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From Where Have all the Trans Persons Come?

Transgender persons and gender diversity have been around since the beginning of time. Early Hebrew language had six terms to define gender differences: Androgyne as being both male and female, ishah for female, ish for male, tumtum for neither male or female, aylonit for a person designated as female at birth who becomes male, and saris for a person designated as male at birth who becomes a female. We now know that there are more than a dozen different gender types.

All children need to be affirmed and encouraged to be who they are. Sadly, we are living in a world that includes fake news and conspiracy theories circulating that are not based on evidence or science. Those caring for children are falsely accused of “grooming” children to be trans. There are false allegations that health care providers are performing inappropriate sex organ surgery on children. The truth is, children as young as age 3 or 4 who demonstrate consistently over the years that they are transgender, are referred to counseling to address essential gender dysphoria. When these children become teenagers, they may request medication to stop or delay their puberty changes (that cannot be reversed) and eventually may also request selected surgeries. For example, some trans boys are uncomfortable when their bodies produce breasts. They may request “top surgery” to remove part of the breast tissue. Later in adulthood, trans persons may elect to have surgical procedures to help better align their physical body with their gender identity. These surgeries are not performed lightly and are only done when requested by the trans person after assessment counseling to affirm their identity and personal choices. The World Professional Association for Transgender Health (WPATH) standards of care 8.0 provides the global science based standards for gender affirming care.

Of the 1.5 million persons in the US who are trans, there is a small number of individuals (roughly 0.2%), who express regret surrounding the procedures. They are vocal and are often used to promote misinformation and laws violating personal rights. The other 99.8% of the trans population view their transition care as “lifesaving” even if some may not be 100% satisfied with the results.


By Kari Armstrong DNP, RNC-OB, C-EFM, and Lolly Lockhart PhD RN.

References and PowerPoint presentation available upon request from


Every culture around the world has individuals whose gender identity does not match their assigned sex. In some parts of the world, those persons are isolated or stigmatized, and currently, too often put to death. Largely for that reason, historically, those people have tried to hide who they know they are. In the past forty plus years, the focus on personal rights has raised the concept of the rights of the community identified as LGBTQIA+. Laws have been passed to establish and protect their rights. For some reason, in the past many decades in the US, there evolved a cultural and social bias against this community, and now, laws against trans person’s rights. 

In the past year, across the country, states including Texas, have passed laws that ban access to gender affirming care for trans youth. Several states have also introduced legislation to make seeking or providing gender affirming care for trans youth “child abuse”. Under these dangerous laws, the goal would be to separate trans children from their parents, forcing those children into the foster care system and out of the homes with loving and supportive families. Also passed are laws that make providing or even assisting a person to receive gender care to be criminal for care providers. Consider the tragic impact that even the idea of these actions has, not only on trans persons and their families, but also all health care providers expected to care for all according to their unique needs and choices. At this time, these issues are being challenged in the courts. Meanwhile, many trans families are moving to states that continue to support trans youth who are seeking gender affirming care.

So, how are our gender and sex determined? Your gender and sex were biologically determined at birth exactly like that of everyone else and it cannot be changed. When you were conceived, you became genetically a female fetus. After 6 to 8 weeks, you experienced a release of testosterone. If it was a lower dose, your body continued to develop female sex organs and characteristics. If it was a higher dose, your body began to form male sex organs and characteristics. Then after another 6 to 8 weeks, you experienced another testosterone release. This time, if it was a lower dose, your brain continued to develop female sex/gender characteristics and perspectives such as sex preferences, choices, and behaviors. If this release was a higher dose, your brain began to develop male sex/gender characteristics and perspectives including sex preferences, choices, and behaviors. 

By the time of your birth, your sex/gender were set to determine who you are for life. Sometime as early as 3 years old, you acted according to how your brain told you, regardless of the sex of your physical body. If your loved ones tried to make you behave differently, you felt sad and frustrated. If they let you be and act like you, you felt happy.

When you began to experience puberty as early as age 8 but usually around 12 years of age, your physical body began to develop according to your assigned physical body sex, male or female, which is not always congruent with the gender also assigned at birth.


There are many other physiological, cultural, and environmental factors that have contributed to the unique person that you are. The result is that most people are heterosexual as male or female, but a portion of society worldwide, whose gender identity does not match their physical bodies, may consider themselves gender diverse and part of the LGBTQIA+ community.

Pause for a moment, and think about your gender including your behaviors, characteristics and preferences. Now, think how you would feel if your physical body and secondary sex characteristics did not match your gender.  How do you imagine you would feel about that mismatch between who you are and what your physical body reflects? This feeling of “mismatch” and any feeling of discomfort associated with it is called gender dysphoria. You likely would feel great anxiety and depression and, if distressed enough by not being accepted for who you are, you may consider suicide, as too many do.  Being asked to live a life that does not belong to you in a body that does not represent you is highly distressing to the individual.

Now think how relieved you would feel if your health care provider offered you options for medically monitored and approved gender affirming care to bring your physical body more in line with your gender. 

Gender affirming care should not be considered child abuse nor should it be criminalized. Our national, state, and local elected officials are responsible for laws, resources, and services that benefit more and do not harm any of their constituents. There are laws and other forms of violence around the world that cause great distress and death, too often by suicide, of innocent persons, including LGBTQIA+ persons. We are better than that. Citizens must learn the facts and science from vetted and reputable sources, and demand civility, equity, and compassion from our elected leaders.


References related to Evidenced Based Gender Diversity and Gender Affirming Care: 


  • National Geographic Special Issue: Gender Revolution (January, 2017)
  • Scientific American Special Issue: Sex and Gender (September, 2017)
  • American Academy of Pediatrics
  • Deutcsch, Madeline (Editor), Guidelines for the Primary Care of Transgender and Gender Nonbinary People. 2016 Second Edition
  • World Professional Association for Transgender Health (WPATH), Standards of Care for the Health of Transgender and Gender Diverse People (2022), Version 8
  • Shapiro, Rabbi Rami, My Teenage Daughter Wants to Transition to a Boy, Spirituality and Health, July/August 2023 page 9.
  • Sherrow, Hogan, Sex, Gender, and Sexuality: What the Science Says, May 26, 2022


* Copies of the Gender training PPT also available.

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