What Does Transgender Mean? 3/28/22

Gender identity refers to a person's understanding of their gender; that is, the gender with which they identify. Transgender is the term used to describe someone who identifies with a gender that is different from their biological sex. While people are born with male or female chromosomes, this does not necessarily dictate gender. Though they are commonly misunderstood, gender identity and sexual orientation are not the same.

1. Transgender vs Sexual Orientation

People confuse or link gender and sexual orientation but they are, in fact, two separate things. Gender is who you are. It is the internal feelings of being a man, woman, or something outside of this traditional, binary understanding. Someone who is transgender does not feel that who they are on the inside matches their assigned gender on the outside. Sexual orientation, on the other hand, defines who you are attracted to. People identify as gay, straight, lesbian, queer, or another orientation regardless of whether they identify as male, female, or another gender.

2. Causes

Although research is still underway to determine what causes someone to be transgender, recent findings indicate that it may occur in the womb. In utero, sexual anatomy develops within the first six weeks. Later, at around six months gestation, the brain either is or is not exposed to a surge of testosterone. These processes are independent of one another. Sexual organs form and, months later, the brain is either masculinized or feminized by the presence or absence of hormones. There is no evidence that environment (nurture) affects either gender or sexual orientation.

3. Genetics

Genetics is another likely cause of transgender identities. One study shows an association between identifying as transgender and the androgen receptor allele. This allele is a variant associated with feminization or under-masculinization in men. In transgendered men who identified as female, this gene variant had longer repeat length than in men who identified as male, indicating that androgen receptors are partially responsible for gender male identity.

4. Differences in Brain Structures

Research has also identified differences in brain structure as a possible cause of transgender identity. A 2014 study found differences in the white matter tracts in the brain between cisgender (agreement between gender and sex) and transgender men and women. These tracts are influenced by hormones during late prenatal and early postnatal development. The study used MRI imaging to examine the microstructure of white matter and identified widespread differences between the study groups in almost all white matter tracts.

5. Raising a Transgender Child

Parents of gender transgender children should consult with medical professionals and mental health specialists to make sure their child has all the support they need to cope with being transgender. Most children who are transgender have a difficult time dealing with the expectations that they conform to standard gender roles. Parents should avoid trying to force the child to conform to their external gender and instead offer acceptance and the freedom to express themselves how they wish.

6. Transitioning

Transitioning is different for every transgender person. Some begin by outwardly expressing their preferred gender around people that they know and trust. They often work their way up to living as their preferred gender by adopting the clothing and grooming habits of their desired sex. Some may change their name, use hormone therapy, or undergo surgeries to modify their bodies to reach an external expression of the gender they are internally.

7. Is It a Mental Health Disorder?

A doctor will only diagnosis a mental health disorder if their patient expresses symptoms that cause them significant stress or disability. Many transgender people do not feel that their gender identity itself is distressing, though their experience in society can lead to issues like anxiety and depression at higher rates than cis-gendered people. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies transgender identity as "gender dysphoria." This has caused some controversy, as it implies that transgender identity is, in fact, a mental disorder. Some experts believe, however, that this diagnosis is necessary to make sure transgender people have access to the care they need, particularly if they are experiencing anxiety and depression.

8. Pronouns

Pronouns are important to those with a transgender identity. For some, association with the gender attached to their birth name and identity causes stress and anxiety. Others are just ready to leave that part of their life behind. Be respectful of pronoun usage. If you do not know what pronoun someone prefers, it is okay to ask politely. If you accidentally use the wrong pronoun, apologize and make an effort to use the correct one in the future.

9. Discrimination

Unfortunately, most anti-discrimination laws in the United States do not offer explicit protections for transgender people. Research shows that this demographic faces severe discrimination in all aspects of their lives, including housing, healthcare, employment, education, and personal relationships. This often leads to additional stress and anxiety, which is amplified by cross-sectional discrimination.

10. Statistics

Discrimination has a huge effect on the quality of life of people who are transgender. Here are some things to keep in mind about the transgender community, from a survey distributed by GLAAD, the most notable LGBTQ support and education resource in the U.S.:

  • About 30% of transgender people have been homeless at some point in their lives and 29% live in poverty.
  • 24% report being verbally harassed while 2%have been physically attacked.
  • Sadly, 40% of transgender people who responded to the survey reported attempting suicide.

Promoting a better understanding of transgender people and other LGBTQ communities, as well as increasing their rights and protections, is one more vital step toward equality.

Queering is Caring 3/7/23

Transgender and non-binary youth are at higher risk of poor mental health outcomes compared to their cisgender peers.

A 2022 National Survey of LGBTQ Youth Mental Health found that nearly 1 in 5 transgender and non-binary youth attempted suicide. Over half of the 34,000 youth (ages 13-24) interviewed reported serious consideration of suicide. And two-thirds reported experiencing symptoms of depression in the past year.

Gender-affirming care is social, psychological, and medication interventions that support and validate a person’s gender identity. This care is known to improve mental health, but few studies look at the impact of pharmacological interventions on trans and non-binary youth.

Diana Tordoff and a team of researchers wanted to know if access to gender-affirming care in the form of puberty blockers and gender-affirming hormones for trans and non-binary youth lowered their risk of suicide and decreased rates of depression and anxiety. They studied 69 youth participants between 13 and 20 years old receiving medications that block puberty changes and gender-affirming hormones (e.g., can lower voices) and 35 participants not receiving either intervention.

In the graphs above, the blue line represents youth who did not receive medical intervention, and the orange line represents the group that received gender-affirming pharmaceutical treatment.

For the blue line, rates of depression and suicidal thoughts increased from the start to the end of the study period. The orange line shows the odds of suicidal thoughts lowering and remaining significantly lower than the blue line in those receiving medications. The researchers found that initiation of puberty blockers and gender-affirming hormones decreased the odds of depression by 60% and decreased the odds of suicidality by 73% compared to the youth who did not receive these treatments.

As more states are introducing anti-transgender bills throughout the country, these researchers suggest that their results demonstrate the positive mental health effects of medical treatments for transgender and binary youth seeking care, therapies that deserve protection.

Databyte via Diana M. Tordoff, Jonathon W. Wanta, and Arin Collin, Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Network Open, 2022.

What Percentage of the Population is Transgender 2022 - Oregon Ranked 8th

How Many Adults and Youth Identify as Transgender in Oregon? - 2017

Identify as transgender by age 13 and older

As of 7/12/22



All Adults


Identify as transgender by race and ethnicity- Oregon

As of 7/12/22

All Other


Oregon Population Surplus by Age & Gender 2020

As of 071222

Monthly Surplus Male/Female
Cume Surplus



The Science About Trans Youth in America

  • The number of young people who identify as transgender in the United States has nearly doubled in recent years, according to a new report.
  • There’s been little data about the long-term development of transgender youths, but a new study found that few children who transition change their minds after five years.
  • Puberty blockers can be used to treat teens as they explore their gender identities. But what do these drugs actually do?
  • The debate over medical treatments for transgender teens isn’t limited to politics. Clinicians also disagree on how to approach gender-affirming care.

    Discrimination, delays and systemic hurdles prevent young transgender people from getting health care of any kind, a study found.

Valentina Sampaio announces she will be Victoria's Secret's first openly transgender model

Ahead of the annual Victoria's Secret catwalk show in New York, models including Adriana Lima and Behati Prinsloo talk about how they feel before hitting the runway.

Model Valentina Sampaio has announced she's making history as the first transgender model to be featured in a Victoria's Secret campaign.

Sampaio, 22, will be featured in Victoria Secret's new Pink campaign, which will be released later this month, her agent Erio Zanon told USA TODAY.

USA TODAY has reached out to Victoria's Secret for comment.

The model recently shared a photo of herself in a bathrobe, teasing she was "backstage" with Victoria's Secret Pink brand using the hashtags "#new #vspink #campaign."

"Never stop dreaming," she added in a separate Instagram caption. "#representatividade #diversity... ?????"

Sampaio previously made history as the first transgender model to pose for Vogue on the cover of Vogue Paris in 2017.

“The world has taken huge steps for transgender people in recent years,” Sampaio told BuzzFeed News at the time. “My cover is another small step — an important step that shows we have the force to be Vogue cover girls. The fashion industry is an instrument to raise flags promoting diversity, where things are more fluid and beauty evolves. Fashion is a world that’s freer.”

She also called on industry professionals to create more opportunities for transgender people.

“It’s not the gender of a person that determines your character or whether you’re good at something or not," she added in the interview. "Many times transgender women find the doors are already closed for them professionally, which only marginalizes us further — but everyone has something to show.”

Savage X Fenty model is taking 'full responsibility' for lying about being transgender

"Orange is the New Black" actress Laverne Cox cheered Sampaio on in her Instagram post comments: "Wow finally!"

"Stunning ????????????" wrote fellow model Lily Aldridge.

