Dr. Rachel Levine at Franklin & Marshall College

Pennsylvania Physician General Dr. Rachel Levine at Franklin & Marshall College.

Dr. Rachel Levine, Pennsylvania’s physician general and one of the few transgender public officials in the nation, spoke Thursday at Franklin & Marshall College’s Common Hour, a community discussion that is open to the public.

Levine’s speech focused on issues faced by transgender people. Here are some takeways from her talk.


Levine said the latest research from the National Center for Transgender Equality surveyed thousands and found that about 40 percent of transgender people have attempted suicide, compared to roughly 5 percent of the population at large.

It also found that about a third of respondents reported a negative reaction from a health care provider upon revealing that they were transgender.

“It’s nothing about being LGBT that predisposes you to mental health issues,” Levine said. “It’s the discrimination and the harassment that people face.”

Language changes

“ ‘Queer’ used to be derogatory,” Levine said. “Now it’s used as an umbrella term.”

On the other hand, she said, “transvestite” was in the past sometimes used generically for a transgender person, but now is considered specific and negative. “Use ‘crossdresses’ instead.”

She also noted that what was formerly termed sexual reassignment surgery should now be called gender confirmation surgery.

Surgeons are in short supply

Nationwide, Levine said, there are only about a dozen surgeons who are experts in gender confirmation procedures.

“There’s insurance coverage now, but those dozen surgeons are booked for the next two years,” she said. “That’s an access problem.”

Hormone therapy is for life

Hormone therapy takes time, Levine said, with the first few years similar to experiencing puberty.

And as things stand, the hormone treatments need to continue for life.

A student asked if gland transplants could replace ongoing hormone treatments. Not at this point, Levine said.

A second question from the audience was on whether hormone therapy increases the risk of cancer.

“It is intensively being studied and there is no evidence of cancer from the hormones,” Levine said.

Minors need parental consent

If the situation is right and parents consent, hormonal treatment can start in the mid-teens, Levine said.

But without parental consent, hormonal therapy cannot start until age 18, unless the child is fully emancipated — a legal process that grants a teenager who is 16 or older legal independence from his or her parents or guardians.

Surgical treatment is not generally recommended before age 18, she said.

The science is still being studied

Levine defined gender identity as “who you feel inside” and said what causes it is still being studied.

“The hypothesis that I will give you is that the organic basis of gender identity is the expression of neurodevelopment of the brain, which is biological — as opposed to a competing hypothesis that this is somehow psychological or developmental,” she said, summarizing a number of studies. “To be fair, there are competing ideas; this is the prevalent theory.”

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