Three years ago, when a fellow transgender writer learned I started my Writing program and intended to write memoir, she asked me facetiously, “Will you write your transition story?”

“Well,” I said, “I have so much more to write about.” She smiled and nodded.

Our transition stories are important. Major turning points in our lives. They lend themselves well to the “traditional” narrative arc: exposition, rising action, climax, falling action, resolution. The protagonist has a goal (living as my true self, a man), but encounters barriers to achieving it (I risk my marriage, my natal family, my life in Tanzania, societal scorn), and my story tells how I overcome obstacles, choose myself, divorce, move continents, and reach my goal of transition.

Telling our transition stories is a key part of processing and healing.

But they are not our only stories. I think a lot of us feel that society reduces us to only our transness, only our transitions. We become a trope. One dimensional. I resist that pigeonholed narrative. I’m confident trans/nonbinary people are not the only minority that sometimes feels this way.

But we, like everyone, are multifaceted, complex, full human beings.

My thesis is both about me as a trans person, and not about my transness. I don’t tell my coming out and transition stories at all; I leapt right over them. I also leapt over my break from Mormonism, my 20-year marriage, divorce, the decade+ living in Tanzania, my career in global health, giving birth and parenting, the painful adjustment as my kid grew into his adulthood, how I discovered my neurodivergence, or how I met and immediately fell in love with my new husband.

Why? I don’t know. I guess I’m not ready to write those stories, at least not to a standard of craft I feel good about.

But the stories in my thesis are, nevertheless, infused with my boy-ness, gender dysphoria, and the embodied consequences of suppressing my Self in order to survive.

I could not begin to heal, to become whole again, until I felt safe enough to live as my Self. And I could not begin to find that Self until after I transitioned. That’s when the real growth began. And though most people are not trans, we each have our own version of authenticity and wholeness that is worth striving toward. My stories, then, are both foreign and familiar.

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About my thesis

The program honored me with the David Everett Award for Outstanding Thesis.

After a girlhood in a large Mormon family marked by all-consuming religious devotion and marriage at nineteen, now in middle-age, I navigate masculinity, family, and dating as a queer, transgender man. A Light in Outer Darkness, a memoir-in-essays, reckons with layered identity, the embodied cost of self-erasure, and the long arc of queer self-discovery.

The seven essays are in chronological order. The first highlights my toddlerhood, written in a voice that captures both the innocence of kid logic and the wisdom of hindsight. It recounts my earliest childhood memories, when I knew I was a boy. Because no one believed me, I donned my “girl disguise” for the next thirty-five years. The ruse proved effective; even I failed to understand my constant discomfort and the underlying sense of wrongness that continues through the subsequent essays.

The second and third essays take place days before my first marriage at age nineteen. Here, I slow time down to bring the reader into my memory of those confusing, life-altering minutes as I was initiated into the “sacred, not secret” Mormon temple rituals. Echoes of the coerced choices I made that day haunt me for decades before I begin to comprehend their embodied impact.

In the fourth essay, time leapfrogs through decades, capturing discrete memories of queer experience and denial. The essay arcs like a rainbow between the youthful me of the first three essays and the forty-something me in the final three. In those, I am myself, a man named Will. As my identity resurfaced and I negotiate old and new relationships as a man, I face the enduring cost of silence, the ache of delayed grief, and the hard-earned path to self.

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About the Video

This video excerpted from my third essay, “I Love to See the Temple, Part 2: Anointing.”

Content warning: ritualized, non-consensual touching. Transcript below.

I created this artwork to help process this experience. Though it was 27 years ago, I can still feel its embodied impact.

Yep, that’s me in the photos, age nineteen. I kept the middle picture whole because I like how I looked there, and because through it all, I am me. My Self is constant and whole.

I chose this piece for my thesis reading because it’s a major moment of psychological rupture and fragmentation. I wanted the audience to feel, to get close to what I felt. It showcases my abilities as a writer to convey that visceral response.

After I chose, edited, and rehearsed it, I then freaked out about my choice. My past Mormon programming came rearing up. The first rule of the temple is that you do not talk about the temple.

I found every excuse to doubt my choice. It’s too intense. It’s too private. It needs a content warning (which we don’t give in the writing program). Most of my family hasn’t talked to me since they learned I criticize their church, including this essay. When I worked my way through one excuse, I found another. I talked through them all in two therapy sessions.

“Why shouldn’t you be able to share your experience?” my therapist asked.

“Because the Devil declared he’d have all power over me if I do,” I told her. Not that I believe that. I don’t believe in a devil, or an afterlife. Or any gods. But the fear, mapped onto my body, into my brain, is real nevertheless.

Ultimately, I emailed my thesis advisor, Susan Muaddi-Darraj, an amazing fiction writer and acclaimed author. She also writes about her cultural heritage in ways that I’m sure she’s gotten flak for. I told her my hesitation and asked for a gut check. She wrote back, ”It’s so filled with tension that it crackles. Nice choice.”

I stuck with my choice. I stand by it. Even though it was terrifying. Even now, I hesitate to publish this post.

Transcript

I’m Will Cole. This is from my memoir entitled, A Light in Outer Darkness. I’m a trans man, and at the time of these events, I was living as a woman, age 19, and being initiated into the Mormon temple, days before my wedding ceremony. I had been told nothing about what to expect. We enter the action right after I have followed instructions to remove all my clothes and cover myself with a large, white cloth, similar to a poncho.

Mom knuckle-taps twice on my stall door, “You okay, honey?”

A familiar discomfort radiates out from my torso. I stand barefoot, covered but exposed. This is what Heavenly Father wants. I open the door.

Mom’s lower jaw is askew and her dark eyes dart around my face. [whisper] “You don’t ever have to be naked,” she says. “Didn’t your dad tell you?”

My left hand clenches the poncho’s edges into my stomach like I’m staunching the seeping blood of a stab wound. Mom envelops me in a hug, saying, “It’ll be okay.”

I command my legs to move, left, right, left, toward a row of curtained cubicles. A gray-haired guide gestures me through with a saccharine smile. I am alone in a four-by-four-foot stall. A wrinkled hand appears around a second curtain and pulls it aside. My brain is a TV stuck between channels. This is what Heavenly Father wants. I step forward.

A new woman in white taps my left fist to release my vice grip, and the cloth falls open. Something in my head is pulling me backward, far, far away.

“Sister,” she says, “say your full name.”

[mumble]

“Say your name again.”

After I repeat, she dips her hand in a burbling fountain and wipes water across my forehead, praying in a lilting rhythm, I wash your head, that your brain and your intellect may be clear and active. I long to bathe in this moment of power, the sole liturgical authority that belongs to women, but I register little. I remember less.

With a wet finger, she blesses my eyes that I may discern between truth and error, ears, and nose, then I feel her stroke the bare skin between my shoulder blades. A roaring white noise fills my ears. Under the cloth, the finger strokes my chest, my belly. A single word penetrates the fog—loins—as a cold finger grazes my inner, upper thigh. My body recoils. Her hot breath hisses as she blesses my feet, that I might run and not be weary, and walk and not faint, but I am a statue.

The blessing of the body parts repeats, now with oil. In and out under the cloth, a hand slithers. I retreat further into the Silent Place.

In the next cubicles, new women’s voices seal the anointing, in the name of Jesus Christ, amen. One phrase pierces through: preparatory to becoming a queen and a priestess unto your husband.

Unto my husband?

My guide holds up a translucent white, knee-length jumpsuit. She holds it open and gestures for me to step into the Garment of the Holy Priesthood. It’s baggy. As she pulls it up under the cloth and onto my shoulders, she drops her hands and gropes for the zipper. My hips jerk backward. From between my legs to my collarbones, she zips the garment up, chanting.

My body is their puppet.

If you’re as steeped in the trans world as I am, you’ll already be familiar with the large overlap between transness and autism. That is, compared to cis people, more trans & gender diverse/nonconforming people are autistic. And compared to allistic (not autistic) people, more autistic people are trans.

Why the overlap?

We don’t really know, but there are lots of theories: biological, genetic, social, and psychological or cognitive.

My favorite hypothesis is that transness and autism aren’t necessarily connected on a biological or genetic level. But since autistic people tend to care less about social norms and cues, we are less prone to peer pressure. Because of that, we are freer to grasp and accept who we really are, rather than repress it to fit in. That includes trans/nonbinary gender identities, gender expression, and various sexualities. (Being gay, bi, and queer are higher among autistic people, too! And among trans people.)

If this hypothesis is true, the prevalence of transness and gayness among autistic people may reflect the “true” prevalence in society. But the non-autistic people repress their “deviant” genders and sexualities more readily, due to social pressures.

Who knows if it’s correct or not. But I like it.

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How Many? How Much?

We don’t have enough research to have precise percentages. Instead, we have fairly wide ranges of numbers. But all data points in the same direction: the overlap is bigger.1

Exact numbers are hard to pinpoint, but here are some of the estimates from pooled and/or larger studies:

• 11% of trans people are autistic, according to a 2023 systemic review and meta-analysis of 25 studies totalling almost 9,000 people of all ages.2

• 7.8% of autistic children and adolsecents sought care for gender dysphoria—that’s 4 times more than the general population.3 In this systematic review:

  • 5.5% to 29.6% of trans adults were autistic

  • 6.3% to 27.1% of children/adolescents with gender dysphoria were autistic

• 1.1% of autistic adolsecents ages 9 to 18 had gender dysphoria, compared to 0.6% in neurotypical (allistic) youth. Autistic adolescents had 3 times greater odds of being diagnosed with gender dysphoria compared to allistic youth.4

  • This study included over a million adolescents at 8 pediatric hospitals.

The numbers have such a wide range for a few reasons.

One, studies have looked at this overlap with different definitions.

• Do they count self-discovered autism? Traits? Or only officially diagnosed?

• Similarly for transness, some count self-identified trans folks, while others measure gender dysphoria, and others only count people who’ve been clinically diagonsed.

Two, they start with different populations.

• Some start with autistc people and assess how many are transgender (or how many experience gender dysphoria).

• Other studies start with transgender/nonbinary people or people with gender dysphoria and assess how many are autistic (or have autistic traits).

Three, they look at different age groups: children, adolescents, adults, or a combo.

I’m Autistic!

Let me end Autism Acceptance Month by sharing that I am autistic. This’ll come as no suprise to other autistic folks, but probably somewhat suprising to allistic (non-autistic) people.

When I tell people who are allistic (or are autistic but don’t realize it yet), I get comments like these:

• “But I couldn’t tell! I would have never guessed.” (Autism doesn’t have a “look”; every autistic person is unique.)

• “I had no idea!” (I became a master masker over my 40+ undiagnosed years.)

• “No way. If you’re autistic, I’m autistic!” (Yes, probably. I have some book recs.)

• “But we’re all a little bit autistic!” (No.)

• “That runs in families. There would be others in (y)our family who are autistic, too!” (There sure are! On both sides!)

Autistic Self-Discovery vs. Professional Diagnosis

Another thing I, and many of us, hear is that autism has to be diagnosed by a profressional who is trained and certified in such assessements. While that’s a nice thing to have, and confirmation can feel important and validating to many people—and be required for access to support services—I’m in the “self-discovered autistic is valid” camp.

I have several reasons for this.

• Like the Autism Self-Advocacy Network (ASAN) and other orgs formed by actually autistic people, I consider autism to be a part of the natural diversity in humans, not a disease or failure. It’s not pathological. It’s not caused by Tylenol or any other medical intervention. It’s not something to be eradicated or cured. Autism can be both an identity to be proud of and celebrated and a developmental disability that may need extra support.

  • While US society is allistic-centric, other cultures and societies are friendlier to autistic people. This meme jokes about a book, “Am I autistic or just German?”

• Assessment is inaccessible. Trained professionals are hard to find and schedule. It can take years to get off a waitlist. Many speciality centers that offer these assessments only consider children. Once you’re 18, you’re ineligible, so it’s extra hard to get an adult diagnosis.

  • I’m lucky in that a friend of mine was getting certified and needed to practice, so they assessed me. But that was years after my self-discovery.

• It’s expensive! Most of the time in the US, health insurance refuses to cover assessments. Out of pocket, most assessors charge thousands of dollars. This widens social and economic gaps, with more White, middle class people able to access diagnosis and supportive resources. This reinforces the misperception that autism is mostly in White boys.