Dozens of photos at

Two Percent of High School Students Identify as Transgender, CDC Report Finds

According to national data, 35 percent of transgender high school students have attempted suicide in the past year. The Centers for Disease Control and Prevention (CDC) surveyed students in 10 states and 9 large urban school districts and found that nearly two percent identified as transgender. The study also found that transgender students are more likely to experience violence and bullying than their non-transgender peers. This is the first time CDC has included a measure of transgender identity in its biennial survey of high school students. To help address health risks among vulnerable youth, CDC recommends that schools adopt anti-bullying policies and train staff how to support students who are struggling. “The CDC’s findings highlight the need for even more policies to protect transgender and gender nonconforming youth,” said Amit Paley, CEO of The Trevor Project, a nonprofit that provides crisis services for LGBTQ youth. Read the full report.

03.023. ISSN 1054-139X. PMID 16488820.

11 Gamarel, Kristi E.; Jadwin-Cakmak, Laura; King, Wesley M.; Lacombe-Duncan, Ashley; Trammell, Racquelle; Reyes, Lilianna A.; Burks, Cierra; Rivera, Bré; Arnold, Emily; Harper, Gary W. (2020-11-30). "Stigma Experienced by Transgender Women of Color in Their Dating and Romantic Relationships: Implications for Gender-based Violence Prevention Programs". Journal of Interpersonal Violence. doi:10.1177/0886260520976186. PMID 33256510. S2CID 227246930.

12 "GLAAD", The SAGE Encyclopedia of LGBTQ Studies, 2455 Teller Road, Thousand Oaks, California 91320: SAGE Publications, Inc., 2016, doi:10.4135/9781483371283.n173, ISBN 978-1-4833-7130-6, retrieved 2020-12-10

Is gender identity biologically hard-wired?

an early age, 8-year-old Skyler Kelly began to let his parents know that what he looked like on the outside, a girl, is not how he felt on the inside. The science of gender identity isn't fully understood, but new research points to a complex set of factors, including biological ones. Special correspondent Jackie Judd talks to families and researchers who are working on these discoveries. (See 9:41 video here or read transcript below.)


Now another installment in our series Transgender in America.

A small number of children as young as 3 are beginning to understand their gender identity as something different from what they were assumed to be at birth.

NewsHour special correspondent Jackie Judd has our story of doctors and families living through these discoveries.


Eight-year-old Skyler Kelly is hoping for a career in the Major Leagues and enjoys the privileges of being big brother to 4-year-old Luke. It is not how life started for Skyler.

TIFFANY KELLY, Mother of Skyler: I can totally see sitting on the hospital bed and days of a long labor and someone saying like, oh, what a sweet little girl.


At a remarkably early age, Skyler, who lives in Seattle, began to let his parents know that what he looked like on the outside, a girl, is not how he felt on the inside.


When people tried to brush my hair, I would try to push the brush away and I would cry and scream. And it was hard in the mornings to even get ready.


Did you also have a fight over clothing, what to wear, what kind of clothes to wear?


Well, I was pretty much allowed to wear what I wanted, except on school pictures. I had to wear a dress, and I hated it.


So did you ever smile in those school pictures? Or…


I smiled, but I didn't like…


But inside?


I did not like it inside.


The why of Skyler's gender identity isn't fully understood. The long-held and now controversial medical view links being transgender to a mental disorder or emotional distress.

However, new science is emerging pointing to a complex set of factors. At the University of Washington, psychology professor Kristina Olson investigates the origins of being transgender.

KRISTINA OLSON, University of Washington: Your biology determines a lot of your psychology, and I think that's kind of where the feeling is right now, that there are probably biological contributors that make a big contribution towards our sense of gender identity, which is psychologically how we feel. Are we male or female or something else, something in between, neither?


Endocrinologist Joshua Safer at Boston University treats hundreds of adult transgender patients and is a leader in the field. He firmly believes gender identity is hard-wired in all of us.

DR. JOSHUA SAFER, Boston University:

In most people, chromosomes, body parts, gender identity align. So, somebody with a male chromosome, somebody with male body parts is going to have male gender identity. That is the usual circumstance.

All of these are independently controlled biologically, and therefore it is no surprise that, in a given subset of the population, one part is not aligned, that whatever genes are controlling that happen to be different for that individual, and that's what's happening with transgender individuals.


Dr. Safer conducted the most extensive review to date of existing studies tying gender identity to biological factors.

The most persuasive evidence he found was in experiments done over the past half-century on people born with the male XY chromosomes, but with the rare condition of ambiguous genitalia. Soon after birth, they were surgically given female genitalia, and then raised as girls.


These kids were dressed in pink and given dresses and dolls and given estrogen when they hit puberty, so that they had appropriate breast development and such. And so we're talking about a pretty extreme approach that, if any approach was going to work, it should have worked.

But what happened instead is, the majority of these kids, if you query, say that they have male gender identity, despite that very, very extreme program.


The conclusion, according to Dr. Safer, is that gender identity cannot be manipulated or taught. A second set of data he reviewed involved the anatomy of the brain. Postmortem testing of women and males at birth who transitioned to females found certain regions to be strikingly similar, though Dr. Safer says more research is needed to determine if those regions are linked to gender identity.

At this lab at the University of Washington in Seattle, a unique long-term study is under way of transgender children, children as young as 3 years of age. With the support of their families, they have transitioned from the gender of their birth to what is called their expressed gender.

Skyler, along with several dozen other kids, both transgender and not, went through a battery of tests in the first phase of the study to pinpoint how they see themselves. This very quick picture and word association, called IAT, or Implicit Association Test, is intended to take a true measure of the strength of a child's identity.


If there is a kid who, at birth, the doctor said this kid is a girl, but later came to identify as a boy, and that kid is living as a boy today, that kid will show the same results on the IAT as any other boy and looks nothing like, say, his sister or another random girl that we just pulled off the street.


Dr. Olson leads the study team.


So, this suggests that this isn't just a thing a kid is saying or pretending to be. This doesn't seem to be a kid being playful or being ornery. This is really, truly how the child seems to identify themselves at this age.


Dr. Olson's research cuts to the core of the dilemma parents of transgender children face, how to know if this is real.

JOSH KELLY, Father of Skyler: I guess my concerns as it evolved, and we were not at the stage of him being an affirmed male, my concerns are, are we jumping the gun, and just wasn't comfortable with that whole thing.


Many people struggle with the same thing and believe transgender children are just going through a phase. Dr. Olson says, in two years of following the same group of youngsters, none has reverted to their gender at birth.

Still, she encounters deep skepticism.


We see a lot of people saying things like, you know, my child thought that they were a dinosaur when they were 4, but I didn't let them live as a dinosaur, and they didn't really think they were a dinosaur.

These kids who are saying, this is who I am, I am a girl, or I am a boy.


The Kellys came to certainty one night when Skyler was about 6, and there was no denying what their child was trying to tell them.


I remember, God, this one awful night. I can still picture us upstairs, and Skyler was just having like a meltdown over nothing, but just a heartbreaking meltdown, like the kind — you can tell the difference betwee a tantrum and an, "I am just so emotionally unhappy."

And Josh and I both just finally saying, what is it? Is there something that you're not telling us? And I said, do you want to whisper it to us? And he whispered and said, I want to start wearing boy's underwear.


And that is when Skyler transitioned, entering first grade as the person he knew himself to be.

Dr. Olson now has about 100 transgender children in the study, and she hopes to follow them into adolescence and adulthood, and that, by learning more, the too-common trajectory of a transgender person's life can be changed.


We all look at the news, and we see those terrible statistics about what life is like for transgender adults; 41 percent of transgender adults attempt suicide. They have extremely high rates of unemployment and discrimination, violence

And what I want to know is, how do we change that? Is there a decision that could be made in a child's life, and instead put them on a path that's more like the other kids that they go to school with and are in their families, where they have just as a good a chance as anyone else?


Of all these words, which words would you choose to describe yourself? Happy, angry, proud, sad? Which words?


Happy, proud.


Happy, proud?




Why happy, proud?


Because I'm happy now that I get to live how I want. And I'm proud — well, I'm proud because my parents understood it, and they're — they're great.


He's super well-adjusted, very happy.


He's braver than I have ever felt. And I hope that he can keep that and that the world doesn't break him of that.


The Kellys say the emerging science of gender identity is less important to them than their child finding acceptance and support. They know it may not be an easy life for Skyler, but it will be an authentic one.

Brain Sex in Transgender Women Is Shifted towards Gender Identity - 3/13/22


Transgender people report discomfort with their birth sex and a strong identification with the opposite sex. The current study was designed to shed further light on the question of whether the brains of transgender people resemble their birth sex or their gender identity. For this purpose, we analyzed a sample of 24 cisgender men, 24 cisgender women, and 24 transgender women before gender-affirming hormone therapy. We employed a recently developed multivariate classifier that yields a continuous probabilistic (rather than a binary) estimate for brains to be male or female. The brains of transgender women ranged between cisgender men and cisgender women (albeit still closer to cisgender men), and the differences to both cisgender men and to cisgender women were significant (p = 0.016 and p < 0.001, respectively). These findings add support to the notion that the underlying brain anatomy in transgender people is shifted away from their biological sex towards their gender identity.

