Trans health and the unanswered questions
When someone transitions often amongst the first questions they will ask are the long term health implications of the medication they will potentially take. It is a question loaded with the potential to both misinform and weaponise against transitioning. This is precisely because there is little to no accurate longitudinal intersectional scientific evidence looking at the long term health outcomes of early age and later age transitioners. Much of this has to do with the desire of trans folk to fade into the background and avoid further contact with the medical profession, though also has to do with the rationale behind many of the scientists wishing to conduct such studies. Trans health has never existed in political vacuum, and as such it is worth asking why there are so many unanswered questions with respect to trans healthcare of all varieties.
For much of trans medicine’s history it has been cloaked in both secrecy and extraordinary gate keeping. The first medical practitioners to offer treatment for gender related issues emerged at the end of the 19th century, often seeking to treat cisgender children with hormonal imbalances, men with sexual health problems, and hysteric women. Trans healthcare emerged from this milieu, first with experimental hormone injections and surgery, and then after the second world war a discrete set of surgical options that relied on rigid gatekeeping to access unless you had money to fly to Casablanca.
Since Christine Jorgensen flew back from Denmark to the US in the early 1950s, the world at large has been dimly aware of the possibilities of trans surgery. Over the course of the next thirty years trans medicine became a political football, and by the early 1980s almost all government sanction trans medicine was banned in the USA and locked behind cisnormative gender expectations in the UK. Other countries took different approaches, but the end result was that the scientific studies of long-term outcomes were never carried out.
Fast forward to 2023, and while much has changed with respect to access to knowledge due to the internet, trans health matters are still pretty much a case of stumbling across the right forum or website. If you transition at any age you want to know that the hormones and other medication you ingest are going to be safe for you to live a long healthy life. That in both the US and the UK the medical profession has scared off so many transitioners from wishing to partake in studies, and even those who do are a small sample size, speaks volumes for the impact of heavy handed gatekeeping.
Science requires trust on both sides of any study, especially those involving vulnerable groups who have been disrespected and abused by scientists in the past. Trans lives when they intersect with the medical profession are often treated inquisitorially, with off-handed lack of empathy, and little to no compassion. Most of the published studies fail to account for the intersectional nature of trans identities, in particular class, race, and ethno-genetics. Trans lives are treated with a broad brushstroke that sees patients as a homogenous lump, rather than individuals.
Unlike other chronic conditions like diabetes or cancer, gender issues are unique to the individual, though patients are treated and are expected to conform to a rigid series of pathways. There is little to no room for personal wishes or desires in the treatment plan, and even when surgery is appropriate there is no clear standard for patients to guage outcomes. Long term studies would provide answers to many of these questions, but to get there will take significant bridge building by the medical profession, insurance companies, governments, and universities with the trans community.
If trans medicalised healthcare is safe then the community needs to see clear proof above and beyond anecdotes in forums and chatrooms. If it is dangerous then it needs to be made clear above and beyond the output of those who seek to oppress trans identities. It is likely that while trans healthcare is safe for the majority of folk, there are going to be instances of danger for some people. Until we have the evidence this is just supposition and unverifiable. As someone who has been on hormones for 23 years and post-op for 15 I can only speak from personal experience, and have never found a verifiable longitudinal study that covers trans folk across multiple decades.
This need for trust is complex and complicated. For each demonising article, transphobic YouTube video, and State sponsored anti-trans legislation another cluster of trans folk shrink into themselves and their community. It becomes increasingly more difficult to coax the likes of myself and other long term transitioners to engage with scientists and healthcare professionals, as we simply do not have faith that they will reciprocate in good conscience. Our identities have been weaponised to the point that unless there is a concerted effort to assure us, we simply will not engage in the process.
Which leaves us back at anecdotes, forums, whispers, and extensive gatekeeping. All trans folk ask is that our identities are validated and accepted, not treated as deranged, disordered, or destructive. Evidence is sorely needed, as otherwise every trans person is simply accepting in good faith that their dolce vida will be measured in decades, not years. The good life should not rely on sticking your finger in the digital air and hoping the breeze is blowing in the right direction the day you land on a website. Trust takes two sides to build, and the medical profession and researchers need to start rebuilding it from their side as much as the trans community need to be assured that staying in the shadows post-transition only works once the science has been done. This is knotty and complex, but until we have evidence there will remain many unanswered questions.