  • Follow Tiffany L Hammond, IG @fidgets.and.fries or on Substack , an autistic, Black mom with autistic boys who helps dispel racial and many other biases about autism. Also check out her bestselling children’s book, A Day with No Words.

  • People of different race/ethnicities do have the same prevalence of autism; the disparities are from racist access issues.5

• On the White boy misperception: autism was first defined through study of a very small number of upper/middle class, White boys. This has led to, among other problems, the lack of recognition of autism in girls, women, and people like me who were raised as girls/lived as women. Instead, many girls and women (and some boys) are misdiagnosed with all sorts of mental health and personality disorders from anxiety and depression to schizophrenia and borderline personality disorder. (They often do expereince anxiety and depression due to having unmet needs and the chronic burden of masking.)

  • Among trans/nonbinary people, autism is evenly distributed in trans women/femmes, trans men/mascs, and nonbinary people.6

  • (See Neurotribes by Steve Silberman for more of this history. People who are autistic existed throughout history and across the world; but humans didn’t put a specific label on this set of features until the 20th century.)

• There are many false assumptions about what autism looks like and what behaviors may spark parents to seek assessment. We tend to think that autistic kids take longer to learn to talk (and that is true of some, while some don’t use speech at all but communicate effectively with the correct aids). But some autistic people are hyperverbal (talk well, early) and hyperlexic (learn to read very young).

  • I’ve heard people say about an adult diagnosis, “But they can’t be autistic; they would have had to exhibit signs in childhood!” But the childhood signs were there, but perhaps brushed off as precociousness, laziness, being difficult, not paying attention, pickiness, overly sensitive, shy, stubborn, quirky, rude, academically gifted, or advanced/wise for their age. (I was seen as precocious, stubborn, picky, shy, quiet, independent, gifted, and wise for my age. Much of that was autism. Some was trauma, partly due to being undiagnosed.)

    • If can be harder for undiagnosed parents (who may have had an undiagnosed parent themselves) to recognize autistic signs and behaviors in their children. If the parents are autistic, things that are normal for the family may fit criteria for diagnosis.

• I’m sure there are other reasons to not privilege formal assessments and diagnoses. Tell me about them in the comments.

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Most of the time, autism is assessed for how it’s different from neurotypical standards, and what is lacks compared to neurotypical ways of being and communicating. But we can flip the script and center autistic ways of being and seeing the world and judge allistic people according to that. There are some hilarious Tiktok videos that do this. For example, “austic people don’t read between the lines” could be flipped to “allistic people can’t speak directly, and only talk around the subject without saying what they mean.”

For more info, check out the Autism Self Advocacy Network (ASAN).

If you want to keep a secret, you must also hide it from yourself.

George Orwell, 1984.

The last time I see Angel, I’m sweating in the July sun on the grounds of a Mormon church. Dozens of other tired 15- and 16-year-old girls snatch their belongings from the belly of the bus.

In the chaos, I stand rigid as a queen’s guard over my three days’ worth of gear, suffused with the aftersmell of campfires. I watch Angel weave among the duffels, pillows, sleeping bags, and those asthmatic foam mats which fashion a momentary maze.

She says, “Found you.” I release a breath. She smiles, her blonde, unwashed hair falling past pale blue eyes. I mirror her smile. She drops her stuff next to mine, then swipes stray locks and tucks them behind her ear. I track each movement.

We turn to search for our rides and watch our cabinmates exchange their promises to keep in touch and their gushy goodbyes. Angel and I share a smirk: what girls.

“I definitely want to stay friends with you,” she says, tilting close, her breath puffing into my ear. Her interlocked fingers twist and strain. Or are those mine?

When we met during cabin intros, she scared me a little: her black hoodie, the tough stance and tight nods, and were those four or five piercings in her left ear? How did we go from strangers to giggling over the grapes that had gone a little fizzy, leaning in, our long, blonde hair falling into one curtain? To tapping and passing in the Cup Game at the picnic table, pressed together, our shoulders and thighs melded?

Trotting dusty trails two by two, Angel amassed my secrets. I gabbed about my school crush, Nathan, and the rustic ring he gifted me. Shaped from a horseshoe nail, the ring derived from his summer pilgrimage to Nauvoo, Illinois—a Mormon holy land on the Mississippi. When I’d learned the ring’s nickname and origin, prairie diamond, an Oregon Trail era substitute for a proper engagement ring, my torso had surged with a fresh thrill. I toted the ring around months after Nathan’s affections had waned. Prattling on about my undying love, I conjured the trinket from my pocket, showed Angel, then slipped it onto my ring finger.

That hot morning on the church grounds, I spot Dad in our green minivan. Angel asks for my number. She grabs my hand and writes her number on my palm. Or is that a moment my memory formed? We live ten minutes apart along the I-15 corridor, but attend different high schools; borders bifurcate the suburban sprawl.

“I for sure want to see you again,” she says.

A nasty chemical sensation flashes from my chest to every extremity. A guillotine slices the air between us. My face burns—not from the sun. My legs crave to sprint but are encased in concrete.

“You coming?” Dad’s voice pierces through the standstill. I can’t muster words. Bobbing my head like a boxer dodging under a jab, I collect my things and trail after Dad.

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A week later, Angel phones—just the once. She says something about getting together. The spiral cord stretches to the kitchen. I stand motionless in the dark hallway. I don’t remember what I say. What does she hear in my voice: Apathy? Loathing? Fear?

I think about the third night of camp, when we snuck out under the moonlit pines to leave our sigils in drying cement. We knelt on the uneven ground, and I twirled the head of Nathan’s ring palmward to achieve the deepest imprint. Pushing my left fist down to apply extra pressure onto my right starfished hand, I felt Angel’s fingertips stretch to mine within a hair’s breadth. I peeked up at her. She gazed back, the moon reflecting in her eyes. I didn’t breathe. The silence passed between us. The aspens quaked their whispers in the wind.

And I sobbed as I wrote this. Not just because it was true allyship and what that young man needed to hear, but because it was what Little Me — and, truly, current me — needed to hear.

And I know I’m not the only one who needs to hear her message of love and acceptance.

“Conversion therapy” is abuse.

Had I come out as a teen, I might have been sent to a “conversion therapy” program or practitioner. (I will not sully the good name of real therapists by associating this abuse with actual, ethical practice.) Fortunately, I was not.

Even so, I was subject to the same religiously-justified, harmful rhetoric. I never—never—heard anything remotely positive about LGBTQ people or queerness while in the LDS (Mormon) church or in my home state of Utah while growing up.

The stigma, fear, and shame were so ferocious that it took me nearly 40 years to come out — even to myself. Only in hindsight could I see the evidence and my denial.

When I came out, my natal family and friends flooded me with their negative messages, through words and actions (cw: transphobia):

• “Being trans is okay as long as you don’t do anything medical about it.”

• “You should be grateful for how God made you and not challenge that.”

• “Why can’t you just be a masculine woman?”

• “I wanted to be a boy when I was little, too, but I don’t think I’m a man. It’s just misogyny.”

• “As a wife and mother, you must sacrifice yourself for the sake of your family.”

• “Your son’s struggles are because of your choice to be trans and your lifestyle.”

• “How can you expect us to submit to your ideology when you don’t respect our religion?”

And because of the anti-LGBTQ environment I grew up in, I knew intellectually that these statements were incorrect and harmful, but I believed them at a deep, emotional, somatic level. The statements all made me cry, despair, and doubt myself. My inner child was terrified, and I needed help to reground myself and see the true me again, my wisest, truest Self.

It’s been 21 years since I left the Mormon religion, 8 years since I came out as trans, and 7 years since I came out as queer. But it’s been only 3 years since I recognized how disconnected from myself and dissociated I had been from my body and emotions since childhood. How pervasive my embodied emotional trauma was, and how it still affected me and held me back. It still clouded my view of myself. Deep down, I still saw myself through the lens of stigma and shame.

That last bulleted comment about “submitting” to my gender “ideology”—from my big sister after 18 months of silence because of her transphobia—was a turning point for me. I finally saw her and other family members’ prejudices clearly. They see me as less than. As unworthy. As having chosen poorly. Sinful. Deceived by the devil.

Some accept me. A couple even affirm me. Other natal family members merely tolerate me. My sister rejects me.

Most importantly, I finally saw myself clearly.

I am worthy. I am whole. I am strong. I am loved.

I deserve more than tolerance, acceptance, or even inclusion. I deserve celebration.

All LGBTQ people do, too. In fact, all people deserve to be seen for who they are, not despite who they are.

And now, I expect it. I accept no less.

When I received my sister’s text last summer, I looked around me and realized I am surrounded by people who love, embrace, and celebrate me: chosen family, friends, colleagues, fellow writers, my readers, my son, and my husband.

Then I did something I’d never done before to a family member: I blocked her.

It wasn’t that one text. That text was the final straw. The rupture was 20 years in the making, ever since I left Mormonism. Understandably, I was so terrified of losing my family that I edited myself and made myself smaller and palatable for them. This fear extended so far that I refrained from liking ex-Mormon-related posts on IG because a family member might see the like.

I pictured a big weight I’d been pulling around on a rope for those 20 years. I dropped the rope. Once I stopped pulling it along, I felt lighter, liberated. In the months since, I’ve been more confident, happier, freer, and more outspoken. I can place boundaries now! And keep them! I can say no!

Don’t get me wrong; it hasn’t been easy. I have moments of doubt, fear, and utter heartbreak. And that’s okay. That doesn’t erase my progress.

Others have noticed a change in me and commented on it. I’ve come into my strength. Imposter syndrome is gone. I’ve written things I never dared to write. Began to heal wounds I buried so deep that I forgot I had dug their graves.

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All this is not to toot my own horn. It’s to comment on the importance of acceptance, affirmation, and celebration of LGBTQ identities. To condemn “conversion therapy” and the shame and stigma that many faith institutions and families embed in their children’s minds and hearts. I am not here to condemn my parents, either. I recognize they were doing the best they could with what they had. That can be true, and at the same time, it’s true that their actions hurt me.

Wrapping up. Above, I said how I learned only negative things about LGBTQ folks. I was 24 years old the first time I heard the LGBTQ community framed in a positive light. I had moved from Utah to Connecticut, and one day, I picked up a Pride Center pamphlet at a cafe. It talked about stigma, discrimination, HIV and STDs, and the fight for marriage equality, yes, but it also talked about the beauty, pride, resilience, and joy in our communities. That pamphlet cracked something open in my mind and heart.

And that, my friends, is worth celebrating.

The “bathroom issue.” People have strong opinions on this one. I know personally how divisive this can be. In early 2024, I texted my natal family about an upcoming bathroom ban in their state, Utah, asking for their help by calling their Senators. “I can’t come visit if there is a bathroom ban in place,” I told them. I don’t feel safe. And there’s the principle of it, too.

My sister—who didn’t even live in Utah—texted back, “But what about women?” We fell into a texting debate where I provided data, and she provided all the fearmongering talking points of the anti-trans machine.

She showed me what she really thinks about me. Some family members came to my aid. Most stayed silent. Others approached it with, “Can’t we all just get along? We’re family!”

Well, no, I’m afraid. We can disagree about pineapple on pizza, not on my human rights:

“We can disagree and still love each other unless your disagreement is rooted in my oppression and denial of my humanity and right to exist.” -not James Baldwin, but Robert Jones, Jr., as “sonofbaldwin”

After that family text exchange, I pulled way, way back. I haven’t talked to that sister since. Distancing myself was heartbreaking; I was depressed for months. She has since doubled down on her stance, stating that my trans identity is “gender ideology,” that I am something to be tolerated at best.

No, thank you. I, like all trans/nonbinary people, deserve celebration. Once I realized that, and that I deserve it from my natal family, too, but wasn’t getting it (with some exceptions), I let go of a gigantic burden.

Which is all to say, I know exactly how divisive and difficult this issue can be.

What does the evidence actually say about trans and nonbinary people and bathrooms?

To share or download the infographics alone, check out my YTC account on IG.

First, bathroom bans harm trans/nonbinary and gender nonconforming people, psychologically and physically.