Keywords: brain, gender identity, machine learning, MRI, sex classifier, transgender

1. Introduction

Transgender people report discomfort with their birth sex and a strong identification with the opposite sex. Transgender women are assigned male at birth but identify as female; transgender men are assigned female at birth but identify as male. Worldwide, the reported prevalence of transgender identities is rising [1], but our scientific understanding of how gender identity develops is still limited. Social explanations pointing to psychosocial and environmental influences [2,3] are complemented by biological explanations that include genetic predispositions and hormonal exposures [4,5,6,7,8,9]. Some (or perhaps all) of the aforementioned variables may have contributed to neuroanatomical variations in transgender brains, as repeatedly observed in both post mortem and in vivo studies published over the past three decades [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28].

However, despite this wealth of research, a clear consensus is still missing in terms of which brain structures are altered in transgender individuals. Possible reasons include analyzing small and/or heterogeneous samples, applying different morphometric methods across studies, as well as focusing on single brain features. The latter is a concern in particular as even within cisgender studies there are large discrepancies in terms of reported sex differences, apart from the larger male and smaller female brain on average [29]. A possible solution is to study brain patterns rather than single features, as lately accomplished using modern machine learning algorithms in both cisgender samples [30,31,32,33,34] and transgender samples [35,36,37,38].

The overarching question addressed in those recent studies is whether the brains of transgender people are concordant with their birth sex or their gender identity, which is usually based on a so-called “classification accuracy” (i.e., how well can a brain be classified as male or as female). Interestingly, some studies [36,37] reported that the classification accuracy was reduced in transgender individuals, albeit not all studies observed this effect [35,36]. The reasons for divergences in study outcomes may be due to including individuals at different points in their gender-affirming process, using univariate classifiers and/or applying binary classifiers contrary to the notion that a mere binary classification may be insufficient to capture interactions between biological sex and gender identity [38].

The current study was designed to shed further light on the question of whether the brains of transgender people resemble their birth sex or their gender identity. For this purpose, we employed a recently developed multivariate classifier [34] that yields a continuous (rather than a binary) estimate for being male or female, in accordance with current biological models [39,40,41,42,43,44,45]. Our study sample consisted of 24 cisgender men, 24 cisgender women, and 24 transgender women before hormone therapy in order to rule out any modifying effects of circulating sex steroids [13,15,35,36,37,46,47,48,49,50,51,52]. We hypothesized that the estimated brain sex in transgender women is shifted away from their biological sex (male) towards their gender identity (female), but still significantly different from both.

2. Materials and Methods

2.1. Participants

Twenty-four transgender women (biological sex: male; perceived gender: female) were recruited through local community organizations and through professionals who offer services to the transgender community. To be included in this study, participants needed to self-identify as transgender women, report no history of hormone therapy, and declare the intention of undergoing estrogen replacement therapy. Moreover, participants were confirmed to be genetic males as defined by the presence of the SRY gene in their genome [53]. Six transgender women reported to be androphile (attracted to men) and 18 transgender women stated to be gynephile (attracted to women). The mean age of the transgender sample was 45.7 ± 13.8 years (range 23–72 years). The cisgender sample—selected from the International Consortium for Brain Mapping (ICBM) database (—was close in age and handedness and consisted of 24 males (45.9 ± 13.7, 23–69 years) and 24 females (46.2 ± 14.0, 23–73 years). All participants provided informed consent, and ethics approval was granted by the Institutional Review Board of the University of California, Los Angeles (UCLA; protocol 041106703, 27 April 2007) and by the University of Auckland (UOA; protocol 022375, 30 November 2021).

2.2. Image Acquisition and Processing

All brain images were acquired on the same 1.5 Tesla MRI system (Siemens Sonata, Erlangen, Germany) using a T1-weighted sequence (MPRAGE) with the following parameters: TR = 1900 ms; TE = 4.38 ms; flip angle = 15°; 160 contiguous 1 mm sagittal slices; FOV = 256 mm × 256 mm; matrix size = 256 × 256, voxel size = 1.0 × 1.0 × 1.0 mm3. Brain images were processed using SPM8 ( and the VBM8 toolbox (, as previously described [34,54,55,56]. In short, all brain images were tissue-classified into gray matter, white matter, and cerebrospinal fluid, and the resulting gray and white matter partitions were spatially normalized to MNI space using 12-parameter affine transformations. Finally, the normalized tissue segments were smoothed using an 8 mm FWHM kernel and resampled at 4 mm voxel size. These images constituted the input for the Brain Sex estimation.

2.3. Independent Training Sample

The Brain Sex classifier was trained on an independent set of MR images from an adult sample obtained from the IXI database ( This training sample comprised brain scans from 547 adults (305 females/242 males) with an age range of 19 to 86 years (mean: 48.1 ± 16.6 years). All images from this training sample underwent the same preprocessing as described above for our current sample, resulting in smoothed normalized tissue segments resampled at 4 mm voxel size.

2.4. Data Reduction

Before training and running the classifier, a further data reduction step was performed as detailed elsewhere [34,54,55,56,57], using the Matlab Toolbox for Dimensionality Reduction ( In short, a principal component analysis (PCA) was run on the aforementioned independent training sample, and then the resulting transformations were applied to the study sample. Both PCA-transformed datasets, the independent training sample and the study sample, were then used as input for the Brain Sex classifier.

2.5. Brain Sex Estimation

Brain Sex was estimated using a Relevance Vector Regression (RVR) machine [58,59] within MATLAB (The MathWorks, Natick, MA, USA), as implemented in “The Spider” ( First, the classifier was trained on the aforementioned PCA-transformed independent training sample coding females as “0” and males as “1”. Then, the trained classifier was applied to the PCA-transformed study sample [54,55,57] generating the person-specific Brain Sex index—a number representing the degree of femaleness/maleness on a continuum (consistent with the training, a Brain Sex index of “0” signifies the average female brain and a Brain Sex index of “1” the average male brain).

2.6. Statistical Analysis

Before the main analysis, we assessed the classifier performance, both in the independent training sample (305 females/242 males) using a 10-fold cross-validation [34] and in our 48 cisgender brains (24 males/24 females). Specifically, the individual Brain Sex estimates were used to calculate the receiver operator characteristic (ROC) and its area under the curve (AUC). Furthermore, binarized estimates (female < 0.5; male = 0.5) were used to calculate the classification accuracy (calculated as the number of true positives + the number of true negatives divided by the sample size) as quality metrics. For the main analysis, we applied an analysis of variance (ANOVA) comparing the 24 transgender women, the 24 cisgender men, and the 24 cisgender women. Significant effects were then followed up by one-tailed post hoc t-tests, in accordance with our hypothesis that brains of transgender women would be classified as less male-typical than brains of cisgender men but still more male-typical than brains of cisgender women. The effect sizes of these post hoc tests were calculated as Cohen’s d based on the difference in means and the pooled standard deviation. For all analyses, Bartlett’s and Lilliefors tests confirmed that the assumptions for parametric tests (i.e., equality of variance and normal distribution of the residuals, respectively) were met.

3. Results

The classifier performed at 90.2% accuracy (AUC = 0.97) when assessed in the training sample and at 88.3% accuracy (AUC = 0.97) when assessed in our 48 cisgender brains. These measures indicate a suitable classification performance and a reliable distinction between the sexes based on brain anatomy. The estimated Brain Sex index was significantly different between the three groups (F(2,69) = 40.07, p < 0.001), with a mean of 1.00 ± 0.41 in cisgender men and of 0.00 ± 0.41 in cisgender women. The Brain Sex of transgender women was estimated as 0.75 ± 0.39, thus hovering between cisgender men and cisgender women, albeit closer to cisgender men (see also Figure 1). The follow-up post hoc tests revealed that transgender women were significantly more female than cisgender men (Cohen’s d = 0.64, t(46) = 2.20, p = 0.016), but significantly less female than cisgender women (Cohen’s d = 1.87, t(46) = 6.48, p < 0.001).

Figure 1

Significant Group Differences in estimated Brain Sex. The x-axis refers to the three groups. The y-axis displays the estimated Brain Sex (0 = average female; 1 = average male). Data are displayed as violin plots for cisgender men (blue), transgender women (pink), and cisgender women (red). The gray center of each violin contains the values between the 25th and 75th percentiles, the 24 black oval markers correspond to the 24 brains in each group, and the ‘+’ marks a brain that is outside the 1.5 interquartile range (vertical gray lines). The asterisks indicate significant group differences.

4. Discussion

The observed shift away from a male-typical brain anatomy towards a female-typical one in people who identify as transgender women suggests a possible underlying neuroanatomical correlate for a female gender identity. That is, all transgender women included in this study were confirmed to be genetic males who had not undergone any gender-affirming hormone therapy. Thus, these transgender women have been subject to the influence of androgens and grown up (at least up until a certain age) in an environment that presumably treated them as males. The combination of male genes, androgens, and (to some degree) male upbringing should ordinarily be expected to result in a male-typical brain [39,40, 41,42,43,44,45], making a female-typical brain anatomy extremely unlikely. Yet, the brain anatomy in the current sample of transgender women is shifted towards their gender identity—an observation that is at least partly in agreement with previous reports, as discussed in the following.

