Treatment of Transgender Individuals Worldwide
By Isabella Bernstein, Raiaab Ajmal and Urmi Shukla, 9/5/2021
Lebanon
Transgender people are those whose gender identity is different from their biological sex. Millions of individuals around the world identify as transgender. As awareness about the LGBTQ+ community increases in societies around the world, more and more individuals are slowly attaining the liberty to access their basic human rights. However, these individuals only make up for a minute fraction of the world’s LGBTQ+ community, with millions still living life under harsh and inhumane circumstances, not being able to express themselves or gain access to their fundamental rights.
A large population of members of the LGBTQ+ community face oppression and discrimination in regions like Asia and Africa, where religion and culture heavily influence societal standards and public prejudice. One such country is Lebanon, a country in the western part of Asia. Like many other Asian countries, the LGBTQ+ community has always been somewhat of a sensitive topic with many individuals disagreeing with the way of life and choices of those who go against supposed social norms. A strong stigma surrounds discussions about transgender individuals and their way of life and mindsets like these propel and allow people in positions of power to approve of discriminatory laws.
Such laws stem from the idea of what is considered “natural” by society. This norm or “natural process” consists of marriage and sexual relations between a man and a woman. This “natural way of life” is directly related to Abrahamic religions which preach such ideologies. However, several communities have manipulated Abrahamic teachings throughout centuries and have allowed for the oppression of individuals. Examples of such discriminatory laws existing in Lebanon include Article 534 and Article 521 of the Penal Code 1943.
Although no law clearly states that being transgender is illegal in Lebanon, Article 534 has been manipulated, allowing for trans individuals to be oppressed, by society and by the law. Article 534 prohibits “sexual intercourse against nature” with a penalty of up to one year imprisonment. Same-sex relationships are described as going “against nature” and this includes transgender individuals engaging in relationships with the opposite gender. This is because transgender individuals are believed to have the gender they were assigned at birth, and their gender change is completely disregarded. Another issue with this article is that the article does not indicate or clarify what the law means by “going against nature” which allows for individuals charged with this article to have different fates. It is up to each judge to rule out whether the case violated article 534 or not.
In an interview with DW, Youmna Makhlouf, a lawyer and activist, described how during preliminary investigations conducted in regards to cases linked to Article 534, the privacy of the charged individuals would be completely disregarded, and officials would be able to seize and search personal possessions like mobile phones. Moreover, detentions and frequently violent visits by officials are also excused under this article.
Article 521 states that it is an offence for a man to “disguise himself as a woman”. The penalty for this offence can result in imprisonment. This article in itself allows for the criminalisation of gender expression since there is a large grey area when describing what “disguise” means. Several gender change individuals, including officials, interpret trans individuals changing their genders as mere “disguises” which are temporary. Their way of life is labelled as a temporary “choice.”
In their report “Don’t Punish Me For Who I Am,” international non-profit organisation Human Rights Watch described the systematic discrimination faced by transgender women in Lebanon. Hundreds of transgender women have had to deal with harassment, abuse, minimum to no employment opportunities, as well as opportunities to carry daily basic tasks like purchasing items. Many resorts to sex work due to the scarcity of employment opportunities, however, the sex work industry has proven to be extremely dangerous, allowing for these women to be treated horrendously.
Although some action is being taken to improve the condition of transgender individuals in Lebanon, such as the landmark ruling of 2016 which was in favour of a transgender man changing his official details on paper, as well as receive treatment and privacy, it is nearly not enough for the betterment of the trans community, and much more action is required for them to gain the liberty to live the way they want.
Sweden
In 1972, Sweden became the first country in the world to legally recognize the validity of gender changes. Transgender individuals, along with the rest of the LGBTQ+ community enjoy protection under the Swedish government. The liberally progressive country has made it clear that equality for all its citizens is of the utmost importance. Hence, Sweden strives to improve its policies with input from the transgender population and medical practitioners.