Policy Brief: Williams Institute. 2025. Safety and Privacy in Public Restrooms and Other Gendered Facilities. UCLA School of Law.

The Williams Institute is a great resource for data and policy briefs about LGBTQ issues. (I know and have worked with some of the researchers there.) This report gathered the empirical research—what the data actually say, rather than speculation and hypotheticals—on laws about access to bathrooms and other gendered facilities (like locker rooms).

This report found that restrictions, bans, and forcing people to use the bathrooms associated with sex assigned at birth (i.e., anti-trans policies):

• Trans people report more harassment & denial of access

• The risk of cisgender people confronting trans people increases

• The data do not support the claims that these laws protect women or children

Moreover, this report found no evidence that trans-inclusive policies increase violations of safety and privacy for cisgender people.

National Survey: James, SE, et al. 2016. The Report of the 2015 US Transgender Survey. National Center for Transgender Equality (now Advocates for Trans Equality a4te.org)

The 2015 USTS had over 27,000 respondents and covered all sorts of health and rights-based topics.

A lot of trans/nonbinary people avoided bathrooms, with consequences to their physical and mental health:

• 59% avoided public restrooms for fear of confrontation

• 32% limited what they ate and drank to avoid having to use a bathroom

• 8% reported urinary or kidney problems due to “holding it”

Others reported being harassed or attacked in bathrooms:

• 12% were verbally harassed

• 1% were physically attacked

NCTE/a4te has conducted multiple national surveys of trans and nonbinary people in the US. The most recent was in 2022 and had over 93,000 respondents! While a4te has released some reports (see link above), the data on bathrooms has yet to be thoroughly analyzed. (I worked on the data, and I’ll tell you, the number of people who wrote in that they developed UTIs from holding it while at school is astounding and heartbreaking!)

Here’s more evidence of the mental health harm of anti-trans bathroom discrimination.

DeChants, et al, 2024. Bathroom avoidance and mental health among transgender and nonbinary youth. LGBT Health.

Price-Feeney, et al, 2021. Impact of Bathroom Discrimination on Mental Health Among Transgender and Nonbinary Youth. Journal of Adolescent Health.

Both of the above studies used data from The Trevor Project’s annual surveys of the mental health of LGBTQ young people ages 13-24. These surveys are large enough that the trans/nonbinary sample is still in the thousands. (I know because I was on that research team with them.) These studies found:

• Being restricted or prevented from using bathrooms aligned with gender identity was linked to

  • more depressive mood

  • more suicidality

  • lower well-being

• Avoiding public bathrooms, which led to more (high odds of)

  • depression, anxiety

  • suicidal thoughts & suicide attempts

• Not eating or drinking to avoid having to use the bathroom

• Urinary and kidney problems from avoiding using the bathroom

And sexual assault:

Murchison, et al. 2019. School Restroom and Locker Room Restrictions and Sexual Assault Risk Among Transgender Youth. Pediatrics.

This study is based off US national data collected in schools in 2017.

• Higher likelihood of sexual assault against trans students in schools with restricted bathroom and locker room access. After adjusting for potential confounders, this study found statistically significantly higher odds of sexual assaults in schools with anti-trans polices (bathrooms where trans/nonbinary youth were forced to use the bathroom of their sex assigned at birth [restricted access]) compared to those with trans-friendly polices:

  • Trans boys: 26% more likely to be sexually assaulted

  • Nonbinary AFAB: 42% more likely to be sexually assaulted

  • Trans girls: 249% more likely to be sexually assaulted!

  • Nonbinary AMAB: not a significant difference

Transgender girls were especially at risk. That comes as no surprise to me, since they are girls forced to use the boys’ rooms.

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Second, the fears that trans-inclusive policies will increase harm to cisgender people, especially women and children, are simply not supported with evidence.

In fact, exclusive bathroom policies harm cisgender people as well as trans/nonbinary people. And inclusive policies benefit everybody, with no evidence of increased harm to cis or trans people!

Hasenbush, et al, 2018. Gender Identity Nondiscrimination Laws in Public Accommodations: A Review of Evidence Regarding Safety and Privacy in Public Restrooms, Locker Rooms, and Changing Rooms. Sexuality Research and Social Policy.

This is a policy analysis looking at crime and safety data before and after gender identity nondiscrimination laws were put in place in various locations in Massachusetts. For each location with nondiscrimination policies, the researchers compared another location without such policies, matching by factors that would likely relate to both nondiscrimination policies and crime rates: geography, population size, age distribution, race, economic status, religion, politics, and a composite crime score.

They checked for crimes for one to two years before policies were put into place and one to two years after, then compared these same years in locations without nondiscrimination policies. (This is a solid method, called difference-in-difference analysis.)

They found

• No evidence that trans-inclusive policies increased criminal incidents

• Claims that these policies will allow predators to exploit cisgender women and children in bathrooms are simply not supported by empirical data

This was true for bathrooms, locker rooms, and changing rooms.

tl;dr: Inclusive policies benefit everyone & hurt no one; trans-exclusive policies cause harm.

Francis, et al, 2022. Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality- and Gender-Diverse Youth. International Journal of Environmental Research and Public Health.

• People perceive that inclusive school facilities reduce harassment and improve well-being

Perales, et al, 2025. Access to inclusive public-toilet options and the well-being of trans and gender-diverse people. Journal of LGBT Studies

• Inclusive facilities at work are linked to better health and well-being for trans/nonbinary employees

Sanchez, et al 2017. Gender-inclusive bathrooms signal fairness across identity dimensions. Social Psychological and Personality Science.

• Cisgender people, especially women and racial minorities, perceive workplaces with gender-neutral restrooms as safer and more inclusive

Riggle, et al, 2018. Experiences of a gender-nonconforming lesbian in the ladies’ restroom. Journal of Homosexuality.

• Cisgender women, such as lesbians or others who have masculine looks, experience harassment and “gender policing” in women’s bathrooms by other cisgender women

Gender neutral options

I love the move toward group/family changing rooms and locker rooms at places like the Y and other recreation centers. Before I passed on testosterone, I joined my local Y because they had family/gender neutral options to change and shower. The lockers are more publicly located, while there are single stalls with toilets, showers, and enough room for a parent with a couple kids, or a person using a wheelchair.

In a city rec center in Springville, Utah, (where I lived when I was 5 and 6), lockers are out in the open lobby, surrounded by single-stall units for changing and showering. They didn’t have trans people in mind when they built these—they were thinking about their large families!

In St. Paul, Minnesota, schools have implemented multistall gender-neutral bathrooms with private stalls. They report great benefits:

• “fewer students smoking in bathrooms,

• less vandalism,

• less bullying,

• fewer lines and

• more kids washing their hands.”

American Psychological Association supports inclusive bathrooms, pointing out that gender-inclusive facilities are helpful not just for trans/nonbinary people, but also for

• parents with children of a different gender

  • (I took my son into the women’s room until he was around 7 or 8.)

• caregivers of people with disabilities of a different gender

• caregivers of older people who may need assistance

Sources

1. Chaney, K. E., & Sanchez, D. T. 2018. Gender-Inclusive Bathrooms Signal Fairness Across Identity Dimensions. Social Psychological and Personality Science, 9(2), 245-253.

2. DeChants JP, Price MN, Nath R, Hobaica S, Green AE. 2024. Transgender and nonbinary young people's bathroom avoidance and mental health. Int J Transgend Health. 2024 Apr 8;26(2):351-359. doi: 10.1080/26895269.2024.2335512.

3. Francis, Jacinta et al. 2022. “Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality and Gender Diverse Youth in Western Australia.” International Journal of Environmental Research and Public Health, Vol. 19, 16, 10089. 15 Aug. 2022, doi:10.3390/ijerph191610089

4. Hasenbush, Amira, Andrew R. Flores, & Jody L. Herman. 2018. Gender Identity Nondiscrimination Laws in Public Accommodations: A Review of Evidence Regarding Safety and Privacy in Public Restrooms, Locker Rooms, and Changing Rooms. Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-018-0335-z

5. Huff M, Edwards KM, Mauer VA, Littleton H, Lim S, Sall KE. 2025. Gender-neutral bathrooms on campus: a multicampus study of cisgender and transgender and gender diverse college students. J Am Coll Health. 2025;73(3):1178-1182. doi:10.1080/07448481.2023.2239358

6. James, S. E., et al. 2016. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality.

7. Murchison, G.R., Agénor, M., Reisner, S.L., & Watson, R.J. (2019). School Restroom and Locker Room Restrictions and Sexual Assault Risk Among Transgender Youth. Pediatrics, 143. DOI:10.1542/peds.2018-2902

8. Perales, F., Giang, M., & Elkin, N. 2025. Access to inclusive public-toilet options and the well-being of trans and gender diverse employees: Novel evidence from a large Australian workplace survey. International Journal of Transgender Health, 1–12. https://doi.org/10.1080/15532739.2025.2469278

9. Price-Feeney M, Green A, Dorison S. 2020. Impact of Bathroom Discrimination on Mental Health Among Transgender and Nonbinary Youth. Journal of Adolescent Health, 2020; 68, 1142-1147

10. Riggle E. D. B. 2018. Experiences of a gender non-conforming lesbian in the "ladies' (rest)room". Journal of lesbian studies, 22(4), 482–495. https://doi.org/10.1080/10894160.2018.1460565

11. Williams Institute. 2025. Safety and Privacy in Public Restrooms and Other Gendered Facilities. UCLA School of Law.https://williamsinstitute.law.ucla.edu/publications/safety-in-restrooms-and-facilites/

Big thanks to Oli Bennan for graphic design and my new logo!

Queer? Trans? Asexuality? Polyamory? Nothing.

Thankfully, more resources exist now to assist with The Talk: Trans/Nonbinary edition. Inclusive education is out there, if you know where to look. (See list below!)

While living in Tanzania—a country with a high percentage of the population living with HIV—I got all sorts of HIV-related questions lobbed at me. As an HIV expert, sexual health educator, and a foreigner who speaks Swahili, people opened up to me. They’d reveal secrets, they’d processed their grief about learning a loved one was diagnosed, and they’d ask questions they felt too shy to speak anywhere else.

• “Is it true that I can share the dinner plate with someone and not get HIV from them?” (Yes, it’s safe. HIV cannot pass that way.)

• “Can I get HIV if I do my family’s laundry and my sister’s period-soaked underwear is in there?” (No. The virus would be destroyed, and your skin would protect you.)

• “What if someone is injured on the soccer field and a little blood splashes into my eye?” (Worry about the unprotected sex you’re having more than a freak accident on the soccer field, please.)

I sometimes spoke about HIV in high school classes at my son’s international school. Once, an educated young woman asked a question that made me realize she believed that it was the sheer number of times one has sex that causes HIV. The probability-based messaging that she had doubtless heard for years was that the more sex you have with more partners, the more likely you are to encounter HIV and possibly acquire it.

Like rolling the dice. The more times you roll, the higher the chance that you’ll land on a six at least once. (But with HIV, it’s more like a 50-sided to a 500-sided die per sex act, depending.) But she learned that more sex = HIV. I explained to her and the class that my partner and I could have sex a billion times (ha!) and as long as it was only with each other, we would not get HIV. Sex does not cause HIV. Sex is a main avenue for HIV to be transmitted.

That experience inspired me to create an after-school club at the school. I called it Teenagers’ Club and led it for four years. While I included sex education, I also included life skills like emotionally healthy relationships, consent, gender equity, communication, goal setting, etc.

This was around 2014 or 2015, before I realized I am transgender, and even longer before I realized I am queer. But I still made the lessons inclusive. One time, I talked to a group of teen boys about homophobia (which was the norm with them) and transness. Using a chart with several spectrums, I explained the differences between

• sexual orientation

• gender identity

• gender expression

• sex assigned at birth

I shared with them where I understood myself to be on each spectrum:

• sexual orientation: I like men.

• gender identity: I’m not all the way on the end of the woman side, but a little inward from that. I said, “There are trans people everywhere, even in Tanzania. They are just so in the closet, they are in the closet to themselves!” I had no idea I was talking about myself.

• gender expression: Kind of in the middle. I dressed pretty androgynously and had a short haircut.

• sex assigned at birth: female

I summed it up with something like “I’m not totally a woman, but I like who I am, and my husband likes me for who I am.” The boys erupted into applause and cheers.