Existing studies using multivariate classifiers aimed to assess whether the brains of transgender persons differ from their biological sex. For example, one study [37] investigated transgender men and transgender women before and after cross-sex hormone therapy using a binary classifier. The authors reported a significantly reduced classification accuracy in transgender persons compared to cisgender persons prior to hormone therapy, and the classification accuracy was even further reduced after therapy. This result might be explained by a shift in brain anatomy towards the gender identity (i.e., away from the biological sex), as also observed in the present study. Two other studies reported similar findings in transgender women but effects seemed to be driven by [36] or became significant only after [35] hormone therapy. Nevertheless, the sample sizes in those studies were extremely small (n = 8 and n = 11, respectively) and analyses were conducted using binary (rather than continuous) classifiers simply categorizing brains either as “male” or as “female”. Continuous classifiers (as applied in the current study) reflect a more nuanced classification by indicating where brains sit on the “male–female” spectrum but, to our knowledge, have not been used in transgender samples when analyzing structural magnetic resonance imaging (MRI) data. Nevertheless, even though findings are not immediately comparable, all existing structural MRI classifier studies—as well as a recent resting-state functional MRI classifier study [38]—seem to support the notion of a “shift” away from the biological sex towards the gender identity in transgender people. This shift has also been observed previously in some traditional region-of-interest studies focusing on single brain features and brain areas, such as the uncinate nucleus (INAH-3) [60], the insula and pars triangularis [14], the area around the central sulcus, posterior cingulate, and occipital regions [23] as well as the bed nucleus of the stria terminalis [22,28], just to name a few.

Future studies may further contribute to this field of research by replicating the current findings using continuous multivariate classifiers in independent samples. Ideally, those samples will be larger in size and include both transgender women and transgender men. Moreover, given that sexual orientation has been reported to affect brain anatomy [20,61,62,63,64,65,66], future studies might consider stratifying their transgender group(s), as well as their cisgender groups according to whether people are attracted to men, women, or both.


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Articles from Journal of Clinical Medicine are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

Transgender Day of Visibility 2021

This year marks the 12th International Transgender Day of Visibility (TDoV), an annual event to honor and acknowledge the transgender and nonbinary community while also raising awareness about the discrimination this community faces worldwide. TDoV is a time to celebrate the resiliency of transgender and nonbinary people, especially in the face of unprecedented attacks by state legislatures across the country targeting transgender youth.

Visit Equality Federation’s tracker of anti-trans legislation across the country.

Many transgender people, particularly transgender women and transgender people of color, still face enormous barriers to their safety, health, and well-being. This year alone, at least 12 transgender or gender non-conforming people have been murdered, the majority of these people being Black and Latinx transgender women. Additionally, transgender women are 3.8 times more likely to live in poverty than the general population. For the 16% of transgender people who live in rural America, structural challenges of rural life—such as fewer healthcare or employment options—means the impact of discrimination is particularly profound.

To date in 2021 alone, four states have enacted harmful policies targeting transgender youth and their ability to participate in sports through school, with at least 30 states considering such laws. Additionally, at least 20 states are considering legislation that would ban transgender youth from receiving gender-affirming medical care.

These bills would mean that a transgender girl, for example, would not be allowed to participate in sports with her classmates. By telling transgender girls that they can’t play girls’ sports, or transgender boys that they can’t play boys’ sports, they miss out on this important childhood experience and all the lessons it teaches.

Strength and Resiliency of Transgender People & Communities

On TDoV, the stories of transgender youth and their families, in particular, provide reminders of the strength and resiliency of transgender people and the importance of love and acceptance. Through family and community acceptance and support, nurturing strong connections to people who care, and establishing a positive sense of identity as a transgender person, parents and communities can help foster and strengthen resilience in transgender and gender diverse young people.

One such family, the Miles Family, shared their family’s journey toward understanding what it means to be transgender, their hopes and dreams for their transgender son, and why they support updating our laws to protect transgender people from discrimination in this video from MAP:

For most LGBTQ people across the country, finding and building community with other LGBTQ people is an important part of life. This is especially true for transgender people living in more hostile environments, like in the U.S. South, where trans-led grassroots and advocacy organizations provide a refuge from the difficulties and potential discrimination of everyday life. Read about some of these amazing groups from our #QueerSouthernStories series:

With the new Biden administration, there are opportunities to address the rampant violence and discrimination facing the transgender community. And with advocacy by trans-led groups like the National Center for Transgender Equality, Transgender Law Center, and the Transgender Legal Defense & Education Fund, advancing vital policy goals—like nondiscrimination, access to health care, and increased community safety—are more possible than ever for the approximately 1.4 million transgender people in the United States.

For example:

Many states have significantly improved the process for transgender and nonbinary people to update their name and gender identity on documents. In 2010, 33 states required proof of “sexual reassignment surgery” or had extremely burdensome processes for updating gender markers on driver’s licenses. But by 2021, only eight states had such requirements, and instead over half of states (29) and D.C. use easy-to-understand forms and require either no medical certification or accept certification from a wide range of providers.

Additionally, in 2021, 19 states and D.C. have gender-neutral “X” options available for driver’s licenses, and 13 states have such options for birth certificates.

Learn more from our Equality Maps on Identity Documents.

Take Action

Call your senators at (202) 224–3121 and tell them why federal nondiscrimination protections like those in the Equality Act are so important to ensure protections for LGBTQ people on things like employment, housing, medical care and education.

  • Pledge your support for the Trans Agenda for Liberation, a community-led guide that addresses the urgent political, legal, and social violence enacted against transgender communities:
  • If you identify as Black and transgender, consider taking a national survey by the Black Futures Lab to better understand opinions on issues affecting Black communities:
  • Learn more about the transgender and nonbinary community on Transgender Day of Visibility:

Resources: Are you one of the 3.8M lgbt people living in rural communities - Spanish - Flyer
Where We Call Home: Transgender People in Rural America - November 2019 (32 page PDF)

Few Transgender Children Change Their Minds After 5 Years, Study Finds NYT 5/4/22

But the study, which began in 2013, may not fully reflect what’s happening today, when many more children are identifying as trans.

Young children who transition to a new gender with social changes — taking on new names, pronouns, haircuts and clothing — are likely to continue identifying as that gender five years later, according to a report published on Wednesday, the first study of its kind.

The data come from the Trans Youth Project, a well-known effort following 317 children across the United States and Canada who underwent a so-called social transition between ages of 3 and 12. Participants transitioned, on average, at age 6.5.

The vast majority of the group still identified with their new gender five years later, according to the study, and many had begun hormonal medications in adolescence to prompt biological changes to align with their gender identities. The study found that 2.5 percent of the group had reverted to identifying as the gender they were assigned at birth.

As tension mounts in courtrooms and statehouses across the country about the appropriate health care for transgender children, there’s been little hard data to draw on about their long-term development. The new study provides one of the first large data sets on this group. The researchers plan to continue following this cohort for 20 years after their social transitions began.

“There’s this sort of idea that the kids are going to be starting those things and that they’re going to change their minds,” said Kristina Olson, a psychologist at Princeton University who led the study. “And at least in our sample, we’re not finding that.”

Dr. Olson and other researchers pointed out, however, that the study may not generalize to all transgender children. Two-thirds of the participants were white, for example, and the parents tended to have higher incomes and more education than the general population. All of the parents were supportive enough to facilitate full social transitions.

And because the study began nearly a decade ago, it’s unclear whether it reflects the patterns of today, when many more children are identifying as trans. Two-thirds of the study’s participants were transgender girls who were assigned boys at birth. But in the past few years, youth gender clinics worldwide have reported a swell of adolescent patients assigned girls at birth who had recently identified as trans boys or nonbinary.

This group also has a high rate of mental health concerns, including autism and ADHD, noted Laura Edwards-Leeper, a clinical psychologist in Oregon who specializes in the care of transgender children. “That’s really the group I’m most concerned about these days,” she said.

“I would say that this study tells us nothing about those kids,” Dr. Edwards-Leeper added. “It’s just that different.”

The Trans Youth Project researchers began recruiting participants in 2013, traveling to more than 40 states and two Canadian provinces to interview families. Such in-depth data is rare in this type of research, which is often sourced from online surveys or through children referred to specific gender clinics, who are typically older and often from more limited geographic areas.

Previously published work from the project showed that the children who were supported by their parents during social transitions were roughly equal to non-transgender children in terms of rates of depression, with slightly elevated rates of anxiety.

The new study, published in the journal Pediatrics, followed this cohort as they reached a milestone roughly five years out from their initial social transitions. The study found that 94 percent of the group still identified as transgender five years later. Another 3.5 percent identified as nonbinary, meaning they did not identify as boys or girls. That label wasn’t as widely used when the researchers began the study as it is today.

By the end of the study period, in 2020, 60 percent of the children had started taking either puberty-blocking drugs or hormones. The researchers are still collecting data about how many of the teenage participants had undergone gender surgeries, Dr. Olson said.

Eight children, or 2.5 percent, had switched back to the gender they were assigned at birth. Seven of them had socially transitioned before the age of 6 and transitioned back before the age of 9. The eighth child, at 11 years old, reverted after starting on puberty-blocking drugs.

Research from the 1990s and 2000s had suggested that many children diagnosed with gender identity disorder (a psychological diagnosis that no longer exists) would resolve their gender difficulties after puberty, typically by ages 10 to 13. Some of those earlier studies have been criticized because the children’s doctors advised their parents to steer them away from a transgender identity.