In addition to recognizing gender changes in 1972, the Swedish government allowed an individual to change the gender marker on all official identification documents. However, this law did not fully allow transgender people to live as their true selves. Changing gender markers required transgender individuals to be Swedish citizens, above eighteen years of age, and unmarried. Furthermore, a trans person would have to live for two years as the opposite gender and undergo sterilization and sex reassignment surgeries. In 2013, the Swedish government re-evaluated its standards, leading to the removal of citizenship and unmarried status. With the Stockholm Administrative Court of Appeal’s declaration that requiring sterilization and sex reassignment surgery was unconstitutional, legal gender changes could now occur without surgeries or hormone therapy. Individuals who underwent surgeries following the old policies received monetary compensation from the Swedish cabinet.
The government continued to update its laws to best protect the trans demographic. In 2009, Sweden’s Anti-Discrimination Act guaranteed the protection of all “transgender identities and expressions.” A decade later, an amendment to the country’s fundamental Freedom of the Press Act (1949) provided stronger protection against transgender hate crimes. Meanwhile, to maintain public transparency, the nation established the Equality Ombudsman to investigate the treatment of marginalized populations, particularly the LGBTQ+ community, at healthcare centres. Currently, the Swedish government is in the process of drafting more legislation that would allow a legal gender change without psychological evaluation or medical intervention.
In 2018, under guidance from the LGBTQ+ group, RFSL, the government “proposed a new law which would reduce the minimum age for sex reassignment medical care from eighteen to fifteen, remove all need for parental consent, and allow children as young as twelve to change their legal gender.” Despite the desire to move forward, this law did not come without controversy. Some scientists believed that medical gender change procedures were still in their experimental stages for children. Psychologists questioned whether children are developmentally ready to make such life-altering decisions.
Reports of gender dysphoria among teenagers was also a growing cause for concern. The Board of Health and Welfare reported a 1500 per cent increase in gender dysphoria diagnoses between 2008-2018 for children thirteen to seventeen. Because of the lack of research on gender dysphoria, few people understand it. Although dialogue on the topic has become mainstream, the media still tends to antagonize trans individuals. Some media sources feature content regarding suicides and regret post-surgery. Malou von Silvers, a famous journalist, dedicated a week to discussing gender dysphoria among teenage girls. Yet, no transgender individual participated in these nightly episodes.
Representation for transgender people is extremely important. In healthcare specifically, they struggle to be heard. While Swedish law prevents discrimination, there is still considerable prejudice against trans individuals. According to a report by The Guardian, the law does not require medical practitioners to be knowledgeable about LGBTQ+ issues. The health system does not always respect patients’ gender identity. Therefore, trans people feel that they can no longer trust their healthcare providers. To combat this issue, scientists recommend that more providers receive comprehensive education about the LGBTQ+ community.
While demands for education continue to grow, anecdotal documentaries sparked changes in protocol that challenge gender transitioning for young adults. Because of this, doctors cannot prescribe puberty blockers or hormones. Currently, the protocols are under review by the Swedish Agency for Health Technology Assessment and Assessment of Social Services, The Swedish Medical Products Agency, and the National Board of Health and Welfare. Although some medical facilities want to cater to their patients, others believe that each situation should be examined by an ethics board.
Presently, Sweden continues to update its policies to best serve the transgender community. Yet, debates regarding the maturity of young adults wishing to transition will still occur. Sweden faces difficult decisions, as liberty and safety must not be compromised.
USA
2021 has seen a massive onslaught of anti-transgender legislation in the United States, with 28 states set to vote on bills attempting to curb the accessibility of gender-affirming healthcare and sports for transgender youth this year. The anti-transgender policy is not new in America - the Trump administration notably banned the demographic from serving in the military a few years ago - but this year is unprecedented in the extremity and number of bills. While the Biden administration actively tries to expand federal protections and anti-discriminatory policies for transgender individuals, conservative lawmakers in an increasing number of states are pushing back.