May we all celebrate each other as those boys celebrated me that day.

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TGE-specific Resources:

Planned Parenthood’s general info is inclusive, and they have trans-specific articles like What do I need to know about sexual health as a trans or nonbinary person?

The National LGBTQ+ Health Education Center has tons of educational resources (mostly geared toward healthcare providers), like Sexual Health among Transgender People

Trans Teen Family Network (TTFN) Conversation Toolkit isn’t sexual and reproductive health-specific, but aimed more generally toward improving communication between parents/caregivers and their teens. A paired toolkit on the website is for mental health providers working with trans teens and their families.

LGBTQ-Inclusive Resources:

Bedsider.org (Birth control support network)

Go Ask Alice Resource Hub

I Wanna Know

I’ve met with the scientists leading the following studies, which promote health communication between parent and teen:

The Parents ASSIST & Parents GIST Studies

Parents GIST is a study for parents of LBTQ+ youth (trans/nonbinary kids and queer/lesbian/bisexual cis girls) ages 12-18 years. They’re looking for parents and caregivers to join their study on health communication with their youth. It’s all virtual, and the parent and son can each earn up to $275 for their time. It’s based at the University of Pennsylvania Nursing School.

Parents ASSIST is a study for parents of gay and bisexual, cisgender young men ages 12-18 years. They’re looking for parents and caregivers to join their study on health communication with their youth. It’s all virtual, and the parent and son can each earn up to $325 for their time. It’s based at the University of Pennsylvania Nursing School.

The seven years since then have flown by, and I know I made the right decisions for me. Yes, divorce was disruptive and sad, but it was also the best choice for my son and me. My ex and I don’t talk anymore, but he’s remarried and has his own life.

But I was so sure I needed testosterone that an hour after my ex and I had The Divorce Talk, I’d scheduled my appointment for the very next week, March 13, 2019.

2019: I felt amazing and exhilarated. That same week, I came out as queer and had my first queer kiss. What a whirlwind! The first year on T is marked by the four Hs: hungry, horny, hairy, and hot!

2020: Oof. The pandemic officially hit the US that same week. I was dating a woman—my first and only girlfriend. I took her on a remote weekend getaway in West Virginia, where everyone mistook me for her girlfriend (instead of boyfriend). Ugh. At least everyone read us as a queer couple!

2021: My friends and I were masking, and I’d had my first COVID shot. My boyfriend, Josh, planned a COVID-safe trip to New Haven to visit my old stomping grounds. He didn’t know it, but I’d been carrying the engagement ring in my pocket for months, and almost popped the question in a romantic moment on the top of East Rock. I surprised him with an elaborate proposal two weeks later.

2022: A big year of change. I was planning my wedding to Josh. I had moved to a “comms on a need-to-know basis only” with my ex. My son was in a rough transitional period in life. I was shifting from a full-time faculty job to a director position at The Trevor Project. At a silent retreat about transitions, I realized I’d neglected my inner child, “Little Will,” and added Internal Family Systems (parts work) and EMDR to my usual therapy.

2023: My husband’s MFA graduation reading happened to fall on my manniversary—huge day to celebrate him. And I was more than happy to. Later that year, I had done enough therapy to realize how dissociated I’d been all my life and had begun to feel my bodily sensations. I had panic attacks in religious buildings and realized I had complex PTSD and a whole lot of emotional healing to do. I also left the Trevor Project and started my own business!

2024: This year was hard. For the first time, I didn’t make a progress video. I’d had a big rift with most of my natal family about trans rights, and was grieving. In March, I took a weekend silent retreat focusing on honoring our ancestors. I realized how much resentment I felt toward mine for being Mormon, and developed compassion for them and, most importantly, for my Mormon past and that younger part of me. For the first time, I could look back at my childhood journals and begin to process my religious and relational traumas. Gaining more confidence, I began telling my stories on stage. For the first time, I recognized what thriving felt like.

2025: What a year! Thriving?! Bitch, please. Because of the election/inauguration, I was cycling through major emotions that I’d never learned to feel or cope with, like anger and fear. In March, I desperately wanted to leave the country, and my husband was going through major workplace changes. My main coping tool was to throw myself into Your Trans Cousin and other writing. For the first time, I integrated my public health career and my writing persona, which only made me stronger. My writing took off, and I got a dozen essays published.

In April, I marked my 20th anniversary of exiting Mormonism. In a way, I’d been grieving for those 20 years. That summer, when I let my natal family see my writing—my whole self, including how their church harmed me—most of them chose to defend the church rather than witness my pain. This is when I realized that I was merely tolerated. That I had been accepting scraps and thanking them for the feast. But I—and we all—deserve celebration for who we are, not despite who we are. I set down the baggage of hoping they’d love me in the way I deserve to be loved.

2026: Somewhere in the last few months, I’ve found acceptance—self-acceptance. It has been liberating and exhilarating. Now that I’ve stopped breaking myself up into palatable bits, I’m far more confident and more at ease with myself. As Josh said, “[My] light has returned.”

My personal growth, strength, and healing have been possible only since I started my transition. Before, I was in survival mode and didn’t even know it. The progress I’ve made didn’t come overnight. It’s come in little steps, hard work, new self-realizations, choices to do better, a safe partnership with Josh, and a whole lot of therapy, over the past seven years.

I’m not “all better.” Rather, I see plenty of work I still want to do on myself. Personal growth doesn’t have an endpoint. May I continue to grow, heal, love, and seek joy.

I hope you find these “Tips & Scripts” useful. Tips are action items. Scripts give examples of what to say when discussing key topics with or about trans/nonbinary folks.

Accessibility note: Rather than put the text in alt-text, I’ve typed the Tips & Scripts out above each image. Alt-text includes descriptions of the images without the text.

I’ve adapted the Tips & Scripts I shared for the winter holidays for all year.

These new ones are also available on Canva and on my IG account and are shareable.

• Tip: Be a safe person. Ensure your home is a safe place.

• Script: I’m so glad you came to me to talk about this. We’ll figure this out together."

• Tip: Get their input. Ask them how they feel and what they are comfortable with. Offer to talk to others, to be a buffer, and to support their needs.

• Script: How would you feel if I told our cousins you are trans? Does that feel good for me to let them know, or would you rather tell them yourself?

• Tip: Use their new name. Once they announce a new name, update it in your phone contacts, email provider, on birthday cards, etc. Assume affirmation as the default. If in doubt, check in with them.

• Script: I updated your name in the employee service system, but I saw it’s still popping up as your old name on your time card. Let me look into that for you to make sure it works next time.

• Tip: Practice their pronouns when they are not around and offer to help other folks practice, before an event, too. Saying their name and pronouns in positive sentences can retrain your brain.

• Script: Sharen is hilarious; I love it when she makes me laugh.

• Script: Jericho’s been training for a marathon. I’m so proud of their dedication.

• Tip: Follow their timeline. They may not be ready to be out to the family, school, or their faith community. Respect that.

• Script: I know you’re not out at work. How would you like me to refer to you at your colleague’s dinner party?

• Tip: Role-play how to handle potential situations.

• Script:

  • Cousin: I’ve always called you [old name]. I’m not changing that!

  • Sibling: Well, you always go by Danny and hate being called Daniel. How would you feel if I kept calling your Daniel?

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• Tip: Prioritize their mental health and identity over others’ opinions. Establish expectations beforehand. Follow through.

• Script: [to random cis person with a strong and uninformed opinion on trans lives] I know what you heard on that podcast. I prefer to listen to people with lived experience and those with credentials and expertise. May I recommend a podcast I trust on trans issues?

• Tip: Remove emotional burdens from them as much as possible. Set and maintain boundaries.

• Script: This is who she is. I need you to respect that. If you want to have a relationship with her, you must gender her correctly. Are you open to me sending some resources to help?

• Tip: Believe them. Validate their experiences and feelings rather than minimizing, pressuring, undermining, or guilt-tripping them.

• Script: The barista misgendered you twice?!? How rude!

• Script: It must feel awful to have the security guard treat you like that. Would you like me to listen to you to vent, hug you, distract you, or something else?

• Tip: Pay attention to nonverbal cues. Being misgendered is distressing. They may become dysregulated more easily.

• Script: Fam, you look like your social battery is low. Let me know when you want to leave.

• Tip: Support other family members. They need attention, too.

• Script: [to sibling] I know I’ve been paying extra attention to [trans child], so I’m checking in with you. How about on the weekend, we do your favorite activity, just you and me?

• Tip: Be on '“pronoun duty.” Quickly correct anyone who misgenders them. Recruit other supportive people to the cause.

• Script: Remember, Will goes by he. Angela uses they, not she.

• Tip: Support affirming and safe events and spaces. Recognize that being with fellow trans/nonbinary people is sustaining and enriching for them. And that means nothing negative about you. This applies to their other identities, too.

• Script: I saw the LGBTQ center is hosting an event for Black trans masc folx. Do you want the info to see if you want to go?

• Tip: Use alternative phrases or labels. Get creative with your word choices to avoid outing them. Try gender neutral words: child, parent, spouse, friend, fam, or a neutral nickname.

• Script:

  • Relative: How’s [old name]? Is she a track star again?

  • Parent: Oh, track is out, art is in. There’s a big exhibition at the high school, and I’m such a proud parent.

• Tip: Make an exit strategy. Make a plan ahead of time. Gamify it: use a code word, a texted emoji, or another signal.

• Script: Before the party, who about we come up with a couple of signls or codewords? One to say, “Help me out of this conversation,” and another to say, “I’m done; Let’s go home now.” What do you think?

• Tip: Feel your feelings. Your feelings are valid, too, but apply the Ring Theory. Express your unpleasant emotions to others who are on the same ring as you emotionally or further away, rather than into the center—especially your trans loved one.

• Script:

  • To a friend: It’s weird that we grew up as sisters, but now he’s my brother. I’m happy for him, but also sad about the idea of my sister being gone.

  • Friend: That makes sense. Would you like to tell me some favorite memories from your childhood together?

• Tip: Correct your mistakes. Be gentle with yourself and hold yourself accountable. Practice when they are not around. Your discomfort about messing up isn’t equivalent to their discomfort at being misgendered.

• Script: I know I keep slipping up with your old pronouns. I’m sorry about that. I’ll do better.

• Tip: Be honest about your own capacity.

• Script: I am feeling upset and need to go on a walk. I’ll text when I’m feeling calmer and can talk about this.

Final slide: Adapt as needed. Adjust for the person’s age, neurotype, culture, disability status, personality, etc. Your TRans Cousin is a parent, transgender man, educator, social and behavioral scientist, and writer. In creating these, he imagined the support he wished he had and how he wished he had supported his son. Feel free to add your ideas or ask questions in the comments. Thanks to Sara and Sarah for their moms-of-trans-kids’ perspectives and to Sharen and Jericho for their trans therapist perspectives. Huge gratitude to Oli for the original graphic design.

I’m confident most of my readers fall into that description.

Others think trans/nonbinary people are delusional, ill, or deviant. They think of transness as pathological, as “gender ideology,” as something insidious to be eradicated. This point of view glared at me this week from the DefSec’s statement about Scouting America (as covered by Erin in the Morning). This week’s actions in Kansas to immediately invalidate trans people’s state IDs also springs from this place. It broke and continues to break my heart when it comes from my own family members.

Whenever I get trolls who clearly fall in this camp, I delete their comments and block them. Their minds and hearts are not open to listening to anything I have to say. I don’t have the time for that emotional labor and no patience for their vitriol.

Plenty of people are somewhere in the middle; not fully supportive, not actively ruining our lives. Nothing in society is ever a cut-and-dry binary, two buckets where you belong in either one or the other, A or B, 0 or 1. Even in biology, things are more fluid and spectrum-y. Though this essay discusses two approaches, imagine them as points on a spectrum, or even as areas floating in 3D space. (I tell my students, all models are wrong; some are useful.)

To understand how there can be such disparate approaches, we need to take a big step back into how we look at and understand the world, which lenses we have in our proverbial glasses. At everything, not just sex/gender.

But first, let me make this clear: though I’m discussing two different approaches, they are not equally valid, helpful, or evidence-based. One (support, affirmation) leads to better health outcomes, and there is scientific consensus; we know this. One (eradication, pathologization) leads to worse health outcomes and is based on fear and hate; we know this.

