Discourses on TGD (transgender and gender-diverse) populations

 

Contents

• Transgender rights

  • Healthcare

    • The pathologisation of transness

    • Regulations on gender-affirming care

      • Section 1557 of the Affordable Care Act

      • The Protecting Children From Chemical And Surgical Mutilation Order

      • Benefits of HRT

      • The Defending Women From Gender Ideology Extremism And Restoring Biological Truth To The Federal Government Order

    • "Turning cis kids into trans kids"

    • The "Trans Industrial Complex"

    • Barriers

  • Right to exist in public spaces

    • Sex-segregated public spaces and bathrooms

    • Schools​

    • Sports

• References

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​​​​Transgender rights

 

​Healthcare

The pathologisation of transness 

 

The DSM-V

The most recent, fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) denotes a section on "gender dysphoria". It describes gender dysphoria as the gender identity-related distress that some TGD people experience (American Psychiatric Association, 2013).

 

Gender dysphoria replaced the previous term of "Gender Identity Disorder" as it was in DSM-IV. However, since this 'diagnosis' remains in DSM-V, gender dysphoria still carries connotations of being a mental problem. 

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The ICD-11

The most recent, eleventh version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) denotes a section on "gender incongruence". It describes incongruence between an individual´s experienced gender and their assigned sex (World Health Organization, 2022).

 

Gender incongruence replaced the previous term of "transsexualism" as it was in DSM-IV.

Rather than being classed under “mental and behavioural disorders” as it was in ICD-10, gender incongruence is now classed separately under "conditions related to sexual health".

These changes show continual work of organisations to depathologise transness for TGD populations.

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The fight to access gender-affirming care

In parts of the world, TGD individuals are still pathologised through psychiatric diagnoses, made to undergo reparative therapies aimed at changing their gender identity or expression; or undergo psychiatric evaluations based on binary and heteronormative frameworks to be able to access hormone treatments or gender-affirming medical procedures (Schwend, 2020). 

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In some US states, it had been possible for TGD adolescents to start hormone replacement therapy (HRT) without needing a letter of referral from a healthcare professional if they gave informed consent to treatment (Coleman et al., 2022). However, as of 2026, half of US states have laws and policies banning gender-affirming care access for youth (Dawson & Kates, 2025).​

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​Regulations on gender-affirming care

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Section 1557 of the Affordable Care Act (ACA)

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Section 1557 is the civil rights provision of the Affordable Care Act (ACA). It is a federal law which determines what constitutes discrimination in healthcare settings, and accordingly, whether funding is given to efforts upholding non-discriminatory care provision.

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In 2020, the Trump administration rewrote Section 1557. Under this change, sex-based discrimination no longer involved discrimination on the basis of gender identity and sex stereotyping. This means the misgendering of, or other behaviours which may cause discomfort to TGD individuals would no longer violate the federal law.

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The Protecting Children From Chemical And Surgical Mutilation Order

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In 2025, the Trump administration's Protecting Children From Chemical And Surgical Mutilation Order was published. It supposes gender-affirming surgery to be "regrettable", "dangerous"and "destructive", denounces the World Professional Association for Transgender Health, and defunds all gender-affirming surgery (GAS) and hormone treatments for all individuals below 19 years of age.

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The discourse that many TGD individuals regret medically transitioning is widespread, but false. The prevalence of regret post-GAS has been found to range from 0.3%-1% (Jedrzejewski et al., 2023; Narayan et al., 2021; Bustos et al., 2021). In fact, GAS regret rates are significantly lower compared to the average surgical regret rate of 14.4% in general populations (Barbee et al., 2023), the 7% regret rate of having children, and 16.2% regret rate of getting a tattoo (Thornton et al., 2024).

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GAS is generally not dangerous, with low complication rates for mastectomy and breast augmentation, as well as relatively low complication rates for genital surgeries (Akhavan et al., 2021).

