“Now, I wish that someone told me that when I was in high school that I could have felt like a woman when it came time to take showers in PE," Huckabee said. "I'm pretty sure that I would have found my feminine side and said, 'Coach, I think I'd rather shower with the girls today.' You're laughing because it sounds so ridiculous doesn't it?"

Yes! It does sound ridiculous. The reason it sounds ridiculous is because it is so ill informed. This quote from Governor Huckabee is representative of so many government officials who have a momentous and vicious misunderstanding about the condition of being transgender. Though many have, and will, write the following words it is apparent that they cannot be shared too often.

Even people with mental illness do not have a requirement to explain the seriousness of their condition. Would Governor Huckabee have said the same thing about someone confined to a wheelchair or a diabetic? I hope not. But, this form of ignorance permeates policy decisions being made nationwide and at the federal level. It literally impacts lifesaving healthcare. It withholds civil rights. It denies science. It has the appearance of maliciousness, but in the hope that it is simply ignorance, I will attempt to explain, once again, that being transgender is a genuine condition over which we have no more control than blue eyes.

The World Professional Association for Transgender Health (WPATH) is a worldwide organization of 1500 medical, mental health, social scientist, and legal professional members, all of whom are engaged in clinical practice and/or research that affects the lives of transgender and transsexual people. WPATH is the oldest professional association in the world that continuously has been concerned with this clinical specialty, since 1979.

They meet once a year to continuously develop the best Standard of Care for transgender people. Their work is embodied in a 105 page document; the “WPATH Standards of Care” which is regularly revised as a result of widespread study of “transgenderism”. Importantly, from their website is:

“Gender Dysphoria (GD), often associated with transsexualism, is a condition recognized in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5, 2013), published by the American Psychiatric Association. Previous nomenclature for gender dysphoria includes transsexualism and gender identity disorder (GID), conditions which are also recognized in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, published by the World Health Organization, of which the United States is a member. Nomenclature is subject to changes, and new terminology and classifications may be arrived at by various medical organizations or administrative bodies, but these events shall not in themselves change the meaning or intent of this WPATH statement.

“The criteria currently listed for GD are descriptive of many people who experience dissonance between their sex as assigned at birth and their gender identity. Gender identity is common to all human beings, is developed in early childhood, and is thought to be firmly established in most people—transgender or not—by age 4, though for some transgender individuals, gender identity may remain somewhat fluid for many years, while for others, conditions specific to individual lives may constrain a person from acknowledging or even recognizing any gender dysphoria they may experience until they are well into adulthood”

Biology. WPATH members’ research, and that of many other genetic and neuroscientists, indicates that the etiology of being transgender is likely biological. Though inconclusive, there are indications that brain structures of male-to-female transsexuals have similarities to the brains of genetic women. It is also thought that these similarities occur in utero and are the result of anomalous hormonal conditions affecting the balance of testosterone and estrogen before birth. Gender identity manifests before puberty when sexual identity is more firmly established. One of the barriers to conclusive research is the limited opportunity to study transgender brains. However, there is also continuing research into the genomic causes of being transgender. For purposes of this writing, it is probably more important to recognize the effort to identify the cause rather than the results because it validates the reality of being transgender. And, what if we ignore these indications and we are wrong? With the oft cited 41% suicide rate among transgender people, as we struggle to integrate our true selves, what would be the cost in lives?

Virtually all major universities in the United States, from the Stanford to Johns Hopkins, have gender clinics for the treatment of various forms of gender non-conformity. The following list is not intended to be exhaustive in any way, but only a sampling to reveal the breath and importance of treatment options available to gender non-conforming people as further recognition of the reality of being transgender.

• Psycho-endocrine Clinic at Columbia University Medical Center, New York, NY

• New York University Gender and Sexuality Service, New York, NY

• Children’s Hospital of Philadelphia Gender & Sexuality Development Clinic, Philadelphia, PA

• Gender and Sexual Development Program of Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA

• Gender Clinic at Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME

• Health Care for Gender and Sexually Diverse Individuals, Providence, RI

• Warren Alpert School of Medicine at Brown University

• Gender & Sex Development Program, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL

• University of Iowa Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Clinic, Coralville, IA

• Transgender Clinic at Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

• University of Nebraska Medical Center, Omaha, NE

• Gender and Sexuality Psychosocial Programs, Children’s National Medical Center, Washington, DC

• Gender Education and Care Interdisciplinary Support (GENECIS) Program (University of Texas Southwestern Medical Center and Children’s Medical Center), Dallas, TX

• Children’s Hospital Colorado’s Gender and Sexual Development Program, Denver, CO

• Doernbecher Children’s Hospital Division of Pediatric Endocrinology, Portland, OR

• Gender Management Clinic at Rady Children’s Hospital, San Diego, CA

• Arnold Palmer Hospital for Children Division of Adolescent Medicine, Orlando, FL

• Duke University Child and Adolescent Gender Care

• The Washington University Transgender Center at St. Louis Children's Hospital

• Division of Adolescent Medicine at Golisano Children's Hospital, University of Rochester

Government entities, at the State and Federal level, recognize the existence of transgender citizens. The State department allows gender changes on passports with medical certification. So does the FAA, the Social Security Administration, and roughly 34 states’ Departments of Motor Vehicles. Despite recent attempts to the contrary, the military continues to allow transgender enlistments and service.

Transgender people think about their gender nearly all the time. We dream in another gender or with gender themes. We almost always recognize that something “doesn’t fit” at a very early age; around 6, long before we can understand what it is. Cis-gender people do not have this preoccupation. When we are diagnosed, we find that transgender is consistent, persistent, and insistent. This means that it’s not an isolated manifestation, like just for Halloween. It’s continuous and stubborn. And, if we try to ignore it or “cure” ourselves, it comes back.

So, despite Governor Huckabee’s ignorant assertions, and the assumptions of others in certain policy making roles, ultimately transgender people have only one choice and it’s not our gender identity. We can enter therapy or take medications to subtly reduce our constant buzz, but after hours of talk therapy it’s a decision between a) what we can live with, and b) what we are willing to give up in order to live as our true selves. The only choice we have is to successfully navigate our condition and survive without continuous anxiety, guilt, shame, unemployment, and poverty. Or, succumb to debilitating heath conditions, mental illness, and maybe loss of life.

#Transgender