Note: The passage of a so-called “bathroom bill” in North Carolina — which states that people must use the public restroom that corresponds to the gender on their birth certificates — and similar efforts in other states have provoked discussion nationally about transgender issues. Because so much confusion surrounds this issue, we asked the state’s physician general to explain what it means to be transgender.
As sexual and gender minorities, lesbian, gay, bisexual and transgender people have been often misunderstood or misrepresented. Despite significant recent strides in the fight for full equality, the LGBT community continues to face significant stigma and discrimination for who they are or who they love.
The term “gender identity” is a person’s internal concept of self as a male, female or blend of both or neither.
Everyone has a gender identity.
If you’re cisgender, your gender identity matches the sex you were assigned at birth.
Transgender people’s gender identity is different from the sex to which they were assigned at birth.
So a transgender women is a person assigned the male sex at birth but whose gender identity is female. A transgender man was assigned female sex at birth but identifies as a man.
The two terms, sexual orientation and gender identity, are totally independent concepts. Being a transgender person does not imply any specific sexual orientation.
The growing body of medical literature points toward the neurodevelopment of brain as the origin of a person’s gender identity. These medical studies — and the recent change by the American Psychiatric Association to recognize gender dysphoria as a condition and not a mental disorder — reflect a positive shift.
The American Academy of Pediatrics, the American Medical Association and the Pennsylvania Medical Society support access to care for the LGBT community and a commitment to eliminate health care disparities. LGBT people continue to face worse health outcomes, and transgender people face particular disparities rooted in historical stigma and discrimination.
Transgender people, including youth, continue to face higher rates of HIV and other sexually transmitted diseases, victimization, mental health issues and suicide, and are less likely to have health insurance than heterosexual, gay or bisexual individuals.
Clear medical standards exist for the treatment of transgender people. The World Professional Association for Transgender Health establishes evidence-based standards of care, including the treatment of young people. Research proves that health outcomes for transgender youth are improved when they have the support of family, friends and their community, along with access to medical care that supports their gender identity.
I transitioned while living here in southcentral Pennsylvania and working as a physician at Penn State Hershey Medical Center. I was very pleased by the support of my community. I was not just tolerated, I was not just accepted, but welcomed and celebrated.
It is a significant process to change your gender. Most people may question many things in their lives: They may question their family, they may question their job, but they will not question their gender. I had questioned my gender from an early age, but did not know how to vocalize my feelings.
As Pennsylvania’s physician general, who happens to be a transgender woman, I am pleased to reach out to the transgender community and serve as a mentor, advocate or role model for transgender youth and adults. It is important to note that, despite all the challenges, transgender people are resilient.
In Pennsylvania, where LGBT people can still be fired for who they love, where transgender youth lack protections of comprehensive anti-bullying laws or protection from so-called “reparative therapy,” it is important to keep in mind how vulnerable this community can feel.
Gov. Tom Wolf is a staunch advocate of LGBT rights. In April 2016, he took a decisive step to extend protections to LGBT Pennsylvanians who work for or on behalf of the commonwealth. This important step was necessary because Pennsylvania lacks statewide comprehensive nondiscrimination legislation.
What happened in North Carolina, and what is going on in other states, should be a call to action to the Legislature to pass comprehensive non-discrimination legislation now. We must ensure equal protection under the law for all Pennsylvanians.
Dr. Rachel Levine is the physician general for the commonwealth of Pennsylvania and professor of pediatrics and psychiatry at the Penn State College of Medicine. She graduated from Harvard College in 1979 and the Tulane University School of Medicine in 1983.