June/July ‘23: Trans existence is not negotiable

Written by: Morgan Lee Egnot, MS (they/them) (G3 - MSTP)

The views expressed in this piece are those of the author. They do not represent the official views of the University of Pittsburgh School of Medicine or the University of Pittsburgh.

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Since starting the PhD phase of my degree program in 2020, over 900 bills targeting trans existence and autonomy have been proposed across the United States. As of my writing this article in July 2023, 562 of those bills have been introduced in 2023 alone [1]. Globally, from the beginning of 2020 to the end of 2022, over one thousand trans people have been murdered – around one death every day [2,3,4]. As a nonbinary trans person, I have unwillingly become used to waking up every day to learn of another murder, another law enacted restricting trans bodily autonomy, another attempt at criminalizing trans existence passed, and having to quietly suppress my thoughts about my community’s mortality as I set up my samples for another long day in lab. My doctoral thesis work in bioengineering, which will become the foundation for the rest of my scientific career, will hopefully advance knowledge of vaginal biomimicry and tissue engineering and add to the small but growing field of gender affirming pelvic medicine [5,6]. It also does nothing to stop the bills or the murders.

In the face of escalating attacks on our personhood, trans people have found sanctuary in each other through an unwavering determination to carve out their own existence and chart their own futures. We create joy, find community in each other, and create intersectional solidarity as politicians seek to eradicate us [7,8,9]. However, there are some places trans people cannot easily reach, as is clearly the case in clinical medicine and research [10]. The transphobia instilled in medical education has become another convenient tool to maintain power dynamics that prioritize the maintenance of existing white, cis, affluent perspectives, while pathologizing trans peoples’ quest for bodily autonomy and silencing their joy [11,12,13]. True trans liberation in medicine must come with the reckoning of powerful people - physicians, scientists, trainees - with their status and privilege. They must choose to make themselves vulnerable by advocating for trans people without reservation. As physicians, scientists, and trainees, we have disproportionate access to financial and social capital that we can use to drive change and advocate for those harmed by the oppressive structures we inhabit. We cannot change the ways we have hurt people in the past, so we instead must make a commitment to pull ourselves away from comfortable passivity as more trans people are killed. Simultaneously, we cannot allow ourselves to misdirect anger at trans people holding mirrors to the people and structures they have been hurt by, and retreat to the comfort of ivory towers. Trans and cis people are not each other’s enemy, and we must learn from each other to transform and abolish the systems of power that oppress all people [14].

Aspiring trans allies in Pittsburgh should know that transphobia is alive and well here, and it permeates Pittsburgh’s most prolific clinical and higher education institutions [15,16,17]. In a time of heightened visibility where it has become increasingly dangerous to openly exist as trans, it is critical for physicians, scientists, and trainees to voice their support for trans autonomy both within and outside of their work. I hope to use my personal experience as just one trans person among millions to provide some action items for aspiring allies and accomplices:

1. Learn about what it means to be trans, the history of trans people in your community, and how internalized transphobia permeates medical and research institutions [18].

2. Devote time to understanding how race, disability, migrant status, incarceration, and other dimensions of marginalization put many trans people at even greater risk of violence and death [19,20]. Of the hundreds of murders of trans people that are recorded every year, the majority are of trans women of color, sex workers, and migrants [2]. 

3. Understand how bans on trans gender affirming care also rob intersex people of their own bodily autonomy by codifying unnecessary and harmful cosmetic surgeries on intersex children. These procedures have been condemned by the United Nations, and intersex survivors have described these surgeries as mutilation [21,22].

4. Learn how to advocate for better research and clinical care for trans people. Read healthcare perspectives written by trans people and incorporate inclusive practices into your clinic or lab [23,24].

5. Cultivate literacy of common fallacies in transphobic rhetoric and learn to look for them in bills proposing restrictions on gender affirming care, participation in sports, bathroom access, drag bans, and more [25]. Use your existing talents in science communication to speak out on these bills and advocate on behalf of trans people in government spaces.

6. Work and share power with local trans communities in Pittsburgh. Attend the 2023 TransPride YOUniting Health and Wellness Conference [26].

