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A new study reported in Crikey has examined the overwhelmingly negative way trans and gender-diverse people (for readability simply referred to as trans people) are reported on in the news media. This article intends to be a palate cleanser for such media reporting — by bringing some facts to the trans debate.

So you think you can trans

A 2018 survey of Australians in years 10 to 12 found that 2.3% identified as trans and gender-diverse. That’s roughly 35,000 trans Australians in that age group alone.

Exploring and establishing one’s identity is often difficult enough, without the added burden of working out something as fundamental as where one sits on the gender spectrum. Accordingly, trans people experience a disproportionate prevalence of mental health disorders such as depression and anxiety.

Fortunately healthcare for trans people is evolving rapidly. In the past five years there has been a dramatic shift away from framing gender diversity as a mental health disorder towards a model that acknowledges that normal is a big spectrum and we should get on with the business of affirming that. Hence the development of gender-affirming healthcare.

Gender and sex

Gender is how someone identifies and presents themselves; sex refers to biology. To avoid conflation, we refer to whether someone was assigned male at birth (AMAB) or assigned female at birth (AFAB), not forgetting those who are born intersex.

Not all trans people choose to have medical or surgical affirmation, and it is not a prerequisite of being trans to have either. But for those who do choose medical affirmation, hormone therapy is now as simple as a visit to the GP instead of the old model that necessitated engaging with a psychiatrist and endocrinologist.

A thorough mental health assessment is still required before gender-affirming surgery, according to the World Professional Association for Transgender Health guidelines.

If an AMAB’s gender lies in a feminine direction, they can be prescribed feminising hormone therapy. Similarly, a masculine AFAB can be prescribed masculinising hormone therapy. There are risks and potentially undesirable permanent effects associated with both these interventions and there will be a proportion of people who regret their therapy (estimated to be up to 0.6%).

But consider a “typical” medical intervention. Someone has a problem; a treatment is available. You weigh up the risks and benefits of the treatment and decide together how to proceed. For a trans person, the benefits are wholly subjective and unquantifiable; the risks are very quantifiable. So the usual arithmetic does not apply and all the doctor can do is fully inform the person of the risk. If the person accepts that risk then we proceed under the informed consent model of care.

Change

The individual success of gender-affirming hormone therapy, the inward and outward changes to the self, is determined subjectively. Blood tests monitor physiological changes for safety and medication dosage adjustment. After a brief learning curve, it’s really not that difficult for medical generalists to add gender-affirming healthcare to their skill set.

Hundreds of GPs across Australia are offering gender-affirming care to adults. People under 18 still require the written consent of both parents to proceed and people under 16 often work with specialist multidisciplinary units such as the one featured on Australian Story’s profile of the wonderful Michelle Telfer last month.

Relentless negative coverage of trans people is unhelpful and the tired reiteration of the same one joke over and over again (“omg millennials have as many genders as they do avocados”) is exceedingly tedious.

While there’s always room for progress, the reality is that it has never been easier for trans people to have their gender affirmed medically if they choose.

So if you are trans and reading this, I want you to know that there are healthcare workers out there who would love to meet you. And News Corp can fuck right off.