The bills concerning transgender youth and high school sports are attempting to stop trans-women from competing in women’s or girls’ teams. Athletes would be required to compete based on their biological sex rather than their gender identity. These bills claim that fairness in women’s sports is threatened by the presence of transgender athletes, whose physiological advantages might undermine the very purpose of women’s-only sports events. Transgender women typically have greater amounts of testosterone, a hormone that helps them build strength and muscle mass. Hence, most professional level sports allow transgender athletes to compete based on their gender identity once the athlete has been suppressing testosterone for a year. However, hormone suppressants do not negate other advantages, such as larger skeletal structures, greater muscle mass, less body fat, bigger hearts, and greater oxygen-carrying capacity. Despite this, organizations like the NCAA allow transgender collegiate athletes to play. But for high schoolers, the situation is more complicated. Hormone suppressants aren’t always prescribed to minors who identify as transgender, and many states are also concurrently trying to ban gender-affirming healthcare for minors. Additionally, most of the benefits of puberty kick in between a typical high schooler’s junior and senior years, making transgender women’s physiological benefits less impactful in their first few years. For these reasons, hormone suppressants are not typically required of trans athletes at the high school level.
Furthermore, many Democratic opposers of these bills believe that they do not stem from a desire to protect women in sports - instead, from a place of discrimination. Transgender individuals make up about 0.6% of the total population, and even smaller percentages are involved in high school competitive sports. Joanna Harper, a researcher who studies the effects of hormone therapy, estimates that in every 200,000 women in college sports, about 50 are transgender. This disproportionate reaction to a practically non-existent problem points to motivations beyond providing level playing grounds for women and girls in sport. The Associated Press contacted two dozen legislators who had sponsored bills limiting the ability of transgender athletes to play on women’s teams, and according to the agency, most of them could not cite a single instance in their state where transgender participation had caused issues.
Beyond the basic restrictions, the bill would also force any athlete whose gender identity was questioned to undergo certain tests to prove their biological sex before they can compete, ranging from a DNA test to a professional physical examination.
Dozens of states are also attempting to ban gender-affirming healthcare from transgender minors. In March, the Arkansas State House and Senate voted to make it a felony for doctors to provide this kind of healthcare to youth. Texas is trying to pass a similar bill, with the added provision that parents who allow their child access to gender-affirming healthcare will be classified as child abusers, meaning their kids can be taken away from them.
These laws are against the advice of the American Medical Association, the Endocrine Society, the Pediatric Endocrine Society, the American Academy of Pediatrics, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry, who all maintain that access to gender-affirmative treatments is important for the wellbeing of trans youth.
Proponents of these bills claim that children’s brains are too underdeveloped to determine whether they are transgender or not and that social media and the widening culture of acceptance around LGBTQ+ individuals could influence a child to mistakenly believe that they are in the wrong body. However, according to Megan Mooney, the former president of the Texas Psychological Association, children as young as 2 or 3 can develop ideas about gender identity, without the influence of culture or digital media. By 6 or 7, she says their sense of gender identity is fairly stable.
Furthermore, trans youth are not being exposed to irreversible treatments as it is. As outlined in the guidelines of the Endocrine Society, no medical interventions occur before the onset of puberty. After that, hormone blockers can be prescribed. These blockers delay the progression of puberty until the individual stops the treatment, after which puberty continues normally. These blockers prevent their bodies from developing characteristic male/female features that might trigger dysphoria in the future, and explore their gender identity without the looming pressure of physical developments. Children have more time to think over their gender, and can even continue with puberty if they determine they are not transgender. A study at an Amsterdam clinic showed improvements in overall mental health, depression, and functioning in youth who used blockers.
By blocking access to this healthcare, lawmakers risk the mental health and safety of transgender youth. Gender dysphoria can trigger depression, anxiety, suicidal ideations, and social isolation, and without the option of gender-affirming healthcare, are at greater risks for all of the above. Many states proposing bans on transgender healthcare do not have carve-outs for youth who are already in the midst of a treatment plan.
Even without laws that are aimed at restricting their access to sports and life-saving healthcare, trans kids are already a high risk demographic. These laws put them in greater jeopardy, and are likely based more on discrimination rather than science or fairness.