In the decades since that work was done, societal acceptance of gender diversity has grown, medical practice has shifted and the number of transgender children has increased significantly.

For those reasons, it doesn’t make sense to compare the new study with older research, said Russ Toomey, a professor of family studies and human development at the University of Arizona.

“It’s really comparing apples to oranges,” Dr. Toomey said. Many of the children in the earlier studies were effeminate boys whose parents were upset about their behavior, they said. “Many of these kids in these early studies that are frequently cited were never even labeling themselves or being labeled as transgender.”

The new study could suggest that transgender children, when supported by their parents, thrive in their identities. But it’s also possible that some of the children who still identified as transgender by the end of the study — or their parents — felt pressure to continue on the path they started.

“I think depending on your perspective, people will probably interpret this data differently,” said Amy Tishelman, a clinical psychologist at Boston College and lead author of the World Professional Association of Transgender Health’s standards of care chapter on children.

“Some people may say that kids get on this trajectory of development and they can’t get off and that the medical interventions may be irreversible and they may come to regret it,” she said. “Other people will say kids know their gender, and when they’re supported in their gender, they’re happy.”

While most clinicians agree that social transitions can be helpful for some children who are questioning their assigned gender, Dr. Tishelman said, it’s also important to give support to those who change their minds. “It’s just really important that kids can continue to feel like it’s OK to be fluid, to continue to explore,” she said.

More data on the cohort as it continues into adolescence could reveal how many children choose to detransition after beginning hormone therapy.

Dr. Olson said her group would soon be publishing an additional qualitative study that described the experiences of the relatively small number of children in the cohort who switched back to their original gender identity. These children did well, she said, when supported by their families.

“In our work we don’t just want to know what category they fit in today vs. tomorrow,” Dr. Olson said.

“I think of all these kids as gender diverse in different ways,” she added, “and we want to understand how to help their lives be better.”

Correction: May 4, 2022

An earlier version of this article referred incorrectly to a psychological diagnosis. As the article noted, research from the 1990s and 2000s looked at children diagnosed with gender identity disorder — but not gender dysphoria, a diagnosis that came into use more recently.

The Science About Trans Youth in America

The number of young people who identify as transgender in the United States has nearly doubled in recent years, according to a new report.

There’s been little data about the long-term development of transgender youths, but a new study found that few children who transition change their minds after five years

Puberty blockers can be used to treat teens as they explore their gender identities. But what do these drugs actually do?

The debate over medical treatments for transgender teens isn’t limited to politics. Clinicians also disagree on how to approach gender-affirming care.

Discrimination, delays and systemic hurdles prevent young transgender people from getting health care of any kind, a study found.

The trauma of TSA for transgender travelers - CNN - 10/17/19

For Rev. Yunus Coldman, an interfaith minister and a New York-based transgender man, the anxiety of going through a TSA checkpoint starts days before he arrives at the airport.

“I begin to sweat the night before I know I’m getting on a plane because I’m trying to anticipate anything and everything that can happen. What are they going to ask me today? Am I prepared?” Coldman recently told CNN Travel.

Coldman flies for work on a semiregular basis and has faced varying degrees of difficulty getting through security. He claims to have been subject to negative treatment by TSA agents since he started identifying as trans six years ago.

“I had no such encounters with the TSA prior to my transition,” he said.

Flagged by body scanners multiple times because the gender that the agent selected didn’t match the anatomy of his body that the machine identified, Coldman has consequently been subject to pat-downs and bag searches. A couple of years ago, he was detained at New York’s John F. Kennedy International Airport when an agent questioned whether his ID, which was taken when his facial-hair-free face appeared more feminine, was actually him.

Suspicions of his identity are one thing. Coldman’s prosthetic penis, which he compares to “a prosthetic just like someone’s arm or leg,” is another.

To avoid getting flagged by TSA machines while wearing the prosthetic, Coldman lately chooses to pack the item – though he says he has experienced issues in both situations (wearing or packing).

Still, he recalls one instance a few years ago in which TSA agents waved the phallus in the air in plain view of other travelers. Questioning what it was and why Coldman was traveling with it, the agents, according to Coldman, acted inappropriately and unprofessionally.

Security woes

TSA has specific guidelines on how it handles prosthetics, including that “screening involving a sensitive area may be conducted in private with a companion or other individual of your choice.”

But there may be a fine line between what the agency might classify as procedure and what a passenger would call a humiliating experience.

“For many transgender, nonbinary and gender nonconforming people, going through airport security is a grueling and often humiliating and traumatizing ordeal,” says Shannon Minter, legal director of the National Center for Lesbian Rights (NCLR), a nonprofit group that advocates on behalf of LGBTQ people. (“Nonbinary” refers to people who do not identify with either of the two traditional genders, narrowly defined. Intersex people have sex characteristics such as genitals or chromosomes that don’t fit typical binary notions of male or female bodies, according to the United Nations.)

“Some of the worst stories we hear are from gender nonconforming women who are subjected to intentionally assaultive pat-downs from TSA agents. In effect, these women are being asked to accept being sexually assaulted as the price of traveling by air,” Minter said.

TSA’s guidelines, which are publicly available, leave room for what some people might consider an aggressive screening.

“We have very specific instructions on pat-downs,” TSA press secretary Jenny L. Burke told CNN. According to TSA guidelines, agents may inspect “head coverings and sensitive areas such as breasts, groin and the buttocks. You may be required to adjust clothing during the pat-down.”

TSA guidelines also state that during screenings, “you will not be asked to remove or lift any article of clothing to reveal sensitive body areas.”

When asked whether TSA agents asking passengers to show their genitals was against protocol, Burke relayed, “TSA does not conduct strip searches.” According to Burke, TSA agents also undergo official sensitivity training as part of their annual requirement.

But many trans and gender nonconforming people tell a different story about their experience going through airport security.

In fact, a recently published investigation by ProPublica, an independent, nonprofit newsroom for investigative journalism, covered civil rights’ complaints filed from January 2016 through August 2019. It found 5%, or 298 complaints, were related to screening of transgender people. The figure is notable because transgender people are estimated to make up slightly less than 1% of the US population.

Alleged mistreatment

As part of the research, ProPublica put out a call for stories from trans and gender nonconforming people who were mistreated by TSA and received nearly 200 responses. And yet only 14 of the responders said they reported the incident to TSA.

According to the report, many did not file complaints because they didn’t know how or they were afraid of outing themselves as a transgender person. Many also expressed concerns related to reliving the negative experience.

This is true of Devin Alexander, a Washington-based transgender man.

In 2013, he filed a formal complaint via email after a negative encounter with the TSA. He received an automated reply stating someone would get back to him.

When no one did, Alexander followed up via a phone call, he said.

But he didn’t fare much better there. After waiting on hold for more than an hour to speak with someone, he was told he would be sent a letter requesting a written statement. After waiting several weeks to get the official letter detailing next steps for his complaint and receiving nothing, he followed up again.

This time, his call led him to a person who informed him there was no record of his complaint, Alexander said.

Burke confirmed this, saying “TSA does not have a complaint with that name in the civil rights complaints database. Also of note, under published records management protocols, our electronic records are purged after six years from date of closure.”

Burke added: “The TSA Contact Center purges records after three years per records management protocols.”

Alexander was left feeling defeated.

“And honestly? I couldn’t stand repeating the story. Even now it makes me feel icky,” he says, referring to his experience going through a body scanner wearing a binder, an undergarment used to flatten one’s chest, at John F. Kennedy Airport several years ago.

“I had to go through a pat-down and was asked what I was wearing under my shirt. When I said, quietly, I was a transgender man, and wore a chest binder because I hadn’t had surgery yet, she very loudly called to another worker and said ‘Hey, we’ve got another one of those trannies again, can you believe the beard on her? You have to pat her, oh right, HIM, down, I can’t, I’m a female.’”

“I was never so f***ing embarrassed in my life. It was so traumatizing I didn’t fly again for about three years!” Alexander told CNN.

Alexander’s experience is, in fact, a common refrain among transgender travelers.

According to ProPublica’s report, transgender people reported varying levels of mistreatment, including multiple instances of being asked to show their genitals to agents – in spite of the TSA guidelines about passengers not being asked to reveal sensitive areas.

And yet the abuses against transgender people continue because of a flawed system that presumes gender at the screening stage.

Is your ID good enough to travel? It may not be next year.

The TSA security journey

According to The National Center for Transgender Equality (NCTE), the screening technology is partially responsible for the disproportionate number of trans people who get flagged at the TSA checkpoints.

The body scanners, also known as millimeter-wave scanners, were originally deployed in 2008 and updated to include Automated Target Recognition in 2013, according to Burke.

The update, mandated by Congress, displays a generic outline of a person on a monitor and highlights any areas on the body that might require additional screening.

The machines rely on fixed technology to identify objects on the body that don’t belong. When you step into the body scanner, the technology scans you and indicates areas on the body warranting further inspection based on bulges or anomalies that don’t align with what the machine was taught is the correct body part for the gender selected by the agent.

