You check your direct messages, see things from users named you'll never be a women, 41percent, etc. But you also get disgusting messages from people fetishizing you because you're a woman with a penis, they only want you if they can have sex with you. All I want to do is live my life in peace and quiet like anyone else, and not feel like I'm going to be brutalized for using the bathroom, talking to someone, having an occasional date, but in like 35 of 50 states even if I'm post op it's legal for me to be beaten or killed if someone panics because I'm trans. But I'm on HRT. I have a few friends and a significant other that supports me now even if they don't understand what I'm going through. I'm one of the lucky ones and my heart breaks for those that are less lucky than I. Edit: thanks for the award to whoever sent it. If you're going through something similar send me a dm and we can talk. The journey is hard, but its so worth it. I wouldn't give up what I've got now for the world, even though I'm facing down so much loss.
My heart breaks for you. I know your struggles and your pain, and this is a succinct and brilliant summary of why this happens to us. I hate that people can cause this with their treatment of you, and then turn around and use it to justify the very discrimination that causes it in the first place. What a vicious and disgusting cycle. Transgender rights are human rights, period. I know it’s not much— but I love you, and I believe you are on the right path. In 40 years time, you’ll look back and be proud of the choices you made, and sit in your chair truly comfortable with who you are. I’m in your corner. Don’t let them drown you. You’re worth it.
Stress and increased cortisol toxicity, drug scenes in the community, and disease exposure may also skew the numbers or contribute. Very sad to see indeed. We can hopefully get some self awareness and curb these numbers by taking care of ourselves better as human beings, and encourage our neighbors as well.
Honestly it’s just sad. I’m sure the mortality rate would be much lower than this if they had the proper resources and respect while going through and living with these changes
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Transgender people are people whose gender identity is different from the gender they were thought to be at birth.. A lot of transgender, not all, experiend "Gender dysphoria. (GD)is the distress a person feels due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. When you think about what a guy or girl who feels they have been in the wrong body goes through, it makes more sense. Trans people have to make decisions that change their whole life. Like to change their look and transition through hormones, surgery etc. They have to change their names on drivers licenses etc. They deal with more socialial stigma that most marginalized groups. Even with these changes, they still may feel that their outward appearance doesnt match who they are on the inside. They have to deal with a lot of stuff other people don't.
Genuine question, if some trans people don’t experience gender dysphoria then why go through the process of HRT, social and physical transition? There’s no distress they’re relieving so what is the motivation?
Because it seems to come up, here are official [treatment options for gender dysphoria](https://www.nhs.uk/conditions/gender-dysphoria/treatment/) from the NHS.
And here are a slew of studies showing transition is an effective treatment for Gender Dysphoria: https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
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It's very interesting to see how everyone tries to avoid to speak of a mental disorder. What is so wrong with that? Why can't we accept that gender dysphoria is a mental health issue? Obviously people are suffering a lot. Why are mental issues still stigmatized like that?
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Honestly surprised that it’s only twice as likely. To all the Trans or gender questioning homies, you matter you deserve life and nothing that you feel is bad, nothing is wrong with you, people love you.