Transgender people are those whose gender identity is different from their biological sex. Millions of individuals around the world identify as transgender. As awareness about the LGBTQ+ community increases in societies around the world, more and more individuals are slowly attaining the liberty to access their basic human rights. However, these individuals only make up for a minute fraction of the world’s LGBTQ+ community, with millions still living life under harsh and inhumane circumstances, not being able to express themselves or gain access to their fundamental rights.
A large population of members of the LGBTQ+ community face oppression and discrimination in regions like Asia and Africa, where religion and culture heavily influence societal standards and public prejudice. One such country is Lebanon, a country in the western part of Asia. Like many other Asian countries, the LGBTQ+ community has always been somewhat of a sensitive topic with many individuals disagreeing with the way of life and choices of those who go against supposed social norms. A strong stigma surrounds discussions about transgender individuals and their way of life and mindsets like these propel and allow people in positions of power to approve of discriminatory laws.
Such laws stem from the idea of what is considered “natural” by society. This norm or “natural process” consists of marriage and sexual relations between a man and a woman. This “natural way of life” is directly related to Abrahamic religions which preach such ideologies. However, several communities have manipulated Abrahamic teachings throughout centuries and have allowed for the oppression of individuals. Examples of such discriminatory laws existing in Lebanon include Article 534 and Article 521 of the Penal Code 1943.
Although no law clearly states that being transgender is illegal in Lebanon, Article 534 has been manipulated, allowing for trans individuals to be oppressed, by society and by the law. Article 534 prohibits “sexual intercourse against nature” with a penalty of up to one year imprisonment. Same-sex relationships are described as going “against nature” and this includes transgender individuals engaging in relationships with the opposite gender. This is because transgender individuals are believed to have the gender they were assigned at birth, and their gender change is completely disregarded. Another issue with this article is that the article does not indicate or clarify what the law means by “going against nature” which allows for individuals charged with this article to have different fates. It is up to each judge to rule out whether the case violated article 534 or not.
In an interview with DW, Youmna Makhlouf, a lawyer and activist, described how during preliminary investigations conducted in regards to cases linked to Article 534, the privacy of the charged individuals would be completely disregarded, and officials would be able to seize and search personal possessions like mobile phones. Moreover, detentions and frequently violent visits by officials are also excused under this article.
Article 521 states that it is an offence for a man to “disguise himself as a woman”. The penalty for this offence can result in imprisonment. This article in itself allows for the criminalisation of gender expression since there is a large grey area when describing what “disguise” means. Several gender change individuals, including officials, interpret trans individuals changing their genders as mere “disguises” which are temporary. Their way of life is labelled as a temporary “choice.”
In their report “Don’t Punish Me For Who I Am,” international non-profit organisation Human Rights Watch described the systematic discrimination faced by transgender women in Lebanon. Hundreds of transgender women have had to deal with harassment, abuse, minimum to no employment opportunities, as well as opportunities to carry daily basic tasks like purchasing items. Many resorts to sex work due to the scarcity of employment opportunities, however, the sex work industry has proven to be extremely dangerous, allowing for these women to be treated horrendously.
Although some action is being taken to improve the condition of transgender individuals in Lebanon, such as the landmark ruling of 2016 which was in favour of a transgender man changing his official details on paper, as well as receive treatment and privacy, it is nearly not enough for the betterment of the trans community, and much more action is required for them to gain the liberty to live the way they want.
Sweden
In 1972, Sweden became the first country in the world to legally recognize the validity of gender changes. Transgender individuals, along with the rest of the LGBTQ+ community enjoy protection under the Swedish government. The liberally progressive country has made it clear that equality for all its citizens is of the utmost importance. Hence, Sweden strives to improve its policies with input from the transgender population and medical practitioners.