That means if the agent thinks you’re male and hits that corresponding button but the machine detects lumps on your chest, you may be flagged.

When the alarm is triggered, what follows are additional screenings intended to determine whether a prohibited item is present on the flagged individual. This added security measure frequently includes a pat-down.

Flagged as different

On the experience of getting flagged by the body scanners, “it creates this vague sense of menace; that you’re being surveilled, being flagged as different. And you don’t know for what. It’s disturbing in that manner,” said Susan Stryker, presidential fellow and visiting professor of women’s, gender and sexuality studies at Yale University.

Stryker, who describes herself as having a “culturally woman’s name and post-surgical body,” acknowledges that as a Caucasian woman, she may carry privilege that other trans people do not.

Still, from 2009 to 2011, Stryker flew weekly between her home in San Francisco and her then job at Indiana University Bloomington, during which time she was flagged by the body scanners and subjected to pat-downs every single week.

“There’s this false belief that there’s something scientific going on,” Stryker said of the body scanner technology.

“But it requires an actual human being to look at another human being pink, or blue, and which button do I push to measure this body against? It’s just a machine of humans observing humans that import all the stereotypes – the scanner doesn’t get rid of that. In some ways, it intensifies it.”

Arrive at the airport with time to spare or last minute? Readers have their say

In March 2019, Emma Smith, a New York-based transgender woman, was stopped by TSA at the security checkpoint in San Francisco International Airport.

“The machine identified a potential threat in my groin,” she said, after an agent pointed to the body scanner machine, which displayed a yellow square hovering over the crotch of a stick figure holding its hands in the air.

Smith was offered a choice to have a pat-down at the checkpoint or in private. She chose the private room option and told the four agents who accompanied her, “I’m trans, and I’m sure that’s what this is about.”

A female agent gave Smith a full pat-down – including the groin area – per protocol.

“I was shaking inside. I collected my things, put on my shoes, the door open now, wondering if the people waiting in line wondered if I was some sort of threat,” Smith says.

The experience was so unsettling it’s impacting Smith’s travel plans involving flying. Smith says she’s considering going to a conference in North Carolina. “The only thing holding me back is fear of encountering trouble while traveling. This includes the TSA, especially in areas known to be not so friendly to trans people,” Smith adds.

TSA in charge

According to Burke, it’s at the discretion of the individual TSA agent to make a split-second decision about someone’s gender and hit the “male” or “female” button on the body scanner machine.

“It is unacceptable that in this day and age, TSA agents are not trained to deal respectfully and reasonably with the reality that many people may have bodies or articles of clothing that do not fit neatly into stereotypical assumptions about gender,” said Minter.

Agents do undergo training, according to Burke.

In addition, Burke relays that all screening procedures are reviewed by TSA’s Civil Rights & Liberties, Ombudsman and Traveler Engagement office to ensure compliance with federal civil rights laws.

Still, there are enough cases where TSA agents have left trans people with troubling accounts of security screenings.

The TSA said in April it is exploring updating the body scanners to help streamline security for all travelers

Until then?

Need to know

“TSA PreCheck has saved so many trans people from bulls***,” says Coldman. “You don’t have to go through body scanners. You don’t have to take your shoes or belt off.”

PreCheck, though, may not be worth the $85 (good for five years) for everyone

The TSA offers some information for transgender travelers on its website, including a note saying the agency is committed to ensuring transgender travelers are met with courtesy and respect.

Burke relays that anyone wanting the assistance of a passenger support specialist at the security checkpoint can contact the TSA Cares helpline at (855) 787-2227 in advance. That hotline is also available for questions about screening policies, procedures and what to expect at a checkpoint. Travelers can also reach out to @AskTSA on Twitter for support.

If you feel you’ve been mistreated by the TSA, you can file a complaint on their site. The National Center for Transgender Equality also offers a comprehensive “Know Your Rights” toolkit for airport security.

When Transgender Travelers Walk Into Scanners, Invasive Searches Sometimes Wait on the Other Side - ProPublica - 8/26/19

Transgender and gender nonconforming people say they have been pressured to expose their genitals during TSA searches at airports. The encounters stem from shortcomings in the agency’s technology and insufficient training of its staff.

On Sept. 15, 2017, Olivia stepped into a full-body scanner at the Fort Lauderdale-Hollywood International Airport.

When she stepped out, a female Transportation Security Administration officer approached. On the scanner’s screen was an outline of a human body with the groin highlighted. The officer told Olivia that because of something the scanner had detected, a pat-down would be necessary.

As a transgender woman, Olivia, 36, had faced additional TSA scrutiny before. On those occasions, a manual search at the checkpoint had been enough to assure TSA officers that there wasn’t a weapon or explosive hidden in her undergarments.

This encounter with the TSA went very differently.

After patting down Olivia and testing her hands for explosive residue, the officer said that she still couldn’t clear Olivia to board her flight and that a further search would be required.

Olivia was led to a private room where, she said, the officer patted her down again, running her hands down Olivia’s legs and over her groin.

“I told her: ‘If the issue is what you are feeling, let me tell you what this is. It is my penis,’” said Olivia, who agreed to be interviewed only if she were identified by her middle name because she fears people will treat her differently if they know she is transgender.

Soon after, three other TSA officers, all of them women and at least one of them a supervisor, entered the room, Olivia said.

TSA rules require that passengers be searched by officers of the same gender as they present. But, according to Olivia, the TSA supervisor told her that she would have to be patted down by a male officer.

After Olivia refused to be searched by a man, the officers told her that because she was not consenting to a search, she could not board her flight and would be escorted out of the terminal.

Olivia said she started crying and pleaded with the officers. “Can I just show you?” she recalled asking them.

TSA officers aren’t supposed to allow passengers to remove undergarments. But Olivia said the officers in the room with her did not object when Olivia pulled her ruffled, black and white skirt and underwear down to her ankles.

Olivia was then cleared to continue to her gate.

A Flawed System

What happened that day traumatized Olivia, who is now fearful of airports, and what she experienced reflects the worst fears of many transgender travelers, who say the TSA is failing them.

Shortcomings in the technology used by the TSA and insufficient training of the agency’s staff have made transgender and gender nonconforming travelers particularly vulnerable to invasive searches at airport checkpoints, interviews and a review of documents and data shows.

The TSA says that it is committed to treating all travelers equally and respectfully. But while the agency has known about the problems for several years, it still struggles to ensure the fair treatment of transgender and gender nonconforming people.

To understand the extent of the problem, ProPublica reviewed publicly available complaint data from the TSA’s website and asked transgender travelers to provide accounts of their experiences at airport checkpoints.

The review, which covered civil rights complaints filed from January 2016 through April 2019, found that 5%, or 298 complaints, were related to screening of transgender people, even though they are estimated to make up slightly less than 1% of the population.

This may understate the proportion of complaints from transgender travelers. When Olivia contacted the TSA, her complaint was filed in a different category — a catchall classification called “sex/gender/gender identity - not transgender.” That category accounts for 15% of the civil rights complaints in the period examined by ProPublica, but the TSA said it did not have a more specific breakdown of these complaints and could not say how many were, like Olivia’s, related in some way to gender identity and screening. ProPublica filed a Freedom of Information Act request in April seeking information about each complaint in those categories, but the agency has not yet provided any response.

When ProPublica asked transgender and gender nonconforming people to tell us about their experiences, we received 174 responses, many of them recounting humiliating treatment after being flagged by full-body scanners for additional scrutiny. Of those people, only 14 said they filed a complaint with the TSA. Many of those who did not file complaints said they didn’t know how, were afraid of outing themselves or didn’t want to relive the experience.

Some of the travelers who responded to ProPublica said they were asked by TSA officers to lift clothing to show private parts of their bodies or were pressured to expose their genitals so that TSA officers would allow them to pass through the security checkpoint.

“Transgender people have complained of profiling and other bad experiences of traveling while trans since TSA’s inception and have protested its invasive body scanners since they were first introduced in 2010,” said Harper Jean Tobin, director of policy at the National Center for Transgender Equality, or NCTE.

The TSA, which is part of the Department of Homeland Security, was created in an overhaul of transportation security after the 2001 terrorist attacks, with the mission to prevent similar tragedies. The agency, replacing a patchwork of private security providers, initially used metal detectors, which had been standard at checkpoints for years. But after a passenger attempted to blow up a plane in 2009 with plastic explosives hidden in his underwear, the agency began using full-body scanners.

The new scanners were designed to detect potential threats that are not necessarily metal. But TSA officers can’t tell by looking at the monitor whether the machine is detecting a weapon, or as in Olivia’s case, a body part that the scanner was not programmed to associate with a woman.

Since implementing the scanning technology, the agency has grappled with privacy and discrimination issues. Like the transgender and gender nonconforming communities, people with disabilities, people who wear religious head coverings and women of color, whose hairstyles trigger the body scanners to alarm more frequently, have raised concerns about profiling and invasive screening.

Jenny Burke, the TSA’s press secretary, said the screening is done “without regard to a person’s race, color, sex, gender identity, national origin, religion or disability.”

In February, the agency rolled out a new online transgender awareness training, mandatory for its 43,000 screeners, and is studying options for better technology, Burke said.