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Current literature suggests the provision of hormone therapy (hormone replacement therapy and pubertal blockers) for TGD individuals is not destructive. Rather, it is a safe and effective way of increasing wellbeing and decreasing suicidality, self-harm, depression and anxiety rates (Allen et al., 2019; De Lara et al., 2020; Grannis et al., 2021; Kaltiala et al., 2020; Kuper et al., 2020; Tordoff et al., 2022; Turban et al., 2020). GAS also yields similar mental health benefits and is reported to have high patient satisfaction (Almazan & Keuroghlian, 2021; Park et al., 2022; Swan et al., 2023).

 

Providing federal funding and support for gender-affirming care would constitute as lifesaving treatment for TGD individuals in any country.​​​

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The Defending Women From Gender Ideology Extremism And Restoring Biological Truth To The Federal Government Order

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In 2025, the Trump administration's Defending Women From Gender Ideology Extremism And Restoring Biological Truth To The Federal Government Order was also published. It states that based on the 'biological reality of sex', the idea of having a gender identity beyond 'biological sex' will no longer be recognised. It also states individuals can only be of the binary sex they belonged to 'at conception' -- they are male if they produce the small reproductive cell, or female if they produce the large reproductive cell. 

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In light of this regulation, the Trump administration has ceased all federal funds for gender-affirming care.

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The discourse that sex is binary and determined by reproductive capacity is used not only by the Trump administration to suppress transgender and gender-diverse (TGD) rights, but is common in everyday society. However, recent research suggests sex and gender extend beyond one's reproductive capacity and may not simply be binary (Joel, 2021; Hyde et al., 2018). Rather, it is a more nuanced picture involving biological characteristics such as chromosomes, hormones, and secondary sexual characteristics. These give rise to multiple levels of sex (Rehmann-Sutter et al., 2023), and depending on such varying levels, an individual's healthcare needs may present differently. The Trump administration's executive decision therefore infringes on TGD populations' right to healthcare and bars individuals from accessing the tailored care they may require.

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These federal limitations are ongoing and have become more restrictive throughout Trump's administrative reigns.​

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"Turning cis kids into trans kids"

There is discourse debating whether education on, and gender-affirming care for TGD populations pressures cisgender youth into becoming TGD. 

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While young people's understanding of their gender and their gender identity may change overtime (Durwood et al., 2022), cisgender youth do not simply "turn trans" once exposed to information about TGD populations. Research suggests early identifying transgender children's sense of their own gender was no more or less stable than cisgender children's (deMayo et al., 2025; Hässler et al., 2022), and that children's stability of gender perception remains similar overtime (i.e. transgender youth tend to remain within the trans umbrella, cisgender youth tend to remain cisgender). Therefore, there is little scientific basis in restricting education on and healthcare for TGD populations.

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The "Trans Industrial Complex"

The "Trans Industrial Complex" is an ideological critique which argues that gender-affirming care is not about the wellbeing of populations, but is rather a ploy created by rich medical providers, insurance providers, lawyers and corporations to profit from the public. Despite being widely discussed among conservative spaces, the idea of such a complex has no empirical basis. On the other hand, TGD populations' increased wellbeing and quality of life from receiving gender-affirming care has been widely researched and documented.​

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Barriers

TGD healthcare experiences have not been researched extensively. Therefore, healthcare services were not designed with TGD populations in mind (Wagner et al., 2016), and TGD populations may struggle to get the care they require. TGD populations face barriers in accessing care, such as a reluctance in disclosing their trans identity in fear of prejudices and stigma, and/or a lack of provider understanding of TGD populations, resources and information (Aylagas-Crespillo et al., 2018; Floyd et al., 2020; Roberts & Fantz, 2014; Velasco et al., 2022; Xavier et al., 2013). In these studies, TGD populations state that inclusiveness of healthcare providers helps them find their experiences more positive, which include empathy and a willingness to learn about and listen to their needs.