In addition to recognizing gender changes in 1972, the Swedish government allowed an individual to change the gender marker on all official identification documents. However, this law did not fully allow transgender people to live as their true selves. Changing gender markers required transgender individuals to be Swedish citizens, above eighteen years of age, and unmarried. Furthermore, a trans person would have to live for two years as the opposite gender and undergo sterilization and sex reassignment surgeries. In 2013, the Swedish government re-evaluated its standards, leading to the removal of citizenship and unmarried status. With the Stockholm Administrative Court of Appeal’s declaration that requiring sterilization and sex reassignment surgery was unconstitutional, legal gender changes could now occur without surgeries or hormone therapy. Individuals who underwent surgeries following the old policies received monetary compensation from the Swedish cabinet.
The government continued to update its laws to best protect the trans demographic. In 2009, Sweden’s Anti-Discrimination Act guaranteed the protection of all “transgender identities and expressions.” A decade later, an amendment to the country’s fundamental Freedom of the Press Act (1949) provided stronger protection against transgender hate crimes. Meanwhile, to maintain public transparency, the nation established the Equality Ombudsman to investigate the treatment of marginalized populations, particularly the LGBTQ+ community, at healthcare centres. Currently, the Swedish government is in the process of drafting more legislation that would allow a legal gender change without psychological evaluation or medical intervention.
In 2018, under guidance from the LGBTQ+ group, RFSL, the government “proposed a new law which would reduce the minimum age for sex reassignment medical care from eighteen to fifteen, remove all need for parental consent, and allow children as young as twelve to change their legal gender.” Despite the desire to move forward, this law did not come without controversy. Some scientists believed that medical gender change procedures were still in their experimental stages for children. Psychologists questioned whether children are developmentally ready to make such life-altering decisions.
Reports of gender dysphoria among teenagers was also a growing cause for concern. The Board of Health and Welfare reported a 1500 per cent increase in gender dysphoria diagnoses between 2008-2018 for children thirteen to seventeen. Because of the lack of research on gender dysphoria, few people understand it. Although dialogue on the topic has become mainstream, the media still tends to antagonize trans individuals. Some media sources feature content regarding suicides and regret post-surgery. Malou von Silvers, a famous journalist, dedicated a week to discussing gender dysphoria among teenage girls. Yet, no transgender individual participated in these nightly episodes.
Representation for transgender people is extremely important. In healthcare specifically, they struggle to be heard. While Swedish law prevents discrimination, there is still considerable prejudice against trans individuals. According to a report by The Guardian, the law does not require medical practitioners to be knowledgeable about LGBTQ+ issues. The health system does not always respect patients’ gender identity. Therefore, trans people feel that they can no longer trust their healthcare providers. To combat this issue, scientists recommend that more providers receive comprehensive education about the LGBTQ+ community.
While demands for education continue to grow, anecdotal documentaries sparked changes in protocol that challenge gender transitioning for young adults. Because of this, doctors cannot prescribe puberty blockers or hormones. Currently, the protocols are under review by the Swedish Agency for Health Technology Assessment and Assessment of Social Services, The Swedish Medical Products Agency, and the National Board of Health and Welfare. Although some medical facilities want to cater to their patients, others believe that each situation should be examined by an ethics board.
Presently, Sweden continues to update its policies to best serve the transgender community. Yet, debates regarding the maturity of young adults wishing to transition will still occur. Sweden faces difficult decisions, as liberty and safety must not be compromised.
USA
2021 has seen a massive onslaught of anti-transgender legislation in the United States, with 28 states set to vote on bills attempting to curb the accessibility of gender-affirming healthcare and sports for transgender youth this year. The anti-transgender policy is not new in America - the Trump administration notably banned the demographic from serving in the military a few years ago - but this year is unprecedented in the extremity and number of bills. While the Biden administration actively tries to expand federal protections and anti-discriminatory policies for transgender individuals, conservative lawmakers in an increasing number of states are pushing back.