But advocates and some lawmakers said the improvements have taken too long for a federal agency that interacts with the public more than many others. On an average day, TSA officers screen more than 2 million people and manually search many of them.

“For many, TSA is not just the public face of government — but its hands, too. Its success as a security agency depends upon the trust and compliance of a diverse public,” Rep. Bennie Thompson, D-Miss., said during his opening statement at a Homeland Security Committee hearing in June.

Transgender people have faced growing uncertainty about whether their civil rights are protected by the federal government. In May, the Trump administration announced plans to roll back protections for transgender people under nondiscrimination laws. Earlier last year, the administration barred transgender people from serving in the military. As ProPublica reported last year, some states bar transgender people from obtaining a state-issued ID that matches their gender presentation unless they provide proof they’ve had surgery.

False Alarms

Most of the incidents ProPublica reviewed for this story started with a body scanner issuing an alarm.

Before a person steps into the full body scanner at an airport, a TSA officer must register the person’s gender, pressing a pink button for a female or a blue button for a male. Generally, the officers make the decision in seconds, based on a person’s appearance.

The body scanner is programmed to look for penises on passengers scanned as male and breasts on passengers scanned as female. If the officer selects the female button and the machine detects something in the passenger’s groin area — like in Olivia’s case — it could interpret a body part as a potential threat, issuing an alarm.

ProPublica also spoke to several cisgender women who said they were flagged for additional scrutiny after a TSA officer scanned them as male, causing their breasts to trigger the alarm. (“Cisgender” describes someone who identifies with the sex they were assigned at birth, meaning they are not transgender.) The women told ProPublica that they believed the officers scanned them as male because they had short hair or, in one case, because they were wearing baggy clothes.

Peter Neffenger, who served as TSA administrator for the last 18 months of the Obama administration, said he heard again and again about the anxiety brought on by the scanners.

“As many in the transgender community explained to me, it’s one of the most stressful parts of the screening process for them,” Neffenger said.

In September 2018, Terra Fox, a transgender woman, was at the airport in Albuquerque, New Mexico, on her way to a conference in Orlando, Florida. When she walked through the body scanner, the machine showed a yellow box over her groin.

Fox said she told the officers at the checkpoint that she is a transgender woman and that the machine was merely detecting her genitals.

Fox asked to be patted down by a woman, but the female officers near her refused to do it.

According to Fox, two male officers brought her to a private room and instructed her to pull down her leggings and show them her genitals. She complied, but the screening lasted so long that she missed her flight. She said the experience has taken a toll on her.

“Every time I travel, I have to cry and feel humiliated,” she said.

Fox has to travel for work frequently and said she doesn’t have the option of avoiding airports.

Terra Fox says she was instructed to pull down her leggings during a TSA search at the airport in Albuquerque, New Mexico. (Adria Malcolm, special to ProPublica)

Allister McGuire, a transgender man who lives on Long Island, N.Y., said he didn’t fly for five years after an experience in the St. Louis Lambert International Airport in 2014. McGuire was taken to a private room after the body scanner went off, displaying a yellow patch on his chest.

“I was very nervous,” McGuire said. “I did not feel safe.”

The two male officers in the room told McGuire to remove his chest binder, a cloth undershirt some trans men and gender nonconforming people use to flatten their chests, and then lifted each of his breasts with their hands, McGuire said. He was eventually allowed to leave, but he said he immediately had to take anxiety medication.

McGuire said he did not file a complaint.

In an interview with ProPublica, McGuire wondered: “If I was coming through as a woman, would [the officers] be touching me like that?”

Burke, the TSA press secretary, said that the agency does not conduct strip searches, but that travelers may be required to “adjust clothing” during the pat-downs. The agency didn’t respond to detailed questions about the allegations made by Fox and McGuire.

Neffenger said that during his time as TSA’s administrator, officers were not supposed to ask people to take off their clothes during a screening. But he acknowledged that it was difficult to keep such an enormous workforce consistently trained.

“It wouldn’t surprise me if you said you discovered that people have asked people to undress,” Neffenger told ProPublica. “It’s a big organization; it’s got a lot of turnover.”

The overall attrition rate for the TSA officers is 17%, which is roughly in line with the federal workforce, according to a report this year by the inspector general for DHS. But officers leave the TSA voluntarily at a higher rate than other federal employees, according to the report, which said “retention and training challenges are contributing factors to airport security weaknesses.”

Neffenger spent 33 years serving in the U.S. Coast Guard before being appointed in 2015 to lead the TSA. He arrived amid fallout from damning revelations about the agency. A leaked government report showed that TSA officers had failed to detect nearly all weapons and explosives smuggled through by DHS investigators during a secret test.

Neffenger said his immediate focus as administrator was to develop a nationwide training program. It was a challenging task, he said, because the intrusive nature of the screening process will inevitably make both passengers and officers uncomfortable.

“Pat-downs are, by definition, invasive,” Neffenger said. “What [TSA officers] are asked to do is stuff people don’t like to do.”

Public Comments

TSA officers would need to do fewer pat-downs if the agency had better technology.

The agency uses a machine called a millimeter wave scanner at nearly every airport in the U.S. The machines, manufactured by L3Harris Technologies, rely on an algorithm to analyze images of a passenger’s body and identify any threats concealed by the person’s clothes.

The TSA has spent about $110 million deploying the machines, which cost about $150,000 each, according to a government report.

Since the TSA began deploying body scanners at airports, LGBTQ advocates have expressed concern that the new screening procedures would disproportionately affect transgender travelers.

In a letter to then-TSA Administrator John Pistole in December 2010, NCTE, the Transgender Law Center and the National Center for Lesbian Rights described two incidents in which transgender men were interrogated by TSA officers because their bodies looked different in the scanners than what the officers expected. The organizations urged Pistole to take immediate action to stop discrimination against transgender people. In a written response, Pistole said the agency was “working hard to respond to the concerns of the traveling public.”

Read More

TSA Agents Say They’re Not Discriminating Against Black Women, But Their Body Scanners Might Be

The full-body scanners at airports across the country frequently give false alarms for Afros, braids, twists and other hairstyles popular among black women.

In 2010, the Electronic Privacy Information Center, or EPIC, sued DHS in response to the TSA’s decision to make body scanners the primary screening system at airports. EPIC argued that the agency should have given the public an opportunity to comment on the technology before it was implemented. The District of Columbia Court of Appeals ruled in favor of EPIC in 2011, though the TSA didn’t begin accepting comments until 2013.

“They are now blaming the scanners when part of the rule-making process is to surface these kinds of issues,” said Jeramie Scott, director of EPIC’s Domestic Surveillance Project.

Burke said the agency procures equipment, such as body scanners, that can accommodate the largest demographic possible. Burke said the TSA does not develop its own technology and solicits private companies to develop scanners that meet the agency’s needs.

Neffenger said talking to transgender people and advocates helped him realize that the agency had to do better.

“You really have to design a system that is as close to 100% as possible,” he said.

The TSA and L3Harris Technologies did not respond to questions about how the scanner’s algorithm processes images to determine threats. (In June, L3 Technologies and Harris Corporation merged to form L3Harris, which has about 48,000 employees and is a key government contractor.)

In a written statement, Jennifer Barton, a spokeswoman for L3Harris, said details about the company’s research and development are confidential. She also said the company is working “with the TSA” on new technology and products that meet the agency’s “evolving requirements and the needs of all passengers.”

“We recognize the importance of ensuring that security scanning equipment accommodate all gender identities, and that is why (the company) is developing technology that moves away from the current male/female imagery and will safely screen passengers without the use of gender-specific images,” Barton wrote.

Barton didn’t respond to follow-up questions about when the technology would be ready for use at airports.

Beyond Technology

While Olivia was searched in the private room in Fort Lauderdale, her fiancee, Marguerite, was waiting on one of the benches near the security checkpoint. Olivia, a trial lawyer, and Marguerite, a school psychologist, had been dating for a year and were planning to marry that winter. The couple were on their way to New York for Marguerite’s brother’s wedding, and Marguerite was worried that they might miss their flight.

“I didn’t know if I could call the police,” Marguerite said. “I didn’t know what my rights were.”

Olivia said she is used to people questioning her appearance — and even her right to exist — because she is transgender. Showing her naked body to TSA officers, however, was a level of invasiveness she wasn’t prepared for.

“The whole weekend of the wedding I replayed the situation in my mind. It ruined the trip,” she said. “As a lawyer I am used to being in control of the situation, but that situation just completely went off the rails.”

Days after the incident, she filed a detailed complaint with the TSA. Her account describes actions, such as the directive that she submit to being searched by a man, that would violate TSA policy.

“As a lawyer I am used to being in control of the situation, but that situation just completely went off the rails,” Olivia said. (Annie Flanagan, special to ProPublica)

Burke, the TSA press secretary, said transgender people are supposed to be patted down by an officer of the same gender that they present.

A TSA officer, who has worked as a screener since 2016 and spoke on the condition of anonymity, said the officers should not have allowed Olivia to expose herself.

“The moment she [Olivia] said she was going to take her clothes off, they had to say: No, we can’t allow that. That is completely against SOP [standard operating procedure],” the TSA officer said.