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Okay, now, an exercise:

How We Look at the World

Let’s take this picture. What do you see?

Most people will say, “a tree.”

And that’s correct.

However, it can be so much more, depending on who you are and your point of view.

• To a new couple, it’s a romantic picnic spot.

• To a hot, weary traveler, it’s a shady resting place. If they are lost, perhaps it also offers a higher perspective, allowing them to see farther and gauge their next destination.

• To a child, it’s a potential play structure. That horizontal branch on the right looks awfully perfect for a swing.

• To a housing development contractor, it may be a nuisance to remove.

• To a lumberjack, it’s potential work and lumber.

• To a botanist, it’s a specific family, genus, and species; it is native or introduced; it has particular morphology—leaves, trunk, bark, branching pattern. They could explore its physiology—how well it photosynthesizes, absorbs water, what happens to the leaves in autumn, and the development of flowers and fruit in the spring. Etc, etc.

• To a bird, it might be a good place to build a nest; it represents safety from predators for itself and its offspring.

• To any number of insects, rodents, fungi, and bacteria, it’s home and food. They don’t even have “tree” as a concept, but it sustains their entire lives.

• And if English isn’t your language, it could be mti, Baum, شجرة, पेड़, árbol, ağaç, etc.

Essentialism & Biological Determinism

If it’s a tree and only a tree and always a tree, that’s an essentialist approach to the world. The thing is its essence, hence essentialism. In essentialism, a tree is and was before humans even existed to name it.

This approach can also be termed biological determinism, because what a thing is and does is determined by its biology. It’s alive, it creates energy from sunlight, it doesn’t move on its own power, and it grows from the ground, using nutrients and water from the soil.

In these approaches, it doesn’t matter who is doing the looking; their perspective doesn’t add to what the tree is. (Going further back, essentialism and biological determinism are grounded in objectivity, a philosophical idea that things are what they are, regardless of who’s looking or thinking.)

Social Constructionism

But if the tree can be shade, rest, home, lumber, a nuisance, a biological specimen, a playground, food, or all those things at once, we are taking a social constructionist approach. This is grounded in subjectivity, the idea that it matters who is doing the looking or thinking.

Plenty of things in society are socially constructed, like nations, money, citizenship, units of time, marriage, masculinity, femininity, patriarchy, race, religions, and gender. Those things don’t exist outside of humans’ creation of them, and they are continually created and recreated—and change—through human interactions, beliefs, agreements, and actions. Through this, we reify them, or make them real.

Some people say, “That’s socially constructed” or “that’s just a social construct” to dismiss it, as if it’s not real or doesn’t matter. “Gender is just a social construct” is often an argument against the existence of trans/nonbinary people. I said it myself plenty of times before I was ready to examine my own gender identity.

But something that is socially constructed is very real, because we all agree that it is real, so it impacts us and matters. I can’t very well get away with being late to every meeting or declaring I don’t have to follow my state and national laws because time, governments, and laws are socially constructed.

Because we’ve created the concept of race to stigmatize certain races, racism exists and has very real, negative impacts on people. The concept of race is based on physiological characteristics such as skin color, nose shape, eye shape, etc., but the choices about what to count as one race and what not are socially determined and change over time.

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Essentialism, Biological Determinism, & Sex/Gender

The binary gender model, the determinist idea that there are only two biologically-determined, unchangeable, opposing sexes, falls within essentialism and biological determinism.

In this model, biological sex determines gender identity, gender expression, and sexual orientation.

• males are always masculine men and are attracted to women

• females are always feminine women and are attracted to men

Rather, that is how many societies, including patriarchal, Christian nationalist, and White supremacist ones, want things to be.

So whenever people do cross the “GENDER LINE: DO NOT CROSS”—and they do often—they get “corrected” in some way: teased, bullied, attacked, stigmatized, discriminated against, criminalized, etc. It can be anything from a sideways glance at a masculine-presenting woman in the grocery store to namecalling a effeminiate boy on the playground to jailing or killing men who have sex with men.

In these contexts, people who are genderqueer, trans, nonbinary, gay, bisexual, etc., learn at young ages that those parts of them are wrong, bad, unacceptable. I’ve recently read David Archuleta’s autobiography, Devout, where he felt attraction to both girls and boys at age five or so, but quickly learned that attraction to girls was expected, wanted, celebrated, and attraction to boys was sinful, ugly, and to be hidden. This morning, I’ve been reading Janet Mock’s book, Redefining Realness. She was raised as a boy, and has similar experiences where others teased, mocked, and disciplined her anytime she acted too girly or indicated attraction to boys.

Janet and David deeply internalized that stigma and carried that shame into adulthood. That is the legacy of the essentialist binary gender model; loathing and self-loathing for anyone who doesn’t fit into the neat, socially-constructed, either/or boxes.

This is also where the idea comes from that crossing that Gender Line—whether through gender identity (who we are regarding gender), gender expression (how we dress and accessorize, and how we talk, walk, and hold our arms, etc.), or sexual orientation (which gender[s] we are attracted to)—is deviant, wrong, or pathological, or caused by trauma.

That pathology theory says that the gayness/transness itself is an illness and leads to worse mental and physical health. And it is true that sexual and gender minorities (e.g., LGBTQ people) as a group deal with more anxiety, depression, suicidality, STDs, etc.

This point of view leads to questions like, “Why would you choose to be trans if it causes depression?” (My brother asked me this.)

Within these lines: content warning for sexual abuse of children

An old, discredited theory (that certain powers that be still espouse) posits that gay/transness is caused by sexual abuse in childhood. To take David and Janet’s stories again, both had parents or others suspect or ask them if sexual abuse or molestation in childhood caused their gayness (for David) or transness (for Janet). In David’s case, he denies being molested (though he shares openly about another family member who was—and is straight) and reassures his mom that, no, being gay is not caused by trauma.

In Janet’s story, she was molested by a teenage step-brother daily when she was eight to ten years old. She knows, however, that she saw herself as a girl long before that happened. She explains—and I agree with her—that predators often target people who are perceived as different. In her case, for being effeminate. So being abused doesn’t cause gayness/transness, but abusers target gay/trans kids, often long before they know what to call their differences.

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The pathology theory was the predominant one in medicine, public health, and society at large in the US up through the 1970s, when a newer (much better) theory came into play (the Minority Stress theory, see below).

That means that the vitriol the DefSec is spouting and this administration’s anti-trans Executive Orders are not new at all. They are a return to the past. They ignore the scientific evidence base we built up since the 1980s.

(The early 1900s’ evidence base for trans-related medical care and sociology was housed in the Sexology Institute in Berlin, Germany, until the Nazis destroyed it in 1933, in the first famous book burning of the Hitler regime. Sexual and gender minorities, i.e., LGBTQ people, were targeted and murdered during the Holocaust, too. Further evidence of how the Gender Binary model is a key feature of patriarchy, fascism, and White Supremacy.)

Social Constructionism & Sex/Gender

In social constructionism, sex and gender have no fixed meaning other than their cultural, social meanings. The underlying reality doesn’t always fit our social constructions. For convenience and comprehension, we place people into discrete bins to creative measureable categories. “How many boys and how many girls are in this school?”

But a social constructionist approach disrupts those neat categories and instead focuses on meanings, practices, symbols, and their relationships to institutions and power.1 It says that the sex/gender binaries are relatively new, culturally-bound, Western, and colonially imposed across the world.

Historically and culturally, we have lots of evidence that sex and gender are and were not considered binary, and there was lots of room for alternative gender expression and identities. The link is to an interactive world map with summaries of various genders from every continent (except Antarctica). The book Before We Were Trans by Kit Heyam is another great resource for learning about this historical and global variety.

Like race, the concept of sex—intersex, female, male—is based in biology and physiological characteristics:

• external genitalia (vulva, phallus, testicles)

• hormones (estrogens, testosterone)

  • in fetal development

  • in pubertal development

• gonads (ovaries, testes, or a mix of both)

• internal reproductive organs (uterus, vagina, prostate, etc.)

• chromosomes (XX, XY, XXY, XO, XYY, etc.)

• secondary sex characteristics (breasts, facial hair, etc.)

We assign sex based usually exclusively by looking at the external genitalia and determining whether the individual has a vulva or a penis/testicles. See more in my post, “Let’s talk about ‘biological’ sex, baby.”

However, intersex people exist, whether they have differences in external genitals, fetal hormones, pubertal hormones, gonads, chromosomes, internal reproductive organs, or secondary sex characteristics.

Where we decide to draw the line to classify an intersex infant as male or female is a social choice. That is, sex is socially constructed, too. (Read anything by Anne Fausto-Sterling for more.)

Using a social constructionist approach, we can further interrogate sex and gender and ask questions like “What does it mean to be a woman?” “What makes a ‘good’ mother?”

When men and boys tell each other, “Act like a man!” or “Be a man!” they are policing the Gender Line (see above), but they are also taking a social constructionist viewpoint—that being a man requires certain behaviors and attitudes, and one can lose the status of “real man.” When they talk this way, they aren’t talking about genitals, chromosomes, or hormones, those biological, physiological markers of maleness. No, they are talking metaphorically; gonads or balls become a symbol for bravery, strength, and manhood itself. (Ironic, since testes are delicate.)

Alternative Theory of LGBTQ Health Disparities

This brings us finally to the alternative explanation for why gayness/transness is associated with worse mental and physical health (on a group level). I’ve already written about the Minority Stress Model.2 It argued that gayness and transness don’t need an explanation or a search for a cause, because there is nothing wrong with it.

Brooks said there is nothing inherently wrong or deviant or ill about being gay (or trans). Instead, the health disparities—the higher depression, anxiety, suicidality, etc.—are because of social stigma and discrimination against being gay (or trans).

If you have a society that affirms, accepts, and celebrates LGBTQ people, those health disparities would not exist. We see this in trans youth whose families fully support and accept them, including helping them access age-appropriate medical care—they have mental health on par with their cisgender peers.

Erase the stigma, and gayness/transness are just a part of the variety of human existence, like hair, skin, and eye color, like personality. Differences that make us unique and beautiful. The spice of life.

And we are worth celebrating.

Note: I owe a lot to Dr. Tonia Poteat for the conceptualization of essentialism vs. social constructionism’s applications to sex and gender.

I’m adding a new resource to our toolkits. Transforming Choices is “an information and resources hub to support empowered healthcare choices now and in later life for transgender and gender-expansive elders, younger adults, and care providers.”

Lauren Catlett (they/them), a nurse, created this as part of their PhD, and I helped review the FAQs before launch.

The needs of trans and nonbinary people later in life and upon death are human—we all desire dignity, choice, respect, and love. But trans folks also have some unique needs around end of life.

For example (these may be hard to read; feel free to skip over!):

• Being gendered and named correctly

  • in any medical care

  • in long-term care & end-of-life care, regardless of legal sex on documents

  • in sex-segregated facilities that do not align with their gender identity

  • in death, on death certificates, and at funerals or memorials

    • Death certificates are notoriously bad at getting trans people’s sex correct, making it difficult to properly estimate how many trans people are killed or complete suicide each year

    • I knew an older trans man online who tragically died alone in a fire at his home. He was misgendered and deadnamed in news coverage

    • All too often, unsupportive families of origin host funerals that do not honor their trans loved ones’ identities

    • My legal sex is male, but still, in my living will, I wrote to treat me as male in death/on death documents

• Having chosen family, partners, or non-biologically related children without legal status

  • to accompany them and advocate in the hospital/for procedures

  • to make medical and end-of-life decisions and handle estates

    • So many trans people are rejected or unaccepted by families of origin, but those families nonetheless may hold next-of-kin and legal status to execute estates and make medical decisions (this often applies to gay/queer people, too)

• Whether or not to continue hormones during palliative or hospice care

• Receiving the correct procedures (pregnancy test or no?) and equipment (urinal or bed pan?) in a sensitive, affirming way in hospital care

With lots to consider, I’m grateful for a resource like Transforming Choices!

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Below is a letter I wrote in 2018 to my university’s security office and Office of Institutional Equity. I still had my old work ID badge with an old picture and my deadname. The security policy was that I could not update it with a chosen name; I had to wait until my legal name change came through. It was “just” a few months, but it was highly distressing. Things came to a head just before I wrote this letter.