The bills concerning transgender youth and high school sports are attempting to stop trans-women from competing in women’s or girls’ teams. Athletes would be required to compete based on their biological sex rather than their gender identity. These bills claim that fairness in women’s sports is threatened by the presence of transgender athletes, whose physiological advantages might undermine the very purpose of women’s-only sports events. Transgender women typically have greater amounts of testosterone, a hormone that helps them build strength and muscle mass. Hence, most professional level sports allow transgender athletes to compete based on their gender identity once the athlete has been suppressing testosterone for a year. However, hormone suppressants do not negate other advantages, such as larger skeletal structures, greater muscle mass, less body fat, bigger hearts, and greater oxygen-carrying capacity. Despite this, organizations like the NCAA allow transgender collegiate athletes to play. But for high schoolers, the situation is more complicated. Hormone suppressants aren’t always prescribed to minors who identify as transgender, and many states are also concurrently trying to ban gender-affirming healthcare for minors. Additionally, most of the benefits of puberty kick in between a typical high schooler’s junior and senior years, making transgender women’s physiological benefits less impactful in their first few years. For these reasons, hormone suppressants are not typically required of trans athletes at the high school level.
Furthermore, many Democratic opposers of these bills believe that they do not stem from a desire to protect women in sports - instead, from a place of discrimination. Transgender individuals make up about 0.6% of the total population, and even smaller percentages are involved in high school competitive sports. Joanna Harper, a researcher who studies the effects of hormone therapy, estimates that in every 200,000 women in college sports, about 50 are transgender. This disproportionate reaction to a practically non-existent problem points to motivations beyond providing level playing grounds for women and girls in sport. The Associated Press contacted two dozen legislators who had sponsored bills limiting the ability of transgender athletes to play on women’s teams, and according to the agency, most of them could not cite a single instance in their state where transgender participation had caused issues.
Beyond the basic restrictions, the bill would also force any athlete whose gender identity was questioned to undergo certain tests to prove their biological sex before they can compete, ranging from a DNA test to a professional physical examination.
Dozens of states are also attempting to ban gender-affirming healthcare from transgender minors. In March, the Arkansas State House and Senate voted to make it a felony for doctors to provide this kind of healthcare to youth. Texas is trying to pass a similar bill, with the added provision that parents who allow their child access to gender-affirming healthcare will be classified as child abusers, meaning their kids can be taken away from them.
These laws are against the advice of the American Medical Association, the Endocrine Society, the Pediatric Endocrine Society, the American Academy of Pediatrics, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry, who all maintain that access to gender-affirmative treatments is important for the wellbeing of trans youth.
Proponents of these bills claim that children’s brains are too underdeveloped to determine whether they are transgender or not and that social media and the widening culture of acceptance around LGBTQ+ individuals could influence a child to mistakenly believe that they are in the wrong body. However, according to Megan Mooney, the former president of the Texas Psychological Association, children as young as 2 or 3 can develop ideas about gender identity, without the influence of culture or digital media. By 6 or 7, she says their sense of gender identity is fairly stable.
Furthermore, trans youth are not being exposed to irreversible treatments as it is. As outlined in the guidelines of the Endocrine Society, no medical interventions occur before the onset of puberty. After that, hormone blockers can be prescribed. These blockers delay the progression of puberty until the individual stops the treatment, after which puberty continues normally. These blockers prevent their bodies from developing characteristic male/female features that might trigger dysphoria in the future, and explore their gender identity without the looming pressure of physical developments. Children have more time to think over their gender, and can even continue with puberty if they determine they are not transgender. A study at an Amsterdam clinic showed improvements in overall mental health, depression, and functioning in youth who used blockers.
By blocking access to this healthcare, lawmakers risk the mental health and safety of transgender youth. Gender dysphoria can trigger depression, anxiety, suicidal ideations, and social isolation, and without the option of gender-affirming healthcare, are at greater risks for all of the above. Many states proposing bans on transgender healthcare do not have carve-outs for youth who are already in the midst of a treatment plan.
Even without laws that are aimed at restricting their access to sports and life-saving healthcare, trans kids are already a high risk demographic. These laws put them in greater jeopardy, and are likely based more on discrimination rather than science or fairness.