7. Above all, when you witness transphobic injustice, resist the urge to do nothing and pretend it is someone else’s job to mitigate, or that this will all be in the past someday. Our success rests on the community we build with each other now, and every small action matters.

It feels like treading water to do trans-centered work as a trans person in a field where representation and funding I need to thrive is so scarce. Like so many other trans people in 2023, I am quietly keeping tabs on the hundreds of bills targeting my existence as I race to finalize my legal name change and book surgery months ahead of time hoping it will still be legal and affordable in my state when I enter the OR as a patient. As a trans medical student pursuing a career in pelvic health and gender affirming care, I have also been watching the list of states I can train and practice medicine in dwindle. By the time I finish my training, could I even get NIH funding to research advances in trans bodily autonomy? Even so, I still consider myself successful. I have a roof over my head, a consistent source of income, excellent job security, and an extraordinary found family – things that are disproportionately challenging for queer people to access. Understand that celebrating already visible and successful trans people is not the end goal of trans advocacy – we cannot turn away from trans people who are multiply marginalized, who exist outside of binary conceptions of identity, and who proudly choose not to alter their presentation for the comfort of cis people. There are so many who must remain closeted for their own survival, and others who are visible and have endured unspeakable hardship as a result. It is necessary to reach them as well, to champion their own safety, medical autonomy, dignity, and success. It is what I am hoping to do with my career, and I hope you will join me.

References

[1] Tracking the rise of anti-trans bills in the U.S.. Accessed 07/06/2023. https://translegislation.com/learn

[2] TMM Update: Trans Day of Remembrance 2020. 11/11/2020. Accessed 07/06/2023. https://transrespect.org/en/tmm-update-tdor-2020/

[3] TMM Update: Trans Day of Remembrance 2021. 11/11/2021. Accessed 07/06/2023. https://transrespect.org/en/tmm-update-tdor-2021/

[4] TMM Update: Trans Day of Remembrance 2022. 11/08/2022. Accessed 07/06/2023. https://transrespect.org/en/tmm-update-tdor-2022/

[5] Sueters J, Groenman FA, Bouman M, Roovers JPW, de Vries R, Smit TH, Huirne JAF. Tissue Engineering Neovagina for Vaginoplasty in Mayer–Rokitansky–Küster–Hauser Syndrome and Gender Dysphoria Patients: A Systematic Review. Tissue Engineering Part B: Reviews. 2023;29(1):28-46. https://www.liebertpub.com/doi/10.1089/ten.teb.2022.0067 doi: 10.1089/ten.teb.2022.0067

[6] Tan Y, Landford WN, Garza M, Suarez A, Zhou Z, Coon D. Complete Human Penile Scaffold for Composite Tissue Engineering: Organ Decellularization and Characterization. Sci Rep. 2019;9(1):16368. Published 2019 Nov 8. https://www.nature.com/articles/s41598-019-51794-6 doi:10.1038/s41598-019-51794-6

[7] Miller B. Posing for LGBTQ+ History. 05/28/2020. Accessed 07/06/2023. https://nmaahc.si.edu/explore/stories/posing-lgbtq-history

[8] Goldberg S. Remembering Tortuguita, Indigenous queer and non-binary environmental activist and forest defender. 03/21/2023. Accessed 07/06/2023. https://www.hrc.org/news/remembering-tortuguita-indigenous-queer-and-non-binary-environmental-activist-and-forest-defender

[9] DuBois LZ, Puckett JA, Price SF, Kuehn K, Lash B, Walker T, Holt NR, Ralston AL, Huit TZ, Miles M, Volk S, Capannola A, Tipton C, Hope DA, Mocarski R, Juster R. The Impact of Sociopolitical Events on Transgender People in the US. Bulletin of Applied Transgender Studies. 2023;2(1-2):1-26. https://bulletin.appliedtransstudies.org/article/2/1-2/1/ doi:10.57814/sdx3-7y41

[10] Das LT. We need more transgender and gender nonbinary doctors. 09/01/2020. Accessed 07/06/2023. https://www.aamc.org/news/we-need-more-transgender-and-gender-nonbinary-doctors

[11] Lett E, Orji WU, Sebro R. Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties. PLoS One. 2018;13(11):e0207274. Published 2018 Nov 16. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207274 doi:10.1371/journal.pone.0207274