I’m sharing in hopes that people will better understand what it can feel like to be trans. [Lightly edited for clarity]

Dear Ms. A & Mr. B & Security Offices,

I am a faculty member and a transgender man. While I am the only (out) transgender faculty member at the School, there are multiple students and staff here, and there are transgender people in the other Schools and the university hospital as well.

I had an unpleasant experience with a security guard regarding my ID badge on the east campus, and I feel compelled to report it and explain the situation that other transgender individuals and I face. I’m not writing to call out a particular staff member; they were doing their job. I am writing to highlight a structural issue that affects me and people like me. I hope that the university can address this issue so that other transgender faculty, staff, and students can move across campuses in peace and get their work done effectively.

This email is long, but the incident requires some background to understand why it was so upsetting for me.

My legal name change has been in process since late October, and probably won’t come through the city court until late January or February at best. A legal name change is a long and expensive process; I have personally paid $245 so far, not including time, transport, and postage. The legal process involves many steps, including posting the old and new names in a local newspaper (at my expense) and a 15-day period where anyone can file a challenge to the change.

Because of this, and other social and emotional reasons, many transgender people have IDs that do not match their chosen names—the names that they go by in work and social circles. My chosen name, Will, for example, is on my faculty page; my intranet faculty data page that is used to report to the Employment Equal Opportunity Office; university email; the research ethics system, my grants account at the National Institute of Health; my PubMed publications page; all social media accounts including Facebook, Google Scholar, ResearchGate, and LinkedIn. All of my colleagues and students at work, and all of my friends and family members call me my chosen name.

If someone at work asked about me by my birth name—my legal name on my ID badge—most people would have no idea who they were talking about. Should you show them the picture of me on my ID badge, they probably would not be able to pick me out from a line-up.

Therefore, when I arrived on campus this academic year after working remotely for several years, I visited my departmental HR representative to ask about adding my chosen name to my ID badge, pending my legal name change. After 30 minutes of calling her supervisors, the Security office (perhaps one of you), etc., she told me there was no way to get my name changed without a legal name change. Ironically, this HR rep’s ID badge is so old and worn out that you cannot see her picture or read her name.

This situation upset me; I left her office fighting back tears, though I am a stoic person and rarely cry. I thought about just paying the fee to get a new badge with a new picture, but the thought of doing so while still keeping my old name on there felt awful, like defeat.

I understand that there are security reasons for this, but the main campus seems to have gotten past this. Trans students there can have their chosen names on their IDs. It seems to me that having a name people actually know me by would create a more secure situation; I’m sure this is true for many people who may not use their birth names for a variety of reasons (e.g., nicknames). Given that IDs have barcodes, ID numbers, and magnetic strips, the written name as it appears seems almost inconsequential to security.

So over these past months, I’ve been stuck with my old ID badge, which has an outdated picture and my birth name. Since I haven’t been able to change it, I’ve been wearing my badge on my belt loop backwards. It’s always visible, but only from the back. The sight of this old version of myself is uncomfortable, even upsetting. Anytime I hear my birth name, even when it’s referring to another person who happens to have that name, I feel sick. Many trans people refer to their birth names as “dead names”; the old, false versions of themselves are dead to them and to society. To be forced to face that old version of oneself is very difficult; it’s like a little stab in the heart.

Wearing my ID backwards has been fine for months in the various buildings and when I pass through the hospital to get from one building to the other (I prefer to avoid the crowds on the street; you never know who is transphobic).

A couple of weeks ago, I picked up a pride sticker at an event at Bayview campus, where I spoke on a panel about how difficult it is not to have my ID match my presentation, and how difficult and costly it is to change one’s name. I put the sticker on my ID badge, over my face. I knew that was not the greatest idea, but I’ve had no problems since then walking into various campus buildings.

I’ve never had a guard ask me to show the front of the ID for all these months, or notice the sticker, until the other day. The guard noticed the sticker as I pulled the badge from my bag as I entered Building X. This guard is particularly a stickler about badges compared to others; I’ve heard many people have trouble with this particular staff member, who is often rude. In contrast, their colleague who was on duty today at the same time always recognizes me, remembers that I have a badge, and nods as I enter and exit.

But previous to today, as long as the stickler guard saw that I had my badge, they were okay. But today, once this staff member saw the sticker, they said I have to take it off. I said okay and turned toward the elevators. I’d gotten away with my little rebellion for a couple of weeks, and the dreaded time had come to stop. The staff member stopped me and insisted I take it off right then and there, so they could see the picture on the badge.

This upset me, knowing I had to reveal my picture and birth name. I didn’t want to see it myself, and I didn’t want anyone else to either. Surprising myself, I started to cry as I tried to pull the sticker off. It was not easy to come off, breaking into little bits, so it took a while. They added, “It’s for the cameras.” (As if the cameras can see the picture on my ID?)

Wanting to explain why I was getting upset, I told them, “I am transgender.” I held up the badge and said, “I am transgender, and this is a woman’s face, and a woman’s name, and it’s really upsetting, and they won’t let me change it, until I legally change my name, and that takes months, and so I always wear it backwards.”

They said, “Now don’t get upset. Some guards aren’t paying enough attention. Don’t get upset.”

I told them, “I know it’s not you, it’s security that won’t let me change it.” I got about half of the sticker off at that point, and obviously, I was uncomfortable.

They said, “That’s good enough,” and let me go. I stormed off to the elevators, in tears. A friend had heard the incident from inside the cafe, came out, called me by my chosen name, said something to the guard I didn’t hear, then came over to the elevators to comfort me.

I tried to compose myself, but continued to silently cry for the next hour, sitting in my office, humiliated and embarrassed, especially since I share an office. I took deep breaths, did a mini meditation session with an app on my phone, and listened to music to help me calm down and concentrate enough to work. I missed a career development session I had intended to attend, too upset to leave my office again, and not wanting to walk back past this security guard to leave the building. I thought about and dreaded facing them again later today, and tomorrow morning, and tomorrow afternoon, and the next day, and the next day. I contemplated working from home.

Needless to say, while the security guards are there to ostensibly make campus safer, it certainly does not feel like “a safe, caring and welcoming environment” to me right now. I have discussed this issue with trans students before; they feel the same way.

The intensity of my reaction surprised me, but it should not have. This is just one example of the microaggressions and aggressions I face multiple times a day, every day, for being me. I am misgendered and mislabeled every day. I worry about my own safety every day, knowing I look “queer” and androgynous. I wonder, is today the day I get attacked for being me?

While trans women are more likely to face violence compared to trans men, still, 1 in 2 trans men have been physically attacked for their gender. Every time I have to show my driver’s license or credit card with my birth name on them, my stomach churns. It all hurts every time.

I lived in the closet in Tanzania until this August, and left—now living 7,000 miles away from my spouse—because that society is so transphobic. I have experienced wonderful things being free to be me in the US, but these systemic and structural barriers still exist here, too. Here, at least, I can call out the transphobic policies and laws and fight for change.

The inability to get my chosen name on my ID badge before a legal name change is one of many unnecessary barriers that make my life more difficult, and I am not alone in this situation on campus.

Changing this policy is a structural change that would make the lives of my transgender siblings and me that much easier.

I am happy to discuss this further to help find a mutually agreeable solution.

The Office’s response was to meet with me, drag the name of the individual security guard out of me, and train them. I tried to insist that the individual guard is beside the point; it’s the policy that needed to change. They didn’t listen.

That guard was nicer to me after that. And I can be grateful for that and still be angry about the individually-focused solution to a systemic issue.

When I wrote the letter, I also shared it with my husband. His response was, “Why do you have to make everything about being trans?” Which is part of why he’s my ex-husband now. I’m getting angry about this for my past self.

Thankfully, others continued to push for policy change, and about three years later, they School allowed chosen names on badges. The timing worked so that my first and only advisee, a nonbinary student, got their school ID badge—just in time for their graduation. Because it was the pandemic anyway, the student had simply avoided coming to campus to get an ID with their deadname on it. And I don’t blame them.

Starting in 2025, when I talk to audiences about trans health and joy, I begin with an exercise. I instruct them to create two columns on a piece of paper, their computer, Notes app, whatever, labeling one Positive, one Negative. Then I give them three minutes to jot down news or information they’ve heard or read about transgender people in 2025—they don’t have to believe it, and it doesn’t have to be accurate.

When we reflect on the exercise as a group, I get the same results, without fail:

• One) It’s way easier to list negative news; positive news is rare or non-existent.

• Two) Items they list on the positive side are from personal connections. A coworker got their ID updated. A cousin started hormones. A swim coach welcomed their trans daughter to the team.

The public is far more likely to hear negative information about trans people. This news is designed to stir up fear. But when someone takes the time first to address their fears, to make a personal connection, and then carefully explain the actual science and facts, they can change their minds.

The weeks after the 2025 presidential inauguration felt like I’d been strapped to a yo-yo in the hands of a 6-year-old. On his first day, President Trump rescinded four pro-LGBTQ executive orders (EOs) and signed three new ones that harmed transgender people, among others, under the label “diversity.” Nine more anti-transgender EOs followed.

Until January 2025, I published my public health work and my creative writing using different names, nervous that coworkers, my Mormon family, or my ex-husband might find my personal stories. (They did.)

After the inauguration, being trans in the U.S. went from difficult to terrifying.

That terror conjured up emotional memories from my childhood. Growing up, I was a little boy who everyone insisted was a girl. In my conservative Mormon upbringing in Utah, life was about cramming myself into a submissive, stay-at-home mom mold, not exploring my gender identity. Though I escaped that religion at 25, my gender exploration stayed on the back shelf for years.

The first time I felt that spark of recognition at seeing myself—a queer, trans man—represented in a book, I was 37. I’d been a wife in a straight marriage for 18 years and was the mother of a 15-year-old boy. By the time I met a fellow trans man (that I know of), I’d already been out for a year.

Since January 30, 2025, I’ve been writing feverishly, a friendly, knowledgeable, vulnerable voice to educate cisgender allies and fellow trans folks. I put together lists like Tips for Allies, Survival Scripts for the Holiday Season, and Resources for Parents of Trans Kids. I “translate” health science concepts, such as minority stress theory, into accessible, easy-to-read blurbs that readers can share with their grandparents or neighbors. And I share my stories along the way, from belonging to despair to how my son and I adjusted when I transitioned from Mom to Dad.

The response to Your Trans Cousin shows that people hunger for accurate, compelling, emotive information about trans issues.

As I’ve grown bolder in my public writing, I also realized I’d been making myself small and palatable for my Mormon family, hiding my writing and therefore most of my authentic self. Yearning for their love, I accepted scraps and thanked them for a feast. Last July, when I let them see the real me through my writing, some of them chastised me, calling me a liar. Others have been silent.

I learned most of them merely tolerate me, whom they consider the ex-Mormon prodigal son (they’re still waiting for my humbled return). I don’t want others to experience that loneliness and heartbreak, so I’ve committed to being the person my younger self needed to see. To write the words my younger self craved.

Through their rejection and the federal government’s, I realized on a deeper level that I deserve better than tolerance. I deserve inclusion, affirmation, and celebration—as do all transgender/nonbinary people.

The wall between my two carefully separated personas crumbled. I realized that integrating my creative and scientific sides empowers my message.

In Your Trans Cousin, I weave my personal stories with scientific evidence on transgender issues and offer actionable skills for practicing allyship.

And we need allies; trans people are a tiny group—less than 1% of the nation—but the federal government treats us like the enemy. What’s especially frustrating about these attacks is that they are built on lies, harmful premises, and claims that contradict and ignore scientific evidence. And human dignity.

Allyship is essential to this reframing and the widespread acceptance of trans/nonbinary people. We need cisgender people to stand up with us, to buffer us from the attacks and emotional strain from constantly having to argue that we exist and deserve basic human rights and dignity.

This Substack provides allies with the tools, data, and statistics to combat the mis- and disinformation about transgender issues with evidence-based and accurate information. It recounts the challenges I and others face as trans people, yes, but also the joys, triumphs, and mundane normalcy of being a human who happens to be trans. Mixing the hard facts of science with emotion—head and heart—is joyful magic.