 

There are also financial barriers, including the lack of insurance (Hines et al., 2019; Roberts & Fantz, 2014), as well as structural barriers at the federal level (see Section 1557 of the Affordable Care Act (ACA), The Protecting Children From Chemical And Surgical Mutilation Order, and The Defending Women From Gender Ideology Extremism And Restoring Biological Truth To The Federal Government Order sections).​​​​

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Right to exist in public spaces

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Sex-segregated public spaces and bathrooms

Bans on Transgender People Using Public Bathrooms and Facilities According to their Gender Identity

These laws require that locker rooms, changing rooms, restrooms, shower rooms and other sex-segregated rooms in K-12 school settings, and sometimes also government-owned buildings, be designated for use based on sex assigned at birth. They sometimes also extend to bathroom use in universities, colleges, public parks, prisons and airports.

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As of February 2026, these bans are active in 20 states (Movement Advancement Project, 2026), with Senate Bill Eight (The Texas Women's Privacy Act) in Texas as one such example.

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A common discourse used by those who oppose gender-affirming use of bathrooms, is that if individuals do not use the bathrooms aligning with their sex at birth, it may give rise to sexual harassment and paedophilia, especially if they have a penis and are entering women's spaces under the guise of 'gender confusion' (Councilor, 2021). To conservatives, transgender rights regarding bathrooms is a safety concern (Wuest, 2019).

 

However, the notion that free access to bathrooms of choice for TGD populations gives rise to sexual crime has no empirical basis. The passing of laws which had allowed TGD individuals to use gender-affirming spaces had not impacted the frequency of sexual crime occurrences in traditionally sex-segregated spaces, like bathrooms, and safety violations in bathrooms are very uncommon (Hasenbush et al., 2019). 

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In the 2015 U.S. Transgender Survey, it was found that six out of ten TGD individuals avoided using the bathroom. The avoidance of bathrooms was associated with fear of being questioned or harassed about bathroom choice, increased suicidal ideation and severe psychological distress (Lerner, 2021). Importantly, this survey was conducted when there were no laws dictating the use of bathrooms for any gender in the US. Research published during Trump's administrative reign, with bathroom bans on the rise, shows that more than 40% of TGD individuals avoid eating or drinking to minimise their use of bathroom, which could lead to health complications (Fredrick & Mann, 2025).

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Furthermore, the use of men's and women's bathrooms further enforces the idea that gender is binary, which often brings discomfort to gender-diverse individuals (Bagagli et al., 2021). Gender-inclusive bathrooms (bathrooms with separate, private stalls, with a shared sink and mirror space for all) are part of an alternative bathroom model which has been implemented in some US school settings, which helps reduce isolation and dysphoria for TGD individuals (McGuire et al., 2021). ​​​​

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Schools

The Ending Radical Indoctrination in K-12 Schooling Order

In 2025, the Trump administration's "Ending Radical Indoctrination in K-12 Schooling" order was published. It states "young men and women are made to question whether they were born in the wrong body", and therefore stops all federal funding on education or support for 'radical gender ideology' in educational settings. It also demands K-12 school staff not to facilitate, and not to conceal a minor's social transitioning from their parents.​

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Research has found TGD individuals who were 'outed' (exposed as being TGD) in adolescence experienced greater psychological distress than those who were 'outed' in their adulthood (Albury, 2025). Upon being 'outed', youth may experience parental rejection, abuse, and even become disowned from their families (Grossman & D’augelli, 2006), which brings great humiliation and pain (Kretz, 2012).

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As discussed above, the discourse that cis children are 'turned into' TGD children through exposure to TGD materials or education is also generally not supported by scientific evidence (see "Turning cis kids into trans kids" section). The vast majority of youth (around 96.7%) still identify as cisgender despite knowing the existence of TGD populations (Herman & Flores, 2025).

 

This order takes away the right of youth to maintain their privacy in trying to 'alleviate their gender confusion'. It endangers youth through 'outing' them when they are not ready, especially if their family is anti-LGBTQ. It is more fruitful for all parties to let TGD individuals come out at their own pace.