[12] Nguyen M, Desai MM, Fancher TL, Chaudhry SI, Mason HRC, Boatright D. Temporal Trends in Childhood Household Income Among Applicants and Matriculants to Medical School and the Likelihood of Acceptance by Income, 2014-2019. JAMA. 2023;329(21):1882-1884. https://jamanetwork.com/journals/jama/article-abstract/2805063 doi:10.1001/jama.2023.5654

[13] Jacobsen K, Devor A. Moving from Gender Dysphoria to Gender Euphoria: Trans Experiences of Positive Gender-Related Emotions. Bulletin of Applied Transgender Studies. 2022;1(1-2):119-143. https://bulletin.appliedtransstudies.org/article/1/1-2/6/ doi:10.57814/ggfg-4j14

[14] Mar RT. Trans Rights Are Women's Rights. 03/17/2023. Accessed 07/06/2023. https://www.aclu.org/news/lgbtq-rights/trans-rights-are-womens-rights

[15] Demjan N. Hold the University Of Pittsburgh Accountable in Protecting LGBTQIA+ Individuals. Updated 03/24/2023. Accessed 07/06/2023. https://www.change.org/p/hold-the-university-of-pittsburgh-accountable-in-protecting-lgbtqia-individuals

[16] Bhasin P. LGBTQ+ healthcare experiences inconsistent, lack some services for transgender Pittsburghers. 03/10/2023. Accessed 07/06/2023. https://www.publicsource.org/transgender-pittsburgh-gender-inclusive-affirming-healthcare-allegheny-network-ahn-upmc/

[17] Sy S. Children’s hospitals become targets of anti-transgender attacks and harassment. 08/31/2022. Accessed 07/06/2023. https://www.pbs.org/newshour/show/childrens-hospitals-become-targets-of-anti-transgender-attacks-and-harassment

[18] Understanding Transgender People: The Basics. 01/27/2023. Accessed 07/06/2023. https://transequality.org/issues/resources/understanding-transgender-people-the-basics

[19] Lett E, Abrams MP, Gold A, Fullerton FA, Everhart A. Ethnoracial inequities in access to gender-affirming mental health care and psychological distress among transgender adults. Soc Psychiatry Psychiatr Epidemiol. 2022;57(5):963-971. https://link.springer.com/article/10.1007/s00127-022-02246-6 doi:10.1007/s00127-022-02246-6

[20] LaPier R. Analysis: How anti-trans laws jeopardize Indigenous peoples’ rights, religious expression. 06/15/2023. Accessed 07/06/2023. https://www.pbs.org/newshour/nation/analysis-how-anti-trans-laws-jeopardize-indigenous-peoples-rights-religious-expression

[21] US: Harmful Surgery on Intersex Children. 07/25/2017. Accessed 07/06/2023. https://www.hrw.org/news/2017/07/25/us-harmful-surgery-intersex-children

[22] Fact Sheet: Intersex. 07/2015. Accessed 07/06/2023. https://www.unfe.org/wp-content/uploads/2017/05/UNFE-Intersex.pdf

[23] Streed CG Jr, Perlson JE, Abrams MP, Lett E. On, With, By-Advancing Transgender Health Research and Clinical Practice. Health Equity. 2023;7(1):161-165. Published 2023 Mar 3. https://www.liebertpub.com/doi/full/10.1089/heq.2022.0146  doi:10.1089/heq.2022.0146

[24] Kidd KM, Sequeira GM, Rothenberger SD, et al. Operationalizing and analyzing 2-step gender identity questions: Methodological and ethical considerations. J Am Med Inform Assoc. 2022;29(2):249-256. https://academic.oup.com/jamia/article-abstract/29/2/249/6362564 doi:10.1093/jamia/ocab137

[25] Pauly M. Inside the Secret Working Group That Helped Push Anti-Trans Laws Across the Country. 03/08/2023. Accessed 07/06/2023. https://www.motherjones.com/politics/2023/03/anti-trans-transgender-health-care-ban-legislation-bill-minors-children-lgbtq/

[26] 2023 TransPride YOUniting Health and Wellness Conference. Accessed 07/06/2023. https://www.transpridepgh.org/2023-hw-conference.html