Thank you for your support.

I teach a couple of courses at Johns Hopkins University, and this one is open to non-JHU folks around the world.

I’m pleased to announce the course Adapting Health Programs for Sexual and Gender Minorities. This online course runs from 6 to 9 July 2026, comprising 4 half-day intensive sessions. Credit or non-credit options & scholarships are available. Apply now at the links below. Previous students were from Kenya, the Philippines, Kyrgyzstan, and Bhutan! I earned an Excellence in Teaching award!

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I approach this with a global, decolonizing, intersectional lens. LGBTQ are Western labels, but sexual and gender minorities exist everywhere and throughout history. Identify resources and develop skills to adapt programs to meet the needs of your communities, including in countries with unfriendly or criminalizing laws (including, ahem, the US).

Many other excellent professors are teaching other gender & health courses. Check those out here!

At the Global Health Summer Institute: Gender and Health Track at Johns Hopkins University (JHU), we believe in breaking down barriers to education and professional development. That’s why we’re excited to announce the availability of full scholarships for a limited number of participants, including both JHU students and non-JHU external learners and professionals.

Whether you’re a student eager to delve deeper into gender studies or a working professional seeking to become a gender specialist/advisor, we hope these scholarships enable our awardees to unlock new career prospects and drive positive change in their communities and beyond.

Don’t miss this opportunity to join a community of changemakers committed to advancing gender and health equity. Explore the eligibility criteria and application process today.

The deadline for scholarship applications is March 15th, 2026. https://lnkd.in/e2bsHjVb

But in good times and bad, I like to remember and honor the strengths and power in our communities, too. Not to veer into toxic positivity territory, but to round things out—we are full, nuanced, complex humans.

In my work, we call this a strengths-based or assets-based approach. What do our LGBTQ communities do well? What goodness do we have going on? Some examples: Mutual aid, clothing swaps, the entire ballroom/house structure built up by Black and Brown trans people. Street medics and queer crisis response teams. Standing up for ourselves at Compton Cafeteria and Stonewall, fighting back against mob control and police brutality. Finding ways to access and continue our care, even when it is restricted. Giving advice and passing down supplies we no longer need, like binders or extra scar tape.

As a late-in-life queer person—I was fully out to friends, colleagues, neighbors, and family by my 40th birthday—I’ve been catching up on queer culture and history. One practice I’ve intentionally cultivated is honoring our Queeors, or queero heroes.

My first queero is a young nonbinary person, Lin, they/them. They are now a young adult, and I’ve known them since they were in their mom’s tummy. They came out as nonbinary at 11. In 2016, their dad was visiting my ex and me in Tanzania and told us that Lin used they/them pronouns.

This sparked a deep recognition in me and jump-started my active gender exploration. I admire Lin’s courage and am grateful they helped me see myself in a new light.

When my now husband and I were planning our wedding, we decided to honor several queeros by naming our tables after them. Since many of our guests probably hadn’t heard of these queeros, we included a card listing their names, photos, and QR codes linking to their Wikipedia pages.

My wedding queeros

Sylvia Rivera (she): Latina trans woman;1 pioneering gay, trans, and sex worker rights activist

Marsha P Johnson (she): Black trans woman;2 pioneering gay, trans, and sex worker rights activist

Miss Major Griffin-Gracy (she): Black trans woman; author, activist, and trans and intersex rights activist

Lou Sullivan (he): White gay trans man; pioneer for awareness of trans men who are gay and their right to transition3

Leslie Feinberg (zi/he/she): White person whose life refused a gender label; author, activist for lesbian and transgender rights

Nick Krieger (he): White trans man; author of the first trans memoir I read & recognized myself in

Daniel M Lavery (he): White trans man; former host of Dear Prudence, author of several books, including a memoir that was influential for my husband

James Baldwin (he): Black cis gay man; author and civil rights activist

Edith Windsor (she): White lesbian cis woman; plaintiff in a US vs Windsor, a huge victory for gay marriage rights4

Bayard Rustin (he): Black cis gay man: civil rights activist and organizer of the 1963 March on Washington, and played a significant role alongside MLK, Jr.

Judith Butler (they/she): White nonbinary lesbian; author, gender studies scholar, and feminist philosopher5

Kiyoshi Kuromiya (he): Japanese-American cis gay man; civil rights, anti-war, and HIV/AIDS activist; survivor of internment camps and colleague of MLK, Jr.

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Why Queeros?

Learning and teaching about LGBTQ health and rights can be stressful and depressing. When I first took LGBTQ health, I’d leave every class session feeling awful. The content was about inequities, disparities, rights violations, police brutality, anti-LGBTQ policies, illness, and death. This makes sense for a public health class.

But what’s unusual about an LGBTQ public health class? Usually, the teachers and many of the students are LGBTQ themselves. This is not true for classes on, say, HIV, tuberculosis, or malaria. It’s unlikely that anyone in the class is living with HIV, or has ever had TB or malaria (though I have had malaria a few times—but it’s not an identity). Even for classes on maternal and neonatal health and on fertility, which I took as a student, I was the only student in the class who had given birth! So this content about disparities and disease wasn’t abstract to other LGBTQ people and me—it was about us, our community, our siblings.

Thus, when I began teaching LGBTQ health, I introduced the concept of queeros. At the end of each session, I’d ask that at least one student share a personal queero—a person, place, or thing that helped them feel good about being LGBTQ. Those who were not LGBTQ themselves could share about a queero who helped them see LGBTQness or people in a positive light.

As I continued to teach two different LGBTQ health classes (one domestic, one global), I formalized the queero sharing into an assignment. Now, in each class, students give a 3- to 5-minute presentation on a queero from around the world. I first demonstrate by giving a presentation about Abina Ahir, a hijra,6 dancer, and HIV activist from India, or David Kato, a gay rights activist from Uganda.

Over the years, my students have honored Jin Xing, Bisi Alimi, The Blood Sisters, Laxminarayan Tripathi, Alray Nelson, Barbara Gittings, and many more people and organizations.

Who are your queeros?

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Extra Background

I adopted the queero concept when I first began co-teaching the Epidemiology of LGBTQ Health course with two of my queeros, Dr. Chris Beyrer. His co-creator of the class, Dr. Tonia Poteat, was a classmate of mine and was moving to a different university as I was coming out. As it worked out, I sat in the class for two terms while Tonia taught remotely, before teaching it myself.

The class is where I first came out with my new name and pronouns. Since Tonia and Chris were teaching, I knew their class would be a safe place for me. On the first day, I reintroduced myself using the new name and pronouns I wanted to test out. This was the first time I’d said my name out loud to anyone other than a barista. I hadn’t even mentioned it to my husband.

All the students were strangers to me at the time, but I’d known Tonia for nearly a decade. I’d asked her if it’d be ok if I sat in on her class. It can be easier to come out to strangers and acquaintances than to loved ones—the stakes are lower.

My voice shook, my body trembled, and I teared up a little as I said, “Hi, I’m faculty here, and I’m Sam, and my pronouns are they/them.”

From the front of the room, Tonia gave a little smile and nod, clearly pleased. After class, she texted me, “Congrats! We have some catching up to do!” I’d learn later that when we first met in 2009, Tonia’s gaydar flashed. I didn’t yet know I was queer, but she did! It’s okay that it took me a while to figure out. I’m just so grateful that I did.

I’m seeking 18-29-year-old trans/gender expansive folks to use an educational app by and for trans/nonbinary folks. As Director of Content Development, I wrote and edited educational modules, infographics, and videos with my multiracial, neurodiverse team of trans and nonbinary 20-somethings.

I’m sharing again because I've gained many new subscribers and added Michigan to the recruitment list.

We are actively recruiting in 11 locations (Massachusetts, Connecticut, Vermont, New York, New Jersey, Maryland, Michigan, Washington DC, Illinois, Oregon, and California). The app is designed for 18 to 29-year-old transgender, nonbinary, and gender expansive people(anyone who isn’t cis).

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Please do not share this on social media. You may share it in DMs, or email it to people who might be interested.

For participants who wish, a parent/guardian/caregiver can also use the app. We have content specifically designed for caregivers, as well as resources to help build the relationship between the young adult and their caregiver. I’m also a parent of a 20-something, so I understand a caregiver’s perspective, too.

This is by and for trans/nonbinary folks.

As part of the TransHealthGUIDE study, transgender health researchers at Boston Children’s Hospital, The University of Michigan, and Massachusetts General Hospital have developed a mobile application called THE GUIDE that aims to mitigate mental health issues faced by trans and gender expansive (TGE) young adults. The team consists mainly of trans and nonbinary staff and receives guidance from a Community Advisory Board of TGE young adults, caregivers, and providers.

This app is a centralized platform that delivers education, resources, and support on gender-related topics, healthy communication, and community engagement for TGE people ages 18-29 years and their caregivers. THE GUIDE is now enrolling study participants in 11 locations: Massachusetts, Connecticut, Vermont, New York, New Jersey, Maryland, Michigan, Washington DC, Illinois, Oregon, and California.

Participation in this study entails using the app and filling out surveys. You are compensated $25 per survey completed. If you are interested in participating in this project, please fill out the following screener: tinyurl.com/theguidescreener

FAQ

The aim of the TransHealthGUIDE is to improve mental health outcomes for trans and gender expansive (TGE) young adults. Our TGE and caregiver intervention is a mobile app that serves as a centralized hub to learn about gender, healthy communication, and community building. In addition to educational content, the app also includes interactive features, community forums, goal tracking, a community resources database, and more.

What does participation entail?

Exploring app features and completing surveys.

How long will the study last?

12 months.

How old do I have to be to participate?

18 to 29 years old.

Are trans people involved in this project?

Yes! Our study team includes members of the trans community as well as our community advisory board.

Will my data be protected?

Yes! All data will be encrypted and stored securely.

What if I decide I don’t want to participate anymore?

That’s completely fine. You can withdraw participation at any time.

Can I enroll without a caregiver?

Absolutely! But caregivers can’t enroll without a paired TGE user.

Will I be compensated?

Participants will be compensated $25 per survey completed, up to $125.

Have more questions?

Email TheGuide@childrens.harvard.edu or visit our screener.

Here is my 2025 list.

Bold means the author is openly trans. The number is the order in which I read them. If they were assigned for class (I’m earning an MA in Writing) or if they were audio, I noted that.

Fiction

• 4: Drinking Coffee Elsewhere, ZZ Packer (class)

• 5: Where the Dead Sit Talking, Brandon Hobson (class)

• 6: The Hundred Thousand Kingdoms, NK Jemison (my therapist recommended I read more fiction; this was first attempt)

• 7: Behind You is the Sea, Susan Muaddi Darraj

• 12: A Woman is No Man, Etaf Rum (class)

• 14: I’m Not Hungry But I Could Eat, Christopher Gonzales (class)

• 15: All Fours, Miranda July (audio)

• 27: Sunbearer Trials, Aiden Thomas

• 38: Cemetery Boys, Aiden Thomas

• 43: Redeployment, Phil Klay

Creative Nonfiction

• 1: The Immortal Life of Henrietta Lacks, Jennifer Skoot

• 2: Angela’s Ashes, Frank McCourt (class)

• 8: I Was My Parents’ American Dream, Malaka Gharib (class)

• 10: Becoming Him: a Trans Memoir of Triumph, Landa Mabenga

• 11: Heir to the Crescent Moon, Sufiya Abdur-Rahman (class)

• 16: Pretty: a Memoir, KB Brookins

• 18: A Primate’s Memoir: A Neuroscientist’s Unconventional Life Among the Baboons, Robert M. Sapolsky

• 19: You’ll Never Believe Me: A Life of Lies, Second Tries, and Things I Should Only Tell My Therapist, Kari Ferrell

• 20: I Remember, Joe Brainard

• 23: I Hate to Leave This Beautiful Place, Howard Norman

• 24: Voice of the Fish: a Lyric Essay, Lars Horn

• 25: You Lied to Me about God, Jamie Marich

• 31: In the Margins: A Trans Man’s Journey through Scripture, Shannon Kearns

• 36: Exvangelicals: Loving, Living, and Leaving the White Evangelical Church, Sarah McCammon

• 39: Slip: Life in the Middle of Eating-Disorder Recovery, Mallary Tenore Tarplay