Olivia said if she’d known she had the right to bring a witness into the private room, Marguerite would have been there with her.

Six weeks after she filed her complaint, on Oct. 31, 2017, Olivia received a letter from the TSA’s Office for Civil Rights and Liberties, Ombudsman and Traveler Engagement. The letter shared the conclusions of the agency’s investigation into the incident: “Our review to date does finds [sic] that the TSA officers and staff did follow Standard Operating Procedures (SOP) in the overall screening and the pat down procedures,” it said.

According to the letter, the agency’s investigation involved “a collection and review of eye-witness statements, close circuit television footage, and any other evidence tending to prove or disprove a traveler’s factual allegations.”

The two-page letter didn’t address Olivia’s claim that she had to expose her genitals to TSA officers.

“My complaint came back and it was not at all what I said had happened,” Olivia said.

Eventually, Olivia filed a Freedom of Information Act, or FOIA, request for the evidence the TSA said it reviewed to investigate her allegations. Her request was denied.

“Nobody called me, nobody did anything, they completely blocked my FOIA request,” she said.

ProPublica also submitted a FOIA request for documents related to the investigation into the incident, along with a privacy waiver signed by Olivia to allow ProPublica to access her records. The agency has yet to provide ProPublica with any of the requested records, citing a backlog in FOIA requests.

ProPublica reviewed the narrative that Olivia included in her original complaint to the TSA, as well as photos she took of the officers involved and an audio recording she made at the end of the incident, to corroborate her description of events.

The agency told ProPublica that it does not have cameras in private screening rooms and did not respond to questions about the incident or Olivia’s complaint.

ProPublica contacted one of the officers at her home in South Florida, but she declined to comment. We could not locate the other two officers.

Deficient Training

TSA officers and supervisors started taking a 30-minute online course titled “Transgender Awareness Training” in February. The course is supposed to teach employees how to interact with transgender people respectfully, according to a one-page summary of the training provided by the TSA.

Burke said that the agency would not provide a copy of the training materials because they are “sensitive security information.”

ProPublica reviewed hundreds of posts and comments from a private Facebook group for current and former TSA employees called “TSA Breakroom.” The conversations in the group, which has more than 18,000 members and is not administered by the TSA, shed some light on the content of the training.

In a series of discussions earlier this year, group members, some of them withholding their names, complained about the program. One of the anonymous posts said the course in the Online Learning Center, or OLC, instructed officers to introduce themselves to passengers by stating their name and the pronouns the officer uses.

A post in a private Facebook group for current and former TSA employees called “TSA Breakroom.”

This kind of introduction is common in the LGBTQ community, but dozens of group members wrote that they didn’t understand the instructions or would not be willing to introduce themselves that way.

Many group members wrote that they worried passengers would be upset if officers asked them about their gender identity.

“I shook my head through that whole dang course,” one member commented in April 2019. “Someone will throat punch me if I say that stupid shit.”

A comment from April 2019 about a transgender awareness training course, posted in a private Facebook group for current and former TSA employees.

Other group members wrote that the training didn’t address the fundamental problem that the scanners have only male and female options.

“I got a pink button and blue button. Which one you want?” one group member wrote.

The current TSA officer who spoke to ProPublica on the condition of anonymity said that she came up with her own ways to screen transgender passengers.

“I flip a coin in my head and hit a button, wait for the person to walk out of the scan, point at the screen and ask the person: Did I scan you right?” the officer said. “It is sort of a discreet way of asking.” If the passenger’s answer is no, the officer asks the passenger to walk through the scanner again and hits the other button.

Another TSA employee, who has worked for the agency for over a decade and spoke on the condition of anonymity, said that the gender buttons are stressful for both passengers and officers.

“A lot of the traveling public already hate us,” she said. “We don’t want to offend people by [scanning them] wrong.”

Some members of Congress have tried to address discrimination against transgender people at TSA checkpoints through legislation. In 2018, Rep. Kathleen Rice, D-N.Y., introduced the Screening With Dignity Act, which proposed funding for TSA training and education and a feasibility study for retrofitting or replacing the millimeter wave scanners. The bill died in the Homeland Security Committee and has not been reintroduced this year.

“It is clear that TSA needs to reassess its technological capabilities and improve its screening procedures to be more inclusive,” said Rice, who was the district attorney for Nassau County, on Long Island, before being elected to Congress. “No one should have to go through airport security scared that they might be humiliated, discriminated against or outed.”

In a 2015 survey (closed) of transgender Americans, NCTE found that of respondents who had gone through airport security in the last year, 43% had a problem at the checkpoint related to being transgender.

Many transgender people fear interacting with law enforcement in any setting. According to the NCTE survey, 57% of respondents said they would be afraid to ask the police for help.

Fox, the transgender woman who said she was asked to expose her genitals at the airport in Albuquerque, said her boyfriend encouraged her to file a complaint, but she decided against it.

“Dealing with the legal system is scary,” Fox said.

Lasting Trauma

When Olivia left the private room where she was searched at the Fort Lauderdale airport, she ran to Marguerite, who was waiting for her on the bench, and wept.

“Calm down, calm down, get your stuff together,” Marguerite can be heard telling Olivia in the audio recording Olivia took on her phone near the end of the incident.

Olivia and her wife, Marguerite. When they have to fly, Marguerite prints out the screening procedures from the TSA’s website in case Olivia is stopped again. (Annie Flanagan, special to ProPublica)

From the time Olivia stepped in the body scanner to the time she was allowed to head to her flight, the encounter spanned just 20 minutes. But it’s been impossible to forget.

Marguerite and Olivia, who married last year, have traveled a few times since the September 2017 trip. Marguerite prints the screening procedures from the TSA website and keeps a copy in her purse, in case she has to show it to a TSA officer.

Each time they travel, Olivia panics as she approaches an airport checkpoint.

“I feel my heart speed up. I start thinking: It is going to happen again, it is going to happen again, it is going to happen again,” she said.

This May, while flying back to Florida from North Carolina, a TSA officer asked Olivia to step aside. The airport body scanner issued an alarm in her groin area. The officer patted her over her jeans and allowed her to head to her flight.

When she left the checkpoint, Olivia ran to Marguerite, who held her as she cried.

Este reportaje es publicado conjuntamente con el Miami Herald, que tradujo al español una versión de esta historia. Puede leerla aquí.

Do you have access to information about the TSA that should be public? Email and Here’s how to send tips and documents to ProPublica securely.

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“People engaged in sex work deserve to be treated with dignity and respect,” the lawmaker behind the bill said.

A month after New York Gov. Andrew Cuomo signed legislation to repeal the state’s controversial “walking while trans” statute, California may be following suit.

On Monday, state Sen. Scott Wiener (D-San Francisco) introduced Senate Bill 357, which aims to repeal California’s own harmful anti-loitering code, which has been in place since 1995. The law’s wording criminalizes not only sex work but “loitering with the intent to solicit as well as directing, supervising, recruiting, or aiding a person who is loitering with the intent to commit prostitution.” That language is vague enough that even wearing tight clothing can technically be grounds for arrest.

According to Weiner, these laws have long been the force behind the targeted persecution of Black and Brown people by police, especially those in the trans community. According to a 2020 UCLA School of Law paper cited by Weiner in remarks shared with CNN, Black adults make up 56.1% of all charges related to the anti-loitering statutes in Los Angeles, despite accounting for only 8.9% of the city’s total population.

If passed, SB 357 would make it harder for police to make arrests solely based on how a person looks on the street. “This is one of those laws based exclusively on stereotypes and profiling,” Wiener told the cable news network. “You don't have to actually do anything to commit this crime. This is based on how you look and how you're acting.”

Wiener, who is openly gay, went on to describe the law as “un-American” and sexist, adding that “people engaged in sex work deserve to be treated with dignity and respect.”

Bamby Salcedo, an L.A.-based trans advocate and founder of the Trans Latin@ Coalition, told CNN that the violence faced by her community is “like a double-edged sword.” “We experience both institutional and interpersonal violence,” she said, adding that she’s known many people “who have been arrested after just walking down the street or hanging out with their friends.”

The proposal is well-timed. 44 trans people lost their lives to violence in 2020, and the majority of those killed were Black and Latina women. This year is already on track to surpass that record total: 10 trans people have already been murdered in less than three months, which is three times as many victims as the same point last year.

During his 2020 campaign, President Joe Biden vowed to fight the epidemic of violence against trans women of color by strengthening hate crimes laws and directing “federal resources to help prevent” more lives from being lost.

This isn’t Weiner’s first attempt to ease the challenges that LGBTQ+ people face. In 2021, the 50-year-old lawmaker has introduced at least two other pro-equality bills: SB 225, which protects intersex children from having their genitals operated on without their consent, and SB 379, which ensures that the University of California Health System works with contractors who provide gender-confirming and reproductive care. If passed, SB 225 would be the first bill of its kind in the United States.

Wiener’s newest bill has already been met with an endorsement from the statewide LGBTQ+ advocacy group Equality California. “All LGBTQ+ people deserve to exist without fear of harassment and violence, which is why we are proud to support SB 357,” said its legislative director, Tami A. Martin, in a statement cited by CNN.
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