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Sports

The Keeping Men Out of Women’s Sports Order

In 2025, the Trump administration's "Keeping Men Out of Women’s Sports" order was published. It states that allowing anyone who identifies as female to participate in women's sports "ignores fundamental biological truths between the two sexes, and deprives women and girls of meaningful access to educational facilities". It therefore ceases all funds to, and condemns TGD individuals who identify as female to compete with and undress before other females, with prioritisation on enforcement within educational institutions.​

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The assumption underlying the discourse that trans women perform better than cis women, purely due to biological sex, is not always founded. While sex differences between elite athletes generally contribute to a performance gap of 8-12%, in ultra-endurance swimming events, women generally outperform men (Sandbakk et al., 2017). Women have also outperformed men in sports like marathon-running (Knechtle et al., 2020).​

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References​

Akhavan, A. A., Sandhu, S., Ndem, I., & Ogunleye, A. A. (2021). A review of gender affirmation surgery: What we know, and what we need to know. Surgery, 170(1), 336–340. https://doi.org/10.1016/j.surg.2021.02.013

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Albury, J. (2025). Living Authentically, Facing the Consequences: Examining the Psychological Implications of Gender and Sexual Minority Outing (Doctoral dissertation, The Florida State University).

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Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Well-Being and Suicidality among Transgender youth after Gender-Affirming Hormones. Clinical Practice in Pediatric Psychology, 7(3), 302–311. https://doi.org/10.1037/cpp0000288

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Almazan, A. N., & Keuroghlian, A. S. (2021). Association between Gender-Affirming surgeries and mental health outcomes. JAMA Surgery, 156(7), 611. https://doi.org/10.1001/jamasurg.2021.0952

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American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

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Aylagas-Crespillo, M., García-Barbero, Ó., & Rodríguez-Martín, B. (2018). Barriers in the social and healthcare assistance for transgender persons: A systematic review of qualitative studies. Enfermería Clínica (English Edition), 28(4), 247–259. https://doi.org/10.1016/j.enfcle.2017.09.005

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Barbee, H., Hassan, B., & Liang, F. (2023). Postoperative regret among transgender and Gender-Diverse recipients of Gender-Affirming surgery. JAMA Surgery, 159(2), 125. https://doi.org/10.1001/jamasurg.2023.6052

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Bagagli, B. P., Chaves, T. V., & Fontana, M. G. Z. (2021). Trans women and public restrooms: the legal discourse and its violence. Frontiers in Sociology, 6. https://doi.org/10.3389/fsoc.2021.652777

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​Bustos, V. P., Bustos, S. S., Mascaro, A., Del Corral, G., Forte, A. J., Ciudad, P., Kim, E. A., Langstein, H. N., & Manrique, O. J. (2021). Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plastic and reconstructive surgery. Global open, 9(3), e3477. https://doi.org/10.1097/GOX.0000000000003477

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Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., . . . Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644

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Councilor, K. C. (2020). The specter of trans bodies: Public and political discourse about “Bathroom Bills”. In The Routledge handbook of gender and communication (pp. 274-288). Routledge.

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Dawson, L., & Kates, J. (2025, November 24). Policy Tracker: Youth access to gender affirming care and state policy restrictions. KFF. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/

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Durwood, L., Kuvalanka, K. A., Kahn-Samuelson, S., Jordan, A. E., Rubin, J. D., Schnelzer, P., Devor, A. H., & Olson, K. R. (2022). Retransitioning: The experiences of youth who socially transition genders more than once. International Journal of Transgender Health, 23(4), 409–427. https://doi.org/10.1080/26895269.2022.2085224

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Grannis, C., Leibowitz, S. F., Gahn, S., Nahata, L., Morningstar, M., Mattson, W. I., Chen, D., Strang, J. F., & Nelson, E. E. (2021). Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys. Psychoneuroendocrinology, 132, 105358. https://doi.org/10.1016/j.psyneuen.2021.105358

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