By Claudia Neuhauser, Ph.D., Associate Vice President of Research and Technology Transfer, Professor of Mathematics, University of Houston; and Brian Herman, Ph.D., Professor, Department of Biomedical Engineering and former Vice President for Research, University of Minnesota and University of Texas Health, San Antonio.
In his book Moral Freedom, Alan Wolfe suggests that “[m]oral freedom means that individuals should determine for themselves what it means to lead a good and virtuous life.” He warned, however, “that if what I’m calling moral freedom does result in a kind of moral libertarianism, […] I think it would be a disaster in the future for America.” In other words, for this philosophy to work, the populace needs to agree on the moral and ethical principles that guide society. Unfortunately, this is not the world we live in. We see political polarization, distrust in institutions, the absence of civility, and discrimination against individuals and cultures daily. Discrimination can take many forms. It can be based on ethnicity, immigration status, the workplace, gender, and sexual orientation.
We typically blog about issues that affect universities and have written about how universities deal with discrimination against underrepresented minorities and women. Discrimination based on gender identity is an area of intense focus and discussion, impacting not only universities but our country. The number of individuals identifying as LBGTQ+ on college campuses is increasing, and many colleges are trying to adapt as best as possible to create an inclusive campus climate that allows these individuals to have the same opportunities for personal and professional development as any other university student, staff and faculty.
Here we address issues the younger members of the trans community are facing. This group is being targeted through discriminatory legislative actions in conservative states that would sharply restrict access of young transgender individuals to gender-affirming care from a healthcare provider, bathrooms that align with their gender, or participation on athletic teams that match their gender identity.
We do not want to minimize the need for discussion and factual data about these and other issues impacting transgender life. Questions like how long to give puberty blockers and at what age to start hormone replacement therapy and allow gender reassignment surgery are all serious and should be answered through research and expert assessment. Similarly, under what conditions trans athletes should be allowed to compete against athletes who match their gender identity is a decision that should be made by athletic organizations with input from experts. Instead, what we are seeing is that some have “put the cart before the horse” and are using legislative fiat to regulate these issues in the absence of sufficient data.
We suggest that we should approach the issues from the viewpoint of Houston native, Texas senator, and US congressional representative Barbara Jordan (1936–1996), who said, “[w]e, as human beings, must be willing to accept people who are different from ourselves.” This is a deeply held belief in many moral systems, including Buddhism, which teaches that all sentient beings want to be happy and not suffer and that we should all show love and compassion to all sentient beings, or Christianity, which teaches compassion and kindness towards others.
Most Americans view LGBTQ+ individuals positively
Americans pride themselves on the freedom they enjoy. Surveys consistently show that as a society, we lean toward accepting the choices of people to live their lives. This extends to the acceptance of LGBTQ+ people. For instance, the percentage of adults in the US who support same-sex marriage reached 71% in 2022, a steady increase from 27% in 1996 when Gallup first asked the question. The overall acceptance of same-sex marriage has been increasing among groups that traditionally opposed it. In 2021, 55% of Republicans supported same-sex marriage, an all-time high and the first time that Gallup found most Republicans being supportive of same-sex marriage. The same survey showed that 83% of Democrats support same-sex marriage.
Even acceptance of transgender individuals appears to be relatively high: 67% of Americans said that greater social acceptance of people who are transgender is generally very good/somewhat good/neither good nor bad for our society. However, when people are asked whether changing one’s gender is morally acceptable, 78% of Liberals agree, while only 23% of Conservatives do.
Trans identities are stable
With more information about and greater acceptance of transgender individuals, there has been an increase in self-identified gender identity. While only 0.1% of Baby Boomers identify as transgender, 2.1% of Generation Z do, according to the 2021 Gallup survey.
Opinion pieces about how to support transgender youth, such as the recent one by Ross Douthat, are typically made by people with little to no understanding or personal experiences of what it is like to be transgender. One of the responses to Douthat came from a doctor and a transgender woman who pointed out the “fearmongering” that is happening when claims are made that “kids could end up having surgery without their parents’ knowledge and consent.” Another response reflects the fact that many children who are transgender know so from a very early age. Even if they do not talk about it. And that sense of identity rarely goes away. It explains why a recent study concluded that retransitions are infrequent. The study followed 317 transgender youth with a medium age of 8.1 years at the start of the study. After five years, 94% continued to identify as binary transgender and 3.5% as nonbinary. Furthermore, the study found that “transgender youth who socially transitioned at early ages continued to identify that way.”
Medical guidelines for transgender individuals
According to a recent study by the Williams Institute, there are approximately 1.6 million individuals (0.5% US adult population) who identify as transgender in the US, and approximately 300,000 of those are people between the ages of13–17, with slightly more transgender individuals identifying as women than men (39% vs. 36%). Many of the current controversies about transgender individuals are focused on those below the age of 18 and include whether children under the age of 18 should be exposed to LGBTQ+ issues at school and how to support transgender youths.
A recent NY Times article discusses the chapter on adolescent care in the forthcoming draft of the new release of the Standards of Care Version 8 (SOCS8) of the World Professional Association for Transgender Health (WPATH). The article points out that the guidelines for adolescent care have already been attacked not only by conservatives but also from within the transgender community, a sign of how difficult any consensus will be. While social transitioning, a recommendation for young children in the SOCS8, is entirely reversible, hormones and surgery are not, and at what age to start those irreversible therapies remains a topic of intense debate.
