Transgender, or trans for short, is a term that describes a person whose gender does not coincide with their sex. Someone’s sex refers to physical and biological features such as reproductive organs and hormones and is assigned at birth.

There are three recognised sexes: male, female, and intersex. Male-assigned people have higher testosterone levels and one X and Y chromosome, while female-assigned people have higher levels of estrogen and progesterone and two X chromosomes.

While society typically sees sex as binary, there are also intersex people. Some male babies are born with extra X chromosomes, and some female children have extra Y chromosomes. Sometimes these differences are only visible when they reach puberty.

Contrary to popular belief, gender has not been defined as binary in the past. Historical documents suggest gender non-conforming people have existed for thousands of years throughout a variety of societies.

Many traditional cultures developed their terminology for trans individuals, such as India, Polynesia, New Zealand, and Arabia. There is also evidence of ancient civilisations having trans people, such as Mesopotamia, Sumerian, Assyria, Babylonia, and Akkadian as early as 4500 years ago.

Gender is currently seen as a spectrum, a social construct associated with behaviours, roles, and norms. As so, it changes between societies and time, involving how people identify themselves. A person’s gender may change multiple times during their life. There are many ways sex and gender relate to each other. Trans people can have binary, non-binary, or no gender identity at all.

Binary genders are the classic female and male, while non-binary is an umbrella term that includes a wide range of identities like the absence of gender, multiple genders (such as fluctuating between genders), genders other than the binary ones, and partial ones.

Non-binary people use pronouns such as they/them, traditionally binary pronouns, no pronouns at all, or neo-pronouns. Some neo-pronouns are zie/zem, ve/ver, and per/per. The terms used to indicate sex are usually amab (assigned male at birth) and afab (assigned female at birth).

A phenomenon that affects most transgender people is gender dysphoria. It is characterised by solid and persistent identification with the opposite sex associated with anxiety, depression, irritability, and often a desire to live as a gender other than the sex of birth.

People with gender dysphoria often believe they are victims of a biological accident and remain cruelly trapped in a body incompatible with their gender identity, significantly increasing suicidal thoughts and tendencies.

The issue of mental health for the population of transgender people needs to be addressed. There is a myth related to the mental health issues of these individuals, which states that being trans itself is a factor that causes suicidal ideation, depression, anxiety, or other mental health issues.

These are ideas under a stigmatising and pathologizing bias, which ignore the positive results of a transition in welcoming environments, with support from parents, friends, and family, access to health care, and monitoring possible transition issues.

Guarantying humanised care, respect, and the use of social names and bathrooms according to the gender identity of trans people in social spaces are other factors that can guarantee the quality and improvement of the mental health of our population.

A large part of their mental suffering comes from the discrimination that exists in health care facilities, in education, and in their own families. LGBT people are commonly excluded from several social groups, either by their parents, families, or by society, constantly having their orientation and identity questioned.

Bullying begins at a very early age and is related to a reaction to the breaking of social gender standards. If a child has a penis, male social behaviour is expected and vice-versa – if he doesn’t have one, he becomes a laughing stock and may be assaulted in various ways. Discrimination notably generates a series of adverse effects on the individual’s mental health and contributes to illness later in life.

The International NGO National Gay and Lesbian Task Force pointed out that 41% of trans people have attempted suicide in the US at some point, compared to 1.2% of the cisgender population (those who are not trans). Research from the Williams Institute in Los Angeles published in 2014 estimated that 40% of trans people have tried to commit suicide. At the same time, research from Columbia University in the States reports that the suicide rate is five times more frequent among LGBT people.

This is a very sensitive issue for the LGBT population in general, especially for trans people, and should be seen initially from a public health perspective that, parallel to transphobia issues, should be prevented continuously and effectively.

It is common to see people presenting indices of regret of people who have undergone sexual reassignment surgery (SRS) to deny access to SRS electing supposed regrets, while science shows that this type of regret is almost non-existent. Regret about having surgery is very rare. All modern studies estimate the level of regret to be below 4%, and most estimate it to be between 1 and 2%. As surgical techniques improve, the risk of long-term complications has fallen to less than 1% in male-to-female patients.

Considering the level of harm possible when medical attention is denied and considering how rare repentance is, declining medical attention to everyone because of the exceptions makes no logical or ethical sense. More research is needed to understand what the risk factors are and improve prevention. It is necessary to demand public policies and the criminalisation of LGBT phobia, and the constant awareness of the gender issue.

After all, if we have groups demanding the end of “gender ideology in schools,” that is, the debate about the reality of LGBT people, the groups marginalised by prejudice will continue to think they are alone in the world and will get sick, whether they are adults or young people.

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