• 42: Immersion: a Linguist’s Memoir, Linda Murphy Marshall

Prescriptive Nonfiction

Therapy/Trauma/Self-Help

• 3: Do Nothing: How to Break Away from Overworking, Overdoing, and Underliving, Celeste Headlee

• 13: Unlearning Shame, Devon Price

• 21: No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model, Richard Schwartz

• 26: Internal Family Systems Therapy, 2nd edition, Richard Schwartz & Martha Sweezy (audio)

• 35: When Religion Hurts You, Laura E Anderson (audio)

• 40: Loving You is Hurting Me: A New Approach to Healing Trauma Bonds and Creating Authentic Connection, Laura Copley (audio)

Trans-related

• 9: Your Child Is Trans, Now What? A Joy-Centered Approach, Ben Greene

• 28: Free to Be: Understanding Kids and Gender Identity, Jack Turban

• 29: Gender Transition for Dummies, Adrien Lawyer, et al

• 33: The Transgender Issue: Trans Justice Is Justice for All, Shon Faye

On Writing/Craft

• 17: On Writing: a Memoir of the Craft, Stephen King (class)

• 22: Crafting the Personal Essay, Dinty Moore (class)

• 32: Thinking Like an Editor: How to Write Great Serious Nonfiction and Get It Published, Susan Rabiner & Alfred Fortunato (class)

• 34: The Author Training Manual: A Comprehensive Guide to Writing Books That Sell, Nina Amir (class)

• 37: The Business of Being a Writer, Jane Friedman (class)

• 41: The Art of Writing: Lu Chi’s Wen Fu, Lu Chi, translated by Sam Hamill (class)

True Crime

• 30: Murderland: Crime and Bloodlust in the Time of Serial Killers, Caroline Fraser (audio)

Politicians who want to deny gender affirming care to youth argue that we lack evidence of the long-term effects. First, that’s false. Second, we can always conduct more research to fill in gaps. But the known benefits of blockers and hormones, including for preteens and teens, greatly outweigh any known risks. The imagined risks—like widespread regret or trends—don’t pan out.

And the harm of withholding is immense—poor mental health; dysphoria; suicidality; permanent physical changes that will need surgery later, like breast growth; undesirable, irreversible changes like height and broad shoulders.

I personally know a few trans/nonbinary teens. Every trajectory is individual. One has not expressed a desire for medical intervention. One declined their parents’ offer to consider blockers and has switched back to identifying with the sex assigned at birth. One had puberty blockers for a few years, then decided to stop those, and not start hormones. One lived as trans masc for several years, used testosterone for two months, liked the slight voice changes it made, and stopped, comfortable with that, and now lives as a woman again. None of them expresses regret; everything was a part of their journeys.

Here are some of the findings from the Netherlands long-term follow-up of trans adults who started blockers (GnRHa) and/or hormones (GAHT, i.e., testosterone or estrogen + androgen blockers) in adolescence (ages 12+). To be clear, we have lots of evidence from other countries, too.

But what about surgeries?!? The Dutch guidelines restrict all gender-affirming surgeries for people aged 18 years and older.

Decision-making, long-term use, satisfaction

• The benefits of blockers outweigh any risks, but withholding treatment causes too much harm to justify withholding (Kreukels 2011)

• Adolescents are capable of making medical decisions through informed consent for beginning puberty blockers (Vrouenraets 2021)

• Earlier is better: Youth referred to the gender identity clinic younger than 14 had better mental health than those who presented after 14, likely due to the older teens’ stress from puberty (de Rooy 2024)

• 98% of transgender adolescents who started puberty-delaying medications and then hormones continued to use hormones 4 years later (van der Loos 2022)

• Trans youth who had blockers then hormones had “clear ideas about their gender identity and treatment wishes.” Trans youth who had blockers but decided against hormones saw using blockers as an extended exploratory stage. That is, blockers served their purpose well (Vrouenraets 2022)

• The number of people seeking transgender-related care increased from 1972 to 2015, but the regret rate for gonadectomy remained extremely low (<1%) (Wiepjes 2018)

• The increase in youth seeking care is due to increased acceptance of seeking care, and not that people with lower intensities of dysphoria or worse psychological functioning are seeking care (Arnoldussen 2020).

Mental Health & Executive Functioning

• Transgender adolescents had worse psychological well-being before treatment, but after starting puberty blockers, they experienced similar or better psychological functioning compared to their cisgender peers (van de Miesen 2020).

• Blockers decreased behavioral and emotional problems and depressive symptoms in transgender adolescents, with no withdrawal, loss-to-follow-up, or discontinuation (de Vries 2011, J Sex Med)

• Blockers, hormones, and surgery (at 18+) relieved gender dysphoria for transgender adolescents seen years later, and they had psychological functioning on par with the general population (de Vries 2014)

• Transgender youth on hormones had IQs and educational achievement on par with their cisgender peers (Arnoldussen 2022, Clin Child Psych)

• Executive brain function was similar in trans adolescents on blockers compared to those not on blockers and also compared to cisgender adolescents (Staphorsius 2015)

• Trans folks had improved satisfaction with physical appearance and feelings of self-worth 6 years after hormones (as older teens) and 1.5 years after gender-affirming surgery (at 18+) (Arnoldussen 2022, LGBT Health)

• The majority of adolescents with gender dysphoria diagnoses did not have co-occurring psychiatric conditions (de Vries 2011, J Child Psychology & Psychiatry)

Physical Health & Appearance

• No evidence of long-term effects of puberty suppression on sexual satisfaction and dysfunction (van der Meulen 2025)

• Blockers then hormones do not compromise cardiovascular health (Klaver 2020)

• After 15 years of blockers then hormones, bone mineral density in transgender young people decreased slightly on the blockers, but returned to baseline levels on hormones (van der Loos 2023; Schagen 2020)

• Transgender girls on puberty blockers then hormones were on average only slightly shorter than their predicted adult height (Boogers 2022).

• Blockers then hormones in adolescence had the desired physical effects: the trans girls look like girls and trans boys look like boys (Klaver 2018)

Also, puberty blockers have been used for decades for cis kids whose puberty starts way too early (Magiakou 2010) and for endometriosis in adolescence (Gallagher 2018).

The tips below focus on adults, young and old, though some apply to any age.

Check out the infographic Tip & Scripts for Supporting Trans/Nonbinary Children during the Holidays.

To view these on a scroll without the text, view them in Canva or on Your Trans Cousin’s new Instagram account.

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I’ve heard it said, “If you think cis is a slur, it’s because you think trans is a slur.” It’s people’s stigma against transness that makes them think cisgender must be bad.

But it’s a descriptive label for a category that didn’t have a label. In language, the default category often goes unlabeled, or gets the privileged label.

This goes for a lot of non-human things, like deep/shallow. When we ask, “How deep is the lake?” that lake can be deep or shallow. But if we ask, “How shallow is it?” it’s a question of how shallow. Deep is not an option expected in that question.

In this example, deep is the default for the dichotomy deep/shallow.  Similarly with tall for tall/short, heavy for heavy/light, expensive for expensive/cheap, old for old/young.

When talking about humans, this language really matters. Think about when all texts let “he” and “man” and “mankind” be the default. They claimed it included everyone, but when you come down to it, they really meant just men. Feminists pushed back, and rightly so, and language has changed.

We’ve been in a transformation where we are pushing these boundaries and saying “Who does this language include? Who does this language exclude? Who does this language render invisible?”

 When reading a book, and the text says, “a person walked down the street,” who we assume that person is? Male, white, non-Hispanic, straight, able-bodied, average height?  In our racist, ableist, etc. society, to be anything different, we would have labeled it as such: e.g., a woman, short, Latinx, Black, gay, in a wheelchair.

In our society, “person,” when unlabeled, defaults to the privileged categories.

It’s not just women speaking up about it now, it’s also neurodivergent people, disabled people, racial/ethnic minorities, Deaf people, etc, etc.

Who do you really mean when you say x?

Thus, language is changing to label the “default” category, too, so that not only the minority group gets a label (trans person, disabled person, Black person).  Everyone should get a label. It upends the privilege of the default.

Saying there are “women” and “people” isn’t fair; that makes women not people, which is of course ridiculous.

(Yet how many times have you seen “women and minorities,” as if half of those minorities are not women, too?)

Similarly, saying there are “trans people” and then there are “people” isn’t fair or accurate. That makes trans people not people, but of course trans people are people.

So how do we talk about those people who aren’t trans other than saying “non-trans,” which labels you by what you are not?

Or “normal” or “regular” people, which is stigmatizing by implying that trans people aren’t normal or regular, when we are?

Hence the term cisgender. It labels the unlabeled. 

Trans = across, on the other side.

Cis = on this side.

Both are Latin, and used in chemistry.

Labeling non-trans people “cisgender” is analogous to naming white people white, instead of just “people.” You can be cis without identifying as cis, or embracing the label of cis, just as I can be white without embracing the label of whiteness. But the fact is, I am white and that brings me certain unearned privileges in life.

So, too, does being cisgender.

This does not erase other categories; it does not erase womanhood, or the category of woman. It’s a different construct, in which some women are cis and some are trans. You can talk about women, but if you really mean those women who are not trans, then saying cisgender women is simply accurate.

If woman, man, and nonbinary are gender identities, trans and cis are gender modalities.

The events in this essay took place in 2017, the summer I was starting to come out as nonbinary. In fact, I came out to my son while on this chimpanzee trekking trip. The essay ends just before I told him.

At the end of that conversation, he asked, “What pronouns do you want me to use for you?” No one had ever asked, and I hadn’t thought about it yet.

I said, “She/her is good for now. But I’ll let you know if that changes.”

Sure enough, a couple of months later, I started using a different name and they/them, and eventually he/him.

In writing and publishing this and other essays, I have had to wrestle with the question of how to refer to myself in the past—before I transitioned, before I came out. I have nearly four decades’ worth of life from before I came out, even to myself!

My husband asked me about this topic the first time we hung out. He was earning an MFA at the time, newly on T himself, and asked me how I handle writing about my past self. I told him that I default to the most affirming, i.e., I was always Will, he/him, I just had to wear a “girl disguise” for a while.

But it’s more complicated than my pat answer from that day. As I said in my post about parts work, I think of different parts of me as he, she, and they. Currently, I think of my youngest past self as a boy, Will, and talk about Little Will. But that boy in me went into hiding at age 3 or 4, when I tried to be the girl everyone told me I was. But before puberty, I was fairly genderless, a tomboy, and sought out the company of my brothers and the neighborhood boys, so I think of that version of me as they/she. Once I hit puberty and lived my life as a woman, wife, and mother, I am more comfortable referring to those versions of myself as she/her. And this is all fluid and changing as I go.

And different people handle the writing issue differently, of course, and I support individual trans/nonbinary folks deciding for themselves what feels right. Some memoirists state their old name in the text, and some use an initial for their past name. So far, I’ve either avoided naming my Self in the story or used a pseudonym for my younger self, usually Sam/Sammy/Samantha.

In my development as a creative writer, I’ve learned to differentiate the author, the narrator, and the character. This is a framework from fiction, but can apply to nonfiction, too—even though all three are me. But they can be “me” at different times in my life, have different points of view, and have various levels of knowledge and opinions about the current events in the story. For example, in my Jarnal piece, Confessions of a Toddler, the character is Little Will, and the narration switches between his point of view and an older, wiser Will’s perspective.

Share Your Trans Cousin

In the chimp essay, the fact that the character (I) was a woman, wife, and mother is key to the family dynamics and to my identification with a mother/baby chimp pair. She is also the narrator for most of the essay, knowing only what I knew at that time. But I also jump forward and reveal some info I know now but didn’t know then.

Still, it’s a little weird to read an essay by a guy named Will about his experiences as a mother. In a recent workshop discussing my essay about very inadequate sex education in my teen years, an instructor asked the other students, “Are you also having trouble remembering that this character is a girl?” That I was (seen as) a girl is essential to how my sex education unfolded, given how differently boys and girls are treated in that regard.

For the chimp essay, I ended up adding a line that became an Editor’s note: “Will is a transgender man, and at the time of the events of this story, he lived as a wife and mother.”

Trans folks, what do you think? How do you handle talking about your past self?