Transgender youth are vulnerable
Statistics bear out the vulnerability of transgender youth. The Trevor Project surveyed nearly 34,000 LGBTQ youth ages 13–24 in the United States. Their findings are published in the 2022 National Survey on LGBTQ Youth Mental Health. Among the youth surveyed, 45% considered attempting suicide in the previous year, and 14% attempted suicide during the same period. Transgender boys and men are at particular risk: According to the survey, 59% considered and 22% attempted suicide in the past year. Community acceptance plays a significant role in reducing suicide attempt rates of LGBTQ youth: Whereas 21% of LGBTQ youth in very unaccepting communities attempted suicide, the rate was 8% for those in very accepting communities. For comparison, the CDC 2019 Youth Risk Behavior Survey found that 18.8% of high-school-aged youths seriously considered and 8.9% attempted suicide.
Transgender youth also show higher rates of depression and anxiety. However, social transitioning can alleviate depression and anxiety, as shown in a recent study of transgender youth between ages 8 and 14 who socially transitioned with family support. The transgender youths in this study were like their cisgender peers (siblings and a control group) in self-reported depression and anxiety symptoms. Parent-reported levels of depression also did not differ among the groups. Only parent-reported levels of anxiety were larger in transgender youth than in the sibling or control group. The authors of this study pointed to limitations, namely that the families in this study were white, well educated, and of higher socioeconomic status.
When we deny young people the freedom to express their identities, we force them into hiding. An identity does not disappear by not acknowledging it. Not being allowed to acknowledge one’s identity, however, forces people to lie about who they are and hide an important part of their identity from others. Is this really the message we want to send to children and young adults? Or would we not rather have them get access to a team of doctors and psychologists who can work with their family to identify the best course of action?
Bans on transgender healthcare and legislative interference
Legislators in several states with conservative republican legislatures have introduced bills that attack transgender children and their parents. These bills have become an important campaign strategy for Republicans in deeply conservative districts who exploit the prejudices of their constituents against transgender youth.
According to the Legislative Tracker of Freedom for All Americans, there are well over 100 bills under consideration that target transgender youth, ranging from limiting access to medical care to requiring schools to out children to their parents and restricting access to bathrooms or athletics. It should not come as a surprise that “93% of transgender and nonbinary youth said that they have worried about transgender people being denied access to gender-affirming medical care due to state or local laws” and that “91% of transgender and nonbinary youth said that they have worried about transgender people being denied access to the bathroom due to state or local laws.”
The bills and executive orders come with real threats to parents who want to follow the advice of healthcare professionals to care for their children. Here are some examples: In February of this year, Texas started to send Child Protective Services to homes of families where transgender children receive gender-affirming care from a physician to investigate the parents for child abuse. Alabama was the first state to make the prescription of puberty blockers to minors a Class C felony, putting any physician at risk of spending up to 10 years in prison for following this standard treatment. On June 2, the State Surgeon General of Florida’s Health Department requested that the Florida Board of Medicine establishes its own standard of care for transgender minors, which essentially amounts to a ban on what is considered standard of care by major medical societies, like the American Academy of Pediatrics and the Endocrine Society.
The current legislative actions are not informed by science. They are driven by ideology. This extends to other transgender issues as well, including whether transgender individuals should be allowed to participate in sports on teams that align with their gender. Legislative actions on transgender girls/women’s participation in sports have taken an all-or-nothing approach. There are no nuances. Not even for prepubescent transgender girls. As legislators make these draconian laws based on the very occasional transgender athlete who competes at the highest level, they should consider that their actions affect thousands of transgender youths who simply want to live normal lives and have fun playing sports.
Accepting people who are different from ourselves
We want to return to Barbara Jordan’s quote we started with. The 2021 Gallup survey we mentioned earlier asked over 12,000 adults whether they identified “as straight or heterosexual, lesbian, gay, bisexual, or transgender.” 20.8% of adults who are currently between 19 and 25 years of age self-identified as LGBT. This is the highest percentage ever and reflects the increasing comfort level of people to accept who they are.
This gives us hope that the currently manufactured hate and vitriol against the LGBTQ+ community will outlive themselves as the younger generation gains influence in our society. Because this generation is growing up in a much more diverse society, they should be expected to be more accepting of people who are different from themselves. They will have to. If they don’t, they will not be able to deal with real and far greater threats to our democratic society that are identified in the Global Trends 2040 report of the National Intelligence Council, “tensions at all levels, from societies divided over core values and goals to regimes that employ digital repression to control populations” to “climate change, disease, financial crises, and technology disruptions.”
We suggest that one strategy for dealing with issues surrounding transgender populations (as well as other individuals who are not part of the “clan”) is to remember that all religions and most philosophies of moral existence focus on acceptance as a major principle. The process of acceptance is a mental way of dealing with issues one has difficulties wrapping one’s head around. Acceptance gives us peace of mind and restrains us from succumbing to destructive impulses like flames of rage and desires for revenge. To practice acceptance effectively requires drawing a clear distinction between the internal state of rejection and the desired state of acceptance by opening oneself up to the realities of basic human nature. The main condition for one to practice acceptance in daily life is genuine compassion and discernment. These mental factors help us to go beyond personal biases and recognize those who are different from us for who they are without judgment.